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Objective: To summarize the progress of the roles and mechanisms of various types of stem cell-based treatments and their combination therapies in both animal studies and clinical trials of lymphedema., Methods: The literature on stem cell-based treatments for lymphedema in recent years at home and abroad was extensively reviewed, and the animal studies and clinical trials on different types of stem cells for lymphedema were summarized., Results: Various types of stem cells have shown certain effects in animal studies and clinical trials on the treatment of lymphedema, mainly through local differentiation into lymphoid endothelial cells and paracrine cytokines with different functions. Current research focuses on two cell types, adipose derived stem cells and bone marrow mesenchymal stem cells, both of which have their own advantages and disadvantages, mainly reflected in the therapeutic effect of stem cells, the difficulty of obtaining stem cells and the content in vivo . In addition, stem cells can also play a synergistic role in combination with other treatments, such as conservative treatment, surgical intervention, cytokines, biological scaffolds, and so on. However, it is still limited to the basic research stage, and only a small number of studies have completed clinical trials., Conclusion: Stem cells have great transformation potential in the treatment of lymphedema, but there is no unified standard in the selection of cell types, the amount of transplanted cells, and the timing of transplantation.

Objective: To investigate the effectiveness of tibial transverse transport (TTT) combined with modified neurolysis in treatment of diabetic foot ulcer (DFU) through a prospective randomized controlled study., Methods: The patients with DFU and diabetic peripheral neuropathy, who were admitted between February 2020 and February 2022, were selected as the research objects, of which 31 cases met the selection criteria and were included in the study. The patients were divided into two groups by random number table method. The 15 patients in the trial group were treated with TTT combined with modified neurolysis, and the 16 patients in the control group received treatment with TTT alone. There was no significant difference in gender, age, duration of DFU, ulcer area, Wagner classification, as well as preoperative foot skin temperature, visual analogue scale (VAS) score, ankle-brachial index (ABI), motor nerve conduction velocity (MNCV) of the common peroneal nerve, MNCV of the tibial nerve, MNCV of the deep peroneal nerve, two-point discrimination (2-PD) of heel, and cross-sectional area (CSA) of the common peroneal nerve between the two groups ( P >0.05). The time for ulcer healing, foot skin temperature, VAS scores, ABI, 2-PD of heel, and CSA of the common peroneal nerve before operation and at 6 and 12 months after operation were recorded and compared between groups. The differences in MNCV of the common peroneal nerve, MNCV of the tibial nerve, and MNCV of the deep peroneal nerve between pre-operation and 12 months after operation were calculated., Results: All patients in both groups were followed up 12-24 months (mean, 13.9 months). The surgical incisions in both groups healed by first intention and no needle tract infections occurred during the bone transport phase. Ulcer wounds in both groups healed successfully, and there was no significant difference in the healing time ( P >0.05). During the follow-up, there was no ulcer recurrences. At 12 months after operation, the MNCV of the common peroneal nerve, the MNCV of the tibial nerve, and the MNCV of the deep peroneal nerve in both groups accelerated when compared to preoperative values ( P <0.05). Furthermore, the trial group exhibited a greater acceleration in MNCV compared to the control group, and the difference was significant ( P <0.05). The foot skin temperature, VAS score, ABI, 2-PD of heel, and CSA of the common peroneal nerve at 6 and 12 months after operation significantly improved when compared with those before operation in both groups ( P <0.05). The 2-PD gradually improved over time, showing significant difference ( P <0.05). The 2-PD of heel and VAS score of the trial group were superior to the control group, and the differences were significant ( P <0.05). There was no significant difference in ABI, foot skin temperature, and CSA of the common peroneal nerve between groups after operation ( P >0.05)., Conclusion: Compared with TTT alone, the TTT combined with modified neurolysis for DFU can simultaneously solve both microcirculatory disorders and nerve compression, improve the quality of nerve function recovery, and enhance the patient's quality of life.

Introduction: Owing to the need for liposuction and its unsuitability for allogeneic transplantation, the clinical application of stromal vascular fraction gel (SVF-gel) combined with fractional CO 2 laser for scar treatment is limited. Adipose tissue extract (ATE), rich in cytokines and growth factors, offers a more convenient option for clinical practice as it can be easily prepared using purely physical methods and has low immunogenicity. We aimed to evaluate the effectiveness of ATE combined with fractional CO 2 laser in the treatment of hypertrophic scars. Methods: ATE was prepared using discarded liposuction fluid from patients undergoing liposuction. A rabbit ear hypertrophic scar model was established and treated with ATE, fractional CO 2 laser, or a combination. PBS was used as a control. The scar appearance and histological changes were observed. The immunohistochemistry method was used to evaluate the expression of α-SMA, while perilipin was detected using immunofluorescence. Additionally, the level of adipogenic signal C/EBPα and PPARγ mRNA was studied. Results: Following treatment, the volume of hypertrophic scar decreased, resulting in a softer texture and thinner dermis. Additionally, there was a decrease in the infiltration of inflammatory cells, and the collagen arrangement became looser and more regular, and the expression of α-SMA also decreased, with the combination of ATE and fractional laser showing the most significant improvement. Moreover, the combination group was found to promote subcutaneous fat regeneration and increase the expression of adipogenic signals C/EBPα and PPARγ. Conclusion: The combination of ATE and fractional CO 2 laser treatment has been shown to inhibit the development of hypertrophic scars. This effect may be attributed to the enhancement of adipogenesis and decrease in collagen deposition., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Cai, Tian, Li, Liu, Li, Zhang, Xiao, Jia and Deng.)

Objective: To review the advances in methods for reconstructing nipple projection based on tissue graft support., Methods: The literature related to nipple projection reconstruction based on tissue graft support was reviewed and summarized in terms of the advantages and disadvantages of various tissue grafts and the improved nipple projection results., Results: Loss of nipple projection is a common cause of decreased patient's satisfaction. Reconstructing nipple projection based on tissue graft support is a more common clinical method and can be done with autologous and allogeneic tissues. Autologous tissue grafts include dermis, adipose tissue with dermis, adipose tissue, ear cartilage, rib cartilage, and contralateral nipple tissue. Autologous tissue grafts are easy to obtain and have no immune rejection, but may lead to donor area damage and prolong the surgical time for tissue collection. Allogeneic tissue grafts include acellular dermal matrix, lyophilized rib cartilage, and extracellular matrix collagen, and decellularized nipple tissue. Allogeneic tissue grafts do not cause additional donor area damage, are highly malleable, and can be designed to be utilized according to the recipient area, but the high cost often limits the development of this technique., Conclusion: There is no gold standard regarding tissue graft-assisted nipple projection reconstruction techniques, and there are advantages and disadvantages to both autologous and allogeneic tissue grafts. Surgeons should choose the appropriate graft based on the actual condition of the patient.

Objective: To review the research progress of supraclavicular vascularized lymph node transfer (VLNT)., Methods: The research literature related to supraclavicular VLNT at home and abroad in recent years was extensively reviewed, and the anatomy of supraclavicular lymph nodes, clinical applications, and complications of supraclavicular VLNT were summarized., Results: The supraclavicular lymph nodes are anatomically constant, located in the posterior cervical triangle zone, and the blood supply comes mainly from the transverse cervical artery. There are individual differences in the number of supraclavicular lymph nodes, and preoperative ultrasonography is helpful to clarify the number of lymph nodes. Clinical studies have shown that supraclavicular VLNT can relieve limb swelling, reduce the incidence of infection, and improve quality of life in patients with lymphedema. And the effectiveness of supraclavicular VLNT can be improved by combined with lymphovenous anastomosis, resection procedures, and liposuction., Conclusion: There are a large number of supraclavicular lymph nodes, with abundant blood supply. It has been proven to be effective for any period of lymphedema, and the combined treatment is more effective. The more clinical studies are needed to clarify the effectiveness of supraclavicular VLNT alone or in combination, as well as the surgical approach and timing of the combined treatment.

Objective: To summarize the research progress of combined surgical treatment of lymphedema based on vascularized lymph node transfer (VLNT), and to provide systematic information for combined surgical treatment of lymphedema., Methods: Literature on VLNT in recent years was extensively reviewed, and the history, treatment mechanism, and clinical application of VLNT were summarized, with emphasis on the research progress of VLNT combined with other surgical methods., Results: VLNT is a physiological operation to restore lymphatic drainage. Multiple lymph node donor sites have been developed clinically, and two hypotheses have been proposed to explain its mechanism for the treatment of lymphedema. But it has some inadequacies such as slow effect and limb volume reduction rate less than 60%. To address these inadequacies, VLNT combined with other surgical methods for lymphedema has become a trend. VLNT can be used in combination with lymphovenous anastomosis (LVA), liposuction, debulking operation, breast reconstruction, and tissue engineered material, which have been shown to reduce the volume of affected limbs, reduce the incidence of cellulitis, and improve patients' quality of life., Conclusion: Current evidence shows that VLNT is safe and feasible in combination with LVA, liposuction, debulking operation, breast reconstruction, and tissue engineered material. However, many issues need to be solved, including the sequence of two surgeries, the interval between two surgeries, and the effectiveness compared with surgery alone. Rigorous standardized clinical studies need to be designed to confirm the efficacy of VLNT alone or in combination, and to further discuss the subsistent issues in the use of combination therapy.

Objective: To explore the effectiveness of microdissected thin thoracodorsal arterial perforator flap (TDAP) in repairing diabetic foot ulcers (DFUs)., Methods: The clinical data of 11 patients with DFUs admitted between March 2020 and February 2021 were retrospectively analyzed, including 5 males and 6 females, aged from 22 to 67 years, with an average of 49.3 years. There were 10 cases of type 2 diabetes and 1 case of type 1 diabetes; the duration of diabetes ranged from 3 months to 25 years (median, 8 months). The duration of DFUs ranged from 6 days to 120 months (median, 1 month). There were 6 cases of grade 3 and 5 cases of grade 4 according to Wagner classification. The tissue necrosis and purulent secretions were found in all ulcer wounds, as well as different degrees of tendon and bone exposure; skin defects ranged from 5 cm×3 cm to 17 cm×6 cm. The DFUs were repaired by microdissected thin TDAP, including 6 cases of flaps (including 1 case of lobulated flap), ranging from 10.0 cm×4.5 cm to 26.0 cm×7.0 cm; 5 cases of chimeric perforator flaps, the range of the flap was 10.0 cm×4.5 cm to 16.0 cm×5.5 cm, and the range of the muscle flap was 6 cm×2 cm to 10 cm×3 cm. The donor site was sutured directly., Results: The operation time ranged from 3.42 to 11.17 hours, with an average of 5.92 hours. All 11 flaps survived and no vascular crisis occurred; 1 patient had a sinus at the edge of the flap, and the surgical area healed well after dressing change. All 11 patients were followed up 6-12 months, with an average of 9 months. The flap texture was good, the recipient site was in good shape, and there was no swelling; the foot contour was good, the shoes were comfortable to wear, and the movement was good. The incision at the donor site healed by first intention, leaving only linear and concealed scar, without obvious depression deformity, and the shoulder joint function was good., Conclusion: On the premise of ensuring sufficient blood supply to the lower extremities and strengthening perioperative management, the microdissected thin TDAP to repair DFUs wounds can achieve better effectiveness and appearance; however, the prolonged operation time increases the probability of anesthesia and surgical risks in patients with DFUs.

Objective: To provide systematic information for deep understanding and improvement of tension-reducing suture of deep layer skin., Methods: The related literature over the years was extensively collected and precisely processed to summarize the characteristics and applications of different tension-reducing suture of deep layer skin., Results: Throughout the development of plastic surgery, tension-reducing suture of deep layer skin mainly includes vertical mattress suture and its modified styles, horizontal mattress suture and its modified styles, and some special types of suture technique, and each one of them has its own characteristics and is suitable for wounds with different tension and shape., Conclusion: Clinically, surgeons need to select appropriate tension-reducing suture techniques according to specific factors such as wound location and tension, so as to fully reduce the tension of the wound, which can achieve good wound healing and prevent the pathological scaring.

Objective: To explore the effectiveness of thin free lateral femoral circumflex artery perforator flaps that dissected under the superficial fascia in repair of scar contracture deformity in hand and foot., Methods: Between January 2017 and October 2020, 15 patients with scar contracture deformity in hand or foot were admitted. There were 9 males and 6 females; aged 6-42 years, with a median age of 23 years. Scar contracture lasted from 1 to 21 years, with a median of 13 years. There were 11 cases of scar contracture deformities in the hands and 4 cases in the feet, all of which showed different degrees of hand and foot joint dysfunction. After the scar contracture was released, the size of wounds ranged from 6 cm×4 cm to 9 cm×8 cm, including 12 cases with exposure of blood vessels, nerves, or tendons, and 4 cases with tendon defects. A thin free lateral circumflex femoral artery perforator flap that dissected under the superficial fascia was used to repair the wound. The size of flap ranged from 6.0 cm×5.0 cm to 10.0 cm×8.5 cm. Fascia strips were used to reconstruct tendons and the donor sites were sutured directly., Results: The venous vascular crisis occurred in 1 flap, and the flap survived successfully after treatment. The rest flaps survived well, and the wounds healed by first intention. All incisions at donor sites healed by first intention. All patients were followed up 6-12 months after operation, with an average of 9 months. The flaps were in good shape and texture. The functions of the affected hand had been restored to a large extent. According to the upper limb function evaluation standard of the Society of Hand Surgery of the Chinese Medical Association, 7 cases were excellent and 4 cases were good. The deformity of the toe joint of the affected foot significantly improved. No muscular hernia, sensory numbness, or other complications occurred at the donor sites., Conclusion: The thin free lateral femoral circumflex artery perforator flap that dissected under the superficial fascia is an effective method to repair scar contracture deformity of hand and foot with well appearance, good function recovery, and less complication of the donor sites.

Objective: To explore the effectiveness of free lobed perforator flaps in repairing of complex wounds of limbs., Methods: Between January 2018 and January 2021, 10 patients with complex wounds of limbs were admitted. There were 7 males and 3 females, aged from 32 to 64 years, with an average age of 45 years. There were 4 cases of traffic accident injuries, 3 cases of machine strangulation injuries, 1 case of machine crush injury, and 2 cases of heavy object crush injuries. There were 5 cases of upper limb wounds and 5 cases of lower limb wounds. The size of wounds ranged from 11 cm×10 cm to 25 cm×18 cm. The wounds were repaired with tri-lobed flaps of the descending branch of the lateral femoral circumflex artery in 7 cases, four-lobed flaps in 2 cases, and with tri-lobed flaps of the descending branch of the lateral femoral circumflex artery combined with oblique branch in 1 case. The size of flaps ranged from 12.0 cm×10.5 cm to 28.0 cm×12.0 cm. The donor sites were sutured directly in 9 cases and repaired with superficial iliac circumflex artery perforator flap in 1 case., Results: Sinus formed at the edge of the flap in 1 patient, which healed after dressing change and drainage; other flaps survived well, and the wounds healed by first intention. The skin flap at donor site survived, and the incisions healed by first intention. All patients were followed up 6-24 months (mean, 11 months). All flaps had good appearance and function, and linear scars were left at the donor site without obvious complications., Conclusion: Free lobed perforator flap is an alternative method to repair complex wounds of limbs with high safety, good effectiveness, and less complications.

Objective: To investigate the vascular anatomy and the clinical application of type Ⅲ perforator flap based on the oblique branch of lateral circumflex femoral artery on skin soft tissue defect at the limbs., Methods: Vascular anatomy of anterolateral thigh flap was performed on a 43-year-old male cadaver perfused with red latex, and the travel and perforating distribution of the oblique branches of lateral circumflex femoral artery were observed. A retrospective case series study was used to analyze the clinical data of 12 patients with skin soft tissue defects of the extremities admitted between January 2018 and September 2019, including 9 males and 3 females; aged from 18 to 65 years, with a median age of 32 years. The injury site included 7 cases of foot and ankle, 3 cases of calf, and 2 cases of hand. The wound size was ranged from 9 cm×7 cm to 28 cm×10 cm. The time from injury to operation was 1-2 weeks, with an average of 10 days. All patients were repaired with type Ⅲ perforator flap based on the oblique branch of lateral circumflex femoral artery, including 3 cases of single-leaf flap, 6 cases of double-leaf flaps, and 3 cases of tri-leaf flaps. The flap ranged from 15 cm×5 cm to 28 cm×10 cm. The donor site was directly sutured or repaired with local flap. The flap survival and complications were observed after operation., Results: The results of vascular anatomy showed that the lateral femoral circumflex artery sent out transverse branches, oblique branches, and descending branches. The oblique branches sent out multiple muscle perforating branches along the way, the perforating branches passed through the anterolateral femoral muscle, and the blood supply scope was the skin of the anterolateral femoral region. The clinical results showed that all flaps survived completely and the incisions healed by first intension. There was no complication such as vascular crisis. All 12 patients were followed up 3-12 months, with an average of 7 months. The appearance and texture of the flap were good. At last follow-up, according to the British Medical Research Council (BMRC) Society for neurological trauma standard, the sensory of the flap reached S 2 in 9 cases and S 3 in 3 cases. Linear scar remained in the donor area, without pain, pruritus, tactile allergy, and other discomfort. The patients and their families were satisfied., Conclusion: Type Ⅲ perforator flap based on the oblique branch of lateral circumflex femoral artery is a reliable method for repairing the soft tissue defect of the limbs, with reliable blood supply, large cutting area, various types of perforator flaps.

Objective: To explore the feasibility and accuracy of modified three longitudinal and five transverse method in locating perforating branches before anterolateral thigh perforator flap (ALTP) repair., Methods: Between January 2019 and December 2019, 41 patients with skin and soft tissue defects were repaired with ALTP. There were 31 males and 10 females. The age ranged from 18 to 61 years, with an average of 32 years. The soft tissue defects were caused by trauma in 38 cases, and the time from injury to operation was 3-7 days, with an average of 4 days. The wounds left after excision of scar contracture deformity because of burn in 3 cases. Soft tissue defects located at upper limbs in 16 cases and lower limbs in 25 cases. The size of soft tissue defects ranged from 10 cm×4 cm to 25 cm×12 cm. Before operation, zonesⅠ, Ⅱ, Ⅲ, and Ⅳwere formed on the anterolateral thigh by modified three longitudinal and five transverse method. The perforating branches were detected in these four zones by Doppler ultrasound, and the skin flaps were designed according to the wound area. The perforating branches were explored during operation, and the distribution and types of perforating branches in each zone and the relationship between perforating branches and lateral femoral cutaneous nerve were observed. The ALTP with the size of 12 cm×5 cm to 30 cm×10 cm was used to repair the wound, and the donor site was sutured directly or repaired with the flap., Results: A total of 117 perforating branches were detected in 41 patients before operation, and 111 perforating branches were found during operation, with a false positive rate of 5%. The probability of perforating branches in zonesⅠ, Ⅱ, Ⅲ, and Ⅳ were 56%, 73%, 76%, and 66% respectively, and the false positive rates were -9%, 7%, 16%, and 4%, respectively. All perforating branches located near the trunk of lateral femoral cutaneous nerve, especially in posterolateral area. There were only 1 perforating branch in 6 cases, 2 perforating branches in 12 cases, 3 perforating branches in 10 cases, and 4 perforating branches in 13 cases. The main types of perforating branches in zonesⅠ, Ⅱ, Ⅲ, and Ⅳ were transverse perforating branches, oblique perforating branches, descending perforating branches, and descending perforating branches, respectively. Partial distal necrosis occurred in 2 cases and complete necrosis occurred in 1 case after operation, and the wounds were repaired with skin grafts. The remaining 38 flaps survived successfully, and the wounds and the incisions of donor sites healed by first intention. All patients were followed up 3 to 12 months, with an average of 6 months. The appearance and texture of the skin flap were acceptable, and linear scar remained in the donor site., Conclusion: It can simply locate and distinguish the perforating branches and better protect the lateral femoral cutaneous nerve by using the modified three longitudinal and five transverse method before ALTP repair.

Objective: To investigate the effectiveness of multiple tension reduction suture of in-situ return needle vertical mattress suture and in-situ return needle horizontal mattress suture combination with intradermal intermittent continuous suture (denominated as Zunyi's Suture Method) on suturing the donor site of the anterolateral thigh flap., Methods: Between January 2019 and December 2019, 62 patients were treated with anterolateral thigh flaps to repair wounds. There were 46 males and 16 females, aged 9-67 years (mean, 31 years). The size of anterolateral thigh flap ranged from 6 cm×5 cm to 25 cm×7 cm. The donor site of the flap was sutured directly by the Zunyi's Suture Method. The skin on both sides of the incision was advanced to the middle, and the wound edge was attached and in a state of negative tension. The intradermal suture line was removed at 7 days after operation. The complications and scars at donor site were observed during follow-up. The Vancouver Scar Scale was used to assess the appearance of scars and the width of scars were measured at 6 months after operation., Results: The flaps survived smoothly, and the wounds healed by first intention. The incisions at donor sites healed by first intention at 2 to 3 weeks after operation. All patients were followed up 7-16 months, with an average of 10.7 months. There was no ischemic necrosis of the donor site or skin threading. There was pigmentation of the needle back point in the early stage, and the pigmentation completely disappeared after 3 to 6 months without scar hyperplasia. At 6 months after operation, liner scars were achieved in all the patients with an average Vancouver Scar Scale score of 2.5 (range, 1.0-3.5) and an average width of 2.4 mm (range, 0.8-9.1 mm)., Conclusion: The suture of the donor site of the anterolateral thigh flap with Zunyi's Suture Method can effectively reduce the tension on wound edges and scar hyperplasia.

Objective: To summarize the research progress of the effects of high glucose microenvironment on the biological activity of adipose-derived stem cells (ADSCs)., Methods: The literature on the high glucose microenvironment and ADSCs at home and abroad in recent years was reviewed, and the effects of high glucose microenvironment on the general characteristics, differentiation potential, angiogenesis, and nerve regeneration of ADSCs were summarized., Results: The accumulation of advanced glycosylation end products (AGEs) in the high glucose microenvironment led to changes in the biological activities of ADSCs through various pathways, including cell surface markers, proliferation, migration, multi-lineage differentiation, secretory function, and tissue repair ability. The ability of ADSCs to promote angiogenesis and nerve regeneration in high glucose microenvironment is still controversial., Conclusion: High glucose microenvironment can affect the biological activity of ADSCs, and the effect and mechanism of ADSCs on angiogenesis and nerve regeneration in high glucose microenvironment need to be further studied.

Objective: To summarize the research progress of adipose-derived stem cells (ADSCs) in promoting the repair of peripheral nerve injury., Methods: The related literature at home and abroad in recent years was widely reviewed, the mechanism of ADSCs promoting the repair of peripheral nerve injury was introduced, and its basic research progress was analyzed and summarized. Finally, the clinical transformation application of ADSCs in the treatment of peripheral nerve injury was introduced, the existing problems were pointed out, and the new treatment regimen was prospected., Results: ADSCs have the function of differentiation and paracrine, and their secreted neurotrophic factors, antiapoptosis, and antioxidant factors can promote the repair of peripheral nerve injury., Conclusion: ADSCs are rich in content and easy to obtain, which has a definite effectiveness on the repair of peripheral nerve injury with potential clinical prospect.

Objective: To investigate effectiveness of anteromedial thigh perforator flap in repair of soft tissue defects of lower limbs., Methods: Between January 2015 and October 2018, 7 patients with soft tissue defects of the lower limbs were repaired with the anteromedial thigh perforator flaps. The patients were males, aged 8-30 years (median, 23 years). There were 5 cases of traffic accident injuries (the time from injury to admission was 1-4 hours, with an average of 1.5 hours), 1 case of scar formation after traffic accident, and 1 case of scar deformity after burn. The defect located in calf in 5 cases, foot in 1 case, and thigh in 1 case. The area of soft tissue defects ranged from 12 cm×4 cm to 21 cm×7 cm; and the area of flaps ranged from 14 cm×5 cm to 24 cm×8 cm. The donor sites were sutured directly., Results: The flaps survived completely after operation in 6 cases, and the wounds healed by the first intention; the partial necrosis of flap occurred and healed after skin graft repair in 1 case. One incision partially ruptured in the donor site and healed after dressing change; the other incisions healed by the first intetion. All patients were followed up 6 months to 2 years with an average of 9 months. Except 1 case complained of edema of the flap, the other patients had good shape, good color, and no swelling., Conclusion: For patients with soft tissue defects of lower limbs that cannot be repaired with anterolateral thigh perforator flap, the anteromedial thigh perforator flap can be used for good results.

Objective: To investigate the application of high frequency color Doppler ultrasound (HFCDU) combined with wide-field imaging in the preoperative navigation of anterolateral thigh perforator flap graft., Methods: Between January 2017 and March 2018, 28 patients with skin and soft tissue defects were treated, including 22 males and 6 females, with an average age of 33.5 years (range, 17-66 years). The causes of injury included 2 cases of scald scar, 7 cases of heavy object crushing injury, 12 cases of traffic accident injury, 4 cases of fall injury, 2 cases of machine injury, and 1 case of infection ulcer. Injury sites included 6 cases of hand and wrist, 12 cases of lower leg, 10 cases of foot. After debridement, the wound area ranged from 6.0 cm×3.5 cm to 24.0 cm×9.0 cm, and all patients were treated with free circumflex femoral artery perforator flap graft. Combo of HFCDU and wide-field imaging navigation were done preoperatively to detect the origin, quantity, course, surface location, hemodynamic characteristics, and the relationship with body area of perforator branch of lateral circumflex femoral artery. According to the perforator information displayed by wide-field imaging of source artery, the dominant perforator was determined to be a pedicle for designed flap. The flap size ranged from 7.0 cm×4.5 cm to 26.0 cm×7.0 cm. The flap donor area was sutured directly., Results: The dominant perforator was successfully detected by HFCDU combined with wide-field imaging in 28 patients before operation. The existence of the perforator was confirmed during operation, and the location was accurate. The course characteristics of the perforate were consistent with the results of wide-field imaging. The grafted flaps survived completely among 27 patients after operation. Necrosis at the edge of the flap was observed in 1 patient, which healed after dressing change. All patients were followed up 3-12 months, with an average of 9 months. All the flaps have good blood supply, good elasticity and shape. The donor areas healed perfectly., Conclusion: Using HFCDU and wide-field imaging navigation for designing of anterolateral thigh perforator flaps can clearly show the characteristics of perforators, hemodynamic information, and the relationship with body area, so that the surgeons can understand the perforators more accurately and intuitively, and improve the success and efficiency of flap graft surgery.

Objective: To investigate the effectiveness of modified free medial plantar flap with preserved abductor hallucis for repairing cicatricial contracture deformity of palm., Methods: Between January 2012 and July 2017, a modified free medial plantar flap with preserved abductor hallucis was used to repair 9 cases of cicatricial contracture deformity at the palm. There were 7 males and 2 females with a median age of 23 years old (range, 15-40 years). The duration of cicatricial contracture was 4-23 years (mean, 9 years). In addition, 3 cases had combined stiffness of finger joints, 2 cases of tendon exposure, and 2 cases with exposed tendon and nerve. The range of flap was 4.5 cm×4.0 cm to 8.0 cm×6.0 cm. The vessel pedicle of the flap was 7-8 cm in length, with an average length of 7.5 cm. Grafting and repairing were performed with full-thickness skin graft from the ilioinguinal region in the donor site., Results: All flaps and skin grafts survived after operation, and all wounds healed at first intention. All 9 patients were followed up 5-22 months (mean, 10 months). The flap exhibited smooth appearance and soft texture, which was similar to that of the normal skin around. The recovery time of dermal sensation was 5-12 months (mean, 9 months). At last follow-up, the flap recovered to level S 4 in 5 cases, level S 3 in 3 cases, and level S 3 in 2 cases. The two-point discrimination was 6.0-10.0 mm (mean, 8.5 mm). According to the assessment of the upper limb function issued by the Hand Surgery Society of Chinese Medical Association, the hand function was excellent in 5 cases, good in 2 cases, and fair in 2 cases. Additionally, the abduction and flexion activities of the great toe of the donor foot were not affected, and the skin grafting area was slightly colored., Conclusion: The modified free medial plantar flap for repairing cicatricial contracture deformity of palm has such advantages as no impact on abductor hallucis, small damage of the donor area, improved survival rate of skin grafting, and the unaffected function of the donor foot.

Objective: To investigate the effect of human adipose-derived stem cells (hADSCs) on pressure ulcers in mouse., Methods: The subcutaneous adipose tissue from voluntary donation was harvested. Then the hADSCs were isolated and cultured by mechanical isolation combined with typeⅠcollagenase digestion. The 3rd generation cells were identified by osteogenic, adipogenic, chondrogenic differentiations and flow cytometry. The platelet rich plasma (PRP) from peripheral blood donated by healthy volunteers was prepared by centrifugation. The pressure ulcer model was established in 45 C57BL/6 mice by two magnets pressurized the back skin, and randomly divided into 3 groups ( n =15). The wounds were injected with 100 μL of hADSCs (1×10 6 cells) transfected with a green fluorescent protein (GFP)-carrying virus, 100 μL human PRP, and 100 μL PBS in hADSCs group, PRP group, and control group, respectively. The wound healing was observed after injection. The wound healing rate was calculated on the 5th, 9th, and 13th days. On the 5th, 11th, and 21st day, the specimens were stained with HE staing, Masson staining, and CD31 and S100 immunohistochemical staining to observe the vascular and nerve regeneration of the wound. In hADSCs group, fluorescence tracer method was used to observe the colonization and survival of the cells on the 11th day., Results: The cultured cells were identified as hADSCs by induced differentiation and flow cytometry. The platelet counting was significantly higher in PRP group than in normal peripheral blood group ( t =5.781, P =0.029). General observation showed that the wound healing in hADSCs group was superior to those in PRP group and control group after injection. On the 5th, 9th, and 13th days, the wound healing rate in hADSCs group was significantly higher than those in PRP group and control group ( P <0.05). Histological observation showed that compared with PRP group and control group, inflammatory cell infiltration and inflammatory reaction were significantly reduced in hADSCs group, collagen deposition was significantly increased, and skin appendage regeneration was seen on the 21st day; at each time point, the expression of collagen was significantly higher in hADSCs group than in PRP group and control group ( P <0.05). Immunohistochemical staining showed that the number of neovascularization and the percentage of S100-positive cells in hADSCs group were significantly better than those in PRP group and control group on the 5th, 9th, and 13th days ( P <0.05). Fluorescent tracer method showed that the hADSCs could colonize the wound and survive during 11 days after injection., Conclusion: Local transplantation of hADSCs can accelerate healing of pressure ulcer wounds in mice and improve healing quality by promoting revascularization and nerve regeneration.

Objective: To explore the effectiveness of propeller facial artery perforator flap to repair the defect after resection of skin malignant tumor at upper lip., Methods: Between July 2012 and January 2017, 17 cases with skin malignant tumor at upper lip underwent tumor resection and the remained defect was repaired with propeller facial artery perforator flap. Among the 17 patients, 3 were male and 14 were female, with an average age of 57 years (range, 35-82 years). There were 5 cases of squamous cell carcinoma and 12 cases of basal cell carcinoma. The disease duration ranged from 4 months to 11 years with an average of 20 months. The tumor size ranged from 1.4 cm×0.3 cm to 3.1 cm×1.4 cm. The extended resection of the tumor tissue was performed according to the characters of tumor. According to the location, size, and shape of the defect and the position of facial artery perforator explored with Doppler ultrasonography, the propeller facial artery perforator flap was designed to repair the defect and partial donor site. The flap size ranged from 5 cm×2 cm to 7 cm×3 cm. The length of the perforator pedicle was 0.5-1.0 cm with an average of 0.8 cm. The defect at donor site was directly closed., Results: Cyanosis occurred in 3 cases of the distal flap after operation, then healing after symptomatic treatment. The remaining flaps survived successfully and the wound healed by first intention. Primary healing was obtained in the donor site. All the patients were followed up 6-36 months with an average of 18 months. The shape of the patient's upper lip was good and the scar on the donor site was unconspicuous. There was no lip deformity, ala nasi deflection, facial tension, entilation dysfunction, or recurrence of tumor during follow-up. At last follow-up, the results of self-evaluation were very satisfactory in 13 cases and satisfactory in 4 cases., Conclusion: Based on multiple advantages of good blood supply, large rotation range, aesthetic outcome, and slight injury of the donor site, propeller facial artery perforator flap is not only an optimal choice for repairing upper lip defect after resection of skin malignant tumors, but also can achieve good functional and cosmetic effectiveness.

Objective: Inducing human amniotic membrane mesenchymal stem cells (hAMSCs) to Schwann cells-like cells (SCs-like cells) in vitro , and to evaluate the efficacy of transplantation of hAMSCs and SCs-like cells on nerves regeneration of the rat flaps., Methods: hAMSCs were isolated from placenta via two-step digestion and cultured by using trypsin and collagenase, then identified them by flow cytometry assay and immunofluorescence staining. The 3rd generation of hAMSCs cultured for 6 days were induced to SCs-like cells in vitro ; at 19 days after induction, the levels of S-100, p75, and glial fibrillary acidic protein (GFAP) were detected by immunofluorescence staining, Western blot, and real-time fluorescence quantitative PCR (qPCR). The levels of brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF) were measured by ELISA in the supernatant of the 3rd generation of hAMSCs cultured for 6 days and the hAMSCs induced within 19 days. In addition, 75 female Sprague Dawley rats were taken to establish the rat denervated perforator flap model of the abdominal wall, and were divided into 3 groups ( n =25). The 3rd generation of hAMSCs (1×10 6 cells) in the proliferation period of culturing for 6 days, the SCs-like cells (1×10 6 cells), and equal volume PBS were injected subcutaneously in the skin flap of the rat in groups A, B, and C, respectively. At 2, 5, 7, 9, and 14 days after transplantation, 5 rats in each group were killed to harvest the flap frozen sections and observe the positive expression of neurofilament heavy polypeptide antibody (NF-01) by immunofluorescence staining., Results: The cells were identified as hAMSCs by flow cytometry assay and immunofluorescence staining. The results of immunofluorescence staining, Western blot, qPCR showed that the percentage of positive cells, protein expression, and gene relative expression of S-100, p75, and GFAP in SCs-like cells group were significantly higher than those in hAMSCs group ( P <0.05). The results of ELISA demonstrated that the expression of BDNF and NGF was significantly decreased after added induced liquid 1, and the level of BDNF and NGF increased gradually with the induction of liquids 2 and 3, and the concentration of BDNF and NGF was significantly higher than that of hAMSCs group ( P <0.05). Immunofluorescence staining showed that the number of regenerated nerve fibers in group B was higher than that in groups A and C after 5-14 days of transplantation., Conclusion: The hAMSCs can be induced into SCs-like cells with the proper chemical factor regulation in vitro , and a large number of promoting nerve growth factor were released during the process of differentiation, and nerve regeneration in flaps being transplanted the SCs-like cells was better than that in flaps being transplanted the hAMSCs, which through a large number of BDNF and NGF were released.

Objective: To evaluate the effectiveness of anterolateral thigh polyfoliate perforator flap plus pedicle with one foliate flap for repairing extremities soft tissue defect., Methods: Between January 2014 and January 2017, 24 patients with extremities soft tissue defects were treated by anterolateral thigh polyfoliate perforator flap plus pedicle with one foliate flap. There were 15 males and 9 females, with a median age of 33.5 years (range, 5-64 years). Wounds located in upper limb in 8 cases, complicated with radial styloid fracture in 1 case, extensor tendon exposure in 3 cases, and brachioradialis muscle tendon exposed in 1 case. Wounds located in lower extremity in 16 cases, complicated with calcaneal or metatarsal, phalangeal fractures in 4 cases, Achilles tendon departure in 1 case, toe long extensor tendon and flexor digitorum longus tendon exposed in 8 cases. The wound area ranged from 8 cm×5 cm to 18 cm×12 cm. According to wound size, anterolateral thigh perforators were detected by conventional ultrasound Doppler (2-5 perforators). The irregular wounds were decomposed into multiple parts and the leaf number (2-4 leaves) of polyfoliate flap depended on the part number of the wound. The flap area ranged from 9 cm×6 cm to 20 cm×14 cm, and the largest area of single leaf was 24 cm×6 cm. The vascular pedicle length ranged from 7 cm to 12 cm. The foliate flap area with protecting pedicle ranged from 5 cm×3 cm to 7 cm×5 cm., Results: All the flaps survived, and no vascular crisis occurred. All the patients were followed up 2-28 months (mean, 9 months). Sinus occurred in 1 case of calcaneal fracture after flap repair, and the sinus was healed after 3 months by conventional dressing. All the flaps were thin and had a good texture. Healing of soft tissue was found in 5 patients with fracture. The wrist and ankle plantar flexion and dorsiflexion function of recipient site were normal in all patients., Conclusion: It is safe and reliable to repair the extremities soft tissue defect with anterolateral thigh polyfoliate perforator flap plus pedicle with one foliate flap. And it is one of the ways to reduce the vascular crisis of the anterolateral thigh free perforator flap.

Objective: To investigate the effectiveness of latissimus dorsi Kiss flap for repairing composite tissue defects and functional reconstruction of upper arm., Methods: Between March 2010 and November 2016, 12 cases of composite tissue defects of upper arm were repaired by latissimus dorsi Kiss flap with blood vessel and nerve bunch. There were 8 males and 4 females with a median age of 34 years (range, 21-50 years). The reason of injury included plowing mechanical injury in 4 cases, traffic accident injury in 5 cases, electrical injury in 2 cases, and resecting upper arm soft tissue sarcoma in 1 case. There were deltoid defect in 5 cases, triceps brachii and brachialis defect in 4 cases, and deltoid, triceps brachii, and brachialis damaged in varying degrees in 3 cases. The defect area ranged from 13 cm×7 cm to 20 cm×8 cm. Among them, there were 6 cases of fracture combined with partial bone exposure, one of them with bone defect. The disease duration was 3 hours to 6 months. The flap size ranged from 10 cm×6 cm to 15 cm×7 cm, and the donor sites were directly sutured., Results: Twelve flaps survived with primary healing of wounds. Ten patients were followed up 6-26 months (mean, 14 months). At last follow-up, the flaps were soft and the skin color was similar to the surrounding skin. No obvious scar was found at donor sites. The abduction range of motion of shoulder was 30-90°. The muscle strength of brachialis were all at grade 4 or above. The superficial sensation and tactile sensation recovered partialy (S 1 in 2 cases, S 2 in 6 cases, S 3 in 2 cases). According to Society of Hand Surgery standard for the evaluation of upper part of the function, the shoulder joint function was excellent in 2 cases, good in 4 cases, and fair in 4 cases., Conclusion: The design of the latissimus dorsi Kiss flaps are flexible, and the donor site can be directly sutured, with the nerves of the latissimus dorsi muscle can partialy reconstruct abduction function of upper arm. In general, the Kiss flap repairing upper arm defect can obtain satisfactory effectiveness.

Objective: To investigate the feasibility and effectiveness of designing wide pedicle of abdominal pedicled flap and repairing large skin defect of upper limb with improved suture method., Methods: Between March 2014 and August 2016, 11 cases with hand and forearm skin soft tissue defect were repaired with abdominal pedicled flaps. Among them, 8 cases were male and 3 were female; aged 18-65 years (mean, 38 years). The causes of injury were machinery injury in 7 cases and traffic accident in 4 cases. The wound located at left upper limb in 6 cases and right upper limb in 5 cases. The size of wound ranged from 12 cm×7 cm to 20 cm×10 cm. The interval from injury to operation was 2-5 days (mean, 4 days). Four cases were repaired with lower abdominal flap and 7 with umbilical flap. The size of flap ranged from 10 cm×9 cm to 22 cm×10 cm. And the flap was designed with wide pedicle at width of 8 to 18 cm (mean, 15 cm); then the wound was sutured with improved method. The pedicle was cut after 3 weeks., Results: All the flaps survived without congestion, necrosis, and tension blisters. The wound and the incision were both healed at stage Ⅰ. All patients were followed up 4-12 months (mean, 8 months). The skin color, texture, and shape were satisfying, and no ulcer formed. Only line-like scar left at the donor site., Conclusion: Abdominal pedicled flap with wide pedicle and improved suture method can reduce the abdominal skin waste, avoid postoperative infection, and be feasible to repair large skin defect of upper limb with advantages of simple operation and reliable fixation.

Objective: To investigate the recontruction of facial aesthetic subunit with kite flap after resection of benign tumor at supraorbital ridge., Methods: From June 2012 to September 2015,12 cases(8 male and 4 female, aged 34-68 years) with benign tumor at supraorbital ridge underwent tumor resection, following by reconstruction with kite flap. The tumor size ranged from 0.3 cm × 1.0 cm to 0.5 cm× 1.0 cm, and the defects size ranged from0.5 cm× 1.2 cmto0.8 cm×1.2 cm.The kite flaps were 0.6 cm × 1.2 cm to 1.0 cm × 1.5 cm., Results: All the 12 flaps survived completely with primary healing and no complication. The scar was inconspicious,which was hidden into brows. The brows showed good symmetric cosmetic effect., Conclusions: The kite flap has reliable blood supply and survival rate, which does not affect the brows symmetry. Aesthetic result can be achieved by Kite flap in the reconstruction of defect after resection of benign tumor at supraorbital ridge.

Objective: To investigate the effectiveness of free superficial iliac circumflex artery perforator flap for repair of foot skin and soft tissue defect., Methods: Between January 2010 and December 2015, 16 patients with ankle skin and soft tissue defect were treated. There were 13 males and 3 females with an average age of 32 years (range, 5-56 years). The causes included traffic accident injury in 8 cases, machinery injury in 3 cases, falling injury in 3 cases, and electrically injury in 2 cases. The time from injury to hospital was 1 to 6 hours (mean, 3.5 hours). The wound sites included foot dorsum skin defect in 6 cases, ankle skin defect in 5 cases, the back foot and ankle skin defect in 5 cases. The skin defect size ranged 5 cm×4 cm to 16 cm×7 cm. All patients had tendon exposure, and 8 patients had fracture. An emergency repair was performed in 6 cases, and selective surgery in 10 cases. The free iliac circumflex artery perforators flap was used to repair defect; the flap size was 6 cm×5 cm to 17 cm×8 cm, and the flap thickness was 0.4 to 1.1 cm (mean, 0.8 cm)., Results: The flaps survived in the other 15 patients with primary healing of wounds except 1 patient because the iliac circumflex artery was too small to provide good blood supply, who underwent repair with local skin flap. Incision at donor site healed by first intention. The 15 cases were followed up 6-24 months (mean, 13 months). The appearance of the foot was satisfactory, and the flap had good texture without bulky flaps., Conclusions: Free iliac circumflex artery perforators flap is one of ideal flaps in repair of skin defect of the foot and ankle because of hidden donor site, reliable blood supply, less injury to donor site, and full use of the flap.

Objective: To preliminarily explore the effects of human dermis derived mesenchymal stem cells (hDMSCs) on expressions of α-smooth muscle actin (α-SMA) and decorin (DCN) in hypertrophic scars fibroblasts (HSFB) at different periods,and to explore the feasibility of MSCs in prevention and treatment of HSFBs., Methods: hDMSCs were cultured with mechanical method combined with enzyme digestion.The cells of the third generation which were well grown were taken,and flow cytometry (FCM) was used to detect CD molecules in hDMSCs.Immunocytochemistry was used to detect cytokeratin 19 (CK19) and vimentin and identify the separated cells.The cells were differentiated into lipoblasts,chondroblasts and osteoblasts.According to the formation course of hypertrophic scar,the scar specimens were divided into 6-month,l-year,and 2-year group with three cases in each group.HSFBs from different groups were co-cultured with well-adherent hDMSCs of the third generation in non-contact transwell co-culture system for 21 days. And HSFBs from the corresponding groups were cultured in normal six-well plate as the controls.Real-time fluorescent-polymerase chain reaction (RT-PCR) and Western Blot were used to detect the expressions of mRNA and proteins of α-SMA and DCN in HSFBs from different groups., Results: hDMSCs highly expressed the surface markers including CD73,CD105,CD44 and CD90,etc.,but did not express hematopoietic stem cell surface markers including CD 14,CD34 and CD45.They positively expressed vimentin but not CK19.The cells can be differentiated into lipoblasts,chondroblasts and osteoblasts,which was in line with the minimum identification standards of mesenchymal stem cells.For HSFB cultured in normal six-well plates,α-SMA mRNA and protein expressions of HSFB in the 6-month,1-year and 2-year groups were 198.20 ± 15.46/0.29 ± 0.070,175.24 ± 17.04/0.38 ± 0.110,and 125.73 ± 6.99/0.33 ±0.085,respectively;while DCN mRNA and protein expressions of HSFB in the corresponding groups were 61.30 ± 9.79/0.015 ± 0.003,70.89 ± 11.29/0.020 ± 0.007,and 77.31 ± 4.80/0.023 ± 0.003,respectively.For HSFB co-cultured with 5 × 104 hDMSCs, oα-SMA mRNA and protein expressions of HSFB in the 6-month,1-year and 2-year groups were 48.40 ± 6.42/ 0.100 ± 0.020,192.16 ± 11.37/0.110 ± 0.014,and 73.33 ± 6.29/0.110 ± 0.016,respectively;while DCN mRNA and protein expressions of HSFB in the corresponding groups were 156.92 ± 14.91/0.049 ±0.015,154.42 ± 18.17/0.033 ± 0.008,and 140.82 ± 7.32/0.030 ± 0.004,respectively.Compared with the control group(Cultured in normal six-well plates), mRNA and protein expressions of α-SMA in HSFBs were decreased after co-culture with 5 × 104 hDMSCs, mRNA and protein expressions of DCN were increased. Furthermore, it suggested that hypertrophic scar changed significantly in the early formation stage namely in the 6-month group., Conclusions: hDMSCs can down-regulate α-SMA mRNA and protein expressions of HSFBs and up-regulate mRNA and protein expressions of DCN in the in-vitro culture system.Those effects were particularly obvious on fibroblasts at the early formation of hyperplastic scar.Anti fibrosis role of hDMSCs is expected to be used in increasing the healing quality of the wound and in the prevention and treatment of pathological scars.

Objective: To investigate the therapeutic effects of repair of skin and soft tissue defects at distal end of finger with serrated flap with digital proper artery and nerve pedicle combined with bilaterally pedicled V-Y advancement flap of the injured finger., Methods: Thirteen patients with skin and soft tissue defects at distal end of 13 fingers were hospitalized from September 2013 to January 2015. After debridement, the wound area of finger ranged from 1.2 cm × 0.8 cm to 1.8 cm × 1.5 cm. Serrated flap with digital proper artery and nerve pedicle combined with bilaterally pedicled V-Y advancement flap of the injured finger were used to repair the defect. The flaps were interruptedly sutured. The areas of bilaterally pedicled V-Y advancement flap and serrated flap with digital proper artery and nerve pedicle ranged from 0.52 to 1.11 and 2.60 to 5.23 cm(2,) respectively., Results: All flaps of 13 patients survived completely. The patients were followed up for 6 to 24 months. The color and texture of the flaps were good. After reconstruction, the finger tips were in round in shape. The appearance of the fingers was consistent with that of the normal fingers, and joint motility was normal. No hook-nail deformity or knuckle dysfunction was found. Sensation of the flaps was estimated as S4, and the distance of two-point discrimination ranged from 2 to 3 mm. The recovery of the joint motion function of the fingers was excellent., Conclusions: Serrated flap with digital proper artery and nerve pedicle, combined with bilaterally pedicled V-Y advancement flap from the injured finger can repair the skin and soft tissue defects at distal end of finger with reliable blood supply and simple operative technic. It also could avoid the formation of deformity subsequent to a linear scar, and a satisfactory appearance with good function could be obtained.

Objective: To investigate the effect with the popliteal intermediate cutaneous artery descending branch island flap repair the wound in the knee joint after resection of scar., Methods: From January 2006 to December 2014,A total of 12 cases of knee joint contracture patients,8 cases were male,4 were female; the age ranged from 4 to 58 years old;8 cases of hot water scald, electric injury in 2 cases,2 cases of scar radioactive contracture,3 cases with ulcer. The knee extension 10 degrees to 30 degrees. For scar excision of knee joint loosening, the scar excision wound size (3-5) cm × (10-14) cm, popliteal intermediate cutaneous wounds with artery descending branch island flap, The flap size (4-6) cm × (11-15) cm. Donor sites were closed directly in 2 cases,10 cases of skin graft., Results: The all were followed up after operation. Follow-up 6 to 24 months, the 12 cases survived completely, and the skin graft donor site homogeneity of survival, the skin color and similar to the surrounding mucosa, soft texture, shape is not bloated, the knee extension of up to 0 degree, and the walking without a limp., Conclusions: The popliteal intermediate cutaneous artery descending branch island flap blood supply is reliable, donor and recipient adjacent region, which has the advantages of simple operation, is one of the ideal flap for repairing the knee joint wound.

Objective: To explore the feasibility and effect of the lateral popliteal artery perforator flap in repairing the skin and soft tissue defect on upper calf., Methods: The position and course of the perforators were confirmed with the color Doppler ultrasound. The flap was designed with the lateral popliteal artery perforator as the pedicle artery to repair the skin and soft tissue defect on upper calf according to the shape and size of the wound., Results: From January 2010 to January 2014,10 patients with traumatic upper calf skin and soft tissue defect were admitted. The wound size ranged from 3 cm ×2 cmto9 cm×6 cm, and the flap size ranged from3 cm×3 cm to 10 cm×8 cm. The wounds at donor sites were closed directly in 4 cases and were covered with split thickness skin graft in 6 cases. All flaps survived completely. Surgical incisions and wounds at donor sites and recipient sites healed primarily. All cases were followed up for 6-15 months (10 months on average) with good flaps color, texture and shape., Conclusions: The lateral popliteal artery perforator flap has reliable blood supply and is easily performed. It is one of the optional methods for repairing wound of the upper calf.

Objective: To investigate the feasibility of the free descending branch of lateral circumflex femoral artery perforator tissue flap (fascia flap plus skin flap) to repair large soft tissue defects of the extremities and its impact on the donor site., Methods: Between January 2013 and February 2015, 9 cases of large tissue defects of the extremities were repaired with the free descending branch of lateral circumflex femoral artery perforator tissue flap. There were 8 males and 1 female, aged from 13 to 56 years (median, 36 years). The causes included traffic accident injury in 6 cases and crushing injury by heavy object in 3 cases. Soft tissue defect located at the lower limbs in 7 cases and at the upper limbs in 2 cases, including 2 cases of simple tendon exposure, 2 cases of simple bone exposure, and 5 cases of tendon and bone exposure. After debridement, the soft tissue defect area ranged from 13 cm x 7 cm to 20 cm x 18 cm. The tissue flaps ranged from 14 cm x 8 cm to 23 cm x 19 cm. The donor site was directly sutured, scalp graft was used to cover the fascia flap., Results: After operation, partial necrosis of the skin grafting on the fascia flap occurred in 2 cases and healed after dressing change. Arterial crisis occurred in 1 case and the flap survived after anastomosis. The other tissue flaps survived and wounds healed by first intention. The skin grafting healed by first intention in 7 cases, by second intention in 2 cases. The patients were followed up 4-24 months (mean, 10 months). The appearance and function of the tissue flaps were satisfactory, only linear scar was observed at the donor site, which had less damage and no effect on walking., Conclusion: Free descending branch of lateral circumflex femoral artery perforator tissue flap can repair large soft tissue defect of the extremities. The donor site can be sutured directly, which reduces damage to donor site and is accord with the principle of plastic surgery.

Objective: To explore the application value of digital subtraction angiography (DSA) in repairing foot and ankle wounds with posterior tibial arterial perforator flaps., Methods: Between January 2010 and May 2014, 12 cases of foot and ankle wounds were repaired using posterior tibial arterial perforator flaps. There were 7 males and 5 females with an average age of 36 years (range, 22-54 years). The causes were machine injury in 2 cases, falling injury in 3 cases, and traffic accident injury in 7 cases. The disease duration ranged from 7 to 45 days (mean, 16 days). The size of wound ranged from 6 cm x 4 cm to 10 cm x 5 cm. Preoperative DSA was performed to observe the orientation and distribution of the posterior tibial arterial perforator and the relationship between perforator vessels. Correspondently, the flaps were designed and harvested. The size of flap ranged from 7 cm x 5 cm to 11 cm x 6 cm. The donor sites were repaired with skin grafts., Results: Posterior tibial arterial perforator vessels send out ascending branches and descending branches while going down in the superficial layer. All branches were connected to form vertical chain-form anastamosis, and its orientation was consistent with limb vertical axis. According to DSA results, the flaps were designed and harvested easily. All flaps survived after operation. Meanwhile, wounds healed by first intention. All skin grafts at donor site survived. All patients were followed up 6 months. The flaps had good appearance, color, and texture. No ulcer was found. Affected feet had normal walking function., Conclusion: The size, distribution, and chain-form anastamosis condition of the posterior tibial arterial perforator vessels can be accurately observed by DSA, which provides imaging evidence for harvesting posterior tibial arterial perforator flaps and improves the success rate for repairing foot and ankle wounds.

Objective: To explore the clinical effects of relaying reversed perforator flaps in repairing skin and soft tissue defects at distal end of finger and donor site., Methods: Seventeen patients (17 fingers) with skin and soft tissue defects at distal end of finger were hospitalized from June 2011 to June 2013. The reversed digital artery perforator flap with branch of digital nerve was used to repair the defect. The first donor site was repaired by dorsal metacarpal artery perforator flap; the second donor site was closed by suturing. The area of skin defect at distal end of finger ranged from 2.0 cm x 1.5 cm to 3.0 cm x 2.0 cm, and the area of digital artery perforator flap and dorsal metacarpal artery perforator flap ranged from 2.2 cm x 1.5 cm to 3.6 cm x 2.5 cm and 2.5 cm x 2.0 cm to 4.2 cm x 3.0 cm, respectively., Results: All the 34 flaps survived completely. Cyanosis and partial necrosis of the epidermis appeared in 1 flap, which was healed after dressing change. All the patients were followed up for 1 to 18 months, with mean time of 8 months. The color, texture and appearance of flaps were satisfactory. There was no depression or breakdown in the first donor sites. Some linear scars appeared in the second donor sites, but they did not affect the general appearance. The donor sites at joint or tendon did not affect the joint activity after healing. The results of function evaluation of range of active movement of the fingers were excellent in 15 cases and good in 2 cases. The results of sensation of the flaps were S3 in 1 finger, S4 in 2 fingers, and S5 in 14 fingers. The distance of two-point discrimination of flaps ranged from 5 to 7 mm, with mean distance of 6 mm., Conclusions: Relaying reversed perforator flap, with reliable blood supply and both donor sites in the hand, can improve the appearance and function of the first donor site as well as repair skin and soft tissue defects at distal end of finger.

Objective: To explore the curative effect of reverse bi-pedicle posterior interosseous artery perforator flap in repairing skin and soft tissue defects on the wrist., Methods: Seven patients with soft tissue defects on the wrist, including simple skin and soft tissue defects in 4 cases and skin and soft tissue defects combined with radial tendon injury in 3 cases, were hospitalized from December 2010 to March 2012. The area of skin defect on the volar side of the wrist ranged from 4.8 cm x 4.0 cm to 6.2 cm x 4.5 cm, while that on the dorsal side ranged from 3.5 cm x 3.2 cm to 6. 5 cm x 5.4 cm. These wounds were respectively caused by traffic injury (3 cases), reamer injury (2 cases), burn (1 case), and tumor resection (1 case). Reverse bi-pedicle posterior interosseous artery perforator flaps were used to repair these defects, with area of one pedicle ranging from 2.5 cm x 2.0 cm to 3.5 cm x 2.5 cm and the area of the other pedicle ranging from 2.5 cm x 2.5 cm to 4.0 cm x 3.0 cm. The donor sites were closed by suturing., Results: All flaps survived completely. Patients were followed up for 6 to 36 months. The color, texture, and appearance of all flaps were satisfactory. At last follow-up, distances of two-point discrimination of flaps ranged from 9 to 13 mm. The dorsal extension and palmar flexion functions of wrist were satisfactory. The results of function evaluation of 7 wrists were excellent in 6 cases and good in 1 case according to the tentative standards for the evaluation of upper extremity function of Society of Hand Surgery of Chinese Medical Association. A linear scar was formed at the donor site., Conclusions: The reverse bi-pedicle posterior interosseous artery perforator flap, with advantages of flexible design, easy to achieve, less injury to donor site, and reliable blood supply, etc., is another choice for repairing skin and soft tissue defects over the wrist.

Objective: To study the expressions of Notch1-4 gene in human keloid-derived mesenchymal-like stem cells, and to explore the Notch signaling pathway's role in the formation of keloid., Methods: Keloid samples were collected to harvest human keloid-derived mesenchymal-like stem cells through two-step enzymatic dissociation method. By flow cytometry, cell phenotype of primary and P3 generation were analyzed. By immunocytochemistry, the expressions of Oct4, vimentin and CK19 were examined. Keloid-derived mesenchymal-like stem cells were induced into osteoblasts in vitro and calcium deposition was detected by Alizarin red S stain. Realtime polymerase chain reaction (RT-PCR) was used to detect the expressions of Notch1-4 mRNA in keloid-derived mesenchymal-like stem cells., Results: Flow cytometry showed that keloid-derived mesenchymal-like stem cells of primary and P3 generation highly expressed CD29, CD44, CD90 from the typical MSC phenotype marker, but they failed to express HSC phenotype markers, such as CD34 and CD45. The results of immunocytochemistry showed that Oct4 from pluripotent stem cell markers and vimentin from mesenchymal cell markers was positive and CK19 from epithelial cell markers was negative. After induced differentiation into osteoblasts in vitro after 21 day, calcium nodules could be seen clearly; Notch1-4 gene were expressed in keloid-derived mesenchymal-like stem cells through RT-PCR. The relative quantitative of Notch2, Notch3 gene were higher than Notch1, Notch4 gene (P < 0.05)., Conclusions: The expression difference of different subtypes from Notch gene in human keloid-derived mesenchymal-like stem ceils may be related to self-renewal, proliferation, differentiation, and participate in the formation of keloid.

Objective: To investigate the characteristics of blood supply of popliteal fossa middle artery pedicled flaps and the feasibility of reconstruction of postburn popliteal fossa contractures using the flaps in children., Methods: Between January 2008 and October 2010, 6 cases of postburn popliteal fossa contractures were recontructed using popliteal fossa middle artery pedicled flaps. Of them, 2 were boys and 4 were girls, aged from 2 years and 2 months to 10 years. All burns were caused by hot water. The wound ranged from 5 cm x 4 cm to 10 cm x 8 cm after scar relaxation. The size of the flap ranged from 6 cm x 4 cm to 11 cm x 9 cm. Donor sites were covered with split-thickness skin graft in 5 cases, and sutured directly in 1 case., Results: All the flaps and the skingraft survived; no vascular crisis or flap necrosis occurred. All incisions at donors and wounds healed by first intention. All patients were followed up 12-24 months. The color, texture, and appearance of the flaps were good. Hyperplastic scar was found at incision of popliteal fossa in 1 case at 6 months after operation; the range of motion (ROM) of the knee joint was 0-175 degrees, and no obvious change was observed at 15 months after operation. The others had no functional disturbance of the knee joints or claudication; the ROM of the knee joint was 0-180 degrees., Conclusion: The popliteal fossa middle artery pedicled flap has reliable blood supply, simple operative procedure, and good results in reconstruction of popliteal fossa contracture.

Objective: To explore the effect of early scrotal dermatoplasty on spermatogenic functional rehabilitation of testis in juvenile pigs with third degree burn wound of the scrotum., Methods: Thirty healthy male Guizhou miniature pigs (weighing 10-15 kg, 2-month-old) were divided into 3 groups: control group (group A, n = 10), natural healing group (group B, n = 10), and dermatoplasty group (group C, n = 10). In group A, the pig was not given any treatment; after third degree burn model of the scrotum was prepared, wounds were not treated in group B and the burn skin was excised and whole hypogastric pachydermia was used for dermatoplasty in group C. At 3 months and 1 year after model preparation, bilateral testis were collected from 5 pigs, respectively. HE staining was performed to observe the effects of different repair method on the morphology of spermatogenic cells and immunohistochemical staining was used to detect Survivin protein expression., Results: All pigs survived to the end of the experiment and the wound healed successfully. Histological observation showed that spermatogenic cells had normal shape at all stages and mature sperms were seen in lumens in group A; the thickness of seminiferous epithelium was thinner, having one layer or two layers of spermatogenic cells in group B; the spermatogenic cells in group C were slightly more than that in group B with some spermatids; and in groups B and C, the spermatogenic cells at 1 year were more than that at 3 months. Immunohistochemistry staining showed that the Survivin protein expression in groups B and C was less than in group A, and group B was less than group C, showing significant differences at 3 months and 1 year (P < 0.05), but no significant difference between 3 months and 1 year in the same group (P > 0.05)., Conclusion: Dermatoplasty has inhibitory effect on spermatogenic functional rehabilitation of testis. Dermatoplasty can decrease spermatogenic cells and reduce Survivin protein expression, but some spermatids still survive in seminiferous tubule.

Objective: To summarize the effect of free skin graft for repairing scrotal avulsion injury, and to investigate the repair impact of the method on spermatogenesis., Methods: Between June 2001 and June 2010, 8 cases of complete avulsion injury of the scrotal skin were treated with the free skin graft, aged 22 to 64 years (mean, 29 years). The causes of injury included machine twisting in 4 cases, animal attack in 3 cases, and traffic accident in 1 case. The time between injury and hospitalization was 1-7 hours (mean, 3.5 hours). Five cases complicated by avulsion of penile skin, 3 by perineal laceration with exposure of testes and spermatic cord, and 1 by avulsion of leg skin., Results: After 10 days, 80% to 95% grafted skin survived. The reconstructed scrotum had shrinks and the wound healed by first intention after dressing change. Eight patients were followed up 12 to 24 months (mean, 16 months). At last follow-up, the patients had relaxed and droop scrotum, and penile erection was normal. Semen quality analysis showed: semen volume of 2-6 mL (mean, 4.2 mL); complete liquefaction with liquefaction time of 15-30 minutes (mean, 23 minutes); sperm density of (12-27) x 10(6)/mL (mean, 16 x 10(6)/mL); sperm motility of 45%-65% (mean, 56%); and sperm motility (grade A) of 25%-42% (mean, 32%)., Conclusion: Complete avulsion of the scrotal skin can be repaired by free skin graft, which has no significant effect on spermatogenesis.