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BACKGROUND: Studies have shown that nucleotide binding oligomerization domain-like receptor protein 3 (NLRP3) inflammasome, interleukin-18, and interleukin-1β levels can induce an inflammatory cascade response to release inflammatory factors, affect metabolic stress, and damage endothelial cells involved in the development and progression of diabetic foot ulcers, which can provide a reference for early infections. OBJECTIVE: To investigate the predictive effect of peripheral blood mononuclear cell NLRP3 inflammasome, interleukin-18 and interleukin-1β levels on early infection after flap repair of diabetic foot ulcers. METHODS: A total of 147 patients with diabetic foot ulcers were selected and divided into infection group and non-infection group according to whether they were infected within 1 week after operation. Logistic regression was used to analyze the relationship between NLRP3 inflammasome, interleukin-18 and interleukin-1β levels in peripheral blood mononuclear cells and early postoperative infections, and to evaluate their predictive values. RESULTS AND CONCLUSION: In 147 patients with diabetic foot ulcers, 35 cases (23.81%) were infected within 1 week after operation, and 47 strains of pathogenic bacteria were isolated, including 25 strains of Gram-positive bacteria (53.19%) and 22 strains of Gram-negative bacteria (46.81%). Univariate analysis showed that Wagner grade, presence of comorbid diabetic nephropathy, operation time, peripheral blood NLRP3 mRNA, Caspase-1 mRNA, ASC mRNA, interleukin-18 and interleukin-1β levels were risk factors for early postoperative infections (all P < 0.05). Multivariate analysis suggested that Wagner grade, NLRP3 mRNA, Caspase-1 mRNA, ASC mRNA, high interleukin-18, interleukin-1β were independent risk factors (all P < 0.05). Receiver operator characteristic curve results showed that the area under the receiver operator characteristic curve of NLRP3 mRNA, Caspase-1 mRNA, ASC mRNA, interleukin-18 and interleukin-1β for early postoperative infections in patients with diabetic foot ulcers was 0.823, 0.705, 0.676, 0.811 and 0.853, respectively, and the area under the curve of combined predictive efficacy was 0.915. To conclude, patients with diabetic foot ulcers are mainly affected by Gram-positive bacteria, and the levels of NLRP3 inflammasome, interleukin-18 and interleukin-1β in peripheral blood mononuclear cells are independent risk factors for early postoperative infections. The combined prediction efficacy of these indicators is better and deserves further in-depth study. [ABSTRACT FROM AUTHOR]

Abstract In oral and maxillofacial surgery, flap repair is essential to the quality of postoperative life. Still, thrombosis is fatal for the survival of the flaps. Besides, some postoperative thrombotic diseases, such as pulmonary embolism, also intimidate patients’ life. The traditional diagnostic methods are still limited by a large amount of hardware and suffer from inconvenience, delay, and subjectivity. Moreover, the treatments mainly rely upon thrombolytics, such as urokinase (UK) plasminogen activator, which may cause bleeding risk, especially intracerebral hemorrhage. Herein, a kind of poly (lactic-co-glycolic acid) (PLGA) nanoparticles (NPs) containing a first near-infrared window (NIR-I) phototheranostic agent Y8 and urokinase plasminogen activator (UK) as the core, and modified with the fibrin-targeting peptide Gly–Pro–Arg–Pro–Pro (GPRPP) were developed for the flap and postoperative thromboembolism treatment (named GPRPP-Y8U@P). The conjugated molecule Y8 endows GPRPP-Y8U@P with the capacity of NIR-II imaging and excellent photothermal/photodynamic therapeutic effects. In vivo experiments demonstrated that GPRPP-Y8U@P could quickly locate thrombus by NIR-II fluorescence imaging, and semi-quantitative analysis of the embolized blood vessels' paraffin section verified its thrombolytic efficiency. Additionally, the urokinase trapped in the NPs would not result in nonspecific bleeding, tremendously improving physical security and curative effects with minimizing side effects. Overall, the advantages of GPRPP-Y8U@P, such as precise localization of the thrombus, thrombus ablation in the site, and mild side effects, demonstrated the attractiveness of this approach for effective clinical monitoring of thrombus therapy.

Background: Stenosis of the anterior nostril will not only affect the beauty but also affect the respiratory function of the nose. Objectives: We explore the clinical application value of expansion mold in treating and preventing anterior nostril stenosis. Material and methods: We analyzed 12 cases of anterior nostril stenosis and 3 cases of anterior nostril trauma in the past five years—every patient using the expansion model for six months. Results: After six months of dilation treatment, 14 cases were cured, and one improved. The total effective rate was 100%, and all the patients were followed up for one year. There were no complications and recrudesced. Conclusions: and Significance: Using expansion mold to treat and prevent anterior nostril stenosis is a simple, safe, and effective method worth widely popularizing.

Objective To analyze the risk factors of postoperative complications after craniofacial flap repair, and to establish a risk prediction model. Methods A total of 120 patients who underwent skin flap repair from October 2017 to September 2020 were selected. Univariate and logistic multivariate regression analyses were used to screen the risk factors for complications after skin flap repair, and a personalized predictive nomogram model was established. Results The incidence of postoperative complications was 25.83%. The main complications were flap vascular crisis, infection, flap avulsion, subcutaneous hematoma and edema. Logistic multivariate regression analysis revealed that the risk factors for complications after skin flap repair included venous end-to-side anastomosis (OR=3.766, 95% CI: 1.587~8.938), excessive intraoperative blood loss (OR=2.889, 95% CI: 1.089~7.668), smoking history (OR=4.697), 95% CI: 1.558~14.161), physician′s surgical skill (OR=3.062, 95% CI: 1.183~7.922) and improper flap design (OR=2.399, 95% CI: 0.861~6.686) (P

Summary: Persistent tracheoesophageal fistulas requiring flap repair of the trachea in the mediastinum are uncommon. A 44-year-old man developed a 5 cm x 2 cm persistent posterior tracheal defect after failed tracheo-esophageal fistula repair. The defect was patch repaired using the de-epithelialized skin paddle of an extended pectoralis major flap tunneled into the mediastinum. The use of cross-field ventilation, second rib removal and an anterior tracheostomy slit were crucial for posterior tracheal repair. No major complication occurred. The patch repair with the de-epithelialized skin paddle of pectoralis major flap mucosalized in 2 weeks and the patient was discharged one month postoperatively. The extended skin paddle of the pectoralis major flap was a useful method for tracheal wrap-around reconstruction.

In oral and maxillofacial surgery, flap repair is essential to the quality of postoperative life. Still, thrombosis is fatal for the survival of the flaps. Besides, some postoperative thrombotic diseases, such as pulmonary embolism, also intimidate patients' life. The traditional diagnostic methods are still limited by a large amount of hardware and suffer from inconvenience, delay, and subjectivity. Moreover, the treatments mainly rely upon thrombolytics, such as urokinase (UK) plasminogen activator, which may cause bleeding risk, especially intracerebral hemorrhage. Herein, a kind of poly (lactic-co-glycolic acid) (PLGA) nanoparticles (NPs) containing a first near-infrared window (NIR-I) phototheranostic agent Y8 and urokinase plasminogen activator (UK) as the core, and modified with the fibrin-targeting peptide Gly–Pro–Arg–Pro–Pro (GPRPP) were developed for the flap and postoperative thromboembolism treatment (named GPRPP-Y8U@P). The conjugated molecule Y8 endows GPRPP-Y8U@P with the capacity of NIR-II imaging and excellent photothermal/photodynamic therapeutic effects. In vivo experiments demonstrated that GPRPP-Y8U@P could quickly locate thrombus by NIR-II fluorescence imaging, and semi-quantitative analysis of the embolized blood vessels' paraffin section verified its thrombolytic efficiency. Additionally, the urokinase trapped in the NPs would not result in nonspecific bleeding, tremendously improving physical security and curative effects with minimizing side effects. Overall, the advantages of GPRPP-Y8U@P, such as precise localization of the thrombus, thrombus ablation in the site, and mild side effects, demonstrated the attractiveness of this approach for effective clinical monitoring of thrombus therapy. [ABSTRACT FROM AUTHOR]

Introduction: Congenital cleft earlobe is a common congenital deformity of earlobe. Various techniques have been described for its repair, but cosmetic deformity usually persists. We present our result using triangular flap repair for simple longitudinal cleft of earlobe. Materials and Methods: The procedure was done in five cases who presented between 2017 and 2020. The technique uses the same principles as in Randall-Tennison triangular flap repair for cleft lip. Results: Earlobes were near-symmetrical, postoperative scar minimal and patient satisfaction was very good in all cases. Ear piercing was done without any complications at least 6 months after surgery. After a follow-up of 1 year, no complications were noted. Conclusions: Triangular flap repair technique for cleft earlobe follows the principles of Randall-Tennison triangular flap repair for cleft lip. It provides very good results with esthetic contour, minimal scar with no complications in case of simple longitudinal cleft.

The 5-item modified frailty index (mFI-5) is a validated tool to assess postoperative risks in older surgical candidates. We sought to compare the predictive ability of mFI-5 to its individual components and other established risk factors for complications in flap reconstruction of late-stage pressure ulcer repair. The 2012 to 2018 American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) database was queried for pressure ulcer diagnosis and reconstructive flap repair procedures. Univariate and multivariate regression analysis models were used to assess how mFI-5, the components of the mFI-5 (functional status before surgery, diabetes, history of chronic obstructive pulmonary disease, history of congestive heart failure, and history of hypertension requiring medicine), and other factors commonly used to risk-stratify (age, obesity, ASA classification, and history of smoking) were associated with complications. 35.1% of the total 1254 flap reconstructive procedures for pressure ulcer repair experienced complications. Most cases had at least one of the five mFI-5 factors in both the complication (42.7%) and no complication (45.7%) cohorts. Compared with the factors making up the mFI-5 score and other common variables used to risk-stratify, mFI-5 was significantly associated with complications in the univariate (OR 1.17, CI 1.03 – 1.33; P = 0.02) and multivariate analysis (OR 1.16, CI 1.02 – 1.34; P = 0.043). The mFI-5 is a useful predictor of postoperative outcomes in patients undergoing reconstructive flap surgery for pressure ulcer injuries compared to other historically considered risk factors for surgical complications. [ABSTRACT FROM AUTHOR]

Objective  This study was aimed to compare the closure of skull base defect in endoscopic endonasal transsphenoid surgery of pituitary tumors, using bipedicled nasal septal flap versus fascial closure. The study hypothesis being that bipedicled nasal septal flap is better, compared with fascial closure of skull base defect post–endoscopic endonasal transsphenoid surgery of pituitary tumors. Methods  All the eligible patients were randomly divided into two groups and then randomly allocated to the surgeons. In one group, fat and fascia lata was used for closure of the skull base defect and nasal septal flap was not harvested whereas in the other, nasal septal flap was used for closure. Results  There was a statistically significant difference in postoperative cerebrospinal fluid leak between the two groups. Patients who had undergone flap repair had lower incidence of postoperative cerebrospinal fluid (CSF) leak. Duration of postoperative hospital stay was also less among the group who underwent flap repair (statistically significant). Conclusion  Bipedicled nasal septal flap serves an excellent cover for the skull base defect following endoscopic endonasal transsphenoidal pituitary surgery. It can prevent postoperative CSF leak even in cases where tissue glue is not used. [ABSTRACT FROM AUTHOR]

Objective To investigate the selection of surgical methods and curative effect of plantar melanoma. Methods We collected the clinical data of 91 patients with plantar melanoma from March 2011 to December 2017. The advantages and disadvantages of various surgical methods were investigated. The relationship of the operation methods, gender, stage, adjuvant therapy, primary tumor diameter with survival rate of patients was analyzed. Results Skin grafts were used to repair the wound in non-weight-bearing area of plantar. The peracentage of grafted skins which survived by first intention reached 86% and there were few postoperative complications. There was no significant difference in healing rate, necrosis rate or infection rate among the sural neurovascular flap, saphenous neurovascular flap, medial plantar artery flap and free anterolateral femoral flap, while patients with free anterolateral femoral flap had shorter avenage length of stay after operation. The 5-year survival rate after surgery was 67%. The 5-year survival time was not affected by operation and gender. The 5-year survival rates of patients with stage Ⅱ and Ⅲ were 85.0% and 40.2%, respectively. The survival rates of patients with tumor size≥3 cm and < 3 cm were 60.6% and 83.5%, respectively. The 5-year survival rate of patients with and without adjuvant therapy was 72.0% and 51.6%, respectively. Conclusion For plantar melanoma patients, skin grafting, sural neurotrophic vascular flap, saphenous neurotrophic vascular flap, medial plantar artery flap and free anterolateral femoral flap could be selected individually to repair surgical wounds after primary resection with good appearance and function and satisfied long-term effect.

Objective: To analyze the clinical characteristics of scar cancer ulcer wound of head and face, and to investigate its diagnosis and treatment., Methods: The clinical data of 14 patients with head and facial scar cancer ulcer wounds who met the selection criteria and admitted between January 2021 and March 2022 were retrospectively analyzed. There were 8 males and 6 females. The age of onset ranged from 21 to 81 years with an average age of 61.6 years. The incubation period ranged from 1 month to 70 years, with a median of 4 years. Site of the disease included 7 cases of head, 6 cases of maxillofacial region, and 1 case of neck region. Injury factors included trauma in 5 cases, scratch in 5 cases, scalding in 2 cases, burn in 1 case, and needle puncture in 1 case. Pathological results showed squamous cell carcinoma in 9 cases, basal cell carcinoma in 3 cases, sebaceous adenocarcinoma in 1 case, papillary sweat duct cystadenoma combined with tubular apocrine sweat gland adenoma in 1 case. There was 1 case of simple extensive tumor resection, 1 case of extensive tumor resection and skin grafting repair, 7 cases of extensive tumor resection and local flap repair, and 5 cases of extensive tumor resection and free flap repair., Results: All the 14 patients were followed up 16-33 months (mean, 27.8 months). Two patients (14.29%) had scar cancer ulcer wound recurrence, of which 1 patient recurred at 2 years after 2 courses of postoperative chemotherapy, and was still alive after oral traditional Chinese medicine treatment. One patient relapsed at 1 year after operation and died after 2 courses of chemotherapy. One patient underwent extensive resection of the left eye and periocular tumor and the transfer and repair of the chimaeric muscle axial flap with the perforating branch of the descending branch of the left lateral circumflex femoral artery, but the incision healing was poor after operation, and healed well after anti-infection and debridement suture. The wounds of other patients with scar cancer ulcer did not recur, and the wounds healed well., Conclusion: Scar cancer ulcer wound of the head and face is common in the middle-aged and elderly male, and the main pathological type is squamous cell carcinoma. Local extensive resection, skin grafting, or flap transfer repair are the main treatment methods. Early active treatment of wounds after various injuries to avoid scar repeated rupture and infection is the foundamental prevention of scar cancer.

Background: Karydakis published a large pilonidal series in 1992, reporting a recurrence rate of less than 1% and complication rate of 8.5%. The aim of this study was to compare the outcomes of Karydakis procedure (KP) performed in the lateral versus the prone position in a consecutive series. Methods: Ninety‐seven consecutive patients undergoing a KP between March 2000 and February 2018 were retrospectively assessed. Patients with disease sinuses or fistulas extending from the midline to either left or right sides only were considered for KP in the contralateral side position. Results: Surgery was carried out for primary pilonidal disease in 71 patients (73%) and for recurrent disease in 26 patients (27%). The majority (62%) of pilonidal tracts veered off from the midline to either the left or right side only. Wound complications, mostly minor skin separation, occurred in 37 patients (38%). Disease recurrence occurred in eight patients (8%). There was no difference between patients who had KP in a lateral position compared with those operated in a prone position regarding wound complications (41% versus 35%, P = 0.675), disease recurrence (9% versus 7%, P = 1.000), mean operating time (64.6 min versus 66.6 min, P = 0.259) and mean length of hospital stay (1 day for both groups). Conclusions: Pilonidal surgery in the lateral position has potential benefits for patient safety, patient comfort and theatre efficiency. The clinical results of this series show that the KP can be performed safely and effectively with the patient in the lateral position for most cases of pilonidal disease. [ABSTRACT FROM AUTHOR]

Objective: To compare the results of pilonidal sinus repair techniques using crystallized phenol after a minimal excision and flap repair. Methods: Patients who underwent surgery between 2008 and 2014 at Health Sciences University Gaziosmanpaşa Taksim Training and Research Hospital were enrolled in the study. Patients who underwent flap repairs with complete excision (group A; n=100) were compared with patients who were treated with minimal excision and crystallized phenol (group B; n=100) in terms of demographic data, postoperative early complication, duration of hospitalization, wound healing time, return-to-work times, recurrence rates, and late complications. Results: In group A, 45 (45%) patients had a history of abscess, and 16 (16%) patients had recurrence. In group B, 35 (35%) patients had a history of abscess, and 18 (18%) patients had recurrence. The mean time periods between the first symptom and presentation to the clinic were 6 and 7 months, respectively, and the median follow-up durations were 44 and 34 months, respectively. The mean duration of hospitalization was significantly shorter in group B (1.1 days) than in group A (3.7 days) (p<0.0001). The duration of postoperative wound healing was significantly shorter in group B (10.1 days) than in group A (18.9 days) (p<0.0001). The return-to-work time was significantly shorter in group B (6.4 days) than in group A (19.2 days) (p<0.0001). Conclusions: Crystallized phenol application following minimal surgical excision was found to be better than complete excision in flap procedures in terms of duration of wound healing, hospitalization, and return-to-work and late complications (numbness, poor esthetics). [ABSTRACT FROM AUTHOR]

Summary: Purpose: Local skin flaps are used for reconstruction of sacral decubitus ulcers because of their structural endurance against the patient''s weight. However, a major concern is associated with decubitus recurrence after repair. Sensory flaps are one choice to prevent recurrence. Thus, we reconstructed sacral decubitus ulcers using Nakajima''s lumbo-gluteal flap as a sensory flap. Patients and methods: Two patients with unstable sacral scars caused by decubitus ulcers were treated operatively. Neither had spinal cord injury, and buttock sensation thus remained. The flap''s proximal end was designed on the posterior iliac crest and included the lateral dorsal cutaneous branch of the fourth lumbar artery as examined preoperatively with a Doppler stethoscope. The distal end was beyond the gluteal fold in case 1, but not in case 2. We subcutaneously dissected the vascular pedicle and the superior cluneal nerve located at the proximal portion of the flap after resection of the unstable scar. We then elevated the flap beneath the fascia of the gluteus maximus of the right buttock, preserving the nerve, artery and subcutaneous tissue as one pedicle, and transferred the flap to the defect. Results: In case 1, 2 cm of the distal end of the flap was lost. The sensation of the proximal two-thirds of the flap was identical to that of the contralateral buttock. However, the distal one-third of the flap, which was elevated from the area caudal to the gluteal fold, had insufficient sensation. Case 2 had complete flap survival and sufficient sensation in all areas of the flap. Decubitus recurrence has not occurred in 7 years in case 1 and in 9 months in case 2. Conclusion: This flap is useful for reconstruction of sacral decubitus ulcers if sensory function of the buttock remains and may be best designed as not extending beyond the gluteal fold. [Copyright &y& Elsevier]

Several biomaterials have been proposed to treat anal fistula alone or in combination with other surgical procedures aiming to reduce recurrence rates while minimizing continence impairment. More recently a porcine dermal matrix injection has been proposed as infill biomaterial to treat fistulae. We propose an approach consisting of non-cutting seton positioning followed several weeks later by flap repair associated with dermal matrix injection into the fistula tracts. We report our experience with this two-staged procedure on 24 consecutive patients with complex anal fistulae with a median follow up of > 12 months. In our experience this two- stage approach seems to be safe and effective. [ABSTRACT FROM AUTHOR]

Introduction: The use of biomaterials to treat anal fistula has drawn great interest. More recently, a porcine dermal matrix injection has been proposed as infill biomaterial to treat fistulas. Methods: We propose a novel approach consisting in non-cutting seton positioning followed by flap repair associated with dermal matrix injection into the fistula tracts after several weeks. Results: We report our experience with this two-staged procedure on 11 consecutive patients with recurrent high trans-sphincteric fistulas with a minimum follow-up of 6 months. Conclusions: In our experience, this two-stage approach seems to be safe and effective. [ABSTRACT FROM AUTHOR]

Failures of flap rotation, flap necrosis, recurrence of the disease, maceration at the incisional line and insufficient or late healing of flap corners which can be associated with ischemia appear to be the main problems associated with the closing techniques during the surgical treatment of this disease. We describe a simple, effective and incision protective repair method for excision of the pilonidal cyst. Data from 17 (12 males and 5 females) consecutive patients who had elective surgery for chronic pilonidal sinus disease with wide excision of all the sinuses and a new flap technique closure with adipo-fascio-cutaneous flaps which was used in our series for the treatment of pilonidal sinus disease were retrospectively analyzed. Satisfactory results were achieved with this flap rotation technique in 17 patients. There were no flap rotation failures, flap necrosis, disease recurrence, incisional line maceration, or delayed wound healing. As a result, presented technique provides avoidance of flap necrosis, maceration on the incision and insufficient or late healing of the flap. We describe a technique which has a minimal amount of scar across the midline natal cleft and fewer flap corners resulting in a lower chance of margin necrosis. [ABSTRACT FROM AUTHOR]

Objective  The anal fistula has been a common surgical ailment reported since the time of Hippocrates but little systematic evidence exists on its management. We aimed to systematically review the available studies relating to the surgical management of anal fistulas. Method  Studies were identified from PubMED, EMBASE, Cochrane Controlled Trials Register, ClinicalTrials.Gov and Current Controlled Trials. All uncontrolled, nonrandomized, retrospective studies, duplications or those unrelated to the surgical management of anal fistulas were excluded. Results  The search strategy revealed 443 trials. After exclusions 21 randomized controlled trials remained evaluating: fistulotomy vs fistulectomy ( n = 2), seton treatment ( n = 3), marsupialization ( n = 2), glue therapy ( n = 3), anal flaps ( n = 3), radiosurgical approaches ( n = 2), fistulotomy/fistulectomy at time of abscess incision ( n = 5) and intra-operative anal retractors ( n = 1). Two meta-analyses evaluating incision and drainage alone vs incision + fistulotomy were obtained. Conclusion  Marsupialization after fistulotomy reduces bleeding and allows for faster healing. Results from small trials suggest flap repair may be no worse than fistulotomy in terms of healing rates but this requires confirmation. Flap repair combined with fibrin glue treatment of fistulae may increase failure rates. Radiofrequency fistulotomy produces less pain on the first postoperative day and may allow for speedier healing. Major gaps remain in our understanding of anal fistula surgery. [ABSTRACT FROM AUTHOR]