Abstract The narrow pedicled intercostal cutaneous perforater (np-ICP) thin flaps were successfully used for reconstruction of hand deformity from scar contraction. This flap was designed with a narrow pedicle (3～5cm in width) which included ICPs of 4th～9th intercostal spaces, and with awide distal part (the maximum is 15cm×15cm) which covered the lower chest and upper abdomen. The thickness of flap was cut until the subdermal vascular networkwas observed. The pedicle was divided between the 7th～14th days after operation. Sixteen flaps in 15 cases were transferred for covering of the skin defects at the dorsum of the hand. The perforators which were included in the narrow pediclewere mostly from the 7th intercostal spaces in 9 flaps. Fifteen of the 16 flapswere survived almost completely, except in one case there was necrosis of the distal portion of the flap. It seemed that this flap was more useful than the conventional methods, not only functionally but also aesthetically. Moreover, the operative techinque was more simple and safer than the island or free intercostalflap due to without the necessity to dissect the main trunk of the intercostalneurovascular bundle. Gentle pressure on the thinning portion of the flap for a short time after operation was important.
目的 探讨准分子激光上皮瓣下角膜磨镶术（LASEK）后角膜上皮下雾状混浊（Haze）的形成原因及防治措施。 方法 2004年2月－2011年12月期间采用LASEK治疗近视患者345 例669 只眼，屈光度?3.50～?13.5 D，平均（?6.87 ± 2.92）D；散光?0.50～?4.00 D，平均（?1.83 ± 1.32）D 。根据患者术前屈光等效球镜度数分为：中度近视组（?3.50～?5.75 D）120只眼，高度近视组（?6.00～?8.75 D）288只眼，超高度近视组（?9.00～?13.50 D） 261只眼。应用综合措施防治Haze，术中用日夜配戴的高亲水性绷带型角膜接触镜覆盖保护角膜上皮瓣，术毕频点激素眼液4次，术后使用激素类联合非甾体类抗炎眼液及降眼压药、抗生素眼液；随访6～12个月，观察术后Haze的发生率，并按Fantes（1990）标准分级，分析相关原因。 结果 LASEK术后6个月时0.5级Haze发生率14.65%（98只眼），无1级Haze。各组0.5级Haze发生率分别为中度近视组2.5%（3只眼），高度近视组11.11%（32只眼），超高度近视组24.14%（63只眼）。 结论 LASEK术后Haze的发生与术眼的屈光度呈正比，与角膜上皮瓣的活性和完整性，术后紫外线照射等有关。术后采用激素类联合非甾体类抗炎眼液及降眼压药等综合防治措施，可减少、减轻Haze的发生，使LASEK技术更安全有效。
ObjectiveTo observe the effectiveness and safety of pseudomonas aeruginosa preparation in treating refractory seroma after breast cancer surgery.MethodsA total of 76 patients with refractory seroma after breast cancer surgery who underwent surgery from October 2018 to August 2019 in our hospital were selected. The subjects were randomly divided into two groups. The patients in the control group (n=36) adopted negative pressure drainage connected with indwelling needle in the lower position of the seroma chamber; on the basis, patients in the experimental group (n=400) were injected with pseudomonas aeruginosa preparation into the seroma chamber. The drainage time, total drainage volume, recurrence rate, and incidence of complications of the two groups were compared.ResultsThere were 4 cases in the experimental group and 3 cases in the control group were lost followed-up, so only 69 cases enrolled in data analysis. The drainage time, total drainage volume, and the recurrence rate of the experimental group were all shorter or less than those of the control group (P<0.05). But there was no significant difference in the incidence of complications between the experimental group and the control group (P>0.05), such as fever, inflamed skin, and infection of incision.ConclusionPseudomonas aeruginosa preparation is an effective treatment for refractory seroma after breast cancer surgery, which can shorten the drainage time and promote wound healing.
In order to resolve the shortcomings of traditional pedicled abdominal skin flap, the pedicled abdominal subcorium vascular-net flap was reformed and applied clinically. Twenty-eight cases with scar on hand or wrist were treated, including 20 males and 8 females. The age was ranged from 18 to 35 years old. The key point in the design was rotating 45 degrees of the flap from the primary site toward the pedicle. The ratio of the length to width of the flap was 1-1.8 : 1, and the wound of the donor site was covered by direct suture. Five to seven days later, all the flaps were divided and survived. The advantages of this flap were as follows: skin-grafting on the donor site was not necessary; the time needed for cutting the pedicle was shortened, and the flap is thinner than the traditional flap.
目的 探讨自制皮下引流管在预防腹部切口脂肪液化中的作用。方法 对我院1995年4月至2011年4月期间收治的1 080例行腹部手术肥胖患者的临床资料进行回顾性分析，其中术中未放置皮下引流管者376例（对照组），术中采用切口放置自制皮下引流管者704例（观察组）。结果 观察组704例患者术后无切口脂肪液化发生，切口一期愈合，切口脂肪液化发生率为0；而对照组376例患者中有58例发生切口脂肪液化，切口脂肪液化发生率为15.4%，伤口经多次换药后愈合。结论 放置皮下引流管有利于减少术后切口脂肪液化的发生，减轻了患者痛苦，缩短了治疗时间。
Objective To explore the mechanism of full-thickness burn wound healing with autoskin grafting in fault hypodermis wound of granulation excision and to evaluate its effect.Methods By the techniques of clinical observation, histopathology, immunohistochemistry,TEM and FCM,we observed changes of the activity andstructure of grafted skin and the granulation tissue,collagnous fiber,microvessels,the ultramicrostructure of fibroblasts and the expression of basic fibroblast growth factor(bFGF) in the base of autoskin grafting in fault hypodermis wound in burned adult minipigs(Group A), and compared with traditional method of autoskingrafting on the basilar fibrous tissue wound of scraped partly granulation being(Group B) and control group (Group C, without treatment except de-fur).Results The grafted skin survived after 3 days of operation, and it had less injury and higher proliferative index(PI) in group A than in group B. The hyperplasiaof granulation tissue and vascular endothelial and the expression of bFGF were more evident in group A. After 5 days, the proliferation of endothelial cells and granulation and the protein synthesis of fibroblasts were more active in groupA, and at this moment, fresh collagen appeared and proliferated more actively in group B. After 7-14 days, epidermic structure and dermic microvascular density became normal gradually, the granulation on grafting base matured and transformed into fibrous connective tissue in group A. The same change deferred about 2 days in group B. After 21 days, the above pathologic change in group A was less than that in group B. After 3060 days of operation, Group A achieved much less contraction and transfiguration than Group B, and the grafted skin was tender and movable. Conclusion Autoskin grafting in fault hypodermis wound of granulation excision has a better effect than traditional operation.
目的:研究糖尿病围手术期应用胰岛素泵持续皮下输注胰岛素的临床疗效。方法:68例糖尿病围手术期患者随机分为33例采用胰岛素泵持续皮下输注胰岛素治疗(CSII组),对照组35例采用常规多次皮下注射胰岛素治疗(MSII组),分别对术前、术后的相关指标进行对比研究。结果:治疗后两组各时点血糖均较治疗前显著下降(Plt;0.01)。CSII组达到目标血糖所用的时间明显少于MSII组(2.9比7.2天)(Plt;0.05),血糖达标率优于MSII组(93.%比77.1%)(Plt;0.05),低血糖发生率低于MSII组(9.1%比34.3%)(Plt;0.01)。待手术时间(4.2比9.4天)和住院时间(16比24天)明显缩短(Plt;0.05),但两组住院总费用无差异(Pgt;0.05)。〖结论:CSII在糖尿病患者围手术期中应用疗效及安全性方面优于MSII。
【摘要】 目的 比较上臂三角肌下缘及腹部脐周皮下注射药物的疼痛程度以及两种注射部位药物注射后局部不良反应。 方法 将2009年9月-2010年5月在我院门诊注射室执行皮下注射的患者200例。采用自身对照，分别在三角肌下缘与腹部脐周行皮下注射，根据视觉模拟评分法，对所有患者进行疼痛程度评估，将所得数据进行对比分析。 结果 腹部脐周皮下注射较上臂三角肌下缘注射疼痛评分低，差异有统计学意义（Z=6.02，Plt;0.005），两组注射局部均无不良反应。 结论 腹部脐周皮下注射疼痛程度较上臂三角肌下缘皮下注射疼痛程度轻。【Abstract】 Objective To compare the difference in pain degrees between subcutaneous injection at the lower edge of upper arm deltoid and at the abdominal peri-umbilicus, and to observe the adverse reactions of the two ways of injection. Methods A total of 200 patients who were in the outpatient injection room from September 2009 to May 2010 were injected subcutaneously at the lower edge of upper arm deltoid and the abdominal peri-umbilicus with the method of self control; the pain degrees were assessed by visual analog score and the data were analyzed. Results The pain scores between the two groups differed much (Z=6.02,Plt;0.005), while the difference in space distributions between the two groups was not significant. Conclusion The pain of subcutaneous injection at the abdominal peri-umbilicus is lighter than that at the lower edge of upper arm deltoid.
Objective To explore the incidence of lipohypertrophy in patients with diabetes by meta-analysis, and provide a reference for preventing and reducing its occurrence. Methods A computer search was performed on PubMed, Embase, Web of Science, China National Knowledge Infrastructure, Wangfang Data and Chongqing VIP databases, supplemented by literature retrospective method and manual search. Relevant documents related to lipohypertrophy in diabetic patients were searched until September 2021. After conducting independent literature screening, data extraction and quality evaluation, the researchers used RevMan 5.4.1 and R 3.3.1 softwares for meta-analysis. Results Ten articles were included, including 0 in Chinese and 10 in English, and 20277 patients in total. The incidence of lipohypertrophy in patients with diabetes was 53% [95% confidence interval (44%, 62%)]. The heterogeneity among studies was statistically significant (I2=99%, P<0.00001). Meta-regression analysis of single covariates and multiple covariates found that publication year, research scope, research area, sample source, research center, and sample size could explaine 51.6% of the heterogeneity. Conclusion The incidence of lipohypertrophy in patients with diabetes is high, and effective intervention measures are urgently needed to prevent, diagnose and treat the problem of lipohypertrophy in patients with diabetes.