[Objective]To discuss the result of using latissimus dorsi musculocutaneous flap which function was recovered by repairing the thoracodorsal nerve with nerve transfering for reconstruction of flexor of elbow or digits in brachial plexus injury patients.[Method]From march 2000 to June 2003,eight patients with brachial plexus total roots avulsion were treated by mlutiple donor nerves transfer.The function of latissimus dorsi muscle recorved well but not the biceps muscle in five patients.The function of flex digits did not recover while the latissimus dorsi muscule recorverd well in three patients.All of them had the aid of latissimus dorsi musculocutaneous flap to reconstruct the flexor of elbow or digits.[Result]The patients were followed up for one year to half past three years,all of musculocutaneous flap were survived,the muscle strenght graded 3 to 4 and the active motion of the elbow was over 100 degrees in flexion and 10 degrees to 25 degrees in extension.All the digits can grasp,the fist closure was about 2 cm and the muscle strenght was grade 3 of the involved digits.[Conclusion]It is a good method to reconstruct the flexor of elbow or digits by the recovered latissimus dorsi musculocutaneous flap in brachial plexus total roots avulsion patients.When treating brachial plexus total roots avulsion patients,it is necessary to repair the thoracodorsal nerve.

[Objective]To observe the complications after surgical treatment of thoracic outlet syndrome and to analyze causes and prevention of complications.[Methods]A retrospective review was done for 62 cases of thoracic outlet syndrome which had been treated by operation from January 2002 to January 2006.All the complications occrred were collected in the following time.[Results]Follow up time was 14 months to 30 months.According to assessment standard described by Wood,treatment outcome was excellent in 26 cases,good in 16 cases,fair in 11 cases and poor in 9 cases.Nine of all the 62 patients had been found complications,including hematoma in 3 cases,lymphadenectomy in 2 cases,cervical plexus injury in 2 cases,phrenic nerve injury in 1 case,brachial plexus injury in 1 case and pneumothorax in 1 case.All the patients were successfully treated.[Conclusions]The occurrences of complications are related to the skill of operation and individual differences of patients.In order to decrease and finally prevent these complications,operative experiences and preventive measures are needed.

ObjectiveTo investigate the effects of chitosan/PVA nerve conduits which used for repairing sciatics nerve defect in rats.MethodsTwenty-seven rats were divided into 3 groups randomly,with 9 rats in each group. Firstly, the 15mm defects in the left sciatic nerves were made in the rats and were respectively repaired with chitosan/PVA conduits graft (group A), the silicon conduits graft (group B),and autografts (group C). At 12 weeks after the operations, the left sciatic nerves were taken out, and the comparative evaluation was made on the repairing effects by wet weight of gastrocnemius and soleus muscles, histological examination,computerized imaging analysis and True Blue retrograde tracing. ResultsThe wet weight of gastrocnemius and soleus muscles showed no significant difference between the chitosan/PVA graft and autograft groups (P ＞ 0.05). The wet weight of gastrocnemius and soleus muscles in significant difference between the chitosan/PVA graft and the silicon group at 12 weeks after the operation(P ＜ 0.05). The nerve fiber density showed no statistically significant differences between the chitosan/PVA and autograft groups(P＞ 0.05).The regenerative nerve fiber in group B had normal morphological and structural characters under transmission electron microscope.True Blue-labeled neuron cell bodies were found within both anterior horn of gray matter in the spinal cord and dorsal root ganglions (DRGs) ipsilateral to the operated side of the tested rats on illumination with ultra-violet light 1 week after the injection of True Blue.Conclusion Chitosan/PVA nerve conduit can effectively promote the nerve regeneration and myelinization of rat sciatic nerve, which is expected to substitute for autograft to repair nerve defects succesfully.

Objective To observe the change rules of insulin receptor from rat bladders after losing lower cen-tal innervations so as to explore the function of insulin receptor in denervated bladder. Methods From January, 2016 to June, 2017, 40 Sprague-Dawley rats were randomly divided into experimental group and control group,each group was 20. The conus medullaris of rats in experimental group were damaged, and rats in control group received sham opera-tion. The rats in 2 groups were sacrificed at different time after surgery (1 day, 1 week, 1 month, 3 months). Bladder specimens were harvested to perform wet weight measurement and immunohistochemical detection of insulin receptor. Results Corresponding to 1 day, 1 week, 1 month and 3 months after surgery, the bladder wet weight of control group were (0.089±0.022)g, (0.094±0.038)g, (0.106±0.112)g and(0.102±0.048)g, and of experimental group were (0.092± 0.026)g, (0.110 ±0.034)g, (0.538 ±0.098)g and (1.528 ±0.462)g. One month and 3 months after surgery, bladder wet weight of experiment group were significantly increased as compared with those of control group (P<0.05). One day, 1 week, 1 month and 3 months after the operation, the positive rate of insulin receptor expression was 60％, 100％, 100％and 80％. And strongly positive rate was 55％. In control group, the positive rate of insulin receptor expression was 20％, 40％, 40％, and 0％. The expression of insulin receptor in experimental group was significantly higher than that in con-trol group in every stage(P<0.05). Conclusion The expression of insulin receptor is significantly increased after den-ervation of bladder. The defections of insulin receptor might lead to apoptosis and muscle wasting after denervation. Re-store insulin receptor function might be key point to prevent bladder tissue from irreversible damage.

Objective To retrospectively analyze treatment status quo of giant cell tumor of bone around the knee in several institutes,and to investigate risk factors affecting selection of surgical manners,tumor recurrence,and functional outcomes.Methods A total of 222 patients with giant cell tumor of bone around the knee confirmed by pathology,who had undergone surgical treatment in 5 institutes from March 2000 to May 2012,were enrolled in this study.There were 120 males and 102 females,with an average age of 35.5 years.The epidemiology,clinical and radiographic features and risk factors affecting selection of surgical manners,tumor recurrence,and functional outcomes were analyzed.Results Intralesional curettage was performed in 128 patients(57.6％),intralesional curettage combined with partial resection in 13 patients (5.8％),and marginal excision in 79 patients (35.5％).A total of 159 patients were followed up.The local recurrence rate was 19.0％ for patients treated with intralesional curettage,8.9％ for marginal excision and 0％ for intralesional curettage combined with partial resection,and the total local recurrence rate was 14.5％(23/159).The mean duration from primary operation to recurrence was 23.9 months.Univariate analysis indicated that surgical manner was the only factor affecting local recurrence.Pathological fracture,Campanacci grades,Enneking system as well as soft tissue mass had a significant influence on the selection of surgical manners.The mean MSTS score after intralesional curettage was obviously higher than that after marginal excision.Conclusion The surgical manner is the only factor affecting local recurrence and limb function.

Macrophages play a crucial role in inflammatory, proliferative and reconstructive phases in wound healing. A dysfunction of macrophage could lead to a delay of healing. As the most common type of chronic wounds, the diabetic wound may ultimately result in a delayed or failed wound healing due to a high glucose microenvironment and abnormal metabolic environment. Such abnormal metabolic environment may lead to the aberrant macrophage polarization, abnormal secretion of cytokines and aberrant phagocytic function hence cause prolonged inflammation with excessive oxidative stress reaction. As the consequence, the inflammatory phase in diabetic wound is lengthy while the proliferative and reconstructive phases are usually delayed. The diabetic wound may result in enormous financial burden to patients, the healthcare and the society. This study briefly reviewed the recent research progresses at home and abroad, and analysed and summarized the roles of the dysfunction of macrophage polarization, secretion and phagocytosis in the process of diabetic wound healing.

This article reviews the research progress in promotion of peripheral nerve regeneration by regulating macrophages, a new idea for the research and treatment of peripheral nerve injury. The Trauma Center of The First People's Hospital Affiliated to Shanghai Jiao Tong University reviewed the relevant literatures in the regulation of macrophages on peripheral nerve regeneration at home and abroad, from 2013 to 2021, were reviewed and analysed. Of the study from 2013 to 2021, autologous nerve transfer was the main option in the treatment of peripheral nerve injury, but it has many setbacks such as insufficient donor, new nerve injury and local neuroma. Modulating macrophage-related function can effectively improve the prognosis of nerve injury. In recent years, the regulation of macrophages in the treatment of nerve injury is mainly through the mechanism of M1 macrophages polarisation to M2 macrophages, increase of phagocytosis, change of the phenotype of macrophages, and so on. By studying the characteristics of macrophages and regulating the function and phenotype of macrophages, it would provide a new idea and important research direction in the treatment of peripheral nerve injury.

As the important components of peripheral nerve tissue, Schwann cells and macrophages interact with each other throughout the whole process of nerve regeneration. They play a key role in Wallerian degeneration, myelin clearance, axonal regeneration and target organ reinnervation in promotion of the repair of a peripheral nerve. In order to improve the simple strategy in treatment of peripheral nerve injury (PNI), great attention about the significance interaction mechanism between Schwann cells and macrophages in the process of nerve regeneration should be paid, as well as the continuous improvement in researches on the repair mechanism of a PNI. Trauma Centre, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine summarises the interaction mechanism of Schwann cells and macrophages in the regeneration of PNI through literature reviews, from 2015 to 2023, on the mechanisms of Schwann cells and macrophages in PNI repair, hence to draw new ideas in the research and clinical treatment of PNI.

Objective To study the effect of using different tibial nerve proximal muscle branchs to repair deep peroneal nerve injury in animal experiment, and to screen out the most optimal donor nerve branch. Methods From June, 2016 to August, 2016, 64 adult female SD rats were randomly divided into 4 groups, which were LHG (using lateral head of gastrocnemius to repair peroneal nerve), MHG(using medial head of gastrocnemius to repair peroneal nerve), SNB (using soleus nerve branch to repair peroneal nerve), and blank. There were16 rats in each group. At 4 and 8 weeks after surgery, each group were tested on behavior, electrophysiology, muscle tension, muscle wet weight and histology, to evaluate function recovery of the muscles controlled by deep peroneal nerve in each group, and to compare recovery of the deep peroneal nerve repaired by different tibial nerve branches. Results Eight weeks after surgery,right foot of the rats in LHG,MHG and SNB group can be extended,toes can be completely opened. Rats in blank group showed limping gait, whose right foot can not be extended, right toe can not be opened, and muscle atrophied. At 4 and 8 weeks after the operation, the recovery rate of LHG, MHG, SNB group (at 4th weeks, 33.60 ±2.22)%, 33.07 ±2.38% and 35.91 ±2.02%; at 8th weeks, 67.16 ±5.74)%, 66.56 ±3.18% and 73.17 ± 5.33%, respectively)was higher than blank group(7.71±1.05% and 7.84±0.78%, respectively)on CMAP amplitude, tibialis anterior muscle contractility, tibialis anterior muscle cell area, muscle cell area. SNB group was superior to the LHG group and LHG group.And the difference was statistically significant(P<0.05). Conclusion All the proxi-mal tibial nerve muscle branchs can be used to repair the deep peroneal nerve injury, and the soleus nerve branch is the preferred donor nerve.

Peripheral nerve injury is common in clinical practice. Today, outcomes of peripheral nerve repair are still not satisfactory. Recently, a large number of studies have shown that exosomes and their bioactive substances can repair peripheral nerve injury by mediating axonal regeneration, activating Schwann cells, regulating inflammation and other pathways to restore nerve function. This review aims to summarise and prospect the role and application of exosomes in peripheral nerve repair from the perspective of Schwann cells, mesenchymal stem cells and macrophages derived exosomes and their bioactive substances.