OBJECTIVE: To investigate the effectiveness of tibial transverse transport (TTT) in treating Wagner grade 3-4 type 2 diabetic foot ulcers and analyze dynamic changes in immunoglobulin levels. METHODS: The clinical data of 68 patients with Wagner grade 3-4 type 2 diabetic foot ulcers treated with TTT between May 2022 and September 2023 was retrospectively analyzed. The cohort included 49 males and 19 females, aged 44-91 years (mean, 67.3 years), with 40 Wagner grade 3 and 28 grade 4 ulcers. The duration of type 2 diabetes ranged from 5 to 23 years, with an average of 10 years. The number of wound healing cases, healing time, amputation cases, death cases, and complications were observed and recorded. Serum samples were collected at 6 key time points [1 day before TTT and 3 days, 7 days (the first day of upward transverse transfer), 14 days (the first day of downward transverse transfer), 21 days (the first day after the end of transfer), 36 days (the first day after the removal of the transfer device)], and the serum immunoglobulin levels were detected by flow cytometry including immunoglobulin G (IgG), IgA, IgM, IgE, complement C3 (C3), C4, immunoglobulin light chain κ (KAP), immunoglobulin light chain λ (LAM). RESULTS: All the 68 patients were followed up 6 months. Postoperative pin tract infection occurred in 3 cases and incision infection in 2 cases. Amputation occurred in 5 patients (7.4%) at 59-103 days after operation, and 8 patients (11.8%) died at 49-77 days after operation; the wounds of the remaining 55 patients (80.9%) healed in 48-135 days, with an average of 80 days. There was no recurrence of ulcer, peri-osteotomy fracture, or local skin necrosis during follow-up. The serum immunoglobulin levels of 55 patients with wound healing showed that the levels of IgG and IgM decreased significantly on the 3rd and 7th day after operation compared with those before operation ( P<0.05), and gradually returned to the levels before operation after 14 days, and reached the peak on the 36th day. IgA levels continued to decrease with time, and there were significant differences at all time points when compared with those before operation ( P<0.05). The level of IgE significantly decreased at 21 days after operation compared with that before operation ( P<0.05), while it was higher at other time points than that before operation, but the difference was not significant ( P>0.05). The level of C3 showed a clear treatment-related increase, which was significantly higher on the 7th, 14th, and 21st days after operation than that before operation ( P<0.05), and the peak appeared on the 14th day. The change trend of C4 level was basically synchronous with that of C3, but the amplitude was smaller, and the difference was significant at 7 and 14 days after operation compared with that before operation ( P<0.05). There was no significant difference in KAP/LAM between different time points before and after operation ( P>0.05). CONCLUSION TTT can accelerate wound healing, effectively treat diabetic foot ulcer, and reduce amputation rate, and has definite effectiveness. The potential mechanisms of TTT in the treatment of diabetic foot ulcers include the dynamic regulation of IgG, IgA, IgM, and IgE levels to balance the process of inflammation and repair, and the periodic increase of C3 and C4 levels may promote tissue cleaning, angiogenesis, and anti-infection defense.
Humans ; Male ; Female ; Middle Aged ; Aged ; Diabetic Foot/immunology* ; Wound Healing ; Adult ; Retrospective Studies ; Aged, 80 and over ; Treatment Outcome ; Tibia/transplantation* ; Diabetes Mellitus, Type 2/complications* ; Amputation, Surgical ; Immunoglobulins/blood* ; Immunoglobulin G/blood*

Objective:To separate and purify the polysaccharides from Polygonatum filipes,characterize their primary structure and investigate the immunomodulatory effects on RAW264.7 macrophages.Methods:Crude polysaccharides from Polygonatum filipes were extracted by ultrasound assisted method,then Polygonatum filipes polysaccharides(CSPFPs)were obtained after elimination of the proteins with combined papain-Sevag method.The total sugar content was determined by phenol-sulfuric acid method.Structures of CSPFPs were analyzed by fourier transform infrared spectroscopy(FT-IR),high performance gel permeation chromatography(HPGPC)and high performance liquid chromatography(HPLC).Effects of CSPFPs on cell viability,pinocytic activity,TNF-α secretion,MAPK and NF-κB signaling pathways of RAW264.7 cells were explored by MTT,Neutral red,ELISA and Western blot,respectively.Results:Extraction rate of CSPFPs by ultrasound-assisted method was 41.61%,which contained total sugar content of 94.00%.CSPFPs with Mw of 3 125 Da was composed of arabinose(1.85%),galactose(6.14%),glucose(56.41%)and mannose(35.60%).The in vitro experiments showed that CSPFPs were non-cytotoxic and enhanced the pinocytic activity,TNF-α secretion and phosphorylation levels of p38,ERK,JNK,p65,IκB and IKK,indicating the activation of MAPK and NF-κB signaling pathways under the concentra-tion of 2.5～200 μg/ml.Conclusion:The ultrasound-assisted method can efficiently isolate CSPFPs with immunomodulatory activity,which provides basic data for the development and application of CSPFPs as an immunostimulant.

Objective:To separate and purify the polysaccharides from Polygonatum filipes,characterize their primary structure and investigate the immunomodulatory effects on RAW264.7 macrophages.Methods:Crude polysaccharides from Polygonatum filipes were extracted by ultrasound assisted method,then Polygonatum filipes polysaccharides(CSPFPs)were obtained after elimination of the proteins with combined papain-Sevag method.The total sugar content was determined by phenol-sulfuric acid method.Structures of CSPFPs were analyzed by fourier transform infrared spectroscopy(FT-IR),high performance gel permeation chromatography(HPGPC)and high performance liquid chromatography(HPLC).Effects of CSPFPs on cell viability,pinocytic activity,TNF-α secretion,MAPK and NF-κB signaling pathways of RAW264.7 cells were explored by MTT,Neutral red,ELISA and Western blot,respectively.Results:Extraction rate of CSPFPs by ultrasound-assisted method was 41.61%,which contained total sugar content of 94.00%.CSPFPs with Mw of 3 125 Da was composed of arabinose(1.85%),galactose(6.14%),glucose(56.41%)and mannose(35.60%).The in vitro experiments showed that CSPFPs were non-cytotoxic and enhanced the pinocytic activity,TNF-α secretion and phosphorylation levels of p38,ERK,JNK,p65,IκB and IKK,indicating the activation of MAPK and NF-κB signaling pathways under the concentra-tion of 2.5～200 μg/ml.Conclusion:The ultrasound-assisted method can efficiently isolate CSPFPs with immunomodulatory activity,which provides basic data for the development and application of CSPFPs as an immunostimulant.

Objective:To investigate the clinical experience of using orbital fat pedicle to correct eyebags with the tear trough and palpebromalar groove deformity.Methods:From February 2020 to May 2021, 35 patients with lower blepharoplasty combined with orbital fat-release were treated in the Facial and Neck Plastic Surgery Center of the Plastic Surgery Hospital of Chinese Academy of Medical Sciences, including 4 males and 31 females. Their age ranged from 35 to 63 years, with an average age of 47.5 years. Different degrees of lower eyelid skin laxity, orbital fat herniation, moderate and severe tear trough, palpebromalar groove deformity were observed in all patients. Preoperative examination showed no symptoms such as lower eyelid ectropion and lower eyelid retreat ment. All 35 patients were treated with transcutaneous incision blepharoplasty, in which the orbital septal fat was released, pulled downward and internally fixed to the appropriate position to fill the tear trough and palpebromalar groove.Results:All patients obtained primary healing, no complications such as hematoma, and infection occured. Postoperative follow-up lasted from 3 to 18 months, with an average of 8.6 months. 35 patients′ eye bags with tear trough and palpebromalar groove deformity were obviously alleviated. Unilateral mild eye bag remained in 2 patients in postoperative 1 month, and 2 cases appeared mild lower eyelid ectropion postoperatively, none of these patients received special treatment and recovered after 3 months.Conclusions:Lower blepharoplasty combined with orbital fat release can effectively repair eye bags and correct tear trough and palpebromalar groove deformity.

Objective:To investigate the method and application experience of nasolabial subcutaneous pedicled flap in the repair of skin defect after resection of nasolabial mass.Methods:From December 2016 to December 2020, a total of 58 patients (43 cases of nevus, 12 cases of seborrheic keratosis and 3 cases of keratinacanthoma) were admitted to the Facial Neck Center of Plastic Surgery Hospital of Chinese Academy of Medical Sciences, including 24 males and 34 females. They ranged from 17 to 55 years old, with an average age of 33 years. The minimum facial tumor area was 0.8 cm×0.8 cmand the maximum was 2.2 cm×2.0 cm. A local skin flap with a subcutaneous pedicle was designed preoperatively in the nasolabial groove area, and the subcutaneous pedicle was transferred to the defect area through subcutaneous tunnel or by disconnecting the surrounding tissue. The tumor was removed and the skin defect was closed at one stage. Postoperative complications were summarized and patient＇s satisfaction was investigated.Results:Follow-up period ranged from 6 to 48 months. All the 58 patients had primary healing of the transfer incisions, and all the flaps survived. The blood supply of the flaps was good, and the scar of the operative area was smooth. After resection of peri-lip mass, there was 1 case with obvious scar in the donor area of nasolabial groove, and the overall satisfaction rate was 98.3%.Conclusions:The application of nasolabial subcutaneous pedicled skin flap to repair the skin defect after resection of nasolabial tumor has the advantages of preventing the pulling deformation of the organ, it can be completed in one stage and repair the facial skin defect from a distant position. In addition, the thickness and color of the skin flap are similar to the defect site, and the scar of the donor site is not obvious, and so the appearance and function of the surgery can be satisfied.

Objective:To investigate the clinical effect of middle and lower facial rhytidectomy by lifting the prolapsed buccal fat pad using a consecutive suspensions in a dragnet fashion.Methods:from December 2016 to October 2019, 42 female patients aged 46 to 65 with aging faces and prolapsed buccal fat pads were treated with multiple suspension method. The incision was the classic temporal to peri-auricular incions. After the skin flap and superficial musculoaponeurotic system(SMAS) flap was elevated. The suspending stitches were arranged with 5 lines from the lateral edge of orbicularis oris muscle to the level of zygomatic process to lift the sagging buccal fat pad and achieve facial rejuvenation. The short and long term complicationsas well as post-operative satisfaction rate were also investigated.Results:After 9-12 months of follow-up, the facial aging characteristics were significantly improved, especially sagging mandibular bag and loose perioral skin. The volume of middle face was restored with natural contour. Post-operative complications included local facial depression (2 patients), slight asymmetry (1 patient) and mild tactile abnormalities (1 patient). Satisfaction survey showed that 28 patients were very satisfied, 12 were satisfied and 2 were dissatisfied. The subjective satisfaction rate was 95.2% (40/42). There were no serious complications such as facial nerve injury or flap necrosis.Conclusions:This technique has a good outcome combined with conventional rhytidectomy, as it can achieve good effect of rejuvenationin the middle and lower face.

Objective:To investigate the clinical effect of middle and lower facial rhytidectomy by lifting the prolapsed buccal fat pad using a consecutive suspensions in a dragnet fashion.Methods:from December 2016 to October 2019, 42 female patients aged 46 to 65 with aging faces and prolapsed buccal fat pads were treated with multiple suspension method. The incision was the classic temporal to peri-auricular incions. After the skin flap and superficial musculoaponeurotic system(SMAS) flap was elevated. The suspending stitches were arranged with 5 lines from the lateral edge of orbicularis oris muscle to the level of zygomatic process to lift the sagging buccal fat pad and achieve facial rejuvenation. The short and long term complicationsas well as post-operative satisfaction rate were also investigated.Results:After 9-12 months of follow-up, the facial aging characteristics were significantly improved, especially sagging mandibular bag and loose perioral skin. The volume of middle face was restored with natural contour. Post-operative complications included local facial depression (2 patients), slight asymmetry (1 patient) and mild tactile abnormalities (1 patient). Satisfaction survey showed that 28 patients were very satisfied, 12 were satisfied and 2 were dissatisfied. The subjective satisfaction rate was 95.2% (40/42). There were no serious complications such as facial nerve injury or flap necrosis.Conclusions:This technique has a good outcome combined with conventional rhytidectomy, as it can achieve good effect of rejuvenationin the middle and lower face.

Epicanthus is a skin fold located in front of the inner canthus. Due to the complexity of the anatomic structure, there are some complications such as insufficient correction, recurrence and obvious scar. To improve the inner canthus shape thoroughly, the epicanthus anatomy is explored. This paper has listed a brief overview of the anatomical research progress of epicanthus and surgical measures method, respectively, in the hope that this review would provide instructive reference for its surgical options.