Analysis of the therapeutic effect of artificial leather embedding combined with fascial sleeve flap transplantation on chronic wounds of lower limbs with bone and plate exposure

Recent Progress in Mesenchymal Stem Cell-Derived Exosomes for Skin Wound Repair

BACKGROUND

Exosomes are nanometer-sized, lipid bilayer membrane vesicles that are secreted by various cell types. Mesenchymal stem cells (MSCs) have been shown to exert therapeutic effects through the secretion of exosomes via a paracrine pathway. Functions: Recent studies have demonstrated that MSC-derived exosomes (MSC-Exos) can effectively transport various bioactive substances, including proteins, mRNAs, microRNAs, long non-coding RNAs, circular RNAs, and lipids, into target cells. This process regulates multiple aspects during wound repair, such as the inflammatory response, cell proliferation, migration, differentiation, angiogenesis, and matrix remodeling.

POTENTIAL APPLICATIONS

By promoting wound healing and inhibiting scar formation, MSC-Exos have shown great promise for clinical applications in wound repair. This review highlights the recent advances in our understanding of the role and mechanism of MSC-Exos during wound repair, providing insights into their potential use in future therapeutic strategies.

Transperineal anastomotic posterior urethroplasty with bulbocavernosus flap and fibrin sealant in the complicated posterior urethral stricture reconstruction: a retrospective cohort study

BACKGROUND

Management of complicated posterior urethral stricture is challenging. Modified transperineal anastomotic urethroplasty (TAU) with bulbocavernosus flap interposition and human fibrin sealant provides another treatment option. The authors aimed to evaluate whether this technique could improve the success rate in the complicated posterior urethral stricture reconstruction in this study.

MATERIALS AND METHODS

Between 2016 and 2019, 48 patients underwent either conventional or modified TAU. The criteria for success included both the absence of clinical symptoms and no need for further surgical intervention during follow-up.

RESULTS

Twelve patients underwent the modified TAU (group A) using bulbocavernosus flap interposition and human fibrin sealant. Thirty-six patients underwent the traditional end-to-end anastomotic urethroplasty (group B). Follow-up was 24.3-57.2 months. The patients in group A had a higher surgery success rate compared to the patients in group B (91.7 vs. 63.9%, P =0.067), with a quasi-significant result. Besides, no postoperative complications were observed in group A, while two individuals in group B had urinary incontinence, but the difference was not significant (0 vs. 5.6%, P =0.404).

CONCLUSION

Based on the preliminary results, modified TAU with bulbocavernosus flap interposition and human fibrin sealant is a safe and feasible technique for complicated posterior urethral stricture reconstruction.

Effects of skin flap grafting combined with vacuum sealing drainage on ulcer area, pain level, and serum inflammation in diabetic foot patients

OBJECTIVE

To study the effects of skin flap grafting combined with vacuum sealing drainage (VSD) on ulcer area, pain level and serum inflammation in patients with diabetic foot (DF).

METHODS

In this retrospective study, 121 patients with DF who were treated in the Affiliated Hospital of Xinyang Vocational and Technical College between April 2018 and April 2022 were included as study subjects, including 50 cases receiving skin flap grafting (control group) and 71 cases receiving skin flap grafting combined with VSD (research group). Information on clinical efficacy, survival rate of the grafted flap, amputation and complications, ulcer area, rehabilitation (granulation tissue formation time, ulcer wound healing time), pain level (Visual Analogue Scale [VAS]), and serum inflammatory factors (interleukin [IL]-6, tumor necrosis factor [TNF]-α, and C-reactive protein [CRP]) were collected for comparative analyses. Univariate and multivariate analyses were conducted to screen the risk factors for patients' prognosis.

RESULTS

The overall response rate and the survival rate of the grafted flap in the research group were markedly higher compared with the control group, while the amputation rate was significantly lower (all P<0.05). Besides, the research group exhibited an evidently smaller post-treatment ulcer area, lower VAS, IL-6, TNF-α and CRP levels, and shorter granulation tissue formation time and ulcer wound healing time than the control group (all P<0.05). Neither group of patients experienced significant complications. The use of skin flap grafting + VSD was a protective factor for postoperative outcome.

CONCLUSIONS

Skin flap grafting combined with VSD is effective in treating DF patients, which can validly reduce ulcer area and inhibit serum inflammation after treatment, thus accelerating rehabilitation.

Clinical application of posterior tibial artery or peroneal artery perforator flap in curing plate exposure after ankle fracture fixation

The study aims to evaluate the clinical application of posterior tibial artery or peroneal artery perforator flap in the treatment of plate exposure after ankle fracture fixation. A posterior tibial artery or peroneal artery perforator flap was used on 16 patients with plate exposure after ankle fracture fixation in our hospital between July 2018 and July 2021. The time required to harvest the flap, the amount of intraoperative blood loss, the duration of postoperative drainage tube placement, the outcome of the flap and the healing observed at the donor site are reported. The sizes of the flaps were 2.5-7.0 cm × 5.0-18.0 cm and averaged 4.0 cm × 12.0 cm. The time required to harvest the posterior tibial artery or peroneal artery perforator flap ranged from 35 to 55 min and averaged 45 min. The amount of intraoperative blood loss ranged from 20 to 50 mL and averaged 35 mL. The duration of postoperative drainage tube placement ranged from 3 to 5 days and averaged 4 days. A total of 15 flaps survived and one flap had partial necrosis and survived after conservative treatment. All donor area defects were directly sewed and stitched without complications. There are multiple advantages of the posterior tibial artery or peroneal artery perforator flap, including simple preparation technique, reliable repair of the defects and without the need for performing microvascular anastomosis. It can be safely used in curing plate exposure after ankle fracture fixation and worth popularizing in grassroots hospitals.