Deep Wound Research Articles

Effectiveness of Autodermoplasty in Combination with Injection of Autological Stromal-Vascular Cell Fraction in Treatment of Deep Burns

Introduction. The use of autologous stromal-vascular cell fraction of adipose tissue seems to be one of the promising technologies to increase the effectiveness of skin grafting and other skin restoration options in burnt patients. The main regenerative component of the stromal-vascular fraction are mesenchymal stem cells, which have a high reparative potential and low immunogenicity.The aim of the study was to increase the effectiveness of surgical treatment of patients with skin burns through the injection of autological stromal-vascular cell fraction of the adipose tissue.Materials and methods. The study was conducted as part of a prospective, open, randomized study involving 61 patients with extensive skin burns treated in burn centers Dzhanelidze Saint-Petersburg Research Institute of Emergency Medicine and Vishnevsky National Medical Research Center of Surgery, Ministry of Health of Russia, in 2021-2023. Cells of the stromal-vascular fraction of the adipose tissue were obtained mechanically and enzymatically. The prepared cell suspension was introduced into the granulation tissue during skin grafting with split autodermal grafts having a high perforation coefficient. During the study, planimetric parameters, as well as the results of histological and immunohistochemical tests, were assessed. The obtained findings were processed using generally accepted algorithms of variation and descriptive statistics. The alternative hypothesis was accepted at p0.05.Results. The proposed technique of autologous stromal-vascular cell fraction of the adipose tissue with simultaneous autodermoplasty with a split perforated graft allowed reducing the time of perforating cell epithelization by 28% (p0.05), the time of final engraftment by 11% (p0.05), the frequency of infectious complications in the postoperative period by 20% (p0.05), as well as the frequency of lysis and rejection reactions by 15% (p0.05). As stated, the introduction of an autologous stromal-vascular fraction during skin grafting resulted in early relief of the inflammatory reaction in the area of a deep burn wound, the fact being supported by clinical, cytological, histological and immunohistochemical tests.Conclusion. The use of cells from the stromal-vascular fraction of the adipose tissue can significantly increase the effectiveness of surgical treatment of patients with extensive skin burns. The proposed technique to obtain and apply the stromal-vascular fraction of the adipose tissue at the stage of autodermoplasty can be introduced into clinical practice in both burn centers and surgical/trauma departments, since it does not require special equipment.

Predominant Use of Bilateral Internal Mammary Arteries in Off-Pump Coronary Artery Bypass Surgery

Bilateral internal mammary artery (BIMA) in coronary artery bypass grafting (CABG) has been shown to provide long-term clinical benefits over single internal mammary artery (SIMA) grafting. Nevertheless, the perceived technical complexity of the procedure and concerns about potential early postoperative complications, particularly sternal wound infections have led to a utilization rate of BIMA grafting of less than 5% in the United States. We systematically compared early (30-day) post-operative outcomes between the BIMA and SIMA cohorts in patients with similar baseline characteristics. A retrospective single center study was conducted on matched patients, using stabilized inverse probability treatment weighting to mitigate bias between the two study cohorts. From 546 off-pump CABG patients initially identified, we examined 328 BIMA and 213 SIMA grafts from the matched samples. Despite utilizing 60.4% BIMA grafts, we observed similar rates of 30-day overall and cardiac mortality between the BIMA and SIMA groups. Rates of 30-day postoperative complications, including superficial and deep sternal wound infections, stroke, sepsis, acute kidney injury, and cardiac arrest, were similar between the two groups. Rates of 30-day overall and cardiac readmission were also similar. Additionally, median length of hospital stays, intensive care unit stay, and ventilation times were similar between the two groups. In conclusion, our data suggest that a BIMA utilization rate of 60.4% in off-pump CABG procedure is achievable without causing any significant increment in early post-operative complications, including deep sternal wound infection.

Phage therapy combined with Gum Karaya injectable hydrogels for treatment of methicillin-resistant Staphylococcus aureus deep wound infection in a porcine model

Skin and soft tissue infections (SSTIs) represent a significant healthcare challenge, particularly in the context of increasing antibiotic resistance. This study investigates the efficacy of a novel therapeutic approach combining bacteriophage (phage) therapy with a gum Karaya (GK)-based hydrogel delivery system in a porcine model of deep staphylococcal SSTIs. The study exploits the lytic activity and safety of the Staphylococcus phage 812K1/420 of the Kayvirus genus, which is active against methicillin-resistant Staphylococcus aureus (MRSA). The GK injectable hydrogels and hydrogel films, developed by our research group, serve as effective, non-toxic, and easy-to-apply delivery systems, supporting moist wound healing and re-epithelialization. In the porcine model, the combined treatment showed asynergistic effect, leading to a significant reduction in bacterial load (2.5 log CFU/gram of tissue) within one week. Local signs of inflammation were significantly reduced by day 8, with clear evidence of re-epithelialization and wound contraction. Importantly, no adverse effects of the GK-based delivery system were observed throughout the study. The results highlight the potential of this innovative therapeutic approach to effectively treat deep staphylococcal SSTIs, providing a promising avenue for further research and clinical application in the field of infections caused by antibiotic-resistant bacteria.

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

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

Coblation Versus Surgical Debridement Against MRSA Infection in Wounds With Shrapnel: A Preliminary Study.

Debridement plays a critical role in wound management. In addition to removing necrotic tissue, debridement can eliminate bacteria frequently harbored within the tissue. This study evaluated a novel debridement method that uses plasma-based radiofrequency technology to remove tissue and bacteria. Coblation is a technology that uses radiofrequency energy to excite the electrolytes in a conductive medium, such as saline, to create a precisely focused plasma. This plasma field contains highly energized particles that possess sufficient energy to break tissue molecular bonds, causing the tissue to dissolve at relatively low temperatures (typically 40 °C to 70 °C). Eighteen deep dermal wounds measuring 22 mm × 22 mm × 3 mm deep were created on pigs. Wounds were inoculated with methicillin-resistant Staphylococcus aureus USA300 (MRSA USA300) in combination with shrapnel and then covered with a polyurethane dressing for 24 hours. Wounds were then randomly assigned to one of the 3 treatment groups: (1) Coblation, (2) surgical debridement, and (3) no debridement. Wounds were biopsied on days 0, 5, 9, and 12, and specimens were processed for MRSA counts using selective media. Statistical analysis was performed using IBM SPSS statistics 27 using one-way ANOVA. Comparison between coblation and surgical debridement showed a decrease in bacterial count in all assessment times. The lowest bacterial count in all assessment times was observed in wounds debrided with coblation showing a statistically significant (P ≤ .05) decrease in more than 2 Log CFU/g on days 0, 5, and 9 compared to no debridement. On day 12, coblation-debrided wounds exhibited 6.10 ± 0.22 Log CFU/g, and this value represents 99.99% of reduction compared with non-debrided wounds (P ≤ .05). More than 96% of reduction (P ≤ .05) resulted in wounds treated with coblation compared with surgically debrided. Reducing MRSA bacterial infection counts, especially of biofilm-associated organisms, in combination with shrapnel may have important clinical implications, especially for the military personnel. Further research into the use of this technology in wound management is warranted.

Development of bovine serum albumin-modified Fe3O4 embedded in porous α-ketoglutaric acid/chitosan (BSA/Fe3O4@KA/CS): A magnetically targeted hemostatic dressing for deep and irregular wounds

Severe bleeding from deep and irregular wounds poses a significant challenge in prehospital and surgical settings. To address this issue, we developed a novel chitosan-based hemostatic dressing with a magnetic targeting mechanism using Fe3O4, termed bovine serum albumin-modified Fe3O4 embedded in porous α-ketoglutaric acid/chitosan (BSA/Fe3O4@KA/CS). This dressing enhances hemostasis by magnetically guiding the agent to the wound site. In vitro, the hemostatic efficacy of BSA/Fe3O4@KA/CS is comparable to that of commercial chitosan (Celox™) and is not diminished by the modification. In vivo, BSA/Fe3O4@KA/CS demonstrated superior hemostatic performance and reduced blood loss compared to Celox™. The hemostatic mechanism of BSA/Fe3O4@KA/CS includes the concentration of solid blood components through water absorption, adherence to blood cells, and activation of the endogenous coagulation pathway. Magnetic field targeting is crucial in directing the dressing to deep hemorrhagic sites. Additionally, safety assessments have confirmed the biocompatibility and biodegradability of BSA/Fe3O4@KA/CS. In conclusion, we introduce a novel approach to modify chitosan using magnetic guidance for effective hemostasis, positioning BSA/Fe3O4@KA/CS as a promising candidate for managing various wounds.

Structural and Functional Salvaging of Traumatic Brachial Artery Cut with Multiple Nerve Cut: Case Series

Upper limb arterial injury is relatively rare among trauma cases. Among them, the majority is contributed by brachial artery injury. Brachial artery injury is associated with nerve injuries given that its anatomical course, which brings a significant impact to the patient. We reported 2 cases of patients who sustained a deep laceration wound over the right upper limb. Both presented to the Emergency department with active bleeding over the wound, and clinically cold right hand, associated with absent radial and ulnar pulses with profound sensory and motor deficit. Wound exploration and brachial artery repair with reverse saphenous vein interposition graft, followed by structural and nerve repair. This case series highlighted the importance of prompt detection and intervention of brachial artery injury. Any further delay might result missing the golden hour of revascularization for the patients. It also showed the importance of consideration of limb salvage in a patient who was deemed Rutherford III, especially nerve cut was uncertain. In conclusion, prompt intervention of traumatic brachial artery injury and proper intraoperative assessment are mandatory to properly decide if a limb is salvageable or not.

Optimum Timing of Tracheostomy After Cardiac Operation: Descriptive Claims Database Study

BackgroundSuitable tracheostomy timing after cardiac operation remains controversial; hence, this study compared the effectiveness of early and late tracheostomy after cardiac operation. MethodsBy using the nationwide administrative claims database in Japan, patients who underwent cardiac operation between April 2010 and March 2020 were identified and included in this study. In-hospital mortality, incidence of deep sternal wound infection, and ventilator-free days were analyzed and compared by dividing patients into 2 groups: an early group (patients who underwent tracheostomy 1-14 days postoperatively) and a late group (patients who underwent tracheostomy 15-30 days postoperatively). Baseline characteristics were adjusted by propensity score weighting. ResultsOf 1240 patients who underwent cardiac operation and postoperative tracheostomy, 784 were included in the main analysis cohort. As the number of days between the operation and tracheostomy increased, in-hospital mortality increased, whereas ventilator-free days decreased. The early and late groups comprised 284 and 326 patients, respectively. After adjustment of baseline characteristics, the in-hospital mortality (odds ratio, 0.65; 95% CI, 0.46-0.91; P = .01) was lower in the early group than in the late group, the incidence of deep sternal wound infection (odds ratio, 0.59; 95% CI, 0.23-1.52; P = .27) was not significantly different between the 2 groups, and the early group had more ventilator-free days compared with the late group (mean difference, 5.1; 95% CI, 3.6-6.5; P < .001). ConclusionsEarly tracheostomy may be considered in patients expected to require prolonged ventilation.

Effects of ON101 for Hard-to-Heal Diabetic Foot Ulcers in a Randomized Phase III Trial: A Post Hoc Analysis.

Objective: Hard-to-heal diabetic foot ulcers (DFUs) are associated with higher mortality rates and an increased medical burden for patients. ON101, a new topical cream, exhibited better healing efficacy than the control dressing in a Phase III trial. In this post hoc analysis, we further identify whether ON101 can improve the healing of ulcers with hard-to-heal risk factors in this cohort of DFU patients. Approach: To compare the efficacy of ON101 with absorbent dressing among various hard-to-heal wounds in patients with DFU, a post hoc analysis of a randomized Phase III trial that included 276 DFU patients was performed by subgrouping those patients based on ulcer depth, location, size, duration, and patients' glycated hemoglobin (HbA1c) levels and body mass index (BMI). Results: In the full analysis set, the proportion of patients achieving healing was 61.7% in the ON101 group and 37.0% in the comparator (p = 0.0001). In subgroup analysis according to risk factors, ON101 demonstrated superior healing capacity on Wagner grade 2 ulcers (p < 0.0001); plantar ulcers (p = 0.0016), ulcer size ≥5 cm2 (p = 0.0122), ulcer duration ≥3 months (p = 0.0043); for patients with HbA1c ≥9% (p = 0.0285); and patients with BMI ≥25 (p = 0.0005). Innovation: ON101, a novel therapeutic drug, can modulate the functions of macrophages and demonstrate superior healing rates to conventional absorbent dressing in patients with hard-to-heal DFUs. Conclusions: The results of this post hoc study suggest that ON101 is a better therapeutic option than conventional dressing used in treatment for DFU patients with higher HbA1c, BMI, or ulcers with complex conditions such as longer duration, deeper wounds, larger size, and plantar location.

Limited debridement combined with ReCell® Techniques for deep second-degree burns.

The purpose of this article is to introduce a method that combines limited debridement and ReCell® autologous cell regeneration techniques for the treatment of deep second-degree burn wounds. A total of 20 patients suffered with deep second-degree burns less than 10% of total body surface area (TBSA) who were admitted to our department, from June 2019 to June 2021, participated in this study. These patients first underwent limited debridement with an electric/pneumatic dermatome, followed by the ReCell® technique for secondary wounds. Routine treatment was applied to prevent scarring after the wound healed. Clinical outcomes were scored using the Vancouver Scar Scale (VSS). All wounds of the patients healed completely. One patient developed an infection in the skin graft area and finally recovered by routine dressing changes. The average healing time was 12 days (range: 10-15 days). The new skin in the treated area was soft and matched the colour of the surrounding normal skin and the VSS score ranged from 3~5 for each patient. Of the 20 patients, 19 were very satisfied and 1 was satisfied. This article reports a useful treatment method that combines electric dermatome-dependent limited debridement and the ReCell® technique for the treatment of deep second-degree burn wounds. It is a feasible and effective strategy that is easy to implement and minimally invasive, and it is associated with a short healing time, mild scar formation and little damage to the donor skin area.

An Optical Tomography-Based Score to Assess Pediatric Hand Burns

To define the morphologic pattern of pediatric hand burns as visualized via optical coherence tomography (OCT) and dynamic OCT (D-OCT). We designed a scoring system to assess the depths of burn wounds on pediatric hands and tested this score in our cohort of children with burn injuries to the hand. Overall, 67 hand burns in 48 children (0–15 years) were prospectively examined. Scans were interpreted by two independent observers. Relevant OCT findings were surface irregularity, loss of epidermis, loss of dermal pattern (skin lines or papillary spots, loss of surface regularity and irregular vascular pattern of the plexus papillaris. Score values were calculated retrospectively. A score of 4 was associated with spontaneous healing without the need for skin grafting, with a positive predictive value of 97%. Deeper wounds with delayed healing and/or the need of skin grafting received a score of 5 or above, with an agreement of medical healing in 80% and a positive predictive value of 56%. OCT and D-OCT provide clinically useful additional information in cases of pediatric hand burns. The OCT burn score has the potential to support clinical decision making and, subsequently, improve clinical outcomes and shorten hospital stays.

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

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

Contemporary morbidity and mortality of open versus robotic cystectomy for bladder cancer: An analysis of the National Surgical Quality Improvement Program (NSQIP) procedure targeted cystectomy database

ObjectivesTo evaluate the association between surgical modality (RARC vs. ORC) and the risk of 30-day complications. Materials and MethodsWe utilized the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) Cystectomy-Targeted database from 2019 to 2021. The primary outcome was a composite of major complications including 30-day mortality, reoperation, cardiac events, and stroke. Secondary outcomes included individual major and cystectomy-specific complications. Propensity score matching (PSM) was employed to minimize inherent differences within our cohort. We performed logistic regression to assess the association between outcomes of interest and operative modality. ResultsWe found no difference between operative modality and the primary outcome, however, RARC was associated with a 70% lower risk of 30-day mortality (OR 0.30, 95% CI 0.13-0.70) and had favorable outcomes with respect to respiratory, deep venous thrombosis, wound complications, and length of stay. Limitations are related to residual confounding given the observational methodology. ConclusionsRARC was associated with reduced risk of multiple 30-day complications, including mortality, as well as organ system and cystectomy-specific outcomes. These data support the clinical benefit of increased adoption of RARC.

The Application of a Synthetic Biodegradable Temporizing Matrix in Extensive Burn Injury: A Unicenter Experience of 175 Cases.

Objectives: Addressing extensive and deep burn wounds poses considerable challenges for both patients and surgeons. The NovoSorb® Biodegradable Temporizing Matrix (BTM) emerged as a novel dermal substitute and has been subjected to evaluation in large burn wound cases, with a specific focus on identifying risk factors associated with suboptimal take rates. Methods: All patients with burn wounds greater than 10% body surface that underwent BTM treatment between March 2020 and November 2023 were eligible for inclusion. Univariate analyses and linear regression models were employed to discern risk factors and predictors influencing the take rates of both the BTM and split-thickness skin grafts (STSGs). Results: A total of 175 patients (mean age 56.2 ± 19.8 years, 70.3% male) were evaluated. The mean take rates of the BTM and STSGs were 82.0 ± 24.7% and 87.3 ± 19.0%, respectively. There were significant negative correlations between BTM take and the number of surgeries before BTM application (r = -0.19, p = 0.01), %TBSA and STSG take (r = -0.36, p = <0.001) and significant positive correlations between BTM and STSG take (r = 0.41, p ≤ 0.001) in addition to NPWT and STSG take (r = 0.21, p = 0.01). Multivariate regression analyses showed that a larger number of surgeries prior to BTM application (OR -3.41, 95% CI -6.82, -0.03, p = 0.04) was associated with poorer BTM take. Allograft treatment before BTM application (OR -14.7, 95% CI -23.0, -6.43,p = 0.01) and failed treatment with STSG before BTM application (OR -20.8, 95% CI -36.3, -5.23, p ≤ 0.01) were associated with poorer STSG take, whereas higher BTM take rates were associated with overall higher STSG take (OR -0.15, 95% 0.05, 0.26, p = 0.01). The Meek technique was used in 24 patients and showed similar take rates (BTM: 76.3 ± 28.0%, p = 0.22; STSG: 80.7 ± 21.1, p = 0.07). Conclusions: This study summarizes our findings on the application of a BTM in the context of large burn wounds. The results demonstrate that successful treatment can be achieved even in patients with extensive burns, resulting in satisfying take rates for both the BTM and STSG. The data underscore the importance of promptly applying a BTM to debrided wounds and indicate good results when using Meek.

Nanotechnology: “Advancing Material Science and Medicine”

Nanotechnology has been a rapidly growing field of advanced science at the inception of this century. Nanotechnology of advanced materials, polymers, principally revolves around endeavours to plan materials at a sub-atomic level to accomplish alluring properties and applications at a naturally visible level. Nanotechnology can be used for the advancement of technologies, ranging from communication and information, health and medicine, future energy, environment and climate change to transport and cultural heritage, personal protective equipment (PPE), fuels, fuel cells, biosensors, disease sensors etc. Nanomaterials will lead to a new approach to manufacturing materials and devices. Faster computers, advanced pharmaceuticals, controlled drug delivery, biocompatible materials, nerve and tissue repair, crackproof surface coatings, better skin care and protection, more efficient catalysts, better and smaller sensors, even more efficient telecommunication. For example, a low risk solution using antibody modified bismuth nanoparticle, in combination with an X-ray dose equivalent to a chest X-ray specifically, has been shown to kill the common bacterium Pseudomonas aeruginosa in a set up designed to resemble a deep wound in human tissue. Nanosized gold particle could catalyse the oxidation of carbon monoxide better than anything previously known. Heparin functionalized nanoparticles have been use for targeted delivery of anti-malarial drugs. Heparin is abundant and cheap, compared to treatments that involve antibodies, an important consideration, since malaria is most common in developing countries. A bone repairing nano-particle paste has been developed that promises faster repair of fractures and breakages. DNA containing two growth genes is encapsulated inside synthetic calcium phosphate nanoparticles. In a remarkable demonstration of the extreme limits of nanoscale engineering, researchers have used the tip of a scanning tunnelling microscope to cleave and form selected chemical bonds in a complex molecule. Many medicinal and industrial endeavours have seen the use of Nanotechnology. Nanoparticles can attach to SARS COV-2 viruses, disrupting their structure and so kill the virus. These and other more recent advances in nanotechnology will be presented at this conference.

Skin graft with dermis and appendages generated in vivo by cell competition

Autologous skin grafting is a standard treatment for skin defects such as burns. No artificial skin substitutes are functionally equivalent to autologous skin grafts. The cultured epidermis lacks the dermis and does not engraft deep wounds. Although reconstituted skin, which consists of cultured epidermal cells on a synthetic dermal substitute, can engraft deep wounds, it requires the wound bed to be well-vascularized and lacks skin appendages. In this study, we successfully generate complete skin grafts with pluripotent stem cell-derived epidermis with appendages on p63 knockout embryos’ dermis. Donor pluripotent stem cell-derived keratinocytes encroach the embryos’ dermis by eliminating p63 knockout keratinocytes based on cell-extracellular matrix adhesion mediated cell competition. Although the chimeric skin contains allogenic dermis, it is engraftable as long as autologous grafts. Furthermore, we could generate semi-humanized skin segments by human keratinocytes injection into the amnionic cavity of p63 knockout mice embryos. Niche encroachment opens the possibility of human skin graft production in livestock animals.

CuCS/Cur composite wound dressings promote neuralized skin regeneration by rebuilding the nerve cell “factory” in deep skin burns

Regenerating skin nerves in deep burn wounds poses a significant clinical challenge. In this study, we designed an electrospun wound dressing called CuCS/Cur, which incorporates copper-doped calcium silicate (CuCS) and curcumin (Cur). The unique wound dressing releases a bioactive Cu2+-Cur chelate that plays a crucial role in addressing this challenge. By rebuilding the “factory” (hair follicle) responsible for producing nerve cells, CuCS/Cur induces a high expression of nerve-related factors within the hair follicle cells and promotes an abundant source of nerves for burn wounds. Moreover, the Cu2+-Cur chelate activates the differentiation of nerve cells into a mature nerve cell network, thereby efficiently promoting the reconstruction of the neural network in burn wounds. Additionally, the Cu2+-Cur chelate significantly stimulates angiogenesis in the burn area, ensuring ample nutrients for burn wound repair, hair follicle regeneration, and nerve regeneration. This study confirms the crucial role of chelation synergy between bioactive ions and flavonoids in promoting the regeneration of neuralized skin through wound dressings, providing valuable insights for the development of new biomaterials aimed at enhancing neural repair.

A Randomized Study Evaluating Clinical Efficacy and Safety of Trusteel® and Ethisteel® Surgical Steel Sutures for Sternal Closure in Subjects Undergoing Surgical Procedures by Sternotomy.

Sternal dehiscence and other post-sternotomy complications, viz. superficial and deep sternal wound infection, mediastinitis, and sternal instability increase the risk of mortality. Sternotomy closure with steel sutures results in a low complication rate. Therefore, this study compared the clinical equivalence of Trusteel® (Healthium Medtech Limited, Bengaluru, India) and Ethisteel® (Ethicon, Johnson & Johnson,Cincinnati, USA) surgical steel sutures for sternal closure following median sternotomy. The primary endpoint of this prospective, single-blind, multicentric, two-arm, randomized (1:1) study (April 2021-April 2023) was a comparison of the proportion of subjects having sternal dehiscence within 26 weeks of the median sternotomy closure between Trusteel® (n=33) and Ethisteel® (n=34) groups. Secondary endpoints comprisedan assessment of intraoperative suture handling, the incidence of mortality and other complications of sternal closure, operative time, intensive care unit (ICU)/hospital stay, return to normal day-to-day activities and work, subject satisfaction and general well-being, and adverse events in both groups. A statistically significant result between the groups was considered at p<0.05. No incidence of sternal dehiscence or other post-operative complications were recorded. A significant difference (p<0.05) in the stretch capacity of Trusteel® and Ethisteel® sutures was noted; otherwise, ease of passage, knot holding, knot security, knot tie-down smoothness, and memory of both sutures had comparable ratings. Operative time, ICU/hospital stay, and return to normal day-to-day activities and work were comparable between the groups. Improvement in post-operative functional abilities, quality of life, and health status was evident in both groups and was comparable. Trusteel® surgical steel suture is clinically equivalent to Ethisteel® surgical steel suture and is safe and effective for sternal closure following median sternotomy.

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

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

Effects of early debridement and conservative eschar removal followed by wound coverage with acellular dermal matrix in the treatment of children with deep burns

Effects of early debridement and conservative eschar removal followed by wound coverage with acellular dermal matrix in the treatment of children with deep burns