Vascular Malformations: Current Progress Toward Drug Therapy.
Vascular Malformations: Current Progress Toward Drug Therapy.
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DOI：
10.1097/scs.0000000000007310
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发表时间：
2021-05-01
期刊：
影响因子：
--
通讯作者：
Sudduth CL
中科院分区：
文献类型：
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作者：
Greene AK;Sudduth CL
Orra博士和他的同事们重新向我们介绍了一种历史性的、天然存在的物质“秘鲁香脂”（BOP），用于腭裂修复术后。1在我早期的实践中，我在我的术后腭修复中使用BOP，不是因为它的抗生素特性，而是因为我觉得它改善了患者术后呼吸的气味。然而，我已经发展到用氧化再生纤维素包装裂缝修复的原始表面，以潜在地减少术后出血。作者给我们一个很好的历史BOP和它的潜在好处愈合和感染控制术后腭裂。本文没有数据可供我们评估BOP用于术后腭的结局。如作者所述，关于BOP的使用，有2个推测性的潜在益处需要考虑。一般来说，我们通过术后瘘和裂开率来评估腭修复的成功率。孤立的纯腭部感染的发生率几乎从未被讨论过，因为它的发生率被发现是如此之低。然而，假设某种形式的感染可能与腭瘘发生率有关，因为全身性围手术期抗生素的使用已被证明可以降低这些发生率。2，3有证据表明，全身抗生素可降低术后上呼吸道感染的发生率，而术后上呼吸道感染与较高的瘘管发生率相关。4.我没有找到关于使用口服局部抗生素对腭瘘发生率的良好研究。局部抗生素的使用通常与纱布包的使用相结合，纱布包使抗生素粘附在腭修复上。我们知道这种包可以降低术后瘘的发生率。5、6这是否是纱布上的抗生素（例如BOP）造成的，还是纱布本身的保护屏障造成的尚不清楚，但我怀疑是后者。虽然我有使用术后包的经验，但我并不经常使用它们，以避免对挣扎儿童的潜在困难移除的需要，以及我担心术后包的破坏可能导致潜在的气道阻塞。但我没有数据来支持这种恐惧。作为一个医学史的爱好者，我很高兴读到BOP的历史价值。我认为有趣的是，作者在文章的开头引用了帕拉塞尔苏斯的一句话，他的信仰作为一个领先的炼金术士，他的一天应该采取一粒盐，或者也许一撮香脂。
Dr Orra and colleagues have reintroduced us to a historic, naturally occurring, substance ‘‘Balsam of Peru’’(BOP) for its post-operative use after cleft palate repair. 1 In my early practice, I used BOP on my post op palate repairs not so much for its antibiotic properties but because I felt it improved the post op smell of the patient’s breath. However, I have evolved to pack the raw surfaces of the cleft repair with oxidized regenerated cellulose to potentially reduce post op bleeding. The authors give us a nice history of BOP and its potential benefits to healing and infection control for the post-operative cleft palate. There is no data with this article for us to assess the outcomes of the use of BOP for the post op palate. There are 2 speculative potential benefits to consider regarding the use of BOP as described by the authors. In general, we evaluate the success of a palate repair by the post op fistula and dehiscence rate. The rate of isolated pure palatal infection is almost never discussed because its incidence is found to be so low. It is assumed however that some form of infection may be tied to palatal fistula rates since the use of systemic perioperative antibiotics has been shown to decrease those rates. 2, 3 There is evidence that systemic antibiotics reduce the rate of post op upper respiratory infections which are associated with a higher fistula rate. 4 I could find no good study regarding the use of applied oral local antibiotics on palatal fistula rates. The use of local antibiotics is usually combined with the use of a gauze pack which keeps the antibiotics adhered to the palate repair. We do know that such packs may reduce the rate of post op fistula. 5, 6 Whether this is a result of the antibiotics on the gauze, as in the case of the BOP, or the protective barrier of the gauze itself is unknown but I suspect it is the latter. Although I have experience in the use of post op packs, I do not routinely use them both to avoid the need of a potential difficult removal in a struggling child and my fear that a post op disruption of the pack could lead to potential airway obstruction. I have no data however, to support this fear. As a lover of medical history, I am delighted to read of the historic value of BOP. I think it is of interest that the authors’ start their article with a quote from Paracelsus whose beliefs as a leading Alchemist of his day should be taken with a grain of salt, or perhaps a pinch of balsam.