The " exploration of treatment technology of chronic wound with sinus tract supported by endoscope and related auxiliary methods" study had been conducted by Wound Healing Center of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine. The feasibility and effectiveness of this technique have been confirmed, and good clinic results have been achieved. In order to further promote the new technology and its related research, the theoretical knowledge and technical experience accumulated in the early stage are summarized as

including four parts: the applicable subjects, the diagnosis and treatment procedures and classification criteria, the healing criteria, and the risk assessment and prevention measures. The purpose of this standard is to facilitate the application of standardized endoscopy technique, to make the most of its technological advantages, prevent risks, and provide a reference for the official version of the diagnosis and treatment standard.

Scar formation is the abnormal healing process of skin after being damaged. The mechanism of scar formation is not clear, and many studies have shown that it is affected by many factors. Based on the over deposition of collagen in scars, many researchers have carried out studies on the mechanism, pathological manifestation, and treatment method of scars. In the treatment aspect of scar, the combination of traditional and new treatment methods has been well accepted and achieved good results. To understand the new advances of scar research and combine it with clinical treatment transformation could lead to the development of more effective prophylactic and therapeutic strategies for scar treatment in the future.

Bacteria usually colonize, reproduce, and grow aggressively on chronic wounds in the form of biofilm. Different from free bacteria, bacteria in biofilm exhibit unique mechanism in epigenetics and biological behavior, especially in resistance to antibiotics and host immunity. In this article, we introduce the composition and structural function of bacterial biofilm, expound the drug-resistance mechanism of bacterial biofilm, discuss the clinical characteristics of bacterial biofilm infection wound and the diagnosis method of biofilm, and analyze the treatment strategy for bacterial biofilm. It is suggested that clinicians should pay more attention to bacterial biofilm infection and advocate in-depth study of bacterial biofilm in order to improve the quality of managing chronic wounds.

Objective To explore the effect of axial flap of adjacent artery perforator with vascular pedicle in repairing scar deformity of face and neck in patients. Methods From January 2010 to June 2018, 38 patients with cicatricial deformity of face and neck after deep burn were admitted to author′s unit, including 22 males and 16 females, aged 5-56 years. The time of admission was 7 months to 19 years after burn injury. The size of wounds ranged from 7.0 cm×4.0 cm to 20.0 cm×10.0 cm after scar tissue was released. Nineteen patients were treated by upper thoracic internal artery perforator flap with size ranged from 7.0 cm×5.0 cm to 18.0 cm×8.5 cm. Among them, 16 cases were preexpanded with expanders at thorax whose rated capacity ranged from 300 to 500 mL and times of water injection of 1.8 to 3.1, and 3 cases were directly used. Twelve patients were treated by transverse carotid artery perforator flap with size ranging from 7.0 cm×4.5 cm to 11.0 cm×8.5 cm, of which 8 patients were preexpanded and 4 cases were directly used. The rated capacity of expander placed at the supraclavicular region ranged from 200 to 350 mL with times of water injection from 1.5 to 2.0. Seven patients were treated by preexpanded superficial temporal frontal branch artery perforator flap with size of 5.5 cm×3.8 cm to 8.0 cm×5.0 cm. The rated capacity of expanders placed at forehead was 150 to 300 mL with times of water injection of 1.5 to 2.0. Donor sites were directly sutured or reversely repaired by pedicled skin tube plasty. After operation, operation times and treatment time were recorded. The survival condition and complications of flaps and follow-up were observed. Results The patients each received 1 to 4 operation (s) with treatment time of 5 to 11 months. All flaps survived after operation. Among them, three flaps with perforating branches of internal thoracic artery had slight blood circulation disturbance at the distal end and were healed after conservative dressing change, etc. Pigment changes were observed at the distal end of thoracic internal artery perforator flaps in two patients in the later stage and was resected and repaired in the second stage. The patients were followed up for 5 to 18 months. The appearance and function of operation area were good with high satisfaction of patient. Conclusions The axial flap of adjacent artery perforator with vascular pedicle for repairing scar deformity of face and neck used directly or preexpanded can solve the problem of lack of normal skin around scar deformity without vascular anastomosis during the operation and with better appearance and function after operation. The donor site often can be directly sutured, but many operations often need to be completed for finishing whole treatment.

Objective To explore the clinical effects of expanded forehead flaps in repairing midfacial defects. Methods From January 2003 to December 2018, 19 patients with midfacial defects were admitted to our unit, including 8 males and 11 females, aged 7 to 52 years. One cylindrical expander with rated capacity ranged from 100 to 170 mL was placed in the forehead of patients in the first stage of expansion, and the total water injection volume was about 2 times of the rated capacity of the expander during 1 to 2 months. The area of midfacial defects was 4 cm×2 cm to 9 cm×5 cm after resection in the second stage surgery. Expanded forehead flaps with vascular pedicle of supratrochlear vessels or frontal branch of superficial temporal vessels were used to repair the midfacial defects, with flap size ranging from 5 cm×2 cm to 16 cm×6 cm. The donor sites were closed by direct suturing. Three weeks later, the pedicle was divided. The complications, blood supply after flap transfer and pedicle division, and the treatment effects during follow-up were observed. Results Among the patients, flaps of 11 patients had vascular pedicle of supratrochlear vessels; flaps of 8 patients had vascular pedicle of frontal branch of superficial temporal vessels. All the flaps survived with no complications and good blood supply after flap transfer and pedicle division. During the follow-up of 6 to 12 months after the third stage surgery of pedicle division of 12 patients, no lower eyelid ectropion occurred, the appearance of the flaps was similar to the surrounding tissue with no swelling. Conclusions The application of expanded forehead flaps can not only repair the defects but also effectively avoid the complication of lower eyelid ectropion, which is a promising method in repairing midfacial defects.

Objective To observe content of cytokine in human stromal vascular fraction gel (SVF-GEL) and effect of SVF-GEL on biological behaviors of epidermal and dermal cells in vitro and clinical efficacy of SVF-GEL. Methods (1) SVF-GEL was prepared using liposuction aspirates harvested from females who received abdomen liposuction in author′s unit. SVF-GEL (1 mL) and high-glucose Dulbecco′s modified eagle medium (DMEM, 1 mL) were respectively cultured for 24 h with high-glucose DMEM containing 10% fetal calf serum, 10 g/L penicillin, and 10 g/L streptomycin, denoted as SVF-GEL group and negative control group, with 6 samples in each group. Content of epidermal growth factor (EGF) and vascular endothelial growth factor (VEGF) in the supernatant was determined by enzyme-linked immunosorbent assay. (2) A number of 5×10⁵ human skin fibroblasts (HSF) and HaCaT cells in logarithmic phase were inoculated and cultured in Transwell chambers for 12 h. All Transwell chambers containing cells were divided into SVF-GEL group (0.5 mL SVF-GEL was added for co-culture) and control group (0.5 mL high-glucose DMEM was added for co-culture), with 9 samples in each group for HSF and HaCaT cells. Scratch assay was performed after culture for 24 h, and residual scratch width was observed at post scratch hour (PSH) 0 (immediately), 24, and 48. Cell migration distance was measured at PSH 24 and 48. After culture for 24, 48, and 72 h, the number of living cell was counted using cell counter. (3) From June 2018 to June 2019, SVF-GEL was applied clinically to treat 15 patients with depressed scars on face, including 2 males and 13 females, aged 19 to 42 years. Survival condition of SVF-GEL and whether complications or not were observed 6 months after surgery. Before surgery and 6 months after surgery, depressed degree, color, and pliability of scar were compared. Vancouver Scar Scale (VSS) was employed to access color, vascularity, and pliability before surgery and 6 months after surgery, and total score was calculated. The number of patients with complete satisfaction or satisfaction was counted six months after surgery. Data were processed with analysis of variance of factorial design, paired samples

test, and Wilcoxon rank sum test. Results (1) The content of EGF in SVF-GEL group and negative control group was (316.6±12.8) and (3.4±0.6) pg/mL, and the content of VEGF in SVF-GEL group and negative control group was (568.67±12.19) and (4.93±0.16) pg/mL, with statistically significant differences between the two groups (

=48.777, 92.485,

<0.01). (2) Residual scratch widths of HSF and HaCaT in SVF-GEL group and control group were decreased gradually along with time elapse, in which those in SVF-GEL group at PSH 24 and 48 were less than those in control group. At PSH 24 and 48, cell migration distances of HSF and HaCaT in SVF-GEL group were more than those in control group (

_HSF=-20.304, -43.516,

_HaCaT=-15.060, -8.684,

<0.01). After culture for 24, 48, and 72 h, the number of living cell of HSF and HaCaT in SVF-GEL group was significantly more than that in control group (

_HSF=-3.374, -6.809, -18.036,

_HaCaT=-4.793, -6.028, -8.141,

<0.05 or

<0.01). (3) Six months after surgery, SVF-GEL grafted into patients survived well without complications, and depressed degree of scar ameliorated obviously with lightened pigmentation and softer texture as compared with before surgery. Compared with those before surgery, VSS scores of color, vascularity, and pliability, and total score of 15 patients with depressed scars on face were obviously decreased 6 months after surgery (

=-2.06, -2.07, -2.07,

=-15.811,

<0.05 or

<0.01). One patient was satisfied with the clinical outcome, and the rest 14 patients were completely satisfied with the clinical outcomes. Conclusions SVF-GEL contains cytokines EGF and VEGF, which can enhance cell migration ability and proliferation ability of HSF and HaCaT cells and have obvious effects on depressed scars for clinical application.

Objective To analyze application and funding projects of National Natural Science Foundation of China (NSFC) in the discipline of burns and plastic surgery over the years, so as to provide reference for subsequent fund application and the search for new research directions in the discipline. Methods Annual statistical reports on funding projects and Internet-based Science Information System of NSFC were used to search the application and funding situation of the science foundation projects related to the discipline of burns and plastic surgery during 1986-2018. The relevant situation was statistically analyzed during 2009-2018, including the amount of applications and grant, funding rate, and appropriation. The amount of the application and grant, funding rate, appropriation, and funding strength of multiple series (Exploration, Talent, Tools, Integration) during 2009-2018 were statistically analyzed. Main granted projects in each year during 2009-2018 were statistically analyzed. Funding situation of research direction in the discipline of burns and plastic surgery was analyzed. Results (1) During the past 33 years, the amount of application and funding in the discipline of burns and plastic surgery were on increase trend generally. (2) During 2009-2018, the total funding rate of the science foundation was 18.63% (611/3 279), with a total appropriation of 26 167.5 ten thousand yuan. (3) During 2009-2018, the more funding projects in the discipline of burns and plastic surgery were General Program of Exploration series and Young Scientists Fund, and Fund for Less Developed Regions of Talent series in turn, their funding rates were respectively 19.11% (330/1 727), 17.72%(216/1 219), and 19.26%(47/244), with appropriations of 18 115.0, 4 450.0, and 1 780.0 ten thousand yuan and funding strength of 54.89, 20.60, and 37.87 ten thousand yuan per project respectively. In addition, the funding rate of the Key Program of Exploration series was 6.82% (3/44) with appropriation of 828.0 ten thousand yuan, and funding strength for each was 276.00 ten thousand yuan. The International (Regional) Cooperation and Exchange Programs received 15 applications, and 4 projects were funded with appropriation of 524.5 ten thousand yuan and the funding strength of 131.13 ten thousand yuan for each. National Science Fund for Distinguished Young Scholars of Talent series received 12 applications, and 1 project was funded with appropriation of 200.0 ten thousand yuan. Tools and Integration series projects received only a few or no application, and none of the application was funded. (4) The funding amount of General Programs was the most, peaking at 50 in 2012, and was decreased slightly in the past 6 years. The funding amount of Young Scientists Fund was relatively less, but it was on increase trend year by year. The funding amount of Fund for Less Developed Regions was the least relatively, with a steady increase trend in general. (5) The amount of funding projects according to the research direction in the discipline of burns and plastic surgery in the order from more to less were H1507 wound healing and scar (219, 35.84%), H1505 burns (168, 27.50%), H1508 body tissue and organs deformity, damage and repair, and regeneration (143, 23.40%), H1509 body surface tissue organ transplantation and reconstruction (53, 8.67%), H1510 cranial and maxillofacial deformities and correction (27, 4.42%), H1506 frostbite (1, 0.16%). Conclusions In recent years, the amount of science foundation projects in the discipline of burns and plastic surgery was on the rise, mainly including General Programs, Young Scientists Fund, and Fund for Less Developed Regions. In the process of science foundation application in the discipline of burns and plastic surgery, it is necessary to provide more ability training and policy support for young outstanding scientific and technological talents. At the same time, we should attach importance to international and regional academic exchanges, and provide a favorable platform for cooperative projects. Besides, research on new hotspots such as chronic wounds and prevention and treatment of scar or not in popular research such as frostbite should be strengthened.

Objective To explore the effects of negative pressure wound therapy (NPWT) combined with delayed repair on Fournier gangrene in perineal region. Methods During July 2010 to September 2018, 16 patients with Fournier gangrene in perineal region were admitted to our center, with 13 males and 3 females, aged 30 to 76 years. In the first stage, the necrotic tissue of the wound was completely removed according to the scope of the lesion, and NPWT was applied. After the operation, general anti-infection and nutritional support were performed. In the second stage, the local flaps, free flaps, or skin grafts were chosen to repair the wounds according to the specific condition of wounds. The average length of stay and pathological diagnosis were recorded, and the survival and follow-up of skin grafts and flaps were recorded. Results All the 16 patients were cured and discharged, with an average of 29.6 days in hospital. The pathological diagnosis of biopsies were necrotizing inflammation. The wound of 1 patient was healed directly after only NPWT, the skin grafts of 5 patients, local flaps of 9 patients, and anterolateral thigh island flap of 1 patient who had NPWT combined with delayed repair survived well. Sixteen patients were followed up for 1 to 2 years after discharge, and no recurrence of Fournier gangrene was found. Among them, 5 patients with wounds involved perineum and scrotum had good appearance and function of scrotum and mons pubis. Conclusions NPWT combined with delayed plastic repair have great effects on Fournier gangrene.

Objective To explore the clinical effects of split-thickness scalp and allogenic acellular dermal matrix (ADM) in repairing deep wounds of hands in patients with extremely extensive burns. Methods Six patients with extremely extensive burns complicated by deep burn in hands were admitted to our department from December 2014 to December 2017, including 4 males and 2 females, aged 21 to 58 years. Their total burn areas were from 85% to 95% total body surface area (TBSA), and the sum of deep-partial thickness and full-thickness wounds was larger than 50% TBSA. Under general anesthesia, deep wounds of 10 dorsal hands were repaired by combined transplantation of split-thickness scalp and allogenic ADM in 4 to 6 weeks after injury. The skin grafting range was beyond the metacarpophalangeal joint, including partial dorsal digital deep wounds. Survival of skin grafts on dorsal hands, follow-up of hand shape and functional recovery were observed and recorded. Results Six patients were successfully treated. There was no infection on the dorsal deep wounds of 10 hands after surgery, and the grafts survived well. During follow-up of 1 to 2 years after operation, there were no recurrent tension blisters or dorsal extension deformity of the metacarpophalangeal joints in 10 hands, the shape and function of hands recovered well, and hand Carroll scores were from 90 to 99 points, with functional levels of Ⅴ and Ⅵ. Conclusions The combined transplantation of split-thickness scalp and allogenic ADM is a good method for repairing deep hand wounds in patients with extremely extensive burns, which can alleviate the cicatrix hyperplasia and contracture of healed hand wounds, and improve the shape and function of hands.

Sternotomy is a routine surgical pathway for heart, lung, and mediastinal surgery. Poststernotomy dehiscence is a common complication of sternotomy, in which infection after poststernotomy dehiscence is one of the most serious postoperative complications in cardiothoracic surgery. Previously, conventional dressing, negative pressure wound therapy, and skin stretching device were used in the treatment of poststernotomy dehiscence, but the outcome of each single method was poor, which caused great pain and burden to the patients and their families. In recent years, tissue flap containing rich blood supply has drawn a lot of attention because of its good wound cover, stable thoracic reconstruction, low infection recurrence rate, and less postoperative complication. In this paper, we reviewed the epidemiological characteristics of poststernotomy dehiscence, and summarized the various classifications for poststernotomy dehiscence and the therapeutic effects of different tissue flap repair. We hope that this review would provide a basis for further construction of the treatment system for poststernotomy dehiscence and the formation of a treatment guideline.

Despite considerable advances in diagnosis and treatment of the critical illness-related corticosteroid insufficiency (CIRCI), it is still not clear that whether it is common in severe burn patients or not, and how clinical diagnosis, treatment, and research progress. Severe burn is a systemic disease involving the damage of multiple organs of the whole body. The course of the disease is relatively long, and there often exists persistent inflammation, immunosuppression, and catabolism. On the basis of CIRCI study, the epidemiological evidence, possible mechanism, suspicious clinical manifestations, diagnosis and treatment of severe burn-related corticosteroid insufficiency (SBRCI) were briefly reviewed in this article in order to help clinical diagnosis and treatment of SBRCI.

Dental stem cell is a kind of stem cell isolated from dental hard tissue or periodontal tissue, including dental pulp stem cell, stem cell from human exfoliated deciduous teeth, stem cell from root apical papilla, periodontal ligament stem cell, dental follicle progenitor cell, and so on. As seed cell, dental stem cell provides safe and efficient cell source for nerve tissue engineering research. The review aims to introduce the characteristics of these dental stem cells in promoting the regeneration and preparation of nerve and the clinical application.

Nanometer zinc oxide has become a new hotspot in the research of tissue engineering materials due to its excellent antibacterial properties, biocompatibility, and anti-tumor properties. In this paper, the existing research results were summarized, generalized, and analyzed. The antibacterial mechanism of nanometer zinc oxide was discussed in depth. The antibacterial properties and advantages of the latest nanometer zinc oxide composite materials were introduced in detail. In this review, we made prospect of the future application of nanometer zinc oxide.

The 2019 Academic Annual Meeting of the Chinese Burn Association, sponsored by the Chinese Medical Association and the Chinese Burn Association, was successfully held in Zhuhai, Guangdong province, from November 6th to 9th, 2019. The theme of this conference was " One China, One Standard--Data Standardization and Construction of National Burn Data Platform" . A total of 2 305 submissions and 1 749 e-posters were received, and 1 097 registered representatives, nearly 2 000 representatives from 9 countries and regions attended the meeting. Focusing on the theme of this conference, a variety of novel forms were adopted such as teaching contest of young surgeons, multi-disciplinary discussion, workshop, and surgery live broadcast on hot issues in key areas of burns. Besides, with the focus on humanistic care and innovation, a multi-disciplinary discussion was warmly conducted. The 2020 academic annual conference is scheduled to be held in Nanchang, China.