| ObjectiveThe clinical analysis and pathological examination of a case of chronic radiation-induced skin injury with local carcinogenesis were carried out,and the clinical manifestations,pathogenesis,treatment principles and medical follow-up of chronic radioactive skin injury were discussed in the literature,and the experience of diagnosis and treatment for similar patients in the future was provided.Methods1.Use the methods of “one to one” and “several to one” to collect the clinical history.One to one: a doctor for a patient.Several to one: several doctors for a patient.2.A detailed physical examination was performed to observe the clinical manifestations.Physical examination should be carried out in a certain order to avoid duplication and omission.In the process of physical examination,we should pay attention to the check examination of left and right and adjacent parts.When conducting physical examination,we should follow the order of sight,touch,percussion and listening.3.The process of pathological section: draw materials-fixed-dewatering transparent-dipping wax,embedding-slice and patch-staining and sealing.4.Medical follow-up: follow-up is usually started shortly after discharge,usually from 3 months to 1 year,depending on the duration and treatment of different diseases.In the recent follow-up,it is mainly to observe the effect and reaction of the patients' treatment,and adjust the medication according to the follow-up situation and the reexamination results;the long term follow-up can obtain the long-term effect,long-term complications and survival time of a certain treatment scheme,which is beneficial to screening more effective treatment methods,and can establish data files,master the law of disease development and guide the treatment.5.Psychological assessment: using the self rating Depression Scale(SDS),the self rating Anxiety Scale(SAS),and Cattell's 16 personality factors test(16PF),the psychological assessment was carried out in the patients.ResultsDue to the work requirements,the patient frequently contact with the x rays,and his left hand dorsal skin appears several unhealed ulcers.Separately on July 19,1991 and October 28,2015,he makes two operations: "the little finger dorsal skin excision and skin grafting of the left hand " and "(left index finger)subcutaneous tumor resection+ flap type shin grafting”.Postoperative pathology of two operations,respectively:(left hand little finger)squamous epithelial II-III degree atypical hyperplasia with local cancer and(finger)squamous carcinoma in situ,plot infiltration,the cutting edge and basal not seen carcinoma involving.With the regular disinfection and anti-infection treatment and so on,the skin graft healed well.27 years of medical follow-up after the first operation of Liu,it was found that Liu was healed in the skin grafting area of left hand surgery without repeated ulcers,but the patient's left hand skin was dry for a long time,desiccated,sensitive to pain temperature,nails easily broken and shedding,and long smear lubricant.In addition,the left index finger and finger extension of the left hand were needed.The function of the curved finger is limited,which seriously affects the normal life.The results of psychological assessment indicated that "Liu" has a variety of emotions,sometimes emotional,prone to worry and depression.Feeling nervous when interacting with strangers,not good at talking,poor social skills and dissatisfaction with the surrounding environment.Also,he has a sense of suspicious and often nervous.ConclusionThe clinical process,pathogenesis and medical treatment of a case of final canceration of chronic radioactive skin injury in hand were analyzed,and the medical follow-up observation and psychological evaluation were successfully carried out for 27 years after the first operation of the patient,which provided the clinical data and accumulated experience for the diagnosis and treatment of similar patients in the future. |
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