Complete Re-epithelialization Research Articles

Natural cross-linker-stabilized acellular porcine corneal stroma for lamellar keratoplasty

Acellular porcine corneal stroma (APCS) is a promising alternative to human donor cornea for lamellar keratoplasty (LKP). However, the detergents, enzymes and physical forces used during decellularization unavoidably alter the cornea's extracellular matrix composition and disrupt its ultrastructure, making it less mechanically stable and liable to degradation both in vitro and in vivo. Herein, we systematically analyzed the low biomechanics and easy degradability of APCS in terms of structure and protein composition. Then, we introduced natural cross-linkers, namely proanthocyanidin (PA), epigallocatechin-3-gallate and genipin, to stabilize the APCS that exhibited color variations during crosslinking. Then, we developed a protective crosslinking system by combining cross-linkers with bovine serum albumin (BSA) to reduce color change, maintain transparency and improve the mechanical property of APCS. PA/BSA-crosslinked APCS (PA/BSA-APCS) shows favorable corneal transparency and swelling property; the improved overall and surface corneal biomechanics were comparable to those of human cornea, revealing strong resistance to enzymatic degradation and good biocompatibility. Results from LKP in the rabbit model showed complete re-epithelialization without graft melting, the stitches were scarcely loosened after the operation and more host keratocytes had migrated in PA/BSA-APCS at six months post-operation. Therefore, PA/BSA-APCS could be useful as a corneal substitute for tissue regeneration and the protective crosslinking system could be applicable in other bioengineering fields.

The Role of Recombinant Proteins and Growth Factors in the Management of Diabetic Foot Ulcers: A Systematic Review of Randomized Controlled Trials.

Background Recombinant proteins and growth factors are emerging therapies for diabetic foot ulcers. Despite several clinical reports, there has been no comprehensive and systematic assessment of the totality of clinical evidence on the efficacy and safety of recombinant proteins and growth factors in diabetic foot ulcers. We tried to address this gap through an updated systematic review of randomized controlled trials (RCTs). Methods PubMed, the Cochrane Library, Scopus, Embase, and Google Scholar databases were searched, and RCTs on the efficacy of recombinant proteins and growth factors in the treatment of cutaneous wounds in diabetic patients were selected. The literature search and assessment were performed by two independent reviewers. Methodological quality of studies was appraised using the Jadad scale. Results We identified 26 RCTs involving diabetic patients with ulcer that evaluated the effectiveness of platelet-derived growth factor, epidermal growth factor, fibroblast growth factor, granulocyte colony-stimulating factor, vascular endothelial growth factor, erythropoietin, transforming growth factor, talactoferrin, and rusalatide acetate. The main primary outcome was complete healing though different indices were employed to define this such as wound closure, granulation tissue formation, or complete reepithelialization. Few studies had a follow-up period to report any recurrence and amputation rate. No adverse effect was reported due to the intervention. Conclusion Overall, there is a greater agreement on the effectiveness of EGF to enhance the healing of diabetic ulcers. Nevertheless, extant evidence is lacking for other agents since few trials have been conducted for most of the growth factors and available studies are heterogeneous in their methodologies.

Multifunctional Chitosan/Polycaprolactone Nanofiber Scaffolds with Varied Dual-Drug Release for Wound-Healing Applications.

Electrospinning-based wound dressings with multifunctional properties, including hemostasis-promoting, antibacterial, drug release, and therapeutic effects, are of great interest in military and civilian trauma healthcare. Herein, we designed lidocaine hydrochloride (LID) and mupirocin-loaded chitosan/polycaprolactone (CSLD-PCLM) scaffolds with multiple functions as wound dressings. Through the dual spinneret electrospinning technique, the scaffolds achieved a nanofiber structure, which enhanced the interfacial interaction between the scaffold and blood cells and showed excellent blood coagulation capacity. In particular, the scaffolds loaded with LID and mupirocin exhibited rapid release of LID and sustained release of mupirocin. The CSLD-PCLM scaffold containing mupirocin exhibited outstanding antibacterial activity. Moreover, the scaffold significantly enhanced the wound healing process with complete re-epithelialization as well as collagen deposition in a full-thickness skin defect model. Thus, CSLD-PCLM nanofibrous scaffolds may ideally meet the various requirements of the wound healing process and are promising candidates for wound dressings in future clinical applications.

Evidence supporting the enhanced efficacy of pentavalent antimonials with adjuvant therapy for cutaneous leishmaniasis: a systematic review and meta-analysis.

Cutaneous leishmaniasis (CL) is one of the major neglected disease worldwide. Although many drugs have been used, the pentavalent antimonials (PA) remain as the first-line choice despite their toxicity and limited efficacy. The combination of two drugs has risen as a potential alternative to increase the cure rate while lowering the side-effects caused by pentavalent antimonials (PA). The objective of this study was to critically review and appraise the potential synergism of the adjuvant therapies of PA with other drugs/interventions previously used in the literature. We carried out a search of literature from PubMed, MEDLINE, Embase, Cochrane and clinicaltrials.gov. Articles that described a two-arm or three-arm design in which one of the arms consisted in a combination of a drug/intervention with intralesional or systemic PA were selected. The primary outcome was proportion of complete clearance of the lesions defined as complete re-epithelization and/or negative direct smear. Our literature search identified 554 references. Thirty-one records with a total sample size of 2668 participants met the eligibility criteria. The studies investigated the association of PA with the following: cryotherapy (five studies), allopurinol, imiquimod, pentoxifylline (four studies each), trichloroacetic acid 50% (three studies) and other additional interventions (eleven studies). Overall, the combined therapy of PA with a supplementary intervention was superior to PA monotherapy (RR: 1.23 95% CI: 1.11-1.35, I2 =64%). In association with PA, the comparator-specific stratified analysis showed that cryotherapy (RR: 1.50 95% CI: 1.25-1.81, I2 =57%) and allopurinol (RR: 1.70 95% CI: 1.37-2.12, I2 =28%) were superior to PA in monotherapy. On the contrary, the combined therapy with imiquimod (RR: 1.08 95% CI: 0.88-1.32, I2 =40%) and pentoxifylline (RR: 1.14 95% CI: 0.94-1.40, I2 =41%) revealed a non-significant result. The application of TCA along with PA did not show significant differences in the clearance rate, although it was close to it (RR: 1.31 95% CI: 0.99-1.73, I2 =84%). The present work represents an attempt to find new and reliable treatment modalities to enhance the efficacy based on the adjuvant therapy of pre-existing drugs/interventions with PA. According to our results, the combination of allopurinol-PA is the most effective adjuvant therapy. The application of cryotherapy and TCA stand as useful and encouraging supplementary interventions. The combination of imiquimod-PA and pentoxifylline adds no additional benefit. The results of this work may be helpful in devising and modifying the current guidelines for CL which face major remaining evidence gaps. Triple therapies consisting in cryotherapy-PA-TCA or allopurinol-PA-cryotherapy or allopurinol-PA-TCA can represent promising treatments yet to be confirmed in future trials.

Microporous Drug Delivery System for Sustained Anti-VEGF Delivery to the Eye.

PurposeTo describe a novel microporous drug delivery system (DDS) for sustained anti- vascular endothelial growth factor (VEGF) delivery to the eye and to evaluate its efficacy in a corneal injury model.MethodsA macro-porous DDS (1.5 × 1.5 × 4 mm) loaded with 2 mg of bevacizumab was implanted subconjunctivally in three Dutch-belted pigmented rabbits after corneal alkali injury (2N NaOH). Three rabbits received sham DDS. Animals were followed for three months and assessed in vivo and ex vivo for corneal neovascularization (NV), epithelial defect, stromal scarring, endothelial cell loss, and expression of angiogenic and inflammatory markers in the cornea and retina.ResultsAnti-VEGF DDS treatment led to complete inhibition of superior cornea NV and complete corneal re-epithelialization by day 58 whereas sham DDS resulted in severe cornea NV and persistent epithelial defect (9%∼12% of total cornea area) through the end of the study. Histologically, anti-VEGF DDS significantly reduced CD45+ and F4/80 CD11b+ cell accumulation (79%, P < 0.05) in the cornea, ameliorated tumor necrosis factor–α expression (90%, P < 0.05), reduced corneal stromal scarring and prevented corneal endothelial cell loss, as compared to sham DDS. Moreover, anti-VEGF DDS achieved retinal penetration and reduction in retinal VEGF levels at 3 months.ConclusionsUse of subconjunctival anti-VEGF DDS suppresses cornea NV, inflammation, stromal scarring, prevents endothelial cell loss, and abrogates retinal VEGF upregulation in a rabbit corneal alkali burn model. Moreover, it delivers anti-VEGF antibodies to the retina for three months. This delivery platform could enable antibody therapy of other corneal and retinal vascular pathologies.Translational RelevanceWe describe a method for sustained anti-VEGF delivery to the eye for the treatment of ocular injuries.

The comparision of glybenclamide and metformin-loaded bacterial cellulose/gelatin nanofibres produced by a portable electrohydrodynamic gun for diabetic wound healing

Wound dressings made from natural polymers are an important aspect of biomaterials. Protein-based materials are less likely to instigate an immunogenic response and have the capacity to degrade in vivo, also without triggering an inflammatory response. Therefore, gelatin (GEL) was chosen and combined with bacterial cellulose (BC) to produce nanofibres and the potential of an all-natural polymer construct was determined. GEL and BC were successfully electrospun with metformin (Met) and glybenclamide (Gb) using a portable, point of need electrospinning set up. The virgin fibre group exhibited a significant effect on the proliferation of L929 (mouse fibroblast) cells but all fibre samples can safely be applied on wound site without risk of cytotoxicity. According to the results obtained by animal tests, the GEL-BC-Gb group showed better recovery than the GEL-BC-Met group. Diabetic wounds treated with GEL-BC-Met were characterized by moderate re-epithelialization and partially organized granulation tissue. Moderate to complete re-epithelialization and well-formed granulation tissue were observed in diabetic wounds treated with GEL-BC-Gb. The histologic scores obtained on day 14 confirmed that the GEL-BC-Gb group played a stronger wound-healing role compared to the GEL-BC-Met group. The highest decrease of TNF-α level was observed in the GEL-BC-Gb group at the end of the experiment but there is no significant difference between drug-loaded fibre groups. Therefore, topical administration of Met and Gb in a sustained release form has a high potential for diabetic wound healing with high bioavailability and fewer systemic side effects but Gb showed better improvement according to the results of the animal tests.

Fluorescence biomodulation in the management of acute traumatic wounds in two aged dogs

Traumatic wounds represent a fairly common reason for the admission of dogs to a veterinary practice. In elderly patients, the management of wound healing can be challenging due to both the concurrent diseases and impaired physiological states, potentially resulting in delayed healing and chronic or non-healing wounds. The aim of this article is to describe an innovative therapy based on photobiomodulation (PBM) for the management of acute traumatic wounds with significant tissue loss in aged dogs. Two mixed breed dogs were presented with similar wounds in the cervical region and were managed with a fluorescence biomodulation system, a form of PBM, which consists of a photoconverter topical gel that is illuminated with a blue light-emitting diode lamp, applied on a weekly basis. Wound closure was achieved after 9 and 16 weekly treatments, respectively, with a complete re-epithelisation of the skin. This fluorescence-generating system is an innovative, non-invasive, wound care therapy and these results indicate it could be successfully applied in the management of acute traumatic wounds with tissue loss in dogs.

Amnion and collagen-based blended hydrogel improves burn healing efficacy on a rat skin wound model in the presence of wound dressing biomembrane.

A burn wound is one of the most frequent and devastating injuries for patients which requires extensive care. Early treatment of burn wounds improves healing significantly. This study was designed to investigate the efficacy of amnion and collagen-based hydrogels on cutaneous burn wound healing in rats with covering membrane. We prepared a novel cell free hydrogel comprising human amnion, rabbit collagen, carboxymethyl cellulose sodium salt, citric acid, methyl paraben, propyl paraben, glycerin and triethanol amine. The wound covering membrane was developed from rabbit collagen and prawn shell chitosan. Beside swelling ratio, water absorption, equilibrium water content, gel fraction and spreadability analysis, in vitro cytotoxicity and biocompatibility tests were performed for the formulated hydrogels. Following the skin irritation study, second-degree burns were created on the dorsal region of the rats and the gels were applied with/without covering membrane to study the wound contraction and re-epithelialization period. The formulated hydrogels were observed non-cytotoxic and compatible with human blood cells. No erythema and edema were found in skin irritation assay confirming the safety and applicability. Hydrogel consisting in a combination of amnion and collagen demonstrated significantly rapid wound healing, driven by complete re-epithelialization (16.75 ± 0.96 days) and closure by wound contraction (72 ± 3.27%, P < 0.0000009) when wound dressing membrane was used, whereas this gel alone healed about 62.5 ± 4.43% (P < 0.00001) and required 18.75 ± 0.50 days to complete re-epithelialization. Additionally, the gel with covering membrane treated group had maximum average body weight, food and water intake. The amnion and collagen-based blended gel offers alternative possibilities to treat skin wounds when covered with film, which could overcome the limitations associated with modern therapeutic products such as high costs, long manufacturing times, complexities, storing, and presence of living biomaterials.

Effectiveness of a single treatment of photodynamic therapy using topical administration of 5-aminolevulinic acid on methicillin-resistant Staphylococcus aureus-infected wounds of diabetic mice

Methicillin-resistant Staphylococcus aureus (MRSA) is the most important representative pathogen which causes clinically relevant infections in diabetic ulceration. We report our investigations on the efficacy of antimicrobial photodynamic therapy with topical 5-aminolevulinic acid (ALA-PDT) on diabetic murine infected wound models induced with a MRSA SA325 strain. A solution of 10 % 5-aminolevulinic acid (ALA) was placed into the wounds followed by delivery of 25 J/cm2 (635 nm). The ALA-PDT treated wounds healed earlier as compared to others (P < 0.5). A significant reduction of bacterial counts (2.05 logs) was detected in wounds after ALA-PDT on Day 2 (P < 0.5). Additionally, histological analysis revealed that wounds treated with ALA-PDT exhibited a more complete re-epithelialization, blood micro-vessels, collagen-volume fraction and considerable decrease in inflammatory cells infiltration. Immunohistochemistry assay demonstrated considerable reduction of proinflammatory cytokines interleukin-1β (IL-1β), earlier expression of vascular endothelial growth factor A (VEGF-A), increase of basic fibroblast growth factor (bFGF) and Ki-67 in the ALA-PDT group (P < 0.5). These data imply that the therapeutic effect of ALA-PDT revealed an accelerated diabetic wound closure rate, together with reduced hyperinflammatory response and elevated growth factors.

Natural Cross-Linkers Stabilizedacellular Porcine Corneal Stroma for Lamellar Transplantation

Acellular porcine corneal stroma (APCS) is a promising alternative to human donor cornea for lamellar keratoplasty (LKP). However, the detergents, enzymes and physical forces during decellularization unavoidably alter cornea extracellular matrix composition and disrupt its ultrastructure, making it less mechanically stable and liable to degradation in vitro and in vivo. Herein, we systematically analyzed the low biomechanics and easy degradability of APCS from structure and protein composition. Then, we introduced natural cross-linkers to stabilize the APCS that exhibited color variations during cross-linking. Herein, we developed a protective cross-linking system by combining cross-linkers with bovine serum albumin (BSA) to reduce color change, maintain transparency, and improve the mechanical properties of APCS. Proanthocyanidin (PA)/BSA-cross-linked APCS showed favorable corneal transparency and swelling property; the improved overall and surface corneal biomechanics were comparable to those of human donor cornea, revealing good cytocompatibility and strong resistance to enzymatic degradation. Results from corneal micropocket implantation indicated that the PA/BSA-cross-linked APCS gets more corneal stroma cells migrated and LKP in the rabbit model showed complete re-epithelialization without graft melt, and the stitches had scarcely loosened one month after the operation. The proposed method may provide more stable cornea substitutes and be applicable in other bioengineering fields.

Accelerated Corneal Cross-linking as an Adjunct Therapy in the Management of Presumed Bacterial Keratitis: A Cohort Study.

To compare the outcomes of accelerated photoactivated chromophore for keratitis corneal cross-linking (PACK-CXL) as an adjunct treatment for bacterial keratitis (PACK-CXL plus standard antibiotic therapy) for patients receiving only standard antibiotic therapy. Retrospective cohort study of outcomes of patients with moderate infectious presumed bacterial keratitis (ulcer diameter 2 to 7 mm and stromal depth < 300 µm) were compared before and after initiation of a new treatment protocol of PACK-CXL in addition to standard antibiotic treatment. A total of 70 eyes of 70 patients were included: 39 eyes in the PACK-CXL plus antibiotic (PACK-ABX) group and 31 eyes in the antibiotic only (ABX) control group. The PACK-ABX group showed shorter times to complete reepithelialization (9.3 ± 6.0 vs 16.0 ± 12.7 days, P = .01) and did not require tectonic emergency keratoplasty (0% versus 19.4%, P = .006). The PACK-ABX group also showed a higher percentage of eyes with complete reepithelialization in 6 days or less (46.2% vs 6.5%, P < .001) and a trend for shorter hospitalizations (6.3 ± 5.0 vs 8.5 ± 4.5 days, P = .06). A multivariate analysis controlling for age showed that PACK-ABX treatment remained significantly associated with early ulcer reepithelialization (odds ratio = 0.09, 95% confidence interval = 0.02 to 0.48, P = .005). This study validates previous findings regarding the use of accelerated PACK-CXL in the treatment of bacterial keratitis. Adding PACK-CXL improved clinical outcomes (reducing healing time) when compared to antibiotics alone. [J Refract Surg. 2020;36(4):258-264.].

Polyethylene‐glycol chitosan hydrogel accelerates traumatic wound healing in diabetic mice

Wounds are considered a public health problem worldwide; it represents a significant economic impact on health systems. Diabetic lesions, microvascular dysfunction, trauma and burns, are some factors related to poor repair. Nowadays in regenerative medicine, biocompatible biomaterials (e.g., hydrogels) have proven been effective in regenerative processes. Therefore, preformed synthetic matrices could be a therapeutic alternative to accelerate wound repair.Objectiveto evaluate the Polyethylene‐glycol chitosan hydrogel (hg‐PEGDA‐Q) effect on traumatic wounds. Two CD1 mice (10 weeks, n = 5) were used: healthy control (CT) and with alloxan‐induced Diabetes Mellitus (DM) (200 mg / kg). Under anaesthesia, two traumatic dorsal wounds separated by 1 cm (diameter (⌀) 5 mm, area 19.63mm2) were caused to each mouse: a) without treatment (WT) (proximal wound) and b) with hydrogel PEGDA‐Q (⌀ 5 mm, thickness 2 mm, distal wound). The macro and microscopic evolution were evaluated on 12 postoperative day. For analyse the macroscopic images were rescaled through a vernier and ImageJ software (1: 1 mm scale). hg‐PEGDA‐Q matrix was synthesized by sequential method and photopolymerization.Resultsin CT group, hg‐PEGDA‐Q decreased the diameter and area with respect to untreated wound (hg‐PEGDA‐Q vs. WT) (⌀ 2.71 ± 0.64 mm vs. 3.71 ± 0.27 mm; area 5.79 ± 1.67 mm2 vs. 9.23 ± 1.97 mm2). In DM group, the same behaviour was observed with hydrogel (DM hg‐PEGDA vs. DM‐WT) (⌀ 3.04 ± 0.64 mm vs. 3.90 ± 0.29mm; area 6.29 ± 2.35 mm2 vs. 12.01 ± 3.66 mm2). Regarding initial diameter (5 mm, day 0), in control group, wound retraction (WR) was (hg‐PEGDA‐Q 45% vs. WT 25%), while in diabetic group WR was (hg‐PEGDA‐Q 39% vs. WT 21%). Comparing the initial area (19.63 mm2 at day 0), in control group the WR was (hg‐PEGDA‐Q 70% vs. WT 52%), while in DM group the WR was (hg‐PEGDA‐Q 67 % vs. WT 38%). Histomorphological analysis: hg‐PEGDA‐Q generated complete reepithelialization and dermo‐epidermal changes suggesting an advanced wound healing process compared to control group without treatment. DM group treated with hg‐PEGDA‐Q changes were similar, however consolidation was lower. In contrast DM WT group, reepithelialization and wound consolidation were deficient. Results indicate PEGDA‐Q hydrogel scaffolding network could be a therapeutic alternative to accelerate healing processes in normal and diabetic conditions

Effect of the topical Klox fluorescence biomodulation system on the healing of canine surgical wounds.

To determine the effect of the Klox fluorescence biomodulation system (Phovia) on the healing of surgical wounds. Prospective, blinded, controlled clinical trial. Healthy dogs undergoing orthopedic surgery (n = 10). Half of the length of each surgical wound was treated with Phovia, and the remaining 50% was treated with saline solution on the first day after surgery and every 3 days until day 13. Wound healing of treated and control areas within each wound was evaluated via macroscopic assessment and histological and immunohistochemical analysis of treated and control wounds. The areas treated with Phovia achieved lower histology scores (P = .001), consistent with complete re-epithelialization, less inflammation of the dermal layer, and greater and more regular deposition of collagen. According to immunohistochemistry, expression of factor VIII, epidural growth factor, decorin, collagen III, and Ki67 was increased in treated compared with untreated tissues. Phovia therapy improved re-epithelialization, decreased dermal inflammation, and improved matrix formation in uncomplicated cutaneous incisional wounds by regulating the expression of key biological mediators. Phovia may be a beneficial adjunct to promote the healing of incisional wounds.

Alvogyl and absorbable gelatin sponge as palatal wound dressings following epithelialized free gingival graft harvest: a randomized clinical trial.

This randomized controlled trial compares for the first time effects of Alvogyl versus absorbable gelatin sponge as palatal wound dressings on postoperative pain, amount of analgesic consumption, post-surgical bleeding, and wound re-epithelization. Following sample size calculation, 36 systemically healthy patients requiring palatal mucosal graft harvesting were randomized to receive Alvogyl (intervention group, 18 patients) or absorbable gelatin sponge (control group, 18 patients) palatal dressings. Patient-reported VAS pain scores over 2weeks were defined as primary outcome. Post-surgical bleeding, number of analgesics consumed, and complete re-epithelialization of the palatal wound for up to 5weeks were defined as secondary outcomes. Although significantly higher VAS pain scores were reported in the control as compared with the intervention group up to 12days post-surgically (from (median [range]) 8.5 [2-10] to 1 [0-2] and from 6 [0-10] to 0 [0-2] respectively), with higher analgesics consumption (from 2 [1-3] to 1 [0-3] and from 1 [0-3] to 0 [0-2] tablets respectively), a multivariate regression analysis considering age, gender, graft width/length, tissue thickness, analgesics intake, and dressing type demonstrated no statistically significant effect of any factor, including dressing type on VAS pain scores. At 4weeks, 22.2% of patients in the intervention group versus 11.1% in the control group demonstrated complete re-epithelization of their palatal engraftment site, before complete re-epithelization in both groups at 5weeks. No post-surgical bleeding was reported with both dressings. Within the study's limitations, results suggest Alvogyl as a practical palatal surgical dressing, comparable with absorbable gelatin sponge in cost, pain reduction, hemostasis, and re-epithelization properties. www.ClinicalTrials.gov Identifier: NCT03402321 CLINICAL RELEVANCE: Alvogyl could present a novel palatal wound dressing material, comparable with gelatin sponge.

A87 A NEW ERA: CIRCUMFERENTIAL ENDOSCOPIC SUBMUCOSAL DISSECTION FOR EARLY ESOPHAGEAL NEOPLASM AND BARRET’S ERADICATION

Abstract Background Endoscopic submucosal dissection (ESD) has become increasingly important over the last few years as the treatment of choice for early gastrointestinal malignancies. Esophageal adenocarcinoma is among the most rapidly rising malignancies associated with a poor 5-year survival rate. ESD is emerging as a novel minimally invasive treatment for superficial esophageal neoplasms. However, with increasing circumference of dissection, the rate of stricture increases with over 90% stricture rate reported with complete circumferential ESD (cESD). Currently, for superficial Barrett’s neoplasms the dysplastic lesion is resected and subsequent eradication of remaining Barrett’s is with radiofrequency ablation over multiple sessions. Aims To report on a case of cESD for intramucosal carcinoma and Barrett’s eradication with one procedure with the application of prophylactic dual steroid treatment (DST) for prevention of stricture. Methods We present the case of a 62-year-old female with C1M5 Barrett’s esophagus with pathology confirming high grade dysplasia with a focus suspicious for intramucosal adenocarcinoma. Staging CT excluded metastatic disease. Repeat endoscopy with magnification revealed multiple areas with highly irregular vascular and surface patterns with premature loss of acetowhitening reaction consistent with multifocal at least high-grade dysplasia. Subsequently, the entire segment of Barrett’s was removed via cESD. Histopathologic analysis of the resected tissue confirmed multifocal high grade disease with margins negative for dysplasia or intestinal metaplasia. The patient was started on DST with oral prednisone and topical (swallowed) budesonide along with sucralfate as prophylactic measures to prevent luminal stricturing. Results During the re-epithelization period the patient required 2 prophylactic dilations. Five months post-ESD, full clinical, endoscopic and histopathologic healing had been observed. There was complete squamous re-epithelization with normal squamous mucosa without stricture. The patient remains on a yearly endoscopic surveillance protocol. Conclusions cESD represents a novel therapeutic strategy for the definitive histologic and endoscopic eradication of superficial esophageal neoplasms along with remaining Barrett’s. In this patient, there were no complications and significant stricturing was prevented with DST. Multiple prior studies have assessed single steroid therapy as a therapeutic option for strictures. In this report, DST represents a novel regime in preventing severe strictures post cESD. Longer term follow-up and further reports are needed to confirm these findings. Funding Agencies None

Treatment of a Traumatic Equine Wound Using Nile Tilapia (Oreochromis niloticus) Skin as a Xenograft

Background: Wounds are disruptions of the normal continuity of anatomic structures, generally due to local trauma. They are extremely prevalent in animals, especially horses, and a common reason for seeking veterinary attention. Their management aims to restore the function and integrity of the affected area in the shortest possible time and cost, while providing satisfactory cosmetic results. This task becomes challenging when working with horses, considering the contact between wounds and contaminated environment is common. Thus, the present study aims to report the case of a traumatic equine wound treated with Nile Tilapia Fish Skin (NTFS).Case: A male 27-year-old horse previously castrated, with no defined breed (NDB), and weighing 400 kg presented a 6.0 x 5.5 cm superficial wound in the distal left anterior limb (LAL) due to skin laceration. The animal belonged to the cavalry of the Military Police of Ceará, a public institution in Fortaleza, Brazil. Although in excellent general health, with no previous comorbidities or restriction of movement, the animal was removed from its role in equine-assisted therapy (EAT) until complete wound healing, aiming adequate evaluation of the novel biomaterial via lower influence of external factors. After informed consent from the owner was obtained, Nile Tilapia Fish Skin was applied to the lesion. The Ethics Committee on the use of animals of the Drug Research and Development Center of the Federal University of Ceará, Fortaleza, Brazil, approved the study protocol. Compliance with regulations on the ethical treatment of animals was performed. Nile Tilapia Fish Skin application followed a protocol similar to that established in human clinical studies. Initially, the horse was submitted to wound cleaning with tap water and 2% chlorhexidine gluconate, with no requirement of pre-treatment surgical debridement, as there was no area of necrosis. Before application, the biomaterial was washed thrice in sterile 0.9% saline for 5 min, allowing glycerol removal. Only one sample was required. Coverage of 1 cm of healthy skin in wound borders was performed to ensure movement inthe first days of treatment or xenograft retraction after adherence to wound bed would not lead to uncovering of any affected area. The xenograft was then covered with a secondary dressing (i.e., dry gauze and regular bandage), followed by an elastic bandage, in order to reduce the risk of contamination and allow proper adherence. After seven days, when the secondary dressing was removed, it was observed the xenograft remained intact and well adhered to the wound bed. The patient’s distal LAL was washed with tap water and 2% chlorhexidine, and the xenograft was easily removed, exposing the wound bed. Clinical evaluation revealed remarkable improvement in the aspect of the lesion, with a decrease in the amount of granulation tissue and no significant presence of exudate. The above-cited findings motivated us to continue adopting the same protocol, which was repeated every seven days. On day 42 of treatment, after six applications of NTFS, wound reepithelialization was found to be complete, with no side effects detected on the animal, which successfully returned to its regular activities.Discussion: The current study demonstrates the potential of NTFS as a practical and low-cost dressing option for the management of accidental wounds in horses. The treated animal showed complete reepithelialization of the lesion, with satisfactory cosmetic and functional outcomes and no allergic reactions or toxicities. Also, no signs of discomfort (e.g., burning and itching) were detected, considering the patient did not try to remove the secondary dressing on its own and consistently respected the changing times.

Use of ovine acellular peritoneal matrix combined with honey and ovine fetal skin extract in the healing of full-thickness infected burn wounds in a rat model.

Treatment of infected burn wounds remains a challenge in burn units. Silver-sulfadiazine (SSD) is the most commonly used topical antimicrobial agent in managing these wounds. We aimed to accelerate the healing of burn wounds by combined application of ovine acellular peritoneal matrix (OAPM), honey (H), and ovine fetal skin extract (OFSE). Sixty-four standardized burn wounds were created on the dorsum of 16 rats and were subsequently inoculated with Staphyloccocus aureus and Pseudomonas aeruginosa. After 48 hr, the wounds were surgically debrided and received either physiologic saline (control group) or SSD, OAPM+SSD, OAPM+H+SSD, and OAPM+H+OFSE+SSD. The healing wounds were evaluated for size, bacterial counts, histopathology, and biomechanical properties on days 3, 7, 14, 21, and 28 after surgery. All treatments had effectively reduced the level of S. aureus and P. aeruginosa on wounds compared to the control group by day 3 and 7. The wounds treated with combined application of OAPM+H+OFSE+SSD demonstrated considerable inflammation reduction, fibroplasia, complete re-epithelialization, and wound contraction together with significantly lesser scar tissue formation. Treatment with OAPM+H+OFSE+SSD showed superior biomechanical properties of the healing wounds. The findings suggested that the synergistic effect of dressing the wounds with OAPM, H, and OFSE was a very effective approach in accelerating the healing process of the experimentally induced infected full-thickness burn wounds in rats.

The use of autologous epidermal grafts for diabetic foot ulcer emergencies: A clinical study.

There are various surgical and invasive treatment systems such as conservative skin grafts and autologous epider-mal grafting (AEG) for diabetic foot ulcers. This study aims to evaluate the feasibility of using a novel epidermal graft harvesting system in diabetic foot ulcer emergencies. A retrospective clinical study was conducted with 15 diabetic foot ulcer patients, and after written and signed consent forms were taken, AEG system was applied to all patients. All of the clinical data of the patients such as their American Society of Anesthesiologists (ASA) Physical Status Classification System scores, size of pre-application wound area (cm2), time to complete re-epithelization of the wound, pain scores using the visual analog scale (VAS) for both donor and recipient sites, changes in size of wound, complete dermal response time, and patients' demographics, comorbidities were recorded. The age, gender, pre-post appli-cation wound area (cm2), time of healing, ASA, and VAS variables were compared each other and analyzed statistically. P<0.05 was considered as statistically significant. The mean of time for complete wound healing was 5.9 (range 4-8) weeks. There was no statistically difference between recipient wound size and patient's age; size of both types of wounds (cm2) and time (weeks) for complete reduction for both types of wounds; and time to complete both types of wound healing and gender (p=0.509, 0.788, and 0.233, respectively). ASA scores did not impact the time required for complete healing of the wound (p=0.749). The current study has tried to evaluate the efficacy of the AEG system in a homogenous population with diabetic foot ulcers. An epidermal harvesting system may be used effectively and safely in patients with diabetic foot ulcer emergencies.

A comparative clinical study of collagen and paraffin gauze dressing on skin donor site

Background: Split skin grafting (SSG) is a commonly performed plastic surgical procedure. It is done to cover wounds, defects from excision of cutaneous lesions, donor sites of fascio-cutaneous flaps. The harvest of a split thickness skin graft causes a partial thickness injury. Complete re-epithelialization occurs in 10-14 days, although the rate may be affected by the local wound environment. However, tissue desiccation and infection can convert a partial thickness injury to a full thickness loss. Aims and Objectives: The purpose of the study was to determine the best method of dressing the donor site split-thickness graft between conventional paraffin gauze dressing and collagen-based dressings with respect to the rate of healing, pain, secretion, infection, and cost. Settings and Design A hospital based Non-Randomized control trial was conducted in a tertiary hospital setup in Manipur, India, for a period of 2 years. This study was done on 60 patients who underwent split skin graft procedure. Materials and Methods: The selected sample will be divided into two groups. The donor site dressing was done in two different ways. One was dressed with collagen sheet and the other with paraffin gauze dressing. The two groups were compared on the basis of post-operative pain, complication, and healing. Statistical analysis Statistical analysis was done by using IBM SPSS Version 21 for windows. Descriptive statistics such as mean, proportion, percentage were used to present the result. Chi square test was used to see the association of proportions. Student's t- test and repeated ANOVA were used for the continuous variables. P-value Conclusion: In this study it was found that dressing the donor site for split-thickness graft with collagen-based dressings gave better results with respect to the rate of healing and post-operative pain scores than conventional paraffin gauze dressing.

The Morphology of Re-epithelized Skin Following Experimental Open Wound in Wistar Rat Treated with Vitellaria paradoxa Oil

Aims: The present study assessed the morphology of re-epithelized skin following experimental open wound in rat model treated with Vitellaria paradoxa oil.&#x0D; Place and Duration of Study: Anatomy Department, Olabisi Onabano University, Ago Iwoye and Biochemistry Department, Ladoke Akintola University of Technology, Ogbomoso, Nigeria between June, 2018 and March, 2019.&#x0D; Methodology: Excision wounds were surgically created on three groups of ten rats each (II-IV). Group I was assigned as normal control (no surgery), Group II was treated with Vitellaria paradoxa oil, Group III was treated with Dermazin and Group IV was treated with distilled water. Area (cm3) of the wound were measured on days 3, 6 and 9, the rate of wound healing, re-epithelization of the skin were assessed histologically while the thickness of the granular cells layer and the organization of the epidermal squamous cells were evaluated morphologically, the level of collagen was determined in the wounds treated with Vitellaria paradoxa oil and compared with the collagen level in wound treated with distilled water and dermazin.&#x0D; Results: The wound areas significantly (P &lt; 0.05) reduced in V. paradoxa oil treated group indicating the comparative efficacy of V. paradoxa oil. Histological observations indicated gradual and complete re-epithelization of the skin in Vitellaria paradoxa oil treatments group. Increased in collagen deposition in V. paradoxa oil treated group is also observed (P &lt; 0.05).&#x0D; Conclusion: The results of this morphology indicated that V. paradoxa oil is a good potential in re-epithelization of open wound with no clinical disadvantage such as body weight, rectal temperature, packed cell volume using rats as animal model.