To report the methods and effect of axial pattern flap on lower limb in repairing deep wounds of heels by using color Doppler flow imaging (CDFI) technique so as to solve the ever before problems that the vessel can n...To report the methods and effect of axial pattern flap on lower limb in repairing deep wounds of heels by using color Doppler flow imaging (CDFI) technique so as to solve the ever before problems that the vessel can not be displayed in designing axial flap.Methods Suitable axial flaps on lower limbs were selected according to the character of the wounds.There were 25 flaps including 10 cases of the distal-based sural neurovascular flap,nine medial sole flap and six medial leg flap.All the axial pattern flaps were designed on the basis of traditional design ways before operation;then,CDFI appliance with high resolution was used to examine the starting spot,exterior diameter,trail and length of the flap’s major artery.The flaps were redesigned according to the results of CDFI and transferred to cover the wounds.In the meantime,both the results of operation and examination were compared.Results The major artery’s starting spot,exterior diameter,trail and anatomic layers were displayed clearly,in consistency with the results of operation.The flaps survived completely and recovered well,with perfect appearance,color and arthral function.Conclusion CDFI is a simple,macroscopic and atraumatic method for designing the axial pattern flap on lower limb,can provide more scientific and accurate evidence for preoperative determination of flap transplantation and is worthy of clinical application.10 refs,4 figs,2 tabs.展开更多
An increasing utilization of wound-related therapeutic materials and skin bioelectronics urges the development of multifunctional biogels for personal therapy and health management.Nevertheless,conventional dressings ...An increasing utilization of wound-related therapeutic materials and skin bioelectronics urges the development of multifunctional biogels for personal therapy and health management.Nevertheless,conventional dressings and skin bioelectronics with single function,mechanical mismatches,and impracticality severely limit their widespread applications in clinical.Herein,we explore a gelling mechanism,fabrication method,and functionalization for broadly applicable food biopolymers-based biogels that unite the challenging needs of elastic yet injectable wound dressing and skin bioelectronics in a single system.We combine our biogels with functional nanomaterials,such as cuttlefish ink nanoparticles and silver nanowires,to endow the biogels with reactive oxygen species scavenging capacity and electrical conductivity,and finally realized the improvement in diabetic wound microenvironment and the monitoring of electrophysiological signals on skin.This line of research work sheds light on preparing food biopolymers-based biogels with multifunctional integration of wound treatment and smart medical treatment.展开更多
Objective To assess clinical effectiveness of using bilateral pectoralis major or plus rectus abdominis muscle flaps in treating deep sternal wound infection(DSWI) following median sternotomy. Methods Between January ...Objective To assess clinical effectiveness of using bilateral pectoralis major or plus rectus abdominis muscle flaps in treating deep sternal wound infection(DSWI) following median sternotomy. Methods Between January 2009 and December 2013, 19 patients with DSWI after median sternotomy for cardiac surgery were admitted to our hospital, including 14 males(73.7%) and 5 females(26.3%), aged 55±13(18-78) years. According to the Pairolero classification of infected median sternotomies, 3(15.8%) patients were type II, and the other 16(84.2%) were type III. Surgical procedure consisted of adequate debridement of infected sternum, costal cartilage, granulation, steel wires, suture residues and other foreign substances. Sternal reconstruction used the bilateral pectoralis major or plus rectus abdominis muscle flaps to obliterate dead space. The drainage tubes were placed and connected to a negative pressure generator for adequate drainage. Results There were no intraoperative deaths. In 15 patients(78.9%), bilateral pectoral muscle flaps were mobilized sufficiently to cover and stabilize the defect created by wound debridement. 4 patients(21.0%) needed bilateral pectoral muscle flaps plus rectus abdominis muscle flaps because their pectoralis major muscle flaps could not reach the lowest portion of the wound. 2 patients(10.5%) presented with subcutaneous infection, and 3 patients(15.8%) had hematoma. They recovered following local debridement and medication. 17 patients(89.5%) were examined at follow-up 12 months later, all healed and having stable sternum. No patients showed infection recurrence during the follow-up period over 12 months. Conclusion DSWI following median sternotomy may be effectively managed with adequate debridement of infected tissues and reconstruction with bilateral pectoralis major muscle or plus rectus abdominis muscle flap transposition.展开更多
Background: Deep sternal wound infection (DSWI), or mediastinitis, is a devastating complication of coronary artery bypass grafting (CABG). This prospective study aimed to assess our management of DSWI in view of the ...Background: Deep sternal wound infection (DSWI), or mediastinitis, is a devastating complication of coronary artery bypass grafting (CABG). This prospective study aimed to assess our management of DSWI in view of the published literature. Methods: Over 2-years (ending in January 2016), 29 patients (20 males) developed DSWI amongst 520 patients who underwent standard CABG surgeries (5.6%). Pre-, intra- and postoperative variables were documented. Whenever possible, the infections were culture-verified. Besides antibiotics, patients received one or more of the following therapies: drainage, debridement, closed irrigation, sternal re-wiring, vacuum-assisted closure (VAC), and bone resection. Results: the male to female ratio was 2.2:1. Mean age was 58.1 ± 7.3 years. The mean body mass index (BMI) was 27.9 ± 3.4 kg/m<sup>2</sup>. There were 18, 16 and 11 patients with diabetes mellitus (DM), hypertension and chronic obstructive pulmonary disease (COPD) respectively. Cardiopulmonary bypass (CPB) was utilized in 26 (89.7%) patients with a mean time of 117.5 ± 23.3 minutes. Most surgeries (n = 21, 72.4%) lasted 5 - 6 hrs. According to Pairolero classification, there were 3 (10.3%) Type I, 22 (75.9%) Type II and 4 (13.8%) Type III infections. Four (13.8%) cases were culture-verified. Twenty-three (79.3%) DSWIs were surgically managed. Sternal re-wiring was performed in 14 (48.3%) cases while VAC was added to other therapies in 2 (6.9%) patients. DSWIs completely resolved in 18 (62.0%) patients within 3 - 24 weeks while two (6.9%) patients died within 30 days. Conclusion: We have identified six independent risk factors for DSWI (male gender, obesity, DM, hypertension, COPD and CPB), five of them are modifiable.展开更多
Background and Objectives: Duration of antibiotic prophylaxis for cardiac surgery is still debated and controversial. International guidelines are vague: French guidelines recommend an intraoperative administration, w...Background and Objectives: Duration of antibiotic prophylaxis for cardiac surgery is still debated and controversial. International guidelines are vague: French guidelines recommend an intraoperative administration, while the Society of Thoracic Surgeons’ guidelines suggest that optimal postoperative prophylactic antibiotics be given for 48 hours or less. Very few studies have compared the same antibiotic with 2 different administration durations. The study was designed to compare the efficacy of 24-hour administration of cefamandole vs intraoperative cefamandole to prevent deep sternal wound infection and endocarditis after cardiac surgery. Methods: This retrospective and observational study compared the rates of severe surgical site infections (deep sternal wound infection, endocarditis) after cardiac surgery between period 1, 01/01/2008-31/08/2008, with 24-hour administration of cefamandole, and period 2, 01/09/2008-30/04/2009 with intraoperative cefamandole. Results: Among 933 patients, 14 patients (1.5%) developed surgical site infection during the 16-month study: 1.3% during the first period and 1.7% during the second (ns). The populations (470 patients in period 1 and 463 in period 2) were homogeneous and comparable for pre-, intra- and postoperative characteristics. Surgical site infection characteristics (pathogens involved, time to diagnosis) and consequences (longer hospital stay, outcomes) were comparable in the 2 groups. Conclusions: Intraoperative cefamandole was as safe as its 24-hour administration to prevent deep sternal wound infection and endocarditis after adult cardiac surgery.展开更多
Objective:To investigate the clinical effect of modified closed negative pressure suction technique combined with flap transplantation on the treatment of deep chronic refractory wounds.Methods:During March of 2015 to...Objective:To investigate the clinical effect of modified closed negative pressure suction technique combined with flap transplantation on the treatment of deep chronic refractory wounds.Methods:During March of 2015 to April of 2018,52 cases of patients with deep chronic refractory wounds were selected as research objects.They were divided into the control group and the treatment group by use of the random number table method,with 26 cases in each group.Among them,the control group was given conventional debridement combined with flap reconstruction,and the treatment group was treated with modified closed negative pressure suction technique combined with flap transplantation to observe the clinical effect.Results:(1)According to the analysis on the effect of flap transplantation,the excellent and good rate of the treatment group was 92.3%,and in the control group,it was 76.9%(p<0.05).(2)According to the statistics,the incidence of complications in the treatment group was lower than that in the control group(p<0.05).Conclusions:Modified closed negative pressure suction technique combined with flap transplantation has a good effect on the treatment of deep chronic refractory wounds with fewer complications.展开更多
Background:This study aimed to summarize the clinical characteristics of patients with deep sternal wound infection-induced sepsis after median sternotomy and improve the treatment outcomes of infection-related sepsis...Background:This study aimed to summarize the clinical characteristics of patients with deep sternal wound infection-induced sepsis after median sternotomy and improve the treatment outcomes of infection-related sepsis.Methods:A retrospective cohort study was conducted on 21 patients with deep sternal wound infection-induced sepsis after median sternotomy who were admitted to the Department of Critical Care.The clinical manifestations,laboratory test results,infection control,and organ and nutritional support of the patients were summarized,and the follow-up data were obtained.Results:The primary symptoms of deep sternal wound infection-induced sepsis included dyspnea,high fever,chills,and altered state of consciousness.Laboratory test results revealed increased inflammatory markers and decreased oxygenation index.Renal and liver function injury were observed in 8 and 4 patients,respectively;18 and 12 patients demonstrated elevated D-dimer and N-terminal Pro B type natriuretic peptide levels,respectively.Of the 8 patients whose wound secretions tested positive for bacteria,Acinetobacter baumannii and Staphylococcus aureus infections were present in 6 and 2 patients,respectively.One of the 6 patients whose blood cultures tested positive for bacteria demonstrated Candida albicans infection.Fifteen patients received ventilator-assisted ventilation and 2 patients received renal replacement therapy.Of all the 21 patients,17 were cured,2 died,and 2 were discharged.Conclusion:Postmedian sternotomy sepsis attributed to a deep sternal wound infection usually results from a preexisting condition.The most prominent clinical manifestation is dyspnea,which is sometimes accompanied by the impairment of organ function.Infection prevention,proper nutrition support,and maintenance of healthy organ function are the cornerstones for successful treatment outcomes.展开更多
目的:探究基于行动研究法的健康管理联合负压封闭引流(Vacuum sealing drainage,VSD)技术对深度烧伤患者心理状态及创面修复效果的影响。方法:选取2021年9月-2023年6月笔者科室收治的98例深度烧伤患者,经随机单双号法分为常规组(单号,n=...目的:探究基于行动研究法的健康管理联合负压封闭引流(Vacuum sealing drainage,VSD)技术对深度烧伤患者心理状态及创面修复效果的影响。方法:选取2021年9月-2023年6月笔者科室收治的98例深度烧伤患者,经随机单双号法分为常规组(单号,n=49)和行动法组(双号,n=49),两组均实施VSD技术治疗,常规组采用常规护理干预,行动法组采用基于行动研究法的健康管理。比较两组患者疾病认知水平、负性情绪[自我感受负担量表(Self-perceived burden scale,SPBS)]、伤残接受度[伤残接受度量表(Acceptance of disability scale,AODS)]、生活质量[中文版精简烧伤健康量表(Burn specific health scale-brief,BSHS-B)]、创面美观度[温哥华瘢痕量表(Vancouver scar scale,VSS)]评分及护理满意度。结果:干预后,行动法组患者对疾病的认知情况评分、AODS、BSHS-B评分及护理满意度均高于常规组,SPBS、VSS评分均低于常规组,差异均有统计学意义(P<0.05)。结论:对行VSD治疗的深度烧伤患者采用基于行动研究法的健康管理,可明显提高患者的疾病认知和伤残接受度,调节其负性情绪,利于创面外观恢复及生活质量提升,患者满意度较高,值得推荐。展开更多
文摘To report the methods and effect of axial pattern flap on lower limb in repairing deep wounds of heels by using color Doppler flow imaging (CDFI) technique so as to solve the ever before problems that the vessel can not be displayed in designing axial flap.Methods Suitable axial flaps on lower limbs were selected according to the character of the wounds.There were 25 flaps including 10 cases of the distal-based sural neurovascular flap,nine medial sole flap and six medial leg flap.All the axial pattern flaps were designed on the basis of traditional design ways before operation;then,CDFI appliance with high resolution was used to examine the starting spot,exterior diameter,trail and length of the flap’s major artery.The flaps were redesigned according to the results of CDFI and transferred to cover the wounds.In the meantime,both the results of operation and examination were compared.Results The major artery’s starting spot,exterior diameter,trail and anatomic layers were displayed clearly,in consistency with the results of operation.The flaps survived completely and recovered well,with perfect appearance,color and arthral function.Conclusion CDFI is a simple,macroscopic and atraumatic method for designing the axial pattern flap on lower limb,can provide more scientific and accurate evidence for preoperative determination of flap transplantation and is worthy of clinical application.10 refs,4 figs,2 tabs.
基金supported by the National Natural Science Foundation of China(22274053,22274051)the director fund of Shanghai Key Lab for Urban Ecological Processes and Eco-Restoration(SHUES2022C03)+2 种基金the Shanghai Municipal Science and Technology Major Project(“Beyond Limits manufacture”),and the Fundamental Research Funds for the Central UniversitiesAll experiments with human research participants were approved by the Human Research Protection Committee of East China Normal University(approved number:HR 805-2022)Study Participation:Prior to participation in the experiments,informed consent was obtained from the volunteer in all experiments.All animal experiments were approved by the Animal Ethics Committee of East China Normal University(approved number:ARXM2022163).
文摘An increasing utilization of wound-related therapeutic materials and skin bioelectronics urges the development of multifunctional biogels for personal therapy and health management.Nevertheless,conventional dressings and skin bioelectronics with single function,mechanical mismatches,and impracticality severely limit their widespread applications in clinical.Herein,we explore a gelling mechanism,fabrication method,and functionalization for broadly applicable food biopolymers-based biogels that unite the challenging needs of elastic yet injectable wound dressing and skin bioelectronics in a single system.We combine our biogels with functional nanomaterials,such as cuttlefish ink nanoparticles and silver nanowires,to endow the biogels with reactive oxygen species scavenging capacity and electrical conductivity,and finally realized the improvement in diabetic wound microenvironment and the monitoring of electrophysiological signals on skin.This line of research work sheds light on preparing food biopolymers-based biogels with multifunctional integration of wound treatment and smart medical treatment.
文摘Objective To assess clinical effectiveness of using bilateral pectoralis major or plus rectus abdominis muscle flaps in treating deep sternal wound infection(DSWI) following median sternotomy. Methods Between January 2009 and December 2013, 19 patients with DSWI after median sternotomy for cardiac surgery were admitted to our hospital, including 14 males(73.7%) and 5 females(26.3%), aged 55±13(18-78) years. According to the Pairolero classification of infected median sternotomies, 3(15.8%) patients were type II, and the other 16(84.2%) were type III. Surgical procedure consisted of adequate debridement of infected sternum, costal cartilage, granulation, steel wires, suture residues and other foreign substances. Sternal reconstruction used the bilateral pectoralis major or plus rectus abdominis muscle flaps to obliterate dead space. The drainage tubes were placed and connected to a negative pressure generator for adequate drainage. Results There were no intraoperative deaths. In 15 patients(78.9%), bilateral pectoral muscle flaps were mobilized sufficiently to cover and stabilize the defect created by wound debridement. 4 patients(21.0%) needed bilateral pectoral muscle flaps plus rectus abdominis muscle flaps because their pectoralis major muscle flaps could not reach the lowest portion of the wound. 2 patients(10.5%) presented with subcutaneous infection, and 3 patients(15.8%) had hematoma. They recovered following local debridement and medication. 17 patients(89.5%) were examined at follow-up 12 months later, all healed and having stable sternum. No patients showed infection recurrence during the follow-up period over 12 months. Conclusion DSWI following median sternotomy may be effectively managed with adequate debridement of infected tissues and reconstruction with bilateral pectoralis major muscle or plus rectus abdominis muscle flap transposition.
文摘Background: Deep sternal wound infection (DSWI), or mediastinitis, is a devastating complication of coronary artery bypass grafting (CABG). This prospective study aimed to assess our management of DSWI in view of the published literature. Methods: Over 2-years (ending in January 2016), 29 patients (20 males) developed DSWI amongst 520 patients who underwent standard CABG surgeries (5.6%). Pre-, intra- and postoperative variables were documented. Whenever possible, the infections were culture-verified. Besides antibiotics, patients received one or more of the following therapies: drainage, debridement, closed irrigation, sternal re-wiring, vacuum-assisted closure (VAC), and bone resection. Results: the male to female ratio was 2.2:1. Mean age was 58.1 ± 7.3 years. The mean body mass index (BMI) was 27.9 ± 3.4 kg/m<sup>2</sup>. There were 18, 16 and 11 patients with diabetes mellitus (DM), hypertension and chronic obstructive pulmonary disease (COPD) respectively. Cardiopulmonary bypass (CPB) was utilized in 26 (89.7%) patients with a mean time of 117.5 ± 23.3 minutes. Most surgeries (n = 21, 72.4%) lasted 5 - 6 hrs. According to Pairolero classification, there were 3 (10.3%) Type I, 22 (75.9%) Type II and 4 (13.8%) Type III infections. Four (13.8%) cases were culture-verified. Twenty-three (79.3%) DSWIs were surgically managed. Sternal re-wiring was performed in 14 (48.3%) cases while VAC was added to other therapies in 2 (6.9%) patients. DSWIs completely resolved in 18 (62.0%) patients within 3 - 24 weeks while two (6.9%) patients died within 30 days. Conclusion: We have identified six independent risk factors for DSWI (male gender, obesity, DM, hypertension, COPD and CPB), five of them are modifiable.
文摘Background and Objectives: Duration of antibiotic prophylaxis for cardiac surgery is still debated and controversial. International guidelines are vague: French guidelines recommend an intraoperative administration, while the Society of Thoracic Surgeons’ guidelines suggest that optimal postoperative prophylactic antibiotics be given for 48 hours or less. Very few studies have compared the same antibiotic with 2 different administration durations. The study was designed to compare the efficacy of 24-hour administration of cefamandole vs intraoperative cefamandole to prevent deep sternal wound infection and endocarditis after cardiac surgery. Methods: This retrospective and observational study compared the rates of severe surgical site infections (deep sternal wound infection, endocarditis) after cardiac surgery between period 1, 01/01/2008-31/08/2008, with 24-hour administration of cefamandole, and period 2, 01/09/2008-30/04/2009 with intraoperative cefamandole. Results: Among 933 patients, 14 patients (1.5%) developed surgical site infection during the 16-month study: 1.3% during the first period and 1.7% during the second (ns). The populations (470 patients in period 1 and 463 in period 2) were homogeneous and comparable for pre-, intra- and postoperative characteristics. Surgical site infection characteristics (pathogens involved, time to diagnosis) and consequences (longer hospital stay, outcomes) were comparable in the 2 groups. Conclusions: Intraoperative cefamandole was as safe as its 24-hour administration to prevent deep sternal wound infection and endocarditis after adult cardiac surgery.
文摘Objective:To investigate the clinical effect of modified closed negative pressure suction technique combined with flap transplantation on the treatment of deep chronic refractory wounds.Methods:During March of 2015 to April of 2018,52 cases of patients with deep chronic refractory wounds were selected as research objects.They were divided into the control group and the treatment group by use of the random number table method,with 26 cases in each group.Among them,the control group was given conventional debridement combined with flap reconstruction,and the treatment group was treated with modified closed negative pressure suction technique combined with flap transplantation to observe the clinical effect.Results:(1)According to the analysis on the effect of flap transplantation,the excellent and good rate of the treatment group was 92.3%,and in the control group,it was 76.9%(p<0.05).(2)According to the statistics,the incidence of complications in the treatment group was lower than that in the control group(p<0.05).Conclusions:Modified closed negative pressure suction technique combined with flap transplantation has a good effect on the treatment of deep chronic refractory wounds with fewer complications.
文摘Background:This study aimed to summarize the clinical characteristics of patients with deep sternal wound infection-induced sepsis after median sternotomy and improve the treatment outcomes of infection-related sepsis.Methods:A retrospective cohort study was conducted on 21 patients with deep sternal wound infection-induced sepsis after median sternotomy who were admitted to the Department of Critical Care.The clinical manifestations,laboratory test results,infection control,and organ and nutritional support of the patients were summarized,and the follow-up data were obtained.Results:The primary symptoms of deep sternal wound infection-induced sepsis included dyspnea,high fever,chills,and altered state of consciousness.Laboratory test results revealed increased inflammatory markers and decreased oxygenation index.Renal and liver function injury were observed in 8 and 4 patients,respectively;18 and 12 patients demonstrated elevated D-dimer and N-terminal Pro B type natriuretic peptide levels,respectively.Of the 8 patients whose wound secretions tested positive for bacteria,Acinetobacter baumannii and Staphylococcus aureus infections were present in 6 and 2 patients,respectively.One of the 6 patients whose blood cultures tested positive for bacteria demonstrated Candida albicans infection.Fifteen patients received ventilator-assisted ventilation and 2 patients received renal replacement therapy.Of all the 21 patients,17 were cured,2 died,and 2 were discharged.Conclusion:Postmedian sternotomy sepsis attributed to a deep sternal wound infection usually results from a preexisting condition.The most prominent clinical manifestation is dyspnea,which is sometimes accompanied by the impairment of organ function.Infection prevention,proper nutrition support,and maintenance of healthy organ function are the cornerstones for successful treatment outcomes.
文摘目的:探究基于行动研究法的健康管理联合负压封闭引流(Vacuum sealing drainage,VSD)技术对深度烧伤患者心理状态及创面修复效果的影响。方法:选取2021年9月-2023年6月笔者科室收治的98例深度烧伤患者,经随机单双号法分为常规组(单号,n=49)和行动法组(双号,n=49),两组均实施VSD技术治疗,常规组采用常规护理干预,行动法组采用基于行动研究法的健康管理。比较两组患者疾病认知水平、负性情绪[自我感受负担量表(Self-perceived burden scale,SPBS)]、伤残接受度[伤残接受度量表(Acceptance of disability scale,AODS)]、生活质量[中文版精简烧伤健康量表(Burn specific health scale-brief,BSHS-B)]、创面美观度[温哥华瘢痕量表(Vancouver scar scale,VSS)]评分及护理满意度。结果:干预后,行动法组患者对疾病的认知情况评分、AODS、BSHS-B评分及护理满意度均高于常规组,SPBS、VSS评分均低于常规组,差异均有统计学意义(P<0.05)。结论:对行VSD治疗的深度烧伤患者采用基于行动研究法的健康管理,可明显提高患者的疾病认知和伤残接受度,调节其负性情绪,利于创面外观恢复及生活质量提升,患者满意度较高,值得推荐。
