中华烧伤与创面修复杂志

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

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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.

Application effects of the hydrosurgical debridement system in ex vivo porcine burn skin models of eschar excision and debridement

Pan Xuanliang, Chen Jiong, Han Chunmao, Wang Xingang

, Available online , doi: 10.3760/cma.j.cn501225-20250327-00146

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Objective To investigate the application effects of the hydrosurgical debridement system (hereinafter referred to as the water jet) in ex vivo porcine burn skin models of eschar excision and debridement. Methods This was a grouped basic research study.Twenty-three young physicians (20 males, 3 females, aged 30-43 years) participated in the 2024 Zhejiang Provincial Burn Surgery Skills Competition. Each physician performed eschar excision and debridement procedures using both the water jet and conventional instruments (a dermatome and a scalpel) in ex vivo porcine burn skin models of early-stage eschar excision and late-stage debridement of liquefied eschar (each measuring 12 cm×8 cm). The operation time (assessing speed) and weight of removed tissue (assessing precision) were recorded for both techniques in both procedures. Results In escharectomy procedures, the operative time of the water jet (122 (96, 145) s) showed no significant difference compared with conventional instruments (125 (56, 233) s), P>0.05; however, the tissue removal weight of the water jet (2.88±0.27) g was significantly less than (13.81±1.93) g of conventional instruments (P<0.05). In debridement procedures, the operative time of the water jet (121±9) s was significantly shorter than (368±33) s of conventional instruments (P<0.05); however, the tissue removal weight of the water jet (30.85±1.98) g was significantly greater than (21.48±1.45) g of conventional instruments (P<0.05). Conclusions Compared with conventional instruments, the water jet can remove necrotic tissue in ex vivo porcine burn skin more precisely and reduce damage to healthy tissue in early-stage eschar excision; however, in late-stage debridement of liquefied eschar, although it significantly improves debridement speed, it may remove excessive normal tissue.

Practice guideline for adult burn rehabilitation nursing (2026 edition)

, Available online , doi: 10.3760/cma.j.cn501225-20260402-00138

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Burn patients are often accompanied by problems such as functional and psychological impairments, difficulties in social adaptation. Rehabilitation nursing plays an important role in functional recovery, complication prevention, and improvement of quality of life. To further assist nurses in implementing adult burn rehabilitation nursing in a scientific and standardized manner, the guideline writing group, based on evidence from evidence-based medicine and guided by the Delphi method, developed 16 recommendations addressing 11 clinical questions in adult burn rehabilitation nursing. These recommendations cover multidisciplinary teams, rehabilitation nursing assessment, positioning, edema management, scar care, orthosis care, activities of daily living, pain care, sleep management, psychological interventions, and follow-up care, providing an evidence-based foundation to support clinical practice.

Clinical evaluation and repair strategies for complex inguinal wounds

Du Weili, Liu Zixi, Xiong Feng, Cao Tongyu, Zhang Huijun, Che Kexin, Shen Yuming

, Available online , doi: 10.3760/cma.j.cn501225-20260505-00182

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Objective To explore the clinical evaluation and repair strategies for complex inguinal wounds. Methods This study was a retrospective case series study. Between September 2020 and December 2025, 15 patients with complex inguinal wounds meeting the inclusion criteria were admitted to Beijing Jishuitan Hospital of Capital Medical University. There were 10 males and 5 females, aged 12 to 79 years. Preoperatively, detailed medical history inquiry, physical examination, and multiple auxiliary examinations were performed to precisely evaluate the involvement of vital anatomical structures and infectious status in the inguinal region. After timely management of femoral artery lesions, precise debridement was carried out. The sizes of inguinal wounds after debridement ranged from 11.0 cm×4.0 cm to 20.0 cm×9.0 cm. According to the wound bed conditions after debridement, well-vascularized tissue flaps were selected to obliterate the wound cavity and achieve wound closure. The following data were recorded, including the involvement of femoral vessels by the wound, the exposure and retention or removal of prosthetic vascular grafts, management of the femoral artery in patients with radiation-induced wounds, type and size of the adopted tissue flaps, closure methods of the donor site wounds, results of bacterial culture of preoperative wound exudate samples, and intraoperative histopathological examination of wounds. The tissue flaps survival and wound healing were observed at postoperative two weeks. During follow-up, the appearance of tissue flaps, recurrence of wounds, patency of femoral artery, swelling of the affected limb, scar formation of the donor sites, and occurrence of abdominal wall hernia at the donor site of rectus abdominis musculocutaneous flap were observed. Results All inguinal wounds involved the femoral vessels. Exposure of the prosthetic vascular graft was observed in 4 patients, among which the prosthetic vascular graft was preserved in three patients and removed in one patient. Two patients received preoperative covered stent implantation, one patient underwent intraoperative femoral artery resection and implantation with the prosthetic vascular graft, and femoral artery was successfully preserved without rupture in the remaining patients. The inguinal wounds were repaired with thoracoumbilicus flap combined with rectus abdominis musculocutaneous flap in 11 patients, tensor fasciae latae musculocutaneous flap combined with sartorius muscle flap in one patient, tensor fasciae latae musculocutaneous flap combined with rectus femoris muscle flap in one patient, and pedicled anterolateral thigh flap chimerized with vastus lateralis muscle flap in two patients. The sizes of tissue flaps ranged from 13.0 cm×6.0 cm to 26.0 cm×14.0 cm. Only the donor site wound in one patient was covered with split-thickness skin graft, and the donor site wounds in remaining 14 patients were closed by primary suture. Bacterial culture of preopertive wound exudate samples showed monomicrobial infection in 7 patients and mixed infection of two types of bacteria in 8 patients. Intraoperative histopathological examinations of wounds revealed inflammatory changes without neoplastic component. The tissue flaps in all patients survived completely and the wounds healed well at postoperative two weeks. During follow-up of 6 months to 3 years, most of the tissue flaps maintained satisfactory appearance, while a small number of tissue flaps presented mild bulkiness. No wound recurrence was observed. Computed tomography angiography confirmed patent femoral arteries in 14 patients, and obvious relief of preoperative lower limb swelling was achieved in 9 patients. The donor site with skin grafting showed unremarkable scarring in one patient, while mild linear scars were noted at the donor sites in the other 14 patients. No abdominal wall hernia occurred at the donor sites of rectus abdominis musculocutaneous flaps. Conclusions For complex inguinal wounds, optimal clinical repair outcomes can be achieved via preoperative precise evaluation of major vessels, prosthetic vascular grafts, and soft tissue infection, and adequate vascular intervention, intraoperative precise debridement, followed by wound closure using well-vascularized tissue flaps.

Surgical designs and clinical effects of pedicled transfer of extended lower trapezius musculocutaneous flap in repairing massive wounds in the shoulder and back

Wang Miao, Xie Tingjun, Li Shanshan, Chen Zixiang, Zhu Shan, Zang Mengqing, Liu Yuanbo

, Available online , doi: 10.3760/cma.j.cn501225-20260414-00152

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Objective To explore the surgical designs and clinical effects of pedicled transfer of extended lower trapezius musculocutaneous flap (e-LTMF) based on the dorsal scapular artery in repairing massive wounds in the shoulder and back. Methods This study was a retrospective case series study. From January 2009 to April 2023, 41 patients with massive wounds in the shoulder and back who met the inclusion criteria were admitted to Plastic Surgery Hospital of Chinese Academy of Medical Sciences and Peking Union Medical College, including 26 males and 15 females, aged 4 to 83 years. The surgical design was selected according to the nature of the wound and the timing of surgery. The 15 patients repaired with the conventional e-LTMF were included in conventional group, the 15 patients repaired with the modified e-LTMF incorporating a distal segment of the latissimus dorsi muscle were included in modified group, and the 11 patients repaired with the pre-expanded e-LTMF were included in pre-expanded group. The wound areas ranged from 7 cm×5 cm to 21 cm×12 cm and the harvested musculocutaneous flap areas ranged from 7 cm×5 cm to 33 cm×10 cm in patients in conventional group. The wound areas ranged from 16 cm×8 cm to 28 cm×18 cm and the harvested musculocutaneous flap areas ranged from 25 cm×8 cm to 40 cm×12 cm in patients in modified group. The wound areas ranged from 12 cm×8 cm to 36 cm×12 cm and the harvested musculocutaneous flap areas ranged from 22 cm×8 cm to 35 cm×15 cm in patients in pre-expanded group. The musculocutaneous flaps were transferred to the recipient sites by propeller rotation or as islands through subcutaneous tunnels. The donor site wounds were repaired by direct suture, local flap transfer, or skin grafting. After surgery, the survival of musculocutaneous flaps was observed, the complete survival rate and the necrosis rate of musculocutaneous flaps were calculated, and the management and outcome of the necrotic musculocutaneous flaps were recorded. During follow-up, the appearance and texture of the musculocutaneous flaps, the functional recovery of the affected upper limb and the shoulder and back at recipient sites, the tumor recurrence in patients with tumors, and the wound healing at donor sites were observed. Results After surgery, among the 41 patients, the musculocutaneous flaps survived completely in 38 patients, with a complete survival rate of musculocutaneous flaps of 92.7% (with a 95% CI of 80.6% to 97.5%). The necrosis of the musculocutaneous flaps occurred in 3 patients, with a necrosis rate of musculocutaneous flaps of 7.3% (with a 95% CI of 2.5% to 19.4%). Among them, total necrosis of the musculocutaneous flaps occurred in one patient in conventional group, whose wound healed after skin grafting. Distal necrosis of the musculocutaneous flap occurred in two patients in modified group, whose wounds healed after dressing change. During the follow-up of 1 to 48 months after surgery, the color and texture of the musculocutaneous flaps were similar to those of the normal skin surrounding the recipient sites, no obvious limitation was observed in the motion of the affected upper limb or the shoulder and back at recipient sites, and no tumor recurrence was observed in patients with tumors. The wounds at donor sites all healed well. Conclusions The three surgical designs of e-LTMF can be used to repair massive wounds of varying complexity in the shoulder and back, with fairly good postoperative musculocutaneous flap survival, appearance and texture, functional recovery of the affected upper limb and the shoulder and back at recipient sites, and donor site wound healing. Among them, the conventional e-LTMF can be used for simple skin and soft tissue defects, the modified e-LTMF incorporating a distal segment of the latissimus dorsi muscle can be used for complex wounds complicated by exposure of critical structures, wound infection, or dead-space formation, and the pre-expanded e-LTMF can be used for elective reconstruction of wounds requiring larger musculocutaneous flap coverage.

Performance of phenylboronic acid-modified GelMA hydrogel loaded with copper-doped cerium oxide nanozyme and its effect on healing of infected burn wounds in mice

Shang Yijiang, Chen Yuerong, Liang Zhen, Wang Xupeng

, Available online , doi: 10.3760/cma.j.cn501225-20260430-00178

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Objective To explore the performance of phenylboronic acid-modified gelatin methacryloyl (GelMA) hydrogel loaded with copper-doped cerium oxide nanozyme (hereinafter referred to as composite hydrogel) and its effects on healing of infected burn wounds in mice. Methods This study was an experimental study including group design and repeated measures design. The phenylboronic acid-modified GelMA hydrogel (hereinafter referred to as simple hydrogel) with a three-dimensional loose porous network structure was prepared. The copper-doped cerium oxide nanozyme with a uniform spherical structure was prepared by a hydrothermal method. The copper-doped cerium oxide nanozyme with a final mass concentration of 100 μg/mL, which had no obvious effect on the viability of human umbilical vein endothelial cells and possessed high superoxide dismutase and catalase activities, was screened out and added into the simple hydrogel to prepare the composite hydrogel. After the composite hydrogels were soaked in phosphate buffer saline (PBS) or hydrogen peroxide solution for 24, 48, and 72 h, the release percentages of copper-doped cerium oxide nanozymes in the composite hydrogel were calculated, with sample size of 3. Thirty 8-week-old male BALB/c mice were taken, and after two burn wounds were created at symmetrical positions on both sides of the spine, methicillin-resistant Staphylococcus aureus (MRSA) bacterial suspension was dropped to construct infected burn wounds. According to the random number table method (the same grouping method below), the mice were divided into control group, simple hydrogel group, and composite hydrogel group, with 10 mice in each group (20 wounds). No drug intervention was performed on the wounds of the mice in control group, the simple hydrogel and composite hydrogel were dropped on the wounds of the mice in simple hydrogel group and composite hydrogel group, respectively, lasting for 14 d. At post injury day (PID) 3, 7, and 14, the percentage of residual wound area was measured and calculated, with sample size of 4. At PID 3, the MRSA concentration in the wound was calculated using the "plate counting method", with sample size of 3. At PID 5, the wound blood perfusion volume was evaluated by a laser speckle blood flow imaging system, with sample size of 3. Another 6 8-week-old male BALB/c mice were taken and divided into PBS group and composite hydrogel implantation group, with 3 mice in each group, and PBS was subcutaneously injected and composite hydrogels were subcutaneously implanted into the center of the mice's backs, respectively. At 14 d after treatment, abdominal whole blood was collected, then the blood routine test indexes and blood biochemical test indexes were detected. Results After immersion in PBS and hydrogen peroxide solution for 24, 48, and 72 h, respectively, the overall differences in the release percentages of copper-doped cerium oxide nanozymes in the composite hydrogel were statistically significant (with F values of 30.29 and 65.16, respectively, P<0.05). At PID 3, 7, and 14, compared with those in control group, the percentages of residual wound area of mice in simple hydrogel group and composite hydrogel group were all significantly reduced (P<0.05); the percentages of residual wound area of mice in composite hydrogel group were significantly lower than those in simple hydrogel group (P<0.05). At PID 3, compared with that in control group, the MRSA concentrations in the wounds of mice in simple hydrogel group and composite hydrogel group were both significantly decreased (P<0.05); the MRSA concentration in the wounds of mice in composite hydrogel group was significantly lower than that in simple hydrogel group (P<0.05). At PID 5, compared with (221±25) perfusion units in control group, the wound blood perfusion volumes of mice in simple hydrogel group and composite hydrogel group ((313±53) and (535±104) perfusion units, respectively) were both significantly increased (P<0.05); the wound blood perfusion volume of mice in composite hydrogel group was significantly higher than that in simple hydrogel group (P<0.05). At 14 d after treatment, the blood routine test indexes and blood biochemical test indexes of mice in composite hydrogel implantation group and PBS group were all maintained within normal physiological ranges. There were no statistically significant differences between the two groups of mice (P>0.05). Conclusions The composite hydrogel possesses good biocompatibility, reactive oxygen species responsiveness, and excellent antibacterial properties, and the healing of infected burn wounds in mice can be accelerated by it through the early elimination of MRSA in the wounds and the promotion of blood flow recovery.

Role and mechanism of infrared thermography in early identification of necrosis risk in random-pattern flaps

Jiang Xiaoqiong, Xu Jie, Ling Xiangwei, Cai Fuman, Chen Hao, Xiao Jian

, Available online , doi: 10.3760/cma.j.cn501225-20241118-00453

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Objective To investigate the role and mechanism of infrared thermography (IRT) in early identification of necrosis risk in random-pattern flaps (RPFs). Methods This study was designed as a group-comparison experimental study. A RPF model was established on the dorsum of 92 male C57BL/6 mice aged 6-8 weeks. The flap was divided into three equal zones (zones Ⅰ, Ⅱ, and Ⅲ) from the caudal to the cephalic end. The relative temperatures (RTs) of the three zones were measured using an infrared thermal imager at postoperative day (PPD) 0 (immediately), 3, and 7. At PPD 3 and 7, receiver operating characteristic (ROC) curves were used to evaluate the predictive efficacy of the RT of zone Ⅱ for flap necrosis, and the optimal cutoff values were determined. Based on the RT of flap zone Ⅱ at PPD 3, mice were divided into >-0.1 ℃ group and ≤-0.1 ℃ group; based on the RT of flap zone Ⅱ at PPD 7, mice were divided into >0.1 ℃ group and ≤0.1 ℃ group, with 4 mice in each group. The percentage of surviving area of flap zone Ⅱ was calculated for the first two groups of mice at PPD 3 and for the latter two groups of mice at PPD 7. Laser Doppler perfusion imaging was used to measure blood perfusion volume in flap zone Ⅱ of the above groups at the corresponding time points. At PPD 3, the tissue from flap zone Ⅱ of >-0.1 ℃ and ≤-0.1 ℃ groups of mice was collected for transcriptomic sequencing to identify differentially expressed genes (DEGs), for immunofluorescence staining to calculate the ratios of inducible nitric oxide synthase (iNOS)/CD68 and arginase 1 (ARG1)/CD68, for immunohistochemical staining to detect the expression of chemokine ligand 2 (CCL2), for dihydroethidium (DHE) staining to detect the expression of DHE, for real-time fluorescence quantitative reverse transcription polymerase chain reaction to measure mRNA expressions of tumor necrosis factor α (TNF-α), interleukin-1β (IL-1β), and IL-10, and for Western blotting to detect protein expressions of CD68, iNOS, ARG1, heme oxygenase-1 (HO-1), and superoxide dismutase 1 (SOD1). Results From PPD 0 to 7, RTs in flap zones Ⅰ and Ⅱ showed an increasing trend, while RTs in flap zone Ⅲ showed a trend of initial increase followed by decrease. At PPD 3 and 7, the areas under the ROC curves of the RT of flap zone Ⅱ for predicting flap necrosis were 0.82 and 0.85 (with 95% CIs of 0.72-0.93 and 0.78-0.93, respectively), with optimal cutoff values of -0.1 and 0.1 ℃, respectively. At PPD 3, there were no statistically significant differences in the percentage of surviving area or blood perfusion volume in flap zone Ⅱ between ≤-0.1 ℃ group and >-0.1 ℃ group of mice (P>0.05). At PPD 7, the percentage of surviving area (t=4.19, P<0.05) and blood perfusion volume (t=5.58, P<0.05) in flap zone Ⅱ were significantly decreased in ≤0.1 ℃ group of mice compared with those in >0.1 ℃ group. At PPD 3, compared with that in >-0.1 ℃ group, there were 2 849 DEGs in tissue of flap zone Ⅱ in ≤-0.1 ℃ group of mice, including 1 509 upregulated DEGs and 1 340 downregulated DEGs. At PPD 3, there were significantly lower iNOS/CD68 ratio (t=4.97, P<0.05) and significantly higher ARG1/CD68 ratio (t=3.42, P<0.05), significantly lower expressions of CCL2 and DHE, mRNA expressions of TNF-α and IL-1β, as well as protein expressions of CD68 and iNOS (with t values of 4.82, 4.51, 4.43, 5.47, -3.69, and -6.14, respectively, P<0.05), and significantly higher mRNA expression of IL-10 and protein expressions of ARG1, SOD1, and HO-1 (with t values of 8.58, 8.61, 6.24, and 11.03, respectively, P<0.05) in tissue of flap zone Ⅱ in >-0.1 ℃ group of mice compared with those in ≤-0.1 ℃ group. Conclusions IRT enables early and objective prediction of necrosis risk of RPFs in mice through monitoring flap temperature. The RT ≤-0.1 ℃ in flap zone Ⅱ at PPD 3 is associated with marked inflammatory response, immune cell infiltration, and oxidative stress in the tissue. CCL2 may serve as a key chemokine inducing macrophage polarization.

Clinical efficacy of thinned free flaps for wound reconstruction after extremity malignant tumor resection

Li Bin, Yang Yong, Li Pengcheng, Yang Fajun, Tong Dedi, Wang Zhixin, Li Feng, Wang Yang

, Available online , doi: 10.3760/cma.j.cn501225-20260426-00167

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Objective To evaluate the clinical efficacy of thinned free flaps in repairing soft tissue defects following resection of extremity malignant tumors. Methods This study was a retrospective case series study. From June 2023 to February 2026, 17 patients with extremity malignant tumors who met the inclusion criteria were admitted to the Department of Hand Surgery, Beijing Jishuitan Hospital of Capital Medical University. The cohort consisted of 11 males and 6 females, aged 38-91 years. Tumors were located in the upper extremity in 9 cases and in the lower extremityin 8 cases. Pathological diagnoses included squamous cell carcinoma (6 cases), dermatofibrosarcoma protuberans (2 cases), liposarcoma (2 cases), synovial sarcoma (2 cases), malignant peripheral nerve sheath tumor (2 cases), epithelioid sarcoma (1 case), and angiosarcoma (2 cases). All patients underwent wide tumor resection, resulting in soft tissue defects with exposure of deep structures. The defect size ranged from 4 cm×4 cm to 24 cm×12 cm. Thinned free flaps were used for wound repair, including anterolateral thigh flaps (7 cases), groin flaps (6 cases), medial sural artery perforator flaps (2 cases), deep inferior epigastric artery perforator flaps (1 case), and medial plantar flaps (1 case). The flap size ranged from 4 cm×4 cm to 24 cm×13 cm, with a thickness of 4-10 mm (with mean of 5.8 mm). Donor sites were closed by direct suture and local relay flap or skin grafting. Postoperative flap survival and recipient site complications (infection, hematoma, delayed wound healing, etc.) were recorded, along with donor site healing status and associated complications. A comprehensive assessment of reconstructive outcomes (excellent, good, and poor) was conducted at the final follow-up. Tumor prognosis of all patients was tracked and documented. Results Sixteen flaps survived completely with ruddy color, normal skin temperature, and intact capillary refill. One patient who underwent groin flap reconstruction for a defect following resection of angiosarcoma on the dorsum of the hand developed epidermal necrosis at the distal portion of the flap on postoperative day 3, which healed after routine dressing changes. No infection, hematoma, or delayed wound healing occurred in any recipient site. Donor sites healed uneventfully in 15 patients, while 2 patients experienced delayed healing. No major complications were observed in any donor site. At the last follow-up, the reconstructive outcomes were rated as excellent in 14 patients and good in 3 patients. The follow-up period ranged from 2 to 34 months. Local recurrence occurred in 3 patients at 24, 10, and 3 months postoperatively, respectively. Metastasis (lymph node and distant) occurred in 2 patients at 11 months postoperatively in both cases. The remaining 12 patients showed no evidence of local recurrence or distant metastasis. Conclusions Thinned free flaps are effective for reconstructing wounds following extremity malignant tumor resection, with a high flap survival rate, satisfactory reconstructive outcomes, and low donor-site morbidity.

Effects of astragaloside Ⅰ on full-thickness skin defects in diabetic rats and its underlying mechanism

Li Yi, Zheng Yaoyi, Wang Yahong, Zhang Ziyang, Liu Jinpeng, Luo Zhonghua

, Available online , doi: 10.3760/cma.j.cn501225-20260116-00026

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Objective To investigate the effects of astragaloside I (AS-Ⅰ) on full-thickness skin defects in diabetic rats and its underlying mechanism. Methods This study was an experimental study with grouped design and repeated measures design. Twenty-four male Sprague-Dawley rats aged 6-8 weeks were divided into control group (n=6) and modeling group (n=18) using a random number table method (the same grouping method was used throughout). After successful induction of diabetes mellitus, the modeling group was further divided into model group, low-dose AS-Ⅰ group, and high-dose AS-Ⅰ group, with 6 rats in each group. A full-thickness skin defect wound with a diameter of 10 mm was created on the back of each rat. Wounds in control group group and model group were treated with normal saline, while those in low-dose AS-Ⅰ group and high-dose AS-Ⅰ group were treated with 1.15 and 11.50 mmol/L AS-I, respectively, for 3 consecutive days. Wound healing rates of rats were calculated at post-injury days (PIDs) 3, 5, 7, 9, 13, and 15. At PIDs 15, Masson's trichrome staining was used to assess collagen deposition; immunohistochemical staining was performed to detect Ki-67 positive expression in wound tissues, and the expression level was quantified. Network pharmacology analysis was applied to screen for potential key targets of AS-Ⅰ intervention in diabetic wound healing. Molecular docking simulation was utilized to validate the binding of AS-Ⅰ to the target proteins, and molecular dynamics simulation was performed to verify the stability of the interaction between AS-Ⅰ and forkhead box protein O1 (FOXO1). At PIDs 15, Western blotting was used to determine the protein expression levels of epidermal growth factor receptor (EGFR), cyclin-dependent kinase 2 (CDK2), growth factor receptor-bound protein 2 (GRB2), phosphatidylinositol 3-kinase catalytic subunit alpha (PIK3CA), signal transducer and activator of transcription 3 (STAT3), and FOXO1 in wound tissues of rats among four groups. Results Compared with those in control group, the wound healing rates of rats in model group at PIDs 3 and 15 were significantly decreased (P<0.05); whereas the healing rates of rats in low-dose AS-Ⅰ group at PIDs 7 and 13, and in high-dose AS-Ⅰ group at PIDs 5, 7, 9, 13, and 15 were significantly increased (P<0.05). Compared with those in model group, wound healing rates of wats in both low-dose AS-Ⅰ group and high-dose AS-I group at PIDs 3, 9, 13, and 15 were significantly increased (P<0.05). At PIDs 15, In control group, collagen fibers in the wounds of rats were regularly and densely arranged; in model group, they were sparse and disorganized; improved collagen deposition in the wounds of rats was observed in low-dose AS-Ⅰ group compared with the model group; collagen fibers in the wounds of rats in high-dose AS-Ⅰ group exhibited densely and orderly arranged with higher maturity. At PID 15, Compared with that in control group, the Ki-67 expression level in wound tissues of rats in model group was significantly lower (P<0.05); compared with that in model group, the Ki-67 expression level in wound tissues of rats in low-dose AS-Ⅰ group was significantly higher (P<0.05); compared with those in control group, model group, and low-dose AS-Ⅰ group, the Ki-67 expression level in wound tissues of rats in high-dose AS-Ⅰ group was significantly higher (with P values all <0.05). The results of network pharmacology analysis identified 63 overlapping targets between AS-Ⅰ-associated targets and diabetic-wound-related targets, involving the FOXO signaling pathway and protein targets including EGFR, CDK2, GRB2, PIK3CA, and STAT3. The results of molecular docking simulation indicated stable binding of AS-Ⅰ to these targets and to FOXO1 protein, while the results of molecular dynamics simulation demonstrated strong binding affinity between AS-Ⅰ and FOXO1 protein. Compared with those in control group, the protein expression levels of STAT3, GRB2, and FOXO1 in wound tissue of rats in model group were significantly upregulated (with P values all <0.05), while the protein expression levels of PIK3CA, EGFR, and CDK2 were significantly downregulated (with P values all <0.05). Compared with those in model group, the protein expression levels of STAT3, GRB2, and FOXO1 in wound tissue of rats in low-dose group and high-dose AS-Ⅰ group were significantly downregulated (with P values all <0.05), while the protein expression levels of PIK3CA, EGFR, and CDK2 were significantly upregulated (with P values all <0.05). Compared with those in low-dose AS-Ⅰ group, the protein expression levels of STAT3, GRB2, and FOXO1 in wound tissue of rats in high-dose AS-Ⅰ group were significantly downregulated (with P values all <0.05), while the protein expression levels of PIK3CA, EGFR, and CDK2 were significantly upregulated (with P values all <0.05). Conclusions AS-Ⅰ may promote wound healing in full-thickness skin defects of diabetic rats and improve collagen fiber arrangement by regulating the FOXO signaling pathway, which downregulates STAT3, GRB2, and FOXO1 protein expression and upregulates PIK3CA, EGFR, and CDK2 protein expression.

Expert consensus on the application of bone cement in the treatment of diabetic wounds (2026 edition)

, Available online , doi: 10.3760/cma.j.cn501225-20260128-00052

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Diabetic wounds, including diabetic ulcers, represent one of the most severe late-stage complications of diabetes mellitus, characterized by rapid progression, therapeutic challenges, and high risks of amputation or life-threatening consequences. The current treatment principle is to eliminate the wound surface by means of negative pressure suction, dressing changes, and coverage with muscle flaps, skin flaps, autologous skin, and artificial skin tissues, based on improving the blood supply of the limb. In recent years, emerging evidence has highlighted the efficacy of bone cement-based preliminary management for diabetic wounds, followed by skin or flap transplantation for definitive wound coverage. To standardize clinical practices, the Burn and Trauma Branch of Chinese Geriatrics Society jointly organized an expert panel to develop the Expert consensus on the application of bone cement in diabetic wound management (2026 edition). This consensus integrates robust evidence from literature with cutting-edge clinical and basic research advancements, aiming to establish a standardized protocol for bone cement utilization in diabetic wound therapy. It serves as a critical reference for clinicians to enhance diagnostic and therapeutic outcomes in diabetic wound care.

Concepts and clinical practice of functional reconstruction of complex wounds

Shen Yuming, Zhi Lin, Wang Yiwen

, Available online , doi: 10.3760/cma.j.cn501225-20260507-00185

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The paradigm of complex wound management has shifted from simple wound closure toward functional reconstruction. Nevertheless, a systematic framework defining complex wounds, outlining the principles of functional reconstruction, and addressing future directions remains unavailable. Based on a comprehensive review and critical synthesis of the current literature, this article proposes a multidimensional framework for defining complex wounds that incorporates four dimensions: abnormal healing trajectory, involvement of anatomical structures, coexistence of multiple risk factors, and complexity of clinical management. Furthermore, a four-tier conceptual framework for functional reconstruction of these wounds is summarized, emphasizing biological matching between donor and recipient sites, minimization of donor-site morbidity, restoration of aesthetic appearance and sensory function, and functional reconstruction of deep structures, including blood vessels, nerves, tendons, bones, and joints. This review systematically summarizes the historical evolution of complex wound reconstruction, from skin grafting as the cornerstone of wound repair, through microsurgical functional reconstruction, to the emergence of multidisciplinary regenerative strategies, with particular emphasis on the original contributions of Chinese investigators in this field. Future advances driven by the deep integration of regenerative medicine, intelligent navigation, supermicrosurgery, and precision phenotyping are expected to facilitate the transition of complex wound reconstruction from anatomical repair to functional regeneration.

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