体表慢性窦道的病灶清除治疗

体表慢性感染，常见的表现形式有窦道形成、溃疡形成，部分患者经反复清创、引流等治疗，感染灶仍迁延不愈或愈后复发，患者因此痛苦、不便。1997年1月～2004年12月，我院收治31例体表慢性窦道患者，经扩创、引流治疗，仍经久不愈，后采用病灶清除手术，一期缝合伤口，取得了良好疗效，现报告如下。     

脊柱结核的手术治疗与临床分析

目的 探讨脊柱结核的手术治疗。方法 10例脊柱结核患者行手术治疗，4例行病灶前路清除植骨融合术，6例行病灶清除植骨融合钢板内固定术。10例均用三联抗痨治疗至术后9～12个月。结果 患者伤口均一期愈合，无窦道及伤口不愈，随访2年后Frankel评分为D级2例，E级8例。后期脊柱后凸畸形2例。结论 及时正确的手术干预及规范化的抗痨治疗是提高脊柱结核治疗效果的关键。彻底的病灶清除植骨融合术并一期内固定术可以有效防止后凸畸形的发生。     

腰椎术后伤口早期感染的治疗体会

目的探讨腰椎术后伤口早期感染的预防措施及手术治疗方法。方法对7例腰椎术后伤口感染病例拆除伤口部分缝线、及时换药,3例未形成窦道患者肉芽组织生长后清创缝合,4例形成窦道患者术前准备后行伤口切开彻底清除坏死组织、横突间植骨块,伤口一期闭合。结果除1例患者术中清创不彻底导致再次清创外,其余伤口感染患者清创后均一期愈合,随访未见感染复发。结论对早期深部感染需及时处理伤口、使用敏感抗生素,彻底清创,创口可以一期愈合,并可以保留内固定。     

骨折内固定物取出术后骨感染治疗分析

目的回顾分析骨折内固定取出术后骨感染的原因和治疗措施,提高对此类疾病的认识,重视此类手术的规范操作减少感染的发生。方法对自2003—03—2012—10收治的骨折内固定物取出术后骨感染病例29例,在彻底行病灶清除、病灶周围清除扩刨、扩髓和高压脉冲冲洗基础上,采用自行研制的双阀门侧孔式灌洗管灌洗术进行治疗。结果经术后12～36个月,平均18个月的随访,29例切1--I均一期愈合,未出现感染复发。结论切开内固定术和取内固定术术中清创不彻底是感染的主要原因：手术彻底清扩创并置管持续灌洗是治愈骨折内固定物取出术后骨感染的关键。     

后路椎间融合固定术后并发椎间感染12例诊疗分析

[目的] 探讨经腰椎后路行病灶清除、减压、冲洗引流治疗术后椎间感染的疗效.[方法] 回顾后路椎间融合术后椎间感染的12例患者,分析其临床表现及诊疗特点.[结果] 12例椎间融合术后感染病例均通过一次或多次椎间病灶清除、持续冲洗引流而治愈.[结论]一旦确认后路椎间融合术后融合椎间原发感染,应尽快手术治疗,经腰椎后路行感染病灶清除、减压、置管冲洗引流,必要时去除椎间植骨及融合器,能迅速缓解和解除病人症状,同时要有病程长、病情反复、迁延不愈及反复多次手术清创引流的心理准备,一次及多次的彻底清创引流术是治疗后路椎间融合术后椎间感染的主要手段.     

影响胸腰椎结核患者术后复发的危险因素分析

目的分析影响胸腰椎结核患者术后复发的危险因素。方法选取2010-01-2016-01实施一期后路病灶清除、植骨融合内固定术治疗的胸腰椎结核患者230例,术后随访1年,其中复发30例,未复发200例,对比复发与未复发患者临床资料,分析复发特点、复发原因、复发影响因素及预防措施。结果复发患者胸壁或腰椎肿块伴轻微胸痛,形成脓肿有波动感,部分局部伤口破溃迁延不愈,病灶清除不彻底、耐药性结核菌株出现、非活性异物过多放置、内固定松动失效、不正规化疗、长期营养不良是复发的主要原因。多因素Logistic回归分析结果显示,术前抗结核治疗时间短、未达术后制动时间、手术清除病灶不彻底、术后未规范治疗是导致术后复发的独立危险因素(P0.05)。结论胸腰椎结核患者术前抗结核治疗时间短、未达术后制动时间、手术清除病灶不彻底、术后未规范治疗是导致术后复发的独立危险因素,临床医师应给予足够重视。     

游离大网膜移植治疗烧伤后颅骨缺损五例

游离大网膜移植治疗烧伤后颅骨缺损五例刘强，张正之，韩西城头皮颅骨大面积感染缺损是较难处理的严重疾患，并有向颅内扩散，慢性迁延不愈的特点和癌变的可能。骨髓炎的治疗以彻底的病灶清除为最有效的方法，但病灶清除术后常形成较大范围、深浅不一及不规则的头皮和颅骨...     

腰椎结核并远处寒性脓肿误诊3例报道

我院骨科自1989年4月至1992年8月共收治腰椎结核并远处寒性脓肿,误行切开排脓,致使切口经久不愈3例。经结核病灶清除术治疗后原发病及窦道均痊愈。现报道如下: 例一:××,男,39岁,农民,92年8月以腰骶椎体结核并左腹股沟窦道入院。患者半年前发现左腹股沟有一“鸡蛋”大小肿物,轻度疼痛,三月前在某县医院诊为“淋巴结核”,并行局部切开,此后伤口经久不愈合,并普通菌感染。入院时血沉70mm/h。在本科行腰椎结核病灶清除术,术后原发灶及窦道均1期愈合。     

应用外科皮瓣治疗四肢软组织缺损并感染创面

目的 探讨应用外科皮瓣治疗四肢软组织缺损并感染创面的临床效果.方法 对32例感染创面应用各种外科皮瓣治疗.其中游离皮瓣20例,肌皮瓣3例,局部岛状皮瓣9例.结果 本组32例皮瓣全部成活,其中20例伤口一期愈合;11例术后伤口经反复清创、引流后,全部愈合;1例感染创而经久不愈后截肢.术后随访半年到2年,肢体功能及外观满意.结论 应用外科皮瓣治疗四肢软组织缺损感染创面可取得良好的临床效果.     

开放手外伤彻底清创术的重要性（附77例报告）

目的：清楚开放手外伤的彻底清创术对伤口感染愈合的影响。方法：对77例开放手外伤在彻底清创前、后做了伤口的细菌培养，观察了伤口细菌培养的阳性率、阴性率、愈合率。结果：清创术前细菌培养的阳性率及阴性率各为96．1％及3．9％，清创术后各为7．8％及92．2％。伤口一期愈合率为97．4％（75例），二期愈合率为2．6％（2例），术后94．8％（73例）未应用抗生素治疗。结论：由于彻底清创术后细菌的阳性率很低，大多数病例的伤口均可一期愈合，看来，对于彻底清创后的手外伤病例，即使不应用抗生素，也同样可以达到理想的治疗目的。     

载药自固化磷酸钙人工骨治疗慢性骨髓炎

目的 探讨载药自固化磷酸钙人工骨（CPC）治疗慢性骨髓炎的临床疗效.方法 自2002年1月起,对8例慢性骨髓炎患者,行彻底清创后,一期植入载药自固化磷酸钙人工骨.结果 本组均获随访,随访时间为11～35个月,平均21.3个月,1例发生术后伤口表浅感染,随访期间均无骨髓炎复发,未见明显的全身反应,无再骨折,X线片显示,术后骨髓炎区被CPC充分填塞,随访时CPC部分降解成骨.结论 在病灶清除后,一期将载药自固化磷酸钙人工骨植入残留的感染性骨缺损是治疗慢性骨髓炎的较理想的方法.     

Mycobacterium Marinum Infections of the Hand: a Report of Three Cases

We report three cases of mycobacterium marinum infection, characterized by the long duration before a proper diagnosis was made. Mycobacterium marinum is a so-called atypical non-tuberculous mycobacterium, found in salt and fresh water, occasionally infecting humans. Most of the infections involve the fingers and hand, after exposure to contaminated water. It is commonly called fish tank infection.

The clinical pictures can be very different: from a small cutaneous lesion to deep-seated infections of the tendon sheet or joint.

Special transport and culture techniques are required for proper diagnosis. Besides surgical treatment of chronic skin lesions and deep infections, prolonged treatment with appropriate antibiotics is required.     

Clinical outcomes of primary skin closure with Y-V and Z-plasties for Dupuytren's contracture: use of one-stage skin closure

Y-V or Z-plasties are a useful one-stage technique for skin closure after aponeurotomy. However, we know no details about postoperative improvement, particularly at each joint. The purpose of this study was to evaluate the clinical outcomes of primary skin closure with Y-V and Z-plasties for Dupuytren's contracture. We retrospectively reviewed the postoperative results of 23 patients (25 hands, 29 fingers). The preoperative severity of the contracture evaluated by the Meyerding classification was grade I in 11 fingers, II in two fingers, and III in 16 fingers. In total, 26 metacarpophalangeal (MP) joints and 27 proximal interphalangeal (PIP) joints were treated. In each finger we assessed clinical outcomes according to the percentage improvement in extension and a modified version of Tubiana's classification. Primary wound closure was possible in all cases. The mean contracture values were improved from 46.5° preoperatively to 4.2° postoperatively for the MP joint and from 43.9° to 22.4° for the PIP joint. The mean percentage improvement in extension for the MP joint was 92% and for the PIP joint 56%. The rate for the PIP joint of the little finger was 40% and for the other fingers 78%. In total, 83% of the fingers had satisfactory results. For Dupuytren's contracture, primary skin closure with Y-V and Z-plasties gives satisfactory results, more so with involvement of the MP than the PIP joint and less so with involvement of the little finger.     

Clinical outcomes of primary skin closure with Y-V and Z-plasties for Dupuytren's contracture: Use of one-stage skin closure

Abstract

Y-V or Z-plasties are a useful one-stage technique for skin closure after aponeurotomy. However, we know no details about postoperative improvement, particularly at each joint. The purpose of this study was to evaluate the clinical outcomes of primary skin closure with Y-V and Z-plasties for Dupuytren's contracture. We retrospectively reviewed the postoperative results of 23 patients (25 hands, 29 fingers). The preoperative severity of the contracture evaluated by the Meyerding classification was grade I in 11 fingers, II in two fingers, and III in 16 fingers. In total, 26 metacarpophalangeal (MP) joints and 27 proximal interphalangeal (PIP) joints were treated. In each finger we assessed clinical outcomes according to the percentage improvement in extension and a modified version of Tubiana's classification. Primary wound closure was possible in all cases. The mean contracture values were improved from 46.5° preoperatively to 4.2° postoperatively for the MP joint and from 43.9° to 22.4° for the PIP joint. The mean percentage improvement in extension for the MP joint was 92% and for the PIP joint 56%. The rate for the PIP joint of the little finger was 40% and for the other fingers 78%. In total, 83% of the fingers had satisfactory results. For Dupuytren's contracture, primary skin closure with Y-V and Z-plasties gives satisfactory results, more so with involvement of the MP than the PIP joint and less so with involvement of the little finger.     

Repair of the Alar Groove with Combination Partial Primary Closure and Second-Intention Healing

BACKGROUND: The reconstruction of small defects of the alar groove can be a unique challenge owing to the importance of maintaining its concave structure. OBJECTIVE: To present a report of a patient with a small alar groove defect that was repaired using a combination of partial primary closure and second-intention healing. METHODS: A 73-year-old female was referred for the treatment of a basal cell carcinoma of the right nasal ala and underwent Mohs micrographic surgery with clearance of the lesion. The final defect, less than 1 cm, extended to the subcutaneous fat. Two absorbable subcutaneous sutures were placed in the defect, and the wound was then allowed to heal by second intention. RESULTS. This closure yielded a good cosmetic result, with preservation of the alar groove. CONCLUSION: A combination of primary closure and second-intention healing is a time-efficient, low-risk option for nonperforating, small alar groove defects.     

Primary closure of stoma site wounds after ostomy takedown

Background

Ostomy reversal is considered a contaminated surgery and, thus, primary closure is believed to increase infection. Various closure techniques have been described and postulated to be superior to primary closure in regards to decreasing stoma site wound infections. The literature has varied in its support for this hypothesis.

Methods

A retrospective review was performed evaluating several variables including stomal closure method, patient demographics, steroid/immunosuppressant use, chemotherapy or radiation, perioperative antibiotics, and surgical indication to determine whether there was any association with the development of wound infections.

Results

Of 75 patients undergoing ostomy reversal, delayed primary closure/packing/secondary intention was used in 49 (65%), and 26 underwent primary closure (35%). Four patients (5.3%) developed stoma site infections; all had delayed primary closure or packing of their wound (P = .39). No variable was associated significantly with an increased risk of stoma site wound infections.

Conclusions

Primary closure does not increase the rate of infection.     

A new surgical approach for treating infected epidermoid cysts using delayed primary closure

A new surgical approach for treating infected epidermoid cysts was designed. This technique involves the lesion being incised and drained on the first day, 5-7 days after which it is removed together with the cyst wall excised parallel to Langer's tension lines. The wound is then closed by delayed primary closure. We employed this method in the treatment of 12 patients and observed the average time required for recovery (n = 12) was 18.6 +/- 2.5 days (mean +/- SD) and the number of days spent at the outpatient clinic, 10.2 +/- 2.6. There has been no recurrence or secondary infections in any of the patients to date.     

263例成人原发性局灶节段肾小球硬化性肾小球肾炎临床病理分析

目的 了解我国南方地区原发性局灶节段肾小球硬化性（FSGS）肾小球肾炎的发病情况及探讨FSGS临床与病理特征的关系。方法 收集1988年7月至2005年7月经我院肾活检确诊为原发性FSGS的263例成人患者的临床及肾脏病理资料并进行分析。 结果 （1）原发性FSGS占同期成人原发性肾小球疾病 7.02%,占成人原发性肾病综合征（NS）6.33%，其构成比近年有逐渐升高的趋势。青壮年为成人FSGS的主要患病人群，临床以不同程度的蛋白尿为特征，以NS为主要临床表现的有133例，占50.6%。（2）主要病理特征： 48.4%患者肾小球硬化比率≥25%，肾小球硬化并伴有肾小管间质病变者占88.6%，其中伴严重肾小管间质病变占25.2%。（3）肾小球硬化程度及小管间质病变程度与Ccr呈负相关 (P ＜ 0.01），并与Scr水平呈正相关(P ＜ 0.05）。肾小球硬化程度与小管间质病变程度呈正相关(P ＜ 0.01），与血浆白蛋白水平呈正相关(P ＜ 0.05）。肾小管间质病变是FSGS患者出现肾功能不全的重要影响因素。结论 原发性FSGS是成人肾病综合征的主要病理类型之一，就诊时肾小球硬化及肾小管间质纤维化已损害明显，并与肾功能损害密切相关。早期诊断和及时治疗，从而延缓FSGS的进展仍是广大肾脏病工作者探索的重要课题。     

Colostomy wound closure

The management of the wound at the time of colostomy closure has been controversial, and wound infection is a frequently cited complication of this procedure. We have conducted a prospective randomized study of colostomy wound closure in 105 patients with three study groups: (1) primary closure (n = 38); (2) primary closure with subcutaneous drains (n = 29); and (3) delayed primary closure (n = 38). All patients had mechanical bowel preparation with whole gut lavage as well as oral neomycin sulfate/erythromycin estolate and perioperative parenteral cefazolin sodium (Ancef). Five wound infections (4.8%) occurred. Three infections were in the delayed primary closure group and one infection in each of the other two study groups. No statistical difference in wound infection was demonstrated. On the basis of the findings in this study, we would not recommend delayed primary closure for the management of colostomy closure wounds when careful mechanical and antibiotic preparation has been utilized.     

End-of-Skin Grafts in Syndactyly Release: Description of a New Flap for Web Space Resurfacing and Primary Closure of Finger Defects

Treatment of syndactyly necessitates creation of neo-web space and separation of fingers. Traditionally, this has been done by use of flaps taken from the dorsum; the resultant raw areas thus created have been managed by use of skin grafts. The classical teaching has been that the separated fingers will need skin graft as primary closure is not possible. The skin grafts have a tendency to contract and lead to finger flexion contractures and “creep” of the web space. We describe a flap based upon subcutaneous tissue in the web that is moved in a V–Y fashion to resurface the neo-web. The flap donor site can easily be closed primarily. The fingers are then separated; the subcutaneous fat is carefully removed from the finger flaps under magnification to allow primary closure of the finger defects. It has been possible to primarily close the donor site and fingers in all the patients. The procedure has been used in seven patients with 14 web releases. The age varied between 10 months to 3 years. The V–Y advancement flap based upon the subcutaneous pedicle in the region of the web allows adequate creation of a new web space. The careful de-fattening of skin flaps allows the separated fingers to be closed primarily.