Objective:To explore a reasonable relationship between the survival of descending genicular artery (chimeric) perforator flap [DGAPF (-Ch)] and the preservation of the great saphenous vein (GSV), so as to optimise the protection and reduction of a damage to the donor site in clinical applications.Methods:From June 2015 to October 2022, the Division of Orthopaedics and Traumatology of Department of Orthopaedics of Nanfang Hospital, Southern Medical University, conducted cadaver perfusion studies on 15 fresh specimens of human lower extremity, and then on 31 patients who received free DGAPF (-Ch) transfer surgery. Among the patients, 13 had soft tissue defects in hand or forearm, 17 had soft tissue defects in foot or ankle and 1 had early femoral head necrosis after internal fixation for femoral neck fracture. Among them, 6 patients were complicated with bone defect. The size of soft tissue defect was 5.5 cm×3.0 cm-13.0 cm×6.5 cm, the size of flaps was 6.5 cm×3.5 cm-14.5 cm×7.5 cm, and bone flap volume was 3.5 cm×1.5 cm×1.5 cm-5.0 cm×1.5 cm×1.5 cm. All patients underwent preoperative evaluation of donor site by computed tomography angiography (CTA), and the CTA data were processed with Mimics 20.0 to design the flaps. Intraoperatively, the location of the descending genicular artery (DGA) was detected using Doppler ultrasound. When harvesting the flap, the P point (SP-p) was used as the centre to form an arteriovenous pedicle. A matching medial femoral condyle flap was designed to reconstruct the bone defect. The free flap (25 patients) or chimeric flap (6 patients) was transferred to the recipient site, and end-to-end vessel anastomoses were performed to establish the blood supply. After surgery, the patients were kept in bed for 7-9 days. Antibiotics were routinely administered to prevent infection, together with a symptomatic anticoagulation and anti-spasm treatment. The colour, temperature, capillary refilling and tension of the flap were closely observed. All patients were entered in postoperative follow-up at outpatient clinic for review at 1, 3, and 6 months after surgery to observe the appearance, texture and function of the flaps and the condition of the donor sites.Results:Through anatomy observation, cutaneous perforating branch of DGA was located in front of the main trunk of the GSV at the plane of medial femoral condyle. It was found that both of the perforators of cutaneous artery and the branches of osteoarticular artery originated from the DGA. Distance between SP-p and S-p(DSPS) of fresh samples was 2.9-4.1 (3.6±0.5) cm. The DSPS of 31 patients measured in surgery was 2.9-4.3 (3.7±0.4) cm. A total of 30 flaps survived completely. One flap had partial necrosis, which healed at 2 weeks after skin grafting. The postoperative follow-up lasted for 6-48 (mean, 11.23) months. X-rays of 5 patients with chimeric bone flaps showed the healing of bone defects at 3 months after surgery. All donor sites were directly sutured and left with linear scars after healing, except 5 donor sites that received skin grafting. Eight patients received further flap thinning surgery at 3 to 12 months after primary surgery without any complication. All donor sites healed well without numbness.Conclusion:If the GSV is preserved during harvest of a DGAPF(-Ch), it causes less damage to the donor site and does not affect the survival of the flap. The DGAPF(-Ch) without GSV is a better method in the surgical treatment of complex tissue defects.

Objective:To explore a reasonable relationship between the survival of descending genicular artery (chimeric) perforator flap [DGAPF (-Ch)] and the preservation of the great saphenous vein (GSV), so as to optimise the protection and reduction of a damage to the donor site in clinical applications.Methods:From June 2015 to October 2022, the Division of Orthopaedics and Traumatology of Department of Orthopaedics of Nanfang Hospital, Southern Medical University, conducted cadaver perfusion studies on 15 fresh specimens of human lower extremity, and then on 31 patients who received free DGAPF (-Ch) transfer surgery. Among the patients, 13 had soft tissue defects in hand or forearm, 17 had soft tissue defects in foot or ankle and 1 had early femoral head necrosis after internal fixation for femoral neck fracture. Among them, 6 patients were complicated with bone defect. The size of soft tissue defect was 5.5 cm×3.0 cm-13.0 cm×6.5 cm, the size of flaps was 6.5 cm×3.5 cm-14.5 cm×7.5 cm, and bone flap volume was 3.5 cm×1.5 cm×1.5 cm-5.0 cm×1.5 cm×1.5 cm. All patients underwent preoperative evaluation of donor site by computed tomography angiography (CTA), and the CTA data were processed with Mimics 20.0 to design the flaps. Intraoperatively, the location of the descending genicular artery (DGA) was detected using Doppler ultrasound. When harvesting the flap, the P point (SP-p) was used as the centre to form an arteriovenous pedicle. A matching medial femoral condyle flap was designed to reconstruct the bone defect. The free flap (25 patients) or chimeric flap (6 patients) was transferred to the recipient site, and end-to-end vessel anastomoses were performed to establish the blood supply. After surgery, the patients were kept in bed for 7-9 days. Antibiotics were routinely administered to prevent infection, together with a symptomatic anticoagulation and anti-spasm treatment. The colour, temperature, capillary refilling and tension of the flap were closely observed. All patients were entered in postoperative follow-up at outpatient clinic for review at 1, 3, and 6 months after surgery to observe the appearance, texture and function of the flaps and the condition of the donor sites.Results:Through anatomy observation, cutaneous perforating branch of DGA was located in front of the main trunk of the GSV at the plane of medial femoral condyle. It was found that both of the perforators of cutaneous artery and the branches of osteoarticular artery originated from the DGA. Distance between SP-p and S-p(DSPS) of fresh samples was 2.9-4.1 (3.6±0.5) cm. The DSPS of 31 patients measured in surgery was 2.9-4.3 (3.7±0.4) cm. A total of 30 flaps survived completely. One flap had partial necrosis, which healed at 2 weeks after skin grafting. The postoperative follow-up lasted for 6-48 (mean, 11.23) months. X-rays of 5 patients with chimeric bone flaps showed the healing of bone defects at 3 months after surgery. All donor sites were directly sutured and left with linear scars after healing, except 5 donor sites that received skin grafting. Eight patients received further flap thinning surgery at 3 to 12 months after primary surgery without any complication. All donor sites healed well without numbness.Conclusion:If the GSV is preserved during harvest of a DGAPF(-Ch), it causes less damage to the donor site and does not affect the survival of the flap. The DGAPF(-Ch) without GSV is a better method in the surgical treatment of complex tissue defects.

Treatment of adult femoral neck fracture is still a great challenge faced by trauma orthopedists. As treatment effects can be infleunced by multiple factors, like age, gender and preoperative physical condition, they may vary with different treatment schemes. Classification of femoral neck fractures plays an important guiding role in choosing a proper treatment scheme and judging the prognosis. The current classic clinical classification systems for femoral neck fractures include Garden, AO/OTA and Pauwels classifications. Since the recent progress in science and technology has put more advanced technologies into clinic application, such as CT, MRI and Digital Subtraction Angiography (DSA), new ways of classification have appeared. However, each classification has its own shortcomings which need to be improved. This paper reviews the research progress in classification of adult femoral neck fractures and their treatment principles.

Objective:To evaluate internal fixation via only the modified Stoppa approach in the treatment of central hip dislocation complicated with fracture of the posterior acetabular wall.Methods:A retrospective study was conducted in the 13 patients with central hip dislocation and fracture of the posterior acetabular wall who had been treated at Department of Orthopedic Trauma, Nanfang Hospital between February 2015 and February 2018. They were 10 men and 3 women, aged from 31 to 65 years (average, 46.7 years). All patients were treated with internal fixation via only the modified Stoppa approach. The reduction of double-column and posterior wall fractures was evaluated according to the X-ray Matta scoring system, as well as to the Wiberg central-edge (CE) angles between the vertical line of the center point of the femoral head and the lateral edge of the acetabulum and acetabular tolerance on the normal and affected sides immediately after operation; the hip function was evaluated by the modified Merle d'Aubigne and Postel scoring system at 12 months after operation.Results:All patients were followed up for 16 to 52 months (average, 25.6 months). In all of them, reduction and fixation of central hip dislocation and acetabular fracture was completed successfully, and indirect reduction of posterior wall fracture and acetabular tolerance were satisfactory. Operation time ranged from 130 to 270 min, averaging 155.5 min; intraoperative blood loss from 600 to 5,600 mL, averaging 1,150.5 mL; intraoperative infusion of concentrated red blood cells from 2 to 12 U, averaging 6 U. By the X-ray Matta scoring system immediately after operation, anatomical reduction was achieved in 4 posterior wall fractures and satisfactory reduction in 9 ones. There was no significant difference between the normal and affected sides in the CE angle (43.53°±3.46° for the affected side versus 43.19°±3.28° for the normal side) or in the acetabular tolerance (76.56%±15.50% for the affected side versus 75.32%±16.24% for the normal side) ( P>0.05). The modified Merle d'Aubigne and Postel scores at 12 months after operation ranged from 12 to 18 points, averaging 16.5 points; the hip function was assessed as excellent in 9 cases, as good in 3 and as fair in one. By the last follow-up, none of the 13 patients lost fracture reduction, and their internal fixation was firm with no loosening or breakage. Conclusion:In the treatment of central hip dislocation complicated with fracture of the posterior acetabular wall, internal fixation via only the modified Stoppa approach can lead to satisfactory fracture reduction, firm fixation, good hip joint tolerance, and fine clinical efficacy.

Femoral neck fracture in children is usually caused by high-energy trauma. This relatively rare injury characterized by skeletal immaturity is different from that in adult patients in proximal femoral anatomy and blood supply. Currently, a variety of fixation methods have been used for paediatric femoral neck fractures but their overall goal is anatomical reduction and stable fixation. Femoral neck fractures in children are usually associated with a high incidence of complications (e.g. femoral head necrosis, premature epiphyseal closure, coxa vara and nonunion) even after appropriate treatment. This review addresses the anatomic characteristics, treatment strategies and complications in the treatment of paediatric femoral neck fractures.

Objective:To investigate the effect of transforming growth factor (TGF- β) signal in muscle fiber itself during inflammation/immunity response on intramuscular inflammation. Methods:Sixteen wild C57BL/6 mice (wild group) and sixteen mice with skeletal muscle-specific deficiency of T βRⅡ (knock-out group) between 4-8 weeks of age were selected for this study. Acute muscle injury in mice was induced by injection of myotoxin cardiotoxin (CTX) into gastrocnemius. The differences in intramuscular inflammation were compared between the wild and knock-out groups on 0, 4, 7 and 10 d after CTX injection by observing exudation of mononuclear phagocytes, macrophages, M1 type macrophages, CD4 +T cells and helpers T cells (Th1, 2&17). Two newborn C57BL/6 wild mice and 2 SM TGF- βr2-/- knock-out mice were selected to culture primary myoblasts in vitro which were divided into 2 groups: an interferon group subjected to interferon simulation and a control group subjected to addition of an equal amount of solvent. The differences in expression of IL-6, IL-10, MCP-1, MIP-1α, H-2K b, H2-Ea, Toll-like receptor (TLR)3 and TLR7 were compared between the interferon and control groups, as well as between the wild and knock-out groups. Results:On 4&7 d after CTX injection, the ratios of mononuclear/macrophage (75.73%±3.62%, 45.27%± 2.32%), macrophages (38.67%±2.76%, 24.87%±2.19%), M1 macrophages (43.21%±0.11%, 30.43%±2.19%), CD4 +T cells (20.13%±1.62%, 5.67%±0.32%) in the muscle tissue from the knock-out mice were significantly higher than those from the wild mice (58.52%±2.43%, 29.21%±2.45%; 20.63%±2.32%, 16.23%±1.25%; 24.98%±0.35%, 14.23%±1.69%; 10.70%±0.43%, 2.50%±0.45%), with a majority of Th1&Th17 ( P<0.05). In vitro results showed that the levels of IL-6, MCP-1, MIP-1α, H-2K b, H2-Ea and TLR3 were significantly upregulated in the interferon group compared with the control group and that such upregulation in the nock-out mice was more significant than in the wild mice ( P<0.05). Conclusions:Endogenous TGF- β signal activation plays a role in the functional recovery after muscle trauma, because it is involved in the regulation of immune behavior of muscle fibers, thus affecting intramuscular inflammation and muscle regeneration.

With deepening understanding of surgical treatment of calcaneal fractures,clinical applications of external fixators have drawn more attention.At present,however,there has been no systematic review of such applications for intra-articular calcaneal fracture.This review collected all the recent reports available on such applications to analyze the use and clinical indications of different external fixators.Moreover,on the basis of our own clinical experience,we further proposed a novel treatment protocol for intraarticular calcaneal fractures which integrates internal and external fixation and minimally invasive techniques.

Objective To explore the clinical technical points of the treatment of soft tissue defect of the foot and ankle with the supercharged peroneal artery perforator propeller flap,and to provide theoretical support by anatomical observation.Methods From January,2010 to February,2018,a total of 10 patients with soft tissue defect of foot and ankle were treated with supercharged peroneal artery perforator propeller flap.Cause of injury:trauma in 7 cases,wound ulcer in 1 case,and poor healing of the calcaneus incision in 2 cases.Defect site:5 cases of heel,2 cases of medial and lateral malleolus,and 3 cases of dorsum and sole.The size of flap ranged from 6.0 cm×3.0 cm to 16.0 cm×5.0 cm.All patients were followed-up at 1,3,6 months after operation,and the function recovery was judged by AOFAS Ankle Hindfood Scale at 3 months post-opertively.From November,2016 to May,2017,the anatomical basis and operative points of the supercharged peroneal artery perforator flap were summarized.Results All the 10 cases of supercharged peroneal artery perforator propeller flap survived.Two of them had local epidermal necrosis at the proximal end of the flap.After 1 to 2 weeks of dressing,they finally healed.The other 8 cases healed well.Anatomical studies showed that different planes of the supercharged peroneal artery perforator propeller flap can only reduce the compression of the double pedicles and reduce the distal necrosis rate of the flap by rotating in different rotation directions.Conclusion The supercharged peroneal artery perforator propeller flap can enhance the blood supply and venous return in the "big paddle" artery of the flap,preventing distal necrosis.

Objective To explore the clinical effect of endoscope assisted suction-cutter removal of apocrine sweat glands in treatment of osmidrosis.Methods This study generalized and analyzed the curative effects of 30 patients with axillary osmidrosis,treated with endoscopy assisted suction-cutter removal of apocrine sweat glands.The efficacy was evaluated according to the postoperative results and complications.Results In all the 30 patients,wound healed 7 to 10 days after operation,and they resumed almost normal life after treatment.From May 2015 to April 2017,the follow-up visits showed that none of them had relapse,infection or skin necrosis.Surgical scar was slight,and in all the patients,symptoms disappeared.Conclusions The operation of endoscopy assisted suction-cutter removal of apocrine sweat glands is a minimally invasive surgery.The advantages include direct vision,radical operation,well preserved dermal vascular network and lower risk of complications.

Objective To clarify the function of LIM and SH3 domain protein-1 (LASP1) and ferritin in rhBMP2-induced osteogenic differentiation of beagle bone marrow mesenchymal stem cells (BMSCs).Methods After BMSCs from 3-18-month-old C57BL/6J mice were cultured adherently for 24 hours,they were subjected to osteogenic differentiation for 7,14 and 21 days in 3 groups.BMP2 (100 μg/L) and osteogenic differentiation medium was added in the experimental group,only osteogenic differentiation medium was added in the control group,and nothing was added in the blank group.Osteoblast differentiation was determined by examining marker genes (Runx2,OSX,OCN and OPN) using qRT-PCR.The protein expression of both LASP1 and ferritin was investigated using western blotting.After LASP1 and ferritin were silenced in the cells in the experimental group after transfection of shRNA to target LASP1(m),rhBMP2-induced osteogenesis was repeated to verify the roles of LASP1 and ferritin in osteoblast differentiation.Results The qRT-PCR showed successful osteoblast differentiation in the experimental group.Western blotting verified significant down-regulation of LASP1 and up-regulation of ferritin in the experimental group.After the LASP1 gene was silenced,the expression levels of osteoblast differentiation marker genes in the experimental group were higher than those in the control group.Conclusions rhBMP2 can induce mouse BMSCs to differentiate into osteoblasts in a significant manner.Combined with our preliminary research,the present study may confirm that LASP1 and ferritin,which play an important role in regulating cytoskeleton activity and iron metabolism,are critical in the osteogenic differentiation of mouse BMSCs induced by rhBMP2.