Acute Wounds Research Articles

Basic research and clinical exploration of cold atmospheric plasma for skin wounds.

Skin wounds, such as burns, diabetic foot ulcers, pressure sores, and wounds formed after laser or surgical treatment, comprise a very high proportion of dermatological disorders. Wounds are treated in a variety of ways; however, some wounds are greatly resistant, resulting in delayed healing and an urgent need to introduce new alternatives. Our previous studies have shown that cold atmospheric plasma (CAP) has antibacterial activity and promotes cell proliferation, differentiation, and migration in vitro. To further advance the role of CAP in wound healing, we evaluated the safety and efficacy of CAP in vitro by irradiation of common refractory bacteria on the skin, irradiation of normal skin of rats and observing reactions, treatment of scald wounds in rats, and treating clinically common acute wounds. Our findings revealed that CAP can eliminate refractory skin bacteria in vitro; CAP positively affected wound healing in a rat scalding wound model; and direct CAP irradiation of low intensity and short duration did not lead to skin erythema or edema. CAP promises to be a new, economical, and safe means of wound treatment.

They Live in a Desert but Are They Deserted? Analysis of Veteran Patients Undergoing Endovascular Aortic Aneurysm Repair Who Live in Food Deserts

Previous studies have shown that food deserts (FDs) are associated with worse postoperative outcomes, low medication adherence, and decreased screening. We hypothesized that similar to previous studies, FDs would be associated with increased postoperative complications and increased loss to follow-up in a population undergoing endovascular aortic aneurysm repair (EVAR). We retrospectively analyzed a single Veterans Administration Hospital for all patients who underwent an EVAR from January 2010 to December 2021. Patients’ factors collected included age, albumin, body mass index, past medical history, smoking status, medications, anesthesia type, access type, postoperative complications, endoleak history, limb stenosis, readmission rates, and FD status. FD assignment was defined using US Department of Agriculture’s Food Access Research Atlas. The Student t-test** and Fisher exact test* were used. A total of 241 EVARs occurred over the 11-year period. Most patients were male (99.2%), with an average age of 71.7 ± 7.02 years. A total of 57 (23.7%) lived in an FD. Of those living in an FD, there was no statistically significant difference in comorbidities nor ethnicities between the 2 groups. The mean preoperative albumin (3.8 ± 0.37 vs 3.7 ± 0.36; P = .41**) or the mean body mass index (27.4 ± 4.8 vs 28.2 ± 5.0; P = .92**) differed between FD vs non-FD, respectively. There was no statistical difference in postoperative complications including return to the operating room, hemodynamic instability, respiratory failure, acute kidney injury, readmission rates, wound infections, or urinary tract infections. In addition, there was no statistical difference in endoleak rates, limb stenosis, or loss to follow-up rates between the groups. Contrary to previous studies, our data indicate that in a veteran population living in an FD was not associated with increased rate of infection, worse postoperative outcomes, or increased loss to follow-up. Further studies are needed to assess food access impact on EVAR outcomes.

E-selectin Gene Modified Mesenchymal Stem Cell Therapy Reverses Impairments in Wound Healing in Ischemic Limbs

Tissue loss is a major source of morbidity and substantially worsens the risk of extremity amputation in patients with chronic limb-threatening ischemia (CLTI). Although cell-based therapies utilizing mesenchymal stem cells (MSC) hold significant promise to augment wound healing and therapeutic angiogenesis, unmodified MSCs have demonstrated only minor benefits for CLTI in previous clinical trials. Here we report the effects of MSCs engineered to overexpress E-selectin (E-sel), a cell adhesion molecule capable of inducing neovascularization, on a translational murine model recapitulating hindlimb ischemia with cutaneous tissue loss. MSCs were harvested from bone marrow of 8- to 10-week-old FVB/Rosa26SormTmG donor mice and cultured in MesenCult medium. MSCs were verified as CD44+/CD73+/CD105+/CD29+/Sca-1+ by flow cytometry. MSCs underwent viral transduction with E-sel-GFP/AAV or GFP/AAV. Femoral artery ligation was performed in 12- to 14-week-old recipient FVB mice followed by a 4-mm acute cutaneous wound in the ipsilateral limb and local injection of PBS or 1 × 106 donor GFP+/MSCs or E-sel+/MSCs (E-sel+/MSC). Wounds were monitored daily for 7 days, at which point tissue specimens were harvested for microscopy and whole-body DiI perfusion studies. Unmodified MSCs do not express basal levels of E-sel, and E-sel+/MSCs retained MSC phenotype and trilineage differentiation capability. Mice receiving E-sel+/MSC treatment (n = 10) demonstrated accelerated wound closure rates compared to both GFP+/MSCs (n = 10) and phosphate-buffered saline (PBS) (n = 10)-treated mice at each postoperative day (POD) with the highest degree of difference observed at POD 5 (94 ± 3% vs 79 ± 10% GFP vs 72 ± 9% PBS; P < .001) and 7 (98 ± 2% vs 86 ± 8% GFP vs 87 ± 6% PBS; P < .010). Collagen deposition was more abundant in wounds treated with E-sel+/MSCs (21 ± 4% vs 5 ± 1% GFP vs 9 ± 1% PBS). DiI perfusion at POD 10 demonstrated greater vessel density in wounds treated with E-sel+/MSCs (76 ± 15% vs 29 ± 7% GFP vs 9 ± 5% PBS relative vascular density). Wound healing focused polymerase chain reaction array identified upregulation of target genes in wound tissue responding to E-sel+/MSCs. E-sel+/MSCs demonstrated enhanced viability more mTmG+-E-sel+/MSCs (13 ± 3 cells/high powered field [HPF] vs GFP+/MSCs 3 ± 2 cells/HPF vs PBS 0 ± 0 cells/HPF; P < .010) observed at POD 7 on microscopy. Cell-based therapy using E-sel-overexpressing MSCs reverses impairments in wound healing of ischemic limbs. These data exhibit the potential role for E-sel-modified MSCs as a novel therapeutic alternative in future clinical applications for delayed and nonhealing wounds associated with CLTI.

Indicators of the immune status in patients with chronic wounds depending on the stage of the infectious process and the structure of the wound microbiota

The results of immunophenotyping of peripheral blood leukocytes were analyzed in 105 patients with chronic wounds ( the main group , wound duration more than 3 weeks ) at various stages of the infectious process : colonization (n=39), critical colonization (n=37) and infection (n=29). The comparison group consisted of 22 patients with acute wounds ( wound duration up to 4 days ), in which microorganisms were not detected in the wounds . In the main group , changes in immunological reactivity were revealed in the form of an increase in the relative content of T- lymphocytes and a decrease in NK cells , lower indicators of early activation markers on T- helpers and T- cytotoxic lymphocytes (CD4+/CD38+/CD3+, CD8+/CD38+/CD3+, CD3+/ CD71+) and HLADR on B- lymphocytes , a high level of expression of late markers of T- cell activation (CD3+HLADR+). In the comparison group , the levels of expression of integrins (CD11a, CD11b, CD11c) on neutrophils and lymphocytes , as well as the transferrin receptor (CD71) on neutrophils , monocytes and lymphocytes were higher than in the main group . An increase in the activity of neutrophils in the form of expression of CD11a molecules was revealed with the progression of the infectious process in a chronic wound , which may be an additional diagnostic sign of the transition from the stage of colonization to the stage of critical colonization and infection . The highest values of CD11a and CD11c on neutrophils were recorded in the presence of S. aureus monocultures in chronic wounds , the lowest values were recorded when P. aeruginosa and A. baumannii monocultures were isolated from wounds .

Multifunctional antibacterial bioactive nanoglass hydrogel for normal and MRSA infected wound repair

Large-scale skin damage brings potential risk to patients, such as imbalance of skin homeostasis, inflammation, fluid loss and bacterial infection. Moreover, multidrug resistant bacteria (MDRB) infection is still a great challenge for skin damage repair. Herein, we developed an injectable self-healing bioactive nanoglass hydrogel (FABA) with robust antibacterial and anti-inflammatory ability for normal and Methicillin-resistant Staphylococcus aureus (MRSA) infected skin wound repair. FABA hydrogel was fabricated facilely by the self-crosslinking of F127-CHO (FA) and alendronate sodium (AL)-decorated Si-Ca-Cu nanoglass (BA). FABA hydrogel could significantly inhibit the growth of Staphylococcus aureus, Escherichia coli and MRSA in vitro, while showing good cytocompatibility and hemocompatibility. In addition, FABA hydrogel could inhibit the expression of proinflammatory factor TNF-α and enhance the expression of anti-inflammatory factor IL-4/ IL-10. Based on its versatility, FABA hydrogel could complete wound closure efficiently (75% at day 3 for normal wound, 70% at day 3 for MRSA wound), which was almost 3 times higher than control wound, which was related with the decrease of inflammatory factor in early wound. This work suggested that FABA hydrogel could be a promising dressing for acute and MRSA-infected wound repair.Graphical

Microgel Assembly Powder Improves Acute Hemostasis, Antibacterial, and Wound Healing via In Situ Co‐Assembly of Erythrocyte and Microgel

AbstractRapid and effective hemostasis on irregular‐shaped non‐compressible bleeding wounds is still one of the key challenges in clinical practice. Herein, a novel multi‐functional microgel assembly powder (MAP) composed of oxidized dextran/methacrylate gelatin (ODex/GelMA) microgel powder and long‐chain alkyl quaternized chitosan (LQCS) crosslinker powder is reported for acute hemostasis, antibacterial, and wound healing. When MAP is applied onto bleeding wounds, porous ODex/GelMA microgel powder immediately absorbs massive liquid in blood whilst LQCS induces in situ co‐assembly of erythrocytes and microgels. In other words, MAP combines the merits of hemostatic powders and hemostatic hydrogels, that is, the excellent hemostasis performance of MAP is originated from not only the high fluid uptake ratio/rate that causes the aggregation of coagulation factors and erythrocytes, but also the formation of erythrocytes‐involved hydrogel‐like microgel assembly that dramatically improves the mechanical strength, tissue adhesion and wound sealing performance in blood compared with those in PBS. In addition, MAP also exhibits excellent antibacterial ability, and promotes the wound healing in bacterial‐infected full‐thickness skin wounds. The fantastic features of MAP including low cost, easy synthesis and usage, excellent hemostasis on irregular‐shaped, non‐compressible bleeding wounds, outstanding antibacterial and wound healing, good cytocompatibility, make it a promising hemostatic material and wound dressing.

Tannic acid-loaded chitosan-RGD-alginate scaffolds for wound healing and skin regeneration

Hydrogels have drawn much attention in the field of tissue regeneration and wound healing owing to the application of biocompatible peptides to tailor structural features necessitating optimal tissue remodeling performance. In the current study, polymers and peptide were explored to develop scaffolds for wound healing and skin tissue regeneration. Alginate (Alg), chitosan (CS), and arginine-glycine-aspartate (RGD) were used to fabricate composite scaffolds crosslinked with tannic acid (TA), which also served as a bioactive. The use of RGD transformed the physicochemical and morphological features of the 3D scaffolds and TA crosslinking of the scaffolds improved their mechanical properties, specifically tensile strength, compressive Young’s modulus, yield strength, and ultimate compressive strength. The incorporation of TA as both a crosslinker and a bioactive allowed for 86% encapsulation efficiency and burst release of 57% of TA in 24 h, accompanied by an 8.5% steady release per day of up to 90% over 5 d. The scaffolds increased mouse embryonic fibroblast cell viability over 3 d, progressing from slightly cytotoxic to non-cytotoxic (cell viability >90%). Wound closure and tissue regeneration evaluations in a SpragueDawley rat wound model at predetermined wound healing time points highlighted the superiority of the Alg-RGD-CS and Alg-RGD-CS-TA scaffolds over the commercial comparator product and control. The scaffolds’ superior performance included accelerated tissue remodeling performance from the early to the late stages of wound healing, indicated by the lack of defects and scarring in scaffold-treated tissues. This promising performance supports the design of wound dressings that can act as delivery systems for the treatment of acute and chronic wounds.

517 Long Term Scarring Assessment of Burn Wounds Treated with Bioengineered Allogeneic Cellularized Construct

Abstract Introduction Bioengineered allogeneic cellularized construct (BACC) has recently been proven to be effective for treatment of burn wounds and now has FDA approval. There is a paucity of data describing long term (≥1 year) scar characteristics following treatment with BACC, including its potential to modulate the formation of hypertrophic scar (HTS). HTS causes significant physical and psychosocial implications which can result in diminished quality of life. This study aims to characterize post-burn scars resulting from BACC-treated wounds compared to within subject matched autografted wounds using clinical and histologic metrics. Methods Adult patients (n=5) were previously enrolled in a Phase III clinical trial for treatment of their deep partial thickness acute burn wounds. Subjects had clinical scar examinations including imaging, Scar Assessment Scales (POSAS), and non-invasive skin measurements to quantify skin elasticity, erythema, and melanin. Punch biopsies were collected and fixed in formalin from the autograft-treated site (A), the BACC-treated site (B), the donor-site (D), and an area of normal skin (NS). The formalin-fixed biopsies were then embedded in paraffin, sectioned, and stained with H&amp;E, Picrosirius Red, and Herovici. Results The use of BACC produced no difference in POSAS score and achieved elasticity measurements comparable to NS (Table 1). The erythema measurement demonstrated differences between scar sites and each scar site was different from NS. The donorsite also had some variation from NS. The measured melanin levels were different between each scar site, and both were different from NS. The donorsite also had detectable differences in melanin from NS. Measurements of epidermal thickness demonstrated differences between scar sites with BACC being similar to NS. Rete ridge ratio were different between scar sites and between autograft vs. NS. Papillary dermis cellularity had minor differences between scar sites and both scar sites were different from NS. Reticular dermis cellularity was equivalent between autograft and BACC sites and both were different from NS. Papillary and reticular alignment were not different between scar sites. Reticular orientation was not different between autograft and BACC but was different in BACC vs. NS. Papillary dermal thickness was different between autograft and BACC. Conclusions The HTSs resulting from wound closure achieved using BACC are similar to autografting in metrics related to clinical POSAS scores, extracellular matrix, and collagen structure. Scars following autografting or the use of BACC to achieve wound closure differ in metrics related to pigmentation, epidermal structure, and papillary dermal thickness and cellularity. Applicability of Research to Practice These findings may suggest that the use of BACC is a more optimal treatment for certain burn depths in certain patients because some HTS outcomes are equivalent, and it eliminates the need for a donor site.

Cold Atmospheric Plasma: A Noteworthy Approach in Medical Science

Cold atmospheric plasma (CAP) is a novel technology with boundless significance that can be used in the medical sector that offers noninvasive in-vivo applications without damaging the living tissues. CAPs can be obtained by curtailing the concentration of high-energetic electrons per phase and by freezing molecules/atoms (devoid of charge) in plasma utilizing gas circulation and atmospheric air, which includes a variety of charged and neutral reactive entities, UV rays, electric currents, and fields, etc. that have an influence on cellular material in a multitude of diverse manners. Reactive oxygen species (ROS) and reactive nitrogen species (RNS), produced by the plasma, essentially cause biological and therapeutically advantageous plasma effects. CAP plasma has several important biological functions, including the deactivation of pathogens, induction of tissue restoration and cell propagation, the annihilation of cells by triggering apoptosis, etc. Several fundamental concepts are defined, even if the precise process of the effect of plasma on biomolecules is still not properly identified. Depending on the biological synthesis of RNS and ROS in reactions to plasma emissions, the present review described several aspects of plasma therapy in neuroscience, particularly in anti-glioblastoma, neuro-differentiation, and neuroprotection and also the various applications of CAP in medical fields where it is used in the therapy of SARS-CoV-2, cancer therapy, and chronic and acute wounds. Furthermore, the proliferation in stem cells, dental medicines, dermatology, and a brief insight into CAP devices and their risk factors was highlighted.

Maintenance of chronicity signatures in fibroblasts isolated from recessive dystrophic epidermolysis bullosa chronic wound dressings under culture conditions

BackgroundRecessive Dystrophic Epidermolysis Bullosa (RDEB) is a rare inherited skin disease caused by variants in the COL7A1 gene, coding for type VII collagen (C7), an important component of anchoring fibrils in the basement membrane of the epidermis. RDEB patients suffer from skin fragility starting with blister formation and evolving into chronic wounds, inflammation and skin fibrosis, with a high risk of developing aggressive skin carcinomas. Restricted therapeutic options are limited by the lack of in vitro models of defective wound healing in RDEB patients.ResultsIn order to explore a more efficient, non-invasive in vitro model for RDEB studies, we obtained patient fibroblasts derived from discarded dressings) and examined their phenotypic features compared with fibroblasts derived from non-injured skin of RDEB and healthy-donor skin biopsies. Our results demonstrate that fibroblasts derived from RDEB chronic wounds (RDEB-CW) displayed characteristics of senescent cells, increased myofibroblast differentiation, and augmented levels of TGF-β1 signaling components compared to fibroblasts derived from RDEB acute wounds and unaffected RDEB skin as well as skin from healthy-donors. Furthermore, RDEB-CW fibroblasts exhibited an increased pattern of inflammatory cytokine secretion (IL-1β and IL-6) when compared with RDEB and control fibroblasts. Interestingly, these aberrant patterns were found specifically in RDEB-CW fibroblasts independent of the culturing method, since fibroblasts obtained from dressing of acute wounds displayed a phenotype more similar to fibroblasts obtained from RDEB normal skin biopsies.ConclusionsOur results show that in vitro cultured RDEB-CW fibroblasts maintain distinctive cellular and molecular characteristics resembling the inflammatory and fibrotic microenvironment observed in RDEB patients’ chronic wounds. This work describes a novel, non-invasive and painless strategy to obtain human fibroblasts chronically subjected to an inflammatory and fibrotic environment, supporting their use as an accessible model for in vitro studies of RDEB wound healing pathogenesis. As such, this approach is well suited to testing new therapeutic strategies under controlled laboratory conditions.

C-reactive Protein and Immunological Indices of Lectin Extract from Edible Fungus (Pleurotus tuber-regium) on Wounded Rats

Lectins are proteins/glycoproteins of non-immune origin with wide distribution in nature with the ability to agglutinate erythrocytes and recognize glycoconjugates. The study aimed at determining the healing effect of lectin extract from Pleurotus tuber- regium on acute wounds induced in male albino rats. Ten grams of the powdered edible mushroom of Pleurotus tuber-regium were used to extract lectin via the dialysis method. A total of 45 albino rats randomized into 9 groups of 5 rats each into Category A and B groups, and the blood sample was collected by ocular puncture for the category A after 10 days, while cardiac puncture for the Category B group after 28 days. The collected blood sample was analyzed for the various immunological parameters, using the quantitative ELISA technique for C-reactive protein, and Mindray BC-200 machine for full blood count. At negative control, the WBC levels and the neutrophils were increased for the Category B group to 19.79±1.22/L and 3.26±0.25%. A 2mg/kg lectin oral administration had 4.72±0.14% neutrophils for Category A group, while Category B group topical application, the highest value at 8mg/kg lectin had 4.98±0.52%. Both 36 mg/kg amoxicillin application and oral administration of lectin generated factors as C3b, and Histamine (H1and H2) receptors on eosinophils by chemotaxis attraction. With Category B group, 8 mg/kg lectin topical had the highest value of 21.30±2.17% eosinophils, and the difference in Category B group compared to the normal control at 17.64±1.1 81% was significant p≤ 0.05 and the rats would be showing signs of allergic responses. Both the oral and topical lectin applications to the wounded rats had higher platelet levels than the negative control in both Categories A and B groups indicating that lectin mobilized more platelet factors than the negative control group. With negative control, the CRP levels as a marker of inflammation rose to 3 times its normal folds in Category A group with 7.58±0.85ng/L and 6.06±0.85ng/L for Category B group. On 36 mg/kg amoxicillin administration to the rats from zero week to the 3rd week, there was a decrease in weight at 22.4% compared to the normal control of 31.3%. Both oral and topical administrations showed an increase in weight with 26.4% for 8 mg/kg oral administration and 27.3% for 4 mg/kg topical administration. Both 36 mg/kg amoxicillin and 8 mg/kg lectin oral administration had a two weeks period for the complete healing of the wounded rats. Oral administration of lectin to the wounded rats was nutritional and added weight to the rats.

Laser speckle contrast imaging, an alternative to laser doppler imaging in clinical practice of burn wound care derivation of a color code

ObjectiveTo develop a color code and to investigate the validity of Laser Speckle Contrast Imaging (LSCI) for measuring burn wound healing potential (HP) in burn patients as compared to the reference standard Laser Doppler Imaging (LDI). MethodA prospective, observational, cohort study was conducted in adult patients with acute burn wounds. The relationship between mean flux measured with LDI and mean perfusion units (PU) measured with LSCI was expressed in a regression formula. Measurements were performed between 2 and 5 days after the burn wound. The creation of a LSCI color code was done by mapping the clinically validated color code of the LDI to the corresponding values on the LSCI scale. To assess validity of the LSCI, the ability of the LSCI to discriminate between HP < 14 and ≥ 14 days and HP < 21 and original ≥ 21 days according to the LDI reference standard was evaluated, with calculation of receiver operating characteristics (ROC) curves. ResultsA total of 50 patients were included with a median age of 40 years and total body surface area burned of 6%. LSCI values of 143 PU and 113 PU were derived as the cut-off values for the need of conservative treatment (HP < 14 and ≥ 14 days) resp. surgical closure (HP < 21 and ≥ 21 days). These LSCI cut off values showed a good discrimination between HP 14 days versus ≥ 14 days (Area Under Curve (AUC)= 0.89; sensitivity 85% and specificity = 82%) and a good discrimination between HP 21 days versus ≥ 21 days (AUC of 0.89, sensitivity 81% and specificity 88%). ConclusionThis is the first study in which a color code for the LSCI in adult clinical burn patients has been developed. Our study reconfirms the good performance of the LSCI for prediction of burn wound healing potential. This provides additional evidence for the potential value of the LSCI in specialized burn care.

Synthesis of nanostructured silica particles for controlled release of ascorbic acid: Microstructure features and In Vitro scratch wound assay.

To date, the long term stability of ascorbic acid (AA) under physiological conditions represents a major issue for wound healing and tissue regeneration applications. In this study, ascorbylphosphate (AP) was loaded into silica nanoparticles (SiNPs) through a simple one-step procedure, in which sphericalshaped porous SiNPs were obtained via hydrolysis/condensation of tetraethylorthosilicate (TEOS) in the presence of bicarbonate salt and ammonia. The as-prepared SiNPs were characterized by scanning electron microscope (SEM), transmission electron microscope (TEM) and Fourier Transformer Infrared Spectrophotometer (FTIR). Incorporation of bicarbonate salt resulted in the formation of spherical SiNPs with an average diameter of 460±89nm, while further increase of bicarbonate salt led to the formation of silica sheet-like structures.The AP-loaded SiNPs exhibited high loading efficiency from 92.3- 81.5%, according to AP content and sustained release over 3 days. According to cell viability assay, the obtained AP-enriched SiNPS showed no toxicity and supportive effect to the proliferation of human skin fibroblast cells (HSF) at a concentration less than 200μg/mL. Moreover, it was observed that the wound closure percentage (%) after 24h was also shown to increase to 74.1±3.1% for 20AP-loaded SiNPs compared to control samples (50.1±1.8%). The obtained results clearly demonstrated that the developed SiNPs formulation exhibits optimal microstructure features to maintain a sustained release of AA at wound bed for the healing of skin tissue, including acute and chronic wounds. This article is protected by copyright. All rights reserved.

FEWER KNOTS IN CIRCUMCISION ARE ASSOCIATED WITH LESS POSTOPERATIVE PAIN: A RETROSPECTIVE COMPARATIVE STUDY

Male circumcision is the most frequently performed surgical procedure among Muslim and Jewish communities, mainly for medical, religious, and traditional reasons (1-4). In the USA, circumcision is frequently performed for cosmetic purposes. Although it is seen as a simple procedure, it is quite prone to complications like other surgical procedures. The early and long-term complications of circumcision are well known and the overall complication rate has been reported between 0.2% and 3.9%. Common complications associated with circumcision are acute bleeding, pain, edema, wound infection, and unnecessary foreskin. Rare complications include meatal stenosis, urethral fistula, partial and total glandular amputations, glandular necrosis, penile curvature, and penile rotation. In addition, keloid formation and scar hypertrophy are some rare complications that cause poor cosmetic appearance.The aim of paper: Our aim in this study was to investigate the effect of the number of sutures placed during circumcision on postoperative pain, infection, bleeding amount, and analgesic need in children.Materials and methods: A total of 715 patients who applied to our hospital for circumcision requests between November 2019 and January 2022 were retrospectively analyzed. The patients were randomly divided into three groups according to the number of knots used during the surgical procedure: Group 1 (8 sutures), group 2 (6 sutures), and group 3 (4 sutures). The patients were evaluated in terms of whether they needed analgesics in the postoperative period (1-hour), bleeding status, and whether this bleeding needed re-intervention.Results: The average age of the participants in the study was 4.06±2.51 years, and the average weight was 18.66±7.07 kg. The operation was completed using 8 sutures (group 1) in 47.5%, 6 sutures (group 2) in 27.7%, and 4 sutures (group 3) in 24.9% of the patients. Postoperative infection developed in 2.8% of the participants, and bleeding was observed in 25.1%. The number of participants who needed analgesia for the first hour after the operation was 66.8%. The median value of the postoperative pain scale was 5 (range: 1-9), and those with a pain scale of 5-9 were 65.5%. There was no significant difference between the groups in terms of age, weight, development of infection, and bleeding (p&gt;0.05). Analgesia was needed in 88.7% of those in group 1, 69.9% of those in group 2, and 21.6% of those in group 3 (p&lt;0.001). A score (MPOS) of 5 or higher was found in 86.8% of those in group 1, 71% of those in group 2, and 18.6% of those in group 3 (p&lt;0.001).Conclusions: our study showed that group 3 (4 sutures) achieved lower pain scores, less analgesic consumption, and lower agitation scores after circumcision compared to other groups.

Chitosan Sponges Are Associated With Higher Rates of Wound Complications Compared to Calcium Sulfate Beads.

Background In this study, we aimed to determine if there is a difference in the rates of wound dehiscence, delayed union, nonunion, and unanticipated surgery after the use of bioabsorbable local antibiotic-delivery systems (LADS), specifically comparing antibiotic-impregnated calcium sulfate pellets (Osteoset-T, Wright Medical Technology Inc., Arlington, TN, USA, hereafter referred to as beads) and chitosan sponge (Sentrex BioSponge, Bionova Medical, Germantown, TN, USA, hereafter referred to as sponges) in the management of acute and chronic extremity wounds. Methodology We conducted a retrospective comparative cohort study in the setting of a level 1 trauma center. All patients who received either beads or sponges as an adjunct to surgical debridement from January 2010 to December 2017 were included, and 136 patients met the inclusion criteria. The intervention studied was extremity wounds that were treated with bioabsorbable LADS, either beads or sponges. The main outcome measurement was wound dehiscence and the need for unanticipated surgery. Results Of the 136 patients in the study cohort, 78% (106/136) were treated with beads, and 22% (30/136) were treated with sponges. Of the 136 patients, 50 (37%) experienced wound dehiscence, and 49 patients required unanticipated surgery. Overall, 62% (31/50) of patients with wound dehiscence and 67.4% (33/49) of patients requiring unanticipated surgery were seen in the bead cohort (p = 0.0001 and 0.025, respectively). However, in multivariable analyses, we found that the odds of having wound dehiscence and undergoing unanticipated surgery were, respectively, 4.9 (p = 0.001) and 2.8 (p = 0.021) times more likely to occur in the sponge than in the bead group. Conclusions Sentrex sponges appear to be associated with higher rates of wound dehiscence and the need for unanticipated surgery compared to Osteoset beads.

Evidence of bacterial biofilms within acute wounds: a systematic review

The prevalence and role of biofilm formation in acute wounds has seldom been investigated. Understanding the presence of biofilm in acute wounds would allow earlier, biofilm-targeted management, thus decreasing the morbidity and mortality associated with wound infection, improving patient experience and potentially reducing healthcare costs. The purpose of this study was to summarise the evidence for biofilm formation within acute wounds. We conducted a systematic literature review for studies which reported evidence of bacterial biofilm formation in acute wounds. An electronic search of four databases was carried out, without restrictions on date. The search terms included 'bacteria', 'biofilm', 'acute' and 'wound'. A total of 13 studies met the inclusion criteria. Of the studies, 69.2% showed evidence of biofilm formation within 14 days of acute wound formation, with 38.5% showing evidence of biofilm 48 hours after wound formed. The evidence from this review suggests that biofilm formation plays a greater role within acute wounds than previously considered.

Fabrication and evaluation of 3D bio-scaffold wound dressings for monitoring of chronic pH wounds using fuzzy logic analysis

Different types of wounds, such as surgical wounds, first-degree burns, and graft sites are among acute wounds. However, chronic wounds are the ones that have a gradual onset, and the healing process is stopped in terms of factors, such as poor blood flow, local pressure, diabetes and other factors. In this study, a novel wound dress made of carboxymethyl chitosan was composed of titanium nanoparticles (TiNP) using the freeze-drying technique. The wound dress contained pH-sensitive mini-emulsion, in which time and temperature are controlled, and adjusted by pH sensors. A heater was connected to the wound temperature sensor and, as the wound temperature drops below the specified range, it automatically turned on and raised the temperature to the maximum range. The mechanical strength, and biological behavior of tissue were evaluated to find an optimized sample. The prepared wound tissue was characterized using a scanning electron microscope (SEM) and the biodegradation rate was evaluated using weight change analysis. The obtained results show that the stress-strain diagram sample containing polyvinyl alcohol (PVA) had the lowest amount and the sample with TiNP had the highest strength. The results indicate that TiNP has the highest mechanical strength compared to other samples due to its inherent antibacterial properties. Moreover, fuzzy logic modeling was used to find a linguistic model for obtained experimental data. After developing the model, the results found by the model were compared to the experimental outputs. The results show that the developed method was efficient which can be used to predict the output of given data before performing any test practically.

Author Correction: Hyaluronic acid accelerates re-epithelialization and healing of acute cutaneous wounds.

Correction to: Eur Rev Med Pharmacol Sci 2023; 27(3 Suppl): 37-45. doi: 10.26355/eurrev_202304_31320-PMID:37129334-published online on April 27, 2023. After publication, the authors found some transcription mistakes and applied minor corrections to the Abstract and Discussion sections. The sections have been amended as follows: - Abstract section: "an average 80% decrease" has been corrected in "an average 86% decrease"; "a small amount of exudate was noted in 91% of wounds" has been corrected in "a small amount of exudate was noted in 10% of wounds". - Discussion section: "by a reduced wound surface area of 80% at six weeks and a reduced surface area of 95% after eight weeks" has been corrected to "by a reduced wound surface area of 80% at four weeks and a reduced surface area of 86% after six weeks". There are amendments to this paper. The Publisher apologizes for any inconvenience this may cause. https://www.europeanreview.org/article/31320.

Characteristics and Outcomes Among Patients with Acute Extremity Wounds Due to Gunshots Versus Bomb Blasts – A Prospective Cohort Analysis from Two Civilian Hospitals in Iraq and Jordan

Introduction:Gunshots and bomb blasts are important causes of injury within conflict zones and extremities are frequently affected. There is a paucity of research on the characteristics and outcomes among civilians with conflict-related extremity injuries.Method:We performed a prospective cohort analysis utilizing data collected during a randomized trial at two civilian hospitals in Jordan and Iraq between 2015 and 2019. Adult patients who presented within 72 hours of sustaining an extremity injury requiring surgical care were included. We used mechanism of injury (gunshot versus bomb blast) as the exposure and wound closure by day five as the primary outcome measure.Results:The population was predominantly young men (n=163, 94% male, median age 29 years), injured by gunshots (61%) or bomb blasts (39%). Compared to the gunshot group, participants in the bomb blast group had more concomitant injuries (32/63 [51%] vs 11/100 [11%]; p&lt;0.001), larger wounds (median area 100 cm2 [IQR 50–145] vs 53 cm2 [IQR 25–78]; p&lt;0.001) and more frequent infections (16/63 [25%] vs 13/100 [13%]; p=0.04). Wound closure by day five was achieved in 25% (n=16/63) of the bomb blast group and 74% (n=74/100) of the gunshot group (p&lt;0.001). This difference remained after controlling for confounding factors (OR 4.7; 95% CI 1.6–13.7).Conclusion:In this first prospective cohort analysis of civilians with acute conflict-associated injuries, those with extremity wounds caused by bomb blasts had worse outcomes than those with gunshot wounds. Our findings may prove useful to inform treatment protocols for civilians in armed conflict settings.

Analysis of inpatient complications in HIV/AIDS patients undergoing total hip arthroplasty – A propensity matched cohort study

Patients with human immunodeficiency virus (HIV) are at higher risk for orthopedic related diseases due to dysregulation in bone metabolism and metabolic effects related to their medication regimen. Furthermore, the rate of hip arthroplasty in HIV patients is increasing. With the recent changes in THA methodologies and improvements in HIV treatment, there is a need for updated research analyzing hip arthroplasty outcomes in this high-risk patient population. In this study, we used a national database to evaluate postoperative outcomes in HIV patients undergoing THA compared to THA patients without HIV. We use a propensity algorithm to create a cohort of 493 HIV negative patients for matched analysis. Among the 367,894 THA patients included in this study, 367,390 patients were HIV negative and 504 were HIV positive. The HIV cohort had a lower mean age (53.34 vs 65.88, p < 0.001), lower proportion of females (44% vs 76.4%, p < 0.001), lower incidence of diabetes without complications (5% vs 11.1%, p < 0.001) and a lower incidence of obesity (0.544 vs 0.875, p = 0.002). In the unmatched analysis, the incidence of acute kidney injury (4.8% vs 2.5%, p = 0.004), pneumonia (1.2% vs 0.2%, p = 0.002), periprosthetic infection (3.6% vs 1%, p < 0.001), and wound dehiscence (0.6% vs 0.1%, p = 0.009) were higher in HIV cohort, most likely due to inherent demographic variances present in the HIV population. In the matched analysis, the rates of blood transfusion (5.0% vs 8.3%, p = 0.041) were lower in the HIV cohort. Other post-operative variables, such as rates of pneumonia, wound dehiscence, and surgical site infections were not statistically significant between the HIV positive population and HIV negative matched cohort. Our study found similar rates of postoperative complications in HIV positive and HIV negative patients. The rate of blood transfusions in HIV positive patients was also noted to be lower. Our data suggests that THA is a safe procedure in patients infected with HIV.