Objective:To evaluate trauma repair and reconstruction surgery mediated by near-infrared-Ⅱ (NIR-Ⅱ) imaging in practice of enhanced recovery after surgery (ERAS) principles.Methods:A retrospective study was conducted to analyze the data of 38 patients who had undergone trauma repair and reconstruction surgery mediated by near-infrared-Ⅱ (NIR-Ⅱ) imaging in practice of ERAS principles at Department of Orthopedic Trauma and Microsurgery, Zhongnan Hospital from May 2021 to December 2021. There were 22 males and 16 females with an age of (50.3±2.7) years. To implement ERAS, NIR-Ⅱ imaging was used for patency evaluation after vascular anastomosis in 14 cases, for skin flap harvesting and perfusion monitoring in 13 cases, and for evaluation of arterial/venous blood supply after finger replantation in 11 cases. Visual analogue scale (VAS) pain scores at 2, 7 and 14 days after surgery, length of hospital stay, patient satisfaction [by Chinese Hospital Patient Experience and Satisfaction Monitor (CHPESM)], limb function recovery (by Likert scale) and postoperative complications were recorded.Results:All patients were followed up for more than 14 days. All surgeries succeeded. The reconstructed limbs or flaps survived to recover basically normal shape and function. The VAS scores for all patients were (2.1±0.6) points, (1.6±0.6) points and (0.8±0.4) points on postoperative 2, 7 and 14 days, respectively. The length of hospital stay was (9.8±3.4) days, and the patient satisfaction was >95% at discharge. As for the recovery of limb function at the last follow-up evaluated by the Likert 5-point scale, 12 cases experienced no stiffness, 8 ones mild stiffness, 11 ones slightly severe stiffness, 3 ones moderate to severe stiffness, 2 ones severe stiffness, and 2 ones complete stiffness. Complications related to the surgery occurred in none of the patients.Conclusion:In practice of ERAS principles, application of NIR-Ⅱ imaging in trauma repair and reconstruction surgery can effectively alleviate pain, improve satisfaction, reduce hospital stay, and accelerate functional recovery for the patients.

Objective:To evaluate the therapeutic effect of exposed bone cement in treatment of infectious bone and soft tissue defect by comparison with routine bone cement therapy.Methods:A retrospective analysis was carried out in 27 patients who had been treated from January 2016 to January 2020. Of the 27 patients, 12 were treated by exposed bone cement filling for bone defect at the first stage, followed by flap and bone grafting at the second stage. Other 15 patients were treated by routine bone cement filling and flap repair at the first stage, followed by bone grafting at the second stage. Regular dressing change was carried out after surgery. All patients entered follow-up by out-patient review for wound condition and X-ray. Infection rate of bone and soft tissue, time of bone union, flap survive rate and complication were compared between the 2 groups.Results:The follow-up lased for 9-24(16.5±3.9 ) months. The bone defects were all healed. The treatment time of bone defects in the group of exposed bone cement was 25-34(28.5±2.8) weeks. The treatment time of bone defect in the routine cement group was 25-36(29.6±3.4 )weeks. There was no statistical difference between the 2 groups( P<0.05). Two cases in each group had failed in infection control after bone cement implantation. With further debridement, cleaning and other treatment, the infection was under control. All flaps in the 2 groups survived. In the group of exposed bone cement, there were 3 flaps splitting, 2 hemorrhage(effusion) and 1 partial flap necrosis, In the routine bone cement group, there were 4 wound dehiscence, 8 hemorrhage(effusion) and 3 partial flaps necrosis. There was no significant difference in flap complications between the 2 groups( P>0.05). The healing of bone defect was evaluated by Samantha X-ray score, the scores of the 2 groups were 5.41±0.67 and 5.40±0.63, respectively, with no statistical significance. The Paley's approach was used to grade the bone healing and the function of adjacent joints. Paley bone defect healing evaluation results weve all excellent. Joint function assessment were as follow: in the group of exposed bone cement, 6 cases were excellent and 3 were good; in routine bone cement group: 6 cases were in excellent and 5 in good. There was no significant statistical difference. Conclusion:Compared with a routine bone cement treatment, the exposed bone cement in the treatment of infectious bone defects saw a fewer flap splitting and fewer hemorrhage/effusion, without an increase in bone and soft tissue infection. This procedure could be considered for further trials in the treatment of a composite defects of infected bone and soft tissue.

Objective:To access the efficacy of external fixation combined with Prontosan management for open fractures complicated with multidrug-resistant bacterial infection.Methods:A retrospective analysis was conducted of the data of 22 patients with open fracture complicated by multidrug-resistant bacterial infection who had been admitted to Department of Orthopedic Trauma and Microsurgery, Zhongnan Hospital of Wuhan University from January 2015 to January 2020. According to whether the Prontosan management was used or not, the patients were divided into 2 groups.The Protosan group [9 males and 3 females with an age of (44.6±13.1) years] were subjected to external fixation, vacuum sealing drainage(VSD) or conventional dressing changes, and at the same time Protosan management to flush the wound or Prontosan gel to change dressings.The control group[6 males and 4 females with an age of (45.1±11.7) years] were subjected to external fixation plus VSD or conventional dressing changes. Skin flaps or skin grafts were used to repair the wound immediately after the wound infection was controlled in both groups. The time for negative culture of the bacteria on the wound surface, number of debridement, survival of the skinflaps or grafts, and fracture union were recorded and compared between the 2 groups.Results:There was no significant difference in the preoperative general data between the 2 groups which were comparable( P>0.05).All patients were followed up for 10 to 24 months (mean, 14.5 months).In the Prontosan group, the number of debridement was 2.0 (2.0, 3.0) times, significantly fewer than that in the control group [4.0 (3.0, 4.0) times]; the time for negative bacterial culture (8.3±2.2) d, significantly shorter than that in the control group [(14.2±3.1) d]; the fracture union time (5.5±1.1) months, significantly shorter than that in the control group [(6.5 ±1.1) months]; the Samantha X-ray score at 6 months after operation 6.0 (5.0,6.0) points, significantly higher than that in the control group [5.2(4.5,5.5) points] (all P<0.05). Skin flaps or grafts survived in all the patients without any nonunion or chronic osteomyelitis. Conclusion:In the external fixation of open fractures complicated with multidrug-resistant bacterial infection, combination with Prontosan management can effectively control infection and promote granulation, early wound healing and fracture union.

Objective:To analyze the causes of SARS-CoV-2 nosocomial infection among healthcare workers (HCWs) and explore the effective precaution strategies in Emergency Center.Methods:The data of SARS-CoV-2 infected HCWs from January 5 to March 2, 2020 were retrospectively analyzed and compared under different conditions in Emergency Center of Zhongnan Hospital of Wuhan University.Results:Totally 13 SARS-CoV-2 infected HCWs (12 confirmed cases and 1 suspected case) were included in this study. The overall infection rate was 17.8% (13/73). The infection rates in outpatient/rescue room, isolation observation room and isolationin patient ward were 11.8% (4/34), 20.0% (3/15), 25% (6/24), respectively. The infection rate of physician was 13.0% (3/23), and the infection rate of nurse was 20.0% (10/50). All the infected HCWs had the definite exposure with confirmed or suspected COVID-19 patients. One asymptomatic cases were identified by laboratory findings of SARS-CoV-2 infection screening. There was no new confirmed SARS-CoV-2 infected HCWs after February 5, 2020. All the infected HCWs were cured.Conclusions:Under the epidemic of COVID-19, HCWs of Emergency Center have a high risk of occupational exposure and infection, especially for staffs working in COVID-19 isolation units. Scientific prevention and control management can effectively reduce the risk of SARS-CoV-2 infections and ensure the occupational safety for HCWs in Emergency Center.

Objective:To summarize the preliminary experience in ward management, medical protection, standardised diagnosis and treatment procedures in trauma microsurgery during the outbreak of COVID-19.Methods:Taking an example from the Department of Trauma and Microsurgery at Zhongnan Hospital of Wuhan University, the orthopedic patients and medical staff with COVID-19 admitted from Decemberm 31, 2019 to March 1, 2020, in-cluding clinical diagnosis and confirmed cases, were analyzed retrospectively. General information, including age, gen- der, basic diseases, contact history, symptoms, lung CT and prognosis, were collected and analysed preliminarily. On January 20, 2020, the COVID-19 outbreak was confirmed as "human to human transmission". COVID-19 infection of patients and medical staff in the wards were analysed, through the update of protection awareness and control measures. Department management, medical protection and standardized control procedures of trauma microsurgery were explored.Results:Five cases with clinical diagnosis or confirmed COVID-19 were included. One was inpatient and the rest 4 were medical staff, aged 25-81 years, 3 with confirmed and 2 with clinical diagnosis of COVID-19. After the treatment by specialists from Department of Infectious Disease and Department of Respiratory Disease, 4 of infected persons were cured and 1 died. Since January 20, 2020, when it was clear that the virus transmitted to people, there was no new case of infection among the medical staff and inpatients after the multidisciplinary collaboration in the ward prevention and control procedures were standardized and took in action.Conclusion:The spread of the COVID-19 can be effectively controlled by standardised diagnosis and treatment procedurs in the word of trauma microsurgery.

To summarize the application of enhanced recovery after surgery (ERAS) principles in treating long bone defect with free fibula graft (FVFG). Methods From January, 2012 to January, 2017, ERAS principles were applied in 26 cases of long bone defect treating with vascularized fibula flap graft, via a series of com-prehensive measures, including strengthening psychological nursing, nutrition support and pain management, optimiz-ing operation plan, and early scientific functional exercise. Surgical duration, hospital stay time, satisfaction of pa-tients, postoperative visual analogue scale (VAS) score, bone defect healing time, and Enneking score were recorded through regular outpatient follow-up after discharge. Results The average length of surgical duration and hospital stay time was(3.2±0.5) h and (10.2±1.2) d, respectively. Discharged satisfaction was greater than 95%. Postoperative VAS score was less than 3. During the follow-up period of 1.6-6.0 years, 26 fibular flap survived, and all the bone defect were healed, with an average healing time of (5.5±0.6) months.Followed-up at 1.5 years after the operation, the upper limb function of 7 patients increased by 80.1%, and the lower limb function of 19 patients increased by 82.5%. Conclusion The application of ERAS in treating long bone defect with FVFG can obtain satisfactory limb function, alleviate patients’pain, shorten the duration of hospitalization, promote the rehabilitation and satisfaction of patients.

Objective To explore the effect of the use of flap transplantation combined with Masquelet tech-nique in the repair of long bone accompanied with soft tissue defect. Methods The retrospective study includes 16 cases of bone defects over 6.0 cm combined with soft tissue defect from March,2013 to March,2016,13 males and 3 females, of which the ages range from 16 to 65 years. The length of bone defect ranged from 6.0 to 12.0 cm, with an average of 8.5 cm,while the wound defect ranged from 5.2 cm×3.5 cm to 16.0 cm×7.5 cm. There were 8 cases out of 16 involve an infection:3 cases of Staphylococcus aureus(including 1 MRSA),2 cases of Staphylococcus epidermidis, 2 cases of Enterobacter cloacae, and 1 case of Acinetobacter baumannii. The 1 stage surgery in all patients admitted to hospital after complete debridement and external fixation, the clean wounds with bone defect received antibiotic-impregnated bone cement filling operation and a flap transplantation or transposition directly after the debridement, but the infected wounds received vacuum sealing drainage treatment firstly, associated with adequate use of antibi-otics for 1-2 weeks and then the bone cement filling and flap transplantation with infection totally controlled.After 8-12 weeks, we conducted the secondary internal fixation surgery replacing antibiotic-impregnated bone cement with autogenic cancellous bone, vancomycin artificial bone as well as rhBMP-2. All the cases were followed for 6 to 18 months. Results All patients with primary surgery are effectively controlled after 1-4 weeks of anti-infection treat-ment exclusive of the case with MRSA.As the condition of the patient with MRSA relapse,we changed to convention-al treatment: placed a continuous irrigation and suction equipment instead of the bone cement filling, the wound healed completely without fistula formation of osteomyelitis in 6 months after the treatment of Ilizarov technique. All transplantation and transposition flaps survived. As for those who received a secondary bone graft operation, all achieved a bony union in a period of 4-6 months. Conclusion The combination of flap transplantation and Masquelet technique is an effective method to repair limb long bone and soft tissue defect currently.

Objective To compare internal fixation with hallow compression screws combined vascularized bone graft(observation group) with only three hallow compression screws(control group) in young patients' Garden III and IV femoral neck fractures. Methods The patients with femoral neck fracture were treated from January, 2004 to December, 2013 were retrospectively reviewed. A total of 417 displaced femoral neck fractures in young and mid-dle-aged patients were long term followed-up. One hundred and thirty-seven patients were underwent open reduction and internal fixation with 3 hallow compression screws combined with a greater trochanter bone graft supported by the profound branch of medial circumflex femoral artery;280 patients were treated by closed reduction with 3 hallow com-pression screws. Results Patients had been followed-up for 5-12 years. At the last follow-up point, the Harris score of flap in observation group(93.68±5.12) were higher than that in control group(92.53±6.12), while it was no sta-tistical difference(P>0.05). It was 0.7％of nonunion incidence rate in the observation group, and incidence of avascular necrosis of femoral head was 6.6％, and incidence of femoral neck shortening was 8.8％. In the control group, inci-dence of avascular necrosis of femoral head was 14.6％, nonunion incidence rate was 4.6％, and incidence of femoral neck shortening was 22.5％. The differences between two groups was statistically significance( P<0.05). Conclusion The open reduction and internal fixation which is hallow compression screws in combination with a greater trochanter bone graft supported by the profound branch of medial circumflex femoral artery is an optimal treatment for young adults with Garden III and IV femoral neck fractures.

Objective To summarize the clinical experience of treating long bone defect with vascularized fibular graft.Methods From January,2008 to January,2015,31 cases of long bone defect were treated with vascularized fibula composite or not composite tissue flap graft.The length of transplanted fibula was 9-20 cm,and the flap area was 5 cm×3 cm to 21 cm×14 cm.All patients were followed up regularly.Limb function was assessed 12 months after surgery.Results Thirty-one cases of vascularized fibular flap survived after surgery.Thirty patients were followed up for 1.5 to 6 years (average,2.5 years).One patient was lost to follow-up.The bone defects of patients followed up were healed.There was one case fracture occurred for trauma,was treated with plaster cast for 6 months and healed.The transplanted fibular thickened for 1.3 to 2.5 years(average,1.6 years).Conclusion Vascularized fibular graft can reconstruct long bone defect for single use and shorten the duration of treatment with a good limb function.For cases combined soft tissue defect,vascularized fibula composite tissue flap can be applied to repair at the meantime.

BACKGROUND:Bioactive glass, a multi-phase composite material, has good biological activity, bone conductivity and biocompatibility, but as a bone repair material it cannot be completely degraded, and has low mechanical strength that is insufficient.
OBJECTIVE:To design a kind of bioactive glasses/chitosan composite scaffold, and to investigate its physicochemical properties and cellcompatibility.
METHODS:Hydrochloric acid solution containing 2.0%chitosan was mixed withβ-glycerophosphate at a radio of 7:1 to prepare chitosan solution. Bioactive glasses of 0.5, 1.0, 1.5 g were added into the prepared chitosan solution, and the mass ratios of chitosan and bioactive glass were 2:1, 1:1, and 1:1.5 respectively. The composite materials were immersed and mineralized in simulated body fluid for 7 days.
RESULTS AND CONCLUSION:Scanning electron microscopy showed that the composite scaffold had an interconnected porous structure with the porosity of 89%and the pore size of 100-300μm;bioactive glasses dispersed in a needle shape between the chitosan scaffolds, arranged evenly, and were ful y wrapped tightly by the scaffolds. With the increase in mass of bioactive glass, the porosity of the composites decreased, but the fracture strength gradual y increased. There was a positive correlation between the composite porosity and fracture strength. X-ray diffraction and Fourier transform infrared spectroscopy confirmed that the composite scaffold appeared to have no changes in the nature of single materials, and differential scanning calorimetry analysis showed no mass loss at normal body temperature. After 3 days of mineralization, hydroxyapatite forming on the material surface gradual y grew up as a vil ous shape, and also significantly increased in number. After 7 days of mineralization, hydroxyapatite changed from a vil ous shape to a needle shape, the amount of hydroxyapatite was increased further, and many mineralized products were in a spherical shape.