高压电烧伤创面的处理

本文重点介绍高压电烧伤特点,创面早期处理,清创时机及术中如何处理肌肉、肌腱、神经血管及骨等组织损伤.针对各种不同部位不同形状的创面选择不同的修复方法,重点强调多处域损伤、颈部及阴茎等损伤的皮瓣应用与重建.     

鞍区颅脑枪击伤的救治

目的 探讨鞍区颅脑枪击伤急性期的救治及晚期鞍区金属异物摘除的方法。方法 对7例鞍区颅脑枪击伤患者行早期清创术，3例患者同时摘除金属异物；4例患者晚期采用显微手术摘除下丘脑、垂体内金属弹丸。所有患者均获随访，随访时间3－11年。结果 全部患者均康复，无下丘脑或垂体功能障碍。恢复良好3例，轻残3例，重残1例。结论 鞍区颅服枪击伤患者，应早期行清创术，尽可能摘除金属异物，修补颅底服膜防止脑脊液漏。术后加强抗感染、抗脑水肿治疗。重症患者需及时治疗继发性脑损害，积极治疗内分泌紊乱等并发症，在全身情况稳定后，采用显微手术摘除异物。显微手术对摘除脑深部重要部位的金属异物是一安全可靠的方法。     

Treatment of extracranial gunshot wounds caused by non-lethal weapon

The deaths happened as a result of wounds caused by non-lethal weapon (NLW) are mainly associated with severe and extremely severe damage of brain. However, vast number of specific problems occurs in cases of extracranial gunshot wounds caused by NLW. Taking into account little physicians' experience, and absence of standard approaches to treatment of these wounds till now. This paper embraces peculiarities of clinical signs, diagnosis and surgical treatment of cervical, truncal, and extremities wounds caused by NLW. Our investigation allowed to draw a conclusion that gunshot wounds caused by NLW have similar characteristics. These ones are the same with signs of wounds caused by small arms. Surgical treatment of wounds caused by NLW is based on the standard approaches to treatment of low-velocity missile wounds.     

Treatment results in wounds of the ENT organs]

ENT injuries totaled up to 1.4% from all other wounds. As for localization of wounds the most frequent were neck injuries (53%). Wounds of nose or accessory sinus of nose comprised 45.6%, and ear wounds--1.4%, 5.8% of wounded needed emergency care, 45.8%--secondary surgical care, and 48.4%--tertiary surgical care. The article analyses the errors of medical care, and gives the classification of ENT injuries.     

真空密封术治疗感染性创腔(面)81例

目的　探讨真空密封术 (vacuumsealingtechnique,VST)对感染创腔 (面 )的治疗效果。方法　用VST治疗 81例感染创腔 (面 ) ,其中 3 2例严重感染 ,2 3例皮肤缺损。VST治疗 7～ 2 4d[(12 .8± 4.3 )d]。 5 6例Ⅱ期愈合或缝合 ,16例植皮 ,5例转移皮瓣 ,4例转移皮瓣 +植皮。　结果81例创腔 (面 )全部治愈。3 2例严重感染VST后第 7天 ,78.1% (2 5 3 2 )创腔 (面 )感染由重转轻 (P <0 .0 1)。VST第 14天 ,创腔 (面 )细菌培养阳性率由VST前的 81.8% (18 2 2 )降至 2 1.1% (4 19) (P <0 .0 1) ;VST第 14天 ,皮肤缺损创面优良肉芽由VST前的 8.7% (2 2 3 )升至 85 .7% (12 14) (P <0 .0 1) ;创腔 (面 )面积缩小 2 7%。　结论　VST能迅速控制创腔 (面 )感染 ,有效促进肉芽组织生长 ,明显缩短创腔 (面 )治愈时间     

真空封闭技术治疗开放性骨折合并的感染创面

目的：探讨开放性骨折合并感染创面的有效治疗方法。方法：1995年2月－2000年10月共收治开放性骨折合并创面感染18例，其中表浅感染2例，深部感染7例，创伤后慢性骨髓炎9例，创面彻底清创后，将内置引流管的聚乙烯醇缩甲醛（PVA）泡沫置入创面，再用聚氨酯（PU）薄膜将PVA泡沫及周围正常皮肤一起覆盖密封，引流管接负压瓶，形成真空封闭，结果：处理14－30d(平均18．6d)，创面感染均得到控制，创面肉芽新鲜，创面面积缩小16．2％，II期游离植皮后，创面均愈合，其中14例随访1．5－36个月，感染无复发，结论：真空封闭技术能有效控制开放性骨折合并的创面感染，促进创面肉芽组织生长，有利于创面收缩。     

Abdominal stab wounds: Self-inflicted wounds versus assault wounds

Intentional penetrating wounds, self inflicted or inflicted by others, are increasingly common. As a result, it can be difficult for the forensic examiner to determine whether the cause is self-inflicted or not. This type of trauma has been studied from a psychological perspective and from a surgical perspective but the literature concerning the forensic perspective is poorer. The objective of this study was to compare the epidemiology of abdominal stab wounds so as to distinguish specific features of each type. This could help the forensic scientist to determine the manner of infliction of the wound.We proposed a retrospective monocentric study that included all patients with an abdominal wound who were managed by the visceral surgery department at Angers University Hospital. Demographic criteria, patient history, circumstances and location of the wound were noted and compared. A comparison was drawn between group 1 (self inflicted wound) and group 2 (assault).This study showed that the only significant differences are represented by the patient's prior history and the circumstances surrounding the wound, i.e. the scene and time of day. In our study, neither the site, nor the injuries sustained reveal significant clues as to the origin of the wound. According to our findings, in order to determine the cause, the forensic examiner should thus carefully study the circumstances and any associated injuries.     

手部深度烧伤的早期处理与瘢痕的防治

目的:总结手部深度烧伤的早期处理与增生期瘢痕的防治经验.方法:烧伤早期全程采用皮肤再生医疗技术治疗,典型的深Ⅲ度烧伤创面早期辅以"坏死层薄化技术"处理,充分发挥"激活潜能再生细胞疗法"的作用,为创面提供良好的生理再生环境,实施创面修复与瘢痕防治同步进行的综合治疗措施.结果:183只手(包括深Ⅲ度)烧伤创面全部非植皮自愈,无伤残功能障碍.结论:皮肤再生医疗技术治疗手部深度烧伤创面能实现自然愈合,防治瘢痕疗效良好.     

封闭负压引流早期处理软组织贯通枪伤实验研究

目的：研究应用封闭负压引流技术（vacuum sealing drainage,VSD）处理早期贯通性枪伤的疗效。方法：8只市售健康成年猪用国产95式步枪造成双侧软组织贯通伤,随机配对分成实验组和对照组,伤后3 h,实验组进行VSD处理,对照组常规处理伤口。于伤后2、24、48和72 h做磁共振成像（MRI）检查,伤后3、12、24、48、72 h取伤道内组织做细菌学检查,伤后72 h处死,对伤道横截面进行肉眼观察和病理学检查。结果：MRI上＂双低信号区＂经病理学观察证明为凝固性坏死组织。VSD处理显著抑制细菌增殖,常规方法不能阻止感染,72 h后仍可见伤道周围组织明显水肿。结论：VSD处理早期枪伤可起到抗感染、解压和促进愈合作用,并使坏死组织和未失活组织之间的界限易于辨认。     

Timing of skin wounds

Wound examination is indispensable in forensic practice. It is always necessary to determine wound vitality or wound age to correctly evaluate the relationship between death and any wounds. Thus, the determination of wound vitality or wound age is a classic but still modern theme in forensic pathology. Skin wound healing is a primitive but well orchestrated biological phenomena consisting of three sequential phases, inflammation, proliferation, and maturation. Many biological substances are involved in the process of wound repair, and this short and simplified overview of wound healing can be adopted to determine wound vitality or wound age in forensic medicine. With the development of immunohistochemistry and chemical analyses, the scientific field of wound age determination has advanced progressively during recent years. In particular, it has been demonstrated that collagens, cytokines, and growth factors are useful candidates and markers for the determination of wound vitality or age. In this review article, some interesting and instructive results are presented, contributing to the future practice of every forensic pathologist.     

Endovideosurgery of gunshot wounds

The paper deals with the opportunities of using endovideosurgery in local armed conflicts. There were worked out methods and technique of endovideosurgical operations in case of gunshot wounds of a chest, a belly and lower limbs. Due to a low level of traumatism and high efficiency the method promotes the decrease of the number of complications, early activation of the insured servicemen during the post-operation period, the reduction in time of treatment and rehabilitation and can be recommended at the initial stage of medical evacuation.     

Gluteal gunshot wounds

Experience with advanced surgery for the treatment of civilian gunshot injuries supports the changes in approach and indications for the treatment of war gunshot injuries. Eight patients with gluteal gunshot wounds are presented with typical war injuries. They were wounded during 1992 and 1993 in the war in Croatia and Bosnia and Herzegovina. Surgical complications were experienced in two cases. Complications developed in cases of colonic and rectal injuries for which advanced surgery was performed in the treatment of the war wound. Poor conditions for advanced surgery during war can change the final result, making the outcome of the war wound worse.