ObjectiveTo review the research progress of modern biological dressings. MethodsThe related literature at home and abroad was reviewed, analyzed, and summarized in the progress of biological dressing situation and various types of biological dressing research. ResultsCompared with the traditional dressing, the biological dressing can greatly promote wound healing. Biological dressings are mainly divided into the natural materials, artificial synthetic materials, and drug loaded dressings. The natural material dressings are mainly the alginate dressing, this kind of dressing can promote wound healing, which has been confirmed by a large number of studies. The artificial synthetic materials include film dressings, liquid, water colloids, gels, and foam, each has its own advantages and disadvantages, which can be chosen according to need. The drug dressing can play the role of drug loading, and further promote the wound healing; using microcapsule technology to construct the dressing and choosing Chinese medicine as drugs is the research direction of load. ConclusionThe experiment and clinical application of biological dressing are many types, clinical application prospect is wide, but each has its own advantages and disadvantages, further study is needed to improve its efficacy.
ObjectiveTo investigate the effectiveness of using a sensory prefabricated flap to repair the heel avulsion injury. MethodsBetween August 2012 and August 2013, 6 cases of heel avulsion injury were treated. There were 4 males and 2 females, aged 16-54 years (mean, 29 years). The causes were crush injury in 4 cases and wheel twist injury in 2 cases. The injury to admission time was 2-6 hours (mean, 4 hours). The size of skin avulsion ranged from 5 cm×3 cm to 15 cm×8 cm. Avulsion skin had no replanted condition. At one stage operation, the avulsed heel skin soft tissue was made the full thickness skin graft which was fostered on the anterolateral thigh with lateral circumflex femoral artery perforator, and the lateral femoral cutaneous nerve was put beneath the skin to prefabricate the prefabricated flap; at two stage operation, the prefabricated skin flap pedicled with lateral circumflex femoral artery was used to repair the wound, and the lateral femoral nerve was anastomosed with the calcaneal nerve to reconstruct the feeling. ResultsSix prefabricated flaps all survived, and re-plantation flaps survived after operation. The wounds healed by first intention at donor site and recipient site. The patients were followed up 1-2 years (mean, 1.5 years). The flaps had satisfactory appearance and soft texture. At 1 year after operation, the sensation of the flaps was S3, with two-point discrimination of 22-27 mm (mean, 24.3 mm). According to ZHANG Ming's evaluation standards, the results were excellent in 5 cases, and good in 1 case. The patients could walk normally or with weight-bearing; only linear scar formed at the donor site. ConclusionFor patients with heel soft tissue avulsion injury without replantation qualification, a sensory prefabricated flap by the avulsed heel skin soft tissue can transplanted to repair the heel defect. Satisfactory effectiveness can be obtained in heel appearance and function recovery.
Objective To systematically evaluate the effectiveness of aloe vera and its products (e.g. dressing for external use, and gel) for both acute (e.g. laceration, surgical incision, and burn) and chronic (e.g. infectious wound, and artery and venous ulceration) wounds. Methods With “aloe” and “wound” as the index words, such databases as Cochrane Library, PubMed, EMbase, CBM, CNKI and VIP were searched from the inception to April, 2012 to collect the randomized controlled trials (RCTs) about aloe vera or its products for treating acute and chronic wounds. Two authors independently screened literature, extracted data and assessed the risks of bias. Then meta-analysis was conducted using RevMan 5.0 software. Results A total of 15 RCTs involving 773 participants were included, and all studies were of low quality. There were 8 RCTs which evaluated aloe vera for treating acute wounds (burn, haemorrhoidectomy, and skin biopsy), and no RCT reported the incidence of infection. Compared with silver sulfadiazine, aloe vera products could increase the proportion of healing wounds for patients with burn (RR=1.28, 95%CI 1.03 to 1.60, P=0.03 ); compared with antibiotic cream, aloe vera products could reduce the average healing time for patients with burn (MD= ?12.90, 95%CI ?13.29 to ?12.51, Plt;0.000 01); compared with conventional therapy, aloe vera gel could increase the proportion of healed patients with acute surgical wounds (RR=16.33, 95%CI 3.46 to 77.15, P=0.000 4), and could increase the proportion of healed patients with pressure sores (RR=1.73, 95%CI 1.21 to 2.49, P=0.003). Conclusion The application of aloe vera topical agents and dressings is positively significant to both acute and chronic wounds. But this conclusion still needs to be supported by high quality trials.
Objective To explore the effectiveness and safety of topical phenytoin for wound healing. Methods We searched MEDLINE (1966 to Oct. 2002), EMBASE (1984 to 2002), The Cochrane Library (Issue 4, 2002), Biological Abstracts (1993 to 1996), Cancerlit (1997 to Sept. 2002), Life Science Collection (1982 to Mar. 1995), International Pharmaceutical Abstracts (1970 to 2002), and CBMdisc (1978 to Jan. 2003). Controlled trials on topical phenytoin for wound healing were identified. The methodological quality of included studies was assessed, and a descriptive analysis was performed. Results Nine studies (507 cases) including 1 randomized controlled trials (RCT) and 8 non-randomized controlled trials were included. These studies were of poor methodological quality. Because there were a variety of etiology of ulcers, differnet interventions in control groups, and different outcome measures, for which meta-analysis was difficult to perform, a descriptive analysis of the results was presented. Most studies showed that topical phenytoin had better effects on improving healthy granulation appearance, increasing complete recovery rate, reducing time for complete recovery, and positive cases of bacterial culture than those of control groups. Mild side effects were observed in only one study.Conclusions The reviewers think that the inclusion studies less rigorous than randomized controlled trials could result in misleading findings.Some well designed randomized controlled trials of topical phenytoin for wound healing are warranted.
【Abstract】ObjectiveTo study the positive effect of recombinant human epidermal growth factor (rhEGF) on rabbit intestinal anastomotic wound healing after bowel resection. MethodsFortyeight white rabbits were randomly divided into study group in which rhEGF was injected and spinged in the submucosa and mucosa respectively during intestinal anastomosis after bowel resection, and control group in which only intestinal resection and anastomosis was performed. The leukocyte was counted. The incidence of anastomotic leakage and the synthesis of collagen fibrils and hydroxyproline were observed. ResultsThe leukocyte numbers in the anastomotic tissue in two groups rabbits increased slightly 3 d, 5 d and 7d after intestinal anastomosis, but the difference between study group and control group was insignificant (Pgt;0.05). The incidence of anastomotic leakage in the control group (16.7%) was higher than that of the study group (4.3%). The area of collagen fibrils 3 d, 5 d and 7d after intestinal anastomosis in the study group were significantly more than that in the control group (P＜0.05). Number of fibroblast was higher in the study group and the cells appeared bigger nucleus and dense colouration as well as enriched plasm. Angiogenesis in anastomosis tissue in the study group was significant and normal structure was present. Cell structure of anastomosis mucosa was damaged in the control group. Synthesis of hydroxyproline in anastomotic tissue 5 d and 7 d after anastomosis in the study group was more than that in the control group (P＜0.05).ConclusionInflammation was present in the whole process of wound healing, and local using of EGF had insignificant effect on system inflammation. EGF functions as chemoattractant and increases the recruitment of leukocytes, monocytes and fibroblasts into the wound area. EGF increases the production of collagen, angiogenesis and the synthesis of hydroxyproline. So EGF could promote wound healing and protect from anastomosis leakage in this study.
Abstract： Objective To introduce the early experience of using vacuum-assisted closure （VAC） in the treatment of wound dehiscence after thoracic and cardiovascular surgery. Methods This report retrospective1y analyzed the clinical data of 12 patients who underwent VAC in the treatment of wound dehiscence after thoracic and cardiovascular surgery in the Affiliated Hospital of the Logistics University of CAPF between October 2010 and October 2011. There were 7 male patients and 5 female patients with their mean age of 64.3 years （ranging from 39 to 80 years）. All patients underwent operation via median sternotomy or lateral thoracic incision. All the wound dehiscence was deep to sternum or rib. After debridement of necrotic tissue, the wound surfaces were covered with VAC sponges, and intermittent negative pressure therapy was used. The VAC sponges were changed every 7-10 days. Results All the patients underwent an average of 2 times to change the VAC sponges during VAC treatment. After VAC treatment, the edema around the surgical wounds gradually disappeared, and the granulation tissue was refreshed. The overall conditions of all the patients were improved. The patients could leave their bed, walk in the ward, and look after themselves. Antibiotic treatment was no longer used. The residents checked up the negative pressure system every day to see whether it worked well. The patients were no longer afraid of changing dressing and pain every day. All the patients were healed, discharged from the hospital and followed up at outpatient department for a mean time of 7 months. Their wounds all healed well during follow-up. Conclusion VACsystem is easy to use. It can facilitate the healing of wound dehiscence quickly, decrease the inflammatory reaction of local wound and the body, and shorten the rehabilitation time. It’s also helpful to reduce the residents’ work load. It is recommended in the treatment of wound dehiscence after thoracic and cardiovascular surgery.
Objective To evaluate outcomes of vacuum sealing drainage（VSD）for the treatment of wound infection after cardiac surgery.?Methods?We retrospectively analyzed clinical data of 70 patients（with valvular heart disease，congenital heart disease or coronary heart disease）who underwent cardiac surgery via mid-sternotomy and had postoperative wound infection from Jan. 2008 to Jan. 2012 in General Military Hospital of Guangzhou Command. According to different treatment strategy for wound infection, all the patients with wound infection （incision longer than 5 cm） were randomly divided into VSD group （n=35） and control group（n=35） by random number table，while VSD treatment was used for patients in VSD group and routine treatment was used for patients in control group. Treatment outcome，duration of wound infection, duration of antibiotic treatment and treatment cost were compared between the two groups.?Results?There was no in-hospital death in both groups. Wound exudate significantly decreased and fresh granulation tissue grew well in the wound in most VSD group patients after VSD treatment. The cure rate of VSD group was significantly higher than that of control group （94.3% vs. 60.0%，P＜0.05）. Duration of wound infection （12.9±3.4 d vs. 14.8±4.1 d；t=-2.094，P=0.040）and duration of antibiotic treatment （7.0±1.5 d vs. 8.3±1.9 d；t=-2.920，P=0.005） of VSD group were significantly shorter than those of control group. There was no statistical difference in treatment cost between the two groups. Fifteen patients in VSD group were followed up （42.9%） for 3 months with good wound healing, and 20 patients in VSD group were lost in follow-up.?Conclusion?VSD is effective for the treatment of wound infection after cardiac surgery with shortened treatment duration and similar treatment cost compared with routine treatment.
Objective To explore the effectiveness of staged treatment of open Pilon fracture combined with soft tissue defect. Methods Between June 2007 and December 2012, 18 cases of open Pilon fracture combined with soft tissue defect were treated. There were 14 males and 4 females with an average age of 35 years (range, 19-55 years). The causes of injury included falling from height in 12 cases, traffic accident in 4 cases, and crushing by machine in 2 cases. According to AO classification, 1 case was classified as type B2 fracture, 3 cases as type B3 fracture, 5 cases as type C1 fracture, 5 cases as type C2 fracture, and 4 cases as type C3 fracture. Sixteen cases accompanied by fibular fracture (14 cases of simple fibular fracture and 2 cases of communicated fibular fracture). According to Gustilo classification, the soft tissue injuries were all type IIIB. In first stage, debridement and vaccum sealing drainage combined with external fixation were performed; open reduction and internal fixation of simple fibular fracture were used. In second stage, open reduction and internal fixation of Pilon fracture and communicated fibular fracture were performed, and the flaps of 6 cm × 5 cm to 18 cm × 14 cm were applied to repair soft tissue defect at the same time. The donor site was repaired by skin graft. Results Partial necrosis occurred in 2 flaps, the other 16 flaps survived completely. The incisions of donor sites healed by first intention, the skin graft survived completely. The average follow-up interval was 12 months (range, 6-24 months). The X-ray films showed that the bone healing time ranged from 5 to 8 months (mean, 6 months). No internal fixation failure was found. At last follow-up, the average range of motion of the ankle joint was 37° (range, 26-57°). According to the American Orthopedic Foot and Ankle Society (AOFAS) scale, the average score was 80.2 (range, 72-86). Traumatic arthritis occurred in 2 cases (11%). Conclusion The staged treatment has the advantages of accurate evaluation of soft tissue injury, shortened cure time, good reduction of the articular surface, and reduced incidence of infection, so it is an optimal method to treat open Pilon fracture combined with soft tissue defect.
Objective To investigate the clinical application of micro transverse flap pedicled with superficial palmar branch of radial artery from palmar wrist to repair skin defect of finger. Methods Twenty-six cases (26 fingers) with skin defect of finger were repaired with micro transverse flap pedicled with superficial palmar branch of radial artery from palmar wrist between December 2011 and February 2013. There were 20 males and 6 females with the average age of 31.5 years (range, 20-56 years). The causes of injury included cutting injury in 20 cases and crushing injury in 6 cases. The time from injury to admission was 1-5 hours with an average of 2 hours. Injured fingers included thumb in 6 cases, index finger in 6 cases, middle finger in 6 cases, ring finger in 4 cases, and little finger in 4 cases; the locations were the dorsal side of the finger in 6 cases, lateral side in 6 cases, and the volar of the finger tip in 14 cases; there were 4 cases on the proximal phalangeal skin, 8 cases on the middle phalangeal skin, and 14 cases on the distal phalangeal skin. The defect area ranged from 2.0 cm × 1.5 cm to 4.0 cm × 2.0 cm, and the flap area ranged from 2.5 cm × 2.0 cm to 4.5 cm × 2.5 cm. All the donor sites were directly sutured. Results The flaps of 25 cases survived well after operation, and wound healed by first intention； 1 case had partial necrosis and the wound had a scar healing by changing dressing. All cases were followed up 6-12 months (mean, 10 months). The color and appearance of the flaps were satisfactory with tender texture. The two-point discrimination of the flap was 5-8 mm (mean, 6.8 mm). The donor sites healed primarily without scar contracture and limitation of wrist flexion or extension. Conclusion The micro transverse flap pedicled with superficial palmar branch of radial artery from palmar wrist is a good option to repair skin defect of finger. It has the advantages of hidden donor site, the same operative field, great comparability of flap and finger skin, and it can be used as a vascularized tendon or nerve graft.
Objective To investigate the effectiveness of cross finger flap pedicled with the dorsal branch of proper digital artery in repairing degloving injury of the fingertip. Methods Between January 2010 and June 2012, 13 cases of degloving injury of single fingertip were treated, including 9 males and 4 females with an average age of 33.6 years (range, 17-46 years). The defect locations were index finger in 5 cases, middle finger in 3 cases, ring finger in 3 cases, and little finger in 2 cases, including 4 cases of mechanical injury, 6 cases of twist injury, and 3 cases of crushing injury. The extent of skin avulsion was beyond the distal interphalangeal joint. The length of the avulsion was 1.0-2.1 cm (mean, 1.8 cm). Complicated injuries included phalangeal fracture in 2 cases. The time from injury to operation was 90-330 minutes (mean, 150 minutes). The wound was repaired with the cross finger flap pedicled with the dorsal branch of proper digital artery. The size of flaps ranged from 3.2 cm × 2.3 cm to 4.2 cm × 3.1 cm. After 3-4 weeks, the pedicle was cut. The donors were closed by skin graft. Results Tension blisters of the flap and partial necrosis of skin graft occurred in 3 cases and in 1 case respectively, which were cured after symptomatic treatment; the flap and skin graft survived, and primary healing was obtained in the other cases. Thirteen patients were followed up 6-10 months (mean, 7 months). The texture and appearance of all the flaps were satisfactory. At 6 months after operation, two-point discrimination ranged from 7 to 10 mm (mean, 8.1 mm). The total active movement of the fingers were excellent in 10 cases and good in 3 cases, and the excellent and good rate was 100%. Conclusion The treatment of degloving injury of fingertip with the cross finger flap pedicled with the dorsal branch of proper digital artery is recommendable for the advantages of reliable blood supply, simple operation, high survival rate of the flap, good function recovery of the finger, and satisfactory appearance.