目的 探讨负压封闭引流联合水动力清创治疗深度烧伤的临床效果.方法 选取自2015年2月至2018年2月张家港市第一人民医院收治的深度烧伤患者80 例为研究对象.通过随机抽签法将所有患者分为A、B两组,每组各40 例.A组采用常规手术器械清创结合负压封闭引流治疗;B组采用水动力清创结合负压封闭引流治疗.两组清创后均采用自体中厚皮移植进行移植修复.比较两组首次手术中每1%总体表面积( TBSA)创面清创时间、首次手术中每1% TBSA创面清创出血量、首次手术后7d创面分泌物细菌培养阳性率、首次手术后7d植皮成活率、需要二次清创手术百分比、创面完全愈合时间和住院时间、住院费用、手术前后创面组织炎症因子水平.结果 B组首次手术每1% TBSA创面清创时间、每1% TBSA创面清创出血量、首次手术后7 d创面分泌物细菌培养阳性率、二次清创手术百分比、创面完全愈合时间、住院时间、住院费用均低于A组,而植皮成活率显著高于A组,两组比较,差异均有统计学意义(P＜0.05). B组清创后即刻、7 d创面组织白细胞介素-6、肿瘤坏死因子-α水平低于A组,两组比较,差异均有统计学意义(P＜0.05).结论 负压封闭引流联合水动力清创治疗深度烧伤的效果明显,可有效缩短手术时间、减少出血,有效减轻创面炎症反应,减少创面感染率,同时有效提高植皮成活率,有利于促进患者早日康复.

BACKGROUND:Biological artificial skin made by fibroin, connective tissues, biopolymer materials, synthetic polymeric material, nano materials as wel as sensor and non-biological artificial skin both have achieved satisfactory effects in clinical trials, but there is stil a significant difference from the natural skin. OBJECTIVE:To investigate the treatment outcomes of epidermal stem cel s/porcine acel ular dermal tissue-engineered skin for ful-thickness skin defects in rats. METHODS:Twenty Sprague-Dawley rats were selected to make the skin defect model on the rat back, and then randomly divided into experimental and control groups, fol owed by subjected to the implantation of human epidermal stem cel s/porcine acel ular dermal tissue-engineered skin and porcine acel ular dermal matrix, respectively. Gross, histological and immunohistochemical observations were performed at 4 weeks after implantation.RESULTS AND CONCLUSION:Gross observation:the wound in the experimental group healed wel , and the skin had good elasticity;the control group showed scar formation in the implanted site and the texture was hard. Histological observation:there were good epidermal and dermal structures under microscope in both groups, and the basal layer, stratum corneum and stratum corneum of the epidermis could be distinguished clearly. Compared with the experimental group, more fibrous connective tissue could be found in the control group. Immunohistochemical observation:the wound surface in the experimental group was positive for the anti-HLA class I antigen, while the wound surface in the control group negative for the anti-HLA class I antigen. These findings suggest that the human epidermal stem cel s/porcine acel ular dermal tissue-engineered skin can effectively inhibit the scar formation and contracture in the repair of ful-thickness skin defects.

BACKGROUND As patients with thoracic duct injuries often suffer from severe local soft tissue defects, integrated surgical treatment is needed to achieve damage repair and wound closure. However, thoracic duct chylous fistula is rare in burn patients, although it typically involves severe soft tissue damage in the neck or chest. CASE REPORT A 32-year-old male patient fell after accidentally contacting an electric current (380 V) and knocked over a barrel of sulfuric acid. The sulfuric acid continuously poured onto his left neck and chest, causing combined electrical and sulfuric acid burn injuries to his anterior and posterior torso, and various parts of his limbs (25% of his total body surface area). During treatment, chylous fistula developed in the left clavicular region, which we diagnosed as thoracic duct chylous fistula. We used diet control, intravenous nutritional support, and continuous somatostatin to reduce the chylous fistula output, and hydrophilic silver ion-containing dressings for wound coverage. A boneless muscle flap was used to seal the left clavicular cavity, and, integrated, these led to resolution of the chylous fistula. CONCLUSIONS Patients with severe electric or chemical burns in the neck or chest may be complicated with thoracic duct injuries. Although conservative treatment can control chylous fistula, wound cavity filling using a muscle flap is an effective approach for wound healing.

目的:探讨丹参酮ⅡA磺酸钠注射液对烧伤患者植皮创面愈合及瘢痕形成情况的影响.方法:选取2014年3月至2014年12月我院收治的烧伤植皮患者62例,根据临床用药分为试验组(使用丹参酮ⅡA磺酸钠注射组)与对照组(未使用丹参酮ⅡA磺酸钠注射液).比较两组创面愈合情况,术后植皮成活率及愈合后瘢痕形成情况.结果:①经治疗,两组创面均愈合,试验组患者植皮成活率为(97.12± 1.89)％,高于对照组(89.96±1.86)％,差异具有统计学意义(P＜0.01);试验组愈合时间较对照组短,试验组创面愈合时间为10.1±:1.9天,对照组为14.3± 2.3天,两组比较差异具有统计学意义(P＜0.001);瘢痕形成评价试验组均优于对照组,差异具有统计学意义,其中血肿面积(1.50±0.03 vs.3.04± 0.08,P＜0.01)、畸形率[2(6.45) vs.8(25.81),P ＜0.05]、感染率[2(6.45)vs.9(29.03),P＜0.05].结论:丹参酮ⅡA磺酸钠注射液对于烧伤植皮创面的患者,能够提高植皮成活率,促进创面愈合,减轻瘢痕形成,改善创面愈合质量.

目的 观察软聚硅酮敷料联合藻酸钙敷料应用于烧伤后皮肤移植供皮区的疗效.方法 将80例烧伤患者随机分为试验组(n=39)和对照组(n=41).试验组供皮区内层覆盖藻酸钙敷料(德湿康敷料),外层覆盖软聚硅酮敷料(美皮康);对照组供皮区内层覆盖洗必泰油纱,外层覆盖多层无菌纱布.评价两组患者供皮区的创面愈合、疼痛改善及瘢痕形成情况.结果 术后第7、10、12天试验组创面愈合率[(51.31±7.09)％、(78.77±8.80)％、(96.44±3.24)％]均高于对照组[(45.85±5.54)]％、(73.63±7.73)％、(93.12±4.08)％],差异有统计学意义(P＜0.01).试验组创面愈合时间短于对照组[(10.95±1.41)d vs (11.93±1.44)d,P＜0.01].术后第1、3、7、10天试验组视觉模拟评分(VAS)为5.36±1.21、4.29±1.25、4.00±0.46、1.00±0.45,均低于对照组(7.34±1.34、5.89±1.39、4.50±0.74、1.35±0.52),差异有统计学意义(P＜0.01).创面愈合后第1、3、6、12个月试验组温哥华瘢痕评价(VSS)评分(3.82±1.47、6.00±1.61、3.77±2.28、2.59±1.39)均低于对照组(5.80±1.68、7.80±1.65、5.24±1.67、4.05±1.41),差异有统计学意义(P＜0.01).结论 软聚硅酮敷料与藻酸钙敷料联合应用可以显著提高供皮区创面愈合率、缩短创面愈合时间、缓解换药疼痛、改善愈合质量,有望成为有效的保护供皮区的临床治疗手段之一.

目的：观察应用局部皮瓣修复面部皮肤肿瘤软组织缺损的临床疗效。方法：通过对2013年5月至2014年5前来我院治疗面部皮肤肿瘤软组织缺损的50例患者病历进行分析和回顾，对患者进行手术治疗局部皮瓣修复面部缺损，采用合适患者面部缺损的皮瓣进行修补，并记录患者的临床表现。结果：术后患者皮瓣修补完全成活，边缘处和周围组织吻合良好，术后患者无感染及并发症。结论：局部皮瓣修复面部皮肤肿瘤软组织缺损疗效明显，得到广大患者的好评。

Objective To Summarize the characteristic of refractory bum and traumatic wounds in old people to find out the effective therapeutic method for this disorder. Methods 8 case of old burn and traumatic patients were retrospectively studied in our department for ten years from March 1995 to August 2006. we intend to analyze the relationship between the causes, the intercurrent disorders, the therapeutic methods and treatment results of refractory burn and traumatic wounds in old patients. Results In these patients, there are some of concomitant associated disorders, including diabetes, hypertension, rheumatoid arthritis and nephropathy, which could tamper with cicatrization of the wounds. 5 case were successfully treated by proceeding skin autograft, 2 cases were amputated, and 1 case was dead because he gave up any treatments we provided. Conclusions We consider that the preferred curative modality for refractory bum and traumatic wounds of old patients is surgery. The different preconditions against the relevant disorders, which include the supply of nutrient, effective antibiotic and active therapy for the incidental chronic diseases.

随着生活水平的提高,老年人群逐渐增加,由于老年人各器官系统功能衰退,抗病力差,发生烧伤并发症及死亡率较高,是烧伤治疗中最困难的问题之一.我院自1995至2005年收治60岁以上农村老年烧伤35例,现分析如下.

我们对我院近十年收住的吸入性损伤患者进行了详细的临床观察,认为地塞米松早期应用对吸入性损伤患者的转归是有利的.现报道如下:

目的:为解决手足背肉芽创面采用刃厚或中厚皮片移植修复后遗留瘢痕多、不耐磨,影响外观和功能的缺点.方法:采用全厚皮片移植修复手足背肉芽创面11例,术前作肉芽创面分泌物培养及药敏试验,敏感抗生素湿敷4 ～5天,术中将肉芽组织刮除,削除大部分纤维板,术后固定,早期进行关节活动范围训练、牵引治疗及超声波治疗.结果:11例皮片均成活.随访16个月～3年,3 例( 4处)皮片边缘瘢痕轻度增生,余平坦.手背功能恢复优7例,足背功能恢复优2例,良2例. 结论:全厚皮片移植修复手足背肉芽创面是切实可行的,并具有皮肤外观好,柔软性,耐磨性好,瘢痕少,功能影响小 ,避免再次手术整复等优点.

对以浅Ⅱ度烧伤为主的小儿烧伤创面68例应用辐照猪皮,观察了其对创面的影响、创面的抗感染能力及愈合时间.结果浅Ⅱ度创面愈合时间为8±2.1天;部分偏浅的深Ⅱ度为12±2.8天;其余深Ⅱ度的为20±2.4天.68例无一发生感染,均平稳渡过休克期.故认为以浅Ⅱ度为主的小儿烧伤创面应常规应用辐照猪皮.