Delayed Wound Healing Research Articles

Comparing Cortiva Silhouette to AlloDerm for Use in Prepectoral Two-stage Prosthetic Breast Reconstruction.

The use of acellular dermal matrices (ADMs) in implant-based breast reconstruction has become increasingly routine during the past 20 years. ADMs improve soft-tissue support, facilitate greater tissue expander (TE) fill volumes, and reduce rates of capsular contracture. As the ADM market continues to grow, outcomes studies are necessary to assess the risks and benefits of each product. In this study, we compare the performance of Cortiva Silhouette, the thinnest ADM widely available, to AlloDerm, commonly considered the industry standard. We performed a retrospective review of 178 consecutive two-stage prosthetic breast reconstructions performed by the senior author. In every case, either Cortiva or AlloDerm was used to provide soft-tissue support during TE placement. Subjects were divided into Cortiva and AlloDerm cohorts and compared across patient characteristics and reconstructive outcomes variables. During the study period, AlloDerm was used in 116 reconstructions; Cortiva was used in 62. After propensity score matching (62 AlloDerm, 62 Cortiva), Cortiva was associated with greater intraoperative and final TE fill volumes, as well as larger silicone implants. Cortiva was also associated with fewer complications overall, and fewer instances of mastectomy skin necrosis, delayed wound healing, and seroma. Cortiva Silhouette is noninferior to AlloDerm in terms of safety and providing soft-tissue support in prepectoral two-stage implant-based breast reconstruction. In this study, Cortiva supported greater TE fill volumes and larger silicone implants relative to AlloDerm and was associated with fewer complications.

Education on Kegel Exercises as an Effort to Accelerate Healing of Perineal Wounds in Postpartum Mothers at the Driyorejo Gresik Community Health Center

Infections in the postpartum period are caused by delays in perineal wound healing. Kegel exercises are exercises to strengthen the pelvic floor muscles, help prevent urinary incontinence problems, and can stretch the perineal tissue as the baby's birth canal. Accelerate healing of perineal wounds in postpartum mothers at the Driyorejo Gresik Community Health Center through Kegel exercise education. This community service was carried out on postpartum mothers with perineal wounds in the Driyorejo Gresik Community Health Center working area in March 2024. The number of postpartum mothers who were given Kegel exercises was 30 people. Service activities are divided into 3 stages, namely preparation, implementation and evaluation. The results of the activity showed a decrease in REEDA scores after doing Kegel exercises. Giving Kegel exercises can speed up the healing of perineal wounds. Kegel exercises given to postpartum mothers for 7 days and done 3 times a day with movements that activate the pubococcygeal muscles can improve blood and oxygen circulation to the muscles and tissues around the perineum.

Optimizing Negative Pressure Wound Therapy in Abdominoplasty Incisions: Chevron Modification.

There has been increased use of negative pressure wound therapy (NPWT) to aid closure of abdominoplasty incisions; this obviates previous complications, including delayed wound healing. We describe a reproducible method of NPWT-assisted wound healing applicable to abdominal wounds. We propose a modified method of NPWT application, specific to the to Avance Solo NPWT system, to achieve optimal wound healing by promoting a suitable environment and decreasing high-tension forces. Postoperatively, this technique enables patient and nursing ease owing to increased durability and drainless follow-up. This is further emphasized by the results of a quantitative analysis of a 100-patient case series measuring clinically relevant objective and patient-satisfaction outcomes, and the cost analysis of use.

Fingertip Reconstruction in Hand Injuries

Fingertip amputations are a significant issue in the United States, with approximately 45,000 performed annually, with a 7.5 per 100,000 incidence rate. The primary cause of finger injuries is metal objects and bladed hand instruments, which can lead to cuts, loss of limbs, or damage to nerves and blood vessels. Therapy aims to restore sensation, long-lastingness, and bone support for nail development. Inadequate management can result in cosmetic issues, cold sensitivity, skin soreness, and persistent impairment in functionality. Nail bed injuries, such as lacerations, avulsions, and crush injuries, can result in post-traumatic fingertip amputation. Physical examinations are necessary to evaluate the functional and sensory capabilities of the damaged finger. Surgical intervention is necessary for severe cases, with primary closure or revision amputation being the preferred procedure. Full-thickness skin grafting is also used for fingertip amputations, preserving the structure of the recipient's fingers and addressing areas with insufficient skin. Flap repair is a method for managing fingertip amputations, using skin from another area or distant region. Local flaps are best for small covering areas, while regional flaps are used for extensive incisions. These flaps prevent prolonged immobilization and allow for a return of feeling in the fingertip. Post-amputation complications include delayed wound healing, nail abnormalities, heightened sensitivity, pain, intolerance to cold, scar retraction, limited finger movement, persistent ulcers, infection, and loss of tissue flaps. Inadequate management of fingertip amputations can lead to cosmetic flaws, reduced tolerance to cold, and increased skin sensitivity.

Limb salvage using radical combined hyperthermia and radiotherapy for myxofibrosarcoma of the lower leg in an elderly patient.

Soft tissue sarcomas account for only 1.5% of malignant tumors in adults and are therefore challenging to treat. We present a case of myxofibrosarcoma of the lower leg in an 88-year-old woman who successfully responded to combined hyperthermia and radiotherapy. We proposed a below-knee amputation because of the spread of the lesion, but the patient opted for hyperthermia with radiotherapy. One and a half years later, the tumor partially regrew, and the regrown mass was resected with an R0 margin. Unfortunately, the patient developed a surgical site infection immediately after the resection, and a skin ulcer formed. It took about 2years for conservative treatment to result in complete ulcer epithelization. The patient has been ambulant, and has not experienced any symptoms of local recurrence or metastasis in the two and a half years since the surgery. Although adverse events related to combined hyperthermia and radiotherapy, such as delayed wound healing, should be considered, it could be an option for the treatment of localized soft-tissue sarcoma, especially in elderly patients.

Antibacterial and antioxidative hydrogel dressings based on tannic acid-gelatin/oxidized sodium alginate loaded with zinc oxide nanoparticles for promoting wound healing

Wound infection resulting in delayed wound healing and wound deterioration remains a clinical challenge. Recently, multifunctional hydrogel dressing was a promising strategy which has attracted wide attention in preventing wound infection and promoting wound healing. In this study, a hybrid hydrogel made of gelatin (GL), tannic acid (TA), oxidized sodium alginate (OSA), and zinc oxide nanoparticles (ZnO NPs) was prepared mainly by double network cross-linking approach, named tannic acid-gelatin/oxidized sodium alginate/zinc oxide (TA-GL/OSA/ZnO). The composite hydrogels exhibited improved mechanical properties, which provided by TA modified the structure of GL network, Schiff base reaction between GL and OSA, and the strengthening effect of ZnO NPs. Meanwhile, the composite hydrogel showed high antibacterial activity against Staphylococcus aureus (S. aureus) (97.8 % ± 0.9 %) and Escherichia coli (E. coli) (96.6 % ± 1.2 %), attributed to the synergistic effect of TA and ZnO NPs. Furthermore, benefiting from the good antioxidative properties of TA, the sustain-released Zn2+ with the good capability to kill bacteria, and promoting the regeneration of skin epithelial tissues in BALB/c mice constantly, the multifunctional hydrogel had a significant therapeutic effect on wound healing and broad application prospects.

Automated Analysis Of Diabetic Vasculopathy Using Semantic Segmentation Of Thermal Images Of Peroneal Vessel

Introduction: Diabetic vascular disease is one of most serious health problems in diabetic patients, it causes the development of severe complications including delayed wound healing and increased susceptibility to infections. Methods: To provide accurate and are non-invasive diagnosis, current work emphasizes on Diabetic Vasculopathy (DV) that is analysed with thermoregulation images through Semantic Segmentation (SS). A novel methodology was adapted, combining thermoregulation imaging with SS using the U-Net++ model to investigate temperature distributions at the skin level. This work introduces a novel method that utilizes MobileNetV2 as the encoder for fast Feature Extraction (FE). Results: The results from the suggested model, achieves a segmentation accuracy of 95%, which is significantly more compared to that of DeepLabV3+ and PSPNet models. A mean and Intersection over Union (IoU) of 85% and 87% was reported by the suggested frameworks throughout the training and validation phases. Conclusion: Classifying normal and abnormal regions can be done via the outcomes, as it offers the great visibility in the thermal image for clinicians by detecting the non-thermal regions

Association of Anemia and Diabetic Retinopathy Among Patients With Type 2 Diabetes Mellitus: Retrospective Cross-Sectional Study.

Introduction Type 2 diabetes mellitus (T2DM) is a common metabolic disorder characterized by the combination of defective insulin secretion and the inability of insulin-sensitive tissues to respond appropriately to insulin. Diabetic retinopathy (DR) is a common microvascular complication that can result in a preventable cause of blindness. Research to determine the prevalence of anemia among diabetic patients is necessary to assess whether treatment practices should be changed. Anemia is a common complication in patients with T2DM and has been associated with the progression of DR. In this study, our aim is to determine the prevalence of DR and its association with hemoglobin levels in patients diagnosed with T2DM in Dubai, UAE. Methods In this retrospective cross-sectional study, we extracted the data using electronic medical records. The study was performed over a span of three years in Dubai from 2019 to 2022. A total of 368 T2DM patients were included based on retinal exam findings classified into mild, moderate, severe non-proliferative retinopathy, and proliferative retinopathy. Descriptive statistics were used for categorical (frequency, percentage) and continuous variables (mean, SD), with chi-square/Fisher exact tests for categorical associations, ANOVA for continuous variables, and multiple logistic regression to identify DR risk factors, using OR, 95% CI, and p < 0.05 for significance. Results The prevalence of anemia (defined as hemoglobin levels ≤13 mg/dL for men and ≤12 mg/dL for women) was observed in 39.4% of individuals with DR aged between 40 and 88 years; 60.6% of the patients had normal hemoglobin, while 91 individuals (24.7%) exhibited mild anemia, 53 individuals (14.4%) showed moderate anemia, and only one individual (0.3%) had severe anemia. DR grading was as follows: mild non-proliferative DR (16.8%), moderate non-proliferative DR (30.2%), severe non-proliferative DR (13.3%), and proliferative DR (39.7%). Macular edema was present in 59.2% of patients, showing a statistically significant association with more severe DR stages (p < 0.0001). No significant association was found between hemoglobin levels and DR severity (p = 0.568). However, among males, a significant difference in mean hemoglobin levels across DR grades was observed (p = 0.009), with higher hemoglobin levels associated with lower odds of severe DR (OR = 0.775, p = 0.036). Macular edema strongly predicted DR severity, with significant odds ratios across all stages (p < 0.0001). Conclusions There is a significant prevalence of anemia among the examined population. DR severity was notably associated with lower hemoglobin levels in males, and macular edema was significantly linked to more severe stages of DR. Vigilant monitoring and integrated care for both anemia and DR are crucial to optimize patient outcomes and mitigate complications. Regular retinopathy screening is essential for early detection and timely intervention, particularly considering the challenges posed by anemia, such as delayed wound healing and increased infection risk post-screening.

Differences in Perineal Wound Healing Between Doing Kegel Exercises and Not Doing Kegel Exercises

Perineal wounds are lacerations or injuries that occur along the birth canal (perineum) due to the delivery process. Wound healing is the process of replacing and repairing damaged tissue function. The purpose of this study was to see the difference in perineal wound healing between those who did Kegel exercises and those who didnot do Kegel exercises. The research method uses a Quasi-Experimental with the Posttest Only Control Group Design approach. The number of samples taken were 18 postpartum women with perineal wounds at PMB Sri Puji UW S.Tr.Keb. The sampling technique used was purposive sampling. Data collection techniques using observation sheets. Statistical test using the Mann Whitney. The results of the study after being given the treatment obtained the value of Asymp.Sig = 0.028, thus the Asymp.Sig was smaller than α &lt;0.05, thus it can be said that there was a difference in the group that did Kegel exercises and those who did not do Kegel exercises. Because there is a significant difference, it can be said that "there is an effect of doing Kegel exercises on the healing of perineal wounds in postpartum women" at PMB Sri Puji UW S.Tr.Keb Sampang. It is hoped that the results of the research can become information for the development of health sciences, especially health in postpartum women in healing perineal wounds and reducing delays in perineal wound healing. As well as management by doing Kegel exercises to speed up the healing process of perineal wounds.

Prophylactic effect of tissue flap in the prevention of bronchopleural fistula after surgery for lung cancer.

Bronchopleural fistula (BPF) is a serious complication of lung resection. To avoid BPF, the bronchial stump/anastomotic site is often covered with a flap of surrounding tissue. One risk factor for BPF is radical lung resection after induction chemoradiotherapy for lung cancer. We retrospectively reviewed our database to elucidate the characteristics of tissue flaps that prevent BPF. This retrospective study included 152 patients treated between 1999 and 2019. We examined the clinicopathological characteristics, including the type and thickness of the tissue flap used to cover the bronchial stump/anastomotic site, and postoperative complications, including BPF. BPF occurred in 5 patients (3.3%). All 5 patients had complications that could have affected delayed wound healing, such as pneumonia. The covering tissue flap thickness was significantly greater in patients without BPF than in those who developed BPF (p = 0.0290). Additionally, the tissue flap thickness was significantly greater than in those with BPF (p = 0.0077), even in high-risk patients who developed pneumonia or radiation pneumonitis on the operative side within 6months postoperatively. Perioperative management is crucial to avoid complications affecting the healing of the bronchial stump/anastomotic site, and the covering tissue flap thickness may be an important factor in avoiding or minimizing BPF.

Interplay Between FoxM1 and Dab2 Promotes Endothelial Cell Responses in Diabetic Wound Healing.

Diabetes mellitus can cause impaired and delayed wound healing, leading to lower extremity amputations; however, the mechanisms underlying the regulation of vascular endothelial growth factor (VEGF)-dependent angiogenesis remain uncertain and could reveal new therapeutic targets. In our study, the molecular underpinnings of endothelial dysfunction in diabetes were investigated, focusing on the roles of Disabled-2 (Dab2) and Forkhead Box M1 (FoxM1) in VEGF receptor 2 (VEGFR2) signaling and endothelial cell (EC) function. Bulk RNA-sequencing analysis identified significant downregulation of Dab2 in high concentrations glucose treated primary mouse skin ECs, simulating hyperglycemic conditions in diabetes mellitus. In diabetic mice with a genetic EC deficiency of Dab2 angiogenesis was reduced in vivo and in vitro when compared with wild-type mice. Restoration of Dab2 expression by injected mRNA-containing lipid nanoparticles rescued impaired angiogenesis and wound healing in diabetic mice. At the same time, FoxM1 was downregulated in skin ECs subjected to high glucose conditions as determined by RNA-sequencing analysis. FoxM1 was found to bind to the Dab2 promoter, regulating its expression and influencing VEGFR2 signaling. The FoxM1 inhibitor FDI-6 reduced Dab2 expression and phosphorylation of VEGFR2. These findings indicate that restoring Dab2 expression through targeted therapies can enhance angiogenesis and wound repair in diabetes. To explore this therapeutic potential, we tested LyP-1-conjugated lipid nanoparticles (LNPs) containing Dab2 or control mRNAs to target ECs and found the former significantly improved wound healing and angiogenesis in diabetic mice. This study provides evidence of the crucial roles of Dab2 and FoxM1 in diabetic endothelial dysfunction and establishes targeted delivery as a promising treatment for diabetic vascular complications.

Outcomes of revascularization of stenotic inframalleolar lesions in chronic limb-threatening ischemia.

For chronic limb-threatening ischemia, revascularization has been reported for occlusions but not for stenosis in the inframalleolar (IM) lesions. We investigated the clinical outcomes of balloon dilation for stenotic IM lesions distal to the treatment target in the infrapopliteal (IP) legion. We conducted a retrospective analysis of patients who had chronic limb-threatening ischemia and underwent revascularization of stenotic IM lesions distal to the target IP lesions between January 2015 and August 2022. The outcome measures were amputation-free survival, wound healing rate, and freedom from target IM reintervention. The 87 patients had a mean age of 72.7 ± 10.7 years and comprised 67.8% men, 74.7% with diabetes mellitus, 55.2% on dialysis, 33.3% who had Rutherford six classification. The amputation-free survival (AFS), wound healing, and freedom from target IM reintervention rates at 1 year were 82.9%, 53.3%, and 58.4%, respectively. On Cox proportional multivariate analysis, the predictors were Wound, Ischemia, and foot Infection (WIfI) ≥3 and diffuse stenosis in the target IM vessels for delayed wound healing and Global Limb Anatomic Staging System stage Ⅲ and ≥3 diseased IM vessels before endovascular therapy for target IM reintervention. At the time of reintervention, the lesion morphology had progressed from stenosis to occlusion in 50% of cases. In patients with chronic limb-threatening ischemia, revascularization of stenosis in IM lesions showed a high reintervention rate and progression of lesion morphology, although AFS and wound-healing rates were acceptable.

A Modified Fixation Method for Talonavicular Arthrodesis in the Treatment of Müller-Weiss Disease: The Use of the Shape-Memory Alloy Staple as an Adjunct.

Arthrodesis, usage of metallic implants for internal fixation, is commonly employed as the primary treatment modality for Müller-Weiss disease (MWD). Nevertheless, the efficacy of the current methods of fixation leaves room for improvement. Inadequate fixation strength and the risk of fixation failure are both critical concerns requiring attention. This study explored the clinical effects of implementing a modified fixation technique in talonavicular arthrodesis for the treatment of MWD. A total of 14 cases diagnosed with MWD undergoing talonavicular (TN) arthrodesis from January 2021 toMarch 2023 were included in the retrospective study. The fixation method for fusion involved the use of screws, with additional support from the shape-memory alloy (SMA) staple. Relevant clinical outcomes and complications were evaluated preoperatively and postoperatively. Paired-samples t-test was used for all data comparisons. Radiographic evidence confirmed solid fusion, and follow-up evaluations showed satisfactory results in all cases. The American Orthopedic Foot and Ankle Society (AOFAS) scores were elevated from 32.21 ± 4.0 (range: 22-38) preoperatively to 86.5 ± 2.7 (range: 81-90) postoperatively (p < 0.001). The visual analog scale (VAS) scores declined from 7.40 ± 0.8 (range: 6-8.5) preoperatively to 1.21 ± 1.1 (range: 0-3) postoperatively (p < 0.001). The lateral Meary's angle changed from 13.50 ± 5.2 (range: 8-24) preoperatively to 4.14 ± 2.9 (range: 1-11) degrees postoperatively (p < 0.001). The calcaneal pitch angle increased from 10.07 ± 4.0 (range: 5-19) preoperatively to 14.35 ± 4.0 (range: 8-21) degrees postoperatively (p < 0.001). The talar-first metatarsal angle decreased from 11.71 ± 3.8 (range: 8-18) preoperatively to 4.28 ± 3.1 (range: 0-9) degrees postoperatively (p < 0.001). One patient was observed to experience delayed wound healing and wound infection. No nerve damage, malunion, pseudoarthrosis, or fixation failure were observed. The results indicated that the fusion of the TN joint using a combination of screws and shape memory alloy staples, could lead to favorable clinical outcomes and significantly enhance the quality of life for patients with MWD. This technique is not only safe and effective but also straightforward to perform.

Surgical and irradiated case of early breast cancer in a patient with Ehlers–Danlos syndrome

BackgroundEhlers–Danlos syndrome (EDS) is a rare inherited connective tissue disease characterized by hyperextensibility of the skin and joints and tissue fragility of the skin and blood vessels, Vascular EDS is the most severe form of EDS, with abnormal arterial fragility. There have been no reports of breast cancer occurring in patients with vascular EDS. Here, we report here a very rare case of breast cancer in a patient with vascular EDS.Case presentationA 46-year-old woman with vascular EDS underwent partial left mastectomy and sentinel lymph node biopsy for left breast cancer (cStage 0) detected by medical examination. The final pathological diagnosis was invasive ductal carcinoma of the breast (pStage IA) [hormone receptor-positive, HER2 score 2 equivocal (FISH-positive), Ki-67LI 18%, luminal-HER2 type]. BluePrint was submitted as an aid in determining the postoperative treatment strategy, BluePrint Molecular Subtype HER2-type. However, the 10-year breast cancer mortality risk using Predict was low (5%). After consultation with the patient, the decision was made to administer postoperative radiation to the preserved breast along with hormone therapy only. There was no delay in postoperative wound healing, and the patient was free of metastatic recurrence for 9 months after surgery.ConclusionWe performed surgery, postoperative radiotherapy, and hormonal therapy in a breast cancer patient with vascular EDS without major complications.

Wound closure techniques for spinoplastic surgery: a review of the literature.

The approach to skin closure in spinal surgery is dependent on surgeon preference and experience. Wound complications, including dehiscence and surgical site infection (SSI), are common following spine surgery. The authors reviewed various wound closure techniques employed in spinal surgery. A systematic review was conducted to identify articles comparing wound closure techniques after posterior spinal surgery. Articles that employed experimental or observational cohort study designs and reported rates of SSI, dehiscence, or scarring following spinal surgery were included. Eight studies examining closure techniques of the skin were identified: five retrospective cohort studies and three randomized-controlled trials. No differences in the incidence of SSI were reported based on suture technique, although staples were associated with higher SSI rates in single level spinal fusion, and barbed suture resulted in decreased wound complications. The use of intracutaneous sutures was associated with a higher incidence of wound dehiscence when compared to tension-relieving far-near near-far suture (FNS) and far-near near-far interrupted point (FNP) sutures. However, the latter two also resulted in the highest rates of delayed wound healing (i.e., time to fully heal). Modified Allgöwer-Donati suture (MADS) resulted in smaller scar area when compared to vertical mattress suture. Significant differences exist in wound healing when comparing suture techniques in spinal surgery. Surgical staples allow for faster closing time, but are also associated with higher wound complications. Intracutaneous sutures appear to have higher rates of dehiscence compared to vertical mattress suture but display faster wound healing. Future studies are necessary to elucidate contributory factors, including local ischemia and changes in tensile forces. Level IV.

Delayed Wound Healing in a Young Patient with TNXB Variants and the Role of WES

After decades of quality improvement efforts, surgical site infections and abnormal wound healing remain intermittent complications in surgery. In both cases, the complication and abnormality may be superficial, restricted to the skin, or deeper within the tissue. The synthesis of connective tissue proteins, critical for structural support as part of the extracellular matrix, is under the control of multiple genes, forming a complex adaptive network. We report an unusual case of delayed and abnormal wound healing with chronic infection in a 16-year-old patient following surgery for scoliosis. Skin patch test showed that he is allergic to cobalt, a component of fixation hardware used in his surgery. He underwent evaluation by clinical genetics with whole exome sequencing (WES) which showed two (maternally and paternally inherited) variants in the TNXB ( Tenasin XB) gene. These two variants are variants of uncertain significance (VUS). TNXB encodes tenascin-XB which is an extracellular matrix glycoprotein located primarily in the basement membrane. Autosomal recessive pathogenic and likely pathogenic variants in TNXB cause TNXB-related classical-like Ehlers-Danlos Syndrome. At present, there are no causal linkages of these VUSs in TNXB to abnormal wound healing. However, as WES becomes more affordable, its use will increase and therefore it is important that we start to document such associations.

THE ROLE OF ANTIBACTERIAL HYDROGEL COATING ON COMPLICATION RISKS AFTER COMPLEX PRIMARY AND CEMENTLESS HIP REVISION ARTHROPLASTY: A RETROSPECTIVE MATCHED COHORT STUDY

This study aimed to verify the hypothesis that an antibiotic loaded hydrogel, defensive antimicrobial coating (DAC), reduces overall complication and infection rates when used for high-risk primary and revision total hip arthroplasty (THA).This was a retrospective study matched cohort study of 238 patients, treated with cementless implants with and without DAC. A sub-group analysis of patients undergoing 2nd stage revision THA for prosthetic joint infection (PJI) was also conducted. Re-infection rates within 2 years, complications necessitating surgical intervention and radiographic analysis for aseptic loosening was assessed.The mean age was 68.3±11.5 years, with 39 (32.8%) Macpherson class A, 64 (53.8%) class B and 16 (13.4%) class C patients. 4 (3.4%) patients in the DAC group developed complications including 1 PJI and 1 delayed wound healing, while 13 (10.9%) patients in the control group developed complications including 5 PJIs and 3 delayed wound healing (p=0.032). PJI rates (p=0.136) and delayed wound healing rates (p=0.337) were not statistically significant. For 2nd stage revision THA for PJI there were 86 patients in the DAC group and 45 in the control group. 1 (1.2%) patient in the DAC group developed complications with no recurrences of infection or delayed wound healing, while 10 (22.2%) patients in the control group developed complications including 4 recurrent PJI and 1 delayed wound healing (p=0.003). Recurrent PJI rates were statistically significant (p=0.005) while delayed wound healing rates were not (p=0.165). Patients treated with DAC also had lower rates of aseptic loosening (0% vs 6.7%; p=0.015).Antibiotic impregnated hydrogel coatings on cementless implants showed decreased complication rates after complex primary or revision THA. In 2nd stage revision THA for PJI, it was associated with reduced risk of re-infection and aseptic loosening.

Antimicrobial Peptide Identified via Machine Learning Presents Both Potent Antibacterial Properties and Low Toxicity toward Human Cells.

Preventing infection is a critical clinical challenge; however, the extensive use of antibiotics has resulted in remarkably increased antibiotic resistance. A variety of antibiotic alternatives including antimicrobial peptides (AMPs) have been studied. Unfortunately, like most conventional antibiotics, most current AMPs have shown significantly high toxicity toward the host, and therefore induce compromised host responses that may lead to negative clinical outcomes such as delayed wound healing. In this study, one of the AMPs with a short length of nine amino acids was first identified via machine learning to present potentially low cytotoxicity, and then synthesized and validated in vitro against both bacteria and mammalian cells. It was found that this short AMP presented strong and fast-acting antimicrobial properties against bacteria like Staphylococcus aureus, one of the most common bacteria clinically, and it targeted and depolarized bacterial membranes. This AMP also demonstrated significantly lower (e.g., 30%) toxicity toward mammalian cells like osteoblasts, which are important cells for new bone formation, compared to conventional antibiotics like gentamicin, vancomycin, rifampin, cefazolin, and fusidic acid at short treatment times (e.g., 2 h). In addition, this short AMP demonstrated relatively low toxicity, similar to osteoblasts, toward an epithelial cell line like BEAS-2B cells.

Quaternary ammonium grafted chitosan hydrogel with enhanced antibacterial performance as tannin acid and deferoxamine carrier to promote diabetic wound healing

The delay of diabetic wound healing puts a huge burden on the society. The key factors hindering wound healing include bacterial infection, unresolved inflammation and poorly generated blood vessels. In this paper, glycidyl trimethyl ammonium chloride (GTA) was grafted to chitosan (CS) to obtain quaternary ammonium grafted chitosan (QCS) with enhanced antibacterial performance, and then cross-linked by dialdehyde terminated poly(ethylene oxide) (PEO DA) to construct QCS/PEO DA hydrogel with tissue adhesion, biodegradation and self-healing properties. The QCS/PEO DA hydrogel is loaded with tannin acid (TA) and deferoxamine (DFO) to enhance antioxidant property and angiogenesis. At the same time, the TA and DFO loaded TA@DFO/hydrogel preserved the biocompatibility and biodegradability of chitosan. Moreover, the multifunctional hydrogel behaved excellent hemostatic properties in mice model and significantly promoted the healing efficacy of diabetic wounds. Overall, the TA@DFO/hydrogel is promising anti-infection dressing material for diabetic wound healing.

Fe-doped herbal medicine-based carbon dots nanozyme as safe and effective antimicrobial and wound healing agent

Bacterial infections pose a serious worldwide public health concern and play an important role in slowing or dramatically delaying wound healing. However, traditional antibiotics are faced with obstacles such as bacterial resistance and unsatisfactory biocompatibility, which has impeded further clinical translation. In recent years, antimicrobial nanomaterials have emerged as viable alternatives for combating bacterial infections, and carbon dots (CDs) have received particularly widespread attention due to their superior characteristics. In this work, a simple and eco-friendly one-step hydrothermal method was employed using the natural herbal medicine Eucommia ulmoides as a biomass carbon source to synthesize an Fe-doped CDs nanozyme (Fe-CDs) with good peroxidase-like (POD-like) activity, high biocompatibility, and strong antimicrobial activity for safe and effective antimicrobial therapy and the promotion of wound healing. L929 cells co-cultured with Fe-CDs did not show significant cytotoxicity and favored cell proliferation at appropriate concentrations. In addition, Fe-CDs catalyzed the decomposition of low-concentration H2O2 to ·OH, leading to enhanced antimicrobial activity. Both in vitro and in vivo experiments demonstrated that Fe-CDs exhibit potent antibacterial properties, the ability to promote cell migration and angiogenesis, and significant potential for promoting the healing of infected wounds. In summary, a green and safe antimicrobial nanozyme based on a biomass herbal medicine was developed in this work, offering promising insight into the development of novel antimicrobial materials and tissue regeneration engineering.