To investigate the efficacy of standardized complete decongestive therapy (CDT) in subclinical lower extremity lymphedema.

From June 2021 to December 2022, 23 patients with subclinical lower extremity lymphedema treated in the Department of Burn, Plastic and Cosmetic Surgery, Xi′an Central Hospital, Xi′an Jiaotong University were selected as the research objects, and the patients were treated with standardized CDT and followed up for 12 months. The lower extremity lymphedema index (LELI) was used to evaluate the severity of limb swelling, and lymphedema functioning, disability and health questionnaire for lower limb lymphedema (Lymph-ICF-LL) was used to evaluate the improvement of subjective limb symptoms and psychological symptoms. Spearman correlation analysis was used to analyse the correlation between subjective limb symptoms and LELI.

The LELI of patients before treatment and 6, 12 months after treatment was 229.94±13.22, 213.13±16.68 and 207.60±15.51, respectively, the difference was statistically significant (F=58.316, P=0.001), indicating that the lower limb volume gradually decreased after standardized CDT treatment. The limb symptom score of Lymph-ICF-LL before treatment and 6, 12 months after treatment was 23.12±6.16, 17.43±7.39 and 14.30±8.42, respectively, with statistically significant difference (F=20.026, P=0.001), indicating that the limb symptoms of patients were alleviated after standardized CDT treatment. The psychological symptom score of Lymph-ICF-LL before treatment and 6, 12 months after treatment was 18.83±10.51, 17.09±10.66 and 14.57±7.48, respectively, the difference was not statistically significant (F=2.315, P=0.136), indicating that the psychological symptoms of patients after standardized CDT treatment were not significantly improved. There was a moderate positive correlation between tension and LELI (r=0.522, P=0.011), and a low positive correlation between numbness and LELI (r=0.447, P=0.032). There was no correlation between swelling, heaviness, pain and LELI (r=0.202, 0.374, 0.255; P=0.356, 0.079, 0.240).

As a conservative treatment for lymphedema combining intervention measures and lifestyle changes, standardized CDT can alleviate limb swelling and relieve limb symptoms, which is worthy of further promotion.

To compare the clinical efficacy of complex decongestive therapy (CDT) combined with lymphaticovenular anastomosis (LVA) and CDT alone in the treatment of secondary lymphedema.

Thirty-three patients with secondary lower limb lymphedema admitted to the Rehabilitation Department of Shenzhen Dapeng New Area Nan′ao People′s Hospital from March 2023 to July 2023 were selected. The patients were divided into CDT combined with LVA group and CDT group according to underwent LVA or not, among which 12 cases were in CDT combined with LVA group and 21 cases were in CDT group.The CDT group were treated with standard CDT, and the CDT combined with LVA group were treated with LVA on the basis of CDT. The circumference of the affected limb, VAS score, and QLQ-C30 score were compared between the two groups before treatment, after 1 month of treatment, and 6-month follow-up.

The circumference of the affected limb, VAS score, and QLQ-C30 score of both groups improved significantly compared with pre-treatment, and the differences were statistically significant (P<0.05).Both treatment modalities improved the symptoms of swelling, pain, and quality of life. There were statistically significant differences in the change of circumference of the affected limbs at the ankle[(3.00±1.49)cm vs (1.35±1.08)cm], 10 cm below the inferior border of the patella[(2.87±1.51)cm vs (1.64±1.25)cm ], mid-knee[(3.50±2.44)cm vs (1.34±1.27)cm], 10 cm above the superior border of the patella[ (3.87±1.94)cm vs (1.67±1.17)cm ], VAS scores[(4(3, 5) vs 3(2, 4)], and QLQ-C30 scores[(11.50±4.40) vs (7.43±2.42)] between the two groups, and the improvement was more pronounced in the CDT combined with LVA group compared with that in the CDT group. At 6-month follow-up, no significant difference was found in the circumference of the affected limb at the ankle, 10 cm below the inferior border of the patella, mid-knee, and 10 cm above the superior border of the patella in the CDT combined with LVA group compared with that after 1 month of treatment (P>0.05), and the difference in the CDT group was significant compared with that after 1 month of treatment (P<0.05).

CDT combined with LVA can improve the degree of swelling, relieve pain, and improve the quality of life of patients with secondary lymphedema to a greater extent, and its effect is better than that of CDT alone, and the short- and medium-term efficacy is better.

To observe the effect of axillary lymph node dissection (ALND) and preventive lymphaticovenular anastomosis (LVA) on postoperative upper limb lymphedema and quality of life in patients with breast cancer based on the multidisciplinary callabration model.

A total of 17 patients with breast cancer who underwent ALND and preventive LVA admitted to the Department of Breast Surgery of Affiliated Tumor Hospital of Guangxi Medical University from August 2022 to July 2023 were entrolled. By establishing a multidisciplinary team, the medical model of preoperative multi-disciplinary treatment, assisting patient decision-making, postoperative rehabilitation guidance, and internet plus management were implemented. Monitored the circumference of the upper limbs and evaluated the postoperative quality of life using the Chinese version of the WHOQOL-BREF.

The follow-up time was 9.60-19.30 (12.74±2.51) months.The difference in the circumference of upper limbs was 0.50 (0.03, 0.88)cm before surgery and 0.50 (0.13, 1.00)cm at the last follow-up, no limb lymphedema occured after operation. At the last follow-up, the patient′s quality of life score was 15.40±2.37, 16.64±2.19, 14.80±2.66 and 15.43±2.12 in the physiological, psychological, social relations and environmental fields, respectively, and the highest scores was in the psychological fields.

Preventive LVA under the multidisciplinary callabration model can increase the participation of breast cancer patients in treatment decision-making, reduce the occurrence of postoperative lymphedema and improve the quality of life of patients.

To explore the application effect of methylene blue lymphangiography combined with indocyanine green angiography for the preoperative localization of lymphatic vessels in lymphaticovenular anastomosis (LVA).

Fifty-three cases of lower extremity lymphedema patients underwent LVA in the Department of Burn, Plastic and Cosmetic Surgery of Xi′an Central Hospital, Xi′an Jiaotong University from February 2021 to May 2023 were selected. The patients were divided into control group (24 cases) and study group (29 cases), according to different methods for preoperative lymphatic vessel localization in LVA. The control group used traditional methylene blue lymphangiography, while the study group used methylene blue lymphangiography combined with indocyanine green angiography for preoperative lymphatic vessel localization.Observed internal methylene blue staining, lymphatic vessel identification time, operation time, the number of anastomosed lymphatics per incision, extra-lymphatic blue contamination, epidermal ulceration of the patients. Lower extremity lymphedema index (LELI) and lymphoedema functioning, disability and health questionnaire for lower limb lymphoedema (Lymph-ICF-LL) before and 3, 6 months after operation were compared between the two groups.

The lymphatic vessel identification time [14 (8, 22) min] and the operative time [(185.93 ± 33.43) min] in the study group were both shorter than those in the control group [20 (13, 30) min, (217.00 ± 59.19) min], and the differences were statistically significant (Z=-3.592, P<0.001; t=2.404, P=0.020). The success rate of methylene blue staining in the study group (65.52%) was higher than that in the control group (46.88%), and the proportion of extra-lymphatic blue contamination (4.31%) was lower than that in the control group (13.54%), with statistically significant differences (χ²=7.451, 5.761; P=0.006, 0.016). There was no statistically significant difference in the number of anastomosed lymphatics per incision between the two groups (Z=-1.757, P=0.079). The LELI(F=112.889, 136.113; P<0.001) and Lymph-ICF-LL scores (F=71.956, 113.342; P<0.001) were significantly reduced in both groups at 3 and 6 months after surgery compared to preoperative, and the prognosis improved.

Methylene blue lymphangiography combined with indocyanine green angiography used in LVA for the preoperative localization of lymphatic vessels, can make methylene blue staining of lymphatic vessels more accurate and shorten the lymphatic vessel identification time and operation time.

To explore and compare the clinical efficacy and safety of different methods combined with radiation therapy (RT) for repairing thin scar tissue.

A retrospective analysis was conducted on 38 patients with chest scars (64 scars) admitted to the Department of Plastic Surgery in Inner Mongolia Medical University Affiliated Cancer Hospital from October 2019 to October 2022, as well as 16 patients with chest scars (35 scars) admitted to the Department of Burn and Plastic Surgery in 969th Hospital of in the Joint Logistics Support Force of the People′s Liberation Army. According to different treatment methods, they were divided into radiotherapy (RT) group (n=18), surgery combined with radiotherapy (SCR) group (n=19), and CO₂ dot array laser combined with radiotherapy (LCR). The combined with radiosurgery (LCR) group (n=17) had 34, 33, and 32 scars in the three groups of patients, respectively. Before treatment, 6 months and 12 months after treatment, the Vancouver scar scale (VSS) and patient and observer scar assessment scale (POSAS) were used to evaluate the degree of scar improvement and clinical efficacy. The Likert scale was used to evaluate satisfaction, and an online questionnaire was used to evaluate adverse reactions and recurrence rates. Treatment related indicators were recorded.

The total POSAS score and VSS score of patients in the RT group, SCR group, and LCR group were lower than before treatment at 6 and 12 months after treatment (P<0.01). The total POSAS score and VSS score of the RT group increased compared to 6 months after treatment, while the total POSAS score and VSS score of the SCR and LCR groups decreased compared to 6 months after treatment. At 12 months after treatment, the LCR group had the lowest total POSAS score and VSS score, followed by the SCR group, and the RT group had the highest score. There was a significant difference in the effective rate between the SCR group and the LCR group compared to the RT group( χ²=19.304, P<0.01), there was no significant difference between the SCR group and the LCR group. The effective rate of the RT group was 27.78%, the SCR group was 78.95%, and the LCR group was 94.12%. There was a significant difference in satisfaction between the SCR group and the LCR group compared to the RT group( χ²=10.41, P<0.01), there was no significant difference between the SCR group and the LCR group. The satisfaction rate of the RT group was 52.94%, the SCR group was 84.21%, and the LCR group was 94.12%. After 12 months of treatment, the recurrence rate in the RT group was 72.22%, the SCR group had a recurrence rate of 21.05%, and the LCR group had a recurrence rate of 5.88%. There was a significant difference in the one-year recurrence rate( χ²=19.30, P<0.01).

LCR has the characteristics of simple and efficient operation, easy nursing, minimal trauma, good therapeutic effect, and high safety. It is easy for patients to accept, especially suitable for patients with multiple or large areas of thin scars, obvious surgical contraindications, or unwillingness to receive surgical treatment. Simple RT is mainly used to improve subjective symptoms such as pain and itching, while SCR is more suitable for the treatment of isolated or small amounts of medium and large scars. In clinical practice, it should be flexibly selected according to the actual situation.

To investigate the clinical efficacy of one-stage transplantation of artificial dermis combined with split-thickness skin grafts for repairing skin defects in the skin flap donor site.

A retrospective review of 221 patients who underwent skin flap surgery at the Department of Orthopedics, Shanghai Sixth People′s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2018 to December 2021 was conducted. According to the repair method of the skin flap donor site, the patients were divided into two groups. There were 115 patients in the observation group, and the skin defect range of the skin flap donor site was 11-240cm². The patients were treated with one-stage transplantation of artificial dermis combined with split-thickness skin grafts. There were 106 patients in the control group, and the skin defect range of the skin flap donor site was 11-243cm².The patients were treated with one-stage transplantation of full-thickness skin grafts. Follow up for 6 to 24 months was conducted to observe the survival rate of two groups of skin grafts, healing time of the donor site, patient satisfaction [Visual Analog Self Rating Scale (VAS)], scar hyperplasia in the flap donor site [Vancouver scar scale (VSS)], and joint function of the upper and lower limbs around the donor site [disabilities of the arm shoulder and hand (DASH) and American orthopaedic foot and ankle society(AOFAS) ]. SPSS and GraphPad Prism 9 software were used for statistical analysis, and t-test, Wilcoxon test, chi square test, and Fisher′s exact test were used for data comparison.

The survival rate of the artificial dermis combined with blade thickness skin grafting group was slightly higher than that of the medium thickness skin grafting group, but the difference was not statistically significant (95.7% and 93.4%, P>0.05). There was no statistically significant difference between the two groups in wound healing time [observation group and control group were 18.00 (16.00, 20.00) days and 17.50 (16.00, 20.00) days respectively] and patient satisfaction [observation group and control group were 5.00 (4.00, 6.00) and 5.00 (4.00, 7.00) days respectively (P>0.05)]. The degree of scar formation in both the recipient and donor areas of the artificial dermis combined with blade thickness skin grafting group was better than that in the medium thickness skin grafting group (the VSS scores in the recipient area were 4.00 (3.00, 5.00) and 5.00 (4.00, 6.00), Z=-3.647, P<0.01). The VSS scores of the donor site were 2.00 (1.00, 3.00) and 4.00 (3.00, 4.25), Z=-8.859, P<0.01), respectively. The adjacent joint function of the artificial dermis combined with blade thick skin grafting group was significantly better than that of the medium thick skin grafting group [upper limb function scores were 41.50 (40.00, 47.00) and 49.00 (45.25, 54.00), Z=-4.961, P<0.01]. The lower limb function scores were 91.00 (87.00, 93.50) and 82.00 (78.00, 86.25) (Z=-7.857, P<0.01), respectively.

One-stage transplantation of artificial dermis combined with split-thickness skin grafts is a good method for repairing skin flap donor sites, which can provide good tissue coverage for the donor site, especially on the tendon sheath, while avoiding scar contracture and ensuring the effective sliding of tendon tissues, which is beneficial to the recovery of adjacent joint function.

To explore the effect of the repair of deep wounds with grafting of artificial dermis in combination with autologous miniature skin pillar dot seeding.

Fourteen patients with deep wounds admitted to Department of Burns and Wound Repair, Dongguan Houjie Hospital from May 2022 to June 2023 were enrolled in the study including 8 males and 6 females, with the mean age of 31-86 (47.7±10.7) years. Six patients got burns and frostbite, 3 patients got contusions and scratchs, 2 patients got varicose ulcers, 2 patients got diabetic foot, and 1 patient got car accident damage.All the wounds were covered by artificial dermis in combination with autologous miniature skin pillar dot seeding after debridement thoroughly. Wound healing and recurrence were observed.Vancouver scar scale (VSS) was used to score the pigmentation, height, vascurity and pliability of scars, and the total score was calculated. Adverse reactions during the treatment process were recorded.

All the grafted miniature skin pillar of fourteen patients were survived and fused, and the wounds were healed. The hospital stay was 6-51 (22.3±9.9)days, and the wound healing time was 12-42 (22.2±6.7) days. The total score of VSS was 1-4 (2.8±0.7) points. The color was similar to that of normal skin, the thickness was normal, the hyperemia was not obvious, and the texture was soft. There was no injury of donor site, scar contracture or dysfunction of the operating area after the operation.

Deep wounds can be satisfactorily repaired by grafting of artificial dermis in combination with autologous miniature skin pillar dot seeding with no injury of donor site or recurrence after the operation, which provides a new type of therapy for the management of deep wounds.

To evaluate the clinical efficacy of tibial periosteal distraction combined with platelet-richplasma (PRP) in the treatment of diabetic foot ulcer.

From January 15, 2022 to April 30, 2023, a total of 26 diabetic foot patients with Wagner grade 2 to 4 received comprehensive basic treatment at the Department of Wound Repair and plastic Surgery the Hospital Affiliated to Shandong University of Traditional Chinese Medicine and Peking University Care Luzhony Hospital Burn and Wound Repair Center. They were divided into tibial periosteal stretch group (control group) and tibial periosteal stretch combined with PRP group (observation group) according to random number table, with 13 cases in each group. Tibial periosteal stretch group was treated with tibial periosteal distraction plus routine debridement and dressing change. Tibial periosteal stretch combined with PRP group was treated with tibial periosteal distraction and routine debridement and dressing change with PRP. The numerical oxygen saturation, foot temperature, ankle-brachial index, wound area, numerical rating scale (NRS) score and Bates-Jense wound assessment tool (BWAT), diabetes-Specific quality of life scale (DSQL) score of the two groups were recorded before treatment and 1, 2, 4, and 6 weeks after treatment and wound healing rate at 6 weeks after treatment, computed tomogrophy angiography(CTA) assessment of blood flow of affected limb, clinical efficacy and adverse reactions during treatment were also recorded. The clinical efficacy of the two groups of patients was evaluated.

After treatment, oxygen saturation, foot temperature, ankle-brachial index wound area, NRS score, BWAT score and DSQL score of both groups were improved compared with those before treatment (P<0.05). The wound volume, NRS score, BWAT score and DSQL score of tibial periosteal stretch combined with PRP group were significantly lower than those of tibial periosteal stretch group at each time point after treatment (P<0.05). Follow-up to 6 weeks after treatment, CTA of lower limbs in both showed the formation of small blood vessels and collateral circulation in the stretch area of lower limbs, and some blood vessels extended to the distal end, with no significant difference between the two groups (P>0.05). The wound healing rate and clinical efficacy of tibial periosteal stretch combined with PRP group were better than those of tibial periosteal stretch group (P<0.05). There were no serious adverse reactions in both groups.

Tibial periosteal distraction combined with platelet-rich plasma (PRP) therapy can better promote the healing of diabetic foot ulcer, relieve pain and improve the quality of life of patients.

Bony mallet fingers are generally treated with surgery, and there are few reports on conservative treatment. This study retrospectively analyzed the efficacy of the molded polythene splint for bony mallet finger deformities, providing guidance for clinical treatment.

A retrospective analysis was conducted on 19 patients with distal phalangeal dorsal avulsion fractures resulting in bony mallet fingers treated with splint in Department of Orthopedic Trauma, Beijing Tsinghua Changgung Hospital from March 2015 to September 2021.As a comparison, 29 patients who underwent surgical treatment with Ishiguro′s technique during the same period were collected, and the fracture and joint reduction, active flexion and extension angle of affected finger joint, Dargan function evaluation, complication rate were compared between the two groups.

The average DIPJ extensor lag was 0 °~15 °(4.68 ± 5.00)° in the splinting group and 0 °~12 °(3.14 ± 4.16 )° in the surgical group. There was no significant difference between the two groups(P=0.32). Active flexion angle was 38 °~60 ° (50.42±6.73)° in the splinting group and 35 °~62 °(48.38±7.49)° in the surgical group. There was no significant difference between the two groups(P=0.34). The proportion of affected/healthy side range of motion was (0.74±0.14) in the splinting group and (0.76 ± 0.13) in the surgical group. There was no significant difference between the two groups(P=0.85). 10 were excellent and 9 were good in splinting group on dargan function evaluation and 17 cases were excellent, and 12 cases were good in the surgical group. There was no significant difference between the two groups(P=0.77). The incidence of complications was 47.3% in the splinting group and 44.8% in the surgical group. There was no significant difference between the two groups(P>0.05).

The short-term effect of surgical treatment of bony mallet finger is equivalent to that of splinting, and the incidence of complications is the same, but once the complications of surgical treatment occur, they are more serious and may be permanent. Splinting needs to pay attention to the patient′s compliance in order to achieve better results. Conservative treatment still has therapeutic value for some appropriately selected patients.

To compare the early and mid-term efficacy of rectangular wire loop tie combined with 8 steel cable and traditional Kirschner wire combine with steel cable fixation in the treatment of patellar fracture.

A retrospective study was conducted on 28 patients with patellar fracture in Department of Traumatic Orthopedics, Zhuzhou Central Hospital from January 2020 to June 2022, 15 patients were fixed with rectangular wire loop tie combined with 8 steel cable and 13 patients were fixed with traditional Kirschner wire combine with steel cable. Operation time, intraoperative blood loss, fracture healing time, postoperative internal fixation irritation rate, and knee joint efficacy evaluation at 18 months postoperative follow-up were recorded in the two groups (lysholm evaluation criteria).

There were no significant differences between the rectangular wire loop tie group and the Kirschner wire group in the amount of intraoperative blood loss, the time of fracture healing, and the evaluation of knee joint curative effect at the follow-up of 18 months after surgery (P>0.05), but the rectangular tie group had shorter operation time and lower internal fixation irritation rate(P<0.05).

Fixation of patellar fracture with rectangular wire loop tie combined with 8 steel cable can achieve the same prognostic effect as traditional Kirschner wire combined with steel cable fixation, but its operation time is shorter and can better avoid internal fixation irritation, which is worthy of clinical application.

To establish the airway nursing evaluation index system for inhalation injury, serve as a reference and foundation for standardizing nursing practices and enhancing the quality of care.

Based on the evidence-based summary and expert consensus on airway management for inhalation injury in the previous study of the research group, the research team initially developed a letter questionnaire through discussion and conducted two rounds of expert consultation using the Delphi method. The weightings of each index were determined using an ordinal diagram method, and consistency testing was performed using the analytic hierarchy process.

The recovery rate for both rounds of questionnaires was 100%, the authoritative coefficients were 0.957 and 0.937, and the Kendall harmony coefficients were 0.307 and 0.317, respectively, which passed the consistency test.Finally, an evaluation index system for airway nursing in inhalation injury was established, including 3 first-level indicators, 23 second-level indicators and 102 third-level indicators.

The construction method of airway care evaluation index system of inhalation injury is scientific and reasonable, and the index content is specialized and practical, which provides reference and basis for the effective evaluation of airway care quality of patients with inhalation injury.