Site Healing Research Articles

A Multi-Systems Approach to Human Movement after ACL Reconstruction: The Integumentary System.

Postoperative management of anterior cruciate ligament (ACL) reconstruction has traditionally focused on the evaluation and intervention of musculoskeletal components such as range of motion and patients’ reports of function. The integumentary system can provide early indications that rehabilitation may be prolonged due to protracted or poor healing of the incision sites. Full evaluation of the reconstruction over time, including direction of the incisions, appearance of surgical sites, level of residual innervation, and health of the individual should be considered when determining time-based goals and plans for returning an athlete to activity. Skin care techniques should be used to minimize strain and promote wound healing at the surgical sites, which in turn allows for implementation of other interventions that target other body systems such as locomotion, strength training, and cardiopulmonary conditioning. The integration of the integumentary system with cardiovascular, neurological, and muscular systems is required for a successful return to activity. A multi-physiologic systems approach may provide a unique viewpoint when aiming to attain a greater appreciation of the integumentary system and its integration with other body systems following ACL reconstruction. The purpose of this clinical commentary is to discuss integumentary considerations within a multi-physiologic systems approach to human movement after ACL reconstruction, including an anatomical review, key elements of assessment, and integrated intervention strategies.Level of Evidence5

Effect of Preoperative Serum Transthyretin Levels on Postoperative Clinical Results and Morbidity in Patients Undergoing Spinal Surgery.

Introduction:This study aims to investigate the effects of preoperative serum transthyretin (TTR) levels on surgical success, pain scores, and postoperative morbidity.Methods:Note that, in our clinic, 188 patients who were operated for spinal pathologies between June 2010 and January 2011 were included in this study. Blood samples were drawn from all patients on the morning of surgery, and then, serum TTR measurements were made. Demographic data of all patients were collected, and then their preoperative and postoperative neurological examinations, Karnofsky scores, Visual Analog Scale (VAS) scores, Oswestry disability index (ODI) scores, postoperative infection and wound healing status, hospital stay, and morbidity levels were recorded, and TTR levels were compared.Results:When preoperative TTR level of patients was low, their Karnofsky scores decreased, ODI scores increased, the early postoperative VAS and late postoperative VAS values increased, and the length of hospital stay was increased. Moreover, in patients with low TTR levels, postoperative Karnofsky scores were lower, postoperative ODI levels were higher, postoperative early and late VAS scores were higher, hospital stays were longer, peroperative complication rates were higher, wound infection rates were higher, the delay in wound site healing was higher, and the morbidity rate was higher.Conclusion:Consequently, preoperative low TTR levels have been reported to be an effective parameter that can be used to predict surgical results, wound infection and wound site healing status, perioperative complications, and morbidity in spinal surgery.

To Evaluate Aloe Vera- Chitosan Based Surgical Dressing to Chitosan Dressing Alone on the Healing of Palatal Donor Sites - A Pilot Study

The present study was undertaken to clinically assess the synergistic effect of topically applied Aloe vera Chitosan to Chitosan alone on the healing of palatal donor sites in free gingival graft surgical procedures. 20 subjects (10 per group) were enrolled into this triple blinded randomized clinical trial, designed to evaluate the efficacy of Aloe vera Chitosan to Chitosan on free gingival graft surgical wounds. Subjects were assigned to either Group A (aloe vera + Chitosan) or Group B (Chitosan alone). Visual Analog Scale(VAS) and Wound healing index were recorded at 7th day, 14th day and 21 days postoperative. Results showed no statistical significance when considering VAS. However there was a statistical significance in wound healing (p=0.04) in group A when compared to group B from 14- 21st day postoperative. It is the first human trial and was a pilot study to assess the synergistic effect of Aloe vera and Chitosan on wound healing. The study has shown that a combination of both acts synergistically in accelerating healing especially in areas where faster healing is necessary to provide overall comfort to the patient. It is therefore a futuristic and a promising material as a surgical dressing with further longitudinal trials.

Clinical and cytological assessment of platelet-rich fibrin versus topical ozonated oil in palatal wound healing after free gingival graft harvesting: Randomized controlled trial

ObjectivesThis randomized clinical trial was conducted to assess the effects of platelets-rich fibrin (PRF) and ozonated oil on the healing of palatal donor wound sites and the patient’s morbidity after free gingival graft (FGG) harvesting. Material and methodsThirty-nine patients were randomly assigned and allocated to three groups (n = 13) for each group. In PRF treated group, a PRF membrane was placed over the palatal wounds while, ozonated oil group were treated with 2 mL ozonated oil daily for 1 week. One week post-operatively, the donor site wound healing was recorded by the healing index (HI). A visual analogue scale (VAS) assessed patient’s pain perception. A cytological analysis was performed using the superficial epithelial cell and keratinization indices at 7, 14, 21 days and second month post-operatively. ResultsThere was a statistically significant difference in HI between PRF group in comparing to ozonated oil and control groups (p ≤ 0.0001). Cytological results of PRF group showed a highly significant improvement (p ≤ 0.00001) in re-epithelization and keratinization indices over time. Meanwhile, non-significant difference was observed between PRF and ozonated oil groups after 2 months post-operatively of complete re-epithelization. ConclusionsOur results showed that the application of PRF on donor wound sites has a significant improvement in wound healing and rapid enhancing effect on the re-epithelialization rate comparing to topical ozonated oil.

STAGE III ADENOCARCINOMA IN THE PNEUMONECTOMY SPECIMEN AT TIME OF LUNG TRANSPLANT RESULTING IN POSTTRANSPLANT METASTASIS DESPITE EXPLANTATION

TOPIC: Transplantation TYPE: Fellow Case Reports INTRODUCTION: Only a few reports have detailed the discovery of non-small cell lung adenocarcinoma in the explanted lung at the time of lung transplant (1). Herein, we present the case of a lung adenocarcinoma, identified in the pneumonectomy specimen, determined to have metastasized in the post-transplant period. CASE PRESENTATION: We reviewed the case of a 61-year-old Caucasian male bilateral lung transplant recipient secondary to end-stage pulmonary fibrosis and pulmonary hypertension. Evaluation of the right lung pneumonectomy specimen revealed multiple foci of lung adenocarcinoma in the right upper, middle, and lower lobes (Figure A – pre-transplant; Figure B – post-transplant). DISCUSSION: Final histopathological evaluation confirmed non-resectable lung adenocarcinoma, pT4N2M0, stage IIIB. The patient was not an ideal candidate for adjuvant radiotherapy due to post-transplant anastomosis site healing. He was also not an ideal candidate for immune checkpoint inhibitors due to insufficient evidence for safety in the solid organ transplant setting. His immunosuppression was reduced, and treatment with adjuvant chemotherapy (pemetrexed/cisplatin) was initiated. The patient suffered complications including pancytopenia and acute renal failure, although his allograft function remained stable through 6 months post-transplant. De novo-donor specific antibodies to DQA1 (20,000 MFI) were detected in sera at 6 months post-transplant, requiring plasmapheresis. At 9 months post-transplant, surveillance bronchoscopy with transbronchial biopsy to evaluate for cellular rejection revealed lung adenocarcinoma associated with lymphangitic carcinomatosis. Follow-up imaging with positron emission tomography and magnetic resonance imaging showed brain, bone, and adrenal gland metastasis. The patient is currently receiving palliative-intent chemotherapy and suffering ongoing pancytopenia and myelosuppression. CONCLUSIONS: Pre-transplant malignancies can remain unidentified due to architectural distortion of the lung parenchyma, even despite appropriately timed, aggressive radiographic surveillance. These malignancies portend worse post-transplant outcomes. REFERENCE #1: Choi YJ, Kim SY, Park MS, Lee JG, Paik HC, Lee SH. Incidental Lung Cancer of Explanted Lungs from Lung Transplant Recipients: Incidence, Characteristics, and 5-Year Survival. Yonsei Med J. 2020 Nov;61(11):958-964. doi: 10.3349/ymj.2020.61.11.958. PMID: 33107239; PMCID: PMC7593106. DISCLOSURES: No relevant relationships by Hesham Abdelrazek, source=Web Response No relevant relationships by Ashwini Arjuna, source=Web Response No relevant relationships by Michael Olson, source=Web Response Speaker/Speaker's Bureau relationship with Genentech Please note: $5001 - $20000 by Rajat Walia, source=Web Response, value=Honoraria Speaker/Speaker's Bureau relationship with Boehringer Ingelheim Please note: $5001 - $20000 by Rajat Walia, source=Web Response, value=Honoraria Speaker/Speaker's Bureau relationship with Grifols Please note: $5001 - $20000 by Rajat Walia, source=Web Response, value=Honoraria Speaker/Speaker's Bureau relationship with Shire Please note: $1001 - $5000 by Rajat Walia, source=Web Response, value=Honoraria Speaker/Speaker's Bureau relationship with Astellas Please note: $5001 - $20000 by Rajat Walia, source=Web Response, value=Honoraria

Clinical effect of perforator flap combined with toe transplantation for repairing thumb damage with soft tissue defect of hand

Objective: To investigate the clinical effect of perforator flap combined with toe transplantation for repairing thumb damage with soft tissue defect of hand. Methods: The retrospective observational study method was used. From May 2014 to June 2019, 8 patients with thumb damage and soft tissue defect of hand were admitted to the 988th Hospital of Joint Logistic Support Force of PLA, including 6 males and 2 females, aged from 25 to 46 years. Among them, thumb damage in 3 cases were degree Ⅱ, 1 case was degree Ⅲ, and 4 cases were degree Ⅳ. All thumb damage were repaired with perforator flap combined with toe transplantation. The skin and soft tissue defects of hand were repaired by free anterolateral thigh perforator flap in 6 cases and free deep inferior epigastric perforator flap in 2 cases. The thumb damage of degree Ⅱ was repaired by the first toe transplantation combined with perforator flap, and thumb damage of degree Ⅲ or Ⅳ was repaired by the second toe transplantation combined with perforator flap. The survival and blood supply of reconstructed thumbs and flaps, and wound healing of donor sites were observed after surgery. All the patients were followed up for 10 to 18 months, the appearance of the reconstructed thumbs, sensory recovery, and foot walking function were observed. At the final follow-up, the functional reconstruction of the thumb was evaluated. Results: All the blood supply and survival of the reconstructed thumbs and flaps were good, and all the wounds of donor sites healed well. During the follow-up, the appearances of the reconstructed thumb and flap were good, the sensation of pain and touch of the finger pulp recovered well, and no significant impact on foot walking function was observed. At the final follow-up, the function of reconstructed thumb was evaluated as excellent in 4 cases, good in 3 cases, and fair in 1 case. Conclusions: The repair method of perforator flap combined with toe transplantation technique can complete the targeted repair of thumb damage with skin and soft tissue defect of hand in one stage, minimizing the foot donor site injury and shortening the course of disease and early rehabilitation, which is one of the ideal methods for the treatment of complex thumb damage.

Early treadmill running delays rotator cuff healing via Neuropeptide Y mediated inactivation of the Wnt/β-catenin signaling.

BackgroundDefining the optimal rehabilitation programs for rotator cuff healing remains a challenge. Early treadmill running may have negative effects on tendon-bone interface (TBI) healing with increased expression of Neuropeptide Y (NPY). However, the underlying mechanism is still unknown.MethodsThe mice were randomly assigned to four groups: control group, treadmill group, treadmill ​+ ​BIBO3304 group and BIBO3304 group alone. Specifically, the control group was allowed free cage activity without any treatment after surgery. The treadmill group received early treadmill running initiated from postoperative day 2. The treadmill ​+ ​BIBO3304 group received treadmill running combined with intra-articular injection of BIBO3304 postoperatively. The BIBO3304 group only received type 1 NPY receptor (Y1 receptor, Y1R) antagonist BIBO3304 postoperatively. Healing outcomes of the rotator cuff were evaluated by histological analysis, synchrotron radiation micro-computed tomography (SR-μCT) scanning, and biomechanical testing at 4 and 8 weeks after surgery. The expression of NPY and its Y1 receptor during the treadmill running were tested by immunofluorescence. In addition, the related signaling pathway of Neuropeptide Y among all groups was detected by immunohistochemistry and western-blot.ResultsImmunofluorescence results show that early treadmill training could lead to a significant increase in the expression of NPY at the healing site, and Y1R was widely expressed in both normal or injured rotator cuff without statistical difference. At the same time, early treadmill running delayed the healing of rotator cuff, as indicated with unsatisfactory outcomes, including a significantly lower histological score, decreased bone formation and inferior biomechanical properties at postoperative week 4 and 8. Moreover, the use of BIBO3304 could partly alleviate the negative effects of early treadmill running on the healing of rotator cuff and promote the natural healing process of rotator cuff, as evidenced by significant differences observed between the treadmill and treadmill ​+ ​BIBO3304 groups, as well as observed between the control and BIBO3304 groups. On the other hand, the expressions of Wnt3a and β-catenin in the treadmill group were significantly lower compared with the other groups, while the expression in the BIBO3304 group was the highest, as evaluated by immunohistochemistry and western-blot.ConclusionsEarly treadmill running increased the expression of NPY at the RC healing site, which might burden the expression of Wnt3a/β-catenin and delay the healing process, inhibition of Y1 receptor with BIBO3304 could promote bone-tendon healing through the Wnt/β-catenin signaling.The translational potential of this article: This is the first study to evaluate the specific role of the NPY-Y1R axis and its underlying mechanism by which early treadmill running delays bone-tendon healing. Further, our study may provide references of precise and individualized exercise-based rehabilitation strategies for TBI healing in clinic.The translational potential of this articleThis is the first study to evaluate the specific role of the NPY-Y1R axis and its underlying mechanism by which early treadmill running delays bone-tendon healing. Further, our study may provide references of precise and individualized exercise-based rehabilitation strategies for TBI healing in clinic.

Incidence of Surgical Site Infection among Post C Section Women Presented in Surgical Emergency of tertiary care hospital

Aim: To rule out incidence and risk factors that are associated with infection at site of surgery after cesarean section. Method: A type of retrospective study was conducted on 100 women who underwent cesarean delivery procedures within a period of 8 month from September 2020 to April 2021 and presented in surgical emergency at Mayo Hospital Lahore. The socioeconomic, demographic and clinical parameters of patients were collected by a questionnaire form. A program known as SPSS version 20 was used for analysis of data that is collected in study. Result: After analyzing the data following factors are identified that causes surgical site infection: Higher BMI (more than 30kg/m2), loss of blood during cesarean section(more than 500mL), poor hygienic care after cesarean section, poor socioeconomic status leads to malnutrition of patient and that leads to poor wound healing and surgical site infection. Lack of education is also a key factor in SSIs. Cesarean done in emergency under improper aseptic conditions also promote SSIs. All these factors are associated with incidence of SSI. Conclusion: SSIS are conventional among women presented in surgical emergency of Mayo Hospital Lahore within 30 days of cesarean section. Management of risk factors causing SSIs in women after cesarean section may decrease the incidence of such infections. Keywords: Cesarean section, risk factors, infection at surgery site.

The Impact of Natural Calcium Carbonate and Ubiquinone on Bone Mineral Density in Rabbits

Objective: The aim of this study was to investigate the effect of ubiquinone and/or calcium carbonate (CaCO3) on bone mineral density in rabbits at healing site in mandibular bone postoperatively. Materials and Methods: Sixty healthy white male New Zealand rabbits almost the same age, weight and circumstance were used in this study. All animals were submitted to operation in the mandibular bone region. The groove of 2mm diameter and 6mm length was drilled by the heavy-duty dental engine. After operation rabbits were randomly divided into six groups (each group 10 rabbits) five rabbits for each period; control group (groove was not filled by anything) and treated groups which subdivided into five groups as follows: group I (groove was filled with Ubiquinone), group II (groove was filled with CaCO3), group III (groove was filled with CaCO3: Ubiquinone as a ratio (1:1)), group IV (groove was filled with CaCO3: Ubiquinone as a ratio (1:2)) and group V (groove was filled with CaCO3: Ubiquinone as a ratio (2:1)). Estimated BMD using Densitometry analysis was measured after 15 and 30 days respectively. Results: Statistical analysis showed significant differences between all groups (control and treated). The estimated BMD showed significant increase group I(101±1.05), group II(111±2.23), group III(125±3.54), group IV(126±5.13) and group V(133±6.29) comparing to control group (92±0.15) at follow-up times at 15 day. Also in the present study we found that significant decrease in BMD after 30 days of operation in group I(144±3.45), group II(153±6.24), group III(160±8.94), group IV(165±9.11) and group V(182±12.56) compare to control group(109±1.25) respectively. Adding the ubiquinone and/or CaCO3 showed a significant increase in BMD manifested by bone healing like space-filling and newly formed bone trabeculae and a high number of lacunas compared with the control group. Conclusion: This study concluded that the addition of ubiquinone and/or CaCO3 was successfully increasing in bone healing by increasing BMD compared with the control group. Keywords: Ubiquinone, CaCO3, Bone healing, BMD (Bone Mineral Density).

↵​Efficacy of Multi-ion Doped Plasma Spray Nano-hydroxyapatite Coated Titanium Implants in Long Bone Fracture Repair in Dogs- Radiographical and Bone Markers Evaluation

Background: Fracture of long bones is a common orthopaedic condition noticed in dogs and its primary goal is to completely restore the function of the injured limb as early as possible. Osteo-conductivity of hydroxyapatite can be improved further by decreasing the particle size to nanometre range and incorporation of inorganic materials in hydroxyapatite can enhance osteoblast cell material interactions. Strontium, Zinc, Silver and Fluorine are known to play an important role in the bone formation and also affect bone material characteristics such as crystallinity, degradation behaviour and mechanical properties. When doped with plasma spray nanohydroxyapatite, these multi-ions cause no harm to the physical environment during the degradation process of hydroxyapatite as these are nontoxic and play significant role in bone metabolism, growth and nourishment. Bone markers have tremendous potential as a rapid and sensitive method for assessing the response of the skeleton to medical or surgical interventions providing valuable information regarding bone turn over in animals. Hence, the current study was undertaken to evaluate the potential of multi-ion doped nano-hydroxyapatite coated intramedullary titanium implants in long bone fracture repair in dogs compared to the conventional intramedullary titanium implants through radiographical studies and evaluation of bone markers. Methods: Radiographical evaluation, Sandwich ELISA kits developed by Bioassay technology laboratory. Result: Plasma spray nano-hydroxyapatite coated titanium intramedullary implants have shown excellent osteo-conductivity when doped with multi-ions of Strontium, Zinc, Silver and Fluorine facilitating rapid osteoblastic activity and rapid bone turnover at the fracture site and complete fracture healing by 3rd week post-operatively as evidenced by radiographic scores and a peak BALP (Canine Bone Alkaline Phosphatase) values and early limb usage. Bone reabsorption and bone tissue remodelling due to osteoclastic action at the fracture site was quicker when the multi-ion doped nano-hydroxyapatite coated titanium intramedullary implants were used which is evidenced by the radiographic scores and highest CTX (Canine C-telopeptide of Type 1 Collagen) values indicating completion of fracture healing and near completion of bone tissue remodelling by 9th post-operative week in long bone fracture repair in dogs.

Zoledronic Acid Deteriorates Soft and Hard Tissue Healing of Murine Tooth Extraction Sockets in a Dose-Dependent Manner.

The pathophysiology, histopathology, and immunopathology of bisphosphonate-related osteonecrosis of the jaw (BRONJ) Stage 0 remain unclear. The aim of this study was to investigate the effects of high-dose bisphosphonates on tooth extraction socket healing by creating a murine model of BRONJ Stage 0-like lesions using 8-week-old female C57BL/6J mice. Zoledronic acid (Zol) was administered subcutaneously twice a week for 7weeks at doses of 0.1mg/kg/week (moderate dose; Zol-M), 0.5mg/kg/week (high dose; Zol-H1), and 1.0mg/kg/week (higher dose; Zol-H2). Saline was used as a control (VC). Both maxillary first molars were extracted 3weeks after drug treatment. Maxillae, long bones, and sera were collected 4weeks post-extraction (n = 7 mice/group). Microcomputed tomography, histological, immunohistochemical, and ELISA analyses were performed. A ceiling effect for Zol was noted at the Zol-H1 dose. Osseous healing of extraction sites was significantly impaired with increased necrotic bone and the number of empty lacunae in a Zol dose-dependent manner. Zol significantly decreased epithelial thickness, due to a decrease in thickness of the stratum spinosum, in both Zol-H1 and Zol-H2. Both Zol-H1 and Zol-H2 significantly suppressed the distribution of F4/80+ macrophages in the connective tissue of tooth extraction sockets, although gross healing appeared to be normal. Intriguingly, both Zol-H1 and Zol-H2 significantly increased the numbers of TRAP+ mononuclear cells and detached osteoclasts in the connective tissue and bone marrow of extraction sites compared to VC and Zol-M, correlated with serum TRAcP5b levels. The created murine model of BRONJ Stage 0-like lesions becoming more severe in a dose-dependent manner may help to understand the pathophysiology and histopathology of BRONJ Stage 0 in humans.

The Response and Tolerability of a Novel Cold Atmospheric Plasma Wound Dressing for the Healing of Split Skin Graft Donor Sites: A Controlled Pilot Study

Introduction: Cold atmospheric plasma (CAP) has positive effects on wound healing and antimicrobial properties. However, an ongoing challenge is the development of specific modes of application for different clinical indications. Objectives: We investigated in a prospective pilot study the response and tolerability of a newly developed CAP wound dressing for the acute healing of split skin graft donor sites compared to conventional therapy. Methods: We applied both treatments to each patient (n = 10) for 7 days and measured 4 parameters of wound healing every other day (i.e., 1,440 measurements) using a hyperspectral imaging camera. Additionally, we evaluated the clinical appearance and pain levels reported by the patients. Results: The CAP wound dressing was superior to the control (p < 0.001) in the improvement of 3 wound parameters, that is, deep tissue oxygen saturation, hemoglobin distribution, and tissue water distribution. CAP was well tolerated, and pain levels were lower in CAP-treated wound areas. Conclusion: CAP wound dressing is a promising new tool for acute wound healing.

Learning process and results in endoscopic saphenous vein harvesting technique

Background/Aim: Endoscopic saphenous vein graft harvesting (EVH) has been increasingly used in coronary bypass graft (CABG) surgery in recent years due to its cosmetic advantage and reduced morbidity. However, for the successful application of this technique, a learning process is required. In this study, we aimed to compare the results of the experience we obtained in the initial phase and later periods of the EVH technique. Methods: Forty patients who underwent elective CABG between July 2015 and April 2017 were included in this retrospective cohort study. The first 20 patients (Group 1) and the next 20 patients (Group 2), whose saphenous vein graft (SVG) was prepared with the EVH technique were compared. The length and preparation time of SVGs prepared with EVH, local findings such as hematoma, necrosis, wound infection, and healing, demographic data, comorbidity, intraoperative and postoperative data, postoperative intensive care and hospitalization times, cosmetic satisfaction and wearing compression stockings were recorded. Results: While the mean operation time was 201.4 (25.0) minutes in Group 1, it was 184.6 (17.1) minutes in Group 2 (P=0.018). There was no difference in the mean SVG lengths between the groups (P>0.05). While SVG preparation time was 75.3 (26.2) minutes in Group 1, it was 35.4 (6.0) minutes in Group 2 (P<0.001). The number of minor branch injuries in the SVG in Groups 1 and 2 were eight (40%), and two (10%), respectively, and all underwent primary repair (P<0.001). Mean length of hospital stay was similar between the groups (P=0.955). No hematoma, infection or necrosis requiring surgical intervention was observed in the extremity from which the SVG was taken. The use of compression stockings was longer in group 1 than in group 2 for the reduction or complete disappearance of edema (56.4 (23.3) vs 42.0 (19.4) days, P=0.040). No patient in any of the groups required rehospitalization due to infection at the saphenous vein incision site and incision healing problem. According to the satisfaction survey, cosmetic satisfaction was high in both groups (P=0.530). Conclusion: We think that after the completion of the learning process on twenty patients, the EVH technique can be used more widely, with much better results in terms of both patient cosmetic satisfaction and reducing morbidity.

Systemic Fibrocyte Levels and Keloid Expression of the Chemoattractant CXCL12 Are Upregulated Compared With Patients With Normal Scar.

Fibrocytes are bone marrow mesenchymal precursors with a surface phenotype compatible with leukocytes, fibroblasts, and hematopoietic progenitors that have been shown to traffic to wound healing sites in response to described chemokine pathways. Keloids are focal fibrotic responses to cutaneous trauma characterized by disordered collagen, which may be associated with elevated systemic fibrocyte levels and/or wound bed chemokine expression. Blood specimens from patients with longstanding keloids and those who form grossly normal scars were assayed by fluorescence activated cell sorting analysis for fibrocytes (CD45+, Col I+). The expression of the fibrocyte chemotactic cell surface marker CXCR4, intracellular markers of fibroblast differentiation (pSMAD2/3), and plasma levels of the CXCR4 cognate CXCL12 were compared. Keloid specimens and grossly normal scars were excised, and local expression of CXCL12 was assayed. Keloid-forming patients demonstrated a significantly greater number of circulating fibrocytes (17.4 × 105 cells/mL) than control patients (1.01 × 105 cells/mL, P = 0.004). The absolute number of fibrocytes expressing CXCR4 was significantly greater (P = 0.012) in keloid-forming patients. Systemic CXCL12 levels were insignificantly greater in keloid-forming patients than controls. Keloid specimens had significantly greater CXCL12 expression (529.3 pg/mL) than normal scar (undetectable). Systemic fibrocyte levels and the CXCR4/CXCL12 biologic axis responsible for fibrocyte trafficking to areas of regional fibrosis were both upregulated in patients who form keloids compared with controls. Keloids persistently expressed CXLC12, which serves both as the main chemoattractant for fibrocytes and a downstream mediator for local inflammation, suggesting a role for this biologic axis in keloid formation and possibly recurrence.

Application strategy and clinical effects of paraumbilical perforator flap with inferior epigastric vessels in repairing destructive wounds

Objective: To explore the application strategy and clinical effects of paraumbilical perforator flap with inferior epigastric vessels in repairing various destructive wounds. Methods: The retrospective observational study method was applied. From January 2015 to December 2020, 28 patients (21 males and 7 females, aged 25 to 66 years) with destructive wounds in various body parts were admitted to Beijing Jishuitan Hospital. The wound areas of patients ranged from 17 cm×8 cm to 35 cm×22 cm after debridement. Pedicled or free paraumbilical perforator flaps with inferior epigastric vessels were used to repair the wounds respectively. The areas of flaps were from 18 cm×10 cm to 37 cm×24 cm, and the lengths of vascular pedicles were 13.0-17.0 (15.1±2.3) cm. For type Ⅲ high-voltage electric burn wounds of wrist, two methods were used to reconstruct the blood flow of hand, one is to bridge the radial artery with saphenous vein grafting and the other one is to design blood flow-through flap. The strength of abdominal wall in the donor site was strengthened by polypropylene patch, and then the wounds were directly sutured. If the wounds could not be sutured directly, then allogenic acellular dermal matrix (ADM) was applied to strengthen the abdominal wall first, and then autologous medium-thickness skin graft was taken from the thigh to cover the wounds. The flap transplantation, hand blood flow reconstruction, the repair of donor site, the flap survival, the wound and donor site healing after operation, the appearance of flaps, and the wound and donor site recovery during follow-up were observed. Results: Among the patients in this group, 13 patients were treated with pedicled flap grafting, while 15 patients were treated with free flap grafting. The hand blood flow of 7 patients with type Ⅲ high-voltage electric burn wounds of wrist was reconstructed by bridging radial artery with saphenous vein grafting. The hand blood flow of 3 patients with type Ⅲ high-voltage electric burn wounds of wrist was reconstructed with blood flow-through flap. In 16 patients, the strength of abdominal wall was strengthened using patch in the donor site,and then the donor sites were sutured directly. In 12 patients, the strength of abdominal wall was strengthened using allogenic ADM, and then the donor sites were covered by skin grafting. All the transplanted flaps survived completely. The wounds of 24 patients were healed, while the wounds of 3 patients with type Ⅲ high-voltage electric burn wounds of wrist and 1 patient with chronic radiation ulcer of ilium failed to heal because of there were still some necrotic tissue and purulent secretion under the flaps. The wounds were healed eventually after debridement and dressing changes. During the follow-up of 6 months to 3 years, the flap survived well with good appearance in all patients, and there was no recurrence, or no abdominal wall hernia occurred in the donor site. Conclusions: Paraumbilical perforator flap with inferior epigastric vessels has flexible design, long vascular pedicle, large area for cut. It can be pedicled or freely transplanted, which is a good choice for repairing destructive wounds in various areas.

The impact of closed incisional negative pressure therapy on anterior lateral thigh flap donor site healing and scarring: A retrospective case-control study

The objective of this study was to investigate whether closed incisional negative pressure therapy (cINPT) is suitable to improve anterior lateral thigh (ALT) flap donor site healing and scarring. We identified 271 ALT free flaps of widths between 7 and 9cm and primary donor site closure performed between January 2012 to December 2019. Patients were divided into cases of cINPT versus controls without cINPT as part of this retrospective case-control review. We compared the incidences of postoperative donor site complications (wound dehiscence, infection, seroma, hematoma) and the degree of scarring severity using the Vancouver Scar Scale (VSS) and the Patient and Observer Scar Assessment Scales (POSAS). A total of 106 ALT donor sites received cINPT (39%), whereas the remaining 165 donor sites received conventional dressings (61%). The distribution of gender, age, body mass index, comorbidities, and mean flap sizes were comparable between both groups. The occurrence of surgical wound dehiscence was significantly lower in the cINPT group (2.8%), when compared to controls (9.0%) (p=0.04). Furthermore, the mean length of postoperative hospital stay was significantly shorter in the cINPT group (19±8 days versus 21±11 days; p=0.03). CINPT was associated with a more favorable donor site scar quality when assessed by VSS (p=0.03) and POSAS (p=0.002). The use of cINPT was associated with significantly less ALT donor site complications and superior scar quality accelerating patients' postoperative recovery.

Silver Ion Hydrocolloid Gauze and Self-Adhesive Polyurethane Foam Dressing Combination Therapy Can Better Promote Healing of Skin Graft Donor Area Than Traditional Therapy: A Case Control Study

The management of skin graft donor area has been a troublesome problem in reconstructive surgery. Currently, no guidelines exist for the management of skin graft donor areas, and the disposal methods vary from clinician to clinician. With the goal of providing a better basis for improved patient care, the authors conducted a case control study to investigate whether a combination of silver ion hydrocolloid gauze and self-adhesive polyurethane foam dressing (AG+foam group) was effective in healing skin graft donor sites. Forty-eight patients requiring intermediate-thickness skin graft between January 2014 and December 2015 were included in the study. Inclusion criteria included a skin graft measuring at least 40 cm2 to be harvested from the ipsilateral thigh and patient age of 14 years to 60 years. All patients were treated differently according to the experience of their own doctor. Donor sites were covered with silver ion hydrocolloid gauze and self-adhesive polyurethane foam dressing (AG+foam group, n = 23]) or petrolatum gauze, sterile gauze, and compression bandage (control group, n = 25]). Wounds healed faster (mean, 12.7 days ± 2.4 standard deviation vs 22.0 days ± 5.8; P < .001), with fewer dressing changes (median [interquartile range, IQR], 2 [IQR, 2-3] vs 4 [IQR, 2.5-5]; P = .002), and with reduced pain on first dressing change (median visual analog scale score, 5 [4-6] vs 7 [6-7.5]; P < .001) in the AG+foam group compared with the control group. The Patient and Observer Scar Assessment Scales and overall scar ratings were better in the AG+foam group than in the control group (P < .001 for all). The AG+foam group had no infections; 2 infections occurred in the control group. Combined use of AG+foam dressing may enhance skin graft donor site healing, alleviate pain, and require fewer dressing changes.

Surgery site healing disorder following laparotomy in cattle: a retrospective study

Wound healing processes in consequence to bovine abdominal surgery performed from 2007 to 2016 at the University of Veterinary Medicine in Vienna were retrospectively assessed. The aim of this study was to evaluate the occurrence of wound healing complications following abdominal surgery in cattle during this 10-year-period as well as to identify possible risk factors such as elevated temperatures. Surgical procedures finding inclusion comprised ileus, left and right abomasal displacement, caecal dilation or displacement (right flank laparotomies), foreign body syndrome (left flank laparotomy), and umbilical surgery. Additionally, weather data during the study period were collected in order to investigate the possible association between ambient temperatures and wound healing disorders. During this period 1365 abdominal surgical procedures were performed. The majority (68.6 %) of the cattle were Simmental cows, followed by 19.6 % Holstein Friesians. Female animals were overrepresented (73.0 %), and 24.0 % of the patients were calves. In 156 cases (11.7 %), a postoperative wound healing disorder (WHD) occurred. The majority of the laparotomies were performed from the right side; of these 21.4 % were left abomasal displacements and 21.7 % ileus surgeries. Left abomasal displacements (24.4 %) and surgery in the umbilical region (21.2 %) were associated with a higher occurrence of WHDs than other abdominal surgical procedures. Animals with right abomasal displacement developing WHDs were significantly younger than those without a WHD. A significant association between WHD frequency and higher temperatures could not be demonstrated. A total of 34.6 % WHD occurred during the summer months (June-September). However, the probability of developing WHDs increased significantly starting at an environmental temperature of 12.5 °C. Most WHD were observed in May (17.1 %) followed by July (15.6 %) and June (15.3 %). The occurrence of WHDs is influenced by numerous different factors such as age of the animal, disease, and type of the surgical procedure. The environmental temperature may increase the risk to develop a WHD but is only one parameter of a multifactorial process.

Buccal periosteal inversion (BUPI) for defect closure and keratinized gingiva width preservation after tooth extraction – technique modification

IntroductionSeveral techniques and methods have been proposed to cover alveolar bone after tooth extraction when soft tissue is lacking. Some authors recommend soft tissue flap techniques, and others advocate different types of materials for socket covering. In this article, the authors use a modified buccal inversion technique for adequate coverage of the alveolar ridge to ensure its preservation and to minimize soft tissue shrinkage and loss of keratinized gingiva after tooth extraction. This local mucogingival-periosteal plastic procedure was named by the authors the “Buccal Periosteal Inversion technique” or simply BUPI. Materials and MethodsAfter extraction of a fractured, endodontically compromised lower right first molar, the BUPI technique was performed to cover the alveolus. After reflecting the two-sided full-thickness flap, the periosteum was split in the cranial direction. The inverted periosteum is used to provide tension-free defect closure of the postextractional defect. Detailed technique implementation and patient postoperative healing are presented here in detail. ResultsPostoperative evaluation at six weeks was presented with photos showing adequate surgical site healing, no signs of infection or dehiscence, and no crestal shift of the keratinized gingiva. ConclusionThe buccal periosteal inversion (BUPI) technique is a modified technique that allows full socket coverage, avoiding a keratinized gingiva shift in the crestal direction using only the periosteum as a cover material. By inverting the buccal ridge periosteum alone from its normal position, the osteoclastic effect on the buccal bony wall will be eliminated, and this procedure abolishes the need for additional alveolar coverage materials.

Evaluation of the preliminary clinical effect of flap-raising combined with cortical-perforation technique in tooth extraction cases of patients with potential risk of medication-related osteonecrosis of the jaw

Objective: To evaluate the preliminary clinical effect of flap-raising and cortical-perforation based extraction method in patients with potential risk of medication-related osteonecrosis of the jaw (MRONJ). Methods: Eighteen patients, who needed teeth extraction in the Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology from February 2016 to November 2020, with a history of using anti-resorption/anti-angiogenesis medication were included in this retrospective study. According to the characteristics of the patient's medication history, patients were stratified into three categories, low-dose anti-resorption drug group, high-dose anti-resorption drug group, and high-dose anti-resorption combined with anti-angiogenesis targeted drug group. There were 15 females and 3 males, the average age was 62.4 years (range from 27 to 87 years) old. A total of 31 teeth were indicated for extraction due to chronic infection. The flap-raising and cortical-perforation techniques were used to extract the affected teeth, and the patients were followed up closely. By observing the healing status and swelling degree of the mucosa of tooth extraction sites, whether there was a fistula, pus and bone exposure of jaw bone,the healing of the tooth extraction sites were evaluated. Results: Among the 18 patients, there were 9 cases of osteoporosis and 9 cases of malignant tumors. Classified by medication-using history, 10 cases were treated with low-dose anti-resorption drugs, 5 cases were high-dose anti-resorption drugs, and 3 cases were high-dose anti-resorption drugs combined with anti-angiogenesis drugs. A total of 31 teeth of the patients were extracted by flap-raising and cortical-perforation based extraction method. Thirteen patients completed treatment underwent local anesthesia and five cases were performed under general anesthesia. The shortest follow-up period was 3 months with an average of 13.2 months. Seventeen patients recovered well after the tooth extraction. One patient had the mandible exposed at one extraction site one month after the surgery, resulting in MRONJ. Conclusions: In patients with potential risks of MRONJ, the application of flap-raising and cortical-perforation based teeth extraction method could safely and effectively alleviate the dental inflammation in the oral cavity.