Randomized controlled trial of the absorbency of four dressings and their effects on the evaporation of burn wounds

Background Wound dressings are divided into traditional and new types. The new dressings are thought to accelerate wound healing. The purpose of this study was to supplement the scanty data on the absorbency of the new dressings and their effects on evaporation from the burn surface. Methods The water absorption rate of four dressings (carbon fiber dressing, hydrogel dressing, silver nanoparticle dressing, and vaseline gauze) were measured by the immersion-weight gain method. A total of 120 inpatients with 10% superficial partial-thickness burn wounds were randomly assigned to four groups, each with 30 participants. Carbon fiber dressing, hydrogel dressing, and silver nanoparticle dressing were used in groups A, B, and C as the primary dressing, and traditional vaseline gauze was used in group D as the control. Multi-spot evaporation from normal skin and naked wound, and from wounds covered with each of the four dressings was measured post-burn on days 1, 3, 5, and 7 by an EP-I evaporimeter under conditions of 21ºC –22ºC ambient temperature and 74%–78% humidity. Results The absorption rates of the four dressings were 988% with carbon fiber dressing, 96% with silver nanoparticle, 41% with vaseline gauze, and 6% with hydrogel. Evaporation from the naked burn wounds was about 1/3 higher than from normal skin (P<0.01). Compared with wounds without applied dressing, evaporation from dressed wounds decreased and was time-dependent (P<0.01). The evaporation of wounds with carbon fiber dressing was the lowest ((13.40 ± 2.82) ml∙h(-1)∙m(-2), P<0.01) on day 1 post-burn, compared with the other groups. Conclusion All four dressings have water retention capacity while carbon fiber dressing has the highest absorption rate and shows the best containment and evaporation from the burn wound.     

Postoperative surveillance, registration and classification of wound infection in cardiac surgery--experiences from Great Britain

Wound infection in cardiac surgery is a continuing problem despite improvements in surgical technique. The risk factors for, and appearance of, the infected wound differ from operations in other specialties. A robust definition is required for successful surveillance but many are open to different interpretations. At UCLH, comparison between UK and US definitions shows marked differences in patients defined as infected. Surveillance with feedback is effective if conducted over several years, but a high proportion of infected wounds are only identified during post-discharge follow-up. Deteriorating performance of an individual surgeon can be detected and interventions focused on improving faults identified during data collection. Often highlighting the problem is sufficient to reverse the trend, but the process of audit and control is becoming more important as accountability and performance is demanded by primary care providers and patients.     

Relationship between the distribution of myofibroblasts,and stellar and circular scar formation due to the contraction of square and circular wound healing

Square skin wounds can heal to form a stellar scar with four protrusions at the four angles, whereas circular wounds can heal to form an ellipsoid scar. It is not clear why these differences occur and the aim of the present study was to clarify this phenomenon. Two square or circular full-thickness skin wounds were made on the dorsum of mice, and covered with hydrocolloid dressing. They were observed from day 0 to 15 after wounding, and used to prepare paraffin sections stained with anti-alpha-smooth muscle actin antibody to detect myofibroblasts. The square wound was transiently enlarged by edema and skin tension on day 3, at which time the angles became round, and thus the square form became more circular. Thereafter, the wound contracted rapidly and the circular form was maintained until day 11. On day 11 distinct angles appeared where the scar formation had progressed further, and there were fewer myofibroblasts than in any other section. A stellar scar with protrusions from the four angles was formed on day 15, when myofibroblasts almost disappeared in the protrusions. This indicates that due to the earlier disappearance of myofibroblasts and earlier scarring in the angles of the square wound, the scar angle cannot be pulled into the center of the wound but residual myofibroblasts on the side can pull the side into the center due to myofibroblastic contraction and consequently a stellar scar is formed. Thus, the earlier disappearance of myofibroblasts in the angles is very important for the formation of stellar scars.     

Monitoring the occurrence of wound infections after cardiac surgery

The aim of this study was to demonstrate the use of a graphical method for real-time monitoring of the occurrence of surgical wound infection following cardiac surgery. This included developing and incorporating a risk scoring system so that variations in case-mix could be duly accounted for in the monitoring process. We analysed routinely collected data from a London teaching hospital. These data consisted of records for 2146 patients who had undergone cardiac surgery between April 2000 and March 2004 and whose surgical wounds were followed up as part of the local surveillance programme. The risk model was developed using logistic regression analysis with surgical wound infection diagnosed before hospital discharge as the outcome measure. Factors included in the model were the number of surgical wounds, patient age, operations that combined bypass surgery and valve replacement, renal disease and the number of days between hospital admission and surgery. The model was a good predictor of outcomes recorded within an independent data set (Chi-squared=3.81, P=0.58) and we incorporated it into a graphical tool for monitoring outcomes. The risk model and the associated graphical monitoring method could be valuable tools to assist with infection management. If used in real-time, problems with the care process can be quickly identified allowing timely remedial action to be taken.     

纯钛爪型肋骨接骨板对骨折内固定术后 并发症的影响分析

〔摘 要〕 目的：探讨肋骨接骨板对骨折内固定术后并发症的影响。 方法：选取 2018 年 2 月至 2020 年 2 月于英德市中医 院就诊的 165 例多发肋骨骨折患者,根据治疗方法不同分为两组,对照组 80 例采用传统局部加压包扎疗法,观察组 85 例 采用纯钛爪型肋骨接骨板内固定术治疗。比较两组住院时间、止痛药物使用剂量、引流管放置时间、疼痛评分、术后并发 症等情况。 结果：观察组患者住院时间、引流管放置时间短于对照组,止痛药物使用剂量少于对照组,视觉模拟评分法（VAS） 评分低于对照组,差异均具有统计学意义（P ＜ 0.05）;观察组患者骨折移位、胸廓畸形、迟发性血气胸、肺部感染、肺 不张等术后并发症总发生率低于对照组,差异具有统计学意义（P ＜ 0.05）。 结论：与传统的保守治疗相比,纯钛爪型肋 骨接骨板对骨折内固定术的效果更佳,并发症更少,患者住院时间更短,加速患者康复,减轻患者疼痛感,且手术安全有效, 具有操作微创、简便等优点。     

压疮的伤口评估及局部治疗的临床研究进展

主要从压疮的伤口评估和局部治疗方面提出许多新的概念、新的方法，并就压疮伤口评估及压疮湿性疗法、负压疗法等的临床应用进展进行介绍。     

止血绫修复内镜黏膜下剥离术后创面的应用研究*

目的探讨止血绫在内镜黏膜下剥离术(ESD)后预防创面出血及创面修复中的临床应用价值。方法采用活体兔对比研究手术切开兔胃后的出血量(ml),并以活体猪为研究对象行结肠ESD手术,实验组术后用止血绫进行覆盖,对照组创面则不予以处理,术后3天、1周、2周及4周分别进行内镜及病理学检查,比较两组的创面出血及组织愈合情况。结果兔胃出血量对比实验中,实验组出血量明显低于对照组,实验猪行结肠ESD术后创面均成功覆盖止血绫。行内镜检查及病理检查,实验组存在修复优势。实验组与对照组总共24处创面中,均未出现感染、穿孔等实验相关的不良事件。结论止血绫在临床ESD后创面修复中具有潜在的应用价值。     

门诊伤口管理中心开展分时段预约模式的实践与效果

目的探讨门诊伤口管理中心开展分时段预约模式的方法与效果。方法便利抽样法选择2016年10月来第二军医大学长海医院门诊伤口管理中心就诊的1719例患者为观察组,采用分时段预约模式换药;2015年10月就诊的2941例患者为对照组,按照"先来先换"的原则进行伤口换药,记录并比较两组患者的候诊时间、伤口管理中心工作人员每天上班时的空闲时间及加班时间、患者满意度。结果观察组患者的换药等候时间、工作人员上班时的空闲时间及加班时间均短于对照组患者(均P0.01),观察组患者满意度高于对照组患者(P0.01)。结论分时段预约模式换药的实施有利于缩短患者的等候时间,提高伤口管理中心工作效率,改善患者的就诊体验。     

脱细胞猪真皮基质敷料覆盖治疗小儿特重度烧伤深Ⅱ度创面的护理

目的总结脱细胞猪真皮基质覆盖治疗小儿特重度烧伤深Ⅱ度创面的护理重点。方法回顾性分析2015年4月至2016年4月广州市红十字会医院烧伤重区收治的9例特重度烧伤小儿应用脱细胞猪真皮基质敷料覆盖深Ⅱ度创面的临床资料和护理措施。结果 9例特重度烧伤患儿均平稳渡过休克期,于2~3周全部治愈。结论脱细胞猪真皮基质急诊覆盖治疗小儿特重度烧伤深Ⅱ度创面可以促进创面愈合,护理重点在于生命体征观察与输液护理、疼痛管理与心理护理及术后加强创面生物敷料观察与护理。及时发现、去除脱细胞猪真皮基质敷料下积液、积脓,维持敷料的干燥,防止脱细胞猪真皮基质敷料缩窄影响肢端血运。