Bone Transplantation/adverse effects* ; Transplantation, Autologous/adverse effects*

Microsurgery is not only a technology, but also a science. Microsurgery was enlisted as a tier-three discipline in the Classification of National Clinical Medicine Disciplines (Discipline code 320.2715) in 1992. In the new era, the discipline development of microsurgery should be inherited, innovated, realistic and pragmatic, and it also relies on the other surgical specialties to expand the applications of microsurgery. Microsurgery technology should firmly adhere to its core competitiveness and hold high the banner of microsurgical characteristics by offering the best possible serves to all the clinical surgical disciplines; Pay equal attention to medicine, teaching and scientific researches; Unite, collaborate and strengthen academic exchanges at home and abroad; Focus on talent training (i.e. exports of great country, leading figures, etc.) and support the development of private hospitals specialised in microsurgery. The supportive roles of the Chinese Journal of Microsurgery shall be further enforced to facilitate the discipline development of microsurgery and promoting high-quality development of microsurgery.

Objective In the context of expanding in size and improving the quality of medical consumables,the"one product,one policy"approach has brought challenges to the management of consumables in public hospitals.This study investi-gated the potential management problems in the process of centralized procurement with volume of medical consumables in a pub-lic tertiary hospital in Guangdong Province,and accordingly worked out the corresponding management countermeasures and then assessed their implementation effects.Methods The fishbone diagrams was applied to systematically analyze the potential prob-lems in the implementation process of centralized procurement with volume of medical consumables.Targeted measures were worked out from May to July 2023 in the hospital.The time series data of centralized procurement of coronary stents,pacemak-ers,tubular/end-to-end anastomoses,and spinal products from December 2022 to December 2023 were analyzed.Changes in the monthly implementation rate and contract completion volume pre-and post-intervention were measured to evaluate the effectiveness of the intervention.Results The fishbone diagrams analysis revealed that the primary factors impeding procurement implementa-tion were internal system flaws,personnel management inadequacy,supply issues,and an absence of an information system.Post-intervention,the monthly implementation rate(t=-4.19,P＜0.05)and contract completion(t=-2.38,P＜0.05)significantly improved.Conclusion The implementation of intervention management for centralized procurement with volume of medical consumables can effectively promote the related implementation effect in the department.In the context of centralized pro-curement,clinical and health management personnel need to bolster their professionalism to ensure the procurement management efficiency and quality.It is crucial to deepen policy understanding and implementation,enhance production and distribution process supervision and disciplinary mechanisms,ensure multi-departmental coordination for supply security,and improve hospi-tal information systems and procurement platforms.

Replantation of traumatic amputation in children has its own characteristics. This consensus primarily focuses on the issues related to the treatment of traumatically amputated limb injuries in children. Organised along a timeline, the consensus summarises domestic and international clinical experiences in emergency care and injury assessment of traumatic limb amputation limbs, indications and contraindications for replantation surgery, principles and procedures of replantation surgery, postoperative medication and management, as well as rehabilitation in children. The aim of this consensus is to propose standardise the treatment protocols for limb replantation for children therefore to serve as a reference for clinical practitioners in medical practices, and further improve the treatment and care for the traumatic limb amputations in children.

Objective:To investigate the preoperative risk factors affecting early extremity blood supply after repair of major arterial injury so as to provide clues for prevention of limb ischemia.Methods:The clinical data were retrospectively analyzed of the 139 patients (140 extremities) with major extremity arterial injury who had been admitted to Department of Microsurgery, Orthopaedic Trauma and Hand Surgery, The First Hospital Affiliated to Sun Yat-sen University from January 2003 to December 2019. There were 112 males and 27 females, with a mean age of 30 (20, 44) years. The primary outcome was the early status of blood supply to the injured extremity (48 hours after surgery). Univariate analysis was conducted of such factors as gender, age, ischemia time, injury mechanism, injury site, fracture, soft tissue lesion, and duration of surgery. The significant factors ( P<0.1) were then analyzed by logistic regression, and P<0.05 was considered statistically significant. Results:Ischemia happened in 44 (31.4%, 44/140) extremities within 48 hours after surgery. There were significant differences in injury mechanism, ischemia time, fracture, and soft tissue lesion between patients with and without postoperative extremity ischemia ( P<0.05). Logistic regression analysis indicated that blunt injury ( OR=5.639, 95% CI: 1.068 to 29.761, P=0.042) and soft tissue lesion ( OR=12.568, 95% CI: 3.402 to 46.431, P<0.001) were significant preoperative risk factors affecting the early blood supply after repair of major extremity arterial injury. Conclusion:As blunt injury and soft tissue defect are preoperative risk factors for early extremity ischemia after repair of major extremity arterial injury, surgeons should pay more attention to them when assessing patients and making repair protocols.

Report a case sustained Gustilo type III C open fracture of the left humerus with brachial artery injury who has limb ischemia and wound infection after operation in June, 2014. To salvage the limb, performed cross limb vessel transfer to restore blood supply at one-stage. After multiple debridement, Flow-through flap transfer was performed for definitive reconstruction of the arterial injury and repair the wound in secondary stage. In the 3rd stage, cutting the pedicle of transposition vessels. Follow-up at 1 year after surgery, the patient's left upper limb had survived with limited movement and confirmed Flow-through the vessel reconstruction using CTA.

In and from year 2020, we will work on an enthusiastic initiative: to make the Chinese Journal of Microsurgery a world leading sci-tech journal by executing our new mission "inheritance, innovation, unity, cooperation and internationalization" . Two special columns will be created: World Masters in Microsurgery and Pioneers of Microsurgery in China. We will start to compile a bilingual Bibliographic Index of Literatures in Microsurgery in China (Chinese and English), and publish a commemorative album which includes all the successive members of the editorial boards of the Chinese Journal of Microsurgery. A new academic and communicational forum will be established through a series of academic seminars held by the Chinese Journal of Microsurgery. In addition, we will start professional training programs for the surgeons and junior surgeons who work in the first-line of care in microsurgery, assist and enable them to participate international academic events and build/establish cooperation with their international counterparts. In line with international standards, we will apply bilingual titles and abstracts of articles in both Chinese and English, and add English interpretations/translations to all the references listed in Chinese. We will continue to keep our best work to make our journal being listed by the Medline hence to fulfil international involvement.

As continuous progressive improvement in microsurgery, the postoperative evaluation of severed limbs replantation has been developed from the survival to the functional recovery of replanted extremity. In 1978, Chen Zhongwei devised a system for the function evaluation of the replants, considering "the ability to work, range of motion, recovering of sensation, and recovering of muscle power". This system was called "CHEN’s criteria" and it is still internationally used. In recent years, new parameters and measuring methods have been created without an agreed international standard. This article serves the purpose to offer a reference in the standardization and promotion of a practical standard for the postoperative functional evaluation of severed limb replantation.

The outbreak of COVID-19 around the world has made more than two millions of confirmed patients and serious shortages of healthcare resources and medical staff in many countries. In the battle of fighting COVID-19 in Wuhan, many microsurgery staff across China were sent to Wuhan and put on duty in the treatment of COVID-19 patients. The purpose of this article is to review the personal experiences of microsurgery staff in fighting against COVID-19 as well as to analyse how to act professionally when facing the challenges and change of roles and meanwhile having to give full play to the professional advantages subject to make contributions to the battle of COVID-19. A reference is hereby provided for the microsurgery staff in dealing with a sudden and major epidemic outbreak in the future.

Objective:To observe the effect that covering the nerve suture with CSPGs-gelatin sleeve after the sciatic nerve transection in SD rats, and evaluate its effect to improve nerve regeneration in peripheral nerve transection model.Methods:Covered and protected the sciatic nerve by end-to-end suture in the SD rats with CSPGs-gelatin sleeve. From July, 2019 to September, 2019, 24 SD rats were randomly and evenly divided into 3 groups, which were direct suture group, gelatin sleeve group without CSPGs (blank group), and CSPGs-gelatin sleeve group (CSPGs group). In each group, 3 rats were used to mark fluorescent gold at 5 weeks after operation. At 6 weeks after operation, histological and electrophysiological tests were performed to evaluate the tissue regeneration in the end to end suture and the effect of peripheral nerve regeneration after transection in the other 5 rats. One-way ANOVA was used for data analysis. If the difference between groups was statistically significant, LSD method would be further used for pairwise comparison. P<0.05 was considered statistically significant. Results:The escape distances in direct suture groups, blank group and CSPGs group groups were (787.19±213.77) μm, (547.17±167.71) μm and (350.60±68.58) μm, respectively; The numbers of the axons that grow into the distal basement membrane tube in 3 groups were (6 360±736.89) /mm 2, (8 040±673.05) /mm 2 and (9 000±644.20) /mm 2, respectively; The numbers of sensory nerve cells that were marked by fluorescent gold in the dorsal root ganglion were (124.35±25.88) /mm 2, (165.36±30.74) /mm 2 and (208.98±20.51) /mm 2 in 3 groups, respectively. The differences were significant compared with the CSPGs-gelatin sleeve group ( P<0.05). Thus, it led to a better nerve regeneration after transection in CSPGs-gelatin sleeve group according to the electrophysiological test and histological section observation of gastrocnemius muscles( P<0.05). Conclusion:CSPGs loaded in the gelatin sleeve can inhibit axons regeneration, and prevent the regenerated axons escaping from the end to end suture that may cause disorder axons regeneration or traumatic neuroma, and therefore improve the effective nerve regeneration after sciatic nerve injury in SD rat.