Acellular allogenic dermis combined with VSD for repair of abdominal wall defect: a case series.

OBJECTIVE: To explore the clinical application of acellular allogenic dermis combined with VSD in repairing abdominal wall defect combined with abdominal infection. METHODS: Clinical data of 5 cases of abdominal cavity infection with abdominal wall defect admitted in the Burn Department of Quanzhou First Hospital from January 2019 to January 2022 were collected for this study. The abdominal cavity was closed temporarily after debridement and VSD in the early stage, and the abdominal wall defect was repaired by acellular allogeneic dermis combined with autologous split-thickness skin graft in the second stage. The changes of infection indexes (WBC, CRP, PCT, Lac) before and after treatment and the clinical therapeutic effect were observed. RESULTS: In the 5 observed cases, the infection index decreased significantly, the intra-abdominal pressure was normal, and there was no abdominal wall hernia, intestinal adhesion, intestinal obstruction or any other complications. The wound of abdominal wall defect achieved stage 1 healing, the local scar tissue only has slight proliferation, and the appearance was satisfying. There was no recurrence in 6 months follow-up. CONCLUSION: Early use of VSD can effectively control abdominal infection and reduce the occurrence of intestinal fistula or other complications. In the later stage of treatment, acellular allogenic dermis combined with autologous split-thickness skin graft can effectively repair abdominal wall defect.

Application of Autogenous Dermis Combined With Local Flap Transplantation in Repair of Titanium Mesh Exposure After Cranioplasty.

OBJECTIVES: To investigate the clinical outcome of autogenous dermis combined with local flap transplantation in the treatment of titanium mesh exposure after cranioplasty. METHODS: We studied a total of 8 patients with titanium mesh exposure after cranioplasty. After debridement of the head wound, the autogenous dermal tissue from the lateral thigh was transplanted to the surface of titanium mesh, and the local skin flap was then applied after suturing and fixation to repair the wound on the surface of the dermis. To repair the lateral thigh dermal tissue area, a local skin flap was obtained, and a blade thick skin graft was used. RESULTS: Both dermal tissue and local skin flap survived. In the meanwhile, the donor skin area of the lateral thigh healed well, with only slight scar hyperplasia, and the titanium mesh was preserved. There was no recurrence after 6 months of follow-up. CONCLUSIONS: The application of autogenous dermis combined with local skin flap to repair titanium mesh exposure can effectively avoid skin flap necrosis, potential re-exposure of titanium mesh, sub-flap effusion, infection, and other problems. This method has an ideal effect, has easy access to materials, and reduces patients' economic burden. It is worth popularizing.

SOX10 modulated SMARCA4 dysregulation alleviates DNA replication stress in cutaneous melanoma.

Cutaneous melanoma (CM) is the most fatal type of skin cancer with a high potency of metastasis, yet the treatment for metastatic melanoma remains limited. In this study, we are devoted to addressing the prognostic value and underlying mechanism of DNA damage repair-related genes in CM. We utilized integrated bioinformatic approaches and machine learning models to identify a cluster of convergently expressed DNA damage repair-related genes in melanoma. With multivariate Cox regression, SMARCA4 (also known as BRG1) was identified as an independent prognostic marker for melanoma patients. Yet the expression of SMARCA4 is not altered with the pathological staging or the metastasis condition. SMARCA4 is an essential ATPase subunit of the mammalian SWI/SNF complex. Mechanistically, we demonstrated that SMARCA4 could resolve DNA replication stress and guarantee the proliferation of melanoma cells. Furthermore, we predicted the binding of different transcription factors on the SMARCA4 promoter and unveiled the modulated expression of SMARCA4 by SOX10 in melanoma. Together, we performed integrated approaches to identify SMARCA4 as a promising prognostic marker for melanoma, which was transcriptionally regulated by SOX10 and promoted melanoma cell proliferation by ameliorating DNA replication stress.

Application of damage control surgery in patients with sacrococcygeal deep decubitus ulcers complicated by sepsis.

OBJECTIVE: To evaluate the clinical application of damage control surgery (DCS) in patients with sacrococcygeal deep decubitus ulcers complicated by sepsis. METHODS: We conducted a 3-year retrospective clinical study of 32 patients with deep sacrococcygeal bedsores and sepsis admitted from January 2018 to January 2021. According to the concept of DCS, the wound was temporarily closed with vacuum sealing drainage after primary debridement, and a local rhomboid flap was designed to repair the wound in the second stage. Finally, the clinical therapeutic effect was observed. RESULTS: Twenty-nine patients were treated with skin flap translocation and were cured clinically. Specifically, the skin flap survived in 27 of the 29 patients after the first translocation attempt (success rate of 93.1%). One patient developed incisional dehiscence, and one patient developed a hydrocele under the skin flap. CONCLUSIONS: Application of DCS in patients with sacrococcygeal deep decubitus ulcers complicated by sepsis improves the therapeutic success rate and reduces the risks of the operation and complication rate. It has unique advantages and is worthy of clinical promotion.

Necrotizing Fasciitis Shock Syndrome by Group A Hemolytic Streptococcus: Report of 6 Cases and Clinical Management.

BACKGROUND: To explore the comprehensive treatment of group A streptococcus haemolyticus complicated with streptococcal toxic shock syndrome (STSS) in surgery. METHODS: Six patients with Type II necrotizing fasciitis complicated with STSS were enrolled from September 2018 to October 2019 in the Burn Department at Quanzhou First Hospital. The patients were treated with early incision and reduction of tension, anti-shock, anti-infection, primary debridement and vacuum suction, maintenance of organ function, and adjustment of internal environment, secondary autologous skin graft, and early rehabilitation. RESULTS: Five patients were healed, while one elderly patient refused treatment. CONCLUSIONS: We should be alert to necrotizing fasciitis caused by group A hemolytic streptococcus (GAS) infection and effectively avoid the occurrence of STSS. By making an incision to reduce tension, adopting the principle of anti-infection, and actively anti-shock, maintaining the function of internal organs and the stability of internal environment, debridement and vacuum suction in early and effective stage, followed by selfskin graft to seal the wound and early rehabilitation the treatment of Type II NF and STSS can be effectively improved.