{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T04:26:51Z","timestamp":1790742411930,"version":"4.1.0"},"reference-count":44,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2022,10,2]],"date-time":"2022-10-02T00:00:00Z","timestamp":1664668800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["International Wound Journal"],"published-print":{"date-parts":[[2023,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>The treatment of traumatic wounds with exposed bone or tendons is often challenging. An induced membrane (IM) is used to reconstruct bone defects, as it provides an effective and sufficient blood supply for bone and soft\u2010tissue reconstruction. This study explored a novel two\u2010stage strategy for wound management, consisting of initial wound coverage with polymethyl methacrylate (PMMA) and an autologous split\u2010thickness skin graft under the IM. Fifty inpatients were enrolled from December 2016 to December 2019. Each patient underwent reconstruction according to a two\u2010stage process. In the first stage, the defect area was thoroughly debrided, and the freshly treated wound was then covered using PMMA cement. After 4\u20106\u2009weeks, during the second stage, the PMMA cement was removed to reveal an IM covering the exposed bone and tendon. An autologous split\u2010thickness skin graft was then performed. Haematoxylin and eosin (H&amp;E) staining and immunohistochemical analysis of vascular endothelial growth factor (VEGF), CD31 and CD34 were used to evaluate the IM and compare it with the normal periosteal membrane (PM). The psychological status and the Lower Extremity Function Scale (LEFS) as well as any complications were recorded at follow\u2010up. We found that all skin grafts survived and evidenced no necrosis or infection. H&amp;E staining revealed vascularised tissue in the IM, and immunohistochemistry showed a larger number of VEGF\u2010, CD31\u2010 and CD34\u2010positive cells in the IM than in the normal PM. The duration of healing in the group was 5.40\u2009\u00b1\u20091.32\u2009months with a mean number of debridement procedures of 1.92\u2009\u00b1\u20090.60. There were two patients with reulceration in the group. The self\u2010rating anxiety scale scores ranged from 35 to 60 (mean 48.02\u2009\u00b1\u20098.12). Postoperatively, the LEFS score was 50.10\u2009\u00b1\u20099.77. Finally, our strategy for the management of a non\u2010healing wound in the lower extremities, consisting of an IM in combination with skin grafting, was effective, especially in cases in which bony structures were exposed in the elderly. The morbidity rate was low.<\/jats:p>","DOI":"10.1111\/iwj.13955","type":"journal-article","created":{"date-parts":[[2022,10,2]],"date-time":"2022-10-02T21:34:20Z","timestamp":1664746460000},"page":"1020-1032","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Management of wounds with exposed bone structures using an induced\u2010membrane followed by polymethyl methacrylate and second\u2010stage skin grafting in the elderly with a 3\u2010year follow\u2010up"],"prefix":"10.1111","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5475-0742","authenticated-orcid":false,"given":"Leyi","family":"Cai","sequence":"first","affiliation":[{"name":"Department of Orthopaedics Surgery The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University  Wenzhou Zhejiang Province China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zipu","family":"Hong","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics Surgery The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University  Wenzhou Zhejiang Province China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yingying","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics Surgery The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University  Wenzhou Zhejiang Province China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guangheng","family":"Xiang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics Surgery The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University  Wenzhou Zhejiang Province China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peng","family":"Luo","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics Surgery The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University  Wenzhou Zhejiang Province China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weiyang","family":"Gao","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics Surgery The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University  Wenzhou Zhejiang Province China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhijie","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics Surgery The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University  Wenzhou Zhejiang Province China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feiya","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics Surgery The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University  Wenzhou Zhejiang Province China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,10,2]]},"reference":[{"issue":"12","key":"e_1_2_9_2_1","first-page":"E110","article-title":"Management of a severe degloving injury with a type 2 open tibia fracture using negative pressure wound therapy with instillation and dwell time","volume":"32","author":"Ali M","year":"2020","journal-title":"Wounds"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2020.03.059"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000006589"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.1920160609"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-2001-16357"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-199907000-00013"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0094-1298(20)31536-4"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.5435\/00124635-201102000-00003"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cps.2011.09.011"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00402-021-03935-8"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2020.12.009"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1590\/acb361003"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13018-015-0287-4"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1038\/s12276-018-0062-9"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.janxdis.2005.08.002"},{"issue":"4","key":"e_1_2_9_17_1","first-page":"371","article-title":"The Lower Extremity Functional Scale (LEFS): scale development, measurement properties, and clinical application. 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