Complete Wound Healing Research Articles

Compare the surgical outcome of Fistulectomy and Mucoal advancement flap in perianal fistula.

Objective: To compare the fistulectomy with mucosal advancement flap in treatment of perianal fistula in terms of mean hospital stay, frequency of anal incontinence and wound healing time. Study Design: Randomized Control Trial. Setting: Surgical OPD, DHQ and Allied Hospital, Faisalabad. Period: 1st March 2019 to 28 February 2020. Methods: Conducted on 120 (60 in each group) patients with fistula in ano presenting. Sampling technique was Non probability consecutive sampling. All the Patient age ranges from 20-55 years of either gender having perianal fistula which are low lying fistulas and with single external opening are included in study. Patients having perianal abscess, pilonidal sinus, Inflammatory bowel disease (Crohn’s disease, Ulcerative colitis) or with history of tuberculosis, HIV disease, Complex high lying fistulas with multiple external openings are excluded. Results: In our study, group A underwent fistulectomy while on group B we perform mucosal advancement flap. About 56.67%(n=34) in Group A and 50%(n=30) in Group B were between 20-40 years of age while 43.33%(n=26) in Group A and 50%(n=30) in Group B were between 41-55 years of age, mean+SD was calculated as 38.78+9.07 years and 40.12+8.89 years respectively. According to gender division 86.67%(n=52) in Group A and 78.33%(n=47) in Group B were male while 13.33%(n=8) in Group A and 21.67%(n=13) in Group B were females, mean hospital stay was calculated as 93.93+4.56 hours in Group A and 107.95+4.66 hours in Group B, p value was calculated as 0.0001 showing a significant difference between the two groups. Comparison of anal incontinence in both groups was done showing that 13.33% (n=8) in Group A and 23.33%(n=14) in Group B had anal incontinence, p value was calculated as 0.15. At one month postoperative follow-up only 4 patient (6.7%) in group A showed complete wound healing while in group B 28 patients out of 60(46.6%)showed complete wound healing, P value was calculated as 0.00167 showing a significant difference while there is no significant difference in incidence of early post-operative complications. Conclusion: We concluded that hospital stay was significantly decreased in cases with fistulectomy when compared with MAF while there was no significant difference regarding anal incontinence in both groups.

Healing Effect of Wistar Rat Incision Wounds on Administration of Microemulsion Combination of Green and Red Betel Leaf Extracts

One natural ingredient that has the potential to heal wounds is betel leaf. This study aimed to analyze the healing effect of Incision wounds in Wistar rats when administering a microemulsion combination of green and red betel leaf extracts. This research begins with sample collection, drying process, and extraction. The extract was then formulated into emulgel as a microemulsion in three formulations. These three formulas, along with a positive control and a negative control, were tested on each Wistar rat incision wound. The results of the research showed that emulgel formula 3, which was tested on mice, had the best ability to heal wounds for an average of 2.5 days and kept the mice's body temperature normal; 36.6oC. Formula 3 contains 5% South Kalimantan red betel, 5% South Kalimantan green betel, 5% Central Kalimantan red betel, and 5% Central Kalimantan green betel. This proves that the combination of formula 3 can heal wounds and body temperature in experimental mice. Further research is needed to find the best composition that produces faster, more complete wound healing effects and safely impacts experimental animals.

THE USE OF A POLYVALENT KLEBSIELLA BACTERIOPHAGE IN INFECTION AFTER RECONSTRUCTIVE PLASTIC SURGERY ON THE SPINE IN A CHILD (A CLINICAL CASE)

The incidence of infection after reconstructive plastic surgery on the spine (in particular, spondylodesis) in children remains at a fairly high level and ranges from 0.4% to 8.7%. These complications are often caused by polyresistant bacterial pathogens; this accentuates the need for new effective therapeutic approaches. Bacteriophage preparations in combination with antibiotics can optimize existing strategies for the treatment of infectious diseases, since they are able to selectively destroy bacteria, including biofilm-forming ones. The aim of the study was to draw the attention of practitioners to modern problems of treating polyresistant infections on the example of a case of purulent complication after spinal surgery in a child. Materials and methods. On the basis of the FSBI "Federal Center for Traumatology, Orthopedics and Endoprosthetics" under the Health Ministry of the Russian Federation (the town of Cheboksary) a retrospective analysis of a clinical case of treating early infection after reconstructive plastic surgery on the spine caused by a polyresistant strain of Klebsiella pneumoniae was conducted. Research results. Patient P., 2.2 years old, with congenital pathology of the musculoskeletal system, who repeatedly received medical care in various medical organizations, underwent surgical spine stabilization. In the early postoperative period, an infectious complication developed caused by a polyresistant strain of Klebsiella pneumoniae (a producer of extended-spectrum beta-lactamases and carbapenemases). Along with surgical debridement of the postoperative wound, a combined etiotropic antibacterial therapy was performed (12 weeks). However, complete healing of the postoperative wound was achieved in combination with the administration of a polyvalent klebsiella bacteriophage (10 weeks). Conclusions. This clinical case demonstrates that the use of a polyvalent klebsiella bacteriophage can increase the effectiveness of antibacterial pharmacotherapy in surgical treatment with preservation of metal structures.

A study of scarless wound healing through programmed inflammation, proliferation and maturation using a redox balancing nanogel.

In the study, we have shown the efficacy of an indigenously developed redox balancing chitosan gel with impregnated citrate capped Mn3O4 nanoparticles (nanogel). Application of the nanogel on a wound of preclinical mice model shows role of various signaling molecules and growth factors, and involvement of reactive oxygen species (ROS) at every stage, namely hemostasis, inflammation, and proliferation leading to complete maturation for the scarless wound healing. While in vitro characterization of nanogel using SEM, EDAX, and optical spectroscopy reveals pH regulated redox buffering capacity, in vivo preclinical studies on Swiss albino involving IL-12, IFN-γ, and α-SMA signaling molecules and detailed histopathological investigation and angiogenesis on every stage elucidate role of redox buffering for the complete wound healing process.

Prophylactic negative pressure wound therapy to improve wound healing rates following ileostomy closure: a randomized controlled trial.

Reversal of ileostomy is associated with morbidity including wound infection and prolonged wound healing. Negative pressure wound therapy (NPWT) has been shown to reduce time to wound healing by secondary intention. The aim of this study was to determine whether NPWT improved wound healing rates, compared with simple wound dressings, in patients undergoing reversal of ileostomy where the skin wound is closed with a purse-string suture. This was a dual-centre, open-label, randomized controlled trial with two parallel intervention arms. Patients undergoing elective loop ileostomy reversal were randomized 1:1 to receive NPWT or simple wound dressings. The primary endpoint of the study was assessment of complete wound healing at day 42 post reversal of ileostomy and the secondary endpoints were patient-reported wound cosmesis using a visual analogue scale and rates of surgical site infection (SSI). The study was conducted from June 2018 to December 2021. The trial was approved by the local ethics committee. We enrolled 40 patients, 20 in each arm. One patient in each arm was lost to follow up. Nine patients (9/19, 47.36%) in the simple dressing group had wound healing vs. 13 patients (13/19, 68.42%) in the NPWT group (P = 0.188). There was no significant difference in patient- reported wound cosmesis or SSI. There was no difference in wound healing rates when comparing NPWT to simple wound dressings at early and late time points post reversal of ileostomy, where the skin wound was closed with a purse-string suture.

Evaluation of the efficacy of the Z-plasty surgical technique vs. secondary wound healing mechanism in the treatment of the pilonidal sinus: a clinical trial.

The most important step in treating a pilonidal sinus is eradication by surgical excision. Over the years, various surgical techniques have been reported for wound closure, yet their management still poses a challenge. The current study compares the results of two different methods of wound management: secondary wound healing versus the Z-plasty surgical technique. The current clinical trial recruited 84 uncomplicated pilonidal sinus patients who were to undergo complete surgical excision of the pilonidal sinus. For wound healing, the 84 subjects were equally divided into two groups of 42 patients each. One group was selected for Z-plasty surgical wound closure and the other for the secondary healing mechanism. Outcomes measured consisted of demographic data, length of operation, complications, severity of pain, number of dressings, recurrence, and complete healing time. Age or sex distribution and the median BMI (kg/m²) did not significantly differ between the two groups. The length of the operation for Z-plasty subjects was significantly longer (P <0.0001). The median number of dressing changes for secondary wound healing patients was 38.69, which was significantly higher than the 4.95 dressing changes for the Z-plasty group. The total time recorded for complete wound healing was 21.61±4.27 days in the Z-plasty group and 41.23±24.28 days for secondary wound healing subjects, which was statistically significant. Twenty-four hours postoperation, patients in the secondary wound healing group had significantly more pain, and the Visual Analogue Scale scores of the Z-plasty and secondary wound healing groups were 3.42±0.76 and 6.09±1.2, respectively. Concerning the recurrence rate, there were no significant differences between the two groups. SPSS version 22 performed the analyses, and the independent t-test compared the continuous variables. A P value less than 0.05 was considered statistically significant. Z-plasty is a safe and effective procedure in terms of wound complications and recurrence rate. This method is also cost-effective and better received by patients.

Effects of Medicinal Plants Extracts in Healing Split-Thickness Skin Graft Donor Site Wounds: A Systematic Review of Randomized Clinical Trials

The literature on Split-Thickness Skin Graft (STSG) donor site dressings has not yet identified an ideal dressing, and most products tested by researchers for wound dressing are prohibitively expensive in Low- and Middle-income settings. Clinical trials using biological dressings have offered an alternative option for managing STSG donor sites wound. The aim of this systematic review is to find evidences regarding the effectiveness of medicinal plants on STSG donor site wound healing. A total of 249 papers were identified in the initial search. After removing duplicates and applying the inclusion and exclusion criteria, 6 Randomized Clinical Trials were deemed relevant and included in the final review. Over twenty years four medicinal plants have entered clinical trial to enhance STSG donor site wound healing. The medicinal plants reviewed have large effect size regarding time to complete wound healing and wound score. However, the effect size of Aloe vera regarding time to complete wound healing and pain control vary from study to study. No patient quality of life was assessed neither cost-effectiveness of these products. Medicinal plants are potential cost effective antimicrobial and wound healing products for STSG donor site wound dressing. However, more clinical researches including patient quality of life among outcome measures are needed.

Influence of chitosan and hydroxyethyl cellulose modifications towards the design of cross-linked double networks hydrogel for diabetic wound healing

The wound dressings' lack of antioxidant and antibacterial properties, and delayed wound healing limit their use in wound treatment and management. Recent advances in dressing materials are aimed at improving the limitations discussed above. Therefore, the aim of this study includes the preparation and characterization of oxidized hydroxyethyl cellulose (OHEC) and ferulic acid-grafted chitosan (CS-FA) hydrogel loaded with green synthesized selenium nanoparticles (Se NPs) (OHEC-CS-FA-Se NPs named as nanohydrogel) for diabetic wound healing. The structure and properties of the hydrogel was characterized by FTIR, FE-SEM, HR-TEM, EDAX, UV–Vis spectrophotometry, XRD, DLS, zeta potential and rheological studies. The findings of these experiments demonstrate that nanohydrogel possesses a variety of outstanding qualities, including an optimal gel time, good swelling characteristics, a fair water retention rate, a good degradation rate, and strong mechanical stability. Nanohydrogel has been shown to have a synergistic impact by significantly increasing antioxidant activity by scavenging ABTS and DPPH radicals. The nanohydrogel's strong biocompatibility was confirmed by cytocompatibility testing using L929 mouse fibroblast cells. In addition, the wound healing potential of nanohydrogel was tested on L929 cells by an in vitro scratch assay and the nanohydrogel showed a wound closure rate of 100 % after 12 h. In addition to this study, nanohydrogel has demonstrated significant antimicrobial properties against human and wound infection causing pathogens such as Bacillus subtilis, methicillin-resistant Staphylococcus aureus (MRSA), Escherichia coli, and Pseudomonas aeruginosa. In the animal model, almost complete diabetic wound healing was achieved on day 14 after application of the nanohydrogel. The results obtained indicate that the multifunctional bioactive nature of OHEC-CS-FA-Se NPs showed exceptional antioxidant and antibacterial potential for the treatment of infected and chronic wounds.

Human Fibroblast-Derived Matrix Hydrogel Accelerates Regenerative Wound Remodeling Through the Interactions with Macrophages.

Herein, a novel extracellular matrix (ECM) hydrogel is proposed fabricated solely from decellularized, human fibroblast-derived matrix (FDM) toward advanced wound healing. This FDM-gel is physically very stable and viscoelastic, while preserving the natural ECM diversity and various bioactive factors. Subcutaneously transplanted FDM-gel provided a permissive environment for innate immune cells infiltration. Compared to collagen hydrogel, excellent wound healing indications of FDM-gel treated in the full-thickness wounds are noticed, particularly hair follicle formation via highly upregulated β-catenin. Sequential analysis of the regenerated wound tissues disclosed that FDM-gel significantly alleviated pro-inflammatory cytokine and promoted M2-like macrophages, along with significantly elevated vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) level. A mechanistic study demonstrated that macrophages-FDM interactions through cell surface integrins α5β1 and α1β1 resulted in significant production of VEGF and bFGF, increased Akt phosphorylation, and upregulated matrix metalloproteinase-9 activity. Interestingly, blocking such interactions using specific inhibitors (ATN161 for α5β1 and obtustatin for α1β1) negatively affected those pro-healing growth factors secretion. Macrophages depletion animal model significantly attenuated the healing effect of FDM-gel. This study demonstrates that the FDM-gel is an excellent immunomodulatory material that is permissive for host cells infiltration, resorbable with time, and interactive with macrophages, where it thus enables regenerative matrix remodeling toward a complete wound healing.

Facilitating Healing in Diabetic Foot Ulcers Using Homeopathy in a Multi-Disciplinary Integrative Approach: Two Evidence-Based Case Reports.

A rising incidence of diabetic foot ulcers (DFUs) in India has escalated the rate of lower limb amputations in the country. The present study aims to evaluate the potential healing properties of homeopathic medicines as a part of the integrative management of DFUs through two evidence-based case reports. Two patients with DFUs, identified as Wagner grade 2, having had diabetes for 12 years, were treated with individualized homeopathic medicine within a multi-disciplinary approach. Both cases were on oral hypoglycemic agents for managing blood sugar, continued their diabetic medication, and were advised to use regular wound dressings. The DFUs were assessed using the Pressure Ulcer Scale for Healing (PUSH) score at baseline and every 4 weeks until complete wound healing. Neuropathic changes were evaluated by the 10g monofilament tactile test, and the Modified Naranjo Criteria for Homeopathy-Causal Attribution Inventory (MONARCH) tool was used to assess the likelihood of there being a causal relationship between clinical improvement and the homeopathic intervention. The DFUs showed healing within 12 weeks, with a significant improvement in the PUSH score, though there was no change in tactile sensation as assessed by the monofilament test. The MONARCH tool yielded +9 in both cases, indicating the likelihood of a causal relationship between the clinical outcome and homeopathic intervention. The homeopathic medicines Arsenicum album and Lachesis respectively were found useful by each patient. Homeopathy appeared beneficial in facilitating the early healing of DFUs within a multi-disciplinary integrative approach.

(133) Non-Occupational SCC of the Scrotum; Case Presentation and Management

Abstract Introduction Although the incidence of scrotal malignancies is extremely low Squamous cell carcinoma (SCC) is the most common scrotal malignancy. Its overall annual incidence is approximately 1.5 per 1,000,000 persons in Western countries. It was first linked to the chronic irritation of scrotal skin by the effect of soot in occurring in chimney sweepers hence known as the first described occupational disease. Occupational scrotal SCC was also later described in association with other occupations with chronic carcinogen exposure including cotton mule spinners, paraffin and tar workers, creosote workers, shale oil workers, lathe workers, pitch workers and machine tool setters and operators. Currently most cases result from poor hygiene and chronic inflammation Objective Herein we present a very rare case of SCC of the scrotum referred to us from Dermatology department Methods This 55 years old male patient was referred from dermatology department. He had no underlying occupational hazard. He has been treated for several months of itchy inflammation of the scrotumfor 6 months. Scrotal punch biosy showed moderately differentiated SCC. Clinically there was malignant scrotal ulcer of 4x3 cm with no palpable inguinal lymph nodes. CT staging confirmed localized tumor with no LN or metastatic deposits. Complete excision with 2 cm safety margin confirmed to be negative by frozen section. Final histopathology come to be moderately differentiated SCC pT2Nx. All margins and underlying Dartos were free of tumor infiltration. Results Complete excision could be achieved with intra-operative negative frozen section. Uneventful post-operative course with complete healing of scrotal wound. Conclusions Although rare, scrotal SCC continues to be serious urogenital malignancy which should be suspected even in the absence of occupational exposure. Cooperation and awareness of Dermatologists is important for early detection and management of such rare malignancy. Complete excision with safety margin is usually sufficient for cure. Inguinal Lymphadenectomy is indicated if grossly infiltrated Disclosure No.

Dermal Regeneration Template in the Management and Reconstruction of Burn Injuries and Complex Wounds: A Review.

Dermal scaffolds have created a paradigm shift for burn and wound management by providing improved healing and less scarring, while improving cosmesis and functionality. Dermal regeneration template (DRT) is a bilayer membrane for dermal regeneration developed by Yannas and Burke in the 1980s. The aim of this review is to summarize clinical evidence for dermal scaffolds focusing on DRT for the management and reconstruction of burn injuries and complex wounds. A comprehensive search of PubMed was performed from the start of indexing through November 2022. Articles reporting on DRT use in patients with burns, limb salvage, and wound reconstruction were included with focus on high-level clinical evidence. DRT has become an established alternative option for the treatment of full-thickness and deep partial-thickness burns, with improved outcomes in areas where cosmesis and functionality are important. In the management of diabetic foot ulcers, use of DRT is associated with high rates of complete wound healing with a low risk of adverse outcomes. DRT has been successfully used in traumatic and surgical wounds, showing particular benefit in deep wounds and in the reconstruction of numerous anatomical sites. Considerable clinical experience has accrued with the use of DRT beyond its original application for thermal injury. A growing body of evidence from clinical studies reports the successful use of DRT to improve clinical outcomes and quality of life across clinical indications at a number of anatomical sites.

Hyperbaric Oxygen Therapy for Diabetic Foot Ulcers Based on Wagner Grading: A Systematic Review and Meta-analysis.

Diabetic foot ulcers (DFUs) are common complications of uncontrolled diabetes mellitus that can result in infection and amputation of the lower extremities. This study compared the benefits and risks of hyperbaric oxygen therapy with those of other DFU treatments, based on the Wagner grading system. Systematic searches for randomly controlled trials using hyperbaric oxygen therapy for DFUs were performed using PubMed, the Cochrane Library, and Embase. Data regarding demographics, wound healing, minor and major amputations, operative debridement, nonhealing wounds, and adverse effects were analyzed based on Wagner grades, using RevMan 5.4.1 and Microsoft Excel. Hyperbaric oxygen therapy was significantly superior to other treatments for wound healing rates 8 or more weeks after the final treatment (RR = 2.39; 1.87-3.05; P < 0.00001) minor/distal amputations (RR = 0.58; 0.43-0.80; P < 0.007), and major/proximal amputations (RR = 0.31; 0.18-0.52; P < 0.00001) for the 14 studies analyzed. In addition, this therapy increased the rate of complete wound healing for Wagner grades II (RR = 21.11; 3.05-146.03; P = 0.002), III (RR = 19.58; 2.82-135.94, P = 0.003), and IV (RR = 17.53; 2.45-125.44; P = 0.004); decreased the minor/distal amputation rate for grade III (RR = 0.06; 0.01-0.29; P = 0.0004) and the major/proximal amputation rate on for grade IV (RR = 0.08; 0.03-0.25; P < 0.0001); and decreased the operative debridement rate for Wagner grade II (RR = 0.09; 0.01-0.60; P = 0.01). Moderate-quality evidence revealed that adjunctive hyperbaric oxygen therapy improved DFU wound healing for Wagner grades II, III, and IV; prevented minor and major amputations for grades III and IV, respectively; and prevented operative debridement in grade II wounds.

Benefits of Collaboration Between the Wound, Ostomy, and Continence Nurse and Orthopedic Surgeon When Treating Skin Defects After Soft Tissue Sarcoma Resection: A Retrospective Case-Control Study.

The purpose of this study was to evaluate the benefits of collaborative management between orthopedic surgery and WOC nurses in patients undergoing resection of subcutaneous sarcomas. Retrospective case-control study. The sample comprised 25 patients who underwent wide resection for soft tissue sarcoma, followed by 2-stage split-thickness skin grafting. Data collection occurred between January 2015 and April 2021 in a university hospital based in Kagoshima, Japan. For comparison, we categorized these patients into 2 groups: intervention group participants were managed by an orthopedic surgeon and a WOC nurse; nonintervention group members were managed without WOC nurse participation. Patient background and treatment-related information was retrospectively collected from medical records and compared between the WOC nurse intervention group and the nonintervention group, including maximum tumor diameter, surgical time, maximum skin defect diameter, length of hospital stay, and time from surgery to complete wound healing. The average length of hospital stay was significantly shorter in the WOC nurse intervention group compared with the nonintervention group (38.3 days, SD = 8.0 vs 47.1 days, SD = 10.2; P = .023). Collaborative wound management with a WOC nurse resulted in a shorter hospital length of stay when compared to traditional management with WOC nurse involvement. Based on these findings, we assert that WOC nurses provide an important bridge between postoperative wound management in patients undergoing resection of subcutaneous sarcomas.

Formulation and Test of Burns Healing Effects of Preparations Cream Extract Leaf Nangka Kuning (Vincetoxicum villosum (Blume) Kuntze)

V. villosum (Blume) Kuntze shows inhibition of the growth of Pseudomonas aeruginosa which is usually the cause of infection in burn wounds. The aim of this research was to formulate V. villosum (Blume) Kuntze leaf extract into a cream preparation and determine the time needed for V. villosum (Blume) Kuntze leaf extract cream to heal burn wounds in rabbits. This research was a type of experimental research. The research was conducted at the University of Bengkulu Laboratory in September 2022-August 2023. The equipment used was the Ohaus Starter 3100 brand pH meter and the NDJ-8S viscometer. The materials used are V. villosum (Blume) Kuntze leaf extract, mice, ethanol solvent. Oil-in-water (O/W) phase cream formulation with 3 variations of stearic acid and triethonolamine emulsifiers (15:4), (16:3) and (17:2). Then the three formulas were evaluated for their preparations which included organoleptic tests, homogeneity tests, pH tests, adhesion tests, spreadability tests, viscosity tests and descriptive stability tests. The activity test against burn wound infections used rabbits consisting of groups K1 (without treatment), K2 (given 0.2% hyaluronic acid cream), P1 (given 2% V. villosum (Blume) Kuntze leaf extract), and P2 (given 2% V. villosum (Blume) Kuntze leaf extract cream). Groups K2, P1 and P2 showed perfect wound healing on day 12. Meanwhile group K1 experienced incomplete wound healing until day 14. Based on the results of the study it can be concluded that the cream formulations I, II and III were declared stable at a temperature of 25º and the extract cream Kuntze V. villosum (Blume) Kuntze leaves showed complete wound healing in 12 days. The results of the Kruskal Wallis test obtained p value = 0.670 &gt; 0.05, which means there is no difference in the length of the healing process for all treatments.

Efficacy of Marham-e-Dakhilyun Ointment and Alum Perineal Wash for Perineal Wound Healing and Pain Intensity in Postpartum Women: A Self-control Clinical Trial

Background and Objective:: Episiotomy, worldwide, is the most frequently performed obstetric surgical procedure. Delayed wound healing potentially amplifies the risk of wound infection, structural muscular alterations, and ultimately contributes to the loss of muscle tone. In addition, rapid and complete repair of the episiotomy or perineal tear is very important as the pain and discomfort of episiotomy wounds may affect the quality of life of postnatal mothers. Therefore, we aimed to determine the efficacy of Marham-e-Dakhilyun ointment and alum perineal wash on perineal wound healing and pain intensity in postnatal mothers. Materials and Methods:: A single-arm self-controlled study was conducted on postnatal mothers aged 18 to 40 years, who underwent full-term normal cephalic singleton vaginal delivery with episiotomy and/or 1st, 2nd, or 3rd-degree perineal tears. The recommended external care regimen for a period of 10 days involved perineal wash with a solution of alum powder (2 gm/500ml), followed by the application of Marham-e Dakhilyun ointment twice daily to the perineal wound. For the primary evaluation of wound healing, the REEDA (redness, edema, ecchymosis, discharge, and approximation) scale has been utilized, while the secondary assessment involved the use of the VAS (visual analog scale) pain intensity scale. The therapeutic outcome was determined based on the grading of REEDA scores on days 10-14 and VAS scores. Results:: We observed our trial medicine showed complete wound healing in 86.4% on days 10- 14. The mean pain reduction percentage (PR %) was 96.85% on days 10-14 from baseline. The REEDA score was 2.41±0.81 and 0.23±0.61 at one hour and day 10-14, respectively, with significant differences (p &lt; 0.001). The VAS score was 2.86±1.08 and 0.09±0.29 at one hour and day 10-14, respectively, with significant differences (p &lt; 0.001). Therefore, the trial ointment and alum have demonstrated beneficial effects in promoting perineal wound healing and alleviating pain in postnatal mothers. Conclusion:: The potential efficacy of Marham-e-Dakhilyun can be attributed to its composition of various phytoconstituents, such as oleuropein, phenolic acids, flavonols, flavones, linoleic acid isovitexin, vitexin vanillic acid, salicylic acid, beta-D-glucopyranoside, olanigroside Y1, solasonine, gallic acid, aucubin, scopoletin, and lantamajoside. These constituents have been proven in research studies to possess anti-inflammatory, wound healing, antimicrobial, analgesic, and antioxidant properties. The investigators have optimized the use of these Unani medicines to provide clinical evidence supporting their effectiveness in the wound-healing process and in reducing pain intensity.

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

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

Clinical outcomes of reposition flap transfer for fingertip amputation.

This study aimed to describe the reposition flap for reconstructing fingertip amputation when replantation is not possible. This study retrospectively reviewed the records of patients with reposition flap transfers and investigated postoperative clinical outcomes and patient satisfaction. Sixteen patients with fingertip amputations treated with a reposition flap from 2016 to 2020. The mean age at injury was 46years (range, 26-70years). Ten cases were treated with oblique triangular advancement flaps, 3 with retrograde-flow digital artery flaps, and 3 with thumb palmar advancement flaps. Postoperative outcomes, including wound healing period and the IP/PIP extension angle, and the presence of grafted bone absorption and patient satisfaction were evaluated as of 3years after surgery. The average reduction in passive extension angle of the IP/PIP joint was 19°. The average time for complete wound healing was 28days (range, 18-41days). The reduction in passive extension angle of the IP/PIP joint was significantly correlated with the wound healing period (r = 0.66, p = 0.01). The absorption of the grafted bone was observed in 3 cases. In these cases, the distal tip of the flap became thin due to flap retraction and an insufficient flap volume. All patients were highly or fairly satisfied with the results of surgery. Our findings show that IP/PIP flexion contracture can occur due to delayed wound healing after reposition flap transfer, but the patient satisfaction level was generally high. Therefore, reconstruction using a reposition flap gives acceptable clinical outcomes and high patient satisfaction as a result of medium to long-term.

Effectiveness of Ya-Samarn-Phlae in diabetic wound healing: Evidence from in vitro studies and a multicenter randomized controlled clinical trial

Ethnopharmacological relevanceYa-Samarn-Phlae (YaSP) has traditionally been widely used in southern Thailand for treating chronic and infected wounds, including diabetic foot ulcers. However, there are only a limited number of clinical studies supporting the use of this polyherbal formulation. Therefore, the present work aims to provide clinical evidence to support the application of YaSP, prepared according to a standardized traditional procedure (T-YaSP). Additionally, its potential chemical markers and wound healing-related biological activities were examined. Materials and methodsThe in vitro wound healing-related biological activities of YaSP ethanol extract and T-YaSP, including antibacterial activity against Staphylococcus epidermidis, inhibition and eradication of staphylococcal biofilm, anti-inflammatory effects, and enhancement of human dermal fibroblast migration in scratch wounds, were examined using well-established protocols. The chemical profiles of the ethanol extract of YaSP and T-YaSP were compared, and with promising chemical markers, arecoline, alpha-mangostin, and curcumin were selected and quantified using the HPLC method. A prospective, multicenter, randomized, controlled, parallel-group study was conducted over 12 weeks to evaluate the efficacy of the YaSP solution as an adjunct therapy, combined with standard wound care, for diabetic ulcers compared to standard treatment. ResultsThe YaSP extract reduces NO production and can scavenge NO radicals in LPS-induced RAW 264.7 macrophage cells. Additionally, in a scratch assay, this extract and one of its herbal components, Curcuma longa, enhance the migration of human dermal fibroblasts. T-YaSP, containing 2.412 ± 0.002 mg/g of arecoline, 2.399 ± 0.005 mg/g of curcumin, and 0.017 ± 0.000 mg/g of α-mangostin, has shown the ability to inhibit the development and eradicate the mature biofilm of S. epidermidis. The use of T-YaSP as an adjunct therapy led to a significantly higher proportion of patients achieving healing within six weeks compared to the standard treatment group (36%/9 patients vs. 4%/1 patient; p = 0.013). After 12 weeks, 19 out of 25 patients in the T-YaSP group experienced complete healing, whereas only four patients in the standard treatment group achieved complete wound healing (76% in the T-YaSP group vs. 16% in the control group; p < 0.001). ConclusionThe results presented here represent the first randomized controlled trial to demonstrate the effectiveness of the traditional polyherbal solution, T-YaSP, which exhibits a wide range of wound healing-related activities. Utilizing T-YaSP as an adjunctive treatment resulted in a significant improvement in the number of type 2 diabetic patients achieving complete healing. However, to explore and utilize YaSP further, conducting a double-blind, randomized controlled trial with a larger population is necessary.

The Effects of Cellular Skin Substitutes on Diabetic Foot Ulcer Healing: A Systematic Review

Introduction: Diabetic foot ulcer (DFU) is one of the most common lower extremity diabetes-related complications. New therapies have been developed to increase the likelihood of wound healing and reduce complications, including biological and/or synthetic grafts that allow a temporary or permanent occlusion of wounds. Although their efficacy has been demonstrated, novel skin substitutes have been available, and few studies have described the head-to-head comparative effectiveness of those products. Therefore, this mini-review aims to analyze the available randomized clinical trials studying the impact of different cellular skin products on the healing of DFUs. Methods: The databases PubMed, EMBASE, Scopus, Scielo, and Lilacs were assessed from inception to July 30th, 2023, to identify randomized clinical trials on the effects of cellular skin substitutes on ulcer healing in adult patients aged 18 years or older with DFUs restricted to the skin and subcutaneous tissue, compared to standard of care or other skin substitutes. Results: Based on eligibility criteria, 22 articles were selected. These studies showed the efficacy and safety of cell skin substitutes compared to standard treatments, as demonstrated by the reduction in the total area of the ulcer and rates of complete wound healing. We identified a few studies with head-to-head comparisons among those products. Discussion: Cellular skin substitutes have shown promising results in healing DFUs as complementary therapies to the standard of care. Their incorporation into standard-of-care treatments could be discussed. Future studies should focus on head-to-head comparisons, cost-effective analysis, and long-term efficacy and safety.