Wound Dimensions Research Articles

Conventional Versus Regenerative Methods for Wound Healing: A Comparative Experimental Study on a Sheep Model

Background and Objectives: Wound healing is a complex process involving cellular, anatomical, and functional repair, often hindered in chronic wounds associated with diseases like diabetes and vascular disorders. This study investigated the efficacy of conventional and regenerative wound healing approaches in a sheep surgical wound model. Materials and Methods: Six female Bergamasca sheep underwent five full-thickness skin lesions treated with various methods: sterile gauze (control), chlorhexidine, sodium hypochlorite, micronized dermis system application, and dermal matrix. Wound healing progression was monitored over 42 days through wound dimension measurements, exudate analysis, and histopathological evaluations. Results: The results indicated that all wounds healed completely by day 42, with significant reductions in wound size and exudate over time. Notably, Micronized dermis system application and dermal matrix treatments showed a faster evolution in exudate characteristics and improved collagen reorganization compared to other treatments. Histological analysis revealed earlier neovascularization and better reconstitution of hair follicles in these groups. Despite the lack of significant differences in healing time, both regenerative approaches enhanced wound healing phases, contributing to exudate control, angiogenesis promotion, and reduced scar formation. Conclusions: The findings suggest that while micronized dermis system application and dermal matrix do not accelerate acute wound healing compared to conventional methods, they offer potential benefits in managing exudate and improving tissue regeneration, warranting further investigation in chronic wound scenarios.

Prediction of Healing Trajectory of Chronic Wounds Using a Machine Learning Approach.

Objective: New treatment options are emerging for chronic wounds, which represent a growing problem because of population ageing and increasing burden of chronic disease. While promising, the existing evidence for advanced modalities is commonly derived from small and/or poorly controlled studies and clear criteria for selecting patients, who are likely to benefit from these expensive options are lacking. In this study, we develop and validate a machine learning model to predict if a chronic wound, independent of etiology, is expected to heal within 12 weeks to identify cases in potential need of advanced treatment options. Approach: Retrospective analysis of electronic health record data from 2014 to 2018 covering 532 wound care clinics in the United States and 261,398 patients with 620,356 unique wounds. Prediction of 12-week healing trajectories with a machine learning model. Results: The best-performing model in a training dataset of a randomly drawn 75% subset of wounds contained variables for patient demographics, comorbidities, wound characteristics at initial presentation, and changes in wound dimensions over time, with the latter group being the most influential predictors. The final machine learning model had a high predictive accuracy with area under the receiver operating characteristic curves of 0.9 and 0.92 after 4 and 5 weeks of treatment, respectively. Innovation: A machine learning model can identify chronic wounds at risk of not healing by week 12 with high accuracy in the early weeks of treatment. Conclusions: If embedded in real-world care, the generated information could be able to guide effective and efficient treatment decisions.

The Influence of Glycemic Control Over Post-extraction Healing in Diabetic Patients.

Background Diabetes mellitus hinders wound healing after tooth extractions due to hyperglycemia, causing complications like infections and delayed recovery. The precise role of glycemic control in healing remains uncertain. This study aims to clarify it by comparing outcomes in patients with well-controlled and poorly controlled blood sugar levels. Material and methods This prospective observational study at Priyadarshini Dental College and Hospital (October-November 2023) involved 100 insulin-dependent diabetic patients (n = 100) requiring dental extractions, divided into group A with random blood sugar (RBS) ≤150 mg/dL (n = 50) and group B with RBS between 151 and 240 mg/dL (n = 50). Inclusion criteria included fully erupted teeth in patients aged 18 or older, while exclusion criteria comprised those on antibiotics, with systemic immunodeficiency, undergoing chemotherapy, or with active infections. Preoperative RBS and post-extraction wound dimensions were recorded, and clinical outcomes, such as pain, bleeding, infection, dry socket, and tissue color changes, were assessed on days 1, 7, and 14. Ethical approval was obtained from the Institutional Ethical Committee (IEC-PDCH5/4-2023) and the Indian Council of Medical Research (ICMR Reference ID: 2023-14931). Data were analyzed using chi-square and independent sample t-tests. Results The findings suggest that higher glycemic levels (151-240 mg/dL) are associated with increased pain and complications but do not significantly affect healing outcomes compared to levels ≤150 mg/dL. Group A shows better healing status, while group B has a higher incidence of moderate pain and bleeding. Conclusion This study indicates that glycemic levels between 151 and 240 mg/dL have no significant impact on post-extraction healing compared to levels ≤150 mg/dL in diabetic patients. Elevated blood sugar within this range may not increase the risk of delayed healing or complications. However, managing blood sugar levels is still critical, as uncontrolled diabetes can lead to adverse outcomes. Further research is required to determine the ideal glycemic range for optimal healing in diabetic patients.

Management of Odonto-onycho-dermal dysplasia: the role of botulinum toxin

Various methods exist for measuring wound dimensions, including photography, comparison, ruler, or graph techniques1. With the advancement of current-generation smartphones equipped with high-quality built-in cameras, accessibility to such technology has become more widespread and affordable. Leveraging specific applications developed for these smartphones has provided numerous advantages in the medical field. One such software, Imitomeasure, has been designed to measure wound dimensions without direct contact with the wound site. Unlike traditional clinical measurements involving rulers or tape, Imitomeasure offers a non-contact approach, reducing the risk of infection transmission to the patient. The efficacy of Imitomeasure has been evaluated, revealing its effectiveness in wound dimension assessment. In this investigation, the dimensions of bedsores located over bilateral greater trochanteric regions and presacral region of a patient who was bed-ridden due to Parkinson disease were assessed using the Imitomeasure application on a smartphone.

Laser wounding pattern in relation to vascular tissue development for the stimulation of adventitious root formation in rose cuttings

The stimulation of adventitious root formation from laser-wounded rose cuttings in our previous study suggests that exposing the phloem proximities is one of the most relevant aspects for a positive effect on rooting response. But, the specific dimensions that wound patterns must fulfill to optimize rooting promotion remain unknown. This study analyzed the effect of wounded area and wound perimeter of laser marking patterns on the development of phloem, xylem, and callus using cross sections of single-leaf cuttings of Rosa canina 'Pfänder'. Four distinct laser patterns were designed and marked along the cutting base. Among these, three patterns were based on longitudinal strips, while one pattern was characterized by small squares, resulting in two distinct wound area levels and four wound perimeter levels. Periodic evaluations of stem sections showed that the development of phloem and xylem was significantly influenced by the pattern's geometry. Larger dimensions of xylem were associated with patterns of greater area and a smaller perimeter, while an increase in phloem was related to patterns of longer perimeter distributed in smaller areas. The maximum rooting success in wounded cuttings reached 44% in contrast to 9% observed in the control group in the absence of additional wounds. The development of vascular tissue was significantly correlated with adventitious rooting, with phloem being more closely linked with a Pearson coefficient of 0.92 compared to 0.30 for xylem. Additionally, a negative Pearson coefficient of −0.92 between the ratio area: perimeter and adventitious root formation showed that laser patterns with large wounded area with less borders led to a reduced rooting response. The results provide evidence of how wounded tissue contributes to the intrinsic development of adventitious roots and reveal the importance of proper wound dimensions.

Treatment of Urolithiasis with Thulium Fiber Laser in Fragmentation Mode Using Optimized Pulse Sequences.

Objectives: The super-pulsed thulium fiber laser (SP TFL) is a new alternative to high-power holmium laser for intracorporeal lithotripsy. The SP TFL has shown advantages in dusting regimes, but benefits in fragmentation regimes are less understood. The second-generation SP TFL introduces an advanced fragmentation pulse (AFP) sequence to maximize SP TFL's efficiency in fragmentation. This study evaluates safety and efficacy of the SP TFL fragmentation mode in ureteroscopy (URS) and mini percutaneous nephrolithotomy (mini-PCNL). Materials and Methods: The study was conducted in two phases. Safety of a new AFP was compared ex vivo to standard SP TFL fragmentation settings by measuring the dimensions of wounds created in porcine kidney after laser exposure for 0.5, 1.0, and 2.0 s. The resulting wounds were evaluated histologically using nitro blue tetrazolium chloride (NBTC) stain. In the clinical phase, the second-generation SP TFL was used to fragment and extract ureteral and renal stones in 40 patients using ureteroscopic and percutaneous approaches. The stone size, volume, density, laser-on-time, and total energy were recorded for each patient. In addition, the chemical composition, ablation rate, and ablation efficiency were assessed for each stone treatment. Results: The ex vivo mucosa damage profiles caused by AFP were similar to those caused by regular pulses. In clinical phase, the median volume and density for ureteral stones were 0.4 cm3 and 1029 Hounsfield units (HU), for renal stones 1.3 cm3 and 1113 HU, respectively. Different stone types were crushed into fragments suitable for extraction. The mean AFP energy was 3 J and the average power for ureteral stones was 10.5 W, whereas for renal stones it was 28.5 J and 31 W, respectively. The overall complication rate was low in both groups. Conclusion: ST PFL with AFP capability facilitates effective fragmentation of ureteral and renal stones of any composition during URS and mini-PCNL with minimal complication rates.

Assessment of wound dimensions using a smartphone-based application - Imitomeasure in wound assessment

Dimensions of wounds can be measured using several methods such as a photograph, a comparison, a ruler, or a graph. Current generation smartphones have high quality in-built cameras, and they are easily accessible than before and have become affordable. Making use of certain applications built for these smartphones have helped achieve various benefits in medical field. A software called Imitomeasure has been developed for the purpose of measuring wound dimensions without touching the wound. This app has the advantage over clinical measurement using rule or tape, in that, it is a non-contact method, hence less chances of spreading infection to that patient. The effectiveness of Imitomeasure has been assessed, and it has been found to be a very effective application in measuring wound dimensions. In this study, the size of wounds over gluteal region has been measured using Imitomeasure application in a smartphone.

Evaluation of Wound Measurements Utilizing a Smartphone App - Imitomeasure for Wound Analysis

Various methods exist for measuring wound dimensions, including photography, comparison, ruler, or graph techniques1. With the advancement of current-generation smartphones equipped with high-quality built-in cameras, accessibility to such technology has become more widespread and affordable. Leveraging specific applications developed for these smartphones has provided numerous advantages in the medical field. One such software, Imitomeasure, has been designed to measure wound dimensions without direct contact with the wound site. Unlike traditional clinical measurements involving rulers or tape, Imitomeasure offers a non-contact approach, reducing the risk of infection transmission to the patient. The efficacy of Imitomeasure has been evaluated, revealing its effectiveness in wound dimension assessment. In this investigation, the dimensions of bedsores located over bilateral greater trochanteric regions and presacral region of a patient who was bed-ridden due to Parkinson disease were assessed using the Imitomeasure application on a smartphone.

Multimodal imaging device to comprehensively assess infection, oxygenation, and wound analytics-A pilot study.

Wound analytics, infection detection, and oxygenation measurement are the three critical prerequisites for appropriate wound care. Although devices that rapidly detect the above-mentioned parameters independently exist, there is no single point-of-care device that is enabled with all the three functionalities. Through this study, we are introducing and evaluating the performance of Illuminate Pro Max-a novel, rapid, hand-held non-contact, point-of-care multimodal imaging device that is equipped to measure the three wound assessment parameters. Here, a total of 60 diabetic foot ulcer patients were imaged using Illuminate Pro Max to detect bioburden and measure StO2 levels and wound dimensions (size and depth). The results were further evaluated against the current gold standard technique for each parameter, that is, culture test to detect bioburden, a transcutaneous oxygen pressure (TcPO2) measuring device-Perimed Periflux 5000 to measure oxygenation, and paper ruler to measure wound size. Culture tests reported 42 samples as infection-positive and 18 samples as infection-negative. On comparing with the culture report, the device showed 88% sensitivity and 86% PPV in detecting the bioburden. Wound dimensions (length and width) were comparable with the paper scale measurements. Wound depth was also reported by the device. The StO2 map generated by the device depicted the tissue oxygenation levels in various regions of the wound. In conclusion, this novel, comprehensive point-of-care multispectral imaging device can be an effective tool for rapid wound assessment which can help in prompt treatment.

A Randomized Controlled Trial Comparing Collagen Matrix to Hemostatic Gelatin Sponge as Socket Seal in Alveolar Ridge Preservation.

(1) Objectives: This study aimed to compare a collagen matrix to a hemostatic gelatin sponge as a socket seal in alveolar ridge preservation (ARP). (2) Methods: Systemically healthy patients planned for ARP at two sites with more than 50% of the buccal bone wall remaining after tooth extraction were eligible for inclusion. ARP involved socket grafting using collagen-enriched deproteinized bovine bone mineral. Sites were then randomly assigned to the test group (collagen matrix) or the control group (hemostatic gelatin sponge). The primary outcome was soft tissue thickness in the center of the site at 4 months, analyzed on cone-beam computed tomography. Secondary outcomes included the buccal and lingual soft tissue heights, horizontal bone loss, buccal soft tissue profile changes, wound dimensions, and Socket Wound Healing Score (SWHS). (3) Results: In total, 18 patients (12 females, 6 males) with a mean age of 57.3 years (SD 11.1) were included. Four months after ARP, the soft tissue thickness in the center of the site amounted to 2.48 mm (SD 0.70) in the test group and 1.81 mm (SD 0.69) in the control group. The difference of 0.67 mm (95% CI: 0.20-1.14) in favor of the collagen matrix was statistically significant (p < 0.009). The buccal soft tissue height was also statistically significantly higher for the collagen matrix (0.72 mm; 95% CI: 0.06-1.38; p = 0.034). A trend favoring the collagen matrix was found for the lingual soft tissue height (p = 0.066). No significant differences between the groups in terms of horizontal bone loss, buccal soft tissue profile changes, wound dimensions, and the SWHS were found. (4) Conclusions: The absence of significant differences in hard tissue outcomes suggests that both the collagen matrix and hemostatic gelatin sponge effectively sealed the extraction socket and supported bone preservation. However, the collagen matrix better maintained soft tissue dimensions. The clinical relevance of this finding with respect to the necessity for adjunctive soft tissue augmentation at the time of implant placement is yet to be studied.

Preclinical Assessments of a Novel Peel and Place Extended-Wear Negative-Pressure Wound Therapy Dressing for up to 35 Days in a Porcine Model.

Objective: While the use of negative pressure wound therapy (NPWT) with reticulated open cell foam (ROCF) is well established, the characteristics of ROCF do not allow for extended-wear use. There is the potential for dressing tissue ingrowth if left in place for greater than the recommended 2-3 days. An easy to use, novel peel and place dressing has been designed for extended wear with the wound management advantages of ROCF while alleviating the challenges of tissue ingrowth. Approach: Paraspinal, full-thickness or deep muscle excisional wounds were created in 11 and 2 swine, respectively, dressings applied with continuous negative pressure at -125 mmHg, and dressings changed weekly. Full-thickness excisional wounds were treated for 13 days and deep muscle wounds for 35 days. Wound dimensions were assessed. Granulation tissue thickness and re-epithelialization were measured via digital morphometry. Tissue quality, fibrinous material prevalence, and dressing removal peel force were analyzed. Results: The peel and place dressing substantially reduces dressing tissue ingrowth, is easy to remove with markedly low dressing peel force and promotes more granulation tissue at day 13 than ROCF with an interface layer. The extended-wear peel and place dressing, when applied to deep muscle wounds with weekly dressing changes, was applied for a total of 35 days. Successful wound closure was evident without any negative impact on wound healing. Innovation: This study assessed the wound management capabilities of an extended-wear peel and place NPWT dressing used until wound closure. Conclusion: The peel and place dressing is a suitable extended-wear NPWT dressing.

Integrating new approaches to care in a vascular wound clinic

IntroductionAn evidence-based approach is essential in the treatment of wounds to optimise healing, reduce costs and improve patient outcomes. AimThis case study aimed to demonstrate our model of care, which assesses and manages patients with venous disease and complex wounds. In this case, venous leg ulcer (VLU) was treated with TLC-NOSF dressing and therapeutic compression. The wound was serially assessed using a smart App that gave the patient a graphic representation of their progress. DesignDescriptive Observational Case Study. Clinical careAn evidence-based approach for managing a chronic, severe VLU. The patient was initially seen at the Outpatient Vascular Wound Clinic twice weekly, then every two weeks for conservative sharp wound debridement, skin care, dressing change, and compression therapy using a compression (Ready) wrap. Wound progress was monitored by the digital application ‘Tissue Analytics’, a “purposedesigned digital wound management platform that records, tracks, and analyses wounds”. ResultsWeek 1: On initial review, ulcer length was 3.15cm, width was 3.1 cm, and total surface area was 6.31 cm2. The wound base was mildly sloughy (<25%), with areas of good granulation tissue on view.Week 12: Length was 1.32 cm, width 1.50 cm, and total surface area of 1.45 cm2, a 77% reduction in wound size.Week 24: The length was 0.48 cm, the width was 0.64 cm, and the total surface area was 0.18 cm2. This represented a 97% reduction in wound size.Week 36: Length was 0.01 cm, the width 0.06 cm, with a total surface area of 0.00 cm2. This represented a 99.99% reduction in wound size. ConclusionThe patient’s treatment for a complex venous leg ulcer included the application of TLC-NOSF dressing in combination with individualised therapeutic compression therapy. We found TLC-NOSF was very effective in combination with the best standard of VLU care (i.e. therapeutic graduated compression therapy). The clinician and patient were impressed with the healing rate at 12 weeks, as the wound dimensions were the lowest since the wound started six years ago. This dramatically improved patient concordance and engagement in care. Despite incomplete healing at 36 weeks, the wound-healing journey over the 36 weeks indicated wound closure was close. In addition, using a wound assessment App, the patient could immediately see the benefits of the new treatment, facilitating patient compliance with the treatment.

The Lacing Dermatotraction Suturing Technique

Introduction: Hailing from a tertiary government-aided center, infected surgical wounds varying from diabetic foot and necrotizing fasciitis to surgical site infection are by far the most common cluster of cases encountered in our practice. Due to an overall lack of patient education on wounds, most of these patients present late, necessitating extensive debridement and tissue loss.&#x0D; Aim and Objective: To describe the lacing dermatotraction technique and to study its application in aiding early secondary closure of infected surgical wounds.&#x0D; Material and Methods: An interventional Study was conducted at VICTORIA Hospital, Bangalore, from February 2020 to October 2021. Fifty-four patients with Infected wounds were debrided until healthy margins were obtained, followed by applying the shoelace tension lacing suture. This consisted of an infant feeding tube running under loops of prolene fixed 1 cm away from the edge of the wound. One end of the IFT is anchored to the skin, and the other is held in position with single throws of no-1 silk suture, which can be loosened at the next sitting for adequate wound exposure, which aids in better debridement. The tension suture is again tightened to attain the maximal possible wound approximation. Thus, constant traction on the skin edges creates progressive closure until secondary closure is achieved.&#x0D; Results: 54 Patients were enrolled, consisting of 8 amputation stump infections, 11 diabetic foot, 14 disarticulations, five bed sore, 12 fasciotomies, three mastectomy flap necrosis, and one traumatic avulsion. There were 38 males and 16 females, with a mean age of 53.4 years. The mean duration of the wound at presentation was 17 days, and they were subjected to an average of 11 days of debridement. Mean wound dimensions - length= 11.02cm, breadth=4.86cm and area = 53.55 cm2. On applying the lacing, the wounds were debrided for an average of 8.85 days with 2.9 tightening. Secondary closure was achieved in 45 (83.33%) patients,.&#x0D; Conclusion: The lacing technique is inexpensive and safe to achieve early secondary closure of infected wounds. It avoids the need for skin grafts, reducing the need for anesthesia, hospital expenditure, and duration of hospital stay of patients.&#x0D;

Extracorporeal shockwave therapy (ESWT) in an outpatient wound care clinic: case series analysis of a non-invasive technology in the management of chronic wounds for wound bed preparation.

Extracorporeal shockwave therapy (ESWT) has been shown to reduce wound dimensions and healing time in chronic wounds and should be considered a valuable tool in the healing of chronic complex lower extremity wounds. The aim of this small case series was to evaluate the effect of ESWT on complex chronic wounds in patients with multiple comorbidities in a medically underserved outpatient wound care clinic setting. All patients had baseline wound measurements taken. Pictures of the wounds were also taken at the time of the initial visit. Patients selected for ESWT received weekly treatments for a maximum recorded duration of 12 weeks in the form of focused electro-hydraulic acoustic pulses. Wound beds were cleansed according to standard of care. Thirteen patients were followed with a total of 18 wounds treated. After retrospectively analyzing the data, 3 subjects and a total of 5 wounds were excluded, leaving 10 total subjects and 13 wounds. Out of these wounds, 12 healed completely by or before week 12 of ESWT. All wounds demonstrated significant wound dimension reduction during the first 12 weeks of treatment. ESWT could offer accessible, fast, safe, and cost-effective management of some complex chronic wounds. Further research is needed to validate these findings.

The wounding potential of assault rifles: analysis of the dimensions of entrance and exit wounds and comparison with conventional handguns. A multicentric study.

The appearance of agunshot wound (GSW) is greatly influenced by the velocity of the projectile, where high-velocity projectiles (HVPs) are defined as ballistic agents reaching a muzzle velocity of > 600 m/s fired from assault rifles. The aim of the study is to present and explain the differences in the dimensions of entrance and exit wounds between the most used handguns and assault rifles and to propose a predictor of HVP, i.e., the ratio of exit and entrance wounds (EX/ENR). The surface area of entrance and exit GSWs and the EX/ENR were calculated. 66perforating GSWs produced by NATO FMJ 7.62 × 52 mm and 5.56 × 42 mm fired from assault rifles were assigned to the HVP, while 64 lesions produced by conventional projectiles fired from revolvers and semi-automatic pistols were assigned to the low-velocity projectile (LVP) group. The dimensions of the exit wounds of the HVP group were significantly higher when compared to the LVP group (95% CI 0.9886-2.423, p < 0.05). The HVP group showed significantly higher values for the EX/ENR when compared to the LVP group (95% CI 2.617-7.173, p < 0.05). The evaluation of the EX/ENR can be considered an adequate tool to assess the type of weapon involved and to roughly estimate the associated wounding mechanisms, which can guide both the physician in the management and treatment of the patients affected by GSW, and the forensic pathologist in crime investigation.

Outcome of Perforator Based VY Advancement Fasciocutaneous Flap for Sacral Pressure Sore Reconstruction

Background: Pressure sores are an ancient medical problem; were even found in autopsies of Egyptian mummies. Sacral pressure sore is more common among paraplegic and bedridden patients. The principle of treatment is excision of all dead &amp; devitalized tissue including scars, underlying bursa, and the involved bone, followed by durable coverage with Flap. Various flaps have been used to reconstruct the pressure sore, including Fasciocutaneous flaps, muscle flaps and free flaps. Among various local flaps, perforators based V-Y advancement fasciocutaneous flap is a reasonable and flexible option with good outcomes for sacral pressure sores reconstruction. Objectives: The purpose of this study was to evaluate the outcome of perforator based V-Y advancement fasciocutaneous flap for sacral pressure sores reconstruction concerning the sociodemographic characteristics of the patients, defect size, and outcome of surgery. Methods: This was a prospective observational study, conducted in the Burn &amp; Plastic Surgery department of Rangpur Medical College Hospital, Rangpur over a period of three years from August 2018 to September 2021 through purposive sampling. Patients of all ages and sexes having grade IV sacral pressure sores were included in this study. In all cases, perforator- based V-Y advancement fasciocutaneous flaps were used. Surgical technique, patient demographics, and outcome were evaluated. Results: A total of 30 patients were operated on. The age range was 18 – 65 years, among them 43.33% of patients were in the age range of 31 – 40 years. 80% of patients in this series were male. Traumatic paraplegia was the main cause of sacral pressure sore, and it was 70%. This study showed that in context to the length and breadth of the wound, a majority (30%) of the patients had a wound dimension of 71–90cm2. The smallest wound dimension was (5x6) = 30cm2 and largest wound dimension was (10x16) = 160cm2. Twenty-one sores that ranged from 6cm to 10cm were reconstructed with unilateral flaps and 09 sores that ranged from 11cm to 16cm were reconstructed with bilateral flaps. In this study, 06 (20%) patients had complications and all were managed conservatively. Three patients had infections and were treated according to the culture sensitivity report. Two patients had marginal flap necrosis at the vertical limb of Y which healed conservatively. One patient developed a seroma due to a blockage of the drain tube, which was resolved spontaneously. There was no flap loss in our study. The average follow-up period was one year. No recurrence of pressure sore during this period. Conclusion: The simplicity of the surgical procedure, minimum or no morbidity in the donor area, and satisfactory outcome in terms of recurrence make this a reasonable option for the reconstruction of the sacral pressure sore. J Rang Med Col. September 2023; Vol. 8, No. 2: 20-24

The Effect of Lavandula stoechas on Wound Healing in an Experimental Diabetes Model.

Diabetic foot is a consequential and dangerous complication of diabetes, contributing to decreased quality of life, escalated hospitalizations, and increased mortality rates. Using an experimental model of diabetes, this study aims to investigate the effect of Lavandula stoechas on wound healing. A total of 35 albino Wistar rats, 250-350 grams in weight, were used. The rats were divided into five groups, seven rats in each group. Of these, 21 rats were induced with 50 mg/kg streptozotocin (STZ) to mimic the diabetic condition. Additionally, 14 rats remained non-diabetic and served as the control group. The diabetic rats were further divided into three subgroups. The non-diabetic group was split into two subgroups based on the dressing materials used (allicin, physiological serum, and control). Wound dimensions were assessed on Days 0, 7, 14, and 21. Biopsies were taken from the wound sites at the same time. There were significant differences between groups on Days 7, 14, and 21. The percentage of healing was highest in the Lavandula Stoechas group on Days 7, 14, and 21. Microscopic examination of the biopsies supported accelerated wound healing on Days 7 and 14. Reduced mononuclear cell density and increased hair follicle and adipose tissue development were observed in the DM (diabetes mellitus)-Lavandula Stoechas group on Day 7. On Day 14, the DM-Lavandula Stoechas group increased collagen levels and hair follicles. Similarly, the non-DM-Lavandula Stoechas group showed reduced bullae, dermal edema, and intraepithelial edema on Day 7. This was followed by increased fibroblast levels on Day 14. In conclusion, this study provides compelling evidence for the potential of Lavandula stoechas extract in the enhancement of diabetic wound healing. The multiple interactions revealed here highlight the need for further investigation into the underlying mechanisms. A cost-effective use of Lavandula stoechas opens up promising prospects in managing diabetic foot healing. This warrants additional research and clinical translation.

Repair of ischial tuberosity pressure ulcer with a perigluteal muscle flap

Background: Pressure ulcers are caused by long-term pressure on tissues. Hip pressure ulcers are the most common type. Pressure ulcers in the buttocks are classified into three types: sacrococcygeal, ischial tuberosity, and femoral tuberosity. Methods: We used perigluteal muscle tissue flaps to treat nine cases of grade IV pressure ulcers from January 2016 to August 2018. A retrospective study was conducted on all patients who had an ischial tuberosity pressure ulcer repaired with a perigluteal muscle flap. The gluteus maximus myocutaneous flap was combined with the gluteal fasciocutaneous flap, the biceps femoris myocutaneous flap was combined with the gluteal fasciocutaneous flap, the gracilis myocutaneous flap, the biceps femoris myocutaneous flap, and the semitendinosus and semimembranosus myocutaneous flap. Wounds of different sizes and depths were encountered, the details of which are discussed in treatment methods. Data from patients, including age, gender, cause of injury, wound dimensions, the timing of flap coverage, and complications, were analyzed. Results: The appearance of the skin flap was complete after muscular tissue flap repair, with no visible scar hyperplasia. However, after six to 12 months of follow-up, the flap was soft and left a small linear scar. Conclusions: In the repair of an ischial tuberosity pressure ulcer, a peri gluteal muscle flap provides both aesthetic and functional results. Before using muscle tissue flap transplantation, it is recommended to perform multiple debridement + VSD to improve the wound foundation.

Jet Lavage Irrigation Resolves Stage 4 Pelvic Pressure Injury Undermining.

Patients with stage 4 pelvic pressure injuries that have large, undermined cavities are at high risk for treatment failure and often fall into the category of palliative care. This case series identified five cases where treatment had stalled, and surgical reconstructive options were limited. Jet lavage irrigation in the outpatient setting was assessed as a treatment alternative. From an investigational review board study assessing the use of low-pressure jet lavage irrigation in the outpatient setting for chronic wounds, five patients were identified where the wound dimension increased at least 50% resulting from undermined cavities. All were considered high risk with Charlson Comorbidity Index scores of 5 or greater, and their wound healing had stalled with extended treatments of topicals and medicated dressings. A team of physical therapists irrigated these patients' wounds at the bedside with 3 L of saline 3 to 5 days per week using a special long irrigation tip to reach the depth of the undermined cavity. Digital planimetry was used to assess healing with wound size as the outcome. Reduction of the undermined cavities was seen early within the first 3 weeks. No patient developed wound sepsis, and bacterial contamination was determined by use of autofluorescence digital imaging. Undermining resolution occurred in four patients, and one patient with an improving wound died of COVID-19. This simple method offered clear benefits in each patient, but only one patient survived to complete wound healing. Patient and family satisfaction were high regarding the treatment, which created a painless, odor-free wound.

519-P: Randomized Clinical Trial to Compare Cryopreserved and Lyopreserved Placental Cord Tissue to Treat Complex Diabetic Foot Surgical Wounds—A Proof of Concept Study

Objective: To compare the incidence of infection, healing and time to heal in patients treated with cryopreserved (CPAT) and lyopreserved amniotic tissue (LPAT) in complex diabetic surgical wound (CDFW). Methods: This single-blinded 12-week randomized clinical trial compared cryopreserved and lyopreserved amniotic cord tissue to treat complex diabetic foot wounds (CDFW). LPAT or CRAT was applied at baseline and again after four weeks. We enrolled subjects with UT2A-D and 3A-D wounds (depth to tendon, muscle, or bone with infection and/or PAD) and excluded subjects with ABI&amp;lt;0.5 or TBI&amp;lt;0.3, untreated osteomyelitis, and autoimmune diseases. We used a 3-D camera to evaluate wound area and volume. The Chi-squared test was used to compare clinical outcomes and the Wilcoxon Ranked Sum Test to compare wound area and volume. Results: The mean baseline wound areas were 12.9cm2 ±10.7 for CPAT and 11.7cm2 ±7.0 for LPAT. The mean baseline wound volume were 7.5cm3 ±8.1 for CPAT and 9.2cm3±10.2 for LPAT. There was no difference between CPAT and LPAT in healing (36.8% vs. 19.0%, p=0.21) and infection (10.5% vs. 9.5%, p=0.72). There was no difference in mean wound area reduction between CPAT and LPAT (75.9± 32.3% vs. 65.5±38.4%, p=0.41), nor in mean volume reduction (85.0±30.8% vs. 79.9±31.9%, p=0.61). When we stratified wound dimensions, there was no difference between CPAT and LPAT in subjects that had 90-99% wound volume reduction (36.8% vs. 47.6%), 70-89% wound volume reduction (15.8% vs 19.0%) and 0-69% wound volume reduction (10.5% vs. 19.0%). There was no difference between CPAT and LPAT in subjects that had 90-99% wound area reduction 90-99% (10.5% vs. 23.8%), 70-89% (26.3% vs. 19.0%) and 0-69% (26.3% vs. 38.1%). Conclusion: Cryopreserved and Lyopreserved amniotic tissue provided similar results in patients with complex diabetic foot wounds. Disclosure L.A.Lavery: Research Support; AstraZeneca, Tissue tech, American Diabetes Association, PolarityTE, Inc., Microbion, Jarvis, Integra Lifesciences Holdings Corp, Smith+Nephew. A.L.Killeen: Research Support; 3M/KCI, AstraZeneca, BioTissue surgical, Hologenix, LLC, Integra LifeSciences, Kent Imaging Inc., Microbion, PolarityTE, Inc., Smith+Nephew, Stark Enterprises, LLC, Xyken, VasoActiv, ViOptix. M.A.Suludere: None. P.Crisologo: None. Funding Smith &amp; Nephew