[Clinical application of platelet-rich fibrin in chronic wounds combined with subcutaneous stalking sinus].

Objective: To investigate the clinical effect of platelet-rich fibrin (PRF) in the treatment of chronic wounds combined with subcutaneous stalking sinus caused by various kinds of reasons. Methods: The clinical data of 72 patients with chronic wounds and combined with subcutaneous stalking sinus caused by various kinds of reasons admitted to our unit from June 2015 to February 2017, conforming to the study criteria, were collected and retrospectively analyzed. Patients were divided into group PRF (n=39) and routine dressing change (RDC) group (n=33) according to their treatment. The subcutaneous stalking sinuses of patients in group PRF were filled with PRF 1 or 2 times after debridement, while the surface of wound was covered by vaseline gauze and aseptic dressing, and dressing change was performed once per 2-3 days. The wounds of patients in group RDC were filled with iodine gauze after debridement of wounds and wrapped up with conventional aseptic dressing, and dressing change was performed once per 0.5-2.0 days. The times of operation, the times of dressing change, the time for negative-conversing of bacteria culture in the secretion of wound, the time of subcutaneous stalking sinus closure, and the complete healing time of wounds of patients in two groups were recorded. Data were processed with Chi-square test and independent sample t test. Results: The operation times of patients in two groups were close (t=0.565, P>0.05). The dressing changes of patients in group PRF were (6.4±2.1) times, significantly less than (19.2±6.2) times in group RDC, t=12.107, P<0.01. The time for negative-conversing of bacteria culture in the secretion of wound of patients in group PRF was (15±5) d, significantly shorter than (25±9) d in group RDC, t=6.087, P<0.01. The time of subcutaneous stalking sinus closure of patients in group PRF was (12±5) d, significantly shorter than (24±8) d in group RDC, t=7.315, P<0.01. The complete healing time of wounds of patients in group PRF was (23±7) d, significantly shorter than (35±10) d in group RDC, t=5.924, P<0.01. All the chronic wounds of patients in two groups were completely healed, and there were no break or new sinus formed during the follow-up of 4-12 months after discharge. Conclusions: The application of PRF in the treatment of chronic wounds combined with subcutaneous stalking sinus caused by various reasons can bring about rapidly healing of wounds, definite effect, and convenient operation, thus is worth promoting and applying in clinic.

[Clinical outcome of totally thoracoscopic cardiac surgery for mitral valve replacement: a series of 634 cases].

OBJECTIVE: To summarize the clinical outcome of totally thoracoscopic cardiac surgery for mitral valve replacement. METHODS: Clinical data of 634 cases undergoing totally thoracoscopic cardiac surgery for mitral valve replacement from May 2004 to February 2016 in Department of Thoracoscopic Cardiacsurgery, Shanghai Yodak Cardiothoracic Hospital was analyzed retrospectively. There were 292 male and 342 female patients, aged from 17 to 68 years with a mean of (45±13) years. All the 634 patients had moderate-severe mitral valve stenosis and (or) incompetence, 263 patients had moderate-severe tricuspid valve incompetence, 356 patients had atrial fibrillation, 46 patients had left atrium thrombosis. Cardiopulmonary bypass was established with right femoral artery and a single 2 stage venus cannula in the right atrium. The ascending aorta was cross-clamped and the myocardium was protected by coronary perfusion with cold crystalloid cardioplegia. Totally thoracoscopic mitral valve replacement were performed. RESULTS: Thirteen cases had incision expanded and 8 cases had conversions to sternotomy. Cardiopulmonary bypass and aortic cross-clamp time were (89±18) minutes and (51±12) minutes, respectively. Operation time was (3.1±1.2) hours. Mechanical ventilation time and intensive care unit stay were (17±6) hours and (27±8) hours, respectively. Postoperation drainage quantity was (390±70) ml. The hospital days was (9.2±2.1) days. There were 5 cases in-hospital deaths. Postoperative complications occurred in 42 cases (6.6%), including 18 cases of right hemoneumothorax, 12 cases of reoperation for bleeding, 3 cases of perivalvular leakage (reoperation was done in 1 patient), 3 cases of low cardiac output syndrome, 2 cases of acute renal failure, 2 cases of inferior vena cava injury, 1 case of right femoral artery thrombosis and liver injury, respectively. The mean duration of follow-up was (58±9) months in 608 cases, with a follow-up rate of 96.7% (608/629). Three patients had died during the period of follow-up caused by congestive heart failure (2 patients) and stroke (1 patient). Late complication among 605 survivors were 37 cases, including 32 cases of moderate tricuspid valve insufficiency, 3 cases of stroke, 1 case of perivalvular leakage and infective endocarditis, respectively.There was no reoperation during the period of follow-up. CONCLUSION: Totally thoracoscopic cardiac surgery for mitral valve replacement is safe and effective, with unique superiority and clinical feasible.