四点荷包缝合圆形皮肤病灶的实验研究

目的探讨四点荷包缝合方法修复较小圆形皮肤组织缺损的效果. 方法在3只家猪的胸背部做直径3 cm的圆形皮肤软组织缺损,共18处创口,分别予以不同的缝合方法,直接关闭创口,观察创面愈合情况.结果四点荷包缝合法和四边梭形切除加四点荷包缝合法两组缝合创面平整美观,不需要切除较多的边缘正常组织,效果优于其他方法.结论四点荷包缝合方法是一种较好的关闭圆形病灶的缝合方法.     

急性皮肤软组织损伤的早期整形外科处理

目的根据应用整形外科原则和技术,处理急性皮肤软组织损伤的方法和经验。减少瘢痕面积及增生程度。方法根据创面情况寻则适当的整形外科原则和技术进行处理。不伴组织缺损的普通裂伤应用整形外科精细缝合法关闭伤口。伴有组织器官缺损的创面应用组织移植方法进行修复。包括皮片、皮瓣移植。常用的整形外科技术,对体表皮肤软组织急性创口进行严格清创。结果本组共治疗1500例患者,1300例伤口Ⅰ期愈合,随访6个月至1年,无明显瘢痕增生,无功能障碍,不需Ⅱ期修复,并且做到减少瘢痕面积及减轻瘢痕美容效果。结论应用整形外科基本原则和技术处理各种急性皮肤外伤。可获得满意效果,值得临床推广应用。     

垂直部分喉切除术创面的修复

１９８２￣１９９４年１３年间，我科共行垂直部分喉切除术治疗喉癌患者３２例。癌肿切除后所遗创面采用创缘粘膜直接缝合，颈前带状肌肌膜和皮肤切缘带颈阔肌蒂皮瓣等三种方法进行修复。认为以前两种修复法效果较好，无并发症发生，但如创面缺损较大时，仍应采取带蒂皮瓣法。     

负压封闭引流治疗四肢皮肤缺损的护理体会

目的 总结负压封闭引流在手足毁损伤治疗中的护理体会.方法 26例手（足）毁损伤患者采用负压封闭引流治疗,（vacuum sealing drainage VSD）,7～15 d后去除VSD装置,见四肢皮肤缺损创面新鲜肉芽组织生长,在创面上游离植皮或直接缝合伤口.结果 18例患者创面肉芽生长新鲜,行或直接缝合创口游离植皮.6例患者骨外露较多,进行2～3次负压封闭引流,创面新鲜肉芽组织生长后行皮瓣移植术.结论 封闭负压吸引可以控制感染、免除换药、刺激创面肉芽组织快速生长,促进创面愈合,为组织皮瓣移植提供了良好的条件.     

Ⅰ期切除缝合术治疗低位肛瘘临床分析

目的探讨低位肛瘘Ⅰ期切除缝合术的适应证、方法和效果。方法对160例低位肛瘘患者行Ⅰ期切除缝合术,对患者的临床资料进行回顾性分析。结果 160例患者全部治愈,创面愈合时间5～16 d,平均8 d。其中3例术后创口感染,经引流换药后愈合。所有病例愈合后瘢痕平而小,均未发生大出血、肛门狭窄、肛门失禁等并发症。本组随访150例,随访3个月～3年,未见复发。结论选择好适应证,规范进行操作,低位肛瘘Ⅰ期切除缝合术可缩短创面愈合时间、减轻患者痛苦和术后水肿、减少皮下积液、消灭死腔、防止术后感染,同时由于手术对正常组织损伤小,便于创面Ⅰ期愈合,术后复发率及创口感染率较常规肛瘘切除术低。     

红霉素眼膏在眼周皮肤裂伤清创缝合术后的应用

眼周皮肤破裂伤是眼科的急诊。患者就诊时多数创口边缘不整齐，伴有皮肤缺口，大量渗出液，眼睑肿胀等。大多数患者经过清创缝合后，需要敷料绷带加压包扎，起到止血减轻肿胀的作用，第2天换药时，由于创口继续有渗出，创面皮肤与敷料粘贴在一起，不易去除敷料，患者出现创面再次出血疼痛等症状。造成不必要的伤害。创口不易愈和，经过临床实践，笔者在眼周创面上涂上红霉素眼膏，对创口有一定的保护作用，效果很好，改善上述症状。     

缝线法矫正乳头内陷

目的介绍一种中度以下乳头内陷的矫正方法。方法采用8字缝合法或荷包缝合法，使乳头、乳晕处基底部周围组织向乳头中底部靠拢，使乳头下撵托组织增加，并形成一定的疤痕组织衬托，使乳头突出。结果17例病人，15例达到Ⅰ期效果．2例(8字缝合法、荷包缝合法各1例)术后乳头内陷再度复发，采用切开法Ⅱ期矫正后痊愈。结论缝合法矫正乳头内陷，乳头、乳晕局部无切口，操作简单，损伤较小。     

颌面部组织缺损邻位皮瓣修复观察

目的探讨颌面部病变切除后遗留的创面或因外伤造成的组织皮肤缺损(不能或不宜直接缝合者)的修复方法。方法回顾性分析1996～2002年诊治的37例颌面部组织缺损的临床资料．在颌面部组织缺损设计原则上尽量利用邻位组织瓣为主,必要时也选用远处组织瓣或舌瓣、腭瓣等修复之。其中应用鼻唇沟瓣18例,鼻唇沟瓣旋转灵活,主要用于上、下唇组织缺损修复;邻位颌面部旋转皮瓣16例,用于修复颌面部小型组织缺损;邻位颈部旋转皮瓣3例,整复较大的颌面组织缺损,供瓣区创面可行全厚皮片游离移植。结果37例皮瓣转移全部成活,术后随访2年,面部形态及功能满意。结论颌面部组织缺损修复宁近勿远,就近取材,邻位皮瓣移位方便,手术操作简单,是最为理想的颌面部组织缺损创面修复方法之一。     

颊脂垫在口腔缺损修复中的应用

随着社会的发展和科学技术的进步,人们对生活质量的提高以及审美度的要求也随之增加。因此,尽量减小创伤而达到最好的修复效果是患者和医生的共同期许和共同目标。口腔内肿瘤的切除往往导致不同的皮肤软组织损伤,因而临床上常根据组织缺损创面的部位,进行必要的修复是非常重要的环节。对于口腔内肿瘤的切除所造成的缺损,直接拉拢缝合,临近组织瓣旋转,游离皮片移植及远位组织瓣移位等作为其主要的修复方法。这些方法最终要达到恢复口腔功能,闭合创面的目的。对修复方法的选择主要依据缺损面部位、缺损面大小和缺损面复原快慢,为了达到此要求和在2010年5月至2015年4月,对34例口腔内缺损患者,我们用颊脂垫瓣修复的各种方法进行治疗,取得了良好的术后效果,现报告如下。     

负压闭式引流联合冰蜜膏在慢性骨髓炎皮肤软组织缺损修复中的应用

目的:探讨负压闭式引流术(VSD)联合冰蜜膏换药在慢性骨髓炎皮肤软组织缺损修复中的应用价值。方法:22例慢性骨髓炎合并皮肤软组织缺损病例,均行VSD引流术后行冰蜜膏换药。结果:冰蜜膏换药3d后见创面肉芽组织生长,2周后创面明显缩小。随机抽检10例行细菌培养均呈阴性。8例肉芽生长良好基本覆盖创面,12例非关节及非负重部位直接缝合。结论:VSD联合冰蜜膏治疗慢性骨髓炎皮肤软组织缺损疗效显著,能促进肉芽组织生长、减少创面污染,为二期手术提供条件。     

网状减张小切口在四肢创伤中的应用

目的寻找一种在严重开放性损伤伴皮肤缺损或严重挫伤或骨折需行内固定病例中简单易行、有效的闭合创面手术方法。方法回顾2006年12月～2011年5月应用网状减张小切口一期缝合治疗严重开放伤53例的临床资料。结果本组53例严重开放伤,皮肤优良愈合率为94.3%。结论本方法操作简单,使皮肤在无张力的情况下愈合,无严重并发症,治疗效果可靠。     

小儿唇裂修复中粘合剂粘合与传统缝合的对比研究

目的对比研究爱必肤粘合剂与传统缝合方法对唇裂修复术白唇手术切口的作用。方法将同期的小儿唇裂手术随机分组,32例白唇切口皮肤予爱必肤粘合,32例白唇切口皮肤按传统方法予丝线缝合,观察切口疼痛程度、愈合情况、感染率及美观效果。结果爱必肤组切口疼痛率低（χ^2=9.69,P〈0.01）,切口及针眼疤痕不明显（χ^2=7.59,P〈0.01）,切口甲级愈合率及感染率两组差异无统计学意义。结论爱必肤作为关闭切口皮肤的一种方法,在小儿唇裂手术中值得大力推广。     

负压封闭引流技术治疗骨科特殊创面的临床研究

目的探讨负压引流技术治疗骨科特殊创面的临床疗效。方法对我科收治的33例骨科特殊创面的患者采用负压封闭引流技术治疗,3-10d后,直接缝合伤口或植皮。结果 33例创面肉芽生长均良好,除患者拒绝植皮1例,因老年患者心力衰竭而无法植皮1例,余创面经植皮或皮瓣转移后愈合良好。总有效率100%。结论负压封闭引流技术手术操作简单,其适应证广,绝大多数的骨科特殊创面都可应用,其疗效确切,适合基层医院推广应用。     

Impairment of wound healing by reactive skin decontamination lotion (RSDL®) in a Göttingen minipig® model

Abstract

Reactive Skin Decontamination Lotion (RSDL^®) is an FDA-approved skin decontamination kit carried by service members for removal and neutralisation of vesicants and nerve agents. The RSDL kit, comprised of a lotion-impregnated sponge, was shown to be the superior medical decontamination device for chemical warfare agent (CWA) exposure on intact skin. In the event of a chemical exposure situation (i.e. terrorism, battlefield) physical injuries are probable, and preservation of life will outweigh the risk associated with application of RSDL to compromised skin. The purpose of this study was to quantify the rate and quality of wound healing in epidermal skin wounds treated with RSDL in a porcine model. Degree of wound healing was assessed using bioengineering methods to include ballistometry, colorimetry, evaporimetry, and high-frequency ultrasonography. Clinical observation, histopathology and immunohistochemistry were also utilised. All pigs received four bilateral superficial abdominal wounds via a pneumatic dermatome on their ventral abdomen, then were treated with the following dressings over a seven-day period: RSDL sponge, petroleum based Xeroform^® gauze, 3?M? Tegaderm? Film, and 3?M? Tegaderm? Foam. Two additional non-wounded sites on the flank were used as controls. Two groups of pigs were then evaluated for a 21- or 56-day time period, representing short- and long-term wound-healing progression. Our findings indicated RSDL had a negative impact on wound-healing progression at both 21 and 56?days post-injury. Wounds receiving RSDL demonstrated a decreased skin elasticity, significant transepidermal water loss, and altered skin colouration and thickness. In addition, the rate of wound healing was delayed, and return to a functional skin barrier was altered when compared to non-RSDL-treated wounds. In conclusion, wound management care and clinical therapeutic intervention plans should be established to account for a prolonged duration of healing in patients with RSDL-contaminated wounds.     

血余炭纳米纤维膜促进家兔创面愈合的实验研究

目的探讨一种新型止血敷料——血余炭纳米纤维膜促进家兔创面愈合的作用。方法建立家兔背部双侧圆形创伤模型,每只兔子6个创面,将创面随机分为3组,分别给予医用纱布、血余炭纳米纤维膜和明胶海绵进行治疗,观察创面的愈合时间和愈合率,检测组织中羟脯氨酸含量的变化,并观察组织病理学变化。结果实验结果显示,血余炭纳米纤维膜具有较好的止血性能,显著缩短创面愈合时间,提高愈合率。血余炭纳米纤维膜组在给药后3、7、14d的创面组织中羟脯氨酸含量均显著高于医用纱布对照组（P〈0．01）;在给药后7d,血余炭纳米纤维膜组的创面组织中羟脯氨酸含量明显高于明胶海绵组（P〈0．05）。组织学观察结果显示,给药后3、7d,血余炭纳米纤维膜组的肉芽组织中成纤维细胞数量较医用纱布组和明胶海绵组均显著升高（P〈0．05,P〈0．01）;血余炭纳米纤维膜组肉芽组织中毛细血管数量显著高于明胶海绵组和医用纱布组（P〈0．05,P〈0．01）。结论血余炭纳米纤维膜具有显著的促进皮肤创面愈合的作用。     

负压封闭引流在组织损伤创面修复中的作用

目的研究探索负压封闭引流技术在难治性急、慢性组织损伤创面修复中的作用和临床疗效。方法对93例不同因素导致严重组织创伤的患者,根据组织损伤程度及创面感染情况,彻底清除创面的坏死失活组织、分泌物和异物等,尽量保留间生态组织,开放所有腔隙。使用Vacuseal材料和生物透性薄膜在组织创伤部位行持续负压封闭引流。结果 93例患者持续负压引流5～7d后,取出Vacuseal材料,有77例形态学观察创面缩小约≥20%,创腔完全消失,创面肉芽组织新鲜平坦,无水肿、渗出。感染创面经培养均为阴性。其余16例患者创面较大、创腔较深或感染较重,多次重新更换Vacuseal材料,继续负压引流,创面创腔肉芽组织生长均鲜活平整。采用Ⅱ期缝合19例,自体皮片移植修复23例,游离皮瓣转移修复27例,网状皮片覆盖14例,中厚皮片植皮覆盖10例,皮瓣(片)成活率100%。结论负压封闭引流能够彻底清除腔隙或创面分泌物和坏死组织,可显著提高肉芽创面血流量,改善局部微循环和组织水肿的消退,促进修复细胞增殖,刺激肉芽组织生长,加速急、慢性组织损伤创面修复愈合的速度。鲜活的肉芽组织能有效的使皮瓣(片)紧贴创面,防止皮片的移动并有利于皮瓣(片)的存活。     

Effects of Epidermal Growth Factor Dosage Forms on Mice Full-thickness Skin Wound Zinc Levels and Relation to Wound Strength

Epidermal growth factor (EGF) and zinc promote re-epithelization and reparative tissue strength by enhancing deposition of collagen at the site of the wound. In this study two EGF dosage forms were chosen to assess the effect of zinc levels on wound healing and for comparison with wound tear strengths. A solution of EGF in 0.9% w/v NaCl and an EGF gel in 0.2% Carbopol 940 polymer (5 μL) were applied to full-thickness skin wounds of mice twice a day for 7 and 15 days. Wound zinc levels were higher on day 7 than on day 15, especially in wounds treated with EGF. The wound zinc levels of the gel + EGF group on day 15 were similar to those of normal control skin. These results imply that there is a close connection, but no direct relationship, between EGF application in both dosage forms and wound zinc levels during healing.     

富含血小板血浆修复小鼠皮肤组织缺损创面的实验研究

摘要：目的 研究富含血小板血浆（PRP）的不同处理方式对小鼠皮肤创伤愈合的影响。方法 清洁级健康雄性 C57BL/6J小鼠27只,其中12只用于制备PRP,另外15只小鼠根据随机数字表法将其分为对照组、PRP注射组以及 PRP凝胶组,每组5只。3组小鼠均建立皮肤创伤模型。PRP注射组将小鼠皮肤伤口等分6点皮下注射PRP,每点注 入0.1 mL;对照组按照相同方法注射等量生理盐水;PRP凝胶组将PRP激活制备成凝胶后覆盖在每只小鼠皮肤伤口 上。3组小鼠均仅在术后当天给药1次,并分别于当天,第3、7、11、14天拍照时计算伤口面积。第14天处死3组小 鼠,收集创口处皮肤组织,用免疫荧光染色评价胶原蛋白表达;实时荧光定量PCR检测Ⅰ型胶原α1链（COL1A1）、Ⅲ 型胶原α1链（COL3A1）、转化生长因子-β1（TGF-β1）、血小板源性生长因子（PDGF）、血管内皮生长因子（VEGF）的 mRNA表达。结果 与对照组和PRP注射组相比,在术后不同时间点,PRP凝胶组的皮肤伤口明显愈合且伤口面积 减小（P＜0.05）。术后第11、14天,与对照组相比,PRP注射组伤口面积减小（P＜0.05）。术后第14天,与对照组和 PRP注射组相比,PRP凝胶组胶原蛋白表达明显增加,VEGF、COL1A1、COL3A1、TGF-β1、PDGF的mRNA水平升高 （P＜0.05）。结论 将PRP激活制备成凝胶可有效修复小鼠皮肤组织缺损创面     

Potential of Ozonated Sesame Oil to Augment Wound Healing in Rats

The hypothesis that ozonated oil has wound healing property was investigated in an excision wound model using Sprague Dawley rats. The animals were divided into four groups, which were treated with sesame oil (vehicle), framycetin (standard), or two doses of ozonated sesame oil (peroxide values 500 and 700 mEq/1000 g, respectively). The formulations were topically applied on the excision wounds once daily for 11 consecutive days and the animals were euthanized on the 12^th day. Wound healing was assessed by measuring the wound contracture, tensile strength, collagen content and superoxide dismutase activity of skin of the excised wound area. On the terminal day, areas of the wounds of the group receiving high dose ozonated oil were significantly smaller than those of the group treated with vehicle. Ozonated oil treated wounds had significantly higher tensile strength, collagen content and superoxide dismutase activity than that of the vehicle treated wounds. Histopathological analysis of skin of the excised wound area treated with ozonated oil revealed better healing activity vis-à-vis vehicle-treated wounds. Thus, it can be concluded that ozonated oil can be of potential therapeutic use for healing wounds.     

Differential expression of system L amino acid transporters during wound healing process in the skin of young and old rats

In order to elucidate the role of the system L-type amino acid transporters (LATs) in the wound healing process of aged and young subjects, we investigated the expression of LAT1, LAT2 and their subunit 4F2hc in the skin healing process after artificial wounds of dorsal skin in the young and old rats. Methods: The 1 cm full-thickness incisional wounds were made through the skin and panniculus carnosus muscle. The wounds were harvested at days 1, 3, 5 and 7 post-wounding, the experimental controls were harvested the skin of rat without wounds and the various analyses were performed. Results: In young rats, gradually and noticeable wound healing was detected, however, in old rats, wound healing was found to be greatly delayed. In young rats, the expression of LAT1 was increased rapidly on the day 1 after wound induction, on the other hand, in old rats, the expression of LAT1 after wound induction was not different from the control group. In young rats, the expression of LAT2 after the induction of wound was not different from the control group, however in old rats, the expression of LAT2 on the day 1 of wound induction was rapidly elevated. Conclusion: These results suggest that the LAT1 and LAT2 increase in the wound healing process after cell injury in young and old rats, respectively.