Multi-staged flap reconstruction for complex radiation thoracic ulcer

INTRODUCTION

Chest wall reconstruction due to previous radiation therapy can be challenging and complex, requiring a multidisciplinary approach.

PRESENTATION OF CASE

The authors present the case of a 84-year-old woman with a right chest wall radionecrosis ulcer, that was submitted to an ablative surgery resulting in a full-thickness defect of 224 cm², firstly reconstructed with a pedicled omental flap. Due to partial flap necrosis, other debridements and chest wall multi-staged flap reconstruction were performed.

DISCUSSION

This case highlights that the reconstructive choice should be individualized and dependent on patient and local factors. The authors advise that surgical team should work closely and be well versed in chest wall reconstruction with a variety of pedicled flaps, when a complication occurs.

CONCLUSION

A multi-staged flap reconstruction could be a salvage procedure for the coverage of complex, great and complicated chest wall defects due to previous radiation therapy.     

Uso profiláctico de apósitos de silicona para minimizar las lesiones por presión: revisión sistemática y metaanálisis

ObjectivePreventing hospital-acquired pressure injuries (PI) in critically ill patients remains a significant clinical challenge because of its associated high risk for comorbid conditions. We assessed the preventive effectiveness of silicone dressings among patients admitted in intensive care units and non-intensive care units settings.MethodsA literature search was conducted across 3 electronic databases (MEDLINE, EMBASE, Cochrane Central) from inception through December 2021. Studies assessing the effectiveness of silicone dressing on the incidence of PI on the sacral area were included. evaluations were reported as risk ratios (RRs) with 95% confidence interval, and analysis was performed using a random-effects model.ResultsOf the 1,056 articles retrieved from the initial search, 11 studies were included in the final analysis. Silicone dressings significantly reduced the incidence of PI compared to usual care (RR: 0.30, 95%CI: 0.19-0.45, P < 0.01). We found no significant difference between results of studies conducted in intensive care settings (RR = 0.25, 95%CI: 0.15-0.43, P < 0.01) and non-intensive care settings (RR = 0.38, 95%CI: 0.17-0.83, P = 0.01) (P-interaction: 0.39). Silicone dressings reduced the risk of developing PI among patients using five-layer foam Border dressing (Mepilex® Sacrum) (RR: 0.31, 95%CI: 0.20-0.48, P < 0.01), and dressing Allevyn Gentle Border® (RR: 0.10, 95%CI: 0.01-0.73, P = 0.02) with no significant difference upon subgroup analysis (P-interaction: 0.27).ConclusionThe present meta-analysis suggests that silicone dressings consistently reduce the incidence of PI in intensive as well as in non-intensive care settings, regardless of the type of dressing used.     

质量管理工具在基层医院难免性压疮管理中的应用

目的探讨将质量管理工具应用到难免性压疮管理中的效果。方法采用质量管理工具中的查检表对难免性压疮高危患者上报及发生例数进行统计、绘制特性要因图(鱼骨图)后进行原因分析,确定和解决难免性压疮管理中的问题。结果质量管理工具应用前后难免性压疮发生率比较,差异有统计学意义(P0.05)。结论将质量管理工具应用到难免性压疮管理中可有效减少难免性压疮的发生,达到护理质量与安全的持续改进。     

肿瘤患者难免性压疮预测评价指标的构建

目的探讨肿瘤患者难免性压疮的概念及预测指标,为难免性压疮管理提供依据。方法选择上海市、重庆市、广东省、湖南省、河南省、四川省共20名专家,采用德尔菲法就肿瘤患者难免性压疮的概念及预测指标进行3轮函询。结果肿瘤患者难免性压疮的概念界定为＂肿瘤患者在具有高度水肿、大小便失禁、恶病质、强迫体位等高危压疮因素的基础上,因翻身计划无法落实（≥3d）、皮肤有现存或潜在的损伤、脱离照护3项中的1项或多项所引起的压疮＂。其预测指标包括存在压疮高危因素、翻身计划持续不能实现、皮肤有现存或潜在的损伤、脱离护士照护4个条目,变异系数0.0856～0.1779,权重依次为0.2899、0.2743、0.2743、0.1615。3轮专家咨询的积极系数分别为90.9%、100%和100%;专家的权威系数为0.88。结论专家协调程度较高,肿瘤患者难免性压疮的概念和预测评价指标可作为制定肿瘤患者压疮管理制度和护理压疮的依据。     

三叶因子-1及生存素对良恶性胃溃疡判断的临床意义

目的：分析外周血三叶因子-1及生存素对良恶性胃溃疡判断的临床意义。方法选择胃癌患者93例,其中无癌前病变胃溃疡组（A组）、癌前病变胃溃疡组（B组）及溃疡型胃癌组（C 组）,分别为41、32、20例。分别检测指标生存素、TIFF1、CEA、PGⅠ。结果 B组患者期较A组生存素及TIFF1有显著性差异（P〈0.05）,C组生存素及TIFF1较 A、B组存在显著性差异（P〈0.05）。B组较 A组 PGⅠ、CEA 有显著性差异（P〈0.05）,C 组 PGⅠ、CEA 较 A、B组存在显著性差异（P〈0.05）,PGⅡ未见显著性差异（P〈0.05）。生存素与 PGⅠ、CEA显著相关（P〈0.05）,TIFF1与PGⅠ、CEA显著相关（P〈0.05）,与PGⅡ未见显著相关性（P〈0.05）。结论生存素水平与三叶因子-1为胃溃疡进展的重要因子,是反映胃溃疡恶性变进展的重要指标。     

胃溃疡患者焦虑状态与TIFF1及EGF水平关系分析

目的：探讨胃溃疡患者不同焦虑状态与TIFF1及 EGF水平的关系并进行相关性分析。方法对入选的胃溃疡患者95例采用汉密尔顿焦虑量表（HAMA）进行评估,分为明显焦虑组、焦虑组及无焦虑组,每组分别有41、32、22例。入选后分别行TIFF1及 EGF、PGⅠ、PGⅡ测定。结果焦虑组 HAMA评分、TIFF1及 EGF较无焦虑组差异显著（P〈0.05）,明显焦虑组 HAMA评分、TIFF1及 EGF较无焦虑组差异显著（P〈0.05）。焦虑组 PGⅠ、PGⅠ/PGⅡ较无焦虑组显著下降（P〈0.05）,明显焦虑组 PGⅠ、PGⅠ/PGⅡ较无焦虑组及焦虑组均存在有显著性差异（P〈0.05）。HAMA与TIFF呈显著负相关,与PGⅠ、PGⅠ/PGⅡ呈显著负相关（P〈0.05）。结论焦虑状态是的影响胃溃疡患者TIFF1及 EGF水平的重要因素,焦虑状态加重将直接影响到对胃黏膜损伤的修复能力。     

胃镜下注射去甲肾上腺素联合奥美拉唑治疗消化性溃疡出血的疗效观察

目的探讨胃镜下注射去甲肾上腺素联合奥美拉唑治疗消化性溃疡出血的疗效及安全性。方法将82例消化性溃疡出血患者随机分为观察组和对照组,每组各4l例。观察组采用胃镜下注射去甲肾上腺素联合奥美拉唑治疗,对照组采用奥美拉唑联合立止血治疗。结果观察组总有效率明显高于对照组,两组比较差异有统计学意义（P〈0．05）;两组患者24h、48h及72h空腹胃液pH值逐渐升高,与治疗前相比有统计学意义（P〈0．05）,且观察组升高幅度明显优于对照组（P〈0．05）;观察组患者止血时间、输液时间、住院时间均明显低于对照组（P〈0．05）,输血量及住院费用较对照组明显减少（P〈0．05）,再出血发生率明显低于对照组（P〈0．05）。两组均未见明显不良反应。结论胃镜下注射去甲肾上腺素联合奥美拉唑治疗消化性溃疡出血疗效确切,安全可靠,值得临床推广应用。     

姜黄素减轻小鼠深部组织压力性损伤

目的评价姜黄素(Cur)对缺血-再灌注所致小鼠深部组织压力性损伤(DTPI)创面愈合的影响。方法将小鼠随机分为对照组(Con)、模型组(Mod)、姜黄素4和8 mg/kg干预组(Cur 4,Cur 8),每组10只。磁铁压迫法构建深部组织损伤模型,每隔48 h于创面注射姜黄素,拍照观察伤口愈合情况。HE染色观察伤口愈合病理改变,realtime PCR检测肿瘤坏死因子(TNF-α)、白介素-6(IL-6)、白介素-10(IL-10)、血管内皮生长因子(VEGF-α)、转化生长因子-β(TGF-β)的mRNA表达;Western blot检测VEGF-α、TGF-β、Stat3、p-Stat3蛋白的表达。结果与对照组相比,模型组伤口逐渐恶化,病理学改变明显。与模型组相比,Cur 8组伤口愈合明显加快(P<0.05);Cur 8组炎性细胞浸润减少,新生血管密度增多。Cur 8组TNF-α、IL-6的mRNA表达量均低于模型组,IL-10、VEGF-α和TGF-β表达量均高于模型组(P<0.05);Cur 8组VEGF-α、TGF-β、p-Stat3蛋白表达水平均高于模型组(P<0.05)。结论姜黄素可减轻小鼠缺血-再灌注所致的DTPI,其机制可能与抑制炎性反应及促进血管再生有关。     

交锁髓内钉早期动力化对胫骨骨折愈合的促进作用

目的 分析交锁髓内钉早期动力化对胫骨骨折愈合的促进作用。方法 选择2018年3月~2019年3月在我院治疗的90例胫骨骨折患者,采用随机数字表法分为对照组和观察组,各45例。对照组采用常规交锁髓内钉治疗,观察组采用交锁髓内钉早期动力化治疗,比较两组骨折愈合率、Rasmussen 评分、骨折愈合时间、并发症发生情况。结果 观察组骨折愈合率为95.56%,高于对照组的82.22%,差异有统计学意义（P＜0.05）;观察组Rasmussen 评分高于对照组,骨折愈合时间均短于对照组,差异有统计学意义（P＜0.05）;观察组并发症发生率为6.67%,低于对照组的15.56%,差异有统计学意义（P＜0.05）。结论 交锁髓内钉早期动力化对胫骨骨折愈合,缩短愈合时间,提高骨折愈合率,并且临床并发症少,利于患者的良好预后,值得临床应用。