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Objective:To evaluate the clinical effects of adjustable traction skin stretchers used in repair of wounds at the lower leg, foot and ankle.Methods:A retrospective study was performed to analyze the clinical data of 56 patients who had been treated for skin defects at the lower leg, foot and ankle from August 2016 to September 2022 at The First Affiliated Hospital of Zhengzhou University, Honghui Hospital, Affiliated to Xi'an Jiaotong University Medical College, The First Affiliated Hospital of Henan Polytechnic University, and Yunnan Zhongde Orthopedic Hospital. There were 35 males and 21 females, aged (39.9±18.7) years. There were 43 traumatic wounds, 3 burns, 6 inflammatory wounds, 3 relief incisions due to osteofascial compartment syndrome, and 1 scar. The areas of skin defect ranged from 2.5 cm × 2.0 cm to 20.0 cm × 10.0 cm. The duration of wounds was (8.6±7.8) d. All the wounds were repaired with adjustable traction skin stretchers. The row-hook type of skin stretchers was used in 28 cases, the single-rod type in 20 cases, the single-rod type combined with an external fixator in 5 cases, and a combination of the row-hook type and the single-rod type in 3 cases.The time for wound traction closure, color of wound skin margin, skin swelling around the wound, functional recovery of affected limb and complications were recorded.Results:The time from skin stretching to wound closure was (7.8±3.8) d in the 56 patients. The color of wound skin edge after stretching was normal in 16 cases, dark red in 38 cases, and dark in 2 cases; the skin swelling around the wound was degree 1 in 21 cases, degree 2 in 33 cases, and degree 3 in 2 cases. The 56 patients were followed up for (8.9±4.1) months. Primary wound closure was achieved in 48 patients, and secondary wound closure in 8 patients after repair with an autologous skin graft. Partial skin necrosis occurred due to tension blisters after skin stretching in 2 patients, one of whom was repaired with an autologous skin graft and the other of whom by dressing change. Deep bone infection recurred in 2 patients whose wounds healed after their bone defects were repaired using Ilizarov technique of bone transfer. In the 56 patients, the muscle strength of the lower extremity beyond the wound was recovered to normal, and the range of motion of the joints adjacent to the wound also recovered to normal.Conclusion:In repair of wounds at the lower leg, foot and ankle, adjustable traction skin stretchers can lead to fine clinical effects and limited complications, because the stretchers can control the tension of skin digitally and precisely.
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Objective To investigate the most important risk factors leading to failure of replantation of severed distal fingers so as to provide theoretic foundation for an improvement of survival rate. Methods Medical records of 65 amputated distal fingers underwent replantation were retrospectively studied to determine the independent risk factor for failure by using univariate and multivariate statistical analyses. Results Of 65 fingers treated with replantation, 8 (12%) failed. Univariate analysis showed that the increase of platelet level was the risk factor leading to failure of replantation (P= 0.041) . Manner of venous drainage (? 2=12.483, P=0.002), injury cause (? 2= 7.992, P= 0.018) , reconstruction of arteries (? 2=4.158, P=0.041) and preservation of the severed finger (? 2=6.240, P=0.044) were significantly correlated with the failure of replantation. However, multivariate logistic regression analyses showed that platelet level (OR=1.020, P=0.046) and manner of venous drainage (OR=0.154, P=0.040) were the significant independent predictors for failure of replantation. Six (38%) out of 16 amputated fingers replantation by means of single venous anastomosis resulted in failure. Of 26 amputated fingers treated with single venous drainage by bloodletting of finger tip, one (4%) failed. However, only one finger (4%) failed when 23 amputated fingers were treated with venous reflux by a combination of these two ways. Conclusions High level of platelet and venous reflux through anastomosis are the independent predictors affecting replantation of the severed fingers. Augmentation of anticoagulation as well as venous drainage determined by concrete lesion condition contribute to a higher clinical survival rate of replantation.
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Profilin-Ⅰis a small actin monomer-binding protein involved in regulating actin polymerization.It plays an important role in cell proliferation,differention,motility and signals transduction in different cell types including endothelial cells and vascular smooth muscle cells.This article recapitulates the wealth of information on structure,function of profilin-Ⅰand its potential role in the genesis and development of cardiovascular diseases.