Perforator flap transplantation is a common procedure for repairing large-area soft tissue defects. However, flap necrosis due to vascular crisis remains a major cause of surgical failure. Early detection of blood perfusion disorders is crucial for improving the success rate of flap transplantation. Current monitoring techniques include invasive methods, which carry risks and complexities, as well as non-invasive methods that require expensive equipment and expert evaluation. Bedside observation remains the primary clinical monitoring approach but is subjective and time-consuming. This study proposes an novel flap blood perfusion monitoring scheme based on remote photoplethysmography (rPPG) signals, which allows real-time evaluation of flap perfusion in a non-contact manner to improve monitoring efficiency and accuracy. The method integrates computer vision and signal processing technologies, enabling rapid and accurate assessment of flap blood flow status without additional invasive procedures. Our research aims to provide a more non-invasive and easy-to-use monitoring approach for flap transplantation, thereby enhancing clinical outcomes and increasing transplant success rates.

Our institution has conducted an annual perforator flap-based microsurgical training course for clinicians from different institutions. This study aims to characterize the post-training practice patterns and outcomes of the course. From 2016 to 2022, a two-week course was conducted annually, including three modules: theoretical lectures, cadaver-based surgical simulation, and live surgical demonstrations. A cross-sectional study was carried out among course participants in November 2024. Participant demographics, training backgrounds, course evaluations, and their clinical practice over the two years following the training were collected and analysed. A total of 279 two-year follow-up questionnaires were distributed, with a 74.6

BACKGROUND:Multiple finger skin defects with exposed bone or tendon are challenging to reconstruct while preserving finger independence. Traditional approaches require multiple operations, secondary finger separation, or multiple vascular anastomoses. We systematically evaluated the use of free poly-foliate perforator flaps for one-stage reconstruction of multiple finger defects and report the largest focused case series to date. METHODS:Thirty-nine patients (27 men, 12 women; mean age 36.6 years) with multiple finger skin defects underwent reconstruction using free poly-foliate perforator flaps from five donor sites: posterior interosseous artery (n=17), radial collateral artery (n=8), dorsalis pedis artery (DPA, n=6), anterolateral thigh (n=1), circumflex scapular artery (n=3), and combined flaps (n=4). Flaps were designed with 2-4 foliates based on preoperative Doppler localization. Only one set of vascular anastomoses was performed per patient. Most donor sites were closed primarily except for DPA flaps, which required skin grafting; all donor sites healed without functional impairment. RESULTS:Overall, 100 foliates from 46 flaps were transferred. Complete flap survival was achieved in 36 patients; only 3 patients experienced necrosis of a single foliate. Most donor sites closed primarily except for DPA flaps, which required skin grafting. No iatrogenic syndactyly or secondary finger separation was needed. At the final follow-up, excellent-to-good functional outcomes were obtained in 92.3% of the patients. CONCLUSION:Free poly-foliate perforator flaps enable single-stage, independent reconstruction of multiple finger skin defects with high flap survival, low donor-site morbidity, and avoidance of secondary procedures.

The study by Chen et al recently published in World Journal of Methodology provides a significant advancement in the field of diabetic wound healing by demonstrating that low-energy fractional carbon dioxide laser preconditioning (40 mJ/cm², 300 Hz, 5% density) significantly enhances the angiogenic potential of adipose-derived mesenchymal stem cell-derived exosomes. This single-exposure, 10 mm × 10 mm Micro-DeepFX protocol raised the culture temperature to 42.7 °C and increased exosomal sphingosine-1-phosphate (S1P) content by about 1.8-fold (enzyme-linked immunosorbent assay: 2.4 ng/109 vs 1.3 ng/109 particles, P < 0.01). Through carefully controlled photothermal stimulation, the authors enriched exosomal S1P) content, thereby activating the S1PR1/AKT/HIF-1α signalling axis in endothelial cells. This mechanistic cascade resulted in improved proliferation, migration, and tube formation, ultimately accelerating wound closure in diabetic mouse models. The work under discussion highlights a clinically feasible, non-chemical strategy for augmenting exosome bioactivity and offers strong translational potential. However, the heterogeneity of donors, the limited mechanistic depth of exosomal lipid remodelling, and the need for validation in larger and more clinically representative models warrant further investigation.

Diabetic foot ulcer (DFU), a common complication of diabetes, is often associated with non-healing wounds that can eventually lead to infection and amputation. Epitranscriptomic modifications have been shown to have an important impact on metabolic diseases. Recently, a study by Xiao et al published in World Journal of Diabetes focused on the role of the N7-methylguanosine-related decapping scavenger enzyme (DCPS) in DFU. They found that DCPS is linked to keratinocyte dysfunction in DFU and that in DFU tissue and diabetic mouse skin, DCPS is significantly down-regulated. Silencing DCPS induces cell cycle arrest and apoptosis, thereby inhibiting keratinocyte proliferation and migration. These findings suggest that impaired RNA cap turnover and mRNA decay may lead to defective wound healing in diabetes-a mechanism that is different from changes in RNA methylation alone. This study highlights DCPS as a potential biomarker and therapeutic target for treatment of diabetic wounds.

Background Flaps based on the subscapular artery are versatile options in reconstructive surgery. However, after extensive flap harvest, primary donor-site closure may be difficult, and skin grafting may be required. In pediatric patients, skin grafting may be associated with additional donor-site morbidity, scar contracture, contour mismatch, and potential growth-related concerns. Although local pedicled flaps have been used for donor-site closure in regions such as the anterolateral thigh and forearm, their application after subscapular artery system flap harvest remains limited. Methods We report three pediatric patients aged 4–7 years who underwent reconstruction with subscapular artery flaps for complex defects of the foot dorsum, upper arm, and heel. In each case, the subscapular donor-site defect could not be closed primarily. Instead of skin grafting, individualized local pedicled flaps, including triangular perforator-based, transposition, and keystone-like trapezoidal designs, were used to achieve tension-free closure. Flap design was based on donor-site geometry, adjacent tissue laxity, and available perforators. Results All subscapular artery flaps and local pedicled flaps survived completely. Donor-site defects were closed without skin grafting, wound dehiscence, or delayed healing. The donor sites healed with linear scars, and no donor-site complications were recorded during follow-up of 2 months to 3 years. Conclusion In selected pediatric patients, individualized local pedicled flaps may provide a feasible option for closing subscapular donor-site defects when primary closure is not possible. This approach may reduce closure tension and avoid skin grafting, but larger studies with longer follow-up are needed to better define its indications and long-term outcomes.

BACKGROUND:Primary malignant bone tumors, as diseases that mostly occur in adolescence, seriously affect all aspects of the lives of patients and their families. Effective bone tumor nursing is essential to maintain or improve patients' quality of life. Consequently, investigating bone tumor nursing is of utmost importance. This study aimed to provide a comprehensive, up-to-date synthesis of all published bone tumor nursing research articles and predict future areas of research and emerging trends. METHODS:A bibliometric analysis was conducted using the Web of Science Core Collection to identify and analyze nursing research publications on primary malignant bone tumors from January 1, 2004, to September 12, 2025. The analysis and visualization were performed using various scientometric tools. Key characteristics of the publications, including country of origin, institutions, authors, journals, keywords, and references, were thoroughly examined. RESULTS:A total of 686 studies were included in the analysis, with 5376 authors, 70 countries, and 1422 institutions publishing research focused on nurse-related studies in primary malignant bone tumors. The United States and Memorial Sloan Kettering Cancer Center led the lists of publications. The most prolific cited and co-cited authors were Oeffinger, Kevin C, and Bacci, G, respectively. Pediatric Blood & Cancer published the most articles, whereas Journal of Clinical Oncology was the most frequently cited journal. The analysis of keyword co-occurrence and literature co-citation identified several emerging hotspots and trends in the field of primary malignant bone tumor nursing, including prognostic evaluation, clinical intervention, and subtype-targeted nursing care. CONCLUSION:In recent years, the advancement in nurse-related research in primary malignant bone tumors has accelerated rapidly. A comprehensive bibliometric analysis was utilized to verify the prominent areas of investigation and anticipate future research directions, with the aim of providing valuable insights and recommendations for future studies.

The purpose of this study is to reveal the expression profile of microRNA (miRNA) in the plasma exosomes of patients with alcohol-induced osteonecrosis of the femoral head (AIONFH), and to further explore the potential effect of alcohol-stimulated hepatocyte exosomes on vascular endothelial cells (VECs). The total RNA of plasma exosomes of normal people (NC-Exos) and patients with AIONFH (AI-Exos) were extracted, followed by Illumina high-throughput sequencing. GO and KEGG analyses were performed. MiR-155-5p in alcohol-stimulated hepatocyte exosomes (AML-Exos) was detected by RT-PCR. The effects of AI-Exos/AML-Exos on the migration, proliferation, and apoptosis of VECs were detected by wound healing assay, CCK-8 assay, and flow cytometry, respectively. The expression of HIF-1α in VECs, a target gene of miR-155-5p, was detected by Western Blot and qRT-PCR. High-throughput sequencing showed that 82 miRNAs were differentially expressed in AI-Exos. RT-PCR results indicated that miR-155-5p, which targets to regulate HIF-1α as confirm via dual-luciferase assay, was the most significantly up-regulated in AI-Exos. Further studies demonstrated that miR-155-5p was specifically up-regulated in AML-Exos. Both AI-Exos and AML-Exos inhibited the proliferation and migration of VECs, promoted their apoptosis, and down-regulated the expression of HIF-1α and VEGFA. This study is the first to reveal the miRNAs expression profile in plasma exosomes of AIONFH patients and suggest a potential mechanism by which exosomes released from alcohol-stimulated hepatocytes may regulate VECs in AIONFH.

ABSTRACTIntroductionReconstruction for various regions of the foot and ankle in pediatric patients remains a challenging topic. This study presents the circumflex scapular artery perforator (CSAP) flap and its surgical refinements for addressing soft tissue defects in various regions of the foot and ankle in pediatrics.Patients and MethodsForty‐seven patients underwent CSAP flap and its surgical refinements for the reconstruction of foot and ankle defects from 2010 to 2022. Mean age was 6.9 (range 2–14). Defects were observed in the ankle, dorsal foot, heel, and sole. The classic CSAP flap was used in 23 patients, and the CSAP flap with refined techniques was utilized in 24 patients, including double skin paddle, debulking, flow‐through, and chimeric CSAP flaps.ResultsThe size of the CSAP flaps ranged between 4.5 × 4 and 18 × 6.5 cm2. All flaps survived except for one case. The patient suffered total flap necrosis and was treated with a secondary reconstructive surgery. Primary closure of the donor site was achieved in all cases. The average follow‐up period was 15.6 months. At the final follow‐up, the mean AOFAS score was 93.6 (range 77–100). Mean VAS flap appearance score was 8.1 (range 6–10). Most patients showed satisfactory results.ConclusionThe CSAP flap and its surgical refinements are alternative options for repairing pediatric foot and ankle defects, especially in cases involving large defects around the ankle joint, dorsal foot, and non‐weight‐bearing regions of the heel and sole.

In postoperative scenarios, arterial embolisms, while not rare, can profoundly affect flap viability. This case study elucidates a distinctive occurrence of embolism a week after surgery, underscoring the importance of examining areas beyond anastomotic sites. Surgeons must scrutinize distal vessel segments for discoloration to ensure successful flap rescue.

ABSTRACT Background and Aims The exposure of tendons, blood vessels, nerves, and bone due to soft tissue defects in the foot poses a significant challenge for microsurgeons. Free perforator flaps and pedicled perforator flaps are currently the most common methods used for repairing small areas of soft tissue defects in the distal lower limb. Methods A retrospective analysis was carried out on 124 patients with small soft tissue defects in the distal lower limb from January 2009 to December 2021. The evaluation criteria encompassed the patient's intraoperative condition, the occurrence of short‐term and long‐term postoperative complications, as well as the esthetic and functional outcomes. Results In this study, two groups of patients with similar soft tissue defects were included. However, the free perforator flap group showed more severe wound damage compared to the pedicled perforator group. Intraoperatively, the pedicled perforator group needed a larger flap area for wound repair, and the free perforator group had higher intraoperative blood loss and longer operation time. Postoperatively, the incidence of complications was significantly higher in the pedicled perforator group, while the esthetic outcomes were poorer, but the functional evaluation results were better. Conclusion For small soft tissue defects in the distal lower limb, both free perforator flap and pedicled perforator flap are effective in wound repair. The free perforator flap has the advantage of being able to handle more complex wounds with less limitation by location. In cases where the microsurgical expertise is relatively limited and the injuries are minor, pedicled perforator can be considered as the primary choice. Level of Evidence III, case‐control study.

Osteonecrosis of the femoral head usually occurred after glucocorticoid (GC) therapy. The gut microbiota was considered an indispensable part of maintaining human health, and the concept of the gut microbiota -bone axis was also proposed. In our study, we aimed to elucidate the link between steroid-induce osteonecrosis of the femoral head (SIONFH) and the gut microbiota; Methods: The methylprednisolone (MPS) was used to establish the rat model with SIONFH. During rat modeling, some plasma indexes and the gut microbiota were detected by ELISA and 16 S rRNA gene sequencing. In addition, we deeply explore the relationship between these plasma indexes and gut microbiota by using various bioinformatic methods; Results: Our data revealed that there were specific microbes colonized in the gut of rat with SIONFH. Compared to the control group, Prevotellaceae and Oscillospiraceae were replaced by Lactobacillaceae and Bacteroidaceae families in the SIONFH group. Equally, we found that the decreased beneficial gut microbiota maybe a mediation effect between the SIONFH and the increased IgM level; Conclusions: Oscillospiraceae and Prevotellaceae had bone-protective effects and balance the osteoblast-osteoclast balance. Our study showed that the loss of Oscillospiraceae and Prevotellaceae was associated with SIONFH, an effect mediated by elevated plasma IgM.

ABSTRACT Background and Aims Primary medical institutions commonly employ perforator‐pedicled propeller (PPP) flaps and V‐Y flaps as the main methods for managing small soft tissue defects resulting from trauma or lesion resection. However, both surgical techniques have inherent limitations. Therefore, this study aims to investigate the feasibility of utilizing perforator‐pedicled (PP) V‐Y flaps for reconstructing small area soft tissue defects and evaluate their clinical effectiveness. Methods The study conducted a retrospective analysis from January 2010 to December 2022, involving 49 patients with small soft tissue defects resulting from trauma or lesion resection (21 PP V‐Y flaps and 28 PPP flaps). Evaluation criteria encompassed intraoperative conditions, postoperative short‐ and long‐term complications, and aesthetic outcomes. Results The results of this study showed that all flaps in the PP V‐Y flap group survived, while six cases in the PPP flap group had partial necrosis. The donor area was closed directly in one stage for the group of perforator pedicled V‐Y flaps, while skin grafting was required to repair the donor area for eight cases from the group of PPP flaps, leading to delayed healing in this region. Furthermore, aesthetic evaluation favored PP V‐Y flaps as they exhibited significantly better appearances in both donor and recipient areas. Conclusion In this study, compared to the PPP flap, the PP V‐Y flap demonstrates superior outcomes with regard to reduced postoperative complications and enhanced aesthetic appearance. PP V‐Y flap is an ideal technique for repairing small soft tissue defects of limbs, which is suitable for implementation in primary medical institutions. Level of evidence: III, Case–control study.

Osteomyelitis caused by methicillin-resistant Staphylococcus aureus (MRSA) biofilms poses a major therapeutic challenge due to persistent infection and bone loss. Optimizing anti-infection and promoting bone repair are the main goals to improve the efficiency of osteomyelitis treatment. Herein, we present an ultrasound (US)-actived Cu-BTO@Gua composite piezoelectric sonosensitizer, created by conjugating guanidine (Gua) groups, a component that permeates the biofilm matrix, onto US-absorbing Cu-doped barium titanate (BTO). The guanidine groups demonstrate strong affinity for matrices abundant in negatively charged components, facilitating deeper biofilm penetration. Cu doping not only amplifies the piezoelectric effect, but also introduces abundant oxygen vacancies to suppress electron-hole pair recombination. Under US irradiation, the nanocomposite catalyzes the substrate to produce toxic ROS in the acidic infection microenvironment, while Cu depletes glutathione to aggravate oxidative stress, leading to bacterial toxin inactivation, biofilm disintegration, and bacterial death. Additionally, Cu-BTO@Gua promotes the polarization of M1 macrophages to the M2 phenotype by inhibiting nuclear factor-κB, which subsequently activates the transforming growth factor β (TGF-β) signaling pathway to support osteogenesis. This dual-action approach offers a promising strategy for improving clinical outcomes of complex bone infections.

Bone metabolism is a dynamic balance between bone formation and absorption regulated by osteoblasts/osteoclasts. Bone metabolic disorders can lead to metabolic bone disease. Osteoporosis (OP), osteoarthritis (OA) and femoral head necrosis (ONFH) are common metabolic bone diseases. At present, the treatment of metabolic bone disease is still mainly to relieve pain and improve joint function. However, surgical treatment does not apply to the vast majority of high-risk groups, including postmenopausal women, patients with diabetes, cirrhosis, etc. Exosomes (Exos) are nanoscale membrane vesicles that are released by almost all cells. Exos are rich in a variety of bioactive substances, such as non-coding RNAs, nucleic acids, proteins and lipids. In view of the structure of Exos, it can protect the biologically active molecules can be smoothly delivered to the target cells and involved in the regulation of cell function. In this review, we focus on the regulation mechanism and function of bone homeostasis mediated by exosomal ncRNAs (Exos-ncRNAs), including macrophage polarization, autophagy, angiogenesis, signal transduction and competing endogenous RNA (ceRNA). We summarized the therapeutic strategies and potential drugs of Exos-ncRNAs in metabolic bone disease. Moreover, we discussed the shortcomings and potential research directions of Exos as carrier to deliver ncRNAs to play a role.

Background: Skin flap transplantation is a routine strategy in plastic and reconstructive surgery for skin-soft tissue defects. Recent research has shown that M2 macrophages have the potential for pro-angiogenesis during tissue healing.Methods: In our research, we extracted the exosomes from M2 macrophages(M2-exo) and applied the exosomes in the model of skin flap transplantation. The flap survival area was measured, and the choke vessels were assessed by morphological observation. Hematoxylin and eosin (H&E) staining and Immunohistochemistry were applied to assess the neovascularization. The effect of M2-exo on the function of Human umbilical vein endothelial cells (HUVECs) was also investigated. We also administrated 2-methoxyestradiol (2-ME2, an inhibitor of HIF-1 alpha) to explore the underlying mechanism. We tested the effects of M2-Exo on the proliferation of HUVECs through CCK8 assay and EdU staining assay.Results: The survival area and number of micro-vessels in the skin flaps were increased in the M2-exo group. Besides, the dilation rate of choke vessels was also enhanced in the M2-exo group. Additionally, compared with the control group, M2-exo could accelerate the proliferation, migration and tube formation of HUVECs in vitro. Furthermore, the expression of the pro-angiogenesis factors, HIF-1 alpha and VEGFA, were overexpressed with the treatment of the M2-exo. The expression of HIF1AN protein level was decreased in the M2-exo group. Finally, treatment with HIF-1 alpha inhibitor reverses the pro-survival effect of M2-exo on skin flaps by interfering with the HIF1AN/HIF-1 alpha/VEGFA signaling pathway.Conclusion: This study showed that M2-exosomes promote skin flap survival by enhancing angiogenesis, with HIF1AN/HIF-1 alpha/VEGFA playing a crucial role in this process.

BACKGROUND:The reconstruction of complex wounds of the hand still has challenges in achieving aesthetic, functional and sensory recovery. We presented our experience of using the polyfoliate and chimeric radial collateral artery perforator flaps (RCAPF) to repair complex hand defects, aiming to explore the feasibility of special-form RCAPFs in hand coverage and enhance the comprehension of their respective indications. METHODS:From June 2014 to March 2021, 26 cases (19 males and 7 females, mean 44.4 years) underwent defect and sensation reconstruction of their hands with special-form RCAPFs, which manifested as multiple adjacent or irregular single wounds and composite tissue defects complicated with a degree of nerve injury. The clinical effects of the free RCAPFs were evaluated by integrating the postoperative and long-term follow-up outcomes of all cases. RESULTS:Altogether 8 polyfoliate flaps, 17 chimeric flaps and 1 polyfoliate-chimeric flap were harvested. Of them, 23 flaps survived uneventfully in one stage. Venous congestion occurred in 3 cases, two of which survived through vascular exploration and another one was finally repaired by the contralateral RCAPF. The follow-up results showed that the appearance of both the recipient and donor sites mostly recovered satisfactory. All the bone flaps properly healed. The BMRC sensory evaluation results of all skin flaps were S4 in 8 flaps, S3 in 18 flaps, and S2 in 9 flaps. CONCLUSIONS:The free RCAPFs can be designed in various forms with a reliable blood supply, contributing to reconstructing simple and multiple wounds of the hand with or without bone defects and dead space.