Repair of cervical postradiation ulcer following radical mastectomy with lower trapezius myocutaneous flap / 中华烧伤杂志

<p><b>OBJECTIVE</b>To explore the clinical effects of ipsilateral lower trapezius myocutaneous flap for repairing cervical ulcer as a result of radiotherapy after radical mastectomy.</p><p><b>METHODS</b>Six patients with cervical ulcers as a result of radiotherapy after radical mastectomy were hospitalized from March 2010 to February 2015, suffering from persistent pain in different degrees. The wound area ranged from 6 cm × 4 cm to 10 cm × 6 cm before debridement, 8 cm × 5 cm to 16 cm × 10 cm after debridement. Ipsilateral lower trapezius myocutaneous flap was used to repair the wound after thorough debridement, with the area ranging from 10 cm × 7 cm to 20 cm × 13 cm. The donor sites were sutured directly or covered with medium-thickness skin graft obtained from the back.</p><p><b>RESULTS</b>Pain was obviously relieved in all the patients 2 days after surgery. The wounds in five patients were healed, while necrosis of superficial skin approximately 1 cm in diameter appeared at the distal end of one myocutaneous flap, and it healed after dressing change. During the follow-up period of 3 to 18 months, no recurrence of ulcer was found, the texture of the myocutaneous flaps was soft with good appearance, and the donor sites healed well.</p><p><b>CONCLUSIONS</b>On the basis of thorough debridement, it is feasible to repair the cervical ulcer as a result of radiotherapy after radical mastectomy with the ipsilateral lower trapezius myocutaneous flap.</p>

Analysis of clinical characteristics of 443 patients with inhalation injury / 中华烧伤杂志

<p><b>OBJECTIVE</b>To explore the epidemiological characteristics of inhalation injury and to summarize the clinical application experience of diagnostic standard of burn of larynx.</p><p><b>METHODS</b>Medical records of 443 patients with inhalation injury admitted to our burn unit from January 1999 to June 2013 were analyzed, including gender, age, severity of inhalation injury, complications and diseases before injury; total area and that of full-thickness burn injury, admission time after burn, and burn condition of larynx of patients with different degrees of inhalation injury; treatment and outcome including rate, time, and complication of tracheotomy, mortality, and cause of death. Data were processed with nonparametric Kruskal-Wallis test and chi-square test. The relationship between severity of inhalation injury and total burn area, degree of burn of larynx, tracheotomy rate, and mortality was assessed by Spearman correlation analysis.</p><p><b>RESULTS</b>(1) Among the patients, there were 353 (79.7% ) male and 90 (20.3% ) female, with the ratio of male to female 4:1. There were 64 (14.4%) patients younger than or equal to 20 years, 203 (45.8%) patients older than 20 years and younger than or equal to 40 years, 144 (32.5%) patients older than 40 years and younger than or equal to 60 years, and 32 (7.2%) patients older than 60 years. The numbers of patients with mild, moderate, and severe inhalation injury were respectively 297, 108, and 38. Seven patients suffered from complications, and 21 patients had diseases before injury. There were statistically significant differences among the patients with different degree of inhalation injury in regard to total burn area and full-thickness burn area (with H values respectively 73.752 and 142.830, P values below 0.01), while no statistically significant difference was observed in admission time after burn ( H = 1.528, P > 0.05). Correlation analysis showed that severity of inhalation injury was positively correlated with total burn area (r = 0.399, P < 0.001). Among the patients with mild inhalation injury, incidences of patients with mild, moderate, and severe burn of larynx were respectively 68.0% (202/297), 32.0% (95/297), and 0, and those among the patients with moderate inhalation injury were respectively 0,53.7% (58/108), and 46.3% (50/108). There were statistically significant differences in degree of burn of larynx of patients with different degree of inhalation injury (χ2 = 336.703, P < 0.001). Correlation analysis showed that severity of burn of larynx was positively correlated with severity of inhalation injury (r = 0.700, P < 0.001). (2) The rate of tracheotomy was 37.02% (164/443). The rates of tracheotomy in patients with mild, moderate, and severe inhalation injury were respectively 10.44% (31/297), 87.96% (95/108), and 100.00% (38/38), χ2 = 271.654, P < 0.001. Correlation analysis showed that the rate of tracheotomy was positively correlated with severity of inhalation injury (r = 0.784, P < 0.001). Tracheotomy was done mainly within 6 h post burn (63.4%, 104/164). The incidence rate of complication of tracheotomy was 5.5% (9/164). (3) Thirty-one patients died, with a mortality rate of 7.00%. The mortality rates of patients with mild, moderate, and severe inhalation injury were respectively 1.01% (3/297), 12.96% (14/108), and 36.84% (14/38), H = 74.273, P < 0.001. It was found that the mortality was positively correlated with severity of inhalation injury (r = 0.371, P < 0.001). The causes of death of the patients were respectively sepsis (14, 45.2%), respiratory failure (7, 22.6%), airway obstruction (2, 6.5%), airway hemorrhage (2, 6.5%), cerebral hemorrhage (2, 6.5%), cardiac accident (2, 6.5%), and diabetes insipidus (1, 3.2%), and 1 (3.2%) patient quit treatment and discharged from hospital for economic reason.</p><p><b>CONCLUSIONS</b>Among the patients with inhalation injury, male is dominated in number, and the young adults formed the highest constituent ratio. The severity of inhalation injury was correlated with total burn area, severity of burn of larynx, tracheotomy rate, and mortality. With the guidance of diagnostic criteria of burn of larynx and indication of tracheotomy, the risk of laryngeal obstruction can be eliminated. The early preventive tracheotomy can decrease the difficulty and risk of the operation.</p>

A retrospective analysis of 5 cases of major burns treated by goat acellular dermal matrix combined with hyaluronic acid / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the clinical efficacy of the goat acellular dermal matrix combined with hyaluronic acid (h-GADM) in the treatment of major burns.</p><p><b>METHODS</b>A retrospective analysis of 5 patients with major burns undergoing combines microskin and h-GADM grafting. All patients were male, aged 33 to 50 years, and mean burn area were 83% ± 11%, which III degree wounds 60% to 90%. After extensive burns patients admitted to hospital in accordance with conventional treatment processes included fluid resuscitation, airway management, wound management, infection control and other treatment. The patients received the surgery after the shock of spending and hemodynamically stable. Summarized the feasibility and operative techniques of the new method, and elaborated on details by a typical case as an example.</p><p><b>RESULTS</b>All the 5 patients were survival, go through the shock period smoothly, not haven any serious complications as lung infection, wound sepsis, septicemia and kidney failure occurred. A total of nine mircoskin graft operations were undergoing and covered 17 limbs. The average time of the h-GADM desquamtion was (17.7 ± 2.7) days after operation, the hospitalization time was (115 ± 27) days. After (72 ± 6) days, the residual wound was less than 5% total body surface area.</p><p><b>CONCLUSION</b>The h-GAMD can be a good alternative to cadaver skin in the treatment of major burns.</p>