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
Victoria E. Elliott
Issue: Volume 64 - Issue 11 - November 2018 ISSN 1943-2720
Index: Ostomy Wound Manage. 2015;64(11):13.
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Last December, the Association for the Advancement of Wound Care (AAWC) leadership, staff, and key stakeholders embarked on a brand and marketing assessment to shift our brand, brand promise, and brand experience from its current form — a transaction-oriented, unidirectional experience — to one that more adequately reflects the true nature of the organization: relationship driven, human-centric, collaborative, and responsive. Using a facilitated process informed by a survey of key stakeholders, including Board and committee members and AAWC supporters, the assessment yielded 3 themes that now drive the AAWC’s brand:
Accessible: Every member’s ability to interact with the industry’s best and obtain information from this multidisciplinary organization whose desire is to become intuitive and innovative;
Connected: Endeavoring to change the perception of being a transactional-based organization and moving toward creating a connected wound care community; and
Collaborative: Selfless members and leaders underscoring the multidisciplinary and inclusive nature of the AAWC and a contemporary approach to delivering the education the AAWC strives to provide.
These themes have helped focus member communications and branding of the AAWC message. For example, the new AAWC video, now featured on the AAWC home page, showcases members’ experience with the Association. The themes also have helped formulate new member-centric, value-driven initiatives including:
A hands-on compression workshop on venous ulcers at SAWC Fall;
Journal Club monthly webinar series; and
AAWC Wound News You Can Use — a new weekly electronic publication that launched in October.
Beyond the success of these programs, the Board recognized the need for a broader, more strategic approach to the requisites of members and prospective members. For the past 2.5 months, the Board and staff have developed and executed a strategic planning initiative that yielded 3 bold objectives, each to be supported by appropriate research and evaluation to ensure their successful implementation and impact. Information used to inform the plan included input from a membership survey along with results of a former member and a leadership survey. The AAWC Board is grateful to the 362 members who responded to Dr. Serena’s invitation to participate in this important exercise, yielding an impressive 17.5% response rate. The results include representation from all of AAWC’s clinical membership categories throughout the United States and internationally, most of whom work in wound clinics (42%) or hospitals (28%) and who identify with the Baby Boomer generation (54%) or Generation X (31%). Of those that responded, about half have been members for more than 5 years, 21% for 5 to 9 years, and 14% for more than 15 years. Respondents reported that they value each of AAWC’s programs and services equally, with SAWC Spring and Fall rating the highest, followed closely by the Professional Resources section on the website, Pressure Ulcer Summit, the Podium to Practice track, and Journal Club and Scholarships. The AAWC similarly was rated highly on how well it is delivering on each of these programs. When asked about new services members may find valuable, most ranked regional education events with single topic symposia the highest (>80%). More than 70% of respondents felt the AAWC’s multidisciplinary focus remains important to the work of both the Association and the profession, but the AAWC received a score of only 3.8 out of 10 for how well it delivers on its mission. Most respondents appreciate that the AAWC collaborates with other organizations to further the Association’s mission, and nearly 100% agree that the AAWC should continue in this vein. Approximately 32% of respondents are aware of the Healthcare Public Policy committee’s work on their behalf, 70% agree on its importance to the profession, and more than 60% view AAWC’s public policy work as valuable to the membership. Open-ended survey questions yielded vast amounts of insight into what members are seeking for new and improved website features, public policy initiatives, and what the AAWC can do to increase its value to our members in the wound care profession.
We are in the process of using these data to create a detailed strategic planning document with an operating budget and infrastructure to support its implementation. Members can look for additional details on strategic planning, coming soon to the AAWC website.
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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