同步报告病例4（第八回）：没有最烂，只有更烂。一个危重足患者保脚经历

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15 10月 2019

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Author : 伤口世界

原创：十六点五中山二院糖尿病足中心

在瑟瑟寒风中

我们迎来了新的一年---2019年

可惜在新的一年的第一天

心情如同广州的天气

没有明媚的阳光

也没有和煦的春风

只要冷冷的细雨

从去年2018年12月29日拆除了

患者左足负压之后

患者每次更换敷料总是绿绿的

看着这些绿色

没有一点“春风又绿江南岸”的感动

而是越来越重的焦虑

“绿脓”又如约而至

更令人烦躁的是患者每天都在腹泻

虽然多次调整治疗方案

仍然没有明确的好转

在大家共同的努力下

虽然没有出现严重的水电解失衡

但严重的腹泻导致进食在不断减少

而大量的渗液的出现

使得病人的有所好转的一般情况

又开始变差

糖尿病足的残酷性再次显示出来

微信中不断地飘着红色的祝福

多么希望患者能出现更多的红色肉芽

估计现在除了我们

还有“股友”和我们一样特别希望出现红色

绿色，一种可怕的颜色

权衡再三

还是停掉了所有的抗生素

并且向换药的姑娘再三强调要仔细用安尔碘换药

希望能够重复之前的经验

通过不懈的耐心和细心

把绿色变为红色

天气预防说

广州还要稍微温暖了一点点

继续寒冷到周末

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伤口世界

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负压封闭引流技术在创面修复应用的专家共识（2025版） 2026-09-14 00:00

大湾区慢性创面医护康标准化体系建设联盟，《中国科技论文》体表外科卷编辑委员会，黄广涛¹，吴军¹，郇京宁^1，2

（1.深圳大学第一附属医院（深圳市第二人民医院）烧伤整形科，广东深圳518000；2.上海交通大学医学院附属瑞金医院烧伤整形与创面修复科，上海200011）

摘要：负压封闭引流技术（negative pressure wound therapy， NPWT）自2017年国内首部烧伤外科应用专家共识发布以来，其技术类型与临床应用范围均取得了显著拓展。特别是在促进各类急慢性创面愈合及预防外科手术部位感染方面，已累积了大量高质量循证证据。为整合国内外最新研究成果与临床实践经验，规范操作标准，提升治疗水平，国内创面修复相关多学科领域的专家共同撰写了本更新版共识。本共识汇聚了国内多位在创面相关的多学科领域的专家，结合国内外最新研究成果，遵循严谨的循证医学原则，采用系统综述方法，聚焦于NPWT的技术分类、适应症、参数优化及并发症处理等核心议题。工作小组系统检索了PubMed、Web of Science、IEEE Xplore及中国知网等数据库中2015—2025年相关文献，共获得791篇。经去重、筛选，并根据纳入标准（临床研究、随机对照试验、meta分析及相关共识等）最终纳入210篇文献进行证据综合与评价。本共识旨在为创面修复相关学科的临床医生提供基于最新证据、统一且可操作的治疗方案与技术规范。共识内容充分结合了我国临床实践的现状与需求，以期推动NPWT在国内的合理、规范及高效应用，最终惠及广大患者。

关键词：负压封闭引流技术；手术部位感染；创面修复；手术切口并发症

Expert consensus on the application of negative pressure wound therapy in wound repair （2025 Edition）

Alliance for Standardized Construction of Chronic Wound Care and Rehabilitation in the Greater Bay Area， Editorial Committee of China Sciencepaper： Superficial Systems Surgery Volume， HUANG Guangtao¹， WU Jun¹， HUAN Jingning^1，2

（1. Department of Burn and Plastic Surgery， The First Affiliated Hospital of Shenzhen University （Shenzhen Second People’s Hospital）， Shenzhen， Guangdong 518000， China；2. Department of Burn， Plastic Surgery and Wound Repair， Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine， Shanghai 200011， China）

Abstract：Since the publication of the first domestic expert consensus on the application of negative pressure wound therapy （NPWT） in burn surgery in 2017， both the types of techniques and the scope of clinical applica⁃tions have significantly expanded. In particular， a substantial body of high-quality evidence has accumulated regarding its role in promoting the healing of various acute and chronic wounds and in preventing surgical site infections. To integrate the latest research findings and clinical experience both domestically and internationally，standardize operational protocols， and enhance treatment efficacy， a multidisciplinary group of domestic experts in wound repair jointly developed this updated consensus. This consensus brings together insights from multiple domestic experts in wound-related multidisciplinary fields， incorporates the latest research advances， adheres to rigorous evidence-based medicine principles， and employs systematic review methodology. It focuses on core issues related to NPWT， including technical classifications， indications， parameter optimization， and complica⁃tion management. The working group systematically searched relevant literature in databases including PubMed，Web of Science， IEEE Xplore， and the China National Knowledge Infrastructure （CNKI） published between 2015 and 2025， retrieving a total of 791 articles. After deduplication， screening， and applying inclusion criteria （clinical studies， randomized controlled trials， meta-analyses， and relevant consensus documents），210 articles were ultimately included for evidence synthesis and evaluation. This consensus aims to provide clinicians in wound repair-related disciplines with unified， actionable treatment protocols and technical standards based on the latest evidence. The content fully integrates the current status and needs of clinical practice in China， with the goal of promoting the rational， standardized， and efficient application of NPWT nationwide， ultimately benefiting a greater number of patients.

Keywords：negative pressure wound therapy； surgical site infection； wound repair； surgical incision complications
Robotic retroperitoneal lymphadenectomy in paratesticular rhabdomyosarcoma 2026-09-12 00:00

Yesica Y. Quiroz ¹ , Enver Moncada ² , Erika Llorens ³ , Ivan Schwartzmann ⁴ , Jorge Caffarati ⁵ , Anna Bujons ^*

Summary

Introduction

Paratesticular sarcoma is an aggressive malignant tumor of mesenchymal origin. The rhabdo-myosarcoma is the most common among children. Rhabdomyosarcoma treatment consists of surgery, chemotherapy and radiotherapy. Prognosic depends on local recurrence and distant metastasis.

Material and methods

We present the case of a 16-year-old male, who in April 2016 underwent right radical orchiectomy surgery by testicular mass rapidly evolving, with pathological results indicating a paratesticular rhabdomyosarcoma. The extension study showed a precaval adenopathy suggestive of lymph node metastasis, therefore it was a high-grade rhabdomyosarcoma. There was an appropriate response after chemotherapy (Protocol EpSSG RMS2005) and we decided to perform a robotic.

Results

We performed a transperitoneal approach with 8 mm trocar and 12 mm optica trocar. We accessed the retroperitoneal space through a latero-colic incision. Then we performed a craniocaudal lymph node dissection until the aortic bifurcation. The surgical time was 240 min with a blood loss of 200 ml. There were no complications. The patient was discharged on the fourth day after surgery. Pathology showed metastasis of rhabdomyosarcoma without capsular rupture. After two months, we placed the left testicle into inguinal canal prior to radiotherapy.

Conclusions

Robotic lymph node metastasis lymphadenectomy from paratesticular sarcomas is a feasible treatment with the advantage of minimally invasive surgery and acceptable morbidity.
Robotic-assisted laparoscopic repair of a congenital rectourethral fistula with duplicated urethra 2026-09-11 00:00

Rohan G. Bhalla ^a , Belinda Li ^{b,d, *}, Mark C. Adams^b , Wallace W. Neblett^c , John C. Thomas ^b

Summary

Objective

To describe our experience with robot-assisted laparoscopic transperitoneal repair of a congenital rectourethral fistula in a pediatric patient with a urethral duplication.

Methods

The patient is a 2-year-old male with a past medical history of Tetralogy of Fallot presenting with a febrile urinary tract infection (UTI). He was diagnosed with urethral duplication and a rectourethral fistula by voiding cystourethrogram (VCUG). The parents were counseled on various options and agreed to proceed with a robotic repair.

Results

Robotic-assisted transperitoneal rectourethral fistula repair was performed. The procedure time was 229 min with an estimated blood loss (EBL) of 15 mL. His postoperative course was unremarkable. At his 2- week follow-up, the urethral catheter was removed and the patient was voiding normally and having normal bowel movements.

Conclusion

Congenital rectourethral fistula with urethral duplication is a rare anomaly with only a few reports in the literature. Pediatric robotic-assisted trans-peritoneal rectourethral fistula repair is a technically feasible approach in infants with minimal morbidity that allows for excellent visualization and avoids open repair.

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主任医师、教授、博导，南方医科大学第三附属医院（广东省骨科医院）院长