Acute Traumatic Wounds Research Articles

The use of a novel nitric oxide wound dressing in acute traumatic wounds in dogs.

To describe the use of a novel wound dressing that delivers nitric oxide (NO) to naturally occurring traumatic wounds in dogs. 24 client-owned dogs with 30 wounds. Dogs were presented with acute traumatic wounds requiring open wound management. Wounds were bandaged with a novel NO wound dressing and reassessed as needed for continued open wound management until wounds healed by second intention or wound closure was recommended. Dogs could be removed from the study at any point at the clinician's discretion. All wounds had the novel NO wound dressing used during open wound management until wound closure was recommended. Median time to wound closure was 6 days (range, 2 to 42). There were no complications directly attributed to the use of the novel wound dressing that clinically affected the dogs. Three wounds dehisced following wound closure. Wound healing was confirmed in 19 dogs with 25 wounds, with 3 dogs lost to follow-up prior to suture removal. Only 7.1% of wounds had clinical signs consistent with wound infection following wound closure. The novel NO wound dressing was easy to use and well tolerated in dogs with naturally occurring traumatic wounds. It can be used throughout all phases of wound healing, simplifying open wound management.

Cutaneous Wound Healing and the Effects of Cannabidiol.

Cutaneous wounds, both acute and chronic, begin with loss of the integrity, and thus barrier function, of the skin. Surgery and trauma produce acute wounds. There are 22 million surgical procedures per year in the United States alone, based on data from the American College of Surgeons, resulting in a prevalence of 6.67%. Acute traumatic wounds requiring repair total 8 million per year, 2.42% or 24.2 per 1000. The cost of wound care is increasing; it approached USD 100 billion for just Medicare in 2018. This burden for wound care will continue to rise with population aging, the increase in metabolic syndrome, and more elective surgeries. To heal a wound, an orchestrated, evolutionarily conserved, and complex series of events involving cellular and molecular agents at the local and systemic levels are necessary. The principal factors of this important function include elements from the neurological, cardiovascular, immune, nutritional, and endocrine systems. The objectives of this review are to provide clinicians engaged in wound care and basic science researchers interested in wound healing with an updated synopsis from recent publications. We also present data from our primary investigations, testing the hypothesis that cannabidiol can alter cutaneous wound healing and documenting their effects in wild type (C57/BL6) and db/db mice (Type 2 Diabetes Mellitus, T2DM). The focus is on the potential roles of the endocannabinoid system, cannabidiol, and the important immune-regulatory wound cytokine IL-33, a member of the IL-1 family, and connective tissue growth factor, CTGF, due to their roles in both normal and abnormal wound healing. We found an initial delay in the rate of wound closure in B6 mice with CBD, but this difference disappeared with time. CBD decreased IL-33 + cells in B6 by 70% while nearly increasing CTGF + cells in db/db mice by two folds from 18.6% to 38.8% (p < 0.05) using a dorsal wound model. We review the current literature on normal and abnormal wound healing, and document effects of CBD in B6 and db/db dorsal cutaneous wounds. CBD may have some beneficial effects in diabetic wounds. We applied 6-mm circular punch to create standard size full-thickness dorsal wounds in B6 and db/db mice. The experimental group received CBD while the control group got only vehicle. The outcome measures were rate of wound closure, wound cells expressing IL-33 and CTGF, and ILC profiles. In B6, the initial rate of wound closure was slower but there was no delay in the time to final closure, and cells expressing IL-33 was significantly reduced. CTGF + cells were higher in db/bd wounds treated with CBD. These data support the potential use of CBD to improve diabetic cutaneous wound healing.

A Novel Method on Wound Identification using Machine Learning and Image Processing

Automated wound detection using advanced computer vision techniques has emerged as a promising avenue within the realm of healthcare. This approach offers a streamlined and accurate means of identifying a variety of acute injuries, including bruises, abrasions, and traumatic wounds. Wound identification and assessment are crucial tasks in medical practice, facilitating appropriate treatment planning and monitoring of patient recovery. Traditional methods of wound assessment often rely on visual inspection by healthcare professionals, which can be subjective and time-consuming. In recent years, advances in machine learning (ML) and image processing have offered promising avenues for automating wound identification and analysis. This paper presents a comprehensive review of existing techniques and proposes a novel approach that leverages ML algorithms and image processing methods for accurate wound identification. We discuss various challenges, such as data variability, and provide insights into future research directions to enhance the efficacy and applicability of automated wound identification systems. In this study, we delve into the application of YOLO v8, a cutting-edge real-time object detection framework, for automated wound detection across diverse clinical scenarios

Dermatophytosis is uncommon in asymptomatic wild eastern cottontail rabbits in Illinois, Midwestern United States.

To investigate the presence of dermatophytes on the haircoat of wild eastern cottontail rabbits (ECR) (Sylvilagus floridanus) with and without skin lesions. 2-week-old or older ECR admitted to a Wildlife Medical Clinic (WMC) in central Illinois, Midwest United States, from September 2021 to August 2022. ECR were surveyed over a 1-year period to assess the prevalence and seasonality of dermatophytosis. A Wood's lamp exam was performed over the haircoat. Hairs were sampled with a sterile toothbrush and plated on Sabouraud dextrose agar. The plates were photographed twice weekly for 3 weeks, and colonies were identified as contaminants or dermatophytes. 523 ECR were admitted to WMC, 141 ECR met the age inclusion criteria, and 121 samples were plated. ECR presented as a litter were sampled together. None of the sampled ECR presented skin lesions other than acute traumatic wounds. No fluorescence was observed on any ECR during the Wood's lamp examination. Based on culture colony morphology, 115/121 of the samples were identified as contaminants and no growth was observed in 6/121 of plates. Dermatophytes' colonies were not identified on any of the culture plates. Dermatophytes are zoonotic fungi and can potentially be carried by wild animals. The fungal infection poses a health concern to humans and domestic pets through direct interaction. Our current results suggest that dermatophytosis may not be prevalent in asymptomatic wild rabbits in the studied areas of the Midwestern United States.

Antimicrobial or Antiseptic Cleansers for Wounds

&#x0D; For chronic wound care, the majority of evidence suggested that antiseptic agents do not add additional clinical benefits compared with saline. No differences were observed between antiseptics and saline in the incidence of adverse events.&#x0D; For surgical wound care, irrigation with antibiotic agents is likely associated with lower rates of surgical site infections compared with saline irrigation. Depending on the type of antiseptic agent, type of surgery, and depth of infection, antiseptic irrigation may have superior or similar efficacy compared with saline in surgical site infection and wound healing rates. Indirect evidence suggested antibiotics were not superior to antiseptics for prevention of surgical site infections. No differences were observed between antiseptic irrigation and saline irrigation in the incidence of adverse events and length of hospital stay.&#x0D; For acute traumatic wound care, a limited number of studies provided mixed results on the effectiveness of povidone-iodine compared with saline for preventing infection. The effect of antiseptic agents on bacterial load was unclear. No robust conclusions could be drawn due to very low certainty of the evidence.&#x0D; The economic evaluation study showed that irrigation with hypochlorous acid preserved wound cleanser was a cost-effective strategy in the short term compared with saline for the treatment of severely complex wounds during ultrasonic debridement. However, we have little confidence in the findings due to several limitations in the methods of the study.&#x0D; We did not identify any studies that compared the clinical effectiveness and cost-effectiveness of antimicrobial or antiseptic wound cleansers with antimicrobial dressings or of different types of antimicrobial or antiseptic wound cleansers for the management of wounds.&#x0D; We did not identify any evidence-based guidelines regarding the use of antimicrobial or antiseptic wound cleansers for the management of wounds.&#x0D;

Topical oxygen therapy in acute traumatic musculoskeletal wounds of the foot and ankle

To quantify the reduction in wound size and change in wound quality following low-cost topical oxygen therapy (TOT) in patients with acute traumatic musculoskeletal wounds of the foot and ankle. This prospective interventional study included patients with acute traumatic musculoskeletal wounds of the foot and ankle of <3 weeks' duration after they had undergone debridement and required subsequent wound coverage. A sterile C-Arm cover was used to cover the wound and 100% oxygen was administered at 1 atm, at a rate of 10l/min for 90 minutes on each of four consecutive days, through a suction catheter connected to an oxygen cylinder. The cycle was repeated after a three-day break. Wound surface area (by plotting on graph paper) and wound quality (by modified wound infection checklist score and swabs for culture and Gram staining) were assessed before and after TOT application. The study cohort included 20 patients ≥18 years of age. There was a statistically significant (p<0.001) reduction in mean wound surface area from 79.3cm2 at baseline to 69.6cm2 after two cycles of TOT. The mean modified wound infection checklist score was 13.6 and 0.8, respectively, before and after two cycles of TOT, suggesting statistically significant improvement (p=0.02) in wound quality. All patients showed no growth in their wound culture after TOT. TOT appears to be a promising and cost-effective alternative in the management of traumatic wounds. However, future studies with larger sample sizes and control groups for comparison are needed to establish the benefit of TOT in acute traumatic musculoskeletal wounds.

Revisiting the Role of Amniotic Membrane Dressing in Acute Large Traumatic Wounds: A Randomized Feasibility Study at a Level 1 Trauma Centre.

Acute large traumatic wounds require temporary dressing prior to the definitive soft tissue reconstruction, as the physiological derangement during the immediate postinjury period delays the definitive surgical intervention. Selecting an ideal dressing material from numerous available synthetic dressings and skin substitutes poses a challenge. Although amniotic membrane (AM) scaffold has a definitive role in promoting wound healing in burns and chronic wounds, however, its efficacy in acute large traumatic wound is lacking. The present trial aimed to evaluate the safety and efficacy of AM in wound bed preparation before the definitive soft-tissue reconstruction in acute large traumatic wounds. Sixty patients with acute large traumatic wounds (>10 cm × 10 cm) were divided into two groups (conventional dressing and AM dressing) using simple mixed block randomization. Wounds were assessed using the Bates Jensen Score at various timelines for the signs of early wound healing. The primary outcome was to evaluate the time taken for the wound bed preparation for definitive soft-tissue reconstruction. The secondary outcome was the pain assessment and complications, if any. There was significant reduction in the wound exudate as well as peripheral tissue edema in the intervention group (P = 0.01). AM dressing was significantly less painful (P = 0.01). The incidence of wound infection and need for debridement was decreased in the intervention group. However, the time interval to definitive soft-tissue coverage was statistically insignificant and comparable in both the groups. No adverse reactions were seen in either group. AM dressings are safe and efficacious with significant reduction in wound exudates and peripheral edema. However, these dressings do not hasten the wound maturation as compared to conventional dressings. AM dressings can be used as a less painful alternative to conventional dressing in the management of large acute posttraumatic wounds.

Gelatin Microspheres Loaded with Wharton's Jelly Mesenchymal Stem Cells Promote Acute Full-Thickness Skin Wound Healing and Regeneration in Mice.

Objective: At present, there is an urgent need to develop a novel and practical therapeutic approach to accelerate the healing of acute wounds. Mesenchymal stem cell (MSC)-based therapy is emerging as a promising therapeutic approach for acute skin wounds. However, there are still challenges in clinical application of this strategy, such as low survivability, low retention time, and less engraftment in skin wounds. Approach: Wharton's jelly mesenchymal stem cells (WJMSCs) were seeded into three-dimensional (3D) gelatin microspheres (GMs) to identify the biocompatibility of GMs. WJMSCs were embedded in GMs and then encapsulated with Pluronic F-127 (PF-127) and sodium ascorbyl phosphate (SAP) combination to transplant onto acute full-thickness skin wound in mice. Histology, immunohistochemistry, and immunofluorescence assay were used to investigate the skin wound healing, dermis regeneration, collagen deposition, cell proliferation, and neovascularization. Results: Three-dimensional GM had strong biocompatibility, compared with two-dimensional adherent culturing, GM loading increased the cell viability and proliferation ability of WJMSCs. WJMSCs+GM+PF-127+SAP transplantation increased skin wound healing rate, dermis regeneration, and type III collagen deposition through improving macrophage polarization, cell proliferation, neovascularization, cell retention, and engraftment at skin wound site. Innovation: The effective 3D encapsulation technology for WJMSCs solved the main problems of cell activity and residence time during MSC transplantation. WJMSCs+GM+PF-127+SAP transplantation will be a new and effective MSC biomaterials-based therapeutic strategy for acute skin traumatic wounds. Conclusion: WJMSCs+GM+PF-127+SAP transplantation facilitated acute full-thickness skin wound healing and regeneration and might be a new and effective therapy for acute skin traumatic wounds.

Silver Nanoparticle-Based Dressings for Various Wounds: Benefits and Adverse Effects.

Silver nanoparticles (AgNP) are a novel therapeutic approach to wound dressings because of their antibacterial properties. Silver has been used throughout history for many purposes. However, evidence-based information about the benefits of AgNP-based wound dressings and potential adverse effects is still required. This study is to comprehensively review the benefits and complications of AgNP-based wound dressings for different wound types and address the knowledge gaps. We collected and reviewed the relevant literature from available sources. AgNP-based dressings have antimicrobial activity and promote healing with only minor complications, making them suitable for several types of wounds. However, we could not identify any reports on AgNP-based wound dressings for common acute traumatic wounds, such as lacerations and abrasions; this includes comparative studies of AgNP-based and conventional wound dressings for such wound types. AgNP-based dressings benefit traumatic, cavity, dental, and burn wounds with only minor complications. However, further studies are needed to discern their benefits for specific traumatic wound types.

Urinary Bladder Matrix Grafting Versus Flap Coverage for Acute or Infected Wound Defects in Patients With Orthopaedic Trauma.

Urinary bladder matrix (UBM) grafting of acute or infected wound defects has been reported to be successful in small case series. The purpose of this study was to compare the outcomes of UBM grafting with flap coverage. This is a retrospective comparative study. Level-1 trauma center. Orthopaedic trauma patients with wound defects not amenable to primary closure or skin grafting. Wound coverage with UBM grafting (n = 26) by orthopaedic trauma surgeons versus flap coverage (n = 26) by microvascular-trained plastic surgeons. Primary wound coverage success, complications, returns to the operating room, hospital length of stay, and time to wound healing. The UBM group was more likely to have an American Society of Anesthesiologist class ≥3 (58% vs. 23%, P = 0.02), a foot/ankle wound (77% vs. 12%, P &lt; 0.001), an infected wound defect (81% vs. 50%, P = 0.03), and smaller defects (21 vs. 100 cm 2 , P = 0.02). UBM grafting resulted in a longer time to wound healing (6 vs. 2 months, P = 0.002) and a shorter hospital length of stay (2 vs. 14 days, P &lt; 0.0001). UBM and flap groups had similarly high rates of failure of primary wound coverage (31% vs. 31%; P = 1.0), complications (46% vs. 62%, P = 0.4), and returns to the operating room (46% vs. 65%; P = 0.2). All 3 acute traumatic wounds undergoing UBM grafting concurrently with fracture fixation experienced graft failure and osteomyelitis. UBM grafting is an effective alternative to flap coverage for small traumatic or infected wounds but should be avoided in acute traumatic wounds undergoing fracture fixation. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Pathomorphological characteristics of the wound bed prior to skin autografting

Objective: to conduct a comparative pathomorphological analysis of wounds of various origins requiring full-thickness skin autografting. Materials and Methods. Histomorphological comparison of the wound bed prior to plastic surgery with full-thickness skin autografts was performed in three groups of patients: (1) during excision of scar tissue in elective surgery; (2) in case of traumatic skin detachments with autografting sensu Krasovitov; (3) when excising the granulation tissue to the fibrous layer. The object of the study included biopsy specimens from patients of three study groups. Results. The histological picture of wounds after removal of scars was characterized by well-developed dense fibrocellular connective tissue and had signs of chronic inflammation. In contrast to the cicatricial wound, acute lesions were characterized by granulation and mature dense fibrous connective tissues with pronounced inflammatory changes, each of which had its own characteristics. Conclusion. The results of the comparative analysis revealed the features of the morphological picture of wounds depending on the type of damage. In the group of acute injuries, traumatic and burn wounds, the most pronounced tissue damage was revealed. Given the obtained data, it should be assumed that full-thickness skin autografting will yield the best result in the group of patients after the planned excision of scar tissue.

Use of single-layer artificial dermal template in patients with trauma and burns.

Artificial dermal templates (ADTs), were designed initially to provide extracellular matrix and skin substitute for extensive burn injuries. Use of ADTs in a variety of other indications, has also been described in the literature. In this study, we describe our experience of using ADTs for different indications in burn contractures and wound coverage. In this retrospective study, patients requiring burn scar contracture release, permanent wound coverage for acute traumatic wounds and temporary wound coverage to prepare for complex reconstructions, and where the ADT Pelnac (Gunze Ltd., Japan) was applied, were evaluated. Data regarding patient sex, age, type and location of injury, comorbidities, operations and complications were recorded. A total of 24 patients were included in the study, of whom 12 patients were operated on for burn contractures. ADTs were used with split-thickness skin grafts (STSGs) or Z-plasties in a single-stage procedure. In six patients, ADT and STSGs were used to cover defects with exposed bone or tendon. Of the patients, six had their wounds covered temporarily while they were stabilised for complex reconstructions or were awaiting definitive histopathological results. Revisional surgeries due to graft failures or insufficient contracture releases were required by 12 patients. All temporary wound coverage patients had successful flap reconstructions after stabilisation of their general status, had tumour-free margins in the histopathological examination, and no necrosis or infection was seen on follow-up. In this study, ADTs had positive effects on selected patients, but comprehensive and comparative clinical studies are needed for different indications to choose between these templates.

Antiseptic versus non-antiseptic solutions for preventing infection in acute traumatic wounds: a systematic review.

To compare the effectiveness of antiseptic solutions to that of non-antiseptic solutions in reducing wound infection rate, reducing bacterial load and improving wound healing. We searched PubMed MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), ProQuest Medical Database and medRxiv for randomised controlled trials (RCTs) comparing antiseptic solutions with non-antiseptic solutions in simple, uncomplicated acute traumatic wounds. Qualitative data synthesis was employed. Risk of bias was assessed and GRADE assessment was used to evaluate quality of evidence. In this systematic review, four studies with a total of 875 participants were included, of which two studies showed a significant reduction of wound infection rate using povidone-iodine (p=0.001 and p=0.03). The use of non-antiseptic solutions significantly increased bacterial load on acute traumatic wounds (p=0.0001). The quality of evidence was very low. No studies reported on wound healing outcome. No robust conclusions can be implemented in clinical practice. Future studies are needed to compare the use of antiseptic and non-antiseptic solutions in acute traumatic wounds.

Is the use of specific time cut-off or “golden period” for primary closure of acute traumatic wounds evidence based? A systematic review

The time cut-off for primary closure of acute wounds is not clearly defined in the literature or in the surgical textbooks. It is even unclear whether the wound age increases wound infection rate. The scarcity of scientific evidence may explain the diverse wound management practices. To give guidance for further research in the field, this systematic review assessed recent evidence on the impact of wound age on the infection rate and on the selection of wound closure method. Using predefined criteria, we systematically searched Cochrane Central Register of Controlled Trials/CENTRAL, Cochrane Database of Systematic Reviews, MEDLINE, Scopus, Web of Science Core Collection, Current Contents, SciELO Citation Index, KCI-Korean Journal Database, Russian Science Citation Index, BIOSIS Citation Index, Data Citation Index, LILACS/Latin American and Caribbean Health Sciences Literature, and African Index Medicus; as well as online trial registries: ClinicalTrials.gov, WHO International Clinical Trials Registry Platform/WHO ICTRP, and CenterWatch. Nine studies met the selection criteria and were included in the review. This review could not establish the time frame for primary closure of wounds. The time intervals mentioned in many surgical textbooks were supported by only a few low-quality studies. More important factors to be considered when delaying primary closure of acute wounds were the history of diabetes, wound location, wound length, and the presence of a foreign body.

The Benefits and Harms of Cleansing for Acute Traumatic Wounds: A Narrative Review.

Acute traumatic wound cleansing is currently a controversial issue demonstrated by the variability in solutions and techniques used to clean wounds in clinical practice. Although there is evidence of improved infection outcomes in wounds cleansed with antiseptics, these observations are often undermined by concurrent use of antibiotics in addition to poor study design. Cleansing techniques including pressurized irrigation have also been investigated indicating potential harms such as edema and inconsistencies in irrigation pressures. The purpose of this article is to provide a narrative review on the contemporary evidence indicating the potential harms and benefits of wound cleansing in the context of acute traumatic wounds.This literature review reveals that acute wound cleansing in clinical practice remains heavily dependent on tradition rather than robust clinical evidence. The evidence base remains limited because of methodological and pragmatic issues in obtaining definitive data on the efficacy of specific agents and techniques. Future studies should focus on establishing the relative benefits of different cleansing solutions and techniques. Establishing the most effective use of antiseptic cleansing solutions may also help reduce further antimicrobial resistance as observed in recent studies. Clinicians responsible for cleansing wounds must consider patient preference when deciding which solution and techniques are used. In addition, a risk assessment considering the potential harms and benefits of different solutions and techniques must be performed.

EFFECT OF HUMAN PLATELET LYSATE ON HUMAN MESENCHYMAIS STEM CELL SUPPLEMENTATION AND APPLICATION IN ACUTE NEURAL INJURY MODEL: STAB WOUND

Traumatic brain injury(TBI) affects millions of people around the world resulting in acute or chronic motor deficiencies.At long-term, TBI causes cognitive/behavioral commitment impacting severely in the life quality. Currently, treatments for TBI are still limited, but mesenchymal stem cells(hMSCs) therapy, due to their plastic, neuroregenerative and immunoregulatory abilities are considered a promisor strategy. Objective: This study we intend to evaluate the impact of supplementation with Human Platelet Lysate(hPL) on the cultivation of hMSCs and its application in an acute neuronal traumatic experimental model Stab Wound(SW). Methodology: Bone marrow hMSCs were cultivated under two conditions: i)with 10% of Bovine Fetal Serum (FBS_hMSCs) or ii)with 10% of highly concentrated hPL(hPL_MSCs).Subsequently both cells population were characterized "in vitro" according to immunophenotype panel, markers of proliferation and oxidative stress(Ki-67 and JC-1).The neurodifferentiation of hMSCs was evaluated by immunofluorescence(β Tubulin-3) and RT-PCR(NeuN,Nestin,GFAP,Iba,NeuroG2 and NeuroD1 genes).The therapeutic potential was investigated "in vivo" using the SW model and histopathological analysis were performed(Iba and DCX).Results: Both hMSCs subsets were fibroblastoid and presented the characteristic MSCs phenotype profile(negative for CD14,CD31,CD45, and positive for CD73,CD90,CD105,CD117,CD133/2,HLA-DR),however hPL_MSCs showed a reduction in the expression of PDL-1 and PDL-2.Along the passages, the hPL_MSCs cultures showed progressively unexpected morphological changes (reduction in the number of nucleolus and cell augmentation/elongation),suggesting a pseudo-neurodifferentiation "in vitro", which was further confirmed by neuronal markers up-regulation.The FBS_hMSCs cultures remained morphologically unaltered. When compared to the FBS_hMSCs cultures, the hPL_MSCs also presented lower cellular stress with a reduced proliferative potential. We analyzed the brain damage tissues infused with both cells, the neuroprotective potential (DCX+ cells) was quite similar, however the neuronal sections treated with hPL_MSCs showed low presence of Iba+ inflammatory cells at the injury site. Conclusion: Preliminary, our results suggest that hPL_MSCs present classic neuronal characteristics “in vitro” with a neuroregenerative potential “in vivo”, and suggesting that hPL is a promisor inductor of neural-like cells being a potential tool for cellular therapy in TBI context. Traumatic brain injury(TBI) affects millions of people around the world resulting in acute or chronic motor deficiencies.At long-term, TBI causes cognitive/behavioral commitment impacting severely in the life quality. Currently, treatments for TBI are still limited, but mesenchymal stem cells(hMSCs) therapy, due to their plastic, neuroregenerative and immunoregulatory abilities are considered a promisor strategy. Objective: This study we intend to evaluate the impact of supplementation with Human Platelet Lysate(hPL) on the cultivation of hMSCs and its application in an acute neuronal traumatic experimental model Stab Wound(SW). Methodology: Bone marrow hMSCs were cultivated under two conditions: i)with 10% of Bovine Fetal Serum (FBS_hMSCs) or ii)with 10% of highly concentrated hPL(hPL_MSCs).Subsequently both cells population were characterized "in vitro" according to immunophenotype panel, markers of proliferation and oxidative stress(Ki-67 and JC-1).The neurodifferentiation of hMSCs was evaluated by immunofluorescence(β Tubulin-3) and RT-PCR(NeuN,Nestin,GFAP,Iba,NeuroG2 and NeuroD1 genes).The therapeutic potential was investigated "in vivo" using the SW model and histopathological analysis were performed(Iba and DCX).Results: Both hMSCs subsets were fibroblastoid and presented the characteristic MSCs phenotype profile(negative for CD14,CD31,CD45, and positive for CD73,CD90,CD105,CD117,CD133/2,HLA-DR),however hPL_MSCs showed a reduction in the expression of PDL-1 and PDL-2.Along the passages, the hPL_MSCs cultures showed progressively unexpected morphological changes (reduction in the number of nucleolus and cell augmentation/elongation),suggesting a pseudo-neurodifferentiation "in vitro", which was further confirmed by neuronal markers up-regulation.The FBS_hMSCs cultures remained morphologically unaltered. When compared to the FBS_hMSCs cultures, the hPL_MSCs also presented lower cellular stress with a reduced proliferative potential. We analyzed the brain damage tissues infused with both cells, the neuroprotective potential (DCX+ cells) was quite similar, however the neuronal sections treated with hPL_MSCs showed low presence of Iba+ inflammatory cells at the injury site. Conclusion: Preliminary, our results suggest that hPL_MSCs present classic neuronal characteristics “in vitro” with a neuroregenerative potential “in vivo”, and suggesting that hPL is a promisor inductor of neural-like cells being a potential tool for cellular therapy in TBI context.

Anesthesia with topical lidocaine hydrochloride gauze in acute traumatic wounds

Background: Using gauze soaked in lidocaine hydrochloride (2%) can induce anesthesia to suture wounds painlessly, without causing anxiety due to fear of injection in adult patients who referred to the emergency department with limb laceration. Methods: This is a triple-blind interventional study in which trauma patients with limb wounds enter the study. Distilled water impregnated gauze will be used for the control group and 2% lidocaine impregnated gauze will be used for the intervention group. The gauze will be placed on the wound for 5 minutes. The pain will be assessed with VAS. Results: A total of 180 people were enrolled in the study, which followed a normal distribution (Pv = 0.079) by Kolmogorov-Smirnov statistical test. The mean age of the participants is 32.02± 13.97 years. The pain intensity of patients in the case group based on VAS at the time of admission was 7.92 ±0.64. The severity of pain in patients after lidocaine-impregnated gauze anesthesia is 7.54±0.91. The severity of pain in patients based on VAS at the time of admission was 7.82± 0.61. The severity of patients' pain after anesthesia with lidocaine-impregnated gauze was 3.51±1.51. In the case group, the topical injection of lidocaine was repeated for anesthesia for all patients, while in the control group, the injection was repeated only for 3 patients. Pv≤0.0001) Conclusion: the pain intensity after anesthesia is significantly different and in the anesthesia group with local the injection has dropped dramatically

A Comparative Study between Indigenous Low Cost Negative Pressure Wound Therapy with Added Local Oxygen versus Conventional Negative Pressure Wound Therapy.

Introduction:The incidence of compound fractures and severe soft tissue loss has increased manifolds due to high speed traffics. Negative Pressure Wound Therapy (NPWT) is a treatment modality for managing soft tissue aspect of such injuries. It reduces the need of flap coverage. However, many patients from developing countries cannot afford a conventional NPWT. We developed an indigenous low cost NPWT for our patients and supplemented it with Topical Pressurised Oxygen Therapy (TPOT). We conducted this study to compare its treatment outcome with the use of conventional NPWT.Materials and Methods:The study was conducted from 2018 to 2020 at a tertiary care teaching hospital. A total of 86 patients were treated with NPWT and their results were assessed for various parameters like reduction in wound size, discharge, infection, etc. We included patients with acute traumatic wounds as well as chronic infected wounds, and placed them in three treatment groups to receive either conventional NPWT, Indigenous NPWT and lastly NPWT with supplement TPOT.Results:We observed a significant reduction of wound size, discharge and infection control in all three groups. The efficacy of indigenous NPWT is at par with conventional NPWT. Only six patients who had several comorbidities required flap coverage while in another four patients we could not achieve desired result due to technical limitations.Conclusion:Indigenous NPWT with added TPOT is a very potent and cost effective method to control infection and rapid management of severe trauma seen in orthopaedic practice. It also decreases the dependency on plastic surgeons for management of such wounds.

What is the effect of age on wound healing in the acute trauma setting? A scoping review

The ability to heal an acute traumatic wound or wounds is a complex matrix of overlapping biological processes impacted by intrinsic and extrinsic human factors. As we age, the body's physiological resilience is compromised and homeostasis becomes difficult to maintain. This scoping review examines the influence of biological ageing and the impact of age-related concerns on wound healing, including frailty, malnutrition, pre-existing medical conditions and clinician practices. Frailty rather than age was seen to have a greater physiological impact on outcome, resilience and healing. Clinician support, education and engagement were fundamental to achieve acute wound healing in the aged population. With an increasing ageing population, specialised knowledge, guidelines and structures to support geriatric care are recommended for best clinical practice.

Fluorescence biomodulation in the management of acute traumatic wounds in two aged dogs

Traumatic wounds represent a fairly common reason for the admission of dogs to a veterinary practice. In elderly patients, the management of wound healing can be challenging due to both the concurrent diseases and impaired physiological states, potentially resulting in delayed healing and chronic or non-healing wounds. The aim of this article is to describe an innovative therapy based on photobiomodulation (PBM) for the management of acute traumatic wounds with significant tissue loss in aged dogs. Two mixed breed dogs were presented with similar wounds in the cervical region and were managed with a fluorescence biomodulation system, a form of PBM, which consists of a photoconverter topical gel that is illuminated with a blue light-emitting diode lamp, applied on a weekly basis. Wound closure was achieved after 9 and 16 weekly treatments, respectively, with a complete re-epithelisation of the skin. This fluorescence-generating system is an innovative, non-invasive, wound care therapy and these results indicate it could be successfully applied in the management of acute traumatic wounds with tissue loss in dogs.