Skin Flap Repair Research Articles

Reactive Oxygen Species Scavenging Injectable Hydrogel Potentiates the Therapeutic Potential of Mesenchymal Stem Cells in Skin Flap Regeneration.

Cell-based therapies offer tremendous potential for skin flap regeneration. However, the hostile microenvironment of the injured tissue adversely affects the longevity and paracrine effects of the implanted cells, severely reducing their therapeutic effectiveness. Here, an injectable hydrogel (nGk) with reactive oxygen species (ROS) scavenging capability, which can amplify the cell viability and functions of encapsulated mesenchymal stem cells (MSCs), is employed to promote skin flap repair. nGk is formulated by dispersing manganese dioxide nanoparticles (MnO2 NPs) in a gelatin/κ-carrageenan hydrogel, which exhibits satisfactory injectable properties and undergoes a sol-gel phase transition at around 40 °C, leading to the formation of a solid gel at physiological temperature. MnO2 NPs enhance the mechanical properties of the hydrogel and give it the ability to scavenge ROS, thus providing a cell-protective system for MSCs. Cell culture studies show that nGk can mitigate the oxidative stress, improve cell viability, and boost stem cell paracrine function to promote angiogenesis. Furthermore, MSC-loaded nGk (nGk@MSCs) can improve the survival of skin flaps by promoting angiogenesis, reducing inflammatory reactions, and attenuating necrosis, providing an effective approach for tissue regeneration. Collectively, injectable nGk has substantial potential to enhance the therapeutic benefits of MSCs, making it a valuable delivery system for cell-based therapies.

IGF-PLGA microspheres promote angiogenesis and accelerate skin flap repair and healing by inhibiting oxidative stress and regulating the Ang 1/Tie 2 signaling pathway

Random flaps are widely used in the treatment of injuries, tumors, congenital malformations, and other diseases. However, postoperative skin flaps are prone to ischemic necrosis, leading to surgical failure. Insulin-like growth factor- 1(IGF-1) belongs to the IGF family and exerts its growth-promoting effects in various tissues through autocrine or paracrine mechanisms. Its application in skin flaps and other traumatic diseases is relatively limited. Poly (lactic-co-glycolic acid) (PLGA) is a degradable high-molecular-weight organic compound commonly used in biomaterials. This study prepared IGF-PLGA sustained-release microspheres to explore their impact on the survival rate of flaps both in vitro and in vivo, as well as the mechanisms involved. The research results demonstrate that IGF-PLGA has a good sustained-release effect. At the cellular level, it can promote 3T3 cell proliferation by inhibiting oxidative stress, inhibit apoptosis, and enhance the tube formation ability of human umbilical vein endothelial cells (HUVEC) . At the animal level, it accelerates flap healing by promoting vascularization through the inhibition of oxidative stress. Furthermore, this study reveals the role of IGF-PLGA in activating the Angiopoietin-1(Ang1)/Tie2 signaling pathway in promoting flap vascularization, providing a strong theoretical basis and therapeutic target for the application of IGF-1 in flaps and other traumatic diseases.

Supramolecular Assembly Based on Calix(4)arene and Aggregation-Induced Emission Photosensitizer for Phototherapy of Drug-Resistant Bacteria and Skin Flap Transplantation.

Photodynamic therapy as a burgeoning and non-invasive theranostic technique has drawn great attention in the field of antibacterial treatment but often encounters undesired phototoxicity of photosensitizers during systemic circulation. Herein, a supramolecular substitution strategy is proposed for phototherapy of drug-resistant bacteria and skin flap repair by using macrocyclic p-sulfonatocalix(4)arene (SC4A) as a host, and two cationic aggregation-induced emission luminogens (AIEgens), namely TPE-QAS and TPE-2QAS, bearing quaternary ammonium group(s) as guests. Through host-guest assembly, the obtained complex exhibits obvious blue fluorescence in the solution due to the restriction of free motion of AIEgens and drastically inhibits efficient type I ROS generation. Then, upon the addition of another guest 4,4'-benzidine dihydrochloride, TPE-QAS can be competitively replaced from the cavity of SC4A to restore its pristine ROS efficiency and photoactivity in aqueous solution. The dissociative TPE-QAS shows a high bacterial binding ability with an efficient treatment for methicillin-resistant Staphylococcus aureus (MRSA) in dark and light irradiation. Meanwhile, it also exhibits an improved survival rate for MRSA-infected skin flap transplantation and largely accelerates the healing process. Thus, such cascaded host-guest assembly is an ideal platform for phototheranostics research.

Limited internal fixation combined with a hinged external fixator in treatment of peri-elbow bone infection

To evaluate the effectiveness of limited internal fixation combined with a hinged external fixator in the treatment of peri-elbow bone infection. The clinical data of 19 patients with peri-elbow bone infection treated with limited internal fixation combined with a hinged external fixator between May 2018 and May 2021 were retrospectively analyzed. There were 15 males and 4 females with an average age of 44.6 years (range, 28-61 years). There were 13 cases of distal humerus fractures and 6 cases of proximal ulna fractures. All the 19 cases were infected after internal fixation of fracture, and 2 cases were complicated with radial nerve injury. According to Cierny-Mader anatomical classification, 11 cases were type Ⅱ, 6 cases were type Ⅲ, and 2 cases were type Ⅳ. The duration of bone infection was 1-3 years. After primary debridement, the bone defect was (3.04±0.28) cm, and the antibiotic bone cement was implanted into the defect area, and the external fixator was installed; 3 cases were repaired with latissimus dorsi myocutaneous flap, and 2 cases were repaired with lateral brachial fascial flap. Bone defects repair and reconstruction were performed after 6-8 weeks of infection control. The wound healing was observed, and white blood cell (WBC), erythrocyte sedimentation rate (ESR), and C-reaction protein (CRP) were reexamined regularly after operation to evaluate the infection control. X-ray films of the affected limb were taken regularly after operation to observe the bone healing in the defect area. At last follow-up, the flexion and extension range of motion and the total range of motion of the elbow joint were observed and recorded, and compared with those before operation, and the function of the elbow joint was evaluated by Mayo score. All patients were followed up 12-34 months (mean, 26.2 months). The wounds healed in 5 cases after skin flap repair. Two cases of recurrent infection were effectively controlled by debridement again and replacement of antibiotic bone cement. The infection control rate was 89.47% (17/19) in the first stage. Two patients with radial nerve injury had poor muscle strength of the affected limb, and the muscle strength of the affected limb recovered from grade Ⅲ to about grade Ⅳ after rehabilitation exercise. During the follow-up period, there was no complication such as incision ulceration, exudation, bone nonunion, infection recurrence, or infection in the bone harvesting area. Bone healing time ranged from 16 to 37 weeks, with an average of 24.2 weeks. WBC, ESR, CRP, PCT, and elbow flexion, extension, and total range of motions significantly improved at last follow-up ( P<0.05). According to Mayo elbow scoring system, the results were excellent in 14 cases, good in 3 cases, and fair in 2 cases, and the excellent and good rate was 89.47%. Limited internal fixation combined with a hinged external fixator in the treatment of the peri-elbow bone infection can effectively control infection and restore the function of the elbow joint.

Comparison of the application methods and effects of skin flaps in the repair of defects in different parts of the nose according to the concept of aesthetic nosesubunits

Objective: To analyze the difference of application methods and effects of local flap in small and medium-sized defects of different aesthetic subunits of nose, in order to provide reference for clinical work. Methods: A retrospective analysis was made on 59 patients with external nasal masses and scars who underwent surgical treatment in the Department of Aesthetic Plastic Surgery of the Affiliated Hospital of Qingdao University from July 1, 2021 to January 30, 2022, including 27 females and 32 males, aged 15 to 69 years. Using Likert scale, the repair methods and effects of local flap for nasal soft tissue defects were evaluated and summarized from three aspects of texture, flatness and scar concealment. GraphPad Prism 5.0 software was used for data statistics and analysis. Results: The use of skin flaps to repair small and medium-sized areas of the nose could achieve satisfactory results. For patients with different subunits, in terms of skin flatness and scar concealment degree in the operation area, patients' satisfaction with the dorsal and lateral nasal areas was higher than that of the alar and tip areas, respectively (F=6.40, P=0.001; F=10.57, P<0.001). For patients with different skin flap repair methods, the satisfaction of patients with Z-plasty and Dufourmentel skin flap was higher than that of other skin flap repair methods (F=4.38, P=0.002), and the satisfaction of patients with Dufourmentel skin flap was the highest in the degree of scar concealment (F=2.57, P=0.038). Conclusions: In the small and medium-sized defects of the nose, the use of multiple local flaps can achieve good cosmetic effects and functional recovery. The operator should select the appropriate flap repair method according to the characteristics of different aesthetic subunits of the nose.

The Efficacy of Wide-Awake Local Anesthesia No Tourniquet (WALANT) in Common Plastic Surgery Operations Performed on the Upper Limbs: A Case-Control Study.

The wide-awake local anesthesia no tourniquet (WALANT) technique is commonly used in elective hand surgery, whereas its application in plastic surgery is still limited. The aim of the study is to evaluate the feasibility and efficacy of WALANT in common plastic surgery operations performed on the upper limbs. Patients who underwent those operations under WALANT were matched and compared with patients who had general or regional anesthesia without infiltration of a local anesthetic solution. All operations were performed by the same surgeon. Data from 98 operations were collected and analyzed for the total operation time, operation theatre time and complication and patient satisfaction rates. All operations under WALANT, mainly skin tumor excision and flap repair or skin grafting and burn escharectomy with or without skin grafting, were completed successfully. No statistical difference in total operation time and complication rates was revealed. Statistical significance favoring WALANT was identified regarding the mean operation theatre time and patient satisfaction. WALANT is an effective method for common plastic surgery operations performed on the upper limbs that is associated with better operation theatre occupancy and high patient satisfaction rates.

SDF-1 Functionalized Hydrogel Microcarriers for Skin Flap Repair.

Critically sized skin flaps used to treat skin defects often suffer from necrosis due to insufficient blood supply. Hence there is an urgent need to improve the survival rate of skin flaps by promoting local angiogenesis. The delivery of growth factor loaded microcarriers have shown promise in enhancing defect repair, however, their rapid clearance from the defect site limits their regenerative potential. Thus, it is critical to develop microcarriers which can promote the sustained release of bioactive factors to effectively stimulate tissue repair. This study aimed to develop a stromal cell-derived factor 1 (SDF-1) loaded microcarrier coated with Matrigel (MC@SDF-1@Mat) to promote skin flap repair. SEM imaging showed that the surface of the microcarrier was coated by a porous Matrigel film. The drug release experiment showed that the Matrigel-coated microcarriers enhanced the sustained release of the model drug methylene blue when compared to uncoated group. MC@SDF-1@Mat significantly promoted the proliferation, migration, and angiogenesis of HUVECs via CCK-8, wound healing assay, and tube formation assay, respectively. Moreover, the murine random skin flap model was further established and treated. It was found that the flap necrosis area in the MC@SDF-1@Mat treated group was significantly reduced. H&E and Masson staining showed the histological structure and collagen organization exhibited a normal phenotype in the MC@SDF-1@Mat treated group. Additionally, CD31 immunohistochemical analysis showed that the MC@SDF-1@Mat treated group exhibited the greatest degree of neovascularization. In conclusion, our SDF-1 functionalized gelatin-based hydrogel microcarrier has potential clinical applications in promoting skin flap repair and drug delivery.

Surgical pearl: Linear closures on the anterior lower leg

Closing defects on the lower leg after Mohs surgery have long posed a surgical challenge because of dynamic movement, increased tension, and poor skin laxity.1 When primary closure is not attainable, alternative closure methods include skin grafting, second-intention healing, flap repair, and suture retention device utilization.1,2 Although these methods have demonstrated efficacy in anterior lower leg defect repairs, they each have limitations, such as cost, a prolonged healing time, technical challenges, and an increased number of follow-up visits.

Modulated integrin signaling receptors of stem cells via ultra-soft hydrogel for promoting angiogenesis

Integrin is a widely distributed adhesion molecule on cell membrane surface, which plays a role in transferring mechanical properties signals of the extracellular matrix into cells during cell adhesion to the extracellular matrix. In this study, by introducing long-chain polyethylene glycol molecules that can be photo-crosslinked into gelatin chains, ultra-soft hydrogel that can simulate soft tissue in vivo is constructed and stimulated by "low matrix stiffness" of the integrin signaling pathway, to promote the vascularization function of stem cells. The storage modulus of the ultra-soft hydrogel at room temperature is as low as 3.24 ± 0.18 Pa and as high as 40.83 ± 1.32 Pa. In vitro experiments showed that the stiffness of hydrogel affects the activation of the phosphorylation of VEGFR by regulating the phosphorylation of integrin and further controls the activation of the ERK pathway, thus regulating the vascularization of ADSCs. In vivo experiments have proved that ADSCs encapsulated in PEG-Gel have excellent performance in repairing skin flaps. The ultra-soft hydrogel can promote the vascularization of ADSCs by activating the "extracellular matrix stiffness-integrin-VEGFR-ERK" regulatory pathway, which is a potential regenerative repair material for promoting the application of stem cells in skin flap repair.

MSC‐Laden Composite Hydrogels for Inflammation and Angiogenic Regulation for Skin Flap Repair

AbstractPressure‐driven, spreadable, deferoxamine (DFO)‐laden hydrogels are developed toward treatment for improved skin flap tissue repair. Further, mesenchymal stem cells (MSCs) are incorporated into silk nanofiber systems and then added to silk hydrogels to optimize angiogenesis and moderate inflammatory reactions in skin flap tissues for repair. The combined (composite) systems result in improved tissue outcomes. For example, the DFO release from the hydrogels is maintained while the system moderated negative influences of DFO on cells at the skin flap site with improved vasculization and for control of immune reactions. Both in vitro and in vivo results reveal improved outcomes with these composite hydrogel systems when MSCs are included. The synergistic action of DFO‐laden silk nanofibers combined with MSC‐laden microgels results in improved functional recovery of skin flaps in vivo when compared to control systems. Considering the ease of use of this system toward clinical applications, these new hydrogels are candidates for skin flap regeneration in surgical settings.

Lateral Circumflex Femoral Vascular Chimeric Fascia Flap Reduces Pain and Promotes Wound Healing in Repairing Skin and Tendon Defects of Hand, Foot, and Ankle.

The purpose of this study was to investigate the clinical efficacy of lateral circumflex femoral artery embedded with fascia lata flap in the repair of skin and tendon defects in hand, foot, and ankle. From January 2020 to June 2021, 32 patients with skin and tendon defects of the hand, foot, and ankle admitted to our hospital were selected as the study subjects. According to the random number table method, they were divided into the observation group (16 cases, treated with rotational lateral femoral vascular inlay broad fascial flap repair) and the control group (16 cases, treated with conventional skin flap repair) and followed up for 6 months. The postoperative tendon midactivity measurement scale (TAM), ankle-hindfoot scoring system (AOFAS), and lower limb functional evaluation scale (LEFS) scores were all higher in the observer group than in the control group The number of people with infection, implant necrosis, and subcutaneous hematoma in the observation group (total incidence 6.25%) was less (lower) than that in the control group (50.00%), and the total number of people with significant and fair clinical efficacy in the observation group (total effective rate 100.00%) was more (higher) than that in the control group (68.75%). The application of early plastic surgery to the clinical treatment of patients with deep burns on the hand can reduce the patient's pain and promote the healing of the wound. It is of great significance to reduce the risk of complications such as necrosis of the skin graft and improve the efficacy of the surgery.

The application of local rotating flap and latissimus dorsi flap in thoracic deformity correction.

Wound healing problem is one of the main complications after correction of chest wall deformity. Orthopedic flap tissue repair technique has a clear significance in non-healing wound and defect wound and provides a new choice for poor wound healing after orthopedic surgery of chest wall deformity. To investigate, the application value of modified local rotary flap and latissimus dorsi myocutcutaneous flap in the treatment of poor wound healing after orthodontic treatment of chest wall deformity. A retrospective analysis was performed on patients who admitted to our department from August 2012 to November 2019 due to non-healing incision after surgery for thoracic deformity. Skin flap was selected according to the size of the wound surface, and the effect of skin flap repair was observed. The clinical data of the included patients were recorded, and the preoperative and postoperative wound conditions were evaluated. This study included 13 patients with chest wall deformity who received plastic surgery tissue using flap technique for wound repair, 11 cases used modified local rotation skin flap, and 2 cases used modified latissimus dorsi myocutaneous flap. The mean age of the 13 patients was 18.54±4.14years old, the mean body mass index (BMI) was 17.02±2.16kg/m2 , and the mean preoperative nonunion time of the incision was 64.77±93.01days. Five patients had positive bacteria culture on the wound surface, including 3 cases of Staphylococcus aureus, 1 case of Pseudomonas aeruginosa, and 1 case of Staphylococcus epidermidis. All the 13 patients achieved primary grade A healing. The modified local rotary flap and latissimus dorsi musculocutaneous flap have a significant effect on the postoperative correction of chest wall deformity, which can ensure wound healing while retaining the orthopedic plate to the maximum extent to ensure the effect of the correction.

Use of the O-Z Flap to Repair Scalp Defects After Cancer Tumor Resection.

Large benign and malignant tumors in the scalp cannot be sutured directly after resection. Instead, skin grafting or skin flap repair is the most commonly used techniques. Local tissue depression and lack of hair growth are some of the drawbacks associated with these techniques. The use of a modified local flap (the O-Z flap) may effectively overcome these issues. To explore the application of O-Z flap in wound repair after excision of benign and malignant tumors of the scalp. Between April 2016 and November 2017, the authors treated 6 patients with scalp tumors. They underwent round or oval radical tumor resection with negative margins. Tumor specimens were diagnosed by cryosection during operation. According to the wound defect size and location, surrounding scalp looseness, and hair distribution, 2 rotating flaps in opposite directions were formed on the left and right sides or front and back of the wound. Subsequently, the skin flaps were rotated in opposite directions to repair the wound. The scalp tumors comprised 2 cases of basal cell carcinoma, 2 cases of squamous cell carcinoma, 1 case of hair sheath carcinoma, and 1 case of epidermoid cyst. After complete tumor resection, the wound defect area was between 3.0 cm × 3.5 cm and 5.0 cm × 6.0 cm. After operation, approximately 6% of the tip of the skin flap was necrotized. The wounds healed after 4 weeks of dressing treatment. All skin flaps survived in stage I and no complications occurred. All patients were followed up for 3 to 12 months; the scalps were in good condition and no tumor recurrence was found. The use of the O-Z flap to repair scalp wounds offers flexible design, good blood circulation, uniform tension, and good hair growth after operation; thus, this technique is suitable for wound repair following scalp tumor resection.

Clinical analysis of oral and oropharyngeal cancer resection through oral approach

Objective:To investigate the treatment effect of oral and oropharyngeal cancer resection through oral approach. Methods:Forty-eight patients who with oral and oropharyngeal cancer were admitted to the Department of Oral and Maxillofacial Surgery of the First Affiliated Hospital of Bengbu Medical College from January 2015 to January 2018, and all received preoperative chemotherapy, surgical treatment and postoperative radiotherapy. Among them, twenty-four patients who were treated with tumor resection through oral approach in the experimental group, the other twenty-four patients were treated with tumor resection by external approach in the control group. During the operation, both groups of patients were underwent selective neck lymph node dissection and free skin flap transplantation, and preventive radiotherapy were performed after the operation. The operation time, blood loss, and the positive rate of the wound around the wound and the undercut margin of the two groups were compared, and the survival rate of the skin flap was analyzed. The Kaplan-Meier method was used to calculate the survival rate after 3 years of regular follow-up after surgery, and the difference between the curves of the two surgical methods were compared by the Log-rank test, and the quality of life of patients in one year after operation was investigated and analyzed by Washington University students'quality questionnaire 4. Results:The operation time and blood loss of the experimental group were less than the control group, but the difference was not statistically significant（P>0.05）. The positive rate of frozen margins in both groups was 0. The flap survival rate was 95.8% in the experimental group and 91.7% in the control group, there was no significant difference between the two groups（P>0.05）, the overall flap survival rate in the two groups was 93.8%. The survival rates of the experimental group were 91.7%, 83.3%, and 74.8% in the 1-, 2-, and 3-years after surgery, and 87.5%, 79.2%, and 75.0% in the control group, there was no statistically significant difference between the experimental group and the control group（P>0.05）. The 1-year, 2-year and 3-year overall survival rates of the two groups were 93.1%, 83.7% and 78.8% respectively. Compared with the control group, the scores of appearance, activity, recreation, swallowing, chewing, speech and mood in the experimental group were significantly higher（P<0.05）. Conclusion:Resection of oral cancer tumors through the oral approach with free skin flap repair is in line with the concept of minimally invasive surgery, which improves the quality of life of patients after surgery while ensuring the survival rate, and is worthy of clinical application and promotion.

Wound Management of Multi-Site Pressure Ulcer at Different Stages in Elderly Patients.

ObjectiveThe present study aims to explore the individualized treatment options for multisite pressure ulcer (PU) at various stages in elderly patients with multiple medical conditions.MethodsStages 1 and 2 PU at 146 sites were treated with closed negative pressure suction combined with continuous micro-oxygen perfusion and the local application of foam dressings, silver ion dressings, and moist burn cream. Stages 3 and 4 PU in the sacrococcygeal region were treated with skin or myocutaneous flap transplantation.ResultsStages 1 and 2 PU healed after treatment with closed negative pressure suction combined with continuous micro-oxygen perfusion and dressing changes. One case died during hospitalization due to an illness. Skin or myocutaneous flap repair was conducted in 34 cases of stage 3 or 4 PU in the sacrococcygeal area. Of these cases, 28 achieved primary healing, and 6 required two or three surgeries, 5 of which received micro-skin implantation. In addition, 10 small deep PU at other sites were repaired by direct excision and suturing or local flap repair. Seven cases were transferred to other departments or hospitals due to concomitant diseases or were discharged automatically without surgical treatment.ConclusionHome care for geriatric patients is difficult. PU often occur at multiple sites because of the duration of various pressures, and different sites may demonstrate different stages because of varying degrees of pressure. When actively treating stages 3 and 4 PU, the trauma management of stages 1 and 2 PU should not be neglected.

Therapeutic application of skin stretch closure device for treatment of limbs skin wound defects in children

To analyze the clinical application value of adjustable skin retractor in large area of limb wound defect in children. From January 2017 to January 2019, 11 children including 9 males and 2 females, aged 4 to 12 (8.3±2.7) years old with severe lower extremity wound defects were treated with adjustable skin stretch and closure device, all of them were unilateral lower extremity large area wound defects, including 4 cases of limb skin defect caused by traffic accident, 3 cases of failure to close after osteofasciotomy and decompression, 3 cases of plate exposure after internal fixation of lower extremity fracture and 1 case of ischemic necrosis after debridement and suturing of skin avulsion. The width of the wound was (5.6±1.2) cm and the length was (7.0±1.6) cm. VSD negative pressure drainage and expanded suture were used in all the patients. Four of them had been treated with free skin graft and two had been treated with local flap transfer. The graft or flap operation failed, and the effect of the early treatment was not good. After 5 to 14 (10.5±2.6) days of continuous traction, the wound was closed and no skin grafting or flap repair was performed. No complications such as poor blood supply, skin infection and necrosis, peripheral sensory disturbance occurred. All 11 patients were followed up for 3 to 18 (8.9±3.8) months. The wound edge skin was linear healing with slight scar. It is in accordance with Wolff's law and the concept of natural tissue reconstruction to treat large-scale limb wound defects in children with adjustable skin stretch and closure device, which provides an effective method for the treatment of limb skin and soft tissue defects in children.

Clinical features and treatment of 140 cases of Marjolin's ulcer at a major burn center in southwest China.

Marjolin's ulcer is a type of malignant tumor that occurs in scar tissue. The present study aimed to summarize and analyze the aetiology, clinical characteristics, treatment methods, metastasis and prognosis of this disease. A total of 140 cases of Marjolin's ulcer encountered at the Institute of Burn Research, Southwest Hospital (Chongqing, China) between January 2013 and December 2017 were retrospectively analyzed. Demographic data, clinical characteristics, occurrence of bone invasion and lymph node metastasis, as well as treatment and prognosis were statistically analyzed. Among the 140 patients, the initial injury or primary disease occurred at 1–75 years of age, while Marjolin's ulcer occurred at 15–85 years of age (mean, 53.3±1.2 years). The mean latency period was 28.8±1.7 years. The most common initial injury of the patients was flame burns, followed by skin masses, trauma, skin ulcerations caused by repeated scratching/friction, and scalding. The age at onset of initial injury or disease in patients had a significantly negative correlation with the latency period (P<0.01). The most common lesion locations were the lower limbs (42.1%), followed by the head, face and neck (34.5%). Of the 140 patients, 46 cases (32.9%) had bone invasion, 33 cases (23.6%) had lymph node enlargement and only 5 cases (3.6%) had lymph node metastasis. The skull was the bone that was most susceptible to Marjolin's ulcer invasion. The prevalence of bone invasion in patients with head, face and neck lesions was significantly higher than that in patients with lesions in other locations (P<0.01). The surgical methods applied were skin grafting, local flap repair, amputation and island flap repair. In the 65 cases who underwent follow-up, recurrence mainly occurred within 1 year after surgery. In conclusion, Marjolin's ulcer mainly occurred in males and was a scar carcinoma after a flame burn in most cases. Autologous skin grafting and local skin flap repair were the major repair methods. The peak period of recurrence was within one year after surgery and patients should receive regular follow-ups.

Contemporary analysis of management of isolated pendulous urethral strictures using pedicled skin flap urethroplasty repair.

To evaluate contemporary outcomes of urethroplasty employing a pedicled skin flap for isolated pendulous urethral strictures. Inclusion of males > 18years of age with isolated pendulous urethral strictures treated between 1996 and 2012. A total of 81 patients with isolated pendulous urethral stricture were identified. Twenty-eight patients underwent repair with a pedicled skin flap during the study period. The median age of the patients treated with a pedicled skin flap was 47years old (range 21-74). The etiology of the strictures was considered to be idiopathic in 10 patients (35.7%), iatrogenic in 9 patients (32.1%), as a complication of prior hypospadias repair in 6 patients (21.4%), infectious in 2 patients (7.1%), and traumatic in 1 patient (3.6%). The median follow-up was 27months (range 1-214). Urethroplasty success was noted in 19/21 patients (90.5%). Urethral stricture recurrence occurred in 2 of the 21 patients (9.5%). The pedicled skin flap repair for pendulous urethral strictures remains a durable and safe technique in patients without LS.

Discussion on dealing skills of complex soft tissue problems in osteomyelitis treated by Ilizarov technique

To discuss skills for the treatment of complex soft tissue problems in osteomyelitis using Ilizarov techniques. The clinical data of 31 patients with complex soft tissue problems during the treatment of osteomyelitis with Ilizarov technique between January 2015 and June 2017 were retrospectively analyzed. There were 23 males and 8 females, with an age of 14-67 years (mean, 37.8 years). All the patients were post-traumatic chronic osteomyelitis, the disease duration was 12 days to 16 months (mean, 6.3 months). They went through 2-8 times surgeries (mean, 3.8 times). There were 29 cases of soft tissue insertion after bone grafting; 1 case of strephopodia and calcaneal osteomyelitis with plantar skin infection defect; 1 case of the open tibial fracture postoperative infection, the skin defect of infection was more than that of bone defect. The soft tissue defect area was 4.5 cm×4.0 cm to 16.5 cm×8.5 cm. Soft tissue depression and insertion was corrected by subcutaneous insertion of Kirschner wire after slow elastic retraction. Soft tissue defects were gradually resolved through slow traction. All patients were followed up 6-24 months (mean, 11.5 months). All wounds healed by first intention, and skin graft and flap repair were not performed in the two stage. One case of strephopodia and calcaneal osteomyelitis with plantar skin infection defect was treated with slow skin traction, no secondary suture was performed; no skin ulceration was found after walking for 3 months, and the feeling was slightly lower than normal. One case of soft tissue transverse traction wound completely covered, with no bone exposure and no obvious pigmentation of local soft tissue, the feeling was slightly lower than normal, the skin elasticity was worse than normal, and the color, temperature had no obvious abnormalities. There was no severe needle eye reactions in 29 patients with skin depressions corrected by Kirschner wire. Six cases of Kirschner wire showed elastic retraction and lacerate skin; 1 case of plantar skin traction had 2 times of exudation of the needle eye and local skin reddish phenomenon; the symptoms relieved when the traction needle was changed once, the traction was stopped for 1 week, the dressing was changed and antibiotics were used once. One patient with transverse traction had 3 times of pin-eye infection, and the treatment was completed after adjusting the traction device and symptomatic treatment. For most of the complex soft tissue problems in osteomyelitis, early and effective intervention with Ilizarov technique can be easily, economically, and effectively solved, which provides a new way for clinical treatment.

Analysis of Staged Treatment for Gustilo Anderson IIIB/C Open Tibial Fractures

Background:Gustilo Anderson III B/C open tibial fractures are more difficult to manage than I, II, and III A fractures. These open tibial fractures are often associated with wound infection, soft tissue necrosis, bone nonunion, osteomyelitis or amputation. Staged treatment for this severe trauma is very necessary.Materials and Methods:25 cases of Gustilo Anderson IIIB/C open tibial fractures with serious soft-tissue defects treated between January 2010 and January 2015 were included in this study. The treatment was administered in three stages. The first stage included emergency debridement, external fixation, repair of damaged main blood vessels and nerves, covering of the wound, and infection control. The second stage involved skin flap or skin graft placement to repair wounds. The third stage involved replacement of the external fixator with an internal fixator and the placement of bone grafts.Results:All the skin flaps or skin grafts survived, and a small necrotic area in the distal flap was observed in only two cases (which resolved spontaneously after the dressing was changed). Bone union occurred at the predicted time in 23 cases, while it was delayed in 2 cases. The rate of excellent and good was 88%.Conclusion:Staged treatment was safe and effective for Gustilo Anderson IIIB/C tibial fractures. The timing for the placement of internal and external fixators and choosing the appropriate skin flap repair technique are important.