Cardiac wounds. Experience from 10 years of war. Apropos of 32 cases treated surgically

Thirty-two patients with cardiac wounds from high velocity firearms (bullets or shrapnel) were operated. Seven of these patients who had no cardiac activity on arrival underwent emergency thoracotomy with a mortality of 85%. The other twenty-five patients underwent planned sternotomy with a mortality of 12%. The authors analyse these case with emphasis on the diagnostic and therapeutic management.     

阴囊坏疽的治疗体会(附14例报告)

目的总结阴囊坏疽的治疗方法。方法2003年8月至2005年6月诊治阴囊坏疽14例，患者年龄27～74岁，平均48岁。阴囊坏疽并发肛周、阴茎坏疽者2例，并发肛周、阴茎、腹股沟区坏疽者10例，并发肛周、阴茎、腹股沟区、腹部皮下坏疽者2例。其中并发阴茎坏死3例，并发睾丸炎5例。14例细菌培养均为阳性。14例均采用Ⅰ期清创、阴囊成形、置管引流术，同时给予抗炎对症治疗。3例阴茎坏死者行阴茎全切、尿道造瘘术，2例腹部坏疽者行腹部皮下切开清创引流，5例睾丸炎者行单侧睾丸切除。结果12例阴囊成形术Ⅰ期愈合，2例尿道造瘘术患者痊愈出院。10例阴茎皮肤坏疽者1个月后阴茎植皮，痊愈出院。死亡2例。结论早期及时清创和抗炎对症治疗是治疗本病的关键，Ⅰ期清创、阴囊成形及置管引流是治疗阴囊坏疽的有效方法。     

Fournier坏疽诊治体会（附30例报告）

目的探讨Fournier坏疽的临床特点和影响预后的相关因素。方法回顾性分析过去5年我院收治的Fournier坏疽30例临床资料。结果 30例患者经积极外科清创等治疗,治愈29例（96.7%）,死亡1例（3.3%）。结论早期诊断和积极彻底清创手术联合使用广谱抗生素,以及全身支持疗法是Fournier坏疽治疗成功的关键。     

胫骨结节骨折30例治疗体会

1996年6月～2005年6月,我们采用中西医结合治疗胫骨结节骨折患者30例疗效满意,报道如下。     

Hyperbaric oxygen in the treatment of clostridial gas gangrene

Thirty-two cases with clostridial gas gangrene were treated during the years 1971-87 in the Department of Surgery, Turku University Central Hospital. The presumptive diagnosis was made on the basis of the clinical appearance of the patient and presence of gram-positive bacilli on a smear. Each patient underwent surgical debridement, antibiotic therapy and hyperbaric oxygen treatment. Seventeen cases had diffuse spreading myonecrosis, 11 of whom survived. Fifteen patients developed clostridial cellulitis with toxicity, 12 survived. Thus the over-all mortality was 28.1%. All those patients who died had been transferred from other hospitals of the country and were already moribund on arrival. Twenty-two infections developed postoperatively, in 6 cases trauma was the antedecent cause and 4 were spontaneous infections. None of the patients with a posttraumatic infection died. The most common underlying disorders included arteriosclerosis, diabetes mellitus, malignancy and Buerger's disease. The addition of hyperbaric oxygenation to the treatment of gas gangrene--although strictly adjunctive to surgery, antibiotics and supportive therapy--has dramatically changed the surgical approach to treatment. Early diagnosis remains essential. Patient survival can be achieved if the disease is recognized early and appropriate therapy applied promptly.     

泌尿系器官气性坏疽三例诊疗分析

泌尿系器官感染虽然常见混合细菌生长，但由（或合并）产气杆菌引起的严重感染较为少见。产气杆菌导致的泌尿系器官感染病程凶险，认识不足则容易延误治疗。本文回顾性分析我科近几年诊治的3例不同泌尿系器官的“气性坏疽”，试图探讨不同泌尿系器官“气性坏疽”之间的内在联系。     

Acute war wounds of the spinal cord: Analysis of 184 cases

Pessimistic attitude regarding spinal cord wounds has been recounted. Gradual shift of opinion has led to increased number of laminectomies and fairly encouraging results. Unreliability of clinical signs and x-rays as to cord section is emphasized. Prognosis as to life and return of function after laminectomy is evaluated. Indications for laminectomy and hemi-laminectomy are described. A careful and exacting study, care and rehabilitation program is indicated, and may provide a clue for further improvement.     

The treatment of traumatic and war wounds of the vascular system

Surgeons in general have not been trained in the management and treatment of the lesions involving the vascular system.Knowledge of these lesions will become increasingly important with our participation in a major war.It is not necessary to amputate when a major vessel has been severed.Arteries may be repaired by suturing or venous transplants.Many methods of stimulating collateral circulation are available.Perivertebral sympathetic nerve block has proved helpful.In neglected or advanced gangrene requiring amputation, the refrigeration technic reduces the mortality.     

应用封闭式负压引流技术辅助治疗阴囊坏疽体会（附8例报告）

目的观察应用封闭负压引流技术辅助治疗阴囊坏疽的临床效果。方法对我科于2005年6月-2010年10月诊治的阴囊坏疽8例进行回顾性分析。本组患者局限于阴囊5例,并发双侧腹股沟区,阴茎皮下坏疽2例;并发肛周,左侧腹股沟区坏疽1例。8例均进行手术清创,并应用VSD持续负压吸引,同时给予抗感染对症治疗。拆除敷料创面干净后行二期手术。结果 6例使用VSD1次,行II期直接缝合后愈合;2例使用VSD2次,行腹股沟皮瓣转移后愈合。结论在清创后配合使用封闭式负压引流技术是治疗阴囊坏疽的一种有效方法,封闭式负压引流技术能够促进伤口的愈合,明显缩短治疗时间,减少换药次数,而且简单易行,值得推广。     

Reconstructive challenges in war wounds

War wounds are devastating with extensive soft tissue and osseous destruction and heavy contamination. War casualties generally reach the reconstructive surgery centre after a delayed period due to additional injuries to the vital organs. This delay in their transfer to a tertiary care centre is responsible for progressive deterioration in wound conditions. In the prevailing circumstances, a majority of war wounds undergo delayed reconstruction, after a series of debridements. In the recent military conflicts, hydrosurgery jet debridement and negative pressure wound therapy have been successfully used in the preparation of war wounds. In war injuries, due to a heavy casualty load, a faster and reliable method of reconstruction is aimed at. Pedicle flaps in extremities provide rapid and reliable cover in extremity wounds. Large complex defects can be reconstructed using microvascular free flaps in a single stage. This article highlights the peculiarities and the challenges encountered in the reconstruction of these ghastly wounds.KEY WORDS: Delayed reconstruction, reconstructive challenges, war wound, wound debridement