This article comprehensively reviews the research progress in the management principles of acute closed soft tissue injuries,summarizing the retention and updates of the four main principles (RICE,PRICE,POLICE,and PEACE&LOVE) at different stages.Traditional methods such as compression,elevation,rest,and protection remain valuable.However,with the advancement in rehabilitation philosophy,early active rehabilitation plays an increasingly important role in the tissue healing process.Traditional cold therapy remains a choice because of its benefits.Non-steroidal anti-inflammatory drugs play a positive role in relieving the acute pain and swelling and improving the function of soft tissue,being preferred by both patients and medical practitioners.Therefore,advantages outweigh disadvantages in the clinical application of non-steroidal anti-inflammatory drugs.Finally,modern medical models have begun to incorporate more social and psychological factors,focusing on patients' mental state and social environment,while guiding patients to actively participate in the rehabilitation process,which can accelerate the recovery process and improve treatment outcomes.
Humans ; Soft Tissue Injuries/therapy* ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use*

Objective: To assess the current situation of early treatment of partial-thickness burn wounds by professional burn medical staff in China, and to further promote the standardized early clinical treatment of partial-thickness burn wounds. Methods: A cross-sectional investigation was conducted. From November 2020 to February 2021, the self-designed questionnaire for the early treatment of partial-thickness burn wounds was published through the "questionnaire star" website and shared through WeChat to conduct a convenient sampling survey of domestic medical staff engaged in burn specialty who met the inclusion criteria. The number, region, and grade of the affiliated hospital, the age, gender, occupation, and seniority of the respondents were recorded. The respondents were divided into physician group and nurse group, senior group and junior group, eastern region group and non-eastern region group, primary and secondary hospital group and tertiary hospital group. Then the seniority, grade of the affiliated hospital, region of the affiliated hospital of the respondents in physician group and nurse group, conventional treatment of partial-thickness burn blisters, reasons for retaining vesicular skin, reasons for removing vesicular skin, and the conventional selection and optimal solution recommendation of topical drugs or dressings for partial-thickness burn wounds in the early stage of respondents in each of all the groups were recorded. Data were statistically analyzed with chi-square test. Results: The survey covered 31 provinces, municipalities, and autonomous regions in China (except for Hong Kong, Macau, and Taiwan regions). A total of 979 questionnaires were recovered, which were all valid. The 979 respondents came from 449 hospitals across the country, including 203 hospitals in the eastern region, 116 hospitals in the western region, 99 hospitals in the central region, and 31 hospitals in the northeast region, 348 tertiary hospitals, 79 secondary hospitals, and 22 primary hospitals. The age of the respondents was (39±10) years. There were 543 males and 436 females, 656 physicians and 323 nurses, 473 juniors and 506 seniors, 460 in the eastern regions and 519 in the non-eastern regions, 818 in tertiary hospitals and 161 in primary and secondary hospitals. There were statistically significant differences in the composition of different seniority in the respondents between physician group and nurse group (χ²=44.32, P<0.01), while there were no statistically significant differences in grade or region of the affiliated hospital of the respondents between physician group and nurse group (P>0.05). There were no statistically significant differences in the conventional treatment of partial-thickness burn blisters among respondents between different occupational groups, seniority groups, and region of the affiliated hospital groups (P>0.05).The respondents in different grade of the affiliated hospital groups differed significantly in the conventional treatment of partial-thickness burn blisters (χ²=6.24, P<0.05). Compared with respondents in nurse group, larger percentage of respondents in physician group chose to retain vesicular skin for protecting the wounds and providing a moist environment, and alleviating the pain of dressing change (with χ² values of 21.22 and 19.96, respectively, P values below 0.01), and smaller percentage of respondents in physician group chose to retain vesicular skin for prevention of wound infection (χ²=23.55, P<0.01). The reasons for retaining vesicular skin of respondents between physician group and nurse group were similar in accelerating wound healing, alleviating pigmentation and scar hyperplasia post wound healing (P>0.05). Compared with respondents in junior group, larger percentage of respondents in senior group chose to retain vesicular skin for protecting the wounds and providing a moist environment and alleviating the pain of dressing change (with χ² values of 10.36 and 4.60, respectively, P<0.05 or P<0.01), and smaller percentage of respondents in senior group chose to retain vesicular skin for prevention of wound infection (χ²=8.20, P<0.01). The reasons for retaining vesicular skin of respondents in senior group and junior group were similar in accelerating wound healing, alleviating pigmentation and scar hyperplasia post wound healing (P>0.05). The 5 reasons for the respondents between eastern region group and non-eastern region group, primary and secondary hospital group and tertiary hospital group chose to retain vesicular skin were all similar (P>0.05). Compared with those in physician group, significantly higher percentage of respondents in nurse group were in favor of the following 6 reasons for removing the vesicular skin, including convenience for using more ideal dressings to protect the wounds, prevention of wound infection, facilitating the effect of topical drugs on the wounds, the likely rupture of blisters and wound contamination, accelerating wound healing, and alleviating pigmentation and scar hyperplasia post wound healing (with χ² values of 4.35, 25.59, 11.83, 16.76, 46.31, and 17.54, respectively, P<0.05 or P<0.01). Compared with respondents in senior group, larger percentage of respondents in junior group chose to remove vesicular skin for the reasons such as the likely blister rupture and wound contamination, preventing wound infection, accelerating wound healing, and alleviating pigmentation and scar hyperplasia post wound healing (with χ² values of 17.25, 18.63, 14.83, and 10.23, respectively, P values below 0.01). Compared with respondents in non-eastern region group, larger percentage of respondents in eastern region group chose to remove vesicular skin for preventing wound infection and the likely rupture of blisters and wound contamination (with χ² values of 9.30 and 8.65, respectively, P values below 0.01). The 6 reasons for the respondents between tertiary hospital group and primary and secondary hospital group choose to remove vesicular skin were similar (P>0.05). Compared with respondents in physician group, larger percentage of respondents in nurse group chose to use moisturizing materials for partial-thickness burn wounds in the early stage (χ²=6.18, P<0.05), and smaller percentage of respondents in nurse group chose other topical drugs or dressings (χ²=5.20, P<0.05). Compared with respondents in junior group, larger percentage of respondents in senior group chose to use moisturizing materials and other topical drugs or dressings for partial-thickness burn wounds in the early stage (with χ² values of 4.97 and 21.80, respectively, P<0.05 or P<0.01). Compared with respondents in non-eastern region group, larger percentage of respondents in eastern region group chose to use topical antimicrobial drugs for partial-thickness burn wounds in the early stage (χ²=4.09, P<0.05), and smaller percentage of respondents in eastern region group chose to use other topical drugs or dressings for the partial-thickness burn wounds in the early stage (χ²=5.63, P<0.05). Compared with respondents in primary and secondary hospital group, larger percentage of respondents in tertiary hospital group chose to use biological dressings for partial-thickness burn wounds in the early stage (χ²=9.38, P<0.01). The optimal solution recommendation of topical drugs or dressings for partial-thickness burn wounds in the early stage varied significantly among the respondents between different occupational groups and seniority groups (with χ² values of 39.58 and 19.93, respectively, P values below 0.01). There were no statistically significant differences between eastern and non-eastern region groups, tertiary hospital group and primary and secondary hospital groups in optimal solution recommendation of topical drugs or dressings for partial-thickness burn wounds in the early stage (P>0.05). Conclusions: The conventional treatment measures of partial-thickness burn blisters and reasons for preserving blister skin by professional burn medical staff in China are relatively consistent, but there are great differences in the selection of reasons for removing blister skin, the conventional selection and optimal solution recommendation of topical drugs or dressings for partial-thickness burn wounds in the early stage. Therefore, it is urgent to establish a clinical treatment standard for partial-thickness burn wounds.
Adult ; Blister ; Burns/drug therapy* ; Cicatrix/pathology* ; Cross-Sectional Studies ; Female ; Humans ; Hyperplasia ; Male ; Medical Staff ; Middle Aged ; Occupations ; Pain ; Soft Tissue Injuries ; Wound Infection

On December 22, 2017, a 35-year-old male hemophilia A patient with a secondary chronic refractory wound after left knee joint surgery was transferred from the Department of Hematology of Maoming People's Hospital to the Department of Burns and Plastic Surgery in the same hospital. The physical examination revealed that the patient's left knee joint was swollen, with a full-thickness skin defect wound of 4 cm×4 cm on the lateral side of the joint and a large number of dark red blood clots at the bottom of the wound. The wound bleeding was controlled by intravenous infusion of plasma, cryoprecipitate, and human coagulation factor Ⅷ. After con- ventional debridement and dressing changes until the wound infection was controlled and necrotic tissue was removed, a subcutaneous cavity wound of 2 cm×2 cm in area and 3 cm in depth remained in the left knee joint and was difficult to heal. Nineteen days after transfer, the patient received autologous platelet-rich plasma (PRP) treatment, and 32 days after PRP treatment, the wound in left knee joint was healed with epithelialization. This case suggests that autologous PRP therapy would be a good option for hemophilia complicated chronic refractory wounds when they could not be repaired by surgery.
Adult ; Hemophilia A/therapy* ; Humans ; Knee Joint/surgery* ; Male ; Platelet-Rich Plasma ; Skin Transplantation ; Soft Tissue Injuries/surgery* ; Treatment Outcome ; Wound Healing

OBJECTIVE: To explore the clinical effect of vacuum sealing drainage (VSD) technique and Ointment in the treatment of foot skin defect. METHODS: From November 2017 to April 2019, 21 patients (21 feet) with foot skin defect were treated with VSD technique and Ointment. There were 17 males and 4 females, aged from 24 to 60 years old with an average of (37.8±11.2) years, 9 cases caused by traffic accident injury, 6 cases by heavy injury, 6 cases by falling injury. The time from injury to operation was for 3 to 36 (8.6±7.2) h, and the area of foot skin defect was for 20.35 to 83.43(47.2±19.5) cm. All patients underwent debridement or phaseⅠtemporary fixation in emergency, and three-dimensional imagingof the foot was performed by using Mimics software, and the defect area was rendered. The quality of wound healing and complications were observed, and the clinical effect was evaluated by Maryland foot function score. RESULTS: All the 21 patients were followed up for 7 to 17 (10.8±2.7) months. There was no infection or nonunion in all patients. At the final follow-up, the skin margin of the healing site grew tightly, the skin was elastic, the texture was tough, the appearance was no obvious carbuncle. The time of wound healing was for 18 to 63 (41.2±13.3) days. Eight patients underwent stageⅡfixation or/and fusion, and all incisions healed by stageⅠ. According to Maryland's foot scoring, 9 cases got excellent results, 11 good, and 1 middle. CONCLUSION VSD can effectively remove the necrotic tissue of the wound, provide a smooth drainage of the wound, combine with Ointment to prevent infection and promote the rapid growth of granulation tissue, whose whole treatment cycle was short, the wound healing site was highquality, the limb function was good, and the clinical effect was satisfactory.
Adult ; Drainage ; Female ; Humans ; Male ; Middle Aged ; Negative-Pressure Wound Therapy ; Skin Transplantation ; Soft Tissue Injuries ; surgery ; Treatment Outcome ; Young Adult

To systematically evaluate the clinical efficacy and safety of Cheezheng Pain Relieving Plaster in the treatment of soft tissue injury. Four Chinese databases(namely CNKI, WanFang, VIP, CBM) and 2 English databases(namely PubMed, Cochrane Library) were retrieved from the establishment of each database to March 2019. The randomized controlled trials of Cheezheng Pain Relieving Plaster compared with routine therapy in treatment of soft tissue injury were included. The quality of the included studies was assessed using the Cochrane Risk Assessment Tool. Five studies were included, and 367 patients were enrolled. None of the included studies reported randomized concealment, blinding, follow-up and dropping off. The results showed that Cheezheng Pain Relieving Plaster may have advantages in alleviating joint pain, swelling, tenderness and dysfunction and other symptoms, with no serious adverse reaction. Compared with routine therapy, Cheezheng Pain Relieving Plaster may have advantages in the treatment of soft tissue injury. However, due to the quality of the included RCTs, the conclusions of this study were limited. In addition, to produce high-quality evidences for the clinical application of Cheezheng Pain Relieving Plaster, the conclusions of this study shall be further verified with large-sample, scientifically designed and strictly implemented clinical trials.
Arthralgia/drug therapy* ; Drugs, Chinese Herbal/therapeutic use* ; Edema/drug therapy* ; Humans ; Pain/drug therapy* ; Randomized Controlled Trials as Topic ; Soft Tissue Injuries/drug therapy* ; Treatment Outcome

OBJECTIVETo observe the effects of artificial dermis combined with basic fibroblast growth factor (bFGF) on the treatment of cicatrix and deep skin wounds.

METHODSThe clinical data of 72 patients with wounds repaired with artificial dermis, hospitalized in our unit from October 2010 to April 2015, conforming to the study criteria, were retrospectively analyzed. The types of wounds were wounds after resection of cicatrices, deep burn wounds without exposure of tendon or bone, and wounds with exposure of small area of tendon or bone, in a total number of 102. Wounds were divided into artificial dermis group (A, n=60) and artificial dermis+ bFGF group (B, n=42) according to whether or not artificial dermis combined with bFGF. In group A, after release and resection of cicatrices or thorough debridement of deep skin wounds, artificial dermis was directly grafted to wounds in the first stage operation. After complete vascularization of artificial dermis, wounds were repaired with autologous split-thickness skin grafts in the second stage operation. In group B, all the procedures were exactly the same as those in group A except that artificial dermis had been soaked in bFGF for 30 min before grafting. Operation area, complete vascularization time of artificial dermis, survival of skin grafts, and the follow-up condition of wounds in the two groups were recorded. Data were processed with t test and Fisher's exact test.

RESULTS(1) Operation areas of wounds after resection of cicatrices, deep burn wounds without exposure of tendon or bone, and wounds with exposure of small area of tendon or bone in the two groups were about the same (with t values from -1.853 to -0.200, P values above 0.05). Complete vascularization time of artificial dermis in wounds after resection of cicatrices, deep burn wounds without exposure of tendon or bone, and wounds with exposure of small area of tendon or bone in group B were respectively (15.6 ± 2.9), (14.7 ± 2.7), and (20.3 ± 4.4) d, and they were shorter by an average time of 2.7, 4.0, 7.4 d, respectively, as compared with those in corresponding types of wounds in group A [respectively (18.3 ± 4.7), (18.7 ± 4.2), and (27.7 ± 8.8) d, with t values from -2.779 to -2.383, P values below 0.05]. (2) The ratio of skin grafts with excellent survival in the three types of wounds in group B were higher than those in corresponding types of wounds in group A, but there were no statistically significant differences (with P values above 0.05). (3) Patients were followed up for 1 to 48 months, and there were no obvious cicatrices in skin graft sites and the donor sites during the following time.

CONCLUSIONSArtificial dermis combined with bFGF can effectively shorten the vascularization time of artificial dermis in wounds after resection of cicatrices and deep skin wounds.

Burns ; therapy ; Cicatrix ; therapy ; Debridement ; Dermis ; injuries ; Fibroblast Growth Factor 2 ; therapeutic use ; Humans ; Retrospective Studies ; Skin Transplantation ; Skin, Artificial ; Soft Tissue Injuries ; therapy ; Transplantation, Autologous ; Wound Healing

A 31-year-old male motorcyclist presented with prepatellar swelling of the left knee after a collision with a car. Magnetic resonance imaging of the knee showed no bony or ligamentous injury to the knee. Instead, a well-defined, thin-walled, T2-weighted hyperintense fluid collection with internal septations was identified in a prefascial location overlying the left patella and patellar tendon. The findings were in keeping with those of a Morel-Lavallée lesion, a closed internal degloving injury. Morel-Lavallée lesions are occasionally encountered after a blunt soft-tissue trauma. The presentation and imaging features are discussed.
Adult ; Compression Bandages ; Humans ; Knee Injuries ; diagnosis ; therapy ; Magnetic Resonance Imaging ; methods ; Male ; Physical Therapy Modalities ; Soft Tissue Injuries ; diagnosis ; therapy ; Trauma Severity Indices

OBJECTIVETo explore the influence of hydrogen sulfide on the intestinal biological barrier, by applying exogenous hydrogen sulfide and hydrogen sulfide synthase inhibitor for the treatment of rats with severe burn injury.

METHODSOne hundred and four SD rats were divided into sham injury (SI, n = 8), burn control (BC, n = 32), sodium hydrosulfide (SH, n = 32), and propargylglycine groups (PPG, n = 32) according to the random number table. Rats in group SI were sham injured without fluid resuscitation. Rats in the latter 3 groups were inflicted with 30% TBSA full-thickness scald (referred to as burn below) on the back and intraperitoneally injected with 40 mL/kg balanced salt solution immediately after injury. Rats in groups SH and PPG were respectively intraperitoneally injected with SH (56 µmol/kg) and PPG (45 mg/kg) within 1 hour post injury. From post injury day (PID) 2, SH (56 µmol/kg) and PPG (45 mg/kg) were respectively intraperitoneally injected once a day to rats in groups SH and PPG. Eight rats from groups BC, SH, and PPG were sacrificed on PID 2, 7, 14 and 21, and ceca samples were collected. Ceca samples were added to the appropriate culture medium after being homogenized and diluted, for the culture of Bifidobacterium, Lactobacillus, Enterococcus, Enterobacter, and Candida albicans. The content of bacteria was calculated after the bacteria number was counted. The same procedure was performed for rats in group SI. Data were processed with logarithmic function, one-way analysis of variance, analysis of variance of factorial design, and SNK-q test.

RESULTSOn each PID, the content of Bifidobacterium and Lactobacillus in the ceca of each group with burned rats was less than that of group SI (with q values from 4.12 to 20.74, P values below 0.05); while the content of Enterococcus, Enterobacter, and Candida albicans was more than that of group SI (with q values from 2.84 to 68.29, P values below 0.05). Compared with that of group BC, the content of Bifidobacterium and Lactobacillus in the ceca of rats in group SH were increased on each PID (with q values from 2.88 to 17.57, P values below 0.05). In group SH, the content of Bifidobacterium peaked as (6.54 ± 0.35) lg (CFU/g) on PID 7, the content of Lactobacillus peaked as (7.25 ± 0.71) lg (CFU/g) on PID 21. Compared with that of group BC, the content of Enterococcus, Enterobacter, and Candida albicans in the ceca of rats in group SH was reduced on each PID (with q values from 2.79 to 29.59, P values below 0.05). Compared with that of group BC, the content of Bifidobacterium and Lactobacillus in the ceca of rats in group PPG was decreased on each PID (with q values from 2.82 to 46.56, P values below 0.05); while the content of Enterococcus, Enterobacter, and Candida albicans was significantly increased on each PID (with q values from 2.93 to 41.42, P values below 0.05). In group PPG, the content of Enterococcus peaked as (9.41 ± 0.22) lg (CFU/g) on PID 21, the content of Enterobacter peaked as (9.96 ± 0.24) lg (CFU/g) on PID 14, and that of Candida albicans peaked as (3.94 ± 0.84) lg (CFU/g) on PID 14.

CONCLUSIONSExogenous hydrogen sulfide can subdue the growth of pathogenic bacteria while promote that of probiotics, thus helping maintain the integrity of intestinal biological barrier of rats with burn injury.

Animals ; Burns ; drug therapy ; pathology ; Hydrogen Sulfide ; pharmacology ; therapeutic use ; Intestines ; pathology ; Rats ; Rats, Sprague-Dawley ; Soft Tissue Injuries

OBJECTIVETo observe the soft tissue regeneration after implantation of two novel citric acid-based biodegradable materials in the skull defects in rats.

METHODSTwo novel citric acid-based biodegradable materials were implanted in the muscular tissues in the thigh and harvested 2 weeks later. Another 40 rats with surgically induced cranial defect were randomized into control group, autograft group, CUPE-HA group, and POC-HA group (n=10), and 3 months after implantation, the materials were harvested for histological and morphometric analyses.

RESULTSSoft tissue regeneration was stimulated by the two biodegradable materials in the muscular tissues. The implants also stimulated angiogenesis and soft tissue regeneration in the cranial defect and accelerated of intramembranous ossification.

CONCLUSIONThe 2 novel citric acid-based biodegradable materials can induce angiogenesis and soft tissue regeneration and accelerate intramembranous ossification in rats with cranial defects.

Absorbable Implants ; Animals ; Citric Acid ; Neovascularization, Physiologic ; Osteogenesis ; Rats ; Regeneration ; Skull ; Soft Tissue Injuries ; therapy ; Wound Healing

The vast majority of the published papers dealing with the treatment of wounds in the past few decades reported that extracorporeal shock wave therapy (ESWT) used in wound repair is easy in manipulation, noninvasive, safe, effective, and well tolerated by patients. However, little is known about the mechanism of ESWT in wound healing to date. In this article, we reviewed the literature to identify the potential cellular and molecular mechanisms of ESWT in the process of wound healing, and the results of the literature showed that the mechanism of ESWT in promoting wound healing is the result of heterogeneous biological effects.
High-Energy Shock Waves ; therapeutic use ; Humans ; Skin ; Soft Tissue Injuries ; therapy ; Ultrasonic Therapy ; methods ; trends ; Wound Healing ; physiology