Objective To observe the clinical effect of nanosilver/porcine acellular dermal matrix dressing on superficial second degree burn wounds. Methods From January 2014 to December 2015,90 patients with superficial second degree burn were treated and observed in the Department of Burns and Plastics Surgery, General Hospital of Beijing Military Region. According to the order of admission and random number table, the patients were randomly divided into 3 groups, nanosilver dressing group, porcine acellular dermal matrix dressing group and nanosilver/porcine acellular dermal matrix dressing group, each group of 30 patients. On the day of admission, the wounds areas were calculated by taking pictures and the wound secretion was taken for bacterial culture by using the throat swab, burn wounds were treated with debridement, then apply nanosilver dressing, porcine acellular dermal matrix dressing and nanosilver/porcine acellular dermal matrix dressing on the wounds. On the 5th day after treatment , the wound secretion was taken for bacterial culture by using the throat swab again. Pain score was assessed by asking and observing the changes of pain in patients after dressing change. On the 7th day after treatment, the wounds areas were calculated by taking pictures. The wound healing rate was calculated. Wound healing time was recorded. The data were compared by using one-way ANOVA test, SNK-q test and Chi-square test. Results On the 5th day after treatment, the wound bacterial culture results of nanosilver dressing group, porcine acellular dermal matrix dressing group and nanosilver/porcine acellular dermal matrix dressing group were 2(6.6%),9(30. 0%),1(3. 3%),there were significant differences among the three groups(χ2 =10. 962,P=0. 004). The wound bacterial culture result of the nanosilver/porcine acellular dermal matrix dressing group was better than the porcine acellular dermal matrix dressing group, there was significant difference between the two groups(χ2=7. 680,P=0. 006). The pain scores of nanosilver dressing group, porcine acellular dermal matrix dressing group and nanosilver/porcine acellular dermal matrix dressing group on the 5th day after treatment were [(8. 6±0. 5)points,(6. 6±0. 8)points,(0. 6±1. 3)points], the wound healing rates of the three groups on the 7th day after treatment were [(61. 67±18. 22)%,(86. 77 ±15.32)%,(99. 80±0. 56)%], the wound healing time of the three groups were [(11. 5±1. 3) days,(10.3±0.7)days,(7. 3±0. 7)days], there were significant differences among the three groups(F=201. 7,19. 9,55. 7,P values were all less than 0. 05). The pain score of the nanosilver/porcine acellular dermal matrix dressing group on the 5th day after treatment was lower than the other two groups( P values were all less than 0. 05), the wound healing rate of the nano-silver/porcine acellular dermal matrix dressing group on the 7th day after treatment was better than the other two groups(P values were all less than 0. 05), the wound healing time of the nanosilver/porcine acellular dermal matrix dressing group was shorter than the other two groups(P values were all less than 0. 05). Conclusion The nanosilver/porcine acellular dermal matrix dressing has the effects of anti-infection, promoting wound healing and reducing the pain when dressing changing.

Objective To retrospectively analyze the effects of management techniques including systemic and topical therapeutic treatments for patients with toxic epidermal necrolysis(TEN). Methods The comprehensive therapy based on systemic treatments such as anti-shock, anti-infection, anti-allergic drug and primary disease treatment. Topical treatments for skin lesions included applications of acellular dermal sheet, nano silver dressing, artiifcial cellular healing membrane, growth factor, suspension bed, wound therapeutic apparatus and semi-conductive laser. Results Among these 22 patients, 19 patients were cured and discharged, 1 patient died from pulmonary embolism and 2 patients died from septic shock. Conclusions Systemic measures play key roles in maintaining stability of internal environment, which may control the progression of skin lesions and decrease the incidence of infection. Topical measures also play key roles in TEN treatment, e.g. relieving wound deepening by application of suspension bed, decreasing the incidence of wound infection by nano silver dressing, accelerating wound healing and reducing the pain of patients by application of acellular dermal sheet, artiifcial cellular healing membrane, growth factor and semi-conductive laser, etc.

目的 探讨因脏器功能不全等原因,不能耐受全身麻醉、腰麻或创伤较大的手术的重症患者,以及患者及家属拒绝进行创伤较大手术的患者,用床旁局部麻醉微创嵌入微粒皮的植皮法加速难愈合创面愈合的方法.方法 本组患者褥疮3例,糖尿病足2例.均因心肺功能不全、肺部感染、脑梗死等原因长期卧床,不能耐受全身麻醉或连续硬膜外麻醉.在全身支持治疗、创面清创、换药、负压治疗的基础上,将长条形微粒皮嵌植到创面肉芽组织内,使之成为创面中的皮岛以加速愈合修复创面.结果 4例治愈出院,1例进行过3次微粒皮嵌入植皮后,微粒皮成活并在创面中形成多个皮岛,在皮岛向周围扩展、融合的过程中患者因心脏功能衰竭死亡；4例出院患者随访3个月～1年无复发.结论 床旁局部麻醉微创嵌入微粒皮的植皮法具有创伤小、简单易行等特点,只要全身情况稳定就可以有效地治疗危重患者难愈性创面.

Objective A convenient preparation method to combine nano-silver with acellular dermal matrix ( ADM ) is introduced and it can enhance the antibacterial properties of ADM. The antibacterial effects of this composite biological dressing are assesed comparing with the tradition simple dressing. Methods The minimal inhibitory concentration ( MIC) and minimum bactericidal concentration ( MBC) of nano-silver solution were detected by double dilution method and medium inoculation method respectively. The ADM was soaked into nano-silver solution of different concentrations for a certain time to get nano-silver/ADM. In Kirby-Baucer method,the antibacterial properties were assessed by comparing nano-silver/ADM that soaked in different concentrations of nano-silver. Results The MIC and MBC of nano-silver solution to Staphylococcus aureus were 8 mg/L and 64 mg/L respectively,while the MIC and MBC to Pseudomonas aeruginosa were 8 mg/L and 32 mg/L respectively. Nano-silver/ADM compound dressing was got. Nano-silver/ADM was superior to Aikexin in the antibacterial effects on either Staphylococcus aureus or Pseudomonas aeruginosa. Conclusions Nano-silver/ADM has both the biological activity of ADM and the excellent antibacterial effect of nano-silver. Nano-silver/ADM is a clinically useful antibacterial and biological composite dressing.

OBJECTIVE:To explore the application of damage control surgery (DCS) strategy in the treatment of severe burn-trauma combined injury.METHODS:From January 2004 to December 2009, 28 patients with severe burn-trauma combined injury received salvage treatment according to DCS, including 12 cases of burn combining injury at 2 sites, 6 cases of burn combining injury at 3 sites, and 10 cases of burn combining injury at 4 sites or above. There were 18 males and 10 females with a median age of 39.5 years (range, 8-56 years). The burn area was 15% to 56% of total body surface area. The injury severity score a (ISS) was 25 to 56, and the traumatic index was 17 to 24. Lethal triad syndrome occurred in all patients. Of them, 16 cases were on admission immediately after first-aid, and 12 cases were transferred from other hospitals. The time from injury to hospitalization was 20 minutes to 36 hours. All patients were treated by immediate fluid resuscitation and emergent operation to control hemorrhage and contaminations. Biological dressings were used to seal the wounds provisionally. The systemic therapy was carried out as soon as the vital signs of the patients became stable.RESULTS:In 26 survivors, 23 achieved wound healing by first intention, 3 had a little residual wound at discharge. The hospitalization days were 31 to 398 days (62 days on average). However, 1 patient died of multiple organ failure, another 1 patient died of severe cerebral trauma with refractory shock.CONCLUSION:The DCS strategy is effective in reducing mortality of patients with severe burn-trauma combined injury.

Objective To evaluate the impact of sepsis bundle treatment on morbidity of sepsis or septic shock in burned patients. Methods A retrospective clinical study was conducted on burned patients with severe sepsis or sepsis shock in burn intensive care unit. 95 patients were divided into control group(43 patients) and study group (52 patients)according to their treatment. The relationship between sepsis bundle index and sepsis, septic shock and 28-day mortality respectively were analyzed with logistic regression analysis. The compliance of sepsis bundles,and 28-day mortality were noted. Results The 28-day mortility rate,the mobidity of sepsis and septic shock in study group was lower than that of control group (P ＜ 0. 05). It could be found that 6-hour EGDT and 24-hour EGDT was the independent protective factor of sepsis and septic shock through logistic regression analysis ,and blood gas analysis, EGDT and vasoactive drug were correlated with 28-day mortality(P ＜0. 05). Compliance with sepsis bundles of 6-hour EGDT and 24-hour EGDT in study group was only 51.9%, and 63.2% respectively. Conclusion Sepsis bundle was able to improve survival rate in severe burn patients. Compliance with sepsis bundles in burn medical staff needed a buring improve.

烧伤患者治疗后生理和心理方面的社会回归问题日益受到关注[1],创伤愈合的目标也从解剖愈合逐渐过渡到重视外观恢复与组织功能重建的"完美愈合".烧伤早期治疗理念发生了重大变化[2].有学者早在20世纪70年代就大力倡导早期康复治疗[3].目前,将康复治疗的理念融入烧伤早期治疗,已成为提高烧伤救治质量的重要课题.我们设计此临床研究,以观察早期康复治疗在烧伤临床的应用效果以及对后期功能评价的影响.

Objective To study the immune opsonization of thymic peptide in severe burned patients.Methods The peripheral blood was drawn from 30 severe burned patients(15 of them were given 1.6mg thymic peptide every other day) on days 3,7,14,28 after injury.TNF-α and IFN-γ were measured by means of ELISA.The expressed HLA-DR of monocyte was measured by means of flow cytometry.Results The IFN-γ of the patients who were given thymic peptide increased,which was not found in control group.The TNF-α of the two groups had no significant difference.The HLA-DR in thymic peptide group was higher than that in control group.Conclusion Thymic peptide can largely improve the immune function of severe patients.

患者女,20岁,7个月时右睑部出现米粒般大小肿物,随年龄增长肿瘤进行性增大并逐渐影响进食,患者出现头痛、头胀、右眼视力丧失,右耳听力下降及肿物破溃等症状,于2007年12月3日入院.

目的 对传统交腿皮瓣移植术加以改进,并探讨其临床应用.方法 30例交腿皮瓣移植术采用供区皮瓣轴型化,供区皮瓣预扩张,同侧大腿皮瓣向小腿移植,受区血管植入皮瓣以及用外固定架制动等方法 .结果 全部皮瓣成活良好.避免了传统方法 交腿皮瓣血运不良,覆盖而积小,蒂短,旋转弧度小,位置不易和创而楔合,需重叠交腿,制动小适,供区植皮粘连等缺点.结论 改进的交腿皮瓣移植术安全可靠,简单易行,优点明显.

Objective To investigate the clinical efficacy of enternal nutrition of high-energy density nutrition emulsion in severely burned patients.Methods Forty patients who were burned 31%-70%of the total body surface area(TBSA,Ⅲdegree burned area11%TBSA) were randomly divided into study group and control group(n=20 in each group).From the day after burned,all the two groups were fed with enternal nutrition by a nasal feeding tube. The study group was fed with high-energy density nutrition emulsion and common diets,while the control group was supported with common diets.Hemoglobin,serum albumin,total lymphocyte count,complications,and nitrogen balance were determined at baseline and 1,3,7,10,14,and 21 days after enternal nutrition support.Results The serum albumin levels were significantly higher in study group than those in control group on day 14 and day 21(P0.05).Total lymphocyte count and hemoglobin showed no significantly different changes(P0.05).The nitrogen balance in study group were significantly higher than that in control group 10 days after nutritional support(P0.05),and the incidences of complications such as distension,diarrhea,nausea,and vomiting were lower in study group than those in control group.Conclusion High-energy density nutrition emulsion can improve the nitrogen balance in severely burned patients and reduce the incidences of intestinal complications in enternal nutrition.

目的:评价短期应用重组人生长激素(rhGH)对小儿烧烫伤的治疗效果及治疗后对其生长发育的影响.方法:选取82例住院烧烫伤患儿,随机分为rhGH治疗组58例和对照组24例.rhGH治疗组在常规治疗的基础上给予rhGH皮下注射0.3 IU/kg,每晚1次,连续使用10 d.对照组只给予常规治疗,于相应时间皮下注射2 ml生理盐水.另选30例发育正常的整形患儿作为正常对照.动态观察应用rhGH(或生理盐水)前1 d、应用后5 d后,出院时及出院后6、12、18、24个月两组患儿血生长激素、血糖水平;患儿于入院时测量身高、体重,计算体质指数(BMI),出院后6～24个月进行追踪性观察,与同时期同年龄段北京市正常小儿生长指标进行对比,评价影响.结果:rhGH治疗组创面愈合速度较对照组明显加快;创面愈合后瘢痕增生及痛痒程度明显轻于对照组,差异有显著性(P<0.05).rhGH治疗前两组血生长激素水平均明显低于正常水平.rhGH治疗第5天患儿的生长激素水平明显高于正常组水平和对照组(P<0.001),至出院时两组均趋于正常.伤后两组血糖水平均有轻度升高,激素治疗第5天恢复正常,但差异无显著性,两组之间各时间比较差异均无显著性.两组出院时体重和BMI均低于北京市儿童正常标准,但两组间身高、体重和BMI差异均无显著性.结论:临床短期小剂量使用生长激素治疗小儿烧烫伤能够加速创面愈合,提高创面愈合质量.创面愈合后小剂量短期应用的生长激素不会对小儿的生长发育造成后续影响.

OBJECTIVE:To study the clinical characteristics and the treatment of periorbital injuries.METHODS:61 cases were treated, including 30 cases orbitozygomatic fracture, 6 cases of frontal-orbital fracture, 8 cases of naso-ethmoid-orbital fracture, 7 cases of blow -out fracture and 10 cases of complicated fracture. The patients were diagnosed after physical examination and other examination, like CT. Through bicoronal or local mini incision at the end of eyebrow, combined with subciliary incision and local wound approach, the fractured sites were exposed completely. Then the fractured fragments were repositioned and fixed rigidly. The orbital wall was reconstructed with titanium net and Medpor.RESULTS:The wounds healed primarily. Good cosmetic and functional results achieved in most of the patients. 4 cases underwent second-stage ophthalmectomy. 2 patients had diplopia after operation, but improved gradually. 3 cases of blepharoptosis needed further treatment.CONCLUSIONS:Early diagnosis and treatment is very important for periorbital injuries. Fracture reposition and orbital wall reconstruction should he performed at early period.

>严重全颜面骨折涉及面颅骨多个部位,不仅危及患者的生命,而且对颅面功能和外观常产生巨大影响。自2004年2月至2007年2月,我科共收治40例此

Objective To explore the clinical significance of using large muscular flaps taken from major extremities preparing to be amputated to treat life-threatening refractory wounds. Methods Keeping the soft tissue of the extremities, following amputation of proximal humerus, proximal femur, shoulder or hip to obtain large muscular flaps with good blood supply to repair life-threatening refractory wounds of seven patients caused by radiotherapy, resection of malignant tumor or electrical burn. Results All flaps survived completely with good blood circulation. The dimension of the flaps was large enough to reconstruct these wounds. Patients reported good pain relief, health and life improvement. Four patients fully recovered while the other three died of the metastasis of the cancer or complications. Conclusions Sometimes, amputation, obtaining and application of the muscular flap is an effective method to repair the large refractory wounds.

Objective To explore the repair of the open compound wounds in lower extremities caused by multiple factors. Methotis Transplantation of cutaneous.musculo-cutaneous or greater omentum flaps were applied to 155 patients of open compound lower extremity wounds. Results The wound healing rate following first operation was 50% and that following two operations was 14.8%.While the wounds were healed in 7.7% of patients after three operations. Conclusion Transplantations of cutaneous,musculo-cutaneous or greater omentum flaps ale effective to repair and reconstruct the open compound lower extremity wounds.

Objective To investigate the choices and the clinical efficacy of different flaps on the repair of deep Ⅲ burn wounds in the facio-cervical region. Methods From January 1998 to December 2007,32 cases of the deep Ⅲ burn wounds in the faces region were repaired with 4 kinds of flaps,including 2 free flaps, 16 pedicle flaps, 18 local flaps, 2 tube flaps.Results Except five cases of the distal small area necrosis healed after treatment, the other 33 flaps all survived.After 5 months to 3 years,the flaps showed texture flexibility,scalability,light contracture of organizations, small changes in skin color,and satisfactory shapes.Conclusions The flaps with sufficient blood circulation and a completely subcutaneous adipose tissue after transplantation not only can be used to repair skin defects and significantly improve the local tissue blood circulation area to prevent infection,but also it is the greatest possibility of the repair of facial appearance and function. In accordance with wound size and surrounding tissues conditions, local flaps or pedicle flaps should be prefered in operation, otherwise free flaps or tube flaps be chosen.

OBJECTIVE:To investigate the therapeutic effect of infected incision wounds after sternotomy by using different reconstructive methods.METHODS:From December 1997 to December 2006, 13 patients (8 males, 5 females; age, 28-72 years averaged 52 years) with infected incision wounds after sternotomy underwent the reconstruction surgery respectively using the pectoralis major muscle flaps, the medial flaps of the pectoralis major muscle, the rectus abdominis muscle flaps or the greater omentum transpositions. Among the patients, 8 were complicated by diabetes mellitus, 4 by pneumonia and heart failure, 3 by empyema, 4 by chronic insufficiency of the pulmonary function, 1 by malignant tumor, and 6 by severe obesity. Freshly-split wounds were found in 11 patients and chronic wounds in the other 2 patients. The size of the wounds was 10 cm X 5 cm-22 cm X 10 cm.RESULTS:Among the 13 patients, 10 survived after operation and the other 3 died of massive hemorrhage from the anastomostic rupture of the blood vessel, pneumonia, and cancer metastasis, respectively. Of the 10 patients, 6 had their wounds healed by first intention. The follow-up for 6 months to 5 years revealed that there was no recurrence in all the survived patients. Of the 10 patients, 2 developed partial necrosis of the skins at the sutured wounds, which was healed after the skin grafting operation; 2 had an infection at the drainage area but had a healing after the dressing changes.CONCLUSION:The smaller wounds in the upper part of the sternotomy incision should be repaired with the medial flaps of the pectoralis major muscle; the greater wounds in the upper part of the incision should be repaired and reconstructed with the rectus abdominis muscle flap; the smaller wounds in the lower part of the incision should be repaired with the pectoralis major muscle flap, and if the wounds are longer, they should be repaired and reconstructed with the pectoralis major muscle flap and the rectus abdominis muscle flap; and if the wounds are huge enough with an exposure of the important internal organs, the greater omentum transposition should be used, and the residual wounds should be treated with dressing changes and even skin grafting.

OBJECTIVE To look for a better approach to burned infants complicated with rotavirus diarrhea. METHODS Twelve cases of burned infants with diarrhea happened within autumn or winter in the recent 4 years were analyzed. RESULTS All of them with watery diarrhea were also accompanied with fever,vomiting,nausea,and distention.Six of them (50%) had a contact history with infants with diarrhea.From 12 cases the diarrhea of 3 cases happened before admission,1 case in 1-5 days after admission,2 cases in 5-10 days after admission,2 cases in 10-20 days after admission,and 4 cases happened more than 20 days after admission.six cases showed acute respiratory symptom at first,then after 2-4 days the diarrhea came,experienced a total 3-10 day duration.All of them were treated well with comprehensive approach including antibiotics,antidiarrheal,oral rehydration or intravenous fluids,protection of burned area from contamination and so on. CONCLUSIONS During autumn or winter,rotavirus enteritis be highly on alert,the burned infants are accompanied with a watery diarrhea and no red or white blood cells being found in the stool analysis.Isolation of the patients,and sterilized operation are most important to prevent infection spreading.Antidiarrheal,supplement of the lost liquid,protection of the burned area from contamination are the key points to guarantee a successful treatment.

Objective To investigate the influence of topical use of coagulation drug on the regional bleeding and its roles in the liposuction patients. Methods The concentration of red blood cell and white blood cell and hemoglobin in the liposuction infiltrating fluid was evaluated both in the topical use of coagulation drug patient group and no topical use of coagulation drug patient group,by which the regional bleeding condition was determined. Results The concentration of red blood cell and white blood cell and hemoglobin in the liposuction infiltrating fluid in the topical use of coagulation drug patient group was much lower than that of no topical use of coagulation drug patient group (P0.01). Conclusion Topical use of coagulation drug in the liposuction patients can obviously reduce the regional bleeding.