Application of autologous fat grafting in breast augmentation / 中华医学美学美容杂志

Objective To report our experience of breast augmentation patients with fat grafting.Methods The treatment of 560 patients with fat grafting for breast augmentation was summarized in our hospital from Jan.2011 to Dec.2015.Fat was harvested using low negative pressure liposuction technique with 3-hole blunt cannula (diameter 2.5 mm).The fat was managed using cotton pad for concentration of fat tissue and separating them from fluids,oil,and debris.A diameter 2.5 mm,1-hole blunt cannula was used to place the fat through 3-mm incision on inframammary fold,fat grafting with multi-level and multi-tunnel and multi-point injection ways,regularly taking picture for imaging evaluation.Results All patients were successfully performed with breast augmentation,and no severe complications occurred.Grafted fat volume ranged from 180 to 400 ml (average,235 ml) per breast.Most of women had a significant improvement in their breast size and shape postoperatively,and the breasts were soft and natural in appearance.The patients were followed up for 18-24 months,and the outcome were satisfactory.Conclusions Autologous fat grafting for breast augmentation simplifies the operation procedure with satisfied results (natural breast and body contouring) and avoids the complications of breast prosthetic procedures.

Evaluation of radiofrequency electronic system in intraoperative monitoring of surgical textiles / Avaliação de sistema eletrônico por radiofrequência para monitoramento intraoperatório de têxteis cirúrgicos

ABSTRACT Objective To test performance of SurgiSafe®, a radiofrequency electronic device to detect surgical textiles during operations as compared to manual counting. Methods Surgical sponges with radiofrequency TAGs were placed in the abdominal cavity of a pig submitted to laparotomy, in randomly distributed sites. The TAGs were counted manually and also using SurgiSafe®. Positive and negative predictive values, sensitivity, specificity and time required for counting were analyzed for both methods. Results Through the analysis of 35 surgical cycles, SurgiSafe® immediately identified all sponges, with specificity, sensitivity, positive and negative predictive values of 100%. Although not statistically significant, the manual count had sensitivity of 99.72% and specificity of 99.90%. Conclusion SurgiSafe® proved to be an effective device to identify surgical sponges in vivo, in real time; and its use as an adjuvant to manual counting is very helpful to increase patient's safety.

RESUMO Objetivo Testar o desempenho do SurgiSafe®, dispositivo eletrônico de detecção de têxteis cirúrgicos por radiofrequência no intraoperatório, comparado à contagem manual. Métodos Gazes com etiquetas de radiofrequência (TAGs) foram alocadas na cavidade abdominal de um suíno submetido à laparotomia, em locais distribuídos aleatoriamente. As TAGs foram contadas manualmente e com uso do SurgiSafe®. Valores preditivos positivos e negativos, sensibilidade, especificidade e tempo de contagem foram analisados para ambos os métodos. Resultados Por meio da análise de 35 ciclos cirúrgicos, o SurgiSafe® fez a identificação instantânea de todas as gazes, com especificidade, sensibilidade, valores preditivos negativo e positivo de 100%. Apesar de não apresentar significância estatística, a contagem manual apresentou sensibilidade de 99,72% e especificidade de 99,90%. Conclusão O SurgiSafe® mostrou-se eficaz para contabilização de têxteis cirúrgicos em tempo real in vivo, e seu uso como adjuvante na contagem manual é de grande valor para o aumento de segurança do paciente.

Comparison of the curative effect of B-Lynch suture and intrauterine gauze packing in the treatment of intractablepostpartum hemorrhage / 中国基层医药

Objective To compare the clinical curative effect of B-Lynch suture and intrauterine gauze packing in the treatment of intractable postpartum hemorrhage.Methods 118 patients with refractory postpartum hemorrhage after cesarean section were selected,they were randomly divided into observation group(n=59)and the control group(n=59)according to the digital table.The observation group was treated by the B-Lynch suture,the control group was given intrauterine gauze packing treatment.The operation effect,incision healing time and complications were compared between the two groups.Results The operation time,intraoperative blood loss,postoperative 24h blood loss,blood transfusion amount of the control group were(51.25±9.15)min,(1 672.09±378.53)mL,(443.72±112.29)mL,(1 737.21±472.16)mL respectively,which of the observation group were(38.35±8.58)min,(1 177.18±332.64)mL,(123.47±24.17)mL,(1 165.17±352.15)mL,respectively,the differences between the two groups were statistically significant(t=7.899,7.544,7.899,7.544,all P<0.05).The success rate of hemostasis,blood transfusion rate,uterus resection rate,recovery time of incision,length of hospital stay in the control group were 66.10%,71.18%,20.34%,(9.64±1.39)d,(11.14±2.18)d,respectively,which in the observation group were 86.44%,55.93%,6.78%,(7.25±1.28)d,(8.13±1.55)d,respectively,the differences between the two groups were statistically significant(x2=11.429,5.020,7.846,t=9.715,8.643,all P<0.05).The incidence rate of complication of the control group was 67.79%,which of observation group was 18.64%,the difference between the two groups was statistically significant(x2=49.221,P<0.05).The total effective rate of the control group was 72.88%,which was lower than 93.22% of the observation group(x2=14.695,P<0.05).Conclusion The B-Lynch suture in the treatment of postoperative intractable hemorrhage can improve the effect of treatment,promote patients' early resumption of incision,reduce the length of hospital stay,decrease incidence of complications,which is better than intrauterine gauze packing.

Clinical analysis of gauze packing oppression in 18 cases of patients with severe liver injury of / 中国基层医药

Objective To investigate the effects of application of gauze packing oppression in severe liver trauma therapy.Methods Clinical data of gauze packing oppression treated 18 patients with severe liver laceration were retrospectively analysized,with gauze packing oppression,postoperative hemostatic,antibiotic therapy and nutritional support,a t 5 -7 d began plucking gauze,12 -14 d after pulling,no bleeding wounds gradually healed. Results 17 cases were cured,1 died,the cure rate of 95%,the cause of death as multiple injuries caused by the merger of multiple organ failure;postoperative pull gauze(or bandage)again bleeding in 6 cases,2 cases of secondary hemorrhage,the drug was difficult to control again laparotomy to stop bleeding;after 4 cases of subphrenic effusion, infection,complicated with biliary fistula in 5 cases,liver abscess in 2 cases,3 cases of abdominal infection,wound infection in 3 cases.Conclusion For patients with severe liver rupture gauze packing to stop bleeding is still simple and effective ways to deal under an emergency situation for the hospital,both a method of treatment,but also packing oppression to stop bleeding temporarily for processing and then sent to a higher level hospital completely win time,can effectively reduce the mortality and reduce complications.

Surgical item left in the abdomen six years after abdominoplasty: case report / Corpo estranho retido cirurgicamente em abdômen seis anos após abdominoplastia: relato de caso

The retained surgical item in patients after closure of the wound is a situation that although rare is preventable and requires specific care such as institutional protocols for prevention. We report a case of removal of an already encapsulated pads by fibrin tissue (textiloma) from a patient six years after an abdominoplasty, which formed a palpable mass in her abdomen. The retained surgical items lead to variable symptoms such as palpable masses, compressions, non-absorptive loss and, sometimes, severe complications. The diversity of manifestations combined with their few frequency, most of the times, lead to underdiagnosis. Treatment should be individualized for each case, although in case of symptoms removal is indicated in most cases. Surgical removal is associated with complications as longer as objects remain in patient's body.

A permanência de corpos estranhos em pacientes após o fechamento da ferida operatória é uma situação que, embora rara, é evitável e demanda cuidados específicos como protocolos institucionais de prevenção. O caso relata a retirada de uma compressa já encapsulada por tecido de fibrina (textiloma) de uma paciente seis anos após abdominoplastia, formando uma massa palpável em seu abdômen. A permanência desses itens cirúrgicos leva a sintomas variáveis como massas palpáveis, compressões, síndromes disabsortivas e, algumas vezes, graves complicações. A diversidade de manifestações combinada a sua pouca frequência levam, muitas vezes, ao subdiagnóstico. O tratamento deve ser individualizado para cada caso, embora na presença de sintomas a retirada é indicada na grande maioria das vezes. A cirurgia de retirada está mais associada a complicações quanto maior tempo de permanência dos objetos no corpo do paciente.

Gauze packing for massive hemorrhage in pelvic fracture / 中华创伤杂志

Objective To investigate the clinical value of gauze packing for haemodynamically unstable pelvic fracture.Methods Between January 2006 and January 2014,gauze packing was used to treat haemodynamically unstable pelvic fracture in 42 patients consisting of 23 males and the 19 females aged 34.2 years (range,18 to 54 years).AO classification of the fracture was type B1 in 9,B2 in 5,B3 in 3,C1 in 13,C2 in 4,and C3 in 8 patients.All the patients were diagnosed with hypovolemic shock upon admission with the systolic pressure of (75.4 ± 4.3) mmHg and heart rate of (126.5 ± 12.4) beats/ min.Injury severity score (ISS) was (38.7 ± 6.2)points.Anti-shock treatment,internal or external fixation of pelvic ring,and gauze packing were performed immediately to control the hemorrhage following pelvic fracture.Results Systolic pressure was (95.2 ± 4.6) mmHg and mean heart rate was declined to (85.4 ± 13.2)beats/min after pelvis volume control and gauze packing,with significant differences compared to these preoperatively (P ＜ 0.05).Red blood cell transfusion before internal or external fixation and gauze packing was (15.0 ± 2.4) units versus (8.3 ± 1.5) units within the first postoperative 24 hours (P ＜ 0.05).Twenty-four out of the 42 patients underwent temporary abdominal aorta occlusion.Six patients died postoperatively with the death rate of 14％.Mean time of removing the packing gauze was (51.4 ± 10.3) hours (range,24-168 hours).Conclusion Anti-shock treatment with concurrent gauze packing and pelvis volume control is effective to arrest the massive hemorrhage in hemodynamically unstable pelvic fracture.

External use of recombinant human granulocyte-macrophage colony stimulating factor hydrogel to repair thick skin graft donor sites / 中国组织工程研究

BACKGROUND:There are less reports about the external use of recombinant human granulocyte-macrophage colony stimulating factor (rhGM-CSF) hydrogel to repair thick skin graft donor sites. By now, relevant self-control studies have not been retrieved. OBJECTIVE:To observe the effect of rhGM-CSF on the repair of thick skin graft donor sites. METHODS:Sixty patients with burns and scar hyperplasia undergoing autologous thick skin grafting were enroled, 47 males and 13 females, aged 18-65 years. The thigh was selected as donor sites. According to the depth of donor sites, the patients were divided into 0.4 mm and 0.55 mm groups, with 30 cases in each group. Wounds on the symmetric areas with equal area and same depth were selected or wounds with same depth were selected and divided equaly. The wounds were randomly assigned into treatment group and control group. The treatment group was treated with rhGM-CSF hydrogel externaly; the control group was only given vaseline dressing. At postoperative 3, 7, 10, 14 days, the fresh dressing was changed. Then, the wound appearance, healing time, healing rate and adverse effects were observed in the two groups. RESULTS AND CONCLUSION:At 14 days after operation, the wound surface was smoother and the pigmentation was relatively less in the treatment group compared with the control group; the degree of wound pain was less in the treatment group than the control group during dressing change (P < 0.05). At 10 and 14 days after operation, the healing rate and healing time were better in the treatment group than the control group (P < 0.05). No general malaise or hypersensitivity cases were reported, and local issue hyperplasia was also not found. Al the above indicate that the external use of the rhGM-CSF hydrogel can evidently shorten the healing time and improve the healing condition when it is applied in the thick skin graft donor sites.

Gossypiboma: Twelve Years There-After.

Gossypiboma is used to describe a retained cotton matrix surgical material in the body after an operation. Retained intra-abdominal surgical sponge is an uncommon surgical error. Among retained foreign bodies, a surgical gauze or sponge constitutes the most frequently encountered object because of its common usage, small size and amorphous structure. We report a case of a 32-year-old female patient who presented a left sided abdominal mass 12 years after an exploratory laparotomy. The policy of prevention coupled with use of several adjunct technologies which accounts for sponge use will help to reduce the incidence of gossypibomas.

Clinical research on three ways in treatment of little area bleeding / 中国基层医药

Objective To observe the effects of three ways in treatment of little area bleeding.Methods 180 cases were randomly divided into 3 groups,60 cases in each group, they were performed septomucotomy,vaseline gauze packing and microwave treatment respectively. Results The effective power of septomucotomy group and microwave treatment group had no obvious difference (P ＞ 0. 05), while it had obvious difference (P ＜0. 05) when the two groups compare with the vaseline gauze packing group respectively. The cure rate had significant difference(P ＜ 0. 05) when the single one compare with each other between the three groups. The septomucotomy group had the best cure rate. Conclusion Septomucotomy and microwave treatment could both gain good curative effect in the treatment of little bleeding,we may select one flexibly.