Objective:To explore the efficacy of free medial sural artery perforator flap transplantation in repairing electrical burn wounds on hands and feet.Methods:This study was a retrospective observational study. From November 2017 to September 2023, 21 male patients aged 28-51 years with electrical burns on hands and feet who met the inclusion criteria were admitted to Tongren Hospital of Wuhan University & Wuhan Third Hospital. There were 23 wounds, of which 14 were on the hand and 9 on the foot; 9 were associated with exposed tendon injury, 6 were associated with bone exposure or necrosis, and 8 were associated with joint injury. The wound area after debridement was 4.0 cm×2.5 cm-14.0 cm×10.0 cm. For 2 relatively wide wounds and 2 adjacent fingers/toes wounds, the lobulated flaps centered on 2 medial sural artery perforators were designed and incised for repair. For other wounds, medial sural artery perforator flaps were designed and incised. The flap area was 5.0 cm×3.0 cm-16.0 cm×11.0 cm. The arteriovenous vessels of flap were anastomosed end-to-end with the arteriovenous vessels of the recipient area; the cutaneous nerves of 10 flaps were anastomosed with the nerves in hand wound, and the sural nerve bundle was cut to repair one digital nerve defect. The donor site wound was closed with tension-relieving sutures. Postoperative flap survival and wound healing at donor site were recorded. During follow-up, subsequent flap revision was recorded, the texture and appearance of the flap, as well as the scarring and functional recovery of the donor area of the lower leg, were observed. At the last follow-up, the recovery of hand flap sensation was observed, the satisfaction of patients with the treatment effect of each operation was investigated by using Likert scale, the hand function of the affected hand in patients with hand wounds was evaluated by using the trial standards for evaluation of partial function of upper extremity by the Hand Surgery Society of Chinese Medical Association, and the weight-bearing walking ability of the affected foot in patients with foot wounds was evaluated by Holden walking ability grading.Results:There was a slight necrosis at the distal end of one flap after surgery, which healed after dressing change. All 23 flaps survived. The sutures of the two donor areas were poorly healed due to high local tension, and the second sutures were performed after debridement and drainage, and the healing was good. The wounds of the remaining 21 donor sites healed well. Follow-up of 6-26 months after surgery showed that 3 flaps were slightly bloated, and the appearance was improved after flap reconstruction; the other flaps did not undergo subsequent revision. All flaps were soft and similar to the surrounding tissue morphology. Linear scar remained in the donor site of the lower leg, and walking function was normal. At the last follow-up, the protective sensation of the hand flap was restored; the patients were very satisfied with the results of 21 surgeries and were relatively satisfied with the results of 2 surgeries. Among the 14 patients with hand wounds, the affected hand function was rated as excellent in 10 cases, very good in 3 cases, and acceptable in one case, and the weight-bearing walking ability of the affected foot in 7 patients with foot wounds was all rated as grade Ⅴ.Conclusions:The medial sural artery perforator flap has the advantages of reliable blood supply, appropriate thickness and smoothness, and can be lobulated or cut according to the shape of the wound. The flap demonstrates superior aesthetic and functional restoration in repairing electrical burn wounds on hands and feet, achieving high patient satisfaction with the surgical treatment effect.

Objective:To explore the efficacy of free medial sural artery perforator flap transplantation in repairing electrical burn wounds on hands and feet.Methods:This study was a retrospective observational study. From November 2017 to September 2023, 21 male patients aged 28-51 years with electrical burns on hands and feet who met the inclusion criteria were admitted to Tongren Hospital of Wuhan University & Wuhan Third Hospital. There were 23 wounds, of which 14 were on the hand and 9 on the foot; 9 were associated with exposed tendon injury, 6 were associated with bone exposure or necrosis, and 8 were associated with joint injury. The wound area after debridement was 4.0 cm×2.5 cm-14.0 cm×10.0 cm. For 2 relatively wide wounds and 2 adjacent fingers/toes wounds, the lobulated flaps centered on 2 medial sural artery perforators were designed and incised for repair. For other wounds, medial sural artery perforator flaps were designed and incised. The flap area was 5.0 cm×3.0 cm-16.0 cm×11.0 cm. The arteriovenous vessels of flap were anastomosed end-to-end with the arteriovenous vessels of the recipient area; the cutaneous nerves of 10 flaps were anastomosed with the nerves in hand wound, and the sural nerve bundle was cut to repair one digital nerve defect. The donor site wound was closed with tension-relieving sutures. Postoperative flap survival and wound healing at donor site were recorded. During follow-up, subsequent flap revision was recorded, the texture and appearance of the flap, as well as the scarring and functional recovery of the donor area of the lower leg, were observed. At the last follow-up, the recovery of hand flap sensation was observed, the satisfaction of patients with the treatment effect of each operation was investigated by using Likert scale, the hand function of the affected hand in patients with hand wounds was evaluated by using the trial standards for evaluation of partial function of upper extremity by the Hand Surgery Society of Chinese Medical Association, and the weight-bearing walking ability of the affected foot in patients with foot wounds was evaluated by Holden walking ability grading.Results:There was a slight necrosis at the distal end of one flap after surgery, which healed after dressing change. All 23 flaps survived. The sutures of the two donor areas were poorly healed due to high local tension, and the second sutures were performed after debridement and drainage, and the healing was good. The wounds of the remaining 21 donor sites healed well. Follow-up of 6-26 months after surgery showed that 3 flaps were slightly bloated, and the appearance was improved after flap reconstruction; the other flaps did not undergo subsequent revision. All flaps were soft and similar to the surrounding tissue morphology. Linear scar remained in the donor site of the lower leg, and walking function was normal. At the last follow-up, the protective sensation of the hand flap was restored; the patients were very satisfied with the results of 21 surgeries and were relatively satisfied with the results of 2 surgeries. Among the 14 patients with hand wounds, the affected hand function was rated as excellent in 10 cases, very good in 3 cases, and acceptable in one case, and the weight-bearing walking ability of the affected foot in 7 patients with foot wounds was all rated as grade Ⅴ.Conclusions:The medial sural artery perforator flap has the advantages of reliable blood supply, appropriate thickness and smoothness, and can be lobulated or cut according to the shape of the wound. The flap demonstrates superior aesthetic and functional restoration in repairing electrical burn wounds on hands and feet, achieving high patient satisfaction with the surgical treatment effect.

Objective:To investigate the influence of muscle energy technology (MET) combined with Maitland joint mobilization surgery on the elbow joint flexion function in patients with deep burn of elbow joint.Methods:A retrospective controlled clinical trial was conducted. From January 2020 to January 2022, 53 patients with elbow joint flexion dysfunction after deep burns who met the inclusion criteria were treated in Tongren Hospital of Wuhan University & Wuhan Third Hospital, including 32 males and 21 females, aged (37±12) years. According to the treatment method used, the patients were divided into conventional treatment alone group (15 cases), conventional treatment+joint mobilization surgery group (18 cases), and conventional treatment+joint mobilization surgery+MET group (20 cases). Before treatment and 2 months after treatment, the patient's elbow joint range of motion was measured using a protractor, the Mayo elbow joint function score was used to evaluate elbow joint function, a portable muscle strength tester was used to measure elbow extensor muscle strength, and visual analogue scale was used to evaluate pain degree. Data were statistically analyzed with one-way analysis of variance, least significant difference test, paired sample t test, Kruskal-Wallis H test, Wilcoxon signed rank-sum test, chi-square test, Fisher's exact probability test, and Bonferroni correction. Results:After two months of treatment, the elbow joint range of motion and elbow joint function scores of patients in conventional treatment+joint mobilization surgery group and conventional treatment+joint mobilization surgery+MET group ((103±12)° and 60 (50, 66), (131±14)° and 73 (65, 80)) were significantly larger and higher than those in conventional treatment alone group ((77±15)° and 45 (35, 50), P values all <0.05), respectively. The elbow joint range of motion and elbow joint function scores of patients in conventional treatment+joint mobilization surgery+MET group were significantly larger and higher than those in conventional treatment+joint mobilization surgery group ( P values all <0.05), respectively. After two months of treatment, the elbow extensor muscle strength and pain score of patients in conventional treatment+joint mobilization surgery+MET group were respectively significantly larger and lower than those in conventional treatment alone group and conventional treatment+joint mobilization surgery group ( P values all <0.05). The elbow extensor muscle strength and pain score of patients in conventional treatment+joint mobilization surgery group were similar to those in conventional treatment alone group ( P>0.05). The elbow joint range of motion and elbow extensor muscle strength (with t values of 9.37, 25.54, 28.71, 6.70, 7.20, and 7.01, respectively, P<0.05), elbow joint function scores and pain scores (with Z values of 3.15, 3.63, 3.93, 3.30, 3.52, and 3.84, respectively, P<0.05) of patients in conventional treatment alone group, conventional treatment+joint mobilization surgery group, and conventional treatment+joint mobilization surgery+MET group after two months of treatment were significantly improved compared with those before treatment. Conclusions:The combination of MET and Maitland joint mobilization surgery can effectively improve elbow joint range of motion, elbow joint function, elbow extensor muscle strength, and pain of patients with deep elbow joint burns, therefore it is worthy of promotion.

Objective:To observe the effects of balance training combined with routine training on patients with lower limb motor and balance dysfunctions after severe burns.Methods:A prospective randomized controlled study was conducted. From January 2016 to January 2020, sixty-four patients with lower limb motor and balance dysfunction after severe burns who met the inclusion criteria were admitted to Tongren Hospital of Wuhan University&Wuhan Third Hospital. According to the random number table, the patients were divided into routine training (RT) group and combined training (CT) group. There were 32 cases in each group, 22 males and 10 females in RT group, aged 40.5 (35.5, 52.8) years, and 24 males and 8 females in CT group, aged 37.0 (30.0, 44.0) years. Patients in RT group performed conventional treatment including knee joint stretch, continuous passive motion, lower limb muscle strength training, and pressure therapy etc., while patients in CT group received balance training in addition to RT treatment including sitting balance, center of gravity transfer, pelvic stability, standing alternately on one leg, and standing on balance pad. Patients in both groups were treated for 4 months. Before treatment and after 4 months of treatment, the Berg Balance Scale, Lower Extremity Function Scale, and Activities-specific Balance Confidence Scale were used to evaluate the balance function, lower limb function, and balance activity self-confidence of patients respectively. Data were statistically analyzed with independent sample t test, paired sample t test, Mann-Whitney U test, Wilcoxon signed rank test or chi-square test. Results:Before treatment, the Berg balance score of patients in RT group was (25±9) points, which was similar to (25±7) points in CT group ( t=-0.154, P>0.05). After 4 months of treatment, the Berg balance score of patients in CT group was (43±6) points, which was significantly higher than (40±6) points in RT group ( t=2.028, P<0.05). The Berg balance scores of patients in RT and CT groups after 4 months of treatment were obviously higher than those before treatment ( t=-15.189, -26.200, P<0.01). Before treatment, the lower limb function score of patients in RT group was 25.0 (16.5, 30.0) points, which was similar to 23.0 (10.3, 28.8) points in CT group ( Z=-1.575, P>0.05). After 4 months of treatment, the lower limb function score of patients in CT group was 55.0 (35.0, 60.0) points, which was significantly higher than 43.0 (36.0, 53.0) points in RT group ( Z=-2.744, P<0.01). The lower limb function scores of patients in RT and CT groups after 4 months of treatment were obviously higher than those before treatment ( Z=-4.943, -4.955, P<0.01). Before treatment, the balance activity self-confidence scores of patients in the two groups were similar ( t=-0.966, P>0.05). After 4 months of treatment, the balance activity self-confidence scores of patients in CT group was significantly higher than that in RT group ( t=3.343, P<0.01). The balance activity self-confidence scores of patients in RT and CT groups after 4 months of treatment were obviously higher than those before treatment ( t=-19.611, -34.300, P<0.01). Conclusions:Conventional treatment combined with balance training for patients with lower limb motor and balance dysfunctions after severe burns can effectively promote the recovery of their lower limb motor and balance function.

Objective: To observe the therapeutic effects of Archimedes sling system in the rehabilitation of knee joint flexion dysfunction of patients after deep burns. Methods: Thirty-seven patients with knee joint flexion dysfunction after deep burn, conforming to the study criteria and hospitalized in Burn Rehabilitation Center of Tongren Hospital of Wuhan University & Wuhan Third Hospital from March 2015 to December 2017, were recruited in this prospective controlled study. According to the order of admission, 18 odd-numbered patients and 19 even-numbered patients were enrolled in conventional treatment (CT) group [13 males and 5 females, aged (42±10) years] and sling treatment (ST) group [13 males and 6 females, aged (37±10) years] respectively. Patients in group CT were conventionally conducted with knee joint mobilization treatment, continuous passive motion treatment, and pressure therapy, while patients in group ST were conducted with supine knee joint flexion and extension training and micro-squat short arc resistance training with Archimedes sling system besides CT. Patients in the 2 groups were treated for 6 months, and 1 course of treatment was 1 month. Before treatment and after 6 months of treatment, the knee joint active motion range was measured and the difference value was calculated, the American Hospital for Special Surgery (HSS) knee joint score was used to assess the functional disorder of patients, and the self-function satisfaction of patients were evaluated with modified Likert Scale. Data were processed with independent sample t test, paired sample t test, and chi-square test. Results: (1) Before treatment, the difference value of knee joint active motion range of patients in group CT was (45±11)°, which was similar to (44±12)° in group ST (t=-0.206, P>0.05). After 6 months of treatment, the difference value of knee joint active motion range of patients in group ST was (89±14)°, which was obviously higher than (75±12)° in group CT (t=0.897, P<0.01). The difference values of knee joint active motion range of patients in groups CT and ST after 6 months of treatment were obviously higher than those before treatment (t=-13.394, -29.459, P<0.01). (2) Before treatment, the HSS knee joint score of patients in group CT was (40±10) points, which was similar to (36±11) points in group ST (t=0.816, P>0.05). After 6 months of treatment, the HSS knee joint score of patients in group ST was (68±13) points, which was obviously higher than (57±10) points in group CT (t=0.162, P<0.01). The HSS knee joint score of patients in groups CT and ST after 6 months of treatment were obviously higher than those before treatment (t=-12.410, -30.559, P<0.01). (3) Before treatment, the self-function satisfaction scores of patients in the two groups were similar (t=0.140, P>0.05). After 6 months of treatment, the self-function satisfaction score of patients in group ST was obviously higher than that in group CT (t=3.103, P<0.01). The self-function satisfaction scores of patients in groups CT and ST after 6 months of treatment were obviously higher than those before treatment (t=-11.697, -29.029, P<0.01). Conclusions The Archimedes sling system can effectively increase the difference value of knee joint active motion range, alleviate the degree of knee joint dysfunction, and enhance the self-function satisfaction of patients on the basis of conventional rehabilitation treatment for patients with knee joint flexion dysfunction after deep burns.

In May 2015, a child with absence of most of the five fingers with scar formation after healing of a left hand burn wound hospitalized in our burn ward. According to the free online design program for making artificial limbs using three-dimensional printing technology on the internet, a utility artificial hand, most of which made of plastic parts, was designed for the child and printed by a three-dimensional printer. The child was instructed to wear and use the utility artificial hand, including driving the finger part of the utility artificial hand to make a grasping action by flexing the wrist joint. On the first day of using the utility artificial hand, the time the right hand and the utility artificial hand took to finish the Nine-Hole Peg Test (NHPT) was 24 and 325 s, respectively. After training, the child could grab some light and rough objects. After 3 months of follow-up, the child could use the utility artificial hand to cooperate with the upper limb of the healthy side to make the movements of picking up the basketball and keeping the balance of body on the bicycle. The time the right hand and the utility artificial hand took to finish NHPT was 21 and 193 s, respectively. The time the utility artificial hand took increased by 40.6% compared with the initial period. By assembling the three-dimensionally printed utility artificial hand, the partial appearance image of the child was restored, and some of the hand functions were compensated, which improved the self-care ability of the child in daily life and was beneficial to his physical and mental development.

Objective: To observe the clinical effects of the Joint Active System on the treatment of joint dysfunction after deep burn. Methods: Twenty-two patients with joint dysfunction after deep burn were hospitalized in Institute of Burns of Tongren Hospital of Wuhan University & Wuhan Third Hospital from January 2015 to October 2016, involving 18 elbow joints with flexion disorder, 10 wrist joints with dorsal extension disorder, and 12 ankle joints with dorsal extension disorder. They were treated with the elbow joint activity training device, the wrist joint activity training device, and the ankle joint activity training device of the Joint Active System, respectively. The treatment was carried out 3 times each day with interval of 6 h, 30 minutes each time, and it lasted for four to seven months, with one month as a course of treatment. Before treatment and 1, 2, 3, 4 month (s) after, active motion range of each joint was measured by joint goniometer. Function improvement of each joint was evaluated, and the total effective ratio was calculated 4 months after treatment. Satisfaction degree of patients was assessed by the modified Likert Scale 1, 2, 3, 4 month (s) after treatment. Data were processed with one-way analysis of variance for repeated measurement and LSD test. Results: Before treatment and 1, 2, 3, 4 month (s) after, flexion active motion range of elbow joints were (61±23), (78±22), (89±20), (96±20), and (103±19)°; dorsal extension active motion range of wrist joints were (23±7), (31±6), (38±9), (44±5), and (49±8)°; dorsal extension active motion range of ankle joints were (-31±12), (-23±10), (-16±7), (-12±6), and (-8±4)°, respectively. The active motion range of each joint was obviously higher 1, 2, 3, 4 month (s) after treatment than the previous time point of the same joint (with P values below 0.01). Four months after treatment, the total effective ratios of function improvement of elbow joints, wrist joints, and ankle joints were 5/6, 9/10, and 2/3, respectively. Scores of satisfaction degree of the patients 1, 2, 3, 4 month (s) after treatment were (1.3±0.7), (2.2±1.0), (2.8±0.8), and (3.3±0.6) points, respectively. Scores of satisfaction degree of the patients were obviously higher 2, 3, 4 months after treatment than the previous time point (with P values below 0.05). Conclusions Joint Active System can improve the active range of motion of each joint obviously in treating joint dysfunction after deep burn, with total effective ratio of function improvement of each joint surpassing 0.66, and the majority of patients are quite satisfied with the curative effects.