中华烧伤与创面修复杂志

Current status of post-traumatic growth among university students and its mediation pathway with post-traumatic stress symptom

Wang Ya, Xiang Xiaorun, Zhao Yaping, Gu Haiyan, Deng Xiaofeng, Sun Wei

, Available online , doi: 10.3760/cma.j.cn501225-20260309-00099

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Objective To investigate the current status of post-traumatic growth (PTG) among university students, and to explore its translational pathway with post-traumatic stress symptom (PTSS). Methods This study was a multicenter cross-sectional survey. From December 2024 to January 2025, using convenience sampling, 718 university students aged ≥18 years who met the inclusion criteria and had experienced life stress events in the past year were selected from two comprehensive universities and one medical university in Chongqing as the study participants. A self-designed demographic questionnaire was used to collect demographic information of the university students, including gender, age, grade level, and family structure, etc. The adolescent self-rating life events checklist was used to assess university students' experiences of life stress events and whether they were affected by these events. The post-traumatic stress disorder checklist-civilian version, the Chinese-Posttraumatic Growth Inventory, the 10-item Connor-Davidson resilience scale, and the Chinese PERMA-Profiler were used to assess university students' levels of PTSS, PTG, psychological resilience, and well-being, respectively. University students were classified according to demographic information and whether they were affected by life stress events, and their total PTG scores were compared. Correlations between PTG and PTSS, psychological resilience, and well-being in university students were analyzed. Independent influencing factors for PTG among university students were identified. A structural equation model was constructed to analyze the mediating effects of well-being and psychological resilience on the translation between PTSS and PTG. Results Totally 718 questionnaires were distributed, and 647 valid questionnaires were returned, with a valid response rate of 90.1%. Among the university students, there were 584 males and 63 females, aged 18 to 27 years. There were 84 first-year students, 178 second-year students, 196 third-year students, and 189 fourth-year students by grade level. There were 582 students from two-parent families and 65 from single-parent families in the family structure. Totally 102 students were affected by life stress events, while 545 students were not affected by life stress events. The life stress events experienced by university students included 27 items, such as physical trauma, acute or serious illness, interpersonal tension, and academic pressure. The total scores of PTSS, PTG, psychological resilience, and well-being among university students were 18.00 (17.00, 27.00), 64.00 (41.00, 80.00), 30.00 (21.00, 39.00), and 118.00 (90.00, 135.00), respectively. Comparisons of total PTG scores among university students showed statistically significant differences by different age, family structure, and exposure to life stress events (with Z values of -3.426, -2.285, and -3.693, respectively, P<0.05). The total PTG score and its subdimension scores among university students were significantly positively correlated with the total psychological resilience score, the total well-being score and its subdimension scores (with r values of 0.377 to 0.653, P<0.05). Age, family structure, whether being affected by life stress events, well-being, and psychological resilience were independent influencing factors for PTG among university students (with β values of -0.144, 0.109, -0.151, 0.181, and 0.603, respectively, P<0.05). The constructed model was a multiple mediation model. Between PTSS and PTG, both the independent mediating effect of well-being and the serial mediating effects of well-being and psychological resilience were statistically significant (with β values of -0.140 and -0.287, respectively, 95% CI of -0.224 to -0.075 and -0.381 to -0.214, respectively, P<0.05), and the serial mediating effect of well-being and psychological resilience was significantly higher than the independent mediating effect of well-being (β=0.146, with a 95% CI of 0.027 to 0.275, P<0.05). Conclusions PTG among university students is at a moderate level. Well-being and psychological resilience play a serial mediating role in the translation between PTSS and PTG among university students.

Clinical categorization and microsurgical reconstructive algorithm for complex tissue defects of the ankle and foot

Tang Juyu

, Available online , doi: 10.3760/cma.j.cn501225-20260407-00143

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The ankle and foot have a special anatomical structure and undertake crucial functions of body such as weight bearing, walking, running, and jumping. High-energy injuries often lead to complicated conditions and pose challenges to clinical tissue reconstruction. Complex tissue defects of the ankle and foot mostly present as multicompartmental defects involving skin and soft tissue, tendons, bones, and joints, as well as large-area skin and soft tissue defects. We divided the ankle and foot into nine regions based on the anatomical characteristics and physiological functions of different sites. Ten clinical types were then classified according to the involved regions of tissue defects and the presence of combined deep tissue defects. For each clinical type, appropriate flap donor sites and suitable special form of perforator flap procedures can be selected based on the requirements of microsurgical reconstruction, so as to achieve personalized and precise reconstruction and obtain optimal restoration of the appearance and function of the ankle and foot with minimal donor-site morbidities.

Expert consensus on airway lavage therapy for adult burn patient (2026 edition)

, Available online , doi: 10.3760/cma.j.cn501225-20260212-00080

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Airway lavage therapy is an important method for clearing airway secretions and sloughed tissue in burn patients. It primarily includes fiberoptic bronchoscopy-guided lavage and direct airway lavage . To further improve the standardization, safety, and effectiveness of airway lavage therapy in burn patients, the consensus writing group, based on evidence from evidence-based medicine and guided by the Delphi method, conducted literature searches, quality evaluations, evidence synthesis, and expert consultations. They formulated the expert consensus on airway lavage therapy for adult burn patient (2026 edition), which provides a reference for clinical practice, covering topics such as indications and contraindications for airway lavage, pre-procedural preparation, timing and protocols of the procedure, monitoring, and management of complications.

A brief discussion on microsurgery techniques and free perforator flaps for wound repair

Deng Chengliang, Jian Xichao

, Available online , doi: 10.3760/cma.j.cn501225-20260224-00085

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Microsurgical techniques have evolved from conventional microsurgical anastomosis to supermicrosurgery and now to robot-assisted surgery, continuously advancing towards greater precision, detail, and intelligence. Free flap transplantation has undergone a conceptual innovation, shifting its focus from solely repairing the recipient area to also protecting the donor area. This has driven the development of free perforator flaps towards ultra-thin, chimeric, and functional directions, while also gradually exploring cutting-edge fields such as allogeneic or xenogeneic transplantation. Furthermore, artificial intelligence technology is increasingly integrated into the entire process of wound repair preoperative planning, intraoperative navigation, and postoperative evaluation, facilitating a transition in clinical decision-making from experience-dependent to evidence-based approaches. This paper briefly discusses the microsurgery techniques and free perforator flaps for wound repair, aiming to offer theoretical support for their clinical application and optimization.

Clinical efficacy of orthoplastic management for Gustilo type ⅢB open ankle fractures

Lin Fang, Kang Yongqiang, Rui Yongjun, Liu Jun, Wang Yapeng, Wu Yongwei, Ma Yunhong, Wang Peng, Shan Xiaotian

, Available online , doi: 10.3760/cma.j.cn501225-20260108-00016

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Objective To investigate the clinical efficacy of orthoplastic management for Gustilo type ⅢB open ankle fractures. Methods This study was a retrospective case series study. From January 2018 to August 2024, 33 patients with Gustilo type IIIB open ankle fractures who met the inclusion criteria were admitted to Wuxi Ninth People's Hospital, including 25 males and 8 females, aged 25-65 (44±12) years. The area of skin and soft tissue defects ranged from 6 cm × 3 cm to 27 cm × 14 cm. The length of bone defect ranged from 3.0 to 9.2 cm (mean 3.7 cm). All patients were treated with a standardized orthoplastic management. Phase 1 (Stage 1): emergency radical debridement was performed, antibiotic-loaded bone cement was placed in the tibial defect, temporary stabilization was achieved with an external fixator or an antibiotic cement-coated plate, nerves and tendons were repaired, and the remaining wound was covered with vacuum-assisted closure. Phase 1 (Stage 2): within 3 to 7 days, repeat debridement and bone cement exchange were performed, definitive internal fixation was either applied or retained, and soft tissue reconstruction was completed with a free anterolateral thigh (ALT) flap. Phase 2 (Stage 3): at 7 to 30 weeks post-injury (mean 15.8 weeks), the bone cement spacer was removed, the defect volume was measured, and precise iliac crest bone graft mixed with vancomycin was implanted; the induced membrane and soft tissues were then sutured. Postoperative flap survival and infection-related complications at different stages were recorded. During follow-up, flap appearance and texture, scar condition at the donor and recipient sites, and bone healing were documented. At the last follow-up, the score of the affected foot was evaluated using the foot and ankle function assessment scale, and the recovery of activities of daily living was calculated. The Physical Component Summary (PCS) and Mental Component Summary (MCS) scores were assessed using the 36-Item Short Form Health Survey (SF-36) to reflect patient health outcomes. Results Complete flap survival was achieved in 30 patients. Partial flap necrosis occurred in 3 patients, among whom 1 case healed by direct suture after debridement, and 2 cases healed by skin grafting after debridement. Infection-related complications occurred in 4 patients, including superficial infection in 3 cases (1 after stage I second phase, 2 after stage II third phase), all of which were controlled after debridement with wound healing. Bone infection occurred in 1 case (after stage I second phase), which was controlled after repeated thorough debridement and antibiotic-loaded bone cement packing, and bone grafting healed. The follow-up period ranged from 12 to 57 months (mean 26.7 months). All flaps showed good color and texture. Scar hyperplasia at the flap donor site occurred in 3 cases, while only linear scars remained at the recipient site. At final follow-up, the FAAM score score of the affected foot was (71±4) points, and the recovery of activities of daily living reached (85±5)%. The PCS score on the SF-36 was (78±4) points, and the MCS score was (70±11) points. Conclusions The orthoplastic management for Gustilo type ⅢB open ankle fractures resulted in low infection and complication rates, along with satisfactory functional recovery of the ankle joint.

Effects of glutathione on acute photodamage in mice and its underlying mechanism

Wang Qi, Zhou Ling, Deng Yin, Qiu Zijin, Wu Xia, Zhao Chuan

, Available online , doi: 10.3760/cma.j.cn501225-20250628-00284

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Objective To investigate the effects of glutathione on acute photodamage in mice and its underlying mechanism. Methods This study was a group-designed experimental study. Fifteen 8-week-old male C57BL/6 mice were shaved on the dorsal skin and randomly divided into blank control group, model group, low-dose intervention group, medium-dose intervention group, and high-dose intervention group using a random number table, with 3 mice in each group. Mice in model group received daily combined irradiation of ultraviolet B and ultraviolet A on the dorsal skin to cause acute photodamage, followed by intraperitoneal injection of phosphate-buffered saline (PBS). Mice in blank control group received no ultraviolet irradiation but only daily intraperitoneal injection of PBS. Mice in the low-dose intervention group, medium-dose intervention group, and high-dose intervention group received intraperitoneal injections of 50, 100, and 200 mg/kg of glutathione, respectively, after daily ultraviolet irradiation. On day 7 post-injury (2 hours after the last injection), the color and morphology of the dorsal skin of mice in each group were observed grossly. Then, dorsal skin tissues were excised for the following assays. Hematoxylin-eosin staining was used to examine the structure of the stratum corneum, epidermis, and dermis, the morphology of appendages (hair follicles, sweat glands, sebaceous glands), the presence of hemorrhage, and inflammatory cell infiltration, and to measure epidermal thickness. Masson staining was used to detect the collagen deposition in the skin tissue. Western blotting was used to detect the expression levels of inflammation-related proteins (interleukin-1β (IL-1β), IL-6, tumor necrosis factor-α (TNF-α), and matrix metalloproteinase 1 (MMP-1)) in the skin tissue. Results On day 7 post-injury, compared with that in blank control group, the skin of mice in model group showed extensive scaling, redness, swelling, and crusting. Compared with that in model group, the severity of photodamage on the skin of mice in low-intervention group, medium-intervention group, and high-dose intervention group was alleviated successively. On day 7 post-injury, compared with that in blank control group, the dorsal skin tissue structure of mice in model group was disorganized, characterized by thickened and detached stratum corneum, increased number and disordered arrangement of epidermal cell layers, dermal edema, abnormal morphology of appendages (hair follicles, sweat glands, sebaceous glands), scattered hemorrhagic foci, and extensive inflammatory cell infiltration. Compared with those in model group, the degree of tissue disorganization in the skin of mice in low-intervention group, medium-intervention group, and high-dose intervention group was alleviated successively. On day 7 post-injury, the epidermal thickness of the skin of mice in model group was (116.4±6.4) μm, which was significantly greater than (20.9±1.6) μm in blank control group (P<0.05). Compared with that in model group, the epidermal thickness of the skin of mice in medium-dose intervention group and the high-dose intervention group ((77.7±5.6) μm and (56.9±0.8) μm, respectively) was significantly decreased (both P values<0.05). On day 7 post-injury, compared with that in blank control group, the dorsal skin tissue of mice in model group showed a significant increase in collagen fiber content and disorganized fiber arrangement, indicating a certain degree of collagen fiber proliferation. Compared with that in model group, the arrangement of collagen fibers in the dorsal skin tissue of mice in low-intervention group, medium-intervention group, and high-dose intervention group became progressively more regular, and the overall tissue structure gradually recovered to normal. On day 7 post-injury, compared with those in blank control group, the expression levels of IL-1β, IL-6, TNF-α, and MMP-1 in the skin of mice in model group were significantly increased (all P values <0.05). Compared with those in model group, the expression levels of IL-1β and IL-6 in the skin of mice in low-dose intervention group were significantly decreased (both P values <0.05), while the expression levels of IL-1β, IL-6, TNF-α, and MMP-1 in the skin of mice in medium-dose intervention group and high-dose intervention group were significantly decreased (all P values <0.05). Conclusions Glutathione can significantly alleviate acute skin photodamage induced by combined irradiation of ultraviolet B and ultraviolet A in mice, with a clear dose-dependent protective effect, and its mechanism may be related to inhibiting the expression of inflammatory factors, reducing MMP-1-mediated collagen degradation, and improving dermal collagen structure.

Research on the pharmacokinetics of linezolid in burn patients

Fang Yan, Ding Peijie, Fang Jie, He Xiaoshuang, Bian Xiaolan, Liu Yan, Wei Lailai, Shi Yan

, Available online , doi: 10.3760/cma.j.cn501225-20251028-00447

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Objective To analyze the pharmacokinetic differences of linezolid between burn patients and patients with pulmonary infection, and to explore the influencing factors. Methods This study was a retrospective cohort study. From August 1^st, 2024 to August 1^st, 2025, 74 burn patients (with 81 plasma trough concentration measurements) admitted to the Department of Burn of Ruijin Hospital of Shanghai Jiao Tong University School of Medicine, who received linezolid treatment of 600 mg every 12 hours and completed monitoring of plasma trough concentration of linezolid (hereinafter referred to as plasma trough concentration) were included as burn group. There were 22 males and 52 females, aged 16-87 years. During the same period, 74 patients with pulmonary infection (with 75 plasma trough concentration measurements) admitted to the Department of Critical Care Medicine of the same hospital who received the same linezolid treatment and completed monitoring of plasma trough concentration were included as pulmonary infection group. There were 51 males and 23 females, aged 23-90 years. The plasma trough concentrations were detected at 30 min before the fifth administration using liquid chromatography-tandem mass spectrometry. In burn group of patients, the correlations between plasma trough concentration and age, body weight, total burn area, full-thickness burn area, admission time after burn, serum albumin level, serum creatinine level, and creatinine clearance rate were analyzed. In pulmonary infection group of patients, the correlations between plasma trough concentration and age, body weight, serum albumin level, serum creatinine level, and creatinine clearance rate were analyzed. The interactions of plasma trough concentration with age, body weight, serum albumin level, and serum creatinine level between the two groups of patients were analyzed. Results The plasma trough concentration of linezolid in burn group of patients was 2.30 (0.65, 5.70) mg/L, which was significantly lower than 4.07 (2.01, 7.82) mg/L in pulmonary infection group (Z=-3.131, P<0.05). The proportion of patients with plasma trough concentration <2 mg/L in burn group of patients was 46.9% (38/81), which was significantly higher than 22.67% (17/75) in pulmonary infection group (χ²=10.030, P<0.05). In burn group of patients, the plasma trough concentration was significantly positively correlated with age (rs=0.483, P<0.05), and significantly negatively correlated with body weight and full-thickness burn area (with rs of -0.247 and -0.231, respectively, P<0.05). In pulmonary infection group of patients, the plasma trough concentration was significantly negatively correlated with creatinine clearance rate (rs=-0.344, P<0.05), and significantly positively correlated with serum creatinine level (rs=0.255, P<0.05). Both in pulmonary infection group and burn group of patients, the plasma trough concentration showed a significant interaction with the serum albumin level (with β values of 0.201 and -0.145, respectively, 95%CI of -0.085 to 0.488 and -0.344 to 0.055, respectively, P<0.05). Conclusions Under the standard dosing regimen of linezolid, the plasma trough concentration in burn patients was significantly lower than that in patients with pulmonary infection, and the proportion of low drug exposure was higher. In burn patients, the plasma trough concentration was correlated with age, body weight, and full-thickness burn area. Both in burn patients and patients with pulmonary infection, the plasma trough concentration showed a significant interaction with serum albumin level.

Clinical effects of harvesting superficial iliac circumflex artery PSP flaps via subdermal approach in repairing skin and soft tissue defects in hands and feet

Zhu Xuwei, Zhou Feiya, Ding Jian, Li Zhijie, Zhang Wenzhen, Li Shi

, Available online , doi: 10.3760/cma.j.cn501225-20241215-00487

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Objective To investigate the safety and effects of harvesting superficial iliac circumflex artery pure skin perforator (PSP) flaps via subdermal approach in repairing skin and soft tissue defects in hands and feet. Methods This study was a retrospective case series study. From March 2022 to February 2024, 14 patients with 15 skin and soft tissue defect wounds in hands and feet who met the inclusion criteria were admitted to the Department of Wound Repair of the Second Affiliated Hospital of Wenzhou Medical University. After debridement, the wound areas ranged from 5.6 cm×1.9 cm to 14.0 cm×7.0 cm. Before surgery, the perforators were located using high-frequency ultrasound. During surgery, 15 superficial circumflex iliac artery PSP flaps were harvested via the subdermal approach for repairing the wounds. The flap harvesting time ranged from 37 to 140 minutes, and the flap sizes ranged from 5.6 cm×1.9 cm to 14.0 cm×7.0 cm. Vascular anastomosis was performed between the donor and recipient sites. The donor site wounds were closed by direct suturing. After surgery, the survival of flaps was observed, and the occurrence of complications was recorded. At the final follow-up, the 5-point Likert scale was used to evaluate the flaps from four aspects: overall aesthetic appearance, contour similarity to surrounding tissue, color similarity to surrounding tissue, and texture similarity to surrounding tissue. Results All 15 flaps survived successfully after surgery. One flap developed purple plaque,whicts stabilized after dressing chanes.One flap developed venous crisis, which alleviated after surgery. One patient experienced delayed healing of the donor site wound, which successfully healed one week after debridement and dressing changes. At the final follow-up, the overall aesthetic appearance score of the flaps ranged from 3.3 to 5.0, with an average of 4.5; the contour similarity to surrounding tissue ranged from 3.7 to 5.0, with an average of 4.7; the color similarity to surrounding tissue ranged from 3.3 to 5.0, with an average of 4.5; the texture similarity to surrounding tissue ranged from 3.7 to 5.0, with an average of 4.8. Conclusions Harvesting the superficial iliac circumflex artery PSP flaps via the subdermal approach for repairing skin and soft tissue defects in hands and feet is a safe and feasible surgery as that all the flaps survived after surgery, with favorable aesthetic appearance, contour, color, and texture.

Clinical application effects of vertical mattress suture combined with teardrop-shaped end-to-side arterial anastomosis technique in free flap transplantation for repairing limb wounds

Chen Tao, Deng Chengliang, Gao Shaoying, Zhou Jian, Zhang Tianhua

, Available online , doi: 10.3760/cma.j.cn501225-20260131-00061

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Objective To explore the clinical feasibility, safety, and effects of vertical mattress suture combined with teardrop-shaped end-to-side arterial anastomosis technique applied in free flap transplantation for repairing limb wounds. Methods This study was a case series study. From March 2023 to December 2024, 41 patients with skin and soft tissue defect wounds in limbs who met the inclusion criteria were admitted to the Department of Burn and Plastic Surgery of the Affiliated Hospital of Zunyi Medical University. Among them, there were 29 males and 12 females, aged from 39 to 74 years. After debridement, the wound areas ranged from 5.8 cm×3.5 cm to 17.5 cm×6.6 cm. The wounds were repaired with free anterolateral femoral perforator flaps, thoracodorsal artery perforator flaps, latissimus dorsi myocutaneous flaps, and medial sural artery perforator flaps, with flap areas of 8.0 cm×4.0 cm to 19.5 cm×7.0 cm. Due to atherosclerosis or even intimal delamination of recipient arteries, or significant mismatch in arterial diameters between the donor and recipient sites, the vertical mattress suture combined with teardrop-shaped end-to-side arterial anastomosis technique was used for arterial anastomosis of in the donor and recipient sites. The wounds in the donor site were directly closed after reducing tension. During the operation, the situation of atherosclerosis, intimal delamination, or significant mismatch in arterial diameters between the donor and recipient sites was observed. After surgery, the complete survival of the flaps was observed, and the complete flap survival rate was calculated. The occurrence of postoperative complications was recorded. During the follow-up after surgery, the color, texture, and hypertrophy of the surviving flaps, as well as scar hyperplasia in the donor site were observed. Before surgery and at the final follow-up, the functional recoveries of the affected limbs were assessed in patients with wounds in upper and lower limbs using the upper limb function index (UEFI) and foot function index (FFI), respectively. At the final follow-up, the satisfaction of patients with the appearance of the donor and recipient sites and the function of the affected limbs were recorded. Results During the operation, it was observed that 23 patients had atherosclerosis in the recipient artery anastomosis area, even with intimal delamination; in 18 patients, there was a significant difference in the diameter of the flap artery and the recipient artery, with the ratio ranging from 1.0:1.5 to 1.0:3.3, with an average of 1.0:2.4. After surgery, 40 patients had complete flap survival, with a complete flap survival rate of 97.6% (40/41). After surgery, five patients with infectious wounds had delayed suture healing, which healed after dressing changes. No arterial crisis occurred in all patients during hospitalization after surgery. During follow-up of 6 to 18 months after surgery, the surviving flaps had similar color and texture to the recipient skin, with a full appearance but not bloated. Only linear scars occurred in the donor site, with no obvious hypertrophic scar. Before surgery, the UEFI of upper limbs ranged from 29 to 54, with an average of 41; at the final follow-up, the UEFI of upper limbs ranged from 59 to 72, with an average of 73. Before surgery, the FFI of lower limbs ranged from 43 to 87, with an avarage of 73; at the final follow-up, the FFI of lower limbs ranged from 15 to 42, with an average of 29. At the final follow-up, 24 out of 28 patients with wounds in lower limbs were able to walk without the assistance of auxiliary tools; patients were satisfied with the appearance of the donor and recipient sites, as well as the functional recovery of the affected limbs. Conclusions The vertical mattress suture combined with teardrop-shaped end-to-side arterial anastomosis technique effectively achieves the eversion and apposition of the arterial intima, reduces the risk of dissection and stenosis at the arterial anastomosis site, and significantly improves the patency rate of the anastomosis site. This technique applied in free flap transplantation for repairing limb wounds can prevent arterial crisis, with high flap survival rate and satisfaction of patients after surgery, thus having application value in clinical practice.

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