Dressing Changes Research Articles

D150. Effectiveness of Traumatic Wounds Treatment with Negative-pressure Wound Therapy with Instillation: Pragmatic Randomized Control Trial

PURPOSE: Negative Pressure Wound Therapy (NPWT) has been associated with instillation (NPWTi) to provide cleaning cycles combined with vacuum therapy, avoiding constant dressings changes. NPWTi meets the treatment demands of wounds at risk infection. The aim of this study is to compare clinical results and direct costs of soft tissue traumatic wounds treatment submitted to three different coverings. METHODS: Prospective, pragmatic randomized controlled trial evaluating adult patients with traumatic wounds. 120 patients with 131 wounds were randomized to standard of care, mainly with layers of gauze (n=41), conventional NPWT (n=46), and NPWTi (n=44). Negative pressure was set at -125 mmHg in continuous mode, applied for two hours in the NPWTi group, followed by normal saline instillation with 20 minutes of dwell time. RESULTS: Sample consisted of 120 patients from 139 screened for eligibility. The mean age was 37.3 (SD14.9; min16;max86) years, primarily male (78%) with low Charlson Index (0.36;SD 1.0). Wounds were mainly degloving injuries (57%) with a mean size of 192 cm2 (min13; max1303), affecting predominantly lower extremities (85%), caused by vehicle accidents. There were no statistical differences between groups regarding baseline data. Wound time of closure (in days) was lower in the instillation group (9.2NPWTi; 11.5NPWT;14.6Layering; p=0.005), as well as the number of surgical procedures (2.9NPWTi; 3.5NPWT;6.9 Layering; p<0.001). Length of stay (in days) was slightly lower in the NPWT group (25.1NPWT;27.8NPWTi;29.1Layering; p=0.226). Costs (in $USD) were higher in the Gauze group ($5510NPWTi; $5,643NPWT;$7,162Gauze;p=0.873). CONCLUSION: Negative pressure with or without installation therapy was more effective and less costly than gauze therapy in treating complex traumatic wounds.

Ludwig’s angina in a child: a case report and literature review

BackgroundLudwig’s angina is a diffuse cellulitis in the sub-mandibular space, which extends to the sublingual space. It is an emergency that often occurs in adults as a complication of oral infections. It is rare in children and is particularly life-threatening due to the smaller size, as well as the characteristics in these spaces in a child. This is the case of Ludwig’s angina in a 2-year-old boy, with rapid onset of signs of respiratory discomfort, no dental or systemic etiology, and great evolution.Case presentationA little boy was brought by his mom to the emergency room for the onset a firm swelling in the sub-mental region along with pain and fever, which appeared 3 days prior to the consultation. He was first examined by a pediatrician who prescribed oral broad-spectrum antibiotics (amoxicillin). The symptoms worsened over 48 h, as the little boy presented respiratory discomfort in supine position.He was admitted in the emergency department. Without dysphagia or respiratory distress.The clinical examination showed swelling in the sub-mental and sub-mandibular region with/without trismus or signs of oral infection. The laboratory investigations showed hyper-leukocytosis with a microcytic hypochromic anemia.CRP = 300; HIV test was negative.The computed tomography (CT scan) showed a diffuse abscess in the sub-mental and sub-mandibular and sub-lingual regions.No mediastinal collection was found.The diagnosis of Ludwig’s angina was established.The patient underwent percutaneous surgical drainage of 15 ml of pus, which alleviated his symptoms, the treatment was carried out through broad-spectrum antibiotics, analgesics, and daily cleaning of the wound and change of surgical dressing. Bacteriological exam found gram-positive cocci in chains. The culture showed a Staphylococcus aureus. The patient presented clinical and biological improvement and was discharged after 7 days.Six months follow-up showed a healthy child, without signs of infection or any other complication.ConclusionLudwig’s angina in children -however rare- is a potentially life-threatening, rapidly spreading, bilateral swelling of the sub-mandibular. Its management is based on airway control, drainage of the collection and broad-spectrum intravenous antibiotics, as well as surveillance of the biological parameters.Early diagnosis and appropriate management enhances outcome and decreases mortality significantly.

Research Progress of Traditional Chinese and Western Medicine Dressing Change on Wound Healing After Anal Fistula Surgery

With the change of people’s lifestyle and diet, the incidence of anorectal diseases is increasing year by year. Anal fistula is a common anorectal disease. Because it cannot heal by itself, surgery has become the main treatment method. Due to the particularity of wound location and physiological structure, the wound is easily contaminated by bacteria, so dressing change after surgery plays a decisive role in wound healing. Modern western medicine and traditional Chinese medicine have different dressing changing methods respectively. In this paper, we reviewed commonly used dressing changing methods of traditional Chinese and western medicine after anal fistula surgery.

Fractional Epidermal Skin Grafts in Hard-to-Heal Wounds: Case Series.

Cellutome™ is a minimally invasive, automated system for harvesting fractional epidermal micrografts. This therapy is indicated for granulating, small size, poor exuding acute wounds. We enrolled 15 patients with 9 venous leg ulcers and 6 atypical ulcers. The micrografts were applied with a nonadherent dressing and covered with a polyurethane foam and multilayer bandage. We scheduled 3 weekly visits for the change of the secondary dressings and multilayer bandage and clinical assessment (Wound Bed Score [WBS], pain assessment, and healing rate). The lesions were measured with the Silhouette Star™ system, a software that allows measurement of perimeter and area from a digital image. The only symptom during the procedure was a sensation of warmth. The donor area healed in 2 weeks in all patients (n = 15). We reported an area reduction of 24.30% in typical ulcers and 38.82% in atypical ulcers after 3 weeks. The average WBS improved in all ulcers from 13.06 to 14.93. The average healing rate was 0.19 mm/day both in typical and atypical ulcers. Consequently, in our small case series fractionated epidermal graft treatment significantly promoted the healing rate in all chronic ulcers regardless of etiology. Future studies with larger case series will be needed.

Incidence rate and risk factors of surgical wound infection in general surgery patients: A cross-sectional study.

Hospital-acquired infections (HAIs) are considered a major challenge in health care systems. One of the main HAIs, playing an important role in increased morbidity and mortality, is surgical wound infection. Therefore, this study aimed to determine the incidence rate and risk factors of surgical wound infection in general surgery patients. This cross-sectional study was performed on 506 patients undergoing general surgery at Razi hospital in Rasht from 2019 to 2020. Bacterial isolates, antibiotic susceptibility pattern, antibiotic administration, and its type, operation duration and shift, the urgency of surgery, people involved in changing dressings, length of hospitalisation, and levels of haemoglobin, albumin, and white blood cells after surgery were assessed. The frequency of surgical wound infection and its association with patient characteristics and laboratory results were evaluated. The SPSS software package (version 16.0, SPSS Inc., Chicago, IL, USA) was used to analyse the data. Quantitative and qualitative variables were presented using mean (standard deviation) and number (percentage). The Shapiro-Wilk test was used to evaluate the normality of the data in this study. The data did not have a normal distribution. Hence, χ2 and Fisher's exact tests were used to evaluate the relationship between variables. Surgical wound infection occurred in 4.7% (24 cases) of patients with a mean age of 59.34 (SD=14.61) years. Preoperative (>3 days) and postoperative (>7 days) hospitalisation, history of immunodeficiency (P< 0.001), and interns responsible for changing dressings (P= 0.021) were associated with surgical wound infection incidence. About 9.5% and 4.4% of surgical wound infection cases were significantly associated with pre- and postoperative antibiotic use. Gram-positive cocci were the most prevalent strains isolated from 24 surgical wound infection cases (15/24, 62.5%). Among these, Staphylococcus aureus was the predominant species, followed by coagulase-negative staphylococci. In addition, the most common Gram-negative isolates identified were Escherichia coli bacteria. Overall, administration of antibiotics, emergency surgery, surgery duration, and levels of white blood cells and creatinine were identified as surgical wound infection-associated risk factors. Identifying important risk factors could help control or prevent surgical wound infections.

WOMEN'S CLOTHES AND DECORATIONS OF THE CITY OF NAKHCHIVAN

The land of Azerbaijan is divided into various historical and ethnographic regions in terms of their unique customs and traditions. One of such historical and ethnographic regions is Nakhchivan. In the XIX-XX centuries, this region consisted of two large cities - Nakhchivan and Ordubad. The article explores women's clothing, jewelry and decor items typical for the Nakhchivan region of Azerbaijan. National clothes are an important ethnographic phenomenon that characterizes, distinguishes and conveys the national aspect as a kind of material culture. Like other areas of material culture, clothing is also related to the socio-economic conditions of human life and clearly reflects the labor activity of people, artistic and aesthetic taste and class differences between social groups of society. In addition to religious beliefs, climatic, geographical and natural conditions also influence the style of clothing. The study of folk costumes in historical and ethnographic regions determines the general (similar) and local (different) characteristics of the Azerbaijani clothing culture and helps to closely monitor ethnocultural ties with the neighboring peoples of Azerbaijan. It is clear from research that although the clothing style of the 19th century is a logical continuation of the types of clothing formed in previous historical periods in accordance with the style method and sewing technique, it has undergone changes in accordance with the needs of the new period. This feature is most often found in urban and professional clothing. In particular, the deepening of the division of labor led to the creation of various types of professional clothing. The growth of trade union differences in society over time manifested itself in their clothing. Researchers note that in the 19th century, changes took place in Azerbaijani clothing, one of which was the gradual disappearance of military clothing and related types and their disappearance from the market over time. Only the dagger hanging from the belt and lead pockets on the side of the rope remain in addition to the clothes. After that, these elements partially lost their functional significance, which was preserved as a decorative element of decor Clothes are usually made from cloth. Fabric is one of the elements that reflect the culture of people. The patterns and colors of fabrics are important features that make the difference both between people and between rich and poor.&nbsp;&nbsp; Since the middle of the 20th century, as in any clothing, national features began to disappear in women's clothing over time. Changes to the shape and features of clothing are now reflected in the style of clothing. Today, national clothes are practically not used among the townspeople. In particular, the media and the socio-economic structure form the basis of the dress change. In addition, the death of older people who wore traditional clothes and the interest of young people in today's fashion have led to the fact that national clothes are not in demand and are on the verge of extinction every day. To prevent this, it is necessary to create the necessary infrastructure for the transfer of these clothes to future generations.

Effect of Therapeutic Hospital Clown Use on Children's Behavioral Adherence During Burn Dressing Changes

Effect of Therapeutic Hospital Clown Use on Children's Behavioral Adherence During Burn Dressing Changes

Effect of Negative Pressure Wound Therapy on Diabetic Foot Ulcers

BACKGROUND&#x0D; In this study, we wanted to evaluate the effect of negative pressure wound therapy on diabetic foot ulcers.&#x0D; METHODS&#x0D; This was a hospital based prospective comparative study, conducted among 40 patients who came for treatment of diabetic foot ulcers to the Department of General Surgery, Kamineni Academy of Medical Sciences and Research Centre, Hyderabad, Telangana, over a period of 2 years from September 2019 to September 2021, after obtaining clearance from Institutional Ethics Committee and written informed consent from the study participants.&#x0D; RESULTS&#x0D; The increase in amount of granulation tissue negative pressure wound therapy (NPWT) and saline-soaked gauzed dressing (SSGD groups were found to be statistically significant. Mean change (increase in granulation tissue in NPWT &amp; SSGD groups) from day 0 to day 42 were 78.083 % and 66.103 % respectively. Whereas in NPWT and SSGD groups, the size of ulcer was decreased which was statistically significant. Mean decrease in ulcer size in NPWT &amp; SSGD groups from day 0 to day 42 were 52 cm sq and 29.15 cm sq respectively. The mean duration of stay in hospital in NPWT &amp; SSGD groups were 29.35 + 4.51 days and 32.75 + 4.75 days with p value of 0.02, which is statistically significant. Among patients with NPWT, response was present in 95 % (19) patients and among patients with SSGD, response was present in 85 % (17) patients. The association between the groups was found to be statistically not significant.&#x0D; CONCLUSIONS&#x0D; Length of stay was shorter in the NPWT group when compared with that of SSGD group. Rate of granulation tissue formation was faster in NPWT group when compared to SSGD group. Reduction in ulcer size was significantly better in the NPWT group. Patient compliance and satisfaction was better in NPWT group. Lesser number of changes of dressings were needed in the NPWT group. It could be concluded that negative pressure wound therapy helps in faster healing, better, safe, and convenient as compared to saline soaked gauzed dressing in the treatment of diabetic foot ulcers.

Analgesic protocol for procedural pain treatment of second-degree burns in children

Background/Aim. Children with burns are submitted to multiple painful and anxiety-related procedures during the change of wound dressing, treatment, and rehabilitation. The objective of analgesic treatments for procedural pain is the safe and efficient management of pain and emotional stress, which requires a careful, balanced, and systematic approach. The aim of this study was to determine the effectiveness of analgesic and/or local anesthetic in relieving the intensity of procedural pain. Methods. The study included 120 pediatric patients with second-degree burns who were allocated into four groups of 30 children (control group, groups I, II, and III). During the change of wound dressings, children in the control group did not receive any analgesics, while in the remaining three groups, 30 minutes prior to the change of wound dressing, oral nonsteroidal anti-inflammatory drug (group I), local anesthetic (group II), or both medications (group III) were administered. Results. The average visual analog scale (VAS) score for assessing pain was statistically significantly higher in the control group on all tested days compared with children in the other three treated groups. On the first test day (24 hrs after sustaining the burn injuries), all children had high VAS scores, and ac-cording to the receiver operating characteristics (ROC) analysis, the boundary value was 89.50/100. There was a remarkable difference in the VAS score between the groups on the fifth day of dressing change with the boundary value of 57.50/100 and on the seventh day when the boundary value was 43.50/100. Children who experienced the lowest intensity pain during dressing changes of burn wounds for all test days were those from the group who received both systemic analgesic and local anesthetic. Conclusion. The study confirmed the importance of introducing the complex polymodal protocol in treating procedural pain in second-degree burns. The protocol should include analgesics as well as anesthetics since they both contribute to achieving the best results in pain reduction and treatment outcomes.

Pocahontas and the English Boys: Caught between Cultures in Early Virginia

In a deeply nuanced study, Kupperman deftly crafts a narrative based on her decades of study into the early Virginia colony and the Atlantic world, of the important role of captive children and the exchange of peoples in the settlement process. By highlighting the experiences of Pocahontas, Thomas Savage, Henry Spelman, and Robert Poole, Kupperman creates a model for insight into the fraught relationships these youths would have with both their communities of origin and their adoptive kin. The exchange of children in Virginia allowed for language acquisition, as child intermediaries learned the customs and languages of their communities, which in turn allowed them to become interpreters at a young age. This important tool in settlement, however, also placed enormous pressure on these four youths who were still malleable in their adolescence. The desires to please disparate masters led to fraught and tense situations for all involved. For the boys, Kupperman argues that “they were so young themselves that they might not necessarily understand everything about their own cultures and the deeper meanings attached to words and concepts,” leaving spaces for ambiguity that both the Algonquian and English leaders could make use of and manipulate (p. 12).While Pocahontas's story is a focus of some of the book, the greater contribution to the scholarship of early Virginia and the Atlantic World here is Kupperman's focus on Thomas, Henry, and Robert, providing a well-researched and illuminating understanding of their lives in the colony and the pressures they faced. Throughout seven chapters, Kupperman traces not only the history of the Virginia Company (and its failure) but the rise and fall of relationships and alliances, and the interpersonal public and private socio-politics of the era. Interweaving familiar parts of the narrative, including the infamous “rescue” of John Smith, with a close read of archival sources, Kupperman shares the story of the exchange of children caught in a series of wars, disease, trade, and colonial expansion. Within these stories are details of life and interaction; Kupperman asks, for example, about Thomas Savage, “Did he find it liberating to switch to Powhatan clothing, which was so much freer than the English? Or did he find it hard to adjust to being so exposed?” (p. 31).For Pocahontas, Kupperman shares what life was like in London at the time of her visit, describing the drastic change in dress for the young woman, including a “high-bodied” gown with a “large starched collar that was supported by a network of wires. So your clothes poked and scratched you throughout the day, not to mention how heavy it all was” (p. 114). These detailed analyses of the day-to-day experiences and the challenges these children faced provide scholars with excellent materials with which to inform classroom discussions as well as further research. Kupperman suggests the larger trauma that Pocahontas faced under English expectations that she act as an intermediary to convert her people to Christianity, opining that “inner turmoil over what would happen once they were back in Virginia must have been intolerable” (p. 139). Sadly missing from the story are some of the deeper Indigenous perspectives and analyses of the story of her abduction and conversion, a story that many view as one of the first missing and murdered Indigenous women.The last two chapters expand upon the rising tobacco economy and the failure of the Virginia Company as well as the role of young English and Native boys as interpreters, some of whom fared well and others who became casualties of the system as “manipulation and double dealing using young go-betweens happened everywhere in the Atlantic” (p. 173). By focusing on the children involved, their experiences, their losses, and the potential psychological impact of their captivity and exchange, Kupperman has produced an important synthesis of this era that allows a glimpse into a terrifying aspect of the colonial era and brings to life their circumstances and hardships.

КОПЫТНЫЕ ВАННЫ В СИСТЕМЕ МЕРОПРИЯТИЙ ДЛЯ ОБЕСПЕЧЕНИЯ ЗДОРОВЬЯ КОПЫТЕЦ КОРОВ

Lameness is widespread in dairy cattle herds all over the world. Up to 25% of highly productive cows of the herd can go lame at the same time, which causes significant damage, mainly affecting dairy productivity, and leads to financial losses. The findings make clearly visible the picture of a decrease in cases of interdigital dermatitis when using hoof baths. In the experimental group, the identified cases of Mortellaro disease had a mild form of M1, which were easily treated with bandages containing powder with zinc oxide, boric acid, acetylsalicylic acid, Egocin 20 (1:1:1:0,5). The resulting powder was applied with a bandage and fixed on the hoof with a special hoof cloth tape. After a double change of dressings with an interval of 3 days, regeneration of the skin and disappearance of clinical signs of the disease were observed. In the control group, the detected cases were in the stage from M1 to M3. The nature of the diseases was medium, with a three-time change of the therapeutic dressing, the recovery time for sick cows was 9 days.

The change of color of female wedding dress in Chinese ancient times

The paper provides a comparison of color changes in female wedding dress in different periods in China. The wedding dress emerged at the presence of Zhou dynasty‘s dress, the main color of it is cyan. In the Tang and Song Dynasties, women wore wedding dress with a large area of cyan. This phenomenon was depicted in combination with handed-down portraits, which gradually proved that traditional women showed ―advocating cyan‖ phenomenon in the choice and inheritance of wedding dress color. However, since the Hongwu period of the Ming Dynasty, the color image of women‘s marriage dress was changed from ―advocating cyan‖ to ―advocating red‖. The symbolic reason might be that the fundamental thought was closely related to the ―Five Cyclic Virtues‖ theory. This system was a means for the emperor to highlight the national luck and consolidate the Han rites.

53: SAFETY OF PERCUTANEOUS DILATATIONAL TRACHEOSTOMY IN PATIENTS RECEIVING ANTIPLATELET THERAPY

Introduction: Tracheostomy is one of the most frequent surgical procedures carried out in critically ill patients. The most popular technique today is the percutaneous dilatational tracheostomy (PDT) which uses serial dilators over a guide wire and is usually done at the bedside in the intensive care unit (ICU) under bronchoscopic guidance. Antiplatelet agents have become a mainstay therapy for vascular diseases; yet they increase the risk of bleeding. The aim of this study is to determine the bleeding risk for patients on antiplatelet therapy who underwent PDT. Methods: A retrospective analysis of patients who underwent PDT admitted to ICU between 2006 and 2021. All data were extracted from electronic health record (EPIC) and operative reports. Minor bleeding is defined as bleeding requiring application of temporary pressure or change of dressing. Major bleeding is defined as bleeding requiring packing with surgicel or transfusion of red blood cells, fresh frozen plasma or platelets. Antiplatelet therapy (APT) is defined as receiving therapy up to and within 24 hours of PDT. Single antiplatelet therapy (SAT) is ASA alone and dual antiplatelet therapy (DAT) is ASA/clopidogrel combination. Results: A total of 677 PDTs were identified and analyzed (567 patients that did not receive antiplatelet therapy [NAT group] and 100 APT group [93 SAT and 17 DAT]). Compared to the NAT group, the APT group were older (71 +/- 12 vs 58 +/- 20, p = 0.0001), had similar gender (male: 60 % vs 60 %, p = 1.0), and similar BMI (29 +/- 9 vs 28 +/- 7, p = 0.2). For minor bleeding (5.1 % in NAT group), the SAT group and DAT group had more bleeding (17 % for SAT, p = 0.0001, and 17.6 % for DAT, p = 0.02). Major bleeding did not significantly differ between SAT and NAT groups (1.1 % vs 0.4 %, p = 0.2), but was significantly higher for DAT group compared to NAT group (5.9 % vs 0.4 %, p = 0.003). Conclusions: In a large single center, there was no significant major bleeding when PDT was performed while patients are on ASA, but there was significantly more major bleeding when patients were on both ASA and clopidogrel. This data should be confirmed in large multicenter prospective studies.

Methoxyflurane for Relief of Procedural Pain in Burn Patients: A Prospective Single-Centre Evaluation Study

Background: Procedural pain in burn patients continues to be a major problem. Frequently used analgesics, such as opioids, may have various side effects, including respiratory depression, nausea, and vomiting. Inhaled methoxyflurane has been used in the pre-hospital setting for trauma-related pain. This pilot study aimed to investigate the feasibility of using methoxyflurane for pain relief during dressings changes for burns in the hospital setting. Methods: In this investigator-initiated pilot study, we included burn patients undergoing dressing changes in the burn ward. The primary outcome was the maximal pain level experienced by the patient during the procedure on a verbal rating scale of 0 to 100. Furthermore, patient satisfaction and the nurse’s assessment of the patient’s pain were reported. We also reported the presence of nausea, vomiting, coughing, and headache, along with changes in the pulse rate, oxygen saturation, and arterial blood pressure. Results: We included 12 patients in the period of June 2021 to July 2022. The median patient-reported maximal procedural pain was 60 (interquartile range (IQR), 37–80), which corresponded well with the nurse’s rating of a median of 57 (IQR 28–67). The patients were satisfied with methoxyflurane as an analgesic, with a median score of 96 (IQR 96–100). One patient reported coughing after the procedure, and another patient experienced nausea one week after the procedure. No clinically important haemodynamic changes during administration were detected. Conclusions: Methoxyflurane was found to be feasible for pain relief in burn patients undergoing dressing changes in the burn ward.

Impact of hidradenitis suppurativa-specific wound dressing system on patient quality of life and dressing-related pain: pilot study.

It is theorised that adhesive-free wound care developed specifically for patients with hidradenitis suppurativa (HS) can improve their quality of life (QoL). Our study aimed to investigate the impact of a novel wound care device on Dermatology Life Quality Index (DLQI) scores, and other factors related to experienced pain, time spent changing dressings, comfort, ease of use and body image. A 21-day, single-arm, unblinded, pilot trial was conducted to assess ease of use and the impact of effective wound care on various aspects of wound management in patients with HS. Participants were provided two trial garments and trial dressings as required, to use over a 21-day period in the home setting. A seven-item questionnaire and the DLQI questionnaire was completed on days 0, 7, 14 and 21. All 15 participants were female, aged >18 years old and with a diagnosis of HS. Mean DLQI score at baseline (day 0) was 19.3, which was reduced to 4.53 on day 21, a significant improvement in 100% of participants (p<0.001). High levels of dressing-related pain, assessed using an 11-point Visual Analogue Scale, reduced from 5.53 at baseline to 0.8 on day 21. Other significant improvements in terms of patient comfort, time spent on changing dressings, body confidence and the dressing's ability to retain exudate were also noted. The results illustrated the improvement made to study participants' day-to-day activities and QoL when effective HS-specific wound care products were provided. Wound care is an essential component in the treatment journey of patients.

MEMS Cavity-Based pH Image Biosensor for Wound Dressings to Monitor Hard-to-Cure Wounds

The biochemical processes in the body, including wound healing, are influenced by pH. When skin is damaged, in the inflammation phase, the pH of the skin is under pH 6.0, and in the granulation and spontaneous reepithelization phase, the pH of the skin oscillates between 6 and 8. If there is a frequent change in the wound dressing, it will make the damage to the skin hard to cure, especially for chronic wounds. In this article, we design and implement a highly sensitive micro-electro-mechanical-system (MEMS) cavity-based pH image biosensor of a <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$100\times100$ </tex-math></inline-formula> array with an integrated readout circuit in a CMOS bulk technology. Based on the proposed pH fringing electrical field model, we predict and optimize the performance of the proposed sensor pattern with cavity structure for operation frequency and various pH ions. The proposed pH biosensor with MEMS cavity structure exhibits a high sensitivity of 201 mV/pH, low drift voltage over time of 2.08 mV, a fast response time of 5 s, high precise repetition of 98.9%, and a pH image of 20 frame rate/s. Since the sensor is a <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$100\times100$ </tex-math></inline-formula> array, it displays a detailed change in the pH image of wound exudate to identify the inflammation stage under pH 6 or spontaneous reepithelization above pH 6 to indicate the need to change the dressing, reducing the clinician’s wasted resources on frequency change of wound dressings.

Indications, anaesthesia and postoperative protocol for replantation and revascularization in the hand in Nordic countries.

In this survey, we compared the current postoperative practices in the largest replantation units of four Nordic countries. The topics included were indication for surgery, anaesthesia, postoperative monitoring, use of antibiotics, anticoagulation and postoperative intravenous fluids, change of dressings, duration of bed rest and hospital stay, hand therapy and follow-up after discharge. Although there were many similarities between the units in the postoperative protocols, we found a large variety of practices. There is no robust evidence to assess or support or reject most of the strategies in postoperative care. The differences in practice warrant prospective studies in order to establish an evidence-based postoperative protocol for replantation surgery.

Application of the distally based sural neurocutaneous flaps in the management of foot and ankle defects in patients with diabetic foot.

BackgroundWe report our experience on the use of a distally based sural flap for soft tissue reconstruction of foot and ankle defects in patients with diabetic foot.MethodsThe actual study is a retrospective, open, non-controlled, and clinical study of 25 patients treated with diabetic foot on whom reconstruction with distally based sural neurocutaneous flaps was performed from May 2019 to December 2021.ResultsThe mean age was 64.9 years, and there were 15 male and 10 female patients. The mean follow-up was 9.8 months, which ranged from 6 to 12 months. The size of the flaps ranged from 6 × 5 to 15 × 9 cm2. Twenty-two of the 25 flaps survived intact with sufficient blood supply. Two cases had a small superficial necrosis, which was resolved after a change of daily dressing and was heeled eventually. In one case, partial necrosis was observed that was managed with minor revision and the use of split-thickness skin graft.ConclusionsThe distally based sural flap is considered to be useful for reconstruction of foot and ankle defects in patients with diabetic foot.

A Granulation Tissue Detection Model to Track Chronic Wound Healing in DM Foot Ulcers

Diabetes mellitus (DM) foot ulcer is a chronic wound and is highly related to the mortality and morbidity of infection, and might induce sepsis and foot amputation, especially during the isolation stage of the COVID-19 pandemic. Visual observation when changing dressings is the most common and traditional method of detecting wound healing. The formation of granulation tissues plays an important role in wound healing. In the complex pathophysiology of excess and unhealthy granulation induced by infection, oxygen supply may explain the wound healing process in DM patients with multiple complicated wounds. Thus, advanced and useful tools to observe the condition of wound healing are very important for DM patients with extremities ulcers. For this purpose, we developed an artificial intelligence (AI) detection model to identify the growth of granulation tissue of the wound bed. We recruited 100 patients to provide 219 images of wounds at different healing stages from 2 hospitals. This was performed to understand the wound images of inconsistent size, and to allow self-inspection on mobile devices, having limited computing resources. We segmented those images into 32 × 32 blocks and used a reduced ResNet-18 model to test them individually. Furthermore, we conducted a learning method of active learning to improve the efficiency of model training. Experimental results reveal that our model can identify the region of granulation tissue with an Intersection-over-Union (IOU) rate higher than 0.5 compared to the ground truth. Multiple cross-repetitive validations also confirm that the detection results of our model may serve as an auxiliary indicator for assessing the progress of wound healing. The preliminary findings may help to identify the granulation tissue of patients with DM foot ulcer, which may lead to better long-term home care during the COVID-19 pandemic. The current limit of our model is an IOU of about 0.6. If more actual data are available, the IOU is expected to improve. We can continue to use the currently established active learning process for subsequent training.

ROS-degradable PEG-based wound dressing films with drug release and antibacterial properties

The management of burn wounds remains a challenge in clinical practice. The need for constant dressing changes results in painful treatments that can be minimized by the use of modern dressings. The ability of the dressing to respond to an external stimulus can be considered a major advantage. This responsiveness allows the material to change its physical properties to release molecules that can aid the healing process or be easily removed from the tissue. Poly(ethylene glycol) (PEG) is a common component of these systems due to its biocompatibility and low toxicity. Due to its versatility, PEG can also be used to easily prepare polyurethane-urea (PUU) films. In this work, innovative PUU films degradable by reactive oxygen species (ROS) were prepared. These films were prepared from PEG with different molecular weights (1–20 kDa) modified with a ROS-responsive telechelic β-aminoacrylate bond. The hydrogel films showed interesting mechanical and thermal properties, good water uptake (up to 225 %), and low cytotoxicity. The mechanical properties were able to be tuned by changing the molecular weight of the PEG precursors, with Young’s modulus ranging from 16 to 2.5 MPa. More importantly, the hydrogel films were degradable by a ROS-mediated cleavage process with visible light, as indicated by the loss of mechanical properties. In addition, the films were found to be capable of being loaded with a drug - silver sulfadiazine (AgSD), leading to the development of materials with antibacterial activity. Therefore, this work provides a promising strategy for the development of an innovative wound dressing that can be used for the treatment of burn wounds.