Researchers have discovered a new way to personalize burn wounds using microenvironment pH
The repair of deep burn wounds requires cutting of the tendon and skin grafting, more or less damage to the remaining normal tissue and leaving scars in the donor site. For some chronic refractory wounds, most of them require tissue flap repair, and it is inevitable that damage will be caused to the donor or donor area.
How to reduce the damage to the donor site and the donor site when repairing the wound, and to reduce the secondary damage caused by the repair surgery by personalized treatment means, the surgeon needs to explore hard.
Wound repair refers to the process of repairing local tissue through regeneration, repair and reconstruction after injury or loss caused by injury. It is divided into acute wound and chronic wound according to wound healing time. During the wound healing process, the pH value drops briefly in the early stage of inflammation, and then in the acute wound, the pH gradually increases with the wound healing, and peaks when the granulation tissue growth is completed, which is alkaline; after the start of epithelialization, the pH value Rapidly drop to the slightly acidic value of the normal epidermis.
In chronic wounds, the pH value of the late stage of inflammation continues to rise until about 8 or even higher, and continues to fluctuate at a higher position, affecting the synthesis of ECM, causing the wound to prolong.
Therefore, monitoring the pH of the wound microenvironment is conducive to the early identification of acute or chronic refractory wounds and the development of appropriate treatment options. In this issue of the key issue, Tian Ruirui and Wei Li summarized the effect of micro-environment pH on wound healing. It is proposed to use the pH value of wound in clinical work as an evaluation index for wound care, focusing on the change of wound microenvironment and pH. The determination and observation of the value may help to dynamically grasp the healing of the wound, understand the patient's condition, and provide reference for subsequent personalized treatment.
Zhou Xing et al. studied the role of integrin-linked kinase (ILK) and its downstream signaling protein kinase B (Akt) and phosphorylated Akt in skin lesions and wound healing in diabetic rats by making a skin wound model of diabetic rats.
The results showed that diabetic skin lesions may be related to the decreased expression of ILK, Akt and phosphorylated Akt. The slow healing of diabetic rats may be related to the decreased expression of phosphorylated Akt, which provides an important theoretical reference for the treatment of diabetic wounds.
Surgical treatment is one of the important methods of wound repair. The selection of personalized repair solutions for different wounds is based on the exploration and expansion of traditional surgical methods. Chang Shusen et al. based on the anatomy of the flap, for the patients with residual nails and nail beds, the design of the finger-toothed finger-integrated arterial pedicle flap combined with the subcutaneous pedicle V-Y propulsion flap to repair the distal end of the finger. Defect of the skin and soft tissue (referring to the length of the distal defect within 1.5 cm) to reconstruct the fingertip.
Because the operation only carries the unilateral finger artery, the finger nerve and its skin branch are not destroyed, the flap feel is unaffected, the fingertip sensation is well reconstructed, and complications such as sensory disturbance are avoided. There are many methods for repairing soft tissue defects in the anterior region of the knee joint, but some flaps and musculocutaneous flaps with vascular pedicles are limited due to the anatomical cut of the vascular pedicle of the flap, limited cutting area and large damage to the donor area. Clinically, a suitable flap should be selected according to the soft tissue defect of the anterior region of the knee joint and its surrounding skin.
Xiao Chao et al used the saphenous artery combined with the inferior medial artery blood supply flap to repair the anterior region of the knee joint. The surgical procedure was relatively simple, and the donor site was less damaged. The vascular anatomy of the flap was relatively constant, the vascular anastomosis network was abundant, and the blood supply was reliable. The larger the area, the need to repair the wound in the anterior region of the knee joint, and the repair effect is better.
Large-area burn treatments often need to consider post-plasticization and functional rehabilitation while repairing wounds. Therefore, the treatment of special-purpose wounds requires early planning and precise scheduling.
Kong Weichang et al. proposed that the use of Meek skin graft combined with large skin graft to repair the wounds of patients with large area burns in special parts can fully exploit the expansion effect of Meek skin, saving the skin source of the donor area, and the saved skin source can be used. Cut large sheets of medium-thickness skin to repair special area wounds.
And Meek skin grafting area rarely leaves obvious scars, and also provides a valuable available skin source for later functional plastic surgery. Head and neck burns account for a large proportion in the distribution of burn sites, and are exposed to the body surface, which requires higher repair effect on wounds.
Traditional surgery for the treatment of head and neck burns is often carried out by packing and compression. Although it continues to this day, there is a shortage of time spent on surgery. Li Feng and other methods are used to pressurize and fix the elastic material. Compared with the traditional surgical plan, the anesthesia and operation time are greatly shortened.
In the research of new materials application, Liu Yang and other studies have shown that the use of artificial dermis combined with bFGF can well repair wounds and deep skin wounds after scar resection, and can also achieve good results for deep skin wounds of some small areas of tendon or bone exposed skin. Fix the effect. Due to the application of bFGF, the artificial dermal vascularization time is shortened, thereby shortening the wound repair time and reducing the abnormal activation state of Fb, thereby reducing scar hyperplasia and less damage to the donor site.
In summary, in the aspect of burn wound repair, each unit explored the application of personalized treatment from different perspectives from basic research to clinical practice, and achieved good results, and provided theoretical basis and guidance for further research. Wound healing is a complex and multi-factor-repairing process that requires continuous research by burn disciplines and related disciplines to advance the progress of wound repair treatment.
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