Objective:To evaluate the clinical effect of antibiotic-loaded bone cement implantation combined with free chimeric tissue flap transplantation in the sequential treatment of severe gouty wounds.Methods:This study was a retrospective observational study. From July 2019 to July 2022, 11 male patients with severe gouty wounds who were aged 33 to 71 years and met the inclusion criteria were admitted and treated at the Affiliated Hospital of Zunyi Medical University. The wounds were located on the hands in 2 cases, the ankles in 5 cases, and the feet in 4 cases. After debridement, the wound area ranged from 5.0 cm×4.0 cm to 22.0 cm×6.0 cm. All wounds were sequentially repaired with antibiotic-loaded bone cement implantation combined with free chimeric tissue flaps transplantation. Two cases were repaired by free perforating branch of superficial circumflex iliac artery with chimeric osseous flaps, with the areas of harvested skin flaps being 5.5 cm×4.0 cm and 8.0 cm×6.0 cm, respectively, and the volumes of iliac bone flaps being 2.0 cm×2.0 cm×1.5 cm and 3.5 cm×2.0 cm×2.0 cm, respectively. Two cases were repaired by free perforating branch of deep circumflex iliac artery with chimeric osseous flaps, with the areas of harvested skin flaps being 6.0 cm×4.0 cm and 7.5 cm×5.0 cm, respectively, and the volumes of iliac bone flaps being 2.0 cm×1.5 cm×1.5 cm and 2.5 cm×2.0 cm×1.5 cm, respectively. Seven cases were repaired by free chimeric myocutaneous flaps based on the descending branch of the lateral circumflex femoral artery. The areas of harvested skin flaps ranged from 9.5 cm×6.0 cm to 25.0 cm×6.5 cm, and the volumes of muscle flaps ranged from 4.0 cm×3.0 cm×2.0 cm to 6.0 cm×5.0 cm×2.5 cm. The donor site wounds were directly sutured. The chimeric tissue flap was freely transplanted to the recipient wound site, of which the iliac bone graft was used to fill the bone defect, the muscle flap was utilized to fill the wound cavity, and the skin flap was employed to cover the wound surface; the arteries and veins in the vascular pedicle were anastomosed with those in the recipient area. At admission and 3 days post antibiotic-loaded bone cement implantation, the changes in white blood cell count, neutrophil and hypersensitive C-reactive protein level, as well as the bacterial culture of wound secretions specimen, and the growth of granulation tissue were observed. After stage Ⅱ surgery, the survival of transplanted chimeric tissue flaps, the occurrence of vascular crisis, and the healing of wounds in donor and recipient sites were observed. During follow-up, the blood supply, appearance, and texture of the transplanted tissue flaps in the recipient sites, the function and appearance of the affected limbs and fingers, and the complications in the donor and recipient sites were observed.Results:Three days post antibiotic-loaded bone cement implantation, white blood cell count, hypersensitive C-reactive protein level, and neutrophil significantly decreased compared with those at admission (with Z values of -2.93 and -2.93 respectively, t=8.63, P<0.05). At admission, all patients exhibited bacterial infections with redness and swelling around the wounds. Three days post antibiotic-loaded bone cement implantation, bacterial cultures of wound secretions specimen were negative, local redness resolved, and granulation tissue showed good growth. After stage Ⅱ surgery, all chimeric flaps survived without vascular crises. The wound healing in the recipient site of the dorsum of the foot in one patient was poor and delayed but healed after dressing changes; all the other recipient sites in remaining patients healed successfully. The donor incision healed well in all patients. During 6 to 24 months of follow-up, the flaps in the recipient area demonstrated good blood circulation, texture, and appearance. Bone healing was achieved in 4 patients with iliac grafts. Nine patients with lower limb wounds were able to bear weight, and the functions including gripping, palm alignment, and finger alignment were significantly improved in 2 patients with hand wounds. No significant complications were observed in donor or recipient sites. Conclusions:In treating patients with severe gouty wounds, the sequential strategy of stage Ⅰ debridement with antibiotic-loaded bone cement implantation followed by stage Ⅱ free chimeric osseous flaps or myocutaneous flaps repair can achieve effectively control of postoperative wound infection, promote wound healing, and well restore the functions of affected finger or limb with no obvious complications, which is worthy of promotion for clinical application.

Objective:To investigate the effects of applying the lateral circumflex femoral artery chimeric perforator flap in repairing composite tissue defects in the ankle and foot area.Methods:This study was a retrospective observational study. From January 2018 to December 2023, 12 patients with composite tissue defects in the ankle and foot area who met the inclusion criteria were admitted to the Department of Burns and Plastic Surgery of the Affiliated Hospital of Zunyi Medical University, including 9 males and 3 females, aged from 4 to 64 years. The causes of the injuries included traffic accident injuries in 7 cases, wringing injuries in 2 cases, crush injuries in 2 cases, and fall injury in 1 case. All patients had combined skin and soft tissue defects, with the defect areas ranging from 10.0 cm×5.0 cm to 22.0 cm×7.0 cm. Among them, 7 patients had ankle joint capsule defects sized from 3 cm×2 cm to 6 cm×5 cm; 3 patients had Achilles tendon defects ranged from 4 to 8 cm in length; 1 patient had an extensor hallucis longus tendon defect of 4 cm in length; 1 patient had an extensor digitorum longus tendon defect of 10 cm in length. All patients underwent repair of the composite tissue defects using the lateral circumflex femoral artery chimeric perforator flaps. Flaps with sizes ranging from 11.0 cm×5.5 cm to 24.0 cm×6.5 cm were used to repair skin and soft tissue defects, and fascia lata flaps with sizes ranging from 4.0 cm×2.5 cm to 17.0 cm×2.0 cm were used to repair joint capsule and tendon defects. The flap donor area wound was closed by suturing. Postoperatively, regular follow-up was conducted to observe the survival of the flaps after surgery, the repair of the defects, the healing of the incisions in the flap donor area, the occurrence of complications, the appearance and texture of the flaps, the scar formation in the surgical area, and the movement of the lower limb on the flap donor side. At the last follow-up, the American Orthopaedic Foot and Ankle Society scoring standard was used to evaluate the function of the ankle and foot.Results:All patients were followed up for 2 to 38 months, with an average of 8.7 months. After surgery, all flaps survived, and all wounds in the recipient areas healed. In patients who underwent ankle joint capsule and tendon reconstruction, there was no swelling in the joints, and the joint movements were good without foot drop or toe drop deformities. All incisions in the flap donor areas were healed without any complication. The families of 2 children took their children back to the hospital for flap thinning at 3 and 4 months respectively after surgery because they felt that the flaps were bulky. The other patients were satisfied with the appearance and texture of the flaps. One child had obvious scar hyperplasia in the early stage, and the scar gradually faded after external application of anti-scar medications and pressure treatment. The scars of the other patients were not obvious. All patients had normal lower limb movements on the flap donor side. At the last follow-up, the functions of the ankle and foot were rated as excellent in 8 cases and good in 4 cases.Conclusions:The lateral circumflex femoral artery chimeric perforator flap is flexible in design. It can repair the composite tissue defects in the skin and soft tissue, joint capsules, and tendons of the ankle and foot simultaneously. There are no obvious complications in the flap donor area. Most patients are satisfied with the appearance of the flap in the recipient area. The flap is soft in texture, and the functions of the ankle and foot are well restored.

Objective:To investigate the clinical effect of chimeric flap with perforating branch of superficial circumflex iliac artery in reconstruction of complex tissue defect in Achilles tendon region.Methods:A retrospective analysis was conducted on 9 patients who underwent reconstruction of composite tissue defects in Achilles tendon region with the perforator flap of lateral femoral circumflex artery, from January 2017 to January 2023 in the Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University. The patients were 7 males and 2 females and at 16 to 54 years, with 36.6 years in average. Causes of injury were: 5 patients by traffic accident, 2 by machine strangulation and 1 by heavy object, also 1 defect was caused by infection. The soft tissue defects were 4.5 cm×6.0 cm to 8.0 cm×12.0 cm in size, and the defects of Achilles tendon were 4.5 cm to 11.5 cm, with an average of 6.8 cm in length. The wounds were managed with VSD after primary surgery, and then stage Ⅰ surgery were followed to reconstruct the defects in Achilles tendon region with perforator flap of lateral femoral circumflex artery. The sizes of chimeric flaps were 6.5 cm×5.0 cm to 18.0 cm×6.5 cm, including 3 lobuated flaps. The fascia grafts were 5.5 cm to 12.0 cm, with an average of 7.0 cm. Scheduled postoperative follow-ups were conducted in outpatient clinic and via telephone or WeChat interviews, together with the advices for rehabilitation training. Postoperative functions of the Achilles tendon and ankle function were evaluated using Arner-Lindholm criteria and the ankle and hindfoot functional score of American Orthopaedic Foot and Ankle Society (AOFAS).Results:All of the 9 chimeric flaps survived and all the donor sites had primary healing. All patients were entered into the postoperative follow-up for 10 to 66 months, with 14.6 months in average. One chimeric flap was found bulky and a flap thinning surgery was further carried out in 3 months under the request of patient. The rest of patients were satisfied with the appearance and texture of the flaps. The range of ankle plantar flexions was found at 42.9°±1.8° and the dorsal flexions was at 16.2°±2.5°. There was no significant decrease in circumference and no discomfort or muscle re-rupture in the affected legs. Thompson test was found negative. There was no wound related complications during follow-up. Reconstructive surgery were found effective based on Arner-Lindholm criteria, with excellent in 6 patients, good in 2 and 1 in fair. The ankle and subtalar joint function was evaluated according to the ankle-hindfoot function score of AOFAS, with 7 patients scored 90-100 point and 2 scored 75-89 point, and 7 patients were in excellent and 2 in good.Conclusion:The chimeric perforator flap of lateral femoral circumflex artery is safe and reliable in reconstruction of composite tissue defects in Achilles tendon region. It can effectively restore the function and appearance of ankle and hindfoot in patients with composite tissue defects in the Achilles tendon region.

Objective:To explore the clinical application value of infrared thermal imaging in assisting the repair of complex joint tissue defects in children using the lateral femoral circumflex artery (LFCA) chimeric perforator flap.Methods:A retrospective analysis was conducted on clinical data from the Department of Burns and Plastic Surgery at the Affiliated Hospital of Zunyi Medical University between May 2019 and September 2023. The study included cases where the LFCA perforator chimeric flap was used to repair complex joint tissue defects in children. Preoperative perforator mapping was performed using an infrared thermal imaging device combined with a portable Doppler. The flap and fascial flap were designed based on the distribution of hot spots and thermal lines. Intraoperative confirmation of perforator distribution was carried out. Postoperative follow-ups were conducted to assess flap survival, the need for secondary thinning procedures, wound healing status, donor site scarring, joint swelling, and functional recovery.Results:A total of 11 pediatric patients were enrolled, including 8 males and 3 females, aged 2 to 14 years (mean age: 5.8 years). The injury mechanisms included traffic accidents (6 cases), wheel spoke injuries (2 cases), falls (2 cases), and heavy object crush injuries (1 case). Affected joints included the wrist (1 case), knee (2 cases), and ankle (8 cases). Associated injuries included metacarpal fracture (1 case), metatarsal fractures (2 cases), and extensor tendon defects (1 case). Tendon defect length was 3 cm, joint capsule defect area ranged from 2 cm × 3 cm to 4 cm × 6 cm, and fascial flap size ranged from 2 cm × 4 cm to 2 cm × 14 cm. Skin defect area ranged from 5 cm × 3 cm to 16 cm × 9 cm, and flap size ranged from 6 cm × 4 cm to 15 cm × 5 cm. Preoperative infrared thermography identified 28 hot spots, with 26 perforators confirmed intraoperatively (positive rate: 92.9%). Thermal line distribution zones consistently corresponded to perforator branches. All 11 flaps survived, with primary healing achieved at both donor and recipient sites. Follow-up duration ranged from 6 to 36 months (mean: 10.5 months). All recipient sites exhibited soft flap texture. One case required secondary debulking due to flap bulkiness. Donor sites showed only linear scarring. During follow-up, no significant joint swelling, functional impairment, or joint dislocation was observed.Conclusion:Infrared thermal imaging-assisted perforator mapping for the design of LFCA chimeric perforator flaps is a safe and reliable method for repairing complex joint tissue defects in children. It provides accurate perforator localization, offering significant clinical value for the design and harvesting of LFCA chimeric perforator flaps in pediatric patients.

Objective:To explore the research hotspots and emerging trends in the field of breast cancer-associated lymphedema, as reflected in the domestic and international literatures.Methods:The bibliometric method was used to retrieve literatures related to breast cancer-associated lymphedema from the Wanfang Database, China National Knowledge Infrastructure, China Science and Technology Journal Database, and the core collection of Web of Science, covering the time range from January 1, 2014, to December 31, 2023. CiteSpace 6.3.R3 software was employed for analysis, which involved statistical assessment of the publication volume, authors, countries, and institutions, as well as the identification of highly cited papers. A co-occurrence analysis of keywords was performed, followed by burst analysis and cluster analysis based on the results.Results:A total of 4 419 Chinese-language articles were retrieved from the three Chinese databases, of which 2 888 were included after duplicate removal. The Web of Science Core Collection yielded 2 142 English-language articles. Among the domestic authors, the top three with the highest publication counts were Zhang Lijuan (25 papers), Jia Jie (22 papers), and Zhong Qiaoling (21 papers). In the English-language literatures, the top three authors with the highest number of publications were Singhal D (32 papers), Devoogdt N (27 papers), and Boyages J (27 papers). A total of 76 countries worldwide had conducted research on breast cancer-associated lymphedema, with the United States contributing the most publications (748 papers), followed by China (227 papers). In total, 642 institutions worldwide had publications on this topic, with 385 domestic institutions. The leading domestic institution was Jiangxi Provincial Cancer Hospital (31 papers), while the top foreign institution was Harvard University (118 papers). The Top 10 most cited papers focused on key research areas in breast cancer-associated lymphedema. A total of 359 Chinese keywords and 513 English keywords were included for co-occurrence analysis. The five most frequent Chinese keywords were quality of life, nursing, complications, upper limb function, and risk factors. In the English literatures, the top five most frequent keywords were quality of life, women, survivors, risk factors, and surgery. Cluster analysis of the keywords revealed 16 clusters in the Chinese literatures, with the largest cluster "functional exercise", while 17 clusters were identified in the English literatures, with the largest cluster "lymph node transfer". The five most consistent clusters in Chinese literatures were lymphatic drainage, rehabilitation, functional impairment, evidence-based nursing, and circumferential lymphatics. In recent years, emerging topics in Chinese literatures included lymphatic drainage, breast reconstruction, and pathophysiology. In English literatures, the consistent top clusters were transplantation, node biopsy, morbidity, identification, and randomized trials, with recent emerging topics including obesity, adipose tissue, healing approaches, lymphatic microsurgical preventive healing approach, and anastomosis.Conclusion:The research on breast cancer-related lymphedema both domestically and internationally shows similarities and differences in direction and focus. Common research hotspots across both domestic and international studies include lymphatic drainage, functional exercise, health behaviors, and lymph node transfer. Recent emerging topics in Chinese literatures include lymphatic drainage, breast reconstruction, and pathophysiology. In contrast, English literatures focus more on the areas such as obesity, adipose tissue, healing methods, and lymphatic anastomosis.

Objective:To investigate the clinical effect of chimeric flap with perforating branch of superficial circumflex iliac artery in reconstruction of complex tissue defect in Achilles tendon region.Methods:A retrospective analysis was conducted on 9 patients who underwent reconstruction of composite tissue defects in Achilles tendon region with the perforator flap of lateral femoral circumflex artery, from January 2017 to January 2023 in the Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University. The patients were 7 males and 2 females and at 16 to 54 years, with 36.6 years in average. Causes of injury were: 5 patients by traffic accident, 2 by machine strangulation and 1 by heavy object, also 1 defect was caused by infection. The soft tissue defects were 4.5 cm×6.0 cm to 8.0 cm×12.0 cm in size, and the defects of Achilles tendon were 4.5 cm to 11.5 cm, with an average of 6.8 cm in length. The wounds were managed with VSD after primary surgery, and then stage Ⅰ surgery were followed to reconstruct the defects in Achilles tendon region with perforator flap of lateral femoral circumflex artery. The sizes of chimeric flaps were 6.5 cm×5.0 cm to 18.0 cm×6.5 cm, including 3 lobuated flaps. The fascia grafts were 5.5 cm to 12.0 cm, with an average of 7.0 cm. Scheduled postoperative follow-ups were conducted in outpatient clinic and via telephone or WeChat interviews, together with the advices for rehabilitation training. Postoperative functions of the Achilles tendon and ankle function were evaluated using Arner-Lindholm criteria and the ankle and hindfoot functional score of American Orthopaedic Foot and Ankle Society (AOFAS).Results:All of the 9 chimeric flaps survived and all the donor sites had primary healing. All patients were entered into the postoperative follow-up for 10 to 66 months, with 14.6 months in average. One chimeric flap was found bulky and a flap thinning surgery was further carried out in 3 months under the request of patient. The rest of patients were satisfied with the appearance and texture of the flaps. The range of ankle plantar flexions was found at 42.9°±1.8° and the dorsal flexions was at 16.2°±2.5°. There was no significant decrease in circumference and no discomfort or muscle re-rupture in the affected legs. Thompson test was found negative. There was no wound related complications during follow-up. Reconstructive surgery were found effective based on Arner-Lindholm criteria, with excellent in 6 patients, good in 2 and 1 in fair. The ankle and subtalar joint function was evaluated according to the ankle-hindfoot function score of AOFAS, with 7 patients scored 90-100 point and 2 scored 75-89 point, and 7 patients were in excellent and 2 in good.Conclusion:The chimeric perforator flap of lateral femoral circumflex artery is safe and reliable in reconstruction of composite tissue defects in Achilles tendon region. It can effectively restore the function and appearance of ankle and hindfoot in patients with composite tissue defects in the Achilles tendon region.

Objective:To evaluate the clinical effect of antibiotic-loaded bone cement implantation combined with free chimeric tissue flap transplantation in the sequential treatment of severe gouty wounds.Methods:This study was a retrospective observational study. From July 2019 to July 2022, 11 male patients with severe gouty wounds who were aged 33 to 71 years and met the inclusion criteria were admitted and treated at the Affiliated Hospital of Zunyi Medical University. The wounds were located on the hands in 2 cases, the ankles in 5 cases, and the feet in 4 cases. After debridement, the wound area ranged from 5.0 cm×4.0 cm to 22.0 cm×6.0 cm. All wounds were sequentially repaired with antibiotic-loaded bone cement implantation combined with free chimeric tissue flaps transplantation. Two cases were repaired by free perforating branch of superficial circumflex iliac artery with chimeric osseous flaps, with the areas of harvested skin flaps being 5.5 cm×4.0 cm and 8.0 cm×6.0 cm, respectively, and the volumes of iliac bone flaps being 2.0 cm×2.0 cm×1.5 cm and 3.5 cm×2.0 cm×2.0 cm, respectively. Two cases were repaired by free perforating branch of deep circumflex iliac artery with chimeric osseous flaps, with the areas of harvested skin flaps being 6.0 cm×4.0 cm and 7.5 cm×5.0 cm, respectively, and the volumes of iliac bone flaps being 2.0 cm×1.5 cm×1.5 cm and 2.5 cm×2.0 cm×1.5 cm, respectively. Seven cases were repaired by free chimeric myocutaneous flaps based on the descending branch of the lateral circumflex femoral artery. The areas of harvested skin flaps ranged from 9.5 cm×6.0 cm to 25.0 cm×6.5 cm, and the volumes of muscle flaps ranged from 4.0 cm×3.0 cm×2.0 cm to 6.0 cm×5.0 cm×2.5 cm. The donor site wounds were directly sutured. The chimeric tissue flap was freely transplanted to the recipient wound site, of which the iliac bone graft was used to fill the bone defect, the muscle flap was utilized to fill the wound cavity, and the skin flap was employed to cover the wound surface; the arteries and veins in the vascular pedicle were anastomosed with those in the recipient area. At admission and 3 days post antibiotic-loaded bone cement implantation, the changes in white blood cell count, neutrophil and hypersensitive C-reactive protein level, as well as the bacterial culture of wound secretions specimen, and the growth of granulation tissue were observed. After stage Ⅱ surgery, the survival of transplanted chimeric tissue flaps, the occurrence of vascular crisis, and the healing of wounds in donor and recipient sites were observed. During follow-up, the blood supply, appearance, and texture of the transplanted tissue flaps in the recipient sites, the function and appearance of the affected limbs and fingers, and the complications in the donor and recipient sites were observed.Results:Three days post antibiotic-loaded bone cement implantation, white blood cell count, hypersensitive C-reactive protein level, and neutrophil significantly decreased compared with those at admission (with Z values of -2.93 and -2.93 respectively, t=8.63, P<0.05). At admission, all patients exhibited bacterial infections with redness and swelling around the wounds. Three days post antibiotic-loaded bone cement implantation, bacterial cultures of wound secretions specimen were negative, local redness resolved, and granulation tissue showed good growth. After stage Ⅱ surgery, all chimeric flaps survived without vascular crises. The wound healing in the recipient site of the dorsum of the foot in one patient was poor and delayed but healed after dressing changes; all the other recipient sites in remaining patients healed successfully. The donor incision healed well in all patients. During 6 to 24 months of follow-up, the flaps in the recipient area demonstrated good blood circulation, texture, and appearance. Bone healing was achieved in 4 patients with iliac grafts. Nine patients with lower limb wounds were able to bear weight, and the functions including gripping, palm alignment, and finger alignment were significantly improved in 2 patients with hand wounds. No significant complications were observed in donor or recipient sites. Conclusions:In treating patients with severe gouty wounds, the sequential strategy of stage Ⅰ debridement with antibiotic-loaded bone cement implantation followed by stage Ⅱ free chimeric osseous flaps or myocutaneous flaps repair can achieve effectively control of postoperative wound infection, promote wound healing, and well restore the functions of affected finger or limb with no obvious complications, which is worthy of promotion for clinical application.

Objective:To investigate the effects of applying the lateral circumflex femoral artery chimeric perforator flap in repairing composite tissue defects in the ankle and foot area.Methods:This study was a retrospective observational study. From January 2018 to December 2023, 12 patients with composite tissue defects in the ankle and foot area who met the inclusion criteria were admitted to the Department of Burns and Plastic Surgery of the Affiliated Hospital of Zunyi Medical University, including 9 males and 3 females, aged from 4 to 64 years. The causes of the injuries included traffic accident injuries in 7 cases, wringing injuries in 2 cases, crush injuries in 2 cases, and fall injury in 1 case. All patients had combined skin and soft tissue defects, with the defect areas ranging from 10.0 cm×5.0 cm to 22.0 cm×7.0 cm. Among them, 7 patients had ankle joint capsule defects sized from 3 cm×2 cm to 6 cm×5 cm; 3 patients had Achilles tendon defects ranged from 4 to 8 cm in length; 1 patient had an extensor hallucis longus tendon defect of 4 cm in length; 1 patient had an extensor digitorum longus tendon defect of 10 cm in length. All patients underwent repair of the composite tissue defects using the lateral circumflex femoral artery chimeric perforator flaps. Flaps with sizes ranging from 11.0 cm×5.5 cm to 24.0 cm×6.5 cm were used to repair skin and soft tissue defects, and fascia lata flaps with sizes ranging from 4.0 cm×2.5 cm to 17.0 cm×2.0 cm were used to repair joint capsule and tendon defects. The flap donor area wound was closed by suturing. Postoperatively, regular follow-up was conducted to observe the survival of the flaps after surgery, the repair of the defects, the healing of the incisions in the flap donor area, the occurrence of complications, the appearance and texture of the flaps, the scar formation in the surgical area, and the movement of the lower limb on the flap donor side. At the last follow-up, the American Orthopaedic Foot and Ankle Society scoring standard was used to evaluate the function of the ankle and foot.Results:All patients were followed up for 2 to 38 months, with an average of 8.7 months. After surgery, all flaps survived, and all wounds in the recipient areas healed. In patients who underwent ankle joint capsule and tendon reconstruction, there was no swelling in the joints, and the joint movements were good without foot drop or toe drop deformities. All incisions in the flap donor areas were healed without any complication. The families of 2 children took their children back to the hospital for flap thinning at 3 and 4 months respectively after surgery because they felt that the flaps were bulky. The other patients were satisfied with the appearance and texture of the flaps. One child had obvious scar hyperplasia in the early stage, and the scar gradually faded after external application of anti-scar medications and pressure treatment. The scars of the other patients were not obvious. All patients had normal lower limb movements on the flap donor side. At the last follow-up, the functions of the ankle and foot were rated as excellent in 8 cases and good in 4 cases.Conclusions:The lateral circumflex femoral artery chimeric perforator flap is flexible in design. It can repair the composite tissue defects in the skin and soft tissue, joint capsules, and tendons of the ankle and foot simultaneously. There are no obvious complications in the flap donor area. Most patients are satisfied with the appearance of the flap in the recipient area. The flap is soft in texture, and the functions of the ankle and foot are well restored.

Objective:To explore the clinical application value of infrared thermal imaging in assisting the repair of complex joint tissue defects in children using the lateral femoral circumflex artery (LFCA) chimeric perforator flap.Methods:A retrospective analysis was conducted on clinical data from the Department of Burns and Plastic Surgery at the Affiliated Hospital of Zunyi Medical University between May 2019 and September 2023. The study included cases where the LFCA perforator chimeric flap was used to repair complex joint tissue defects in children. Preoperative perforator mapping was performed using an infrared thermal imaging device combined with a portable Doppler. The flap and fascial flap were designed based on the distribution of hot spots and thermal lines. Intraoperative confirmation of perforator distribution was carried out. Postoperative follow-ups were conducted to assess flap survival, the need for secondary thinning procedures, wound healing status, donor site scarring, joint swelling, and functional recovery.Results:A total of 11 pediatric patients were enrolled, including 8 males and 3 females, aged 2 to 14 years (mean age: 5.8 years). The injury mechanisms included traffic accidents (6 cases), wheel spoke injuries (2 cases), falls (2 cases), and heavy object crush injuries (1 case). Affected joints included the wrist (1 case), knee (2 cases), and ankle (8 cases). Associated injuries included metacarpal fracture (1 case), metatarsal fractures (2 cases), and extensor tendon defects (1 case). Tendon defect length was 3 cm, joint capsule defect area ranged from 2 cm × 3 cm to 4 cm × 6 cm, and fascial flap size ranged from 2 cm × 4 cm to 2 cm × 14 cm. Skin defect area ranged from 5 cm × 3 cm to 16 cm × 9 cm, and flap size ranged from 6 cm × 4 cm to 15 cm × 5 cm. Preoperative infrared thermography identified 28 hot spots, with 26 perforators confirmed intraoperatively (positive rate: 92.9%). Thermal line distribution zones consistently corresponded to perforator branches. All 11 flaps survived, with primary healing achieved at both donor and recipient sites. Follow-up duration ranged from 6 to 36 months (mean: 10.5 months). All recipient sites exhibited soft flap texture. One case required secondary debulking due to flap bulkiness. Donor sites showed only linear scarring. During follow-up, no significant joint swelling, functional impairment, or joint dislocation was observed.Conclusion:Infrared thermal imaging-assisted perforator mapping for the design of LFCA chimeric perforator flaps is a safe and reliable method for repairing complex joint tissue defects in children. It provides accurate perforator localization, offering significant clinical value for the design and harvesting of LFCA chimeric perforator flaps in pediatric patients.

Objective:To explore the research hotspots and emerging trends in the field of breast cancer-associated lymphedema, as reflected in the domestic and international literatures.Methods:The bibliometric method was used to retrieve literatures related to breast cancer-associated lymphedema from the Wanfang Database, China National Knowledge Infrastructure, China Science and Technology Journal Database, and the core collection of Web of Science, covering the time range from January 1, 2014, to December 31, 2023. CiteSpace 6.3.R3 software was employed for analysis, which involved statistical assessment of the publication volume, authors, countries, and institutions, as well as the identification of highly cited papers. A co-occurrence analysis of keywords was performed, followed by burst analysis and cluster analysis based on the results.Results:A total of 4 419 Chinese-language articles were retrieved from the three Chinese databases, of which 2 888 were included after duplicate removal. The Web of Science Core Collection yielded 2 142 English-language articles. Among the domestic authors, the top three with the highest publication counts were Zhang Lijuan (25 papers), Jia Jie (22 papers), and Zhong Qiaoling (21 papers). In the English-language literatures, the top three authors with the highest number of publications were Singhal D (32 papers), Devoogdt N (27 papers), and Boyages J (27 papers). A total of 76 countries worldwide had conducted research on breast cancer-associated lymphedema, with the United States contributing the most publications (748 papers), followed by China (227 papers). In total, 642 institutions worldwide had publications on this topic, with 385 domestic institutions. The leading domestic institution was Jiangxi Provincial Cancer Hospital (31 papers), while the top foreign institution was Harvard University (118 papers). The Top 10 most cited papers focused on key research areas in breast cancer-associated lymphedema. A total of 359 Chinese keywords and 513 English keywords were included for co-occurrence analysis. The five most frequent Chinese keywords were quality of life, nursing, complications, upper limb function, and risk factors. In the English literatures, the top five most frequent keywords were quality of life, women, survivors, risk factors, and surgery. Cluster analysis of the keywords revealed 16 clusters in the Chinese literatures, with the largest cluster "functional exercise", while 17 clusters were identified in the English literatures, with the largest cluster "lymph node transfer". The five most consistent clusters in Chinese literatures were lymphatic drainage, rehabilitation, functional impairment, evidence-based nursing, and circumferential lymphatics. In recent years, emerging topics in Chinese literatures included lymphatic drainage, breast reconstruction, and pathophysiology. In English literatures, the consistent top clusters were transplantation, node biopsy, morbidity, identification, and randomized trials, with recent emerging topics including obesity, adipose tissue, healing approaches, lymphatic microsurgical preventive healing approach, and anastomosis.Conclusion:The research on breast cancer-related lymphedema both domestically and internationally shows similarities and differences in direction and focus. Common research hotspots across both domestic and international studies include lymphatic drainage, functional exercise, health behaviors, and lymph node transfer. Recent emerging topics in Chinese literatures include lymphatic drainage, breast reconstruction, and pathophysiology. In contrast, English literatures focus more on the areas such as obesity, adipose tissue, healing methods, and lymphatic anastomosis.