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At present, several measures are often used to deal with the wound, such as reducing the partial pressure, containing the wound infection, thorough debridement dressing, strengthening the local blood circulation, negative pressure closed aspiration and wet dressing methods, most of them can achieve good prognosis, but there are still some patients with non-healing wound, avascular necrosis of tissue and even gangrene, severe cases need amputation. In recent years, with the rapid development of stem cell research, the paracrine function of stem cell has received widespread attention in the treatment of chronic wounds, and stem cell-derived exosomes have become a new strategy for the treatment of non-healing wounds. Exosomes are double membrane sacs of lipid secreted by cells, with a diameter of 30-100 nm, which are paracrine products of stem cells. Studies have shown that stem cell exosomes participate in wound repair by means of many measures, including regulating inflammatory response, regulating the growth and expansion of extracellular matrix, promoting angiogenesis and inhibiting scar formation. However, exosomes from different stem cells have different regulatory mechanisms on wound healing. This paper reviews the role and related mechanism of exosomes derived from stem cells in wound treatment, and provides a theoretical basis for the application of exosomes in clinical treatment of non-healing wounds.
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Objective:To investigate the clinical efficacy of integrated steel plate system combined with Kirschner wire internal fixation in the treatment of Lisfranc injury.Methods:Data of 30 cases with Lisfranc injury who were admitted from January 2010 to December 2018, including 22 males and 8 females were retrospectively analyzed. The age ranged from 22 to 58 years, with an average age of 44.5 years. All of them were closed injuries, including 8 cases involving metatarsal tarsal base fracture, and 2 cases with compression fracture of dice. Classification of Lisfranc joint injury: 6 cases of injury of the inner column alone, 10 cases of injury of the inner column and the middle column, 4 cases of injury of the middle column and the outer column, 10 cases of injury of the three columns. Cause of injury: traffic injury in 12 cases, machine injury in 10 cases, fall injury in 8 cases. The time from injury to operation was 2-7 d, with an average of 5 d. After the improvement of soft tissue conditions, all patients were treated with open reduction and internal fixation using integrated plate system combined with Kirschner wire, followed up by regular post-operative imaging examination, and the therapeutic effect was evaluated by the American Association of Foot and Ankle Surgery (AOFAS) midfoot score.Results:Thirty patients were followed up for 12-30 months (mean 24 months), during which no soft tissue complications such as wound infection and skin necrosis were observed. Average postoperative healing was observed at 12 weeks (10-16 weeks) for them who combined with fracture. At the latest follow-up, the AOFAS midfoot score was 65-95 points (mean 85 points). The midfoot function scores of the 30 patients were: excellent in 15 cases, good in 10, fair in 3, poor in 2. The excellent and good rate was 83.3% (25/30). One patient showed low toxicity and red skin 8 months after the operation. The integrated steel plate system was removed and the skin healed smoothly after the operation. One year after surgery, 10 patients requested removal of the internal fixation. None of the patients had the complication of plate, screw and Kirschner wire fracture. Two patients with three-column injury developed traumatic arthritis and walking pain 12 and 18 months after surgery, respectively, and then underwent metatarsal tarsal joint fusion. The postoperative pain disappeared.Conclusion:The integrated steel plate system combined with Kirschner wire internal fixation for the treatment of Lisfranc injury is simple, can avoid joint redislocation and articular cartilage reinjury, is a safe and effective method for the treatment of Lisfranc injury.
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Objective:To explore the repair of fingertip defects with transplantation of different types of free perforator flaps pedicled with the superficial palmar branch of radial artery (SPBRA).Methods:A retrospective analysis was carried out of the clinical data of 46 fingers from 38 cases [28 males and 10 females, aged 17-54 years with a mean age at (38.5±15.5) years] with tissue defects of fingertips that were repaired with free perforator flaps based on SPBRA, between January, 2013 and December, 2018. The soft tissue defects were 1.5 cm ×3.5 cm to 2.5 cm×5.5 cm. Among them, 8 cases were repaired with bilateral free SPBRA perforator flaps. Thirteen flaps carried long palmar tendon. Thirty flaps carried radial nerve and the other 16 flaps without. The size of flaps was 1.6 cm×4.0 cm- 2.8 cm×6.0 cm. Donor sites were all closed directly. Monthly postoperative follow-up was conducted. All the evalua- tion indexes of flap were measured and recorded. Instructed patients to do wrist and finger joint exercises.Results:All 46 flaps survived. No vascular crisis happened and all skin grafts survived in donor sites. There was 0.5 cm×0.3 cm of distal flap necrosis in 1 case and healed by dress changing. Thirty-eight cases had followed-up for 6 to 24 months. The flaps were soft and elastic, and colours were near to normal. There was no bulkiness. Sensory function re- covered well and TPD was 5.0-8.5 mm. The function and appearance of the finger were good. According to the Oper- ative Hand Surgery Function Evaluation of Flap after 6 months, the result was excellent in 42 cases, good in 3 cases, fair in 1 case, with 97.83% of excellent and good rate.Conclusion:Using different types of free tissue perforator flap based on SPBRA can repair fingertip defect, and reconstruct the defect of digital artery, nerve or tendon in one stage. The operation was simple and easy to do, and can achieved good results with high survival rates and good function recovery.
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Objective To explore the clinical outcomes of free latissimus dorsi lobulated musculocutaneous flap for repairing the soft tissue defects of the shank.Methods From January 2011 to December 12,free latissimus dorsi lobulated musculocutaneous flap was transferred to repair soft tissue defects of the shank in 22 cases.There were 16 males and 6 females retrospectivelyanalyzed,with an average age of 37.5±2.5 years.The wounds all had tendon,bone and/or internal fixation exposed.The size of the defect area was 18 cm×10 cm to 28 cm×15 cm.At first,the site of perforator vessels was determined by Doppler as the center,then the lobulated flaps were designedaccording to the wound shape and size.During the operation,the thoracic and dorsal nerves and part of latissimus dorsi muscle were preserved,and the myocutaneous flap was formed into lobulated myocutaneous flap.Finally,the pedicle was dissociated to the appropriate lengthwhen only the vascular pedicle was connected with the flap.After the combination of the two lobulated myocutaneous flaps,the skin flap was trimmed,and the subcutaneous fat was removed in a step-like way from the peripheral to the point of perforation of vascular cutaneous branches.Only the dermis was retained around the integral skin flap,and the blood supply of the skin flap was observed at the same time to prevent the injury of perforating vessels.The transplantation of musculocutaneous flap was performed to repair the leg wound.All donor sites were sutured directly.The flap survival was observed according to the comprehensive evaluation standard of hand surgery.Results All the 22 flaps survived,and the size of lobulated musculocutaneous flap was 20 cm× 12 cm to 30 cm× 16 cm.No vascular crisis happened,and all skin grafts survived in donor sites.22 cases were follow-up for 6 to 24 months.The flaps were supple and elastic with nearly normal color.There was no bulkiness.Sensory function recovered well and two-point discrimination (2-PD) was about 3.5-5.0 cm.The function and appearance of the foot and ankle was good.According to the operative hand surgery function evaluation of flap,the results were excellent in 13 cases,good in 8 cases,fair in 1 case,with excellent and good rate of 95.45％ (21/22).1.0 cm×0.5 cm of the distal of flap was necrosis in 1 case and healed by dress changing.Conclusion The free latissimus dorsi lobulated musculocutaneous flap is an improvement of the traditional latissimus dorsi flap.The survival rate of musculocutaneous flap is high and the clinical effect of repairing soft tissue defect of lower leg is satisfactory.
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Objective To discuss the clinical efficacy of suture anchor associated with open reduction and internal fixation (ORIF) in the treatment of ankle fractures with deltoid ligament rupture.Methods To retrospectively analyze 32 patients' information admitted to Dalian Central Hospital from January 2010 to December 2015 treated by suture anchor associated with ORIF,there were 25 male,7 female,and the average age was 46.6 years old (ranged from 28 to 66 years old).14 cases lefi side and 18 cases right side.All cases were closed fractures with no combinedfractures elsewhere.The timing from injury to therapy was 2 to 8 days,4.8d on average.According to Lange-Hansen classification system,6 cases were supination-external rotation (SER),18 were pronation-external rotation (PER) and 8 cases were pronation-abduction (PA).All of 32 cases were treated by suture anchor technique,then evaluated its clinical efficacy on suture anchor technique by judging improvements on clinical syndromes and signs,and radiological examination.All patients were not provided with gypsum external fixation after operation,ankle functioning practice was allowed at early-stage and partially weight-bearing was permitted during the first 6 weeks of post-operation,and full weight -bearing on 12 weeks.The ankle foot function score was evaluated by American Orthopedic Foot and Ankle Society (AOFAS).Results All 32 cases were followed from 6 to 18 months,12 months on average.Fracture union time was 8 to 12 weeks,10 weeks on average.No infection,delayed union,nerve injury,screw loosening or osteomyelitis after surgery.1 case of wound partially split and part of titanium plate screws exposed,and it was recovered through debridement for 3 weeks.2 cases of traumatic arthritis with walking pain,1 of which was treated by joint fusion and recovered then and the other was lost in follow-up,because of medical expense.AOFAS evaluation:16 cases were excellent,11 cases were good,3 cases were fair and 2 cases were poor.The excellent and good rate reached 84.4％ (27/32).X-ray measurement showed the medial malleolus space of pre-operation was (5.32±0.38) mm on the affected side,and (2.67±0.26) mm of post-operation,the difference was statistically significance.X-ray measurement showed the medial malleolus space was (2.78±0.23) mm on the affected side 8 months after operation,compared to the space (2.56±0.26) mm on unaffected side which indicated no statistically significance.Conclusion It shows promising clinical efficacy through suture anchor technique associated with ORIF in the treatment of ankle fractures with deltoid ligament rupture.
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Objective To explore the clinical outcome of free super?thin anterolateral femoral perforator lobulated skin flap with nerve for repairing the tissue defect of the foot and ankle. Methods Free super?thin anterolateral femoral perforator lob?ulated skin flap with nerve was transferred to repair soft tissue defects of the foot and ankle in 32 cases. There were 20 males and 12 females with an average age of 35.5 years (range, 21-50 years). The wounds located in dorsal and plantar ankle skin with ten?don, bone and/or internal fixation exposed. The defect area was from 12 cm×10 cm to 20 cm×15 cm. At first the site of perforator vessels were determined by Doppler, according to the wound shape and size, the flaps were designed and harvested with the site as center;the femoral lateral cutaneous nerve was carried and most tensor fascia was reserved. During flap harvesting trimming of the flap was carried out, the flap was freed and only connected with its vascular pedicle. A step?wise defatting was done from the pe?riphery of the flap towards the vascular pedicle with 1.0 to 2.0 cm tissue around the perforator preserved. Flap circulation was care?fully observed to prevent damage to the perforators. The vascular pedicle was disconnected and formed a split leaf skin flap, and then the flap was transferred to the foot and ankle to cover the defect. Results All the 32 flaps were survived. No vascular crisis happened and all skin grafts were survived in donor sites. Necrosis of 1.5 cm×1.0 cm of the distal flap occurred in 1 case five days after surgery and it was healed by dress changing. All the 32 cases were followed?up for 6 to 24 months (average, 13 months). The flaps were supple and elastic with near normal color. There was no bulkiness. Sensory function was recovered well and two point discrimination (2?PD) was about 3.0-5.0 mm. The function and appearance of the foot and ankle were good. According to the Chi?nese Medical Association of hand surgery upper limb function evaluation of upper limb, the results were excellent in 22 cases, good in 9, fair in 1, with 97%(31/32) overall excellent and good rate. Conclusion The free super?thin anterolateral femoral perfo?rator lobulated skin flap with nerve is an improvement of the traditional anterolateral thigh flap. The survived flaps are ideal in terms of covering foot and ankle defects and restore function.
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Objective To explore the incidence rate and the risk factors of deep vein thrombosis (DVT) in patients with traumatic fractures so as to provide references for prevention of DVT.Methods All of 534 Patients with fresh four extremities or pelvic fracture between January 2010 and December 2013 were involved in this study.The incidence of DVT under 5 risk factors including general state, injury type, fracture condition, operation and laboratory examination were analyzed.Each patient underwent three Doppler ultrasound exams in actions as the epidemiology diagnostic criterion for DVT.Results The total incidence rate of DVT in 534 patients was 11.99％.The univariate analysis showed that male patients with age≥60 years, BMI≥25 kg/m2, history of smoking, lack of exercises, history of diabetes, hypertension and coronary artery disease had higher incidence rate of DVT.In different injury types, the fall injury caused the highest incidence rate of DVT (45.71％).There were different DVT rates for different fracture sites, with the highest incidence rate of DVT for femur shaft fracture (20.69％).The incidence rate of DVT was 50.00％ for fractures of more than three parts, 15.29％ for fractures of two parts and only 3.98％ for sole part.The incidence rate of DVT for comminuted fractures was higher than others.The operation duration, massive transfusion during operation and general anesthesia were related with the increase of incidence of DVT.Positive ACA and enhancement of D-dimer, Fib and CRP were related with the increase of incidence of DVT.Conclusion The incidence of DVT in patients with traumatic fractures approaches a considerable level.It has relationships with age≥60 years, BMI≥25 kg/m2, history of smoking, fall injury, fracture of femoral shaft and hip, more than three parts of fractures, comminuted fractures, operation duration≥2 hours, largely blood transfused, massive transfusion during operation, general anesthesia, positive ACA, enhancement of D-dimer, Fib and CRP.The surgeons should recognize the importance to prevent DVT and PE in the traumatic patients.
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Objective To evaluate the clinical effect of the treatment for calcaneal fractures by locking compression plate.Methods From January 2008 to December 2011,30 patients with 40 calcaneal fractures were operated with locking compression plate.There were 25 males (33 feet) and 5 females (7 feet) with an average age of 44.8 years (range,22-60 years).Fifteen feet were on the left side,and 25 feet were on the right side.All patients had closed fractures,with complicated spinal injury in 2 patients.According to Sanders classification,20 feet were type Ⅱ[fractures,15 feet were type Ⅲ,and 5 feet were type Ⅳ.The lateral approach was adopted for all the patients in the treatment in which locking compression plate fixation was used but no external fixation.Early and suitable rehabilitation was carried out postoperatively.The patients could bear part of the loading six weeks after the operation and all the loading twelve weeks after the operation.The results were validated using the Anerican Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale.Results The patients were followed up for 8-20 months (average,12 months).Bone union occurred in all cases with roentgenographic evidence during 8-12 weeks postoperation (average,10 weeks).None of the patients had such complications as nerve injury or osteomyelitis.Incision dehiscence occurred in one case in which a little part of titanium plate and screw was exposed,but the incision was healed by dressing 1 month later.Two patients had subtalar arthritis and suffered from the pain while walking.Of the two patients,the pain was relieved for one after the operation of subtalar joint fusion,and the other was lost to the follow-up after he or she refused further treatment for economic reasons.According to AOFAS foot score standard,the effects of 20 cases were excellent,17 were good,and 3 were fair.The excellent and good rate was 92.5％.Conclusion The application of locking compression plate is an effective and satisfied treatment of calcaneal fractures which is beneficial for healing and functional exercise.Moreover,the rate of soft tissue complication after operation is low.