摘要：Objective The present study aims to explore the individualized treatment options for multisite pressure ulcer (PU) at various stages in elderly patients with multiple medical conditions. Methods Stages 1 and 2 PU at 146 sites were treated with closed negative pressure suction combined with continuous micro-oxygen perfusion and the local application of foam dressings, silver ion dressings, and moist burn cream. Stages 3 and 4 PU in the sacrococcygeal region were treated with skin or myocutaneous flap transplantation. Results Stages 1 and 2 PU healed after treatment with closed negative pressure suction combined with continuous micro-oxygen perfusion and dressing changes. One case died during hospitalization due to an illness. Skin or myocutaneous flap repair was conducted in 34 cases of stage 3 or 4 PU in the sacrococcygeal area. Of these cases, 28 achieved primary healing, and 6 required two or three surgeries, 5 of which received micro-skin implantation. In addition, 10 small deep PU at other sites were repaired by direct excision and suturing or local flap repair. Seven cases were transferred to other departments or hospitals due to concomitant diseases or were discharged automatically without surgical treatment. Conclusion Home care for geriatric patients is difficult. PU often occur at multiple sites because of the duration of various pressures, and different sites may demonstrate different stages because of varying degrees of pressure. When actively treating stages 3 and 4 PU, the trauma management of stages 1 and 2 PU should not be neglected.

摘要：Topical treatment for facial burns, Review question, We reviewed the evidence about the effects of topical (applied to the surface of the skin) treatments for healing burn wounds on the face or neck. We wanted to find out which treatments were most effective at healing these wounds and improving the appearance of scars, which is a particularly important issue in relation to facial burn injuries. We also wanted to find out how topical treatments affected the risk of complications such as infection and pain, and how they impacted on peoples' quality of life., Background, Burn injuries are an important health problem, and a major global cause of disability and disfigurement in both adults and children. Women and children in low‐income countries are at particular risk. Burns pose particular problems when they occur on the head or neck. The face is central to a person's identity and plays a vital role in communication. Other basic functions such as hearing, smell and breathing may become affected as a direct result of a facial burn. Topical treatments such as (non) antimicrobial creams and skin substitutes, are most commonly used to treat facial burns. We wanted to compare the effectiveness of these treatments to evaluate their benefits and harms., Study characteristics, In December 2019, we searched for randomised controlled trials (RCTs) investigating topical treatments for facial burns. RCTs are medical studies where the treatment or care people receive is chosen at random. This type of study design provides the most reliable health evidence about whether different approaches to treatment or care can make a difference. We found 12 studies that were suitable for inclusion in this review update, with 507 participants with mean ages ranging from 5.3 to 41.9 years. Three studies compared antimicrobials with non‐antimicrobials agents, two studies compared different antimicrobials, four studies compared skin substitutes with antimicrobials, while four studies compared a variety of topical treatments. One study contributed to two comparisons. Eight studies were small (fewer than 40 participants) and almost all studies were at high risk of bias due to lack of blinding (where participants and evaluators may have known which group the participants were allocated to and interpreted effects differently)., Key results, Overall, there is mainly low to very low‐certainty evidence on the effects of any topical intervention on wound healing or infection in people with facial burns. In addition, there is low to very low‐certainty evidence on the effects of the included interventions on need for surgery, pain, scar quality, patient satisfaction, length of hospital stay and side effects., All results were at high risk of bias and varied, which may have exaggerated the effects., Certainty of the evidence, Overall, the certainty of the evidence about the effectiveness of topical treatments for facial burns is low to very low. There is insufficient reliable evidence as to whether topical treatments improve outcomes for people with facial burns including improving wound healing, or rates of infection. Better trial design and reporting of these studies is required to contribute to evidence‐based burn care., How up to date is this review?, We searched for studies that had been published up to December 2019.

摘要：IntroductionConventional management of partial thickness facial burn wounds includes the use of silver sulphadiazine dressings. Silver sulphadiazine forms an overlying slough that makes wound healing assessment difficult. Moist exposed burn ointment (MEBO) has been proposed as the ideal burn wound dressing both for burns of the face and other sites. Proponents of MEBO claim that it accelerates wound healing and results in scarless wound healing and at the same time reduce bacterial colonisation and the need for analgesics. We present here our experience with MEBO in the management of partial thickness burns of the face.Materials and methodsOne hundred and fifteen patients with partial thickness burns were randomly assigned to conventional treatment or MEBO. Out of this, 112 were analysed. Thirty-nine patients sustained facial burns; 17 received MEBO and 22 received silver sulphadiazine. Patients were followed up daily until the burn wounds were reduced by 75% of original body surface area (BSA).ResultsIn patients with facial burns, MEBO was similar to silver sulphadiazine therapy with respect to rate of wound healing. Minimal slough was present over the wounds in MEBO-treated wounds resulting in clearer assessment of healing progression.ConclusionsAdvantages of MEBO as compared to silver sulphadiazine in the management of partial thickness burns of the face include convenient change of dressing and easier assessment of healing progression. This suggests that MEBO is a useful alternative therapy for partial thickness burns of the face.

摘要：Improved healing of full- and partial-thickness cutaneous wounds in wet and moist environments is due primarily to retention of biological fluids over the wound preventing desiccation of denuded dermis or deeper tissues. This also allows faster and unimpeded migration of keratinocytes over the wound surface and enables the naturally occurring cytokines and growth factors to exert their beneficial effect on wound contracture and reepithelialization. Despite all these documented benefits creating and maintaining a sealed moist environment over large surface areas such as large skin graft donor sites or extensive burns is technically difficult if not impossible. The preliminary investigation carried out between 1999 and 2000 studied the healing of a split-thickness skin graft (STSG) following application of moist exposed burn ointment (MEBO). This compound provides a moist environment without the need of an overlying occlusive dressing, and compares favorably with Sofra-Tulle semi-open dressing. Healing of STSG donor sites was then evaluated from January to September 2001 in a prospective study comparing the effect of Tegaderm, a semipermeable membrane occlusive dressing, and MEBO, two different types of moist dressings. Wound healing was evaluated by measuring transepidermal water loss (TEWL), and scar quality was assessed by two independent observers using a visual analogue scale. Faster healing was observed clinically with MEBO application. Physiological healing as determined by TEWL measurements occurred at an extremely significant earlier stage for MEBO, and this was associated with better scar quality demonstrating a positive relationship between function and cosmetic appearance. Moreover, simple ointment application was definitely more practical than application of the occlusive self-adhesive membrane.