Healing Area Research Articles

Healing of chronic wounds at the remodeling stage: the ratio of hormonal and immune parameters

Background. Both patients and healthcare systems around the world experience the negative consequences of chronic wounds. Chronic wounds often precede serious events such as amputation and premature death. Objective: to study the relationship between endocrine factors (insulin and cortisol) and bioactive molecules (interferon-γ (IFN-γ) and transforming growth factor-β1 (TGF-β1)), influencing the development of reparative processes of chronic wounds at the remodeling stage in an experiment, and to analyze the features of the histostructure of rat skin in the area of chronic wound healing. Materials and methods. The study was conducted on 12 white rats. Animals were randomized into intact and experimental groups, with 6 participants in each group. Chronic wounds were induced in the experimental group. Rats were euthanized on the 28th day of the experiment. In the blood serum, the insulin, cortisol, IFN-γ, and TGF-β1 levels were determined by enzyme immunoassay. Histological examination was carried out using generally accepted methods. Results. It was shown that the concentrations of insulin, cortisol, and TGF-β1 in animals of the experimental group were almost doubled compared to intact rats. The level of IFN-γ in animals with wounds was 1.2 times lower than in intact rats. Microscopic examination showed that the wounds were at the stage of remodeling. At the same time, signs of inflammation are partially preserved, which may indicate chronicity of the reparative process. Conclusions. Understanding the mechanisms of reparative processes during wound healing will allow for the development of clinical protocols to improve care for patients with injuries.

Synthesis, characterisation and functionalization of Hercynite nanoparticles for improved antibacterial activity

Hercynite i.e.,FeAl2O4 is an earth-abundant spinel mineral with a cubic crystal structure and belongs to the normal spinel ferrites possessing optical absorption in the visible range as well as superior magnetic and thermal properties. Herein, we synthesized nanosized FeAl2O4 where the citric acid-mediated sol–gel auto-combustion method was employed to achieve its pure phase and studied its physicochemical properties. Furthermore, the superior colloidal dispersion stability of the FeAl2O4 nanoparticles was achieved required for antibacterial activity and standardised via post-synthesis surface functionalisation using amino-propyl-triethoxysilane (APTES). We further characterised the material using states of art characterisation techniques for their structural, morphological, optical and thermal properties. Finally, the antibacterial activity of pure and surface functionalised FeAl2O4 nanoparticles was investigated against the Escherichia coli (E. coli) strain. We observed good penetration of surface functionalised FeAl2O4 nanoparticles into the bacterial membranes due to the high degree of dispersion achieved via cationic surface charge. Conclusively, a key finding of this study is the enhanced antibacterial properties of surface functionalised FeAl2O4 nanoparticles for the concentration of 31 µg/mL compared to pure FeAl2O4 nanoparticles at 62 µg/mL. This study has great relevance in the area of wound healing and tissue regeneration in the future.

Application of Modified Skin Stretching for Soft Tissue Defect Reconstruction in the Ankle and Foot: A Retrospective Report.

The failure rate of foot and ankle soft tissue defect reconstruction with flap is relatively high, often posing a significant burden on patients. The aim of this study is to explore the effectiveness of repeated stretch sutures in repairing skin and soft tissue defects of the ankle and foot. Twenty-three patients with ankle and foot skin and soft tissue defects were retrospectively analyzed between February 2016 and February 2019. Sutures were repeatedly stretched every 3-5 days. Local skin grafting was performed if necessary after wound surfaces disappeared or exposed tendons and bones were covered by soft tissue. Wound healing time, postoperative healing area, Vancouver Scar Assessment Scale, sensation, and function of the new skin were evaluated. Healing time was 17-35 (24.43 ± 5.29) days. Ten patients wholly healed, and 13 healed by approximately 70.08% ± 6.59%. The Vancouver Scar Assessment Scale average score was 2.83 ± 1.19 points, of which 15 cases were excellent (0-3 points) and 8 cases were good (4-7 points). The sensation and function of the new skin after repair were equivalent to those of normal skin after the last follow-up. Applying repeated tension sutures on the skin and soft defects of the ankle and foot reduced the skin graft area and decreased complex high-risk surgical flaps' use and transplantation area.

Comparison of three approaches for treating the bony access window in lateral sinus floor elevation: a retrospective analysis

The aim of this study was to retrospectively determine the effects of applying different treatment methods to the bony access window on the healing outcomes in lateral sinus floor elevation (SFE). Lateral SFE with implant placement was performed in 131 sinuses of 105 patients. The following three treatment methods were applied to the bony access window: application of a collagen barrier (group CB), repositioning the bone fragment (group RW) and untreated (group UT). Radiographic healing in the window area, augmented bone height changes and marginal bone level changes were examined. Mixed logistic and mixed linear models were analyzed. Over 4.3 ± 1.4 years of follow-up, the implant survival rate was 100% in groups CB and UT, and 96.9% in group RW. The treatment applied to the window did not significantly influence the radiographic healing in the window area, augmented bone height changes or marginal bone level changes (p > 0.05). The healed window areas had generally flat morphologies and were fully corticalized. The mean changes in the augmented bone were less than 1.5 mm in all groups. Marginal bone level changes were minimal. In conclusion, Healing outcomes were not different among three different methods to treat the bony access window in lateral SFE.

Efficacy of Avocado Oil Cream in Wound Repair: Macroscopic Analysis, Inflammatory Cells Count, and Collagen Density

The wound healing process goes through a series of complex stages that are mutually continuous, namely inflammation, proliferation, and maturation. Following wound formation and the release of proinflammatory cytokines and growth factors, inflammation occurs immediately after the hemostasis phase. Proliferation occurs when products processed by the growth factors are present. The final stage, maturation, is portrayed by the plan of the extracellular network. This study utilized oil from avocado fruit (Persea americana), which contains linoleic and oleic acid content that supports skin tissue repair. The study aimed to explore the effects of using avocado oil cream on the area of wound healing, the number of inflammatory cells, and the collagen density. Twenty-four female mice, aged eight weeks, were used as experimental animals by making excision wounds using a 4 mm biopsy punch on the dorsal skin on the left and right sides. The mice were divided into four groups based on the percentage of avocado oil in the topical cream included Group K (control, topical cream without avocado oil), Group P1 (5% topical avocado oil cream), Group P2 (10% topical avocado oil cream), and Group P3 (15% topical avocado oil cream). Macroscopic examination of the wounds was conducted daily on days 3, 6, and 9 after topical cream treatment using a digital caliper. A total of 48 skin tissue samples were collected from days 3, 6, and 9 after cream application, which were then processed for histopathology evaluations using hematoxylin-eosin staining and Masson’s Trichrome staining. Hematoxylin-eosin staining was used to count the inflammatory cells, and Masson's Trichrome staining was employed to assess collagen density. The results revealed that avocado oil had a great impact on wound closure after 9 days of 15% avocado oil cream treatment, reducing the inflammatory cells after 3-6 days of 10% avocado oil cream therapy, and increasing collagen density after 9 days of 15% avocado oil cream application, as compared to the control, non-avocado oil cream group. Avocado oil can help close wounds, reduced the number of inflammatory cells, and increased collagen density when used in topical pharmaceutical formulations. Avocado oil cream may, therefore, be considered a viable option for wound repair treatment.

Development of a Healing, Antimicrobial, and Anti‐Inflammatory Gel Containing Cellulose and Curcumin for Wound Treatment

AbstractThis work presents the production of a gel containing bacterial cellulose and curcumin and the anti‐inflammatory and healing activity assayed according to an animal model (BC‐curcumin). The methodology consisted of the production of bacterial cellulose (BC) using a glycerol‐based culture medium, subsequentially purified and transformed into a powder and added to an ethanolic curcumin solution, acting as a carrier matrix of a bioactive compound, as well as this component present in the gel proposal, promotes the prolonged liberation of curcumin. The BC and BC‐curcumin were characterized by infrared spectroscopy, thermogravimetric analysis, and scanning electron microscopy. The antimicrobial activity of the developed gel was confirmed through halo inhibition zone assay and minimum inhibitory concentration against strains of Pseudomonas aeruginosa, Staphylococcus aureus, and Escherichia coli, whose presenting halos with diameters of 21, 26, and 14 mm, and concentrations of 63.78, 6.16 and 136.65 μg mL−1 for the three microorganisms, respectively. The healing and anti‐inflammatory activities were observed according to in vivo assays using Wistar rats, which demonstrated a high healing potential, also confirmed by histopathological study of the tissue samples extracted from the healing area.

Application of Continuous Care Pattern Based on Information-Motivation-Behavioral Skills Model in out-of-Hospital Rehabilitation of Diabetic Foot Ulceration Patients: A Randomized Controlled Trial.

To explore the effect of information-motivation-behavioral skills model (IMB)-based continuous nursing model on the out-of-hospital rehabilitation of diabetic foot ulceration (DFU) patients, and to provide a theoretical basis for long-term disease management of DFU patients. A total of 88 patients with DFU admitted to our Hospital were included in this prospective study. The patients were divided into control and study groups using the random number table method, with 44 cases in each group. Patients in the study group received both routine care and IMB-based continuing care, and the control group received only routine care. At week 1, FBS, PBG (2 h) and HbA1c were significantly decreased in the study group compared with that in the control group (P < .05). At week 3 and 6, blood glucose indicators were significantly improved in both groups compared with week 1 (P < .05). In additional, the number of non-infected patients at week 1 and week 3 in the study group was significantly higher than that in the control group (P < .05). At week 3, the number of cured patients was significantly higher in the study group than that in the control group (P < .05). And the area of ulcer healing in the study group was significantly larger than that in the control group at week 1 and week 3 (P < .05). In conclusion, the continuous nursing mode based on IMB can help DFU patients manage blood glucose level, reduce wound infection, and accelerate wound healing, which is worthy of wide clinical application and promotion.

EFFECTIVENESS OF AUTOLOGOUS PLATELET-RICH PLASMA FOR HEALING DIABETIC FOOT ULCERS

Autologous platelet-rich plasma (APRP) is widely used to accelerate the healing of chronic wounds. However, the advisability of its use in patients with diabetic foot ulcers (DFU), which develop in various forms of the disease and are associated with complex metabolic conditions, is still being discussed. This study consisted in a comparative analysis of the effectiveness of local use of autologous platelet-rich plasma in the treatment of DFU in patients with neuropathic and neuroischemic forms of the disease. A total of 106 patients with type 2 diabetes mellitus undergoing hospital treatment were divided into a study group (n=48) and a traditional wound therapy group (n=58), similar in ankle-brachial index values ​​and ulcer size. Systemic therapy in both groups of patients included measures to regulate metabolism and nutrition, and infection control. Treatment results were assessed by the area of foot wounds and duration of healing. The duration of therapy and the mean platelet concentration in autologous plasma did not differ between groups. The wound healing time in patients with the neuropathic form (60.4±23.77 days) and the neuroischemic form of the disease (64.8±29.6 days) during treatment with APRP was significantly shorter than in the subgroups of the comparison group with traditional treatment of DFU (85.11±40.7 and 90.40±47.12 days respectively) (p&lt;0.01), but there was no significant difference between the subgroups receiving treatment with APRP. Although there was no significant difference in the average daily healing area among all subgroups (p&gt;0.05), the rate of wound healing in the subgroups with APRP was higher (14.85±10.66 and 15.33±14.91 mm2/day, respectively) than in the subgroups of the comparison group (8.39±6.02 and 8.79±7.13 mm2/day, respectively), which confirms the effectiveness of local treatment with APRP in combination with traditional systemic therapy.

Superoxide dismutase-contained solid lipid nanoparticles: Formulation development and In-vivo evaluation for second-degree burn wound healing in rats

IntroductionSuperoxide dismutase (SOD), a natural enzyme with high antioxidant activity, reduces injury and accelerates wound healing by scavenging superoxide radicals. This enzyme plays an important role in cellular defense against oxidative stress such as burn injury. The aim of this study was to load SOD into solid lipid nanoparticles for the treatment of rat burn wounds. MethodsSolid lipid nanoparticles were prepared by Solvent Emulsification Diffusion method and evaluated for particle size, enzyme activity and enzyme entrapment efficiency. Twenty-seven rats in 3 different groups were induced with deep second-degree burns and then treated with SOD-loaded solid lipid nanoparticles, solid lipid nanoparticles without enzyme, or SOD solution. After the treatment period, the wounds were evaluated macroscopically for the area of healing and microscopically for indices of re-epithelialization, granulation tissue and angiogenesis. ResultsThe optimized SOD-loaded solid lipid nanoparticles showed a particle size of 35–85 ± 2.41 nm, 78.4 ± 4.31 % entrapment efficiency and 90 % initial enzyme activity. Macroscopic examination showed that the best recovery rate belonged to the solid lipid nanoparticle group. Pathological studies also showed that angiogenesis and granulation tissue were significantly better in this group. Compared to the other two groups, SOD-loaded solid lipid nanoparticles showed a significant improvement in pathological factors, particularly angiogenesis and granulation tissue, as well as a faster reduction in the number of inflammatory cells. ConclusionBased on this study, solid lipid nanoparticles could be used as an effective delivery system for SOD in the treatment of second-degree burns.

Green and facile fabrication of robust calcium alginate sponges via thermally bonded nonwoven induced freeze-drying for dressing applications

Alginate sponges have been widely studied in areas of wound healing, drug release, tissue engineering, and wastewater treatment due to their potential biological activity, biocompatibility, high porosity, and large surface area. However, their poor mechanical properties greatly limit the practical applications of alginate sponge. In this study, a structurally controllable and high-performance sponge material preparation strategy was proposed by optimizing the structure of the freeze-dried calcium alginate (CA) sponge using fluffy and porous thermally bonded nonwovens (NWs). The performance of composite sponges (CA@NWs) prepared at different pre-freezing temperatures and concentrations were tested. The results showed that the NWs skeleton could improve the formation structure and size stability of the freeze-dried CA sponge, making it have good fluid absorption, moisture permeability, moisture retention, and wet state mechanical properties. The RF-1.0-CA@NWs sponge had the highest fluid absorption rate of 1415 %. The wet state RF-1.5-CA@NWs sponge had tensile strengths of 1.913 MPa and 0.465 MPa in the MD and CD directions, respectively, which was about 95 times higher than that of the wet state pure CA sponge.

Promoting health and wellness through Indigenous sacred sites, ceremony grounds, and land-based learning: a scoping review

This study analyzes the literature on Indigenous sacred sites within the larger topic areas of land-based education and healing, as per the guidance of Anishinaabe (a group of Indigenous Peoples from the Great Lakes and the Great Plains areas of contemporary Canada and USA) Elders and community leaders in eastern Manitoba, Canada. A scoping review was conducted to identify the size, scope, nature, and key themes of existing research in seven databases, inclusive of gray literature which is a key source for Indigenous organizations. In total, we analyzed 35 articles and documents. The emerging themes included: (1) sacred sites and the promotion of health and wellness; (2) sacred sites as places of knowledge; (3) the desecration and protection of sacred sites; and (4) legal battles between Indigenous Peoples and the state. Recommendations to advance understandings and correct colonially imposed imbalances are discussed, and health and legal implications are outlined.

Isolation and characterization of secondary metabolites from Bryophylum pinnatum (Lam.) Oken and assessment of wound healing efficacy using animal model

Wound healing is a complex and intrinsic process that implicates various stages in skin tissue regeneration, may further improvise using secondary metabolites. During a screening of plants traditionally utilized for wound healing, especially by tribals, we encountered Bryophyllum pinnatum (Lam.) Oken Plant. Further, we considered the leaf extract of Bryophyllum pinnatum (Lam.) Oken in various solvents for In vivo characterization of wound healing. The leaf extracts were prepared in petroleum ether, ethyl acetate, and ethanol and further identified the phytochemicals via advanced analytical techniques. The solvent extracts in the ointment base (1 % and 2 % w/w) were prepared and tested against the acute and burn wound models along with control and positive control (Cipladine 1 %). The ethanolic extract had higher phytochemical constituents was tested against the rat model, was found that 2 % w/w ethanolic ointment base stimulated the wound healing area, hydroxyproline content, and wound index and simultaneously reduced the epithelization period compared to the control. The present study concluded that the Ethanolic extract of Bryophyllum pinnatum leaves loaded ointment further promote the % of wound contraction rate, epithelization, and promotion of angiogenesis, exhibited the potential to be utilized to treat wounds.

Negative Pressure Wound Therapy-A Vacuum-Mediated Positive Pressure Wound Therapy and a Closer Look at the Role of the Laser Doppler.

Background: Negative pressure wound therapy (NPWT) is an intensely investigated topic, but its mechanism of action accounts for one of the least understood ones in the area of wound healing. Apart from a misleading nomenclature, by far the most used diagnostic tool to investigate NPWT, the laser Doppler, also has its weaknesses regarding the detection of changes in blood flow and velocity. The aim of the present study is to explain laser Doppler readings within the context of NPWT influence. Methods: The cutaneous microcirculation beneath an NPWT system of 10 healthy volunteers was assessed using two different laser Dopplers (O2C/Rad-97®). This was combined with an in vitro experiment simulating the compressing and displacing forces of NPWT on the arterial and venous system. Results: Using the O2C, a baseline value of 194 and 70 arbitrary units was measured for the flow and relative hemoglobin, respectively. There was an increase in flow to 230 arbitrary units (p = 0.09) when the NPWT device was switched on. No change was seen in the relative hemoglobin (p = 0.77). With the Rad-97®, a baseline of 92.91% and 0.17% was measured for the saturation and perfusion index, respectively. No significant change in saturation was noted during the NPWT treatment phase, but the perfusion index increased to 0.32% (p = 0.04). Applying NPWT compared to the arteriovenous-vessel model resulted in a 28 mm and 10 mm increase in the venous and arterial water column, respectively. Conclusions: We suspect the vacuum-mediated positive pressure of the NPWT results in a differential displacement of the venous and arterial blood column, with stronger displacement of the venous side. This ratio may explain the increased perfusion index of the laser Doppler. Our in vitro setup supports this finding as compressive forces on the bottom of two water columns within a manometer with different resistances results in unequal displacement.

PRAXIS OF PASTORAL CARE TO TEENAGERS IN THE NIGERIAN CONTEXT

Pastoral care is the spiritual and morally sustaining concern of the pastors for their flock, of which teenagers are inclusive. Every teenager needs the full attention of the pastoral caregiver in the area of healing, sustaining, guiding, educating, nurturing and reconciling to God. The paper examined how pastoral caregivers can comprehend the peculiarities of teenagers in Nigeria to minister accurately and adequately to them. The findings of the study revealed that there is a wide generational gap that often causes a problem between adults and teenagers. It also revealed that teenagers have a hardened lifestyle when their survival needs are deficient or are neglected due to parental or societal challenges that negatively affect them. The paper recommends that pastoral caregivers familiarize themselves with the peculiarities of teenagers, especially in Nigeria, and also get a proper understanding and adequate deployment of the pastoral care functions to minister effectively to teenagers in this contemporary time.

Discussion on the mechanism of Danggui Sini decoction in treating diabetic foot based on network pharmacology and molecular docking and verification of the curative effect by meta-analysis.

The main active components and mechanism of Danggui Sini decoction (DSD) in treating diabetic foot (DF) were studied and verified by network pharmacology and molecular docking. Evidence-based medicine was used to prove its efficacy. The TCMSP systematic pharmacology platform screened out DSD's practical components and targets-screening disease targets in GeneCards database, using Cytoscape 3.7.2 to draw DSD-active ingredient-target network diagram, and drawing the protein interaction network diagram through STRING database. The Metascape platform was used to analyze the GO function enrichment and KEGG signal pathway. The molecular docking experiment was carried out by using Auto Dock vina 4.2. The related literature on DSD in treating DF in China Zhiwang, Wanfang, Weipu, and China Biomedical Literature Database was searched. The literature was screened, data was extracted, and quality was evaluated according to the inclusion and exclusion criteria. Then, a meta-analysis was performed using RevMan 5.3 software. A total of 256 targets of all effective components of DSD were obtained. Among 1,272 disease targets, there are 113 common targets. The GO analysis received 6,179 entries, and the KEGG pathway enrichment analysis found 251 related pathways. The molecular docking results of the main targets of diabetic foot and the active substances of DSD all showed a high docking activity. The meta-analysis included six literature, all of which were randomized controlled experiments. The quality grade of the literature was C, and the results showed that the total effective rate of clinical efficacy in the experimental group was significantly higher than that in the control group. DSD may treat DF by participating in biological processes such as cell proliferation regulation, inflammatory reaction, oxidative stress reaction, and promotion of angiogenesis. DSD treats DF through AKT1, TP53, IL6, TNF, VEGFA, and other targets. DSD plays a role in treating DF mainly through the AGE-RAGE signaling pathway and PI3K-AKT signaling pathway. The molecular docking results of AKT1, TP53, IL-6, TNF, and VEGFA with the active substances of DSD show that they all have a high docking activity; among them, VEGFA has a higher docking activity. Compared with conventional treatment, DSD has a high effective rate, short wound healing time, large wound healing area, and high ABI index.

Spincare System Demonstrates Safety and Efficacy in Treating Partial-Thickness Burns.

Partial-thickness burns are the most common form of burns, affecting the dermis and possibly resulting in scarring and infection. The Spincare System is a new device that uses electrospinning technology to create a temporary skin-like matrix that can be applied to wounds. This study evaluated the performance, safety, and efficacy of Spincare in treating superficial to partial-thickness burns not considered for surgery. A prospective single-arm, open-label, multicenter study was conducted in 3 adult burn units across Israel. Forty-four patients with superficial to intermediate burns of up to 10% of TBSA were enrolled. Spincare was applied to the wounds, and follow-up visits were performed on days 7, 14, and 21 and months 3 and 6 posttreatment. Thirty-one patients with 36 wounds completed the day 21 visit. The mean wound healing area on day 21 was 97.26 ± 9.41%, and the mean healing time was 12.8 ± 4.3 days. Only one moderate adverse event was observed concerning the treatment, and it is important to acknowledge the potential progression of this hypertrophic scar into a keloid. This study demonstrated that Spincare is a safe and effective device for treating superficial to intermediate partial-thickness burns. Spincare achieved rapid and complete wound healing with a low incidence of adverse events.

Near-in-situ investigation of surface crack healing and strengthening mechanism of Ti-43.5Al-4Nb-1Mo-0.1B alloy by novel electroshock treatment

The Ti-43.5Al-4Nb-1Mo-0.1B (TNM) alloy is prone to emerge surface cracks and other defects during processing and service, which will deteriorate the mechanical properties and fatigue life of the materials. In this work, a novel electroshock treatment (EST) for the surface crack repair and strengthening process has been proposed. Combined with near-in-situ experiments and theoretical analysis, the influence law and healing mechanism of different current densities and EST modes on the healing of surface cracks in the alloy were investigated. The scanning electron microscopy (SEM) near-in-situ observation reveals that the main factors influencing the healing of surface cracks relate to the time of energization, the current density, and the cracking angle. Meanwhile, the crack tip and locally bulging deflected positions are more likely to be healed in a short time under continuous EST mode and medium current density (75 A/mm2). The surface crack width at the calibration position decreases from 0.47 μm and 2.23 μm to 0 μm and 0.03 μm, respectively. The electron back scattered diffraction (EBSD) results show that the dislocation density increases around the surface crack healing area, and the dislocation density at the crack tip and away from the healing region is decreased and uniformly distributed after EST, which can further suppress the generation and propagation of the crack, resulting in a 20.1 % increase in tensile strength and a 40.3 % increase in fracture strain. Considering the coupling influence of the thermal and non-thermal effects of EST, a two-stage progressive atomic diffusion of thermal compressive stresses and crack bonding interfaces has been proposed to describe the evolution process of surface crack healing during EST.

Rethinking Cognitive Psycho-education -4T Model- in the Psychotherapy of Religious Obsessive-Compulsive Disorder: Report of Three Resistant Cases

Obsessive Compulsive Disorder is one of the most resistant disorders in the field of psychopathology. As this disorder challenges clinicians in pharmacological treatments; In psychotherapies, it brings together resistance in the areas of therapeutic alliance and healing. ERP, which is the gold standard, also fails when a full consensus cannot be achieved in the cognitive process. The Vesvese Treatise, was written for people with religious obsessions. The 4T Model (the first letters of the four cognitive levels in Turkish), adapted from the content of this work, was integrated into the classical treatment rationale of patients with CBT, and by using it in the fields of "formation and source of obsession", "normalization" and "cognitive restructuring", the stage of individualization of the CBT model for the patient was provided on the 4T model. The results obtained in 4 OCD Resistant Cases treated with this method showed that the model made a significant difference especially in the field of "thought-action fusion", and that it was convincing and practical in the "cognitive restructuring" process with the hierarchy of thought it presented.

Association of Stability and Size of Unhealed Area With Failure After Internal Fixation for Osteochondritis Dissecans Lesions of the Knee: Radiological Evaluation Using Computed Tomography

Background: Open reduction and internal fixation (ORIF) has been widely performed because the osteochondral component of the osteochondritis dissecans (OCD) lesion is the most suitable for reconstructing the joint structure. Purpose: To evaluate radiological healing in terms of reconstructed bony structure after ORIF with bone graft by computed tomography (CT), to identify preoperative prognostic factors for failure, and to determine the cutoff value of radiological healing for risk of failure. Study Design: Case-control study; Level of evidence, 3. Methods: A retrospective cohort study of 42 patients (44 knees) who underwent internal fixation with bone graft for OCD lesions of the knee from 2004 to 2018 was conducted. All patients were evaluated 6 months postoperatively, and if not healed 6 months after surgery, they were evaluated by CT periodically thereafter. Radiological healing was judged according to the following 3 criteria: (1) reossification of the OCD lesion, (2) bony continuity between the OCD lesion and basal floor, and (3) reconstructed bony surface of the femoral condyle reconstructed to match the normal joint. Then, the percentage of the radiological healing area was calculated as the ratio of the healing length to the total lesion length. The nonhealing area was calculated by multiplying the sum of the total nonhealing length. Clinical failure was defined as any definitive reoperation for the same OCD lesion, such as fragment excision, or a cartilage restoration procedure. After 6 months, all eligible patients underwent arthroscopy to check for protrusion of the absorbable pin into the joint; the removal of an absorbable pin protruding into the joint was not considered a failure. Results: Clinical failure was recorded for 4 cases (9.1%). The mean overall percentage of the radiological healing area of OCD 6 months after ORIF with bone graft was 79.5% ± 24.4%, and the mean overall nonhealing area at 6 months was 87.8 ± 107.9 mm2. The percentages of radiological healing area of stable (International Cartilage Regeneration & Joint Preservation Society OCD II) lesions and femoral condylar (lateral femoral condyle + medial femoral condyle) lesions were significantly lower than unstable lesions and femoral groove lesions, respectively (P = .01 and P = .03, respectively). On receiver operating characteristic curve analysis, the cutoff points for predicting a significantly increased risk of failure were 33.9% (sensitivity, 100%; specificity, 100%; area under the curve, 1) for the percentage of radiological healing area and 222.9 mm2 (sensitivity, 95%; specificity, 100%; area under the curve, 0.956) for the nonhealing area 6 months postoperatively. Conclusion: A stable lesion and a femoral condylar lesion were the predictors of poor radiological healing on CT images 6 months after ORIF with bone graft. The risk of failure was increased significantly in cases with only approximately one-third of the lesion healed or in cases with large nonhealing areas at 6 months postoperatively.

Accelerated wound healing after topical application of hyaluronic acid cotton to hemorrhoidectomy wounds in a rat model.

Anal wounds following hemorrhoidectomy can lead to severe pain and postoperative bleeding, impacting patient recovery and quality of life. Hyaluronic acid (HA) stimulates tissue regeneration and wound healing by accelerating cell migration and proliferation. This study aimed to investigate the differences in wound healing rate and completeness of recovery of perianal wounds topically treated with HA-soaked cotton in a murine model. Forty-eight 8-week-old Sprague-Dawley rats with perianal wounds created using a biopsy punch were divided into 2 groups: simple dressing with gauze (control) and topical HA-soaked cotton. A single application of HA-soaked cotton was administered after surgery. Wound healing rate and completeness of recovery were evaluated by measuring the healed area and conducting histological analyses. The HA-cotton group exhibited a shorter complete wound healing duration compared to the control group (13.9 days vs. 16.4 days, P = 0.031). Differences in wound healing area between the 2 groups were greatest on postoperative day 2 (51.6% vs. 28.8%, P < 0.001). The HA-cotton group exhibited fewer cases of granulation tissue (2 vs. 5) or redness (0 vs. 3) upon complete wound healing. Histologically, the HA-cotton group showed accelerated reepithelialization, rapid shift to lymphocyte-dominant inflammation, enhanced fibroblast proliferation, and increased collagen deposition compared to the control group. Herein, topical application of HA-soaked cotton on perianal wounds in rats resulted in accelerated wound healing, particularly in the initial stages, and improved completeness of recovery, underscoring the potential of the topical application of HA-soaked cotton on hemorrhoidectomy wounds in human patients to improve wound healing.