Complete Wound Healing Research Articles

Population-based cohort data used to assess trends in early resumption of sexual activity after voluntary medical male circumcision in Rakai, Uganda.

Voluntary medical male circumcision (VMMC) reduces the risk of heterosexual acquisition of HIV by 50%-60%. The Uganda Ministry of Health recommends abstinence of sex for 42 days after VMMC to allow complete wound healing. However, some men resume sex early before the recommended period. We estimated trends in prevalence and risk factors of early sex resumption (ESR) among VMMC clients in Rakai, Uganda, from 2013-2020. Data from the Rakai Community Cohort Study (RCCS), a cross-sectional study, were analyzed. Data included consenting males aged 15-49 years in RCCS who self-reported having received VMMC between the period of 2013 to 2020. ESR prevalence and associated risk factors were assessed using modified Poisson regression to estimate adjusted prevalence ratios (aPR). Overall, 1,832 participants were included in this study. ESR decreased from 45.1% in 2013 to 14.9% in 2020 (p<0.001). Across the first three surveys, ESR prevalence was consistently higher among the married participants than the never married participants, aPR = 1.83, 95% CI: [1.30,2.57]; aPR = 2.46, 95% CI: [1.50,4.06]; aPR = 2.22, 95% CI: [1.22,4.03]. ESR prevalence was higher among participants who reported to have more than one sexual partner than participants with one partner, aPR = 1.59, 95% CI: [1.16,2.20]. In the fourth survey from 2018-2020, ESR prevalence was significantly higher among participants with primary education than participants with post-primary, aPR = 2.38, 95% CI: [1.31, 4.30]. However, ESR prevalence was lower among participants aged at least 45 years than participants aged 15-19 years, aPR = 0.0, 95% CI: [1.86e-07, 2.69e-06]. Overall, participants who reported primary school as their highest level of education reported ESR more often than those with post-primary education aPR = 2.38, 95% CI: [1.31, 4.30]. Occupation and known HIV status were not associated with ESR. Self-reported ESR after VMMC declined between 2013 and 2020. Targeted efforts for counseling focusing on married men, men who had multiple sex partners, and men with lower levels of education may decrease ESR.

Effectiveness of wide local excision and secondary intention healing in Hidradenitis Suppurativa: a single-center study on quality of life and mental health outcomes.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that significantly impacts patients' quality of life and mental health. Effective management often involves both medical and surgical interventions. The aim of the study was to assess the effectiveness of wide local excision and secondary intention healing in improving quality of life and mental health in patients with moderate to severe HS. A single-center prospective study was conducted with 40 patients suffering from moderate to severe HS, refractory to prior treatments. Pre-surgical ultrasound mapping of lesions was performed using Ultra High-Frequency Ultrasound (UHFUS). Patients underwent wide surgical excision followed by secondary intention healing based on HS-TIME principles. Quality of life was measured using Skindex-16, and mental health was assessed using the Hospital Anxiety and Depression Scale (HADS), with subscales for anxiety (HADS-A) and depression (HADS-D). Assessments were conducted at baseline, 4 weeks post-surgery, and after complete wound healing. Statistical analyses included paired t-tests and multiple linear regression to determine factors influencing outcomes. The study included 14 males and 26 females with a mean age of 39 years. Significant improvements were observed in Skindex-16 scores (pre: 57.92, post: 16.03) and HADS scores (HADS-A: pre: 6.13, post: 2.63; HADS-D: pre: 5.50, post: 3.21), indicating reduced pain, discomfort, and psychological distress. Multivariate analysis revealed that improvements were associated with male sex, HS stage II, longer disease duration, and lower BMI. Wide local excision combined with secondary intention healing significantly improves quality of life and mental health in HS patients. The findings suggest that a comprehensive approach addressing both surgical and psychological aspects can enhance patient outcomes. Future research should focus on long-term benefits and the development of standardized postoperative care protocols.

Management of Burn Wound in Diabetic Old Patient with Panchagavya Formulations – A Case Report

ABSTRACT Burn injuries are often prevalent and among the most catastrophic injuries encountered in casualty or surgery departments, involving skin and other tissues. These injuries typically result from heat sources such as solids, liquids, or fire, while scalds arise from hot liquids, electricity, chemicals, cold, friction, or radiation. Despite varying causes, the male-female ratio of burn cases remains consistent. In India, the annual incidence of burns is estimated at six to seven million. Topical antimicrobial agents are crucial for treatment. This case study focuses on an 83-year-old woman with acute burn wounds on her right leg and abdomen, accompanied by pain, discharge, foul odor, edema, and skin discoloration. Treatment involved Panchagavya Chikitsa, utilizing local applications of Gomutra twice daily for wound cleaning and Jatyadi Ghrita twice daily for wound healing over 60 days. Additionally, 15 ml of Gomutra Arka was administered internally twice daily for 15 days. Significant improvements were observed, including complete wound healing and associated symptom resolution. The positive outcomes may be attributed to the local and systemic effects of Gomutra, Jatyadi Ghrita, and Gomutra Arka, which possess antimicrobial, antiseptic, scrapping, and wound-healing properties. The findings suggest that Panchagavya formulations effectively and safely manage burn wounds, even in geriatric patients. Jatyadi Ghrita and Gomutra demonstrated promising results without causing adverse effects in this case.

Development of κ-carrageenan-based transparent and absorbent biodegradable films for wound dressing applications

Wound healing remains a critical challenge in healthcare, requiring advanced wound dressings with superior properties like transparency, absorbency, and biocompatibility. However, gaps exist in the use of marine-derived biopolymers for sustainable dressings. This study addresses this gap by combining κ-carrageenan (KC) with polyvinyl pyrrolidone (PVP) to develop transparent and absorbent biodegradable films through solvent casting and lyophilization techniques. Lyophilized films exhibited superior absorbency (9.17 g/cm2) and moisture management, with a water vapour transmission rate of 3990.67 g/m2/24 h, while solvent-cast films showed 78 % transmittance, enabling wound visualization. Mechanical testing revealed high tensile strength (31.5 MPa) and folding endurance (410 folds), ensuring durability. In vitro bactericidal assays confirmed efficacy against MRSA and E. coli, and in vivo tests on Wistar rats showed complete wound healing within 16 days with 91.1 % closure, outperforming untreated controls (76.7 %). This is the first study to explore lyophilized KC-PVP films for wound dressing applications, demonstrating potential for drug release, absorbency, and biodegradability. The innovative combination of biopolymers and fabrication techniques offers a sustainable, high-performance solution for wound care.

Is Prompt Hyperbaric Oxygen Adjunctive Therapy Able to Reduce Mortality and Amputation in Management of Necrotizing Soft-Tissue Infection?

Background: Necrotizing soft-tissue infection (NSTI) is a rare and serious disease with high morbidity and mortality. Standard therapeutic concepts have included urgent surgical intervention, broad-spectrum antibiotic treatment, and intensive care. Hyperbaric oxygen therapy (HBOT) is used as adjuvant therapy in some centers, but its benefits remain controversial. Methods: A retrospective analysis was conducted in which 98 patients with a clinical diagnosis of NSTI were treated with standard treatments plus HBOT. The clinical outcomes were wound healing, performance status, hospital length, complication rate, recurrence rate, morbidity (amputation rate), and mortality. Primary or secondary outcomes were compared between the time interval of HBOT and the clinical outcomes. Results: The average times from diagnosis of NSTI to initial HBO treatment and from initial surgery to initial HBO treatment were both significantly longer in dead patients than in surviving patients (P = 0.031; P = 0.020). These two time intervals were both significantly longer in amputated patients than in preserved patients (P = 0.031; P = 0.037). Conclusions: Using combined treatment with early surgical debridement combined with HBOT, it is possible to reduce hospital stay, intensive care unit stay, number of debridements, improve complete wound healing rate, and lower amputation and mortality rates among patients with NSTI. The early onset of HBOT soon after diagnosis, especially during critical conditions, is proved to be associated with higher survival and preservation rates.

Addressing the Peri-Wound Intact Skin of Hard-To-Heal Diabetic Foot Ulcers With Topical Red Deer Conditioned Media (PTT-6TM) Skin Conditioner: A Case Series on Clinical Efficacy.

The healing of diabetic foot ulcers (DFUs) can be hindered by the susceptibility of the surrounding intact skin to pro-inflammatory proteases. A conditioned media, known as PTT-6TM, derived from mesenchymal stem cells found in the lining of red deer umbilical cords, has been formulated to protect the intact peri-wound skin of DFUs. The aim is to evaluate the clinical effectiveness of PTT-6TM in managing peri-wound intact skin in hard-to-heal DFUs. Patients with DFUs that persisted for over 3 months were divided into two subgroups. The active wound group received standard-of-care treatment protocol followed by PTT-6TM application around the peri-wound area, while the maintenance wound group applied PTT-6TM media over the healed wound site. Forty cases were recorded, of which 22 (55%) were included in the active wound group. The majority were male (75%, n = 30) and vast majority had cardiovascular risk factors, including diabetes mellitus (100%, n = 40), hyperlipidemia (82.5%, n = 33), and hypertension (77.5%, n = 31). Most patients had forefoot wounds (80%, n = 32) on the plantar aspect (82.5%, n = 33). The patients in the active wound group had chronic DFUs for a mean of 218 ± 201 days. Of those treated with PTT-6™ media, 68.4% (n = 13) achieved complete wound healing within a mean duration of 69 ± 50 days. Additionally, most patients in the maintenance wound group remained ulcer-free at 3 months (91.7%, n = 11) and 6 months (66.7%, n = 6). The study results suggest that PTT-6TM media may serve as an additional treatment modality for enhancing the microenvironment at the peri-wound intact skin site. This could indirectly facilitate wound healing by preserving the integrity of the peri-wound intact skin.

Management of pediatric thyroglossal duct cyst: A case report

Introduction: Thyroglossal duct cysts are common congenital neck anomalies in children, diagnosed through clinical assessment and ultrasound, and treated with the Sistrunk procedure to prevent complications like infection and malignancy. Case Description: We present a case of a 4-year-old male patient with a progressively enlarging neck mass for three months. The mass was asymptomatic, did not cause any eating difficulties, and moved upwards during swallowing and tongue protrusion. Upon physical examination, a soft, mobile, cystic mass approximately 3 cm in diameter was identified beneath the hyoid bone. Supporting examinations, including ultrasound and fine-needle aspiration cytology, led to the diagnosis of a thyroglossal duct cyst. The patient underwent a successful Sistrunk procedure, which involved the excision of the cyst along with a portion of the hyoid bone. Postoperative management included administration of intravenous antibiotics and paracetamol, culminating in a full recovery without any signs of infection. The patient exhibited complete wound healing within two weeks. There was no evidence of cyst recurrence during a follow-up examination six months later. Conclusion: Despite being common, thyroglossal duct cysts require thorough evaluation to avoid misdiagnosis, and are typically identified by a slowly growing midline neck mass that moves with swallowing and tongue protrusion, often near the hyoid bone.

Challenges in the diagnosis and management of soft tissue tumors of the oral cavity.

Soft tissue lesions are among the most prevalent forms of tumors or tumor-like alterations within the oral cavity. They exhibit a wide spectrum of characteristics, ranging from benign, noninvasive lesions to malignant tumors, which collectively present a diagnostic challenge. A 67-year-old patient presented with an incidental finding of induration on the right cheek during dental hygiene. The intraoral examination revealed a soft, non-tender swelling measuring 20 mm in diameter. The sensitivity and percussion tests for the teeth in the fourth quadrant yielded unremarkable results. Panoramic radiography (OPG) revealed tip-ping of the premolars and an unclear apical finding in region 44. Cone-beam computed tomography (CBCT) revealed a sharply defined, lobulated hypodense lesion in the right buccal area. To clarify the diagnosis and optimize perioperative management, a 3 Tesla dental magnetic resonance imaging (MRI) scan was performed. This identified a 23×6×23 mm lipoma along the right mandibular ramus, causing detachment of the buccinator and de-pressor anguli oris muscles. A cinematic rendering reconstruction derived from the MRI data facilitated enhanced visualization for preoperative planning. The surgical excision was performed under local anesthesia, resulting in the successful removal of the neoplasm while preserving the mental nerve and submandibular gland. Histo-pathology confirmed the presence of a lobulated mature cell lipoma. The patient exhibited no complications during the removal of the sutures, with complete wound healing and no recurrence observed. This article highlights the efficacy of advanced MRI diagnostics and post-processing techniques in the management of ambiguous soft tissue neoplasms.

The Effects of Low-Level Laser Therapy on Wound Healing and Pain Management in Skin Wounds: A Systematic Review and Meta-Analysis.

Low-level laser therapy (LLLT) is a non-invasive application of non-thermogenic light that is proven to promote tissue healing and alleviate pain. The authors aim to conduct the first meta-analysis, evaluating the effects of LLLT on wound healing and pain in skin wounds by comparing it to skin wounds not treated with LLLT. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed by searching the electronic databases. Eighteen randomised controlled trials that met the inclusion criteria were included in the study. Six hundred seventy skin wounds were analysed in the study. The primary outcome measures were the percentage reduction in wound size and the rate of complete wound healing. The secondary outcome measures included the visual analogue scale (VAS) for pain and the perineal pain score in episiotomy wounds. The percentage reduction of wound size in the LLLT group was significantly greater than that in the control group (95% confidence interval, CI, 13.93-37.70; p < 0.0001). In addition, the rate of wound healing was significantly greater in the LLLT group (95% CI, 2.32-16.70; p = 0.0003). LLLT has been shown to reduce pain, with the VAS scores for pain being significantly lower in the LLLT group after treatment (95% CI, -2.52 to -0.19; p = 0.02). The authors present the first meta-analysis within the literature showing the effects of LLLT on wound healing and pain in skin wounds. Higher quality trials are recommended to enhance the current evidence base.

Electricallymodified bacterial cellulose tailored with plant based green materials for infected wound healing applications

Effective treatment of infected wounds remains a challenge due to the rise of antibiotic-resistant microorganisms. The development of advanced materials with strong antimicrobial properties is necessary to address this issue. In this study, a unique composite of electrically modified bacterial cellulose (EBC) with allantoin (ABC) and zein was developed by dipping diffusion method. Morphological structural analysis revealed a uniform distribution of zein and aligned fibers, confirming the synthesis of the ABC-Zein composite. The formation of ABC-Zein was further confirmed by attenuated total reflection-Fourier transform infrared (ATR-FTIR), which displayed additional peaks corresponding to EBC, indicating the incorporation of zein into ABC. X-ray diffraction (XRD) analysis of ABC-Zein demonstrated a similar crystalline structure with EBC. The ABC-Zein showed mechanical integrity (tensile strength: 1.15 ± 0.21 MPa), thermal stability (degradation temperature: 290 °C), porous structure (porosity: 40.23 ± 0.21 %), and hydrophilic (water contact angle: 53.3 ± 5.3°) properties. Furthermore, the antimicrobial agent terpinen-4-ol (T4O), derived from tea tree oil, was incorporated into the ABC-Zein composite. Biological studies confirmed the antimicrobial efficacy (Staphylococcus aureus inhibition: 88.5 ± 7.19 %) and biocompatible (cell viability: 84.95 ± 5.6 %, hemolysis: 4.479 ± 0.39 %) nature of the T4O-ABC-Zein composite. The combined effects of the aligned fiber structure, zein protein, and antimicrobial T4O significantly enhanced infected wound healing by day 7, promoting inflammatory response, granular tissue formation, cell proliferation, and angiogenesis. By day 14, T4O-ABC-Zein facilitated complete wound healing, with reepithelization, collagen I deposition, and downregulation of CD 31, Ki67, and α-SMA. Overall, the innovative T4O-ABC-Zein composite, with an aligned fiber structure, improved biocompatibility, and antimicrobial properties, holds significant potential for the treatment of infected wounds.

"Navigating the tides of recovery": early vs. delayed osteosynthesis for closed tibia fractures complicated by acute compartment syndrome - an analysis of one hundred and three cases.

In cases of closed tibia fractures with acute compartment syndrome (ACS), there is no established agreement on whether performing internal fixation at the time of closure or after healing of the fasciotomy wounds would affect the likelihood of non-union or infection risk. The study aims to compare fracture union rates, incidence of infection, and overall outcomes between early and delayed definitive fixation. Retrospective analysis of closed tibia fractures (AO/OTA 41, 42) with ACS between 2010 and 2019 with a minimum two years follow-up. The patients were grouped into group-1 (early-definitive fixation group) and group-2 (delayed-definitive fixation group). The patients were further subdivided into - 1A(early-plate osteosynthesis), 1B(early-intramedullary nail fixation), 2A(delayed-plate osteosynthesis), and 2B(delayed-intramedullary nail fixation). Incidence of ACS in closed tibia fractures was 3.85%. Of the 103 patients included, the patients with plate fixation had a significantly higher union rate in the delayed group (100% vs. 91.66%; P = 0.0001). Similarly, among patients with nail fixation, a significantly higher union rate was seen in the delayed group (96.30% vs. 85.19%; P = 0.0016). The overall incidence of infection was 22.3% (23/103). Moreover, infection was higher in the early definitive fixation group (30.16% vs. 10%; P = 0.016). With a lower incidence of infection and higher union rate among the delayed definitive fixation group, we propose to postpone the definitive fixation of closed tibia fractures complicated by ACS till the complete healing of fasciotomy wounds. This allows for adequate soft tissue healing and improvement in the biological environment of fracture, which boosts the chances of successful union and reduces infection risks.

Utility and Outcomes of a Keystone Perforator Island Flap for Reconstruction at Various Anatomical Locations: A Prospective Study.

Background In Yemen, traumatic wounds are prevalent, imposing a substantial burden on plastic surgery teams operating within limited-resource settings. Advanced microsurgical reconstruction options are scarce, and expertise in free flap techniques is limited. While local flaps are commonly used for soft tissue reconstruction, there is a need for simpler, effective alternatives with lower complication rates. This study aimed to evaluate the effectiveness and outcomes of the keystone island perforator flap (KIPF) as a viable alternative for soft tissue coverage in resource-challenged facilities. Methods From February 2021 to December 2023, a single surgeon's team in three plastic and reconstructive surgery departments in Sana'a, Yemen, conducted this prospective study, which included 35 patients who underwent KIPF for various soft tissue defects. We assessed patient demographics, intraoperative variables, and postoperative outcomes, including aesthetic outcomes evaluated using the Patient and Observer Scar Assessment Scale (POSAS) at six months postoperatively. We analyzed the factors influencing flap success and complication rates. Results The mean age of patients was 29 ± 11.75 years, with the majority being males, comprising 86% of the sample. Trauma was the leading cause of tissue defects (77.1%), primarily affecting the legs (57.14%) and feet (11.43%). The mean operative time was 73.57 minutes. Complications occurred in 26% of patients, with flap dehiscence being the most common (11.43%). Ninety-seven percent of patients experienced flap survival, and 91.4% experienced complete wound healing within a median of 16 days.Scar assessments at six months postoperatively indicated satisfactory aesthetic outcomes, with scars resembling normal skin. Conclusion The KIPF technique proves to be a reliable and practical option for soft tissue reconstruction in resource-limited settings. Its simplicity, minimal postoperative care needs, and high flap survival rates make it an advantageous alternative to more complex reconstructive techniques. This study supports the adoption of KIPF as a standard approach in similar environments with limited reconstructive surgery capabilities.

Cold atmospheric plasma as a promising tool in treatment of Trichophyton rubrum-induced skin infection in a guinea pig model of experimental dermatophytosis

The emergence of high-resistance strains to known antifungal drugs has highlighted the urgency of developing novel therapies for chronic dermatophytosis as a global health problem. An experimental dermatophytosis model in guinea pigs was developed to investigate the in vivo wound healing effects of cold atmospheric plasma (CAP) on T. rubrum skin invasion. Guinea pigs were experimentally infected with T. rubrum and wound healing was evaluated at 1, 4, 8 and 12 days post infection in the CAP-treated, terbinafine-treated and non-treated controls. Our results showed that CAP strongly inhibited the fungal virulence in vitro in culture media and in vivo on the skin lesions of experimentally infected guinea pigs even more efficient than that of terbinafine, resulting in complete wound healing at 8 days post infection. These results indicate that CAP would be considered as a promising tool comparable to conventional chemical therapies, for the treatment of drug-resistant chronic dermatophytosis caused by T. rubrum.

Percutaneous Deep Venous Arterialization by Balloon Angioplasty without Stent Implantation for Patients with Chronic Limb-Threatening Ischemia Undergoing Hemodialysis: A Retrospective Cohort, Single-Center, Single-Arm Study.

This retrospective, single-center study aimed to determine the efficacy of percutaneous deep venous arterialization in patients on hemodialysis with chronic limb-threatening ischemia. Twenty-one consecutive limbs on hemodialysis with chronic limb-threatening ischemia were treated with percutaneous deep venous arterialization using balloon angioplasty following a failed pedal arterial reconstruction between May 2021 and June 2022. An arteriovenous fistula near the ankle joint was created to ensure sufficient venous flow reversal to the pedal veins. In case of occlusion of the tibial artery, a guidewire was advanced (subintimal) to the ankle joint vicinity was technically important. The primary outcome measures were the 6-month complete wound healing and freedom from major amputation rates; the secondary outcome measure was the 6-month amputation-free survival. Occlusion of all pedal arteries was observed in 17 limbs (81.0%). Arteriovenous fistulas were predominantly created at the distal portions of the posterior tibial artery and vein in 18 limbs (85.7%). No extravasation at the fistulas was observed. Re-intervention was required in 16 limbs (76.2%) due to tibial artery or deep vein occlusion. The 6-month complete wound healing rate was 42.9% (nine limbs), with a median healing time of 85 days (interquartile range: 58-151 days). The 6-month freedom from major amputation and amputation-free survival rates were 90.5% (19 limbs) and 61.9% (13 limbs), respectively. Balloon angioplasty without stent implantation for percutaneous deep venous arterialization is promising for improving the complete wound healing and amputation-free survival rates after pedal artery reconstruction failure. Level 3b, retrospective cohort study.

The Efficacy of Negative Pressure Wound Therapy (NPWT) on Healing of Diabetic Foot Ulcers: A Literature Review.

Diabetes mellitus is a complex disorder that requires continuous management to control blood sugar levels and prevent complications. Diabetic foot ulcers (DFU) are the most common complication in diabetic patients. A popular therapy modality with considerable advantages in the management of diabetic foot ulcers today is negative pressure wound therapy (NPWT). This study aimed to review related articles about the efficacy as well as the complications or adverse effects of using NPWT on the healing of DFUs. Searching English databases from PubMed, Ebscohost, Proquest and Science Direct was done to identify relevant citations published between January 2017 and January 2022. A combination of terms was used with the boolean formulation of "negative pressure wound therapy OR NPWT" OR "vacuum-assisted closure or VAC" AND "diabetic foot ulcers OR diabetic foot wound" AND "wound healing" AND "Conventional dressings" and map terms were also used for the subject heading. Some potentially relevant citations of articles from the bibliographies are also reviewed. This study included 8 related articles consisting of 6 RCTs, 1 cohort study and 1 Quasy experimental study. There were various methodological techniques for using NPWT and outcome measures among studies. The results of this literature review showed that NPWT was more efficacious than the other conventional or advanced moist dressings. This therapy revealed a faster healing time with complete wound healing and formation of granulation tissue and reduction in wound size. The complications or adverse effects of NPWT, such as amputation rate, bleeding and pain, were not different from conventional or advanced moist dressings, though. NPWT was more efficacious than other conventional or advanced moist dressings for the healing of DFUs. However, complications or adverse effects of using this therapy showed no significant difference with other conventional or advanced moist dressings.

Great Saphenous Vein Arterialization in Patients with Severe Chronic Limb Threatening Ischemia: A Last Resort for Limb Salvage

ObjectiveIn one-fifth of patients with chronic limb-threatening ischemia there are no revascularisation options. In those cases, venous arterialisation could be a last resort for limb salvage. This study examines the clinical outcome of 17 patients, with non-healing wounds (Fontaine 4), who underwent Great Saphenous Vein (GSV) arterialisation leaving the distal saphenous side branches open and avoiding incisions in the lower leg and foot. MethodsIn this retrospective study all the patients who underwent GSV arterialisation between 1 January 2020 and 1 October 2023 were included. During the procedure, a small incision was made in the groin to identify the GSV and SFA. The GSV was detached from the deep venous system, the upper leg side branches were ligated, and the side branches distal to the knee joint were left open to create a pressure drop. Valvulotomy of the GSV down to the foot was performed in all patients. This approach does not necessitate the use of grafts or stents so that a serious infected foot can also be treated. For this study we have analysed the Limb salvage, wound healing, and mobility after treatment and observed pre and postoperative skin oxygenation over a one-year period. ResultsThis intervention resulted in a limb salvage rate of 46% and a secondary patency of 88% after one year in cases where amputation would have otherwise been necessary. Pre- and postoperative TcPO2 measurements indicated a gradual but consistent increase in skin oxygenation in 71% of the patients with a GSV larger than 3mm, underscoring the importance of future patient selection. All patients who successfully received arterialisation showed complete wound healing and improved mobility. ConclusionThis study introduced a promising approach to venous arterialisation in patients with severe CLTI who have no other treatment options, potentially impacting disease burden and quality of life significantly.

Usefulness of Platelet-rich Fibrin in Open Fractures of Tibia: A Randomised Comparative Pilot Study

Background and Aims: Platelet-rich fibrin (PRF), rich in growth factors and cytokines, found useful for bone healing in animal studies, has paucity of literature on open fractures in humans. This randomised comparative interventional study aimed to find out the role of PRF in wound healing and fracture union in open fractures of tibia. Material and Methods: Random computerised allocation of 14 open tibial shaft fractures managed with an external fixator were done into PRF and non-PRF groups. Autologous PRF injected at fracture site, with PRF gel over open wounds in the PRF group, was compared with conventional standard treatment in the non-PRF group. Wound assessment on day 3, day 7 and weekly till complete wound healing and radiographs for fracture union at 3, 6, and 12 months were done in both groups. The statistical analysis was done using an unpaired t-test (wound size assessment) and chi-squared test (fracture union), using SPSS version 25. Results: Fractures union in PRF group 7/8 (87.5%) was better than 3/6 (50%) in non-PRF group. External fixators were removed 4 weeks earlier in PRF group. Wound healing time, though not statistically significant, was faster in PRF group (36.25±3.03 days) compared to non-PRF (42±7 days), even with larger wound size in PRF group (7.87±1.43 cm 2 ) than non-PRF group (7.5±1.5 cm 2 ). Conclusions: Results of injectable PRF at fracture site and PRF gel over the wound are encouraging, found to be safe, with faster wound healing and better fracture union in the small sample size of this pilot study.

Free Flap Limb Salvage and Ulcer Recurrence in Chronic Limb-threatening Ischemia.

Free flap transfer is a well-established treatment for foot reconstruction in patients with chronic limb-threatening ischemia (CLTI) and can achieve prolonged amputation-free survival. However, reports on ulcer recurrence after free flap transfer are scarce, with most focusing on trauma patients. Therefore, we retrospectively reviewed patients with CLTI who underwent free flap reconstruction at our institution over a 17-year period. Patient characteristics, ulcer recurrence rates, activity level, and variables associated with ulcer recurrence were investigated in patients who met the following criteria: successful reconstructive surgery, complete wound healing, and at least 1 year of follow-up. Free flap foot reconstruction was performed in 42 patients (92.9% male, 7.1% female; mean age 57.1 years, range 37-81 years). Among them, 39 patients (92.9%) had diabetes mellitus, 15 (35.7%) had critical limb ischemia, and 15 (35.7%) had end-stage renal disease/hemodialysis. Mean postoperative follow-up was 60.5 (range 12.0-208.0) months. The 5-year primary ulcer recurrence-free survival rate was 48.7%. High activity level and selection of the posterior tibial artery as the recipient artery were significantly associated with ulcer recurrence [hazard ratio, 3.59 and 9.81; P = .046 and P < .001, respectively]. Activity levels were not significantly different before and 1 year after surgery. In conclusion, survival analysis revealed that ulcer recurrence is most likely to occur within the first 2 years after surgery. Although recurrence occurred in approximately half of the patients, most patients maintained activity levels comparable to their preoperative levels.

Staged surgical treatment of wounds of the extra-abdominal rectum

AIM: to improve the algorithm and results of surgical treatment of combat wounds of the rectum. PATIENTS AND METHODS: thirty-one patients with combat injuries of the rectum were included in the cohort. RESULTS: twenty-seven (87.1 %) patients were discharged in satisfactory condition, 4 (12,9 %) patients died. Sepsis developed in all four patients: in two of them sepsis was on the background of necrotising fasciitis and one had peritonitis. Endoscopic control revealed 10 wounds of the extraperitoneal part of the rectum undiagnosed at the 1st and 2nd stages of medical care. Surgical care included all four main components: diverting stoma, distal washout (mechanical cleansing of the rectum to clear water), suturing of the lesion through perineal access, drainage or tamponisation of the presacral space was done in 20 (64.5 %) patients. Endoluminal VAC therapy was used in 12 patients. In 11 of them, VAC treatment was successful with complete healing of rectal wall wounds. CONCLUSION: the four-component treatment approach is the optimal option for wounds of the extraperitoneal part of the rectum. Diverting stoma and distal bowel washout prevents severe infection. Endoluminal VAC therapy, in some cases, can be used as an alternative to presacral drainage and suturing of the rectal wall lesion.

Tibial transverse transport promotes wound healing in diabetic foot ulcers by stimulating endothelial progenitor cell mobilization and homing mediated neovascularization

Background Diabetic foot ulcers (DFUs) are a common and serious complication of diabetes, often leading to amputation and decreased quality of life. Current treatment methods have limited success rates, highlighting the need for new approaches. This study investigates the potential of tibial transverse transport (TTT) to promote wound healing in DFUs. Methods To test this hypothesis, the study used New Zealand White rabbits to establish a diabetic model and simulate foot ulcers, followed by the treatment of unilateral TTT or bilateral TTT. The study employed histological analysis, flow cytometry, ELISA, and qPCR to assess the impact of TTT on tissue repair and endothelial progenitor cell (EPC) mobilization and homing, aiming to understand the underlying biological processes in wound healing. Results TTT significantly enhanced wound healing in diabetic rabbit foot ulcers. Specifically, bilateral TTT led to complete wound healing by day 19, faster than the unilateral TTT group, which healed by day 26, and the sham operation group, which nearly healed by day 37. Histological analysis showed improved tissue architecture, collagen deposition, and neovascularization in TTT-treated groups. Furthermore, TTT treatment resulted in a significant increase in VEGFR2 expression and VEGFR2/Tie-2 positive cells, particularly in the bilateral group. These findings were corroborated by qPCR results, which showed increased expression of VEGFA and CXCL12 by TTT. Conclusions: TTT may be a promising treatment for DFUs, significantly enhancing wound healing by stimulating EPC mobilization and homing mediated angiogenesis. This novel approach could substantially improve treatment outcomes for diabetic patients with chronic foot ulcers.