A retrospective study of the anterolateral thigh perforator flap in the treatment of chronic osteomyelitis of the leg with skin defects.

Background: As a chronic inflammatory process, chronic osteomyelitis is caused by bacterial infections that lead to bone destruction. This disease is more common in patients with open fractures and those undergoing multiple surgical procedures after trauma. We aimed to provide a comprehensive overview and critical assessment of the therapeutic efficacy of the anterolateral thigh (ALT) perforator flap in the management of chronic osteomyelitis with dermatologic and soft tissue imperfections localized in the lower extremity. Methods: A retrospective analysis involving a cohort of 16 patients who underwent ALT perforator flap reconstruction for the management of chronic osteomyelitis in the calf region that manifested with integumentary deficiencies was conducted. Results: During the follow-up period spanning from 4 months to 2 years, all 16 patients who underwent ALT perforator flap transplantation exhibited flap viability. Among these cases, 15 patients made a full recovery from the infection and 1 patient had partial survival. Among the 15 cases, 2 patients developed vascular crisis (owing to venous thrombosis during surgical exploration). One patient had a relapse of the disease 1-year post-surgery. The success rate of this surgical method was 15/16, and the surgical complications included flap crisis, flap necrosis, delayed wound healing, and recurrence of infection. Conclusion: The ALT perforator flap, which can cover bone and soft tissues and effectively control infections, can be applied to the treatment of chronic osteomyelitis of the lower limbs with skin defects. Overall, the muscle flap fills the dead space and medullary cavity and skin flap covers the skin defect.

Management of Ulcers and Lymphorrhea in Lower Limbs after Charles Procedure via Supermicrosurgery.

An 80-year-old female patient was admitted to the hospital due to recurrent lymphedema, ulcers, and lymphorrhea in the right lower limb for 7 years. The physical examination revealed changes after the Charles procedure below the right knee joint plane, with a 7 × 7 cm2 lymphorrhea area in the lower one-third plane of the anterior tibia area. Continuous lymphatic exudation and scattered ulcers could be seen. The dorsal artery of the foot could not be reached due to the thickening and fibrosis of the dorsal skin of the foot. The peripheral blood circulation was favorable. The glycated hemoglobin test revealed that blood sugar was not high and could be controlled. The color Doppler ultrasound of lower limb blood vessels revealed no obvious stenosis of arteries, with normal venous return. In addition, no varicose veins or deep venous thrombosis were observed. Based on these findings, the patient was diagnosed with primary lymphedema combined with lymphorrhea after the Charles procedure, complicated with diabetes. After admission, the patient underwent lymphaticovenous anastomosis on the right lower limb under general anesthesia. During the follow-up of 2 months after surgery, it was found that the lymphorrhea was alleviated, the ulcer basically healed, and the swelling on the right lower limb decreased. At the follow-up of 6 months after surgery, the lymphorrhea was eliminated and the ulcer was healed. There were 1-cm reduction in leg and back circumference and 10% volume reduction. The lymphedema quality-of-life score of this patient was 57 points after surgery.

Limb Preservation and Functional Reconstruction after Complete Amputation and Replantation of the Upper Arm and Thigh.

A 26-year-old man was admitted to our hospital due to the replantation of the severed right upper arm and right thigh injury 6 days before. The patient received emergency treatment at a local hospital. He underwent amputation and replantation for the right upper arm and right thigh. After surgery, he experienced fever, limb swelling, and wound pain. At the time of admission to our hospital, the patient exhibited stable vital signs. An infection was found at the replanted wound, and the culture results showed Pseudomonas aeruginosa. After admission, the patient underwent symptomatic antiinflammatory treatment. In addition, he received fracture reduction and external fixation with a bracket, radial nerve exploration and release of the upper and lower limb external fixation with a bracket, upper femur osteotomy, and external fixation with a bracket. He also received reconstruction of elbow flexion functions with biceps femoris tendon transplantation; reconstruction of wrist joint fusion, finger extension function, and palm function; removal of the femoral external fixation with a bracket; and tibiofibular osteotomy and leg lengthening surgery. Moreover, the anterior tibial tendon was fixed to correct foot drop deformity, and the external fixation bracket was removed. Owing to these efforts, the patient achieved limb preservation with well-reconstructed functions.

Well Leg Compartment Syndrome in the Thigh and Calf Caused by a Forced Prone Position after Syncope.

An 80-year-old male patient was admitted to the hospital due to swelling in the right lower limb with local blisters caused by a forced prone position for 9 hours after syncope. The patient got up in the middle of the night and fainted beside the bed due to a transient cerebral ischemia attack. The front of the right thigh and calf contacted the bed edge, presenting a forced prone position for 9 hours. The physical examination revealed swelling of the right lower limb, accompanied by local tension blisters, and the tension of the thigh and calf was increased. The patient had a history of diabetes, and no lower limb artery or vein thrombosis was found on B-ultrasound. Based on these findings, the patient was diagnosed with well leg compartment syndrome in the right thigh and calf. When the patient was admitted, the creatine phosphokinase level was 62,300 u/L, and the creatinine level was 2.66 mg/dL. Besides, the urea level of this patient was 11 mmol/L. He developed anuria with a high creatinine level, indicating acute kidney injury. Subsequently, temporary hemodialysis was performed for treatment. The patient underwent fasciotomy of the right thigh and calf, and the vacuum-assisted closure device was adopted for wound treatment. After 2 weeks of decompression, the wound was directly sutured under tension. After renal replacement therapy, the creatine phosphokinase level of this patient was 102 u/L, and the creatinine level was 95 mol/L, which tended to be normal.

Limb Salvage Using Lateral Circumflex Femoral Artery Graft for a Hand Vibration Syndrome.

A 50-year-old man was admitted to the hospital with a chief complaint of long-standing cold-induced numbness in the fingers for more than a year, accompanied by persistent hand pain and fingertip ulceration for 3 months. On physical examination, radial and ulnar artery pulsation was absent in both limbs, and pale skin color, low skin temperature, and limited finger range of motion were noted. Gangrene was detected in the fingertips of the left index and middle fingers, and the right middle and ring fingers. The patient was diagnosed with bilateral arterial occlusion and vibration white finger. Upon admission, the patient underwent an intervention surgery on the right side. Subsequently, transplantation of the descending branches of the left and right lateral femoral circumflex arteries was performed to restore blood flow in the bilateral radial arteries. Additionally, debridement was conducted without shortening after the surgical procedure, the patient received anticoagulation, anti-inflammatory, and symptomatic treatment. The bilateral finger skin temperature increased by 3 °C postoperatively, and the accompanying pain and numbness were alleviated. The wound healed 1 month after surgery, and no recurrence of pain or ulcer was reported during the 1-year follow-up period. Eventually, his hand function recovered, without any impact on the vascular donor site.

Facile synthesis of a carbon supported lithium iron phosphate nanocomposite cathode material from metal-organic framework for lithium-ion batteries.

Lithium iron phosphate (LiFePO4, LFP) has become one of the most widely used cathode materials for lithium-ion batteries. The inferior lithium-ion diffusion rate of LFP crystals always incurs poor rate capability and unsatisfactory low-temperature performances. To meet with the requirements from the ever-growing market, it is of great significance to synthesize carbon supported LFP nanocomposite (LFP/C) cathode materials using cost effective and environmentally friendly methods. In this work, an LFP/C cathode material is straightforwardly prepared from a metal-organic framework (MOF) precursor ferric gallate (Fe-GA) using its self-template effect. The Fe-GA precursor is firstly fabricated from the redox coprecipitation reaction between Fe foils and gallic acid (GA) molecules in mild aqueous phase. Then the Fe-GA is directly converted to the LFP/C sample after a following solid-state reaction. In half-cells, the LFP/C composite exhibits a reversible capacity of 109.7 mAh·g-1 after 500 cycles under the current rate of 100 mA·g-1 at 25 °C as well as good rate capabilities. In the LFP/C//graphite full-cells, the LFP/C composite can deliver a reversible capacity of 71.4 mAh·g-1 after 50 cycles in the same condition as the half-cells. The electrochemical performances of the LFP/C cathode in half-cells at lower temperature of -10 °C are also examined. Particularly, the evolution of samples has been explored and the lithium-ion storage mechanism of the LFP/C cathode has been unveiled. The sample synthesis protocol is straightforward, eco-friendly and atomic efficient, which can be considered to have good potential for scaling-up.

Role of microsurgical techniques combined with Ilizarov techniques in limb salvage and functional reconstruction of thermal­crush injuries of the hand: A case report.

The Ilizarov technology was proposed by Former Soviet orthopedic physician Ilizarov. It is a medical method to reconstruct missing tissues. Ilizarov technology combined with soft tissue stretching technology is of great significance in the treatment of common orthopedic problems like bone defects, finger absence, joint contracture and joint stiffness following thermal-crush injuries of the hand. In the present study a 25-year-old male patient sought for limb salvage treatment 1 month after sustaining thermal-crush injuries of the right hand and forearm. The patient had been treated by another hospital with multiple procedures of debridement, and recommended for forearm amputation. The patient was diagnosed with: i) Postoperative infection of thermal-crush injuries of the right hand and right forearm; ii) comminuted open fractures of the proximal and distal phalanges of the right thumb; iii) osteomyelitis; iv) palm skin defects with exposed tendons; and v) skin defects of the opisthenar and the forearm. After a series of treatments including debridement, removal of necrotic tissue, tissue transplantation, skin pedicle, bone lengthening, external shaping, tissue release, joint fusion, traction and rehabilitation exercises, the patient recovered some hand function. Overall, thermal-crush injuries of the hand are severe, complicated combined injuries composed of both heat burn and compression injury and their treatment is challenging. Overall, microsurgery combined with Ilizarov technology can effectively reconstruct the function of complex thermal-crush injuries of the hand.

Replantation of multiple fingertip amputations using super microsurgery: A case report and literature review.

Background: The fingertip amputation is an amputation type of the finger beyond the proximal nail fold. There is no vein available for anastomoses on the dorsal side of the finger, and the palmar vein of the finger is small and tightly attached to the skin. Therefore, it is relatively difficult to implement surgical anastomoses, which poses challenges to the clinical treatment of fingertip amputations. Case report: A 29-year-old male was admitted to the hospital due to "the amputation of the fingertips of the right index, middle, and ring fingers caused by a heavy object compression 3 h ago". The admission examination revealed that the right index, middle, and ring fingers were completely severed at the 1/2 plane of the nail bed, with irregular sections, severe contusion, and pollution. The X-ray examination showed comminuted fractures of the distal phalanges of the right index, middle, and ring fingers. Based on these findings, the patient was diagnosed with multiple severed fingertips of the right hand (Tamai Zone 1). The patient underwent debridement, vascular exploration, and replantation of the right index, middle, and ring fingertips under emergency general anesthesia. After surgery, anti-inflammatory, spasmolytic, and anticoagulant treatment and regular dressing changes were conducted. The patient did not receive a blood transfusion, and all three fingers survived. The appearance of these fingers was favorable 3 months after surgery, and the flexion and extension of these fingers were normal. Eventually, the patient achieved excellent Chen's hand function scores. Conclusions: To the best of our knowledge, this may be the first successful case regarding the replantation of three fingertips after amputations in Tamai Zone 1 with favorable outcomes. It can be maintained that super microsurgery can be used for the replantation of multiple fingertip amputations.

Ectopic multiple digit replantation salvage of hand torsion injury following anterolateral thigh perforator flap coverage.

Retrieval of four finger injury at proximal stump amputation with segmental injury along with soft tissue defect and impending compartment syndrome continues to be challenge for the surgeon. Immediate transplant considering temporary ectopic foster as a practical option in special case. We describe temporary ectopic finger implant for crush injury at Metacarpophalangeal (MCP level) with hand torsion along with forearm compartment was fostered to Dorsum of the foot. The torsion fingers was temporary fixed with mini external fixator for stabilization as salvage, ALT free flap was used to cover soft tissue defect of the hand. Replantation of survived figure was performed using the long pedicle to anatomical site without crushing the MCP joint to allow for later tendon transfer for finger. Satisfactory function regained with no foster site (foot) complication like pain or disability. The author validated ectopic foster for amputee as and procedure of choice for salvage of extremity under special circumstances.

Consecutive engineering of anodic graphene supported cobalt monoxide composite and cathodic nanosized lithium cobalt oxide materials with improved lithium-ion storage performances.

Downsizing the electrochemically active materials in both cathodic and anodic electrodes commonly brings about enhanced lithium-ion storage performances. It is particularly meaningful to explore simplified and effective strategies for exploiting nanosized electrode materials in the advanced lithium-ion batteries. In this work, the spontaneous reaction between few-layered graphene oxide (GO) and metallic cobalt (Co) foils in mild hydrothermal condition is for the first time employed to synthesize a reduced graphene oxide (RGO) supported nanosized cobalt monoxide (CoO) anode material (CoO@RGO). Furthermore, the CoO@RGO sample is converted to nanosized lithium cobalt oxide cathode material (LiCoO2, LCO) by taking the advantages of the self-templated effect. As a result, both the CoO@RGO anode and the LCO cathode exhibit inspiring lithium-ion storage properties. In half-cells, the CoO@RGO sample maintains a reversible capacity of 740.6 mAh·g-1 after 300 cycles at the current density of 1000 mA·g-1 while the LCO sample delivers a reversible capacity of 109.1 mAh·g-1 after 100 cycles at the current density of 100 mA·g-1. In the CoO@RGO//LCO full-cells, the CoO@RGO sample delivers a reversible capacity of 553.9 mAh·g-1 after 50 cycles at the current density of 200 mA·g-1. The reasons for superior electrochemical behaviors of the samples have been revealed, and the strategy in this work can be considered to be straightforward and effective for engineering both anode and cathode materials for lithium-ion batteries.

The Limb Salvage Approach for the Surgical Management of Necrotizing Soft Tissue Infection.

Necrotizing soft tissue infection (NSTI) is a complex infection known for its rapid progression of necrosis within the subcutaneous tissue and fascia. Time is of essence for the management of NSTI. In this report, we present a case of NSTI after infection of poorly managed diabetic foot ulcer in the ankle. The limb salvage approach involves sequential staged procedures. Multiple surgical debridements and "washout" were performed for source control. At the same time, the patient also received a systemic antibiotic regimen. In the second stage, a perforator free flap taken from the anterolateral thigh was used to repair the extensive soft tissue defect and reconstruct a functional foot to achieve maximal limb salvage. The kickstand technique of external fixation was used to reduce soft tissue compression and enhance the surgical offloading of the skin flap. At the 2-year follow-up, the skin integrity of the flap was well-preserved, and the patient returned to his premorbid quality of life.

Engineering a hierarchical reduced graphene oxide and lignosulfonate derived carbon framework supported tin dioxide nanocomposite for lithium-ion storage.

Tin dioxide (SnO2) is widely recognized as a high-performance anode material for lithium-ion batteries. To simultaneously achieve satisfactory electrochemical performances and lower manufacturing costs, engineering nano-sized SnO2 and further immobilizing SnO2 with supportive carbon frameworks via eco-friendly and cost-effective approaches are challenging tasks. In this work, biomass sodium lignosulfonate (LS-Na), stannous chloride (SnCl2) and a small amount of few-layered graphene oxide (GO) are employed as raw materials to engineer a hierarchical carbon framework supported SnO2 nanocomposite. The spontaneous chelation reaction between LS-Na and SnCl2 under mild hydrothermal condition generates the corresponding SnCl2@LS sample with a uniform distribution of Sn2+ in the LS domains, and the SnCl2@LS sample is further dispersed by GO sheets via a redox coprecipitation reaction. After a thermal treatment, the SnCl2@LS@GO sample is converted to the final SnO2/LSC/RGO sample with an improved microstructure. The SnO2/LSC/RGO nanocomposite exhibits excellent lithium-ion storage performances with a high specific capacity of 938.3 mAh/g after 600 cycles at 1000 mA g-1 in half-cells and 517.1 mAh/g after 50 cycles at 200 mA g-1 in full-cells. This work provides a potential strategy of engineering biomass derived high-performance electrode materials for rechargeable batteries.

Engineering a hierarchical carbon supported magnetite nanoparticles composite from metal organic framework and graphene oxide for lithium-ion storage.

Fe based metal organic framework (MOF) materials are being extensively investigated as a precursor sample for engineering carbon supported iron containing nanoparticles composites. Rational design and engineering Fe-containing MOFs with optimized structures using economic and eco-friendly methods is a challenging task. In this work, 1,3,5-benzenetricarboxylic acid (C9H6O6, trimesic acid, H3BTC) and metal Fe are employed to synthesize a MOF sample Fe-BTC in a mild hydrothermal condition. Moreover, with the addition of a small quantity of graphene oxide (GO) as dispersant, a redox coprecipitation reaction has taken place where small Fe-BTC domains well dispersed by reduced graphene oxide (RGO). The Fe-BTC/RGO intermediate sample is finally converted to the hierarchical Fe3O4@C/RGO composite, which delivers an ultrahigh specific capacity of 1262.61 mAh·g-1 at 200 mA·g-1 after 150 cycles and a superior reversible capacity of 910.65 mAh·g-1 at 1000 mA·g-1 after 300 cycles in half cells. The full cell performance for the Fe3O4@C/RGO composite have been studied. It is also revealed that the improved structural stability, high pseudocapacitive contribution and enhanced lithium-ion and electron transportation conditions jointly guarantee the outstanding lithium-ion storage performances for the Fe3O4@C/RGO composite over long-time cycling. The synthesized samples have good potential for wider application.

Controllable engineering magnetite nanoparticles dispersed in a hierarchical amylose derived carbon and reduced graphene oxide framework for lithium-ion storage.

A straightforward and eco-friendly method is demonstrated to engineer magnetite (Fe3O4) nanoparticles well dispersed by an amorphous amylose-derived carbon (AMC) and reduced graphene oxide (RGO) framework. Naturally available amylose (AM) serves as both reducing agent for few-layered graphene oxide (GO) in the first mild redox coprecipitation system and precursor for small-sized pyrolytic AMC in the following thermal treatment. In particular, the presence of the AM molecules effectively limits the crystal growth kinetics for the akaganeite (FeOOH) in the intermediate FeOOH@AM/RGO sample, which contributes to the transformation to Fe3O4 nanoparticles with significantly controlled size in the final Fe3O4@AMC/RGO composite. As a result, both Fe3O4 nanoparticles and AMC domains are adjacently anchored on the larger sized RGO sheets, and a unique hierarchical structure has been engineered in the Fe3O4@AMC/RGO sample. Compared with the controlled Fe3O4@RGO sample, the Fe3O4@AMC/RGO composite exhibits remarkably enhanced initial coulombic efficiency, superior cycling stability and rate performance for lithium-ion storage. The mechanisms of the interaction between GO sheets and AM molecules as well as the inspiring electrochemical behaviors of the Fe3O4@AMC/RGO electrode have been revealed. The Fe3O4@AMC/RGO sample possesses good potential for scaling-up and finding applications in wider fields.

One-Step Engineering Carbon Supported Magnetite Nanoparticles Composite in a Submicron Pomegranate Configuration for Superior Lithium-Ion Storage.

In this work, magnetite nanoparticles (Fe3O4) that are well dispersed by a submicron sized carbon framework in a pomegranate shape are engineered using a flexible one-step spray pyrolysis strategy. Under inert gas atmosphere, the homogeneously mixed Fe3+ ions and chitosan (CS) molecules are in situ transformed to Fe3O4 nanoparticles and spherical nitrogen-doped carbon coating domains, respectively. Moreover, the obtained Fe3O4@C composite exhibits a unique submicron sized pomegranate configuration, in which favorable electric/ionic pathways have been constructed and the Fe3O4 nanoparticles have been effectively dispersed. When used as an anode electrochemical active material, the Fe3O4@C composite exhibits impressive lithium-ion storage capabilities, and maintains a reversible capacity of 500.2 mAh·g-1 after 500 cycles at a high current density of 1000 mA·g-1 as well as good rate capability. The strategy in this work is straightforward and effective, and the synthesized Fe3O4@C material has good potential in wider applications.

Sodium carboxymethylcellulose induced engineering a porous carbon and graphene immobilized magnetite composite for lithium-ion storage.

Immobilizing nanosized electrochemically active materials with supportive carbonaceous framework usually brings in improved lithium-ion storage performance. In this work, magnetite nanoparticles (Fe3O4) are stabilized by both porous carbon domains (PC) and reduced graphene oxide sheets (RGO) to form a hierarchical composite (Fe3O4@PC/RGO) via a straightforward approach. The PC confined iron nanoparticle intermediate sample (Fe@PC) was first fabricated, where sodium carboxymethylcellulose (Na-CMC) was employed not only as a cross-linker to trap ferric ions for synthesizing a Fe-CMC precursor sample, but also as the carbon source for PC domains and iron source for Fe nanoparticles in a pyrolysis process. The final redox reaction between Fe@PC and few-layered graphene oxide (GO) sheets contributed to the formation of Fe3O4 nanoparticles with reduced size, avoiding any severe aggregation or excessive exposure. The Fe3O4@PC/RGO sample delivered a specific capacity of 522.2 mAh·g-1 under a current rate of 1000 mA·g-1 for 650 cycles. The engineered Fe@PC and Fe3O4@PC/RGO samples have good prospects for application in wider fields.

Simple and effective synthesis of zinc ferrite nanoparticle immobilized by reduced graphene oxide as anode for lithium-ion batteries.

In this work, a simple and effective method is developed to synthesize zinc ferrite nanoparticles (ZnFe2O4) in a redox coprecipitation reaction system containing only ferrous and zinc salt followed by a solid-state reaction. On this foundation, ZnFe2O4 nanoparticles with reduced size are further immobilized by reduced graphene oxide (RGO) to engineer a ZnFe2O4/RGO composite by simply introducing graphene oxide (GO) in the above reaction system. The ZnFe2O4/RGO composite electrode exhibits attractive lithium-ion storage capability with a reversible capacity of about 760 mAh·g-1 for 200 charge/discharge cycles and 603 mAh·g-1 for 700 cycles under a current rate of 1.0 A·g-1. The robust and porous RGO supporting framework, well immobilized ZnFe2O4 nanoparticles with controlled size and pseudocapacitive behavior of the composite jointly ensure the good battery performance. Moreover, the synthetic route for ZnFe2O4 nanoparticles and ZnFe2O4/RGO composite is simple and economic, which may be further developed for massive production and applied in other fields.

Experimental Study and Preliminary Clinical Application of Mini-invasive Percutaneous Internal Screw Fixation for Scaphoid Fracture under the Guidance of a 3D-printed Guide Plate.

This study explored the feasibility of employing computer-aided design (CAD) and 3 dimensional (3D)-printed personalized guide plate for the mini-invasive percutaneous internal screw fixation of fractured scaphoid. The study consisted of two parts: (1) experimentation on upper limbs from corpses and (2) preliminary clinical application. Corpse experiments involved upper limbs of 6 adult corpses. The specimens of upper limbs were subjected to plain CT scan. Then the CT data were input into computer to conduct 3D reconstruction of wrist region. The direction and depth of the guide wire and screw were designed on the basis of the principle that screw should lie at the center of scaphoid and the long axis of the screw should be aligned with that of the scaphoid. The carpal bone model and the guide plate were designed and 3D-printed. By using the guide plates, the guide wire was placed and the cannulated compression screw was inserted. The wrist region was examined by X-ray and CT to observe the location of the screw in the scaphoid. The scaphoid was longitudinally excised to grossly observe the location and evaluate the result of screw insertion. For clinical application, the guide plate was employed in 4 patients with fresh scaphoid fracture using the aforementioned operative technique. Our results showed that, in the 6 corpse limbs, the guide plate well fitted the skin surface and the guide wire and screw were accurately put in place in one session. X-ray examination and gross observation confirmed that the screw was satisfactorily positioned and the result met the requirements of the preoperative design. For 4 patients, the guide wire and screw were all precisely inserted into place in one session. The operation time and X-ray exposure times were apparently reduced. The imaging examination exhibited satisfactory results and the hand functioned well. It was concluded that the operative guide plate used for the mini-invasive percutaneous internal screw fixation of fractured scaphoid not only can assist in accurate placement of screw but also shorten operation time and reduce insertion and X-ray exposure times, thereby reducing the radiation injury and damage to the substance and the blood circulation of carpal bone. Its use can also improve the learning curve of surgeons.