Objective To explore the feasibility and technique of reconstruction of extensive softtissue defects at upper extremities using the pre-expanded paraumbilical perforator (PUP) flaps.Methods Pre-expanded PUP flap was used to reconstruct large soft-tissue defect at the upper extremity according to the size,shape,and location of the defect in a multiple-staged procedure.Results From Sept.2009 to Sept.2015,81 patients underwent defect reconstruction using the pre-expanded PUP flaps.93 preexpanded PUP flaps were used.Unilateral flap was used in 70 patients.Bilateral flaps were used to reconstruct the circumferential forearm defects in eight patients (16 flaps).Bilateral flaps were used to reconstruct bilateral forearm defects in three patients (6 flaps).The size of the flaps ranged from 8 cm ×6 cm to 40 cm × 15 cm.Small-sized distal flap necrosis occurred in five patients after division of the proximal pedicle of the flap.The patients were followed up for 1 to 5 years (average 3.5 years) with satisfactory functional and aesthetic outcomes.Dysfunction of the shoulder and elbow joints was not noticed postoperatively.Conclusions The pre-expanded paraumbilical perforator flap provides a valuable option for different defects reconstruction at the upper extremity.

Objective To explore the feasibility and technique of reconstruction of extensive softtissue defects at upper extremities using the pre-expanded paraumbilical perforator (PUP) flaps.Methods Pre-expanded PUP flap was used to reconstruct large soft-tissue defect at the upper extremity according to the size,shape,and location of the defect in a multiple-staged procedure.Results From Sept.2009 to Sept.2015,81 patients underwent defect reconstruction using the pre-expanded PUP flaps.93 preexpanded PUP flaps were used.Unilateral flap was used in 70 patients.Bilateral flaps were used to reconstruct the circumferential forearm defects in eight patients (16 flaps).Bilateral flaps were used to reconstruct bilateral forearm defects in three patients (6 flaps).The size of the flaps ranged from 8 cm ×6 cm to 40 cm × 15 cm.Small-sized distal flap necrosis occurred in five patients after division of the proximal pedicle of the flap.The patients were followed up for 1 to 5 years (average 3.5 years) with satisfactory functional and aesthetic outcomes.Dysfunction of the shoulder and elbow joints was not noticed postoperatively.Conclusions The pre-expanded paraumbilical perforator flap provides a valuable option for different defects reconstruction at the upper extremity.

Objective:To explore the feasibility and clinical outcomes of punch excision combined with superficial X-ray and intralesional drug injection in the treatment of chest multiple keloids.Methods:Patients with chest multiple keloids in Dermatology Hospital of Southern Medical University from March 2020 to June 2021 were selected and randomly divided into observation group and control group according to random number table. In the observation group, punch excision was performed first, superficial X-ray was irradiated once within 24 h after surgery, and then once a week, for a total of 4 sessions. One week after radiotherapy, intralesional injection was performed with 5 ml mixture of 1 ml triamcinolone acetate injection, 0.6 ml fluorouracil injection and 3.4 ml 2% lidocaine hydrochloride injection, once a month, for a total of 4 times. Single injection endpoint reaction was keloid whiteness. The control group did not receive punch excision, and other treatments were the same as those in the observation group. Vancouver scar scale (VSS) score and efficacy evaluation (cure, excellent, improvement, ineffective) were performed before treatment and 3, 6, 12 months after treatment. Total keloids volume, intralesional injection volume and adverse reactions before and after treatment were recorded. SPSS 26.0 software was used for data analysis, and the measurement data were expressed as Mean±SD. Independent sample t-test was used for comparison between two groups, and repeated measurement data analysis of variance was used for comparison before and after treatment in the same group. Statistical data were expressed as % and χ2 test was used for comparison between groups. P<0.05 was considered statistically significant. Results:A total of 58 patients were included, 29 in each group. There were 36 males and 22 females. The age ranged from 18 to 59 years old, with an average age of 29. The number of chest keloids in each patient was 5-12. Before treatment, the VSS scores of observation group and control group was 13.21±1.24 and 12.90±1.21 respectively. There was no significant difference in VSS scores between the two groups before treatment ( t=0.97, P=0.337). After 3, 6 and 12 months of follow-up, the VSS scores of the observation group were 4.21±1.26, 4.34±1.40 and 4.55±1.33 respectively, while those of the control group were 5.66±1.32, 6.07±1.44 and 6.62±1.40 respectively. The differences between the two groups were statistically significant ( t=-4.27, -4.63, -5.78, all P<0.001). Intra-group comparison showed that there were no statistically significant differences in VSS scores at 3, 6 and 12 months after treatment in the observation group ( F=2.50, P=0.111), while VSS scores at 3, 6 and 12 months after treatment in the control group showed a gradually increasing trend, with statistically significant difference ( F=30.75, P<0.001). In the observation group, 22 cases showed excellent effect, 7 cases improved, and the excellent rate was 75.86%(22/29). In the control group, there were 6 cases of excellent effect and 23 cases of improvement, the excellent rate was 20.69%(6/29), and the difference between the two groups was statistically significant ( χ2=17.68, P<0.001). Before treatment, the total keloids volume of the observation group was (7.76±1.71) cm 3, which was (8.27±1.26) cm 3 of the control group, and there was no significant difference between the two groups before treatment ( t=-1.28, P=0.207). In the follow-up of 12 months after treatment, the total keloids volume of the observation group[(2.57±0.59) cm 3] was significantly smaller than that of the control group[(5.51±1.39) cm 3], and the difference was statistically significant ( t=-10.47, P<0.001). The total amount of intralesional injection in the observation group[(6.45±1.25) ml] was less than that in the control group[(11.00±1.73) ml], and the difference was statistically significant ( t=-11.48, P<0.001). Transient hyperpigmentation appeared in the irradiation area 3-5 days after superficial X-ray, which subsided naturally within 6 months in both groups. In addition, there were 5 adverse reactions in the observation group, including delayed healing (2 cases), telangiectasia (2 cases) and abnormal menstrual cycle (1 case). There were 13 cases of adverse reactions in the control group, including telangiectasia (7 cases), abnormal menstrual cycle (2 cases), and atrophic and sunken skin (4 cases). The incidence of adverse reactions in the observation group was significantly lower than that in the control group, and the difference was statistically significant [17.24%(5/29) vs. 44.83%(13/29), χ2=5.16, P<0.001]. Conclusion:Punch excision combined with superficial X-ray and intralesional drug injection for the treatment of chest multiple keloids has the advantages of simple operation, good therapeutic effect and less adverse reactions.

Objective:To explore the feasibility and clinical outcomes of punch excision combined with superficial X-ray and intralesional drug injection in the treatment of chest multiple keloids.Methods:Patients with chest multiple keloids in Dermatology Hospital of Southern Medical University from March 2020 to June 2021 were selected and randomly divided into observation group and control group according to random number table. In the observation group, punch excision was performed first, superficial X-ray was irradiated once within 24 h after surgery, and then once a week, for a total of 4 sessions. One week after radiotherapy, intralesional injection was performed with 5 ml mixture of 1 ml triamcinolone acetate injection, 0.6 ml fluorouracil injection and 3.4 ml 2% lidocaine hydrochloride injection, once a month, for a total of 4 times. Single injection endpoint reaction was keloid whiteness. The control group did not receive punch excision, and other treatments were the same as those in the observation group. Vancouver scar scale (VSS) score and efficacy evaluation (cure, excellent, improvement, ineffective) were performed before treatment and 3, 6, 12 months after treatment. Total keloids volume, intralesional injection volume and adverse reactions before and after treatment were recorded. SPSS 26.0 software was used for data analysis, and the measurement data were expressed as Mean±SD. Independent sample t-test was used for comparison between two groups, and repeated measurement data analysis of variance was used for comparison before and after treatment in the same group. Statistical data were expressed as % and χ2 test was used for comparison between groups. P<0.05 was considered statistically significant. Results:A total of 58 patients were included, 29 in each group. There were 36 males and 22 females. The age ranged from 18 to 59 years old, with an average age of 29. The number of chest keloids in each patient was 5-12. Before treatment, the VSS scores of observation group and control group was 13.21±1.24 and 12.90±1.21 respectively. There was no significant difference in VSS scores between the two groups before treatment ( t=0.97, P=0.337). After 3, 6 and 12 months of follow-up, the VSS scores of the observation group were 4.21±1.26, 4.34±1.40 and 4.55±1.33 respectively, while those of the control group were 5.66±1.32, 6.07±1.44 and 6.62±1.40 respectively. The differences between the two groups were statistically significant ( t=-4.27, -4.63, -5.78, all P<0.001). Intra-group comparison showed that there were no statistically significant differences in VSS scores at 3, 6 and 12 months after treatment in the observation group ( F=2.50, P=0.111), while VSS scores at 3, 6 and 12 months after treatment in the control group showed a gradually increasing trend, with statistically significant difference ( F=30.75, P<0.001). In the observation group, 22 cases showed excellent effect, 7 cases improved, and the excellent rate was 75.86%(22/29). In the control group, there were 6 cases of excellent effect and 23 cases of improvement, the excellent rate was 20.69%(6/29), and the difference between the two groups was statistically significant ( χ2=17.68, P<0.001). Before treatment, the total keloids volume of the observation group was (7.76±1.71) cm 3, which was (8.27±1.26) cm 3 of the control group, and there was no significant difference between the two groups before treatment ( t=-1.28, P=0.207). In the follow-up of 12 months after treatment, the total keloids volume of the observation group[(2.57±0.59) cm 3] was significantly smaller than that of the control group[(5.51±1.39) cm 3], and the difference was statistically significant ( t=-10.47, P<0.001). The total amount of intralesional injection in the observation group[(6.45±1.25) ml] was less than that in the control group[(11.00±1.73) ml], and the difference was statistically significant ( t=-11.48, P<0.001). Transient hyperpigmentation appeared in the irradiation area 3-5 days after superficial X-ray, which subsided naturally within 6 months in both groups. In addition, there were 5 adverse reactions in the observation group, including delayed healing (2 cases), telangiectasia (2 cases) and abnormal menstrual cycle (1 case). There were 13 cases of adverse reactions in the control group, including telangiectasia (7 cases), abnormal menstrual cycle (2 cases), and atrophic and sunken skin (4 cases). The incidence of adverse reactions in the observation group was significantly lower than that in the control group, and the difference was statistically significant [17.24%(5/29) vs. 44.83%(13/29), χ2=5.16, P<0.001]. Conclusion:Punch excision combined with superficial X-ray and intralesional drug injection for the treatment of chest multiple keloids has the advantages of simple operation, good therapeutic effect and less adverse reactions.

Ferroptosis is a kind of programmed cell death, involves multi-molecular and multi-signaling pathways, and the core processes is iron overload and lipid peroxidation. It affects cancer, neurological disease, cardiovascular disease, digestive system disease, and many other diseases. While, ischemia-reperfusion injury is an extremely complex pathological process, including ischemia-reperfusion injury of the heart, brain, liver and kidney, etc., which often occurs in shock, organ surgery and organ transplantation, seriously affecting human health, and there is no effective radical treatment. However, ferroptosis is closely related to ischemia-reperfusion injury so that it is possible to find the prevention and treatment measures of ischemia-reperfusion injury by exploring the internal relationship between them. Therefore, the author tries to summarize the signaling pathways of ferroptosis, and explores the relationship between ferroptosis and ischemia-reperfusion injury of heart, brain, liver and kidney by moderating the ferroptosis targets properly to find the effective ways to treat cancer, improve inflammation and relieve other diseases.

Objective To explore the feasibility and technical tips of the reconstruction of defects around the knee using the reverse-flow thigh flaps based on different branches of the lateral circumflex femoral artery ( LCFA) .A classification method of these flaps was proposed .Methods According to the characteristics of the defects and the LCFA arborizing condition , an optimal reverse-flow thigh flap was chosen for defect reconstruction .Results From 2010 to 2016, 23 patients underwent defect reconstruction using the reverse-flow thigh flaps .The flaps were classified into four different types according to the origin of the perforating vessels on which the flap was based , including the descending ( typeⅠ) , oblique ( typeⅡ) , rectus femoris ( type Ⅲ) , and transverse branches ( type Ⅳ) .In our series of patients , 7 type Ⅰflaps, 10 typeⅡ, 5 typeⅢ, and 1 typeⅣwere included.The reverse flow from the rectus femoris branch was combined and a dual pedicle was formed in 5 patients.The flap size ranged from 8 cm ×7cm to 24 cm × 12 cm.The perforating vessels included septocutaneous in 7 cases and musculocutaneous in the remaining 16.The pedicle length and distance from the pivot point to the superolateral border of the patella were 8.5 cm to 25 cm (mean, 17 cm) and 5 cm to 16 cm (mean, 11.48 cm) respectively.Pre-transfer donor site expansion was conducted in 5 patients.The donor sites were managed by direct closure in 18 cases, free skin grafting in 4, and transferring a pedicled deep inferior epigastric artery perforator flap in the remaining 1.All flaps survived after the surgery except one in which the venous congestion of the flap occurred postoperatively , resolved after using conservative treatment .The patients were followed for 1 to 48 months, tumor recurrence was not noticed and all patients were satisfied with the reconstructive outcomes .Conclusions LCFA-based classification system of the reverse-flow thigh flaps would provide surgeons more options when a defect around knee needs to be reconstructed .

Objective To explore the feasibility and technical tips of the reconstruction of defects around the knee using the reverse-flow thigh flaps based on different branches of the lateral circumflex femoral artery ( LCFA) .A classification method of these flaps was proposed .Methods According to the characteristics of the defects and the LCFA arborizing condition , an optimal reverse-flow thigh flap was chosen for defect reconstruction .Results From 2010 to 2016, 23 patients underwent defect reconstruction using the reverse-flow thigh flaps .The flaps were classified into four different types according to the origin of the perforating vessels on which the flap was based , including the descending ( typeⅠ) , oblique ( typeⅡ) , rectus femoris ( type Ⅲ) , and transverse branches ( type Ⅳ) .In our series of patients , 7 type Ⅰflaps, 10 typeⅡ, 5 typeⅢ, and 1 typeⅣwere included.The reverse flow from the rectus femoris branch was combined and a dual pedicle was formed in 5 patients.The flap size ranged from 8 cm ×7cm to 24 cm × 12 cm.The perforating vessels included septocutaneous in 7 cases and musculocutaneous in the remaining 16.The pedicle length and distance from the pivot point to the superolateral border of the patella were 8.5 cm to 25 cm (mean, 17 cm) and 5 cm to 16 cm (mean, 11.48 cm) respectively.Pre-transfer donor site expansion was conducted in 5 patients.The donor sites were managed by direct closure in 18 cases, free skin grafting in 4, and transferring a pedicled deep inferior epigastric artery perforator flap in the remaining 1.All flaps survived after the surgery except one in which the venous congestion of the flap occurred postoperatively , resolved after using conservative treatment .The patients were followed for 1 to 48 months, tumor recurrence was not noticed and all patients were satisfied with the reconstructive outcomes .Conclusions LCFA-based classification system of the reverse-flow thigh flaps would provide surgeons more options when a defect around knee needs to be reconstructed .

Objective: To explore the clinical effects and key techniques of expanded super-thin perforator flaps in the shoulder, neck, and chest in reconstruction of extensive burn scars in the face. Methods: From January 2008 to November 2018, 22 patients with extensive burn scars in the face were admitted to the Department of Plastic Surgery of Dongguan Kanghua Hospital and the Department of Plastic Surgery of Dermatology Hospital of Southern Medical University, with 3 males and 19 females, aged from 4 to 48 years. There were 16 cases of type Ⅱ and 6 cases of type Ⅲ in facial scars. Before the first stage of expansion surgery, Doppler blood flow survey meter or multi-slice CT was used to locate the perforator vessels. One to four expanders with rated capacity ranged from 100 to 600 mL were placed in the patients. We gave 20% to 30% of the rated capacity of expander intro-operation and common injection with 10% to 15% of the rated capacity of expander per week post-operation until the volume reached 1.5 to 2.5 times of the rated capacity of expander during the past 3 to 4 months. At the second stage of surgery, the perforators were located again before surgery with the same method. The size of defects after the excision of facial scars ranged from 6 cm×4 cm to 18 cm×16 cm. With perforators used as nutrient vessels, narrow pedicle flaps or random flaps ranging from 6 cm×6 cm to 22 cm×18 cm were elevated as rotating or advancing to reconstruct the defects. The donor sites were sutured directly. Some of the flaps needed stage Ⅲ operation for cutting the pedicle. The survival of flaps, post-operation complications, and follow-up were assessed. Results: All flaps of 22 patients survived. All the donor sites were closed simultaneously. One patient underwent an additional surgery for 5 cm×4 cm necrosis on distal part of flap caused by subcutaneous hematoma. Two patients with epidermis blister on the flaps were healed by themselves after dressing change. Due to rapid expansion, blood capillary proliferation appeared on the central part of the flap in 3 cases, after slowing down the expansion speed properly, which had no impact on flap transfer. No ischemia or venous congestion phenomenon were observed in the other flaps. During follow-up of 5 to 48 months, the flaps of patients showed no significant bloated appearance, with good complexion and texture, and even could reproduce facial fine-grained expressions naturally. Conclusions For the reconstruction of extensive burn scars in the face, expanded super-thin perforator flaps can not only acquire large and thin flaps with high matching degree surface skin defect, but also reproduce facial fine-grained expressions. It is a simple and safe method which conforms to the facial aesthetic standard.