Burn patients are often accompanied by problems such as functional and psychological impairments, difficulties in social adaptation. Rehabilitation nursing plays an important role in functional recovery, complication prevention, and improvement of quality of life. To further assist nurses in implementing adult burn rehabilitation nursing in a scientific and standardized manner, the guideline writing group, based on evidence from evidence-based medicine and guided by the Delphi method, developed 16 recommendations addressing 11 clinical questions in adult burn rehabilitation nursing. These recommendations cover multidisciplinary teams, rehabilitation nursing assessment, positioning, edema management, scar care, orthosis care, activities of daily living, pain care, sleep management, psychological interventions, and follow-up care, providing an evidence-based foundation to support clinical practice.
Objective: To explore the surgical designs and clinical effects of pedicled transfer of extended lower trapezius musculocutaneous flap (e-LTMF) in repairing massive wounds in the shoulder and back. Methods: This study was a retrospective case series study. From January 2009 to April 2023, 41 patients with massive wounds in the shoulder and back who met the inclusion criteria were admitted to Plastic Surgery Hospital of Chinese Academy of Medical Sciences and Peking Union Medical College, including 26 males and 15 females, aged 4 to 83 years. The surgical design was selected according to the nature of the wound and surgical timing. The 15 patients repaired with the conventional e-LTMF were included in conventional group, the 15 patients repaired with the modified e-LTMF incorporating a distal segment of the latissimus dorsi muscle were included in modified group, and the 11 patients repaired with the pre-expanded e-LTMF were included in pre-expanded group. The wound areas ranged from 7 cm×5 cm to 21 cm×12 cm and the harvested musculocutaneous flap areas ranged from 7 cm×5 cm to 33 cm×10 cm in patients in conventional group. The wound areas ranged from 16 cm×8 cm to 28 cm×18 cm and the harvested musculocutaneous flap areas ranged from 25 cm×8 cm to 40 cm×12 cm in patients in modified group. The wound areas ranged from 12 cm×8 cm to 36 cm×12 cm and the harvested musculocutaneous flap areas ranged from 22 cm×8 cm to 35 cm×15 cm in patients in pre-expanded group. The musculocutaneous flaps were transferred to the recipient sites in a fashion of propeller rotation or as an island flap through a subcutaneous tunnel. The donor site wounds were repaired by direct suture, local flap transfer, or skin grafting. After surgery, the survival of musculocutaneous flaps was observed, the complete survival rate and the necrosis rate of musculocutaneous flaps were calculated, and the management and outcome of the necrotic musculocutaneous flaps were recorded. During follow-up, the appearance and texture of the musculocutaneous flaps, the recovery of the affected upper limb and the shoulder and back at recipient sites, the tumor recurrence in patients with tumors, and the wound healing at donor sites were observed. Results: After surgery, among the 41 patients, the musculocutaneous flaps survived completely in 38 patients, with a complete survival rate of musculocutaneous flaps of 92.7% (with a 95% CI of 80.6% to 97.5%). The necrosis of the musculocutaneous flaps occurred in 3 patients, with a necrosis rate of musculocutaneous flaps of 7.3% (with a 95% CI of 2.5% to 19.4%). Among them, total necrosis of the musculocutaneous flaps occurred in one patient in conventional group, whose wound healed after skin grafting. Distal necrosis of the musculocutaneous flap occurred in two patients in modified group, whose wounds both healed after dressing changes. During the follow-up of 1 to 48 months after surgery, the color and texture of the musculocutaneous flaps were similar to those of the normal skin surrounding the recipient sites, no obvious limitation was observed in the motion of the affected upper limb or the shoulder and back at recipient sites, and no tumor recurrence was observed in patients with tumors. The wounds at donor sites all healed well. Conclusions: Three surgical designs of e-LTMF can be used to repair massive wounds of varying complexity in the shoulder and back, achieving good outcomes in postoperative musculocutaneous flap survival, appearance and texture, recovery of the affected upper limb and the shoulder and back at recipient sites, and donor site wound healing. Among them, the conventional e-LTMF can be used for repairing simple skin and soft tissue defects, the modified e-LTMF incorporating a distal segment of the latissimus dorsi muscle can be used for repairing complex wounds complicated by exposure of critical structures, wound infection, or dead-space formation, and the pre-expanded e-LTMF can be used for elective reconstruction of wounds requiring larger musculocutaneous flap coverage.
Objective: To evaluate the clinical efficacy of thinned free flaps in reconstructing the wounds following excision of malignant extremity tumors. Methods: This study was a retrospective case series study. From June 2023 to February 2026, 17 patients (11 males and 6 females, aged 38-91 years) with malignant extremity tumors who met the inclusion criteria were admitted to the Department of Hand Surgery of Beijing Jishuitan Hospital of Capital Medical University. Tumors were located in the upper extremity in 9 patients and in the lower extremity in 8 patients, including 6 patients of squamous cell carcinoma, 2 patients of dermato-fibrosarcoma protuberans, 2 patients of liposarcoma, 2 patients of synovial sarcoma, 2 patients of malignant peripheral nerve sheath tumor, 1 patient of epithelioid sarcoma, 1 patient of angiosarcoma, and 1 patient of cutaneous carcinoma. Wide excision of the tumor was performed, with soft tissue defect areas ranging from 4 cm×4 cm to 24 cm×12 cm. Thinned free flaps were used for wound reconstruction, including 7 anterolateral thigh flaps, 6 groin flaps, 2 medial sural artery perforator flaps, 1 inferior epigastric artery perforator flap, and 1 medial plantar flap. Flaps were harvested with areas ranging from 4 cm×4 cm to 24 cm×13 cm, with a thickness of 4-10 mm (with a mean of 5.8 mm). Donor site wounds were closed by direct suture, local relay flaps or skin grafting. Postoperative flap survival was recorded, as well as the occurrence of complications at the flap recipient site including infection, hematoma, and delayed wound healing, and the healing status and complications at the donor site. A comprehensive assessment of flap reconstructive outcomes was conducted at the final follow-up. Tumor prognosis of all patients was tracked and documented. Results: Postoperatively, the flaps in 16 patients survived uneventfully. One patient who underwent groin flap reconstruction for wound following resection of angiosarcoma on the dorsum of the hand developed epidermal necrosis at the distal portion of the flap on postoperative day 3, which healed after dressing changes. No infection, hematoma, or delayed wound healing occurred in any flap recipient site. Donor site wounds healed uneventfully in 15 patients but showed delayed healing in 2 patients. No major complications were observed in any donor site wound. At the last follow-up, the flap reconstructive outcomes were rated as excellent in 14 patients and good in 3 patients. The follow-up period ranged from 2 to 34 months. Local recurrence of tumors occurred in 3 patients. Metastasis of tumors developed in 2 patients. The remaining 12 patients showed no signs of local tumor recurrence or distant metastasis. Conclusions: Clinical use of thinned free flaps to reconstruct the wounds following excision of malignant extremity tumors yields excellent reconstructive outcomes, with few donor site complications.
The repair of complex wounds has shifted from simple wound closure toward functional reconstruction. Nevertheless, a systematic exposition regarding their definition, the principles of functional reconstruction, and future directions is currently lacking. Based on a literature review and comprehensive analysis, this article proposes that the definition of complex wounds should incorporate four dimensions including abnormal healing timeline, involvement of anatomical structures, coexistence of multiple risk factors, and complex management requirements. Furthermore, the core concept of functional reconstruction for such wounds can be summarized into four-tiered principles: biological matching between donor and recipient sites, minimization of donor-site morbidity, restoration of aesthetic appearance and sensory function, and functional reconstruction of deep structures, including blood vessels, nerves, tendons, bones, and joints. This article systematically reviewed the developmental trajectory of complex wound reconstruction, from skin grafting as the cornerstone of wound repair, to microsurgery for functional reconstruction, and onward to the emergence of multidisciplinary regenerative strategies, highlighting the original contributions of Chinese investigators in this field. In the future, the deep integration of technologies such as regenerative medicine, intelligent navigation, super-microsurgery, and precision subtyping is expected to facilitate the transition of complex wound reconstruction from anatomical repair to functional regeneration.
Objective: To explore the performance of phenylboronic acid-modified gelatin methacryloyl (GelMA) hydrogel loaded with copper-doped cerium oxide nanozyme (hereinafter referred to as composite hydrogel) and its effects on healing of infected burn wounds in mice. Methods: This study was an experimental study including group design and repeated measures design. The phenylboronic acid-modified GelMA hydrogel (hereinafter referred to as simple hydrogel) with a three-dimensional loose porous network structure was prepared. The copper-doped cerium oxide nanozyme with a uniform spherical structure was prepared by a hydrothermal method. The copper-doped cerium oxide nanozyme with a final mass concentration of 100 μg/mL, which had no obvious effect on the viability of human umbilical vein endothelial cells and possessed high superoxide dismutase-like and catalase-like activities, was screened out and added into the simple hydrogel to prepare the composite hydrogel. After the composite hydrogels were soaked in phosphate buffer saline (PBS) or hydrogen peroxide solution for 24, 48, and 72 h, the release percentages of copper-doped cerium oxide nanozymes in the composite hydrogel were calculated, with a sample size of 3. Thirty 8-week-old male BALB/c mice were taken to establish a burn wound infection model by creating symmetrical burn wounds on both sides of the spine, and then dropping methicillin-resistant Staphylococcus aureus (MRSA) bacterial suspension to the wounds. According to the random number table method (the same grouping method below), the mice were divided into control group, simple hydrogel group, and composite hydrogel group, with 10 mice in each group (20 wounds). No drug intervention was administered to the wounds of mice in control group, the simple hydrogel and composite hydrogel were dropped on the wounds of mice in simple hydrogel group and composite hydrogel group, respectively. At post injury day (PID) 3, 7, and 14, the residual wound area was measured and the percentage of residual wound area was calculated. At PID 3, the MRSA concentration in the wound was measured using the plate counting method. At PID 5, the wound blood perfusion volume was evaluated by a laser speckle blood flow imaging system. Another six 8-week-old male BALB/c mice were taken and divided into PBS group and composite hydrogel implantation group, with 3 mice in each group, and PBS was subcutaneously injected and composite hydrogels were subcutaneously implanted into the center of the mice's backs, respectively. At 14 d after treatment, abdominal whole blood of mice was collected, then the blood routine test indexes and blood biochemical test indexes were detected. Results: After immersion in PBS or hydrogen peroxide solution for 24, 48, and 72 h, respectively, the overall differences in the release percentages of copper-doped cerium oxide nanozymes in the composite hydrogel were statistically significant (with F values of 30.29 and 65.16, respectively, P<0.05). At PID 3, 7, and 14, compared with those in control group, the percentages of residual wound area of mice in simple hydrogel group and composite hydrogel group were all significantly reduced (P<0.05); the percentages of residual wound area of mice in composite hydrogel group were significantly lower than those in simple hydrogel group (P<0.05). At PID 3, compared with that in control group, the MRSA concentrations in the wounds of mice in simple hydrogel group and composite hydrogel group were both significantly decreased (P<0.05); the MRSA concentration in the wounds of mice in composite hydrogel group was significantly lower than that in simple hydrogel group (P<0.05). At PID 5, compared with (221±25) perfusion units in control group, the wound blood perfusion volumes of mice in simple hydrogel group and composite hydrogel group ((313±53) and (535±104) perfusion units, respectively) were both significantly increased (P<0.05); the wound blood perfusion volume of mice in composite hydrogel group was significantly higher than that in simple hydrogel group (P<0.05). At 14 d after treatment, the blood routine test indexes and blood biochemical test indexes of mice in composite hydrogel implantation group and PBS group were all maintained within normal physiological ranges, with no statistically significant differences between the two groups (P>0.05). Conclusions: The composite hydrogel possesses good biocompatibility, reactive oxygen species responsiveness, and excellent antibacterial properties. It can accelerate wound healing by eliminating MRSA from the infected burn wounds in mice at early stage and promoting blood flow recovery.
Objective: To explore the clinical evaluation and repair strategies for complex inguinal wounds. Methods: This study was a retrospective case series study. From September 2020 to October 2025, 15 patients with complex inguinal wounds who met the inclusion criteria were admitted to Beijing Jishuitan Hospital of Capital Medical University. There were 10 males and 5 females, aged 12 to 79 years. Preoperatively, the involvement of vital structures and infectious status in the inguinal region was precisely evaluated through medical history inquiry, physical examination, and multiple auxiliary examinations. After timely management of femoral artery lesions, precise debridement was carried out. The sizes of inguinal wounds after debridement ranged from 11.0 cm×4.0 cm to 20.0 cm×9.0 cm. According to the wound bed conditions after debridement, well-vascularized tissue flaps were selected to obliterate the wound cavity and achieve wound closure. The following data were recorded, including the involvement of femoral vessels by the wound, the exposure and retention or removal of prosthetic vascular grafts, management of the femoral artery in patients with radiotherapy, the type and size of the adopted tissue flaps, the methods of wound closure at the donor site, the preoperative bacterial culture results of wound exudate samples, and the results of intraoperative histopathological examination of wounds. The survival of tissue flaps and wound healing were observed two weeks postoperatively. During follow-up, the appearance of tissue flaps, recurrence of wounds, patency of femoral artery, swelling of the affected limb, scar formation of the donor sites, and occurrence of abdominal wall hernia at the donor site of rectus abdominis myocutaneous flap were observed. Results: All inguinal wounds involved femoral vessels. Exposure of the prosthetic vascular graft was observed in 4 patients, among which the prosthetic vascular graft was preserved in three patients and removed in one patient. Among patients with radiotherapy, two patients received preoperative covered stent implantation, one patient underwent intraoperative femoral artery resection and prosthetic vascular vessel grafting, and the femoral artery in the remaining patients was successfully preserved without rupture. Eleven cases of inguinal wounds were repaired with thoracoumbilical flaps combined with rectus abdominis myocutaneous flap, one case was repaired with tensor fasciae latae myocutaneous flap combined with sartorius muscle flap, one case was repaired with tensor fasciae latae myocutaneous flap combined with rectus femoris muscle flap, and two cases were repaired with pedicled anterolateral thigh flap chimerized with vastus lateralis muscle flap. The sizes of tissue flaps ranged from 13.0 cm×6.0 cm to 26.0 cm×14.0 cm. Only the donor site wound in one patient was covered with split-thickness skin graft, and the donor site wounds in the remaining 14 patients were closed by primary suture. The preoperative bacterial culture results of wound exudate samples showed monomicrobial infection in 7 patients and mixed infection of two types of bacteria in 8 patients. The results of intraoperative histopathological examinations of wounds revealed inflammatory changes without neoplastic component. The tissue flaps in all patients survived completely, and the wounds healed well at postoperative two weeks. During postoperative follow-up of 6 months to 3 years, most of the tissue flaps maintained good appearance, while a small number of tissue flaps presented mild bulkiness. No wound recurrence was observed. Computed tomography angiography confirmed patent femoral arteries in 14 patients, and obvious relief of preoperative lower limb swelling was achieved in 9 patients. The donor site wound with skin grafting showed unremarkable scarring in one patient, while mild linear scars were noted at the donor sites in the other 14 patients. No abdominal wall hernia occurred at the donor sites of rectus abdominis myocutaneous flaps. Conclusions: For complex inguinal wounds, optimal clinical repair outcomes can be achieved via preoperative precise evaluation of large blood vessels, prosthetic vascular grafts, and soft tissue infection, and adequate vascular intervention, intraoperative precise debridement, followed by wound closure using well-vascularized tissue flaps.
Diabetic wounds, including diabetic foot ulcers, represent one of the severe complications associated with diabetes mellitus, which progress rapidly, are difficult to treat, and frequently lead to amputation or even life-threatening consequences. The current treatment principles for closing the wounds are based on improving limb blood supply while combining the application of surgical techniques-such as negative-pressure drainage, wound dressing changes, and coverage with muscle flaps, skin flaps, autologous skin, or artificial skin substitutes. In recent years, numerous studies have reported on the therapeutic approach involving the initial management of diabetic wounds with bone cement, followed by skin or flap transplantation for definitive wound coverage. To further standardize the application of bone cement in the treatment of diabetic wounds, the Burns and Trauma Branch of Chinese Geriatrics Society jointly organized an expert panel to develop the Expert consensus on the application of bone cement in the treatment of diabetic wounds (2026 edition). This consensus, which is based on evidence from literature search integrating the latest advances in clinical and basic research, aims to establish a standardized protocol for treating diabetic wounds with bone cement. It serves as a critical reference for clinicians to enhance the diagnostic and therapeutic outcomes of diabetic wounds.
Objective: To investigate the effects of astragaloside Ⅰ (AS-Ⅰ) on full-thickness skin defects in diabetic rats and its underlying mechanism. Methods: This study was an experimental study with grouped design and repeated measures design. Twenty-four male Sprague-Dawley rats aged 6-8 weeks were divided into control group (n=6) and modeling group (n=18) using a random number table method (the same grouping method was used throughout). After successful induction of diabetes mellitus, the modeling group was further divided into model group, low-dose AS-Ⅰ group, and high-dose AS-Ⅰ group, with 6 rats in each group. A full-thickness skin defect wound of 10 mm in diameter was created on the back of each rat. Wounds in control group and model group were treated with normal saline, while wounds in low-dose AS-Ⅰ group and high-dose AS-Ⅰ group were treated with 1.15 and 11.50 mmol/L AS-Ⅰ, respectively, for 3 consecutive days. Wound healing rates of rats were calculated at 3, 5, 7, 9, 13, and 15 days after injury. At 15 days after injury, Masson's trichrome staining was used to assess the deposition of collagen fibers in wound tissue; immunohistochemical staining was performed to detect Ki-67 positive expression in wound tissue, and the expression level was quantified. Network pharmacology analysis was applied to screen for potential core targets of AS-Ⅰ in treatment of diabetic wounds; molecular docking simulation was utilized to validate the binding affinity of AS-Ⅰ to the core targets, and molecular dynamics simulation was performed to verify the dynamic stability of the interaction between AS-Ⅰ and forkhead box O1 (FOXO1). At 15 days after injury, Western blotting was used to determine the protein expression levels of epidermal growth factor receptor (EGFR), cyclin-dependent kinase 2 (CDK2), growth factor receptor-bound protein 2 (GRB2), phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA), signal transducer and activator of transcription 3 (STAT3), and FOXO1 in wound tissue of rats in four groups. Results: Compared with those in control group, the wound healing rates of rats in model group at 3 and 15 days after injury were significantly decreased (P<0.05); whereas the wound healing rates of rats in low-dose AS-Ⅰ group at 7 and 13 days after injury, and in high-dose AS-Ⅰ group at 5, 7, 9, 13, and 15 days after injury were significantly increased (P<0.05). Compared with those in model group, the wound healing rates of rats in both low-dose AS-Ⅰ group and high-dose AS-Ⅰ group at 3, 9, 13, and 15 days after injury were significantly increased (P<0.05). At 15 days after injury, collagen fibers in the wound tissue of rats in control group were arranged in an orderly and dense manner; whereas those in the wound tissue of model group were sparse and disorganized; the deposition of collagen fibers in the wound tissue of rats in low-dose AS-Ⅰ group was improved compared with model group; collagen fibers in the wound tissue of rats in high-dose AS-Ⅰ group exhibited dense and orderly arrangement with a high degree of maturity. At 15 days after injury, the expression level of Ki-67 in wound tissue of rats in model group was significantly lower than that in control group (P<0.05); compared with that in model group, the Ki-67 expression level in wound tissue of rats in low-dose AS-Ⅰ group was significantly higher (P<0.05); compared with those in control group, model group, and low-dose AS-Ⅰ group, the Ki-67 expression level in wound tissue of rats in high-dose AS-Ⅰ group was significantly higher (with P values all <0.05). The results of network pharmacology analysis identified 63 overlapping targets between AS-Ⅰ-associated targets and diabetic wound-related targets, involving the FOXO signaling pathway (with target protein FOXO1) and target proteins including EGFR, CDK2, GRB2, PIK3CA, and STAT3. The results of molecular docking simulation showed that AS-Ⅰ exhibited strong binding affinity to the target proteins. The results of molecular dynamics simulation demonstrated that the conformation of the complex formed by AS-Ⅰ and FOXO1 protein could maintain dynamic stability. At 15 days after injury, compared with those in control group, the protein expression levels of STAT3, GRB2, and FOXO1 in wound tissue of rats in model group were significantly upregulated (with P values all <0.05), while the protein expression levels of PIK3CA, EGFR, and CDK2 were significantly downregulated (with P values all <0.05). Compared with those in model group, the protein expression levels of STAT3, GRB2, and FOXO1 in wound tissue of rats in low-dose AS-Ⅰ group and high-dose AS-Ⅰ group were significantly downregulated (with P values all <0.05), while the protein expression levels of PIK3CA, EGFR, and CDK2 were significantly upregulated (with P values all <0.05). Compared with those in low-dose AS-Ⅰ group, the protein expression levels of STAT3, GRB2, and FOXO1 in wound tissue of rats in high-dose AS-Ⅰ group were significantly downregulated (with P values all <0.05), while the protein expression levels of PIK3CA, EGFR, and CDK2 were significantly upregulated (with P values all <0.05). Conclusions: AS-Ⅰ may promote wound healing of full-thickness skin defects and improve collagen fiber arrangement in diabetic rats by downregulating the protein expression of STAT3, GRB2, and FOXO1 and upregulating that of PIK3CA, EGFR, and CDK2.
Objective: To investigate the role and mechanism of infrared thermography (IRT) in early identification of necrosis risk in random-pattern flaps (RPFs) of mice. Methods: This study was an experimental study with a grouped design. A RPF model was established on the dorsum of 92 male C57BL/6J mice aged 6-8 weeks. The flap was divided into three equal zones (zones Ⅰ, Ⅱ, and Ⅲ) from the caudal to the cephalic end. The relative temperatures (RTs, the difference between the target zones and the normal control zone) of the three zones were measured using an infrared thermal imager at postoperative day (POD) 0 (immediately), 3, and 7. At POD 3 and 7, receiver operating characteristic (ROC) curves were used to evaluate the predictive efficacy of the RT of flap zone Ⅱ for flap necrosis and to determine the optimal cutoff values. Based on the RT of flap zone Ⅱ at POD 3, mice were divided into >-0.1 ℃ group and ≤-0.1 ℃ group; based on the RT of flap zone Ⅱ at POD 7, mice were divided into >0.1 ℃ group and ≤0.1 ℃ group. The survival rate of flaps was calculated for the first two groups of mice at POD 3 and for the latter two groups of mice at POD 7. Laser Doppler perfusion imaging was used to measure blood perfusion volume of flaps in the above groups at the corresponding time points. At POD 3, the tissue of flap zone Ⅱ from >-0.1 ℃ and ≤-0.1 ℃ groups of mice was collected for transcriptomic sequencing to screen for differentially expressed genes (DEGs) with significantly differential expression, for immunofluorescence staining to calculate the ratios of inducible nitric oxide synthase (iNOS)/CD68 and arginase 1 (ARG1)/CD68, for immunohistochemical staining to detect the expression of C-C motif chemokine ligand 2 (CCL2), for dihydroethidium (DHE) staining to detect the expression of DHE, for real-time fluorescence quantitative reverse transcription polymerase chain reaction to measure the mRNA expressions of tumor necrosis factor α (TNF-α), interleukin-1β (IL-1β), and IL-10, and for Western blotting to detect the protein expressions of CD68, iNOS, ARG1, heme oxygenase-1 (HO-1), and superoxide dismutase 1 (SOD1). The sample size was three for the DEGs screening and protein expression detecting experiments, and 4 for the remaining experiments. Results: From POD 0 to 7, RTs of flap zones Ⅰ and Ⅱ showed an increasing trend, while RTs in flap zone Ⅲ rose initially and then decreased. At POD 3 and 7, the areas under the ROC curves of the RT of flap zone Ⅱ for predicting flap necrosis were 0.82 and 0.85, respectively (with 95% CIs of 0.72-0.93 and 0.78-0.93, respectively), with optimal cutoff values of -0.1 and 0.1 ℃, respectively. At POD 3, there were no statistically significant differences in the survival rate or blood perfusion volume of flaps between ≤-0.1 ℃ group and >-0.1 ℃ group of mice (P>0.05). At POD 7, the survival rate (t=4.19, P<0.05) and blood perfusion volume (t=5.58, P<0.05) of flaps were significantly decreased in ≤0.1 ℃ group of mice compared with those in >0.1 ℃ group. At POD 3, compared with that in >-0.1 ℃ group, there were 2 849 DEGs in tissue of flap zone Ⅱ in ≤-0.1 ℃ group of mice, including 1 509 upregulated DEGs and 1 340 downregulated DEGs. At POD 3, there were significantly lower iNOS/CD68 ratio (t=4.97, P<0.05) and significantly higher ARG1/CD68 ratio (t=3.42, P<0.05), significantly lower expressions of CCL2 and DHE, mRNA expressions of TNF-α and IL-1β, as well as protein expressions of CD68 and iNOS (with t values of 4.82, 4.51, 4.43, 5.47, 3.69, and 6.14, respectively, P<0.05), and significantly higher mRNA expression of IL-10 and protein expressions of ARG1, SOD1, and HO-1 (with t values of 8.58, 8.61, 6.24, and 11.03, respectively, P<0.05) in tissue of flap zone Ⅱ in >-0.1 ℃ group of mice compared with those in ≤-0.1 ℃ group. Conclusions: IRT enables early and objective prediction of necrosis risk of RPFs in mice through monitoring flap temperature. The RT ≤-0.1 ℃ in flap zone Ⅱ at POD 3 is associated with marked inflammatory response, immune cell infiltration, and oxidative stress in the tissue. CCL2 may serve as a key chemokine inducing macrophage polarization.
Objective: To investigate the application effects of the hydrosurgical debridement system (hereinafter referred to as the hydrosurgery system) in eschar excision and debridement in ex vivo porcine skin burn wound models. Methods: This was a basic research study using grouped design. On November 21st, 2024, 23 young surgeons (20 males and 3 females, aged 30-43 years) participated in the 2024 Zhejiang Provincial Burn Surgery Clinical Skills Competition in Ningbo city. Each surgeon used the hydrosurgery system and convetional instruments to perform eschar excision (using the hydrosurgery system and roller dermatome) and debridement (using the hydrosurgery system and conventional scalpel) on ex vivo porcine skin burn wound models featuring both early-stage eschar and late-stage liquefied eschar (both with an area of 12 cm×8 cm), respectively. The operative time (assessing speed) and amount of removed tissue (assessing precision) were recorded for both instruments in both procedures. Results: The operative time for eschar excision was not statistically different between the hydrosurgery system (122 (96, 145) s) and traditional instrument (125 (56, 233) s), P>0.05; however, the amount of removed tissue by the hydrosurgery system (2.88±0.27) g was significantly less than that (13.81±1.93) g by traditional instrument (t=-5.44, P<0.05). The operative time for debridement by the hydrosurgery system ((121±9) s) was significantly shorter than that ((368±33) s) by traditional instrument (t=-7.00, P<0.05); however, the amount of removed tissue by the hydrosurgery system ((30.85±1.98) g) was significantly greater than that ((21.48±1.45) g) by traditional instrument (t=4.00, P<0.05). Conclusions: Compared with traditional instruments, the hydrosurgery system allows more precise removal of necrotic tissue and minimize damage to healthy tissue in early-stage eschar excision in ex vivo porcine skin burn wounds; however, while it significantly accelerates debridement during late-stage debridement of liquefied eschar, it may remove excessive normal tissue.
Objective:To investigate the influence and mechanism of Prussian blue nanoparticles (PBNPs) combined with mouse adipose-derived mesenchymal stem cells (ADSCs) on full-thickness skin defect wounds in diabetic mice.Methods:This study was an experimental study using group design and repeated-measures design. PBNPs were prepared by hydrothermal synthesis, and their morphology was characterized by transmission electron microscopy. ADSCs were isolated from five male 6-8-week-old Institute of Cancer Research (ICR) mice, USA via collagenase digestion. The cells were divided into control group cultured under routine conditions, high-glucose group cultured with glucose in a final molarity of 30.0 mmol/L, and low-PBNP group and high-PBNP group pretreated with 10 or 20 μg/mL PBNP for 12 h, respectively, followed by the same treatment as in high-glucose group. After 24 h of culture, cell viability was assessed using the cell counting kit-8, the proportion of senescent cells in the cells was detected by β-galactosidase staining, and the protein expression levels of senescence-associated proteins p16 and p21 were determined by Western blotting. Twenty-four male 6-8-week-old ICR mice were used to establish the diabetic model. A full-thickness skin defect wound was then created on the back of each mouse. The injured mice were divided into four groups (with 6 mice in each group) according to the random number table method, including control group with wounds treated with normal saline, ADSC group with wounds treated with normal saline containing 5×10 6 ADSC (the same number of cells used below), low-PBNP group and high-PBNP group with wounds treated with normal saline containing ADSC pretreated with 10 and 20 μg/mL PBNP for 12 h, respectively. Wound healing was observed at post-injury day (PID) 0 (immediately), 3, 7, 10, and 14. The percentage of remaining wound area was calculated at PID 3, 7, 10, and 14. At PID 7, the protein expression levels of the cell proliferation markers Ki67 and vascular endothelial growth factor (VEGF) in wound tissue were detected by immunofluorescence method. At PID 14, the expression levels of tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), IL-6, and IL-10 in wound tissue were determined by enzyme-linked immunosorbent assay. Results:PBNPs exhibited a dispersed regular cubic structure. After 24 h of culture, compared with those in control group, cells in high-glucose group showed a significantly lower cell viability ( P<0.05), a significantly higher proportion of senescent cells ( P<0.05), and significantly higher protein expression levels of p16 and p21 ( P<0.05). Compared with those in high-glucose group, cells in low-PBNP and high-PBNP groups showed significantly higher cell viability ( P<0.05), significantly lower proportions of senescent cells ( P<0.05), and significantly lower protein expression levels of p16 and p21 ( P<0.05). From PID 0 to 14, the wounds of mice in all four groups healed gradually. At PID 3, 7, 10, and 14, the percentages of remaining wound area of mice in high-PBNP group were (75.3±3.1)%, (46.7±2.5)%, (24.0±5.2)%, and (8.0±1.0)%, respectively, all significantly lower than (85.0±2.0)%, (62.7±3.1)%, (46.7±3.8)%, and (19.3±2.1)% in ADSC group ( P<0.05). At PID 7, the percentage of remaining wound area of mice in ADSC group was significantly lower than that in control group ((77.3±3.2)%, P<0.05). At PID 7, the protein expression levels of Ki67 and VEGF of cells in ADSC group were significantly higher than those in control group ( P<0.05), the protein expression levels of Ki67 of cells in low-PBNP and high-PBNP groups and the protein expression level of VEGF of cells in high-PBNP group were significantly higher than those in ADSC group ( P<0.05). At PID 14, compared with those in control group, wound tissue in ADSC group showed a significantly higher expression level of IL-10 ( P<0.05) and significantly lower expression levels of TNF-α, IL-1β, and IL-6 ( P<0.05); compared with those in ADSC group, wound tissue in low-PBNP and high-PBNP groups showed significantly higher expression levels of IL-10 ( P<0.05) and significantly lower expression levels of TNF-α, IL-1β, and IL-6 ( P<0.05). Conclusions:PBNP can inhibit high glucose-induced senescence of mouse ADSCs. PBNP combined with mouse ADSCs is more effective than mouse ADSCs alone in promoting cell proliferation and angiogenesis in full-thickness skin defect wounds of diabetic mice, inhibiting the release of inflammatory cytokines, and accelerating wound healing.
Objective:To investigate the effects and mechanisms of polyvinyl alcohol/ionic liquid-tannic acid composite hydrogel (PIT) on wound healing of full-thickness skin defects in diabetic mice.Methods:This study was an experimental research involving grouped design and repeated measurements. An ionic hydrogel matrix crosslinked by polyvinyl alcohol-4-(1H)-vinylimidazole-1-methylene benzoic acid and oxidized hyaluronic acid was prepared, and tannic acid was loaded via Cu 2+ chelation to construct PIT. A 1,1-diphenyl-2-picrylhydrazyl (DPPH) solution was prepared and reacted respectively with tannic acid and PIT for 24 hours. An ultraviolet spectrophotometer was used to detect the DPPH radical scavenging rate. According to the random number table method (the same grouping method below), mouse macrophage RAW264.7 cells were divided into a phosphate buffered saline (PBS) group cultured with PBS, as well as a hydrogen peroxide group and a PIT group, in which cells were first treated with hydrogen peroxide for 12 hours and then respectively cultured under routine condition and with PIT. After 24 hours of culture, the fluorescent probe method was adopted to detect the intracellular reactive oxygen species (ROS) level. Escherichia coli ATCC 25922, Staphylococcus aureus ATCC 25923, methicillin-resistant Staphylococcus aureus (MRSA) BNCC 337371, and human umbilical vein endothelial cells (HUVECs) were collected and all divided into PBS group, tannic acid (TA) group, and PIT group, which were cultured with PBS, TA solution, and PIT, respectively. After 12 hours of bacterial culture, the plate counting method was used to count bacterial colonies; after 24 hours of cell culture, the tube formation assay was performed to measure the total tube length, the number of branching nodes, and the number of branches. The sample size of all the above experiments was 3. Eighteen 8-week-old male Kunming mice were selected and divided into PBS group, TA group, and PIT group (with 6 mice in each group) to establish a full-thickness skin defect wound model of diabetes (with one wound in each mouse). At post injury day (PID) 0 (immediately), the wounds of mice in PBS group, TA group, and PIT group were treated respectively with PBS, TA solution, and PIT by topical application, and then the dressings were changed daily. The wound healing status was observed at PID 0, 4, 8, and 12, and the wound healing rates at PID 4, 8, and 12 were calculated. At PID 12, wound tissue was harvested. Hematoxylin-eosin staining was performed to observe the status of wound re-epithelialization and to measure the thickness of newly formed epithelium. Masson staining was performed to observe the deposition of collagen fibers in wounds and to calculate the proportion of collagen fiber-positive area. Results:After 24 hours of reaction, the DPPH radical scavenging rate of PIT was significantly higher than that of TA ( t=16.35, P<0.05). After 24 hours of culture, the ROS level of RAW264.7 cells in hydrogen peroxide group was significantly higher than that in PBS group ( P<0.05), and the ROS level of RAW264.7 cells in PIT group was significantly lower than that in hydrogen peroxide group ( P<0.05). After 12 hours of culture, the bacterial colony counts of Escherichia coli, Staphylococcus aureus, and MRSA in PIT group were significantly less than those in PBS group and TA group ( P<0.05). After 24 hours of culture, compared with those in PBS group and TA group, the total tube length of HUVECs in PIT group was significantly increased (with P values both <0.05), and the number of branching nodes and the number of branches increased significantly (with P values all <0.05). From PID 0 to 12, the wounds of mice in all three groups healed gradually. At PID 4, 8, and 12, the wound healing rates of mice in PIT group were (31.6±2.0)%, (51.8±2.5)%, and (97.9±1.5)%, respectively, which were significantly higher than (18.6±0.6)%, (39.5±2.0)%, and (74.6±2.0)% in PBS group and (21.5±1.1)%, (40.7±0.8)%, and (85.3±2.1)% in TA group ( P<0.05). At PID 12, the wound re-epithelialization of mice in PBS group was incomplete, and collagen fibers were sparsely distributed with disordered arrangement; the degree of wound re-epithelialization of mice in TA group was higher than that in PBS group, and collagen fibers were distributed in bundles with loose arrangement; the degree of wound re-epithelialization of mice in PIT group was higher than that in TA group, and collagen fibers were densely and orderly arranged in layers. At PID 12, compared with those in PBS group and TA group, the thickness of newly formed epithelium in wounds of mice in PIT group was significantly increased (with P values both <0.05), and the proportion of collagen fiber-positive area was significantly increased (with P values both <0.05). Conclusions:PIT significantly accelerates the wound healing of full-thickness skin defects in diabetic mice through multiple mechanisms driven by metal ion chelation including antibacterial, antioxidant, and pro-angiogenesis activities, thereby improving the quality of tissue repair.
Objective:To evaluate the effects of pulsed dye laser (PDL) combined with fractional carbon dioxide laser in the treatment of hypertrophic scars (HSs) in children.Methods:This study was a meta-analysis. Databases including PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, and VIP Chinese Journal Service Platform were retrieved to obtain the publicly published retrospective and prospective studies on the effects of PDL combined with fractional carbon dioxide laser for pediatric HS from the establishment of each database to October 31, 2024. The outcome indexes included the total score of the patient and observer scar assessment scale (POSAS) and laser treatment-related adverse reactions. Stata version 16.0 software was used to conduct a meta-analysis.Results:A total of 7 studies were included, involving 348 children with HSs. Meta-analysis results showed that the total POSAS scores in HS children who received PDL combined with fractional carbon dioxide laser treatment were significantly lower than those before treatment (with a standardized mean difference of -7.76, a 95% CI of -10.91 to-4.61, P<0.05). Subgroup analysis results suggested that geographic distribution, scar duration (divided into ≤3 months group and >3 months group), intervention measures, and fractional carbon dioxide laser energy parameters might be sources of heterogeneity for the total POSAS score. The incidence of adverse reactions of PDL combined with fractional carbon dioxide laser for pediatric HS was 3.50% (with a 95% CI of 1.60% to 6.00%, P<0.05). There was no publication bias in the total POSAS score, its subgroup analyses (including geographic distribution, scar duration, intervention measures, fractional carbon dioxide laser energy parameters, and assessor), or adverse reactions related to laser treatment ( P>0.05). Conclusions:PDL combined with fractional carbon dioxide laser is beneficial for the recovery of pediatric HS, with a low rate of adverse reactions and a favorable safety profile. For pediatric HS, the early intervention window within 3 months after scar formation should be prioritized, and a regimen combining low-energy fractional carbon dioxide laser flexibly with PDL should be adopted to achieve better therapeutic outcomes.
The American Burn Association Clinical Practice Guideline on blood product transfusion in burn care was released in July 2025. Based on the PICO (Population, Intervention, Comparison, Outcome) framework and available evidence, the guideline provided evidence-based recommendations for blood product transfusion issues during hospitalization of adult burn patients, covering the management of transfusion indications, viscoelastic testing, the use of erythropoietin and tranexamic acid, and blood product transfusion strategies, etc. This article interpreted the key points of the guideline to facilitate their understanding and application by clinical medical professionals.
Objective:To investigate the value of shear wave elastography (SWE) in the early diagnosis of diabetic peripheral neuropathy (DPN) in patients with type 2 diabetes mellitus.Methods:This study was a diagnostic case-control study. From May 2021 to October 2022, 68 patients with type 2 diabetes mellitus who met the inclusion criteria were admitted to the Department of Burns and Plastic Surgery of Affiliated Hospital of Zunyi Medical University, including 45 males and 23 females, aged (57±10) years. According to whether the DPN was present, the patients were divided into DPN group (38 patients) and non-DPN group (30 patients). During the same period, 30 healthy volunteers who underwent physical examinations at the health examination center of the hospital were recruited as healthy control group, including 19 males and 11 females, aged (56±10) years. Cross-sectional areas of the bilateral common peroneal nerves and tibial nerves measured by a color Doppler ultrasonography system in two-dimensional ultrasonography mode, and the stiffness of the bilateral common peroneal nerves and tibial nerves measured in SWE mode were compared between volunteers in healthy control group and two groups of patients at admission. Independent risk factors for the development of DPN were screened in the three groups of participants. Receiver operating characteristic curves were used to evaluate the diagnostic value of common peroneal nerve stiffness, common peroneal nerve cross-sectional area, tibial nerve stiffness, and tibial nerve cross-sectional area for DPN in two groups of patients. The correlations of common peroneal nerve stiffness and common peroneal nerve cross-sectional area with the Toronto clinical scoring system (TCSS) score were analyzed in patients of DPN group.Results:At admission, the cross-sectional areas of the bilateral common peroneal nerves of patients in DPN group were significantly larger than those of patients in non-DPN group and volunteers in healthy control group ( P<0.05); there was no statistically significant difference in the cross-sectional area of the bilateral tibial nerves between volunteers in healthy control group and two groups of patients ( P>0.05). At admission, the stiffness of the bilateral tibial nerves and common peroneal nerves of patients in both non-DPN group and DPN group was significantly greater than that of volunteers in healthy control group ( P<0.05); the stiffness of the left tibial nerve and the bilateral common peroneal nerves of patients was significantly greater in DPN group than in non-DPN group ( P<0.05). The results of multivariable ordinal logistic regression analysis showed that common peroneal nerve stiffness, tibial nerve stiffness, and common peroneal nerve cross-sectional area were all independent risk factors for the development of DPN among the participants in the three groups (with ORs of 0.91, 0.93, and 0.75, respectively, 95% CIs of 0.89 to 0.95, 0.89 to 0.97, and 0.58 to 0.96, respectively, P<0.05). In the two groups of patients, common peroneal nerve stiffness yielded the largest area under the curve for diagnosing DPN, which was 0.85 (with a 95% CI of 0.74 to 0.92). The optimal cutoff value was 75.29 kPa, with a sensitivity of 76.32% and a specificity of 90.00% at the optimal cutoff value. In DPN group, common peroneal nerve stiffness and common peroneal nerve cross-sectional area of patients were significantly positively correlated with the TCSS score (with r s values of 0.83 and 0.89, respectively, P<0.05). Conclusions:SWE demonstrates excellent performance in assessing peripheral nerve stiffness in patients with type 2 diabetes mellitus. In particular, common peroneal nerve stiffness measured by SWE has high diagnostic value for patients complicated with DPN and is correlated with clinical severity. It may serve as an auxiliary imaging marker for the early screening and severity assessment of DPN.
Objective:To explore the causal relationships between human inflammatory proteins and hypertrophic scars (HS) and keloids.Methods:This study was conducted based on bidirectional two-sample Mendelian randomization (MR) analysis. Data of human inflammatory proteins, HS, and keloids were acquired from genome-wide association study database. The inverse variance weighted (IVW) method was adopted to evaluate the causal relationships between 91 kinds of human inflammatory proteins and HS and keloids, i.e., a forward MR analysis. For the above associations, Cochran's Q test was used to assess heterogeneity, MR-Egger regression and MR-PRESSO outlier tests were performed to evaluate horizontal pleiotropy, and the leave-one-out method was applied to analyze the robustness of the results. The IVW method was also used to evaluate whether there was a reverse causal relationship between HS, keloids and inflammatory proteins screened out by aforementioned forward MR analysis.Results:CD6, leukemia inhibitory factor (LIF), tumor necrosis factor ligand superfamily member 12 (TNFSF12), programmed death-ligand 1 (PD-L1), interleukin-17C (IL-17C), LIF receptor (LIFR), osteoprotegerin (OPG), and fibroblast growth factor 23 (FGF23) had significant causal relationships with HS (with ORs of 1.365, 0.506, 1.567, 1.683, 0.621, 1.375, 0.623, and 0.553, respectively, 95% CIs of 1.100-1.693, 0.289-0.887, 1.081-2.273, 1.090-2.599, 0.408-0.947, 1.025-1.845, 0.402-0.966, and 0.315-0.971, respectively, P<0.05). Among them, CD6, TNFSF12, PD-L1, and LIFR were risk factors for HS, while LIF, IL-17C, OPG, and FGF23 were protective factors for HS. CD5, IL-10 receptor subunit alpha (IL-10RA), IL-5, LIF, and OPG had significant causal relationships with keloids (with ORs of 0.744, 1.303, 0.686, 0.603, and 0.715, respectively, 95% CIs of 0.573-0.965, 1.024-1.660, 0.472-0.996, 0.431-0.842, and 0.553-0.924, respectively, P<0.05). Among them, IL-10RA was a risk factor for keloids, whereas CD5, IL-5, LIF, and OPG were protective factors for keloids. No significant heterogeneity or horizontal pleiotropy was observed in the above associations ( P>0.05), and the robustness of the results was not driven by any single nucleotide polymorphism. Significant reverse causal relationships existed between HS and TNFSF12 and LIFR of the 8 inflammatory proteins which had significant causal relationships with HS screened out by aforementioned forward MR analysis (with ORs of 0.972 and 0.968, respectively, 95% CIs of 0.949-0.997 and 0.942-0.994, respectively, P<0.05). No reverse causal relationship was found between keloids and the 5 inflammatory proteins which had significant causal relationships with keloids screened out by aforementioned forward MR analysis ( P>0.05). Conclusions:CD6, TNFSF12, PD-L1, and LIFR may increase the risk of HS, while LIF, IL-17C, OPG, and FGF23 may decrease the risk of HS. IL-10RA may increase the risk of keloids, while CD5, IL-5, LIF, and OPG may decrease the risk of keloids.
Diabetic wounds are a severe complication of diabetes, which can lead to amputation or even mortality in severe cases. While normal wound healing consists of four phases: hemostasis, inflammation, proliferation, and remodeling, diabetic wounds tend to become chronic and refractory primarily due to a prolonged inflammatory phase. In diabetic wounds, insufficient synthesis and release of endogenous calcitonin gene-related peptide (CGRP) is a critical upstream mechanism underlying the disrupted neuro-immune communication, the persistent inflammation, and the arrested wound healing process. In contrast to pure skin defect wounds, where CGRP is rapidly upregulated after injury, CGRP remains persistently low in diabetic wound tissue, consequently failing to drive macrophage polarization towards the M2 phenotype or promote vascular maturation and collagen fiber deposition in the later phase of inflammation. In the early inflammatory phase, CGRP exerts pro-inflammatory effects by enhancing angiogenesis and modulating macrophage polarization. In the late inflammatory phase, CGRP upregulates thrombospondin-1, promotes neutrophil apoptosis and phagocytic clearance, thereby inhibiting excessive inflammatory response and shifting the wound microenvironment from a pro-inflammatory state to a pro-reparative state. Restoring CGRP signaling reconstructs the neuroimmunomodulation axis and improves wound repair while relieving diabetic neuropathic pain. Engineered CGRP combined with intelligent delivery systems offers promising prospects for diabetic wound therapy. However, large-scale clinical trials are still required to validate its clinical efficacy and safety. This paper systematically analyzes the mechanisms and application strategies of CGRP in facilitating diabetic wound repair, which can provide a theoretical basis and innovative strategies for clinical management.
Diabetic foot ulcers (DFUs) fall into a vicious cycle of difficulty healing due to hyperglycemia-induced persistent inflammation, accumulation of reactive oxygen species (ROS), tissue hypoxia, and susceptibility to infection. This paper reviews the pathological microenvironmental characteristics of DFUs, the design strategies of smart materials, and their integration with artificial intelligence (AI). Given the complex pathological microenvironment of DFUs, traditional dressings that provide simple coverage are no longer adequate, whereas responsive smart materials that are capable of dynamically sensing and actively modulating the wound microenvironment have demonstrated great potential. Furthermore, the paper highlights four key design strategies for responsive smart materials: using glucose-responsive smart materials to improve local hyperglycemia at the wound site; using ROS-scavenging smart materials to eliminate ROS and restore redox homeostasis; applying oxygen-generating materials to relieve hypoxia and to promote angiogenesis; and utilizing smart antibacterial materials to combat microbial biofilms and achieve potent bactericidal effects. Currently, the development trend of smart materials has shifted from single functionality towards integrated multifunctional synergistic systems. The paper further discusses the potential of integrating AI into material design, preparation optimization, and wound monitoring and treatment decision-making. Although most smart materials are still at the experimental stage and face challenges related to cost and manufacturing processes, next-generation smart materials are expected to achieve dynamic monitoring and autonomous treatment through interdisciplinary innovation, thereby fundamentally improving DFU healing rates and reducing the risk of amputation in patients.
The 21st Chinese Conference on Burns and Wound Repair was successfully held in the historic city of Xi'an from May 28th to 30th, 2026, bringing together over 800 participants from across the country for this academic event. The conference featured one main venue and six parallel thematic sub-forums and invited over 300 renowned experts and scholars from China and abroad to engage in in-depth academic exchanges and intellectual dialogues over three days around key topics such as severe burn care, acute and chronic wound management, scar prevention and treatment, rehabilitation and nursing, and youth innovation. The conference showcased the latest breakthroughs and cutting-edge achievements in burn medicine and wound repair fields in China, enhanced the capabilities and standards in critical injury management, complex wound repair, and comprehensive scar prevention and treatment. The conference thereby effectively promoted the high-quality development of burn care and wound repair in China.
Objective:To investigate the clinical efficacy of pedicled double-perforator flap of the inferior epigastric artery in reconstructing the soft tissue defects following resection of cutaneous malignant tumors adjacent to major vessels and/or nerves in the groin or thigh.Methods:This study was a retrospective case series study. From June 2016 to June 2023, 12 patients (8 males and 4 females, aged 58 to 76 years) with cutaneous malignant tumors in the groin or thigh who met the inclusion criteria were admitted to the Department of Burn Plastic Surgery and Wound Healing of the 988 th Hospital of the Joint Logistics Support Force of PLA. In all patients, the depth of tumor invasion extended close to the major vessels and/or nerves. Radical extended resection of the tumors was performed, resulting in postoperative soft tissue defects ranging from 16 cm×13 cm to 37 cm×17 cm in size. A pedicled double-perforator flap of the inferior epigastric artery based on the paraumbilical and thoracic paraumbilical perforators was designed and harvested, with flap dimensions ranging from 15 cm×14 cm to 38 cm×18 cm. The flaps were transferred to the recipient site wound through a subcutaneous tunnel and sutured in place. Primary closure of the donor site wound was achieved in 8 patients; in the remaining 4 patients, the donor site wound was first approximated with sutures to reduce its size, then covered with negative-pressure sealing drainage dressing, with secondary closure performed at a later stage. Postoperative observations included flap blood supply, flap survival, occurrence of vascular crisis, and wound healing of donor and recipient sites. Operative duration and length of hospital stay of patients were recorded. During follow-up after surgery, tumor recurrence, flap contour, and donor site scar were observed, and whether abdominal wall function was affected by the scar was assessed. Results:All 12 patients achieved good flap blood supply and uneventful survival, with no vascular crisis. Wounds in both donor and recipient sites healed successfully. Operative duration of patients ranged from 2.0 to 3.0 hours, and length of hospital stay ranged from 15 to 24 days, with a mean of 18.6 days. During a follow-up period of 1 to 6 years after surgery, no local tumor recurrence was observed. Some flaps appeared slightly bulky, but their elasticity and texture showed no significant differences compared with the surrounding tissue. The donor site only exhibited a linear scar, with no significant impact on abdominal wall function.Conclusions:For soft tissue defects following resection of cutaneous malignant tumors adjacent to major vessels and/or nerves in the groin or thigh, the pedicled double-perforator flap of the inferior epigastric artery is a viable reconstructive option. This flap provides a large surface area for effective reconstruction while minimizing the impact on aesthetics and function of the donor site.
