The treatment of chronic wounds in the Aged is often difficult. Masquelet technique is used for the treatment of infected large segmental bone defects as it provides an adequate blood supply for bone and soft tissue reconstruction. In this study, a two-stage wound management strategy was used, consisting of covering the initial wound with bone cement and skin grafting under induced membranes. From September 2020 to September 2022, 20 Aged patients with chronic refractory wounds of the lower extremities with exposed bone or tendons were recruited in the Department of Wound Repair Surgery of the Second Affiliated Hospital of Wenzhou Medical University. Each patient was reconstructed according to a two-stage process. In the first stage, while treating the patient's underlying disease, several debridements were first performed on the wound; subsequently, the Masquelet technique was applied to seal the wound with antibiotic bone cement. Four to 6 weeks later, the second stage was initiated-after confirming the sufficient formation of wound induced membranes, the bone cement was removed, and free skin grafts were finally used to cover the chronic refractory wounds on the extremities. The area of the defects ranged from 4.5 × 3.0 cm to 15.0 × 6.0 cm, and all soft tissue defects were associated with tendon or bone exposure. After the surgery, patients attended regular outpatient visits and were followed up by telephone and video to observe the healing of the wounds and whether there were any complications in the donor site. The Lower Extremity Function Scale (LEFS) score was used to evaluate the functional recovery of the lower extremities. We found that all implants survived without necrosis or infection. All 20 cases were followed up regularly after surgery for 3 to 12 months, with a mean of 7.6 months. In the first stage, Induced Membranes induction was performed 1-4 times, with an average of (1.3 ± 0.7) times, and in the second stage, free skin grafting was performed on the induction membrane, and all 20 cases of skin grafting survived without necrosis or infection; the appearance and texture of the skin in the grafted area were satisfactory, and the postoperative LEFS score was (69.83 ± 10.82). Finally, our strategy for the management of chronic refractory wounds in the Aged can achieve satisfactory clinical results, reduce surgical risk, be simple and reliable, and be an effective addition to the repair modality.

BACKGROUND:Fracture-related infection (FRI) of the calcaneus with associated soft tissue defects after open reduction and internal fixation (ORIF) presents significant therapeutic challenges. This study evaluates the efficacy of two filling techniques-bone cement with local flap transfer (BC+LFT) and free myocutaneous flap (FMF)-in managing these complex cases, with consideration of the FRI classification system. METHODS:A retrospective analysis on patients treated between June 2017 and June 2024 was done. Based on post-debridement defect size, patients were allocated to BC + LFT (defects ≤3 cm) or FMF (defects >3 cm). All cases were classified according to the FRI criteria. Surgical management included radical debridement, dead space obliteration, and soft tissue reconstruction. Outcomes were assessed via AOFAS hindfoot scores, VAS pain scores, complication rates, and radiographic evaluation. RESULTS:A total of 43 patients were included (25 BC+LFT, 18 FMF). The FMF group had longer operative times and greater blood loss (p < 0.05), but no significant differences were observed in debridement frequency, hospitalization, or complication rates. Both groups showed significant improvement in functional and pain scores at final follow-up. Fracture union was achieved in all cases without recurrence of infection. CONCLUSION:Both BC + LFT and FMF are effective for managing calcaneal FRI with soft tissue defects. The choice of technique should be individualized based on defect size and patient factors, with FRI classification providing valuable guidance for clinical decision-making.

Sensation is essential for finger pulp functionality. Our objective was to compare the sensory outcomes of forearm vs. medial foot arterialized venous flap reconstruction of finger pulp defects. We conducted a study involving 26 arterialized venous flap reconstruction in 25 patients for finger pulp damage. The patients were categorized into two groups based on the donor site: the forearm group (n = 14) and the medial foot group (n = 12). All flaps in both the forearm and medial foot groups survived without complications. Patients in the medial foot group experienced significantly improved sensory recovery compared to those in the forearm group. The majority of cases in the forearm group exhibited venous congestion and bullae formation within 5–10 days postoperatively. Conversely, in the medial foot group, all cases were free from venous congestion or bullae formation. Our findings indicate that arterialized venous flaps from the medial foot for finger pulp defect reconstruction yield superior sensory recovery outcomes compared to those from the forearm. Non-sensate arterialized venous flaps from the medial foot can provide satisfactory sensation for finger pulp coverage. Level III. Clinical trial number: not applicable.

BACKGROUND:Gustilo type III open fractures of the upper extremity present severe soft‑tissue and bony injuries. Free flap reconstruction is standard, but the optimal timing remains debated. This study aimed to assess the association between timing of coverage and postoperative infection rates. METHODS:In this observational cohort study, 85 patients with upper limb Gustilo III fractures (2018-2024) were allocated to three groups based on clinical decision: emergency (same anesthetic, n = 25), sub‑emergency (within 72 h, n = 26), or delayed (>72 h, n = 34). Demographics, perioperative data, and complications were analyzed. Multivariable logistic regression was performed but limited by low event numbers. RESULTS:Baseline characteristics were comparable except for higher Injury Severity Score (ISS) in the delayed group (p = 0.001). Infection rates were 4.0% (1/25) in emergency, 3.8% (1/26) in sub‑emergency, and 29.4% (10/34) in delayed group (p = 0.001). Osteomyelitis, flap necrosis, and bone defects occurred almost exclusively in the delayed group. Multivariable analysis (13 total infections) did not identify timing as an independent predictor (p = 0.831); higher ISS, longer operative time, and extended hospital stay showed trends but were not statistically significant. Functional recovery (QuickDASH, SF‑12 PCS) was superior in both early groups. Patient satisfaction was highest in the sub‑emergency group. CONCLUSIONS:In this observational study, free flap coverage beyond 72 h was associated with higher unadjusted infection rates; however, this finding cannot be interpreted causally due to severe confounding-by-indication, as the delayed cohort sustained significantly higher baseline trauma severity (ISS). Emergency and sub-emergency (<72 h) coverage demonstrated comparable favorable outcomes, suggesting that the sub-emergency window represents a safe, logistically advantageous alternative LEVEL OF EVIDENCE: III; Therapeutic.

PURPOSE:The pure skin perforator (PSP) flap technique offers a reliable solution for aesthetic limb reconstruction by reducing flap thickness to approximately 2 mm while preserving blood supply. The subdermal approach simplifies flap harvesting, reducing surgical time and donor site morbidity. This study aimed to evaluate the clinical outcomes and feasibility of using the subdermal approach for harvesting superficial circumflex iliac artery (SCIA)-based PSP flaps in reconstructing hand and wrist defects. METHODS:This retrospective study included 11 patients with hand or wrist skin defects, who underwent SCIA-PSP flap reconstruction using the subdermal approach between March 2022 and February 2024. Flap design and harvesting were guided by preoperative high-frequency ultrasonography, with dissection at the subdermal plane using a surgical microscope. Postoperative care included monitoring flap viability and assessing aesthetic outcomes at 6 months using a five-point Likert scale. RESULTS:A total of 13 flaps were harvested, with two flaps harvested in cases 5 and 6, respectively. The flap sizes ranged from 11 to 98 cm2 (mean: 47.5 cm2). Harvest times ranged from 37 to 140 minutes (mean: 70.1 minutes). Twelve flaps were successfully transferred, with one experiencing partial necrosis. Aesthetic outcomes at 6 months showed favorable results, with mean scores of 4.5 for overall aesthetic outcome and 4.7 for contour and texture match. CONCLUSIONS:The subdermal approach for harvesting SCIA-PSP flaps is a feasible and effective technique for hand and wrist reconstruction, yielding excellent aesthetic results. Further research is needed to confirm its broader clinical applications. TYPE OF STUDY/LEVEL OF EVIDENCE:Therapeutic IV.

Diabetic wounds are hard to heal due to ferroptosis, a specific type of cell death triggered by high blood sugar in human umbilical vein endothelial cells (HUVECs) in the lining of blood vessels. Ferroptosis occurs as a result of excessive iron accumulation and lipid peroxidation. The resulting impairment in endothelial function and tissue scaffolding creates a persistent barrier against effective wound healing. Our study found that artemisitene (ATT), a bioactive compound derived from the herb Artemisia annua, speeded up diabetic wound healing by blocking ferroptosis through the Nrf2 (NFE2 like bZIP transcription factor 2, also known as NRF2: Nuclear factor erythroid 2-related factor 2)/GPX4 (Glutathione peroxidase 4) pathway. In studies with HG (high glucose)-damaged HUVECs, treatment with ATT (20 μM) effectively counteracted harmful iron buildup and lipid peroxidation, while also restoring mitochondrial health and reducing the levels of damaging reactive oxygen species (ROS). Computational modeling confirmed that ATT binds tightly to both Nrf2 and GPX4 molecules. Notably, when Nrf2 was blocked, ATT completely lost its protective effect, indicating that Nrf2 is essential for its action. In diabetic rats, applying ATT directly to wounds (20 mg/kg/day) significantly accelerated the rate of wound closure. This treatment worked by triggering two key regenerative processes: stronger new blood vessel growth and better-organized collagen structure. In practical terms, ATT prevents diabetic wound complications through three connected mechanisms: it uses GPX4 to counteract lipid peroxides, leverages Nrf2 to restore healthy antioxidant balance, and regenerates endothelial cells to drive new blood vessel formation. As the first drug of its kind to target ferroptosis this way, ATT offers a promising multitarget approach for diabetic wounds, tackling the combined problems of oxidative damage, mitochondrial failure, and poor tissue regeneration.

BackgroundThe mechanism of Nicotinamide Adenine Dinucleotide (NAD+) metabolism-related genes (NMRGs) in diabetic peripheral neuropathy (DPN) is unclear. This study aimed to find new NMRGs biomarkers in DPN.MethodsDPN related datasets GSE95849 and GSE185011 were acquired from the Gene Expression Omnibus (GEO) database. 51 NMRGs were collected from a previous article. To explore NMRGs expression in DPN and control samples, differential expression analysis was completed in GSE95849 to obtain differentially expressed genes (DEGs), and the intersection of DEGs and NMRGs was regarded as DE-NMRGs. Next, a protein-protein interaction (PPI) network based on DE-NMRGs was constructed and biomarkers were screened by eight algorithms. Additionally, Gene Set Enrichment Analysis (GSEA) enrichment analysis was completed, biomarker-based column line graphs were constructed, lncRNA-miRNA-mRNA and competing endogenouse (ce) RNA networks were constructed, and drug prediction was completed. Finally, biomarkers expression validation was completed in GSE95849 and GSE185011.Results5217 DEGs were obtained from GSE95849 and 21 overlapping genes of DEGs and NMRGs were DE-NMRGs. Functional enrichment analysis revealed that DE-NMRGs were associated with glycosyl compound metabolic process. The PPI network contained 93 protein-interaction pairs and 21 nodes, with strong interactions between NMNAT1 and NAMPT, NADK and NMNAT3, ENPP3 and NUDT12 as biomarkers based on 8 algorithms. Expression validation suggested that ENPP3 and NUDT12 were upregulated in DPN samples (P < 0.05). Moreover, an alignment diagram with good diagnostic efficacy based on ENPP3 and NUDT12 were identified was constructed. GSEA suggested that ENPP3 was enriched in Toll like receptor (TLR) pathway, NUDT12 was enriched in maturity onset diabetes of the young and insulin pathway. Furthermore, 18 potential miRNAs and 36 Transcription factors (TFs) were predicted and the miRNA-mRNA-TF networks were constructed, suggesting that ENPP3 might regulate hsa-miR-34a-5p by affecting MYNN. The ceRNA network suggested that XLOC_013024 might regulate hsa-let-7b-5p by affecting NUDT12. 15 drugs were predicted, with 8 drugs affecting NUDT12 such as resveratrol, and 13 drugs affecting ENPP3 such as troglitazone.ConclusionENPP3 and NUDT12 might play key roles in DPN, which provides reference for further research on DPN.

Purpose: To describe and evaluate the anatomical skin shape of the first web space in cadavers and to guide flap design for this area. Methods: Twelve cadavers (24 hands on both sides) were selected. Marker points were chosen based on the characteristics of the first web for morphological measurement and observation. The morphological characteristics of the first web under the radial or palmar abduction position of the thumb were measured and compared. The best morphologic features and parameters of the first web repairing flap were obtained. Results: When the thumb was in the palmar abduction position, the maximum distance a(p) was 6.78 +/- 0.72 cm and the skin area s(p) was 20.09 +/- 2.63 cm(2), both of which were significantly greater than the distance a(r) of 5.86 +/- 0.74 cm and the skin area s(r) of 17.39 +/- 2.15 cm(2) when the thumb was in the radial abduction position (P < 0.05). There was no significant difference in the length b(r) and b(p) of the long axis of the flap between two different abduction positions (P > 0.05). It is found that the shape of the first web area was not a symmetrical spindle but an irregular quadrilateral inclined to the index finger side. Conclusion: The flap design and measurement for the first web space covering should take the maximum palmar abduction position of the thumb as a reference. The asymmetric quadrilateral flap design is more in line with the anatomical and morphological characteristics of the region. (c) 2024 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

Purpose The reconstruction of medium-sized soft tissue defects of the fingertip remains a challenge for hand surgeons. The aim of this study was to compare the outcomes of modified triangular neurovascular unilateral advancement flap and digital artery dorsal perforator flap in the treatment of this injury. Methods From May 2018 to May 2022, 70 patients with medium-sized volar soft tissue defects were enrolled. The patients were divided into two groups based on the flap type: modified triangular neurovascular unilateral advancement flap (Group A) and digital artery dorsal perforator flap (Group B). The debridement times, defect size, operation time, and flap survival rate were recorded. At follow-up, hand function, aesthetics, and complications were evaluated. Function was evaluated using the TAM score. The aesthetics of the reconstructed and donor sites were assessed using the vancouver scar scale (VSS). The static two-point discrimination of the finger pulp served as a measure of tactile agnosia. Results A total of 10 patients were lost to follow-up for various reasons, resulting in 30 cases remaining in each group. The general information of the two groups showed no significant differences in age, sex, injury side, cause of injury, time from injury to surgery, and operation time ( P > 0.05). Additionally, the debridement times and size of the defect were similar between the groups ( P > 0.05). However, the operation time was significantly shorter in Group A compared to Group B ( P = 0.001). With regard to complications, there was no significant difference between them. At one-month follow-up, TAM scores indicated that Group B performed significantly better than Group A. However, at the final follow-up period, there was no significant difference in TAM scores between the two groups. When considering the VSS, significant differences were observed between the two groups in both the reconstructed site and donor site. Conclusion Both flaps can effectively repair medium-sized fingertip defects. Furthermore, the modified triangular neurovascular unilateral advancement flap offers anatomical reconstruction possibilities, ensuring satisfactory sensation and cosmetic contour.

BACKGROUND:Degloving soft tissue injuries (DSTIs) of the extremities, which are often underestimated in terms of their severity, present significant challenges to reconstructive surgeons. We propose a comprehensive management protocol to standardize the reconstructive approach, aiming for successful treatment of these devastating injuries. METHODS:We retrospectively analyzed data from consecutive patients with extremity DSTIs over a 12-year period. Patients were categorized into three age groups (0-17, 18-65, and >65 years) to highlight the different treatment options based on age. Various surgical techniques were employed depending on the injury pattern. Treatment strategies for each patient were individualized based on age, underlying conditions, and injury type. Wound healing, complications, and functional outcomes were recorded. RESULTS:Of the hospitalized patients, 20 were lost to follow-up, and 105 were included in the analysis. The mean age at the time of injury was 40 ± 44.9 years, with a mean follow-up of 30.1 ± 12.7 months. Furthermore, 19 % of patients were aged 0-17 years, 61 % were aged 18-65 years, and 20 % were aged >65 years. Treatment plans were personalized based on injury characteristics, with numerous patients being treated with a combination of multiple surgical techniques. Older patients had significantly longer wound healing times and delayed return to activities of daily living compared to the other age groups. Overall, patients were generally satisfied with their outcomes. The total complication rate was 46.7 %, with 79.5 % being categorized as major complications. Each complication was addressed with a tailored treatment plan. CONCLUSION:The management of DSTIs should be individualized, taking into account the specific characteristics of each injury. Age and medical fitness play crucial roles in determining both the surgical approach and prognosis. An accurate initial evaluation and thorough debridement are essential for optimal outcomes.

目的:介绍应用彩色多普勒在术前对股前外侧皮瓣穿支血管进行精准定位后，切取不携带主干血管的短蒂单穿支股前外侧皮瓣游离移植修复四肢中小面积皮肤缺损的手术方法和临床效果。方法:自2017年12月至2019年9月，我科对15例四肢中小面积皮肤缺损患者应用短蒂股前外侧单穿支皮瓣游离移植修复，皮瓣供养动脉与受区动脉端侧吻合，皮瓣静脉与受区静脉端端吻合。皮瓣切取面积6 cm×5 cm~11 cm×7 cm，所有皮肤缺损创面均伴有肌腱或骨外露，皮瓣均为单穿支皮瓣，皮瓣的游离时间为30~40 min，平均切取时间为35 min。皮瓣供区一期缝合。结果:术后15例皮瓣全部存活，随访时间3~12个月，平均7.2个月，皮瓣外形满意，供区创面Ⅰ期愈合。结论:利用彩色多普勒在股前外侧的近中段对皮瓣穿支入皮点及穿支血管在皮下和肌肉内的行径进行精确定位，选择合适的穿支作为皮瓣的供养血管，应用"Free-style"理念切取短蒂股前外侧皮瓣，对供区损伤小，切取较传统方式简便，手术时间短，供区能直接缝合，是一种理想的应对血管变异的手术方法。对显微外科技术和彩色多普勒操作技术和要求较高。

Objective:To scientifically measure and morphologically evaluate the anatomical shape of the skin in the first web space based on cadavers, and to guide the design of flap in this area.Methods:Sixteen human cadavers fixed with 10% formaldehyde without injury or deformity on the hand were selected in the Department of Hand Surgery, the Third Hospital of Suqian. According to the characteristics of the first web area, marker points were selected for measurement and morphological observation. Morphological characteristics of the first web with thumb radial abduction(r) or palmar abduction(p) were measured and compared. The t-test was used for statistical analysis. P<0.05 was considered statistically significant. According to the results of measurement, standardised shapes and parameters of the skin were obtained for flap repair of defect of the first web. Results:When the thumb was in palmar abduction, the maximum distance [a(p)] of the first web of female(F) and male(M) was 5.78/8.42 cm(F/M), and the skin [S(p)] was 17.09/23.63 cm 2(F/M), both were significantly greater than the distance [a(r)] at 4.86/6.28 cm and the area of skin area [S(r)] at 14.39/20.15 cm 2 when thumb was in the radial abduction position( P<0.05). There was no significant difference in the length of [b(r)] and [b(p)] alone the long axis of flap between palmar and radial abductions(7.54/9.38 cm and 7.34/9.74 cm, respectively) of the thumb( P>0.05). It was found that the area of first web was not shaped as a symmetrical spindle, but an irregular quadrilateral inclined to the index finger. Conclusion:Design and measurement of a flap for the first web space should take the maximum palmar abduction of a thumb as a reference. The asymmetric quadrilateral flap design is more in line with the anatomical and characteristics in the region.

The purpose of this study was to compare the reconstructive outcomes of soft-tissue defects around foot and ankle with vaccum sealing drainage (VSD) or induction membrane (IM) of cement formation and attempt to provide an optimal strategy for elderly patients. A retrospective review of all continuous patients with foot and ankle reconstruction using different flaps from October of 2016 and October of 2020 was performed. Based on the different way, the patients were divided into two groups: VSD group (n = 26) and IM group (n = 27). Outcomes were assessed according to the size of the defect, frequency of debridement procedures, hospitalization time, duration of healing, the healing rate, major amputation rate, functional outcomes and complications. Immunohistochemistry (IHC) detection of vascular endothelial growth factor (VEGF) was also be completed. We found that there was no difference in demographic characteristics, size of the defect, debridement times and functional outcomes between the two groups (p > 0.05); however, a significant difference in the wound healing time, hospitalization time and complications were noted between them(p < 0.05). The fresh granulation tissue of both groups showed abundant positive expression of VEGF. Thus, the VSD and IM are both available for foot and ankle reconstruction in elderly patients. However, the IM group offers short hospitalization time, duration of healing and lower frequency of postoperative complications. Thus, we advocate the IM for reconstruction of defects of the foot and ankle region in the elderly patients.

目的:探讨游离皮瓣亚急诊修复老年（>65岁）患者小腿Gustilo Ⅲ型骨折创面的围手术期护理。方法:2019年12月-2021年10月，温州医科大学附属第二医院骨科对20例游离皮瓣（背阔肌皮瓣、股前外侧肌皮瓣、腹股沟皮瓣）亚急诊移植治疗小腿Gustilo Ⅲ型骨折创面的围手术期护理进行总结。规范临床护理重点，完善术前检查，对基础疾病及时进行干预性治疗，术前沟通和心理疏导、评估供（受）区血管和皮肤条件；术后注重患者全身情况的监护，皮瓣血液循环状态的观察，局部按摩，抗凝、改善微循环治疗阻断血液循环障碍进展，皮瓣下积极引流预防感染，预防深静脉血栓和压疮形成，并注意供区伤口护理。术后20例患者均采用回院门诊定期随访。结果:2例出现术后皮瓣静脉回流障碍，其中1例经抗凝、补液、局部按摩后静脉回流障碍解除，另外1例经手术血管探查后静脉回流障碍解除，2例皮瓣完全成活。1例出现术后低血容量不足，皮瓣区域性动脉血供不足，经过扩容输血后，皮瓣最终完全成活。本组20例皮瓣均完全成活，皮瓣供区伤口完全愈合。患肢未出现皮瓣感染及骨感染等并发症。结论:游离皮瓣移植是治疗老年患者小腿Gustilo Ⅲ型骨折创面的可靠治疗方式，全面、正确、有效的围手术期护理是手术成功的关键，能有效缩短治疗周期，减少术后骨感染的发生。

Background: Deep venous thrombosis (DVT) is a common perioperative complication of femoral intertrochanteric fracture and can cause pulmonary embolism (PE). Therefore, early prevention, diagnosis and treatment are of great significance. This study aimed to identify the risk factors of DVT in elderly femoral intertrochanteric fracture patients and establish a nomogram model.Methods: From August 2014 to June 2021, a total of 1652 femoral intertrochanteric fracture patients over the age of 65 were enrolled in our study. We distinguished independent risk factors by univariate and multivariate Cox analyses. A nomogram model was then built, and the discriminative and calibration of the model was evaluated through receiver operating characteristics (ROC) and calibration plots.Findings: A total of 378 patients developed DVT (292 in the training group, 86 in the validation group) while the remaining patients did not. According to the univariate and multivariate Cox analyses results, age (OR = 1.07, 95%CI: 1.04 – 1.10), fibrinogen (OR = 2.09, 95%CI: 1.68 – 2.60), D-dimer (OR = 1.33, 95%CI: 1.27 – 1.40), time from injury to admission (OR = 1.78, 95%CI: 1.55 – 2.05), functional status (OR = 4.21, 95%CI: 2.86 – 6.20), and diabetes (OR = 1.65, 95%CI: 1.10 – 2.48) were identified as independent risk factors of DVT. The ROC values for DVT of the training and validation group were 0.862 and 0.912, and the P-value of the Hosmer-Lemeshow calibration test was 0.767.Interpretation: This nomogram model can be used to predict the probability of preoperative DVT in elderly patients with femoral intertrochanteric fracture and guide physician in perioperative thrombosis management.Funding Information: This research was supported by Wenzhou Basic Scientific Research project funding (No. Y2020403).Declaration of Interests: None of the author shave conflicts of interest to disclose. None of the authors have financial relationships relevant to this article to disclose.Ethics Approval Statement: This study followed the guidelines of the “Declaration of Helsinki” and was approved by the ethics committee of our hospital (The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China, NO. L-2020-22). All data is analyzed anonymously, and personal identifiers are completely deleted.

Objective Composite tissue loss involving the distal finger pulp and the nail is a common but challenging finger injury to restore. This study introduces a reconstruction procedure for a distal finger pulp and nail defect using a partial toenail flap transfer. Methods Twenty digits, including 16 thumbs, two index fingers, and two middle fingers, with composite soft tissue defects were treated with a partial toenail flap transfer from October 2015 to January 2020. Shortening revision of the great toe phalanx, a V‐Y advancement flap of the toe pulp, and a local pedicle flap from a second toe transfer were used to cover the donor sites, and no skin grafts were required. Functionality was evaluated using the validated Spanish version of the Quick‐DASH scale. The aesthetics of both the reconstructed and donor sites were evaluated using the Vancouver Scar Scale (VSS). The static two‐point discrimination (2‐PD) of the finger pulp was used as a measure of tactile agnosia. Results All donor site wounds healed well. The average follow‐up time was 23.6 months (6–39 months). The mean Quick‐DASH functional score was 7.1. The VSS scores were 4.02 ± 0.29 and 4.00 ± 0.38 for the reconstructed and donor sites, respectively. The static 2‐PD of finger pulp was 4.5 ± 0.76 mm. The patients were satisfied with finger motion, sensory function, and aesthetic contour. Conclusions Partial toenail flap transfer is the recommended treatment to regain motion, sensation, function, and a satisfactory aesthetic appearance when considering repairing a composite soft tissue distal finger defect with accompanying loss of the perionychium, particularly in the thumb, index finger, or middle finger.

Background: Random-pattern skin flaps are often utilized to cover numerous skin defects that can occur for a variety of causes, although tissue ischemia is the most prevalent consequence that leads to surgery failure. Protein Kinase D1 (PKD1), a calcium/calmodulin-dependent serine/threonine kinase, has been linked to angiogenesis and has been shown to protect against ischemic cardiovascular disease in several studies. However, no relevant studies on skin flaps have been recorded. Methods: Sixty male Sprague-Dawley rats were randomly separated into control, PKD1, and CID755673 group. We observed postoperative survival, laser Doppler and lead oxide/gelatin angiography were used to assess blood flow, HE (hematoxylin and eosin) staining was used to observe neovascularization, and determined the level of related protein expression through Immunoblotting and immunohistochemistry. Results: The PKD1 group has the largest survival area and the most abundant blood supply. The level of angiogenesis and oxidative stress is the highest, and the level of apoptosis is the lowest. The CID755673 group is the opposite. Conclusion: The findings show that PKD1 increases the flap’s survival rate and is linked to increased angiogenesis, reduced oxidative stress, and apoptosis inhibition.

A diabetic wound is a refractory disease that afflicts patients globally. MicroRNA-146a-5p (miR-146a-5p) is reported to represent a potential therapeutic target for diabetic wounds. However, microRNA easily degrades in the wound microenvironment. This study extracted bone marrow mesenchymal stem cell (BMSC)-derived exosomes (EXO). Electroporation technology was used to load miR-146a-5p into EXO (labeled as EXO-miR-146a). The endothelial cells (human umbilical vein endothelial cells [HUVECs]) and macrophages were cocultured in transwell chambers in the presence of high glucose. Cell proliferation, migration, and angiogenesis were measured with cell counting kit 8, scratch, and tube forming assays, respectively. Flow cytometry was introduced to validate the biomarker of macrophages and BMSCs. The expression level of macrophage polarization-related proteins and tumor necrosis factor receptor-associated factor 6 (TRAF6) was assessed with western blotting analysis. The full-thickness skin wound model was developed to verify the in vitro results. EXO-miR-146a promoted the proliferation, migration, and angiogenesis of HUVECs in the hyperglycemic state by suppressing the TRAF6 expression in vitro. Additionally, EXO-miR-146a treatment facilitated M2 but inhibited M1 macrophage polarization. Furthermore, EXO-miR-146a enhances reepithelialization, angiogenesis, and M2 macrophage polarization, thereby accelerating diabetic wound healing in vivo. The EXO-miR-146a facilitated M2 macrophage polarization, proliferation, migration, and angiogenesis of HUVECs through TRAF6, thereby ameliorating intractable diabetic wound healing. These results established the basis for using EXO to deliver drugs and revealed mediators for diabetic wound treatment.

Objective:To introduce a surgical method and clinical effect of using Masquelet technique combined with skin graft to cover chronic refractory wounds in elderly patients.Methods:From September 2020 to September 2022, 20 elderly patients with wounds of bone or tendon exposure in lower limbs were treated in the Department of Wound Repair, the Second Affiliated Hospital of Wenzhou Medical University. Due to the age and poor general condition of the patients, flap transfer for wound coverage were not allowed. Masquelet technique was therefore applied in the treatment of chronic wounds of such patients. Sizes of wounds were found at 4.5 cm×3.0 cm to 15.0 cm×6.0 cm and all accompanied with tendon and bone exposure, after thorough debridement. Wounds were then sealed with antibiotic bone cement several times. After having induced formation of membrane in wounds, free mesh skin graft was used to cover the refractory wounds. The patients were entered in follow up regularly after surgery at outpatient service, and telephone or video reviews. The wound healing of patients and whether there were related complications in the skin donor area were observed. The number of operation times in the first stage was 1-4 with an average of 1.3 times ± 0.7 times. Lower Extremity Function Scale (LEFS) was used to evaluate the recovery of lower limb function.Results:All 20 wounds healed well. The follow-up time was 3-12 months, with an average of 7.6 months. The appearance and texture of the skin in the wounds area were satisfactory. The mean LEFS was 69.83 point ± 10.82 point.Conclusion:Using Masquelet technique combined with free skin grafting to treat refractory wounds in the elderly patients can achieve satisfactory clinical outcomes. It is a simple and reliable supplement to the wound repair, and can reduce the surgical risk.

Objective The fixation of the coronoid fractures in terrible triad injuries is quite challenging. In this study, we introduce a minimally invasive technique using a syringe as a guide for insertion of the cannulated screw in an anterior to posterior fashion to fix the coronoid fracture in patients with terrible triad injuries. Methods In this retrospective study, clinical data of patients suffering from terrible triad injuries between 2012 and 2019 were analyzed. Fifteen patients with an average age of 38.2 years old (21–56 years) were enrolled in this study, of which 12 were males and three were females. The Regan–Morrey type II and type III coronoid fractures in these patients were treated with cannulated screws, inserted anteriorly using a 1 mL syringe as a guide. Outcome measures included pain, range of motion, stability and daily function using Mayo Elbow Performance scores (MEPs). The anteroposterior and lateral radiographs were used for evaluating a healing fracture. Results After a mean follow up of 44.2 months (range 13–80), the mean elbow flexion was 128.2°, extension was 12.3°, forearm pronation was 74.6° and supination was 73.6°. A concentric reduction was maintained without severe pain, stiffness, and radiographic evidence of instability in all patients during the follow‐up period. The mean MEPs was 89.7 points. Conclusion The anteroposterior cannulated screw fixation via simple syringe guide is a minimally invasive and safe option for surgical treatment of coronoid fractures in terrible triad injuries.