Skin perfusion pressure (SPP) is the perfusion pressure at the skin level,and it can serve as an index of microcirculation in skin and subcutaneous tissue.SPP can be measured simply,with less injury and high reproducibility in a short time,without interfering vascular calcification.It has been widely used in various fields,including evaluation of critical limb ischaemia and effect of vascular surgery,selection of proper level of amputation,and prediction of wound healing.So far,there is no relevant reports about the application of SPP in China.This article reviews the clinical application of SPP abroad.

Objective To study the anatomical basis of the sensory perforator flap from the ulnar palmar digtal artery of the little finger and its application in reconstruction of soft tissue defect on the finger pulp.Methods The origins and distributions of the blood vessels and nerves of the hypothenar region were observed in 6 fresh cadavers whose upper limbs were perfused with red latex.From September 2013 to November 2015,13 cases with soft tissue defects on the finger pulp were treated.All patients received the sensory perforator flap from the ulnar palmar digtal artery of the little finger.The donor site was sutured directly.Results Through anatomical study,we found that the ulnar palmar digital artery of the little finger gives off constant cutaneous perforarter to nourish the skin of the hypothenar region,so do the ulnar palmar digital nerve of the little finger.The diameter of the artey is about 1.28 mm and suitable for microvascular anastomosis.All the 13 flaps survived.The patients were followed up for 3 months to 15 months.All the flaps had a good appearance.The sensation of the flaps recovered to S3 and two-point discrimination was 8-9 mmm.All the fingers had good function.There was only one linear scar on the hypothenar region without any discomfort.Conclusions The ulnar palm digital artery of the little finger contains constant branches to nourish the skin of the hypothenar region,so do the ulnar palrnar digital nerve of the little finger.So we can design a flap with sensory nerve on the hypothenar region.It is an effective method to repair soft tissue defect of the finger pulp with the free sensory perforator flap from the ulnar palmar digtal artery of the little finger.

Objective To study the anatomical basis of the sensory perforator flap from the ulnar palmar digtal artery of the little finger and its application in reconstruction of soft tissue defect on the finger pulp.Methods The origins and distributions of the blood vessels and nerves of the hypothenar region were observed in 6 fresh cadavers whose upper limbs were perfused with red latex.From September 2013 to November 2015,13 cases with soft tissue defects on the finger pulp were treated.All patients received the sensory perforator flap from the ulnar palmar digtal artery of the little finger.The donor site was sutured directly.Results Through anatomical study,we found that the ulnar palmar digital artery of the little finger gives off constant cutaneous perforarter to nourish the skin of the hypothenar region,so do the ulnar palmar digital nerve of the little finger.The diameter of the artey is about 1.28 mm and suitable for microvascular anastomosis.All the 13 flaps survived.The patients were followed up for 3 months to 15 months.All the flaps had a good appearance.The sensation of the flaps recovered to S3 and two-point discrimination was 8-9 mmm.All the fingers had good function.There was only one linear scar on the hypothenar region without any discomfort.Conclusions The ulnar palm digital artery of the little finger contains constant branches to nourish the skin of the hypothenar region,so do the ulnar palrnar digital nerve of the little finger.So we can design a flap with sensory nerve on the hypothenar region.It is an effective method to repair soft tissue defect of the finger pulp with the free sensory perforator flap from the ulnar palmar digtal artery of the little finger.

On April 26, 2018, a 55-year-old male patient with severe phenol burn complicated with acute poisoning was admitted to the Second Affiliated Hospital of Zhejiang University School of Medicine. The patient quickly developed the symptoms of central nervous system including blurred consciousness and restlessness, anuria, and respiratory failure. After self-rescue before admission and a series of measures in hospital including wound decontamination to reduce phenol absorption, rapid massive infusion and hemodialysis+ hemoperfusion, continuous renal replacement therapy for speeding up phenol excretion and organ function maintenance, the poisoning symptoms were effectively alleviated, and the patient was finally rescued successfully and discharged on post injury day 29. This case suggests that early hemodialysis combined with hemoperfusion and continuous renal replacement therapy are effective methods for treating severe phenol burn complicated with acute poisoning.

Objective:To explore the epidemiological characteristics and risk factors of sepsis development and death in patients with extremely severe burns.Methods:A retrospective case series study was conducted. From January 2017 to December 2021, 135 patients with extremely severe burns who met the inclusion criteria were admitted to the Department of Burn and Wound Repair of the Second Affiliated Hospital of Zhejiang University School of Medicine, including 100 males and 35 females, aged 18-84 years. The incidence and diagnosis time of sepsis, the rate of positive microbial culture of blood samples (hereinafter referred to as positive blood culture), and the mortality rate of all patients, as well as the incidence of sepsis and the pathogen of infection in patients with positive blood culture were recorded (statistically analyzed with chi-square test or Fisher's exact probability test). According to the occurrence of sepsis, all patients were divided into sepsis group (58 cases) and non-sepsis group (77 cases), and the gender, age, body mass index, history of hypertension, history of diabetes, combination of inhalation injury, burn site, burn type, total burn area, and combined injury of patients were compared between the two groups. According to the outcome, all patients were divided into death group (37 cases) and survival group (98 cases), and the aforementioned data grouped according to sepsis as well as the stability of shock period and the combination of sepsis of patients were compared between the two groups. The aforementioned data between two groups were statistically analyzed with univariate analysis of independent sample t test, Wilcoxon rank-sum test, Mann-Whitney U test, chi-square test, or Fisher's exact probability test. Factors with P<0.1 were selected for multivariate logistic regression analysis to screen independent risk factors of sepsis and death in patients with extremely severe burns. Results:Among all patients, the incidence of sepsis was 42.96% (58/135), the diagnosis time of sepsis was 14 (7, 24) d after injury, the positive blood culture rate was 62.22% (84/135), and the mortality rate was 27.41% (37/135). The incidence of sepsis of patients with positive blood culture was 69.05% (58/84). The top 5 pathogenic bacteria in the detection rate of septic patients with positive blood culture were Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus, and Enterobacter cloacae, ranking from high to low, and the proportion of Acinetobacter baumannii infected was significantly higher than that of non-septic patients with positive blood culture ( χ2=7.49, P<0.05). Compared with those in non-sepsis group, the proportion of combination of inhalation injury, the proportion of perineal burns, and the total burn area of patients in sepsis group increased significantly (with χ2 values of 11.08 and 17.47, respectively, Z=5.68, P<0.05), while the other indicators did not change significantly ( P>0.05). Multivariate logistic regression analysis showed that combination of inhalation injury, total burn area ≥80% total body surface area (TBSA), and perineal burns were independent risk factors for patients with extremely severe burns developing sepsis (with odds ratios of 3.15, 7.24, and 3.24, respectively, with 95% confidence intervals of 1.07 to 9.29, 1.79 to 29.34, and 1.21 to 8.68, respectively, P<0.05). Compared with those in survival group, the proportion of combination of inhalation injury, the proportion of perineal burns, and the proportion of combination of sepsis (with χ2 values of 6.55, 11.64, and 22.26, respectively, P values all <0.05), total burn area ( Z=4.25, P<0.05), and proportion of instability of shock period ( P<0.05) of patients in death group all increased significantly, while the other indicators did not change significantly ( P>0.05). Multivariate logistic regression analysis showed that the instability of shock period and combination of sepsis were independent risk factors for death of patients with extremely severe burns (with odds ratios of 4.87 and 3.45, respectively, with 95% confidence intervals of 1.21 to 19.57 and 1.28 to 9.33, respectively, P<0.05). Conclusions:Patients with extremely severe burns have a high incidence of sepsis and a high mortality rate. The peak period of sepsis onset is 2 weeks after injury, with Acinetobacter baumannii as the most prominent infectious pathogen. Combination of inhalation injury, total burn area ≥80% TBSA, and perineal burns are independent risk factors for extremely severe burn patients complicated with sepsis, and combination of sepsis and instability of shock period are independent risk factors for death of patients with extremely severe burns.

Objective:To explore forecast indicators for the prognosis of sepsis in adult extremely severe burn patients.Methods:Case data of adults with extremely severe burns combined with sepsis admitted to the Second Affiliated Hospital of Zhejiang University School of Medicine from January 2017 to December 2021 were retrospectively collected. According to the prognosis, all patients were divided into a death group and a survival group. The general conditions of the two groups were compared. The clinical symptoms, vital signs, platelet count (PLT), white blood cell count (WBC), neutrophil ratio, procalcitonin (PCT), blood sodium, blood glucose, hemoglobin and albumin levels at diagnosis of sepsis were also compared between the two groups. The independent sample t test, Mann?Whitney U test, or Fisher's exact probability test was used for group comparison. Variables with statistical significance in univariate analysis were included in the Cox regression model for multivariate analysis to assess the effect of each index on the outcome of extremely severe burn patients with sepsis. The predictive value of each index for sepsis outcome was analyzed by the receiver operating characteristic curve (ROC). Results:A total of 60 patients with particularly severe burn sepsis were selected, including 41 males and 19 females aged 18 to 84 years. The diagnosis time of sepsis was 14 (7, 24) days after injury. There were 29 patients in the death group and 31 patients in the survival group, and the mortality rate was 48.3%. Compared with the survival group, PLT and hemoglobin levels in the death group decreased significantly (both P<0.05), and PCT and blood sodium levels increased significantly (both P<0.05), while the other indicators did not change significantly (all P>0.05). The results of multivariate Cox regression analysis showed that hemoglobin ( HR=0.936, 95% CI: 0.935-0.991) and serum sodium levels ( HR=1.031, 95% CI: 1.010-1.052) at the time of sepsis diagnosis were independent risk factors affecting the prognosis of sepsis in extra-severe burn patients (both P<0.05). ROC curve analysis showed that the AUCs of hemoglobin, blood sodium and PCT for predicting the prognosis of extremely severe burn patients with sepsis were 0.747, 0.811 and 0.690, respectively (all P<0.05). The cut-off value of hemoglobin for predicting prognosis was 77 g/L, with a sensitivity of 69.0% and specificity of 74.2%. The cut-off value of blood sodium for predicting prognosis was 138 mmol/L, with a sensitivity of 89.7% and specificity of 61.3%. The cut-off value of PCT was 3.51 μg/L, with a sensitivity of 65.5% and specificity of 74.2%. Conclusions:Hemoglobin, blood sodium and PCT may be predictors of outcome in extremely severe burn patients with sepsis.