Integrating digital design with 3D printing technology achieves customized and precise approaches for flap transplantation to facilitate fingertip defect surgery.

OBJECTIVE: This study investigates the clinical efficacy of integrating digital design with three-dimension (3D) printing technology in the transplantation of flaps for fingertip defects. METHODS: A retrospective analysis was conducted from October 2019 to June 2021 on 90 cases of patients with fingertip defects. These included 45 cases in which digital design, coupled with 3D printing, assisted the operation (3D printing group), and another 45 cases where patients underwent traditional pedicle flap transplantation and skin grafting (traditional operation group). A six-month postoperative follow-up assessed various measurements between the two groups, comparing the skin flap survival rate, aesthetic outcome, cold intolerance, sensory recovery, and overall skin flap performance. RESULTS: ① Statistical analysis utilizing the independent samples t-test revealed a significant reduction in both operation time and flap anastomosis rate for the 3D printing group compared to the traditional operation group (P < 0.05). ② Conversely, the survival rate, aesthetic outcome, and cold intolerance showed no significant disparities between the groups (P > 0.05). ③ Further, the Mann-Whitney U test indicated no significant difference in sensory recovery and overall efficacy assessment between the two cohorts (P > 0.05). CONCLUSION: Integrating digital design with 3D printing technology facilitated the surgical management of fingertip defects, achieving customized and precise approaches in flap transplantation. This precision in personalized skin flap design contributed to reduced operative time and enhanced surgical efficiency in such procedures.

Extramammary Paget's Disease of the Scrotal and Penile: A Case Report and Review of the Literature.

INTRODUCTION: Extramammary Paget's disease of the scrotum and penis is a relatively rare cutaneous malignant tumor. At present, its pathogenesis, and clinical and pathological characteristics are not very clear. This is controversial regarding surgical margin width to decrease the high recurrence rate. This paper aimed to report the case and review the literature of extramammary Paget's disease of scrotum and penis. CASE PRESENTATION: We presented the case of a 74-year-old male patient with the patchy erythema and pruritus in the perineum who was admitted to our department. Biopsy of the large plaque revealed Paget disease. Under the condition of ensuring negative surgical margins by rapid frozen pathology, a wide local excision of the lesion, bilateral orchiectomy, and adnexectomy were performed on the patient. Pathology revealed that many scattered vacuolated Paget cells were observed in the epidermal layer, and the diagnosis was Paget's disease of the scrotum and penis. The 2 cm outside the skin lesion was used as the initial surgical margin, and free skin flap transplantation was used to repair the surgical wound. The patient recovered well and was discharged 1 week after surgery. CONCLUSION: Currently, histopathologic biopsy is the most important diagnostic method for EMPD. Once confirmed, for patients eligible for surgical intervention, wide local excision of the lesion and rapid intraoperative frozen pathological examination should be performed as soon as possible. The skin flap transplantation is the first choice for the repair of large-scale wound after surgery.

Analysis of material parameter uncertainty propagation in preoperative flap suture simulation.

Skin flap transplantation is the most commonly used method to repair tissue defect and cover the wound. In clinic, finite element method is often used to design the pre-operation scheme of flap suture. However, the material parameters of skin flap are uncertain due to experimental errors and differences in body parts. How to consider the influence of material parameter uncertainty on the mechanical response of flap suture in the finite element modeling is an urgent problem to be solved at present. Therefore, the influence of material parameter uncertainty propagation in skin flap suture simulation was studied, Firstly, the geometric model of clinical patient's hand wound was constructed by using reverse modeling technology, the patient's three-dimensional wound was unfolded into a flat surface by using curved surface expansion method, yielding a preliminary design contour for the patient's transplant flap. Based on the acquired patient wound geometry model, the finite element model of flap suture with different fiber orientations and different sizes was constructed in Abaqus, and the uncertainty propagation analysis method based on Monte Carlo simulation combined with surrogate model technology was further used to analyze the stress response of flap suture considering the uncertainty of material parameters. Results showed that the overall stress value was relatively lower when the average fiber orientation was 45°. which could be used as the optimal direction for the flap excision. when the preliminary design contour of the flap was scaled down within 90%, the stress value after flap suturing remained within a safe range.

IL-4 modified expanded polytetrafluoroethylene (e-PTFE) surgical patch promotes angiogenesis in transplanted flap and inhibits inflammatory response.

Skin flap transplantation is one of the most common tissue transplantation methods for wound repair and organ reconstruction in plastic surgery. During the transplantation process, the inflammatory response of transplanted flap and angiogenesis are critical to the successful rate of skin flap transplantation. In recent years, to improve the biocompatibility and cell affinity of biomedical materials, the modified biomaterials have gradually become a popular subject in scientific researches. In our study, the IL-4 modified expanded polytetrafluoroethylene (e-PTFE) surgical patch IL4-e-PTFE was prepared, and the rat skin flap transplantation model was constructed. The results of cell experiment prove that IL-4 has potentiation in the angiogenesis of human umbilical vein endothelial cell (HUVEC) induced by monocyte, and IL-4 can also promote angiogenesis by inducing the M2 macrophages. According to the results of in vivo experiment, the apoptosis level of transplanted flap cells of rats in the IL4-e-PTFE group was lower than that in the e-PTFE group, and in the IL4-e-PTFE group, the expression levels of pro-inflammatory cytokines IL-1ß, IL-6 and TNF-α showed significantly decline compared to the e-PTFE group, while the expression levels of anti-inflammatory cytokines IL-1Ra, IL-10 and TGF-ß presented significant increase compared to the e-PTFE group; the immunofluorescence staining results show that the number of M2 macrophages in transplanted flap area of rats in the IL4-e-PTFE group was significantly higher than that in the e-PTFE group, and the angiogenesis level was remarkably improved. In this study, by preparing IL4-e-PTFE and carrying out the cell and in vivo experiments, a reference method is proposed, which can reduce the inflammatory response during skin transplantation process using e-PTFE and optimize the long-term effects of flap blood vessels, hoping to provide a broader space for the applications of e-PTFE in medicine.

The efficacy and safety of platelet-rich plasma in the tendon-exposed wounds: a preliminary study.

OBJECTIVE: Currently, among wounds with large skin tissue defects caused by various reasons, the treatment of refractory wounds is still a major clinical problem. This study is aimed to preliminarily assess the therapeutic potentials of platelet-rich plasma (PRP) in refractory wounds with exposed tendons, as well as corresponding efficacy and safety. METHODS: A total of 12 patients (5 males and 7 females) with refractory wounds and exposed tendons who were admitted to our hospital from June 2018 to December 2020 were included in this study. After the preparation of PRP, the included patients underwent the PRP injection after the debridement of wounds, and the efficacy and prognosis were assessed by the same group of senior surgeons. RESULTS: The average age of included patients was 42.7 ± 12.9 years, and the causes of injury included traffic accidents (3 cases), contusion (2 cases), burns (2 cases), diabetes complications (4 cases), and melanoma complications (1 cases). The average healing time was 23.0 ± 5.0 days, and the mean size of the wound was 3.1 × 5.1 cm2. During the whole treatment process, Vancouver Scar Scale (VSS) decreased from 7.4 ± 1.6 before PRP treatment to 3.6 ± 0.9 after treatment (P < 0.001), Manchester Scar Scale (MSS) decreased from 12.3 ± 4.5 before PRP treatment to 5.4 ± 1.2 after treatment (P < 0.001), and no redness and swelling were observed around wounds, the size and degree of wounds gradually reduced, the coverage rate of granulation tissue was acceptable, overall quality of scar was relatively good, skin sensitivity around wounds was normal, there was no local wounds secretion, and postoperative patient's satisfaction was relatively good during follow-up. CONCLUSIONS: Our study has preliminarily indicated that PRP can promote the wounds healing, reduce the inflammation around wounds, and improve the granulation tissue and angiogenesis, thereby effectively polishing up the safety and efficacy.

Masquelet technique combined with modified Sauve­Kapandji, negative pressure drainage and flap transplantation for the treatment of a Gustilo­Anderson III type C open fracture of the forearm: A case report.

Gustilo-Anderson III Type C open fracture is a high-energy injury with severe bone defects and extensive soft-tissue and vascular damage. Successful limb salvage remains challenging for surgeons due to the inherent risks of vascular damage, infection, nonunion and even amputation. The present case study reports on a 55-year-old male who presented with a Gustilo-Anderson III type C open fracture, which was successfully salvaged by a combined Masquelet and microsurgical approach. The modified Sauve-Kapandji technique was used to improve wrist mobility. Sufficient preoperative evaluation, a detailed surgical plan, positive revascularization, thorough debridement and prevention of complications are key to successful limb salvage. The range of motion test was excellent one year after surgery. The patient was able to take care of their daily life, return to performing a light-labor job and is satisfied with the function of the limb. Therefore, the Masquelet technique combined with modified Sauve-Kapandji technique, negative pressure drainage and skin-flap transplantation may be a reasonable and effective treatment for Gustilo-Anderson III type C open forearm fracture.

Ginsenoside Rb3 attenuates skin flap ischemia-reperfusion damage by inhibiting STING-IRF3 signaling.

We investigate the protective effect of ginsenoside Rb3 on skin flap microvasculature following ischemia-reperfusion (I/R) injury and its regulatory mechanism. We used a rat model of I/R injury with the right iliolumbar artery and oxidative stress model of human dermal microvascular endothelial cells. The effects of Rb3 on skin flap tissue and endothelial cell survival, STING-IRF3 pathway activation, and endothelial cell adhesion were measured. Following reperfusion, the survival rate of rat perforator flaps in the Rb3-treated group gradually increased with increasing Rb3 concentration. The treatment also reduced the amount of STING protein, phosphorylated IRF3, and P-selectin in skin flap tissue, with this change being most obvious in microvascular endothelial cells. In vitro, activated IRF3 binds to the P-selectin promoter and induces P-selectin expression. Our results suggest that Rb3 plays a role in reducing I/R flap damage through negatively regulating STING-IRF3 activation to limit leukocyte-endothelial cell adhesion.

Clinical study on orthopaedic treatment of chronic osteomyelitis with soft tissue defect in adults.

To investigate the clinical application value of different flap transfer and repair techniques in adult patients with chronic osteomyelitis of limbs complicated with soft tissue defects. According to the characteristics and defects of 21 cases, different plastic surgery was applied, including debridement, negative pressure device, and tissue flap to cover wound. Among 21 cases of chronic osteomyelitis complicated with local soft tissue defect, 15 patients were repaired with sural neurotrophic musculocutaneous flap transfer, 2 patients were repaired with medial plantar skin flap transfer, 2 patients were repaired with ilioinguinal skin flap transfer, 1 patient was repaired with z-forming wound, and 1 patient was repaired with soleus muscle flap combined with full-thickness skin graft. All the 21 patients underwent bone cement implantation after dead bone osteotomy. Among them, 19 patients underwent bone cement replacement with 3D prosthesis within 6 months to 1 year after surgery, and 2 patients carried bone cement for a long time. Early intervention, thorough debridement, removal of necrotic or infection, and then selecting the appropriate wound skin flap coverage are important means of guarantee slow osteomyelitis wound healing and for providing a possible way to permanent prosthesis implantation subsequently.

[Reconstruction of scarring pharyngeal stenosis with forearm free flap:a case report].

A 33-year-old man presented with recurrent oral ulcers for more than 10 years,accompanying dyspnea and dysphagia for 1 year and aggravate for 1 month.Physical examination:pharyngeal cavity stenosis,mucous retention, epiglottis was extruded into the infant type. Electronic laryngoscope:Epiglottis curl,bilateral pyriform sinus disappeared.Ulcer and scar changes can be seen in the lateral wall of bilateral hypopharynx, piriform sinus and posterior annular area,and cover the throat inlet.Neck CT showed: soft tissue thickening in the posterior wall of oropharynx and laryngopharynx-prevertebral fascia, thickening in the right aryepiglottic fold and with local niche;slight uneven enhancement in enhanced scanning, and disappearance of bilateral pyriform sinus.Bilateral parapharyngeal space is clear, laryngopharyngeal wall is not thick, bilateral vocal cords are not thick, and laryngopharyngeal space is clear.Diagnosis: pharyngeal stenosis (scar?); Behcet's disease..

Adipose mesenchymal stem cell-derived exosomes stimulated by hydrogen peroxide enhanced skin flap recovery in ischemia-reperfusion injury.

BACKGROUND: Mesenchymal stem cell (MSC)-derived exosomes have been recognized as new candidates for the treatment of ischemic disease or injury and may be an alternative treatment for cell therapy. This aim of the study was to evaluate whether exosomes derived from adipose mesenchymal stem cell (ADSC) can protect the skin flap during ischemia-reperfusion (I/R) injury and induce neovascularization. METHODS: To investigate the effects of exosomes in the I/R injury of flap transplantation in vivo, flaps were subjected to 6 h of ischemia by ligating the left superficial inferior epigastric vessels (SIEA) followed by blood perfusion. Exosomes derived from normal ADSC (ADSC-exos) and exosomes derived from ADSC preconditioned with H2O2 (H2O2-ADSC-exos) were injected into the flaps. Then, the blood perfusion unit (BPU) of the flaps was measured by Laser Doppler Perfusion Imaging (LDPI) and microvessel density was determined by the endothelial with cell marker CD31 with Immunohistochemistry (IHC) staining. Inflammatory cell infiltration of the skin flap and apoptosis were detected by hematoxylin & eosin staining (H&E) and the TdT-mediated biotinylated dUTP nick end-labeling (TUNEL) technique. RESULTS: In vivo, exosomes significantly increased flap survival and capillary density compared to I/R on postoperative day 5, and decreased the inflammatory reaction and apoptosis in the skin flap (P < 0.05). Furthermore, H2O2-ADSC-exos had better outcomes compared to normal exosomes (P < 0.05). ADSC-exos could significantly increase human umbilical vein endothelial cell (HUVEC) proliferation (P < 0.05), but no statistic difference was found in exosomes derived from different microenvironments (P > 0.05). HUVEC co-cultured with H2O2-ADSC-exos increased the migration ratio and generated more cord-like structures compared to ADSC-exos and the control group (P < 0.05). CONCLUSION: ADSC-exos can enhance skin flap survival, promote neovascularization and alleviate the inflammation reaction and apoptosis in the skin flap after I/R injury. The use of a specific microenvironment for in vitro stem cell culture, such as one containing a low concentration of H2O2, will facilitate the development of customized exosomes for cell-free therapeutic applications in skin flap transplantation.

To repair soft tissue defects of the foot through the free abdominal flap / 中华整形外科杂志

Objective@#To investigate the effect of free abdominal flap in repairing soft tissue defects of the foot.@*Methods@#From 2011.10 to 2017.11, there were 5 patients whose foot had soft tissue defect, in order to repairing, we had to do debridment at the early time, then made the anterior iliac artery or the inferior epigastric artery as the axial vessel.@*Results@#After the flap transplantation there was no vascular crisis in the 5 patients , followed up for 3 months to 1 years, the blood supply, texture, elasticity and the foot was well in shape and feeling, the patients were satisfied, and the feet were functionally normal.@*Conclusions@#The application of free abdominal skin flap covers the soft tissue defect of the foot, the wound surface, the blood vessel the donor site is consistent, the flap is easy to prepare, and the area can be sutured directly, this is an effective treatment method.

Patients′self-care management after eyelid reconstructing with free flap-skin / 中国实用护理杂志

Objective To explore the method of self-care management education for patients who have received the eyelid reconstruction surgery by transplanting with free flap-skin. Methods There were 11 cases (15 eyes) who achieved self-care management and continued nursing, including the preoperative, postoperative nursing care of the donor-skin area, eye nursing, diet guidance, medication guidance, safety protection and its like. Results None of the cases revealed infection and all the grafts showed good biological activity among the 11 cases (15 eyes). Conclusions After self-care management education and continued nursing, the averaged hospitalization days of the patients are shortened; the cost is reduced, and the successful rate of the eyelid′s construction by free skin-flap transplantation is enhanced. Self-care management education and continued nursing care played an important role in promoting the healing and improving the successful rate of eyelid′s skin-flap transplantation.

Effects of two lubricants on skin preparation from donor site in patients with skin flap transplantation / 现代临床护理

Objective To explore the effects of two lubricants on skin preparation from donor site in patients with skin flap transplantation. Methods According to digit number table, 83 patients undergoing wound repair using modified fascia flap were divided into observation group (n=41) and control group (n=42). The former group were treated with Johnson K-Y Lubricant, while the latter with talcum powder. The two groups were compared in terms of the skin flap quality from donor site, pain degree and number of bacteria before and after transplantation. Results There was no significant difference in bacteria number before and after transplantation in the two groups (P>0.05), but the difference between the groups was significant (P<0.01). The flap preparation quality in the observation group was significantly better than that of control group and the pain degree was significantly lower than that of observation group. Conclusion Johnson K-Y Lubricant can significantly improve flap preparation quality and reduce pain.

Application study of comfortable nursing in patients with skin flap transplantation after hand injury / 中国实用护理杂志

Objective To explore the application effect of comfortable nursing in patients with skin flap transplantation.Methods 140 patients with skin flap transplantation after hand injury were divided into the observation group and the control group with 70 cases in each group.The control group received routine numing while the observation group was given comfortable numing.The numing effect of the two groups was compared.Results The rehabilitation effect of the observation group was beuer than that of the control group(P＜0.01).Conclusion Comfortable nursing had evident promoting effect for the rehabilitation of patients with skin flap transplantation after hand injury.

THE DISTRIBUTION CHANGE OF THE FGF-R IN THE FLAP TRANSPLANTATIN / 解剖学报

Objective To examine the chracteristics of distribution of the FGF R before and after the flap transplantation and the influence of exogenic bFGF on the distribution of FGF R. Method Caudally based random skin flaps were raised on the backs of Wistar rats,bFGF was instilled under flaps after closure.An immunohistochemical techniques stanining method was used. Results FGF receptors distributes in the stratum basal of epidermis,the vascular endothelial cells in the dermis and hypodermis,the fibroblasts and the epithelial cells of the hair follicle and the sweat gland.In compared with preoperation,the quantity of increased gradually from the 1st day to the fifth day after operation,and the peak value is on the fifth day,it then recovered to the pre operation level on the serventh day.After applying the exogenic bFGF,the positive immunoreactive cells in the experimental group,increased remarkably from the Ist day to the 3rd day after operation in contrast with the control group.The peak value is on the 3rd day which was two days earlier than that of the control group and the peak value of the experimental group is remarkably higher than that of the control group.Conclusion\ FGF R distributes in the stratum basal of epidermis,the vascular endothelial cells in the dermis and hypodermis,the fibroblasts,and the epithelial cells of the hair follicle and the sweat gland.In compaired with pre operation,the quantity of the positive immunoreactive cells of FGF R were increased gradually from the Ist day to fifth day after operation,and the peak value is on the fifth day.After applying the exogenic bFGF,the positive immunoreactive cells of FGF receptors were increased.\;[