Wound Cavity Research Articles

Unraveling the Narrative of Orbital Cellulitis as a Sequelae to Trauma

Abstract Orbital cellulitis is often seen as a serious complication of acute rhinosinusitis. Facial trauma is one of the possible causes of orbital cellulitis. A middle-aged man, a mason by occupation, presented to ENT OPD following a facial trauma. He presented with a laceration over the right zygomatic region with right-sided periorbital swelling and redness. Wide-spectrum antibiotics were initiated for the patient. Pus was drained daily, and surgical debridement of the wound followed by sterile dressing of the wound cavity was done regularly until the pus discharge totally stopped. The patient was taken for secondary suturing and was discharged after that. However, the patient lost to follow-up. Facial trauma is a cause of orbital cellulitis. Orbital cellulitis is an emergency condition and requires urgent medical attention. Adequate antibiotic therapy is of utmost importance to treat the condition. Surgical care is advisable if the medical line of management fails.

Methylene Blue Solid Alginate Gels for Photodynamic Therapy: The Peculiarities of Production and Controlled Release of the Dye

The purpose of this work is to establish the influence of the nature of solid alginate gels (alginic acid, AAG; calcium alginate, CAG) and the conditions of methylene blue (MB) introduction to alginate matrices upon its release into aqueous media. MB is an active photosensitizer, which is used in the photodynamic therapy of tumors and purulent wounds. Solid alginate gels based on AAG and CAG were obtained by adding hydrochloric acid and calcium chloride to sodium alginate. The dye was introduced into the matrix either at the stage of gelation or by immersing the gel in an aqueous solution of the dye. It has been shown that the strength of the dye’s attachment to AAG is higher than that of CAG, which leads to a higher rate of MB release from CAG into aqueous media. It has also been shown that, when introduced at the stage of gel formation, MB is released into both the water and buffer solutions. When MB is introduced by gel immersion into an MB solution, the dye may be released only into salt solutions. An alginate gel with immobilized MB can be used as a solid photosensitizing system with the controlled release of the photoactive agent into the wound cavity for photodynamic treatment.

Effectiveness of cold plasma application in oral wound healing process: A scoping review.

Cold atmospheric plasma (CAP) has shown an ability to promote wound healing by modulating biological processes without causing thermal damage. This scoping review aimed to evaluate the effectiveness of CAP application in the oral wound healing process. An electronic literature search was conducted using PubMed/Medline, Embase, Web of Science, Scopus, and grey literature (Google Scholar). The search included all articles published up to October 11, 2023. Only studies focusing on the different CAP types' effects on oral cavity wounds or cells were included in the review. This review analyzed 13 studies including seven cell culture studies, one animal study, and five human studies (three invivo and two exvivo). The findings from the reviewed articles suggest that CAP may have therapeutic potential. It can maintain cell viability and influence gene expression, accelerate wound healing, and modulate inflammation-related cytokines. DBD plasma exhibited time-sensitive effects on cellular behavior and microplasma irradiation positively impacted cell count, biochemical profiles, and cellular migration. The application of CAP has been shown to have a positive impact on the healing of oral wounds in cell culture, animal, and human studies.

449. CAN LARGE ANASTOMOTIC LEAKAGE AFTER ESOPHAGEAL SURGERY BE TREATED BY ENDOLUMINAL VACUUM-ASSISTED CLOSURE (EVAC THERAPY)?: A CASE REPORT

Abstract Background Anastomotic leakage after esophageal surgery is a deadly complication which approach is still under debate. The high morbimortality of the surgical approach has led to debate whether there are any alternative treatments. The appropriate strategy is based on many factors that include patient’s general conditions, size of anastomotic leakage and diagnosis delay. EVAC (Endoscopic vacuum assisted wound closure) is an emerging technique to treat these patients that can be placed either into the cavity or in the lumen under endoscopic guidance. It is then connected to a negative continuous pressure of 75-125mmhg and then reviewed after 3-4 days. Methods A 62-year-old man with esophageal squamous cell carcinoma underwent neoadjuvant chemoradiotherapy, followed by a minimally invasive Mckeown esophagectomy. On the fourth postoperative day, inflammatory indexes increased, and a CT scan showed an anastomotic leakage. It was decided to perform an endoscopy that showed that the leakage was about 70% of the anastomosis opening to a wound cavity of 5cm with necrotic tissue and fibrosis. Due to the clinical stability of the patient, it was decided to treat the anastomotic leakage conservatively by EVAC therapy. Results To start the EVAC therapy a polyurethane sponge was placed in the cavity via an overtube during the first endoscopy. The patient underwent a total of 14 EVAC sessions over 85 days. As we performed the sessions, healthy granulation tissue appeared leading the leakage and the cavity size to progressively improve. After the 13th session, the endoscopic evaluation showed a healed anastomosis. A CT scan with oral contrast was performed showing leak resolution. The patient started oral intake and was discharged after four days. Conclusions Treatment of anastomotic leakage after esophagectomy is still challenging and presenting high morbidity. The appropriate strategy needs to be individualized. Although surgical reintervention was the classical approach for these patients, new strategies have appeared like the EVAC. It is a promising option to improve the outcome of patients with transmural leakages who would otherwise require surgery. It has demonstrated that it is a reliable, safe and effective treatment.

Reconstruction for extensive sacrococcygeal defects in complex tumor patients with personalized customized gluteus maximus myocutaneous flaps

AimTo evaluate the clinical effects of personalized customized gluteus maximus myocutaneous flaps (GMMF) for reconstruction of extensive sacrococcygeal soft tissue defects in complex tumor patients. MethodsA retrospective chart review was conducted on 8 patients who underwent personalized customized GMMF reconstruction for large sacrococcygeal defect from December 2021 to August 2023. The personalized customized GMMF were designed based on the variations of tissue defect in location, shape and volume of different dead spaces. The principle of the personalized GMMF is to ensure that the rotation point of the flap can reach the farthest end of the defect. Patient demographics, operative characteristics, and perioperative risk factors were analyzed. Clinical outcomes were assessed, focusing on complications such as flap necrosis, wound dehiscence, infection, seroma, and hematoma. ResultsSix patients with rectal cancer and two with sacral tumors underwent personalized customized GMMF reconstruction for extensive sacrococcygeal defects. The average volume of the wound cavity was 104 mL, with a mean vertical depth was 10.8 cm. Six patients had low serum albumin (<35 g/L). After a mean follow-up of 15.5 months, no major complications occurred, except for one seroma that resolved within 2 weeks. ConclusionThe personalized customized GMMF described in this study is an effective method for reconstructing large sacrococcygeal wounds with significant depth in complex tumor patients. It allows for greater rotation of the muscle flap into the sacrococcygeal wound defect and provides adequate blood supply by utilizing the bulk of muscle tissue to obliterate dead space.

Heterogeneous acellular dermal matrix for wound repair after endoscopic Type-Ⅴa cordectomy

Objective:To observe the clinical effect of placing heterogeneous acellular dermal matrix membrane for laryngeal cavity wound healing after CO2 laser Type-Ⅴa cordectomy for glottic carcinoma. Methods:Thirty-five patients with bilateral vocal cord laryngeal cancer who underwent endoscopic CO2 laser surgery at the Department of Otorhinolaryngology Head and Neck Surgery, the Second Xiangya Hospital of Central South University from March 2018 to December 2019 were selected and divided into 2 groups, including 18 patients in the study group and 17 patients in the control group. The control group was simply placed silicone tube stent, while in the study group, heterogeneous acellular dermal matrix membrane was coated with silicone tube stent. The postoperative laryngeal wound repair and clinical manifestations were observed and compared between the two groups. Results:Compared postoperative laryngeal wound after 6 months: no patients in the study group had granulation tissue, whereas 4 patients in the control group had granulation tissue; 3 patients in the study group developed moderate to severe tissue adhesion, while 9 patients in the control group; 10 patients in the control group developed 2nd to 4th degree laryngeal obstruction, compared with only 4 patients in the study group. Conclusion:The primary placement of ADM can reduce laryngeal granulation tissue and tissue adhesion after CO2 laser Type-Ⅴa cordectomy for laryngeal cancer, and may reduce the occurrence of postoperative laryngeal obstruction.

Effect of Programmed Sanitation on the Dynamics of Cytological Picture in the Surgical Treatment of Soft Tissue Phlegmon

The aim of the study was to investigate cytological features of healing processes in patients with soft tissue phlegmons using programmed sanitation technologies.Materials and methods. The study involved 245 patients with purulent phlegmon of soft tissues of various localizations. The patients were randomized into two groups. The patients of the main group (n=127) were exposed to programmed sanitation with AMP-01 device in the postoperative period. After the phlegmon opening and surgical treatment, tubular drains were installed into the wound cavity, the wound was sutured tightly, and the drains were removed through separate incisions and connected to the device. The device was used to detect the parameters of sanitation (speed, time, volume during injection or aspiration). The patients of the comparison group (n=118) received conventional local treatment after surgery. The dynamics of the healing processes of purulent wounds was assessed by the cytological examination findings of the material taken during surface or puncture biopsy.Results. A higher rate of cellular reactions was registered in patients of the main group. There was a statistically significant faster decrease in degenerative forms of neutrophils, higher values of the regenerative-degenerative index (p0.001) indicating an acceleration of the relief of the inflammatory process. In addition, in patients of the main group, the appearance of macrophages and fibroblasts (p0.001) was statistically significantly observed at an earlier time, which evidenced a higher rate of proliferative processes; on the 9th day of the postoperative period the cytological picture corresponded to the regenerative type of cytograms. In patients of the comparison group, a prolonged inflammation and regeneration phase was recorded.Conclusion. Cytological examination of smears in patients with soft tissue phlegmons exposed to programmed sanitation revealed a higher rate of cellular reactions, which contributed to a reduced inflammation phase and accelerated wound reparative processes.

A self-powered, anti-bacterial, moist-wound dressing made with electroactive free-flowing hydrogel particles, encourage faster wound closure

Chronic exuding wounds continue to present a significant healthcare challenge, with prolonged healing times and an increased risk of complications. The wounds with their complex contours and hard-to-reach areas, can particularly benefit from the advantages offered by free-flowing hydrogel particles. Innovative approaches are needed to enhance the healing process and improve outcomes in wound care. Building upon previous research on piezo-driven electrical stimulation, herein, we introduce self-powered, silver nanoparticles containing electroactive hydrogel particles as an innovative wound dressing specifically designed to fill deep irregular wound cavities. Apart from providing anti-bacterial and a moist wound environment, the hydrogel particles provide electrical stimulation to the wound-bed. The self-powered dressing eliminates the need for an external power source by harnessing the electrical activity from a piezo-responsive polyvinylidene fluoride (PVDF) membrane, thereby improving patient compliance. The electroactive hydrogel particles exhibited improved cellular responses including cell migration, proliferation and angiogenesis. Accelerated wound closure, increase in collagen synthesis and improvement in angiogenesis was observed in rats treated with the dressing. By elucidating the mechanisms and benefits of this innovative approach, we seek to highlight its potential as an effective and practical solution for the treatment of challenging wounds.

A controlled aspiration system with monitoring of impedance in surgical wound cavities

A controlled aspiration system with monitoring of impedance in surgical wound cavities

Immobilization of hUC-MSCs conditioned medium on 3D PLLA collagen-coated matrix enhances diabetic wound healing progression

Conditioned medium (CM) derived from human umbilical cord-mesenchymal stem cells (hUC-MSCs) which contains numerous amounts of growth factors, has demonstrated potential in treatment of diabetic wounds. However, for practical application, a biodegradable supporting material is needed to hold the CM and fill in the injury site, where deep cavity wounds are often present in diabetic patients. Poly-l-lactic acid matrix coated with collagen (PLLA/CC) is a suitable carrier due to its biodegradability and biocompatibility. Thus, we present a method to immobilize the hUC-MSCs CM on PLLA/CC through freeze-drying process (PLLA/CC CM FD). When seeded on PLLA/CC CM FD, fibroblasts had an increased cellular function in producing collagen; although no enhancement in cell viability was observed. Moreover, implantation of PLLA/CC CM FD on the wound of diabetic rats showed improvement in wound closure and collagen deposition in the wound area. Altogether, this study exhibits the potential of PLLA/CC CM FD as a therapy for diabetic deep cavity wound.

Reducing the incidence of problematic seroma formation and skin necrosis post-lymphadenectomy: Triple action of topical tranexamic acid, negative pressure wound therapy, and prolonged drainage

BackgroundAxillary and inguinal lymph node dissections are commonly associated with complications that often require additional interventions. MethodsPatients who underwent axillary or inguinal lymphadenectomy via standard procedures were compared to an intervention cohort of patients who underwent axillary or inguinal lymphadenectomy with the use of topical tranexamic acid (TXA) to the wound cavity, a PICO (Smith&Nephew UK) closed-incision negative pressure dressing, and discharged early with a drain in-situ. ResultsSeventy-six patients in the control group (mean age 65.8 years, mean BMI 28.4 kg/m2) underwent open lymphadenectomy without topical TXA and a simple dressing. Seventy-eight patients were included in the intervention group (mean age 67.1 years, mean BMI 28.5 kg/m2). Patients in the intervention group had an inpatient stay of mean 5.6 days fewer than those in the control group (CI 3.09–5.31; p < .0001), an estimated saving to the healthcare trust of £ 3046.40 (US$3723.61) per patient in “bed days.” They had longer drain duration (mean 15 days vs. 8.3 days); however, they had a statistically significant lower risk of seroma formation requiring drainage (6.4% vs. 21%; p = .009), and skin necrosis (0% vs. 6.6%; p = .027). They also had a lower risk of infection (17% vs. 29%), wound dehiscence (15% vs. 25%), and readmission (7.7% vs. 14%), although they were not statistically significant.Patients in the control group were more likely to receive antibiotics as inpatients (51% vs. 7.7%; p < .00001) and on discharge (24% vs. 5%; p < .0011) than those in the intervention group. ConclusionsTopical TXA, PICO dressing, and early discharge with a drain following lymphadenectomy results in a reduced rate of complications.

Coverage of complex pararectal pelvic defects: role of the free myocutaneous musculus vastus lateralis flap

In the event of an advanced rectal carcinoma, an evisceration with rectal amputation may become necessary. The resulting defects, due to their extent, depth, or local tissue damage from previous surgeries and radiation, can in many cases only be closed through free microvascular tissue transfer. In this case series, we demonstrate the successful combination of a musculocutaneous musculus vastus lateralis flap (MVL) with a direct connection to the superior gluteal artery. Over a 47-month period, we retrospectively examined 11 cases of patients with dorsal pelvic defects after evisceration and rectal amputation that could not be closed using local or regional means. In cases of extensive defects with deep pararectal wound cavities, all these patients underwent defect coverage through a free myocutaneous MVL flap with a direct vascular anastomosis to the superior gluteal vessels. The mean defect size was 290.0 cm² (SD: 131.2; range: 200-600 cm²). The mean defect depth was 10.5 cm, necessitating MVL flap reconstruction with an average size of 336.3 cm². Three operative revisions were required due to postoperative bleeding. There were no arterial or venous thromboses, and no flap loss occurred. Only one necrosis of a distal flap tip was observed, which could be corrected secondarily by direct suturing. The case-mix evaluation yielded an average value of 24.251 (SD: 21.699; range: 7.036-65.748) points, emphasizing the complexity of the cases. Our results indicate that a free microvascular MVL flap is a viable therapeutic option for pararectal defects that cannot be closed by local or regional methods. The superior gluteal artery proves to be a safe and sufficient vascular connection. In combination, even extensive defects can be successfully closed.

Oral ulcer treatment using human tonsil-derived mesenchymal stem cells encapsulated in trimethyl chitosan hydrogel: an animal model study

BackgroundOral ulcers are a common side effect of chemotherapy and affect patients’ quality of life. While stem cell transplantation is a potential treatment for oral ulcers, its efficacy is limited as the stem cells tend to remain in the affected area for a short time. This study aims to develop a treatment for oral ulcers by using trimethyl chitosan (TMC) hydrogel with human tonsil-derived stem cells (hTMSCs) to increase the therapeutic effect of stem cells and investigate their effectiveness.MethodsAnimals were divided into four experimental groups: Control, TMC hydrogel, hTMSCs, and hTMSCs loaded in TMC hydrogel (Hydrogel + hTMSCs) (each n = 8). Oral ulcers were chemically induced by anesthetizing the rats followed by injection of dilute acetic acid in the right buccal mucosa. After confirming the presence of oral ulcers in the animals, a single subcutaneous injection of 100 µL of each treatment was applied to the ulcer area. Histological analyses were performed to measure inflammatory cells, oral mucosal thickness, and fibrosis levels. The expression level of inflammatory cytokines was also measured using RT-PCR to gauge therapeutic the effect.ResultsThe ulcer size was significantly reduced in the TMC hydrogel + hTMSCs group compared to the control group. The stem cells in the tissue were only observed until Day 3 in the hTMSCs treated group, while the injected stem cells in the TMC Hydrogel + hTMSCs group were still present until day 7. Cytokine analysis related to the inflammatory response in the tissue confirmed that the TMC Hydrogel + hTMSCs treated group demonstrated superior wound healing compared to other experimental groups.ConclusionThis study has shown that the adhesion and viability of current stem cell therapies can be resolved by utilizing a hydrogel prepared with TMC and combining it with hTMSCs. The combined treatment can promote rapid healing of oral cavity wounds by enhancing anti-inflammatory effects and expediting wound healing. Therefore, hTMSC loaded in TMC hydrogel was the most effective wound-healing approach among all four treatment groups prolonging stem cell survival. However, further research is necessary to minimize the initial inflammatory response of biomaterials and assess the safety and long-term effects for potential clinical applications.

Efficacy of Kajjalikodaya Malahara in Chronic Post Operative Wound

Surgery is the choice of treatment in almost emergency conditions for saving the life of a patient. Sometimes it will leave post operative wound with continuous discharge even with conservative management rarely. Methods: A patient suffering with post operative wound with discharge since 4 yrs. on anterior lateral part of right thigh. Had undergone modern treatment with no results. On consultation, he was advised to apply Kajjalikodaya malahara (KJM) once in a day without any internal medications. Results: The results were appreciable starting from reduction in the discharge to closing the wound cavity without discharge in 60 days. Discussion: The results indicates that the Malahara Kalpana KJM (Kajjalikodaya malahara) therapeutically efficient as indicated in the classics that Asadhya (incurable) Chira varna (chronic wound) will also be relieved.

Features of apoptotic and proliferative processes in experimental infected radiation-induced skin ulcer under conditions of photodynamic therapy and the use of platelet-rich plasma.

. Aim: The purpose of the study was to identify the features of apoptotic and proliferative processes in experimental Staphylococcus aureus-infected radiation skin ulcer under conditions of photodynamic therapy and the use of platelet-rich plasma. Materials and Methods: An experimental study was conducted on 95 six-month-old male rats of the WAG population, which were divided into three groups. Group 1 included 25 animals that were simulated a radiation ulcer of the skin in the thigh area with subsequent application to its surface on the 7th day after irradiation with 0.2 ml of a suspension of the Staphylococcus aureus (ATCC 25923) reference strain (0.5 million microbial cells/cm2). Group 2 included 25 animals with Staphylococcus aureus-infected radiation skin ulcer, which were subjected to photodynamic therapy a day after infection. Group 3 included 45 animals with Staphylococcus aureus-infected radiation skin ulcers, which, 1 day after infection, received photodynamic therapy in the first half of the day, and in the second half of the day the periphery of the wound defect was injected with platelet-rich plasma. The material for the study was skin with underlying soft tissues from the area of radiation exposure. Histological, immunohistochemical, morphometric and statistical methods were used. Results: In cases of simultaneous use of photodynamic therapy and platelet-rich plasma, compared with photodynamic therapy alone, the processes ofapoptosis and proliferation were more balanced, active, with a shift in the proliferative-apoptotic ratio towards proliferation processes and met the needs of the regenerative process. From the 10th to the 22nd day of the experiment these processes increased, which indicated active healing processes, that, during survey microscopy on the 22nd day, were manifested by the complete filling of the wound cavity with granulation and connective tissues with the presence of an epithelial layer on the surface of the regenerate. From the 22nd to the 45th day of the experiment, a decrease in the rate of regeneration was recorded, as evidenced by a decrease in the intensity of apoptotic and proliferative processes. The intensity of the latter was sufficient, which led to the healing of Staphylococcus aureus-infected radiation skin ulcer on the 45th day with complete restoration of the original structure of the skin. Conclusions: Photodynamic therapy in combination with the use of platelet-rich plasma balancedly activates apoptotic and proliferative processes with a predominance of the latter in granulation and connective tissues filling the lumen of Staphylococcus aureus-infected radiation skin ulcer, which on the 45th day of the experiment leads to wound healing with complete restoration of the original structure of the skin.

Negative Pressure Wound Therapy in the Treatment of Sternal Infection after Cardiac Surgery: a Case Report and Literature Review

The aim. To assess the effectiveness of negative pressure wound therapy (NPWT) in the treatment of sternal infection following heart surgery.&#x0D; Materials and methods. During 2019-2022, six patients aged from 46 to 69 years underwent NPWT for sternal infection which occurred within 2 to 24 weeks after complete median sternotomy. For the purpose of temporary wound closure, standard dressing kits with sorption sponge were used. Negative pressure was created by electric vacuum pump with a constant vacuum mode at a range of -75 to -115 mm Hg and a duration of 4-5 days per session. In all cases determination of serum procalcitonin, bacteriological examination of wound discharge, computed tomography (CT) of the chest were performed in dynamics.&#x0D; Results. The study revealed that NPWT in all cases promoted wound cleansing, gradual closing of fistulas and non-grooving pockets, termination of inflammatory process, reduction of the wound cavity, thus accelerating complete wound healing. A significant reduction in the level of wound contamination was revealed after the first NPWT session (below the critical level of 103 CFU), compared to that before treatment (107-108 CFU). Normalization of the level of procalcitonin in the blood serum was determined by day 5-7 of NPWT. CT showed the signs of sternum stability and reduction of inflammatory process in surrounding tissues after treatment. Each treatment case required from 2 to 4 sessions. The duration of hospital stay ranged between 25 and 35 days. A treatment case of one of the 6 patients included in the study is described.&#x0D; Conclusions. NPWT has proven to have positive clinical effect in the local treatment of postoperative sternal infection and can be applied as an ultimate or a transitional option. Methodology of its clinical application needs further elaboration.

Post-injection necrotic phlegmon of the penis in a 13-year-old boy

The practice of injecting various substances into the tissues of the penis in order to increase its size is found among adult men in different countries. An analysis of domestic and world literature revealed only one publication of a clinical case of treatment of a 16-year-old teenager with penile oleogranuloma. A 13-year-old boy was admitted to the pediatric surgical department with complaints of pain and severe swelling of the penis. According to the patient (found out later), these symptoms appeared 3 days after injecting 4 ml of Vaseline oil with a syringe under the skin of the penis. Swelling and hyperemia of the skin appeared, the next day the temperature rose to 40 °C, dizziness, nausea appeared, there were repeated vomiting and loose stools. The cause of the disease was established only after detailed questioning in the department. Local status: the penis is sharply increased in volume due to pronounced vitreous edema, mainly along the dorsal surface, the skin is hyperemic with dark areas and detachment of the epidermis. Diagnosis: “Necrotizing phlegmon of the penis, condition after injections of Vaseline oil”. After medical preparation, surgery was performed. Under endotracheal anesthesia, a 2 cm incision was made along the dorsal surface of the penis. A turbid liquid of 35–40 ml was released from the wound cavity, drainage was done with rubber drains. After the operation, antibacterial therapy and dressings with hydrophobic ointment were carried out. The general condition of the child returned to normal, the wound was cleaned, a defect measuring 5 × 3 × 0.2 cm was formed. After 2 weeks, plastic surgery was performed according to the Diettel method: the foreskin was cut to the area distal to the granulating wound, the outer and inner leaves of the foreskin were sharply separated, a graft was formed from the outer layer and fixed to the wound. The postoperative period was favorable, healing was by primary intention. The patient was discharged in satisfactory condition on the twenty-fourth day from hospitalization. When examined after 4 months, the patient has no complaints; on the dorsum of the penis there is a normotrophic scar measuring 2 × 3.5 cm, which does not interfere with skin mobility. The introduction of foreign bodies under the skin of the penis, accompanied by serious complications, began to be practiced among adolescents. Therefore, this case report will be of interest not only for pediatric surgeons and urologists, but also for doctors of other specialties who may be approached by patients with changes in the penile area, since a true history cannot always be ascertained.

Effectiveness of stingless bee (Kelulut) honey versus conventional gel dressing in diabetic wound bed preparation: A randomized controlled trial

PurposeKelulut honey contains trehalulose and has high antioxidant content, such as phenolic and flavonoid substances, which can promote wound healing. This study evaluated the effectiveness of Kelulut honey in diabetic wound healing compared to a commercially available conventional gel dressing (Intrasite gel). MethodsA prospective, randomized, single-blinded control trial was performed on eligible diabetic patients with full-thickness cavity wounds. Patients’ demographics, size and site of wounds, and baseline routine blood investigations were recorded. The wounds were dressed every other day with Kelulut honey for the intervention group or gel for the control group. The wound size reduction and granulation tissue formation percentage were calculated every 6 days for 1 month. ResultsSeventy-one patients were randomized. After 30 days of follow-up, 62 participants were available for analysis: 30 from the control group and 32 from the treatment group. The control group had increased granulation tissue at baseline and more wounds on the lower limb and posterior trunk. Both groups showed an increasing mean and median percentage of wound epithelialization and granulation tissue over time, with significantly higher values at every timepoint in the honey group (p < 0.05). However, repeated measures analysis of variance and analysis of covariance revealed no significant interaction effect between the different treatments and time, with F (2.02, 121.28) = 0.88, p = 0.417 and F (1.60, 93.95) = 0.79, p = 0.431, respectively. ConclusionThis study revealed that Kelulut honey was comparable to and as effective as the conventional gel in treating diabetic wounds in terms of promoting epithelialization and granulation tissue formation.

In Situ Sodium Chloride Cross-Linked Fish Skin Collagen Scaffolds for Functional Hemostasis Materials.

Current fish collagen hemostasis for wound healing products is commonly obtained by electrospinning or artificial cross-linking fish collagen fibers which lacks mechanical properties, and biofunctions. Here, a new bio-active fish skin scaffold (FSS) is shown using in situ cross-linked scaleless freshwater fish skin adding adipose-derived stem cells (ASCs)-produced exosomes for hemostasis and wound healing. The structure, pore size, and the thickness of FSS is studied by swelling test, Fourier-transform infrared (FT-IR) spectra, scanning electron microscope (SEM) images, and histological analysis. The biofunctions of the FSS are also tested in vitro and in vivo. FSS keeps two functional layers: The dermis layer collagen forms a sponge like structure after swelling and in situ cross-linking treatments. The pore size of the FSS is ≈152 ± 23.54 µm, which is suitable for cells growing, angiogenesis and ASCs exosomes accelerate wound healing. The fat-rich epidermis layer can keep the wound moisty and clean before completely healed. In vitro and in vivo experimental results indicate that FSS+Exosomes enhances rat skin cavity wound healing. In situ sodium chloride cross-linked FSS+Exosomes provides a new strategy as functional hemostatic dressing scaffold for wound healing.

The Use of Active Coagulation Whole Blood-An Innovative Treatment Strategy for Hard-To-Heal Wounds.

Deep and tunneling wounds are a challenge to apply and maintain most advanced wound dressings to promote effective healing. An autologous whole blood clot is a topical treatment and has been found to be safe and effective in healing cutaneous wounds. The active coagulation whole blood (ACWB) clot treatment, using the patient's own blood, is used to treat deep and tunneling wounds, by mixing the blood with coagulation components and applying it into the wound cavity allowing the clot to re-form inside the wound. We aimed to explore ACWB treatment in hard-to-heal wounds. 5 patients with multiple comorbidities, exhibiting surgical abdominal wound, chronic pilonidal sinus, stage 4 sacral pressure ulcer with exposed bone, post-amputation surgical site wound, and non-healing wound dehiscence at the site of a prior hip replacement, were all treated with the ACWB clot treatment. Complete wound healing was observed in 4/5 cases. In the fifth case, there was a 70% reduction in the depth and surface area of the abdominal surgical wound. The ACWB treatment was found to be effective in deep wounds with cavities and exposed structures. ACWB, in its flowable form, can effectively provide coverage of the deepest interstices of the wound's cavities by virtue of its liquid properties, forming a fibrin matrix, mimicking the role of the extracellular matrix. The flowable formulation of ACWB treatment safely and efficiently provides coverage of the entirety of the wound surface to improve the time and process of complex wound surface healing.