Effect of Elevated Blood Glucose on Postoperative Complications Among Diabetic Patients After Surgical Treatment of Torsional Ankle Fracture.

BACKGROUND: This study aims to evaluate the association of elevated blood glucose and postoperative complications among diabetic patients after surgical treatment of torsional ankle fracture. METHODS: This was a retrospective study of consecutive diabetic patients treated surgically for a torsional ankle injury between January 2017 and December 2021 at a large tertiary hospital. All patients who met inclusion and exclusion criteria were divided into a high-HbA1c group or a low-HbA1c group according to the HbA1c cutoff of 7.0% within 3 months of operation, then a propensity score match was performed to control potential confounding factors. The primary outcomes were postoperative complications, and secondary outcomes were unplanned secondary procedures. RESULTS: A matched cohort of 238 patients was finally included, with 119 patients with high HbA1c levels and 119 with low HbA1c levels. Patients with high HbA1c levels experienced more complications (31.1% vs 18.5%, P < .01) and more secondary procedures (22.7% and 8.4%, P < .01) than those with low HbA1c levels. Multivariate logistic regression indicated that patients with high HbA1c levels were significantly associated with higher proportions of any complications (OR 2.25, 95% CI 1.08-4.69; P = .03), superficial infection (OR 4.03, 95% CI 2.13-5.41; P < .01), deep infection (OR 1.42, 95% CI 1.23-2.02; P < .01), and any unplanned secondary operations (OR 3.72, 95% CI 1.62-8.52; P < .01) compared with those with low HbA1c levels after controlling for potential confounders. Multivariate linear regression showed that high HbA1c levels were significantly associated with a higher number of complications (ß = 4.61, 95% CI 2.63-18.18; P < .01) and a higher number of secondary procedures (ß = 4.44, 95% CI 2.79-10.87; P < .01). CONCLUSION: Patients with an HbA1c >7.0% within 3 months of operation are more likely to have a wound issue/infection and more likely to undergo a secondary procedure after surgical treatment of torsional ankle fractures in diabetic patients than patients with an HbA1c ≤7.0% within 3 months of operation. LEVEL OF EVIDENCE: Level III, retrospective cohort study.

ZDHHC16 restrains osteogenic differentiation of bone marrow mesenchymal stem cells by inhibiting phosphorylation of CREB.

Aims: The osteogenesis of human bone marrow mesenchymal stem cells (hBMSCs) plays a critical role in fracture healing. Osteogenic differentiation is regulated by a variety of post-translational modifications, but the function of protein palmitoylation in osteogenesis remains largely unknown. Methods: Osteogenic differentiation induction of hBMSCs was used in this study. RT‒qPCR and immunoblotting assays (WB) were used to test marker genes of osteogenic induction. Alkaline phosphatase (ALP) activity, ALP staining and Alizarin red staining were performed to evaluate osteogenesis of hBMSCs. Signal finder pathway reporter array, co-immunoprecipitation and WB were applied to elucidate the molecular mechanism. A mouse fracture model was used to verify the in vivo function of the ZDHHC inhibitor. Key findings: We revealed that palmitic acid inhibited Runx2 mRNA expression in hBMSCs and identified ZDHHC16 as a potential target palmitoyl acyltransferase. In addition, ZDHHC16 decreased during osteogenic induction. Next, we confirmed the inhibitory function of ZDHHC16 by its knockdown or overexpression during osteogenesis of hBMSCs. Moreover, we illustrated that ZDHHC16 inhibited the phosphorylation of CREB, thus inhibiting osteogenesis of hBMSCs by enhancing the palmitoylation of CREB. With a mouse femur fracture model, we found that 2-BP, a general inhibitor of ZDHHCs, promoted fracture healing in vivo. Thus, we clarified the inhibitory function of ZDHHC16 during osteogenic differentiation. Significance: Collectively, these findings highlight the inhibitory function of ZDHHC16 in osteogenesis as a potential therapy method for fracture healing.

[The second dorsal metacarpal artery flap relaying the dorsal island flap of the index finger for the repair of soft tissue defect of thumb].

Objective: To investigate the effectiveness of the second dorsal metacarpal artery fascial vascular pedicle retrograde island flap relaying the dorsal island flap of the index finger in repairing skin and soft tissue defects of the thumb. Methods: The clinical data of 8 patients with skin and soft tissue defects of thumb between October 2019 and January 2021 were retrospectively analyzed. There were 3 males and 5 females with an average age of 35 years (range, 18-52 years). The causes of injury included machine injury in 2 cases, crush injury in 3 cases, and cutting injury in 3 cases. There were 2 cases of dorsal defect of the proximal part, 1 dorsal defect of the distal part, and 5 instances of the distal part defect. The skin and soft tissue defects ranged from 1.7 cm×1.4 cm to 3.0 cm×2.5 cm. The time from injury to flap repair was 7-21 days, with an average of 14 days. Firstly, the dorsal island flap of the index finger (dorsal side of the proximal part of the index finger) was used to repair the defect of the thumb. Then the second dorsal metacarpal artery fascia vascular pedicle retrograde island flap (near the radial side of the back of the hand) was used to repair the dorsal defect of the index finger; the donor site was sutured directly. Results: Vascular crisis of the flap occurred in 1 case within 48 hours after operation, and the flap was bloated and bruised in 1 case due to excessive suture tension, and all the flaps survived after symptomatic treatment; partial skin margin of the flap was necrotic in 1 case after operation, and the incision healed after dressing change; the other 5 flaps survived, and all the wounds in the donor and recipient sites healed by first intention. All the 8 patients were followed up 3-10 months, with an average of 6 months. One patient had mild scar; the other patients had no significant difference in the color of the flap and the surrounding skin, no adhesion of tendons, and little interference of index finger function, and there was no obvious pain and dysfunction in the donor and recipient sites of the flap. At last follow-up, the extension-flexion range of motion of the metacarpophalangeal joint of the thumb was 0°-55°, and that of the interphalangeal joint was 0°-75°; the extension-flexion range of motion of the metacarpophalangeal joint of the index finger was 0°-82°, that of the proximal interphalangeal joints was 0°-90°, and that of the distal interphalangeral joints was 0°-65°. Conclusion: The application of the second dorsal metacarpal artery fascial vascular pedicle retrograde island flap relaying the dorsal island flap of the index finger to repair skin and soft tissue defect wounds of thumb is a feasible treatment with reliable blood supply, less postoperative complications, no need for skin grafting, less interference to the function of the index finger, and satisfactory wound repair effect.

Plating after lengthening in treating phalangeal and metacarpal deficiency: An alternative method.

OBJECTIVES: This study aims to investigate whether plating after lengthening in patients with phalanges and metacarpals deficiency could significantly shorten the duration of external fixation and decrease bone healing index. PATIENTS AND METHODS: Between February 2010 and December 2018, 11 phalanges in nine patients (6 males, 3 females; mean age: 28.4±4.4 years; range, 22 to 35 years) and nine metacarpals in six patients (2 males, 4 females; mean age: 21.0±2.9 years; range, 16 to 25 years) were lengthened at a rate of 0.25 mm in two increments. A unilateral external fixator was applied in all cases. A locking compression plate was applied at the end of the distraction period before the external fixator was removed. Removal of the plate was considered two years after the internal fixation. RESULTS: The desired length and bone consolidation were achieved in all cases. The additional lengths achieved in the phalanges and metacarpals group were 18.3 mm and 27.7 mm on average, respectively. The bone healing indexes in the phalanges and metacarpals were 1.33 and 1.44 mo/cm, respectively. No significant difference was observed in the pre- and postoperative range of motion of involved metacarpophalangeal joint of both phalangeal (95% CI: -0.469~1.014, t=0.820, p=0.432) and metacarpal (95% CI: -0.689~0.975, t=0.420, p=0.689) lengthening cases. Only one case of minor complication (track infection) occurred. CONCLUSION: Plating after lengthening is an ideal method for phalanges and metacarpals deficiency. Its advantages include shorter duration of external fixation, lower complication rate, and early functional recovery.

Severe spaghetti wrist injury: Should we expand the terminology from wrist to proximal forearm?

OBJECTIVES: This study aims to point out the key principles for the management of multicomponent soft tissue injuries of the wrist and forearm to discuss whether we should expand the term "spaghetti" from the wrist to forearm in such terrifying cases. PATIENTS AND METHODS: Data from a total of 50 patients (44 males, 6 females; mean age: 48.5±25.7 years; range, 10 to 70 years) who were treated for multicomponent soft tissue injuries of the wrist and forearm, including at least one major artery and one major nerve, between February 2020 and December 2021 were retrospectively analyzed. The patients were divided into the wrist injury group (n=30) and forearm injury group (n=20) according to the location of laceration. Demographic characteristics, including age, sex ratio and mechanism and side of injury, total lacerated structures, and outcomes, including tendon function, opposition, intrinsic muscle function, deformities, sensation and grip strength were evaluated. RESULTS: In the wrist injury group, a mean of 12.27±3.53 structures at the volar side were injured. It took a mean time of 1.8±0.4 h for emergency surgical repair and, after a mean of 16.6±5.3 month follow-up, most patients received excellent/good outcomes in the six aspects. In the forearm injury group, a mean of 12.95±2.96 structures at the volar side were injured. It took an average time of 2.1±0.4 h for emergency surgical repair and, after a mean of 15.4±6.4 month follow-up, most patients received excellent/good outcomes and were satisfied with the functional recovery. Only surgical time (p=0.018) and final grip strength (p=0.023) between the two groups showed a statistically significant difference. CONCLUSION: We propose to merge the severe wrist and proximal forearm laceration of multiple tendons/muscles with at least one major artery and one major nerve as a whole, namely the spaghetti-ketchup injury, since the laceration of wrist and that of proximal forearm in this study share similar mechanisms and outcomes after primary repair or reconstruction.

Novel use of close-wedge osteotomy and monorail external fixator in the treatment of chronic Monteggia fracture.

OBJECTIVES: This study aims to evaluate the efficacy of close-wedge osteotomy and monorail external fixator in the treatment of chronic Monteggia fracture. PATIENTS AND METHODS: Between January 2014 and December 2021, data of a total of 22 patients (14 males, 8 females; mean age: 15.6±5.1 years; range, 6 to 25 years) who suffered from chronic Monteggia fractures were retrospectively reviewed. All the patients were treated for acute angulation of the ulna after osteotomy and gradual angulation for radial head reduction. Range of motion of the elbow and forearm, the angle between the longitudinal axis of proximal radius and the hypothesized Storen's line (RSA), Visual Analog Scale (VAS), and Mayo Elbow Performance Score (MEPS), as well as Disabilities of Arm, Shoulder and Hand (DASH) score were recorded preoperatively and at the final follow-up. RESULTS: Objective parameters were all significantly improved in the aspects of range of motions of the elbow and forearm, and RSA (21.4±4.5° preoperatively and 2.0±1.4° at the final follow-up, t=18.20, p<0.05). The level of pain due to the chronic injury was eliminated, as the mean VAS was significantly lower at the final follow-up compared to preoperative scoring (2.8±2.0 preoperatively and 0.5±0.9 at the final follow-up, t=4.86, p<0.05). The function of the elbow and upper limb was restored, which was indicated by improved MEPS (73.2±12.5 preoperatively and 96.6±6.4 at the final follow-up, t=7.70, p<0.05) and DASH (28.3±6.0 preoperatively and 4.1±2.0 at the final follow-up, t=19.35, p<0.05). No complication was observed. CONCLUSION: Close-wedge osteotomy and gradual lengthening with monorail external fixator in the treatment of chronic Monteggia fracture showed great efficacy. We also provided a specified osteotomy site aiming at PRUJ reconstruction.

Spatiotemporal effects of urban ecological land transitions to thermal environment change in mega-urban agglomeration.

Urban ecological land transitions (UELTs) have far-reaching effects on the thermal environment, but their dynamic effects in urban agglomerations remain poorly understood. This study defines the UELTs concept and quantifies its spatiotemporal effects and driving mechanisms on land surface temperature interdecadal variations (LSTIVs) in the Guangdong-Hong Kong-Macao Greater Bay Area using remote sensing, fuzzy overlay, shape-weighted landscape evolution index, and Geodetector methods. The results showed that UELTs shifted from degradation, increasing pressure, and decreasing vegetation proportion in the central city to scattered restoration, pressure relief, and increasing vegetation proportion in 2010-2020. LSTIVs simultaneously transitioned from rapid growth and contiguous expansion to reduction and dispersion. Moreover, the contribution of UELTs to LSTIVs increased by 19.49% from 2000 to 2020, and gradually shifted from being driven by dominant transition (isolating and adjacent degradation) (mean q = 0.58) to recessive transition (increased population and construction land pressure) (mean q = 0.62), where q is the determinant power. Interactions between edge-expansion and infilling restoration with the blue-green ratio (BGR; i.e., ratio of waterbodies to vegetation), habitat quality, and population layout had significant effects on LSTIVs. In addition, the relative magnitude of the effect of UEL restoration-degradation and BGR on LSTIVs was not fixed, but rather related to their interaction effect and the urban agglomeration development stage. Therefore, in addition to promoting an increase in UEL, optimizing the landscape structure of UEL (e.g., increasing aggregation and connectivity, adjusting BGR) and UEL distribution with other human factors are also crucial to reduce the urban thermal environment.

Hinge positioning method of Ilizarov apparatus in correcting radial head luxation caused by multiple hereditary exostoses.

OBJECTIVES: In this study, we present a specified hinge positioning method to achieve satisfying and steerable lengthening and angulation to correct forearm multiple hereditary exostoses (MHE) combined with severe radiocapitellar joint dislocation using Ilizarov ring fixators. PATIENTS AND METHODS: Between January 2014 and December 2018, a total of 30 forearms of 23 patients (11 males, 12 females; mean age: 18.3±6.8 years; range, 8 to 35 years) who suffered from type IIa (n=2) or IIb (n=28) MHE with severe radiocapitellar joint luxation were retrospectively analyzed. All patients were treated with Ilizarov external fixators with our specified hinge positioning method. Range of motion of the elbow, forearm and wrist and Visual Analog Scale (VAS), as well as Disabilities of Arm, Shoulder, and Hand (DASH) score, and radiological parameters, including radial articular angle (RAA), ulnar variance (UV) and carpi slip (CS), were recorded preoperatively and at final follow-up and were compared. RESULTS: Clinical and radiological outcomes were evaluated. Range of motion of the elbow, forearm and wrist, VAS, DASH and radiological features, including RAA, CS, and UV were significantly improved, except for range of motion of the forearm supination. Temporary nail track infection was seen in two of the forearms and was controlled with oral antibiotics. None of the patients developed radial head dislocation again. CONCLUSION: Clinical and radiological outcomes of this novel hinge positioning method are satisfactory in treating MHE with severe radial head dislocation, and this method can be an alternative treatment for MHE by setting a milestone for accurate radiocapitellar joint reduction.

Influence on emergency digit replantation and outcome assessment after COVID-19 virus nucleic acid testing normalization.

Objective: The study aims to compare the implementation and prognosis of emergency digit replantation surgery before and after normalized corona virus disease 2019 (COVID-19) nucleic acid testing for patients taking emergency operation and to explore the influence of normalized COVID-19 nucleic acid testing on replantation surgery. Method: Normalized COVID-19 nucleic acid testing for patients taking emergency operation has been carried out since 1 August 2021 at our hospital, which means each patient who needs emergency surgical treatment has to obtain either positive or negative results of COVID-19 nucleic acid before entering the operating room. This research reviewed and compared the prognosis of the injured extremity that had emergency severed digit replantation between June and September 2021, at the Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, and analyzed the impact of normalized COVID-19 nucleic acid testing on the outcome of the replanted fingers of different severity using disability of arm-shoulder-hand (DASH) and hand injury severity scoring (HISS) scoring systems. Results: A total of 54 cases with 74 severed replanted phalanges were included replanted by the research group between 1 August and 30 September 2021, without any COVID-19 suspected/confirmed case detected. Compared with previous period (1 June to 31 July, 2021), although the interval between emergency visits and emergency replantation did increase significantly after normalized COVID-19 nucleic acid testing [(3.83 ± 0.94) to (1.77 ± 0.67) h, P < 0.05], we observed no significant difference in the improvement rate of the DASH scoring of the disabled upper extremity 3-month postoperatively (P = 0.538) nor in the complication rate (P = 0.344). Moreover, there was no significant difference in the improvement rate of the DASH scoring of the disabled upper extremity 3-month postoperatively in patients with different traumatic severities before and after normalized COVID-19 nucleic acid testing (moderate P = 0.269, severe P = 0.055, major P = 0.149). Conclusion: Despite the preoperative delay, the policy of COVID-19 nucleic acid testing normalization does not have explicit influence on the short-term outcomes of emergency digit replantation surgery. With this evidence, microsurgeons could pay attention to the patients' anxiety and spend more effort in comforting them during the prolonged preoperative wait. These insights may have implications for other emergency department resource management whenever a social crisis occurs.

Celecoxib-Loaded Electrospun Fibrous Antiadhesion Membranes Reduce COX-2/PGE2 Induced Inflammation and Epidural Fibrosis in a Rat Failed Back Surgery Syndrome Model.

To date, failed back surgery syndrome (FBSS) remains a therapy-refractory clinical condition after spinal surgery. The antiadhesion membrane is applied to prevent FBSS by isolating fibrosis; however, the inflammation stimulated by the foreign body and surgical trauma needs to be further resolved simultaneously. Therefore, we developed new electrospun polycaprolactone (PCL) fibrous membranes loaded with celecoxib (CEL) to prevent fibrosis and inflammation associated with FBSS. The CEL-loaded PCL fibers were randomly distributed, and the drug was released over two weeks. Fluorescence micrographs revealed that the fibroblasts proliferated less on the PCL-CEL fibrous membranes than in the PCL group and the blank control. In the rat laminectomy model after 4 weeks, magnetic resonance imaging of epidural fibrosis was least in the PCL-CEL group. Expression of COX-2 and PGE2 was lower in the PCL-CEL group. It concluded that the CEL-loaded PCL membrane could reduce fibrosis and inflammation in a rat model of FBSS via COX-2/PGE2 signaling pathways.

Resection arthrodesis using distraction osteogenesis then plating as a hybrid surgical technique for the management of bone sarcomas of the distal tibia.

PURPOSE: We report the oncological and functional results of limb salvage for bone sarcomas involving the distal tibia using hybrid surgical technique of resection arthrodesis by bone transport then plating. METHODS: Five patients (mean age 18.6 years) with primary distal tibial sarcomas (two Ewing's sarcomas and three osteosarcomas) were treated by this method. The average duration of follow-up is 53 months. All patients accepted distraction osteogenesis with a standard technique using external fixator after wide (four cases) or marginal (one case) resection in the first operation. They were re-admitted for the second surgical treatment (plate insertion and removal of the external fixator) one to two months after they achieved the necessary limb length and desired alignment. RESULTS: Solid union of the lengthening site and sound fusion of the ankle were achieved in all five patients with full and unassisted weight bearing. The mean lengthening was 11.8 cm (range 8-14 cm) and the external fixation index (EFI) was 29.3 days/cm (range 22.8-36.3 days/cm). The mean functional score according to the rating system of the Musculoskeletal Tumour Society was 88% (83-90%). One patient showed poor response to chemotherapy, had local recurrence of sarcoma one year after plating, and was treated with above-knee amputation. CONCLUSIONS: In carefully selected patients with primary distal tibial sarcomas, this hybrid method can effectively eliminate tumor lesion, reconstruct function, and shorten the length of wearing an external fixator by a meticulous conversion to internal fixator.

Celastrol improves self-renewal and differentiation of human tendon-derived stem cells by suppressing Smad7 through hypoxia.

BACKGROUND: We aimed to evaluate the potential enhancing effect of celastrol on the stemness of human tendon-derived stem cells (hTSCs) in vitro and the underlying molecular mechanisms. METHODS: The capability of hTSC self-renewal was assessed by cell proliferation and colony formation as determined with the CCK-8 kit. Adipogenesis, chondrogenesis, and osteogenesis were determined by Oil Red O, Alcian Blue, and Alizarin Red staining, respectively. The relative mRNA levels of Sox9, PPARγ, Runx2, Smad7, and HIF1α were determined by real-time polymerase chain reaction (PCR). The levels of Smad7 and HIF1α protein were measured by immunoblotting. The chromatin immunoprecipitation (ChIP) assay was used to assess the direct binding of HIF1α to the Smad7 promoter. Suppression of Smad7 induced by hypoxia was examined using the luciferase reporter assay. RESULTS: We found that treatment with celastrol resulted in improvement in both the multi-differentiation potential and self-renewal capability of hTSCs. Celastrol elicited hypoxia and subsequently suppressed the expression of Smad7 through direct association with the hypoxia response element consensus sequence. Further, we demonstrated that both Smad7 and HIF1α were involved in the beneficial effects of celastrol on the differentiation and self-renewal of hTSCs. CONCLUSIONS: We demonstrated the positive effect of celastrol on the stemness of hTSCs and elucidated the essential role of the HIF1α-Smad7 pathway in this process.

[Clinical application progress of the Sauvé-Kapandji procedure].

Objective: To review the clinical application progress of the Sauvé-Kapandji procedure. Methods: The indications, techniques, effectiveness, and modifications of the Sauvé-Kapandji procedure were analyzed and evaluated by an extensive review of the relevant literature. Results: The Sauvé-Kapandji procedure can be applied for various disorders of the distal radioulnar joint. Risk of series of complications exist, which might be reduced by modification of the procedure. Conclusion: The Sauvé-Kapandji procedure, as a salvage operation, can be a good alternative by meticulous manipulation for appropriate cases with distal radioulnar joint disorders.

Rational design of YAP WW1 domain-binding peptides to target TGFß/BMP/Smad-YAP interaction in heterotopic ossification.

The transforming growth factor-ß/bone morphogenic protein/Smad signaling pathway has been raised as a new and promising therapeutic target of heterotopic ossification, which is mediated by recruitment of transcription coactivator Yes-associated protein (YAP) to Smad. Here, we described a successful integration of computational modeling and experimental assay to rationally design novel peptide aptamers to disrupt YAP-Smad interaction by targeting YAP WW1 domain. In the protocol, a computational genetic evolution strategy was used to improve a population of potential YAP WW1-binding peptides generated from the YAP-recognition site in Smad protein, from which several promising peptides were selected and their affinities toward YAP WW1 domain were determined using binding assay. In addition, a high-activity peptide was further optimized based on its complex structure with YAP WW1 domain to derive a number of derivative peptides with higher binding potency to the domain. We also found that a strong YAP WW1 binder should have a negatively charged N-terminus, a positively charged C-terminus and a nonpolar core to match the electrostatic distribution pattern in peptide-binding pocket of YAP WW1 domain, which may also form additional nonbonded interactions such as hydrogen bond, salt bridge and π-π stacking to confer stability and specificity for the domain-peptide recognition.

Highly flexible and rapidly degradable papaverine-loaded electrospun fibrous membranes for preventing vasospasm and repairing vascular tissue.

Vasospasm is a common post-operative complication after vascular anastomosis. Currently, the main treatment is a local injection of antispasmodic drugs. However, this method has a high rate of relapse and is subject to a large degree of individual variation, and repeated injections cause additional pain for patients. In this study, we developed highly flexible and rapidly degradable papaverine-loaded electrospun fibrous membranes to be wrapped around vascular suturing to prevent vasospasm. Poly-l-lactic acid/polyethylene glycol (PLLA/PEG) electrospun fibers containing papaverine maintained a high degree of flexibility and could withstand any folding, and are therefore suitable for wrapping vascular suturing. A rapid release of papaverine, between 2 and 7 days, was achieved by adjusting the proportions of PEG and PLLA. PLLA electrospun fibers containing 40% PEG (PLLA-40%) could control drug release and polymer degradation most effectively during the first 2 weeks post-operation. Testing using an in vivo rabbit model showed that PLLA-40% fibrous membranes produced significant antispasmodic effect without observable inflammation or hyperplasia, and the fibrous membranes were ideally biodegradable, with no impact on regional blood flow, pressure, vessel diameter or surrounding tissue hyperplasia. Therefore, papaverine-loaded electrospun fibrous membranes show the potential to greatly reduce post-operative vasospasm and maintain regular vascular morphology during antispasmodic therapy.

Evaluation of oriented electrospun fibers for periosteal flap regeneration in biomimetic triphasic osteochondral implant.

Osteochondral defects represent a serious clinical problem. Although the cell-scaffold complexes have been reported to be effective for repairing osteochondral defects, a periosteal flap is frequently needed to arrest leakage of the implanted cells into the defect and to contribute to the secretion of cytokines to stimulate cartilage repair. The electrospun mesh mimicking the function of the flap assists tissue regeneration by preventing cell leakage and merits favorable outcomes in the cartilaginous region. In this study, an oriented poly(ε-caprolactone) (PCL) fibrous membrane (OEM) was fabricated by electrospinning as a periosteal scaffold and then freeze-dried with a collagen type I and hyaluronic acid cartilage scaffold (CH) and finally, freeze-dried with a tricalcium phosphate (TCP) bone substratum. Scanning electron microscopic images show obvious microstructure formation of the trilayered scaffolds, and electrospun fibrous membranes have an oriented fibrous network structure for the periosteal phase. Also shown are opened and interconnected pores with well designed three-dimensional structure, able to be bound in the CH (chondral phase) and TCP (osseous phase) scaffolds. In vitro results showed that the OEM can promote the orientation of bone marrow mesenchymal stem cell (BMSCs) and BMSCs can penetrate into the CH and TCP. After successfully combining the BMSCs, the tissue-engineered cartilage which contained the OEM and TCP complex was successfully used to regenerate the osteochondral defects in the rabbit model with greatly improved repair effects.

Comparative study of two types of distally based sural neurocutaneous flap for reconstruction of lower leg, ankle, and heel.

BACKGROUND: Soft-tissue defects in the lower leg, ankle, and heel often require reconstruction with local or free flaps. We try to compare the clinical outcome and complications following transfer of a perforator pedicle-based sural neurocutaneous flap (P-NCF) or a fascia pedicle-based sural neurocutaneous flap (F-NCF). METHODS: Between March 2007 and December 2010, 92 patients (mean, 36.52 years) with a distal leg soft-tissue defect were included. Forty-eight patients treated with P-NCF were compared with 44 patients treated by F-NCF. The etiology, size, and operation time were noted. The clinical outcomes and the complications have been analyzed. RESULTS: Age, sex, and defect etiology, duration of surgery and, area of flaps did not reveal significant differences in term of clinical outcome. Minor flap necrosis (<10%) was observed in 20.5% of the F-NCF group and 6.25% of the P-NCF group. Patient satisfaction, aesthetic appearance, and functional outcome were comparable in both groups. CONCLUSION: A high rate of complications was observed in the F-NCF group. Based on our finding, a perforator-based flap is more reliable than a fascia-based flap and the two types of flaps are both valuable choices for reconstructive surgery.

Arcus venosus dorsalis pedis graft to restore the superficial palmar arch in devascularized hands.

For complex amputation injuries and anatomical characteristic of the metacarpus, restoration to the superficial palmar arch in severe devascularized or amputated hands remains a daunting challenge. In this article, we treated a series of five cases using an arcus venosus dorsalis pedis (AVDP) graft to restore the superficial palmar arches in devascularized hands. All hands survived and satisfying function was gained. The AVDP graft may be a suitable option to restore the superficial palmar arch in devascularized hands.

[In vivo experimental study on antibacterial and osteogenic capabilities of hydroxyapatite antimicrobial coating with silver].

OBJECTIVE: To investigate the antibacterial and osteogenic capabilities in vivo of hydroxyapatite (HA)/silver (Ag) coating. METHODS: HA/Ag coating (Ag quality percentage was 3%) and HA coating were deposited to external fixator Schanz screws. The tibial fracture model was established in right hindlimb of 18 adult male Beagle dogs (weighing 15-20 kg). The tibia was stabilized with an external fixator and 2 Schanz screws of HA coating at proximal tibia (control group, n = 18) and HA/Ag coating at distal tibia (experimental group, n = 18), and every screw incision was infected with Staphylococcus aureus. Infection in screw holes and the changes of bone-screw interface were observed by wound grading and X-ray films. RESULTS: In control group, wounds infection became worse with time (chi2 = 13.492, P = 0.001), while in experimental group, no obvious change was observed chi2X = 0.208, P = 0.901). The wound grading of experimental group was significantly better than that of the control group at 1, 2, and 3 weeks (P < 0.05). Laser scanning confocal microscope showed that there was bacterial adhesion on the surface of screws in 2 groups, viable bacteria mainly in control group and non-viable bacteria mainly in experimental group. The scanning electron microscope (SEM) observation results of the fractured sclerous tissue section showed that an obvious transparent boundary between screw and bone in control group, but no obvious boundary in experimental group. The osseointegration ratios were 76.23% +/- 15.54% in control group and 93.42% +/- 5.53% in experimental group, showing significant difference ( t = 8.843, P = 0.000). The SEM observation showed that HA/Ag coating integrated with new bone and the surface of implant was filled with new bone in experimental group; obvious interspace was seen between the HA coating and new bone in control group. CONCLUSION: HA/Ag coating has good antibacterial and osteogenic capabilities, so it can take effects in preventing infection in screw holes and loosening of implants.

The free peroneal perforator-based sural neurofasciocutaneous flap: a novel tool for reconstruction of large soft-tissue defects in the upper limb.

BACKGROUND: The sural neurofasciocutaneous flap has been widely used for reconstruction of soft-tissue defects in the lower leg, ankle, and foot. It can provide a large amount of tissue without compromising the function of the leg. The authors report the applications of the free peroneal perforator-based sural neurofasciocutaneous flap. METHODS: The free sural neurofasciocutaneous flap based on a single peroneal perforator is described. The peroneal perforator, which emerges from the posterior crural septum at the junction of middle and lower thirds of the fibula, was chosen as the pedicle of the flap. Six perforator-based sural neurofasciocutaneous flaps were transferred to resurface large soft-tissue defects in the upper limb. The size of the defects ranged from 15 × 6 cm to 45 × 10 cm. RESULTS: All six flaps survived completely without necrosis. The area of the flaps ranged from 16 × 8 cm to 30 × 10 cm. The average diameter of the peroneal perforator ranged from 1.0 to 1.5 mm, and the length of the perforator pedicles ranged from 4 to 6 cm. One patient developed arterial thrombosis after surgery, which was treated by removal of the thrombus and reanastomosis. No severe venous congestion was observed. All the patients were satisfied with the aesthetic outcome postoperatively at 3 to 12 months' follow-up. There were no serious donor-site complications. CONCLUSION: The free perforator-based sural neurofasciocutaneous flap is a good alternative for reconstruction of extensive soft-tissue defects in the upper limb.