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2026, Volume 42,  Issue 9

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Academician Forum
From China to the world: the internationalization path and prospects of a discipline system for wound repair with Chinese characteristics
Fu Xiaobing
2026, 42(9): 803-808. doi: 10.3760/cma.j.cn501225-20260722-00270
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Based on the author's personal experience, this paper presents a comparative systematic review of the internationalization path and prospects of a discipline system for wound repair with Chinese characteristics from the 1990s to the new era. This trajectory of internationalization has significantly contributed to the development of China's disciplinary framework in construction of the discipline system for wound repair, basic research, clinical management, talent cultivation, and in serving the vast number of patients. All of these practices played an important role in construction of a wound repair discipline system with Chinese characteristics. These experiences have significant reference value for further constructing and improving the Chinese-characteristic wound repair discipline system in the new era.
Guideline and Consensus
Expert consensus on the application of the hydrosurgery system in wound debridement (2026 edition)
2026, 42(9): 809-819. doi: 10.3760/cma.j.cn501225-20260211-00078
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As a novel surgical debridement device, the hydrosurgery system has significant clinical value in facilitating wound healing and wound bed preparation. Compared with conventional surgical debridement, the hydrosurgery system possesses prominent advantages, including high tissue selectivity, a high safety profile, and precise debridement performance, leading to its increasingly expanded application in wound management. However, there is a lack of consensus regarding the rational use of the system, accurate mastery of the key operational essentials, as well as accurate identification of indications and contraindications or relative contraindications for this system. Accordingly, the Wound Repair Professional Committee of Chinese Medical Doctor Association assembled renowned experts in the fields of burns, trauma, and wound repair in China. Based on evidence-based medical evidence, combined with domestic and international research advances and clinical practice experience, the committee formulated the Expert consensus on the application of the hydrosurgery system in wound debridement (2026 edition) to provide references for the clinical use of the hydrosurgery system.
Expert Forum
Artificial intelligence-enabled full-course diagnosis and treatment for patients with severe burns and wounds requiring repair: from risk prediction to causal inference
Nie Weizhi, Xie Keliang
2026, 42(9): 820-827. doi: 10.3760/cma.j.cn501225-20260718-00265
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The diagnosis and treatment of severe burns and complex wounds require the coordinated management of local tissue injury, systemic pathophysiological changes, and sequential clinical interventions. Existing diagnostic and treatment pathways can support bedside evidence-based decision-making and allow clinicians to adjust treatment as a patient's condition evolves. However, limitations remain in the consistency of prehospital and primary-care assessments, the longitudinal integration of multimodal information, and the use of risk prediction results to support clinical decisions. Based on the clinical requirements of severe burn and complex wound care and the available evidences form artificial intelligence studies, this expert commentary examines the capability boundaries of current care pathways, the potential clinical benefits for different users, and the conditions required to extend risk prediction to constrained causal inference. We propose a full-course dynamic diagnostic and treatment framework comprising wound assessment, systemic monitoring, and clinical intervention. Standardized image analysis is used to assess wound area, depth, necrosis, infection, and healing trajectories. Time-series models integrate vital signs, laboratory measurements, inflammatory and infectious markers, metabolic and coagulation status, and organ function to continuously monitor the patient's systemic condition. At the same time, clinical interventions, including fluid resuscitation, anti-infective treatment, debridement and wound coverage, nutritional support, and rehabilitation, are aligned along a unified timeline to preserve the temporal relationships among changes in patient status, intervention timing, and clinical outcomes. Risk prediction is used to estimate potential clinical outcomes that may occur under the existing diagnostic and treatment pathways, whereas counterfactual simulation must be based on explicit causal assumptions, applicability conditions, uncertainty estimates, and boundaries of responsibility, and its results cannot be used directly as treatment prescriptions. The clinical value of artificial intelligence should be established through prospective studies that directly compare the effects of clinicians' independent judgments with those of their artificial intelligence-assisted judgments. In addition to discrimination, evaluation should include assessment time, inter-clinician agreement, calibration, warning lead time, alert and workflow burden, changes in clinical decisions, patient safety, and clinical outcomes. Addressing the capability boundaries of current care pathways, intelligent wound assessment, systemic risk monitoring, causal inference, and translational implementation and governance, this article discusses the pathways and boundaries of artificial intelligence integration into full-course diagnosis and treatment for patients with severe burns and wounds requiring repair.
Original Article · Exploration on Artificial Intelligence in the Diagnosis and Treatment of Burns and Wounds
Application effect of LLMs as decision-support tools in emergency burn treatment
Yan Mengting, Wei Jintao, Jiang Shouyin, Wu Pan, Wang Xingang
2026, 42(9): 828-836. doi: 10.3760/cma.j.cn501225-20260601-00223
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  Objective  To explore the application effect of large language models (LLMs) as decision-support tools in emergency burn treatment.  Methods  This study was a cross-sectional study. A total of 100 burn patients meeting the inclusion criteria were admitted to the Department of Emergency Medicine of the Second Affiliated Hospital of Zhejiang University School of Medicine between September 2025 and April 2026, including 52 males and 48 females, aged 34.5 (25.0, 56.8) years. Based on patients' discharge summaries, the diagnoses and treatment plans reviewed and confirmed by an expert panel, consisting of two emergency medicine physicians with associate senior titles and one burn and wound-repair specialist with a senior title from the hospital, were taken as the gold standard. Based on the gold standard and in a blind manner, two burn and wound-repair physicians with more than 5 years of working experience in the hospital used the Likert scale to evaluate the diagnostic accuracy and rationality of treatment plans, which were generated during May 25-28, 2026 for the aforementioned 100 patients by 4 LLMs (ChatGPT-5.5, Doubao-2.0-Pro, Qwen-3.6-Max-Preview, and Gemini 3.5 Flash) as well as 10 emergency medicine department junior physicians (EDJPs). The percentage of diagnostic accuracy scores and treatment plan rationality scores for the 100 patients were compared among EDJPs and the four LLMs; the percentage of diagnostic accuracy scores across patients with varying burn severities were also compared among EDJPs and the four LLMs; the consistency of diagnostic accuracy scores and treatment plan rationality scores were compared between the two evaluators.  Results  The percentages of diagnostic accuracy scores for the 100 patients by Doubao-2.0-Pro, Gemini 3.5 Flash, ChatGPT-5.5, and Qwen-3.6-Max-Preview were 100% (100%, 100%), 100% (100%, 100%), 100% (50%, 100%), and 100% (50%, 100%), respectively, which were all significantly higher than the 100% (50%, 100%) by EDJPs (P<0.05). The treatment plan rationality scores for the 100 patients by Doubao-2.0-Pro, ChatGPT-5.5, and Gemini 3.5 Flash were 4.0 (4.0, 4.0), 4.0 (4.0, 4.0), and 4.0 (4.0, 4.0), respectively, which were all significantly higher than the 4.0 (3.0, 4.0) by EDJPs (P<0.05). The treatment plan rationality scores for the 100 patients by Doubao-2.0-Pro and ChatGPT-5.5 were significantly higher than the 4.0 (3.0, 4.0) by Qwen-3.6-Max-Preview (P<0.05). The percentages of diagnostic accuracy scores for patients with mild burns by Doubao-2.0-Pro, Gemini 3.5 Flash, and ChatGPT-5.5 were significantly higher than that by EDJPs (P<0.05); the percentages of diagnostic accuracy scores for patients with moderate burns by Doubao-2.0-Pro, Qwen-3.6-Max-Preview, and Gemini 3.5 Flash were significantly higher than that by EDJPs (P<0.05); the differences in percentages of diagnostic accuracy scores were not statistically significant among EDJPs and the four LLMs for patients with severe and extremely severe burns (P>0.05). Good consistency was observed for diagnostic accuracy scores between the two evaluators (with an interclass correlation coefficient of 0.821, with a 95% CI of 0.746-0.876), and moderate consistency was noted for treatment plan rationality scores (with an interclass correlation coefficient of 0.650, with a 95% CI of 0.522-0.749).  Conclusions  Doubao-2.0-Pro, ChatGPT-5.5, and Gemini 3.5 Flash matched or even surpassed EDJPs in terms of diagnostic accuracy and treatment plan rationality for emergency burn patients, showing preliminary potential to serve as tools for second clinical opinions in burn care.
Establishment and preliminary clinical validation of an artificial intelligence-assisted perforator identification model for anterolateral thigh perforator flaps based on ICGA videos
Hou Xinwei, Dong Shuai, Zhu Bo, Wu Chenglong, Tian Yongsheng, Wang Shi, Liu Zeyu, Ju Jihui, Wang Kai
2026, 42(9): 837-846. doi: 10.3760/cma.j.cn501225-20260531-00222
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  Objective  To establish and preliminarily clinical validate an artificial intelligence-assisted perforator identification model for anterolateral thigh perforator flaps based on indocyanine green angiography (ICGA) videos.  Methods  This study was a cross-sectional study. From January to July 2024, 70 patients who met the inclusion criteria and underwent anterolateral thigh perforator flap repair surgery were admitted to Suzhou Ruihua Orthopedic Hospital of Soochow University. There were 54 males and 16 females, aged 10 to 70 years. Fifty patients were selected as the training set for model parameter training using the random function in Python 3.13, and the remaining 20 patients were assigned as the validation set for independent validation. All patients received preoperative color Doppler ultrasound (CDU) and ICGA examinations. Postoperatively, artificial intelligence-assisted identification based on ICGA videos was adopted for perforator localization. Four perforator sites were designated in the anterolateral thigh perforator flap area of each patient. In the training set and the validation set of patients, the positive in perforator localization of CDU, ICGA-manual interpretation, and artificial intelligence-assisted ICGA (ICGA-AI) was collected, and the positive rate was calculated. The sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and balanced accuracy of the three methods for perforator localization were calculated; the consistency of the perforator localization results between the three methods and the intraoperative exploration was recorded. The distance between the perforator localization points determined by the three methods and the corresponding actual intraoperative cutaneous perforator entry point (error distance of perforator localization) was measured. The consistency between the dominant perforator localized by ICGA-AI and that determined intraoperatively was recorded, and the localization accuracy of the dominant perforator was calculated.  Results  There were no statistically significant differences in the positive rates of perforator localization among the three methods in both the training set and the validation set of patients (P>0.05). In the training set of patients, the sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and balanced accuracy for perforator localization were 88.70%, 85.88%, 89.47%, 84.88%, 87.50%, and 87.29% for CDU, 93.91%, 89.41%, 92.31%, 91.57%, 92.00%, and 91.66% for ICGA-manual interpretation, and 82.61%, 83.53%, 87.16%, 78.02%, 83.00%, and 83.07% for ICGA-AI, respectively; the consistency between the perforator localization results by CDU, ICGA-manual interpretation, and ICGA-AI and the findings from intraoperative exploration was strong or almost perfect (with κ of 0.74, 0.84, and 0.66, respectively, P<0.05). In the validation set of patients, the sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and balanced accuracy for perforator localization were 95.24%, 78.95%, 83.33%, 93.75%, 87.50%, and 87.09% for CDU, 95.24%, 92.11%, 93.02%, 94.59%, 93.75%, and 93.67% for ICGA-manual interpretation, and 95.24%, 94.74%, 95.24%, 94.74%, 95.00%, and 94.99% for ICGA-AI, respectively; the consistency between the perforator localization results by CDU, ICGA-manual interpretation, and ICGA-AI and the findings from intraoperative exploration was strong or almost perfect (with κ of 0.75, 0.88, and 0.90, respectively, P<0.05). In the training set of patients, the error distance of perforator localization of ICGA-AI was 0.84 (0.70, 0.98) cm, which was significantly shorter than 1.41 (0.80, 2.00) cm of CDU (Z=-2.56, P<0.05) and 1.50 (1.03, 1.80) cm of ICGA-manual interpretation (Z=-5.88, P<0.05). In the validation set of patients, the error distance of perforator localization of ICGA-AI was 0.52 (0.35, 0.71) cm, which was significantly shorter than 1.50 (1.00, 2.25) cm of CDU (Z=-3.23, P<0.05) and 1.56 (1.41, 2.00) cm of ICGA-manual interpretation (Z=-3.52, P<0.05). In the training set and the validation set of patients, the localization accuracy of ICGA-AI for the dominant perforator was 82.00% (41/50) and 90.00% (18/20), respectively.  Conclusions  An artificial intelligence-assisted perforator identification model for anterolateral thigh perforator flaps based on ICGA videos is established. In patients of the validation set, this model shows smaller localization errors and higher accuracy in locating dominant perforators, which can assist with preoperative perforator localization.
Construction and validation of a multimodal risk prediction model for burn sepsis in infants and toddlers based on deep learning
Shen Yuhe, Zhang Lei, Ji Yi, Chen Sheng, Shen Weimin
2026, 42(9): 847-856. doi: 10.3760/cma.j.cn501225-20260519-00200
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  Objective  To construct and validate a multimodal risk prediction model (hereinafter referred to as the multimodal prediction model) for burn sepsis in infants and toddlers based on deep learning.  Methods  This retrospective cohort study included 1 709 burned infants and toddler patients (hereinafter referred to as pediatric patients) with total burn area ranged from 1.0%-85.0% total body surface area who were admitted to the Department of Burn and Plastic Surgery of Children's Hospital of Nanjing Medical University and met the eligibility criteria from January 2015 to December 2025. According to clinical outcomes, pediatric patients were divided into sepsis group (n=54, 34 males and 20 females, aged 500.0 (270.3, 695.0) days) and non-sepsis group (n=1 655, 998 males and 657 females, aged 515.0 (365.0, 790.0) days). Clinical data collected within 24 h after admission were analyzed and compared between the two groups of pediatric patients, including the total burn area, full-thickness burn area, the proportion of pediatric patients with concomitant inhalation injury, elevated C-reactive protein (CRP), and elevated procalcitonin, prothrombin time (PT), albumin level, and white blood cell count. A multimodal prediction model was constructed by integrating burn wound image features and paired clinical scale features. Its performance was compared with that of random forest, XGBoost, TabTransformer, ResNet, Vision Transformer, and Swin Transformer models (six control models), and its internal performance was evaluated using five-fold cross-validation. Gradient-based feature importance analysis was performed to interpret the multimodal prediction model and to quantify the contribution of clinical features. Gradient-weighted class activation mapping was applied for visualization of the multimodal prediction model.  Results  Compared with those in non-sepsis group, pediatric patients in sepsis group had significantly larger total burn area and full-thickness burn area (with Z values of 8.266 and 7.945, respectively, P<0.05). Additionally, the proportions of pediatric patients with concomitant inhalation injury, elevated CRP, and elevated procalcitonin, and white blood cell count were significantly higher (with χ2 values of 4.914, 7.803, and 8.859, respectively, Z=1.969, P<0.05), while albumin levels were significantly lower (Z=-2.132, P<0.05), and PT was significantly prolonged (Z=-4.247, P<0.05). The multimodal prediction model achieved an area under the receiver operating characteristic curve of 0.931±0.009 for predicting post-burn sepsis of pediatric patients, which was higher than that of random forest, XGBoost, TabTransformer, ResNet, Vision Transformer, and Swin Transformer models (with values of 0.861±0.031, 0.862±0.025, 0.876±0.019, 0.897±0.015, 0.900±0.015, and 0.916±0.012, respectively). The Dice similarity coefficient of the multimodal prediction model for burn wound image segmentation was higher than that of the ResNet, Vision Transformer, and Swin Transformer models. Across five-fold cross-validation, the multimodal prediction model exhibited superior overall predictive performance compared to the six control models. Gradient-based feature importance analysis revealed that PT had the highest normalized importance weight (1.000), followed by diastolic blood pressure (0.855). The wound regions delineated by the multimodal prediction model were largely consistent with those manually annotated by physicians.  Conclusions  The constructed multimodal prediction model demonstrates good discriminative performance and clinical application value for assessing the risk of post-burn sepsis in pediatric patients.
Original Article
Anatomical characteristics of the saphenous branch flap with the descending genicular artery and its efficacy in repairing anterior knee wounds in elderly patients
Ding Wei, Liu Xiangkun, Cheng Shaowen, Li Lei, Zhao Feilong, Bao Wenxiu, Chi Zhenglin
2026, 42(9): 857-865. doi: 10.3760/cma.j.cn501225-20250729-00332
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  Objective  To investigate the anatomical characteristics of the saphenous branch flap with the descending genicular artery and its efficacy in repairing anterior knee wounds in elderly patients.  Methods  This study consisted of an invasive observational study and a retrospective case series study. From April to July 2018, the anatomical study was conducted on the lower limb specimens from 5 voluntarily donated adult cadavers (4 males and 1 female, aged 52-71 years) obtained from the Department of Clinical Anatomy of Wannan Medical University. Fine dissections were performed on both lower limbs of each of the 5 cadavers. The origin of the descending genicular artery, external diameter at the origin, length at the origin, and vertical distance from the origin to the medial femoral epicondyle, as well as the origin, external diameter at the origin, and intermuscular course length of its saphenous branch were observed and recorded. From August 2018 to October 2024, 19 elderly patients (12 males and 7 females, aged 60-78 years) with anterior knee wounds meeting the inclusion criteria were treated at Yijishan Hospital of Wannan Medical University. The wound sizes ranged from 5.0 cm×4.0 cm to 15.0 cm×7.5 cm after debridement. All wounds were repaired using the saphenous branch flap with the descending genicular artery, with flap sizes ranging from 6.0 cm×5.0 cm to 16.0 cm×8.5 cm. The donor site wounds were directly sutured. Postoperative assessments included flap survival, wound healing in the donor and recipient sites, and follow-up evaluations of flap texture and appearance, scar formation in the donor and recipient sites. At the last follow-up, two-point discrimination distance of the flap was measured, the two-point discrimination of flap was graded according to the trial standards for evaluation of partial function of upper extremity by the Hand Surgery Society of Chinese Medical Association, and knee joint function was evaluated and graded using the International Knee Documentation Committee Subjective Short Form.  Results  In the 10 lower limb specimens, the descending genicular artery all originated from the femoral artery, with an external diameter of (2.00±0.30) mm at the origin, a length of (0.8±0.3) cm at the origin, and a vertical distance of (12.5±0.8) cm from the origin to the medial femoral epicondyle. The saphenous branch of the descending genicular artery originated from the descending genicular artery in 8 lower limb specimens and from the femoral artery in 2 lower limb specimens. The saphenous branch of the descending genicular artery had an external diameter of (1.20±0.20) mm at the origin and an intermuscular course length of (10.0±0.8) cm. All flaps survived uneventfully after surgery, and the wounds in both donor and recipient sites healed well. During a follow-up period of 6 to 12 months, the flaps closely matched the normal skin in the recipient site in texture, color, and thickness, and only linear scars exhibited in the donor and recipient sites. At the last follow-up, the two-point discrimination was graded as S4 in 7 cases and S3+ in 12 cases; the knee joint function was rated as excellent in 11 cases, good in 6 cases, and poor in 2 cases.  Conclusions  The descending genicular artery and its saphenous branch have a high occurrence rate and a constant anatomical location, and the vascular pedicle length and external diameter of the saphenous branch of the descending genicular artery are highly suitable for flap harvesting and transfer. The application of the saphenous branch flap with the descending genicular artery in repairing anterior knee wounds can achieve satisfactory recovery of donor and recipient site appearance, flap sensation, and knee joint function, making it a suitable option for anterior knee wound repair in elderly patients.
Effects of pulsed electromagnetic fields on high-glucose-induced inhibition of HUVEC proliferation and its underlying mechanisms
Cao Tao, Ji Peng, Zhang Zeng, Xiao Dan, Zhao Ming, He Wenqiao, Chen Bo, Tao Ke
2026, 42(9): 866-875. doi: 10.3760/cma.j.cn501225-20251216-00523
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  Objective  To investigate the effects of pulsed electromagnetic fields (PEMFs) on high-glucose (HG)-induced inhibition of human umbilical vein endothelial cells (HUVECs) proliferation and its underlying mechanisms.  Methods  This study was an experimental research involving grouping design and factorial design. HUVECs were divided into a conventionally cultured control group, a PEMF group with conventional culture exposed to PEMF stimulation at frequency of 15 Hz, intensity of 0.5 mT, and duration of 0.5 h/d for 2 consecutive days, a HG group cultured with final molarity of 30 mmol/L glucose (hereinafter referred to as HG culture), and a HG+PEMF group received the aforementioned PEMF stimulation while under HG culture. Cell proliferation was assessed using cell counting kit-8 (CCK-8) after 24, 36, and 48 h of culture. After the optimal PEMF stimulation duration 1.0 h/d was screened out, HUVECs were collected and grouped as before. Except for the PEMF stimulation duration of 1.0 h/d, all other treatments were the same as before. Western blotting was employed to detect the protein expression levels of Wnt-3a and β-catenin in cells in each group after 48 h of culture, transcriptomic sequencing was performed on cells in HG and HG+PEMF groups after 48 h of culture to screen for differentially expressed genes (DEGs) with significant differential expression, and Western blotting was used to detect the protein expression level of adenomatous polyposis coli (APC) in cells in each group after 48 h of culture. HUVECs were divided into a HG group, a HG+PEMF group, and an APC overexpression group. The cells in HG group were cultured in HG medium; the cells in HG+PEMF group were cultured in HG medium while receiving PEMF stimulation with frequency of 15 Hz, intensity of 0.5 mT, and duration of 1.0 h/d for 2 consecutive days; the cells in APC overexpression group were transfected using a plasmid to overexpress APC gene, and then subjected to the same treatment as that in HG+PEMF group. Cell proliferation was detected by CCK-8 after 36 and 48 h of culture, and protein expression levels of APC, β-catenin, and Wnt-3a in cells were detected by Western blotting after 48 h of culture. The sample size for the experiments was three.  Results  After 24, 36, and 48 h of culture, cell proliferation levels in HG group were all significantly lower than those in control group (P<0.05). After 36 and 48 h of culture, the cell proliferation levels in HG+PEMF group were significantly increased compared with those in HG group (P<0.05). After 48 h of culture, the protein expression levels of Wnt-3a and β-catenin in HG group of cells were significantly lower than those in control group and HG+PEMF group (P<0.05). Transcriptomic sequencing showed that after 48 h of culture,compared with those in HG group, there were 573 DEGs significantly expressed in the cells of HG+PEMF group, among which the gene expression of APC, the key regulatory protein of the Wnt pathway, was significantly downregulated. After 48 h of culture, the protein expression level of APC in HG group of cells was significantly higher than that in control group and HG+PEMF group (with P values both <0.05). After 36 and 48 h of culture, the cell proliferation levels in HG+PEMF group were 0.479±0.016 and 0.552±0.029, respectively, which were significantly higher than 0.363±0.019 and 0.437±0.010 in HG group and 0.358±0.005 and 0.439±0.020 in APC overexpression group (with P values all <0.05). After 48 h of culture, the protein expression level of APC in cells of HG+PEMF group was significantly lower than that in HG group and APC overexpression group (with P values both <0.05), and the protein expression levels of Wnt-3a and β-catenin were significantly higher than those in HG group and APC overexpression group (P<0.05).  Conclusions  PEMF stimulation at the frequency of 15 Hz, intensity of 0.5 mT, and duration of 1.0 h/d for 2 consecutive days can alleviate the inhibitory effect of HG on HUVEC proliferation. The mechanism involves the downregulation of APC protein expression in cells by PEMF, which attenuates the suppression of the Wnt/β-catenin pathway and subsequently modulates the expressions of Wnt-3a and β-catenin.
Preparation of Lip-TTO-PHMB and evaluation of its in vitro antibacterial activity and biocompatibility
Cui Lifan, Jin Jian, Wu Hongwei
2026, 42(9): 876-885. doi: 10.3760/cma.j.cn501225-20250406-00167
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  Objective  To prepare a lecithin liposome-tea tree essential oil-polyhexamethylene biguanide hydrochloride complex (Lip-TTO-PHMB) and to investigate its invitro antibacterial activity and biocompatibility.  Methods  This study was an experimental research including group design, factorial design, and repeated measurement design. Lip-TTO-PHMB was prepared by the thin-film hydration method. Through single-factor experiments combined with the Box-Behnken response surface methodology, the optimal preparation condition for Lip-TTO-PHMB was determined as follows: mass ratio of egg yolk lecithin to cholesterol of 3.77:1.00, volume fraction of tea tree essential oil of 0.64%, and volume fraction of polysorbate 80 of 0.13%. The model-predicted encapsulation efficiency was 51.035%. Lip-TTO-PHMB was prepared under the optimal preparation condition and its encapsulation efficiency was measured by ultracentrifugation ultraviolet method. Mouse fibroblasts L929 were divided into lecithin liposome-polyhexamethylene biguanide hydrochloride (Lip-PHMB) group treated with Lip-PHMB, Lip-TTO-PHMB group treated with Lip-TTO-PHMB, and polyhexamethylene biguanide hydrochloride (PHMB) group treated with PHMB, with the final mass concentrations of PHMB adjusted to 62.5, 31.3, and 15.6 μg/mL, and the cell viability was detected by the thiazolyl blue assay after 24 h of culture. Another batch of L929 cells were divided into the same groups as before and treated with the corresponding materials with the final mass concentration of PHMB at 15.0 μg/mL, and the cell viability was detected by live/dead cell staining after 24 h of culture. The sample size for the above experiments was 4. Human immortalized keratinocytes (HaCaTs) were divided into control group cultured with serum-free MEM medium, PHMB group treated with PHMB, and Lip-TTO-PHMB group treated with Lip-TTO-PHMB, with the final mass concentration of PHMB at 15.0 μg/mL. The scratch test was performed to detect the cell migration rates at 24 and 48 h after scratch (with the sample size of 3). The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of PHMB in three materials against Staphylococcus aureus ATCC 6538 and Escherichia coli ATCC 8739 were determined by the broth microdilution twofold dilution method, with the sample size of 5.  Results  The measured encapsulation efficiency of Lip-TTO-PHMB was (52.35±0.24)%, which was close to the model-predicted value. The results detected by thiazolyl blue assay showed that after 24 h of culture, at PHMB final mass concentrations of 62.5, 31.3, and 15.6 μg/mL, the viability of L929 cells in Lip-PHMB group and Lip-TTO-PHMB group was significantly higher than that in PHMB group (P<0.05), and the viability of L929 cells in Lip-PHMB group was significantly higher than that in Lip-TTO-PHMB group (P<0.05). The results detected by live/dead cell staining showed that after 24 h of culture, the viability of L929 cells in PHMB group was significantly lower than that in Lip-PHMB group and Lip-TTO-PHMB group (with P values both<0.05). At 24 and 48 h after scratch, the migration rates of HaCaT cells in Lip-TTO-PHMB group were significantly higher than those in PHMB group (P<0.05); at 48 h after scratch, the migration rate of HaCaT cells in control group was significantly higher than that in PHMB group (P<0.05). The MICs of Lip-PHMB, Lip-TTO-PHMB, and PHMB against Staphylococcus aureus were 31.3, 15.6, and 15.6 μg/mL, respectively, and those against Escherichia coli were 31.3, 15.6, and 7.8 μg/mL, respectively. The MBCs of Lip-PHMB, Lip-TTO-PHMB, and PHMB against Staphylococcus aureus were 20, 10, and 15 μg/mL, respectively, and those against Escherichia coli were 30, 20, and 20 μg/mL, respectively.  Conclusions  The Lip-TTO-PHMB is prepared successfully, and the material possesses excellent antibacterial activity while retaining favorable biocompatibility.
Discipline Construction
2026, 42(9): 886-887. doi: 10.3760/cma.j.cn501225-20260112-00020
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2026, 42(9): 888-889. doi: 10.3760/cma.j.cn501225-20251029-00450
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Review
MOIST: a new concept for local management of chronic wound and its clinical significance
Wang Xiaohui, Gong Xiaoyan, Chen Ting, Cai Honglin, Zhao Zhenni, Chen Zhuoying, Wang Kaili
2026, 42(9): 890-895. doi: 10.3760/cma.j.cn501225-20250228-00103
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The repair of chronic wounds is a complex medical challenge involving multiple factors. The diagnosis, treatment, and nursing process are intricate and challenging, imposing a heavy burden on both patients and healthcare providers. With the advancement of clinical medicine, new technologies and methods for local wound treatment are constantly emerging. The wound management principles provide an evidence-based framework for medical staff to standardize clinical practice. The MOIST (M: moisture balance, O: oxygen balance, I: infection control, S: support strategy, T: tissue management) concept was proposed for the first time by a German expert group in 2017 and was updated by an interdisciplinary expert group in 2023, aiming to provide standardized guidance for the treatment and care of chronic wounds. Currently, this concept has been widely applied internationally and has both educational and clinical practice guidance functions. Based on the MOIST concept and focusing on the essential issues in chronic wound management, this article systematically elaborates on the key points, difficulties, and latest progress, with the aim of providing an evidence-based reference for clinical practice.
Research progress on the application of stem cells and their derivatives in chronic wound repair
Wu Ruixue, Shen Jiamen, Duan Fengyin, Chen Bo, Sheng Qihao, Yang Lizhu, Li Xiaokun, Xu Qian, Wang Zhouguang
2026, 42(9): 896-902. doi: 10.3760/cma.j.cn501225-20251110-00466
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Chronic wounds are characterised by factors including persistent inflammation, impaired angiogenesis, cellular dysfunction, and infection, which hinder the normal healing process, thereby not only severely compromising patients' quality of life but also imposing a substantial socioeconomic burden. For this type of wounds, conventional treatments are often limited in efficacy and associated with issues such as prolonged treatment duration and high costs. Recently, research on stem cells and their derivatives in the field of wound repair has been developing rapidly. Stem cells accelerate wound healing primarily through potent paracrine effects and immunomodulatory functions, complemented by multilineage differentiation potential, which synergistically modulate inflammation, promote angiogenesis, and facilitate collagen remodeling. Furthermore, engineering strategies including genetic modification, three-dimensional culture, and biomaterial-based delivery have significantly improved stem cell bioactivity and adaptability to the wound microenvironment. Concurrently, stem cell derivatives, particularly exosomes, have attracted increasing attention as a next-generation "cell-free" therapeutic strategy owing to their low immunogenicity, high stability, abundance of bioactive factors, and capacity for bioengineering modification. It offers a new approach to the precise regeneration of complex wounds. This review aims to review the pathological mechanisms underlying chronic wounds, research progress on therapeutic application of stem cells and their derivatives, engineering strategies, and translational challenges in clinical application, providing a reference for future research in the field.

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