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
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.
Authors
Barbara C. Zeiger
Keywords
certification
innovations
electric dressing
wound monitor
Collagen
indexing
bioprinters
Issue: Volume 65-Issue 10-October 2019-ISSN 2640-5245
Index: Wound Management & Prevention 2019;65(10):6
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Article
Wound care clinicians, especially nurses, are overwhelmed with work. Job openings are available everywhere. Nursing shortages imply more work for existing clinicians who need time savers to stay abreast of evidence-based care development.
As such, health professionals struggling with challenging wounds and industry scrambling to create innovative products to face those challenges may seem frustrated that nothing has come along or appears on the horizon to revolutionize wound care. Wound care news includes several intriguing and promising concepts recently presented in peer-reviewed publications and all worthy of consideration and further research. Will these innovations be proven by ongoing, reputable scientific studies, published in reputable scientific literature, to be efficacious and effective and to make life and work easier for practitioners...or just a flash in the pan?
Electric dressings. A dressing that disrupts biofilm infection utilizing an electric field was developed through research conducted at the Indiana Center for Regenerative Medicine and Engineering (Indiana University School of Medicine, Indianapolis, IN). Bacteria use electric fields to communicate among themselves to form biofilm; researchers are exploring use of an electric field-based dressing instead of antibiotics (which can engender resistance) to break up biofilms. The low voltage is electrochemically generated and will not harm the patient. The United States Food and Drug Administration recently approved the dressing for burn care.
Wound monitors. An open-mesh electromechanical sensor that monitors lactate and oxygen on the skin, 2 critical biomarkers of wound healing progress, has been developed by researchers at the Intimately Bio-Integrated Biosensors Lab at Binghamton University (Binghamton, NY). The sensor structure is similar to the skin’s microarchitecture and can mimic the skin’s elasticity. The sensor’s creators hope it will enhance understanding of wound chemical and physiological activity.
Bioprinters. A mobile skin bioprinting system developed by the Wake Forest Institute for Regenerative Medicine (Winston-Salem University, Winston-Salem, NC) will facilitate printing bilayered skin directly into a wound. Dermal fibroblasts and epidermal keratinocytes are isolated from a small biopsy of uninjured tissue, expanded, mixed into a hydrogel, and placed into the bioprinter. Data from the scanned wound are fed into software that designates where in the wound the cells should be delivered, replicating and accelerating skin structure and function. The system provides solutions to the challenges of limited grafts from healthy autologous skin and from donors. The concept is awaiting clinical trials in humans.
Collagen powder. Collagen powder has been found to be as effective as primary closure with nonabsorbable sutures in managing skin biopsy wounds by physician researchers at the George Washington University, Washington, DC. Collagen powder helps stop bleeding, attracts immune and skin cells central to wound healing, stimulates new blood vessel formation, and does not cause irritation or foster bacterial growth.
Wound Management & Prevention news. Wound Management & Prevention has been indexed in the Cumulative Index of Nursing and Allied Health Literature (CINAHL) since its inception as Ostomy Wound Management in 1985 and added to other indices throughout its 35-year history. Indexing is important because the scientific quality of indexed journals is thought to be more substantive than that of nonindexed journals. A journal’s impact factor (ie, the yearly average number of citations that recent articles published in a given journal received) is a reflection of the journal’s value among other publications and is calculated in Thomson Reuters Journal Citation Reports.
Beginning with the January 2019 issue, Wound Management & Prevention (previously categorized by several scientific publication indices primarily as a surgical journal) has been reclassified as a nursing/dermatology nursing journal, affecting how we are listed among these esteemed entities. These indices include the Social Sciences Citation Index, Journal Citation Reports/Social Sciences Edition, and Current Contents/Social and Behavioral Sciences, in addition to current listings in Science Citation Index Expanded (also known as SciSearch), Journal Citation Reports/Science Edition, and Current Contents/Clinical Medicine. The reclassification will result in easier and more appropriate access for researchers (which, in turn, will improve our impact factor) and, more importantly, will facilitate enhanced access for clinicians looking for evidence-based guidance at the bedside.
From quality of life to quality of care, we are determined to keep you abreast of what’s happening in the wound care niche. You can rest assured Wound Management & Prevention is certainly not a flash in the pan.
伤口世界平台生态圈,以“关爱人间所有伤口患者”为愿景,连接、整合和拓展线上和线下的管理慢性伤口的资源,倡导远程、就近和居家管理慢性伤口,解决伤口专家的碎片化时间的价值创造、诊疗经验的裂变复制、和患者的就近、居家和低成本管理慢性伤口的问题。
2019广东省医疗行业协会伤口管理分会年会
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