BACKGROUND: Severe stroke has high rates of mortality and morbidity. This study aimed to investigate the clinical course, causes of worsening, and outcomes of severe ischemic stroke. METHODS: This prospective, multicenter cohort study enrolled adult patients admitted ≤30 days after ischemic stroke from nine hospitals in China between September 2017 and December 2019. Severe stroke was defined as a score of ≥15 on the National Institutes of Health Stroke Scale (NIHSS). Clinical worsening was defined as an increase of 4 in the NIHSS score from baseline. Unfavorable functional outcome was defined as a modified Rankin scale score ≥3 at 3 months and 1 year after stroke onset, respectively. We performed Logistic regression to explore baseline features and reperfusion therapies associated with clinical worsening and functional outcomes. RESULTS: Among 4201 patients enrolled, 854 patients (20.33%) had severe stroke on admission. Of 3347 patients without severe stroke on admission, 142 (4.24%) patients developed severe stroke in hospital. Of 854 patients with severe stroke on admission, 33.95% (290/854) experienced clinical worsening (median time from stroke onset: 43 h, Q1-Q3: 20-88 h), with brain edema (54.83% [159/290]) as the leading cause; 24.59% (210/854) of these patients died by 30 days, and 81.47% (677/831) and 78.44% (633/807) had unfavorable functional outcomes at 3 months and 1 year respectively. Reperfusion reduced the risk of worsening (adjusted odds ratio [OR]: 0.24, 95% confidence interval [CI]: 0.12-0.49, P  <0.01), 30-day death (adjusted OR: 0.22, 95% CI: 0.11-0.41, P  <0.01), and unfavorable functional outcomes at 3 months (adjusted OR: 0.24, 95% CI: 0.08-0.68, P <0.01) and 1 year (adjusted OR: 0.17, 95% CI: 0.06-0.50, P  <0.01). CONCLUSIONS: Approximately one-fifth of patients with ischemic stroke had severe neurological deficits on admission. Clinical worsening mainly occurred in the first 3 to 4 days after stroke onset, with brain edema as the leading cause of worsening. Reperfusion reduced the risk of clinical worsening and improved functional outcomes. REGISTRATION ClinicalTrials.gov , NCT03222024.
Humans ; Male ; Female ; Prospective Studies ; Ischemic Stroke/mortality* ; Aged ; Middle Aged ; Aged, 80 and over ; Stroke ; Brain Ischemia

Objective:To investigate the clinical effect of chimeric flap with perforating branch of superficial circumflex iliac artery in reconstruction of complex tissue defect in Achilles tendon region.Methods:A retrospective analysis was conducted on 9 patients who underwent reconstruction of composite tissue defects in Achilles tendon region with the perforator flap of lateral femoral circumflex artery, from January 2017 to January 2023 in the Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University. The patients were 7 males and 2 females and at 16 to 54 years, with 36.6 years in average. Causes of injury were: 5 patients by traffic accident, 2 by machine strangulation and 1 by heavy object, also 1 defect was caused by infection. The soft tissue defects were 4.5 cm×6.0 cm to 8.0 cm×12.0 cm in size, and the defects of Achilles tendon were 4.5 cm to 11.5 cm, with an average of 6.8 cm in length. The wounds were managed with VSD after primary surgery, and then stage Ⅰ surgery were followed to reconstruct the defects in Achilles tendon region with perforator flap of lateral femoral circumflex artery. The sizes of chimeric flaps were 6.5 cm×5.0 cm to 18.0 cm×6.5 cm, including 3 lobuated flaps. The fascia grafts were 5.5 cm to 12.0 cm, with an average of 7.0 cm. Scheduled postoperative follow-ups were conducted in outpatient clinic and via telephone or WeChat interviews, together with the advices for rehabilitation training. Postoperative functions of the Achilles tendon and ankle function were evaluated using Arner-Lindholm criteria and the ankle and hindfoot functional score of American Orthopaedic Foot and Ankle Society (AOFAS).Results:All of the 9 chimeric flaps survived and all the donor sites had primary healing. All patients were entered into the postoperative follow-up for 10 to 66 months, with 14.6 months in average. One chimeric flap was found bulky and a flap thinning surgery was further carried out in 3 months under the request of patient. The rest of patients were satisfied with the appearance and texture of the flaps. The range of ankle plantar flexions was found at 42.9°±1.8° and the dorsal flexions was at 16.2°±2.5°. There was no significant decrease in circumference and no discomfort or muscle re-rupture in the affected legs. Thompson test was found negative. There was no wound related complications during follow-up. Reconstructive surgery were found effective based on Arner-Lindholm criteria, with excellent in 6 patients, good in 2 and 1 in fair. The ankle and subtalar joint function was evaluated according to the ankle-hindfoot function score of AOFAS, with 7 patients scored 90-100 point and 2 scored 75-89 point, and 7 patients were in excellent and 2 in good.Conclusion:The chimeric perforator flap of lateral femoral circumflex artery is safe and reliable in reconstruction of composite tissue defects in Achilles tendon region. It can effectively restore the function and appearance of ankle and hindfoot in patients with composite tissue defects in the Achilles tendon region.

Objective:To evaluate the clinical effect of antibiotic-loaded bone cement implantation combined with free chimeric tissue flap transplantation in the sequential treatment of severe gouty wounds.Methods:This study was a retrospective observational study. From July 2019 to July 2022, 11 male patients with severe gouty wounds who were aged 33 to 71 years and met the inclusion criteria were admitted and treated at the Affiliated Hospital of Zunyi Medical University. The wounds were located on the hands in 2 cases, the ankles in 5 cases, and the feet in 4 cases. After debridement, the wound area ranged from 5.0 cm×4.0 cm to 22.0 cm×6.0 cm. All wounds were sequentially repaired with antibiotic-loaded bone cement implantation combined with free chimeric tissue flaps transplantation. Two cases were repaired by free perforating branch of superficial circumflex iliac artery with chimeric osseous flaps, with the areas of harvested skin flaps being 5.5 cm×4.0 cm and 8.0 cm×6.0 cm, respectively, and the volumes of iliac bone flaps being 2.0 cm×2.0 cm×1.5 cm and 3.5 cm×2.0 cm×2.0 cm, respectively. Two cases were repaired by free perforating branch of deep circumflex iliac artery with chimeric osseous flaps, with the areas of harvested skin flaps being 6.0 cm×4.0 cm and 7.5 cm×5.0 cm, respectively, and the volumes of iliac bone flaps being 2.0 cm×1.5 cm×1.5 cm and 2.5 cm×2.0 cm×1.5 cm, respectively. Seven cases were repaired by free chimeric myocutaneous flaps based on the descending branch of the lateral circumflex femoral artery. The areas of harvested skin flaps ranged from 9.5 cm×6.0 cm to 25.0 cm×6.5 cm, and the volumes of muscle flaps ranged from 4.0 cm×3.0 cm×2.0 cm to 6.0 cm×5.0 cm×2.5 cm. The donor site wounds were directly sutured. The chimeric tissue flap was freely transplanted to the recipient wound site, of which the iliac bone graft was used to fill the bone defect, the muscle flap was utilized to fill the wound cavity, and the skin flap was employed to cover the wound surface; the arteries and veins in the vascular pedicle were anastomosed with those in the recipient area. At admission and 3 days post antibiotic-loaded bone cement implantation, the changes in white blood cell count, neutrophil and hypersensitive C-reactive protein level, as well as the bacterial culture of wound secretions specimen, and the growth of granulation tissue were observed. After stage Ⅱ surgery, the survival of transplanted chimeric tissue flaps, the occurrence of vascular crisis, and the healing of wounds in donor and recipient sites were observed. During follow-up, the blood supply, appearance, and texture of the transplanted tissue flaps in the recipient sites, the function and appearance of the affected limbs and fingers, and the complications in the donor and recipient sites were observed.Results:Three days post antibiotic-loaded bone cement implantation, white blood cell count, hypersensitive C-reactive protein level, and neutrophil significantly decreased compared with those at admission (with Z values of -2.93 and -2.93 respectively, t=8.63, P<0.05). At admission, all patients exhibited bacterial infections with redness and swelling around the wounds. Three days post antibiotic-loaded bone cement implantation, bacterial cultures of wound secretions specimen were negative, local redness resolved, and granulation tissue showed good growth. After stage Ⅱ surgery, all chimeric flaps survived without vascular crises. The wound healing in the recipient site of the dorsum of the foot in one patient was poor and delayed but healed after dressing changes; all the other recipient sites in remaining patients healed successfully. The donor incision healed well in all patients. During 6 to 24 months of follow-up, the flaps in the recipient area demonstrated good blood circulation, texture, and appearance. Bone healing was achieved in 4 patients with iliac grafts. Nine patients with lower limb wounds were able to bear weight, and the functions including gripping, palm alignment, and finger alignment were significantly improved in 2 patients with hand wounds. No significant complications were observed in donor or recipient sites. Conclusions:In treating patients with severe gouty wounds, the sequential strategy of stage Ⅰ debridement with antibiotic-loaded bone cement implantation followed by stage Ⅱ free chimeric osseous flaps or myocutaneous flaps repair can achieve effectively control of postoperative wound infection, promote wound healing, and well restore the functions of affected finger or limb with no obvious complications, which is worthy of promotion for clinical application.

Objective:To investigate the effects of applying the lateral circumflex femoral artery chimeric perforator flap in repairing composite tissue defects in the ankle and foot area.Methods:This study was a retrospective observational study. From January 2018 to December 2023, 12 patients with composite tissue defects in the ankle and foot area who met the inclusion criteria were admitted to the Department of Burns and Plastic Surgery of the Affiliated Hospital of Zunyi Medical University, including 9 males and 3 females, aged from 4 to 64 years. The causes of the injuries included traffic accident injuries in 7 cases, wringing injuries in 2 cases, crush injuries in 2 cases, and fall injury in 1 case. All patients had combined skin and soft tissue defects, with the defect areas ranging from 10.0 cm×5.0 cm to 22.0 cm×7.0 cm. Among them, 7 patients had ankle joint capsule defects sized from 3 cm×2 cm to 6 cm×5 cm; 3 patients had Achilles tendon defects ranged from 4 to 8 cm in length; 1 patient had an extensor hallucis longus tendon defect of 4 cm in length; 1 patient had an extensor digitorum longus tendon defect of 10 cm in length. All patients underwent repair of the composite tissue defects using the lateral circumflex femoral artery chimeric perforator flaps. Flaps with sizes ranging from 11.0 cm×5.5 cm to 24.0 cm×6.5 cm were used to repair skin and soft tissue defects, and fascia lata flaps with sizes ranging from 4.0 cm×2.5 cm to 17.0 cm×2.0 cm were used to repair joint capsule and tendon defects. The flap donor area wound was closed by suturing. Postoperatively, regular follow-up was conducted to observe the survival of the flaps after surgery, the repair of the defects, the healing of the incisions in the flap donor area, the occurrence of complications, the appearance and texture of the flaps, the scar formation in the surgical area, and the movement of the lower limb on the flap donor side. At the last follow-up, the American Orthopaedic Foot and Ankle Society scoring standard was used to evaluate the function of the ankle and foot.Results:All patients were followed up for 2 to 38 months, with an average of 8.7 months. After surgery, all flaps survived, and all wounds in the recipient areas healed. In patients who underwent ankle joint capsule and tendon reconstruction, there was no swelling in the joints, and the joint movements were good without foot drop or toe drop deformities. All incisions in the flap donor areas were healed without any complication. The families of 2 children took their children back to the hospital for flap thinning at 3 and 4 months respectively after surgery because they felt that the flaps were bulky. The other patients were satisfied with the appearance and texture of the flaps. One child had obvious scar hyperplasia in the early stage, and the scar gradually faded after external application of anti-scar medications and pressure treatment. The scars of the other patients were not obvious. All patients had normal lower limb movements on the flap donor side. At the last follow-up, the functions of the ankle and foot were rated as excellent in 8 cases and good in 4 cases.Conclusions:The lateral circumflex femoral artery chimeric perforator flap is flexible in design. It can repair the composite tissue defects in the skin and soft tissue, joint capsules, and tendons of the ankle and foot simultaneously. There are no obvious complications in the flap donor area. Most patients are satisfied with the appearance of the flap in the recipient area. The flap is soft in texture, and the functions of the ankle and foot are well restored.

Objective:To analyze serum inflammatory factors associated with antihistamine resistance in patients with chronic spontaneous urticaria (CSU) .Methods:A total of 88 CSU patients were enrolled from Guangzhou Dermatology Hospital from January 2022 to December 2024. All patients received antihistamine treatment according to the "Guideline for diagnosis and treatment of urticaria in China (2022) " . Based on the 7-day urticaria activity score (UAS7) after 4-week treatment, these patients were divided into an antihistamine-sensitive group and an antihistamine-resistant group. Serum levels of inflammatory factors at the initial visit were analyzed using the Olink-targeted proteomics technology. Specific biomarkers associated with antihistamine resistance were identified, and Spearman correlation analysis was carried out to analyze correlations among differentially expressed proteins. A logistic regression model was constructed based on the Olink proteomics data, and the predictive performance of the model was evaluated using receiver operating characteristic (ROC) curve analysis. Measurement data were expressed as mean ± standard deviation or median (lower quartile, upper quartile) .Results:The 88 CSU patients aged 12 to 81 (38.78 ± 13.89) years, with the disease duration being 18 (7.00, 60.00) months. There were 32 patients in the antihistamine-sensitive group and 56 in the antihistamine-resistant group. No significant differences were found between the two groups in terms of age, disease duration, gender, or history of allergic diseases (all P > 0.05) . After 4 weeks of antihistamine treatment, the UAS7 score was significantly higher in the antihistamine-resistant group (25.00 [15.25, 31.00] points) than in the antihistamine-sensitive group (0.50 [0.00, 4.00] points; Z = -7.08, P < 0.001) . The Olink-targeted proteomics identified 5 differentially expressed proteins between the two groups: compared with the antihistamine-sensitive group, the antihistamine-resistant group showed > 2-fold higher expression of fibroblast growth factor 19 (FGF19) , interleukin-15 receptor subunit alpha (IL-15RA) , eotaxin (CCL11) , and monocyte chemoattractant protein-1 (MCP-1) ; in contrast, the expression of sulfotransferase 1A1 (ST1A1) in the antihistamine-sensitive group was 2.54 times that in the antihistamine-resistant group. Among the differentially expressed proteins, MCP-1 showed the highest specificity (1.00) for predicting antihistamine resistance, followed by CCL11 (0.97) . Correlation analysis revealed a significant positive correlation between MCP-1 and CCL11, and a significant negative correlation between IL-15RA and ST1A1. ROC curve analysis showed that MCP-1 and CCL11 had area under the curve values of 0.603 and 0.630, respectively, in predicting antihistamine resistance. Conclusion:MCP-1 and CCL11 may be potential biomarkers for predicting antihistamine resistance in CSU patients.

Background and aims:Studies indicate that the gut microbiota and its metabolites are involved in the progression of cardiovascular diseases,and enterohepatic circulation plays an important role in this progression.This study aims to identify potential probiotics for the treatment of unstable angina(UA)and elucidate their mechanisms of action.Methods:Initially,the gut microbiota from patients with UA and control was analyzed.To directly assess the effects of Bifidobacterium supplementation,10 patients with UA were enrolled and administered Bifidobacterium(630 mg per intake twice a day for 1 month).The fecal metagenome,serum trimethyl-amine N-oxide(TMAO)levels,and other laboratory parameters were evaluated before and after Bifido-bacterium supplementation.Results:After supplementing with Bifidobacterium for 1 month,there were statistically significant dif-ferences(P＜0.05)in TMAO,aspartate aminotransferase,total cholesterol,and low-density lipoprotein compared to before.Additionally,the abundance of Bifidobacterium longum increased significantly,although the overall abundance of Bifidobacterium did not reach statistical significance.The gut micro-biota,metabolites,and gut-liver axis are involved in the progression of UA,and potential mechanisms should be further studied.Conclusions:Metagenomic analysis demonstrated a reduced abundance of Bifidobacterium in patients with UA.Supplementation with Bifidobacterium restored gut dysbiosis and decreased circulating TMAO levels in patients with UA.This study provides evidence that Bifidobacterium may exert cardiovascular-protective effects through the gut-liver-heart axis.

Esophagectomy is an effective treatment for esophageal cancer,and there has been growing attention on the importance of postoperative pain management in patients undergoing the surgery.Epidural analgesia is the preferred analgesic approach for open esophagectomy.With the development of surgical technology,minimally invasive esophagectomy(MIE)has become the mainstream surgical approach.However,no conclusion has been reached concerning whether epidural analgesia is still the preferred analgesic approach for MIE.Herein,we analyzed the relevant literature published in recent years and found that epidural analgesia continued to be an important analgesic approach for MIE,offering the best analgesic effect.Epidural analgesia can reduce postoperative pulmonary complications,improve the quality of life,and reduce the stress response.Adverse effects can be minimized through accurate selection of epidural puncture segments,individualized medication,and multimodal analgesia strategies.In the future,precision-based multimodal analgesia can be achieved using emerging technologies such as big data analytics and artificial intelligence.

OBJECTIVE: To compare the effects of different chest compression rates (60-140 times/min) on hemodynamic parameters, return of spontaneous circulation (ROSC), resuscitation success, and survival in a porcine model of cardiac arrest (CA) followed by cardiopulmonary resuscitation (CPR). METHODS: Forty healthy male domestic pigs were randomly divided into five groups based on chest compression rate: 60, 80, 100, 120, and 140 times/min (n = 8). All animals underwent standard anesthesia and tracheal intubation. A catheter was inserted via the left femoral artery into the thoracic aorta to monitor aortic pressure (AOP), and another via the right external jugular vein into the right atrium to monitor right atrial pressure (RAP). In each group, animals were implanted with a stimulating electrode via the right external jugular vein to the endocardium, and ventricular fibrillation (VF) was induced by delivering alternating current stimulation, resulting in CA. After a 1-minute, manual chest compressions were performed at the assigned rate with a compression depth of 5 cm. The first defibrillation was delivered after 2 minutes of CPR. No epinephrine or other pharmacologic agents were administered during the entire resuscitation process. From 1 minute before VF induction to 10 minutes after ROSC, dynamic monitoring of AOP, coronary perfusion pressure (CPP), and partial pressure of end-tidal carbon dioxide (P_ETCO₂). Cortical ultrastructure was examined 24 hours post-ROSC using transmission electron microscopy. RESULTS: With increasing compression rates, both the total number of defibrillations and cumulative defibrillation energy significantly decreased, reaching their lowest levels in the 120 times/min group. The number of defibrillations decreased from (4.88±0.83) times in the 60 times/min group to (2.25±0.71) times in the 120 compressions/min group, and energy from (975.00±166.90)J to (450.00±141.42)J. However, both parameters increased again in the 140 times/min group [(4.75±1.04)times, (950.00±207.02)J], the differences among the groups were statistically significant (both P < 0.01). As compression frequency increased, P_ETCO₂, pre-defibrillation AOP and CPP significantly improved, peaking in the 120 times/min group [compared with the 60 times/min group, P_ETCO₂ (mmHg, 1 mmHg≈0.133 kPa): 18.69±1.98 vs. 8.67±1.30, AOP (mmHg): 95.13±7.06 vs. 71.00±6.41, CPP (mmHg): 14.88±6.92 vs. 8.57±3.42]. However, in the 140 times/min group, these values declined significantly again [P_ETCO₂, AOP, and CPP were (10.59±1.40), (72.38±11.49), and (10.36±4.57) mmHg, respectively], the differences among the groups were statistically significant (all P < 0.01). The number of animals achieving ROSC, successful resuscitation, and 24-hour survival increased with higher compression rates, reaching a peak in the 120 times/min group (compared with the 60 times/min group, ROSC: 7 vs. 2, successful resuscitation: 7 vs. 2, 24-hour survival: 7 vs.1), then decreased again in the 140 times/min group (the animals that ROSC, successfully recovered and survived for 24 hours were 3, 3, and 2, respectively). Transmission electron microscopy revealed that in the 60, 80, and 140 times/min groups, nuclear membranes in cerebral tissue were irregular and incomplete, nucleoli were indistinct, and mitochondria were swollen with reduced cristae and abnormal morphology. In contrast, the 100 times/min and 120 times/min groups exhibited significantly attenuated ultrastructural damage. CONCLUSIONS Among the tested chest compression rates of 60-140 times/min, a chest compressions frequency of 120 times/min is the most favorable hemodynamic profile and outcomes during CPR in a porcine CA model. However, due to the wide spacing between groups, further investigation is needed to determine the optimal compression rate range more precisely.
Animals ; Cardiopulmonary Resuscitation/methods* ; Swine ; Male ; Heart Arrest/therapy* ; Heart Massage/methods* ; Hemodynamics

Objective:To evaluate the clinical effect of antibiotic-loaded bone cement implantation combined with free chimeric tissue flap transplantation in the sequential treatment of severe gouty wounds.Methods:This study was a retrospective observational study. From July 2019 to July 2022, 11 male patients with severe gouty wounds who were aged 33 to 71 years and met the inclusion criteria were admitted and treated at the Affiliated Hospital of Zunyi Medical University. The wounds were located on the hands in 2 cases, the ankles in 5 cases, and the feet in 4 cases. After debridement, the wound area ranged from 5.0 cm×4.0 cm to 22.0 cm×6.0 cm. All wounds were sequentially repaired with antibiotic-loaded bone cement implantation combined with free chimeric tissue flaps transplantation. Two cases were repaired by free perforating branch of superficial circumflex iliac artery with chimeric osseous flaps, with the areas of harvested skin flaps being 5.5 cm×4.0 cm and 8.0 cm×6.0 cm, respectively, and the volumes of iliac bone flaps being 2.0 cm×2.0 cm×1.5 cm and 3.5 cm×2.0 cm×2.0 cm, respectively. Two cases were repaired by free perforating branch of deep circumflex iliac artery with chimeric osseous flaps, with the areas of harvested skin flaps being 6.0 cm×4.0 cm and 7.5 cm×5.0 cm, respectively, and the volumes of iliac bone flaps being 2.0 cm×1.5 cm×1.5 cm and 2.5 cm×2.0 cm×1.5 cm, respectively. Seven cases were repaired by free chimeric myocutaneous flaps based on the descending branch of the lateral circumflex femoral artery. The areas of harvested skin flaps ranged from 9.5 cm×6.0 cm to 25.0 cm×6.5 cm, and the volumes of muscle flaps ranged from 4.0 cm×3.0 cm×2.0 cm to 6.0 cm×5.0 cm×2.5 cm. The donor site wounds were directly sutured. The chimeric tissue flap was freely transplanted to the recipient wound site, of which the iliac bone graft was used to fill the bone defect, the muscle flap was utilized to fill the wound cavity, and the skin flap was employed to cover the wound surface; the arteries and veins in the vascular pedicle were anastomosed with those in the recipient area. At admission and 3 days post antibiotic-loaded bone cement implantation, the changes in white blood cell count, neutrophil and hypersensitive C-reactive protein level, as well as the bacterial culture of wound secretions specimen, and the growth of granulation tissue were observed. After stage Ⅱ surgery, the survival of transplanted chimeric tissue flaps, the occurrence of vascular crisis, and the healing of wounds in donor and recipient sites were observed. During follow-up, the blood supply, appearance, and texture of the transplanted tissue flaps in the recipient sites, the function and appearance of the affected limbs and fingers, and the complications in the donor and recipient sites were observed.Results:Three days post antibiotic-loaded bone cement implantation, white blood cell count, hypersensitive C-reactive protein level, and neutrophil significantly decreased compared with those at admission (with Z values of -2.93 and -2.93 respectively, t=8.63, P<0.05). At admission, all patients exhibited bacterial infections with redness and swelling around the wounds. Three days post antibiotic-loaded bone cement implantation, bacterial cultures of wound secretions specimen were negative, local redness resolved, and granulation tissue showed good growth. After stage Ⅱ surgery, all chimeric flaps survived without vascular crises. The wound healing in the recipient site of the dorsum of the foot in one patient was poor and delayed but healed after dressing changes; all the other recipient sites in remaining patients healed successfully. The donor incision healed well in all patients. During 6 to 24 months of follow-up, the flaps in the recipient area demonstrated good blood circulation, texture, and appearance. Bone healing was achieved in 4 patients with iliac grafts. Nine patients with lower limb wounds were able to bear weight, and the functions including gripping, palm alignment, and finger alignment were significantly improved in 2 patients with hand wounds. No significant complications were observed in donor or recipient sites. Conclusions:In treating patients with severe gouty wounds, the sequential strategy of stage Ⅰ debridement with antibiotic-loaded bone cement implantation followed by stage Ⅱ free chimeric osseous flaps or myocutaneous flaps repair can achieve effectively control of postoperative wound infection, promote wound healing, and well restore the functions of affected finger or limb with no obvious complications, which is worthy of promotion for clinical application.

Objective:To investigate the effects of applying the lateral circumflex femoral artery chimeric perforator flap in repairing composite tissue defects in the ankle and foot area.Methods:This study was a retrospective observational study. From January 2018 to December 2023, 12 patients with composite tissue defects in the ankle and foot area who met the inclusion criteria were admitted to the Department of Burns and Plastic Surgery of the Affiliated Hospital of Zunyi Medical University, including 9 males and 3 females, aged from 4 to 64 years. The causes of the injuries included traffic accident injuries in 7 cases, wringing injuries in 2 cases, crush injuries in 2 cases, and fall injury in 1 case. All patients had combined skin and soft tissue defects, with the defect areas ranging from 10.0 cm×5.0 cm to 22.0 cm×7.0 cm. Among them, 7 patients had ankle joint capsule defects sized from 3 cm×2 cm to 6 cm×5 cm; 3 patients had Achilles tendon defects ranged from 4 to 8 cm in length; 1 patient had an extensor hallucis longus tendon defect of 4 cm in length; 1 patient had an extensor digitorum longus tendon defect of 10 cm in length. All patients underwent repair of the composite tissue defects using the lateral circumflex femoral artery chimeric perforator flaps. Flaps with sizes ranging from 11.0 cm×5.5 cm to 24.0 cm×6.5 cm were used to repair skin and soft tissue defects, and fascia lata flaps with sizes ranging from 4.0 cm×2.5 cm to 17.0 cm×2.0 cm were used to repair joint capsule and tendon defects. The flap donor area wound was closed by suturing. Postoperatively, regular follow-up was conducted to observe the survival of the flaps after surgery, the repair of the defects, the healing of the incisions in the flap donor area, the occurrence of complications, the appearance and texture of the flaps, the scar formation in the surgical area, and the movement of the lower limb on the flap donor side. At the last follow-up, the American Orthopaedic Foot and Ankle Society scoring standard was used to evaluate the function of the ankle and foot.Results:All patients were followed up for 2 to 38 months, with an average of 8.7 months. After surgery, all flaps survived, and all wounds in the recipient areas healed. In patients who underwent ankle joint capsule and tendon reconstruction, there was no swelling in the joints, and the joint movements were good without foot drop or toe drop deformities. All incisions in the flap donor areas were healed without any complication. The families of 2 children took their children back to the hospital for flap thinning at 3 and 4 months respectively after surgery because they felt that the flaps were bulky. The other patients were satisfied with the appearance and texture of the flaps. One child had obvious scar hyperplasia in the early stage, and the scar gradually faded after external application of anti-scar medications and pressure treatment. The scars of the other patients were not obvious. All patients had normal lower limb movements on the flap donor side. At the last follow-up, the functions of the ankle and foot were rated as excellent in 8 cases and good in 4 cases.Conclusions:The lateral circumflex femoral artery chimeric perforator flap is flexible in design. It can repair the composite tissue defects in the skin and soft tissue, joint capsules, and tendons of the ankle and foot simultaneously. There are no obvious complications in the flap donor area. Most patients are satisfied with the appearance of the flap in the recipient area. The flap is soft in texture, and the functions of the ankle and foot are well restored.