Pinch skin grafting or porcine dermis in venous ulcers: a randomised clinical trial

Chronic venous ulcers are common, and even with effective compression or elevation large ulcers may take months to heal. Pinch skin grafting may allow healing from epithelial islands throughout the surface area of the ulcer, and a prospective randomised trial was therefore conducted comparing this treatment with porcine dermis dressings. Most patients were treated as outpatients, 25 ulcers being randomised to treatment with pinch skin grafts and 28 to treatment with porcine dermis. Though the groups were well matched, the mean healing rate in the first week was 15 cm2 for pinch skin grafts compared with 3.5 cm2 with porcine dermis (p less than 0.02). By life table analysis 64% of ulcers treated by pinch grafts were healed at six weeks and 74% by 12 weeks compared with 29% and 46% of ulcers, respectively, treated with porcine dermis dressings (chi2 = 4.1; p less than 0.05). All ulcers that failed to heal within 12 weeks included an area posterior to the medial malleolus, where local compression may have been inadequate. Pinch skin grafting improves the rate of healing in large venous ulcers and is a simple technique that may be performed as an outpatient procedure under local anaesthesia.     

Healing of chronic arterial and venous leg ulcers through systemic effects of electromagnetic fields [corrected

BACKGROUND: Mitogen-activated autologous peripheral blood mononuclear cells applied locally on the ulcer surface promote healing of chronic arterial and venous leg ulcers. In vitro, extremely low frequency electromagnetic fields (ELF) interact with peripheral blood mononuclear cells (PBMC) via Ca++ channels, activating signal transduction cascades, promoting cytokine synthesis, and changing cell proliferation patterns. METHODS: ELF frequencies were configured to interact in vitro with the proliferation patterns of PBMC obtained from normal human volunteers. These ELF were then applied peripherally as the sole treatment to 26 patients with 42 chronic leg ulcers of predominantly arterial or venous etiology unresponsive to previous medical and/or surgical treatments in a phase I before-after design. RESULTS: At admission, age of ulcers had a skewed distribution with a median of 639 days. Wound healing or deleterious effects began in all patients during the first 2 weeks after ELF exposure, permitting their previously unresponsive ulcers to function as internal controls. After ELF exposure, 69% of all lesions were cured or healed >50% in a period <4 months. Defective wound healing was observed in lesions associated with important arterial occlusion, uncontrolled arterial hypertension, severe lipodermatosclerosis, non-pitting edema, and obesity (body mass index >30). Lesions worsened in patients with autoimmune diseases. CONCLUSIONS: Systemic effects are hypothetically explained by ELF activation of PBMC and their subsequent transportation to the ulcer site via humoral route. This therapy is effective in selected patients with chronic arterial and venous leg ulcers.     

筋膜下穿通静脉断离与泡沫硬化剂联合治疗小腿溃疡患者临床效果观察

目的：探讨筋膜下穿通静脉断离与泡沫硬化剂联合治疗小腿溃疡患者临床效果。方法：选自我院于2017年1月至2018年1月期间收治的小腿溃疡患者81例,按照随机表法分为观察组42例与对照组39例。对照组采用传统大隐静脉剥脱术治疗,观察组采用筋膜下穿通静脉断离与泡沫硬化剂联合治疗。比较两组术后恢复时间、术后愈合和术后并发症,及术前和术后VAS评分、静脉水肿、静脉曲张和色素沉着积分变化。结果：观察组术后恢复时间快于对照组,且有统计学差异(P<0.05);而两组术后愈合比较无统计学差异(P>0.05)。观察组术后并发症发生率(7.14%)低于对照组(30.77%),且有统计学差异(P<0.05)。两组术后VAS评分降低(观察组：t=22.295,对照组：t=13.795,P<0.05);观察组术后VAS评分低于对照组(t=10.748,P<0.05)。两组术后静脉水肿、静脉曲张和色素沉着积分降低(观察组：t=16.275、19.632、33.676,对照组：t=7.898、12.035、20.266,P<0.05);观察组术后静脉水肿、静脉曲张和色素沉着积分低于对照组(t=10.650、12.150、16.365,P<0.05)。结论：筋膜下穿通静脉断离与泡沫硬化剂联合治疗小腿溃疡患者临床效果显著,值得临床借鉴。     

预缝合皮肤扩张术的实验与临床观察

以小白猪为实验模型,观察预缝合后皮肤扩展面积及生物力学方面的改变。结果显示：预缝合术后２４、４８、７２ｈ皮肤面积分别增加２７．２％、３１．５％和５８．３％,表皮、真皮厚度变薄,与对照区比较有显著差异（Ｐ＜０．０１）。电镜观察显示扩张区成纤维细胞之粗面内质网有空泡样改变,但未见核坏死表现;自１９９３年开始在１０例瘢痕病例行预缝合软组织扩张,术后１～２天切除瘢痕,取得较满意的效果。说明预缝合软组织扩张术在治疗较大面积由于瘢痕或其它原因造成的皮肤缺损时是一种可以采用的手术方法。     

低张力压力绷带治疗慢性下肢静脉性溃疡的临床研究

目的：研究低张力压力绷带促进慢性下肢静脉性溃疡愈合的作用。方法2012年6月至2013年9月入住我科慢性下肢静脉性溃疡患者30例按伤口包扎材料不同随机分为低张力压力绷带组和传统弹力绷带组,每组各15例。比较患者溃疡愈合时间、疼痛积分和生存质量（慢性静脉功能不全生存质量量表,CIVIQ量表）,评价低张力压力绷带促进慢性下肢静脉溃疡愈合的有效性及舒适性。结果低张力压力绷带组溃疡愈合时间短于传统弹力绷带组（P〈0．05）,生存质量评分高于传统弹力绷带组,绷带使用期间疼痛积分差异无统计学意义。结论低张力压力绷带包扎能够促进慢性下肢静脉溃疡愈合,提高生存质量,值得临床推广应用。     

Human amnion in the treatment of chronic ulceration of the legs

A prospective study to evaluate the efficacy of human amniotic membrane dressings in the treatment of chronic leg ulcers was conducted on 15 patients. Patients with two ulcers were selected. One ulcer was treated with human amnion and the other, treated with standard dressings, served as a control. The rate of healing of the two ulcers was observed and compared. Chronic ulcers of post-phlebitic, post-irradiation and post-burn origin responded to treatment with human amnion and healed more rapidly than the control ulcer. Ulcers associated with rheumatoid arthritis and vasculitis showed no improvement. It was observed that all ulcers treated with human amnion quickly became pain-free.     

胎兔、成兔皮肤正常及创伤愈合过程中透明质酸的定位分布

目的: 观察胎兔、成兔皮肤在正常及创伤愈合过程中透明质酸(HA)的定位分布变化. 方法: 在已建立的胎兔创伤膜型上,切取正常及创伤皮肤组织标本,用Sauder染色方法,对细胞外基质中的HA进行了定位观察. 结果: 发现随胎龄不断增长,表皮层分化的成熟,表皮层中除基底层外HA分布逐渐减少,真皮层呈一致弥漫性分布. 成兔皮肤表层无HA染色,真皮网状层的HA多围绕胶原纤维分布,密度较深. 胎兔、成兔皮肤HA染色最浓的部位位于基底层附近. 皮肤创伤后,胎兔及成兔均表现出表皮基底层及真皮层HA合成增加,两者的差别不甚显著,而胎兔则在创伤后第5日完全愈合. 结论: HA是参与创伤愈合反应的主要细胞外基质,在创伤愈合及瘢痕形成中具有十分重要的作用.     

硅凝胶药膜修复中厚断层皮供区创面

目的：探讨用含环丙沙星的硅凝胶药膜治疗自体中厚断层供皮区创面,促进创面愈合防止瘢痕增生。方法：对２０例切取自体中厚皮供皮区创面,每例病人一半创面用硅凝胶膜治疗,另一半用常规凡士林纱布治疗。结果：用硅凝胶药膜治疗区域比用凡士林纱布治疗区域疼痛轻,创面愈合快、疤痕增生不明显。结论：含抗生素的硅凝胶药膜能促进中厚供皮区愈合,防止感染并可控制供皮区疤痕增生。     

Chronic ulcer of the leg: clinical history

Six hundred patients with chronic leg ulcers were studied by detailed history and examination as part of a population survey. In 22% ulceration began before the age of 40, and in this group the sex incidence was equal. Over age 40 there was an increasing preponderance of women. Ulcers were significantly more common in the left leg in women but not in men. The site of 26% of ulcers did not include the classical medial goiter area. The median duration of the ulceration at the time of the survey was nine months and 20% had not healed in over two years. The great majority of patients had had recurrence, 66% having had episodes of ulceration for more than five years. Healing of ulcers is a serious problem, but preventing recurrence is the greater challenge.     

复方磺胺嘧啶锌凝胶在治疗下肢静脉性溃疡中的应用

目的 观察复方磺胺嘧啶锌凝胶治疗下肢静脉性溃疡的疗效.方法 选择2015年1月至2019年12月于我院就诊的下肢静脉性溃疡患者,包括尚未行手术治疗的门诊换药患者40例和手术治疗患者40例.采用随机数字表法将未手术患者随机分为未手术试验组(20例)及未手术对照组(20例),将手术治疗患者随机分为手术试验组(20例)及手术...     

Microcirculation disturbances in patients with venous ulcer before and after healing as assessed by laser Doppler flux-metry

BACKGROUND: We studied whether a characteristic pattern of laser Doppler flux (LDF) could be identified in perimalleolar skin of patients with venous ulcer before and after ulcer healing. METHODS: Nine subjects with venous ulcer that healed after conservative treatment in 1-6 months and nine healthy persons were included in the study. Microcirculation investigations of laser Doppler flux (LDF) were carried out before and after ulcer healing at rest, upon arterial occlusion, during thermal stimulation and during experimental venous hypertension. RESULTS: Resting LDF expressed as median and range (in arbitrary perfusion units) was significantly higher in patients with venous ulcer in comparison to healthy subjects: 60.6 (40.2-156.5) vs. 9.2 (6.5-19.5), p=0.008. During thermal stimulation and during postischemic reactive hyperemia, absolute values of LDF were slightly but significantly higher in patients with venous ulcer than in healthy subjects, but indices of hyperemic reactivity were very low in patients (median postischemic LDF increase to 101.8 vs. 450.0% in healthy controls, p=0.008; and thermally induced LDF increase to 125.5 vs. 881.5% in healthy controls, p=0.008. Experimental venous hypertension (cuff pressure 40 and 70 mmHg, respectively) led to an equally pronounced relative reduction of LDF in healthy persons as in patients with venous ulcer before and after ulcer healing, but the absolute values of flow remained about six to seven times higher in patients when compared to healthy subjects. Hyperemic reactivity and venoarteriolar response did not change after ulcer healing. CONCLUSIONS: Elevated basal LDF and preserved maximal LDF during reactive hyperemia were found in perimalleolar skin of patients with venous ulcers that eventually healed. The relative venoarteriolar response was preserved in spite of elevated absolute values of LDF during experimental venous hypertension. These hemodynamic characteristics remained unchanged after epithelialization of venous ulcers.     

The treatment of varicose leg ulcers by hyperbaric oxygen

Hyperbaric oxygen at 2 atmospheres pressure was administered to nineteen cases of chronic varicose leg ulceration. Treatment was given for 2 hr on 5 days of each week. Bacterial infection of the ulcers was suppressed, and drying of the lesions occurred within hours of commencing treatment. Epithelialization of healthy granulation tissue was a constant feature. Simple venous ulcers consistently responded better than those cases where arterial insufficiency was present. No adverse reactions were observed. Seventeen of the nineteen patients had their ulcers healed after a mean exposure to OHP of 60·7 hr.     

The limerick leg-ulcer project: Early results

Nurse led clinics in joint hospital and community settings are now being advocated as the most effective and economic way of dealing with leg ulcers. However, little information exists on the profile and outcome of patients with venous ulcers treated either in the community or in the hospital setting. Over a 2 yr period we assessed 134 patients with leg ulcers of whom 122 were deemed suitable for compression bandaging therapy. Thirty-four patients (28 per cent) were treated by the newly developed community service and 88 (72 per cent) were treated at the hospital clinic. Our overall healing rate for venous ulcers was 50 per cent @ 40 weeks. This probably reflects the long duration (48 per cent >2 yr) and large size (0.5–600 cm²) of ulcer prior to treatment. There were no differences in outcome between hospital (50 per cent @ 40 weeks) and community (35 per cent @ 40 weeks) based treatment (p>0.05). We conclude that most venous ulcers can be effectively treated in the community and resources should be provided to achieve this goal.     

创面愈合中真皮组织再生过程的观察

 目的 研究全层皮肤创面愈合过程中真皮的再生模式以及与表皮层、基底膜层再生的关系。方法 在大鼠鼠背制备全层皮肤创面（n=10）。分别于第1，2，3，4，5周取创面标本。行HE、PAS染色以及用碱性水浸泡方法制作扫描电镜标本，在光镜和扫描电镜下观察创面愈合中真皮的再生情况。结果 在术后第1,2周时在创缘可见新生的薄层表皮向创面中心移行生长；随后是表皮下真皮浅层的生长，而深层真皮相对保持静止。在第3周时，在新生表皮下方与新生真皮的部位之间见不连续的PAS阳性带，在第5周时，创面外周见连续的PAS阳性带，而在创面中央处仍不连续。扫描电镜的观察显示创面边缘真皮乳头层较网状层率先向创面中央生长，网状层生长较缓慢，在后期与肉芽组织转化而来的结缔组织相融合。结论 创伤后真皮乳头层和网状层表现出不同的再生模式。乳头层真皮的再生与表皮的再生密切相关。表皮的新生和移行发生在在乳头层真皮新生之前，而基底膜结构在表皮和真皮乳头层均形成后才开始形成。     

Venous ulceration: factors influencing recurrence after standard surgical procedures

Ninety patients with chronic venous ulceration were investigated to determine the extent of the incompetence of the venous valves. They were then treated by established surgical methods to control reflux. All wore fitted compression stockings and were regularly followed up. Forty-two patients had valvular incompetence confined to the perforating and superficial veins. All their ulcers healed and only one developed a minor recurrence during the three year follow-up. Nineteen patients had additional but limited incompetence of the deep veins; all their ulcers healed, but three developed a recurrence. Twenty-nine patients had extensive deep vein valvular incompetence including incompetence of the popliteal valve; in 12 of these patients either the ulcer failed to heal or the patient developed a recurrent ulcer within 18 months. Thirty-two other patients developed further venous reflux from the opening of new channels, including the perforating veins of the foot, and required sclerosants or local ligation. It was concluded that established surgical techniques, thoroughly performed, were very effective for the treatment of chronic venous ulceration provided the popliteal valves were competent. When the popliteal valves were incompetent the recurrence rate was unacceptably high and additional methods, including vein valve transplants, excision of the ulcer with skin grafting and lumbar sympathectomy, were considered. Nine of 11 patients who received a vein valve transplant had falls in their ambulant venous pressures, improvement in the nutrition of their skin and healing of their recurrent ulcers.     

系统性湿性疗法治疗Ⅱ～Ⅳ度压疮的临床观察

目的 探讨系统性湿性疗法对Ⅱ～Ⅳ度压疮的治疗效果。 方法 2010年1月至2011年1月,我科共收治压疮患者30例,其中男21例、女9例;年龄60～80岁,平均(71±8.5)岁。创面类型：Ⅱ度压疮7例、Ⅲ度12例、Ⅳ度11例。按湿性疗法进行系统换药,观察各创面的肉芽生长和愈合情况。结果 湿性疗法换药后,创面肉芽生长良好,感染控制好,所有创面均在1～6周内愈合,随访3个月,未再复发。 结论 湿性疗法是治疗深度压疮的较理想的方法 之一,值得推广应用。     

糖尿病慢性难愈合创面大鼠模型的制备

为建立糖尿病状态下慢性难愈合创面动物模型，在实验性糖尿病大鼠背部人工造成圆形无菌创面，并观察创面愈合过程。结果，伤后第７天糖尿病大鼠创面仅愈合４０％，而对照组动物已愈合７０％。伤后第１４天后者已完全愈合，而糖尿病大鼠仍有约０．４ｃｍ＾２的残余创面，直到伤后第３０天仍有少数动物的创面未完全愈合。     

术前MRV联合多普勒超声在活动性下肢静脉性溃疡诊断及治疗中的作用

目的 探讨术前磁共振静脉造影(magnetic resonance venography, MRV)检查在活动性下肢静脉性溃疡诊断及治疗中的作用。方法 回顾性分析60例慢性下肢静脉性溃疡患者资料,根据术前进行MRV联合多普勒超声检查(35例)和单纯多普勒超声检查(25例),分别设定为A组和B组。患者行腔内激光治疗技术(endovenous laser ablation, EVLT)联合隐股静脉结扎术,应用Kaplan-Meier生存分析方法对两组患者术后6个月的溃疡愈合率及术后36个月的溃疡复发率进行统计学分析。结果 随访36个月,随访率93.33%。两组患者的性别、年龄、溃疡直径和溃疡持续时间差异无统计学意义。术后6个月,两组患者的累积溃疡愈合率差异没有统计学意义(88.6% vs 92%, P=0.642)。36个月的随访期中,A组累积溃疡复发率明显低于B组(5.7% vs 24%, P=0.037)。结论 术前MRV联合多普勒超声检查对活动性下肢静脉性溃疡的诊断和治疗具有重要的指导价值。     

腔镜辅助手术治疗下肢原发性静脉曲张

目的:探讨腔镜技术在下肢原发性静脉曲张手术中应用的可行性和结果。方法:腔镜辅助手术治疗24例(32条患肢)下肢原发性静脉曲张病人。术后随访3～22个月;传统手术治疗20例(27条患肢)下肢原发性静脉曲张病人.术后随访5～24个月。结果:腔镜辅助手术治疗24例病人术后肢体症状和浅静脉曲张消失,16例合并有静脉性溃疡患者短期内溃疡愈合,随访3～22个月只有1(1/32)条患肢复发静脉曲张,其余病人未见静脉曲张复发及并发症;而传统手术治疗20例病人术后肢体症状和浅静脉曲张消失,10例合并有静脉性溃疡患者短期内溃疡愈合,随访5～24个月有3(3/27)条患肢复发静脉曲张,2(2/10)条患肢复发溃疡。结论:腔镜辅助手术治疗下肢原发性静脉曲张手术效果好,术后复发率低,患肢创伤小,病人满意度高,是治疗下肢原发性静脉曲张的有效方法。     

高频超声用于儿童皮肤厚度测量的可行性研究

目的 探讨高频超声应用于儿童皮肤厚度测量的可行性和可靠性.方法 应用13mHz的高频超声对34例儿童的7个部位皮肤进行厚度测定.结果 13 mHz的高频超声能较精确地测量所扫查部位的表皮和真皮的厚度,并清晰地显示真皮-皮下的分界线.结论 13 mHz的高频超声可以使皮肤结构清晰显像,将其用于儿童皮肤厚度的检测切实可行,数据可靠,为临床提供了一种无创测量儿童皮肤厚度的方法.