ABSTRACT
ObjectiveTo establish a rat model of pure sensory nerve injury or pure motor nerve injury combined with skin defect to examine the effect of highly selective nerve injury on skin wound healing.MethodsA total of 90 male Sprague-Dawley rats were randomly and equally divided into three different groups including Group A (posterior rhizotomy + cutaneous excision wounding group),Group B (anterior rhizotomy + cutaneous excision wounding group) and Group C ( sham operation + cutaneous excision wounding group).The wound healing rate was detected at days 2,7,14 and 21 after injury.The CGRP mRNA expression was determined by reverse transcription-polymerase chain reaction (RT-PCR) at days 1,3,7 and 14 after injury.The Bcl-2 protein expression was determined by immunohistochemistry at days 3,7,14 and 21 after injury.ResultsThe wound healing rate in the Groups A and C was significantly higher than that in the Group B at day 2 ( P ＜ 0.05 ),with no statistical difference between Group A and Group C (P ＞ 0.05 ).The wound healing rate in the Group C was higher than that in the Groups A and B at days 7 and 14 (P ＜0.05),with no statistical difference between Group A and Group B (P ＞0.05).The wound healing rate in the Groups B and C was higher than that in the Group A at day 21 ( P ＜ O.05 ),with no statistical difference between Group B and Group C ( P ＞ 0.05 ).The CGRP mRNA was expressed in three groups and the expression was up-regulated after wound.The CGRP mRNA expression in the Groups B and C was significantly higher than that in the Group A at days 1,3 and 7,with no statistical difference between Group B and Group C ( P ＞ 0.05 ).The CGRP mRNA expression was distributed as Group C ＞ Group B ＞ Group A at day 7 ( P ＜ 0.05 ) and Group B ＞ Group A ＞ Group C at day 14 (P ＜ 0.05 ).Immunohistochemistry indicated that there was no statistical difference in Bcl-2 protein expression at day 3 after injury in all groups; that the Bcl-2 protien expression in the Group C was significantly higher than that in the Groups A and B at day 7 ( P ＜ 0.05 ),with no statistical difference between Group A and Group B ( P ＞ 0.05 ) ; that the Bcl-2 protien expression was distributed as Group C ＞ Group B ＞ Group A at day 14 ; that the Bclo2 protien expression in the Group B was higher than that in the Groups A and C at day 21 (P ＜0.05),with no statistical difference between Group A and Group C (P ＞ 0.05).ConclusionsIn wound healing process,the sensory nerve plays a more important role than the motor nerve.Denervation of the nerves ( especially the sensory nerves) is not conducive to wound healing,and complete innervation is necessary for normal wound healing.
ABSTRACT
Objective To explore the repair method for refractory diabetic wound. Methods A total of 206 patients with refractory diabetic foot ulcers were treated with proper surgical treatments.Results Of all, 106 patients were treated by skin flap (51.5 % ), with one stage wound healing rate of 85.8%; 122 patients were repaired with split-thickness skin graft ( 59.2% ), with survival rate of the graft for 79.5%. Simple toe amputation was made in 34 patients (46 toes). The high level amputation was performed in 56 patients (27.2%). Of all, 132 patients were followed up for 6-18 months, which showed that ulcer recurred in 12 patients (9.1%). Conclusion Timely and effective treatment as well as flap and skin graft repair could reduce high level amputation rate of diabetic foot ulcer and promote the quality of life.
ABSTRACT
BACKGROUND: The wound eschars are often excised from the large wounds of deep second degree bum, but the tangential excision may remove excessive tissues of the epithelial regeneration in residual skin wounds.OBJECTIVE: To investigate the therapeutic effect of electro-driven abrasion treatment in deep second-degree bum wounds on keratin 19 expression, the marker of the epithelial stem cell in residual skin wounds.DESIGN, TIME AND SETTING: Randomized controlled trials were performed from October 2002 to January 2004 in the Guangxi Medical University.MATERIALS: Forty patients suffered thermal (heat or fire) burns were recruited from Department of Burn and Plastic Surgery,aged 18-37 years. The average burn size approaches 15% -45% total body surface area, while deep second-degree burn size was 15%-30%. The patients were divided randomly into two groups, abrasion treatment group (n=20) and tangential excision treatment group (n=20).METHODS: Abrasion treatment group: The wound eschers were removed from superficially to deeply by the electro-driven abrasion instrument, until the wound beds were red hyperaemia or bead bleeding. Tangential excision treatment group: The wound eschars were excised by the skin graft knife, until the wound beds were chalkiness and wet. There were not brown tissue and reticular vascular thrombi. The wound beds were bead bleeding after the hemostasia strap was relaxed. At times the operations were so excessively deep as that fat tissues on the wound beds were revealed. The wound beds in two groups were covered by porcine skin postoperation.MAIN OUTCOME MEASURES: Tissue specimens were taken from the wounds to detect keratin 19 expression in regenerative tissues by using S-P immunohistochemical method before and after operation. Assisted by optical microscope (100x), five view areas were randomly selected to count cells. The healing time of the wounds in two groups was recorded, the granulation wounds that failed to heal required secondary operation.RESULTS: Electro-driven abrasion treatment could preserve more skin attachment, such as dermis, hair foltides, sebaceous glands,and sweat glands. Tangential excision treatment could preserve less skin attachment, such as lamina network tissue residuals, some hair follicles and sweat glands. At times the fat tissues on the wound beds were revealed, rather than dermis. Results of cell counts expression, keratin 19 expression in the residual skin wounds could be seen in both two groups before and after operations. No significant difference was found in the keratin 19 expression before and after abrasion treatment (P > 0.05), while keratin 19 expression counts in the tangential excision treatment group were decreased compared with before operation (P < 0.05). The healing in the abrasion treatment group occurred eadier than in the tangential excision treatment (P < 0.05). There were 2 wounds in the abrasion treatment group and 8 wounds in the tangential excision treatment group requiring secondary operation (P < 0.05).CONCLUSION: Applying electro-ddven abrasion treatment to heal deep second-degree burn wounds is efficient and induces less damages to tissues. Compared with tangential excision treatment, it can preserve more regenerated skin tissues, and is helpful to repair of epithelial stem cells through the regeneration and to shorten the healing time of wounds.