Ulcer Healing Research Articles

Autologous cell therapy for ischemic diabetic foot: a meta-analysis of randomized controlled trials for the development of the Italian guidelines for the treatment of diabetic foot syndrome.

To assess the efficacy and safety of autologous cell therapy (ACT) in patients with ischemic diabetic foot ulcers (DFU). The present meta-analysis was designed to support the development of the Italian Guidelines for the Treatment of Diabetic Foot Syndrome (DFS). A Medline and Embase search were performed up to Feb 1st, 2024 collecting all RCTs including diabetic patients or reporting subgroup analyses on diabetic patients with ischemic foot ulcers comparing ACT with placebo/no therapy/standard of care (SoC), with a duration of at least 26 weeks. Prespecified endpoints were: major amputation (principal) and minor amputation, ulcer healing, time-to-healing, transcutaneous oxygen pressure (TcPO2), ankle-brachial index (ABI), pain, and all-cause mortality (secondary). Any ACT was allowed, irrespective of cell product type and route of administration (intra-arterial and intramuscular). Seven studies fulfilled all inclusion criteria, all using intramuscular transplantation as route of administration, but only 2 had a follow-up greater than 26 weeks. Participants treated with ACT had a significantly lower risk of major amputations in comparison with SoC/placebo (MH-OR 0.47 [0.24, 0.92], p = 0.03). ACT was also associated with a significantly higher rate of ulcer healing (MH-OR: 10.1 [3.5, 29.6], p < 0.001), greater increase of TcPO2 and ABI values (WMD: 17.57 [13.02, 22.12], p < 0.001), and reduction of pain (WMD: -1.83 [-2.32, -1.34], p = 0.003). ACT must be considered as a potential therapy for patients with ischemic diabetic foot ulcers. Further studies are needed to better clarify their role in the treatment and management of DFS.

Refractory gastrointestinal bleeding caused by splenic artery pseudoaneurysm rupture.

A 64-year-old man was admitted for hematemesis. Esophagogastroduodenoscopy revealed a gastric ulcer with a visible vessel on the posterior wall of the gastric body. After admission, the patient developed multiple episodes of massive hematemesis. During emergent esophagogastroduodenoscopy, he developed hemodynamic instability due to spurting bleeding. On day 18 of hospitalization, hemostasis was achieved using hemostatic forceps; however, contrast-enhanced computed tomography performed on the same day revealed a small splenic artery pseudoaneurysm (SAP) that had not been previously detected. To prevent fatal re-bleeding, interventional radiology was performed, and coil embolization was applied proximal to the pseudoaneurysm. The patient recovered without further hematemesis. One month later, exposed coils were observed from the healing ulcer, and celiac trunk angiography confirmed splenic artery thrombosis. Despite multiple attempts at endoscopic intervention, the patient developed recurrent hematemesis, suggesting that the gastric ulcer had eroded into the splenic artery, forming the SAP and causing significant hemorrhage. Although SAPs secondary to gastric ulcers are extremely rare, early recognition is critical because they carry a high risk of rupture and mortality. Endoscopic procedure alone may be insufficient, and an endovascular approach is a standard treatment to prevent life-threatening re-bleeding.

Clinical effects of anweiyang capsule and Pinellia decoction for eradication of Helicobacter pylori and healing of peptic ulcers

Peptic ulcers are a prevalent and often chronic condition within the digestive system, frequently prone to recurrence. This study aims to evaluate the clinical effects of Anweiyang capsule combined with Pinellia Heart-Draining Decoction on Helicobacter pylori eradication, ulcer healing rates, and improvement of Traditional Chinese Medicine (TCM) syndromes in patients with peptic ulcers. A total of 100 patients were randomly assigned to an observation group (n = 50), receiving the herbal combination, and a control group (n = 50), receiving standard Western medical treatment. The total effective rate was significantly (P < 0.05) higher in the observation group (96%) compared to the control group (80%). After 4 weeks of treatment, serum procalcitonin (PCT) and C-reactive protein (CRP) levels decreased, while prostaglandin E2 (PGE2) levels increased in both groups; however, the observation group exhibited better results (P < 0.05). The observation group achieved a H. pylori eradication rate of 94% and an ulcer healing rate of 82%, compared to 64% and 56% in the control group, respectively. Improvement in TCM syndrome scores was more significant in the observation group (P < 0.05). Moreover, the incidence of adverse reactions was significantly (P < 0.05) lower in the observation group (4%) compared to the control group (18%). In conclusion, Anweiyang capsule combined with Pinellia Heart-Draining Decoction significantly enhances the eradication rate of H. pylori and the ulcer healing rate without substantially increasing the risk of adverse reactions, demonstrating its safety and reliability for patients.

Management of Dustavrana by Chedana Karma and application of Madhu - A Case Study

Dusta Vrana management is most complicated problem encountered by medical practitioner all over the globe, that is non-healing, rapidly growing, disturb the day to day activities of patients, without early and optimal intervention it may ends with amputation of affected limb to save the life, This study reveals that Chedan (debridement) of necrotic patches followed by application of Madhu gives tremendous result in healing of ulcers, As per Sushruta Samhita, Lakshana of Dusta Vrana are Dourganda, Putisrava, Twak Mamsadi Kotha etc., In this case we had Lakshanas like Twak Kotha, Dourganda, Atiputisrava, Kandu etc. In Sushruta Samhita, Chikitsa Sthana 1st chapter Sushruta describes Shasti Upakrama for Vrana Chedana and Madhu Lepana is one among them. Chedana is mainly indicated for Dustavrana, Kotha etc., Honey has properties like Vrana Shodana, Vrana Ropana, Vvrana Sandhaniya. A 45 year male patient with wound over lateral aspect of thigh, knee joint and over lateral aspect of tibia associated with pain, itching fever since 1 week. Patient also had a history of admission in allopathic hospital under diagnosis of cellulitis, where in fasciotomy / fasciectomy was done. As the patient didn’t get relief so he approached our hospitals Shalya Tantra OPD. Patient had no comorbidity like diabetic mellitus, hypertension and patient was treated with Chedana Karma and application of Madhu along with Shamana Aushadi which has been discussed here.

Degree of sulfation of freeze-dried calcium alginate sulfate scaffolds dramatically influence healing rate of full-thickness diabetic wounds.

Diabetic foot ulcer (DFU) is a chronic and non-healing wound in all age categories with a high prevalence and mortality in the world. An ideal wound dressing for DFU should possess the ability of adsorbing high contents of exudate and actively promote wound healing. Here, we introduced the calcium alginate sulfate as a new biomaterial appropriate for use in wound dressing to promote the healing of full-thickness ulcers in a diabetic mouse model. In this regard, alginate sulfate (Alg-S) solutions with different degree of substitution (DS) of 0.2, 0.5, and 0.9 were synthesized, freeze-dried, crosslinked by calcium cations, purified by washing and refreeze-dried. Primary analyses including swelling ratio, porosity content and mechanical properties revealed that all Alg-S scaffolds possess necessities for use as a wound dressing. After confirming the cytocompatibility of both alginate and alginate sulfate-based scaffolds by MTT assay, they were used as wound dressing for healing of full-thickness ulcers in diabetic mice. The results of wound healing process confirmed that calcium alginate sulfate scaffolds can heal the wounds faster than both alginate-treated and non-treated wounds. Furthermore, the histological analyses of healed tissues reveled normal regeneration of the skin tissue layers and collagen deposition similar to the healthy tissue.

Efficacy of Bismuth Quadruple Therapy in the Treatment of Helicobacter pylori-Infected Peptic Ulcer Children in Vietnam.

The continuous increase in drug-resistant strains, the lack of novel antibiotics, and the fewer options available to combat antibiotic-resistant infections in pediatrics pose significant challenges to the eradication of Helicobacter pylori (H. pylori) in children. This study evaluated the efficacy of first-line therapy with bismuth quadruple therapy in H. pylori-positive pediatric patients with peptic ulcers. 136 patients (aged between 8 and 17 years) diagnosed with active peptic ulcers with H. pylori infection were enrolled in this study. Patients with H. pylori strain sensitive to tetracycline and metronidazole were assigned to bismuth quadruple therapy, including a proton pump inhibitor (PPI), bismuth, tetracycline, and metronidazole. Antibiotic resistance of H. pylori was analyzed by the Epsilometer test. Treatment efficacy was evaluated at 12 weeks based on H. pylori eradication and peptic ulcer healing rates. H. pylori infection status was evaluated by a 13C-urea breath test. Most isolates showed extremely high rates of resistance to commonly prescribed antibiotics used for children, including clarithromycin (97.0%) and amoxicillin (84.6%), while the low rate of resistance to levofloxacin (16.2%). The overall success rate of eradication therapy in the intention-to-treat and the per-protocol group were 86.0% and 89.3%, respectively. Peptic ulcer healing rates for total patients at 6 weeks and 12 weeks were 75.0% and 97.7%, respectively. There were no entail unpleasant adverse events, and peptic ulcer symptoms decreased steadily over time in all cases. The bismuth quadruple therapy with a 2-week PPI pretreatment and followed by prolonged PPI was highly successful in eradicating H. pylori infection and healing ulcers in pediatric patients with active peptic ulcer. This might be preferable as a first-line empiric treatment regimen for H. pylori-positive pediatric patients with peptic ulcers, especially in populations with high rates of resistance to amoxicillin and clarithromycin.

Short review of diagnosis and revascularization for thromboangiitis obliterans

This short review focuses on recent diagnostic criteria and outcomes after revascularization in thromboangiitis obliterans (TAO, Buerger disease). The incidence and disease have decreased worldwide, including in Eastern Asia, except in regions where inexpensive tobacco products are widely consumed. However, the global epidemiology remains unclear due to the lack of definitive diagnostic biomarkers. Clinical diagnostic criteria are also not standardized but have been updated according to medical advances and current patient characteristics. Notably, neither of the two recently proposed criteria excludes patients with risk factors for atherosclerosis, as these conditions may coexist with TAO and are often seen in young patients. Young age at onset is no longer essential. Objective test findings are required, and typical vascular imaging findings are essential for definitive diagnosis. Suspected diagnosis is allowed for patients who have difficulty undergoing tests. Revascularization for TAO is typically directed at below-the-knee lesions, which are characterized by poor distal runoff, associated inflammation, and prone to spasm. Recently, both bypass surgery (BS) and endovascular treatment (EVT) have shown improved outcomes. Two studies on BS published after 2000 reported primary patency rates exceeding 50% at 3 years. A systematic review and meta-analysis of EVT, which mostly consisted of balloon angioplasty, revealed that multiple reinterventions were often required; however, the secondary patency and limb salvage rates at 3 years were comparable to those of BS. Short-term arterial patency, whether achieved by BS or EVT, can be sufficient for ulcer healing. Given that TAO is a highly thrombogenic condition, the administration of potent antithrombotic therapy during and after revascularization is crucial to maintain arterial patency.

Evaluating the Role of Hyperbaric Oxygenation Therapy in Improving Diabetic Foot Ulcer Healing: A Systematic Review

Background: Diabetic foot ulcer (DFU) is a frequent complication of poorly controlled diabetes mellitus and can lead to amputation, significantly impacting quality of life. Although DFU is common, its treatment remains complex and could benefit from improvement. Hyperbaric oxygenation therapy (HBOT) is a noninvasive procedure that has recently shown potential as an alternative treatment for DFU. Given the increasing interest in HBOT, with many centers actively researching and developing advancements in this area, this review aims to not only gather and analyze relevant studies but also assess the feasibility of integrating HBOT into clinical practice as a viable, noninvasive alternative for DFU treatment.Methods: This review was conducted following the 2020 Preferred Reporting Items for Systematic Review and Meta-Analysis guideline on studies published on HBOT for DFU. Each included study was critically appraised using the 2020 JBI Checklist for Randomized Controlled Trials.Results: From three databases, eight out of 1,665 records were included for this review. Critical appraisal revealed that of the eight studies, only three fulfilled all criteria outlined in the checklist, as three studies did not indicate blinding, and two studies were open-label. The utilization of HBOT in the treatment of DFU resulted in various changes both in the wound healing process and risk of complications.Conclusion: Based on the majority of the included studies, HBOT revealed a positive impact in aiding the healing of DFUs and in mitigating various risk of complications.

Efficacy of Autologous Platelet Rich Plasma For Treatment of Diabetic Foot Ulcer

Background: Diabetic foot ulcer (DFU) is a common complication of long standing uncontrolled diabetes mellitus. There are different types of treatment commonly practiced among the clinicians to treat DFU. Among them, autologous platelet rich plasma (PRP) application is getting popularity day by day throughout the western world. Methodology: It was a prospective, randomized, controlled study that was carried out among 40 DFU patients in the Department of Surgery, Dhaka Medical College Hospital. Among them, 20 patients were treated by autologous PRP and another 20 patients were treated by conventional method. They were followed up for 12 weeks period. Data collected from the participants were analyzed to compare the healing rate among two groups. Result: In PRP treated ulcers, healing rate was significantly faster and better in comparison to conventionally treated ulcers. After 10th weeks follow up, in PRP group 14 ulcers were completely healed whereas in control group,4 ulcers were completely healed. On the contrary, 3 ulcers in control group showed further deterioration. At the end of 12th weeks follow up, 19 ulcers in PRP group were completely healed whereas 13 ulcers in control group were completely healed. In PRP group no patient showed any complication during treatment, whereas in control group 7 patients experienced local complications. Conclusion: Treatment of diabetic foot ulcer with autologous platelet rich plasma results in faster and better ulcer healing in comparison to conventional treatment. PRP accelerates the healing rate and keep the ulcer area safe from external pathogens. Hence, autologous PRP is a better selection for DFU treatment. J Dhaka Med Coll. 2023; 32(1) : 38-42

Human keratin matrix in addition to standard of care accelerates healing of venous ulcers: a case series.

Venous leg ulcers (VLUs) are often large and complicated wounds that, despite combinations of advanced wound care techniques and systemic treatment of underlying vascular issues, take many months to heal and have high rates of recurrence. In this study, we investigated the efficacy of a novel wound care solution-human keratin matrix (HKM). A case series of VLUs were treated with HKM in conjunction with indicated vascular intervention and standard of care (SoC) procedures. For analysis, these wounds were divided into very large (>200 cm2) and smaller (<35 cm2) wounds. The cohort comprised 16 VLUs (very large=7; smaller=9). Very large VLUs were reduced in size by an average of 71% within 10 weeks, and showed a 50% size reduction within four applications of HKM. Smaller VLUs reduced by 50% in size within the first three weeks of treatment, and 88.9% of these wounds healed completely with an average of 4.5 HKM applications over an average of 6.5 weeks. The results of this series highlight the potential of HKM, in combination with indicated systemic interventions and SoC, as an effective treatment for hard-to-heal (chronic) VLUs, even in very large wounds.

Clinical Efficacy of a Contralateral Shoe Lift in Patients with Diabetic Foot Ulcers and Induced Limb-Length Discrepancies: A Randomized Controlled Trial.

Objective: To evaluate the clinical efficacy of combining an offloading device with a contralateral shoe lift to compensate for induced limb-length discrepancies in participants with plantar diabetes-related foot ulcers. Approach: Between March 2021 and December 2023, 42 consecutive patients with active plantar diabetic foot ulcers (DFUs) were randomly assigned (1:1) to the treatment group (limb-length discrepancy compensation with a shoe lift in the therapeutic footwear of the contralateral limb) or a control group that did not receive limb-length discrepancy compensation. Primary outcomes included the 20-week wound-healing rate and wound area reduction. Secondary outcomes included minor amputation, new ulcers in the contralateral limb, perceived comfort, and hip pain. Results: On an intention-to-treat basis, 15 participants in the control and 19 in the treatment group showed ulcer healing (p = 0.0023). In those with >80% adherence to the offloading device, multivariate analysis showed that the shoe lifts improved ulcer healing time. The use of a shoe lift reduced the number of minor amputations and the occurrence of new ulcers in the contralateral limb (p = 0.035; p = 0.033 respectively). Hip pain and perceived comfort improved with the use of shoe lifts (p < 0.001). Innovation: It validates the use of shoe lifts for patients with DFUs, as it is the first largest study of its kind to establish a clear reference standard to guide clinician decision-making. Conclusion: The use of shoe lifts reduced healing time in participants with diabetes and active plantar foot ulcers. Shoe lifts reduce late complications, including new ulcers in the contralateral limb and minor amputations.

Analysis of mRNA expression profile in the treatment of diabetic foot ulcer healing by tibial cortex transverse distraction

To investigate mRNA Expression profile and associated signaling pathways in the treatment of diabetic foot ulcer healing by tibial cortex transverse distraction. Tissue samples were collected from the wound edge before and after the surgery. After reference genome transcriptome sequencing and subsequent bioinformatics analysis, the differentially expressed genes and related pathways were explored, and functional analysis of important genes and pathways was conducted. qRT-PCR was used to verify the significantly expressed genes-HLA-DRB1, HLA-DRB5, CXCL5 and IGFL1. There were 2441 significantly up-regulated and 3904 significantly down-regulated genes in the postoperative group. The qRT-PCR results showed the expression of HLA-DRB1, HLA-DRB5 and CXCL5 was consistent with the transcriptional sequencing results. CXCL5 and CXCL6 differentially up-regulated genes are involved in the process of neovascularization, and HLA-DRB1 is involved in the improvement of the degree of diabetic peripheral nerve degeneration. Pathway analysis showed that differential genes were most significantly enriched in Adherens junction, Inflammatory mediator regulation of TRP channels and Wnt signaling pathway. Inflammatory mediator regulation of TRP channels is involved in the improvement of peripheral neurodegeneration, VEGF signaling pathway is involved in the process of neovascularization, and Wnt signaling pathway is involved in the process of bone healing. Significantly up-regulated CXCL5 and CXCL6 and enriched VEGF signaling pathway analyzed are involved in postoperative lower limb neovascularization. The HLA-DRB1 and the enriched Inflammatory mediator regulation of TRP channels may be related to the improvement of postoperative peripheral neurodegeneration. The differentially expressed genes and related pathways can provide objective basis for further mechanism study.

Gastroprotective Efficacy of North African Medicinal Plants: A Review on Their Therapeutic Potential for Peptic Ulcers

ABSTRACTPeptic ulcer disease remains a prevalent gastrointestinal disorder worldwide. Current treatments often have limitations, sparking interest in alternative therapies from medicinal plants. This review examines the gastroprotective potential of 54 North African medicinal plants against peptic ulcers. An extensive literature search was conducted, focusing on plants with preclinical and clinical evidence of anti‐ulcer efficacy and documented use in North African traditional medicine. The review identified several promising plant species, such as licorice (Glycyrrhiza glabra), chamomile (Matricaria chamomilla), olive (Olea europaea), pomegranate (Punica granatum), Aloe vera, and black seed (Nigella sativa), along with their bioactive constituents, including flavonoids, tannins, and terpenoids. These compounds exhibit gastroprotective properties through multiple mechanisms, such as enhancing the gastric mucosal barrier, inhibiting acid secretion, displaying antioxidant and anti‐inflammatory effects, promoting ulcer healing, and combating Helicobacter pylori infection. The evidence presented includes in vitro assays, animal models, and some clinical studies. While many of the 53 plants reviewed demonstrated significant anti‐ulcer effects compared to standard drugs, further clinical research is needed to establish efficacy and safety in humans. The synergistic actions of phytochemical mixtures in medicinal plant extracts likely contribute to their therapeutic potential. This review highlights the role these North African medicinal plants may play in the prevention and treatment of peptic ulcers and identifies promising candidates for further research and development of evidence‐based botanical therapies.

NIR-II Image-Guided Wound Healing in Hypoxic Diabetic Foot Ulcers: The Potential of Ergothioneine-Luteolin-Chitin Hydrogels.

Hypoxic diabetic foot ulcers (HDFUs) pose a challenging chronic condition characterized by oxidative stress damage, bacterial infection, and persistent inflammation. This study introduces a novel therapeutic approach combining ergothioneine (EGT), luteolin (LUT), and quaternized chitosan oxidized dextran (QCOD) to address these challenges and facilitate wound healing in hypoxic DFUs. In vitro, assessments have validated the biosafety, antioxidant, and antimicrobial properties of the ergothioneine-luteolin-chitin (QCOD@EGT-LUT) hydrogel. Furthermore, near-infrared II (NIR-II) fluorescence image-guided the application of QCOD@EGT-LUT hydrogel in simulated HDFUs. Mechanistically, QCOD@EGT-LUT hydrogel modulates the diabetic wound microenvironment by reducing reactive oxygen species (ROS). In vivo studies demonstrated increased expression of angiogenic factors mannose receptor (CD206)and latelet endothelial cell adhesion molecule-1 (PECAM-1/CD31), coupled with decreased inflammatory factors tumor necrosis factor-α (TNF-α) and Interleukin-6 (IL-6), thereby promoting diabetic wound healing through up-regulation of transforming growth factor β-1 (TGF-β1).

Effect of Treatment of Neuropathic and Ischemic Diabetic Foot Ulcers with the Use of Local Ozone Therapy Procedures-An Observational Single Center Study.

Background: Diabetes ranks high among worldwide global health problems, and diabetic foot ulcer syndrome (DFU) is considered as one of its most serious complications. The purpose of this study was to evaluate the impact of local ozone therapy procedures on the wound healing process in patients with two DFU types: neuropathic and ischemic. Material and Methods: In the retrospective study reported here, the treatment outcomes of 90 patients were analyzed: 44 males (48.8%) and 46 females (51.2%), in the age range between 38 and 87 years of age, with neuropathic (group 1) and ischemic (group 2) diabetic foot ulcers treated by means of local ozone therapy. The assessment of therapeutic effects in both groups of patients included an analysis of the rate of ulcer healing using planimetry and an analysis of the intensity of pain associated with ulcers performed using the VAS scale. Results: After the application of ozone therapy procedures, a statistically significant decrease in the surface area of the ulcers was obtained in both groups of patients, respectively: in group 1 from 7 (6-7.5) cm2 to 3 (2-3.5) cm2 and in group 2 from 7.5 (6.5-8) cm2 to 5 (4.5-5.5) cm2 (p < 0.001), with a complete healing of ulcers not observed in any patients from groups 1 and 2. After treatment, the surface area of the assessed ulcers was smaller in the neuropathic group. The intensity of pain experienced after treatment also decreased with statistical significance in both groups (p < 0.001). Conclusions: Short-term local ozone therapy was effective in promoting wound healing and alleviating pain in patients with DFUs of both neuropathic and ischemic etiology. The effectiveness of therapy in the neuropathic type of DFUs was significantly higher than in the ischemic type, in which patients had a higher incidence of risk factors and more advanced lesions, characterized by a larger initial ulcer area and greater intensity of pain.

Preliminary application of ulnar cortex transverse transport technique in treatment of upper extremity thromboangiitis obliterans

To investigate the feasibility and effectiveness of ulnar cortex transverse transport technique in treating upper extremity thromboangiitis obliterans (TAO). A retrospective analysis was conducted on the clinical data of 7 male patients with upper extremity TAO who were admitted and met the inclusion criteria between January 2019 and July 2022. The patients ranged in age from 32 to 50 years, with a mean age of 40.1 years. The disease duration ranged from 6 to 24 months, averaging 13.6 months. The smoking history ranged from 8 to 31 years, with a mean of 18.4 years. All patients presented with finger ulcers or gangrene, including 1 case affecting the thumb and index finger, 1 case affecting the index and middle fingers, 1 case affecting the middle and ring fingers, 1 case affecting only the ring finger, and 3 cases affecting the ring and little fingers. The preoperative visual analogue scale (VAS) score was 9.1±0.7. All patients underwent treatment with the ulnar cortext transverse transport technique. The wound healing time and the disappearance time of rest pain were recorded. The VAS score was used to assess the degree of hand pain before and after operation. Serum interleukin 6 (IL-6) levels were measured before operation and at 1 month after operation. Computed tomography angiography (CTA) of the affected limb was performed before operation and at 3 months after operation to evaluate changes in blood vessels. The clinical outcomes were evaluated at 1 year after operation based on the Patwa and Krishnan grading system. All 7 patients were followed up 12-17 months, with an average of 13.7 months. All patients experienced successful healing of ulcers, with wound healing time ranging from 14 to 21 days, averaging 17.3 days. During the follow-up, no complication occurred, and there was no recurrence of ulcers. The disappearance time of rest pain ranged from 8 to 15 days, averaging 12.1 days. The pre- and post-operative (1-month) serum IL-6 levels were (25.1±5.9) pg/mL and (11.9±2.9) pg/mL, respectively, with a significant difference ( t=5.363, P=0.002). CTA examination at 3 months after operation revealed partial revascularization of upper extremity arteries and establishment of collateral circulation, showing significant improvement compared to preoperative status. The VAS scores at 1, 7, 28 days, and 6 months postoperatively were 6.4±0.8, 3.7±0.8, 0.6±0.8, and 0.1±0.4, respectively, all of which significantly improved compared to preoperative scores ( P<0.05). Furthermore, the VAS scores gradually decreased over time, with significant differences observed between postoperative time points ( P<0.05). At 1 year after operation, the effectiveness of all 7 patients were evaluated as excellent based on the Patwa and Krishnan grading system. The ulnar cortex transverse transport technique can improve blood circulation in the upper limb of patients with TAO, reconstruct microcirculation, inhibit inflammation, promote ulcer healing, and alleviate limb pain.

Mechanism of cold atmospheric plasma in treatment of chronic skin ulcer

To review the mechanism of cold atmospheric plasma (CAP) in the treatment of chronic skin ulcer, providing a new idea for ulcer therapy. The literature about CAP in the treatment of chronic skin ulcers in recent years was extensively screened and reviewed. The treatment principle, active ingredients, and mechanism were summarized. CAP is partial ionized gas discharged by plasma generator in high frequency under high voltage. It contains electrons, positive and negative ions, reactive oxygen species, reactive nitrogen species, and ultraviolet rays. In vitro and animal experiments show that the active ingredients contained in CAP can inactive microorganisms, against biofilm, regulate immune-mediated inflammatory, promoting blood flow, stimulate tissue regeneration and epithelial formation in the course of wounds healing. CAP play a role in different stages of chronic skin ulcer healing, with good effectiveness and safety, and broad clinical application prospects. But more studies are needed to explore the indications and dosages of CAP therapy.

Efficacy and safety of digital nerve block for pain management during sharp debridement of digital ulcers in systemic sclerosis: A prospective observational study.

Systemic sclerosis (SSc) is a chronic autoimmune disease characterized by fibrosis and vascular abnormalities, often leading to the development of digital ulcers (DUs). DUs are painful and debilitating, significantly impacting patients' quality of life. Effective pain management during debridement is crucial, yet there is no consensus on the optimal approach. This study evaluates the efficacy and safety of digital nerve block (DNB) using lidocaine and mepivacaine for pain control during sharp debridement of DUs in SSc patients. This prospective observational study was conducted from September 2023 to May 2024 at the Rheumatology Operating Unit, University of Verona. Patients were randomized to receive either 1 mL of 2% lidocaine or 2% mepivacaine for DNB. Pain levels were assessed using a categorical grading scale during the injection and debridement. The outcomes were pain control and performance of lidocaine versus mepivacaine. The cohort developed 46 ulcers. The pain was abolished in almost all patients. Lidocaine achieved faster anaesthesia (127.92 ± 34.32 s) compared with mepivacaine (252.65 ± 49.89 s, p < 0.001). Mepivacaine resulted in less pain during injection (p = 0.006). No significant difference in pain levels during debridement was observed between the two anaesthetics. Three mild adverse effects (Raynaud's phenomenon) were reported. All procedures were completed successfully, and 35 ulcers healed with a mean time of 6.1 ± 7.77 weeks. DNB with mepivacaine provides effective pain control during DU debridement in SSc patients, with lower injection site pain and comparable efficacy to lidocaine. The procedure is safe, well-tolerated and facilitates successful ulcer healing. Further studies with larger cohorts are warranted to confirm these findings.

Photobiomodulation using red and infrared spectrum light emitting-diode (LED) for the healing of diabetic foot ulcers: a controlled randomized clinical trial.

Assessing the responses to the application of photobiomodulation using red and infrared spectrum light-emitting diodes (LED) on diabetic foot ulcers. Diabetic volunteers, of both genders, aged between 30 and 65 years, with grade I or II ulcers, were randomized into the groups: red LED, infrared LED, LED associated, and control. Home-based interventions took place on a daily basis for 12 weeks. Assessments of sample characterization were performed on day 1 and 90, and the variables wound healing index, mean skin temperature, sensitivity and pain in the wound area were measured at the pre-intervention time on days 1, 30, 60 and 90, with subsequent follow-up 30 days after the end of treatment. For statistical analysis, the software SPSS, version 17.0, intention-to-treat analysis, data normality was tested, and the linear mixed effects model, with a significance level of 5%. Magnitudes of clinical effect by Cohen's d. At the pre vs post intervention time of 90 days, we found a large clinical effect of G-LED V (d=1.7) and G -LED IV (d=1.6) in relation to G-C, where these intervention groups showed a tendency for faster wound healing compared to G-C. We also observed small clinical effect of G-LED IV, which showed greater reduction in the area in relation to G-LED V (d=0.4) and G-LED A (d=0.3). Conclusion: The use of individually applied red and infrared LED phototherapy clinically tended to be more effective for the reduction of diabetic foot ulcer areas, and infrared LED was the most effective. Trial registration: NCT03250533 (clinicaltrials.gov).

A chitosan-modified tea tree oil self-nanoemulsion improves antibacterial effects in vivo and in vitro and promotes wound healing by influencing metabolic processes against multidrug-resistant bacterial infections

Infectious diseases, especially multidrug-resistant bacterial infections, have caused crises and majorly disrupted public health and economic stability worldwide. Many natural essential oils, especially tea tree oil, have potential to treat multidrug-resistant bacteria, such as H. pylori and P. aeruginosa. However, there are some problems need to be solved, such as poor stability upon light or oxygen exposure. Therefore, it is urgent to develop the ideal formation to tackle these difficulties. Herein, we reported the novel chitosan-modified self-nanoemulsion (TNE) encapsulating natural essential tea tree oil with strong antibacterial and stability characterize. In this study, we found that this self-nanoemulsion (size: 212 nm, PDI: 0.124, zeta potential: −20.5 mV, 6 % tea tree oil) not only had physical properties, good stability and tissue safety, but also had better antibacterial synergism (2–8 times) than that of water suspension against various multidrug-resistant bacterial (such as H. pylori, MRSA and P. aeruginosa). Additionally, TNE showed high antibacterial effectiveness in vivo, reduced inflammation, promoted ulcer healing after H. pylori infection and accelerated wound healing after P. aeruginosa infection. Importantly, this novel self-nanoemulsion can induce 274 protein down-regulated and 251 protein up-regulated, and disrupt H. pylori metabolic processes (glyoxylate, dicarboxylic acid, glutamate and tryptophan metabolism) and reduced its viability, leading to significant synergistic antibacterial effects. TNE is a potential treatment for skin wounds or ulcers caused by multidrug-resistant bacterial infections.