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Neurofibromatosis concurrent tumor ulcer therapy and skin care experience

Author: Anonymous From: www.yourpaper.net Posted: 2010-06-24 16:45:12 Read:
Author: Sun Yiping Sunxi, Shan Wu Haiying
the [keyword] neurofibromatosis tumor ulcer skin care
Neurofibromatosis is a rare benign tumor of the skin and subcutaneous tissue in the clinical, occurred in the trunk, and can age and replication. Usually only partial mass, when patients bedridden due to other injuries, often due to the dorsal trunk compression result in multiple tumor surface skin ulcers, secondary infection and prolonged healing [1]. Beijing Military Region Beidaihe Sanatorium neurosurgery in May 2004 to May 2009 were treated six cases of prolonged bed rest due to injury in patients with neurofibromatosis. The report is as follows.
1 clinical data
1.1 General Information
This group of patients, 5 males and 1 female; aged 35 to 62 years (mean 47.3 years). Admission diagnosis: 3 cases of traumatic subdural hematoma, cerebral contusion cases, spinal cord injury one cases of hypertensive cerebral hemorrhage. Clinical manifestations: neurofibroma parts mostly to the back of the chest, after the number ranging from tens to hundreds of small as a grain of rice, like walnut, was nodular mass or by pedicle loosely hung on the skin surface. Ulcers involving the 31 tumor involving pedunculated tumor in 5 cases, a total of 26 tumor; involving nodular tumor in 2 cases, a total of five tumor. Admission to the tumor surface skin ulcers (7.41 2.52) d.
1.2 Treatment and results
The group of surgical treatment in 5 cases, a total of 27 tumors, the incision healed; wound dressing 23 d after the four tumor ulcer healing a case. A patient died 44 d after the onset of lung infection.
1.3 Typical cases
Patients, male, 57 years old, young onset, age increased tumor growth to hundreds of body scattered, the majority of the trunk, the tumor is gradually increasing, some were "pocket" like. The first diagnosis of hypertensive cerebral hemorrhage, intracranial hematoma puncture drainage, tracheotomy surgery immediately after admission line. Two pressure areas at the back of the 3 d after tumor congestion, given infrared heat lamp irradiation, increased the number of stand up, local massage, reducing the pressure-time care, 5 d after the tumor ulcers treated with conventional dressing 10 d wound continues to expand, white discharge, and the new ulcers tumor, to give surgical resection ulcer tumor, the incision healed. discussion
Neurofibroma is a benign tumor originated in the axon sheath Schwann cells and perineurioma of cells, neurofibromatosis clinical manifestations and pathological solitary neurofibroma [2]. This group of patients histological observation, see rare tumor epidermal spinous layer cells, papillary dermis and reticular layer meager transparent; aneurysm number of blood vessels, small diameter vascular network in the dermal vascular network and nipple imperfect development of the local blood supply not rich. Tumor ulceration occurred in small pedicle and larger tumor (26/31), in the event of ulcer easy to secondary infection and difficult healing; family refused surgery patients after 3 weeks 4 ulcers in the tumor only a healing is evident. 5 ulcers nodular tumor protruding parts in the trunk dorsal close relationship with tumor size. Due to a lack of experience in dealing with the first patient, given to dressing 10 days, because the wound healed sexual expand the line after tumor resection; subsequent five patients with ulcers in 4 cases by early surgical resection of the tumor incision healed .
A large number of clinical nursing practice proved: application bedsores medical jet air cushion can effectively prevent the occurrence of pressure ulcers skin. Surgery, imaging studies, physical therapy rehabilitation, hyperbaric oxygen therapy process with the above conditions, and is easy to overlook during skin care. When neurofibroma pedicle and torso angled, twisting, folding easily block the tumor blood supply. The tumor ischemic tolerance has not been reported only observed in our case caused the two tumor ulcer accurate pressure time, 1 case of hematoma puncture and drainage during surgery, nurse handover time interval of 45 min Immediately after skin congestion and edema, followed by blisters and ulcers of tumor; 1 case in the hyperbaric oxygen therapy process, the compression time of 70 min.
To prevent ulcers, can be applied to automatic inflatable cushion, keeping the beds clean, dry, wrinkled, slag dust; sheets and skin clean and dry, with 50% ethanol massage bone protuberance at the tumor, 3 to 5 min / in order to improve local blood circulation. To avoid dressing dressing is too thick or tape breathable bad, avoid dressing the corners compression, friction and other tumors. When patients with hypotension, hypovolemia, anemia, hypothermia treatment, the application of vasopressors, especially in imaging studies, physical therapy rehabilitation, hyperbaric oxygen therapy process to strengthen the skin care and handling of patients, the patient must be lifted off the bed surface, should not drag, pull, push. Once an ulcer should be early removal of the tumor in order to facilitate healing, small tumor or small pedicle laser ablation convenient than traditional surgery.
[1] Jieping, Qiu, editor-in-chief Huang Si surgery [M]. 6th edition, Beijing: People's Health Publishing House ,2000:575-576

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