Objective:To discuss the clinical presentations,diagnosis,and treatment methods of the patients with Fournier's gangrene,and to enhance the clinicians'awareness of this condition.Methods:The clinical data including symptoms,signs,radiological findings,and surgical outcomes of one patient with Fournier's gangrene were collected.The relevant literatures were reviewed to summarize the clinical characteristics,diagnosis,and treatment methods for this condition.Results:The patient,a 42-year-old male,was admitted because of a history of infection around the perineum,scrotum,and perianal area for 13 d.His medical history included acute myeloid leukemia for 10 months,during which the patient underwent eight chemotherapy sessions in the local hospital.The abdominal CT scan results showed thickened,dense,and turbid soft tissue in the left inguinal area.The complete blood count reuslts showed the white blood cell count was 23.99×109 L-1.The cultures of wound secretions grew the Escherichia coli and Proteus mirabilis.The examination results showed there was necrosis of the scrotal skin and skin near the anus on the left buttock;the skin was blackened,hard,and demarcated from the surrounding normal skin with slight purulent exudation and no foul smell.The surrounding skin was significantly swollen and red;the rectal examination results showed no bleeding or fistulas.The patient underwent emergency debridement surgery on the admission day,followed by dressing changes,multiple applications of simplified negative pressure,perineal flap reconstruction,and skin grafting.The patient recovered well with normal function and had no complications.Conclusion:Fournier gangrene has acute onset and rapid progression,and the clinical manifestations are non-specific.The range of infection is not consistent with the progression of the disease.The diagnosis mainly depends on intraoperative exploration.Repeated radical surgery is the main treatment.The prognosis of this disease is good,and the recurrence rate is low,although long-term follow-up is still necessary after surgery.

In the expansive field of burn medicine, inhalation injury, as one of the complex and challenging issues, has consistently captured the attention of the burn community. With the comprehension of inhalation injury has becoming increasingly profound and comprehensive, the complexity of their conditions and the uniqueness of their treatment options become especially significant when our attention is focused on the special group of children. The objective of this paper is to examine the intricate causes of inhalation injuries in children, with a particular emphasis on the distinctive characteristics of inhalation injuries in children and the subtle alterations in their pathophysiological mechanisms. In light of the aforementioned considerations, we further explore and discuss the precise diagnostic methods and efficacious therapeutic options for this type of injury, aiming to provide strong support for the research development and practical applications in this field, and to facilitate the knowledge update and technological innovation in this domain.

Burn rehabilitation is an important part of burn discipline. As the goal of burn treatment has changed from saving lives and wound elimination to high-quality recovery of body function, burn rehabilitation has been integrated into all levels of burn treatment. In clinical practice, with the establishment of the concept of early preventive rehabilitation, the remodeling of the concept of functional reconstruction in wound repair, and the clarity of the concept of overall rehabilitation, the concept of burn rehabilitation has changed fundamentally. Burn rehabilitation system is not a simple accumulation of directional medical technologies, but an additive expression of multiple medical technologies, covering multi-disciplinary content, including the introduction and application of interdisciplinary new technologies, and involvement of subspecialties. Burn rehabilitation runs throughout the whole process of burn treatment, including early body positioning, later targeted physical and chemical treatments, and even the neurocognitive treatment, which is accompanied by the evaluation of rehabilitation quality throughout the entire process of rehabilitation.

Objective:To investigate the effect of virtual reality (VR) video-based pre-discharge psychological intervention on the post-discharge emotions of patients with deep facial burn.Methods:From October 2017 to September 2019, 84 patients with deep facial burn who were hospitalized in the First Hospital of Jilin University and met the inclusion criteria were enrolled in the prospective randomized controlled study were. According to the random number table, the patients were divided into two groups, with 40 cases (21 males and 19 females) left in VR video group, aged 18-53 years and 41 cases (22 males and 19 females) in general video group, aged 19-55 years after several patients dropped out in follow-up. Seven patients who had been treated in the First Hospital of Jilin University from January 2014 to December 2016 and returned to work and life after recovering from the deep facial burn were selected, and then the pictures and corresponding commentaries before and after burn injuries, the problems and solutions after discharge, and the image data of living status of each patient were edited and recorded into a video. From seven days before discharge, the patients in VR video group began to watch videos by wearing VR glasses, while the patients in general video group began to watch videos on a tablet computer, for 7 days . On the 7th day before discharge (before watching the videos) and one month after discharge, the Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), and Social Avoidance and Distress (SAD) Scale were used to evaluate the level of anxiety, depression, and social avoidance and distress of patients in both groups. Data were statistically analyzed with paired or independent sample t test, chi-square test, or Fisher′s exact probability test. Results:On the 7th day before discharge, the scores of anxiety, depression, and social avoidance and distress of patients in general video group were (34±7), (34±6), and (11.5±3.9) points, respectively, close to (35±7), (35±5), and (10.5±3.9) points in VR video group ( t=-0.803, -1.050, 1.122, P>0.05), and the scores of both groups were higher than the national norms. One month after discharge, the scores of anxiety, depression, and social avoidance and distress of patients in VR video group were (31±5), (31±5), and (7.2±2.5) points, respectively, significantly lower than the scores on the 7th day before discharge ( t=6.609, 7.492, 7.622, P<0.01); the scores of anxiety, depression, and social avoidance and distress of patients in general video group were (37±7), (38±8), and (13.9±7.4) points, respectively, significantly higher than the scores on the 7th day before discharge ( t=2.802, 3.599, 2.739, P<0.01). One month after discharge, the scores of anxiety, depression, and social avoidance and distress of patients in VR video group were significantly lower than those in general video group ( t=4.722, 5.043, 5.490, P<0.01). Conclusions:Pre-discharge psychological intervention of patients with deep facial burn using VR videos can alleviate their bad emotions after discharge, such as anxiety, depression, and social avoidance and distress.

Objective:To explore the effects of sequential application of intensive pulsed light and carbon dioxide laser in treating the hypertrophic scars of burn children at early stage.Methods:A retrospective cohort before-after control study in the same patients was conducted. From January 2016 to December 2018, 145 burn children with hypertrophic scar at the early stage who met the inclusion criteria were admitted to the First Hospital of Jilin University, including 82 males and 63 females, aged 1 to 12 (3 (2, 6)) years. All the children were firstly treated with intense pulsed light therapy (no anesthesia or intravenous-inhalation combined anesthesia) at an interval of once per month, and then changed to carbon dioxide laser therapy (topical anesthesia or intravenous-inhalation combined anesthesia) when the degree of scar hyperemia was reduced, at an interval of once every 3 months, for a total of 3 times. Before the first intense pulsed light treatment (hereinafter referred to as before the first treatment) and 3 months after the last carbon dioxide laser treatment (hereinafter referred to as after the last treatment), scar scoring was evaluated by Vancouver Scar Scale (VSS), and scar hyperemia (denoted as hemoglobin level) was measured with Antera 3D ? camera. The times of intense pulsed light, the time of single treatment, the anesthesia method, and the time of intravenous-inhalation combined anesthesia of intense pulsed light and carbon dioxide laser treatment were analyzed. After the last treatment, Likert Scale was used to evaluate the efficacy satisfaction of both doctors and patients. Adverse reactions were recorded during the treatment. Data were statistically analyzed with Wilcoxon signed rank sum test, and paired sample t test. Results:The color, vascular distribution, thickness, and softness scores, and total score in VSS scoring of scars of children after the last treatment were significantly lower than those before the first treatment ( Z=-6.05, -10.34, -9.84, -9.28, -10.43, P<0.01). The hemoglobin level of scar of children after the last treatment was 1.86±0.24, significantly lower than 2.27±0.32 before the first treatment ( t=17.65, P<0.01). A total of 411 times of intense pulsed light therapy were performed, (2.8±0.6) times per person, and the single treatment time was 35 (20, 45) s. There were 392 times (95.38%) without anesthesia, and 19 times (4.62%) with intravenous-inhalation combined anesthesia with time of 6 (5, 8) min. The single treatment time of carbon dioxide laser therapy was 5 (3, 10) min. There were 364 times (83.68%) of topical anesthesia and 71 times (16.32%) of intravenous-inhalation combined anesthesia with time of 10 (8, 15) min. After the last treatment, the efficacy satisfaction scores of doctors and patients were (4.3±0.7) and (3.8±1.0) points, respectively. Blisters occurred in 5 cases after intense pulsed light treatment, which were healed naturally after drainage. One child developed local skin infection, skin redness and swelling accompanied by purulent exudate after carbon dioxide laser treatment, which was improved after skin disinfection and external use of mupirocin ointment. No inflammatory pigmentation, worsening of hyperplasia of scar, erythema, or other skin adverse reactions or anesthetics-related adverse reactions occurred in any child. Conclusions:Sequential application of intense pulsed light and carbon dioxide laser to treat the hypertrophic scars of burn children at early stage can obviously improve the appearance and texture of scar, with higher satisfaction of doctors and patients and fewer adverse reactions.

Fournier gangrene is a relatively rare clinical critical disease, and its clinical symptoms are not specific and easily unrecognized by some clinicians. It has the features of acute onset, quick development, severe illness, and often accompanied by infection shock which is seriously life-threatening. It is difficult in treatment with high medical costs and long length of hospitalization, which increases pain for patients and relatives and brings heavy economic and psychological burden on patients, society, and medical workers. By reviewing the literature home and abroad and combined with clinical practice, I summarize the researches on concept, epidemiology, clinical manifestation, diagnosis and treatment of Fournier gangrene, in order to provide reference for vast number of clinical workers.

Objective:To investigate the effect of virtual reality (VR) video-based pre-discharge psychological intervention on the post-discharge emotions of patients with deep facial burn.Methods:Enrolled in the prospective randomized controlled study were 84 patients with deep facial burn that were hospitalized from October 2017 to September 2019 in the First Hospital of Jilin University and met the inclusion criteria. According to the random number table, the patients were divided into two groups, with some losing touch in follow-up, there were 40 cases (21 males and 19 females) left in VR video group, aged 18~53 years, while there were 41 cases (22 males and 19 females) left in general video group, aged 19~55 years. Seven patients who had been treated in the First Hospital of Jilin University from January 2014 to December 2016 and returned to work and life after recovering from the deep facial burn were selected, and then a video was made for each of them based on the pictures taken before and after they got burned and at each stage of treatment with the relevant oral explanations, the problems they faced after discharge and the solutions adopted for those problems, and the image data about their living conditions. Seven days before discharge, the patients in VR video group began to watch videos by wearing VR glasses, while the patients in general video group began to watch videos on a tablet computer. On the 7th day before discharge (before watching the videos) and 1 month after discharge, the Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS) and Social Avoidance and Distress (SAD) Scale were used to evaluate the level of anxiety, depression, social avoidance and distress of patients in both groups. Data were statistically analyzed with t test, chi-square test, or Fisher's exact probability test.Results:On the 7th day before discharge, the scores of anxiety, depression, and social avoidance and distress of patients in general video group were (34±7), (34±6), and (11.5±3.9) points, respectively, close to (35±7), (35±5), and (10.5±3.9) points in VR video group, and the scores of both groups were higher than the national norms. One month after discharge, the scores of anxiety, depression, and social avoidance and distress of patients in VR video group were (31±5), (31±5), and (7.2±2.5) points, respectively, significantly lower than the scores on the 7th day before discharge (t=6.609, 7.492, 7.622, P<0.01); the scores of anxiety, depression, social avoidance and distress of patients in general video group were (37±7), (38±8), and (13.9±7.4) points, respectively, significantly higher than the scores on the 7th day before discharge (t=2.802, 3.599, 2.739, P<0.01). One month after discharge, the scores of anxiety, depression, and social avoidance and distress of patients in VR video group were significantly lower than those in general video group (t=4.722, 5.043, 5.490, P<0.01).Conclusions:The unhealthy emotions of patients with deep facial burn, such as anxiety, depression, and social avoidance and distress, can be alleviated after discharge if they undergo psychological intervention by watching VR videos before discharge.

Objective: To explore the effects of recombinant human granulocyte macrophage colony stimulating factor (rhGM-CSF) gel on treatment of thefull-thickness frostbite wounds on foot and hand. Methods: From November 2013 to April 2017, a total of 45 patients of 71 full-thickness frostbite wounds on foot and hand meeting the inclusion criteria were admitted to the First Hospital of Jilin University and the prospective randomized controlled study was done. The patients were divided into rhGM-CSF group of 24 patients with 35 wounds and control group of 21 patients with 36 wounds according to the random number table. There were 20 males and 4 females, aged (38±13) years among patients in rhGM-CSF group, and there were 19 males and 2 females, aged (36±14) years among patients in control group. Patients in 2 groups were performed with the same systemic treatment of rewarming, anti-inflammation, pain relief, anti-infection, anti-coagulation, and thrombolysis. Wounds of patients in rhGM-CSF group and control group were respectively treated with rhGM-CSF gel and aloe vera gel for external usage with 10 mg for every square centimeter and dressing change once every 24 hours, until wounds healed completely. The wound inflammatory response was scored on treatment day (TD) 1, 3, 7, 14, wound secretion was collected for bacteria culture and positive bacteria detection rate was calculated before treatment and on TD 6 and 12, adverse drug reaction after drug use was observed, and the complete wound healing time was recorded. Data were processed with Fisher′s exact probability test, analysis of variance for repeated measurement, t test, and Bonferroni correction. Results: The scores of wound inflammatory response of patients in 2 groups on TD 1 and 3 were close (t=0.37, 2.93, P>0.05). The scores of wound inflammatory response of patients on TD 7 and 14 in rhGM-CSF group were significantly higher than those in control group (t=5.77, 5.83, P<0.01). The results of bacteria culture of wound secretion of patients in 2 groups before treatment were negative. The positive bacteria detection rates of wound secretion of patients in rhGM-CSF group on TD 6 and 12 were 5.71% (2/35) and 22.86% (8/35), which were slightly lower than 13.89% (5/36) and 30.56%(11/36) in control group respectively, but there was no significantly statistical difference (P>0.05). No adverse drug response occurred in patients in rhGM-CSF group, while 1 patient in control group had adverse drug response, with symptoms of redness and swelling of wounds and patchy erythema on skin around wounds, which were alleviated by irrigating with normal saline. The complete wound healing time of patients in rhGM-CSF was (12.3±0.5) d, which was significantly shorter than (16.5±0.8) d in control group (t=24.89, P<0.05). Conclusions The topical rhGM-CSF gel has effects of shortening time of wound healing and reducing inflammatory response of wound on treatment of full-thickness frostbite wounds on foot and hand, which is safe in clinical application.

Objective: To investigate effects of clinical strategy on repair of pressure injury on ischial tuberosity based on the histopathological type. Methods: From January 2014 to January 2018, 33 patients with 33 pressure injuries on ischial tuberosity were admitted to our department. There were 25 males and 8 females aged 35 to 87 years. Pressure injuries on ischial tuberosity were repaired with different methods according to pathological types of denatured tissue on basal parts of wounds and tissue defect volumes. Areas of wounds after thorough debridement ranged from 2.0 cm×1.0 cm to 14.0 cm×12.0 cm. Pressure injuries of necrosis type with tissue defect volumes of 6.5-9.5 cm³ were sutured directly after debridement at the first stage. Tissue defect volumes of 3 patients with pressure injuries of granulation type ranged from 56.0 to 102.5 cm³. According to situation around wounds, the above mentioned 3 patients were respectively repaired with posterior femoral Z-shaped reconstruction, posterior femoral advanced V-Y flap, and posterior femoral propeller flap. Tissue defect volumes of 5 patients with pressure injuries of infection type ranged from 67.5 to 111.0 cm³. Among the patients, 2 patients were repaired with posterior femoral propeller flaps, 2 patients were repaired with posterior femoral advanced V-Y flaps, and 1 patient was repaired with posterior femoral Z-shaped reconstruction. Among patients with pressure injuries of synovium type, wounds of 14 patients with tissue defect volumes 6.4-9.5 cm³ were sutured directly after debridement, and tissue defect volumes of another 8 patients were 97.0-862.5 cm³. Among the 8 patients, 7 patients were repaired with gluteus maximus myocutaneous flaps and continued vacuum sealing drainage was performed for 7 to 14 days according to volume of drainage, and 1 patient was repaired with posterior femoral propeller flap. Areas of flaps or myocutaneous flaps ranged from 3.5 cm× 2.5 cm to 14.0 cm×12.0 cm. The donor sites of flaps were sutured directly. Operative areas after operation and healing of wounds during follow-up were observed. Results: The sutured sites of 33 patients connected tightly, with normal skin temperature, color, and reflux. During follow-up of 12 months, wounds of 25 patients healed well with no local ulceration, and 8 patients were admitted to our department again due to recurrence of pressure injuries on or near the primary sites. Pathological types of pressure injuries of the 8 patients were synovium types. After complete debridement, the tissue defect volumes were 336.8-969.5 cm^3, wounds with areas ranged from 8.0 cm×7.0 cm to 14.0 cm×12.0 cm were repaired with gluteus maximus myocutaneous flaps or posterior femoral propeller flaps which ranged from 8.0 cm×7.0 cm to 14.0 cm×12.0 cm. Eight patients were discharged after wound healing completely. During follow-up of 12 months, operative sites of the patients healed well, with no recurrence. Conclusions Appropriate and targeted methods should be chosen to repair pressure injuries on ischial tuberosity based on the pathological types. Direct suture after debridement is the first choice to repair pressure injury of necrosis type. Pressure injuries of granulation type and infection type can be repaired with posterior femoral propeller flap, Z-shaped reconstruction, or advanced V-Y flap according to situation around wounds. Gluteus maximus myocutaneous flap is the first choice to repair pressure injury of synovium type. In addition, recurrence-prone characteristics of pressure injury of synovium type should be taken into consideration, plan should be made previously, and resources should be reserved.

Objective To investigate the value of T2WI histogram analysis in differential diagnosis of glioblastoma multiform (GBM) from solitary metastasis.Methods Data of 103 patients with pathologically confirmed GBM (GBM group,n=57) and solitary brain metastasis (solitary brain metastasis group,n =46) were retrospectively reviewed.All patients underwent conventional MR scanning,including axial T1WI,T2WI,FLAIR and contrast-enhanced T1WI before surgery.The histogram metrics,including mean,standard deviation (SD),median,kurtosis and skewness were calculated from ROI,which were manually placed on the maximal section of the solid part of tumors on T2WI by using Image J software.ROCs were generated to evaluate differential diagnostic performance of the histogram metrics with significant difference between both groups.Results The values of mean,SD and median were significantly higher in GMB group than those in solitary brain metastasis group (P＜0.05).The areas under ROC curve of mean,SD and median was 0.772 (95％ CI [0.681,0.862],P＜0.001),0.719 (95％ CI [0.616,0.822],P＜0.001) and 0.767 (95％ CI [0.674,0.860],P＜0.001),respectively;and the diagnosis cutoff value of mean,SD and median was 509.575,58.844 and 550.500,respectively.The sensitivity of the three parameters was 0.719,0.702 and 0.719,and the specificity was 0.783,0.652,and 0.826,respectively.Conclusion The value of mean,SD and median of T2WI histogram analysis can be helpful to differentiating GBM and solitary brain metastasis,of which the mean value is the best for differential diagnosis.