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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.
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Flap surgery is an important method to repair large open wounds in trauma and plastic surgery. However， flap necrosis is a common issue. Good blood circulation that provides nutrition is a necessary condition for the survival of the flap. Promoting revascularization， establishing blood circulation， and restoring blood perfusion as soon as possible after flap transplantation is crucial for flap survival. However， revascularization/blood reperfusion can cause flap ischemia-reperfusion injury （FIRI） after flap repair. If FIRI is not treated correctly and timely， it can cause flap necrosis and graft failure eventually. Previous studies have shown that the signaling pathways related to cell proliferation and apoptosis， such as the Notch signaling pathway， mitogen-activated protein kinase （MAPK） signaling pathway， and phosphatidylinositol 3-kinase/protein kinase B （PI3K/Akt） signaling pathway， and inflammation-related pathways， such as nuclear factor E2-related factor 2 （Nrf2） signaling pathway， and nuclear factor-κB （NF-κB） signaling pathway can promote angiogenesis， improve local blood supply， inhibit the production and expression of inflammatory mediators， reduce oxidative stress and apoptosis， relieve ischemia-reperfusion injury （IRI）， and promote rapid healing after flap repair. By consulting a large number of modern medical research literature， this study reveals that both Chinese medicine monomers and Chinese medicine compounds can promote revascularization， restore blood perfusion， and accelerate healing after flap repair by regulating the expression of key protein molecules in the above-mentioned signaling pathways. This study summarized the research status in China and abroad， aiming to provide references for the in-depth study and clinical application of Chinese medicine to promote the healing of skin flaps after repair.
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Objective:To explore the application value of different methods of segmented latissimus dorsi myocutaneous flap in repairing chest wall defects after local advanced breast cancer surgery.Methods:The clinical data of 64 patients with unilateral locally advanced breast cancer admitted to Shanxi Cancer Hospital from Feb. 2019 to Jan. 2020 were selected. All patients underwent modified radical mastectomy for breast cancer. The patients were divided into two groups according to the random number table method. Antegrade (group A, n=32 cases) and retrograde (group B, n=32 cases) were used to design and cut the segmented latissimus dorsi myocutaneous flap to repair the defects. The range of skin island cut was 14 cm×6 cm-19 cm×7 cm; The donor area of the flap was closed directly. The application effects of the two groups of methods were compared. Results:In group A, one antegrade flap was partially necrotic, while in group B, six retrograde flaps were partially necrotic ( P>0.05). The delayed healing rate of donor site incision in group A was 6.25%, significantly lower than that in group B (25.00%) ( χ2=4.267, P=0.039). All the patients in both groups were followed up for 12 to 24 months, and the appearance and texture of the flaps were satisfactory; Only linear scar was left in the donor area, and the shoulder joint activity was not affected. The mean survival time was 20.8 months. Conclusion:The antegrade latissimus dorsi myocutaneous flap can repair the large area defect of chest wall after LABC, which can ensure the blood supply of the flap to the greatest extent, reduce the closing tension of the donor area, the incidence of postoperative complications, and promote the healing of the incision.
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Objective To explore the curative effect of pedicled retrograde posterior leg myocutaneous flap in patients with ankle soft tissue defect,and analyze its related factors on patients'sensory function.Methods The data of 120 patients with ankle soft tissue defect who were treated in our hospital from January 2015 to January 2022 and followed up for one year after operation were selected.Among them,60 cases were repaired with pedicled posterior leg myocutaneous flap(group A),40 were repaired with medial foot flap(group B)and 40 were repaired with ankle epithelial flap(group C).The healing(flap survival,infection,appearance,texture),sensory function,appearance satisfaction,Baird-Jackson score and complications of patients with ankle soft tissue defect in each group were compared.Results There was no difference in baseline data among the groups(P>0.05).Patients with ankle soft tissue defect in each group were observed for one year after flap repair.The survival rate of flap in group A was higher than that in group B and C,and the difference was statistically significant(P<0.05).There was no significant difference in infection,appearance,texture and walking function among the groups(P>0.05).After flap repair,the sensory function score of group A was better than that of group B and C,and the difference was statistically significant(P<0.05).The appearance satisfaction of group A was higher than that of group B and C,showing statistical significance(P<0.05).There was no difference in complications after flap repair in each group(P>0.05).Conclusion Skin flap should be chosen according to the area,shape and characteristics of the skin flap for patients with ankle soft tissue defect,and pedicled retrograde posterior leg myocutaneous flap has better curative effect,higher survival rate and higher excellent and good rate of ankle function.It is more helpful for limb function recovery of patients with ankle soft tissue defect.
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Introduction : In our institute, we have used the pedicled right atrial wall flap as an alternative to a free patch to close Atrial Septal Defect (ASD) in a series of patients. We hereby, report its results. Methods : Between January, 2016 and September, 2018, 24 patients (mean age 25.2 ± 12.43 years; range 5 years to 51 years), underwent closure of ASD with pedicled right atrial wall flap. All the patients who underwent this procedure had ostium secundum type of ASD without any other Intra-cardiac anomaly. Results : The intraoperative and postoperative period was uneventful in all the patients. The mean aortic crossclamp (X- clamp) time was 13 ± 2.99 minutes (Mean ± SD) and the mean duration for Cardiopulmonary Bypass (CPB) was 46.5 ± 10.23 minutes (Mean ± SD). There was no mortality. All the patients were discharged either on 3rd or 4th postoperative day. The pre-discharge and latest follow-up Transthoracic Echocardiographic Evaluation was found satisfactory in all the patients. None of them revealed any residual shunt, peri-flap Thrombosis, Flap dehiscence or shrinkage, or Cardiac Dysfunction. Conclusions : The Pedicled Right Atrial Wall Flap can be safely used as an alternative for pericardial patch for ASD closure. It is a novel technique with several advantages.
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Objective To investigate the clinical effect of treatment with local skin flap after primary surgical resection of non melanoma skin cancer.Methods A total of 176 patients with head and facial skin cancer who were admitted into our hospital from September 2008 to September 2015 were divided into three groups according to different repair plans.Namely,the suture group (41 cases),the local skin flap group (81 cases) and the skin graft group (54 cases).The repair effect of the three groups were compared after the operation.Results The good rate was 68.39%(28/41) in the suture group,98.77%(80/81) in the local skin flap group,and 83.33%(45/54) in the skin graft group,and it was significantly higher than any of the other two groups with statistically significant difference(P0.05).The 3 groups were followed up for a period of 1 year,as a result,there was no recurrence and distant metastasis.Conclusion For patients with head and facial non melanoma skin cancer,repaired with local skin flap healing treatment after primary surgical resection can not only get high healing rate but also significant improvement of patient satisfaction rate.In addition,it can lower the rate of recurrence and distant metastasis after operation.
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Objective To summarize perioperative points for nursing patients with extramammary Paget’s disease undergoing resection of tumor of vulva expansion and flap repair.Method Eleven patients with extramammary Paget’s disease were managed with resection of tumor of vulva expansion and flap repair,and with perioperative care as well.Results The tumors in all of the patients were removed completely and the flaps survived.All patients were discharged for hospitalization of(4.5±0.7)days.No flap infection or necrosis occurred.Conclusion The measures for nursing the patients with extramammary Paget’s disease undergoing resection of tumor of vulva expansion and flap repair may include preoperative preparation,mental care,postoperative observation of flaps, prevention of complications,health education,instruction on nutrition and formation of proper life style,which may be beneficial for the smooth manipulation of resection as well as for the postoperative rehabilitation.
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Objective To investigate the skin flap in the repair of tongue cancer resection surgery and perioperative nursing measures.Methods 36 patients with tongue cancer undergoing resection of primary lesion of tongue,floor of the mouth,the cervical lymph node in combination with free flap transfer for repair,and during the preoperative,intraoperative and postoperative period nursing measures were implemented.Results The masticatory function,aspiration rate and functions of language of patients 6months after discharge showed obvious improvement compared with those upon discharge.The difference was statistically significant.The UW-QOL quality of life score ranged from 320 to 1200 points,with an average score of (960.21 +146.84)points.One of the highest scoring items was pain,followed by anxiety,saliva was the lowest.Conclusions For patients with tongue cancer undergoing resection and skin flap repair,nursing methods are very important,which were the guarantee of improving the quality of life of patients.