The experience of the treatment of 5 thoracic ulcers and 1 large and deep neck ulcer was reported. Vascularized latissimus dorsi and rectus abdominis myocutaneous flaps were used to treat the ulcers with one failure. No recurrence was foundduring the followup from one to five years. In the early stage of acute inflammatory necrosis, treatment was focused on debridement. In order to remove the necrotic tissue and provide good drainage, it was not appropriate to cover the wound immediately. In the chronic stage, the radiation ulcers with their adjacent tissues should be excised. Island myocutaneous flap and axial pattern skin flap were selected to repair the wound. If the wound was too large, two flaps may be combined to cover it. No matter what kind of flap was chosen, the donor site should be far away from the ulcer.
OBJECTIVE To study the relationship between the changes of mRNA expression in wound tissues of diabetic ulcers and tissue repair. METHODS The mRNA expression of TGF-beta 1 and IL-6 in eight bioptic samples of diabetic ulcers were detected by RT-PCR and pathologic methods, and the surrounding normal skins from the same patients were measured as control group. RESULTS The mRNA expression levels of TGF-beta 1 were markedly decreased in the diabetic ulcers compared with control group, while the mRNA expression levels of IL-6 were increased at the same reaction conditions. CONCLUSION The different changes of mRNA expression level of TGF-beta 1 and IL-6 in wound tissue result in low production and decreased activity of TGF-beta 1 and IL-6, which lower the reparative ability of wound tissue.
Eight cases of gastric remnant carcinoma are reported and its possible etiology, course of disease, prevention and treatmant are discussed together with literature review. Duodenal ulcer, except with serious complications, should be treated conservatively. For benign gastric ulcer gastrectomy may be considered in individual case, but the operative indication can be controlled by its lesions. Regular follow-up study should be performed on patients who had gastrectomy for more than five years.
ObjectiveTo investigate the relationship between the nucleotide binding oligomerization domain like receptor protein 3 (NLRP3) inflammasome and inflammatory reaction of venous ulcer of lower extremity.MethodsTwenty-four patients with active venous ulcer of lower extremity (active ulcer group), 24 patients with non exudative venous ulcer of lower extremity as positive control (non-active ulcer group), and 24 patients with traumatic wound as negative control (traumatic-wound group) were enrolled. The clinical data of the three groups were compared, the tissue samples around the wound were harvested, and the expressions of NLRP3 protein were detected by immunohistochemistry among the three groups. Enzyme linked immunosorbent assay (ELISA) was used to detect the IL-1β and IL-18 protein levels, RT-PCR was used to detect the mRNA expressions of apoptosis associated speck like protein containing CARD (ASC), caspase-1, c-Jun N-terminal kinase (JNK), p38, nuclear factor (NF)-κB p65 and NF-κB inhibitor alpha (NF-κB IkBα), and Western blotting was performed to evaluate the level of NLRP3 inflammasome in wound tissues.ResultsThe inflammatory response in the non-active ulcer group and trauma-wound group were milder than that in the active ulcer group. The levels of IL-1β and IL-18 proteins in the active ulcer group were higher than those in the non-active ulcer group and the traumatic-wound group [IL-1β: (146.621±11.597) ng/L vs. (80.967±14.213) ng/L vs. (84.962±19.484) ng/L, F=136.200, P<0.001; IL-18: (119.814±12.788) ng/L vs. (72.899±17.220) ng/L vs. (48.131±10.407) ng/L, F=167.910, P<0.001]. The results of RT-PCR showed that the mRNA expressions of ASC [(0.030±0.012) ng/L vs. (0.021±0.005) ng/L vs. (0.016±0.004) ng/L, F=18.106, P<0.001], caspase-1 [(0.054±0.012) ng/L vs. (0.013±0.009) ng/L vs. (0.018±0.006) ng/L, F=130.372, P<0.001], NF-κB p65 [(0.093±0.015) ng/L vs. (0.038±0.013) ng/L vs. (0.043±0.014) ng/L, F=110.950, P<0.001], NF-κB IkB-α [(0.085±0.015) ng/L vs. (0.078±0.015) ng/L vs. (0.041±0.016) ng/L, F=53.070, P<0.001], and JNK [(0.075±0.018) ng/L vs. (0.042±0.013) ng/L vs. (0.039±0.014) ng/L, F=41.271, P<0.001] in the wound tissues of the active ulcer group were higher than those in the non-active ulcer group and the traumatic-wound group. And the mRNA expression of p38 in the wound tissues of the active ulcer group was lower than that in the non-active ulcer group [(0.050±0.008) ng/L vs. (0.064±0.014) ng/L, P<0.05]. The result of Western blotting showed that the relative expression level of NLRP3 protein in the wound tissues of the active ulcer group was higher than that in the trauma-wound group and non-active ulcer group (0.767±0.272 vs. 0.605±0.212 vs. 0.556±0.183, F=4.804, P=0.012).ConclusionNLRP3 inflammasome is closely related to the wound in venous ulcer of lower extremity and provides a new target to the therapy of venous ulcer of lower extremity.
Objective To discuss the surgery procedure and the cl inical effectiveness of repairing skin and soft tissue defects in the lateral foot and the heel with the abductor digiti minimi muscle flap. Methods Between July 2002 and October 2010, 8 patients with skin and soft tissue defects in the lateral foot and the heel were treated. There were 6 males and2 females with an average age of 42 years (range, 28-65 years). The locations were the left foot in 5 cases and the right foot in 3 cases. Defects were caused by ulcer of the heel in 2 cases, by poor heal ing of incision after calcaneus fracture surgery in 1 case, and by crushing in 5 cases. The defect size ranged from 1.5 cm × 1.0 cm to 8.0 cm × 2.6 cm. The disease duration was 30 minutes to 26 months. The result of bacterial culture was positive in 2 cases. After 9 to 15 days of debridement and dressing change, defects were repaired with the abductor digiti minimi muscle flap of 5.6 cm × 1.5 cm to 7.6 cm × 1.8 cm at size. The donor sites were sutured directly. Results Partial necrosis of muscle flap occurred in 1 case at 4 days after operation, which was cured by symptomatic treatment, and the other muscle flaps survived. All incisions of the donor sites healed by first intention. The muscle flaps survived and the granulation grew well at 9-21 days after operation, and the muscle flap wounds were repaired by free leg edge thickness skin grafting. Wounds were repaired by one-stage free skin grafting in 1 case and by two-stage free skin grafting in 7 cases; all skin flaps survived and wounds healed by first intention. Seven patients were followed up 9-18 months (mean, 11 months). The appearance, texture, and sensation were satisfactory. The two-point discrimination was 16-23 mm (mean, 19.5 mm). Epidermal abrasion occurred in 1 case of heel ulcer after weigt-bearing walking. Hallux valgus and muscle weakness occurred in 1 case of necrosis of the peroneus length tendons; and the satisfactory results were achieved in the other patients. Conclusion It has satisfactory effectiveness to use the abductor digiti minimi muscle flap for repairing skin and soft tissue defects in the lateral foot and the heel, which has the advantages of easy-to-operate, safe, less injury at donor site, goodappearance and texture, and good recovery of sensation.
ObjectiveTo elucidate the characteristics of colonic Crohn’s disease (CD) and evaluate effectiveness of surgical treatment.MethodClinical data of 28 cases with colonic CD who underwent surgery at West China Hospital of Sichuan University between Feb. 2009 and Jan. 2017 were retrospectively analyzed.ResultsDefinite diagnosis of colonic CD was performed in 12 cases preoperatively (42.9%), but 16 cases (57.1%) were misdiagnosed as other disease, ulcerative colitis (5 cases, 17.9%), tumor (4 cases, 14.3%), appendiceal disease (4 cases, 14.3%), and intestinal tuberculosis (3 cases, 10.7%) were the major causes of preoperative misdiagnosed disease. Of the 28 cases, elective surgery was performed in 26 cases and emergency surgery in 2 cases. The major surgical procedures were segmental colectomy(10 cases) and right hemicolectomy (6 cases), as well as ilecolostomy (9 cases), colocolostomy(6 cases), ileostomy(9 cases), colostomy (6 cases), and so on. The length of the first hospital stay of operation related to intestinal lesions in this group was 5–74 d (mean of 25.4 d). Postoperative complications were occurred in 9 cases (32.1%), all these cases didn’t receave medical treatment. Twenty cases were followed up, and the follow-up time was 7–78 months (mean of 33.4 months), 8 cases lost follow-up. The prognosis of the follow-up cases was good.ConclusionsColonic CD has occult clinical manifestation, resulting in misdiagnosis and mistreatment. Segmental resection of the colon is the important treatment for colonic CD. For patients with complications, multidisciplinary diagnosis and treatment is necessary. In addition, systematic medical treatment before surgery helps to reduce the risk of the first surgery associated with intestinal lesions.
To assess the rel iabil ity of diabetic cutaneous ulcer surface area (DCUSA) measurement usingdigital planimetry method (A) and transparency tracing method (B). Methods Images of diabetic cutaneous ulcers from35 inpatients with diabetic skin ulcers from September 2005 to April 2007 were taken by a digital camera once a week or twice a week over a period of 12 weeks, resulting in 305 photographs; the ulcers were traced on a grid with acetate wound tracings, simultaneously. A total of 305 pairs of DCUSA which were calculated respectively throughout digital camera combined with Image J medical imaging software and transparency tracing with grid sheet by two independent observers sequentially were obtained. The intraclass correlation coefficients (ICCs, one-way random effect model) was used as an indicator of chancecorrected agreement to estimate the relative rel iabil ity for the interobserver data. Multiple l inear regression analysis was also used to measure the relationship of these two methods. Results DCUSA obtained from method A and obtained from method B was (4.84 ± 7.73) cm2 and (5.03 ± 7.89) cm2, respectively; no significant difference was found (P gt; 0.05). ICCs was high (ICCs=0.949 for method B and 0.965 for method A), indicating that the relative rel iabil ity for the interobserver was excellent. The method A were highly correlated with measurements obtained from method B (r = 0.957, P lt; 0.05). Conclusion The digital planimetry method described in this study represents a simple, practical, without any wound damage and contamination, and inexpensive technique to accurately evaluate the areas of diabetic cutaneous ulcers. The photographic technique combined with Image J medical imaging software should be considered for wound measurement.
ObjectiveTo systematically review the clinical efficacy and safety of hyperbaric oxygen therapy as adjunctive treatment for diabetic foot ulcers.
MethodsSuch databases as The Cochrane Library (Issue 1, 2014), PubMed, EMbase, CBM, VIP, CNKI and WanFang Data were searched up to January 2014 for randomized controlled trials (RCTs) about hyperbaric oxygen therapy as adjunctive treatment for diabetic foot ulcers. According to the inclusion and exclusion criteria, two reviewers independently screened literature, extracted data, and assessed methodological quality of included studies. Then, meta-analysis was performed using RevMan 5.2 software.
ResultsFourteen RCTs involving 910 patients were included. The results of meta-analysis showed that, hyperbaric oxygen therapy combined with routine therapy was superior to routine therapy alone regarding ulcer healing rates (RR=2.16, 95%CI 1.43 to 3.26, P=0.000 3), incidence of major amputation (RR=0.20, 95%CI 0.10 to 0.38, P < 0.000 01), reduction of ulcer area (MD=1.73, 95%CI 1.34 to 2.11, P < 0.000 01), and improvement of transcutaneous oxygen tension (MD=14.75, 95%CI 2.01 to 27.48, P=0.02). However, no significant difference was found between the two group in minor amputation rates (RR=0.70, 95%CI 0.24 to 2.11, P=0.53). In addition, neither relevant serious adverse reaction nor complications were reported when using hyperbaric oxygen therapy as adjunctive treatment.
ConclusionCurrent evidence shows that hyperbaric oxygen therapy as adjunctive treatment could improve ulcer healing and reduce incidence of major amputation.
OBJECTIVE: To explore a method to repair severe radiation-induced ulcer and evaluate its clinical effects. METHODS: From August 1988 to December 1998, 12 cases of severe radiation-induced ulcer were treated by muscular or musculocutaneous flap transfer, which included 1 case of pectoralis major muscular flap, 3 cases of three-lobed transverse rectus abdominis musculocutaneous flap, 2 cases of latissimus dorsi musculocutaneous flap, 1 case of tensor fascia lata musculocutaneous flap, 1 case of longitudinal rectus abdominis musculocutaneous and tensor fascia lata musculocutaneous flap, 1 case of gastrocnemius muscular flap, 1 case of gluteus major musculocutaneous flap, huge filleted musculocutaneous flap from lower limbs in 1 case and from upper limbs in 1 cases. RESULTS: All the flaps survived. Primary healing occurred in 9 cases and secondary healing in 3 cases. The extensive multiple ulcers in 2 cases were repaired with filleted limb musculocutaneous flap, and patients were saved. And in other 3 cases, the chest wall defect as the result of radionecrosis were repaired with simultaneous breast reconstruction. CONCLUSION: Muscular or musculocutaneous flaps have abundant blood supply, they are ideal tissue to fill the cavity and repair the defect, especially in repairing severe radiation-induced ulcers.
ObjectiveTo evaluate the clinical experiences and treatment effectiveness of chronic venous insufficiency with venous ulcer in lower limb. MethodsSeventy-eight patients (88 limbs) suffering lower limb chronic venous insufficiency with venous ulcer from May 2004 to April 2011 in this hospital were analyzed retrospectively. All the patients had undergone high ligation for great saphenous vein plus endovenous laser treatment plus subfascial endoscopic perforator vein surgery (SEPS). ResultsPostoperative complications included 3 cases of subfascial haematoma; 2 cases of pneumohypoderma; 3 cases of numbness in anterior tibial and ankle areas. All the ulcers healed between 4 to 6 weeks. Follow up period was between 6 months to 5 years. There was only one recurrence due to residual varicose from ankle area. The mean operation time was 20 min (15－30 min) in SEPS, the average blood loss was 2 ml (1－5 ml), and the mean duration of postoperative hospitalization was 5 d (2－8 d). ConclusionsSEPS is a first treatment choice for CVI with venous ulcer. It has less invasiveness, lower chances for bleeding, shorter operation time, quicker recovery, and fewer complications.
