To investigate the clinical manifestations, diagnosis, differential diagnosis and treatment of skin and soft tissue actinomycosis and to improve the wound surgeons’ understanding of skin and soft tissue actinomycosis.

One case of skin and soft tissue actinomycosis on the back was reported and related literatures with "actinomycosis, actinomycete infection, skin, soft tissue" and "actinomycosis, cutaneous, soft tissue" reviewed as searching terms in CNKI and PubMed, respectively.

Compared with searched 20 literatures, it was typical with self-characteristic on the clinical manifestation, diagnosis, differential diagnosis and treatment. In this case, there was no obvious cutaneous mass on admission, but it was typical of multiple sinuses accompanied by more brown pus in the subcutaneous infected tissue. Actinomycetes were cultured from the patient on the 9th day after admission, however, no typical "sulfur particles" were observed by naked eye, bacterial culture and histopathology. The physical examination, intraoperative findings and auxiliary examination results of this case were highly similar to the clinical manifestations of gas gangrene, so that it was highly suspected of clostridium perfringens infection at first. But clostridium perfringens was not detected by repeated bacterial culture and smears. The treatment mainly included general treatment, surgical debridement and the use of antibiotics.

Primary skin and soft tissue actinomycosis is a rare disease with various clinical manifestations. There is relatively typical characteristics but no specificity. Therefore, the diagnosis should be considered comprehensively and differentiated carefully. Because of the low morbidity and difficulty in diagnosis, wound surgeons should pay attention to skin and soft tissue actinomycosis and make the correct diagnosis and treatment early.

To retrospectively analyze the clinical failure effect of core decompression with implantation of autologous bone marrow mononuclear cells for the treatment of osteonecrosis of the femoral head(ONFH).

In total, 38 patients (50 hips) underwent core decompression and implantation of autologous bone marrow mononuclear cells for treatment of ONFH during the period from July 2011 to September 2012. There were 28 male and 10 female cases, with an average age of 31.9. Three patients (5 hips) lost follow up. The patients were classified by their Association Research Circulation Osseous(ARCO) staging and China-Japan Friendship Hospital (CJFH) typing system. The clinical evaluation was conducted by pre-and post-operative Harris hip scores (HHS). The data were analyzed by Pearson test.

Hip replacement surgery was performed for 19 hips; 3 hips Harris score of less than 70 but did not undergo total hip arthroplasty. Surgical failure rates for patients belonging to ARCO stage Ⅱ, ⅢA and ⅢB were 22.2%、62.5%、100%, value 10.03, likelihood ratio 11.54, linear-by-linear association 9.81. The failure rates of L2, L3 and (C+ L1) type were 66.7%, 76.0%, 5.9%, value 20.32, likelihood ratio 23.38, linear-by-linear association 19.14. There were significant differences between different stages and types(with P values were 0.00).

Stage and type are risk factors of this surgery. Patients belonging to ARCO Ⅲ and those with necrotic lesions involving the lateral pillar (L2 and L3 type) showed high surgical failure rates. The best indications of this procedure are for ARCO stage Ⅱ and CJFH L1 and C type.

To investigate the clinical manifestation, diagnosis, treatment and prognosis of cutaneous Nocardia infection, and improve the knowledge of Nocardia.

Two cases of cutaneous nocardiosis were selected from June 2016 to May 2017 in Department of Burns and Plastic Surgery, Fourth Medical Center of PLA General Hospital. Two patients were treated with surgical debridement after admission. After debridement, they were treated with negative pressure sealing drainage. When the bacterial culture was confirmed as Nocardia, sensitive antibiotics were used in combination with oral sulfamethoxazole. The clinical data and treatment process of the patients were analyzed, and the related literature of nocardiosis was searched and consulted to make a systematic statement of nocardiosis.

Two patients were cured. The clinical manifestations and radiographic examination of cutaneous nocardiosis were not specific and easy to be misdiagnosed.

It is a rare disease that the pathogen culture as Nocardia is the main basis for the diagnosis of the disease. Cutaneous nocardiosis with abscess should be treated with surgical incision and drainage, combining with sulfanilamide.

To retrospectively investigate the epidemiological characteristics and related medical information of hospitalized cases of skin and soft tissue injury in wound repair center from a tertiary hospital in Beijing.

All data of hospitalized cases from January 1, 2017 to December 31 in the Department of Burns and Plastic Surgery, Wound Repair Center, Fourth Medical Center of Chinese PLA General Hospital were collected and analyzed. The information included patients basic data, wound types, locations and microbiology information, therapies, outcomes, and health economics information. The epidemiological features of hospitalized patients was described, and the effects of gender, course of wound, wound type, treatment on wound infection, curative effects, hospitalization time and hospitalization expenses were compared. Data were processed with one-way analysis of variance, Wilcoxon rank test, Kruskal-Wallis H test, chi-square test and H test.

Six hundred and thirty-nine patients were finally included in this study, including 420 males and 219 females. (1) The mean age of patients was 57.00 (43.00-67.00) years old, the mean age of female was greater than that of male, the difference was statistically significant (Z=-2.605, P<0, 05). (2) Two hundred and ninty patients with chronic basic diseases, the most common diseases were diabetes mellitus, hypertension, coronary atherosclerotic heart disease. (3) The number of patients with chronic skin and soft tissue injuries was more than acute skin and soft tissue injuries. (4) The most common causes were postoperative non-healing wounds, diabetic foot ulcer, pressure injury and soft tissue infections, the most common locations were the feet, lower extremities and chests. (5) Bacterial examination of the wound showed Gram-negative bacteria composition ratio was the highest (57.61%). Common bacteria were Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Pseudomonas aeruginosa. (6) One hundred and thirty-six patients underwent simple dressing treatment, 118 underwent simple continuous negative pressure drainage, and 385 underwent surgical treatment, of which 130 underwent multiple surgical treatments. Two hundred and eighty-two patients were cured, 313 improved, 39 not healed, and 5 people dead. (7) The average hospitalization expense was 34, 354.15 (16 449.72-75 018.24) yuan. The average length of hospital stay was 21.00 (11.00-40.00) days. According to the wound types, the hospitalization expense and day of immune-mediated skin ulcer were the highest, and the hospitalization expense and day of hypertrophic scar were the lowest. According to the cost types, the hospitalization expense and day of patients with employment injury insurance are the highest, and the hospitalization expense and day of self-paying patients were the lowest.

Most of the patients are middle-aged and older, and with chronic basic diseases. The main course of the disease is chronic skin and soft tissue injury. The common causes are postoperative non-healing wounds, diabetic foot ulcer, pressure injuries and soft tissue infections. The sites are concentrated in the feet, lower limbs and chests. The proportion of Gram-negative bacteria infection is higher, which showes that it is necessary to strengthen the antibiotic treatment of such microbiology. Surgical debridement, continuous negative pressure drainage are effective measures for the treatment of patients with skin and soft tissue injury.

To summarize the experience of vacuum sealing drainage (VSD) combined with skin grafting in the treatment of diabetic foot.

The clinical data of 30 patients with diabetic foot admitted from August 2016 to August 2017 in the Department of Vascular Ulcer Surgery, Affiliated Hospital of Liaoning University of Traditional Chinese Medicine were retrospectively analyzed. All patients were of Wagner grade 4 to 5. The treatment methods included debridement, VSD and skin grafting. The length of hospital stay, limb function and appearance, and scar contracture in the skin graft area were observed. After discharge, 30 patients were followed up by telephone and outpatient clinic for 3 to 12 months, with an average of 5 months. Limb appearance, function and ulcer recurrenceobservation were observed.

Three patients had ischemia of the foot, CT angiography (CTA) showed occlusion of the lower extremity arteries. Superficial femoral artery was opened, balloon dilatation and stenting were performed. After debridement, skin grafting was performed after VSD, and the wound healed completely. After debridement and VSD treatment of 23 patients, fresh granulation tissue grew and the wound healed completely after skin grafting. In the other 4 cases, due to serious wound infection, there were more tissue defects after debridement. After intermittent debridement and VSD treatment, the granulation tissue grew well and most of the grafts survived after skin grafting. All diabetic foot wounds were cured with an average hospitalization time of 35 days (27 to 50 days); 27 cases had good skin color, good elasticity and good recovery of foot movement function; 3 case had small ulcers due to friction at the plantar or foot front, which were changed dressing for about a week after outpatient treatment. All patients healed without recurrenc during follow-up period.

On the basis of debridement, VSD combined with skin grafting can shorten the course of disease and improve the limb salvage rate.