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Skin cancer should be excised with sufficient margin to reduce recurrence rate. However, the surgeon always has to worry about the reconstruction method of skin defects after excision. In particular, defects in the plantar surface of the foot are difficult to reconstruct due to their position and structure, and various methods are applied by each surgeon. Surgeons think which methods are easier to apply to patients and less morbidity. To alleviate these concerns, we applied artificial dermal substitute to skin defects after skin cancer. Bowen's disease (squamous cell carcinoma in situ) and melanoma in situ on the plantar surface of the foot were subjected to wide excision with sufficient margin. After excision, a skin defect with exposed plantar fascia was applied with a matrix defect and vacuum. A granulation tissue (dermal matrix) was formed and a split-thickness skin graft was performed. Both patients had good functional results and no problems with skin donor sites. Thus, we report a skin graft method that is relatively easy to apply after skin cancer excision on the plantar surface of the foot.

Objective This study examines whether cross-education training of the healthy limb promotes cross-transfer through central nervous system stimulation, enhancing the function, kinematic parameters, dynamic balance, and plantar pressure of the affected knee joint in patients recovering from postoperative anterior cruciate ligament reconstruction (ACLR). Methods Forty anterior cruciate ligament reconstruction (ACLR) patients, 5–6 weeks postoperatively, were included and randomly assigned to either an experimental group ( n  = 20) or a control group ( n  = 20). The experimental group participated in six weeks of cross-education (CE) training in addition to conventional rehabilitation, while the control group received only conventional rehabilitation. Assessment outcomes included knee function (Lysholm score, joint mobility, and surface electromyographic characteristics of the rectus femoris muscle), kinematic parameters (stride length, stride speed, and stride width), dynamic balance (gait line length, single-support line length, and medial-lateral displacements), and plantar pressure (forefoot, midfoot, and hindfoot pressures). The effect of CE training on postoperative ACLR rehabilitation was comprehensively assessed by comparing the pre- and post-intervention changes within each group and the differences between the groups. Results Before the intervention, no statistically significant differences were observed between the two groups across all measured parameters ( P  > 0.05). Following the intervention, significant improvements in knee function, kinematic parameters, balance function, and plantar pressure were observed in both groups, with the experimental group showing significantly more significant improvements ( P  < 0.05). The Lysholm score, range of motion (ROM), and surface electromyographic activity of the rectus femoris muscle were significantly higher in the experimental group compared to the control group ( P  < 0.01). Among kinematic parameters, the experimental group demonstrated a significant increase in stride length and reduced stride width, whereas differences in stride speed were not statistically significant ( P  > 0.05). Regarding balance function, the experimental group exhibited significantly longer gait and single-support line lengths, significantly reducing medial-lateral displacement ( P  < 0.05). Analysis of plantar pressure revealed significant improvements in forefoot and hindfoot pressures in the experimental group, with a particularly notable increase in hindfoot pressure ( P  < 0.05). However, changes in midfoot pressure were not statistically significant ( P  > 0.05). Conclusion CE training markedly enhanced knee function, kinematic metrics, dynamic stability, and plantar pressure in postoperative ACLR patients providing initial evidence for the prospective utilization of CE theory in rehabilitation. Nonetheless, the fundamental mechanics of its effects remain ambiguous, and variables such as individual differences and neuromuscular adaptation processes may affect training results. Future studies should examine its long-term impacts and uncover potential neuromuscular pathways to establish a solid scientific basis for improving postoperative rehabilitation procedures.

Compare maximum plantar force (Fmax) during running in soccer players following anterior cruciate ligament reconstruction (ACLR) as they pass return to sport (RTS) criteria. Case control study. Soccer players after ACLR (n=16) and matched healthy controls (n=16) ran on a treadmill at 12, 14 and 16km/h while plantar loading data was measured using an in-shoe pressure system (Pedar-X, Novel). Fmax and contact time of the injured and uninjured limbs in athletes <9months post-ACLR and those ≥9months ACLR were compared to healthy players (no ACLR). Significant differences with large effect sizes in Fmax asymmetry were seen at all running speeds for the athletes <9months ACLR compared to those ≥9months, and the healthy subjects. Fmax difference peaked at 16km/h; 32±11%BW in <9months ACLR group compared to 6±5%BW in ≥9months group; ES=1.67, p<0.01. There was a non-significant trend for increasing asymmetry with increasing speed for subjects who were <9months after ACLR while the reverse was true for those ≥9 months and the healthy subjects. Relatively large unloading of the ACLR limb (but not differences in contact times) are seen during running for athletes <9months post-ACLR despite having completed functional criteria required to permit RTS training. These asymmetries appear to slightly increase with increasing speed, and the reverse is true for healthy controls and those ≥9months after ACLR surgery.

Background Reconstruction of the soft tissue defects of the heel has been an area of challenge over the years for plastic and reconstructive surgeons. The medial plantar artery flap has helped cover these defects. Methods A retrospective analysis of 41 patients who underwent reconstruction of heel and sole defects at our Institution between January 1, 2007, and December 31, 2018, was done. The mean duration of follow-up was 42.42 months. The flap is based on the medial plantar artery. Results Forty one patients underwent medial plantar artery flap reconstruction. The lesions were located over the heel in 25 patients or the weight-bearing area of the foot in 16 patients. The size of the defect ranged from 3 × 2 to 10 × 7 cm. None of the patients developed flap loss. Minor wound complications were seen in a minority of patients. All patients had sensate flaps with a return to full weight mobilization between 8 and 10 weeks after surgery. There were no late flap failures. Conclusions The medial plantar artery flap is robust, and sensate and is a good option for reconstruction of heel and sole defects.

Background People who have undergone anterior cruciate ligament reconstruction have an increased risk of osteoarthritis. Abnormality of lower limb kinematics will occur after the operation. This may be related to lower limb muscle strength, the co-excitation of hamstrings and quadriceps femoris, and the weakness of proprioception. Proprioceptive training can improve the proprioception of lower limbs and promote the recovery of lower limb kinematics. Our research objective is to observe whether proprioceptive training can improve the proprioception of lower limbs within 3 months after surgery and whether the recovery of proprioception can correct the abnormal lower limb kinematics. The secondary objective is to explore the underlying mechanism of postoperative lower limb gait abnormalities. Methods/design This study is a prospective single-center randomized clinical trial to be conducted in the Sports Medicine and Orthopedics of Zhongda Hospital Southeast University. Forty participants aged 18–50, preparing to undergo anterior cruciate ligament reconstruction, and initial anterior cruciate ligament reconstruction using hamstring tendons as grafts will be randomly assigned to the intervention or comparator group. People in the intervention group will add proprioceptive training three times a week, 20 min each time. The intervention will be conducted on the first day after surgery. The researcher mainly collects the data of joint of sense, gait, and plantar pressure. The assessment will be divided into three stages: after signing the informed consent form (within 2 weeks before surgery), 6 weeks after surgery, and 12 weeks after surgery. Discussion The main purpose of our study is to explore whether the proprioception of patients after anterior cruciate ligament reconstruction is weakened, whether the lower limb kinematics is abnormal and whether the lower limb kinematics can be corrected through proprioceptive training. Trial registration Chinese Clinical Trial Registry ChiCTR2200065808. Registered on 15 November 2022; Version 1.

Objective This study explores how extracellular vesicles (EVs) derived from keratinocytes cultured in Gelatin Methacryloyl (GelMA) hydrogels facilitate microvascular regeneration and enhance wound repair in diabetic skin ulcers. Methods EVs were harvested from keratinocyte cultures via ultracentrifugation and ultrafiltration, followed by characterization. Their uptake and angiogenic effects on human umbilical vein endothelial cells (HUVECs) were assessed in the following experimentations. Transcriptomic profiling of EV-treated HUVECs identified angiogenesis-related gene expression changes. A diabetic murine wound model was established and validated via glycemic profiling and pancreatic histology. In vivo effects of GelMA-EVs were evaluated through wound closure rates, histology (re-epithelialization, vascularization, collagen deposition), CD31 staining, and microvascular imaging. Results Keratinocyte-derived EVs significantly enhanced HUVEC proliferation, migration, and tube formation. Mechanistic studies reported elevated PDGF expression, activating the PI3K/AKT pathway. In vivo experiments validated that GelMA hydrogel-loaded EVs increased PDGF expression in wound tissues, promoting microvascular reconstruction and accelerating wound healing in diabetic mouse skin ulcers. Conclusion GelMA hydrogel-loaded EVs derived from keratinocytes upregulate PDGF, activating the PI3K/AKT pathway to promote microvascular network reconstruction and enhance wound healing in diabetic mouse skin ulcers. Graphical Abstract Graphical Highlight Keratinocyte-derived EVs were loaded into GelMA hydrogel for sustained release. GelMA-EVs significantly enhanced endothelial proliferation, migration, and tube formation. In vivo, GelMA-EVs accelerated diabetic wound healing and microvascular reconstruction. Mechanistically, EVs activated the PDGF/PI3K/AKT pathway to mediate regeneration.

Background The management of anterior colliculus fractures in combination with deltoid ligament injuries is a topic of debate, and there is a need to improve surgical outcomes. The purpose of the present study was to describe the application of a modified double-row suture bridge technique and evaluate its early clinical outcomes in the management of anterior colliculus fracture combined with deltoid ligament injury. Methods From 2020 to 2022, 12 patients with anterior colliculus fracture combined with deltoid ligament injury were treated using a modified double-row suture bridge technique. For clinical outcome evaluation, objective data are presented through clinical examination findings; radiographic assessments, including X-rays and computed tomography (CT); and follow-up analysis utilizing American Orthopaedic Foot & Ankle Society ankle‒hindfoot (AOFAS) scores, Olerud Molander Ankle Scores (OMAS), and visual analogue scale (VAS) scores. Preoperative and follow-up scores were compared with Student’s t test. ( p  < .05). Results The mean age of the patients was 52.67 ± 9.42 years (range: 39–74). The mean duration of follow-up was 14.42 ± 1.51 months (range: 12–17). At the final follow-up, the mean AOFAS score ( P  < 0.001) improved to 91.50 ± 2.65 points (range: 87–96), the mean OMAS ( P  < 0.001) improved to 77.08 ± 3.97 points (range: 70–85), and the mean VAS score ( P  < 0.001) improved to 0.25 ± 0.45 points (range: 0–1). Nine patients achieved excellent outcomes, and three achieved good outcomes according to the AOFAS score. Follow-up imaging evaluation indicated satisfactory alignment of the fracture and complete healing. Clinical examination suggested good mobility of the ankle. At the last follow-up, ankle dorsiflexion mobility was 14–18 degrees, plantar flexion mobility was 42–45 degrees, inversion mobility was 27–32 degrees, and eversion mobility was 22–25 degrees. Conclusions The modified double-row suture bridge technique is effective for achieving anatomic reduction of anterior colliculus fractures, and the technique also provides substantial benefit to the injured deltoid ligament. With this technique, the clinical outcomes can be significant and encouraging, indicating a new stage in its application and development.

Purpose This study aims to identify a repair procedure for ulcers or defect of the forefoot region. The general distribution and variation of the vascular anatomy of the distally based venocutaneous flap on the medial plantar artery of the hallux with medial plantar vein and nutrient vessels were investigated. This study especially focused on the vascularization of the medial side of the foot and the determination of the contribution of the nutrient vessels of medial plantar vein and medial dorsal cutaneous nerve to flap viability. Experiments were conducted to obtain information for operating procedures and to understand the vascular reliability of the flap. Methods Thirty cadavers were available for this anatomical study after arterial injection. The tuberosity of the fifth metatarsal bone was adopted as the anatomical landmark. Microdissection was conducted under a microscope, and details of the course and distribution of the medial plantar vein and the communication of the medial plantar artery of the hallux with the fascial vascular network surrounding the medial plantar vein were recorded. The flap-raising procedure was performed in a fresh cadaver specimen. Results The medial plantar vein was incorporated by the medial end of the dorsal pedal vein arch and medial dorsal vein of the hallux around the first metatarsal–medial cuneiform joint. It traveled along the medial margin of the foot and drained into the great saphenous vein at the level of the medial malleolar. The outer diameter of the nerve at the intermalleolar line was 3.2 ± 0.5 mm. These nutrifying arteries to the medial plantar vein were present segmentally and mainly came from the medial plantar artery of the hallux, which traveled forward in the fascia between the abductor hallucis tendon and the first metatarsal bone, emerged into the superficial layer 2.2 ± 0.7 cm proximal to the first metatarsophalangeal joint, and gave off many minute branches. These branches communicated with the fascial vascular network surrounding the medial plantar vein, supplying the fascia and integument of the medial foot. Conclusion Reliable venocutaneous flap with medial plantar vein and nutrient vessel flaps can be raised based solely on the perforator of the medial plantar artery of the hallux. This flap should be considered as a preferential way to reconstruct soft-tissue defects of the forefoot.

Background Soft-tissue defects of the forefoot are difficult to cover adequately, particularly, although multiple options for reconstruction are available. This study especially focused on the vascularization of the medial side of the foot and the determination of the contribution of the nutrient vessels to medialis pedis flap viability. Methods Thirty cadavers were available for this anatomical study. Microdissection was conducted under a microscope, and details of the course and distribution and the communication of the first plantar metatarsal artery with the fascial vascular network of the medial side of the foot were recorded. Clinically, six cases of soft-tissue defects at the forefoot region were reconstructed with distally based medialis pedis flap. Results The perforator of the first plantar metatarsal artery pierces in the superficial fascia of the medial aspect of the foot 2.2 ± 0.7 cm proximal to the first metatarsophalangeal joint, vascularize the skin of the medial plantar region. The anatomical study showed that the vasculature pattern could roughly be classified into two types. In terms of clinical application, all flaps completely survived, and one patient had partial loss of skin graft. Conclusion The perforators of the medialis pedis flap are presented constant. The forefoot region can be repaired by the distally based medialis pedis flap on the perforator of the medial plantar artery of the hallux or the first plantar metatarsal artery perforator with medial plantar vein, medial plantar cutaneous nerve and nutrient vessels.

The function of the donor foot has been affected after using big toe wrap-around flap for thumb reconstruction. A modified operation method has been developed to reduce the adverse effect on the donor foot. The current study compared the long-term effect of the classic and the modified operation methods on the donor foot. Gait analysis was carried out, including how the patient walked, the walking speed and walking distance, and how the patient jumped and ran. Plantar pressure was measured while the patient was standing and moving. A total of 45 patients who received the 2 different operation methods were included. The follow-up time was 4–10 years with a mean of 6.5 years. Various degrees of complications occurred for the 21 patients who received the classic operation method. For these patients, plantar pressure of the donor foot was obviously different comparing with the healthy unaffected foot while the patient was standing or walking. For the 24 patients who received the modified operation method, no obvious complications were observed and the plantar pressure of the donor foot and the healthy unaffected foot was similar while the patient was standing or walking. In conclusion, both the classic and the modified operation methods have affected the function of the donor foot after using the big toe wrap-around flap for thumb reconstruction. However, the donor foot was less affected when the modified operation method was used.