Objective To provide the applied anatomy of the posterior intercostal artery perforator flap and the clinical results of repairing the soft tissue defects with lateral perforator flap. Methods Six fresh adult cadavers were injected with a lead oxide-gelatin mixture for three-dimensional visualization reconstruction using a 64-slice spiral computed tomography scanner and specialized software (Materiaise's interactive medical image control system,MIMICS).The origin,course,diameter,and distribution of the the 6-10th posterior intercostal artery perforators in the thoroax region were observed and measured.Clinically,nine cases were treated with the lateral perforator flap supplied by 7-10th posterior intercostal artery transplantation for repairing wounds in upper limbs.The flap size was 9 cm × 7 cm-16 cm × 12 cm. Results The 6-10th posterior intercostal artery perforator (outer diameter 1.70 ± 0.14 mm) were from the artery in the chest region, which pierce in deep fascia near midaxillary line. The average pedicle length from the deep fascia was (87.56 ± 6.48) mm.All of 9 cases were repaired successfully,the clinical results were satisfactory.Conclusion The posterior intercostal artery perforator flap can be used to form many kinds of axial skin flaps,it is a good option for repairing soft-tissue defect.

Objective To analyze the effect of decompression internal fixation with different approaches on treating thoracolumbar burst fracture patients complicated with spinal cord injury.Methods A total of 78 thoracolumbar burst fracture patients with spinal cord injury were selected.According to the different approaches,they were divided into group A (anterior approach decompression,n =40) and group B (posterior approach decompression,n =38).The general information,the basic operation situation,the Cobb angle,vertebral height and Frankel grade before and after operation were compared between two groups.Results The bone graft fusion time in group A was significantly less than that in group B (P ＜ 0.05),and the operation time,the hospitalization time and the intra-operative blood loss showed no significant differences between two groups (P ＞ 0.05).The Cobb angle,vertebral height and Frankel grade after operation were better than those before operation in both groups (P ＜ 0.05),but the Cobb angle,vertebral height and Frankel grade at the same time showed no significant differences between two groups (P ＞ 0.05).Conclusion The decompression internal fixation with anterior,posterior approaches can effectively treat thoracolumbar burst fracture patients complicated with spinal cord injury,but for anterior approach,the bone graft fusion time is shorter and the Cobb angle loss is less.

Objective To analyze the effect of decompression internal fixation with different approaches on treating thoracolumbar burst fracture patients complicated with spinal cord injury.Methods A total of 78 thoracolumbar burst fracture patients with spinal cord injury were selected.According to the different approaches,they were divided into group A (anterior approach decompression,n =40) and group B (posterior approach decompression,n =38).The general information,the basic operation situation,the Cobb angle,vertebral height and Frankel grade before and after operation were compared between two groups.Results The bone graft fusion time in group A was significantly less than that in group B (P ＜ 0.05),and the operation time,the hospitalization time and the intra-operative blood loss showed no significant differences between two groups (P ＞ 0.05).The Cobb angle,vertebral height and Frankel grade after operation were better than those before operation in both groups (P ＜ 0.05),but the Cobb angle,vertebral height and Frankel grade at the same time showed no significant differences between two groups (P ＞ 0.05).Conclusion The decompression internal fixation with anterior,posterior approaches can effectively treat thoracolumbar burst fracture patients complicated with spinal cord injury,but for anterior approach,the bone graft fusion time is shorter and the Cobb angle loss is less.

Objective To investigate the expression and the relationship with angiogenesis of miR-195 and NLR family member X1 (NLRX1) in granulation tissue after negative-pressure wound treatment (NPWT).Methods Six patients were collected who received negative pressure treatment with refractory wound granulation.The levels of miR-195, NLRX1 mRNA and NLRX1 proteins were measured.The expression of NLRX1 and the micro-vascular density (MVD) of CD31 were detected by immunohistochemistry (IHC).Results MiR-195 and MVD were significantly higher in granulation tissue after 7 days negative pressure treatment (P＜0.05), and NLRX1 was significantly lower (P ＜0.05).In granulation tissue,the expression of miR-195 was negatively correlated with NLRX1 (r =-0.856, P ＜0.001), the expression of NLRX1 was negatively correlated with MVD (r =-0.618, P ＜0.05), and the expression of miR-195 was positively correlated with MVD (r =0.630, P ＜ 0.05).Conclusions Negative pressure wound therapy can promote the formation of granulation vessels and the wound healing.The therapeutic mechanism may inhibit the expression of NLRX1 and upregulate the expression of miR-195 to promote angiogenesis.

Objective:To investigate the influence factors of poor efficacy after flap repair operation in patients with pressure ulcers.Methods:The retrospective case series study was conducted. From January 2011 to June 2021, 125 patients with stage Ⅲ and Ⅳ pressure ulcers treated in Hainan General Hospital met the inclusion criteria. There were 82 males and 43 females, aged 15-90 (57±20) years. According to the postoperative effects, the patients were divided into poor efficacy group (47 cases) and good efficacy group (78 cases). The clinical data of patients in the two groups were collected, including the age, gender, location, stage, size, and bone exposure of pressure ulcers, preoperative microorganism culture results of wound exudate sample, whether combined with osteomyelitis, diabetes, lower limb paroxysmal myospasm, and gatism or not, the number of surgical debridement combined with negative-pressure wound therapy, type of surgical flap, postoperative position, and preoperative albumin, leukocyte, C-reactive protein (CRP), and hemoglobin. Data were statistically analyzed with independent sample t test, Mann-Whitney U test, and chi-square test. The binary multivariate logistic regression analysis was conducted to screen the independent risk factors influencing the poor efficacy after flap repair operation in 125 patients with stage Ⅲ and Ⅳ pressure ulcers. Results:The ratio of patients with lower limb paroxysmal myospasm in poor efficacy group was 22/47, which was significantly higher than 3/78 in good efficacy group ( χ2=33.83, P<0.01). The preoperative hemoglobin level of patients in poor efficacy group was (102±17) g/L, which was significantly lower than (113±20) g/L in good efficacy group ( t=-3.24, P<0.01). The preoperative CRP level of patients was 39.1 (14.1, 91.6) mg/L in poor efficacy group, which was significantly higher than 15.3 (6.6, 42.0) mg/L in good efficacy group ( Z=-3.04, P<0.01). There were no statistically significant differences in other indexes between patients in the two groups ( P>0.05). Multivariate logistic regression analysis showed that age, lower limb paroxysmal myospasm, and preoperative hemoglobin level were the independent risk factors for poor efficacy after flap repair operation in patients with pressure ulcers (with odds ratios of 1.03, 40.69, and 0.97, 95% confidence intervals of 1.00-1.06, 9.18-180.39, and 0.95-1.00, respectively, P<0.05 or P<0.01). Conclusions:Poor efficacy after flap repair operation in patients with pressure ulcers is affected by many factors, among which the age, lower limb paroxysmal myospasm, and preoperative hemoglobin level are the independent risk factors.