Objective: To compare and analyze the effect of repairing small skin and soft tissue defect wounds in functional areas of children with full-thickness skin grafts from different sites of abdomen. Methods: A prospective randomized controlled study was conducted. From January 2019 to June 2020, 60 female children with small skin and soft tissue defects in functional areas requiring full-thickness skin grafting, who met the inclusion criteria, were admitted to the First Affiliated Hospital of Air Force Medical University. According to the random number table, the children were divided into two groups, with 28 cases left in lateral abdomen group aged 5 (3, 8) years and 29 cases in lower abdomen group aged 5 (3, 7) years after the exclusion of several dropped-out children in follow-up. In lower abdomen group, 20 (12, 26) cm² wounds of children were repaired with (24±10) cm² full-thickness skin graft from transverse skin lines in the inferior abdomen area, while in lateral abdomen group, 23 (16, 32) cm² wounds of children were repaired with (24±9) cm² full-thickness skin graft from below the umbilical plane to above the groin in the lateral abdomen area. All the children were treated with continuous intradermal suture at the donor site incision and received continuous negative pressure treatment of -10.64 to -6.65 kPa in the donor and recipient areas after operation. The donor site was treated with a medical skin tension-reducing closure device since post-surgery day (PSD) 7. The use of medical skin tension-reducing closure device at the donor site, postoperative complications and suture removal time of the donor area were recorded, and the incidence of complications was calculated. On PSD 7, a self-designed efficacy satisfaction questionnaire was used to investigate the parents' satisfaction with the curative effect of their children. In post-surgery month (PSM) 1 and 6, Vancouver scar scale (VSS) was used to evaluate the scar at the donor site, and the VSS score difference between the two time points was calculated; the scar width at the donor site was measured with a ruler, and the scar width difference between the two time points was calculated. Data were statistically analyzed with independent sample t test or Cochran & Cox approximate t test, Mann-Whitney U test, and Fisher's exact probability test. Results: The proportion of children in lateral abdomen group who used the medical skin tension-reducing closure device in the donor area for equal to or more than 4 weeks after surgery was significantly higher than that in lower abdomen group (P<0.05). On PSD 7, there was one case of partial incision dehiscence in the donor area, one case of peripheral skin redness and swelling in the donor area, and one case of fat liquefaction in the donor area in lateral abdomen group, and one case of partial incision dehiscence in the donor area in lower abdomen group. The incidence of postoperative complications at the donor site of children in lower abdomen group was significantly lower than that in lateral abdomen group (P<0.05). Compared with that in lateral abdomen group, the suture removal time at the donor site of children after surgery in lower abdomen group was significantly shorter (t'=17.23, P<0.01). On PSD 7, the satisfaction score of parents with the curative effect of their children in lower abdomen group was significantly higher than that in lateral abdomen group (t'=20.14, P<0.01). In PSM 1 and 6, the VSS scores of scar at the donor site of children in lower abdomen group were 2.7±0.9 and 2.8±1.0, respectively, which were significantly lower than 7.1±2.2 and 9.1±2.7 in lateral abdomen group (with t values of 10.00 and 11.15, respectively, P<0.01). In PSM 6, the VSS score of scar at the donor site of children in lateral abdomen group was significantly higher than that in PSM 1 (t=3.10, P<0.01), while the VSS score of scar at the donor site of children in lower abdomen group was not significantly higher than that in PSM 1 (P>0.05). The VSS score difference of scar at the donor site of children in lateral abdomen group was significantly greater than that in lower abdomen group (Z=-8.12, P<0.01). In PSM 1 and 6, the scar widths at the donor site of children in lower abdomen group were 2.0 (1.0, 2.0) and 2.0 (2.0, 3.0) mm, respectively, which were significantly narrower than 6.0 (4.0, 10.0) and 8.5 (5.0, 12.0) mm in lateral abdomen group (with Z values of -13.41 and -14.70, respectively, P<0.01). In PSM 6, the scar width at the donor site of children in lateral abdomen group was significantly wider than that in PSM 1 (Z=-2.79, P<0.01), while the scar width at the donor site of children in lower abdomen group was not significantly wider than that in PSM 1 (P>0.05). The difference of scar width at the donor site of children in lateral abdomen group was significantly greater than that in lower abdomen group (Z=-14.93, P<0.01). Conclusions: The use of full-thickness skin grafts from the lower abdomen to repair small skin and soft tissue defect wounds in functional areas of children, especially girls, is effective, simple and easy to operate, and conforms to the principle of aesthetic repair. Compared with transplantation with full-thickness skin graft from the lateral abdomen, lower abdominal full-thickness skin grafting has a low incidence of donor site complications and no obvious scar hyperplasia, which is worthy of clinical promotion.
Abdominal Cavity/surgery* ; Child ; Cicatrix/surgery* ; Female ; Humans ; Postoperative Complications/surgery* ; Prospective Studies ; Skin Transplantation ; Wound Healing

A 59-year-old male patient with local sinus tract formation due to residual foreign body was admitted to the Second Affiliated Hospital of Zhejiang University College of Medicine on December 17, 2018. The examination showed that the residual foreign body was the component of a sticky cloth implanted when the patient underwent appendectomy 27 years ago. Hypertrophic scar developed at the right-lower abdominal incision for appendectomy 23 years ago and the secondary infection after cicatrectomy resulted in non-healing of the wound. The chronic refractory wound healed completely after surgical treatment in our hospital after this admission. The postoperative pathological examination revealed local inflammatory granuloma. This case suggests that chronic refractory wound is likely to form when secondary infection occurs following the surgical procedure near the implant, and aggressive surgery is an effective way to solve this problem.
Abdomen ; Abdominal Cavity ; Cicatrix, Hypertrophic ; Coinfection ; Foreign Bodies/surgery* ; Humans ; Male ; Middle Aged

Gastrointestinal fistula patients may suffer from complicated intra-abdominal infection and sepsis with improper treatment, which is characterized by high mortality ranging from 20% to 60%, as well as high medical costs. Gastrointestinal fistula patients with complicated intra-abdominal infections are not often diagnosed early, and proper treatment remains an unsolved problem. Therefore it is a great challenge for surgeons to repair broken intestines under complicated intra-abdominal infection conditions and to repair ruptured intestines under conditions of severe abdominal adhesions and swelling of the intestinal wall and mesentery. After the open abdominal approach was first adopted to treat complicated intra-abdominal infection patients by Duff and Moffat in 1981, it gradually began to be used more widely. However, some investigators have reported that the open abdomen approach has not been effective in controlling controlled mortality, instead, it may even increase mortality. For this reason, the approach has only been used in large medical centers rather than having been widely popularized. In this review, the effect, timing, indications of open abdomen approach and the principles for the open abdominal wound management are summarized, and the reason for the various efficacy among different centers is also analyzed. We provide a new perspective for clinicians to manage the gastrointestinal fistula patients with complicated intra-abdominal infection.
Abdominal Cavity ; surgery ; Digestive System Fistula ; surgery ; Humans ; Intraabdominal Infections ; surgery ; Sepsis ; surgery

OBJECTIVETo identify the value of lymphography in the location and treatment decision of chyle leakage.

METHODSThe clinic data of 177 patients suffered from chyle leakage admitted in 6 medical centers in Shanghai from February 1998 to December 2014 was analyzed retrospectively. There were 94 male and 83 female patients aging from 9 to 84 years with a mean of 49 years, including 128 cases of chyluria, 34 cases of primary chylothorax and 15 cases of other chyle leakage. All patients had failed to conservative treatment more than 2 weeks. Pedal lymphography was performed in every patient to investigate the site and range of chyle leakage. Effect of surgical or conservative management was compared according to the different results of lymphography.

RESULTSNo serious complication was noticed. For all 177 patients, lymphography showed localized lymphatic diseases in 148 cases (83.6%), including 125 cases of lymphatic renal pelvic leaks, 14 cases of unilateral identified leak within thorax and 9 cases of chyle leakage in neck, heart, abdomen or scrotum. Among these patients, surgical treatment cured 129 and improved 3 patients but failed in 2 patients, while the remaining 14 cases had their leaks decreased after lymphography and cured by conservative management. For those 15 patients having disseminated lymphatic diseases or 14 with no abnormality under lymphography, surgery only cured 2 and improved 1 patient but failed in 8 patients (with 3 death), whereas continuous conservative treatment cured 11 patients, improved 5 patients but only failed in 2 patients (with one death). For localized leakage, surgical treatment showed better efficacy (98.5% vs. 3/11), whereas conservative treatment had significantly higher successful rate than surgical interventions in patients with disseminated lymphatic diseases or no abnormality under lymphography (16/18 vs. 3/11).

CONCLUSIONSLymphography could identify the location and range of complicate chyle leakage failed to primary conservative management. Patients with disseminated lymphatic diseases or no abnormality under lymphography would be better managed by continuous non-operative treatment partly due to therapeutic effect of lymphography, while surgical intervention could be a good option for patients having localized lymphatic etiology.

Abdominal Cavity ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Chyle ; Chylothorax ; diagnosis ; surgery ; Female ; Heart ; Humans ; Kidney Pelvis ; Lymphatic Diseases ; Lymphography ; Male ; Middle Aged ; Neck ; Retrospective Studies ; Scrotum ; Young Adult

OBJECTIVETo explore the correlation between signs of living body in abdominal and pelvic cavities and syndrome typing of Chinese medicine (CM) in colorectal cancer patients.

METHODSTotally 112 colorectal cancer patients undergoing open abdominal surgery or laporoscopic surgery were syndrome typed as five types, i.e., inner-accumulation of damp and heat, blockage of stasis and toxin, Pi-Shen yang deficiency, blood-qi deficiency, Gan-Shen yin deficiency. Signs of living body in abdominal and pelvic cavities were collected. The correlation between signs of living body in abdominal and pelvic cavities and syndrome typing of CM were analyzed.

RESULTSRed colorectal canals or mass were dominated in colorectal cancer patients with inner-accumulation of damp and heat syndrome. Dark purple colorectal canals or mass were dominated in colorectal cancer patients with blockage of stasis and toxin syndrome. Reddish colorectal canals or mass were dominated in colorectal cancer patients with blood-qi deficiency syndrome. Pale colorectal canals or mass were dominated in colorectal cancer patients with Pi-Shen yang deficiency syndrome. Whitish or red-white stripes were dominated in colorectal cancer patients with Gan-Shen yin deficiency syndrome. Dropsy colorectal canal was associated with Pi-Shen yang deficiency syndrome. Intracavitary effusion was often seen in colorectal cancer patients with inner-accumulation of damp and heat syndrome. The effusion was yellowish in less amount. Intracavitary adhesion was often seen in colorectal cancer patients with blockage of stasis and toxin syndrome. There was no correlation between the maximum diameter of mass or each syndrome type of CM.

CONCLUSIONThere existed correlation between signs of living body in abdominal and pelvic cavities and syndrome typing of CM, which could be taken as one of references for syndrome typing of colorectal cancer patients.

Abdominal Cavity ; pathology ; Colorectal Neoplasms ; diagnosis ; surgery ; Humans ; Medicine, Chinese Traditional ; Pelvis ; pathology ; Yang Deficiency ; diagnosis ; Yin Deficiency ; diagnosis

OBJECTIVETo analyze the pattern and the clinicopathologic risk factors of lymph node metastasis (LNM) in pN1 stage esophageal squamous cell carcinoma.

METHODSClinical data of 181 patients (154 male and 27 female patients, aging from 38 to 84 years) who underwent esophagectomy during January 2005 and December 2008 were reviewed, including 69 cases through left thoracotomy and 112 cases through right thoracotomy. All patients underwent systematic lymphadenectomy. The risk factors related to lymph node metastasis were analyzed by χ² test and Logistic regression analysis.

RESULTSThe relatively highest LNM site were middle and lower thoracic paraesophageal (38.4%), right and left cardiac (35.3%) and the left gastric artery (38.8%). The LNM of middle and lower thoracic paraesophageal was correlated with T stage (χ² =11.754, P=0.009). A correlation was also found among the LNM of upper mediastinum and the location of tumor (P=0.039). The T stage (χ² =8.694, P=0.034) and TNM stage (χ² =6.906, P=0.032) were the risk factors of the LNM of middle and lower mediastinum. The risk factors of the LNM of abdomen were the location of tumor, the length of tumor, T stage and TNM stage (χ² =5.713 to 16.749, P>0.05). Multivariate analysis showed that the location of tumor is the independent risk factors for the abdominal lymph node metastasis.

CONCLUSIONSThe relatively highest LNM sites are correlated with the location of tumor, T stage, the length of tumor and TNM stage. According to the risk factors of LNM, the relatively highest LNM sites should be mainly swept.

Abdomen ; Abdominal Cavity ; Adult ; Aged ; Aged, 80 and over ; Carcinoma, Squamous Cell ; pathology ; surgery ; Esophageal Neoplasms ; pathology ; surgery ; Esophagectomy ; Female ; Humans ; Lymph Node Excision ; Lymph Nodes ; Lymphatic Metastasis ; Male ; Mediastinum ; Middle Aged ; Multivariate Analysis ; Neoplasm Staging ; Risk Factors ; Thoracotomy

The aim of this paper is to explore the prevention of rabbit postoperative abdominal cavity adhesion with poly (lactic-co-glycotic acid) (PLGA) membrane and the mechanism of this prevention function. Sixty-six Japanese white rabbits were randomly divided into normal control group, model control group and PLGA membrane group. The rabbits were treated with multifactor methods to establish the postoperative abdominal cavity adhesion models except for those in the normal control group. PLGA membrane was used to cover the wounds of rabbits in the PLGA membrane group and nothing covered the wounds of rabbits in the model control group. The hematologic parameters, liver and kidney functions and fibrinogen contents were detected at different time. The rabbit were sacrificed 1, 2, 4, 6, 12 weeks after the operations, respectively. The adhesions were graded blindly, and Masson staining and immunohistochemistry methods were used to observe the proliferation of collagen fiber and the expression of transforming growth factor β1 (TGF-β1) on the cecal tissues, respectively. The grade of abdominal cavity adhesion showed that the PLGA membrane-treated group was significant lower than that in the model control group, and it has no influence on liver and kidney function and hematologic parameters. But the fibrinogen content and the number of white blood cell in the PLGA membrane group were significant lower than those of model control group 1 week and 2 weeks after operation, respectively. The density of collagen fiber and optical density of TGF-β1 in the PLGA membrane group were significant lower than those of model control group. The results demonstrated that PLGA membrane could be effective in preventing the abdominal adhesions in rabbits, and it was mostly involved in the reducing of fibrinogen exudation, and inhibited the proliferation of collagen fiber and over-expression of TGF-β1.
Abdominal Cavity ; surgery ; Animals ; Collagen ; metabolism ; Lactic Acid ; Polyglycolic Acid ; Rabbits ; Tissue Adhesions ; prevention & control ; Transforming Growth Factor beta1 ; metabolism

Minimally invasive surgery is being widely accepted in various fields of surgery. Although several appendectomy techniques have been reported but, there is no standardization. We report here the experiences of transumbilical endoscopic appendectomy in humans. Between July 2008 and September 2010, ten patients with appendicitis successfully underwent transumbilical endoscopic appendectomies. There were 7 cases of suppurative, 2 cases of gangrenous and 1 case of perforated in operative findings. The ages of the patients were 13-56 years (mean age, 32.7 +/- 15.4 years). Under general anesthesia, a 15-mm port was inserted through the umbilicus and then a two-channel endoscope was inserted in the peritoneal cavity. After appendix identification, counter-traction of the appendix with a direct abdominal wall puncture using a straight round needle prolene was performed to achieve good visualization of the operative field. Tissue dissection was performed using an endoscopic needle knife. Tissue grasping and resected appendix retrieval were done with endoscopic forceps. The average operation time was 79.5 +/- 23.6 minutes (range, 45 to 110 minutes). No procedures were converted to laparoscopic or open appendectomy. Hospital stay was 4-6 days. All patients completely recovered without complications. As it is highly maneuverable, we believe transumbilical endoscopic appendectomy can be a feasible method. And, as surgeons want to proceed from laparoscopic surgery to natural orifice transluminal endoscopic surgery, this procedure could be a triable method.
Abdominal Wall ; Anesthesia, General ; Appendectomy* ; Appendicitis ; Appendix ; Endoscopes ; Endoscopy ; Hand Strength ; Humans ; Laparoscopy ; Length of Stay ; Natural Orifice Endoscopic Surgery ; Needles ; Peritoneal Cavity ; Polypropylenes ; Punctures ; Surgical Instruments ; Surgical Procedures, Minimally Invasive ; Umbilicus

OBJECTIVETo investigate the postoperative adverse events and survival of patients with sustained-released fluorouracil implanted during operation.

METHODSData of 124 patients with advanced gastric cancer undergoing radical operation in Tianjin Medical University Cancer Institute and Hospital from January 2007 to January 2009 were analyzed retrospectively. All the patients were divided into two groups according to whether intra-operative fluorouracil was implanted or not. The treatment group(n=64) was implanted with fluorouracil in abdominal cavity after radical resection. The control group(n=60) did not receive fluorouracil implant in abdominal cavity after radical resection. Abdominal drainage fluid, temperature and adverse events within 15 postoperative days and 3-year survival were observed and compared between the two groups.

RESULTSPathological findings of the two groups were similar. No statistical significances existed in abdominal drainage fluid, temperature and adverse events within 15 postoperative days(P>0.05). The 3-year survival rate was higher in treatment group(64.3% vs. 42.4%, P=0.018).

CONCLUSIONIntra-operative sustained-released fluorouracil implants are safe and tolerable, and can improve the survival rate of patients with advanced gastric cancer.

Abdominal Cavity ; Antimetabolites, Antineoplastic ; administration & dosage ; therapeutic use ; Fluorouracil ; administration & dosage ; therapeutic use ; Humans ; Retrospective Studies ; Stomach Neoplasms ; drug therapy ; surgery ; Survival Rate

A 55-year-old male patient suffered from severe high-voltage electric burn with an area of 20%TBSA full-thickness injury. The injury involved the distal end of left upper limb, right trunk, and whole abdominal wall. Fracture of the 7th-10th ribs was found in the right side of chest, with perforation of abdominal cavity, and bilateral pleural effusion was found. Part of the small intestine was necrotic and exposed. At the early stage, xeno-acellular dermal matrix was grafted after debridement of abdominal wound; peritoneal lavage was performed; negative pressure drainage was performed in orificium fistula of intestine for promoting the adhesion between perforated intestine and abdominal scar. Two orificium fistulas formed after closure of abdominal granulation wound by autologous skin grafting. Eschar of chest wall and denatured ribs were retained. The risk of infection of thoracic cavity was decreased by promoting the adhesion between lung tissue and chest wall. During the treatment, the patient was diagnosed with Henoch-Schonlein purpura nephritis by renal biopsy, with the symptoms of purpura in the lower limbs, heavy proteinuria, severe hypoalbuminemia, edema, etc. After control of kidney damage by immunosuppressive treatment instead of glucocorticoid, alleviation of the levels of proteinuria and blood albumin, free latissimus dorsi myocutaneous flap was excised to repair chest wall, and free skin graft was excised to repair intestinal fistula. After all the wounds were successfully covered, the patient was treated with glucocorticoid combined with immunosuppressants for more than 1 year. The patient was followed up for 3 years, and his renal function was completely recovered with satisfactory clinical outcome.
Abdominal Cavity ; Abdominal Injuries ; complications ; surgery ; Burns, Electric ; complications ; surgery ; Humans ; Male ; Middle Aged ; Nephritis ; complications ; surgery ; Purpura, Schoenlein-Henoch ; complications ; surgery ; Thoracic Cavity ; Thoracic Injuries ; complications ; surgery