Early treatment of high-voltage electric burn wound in the limbs / 中华烧伤杂志

<p><b>OBJECTIVE</b>To summarize the experience of early treatment of high-voltage electric burn wounds in the limbs.</p><p><b>METHODS</b>Fifty-four patients (50 males and 4 females, aged from 10 to 56 years) with high-voltage electric burn wounds in 97 limbs (67 upper limbs and 30 lower limbs) were hospitalized in our burn wards from January 2003 to December 2010. A total of 119 burn wounds in wrist-forearm, forearm-elbow-upper arm, shoulder-axillary region, ankle-foot, lower leg, around the knee, thigh-inguinal region were treated with incision for decompression within 10 days after burn. Under the premise of relatively stable systemic condition of the patients, certain surgical operations were performed as follows. (1) Sixteen limbs with 16 wounds were amputated, among them forearm amputation was performed for 5 upper limbs with necrosis, with preservation of elbow joints, and the residual wounds of the elbow and upper arm were repaired with pedicled latissimus dorsi musculo-cutaneous flaps; 1 upper limb with upper arm amputated, with preservation of shoulder joint, was repaired with pedicled latissimus dorsi musculo-cutaneous flap. (2) Ninety-five wounds were covered with various tissue flaps with abundant blood supply after early debridement, in which 3 brachial arteries, 1 vein, 1 brachial artery and vein were reconstructed in 5 wrist wounds, artery reconstruction was performed in elbow wound of 1 case with injured brachial artery. (3) Eight wounds were treated with free skin grafting. Wound healing conditions were observed and followed up.</p><p><b>RESULTS</b>Wounds in 16 limbs healed after amputation and repair. Blood supply and (or) venous return of hands were restored in 5 wrist wounds after vessel reconstruction. After artery reconstruction, abundant blood supply was observed in 1 case with injured brachial artery and amputation was avoided. Necrosis occurred in distal parts of tissue flaps in 5 wounds after grafting, in which 2 wounds healed after removal of necrotic tissue followed by closure with suture, and 3 wounds healed after debridement and free skin grafting. Tissue flap infection occurred in wrist (5 wounds), elbow (1 wound), ankle-foot (2 wounds), and healed after debridement and suture. The other tissue flaps survived after grafting. Six wounds healed after skin grafting. Partial necrosis occurred in 2 wounds after skin grafting, and they were healed after second skin grafting. Thirty-seven patients were followed up for 6 to 12 months, the skin flaps survived with satisfactory appearance and texture.</p><p><b>CONCLUSIONS</b>Early extensive compartment release through fasciectomies and escharectomies, early debridement, early vascular grafting, early wound coverage with contemporary reparative and reconstructive surgical techniques are rational options for the treatment of high-voltage electric burns in the limbs.</p>

Effect of electroacupuncture on lipid metabolism in metabolic syndrome / 中国针灸

<p><b>OBJECTIVE</b>To probe into the mechanism of electroacupuncture intervention for lipid metabolism of metabolic syndrome patients.</p><p><b>METHODS</b>Eighty cases of metabolic syndrome were randomly divided into an electroacupuncture combined with western medicine group (observation group) and a simple western medicine group (control group), 40 cases in each group. The observation group was treated with electroacupuncture at Back shu points, Zusanli (ST 36),Zhongwan (CV 12),Sanyinjiao (SP 6) etc. as main combined with oral administration of Simvastatin, Glipizide XL, and Felodipine sustained-release tablets for lipid-lowering, glucose-lowering and antihypertensive treatment; the control group was treated with oral administration of western medicine only (the medicine was the same with observation group). The Body Mass Index (BMI) and the blood lipid of the patients were detected respectively before and after treatment.</p><p><b>RESULTS</b>The BMI, Three Acids Glyceride (TG), Total Cholesterol(TC), Low Density Lipoprotein Cholesterol (LDL-C) and High Density Lipoprotein Cholesterol (HDL-C) were compared respectively before and after treatment, there were significant differences between them in observation group (all P < 0.01); while in control group, there were significant differences of TG,TC,LDL-C and HDL-C before and after treatment (all P < 0.01), and with no significant difference in BMI before and after treatment. There were significant differences of BMI,TG,TC,LDL-C and HDL-C between two groups after treatment (P < 0.01, P < 0.05).</p><p><b>CONCLUSION</b>The electroacupuncture has an obvious effect to reduce body mass, and acupuncture combined with medication has a better effect of improving the lipid metabolism than simple medication.</p>

Experimental studies and clinical application of quickly prefabricated random skin flap / 中华整形外科杂志

<p><b>OBJECTIVE</b>To enlarge the ratio of length to width of a prefabricated random skin flap in a short period, in order to meet a special clinical need.</p><p><b>METHODS</b>A white rat and a white mini-pig was chosen for an animal model for the experiment. They were divided into the experimental group and the control. The prefabricated flap was formed as the planned design. In the experimental group, the flaps were treated with a desired pressure in certain intervals at the planned part of the flap. We estimated and inspected the digitized perfusion of flap microcirculation, and made overcong and wide random skin flap survive within 24 hours, and this technique was finally used for the clinical wound treatment.</p><p><b>RESULTS</b>As expected, the survival area of the flap in the experimental group was significantly larger than the control. This technique was successfully used to repair the defects of the special sites in plastic and reconstructive surgery.</p><p><b>CONCLUSION</b>The method of quickly prefabricated random flap could enlarge the ratio of length to width of the flap and put the flap in shape in short time. With the digitized estimating and inspecting, this method could obviously improve the survival area of the random flap and could also be very useful for the clinical treatment.</p>

Study in functional compensation of skin flap:an experimental of fast prefabricated random skin flap / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the possibility and the limit in increasing the survival area of the random skin flap by extremely increasing the ratio of its length and width within 24 hours.</p><p><b>METHODS</b>SD rats (n = 20) were chosen for this study. The rats were randomly divided into: subject group and control one. Pre-made skin flap was prepared as design. The subject group was carried out rapid pre-fabricated skin flap formation training. No training was performed in control group. The changes in perfusion value of micro-circulation inside skin flap were monitored during the whole process, and micro-circulation parameters of the skin flap were used to evaluate whether its blood circulation network was mature or not.</p><p><b>RESULTS</b>Training of pre-made skin flap at 18th hour, the perfusion value of its micro-circulation was basically stable, Skin flap formation was finished at 24th hour. Survival area in control group was (68.25 +/- 0.18)% and in subject group was (97.25 +/- 0.24)% (P < 0.01). There was a significant difference between the two groups.</p><p><b>CONCLUSIONS</b>Within short time, it is possible to establish micro-circulation in skin flap which exceeds the limit set by traditional theory. Digitalized judgment can be used to monitor the fast formation of super-big skin flap. This method is reliable and can increase the survival rate of random skin flap.</p>