Autologous fat grafting combined with negative pressure wound therapy in severe diabetic foot ulcer: a case study.

OBJECTIVE: Hard-to-heal wounds are a surgical challenge, and diabetic foot ulcers (DFUs) are one of the most common and severe varieties. Previous studies have shown that autologous fat grafting (AFG) and negative pressure wound therapy (NPWT) have the potential to promote wound healing. This case study describes how these two methods together helped in the healing of a serious DFU. CASE HISTORY: A 65-year-old female patient had a severe DFU on her right foot, with a 30-year history of disease and renal failure. By the time symptoms were evident, regular dressing changes and antibiotic treatment were inadequate. She received surgical debridement, AFG and NPWT. Finally, as the granulation tissue covered the full wound bed, the wound was closed by split-thickness skin grafting. One month later, the DFU was fully healed with no recurrences. CONCLUSION: The application of AFG or components of adipose tissue to treat hard-to-heal wounds has been researched at both the molecular level and in clinic. In this case, we have proved the curative effect of jointly using AFG and NPWT.

Clinical value of serum new molecular markers in the early diagnosis of sepsis in elderly patients with burns / 中华老年医学杂志

Objective@#To investigate the clinical value of the serum new molecular markers, soluble triggering receptor expressed on myeloid cells-1(sTREM-1)and soluble hemoglobin scavenger receptor(sCD163), in the diagnosis of sepsis in elderly patients with burns.@*Methods@#A total of 58 inpatients with burns from Jun 2017 to June 2018 were enrolled in the study.Patients were divided into three groups: the sepsis group(n=12), the localized infection group(n=21)and the non-infection group(n=29). The levels of sTREM-1 and sCD163 were determined by enzyme-linked immunosorbent assays(ELISAs). The clinical diagnostic value of sTREM-1 and sCD163 was assessed by receiver operating characteristic(ROC)curve analysis.@*Results@#There was a statistically significant difference in the levels of sTREM-1 and sCD163 at day 1 between the three groups(F=20.994 and 38.363, P<0.01). Serum levels of sTREM-1 and sCD163 were higher in the sepsis group than in the localized infection group and the non-infection group.Serum levels of sTREM-1 and sCD163 were higher in the localized infection group than in the non-infection group.Serum levels of sTREM-1 and sCD163 were lower at day 7 than those at day 1 in all groups(F=21.242 and 41.035, P<0.01). Serum sTREM-1 levels were positively correlated with serum sCD163 levels(r=0.609, P=0.000). The AUC of sTREM-1 and sCD163 for the diagnosis of sepsis was 0.880(95%CI: 0.816~0.926).@*Conclusions@#Serum levels of sTREM-1 and sCD163 are elevated with increasing degrees of infection.Monitoring serum sTREM-1 and sCD163 levels is helpful for the diagnosis of sepsis in elderly patients with burns.

Clinical value of serum new molecular markers in the early diagnosis of sepsis in elderly patients with burns / 中华老年医学杂志

Objective To investigate the clinical value of the serum new molecular markers,soluble triggering receptor expressed on myeloid cells-1 (sTREM-1)and soluble hemoglobin scavenger receptor(sCD163),in the diagnosis of sepsis in elderly patients with burns.Methods A total of 58 inpatients with burns from Jun 2017 to June 2018 were enrolled in the study.Patients were divided into three groups:the sepsis group(n=12),the localized infection group(n=21)and the non-infection group (n=29).The levels of sTREM-1 and sCD163 were determined by enzyme-linked immunosorbent assays(ELISAs).The clinical diagnostic value of sTREM-1 and sCD163 was assessed by receiver operating characteristic(ROC)curve analysis.Results There was a statistically significant difference in thelevels of sTREM-1 and sCD163 at day 1 between the three groups(F =20.994 and 38.363,P＜0.01).Serum levels of sTREM-1 and sCD163 were higher in the sepsis group than in the localized infection group and the non-infection group.Serum levels of sTREM-1 and sCD163 were higher in the localized infection group than in the non-infection group.Serum levels of sTREM-1 and sCD163 were lower at day 7 than those at day 1 in all groups(F=21.242 and 41.035,P＜0.01).Serum sTREM-1 levels were positively correlated with serum sCD163 levels (r =0.609,P =0.000).The AUC of sTREM-1 and sCD163 for the diagnosis of sepsis was 0.880(95％CI:0.816～0.926).Conclusions Serum levels of sTREM-1 and sCD163 are elevated with increasing degrees of infection.Monitoring serum sTREM-1 and sCD163 levels is helpful for the diagnosis of sepsis in elderly patients with burns.

Application of botulinum toxin type A in myocutaneous flap expansion.

BACKGROUND: Although the use of the expanded myocutaneous flap has many advantages, the time course is prolonged. The net gain in surface area during acute expansion is insufficient. In this study, botulinum toxin type A was applied to shorten the flap expansion period while obtaining an adequate surface area that would meet surgical requirements. METHODS: Seven minipigs were used for the authors' experiments. Two sides of the dorsolumbar section in each pig were divided randomly into the botulinum toxin type A-treated and the saline-treated groups. Two 200-ml expanders were implanted in the submuscular pocket. Inflation began 2 weeks later, and the period of expansion was observed in a double-blind manner. Two weeks after the final inflation, the expansion area was measured, and a 10 x 6-cm myocutaneous flap was elevated and sutured in situ, and the contraction of the myocutaneous flap was observed. RESULTS: Botulinum toxin type A shortened the expansion time by 17 days (p < 0.001). The average increment of effective expansion area (p = 0.009) and the average recruitment area (p = 0.001) in the botulinum toxin type A-treated group were significantly higher than in the saline-treated group. Moreover, contraction in axial length and width of the botulinum toxin type A-treated group was lower than that of the saline-treated group at each time point following transposition (p < 0.001). CONCLUSIONS: Botulinum toxin type A could decrease the resistance to myocutaneous flap expansion, speed up the inflation, increase the expansion area, and reduce the contraction of the myocutaneous flap. It is a safe and convenient method with which to assist myocutaneous flap expansion.