封闭负压引流对猪皮肤软组织爆炸伤感染创面肉芽组织生成的影响

目的　观察封闭负压引流技术 (VAC)对猪皮肤软组织爆炸伤感染创面肉芽组织生成的影响。方法　用电雷管在 4只 15～2 0kg的小白家猪双侧肩胛及双侧臀部造成 16个爆炸伤创面 ,随机分为对照组和治疗组。各组创面伤后 72h内不做任何处理 ,以造成创面感染。伤后第 3天起 ,对照组油纱布换药 ,治疗组用 - 15kPa的VAC治疗。于治疗前和治疗后 1、3、6、9、14、19、2 4天测量创面深度 ,并取创面中心的活组织进行HE染色和免疫组化染色 ,观察血管内皮细胞和增殖细胞的数目 ,计算增殖指数。结果　治疗后 1～ 19天 ,治疗组创面深度较对照组浅 (P <0 0 1) ;治疗后 1～ 6天 ,治疗组创面中血管内皮细胞数较对照组显著增高 (P <0 0 1) ;治疗后 1～ 3天 ,治疗组创面的增殖指数较对照组高 (P <0 0 1)。结论　与常规治疗相比 ,VAC能快速启动猪皮肤软组织爆炸伤感染创面肉芽组织生成 ,缩短肉芽组织填平伤口的时间。     

Veno-occlusive disease in a child with rhabdomyosarcoma after conventional chemotherapy: report of a case and review of the literature

Although veno-occlusive disease of the liver is a well-known complication of high-dose chemotherapy and bone marrow transplantation, it has rarely been observed in children who receive conventional chemotherapy. Most cases in the literature consists of children with Wilms tumor. It has been very uncommon in rabdomyosarcoma patients until recently, although they commonly receive similar anticancer agents. Here the authors report a 2-year-old boy with rhabdomyosarcoma who developed veno-occlusive disease while receiving VAC (vincristine, actinomycin D, cyclophosphamide) chemotherapy regimen according to the IRS-IV protocol. The patient gradually recovered during 2 weeks with supportive treatment only.     

Initial Experience of Laparostomy with Immediate Vacuum Therapy in Patients with Severe Peritonitis

INTRODUCTION

To report our initial experience of laparostomy and immediate intra-abdominal vacuum therapy in patients with severe peritonitis due to intra-abdominal catastrophes.

PATIENTS AND METHODS

Twenty-seven patients underwent emergency laparotomy and laparostomy formation with the application of immediate intra-abdominal TRAC–VAC® therapy (male:female ratio, 1:1.2; median age, 73 years; range, 34–84 years). Predicted mortality was assessed using the P-POSSUM score and compared with clinically observed outcomes.

RESULTS

Ten patients (37%) with a mean predicted P-POSSUM mortality of 72%, died of sepsis and multi-organ failure. Seventeen patients (mean P-POSSUM 48% expected mortality) survived to discharge. One patient with pancreatitis died from small bowel obstruction 1-year post discharge, two patients developed a small bowel fistula. One patient had an allergic reaction to the VAC dressing. Our patients, treated with laparostomy and TRAC VAC therapy, had a significantly improved observed survival when compared to P-POSSUM expected survival (P = 0.004).

CONCLUSIONS

Laparostomy with immediate intraperitoneal VAC therapy is a robust and effective system to manage patients with intra-abdominal catastrophes. There were significantly improved outcomes compared to the mortality predicted by P-POSSUM scores. Damage control surgery with laparostomy formation and intra-abdominal VAC therapy should be considered in patients with severe peritonitis.     

封闭负压引流技术对加速慢性创面愈合的机制

摘要:目的研究封闭负压引流技术对人慢性创面中活性形式明胶酶(活性MMP-2、活性MMP-9)的影响。方法对5例慢性创面患者给予创面封闭负压引流(-120mmHg压力)150d,分别于吸引前和吸引后24h、3、5、10、15d收集创面渗出液。另以10例乳腺癌切除术后第3天的创面引流液为急性创面对照。用Zymography法测明胶酶活性,并用薄层分析仪分析试验结果。结果封闭负压引流治疗前,1例的活性MMP-2和另1例的活性MMP-9较对照组高,两例的活性形式明胶酶总活性(两种酶活性之和)较对照组活性高。封闭负压引流治疗后,慢性创面渗出液中活性MMP-2、活性MMP-9及活性形式明胶酶总活性与对照组比较无统计学差异(P>0.05)。结论人慢性创面中活性形式明胶酶的活性过低或活性过高均可能是慢性创面长期不愈的原因,封闭负压引流能调节慢性创面中活性形式明胶酶的活性。     

Abdominal wall reconstruction with Two‐step Technique (TST): a prospective study in 20 patients

Abdominal wall defects continue to be a challenging problem for reconstructive surgeons. The aim of our study was to report a 3‐year experience using a simple Two‐step Technique (TST) to treat abdominal wall defects. Between January 2008 and December 2010, 20 patients with abdominal wall defects were treated by TST. Patients had a mean age of 37·5 ± 14·9 years (range: 22–85 years); 5 were women and 15 were men. The size of the defects was prospectively analysed. Early and late complications were recorded. Hospital stay, post‐procedure downtime and patient overall satisfaction were systematically assessed. A secondary defect resulting from self‐manipulation and an infection were responsible for a complication rate of 10%. Both underwent successful surgical revision which led to full resolution. The average hospital stay was 11·2 ± 4·9 weeks for the series. Long‐term complications were scar hyperpigmentation in 11 cases, scar hypertrophy in 5 cases and scar widening in 3 cases. Mean patient satisfaction was 8·3 ± 0·5 [visual analogue scale (VAS) 0–10]. Average downtime post surgery was 4·1 ± 1·2 weeks. The mean follow‐up was 24·6 ± 6·7 months. Reconstruction of abdominal wall defect with the TST is a reliable and reproducible technique. This technique provides excellent outcomes, and we anticipate that it will become widespread in the near future.     

Caustic burn caused by intradermal self administration of muriatic acid for suicidal attempt: optimal wound healing and functional recovery with a non surgical treatment

Background

Caustic burns are burns of third and fourth degree caused by strong acids or strong bases. Muriatic acid is often used for suicidal attempt by ingestion. We describe a case of a caustic skin lesion caused by intravenous failed attempt of suicide by injection of Muriatic acid in a woman affected with bipolar-syndrome. Generally, caustic burns are treated by cleansing, escarectomy and coverage with skin grafts.

Case report

We treated the patient with a non invasive technique with collagenase and hyaluronic acid sodium salt cream (Bionect start^®), hyaluronic acid-based matrix (Hyalomatrix^®) and Vacuum-Assisted Closure (VAC) Therapy^®.

Results

We obtained complete healing in 6 weeks.

Conclusions

Combined use of non invasive techniques seems to ensure only advantages for both the patients and the Health System. It reduces health care costs and risks for the patients such as nosocomial infections. Patient’s compliance is high, as its quality of life. Complete healing of the wound is fast and recovery of function is full.     

Vacuum‐assisted closure (VAC)‐Instill® with continuous irrigation for the treatment of Mycoplasma hominis mediastinitis

A 56‐year‐old patient who underwent ascending aorta replacement postoperatively developed mediastinitis with atypical Mycoplasma hominis. We present the first successful treatment of M. hominis mediastinitis after cardiac surgery with vacuum‐assisted closure (VAC)‐Instill^® therapy combined with dilute antiseptic irrigation for bacterial eradication.