Objective To evaluate the effect of surgical management of primary venous reflux disease in lower extremity. Methods Literatures about the surgical management of venous reflux disease in lower extremity were collected and reviewed. Results In patients with primary venous reflux disease,comprehensive surgical management of concomitant superficial,deep and perforating veins might greatly improve the clinical effect. Conclusion Comprehensive surgical management will be the direction of surgical management of primary venous reflux disease in lower extremity.
ObjectiveTo explore the effectiveness of the first-stage debridement and Ilizarov metatarsal bone lengthening in treatment of diabetic foot ulcer complicated with chronic osteomyelitis of metatarsal head.MethodsBetween January 2015 and October 2018, 8 cases (9 feet, 11 sites) of diabetic foot ulcer complicated with chronic osteomyelitis of metatarsal head were treated by first-stage debridement and Ilizarov metatarsal bone lengthening. There were 3 males (4 feet, 5 sites) and 5 females (5 feet, 6 sites), with an average age of 57.5 years (range, 44-65 years). According to diabetic foot Wagner grade, 6 cases (7 feet) were grade 3 and 2 cases (2 feet) were grade 4. The chronic osteomyelitis located at left foot in 4 cases, right foot in 3 cases, and bilateral feet in 1 case. The duration of chronic osteomyelitis was 1-5 years (mean, 3.1 years). The chronic osteomyelitis site was the 1st metatarsal head in 3 feet, the 3rd metatarsal head in 1 foot, the 4th metatarsal head in 1 foot, and the 5th metatarsal head in 6 feet. Two patients had chronic osteomyelitis at 2 sites on 1 foot. The length of lengthened metatarsal bone, lengthening time, and the time of wearing external fixation frame were recorded, and the external fixation frame index was calculated. The healing conditions of foot ulcer and lengthening bone segment were observed, the healing time was recorded, and the healing index of lengthening bone was calculated. The ankle function was evaluated according to the American Orthopedic Foot and Ankle Society (AOFAS) score criteria.ResultsAll patients were followed up 9-26 months with an average of 15.0 months. Except pin tract infection during the bone lengthening period, there was no complications such as skin necrosis and vascular or nerve injury occurred during treatment. The length of lengthened metatarsal bone was 12-35 mm with an average of 20.5 mm; the metatarsal bone lengthening time were 21-84 days with an average of 57.8 days. The average time of wearing external fixation frame was 14.6 weeks (range, 10.4-21.1 weeks) and the external fixation frame index was 54.3 days/cm (range, 42.9-59.2 days/cm). The ulcer wound healed with an average healing time of 30.5 days (range, 19-70 days) and no ulcer recurrence was observed during follow-up. Bone healing was obtained in all bone lengthening segments, and the average healing index was 42.5 days/cm (range, 37-51 days/cm). The average AOFAS score was 91.7 (range, 87-95); 5 feet were excellent and 4 feet were good. The excellent and good rate was 100%.ConclusionThe metatarsal bone lengthening under Ilizarov law of tension-stress after debridement can promote diabetic foot ulcers healing and reconstructing the length of metatarsal to retain the function of metatarsal load and avoid amputation. This is an effective method for the treatment of diabetic foot ulcer complicated with chronic osteomyelitis of metatarsal head.
ObjectiveTo explore the clinical efficacy of ultrasound debridement combined with autolytic debridement in the treatment of diabetic foot ulcers.MethodsA total of 60 diabetic foot ulcers patients who were diagnosed and treated in Jinshan Hospital of Fudan University from April 2019 to April 2020 were enrolled in the study and randomly divided into two groups, with 30 cases in each group. The trial group received autolytic cleansing combined with ultrasound debridement treatment, and the control group only received autolytic debridement treatment. The baseline conditions, wound treatment efficacy, number of dressing changes, length of hospital stay, treatment cost, wound healing time, wound shrinkage rate, and the time required for the wound to turn into 100% red granulation were compared between the two groups.ResultsThere was no statistically significant difference in gender, age, duration of diabetes or Wagner grade of diabetic foot between the two groups (P>0.05). The efficacy of wound healing in the trial group was better than that in the control group (Z=−2.146, P=0.032). The number of dressing changes [(11.76±2.23) vs. (17.34±4.43) times] and the length of stay [(18.03±3.73) vs. (25.43±4.43) d] in the trial group were lower than those in the control group, and the differences were statistically significant (P<0.05). The difference in treatment cost between the two groups was not statistically significant (P>0.05). The wound healing time of the trial group [(48.43±18.34) vs. (65.24±19.62) d], the wound shrinkage rate [(78.35±8.34)% vs. (56.53±6.54)%] and the time required for the wound to turn into 100% red granulation [(16.34±2.42) vs. (24.55±3.23) d] were better than those of the control group, and the differences were statistically significant (P<0.05). During the treatment process, no patient in the trial group had wound bleeding and had difficulty in stopping bleeding during ultrasonic debridement, and no patient had intolerable pain related to ultrasonic debridement. No patients in either group withdrew early.ConclusionsUltrasound debridement combined with autolytic debridement can effectively improve the curative effect of patients with diabetic foot ulcers and shorten the wound healing time. Therefore, it is worthy of promotion and application in the wound care of patients with diabetic foot ulcers.
To explain how to treat common gastric diseases like chronic gastritis, peptic ulcer, functional dyspepsia and gastric oesophageal reflux disease (GORD) based on evidence-based medicine. Through this paper, we try to help readers find and use clinical evidence to solve clinical problems.
ObjectiveTo observe the effect of silver dressings on treating diabetic foot ulcer infection. MethodsA total of 105 patients with diabetic foot ulcers treated from May 2012 to April 2014 were randomly divided into two groups:group A and B. Patients in group A were treated with imported silver ion alginate dressing, while group B was treated with domestic nanometer silver dressing. All patients were given basic treatment, and the effect of silver dressing was evaluated by observing bacterial clearance rate and wound healing score. ResultsThere were significant improvement in bacterial clearance rate and wound healing score in both two groups after treatment. The bacterial clearance rate was similar between the two groups (P>0.05). However, the descending trend of wound healing score in group A was significantly more obvious than group B (P<0.01). ConclusionBoth two silver dressings are effective in the treatment of diabetic foot ulcer infection, but the effectiveness of silver ion alginate dressing is superior. Bacterial clearance rate and wound healing score are objective and applicable index to evaluate the treatment effects of silver dressing.
Objective To explore the method of the distal perforator-based gluteus maximus muscle V-Y flap to treat the sacral ulcer and to simplify the operative procedures.Methods From March 2002 to March 2005, 11 cases of sacral ulcer were repaired by distal perforatorbased gluteus maximus muscle flaps. The area of sacral ulcer ranged from 13 cm×11 cm to 18 cm×14 cm. Of 11 cases, 7 were female and 4 were male,whose age ranged from 21 to 69 years, and the disease course was 8 months to 3 years.A triangular flap was designed to create a V-Y advancement flap.The length of the base was made almost equal to the diameter of the defect.The apex of the tringle was located near the great trochanter. The medial part of the flap was elevated as a fasciocutaneous flap by dissecting the layer between the fascia and the muscle.The distal part ofthe flap was elevated by dissecting the layer between the gluteus maximus muscle and the fascia of the deeper muscle group.The flap was advanced to the defect. Results All the flaps survived. After a follow-up of 5 months to 3 years, the bilateral buttocks were symmetry and whose appearance was satisfactory. Except for 1 case dying of other disease, no recurrence of ulcer was observed.All the flaps survived. Conclusion The distal perforatorbased fasciocutaneous V-Y flap for treatment of sacral ulcers is a simple and reliable technique, which has several advantages over the conventional V-Y flap technique,such as excelent excursion,viable coverage with the fasciocutaneous component, high flap reliability, preservation of the contralateral buttock, and preservation of the gluteus maximus muscle function.
【Abstract】 Objective To discuss the role of leukocyte activation and inflammatory processes in the disease of chronic venous insufficiency （CVI）. Methods The relevant literatures about the role of leukocyte activation and inflammatory reaction in CVI were reviewed. Results The role of inflammatory reaction in occurrence and development of venous diseases has been studied a lot in recent years. It was found that the leukocyte activation and inflammatory reaction are involved in the structural remodeling of venous valves and walls, leading to valvular incompetence and formation of varicose veins. Conclusion Leukocyte activation and inflammatory processes take important roles in the occurrence and progression of CVI.
OBJECTIVE: To localize the distribution of basic fibroblast growth factor (bFGF) and transforming growth factor-beta(TGF-beta) in tissues from dermal chronic ulcer and hypertrophic scar and to explore their effects on tissue repair. METHODS: Twenty-one cases were detected to localize the distribution of bFGF and TGF-beta, among them, there were 8 cases with dermal chronic ulcers, 8 cases with hypertrophic scars, and 5 cases of normal skin. RESULTS: Positive signal of bFGF and TGF-beta could be found in normal skin, mainly in the keratinocytes. In dermal chronic ulcers, positive signal of bFGF and TGF-beta could be found in granulation tissues. bFGF was localized mainly in fibroblasts cells and endothelial cells and TGF-beta mainly in inflammatory cells. In hypertrophic scar, the localization and signal density of bFGF was similar with those in granulation tissues, but the staining of TGF-beta was negative. CONCLUSION: The different distribution of bFGF and TGF-beta in dermal chronic ulcer and hypertrophic scar may be the reason of different results of tissue repair. The pathogenesis of wound healing delay in a condition of high concentration of growth factors may come from the binding disorder of growth factors and their receptors. bFGF may be involved in all process of formation of hypertrophic scar, but TGF-beta may only play roles in the early stage.
Objective To investigate the effects and possible mechanism of the local content changes of nitrogen monoxidum on bile reflux in rats’ pylori stress ulcer. Methods Fifty adult SD rats were restrained in planes and then were soaked in cold water to make stress ulcer. They were divided into three groups randomly: the stress group (30 cases), the L-NAME group (10 cases), whose pylori were injected with L-NAME solution and the normal saline group (10 cases), whose pylori were treated with saline solution. Besides, there were another 10 rats taken as the control group. The gastric ulcer index, pH value and bile acid concentration of gastric juice in each group were measured before and after stress. The local concentrations of nitrogen monoxidum in rats’ pylori were also measured by nitrogen monoxidum Biochemical Detection Kit. Results The local content of nitrogen monoxidum in rats’ pylori increased to maximum at 1 h after stress （P＜0.01）, while the bile acid and pH value of gastric juice went up to the maximum at 2 h after stress （P＜0.01）. The ulcer index reached the peak value at 4 h after stress （P＜0.01）. The bile acid concentration and ulcer index of the group injected with L-NAME solution in rats’ pylori decreased significantly compared with those of the group treated with normal saline solution (P＜0.01). The local concentration of nitrogen monoxidum also decreased significantly in the L-NAME group (P＜0.05）. However, there was no difference on pH values of gastric juice between those two groups (Pgt;0.05). Conclusion There is a positive correlation between the local concentration of nitrogen monoxidum in pylori and bile acid in the stomach in rats with stress ulcer. Injection of L-NAME solution in rats’ pylori may reduce the local content of nitrogen monoxidum so that the pyloric sphincter become less tense, which may lead to the significant decreases of ulcer index and bile acid in the stomach. Thus, L-NAME may protect gastric mucus effectively.
ObjectiveTo investigate the value of the change trend of lactic acid level 24 h after operation in predicting the complications of upper gastrointestinal ulcer perforation. MethodsA total of 167 patients with upper digestive tract ulcer perforation who underwent surgical treatment in Shougang Hospital of Peking University from March 2021 to June 2023 were selected as the study objects, and were divided into mild to moderate group (n=117) and severe group (n=50) according to the severity of the disease. General data and lactic acid levels in 24 h after surgery were compared between the two groups. In addition, according to whether the patients had complications or not, they were divided into a group without complications (n=119) and a group with complications (n=48). The general data of the two groups were compared. A combined model was constructed, and Cox regression model was used to analyze the relationship between the change of lactic acid level at 24 h after operation and the complications of infection. Logistic regression model combined with restricted cubic spline model was used to analyze the dose-response relationship between lactic acid level and infection complications in patients with upper gastrointestinal ulcer perforation 24 h after operation. Log-binomial model was used to analyze the risk effect of complication types on lactic acid levels in patients with upper gastrointestinal ulcer perforation. ResultsAt 8, 16 and 24 h after operation, lactic acid levels in both groups (mild to moderate group and severe group) were significantly lower than before operation, and lactic acid level in mild to moderate group was significantly lower than that in severe group (P<0.05). Repeated measurement ANOVA showed that the time effect, intergroup effect and interaction effect of lactic acid levels were significantly different between the two groups (P<0.05). There were significant differences in exhaust time, postoperative hospital stay, C-reactive protein, lactic acid level and red blood cell distribution width between the complicated group and the uncomplicated group (P<0.05). The combined model showed that each longitudinal increase of 1 mmol/L in lactic acid level 24 h after operation, was associated with a 4% increased risk of infection complications. The limit cubic spline map showed that lactic acid level at 24 h after operation was 4.22 mmol/L as the critical point of the dose-response relationship in the infection complications of patients with upper gastrointestinal ulcer perforation. Log-binomial model analysis results showed that when lactic acid level ≥4.22 mmol/L, patients with upper gastrointestinal ulcer perforation in the complication group had the highest risk of abdominal infection. The risk ratios (95%CI) before and after adjustment were 2.09 (1.25, 2.64), 2.16 (1.28, 2.05) and 2.20 (1.32, 2.63) times of those in the uncomplicated group, and the risk ratios of different lactic acid levels were statistically significant before and after adjustment (P<0.05). ConclusionLactic acid level increased 24 h after operation in patients with upper gastrointestinal ulcer perforation is closely related to infection complications, and has a high predictive value for infection complications in patients with upper gastrointestinal ulcer perforation.