Focal injection of vancomycin combined with surgical debridement–dermatoplasty in the treatment of pseudo-epitheliomatous granuloma

Background

Pseudo-epitheliomatous granuloma (PEG) can occur in some small skin wounds with secondary infections resulting from improper treatments. It is difficult to heal and can easily relapse.

Objectives

This study explores the clinical and pathological characteristics of PEG and effective treatments.

Patients and methods

Tissue specimens of PEG obtained from 11 patients (age range: 2–67 years) were sent for microbial examination and histological observation. The local lesions were treated by focal injection of vancomycin combined with surgical debridement–dermatoplasty.

Results

The diagnosis of PEG was based on histological examination, which revealed long epithelial peduncle encapsulated granulation tissue-like honeycomb in which more vessels, macrophages, lymphocytes and mast cells and less extracellular matrix were distributed. Bacteria such as Staphylococcus aureus, Bacillus pyocyaneus, ethylene-type Streptococcus, stool Streptococcus and F-citric acid Bacillus were found in the microbial culture of the specimens. They were tolerant to celbenin but sensitive to vancomycin. PEG could be cured by focal application of vancomycin combined with free skin or skin flap after thorough debridement. The relapse of PEG could be prevented by the therapy.

Conclusion

Focal injection of vancomycin combined with surgical debridement–dermatoplasty is an effective therapy for PEG.     

手背深Ⅱ度烧伤削痂后延期植皮术的疗效观察

目的:评价削痂后延期植皮术治疗手背深Ⅱ度烧伤后溶痂或合并感染创面的疗效。方法:61例患者,随机分组为试验组29例,对照组32例。试验组入院后即行手背削痂术,术后24～48h内行中厚皮移植术;对照组入院后保守治疗,待创面新鲜肉芽组织形成,行中厚皮移植术。结果:试验组及对照组治疗后,植皮术后20d植皮成活率达优者分别为69.0%和34.4%,术后1年掌指关节功能恢复达优者分别为72.4%和40.6%,术后2年手背皮肤质地恢复程度达优者分别为86.2%和31.2%。两组比较差异均有显著性(P<0.05)。结论:运用削痂后延期植皮术治疗手背深Ⅱ度烧伤后溶痂或合并感染创面疗效显著,明显优于肉芽创面形成后行中厚皮移植术。     

游离植皮联合负压引流技术治疗皮肤缺损的临床观察

目的:观察游离植皮结合持续负压吸引治疗皮肤缺损的临床疗效。方法:对符合植皮条件的65例皮肤缺损患者随机分组:VSD组(35例)植皮后采用VSD进行创面加压,打包组(30例)植皮后采用传统打包加压,术后10d拆除VSD及加压包,观察植皮成活率及创面愈合优良率。结果:VSD组植皮创面愈合优良率(88.6%)明显高于传统打包组(70.0%),差异具有明显统计学意义(P<0.01);创面愈合平均时间VSD组(11.86±0.91)d,打包组(12.57±0.90)d,差异具有明显统计学意义(P<0.05)。结论:VSD可促进游离植皮成活及创面恢复,疗效优于传统打包植皮。     

Primary cutaneous anaplastic large‐cell lymphoma: a case report

Primary cutaneous anaplastic large‐cell lymphoma (PCALCL) is a part of the spectrum of CD30+ lymphoproliferative cutaneous processes. The characteristics include single or multifocal nodules that ulcerate as skin lesion, slow disease progression, autoregressive, and recurrent in few years. The present study report the case of a 16‐year‐old boy presenting PCALCL with single nodules, ulcer, keloid, and scab in his right‐side face. He showed a good response to the treatment with systemic chemotherapy and dermatoplasty, and regained confidence after the appearance of recovery. There is no relapse of the primary lesion and organs involved till now. The chemotherapy combining with surgical excision and dermatoplasty is a good method for PCALCL, per the lesion biopsy and positron emission tomography‐computed tomography before and after treatment.     

烧伤湿润疗法的辩证思维

目前我国所实行的烧伤外科技术是上个世纪50年代初从西方国家引进的,几十年来其治疗主体技术并没有实质性变化,技术核心是让烧伤创面干燥,深度烧伤创面实行切削痂与植皮手术治疗.实践证明,用外科技术治疗烧伤具有很大的局限性,它并不能有效地挽救所有重度烧伤患者的生命,也不能免除烧伤创面愈合后留有瘢痕的痛苦.上世纪末,中国学者徐荣祥教授根据祖国医学"理"、"法"、"方"、"药"理论,创立了烧伤湿性医疗技术:"基本禁止切削痂手术,限制使用抗生素,保持创面生理性湿润,暴露创面和无需植皮".该方法简便易行,治疗效果也令人满意,克服了烧伤外科技术的某些弊端.由于新技术的主体部分是让创面始终保持湿润状态,冲撞了烧伤外科认为潮湿必定发生细菌感染的理念,从而引发了一场不大不小的争议.为了澄清事实,根据自己过去的研究结果,参照有关文献,从湿性疗法与传统疗法的分歧焦点,重新认识烧伤发病、辩证思维中湿的概念等几个方面进行了讨论.     

Sensory reinnervation of free flaps in reconstruction of the breast and the upper and lower extremities

There is long-standing debate about sensate versus non-sensate free microvascular flaps among microsurgeons. The principle of connecting not only the vascular supply, but also sensitive nerves, in free tissue transfer is attractive. However, increased operating time and partial spontaneous innervation led to the common decision to restrict microsurgical tissue transfer to the vascular anastomosis and to leave the nerves "untreated". Nevertheless, in special cases such as breast reconstruction or extremity reconstruction, the question about sensory nerve coaptation of the flaps remains open. We present our experience with free microvascular tissue transfer for breast and extremity reconstruction and compare the data with previous literature and conclude that most free flap surgeries do not benefit from nerve coaptation.     

削痂植皮术联合负压封闭引流技术在深度烧伤创面修复中的应用

目的观察削痂植皮术后联合应用负压封闭引流技术（vacuum sealing drainage,VSD）对深度烧伤创面的治疗效果。方法对四川省人民医院烧伤科2008-08/2010-08收治的54例深度烧伤病例（随机分成2组,其中28例（实验组）采用削痂植皮术后联合VSD技术封闭创面,26例（对照组）采用削痂植皮术后普通敷料加压包扎封闭创面,对两组术后的平均换药次数、创面平均愈合时间、植皮成活率情况、平均住院时间进行统计学分析,对此两种方法进行评价。结果实验组与对照组比较,在平均换药次数、创面平均愈合时间、植皮成活率、平均住院时间的对比,差异有统计学意义（P〈0.05）。结论深度烧伤创面采用削痂植皮术联合负压封闭引流技术与传统削痂植皮后加压包扎相比,减少了平均换药次数,缩短创面平均愈合时间及平均住院时间,提高了植皮成活率,取得显著疗效。该手术方法操作简单,术后护理方便,是一种较理想的植皮后的固定方法,有利于创面的愈合,值得临床推广应用。     

硬脑膜植皮术

1984年5月至10月,我们对三例头皮、颅骨缺损的病人施行了硬脑膜植皮术,取得良好效果。例1,女,52岁,住院号233350。因右侧颞部生疮溃烂、时好时坏43年,于1984年5月7日住院。检查:右颞部头皮溃烂3×4cm~2,肉芽苍白,有脓性渗液。周围皮肤萎缩呈瘢痕状。右眼外眥被牵拉上翻畸形。头颅拍片:右颞骨片状骨质破坏。创面脓液培养副大肠杆菌和葡萄球菌生长。诊断:右颞头皮溃疡并发右颞骨骨髓炎(慢性),于1984年5月24日手术,局部麻醉,环形切除右颞部头皮,颅骨6×6 cm~2(包括溃疡及其瘢痕)。硬脑膜外有大量炎性肉芽组织,将其全部刮除、创面用0.25％氯霉素溶液、双     

睑缘重建治疗复发性上睑乱睫的效果

目的探讨睑缘切开加植皮治疗复发性上睑乱睫的临床疗效。方法对25例（35眼）复发性上睑乱睫以双重睑方法皮肤切开提取皮肤条，睑缘沿灰线切开植入皮肤条，术后随访6～36个月，观察上睑形态及睫毛情况。结果25例（35眼）中无倒睫复发，3例（3眼）植入皮片稍隆起，但未触及眼球。结论睑缘沿灰线切开加植皮治疗复发性上睑乱睫操作简单，复发率低。     

游离植皮结合负压封闭引流技术治疗难治性褥疮创面

目的：探讨难治性褥疮创面植皮后使用负压封闭引流（vacuum sealing drainage,VSD）技术的临床效果。方法：对16例难治性褥疮患者有效清创,待缺损区创面新鲜时,取刃厚皮片或薄中厚皮片,大块邮票状植皮后,VSD敷料结合半透膜覆盖。结果：16例患者植皮完全成活,2例患者去除VSD敷料后,边缘少许坏死,积极换药后成活,皮片功能均恢复正常。结论：该手术方法操作简单,术后护理方便,是对部分褥疮患者一种较理想的植皮方法。