Ginger moxibustion has the effect of regulating zang-fu organs and activating qi and blood circulation. When used, ginger paste is required to be close to human skin. Currently, the ginger box used clinically in the hospital can't meet the requirement of large area fitting human skin, and the efficacy of ginger moxibustion is significantly reduced. In this study, a flexible ginger paste box was proposed, which was composed of flexible components polydimethylsiloxane (PDMS), spring and wire netting. The large flexibility of the structure made it fit well with human skin. Finite element method was used to study the fitting degree between ginger paste box and waist soft tissue. Finite element models of flexible ginger paste box and waist soft tissue were established based on Hypermesh and Abaqus software. The equivalent contact area between the flexible ginger paste box and waist was obtained by numerical simulation under different PDMS unilateral thickness, spring wire diameter, wire netting diameter and ginger paste layer thickness. The four parameters were taken as the influencing factors, and the equivalent contact area was taken as the optimization objective. The typical value analysis and variance analysis of S/N were performed by Taguchi method, and the results showed that among the four influencing factors, the wire netting diameter had the largest influence on equivalent contact area and its contribution rate reached 41.98%. The contribution rates of PDMS unilateral thickness, spring wire diameter and ginger paste layer thickness reached 36.48%, 13.97% and 6.50%, respectively. The optimized PDMS unilateral thickness, spring wire diameter, wire netting diameter and ginger paste layer thickness were 1.5, 0.4, 0.15, 35 mm, respectively, and the equivalent contact area was 95.60 cm2. The optimized flexible ginger paste box with great fitting performance can improve the effect of ginger moxibustion.
Objective To evaluate the clinical outcomes of free perforator flaps combined with skin graft for reconstruction of ankle and foot soft tissue defects. Methods Between June 2014 and October 2015, 20 cases of ankle and foot soft tissue defects were treated. There were 16 males and 4 females, aged from 19 to 61 years (mean, 43.3 years). Injury was caused by traffic accident in 7 cases, by crashing in 9 cases, and machine twist in 4 cases. The locations were the ankle in 6 cases, the heel in 3 cases, the dorsum pedis in 4 cases, and the plantar forefoot in 7 cases of avulsion injury after toes amputation. The size of wound ranged from 15 cm×10 cm to 27 cm×18 cm. The time from injury to treatment was from 11 to 52 days (mean, 27 days). The anterolateral thigh perforator flap was used in 11 cases, thoracodorsal antery perforator flap in 3 cases, medial sural artery perforator flap in 4 cases, deep inferior epigastric perforator flap in 1 case, and anteromedial thigh perforator flap in 1 case, including 5 chimeric perforator flaps, 5 polyfoliate perforator flaps, 3 flow-through perforator flaps, and 3 conjoined perforator flaps. The size of the perforator flap ranged from 10.0 cm×6.5 cm to 36.0 cm×8.0 cm, the size of skin graft from 5 cm×3 cm to 18 cm×12 cm. Results Venous crisis occurred in 2 flaps which survived after symptomatic treatment; 18 flaps survived successfully and skin grafting healed well. The follow-up time ranged 4-18 months (mean, 8.3 months). The flaps had good appearance, texture and color, without infection. The patients could walk normally and do daily activities. Only linear scars were observed at the donor sites. Conclusion Free perforator flap can be used to reconstruct defects in the ankle and foot, especially in the weight-bearing area of the plantar forefoot. A combination of free perforator flap and skin graft is ideal in reconstruction of great soft tissue defects in the ankle and foot.
ObjectiveTo investigate clinical application of the free peroneal artery perforator flap in soft tissue defect of foot and ankle.MethodsThe clinical data of 18 patients with soft tissue defects of foot and ankle who were repaired with free peroneal artery perforator flaps between March 2019 and March 2020 were retrospectively analyzed. Among them, there were 11 males and 7 females; the age ranged from 21 to 58 years, with an average age of 45 years. The defect was located in the ankle in 2 cases, in the hindfoot in 4 cases, in the midfoot in 5 cases, and in the forefoot in 7 cases. The causes of injury included 11 cases of traffic accident, 4 cases of machine injuries, 3 cases of infection and necrosis after internal fixation. The time from injury to flap repair was 12-48 days, with an average of 24 days. The range of wound was 3 cm×3 cm to 15 cm×8 cm, and the range of skin flap was 4 cm×3 cm to 16 cm×9 cm. The flap harvesting time, operation time, intraoperative blood loss, and complications were recorded; the flap survival and patient satisfaction were observed during follow-up; and the American Orthopaedic Foot and Ankle Society (AOFAS) foot function score was used to evaluate the foot function.ResultsThe flap harvesting time was 15-33 minutes (mean, 22 minutes); the operation time was 120-160 minutes (mean, 150 minutes); the intraoperative blood loss was 90-180 mL (mean, 120 mL). There were 3 cases of vascular crisis after operation, including 2 cases of arterial crisis, which survived after vascular exploration and vein graft repair; 1 case of venous crisis, partial necrosis of the skin flap, and skin grafting to cover the wound after repeated debridement. The remaining 15 skin flaps survived completely. All patients were followed up 6 months. The skin flaps were in good shape without obvious bloat. According to the AOFAS foot function score, 5 cases were excellent, 10 cases were good, and 3 cases were fair. The excellent and good rate was 83.3%.ConclusionThe free peroneal artery perforator flap is easy to harvest, the shape and size of the flap are easy to design, and it does not damage the main blood vessels of the limb. The appearance and function of the limbs are satisfactory after operation. It can be widely used in the repair of soft tissue defects of the foot and ankle.
Objective To investigate the effects of botulinum toxin type A (BTXA) on the excessive expansion speed and blood supply of myocutaneous flap. Methods Seven adult Guizhou minipigs of clean grade were included, female or male and weighing 16-20 kg. The 2.4 mL BTXA solution (96 U) was injected in cutaneous muscle (24 points) of one side as experimental group (n=7), the 2.4 mL saline in the other side as control group (n=7). Two expanders (200mL) were implanted beneath the cutaneous muscle on the bilateral flank of each pig symmertrically at 3 days after injection. One week later, the expanders were filled with saline every 4 days with an intracapsular pressure of 11.97 kPa, and accumulative total amounted to 400 mL for 3 weeks in control group and 5 weeks in experimental group. Then the expanders were taken out; the myocutaneous flaps formed and were sutured in situ. The myocutaneous flaps were cut for histological examination and capillary count. The expansion speed of the myocutaneous flap were recorded. The blood supply of the myocutaneous flap were observed by infrared thermography at 1 week after implantation expanders, before removing the expanders, and at 5 days after myocutaneous flap suture in situ. Results All the animals survived to the end of the experiment. The total expansion time was (54.0 ± 3.1) days in experimental group and (67.0 ± 3.9) days in control group, showing significant difference (t= —8.107, P=0.000). All myocutaneous flaps survived after being sutured in situ. Infrared thermograhy revealed that the temperature of the distal myocutaneous flap in experimental group was significantly higher than that in control group at 1 week after implantation of expanders (P lt; 0.05); at 5 days after myocutaneous flap suture in situ, the temperature of the central flap in experimental group was significantly higher than that in control group (P lt; 0.05); and there was no significant difference between 2 groups at the other time points (P gt; 0.05). The histological observation showed that the blood vessel density of the dermal layer and tissue between the capsule and the muscle layer in experimental group was significantly higher than those in control group (P lt; 0.05). Conclusion When excessive expansion is performed, BTXA can accelerate the expansion rate and improve the blood supply of expanded myocutaneous flaps.
ObjectiveTo systematically review the predictive value of ezrin expression in bone and soft tissue sarcomas.MethodsDatabases including PubMed, EMbase, The Cochrane Library (Issue 2, 2016), CNKI, CBM, VIP, and WanFang Data were searched to collect cohort studies about the prognostic value of ezrin expression in bone and soft tissue sarcomas from inception to May 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was performed by using RevMan 5.3 software.ResultsFinally, a total of 17 cohort studies, involving 1 460 patients were included. The results of meta-analysis showed that: the overall survival (HR=1.90, 95%CI 1.70 to 2.13, P<0.000 01), event-free survival (HR=2.42, 95%CI 1.53 to 3.84, P=0.0002), metastasis-free survival (HR=2.09, 95%CI 1.10 to 3.97, P=0.02) in the bone and soft tissue sarcomas patients with ezrin high expression were lower than patients with lower expression. The same results were also observed in subgroup analysis according to histologica type and ethnicity in overall survival.ConclusionEzrin high expression may be used as a predictive maker for poor prognosis in bone and soft tissue sarcomas. For the quantity and quality limitation of the included studies, this conclusion still needs to be further proved by performing more high quality studies.
Objective To observe the effectiveness of disposable skin stretch closure in the treatment of wounds with skin and soft tissue defects that were difficult to close. Methods The clinical data of 13 patients with skin and soft tissue defects that were difficult to close treated with disposable skin stretch closure and met the selection criteria between July 2021 and February 2022 were retrospectively reviewed. There were 9 males and 4 females, the age ranged from 15 to 71 years with a mean of 39.8 years. The causes of injury included falling injury in 5 patients, traffic accident injury in 5 patients, and falling from height injury in 3 patients. The causes of skin soft tissue defects included open fractures in 4 patients, wound infection in 4 patients, osteomyelitis in 3 patients, degloving injury in 1 patient, and necrosis of skin graft in 1 patient. The injury was located at calf in 8 patients, calcaneus in 3 patients, pelvis in 1 patient, and plantar in 1 patient. The skin and soft tissue defects ranged from 5.0 cm×2.0 cm to 10.5 cm×6.5 cm. Wound conditions (wound closure and wound healing) and the presence or absence of complications were recorded. Results All 13 patients were followed up 32-225 days with a median of 164 days. The wound closure time ranged from 5 to 14 days, with a mean of 8.8 days. The wound closure speed ranged from 0.7 to 13.7 cm2/day, with a mean of 3.6 cm2/day. All wounds healed at grade A, and no complication such as skin edge injury, wound necrosis, infection, dehiscence, and edema occurred. No patient complained of pain or discomfort, and no obvious scarring was found during follow-up. The wound healing time ranged from 17 to 28 days, with a mean of 21.7 days. One of them was transferred to other department due to lung cancer condition changes after using disposable skin stretch closure, and the wound had directly healed without suturing at 17 days after operation. Conclusion The effectiveness of disposable skin stretch closure in the treatment of wounds with skin and soft tissue defects that were difficult to close was exact, with short wound closure time, few complications, and easy operation.
ObjectiveTo investigate the effectiveness of free transverse gracilis myocutaneous flap for soft tissue defects of foot and ankle. Methods Between January 2017 and December 2020, 16 cases (17 feet) of soft tissue defects of foot and ankle were repaired with free transverse gracilis myocutaneous flaps. There were 10 males and 6 females, with an average age of 38 years (range, 23-60 years). There were 9 cases of left foot, 6 cases of right foot, and 1 case of bilateral feet. The causes of soft tissue defect were traffic accident injury in 3 cases, heavy object smash injury in 4 cases, machine injury in 3 cases, infection in 4 cases, electrical burn in 1 case, and synovial sarcoma after operation in 1 case. The wounds located at the distal plantar in 2 cases (2 feet), the heel and ankle in 6 cases (6 feet), the dorsum of the foot in 7 cases (8 feet), and the first metatarsophalangeal joint to the medial malleolus in 1 case (1 foot). The size of wounds ranged from 6 cm×5 cm to 18 cm×7 cm. The size of flap ranged from 11 cm×6 cm to 21 cm×9 cm. The donor site was sutured directly. Results After operation, 1 case (1 foot) of flap vascular crisis, 1 case (1 foot) of partial necrosis of the flap, and 1 case of partial dehiscence of the incision at donor site occurred, all of which healed after symptomatic treatment. The other flaps survived, and the incisions at donor and recipient sites healed by first intention. All patients were followed up 12-36 months (mean, 24 months). Except for 1 case (1 foot) of swollen flap, which underwent two-stage trimming, the other flaps had good shape and texture. All the flaps had a protective feeling. At last follow-up, Kofoed scores of foot and ankle function ranged from 73 to 98 (mean, 89.7); 13 cases were excellent, 2 cases were good, and 1 case was poor, with an excellent and good rate of 93.8%. Linear scar was formed at the donor site without adverse effect on lower limb function. ConclusionThe free transverse gracilis myocutaneous flap is an effective flap for repairing large soft tissue defects of foot and ankle due to its advantages of large excisable area, less variation of vascular anatomy, and concealment of donor site.
OBJECTIVE: To evaluate the application of skin and soft tissue expansion in the treatment of deformity due to extensive severe burn injury and repair of severe deep electrical burned scalp and skull with fresh wound. METHODS: From 1988, 83 cases of application of skin and soft tissue expansion were reported. In those patients with deformity due to severe burn of large area and with whole nasal defect, soft tissue expander was used under the forehead skin graft and venter frontalis, followed by reconstruction of nose with the expanded vascularized skin flap and carved cartilago costalis as nasal frame. In patients of severe deep electrical burned scalp and skull with fresh wound, skin and soft tissue expansion were used to repair the wound simultaneously with scalp burn alopecia, anesthetics and antibiotics injected into the extracapsular space of the expander in case of pain and infection. RESULTS: All of the cases were successfully treated with little pain and minimized infection. CONCLUSION: Skin and soft tissue expansion in a safe and reliable measure in the treatment of deformity due to extensive severe burn injury and repair of severe deep electrical burned scalp and skull with fresh wound.
ObjectiveTo study the effectiveness of Keystone flap in the repair of soft tissue defect of lower extremity.MethodsThe clinical data of 27 cases with soft tissue defects of lower extremity treated by Keystone flap between January 2018 and June 2020 were retrospectively analyzed. There were 18 males and 9 females, with an average age of 43.9 years (range, 8-63 years). The cause of soft tissue defects included skin tumor in 3 cases, ulcer in 2 cases, soft-tissue infection in 8 cases, trauma in 7 cases, and donor site defect after free or pedicled flap transplantation in 7 cases. Defect size ranged from 2.0 cm×1.5 cm to 15.0 cm×9.5 cm. The types of Keystone flaps included type Ⅰ in 2 cases, type Ⅱa in 16 cases, type Ⅱb in 1 case, type Ⅲ in 6 cases, and Moncrieff modified type in 2 cases. The area of flap ranged from 3.0 cm×1.5 cm to 20.0 cm×10.0 cm. The donor site was directly sutured (26 cases) or repaired with skin grafting (1 case).ResultsThe operation time was 45-100 minutes, with an average of 67.5 minutes; the hospitalization stay was 3-12 days, with an average of 8.5 days. Postoperative incision dehiscence occurred in 1 case, and flap marginal necrosis occurred in 2 cases, all of which were completely healed after dressing change; 1 case of incision was swollen and congested with tension blisters, which resolved spontaneously at 7 days after operation. The other flaps and the skin grafting survived and healed successfully, the wounds of recipient and donor sites healed by first intention. The healing time was 2-3 weeks (mean, 2.2 weeks). No pain occurred in all patients. All 27 cases were followed up 3-26 months (mean, 11.5 months). No obvious scar contracture and bloated skin flap were found. The texture and color of the skin in the recipient area were similar to those of the surrounding tissues and feel existed.ConclusionThe Keystone flap is a feasible and efficient way to repair soft tissue defect of lower extremity. Furthermore, the skin color and texture is similar to the surrounding tissue after healing.
Objective To explore the results of repairing widespread traumatic soft tissue defects in the heels and adjacent regions with free latissimus dorsi muscle-skin flaps. Methods From March 1998 to May 2005, 10 cases of widespread traumatic soft tissue defects in the heels and adjacent regions were repaired with free latissimus dorsi muscleskin flaps. Of the 10 patients, 9 were male and 1 was female, whose ages ranged from 32 to 60years, and the disease course was 2 hours to 2 months. The defect was by ploughmachine injury in 5 cases, by crush injury in 2 cases, by snake injury in 2 cases, and electricity injury in 1 case. Eight cases of defects involved in the posteriorof heel and leg, the defect area ranged from 21 cm×12 cm to 35 cm×15 cm; 2 cases had widespread soft tissue defects on heel, ankle, sole and dorsal foot, and the defect area was 27 cm×14 cm and 30 cm×21 cm respectively. All cases were accompanied by the exposure of bone; 6 cases by fracture; 4 cases by openinfection of ankle joint; and 2 cases by injuries of the posterior tibial vessel and the tibial nerve. The sizes of the dissected flap ranged from 25 cm×14 cm to 33 cm×24 cm. The donor sites were covered by large mid-thickness flap. Results There were no postoperative complication of vascular crisis and infection. Ten flaps survived completely and the wounds healed by first intention. After a follow-up of 3 to 24 months, five cases received twostageplastic operation because bulky flaps bring some trouble in wearing shoes. In 5cases of reconstructed sensation, two cases recovered pain and temperature sensation. All cases recovered the abilities to stand and walk without ulcer complication. Conclusion The free latissimus dorsi muscle-skin flap is an ideal flap for repairing widespread traumatic soft tissue defects and infectious wounds with muscle defects and bone exposure in the heel and adjacent regions, because it has such advantages as adequate blood supply, big dermatomic area, and excellent ability to resist infection.