Objective: To compare the predictive efficacy of the Wagner grading system, site, ischemia, neuropathy, bacterial infection, area, depth (SINBAD) grading system, and wound, ischemia and foot infection (WIfI) grading system for short-term wound non-healing and amputation in patients with diabetic foot ulcers (DFUs). Methods: The study was a retrospective cohort study. From January 2023 to December 2024, 400 patients with DFUs who met the inclusion criteria were admitted to the Diabetic Foot Center of the Central Hospital of Wuhan of Tongji Medical College of Huazhong University of Science and Technology. All patients were assessed with Wagner grade, SINBAD score, and WIfI stage within 48 hours of admission. There were 232 males and 168 females, aged 44 to 83 years. Based on whether the wound had healed at 3 months after initial admission, patients were divided into healing group (194 cases) and non-healing group (206 cases); based on amputation, patients who underwent major or minor amputation were included in amputation group (255 cases), while the remaining patients were included in non-amputation group (145 cases); the Wagner grades, SINBAD scores, and WIfI stages of patients in each group were recorded. The amputation and non-healing wound at 3 months after initial admission in patients with different Wagner grades, SINBAD scores, and WIfI stages were compared. Spearman correlation analysis was used to assess the correlation between the Wagner grades, SINBAD scores, WIfI stages and the wound healing time in patients with DFUs. The receiver operating characteristic curves were plotted to evaluate the predictive efficacy of each grading system for non-healing wound at 3 months after initial admission (i.e., short-term wound non-healing) and amputation in patients with DFUs, and the DeLong test was used to compare the differences in the area under the receiver operating characteristic curve (AUROC) among the grading systems. Results: The patients in non-healing group and amputation group had significantly higher Wagner grades, SINBAD scores, and WIfI stages than those in healing group and non-amputation group, respectively (with t values of 8.25, 19.78, and 9.87, 14.05, 11.73, and 16.45, respectively, P<0.05). Among patients with different Wagner grades, SINBAD scores, and WIfI stages, the proportion of amputees and the proportion of patients with non-healing wounds at 3 months after initial admission showed statistically significant differences (with χ2 values of 150.35 and 73.97, 133.84 and 221.10, 187.63 and 83.37, respectively, P<0.05). The Wagner grades, SINBAD scores, and WIfI stages were all significantly positively correlated with the wound healing time in patients with DFUs (with rs values of 0.52, 0.70, and 0.52, respectively, P<0.05). With wounds unhealed at 3 months after initial admission as the prognostic outcome, the SINBAD grading system had the highest AUROC of 0.96 (with 95% CI of 0.94-0.98) and a maximum Youden index of 0.80; the Wagner grading system showed an AUROC of 0.66 (with 95% CI of 0.61-0.72) and a maximum Youden index of 0.28; the WIfI grading system showed an AUROC of 0.69 (with 95% CI of 0.64-0.74) and a maximum Youden index of 0.33. The DeLong test indicated that the predictive efficacy of the SINBAD grading system for short-term wound non-healing in patients with DFUs was significantly superior to that of the Wagner grading system and WIfI grading system, respectively (with Z values of 12.52 and 12.97, respectively, P values both <0.05). With amputation as the prognostic outcome, the WIfI grading system had the highest AUROC of 0.89 (with 95% CI of 0.85-0.93) and a maximum Youden index of 0.75; the Wagner grading system showed an AUROC of 0.87 (with 95% CI of 0.83-0.91) and a maximum Youden index of 0.55; the SINBAD grading system showed an AUROC of 0.80 (with 95% CI of 0.76-0.84) and a maximum Youden index of 0.43. The DeLong test showed that the predictive efficacy of both the WIfI grading system and Wagner grading system for amputation in patients with DFUs was significantly superior to that of the SINBAD grading system, respectively (with Z values of 3.76 and 2.96, respectively, P<0.05). Conclusions: The Wagner grading system, SINBAD grading system, and WIfI grading system can all effectively predict the risk of short-term wound non-healing and amputation in patients with DFUs. The SINBAD grading system performs the best in predicting short-term wound non-healing, while the WIfI grading system has an advantage in predicting amputation. Although the Wagner grading system has poorer predictive efficacy for short-term wound non-healing, it still demonstrates good predictive efficacy for amputation. In clinical practice, different grading systems can be used in combination based on the focus of assessment. 目的： 比较Wagner分级系统和部位、缺血、神经病变、细菌感染、面积、深度（SINBAD）分级系统以及伤口、缺血和足部感染（WIfI）分级系统对糖尿病足溃疡（DFU）患者短期创面未愈合与截肢的预测效能。 方法： 该研究为回顾性队列研究。2023年1月—2024年12月，华中科技大学同济医学院附属武汉中心医院糖尿病足专病中心收治400例符合入选标准的DFU患者，均在入院后48 h内完成Wagner分级、SINBAD评分及WIfI分期评估。患者中男232例、女168例，年龄44~83岁。按照首次入院后3个月时创面是否愈合，将患者分为愈合组（194例）和未愈合组（206例）；另按照患者截肢情况，将行大截肢、小截肢患者纳入截肢组（255例），其余患者纳入未截肢组（145例）。统计各组患者的Wagner分级、SINBAD评分、WIfI分期。另比较不同Wagner分级、SINBAD评分、WIfI分期患者的截肢情况、首次入院后3个月时创面未愈合情况。采用Spearman相关性分析评估Wagner分级、SINBAD评分、WIfI分期与DFU患者创面愈合时间的相关性。绘制受试者操作特征曲线评估各分级系统对DFU患者首次入院后3个月时创面未愈合（即短期创面未愈合）和截肢的预测效能，并采用DeLong检验比较各分级系统的受试者操作特征曲线下面积（AUROC）差异。 结果： 未愈合组、截肢组患者的Wagner分级、SINBAD评分、WIfI分期分别明显高于愈合组、未截肢组（t值分别为8.25、19.78、9.87，14.05、11.73、16.45，P<0.05）。不同Wagner分级、SINBAD评分、WIfI分期患者中，截肢患者比例、首次入院后3个月时创面未愈合患者比例比较，差异均有统计学意义（χ2值分别为150.35、73.97，133.84、221.10，187.63、83.37，P<0.05）。Wagner分级、SINBAD评分及WIfI分期均与DFU患者创面愈合时间呈明显正相关（rs值分别为0.52、0.70、0.52，P<0.05）。以DFU患者首次入院后3个月时创面未愈合为预后观察结局，SINBAD分级系统的AUROC最高，为0.96（95%CI为0.94~0.98），最大约登指数为0.80；Wagner分级系统的AUROC为0.66（95%CI为0.61~0.72），最大约登指数为0.28；WIfI分级系统的AUROC为0.69（95%CI为0.64~0.74），最大约登指数为0.33。DeLong检验显示，SINBAD分级系统对DFU患者短期创面未愈合的预测效能明显优于Wagner分级系统和WIfI分级系统（Z值分别为12.52、12.97，P值均<0.05）。以DFU患者截肢为预后观察结局，WIfI分级系统的AUROC最高，为0.89（95%CI为0.85~0.93），最大约登指数为0.75；Wagner分级系统的AUROC为0.87（95%CI为0.83~0.91），最大约登指数为0.55；SINBAD分级系统的AUROC为0.80（95%CI为0.76~0.84），最大约登指数为0.43。DeLong检验显示，WIfI分级系统和Wagner分级系统对DFU患者截肢的预测效能均明显优于SINBAD分级系统（Z值分别为3.76、2.96，P<0.05）。 结论： Wagner分级系统、SINBAD分级系统及WIfI分级系统均能有效预测DFU患者的短期创面未愈合和截肢风险，其中SINBAD分级系统在预测短期创面未愈合方面表现最优，而WIfI分级系统在预测截肢方面更具优势，Wagner分级系统虽然在短期创面未愈合方面的预测效能较差，但对截肢具有较好的预测效能。临床实践中可根据评估重点，联合应用不同分级系统。.
Objective: To investigate the clinical application effects of indocyanine green angiography (ICGA) combined with color Doppler ultrasound (CDU) in perforator localization of anterolateral thigh perforator flaps. Methods: This study was a retrospective observational study. From January to August 2024, the Department of Hand Surgery admitted 21 patients and the Department of Wound Repair Surgery of Suzhou Ruihua Orthopedic Hospital admitted 35 patients that met the inclusion criteria. These patients underwent surgical repair of the extremity skin and soft tissue defects using anterolateral thigh perforator flaps designed under the assistance of CDU and ICGA. Among them, there were 44 males and 12 females, aged 16 to 71 years. After debridement, the wound area ranged from 7.0 cm×5.5 cm to 40.0 cm×10.0 cm. Before surgery, CDU and ICGA were used to locate the perforators of anterolateral thigh perforator flap. The area of harvested flap ranged from 8.0 cm×6.0 cm to 40.5 cm×11.0 cm. The wounds in flap donor sites were closed directly or covered with the full-thickness skin graft from the contralateral thigh. The number of perforators located by preoperative CDU or ICGA, and the number, origin, type, and caliber of perforators in intraoperative exploration, and flap thickness were recorded. The consistency between preoperative CDU or ICGA localization results and intraoperative exploration findings was assessed. The error distances between preoperative CDU or ICGA localization and intraoperative exploration of perforator, respectively, were measured. Using intraoperative exploration of perforator as the gold standard, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of preoperative CDU and ICGA for perforator localization were calculated. The independent influencing factor for the consistency between CDU or ICGA localization results and intraoperative exploration findings of 56 patients who had anterolateral thigh perforator flap designed under the assistance of CDU and ICGA were screened. Results: A total of 131 perforators were located by CDU and 130 perforators were located by ICGA preoperatively. Intraoperatively, 132 perforators were explored, including 64 perforators from the oblique branch, 49 perforators from the descending branch, 9 perforators from the transverse branch, and 10 perforators from the anterior branch. Among them, 46 perforators were septocutaneous perforators and 86 perforators were musculocutaneous perforators, with a mean caliber of (0.72±0.21) mm. The flap thickness was (1.5±0.6) cm. There was no statistically significant difference in the consistency between preoperative CDU localization results and intraoperative exploration findings and ICGA localization results and intraoperative exploration findings (P>0.05). There was no statistically significant difference in the error distance between preoperative CDU localization and intraoperative exploration of perforator and preoperative ICGA localization and intraoperative exploration of perforator (P>0.05). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of ICGA and CDU in locating perforators were 92.42%, 92.00%, 93.85%, 90.20%, and 92.24%, 84.09%, 80.00%, 84.73%, 79.21%, and 82.33%, respectively. Flap thickness was an influencing factor for the consistency between preoperative ICGA localization results and intraoperative exploration findings of 56 patients who had anterolateral thigh perforator flap designed under the assistance of CDU and ICGA (with odds ratio of 0.20, 95% confidence interval of 0.06-0.66, P<0.05). Perforator type was an influencing factor for the consistency between preoperative CDU localization results and intraoperative exploration findings of 56 patients who had anterolateral thigh perforator flap designed under the assistance of CDU and ICGA (with odds ratio of 3.07, 95% confidence interval of 1.11-8.46, P<0.05). After adjusting for sex, age, body mass index, perforator type, and perforator caliber, flap thickness was an independent influencing factor for the consistency between preoperative ICGA localization results and intraoperative exploration findings of 56 patients who had anterolateral thigh perforator flap designed under the assistance of CDU and ICGA (with odds ratio of 0.15, 95% confidence interval of 0.03-0.73, P<0.05). After adjusting for sex, age, body mass index, flap thickness, and perforator caliber, perforator type was an independent influencing factor for the consistency between preoperative CDU localization results and intraoperative exploration findings of 56 patients who had anterolateral thigh perforator flap designed under the assistance of CDU and ICGA (with odds ratio of 4.25, 95% confidence interval of 1.39-12.98, P<0.05). Conclusions: The combined application of ICGA and CDU for perforator localization in anterolateral thigh perforator flaps in clinic can complete each other to improve the accuracy of localization. Flap thickness significantly affects the accuracy of ICGA localization, while perforator type significantly affects the accuracy of CDU localization. 目的： 探讨吲哚菁绿血管造影（ICGA）联合彩色多普勒超声（CDU）在股前外侧穿支皮瓣穿支定位中的临床应用效果。 方法： 该研究为回顾性观察性研究。2024年1—8月，苏州瑞华骨科医院手外科收治21例、创面修复科收治35例符合入选标准的采用CDU和ICGA辅助设计的股前外侧穿支皮瓣修复四肢皮肤软组织缺损的患者，其中男44例、女12例，年龄16~71岁，清创后创面面积为7.0 cm×5.5 cm~40.0 cm×10.0 cm。术前均采用CDU和ICGA定位股前外侧穿支皮瓣穿支，皮瓣切取面积为8.0 cm×6.0 cm~40.5 cm×11.0 cm。将皮瓣供区创面直接缝合或移植对侧大腿全厚皮修复。记录术前CDU、ICGA定位到的穿支数量，术中探查到的穿支数量、来源、类型、口径，皮瓣厚度。比对术前CDU、ICGA定位结果与术中探查结果一致性，测量术前CDU、ICGA定位到的穿支位置分别与术中探查到的穿支位置的误差距离。以术中探查到穿支为金标准，计算术前CDU和ICGA定位穿支的敏感度、特异度、阳性预测值、阴性预测值、准确性。筛选56例采用CDU和ICGA辅助设计股前外侧穿支皮瓣患者CDU、ICGA定位结果与术中探查结果一致性的独立影响因素。 结果： 术前CDU定位到131条穿支，ICGA定位到130条穿支。术中探查到132条穿支，其中64条穿支来自斜支，49条穿支来自降支，9条穿支来自横支，10条穿支来自前支；46条穿支为肌间隔穿支，86条穿支为肌皮穿支；穿支口径为（0.72±0.21）mm。皮瓣厚度为（1.5±0.6）cm。术前CDU定位结果与术中探查结果一致性和ICGA定位结果与术中探查结果一致性比较，差异无统计学意义（P>0.05）。术前CDU定位到的穿支位置与术中探查到的穿支位置的误差距离和ICGA定位到的穿支位置与术中探查到的穿支位置的误差距离比较，差异无统计学意义（P>0.05）。术前ICGA、CDU定位穿支的敏感度、特异度、阳性预测值、阴性预测值、准确性分别为92.42%、92.00%、93.85%、90.20%、92.24%，84.09%、80.00%、84.73%、79.21%、82.33%。皮瓣厚度为56例采用CDU和ICGA辅助设计股前外侧穿支皮瓣患者术前ICGA穿支定位结果与术中探查结果一致性的影响因素（比值比为0.20，95%置信区间为0.06~0.66，P<0.05），穿支类型为56例采用CDU和ICGA辅助设计股前外侧穿支皮瓣患者术前CDU穿支定位结果与术中探查结果一致性的影响因素（比值比为3.07，95%置信区间为1.11~8.46，P<0.05）。调整了性别、年龄、体重指数、穿支类型、穿支口径后，皮瓣厚度为56例采用CDU和ICGA辅助设计股前外侧穿支皮瓣患者术前ICGA穿支定位结果与术中探查结果一致性的独立影响因素（比值比为0.15，95%置信区间为0.03~0.73，P<0.05）。调整了性别、年龄、体重指数、皮瓣厚度、穿支口径后，穿支类型为56例采用CDU和ICGA辅助设计股前外侧穿支皮瓣患者术前CDU穿支定位结果与术中探查结果一致性的独立影响因素（比值比为4.25，95%置信区间为1.39~12.98，P<0.05）。 结论： 在临床股前外侧穿支皮瓣穿支定位中联合应用ICGA和CDU可优势互补提高定位精度，其中皮瓣厚度显著影响ICGA定位准确性，穿支类型显著影响CDU定位准确性。.
Objective: To explore the effect and mechanism of adipose-derived mesenchymal stem cells (ADSCs) on full-thickness skin defects in diabetic rats using proteomics analysis. Methods: This study was a self-control design experimental study. Four 8 to 10 weeks old male Sprague-Dawley rats were selected, and ADSCs were extracted from their epididymal adipose tissue and successfully identified. The third passage of ADSCs were used for the following experiments. Twenty-four 4 to 6 weeks old male Sprague-Dawley rats were selected and the type 2 diabetes model was successfully established. Among them, 16 diabetic rats weighing 350 to 400 g were chosen, and a full-thickness skin defect wound was created on each side of the spine on their backs at the same level. Using the random number table method, the two wounds of each rat were included in experimental group and control group (with 16 wounds in each group), and the cell suspensions containing ADSCs and phosphate buffered saline were injected at multiple points around and at the base of the wounds immediately after injury, respectively. The wound healing rates were calculated at day 7, 10, and 14 after injury in rats. At day 7 after injury in rats, wound tissue was collected and proteins were extracted. Four-dimensional data-independent acquisition label-free quantitative proteomics technology was used for quantitative proteomics analysis and bioinformatics analysis to screen differentially expressed proteins (DEPs) in the two groups of wound tissue. Then, key DEPs were screened through protein-protein interaction networks, gene ontology (GO) was used for functional annotation and enrichment analysis, and Kyoto encyclopedia of genes and genomes (KEGG) was used for pathway enrichment analysis to further screen target DEPs. The wound tissue of rats 7 days after injury was collected, and Western blotting was used to detect the protein expression of thymocyte differentiation antigen 1 (Thy-1) and G protein-coupled receptor 177/Wnt ligand secretion mediator (GPR177/Wls). Results: At day 7, 10, and 14 after injury in rats, the wound healing rates in experimental group were (66±16)%, (83±8)%, and (93±4)%, respectively, which were significantly higher than (30±8)%, (62±6)%, and (77±8)% in control group (with t values of -4.41, -7.46, and -6.65, respectively, P<0.05). At day 7 after injury in rats, compared with those in control group, a total of 474 DEPs were screened from the wound tissue in experimental group (P<0.05). A total of 224 key DEPs were further screened out, among which 78 DEPs were significantly upregulated and 146 DEPs were significantly downregulated. GO functional annotation analysis showed that the most significantly upregulated and downregulated DEPs mainly affected protein expression under cellular processes and biological regulation conditions, and were related to cell anatomical entities and protein-containing complexes, as well as specific binding and catalytic activity between biomolecules. GO functional enrichment analysis showed that the most significantly upregulated DEPs were significantly enriched in Wnt-protein binding. KEGG pathway enrichment analysis showed that the significantly upregulated and downregulated DEPs were enriched in pathways such as starch and sucrose metabolism, nucleotide metabolism, p53 signaling pathway, and extracellular matrix -receptor interaction, and so on. A total of 4 target proteins were screened out, including Thy-1, GPR177/Wls, Fer/CIP4 homology domain only 2, and mitochondrial ribosomal protein L21, with the first two being significantly upregulated DEPs while the latter two being significantly downregulated DEPs. At day 7 after injury in rats, the protein expressions of GPR177/Wls and Thy-1 in the wound tissue in experimental group were 0.93±0.07 and 0.96±0.05, respectively, which were significantly higher than 0.39±0.07 and 0.36±0.12 in control group (with t values of 11.61 and 9.41, respectively, P<0.05). Conclusions: Based on proteomics analysis, it was revealed that ADSCs from rats can promote the wound healing of full-thickness skin defects in diabetic rats by upregulating the protein expression of GPR177/Wls and Thy-1. 目的： 基于蛋白质组学分析，探讨脂肪间充质干细胞（ADSC）对糖尿病大鼠全层皮肤缺损的作用及其机制。 方法： 该研究为自身对照设计实验研究。取4只8~10周龄雄性SD大鼠，从其附睾脂肪组织中提取ADSC并成功鉴定，然后取第3代ADSC用于下述实验。取24只4~6周龄雄性SD大鼠并成功构建2型糖尿病模型，选取其中体重为350~400 g的16只糖尿病大鼠，在其背部脊柱两侧同一水平位置各制作1个全层皮肤缺损创面。采用随机数字表法，将每只大鼠的2个创面分别纳入实验组与对照组（每组16个创面），伤后即刻，于创面周围及基底组织分别多点注射含ADSC的细胞悬液和磷酸盐缓冲液。计算大鼠伤后7、10、14 d创面愈合率。大鼠伤后7 d，取创面组织并提取蛋白质，采用四维数据非依赖采集非标记定量蛋白质谱技术行定量蛋白质组学分析及生物信息学分析，筛选2组创面组织中的差异表达蛋白（DEP）。然后通过蛋白质-蛋白质相互作用网络筛选出关键DEP，并应用基因本体论（GO）行功能注释及富集分析、京都基因和基因组百科全书（KEGG）行通路富集分析，同时进一步筛选目标DEP。取大鼠伤后7 d创面组织，采用蛋白质印迹法检测胸腺细胞分化抗原-1（Thy-1）和G蛋白偶联受体177/Wnt配体分泌介质（GPR177/Wls）的蛋白表达量。 结果： 大鼠伤后7、10、14 d，实验组创面愈合率分别为（66±16）%、（83±8）%、（93±4）%，均显著高于对照组的（30±8）%、（62±6）%、（77±8）%，t值分别为-4.41、-7.46、-6.65，P<0.05。大鼠伤后7 d，相较于对照组，从实验组创面组织中共筛选出474个DEP（P<0.05）。进一步筛选出224个关键DEP，其中78个DEP显著上调，146个DEP显著下调。GO功能注释分析显示，显著上调和显著下调的DEP主要在细胞过程和生物调控的条件下影响蛋白质的表达，与细胞解剖实体和含蛋白质复合物有关，与生物分子之间的特异性结合和催化活性有关。GO功能富集分析显示，首要的DEP（显著上调）显著富集于Wnt-蛋白结合。KEGG通路富集分析显示，显著上调和显著下调的DEP富集通路包括淀粉和蔗糖代谢、核苷酸代谢、p53信号通路、细胞外基质-受体相互作用等。共筛选出4个目标蛋白：Thy-1、GPR177/Wls、FCH结构域蛋白2、线粒体核糖体蛋白L21，前两者为显著上调DEP，后两者为显著下调DEP。大鼠伤后7 d，实验组创面组织中GPR177/Wls和Thy-1的蛋白表达量分别为0.93±0.07、0.96±0.05，均显著高于对照组的0.39±0.07、0.36±0.12（t值分别为11.61、9.41，P<0.05）。 结论： 基于蛋白质组学分析，揭示了大鼠ADSC能通过上调GPR177/Wls和Thy-1的蛋白表达量促进糖尿病大鼠全层皮肤缺损创面愈合。.
Objective: To analyze the epidemiological characteristics of adult inpatients with diabetes-related chronic non-healing wounds in Hainan province. Methods: This study was a retrospective cohort study. From July 2019 to July 2024, 1 372 adult inpatients with diabetes-related chronic non-healing wounds and conformed to the inclusion criteria were admitted to three hospitals in Hainan province, including 951 cases in the First Affiliated Hospital of Hainan Medical University, 287 cases in the Second Affiliated Hospital of Hainan Medical University, and 134 cases in Hainan Sino-German Orthopedic Hospital. The clinical data of patients were collected, including age, gender, occupation, disease duration and type of diabetes mellitus, underlying comorbidity, formation cause, type, location, and number of wounds, pathogenic microorganism culture result of wound secretion specimens on admission, treatment modality and outcome at discharge, and hospitalization duration and hospitalization costs of patients with different types of wounds. Results: The patients were 18-96 years in age, with 892 patients aged ≥60 years. There were 889 males and 483 females, with 838 agricultural workers. The duration of diabetes mellitus was 10 (5,18) years, and 98.91% (1 357/1 372) of the patients had type 2 diabetes mellitus. Patients with diabetes mellitus were often combined with hypertension (678 cases), arterial disease (300 cases), and stroke (220 cases). The primary cause of wound formation was infection (930 cases). The predominant type of wounds was diabetic foot ulcer (809 cases), followed by other wounds (232 cases), pressure ulcers (187 cases), and traumatic ulcers (144 cases). The wounds were primarily located on feet (809 wounds) and lower legs (474 wounds) with single wound (997 cases). The pathogenic microorganism culture results of wound secretion specimens from 540 patients were positive, with a total of 606 strains of pathogenic microorganism detected, predominantly Gram-negative bacteria (324 strains). The main pathogenic microorganisms were Staphylococcus aureus (125 strains), Pseudomonas aeruginosa (71 strains), and Escherichia coli (71 strains). Fungal detection rate was high of 6.11% (37/606). The primarily wound treatment modalities included simple debridement (396 cases) and debridement combined with vacuum sealing drainage (444 cases). At discharge, the wounds in 84.62% (1 161/1 372) of the patients showed improvement, 11.30% (155/1 372) of the patients achieved wound healing, and 3.28% (45/1 372) of the patients experienced wound exacerbation; the other 0.80% (11/1 372) of the patients died. Patients with diabetic foot ulcer exhibited significantly longer hospitalization duration (18 (10, 29) d) and higher hospitalization costs (3.9 (2.1, 6.0) ten thousand yuan) compared with patients with pressure ulcer (14 (7, 21) d and 2.8 (1.5, 4.2) ten thousand yuan), traumatic ulcer (12 (6, 18) d and 2.3 (1.2, 3.5) ten thousand yuan), and other wounds (16 (8, 25) d and 3.1 (1.8, 5.0) ten thousand yuan), P<0.05. Conclusions: The adult inpatients with diabetes-related chronic non-healing wounds in Hainan province are predominantly elderly male agricultural workers with underlying comorbidities. The detected predominant pathogenic microorganisms in wounds are Gram-negative bacteria, and fungal detection rate is high. Diabetic foot ulcer poses greater treatment burden, and patients with diabetic foot ulcers had significantly longer hospitalization duration and higher hospitalization costs compared with those of other wounds. 目的： 分析海南省糖尿病相关慢性难愈性创面成年住院患者的流行病学特征。 方法： 该研究为回顾性队列研究。2019年7月—2024年7月，海南省3家医院收治1 372例符合入选标准的糖尿病相关慢性难愈性创面成年住院患者，其中海南医科大学第一附属医院收治951例、海南医科大学第二附属医院收治287例、海南省中德骨科医院收治134例。收集患者临床资料，包括年龄、性别、职业，糖尿病病程、分型，合并基础疾病，创面形成原因、类型、部位、数量，入院时创面分泌物标本病原微生物培养结果，创面治疗方式及出院时转归情况，以及不同类型创面患者的住院时间、住院费用。 结果： 患者年龄18~96岁，其中≥60岁者892例；患者中男889例、女483例；农业从业者838例。患者糖尿病病程为10（5，18）年，98.91%（1 357/1 372）的患者为2型糖尿病患者。糖尿病患者常合并高血压（678例）、动脉性疾病（300例）和脑卒中（220例）等。创面形成原因以感染为主（930例）；创面类型以糖尿病足溃疡（DFU）为主（809例），其次为其他创面（232例）、压力性损伤（187例）、创伤性溃疡（144例）；创面主要位于足部（809个）及小腿（474个），且主要为1个创面（997例）。540例患者创面分泌物标本病原微生物培养结果为阳性，共检出病原微生物606株，以革兰阴性菌（324株）为主，主要病原微生物为金黄色葡萄球菌（125株）、铜绿假单胞菌（71株）和大肠埃希菌（71株）；真菌检出率较高，为6.11%（37/606）。创面治疗方式以单纯清创（396例）、清创+负压封闭引流（444例）为主。出院时，84.62%（1 161/1 372）的患者创面好转，11.30%（155/1 372）的患者创面愈合，3.28%（45/1 372）的患者创面加重，其余0.80%（11/1 372）的患者死亡。DFU患者住院时间［18（10，29）d］及住院费用［3.9（2.1，6.0）万元］均较压力性损伤患者［14（7，21）d、2.8（1.5，4.2）万元］、创伤性溃疡患者［12（6，18）d、2.3（1.2，3.5）万元］及其他创面患者［16（8，25）d、3.1（1.8，5.0）万元］显著增加（P<0.05）。 结论： 海南省糖尿病相关慢性难愈性创面成年住院患者以老年男性农业从业者为主，通常合并基础疾病，创面检出病原微生物以革兰阴性菌为主，真菌检出率较高。DFU治疗负担最重，DFU患者住院时间及住院费用均较其他创面患者显著增加。.
Diabetic foot ulcer (DFU) is a common and serious chronic complication in patients with diabetes, characterized by high recurrence rates, risks of disability and mortality, which imposes a heavy burden on individual health and the social healthcare system. Mitochondrial dynamics refer to the dynamic balance between mitochondrial fission and fusion that maintains cellular energy metabolism and homeostasis. However, in the pathological environment of diabetes, hyperglycemia and oxidative stress disrupt this balance, leading to mitochondrial dysfunction and further exacerbating the inflammatory response and tissue damage in DFU. In recent years, intervention strategies targeting mitochondrial dynamics have been considered a potential therapeutic approach to alleviate DFU symptoms and promote wound healing. Based on the latest domestic and international research, this article reviews the progress of research on mitochondrial dynamics in DFU, with a focus on exploring its core mechanisms and regulatory factors in the pathological process of DFU, and summarizes the current main intervention strategies. Through systematic analysis, this article aims to deepen the understanding of the mechanisms underlying mitochondrial dynamics in DFU and to provide new ideas for targeted therapy in clinical practice. 糖尿病足溃疡（DFU）是糖尿病患者常见且严重的慢性并发症，具有高复发率、致残和致死风险，给个人健康与社会医疗系统带来沉重负担。线粒体动力学指线粒体通过分裂与融合的动态平衡维持细胞的能量代谢和稳态，而在糖尿病病理环境中，高血糖和氧化应激会破坏这一平衡，导致线粒体功能紊乱，进一步加剧DFU的炎症反应和组织损伤。近年来，靶向线粒体动力学的干预策略被认为是改善DFU症状、促进创面愈合的潜在治疗手段。该文基于国内外最新研究，综述DFU中线粒体动力学的研究进展，重点探讨其在DFU病理过程中的核心作用机制及调控因素，并总结当前主要的干预策略。通过系统分析，该文旨在加深对DFU相关线粒体动力学机制的理解，为临床提供新的靶向治疗思路。.
Objective: To explore the effects of mitochondrial transplantation on full-thickness skin defects in diabetic rats. Methods: This study was an experimental study. Functionally intact mitochondria were extracted from the liver tissue of 6-8-week-old male Sprague Dawley rats (the same age and sex below). Mouse L929 cells and human umbilical vein endothelial cells (HUVECs) were cultured in medium containing high-glucose (50 mmol/L) for 24 hours to induce high-glucose injury. According to the random number table method (the same grouping method below), they were then divided into control group (Ctrl group, treated with conventional medium), growth factor group (GF group, treated with medium containing 20 U/mL recombinant human epidermal growth factor), and mitochondrial group (Mito group, treated with medium containing 12.5 μg/mL exogenous mitochondria). The scratch assay was performed to evaluate the migration rate of mouse L929 cells at 6 hours after scratching (n=3). The length and number of branch nodes of tube formed by HUVECs were measured after 2 and 6 hours of culture (n=3). After 24 hours of culture, the reactive oxygen species (ROS) levels and mitochondrial membrane potential in aforemetioned two types of cells were detected according to the kit instructions (n=6). Eighteen Sprague Dawley rats were selected and a type 1 diabetic rat model was successfully established. Then, the full-thickness skin defects with a diameter of 1 cm were created on their backs. The rats were divided into Ctrl group, GF group, and Mito group (with each group of 6 rats). At post-injury days (PID) 0 (immediately), 3, and 6, the wounds were subcutaneously injected with normal saline (Ctrl group), topically sprayed with an equal amount of rhEGF solution at a dose of 40 U/cm² (GF group), or subcutaneously injected with equal amount of mitochondrial suspension at a dose of 5 μg/g (Mito group), respectively. The percentage of remaining wound area of rats was calculated at PID 3, 6, and 12. At PID 12, the epithelialization and collagen deposition in the wound of rats were detected by hematoxylin and eosin staining and Masson's staining, respectively. Immunofluorescence staining was used to detect the expression of CD31 (a marker for neovascularization) and neurofilament 200 (a marker for nerves) in the wound of rats. The ROS levels, number of apoptotic cells, ATP content in the wound of rats were detected according to the kit instructions. The levels of tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), and IL-6 in the wound of rats were detected by enzyme-linked immunosorbent assay. Results: At 6 hours after scratching, compared with that in Ctrl group, the migration rate of mouse L929 cells in GF group was significantly increased (P<0.05). compared with that in GF group, the migration rate of mouse L929 cells in Mito group was significantly increased (P<0.05); After 2 and 6 hours of culture, compared with those in Ctrl group, the numbers of branch nodes and the lengths of tube formed by HUVECs in both GF group and Mito group were significantly increased (P<0.05). Compared with those in GF group, the numbers of branch nodes and the lengths of tube formation of HUVECs after 2 and 6 hours of culture in Mito group were significantly increased (P<0.05). After 24 hours of culture, compared with those in Ctrl group, the ROS levels in both mouse L929 cells and HUVECs in GF group and Mito group were significantly decreased (P<0.05), while the mitochondrial membrane potentials were significantly increased (P<0.05); compared with those in GF group, the ROS levels in both mouse L929 cells and HUVECs in Mito group were significantly decreased (P<0.05), while the mitochondrial membrane potentials were significantly increased (P<0.05). At PID 3, 6, and 12, the percentages of remaining wound area of rats in Mito group ((46±3)%, (37±3)%, (18±3)%) were significantly lower than those in Ctrl group ((71±4)%, (63±4)%, (47±5)%) and GF group((62±3)%, (54±3)%, (33±4)%), P<0.05. At PID 12, in the wounds of rats in Mito group, the status of epithelialization and collagen deposition, as well as the conditions of angiogenesis and nerve repair, were superior to those in growth factor and control groups. Compared with those in Ctrl group, the ROS levels and number of apoptotic cells in the wounds of rats in GF group and Mito group were significantly decreased (P<0.05), the ATP content significantly increased (P<0.05), and the levels of TNF-α, IL-1β, and IL-6 were all significantly reduced (P<0.05). Compared with those in GF group, the ROS levels and number of apoptotic cells in the wounds of rats in Mito group were significantly decreased (P<0.05), the ATP content significantly increased (P<0.05), and the levels of TNF-α, IL-1β, and IL-6 were all significantly reduced (P<0.05). Conclusions: Mitochondrial transplantation enhances mitochondrial ATP production and reduces the level of oxidative stress in cells under high-glucose injury, which improves the migration capacity of mouse L929 cells and the angiogenesis capacity of HUVECs. Simultaneously, it facilitates epithelialization and collagen deposition in full-thickness skin defect wounds of diabetic rats, reduces the levels of inflammatory cytokines, and inhibits cell apoptosis, thereby accelerating wound healing. 目的： 探讨线粒体移植对糖尿病大鼠全层皮肤缺损的影响。 方法： 该研究为实验研究。提取6~8周龄雄性SD大鼠（鼠龄及性别下同）肝脏组织中功能完整的线粒体。取小鼠L929细胞和人脐静脉内皮细胞（HUVEC），用含50 mmol/L葡萄糖的培养基培养24 h对细胞造成高糖损伤，随后按照随机数字表法（分组方法下同）将其分为用常规培养基处理的对照组、用含20 U/mL重组人表皮生长因子（rhEGF）的培养基处理的生长因子组和用含12.5 μg/mL外源性线粒体的培养基处理的线粒体组。采用划痕试验检测划痕后6 h时小鼠L929细胞的迁移率；培养2、6 h后，检测HUVEC的成管长度与交叉点数，样本数均为3。培养24 h后，按照试剂盒说明书检测前述2种细胞中的活性氧水平和线粒体膜电位，样本数均为6。取18只SD大鼠，成功制成1型糖尿病模型后于其背部制作直径1 cm的全层皮肤缺损创面。将大鼠分为对照组、生长因子组和线粒体组（每组6只），均于伤后0（即刻）、3、6 d，分别在其创面皮下注射生理盐水、创面上喷洒等量的剂量为40 U/cm²的rhEGF溶液、创面皮下注射等量的剂量为5 μg/g的线粒体悬液。计算伤后3、6、12 d大鼠剩余创面面积百分比。伤后12 d，行苏木精-伊红染色和Masson染色分别观察大鼠创面中上皮化和胶原沉积情况，采用免疫荧光法检测大鼠创面中新生血管特异性标志物CD31及神经特异性标志物神经丝蛋白200的表达情况，按照试剂盒说明书检测大鼠创面中活性氧水平、凋亡细胞数、ATP含量，采用酶联免疫吸附测定法检测创面中肿瘤坏死因子-α（TNF-α）、白细胞介素-1β（IL-1β）、IL-6水平。 结果： 划痕后6 h时，与对照组相比，生长因子组小鼠L929细胞迁移率明显升高（P<0.05）；与生长因子组相比，线粒体组小鼠L929细胞迁移率明显升高（P<0.05）。培养2、6 h后，与对照组相比，生长因子组和线粒体组HUVEC的成管交叉点数均显著升高（P<0.05），成管长度均显著增长（P<0.05）。与生长因子组相比，线粒体组HUVEC培养2、6 h后的成管交叉点数均显著升高（P<0.05），成管长度均显著增长（P<0.05）。培养24 h后，与对照组相比，生长因子组和线粒体组小鼠L929细胞和HUVEC中活性氧水平均显著降低（P<0.05），线粒体膜电位均显著升高（P<0.05）；与生长因子组相比，线粒体组小鼠L929细胞和HUVEC中活性氧水平均显著降低（P<0.05），线粒体膜电位均显著升高（P<0.05）。伤后3、6、12 d，线粒体组大鼠剩余创面面积百分比分别为（46±3）%、（37±3）%、（18±3）%，均明显低于对照组的（71±4）%、（63±4）%、（47±5）%和生长因子组的（62±3）%、（54±3）%、（33±4）%，P<0.05。伤后12 d，线粒体组大鼠创面中上皮化及胶原沉积情况、血管新生及神经修复情况均优于生长因子组和对照组；与对照组相比，生长因子组和线粒体组大鼠创面中活性氧水平均明显降低（P<0.05），凋亡细胞数均明显减少（P<0.05），ATP含量均明显升高（P<0.05），TNF-α、IL-1β、IL-6水平均显著降低（P<0.05）；与生长因子组相比，线粒体组大鼠创面中活性氧水平明显降低（P<0.05），凋亡细胞数明显减少（P<0.05），ATP含量明显升高（P<0.05），TNF-α、IL-1β、IL-6水平均显著降低（P<0.05）。 结论： 线粒体移植能够通过促进高糖损伤细胞中线粒体ATP的产生、减少氧化应激水平，改善小鼠L929细胞的迁移能力和HUVEC的血管形成能力；同时可以促进糖尿病大鼠全层皮肤缺损创面的上皮化和胶原沉积，降低炎症因子水平、抑制细胞凋亡，进而加速创面愈合。.
The repair of facial organ injuries is a complex field in plastic surgery that involves both functional recovery and morphological reconstruction. The therapeutic goal has evolved from traditional wound closure to the harmonious integration of form and function. To achieve this new objective, surgical plans need to combine various flap techniques, autologous and allogeneic tissue transplantation approaches, and incorporate emerging methods such as digital design and biomaterials. Although the repair outcomes of facial organ injuries have improved compared to the past, challenges remain, including insufficient nerve function reconstruction, limited scar management, donor site damage, and immune rejection in allogeneic transplantation. This article systematically reviews the mainstream repair methods and advancements in domestic and international research on key facial structures, including the nose, eyelids, lips, and ears, focusing on their defect characteristics and repair difficulties. It emphasizes how to achieve both three-dimensional structural reconstruction and dynamic functional restoration while maintaining aesthetic reconstruction. In the future, the integration of technologies such as tissue engineering, three-dimensional bioprinting, supermicrosurgery, and artificial intelligence will drive the development of facial organ injury repair and reconstruction towards precision, personalization, and minimally invasive approaches, ultimately achieving comprehensive rehabilitation of patients' physical, psychological, and social roles. 面部器官损伤的修复是整形外科中兼具功能恢复与形态重建的复杂领域，其治疗目标已从传统的创面闭合发展为形态与功能的和谐统一，要实现这一新目标，手术方案需结合各种皮瓣技术、自体及异体组织移植策略，融入数字化设计与生物材料等新兴手段。尽管现今面部器官损伤修复效果较以往已有提升，但仍面临神经功能重建不足、瘢痕管理效果有限、供区损伤及异体移植免疫排斥等挑战。该文围绕鼻、眼睑、唇、耳等面部关键结构的缺损特点与修复难点，系统阐述了当前国内外对于相关结构的主流修复方法与进展，重点探讨了如何在重建三维结构与恢复动态功能的同时，兼顾美学重建。未来，组织工程、三维生物打印、超级显微外科与人工智能等技术的融合将推动面部器官损伤修复与重建向精准化、个性化和微创化方向发展，最终实现患者生理、心理与社会角色的全面康复。.
The core objective of superficial organ reconstruction is to perfectly restore the organ's morphological structure and biological function. Currently, significant progress has been achieved in structural construction, blood supply assurance, and morphological and functional reconstruction of superficial organ reconstruction, primarily relying on approaches including surgical techniques, tissue engineering, and regenerative medicine. In the future, with the integration and application of cutting-edge technologies such as gene editing, artificial intelligence, three-dimensional printing, and brain-computer interfaces, superficial organ reconstruction is poised to enter a new historical stage characterized by high intelligence, precision, and comprehensive functional restoration. This article focuses on superficial organ reconstruction, systematically outlines its concept, challenges, and current development status, and proposes future perspectives for this field. 体表器官再造的核心目标是完美重建器官的形态结构与生物功能。当前主要依赖外科技术、组织工程与再生医学手段，使得体表器官再造在结构构建、血运保障、形态与功能重建等方面取得显著进展。未来，随着基因编辑、人工智能、三维打印及脑机接口等前沿技术的融合应用，体表器官再造必将迈向一个能够实现高度智能化、精准化和功能完备化的全新历史阶段。该文聚焦体表器官再造，系统梳理其概念、挑战与发展现状，并提出未来这一领域的发展展望。.
The foot and ankle have a special anatomical structure and bear crucial functions of body such as weight bearing, walking, running, and jumping. High-energy injuries to these areas are complex, posing challenges to clinical tissue reconstruction. Complex foot-ankle tissue defects mostly present as multicompartmental defects involving skin and soft tissue, tendons, bones, and joints, as well as large-area skin and soft tissue defects. We divided the foot and ankle into nine regions based on the anatomical characteristics and physiological functions of different sites. Ten clinical types were then classified according to the involved regions of tissue defects and the presence of combined deep tissue defects. For each clinical type, appropriate flap donor sites and suitable special form of perforator flap procedures can be selected based on the requirements of microsurgical reconstruction to achieve personalized and precise reconstruction, so as to achieve the optimal restoration of the appearance and function of the foot and ankle with minimal donor-site damage. 足踝部解剖结构特殊，承担负重、行走、跑跳等重要的人体功能，高能损伤后伤情复杂，临床组织重建困难。足踝部复杂组织缺损多表现为累及皮肤软组织、肌腱、骨、关节等多元组织的缺损和巨大面积的皮肤软组织缺损。笔者根据足踝部各区域解剖特点与生理功能，将该部位划分为9个区域，然后根据组织缺损累及区域和是否合并深部组织缺损，将该部位缺损划分为10种临床类型。对于每一种临床类型，都可依据其显微重建要求选择合适的皮瓣供区和适宜的特殊形式穿支皮瓣术式，以实现个性化精准重建，达到以最小的供区损害获得最佳的足踝部外形与功能的恢复。.
Objective: To investigate the effects of polyvinyl alcohol-boric acid (PVA-BA)-based functionalized hydrogels on human skin fibroblasts (HSFs) and HaCaT cells, providing experimental evidences for subsequent in vivo studies on wound repair and clinical translation of this hydrogel system. Methods: This study was an experimental investigation based on grouped and repeated measures designs. Based on PVA-BA, a freeze-thaw cycling method was employed to prepare PVA-BA hydrogel, PVA-BA-S hydrogel loaded with SB431542 at a final molarity of 5 μmol/L, and PVA-BA-B hydrogel loaded with BML-284 at a final molarity of 1 μmol/L. Fourier transform infrared spectroscopy and X-ray diffraction were employed respectively to characterize the characteristic absorption peaks and diffraction peaks of the above-mentioned three hydrogels. The drug release of PVA-BA-S hydrogel and PVA-BA-B hydrogel in phosphate-buffered saline (PBS) at pH 5.5 and 7.4 was detected by liquid chromatography, and the cumulative drug release rate at 48 hours of immersion was calculated. According to the random number table method, HSFs were divided into control group with conventional culture, activation-only group with conventional culture after treatment with recombinant human transforming growth factor-β1 (TGF-β1) protein for 24 hours, as well as PVA-BA group and PVA-BA-S group cultured with PVA-BA hydrogel extract and PVA-BA-S hydrogel extract, respectively, after treatment with recombinant human TGF-β1 protein for 24 hours. After 24 hours of culture, mRNA expression levels of TGF-β signaling pathway-related factors α-smooth muscle actin (α-SMA), TGF-β, Smad2, Smad3, type Ⅰ collagen (COL Ⅰ), and COL Ⅲ in HSFs were detected using real-time fluorescence quantitative reverse transcription polymerase chain reaction. Protein expression levels of COL Ⅰ and COL Ⅲ in HSFs were assessed via the immunofluorescence method. According to the random number table method, HaCaT cells were divided into control group with conventional culture, PVA-BA group cultured with PVA-BA hydrogel extract, and PVA-BA-B group cultured with PVA-BA-B hydrogel extract. After 24 hours of culture, mRNA expression levels of Wnt signaling pathway-related factors β-catenin, matrix metalloproteinase-9 (MMP-9), E-cadherin, and N-cadherin in HaCaT cells were detected by real-time fluorescence quantitative reverse transcription polymerase chain reaction. The protein expression level of keratin 5 was assessed via the immunofluorescence method. Except for characterization, the sample size for each experiment was 3. Results: The Fourier transform infrared spectroscopy spectra of the PVA-BA hydrogel, PVA-BA-S hydrogel, and PVA-BA-B hydrogel all exhibited stretching vibration peaks corresponding to C-O and B-O bonds within the B-O-C group at wavenumbers of 1 100 and 1 450 cm⁻¹, and the X-ray diffraction patterns all formed a sharp diffraction peak at around 20°. At 48 hours of immersion, the cumulative drug release rate of PVA-BA-S hydrogel in PBS at pH 5.5 was (70.9±2.3)%, which was significantly higher than (60.0±2.2)% in PBS at pH 7.4 (t=6.02, P<0.05); the cumulative drug release rate of PVA-BA-B hydrogel in PBS at pH 5.5 was (83.9±2.2)%, which was significantly higher than (65.2±1.7)% in PBS at pH 7.4 (t=11.63, P<0.05). After 24 hours of culture, the mRNA expression levels of TGF-β, COL Ⅰ, COL Ⅲ, and Smad3 of HSFs in PVA-BA-S group were significantly higher than those in control group (P<0.05), the mRNA expression levels of TGF-β, COL Ⅰ, COL Ⅲ, α-SMA, Smad2, and Smad3 were significantly lower than those in activation-only group and PVA-BA group (P<0.05), and the protein expression levels of COL Ⅰ and COL Ⅲ of HSFs in PVA-BA-S group were significantly lower than those in activation-only group and PVA-BA group (P<0.05). After 24 hours of culture, compared with those in control group and PVA-BA group, the PVA-BA-B group showed significantly increased mRNA expression levels of β-catenin, MMP-9, and N-cadherin (P<0.05) and a significantly decreased mRNA expression level of E-cadherin (with P values both <0.05) in HaCaT cells; the protein expression level of keratin 5 of HaCaT cells in PVA-BA-B group was significantly higher than that in control group and PVA-BA group (with P values both <0.05). Conclusions: The PVA-BA-based PVA-BA-S and PVA-BA-B hydrogels can effectively inhibit the fibrotic phenotype of activated HSFs and enhance the migratory ability of HaCaT cells by regulating the TGF-β signaling pathway and Wnt signaling pathway, respectively, providing a novel drug delivery strategy for functional wound healing. 目的： 探讨基于聚乙烯醇-硼酸（PVA-BA）的功能化水凝胶对人皮肤成纤维细胞（HSF）和HaCaT细胞的作用，为后续该水凝胶系统应用于创面修复的体内研究及临床转化提供实验依据。 方法： 该研究为成组设计与重复测量设计实验研究。基于PVA-BA，采用冻融循环法制备PVA-BA水凝胶、负载终物质的量浓度为5 μmol/L SB431542的PVA-BA-S水凝胶、负载终物质的量浓度为1 μmol/L BML-284的PVA-BA-B水凝胶，分别采用傅里叶变换红外光谱仪、X射线衍射仪对前述3种水凝胶的特征吸收峰、衍射峰进行表征。利用液相色谱仪检测PVA-BA-S水凝胶和PVA-BA-B水凝胶各自在pH值为5.5和7.4的磷酸盐缓冲液（PBS）中的释放情况，计算浸泡48 h时的药物累计释放率。采用随机数字表法将HSF分为常规培养的对照组、经重组人转化生长因子-β1（TGF-β1）蛋白处理24 h后常规培养的单纯激活组，以及经重组人TGF-β1蛋白处理24 h后分别用PVA-BA水凝胶浸提液、PVA-BA-S水凝胶浸提液培养的PVA-BA组、PVA-BA-S组。培养24 h后，采用实时荧光定量反转录PCR法检测HSF中TGF-β信号通路相关因子α-平滑肌肌动蛋白（α-SMA）、TGF-β、Smad2、Smad3、Ⅰ型胶原蛋白（COLⅠ）、COLⅢ的mRNA表达水平，采用免疫荧光法检测HSF中COLⅠ、COLⅢ的蛋白表达水平。采用随机数字表法将HaCaT细胞分为常规培养的对照组、用PVA-BA水凝胶浸提液培养的PVA-BA组及用PVA-BA-B水凝胶浸提液培养的PVA-BA-B组，培养24 h后，采用实时荧光定量反转录PCR法检测细胞中Wnt信号通路相关因子β-连环蛋白、基质金属蛋白酶9（MMP-9）、E-钙黏蛋白、N-钙黏蛋白的mRNA表达水平，采用免疫荧光法检测细胞中角蛋白5的蛋白表达水平。除表征外，以上实验样本数均为3。 结果： PVA-BA水凝胶、PVA-BA-S水凝胶、PVA-BA-B水凝胶的傅里叶变换红外光谱均在波数1 100、1 450 cm-1处表现出B-O-C中C-O和B-O的伸缩振动峰，X射线衍射图谱均在20°左右形成一个尖锐的衍射峰。浸泡48 h时，PVA-BA-S水凝胶在pH值为5.5的PBS中的药物累计释放率为（70.9±2.3）%，显著高于在pH值为7.4的PBS中的（60.0±2.2）%（t=6.02，P<0.05）；PVA-BA-B水凝胶在pH值为5.5的PBS中的药物累计释放率为（83.9±2.2）%，显著高于在pH值为7.4的PBS中的（65.2±1.7）%（t=11.63，P<0.05）。培养24 h后，PVA-BA-S组HSF中TGF-β、COLⅠ、COLⅢ、Smad3的mRNA表达水平均显著高于对照组（P<0.05），TGF-β、COLⅠ、COLⅢ、α-SMA、Smad2、Smad3的mRNA表达水平均显著低于单纯激活组及PVA-BA组（P<0.05）；PVA-BA-S组HSF中COLⅠ、COLⅢ的蛋白表达水平均显著低于单纯激活组和PVA-BA组（P<0.05）。培养24 h后，与对照组及PVA-BA组比较，PVA-BA-B组HaCaT细胞中β-连环蛋白、MMP-9、N-钙黏蛋白的mRNA表达水平均显著升高（P<0.05），E-钙黏蛋白的mRNA表达水平显著降低（P值均<0.05）；PVA-BA-B组HaCaT细胞中角蛋白5的蛋白表达水平显著高于对照组与PVA-BA组（P值均<0.05）。 结论： 基于PVA-BA的PVA-BA-S水凝胶和PVA-BA-B水凝胶可分别通过调控TGF-β信号通路和Wnt信号通路有效抑制活化HSF的纤维化表型及增强HaCaT细胞迁移能力，为创面功能性愈合提供了一种新型药物递送策略。.
Objective: To investigate the effects and mechanism of tannic acid/magnesium nanocomplex (MgTA NC) on wound healing in rats with full-thickness scald. Methods: This study was an experimental study. The MgTA NC with good biocompatibility was synthesized using the hydrothermal method. Mouse RAW 264.7 cells were divided into endotoxins/lipopolysaccharides (LPS) alone group, low MgTA NC group, medium MgTA NC group, and high MgTA NC group, which were all treated with LPS at final mass concentration of 1 μg/mL, and then cultured respectively with MgTA NC at the final mass concentration of 0 (without), 2.5, 5.0, or 7.5 μg/mL for 24 hours. The protein expressions of M1 type macrophage marker inducible nitric oxide synthase (iNOS), M2 type macrophage marker CD163, as well as glycolysis metabolism-related proteins pyruvate kinase type M2 (PKM2) and hexokinase in cells were detected by Western blotting; the expression levels of succinate dehydrogenase and isocitrate dehydrogenase in cells were detected by enzyme-linked immunosorbent assay method. The sample size in cell experiment was 3. Twelve six-week-old male Sprague-Dawley rats were selected and subjected to full-thickness scald on their backs using a temperature-controlled electrothermal burn device. The rats were assigned to control group, simple hydrogel group, and composite hydrogel group according to the random number table method, with 4 rats in each group. The wounds were treated with phosphate buffered saline, methacrylated gelatin (GelMA) hydrogel, or GelMA hydrogel loaded with MgTA NC, respectively. The wound healing rates were calculated at post-injury day 3, 7, and 14 (with the sample size of 4), and the expression level of inflammatory factor tumor necrosis factor α (TNF-α) in the wound tissue at post-injury day 14 was detected by immunohistochemical staining. Results: After 24 hours of culture, the protein expressions of iNOS, the M1 type macrophage marker in RAW 264.7 cells decreased successively in LPS alone group, low MgTA NC group, medium MgTA NC group, and high MgTA NC group, while the protein expressions of CD163, the M2 type macrophage marker increased successively, and the protein expressions of PKM2 and hexokinase decreased successively. After 24 hours of culture, compared with those in LPS alone group, the expression levels of succinate dehydrogenase and isocitrate dehydrogenase in RAW 264.7 cells in low MgTA NC group were significantly increased (P<0.05); compared with those in low MgTA NC group, the expression levels of succinate dehydrogenase and isocitrate dehydrogenase in RAW 264.7 cells in medium MgTA NC group were significantly increased (P<0.05); compared with those in medium MgTA NC group, the expression levels of succinate dehydrogenase and isocitrate dehydrogenase in RAW 264.7 cells in high MgTA NC group were significantly increased (P<0.05). At post-injury day 3, there was no statistically significant difference in the wound healing rate among the three groups of rats (P>0.05). At post-injury day 7 and 14, the wound healing rates of rats in simple hydrogel group were (52.28±5.11)% and (81.11±2.09)%, and those in composite hydrogel group were (76.81±2.68)% and (98.93±0.29)%, which were significantly higher than (32.75±6.86)% and (60.10±2.10)% in control group, respectively (P<0.05); the wound healing rates of rats in composite hydrogel group were significantly higher than those in simple hydrogel group (P<0.05). At post-injury day 14, the expression of TNF-α in the wound tissue of rats in simple hydrogel group and composite hydrogel group was significantly reduced compared with that in control group, and the expression of TNF-α in the wound tissue of rats in composite hydrogel group was significantly reduced compared with that in simple hydrogel group. Conclusions: MgTA NC exhibits excellent biocompatibility, and it is capable of modulating macrophage polarization toward the M2 type, effectively reducing glycolysis level and enhancing oxidative phosphorylation level of macrophages, suppressing excessive inflammatory responses and enhancing the ability of tissue regeneration and repair, therefore significantly accelerating wound healing in rats with full-thickness scald. 目的： 探讨单宁酸/镁纳米复合物（MgTA NC）对Ⅲ度烫伤大鼠创面愈合的作用及其机制。 方法： 该研究为实验研究。通过水热法制备了生物相容性良好的MgTA NC。取小鼠RAW 264.7细胞，分为单纯内毒素/脂多糖（LPS）组、低MgTA NC组、中MgTA NC组、高MgTA NC组，均先用终质量浓度1 μg/mL的LPS处理，再分别采用终质量浓度0（不含）、2.5、5.0、7.5 μg/mL的MgTA NC培养24 h后，采用蛋白质印迹法检测细胞中M1型巨噬细胞标志物诱导型一氧化氮合酶（iNOS）、M2型巨噬细胞标志物CD163和糖酵解代谢相关的蛋白M2型丙酮酸激酶（PKM2）、己糖激酶的蛋白表达，采用酶联免疫吸附测定法检测细胞中琥珀酸脱氢酶和异柠檬酸脱氢酶的表达水平。细胞实验样本数均为3。取12只6周龄雄性SD大鼠，使用控温电烫伤仪在其背部造成Ⅲ度烫伤，采用随机数字表法将其分为对照组、单纯水凝胶组和复合水凝胶组（每组4只），分别采用磷酸盐缓冲液、甲基丙烯酸酐化明胶水凝胶、负载MgTA NC的甲基丙烯酸酐化明胶水凝胶处理创面，计算伤后3、7、14 d创面愈合率（样本数为4）。伤后14 d，行免疫组织化学染色观察创面组织中炎症因子肿瘤坏死因子α（TNF-α）的表达。 结果： 培养24 h后，单纯LPS组、低MgTA NC组、中MgTA NC组、高MgTA NC组RAW 264.7细胞中M1型巨噬细胞标志物iNOS的蛋白表达依次减少，M2型巨噬细胞标志物CD163的蛋白表达依次增加，PKM2和己糖激酶的蛋白表达均依次减少。培养24 h后，与单纯LPS组比较，低MgTA NC组RAW 264.7细胞中琥珀酸脱氢酶和异柠檬酸脱氢酶的表达水平均明显升高（P<0.05）；与低MgTA NC组比较，中MgTA NC组RAW 264.7细胞中琥珀酸脱氢酶和异柠檬酸脱氢酶的表达水平均明显升高（P<0.05）；与中MgTA NC组比较，高MgTA NC组RAW 264.7细胞中琥珀酸脱氢酶和异柠檬酸脱氢酶的表达水平均明显升高（P<0.05）。伤后3 d，3组大鼠创面愈合率比较，差异无统计学意义（P>0.05）。伤后7、14 d，单纯水凝胶组［（52.28±5.11）%、（81.11±2.09）%］、复合水凝胶组［（76.81±2.68）%、（98.93±0.29）%］大鼠创面愈合率均明显高于对照组［（32.75±6.86）%、（60.10±2.10）%，P<0.05］，复合水凝胶组大鼠创面愈合率均明显高于单纯水凝胶组（P<0.05）。伤后14 d，单纯水凝胶组和复合水凝胶组大鼠创面组织中TNF-α的表达均明显少于对照组，复合水凝胶组大鼠创面组织中TNF-α的表达明显少于单纯水凝胶组。 结论： MgTA NC具有良好的生物相容性，能调控巨噬细胞向M2型极化，有效降低巨噬细胞糖酵解水平并提高其氧化磷酸化水平，抑制组织过度炎症反应并增强组织的再生及修复能力，从而加速Ⅲ度烫伤大鼠创面愈合。.
With the improvement of living standards and dietary conditions of civilians, the incidence of diabetes mellitus is also increasing gradually. Diabetic foot ulcers (DFU), a serious complication of diabetes mellitus, are associated with high rates of amputation and mortality, placing huge psychological and economic burdens on patients. The complex pathogenesis and difficult-to-heal wounds pose significant challenges to the prognosis of DFU patients. This article will elaborate on the pathogenesis of DFU wounds by integrating the latest research progress at home and abroad and summarize the current treatment schemes for different types of DFU wounds, aiming to provide guidance for clinical treatment of DFU wounds. 随着当前居民生活水平及饮食条件的改善，糖尿病的发病率也逐渐增高。糖尿病足溃疡（DFU）作为糖尿病严重的并发症之一，具有极高的截肢率及致死率，给患者带来了巨大的心理和经济负担。复杂的发病机制及难以愈合的创面对DFU患者的预后造成了极大的挑战。该文将结合当前国内外最新研究进展阐述DFU创面的发病机制，并对当前不同类型的DFU创面治疗方案进行归纳总结，旨在为临床治疗DFU创面提供指导。.
Objective: To explore the application of multidisciplinary team (MDT) diagnosis and treatment model in the management of patients with combined burns and heat stroke. Methods: This study was a retrospective observational study. From January 2022 to December 2024, the Military Burn Center admitted 5 patients and the Department of Critical Care Medicine of the 990th Hospital of PLA Joint Logistic Support Force admitted 4 patients with combined burns and heat stroke that met the inclusion criteria. All patients were male, aged 64-78 (70±5) years. The onset of the disease in patients occurred mainly during June to September, with the time frame predominantly between 10:00 and 14:30, in environment with temperature>30 ℃ and humidity≥60%. Under the MDT diagnosis and treatment model, a fixed MDT was established with the director of the Military Burn Center as the leader, which included specialists from critical care medicine, nephrology, respiratory medicine, cardiology, neurology, anesthesiology, endocrinology, pharmacy, rehabilitation, nutrition, and transfusion medicine. Through clear division of responsibilities, standardized information communication, and daily interdisciplinary handovers, integrated coordination and decision-making in the diagnosis and treatment process were achieved. The burn-related characteristics including total burn area, burn index, and combination of inhalation injury, treatment including infusion rate in the first 24 h post admission, infusion rate in the second 24 h post admission, and total infusion rate within 48 h post admission, use of blood products, status of continuous blood purification (CBP) treatment, administration of invasive mechanical ventilation, and timing of the first surgery, outcomes including length of intensive care unit (ICU) stay, total hospital stay, and mortality within 7 days after admission of patients were recorded. Results: The total burn area of patients was 22.6% (10.5%, 23.0%) total body surface area, the burn index was 12.5 (8.0, 13.5), and 5 patients were combined with inhalation injury. The infusion rate in the first 24 h post admission, infusion rate in the second 24 h post admission, and total infusion rate within 48 h post admission of 7 patients were significantly higher than the planned fluid infusion rates (with t values of 4.39, 8.58, and 3.69, respectively, P<0.05). Blood products were used in 6 patients. CBP was performed in 3 patients with an average duration of 64.7 h, and invasive mechanical ventilation was applied in 4 patients with an average duration of 60.0 h. Five patients underwent surgery, with the first surgery performed at 13-19 (16.0 (13.7, 19.0)) days post admission. The patients' length of ICU stay was 0-504 (216 (18, 252)) h, and the total hospital stay was 0.5-71.0 (11.0 (1.4, 46.5)) d. Four patients died within 7 days after admission. Conclusions: Patients with combined burns and heat stroke are characterized by relatively limited burn area, frequent inhalation injury, and large volume of fluid resuscitation, thus facing clinical challenges such as the need for multiple ways of organ support and delayed surgical timing. In this context, the MDT diagnosis and treatment model centered on the department of burns and department of critical care medicine provides a rational pathway for coordinating complex resuscitation management, organ function support, and decisions on the timing of surgery. 目的： 探讨多学科团队（MDT）诊疗模式在烧伤复合热射病患者救治中的应用。 方法： 该研究为回顾性观察性研究。2022年1月—2024年12月，解放军联勤保障部队第九九〇医院全军烧伤中心收治5例、重症医学科收治4例符合入选标准的烧伤复合热射病患者，均为男性，年龄64~78（70±5）岁。患者发病月份集中于6—9月，时间段集中于10：00—14：30，环境温度>30 ℃，湿度≥60%。在MDT诊疗模式下，由全军烧伤中心主任担任组长，联合重症医学科、肾内科、呼吸内科、心内科、神经内科、麻醉科、内分泌科、药剂科、康复科、营养科及输血科团队组成固定MDT，通过明确分工、标准化信息沟通及每日跨学科交班，实现诊疗过程的统筹协调与决策执行一体化。统计患者的烧伤相关特征，包括烧伤总面积、烧伤指数、合并吸入性损伤情况；治疗情况，包括入院后第1个24 h输液率、入院后第2个24 h输液率、入院后48 h内输液率、血液制品使用情况、行连续性血液净化（CBP）治疗情况、行有创机械通气情况、首次手术时间；预后情况，包括住重症监护病房（ICU）时长、总住院时长、入院7 d内的病死情况。 结果： 患者烧伤总面积为22.6%（10.5%，23.0%）体表总面积，烧伤指数为12.5（8.0，13.5），合并吸入性损伤者5例。7例患者入院后第1个24 h输液率、第2个24 h输液率、48 h内输液率均明显高于预计输液率（t值分别为4.39、8.58、3.69，P<0.05）。6例患者使用了血液制品。3例患者行CBP治疗，平均上机时长64.7 h；4例患者行有创机械通气，平均上机时长60.0 h。5例患者接受手术治疗，首次手术时间为入院后13~19［16.0（13.7，19.0）］d。患者住ICU时长0~504［216（18，252）］h，总住院时长0.5~71.0［11.0（1.4，46.5）］d。4例患者在入院7 d内死亡。 结论： 烧伤复合热射病患者具有烧伤面积相对有限，常伴有吸入性损伤，补液量大等特点，面临需要多种方式器官功能支持、手术时机延迟等临床挑战。在此背景下，以烧伤科和重症医学科为核心的MDT诊疗模式，为统筹复杂的复苏管理、器官功能支持与手术时机决策提供了合理路径。.
Objective: To investigate the current status of post-traumatic growth (PTG) among university students, and to explore its mediation pathway with post-traumatic stress symptoms (PTSS). Methods: This study was a multicenter cross-sectional survey. From December 2024 to January 2025, using convenience sampling, 718 university students aged >18 years who met the inclusion criteria and had experienced stressful life events in the past year were selected from two comprehensive universities and one medical university in Chongqing as the study participants. A self-designed demographic questionnaire was used to collect demographic information of the university students, including gender, age, grade level, and family structure, etc. The adolescent self-rating life events checklist was used to assess university students' experiences of stressful life events and whether they were affected by these events. The post-traumatic stress disorder checklist-civilian version, the Chinese-Posttraumatic Growth Inventory, the 10-item Connor-Davidson resilience scale, and the Chinese PERMA-Profiler were used to assess university students' levels of PTSS, PTG, psychological resilience, and well-being, respectively. University students were classified according to demographic information and whether they were affected by stressful life events, and their total PTG scores were compared. Analysis of the correlation among PTG, PTSS, psychological resilience, and well-being in university students was carried out. Independent influencing factors for PTG among university students were identified. A structural equation model was constructed to analyze the mediating effects of well-being and psychological resilience on the transformation between PTSS and PTG. Results: Totally 718 questionnaires were distributed, and 647 valid questionnaires were returned, with a valid response rate of 90.1%. Among the university students, there were 584 males and 63 females, aged 18 to 27 years. There were 84 first-year students, 178 second-year students, 196 third-year students, and 189 fourth-year students. Among them, 582 students were from two-parent families, and 65 students were from single-parent families. Totally 102 students were affected by stressful life events, while 545 students were not affected by stressful life events. The stressful life events experienced by university students included 27 items, such as physical trauma, acute or serious illness, interpersonal tension, and academic pressure. The total scores of PTSS, PTG, psychological resilience, and well-being among university students were 18.00 (17.00, 27.00), 64.00 (41.00, 80.00), 30.00 (21.00, 39.00), and 118.00 (90.00, 135.00), respectively. Comparisons of total PTG scores among university students showed statistically significant differences by different age, family structure, and exposure to stressful life events (with Z values of -3.426, -2.285, and -3.693, respectively, P<0.05). The total PTG score and its subdimension scores of university students were significantly positively correlated with the total psychological resilience score, the total well-being score and its subdimension scores (with r values of 0.377 to 0.653, P<0.05). Age, family structure, whether being affected by stressful life events, well-being, and psychological resilience were independent influencing factors for PTG among university students (with β values of -0.144, 0.109, -0.151, 0.181, and 0.603, respectively, P<0.05). The constructed model was a multiple mediation model. Between PTSS and PTG transformation, both the independent mediating effect of well-being and the chain-mediating effects of well-being and psychological resilience were statistically significant (with β values of -0.140 and -0.287, respectively, 95% CI of -0.224 to -0.075 and -0.381 to -0.214, respectively, P<0.05), and the chain-mediating effect of well-being and psychological resilience was significantly higher than the independent mediating effect of well-being (β=0.146, with a 95% CI of 0.027 to 0.275, P<0.05). Conclusions: PTG among university students is at a moderate level. Well-being and psychological resilience play a chain-mediating role in the transformation between PTSS and PTG among university students. 目的： 调查大学生创伤后成长（PTG）现状，探讨其与创伤后应激症状（PTSS）之间的中介路径。 方法： 该研究为多中心横断面调查。2024年12月—2025年1月，采用便利抽样法，选取重庆市2所综合大学、1所医科大学中符合入选标准的18岁以上近1年经历生活应激事件的718名在校大学生，作为研究对象。采用自编人口学问卷调查大学生性别、年龄、年级、家庭结构等人口学资料；采用青少年生活事件量表调查大学生生活应激事件经历及是否受这些事件影响；采用创伤后应激障碍自评量表平民版、中文版PTG评定量表、简版心理弹性量表及中文版PERMA幸福指数量表，分别评估大学生PTSS、PTG、心理弹性和幸福感水平。将大学生按人口学资料和是否受生活应激事件影响分类，比较其PTG总评分；分析大学生PTG、PTSS、心理弹性及幸福感之间的相关性；筛选大学生PTG的独立影响因素；通过构建结构方程模型，分析幸福感和心理弹性在PTSS与PTG转化间的中介效应。 结果： 共发放问卷718份，回收有效问卷647份，有效回收率为90.1%。大学生中，男584人、女63人，年龄18~27岁，年级为大一年级者84人、大二年级者178人、大三年级者196人、大四年级者189人，家庭结构为双亲家庭者582人、单亲家庭者65人，受生活应激事件影响者102人、未受生活应激事件影响者545人。大学生经历的生活应激事件包括躯体创伤、患急重病、人际关系紧张、学习压力大等27项。大学生PTSS、PTG、心理弹性和幸福感总评分分别为18.00（17.00，27.00）、64.00（41.00，80.00）、30.00（21.00，39.00）、118.00（90.00，135.00）分。不同年龄、家庭结构、生活应激事件影响大学生PTG总评分比较，差异均有统计学意义（Z值分别为-3.426、-2.285、-3.693，P<0.05）。大学生PTG总评分及其各维度评分与心理弹性总评分、幸福感总评分及其各维度评分均呈显著正相关（r值为0.377~0.653，P<0.05）。年龄、家庭结构、是否受应激事件影响、幸福感和心理弹性均是大学生PTG的独立影响因素（β值分别为-0.144、0.109、-0.151、0.181、0.603，P<0.05）。构建的模型为多重中介模型，在PTSS与PTG转化间，幸福感的单独中介效应及幸福感与心理弹性的链式中介效应均具有统计学意义（β值分别为-0.140、-0.287，95%CI分别为-0.224~-0.075、-0.381~-0.214，P<0.05），幸福感与心理弹性的链式中介效应显著高于幸福感的单独中介效应（β=0.146，95%CI为0.027~0.275，P<0.05）。 结论： 大学生PTG呈中等水平，幸福感和心理弹性在大学生PTSS与PTG转化间发挥链式中介作用。.
Objective: To evaluate the clinical application effects of the "novel three-longitude and five-transverse method" for perforator localization in anterolateral thigh chimeric flaps. Methods: This study was a retrospective study of case series. From June 2021 to June 2023, 15 patients with destructive limb wounds who met the inclusion criteria were admitted to the Affiliated Hospital of Zunyi Medical University. The wounds were located on the upper limbs in 5 cases and the lower limbs in 10 cases, with a post-debridement area ranging from 12 cm×5 cm to 22 cm×7 cm. The "novel three-longitude and five-transverse method" was employed. The anterior superior iliac spine was defined as Point P, the superolateral border of patella was defined as Point A, and the lateral femoral epicondyle was defined as Point B. Point P was connected with Points A and B to form Lines PA and PB. The Point P was connected to the midpoint of the line connecting Points A and B (Point C) to form Line PC. A perpendicular line was drawn from the midpoint of Line PA as Line E. Line E was translated 5 cm proximally to form Line D, while Lines F, G, and H were drawn 5, 10, and 15 cm distally, respectively. The intersections of Lines PA and PB with Lines D, E, F, G, and H were defined as Zones Ⅰ, Ⅱ, Ⅲ, and Ⅳ, respectively. Using Line PC as the flap axis, anterolateral thigh chimeric flaps were designed and harvested within the areas to repair the wounds. The area of harvested flap ranged from 13.0 cm×6.0 cm to 23.0 cm×8.0 cm. The donor site wounds were sutured with tension reduction. During surgery, the number and origin of perforators observed in each zone, as well as the vertical distance from the skin entry point of the perforator to Line PC were recorded. After surgery, flap survival was observed. During follow-up, the color, texture, appearance, and occurrence of complications of flaps, as well as the occurrence of hyperplastic scar formation and muscle herniation in donor sites were observed. Results: During surgery, a total of 75 perforators was identified. Of those perforators, 18 were located in Zone Ⅰ (three originating from the oblique branch of lateral circumflex femoral artery and 15 originating from the descending branch of lateral circumflex femoral artery), 17 were located in Zone Ⅱ (all originating from the descending branch of lateral circumflex femoral artery), 21 were located in Zone Ⅲ (all originating from the descending branch of lateral circumflex femoral artery), and 19 were located in Zone Ⅳ (12 originating from the descending branch of lateral circumflex femoral artery and 7 originating from the peripheral vessels in distal thigh). The skin entry points of 24 perforators were located directly on Line PC, while the skin entry points of the other 51 perforators were located adjacent to it, with the vertical distances to Line PC all less than 1.0 cm. After surgery, one patient developed distal flap bruising, and two patients had minor exudation at the flap margin, which all healed after dressing changes. The flaps in the remaining patients survived smoothly. During the follow-up period of 6 to 40 months, all flaps demonstrated favorable color, texture, and appearance, with no complications observed; the scars in donor sites were mild, with no muscle herniation. Conclusions: The "novel three-longitude and five-transverse method" can effectively locate anterolateral thigh chimeric flap perforators. The method is simple and reliable. The anterolateral thigh chimeric flaps designed and harvested based on this method have good clinical effect in repairing destructive limb wounds, which is worthy of promotion. 目的： 探讨“新型三纵五横法”在股前外侧嵌合皮瓣穿支定位中的临床应用效果。 方法： 该研究为回顾性病例系列研究。2021年6月—2023年6月，遵义医科大学附属医院收治15例符合入选标准的肢体毁损性创面患者，创面位于上肢者5例、下肢者10例，清创后创面面积为12 cm×5 cm~22 cm×7 cm。采用“新型三纵五横法”，以髂前上棘为P点、髌骨外上缘为A点、股骨外上髁为B点，分别将P点与A、B点连接，形成PA、PB线，连接P点与A、B点连线的中点（C点），得到PC线；从PA线中点引一垂线为E线，将E线向近端平移5 cm为D线，向远端分别平移5、10、15 cm为F、G、H线；PA和PB线分别与D、E、F、G、H线相交，形成Ⅰ、Ⅱ、Ⅲ、Ⅳ区。以PC线为皮瓣轴线，在此区域内设计并切取股前外侧嵌合皮瓣修复创面，皮瓣切取面积为13.0 cm×6.0 cm~23.0 cm×8.0 cm。将供区创面行减张缝合。术中记录观察到的各区域内穿支数量、来源及穿支入皮点至PC线的垂直距离。术后观察皮瓣成活情况。随访时观察皮瓣色泽、质地、外形及并发症情况，供区瘢痕增生、肌疝发生情况。 结果： 术中共观察到75条穿支，其中18条穿支位于Ⅰ区（3条来源于旋股外侧动脉斜支、15条来源于旋股外侧动脉降支），17条穿支位于Ⅱ区（均来源于旋股外侧动脉降支），21条穿支位于Ⅲ区（均来源于旋股外侧动脉降支），19条穿支位于Ⅳ区（12条来源于旋股外侧动脉降支、7条来源于大腿下段周边血管）。24条穿支入皮点位于PC线上，51条穿支入皮点位于PC线旁，其至PC线的垂直距离均<1.0 cm。术后1例患者皮瓣远端出现淤紫，2例患者皮瓣边缘少量渗液，均经换药后愈合；其余患者皮瓣顺利成活。术后6~40个月随访时，皮瓣色泽、质地、外形均良好，无并发症发生，供区瘢痕增生不明显，无肌疝发生。 结论： “新型三纵五横法”可有效定位股前外侧嵌合皮瓣穿支，方法简单、可靠，基于该方法设计与切取的股前外侧嵌合皮瓣修复肢体毁损性创面的临床效果良好，值得推广。.
Objective: To explore the clinical application effects of vertical mattress suture combined with teardrop-shaped end-to-side arterial anastomosis technique in free flap transplantation for repairing limb wounds. Methods: This study was a retrospective case series study. From March 2023 to December 2024, 41 patients with skin and soft tissue defect wounds in limbs who met the inclusion criteria were admitted to the Department of Burns and Plastic Surgery of the Affiliated Hospital of Zunyi Medical University. Among them, there were 29 males and 12 females, aged from 39 to 74 years. After debridement, the wound areas ranged from 5.8 cm×3.5 cm to 17.5 cm×6.6 cm. The wounds were repaired with free anterolateral femoral perforator flaps, thoracodorsal artery perforator flaps, latissimus dorsi myocutaneous flaps, and medial sural artery perforator flaps, with flap areas of 8.0 cm×4.0 cm to 19.5 cm×7.0 cm. Due to atherosclerosis or intimal delamination of recipient arteries, or significant mismatch in arterial diameters between the donor and recipient sites, the vertical mattress suture combined with teardrop-shaped end-to-side arterial anastomosis technique was used for arterial anastomosis in the donor and recipient sites. The wounds in the donor site were directly closed after reducing tension. During the surgery, the situation of atherosclerosis or intimal delamination of recipient arteries, or significant mismatch in arterial diameters between the donor and recipient sites was observed. After surgery, the complete survival of the flaps was observed, and the complete flap survival rate was calculated. The occurrence of postoperative complications was recorded. During the follow-up after surgery, the color, texture, and hypertrophy of the surviving flaps, as well as scar hyperplasia in the donor site were observed. Before surgery and at the final follow-up, the function of the affected limbs was assessed in patients with wounds in upper and lower limbs using the upper limb function index (UEFI) and foot function index (FFI), respectively. At the final follow-up, the satisfaction of patients with the appearance of the donor and recipient sites and the function of the affected limbs were recorded. Results: During the surgery, it was observed that 23 patients had atherosclerosis or intimal delamination in the recipient artery anastomosis site; in 18 patients, there was a significant difference in the diameter of the flap artery and the recipient artery, with the ratio ranging from 1.0∶1.5 to 1.0∶3.3, with an average of 1.0∶2.4. After surgery, 40 patients had complete flap survival, with a complete flap survival rate of 97.6% (40/41). After surgery, 5 patients with infectious wounds had delayed suture healing, which healed after dressing changes. No arterial crisis occurred in any patient during hospitalization after surgery. During follow-up of 6 to 18 months after surgery, the surviving flaps had similar color and texture to the recipient skin, with a full but non-bulky appearance. Only linear scars occurred in the donor site, with no obvious hypertrophic scar. Before surgery, the UEFI of upper limbs ranged from 29 to 54, with an average of 41; at the final follow-up, the UEFI of upper limbs ranged from 59 to 72, with an average of 65. Before surgery, the FFI of lower limbs ranged from 43 to 87, with an average of 73; at the final follow-up, the FFI of lower limbs ranged from 15 to 42, with an average of 29. At the final follow-up, 24 out of 28 patients with wounds in lower limbs were able to walk without the assistance of auxiliary tools; all the patients were satisfied with the appearance of the donor and recipient sites, as well as the function of the affected limbs. Conclusions: The vertical mattress suture combined with teardrop-shaped end-to-side arterial anastomosis technique effectively achieves the eversion and apposition of the arterial intima. This technique applied in free flap transplantation to repair limb wounds can prevent arterial crisis, with high flap survival rate and satisfaction of patients after surgery, thus having application value in clinical practice. 目的： 探讨垂直褥式缝合联合水滴形动脉端侧吻合技术在游离皮瓣移植修复四肢创面中的临床应用效果。 方法： 该研究为回顾性病例系列研究。遵义医科大学附属医院烧伤整形外科2023年3月—2024年12月收治41例符合入选标准的四肢皮肤软组织缺损创面患者，其中男29例、女12例，年龄为39~74岁。清创后创面面积为5.8 cm×3.5 cm~17.5 cm×6.6 cm。采用游离股前外侧穿支皮瓣、胸背动脉穿支皮瓣、背阔肌肌皮瓣、腓肠内侧动脉穿支皮瓣修复创面，皮瓣面积为8.0 cm×4.0 cm~19.5 cm×7.0 cm。因受区动脉出现粥样硬化、内膜分层或供受区动脉直径显著不匹配，采用垂直褥式缝合联合水滴形动脉端侧吻合技术行供受区动脉吻合。供区创面经减张后直接闭合。术中观察受区动脉粥样硬化、内膜分层或供受区动脉直径显著不匹配的情况。术后观察皮瓣完全存活情况，并计算皮瓣完全存活率。统计术后并发症发生情况。术后随访时，观察存活皮瓣的色泽、质地和臃肿情况，以及供区瘢痕增生情况。术前及末次随访时，分别采用上肢功能指数（UEFI）及足部功能指数（FFI）评定上肢和下肢创面患者患肢功能。末次随访时，统计患者对供受区外观及患肢功能的满意度。 结果： 术中观察到23例患者受区动脉吻合口区域存在粥样硬化、内膜分层；18例患者皮瓣动脉直径与受区动脉直径存在显著差异，两者之比为1.0∶1.5~1.0∶3.3，平均为1.0∶2.4。术后40例患者皮瓣完全存活，皮瓣完全存活率为97.6%（40/41）。术后，5例感染性创面患者缝合口延迟愈合，经换药后愈合。所有患者术后住院期间未发生动脉危象。术后随访6~18个月，存活皮瓣色泽及质地与受区皮肤相似，外形饱满不臃肿；供区仅存在线性瘢痕，未见明显增生性瘢痕形成。术前，上肢UEFI为29~54，平均41；末次随访时，上肢UEFI为59~72，平均65。术前，下肢FFI为43~87，平均73；末次随访时，下肢FFI为15~42，平均29。末次随访时，28例下肢创面患者中24例可在无辅助工具帮助下行走，所有患者对供受区外观及患肢功能表示满意。 结论： 垂直褥式缝合联合水滴形动脉端侧吻合技术可有效实现动脉内膜外翻对合。该技术应用于游离皮瓣移植修复四肢创面术中能有效预防动脉危象，术后皮瓣存活率高，患者满意度高，在临床中具有一定的应用价值。.
Wound measurement plays a critical role in wound repair and chronic disease management, its accuracy directly influences the development of personalized treatment plans and the evaluation of wound healing progress. Although traditional one-dimensional measurement methods (such as the ruler method and the probe method) are simple to use, they are unable to meet modern clinical demands due to insufficient accuracy and consistency. In recent years, two-dimensional imaging methods, three-dimensional imaging methods, and the corresponding intelligent measurement devices have become mainstream of wound measurement. By employing digital image processing, three-dimensional modeling, and artificial intelligence technologies, the measurement accuracy has been significantly improved, providing multidimensional data support for the assessment of complex wounds. This article systematically reviews the current development status of wound measurement technologies, representative devices, and their clinical applications. It also explores future directions for optimization, including the integration of artificial intelligence, multi-modal data fusion, and privacy protection. The aim is to provide practical guidance and technical references for clinicians and researchers. 创面的测量在创面修复和慢性疾病管理中具有重要意义，其准确性直接影响个性化治疗方案的制订和创面愈合进程的评估。传统的一维测量法（如标尺法和探针法）虽然操作简单，但因精度和一致性不足而难以满足现代临床需求。近年来，二维图像法、三维成像法及相应的智能测量设备逐渐成为创面测量的主流，通过运用数字图像处理、三维建模和人工智能技术显著提高了测量精度，为复杂创面的评估提供了多维度数据支持。该文系统梳理了创面测量技术的发展现状、代表性设备及其临床应用，并探讨了未来结合人工智能、多模态数据融合和隐私保护的优化方向，以期为临床医师和研究人员提供实践指导和技术参考。.
Burn medicine, as the only clinical discipline named based on etiology, is an interdisciplinary subject that integrates burn trauma emergency, wound repair, functional reconstruction, and comprehensive rehabilitation. The history of burn medicine development is an evolutionary history of the continuous integration and permeation of multi-disciplinary technologies and the continuous improvement of theoretical systems. In recent years, with the improvement of public protection awareness and changes in the disease spectrum, the burn discipline is undergoing a profound transformation from single-specialty treatment to the multidisciplinary team (MDT) collaborative diagnosis and treatment model. Its scope has gradually expanded to a more integrated burns and wound repair surgery. This article starts from the changes in the disease spectrum of the discipline, systematically analyzes the necessity, current status, and main practice models of multidisciplinary integration in the diagnosis and treatment of burns and wound repair surgery. It explores the opportunities and challenges that cutting-edge technologies such as artificial intelligence and regenerative medicine pose to the innovative development of the discipline in promoting the MDT collaboration, and puts forward the future direction for the development of MDT collaborative diagnosis and treatment in burns and wound repair surgery, hoping to provide a reference for the discipline construction. 烧伤医学作为唯一以病因命名的临床学科，是一门整合烧创伤急救、创面修复、功能重建和综合康复于一体的交叉性学科。烧伤医学的发展史本质上是一部多学科技术不断融合渗透、理论体系持续完善的演进史。近年来，随着公众防护意识提升与疾病谱变化，烧伤学科正经历从传统单一专科诊疗向多学科团队协作诊疗模式的深度转型，其范畴逐步拓展为更具整合性的烧伤与创面修复外科。该文从学科疾病谱变化切入，系统分析烧伤与创面修复外科诊疗中多学科融合的必要性、现状及主要实践模式；探讨人工智能、再生医学等前沿技术在推动多学科团队协作过程中对学科创新发展的机遇和挑战；提出烧伤与创面修复外科多学科团队协作诊疗体系的未来发展方向，希望为学科建设提供参考。.
Objective: To explore the efficacy of free lateral arm tissue flap in repairing complex finger wounds. Methods: This study was a retrospective case series study. From January 2020 to December 2023, 8 patients with complex finger wounds who met the inclusion criteria were admitted to the 920th Hospital of Joint Logistic Support Force of PLA, including 5 males and three females, aged 24 to 56 years. There were 4 cases with multi-finger skin defects; there were 4 cases with single-finger skin combined with bone defects, three of whom were complicated with extensor tendon defects. The size of skin defects was 2.5 cm×2.0 cm to 8.0 cm×3.5 cm, and the size of bone defects was 1.5 cm×1.0 cm×1.0 cm to 2.0 cm×1.5 cm×1.0 cm. Five cases underwent emergency extended debridement and simultaneous transplantation of free lateral arm tissue flap for repair; the remaining three patients underwent extended debridement in stage Ⅰ and free lateral arm tissue flap transplantation for repair in stage Ⅱ. Four patients each underwent resection of lobulated flaps and chimeric osteocutaneous flaps, including 4 cases carrying the posterior arm cutaneous nerve and three cases having their extensor tendons being reconstructed with the triceps brachii aponeurosis. The size of skin flaps was 3.0 cm×2.5 cm to 9.0 cm×4.0 cm, and the size of bone flaps was consistent with the size of bone defects. The donor site wounds of skin flaps and bone flaps were closed with interrupted sutures. Postoperatively, the survival status of the tissue flaps was observed, and the pedicle division status of the lobulated flaps was recorded. At the final follow-up, the following parameters were assessed and documented: the appearance and texture of skin flaps, the sensory recovery of the affected finger transplanted with the posterior arm cutaneous nerve evaluated using the British Medical Research Council sensory function assessment criteria, the dorsiflexion of the affected finger transplanted with the triceps brachii aponeurosis, the survival of the bone flaps confirmed via X-ray examination, the scar formation at the donor sites of skin flaps, and the function of the affected fingers evaluated based on the trial standard for functional evaluation of the upper limb of the Hand Surgery Society of the Chinese Medical Association. Results: Postoperatively, the tissue flaps survived well. The pedicles of the lobulated flaps were successfully divided under local anesthesia 4 weeks after surgery. The follow-up duration ranged from 10 to 24 months, with an average of 13.5 months. At the final follow-up, the color and texture of the skin flaps were good, the sensation of the affected fingers transplanted with posterior arm cutaneous nerve recovered to level S2 or S3, the affected fingers transplanted with triceps brachii aponeurosis all achieved limited improvement in dorsiflexion, X-ray examination showed that the bone flaps survived, linear scars formed at the donor sites of skin flaps after wound healing, and the function of the affected fingers was evaluated as excellent in 5 cases and good in three cases. Conclusions: The lateral arm tissue is rich in perforators and has few anatomical variations, which can be prepared into lobulated flaps and chimeric osteocutaneous flaps for repairing complex finger wounds. The surgical operation is relatively simple, and the appearance and function of the donor and recipient sites are fairly good after surgery. 目的： 探讨臂外侧游离组织瓣修复手指复杂创面的疗效。 方法： 该研究为回顾性病例系列研究。2020年1月—2023年12月，解放军联勤保障部队第九二〇医院收治8例符合入选标准的手指复杂创面患者，其中男5例、女3例，年龄24~56岁。多指皮肤缺损者4例；单指皮肤及骨复合缺损者4例，其中3例合并伸指肌腱缺损。皮肤缺损大小为2.5 cm×2.0 cm~8.0 cm×3.5 cm，骨缺损大小为1.5 cm×1.0 cm×1.0 cm~2.0 cm×1.5 cm×1.0 cm。急诊扩大清创同期行臂外侧游离组织瓣移植修复者5例；其余3例患者Ⅰ期行扩大清创，Ⅱ期行臂外侧游离组织瓣移植修复。各有4例患者切取分叶皮瓣与嵌合骨皮瓣，其中携带臂后侧皮神经者4例，用肱三头肌腱膜重建伸指肌腱者3例，皮瓣大小为3.0 cm×2.5 cm~9.0 cm×4.0 cm，骨瓣大小与骨缺损大小一致。将皮瓣及骨瓣供区创面间断缝合。观察术后组织瓣存活情况，记录分叶皮瓣断蒂情况。观察并记录末次随访时皮瓣外观、质地，采用英国医学研究委员会感觉功能评定标准评价的移植臂后侧皮神经的患指感觉恢复情况，移植肱三头肌腱膜的患指背伸情况，X线检查确认的骨瓣成活情况，皮瓣供区瘢痕形成情况，采用中华医学会手外科学会上肢部分功能评定试用标准评定的患指功能。 结果： 术后，组织瓣均存活良好。分叶皮瓣均在术后4周局部麻醉下成功断蒂。随访时间10~24个月，平均13.5个月。末次随访时，皮瓣颜色、质地良好，移植臂后侧皮神经的患指感觉恢复至S2级或S3级，移植肱三头肌腱膜的患指背伸均获得有限改善，X线检查提示骨瓣成活，皮瓣供区创面愈合后形成线性瘢痕，患指功能评定为优者5例、良者3例。 结论： 臂外侧组织穿支丰富且解剖变异少，可制备为分叶皮瓣及嵌合骨皮瓣用于手指复杂创面的修复，手术操作相对简单，术后供受区外观和功能较佳。.
Objective: To explore the effects of ultrathin inguinal flap free transplantation in repairing hand and foot wounds. Methods: This study was a case series study. From January 2021 to March 2024, 18 patients (14 males and 4 females, aged 19 to 66 years) with skin and soft tissue defects of hands and feet accompanied by tendon and/or bone injuries and exposure were admitted to Tongren Hospital of Wuhan University & Wuhan Third Hospital. A total of 21 wounds were involved, including 12 on hands and 9 on feet. The area of skin and soft tissue defects after debridement was 5.0 cm×2.5 cm to 16.0 cm×5.0 cm. Using the reverse dissection method, ultrathin inguinal flaps containing the subdermal vascular network were obtained with the pure skin perforator as the center. The size of flaps was 6.0 cm×3.0 cm to 17.0 cm×6.5 cm. Among them, 15 flaps were based on the superficial circumflex iliac artery as the vascular pedicle, 5 flaps were based on the common trunk of the superficial circumflex iliac artery and the superficial epigastric artery as the vascular pedicle, and 1 flap was based on the dual vessels of the superficial circumflex iliac artery and the superficial epigastric artery as the vascular pedicle. The flaps were transferred to the recipient wounds, and the arteries and veins of the vascular pedicles were end-to-end anastomosed with the recipient arteries and veins, and then the wounds were closed. The donor site wounds were sutured with tension reduction. During the operation, the thickness of flaps, the diameter of arterial anastomosis in vascular pedicle, the number of pure skin perforators carried, and the distance between adjacent pure skin perforators in multi-perforator flaps were measured and recorded. Postoperatively, the survival of the flaps, the occurrence of complications, as well as the healing of the donor site wounds were observed. During follow-up, the repair of the recipient areas was observed. At the last follow-up, the total active motion (TAM) was used to evaluate the function of the affected fingers, and the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS-AHS) was used to score the function of the affected feet. The Likert scale was used to evaluate the patients' satisfaction with the therapeutic effect. Results: The thickness of flaps of patients was 0.2 to 0.5 cm, with an average of 0.4 cm; the diameter of arterial anastomosis in vascular pedicle was 0.5 to 1.2 mm, with an average of 0.7 mm; 7 flaps each carried one pure skin perforator, 6 flaps each carried two pure skin perforators, and 8 flaps each carried three pure skin perforators. The distance between adjacent pure skin perforators in multi-perforator flaps was 0.8 to 3.5 cm, with an average of 1.7 cm. Postoperatively, one flap showed small area of necrosis, which survived after debridement and suture; the remaining flaps survived smoothly. Three affected fingers had blood supply disorder at the distal end, and all survived after arterial recanalization. One donor site wound healed poorly due to high local tension and healed after debridement and suture, and the remaining donor site wounds healed smoothly. During the 6 to 35 months of follow-up, the flaps were soft and elastic. Two flaps were slightly swollen and underwent thinning treatment 3 to 5 months after surgery. At the last follow-up, the TAM of 10 affected fingers were excellent, and two were good, the AOFAS-AHS score of 9 affected feet was 99 to 100 points, and all 18 patients were very satisfied with the effects. Conclusions: The ultrathin inguinal flap has the advantages of thin thickness, rich blood supply, and reliable harvesting method. Its application in repairing hand and foot wounds after burns and trauma can achieve ideal aesthetic and functional results, with a low rate of secondary revision, and it is worthy of clinical promotion and application. 目的： 探讨超薄腹股沟皮瓣游离移植修复手足创面的效果。 方法： 该研究为病例系列研究。2021年1月—2024年3月，武汉大学同仁医院暨武汉市第三医院收治18例符合入选标准的手足部皮肤软组织缺损伴肌腱和/或骨损伤、外露的患者（男14例、女4例，年龄19~66岁），共21个创面，其中12个位于手部、9个位于足部。清创后皮肤软组织缺损面积为5.0 cm×2.5 cm~16.0 cm×5.0 cm。以纯皮穿支为中心，应用逆行解剖法获取含真皮下血管网的超薄腹股沟皮瓣，皮瓣大小为6.0 cm×3.0 cm~17.0 cm×6.5 cm。其中，15个皮瓣以旋髂浅动脉为血管蒂，5个皮瓣以旋髂浅动脉和腹壁浅动脉共干为血管蒂，1个皮瓣以旋髂浅动脉和腹壁浅动脉双血管为血管蒂。将皮瓣转移至受区创面，将血管蒂中的动静脉与受区动静脉端端吻合，然后封闭创面。减张缝合供区创面。术中，测量并记录皮瓣厚度、血管蒂中动脉吻合口径、携带的纯皮穿支数及多穿支皮瓣中相邻纯皮穿支间距离。术后，观察皮瓣成活情况、并发症发生情况及供区创面愈合情况。随访时，观察受区修复情况。末次随访时，根据总主动活动度（TAM）评估患指功能，采用美国足踝外科医师协会踝-后足评分系统（AOFAS-AHS）对患足功能进行评分，采用利克特量表评价患者对疗效的满意度。 结果： 患者皮瓣厚度为0.2~0.5 cm，平均0.4 cm；血管蒂中动脉吻合口径为0.5~1.2 mm，平均0.7 mm；7个皮瓣各携带1条纯皮穿支，6个皮瓣各携带2条纯皮穿支，8个皮瓣各携带3条纯皮穿支；多穿支皮瓣中相邻纯皮穿支间距离为0.8~3.5 cm，平均1.7 cm。术后，1个皮瓣出现小范围坏死，经清创缝合后成活；其余皮瓣均顺利成活。3个患指远端存在血运障碍，行动脉再通后均成活。1个供区创面因局部张力较高愈合不良，经清创缝合后愈合；其余供区创面均顺利愈合。术后6~35个月随访时，皮瓣质地柔软、弹性良好，其中2个皮瓣因局部稍显臃肿，于术后3~5个月行修薄处理。末次随访时，10个患指的TAM评估为优、2个为良，9个患足的AOFAS-AHS评分为99~100分，18例患者对疗效均表示非常满意。 结论： 超薄腹股沟皮瓣具有厚度薄、血运丰富、切取方法可靠等优点，用于修复手足烧创伤后创面，可获得理想的外形与功能效果，且术后二次修整率低，值得临床推广应用。.