Evaluation of a new tension relief system for securing wound closure: A single-centre, Chinese cohort study.

BACKGROUND: Wounds that have been closed under excessive tension, and skin defects that cannot be closed primarily, pose a daily challenge for the reconstructive surgeon. OBJECTIVE: To evaluate a new tension relief system (TRS) device for skin stretching and secure wound closure. METHODS: From September 2013 to March 2014, a consecutive series of 41 Chinese patients with 43 wounds were enrolled for application of 50 cycles of TRS therapy. TRS was used for two main clinical applications: closure of a variety of surgical/traumatic wounds; and securing wound closure after high-tension suture closure. Basic information and details regarding this therapy and its complications were recorded. Follow-up visits were conducted three to six months after wound closure. RESULTS: Mean residual wound width decreased approximately 20% every two days during cycles of TRS therapy. Infection was the most common complication (five cases). Other complications included dehiscence (two cases) and pressure ulcer (one case). At the six-month follow-up visit, (21 wounds in 20 patients), both the extent of healing and the scar were acceptable. DISCUSSION: There are no absolute contraindications to TRS therapy. The authors have formulated instructions for the prevention and treatment of the most common complications. CONCLUSIONS: The results demonstrate that TRS therapy is a simple, effective method for primary closure of difficult wounds, and large skin and soft-tissue defects. Larger randomized studies are required to further evaluate of the effectiveness, indications, complications and cost effectiveness of this innovative TRS therapy.

HISTORIQUE: Les plaies fermées sous tension excessive et les anomalies cutanées qui ne peuvent pas être fermées par une intervention primaire représentent un problème quotidien pour le plasticien. OBJECTIF: Évaluer un nouveau système de soulagement des tensions (SST) pour étirer la peau et assurer la fermeture des plaies. MÉTHODOLOGIE: De septembre 2013 à mars 2014, une série consécutive de 41 patients chinois présentant 43 plaies ont été inscrits pour recevoir 50 cycles de traitement par SST. Le SST était utilisé pour deux principales applications cliniques : fermer diverses plaies chirurgicales ou traumatiques et assurer la fermeture des plaies après une suture à haute tension. Les chercheurs ont colligé l'information générale et détaillée au sujet de ce traitement et de ses complications. Les rendez-vous de suivi ont eu lieu de trois à six mois après la fermeture des plaies. RÉSULTATS: La largeur des plaies résiduelles moyennes diminuait d'environ 20 % tous les deux jours pendant les cycles de traitement par SST. L'infection était la complication la plus courante (cinq cas). Les autres complications étaient la déhiscence (deux cas) et l'ulcère de pression (un cas). Au rendez-vous de suivi six mois plus tard (21 plaies chez 20 patients), tant le processus de cicatrisation que la cicatrice étaient acceptables. EXPOSÉ: Il n'y a pas de contre-indications absolues au traitement par SST. Les auteurs ont formulé des directives pour prévenir et traiter les complications les plus courantes. CONCLUSIONS: Les résultats démontrent que le traitement par SST est une méthode simple et efficace pour assurer la fermeture primaire de plaies complexes et d'importantes anomalies de la peau et des tissus mous. Des études aléatoires plus vastes s'imposent pour approfondir l'évaluation de l'efficacité, des indications, des complications et du rapport coût-efficacité de ce traitement novateur par SST.

A Skin-stretching Wound Closure System to Prevent and Manage Dehiscence of High-tension Flap Donor Sites: A Report of 2 Cases.

Tension on the suture line of flap donor sites raises the risk of delayed healing and wound dehiscence. Closing a large flap donor site without a skin/flap graft is a major surgical challenge. Recently, the authors started using a skin-stretching wound closure system designed to harness both mechanical creep and stress-relaxation principles for the management of a variety of surgically closed wounds, including flap donor sites. The system consists of a pair of attachment plates connected by a long, flexible approximation strap that can be invasively (sutured) or noninvasively (by adhesion) secured to the skin wound edges and gradually tightened. The care and outcomes of 2 of the 41 patients whose wounds were managed with this system at the authors\'92 plastic/reconstructive and wound repair center during a period of 7 months are described. The first case involved a 20-year-old patient with a 16 cm x 8 cm deep inferior epigastric perforator flap to reconstruct a malignant tumor resection of the groin. The second patient required a 10 cm x 8 cm anterolateral thigh free-flap to repair a traumatic dorsal skin, soft tissue defect. Wounds were assessed and tension adjusted every 2 or 3 days. Both lesions healed by primary intention and with a good cosmetic outcome. Controlled clinical studies are needed to examine the effectiveness, efficacy, indications, complications, and cost effectiveness of this closure system.

Follicular unit transplantation for the treatment of secondary cicatricial alopecia.

BACKGROUND: Cicatricial alopecia encompasses a diverse group of disorders characterized by the permanent destruction of hair follicles and irreversible hair loss. Follicular unit transplantation was developed in 1994. However, large-scale clinical trials are necessary to study follicular unit transplantation for treating Chinese cicatricial alopecia patients. OBJECTIVE: To investigate the efficacy of follicular unit transplantation in the treatment of cicatricial alopecia in Chinese patients. METHODS: Patients with cicatricial alopecia were enrolled. The designated recipient area, follicular unit density of the donor site, transplanted density and operative time were recorded. Postoperative follow-up was conducted within six to 24 months; the density of hair in the recipient area was calculated using a Folliscope (Hansderma Co, USA). Patients' self-reported satisfaction and long-term complications were recorded. RESULTS: Thirty-seven patients were enrolled. Cicatricial alopecia was caused by burns (n=8), trauma (n=21) and plastic surgery (cleft lip and palate repair [n=8]). Burn patients had a significantly larger bald area than the other patients (P<0.01). The operative time was significantly correlated with recipient area. The longest operation was 14.5 h; the largest transplanted area was 96 cm(2). At follow-up, the surviving follicular unit density/transplanted follicular unit density rate was 64.29% to 95.00% (mean 78.96%); the surviving/transplanted (S/T) area was 100% for 30 patients, 90% to 100% for five patients and <90% for two patients. The lowest S/T area was 82.81%. The S/T index was significantly and inversely correlated with operative time. Regarding long-term complications, two patients had postoperative epidermoid cysts that healed with local treatment. CONCLUSION: Follicular unit transplantation is an effective method for treating cicatricial alopecia. It is relatively safe and yields satisfactory postoperative results. Extending the results of the present study to Chinese clinical practice is warranted.

HISTORIQUE: L'alopécie cicatricielle englobe un groupe diversifié de troubles caractérisés par la destruction permanente de follicules pileux et une perte de cheveux irréversible. La greffe folliculaire a été mise au point en 1994. Cependant, des essais cliniques à grande échelle s'imposent pour l'étudier dans le traitement de l'alopécie cicatricielle chez des patients chinois. OBJECTIF: Étudier l'efficacité de la greffe folliculaire pour traiter l'alopécie cicatricielle chez des patients chinois. MÉTHODOLOGIE: Les chercheurs ont recruté des patients présentant une alopécie cicatricielle. Ils ont consigné la zone désignée, la densité des unités folliculaires au foyer du donneur, la densité greffée et le temps d'opération. Ils ont effectué un suivi postopératoire dans les six à 24 mois et calculé la densité pileuse du receveur à l'aide d'un folliscope (Hansderma Co, États-Unis). Ils ont consigné la satisfaction des patients et les complications à long terme. RÉSULTATS: Trente-sept patients ont participé. L'alopécie cicatricielle était causée par des brûlures (n=8), des traumatismes (n=21) et la chirurgie plastique (réparation d'une fissure palatine et labiale [n=8]). Les patients brûlés présentaient des zones d'alopécie beaucoup plus importantes que les autres patients (P<0,01). Le temps de l'opération était corrélé avec la zone du receveur. L'opération la plus longue a pris 14,5 heures et la greffe la plus vaste était de 96 cm2. Au suivi, le ratio entre la densité des unités folliculaires survivantes et la densité des unités folliculaires greffées variait entre 64,29 % et 95,00 % (moyenne de 78,96 %). Le ratio entre la zone survivante et la zone greffée (S/T) était de 100 % pour 30 patients, de 90 % à 100 % pour cinq patients et de moins de 90 % pour deux patients. La zone S/T la plus faible était de 82,81 %. L'indice S/T, significatif, était inversement proportionnel avec la durée de l'opération. Pour ce qui est des complications à long terme, deux patients ont présenté des kystes épidermoïdes postopératoires qui ont guéri grâce à un traitement localisé. CONCLUSION: La greffe folliculaire traite l'alopécie cicatricielle avec efficacité. Relativement sécuritaire, elle donne des résultats postopératoires satisfaisants. Il faudra étendre les résultats de la présente étude à la pratique clinique en Chine.

Cytokines in children with low absolute lymphocyte count / 国际检验医学杂志

Objective To investigate the levels of inflammatory cytokines in children with low absolute lymphocyte count (ALC).Methods 56 patients with low ALC as the patients group and 20 children with healthy physical examination as the control group were enrolled.Several inflammatory cytokines,namely IL-1,IL-6,IL-8 and TNF-βwere measured with enzyme linked immu-nosorbent assay(ELISA)kits.High sensitive C reactive protein(Hs-CRP)was measured by the immunoturbidimetry(ITM)kit with the automatic biochemical analyzer.Results The concentrations of IL-1,IL-6,IL-8 and TNF-βin the patients were(0.096±0.012) ng/mL,(0.118±0.026)ng/mL,(0.388 ±0.069)ng/mL and(1.256 ±0.245 )ng/mL respectively,which had no statistical differ-ences as compared with the control group(P >0.05);the concentration of HsCRP in the patients group was(5.7±2.8)mg/L,while which in the control group was(4.8±2.6)mg/L,showing no statistically significant difference between them(P >0.05).Conclusion The levels of the cytokines in low ALC patients are not increased,which may be related with the other factors.Actively using tra-ditional Chinese medicine treatment is beneficial to the recovery of disease.