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The aim of this study was to identify an efficient approach for 3D imaging of hand. The 3D photographs of hand were taken with Gemini structured-light scanning system (SL scanning) and CT scanning. The 3D photographs, average time of scanning and reconstruction were compared between these two indirect techniques. The reliability, reproducibility and accuracy were evaluated in these two indirect techniques and the direct measurement (DM). Statistical differences in the measurements were assessed by 99% probability, with clinical significance at > 0.5 mm. The Gemini structured-light scanning system established a complete and smooth 3D hand photograph with shorter scanning and reconstruction time. Reproducibility of CT scanning and SL scanning methods was better (P < 0.01, both) than the DM, but did not differ significantly from each other (P = 0.462). Of the 19 (31.58%) measurements obtained, 6 showed significant differences (P < 0.01). Significant differences were observed more often for circumference dimensions (5/9, 55.56%) than for length dimensions (1/10, 10%). Mean absolute error (AE) of the 10 subjects was very low for 3D CT (0.29 ± 0.10 mm) and SL scanning (0.30 ± 0.11 mm). Absolute percentage error (APE) was 4.69 ± 2.33% and 4.88 ± 2.22% for 3D CT and SL scanning, respectively. AE for the PIP circumference between the 3rd finger (0.58 mm) and 4th finger (0.53 mm) scan was > 0.5 mm, indicating significant difference between DM and CT scanning at the level of 99% probability. In this study, the Gemini structured-light scanning system not only successfully established a complete and smooth 3D hand photograph, but also shortened the scanning and reconstruction time. Compared to the DM, measurements obtained using the two indirect techniques did not show any statistically or clinically insignificant difference in the values of the remaining 17 of 19 measurements (89.47%). Therefore, either of the two alternative techniques could be used instead of the direct measurement method.

Objectives This study investigated whether exosomes from LPS pretreated bone marrow mesenchymal stem cells (LPS pre-MSCs) could prolong skin graft survival.Methods The exosomes were isolated from the supernatant of MSCs pretreated with LPS. LPS pre-Exo and rapamycin were injected via the tail vein into C57BL/6 mice allografted with BALB/c skin; graft survival was observed and evaluated. The accumulation and polarization of macrophages were examined by immunohistochemistry. The differentiation of macrophages in the spleen was analyzed by flow cytometry. For in vitro, an inflammatory model was established. Specifically, bone marrow-derived macrophages (BMDMs) were isolated and cultured with LPS (100 ng/ml) for 3 h, and were further treated with LPS pre-Exo for 24 h or 48 h. The molecular signaling pathway responsible for modulating inflammation was examined by Western blotting. The expressions of downstream inflammatory cytokines were determined by Elisa, and the polarization of macrophages was analyzed by flow cytometry.Results LPS pre-Exo could better ablate inflammation compared to untreated MSC-derived exosomes (BM-Exo). These loaded factors inhibited the expressions of inflammatory factors via a negative feedback mechanism. In vivo, LPS pre-Exo significantly attenuated inflammatory infiltration, thus improving the survival of allogeneic skin graft. Flow cytometric analysis of BMDMs showed that LPS pre-Exo were involved in the regulation of macrophage polarization and immune homeostasis during inflammation. Further investigation revealed that the NF-κB/NLRP3/procaspase-1/IL-1β signaling pathway played a key role in LPS pre-Exo-mediated regulation of macrophage polarization. Inhibiting NF-κB in BMDMs could abolish the LPS-induced activation of inflammatory pathways and the polarization of M1 macrophages while increasing the proportion of M2 cells.Conclusion LPS pre-Exo are able to switch the polarization of macrophages and enhance the resolution of inflammation. This type of exosomes provides an improved immunotherapeutic potential in prolonging graft survival.

Trauma or lesion resection often causes complex wounds with deep soft tissue defects in extremities. Simply covering with a skin flap will leave a deep dead space resulting in infection, non‐healing wounds, and poor long‐term outcomes. Thus, effectively reconstructing complex wounds with dead space leaves a clinical challenge. This manuscript presents our experience using chimeric medial sural artery perforator (cMSAP) flap, to reconstruct complex soft tissue defects of the extremities, thereby exploring broader analysis and indications for future reference. Between March 2016 and May 11, 2022, patients (8 males and 3 females) with a mean age of 41 years (range from 26 to 55 years) underwent reconstructive surgery with the cMSAP flap. The cMSAP flap consists of an MSAP skin paddle and a medial sural muscle paddle. The size of the MSAP skin paddle ranged between 9 × 5 cm and 20 × 6 cm, and the size of the medial sural muscle paddle ranged between 2 × 2 cm and 14 × 4 cm. Primary closure of the donor site was achieved in all cases. Of the 11 patients, the cMSAP flap survived in 10 cases. The vascular compromise occurred in one special case and was treated with surgical procedures. The mean follow‐up duration was 16.5 months (range of 5–25 months). Most patients present satisfactory cosmetic and functional results. The free cMSAP flap is a good option for reconstructing complex soft tissue defects with deep dead space in extremities. The skin flap can cover the skin defect, and the muscle flap can fill the dead space against infection. In addition, three types of cMSAP flaps can be used in a broader range of complex wounds. This procedure can achieve an individualised and three‐dimensional reconstruction of the defects and minimise the donor site morbidities.

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