Application of Staged Negative Pressure Wound Therapy and Flap Surgery for Infection Control After Patellar Internal Fixation Surgery.

The anatomic position of the patella is superficial, making it vulnerable to injuries. Treatment of patella infection after internal fixation surgery remains a big challenge due to minimal soft tissue coverage and vital tissue exposure. Forty-two patients aged 10 to 59 years were admitted to the institution's burn unit between January 2010 and December 2019. Each presented with infection after patellar fracture surgery. Twenty-seven infections were superficial, whereas 15 were deep with pyogenous arthritis of the knee. Negative pressure wound therapy (NPWT) was applied after radical debridement to remove necrotic subcutaneous tissues and internal fixation devices. In addition, cases with septic arthritis were irrigated continuously with normal saline. After 5 to 10 days of NPWT treatment and irrigation, wound infection was well controlled. Afterward, 42 wounds were resurfaced with pedicled flaps, the 42 patients received 17 reverse-flow anterolateral thigh (ALT) perforator flap, 12 medial sural artery perforator flaps, 7 gastrocnemius musculocutaneous flaps, as well as 6 saphenous artery flaps. Thirty-seven flaps survived uneventfully. However, 3 flaps developed venous congestion in the distal end. Two flaps developed tip necrosis. All patients were followed up between 3 and 48 months. Infection beneath the flap occurred in 3 patients and healed after an additional debridement surgery. The staged NPWT and flap surgery strategy focus on thorough debridement and immediate internal fixation devices removal, effective fracture fixation, efficient NPWT application, targeted administration of antibiotics, and adequate soft tissue coverage. This study established that the procedure was effective in infection control after patellar internal fixation surgery.

Extended Paraumbilical Perforator Flap Pedicled With the Inferior Epigastric Artery for Coverage of Type III Circumferential Electrical Burns of the Wrist.

Type III electrical burns on the wrist are characterized by circumferential wounds, three dimensional with sandwich-like necrosis, and progressive blood circulation disturbances. Limb salvage is challenging, and success in meeting this challenge depends on vascular reconstruction and wound coverage. This article is intended for the following purposes: to investigate the principles of wound debridement, the management of involved blood vessels, and the clinical effects of the extended paraumbilical perforator flap pedicled with the inferior epigastric artery for coverage of type III circumferential electrical burns of the wrist. A total of 13 male patients (age, 20 to 43 years; average, 29 years) were enrolled in the study. After early escharotomy, debridement, and vascular reconstruction, all wounds were repaired with the extended paraumbilical perforator flap pedicled with the inferior epigastric artery. Flap survival was achieved in all 13 patients. Subcutaneous liquefaction necrosis and infection beneath the flap occurred in three patients. Radial or ulnar artery reconstruction via the great saphenous vein (GSV) graft was performed in 12 cases. All patients had a mean follow-up of 6 to 36 months, and the flaps demonstrated satisfactory flexibility and texture. Hand function was preserved in eight patients, and no patients developed abdominal hernia. Thorough debridement, early vascular reestablishment, and wound coverage are essential for the overall limb salvage effort for type III circumferential electrical burns of the wrist. The extended paraumbilical perforator flap may provide a new and appropriate option for the primary repair of extensive soft tissue defects.

Treatment of Pasteurella multocida infection with dressings containing honey and antibacterials: a case report.

Infections secondary to Pasteurella multocida frequently occur in patients who have been exposed to domestic pets. Human infections caused by Pasteurella multocida vary in severity, and clinical features include localised cellulitis, osteomyelitis, systemic bacteraemia, meningitis and pneumonia. No vaccine has been developed against Pasteurella multocida; it is treated with antibacterial agents and, in most cases, surgical intervention. This article discusses the authors' experience in treating a woman with severe cellulitis and osteomyelitis on her hand caused by Pasteurella multocida. She refused surgical intervention and was successfully treated with honey-containing dressings and antibiotics after failure to heal following conservative treatment using conventional wound dressings combined with antibiotics.

Application of a pre-filled tissue expander for preventing soft tissue incarceration during tibial distraction osteogenesis.

BACKGROUND: Bone transport and distraction osteogenesis has been widely used to treat bone defects after traumatic surgery, but, skin and soft tissue incarceration can be as high as 27.6%. AIM: To investigate the efficacy of inserting a tissue expander to prevent soft tissue incarceration. METHODS: Between January 2016 and December 2018, 12 patients underwent implantation of a tissue expander in the subcutaneous layer in the vicinity of a tibial defect to maintain the soft tissue in position. A certain amount of normal saline was injected into the tissue expander during surgery and was then gradually extracted to shrink the expander during the course of transport distraction osteogenesis. The tissue expander was removed when the two ends of the tibial defect were close enough. RESULTS: In all 12 patients, the expanders remained intact in the subcutaneous layer of the bone defect area during the course of transport distraction osteogenesis. When bone transport was adequate, the expander was removed and the bone transport process was completed. During the whole process, there was no incarceration of skin and soft tissue in the bone defect area. Complications occurred in one patient, who experienced poor wound healing. CONCLUSION: The pre-filled expander technique can effectively avoid soft tissue incarceration. The authors' primary success with this method indicates that it may be a valuable tool in the management of incarcerated soft tissue.

Microbial community dynamics in an ANAMMOX reactor for piggery wastewater treatment with startup, raising nitrogen load, and stable performance.

Bacterial community dynamics of the ANAMMOX reactor of an integrated "UASB + SHARON + ANAMMOX" system for treating piggery wastewater were investigated using the Illumina MiSeq method with samples obtained at ~ 2-week intervals during a 314-day period. With aerobic activated sludge as seeds and low content artificial wastewater (NH4+-N 50 mg/L; NO2--N 55 mg/L) as influent for the ANAMMOX reactor, nitrogen removal was initially observed on day 38 with a removal rate 1.3 mg N L-1 day-1, and increased to 90.4 mg N L-1 day-1 on day 55 with almost complete removal of ammonia and nitrite, indicating a successful startup of the reactor. Increasing influent load stepwise to NH4+-N 272.7 mg/L/NO2--N 300 mg/L, nitrogen removal rate increased gradually to 470 mg N L-1 day-1 on day 228, and maintained a stable level (~ 420 mg N L-1 day-1) following introduction of SHARON effluent since day 229. Correlation between microbial community dynamics and nitrogen removal capability was significant (r = 0.489, p < 0.001). Microbial community composition was determined by influent ammonia, influent nitrite, effluent nitrate and some undefined factors. Anammox bacteria, accounting for ~ 98.7% of Planctomycetes, became detectable (0.03% relative abundance) since day 38 and increased to 0.9% on day 58, well consistent with nitrogen removal performance of the reactor. Relative abundance of anammox bacteria gradually increased to 38.4% on day 140 with stepwise increased influent load; decreased to 0.4% on day 169 because of nitrite inhibition; increased to 19.24% on day 233 when the influent load was dropped; kept at ~ 9.0% with SHARON effluent used as influent and dropped to 3.3% finally. Anammox bacteria, only Candidatus Brocadia and Ca. Kuenenia detected, were the most abundant at genus level. Ca. Brocadia related taxa were enriched firstly under low load and detectable during the entire experimental period. Three main groups represented by Ca. Brocadia related OTUs were enriched or eliminated at different loads, but Ca. Kuenenia related taxa were enriched only under high load (NO2--N > 300 mg/L), suggesting their different niches and application for different loads. These findings improve the understanding of relationships among microbial community/functional taxa, running parameters and reactor performance, and will be useful in optimizing running parameters for rapid startup and high, stable efficiency.

Association of running manner with bacterial community dynamics in a partial short-term nitrifying bioreactor for treatment of piggery wastewater with high ammonia content.

Optimization of running parameters in a bioreactor requires detailed understanding of microbial community dynamics during the startup and running periods. Using a novel piggery wastewater treatment system termed "UASB + SHARON + ANAMMOX" constructed in our laboratory, we investigated microbial community dynamics using the Illumina MiSeq method, taking activated sludge samples at ~2-week intervals during a ~300-day period. Ammonia-oxidizing bacteria (AOB) were further investigated by quantification of AOB amoA genes and construction of gene clone libraries. Major changes in bacterial community composition and dynamics occurred when running manner was changed from continuous flow manner (CFM) to sequencing batch manner (SBM), and when effluent from an upflow anaerobic sludge blanket (UASB) reactor for practical treatment of real piggery wastewater was used as influent; differences among these three experimental groups were significant (R (2)  = 0.94, p < 0.01). When running manner was changed from CFM to SBM, relative abundance of the genus Nitrospira decreased sharply from 18.1 % on day 116 to 1.5 % on day 130, and to undetectable level thereafter. Relative abundance of the genus Nitrosomonas increased from ~0.67 % during the CFM period to 8.0 % by day 220, and thereafter decreased to a near-constant ~1.6 %. Environmental factors such as load ammonia, effluent ammonia, effluent nitrite, UASB effluent, pH, and DO levels collectively drove bacterial community dynamics and contributed to maintenance of effluent NH4 (+)-N/NO2 (-)-N ratio ~1. Theses results might provide useful clues for the control of the startup processes and maintaining high efficiency of such bioreactors.

Association between the angiotensin-converting enzyme gene insertion/deletion polymorphism and first-episode patients with schizophrenia in a Chinese Han population.

BACKGROUND: Angiotensin-converting enzyme (ACE), a key enzyme of the renin-angiotensin system, can modulate dopamine turnover in the midbrain. Previous studies have revealed an association between ACE gene insertion/deletion (I/D) polymorphism and chronic schizophrenia, yet results are conflicting. OBJECTIVE: The primary objective of this study was to examine whether the ACE gene I/D polymorphism is associated with first-episode patients with schizophrenia (FEP) in a Chinese Han population. METHODS: The presence of the polymorphism was determined in 220 FEP and 538 healthy controls using a case-control design. We assessed the psychopathology in 212 FEP using the Positive and Negative Syndrome Scale (PANSS). RESULTS: The allelic and genotypic frequencies of the ACE gene I/D polymorphism did not significantly differ between FEP and healthy controls (both p>0.05). However, the negative PANSS symptom was significantly higher in FEP with the D/D genotype than those with I/D and I/I genotypes (all p<0.05) even after Bonferroni corrections (all p<0.05). Furthermore, the D allele of the ACE gene was associated with higher negative PANSS symptom score in FEP. CONCLUSIONS: Our results indicated that even though the ACE gene I/D polymorphism did not associate with FEP, it may play a role in susceptibility to the negative PANSS symptom of FEP in a Chinese Han population.

Firework injuries at a major trauma and burn center: A five-year prospective study.

BACKGROUND AND OBJECTIVE: In China, fireworks are an integral part of the celebration of the annual Spring Festival, but the number of injuries associated with their private use seen in emergency rooms increases dramatically. To raise awareness and help guide future prevention practices in this city, we investigated the epidemiology of firework-related injuries presented at our trauma and burn center in Beijing during the Spring Festivals of 2007-2011. METHODS: Patients were interviewed using a pre-coded questionnaire to elicit information regarding age, gender, causes, injured body part, type of injury, diagnosis, and disposition. RESULT: From 2007 to 2011, during the Spring Festivals 734 patients with fire-work related injuries were seen at our trauma and burn center in Beijing, the median patients of the five year were 140(136-150). The mean age of the patients was 26±15.3 years (range, 1-95 years). Of the 734 patients, the highest proportion of injuries were the 5-14 year-old age group The majority of the patients were male (87.9%), the overall male:female ratio was 7.41:1, and males were predominant in all age groups. For all 5 years, the incidence of firework-related injuries during the Spring Festival Holidays peaked specifically on the first, fifth, and last days, respectively. Injuries were mainly due to improper handling (415/610, 68.0%) or setting off illegal fireworks (195/610, 32.0%). The most frequently injured body parts were the hands and fingers (32.0%), head or face except eyes (28.3%), and trunk (22.4%). Burns were the most common type of injury (65.7%), most of the burned patients (437/453) were between 1% and 10%, and the most common region burned were hands and fingers (218/754). Contusions or lacerations were the second common type of injury (34.3%). Most of the patients (642, 87.5%) were treated and released, while 37 (5%) were treated and transferred, and 55 (7.5%) were admitted for advanced treatment. CONCLUSION: The private use of fireworks during the Spring Festival Holidays is associated with a considerable number of injuries to various parts of the body. We can minimize the number and severity of accidents by raising awareness of safety practices, encouraging professional displays only and motivating manufacturers to adhere to strict quality control.

Effect of a combination of local flap and sequential compression-distraction osteogenesis in the reconstruction of post-traumatic tibial bone and soft tissue defects.

BACKGROUND: Treatment of extensive post-traumatic composite bone and soft tissue defects remains a complicated therapeutic problem and a challenge for surgeons. We investigated the application of local flaps and Ilizarov osteogenesis in the reestablishment of severe combined defects of tibial bone and soft tissue. METHODS: Sixteen patients with bone and soft tissue defects were included. The mean age of the patients was 31.5 years. The average time from injury to initial surgery was 14.4 weeks. The average soft tissue and bone defect sizes were 92.9 cm(2) and 8.7 cm, respectively. Local flaps were created to reconstruct the soft tissue defects. The Ilizarov external fixator or the Orthofix Limb Reconstruction System was used to reconstruct bony defects using delayed distraction osteogenesis. RESULTS: Two myocutaneous flaps and 14 reverse island flaps were applied. All transferred flaps survived. Fifteen patients healed with equal leg length, and one healed with a residual leg-length discrepancy of 1.5 cm. One patient with an Ilizarov external fixator developed ankle joint stiffening and a pin-track infection that was successfully treated with oral antibiotics. No patient developed pin loosening. All patients walked without assistance. Fifteen patients returned to their work, and one lost her job. The results were evaluated using the Paley bone and functional assessment scores. The bone assessment results were excellent in 14 and good in two patients. Functional assessment scores were excellent in 13, good in two, and fair in one patient. CONCLUSION: The combination of local flaps and sequential distraction osteogenesis can be used for successful reconstruction of defects of incorporated bone and soft tissue.

[Treatment of osteomyelitis and soft tissue defects at distal region of leg and foot by pedicled peroneus brevis muscle flaps and reverse island flaps with sural nerve and blood supplying vessels].

OBJECTIVE: To observe the clinical effect of distally pedicled peroneus brevis muscle flaps and reverse island flaps with sural nerve and blood supplying vessels on repairing osteomyelitis and soft tissue defects at distal region of leg and foot. METHODS: Twelve patients with osteomyelitis and soft tissue defects at distal region of leg and foot hospitalized from March 2008 to December 2010. Among them, 7 patients suffered from acute or chronic osteomyelitis and soft tissue defects at the distal end of tibia, 1 patient suffered from chronic osteomyelitis and chronic ulcer in the posterior aspect of achilles tendon, 4 patients suffered from acute or chronic osteomyelitis, soft tissue defects, and exposure of internal fixator in the lateral aspect of calcaneus. After debridement, soft tissue defect sizes ranged from 4 cm×2 cm to 13 cm×9 cm, and bone defect sizes ranged from 3.0 cm×3.0 cm×3.0 cm to 6.0 cm×3.0 cm×4.0 cm. The distally pedicled peroneus brevis muscle flaps with size ranging from 11 cm×3 cm to 16 cm×4 cm were used to fill the wound cavities of bone defects, and reverse island flaps with sural nerve and blood supplying vessels with size ranging from 5 cm×3 cm to 14 cm×10 cm were used for the repair of soft tissue defects. Flap donor sites were closed by direct suture or skin grafting. RESULTS: Muscle flaps and flaps survived in 11 cases, and the wounds healed well. Necrosis appeared in flap and muscle flap at the distal end in one patient, which was repaired with posterior tibial artery perforator myocutaneous flap. Patients were followed up for 6 to 24 months. Osteomyelitis did not recur, and both the texture and shape of flaps were satisfactory. CONCLUSIONS: The distally pedicled peroneus brevis muscle flaps and reverse island flaps with sural nerve and blood supplying vessels are suitable for the repair of osteomyelitis and soft tissue defects at distal region of leg and foot. The operation is simple, safe, reliable, and easy to perform.

Association between DBH 19 bp insertion/deletion polymorphism and cognition in first-episode schizophrenic patients.

Many genes associated with dopamine (DA) and norepinephrine (NE) systems influence cognitive deficits of schizophrenia patients, but one key enzyme is dopamine beta-hydroxylase (DBH), which converts DA to NE and whose activity and levels are under strong genetic control. This study examines the association of the 19 bp insertion/deletion (Ins/Del) polymorphism in the 5' flank of the DBH gene with cognitive deficits in first-episode schizophrenic patients (FEP). We assessed the cognitive function in 195 FEP and 304 healthy controls using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). The 19 bp Ins/Del polymorphism of DBH gene was genotyped. Our results showed that the allelic and genotypic frequencies of the 19 bp Ins/Del polymorphism significantly differed between FEP and healthy controls (both p < 0.05). Cognitive test scores were significantly lower in FEP than healthy controls on all scales (all p < 0.001) except for the visuospatial/constructional index (p > 0.05). Immediate memory abilities significantly differed by genotype (p<0.05) but not genotype×diagnosis. Immediate memory score was lower in FEP with DBH5'-Del/Del genotype (61.3 ± 17.2) than those with DBH5'-Ins/Ins genotype (68.6 ± 16.2; p < 0.05). The 19 bp Del allele was associated with poorer immediate memory performance than the Ins allele in FEP (p < 0.05). However, healthy controls did not show any differences in cognitive function indices between the Ins and Del for either the allele or genotype of the 19 bp Ins/Del polymorphism. Our findings suggest that the DBH5'-Ins/Del polymorphism may play a role in susceptibility to FEP. The DBH5'-Ins/Del polymorphism may also influence immediate memory in FEP. Moreover, FEP had poorer cognitive function than healthy controls in all examined cognitive domains except for the visuospatial/constructional index.

The application of distally pedicled peroneus brevis muscle flaps and retrograde neurocutaneous accompanying artery flaps for treatment of bony and soft-tissue 3-dimensional defects of the lower leg and foot.

To investigate the clinical effect of distally pedicled peroneus brevis muscle flaps and retrograde neurocutaneous flaps on treatment of bone and soft-tissue 3-dimensional defects of the lower leg and foot, the authors retrospectively studied all the patients admitted in their center in 3 consecutive years with bone and soft-tissue defects from March 2008 to February 2011; 21 patients suffering from traumatic and osteomyelitis were treated with peroneus brevis muscle flaps, for obliterating the hole-shaped bony defects after osteomyelitis debridement, and neurocutaneous flaps, for repairing associated soft-tissue defects. After thorough debridement, the average size of soft-tissue defects was 2 cm × 2 cm to 13 cm × 9 cm and that of bony defects was 2 cm × 2 cm × 2 cm to 6 cm × 3 cm × 3 cm. Neurocutaneous flaps completely survived in 20 cases, and the wounds healed at stage I; 1 case developed necrosis in the distal part of the peroneus brevis muscle flap and sural nerve flap, and the wound healed with a saphenous nerve flap. The flaps maintained good texture and shape during a follow-up of 6 to 24 months. Recurrence of osteomyelitis was not observed in any of the patients. In conclusion, distally pedicled peroneus brevis muscle flaps and retrograde neurocutaneous flaps are simple, safe, reliable, and suitable for clinical treatment of hole-shaped bony defects and reconstruction of soft-tissue defects within a single stage, especially when the 2 defects are located in different 3-dimensional spaces.

[Repair of deep burn wound of neck with supraclavicular island flap].

OBJECTIVE: To observe the therapeutic effect of supraclavicular island flap in repairing deep burn wound of neck. METHODS: Six patients with deep burn of neck hospitalized from January 2009 to June 2011 were enrolled in the study. Their total burn area ranged from 6% to 22% TBSA, of which full-thickness area ranged from 3% to 22% TBSA. The neck wound ranged from 12 cm x 5 cm to 15 cm x 8 cm in area, and they were all full-thickness in depth. One of the neck wounds was covered with granulation tissue. Patients underwent either debridement and escharectomy or excision of granulation tissue for the neck wound, and they were covered with supraclavicular island flap designed with the size corresponding to that of wound area. Four donor sites were sutured directly. The other two donor sites were covered with free skin graft. Survival of flaps and healing of donor sites were observed. The appearance and function recovery of operative regions were followed up. RESULTS: Supraclavicular island flaps of 6 patients survived as a whole. All the donor sites healed well. Flaps with satisfactory appearance and feeling sensation, accompanied by unlimited extension of neck were observed in the follow-up duration from 6 to 12 months. Scars observed in the flap edge and the donor sites were linear, and they did not affect the overall appearance and function of patients. CONCLUSIONS: Supraclavicular island flap is a good choice for repairing deep burn wound of neck, and it gives a good shape and function recovery of the neck.

[Analysis of 59 cases of frostbite in plain region].

OBJECTIVE: To retrospectively survey frostbite in patients living in plain regions, and to analyze the features of frostbite and the results after hospitalization. METHODS: Fifty-nine patients with frostbite, aged from 15 to 85 years admitted in Beijing Jishuitan Hospital from 1992 to 2007, were enrolled in this study. Occupation, cause of the injury, initial visit time, position and degree of depth (assessed according to the standard of burn injury) of frostbite, and amputation rate of patients were recorded and analyzed. RESULTS: Most patients of the 59 cases were workers or unemployed, the main reasons of injury were prolonged contact with material in a low temperature, with impaired consciousness, and having an out-door activity. The average first visit time was 11 days after the exposure. Frostbite was superficial 2(nd) to deep 2(nd) degree in 12 patients, while 47 patients were found to have 3(rd) to 4(th) degree injury. Limbs, or fingers and toes were amputated from 40 patients. The differences between patients visited within 3 days after frostbite and patients visited later than 3 days in respect of degree of depth of frostbite and amputation rate were statistically significant (P < 0.05). There was no significant difference in amputation rates in different body parts of frostbite (P > 0.05). CONCLUSIONS: Patients in plain regions mainly suffer frostbite at the distal portions of the extremities. They should visit hospital early after injury so that the degree of frostbite can be alleviated and rate of amputation can be lowered.