中华烧伤与创面修复杂志

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Objective To compare the clinical effects of continuous negative-pressure wound therapy (NPWT) and conventional pressure dressing at at hard-to-fix sites after split-thickness skin grafting. Methods From September 2017 to August 2019, 129 patients who met the inclusion criteria and had spilt-thickness skin grafting at hard-to-fix sites were admitted to the First Affiliated Hospital of Air Force Medical University and included in this retrospective cohort study. The patients were divided into NPWT group (67 patients, 41 males and 26 females, aged (32±6) years) and conventional pressure dressing group (62 patients, 37 males and 25 females, aged (30±5) years) according to whether the hard-to-fix sites were applied with NPWT after spilt-thickness skin grafting. After debridement and spilt-thickness skin grafting at hard-to-fix sites in patients of 2 groups, the wounds of patients in conventional pressure dressing group were applied with conventional pressure bandaging after being filled with dry gauze; for the wounds of patients in NPWT group, the semi-permeable membrane was pasted and sealed for continuous negative pressure suction after filled with dry gauze and placed the drainage foam or drainage tube, with the negative pressure ranging from -16.6 to -9.9 kPa. The bandage was opened during the first dressing change on the 5th day after surgery in NPWT group and on the 7th day after surgery in conventional pressure dressing group. The skin graft surviving area and proportion, the area and proportion of hematoma, the incidence of common complications of skin graft were observed and calculated. The times of postoperative dressing change and the length of hospital stay were counted. Data were statistically analyzed with two independent sample t test, Cochran & Cox approximate t test, chi-square test, and Fisher′s exact probability test. Results (1) At the first dressing change, the skin graft surviving area of patients in NPWT group was (420±94) cm², which was significantly larger than (322±97) cm² in conventional pressure dressing group (t′=12.33, P<0.01); the skin graft surviving area proportion of patients in NPWT group was (97.0±2.3)%, which was significantly higher than (74.4±4.8)% in conventional pressure dressing group (t′=50.11, P<0.01). (2) At the first dressing change, the skin hematoma area of patients in conventional pressure dressing group was (31.7±10.1) cm², which was significantly larger than (3.2±0.7) cm² in NPWT group (t′=23.04, P<0.01); the skin hematoma area proportion of patients in conventional pressure dressing group was (7.3±2.3)%, which was significantly higher than (0.7±0.3)% in NPWT group (t′=76.21, P<0.01). (3) At the first dressing change, there was 1 case of skin movement and no case of skin graft edge tear in NPWT group with an incidence of 1.5% (1/67). In the conventional pressure dressing group, there were 4 cases of skin movement and 2 cases of skin graft edge tear with an incidence of 9.7% (6/62), P<0.05. The incidence of complication of skin graft of patients in NPWT group was significantly lower than that in conventional pressure dressing group (P<0.05). (4) The times of postoperative dressing change of patients in NPWT group was significantly less than that in conventional pressure dressing group (t=7.93, P<0.01). The postoperative length of hospital stay in NPWT group was significantly less than that in conventional pressure dressing group (t=11.71, P<0.01). Conclusions Continuous NPWT can effectively promote wound healing, improve the survival rate of skin graft, reduce the incidence of complications after skin grafting, and shorten the length of hospital stay in split-thickness skin grafting at hard-to-fix sites.

Clinical effects of vacuum sealing drainage in the treatment of alkali burn wounds

Huang Chonggen, Jia Zhigang, Gu Zaiqiu, Zhao Peng, Lyu Guozhong

2020, 36(7): 534-539. doi: 10.3760/cma.j.cn501120-20200115-00024

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Objective To preliminarily observe the clinical effects of vacuum sealing drainage (VSD) in the treatment of alkali burn wounds. Methods From June 2016 to March 2020, 60 male patients with alkali burns who met the inclusion criteria and hospitalized in the Affiliated Hospital of Jiangnan University were recruited in this prospectively randomized control study. According to the random number table, silver sulfadiazine group and VSD group were both allocated with 30 patients, aged (36±8) and (35±10) years respectively; with total burn area of (7.2±2.0) % and (8.5±3.0) % total body surface area respectively. After admission, patients in silver sulfadiazine group were treated with conventional silver sulfadiazine dressing change once a day after debridement; patients in VSD group were given continuous VSD treatment after debridement, with the negative pressure setting at -10.67 kPa, and the negative pressure materials were replaced every 6 to 8 days. On treatment day 1, 4, and 7, the exudate from the wounds of patients in silver sulfadiazine group and the wound drainage fluid of patients in VSD group were collected, the pH value was measured by a portable pH meter, and the volume of exudate/drainage fluid was measured. After 7, 14, and 21 days of treatment, the wound healing rates of patients were calculated in the two groups. Before treatment and 7 days after treatment, venous blood was collected from the patients in the two groups to detect the serum level of tumor necrosis factor α (TNF-α) and interleukin 8 (IL-8). Within treatment day 14, Visual Analogue Scale was used to assess the pain score of patients in the two groups during each time of dressing change. The medical costs and discharge satisfaction scores of patients in the two groups were recorded. Data were statistically analyzed with analysis of variance for repeated measurement, t test, and Bonferroni correction. Results (1) On treatment day 1, 4, and 7, the pH values of the drainage fluid of patients in VSD group were 9.75±0.59, 9.01±0.46, and 8.13±0.28, respectively, which were significantly higher than 9.35±0.62, 8.18±0.18, and 7.58±0.09 of exudate of patients in silver sulfadiazine group (t=2.03, 6.80, 7.56, P<0.05 or P<0.01). On treatment day 1 and 4, the volumes of drainage fluid of patients in VSD group were (553±83) and (239±65) mL respectively, which were significantly higher than (440±77) and (175±49) mL of exudate of patients in silver sulfadiazine group (t=3.44, 2.24, P<0.05). On treatment day 7, the volume of drainage fluid of patients in VSD group was (21±8) mL, which was significantly lower than (149±44) mL of exudate of patients in silver sulfadiazine group (t=-12.61, P<0.01). (2) After 7, 14, and 21 days of treatment, the wound healing rates of patients in VSD group were (39±6) %, (74±10) %, and (92±3) %, respectively, which were significantly higher than (25±3) %, (59±6) %, and (77±6) % in silver sulfadiazine group (t=7.07, 5.59, 7.09, P<0.01). (3) Before treatment, the serum levels of TNF-α and IL-8 of patients in the two groups were similar. After 7 days of treatment, the serum levels of TNF-α and IL-8 of patients in VSD group were significantly lower than those in silver sulfadiazine group (t=-8.75, -8.04, P<0.01). (4) The pain score during dressing change and medical cost of patients in VSD group were significantly lower than those in silver sulfadiazine group (t=-4.28, -7.56, P<0.01), while the discharge satisfaction score of patients in VSD group was significantly higher than that in silver sulfadiazine group (t=10.91, P<0.05). Conclusions The application of VSD technology in clinical alkali burn wounds can effectively promote the removal of residual lye, alleviate the further damage of lye to skin tissue, shorten the wound healing time, effectively remove inflammatory mediators, reduce the pain of dressing change, decrease the total cost of treatment, and enhance satisfaction of patient.

Effect of modified double negative-pressure wound therapy combined with debridement and tension-reduced suture in treatment of patients with stage 4 pressure sores and infection in sacrococcygeal region and its surrounding area

Miao Yingying, Zhang Wuchen, Han Xiubin, Wang Zhongxin

2020, 36(7): 540-546. doi: 10.3760/cma.j.cn501120-20200304-00118

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Objective To investigate the effect of modified double negative-pressure wound therapy combined with debridement and tension-reduced suture in treatment of stage 4 pressure sores and infection in sacrococcygeal region and its surrounding area. Methods From January 2015 to June 2019, 20 patients with stage 4 pressure sores and infection in sacrococcygeal region and its surrounding area were admitted to Department of Burns and Plastic Surgery and Cosmetology of Linyi People′s Hospital. Among them, there were 11 males and 9 females, aged 48 to 88 years. The wounds of 13 patients were located in the sacrococcygeal region, and 8 of them had exposed sacrococcyx. The wounds of 4 patients were located in the greater trochanter area of femur, and the wounds of 3 patients were located in the ischial tuberosity area. All the patients had fever in different degree, bacterial infection, hypoproteinemia, and electrolyte imbalance, etc. at admission. After thorough debridement and dressing change, routine negative-pressure wound therapy with negative pressure value of -16.6 kPa was performed according to the scope of lesions in period Ⅰ. When granulation tissue was fresh with less exudate and without residual necrotic tissue, modified double negative-pressure wound therapy in combination with debridement and tension-reduced suture was performed immediately in period Ⅱ. Modified double negative-pressure wound therapy were persistently performed through negative pressure drainage tube inserted into deep part of wounds and negative pressure drainage tube on surface at the same time, with superficial negative pressure value of -19.9 kPa. Meanwhile, systemic anti-infection and nutritional supports were given. The wounds were monitored for the grade of wound healing and whether skin necrosis, split, or fluid accumulation develop at the suture site. The patients were followed up for 1 to 6 months after discharge to monitor wound healing. Length of hospital stay, infection condition before and after the debridement and tension-reduced suture, and complications during treatment were recorded. Results All wounds achieved first grade healing, with the skin at the suture site healed without split, fluid accumulation, or necrosis. The patients were followed up for 1 to 6 months after discharge, with good shape of surgical incision, little pigmentation on the skin, no hypertrophic scar or contracture, and no recurrence of pressure sores. Length of hospital stay of patients was 24 to 33 d, with an average of 28.5 d. Before debridement and tension-reduced suture, 2 cases were infected with Pseudomonas aeruginosa, 1 case was infected with Escherichia coli and Staphylococcus aureus, and 1 case was infected with Proteus mirabilis. The results of bacterial culture were all negative after debridement and tension-reduced suture. During the treatment, all patients were not complicated with bone or joint infection, necrotizing fasciitis, septicemia, etc. Conclusions Modified double negative-pressure wound therapy combined with debridement and tension-reduced suture for treatment of patients with stage 4 pressure sores and infection in sacrococcygeal region and its surrounding area is easy to operate with minimal injury, easy for patients to accept with a very high level of satisfaction, and is suitable to popularize and applicate for primary hospitals.

Efficacy of hierarchical medical mode path management on the continuous treatment for chronic wound patients

Zhou Xiaojin, Lyu Guozhong, Yang Minlie, Jiang Donglin, Wang Yong, Xie Xiaowei

2020, 36(7): 547-552. doi: 10.3760/cma.j.cn501120-20190408-00170

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Objective To explore the efficacy of hierarchical medical mode path management on the continuous treatment for chronic wound patients. Methods From June 2017 to September 2018, the clinical data of 101 patients with chronic wounds who were just discharged from Department of Wound Repair of the Affiliated Hospital of Jiangnan University (hereafter referred to as the author′s affiliation) and still needed continuous treatment, meeting the inclusion criteria, were analyzed with the method of retrospective cohort study. Based on the management method of continuous treatment after discharge, the patients were divided into path management group (52 patients, 27 males and 25 females, aged (44±6) years, 57 wounds) and conventional management group (49 patients, 26 males and 23 females, aged (45±6) years, 53 wounds). The patients in path management group were carried out with full-path management under hierarchical medical mode, and the patients in conventional management group were carried out with conventional continuous treatment management. The discharge time from the author′s affiliation was the time before continuous treatment management (hereafter referred to as before management), and 12 weeks post discharge was the time after continuous treatment management (hereafter referred to as after management). The depression and anxiety of patients in two groups were assessed by Hamilton Depression Scale 24 item version (HAMD-24) and Self-rating Anxiety Scale (SAS), and the positive ratios of depression and anxiety were calculated. The effective rates of wound treatment, times of debridement and dressing change, and treatment cost during the continuous treatment management period were counted. Data were statistically analyzed with two independent sample t test, chi-square test, Fisher′s exact probability test, and Wilcoxon rank-sum test. Results (1) Before management, the HAMD-24 and SAS scores of patients in two groups were similar. After management, the HAMD-24 and SAS scores of patients in path management group were significantly lower than those of conventional management group (t=4.341, 3.840, P<0.01). Before and after management, the positive rates of depression and anxiety of patients in two groups were similar. (2) After management, the effective rate of wound treatment of patients in path management group was 98.25% (56/57), which was significantly higher than 86.79% (46/53) of conventional management group (χ²=5.341, P<0.05). (3) During the management, the times of debridement and dressing change in patients of path management group was 20±4, which was significantly less than 27±7 of conventional management group (t=5.833, P<0.01). (4) During the management, the treatment cost of patients in path management group was (2 479±213) yuan, which was significantly less than (5 215±326) yuan of conventional management group (t=50.185, P<0.01). Conclusions In the continuous treatment of chronic wound patients, the full-path management under hierarchical medical mode can improve the effective rate of wound treatment, reduce the times of debridement and dressing change and treatment cost, and improve their psychological state.

Effects of early supplement of exogenous L-carnitine on renal function in severely scalded rats

Tian Xixi, Kong Weichang, Li Pengtao, Xia Zhengguo, Xu Jiegou, Xu Qinglian

2020, 36(7): 553-559. doi: 10.3760/cma.j.cn501120-20200203-00038

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Objective To explore the effects of early exogenous L-carnitine supplementation on renal function in severely scalded rats. Methods According to the random number table, sixty-six adult female Sprague-Dawly rats were divided into healthy control group (n=6), scald alone group (n=30), and scald+ carnitine group (n=30). In the latter two groups, the rats were inflicted with full-thickness scald of 30% total body surface area on the back, and the lactated Ringer′s solution was injected through the tail vein for resuscitation immediately after scald. At post injury hour (PIH) 1, rats in scald+ carnitine group were intraperitoneally injected with 100 mg/mL L-carnitine solution 400 mg/kg, while rats in scald alone group were intraperitoneally injected with the same volume of normal saline. Rats in these two groups were injected once every 24 hours thereafter. Six rats were taken from each of scald alone group and scald+ carnitine group to collect the renal tissue and abdominal aorta blood at PIH 6, 12, 24, 48, and 72, respectively. The serum content of total protein, albumin, urea nitrogen, creatinine, and cystatin C were determined by the automatic biochemical analyzer. Renal tissue was stained with hematoxylin-eosin to observe histopathological changes. Rats in healthy control group did not undergo any treatment, and their renal tissue and blood sample were extracted and analyzed in the same way as those of severely scalded rats. Data were statistically analyzed with one-way analysis of variance and Bonferroni method. Results (1) The serum content of total protein and albumin of rats in scald alone group at each time point after injury was significantly lower than that in healthy control group (P<0.05). The serum content of total protein of rats in scald+ carnitine group was significantly higher than that in scald alone group at PIH 12 and 24 (P<0.05), and the serum content of albumin of rats in scald+ carnitine group was significantly higher than that in scald alone group at PIH 12 (P<0.05). The serum content of total protein and albumin of rats in scald alone group and scald+ carnitine group showed a trend of decrease followed by an increase, with the lowest value at PIH 24. (2) The serum content of urea nitrogen and creatinine of rats in scald alone group at each time point after injury was significantly higher than that of healthy control group (P<0.05). The serum content of urea nitrogen of rats in scald+ carnitine group was significantly lower than that in scald alone group at PIH 6, 48, and 72 (P<0.05). The serum content of creatinine of rats in scald+ carnitine group was significantly lower than that in scald alone group at PIH 12, 24, 48, and 72 (P<0.05). The serum content of urea nitrogen and creatinine of rats in scald alone group and scald+ carnitine group showed a trend of increase followed by a decrease, with the peak value at PIH 12. (3) The serum content of cystatin C of rats in scald alone group at PIH 6, 12, 24, 48, and 72 was (0.250±0.030), (0.330±0.070), (0.300±0.060), (0.240±0.060), and (0.190±0.030) mg/L, and the content at the first 4 time points were significantly higher than (0.170±0.020) mg/L of healthy control group (P<0.05). At PIH 24, the serum content of cystatin C of rats in scald+ carnitine group was (0.210±0.040) mg/L, which was significantly lower than that of scald alone group (P<0.05). The serum content of cystatin C of rats in scald alone group and scald+ carnitine group showed a trend of increase followed by a decrease, with the peak value at PIH 12. (4) The renal tissue of rats in healthy control group was almost normal, and the degree of renal tissue injury of rats in scald+ carnitine group was lighter than that in scald alone group at each time point after injury. At PIH 24, the renal tissue of rats in scald alone group showed extensive swelling of the renal tubular epithelial cells, vacuolar degeneration and necrosis, loss of brush borders, and nuclear shrinkage; more than 2/3 of the renal tubular cell nuclei disappeared, the tubular lumen was narrowed, necrotic exfoliated cells could be seen in the lumen, and edema and inflammatory cell infiltration could be seen in the renal interstitial. Compared with those of scald alone group, significantly reduced severity of edema and necrosis of renal tubular epithelial cells, as well as less inflammatory cell infiltration were observed in the renal tissue of rats in scald+ carnitine group. Conclusions Early supplement of L-carnitine in severely scalded rats can reduce the damage of renal cells, accelerate the restoration of the content of total protein, albumin, urea nitrogen, creatinine, and cystatin C, thereby maintaining the stability of renal function metabolism level.

Meta-analysis of clinical effects of microskin grafting and Meek microskin grafting in repairing extensively deep burn wounds

Zhang Gaofei, Liu Wenjun, Wang Di, Duan Jianxing, Li Xiaoqing

2020, 36(7): 560-567. doi: 10.3760/cma.j.cn501120-20190521-00249

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Objective To systematically evaluate the clinical effects of microskin grafting and Meek microskin grafting in repairing extensively deep burn wounds using meta-analysis. Methods Foreign language databases including PubMed and Cochrane Library were searched with the terms of " Meek micrografting, burn" , and Chinese databases including Chinese Journal Full-Text Database, Chinese Biomedical Database, VIP database, and Wanfang Data were searched with the terms in Chinese version of "微粒皮, Meek植皮,烧伤" to retrieve the publicly published randomized controlled trials on the microskin grafting and Meek microskin grafting in repairing extensively deep burn wounds from the establishment of each database to March 20, 2019. The outcome indexes included the survival rate of skin graft, primary healing rate, operation time, and surgical treatment cost after the first operation, as well as the wound healing time and length of hospital stay. RevMan 5.3 and Stata 14.0 statistical software were used to conduct a meta-analysis of eligible studies. Results A total of 821 patients with extensively deep burns were included in 15 studies, including 410 patients in microskin group who received microskin grafting and 411 patients in Meek microskin group who received Meek microskin grafting. The bias risks of the 15 studies included were uncertain. Compared with those of microskin group, the survival rate of skin graft and primary healing rate of patients in Meek microskin group were significantly increased, with relative risks of 0.76 and 0.66 (95% confidence interval=0.66-0.88, 0.50-0.88, P<0.01), the surgical treatment cost was significantly reduced, with a standardized mean difference of 3.19 (95% confidence interval=1.36-5.01, P<0.01), and the operation time, wound healing time, and length of hospital stay were significantly shortened, with standardized mean differences of 6.05, 2.39, and 2.35 (95% confidence interval=3.66-8.44, 1.43-3.35, 2.03-2.68, P<0.01). Subgroup analysis showed that microskin grafting combined with allogenic skin graft might be a heterogeneous source of operation time. Sensitivity analysis showed that the combined effect size was stable in the operation time, surgical treatment cost, and wound healing time. There was no publication bias in the survival rate of skin graft, operation time, wound healing time, and length of hospital stay (P>0.05), while the primary healing rate and surgical treatment cost had publication bias (P<0.01). Conclusions Compared with microskin grafting, Meek microskin grafting improves the rates of skin graft survival and primary healing, shortens operation time, wound healing time, and length of hospital stay, and reduces the treatment cost in treating extensively deep burn wounds.

Experience in the treatment of burn patients combined with inhalation injury during the epidemic of coronavirus disease 2019

Jiang Nanhong, Wang Deyun, Chen Lan, Xie Weiguo

2020, 36(7): 568-574. doi: 10.3760/cma.j.cn501120-20200308-00135

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Objective To introduce the experience in treating burn patients with inhalation injury during the epidemic of coronavirus disease 2019 (COVID-19). Methods Six burn patients combined with inhalation injury were hospitalized in Department of Burns of Tongren Hospital of Wuhan University & Wuhan Third Hospital from February 1 to March 1 in 2020 during the high-incidence period of COVID-19, including 4 males and 2 females, aged 21-63 years, admitted at 2-4 hours after burns, with total burn areas of 1%-20% total body surface area (TBSA) and full-thickness burn areas of 1%-12% TBSA. Among them, 1 case had severe inhalation injury, 2 cases had mild inhalation injury, and 3 cases had moderate inhalation injury. The body temperatures of the patients were normal at the time of admission, with no fever or cough in the past 2 weeks. At admission, chest CT of one patient showed double lower lobes and left upper lobes had multiple slices and slightly high-density shadow of nodules. Chest CT of two patients showed thickening of bilateral lung texture, and the chest CT of remaining patients were normal. After admission, 6 patients were given routine treatment, the medical staffs paid attention to the protection and screened for COVID-19 according to the diagnosis and treatment plan of COVID-19. On post injury day (PID) 1, 3, 6, and 9, vein blood of patients were collected for determination of white blood cell (WBC) count, neutrophil, lymphocyte absolute value, and level of procalcitonin (PCT). Nucleic acid of novel coronavirus was detected by real-time fluorescence quantitative reverse transcription polymerase chain reaction on PID 3 and 6. The temperatures of patients were recorded after admission. The results of chest CT within one week after injury and the prognosis of the patients were recorded. Measurement data distributed normally were expressed as

±s, and measurement data distributed abnormally were expressed as M(P₂₅, P₇₅). Results (1) On PID 1, 3, 6, and 9, WBC counts of patients were respectively (19.8±3.8)×10⁹/L, (17.2±3.4)×10⁹/L, (13.3±3.1)×10⁹/L, and (11.1±1.6)×10⁹/L, neutrophils of patients were respectively 0.919±0.019, 0.899±0.011, 0.855±0.034, and 0.811±0.035, absolute values of lymphocytes of patients were respectively (0.65±0.18)×10⁹/L, (0.65±0.24)×10⁹/L, (0.91±0.34)×10⁹/L, and (1.23±0.42)×10⁹/L, and PCT values of patients were respectively 0.49 (0.36, 1.64), 0.39 (0.26, 0.73), 0.28 (0.18, 0.33), and 0.12 (0.11, 0.20) ng/mL. The values of WBC and neutrophils of patients were higher than the normal value, showing a downward trend. The absolute values of lymphocyte of patients returned to the normal value from PID 6. The PCT values of patients were higher than the normal value. (2) Nucleic acid test results of novel coronavirus of 6 patients were negative on PID 3 and 6. The temperatures of 6 patients ranged from 36.5 to 38.6 ℃. The typical imaging features of COVID-19 were not found in 6 patients within 1 week after injury by chest CT. After treatment for 14-32 days, 6 patients were cured and discharged. Conclusions During COVID-19 pandemic, burn patients combined with inhalation injury should be treated under condition of good protection for doctors and nurses. Meanwhile, virus should be actively screened to reduce the risk of COVID-19 infection among doctors and patients.

Management strategy of burn and wound care ward during coronavirus disease 2019 pandemic

Li Ning, Liu Tingmin, Chen Hualing, Liao Jianmei

2020, 36(7): 575-578. doi: 10.3760/cma.j.cn501120-20200210-00050

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Work flow of clinical microbiology laboratory in the epidemic of the coronavirus disease 2019

Gong Yali, Shi Yunlong, Luo Xiaoqiang, Zhang Cheng, Liu Meixi, Chen Yu, Peng Yizhi

2020, 36(7): 579-581. doi: 10.3760/cma.j.cn501120-20200303-00117

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Evidence summary for postoperative hypothermia rewarming in adults with severe burns

Lu Fuchang, Shen Mingyan, Shen Tao, Chen Huaqing, Fu Yahong, Han Chunmao

2020, 36(7): 582-586. doi: 10.3760/cma.j.cn501120-20190402-00158

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Objective To retrieve, evaluate, and summarize the best evidence for postoperative hypothermia rewarming in adults with severe burns. Methods Foreign language databases including Cochrane Library, Joanna Briggs Institute Evidence-Based Health Care Center Database, PubMed, Ovid-Medline, BMJ Best Practice, and Web of Science were retrieved with the search terms of " severe burn/major burn/severe degree burn" , " hypothermia/warming intervention/hypothermia/temperature/body temperature change" , and " postoperative /perioperative/peri-operative/post-operative" and Chinese databases including Chinese Journal Full-Text Database, Wanfang Database, and VIP Database were retrieved with the search terms of "手术/术后/术中" , "低温/低体温" , and "烧伤" to obtain all the publicly published evidence for postoperative hypothermia rewarming in adults with severe burns from the establishment of each database to April 2018, including systematic evaluations, guidelines, expert consensus, evidence summary, and original research closely related to the evidence. The literatures were screened and evaluated for their quality, the evidences were extracted from them, evaluated, classified in order to summarize the best evidences. Results A total of 8 literatures were included, including one systematic evaluation, three guidelines, one expert consensus, and three evidence summaries. Finally, the best evidences in 8 aspects including the body temperature monitoring site, body temperature monitoring frequency, surface heating, in vivo heating, rewarming start, multi-strategy rewarming, equipment, and personnel training were summarized. Conclusions Based in the evidence-based nursing method, this study retrieves and evaluates the literature, summarizes the evidence analysis and evaluation, and obtains the best evidences of postoperative hypothermia rewarming in adult patients with severe burns, which provides a strong reference for the clinical implementation of rewarming.

Clinical effect of free thoracodorsal artery perforator flap in reconstructing large scar on the facial subunit

Hu Ruibin, Zhou Danya, Wang Xin, Zhu Liang, Zhang Yixin, Xu Heng

2020, 36(7): 586-589. doi: 10.3760/cma.j.cn501120-20190505-00223

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Objective To explore the clinical effect of free transplantation of thoracodorsal artery perforator flap in reconstructing large scar on the facial subunit. Methods From April 2014 to March 2018, 7 patients with large facial scar were admitted to Ningbo NO.6 Hospital, including 3 males and 4 females, aged from 31 to 49 years, 4 with frontal involvement and 3 with chin and neck. Color Doppler ultrasound was used for the positioning of the thoracodorsal artery perforating vessel, and scar resection was performed according to the principle of facial subunit repair. The wound area was 8 cm×6 cm-21 cm×8 cm, and the wound was repaired with the free thoracodorsal artery perforator flap in the area of 9 cm×7 cm-22 cm×9 cm. The donor site was closed directly by suturing. The consistency of the location of the perforating vessel explored during the operation with its preoperative positioning and the flap survival were recorded. The color, texture, and appearance of the flap and the healing condition, scar formation, and function of the donor area were observed during follow-up. Results The locations of the perforating vessels of 7 patients explored during the operation were consistent with those positioned by color Doppler ultrasound before the operation. All the flaps of the 7 cases survived successfully after operation. Postoperative follow-up of 12-18 months showed that the flap color was similar to the surrounding skin of the recipient area, with soft texture and no obvious contracture. Slight bloated appearance was observed in the flaps of 4 cases. All the 7 patients had postoperative healing of the flap donor site without obvious scar hyperplasia or influence on shoulder joint function. Conclusions The anatomy of the perforating vessel of the thoracodorsal artery perforator flap is relatively constant and the flap can be cut in large area with soft texture, good appearance, and concealed donor area, which is a good choice for reconstructing large scar on the facial subunit.

Clinical effects of free thinned deep inferior epigastric artery perforator flap in repairing extensive soft tissue defects in extremities

Liu Yang, Song Dajiang, Xie Songlin, Song Tao, Zhang Wentao, Tian Xiaoning, Cong Fei, Du Xiaolong, Chen Xun, Fan Jinzhu, Hao Dingjun

2020, 36(7): 590-593. doi: 10.3760/cma.j.cn501120-20190415-00185

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Objective To explore the feasibility and clinical effects of using free thinned deep inferior epigastric artery perforator flap to repair extensive soft tissue defects in extremities. Methods From April 2010 to January 2014, 12 patients with extensive soft tissue defect in extremities after trauma, including 10 males and 2 females, aged 21 to 48 years, 6 patients with defect in the back of wrist and 6 patients with defect in ankle were admitted to the Department of Bone Microsurgery of Xi′an Honghui hospital. After debridement, the size of soft tissue defect ranged from 15.0 cm×4.5 cm to 28.0 cm×11.0 cm. The free thinned deep inferior epigastric artery perforator flap was designed, cut and transferred for reconstruction, with size of 15.0 cm×5.0 cm to 29.0 cm×12.0 cm. The flap thickness ranged from 4.0 to 6.5 cm before defatting, and was 0.6 to 0.9 cm after defatting. All the donor sites of flaps were closed directly by suturing. The flap survival and the appearance and function of flap and donor site were observed during follow-up. Results All the flaps survived smoothly after surgery. During follow-up of 10 to 42 months, the flaps showed no bloat in appearance, no further flap revision or defatting procedures were required, the distance of static 2-point discrimination was 11 to 17 mm (14.5 mm on average). The abdominal function of patients was not affected, and no postoperative abdomen hernia or ulceration was noted. Conclusions The free thinned deep inferior epigastric artery perforator flap is thin and suitable for repairing extensive soft tissue defects in extremities with very good outcomes.

Ten cases of wound hemostasis with glove bandaging in hand skin grafting