中华烧伤与创面修复杂志

Zhang Pingyuan, Wang Kaifa

, Available online , doi: 10.3760/cma.j.cn501225-20240103-00004

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Count data are very common in biomedical research, and such data is often organized in the form of contingency table. For count data, the common research purpose is to test whether two factors are independent, therefore chi-square test is often used for statistical analysis, but it is easy to overlook the applicable conditions of chi-square test and the correction of results under different conditions. In addition, for count data, there are also other research purposes, such as testing whether there is a linear trend between two categorical variables, whether the results are consistent, and so on. Therefore, how to choose appropriate testing methods based on different research purposes is also a problem worth paying attention to in practical applications. In this study, the commonly used statistical methods for various count data are systematically summarized through a series of examples, and the most common misuses of the chi-square test are analyzed.

Clinical effects of free dorsal interosseous artery perforator flaps in repairing multiple finger skin soft tissue defects

Zheng Yun, Cheng Liangkun, Cui Liuchao, Tan Yuzhong, Tian Lin

, Available online , doi: 10.3760/cma.j.cn501225-20231130-00221

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Objective To investigate the clinical effects of free dorsal interosseous artery perforator flaps in repairing multiple fingers skin soft tissue defects. Methods The study was a retrospective observational study. From April 2020 to June 2022, 7 patients with multiple fingers skin and soft tissue defects were admitted to the Department of Hand Microsurgery of the Chongqing Great Wall Orthopaedic Hospital, including 4 males and 3 females, aged 27 to 54 years. A total of 18 fingers were injured in 7 patients, of which 4 fingers were involved in 1 case, 3 fingers were involved in 2 cases, and 2 fingers were involved in 4 cases. The area of skin and soft tissue defects after stage Ⅰ debridement ranged from 3.0 cm×2.0 cm to 7.5 cm×3.0 cm. All patients underwent stage Ⅰ debridement, stage Ⅱ interosseous dorsal artery perforator flap transplantation to repair the wound, stage Ⅲ flap pedicle division and finger-split. The incision area of the flap was 4.0 cm×2.5 cm to 10.5 cm×3.5 cm. The interosseous dorsal artery was anastomosed with the proper digital artery by end to end, and the concomitant veins of 2 interosseous dorsal arteries were anastomosed with 2 superficial subcutaneous veins of the fingers by end to end. The donor area was treated by subcutaneous suture after full reduction of tension. The survival of flap after stage Ⅲ was observed. Follow-up was conducted once every 3 months after the operation of stage Ⅲ to observe the appearance, texture, and sensation of the operative areas in fingers, the range of motion of the finger joint and the healing of the donor area. At the last follow-up, the function of fingers was assessed according to the trial standard of upper limb partial function assessment of the Hand Surgery Society of Chinese Medical Association. Results All the flaps in 7 patients survived after stage Ⅲ operation. During follow-up of 6 to 36 months after stage Ⅲ operation, only 3 patients with bloated flap underwent the flap volume reduction operation in 3 months and later, and the finger appearance in the other patients recovered well. Only linear scar remained in the donor areas of 6 patients, and 1 patient had scar hyperplasia in the donor area, which was significantly improved after laser treatment. At the last follow-up, the finger function was evaluated as excellent in 5 cases and good in 2 cases. Conclusions The flaps pedicled with multiple interosseous dorsal artery perforators were used to repair skin and soft tissue defects of multiple fingers, only one set of blood vessels need to be anastomosed during the operation without damaging the main vessels, which reduces the incidence of postoperative vascular crisis. Besides, the finger-split operation is simple and the appearance and function in the donor and recipient areas are good. This method is worthy of clinical promotion.

Effects of recombinant human metallothionein-Ⅲ combined with wound dressing on wound healing of full-thickness skin defects in mice

Shen Xin, Sun Zuoyi, Zhang Rui, Xue Yuying

, Available online , doi: 10.3760/cma.j.cn501225-20231031-00164

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Objective To investigate the effects of recombinant human metallothionein-Ⅲ (rh-MT-Ⅲ) combined with wound dressing on wound healing of full-thickness skin defects in mice. Methods This study was an experimental study. Twenty-four half male and half female 6 weeks old ICR mice were taken, and two symmetrical round full-thickness skin defect wounds were prepared on the back of each mouse. The mice were stratified and randomly divided into saline group, dressing group, rh-MT-Ⅲgroup (applying the corresponding solution on the wounds) and combined treatment group (applying a mixture of rh-MT-Ⅲ and wound dressing on the wounds) according to sex and body weight, with 6 mice in each group. From 1 to 7 d after injury, all mice were observed daily for changes in activity, diet, and fur growth, their body weights and wound areas were recorded, and the percentages of relative wound areas were calculated. On 7 d after injury, the wound tissue of mice was taken for hematoxylin-eosin staining to observe the newborn granulation tissue, for Masson staining to observe collagen fibre deposition, and for immunofluorescence staining to detect cell proliferation (expressed as Ki67 relative fluorescence intensity) and cell apoptosis (expressed as TUNEL relative fluorescence intensity). The sample size in the above experiments was 6. Results No abnormalities in activity, diet, and fur growth were observed in the 4 groups of mice within 7 d after injury. There was no statistically significant differences in the overall comparison of the body weights of mice in the 4 groups from 1 to 7 d after injury ( P>0.05). The relative wound area percentages of mice in combined treatment group were significantly lower than those in saline group and rh-MT-Ⅲ group on 2, 3, 4, 5, 6, and 7 d after injury ( P<0.05), and the relative wound area percentages of mice in combined treatment group were significantly lower than those in dressing group on 3, 4, 5, 6, and 7 d after injury ( P<0.05). The relative wound area percentages of mice in dressing group on 6 and 7 d after injury and in rh-MT-Ⅲ group on 7 d after injury were significantly lower than those in saline group ( P<0.05). On 7 d after injury, a large number of capillaries and fibroblasts could be seen in wound tissue of mice in combined treatment group, and the growth of new epithelial tissue at the upper edge of the wound was better than that of the other three groups; the collagen fibres in the wound tissue of mice in combined treatment group had the highest degree of density and arranged in a more orderly manner than those of the other three groups. On 7 d after injury, the relative fluorescence intensity of Ki67 in the wound tissue of mice in dressing group, rh-MT-Ⅲ group, and combined treatment group was (289±35)%, (197±17)%, and (389±56)%, which was significantly higher than (100±15)% of saline group, respectively ( P<0.05), and the relative fluorescence intensity of Ki67 in the wound tissue of mice in combined treatment group was significantly higher than that of dressing group and rh-MT-Ⅲ group ( P<0.05). On 7 d after injury, the relative fluorescence intensity of TUNEL in the wound tissue of mice in dressing group, rh-MT-Ⅲ group, and combined treatment group was (55.5±5.7)%, (66.7±8.0)%, and (20.0±2.2)%, which was significantly lower than (100.0±12.9)% in saline group, respectively ( P<0.05), and the relative fluorescence intensity of TUNEL in the wound tissue of mice in combined treatment group was significantly lower than that of dressing group and rh-MT-Ⅲ group, respectively ( P<0.05). Conclusions rh-MT-Ⅲ combined with wound dressing can promote the growth of granulation tissue around the wound as well as collagen deposition, increase the cell proliferation vitality, reduce cell apoptosis, and promote the re-epithelialization of skin at the edge of the wounds, thus accelerating the healing of full-thickness skin defect wounds in mice.

Effects of advanced platelet-rich fibrin/chitosan temperature-sensitive hydrogel on full-thickness skin defect wound healing in diabetic rats

Xun Haoyi, Su Xiaowei, Hu Fangchao, Liu Xiangyu, Wu Yushou, Liu Tian, Sun Ran, Duan Hongjie, Chi Yunfei, Chai Jiake

, Available online , doi: 10.3760/cma.j.cn501225-20231020-00127

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Objective To prepare advanced platelet-rich fibrin (A-PRF)/chitosan temperature-sensitive hydrogel (hereinafter referred to as composite hydrogel) and explore the effects of composite hydrogel on full-thickness skin defect wound healing in diabetic rats. Methods This study was an experimental study. The composite hydrogel with porous mesh structure and temperature-sensitive characteristics was successfully prepared, containing A-PRF with mass concentrations of 10, 15, 20, 50, and 100 g/L. Diabetic model was successfully established in male Sprague-Dawley rats aged 6-8 weeks by intraperitoneal injection of streptozotocin, and 4 full-thickness skin defect wounds were established on the back of each rat (finally 36 rats were successfully established model). Three wounds of each rat were divided into blank group (no drug intervention), positive control group (dropping recombinant human granulocyte-macrophage stimulating factor gel), and chitosan hydrogel group (dropping chitosan hydrogel solution); the remaining one wound of each rat (totally 30 wounds) was added with composite hydrogel solution containing 10, 15, 20, 50, and 100 g/L A-PRF, respectively, and the wounds were set as 10, 15, 20, 50, and 100 g/L composite hydrogel groups, with 6 wounds in each group. On 14 d after injury, 6 rats with one wound in 100 g/L composite hydrogel group were selected for hematoxylin-eosin (HE) staining to observe the inflammation, hemorrhage, or necrosis of the heart, liver, spleen, lung, and kidney. On 10 d after injury, 6 rats with one wound in 15 g/L composite hydrogel group were selected to observe the blood flow perfusion of wounds in the four groups (with sample size of 6). On 0 (immediately), 7, and 14 d after injury, the wound healing in the eight groups was observed and the wound healing rate was calculated. On 14 d after injury, the wound tissue in the eight groups was taken for HE and Masson staining to observe the formation of new epithelium and collagen formation, respectively; the expressions of CD31 and vascular endothelial growth factor A (VEGFA) were detected by immunohistochemistry; the protein expressions of CD31 and VEGFA were detected by Western blotting; the mRNA expressions of CD31 and VEGFA were detected by real-time fluorescent quantitative reverse transcription polymerase chain reaction (with all sample sizes of 4). Results On 14 d after injury, no obvious inflammation, hemorrhage, or necrosis was observed in the heart, liver, spleen, lung, and kidney in the 6 rats. On 10 d after injury, the blood perfusion volume of wound in 15 g/L composite hydrogel group was significantly more than that in blank group, positive control group, and chitosan hydrogel group, respectively (with P values all <0.05). On 7 and 14 d after injury, the wound healing rates of blank group were (26.0±8.9)% and (75.0±1.8)%, which were significantly lower than those of positive control group, chitosan hydrogel group, and 10, 15, 20, 50, 100 g/L composite hydrogel group ((45.8±3.2)%, (49.8±3.7)%, (51.2±2.9)%, (68.5±2.4)%, (68.8±1.5)%, (72.7±2.1)%, (75.0±3.7)% and (79.1±1.9)%, (77.2±1.7)%, (82.3±1.3)%, (89.6±1.9)%, (89.8±1.3)%, (87.3±1.1)%, (87.9±1.3)%), P<0.05; the wound healing rates of positive control group, chitosan hydrogel group, and 10 g/L composite hydrogel group were significantly lower than those of 15, 20, 50, and 100 g/L composite hydrogel group ( P<0.05). On 14 d after injury, the wound epidermization degrees of rats in 15, 20, 50, and 100 g/L composite hydrogel groups were higher than those in the other 4 groups, and the new microvascular situation was better, and the number of collagen was more and arranged more neatly. On 14 d after injury, the percentages of CD31 and VEGFA positive areas in wounds in positive control group and the percentage of VEGFA positive area in wounds in chitosan hydrogel group were significantly higher than those in blank group ( P<0.05), the percentage of VEGFA positive area in wounds in 10 g/L composite hydrogel group was significantly higher than that in blank group, chitosan hydrogel group, and positive control group (with P values all <0.05), and the percentages of CD31 and VEGFA positive areas in wounds in 15, 20, 50, and 100 g/L composite hydrogel groups were significantly higher than those in blank group, positive control group, chitosan hydrogel group, and 10 g/L composite hydrogel group ( P<0.05). On 14 d after injury, the protein and mRNA expressions of CD31 and VEGFA in wound tissue in chitosan hydrogel group, positive control group, and 10 g/L composite hydrogel group were significantly higher than those in blank group ( P<0.05), the protein expression of VEGFA and the mRNA expressions of CD31 and VEGFA in wound tissue in 10 g/L composite hydrogel group were significantly higher than those in positive control group ( P<0.05), the protein and mRNA expressions of CD31 and VEGFA in wound tissue in 15, 20, 50, and 100 g/L composite hydrogel groups were significantly higher than those in blank group, positive control group, chitosan hydrogel group, and 10 g/L composite hydrogel group ( P<0.05), and the mRNA expressions of CD31 and VEGFA in wound tissue in chitosan hydrogel group were significantly lower than those in positive control group ( P<0.05). Conclusions The composite hydrogel has high biological safety, can improve wound blood perfusion, effectively promote the formation of blood vessels and collagen in wound tissue, thus promoting the wound healing of full-thickness skin defects in diabetic rats. 15 g/L is the optimal concentration of A-PRF in composite hydrogel.

Exploring wound healing from the perspective of circadian rhythm regulation

Wang Dali, Qi Fang

, Available online , doi: 10.3760/cma.j.cn501225-20240122-00027

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Wound healing is a complex and finely regulated biological process involving a variety of cell types, such as immune cells, fibroblasts, keratinocytes, endothelial cells, and stem cells. Recent scientific research has unveiled the significant role of circadian rhythms in the regulation of the wound healing process. Although the precise molecular mechanisms by which circadian rhythms regulate wound healing are not yet fully understood, accumulating evidence has revealed that some key signals and cellular functions play crucial roles in the circadian rhythm regulation of wound healing. A deeper understanding of these mechanisms is important not only to uncover the basic biological processes of wound healing, but also to develop new therapeutic strategies, such as regulating circadian rhythms to guide medication and optimize trauma treatment. By reviewing the current research results on circadian rhythm regulation of wound healing, this paper aims to provide a comprehensive perspective on this emerging field and provide valuable insights for future research directions.

Coordinating tissue repair: molecular pathways controlling the function of harmful and repairing neutrophils

He Weifeng, Yan Lingfeng

, Available online , doi: 10.3760/cma.j.cn501225-20240306-00089

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Neutrophils are the most abundant circulating white blood cells and play an indispensable role as first responders of damaged tissue and infected sites in the early inflammatory response of healing. Neutrophils provide immediate host defense by engulfing and destroying pathogens, releasing cytotoxic enzymes and metabolites, and spreading inflammatory networks. However, if left uncontrolled, these defense mechanisms can cause significant collateral damage. Focusing on the precursors of harmful neutrophil inflammation and immunomodulatory deficits, as well as grasping the specific drivers of harmful inflammation, is of great significance for recalibrating inflammation to promote endogenous tissue repair. In this paper, starting from the causes of neutrophil inflammation imbalance, we discuss the main mechanism of neutrophil mediated tissue injury and related pathological manifestations, and emphasize the promising therapeutic targets.

Clinical efficacy of membrane induction technique combined with local myocutaneous flap in repairing sinus cavity pressure injury in the greater trochanteric region

Tong Lin, Zhang Wanfu, Han Fei, Guan Hao

, Available online , doi: 10.3760/cma.j.cn501225-20231029-00144

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Objective To investigate the clinical efficacy of membrane induction technique combined with local myocutaneous flap in repairing sinus cavity pressure injury in the greater trochanteric region. Methods The study was a retrospective case series study. From January 2020 to January 2023, 12 patients with sinus cavity pressure injury in the greater trochanteric region combined with varying degrees of infection who met the inclusion criteria were admitted to the Department of Burns and Cutaneous Surgery of the First Affiliated Hospital of Air Force Medical University, including 8 males and 4 females, aged 42-76 years. There were 9 patients with unilateral greater trochanteric pressure injury, 3 patients with bilateral greater trochanteric pressure injury, and 3 patients complicated with sepsis. The external wound opening area of pressure injury before debridement was 1.5 cm×1.0 cm-3.0 cm×3.0 cm, and the internal cavity area measured during intraoperative debridement was 10.0 cm×8.5 cm-20.0 cm×10.0 cm. After the general condition of the whole body was improved, the covering/filling with antibiotic bone cement after debridement was performed in stage Ⅰ, the wound was repaired with local myocutaneous flap with the area of 10.0 cm×9.0 cm-22.5 cm×11.5 cm in stage Ⅱ, and the wound in the donor area was sutured directly. The levels of inflammatory indicators including white blood cell count, C-reactive protein, procalcitonin, and erythrocyte sedimentation rate, as well as the positive proportions of bacterial culture in wound exudation samples of all patients before and 7 days after the stage Ⅰ operation were compared. The mental status, body temperature, heart rate, and respiratory rate of patients complicated with sepsis before and 3 days after the stage Ⅰ operation were recorded. The survival of local myocutaneous flap and wound healing were observed in all patients after the stage Ⅱ operation. The recurrence of pressure injury and the appearance and texture of the flap were followed up in all patients. Results Compared with those before stage Ⅰ operation, the white blood cell count, C-reactive protein level, procalcitonin level, and erythrocyte sedimentation rate of 12 patients on post stage Ⅰ operation day 7 were significantly decreased (with t values of 6.67, 7.71, 2.72, and 3.52, respectively, P<0.05). The proportion of positive bacterial culture in wound exudation samples on post stage Ⅰ operation day 7 was 2/12, which was significantly lower than 11/12 before stage Ⅰ operation ( P<0.05). The mental state of 3 patients complicated with sepsis improved significantly 3 days after stage Ⅰ operation, which was improved as compared with that before stage Ⅰ operation, their body temperature returned to normal, heart rate was <90 times/min, and respiratory rate was <20 times/min. A total of 15 wounds were repaired by local myocutaneous flaps, 14 local myocutaneous flaps survived well after stage Ⅱ operation and the wounds were healed, while a partial necrosis occurred at the distal end of one local myocutaneous flap, which was healed 14 days after bedside debridement and suturing. Follow-up for 3 to 24 months after stage Ⅱ operation showed that the pressure injury was not recurrent in any patient, the flap was not bloated, the color of the flap was similar to the surrounding skin tissue, and the flap texture was soft. Conclusions Membrane induction technique combined with local myocutaneous flap in the treatment of sinus cavity pressure injury in the greater trochanteric region can decrease the level of inflammatory indicators and alleviate the bacterial load of the wound by covering or filling with antibiotic bone cement, and form the induction membrane to provide a good basis for stage Ⅱ wound repair. The local myocutaneous flap shows good clinical effects including a high survival rate, few complications, and the recurrence rate of postoperative pressure injury was low.

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