1 病例与方法 1.1 病例 收集 2019 年 1 月—2021 年 1 月我院收治的开胸术后切口感染患者 106 例的创面分泌物细菌培养资料.106例中男74例,女32例;年龄8个月～81岁,平均(57.4±15.3)岁.患者入院后即提取创面分泌物标本,共收集120份标本,进行细菌培养和药敏实验.

化脓性角膜溃疡多为角膜外伤后致病菌感染所致,其病程发展迅速,感染不易控制,若治疗不及时或处理不当,角膜可在数小时或1～2 d内全部破坏甚至穿孔.北京丰台右安门医院烧伤整形科自2002年10月-2018年10月共收治6例(6只眼)烧伤后并发化脓性角膜溃疡患者,经积极治疗取得了良好效果,报告如下.

目的:探讨应用外踝上皮瓣修复足、踝部皮肤软组织缺损的临床效果.方法:2012年1月-2018年1月北京朝阳中西医结合急诊抢救中心收治的17例足部及踝部软组织缺损患者,均采用外踝上皮瓣转移修复,封闭创面.结果:14例外踝上皮瓣均存活良好,供瓣区愈合良好.2例皮瓣远端愈合稍差,经换药后创面愈合.1例术后1d出现皮瓣下淤血,再次手术清除血肿后愈合良好.17例患者术后随访3个月～2年,皮瓣颜色好,质地柔软无瘢痕.结论:外踝上皮瓣修复足、踝部深度创面,血管位置恒定,操作简单,是一种值得临床推广应用的手术方法.

Objective: To investigate the efficacy of comprehensive therapy for senile patients withⅢ-Ⅳ stage bedsore. Methods: Comprehensive therapy was carried out and its clinical effects were observed for 63 senile patients withⅢ-Ⅳ stage bedsore from May 2013 to May 2016, including nutrition support, minimally invasive dressing, individualized nursing and repairing surgeries.Results: Complete wound healing were achieved in 22 patients, and the wound surface was reduced by more than 70% in 39 patients which making the nursing difficulty decreased obviously. Two cases died of pneumonia complicated with heart failure.Conclusions: The comprehensive therapy including nutrition support, minimally invasive dressing, individualized nursing and repairing surgeries is a better choice for senile patients withⅢ-Ⅳ stage bedsore.

Objective To explore the surgical treatment of incisional wound infection combined with costochondritis after thoracotomy. Methods There were a total of 166 bedridden inpatients with incisional wound infection after thoracotomy between January 2011 to January 2014,and 35 of them were combined with costochondritis,26 males and 9 females,and the average age was 58.9±15.0 (35-79).Bacterial culture from wound secretion and drug susceptibility were performed,then the wound was debrided and applied with vacuum sealing drainage(VSD)before operation.In the operation,the wound was debrided thoroughtly,and the costicartilage and wire-steel involved were cut off,then bilateral musculocutaneous flaps were transferred to repair the wound.A wound drainage tube was placed under the flaps.After the operation,sensitive antibiotics were administered. Results Drainage tube was discontinued on the third to fifteenth day after operation.27 patients'surgical wounds were healed in 10- 15 days after surgery with good effects.1 patient formed sinus under the musculocutaneous flap and was healed after woud changing.4 patients needed a second operation, one of these relapsed after discharge 6 months and received the surgical debeidement and were healed in 3 weeks.3 patients received the third debeidement operation and the wound were healed. 35 patients had been followed-up for 6 months to 2 years, all the wounds were healed well. Conclusion Using debeidement and applied with vacuum sealing drainage(VSD)before operation,debeidement thoroughtly and cut off the involved costicartilage and wire-steel,then bilateral musculocutaneous flaps were transferred to repair the wound in the operation,then using sensitive antibiotics should afterthe operation,these comprehensive treatment is an ideal method for repair the incisional wound infection combined with costochondritis after thoracotomy and had gained good clincal effect.

目的:探讨藻酸盐银离子敷料辅助治疗深度皮肤软组织缺损创面的临床效果.方法:选择2012年1月-2014年1月我院收治的深度皮肤软组织缺损患者82例,平均年龄(41.77±17.56)岁,随机分为观察组和对照组.创面清创后观察组[创面面积(14.48±5.32)％TBSA]外用藻酸盐银离子敷料换药治疗,对照组[创面面积(13.17±6.48)％TBSA]外用涂有银锌霜皮肤黏膜抗菌剂的纱布治疗.观察两组患者的肉芽生长时间、换药次数、植皮成活率、创面愈合时间、住院时间及治疗前和植皮手术前的创面组织细菌培养阳性率.结果:与对照组比较,观察组患者换药次数减少[(5.75±1.61)次比(9.10±1.56)次],肉芽生长时间[(13.28±1.84)d比(18.98±2.60)d]、创面愈合时间[(26.83±2.17)d比(33.14±10.56)d]及住院时间[(29.35±2.69)d比(35.41±3.03)d]均缩短,植皮成活率提高[(93.78±4.22)％比(90.24±5.63)％],细菌培养阳性率下降(15.0％比40.5％),差异均有统计学意义(P＜0.05).结论:采用藻酸盐银离子敷料治疗深度皮肤软组织缺损创面促进肉芽组织生长,有效控制创面感染,提高了植皮成活率,有利于创面愈合.

Objective To investigate the auxiliary efficacy of Vacuum Sealing Drainage(VSD)in scar ulcer repairing surgeries. Methods 32 patients with the auxiliary efficacy of VSD in the scar ulcer repairing surgeries admitted to our hospital during the period between March 2009 and October 2014 were retrospectively analyzed. Results 32 patients were completely cured with satisfactory function and appearance,in which 3 cases of skin-grafting in first period fitted by VSD and 29 cases of skin-grafting or skin flaps in second period after VSD applied in first debridement epluchage. Conclusion The VSD affiliated surgery is a better choice in repairing the scar ulcer.

目的：探讨磨削术治疗儿童Ⅱ度烧伤创面的临床效果。方法2012年9月至2013年9月北京丰台右安门医院收治的68例开水烫伤儿童烧伤患者，烧伤创面以深浅Ⅱ度为主，完全随机法分为皮肤磨削组（36例）和保守换药组（32例）。皮肤磨削组患儿伤后48 h 内，全身麻醉下行手术治疗，以钢丝球打磨创面坏死组织，直至创面出现弥漫性小出血点，银离子烫伤抗菌敷料覆盖于创面，纱布、棉垫加压包扎，5~7 d 去除外敷料，保留内层银离子烫伤抗菌敷料，给予外喷重组人表皮细胞生长因子；保守换药组采用传统换药方法：外涂复春散1号，抗菌敷料覆盖、重组人表皮细胞生长因子凝胶与抗菌剂隔天换药治疗。比较两组患儿住院期间发热次数、换药次数、创面愈合时间、创面疼痛情况、医疗费用、后期随访效果等方面资料。结果68例患儿均治愈，住院期间，皮肤磨削组患儿换药次数、发热次数、愈合时间、儿童疼痛行为量表（FLACC）评分均低于保守换药组患儿，两组比较差异均有统计学意义（t =-8.087、3.389、-3.971、-4.697，P 均<0.05），皮肤磨削组医疗费用高于保守换药组，两组比较差异有统计学意义（t =10.205，P <0.05）。创面感染率、植皮百分率两组比较，差异均无统计学意义（P >0.05）。后期随访3个月，皮肤磨削组患儿术后大部分创面无明显增生，基本恢复正常，保守换药组愈合时间稍长，瘢痕增生较多。结论磨削术虽存在手术风险与费用高问题，但临床上治疗儿童Ⅱ度烧伤创面是一种有效可行的方法。

目的 探讨隐动脉皮瓣在膝部严重损伤修复中的临床应用.方法 对12例膝部严重损伤患者,采用顺行或逆行隐动脉皮瓣或联合其他皮瓣修复创面.结果 12例病例皮瓣均成活良好,外观满意,其中9例患者功能恢复满意,3例患者伴有股骨、髌骨或胫腓骨骨折,功能恢复基本满意.结论 皮瓣血供丰富、可靠,可切取面积大,与受区质地、色泽相近;可根据实际情况选择顺行、逆行或联合其他皮瓣转移,修复膝部重度损伤效果好.

Objective:To observe the clinical effect of low molecular weight heparin (LMWH)on preventing deep vein thrombosis (DVT)in bedridden patients undergoing skin-grafting. Methods:Eighty-six patients with burn inj ury of both lower limbs or skin donor site on the thigh were randomly divided into two groups. The patients in the control group were given conventional therapy to prevent DVT,such as encouragement of constant contraction of muscles and active move-ment of toes. In the treatment group,5 000 IU LMWH was subcutaneously injected every evening from the fourth day after skin-graft in addition to above muscular contraction for 1 0 days. Automated latex immunoassay was used to assess plasma D-Dimmer 1 ,3 ,7 ,1 4 days postoperation. At the same time,the amount of platelets was monitored in the treat-ment group,and the healing time,and the survival rate of skin graft were compared between the two groups. Color Doppler echocardiography was used to detect DVT pre-operatively and 1 4 days postoperative. Results:Levels of D-Dim-mer increased on day 1 postoperation,and then it declined on day 3 in both groups. It remained normal on day 7 and 1 4 in the treatment group,but it increased in the control group,the difference between the two groups was statistically sig-nificant (P<0.05). No DVT was found in the lower limb of the treatment group with color Doppler echocardiography, but microthrombus in deep vein of lower limb was found in 1 patient in the control group. Healing time and the survival rate of skin grafts were similar between two groups (P>0.05),and no untoward effects of LMWH on platelets were ob-served. Conclusions:Subcutaneous inj ection of LMWH in patients undergoing skin grafting may have some clinical value in prevention and survellance of development of DVT after donation of skin grafts.

目的:探讨逆行缝匠肌肌皮瓣或肌瓣修复小腿和膝周软组织缺损的临床效果.方法:对2006年1月～2014年1月我院收治的9例小腿和膝周软组织缺损患者均采用逆行缝匠肌肌皮瓣或肌瓣转移修复,7例采用肌皮瓣,2例采用肌瓣,封闭创面.供瓣区直接缝合.结果:9例患者缝匠肌肌皮瓣或肌瓣均存活良好,供瓣区愈合良好.1例肌瓣上植皮一期成活.1例患者肌瓣上植皮愈合稍差,经换药后创面愈合;1例患者肌皮瓣远端颜色发暗,经换药后创面愈合.9例患者术后均随访3个月～2年,皮瓣色泽良好,质地柔软,无骨髓炎及窦道形成.结论:采用逆行缝匠肌肌皮瓣或肌瓣是修复小腿和膝周软组织缺损的一种有效方法,临床疗效良好.

牛心包补片作为心血管修补、重建的生物补片，一旦被感染累及，易成为细菌载体，造成组织深部感染。2008年12月-2012年10月，我院对10例心脏手术后胸骨切口感染累及心外周牛心包补片的患者，在全身综合治疗基础上，采用清创联合双侧胸大肌移位对接加充分引流的手术方法治疗，取得良好效果，报告如下。

Objective:To evaluate the effect of Fuchun powder No.1 (复春散 1 号)on the treatment of deep burn injury of head and face. Methods:Eighty patients with head and face burn (deep Ⅱ degree to full thickness injury)admitted from January 2009 to January 2014 were randomly divided into Fuchun powder group and control group(n=4 0 ). All the patients in both groups received debridement of the wounds,and then the patients in Fu-chun powder group were treated with Fuchun powder No.1 (1 0 g powder in 5 0 ml solvent),while patients in the control group were treated with cerium sulfadiazine cream(1 0 g powder in 5 0 ml vehicle)applied topically. The changes in local condition,positive rate of bacterial culture of the wound before and 1 0 days after treatment,and the healing time of the wounds were observed.Results:The time of subsidence of swelling was 2 days [average (4.2 ± 1.2 )days]in Fuchun powder group,and (5.9 ± 1.4 )days in the control group. The positive rate of bacteria of the wound before treatment was 5 5.0% (2 2 patients)in Fuchun powder group and 5 0.0%(2 0 pa-tients)in the control group(P>0.0 5 ),but they were 1 2.5%(5 patients)and 4 2.5%(1 7 patients)respectively on 1 0 days after treatment (P<0.0 5 ). The average healing time was (1 7.2 ± 2.1 )days in Fuchun powder group and (20.4±2.4)days in the control group in patients with deep Ⅱ degree injury(P<0.05).The healing time was(28.4±2.5)days in the Fuchun powder group and(35.2±2.8)days in the control group in patients with full-thickness degree thermal injury(P<0.05). Conclusions:Fuchun powder No.1 is a kind of drug for top-ical use in treating deep burn of head and face.

人体头面部皮肤软组织量有限，较大的缺损无法通过局部皮瓣转移修复。我科2004年1月-2014年1月共收治8例头面部颅骨外露创面的患者，采用单侧或双侧颞浅筋膜瓣转移修复，取得了良好的效果。报告如下。

大部分烧伤患者创面愈合后面临着瘢痕形成和色素沉着的风险,不仪影响容貌,严重者可造成瘢痕挛缩畸形和功能障碍,给患者身心带来巨大痛苦[1].临床上治疗瘢痕和色素沉着的方法众多,却无一理想可靠.笔者单位于2008年5月-2010年7月采用新一代强脉冲光技术即优化脉冲技术[2],治疗681例烧伤患者创面愈合后瘢痕及色素沉着,效果较好,现介绍如下.

1 临床资料 2010年5月-2011年7月,选择在笔者单位急诊入院的深Ⅱ度烧伤患者80例,按照随机数字表法分为2组.(1)高压氧组40例,其中男28例、女12例,年龄14 ～ 63岁,平均36岁.烧伤总面积5.0％ ～ 43.0％ TBSA,创面分布于躯干8例、双上肢12例、双下肢20例,平均手术创面面积18.5％ TBSA.(2)对照组40例,其中男24例、女16例,年龄16～ 68岁,平均38岁.烧伤总面积4.0％ ～41.0％ TBSA,创面分布于躯干9例、双上肢11例、双下肢20例,平均手术面积17.2％ TBSA.2组患者年龄相差3岁,体质指数小于或等于3,创面部位基本相同,无基础疾病.

据国内、外文献报道,在心脏手术患者中胸骨正中切口感染、胸骨裂开、固定胸骨的钢丝外露、深及纵隔形成很难自行愈合的创口,甚至发生迁延性胸骨骨髓炎、纵隔炎等经久不愈甚至全身衰竭死亡的发生率在0.4％ ～8.0％左右[1-4].2007年12月至2010年12月,我们收治转诊来经胸骨正中切口行心胸外科手术的80例胸骨切口创面感染病人,在全身综合治疗的基础上,应用双侧胸大肌起始部分对接的手术方法,治疗取得良好效果,现总结报道如下。

Objective To construct the collagenoblast acellular dermal matrix surrogate transfected by a recombinant pcDNA3.1(+)-VEGF165 plasmid and to evaluate its contribution to agglutination of raw surface of burn patients.Methods VEGF165 gene was obtained by PCR and it was constructed into the expressive vector pcDNA3.1(+).The pcDNA3.1(+)-VEGF165 plasmid was transfected into human collagenoblasts by Lipofectamine 2000 and transfected collagenoblasts were inoculated into the surface of swine acellular dermal matrix.The collagenoblast acellular dermal matrix surrogate was grafted with thin autogenetic skin in deeper wounds of burn patients.Results The expressive vector pcDNA3.1(+)-VEGF165 was successfully constructed and transfected into collagenoblasts.After screening by G418,resistant cells were cultured and passaged.There was no rejection to xenogenic acellular dermal matrix.The survival rate of graft in experimental group was 90.25±5.39% and control group was 83.98±3.63%,there was statistically significant difference(t=3.737,P<0.01).The amount of nascent blood capillaries in experiment group was significantly more than those of control group.Conclusion The collagenoblast acellular dermal matrix surrogate transfected by pcDNA3.1(+)-VEGF165 plasmid can express the active VEGF165 protein and promote the healing of raw surface in burn patients.

目的:观察早期应用人工真皮修复大面积烧伤患者手部创面的效果.方法:选取2009年1月-2010年9月就诊于北京市右安门医院的大面积烧伤患者38例,采用随机分组方法分为两组.人工真皮组19例在早期修复手部创面手术中用人工真皮覆盖创面,2周后用自体刃厚皮片覆盖.对照组19例创面早期切痂、行自体微粒+异体皮移植,后期肉芽组织再行植皮手术.两组术后均行换药、抗感染、加强营养、维护脏器功能等综合治疗,创面愈合后进行功能锻炼.两组均随访0.5～1年,比较两组患者手部功能恢复和皮片挛缩情况.结果:人工真皮组19例38只手于第1次术后3周创面愈合.术后随访观察,术区愈合好,手部伸展、握拳功能良好,复合皮具备较好的弹性,且术区愈后色素及瘢痕轻.对照组1例入院后2周死于重度感染及多脏器功能衰竭,余18例36只手于术后1个月余创面封闭;术后随访观察,术区均有不同程度的瘢痕挛缩、掌指关节背伸畸形、手指间蹼状瘢痕增生,功能活动受限.结论:人工真皮更好地解决了早期无自体皮源时有效封闭创面的问题,是大面积烧伤早期修复手部创面、减轻创伤瘢痕的良好覆盖材料.