1.Clinical research report on Chinese patent medicines and classic traditional Chinese medicine prescriptions (2023)
Xiaolei WU ; Haiyin HU ; Yuetong WANG ; Fauci Alice Josephine ; Yazi ZHANG ; Wenting SONG ; Fengwen YANG ; Boli ZHANG ; Junhua ZHANG ; Zhaochen JI
Digital Chinese Medicine 2025;8(2):123-136
Objective:
Randomized controlled trials (RCTs) of Chinese patent medicines and classic traditional Chinese medicine prescriptions were systematically reviewed from both Chinese and English journals published in 2023. A preliminary summary and evaluation were conducted on the generation and translation of clinical evidence for these treatments. This analysis aims to inform future research on clinical efficacy evaluation and guide the rational application of evidence.
Methods:
RCTs of Chinese patent medicines and classic traditional Chinese prescriptions published in 2023 were comprehensively retrieved from the Artificial Intelligence Clinical Evidence Database for Chinese Patent Medicine (AICED-CPM), with supplementary searches conducted in China National Knowledge Infrastructure (CNKI), Wanfang Data, Chinese Science and Technology Journal Database (VIP), Chinese Biomedical Literature Database (SinoMed), Cochrane Library, PubMed, Embase, and Web of Science. The study characteristics and methodological quality of these RCTs were systematically analyzed and evaluated.
Results:
A total of 1 443 RCTs of Chinese patent medicines were included, comprising 1 399 Chinese articles and 44 English articles. Additionally, 334 RCTs of classic traditional Chinese medicine prescriptions were found, with 331 published in Chinese and 3 in English. 196 567 participants were included, covering 585 types of Chinese patent medicines (487 oral, 61 injectable, and 37 topical) and 179 classic traditional Chinese medicine prescriptions. The involved studies encompassed 22 types of diseases, with research primarily focusing on diseases of the circulatory system, the respiratory system, and the genitourinary system. The sample sizes ranged from 18 to 3 777 participants, and most studies were conducted at a single center. Methodologically, the implementation of allocation concealment and blinding remained insufficiently emphasized.
Conclusion
Overall, compared with 2022, both the number of RCT publications and their methodological quality have improved in 2023, with heightened attention to research on diseases of the genitourinary system. However, quality control and standardized management in the design and implementation processes still require enhancement to produce more high-quality clinical evidence and accelerate the translation and application of this evidence.
2.Study on the Quantification of Traditional Chinese Medicine Tongue Color Classification Based on Hyperspectral Images
Dong ZHANG ; Wentai PANG ; Keyi WANG ; Fengwen YANG ; Junhua ZHANG
World Science and Technology-Modernization of Traditional Chinese Medicine 2024;26(7):1925-1930
Objective Traditional Chinese medicine tongue diagnosis plays an important role in the clinical diagnosis and treatment of diseases,but the current research results are not applicable to the evaluation of clinical efficacy.This study conducted a hierarchical quantitative study on tongue color based on hyperspectral data of tongue images,making it suitable for clinical efficacy evaluation.Methods Establish inclusion and exclusion criteria,obtain tongue images of different spectral wavelengths within the visible light range of 400-1000 nm,and use traditional Chinese medicine clinical experts to distinguish between red tongue and yellow coating in four different color levels(mild,moderate,severe,and severe).Finally,establish a quantitative prediction model for the grade of red tongue and yellow coating based on machine learning models.Results There were significant differences in hyperspectral curve characteristics between red tongue and yellow coating with different color levels,which could be used as the basis for grade quantification.With the help of principal component analysis+random forest model,85.79%and 88.34%of the red tongue and yellow coating with different color levels could be predicted.Conclusion The use of hyperspectral image data features and machine learning models for predicting different color levels of tongue color has achieved good accuracy.
3.Application of highly selective arterial indocyanine green angiography in the design of anterolateral thigh free flap
Shi WANG ; Shuai DONG ; Yang CAO ; Guiyang WANG ; Chengpeng YANG ; Fengwen SUN ; Yongtao HUANG ; Liping GUO ; Liang YANG ; Rong ZHOU ; Jihui JU
Chinese Journal of Burns 2024;40(10):948-954
Objective:To introduce the application of highly selective arterial indocyanine green angiography (hereinafter referred to as highly selective arterial angiography) in the design of anterolateral thigh free flap.Methods:This study was a retrospective observational study. From November 2023 to April 2024, 29 patients with wounds in extremities which were repaired by anterolateral thigh free flaps designed under the assistance of highly selective arterial angiography and met the inclusion criteria were admitted to the Department of Hand Surgery and Department of Wound Repair Surgery of Suzhou Ruihua Orthopedic Hospital, including 26 males and 3 females, aged 16 to 71 years. The wound area after debridement ranged from 8.0 cm×4.5 cm to 27.0 cm×16.0 cm. During the surgery, highly selective arterial angiography was used to assist in flap design. The fluorescence development range of the source arteries or perforators of flaps was observed. The blood supply range of the source arteries or perforators of flaps was determined based on the fluorescence development of the skin, and the excision position of the flap was adjusted. The flap incision area ranged from 9.0 cm×6.0 cm to 29.0 cm×16.0 cm. During the surgery, the number of highly selective arterial angiography, the type of source artery of perforators for puncture, and changes in the excision position of flaps were observed and recorded. After surgery, the blood supply and survival of flaps, the healing of wounds and the survival of skin grafts in the flap donor sites, and the angiography-related complications were observed.Results:All the 32 flaps of 29 patients were successfully excised. The highly selective arterial angiography was performed 37 times, including 13 cases of puncture of the oblique branch of the lateral circumflex femoral artery, 6 cases of puncture of the descending branch, 8 cases of double puncture of the oblique and descending branches, and 2 cases of puncture of arteries from other branches. During the surgery, the excision position of 28 flaps did not change, the excision position of 3 flaps moved towards proximal extremity of the thigh, and the excision position of 1 flap moved towards distal extremity of the thigh. All the flaps survived successfully after the surgery, and there was no partial necrosis of the flaps at the proximal or distal ends. The wounds in the flap donor sites healed, and all skin grafts survived. No angiography-related complications occurred.Conclusions:Highly selective arterial angiography can be used to determine the blood supply range of the source artery and perforators of the anterolateral thigh free flaps during the surgery. It can evaluate the blood supply of flaps more intuitively and objectively. Its application in assisting flap design can avoid partial flap necrosis caused by unreasonable preoperative design to a certain extent, and it is safe and reliable.
4.Effect of Modified Shengjiangsan on Renal Endoplasmic Reticulum Stress and Sirt1/PERK Pathway in Rat Model of Diabetic Nephropathy
Meifang REN ; Zhenhua WU ; Fei GAO ; Guodong YUAN ; Qian ZHANG ; Xiaoling GUO ; Fengwen YANG
Chinese Journal of Experimental Traditional Medical Formulae 2024;30(14):55-62
ObjectiveTo explore the molecular mechanism of modified Shengjiangsan in alleviating endoplasmic reticulum (ER) stress and reducing urinary protein in the rat model of diabetic nephropathy (DN). MethodSeventy-five SD rats were randomized into normal, model, low-, medium-, and high-dose (4.37, 8.73, 17.46 g·kg-1, respectively) modified Shengjiangsan, and irbesartan (0.014 g·kg-1) groups, with 10 rats in each group. Rats were administrated with corresponding doses of medications or distilled water by gavage, once a day, for 8 consecutive weeks. After the last administration, the levels of glucose (GLU) in the blood, 24-hour urinary protein (24 h-UTP), and superoxide dismutase (SOD), malondialdehyde (MDA), and glutathione peroxidase (GSH-Px) in the renal tissue were measured. Hematoxylin-eosin staining, periodic acid-Schiff staining, and transmission electron microscopy were employed to observe the pathological changes in rat kidneys. Immunohistochemistry was employed to measure the expression levels of nephrin, podocin, glucose-regulated protein 78 (GRP78), C/EBP homologous protein (CHOP), and activating transcription factor 4 (ATF4) in the kidneys of rats. Western blot was employed to measure the protein levels of silent information regulator 1 (Sirt1), phosphorylated (p)-protein kinase RNA-like endoplasmic reticulum kinase (PERK), and p-eukaryotic translation initiation factor 2 alpha (eIF2α) in rat kidneys. ResultCompared with the normal group, the modeling caused pathological damage to the kidneys, elevated the levels of GLU and 24 h-UTP (P<0.05), up-regulated the protein levels of GRP78, CHOP, ATF4, p-PERK, and p-eIF2α (P<0.05), and down-regulated the protein level of Sirt1 (P<0.05) in rat kidneys. Compared with the model group, modified Shengjiangsan and irbesartan lowered the GLU and 24 h-UTP levels (P<0.05), alleviated the pathological damage in the renal tissue, down-regulated the protein levels of GRP78, CHOP, ATF4, p-PERK, and p-eIF2α (P<0.05), and up-regulated the protein level of Sirt1 (P<0.05). ConclusionModified Shengjiangsan up-regulates Sirt1 expression and inhibits phosphorylation of proteins in the PERK/eIF2α pathway to reduce ER stress and oxidative stress in the renal tissue, thus alleviating the pathological damage in the renal tissue and reducing urinary protein in DN rats.
5.Effect of Dahuang Xiezhuo Prescription on Renal Tubular Function in Patients with IgA Nephropathy Complicated with Hyperuricemia
Qian ZHANG ; Fengwen YANG ; Meng SHI ; Jinchang LIU ; Gang WANG ; Meifang REN ; Meijiao ZHAO ; Jingyu MAO ; Jinchuan TAN
Chinese Journal of Experimental Traditional Medical Formulae 2023;29(12):135-141
ObjectiveTo observe the effect of Dahuang Xiezhuo prescription on the clinical symptoms, blood uric acid, and renal tubular function of patients with immunoglobulin A (IgA) nephropathy in stages 1-2 of chronic kidney disease (CKD) complicated with hyperuricemia (HUA). MethodSixty patients with IgA nephropathy in stages 1-2 of CKD complicated with HUA of spleen and kidney deficiency and combined turbidity and blood stasis syndromes were randomly divided into an observation group and a control group, with 30 cases in each group. The patients in the control group received basic treatment, i.e., losartan potassium tablets 50-100 mg/time, once per day, and sodium bicarbonate tablets 0.5 g/time, three times per day by oral administration, combined with low-salt, low-fat, and low-purine diet. The patients in the observation group received Dahuang Xiezhuo prescription on the basis of basic treatment, one dose per day, twice a day in the morning and evening with warm water. Both groups were treated for two months. The total scores of traditional Chinese medicine(TCM)syndrome, blood pressure, 24 h urinary protein (24 h UTP), blood urea nitrogen (BUN), serum creatinine (SCr) [glomerular filtration rate (eGFR) was calculated by CKD-epidemiology collaboration (CKD-EPI) formula], serum uric acid (SUA), and renal tubular function indexes [urinary α1-microglobulin (α1-MG), urinary β2-microglobulin (β2-MG), urinary kidney injury molecule-1 (KIM-1), and neutrophil gelatinase-associated lipocalin (NGAL)] of the two groups before treatment and two months after treatment were recorded. The clinical efficacy of the two groups was evaluated two months after treatment. ResultAfter 2 months of treatment,the total effective rate in the observation group was 81.48%(22/27),higher than 50.00%(14/28) in the control group(χ2 =6.661,P<0.05). The total scores of TCM syndrome, 24 h UTP, and SUA in the observation group and the observation group were lower than those before treatment (P<0.05), and compared with the control group after treatment, the observation group decreased more significantly (P<0.05). After treatment, the blood pressure in the observation group and the observation group was lower than that before treatment (P<0.05), and there was no significant difference in blood pressure between the two groups after treatment. After treatment, the levels of urinary α1-MG, β2-MG, KIM-1, and NGAL in the two groups were lower than those before treatment (P<0.05), and the observation group was lower than the control group after treatment (P<0.05). There were no significant inter-group and intra-group differences in BUN, SCr, and eGFR levels before and after treatment. There were no obvious abnormalities in blood routine, liver function, and electrolytes before and after treatment in the two groups, and no adverse reactions such as allergies occurred. ConclusionDahuang Xiezhuo prescription can effectively improve the clinical symptoms of IgA nephropathy with HUA (CKD1-2) patients with spleen and kidney deficiency and combined turbidity and blood stasis syndromes, reduce blood uric acid level, alleviate renal tubular injury, and protect the kidney. The curative effect is better than that of basic treatment.
6.Effect of Dahuang Xiezhuo Prescription on Inflammation and SOCS3/TLR4 Pathway in Rats with Chronic Renal Failure
Xin XIN ; Zhenhua WU ; Miao TAN ; Fei GAO ; Fengwen YANG ; Suzhi CHEN ; Qian ZHANG ; Jinchuan TAN
Chinese Journal of Experimental Traditional Medical Formulae 2023;29(7):95-104
ObjectiveTo observe the intervention effect of Dahuang Xiezhuo prescription (DHXZ) on inflammation and suppressor of cytokine signaling 3 (SOCS3)/Toll-like receptor 4 (TLR4) pathway in rats with chronic renal failure (CRF), and to explore its molecular mechanism in alleviating renal inflammatory response. MethodThe 90 male SD rats, 15 were randomly selected as sham group, and the remaining 75 were used as modeling group to replicate CRF rat model by 5/6 nephrectomy. After successful modeling, the rats were randomly divided into model group, DHXZ low-, medium-, high-dose groups (6.825, 13.65, 27.3 g·kg-1) and Niaoduqing Granules group (2.6 g·kg-1). The drug intervention groups received corresponding drugs by gavage for 8 consecutive weeks. After administration, hematoxylin-eosin (HE) staining and Masson staining were used to observe the morphological changes of rat renal tissue, and blood creatinine (SCr), blood urea nitrogen (BUN) and blood uric acid (UA) were tested. Enzyme-linked immunosorbent assay (ELISA) was performed to detect the serum contents of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and C-reactive protein (CRP). The mRNA expressions of SOCS3 and TLR4 in renal tissue were detected by Real-time fluorescence quantitative polymerase chain reaction (Real-time PCR), and the protein expressions of SOCS3, TLR4, nuclear transcription factor (NF-κB) and myeloid differentiation factor (MyD88) were detected by Western blot. Immunohistochemistry was used to determine the protein expressions of NF-κB, MyD88, NOD-like receptor protein 3 (NLRP3) and melanoma deficiency factor 2 (AIM2). ResultCompared with the sham group, the model group had a significant inflammatory response in renal tissue, and an increase in blood SCr, BUN, UTP, IL-6, TNF-α and CRP (P<0.05). The protein and mRNA expressions of SOCS3 in renal tissue of rats in the model group were lower while the protein expressions of TLR4, NF-κB, MyD88, NLRP3 and AIM2 and the mRNA expression of TLR4 were higher than those in the sham group (P<0.05). Compared with the model group, DHXZ and Niaoduqing granules groups presented markedly reduced inflammatory response in renal tissue and decreased blood SCr, BUN, UTP, IL-6, TNF-α and CRP (P<0.05). Additionally, DHXZ and Niaoduqing granules up-regulated the protein and mRNA expressions of SOCS3 in renal tissue while down-regulated the protein expressions of TLR4, NF-κB, MyD88, NLRP3 and AIM2 and the mRNA expression of TLR4 (P<0.05). ConclusionDHXZ can reduce the release and expression of inflammatory factors, inhibit the inflammatory response and improve renal function, and the mechanism may be related to the regulation of SOCS3/TLR4 signaling pathway.
7.Mechanism of Salvianolate in Inducing Autophagy in Podocytes of Rats with Membranous Nephropathy via AMPK/SIRT1/PGC-1α Signaling Pathway
Yao ZHANG ; Fei GAO ; Miao TAN ; Fengwen YANG ; Suzhi CHEN ; Meifang REN ; Guodong YUAN ; Jinchuan TAN
Chinese Journal of Experimental Traditional Medical Formulae 2023;29(8):203-213
ObjectiveTo observe the effect of salvianolate on the protein expressions of adenosine monophosphate (AMP)-activated protein kinase (AMPK), silent information regulator 1 (SIRT1) and peroxisome proliferator-activated receptor-γ coactivator-1α (PGC-1α), autophagy and apoptosis in kidney tissue of rats with membranous nephropathy (MN), and to explore its possible molecular mechanism against MN. MethodEighty male SD rats were randomly divided into normal group, model group, benazepril hydrochloride group (10 mg·kg-1), and salvianolate low-, medium-, and high-dose groups (16.7, 33.3 and 66.7 mg·kg-1). The rats were modeled by injection of cationized bovine serum albumin (C-BSA) into the tail vein. After successful modeling, rats in the administration groups were given corresponding doses of drugs for 4 consecutive weeks, and then 24-hour urine, serum and kidney tissue were collected for the detection of 24-hour urinary protein (UTP), blood urea nitrogen (BUN), serum creatinine (SCr), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), C reactive protein (CRP), glutathione peroxidase (GSH-Px), superoxide dismutase (SOD), and malondialdehyde (MDA). The pathological changes of kidneys were observed by light microscope, electron microscope and immunofluorescence. Western blot was used to detect the protein expressions of phospho-AMPK (p-AMPK), AMPK, phospho-SIRT1 (p-SIRT1), SIRT1 and PGC-1α in rat kidney tissue. The protein expressions of autophagy-specific gene (Beclin-1), microtubule-associated protein 1 light chain 3 (LC3) Ⅱ, ubiquitin-binding protein (p62), B cell lymphoma (Bcl-2), Bcl-2-associated X (Bax), and cysteine aspartic protease-7 (Caspase-7) in rat kidney tissue were determined by immunohistochemistry (IHC). ResultCompared with the conditions in the normal group, the levels of UTP, IL-6, TNF-α, CRP and MDA in the model group were increased (P<0.05) while the levels of SOD and GSH-Px were decreased (P<0.05), and there was no difference in BUN and SCr. Compared with the model group, the administration groups had lowered UTP, IL-6, TNF-α, CRP and MDA (P<0.05) while elevated SOD and GSH-Px (P<0.05). It could be seen from hematoxylin and eosin (HE) staining, Masson staining, immunofluorescence and electron microscopy that the pathological damage of rat kidney tissue in the model group was significant, but after treatment with benazepril hydrochloride and salvianolate, the pathological damage of kidney cells was gradually improved. The expressions of p-AMPK/AMPK, p-SIRT1/SIRT1, PGC-1α, Bcl-2, Beclin-1 and LC3Ⅱ in rat kidney in the model group were lower than those in the normal group (P<0.05) while the expressions of Bax, Caspase-7 and p62 were higher (P<0.05). Compared with the model group, benazepril hydrochloride group and salvianolate groups had an up-regulation in the expressions of p-AMPK/AMPK, p-SIRT1/SIRT1, PGC-1α, Bcl-2, Beclin-1 and LC3Ⅱ in the kidney (P<0.05) while a down-regulation in the expressions of Bax, Caspase-7 and p62 (P<0.05). ConclusionThe protective effect of salvianolate on the kidneys of MN rats may be related to the activation of AMPK/SIRT1/PGC-1α signaling pathway, the up-regulation of autophagy and the reduction of apoptosis.
8.Distribution characteristics and clinical application of perforators of anterolateral thigh flap pedicled with oblique branch of lateral circumflex femoral artery
Lin YANG ; Yang CAO ; Junnan CHENG ; Yongtao HUANG ; Zhijin LIU ; Qinfeng GAO ; Chengpeng YANG ; Fengwen SUN ; Yucheng LIU ; Jihui JU
Chinese Journal of Plastic Surgery 2023;39(5):463-471
Objective:To explore the distribution characteristics of the perforators of the oblique branch of the lateral circumflex femoral artery, and to report the clinical effect of the anterolateral thigh flap pedicled with the oblique branch in repairing the wounds of the extremities.Methods:The clinical data of the patients with anterolateral thigh flap pedicled with oblique branch of lateral circumflex femoral artery in Suzhou Ruihua Orthopaedic Hospital from December 2020 to April 2021 were analyzed retrospectively. High frequency color Doppler ultrasound was used to detect the large perforators of the oblique branch of the lateral circumflex femoral artery near the midpoint of the line between the anterior superior iliac spine and the lateral margin of the patella. With reference to the location of the perforators, according to the size and shape of the defect in the recipient area, the anterolateral thigh flap pedicled with oblique branch was designed and dissected to repair the wound. During the operation, the distance between the emitting point of the main oblique branch, the skin entry point of the perforators and the anterior superior iliac spine was measured with a steel ruler, the diameter of the perforators was measured with a microscale, and the number of perforators was counted. The survival and complications of the flap were observed and followed up after operation. In the last follow-up, the comprehensive evaluation scale was used to evaluate the repair effect: 90 to 100 points is excellent, 75 to 89 points is good, 60 to 74 points is average, and less than 60 points is poor.Results:A total of 84 patients were included, including 62 males and 22 females, aged from 14 to 82 years (mean 46.9 years), including 32 cases of hand wounds, 6 cases of forearm wounds, 3 cases of upper arm wounds, 10 cases of calves and 33 cases of foot and ankle wounds. The wound area was 6 cm × 4 cm-20 cm × 45 cm. A total of 88 flaps were removed in 84 patients (skin flaps on both thighs were removed in 4 patients). The size of the skin flap of 88 thighs was 7 cm × 5 cm-37 cm × 11 cm, of which 85 sides of 82 cases survived completely. One case of diabetes had complete necrosis 1 month after operation, and 1 case of 34 cm had necrosis of the distal end of 3 cm × 3 cm skin flap. Necrotic skin flaps were repaired with skin grafting. Four patients developed arterial crisis within 24 hours after operation, and those flaps survived after surgical exploration. All donor areas healed. During the follow-up of 6 to 9 months, the shape of the recipient area was normal in all patients, and there was no deep tissue infection such as osteomyelitis. The color and texture of all flaps were good. The sensation returned to S1-S2 after operation. The skin flap comprehensive evaluation scale was used to evaluate the repair effect. The patients’ score ranged from 73 to 94 points, with an average of 88.1 points. Including 33 excellent cases, 46 good cases and 5 average cases, the excellent and good rate was 94.0%(79/84). A total of 215 perforators were marked with 88 flaps before operation, and 208 perforators were found during the operation(the diameter of the perforators was 0.4-1.5 mm), of which 130 were sent out by oblique branches. There were perforators of the oblique branch in all flaps, with an average of 1.5 on each side, including 84(64.6%) septocutaneous perforators and 46(35.4%) musculocutaneous perforators. Most of the oblique branches originate from the lateral circumflex femoral artery, which runs in the intermuscular septum between the rectus femoris and the intermediate femoris muscle. It is divided into deep branches and superficial branches at the middle and upper 1/3 junction of the line between the anterior superior iliac spine and the lateral margin of the patella. The skin perforators of the oblique branch of the lateral circumflex femoral artery is mostly sent out from the superficial branch, and there are 118 perforators located at the midpoint and proximal end of the line between the anterior superior iliac spine and the lateral margin of the patella, accounting for 90.8% (118/130), reaching a peak at 0.4 (there are 37 perforators).Conclusion:The oblique branch of the lateral circumflex femoral artery is relatively constant, and most of the perforators are located near the midpoint of the line between the anterior superior iliac spine and the lateral margin of the patella, and the proportion of septocutaneous perforator is high. The distribution of perforator is regular, the blood supply is reliable, the application mode is flexible, and the donor site position is more concealed while the blood supply of the flap is secured.
9.Curative effects of the superficial peroneal artery perforator flap carrying multiple perforators in repairing hand and foot wounds
Tao ZHANG ; Junnan CHENG ; Lin YANG ; Yongtao HUANG ; Qinfeng GAO ; Fengwen SUN ; Zhijin LIU ; Shengzhe LIU ; Chengpeng YANG ; Yang CAO ; Jihui JU
Chinese Journal of Burns 2023;39(3):234-240
Objective:To investigate the curative effects of the superficial peroneal artery perforator flap carrying two and more homologous perforators in repairing hand and foot wounds.Methods:A retrospective observational study was conducted. From January to September 2021, 23 patients with hand and foot wounds combined with bone or tendon exposure who met the inclusion criteria were admitted to Suzhou Ruihua Orthopaedic Hospital, including 16 males and 7 females, aged 23 to 68 years. After expansion of the wound, the wound area was 3.0 cm×2.0 cm to 11.0 cm×4.0 cm. All the wounds were repaired with the superficial peroneal artery perforator flap carrying two and more homologous perforators. The area of the resected flap was 4.0 cm×2.0 cm to 12.0 cm×5.0 cm. All the wounds in donor areas were sutured directly. During the operation, the resection of the flap, the number and caliber of carried perforators, the caliber of superficial peroneal artery, the length of vascular pedicle, and the number of accompanying veins of the superficial peroneal artery were recorded. The survival of the flap, the occurrence of complications, and the wound healing in the donor area were observed after operation. The recovery of the donor and recipient areas was followed up. At the last follow-up, the comprehensive evaluation scale was used to evaluate the curative effect of flap repair, and the sensory grading scale was used to evaluate the sensory function of the recipient area.Results:Totally 24 flaps were successfully resected in surgical operations, carrying 56 superficial peroneal artery perforators in total, with the caliber of perforators of 0.20-0.70 mm. The calibers of all perforators carried by 7 flaps were smaller than 0.40 mm. Nineteen flaps carried 2 perforators each, 3 flaps carried 3 perforators each, 1 flap carried 4 perforators, and 1 flap carried 5 perforators. During the operation, the superficial peroneal artery was resected with a caliber of 0.40-1.50 mm, the vascular pedicle was 2-6 cm in length, and each superficial peroneal artery had two accompanying veins. After operation, all the flaps survived smoothly, no vascular crisis or distal necrosis occurred, and the wounds healed well in the donor area. During the follow-up of 6 to 10 months after operation, the color, texture, and elasticity of the recipient area were good. Among them, 6 recipient areas were thinned and reshaped because of bloating. There was only linear scar and no obvious scar hyperplasia or pigmentation in the donor area, without significant change in sensory or motor function. At the last follow-up, the curative effect evaluation of flap repair was excellent in 22 flaps and good in 2 flaps, and the sensory function evaluation of the recipient area was grade S 3 in 1 area and grade S 2 in 23 areas. Conclusions:The superficial peroneal artery perforator flap with two and more homologous perforators has sufficient and reliable blood supply and is effective in repairing hand and foot wounds. It provides an ideal solution for the clinical problem in which the original operation scheme is abandoned due to the existence of only multiple slender perforators of caliber smaller than 0.40 mm, and only a single perforator in the operative field that cannot satisfy the needs of the flap blood supply and recipient area.
10.Morphological study on the transverse branch of lateral femoral circumflex artery based on digital subtraction angiography
Yongtao HUANG ; Lin YANG ; Yang CAO ; Yucheng LIU ; Qinfeng GAO ; Chengpeng YANG ; Fengwen SUN ; Junnan CHENG ; Tao ZHANG ; Jihui JU
Chinese Journal of Burns 2023;39(4):337-342
Objective:To summarize the morphological characteristics of the transverse branch of lateral femoral circumflex artery (LFCA) using digital subtraction angiography (DSA) and explore its clinical significance.Methods:A retrospective observational study was conducted. From October 2020 to May 2021, 62 patients with soft tissue injuries in the extremities were hospitalized in Suzhou Ruihua Orthopedic Hospital, including 40 males and 22 females, aged from 20 to 72 years. DSA was performed in the lateral femoral region of patients before the anterolateral thigh flap transplantation, and in combination with imaging scale to observe and measure the general condition of the blood vessels and the occurrence (with the occurrence rate being calculated), source artery, location of the origin point, direction of course, and the location of the perforating point of the cutaneous perforator of the transverse branch of LFCA, and in addition to classify the morphological characteristics of the transverse branch.Results:DSA detection showed that the femoral artery, the deep femoral artery, and the branches of LFCA were clearly distinguishable in 62 patients. Transverse branches of LFCA were observed in 59 patients, including 52 cases with a single transverse branch, and 7 cases with double transverse branches. The occurrence rate of transverse branches was 95.2% (59/62). A total of 66 transverse branches of LFCA were observed, of which 3 originated from the deep femoral artery, and 63 originated from the LFCA. The origin point of the transverse branch was 6.5-12.7 cm away from the anterior superior iliac spine. The transverse branch which was approximately perpendicular to the long axis of the body, originated outwards, ran between the ascending branch of LFCA and the oblique branch of LFCA, and branched along the way, with the trunk running under the greater trochanter. The perforating point of the cutaneous perforator of the transverse branch was 8.0-18.0 cm away from the anterior superior iliac spine. In the classification of morphological characteristics of the transverse branch of LFCA, the most common type was the one that originated from the same trunk with other branches of LFCA, accounting for 50.0% (31/62), followed by the one that originated from the singular trunk of LFCA (12 cases) or deep femoral artery (3 cases), accounting for 24.2% (15/62); the special type accounted for 21.0% (13/62), including 7 cases of double transverse branches and 6 cases of the transverse branch originated from the same trunk with multiple other branches of LFCA; those with small/absent transverse branch only accounted for 4.8% (3/62). Among the above-mentioned common trunk relationship of two branches, those with shared trunk of ascending and transverse branches were most frequently observed, accounting for 77.4% (24/31); those with shared trunks of the transverse and oblique branches (5 cases) and the transverse and descending branches (2 cases) accounted for 22.6% (7/31) altogether.Conclusions:A high incidence rate of the transverse branch of LFCA is observed through DSA. The transverse branch originates from the lateral femoral artery approximately perpendicular to the long axis of the body, mainly from the same trunk with another main branch of LFCA, especially the ascending branch. This positioning analysis can provide an important reference for the design and resection of anterolateral femoral flaps.

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