Clinical effect of the concentrated suture fixation method on skin transplantation in the jaw and neck region / 中华烧伤杂志

<p><b>OBJECTIVE</b>To observe the clinical effect of the concentrated suture fixation method on skin transplantation on deep burn wound or wound of cicatricial deformity after burn in the jaw and neck region.</p><p><b>METHODS</b>One hundred and fourteen patients, hospitalized from April 2002 to December 2011, with deep burn or cicatricial deformity after burn in the jaw and neck region, were divided into packaging group and concentrated suture group according to the random number table. Each group had 57 patients including 48 cases with deep burn and 9 cases with cicatricial deformity. Traditional suture-package fixation method and concentrated suture fixation method were respectively used in packaging group and concentrated suture group to fix the autologous medium split-thickness skin in transplantation on wounds or scars. On post operation day (POD) 14, the skin microcirculatory perfusion flow of skin graft was measured, and the occurrence of ecchymoma, infection, and necrosis of skin in operative region were observed. The elasticity and contracture of grafted skin and scar hyperplasia on wound edge were observed 6 months after operation. Measurement data were processed with u test, while enumeration data with Fisher's exact test or Chi-square test.</p><p><b>RESULTS</b>(1) On POD 14, the skin microcirculatory perfusion flow in concentrated suture group [(2.86 +/- 0.8) V] was significantly higher than that in packaging group [(2.33 +/- 0.15) V, u = 17.776, P < 0.05]. (2) Ecchymoma occurred in 4 patients of packaging group and 3 patients of concentrated suture group, but the difference between two groups was not statistically significant (chi 2 = 0.152, P > 0.05). (3) Infection in operative region was observed in 1 patient of packaging group, while no patient in concentrated suture group showed this symptom. The difference between two groups was not statistically significant (P > 0.05). (4) Grafted skin in 6 patients of packaging group showed foliated necrosis, which was not observed on those of patients in concentrated suture group. The difference between two groups was statistically significant (P < 0.05). (5) Centipede leg-like scar hyperplasia on wound edge occurred in 21 patients in packaging group and 6 patients in concentrated suture group, and the difference between two groups was statistically significant (chi 2 = 10.920, P < 0.05). (6) Poor elasticity of grafted skin was detected in 17 patients of packaging group and 4 patients of concentrated suture group, and the difference between two groups was statistically significant (chi 2 = 9.865, P < 0.05). (7) Obvious contracture of grafted skin was observed in 15 patients of packaging group and 4 patients of concentrated suture group, and the difference between two groups was statistically significant (chi 2 = 11.684, P < 0.05).</p><p><b>CONCLUSIONS</b>Concentrated suture fixation method is suitable for application in transplantation of big sheet skin on wound in the jaw and neck region. It has high survival rate and is convenient for postoperative observation.</p>

Dynamic change in microcirculation of pancreas after experimental high-voltage electric burn / 中华烧伤杂志

<p><b>OBJECTIVE</b>To observe the changes in surface microcirculation of pancreas after high-voltage electric burn (HEB).</p><p><b>METHODS</b>Thirty rabbits were divided into electrical injury (E) group and control (C) group in a simple random method, with 15 rabbits in each group. Rabbit model of HEB was reproduced from E group with TC-30-20KVA type voltage regulator and YDJ-10KVA type experimental transformer. Rabbits in C group were shamly burned with the same equipment as in E group but not electrified. Intravenous blood of rabbits in both groups was drawn 15 mins before HEB and 0, 1, 2, 4, 8 h after to determine the levels of serum amylase and blood glucose. The morphology of the pancreas microvessels and its surrounding tissues, and the dynamic changes in microvascular blood flow were observed with WX-9 microscope and its image analytical system.</p><p><b>RESULTS</b>The level of serum amylase of rabbits in E group increased gradually and peaked (849 +/- 39) U/L at 8 post HEB h (PHH), which decreased gradually reaching the nadir (153 +/- 21) U/L at 8 PHH in C group (P < 0.05). The blood glucose levels of rabbits in E group and C group increased gradually, with the former level obviously higher than the latter (P < 0.05). Arteriole, venule and capillary network on the surface of pancreatic lobules of rabbits in both groups were clearly seen and well-distributed in the natural way before HEB. In E group, arterioles of rabbits contracted at 0 PHH, and increased gradually in caliber size at 1 PHH; venules of rabbits were unevenly thickened at 2 PHH, and dilated at 8 PHH; the capillaries were contracted or with interrupted flow or completely obstructed at 0 PHH, and their thickness were uneven at 2 PHH, showing exudation at 8 PHH. There was no obvious change of microvessels in rabbits in C group at each time point. There was no exudation and bleeding around the microvessels on the pancreas surface of rabbits in both groups before HEB. In E group exudation was observed around microvessels at 1 PHH, bleeding was observed at 2 PHH and became obvious at 4 PHH; exudation and diffuse bleeding from capillaries were observed at 8 PHH. There was no exudation and bleeding in rabbits in C group as observed at each time point. Before HEB, blood flow speed in microvessels of rabbits in 2 groups was similar to each other (P > 0.05), and no erythrocyte aggregation or microthrombus was found in both groups. In E group, blood flow speed slowed down at 0 PHH as compared with that before HEB, it accelerated at 1 h and slowed down later; erythrocyte aggregation in venules and capillaries was found at 0 PHH, and it aggregated gradually. No above-mentioned change was found in C group.</p><p><b>CONCLUSIONS</b>HEB produces microcirculation disturbance and functional disturbance of pancreas.</p>