Objective:o evaluate the clinical efficacy of the induced membrane technique combined with an antibiotic-impregnated bone cement-coated plate fixation in the treatment of chronic osteomyelitis of the distal femur.Methods:A retrospective study was performed on patients diagnosed with chronic osteomyelitis of the distal femur, who received the induced membrane technique combined with an antibiotic-impregnated bone cement-coated plate fixation at Southwest Hospital from November 2016 to December 2022. All patients underwent a two-stage surgical protocol. Stage I involved thorough debridement, placement of antibiotic-impregnated bone cement spacers, and internal fixation with antibiotic-impregnated bone cement-coated plates. Stage II comprised internal fixation for the repair and reconstruction of bone defects. Intraoperatively, microbial culture, antibiotic susceptibility testing, and pathological examination were conducted on bone tissue lesion samples to guide targeted anti-infective therapy. Postoperatively, laboratory markers including C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), along with clinical manifestations (e.g., incision drainage, redness, fever, and pain), were monitored to exclude infection recurrence. Infection control was ultimately confirmed by intraoperative frozen section analysis during the second stage. Additionally, bone healing was evaluated via X-ray of the affected limb every month after the second-stage surgery, and lower limb function was assessed using the final knee range of motion (ROM) and the lower extremity function scale (LEFS).Results:A total of 104 patients met the inclusion criteria, including 70 males and 34 females, with a mean age of 35.2±12.13 years. Thirty-seven patients were diagnosed with chronic hematogenous osteomyelitis (CHO) and 67 with post-traumatic osteomyelitis (PTOM). The mean follow-up was 25.48±6.61 months (range, 12-38 months). After the first-stage surgery, infection recurred in 6 CHO and 15 PTOM patients, requiring repeated debridement. Two CHO patients experienced infection recurrence after second-stage reconstruction, which was successfully controlled with further staged treatment. Five PTOM patients developed nonunion after second-stage bone grafting but ultimately achieved bone union after revision surgery. At final follow-up, CRP levels were 4.45±4.23 mg/L (CHO) and 5.16±4.26 mg/L (PTOM), and ESR levels were 5.47±7.42 mm/h (CHO) and 8.51±8.72 mm/h (PTOM), all significantly lower than preoperative values (CRP: CHO 68.31±65.61, PTOM 42.71±80.46; ESR: CHO 52.18±34.29, PTOM 45.87±39.13; all P<0.05). All patients ultimately achieved bone union. One PTOM patient with a preoperative rupture of the knee extensor mechanism had limited improvement in ROM (15° preoperatively vs. 12° at 4-year follow-up). In the remaining patients, knee ROM at final follow-up was significantly improved (CHO: 101.38°±43.73°, PTOM: 94.28°±43.94°) compared with preoperative values (CHO: 57.17°± 4.53°, PTOM: 39.61°±52.61°; all P<0.05). The final LEFS scores were 72.18±9.51 (CHO) and 71.66±10.25 (PTOM). Conclusion:The findings of this study demonstrate that the combination of the "Chongqing Technique" and the "Membrane-Induced Technique" is effective in eradicating chronic osteomyelitis of the distal femur, promoting bone healing, and restoring satisfactory knee joint function.

Objective:o evaluate the clinical efficacy of the induced membrane technique combined with an antibiotic-impregnated bone cement-coated plate fixation in the treatment of chronic osteomyelitis of the distal femur.Methods:A retrospective study was performed on patients diagnosed with chronic osteomyelitis of the distal femur, who received the induced membrane technique combined with an antibiotic-impregnated bone cement-coated plate fixation at Southwest Hospital from November 2016 to December 2022. All patients underwent a two-stage surgical protocol. Stage I involved thorough debridement, placement of antibiotic-impregnated bone cement spacers, and internal fixation with antibiotic-impregnated bone cement-coated plates. Stage II comprised internal fixation for the repair and reconstruction of bone defects. Intraoperatively, microbial culture, antibiotic susceptibility testing, and pathological examination were conducted on bone tissue lesion samples to guide targeted anti-infective therapy. Postoperatively, laboratory markers including C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), along with clinical manifestations (e.g., incision drainage, redness, fever, and pain), were monitored to exclude infection recurrence. Infection control was ultimately confirmed by intraoperative frozen section analysis during the second stage. Additionally, bone healing was evaluated via X-ray of the affected limb every month after the second-stage surgery, and lower limb function was assessed using the final knee range of motion (ROM) and the lower extremity function scale (LEFS).Results:A total of 104 patients met the inclusion criteria, including 70 males and 34 females, with a mean age of 35.2±12.13 years. Thirty-seven patients were diagnosed with chronic hematogenous osteomyelitis (CHO) and 67 with post-traumatic osteomyelitis (PTOM). The mean follow-up was 25.48±6.61 months (range, 12-38 months). After the first-stage surgery, infection recurred in 6 CHO and 15 PTOM patients, requiring repeated debridement. Two CHO patients experienced infection recurrence after second-stage reconstruction, which was successfully controlled with further staged treatment. Five PTOM patients developed nonunion after second-stage bone grafting but ultimately achieved bone union after revision surgery. At final follow-up, CRP levels were 4.45±4.23 mg/L (CHO) and 5.16±4.26 mg/L (PTOM), and ESR levels were 5.47±7.42 mm/h (CHO) and 8.51±8.72 mm/h (PTOM), all significantly lower than preoperative values (CRP: CHO 68.31±65.61, PTOM 42.71±80.46; ESR: CHO 52.18±34.29, PTOM 45.87±39.13; all P<0.05). All patients ultimately achieved bone union. One PTOM patient with a preoperative rupture of the knee extensor mechanism had limited improvement in ROM (15° preoperatively vs. 12° at 4-year follow-up). In the remaining patients, knee ROM at final follow-up was significantly improved (CHO: 101.38°±43.73°, PTOM: 94.28°±43.94°) compared with preoperative values (CHO: 57.17°± 4.53°, PTOM: 39.61°±52.61°; all P<0.05). The final LEFS scores were 72.18±9.51 (CHO) and 71.66±10.25 (PTOM). Conclusion:The findings of this study demonstrate that the combination of the "Chongqing Technique" and the "Membrane-Induced Technique" is effective in eradicating chronic osteomyelitis of the distal femur, promoting bone healing, and restoring satisfactory knee joint function.

Before scar reconstruction, a plan must be carefully designed in accordance with certain design principles. The new technologies for scar reconstruction should be carried out actively and steadily in a standardized manner, with attentions to the follow-up and evaluation work after reconstruction. The vigorous development of artificial intelligence, the mature of three-dimensional bioprinting technology, and the in-depth breakthrough in basic research are likely to bring revolutionary progress to the field of scar reconstruction.

Objective:To establish a clinical prediction model for infection risk at the placement sites of skin and soft tissue expanders (hereinafter termed as expanders) and to validate the predictive value of the model.Methods:A retrospective observational study was conducted. Totally 2 934 patients who underwent skin and soft tissue dilatation surgery in the Department of Plastic Surgery of the First Affiliated Hospital of Air Force Medical University from January 2009 to December 2018 and met the selection criteria were included. There were 1 867 males and 1 067 females, with a median age of 18 years. Totally 3 053 skin and soft tissue expansion procedures were performed with 4 266 expanders implanted. The following indexes were selected as predictor variables, including patients' age, gender, marital status, ethnicity, hospital admission, surgical indication, disease duration, with/without history of smoking, history of drinking, history of blood transfusion, history of underlying diseases, and inability to use cephalosporin antibiotics due to allergy, number of expander in a single placement, rated volume of expander, water injection rate of expander in the first time, placement site of expander, anesthesia method, duration of operation, and with/without postoperative hematoma evacuation, and infection at the placement site of expander as the outcome variable. Univariate analysis of the data was performed using least absolute shrinkage and selection operator (LASSO) regression to screen the potential risk factors affecting infection at the placement sites of expanders, the factors selected by the univariate analysis were subjected to binary multivariate logistic regression analysis to screen the independent risk factors affecting infection at the placement sites of expanders, and a nomogram prediction model for the occurrence of infection at the placement sites of expanders was established. The C index and Hosmer-Lemeshow goodness of fit test were used to evaluate the discrimination and accuracy of the model, respectively, and the bootstrap resampling was used for internal verification.Results:The results of LASSO regression showed that age, gender, hospital admission, surgical indication, disease duration, history of drinking, history of heart disease, history of viral hepatitis, history of hypertension, inability to use cephalosporin antibiotics due to allergy, number of expander in a single placement, rated volume of expander, placement site of expander, postoperative hematoma evacuation were the potential risk factors for infection at the placement sites of expanders (regression coefficient=-0.005, 0.170, 0.999, 0.054, 0.510, -0.003, 0.395, -0.218, 0.029, 0.848, -0.116, 0.175, 0.085, 0.202). Binary multivariate logistic regression analysis showed that male, emergency admission, disease duration ≤1 year, inability to use cephalosporin antibiotics due to allergy, rated volumes of expanders ≥200 mL and <400 mL or ≥400 mL, and expanders placed in the trunk or the limbs were the independent risks factors for infection at the placement sites of expanders (odds ratio=1.37, 3.21, 2.00, 2.47, 1.70, 1.73, 1.67, 2.16, 95% confidence interval=1.04-1.82, 1.09-8.34, 1.38-2.86, 1.29-4.41, 1.07-2.73, 1.02-2.94, 1.09-2.58, 1.07-4.10, P<0.05 or P<0.01). The C index for evaluating the discriminative degree of the model was 0.63, the Hosmer-Lemeshow goodness of fit test for evaluating the accuracy of the model showed P=0.685, and the C index for internal validation by the bootstrap resampling was 0.60. Conclusions:Male, emergency admission, disease duration ≤1 year, inability to use cephalosporin antibiotics due to allergy, rated volume of expander ≥200 mL, and expanders placed in the trunk or the limbs are the independent risk factors for infection at the placement sites of expanders. The clinical prediction model for infection risk at the placement sites of expanders was successfully established based on these factors and showed a certain predictive effect.

Objective:To explore the clinical effect of pre-expanded deltopectoral flap in the repair of faciocervical lesion and defect.Methods:From July 2004 to August 2018, 355 patients with faciocervical lesion and defect were admitted to the First Affiliated Hospital of Air Force Medical University, including 200 males and 155 females aged 4 to 48 years with major conditions including thermal burn scars, and type Ⅲ and Ⅳ facial-cervical deformities. During the stage Ⅰ skin soft tissue expander implantation surgery, according to the size and location of lesion and defect, expanders with appropriate volume were placed to expand the deltopectoral area. During the stage Ⅱ flap pedicled transposition surgery, after the expander was expanded to the desired volume, the impairment tissue was removed, the flap was designed according to the size of the defect (the unilateral defect area was 7 cm×5 cm to 17 cm×16 cm) and pedicled transposition was carried out. The incision in the chest donor area was directly sutured and closed. After the flap survived, stage Ⅲ flap delay and pedicle division surgery was carried out. The area of one single flap was 8 cm×5 cm to 20 cm×18 cm. The numbers of flaps and expanders, rated volume and expansion of expander, the intervals between surgeries in each stage, flap survival, postoperative complications in surgeries in each stage, and follow-up were recorded and analyzed.Results:A total of 460 pre-expanded deltopectoral flaps were used, including 250 unilateral flaps and 105 bilateral flaps. Totally 460 expanders were used in this group of patients. The rated volume was mostly 500 mL (163 expanders) and 600 mL (142 expanders). The expansion multiple of the expander was (1.14±0.19) times of the rated volume. The flap expansion time of the patients was (96±30) d, the pedicle time was (32±8) d, and the delay time was (7.5±1.6) d. The postoperative complications of patients mainly included infection (29 patients), expander exposure (18 patients), and hematoma (10 patients). During the follow-up of 6 to 120 months, the elasticity, texture, and color of the flaps of patients were similar to the surrounding tissue of the recipient area, and the face and neck were symmetrical, not bloated.Conclusions:The deltopectoral flap obtained by overexpansion has a larger area and a thinner thickness, and the elasticity, texture, and color are similar to the surrounding tissue of the recipient area. After transfer, a stable appearance of the face and neck can be obtained. The main complications are infection and expander exposure, most of which occurred after stage Ⅰ skin soft tissue expander implantation surgery.

Objective:To explore the clinical effect of expanded scalp flaps in repconstructing the wounds after resection of frontal and facial nevus and scar.Methods:From May 2014 to May 2019, 28 patients (5 cases of nevus and 11 cases of scar in the frontal part and 2 cases of nevus, 9 cases of scar and 1 case of verrucous nevus in facial part) were repaired with expanded scalp flaps. According to the size of the lesion, the expander was selected and placed under the galea aponeurotica. After tissue expansion, the wound was reconstructed by random designed or pedicled skin flaps. The pedicled skin flaps took the branch of superficial temporal artery as the pedicle. The pedicle was cut off after 3 weeks. Hair removal by laser was performed 3 to 6 times 2 weeks after removing the suture.Results:In all the 28 cases, expansion in the first stage was sufficient, after skin flap transfer in the second stage, all survived without infection or local necrosis. After the pedicle division, 2 cases had small area of distal blood flow disorder, and the wound was healed after skin grafting The follow-up time ranged from 3 to 31 months. After hair removal by laser, the color and texture matched well with the normal skin in the adjacent area. No contracture and pigmentation occurred, and the effect was satisfactory.Conclusions:The scalp is a good donor site for expansion with sufficient tissue and few secondary deformities. The expanded scalp flap has good blood supply for repairing frontal and facial lesions, after hair removal by laser, the effect is good, and it is worth popularizing and applying.

Objective:To explore the clinical effect of expanded scalp flaps in repconstructing the wounds after resection of frontal and facial nevus and scar.Methods:From May 2014 to May 2019, 28 patients (5 cases of nevus and 11 cases of scar in the frontal part and 2 cases of nevus, 9 cases of scar and 1 case of verrucous nevus in facial part) were repaired with expanded scalp flaps. According to the size of the lesion, the expander was selected and placed under the galea aponeurotica. After tissue expansion, the wound was reconstructed by random designed or pedicled skin flaps. The pedicled skin flaps took the branch of superficial temporal artery as the pedicle. The pedicle was cut off after 3 weeks. Hair removal by laser was performed 3 to 6 times 2 weeks after removing the suture.Results:In all the 28 cases, expansion in the first stage was sufficient, after skin flap transfer in the second stage, all survived without infection or local necrosis. After the pedicle division, 2 cases had small area of distal blood flow disorder, and the wound was healed after skin grafting The follow-up time ranged from 3 to 31 months. After hair removal by laser, the color and texture matched well with the normal skin in the adjacent area. No contracture and pigmentation occurred, and the effect was satisfactory.Conclusions:The scalp is a good donor site for expansion with sufficient tissue and few secondary deformities. The expanded scalp flap has good blood supply for repairing frontal and facial lesions, after hair removal by laser, the effect is good, and it is worth popularizing and applying.

Objective: To explore the clinical effects of expanded forehead flaps in repairing midfacial defects. Methods: From January 2003 to December 2018, 19 patients with midfacial defects were admitted to our unit, including 8 males and 11 females, aged 7 to 52 years. One cylindrical expander with rated capacity ranged from 100 to 170 mL was placed in the forehead of patients in the first stage of expansion, and the total water injection volume was about 2 times of the rated capacity of the expander during 1 to 2 months. The area of midfacial defects was 4 cm×2 cm to 9 cm×5 cm after resection in the second stage surgery. Expanded forehead flaps with vascular pedicle of supratrochlear vessels or frontal branch of superficial temporal vessels were used to repair the midfacial defects, with flap size ranging from 5 cm×2 cm to 16 cm×6 cm. The donor sites were closed by direct suturing. Three weeks later, the pedicle was divided. The complications, blood supply after flap transfer and pedicle division, and the treatment effects during follow-up were observed. Results: Among the patients, flaps of 11 patients had vascular pedicle of supratrochlear vessels; flaps of 8 patients had vascular pedicle of frontal branch of superficial temporal vessels. All the flaps survived with no complications and good blood supply after flap transfer and pedicle division. During the follow-up of 6 to 12 months after the third stage surgery of pedicle division of 12 patients, no lower eyelid ectropion occurred, the appearance of the flaps was similar to the surrounding tissue with no swelling. Conclusions The application of expanded forehead flaps can not only repair the defects but also effectively avoid the complication of lower eyelid ectropion, which is a promising method in repairing midfacial defects.

Objective To evaluate the clinical outcome of reduction plasty for labia minora hy-pertrophy with redundant praeputium clitoridis .Methods A total of 84 cases were included from June 2013 to December 2016 .Arc-shaped resection of labia minora and crescent resection of redundant pra-eputium clitoridis were the two essntial surgical procedure ,and 5-0 VICRYL Rapide was used for su-turing the incision .Results The 84 cases were operated with this mothod with satisfactory aesthetic result .Complications ,such as hematoma ,infection and poor wound healing ,were not observed .Ede-ma was resoluted after one to two weeks .After the reduction plasty of the labial labia ,the vagina and perineum were completely covered in the natural state ,without scar ,also the sensitivity of clitoris was improved due to the better expoure post-operationally .Conclusions The same-stage reduction plasty for labia minora hypertrophy with redundant praeputium clitoridis is a reliable and effective method . Both satisfactory aesthetic result and improved sexual sensitivity are achived ,without hematoma ,in-fection and poor wound healing .

Objective To investigate the application of expanded local flap in repairing extremity scars.Methods Thirty patients with extremity scars contracture as a result of trauma,surgery or infection during July 2000 and March 2013 were included.There were 11 male and 19 female patients with age ranging from 11 to 34 years.Tissue expansion,scar resection,flap transfer and scar management were involved in this process.Results There 24 patients suffered from upper extremity scars and 6 patients suffered from lower extremity scars.Expander exposure was noted in 3 patients,and 3 patients suffered from infection during the expansion.During the 6-month to 1-year follow-up,all patients satisfied with the results in terms of the skin texture,color,flexibility after the treatment with expanded local skin flap.Conclusions The expanded local flaps are suitable for the repair of the longitudinal and oblique scars in the extremities.