Analysis of the Therapeutic Effect of Artificial Leather Embedding Combined with Fascial Sleeve Flap Transplantation on Chronic Wounds of Lower Limbs with Bone and Plate Exposure

Background: After severe trauma of lower limbs, bone、tendon or plate graft exposure is common.The traditional repair method is to use a variety of skin flap transplantation to cover the exposed part, but the wound often can not heal after operation, or the wound is cracked, ulcer, sinus, bone and steel plate are exposed again after wound healing.The reason for this result is that when the flap is covered, the space around the bone plate is not well closed, forming a dead cavity, blood and exudate accumulation, hematoma formation or infection, and finally the wound ruptures again. In addition, due to the swelling and contracture of the flap after operation, the suture tension between the flap and the receiving area becomes larger, the skin becomes thinner and broken, and then the wound is formed. In order to solve the above problems, we carried out the study of artificial true skin embedding combined with fascial sleeve flap transplantation in the treatment of chronic bone plate exposed wounds of lower limbs.Methods: In this paper, 11 cases of chronic wounds with bone exposure and skin necrosis after steel plate implantation were selected. First stage is the wound bed preparation including primary wound expansion,removal of necrotic tissue and incision of sinus wall, removal of deep necrotic bone and fibrotic scarred skin on the outer wall of steel plate to normal tissue on the outer edge of the wound, removal of precipitated peptone and purulent fur in the hole, periphery and bone space of the steel plate, and removal of tendon tissue with basal necrosis and disintegration of the wound. After vacuum sealing drainage (VSD) 1~2 weeks, the peritraumatic basal granulation tissue grew well and there was no necrotic tissue in the wound. In the second stage, the exposed bone was covered with artificial dermis, the steel plate hole or the periphery and the basal space were filled, and the exposed steel plate was completely embedded, and then the fascia sleeve flap was transplanted to cover the wound. The sural neurovascular flap was performed in 9 cases and the lateral superior malleolar artery perforator flap in 2 case. Results: The flap survived well in all 11 cases. During the follow-up of 6 months to the removal of the plate, there was no case of rupture, exposure and sinus formation.Conclusions: Artificial dermal covering combined with fascial sleeve flap transplantation can effectively avoid wound dehiscence or sinus formation caused by foreign body retention, infection and flap contracture,It has good effect in repairing chronic wounds with bone plate exposure after severe trauma of lower limbs.

Analytical Model Formulation of Steel Plate Reinforced Concrete Walls against Hard Projectile Impact

Steel plate reinforced concrete (SC) walls can effectively resist projectile impact by preventing the rear concrete fragments flying away, thus attracting much attention in defence technology. This work numerically and analytically investigated the hard projectile perforation of steel plate reinforced concrete walls. Impact resistance theories, including cavity expansion analysis as well as the petaling theory of thin steel plates were used to describe the cratering, tunneling and plugging phases of SC walls perforation. Numerical modeling of SC walls perforation was performed to estimate projectile residual velocity and target destructive form, which were validated against the test results. An analytical model for SC wall perforation was established to describe the penetration resistance featuring five stages, i.e., cratering, tunneling and plugging, petaling with plugging and solely petaling. Analytical model predictions matched numerical results well with respect to projectile deceleration evolution as well as residual velocity. From a structural absorbed energy perspective, the effect of front concrete panel and rear steel plate thickness combinations was also studied and analyzed. Finally, equivalent concrete slab thickness was derived with respect to the ballistic limit of SC walls, which may be helpful in the design of a protective strategy.