Delayed Wound Healing Research Articles

Histopathological Findings of Epithelial Invasion after Arcuate and Radial Keratotomies.

Complications after arcuate (АKs) and radial keratotomies (RKs) may include infection, delayed wound healing, and epithelial invasion. To assess the histopathologic findings of epithelial invasion following АK/RK. The study included patients who underwent penetrating keratoplasty (PK) after previous АK or RK treatment. In corneas with histologically confirmed epithelial invasion, the following parameters were examined: invasion depth (µm), width (µm) in the superficial, middle, and deep stroma, and the ratio of invasion depth to corneal thickness. The time between АK/RK and PK was compared for corneas with and without detectable epithelial invasion. Out of 31 excised corneas, 7 (22%) showed epithelial invasion 2 to 19 years (median 6 years) after АK/RK. Histological examination revealed different invasion patterns, with a mean depth of 315 (231 to 395) µm or 57% (46 to 66%) of corneal thickness. The mean width in the superficial stroma was 291 (75 to 789) µm, in the middle stroma 210 (33 to 422) µm, and in the deep stroma 164 (19 to 324) µm. No significant association was found between the presence of the epithelial invasion and the time after PK (p = 0.83). In almost a quarter of the eyes after АK or RK, epithelial invasion could be detected. The potential biomechanical instability associated with this should be considered in cases of trauma as well as in the context of planning cataract surgery or PK, particularly in the hands of less experienced surgeons. Nonmechanical contact-free excimer laser trephination may be helpful in PK.

HMGB1 Accelerates Wound Healing by Promoting the Differentiation of Epidermal Stem Cells via the "HMGB1-TLR4-Wnt/Notch" Axis.

Objective: Impairments in the differentiation and migratory capacity of epidermal stem cells (ESCs) are pivotal factors contributing to delayed wound healing. High mobility group box1 (HMGB1) has recently emerged as a potential target for tissue repair. Therefore, we aimed to investigate the role and molecular mechanisms of HMGB1 in ESCs during the wound-healing process. Approach: Initially, we examined the expression of HMGB1 and the differentiation of ESCs in normal skin, normal wounds and chronic wounds. Then, we assessed the ESC migration and differentiation, and the key markers in the Wnt/Notch signaling pathways, after treatment of HMGB1 and inhibitor, and the knockdown of toll-like receptor 4 (TLR4), using scratch assay, qPCR, western blotting, and immunofluorescence. Finally, we conducted mice models to analyze the healing rates and quality invivo. Results: HMGB1 was decreased across all epidermal layers, and the differentiation of ESCs was hindered in diabetic foot ulcer. In vitro, HMGB1 enhanced both the migration and differentiation of ESCs while stimulating the expression of the Wnt/Notch pathway within ESCs. However, the downregulation of TLR4 negated these effects. Finally, our invivo experiments provided evidence that HMGB1 facilitates wound healing and epidermis differentiation via TLR4 and Wnt/Notch signaling pathways. Innovation: This study innovatively introduces HMGB1 as a novel target for skin wound healing and elucidates its mechanisms of action. Conclusions: HMGB1 accelerated wound healing by promoting the differentiation of epidermal stem cells through the "HMGB1-TLR4-Wnt/Notch" axis, which reveals a new potential mechanism and target to expedite wound healing.

Role of Daruharidra Rasakriya Lepa in the management of Dushta Vrana w.s.r. to Chronic Non-Healing Ulcer : A Clinical Study

Background: Vrana is an interruption of continuity of body tissue or part by physical, microbial, chemical or immunological causes, typically associated with loss of function. Vrana can be correlated with wounds and ulcers. Normally, Vranas are healed by itself if kept clean. Wound factors delay wound healing. The presence of infection, insufficient blood supply, tissue tension, radiation, malnutrition, diabetes, consumption of steroids etc. are the important factors which delay the wound healing process. Dushta Vrana is one of the Vranas which needs time for its healing. Acharya Sushruta mentioned Rasakriya under Shasti Upakramas for management of Vrana. Any drug formulation should possess two qualities for proper wound healing i.e., Vrana Shodhana (Making free from undesirable wound factors) and Vrana Ropana (Closure of the wound). Many formulations are in use for centuries. One of them is Daruharidrarasakriya. The objective of the present study is to evaluate the effect of Daruharidraraskriya on the basis of relief in signs and symptoms of Dushta Vrana. Materials and Methods: In this study, Lepa of Daruharidrarasakriya was applied on affected part of 25 patients selected from Shalya OPD, GAMC&H, Akhnoor, for the management of Vrana. Results: The results observed based on the relief obtained on the subjective and objective parameters taken for consideration for this study viz. Pain, Size of ulcer, Discharge, Base (granulation tissue) and were found significant on all the above parameters. Conclusion: It showed that Daruharidraraskriya significantly helped in reduction of the signs and symptoms of the Dushta Vrana, enhancing wound healing process and reducing the morbidity of the patients.

The impact of diabetes on aesthetic procedures

Diabetes may have an impact on aesthetic medicine, influencing both the safety and efficacy of various aesthetic procedures. Key aspects of the impact of diabetes on aesthetic medicine are summarized. Individuals with diabetes often experience dry skin, acondition known as xerosis, which may affect the overall texture and appearance of the skin. Diabetes can compromise the immune system, making individuals more susceptible to skin infections. Aesthetic procedures involve the introduction of foreign substances, and compromised skin integrity may heighten the risk of infection. This underscores the importance of strict hygiene and postprocedure care to minimize the risk of complications. Delayed wound healing can be asignificant concern in aesthetic procedures where incisions, injections, or other manipulations are made, as impaired healing may affect the final outcome and increase the risk of complications. Collagen metabolism, affecting the elasticity and structural integrity of the skin, may influence the long-term results of procedures such as dermal fillers, where collagen plays acrucial role in maintaining skin volume and firmness. Diabetes is linked to vascular complications, including poor blood circulation, which may have implications for procedures like laser treatments or other interventions that rely on adequate blood supply for optimal results.

Adipose-mesenchymal stem cell-derived extracellular vesicles enhance angiogenesis and skin wound healing via bFGF-mediated VEGF expression.

This study aimed to investigate whether extracellular vesicles (EVs) derived from adipose-derived mesenchymal stem cells (ASCs) promote skin wound healing by delivering basic fibroblast growth factor (bFGF) to enhance vascular endothelial growth factor (VEGF) expression. ASCs were isolated and transfected with either a bFGF knockdown lentivirus (Lv-sh-bFGF) or a control lentivirus (Lv-sh-NC). EVs were extracted from ASCs cultures and characterized by transmission electron microscopy, nanoparticle tracking analysis, and Western blotting for surface markers. EVs were extracted from the conditioned mediums of ASCs and subjected to different treatments. These EVs or control treatments were injected at the wound edges. Wound healing was assessed using histological techniques, including H&E and Masson's trichrome staining to evaluate tissue regeneration, collagen organization, and immunohistochemistry for CD31 to quantify microvessel density. Protein expression of bFGF and VEGF was measured by Western blotting. ASC-derived EVs significantly promoted angiogenesis and improved skin wound healing. EVs encapsulating bFGF enhanced VEGF expression in the wound tissue, while knockdown of bFGF reduced both bFGF and VEGF expression, leading to delayed wound healing. Further knockdown of VEGF partially reversed the pro-angiogenic and wound-healing effects of bFGF-encapsulated EVs. This study demonstrates that ASC-derived EVs promoted skin wound repair by enhancing angiogenesis and accelerating tissue regeneration through the bFGF/VEGF axis. These findings highlight the therapeutic potential of ASCs-derived EVs in improving skin wound healing.

535 Vascular abnormalities may be associated with delayed wound healing in myeloid-specific Interferon Regulatory Factor 8 knockout mice

535 Vascular abnormalities may be associated with delayed wound healing in myeloid-specific Interferon Regulatory Factor 8 knockout mice

The Association between High-density Lipoproteins and Periodontitis.

Periodontitis is one of the most typical chronic dental diseases. This inflammatory disease can change various functions of immune cells and impair lipid metabolism through proinflammatory cytokines. High-Density Lipoprotein (HDL) is considered protective of the cardiovascular system. It has anti-thrombotic and anti-inflammatory effects. In this article, we have reviewed the association between periodontitis and HDL. Various studies have demonstrated a reverse relationship between inflammatory cytokines and HDL. HDL contains antioxidative enzymes and proteins, whereas periopathogens impair HDL's antioxidant function. The presence of periodontal bacteria is associated with a low HDL level in patients with periodontitis. Genetic variants in the interleukin- 6 (IL)-6 gene and cytochrome (CYP)1A1 rs1048943 gene polymorphism are associated with HDL levels and periodontal status. Studies showed that HDL levels improve after treatment for periodontitis. On the one hand, periodontal pathogenic bacteria and their metabolites and pro-inflammatory cytokines from periodontal infection can result in various disorders of lipid metabolism and lipid peroxidation. On the other hand, hyperlipidemia and lipid peroxidation stimulate proinflammatory cytokines, resulting in oxidative stress and delayed wound healing, making individuals susceptible to periodontitis.

523 Targeting NETosis to treat delayed wound healing in a humanized mouse model of sickle cell disease

523 Targeting NETosis to treat delayed wound healing in a humanized mouse model of sickle cell disease

Analysing inflammatory responses after mandibular third molar extraction: a comparison of suture-less and multiple suture techniques.

This study aims to compare the outcomes of suture-less and multiple suture closure methods on postoperative pain, swelling, and trismus, and associated complications. This prospective, randomized clinical trial was conducted at the Department of Oral & Maxillofacial Surgery, Goa Dental College & Hospital. Inclusion criteria encompassed subjects aged between 17 and 55 years, classified as American Society of Anaesthesiologists (ASA) I, with asymptomatic impacted third molars falling within the moderately difficult impaction range (Pederson's difficulty index: 5-7). Study excluded individuals classified as ASA II, III, or IV, those with known or suspected allergies to the anaesthetic solution, immunocompromised patients, and individuals taking medications that could affect healing. Pregnant or lactating females and those with a history of bleeding disorders were also excluded. Wound closure methods were compared: Group A underwent primary closure with silk sutures, while Group B had suture-less closure. Subjects were allocated to the specific groups using a simple randomization method. This involved using a lottery-based random sequence to assign each participant to either Group A or Group B. Pain intensity, facial swelling, and trismus were key outcomes. Secondary outcomes included lingual nerve sensation and postoperative complications. Demographics factors, surgical details, radiographic and perioperative data, and physiological parameters were considered. Non-parametric tests and parametric test (repeated measure ANOVA) were employed. Statistical significance was set at P < 0.05. Among 101 participants, both closure techniques exhibited similar outcomes in pain, swelling, and lingual nerve function. However, suture-less closure resulted in significantly less trismus and fewer cases of delayed wound healing. Suture-less method after surgical removal of third molar may reduce trismus compared to multiple sutures. While pain, swelling, and lingual nerve function management were comparable.

A slime-inspired phycocyanin/κ-carrageenan-based hydrogel bandage with ultra-stretchability, self-healing, antioxidative, and antibacterial activity for wound healing.

Hydrogels have attracted extensive attention as wound dressing owing to their excellent multifunctionality, flexibility, and biocompatibility. Due to the frequent movement and stretching of skin as well as complex surface of wound, traditional wound dressings have difficulty to adapt to motion and irregular wounds. Furthermore, excessive reactive oxygen species (ROS) and bacterial infection can induce delayed wound healing. To this end, we developed a set of versatile phycocyanin-based dual network hydrogels (PPC hydrogels) with polyvinyl alcohol (PVA) and κ-carrageenan (CRG) as substrate via forming of borate ester bonds, hydrogen bonds, and electrostatic interaction. The PPC hydrogels not only possessed adaptivity, ultra-stretchability (7036.12 %), efficient self-healing and injectability, but also possessed antioxidative and antibacterial capacities conferred by C-phycocyanin (PC) and rhein. Moreover, the hydrogels also exhibited excellent hemostatic ability and high biocompatibility. More remarkably, the PPC-I hydrogel could accelerate wound healing by effect of anti-inflammation (downregulating TNF-α and IL-6) and promoting collagen deposition and angiogenesis (upregulating CD31), which may be utilized as hydrogel bandages and applied to motion and irregular wounds, thereby promising the application prospect of the hydrogels as wound dressing.

Efektivitas Aromaterapi Inhalasi Lavender Dalam Upaya Meredakan Ansietas Pre-Operasi: Tinjauan Literatur

Surgical procedures can cause anxiety in individuals that can affect both physical and psychological and ultimately result in hemodynamic disorders, post-operative pain, delayed wound healing, risk of infection, possible cancellation of surgery, and longer hospitalization. Non-pharmacological therapy that can be given to treat anxiety is by administering lavender inhalation aromatherapy. This paper aims to analyze the effectiveness of lavender inhalation aromatherapy on pre-operative anxiety levels. This paper uses the literature review method. The search database is through Pubmed, Research Gate, Google Scholar &amp; Portal Garuda publications. Articles obtained from various databases will be selected based on the criteria, namely research articles that can be fully accessed (full text) in Indonesian &amp; English, the year of publication in the last 10 years (2014-2024), no duplication and appropriate articles. From this search, there were 13 articles analyzed from 502 articles selected according to the desired criteria. The results obtained were that the administration of lavender aromatherapy by inhalation was used because it was easier and did not require special skills in its application and was effective in reducing pre-operative anxiety. The entire article shows no negative impacts in administering lavender inhalation aromatherapy, so it is recommended for nurses to apply this intervention because it is safe and effective in overcoming anxiety in pre-operative patients.

Development of a clinical metagenomics workflow for the diagnosis of wound infections

BackgroundWound infections are a common complication of injuries negatively impacting the patient’s recovery, causing tissue damage, delaying wound healing, and possibly leading to the spread of the infection beyond the wound site. The current gold-standard diagnostic methods based on microbiological testing are not optimal for use in austere medical treatment facilities due to the need for large equipment and the turnaround time. Clinical metagenomics (CMg) has the potential to provide an alternative to current diagnostic tests enabling rapid, untargeted identification of the causative pathogen and the provision of additional clinically relevant information using equipment with a reduced logistical and operative burden.MethodsThis study presents the development and demonstration of a CMg workflow for wound swab samples. This workflow was applied to samples prospectively collected from patients with a suspected wound infection and the results were compared to routine microbiology and real-time quantitative polymerase chain reaction (qPCR).ResultsWound swab samples were prepared for nanopore-based DNA sequencing in approximately 4 h and achieved sensitivity and specificity values of 83.82% and 66.64% respectively, when compared to routine microbiology testing and species-specific qPCR. CMg also enabled the provision of additional information including the identification of fungal species, anaerobic bacteria, antimicrobial resistance (AMR) genes and microbial species diversity.ConclusionsThis study demonstrates that CMg has the potential to provide an alternative diagnostic method for wound infections suitable for use in austere medical treatment facilities. Future optimisation should focus on increased method automation and an improved understanding of the interpretation of CMg outputs, including robust reporting thresholds to confirm the presence of pathogen species and AMR gene identifications.

The Midline Lateral Parapatellar Arthrotomy: A Safe Alternative Approach for Lateral Tibial Plateau Fractures.

The midline lateral parapatellar (LP) approach has been shown in a cadaveric study to provide superior articular exposure compared to the anterolateral approach (AL). The purpose of this study was to report on outcomes and complications with the LP approach. Design: Retrospective comparative cohort study and prospective cohort. Academic Level-I trauma center. Adult patients with minimum 3 months follow up who underwent open reduction internal fixation (ORIF) of an acute, isolated lateral tibial plateau fracture (OTA/AO 41-B1, 41-B2, 41-B3) via a LP arthrotomy or AL submeniscal arthrotomy between 2010-2019.Outcome Measures and Comparisons: Retrospective cohort evaluated using postoperative complications including infection, delayed wound healing, and reoperation rate. Prospective cohort evaluated using Short Musculoskeletal Function Assessment (SMFA), knee range of motion (ROM), and complications. The mean age for the LP cohort was 41.5 years (19-79) and 18/32 (56.3%) were male. The mean age for the AL cohort was 42.8 years (18-71) and 29/49 (59.2%) were male. The mean age for patients in the prospective study was 31.4 years (19-59) and 9/14 (64.3%) were male. Mean follow-up was 9.3 months and 20.3 months for the retrospective and prospective cohorts respectively. There was no significant difference in complication or reoperation rate (p>0.39). For the prospective cohort mean ROM was 130 degrees. Mean SMFA dysfunction index (DI) was 9.0 and mean bother index (BI) was 11.1. The lateral parapatellar approach resulted in comparable clinical and functional outcomes to those seen historically with the anterolateral approach. It is a safe alternative and may be of most benefit when treating comminuted lateral tibial plateau fractures. Level III.

Peripheral nerve-derived CSF1 induces BMP2 expression in macrophages to promote nerve regeneration and wound healing

The precise mechanisms regulating inflammatory and prorepair macrophages have not been fully elucidated, despite the pivotal role played by innate immunity in wound healing. We first employed a denervation wound model to validate the crosstalk between neurons and macrophages. Compared to normal wound healing, the denervation wound healing process involved fewer macrophages, decreased angiogenesis, and delayed wound healing. Consistent with the results of the scRNA-seq libraries, the number of early-phase wound proinflammatory and late-phase wound prorepair macrophages were decreased during the denervation wound healing process. We profiled early-phase and late-phase skin wounds in mice at the transcriptional and functional levels and compared them to those of normal wounds. We revealed a neuroimmune regulatory pathway driven by peripheral nerve-derived CSF1 that induces BMP2 expression in prorepair macrophages and enhances nerve regeneration. Crosstalk between neurons and macrophages facilitates the healing process of wounds and provides a potential strategy for wound healing therapy.

Mechanism of cold exposure delaying wound healing in mice

Cold temperatures have been shown to slow skin wound healing. However, the specific mechanisms underlying cold-induced impairment of wound healing remain unclear. Here, we demonstrate that small extracellular vesicles derived from cold-exposed mouse plasma (CT-sEVs) decelerate re-epithelialization, increase scar width, and weaken angiogenesis. CT-sEVs are enriched with miRNAs involved in the regulation of wound healing-related biological processes. Functional assays revealed that miR-423-3p, enriched in CT-sEVs, acts as a critical mediator in cold-induced impairment of angiogenic responses and poor wound healing by inhibiting phosphatase and poly(A) binding protein cytoplasmic 1 (PABPC1). These findings indicate that cold delays wound healing via miR-423-3p in plasma-derived sEVs through the inhibition of the ERK or AKT phosphorylation pathways. Our results enhance understanding of the molecular mechanisms by which cold exposure delays soft tissue wound healing.

Lidocaine-Loaded Thermoresponsive Gel for Accelerated Wound Healing in Dry Socket and Oral Wounds.

Dry socket, also known as alveolar osteitis, presents significant challenges in oral surgery because of severe pain and delayed wound healing. This study aims to address these challenges by developing and evaluating a lidocaine-loaded polyelectrolyte complex thermoresponsive gel (LG) designed to enhance wound healing and provide effective pain management in oral wounds. The thermoresponsive gel transitions from a liquid to a gel at body temperature, ensuring sustained contact with the wound site and prolonged release of lidocaine. The in vitro assessments, including cytotoxicity and wound scratch assays, demonstrated the biocompatibility and therapeutic potential of the LG formulation. Following this, palatal wounds were induced in rats, with healing monitored over a 14-days period. Histological analyses were conducted to assess tissue regeneration and inflammation. The results indicated that the LG formulation significantly improved wound closure rates, reduced inflammation, and accelerated epithelialization compared with control groups, primarily because of the high content of hyaluronic acid (HA). The synergistic effects of HA combined with the thermoresponsive properties of the gel facilitated faster healing. These findings suggest that LG is a promising therapeutic option for enhancing oral wound healing and effectively managing pain, particularly in conditions such as dry socket.

Nitric oxide-releasing self-healing hydrogel for antibacterial and antibiofilm efficacy against polymicrobial infection.

Aim: Bacterial infections and the formation of biofilms are currently key factors in the delay of wound healing. S-Nitroso glutathione (GSNO) is recognized as a nitric oxide (NO) donor that exhibits potent antibacterial and antibiofilm activities. However, some of the stability limitations of NO require it to be prepared pharmaceutically.Materials & methods: Here, we developed a self-healing hydrogel dressing consisting of GSNO, polyvinyl alcohol/borax (PVA/B)and carboxymethyl chitosan (cmCHI). This research aimed to determine the antibacterial and antibiofilm activities of a self-healing hydrogel (PVA-B-cmCHI/GSNO) against multiple bacteria and polymicrobial biofilms.Results: Forty mg/ml PVA-B-cmCHI/GSNO significantly increased the antibacterial activity against Pseudomonas aeruginosa, S. aureus, Methicillin resistant Staphylococcus aureus (MRSA), as indicated by a >5log reduction in bacterial viability (∼99.999% killing). PVA-B-cmCHI/GSNO showed antibiofilm activity three-times greater than that of the blank self-healing hydrogel (PVA-B-cmCHI) by inhibiting 80% of the biofilm formation.Conclusion: The results suggest that the NO-releasing self-healing hydrogels exhibit notable antibacterial and antibiofilm properties and thus could be a promising approach for the treatment of bacterial or biofilm-infected wounds.

Living photosynthetic microneedle patches for in situ oxygenation and postsurgical melanoma therapy

Surgical excision remains the principal treatment for melanoma, while tumor recurrence and delayed wound healing often occur due to the residual tumor cells and hypoxic microenvironment in the postoperative skin wounds. Herein, we present a living photosynthetic microneedle (MN) patch (namely MA/CM@MN) loaded with microalgae (MA) and cuttlefish melanin (CM) for postsurgical melanoma therapy and skin wound healing. Benefiting from the oxygenic photosynthesis of the alive MA in the MN base, the MA/CM@MN can generate oxygen under light exposure, thus facilitating skin cell proliferation and protecting cells against hypoxia-induced cell death. In addition, with CM nanoparticles embedded in the MN tips, the MA/CM@MN can be effectively heated up under near-infrared (NIR) irradiation, contributing to a strong tumor killing efficacy on melanoma cells in vitro. Further experiments demonstrate that the NIR-irradiated MA/CM@MN effectively prevents local tumor recurrence and simultaneously promotes the healing of tumor-induced wounds after incomplete tumor resection in melanoma-bearing mice, probably because the MA/CM@MN can inhibit tumor cell proliferation, stimulate tumor cell apoptosis, and mitigate tissue hypoxia in light. These results indicate that the living photosynthetic MN patch offers an effective therapeutic strategy for postoperative cancer therapy and wound healing applications.Graphical

Thymoquinone-Incorporated CollaGee Biomatrix: A Promising Approach for Full-Thickness Wound Healing.

Wound infection is the leading cause of delayed wound healing. Despite ongoing research, the ideal treatment for full-thickness skin wounds is yet to be achieved. Skin tissue engineering provides an alternative treatment, with the potential for skin regeneration. Background/Objectives: Previously, we characterized a collagen-gelatin-elastin (CollaGee) acellular skin substitute and evaluated its cytocompatibility. The assessments revealed good physicochemical properties and cytocompatibility with human dermal fibroblasts (HDF). This study aimed to incorporate thymoquinone (TQ) as the antibacterial agent into CollaGee biomatrices and evaluate their cytocompatibility in vitro. Methods: Briefly, dose-response and antibacterial studies were conducted to confirm the antimicrobial activity and identify the suitable concentration for incorporation; 0.05 and 0.1 mg/mL concentrations were selected. Then, the cytocompatibility was evaluated quantitatively and qualitatively. Results: Cytocompatibility analysis revealed no toxicity towards HDFs, with 81.5 + 0.7% cell attachment and 99.27 + 1.6% cell viability. Specifically, the 0.05 mg/mL TQ concentration presented better viability, but the differences were not significant. Immunocytochemistry staining revealed the presence of collagen I, vinculin, and alpha smooth muscle actin within the three-dimensional biomatrices. Conclusions: These results suggest that TQ-incorporated CollaGee biomatrices are a promising candidate for enhancing the main key player, HDF, to efficiently regenerate the dermal layer in full-thickness skin wound healing. Further investigations are needed for future efficiency studies in animal models.

Perioperative Management of Takayasu Arteritis for Cardiac Surgery - Review and Single-Center Experience.

Takayasu arteritis (TAK) is classified as a large vessel vasculitis and often causes vascular stenosis, occlusion, and aneurysm formation. Although the principal treatment for TAK involves suppressing inflammation with glucocorticoids, the emergence of biological disease-modifying antirheumatic drugs has considerably changed the treatment landscape of TAK in recent years. Several biological disease-modifying antirheumatic drugs, such as tocilizumab (TCZ), have shown promising effects on TAK in clinical studies. Cardiologists and cardiovascular surgeons encounter patients receiving these drugs who require catheterization, endovascular treatment, or cardiovascular surgery. However, in patients treated with glucocorticoids and TCZ, there needs to be greater awareness of more complications than usual after surgery, such as delayed wound healing, systemic infection, and surgical site infection. In addition, in patients receiving TCZ, inflammatory markers, such as C-reactive protein, may not increase when complications arise from infection. Unfortunately, there are no guidelines or solid evidence that have clearly defined the optimal perioperative treatment strategy for patients with TAK who require cardiovascular surgery. This article reviews the evidence and our recent experience supporting the perioperative use of TCZ, and proposes a protocol that can reduce complications in patients with TAK undergoing invasive cardiovascular treatment.