Search

The infiltration and excessive polarization of M1 macrophages contribute to the induction and persistence of low-grade inflammation in joint-related degenerative diseases such as osteoarthritis (OA). The lipid metabolism dysregulation promotes M1 macrophage polarization by coordinating the compensatory pathways of the inflammatory and oxidative stress responses. Here, a self-assembling, licofelone-loaded nanoparticle (termed LCF-CSBN), comprising chondroitin sulfate and bilirubin joined by an ethylenediamine linker, is developed to selectively reprogram lipid metabolism in macrophage activation. LCF-CSBN is internalized by M1 macrophages via CD44-mediated endocytosis and targets the Golgi apparatus accompanied with the reactive oxygen species-responsive release of licofelone (LCF, dual inhibitor of arachidonic acid metabolism). LCF-CSBN effectively promotes M1 to M2 macrophage transition by reprogramming the Golgi apparatus-related sphingolipid metabolism and arachidonic acid metabolism. Intra-articularly injected LCF-CSBN retains in the joint for up to 28 days and accumulates into M1 macrophages. Moreover, LCF-CSBN can effectively attenuate joint inflammation, oxidative stress, and cartilage degeneration in OA model rats. These findings indicate the promising potential of lipid-metabolism-reprogramming LCF-CSBN in the targeted therapy of OA., (© 2025 The Author(s). Advanced Science published by Wiley‐VCH GmbH.)

Objectives: The polyfoliate anterolateral thigh perforator flap needs to dissect two or more perforators, which is an ideal choice for repairing wide and irregular wounds. However, the uncertainty of perforating vessels restricts the development of this operation. This study discusses the feasibility and clinical efficacy of the polyfoliate anterolateral thigh perforator flap with single-perforator., Methods: Fifteen patients with skin and soft tissue defects in extremities, were treated with polyfoliate anterolateral thigh perforator flap with single-perforator. Based on the perforator detected by Doppler ultrasound or color Doppler ultrasonography before operation, a polyfoliate anterolateral thigh perforator flap with single-perforator was designed. The perforating point of perforator was near the boundary of the skin paddle. Following the perforating vessels and vascular pedicles free, the vessels in the deep layer of the superficial fascia were meticulously free under the microscope. After obtaining the appropriate length, the skinpaddles were separated and recombined. After confirming the blood supply of flap, the vascular pedicle was ligated and transplanted to the recipient area., Results: In 15 cases, the area of the flap was 8.0 cm×5.0 cm+6.0 cm×5.5 cm to 16.0 cm× 9.5 cm+24.0 cm×9.0 cm. All flaps survived well without necrosis and had a satisfactory appearance. The donor area was closed directly. The patients were followed up for 3 to 12 months, with an average of 6 months. The skin flaps were normal in color and good in texture., Conclusions: It's a better method to repair the skin and soft tissue defects in extremities by the polyfoliate anterolateral thigh perforator flap with single-perforator because only one perforator needs to be dissected, a group of blood vessels need to be anastomosed, and only one donor area needs to be sacrificed.

Objective: To explore the feasibility and effectiveness of radial collateral artery polyfoliate perforator flap in repair of resurfacing soft tissue defect of hand., Methods: Between September 2017 and September 2018, the radial collateral artery polyfoliate perforator flaps were transplanted to repair 5 cases of two adjacent wounds of hand and wide or irregular wounds. All patients were male, aged from 27 to 52 years, with an average of 42.5 years. The time from injury to admission was 4 hours to 3 weeks, with an average of 7.3 days. Causes of injury included traffic accident in 2 cases, crushing injury in 2 cases, and paint injection injury in 1 case. The wounds were located at the dorsum of hand in 3 cases, the dorsum of finger in 1 case, and the thumb and thumb web in 1 case. The area of wound ranged from 8 cm×6 cm to 10 cm×8 cm. The area of skin flap ranged from 6.0 cm×3.0 cm to 11.0 cm×4.5 cm, all of which carried the posterior cutaneous nerve of the arm, and the donor site was closed directly., Results: All flaps survived and healed by first intention. All patients were followed up 3-11 months (mean, 6.5 months). The patients were satisfied with the appearance of hands. The flaps were not bulky, and the color and texture were similar to the hand. There was only linear scar in the donor site, no radial nerve injury occurred, and elbow joint function was not affected. One patient underwent finger-splitting and skin flap thinning at 6 months after operation., Conclusion: The radial collateral artery polyfoliate perforator flap is a good method for repairing two adjacent wounds and wide or irregular wounds of hand.

Objective: To investigate the feasibility and effectiveness of the superior lateral genicular artery perforator flap for repairing of soft tissue defects in extremities., Methods: Between September 2010 and October 2017, 11 cases of skin and soft tissue in extremities were repaired with the superior lateral genicular artery perforator flap. There were 10 males and 1 female, with an average age of 37.6 years (range, 6-72 years). The causes of injury were traffic accident in 6 cases, machine injury in 1 case, falling down injury in 1 case, falling from height in 1 case, crushing injury in 1 case, and electric injury in 1 case. The defects located at the forearm in 1 case, knee in 5 cases, popliteal fossa in 2 cases, shank in 1 case, and foot and ankle in 2 cases. The area of the wound ranged from 8.0 cm×4.5 cm to 27.0 cm×8.0 cm. The interval from injury to admission was 6 days on average (range, 3-12 days). The area of perforator flap ranged from 9.0 cm×5.5 cm to 28.0 cm×9.0 cm. There were 8 cases of pedicle flap and 3 cases of free flap. All the donor sites were closed directly., Results: Eight flaps survived without any complications and the donor sites healed by first intention. Two flaps had arterial crisis and 1 flap had venous crisis after operation, and the wounds healed after symptomatic treatment. There was no hematoma and secondary infections in all patients after operation. Ten patients were followed up 2-48 months (mean, 13.1 months). All flaps had satisfied appearance and texture. There was no motion limitations in the hip and knee joints of the operated legs., Conclusion: The superior lateral genicular artery perforator flap not only can be used to repair the soft tissue defect around the knee joint as pedicle flap, but also can be used to repair the forearm and foot skin and soft tissue defects as free flap, which is a feasible way to repair soft tissue defects in extremities.

Objective: To investigate the feasibility and efficacy of the Flow-through chimeric anterolateral thigh perforator (ALTP) flap for one-stage repair and revascularization in complex defects of the extremities., Methods: Between May 2014 and June 2017, 6 patients with soft tissue defects on the limbs combined with dead space, bone defects, or tendon and joint exposure, were reconstructed with the Flow-through chimeric ALTP flap. All 6 patients were male. The patients' mean age was 44 years (range, 26-60 years). The mechanisms of injury were traffic accidents in 4 cases, wringer injury in 1 case, and bruise injury caused by heavy object in 1 case. The defects located at the lower extremity in 5 cases and at the upper extremity in 1 case. The area of the wound ranged from 7 cm×4 cm to 26 cm×10 cm. There were 3 cases of bone defect, 3 cases of joint and tendon exposure, 2 cases of chronic osteomyelitis, and 2 cases of main artery injury. The muscle flap was inserted into the deep dead space, with perforator flap for superficial defect. The area of perforator flap ranged from 10 cm×5 cm to 28 cm×11 cm and the area of muscle flap ranged from 5 cm×2 cm to 20 cm×5 cm. The defects on the donor sites were closed directly., Results: All the flaps were survival without infection and vascular crisis. The wounds of recipient and donor sites healed at first intention. The patients were followed up 3- 24 months (mean, 10 months). Good color and texture of flaps was achieved. The reconstructed main artery patency was achieved and the end of the affected limb was well transported. Only linear scar left on the donor site on thigh with no malfunction., Conclusion: The Flow-through chimeric ALTP flap can construct three-dimensional soft tissue defects without sacrificing the recipient vessels. The Flow-through chimeric ALTP flap is an reliable and ideal method for reconstruction of complex wounds in the limbs with dead space and with or without recipient major vessels injury.

Objective: To explore the feasibility of the propeller flap withadipofascial tissue based on peroneal artery perforator for repairing the wound with a dead space in foot and ankle., Methods: Between January 2013 to December 2014,12 wounds with a dead space in foot and ankle were treated with the propeller flap with adipofascial tissue based on peroneal artery perforator after thorough debridement. The adipofascial tissue was used to fill the dead space, the propeller flap was used to cover the superficial wound. The defect at donor site was closed directly., Results: The size of the propeller flap based on peroneal artery perforator ranged from 4 cm × 10 cm to 7 cm × 16 cm, the size of the adipofascial flap ranged from 2 cm × 4 cm to 5 cm × 7 cm. All flaps survived completely and the wounds healed primarily. The defects at donor sites got primary healing without complications. All patients were followed up for 5 to 21 months with an average of 8 months without recurrence of infection during the follow-up period. The appearance, texture, and color of the flaps were similar to those of the recipient sites. Good function of ankle was achieved., Conclusions: The propeller flap with adipofascial tissue based on peroneal artery perforator is a good option for reconstruction of foot and ankle wounds with dead space.