Objective To evaluate therapeutic effect of endovascular treatment of iliac,femoral or popliteal artery injury with VIABAHN stent.Methods Endovascular treatment of iliac,femoral or popliteal artery injury was performed with VIABAHN stents in 12 patients admitted to our hospital from August 2015 to December 2013.Results Technical success rate was 100％.Strong instant postoperative pulsation of all dorsal and posterior tibial arteries could be palpated.No procedural and postoperative short term complications (endoleak,stent migration,hematoma at puncture site,thrombosis in arteries and stents and contrast nephropathy) were found.ABI value of injured lower limbs was promoted from preoperative 0.45 ± 0.12 to postoperative 0.95 ± 0.06.Mild stenosis (＜ 30％) of proximal end of stent was noted in one case by CTA.Patients were followed up for 3-18 months [averaging (10 ± 4) months].There was no postoperative limb ischeamia related symptoms.ABI was above 0.9 in all patients.Conclusion The short and middle term therapeutic effect of endovascular treatment of iliac,femoral and popliteal artery injury with VIABAHN stent was satisfactory.

OBJECTIVETo explore the biological characteristics of fibroblasts in adult granulation tissue in vitro, including cell viability, CD phenotypic, factor and protein expression, and differentiation, so as to facilitate further research of the role of fibroblasts in early wound healing.

METHODSFibroblasts were isolated from human granulation tissue and cultured by mechanical and enzymatic digestion method. The cell morphology and proliferation were observed under inverted phase contrast microscope. The first and third passages of cells' growth curve were drawn respectively. The surface markers (CD105, CD73, CD90, CD44, CD34, CD45, CD19, CD11b, HLA-DR) of the first and third passage fibroblasts were identified by Flow Cytometry. And the expression of Vimentin, CK19, CD31 and Factor VIII were detected by immunocytochemistry.

RESULTSPrimary cultured fibroblasts were short spindle, polygonal and irregular in shape. The morphology of fibroblasts were uniform by repeatedly passage cultured in vitro and showed spindle-shaped. The proliferative capacity of the fibroblasts were not significantly different, with logarithmic growth phase. From 1 to 4 days, The primary and third passage cells' proliferation was no difference (P > 0.05), After the five days, the proliferative ability of third generation was better than the primary passage (P < 0.01). All fibroblasts highly expressed mesenchymal stem cells' surface markers CD105, CD73, CD90 and CD44, and didnt express hematopoietic stem cells' surface markers CD34, CD45, CD19, CD11b and HLA-DR. The expression of mesenchymal stem cells' surface markers in third generation of cells were increased significantly. Immunocytochemistry showed positive expression of Vimentin, CD31, and negative expression of CK19 and Factor VIII.

CONCLUSIONSFibroblasts in human granulation tissue show the biology characteristics of Mesenchymal Stem Cells. Some biological markers of endothelial cells are expressed in fibroblasts in granulation tissue. The fibroblasts may play an important role during the process of endothelial to mesenchymal transformation in early wound healing.

Objective To explore an anatomical basis for the medial plantar skin flaps and its clinical value of repairing heel defects. Methods The origin,branches,course and distribution of the medial plantar artery and the nerve of flaps were studied in 10 adult cadavers(20 legs).8 cases of homonymy and opposite side heel soft tissue defects with medial plantar skin flaps,aged 10-42 years.Free skin transplantation on the donors. Results The length of media plantar artery deep branch was (8.9±0.2)cm,gives off 3-5 cutaneous branches.Medial plantar nerve have 5-8 branches.it inchdes 3～5cutaneous branches distribute plantar skin and 2-4 plantar digital nerves distribute toes skin.The area of flaps was 4.0 cm×3.0 cm-6.0 cm×5.0 cm in the 8 flaps. 6 pedicle skin flaps were transfenrred to repair homonymy side heel soft tissue defects.2 opposite side heel soft tissue defects were repaired by 2 free flaps.All the flaps were survived. All patients were followed up one months to one year,the function and appearance of the flaps were good.Conclusion The flaps have less anatomic variation or sacrificing major vessels but have reliable blood supply and can restore good sensation after operation.They are ideal flaps for repairing heel soft tissue defects.

With the change of disease spectrum and the progress in the aging of society, chronic wound has gradually become one of the major diseases that threaten human health, and also one of the major economic burdens of family and society. According to the different etiology, the pathogenesis of chronic wound is different, including both systemic factors and local factors. The treatment of chronic wound is a multi-disciplinary integrated treatment process, including internal medicine treatment, surgical treatment, vascular interventional therapy, platelet-rich plasma treatment, and biological therapy, etc. Each treatment regimen has its own indications and pros and cons. To make a treatment regimen, a combination of a variety of options should be chosen according to the patient′s wound conditions. The traditional chronic wound treatment mode is multi-disciplinary team (MDT) treatment mode, which requires the participation of surgeons from multiple departments such as intervention department, plastic surgery department, orthopedics department, etc., and it is also the mainstream mode for treating chronic wound in western countries. According to the domestic medical situation and the experience of our department, we put forward the integrated surgical wound treatment (ISWT) mode, that is to integrate multiple surgical techniques of wound treatment. Compared with the traditional MDT treatment mode, to apply the ISWT mode can make a more reasonable treatment plan, improve the efficiency of diagnosis and treatment, shorten the hospitalization period, and improve the diagnosis and treatment ability of the team. With the increasing incidence of chronic wound, the ISWT mode needs to be further explored and improved, and the team needs more specialized experts to join in.

Mesenchymal stem cells(MSCs) are currently the research hotspot on promoting wound healing and preventing organ fibrosis. The application of MSCs has reached the clinical trial stage, however, its nomenclature and biological mechanism are still controversial. Early researchers believed that MSCs play the biological role by its multi-directional differentiation, to repair damaged tissues. In recent years, researchers have found that the conditioned medium of MSCs has the same effect as MSCs in promoting wound healing and preventing fibrosis organ. This suggested that the biological effects of MSCs may be mainly caused by its paracrine mechanism. In this paper, the nomenclature evolution, biological mechanism of MSCs, and the existing problems are briefly reviewed. The hypothesis of " MSCs microenvironment extracellular vesicles" is proposed and discussed.

In 600 BC, the first pedicled direct cutaneous artery perforator flap—the supravicular artery perforator flap was harvested by Sushruta. In 1973, the first free perforator flap—the superficial circumflex iliac artery flap in the groin was reported by Daniel and Taylor. In 1982, the septocutaneous perforator flap was reported by academician Zhong Shizhen. In 1989, the misculocutaneous perforator flap was reported by Koshima. Reviewing the history of flap surgery, there was a fact that the main evolutionary line was the course of perforator flap. In the future, the clinical application of the traditional random flap (reticulated blood supply flap) and traditional axial flap will be more and more less, whereas the clinical application of perforator flap, especially the direct cutaneous perforator flap and the special type of perforator flap will be more and more extensive.

Skin is the largest sense organ of human, with many mechanoreceptor cells under epidermis or dermis of skin and Merkel cell is one of them. It has been confirmed that Merkel cells play an important role in the process of mechanical transmission of mammalian soft tactile stimulation. Researches showed that Merkel cells had close relation to tactile formation and functioned by Merkel cell-neurite complexes and ion channels Piezo2. This article reviews Merkel cells and the function, problem and prospect of Merkel cells in tactile formation.

Burn pain starts immediately after burn and may last through the whole course of treatment, and it even may accompany patients with deep burn in the phase of scar formation. Burn pain makes patients anxious for a long period of time, thus seriously lowers life quality of them. In recent years, researchers at home and abroad have had new understanding for ideas of treating burn pain, and reports about the treatment of burn pain have been growing. At present, attention to and knowledge about burn pain are far from enough in clinic. There is a long way to go for further improving the treatment level of burn pain and changing ideas about treating it. This article reviews the clarification, the mechanism, the method of assessment, and therapy of burn pain.

Objective To investigate the clinical effect of inherent artery dorsal perforator flaps of thumb radial palmar for coverage of ipsilateral thumb degree Ⅰ and Ⅱ oblique defect of the fingertip.Methods The study included 6 males and 6 females,aged 10-40 years (mean 30 years),with thumb fingertip Ⅰ and Ⅱ degree defect treated between October 2009 and October 2013.Injury resulted from machinery cutting injury in 4 patients,machinery twist injury in 3,cutting by sharp weapons in 3,and crush injury in 2.There were 6 patients with Ⅰ degree defect and 6 patients with Ⅱ degree defect.Defects were all oblique involving more in the radial side rather than in the ulnar side and reconstructed with thumb radial palmar artery perforator flaps.Flap ranged in size from 1 cm × 2 cm to 1.5 cm × 2.5 cm.Donor site was covered with skin grafts.Observation indexes were wound healing condition,flap color,flap swelling degree,and flap temperature.Finger function was measured with upper extremity scoring system formulated by Hand Surgery Branch of Chinese Medical Association.Results All flaps survived and achieved good protective sensation.Wound healed primarily.Color,temperature and texture of the flap returned to almost normal.Moderate swelling of the flaps was detected and subsided around one week.All patients were followed up for 1-36 months (mean 20 months).At the final follow-up,two-point discrimination was 9-11 mm (mean 10 mm).Two patients developed distal interphalangeal joint stiffness and recovered after rehabilitation exercise.Finger function was rated as excellent in 10 cases and good in 2.Conclusion Inherent artery dorsal perforator flap of thumb radial palmar has affirmative effect and allows maximum preservation of finger length and function when applied to repair ipsilateral thumb degree Ⅰ and Ⅱ oblique defect of the fingertip.

Objective To summarize the clinical efficacy of free KISS lateral femoral circumflex artery perforator flap in repairing defects of limbs.Methods Twelve cases were suffered wound surface defects on hands and feet.And the defects were repaired by flap construction from October,2010 to May,2013,based on the characteristics of the defects combined with anatomical features of the free lateral femoral circumflex artery perforator flap.Length of flap was adopted as the width for direct suture in the flap donor.Results Postoperative flap and donor area preliminarily healed.There was no vascular crisis.Twelve cases received 6-18 months followed-up (averaged of 12 months).The skin flap was good in color and texture.The dorsal flap was a bit bloated.Linear scar was remained in distal flap donor area.The quadriceps muscle power level 5,knee flexion,extension 10°-180°.Quadriceps strength,knee flexion and stretch activities were all normal.The flaps recovered protective sense.Four cases had tendon adhesion after hand tendon transplantation.The finger function was well recovered after release.At the last followup,the functions of the upper limbs were evaluated according to the trial evaluation standard of the Hand Surgery Association of Chinese Medical Association:6 cases were excellent,1 case was good,and 1 case was qualified.Conclusion The design of the lobulated tissue flap of the lateral femoral circumflex artery descending branch is flexible.Large area of the surface defect can be repaired.The flap donor area is directly sutured.It is an ideal method to repair the wound tissue defect.