Objective To observe the effect of radiofrequency ablation technology for the treatment of infected wounds in minipigs. Methods Infected wounds of full-thickness skin defects (about 6.15 cm2/wound) were prepared in 8 6-month-old minipigs (weighing, 30-35 kg) using the method of Davis et al. The 160 wounds were randomly divided into 4 groups (n=40). Infected wounds were debrided with the radiofrequency ablation technology in group A, with the electric knife in group B, and with the scalpel in group C; no treatment was done in group D as a control. The healing rate, healing time, and tissue filling rate were observed; bacterial quantitative examination and histological examination were done at 0, 2, 7, and 14 days after operation. Results All infected wounds were successfully established after 48 hours when Staphylococcus aureus dilution were inoculated. The wounds after radiofrequency ablation technology treatment were fresh and flat with slight bleeding; the healing time of group A was significantly shorter than that of groups B, C, and D (P lt; 0.05), and the healing rate of group A was significantly higher than that of groups B, C, and D at 7 and 14 days after operation (P lt; 0.05). The tissue filling rate of group A was significantly higher than that of groups B, C, and D at 2 days after operation (P lt; 0.05); the tissue filling rates of groups A, B, and C were significantly higher than that of group D at 7 and 14 days after operation (P lt; 0.05). At 0, 2, 7, and 14 days, there were significant differences in the bacterial count per gram tissue among 4 groups (P lt; 0.05), the order from low to high was groups A, B, C, and D. The histological observation showed that the surface of wound was smooth in group A at 0 day, and group A was better than the other groups in wound healing; at 2 days, some exudates were observed in 4 groups, but it was least in group A. There was inflammatory cell infiltration in various degrees in 4 groups at 7 and 14 days; it was lightest in group A with thick epithelium and dense collagen bundles, followed by groups B and C, and it was severe in group D. Conclusion The radiofrequency ablation technology can effectively remove the necrotic tissues of infected wounds, remarkably reduce the number of bacteria, improve the healing rate, and shorten the healing time of wounds.
Objective To investigate the therapeutic effectof infected incision wounds after sternotomy by using different reconstructive methods. Methods From December 1997 to December 2006, 13 patients (8 males, 5 females; age, 28-72 years averaged 52 years) with infected incision wounds after sternotomy underwent the reconstruction surgery respectivelyusing the pectoralis major muscle flaps, the medial flaps of the pectoralis major muscle, the rectus abdominis muscle flaps or the greater omentum transpositions. Among the patients, 8 were complicated by diabetes mellitus, 4 by pneumonia and heart failure, 3 by empyema, 4 by chronic insufficiency of the pulmonary function, 1 by malignant tumor, and 6 by severe obesity. Freshlysplit wounds werefound in 11 patients and chronic wounds in the other 2 patients.The size of thewounds was 10cm×5cm-22cm×10cm. Results Among the 13 patients，10 survived after operation and the other 3 died of massive hemorrhage from the anastomostic rupture of the blood vessel, pneumonia, and cancer metastasis, respectively. Of the 10 patients, 6 had their wounds healed by first intention. The follow-up for 6 months to 5 years revealed that there was no recurrencein all the survived patients. Of the 10 patients, 2 developed partial necrosisof the skins at the sutured wounds, which was healed after the skin grafting operation; 2 had an infection at the drainage area but had a healing after the dressing changes. Conclusion The smaller wounds in the upper partof the sternotomy incision should be repaired with the medial flaps of the pectoralis major muscle; the greater wounds in the upper part of the incision shouldbe repaired and reconstructed with the rectus abdominis muscle flap; the smaller wounds in the lower part of the incision should be repaired with the pectoralis major muscle flap, and if the wounds are longer, they should be repaired and reconstructed with the pectoralis major muscle flap and the rectus abdominis muscle flap; and if the wounds are huge enough with an exposure of the important internal organs, the greater omentum transposition should be used, and the residual wounds should be treated with dressing changes and even skin grafting.
目的 探讨可调节负压引流技术结合植皮治疗皮肤缺损伴感染创面的临床效果及护理要点。 方法 对2008年5月－2011年5月收治的106例皮肤缺损伴感染创面患者，采用间歇负压引流治疗3～10 d，负压值设为50～120 mm Hg（1 mm Hg=0.133 kPa），创面达到Ⅱ期植皮条件时，采用大张、网状或邮票状皮片覆盖创面，继续采用持续负压引流治疗3～12 d，负压值设为50～60 mm Hg，同时进行患者心理和可调节负压引流技术创面等护理。 结果 56例大张皮片植皮中，2例皮片出现0.5 cm×1 cm～0.8 cm×1.2 cm皮片坏死；21例邮票状植皮者，1例出现皮片移动皱缩。除5例骨外露，先通过植皮创面缩小后行皮瓣转移，101例创面愈合时间7～25 d，平均14 d，无因所植皮片未成活需再次植皮和因感染死亡或截肢。 结论 可调节负压引流技术结合植皮治疗皮肤缺损伴感染创面，可有效控制感染，减轻患者换药痛苦，减少医务人员换药和护理工作量，加快植皮创面愈合，缩短创面治愈时间。
Objective To review the research progress of new antibacterial hydrogels in the treatment of infected wounds in the field of biomedicine, in order to provide new methods and ideas for clinical treatment of infected wounds. Methods The research literature on antibacterial hydrogels at home and abroad was extensively reviewed in recent years, and the antibacterial hydrogels for the treatment of infected wounds were classified and summarized. Results Antibacterial hydrogels can be divided into three categories: inherent antibacterial hydrogels, antibacterial agent release hydrogels, and environmental response antibacterial hydrogels. The advantages and disadvantages of antibacterial materials, antibacterial mechanism, antibacterial ability, and biocompatibility were discussed respectively. Inherent antibacterial hydrogels have the characteristics of wide source, low cost, and simple preparation, but their antibacterial ability is relatively weak. New antimicrobial substances are added to antibacterial agent release hydrogels, such as antimicrobial peptides, metal ions, graphene materials, etc., providing a new therapeutic strategy for alternative antibiotic therapy. On the basis of the antibacterial material, environmental promoting factors such as photothermal effect, pH value, and magnetic force are added to the environmental response antibacterial hydrogels, which synergically enhances the antibacterial ability of the hydrogel, improves the precise regulation function and bionic effect of the hydrogel. ConclusionThe selection of a variety of materials, the addition of a variety of antibacterial agents, and the effect of various promoting factors make composite hydrogels show multiple characteristics. The development of antibacterial hydrogels that can effectively address practical clinical applications remains a significant challenge. In the future, expanding the application range of antibacterial hydrogels, constructing drug-loaded hydrogels, and developing intelligent hydrogels are still new areas that need to be explored and studied.