Surgical Wound Healing Research Articles

Ultrasound evaluation of post-cesarean uterine wound healing based on a figure of eight suturing technique

Link of Video Abstract: https://youtu.be/15Du23GFCWc Introduction: A niche (also called an isthmocele) is a defect or uterine scar that can be detected by ultrasound a few weeks or months after delivery by cesarean section. A niche is often associated with obstetric complications in subsequent pregnancies, including uterine dehiscence and/or rupture, placenta previa, and placenta accreta. Placenta accreta is characterized by abnormal attachment of the placenta to the uterine wall and is one of the leading causes of maternal morbidity and mortality in developing countries. Therefore, this study aims to evaluate the healing of surgical wounds with the figure of eight suturing techniques. Methods: This study included 32 primigravida patients who underwent cesarean section at RSIA (Mother & Child Hospital) Rosiva from March 2006 to July 2006. On day 6 of the puerperium, the uterine sutures were examined with transvaginal ultrasound. Patients were subsequently allowed to return to their homes to receive outpatient treatment. On day 40, the patients were requested to return to the hospital for a follow-up ultrasound examination. Results: On day 6, incomplete wound healing was found in 31 patients (96.9%) and complete wound healing in 1 patient (3.1%). On day 40, 31 patients (96.9%) experienced perfect or complete healing. Statistical analysis showed a significant difference in wound healing between day 6 and day 40 (p = 0.0001). Conclusion: On day 40 after cesarean section, as many as 96.9% of patients showed perfect/complete wound healing (type I) without a niche. Therefore, these patients had a low risk of obstetric complications associated with uterine scarring in subsequent pregnancies.

Influence of changes in the human intestinal microbiota on slowing the wound process in overweight persons

Overweight and imbalance of the intestinal microbiota are risk factors for disruption of reparative processes during the healing of postoperative wounds. Given the scale of the obesity epidemic in the modern world, the number of overweight patients undergoing surgery for various reasons is also increasing. Potentiation of the risk of a delayed and complicated course of the wound process with a combination of obesity and disturbances in the composition of the intestinal microbiota determines the relevance of this study. Purpose of the study : to study the composition of the intestinal microbiota in patients with overweight and obesity, who have a slowdown in the course of the wound process and the development of complications in the postoperative period. Material and methods . The composition of the intestinal parietal microbiota was studied by microbial markers in the blood using gas chromatography in 49 overweight women who underwent planned surgical interventions for aesthetic indications aimed at correcting body contours from 2019 to 2020. After surgery, women were followed up for 6 months, assessing the timing of wound healing. A comparative analysis of the composition of the intestinal microbiota was carried out in different courses of the wound process, the prognostic significance of individual indicators of the intestinal microbiota was studied in relation to the risk of delayed and complicated wound healing. Results . In the postoperative period, three groups were formed: 1st − complicated wound process (n = 21), 2nd − slow wound process 16 (n = 16), 3rd − standard wound process (n = 12). There were statistically significant differences between the 1st and 2nd groups in terms of “ Peptostreptococcus anaerobius (Gr 1) ≥ 562.0 · 105 cells/g”, p = 0.025) and “ Propionibacterium ≥3.2 · 105 cells/g”, p = 0.0136). Differences were found between the 1st and 3rd groups in terms of “Endotoxin ≥0.7 nmol/ml”, p = 0.051). The highest risk of complicated and delayed postoperative wound healing is observed when the value of the indicators « Propionibacterium ≥32.0 · 105 cells/g”, “ Peptostreptococcus anaerobius (Gr 1) ≥7.0 · 105 cells/g” and “Endotoxin ≥0.7 nmol/ml”. On the basis of the decision tree method, 4 risk classes of a delayed and complicated course of the wound process were identified. The highest risk is in patients with a combination of factors “ Propionibacterium ≥ 3.2 · 105 cells/g” and “Endotoxin ≥ 0.7 nmol/ml”. Conclusion . A number of indicators of intestinal microbiota have a high prognostic value in relation to the risk of developing a complicated and delayed course of the wound process in overweight individuals. The data obtained can be used to predict unfavorable healing of surgical wounds.

Customized External Cranioplasty for Management of Syndrome of Trephined in Nonsurgical Candidates.

Craniectomies represent a lifesaving neurosurgical procedure for many severe neurological conditions, such as traumatic brain injury. Syndrome of trephined (SoT) is an important complication of decompressive craniectomy, and cranial reconstruction is the definitive treatment. However, many patients cannot undergo surgical intervention because of neurological status, healing of the primary surgical wound, or the presence of concurrent infection, which may prevent cranioplasty. To offer a customized external cranioplasty option for managing skull deformities for patients who could not undergo surgical intervention for definitive cranioplasty. We describe the design and clinical application of an external cranioplasty for a patient with a medical history of intractable epilepsy, for which she underwent multiple right cerebral resections with a large resultant skull defect and SoT. The patient had resolution of symptoms and restoration of a symmetrical skull contour with no complication at 17 months. Customized external cranioplasty can improve symptoms associated with SoT for patients who cannot undergo a definitive cranioplasty. In addition, inset monitoring options, such as electroencephalography or telemetric intracranial pressure sensors, could be incorporated in the future for comprehensive monitoring of the patient's neurological condition.

Prediction of the Complicated Wound Process in Overweight Patients Depending on the Composition of the Intestinal Microbiota

Introduction. Overweight and imbalance of the intestinal microbiota are risk factors for disruption of reparative processes during the postoperative wound healing. Given the scale of the obesity epidemic in the modern world, the number of overweight patients undergoing surgery for various reasons is also increasing. The potentiation of the risk of a delayed and complicated course of the wound process combined with obesity and violated composition of the intestinal microbiota determines the relevance of this study.The aim of the study was to investigate the composition of the intestinal microbiota in patients with increased body weight, with long-term non-healing and complicated surgical wounds.Methods. The composition of the parietal intestinal microbiota was studied by microbial markers in the blood using gas chromatography in 49 overweight women who underwent planned surgical interventions for aesthetic indications in the period from 2019 to 2020, aimed at correcting body contours. After the operation, women were observed for 6 months, with assessment of the timing of wound healing. We carried out a comparative analysis of the composition of the intestinal microbiota in the different course of the wound process, studied the prognostic significance of individual parameters of the intestinal microbiota in relation to the risk of delayed and complicated wound healing.Results. In the postoperative period, all patients were divided into three groups: group 1 - complicated wound process (n=21), group 2 - delayed wound process 16 (n=16), group 3 - conventional wound process (n=12). Statistically significant differences were found between groups 1 and 2 in terms of "Peptostreptococcus anaerobius (Gr 1) 562.0" (621.76962.03 versus 101.75371.90, respectively, p=0.025) and "Propionibacterium 3.2" (77.57 48.57 vs. 40.44 38.15, respectively, p=0.014). Differences were found between groups 1 and 3 in terms of Endotoxin 0.7 (0.730.58 nmol/ml versus 0.860.48 nmol/ml, respectively, p=0.051). The most risk of the complicated and delayed postoperative wound healing is observed when the values of the parameters were "Propionibacterium 32.0", "Peptostreptococcus anaerobius (Gr 1) 7.0" and "Endotoxin 0.7". Based on the decision tree analysis, 4 risk classes of delayed and complicated course of the wound process were identified. Patients with a combination of Propionibacterium 3.2 and Endotoxin 0.7 had the highest risk.Conclusion. A number of parameters of the intestinal microbiota have a high prognostic value regarding the risk of developing a complicated and delayed course of the wound process in overweight individuals. The data obtained can be used to predict unfavorable healing of surgical wounds. Further research is needed in this area on a larger sample of patients, including males.

Nutrition of neonates and infants with severe congenital heart disease - the review of the literature

CHD is the most common birth defect with an incidence of 9 per 1,000 live births. The severity of the disease and the choice of treatment depend on the underlying anomaly. Despite advances in medical and surgical treatment that have led to more children with CHD reaching adulthood, disorders such as intestinal dysfunction, poor nutrition, and growth failure are still common in infants with CHD. Increased metabolic demand, decreased caloric intake, malabsorption, genetic factors, and fluid restriction can all result in an energy imbalance that negatively impacts morbidity and mortality in these patients. On the other hand, malnutrition is an important risk factor for adverse postoperative consequences. The state of nutrition affects growth and development, wound healing and the functioning of the immune system. Malnutrition affects both short-term and long-term postoperative outcomes. Recurrent infections caused by impaired immune system function and delayed healing of surgical wounds are considered short-term effects, while impaired growth, physical and cognitive development are seen as long-term effects. High postoperative mortality and morbidity, such as increased rates of hospitalization, delayed growth, prolonged recovery time, and longer hospital stays are associated with preoperative malnutrition. Appropriate nutrition protocols tailored to the requirements of patients with congenital heart disease help to improve short and long-term treatment outcomes. Nutritional and metabolic changes are age-dependent, and since this is a high-risk population, enteral and/or parenteral nutrition is difficult. Sources of increased metabolic demand in CHD include greater workload on the heart, pulmonary hypertension, and increased catecholamine secretion.

Assessment of tissue healing after periodontal and peri-implant surgery

Relevance. In clinical practice, a dentist usually faces surgical wound healing peculiarities. We know that wound healing by primary intention is preferable, but the postoperative period does not always go this way. In practice, doctors observe a variety of wound healing options, which are not always documented correctly and in full. An incomplete and unprecise diagnosis may lead to c omplications, including iatrogenic ones.Material and methods. This study included patients undergoing surgical treatment in the Samara dental outpatient department. The study assessed the healing of periodontal and peri-implant tissues on the 4th-5th day after surgery. One hundred-and-thirty subjects, aged 27 to 65 y.o., participated in the study.Results. The study revealed the criteria for oral surgical wound healing, which included density and quality of the approximation of wound edges, oedema, exudate, hyperemia, fibrin coat amount, and purulent discharge. The study also recorded the subjective sensations of the patients. After analyzing the postoperative wound condition, we divided the patients into groups according to a similar clinical situation. We identified six types of wound healing processes around implants and teeth. Thus, we formed classes and subclasses of our "Classification of periodontal and peri-implant surgical wound healing assessment." This classification will optimize and simplify communication between specialists and speed up medical charting. The analysis helped to develop and implement a decisionmaking algorithm for postoperative surgical site treatment.Conclusion. The method of soft tissue condition classification and treatment after periodontal and peri-implant surgery is easily reproducible and available in routine outpatient surgical practice. The algorithm will allow for the successful treatment of surgical wounds based on the wound-healing process characteristics.

Surgical wound healing quantitative assessment method: the case of dental implant placement using a modified guided bone regeneration technique. Part II

Relevance. The guided bone regeneration (GBR) technique during dental implant treatment, if alveolar bone/part of the jaws is lost, stands out for its effective potential, the main factor of which is the possibility of the necessary bone volume restoration having morphofunctional signs of organotypicity. The prognosis effectiveness of such reconstruction outcome directly depends on the wound process characteristics. The variability of the latter, subject to an unbiased quantitative assessment, can be essential for predictive analysis and prognosis.Aim. The study aimed to develop a technique for quantitative assessment of surgical wound healing (exemplified with an extracted tooth socket), described in the first part of the publication.Materials and methods. The clinical study involved 20 patients of both sexes diagnosed with the condition after dental implantation and reconstruction of the alveolar bone volume using the GBR technique modified by the formation of a situational vicryl framework (SVF). We determined the following parameters: independent and dependent variables, with their indirect mutually dependent influence on a favourable, compromised or unfavourable treatment outcome, based on the wound healing process follow-up and assessment of immediate results in the early, middle and late postoperative period − up to 1 month, and the analysis of delayed – from 1 month to 1 year, and long-term – over one year. These variables are characterized as quantitative indicators – biomarkers, processed by the correlation and regression analysis using the Gretl statistical package.Results. The study revealed a direct correlation regarding all parameters as independent (factor) and dependent (effect) variables necessary for quantifying the wound healing process variability. The created linear regression model confirmed the empirically observed and theoretically substantiated idea of the reciprocal influence of normal and pathological variations of wound healing process on an outcome of dental implantation in the reconstruction of the alveolar bone defect. The correlation and regression analysis for an unbiased quantitative assessment of surgical wound healing demonstrated the statistically explicable behaviour of dependent variables at a 95% le vel.Conclusion. The correlation and regression analysis performed using the presented data indicates a direct correlation between the parameters of a favourable, compromised and unfavourable outcome of dental implantation during the reconstruction of the alveolar bone volume using the GBR technique modified by the formation of SVF and variables expressed by biomarkers, such as the initial complexity of clinical conditions, duration of surgery, mechanical load of the wound, bio-reactive properties of the additional materials required in the w ound.

Biomimicking dual drug eluting twisted electrospun nanofiber yarns for post-operative wound healing

The morbidity rate following a surgical procedure increasing rapidly in the cases associated with surgical site infections. Traditional sutures lack the ability to deliver drugs as the incorporation of the drug in their structure would hamper their mechanical properties. To prevent such infections, we developed an extracellular matrix mimicking electrospun nanofibrous yarns of poly-(D,L)-lactic acid and polyvinyl alcohol loaded with vancomycin and ferulic acid, prepared by uniaxial electrospinning technique. In-vitro characterization such as scanning electron microscopy, Fourier transform infrared spectroscopy, x-ray diffraction, tensile strength testing, degradation studies, and antimicrobial studies along with in-vivo evaluation done with help of incision wound healing rat model and simultaneous testing of microbial load in the incised tissue. The in-vitro studies indicated the nanofiber yarns have size range 200–300 nm with a tensile strength of 7.54 ± 0.58 MPa. The dual drug-loaded yarn showed sustained drug release over a period of 48 h. In-vitro water uptake and biodegradation data indicated optimum results suitable for suturing applications. Antimicrobial study showed excellent antimicrobial activity against both S. aureus and E. coli. Results obtained from in-vivo study suggested excellent wound healing potential of nanofiber yarns as compared with commercial silk sutures. The histopathological studies confirmed restoring ability of nanofiber yarn to the normal skin structure. Enzyme-linked immunosorbent assay (ELISA) study revealed the downregulation of inflammatory markers i.e. TNF-alpha and IL-6, making nanofibers sutures suitable for surgical wound healing applications. Overall, the present study may conclude that the developed dual drug-loaded nanofiber yarns have excellent potential in surgical wound healing applications.

Transplantation of Umbilical Cord-Derived Mesenchymal Stem Cells Attenuates Surgical Wound-Induced Blood-Brain Barrier Dysfunction in Mice.

Blood-brain barrier (BBB) is the most important component of central nervous system (CNS) to keep toxins and pathogens from CNS. Although our studies demonstrated that using interleukin-6 antibodies (IL-6-AB) reversed the increased permeability of BBB, IL-6-AB is limited in their application that only could be used a few hours before surgery and seemed delayed the surgical wounds healing process, which urges us to find another more effective method. In this study, we employed the C57BL/6J female mice to investigate the potential effects of umbilical cord-derived mesenchymal stem cells (UC-MSCs) transplantation on BBB dysfunction induced by surgical wound. Compared to IL-6-AB, the transplantation of UC-MSCs more effectively decreased the BBB permeability after surgical wound evaluated by dextran tracer (immunofluorescence imaging and luorescence quantification). In addition, UC-MSCs can largely decrease the ratio of proinflammatory cytokine IL-6 to the anti-inflammatory cytokine IL-10 in both serum and brain tissue after surgical wound. Moreover, UC-MSCs successfully increased the levels of tight junction proteins (TJs) in BBB such as ZO-1, Occludin, and Claudin-5 and extremely decreased the level of matrix metalloproteinase-9 (MMP-9). Interestingly, UC-MSCs treatment also had positive effects on wound healing while protecting the BBB dysfunction induced by surgical wound compared to IL-6-AB treatment. These findings suggest that UC-MSCs transplantation is a highly efficient and promising approach on protecting the integrity of BBB which caused by peripheral traumatic injuries.

The Impact of Subcutaneous Vacuum Suction Drains on Abdominal Wound Complications in Rural Indian Patients Undergoing Emergency Laparotomy

Surgical Site Infection and wound healing are reported more commonly in abdominal surgeries. Wound dehiscence following SSI is a significant concern. Subcutaneous negative suction drainage will reduce the incidence of SSI and wound dehiscence by draining seroma, promoting wound healing. Objective: This study's objective is to assess and evaluate the impact of subcutaneous drains on the incidence of surgical site infections following an emergency laparotomy procedure. Methodology: A total sample size of 50 patients within the inclusion criteria for 12 months was taken. Patients are followed for 15 days after surgery and are divided into 2 groups as Group A (study group): Emergency surgeries were done with subcutaneous drains. Group B (control group): Emergency surgeries were done without subcutaneous drains. Central randomization was performed. Results: 50 patients were included in the study, with 25 in each group. Hematoma formation was significantly higher among group B (24.0%) than among group A (4.0%). Seroma formation (p-value =0.03917), SSI rate (p-value =0.039), and wound dehiscence/burst abdomen (p-value =0.0415) were more in group B than in group A. The mean wound healing time (days) and mean hospital stay (days) were significantly more in group B. Conclusion: Surgical site infection is commonly due to abdominal cavity infection rather than nosocomial infection. The subcutaneous suction drainage tube is an effective method of abdominal wall closure in cases of peritonitis compared to conventional primary skin closure without drain as it significantly reduces the incidence of wound infection, dehiscence, wound secondary suturing and duration of hospital stay in SSI.

Effects of ozone therapy on periodontal and peri-implant surgical wound healing: a systematic review.

To evaluate the effectiveness of the use of adjuvant ozone therapy in the healing process of wounds resulting from periodontal and peri-implant surgical procedures by answering the following focused question: "Can adjuvant ozone therapy improve wound healing outcomes related to periodontal and peri-implant surgical procedures?". MEDLINE (via PubMed), EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched, without language restriction, for peer-reviewed articles published until 23 March 2022, in addition to manual search. Only controlled clinical trials (randomized or not) were considered. The risk of bias was evaluated by the Cochrane risk-of-bias tool for RCTs - version 1 (RoB1). Data were pooled into evidence tables and a descriptive summary was presented. Of the 107 potentially eligible records, only seven studies were included. Four addressed free/deepithelialized gingival grafts with a palatal donor area, two evaluated implant sites, and one comprised gingivectomy and gingivoplasty. A total of 225 patients were evaluated in the included studies, considering control and test groups (ozone and other adjuvant therapies for comparison). Ozone therapy had a positive effect on outcomes directly or indirectly related to periodontal/peri-implant surgical wound healing. Furthermore, it could also increase the stability of immediately loaded single implants installed in the posterior mandible. In general, ozone therapy seems to both accelerate the healing processes of periodontal/peri-implant wounds and increase the secondary stability of dental implants; however, considering the limited evidence available and the risk of bias in the included studies (none classified as low risk), a definitive conclusion cannot be drawn. (Quintessence Int 2023;54: 100-110; doi: 10.3290/j.qi.b3512007).

Preparing the Bowel (Microbiome) for Surgery: Surgical Bioresilience.

The preparation of the bowel for radical surgery is a corner stone of elective colorectal practice. The evidence for this intervention is of variable quality and it is often contradictory, yet there is now a global move toward the adoption of oral antibiotic therapy for the reduction of perioperative infective complications, such as surgical site infections. The gut microbiome is a critical mediator of the systemic inflammatory response to surgical injury, wound healing, and perioperative gut function. The loss of critical microbial symbiotic functions caused by bowel preparation and surgery has an adverse impact on surgical outcomes, yet the mechanisms through which this occurs are poorly defined. In this review, the evidence for bowel preparation strategies is critically appraised in the context of the gut microbiome. The impact of antibiotic therapy on the surgical gut microbiome and the importance of the intestinal "resistome" to surgical recovery is described. Data to support the augmentation of the microbiome through diet, probiotic and symbiotic approaches, as well as fecal transplantation are also appraised. Finally, we propose a novel strategy of bowel preparation defined as " surgical bioresilience " and define areas or prioritization in this emerging field. This describes the optimization of surgical intestinal homeostasis and core surgical exposome-microbiome interactions that regulate the wound immune microenvironment, the systemic inflammatory response to surgical injury, and gut function across the perioperative time course.

The Effect of Aloe Vera Gel on Saphenous Vein Harvest Wound Healing and Local Pain in Non-diabetic Patients Undergoing CABG Surgery: A Clinical Trial

Background: Coronary artery bypass graft (CABG) is a common surgical procedure in patients with heart disease associated with pain and problems with great saphenous veins (GSVs) wound healing. Objectives: We aimed to determine the effect of aloe vera gel on pain intensity, and GSVs wound healing in non-diabetic patients undergoing CABG. Methods: In this clinical trial, 35 CABG candidate patients fulfilling admission criteria were selected by convenience sampling, and their lower limbs were randomly assigned to the intervention or control group. The wound care for both groups was the same except for using aloe vera gel for the intervention group from the first to the fourth days after surgery. Pain intensity and GSVs wound healing data were collected by Redness, Edema, Ecchymosis, Discharge, and Approximation (REEDA) scale and Visual Analog Scale (VAS) questionnaires on the first, fourth, seventh, and fourteenth days and analyzed by SPSS software. Results: On the seventh day, the mean pain intensity in the intervention group was significantly lower (P = 0.01). The mean scores of wound healing in the intervention limb decreased faster; however, the wound healing score was not significantly different between the two groups at any time (P > 0.05). Using aloe vera gel reduced ecchymosis on the seventh and fourteenth days and reduced pain on the seventh day compared to the control limb (P < 0.001). Conclusions: Aloe vera gel can effectively reduce GSVs' pain intensity and ecchymosis from the seventh day. The topical application of this herb can have various degrees of effectiveness in decreasing pain and speeding up the healing of surgical wounds.

Patient-reported quality of life factors in vascular surgical wounds healing by secondary intention (SWHSI): a qualitative patient and public involvement (PPI) exploration

Background: Surgical wounds healing by secondary intention (SWHSI) represent a significant burden to patients and services. An understanding of quality of life factors affecting this population is essential to recognise the impact of this wound entity on patients. Understanding of the patient experience is necessary to building effective services and designing high-quality research studies to improve care in this population. Methods: Twelve individuals with lived experience of living with a SWHSI or caring for a person with a SWHSI were recruited to one of two focus groups. Participants were identified from those who had previously been recruited into the NIHR-funded SWHSI-2 trial (NIHR17/42/94; a study assessing healing of surgical wound healing by secondary intention). All participants in this cohort had lower limb SWHSIs and a history of peripheral vascular disease. Sessions followed a general topic guide and were guided by the research team. Sessions were audio-recorded, transcribed and analysed using thematic analysis methods. Results: Four main areas of impact on quality of life were identified: mental health, physical symptoms, lifestyle symptoms and service-based impacts. There was a clear heterogeneity of experience seen within the group, with some reporting a more significant impact than others. This was ascribed to the loss of social and professional functioning, and the subsequent impact on mental health. There was a differential impact of this on younger participants (who tended to be employed and hold caring roles for children or family members) compared to older participants who did not have these social roles to fulfil, and were less affected in these areas. The need for improved preoperative counselling was highlighted, as many participants reported feeling unprepared for the postoperative course. Conclusions: This study considered the experiences of patients with a SWHSI and identified the main areas of impact on quality of life. This work will help to underpin future research into treatments and services for the SWHSI population. It may also form the basis for identifying an appropriate patient-reported outcome measure (PROM) related to quality of life in SWHSI for use in the research setting. Limitations of the study included the number and diversity of participants, and the impact of the SARS-CoV-2 (COVID-19) pandemic on the experiences of participants. Further exploration of the area through formal qualitative study is warranted to understand the breadth, generalisability and possible future applications of the work.

Bacteriophages in complex treatment of septic diseases of the hand

To evaluate the effectiveness of bacteriophages in complex surgical treatment of septic diseases of the hand. We analyzed treatment outcomes in 111 patients with septic diseases of the hand (septic arthritis, tendovaginitis, phlegmon). Surgical treatment was finished by primary sutures and drainage. They were divided into two groups. Bacteriophages were used in the main group. Other components of treatment were identical. «Pyobacteriophage complex» was injected into drainage tubes during dressings. Effectiveness of treatment was evaluated considering elimination of septic process, bacterial flora and healing of surgical wound. In addition, we performed in vitro testing of microorganisms for sensitivity to Pyobacteriophage. Staphylococcus and Streptococcus genus prevailed in hand infections. Pasteurella multocida has been isolated after pet bites. Growth of microflora in drainage tubes was observed in 16.7% and 21.1% of cases, respectively (p=0.02). Wound healing via primary intention was found in 83.6% and 71.4%, respectively (p=0.03). When testing in vitro, we observed lysis of cultures of Staphylococcus aureus in 83.6% of cases, Streptococcus pyogenes - in 33.3% of cases. «Pyobacteriophage complex» was effective for septic diseases of the hand. However, its partial lytic activity against the most common pathogens makes it advisable to combine phages and antibiotic therapy. Systematic renewal of phages is important due to widespread resistance of bacteria.

The Effect of Early Mobilization Implementation on the Healing of Sectio Caesarea Operation Wounds at Harapan Insan Sendawar Hospital

Sectio caesarea has become a safe procedure with consideration for the safety of the mother and baby. Early postoperative mobilization has been advocated for patients undergoing major surgery to increase functional capacity and to improve recovery. The purpose of this study was to determine the effect of early mobilization on surgical wound healing at Harapan Insan Sendawar Hospital. This type of research is Quasy Experiment with a static grub comparison research design. A sample of 32 postpartum post-partum mothers with sectio secarea with 16 respondents in the intervention and control groups respectively. The sampling method is non-probability sampling with purposive sampling technique. There is an effect of early mobilization with SC wound healing at Harapan Insan Sendawar Hospital (p-value 0.036).

Aplicação tópica de gentamicina ou cefalotina na cicatrização de feridas cirúrgicas em cães

The present study aimed to evaluate the influence of local administration of gentamicin or cephalothin on the healing of surgical wounds in dogs. Thirty healthy dogs were submitted to surgical castration. They were divided into 2 groups of 15 animals. After the surgical procedure, two 0.6 cm circular cutaneous wounds were made in the abdominal region. Group 1 received 0.1 ml of 0.9% saline in one wound and 0.1 ml of gentamicin (40 mg / ml) in the other wound; and group 2 received 0.1 ml of 0.9% saline and 0.1 ml of cephalothin (200 mg / ml); respectively. All wounds were sutured and assessed macroscopically 1, 3 and 10 days after the operation. On day 10, an incisional biopsy was performed for histopathological evaluation. All analyzes of macroscopic variables did not show significant differences between groups (P <0.05). There were no significant differences between groups for microscopic evaluation of collagenization, vascularization, edema and inflammatory cells (P <0.05). Thus, the topical use of the tested antibiotics does not influence skin healing in dogs.

No Association of Sirolimus with Wound Complications in Children With Vascular Anomalies

IntroductionSirolimus has demonstrated effectiveness as a treatment option for several types of vascular anomalies; however, it has a potential side effect of delayed surgical wound healing. The purpose of this study was to evaluate the association of sirolimus with postoperative complications in the pediatric vascular anomaly population. MethodsA retrospective cohort study was performed for children with a vascular anomaly who underwent excision or debulking of the anomaly from 2015 to 2020. Patient demographics, vascular anomaly characteristics, operative variables, sirolimus dosing information, and perioperative outcomes were collected. Univariate analysis was performed to compare outcomes based on the administration of sirolimus. ResultsForty-seven patients with vascular anomalies underwent 57 surgical procedures (36 without perioperative sirolimus, 21 with perioperative sirolimus). The median age at the time of surgery was seven years (IQR 1.7–14.0). The most common anomalies were lymphatic and venolymphatic malformations. Of the patients administered perioperative sirolimus, the median preoperative and postoperative sirolimus levels were comparable (preoperative 6.9 ng/mL (IQR 4.9–10.1), postoperative 6.5 ng/mL (IQR 4.7–9.4)). The rate of postoperative complications (sirolimus 19%, without sirolimus 11%; p = 0.45) and wound complications (sirolimus 14%, without sirolimus 6%; p = 0.26) were comparable between the cohorts. ConclusionOur results suggest sirolimus may not significantly increase perioperative complication rates in pediatric patients undergoing resection of their vascular anomaly. Level of EvidenceLevel III.

Immediately activating hemostatic cellulose sealants for uncontrolled hemorrhage

The control of bleeding is one of the most important processes in surgical treatments and wound healing, and the development of effective hemostatic agents is urgently required. An ideal hemostatic agent should be immediately activated when exposed to bleeding to reduce blood loss as soon as possible and should be user-friendly for urgent situations. To meet these demands, we functionalized carboxymethyl cellulose (CMC) with two different phenolic moieties, catechol (CA) and pyrogallol (PG), and then formulated each CMC derivative into adhesive hydrogels with high hemostatic ability. These hemostatic platforms exhibited sturdy modulus (CMC-CA: 0.55 ± 0.08 kPa, CMC-PG: 1.37 ± 0.24 kPa), wet-tissue adhesiveness (CMC-CA: 2.19 ± 0.53 kPa, CMC-PG: 3.13 ± 0.25 kPa), and rapid crosslinking within seconds for wound closure. We transformed the CMC hydrogels into a patch design, resulting in 16∼19-fold increase in elastic modulus and 3∼4-fold increase in adhesiveness, which can completely seal the wound for more efficient hemostatic action. The adhesive CMC patches exhibited superior hemostatic capability to fibrin glue as a wound sealant by rapidly stopping bleeding in mouse liver hemorrhage. This study demonstrated that bio-inspired polyphenolic CMC hydrogels produce a highly effective, instantly working hemostatic agent.

DDEL-02. LUMBAR OMMAYA RESERVOIR- A COST EFFECTIVE ALTERNATIVE TO INTRAVENTRICULAR OMMAYA RESERVOIR FOR TREATMENT OF LEPTOMENINGEAL DISEASE

Abstract Introduction Lumbar puncture (LP) is a well-established approach for intrathecal (IT) delivery of chemotherapeutics for leptomeningeal disease (LMD). Intraventricular Ommaya reservoir (OR) has supplanted LPs as an easier and safer route for IT administration. Radiotherapy for treatment of LMD must be delayed in order for surgical wound healing following OR placement. Furthermore, prior cranial radiation can thin the scalp, predisposing to wound breakdown. Placement of lumbar Ommaya reservoir (LOR) provides an alternative to IT delivery, but this has not reached a wide-spread acceptance. Objective Provide cost-analysis and report patient outcomes after placement of LOR. METHODS Following IRB approval, all patients undergoing LOR placement between 2018 and 2020 were retrospectively reviewed. Patients age, primary tumor, survival lengths and complications were reviewed. Average procedure-related treatment cost was obtained from an uncomplicated representative case excluding the surgeon’s fee. RESULTS Fourteen patients (mean age 46.35 years) were identified. The mean follow-up was 440.7 (25-1003) days post-surgery. Acute lymphoblastic leukemia (n = 4), acute myeloblastic leukemia (n = 3), breast carcinoma (n = 3), ependymoma (n = 3), lymphoma (n = 2) and lung adenocarcinoma (n = 1) were identified as underlying malignancy. LMD was diagnosed on average after 581.1 days after the diagnosis of the underlying malignancy. 8 patients succumbed to their malignancy on average after 463.9 and 314.6 days after the diagnosis of LMD and LOR surgery, respectively. There were 2 complications – pain at the site of the LOR and a fractured catheter caused by inadvertent puncture of the catheter. No infections or wound healing complications were noted. Typical cost for placement of LOR and OR was – 17,350 USD and 29,052 USD, respectively. Placement of the LOR proved to be more cost-effective in this cohort by approximately 40% cost reduction. CONCLUSION Placement of LOR is a cost effective alternative to cranial OR with low complication profile, and well tolerated by patients.