Donor Area Research Articles

The use of augmented reality for preoperative preparation of perforated flaps: a pilot study

Augmented reality (AR - augmented reality) is the addition of digital information to one or more senses, which allows the user to perform tasks more efficiently. This can be achieved by overlaying images, videos, or computer models. The aim the study is to study the use of AR for preoperative planning of perforant flaps and compare the results of visualization accuracy of various research methods. 3 patients with oncological diseases were examined, who were planned to lift and transplant a SCIP flap (in two cases) and a propeller flap on the perforant branch of the peroneal artery (in one case). All patients underwent a high-frequency ultrasound of 75 GHz examination of the donor zone and marking along it in the area of the planned flap lift. A CT scan of the donor area was also performed, followed by the superimposition of a segmentation image using HoloLens 2 virtual reality glasses. 7 measurements were obtained. AR for microsurgical planning was performed in two inguinal regions and was 100% correlated with the results of high-frequency ultrasound, in the case of perforant vessels of the peroneal artery, a discrepancy of 5 mm was noted for the X and Y axes in three perforant vessels. Augmented reality allows the reconstructive surgeon to see the anatomy of the area of interest in a particular patient before the incision. This area of medicine is certainly in demand, promising and requires further research with larger patient samples and randomization.

Combined surgery and Preserflo coating with conjunctival graft autologous in acute pseudo‐exfoliative glaucoma

Aims/Purpose: To describe a case of cataract and acute pseudo‐exfoliative glaucoma in which combined surgery with a Preserflo implant was performed and required a conjunctival graft to cover the device due to the friability of the conjunctiva.Methods: A 72‐year‐old male with glaucoma in the left eye (LE) with triple hypotensive treatment, who lost follow‐up due to the pandemic, goes to the emergencies for loss of vision in the LE. A medium dilation, pseudo‐exfoliation and white hypermature cataract can be seen. The intraocular pressure (IOP) is 45 mmHg and does not revert to adequate values with topical and systemic maximum hypotensive treatment. A temporary access cataract surgery is performed without complications. The glaucoma procedure is then performed using the Preserflo implant in the upper nasal area, but the suture produced buttonholes and tears in the conjunctiva that forced us to perform an autologous graft of inferior temporal conjunctiva to cover the implant and ensure a tight closure of the flap.Results: The evolution of AV was favourable. IOP decreased to 10 mmHg and initially at biomicroscopy and Anterior segment optical coherence tomography (AS‐OCT) revealed a diffuse, functioning blister that progressively flattened. The graft was well adhered and positioned. The sclera of the donor area healed by secondary intention. At the 3‐month review, the device was vacuum packed and it was necessary to reintroduce hypotensive eye drops.Conclusions: The Preserflo implant may be less traumatic than other filtering surgeries. The time with hypotensive eye drops contributes to the friability of the conjunctiva and makes us cover the device with an autograft to complete the surgery initially successfully. Although the chronic conjunctival damage may promote fibrosis, disrupt filtration, and require new hypotensive treatment.

Surface scanning and 3D printing for optimized partial auricular reconstruction

We present the resolution of a case of a 50-year-old patient who presented for excision and reconstruction of a malignant skin lesion at the auricular tubercle of the right helix. The patient reported great concern for the aesthetic outcome. The auricular helix has a unique projection, relief, consistency, and size determined by the contralateral side. Its reconstruction is a surgical challenge and requires sophisticated techniques to achieve good results. Therefore, in cases where we are looking for precision and predictability, 3D technology is a great help for the surgeon as it allows pre-surgical patient-specific planning and the printing of sterilisable models that serve as surgical 3D guides. This case was solved with a two-stage reconstruction. First, the lesion was excised, and a retro auricular advancement flap was placed. In the second stage, the placement of cartilage was sectioned using a customised surgical model obtained from the scanning of the contralateral ear surface. This way, the cartilage donor area was optimised, choosing the most similar shape and size with great precision.

Evaluating the extrapolation potential of random forest digital soil mapping

Spatial soil information is essential for informed decision-making in a wide range of fields. Digital soil mapping (DSM) using machine learning algorithms has become a popular approach for generating soil maps. DSM capitalises on the relation between environmental variables (i.e., features) and a soil property of interest. It typically needs a training dataset that covers the feature space well. Mapping in areas where there are no training data is challenging, because extrapolation in geographic space often induces extrapolation in feature space and can seriously deteriorate prediction accuracy. The objective of this study was to analyse the extrapolation effects of random forest DSM models by predicting topsoil properties (OC, clay, and pH) in four African countries using soil data from the ISRIC Africa Soil Profiles database. The study was conducted in eight experiments whereby soil data from one or three countries were used to predict in the other countries. We calculated similarities between donor and recipient areas using four measures, including soil type similarity, homosoil, dissimilarity index by area of applicability (AOA), and quantile regression forest (QRF) prediction interval width. The aim was to determine the level of agreement between these four measures and identify the method that had the strongest agreement with common validation metrics. The results indicated a positive correlation between soil type similarity, homosoil and dissimilarity index by AOA. Surprisingly, we observed a negative correlation between dissimilarity index by AOA and QRF prediction interval width. Although the cross-validation results for the trained models were acceptable, the extrapolation results were unsatisfactory, highlighting the risk of extrapolation. Using soil data from three countries instead of one increased the similarities for all measures, but it had a limited effect on improving extrapolation. Also, none of the measures had a strong correlation with the validation metrics. This was particularly disappointing for AOA and QRF, which we had expected to be strong indicators of extrapolation prediction performance. Results showed that homosoil and soil type methods had the strongest correlation with validation metrics. The results for this case study revealed limitations of using AOA and QRF as measures of extrapolation effects, highlighting the importance of not relying on these methods blindly. Further research and more case studies are needed to address the effects of extrapolation of DSM models.

Extensive Vulvectomy and Reconstructive Flaps for Advanced Vulvar Cancer in Young Woman: Case Reports

Introduction: : Vulvar cancer is a rare disease accounting for approximately 5% of female genital tract tumors worldwide. It is a squamous cell cancer that mostly affects older women over the age of 65. In the existing body of literature, no instances of vulvar cancer have been documented in the form of case reports. Therefore, this study aimed to report the challenges and outcomes of vulvectomy with reconstructive flap in vulvar cancer survivors in a 39-year-old woman. Case Presentation: A 39-year-old woman with a palpable lump around the vulva was present and being examined. The anatomic pathology report (APR) features suggested poorly differentiated malignant tumors. A neoadjuvant chemotherapy was then administered to the patient aimed at shrinking the size of the tumor. However, there was no effective response to the chemotherapy, which resulted in a progressive tumor. Extensive vulvectomy and reconstructive flap were carried out to support quality of life, and the outcomes were reported, including flap, survival, complications, and mortality. These outcomes were evaluated between November 2021 and March 2023. No total flap loss was observed, and neither was there any donor site morbidity or mortality during the process. Conclusions: This study showed that vulvar cancer was a rare condition at a young age. Advanced vulvar cancer was found in the patients and extensive vulvectomy surgery was carried out followed by a pedicled ALT flap. This option was currently the best for immediate reconstruction due to the preservation of sensibility and tissue availability in the donor areas. The result showed no wound dehiscence, marginal necrosis, or surgical site infection. After 15 months of follow-up, the flap was observed to have good vascularization. The association of the Gynecologist with the Plastic Surgeon offered palliative care to improve the quality of life of the patient and provide good postoperative results.

Lipotranferences in post neurosurgical esthetic defects

Background: There are numerous procedures in which, beyond adequate manipulation of the temporalis muscle and cranial closure, patients may present bone and muscle defects due to atrophy and consequent facial asymmetry, causing psychological discomfort and functional deterioration. The objective of our work is to combine the knowledge of plastic surgery and apply it to cranial reconstructions with fat transfers in post-neurosurgical patients, analyzing its results. Methods: During the year 2022, 45 fat transfer procedures were performed for the correction of craniofacial defects, of which 29 were female and 16 were male. All had a surgical history of pterional craniotomies and their variants, orbitozygomatic and transzygomatic approaches, with the consequent volume deficit. Results: The procedure was performed on an outpatient basis, with local anesthesia, and in an average time of 30–40 min. The lower hemiabdominal region was used as the donor area, processing the fat using the decantation technique and injecting it into the receptor area at the craniofacial level. The patients tolerated the procedure adequately without intraoperative complications or superadded events. Conclusion: Fat transfer is a minimally invasive, effective, and cost-effective technique that plastic surgery offers us to implement in post-neurosurgical patients, as it achieves natural results that stand the test of time.

Artificial dermis combined with split-thickness skin autograft in the treatment of hand thermal compression wounds: a single center case-control study.

To explore the clinical effect of artificial dermis combined with split-thickness skin autograft in treating hand thermal compression wounds. Forty-two patients in our hospital from January 2016 to October 2022 with thermal compression wounds were divided into two groups. The survival rate of autologous skin grafts seven days after skin grafting, the number of operations, total hospital stay, total hospitalization cost, and bacterial culture results of secretions were recorded. The visual analog scale was used to evaluate the wound pain. The condition of skin graft rupture was recorded and the scar status of the donor site was evaluated by the Vancouver Scar Scale. It showed combination of artificial dermis, split-thickness skin autograft, and vacuum sealing drainage improves the treatment of hand thermal compression wounds by enhancing the survival rate of skin grafting (95.24% > 66.67%), reducing the number of operations (P < 0.001), relieving wound pain (P < 0.001), effectively controlling wound infection (4.76% < 9.52%), and reducing the skin graft rupture rate after surgery (4.8% < 28.6%). There was no evident scar hyperplasia in the donor (P = 0.003) and skin graft areas (P < 0.001), which had a good recovery of hand function (P = 0.037); however, this treatment strategy may prolong the hospital stay (P = 0.030) and increase the total hospitalization cost (P = 0.030). The composite transplantation of artificial dermis and split-thickness skin combined with the VSD significantly improves treatment and aesthetic outcomes in patients with thermal compression wounds to the hand, which is worth promoting and applying in clinical practice.

Artificial portable plates: A brand new method for assisted colonization of an endangered marine invertebrate, Patella ferruginea

Abstract Limpets play an important role in structuring the intertidal fringe, one of the most heavily impacted marine habitats. A large number of limpet species are listed as Endangered or Vulnerable, including Patella ferruginea, one of the most endangered marine invertebrates in the Mediterranean Sea. Relocation attempts have been made as a conservation tool for reintroductions and population reinforcements for P. ferruginea. Some relocations were mandatory because of port infrastructure repairs in areas where viable populations of this limpet occurred. However, most relocations attempted to date have experienced high mortality rates, leading to the Spanish National Conservation Strategy not recommending this approach for this species. In this study, 84 individuals of P. ferruginea were relocated, using artificial portable plates (APPs) installed on the ripraps of the Port of Ceuta (Western Mediterranean Sea). These plates were divided into two groups and relocated: (i) as a translocation to a nearby site with similar environmental conditions to the donor area (procedural control); and (ii) as a reinforcement translocation to a relatively distant location (30 km, Algeciras Bay) (experimental procedure). The mortality of the translocated individuals in the procedural control after 10 weeks was similar (6.6%) to that expected for natural populations, whereas the mortality rate for individuals in the reinforcement translocation was higher (26.6%). The APPs have been proven to be a feasible method for translocation, as they result in relatively low mortality by preventing the stress and damage caused by limpet detachment from substrata. The constraints caused by reinforcement translocation to a new environment seem to be the cause of the increased mortality, as the translocated limpets changed their home scar at a much higher rate than the control limpets did.

Topical drug delivery of licorice flavonoids and their structure-affinity relationship with the porcine skin

Traditional Chinese medicine (TCM) possesses a long history of clinical application in the transdermal prescriptions, however, their transdermal mechanisms had not been clearly elucidated ascribing to their complex ingredients and different content. In this work, we firstly provide insights reports on the transdermal mechanisms of licorice flavonoids (LFs) extracts and the structure-affinity relationship between LFs compounds and the skin. The permeation properties of LFs extracts were conducted on the porcine skin and rat skin. It was highlighted that chalones and flavanone molecules were easier to permeate through the skin from LFs extracts than isoflavone. Differ from other LFs compounds, insoluble licochalcone A and licoflavone A obtained a higher permeation amount from LFs extracts than its corresponding monomer ingredients affirmed through molecular dynamics simulation study. In the stratum corneum (SC), among 33 kinds of flavonoids, glabridin possessed the highest compatibility with the skin lipids. Furthermore, interaction parameters (χ) values between the drugs and ceramide were negatively correlated with the number of hydrogen bond donor (HBD), polarizability and polar surface area of LFs compounds. The HBD of LFs molecules could help drugs bind to the skin lipids and then formed appropriate hydrogen bond interactions with the skin lipids, further improving the affinity between the drugs and the skin. Moreover, LFs components permeated through the porcine skin by disturbing the lipids arrangement in the SC. In the epidermis and dermis, the positive number and absorption rate of LFs extracts by HaCaT cells was significantly higher than melanocytes and HSF cells after 6 h. This study provided a new approach to unveil the molecular mechanisms of LFs permeation, which gave a reference for permeation of other TCM extracts.

Paradigm Shift from Linear Strip to Follicular Unit Excision in Hair Restoration Surgery.

Follicular unit excision (FUE) is a very effective and valuable modality for obtaining donor hair follicles using manual, motorized, or robotic devices to harvest individual donor follicular units in situ without a linear donor scar or visible scarring making it ideal for patients who wish to wear their hair short and hide signs of surgery. Over the past two decades, FUE has become increasingly popular, and the rising demand for FUE has driven the worldwide market size of hair restoration surgery (HRS) to an unprecedented height.FUE has revolutionized the HRS industry and offers excellent cosmesis and high patient satisfaction. Unfortunately, a large part of the favorable appeal of FUE is due to false claims that it is "minimally invasive," "scarless," or "not even surgery." Most patients opt-in for FUE due to these misconceptions, which are advertised by "black-market" clinics offering low-cost FUE surgery performed by amateur, nonprofessional technicians on unsuspected patients. The technique appears deceptively simple, and many neophyte surgeons falsely believe that the learning curve of FUE is short because the barrier of entry is low and no previous surgical skill is required. Nevertheless, injuries on grafts are extremely easy to occur since FUE is a blind technique and can be minimized only with excellent technique, which takes years to master.FUE actually presents unique challenges for the surgeon and carries potential long-term permanent side effects if not performed properly. The surgeon must have a thorough understanding of the nuances of the FUE surgical technique to ensure consistent graft quality and favorable cosmesis of both donor and recipient areas. Efficient FUE requires dexterity, training, dedication, devotion, enthusiasm, cognitive clarity, scientific knowledge, experience, and an extended learning curve.FUE is an invaluable addition to the armamentarium of a hair restoration surgeon but has to be judiciously performed.

Advances in the Use of Synthetic Bone Augmentation Materials for Oral Implant-related Applications

Insufficient bone in the implant area is a key factor in the outcome of implant restorations. Autogenous bone grafting has long been recognized as the "gold standard" in bone augmentation. However, the problems of secondary damage to the donor area, limited source, easy resorption, and high risk of complications have limited the use of simple autogenous bone in clinical practice. Finding and selecting good autologous bone substitution materials have become the trend of bone augmentation techniques. the use of bone augmentation materials can provide support and stimulate the process of bone augmentation in cases such as bone defects.

Follicular Unit Excision Donor Area Management and Considerations of the Scalp.

Over the last several years, follicular unit excision (FUE) donor harvesting has become the predominant donor harvest method, surpassing the traditional method of linear strip excision donor harvesting. While this may offer advantages in specific clinical settings, the reality of ongoing losses with the natural evolution of male patterned hair loss places a premium on obtaining as much lifetime donor hair as possible to address this clinical reality. This lifetime demand requirement must be weighed against the possibility of a detrimental cosmetic appearance of the donor area with serial donor harvests utilizing FUE. This chapter will examine the important technical and artistic considerations critical for hair restoration surgeons to appreciate in order to maintain cosmetically high-quality donor area outcomes in patients choosing to undergo FUE harvesting for hair transplantation surgery.

Concepts, Terminology, and Innovations in Follicular Unit Excision Hair Restoration Surgery.

Follicular unit excision (FUE) has emerged as the preferred method for hair transplants. Standardized terms and definitions established by members of the International Society of Hair Restoration Surgery and prominent hair restoration surgeons have become the standard, enabling effective knowledge sharing. This chapter provides an overview of the terminology relating to the field.The historical evolution of FUE and its pivotal role in modern hair transplantation is summarized. Anatomical terminology and graft-related definitions follow, providing insights into the scalp's complex structures and graft characteristics. The subsequent sections detail the terminology associated with graft excision and extraction, shedding light on the precise techniques and procedures employed. An exploration of various FUE techniques and the evolving landscape of FUE devices underscores the continual refinement of hair restoration practices. The chapter proceeds to discuss the "safe'" scalp donor zones, donor assessment terminology, and elements in identifying the optimal donor area for a successful FUE procedure. Additionally, punch dynamics and technique characteristics are examined, emphasizing their pivotal role in achieving superior FUE outcomes. The chapter concludes by discussing the classification of punches and graft evaluation terms, offering insights into the tools, and criteria used to assess graft quality and viability.

Follicular Unit Excision-Linear Ellipse Donor Harvesting Technique: Combining Standard Follicular Unit Excision with Follicular Unit Excision inside a Linear Strip (Modified Linear Strip Excision) to Optimize Graft Yield.

Follicular unit excision (FUE) graft dissection has become the dominant method of donor harvesting globally, however, only a percentage of donor hair can be excised inside the safe donor area before visible donor thinning occurs. Compared to linear strip excision (LSE) where all follicular units inside the harvested ellipse of hair are used, FUE poses substantial limitations for lifetime graft yield and, therefore, cosmetic coverage in patients with advanced pattern hair loss. This paper reviews how combining the donor harvesting methods of FUE and LSE has been shown to optimize graft yield while minimizing the risk of donor depletion from overharvesting. It then describes a surgical technique called FUE-Linear Ellipse (FUE-LE) where FUE dissection of grafts inside a demarcated linear ellipse eliminates the need for a large dissection team which has posed a barrier for many new practices that offer both the donor harvesting methods. For practices that currently offer only FUE, the addition of the LSE method by the modified FUE-LE technique is possible without specialized staff training or associated equipment costs. In this paper, surgery practices that have adopted this technique will report on their experiences. Hair restoration surgeons are encouraged to provide both methods of donor harvesting (FUE and LSE using FUE-LE) in order to optimize graft yield for patients and avoid long-term donor depletion. Based on limited experience, it appears the technique of FUE-LE will help achieve this goal.

Temporal Fascia Free Flap for Thumb Coverage in Electrical Burn Injuries: A Case Series Analysis With DASH Score Outcomes Evaluation.

Electrical burns pose unique challenges in reconstructive surgery due to the extensive tissue damage they cause. The thumb is particularly susceptible to electrical burns, leading to severe functional impairment. This case series introduces the use of the temporal fascia free flap for thumb coverage in patients with electrical burn injuries. The study aims to assess the functional outcomes of this approach using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Six male patients underwent thumb reconstruction using temporal fascia free flaps following electrical burn injuries. The extent of the injury was assessed, and necrotic tissue was debrided. Functional outcomes were evaluated using the DASH questionnaire 6 months postoperation. All procedures were conducted in accordance with ethical guidelines, and informed consent was obtained from all patients. All patients achieved successful transplants using temporal fascia free flaps. The average DASH score at the 6-month follow-up indicated satisfactory functional recovery. Patients reported improvements in thumb mobility and functionality, and the cosmetic appearance of the thumb was acceptable. The appearance of the scar in the donor area was well-received. The temporal fascia free flap proved to be an effective method for thumb reconstruction following electrical burn injuries. Its thin and flexible nature allows for optimal contouring and improved range of motion. Although one case of partial flap loss was observed, overall functional and aesthetic outcomes were satisfactory. Further research with larger sample sizes is warranted to optimize surgical techniques and postoperative care for better outcomes.

Optimisation of the blood supply at the flap donor site through the application of cutaneous negative pressure

At present, perforator flaps are a very popular technique in reconstructive surgery. However, in spite of the fact that perforator flaps provide favourable aesthetic results, their use is often related to complications in the form of transplanted tissue perfusion disorders.&#x0D; Objective — to investigate the possibility of optimising the blood supply at the flap donor site through the application of cutaneous negative pressure (NP).&#x0D; Materials and methods. The study was carried out from 2019 to 2021. A single‑arm clinical trial consisted of 20 individuals who presented with deep wound defects requiring flap coverage. A dynamic thermography study was conducted to examine the chosen donor site before and after dressing with NP.&#x0D; Results. The temperature measurements obtained from the two selected warm perforator points and the point in the cool area between perforators prior to the application of NP showed a steady downward trend in temperature. Specifically, the temperature in the cool area was observed to be lower by an average of –1.89 °С and –2.12 °С as compared to warm points. The application of local NP had an impact on trend analysis of skin temperature, which demonstrated a significant decrease in the differences between values seen in the cool and warm areas. This effect was already noted after the first day of the NP system application, as evidenced by the everyday data collection. The «levelling» of temperature curves was associated with temperature rises both in the cool area and at the perforator exit points.&#x0D; Conclusions. The findings obtained from thermography analysis suggest that the application of NP has the potential to enhance blood circulation in the intended donor area. Therefore, it is plausible to discuss the possibility of improved microcirculation in the skin and the beneficial effect of local cutaneous NP application on the state of anastomoses between perforators.&#x0D;

Augmentation of the Anterior Cruciate Ligament Using the Peroneus Longus: Description of the Surgical Technique

Background: The quadruple graft from the hamstring tendons has become a widely used option in the reconstruction of the anterior cruciate ligament (ACL), however, this graft may not have the desirable diameter for the reconstruction, increasing the risk of re-rupture. In this context, the peroneus longus tendon graft appears as an option to complement other grafts, transforming a thin quadruple graft into a sextuple graft. Indications: The sextuple graft technique for ACL reconstruction is used in patients who have a quadruple graft with a diameter of less than 8 mm, and due to its length, it is not possible to make a quintuple graft, for example. Technique Description: Initially, the hamstring tendons are removed with the aid of a tenotome. After that, the anterior half of the peroneus longus tendon is identified and removed. On the back table, the definitive graft is prepared so that we have a sextuple graft with a diameter greater than 8 mm. Finally, the ACL reconstruction is performed anatomically using an adjustable loop device in the femur and an interference screw in the tibia. Results: In our experience with patients who have a hamstring graft diameter of less than 8 mm, we obtained an average increase of 1.8 mm in graft diameter when augmentation was performed with the anterior half of the peroneus longus. Discussion: Grafts less than 8 mm in diameter are at increased risk of rupturing and failure of surgical treatment of the ACL injury. The surgeon must be prepared to make a quintuple or sextuple graft, but in some patients, the tendons are short or there is no availability of a tissue bank, making this practice impossible. The use of the anterior half of the peroneus longus to perform graft augmentation is safe, causing almost no morbidity to the donor area and is easily accessible during the procedure, making it an excellent option for increasing the diameter of thin grafts. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form.

Follicular Unit Excision (FUE) Basics.

Follicular unit excision (FUE) has risen to the forefront as the world's most popular hair transplant procedure. However, most writing on this subject has catered to the advanced practitioner. The goal of this article will be to focus on safe planning and decision making along with key technical steps that will guide the beginner surgeon to harvest a graft safely and to harvest the donor area in a uniform way to avoid overharvesting. Topics covered in this article also include instrumentation and decision making between FUE versus linear strip excision.

Lysozyme stability in various deep eutectic solvents using molecular dynamics simulations

The ability of neat deep eutectic solvents (DESs) to influence protein structure and function has gained considerable interest due to the unstable nature of enzymes or therapeutic proteins, which are often exposed to thermal, chemical, or mechanical stresses when handled at an industrial scale. In this study, we simulated a model globular protein, lysozyme, in water and six choline chloride-based DES using molecular dynamics simulations, to investigate the structural changes in various solvent environments, giving insights into the overall stability of lysozyme. Root mean square deviation (RMSD) and root mean square fluctuations (RMSF) of the C-α backbone indicated that most DESs induced a less flexible and rigid lysozyme structure compared to water. The radius of gyration and end-to-end distance calculations pointed towards higher structural compactness in reline and levuline, while the structure of lysozyme considerably expanded in oxaline. Protein-solvent interactions were further analysed by hydrogen bonding interactions and radial distribution functions (RDF), which indicated a higher degree of lysozyme-hydrogen bond donor (HBD) interactions compared to lysozyme-choline hydrogen bonding. Surface area analysis revealed an overall % increase in total positive, negative, donor, and acceptor surface areas in malicine and oxaline compared to water and other DESs, indicating the exposure of a larger number of residues to interactions with the solvent. Reline, levuline, and polyol-based DESs comparatively stabilized lysozyme, even though changes in the secondary/tertiary structures were observed. Communicated by Ramaswamy H. Sarma

Selection strategy of pedicled axial flaps for repairing high-voltage electric burn wounds in foot and ankle

Objective: To explore the selection strategy of pedicled axial flaps for repairing high-voltage electric burn wounds in foot and ankle. Methods: The retrospective observational research method was used. From January 2017 to December 2022, 16 patients with skin and soft tissue defects in foot and ankle after high-voltage electric burns were treated in General Hospital of Eastern Theater Command, including 11 cases of unilateral defect and 5 cases of bilateral defect. All patients were male, aged from 25 to 75 years. After thorough debridement, the area of the defect to be repaired with the flap was 5.0 cm×4.0 cm to 12.0 cm×8.0 cm. Before operation, the color Doppler ultrasound, computed tomography angiography, or digital subtraction angiography was used to fully evaluate the degree of vascular injury in the affected limb and to identify the distribution and traffic anastomosis of vascular network. Pedicled axial flaps with reliable blood supply were used to repair the wounds as soon as possible, and the area of flaps ranged from 3.0 cm×2.0 cm to 13.0 cm×8.0 cm. The wound in the donor area of flaps was repaired with split-thickness skin graft from head or medium-thickness skin graft from thigh. The flap repair of wounds in various areas of the ankle and foot was recorded. The postoperative survivals of the flaps and skin grafts were observed after surgery. The postoperative appearance of flaps and walking function of patients were followed up. At the last follow-up, the foot and ankle function was evaluated and rated using the American Association of Foot and Ankle Surgeons Ankle Posterior Foot Scoring System. Results: Two wounds in toe area were repaired with reverse dorsal pedis flaps, 3 wounds in medial ankle area and 2 wounds in heel area were repaired with medial plantar flaps, 2 wounds in anterior plantar area combined with toe area were repaired with reverse medial plantar flaps, 2 wounds in anterior plantar area combined with toe area and 5 wounds in anterior plantar area were repaired with reverse medial pedis flaps, 1 wound in toe area was combined with proper plantar digital artery flap, 1 dorsal pedis wound and 1 lateral malleolus wound were repaired with lateral supramalleolar perforator flaps, and 1 lateral malleolus wound and 1 dorsal pedis wound were repaired with sural neurovascular flap. One flap had venous reflux disorder after surgery and survived after treatment, while the other flaps and skin grafts survived completely after surgery. During the follow-up of 6 to 24 months after operation, the appearance of the flaps was good, and the walking function of patients was normal. At the last follow-up, the functional score of foot and ankle was 76 to 95, which was evaluated as excellent in 11 cases and good in 5 cases. Conclusions: According to the condition of high-voltage electric burn in foot and ankle, early and thorough debridement, preoperative imaging examination to evaluate blood vessels of the affected limb, and selection of pedicled axial flap with reliable blood supply are good methods for wound repair and related functional reconstruction of high-voltage electric burn in foot and ankle.