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Objective:To investigate the effects of bandaging methods on breast cancer associated lymphoedema.Methods:By simple random sampling method, a total of 90 cases of breast cancer associated lymphoedema patients who received complex decongestion therapy in Hubei Cancer Hospital from May 2020 to My 2021 were randomly assigned to experimental group and control group, with 45 cases in each group. All patients received complex decongestion therapy. At the pressure bandage stage, the control group received figure-of-eight shape bandaging methods, the experimental group implemented modified bandaging methods: the figure-of-eight shape bandaging methods was used below the elbow joint, the spiral bandaging methods was used above the elbow joint. The arm circumference of affected limb, extracellular water/total body water ratio, general comfort questionnaire, bandage loosening rate as well as bandage loss was compared between two groups.Results:At 20 days after treatment, the arm circumference of affected limb in L 3, L 4 were (20.69 ± 2.06) cm, (25.76 ± 3.79) cm and extracellular water/total body water ratio was (10.15 ± 2.49)% in the experimental group, which were lower than those in the control group (21.97 ± 3.45) cm, (27.33 ± 3.25) cm and (11.67 ± 3.12)%, the differences were significant ( t=2.13, 2.11 and 2.56, all P<0.05); the physiological demension scores and total general comfort questionnaire scores were (11.07 ± 2.09) points and (81.71 ± 5.65) points in the experimental group, which were higher than those in the control group (8.36 ± 2.28) points and (77.29 ± 7.52) points, the difference were statically significant ( t=5.88 and 3.16, P<0.05). The bandage loosening rate was 2.2% in the experimental group, 6.7% in the control group, there was no significant difference between two groups ( χ2=1.05, P>0.05). The average bandage loss was (3.47 ± 0.53) rolls in the experimental group, which was lower than that in the control group (3.79 ± 0.40) rolls, the difference was statically significant ( t=3.28, P<0.01). Conclusions:Modified bandaging methods can decrease breast cancer associated lymphoedema, improve the degree of patient comfort and reduce bandage usage.
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Abstract Damage control surgery principles allow delayed management of traumatic lesions and early metabolic resuscitation by performing abbreviated procedures and prompt resuscitation maneuvers in severely injured trauma patients. However, the initial physiological response to trauma and surgery, along with the hemostatic resuscitation efforts, causes important side effects on intracavitary organs such as tissue edema, increased cavity pressure, and hemodynamic collapse. Consequently, different techniques have been developed over the years for a delayed cavity closure. Nonetheless, the optimal management of abdominal and thoracic surgical closure remains controversial. This article aims to describe the indications and surgical techniques for delayed abdominal or thoracic closure following damage control surgery in severely injured trauma patients, based on the experience obtained by the Trauma and Emergency Surgery Group (CTE) of Cali, Colombia. We recommend negative pressure dressing as the gold standard technique for delayed cavity closure, associated with higher wall closure success rates and lower complication and mortality rates.
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Objective To investigate the promoting effect of local compression and fixation on the healing of anterior tibial flask-like wound after debridement and suture.Methods A retrospective case control study was conducted to analyze the clinical data of 57 patients with simple anterior tibial flask-like wound admitted to the Second Hospital of Shandong University from May 2017 to June 2018.There were 32 males and 25 females,aged 20-60 years [(41.4 ± 8.1) years].The length of wound ranged from 1 to 10 cm.All patients had only acute skin and soft tissue injury,without any fracture,large area skin defect,large area avulsion injury,or chronic diseases such as diabetes mellitus and lower limb vascular disease.The study group contained 37 patients who were treated with local pressure dressing and limb fixation after debridement and suture while the control group included 20 patients who were treated with simple dressing after debridement and suture.At 3,5,7,14,and 21 days after operation,the size of the wound,the type and quantity of exudate,the color of skin around the wound and the type of wound tissue were compared,and the healing time was recorded.Results All patients were followed up for 30-90 days [(52.2 ± 3.5) days].Three days after operation,there was no significant difference between the two groups (P ＞0.05).On the 5th day after operation,the scores of exudate amount,skin color surrounding wound and tissue types of the wound bed in the control group and the study group were (4.2 ± 0.7) points ∶ (3.3 ± 0.6) points,(3.5 ± 0.7) points ∶ (2.5 ± 0.6) points,(3.4 ± 0.6) points ∶(2.5 ± 0.5) points (P ＜ 0.05),but there was no significant difference between the two groups in the scores of the size of wound and the type of exudate (P ＞ 0.05).On the 7th day after operation,the scores of the size of wound,type of exudate,amount of exudate,skin color around the wound and the type of wound tissue in the control group and study group were (3.5 ± 0.5) points ∶ (2.5 ± 0.7) points,(3.4 ±0.7)points ∶ (2.4 ±0.5)points,(4.0±0.8)points ∶ (2.8 ±0.5)points,(3.4 ±0.5)points ∶ (1.3 ±0.5) points,(3.3 ± 0.5) points ∶ (2.1 ± 0.4) points (P ＜ 0.05).On the 14th day after operation,the scores of the scores of the size of wound,type of exudate,amount of exudate,skin color around the wound and the type of wound tissue in the control group and study group were (2.9 ± 0.6)points ∶ (1.2 ±0.7)points,(2.8 ±0.7)points ∶ 0 point,(3.3 ±0.7)points ∶ (1.0 ±0.0)points,(3.1 ±0.6)points ∶(1.1 ± 0.4) points,(3.0 ± 0.6) points ∶ (1.2 ± 0.5) points (P ＜ 0.05).Twenty-one days after operation,the scores of the scores of the size of wound,type of exudate,amount of exudate,skin color around the wound and the type of wound tissue in the control group and study group were (2.5 ±0.7)points ∶0 point,(2.5 ±0.5)points ∶ 0 point,(3.0 ±0.7)points ∶ (1.0 ±0.0)points,(2.6±0.7)points ∶ (1.1 ±0.3) points,(2.6 ± 1.1) points ∶ 0 point (P ＜ 0.05).The wound healing rate was 100％ in both groups.The wound healing time of the control group and the study group was (28.3 ± 6.7) days and (15.2 ± 0.9) days respectively (P ＜ 0.05).Conclusion For anterior tibial flask-like wound,local pressure bandaging and fixation after debridement and suture can significantly promote wound healing compared with conventional simple bandaging,with the advantages of better healing quality and shorter healing time.
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Objective@#To investigate the promoting effect of local compression and fixation on the healing of anterior tibial flask-like wound after debridement and suture.@*Methods@#A retrospective case control study was conducted to analyze the clinical data of 57 patients with simple anterior tibial flask-like wound admitted to the Second Hospital of Shandong University from May 2017 to June 2018. There were 32 males and 25 females, aged 20-60 years [(41.4±8.1)years]. The length of wound ranged from 1 to 10 cm. All patients had only acute skin and soft tissue injury, without any fracture, large area skin defect, large area avulsion injury, or chronic diseases such as diabetes mellitus and lower limb vascular disease. The study group contained 37 patients who were treated with local pressure dressing and limb fixation after debridement and suture while the control group included 20 patients who were treated with simple dressing after debridement and suture. At 3, 5, 7, 14, and 21 days after operation, the size of the wound, the type and quantity of exudate, the color of skin around the wound and the type of wound tissue were compared, and the healing time was recorded.@*Results@#All patients were followed up for 30-90 days [(52.2±3.5) days]. Three days after operation, there was no significant difference between the two groups (P>0.05). On the 5th day after operation, the scores of exudate amount, skin color surrounding wound and tissue types of the wound bed in the control group and the study group were (4.2±0.7)points ∶(3.3±0.6)points, (3.5±0.7)points ∶ (2.5±0.6)points, (3.4±0.6)points ∶ (2.5±0.5)points (P<0.05), but there was no significant difference between the two groups in the scores of the size of wound and the type of exudate (P>0.05). On the 7th day after operation, the scores of the size of wound, type of exudate, amount of exudate, skin color around the wound and the type of wound tissue in the control group and study group were (3.5±0.5)points ∶ (2.5±0.7)points, (3.4±0.7)points ∶ (2.4±0.5)points, (4.0±0.8)points ∶ (2.8±0.5)points, (3.4±0.5)points ∶ (1.3±0.5)points, (3.3±0.5)points ∶ (2.1±0.4)points (P<0.05). On the 14th day after operation, the scores of the scores of the size of wound, type of exudate, amount of exudate, skin color around the wound and the type of wound tissue in the control group and study group were (2.9±0.6)points ∶ (1.2±0.7)points, (2.8±0.7)points ∶ 0 point, (3.3±0.7)points ∶ (1.0±0.0)points, (3.1±0.6)points ∶ (1.1±0.4)points, (3.0±0.6)points ∶ (1.2±0.5)points (P<0.05). Twenty-one days after operation, the scores of the scores of the size of wound, type of exudate, amount of exudate, skin color around the wound and the type of wound tissue in the control group and study group were (2.5±0.7)points ∶ 0 point, (2.5±0.5)points ∶ 0 point, (3.0±0.7)points ∶ (1.0±0.0)points, (2.6±0.7)points ∶ (1.1±0.3)points, (2.6±1.1)points ∶ 0 point (P<0.05). The wound healing rate was 100% in both groups. The wound healing time of the control group and the study group was (28.3±6.7)days and (15.2±0.9)days respectively (P<0.05).@*Conclusion@#For anterior tibial flask-like wound, local pressure bandaging and fixation after debridement and suture can significantly promote wound healing compared with conventional simple bandaging, with the advantages of better healing quality and shorter healing time.
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Objective@#To investigate the effect of different negative pressure of wound negative pressure dressing (NPD) on the survival of full-thickness skin grafts of patients.@*Methods@#One hundred and eleven patients who need skin grafting, conforming to the inclusion criteria were hospitalized in our unit from August 2012 to March 2017, and their clinical data were retrospectively analyzed. Forty-seven patients hospitalized from August 2012 to October 2015 were assigned into traditional treatment group. Sixty-four patients hospitalized from November 2015 to March 2017 were divided into -9.975 kPa negative pressure treatment group (n=34) and -13.300 kPa negative pressure treatment group (n=30). Patients in traditional treatment group received conventional dressing after full-thickness skin grafting. Patients in -9.975 kPa and -13.300 kPa negative pressure treatment groups received -9.975 kPa and -13.300 kPa NPD based on traditional treatment after vacuum sealing, respectively. Dot necrosis area of skin grafts and erosion and escharosis of graft edges of patients in the three groups on post operation day 10 were observed. The percentage of dot necrosis area of skin grafts and occurrence rate of erosion and escharosis of skin graft edges were calculated, respectively. Data were processed with chi-square test, Fisher′s exact test, and Kruskal-Wallis H test.@*Results@#Percentages of dot necrosis area of skin grafts of patients in traditional treatment group and -9.975 kPa and -13.300 kPa negative pressure treatment groups were 17.81%, 3.20%, and 3.00%, respectively. Percentage of dot necrosis area of skin grafts of patients in traditional treatment group was significantly higher than that in -9.975 kPa and -13.300 kPa negative pressure treatment groups (Z=-5.770, -4.690, P<0.001). Percentages of dot necrosis area of skin grafts of patients in -9.975 kPa and-13.300 kPa groups were close (Z=-0.619, P>0.05). The occurrence rates of erosion and escharosis of skin graft edges of patients in traditional treatment group and -9.975 kPa and -13.300 kPa negative pressure treatment groups were 78.7% (37/47), 32.4 (11/34), and 36.7% (11/30), respectively. Erosion and escharosis of skin graft edges of patients in -9.975 kPa and -13.300 kPa negative pressure treatment groups were better than those in traditional treatment group (P<0.001). Erosion and escharosis of skin graft edges of patients in -9.975 kPa and -13.300 kPa negative pressure treatment groups were close (P>0.05).@*Conclusions@#The use of -9.975 kPa and -13.300 kPa NPD in skin grafts after full-thickness skin grafting significantly diminishes the occurrence rates of dot necrosis area of skin grafts and erosion and escharosis of graft edges.
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Background: Delayed wound healing is a significant health problem, particularly in older adults. In addition to the pain and suffering, failure of the wound to heal also imposes social and financial burdens. Vacuum-assisted closure (VAC) therapy has been developed as an alternative to the standard forms of wound management, which incorporates the use of negative pressure to optimize conditions for wound healing and requires fewer painful dressing changes. Aim: To assess whether the management of non-healing wounds using VAC therapy will result in improved efficacy and safety outcomes compared with conventional methods. Materials and methods: Present prospective, time bound study was done for 1 year from January 2016 to December 2016 over 50 subjects (25 cases and 25 controls). Details of cases were recorded including history and wound characteristics. Routine investigations were done. Follow up with size of wound, appearance of granulation tissue after day 0, 3, 6, 9, 12 and so on dressings were done. Results: Patients managed with VAC had increased rate of r epithelialization and fewer patients required repeat split thickness skin graft to the same site. VAC was more effective at treating various chronic and complex wounds, as there was a significantly greater reduction in wound volume, depth and treatment duration. Conclusion: VAC results in better healing than standard methods, with few serious complications. More rigorous studies with larger sample sizes assessing the use of VAC therapy on different wound types are required
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Objective To compare the efficiency of compressive bandage dressing and drainage on the blood loss after total knee arthroplasty (TKA). Methods Patients (n=120) who visited Tianjin General Hospital Bin Hai Branch and Tianjin People's Hospital due to varus knee osteoarthritis and underwent TKA were retrospectively analyzed.There are 20 males and 100 females with, mean age was 65.18±6.88 years. Depending on whether placement of drainage, patients were divided into drainage group (60 cases) and pressure bandage dressing group (60 cases). Blood loss, blood transfusion and full blood count (FBC) were all analyzed after TKA in both groups. Results Blood loss after TKA in drainage and pressure dressing group were (1 026.85±274.44),(789.52±251.58) mL respectively. Blood loss was less severe in pressure dressing group than that in drainage group (t=4.938, P0.05). Conclusion Application of compressive bandage dressing in TKA surgery is easy to be operate and can reduce perioperative blood loss and allogeneic transfusion incidence.
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Decubitus ulcer is a pressure-induced ischemia-reperfusion injury overlying a bony prominence. Various dressing methods have been developed to treat it, but clinical management is still a challenging practice. A patient presented with stage IV decubitus ulcer on the left lateral side of the buttock, which was caused by compulsively lying down on the left side due to schizophrenia. The ulcer was resistant to occlusive dressing method for five weeks. However, the patient successfully recovered in three weeks by our applying a negative pressure dressing with the portable vacuum-assisted closure (VAC) system. Our experience shows negative pressure dressing can be effectively used to treat intractable decubitus ulcer in outpatient settings.