【摘要】 目的 探讨中成药参附注射液对大鼠深Ⅱ度烧伤创面愈合的影响。 方法 选用16只Sprague-Dawley（SD）大鼠，随机分为实验组、对照组，每组各8只，建立20%体表面积深Ⅱ度烫伤模型。烫伤后即刻及此后每天，实验组大鼠以参附注射液20 mL/kg腹腔注射给药，1次/d，连续给药5 d；对照组给予注射等剂量的生理盐水。分别于致伤后的7、14 d取创面组织块，光学显微镜观察成纤维细胞及胶原纤维生长情况，电子显微镜观察致伤后14 d成纤维细胞细胞器情况，分别计算烧伤后第7、14天两组的创面愈合率，并观察比较两组创面愈合的时间。 结果 所有选入实验的SD大鼠均存活至实验结束。实验组、对照组术后第7天创面愈合率分别为（36.34±2.55）%及（33.13±2.62）%，两组差异有统计学意义（t=2.486，P=0.027）；实验组、对照组术后第14天创面愈合率分别为（75.71±2.29）%及（72.36±2.85）%，两组差异有统计学意义（t=2.590，P=0.022）；实验组、对照组创面愈合时间分别为（20.88±1.36）、（22.94±2.16） d，两组差异有统计学意义（t=-2.286，P=0.0395）。伤后7、14 d创面组织块切片光学显微镜观察发现，实验组肉芽组织及胶原纤维较多，排列更有序，表皮基底细胞增殖活跃，炎症反应较轻；伤后14 d时电子显微镜观察发现，实验组成纤维细胞的细胞器更丰富，分泌胶原更多，实验组创面愈合情况优于对照组。 结论 腹腔注射参附注射液可以促进烧伤创面的愈合，其可能的机制为清除氧自由基，抗脂质过氧化。【Abstract】 Objective To explore the effect of Shenfu injection on promoting healing of deep partial-thickness burn wound in rats. Methods Sixteen Sprague-Dawley (SD) rats were randomly selected, and deep partial-thickness burn with 20% of the body surface was inflicted. The rats were randomly divided into experimental group and control group with eight in each group. Rats in the experimental group were treated with abdominal injection of Shenfu injection at a dose of 20 mL/(kg•d) for five days continually, and rats in the control group were treated with the same dose of 0.9% saline solution. The growth of granulation tissue and collagen fibers were evaluated under light microscope at the seventh and the fourteenth day. The growth of fibroblast was observed under transmission electron microscope at the fourteenth day. The cure rate of both groups of rats at the seventh and fourteenth day was calculated. Then we compared their healing time and the cure rate of the traumatic wound respectively. Results All rats had survived until wound healing. The cure rate at the seventh day for the experimental group and the control group was (36.34±2.55)% and (33.13±2.62)%, and their difference was statistical (t=2.486, P=0.027); At the fourteenth day, the cure rate was respectively (75.71±2.29)% and (72.36±2.85)% with a significant difference between each other (t=2.590, P=0.022). The healing time of the experimental group (20.88±1.36) was significantly shorter than that of the control group (22.9±2.16) (t=-2.286, P=0.040). At the seventh and fourteenth day, light microscope observation showed that the growth of granulation tissue and collagen fibers for rats in the experimental group were much more than that in the control group, the basale cell proliferation was more active, and inflammation was slighter. Through transmission electron microscope, we observed more fibroblast and collagen in the experimental group, which showed a better cure than the control group. Conclusion Shenfu injection can significantly promote wound healing of deep partial-thickness burn. It may possibly get this effect through anti-oxidation.
Objective To explore a surgical method for chronic osteomyel itis of sternum after thoracotomy. Methods From January 2006 to February 2009, 11 cases of chronic osteomyelitis after thoracotomy (2 cases of coronary bypass, 6 cases of mitral valve replacement, and 3 cases of ventricular defect repair) were admitted. Of them, there were 6 males and 5females, aged from 6 to 62 years (median 34 years), including 6 cases of simple osteomyelitis of sternum, 2 cases of osteomyelitis of sternum with suppurative infection of mediastinum, and 3 cases osteomyel itis of sternum with costal chondritis. Necrotic sternum were excised and defect was from 4 cm × 3 cm to 7 cm × 4 cm. Greater pectoral muscle flap was designed from 8 cm × 5 cm to 10 cm × 6 cm on one side and was transferred to defect. Negative drainage and sensitive antibiotics were administered after operation. Results Healing by first intention was achieved in 10 patients except 1 patient who had a few discharge at the drainage outlet and whose incision healed 1 week later. The follow up was from 3 to 10 months with an average of 6 months. The formed scars were flat with soft texture in 8 patients and moderately hypertrophy in 3 patients. The wounds healed without pain, relapse or abnormal function of donor upper limb. Conclusion Transplantation of greater pectoral muscle flap is an effective way to repair chronic osteomyelitis of sternum after thoracotomy.
Objective To investigate the effects of glutathione (GSH) on survival of the random skin flap in rats and the probable mechanism that contribute to this effect. Methods Twenty SD rats with 200-250 g in weight, were randomly divided into the experimental group and control group(n=10). Random flap of 8 cm×2 cm in size was made on the back of each rat with the pedicel on the angular of the scapular. GSH(250 mg/kg) and NS of the same dose were injected into the abdominal cavity of rats in the experimental groupand the control group immediately after the operative, 1st and 2nd days respectively. The rats were killed on the 7th day after the operation. The tissue pathology, the survival rate of the flap, the superoxide dismutase(SOD) activity and malonyldialdehyde (MDA) level were compared between two groups. Results The mean survival rate of the flap on the 7th day in the experimental group（56.77%±10.67%） was higher than that in the control group(40.16%±7.12%)(Plt;0.05).SOD activity in experimental group （306.06±84.87 U/mgprot）was higher than that in the control group （224.79±27.12 U/mgprot）, while MDA level （3.835±0.457 nmol/mgprot）was lower than that in the control group (6.127±0.837 nmol/mgprot)(Plt;0.05). Histological observation showed that the neutrophil infiltration was less in experimental group than that in the control group; that the experimental group was surperior to the control group in angiogenesis, fibroblasts, fair cells and cuaneous gland. Conclusion The intraperitoneal use of GSH may promote the survival rate of the random flaps and the possible mechanism for improvement may lies in that the GSH can reduce the level of oxygen free radical and lipidperoxidation,and lessen neutrophil infiltration.
Objective To investigate the effectiveness of high frequency color Doppler ultrasound for detecting perforators in the anterolateral thigh (ALT) flap surgery. Methods Between February 2011 and July 2012, 8 patients underwent high frequency color Doppler ultrasound to detect the perforator anatomy before ALT flap surgery. There were 5 males and 3 females, aged 21-46 years (mean, 34 years). Defects were caused by excision of squamous cell carcinoma in 2 cases, by scalp avulsion in 2 cases, by soft tissue necrosis after neck trauma in 1 case, by excision of groin fibrosarcoma in 1 case, by excision of groin melanoma in 1 case, and by malformation of the face in 1 case. The defect size varied from 12 cm × 7 cm to 22 cm × 18 cm. The perforator with wider caliber, faster flow speed, and shorter intramuscular trajectory was selected, and the flap was designed according to the observed results, which size varied from 14 cm × 9 cm to 25 cm × 20 cm. The donnor sites were repaired by free skin graft. Results Totally, 19 perforators in the flap area were detected by high frequency color Doppler ultrasound, and 18 were identified during operation, with an accuracy rate of 94.7%. The point going out muscle, the travel and direction of perforators observed during operation were basically in accordance with those detected by high frequency color Doppler ultrasound. The other flaps survived, and obtained healing by first intention except 1 flap which had partial fat necrosis with healing by second intention. The skin graft at donor site survived. All patients followed up 4-16 months (mean, 8 months). The flaps had good color and texture. Conclusion High frequency color Doppler ultrasound is a valuable imaging modality for the preoperative assessment of the vascular supply for ALT flap.
Objective To review the emergency management and perioperative strategies for ruptured neurofibromatosis type 1 (NF1)-related giant plexiform neurofibroma (PNF), providing a systematic treatment protocol to improve the therapeutic outcomes and quality of life for patients with giant PNF. Methods The literature on the management of giant PNF rupture and hemorrhage was reviewed, and the diagnosis, treatment, and perioperative management were summarized based on clinical experiences. Results By implementing an integrated diagnostic and treatment strategy that includes early diagnosis, imaging evaluation, emergency ultra-selective arterial embolization combined with surgical excision, acute hemorrhage can be effectively controlled while also reducing the risk of major intraoperative bleeding and minimizing postoperative complications. As a result, this approach significantly improves treatment success rates and patient quality of life. Conclusion For ruptured NF1-related giant PNF, employing emergency ultra-selective arterial embolization combined with surgical excision, under the collaboration of a multidisciplinary team, can effectively improve treatment success rates, rapidly control bleeding, reduce tumor size, and lower mortality. Future research should focus on assessing the long-term quality of life of patients treated for ruptured and hemorrhaging giant PNF and on further optimizing treatment protocols.