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Multi-lobed perforator flap was one of popular approaches for one-stage reconstruction of complex soft tissue defects because of its minimal donor-site morbidity. However, the area of skin island that can be harvested on the donor site is limited on the angiosome distribution, Moreover, large defects require more than the conventional skin island provided by a traditional multi-lobed perforator flap. For further extended skin paddles, this study presented a novel design of waveform-arranged skin paddles to elevated a modified multi-lobed perforator flap for the reconstruction of complex soft tissue defects in the extremities.From March of 2015 to March of 2020, fifteen patients underwent complex soft tissue defects reconstruction with waveform-arranged multi-lobed perforator flaps. According the size, shape and localization of the defects, two strategies were performed to design this modified multi-lobed flap.A total of fifteen waveform-arranged multi-lobed perforator flaps were successfully harvested to reconstruct complex soft tissue defects of the extremities. Among of them, Waveform-arranged dual skin paddles perforator flap were performed in eleven cases, and the waveform-arranged tripaddle perforator flaps were used in four cases. All the flaps survived and no flap related complication was observed postoperatively. The donor sites were closed directly in all cases. The mean follow-up time was 15.6 months. Most of the cases showed satisfactory contour.The waveform design of multi-lobed perforator flap was an alternative approach for reconstruction of complex soft tissue defects; it can maximize the harvested skin area of the donor site to provide extended skin island.

To maximize the morpho-functional recovery on the totally degloved foot while not excessively introducing the technical complexity of microsurgery, we present a regionalized reconstruction, in which the highly functional subunit (weight-bearing area and ankle-around area) is covered by free skin flaps, and the less functional subunit (dorsum) by skin graft.From June 2011 to December 2017, 10 patients who had total degloving injury on foot underwent reconstruction based on regionalized coverage. As the shape of combined flaps resemble a boat sock in high-heeled shoe, we name it as "Boat Sock" flaps. Complication like vascular compromise, partial or total flap loss, Equinus deformity and delayed plantar ulceration were documented elaborately. Secondary surgeries were also recorded. Foot function was evaluated by Maryland foot score at the last follow up.Twenty-one free skin flaps were used for "Boat sock" coverage on highly functional subunits. Flap dimension ranged from 19×5cmThis regionalized coverage by "Boat Sock" flaps and skin graft could serve as a standard procedure for reconstruction of the totally degloved foot, by offering the benefits of multi-plane coverage, a well-contoured ankle, an abrasion-tolerant planta, and eclectic surgical complexities.

Background Complex soft tissue defects in the upper extremities are challenging to reconstruct. The purpose of this study was to share our experience with using four variants of double skin paddle Anterolateral Thigh Perforator (ALT) flap to achieve the customized reconstruction of the complex defects. Patients and methods From January 2007 to December 2019, 15 patients (14 male and 1 female) aged 15–61 years underwent double skin paddle ALT flap reconstruction of the upper extremities. 10 wounds were located in the wrist or hand, while four wounds were located in the forearm, and one wound in the elbow. All the wounds were large with non-adjacent defects and with or without a dead space. Four variants of double skin paddle anterolateral thigh perforator flaps were harvested according to the patient's needs. Results The flaps received were consisted of 7 classic double skin paddle ALT flap, 4 vastus lateralis muscle-chimeric double skin paddle ALT flap, 2 microdissected thin double skin paddle ALT flap, and 2 flow-through double skin paddle ALT flap. The size of the skin flap ranged from 6 × 6 cm2 to 26 × 7 cm2, and the size of the muscle segment ranged from 5 × 2 × 1 cm3 to 16× 6 × 2 cm3. Flap necrosis related to the pedicle kinking was observed in one patient, while the rest of the flaps survived without complications. The follow-up period ranged from 7 to 54 months, with a median of 15.6 months. The mean value of the qDASH scores at the last follow-up was 27.12 ± 16.51 (range, 11.4–59.1). None of the patients showed wrist flexion deformity. Postoperatively, three patients developed finger joint stiffness, which correlated with the severity of the injury. Conclusions Variants of double skin paddle ALT flaps provide versatile design and allow customized reconstruction of complex soft tissue defects in the upper extremities with limited donor site morbidity. We believe that the algorithm provided will help the surgeons with deciding among variants of double skin paddle ALT flap.

Introduction Coverage of circumferential wounds on limbs is a challenging reconstructive job. Here, we propose a skin flap-based algorithm to reconstruct circumferential wound with the chain-linked design and combined transplantation of ALTP and DIEP flap, which could achieve full-coverage and simultaneously primary donor-site closure. Patient and methods From December 2007 to December 2018, 14 patients with circumferential would on upper or lower limbs underwent reconstruction with ALTP or DIEP flap, by the technique of combined transplantation or chain-linked design, or both. The wound was classified into five different types according to the width compared to the donor site (overall magnitudes and regularity), which was separately reconstructed by five different wound decomposition and corresponding flap design. Flap survivorship, complication on recipient or donor site and any secondary surgeries have been recorded. Results 14 patients were successfully treated with 22 flaps, including seven patients reconstructed with one flap (4 bi-pedicled, 2 tri-pedicled), 6 patients reconstructed with two flaps (1 in mono-pedicled, 5 in multi-pedicled), one with 3 flaps and skin grafts. Only one donor site was not directly closed, and one experienced dehiscence but finally healed. All flaps survived uneventfully but three had minor edge necrosis and later treated with skin graft. Conclusion The algorithm is practical in circumferential wound resurfacing on limbs for allowing flexible design, sufficient coverage, and low donor site morbidity.

Summary Background Complex soft-tissue defects of upper extremities still have a high rate of amputation, as the reconstruction of complex soft-tissue defects is always difficult even with the largest conventional free flap. The anterolateral thigh perforator (ALTP) flap is one of the most popular procedures used for the coverage of complex soft-tissue defects of extremities. However, problems associated with donor-site morbidity and inability to repair complex soft-tissue defects in a one-stage procedure persist. The purpose of this study was to present a novel design of using chain-linked bilateral ALTP flap and its various designs for customized reconstruction of complex soft-tissue defects in the hands and forearms. Methods From June 2009 to June 2017, we retrospectively analyzed 15 patients with complex soft-tissue defects in the hands and forearms. All patients in this series underwent extremity reconstruction using the chain-linked bilateral ALTP flaps. Three different types of chain-linked bilateral ALTP flaps were created in this study based on wound characteristics and the maximum available skin paddle size at all donor sites. Results The chain-linked bilateral ALTP flaps were successfully harvested for the reconstruction of complex soft-tissue defects in the hands and forearms. Among them, ten cases were repaired with chain-linked bipaddle ALTP flaps, two cases were treated with chain-linked tripaddle ALTP flaps, and the remaining three cases were used with chain-linked multi-lobed ALTP chimeric flaps. The sizes of the skin paddles ranged from 11 cm × 7 cm to 42 cm × 8 cm. The areas of the total flaps ranged from 245 cm2 to 650 cm2 (mean 419.6 cm2). Only one case required re-exploration because of the venous congestion. The donor sites were closed directly. The mean follow-up time was 16.4 months. Most cases showed satisfactory contour. Conclusion The chain-linked bilateral ALTP flap is a reliable option for one-stage reconstruction of complex soft-tissue defects in the hands and forearms with limited donor-site morbidity. It also provides various flap designs, which allow for more individualized treatment approaches.

Lipopolysaccharide (LPS)-preconditioned mesenchymal stem cells (MSCs) possessed strong immunomodulatory and anti-inflammatory functions by secreting exosomes as major paracrine effectors. However, the specific effect of exosomes from LPS pre-MSCs (LPS pre-Exos) on peripheral nerve regeneration has yet to be documented. Here, we established a sciatic nerve injury model in rats and an inflammatory model in RAW264.7 cells to explore the potential mechanism between LPS pre-Exos and peripheral nerve repair. The local injection of LPS pre-Exos into the nerve injury site resulted in an accelerated functional recovery, axon regeneration and remyelination, and an enhanced M2 Macrophage polarization. Consistent with the data in vivo, LPS pre-Exos were able to shift the pro-inflammation macrophage into a pro-regeneration macrophage. Notably, TNF stimulated gene-6 (TSG-6) was found to be highly enriched in LPS pre-Exos. We obtained si TSG-6 Exo by the knockdown of TSG-6 in LPS pre-Exos to demonstrate the role of TSG-6 in macrophage polarization, and found that TSG-6 served as a critical mediator in LPS pre-Exos-induced regulatory effects through the inhibition of NF-ΚΒ and NOD-like receptor protein 3 (NLRP3). In conclusion, our findings suggested that LPS pre-Exos promoted macrophage polarization toward an M2 phenotype by shuttling TSG-6 to inactivate the NF-ΚΒ/NLRP3 signaling axis, and could provide a potential therapeutic avenue for peripheral nerve repair.

Microplastics, as a group of emerging contaminants, are widely present in environmental media and have the potential to endanger the ecological environment and human health. Due to the inconsistencies and difficulties inherent in the analysis of microplastic particles, global monitoring data on the distribution of microplastics in the environment are still far from sufficient. The fate and migration of microplastics in the environment are also uncertain. Therefore, there have been increasing reviews on the distribution, biological effects, migration, and health risks of microplastics. However, reports focusing on the degradation of microplastics are still rare. Understanding and commanding the environmental behavior of microplastics are of great significance to explore the treatment of microplastic pollution. Although some preliminary studies on microplastics have been carried out, there is still an urgent need to conduct a comprehensive study on environmental behaviors and degradation methods of microplastics in different environmental media. This article summarizes the recent advances on microplastics, basically includes the distribution and ecological impact of microplastics in soil and water environments, then elaborates the migration behavior and influencing factors of microplastics, and focuses on the research progress of microplastics degradation methods. On this basis, the problems existing in the current research and the future development directions have been proposed. This review could provide a more systematic reference for the development and research of microplastics in the future.

This retrospective study was conducted to compare the outcomes between the free deep inferior epigastric artery perforator (DIEP) flap and the circumflex scapular artery perforator (CSAP) flap in reconstruction of moderate-sized soft tissue defects in the foot and ankle of pediatric patients.From January 2004 to December 2016, 42 patients, ranging from 2 to 13 years old, underwent foot and ankle reconstruction, with a free DIEP flap in 21 cases and a free CSAP flap in the other 21cases.All the flaps survived. No marked differences were observed in the demographics, flap size, recipient vessels, and overall early or late complication rate (p 0.05). The CSAP group had a shorter operation time (134.3 ± 25 min vs. 202.4 ± 24.3 min, p 0.05) and flap harvest time (29.7 ± 8.1 min vs. 52.2 ± 9.8 min, p 0.05) than the DIEP group had. In long-term follow-up, the CSAP group showed a lower fat hyperplasia rate (14% vs. 52%, p 0.05) and better cosmetic outcomes than the DIEP group did (p 0.05). The functional outcomes had no marked differences (p 0.05).The DIEP flap and the CSAP flap are both good options for foot and ankle reconstruction of moderate-sized defects in pediatric patients. The CSAP flap has a shorter operation time and flap harvest time, a lower fat hyperplasia rate, and better long-term cosmetic outcomes than the DIEP flap does.

Summary Background Simultaneous reconstruction of composite bone and large soft-tissue defect areas is challenging for reconstructive surgeons. This study presents a microsurgical sequential chimeric flap composed of a flow-through anterolateral thigh perforator (ALTP) flap and a deep circumflex iliac artery perforator (DCIAP) chimeric flap for one-stage reconstruction of a complex tissue defect in limbs. Methods A retrospective analysis was performed among patients who underwent reconstruction of bone composite and large soft-tissue defect areas in limbs using a sequential chimeric flap. A flow-through ALTP flap and a DCIAP chimeric flap were microsurgically fabricated as sequential chimeric flaps. Results Ten patients were successfully treated with the sequential chimeric flaps. All components of the flaps survived in all patients. Primary closure of the donor site was achieved in all cases. The sizes of the flow-through ALTP flaps ranged from 16 × 6 cm to 27 × 8 cm. The size of the cutaneous portion of the DCIAP chimeric flap ranged from 11 × 4 cm to 20 × 9 cm, and bone flap sizes ranged from 1 × 3 × 2 cm to 2.5 × 8 × 3 cm. A vascular compromise was observed postoperatively in one case. Only one case suffered minor wound-edge necrosis. Mean follow-up time was 13.1 months. Most cases showed a satisfactory contour, and no fracture of transferred iliac segments occurred. Conclusion The sequential chimeric ALTP-DCIAP flap is a valuable alternative for one-stage reconstruction of composite bone and large soft-tissue defects in limbs. This approach is flexible and provides a large cutaneous area with primary closure of the donor site.

Background The aim of this study was to explore the hemodynamic and morphological changes of the choke vessels, and to investigate the role of HIF-1α in the flap adaptation to hypoxic and choke vessel transformation after multi-territory perforator flap transplantation. Methods Animal model of single pedicle multi-territory perforator flap was established in the back of SD rats and the blood supply characteristics were studied by gelatin-oxide perfusion technique. HE staining and stereomicroscope were used to observe vascular changes. Afterward, the influence of hypoxia on cell proliferation and apoptosis were detected by MTT assay and flow cytometry, respectively. Besides, the expression of HIF-1α, iNOS and VEGF expression of HUVECs under hypoxia were detected by qRT-PCR and Western blot. Results The results revealed that all the choke vessels immediately began to expand after operation. The day after operation, some of the choke vessels continued to grow and expand, turning into the true anastomosis, while the others gradually dwindled and finally disappeared. Compared with the control group, the day after transplantation, the expression levels of both HIF-1α and iNOS were significantly increased. The only different was that HIF-1α was then maintained a high level, iNOS was significantly decreased aftertimes. What's more, the expression of VEGF was increased to the maximum at 3 days after operation and then decreased. In HUVECs, hypoxia increased the expression of HIF-1α, iNOS and VEGF protein. Besides, it also promoted the proliferation and inhibited the apoptosis. In addition, we also found that hypoxia-induced VEGF and iNOS upregulation is mediated by HIF-1α overexpression and HIF-1α knockout can reverse the effects induced by hypoxia. Conclusions We found that HIF-1α may participate in the early vascular dilatation of transregional skin flap by inducing iNOS expression and promoting the reconstruction of choke vessels through increase VEGF expression.

Osteonecrosis of the femoral head (ONFH) frequently occurs after glucocorticoid (GC) treatment. Extracellular vesicles (EVs) are important nano-sized paracrine mediators of intercellular crosstalk. Herein, we found that intravenous administration of EVs from human urine-derived stem cells (USC-EVs) at the early stage of GC exposure rescues angiogenesis impairment, reduces apoptosis of bone marrow and trabecular bone cells, prevent trabecular bone destruction and improves bone microarchitecture in the femoral heads of rats. In vitro, USC-EVs reverse GC-induced suppression of endothelial angiogenesis and activation of cellular apoptosis. Deleted in malignant brain tumors 1 (DMBT1) and tissue inhibitor of metalloproteinases 1 (TIMP1) are enriched in USC-EVs and essential for USC-EVs-induced pro-angiogenic and anti-apoptotic effects in GC-treated cells, respectively. Knockdown of TIMP1 in USC-EVs attenuates their protective effects against GC-induced ONFH. Our study suggests that USC-EVs are a novel promising nano-sized agent for the prevention of GC-induced ONFH by delivering pro-angiogenic DMBT1 and anti-apoptotic TIMP1.

Two new 2D frameworks of inorganic-organic hybrids, CuI4(bimb)4GeW12O40·2H2O (1) and CuII3Cl2(bimb)3(H2O)4GeW12O40·5H2O (2) were successfully synthesized under hydrothermal conditions by adjusting the stoichiometry of starting materials and pH values with the same starting materials. They were characterized by single crystal X-ray diffraction analysis, IR spectrum and magnetic measurements. Both of them are constructed by coordination polymer chains {CuI(CuII)-bimb}n and {GeW12O40} anions as building blocks. Compound 1 crystallizes in P-1 space group and exhibits a two-dimensional (2D) (3,4)-binodal layer, composed of wavelike {CuI-bimb}n polymer chains bridged by tetradentate [GeW12O40]4− polyanions, with a Schlafli symbol of (83)·(62·84). Compound 2 crystallizes in noncentrosymmetric space group P1 and exhibits a 2D (4,4) layer composed of one-dimensional (1D) tri-chains {CuII3(bimb)3Cl2(H2O)4}∞ constructed by unique three-nuclearity cluster {CuII3Cl2(H2O)4}4+ and bib molecules, bridged by bidentate [GeW12O40]4− anions. Magnetic measurements reveal that ferromagnetic interactions exist among the three-nuclearity cluster {Cu3Cl2O2(H2O)4} in 2.

The heterogeneous catalysts of Fe and Cu-doped monolacunary tungstosilicate have been prepared and characterized by SEM, XRD, IR, XPS, ICP, TG-DSC and H 2 -TPR techniques. The influence factors on the structure of catalysts and catalytic properties have been investigated, such as the additive graphite, doped amount and calcination temperature. After being calcined at appropriate temperature, the graphite was totally decomposed and catalysts of irregular bulk-type structure were converted to uniform nanoplate materials. The catalytic activity of as-prepared catalysts was evaluated by the benzyl alcohol selective oxidation and the simulation gasoline desulfurization. It is proved that transition metal Cu/Fe-codoped tungstosilicates are more active than the corresponding undoped compounds under mild conditions and Cu/Fe-doped amount greatly impacted the catalytic activity, and Cu 1.00 Fe 1.00 SiW 11 sample exhibited the best catalytic activity with 98.0% conversion and 98.3% selectivity in benzyl alcohol selective oxidation into benzaldehyde at 80 °C only for 60 min, and above 98% of the desulfurization rate at 65 °C just for 80 min.

The novel dimeric polyoxometalate, (MnPW11O39)210 − (1a), has been synthesized by reacting [B-α-PW9O34]9 − with Mn2 + ions in weak acid aqueous solution (pH = 5.3) under hydrothermal condition and isolated in the form of (C14H14N4)5H10(MnPW11O39)2·2H2O (1), which was characterized by IR spectroscopy, elemental analysis, thermogravimetric analysis, and magnetic measurements. The polyanion represents the first example of dimeric polyanion based on mono-transition metal (TM) substituted Keggin-type polyanions linked by two TM-μ2-O-TM bridges. Magnetic measurements show that the Mn┄Mn exchange interactions are weakly antiferromagnetic (J = − 0.53 cm− 1).