Nursing Study on Reducing the Incidence of Bleeding and Exudation after PICC Catheterization by Blunt Separation Combined with Early Sheath Removal

Objective: To compare the effects of blunt separation combined with early sheath removal and conventional catheterization on the incidence of bleeding, exudation and subcutaneous congestion after peripherally inserted central catheter (PICC). Methods: 250 patients with PICC catheterization in our hospital were selected, including 125 in the control group and 125 in the observation group. The conventional catheterization method was used in the control group: The sheath was removed by scalpel skin expansion and complete tube delivery in place. The observation group used blunt separation combined with early sheath removal. The success rate of one-time sheath delivery, immediate bleeding, 24-hour bleeding and exudation were compared. Results: The success rate of sheath delivery in the observation group was 100%; The amount of immediate blood loss and blood loss 24h after catheterization in observation group was obviously lower than that in the control group, with statistical significance (P < 0.05). There were 6 cases of exudation in the control group and no exudation in the observation group. There was significant difference in the incidence between the two groups (P < 0.05); There were 10 cases of subcutaneous congestion in the control group and 2 cases of subcutaneous congestion in the observation group. There was significant difference in the incidence between the two groups (P < 0.05); Conclusion: Blunt separation combined with early sheath removal can reduce the occurrence of local blood and fluid leakage after PICC catheterization.

Staged Surgical Reconstruction With Skin Expansion of A Marjolin’s Ulcer With Better Recovery: a Case Report

Marjolin’s ulcers (MUs) are one of the most common tumors developed from non-healing wound with chronic inflammation or injury, specially burn scars, over many years. However, the therapy recommendations for MUs are not yet definitive. Here, we presented a case of 60-year-old man with a chronic non-healing infected wound related to MUs in the right knee. And, the wound made a better recovery after treatment with staged operation in combination with skin expansion.

Structural dermis remodeling in a skin expansion rat model

Introduction. Skin expansion is known to be the most effective way to obtain skin for alloplastic closing of large defects, and it has proven to be successfully used in various fields of surgery, cosmetology, and traumatology. At the same time, the issues of skin flap restructuring when it is stretched and possible range of its application are still relevant. In this regard, the aim was to study the adaptive skin rearrangements of the fibrous skeleton in a murine skin expansion model. Materials and methods. We used the skin of mature male Wistar rats (N=30) after a 2-week stretching. We utilized a complex morphological light and electron microscopy approach as well as an immunohistochemi-cal method to determine the types of collagen and to study the alterations in skin samples. Results. We revealed pronounced reactive changes in the skin structural components in the skin expansion area. On day 14, we observed a decrease in the epidermal cell layer thickness as well as stretching, partial disorganization, and damage of dermal fibrous structure. At the same time, cellular mechanisms of regen-eration and activation of collagen synthesis were launched, the morphological substrate of which was (1) a significant 2.7-fold increase in the number density of fibroblasts, which produce substances for building fibrous structures, (2) a five-fold increase in macrophages, which are a catalyst for the fibroblast functional activity and (3) a collagen fiber types’ redistribution s with Type III collagen structures’ predominance. Conclusion. The results indicate, first of all, the restructuring of the dermal fibrous component, which im-plies reparative and restorative processes. These must be taken into account in clinical practice to achieve not only an esthetic effect but also the subsequent adequate functioning and vital activity of the skin flap. Keywords: skin expansion, fibrous dermis, remodeling, skin, hyperextension

Awesome repetition of number 3 in correction of Trimorphic Extreme Clubfoot Deformities by Triple Surgical Skin Expansion (An Evolutionary, Multifaceted, Scientific Perspective)

Author, a passionate researcher in Clubfoot, since over half a century, published an article on trimorphic extreme clubfoot deformities https://doi.org/10.1007/s00264-017-3741-6, in International Orthopaedics (SICOT) in 2018. This was original research in this grey area, prevalent in LMICs with more than 80 % global population. AIM: Continuing in similar vein, author was motivated to write this unique article with certain “believe-it-or-not” events, under three headings: FIRSTLY; many things are destined to happen in nature at a fixed time and place. This research, happening pointedly at Patiala, is another such event. HOW and WHY of this, are given in PREFACE and INTRODUCTION of author’s Clubfoot Book [57]. SECONDLY: unprecedented, 20 repetitions of number 3 in any research, besides five in personal life and THIRDLY, on Google search, number 3 in numerology, symbolic of planet Jupiter, has innumerable good attributes for the related people. This number has also been found to have, since ancient times, myriad unbelievable, evolutionary bonds, in every area of humanity, on planet earth and beyond; which are scientific, spiritual, socio- religious, political etc. MATERIAL has been derived from the contents of author’s clubfoot research and METHODS have been Google Search, daily living human activities and author’s experience. CONCLUSIONS: 1. Many events are completely scientific; 2. Others are unique coincidences with scientific explanation and 3. Still others are amazing truths, proving once again veracity of famous quote “Truth is Stranger than Fiction”. Because of its uniqueness, this article does need a loud awakening call, to spread its wings.