Objective:To summarize the treatment experience of diabetes mellitus combined with necrotizing fasciitis.Methods:A retrospective analysis was conducted on the clinical data of patients diagnosed with diabetes mellitus and necrotizing fasciitis who were admitted to the Department of Burns and Plastic Surgery, Affiliated Hospital of Guizhou Medical University between September 2018 and December 2020. Upon admission, initial treatment involved blood glucose management, the administration of empirical antibiotics to combat infection, and concurrent nutritional support therapy. Surgical interventions, including either dilatation or incision and drainage, were promptly performed within 24 to 72 hours. During these procedures, necrotic tissues and purulent exudates were collected for pathogen culture and antibiotic sensitivity testing to guide appropriate treatment. Post-operatively, a negative pressure closed drainage system was installed to facilitate wound drainage, combined with 1.5% hydrogen peroxide solution to flush the wound or subcutaneous placement of multiple drainage tubes to drain the wound. If post-surgical infection persisted, additional dilatations were deemed necessary. Under the condition of clean wound and fresh granulation tissue, the wound was repaired by medium-thickness skin grafting on the lateral thigh. The laboratory risk indicator for necrotizing fasciitis (LRINEC) was checked and scored, including C-reactive protein, white blood cell count, hemoglobin, blood sodium, blood creatinine, and blood glucose levels. The total score was 0-13 points. When the score was ≥ 6 points, necrotizing fasciitis should be actively suspected. Observation of trauma infection control, statistics on the number of dilatations, trauma repair modalities, hospitalization time, and amputations, and follow-up of trauma healing and recurrence of necrotizing fasciitis were recorded.Results:A total of nine patients were enrolled, consisting of seven males and two females, with an age range of 39 to 81 years. The study population comprised patients with diabetes mellitus, with durations ranging from 0.5 to 10 years. The affected body parts included one upper extremity, six lower extremities, one perineum, and one case involving both a perineum and a lower extremity. LRINEC score ≥ 8 points in 5 cases and 6-7 points in 4 cases. The wound infection was controlled after 1 time dilatations in 4 cases, 2 times in 3 cases and 3 times in 2 cases, the infection of the trauma was controlled and reached a clean and fresh state of granulation tissue.In 7 cases, the trauma was healed after repairing with thick-medium-thick dermal grafting; in 1 case, the trauma was repaired by thin-medium-thick dermal grafting with scattered punctate recurring oozing, which was healed after changing the medication; and in 1 case, the right middle calf leg was amputated. Microbiological culture result: 2 cases of Staphylococcus aureus treated with intravenous drip of ceftazidime 2 000 mg once a day; 1 case of Pseudomonas pseudomallei was treated with intravenous drip of fluconazole 400 mg once a day; 2 cases of Enterococcus faecalis and 2 cases of Enterococcus faecium treated with intravenous drip of piperacillin and tazobactam sodium 4 500 mg 3 times a day, 2 cases of Escherichia coli treated with intravenous drip of levofloxacin 500 mg once a day. The duration of hospitalization of 9 patients ranged from 24 to 56 days. At discharge, LRINEC was significantly improved compared with admission, and LRINEC score was 0-2 points. Follow-up ranged from 3 months to 2 years, relapsed infection happended in the affected limb wound in one case, which healed after anti-infection and dressing change. The other cases healed well without recurrence. Conclusion:In the management of diabetic necrotizing fasciitis, concurrent comprehensive glycemic control and surgical intervention are crucial. The integration of vacuum sealing drainage and the employment of 1.5% hydrogen peroxide for wound cleansing, along with a consistent and prolonged antibiotics reatment course significantly contributes to improved disease control, promote wound healing, leading to reduced mortality and lower rates of amputation.

Objective:To summarize the treatment experience of diabetes mellitus combined with necrotizing fasciitis.Methods:A retrospective analysis was conducted on the clinical data of patients diagnosed with diabetes mellitus and necrotizing fasciitis who were admitted to the Department of Burns and Plastic Surgery, Affiliated Hospital of Guizhou Medical University between September 2018 and December 2020. Upon admission, initial treatment involved blood glucose management, the administration of empirical antibiotics to combat infection, and concurrent nutritional support therapy. Surgical interventions, including either dilatation or incision and drainage, were promptly performed within 24 to 72 hours. During these procedures, necrotic tissues and purulent exudates were collected for pathogen culture and antibiotic sensitivity testing to guide appropriate treatment. Post-operatively, a negative pressure closed drainage system was installed to facilitate wound drainage, combined with 1.5% hydrogen peroxide solution to flush the wound or subcutaneous placement of multiple drainage tubes to drain the wound. If post-surgical infection persisted, additional dilatations were deemed necessary. Under the condition of clean wound and fresh granulation tissue, the wound was repaired by medium-thickness skin grafting on the lateral thigh. The laboratory risk indicator for necrotizing fasciitis (LRINEC) was checked and scored, including C-reactive protein, white blood cell count, hemoglobin, blood sodium, blood creatinine, and blood glucose levels. The total score was 0-13 points. When the score was ≥ 6 points, necrotizing fasciitis should be actively suspected. Observation of trauma infection control, statistics on the number of dilatations, trauma repair modalities, hospitalization time, and amputations, and follow-up of trauma healing and recurrence of necrotizing fasciitis were recorded.Results:A total of nine patients were enrolled, consisting of seven males and two females, with an age range of 39 to 81 years. The study population comprised patients with diabetes mellitus, with durations ranging from 0.5 to 10 years. The affected body parts included one upper extremity, six lower extremities, one perineum, and one case involving both a perineum and a lower extremity. LRINEC score ≥ 8 points in 5 cases and 6-7 points in 4 cases. The wound infection was controlled after 1 time dilatations in 4 cases, 2 times in 3 cases and 3 times in 2 cases, the infection of the trauma was controlled and reached a clean and fresh state of granulation tissue.In 7 cases, the trauma was healed after repairing with thick-medium-thick dermal grafting; in 1 case, the trauma was repaired by thin-medium-thick dermal grafting with scattered punctate recurring oozing, which was healed after changing the medication; and in 1 case, the right middle calf leg was amputated. Microbiological culture result: 2 cases of Staphylococcus aureus treated with intravenous drip of ceftazidime 2 000 mg once a day; 1 case of Pseudomonas pseudomallei was treated with intravenous drip of fluconazole 400 mg once a day; 2 cases of Enterococcus faecalis and 2 cases of Enterococcus faecium treated with intravenous drip of piperacillin and tazobactam sodium 4 500 mg 3 times a day, 2 cases of Escherichia coli treated with intravenous drip of levofloxacin 500 mg once a day. The duration of hospitalization of 9 patients ranged from 24 to 56 days. At discharge, LRINEC was significantly improved compared with admission, and LRINEC score was 0-2 points. Follow-up ranged from 3 months to 2 years, relapsed infection happended in the affected limb wound in one case, which healed after anti-infection and dressing change. The other cases healed well without recurrence. Conclusion:In the management of diabetic necrotizing fasciitis, concurrent comprehensive glycemic control and surgical intervention are crucial. The integration of vacuum sealing drainage and the employment of 1.5% hydrogen peroxide for wound cleansing, along with a consistent and prolonged antibiotics reatment course significantly contributes to improved disease control, promote wound healing, leading to reduced mortality and lower rates of amputation.

Objective:To observe the effect of vacuum sealing drainage(VSD)combined with hydrogen peroxide irrigation in the treatment of venous leg ulcer (VLU).Methods:The clinical data was focused on the cases with venous leg ulcer, who were treated by the Department of Plastic and Burn Surgery, Affiliated Hospital of Guizhou Medical University from January 2014 to March 2021. According to the treatment method, patients were divided into two groups. After debridement, the intervention group was irrigated with VSD combined with hydrogen peroxide, while the control group was irrigated with VSD combined with normal saline . The duration of VSD treatment was recorded, and the effective rate of wound treatment was calculated. According to the treatment situation, the medium thickness skin graft was performed, and the good survival rate of skin graft was calculated.Results:A total of 55 patients were enrolled in this study. Aged 35 to 86 years old, including 32 males and 23 females. Before the procedure, all the above patients underwent pathological examination to exclude the ulcers caused by malignant tumors. There were 34 cases in the intervention group and 21 cases in the control group. The duration of VSD treatment in the intervention group was (8.53±1.52) d, and that in the control group was (10.33±3.25) d, and the difference was statistically significant ( t=2.39, P=0.025). The effective rate of wound assessment was 82.35% (28/34) in the intervention group and 57.14% (12/21) in the control group; the difference was statistically significant ( χ2=4.16, P=0.041). The good survival rate of skin graft was 91.18% (31/34) in the intervention group and 61.90% (13/21) in the control group; the difference was statistically significant ( χ2=5.24, P=0.022). Conclusions:VSD combined with hydrogen peroxide irrigation is an effective method to treat VLU, which can shorten the preparation time of wounds and improve the survival rate of skin grafts.

Objective:To observe the effect of vacuum sealing drainage(VSD)combined with hydrogen peroxide irrigation in the treatment of venous leg ulcer (VLU).Methods:The clinical data was focused on the cases with venous leg ulcer, who were treated by the Department of Plastic and Burn Surgery, Affiliated Hospital of Guizhou Medical University from January 2014 to March 2021. According to the treatment method, patients were divided into two groups. After debridement, the intervention group was irrigated with VSD combined with hydrogen peroxide, while the control group was irrigated with VSD combined with normal saline . The duration of VSD treatment was recorded, and the effective rate of wound treatment was calculated. According to the treatment situation, the medium thickness skin graft was performed, and the good survival rate of skin graft was calculated.Results:A total of 55 patients were enrolled in this study. Aged 35 to 86 years old, including 32 males and 23 females. Before the procedure, all the above patients underwent pathological examination to exclude the ulcers caused by malignant tumors. There were 34 cases in the intervention group and 21 cases in the control group. The duration of VSD treatment in the intervention group was (8.53±1.52) d, and that in the control group was (10.33±3.25) d, and the difference was statistically significant ( t=2.39, P=0.025). The effective rate of wound assessment was 82.35% (28/34) in the intervention group and 57.14% (12/21) in the control group; the difference was statistically significant ( χ2=4.16, P=0.041). The good survival rate of skin graft was 91.18% (31/34) in the intervention group and 61.90% (13/21) in the control group; the difference was statistically significant ( χ2=5.24, P=0.022). Conclusions:VSD combined with hydrogen peroxide irrigation is an effective method to treat VLU, which can shorten the preparation time of wounds and improve the survival rate of skin grafts.

Objective:To analysis clinical curative effect of laparoscopic radical prostatectomy bladder cancer and influence on serum levels of ferritin (SF),soluble interleukin-2 receptor (SIL-2 R) and rumor specific growth factor (TSGF).Methods:98 cases of bladder cancer who were treated in our hospital from August 2012 to February 2016 were selected and randomly divided into the control group 0=49) and the research group (n=49).The patients in the control group were treated with open radical radical cystectomy,while the patients in the research group were treated with laparoscopic radical cystectomy.Then the operation time,intraoperative blood loss,anal exhaust time,hospitalization,the lymph node cleaning,the serum levels of SF,SIL-2R,TSGF,white blood cells and cortisol,the complications and recurrence rate in the two groups were observed and compared.Results:The operation time of research group was longer than that of the control group,while the intraoperative blood loss,the hospitalization and the anal exhaust time were less than those of the control group,and the differences were statistically significant (P＜0.05).There was no statistically significant difference about the numbers of the lymph node and the recurrence rate between two groups (P＜0.05).After treatment,the serum levels of SF,SIL-2R and TSGF in the two groups decreased,while there was no statistically significant difference between the two groups (P＞0.05);After treatment,the white blood cell count and cortisol rise in the two groups increased,while the research group was lower than that of the control group (P＜0.05).Conclusion:LRC and ORC clinical efficacy similar,both of which can reduce the serum levels of SF,SIL-2R and TSGF of patients with laparoscopic radical prostatectomy bladder cancer.

Objective To provide the anatomical basis for detecting distal outflow tract in late atherosclerosis obliteration in lower extremities.Methods Ten lower extremities that were amputated above knees because of late atherosclerosis obliteration were used in this experiment.The blood vessels in the residual bodies were perfused to run blood vessel cast mould to observe the anatomical and pathological change of the popliteal artery,the anterior and posterior tibial arteries and their collateral vessels.The number and distribution of those collateral vessels were also observed.Results The popliteal artery,anterior and posterior tibial arteries were all occluded due to atherosclerosis.However,there were three types of those collateral arteries:① Atheromatous plaque in bole stretched into collateral arteries and led to occlusion.② Obliteration was only observed at the initial segment,with no obstruction at the distal end but extenuated.③ The collateral arteries originated from the bole artery symmetrically,keeping communicative with each other through punctiform interspaces.The last two types were mainly distributed at the inferior segment of popliteal artery,the superior segment of anterior and posterior tibial arteries,forming vascular anastomosing network in the whole cnemis muscle group.Conclusion Un-obstructed collateral arteries in certain places can be still found,though atherosclerosis obliteration is formed in popliteal artery,anterior and posterior tibial arteries in lower extremities.Therefore,it may be possible to construct collateral outflow tracts if endo-membrane stripping operation is performed.

AIM: To summarize the effect of femoral popliteal arterial graft operation and the influence of construction of bypass circuit outflow tract.METHODS: A retrospective study was performed in 15 cases of femoral popliteal arterial bypass.RESULTS: A femoral popliteal embolism occurred in one patient undergoing simple femoral-popliteal arterial bypass in the early postoperative period and in 2 patients in the long-term followed up.However,the effects of constructing bypass circuit in the same time were very well,and only one patient had chill on the limbs.CONCLUSION: The operative results are better when the construction of bypass circuit is performed in the femoral-popliteal arterial graft operation,further more,a new method is provided for construction of distal end outflow tract.