中华烧伤与创面修复杂志

Preparation of Lip-TTO-PHMB and evaluation of its in vitro antibacterial activity and biocompatibility

Cui Lifan, Jin Jian, Wu Hongwei

, Available online , doi: 10.3760/cma.j.cn501225-20250406-00167

Abstract [FullText HTML]

PDF

Abstract:
Objective To prepare a lecithin liposome-tea tree oil-polyhexamethylene biguanide hydrochloride complex (Lip-TTO-PHMB) and to investigate its in vitro 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 lecithin to cholesterol of 3.77: 1.00, volume fraction of tea tree 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. Mouse fibroblasts L929 were divided into lecithin liposome-polyhexamethylene biguanide hydrochloride (Lip-PHMB) group, Lip-TTO-PHMB group, and polyhexamethylene biguanide hydrochloride (PHMB) group treated with the corresponding materials, with the final mass concentrations of PHMB adjusted to 62.5, 31.3, and 15.6 μg/L, and the cell viability was detected by the thiazolyl blue tetrazolium bromide assay. 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/L, and the cell viability was detected by live/dead cell staining. The sample size for the above experiments was 4. Human immortalized keratinocytes (HaCaT) were divided into control group cultured with serum-free MEM medium, and PHMB group and Lip-TTO-PHMB group treated with the corresponding materials with the final mass concentration of PHMB at 15.0 μg/L. 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 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. After 24 h of culture, at PHMB final mass concentrations of 62.5, 31.3, and 15.6 μg/L, 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). 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 prepared Lip-TTO-PHMB can retain excellent antibacterial activity and possess favorable biocompatibility.

Anatomical characteristics of the saphenous branch flap with the descending genicular artery and its efficacy in anterior knee wound reconstruction in elderly patients

Ding Wei, Liu Xiangkun, Cheng Shaowen, Li Lei, Zhao Feilong, Bao Wenxiu, Chi Zhenglin

, Available online , doi: 10.3760/cma.j.cn501225-20250729-00332

Abstract [FullText HTML]

PDF

Abstract:
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, external diameter at the origin, length, and vertical distance from the origin to the medial femoral epicondyle of the descending genicular artery, 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 after debridement ranged from 5.0 cm×4.0 cm to 15.0 cm×7.5 cm. 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. All 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 and 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 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 always originated from the femoral artery, with an external diameter of (2.00±0.30) mm at its origin, a length of (0.8±0.3) cm, and a vertical distance of (12.5±0.8) cm from its origin to the medial femoral epicondyle. The saphenous branch originated from the descending genicular artery in 8 lower limb specimens and from the femoral artery in 2 lower limb specimens. The saphenous branch had an external diameter of (1.20±0.20) mm at its origin and an intermuscular course length of (10.0±0.8) cm. All flaps survived uneventfully after surgery, and both donor and recipient sites healed well. During a follow-up period of 6 to 12 months, the flaps closely matched 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 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 position, with vascular pedicle length and external diameter well-suited for flap harvesting and transfer. The application of the saphenous branch flap with the descending genicular artery for anterior knee wound repair 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.

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

, Available online , doi: 10.3760/cma.j.cn501225-20260718-00265

Abstract [FullText HTML]

PDF

Abstract:
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 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 predictions to support clinical decisions. Based on the clinical requirements of severe burn and complex wound care and the available evidence on artificial intelligence, 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. Clinical interventions including fluid resuscitation, antimicrobial 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 estimates outcomes that may occur under the current care pathway, whereas counterfactual simulation requires explicit causal assumptions, clearly defined applicability conditions, uncertainty estimates, and accountability boundaries, and should not be directly interpreted as a treatment prescription. The clinical value of artificial intelligence should be established prospectively by comparing clinicians working independently with clinicians assisted by artificial intelligence. 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. The article discusses the pathway and boundaries of artificial intelligence-enabled full-course care from the perspectives of current pathway capabilities, intelligent wound assessment, systemic risk monitoring, causal inference, and translational implementation and governance.

Establishment and preliminary validation of an artificial intelligence-assisted model for identification of perforators of anterolateral thigh perforator flaps based on preoperative indocyanine green angiography (ICGA) videos

Hou Xinwei, Dong Shuai, Zhu Bo, Wu Chenglong, Tian Yongsheng, Wang Shi, Liu Zeyu, Ju Jihui, Wang Kai

, Available online , doi: 10.3760/cma.j.cn501225-20260531-00222

Abstract [FullText HTML]

PDF

Abstract:
Objective To establish and preliminarily validate an artificial intelligence-assisted model for identification of perforators of anterolateral thigh perforator flaps based on preoperative 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. All patients received preoperative color Doppler ultrasound (CDU) and ICGA examinations. 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. With the intraoperative exploration result as the gold standard, 4 perforator sites were preset in the anterolateral thigh perforator flap area of each patient. In the training set and the validation set of patients, cases where the distance between the perforator localization points of CDU, ICGA-manual interpretation, and ICGA-based artificial intelligence (ICGA-AI) and the actual intraoperative cutaneous perforator entry point was ≤1.0 cm (defined as true positive) were calculated, and the positive rate was calculate. In the training set and validation set of patients, 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; the distance between the perforator localization points determined by the three methods and the corresponding actual intraoperative cutaneous perforator entry point (error distance) was measured; the consistency between the dominant perforator localization 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 of CDU, ICGA-manual interpretation, and ICGA-AI were 88.70%, 85.88%, 89.47%, 84.88%, 87.50%, and 87.29%, 93.91%, 89.41%, 92.31%, 91.57%, 92.00%, and 91.66%, and 82.61%, 83.53%, 87.16%, 78.02%, 83.00%, and 83.07%, respectively; the consistency of the perforator localization results between the three methods and the 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 of CDU, ICGA-manual interpretation, and ICGA-AI were 95.24%, 78.95%, 83.33%, 93.75%, 87.50%, and 87.09%, 95.24%, 92.11%, 93.02%, 94.59%, 93.75%, and 93.67%, 95.24%, 94.74%, 95.24%, 94.74%, 95.00%, and 94.99%, respectively; the consistency of the perforator localization results between the three methods and the 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 accuracy of ICGA-AI for dominant perforator localization was 82.00% (41/50) and 90.00% (18/20), respectively. Conclusions This study preliminarily establishes an artificial intelligence-assisted method for identification of perforators of anterolateral thigh perforator flaps based on ICGA videos. In the validation set of patients, this method showed smaller localization errors and higher accuracy of dominant perforator localization, which can assist in preoperative perforator localization.

Expert consensus on the application of the hydrosurgery system in wound debridement (2026 edition)

, Available online , doi: 10.3760/cma.j.cn501225-20260211-00078

Abstract [FullText HTML]

PDF

Abstract:
As a novel surgical debridement device, the hydrosurgery system has significant clinical value in facilitating wound healing and optimizing wound bed preparation. Compared with conventional surgical debridement, the hydrosurgery system possesses prominent advantages, including high tissue selectivity, favorable safety profile, and precise debridement performance, which has contributed to its expanded application in wound management. However, there is a lack of consensus regarding the rational application, 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 burn, 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.

Effects of pulsed electromagnetic fields on high-glucose-induced proliferation inhibition of HUVECs and the underlying mechanisms

Cao Tao, Ji Peng, Zhang Zeng, Xiao Dan, Zhao Ming, He Wenqiao, Chen Bo, Tao Ke

, Available online , doi: 10.3760/cma.j.cn501225-20251216-00523

Abstract [FullText HTML]

PDF

Abstract:
Objective To investigate the effects of pulsed electromagnetic fields (PEMFs) on high-glucose (HG)-induced proliferation inhibition of human umbilical vein endothelial cells (HUVECs) and the underlying mechanisms. Methods This study was an experimental research involving grouping design and factorial design. HUVECs were divided into control group with conventional culture, PEMF group exposed to PEMF stimulation with frequency of 15 Hz, intensity of 0.5 mT, and duration of 0.5 h/d for 2 consecutive days, HG group cultured with final molarity of 30 mmol/L glucose (hereinafter referred to as HG culture), and HG+PEMF group received the aforementioned PEMF stimulation while under HG culture. The cell proliferation levels were detected using cell counting kit-8 (CCK-8) at 0 (immediately), 12, 24, and 48 h after culture. After the optimal PEMF stimulation duration 1.0 h/d was screened, HUVECs were collected and grouped as before. Except for the PEMF stimulation duration of 1.0 h/d, all other treatments remained the same. Western blotting was employed to detect the protein expression levels of Wnt-3a and β-catenin of cells in each group at 48 h after culture, transcriptomic sequencing was performed on cells in HG and HG+PEMF groups at 48 h after 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) of cells in each group at 48 h after culture. HUVECs were divided into HG group, HG+PEMF group, and APC overexpression group. The HG group cells received HG culture; the HG+PEMF group cells received PEMF stimulation with frequency of 15 Hz, intensity of 0.5 mT, and duration of 1.0 h/d for 2 consecutive days while under HG culture; the APC overexpression group cells were constructed into APC gene overexpression cells using plasmid transfection, followed by the same treatment as in HG+PEMF group. Cell proliferation levels were detected by CCK-8 at 0(immediately), 12, 24, and 48 h after culture, and protein expression levels of APC, β-catenin, and Wnt-3a were detected by Western blotting at 48 h after culture. The sample size for the experiments was three. Results At 24, 36, and 48 h after culture, the cell proliferation levels in HG group were significantly lower than those in control group (P<0.05). At 36 and 48 h after culture, the cell proliferation levels in HG+PEMF group were significantly increased compared with those in HG group (P<0.05). At 48 h after culture, the protein expression levels of Wnt-3a and β-catenin in HG group were significantly lower than those in control group and HG+PEMF group (P<0.05). Transcriptomic sequencing showed that compared with those in HG group, there were 573 DEGs with significant differential expression in HG+PEMF group of cells, among which the gene expression of the key regulatory protein of the Wnt pathway, APC, was significantly downregulated. At 48 h after 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). At 36 and 48 h after culture, the proliferation levels of cells 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). At 48 h after culture, the protein expression level of APC in HG+PEMF group of cells 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 with frequency of 15 Hz, intensity of 0.5 mT, and duration of 1.0 h/d for 2 consecutive days alleviates the inhibitory effect of HG on HUVEC proliferation. The mechanism involves the downregulation of APC protein expression by PEMF, which alleviates the suppression of the Wnt/β-catenin pathway and subsequently modulates Wnt-3a and β-catenin expressions.

Application effect of LLMs as decision-support tools in emergency burn treatment

Yan Mengting, Wei Jintao, Jiang Shouyin, Wu Pan, Wang Xingang

, Available online , doi: 10.3760/cma.j.cn501225-20260601-00223

Abstract [FullText HTML]

PDF

Abstract:
Objective To explore the application effect of large language models (LLM) 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 associate senior emergency medicine department physicians and one senior burn and wound repair department physician from the hospital were defined as the gold standard. Two burn and wound repair department physicians with more than 5 years of working experience conducted blind evaluations on the diagnostic accuracy and rationality of treatment plans for all diagnoses and treatment plans generated 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) for the aforementioned 100 patients form May 25-28,2026 using the Likert scale in accordance with the gold standard. 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 inter-rater consistency of diagnostic accuracy scores and treatment plan rationality scores between the two evaluators was assessed. 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% (50.0%, 100%), and 100% (50.0%, 100%), respectively, which were all significantly higher than the 100% (50.0%, 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 and Qwen-3.6-Max-Preview were significantly higher than that by EDJPs (P<0.05). No statistically significant differences in percentages of diagnostic accuracy scores were found among EDJPs and the four LLMs for patients with severe and extremely severe burns (P>0.05). Good inter-rater consistency was observed for diagnostic accuracy scores between the two evaluators (with a 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 a 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 demonstrate diagnostic accuracy and treatment plan rationality equivalent to or even superior to those of EDJPs for patients with emergency burns, showing preliminary potential to serve as burn clinical second-opinion tools.

From China to the world: the internationalization path and prospects of a discipline system for wound repair with Chinese characteristics in China

Fu Xiaobing

, Available online , doi: 10.3760/cma.j.cn501225-20260722-00270

Abstract [FullText HTML]

PDF

Abstract:
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.

Online First

Guidelines and Consensus>>

Notice>>