Objective:To investigate the clinical efficacy of the modified superior gluteal artery perforator (SGAP) flap V-Y advancement technique in the repair of sacrococcygeal pilonidal sinus.Methods:A retrospective analysis was conducted on the clinical data of patients who underwent modified SGAP flap V-Y advancement for the reconstruction of sacrococcygeal pilonidal sinus wounds at the Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, between January 2019 and January 2025. The surgical procedure involved two stages. During the first stage, the sinus tract was preoperatively marked with methylene blue, followed by complete excision of the sinus and surrounding involved tissues. The resultant wound was then treated with vacuum sealing drainage for 3 to 5 days. The second stage consisted of flap repair. A portable Doppler ultrasound was used to identify and mark the superior gluteal artery perforator on one side of the wound. A V-shaped flap was designed transversely, with the base corresponding to the length of the subcutaneous tissue defect on the wound side and the superior and inferior borders extending laterally along the wound margins, ensuring the 1-2 SGAP was included within the flap. Intraoperatively, the wound was re-debrided. The epidermis was removed from the base of the V-shaped flap, and the dermis and subcutaneous tissue were dissected. The dermis and superficial subcutaneous tissue of the contralateral wound edge were also dissected. The flap was then advanced in a V-Y fashion to cover the wound. The de-epithelialized portion of the flap was imbricated and sutured to the contralateral skin edge near the midline. The donor site at the apex of the V-shaped flap was closed directly after subcutaneous tissue tension relief, resulting in a Y-shaped closure. Postoperative flap survival, incision healing, and complications were observed. At the final follow-up, flap appearance, texture, surgical site scarring, and sinus recurrence were assessed, and patient satisfaction with the surgical outcome was investigated.Results:A total of eight patients were included in the study, comprising six males and two females, with ages ranging from 14 to 41 years (mean 22.4 years). Two patients presented with multiple sinus tracts, two with chronic sinus tracts and recurrent inflammation with scar formation, and four with postoperative recurrence. The area of the wound defect after debridement ranged from 4.5 cm×5.0 cm to 6.5 cm×8.0 cm. The flap dimensions ranged from 4.5 cm × 6.0 cm to 6.5 cm × 12.5 cm, with a mean V-shaped flap apex angle of 35° ± 2° (range 20° to 60°). In one patient, slight exudate was observed at the base of the flap, which healed after 12 days of dressing changes and drainage. The remaining flaps survived successfully, and primary closure was achieved in both the donor and recipient sites. The patients were followed for a period of 3 to 64 months, with a mean follow-up duration of 10.7 months. In all patients, the sacrococcygeal flap showed no evidence of bulkiness, exhibiting a color similar to the surrounding skin and a soft texture. Linear scars remained at the surgical site, with no complaints of itching, pain, or other discomfort affecting daily life. No recurrence of pilonidal sinus was observed during the follow-up period. Patients reported satisfaction with the appearance of their buttocks.Conclusion:The modified SGAP flap V-Y advancement technique for the repair of sacrococcygeal pilonidal sinus effectively elevates the gluteal cleft, facilitates off-midline closure, demonstrates reliable result, and provides a high level of patient satisfaction.

Objective:To discusses the feasibility and clinical efficacy of the chimeric musculocutaneous flap pedicled with a superior gluteal artery perforator (SGAP) in treatment of Grade Ⅳ pressure sore around ischial tuberosity.Methods:A retrospective case study was conducted on 8 patients with Grade Ⅳ pressure sores around ischial tuberosity and treated in the Department of Plastic Surgery and Burns, the Affiliated Hospital of Zunyi Medical University from May 2019 to June 2023. The patients included 5 males and 3 females, aged 66.8 (40-78) years. All patients had paraplegia for 2 months to 10 years (mean, 59.2 months) and were complicated with hypoproteinemia. Two of the patients were also with sepsis. History of the Grade Ⅳ pressure sore was up to 1 month to 3.5 years (mean, 19.3 months). The sores were located on the right hip in 5 patients and left hip in 3 patients. The tissue defects of the pressure sore measured at 5 cm×5 cm to 6 cm×9 cm in size and all extended to the ischial tuberosity. Chimeric musculocutaneous flaps pedicled with a SGAP were used in the treatment of defect. The flap size ranged from 4 cm×8 cm to 7 cm×15 cm, and the muscular flap were at 8 cm×4 cm×2 cm to 14 cm×7 cm×5 cm in size. The muscular flaps were used to fill the cavities formed by the ulcer, while the flaps were used to cover the wounds. Donor and recipient site were sutured directly. The postoperative follow-ups were conducted at outpatient clinic and via telephone and WeChat interviews, and focused on evaluations of flap survival, complications, flap appearance and the recurrence of ulcer.Results:All the 8 flaps survived. All patients were included in the 3 to 16 months of postoperative follow-up, with 11.8 months in average. One flap had a partial edge split due to excessive pressure during negative pressure drainage, and healed after debridement and re-suture. Otherwise, the rest of 7 patients had primary healing at both the donor and recipient sites. All flaps had good appearance without ulceration, infection or recurrence of pressure sore.Conclusion:The chimeric musculocutaneous flap pedicled with SGAP offers a reliable blood supply, flexible rotation and sufficient tissue volume. It can be used to effectively reconstruct Grade Ⅳ pressure sore around ischial tuberosity with a reliable clinical effect.

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 investigate the surgical technique and clinical outcomes of the tri-lobed chain medial plantar perforator flaps for reconstruction of soft tissue defects in palmar hand.Methods:A retrospective analysis was conducted on 6 patients (4 males and 2 females; aged 21-63 years with mean age of 39.2 years) who had soft tissue defects in palmar hands and were reconstructed with tri-lobed chain medial plantar perforator flaps in the Department of Plastic Surgery and Burns, the Affiliated Hospital of Zunyi Medical University between July 2024 and April 2025. All defects were located on palmar aspect of the injured hands. Following admission, debridement, fracture reduction and fixation and tendon repairs were carried out in primary surgery for 5 patients who had traumatic injuries with digital or metacarpal fractures and tendon ruptures, and stage-II surgery for soft tissue reconstruction was conducted at 7-9 days later. The patient with scar contracture received preoperative evaluation then followed by a scar excision and release surgery, prior to a reconstructive surgery for soft tissue defects. Four patients presented with multi-site defects, of whom, 1 patient had proximal phalangeal defects of index and middle fingers and a defect of metacarpophalangeal joint of ring finger, 1 patient had a defect of metacarpophalangeal joint of index finger and defects of proximal phalanges of middle and ring fingers, 1 patient had defects of proximal phalanges of index, middle and little fingers, and 1 patient had defects of proximal phalanges of middle, ring and little fingers. Of the patients with finger defects, the sizes of defect ranged from 2.0 cm ×1.8 cm to 6.0 cm×2.8 cm and the defects were reconstructed with individually harvested tri-lobed chain medial plantar perforator flaps. Two patients had soft tissue defects in palmar hands and they were measured at 6.0 cm×5.5 cm and 6.0 cm×7.0 cm in size. The palmar defects were reconstructed using combined tri-lobed chain flaps with the sizes of individual lobulated flap ranging from 2.1 cm×1.9 cm to 6.0 cm×2.9 cm. All foot donor sites were primarily closed with interrupted sutures. Postoperative management included routine anti-inflammatory, anticoagulant and antispasmodic treatment. Patients were discharged at 8-10 days after surgery and the postoperative follow-ups were conducted at outpatient clinic to monitor flap survival, contour, hand function, donor site healing, scar formation and foot function.Results:All flaps survived with primary healing of donor sites. Over the 1 to 9 (mean 6.1) months of postoperative follow-up, all flaps survived well with colour and thickness matching with the surrounding hand skin. At 6 months after surgery, two-point discrimination (TPD) of flaps achieved to 8-11 (mean 8.6) mm. According to the Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, 4 patients achieved function recovery of fingers in excellent and 2 in good. Donor sites exhibited linear scars without painful scarring or paraesthesia, with normal ankle function and gaits.Conclusion:Tri-lobed medial plantar perforator flaps can be used to reconstruct soft tissue defects in palmar hand with primary and direct closure of the flap donor sites. They can simultaneously reconstruct multiple or a large defects, and provide satisfactory aesthetic and functional outcomes. It is a feasible surgical option.

Objective:To explore the clinical effect of thin superficial circumflex iliac artery perforator flap with venous superdrainage in treatment of wound in extremities.Methods:Clinical data of 20 patients who were treated from January 2018 to January 2024 in the Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University were retrospectively analysed. The soft tissue defects in extremity were reconstructed with thin perforator flaps of superficial iliac circumflex artery with venous superdrainage. There were 13 patients with upper limb defects and 7 with ankle defects. Of the defects, 12 were of trauma, 2 of tumour resection, 3 of scar release surgery and 3 of donor flat harvesting. The defects ranged from 5.0 cm×4.0 cm to 18.0 cm×7.0 cm in size. During the surgery, portable Doppler was used to detect the perforating branches of the superficial rotational iliac artery and design flaps. The flaps were 5.0 cm×5.0 cm to 20.0 cm×7.0 cm in size, including 16 single-lobed flaps, 3 double-lobed flaps and 1 triple-lobed flaps. The flaps were 2-7 mm in thickness, with an average of 4 mm. Based on the distribution of perforators, the flaps carried the superficial helioiliac artery and the accompanying vein, as well as the superficial helioiliac vein. The superficial helioiliac artery and the accompanying vein were anastomosed during the surgery, and the superficial helioiliac vein was anastomosed to the superficial or deep vein of the recipient site for superreflux. The donor sites were all directly sutured and closed. Postoperative follow-up was conducted by visits of outpatient clinic, and via telephone and WeChat interviews. The survival and appearance of the flaps and complications were observed.Results:A total of 22 arteries and 42 veins of the 20 flaps were anastomosed in surgery. All flaps survived. The donor sites were closed in the first stage. No vascular compromise occurred. One patient had early exudate under the flap on the exposed wound of interphalangeal joint, which healed after routine dressing change and drainage. All patients were included in the postoperative follow-up, with a peroid over 5 to 40 months, at 10.8 months in average. The flaps were thin and soft, with good wear resistance and without pigmentation. The healing of donor sites was good except 1 donore site that had early lymphatic leakage, which was cured after compression and drainage. A linear scar left at the donor sites and it was acceptable to the patients.Conclusion:The treatment of defective soft tissue wounds in extremities using thin perforator flap with venous superdrainage of the superficial circumflex iliac artery is safe and feasible. No further flap thinning surgery is required, and there is a reliable clinical effect.

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.

Debridement remains a fundamental procedure in wound repair. This paper reviewed the history, concept evolution, methods, and mechanisms in wound repair of debridement, and the cutting-edge progress of precise debridement technology. It also summarized and analyzed the challenges of debridement applied in wound repair, such as insufficient talent training, inadequate digitization and intelligence, difficulty in defining debridement extent, and insufficient clinical guideline and research, and proposed countermeasures. At present, multiple precision debridement technologies have emerged and been applied in clinical practice, while surgical debridement retains its irreplaceable status. Future research direction includes optimizing multimodal integration of these approaches to leverage their complementary benefits. Furthermore, with the deepening application of artificial intelligence in the medical field, debridement will gradually move towards digitalization and intelligence.

Objective:To explore the causal relationship between human circulating inflammatory proteins and pressure injury (PI) mediated by human blood metabolites.Methods:This study employed a method of analysis based on mediated Mendelian randomization (MR). Genome-wide association study data of 91 human circulating inflammatory proteins (14 824 samples), 1 400 human blood metabolites (8 299 samples), and PI (467 794 samples) were retrieved. A significance threshold was established and single nucleotide polymorphisms (SNPs) were used as instrumental variables with the influence of weak instrumental variables excluded. Forward two-sample MR (TSMR) was employed to analyze the causal relationship between circulating inflammatory proteins and PI. The inverse variance weighted (IVW) method served as the primary approach, and the results were validated using the weighted median method, MR-Egger regression, weighted mode method, and simple mode method (the specific analytical methods were the same below). For the SNPs of selected circulating inflammatory proteins, sensitivity analysis was employed, including heterogeneity which was evaluated by the Cochran Q test, horizontal pleiotropy which was evaluated by the MR-Egger intercept test and MR-PRESSO outlier test, and reliability which was evaluated via leave-one-out analysis. Based on reverse TSMR analysis, the IVW method, MR-Egger regression, weighted median method, simple mode method, and weighted mode method were employed to evaluate whether a reverse causal relationship exists between PI and the selected circulating inflammatory proteins. Forward TSMR was employed to analyze the causal relationship between selected circulating inflammatory proteins and 1 400 blood metabolites and to select the blood metabolites. For the SNPs of selected circulating inflammatory proteins, sensitivity analysis was employed as before. Forward TSMR was employed to analyze the causal relationship between selected blood metabolites and PI. For the SNPs of selected blood metabolites, sensitivity analysis was employed as before (except for the leave-one-out analysis). Finally, the mediation effect values and mediation effect ratios of selected blood metabolites in the mediation effect between selected circulating inflammatory proteins and PI were calculated. Results:Five circulating inflammatory proteins and 59 blood metabolites were identified as meeting the exposure factor criteria, with the number of SNPs reaching the significance threshold ranging from 16 to 1 484. All the SNPs were confirmed as strong instrumental variables. The IVW method revealed significant causal relationships between interleukin-33 (IL-33), CUB domain-containing protein 1, IL-5, stem cell factor, and tumor necrosis factor and PI (with odds ratios of 1.29, 1.20, 1.25, 1.16, and 1.23, respectively, 95% confidence intervals of 1.07-1.55, 1.05-1.36, 1.04-1.51, 1.00-1.34, and 1.03-1.47, respectively, P<0.05). The weighted median method confirmed significant causal relationships between IL-33 and IL-5 and PI (with odds ratios of 1.37 and 1.37, respectively, 95% confidence intervals of 1.05-1.79 and 1.04-1.80, respectively, P<0.05). Among these, the most significant causal relationship was observed between IL-33 and PI ( P<0.01). The Cochran Q test indicated no significant heterogeneity in the SNPs of IL-33 which had significant causal relationship with PI ( Q=18.78, P>0.05). The MR-Egger intercept test (with intercept absolute value <0.001, P>0.05) and MR-PRESSO outlier test (with RSSobs value of 20.37, P>0.05) both indicated no significant horizontal pleiotropy in the SNPs of IL-33 which had significant causal relationship with PI. The leave-one-out analysis showed that the significant causal relationship between IL-33 and PI was reliable after removing the SNPs one by one. No significant reverse causal relationships were observed between PI and IL-33 through the IVW method, MR-Egger regression, weighted median method, simple mode method, or weighted mode method (with odds ratios of 1.00, 1.00, 1.00, 1.00, and 1.01, respectively, 95% confidence intervals of 0.98-1.02, 0.96-1.03, 0.97-1.03, 0.93-1.08, and 0.94-1.09, respectively, P>0.05). The IVW method revealed significant causal relationships between IL-33 and 59 blood metabolites (with odds ratios of 0.79-1.20, 95% confidence intervals lower limit range of 0.70-1.07 and upper limit range of 0.89-1.37, P<0.05). The MR-Egger regression and weighted median method confirmed significant causal relationships between IL-33 and 8 and 10 blood metabolites, respectively (with odds ratios of 0.63-1.70 and 0.82-1.21, respectively, 95% confidence intervals lower limit ranges of 0.43-1.29 and 0.70-1.14, respectively, 95% confidence intervals upper limit ranges of 0.94-2.25 and 0.97-1.42, respectively, P values all <0.05). Among these, the most significant causal relationship was observed between blood metabolite X-12798 and IL-33 (with odds ratio of 0.79, 95% confidence interval of 0.70-0.89, P<0.05). The Cochran Q test indicated no significant heterogeneity in the SNPs of IL-33 which had significant causal relationship with blood metabolite X-12798 ( Q=24.94, P>0.05). The MR-Egger intercept test (with intercept absolute value of 0.012, P>0.05) and MR-PRESSO outlier test (with RSSobs value of 27.45, P>0.05) both indicated no significant horizontal pleiotropy in the SNPs of IL-33 which had significant causal relationship with blood metabolite X-12798. The leave-one-out analysis showed that the significant causal relationship between IL-33 and blood metabolite X-12798 was reliable after removing the SNPs one by one. The IVW method revealed significant causal relationship between blood metabolite X-12798 and PI (with odds ratio of 0.92, 95% confidence interval of 0.84-0.99, P<0.05). The MR-Egger regression and weighted median method both confirmed significant causal relationship between blood metabolite X-12798 and PI (with odds ratios of 0.87 and 0.89, respectively, 95% confidence intervals of 0.77-0.98 and 0.80-0.99, respectively, P<0.05). The Cochran Q test indicated no significant heterogeneity in the SNPs of blood metabolite X-12798 which had significant causal relationship with PI ( Q=23.45, P>0.05). The MR-Egger intercept test (with intercept absolute value of 0.015, P>0.05) and MR-PRESSO outlier test (with RSSobs value of 26.01, P>0.05) both indicated no significant horizontal pleiotropy in the SNPs of blood metabolite X-12798 which had significant causal relationship with PI. The mediation effect value was 0.02 and the mediation effect ratio was 8.27%. Conclusions:Significant causal relationships are observed among human circulating inflammatory proteins, blood metabolites, and PI, with the association between circulating inflammatory protein IL-33 and PI being mediated by blood metabolite X-12798.

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.