Venous leg ulcers (VLUs) result from a multifactorial interplay of etiological factors, posing significant challenges in clinical management. Effective treatment requires a comprehensive assessment to identify the underlying pathophysiological mechanisms, followed by the implementation of an individualized, multidisciplinary approach that integrates the expertise of vascular surgeons, wound care specialists, and other pertinent healthcare professionals. Although both domestic and international vascular surgery societies, as well as other relevant specialties, have issued consensus statements on the diagnosis and treatment of VLUs or clinical guidelines for managing chronic lower extremity venous diseases, there remains a notable gap in systematic guidance specifically focused on wound repair for VLUs. In particular, standardized protocols for surgical wound repair are either lacking or insufficiently detailed in these documents. With the establishment and advancement of wound repair as a specialized field in China, Chinese experts have accumulated substantial clinical experience in the diagnosis and management of VLU-related wound healing. To standardize the surgical repair of VLUs and improve both therapeutic outcomes and patients' quality of life, the Wound Repair Professional Committee of the Chinese Medical Doctor Association convened a panel of multidisciplinary experts for extensive deliberations. Based on a synthesis of current international and domestic evidence and clinical practice, the committee reached consensus on evidence-based recommendations for key issues in VLU wound management, including debridement techniques, indications, timing, and approaches to wound repair for VLUs. This consensus is intended to serve as a practical reference for clinicians involved in the care of patients with VLUs.

Reduced wound mechanical tension or stiffness constitutes a critical mechanical microenvironment that promotes ordered scarless regeneration. However, existing clinical biomaterials are insufficient to modulate wound bed stiffness effectively. This study demonstrates that axolotl skin, which possesses an inherent capacity for ordered scarless wound regeneration, exhibits a significantly lower Young's modulus than mouse and human skin, which are characterized by disordered scar repair. Inspired by these cross-species regenerative mechanical characteristics, a series of hydrogels comprising silk fibroin methacryloyl (SFMA) and β-sheet-rich silk nanofibers (BSNF) was developed with identical architectures and tunable Young's moduli (1.79-139 kPa), achieved through pH modulation. These hydrogels biomimic three representative skin mechanical microenvironments: ordered regenerated tissue in axolotls (ERegen-gel); disordered repaired tissue in mice (ENorm-gel); and pathological scar tissue in humans (EScar-gel). The hydrogels remodelled the mechanical microenvironment of the wound bed and regulated wound healing, with ERegen-gel demonstrating superior efficacy in promoting scarless regeneration. This effect was evidenced by accelerated re-epithelialisation, ordered neovascularisation, formation of a basket-weave-like soft extracellular matrix (ECM) resembling unwounded normal skin, and robust regeneration of skin appendages. Mechanistic studies demonstrated that ERegen-gel promoted M2 macrophage polarisation by attenuating Piezo1/Yes-associated protein (YAP) mechanosignalling in macrophages during the early phase of wound healing, thereby modulating the wound immune microenvironment and establishing a favourable foundation for subsequent scarless wound regeneration. In conclusion, biomechanical modulation of the wound microenvironment using an axolotl skin mechanics-biomimetic hydrogel is sufficient to promote scarless wound regeneration. These findings provide a novel strategy for clinical wound repair based on mechanical microenvironment regulation.

Re-epithelialization and extracellular matrix (ECM) regeneration determine the quality of wound repair. Although the physical microenvironment regulates these processes through physio-biochemical coupling, effective approaches are lacking. This study aims to reconstruct biomechanical and electric field microenvironments in wounds and is the first to develop a biomimetic coupling material that modulates wound mechanics and directional electric fields. The coupling material markedly accelerated re-epithelialization and promoted the ordered regeneration and structural remodeling of the ECM. Both axolotl skin-inspired biomechanical materials and application of electric fields at physiological intensities downregulated the expression of the mechanosensitive ion channel Piezo1 in keratinocytes, relieving its inhibitory effect on cell migration. This represents a new mechanism by which a biomimetic material with biomechanical and directional electric field coupling synergistically promotes keratinocyte migration. This study provides a novel strategy with translational potential for wound healing while offering theoretical insights and a versatile platform for research on wound regeneration.

Background and Objective: Chronic refractory wounds not only persist and delay healing, causing physical and mental suffering to patients and reducing their quality of life but also impose a heavy burden on their families and society. Recombinant human acidic fibroblast growth factor (rh-aFGF), approved in China for decades, is a growth factor with multiple biological effects which can promote the healing of various wounds. It is crucial to develop an rh-aFGF expert consensus for standardizing the clinical application of aFGF and enhancing its clinical value. Methods: The literature related to rh-aFGF, including clinical trials, experimental research, and reviews, was collected and selected from PubMed, Web of Science, Medline, CNKI, and the Wangfang database. The expert recommendations were formed by a combination of clinical research quality, use of the Delphi questionnaire, and consensus reached during meetings involving experts. Results: A total of 12 consensus recommendations for clinical application of rh-aFGF on chronic refractory wounds (CRWs) were successfully formulated, of which seven strong, four moderate, and one weak recommendations were suitable for various clinical sets. The recommendations include specifications for duration of rh-aFGF treatment, dosage, types of wounds, and its combination with other products and dressings. Conclusions: rh-aFGF has vital clinical value for healing chronic wounds. This consensus provides clinicians with a reference to guide the application not only of rh-aFGF but also of other growth factor drugs with similar mechanisms for CRWs.

Reduced wound mechanical tension or stiffness constitutes a critical mechanical microenvironment that promotes ordered scarless regeneration. However, existing clinical biomaterials are insufficient to modulate wound bed stiffness effectively. This study demonstrates that axolotl skin, which possesses an inherent capacity for ordered scarless wound regeneration, exhibits a significantly lower Young’s modulus than mouse and human skin, which are characterized by disordered scar repair. Inspired by these cross-species regenerative mechanical characteristics, a series of hydrogels comprising silk fibroin methacryloyl (SFMA) and β-sheet-rich silk nanofibers (BSNF) was developed with identical architectures and tunable Young’s moduli (1.79–139 kPa), achieved through pH modulation. These hydrogels biomimic three representative skin mechanical microenvironments: ordered regenerated tissue in axolotls (ERegen-gel); disordered repaired tissue in mice (ENorm-gel); and pathological scar tissue in humans (EScar-gel). The hydrogels remodelled the mechanical microenvironment of the wound bed and regulated wound healing, with ERegen-gel demonstrating superior efficacy in promoting scarless regeneration. This effect was evidenced by accelerated re-epithelialisation, ordered neovascularisation, formation of a basket-weave-like soft extracellular matrix (ECM) resembling unwounded normal skin, and robust regeneration of skin appendages. Mechanistic studies demonstrated that ERegen-gel promoted M2 macrophage polarisation by attenuating Piezo1/Yes-associated protein (YAP) mechanosignalling in macrophages during the early phase of wound healing, thereby modulating the wound immune microenvironment and establishing a favourable foundation for subsequent scarless wound regeneration. In conclusion, biomechanical modulation of the wound microenvironment using an axolotl skin mechanics–biomimetic hydrogel is sufficient to promote scarless wound regeneration. These findings provide a novel strategy for clinical wound repair based on mechanical microenvironment regulation.

This study aimed to determine whether negative pressure wound therapy (NPWT) improved the survival rate of Meek skin grafting compared to that of traditional dressing in patients with burn injuries. Thirteen patients with burn injuries of similar depths on both limbs were admitted, the limbs were divided into the NPWT + Meek group and the Meek group. The polyamide gauze adherence rate, the wound secretion culture result and the skin survival rate between the 2 groups were compared. The polyamide gauze adherence rate and the skin survival rate in the NPWT + Meek group were higher than those in the Meek group. Therefore, replacing traditional dressing with NPWT for bandaging after Meek skin grafting can improve the skin survival rate.

Pressure ulcers (PUs) are chronic wounds that pose a significant burden on patients, families, and healthcare systems worldwide. This study evaluates the prevalence, trends, and burden of PUs to inform targeted public health policies. Using data from the Global Burden of Disease (GBD) Study 2021, we analysed PU incidence, mortality, and disability-adjusted life years (DALYs) across 204 countries from 1990 to 2021. Trends were assessed using the estimated annual percentage change (EAPC) in age-standardised rates (ASRs), and future projections were made using the ARIMA model. Globally, PU incident cases increased from 1,142,594.8 in 1990 to 2,468,317.5 in 2021. The ASIR showed a slight decrease, from 31.5 to 30.3 per 100,000. The mortality rose from 16,741.1 to 37,032.7, while the ASMR exhibited numerical stability (0.5 per 100,000). The DALYs increased from 408,887.0 in 1990 to 803,747.4 in 2021, with a decline in ASDR, from 10.7 to 9.7 per 100,000. Absolute numbers, ASRs, and EAPCs exhibit a pronounced correlation with the SDI. Moreover, there exist notable disparities across different regions or nations. The burden of PU was notably higher in elderly females, though the increase among the elderly males was also significant. Projections for 2022-2031 indicate a slight decrease in both ASIR and ASMR, while ASDR is expected to rise. While PU incidence remains high, disparities persist, especially in low-SDI regions. Strengthening prevention strategies and improving healthcare access are critical to reducing the global PU burden.

Diabetic foot ulcers (DFUs) are among the most severe late-stage complications in patients with diabetes. It is characterized by complex pathogenic factors, challenging treatments, and high rates of disability and mortality. Therefore, DFUs have become a major therapeutic challenge for patients with diabetes. In recent years, extracorporeal shock wave therapy (ESWT) has emerged as a novel modality for promoting the healing of both acute and chronic superficial wounds. An increasing number of studies have demonstrated significant clinical efficacy in the treatment of DFUs. Developed by experts from the Wound Repair Committee of the Chinese Medical Doctor Association through an extensive review of high-quality literature, this consensus systematically outlines the indications, contraindications, standardized procedures, key technical points, post-treatment patient management and assessment, and prevention and management of potential complications related to ESWT for DFUs. This consensus aims to provide clinical guidance and a practical reference for physicians in wound repair departments to apply ESWT in the management of diabetic foot ulcers.

Venous thromboembolism (VTE) management in adult burn patients has become a crucial focus in China. The intricate nature of VTE necessitates specialized anticoagulation strategies due to the unique challenges posed by burn injuries. To address this pressing issue, the Burn and Trauma Branch of the Chinese Geriatric Medical Association and Critical Care Group of Burn Surgery Branch of the Chinese Medical Association organized a panel of domestic experts in burn surgery, critical care medicine, vascular surgery, nursing, and health statistics and methodology from Chinese hospitals to discuss VTE-related issues in burn injury, the heightened risk factors such as extensive tissue damage and prolonged immobilization, and the delicate balance required in anticoagulation therapy to mitigate bleeding risks. Based on the latest available research evidence as well as the clinical experience of the panel experts, this consensus comprehensively evaluates factors such as generalizability, suitability, and the potential implications for resource allocation. It also appropriately weighs the clinical advantages against possible drawbacks, resulting in the formulation of 21 guideline recommendations. Registration Practice Guideline REgistry for transPAREncy (PREPARE): No. 2023CN656.

Chronic refractory wounds are a common, costly and recurrent complication of diabetes. Platelet-rich plasma (PRP), a new therapy for chronic wounds, is limited by a long treatment period and unstable effects. FG-4592(Roxadustat) is a new prolyl-4-hydroxylation domain(PHD) inhibitor, which can stabilize hypoxia-inducible factor-1α(HIF-1α) effectively. It is a promising drug for wound repair and needs to be demonstrated via various appropriate application scenarios. This study investigated the effects of combining FG-4592 and PRP to promote diabetic wound healing. Diabetic rats were randomly assigned to five groups: nondiabetic control, diabetic untreated, diabetic + PRP, diabetic + FG-4592, and diabetic + PRP + FG-4592. Diabetes was induced with streptozotocin (STZ). A full-thickness skin defect was created, and FG-4592 (peritoneal injection) and PRP (periwound injection) were administered alone or together. Wound healing was assessed by histological analysis (Hematoxylin-Eosin (HE) and Masson staining) and protein expression of HIF-1α, VEGF(vascular endothelial growth factor), α-SMA(α-smooth muscle actin), CoL1α1(collagen type 1 alpha 1), and SDF-1(Stromal Cell-derived Factor 1) via Western blotting and qRT-PCR(Quantitative real time polymerase chain reaction). Immunohistochemistry(IHC) and immunofluorescence(IF) were also used to evaluate CD34 (Cluster of Differentiation 34), CD31(Cluster of Differentiation 31), VEGF(vascular endothelial growth factor), SDF-1(Stromal Cell-derived Factor 1), PCNA(Proliferating Cell Nuclear Antigen), and Integrin-β1 expression. The untreated diabetic group exhibited impaired wound healing, histological damage, and reduced expression of key proteins compared to the nondiabetic control group. Both PRP and FG-4592 alone improved wound healing, reduced damage, and upregulated protein expression. However, the combination of FG-4592 and PRP showed the most significant improvement. This study suggests that FG-4592 combined with PRP accelerates diabetic wound healing by enhancing endothelial progenitor cell recruitment, neovascularization, and cell proliferation and migration via upregulation of HIF-1α and its target genes. This combination therapy may provide a novel approach for treating chronic diabetic wounds.

BACKGROUND:Tophi, a severe complication of advanced gout, developed in approximately 12-35% of patients with gout, with rates as high as 52.56% being reported. Bone and joint damage and chronic refractory wounds caused by gouty tophus present considerable clinical challenges. However, the optimal surgical timing, perioperative management, and treatment approaches for this condition remain unstandardized. Therefore, an expert consensus statement was developed to provide guidance for surgical intervention and improve clinical management of gouty tophus. MATERIALS AND METHODS:A multidisciplinary expert committee representing relevant clinical specialties was established, and key questions on tophus surgery were compiled. Eleven scientific literature databases were queried to retrieve relevant papers, and a literature quality assessment was performed. Four meetings (nominal group technique) and two Delphi voting rounds were conducted to define tophus erosion grading criteria and establish recommendations. Consensus was considered to have been achieved when at least 85% of panelists indicated agreement. Perspectives from two patients with tophi were incorporated through interviews. RESULTS:Grading criteria (grades 1-4) for tophus erosion damage were established, and 14 recommendations for surgical treatment (eight strongly recommended and six conditional) were formulated - two on determining tophus erosion severity, four on perioperative management, and eight on surgical indications and treatment. CONCLUSION:This study presents the first consensus to introduce standardized criteria for grading tophus severity through multidisciplinary collaboration and offers evidence-based recommendations on optimal surgical timing, perioperative management, and treatment strategies to enhance patient outcomes and guide clinical practice. These recommendations may serve as a foundation for future research and standardization efforts in the surgical management of gouty tophus globally.

Wound exudates, the effusion of tissue fluid after injury, can act as a bridge for biochemical substance transfer and provide an environment for wound healing. However, excessive wound exudate prolongs the inflammatory phase and hinders healing, particularly in chronic wounds. Although dressings have long been used to absorb exudates and protect wounds, traditional dressings have non-negligible limitations in exudate management because of their single structure and function. Materials with asymmetric wettability and specific pore structures have unique advantages for controlling unidirectional liquid transport, providing a new approach for exudate management. In recent years, exudate management dressings have advanced significantly, but have seldom been described and discussed in detail. Therefore, this review systematically presents the mechanism, necessity, and configurations of exudate management dressings. Variously, textile-, nano/microfiber-, membrane-, foam/sponge-based, and composite exudate management dressings are reviewed. The methods for evaluating exudate management are briefly described and the current challenges and prospects are presented to provide references for the future development of dressings.

Titanium mesh exposure after cranioplasty is the most serious complication of this procedure. Although some clinical experience has been gradually accumulated over the years in the diagnosis and treatment of titanium mesh exposure, the treatment is often not standardized and it is difficult to achieve satisfactory repair results due to insufficient understanding of its pathogenesis and concurrent infections. To normalize the diagnosis and treatment of titanium mesh exposed wounds after cranioplasty and improve the therapeutic effect and the quality of life of patients, the Wound Repair Professional Committee of Chinese Medical Doctor Association organized an expert discussion based on the literature and current diagnosis and treatment status of titanium mesh exposed wounds after cranioplasty at home and abroad, and reached a consensus on the pathogenesis, preventive measures, and diagnosis and treatment strategies of titanium mesh exposed wounds after cranioplasty to provide reference for relevant clinicians.

Background: Previous reports on the treatment of sacral and ischial pressure in - juries have not provided clear algorithms for surgical therapies. The objective of this study was to establish a reconstruction algorithm to guide the selection of an ideal free -style perforator flap that can be tailored to the defect in question. Methods: We used 23 perforator flaps to reconstruct 14 sacral and 8 ischial defects in 22 pa - tients over 5 years. A reconstruction algorithm system was developed based on the anatomical features of the perforator vessels (diameter, D; pulsatility [++ similar to +++] , P ) and their position in the skin island (DPD ) (ie, D +P +DPD ). A perforator -based propeller flap was applied as the first -line choice; if this plan was not feasible, we applied an altered V -Y advancement model or another second -choice technique. Results: All flaps survived, and only 1 patient experienced partial wound dehiscence, which healed by secondary intention. After an average follow -up period of 11.2 months, no patient experienced recurrence or infection. Conclusions: Free -style perforator flap selection is determined by pressure injury and the desired advantage of a specific approach. The use of free -style perforator -based propeller flaps allows a surgeon to transfer healthy tissue into the defect, shifts the suture line away from the bony prominence, and preserves additional future donor sites. In cases where unexpected variations are encountered, the V -Y advancement model or another technique can be used. The simplified surgical algorithm (D +P +DPD ) can provide versatility and reliability, achieve a dur - able, natural esthetic outcome, and minimize injuries to future donor sites. (c) 2023 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons.

Diabetic foot ulcer complicated with lower extremity vasculopathy is highly prevalent, slow healing and have a poor prognosis. The final progression leads to amputation, or may even be life-threatening, seriously affecting patients' quality of life. The treatment of lower extremity vasculopathy is the focus of clinical practice and is vital to improving the healing process of diabetic foot ulcers. Recently, a number of clinical trials on diabetic foot ulcers with lower extremity vasculopathy have been reported. A joint group of Chinese Medical Association (CMA) and Chinese Medical Doctor Association (CMDA) expert representatives reviewed and reached a consensus on the guidelines for the clinical diagnosis and treatment of this kind of disease. These guidelines are based on evidence from the literature and cover the pathogenesis of diabetic foot ulcers complicated with lower extremity vasculopathy and the application of new treatment approaches. These guidelines have been put forward to guide practitioners on the best approaches for screening, diagnosing and treating diabetic foot ulcers with lower extremity vasculopathy, with the aim of providing optimal, evidence-based management for medical personnel working with diabetic foot wound repair and treatment.

我国烧伤医学工作者曾将烧伤医学打造成了一张响亮的名片.建设创面修复科是我国的创举.从烧伤医学走出来的创面修复医学工作者应立志将这个创面修复新学科打造成新时代临床医学新名片.本文提出了三步走战略构想:利用5年左右时间,夯实现有基础,率先初步建成创面修复学科体系,吸引同行目光;利用10年左右时间,争取建立并完善学科体系,制定和完善临床共识、标准、指南,创新临床技术、研发转化,达到国际先进水平,供国际同行学习;利用15年以上的时间,不断完善学科体系建设,临床规范、治疗技术研发转化和治疗效果达到国际领先水平,学科国际影响力不断攀升,引领国际创面修复学科前沿,使创面修复学科成为新时代中国临床医学的新名片.

•The annual incidence of alcohol-flame burns has consistently risen.•The prevalence of alcohol-flame burns was higher during the COVID-19 epidemic than in the non-epidemic period.•During the COVID-19 epidemic, patients exhibited larger burn sizes, higher burn indexes, longer hospital stays, and an increased incidence of combined inhalation injuries.•It is crucial to raise awareness about the hazards of alcohol abuse and promote responsible alcohol consumption.

Microtubules (MTs) are essential structural elements of cells. MT stability and dynamics play key roles in integrity of cell morphology and various cellular activities. The MT-associated proteins (MAPs) are specialized proteins that interact with MT and induce MT assemble into distinct arrays. Microtubule-associated protein 4 (MAP4), a member of MAPs family, ubiquitously expressed in both neuronal and non-neuronal cells and tissues, plays a key role in regulating MT stability. Over the past 40 years or so, the mechanism of MAP4 regulating MT stability has been well studied. In recent years, more and more studies have found that MAP4 affects the activities of sundry human cells through regulating MT stability with different signaling pathways, plays important roles in the pathogenesis of a number of disorders. The aim of this review is to outline the detailed regulatory mechanisms of MAP4 in MT stability, and to focus on its specific mechanisms in wound healing and various human diseases, thus to highlight the possibility of MAP4 as a future therapeutic target for accelerating wound healing and treating other disorders.