游离第二足趾移植急诊拇指再造38例

目的探讨游离第二足趾移植急诊一期拇指再造的可行性. 方法外伤性拇指缺损清创后采用游离第二足趾移植一期再造拇指. 结果再造拇指38例全部成活,无一例感染,经6～60个月随访,所有再造拇指血运丰富,感觉恢复良好,对指对掌灵活. 结论对于外伤性拇指缺损,只要清创彻底,采用游离第二足趾移植行急诊拇指再造,可以获得满意的再造效果.     

多中心完全随机、标准治疗平行对照评价京万红软膏治疗糖尿病足慢性创面的临床研究

目的：：通过多中心完全随机、标准治疗平行对照方法评价京万红软膏治疗糖尿病足慢性创面的疗效。方法：本研究共有11家医院参加,采用多中心完全随机、标准治疗平行对照、前瞻性临床研究设计。131例糖尿病足溃疡患者随机分为京万红软膏组67例和对照组64例,两组创面面积分别为(16.7±6.1)cm2和(15.9±8.3) cm2,创面形成时间(45.7±68.3)d和(52.5±79.6)d 。两组分别用京万红软膏或复方磺胺嘧啶锌凝胶涂于创面,观察疗程均为20周。结果：两组患者年龄、糖尿病病程、血常规、肝功能、肾功能等数据差异无统计学意义。京万红组于2、5、10、15周创面愈合速率明显优于复方磺胺嘧啶锌凝胶组,以第5周、10周最为明显(P<0.01)。京万红组创面达到完全上皮化平均时间为(46.5±15.6)d,复方磺胺嘧啶锌凝胶组为(67.9±17.9)d,差异显著(P<0.05)。结论：京万红软膏与复方磺胺嘧啶锌凝胶均有促进糖尿病足创面愈合的作用,京万红软膏作用更优。     

狗中度冲击伤复合高速破片致伤的损伤特点研究

本研究初步探讨了狗中度冲击伤复合单侧后肢高速破片伤的致伤特点。结果表明,冲击伤,破片伤及两者复合伤后PaO_2均有降低,而PAP则有所升高,以复合伤后变化的幅度最大。且复合伤后24h肺体指数与肺含水率明显高于冲击伤后及破片伤后。形态学的改变显示:复合伤动物多数发生重度肺损伤,冲击伤动物多数为中度肺损伤,而破片伤动物仅少数出现轻度肺损伤。结果提示:狗肢体高速破片致伤对中度冲击伤的肺损伤具有加重作用。     

乌蔹莓膏在急性骶尾部藏毛窦脓肿术后的应用研究

目的:观察乌蔹莓膏应用于急性骶尾部藏毛窦脓肿术后创面的临床疗效。方法:采用前瞻性随机对照研究方法,纳入84例采用切口开放手术(袋形缝合术)治疗的急性骶尾部藏毛窦脓肿的患者,随机分为试验组(采用乌蔹莓膏换药治疗,n=41)和对照组(采用医用凡士林敷料换药治疗,n=43),比较两组的创面疼痛和渗液情况、创面肉芽生长情况、愈合情况、住院时间及愈合皮肤瘢痕增生情况。结果:试验组的创面疼痛及渗液情况明显轻于对照组(P＜0.05)。试验组的创面肉芽生长更好,创面愈合速度更快,住院时间及愈合时间更短(均P＜0.001)。术后6个月,试验组患者温哥华瘢痕量表(VSS)评分中的色泽、厚度、血管分布、柔软度及总分均明显低于对照组(均P＜0.05)。结论:乌蔹莓膏应用于急性骶尾部藏毛窦脓肿术后创面的疗效较好,可有效减轻术后创面疼痛、渗液,促进肉芽生长,加快创面愈合速度,缩短创面愈合时间及住院时间,抑制瘢痕增生,值得临床推广。     

Nano-silver modified porcine small intestinal submucosa for the treatment of infected partial-thickness burn wounds

Background and aimSilver has been widely used as a topical antimicrobial agent in burn wound care. In a previous study, we demonstrated the introduction of nano-silver particles to porcine small intestinal submucosa (NS-PSIS) led to significant enhancement in antibacterial property in repairing contaminated abdominal defect. In this study, we explored the efficacy of NS-PSIS in the treatment of Pseudomonas aeruginosa-infected partial-thickness burn wounds.Methods48 male Sprague-Dawley rats were divided into four groups of equal number. Standardized and reproducible Pseudomonas aeruginosa-infected partial-thickness thermal burns wound model were created using these rats. NS-PSIS, PSIS (porcine small intestinal submucosa) or lipido-colloid dressingss (Urgotul?) were tested for 14 days to assess their ability to heal the rats’ burn wounds. Control group was without any treatment after the establishment of infected burn-wound. The wound contraction rate, animal body weight change, histological examination, and the quantification of IL-6 and C-reactive protein (CRP) were measured to evaluate the healing effects.ResultsNS-PSIS significantly promoted wound healing and recovered the normal growth of rats. There were significantly lower expression levels of pro-inflammatory cytokine (IL-6) and CRP in NS-PSIS group as compared with the PSIS or Urgotul group in the treatment of infected partial-thickness burn wounds. Histological exams revealed significant less inflammatory cells infiltrating, more re-epithelization and neovascularization in NS-PSIS group. There were also less inflammatory cells infiltrations in the major organs in NS-PSIS group.ConclusionsNano-silver modified porcine small intestinal submucosa (NS-PSIS) can be used as a biological derivative dressing for the treatment of infected partial-thickness burn wounds.     

The utility of traditional prehospital interventions in maintaining thermostasis

Objective. Hypothermia can have a negative effect on the metabolic and hemostatic functions of patients with traumatic injuries. Multiple methods of rewarming are currently used in the prehospital arena, but little objective evidence for their effectiveness in this setting exists. The purpose of this study was to assess the relative effectiveness of traditional prehospital measures in maintaining thermostasis in trauma patients. Methods. Participating helicopter and ground ambulance ALS units were prospectively randomized to provide either routine care only (passive or no warming) or routine care (passive warming) in conjunction with active warming (either reflective blankets, hot pack rewarming, or warmed IV fluids). A total of 174 trauma code patients, aged >14 years, who met inclusion criteria were prospectively enrolled by prehospital providers. Patients who received a non-assigned intervention or who had incomplete temperature data were dropped from the analysis. A total of 134 patients were included in the final analysis. Results. Patients who received hot pack rewarming showed a mean increase in body temperature during transport (+1.36°F/0.74°C), while all other groups (no intervention, passive rewarming, reflective blankets, warmed IV fluids, warmed IV fluid plus reflective blanket) showed a mean decrease in temperature during transport [-0.34 to -0.61°F (-0.2 to -0.4°C); p < 0.01]. In addition, the hot pack group was consistent, with every patient who received hot pack warming showing an increase in body temperature during transport, while in all other groups there were patients who had both increases and decreases in temperature. The intervention groups did not differ significantly on exposure to precipitation, transport unit temperature, total prehospital time, initial vital signs, amount of fluid administered, Injury Severity Score, or Glasgow Coma Score. Conclusions. Most traditional methods of maintaining trauma patient temperature during prehospital transport appear to be inadequate. Aggressive use of hot packs, a simple, inexpensive intervention to maintain thermostasis, deserves further study as a potential basic intervention for trauma patients.