Healing Time Research Articles

Comparative Outcomes of Percutaneous K-Wires Versus Plate Fixation in the Treatment of Distal Radius Fractures: A Focus on Stability in Osteoporotic Patients and Both-Bone Distal End Fractures.

Background Distal radius fractures (DRFs) are commonly treated with percutaneous K-wire or plate fixation. The relative efficacy and stability of these methods, particularly in osteoporotic patients and in cases involving both distal radius and ulna fractures, remain subjects of clinical debate. Objective This study aims to compare the outcomes of percutaneous K-wire fixation versus plate fixation in patients with distal end radius fractures, focusing on postoperative stability in osteoporotic conditions and both-bone distal end fractures. Methods A total of 50 patients were retrospectively analysed and divided into two groups: 25 underwent percutaneous K-wire fixation, and 25 underwent plate fixation. Outcomes measured included bone healing time, complication rates, functional recovery using the DASH score, and radiological outcomes through standard X-ray imaging. Results Preliminary data suggest that plate fixation offers better stability, especially in osteoporotic patients and cases with both-bone involvement. Complications with K-wire fixation were more frequent in these subgroups. Conclusion Plate fixation may provide superior stability and functional outcomes in treating DRFs, particularly in complex cases involving osteoporosis or bone injuries. Further research with larger sample sizes and prospective design is recommended.

Comparing vacuum‐assisted closure against conventional approach in severe deep neck infection: A retrospective case‐control study

AbstractObjectivesTo compare the effectiveness of vacuum‐assisted closure (VAC) against traditional drainage technique, using a retrospective case‐control study design, in terms of managing deep neck infections (DNIs).MethodsPatients presenting to Peking Union Medical College Hospital diagnosed with DNIs were recruited in this study. We analyzed the clinical characteristics of DNI patients and divided them into (a) VAC placement group (26 cases) and (b) traditional drainage group (57 cases) according to whether VAC was placed. The differences in length of stay (LOS), wound healing time, and debridement frequency were compared between the two groups.ResultsEighty‐three patients had multiple‐space infections, i.e. infection at two or more sites. The debridement frequency of the VAC group was significantly lower than that of the traditional drainage group (p = 0.001). The wound healing time of the traditional drainage group and VAC group was 38 days (a range of 13–98 days) and 40 days (a range of 11–106 days), respectively; the average LOS was 15 days (a range of 2–68 days) and 16 days (a range of 4–35 days), respectively; and the debridement frequencies were one time (a range of 0–3 times) and zero times (a range of 0–2 times), respectively. The two groups did not differ significantly in wound healing time and hospitalization duration (p = 0.319 and 0.937).ConclusionsVAC treatment of DNIs has significant advantages in reducing the frequency of debridement and patient suffering, but it does not show significant advantages in wound healing. Randomized trials are still needed to demonstrate its efficacy.

Osteoblast Growth in Quaternized Silicon Carbon Nitride Coatings for Dental Implants.

The demand for dental implants has increased, establishing them as the standard of care for replacing missing teeth. Several factors contribute to the success or failure of an implant post-placement. Modifications to implant surfaces can enhance the biological interactions between bone cells and the implant, promoting better outcomes. Surface coatings have been developed to electrochemically alter implant surfaces, aiming to reduce healing time, enhance bone growth, and prevent bacterial adhesion. Quaternized silicon carbon nitride (QSiCN) is a novel material with unique electrochemical and biological properties. This study aimed to assess the influence of QSiCN, silicon carbide nitride (SiCN), and silicon carbide (SiC) coatings on the viability of osteoblast cells on nanostructured titanium surfaces. The experiment utilized thirty-two titanium sheets with anodized TiO2 nanotubes featuring nanotube diameters of 50 nm and 150 nm. These sheets were divided into eight groups (n = 4): QSiCN-coated 50 nm, QSiCN-coated 150 nm, SiCN-coated 50 nm, SiCN-coated 150 nm, SiC-coated 50 nm, SiC-coated 150 nm, non-coated 50 nm, and non-coated 150 nm. Preosteoblast MC3T3-E1 Subclone 4 cells (ATCC, USA) were used to evaluate osteoblast viability. After three days of cell growth, samples were assessed using scanning electron microscopy (SEM). The results indicated that QSiCN coatings significantly increased osteoblast proliferation (p < 0.005) compared to other groups. The enhanced cell adhesion observed with QSiCN coatings is likely due to the positive surface charge imparted by N+.

Retrospective evaluation of perioperative clinical outcomes of diaphyseal femoral fractures repaired with the string-of-pearls locking plate system with adjunctive fixation.

To evaluate outcomes and complication rate of utilizing a string-of-pearls (SOP) plate augmented with adjunctive fixation in the repair of canine femur fractures. Records of canine patients with mid-diaphyseal femoral fractures repaired with the SOP plate and adjunctive fixation were reviewed. Information retrieved from medical records included signalment, patient weight, fracture configuration, repair technique, healing time, and complications based on perioperative radiographic follow-up to clinical union. Forty client-owned dogs met inclusion criteria for this study. Variables analyzed for association with major complications included body weight, fracture configuration, repair technique, and adjunctive fixation. Major complications requiring surgical revision occurred in 8 of 40 fractures. Five cases experienced intramedullary pin migration and were successfully treated with sedated pin removal. The remaining 3 cases involved implant failure via screw shear breakage and required surgical revision of the fixation to achieve a successful outcome. On the basis of a calculated Bonferroni correction, no statistical significance of the tested variables was found in association with major complications; however, significance was limited due to the low statistical power of this study. The use of adjunctive fixation with the SOP locking plate system led to radiographic union without complication in most cases, and no instances of plate breakage were reported. However, implant complications secondary to the adjunctive fixation can occur. Adjunctive fixation used with the SOP plate for repair of canine femur fractures has a high success rate, though pin migration as a complication persists.

The effect of pin distractor assistance on the reduction of fibular fractures in the treatment of ankle fracture: A retrospective case-control study.

This study will evaluate the therapeutic effect of pin distractor assisted reduction of fibular fracture on ankle fracture. A retrospective analysis was performed on 98 patients diagnosed as ankle fracture or pilon fracture. These patients were all combined with fibular fracture. Retrospective analysis included 48 patients in the experimental group (distractor assisted reduction) and 48 patients in the control group (without pin distractor). The statistical indexes include: the time spent in fracture reduction and fixation, the length of surgical incision, the operative blood loss of fracture operation, the incidence of incision skin necrosis, the incidence of fracture end splitting during reduction, the quality of fracture reduction, the time of fracture healing, infection rate, and The American Orthopedic Foot and Ankle Society score at the last follow-up. There were statistical differences between the 2 groups in the time spent in the reduction and fixation of fractures, the incidence of fracture end splitting during reduction, the quality of anatomical reduction of fractures, and the healing time of fractures. The experimental group was better than the control group. In addition, for patients with long spiral fracture, comminuted fracture, osteoporotic fracture and preoperative delay time for operation more than 2 weeks, the time spent in the reduction and fixation of fracture, the operative blood loss of fracture operation, the incidence of fracture end splitting during reduction, the quality of anatomical reduction of fracture, and the healing time of fracture in the experimental group are also better than those in the control group. The pin distractor assisted reduction of fibular fracture has the advantages of simple operation, less trauma, short operation time, less operative blood loss, and fewer complications. It is especially suitable for patients with long spiral fibular fracture, comminuted fracture, osteoporotic fracture, and long preoperative delay time in ankle fracture.

The oxidized hyaluronic acid hydrogels containing paeoniflorin microspheres regulates the polarization of M1/M2 macrophages to promote wound healing

Controlling excessive inflammation of acute wound is an effective means to shorten the healing time. Therefore, targeted control of the inflammatory response of the wound is a promising therapeutic strategy. In this study, paeoniflorin (Pae) was encapsulated in microspheres and combined with oxidized hyaluronic acid hydrogels to prepare the hydrogel loaded with Pae microspheres (Pae-MPs@OHA) to promote the healing of acute wounds in rats. The results demonstrated that the particle size of the Pae-MPs was 6.84 ± 0.51 μm, and the positive charge was 26.87 ± 1.51 mV. The uniform spherical structure of the Pae-MPs was observed by TEM. The Pae-MPs@OHA can maintain colloidal state in the range of 0.1–3.16 Hz. FTIR suggested that Pae could be effectively wrapped in MPs, and SEM indicated that the Pae-MPs@OHA had a uniform network pore structure. The Pae-MPs@OHA can realize the sustained release of Pae for 96 h. Biocompatibility experiments showed that the Pae-MPs@OHA hydrogels were safe and available. The Pae-MPs@OHA hydrogels can accelerate wound healing in rats. HE and masson staining suggested that the Pae-MPs@OHA could reduce inflammatory cell infiltration, promote re-epithelialization and collagen formation. The Pae-MPs@OHA could decrease the number of M1 and increase the number of M2 in macrophages, thus regulating the release of inflammatory factor TNF-α and IL-1β. The results of molecular docking and western blot results also confirmed that the Pae-MPs@OHA could reduce the expression of NF-κB, pNF-κB, NLRP3, ASC and pro-caspase-1. These findings suggest that the Pae-MPs@OHA has great potential for application in the treatment of inflammatory wound.

Prebiotic and panthenol-containing dermocosmetic improves tolerance from daylight photodynamic therapy: A randomized controlled trial in patients with actinic keratosis

Introduction & ObjectivesTreatment with daylight photodynamic therapy (dPDT) of actinic keratosis (AK) is associated with local skin reactions (LSR), which may affect patients’ quality of life and treatment acceptability. This study explores the potential of a prebiotic and panthenol-containing Dermocosmetic Cream (DC) to enhance tolerance and mitigate post-dPDT induced LSR in the treatment of AKs. Materials & MethodsThis randomized controlled, intra-individual trial included 20 patients with ≥10 AKs in two symmetrical areas on their face or décolleté, treated with a single session of artificial dPDT. After treatment, the two areas were randomized to DC twice daily for 14 days or No-DC. Primary outcomes included clinical signs of LSR graded from 0=none to 3=severe, calculated as a composite score, and assessed on Days 2, 7, 14, and 30 post-treatment, along with AK clearance rate. Secondary outcomes encompassed objectively measured erythema, and clinical and objective skin photoaging assessment. ResultsTopical application of DC following dPDT significantly improved post-treatment tolerance up to two weeks. By Day 2, DC-treated skin had milder LSR (median 3.0, IQR 2.0-4.8) compared to No-DC skin (median 4.0, IQR 3.0-5.0; p=0.011). This improvement continued on Day 7 (DC median 3.0, IQR 2.0-3.8 vs. No-DC median 4.5, IQR 3.0-5.8; p<0.001) and Day 14 (DC median 1.0, IQR 0.0-1.0 vs. No-DC median 1.0, IQR 1.0-2.0; p=0.004). Objective measurements showed milder erythema in DC-treated areas on Day 2 (p=0.045) and Day 7 (p=0.005). Crusting resolved more effectively in DC-treated areas by Day 7 (40% vs. 20%; p=0.039). No significant difference in complete lesion response rate was observed between DC and No-DC skin (p=0.850). By Day 30, clinical photoaging assessment demonstrated significant improvement in dyspigmentation (p=0.004) and skin texture (p<0.001) in both locations. Moreover, objective measurements revealed reduced dyspigmentation in both DC and No-DC treated skin (p≤0.001). ConclusionApplication of a prebiotic and panthenol-containing multipurpose DC significantly enhanced tolerance from artificial dPDT and accelerated healing time up to 14 days after treatment. The use of DC cream did not affect the overall treatment efficacy of dPDT, indicating its potential to enhance patient comfort following dPDT.

The application effect of autologous platelet-rich plasma combined with negative pressure sealing drainage technology in pressure ulcer wound repair.

This study aimed to evaluate the efficacy of combining autologous platelet-rich plasma (PRP) with negative pressure wound therapy (NPWT) for the repair of pressure ulcers. We included 90 patients with pressure ulcers from General Technology Gemstone Flower Healthcare Jilin City Hospital of Chemical Industry between January 2021 and December 2023. Patients were randomly assigned to either a control group or an observation group, with 45 patients in each. The control group received NPWT alone, while the observation group received a combination of PRP and NPWT. Outcomes were compared between the groups, including clinical efficacy, wound recovery time (infection control time, wound healing time, hospital stay), levels of inflammatory markers (C-reactive protein, erythrocyte sedimentation rate, white blood cell count), pain scores (numerical rating scale), Pressure Ulcer Scale for Healing scores, and incidence of complications. The observation group demonstrated a total effective rate of 95.56% (43/45), significantly higher than the control group's 80.00% (35/45) (P < .05). Additionally, the observation group had significantly shorter infection control times, wound healing times, and hospital stays (P < .05). Two weeks post-surgery, the observation group had significantly lower levels of C-reactive protein, erythrocyte sedimentation rate, and white blood cell count, as well as reduced numerical rating scale and Pressure Ulcer Scale for Healing scores (P < .05). The incidence of complications was 6.67% (3/45) in the observation group compared to 33.33% (15/45) in the control group, with a significant difference (P < .05). Combining autologous PRP with NPWT significantly improves clinical outcomes, reduces inflammatory responses, decreases pain, accelerates wound healing, and lowers complication rates in patients with pressure ulcers.

Using Range of Motion Exercises and Smartphone Thermography to Evaluate Wound Healing in Second-Degree Burns

BackgroundBurn injuries can lead to devastating functional impairments and reduced quality of life. An important component of rehabilitation programs is the range of motion exercises, which can accelerate wound healing and prevent contractures. The present study sought to evaluate the effects of a range of motion exercises validated by thermal imagining on patients with second-degree burns. Patients and methodsThis quasi-experimental study included 47 adult patients diagnosed with second-degree burns. Data was collected using a Structured Interview Questionnaire, modified Abbreviated Burn Severity Index (ABSI), the Bates-Jensen Wound Assessment Tool (BWAT), and mobile thermal imaging to assess wound healing. ResultsThe ABSI levels showed that 46.8% of patients had moderate-severity burns, 38.3% had very low severity, and 14.9% had moderately severe burns. While the BWAT scores were 28.9 ± 4.6SD at baseline, 30.1 ± 4.7SD after one week, 19.2 ± 6.5SD after the 2nd week, and finally 17.1 ± 4.3SD on the 3rd week. The FLIR thermal imaging scores over three weeks were statistically significant (p<0.001, Kruskal-Wallis test). The study revealed high statistically significant differences in range of motion and wound healing mean scores. ConclusionsThis study demonstrated that range of motion exercises improved burn wound healing. Additionally, thermal imaging showed high validity for evaluating wound healing potential and progression. It provides viable triage technology while benefiting clinical assessment. Overall, range of motion and smartphone thermography are two evidence-based modalities that can enhance burn management, decrease healing time, lower costs, and improve outcomes.

Evaluation of Antibiotic-Loaded Bone Cement in Treatment of Infected Diabetic Foot: Systematic Review and Meta-Analysis.

Diabetic foot ulcer (DFU) is a common and complex complication in patients with diabetes mellitus. The study of antibiotic-loaded bone cement for the treatment of infected diabetic foot is limited. We aimed to assess the efficacy of antibiotic-loaded bone cement for the treatment of infected diabetic foot. The MEDLINE, Embase, BIOSIS, the Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Knowledge databases were systematically searched up to May 2023 with no language restrictions. We assessed eligible studies for the efficacy of antibiotic-loaded bone cement for the treatment of infected diabetic foot. The standard mean differences (SMDs) or the risk ratios (RRs) were calculated for continuous or dichotomous data, respectively. Data were analysed using the Cochrane Collaboration's RevMan 5.0 software. Nine articles with 565 patients were analysed in our meta-analysis. The wound healing time in ABC group was significantly shorter than that in the control group (SMD=-1.64, 95% CI -2.27 to -1.02 p<0.00001, I2=88%). The ABC group had a significantly decreased number of debridements (SMD=-2.47, 95% CI -4.24 to -0.70, p<0.00001, I2=95%). The pooled data showed no significant difference (RR=0.41, 95% CI 0.12 to 1.39, p=0.84, I2=0%). This is the first meta-analysis comparing the efficacy of antibiotic-loaded bone cement for the treatment of infected diabetic foot. Antibiotic-loaded bone cement treatment significantly shortened the wound healing time and reduced the number of debridements without increasing the incidence of complications. PROSPERO CRD42023406017.

Resolution of Non-Diabetic Intractable Wounds with Severe Comorbidities Using Autologous Micrografts

The wound healing process is a complex mechanism related to many factors, such as the patient’s comorbidity, blood flow, and nutritional status. This study aimed to retrospectively evaluate patients affected by various disease states and treated with Rigenera® technology, a standardized micrograft preparation system. A total of 8 patients were treated with a suspension of autologous micrografts obtained from mechanical disaggregation of small pieces of skin tissue. The micrografts suspension was applied alone to the wound or in combination with porcine collagen scaffolds directly onto the wound as described in the text. Across all cases, there was marked improvement in wound healing, with a mean healing time of 103 days and a reduction of the diameter of the wounds by 54%. Notably, the use of micrografts resulted in an overall higher quality of life for the patients. This simple and low-cost micrografting procedure that can promote wound healing of different kinds of chronic non-healing wounds and does not require postoperative rest.

PKG1 promotes the HIV-induced proliferation, migration, and fibrosis of vascular smooth muscle cells of hemorrhoids

BackgroundHemorrhoids are very common in patients with human immunodeficiency virus (HIV) infection. The risk of postoperative infection is significantly greater in HIV-positive patients than in HIV-negative individuals, and the wound healing time is significantly prolonged. This study aimed to investigate the role of HIV-associated hemorrhoids from the perspective of vascular smooth muscle cell (VSMC) function.MethodsA total of 24 hemorrhoid tissue samples (note: grade IV hemorrhoids were absence) were collected and subjected to Masson staining to evaluate fibrosis in this study. mRNA and protein levels were monitored by qPCR and WB analysis, respectively. Immunofluorescence was conducted to evaluate PKG1 and α-SMA expression. To establish a cell model in vitro, VSMCs were stimulated with envelope glycoprotein (gp) 120, which is a type of HIV envelope protein. Cell proliferation was assessed via a CCK-8 assay and EdU staining. Moreover, a wound healing assay was performed to assess cell migration.ResultsOur data confirmed that fibrosis was present in hemorrhoid tissues from HIV-infected patients and that PKG1 expression was upregulated. Moreover, the administration of HIV gp120 promoted the proliferation and migration of VSMCs. Similarly, fibrosis-related markers (α-SMA, MMP2, MMP3, and TIMP1) were markedly upregulated. However, silencing PKG1 inhibited the proliferation, migration, and expression of fibrosis-related markers in gp120-challenged VSMCs.ConclusionThe present research revealed that PKG1 regulated the proliferation, migration, and fibrosis of VSMCs, thereby exerting detrimental effects on HIV-associated hemorrhoids.

The use of p-toluenesulfonic acid in the removal of biofilm in chronic ulcers

Background: Bacterial biofilms represent a topic of great concern due to their ability to cause chronic, sometimes fatal infections. Considering the prevalence and pathogenicity of biofilms in chronic ulcers, an observational study was designed to evaluate the anti-biofilm capabilities of p-toluenesulfonic acid, using it in the chronic ulcers of patients belonging to the Diabetic Foot clinic. Methods: Preliminary analysis of an observational study on patients attending the diabetic foot clinic with leg ulcers for at least 4 weeks. 17 patients treated with p-toluenesulfonic acid on a weekly basis for a maximum of 16 weeks. The primary outcome was 100% granulation tissue formation at week 16 and 50% reduction in initial chronic ulcer size. Results: The average treatment time was 10 ± 4.8 weeks. 8 patients healed, 7 are undergoing treatment, 1 required reoperation due to post-operative complications and 1 spontaneously dropped out of the study after 6 weeks. In the sample of healed patients, the average treatment time was 10.5 weeks with 100% granulation present at the 6th week. The reduction in the overall size of the ulcer and of the granulation area is not significant in the total sample. The data improves in the sample of healed patients even if it does not reach significance (lesion p-value 0.094, granulation p-value 0.13). Applying the analysis to the delta of the two variables, a measurement of the area that coincides with the margins of the ulcer, a p-value of 0.069 is obtained. The behaviour of the sample does not change when stratified by the dressings applied after treatment with p-toluenesulfonic acid. Conclusions: Treatment with p-toluenesulfonic acid promotes tissue granulation regardless of the type of dressing subsequently applied. The data on the evolution of the size of the lesions were not significant due to the smallness of the sample but in the sample of healed persons, the formation of granulation after an average of 6 applications transforms the "chronic" ulcer into an "active" ulcer, promoting closure within the subsequent 4 weeks. The appearance of granulation confirms healing. Elimination of biofilm with p-toluenesulfonic acid can reduce healing times and the risk of reinfection.

Boron in wound healing: a comprehensive investigation of its diverse mechanisms.

Chronic wounds present a significant clinical challenge due to their prolonged healing time and susceptibility to infection. Boron, a trace element with diverse biological functions, has emerged as a promising therapeutic agent in wound healing. This review article comprehensively investigates the mechanisms underlying the beneficial effects of boron compounds in wound healing. Boron exerts its healing properties through multiple pathways, including anti-inflammatory, antimicrobial, antioxidant, and pro-proliferative effects. Inflammation is a crucial component of the wound-healing process, and boron has been shown to modulate inflammatory responses by inhibiting pro-inflammatory cytokines and promoting the resolution of inflammation. Furthermore, boron exhibits antimicrobial activity against a wide range of pathogens commonly associated with chronic wounds, thereby reducing the risk of infection and promoting wound closure. The antioxidant properties of boron help protect cells from oxidative stress, a common feature of chronic wounds that can impair healing. Additionally, boron stimulates cell proliferation and migration, as well as essential tissue regeneration and wound closure processes. Overall, this review highlights the potential of boron as a novel therapeutic approach for treating chronic wounds, offering insights into its diverse mechanisms of action and clinical implications.

Silver-Treated Silk Fibroin Scaffolds for Prevention of Critical Wound Infections

The risk of infections in chronic wounds represents a serious issue, particularly in aged people and in patients affected by diseases such as diabetes and obesity. Moreover, the growing resistance demonstrated by many bacterial strains has significantly reduced the therapeutic options for clinicians and has become a great challenge for the researchers in the definition of novel approaches that promote the wound healing process and reduce the healing time. Tissue engineering approaches based on biomaterials and three-dimensional scaffolds have demonstrated huge potential in supporting cell proliferation; among them, Bombyx mori-derived silk fibroin is a very appealing possibility for the development of devices with regenerative properties for wound healing applications. However, due to the high risk of infections in chronic wounds, an antibacterial treatment is also strongly encouraged for preventing bacterial proliferation at the wound site. In this work, to develop a device with regenerative and antibacterial properties, antibacterial silver coatings were deposited onto silk fibroin scaffolds, and the effect of the treatment in terms of chemical–physical and microbiological properties was investigated. The results demonstrated that the silver treatment improved the mechanical properties of the protein scaffold and provided good antibacterial efficacy against representative bacterial strains in wound infection, namely Escherichia coli and antibiotic-resistant Pseudomonas aeruginosa.

The association of the perioperative neutrophil-to-lymphocyte ratio with wound healing in patients with Wagner grade 3 and 4 diabetic foot ulcers after tibial cortex transverse transport surgery: a prospective observational cohort study.

Diabetic foot ulcers (DFUs) are severe complications of diabetes, involving multiple etiological factors including neuropathy, vascular insufficiency, and impaired wound healing. The global burden of DFUs is substantial, with significant morbidity and high management costs. Recent advancements have introduced the tibial cortex transverse transport (TTT) technique, which has shown promising results in the management of severe DFUs by promoting angiogenesis and immunomodulation. This prospective cohort study enrolled patients with Wagner grade 3 and 4 DFUs, treated using the TTT technique from May 2022 to September 2023 at MianYang Central Hospital. The study assessed the influence of TTT on the perioperative neutrophil-to-lymphocyte ratio (NLR), an established biomarker of systemic inflammation, and its correlation with wound healing outcomes. A total of 82 patients were enrolled, with 66 completing the study. The survival analysis revealed that patients with a lower preoperative NLR experienced significantly faster wound healing compared with a high NLR (log rank test P< 0.05; hazard ratio (HR) = 0.46; 95% CI: 0.26-0.83). The optimal NLR cutoff values (4.25) were established to predict wound healing times for DFUs. The median NLR was significantly different before TTT surgery, 3 days after TTT surgery, and 1 month after TTT surgery (P<0.05). The TTT technique significantly influences the perioperative NLR and is associated with improved wound healing in DFU patients. The perioperative NLR serves as an effective predictive biomarker for wound healing outcomes, highlighting the significance of interventions targeting NLR values in perioperative management strategies and postoperative monitoring protocols for the treatment of diabetic foot ulcers (DFUs) in clinical practice.

Exploring the Other Side of the River: Early and Midterm Outcomes of Endovascular Pedal Arch Revascularization in Patients with Chronic Limb-Threatening Ischemia.

This study investigated the effect of patency of the pedal arch (PA) on wound healing rate and time, amputation-free survival (AFS), limb salvage, and limb-based patency (LBP) in chronic limb-threatening ischemia (CLTI) patients undergoing endovascular revascularization of infrainguinal arterial lesions. This prospective study included all CLTI patients presenting with wound, ischemia, and foot infection (WIfI) stages 2 to 4 (WIfI ischemia grades 2-3) who underwent endovascular revascularization of infrainguinal arterial disease between April 2019 and April 2021. Pedal angioplasty was attempted in all patients with significant steno-occlusive pedal artery disease. Patients were stratified according to Kawarada PA types. Successful PA revascularization (PAR) was counted when at least 1 pedal vessel is patent. Wound healing rate and time and Kaplan-Meier estimate of AFS and LBP at 2 years were evaluated and compared among the patient groups. A total of 120 patients were categorized according to PA type into type 1 (n = 34; 28.3%), type 2 (n = 64; 53.3%), and type 3 (n = 22; 18.3%). Pedal angioplasty was attempted in 97 patients and was technically successful in 75 patients (77.3%). Successful PAR (with or without pedal angioplasty) was achieved in 98 patients (81.7%). During the follow-up, successful PAR resulted in a better wound healing rate (86.7% vs 59.1%; P = 0.007), major amputation rates (5.1% vs 40.9%; P ≤ 0.001), and AFS (92.9% vs 72.7%; P = 0.018) compared with unsuccessful PAR. There were no significant differences between the 2 groups in wound healing time (3.76 ± 1.99 months vs 3.64 ± 1.94 months; P = 0.798, respectively) or LBP (80.6% vs 72.7%; P = 0.594, respectively). Global Limb Anatomic Staging System (GLASS) stage (odds ratio [OR] = 6.84; 95% CI, 1.30-36.03; P = 0.023) and unsuccessful PAR (OR = 21.64; 95% CI, 4.01-116.69; P ≤ 0.001) were independently associated with failure of wound healing, whereas site of wound lesion (OR = 5.52; 95% CI, 1.15-26.48; P = 0.033), GLASS stage (OR = 24.93; 95% CI, 2.84-218.69; P = 0.004), and unsuccessful PAR (OR = 22.44; 95% CI, 3.53-142.67; P = 0.001) were significant predictors of major amputation. Successful PAR is important for improving clinical outcomes of endovascular revascularization of CLTI patients such as wound healing, amputation-free survival, and limb salvage. Predictors of limb salvage were site of foot lesion, GLASS stage, and successful PAR, whereas GLASS stage and successful PAR were independently associated with improved wound healing. Pedal arch patency positively influences clinical outcomes in patients with chronic limb-threatening ischemia who have ischemic wounds undergoing endovascular revascularization. This study demonstrated that successful pedal arch revascularization (PAR) significantly improved wound healing, amputation-free survival, and limb salvage rates when compared to patients who did not achieve successful PAR. Additionally, the study identified the predictors of limb salvage as the site of foot lesions, GLASS staging, and successful PAR, while both GLASS staging and successful PAR were found to be independently associated with improved wound healing.

Evaluating the Role of Hyperbaric Oxygen Therapy in Enhancing Skin Graft Outcomes: Mechanisms, Clinical Evidence, and Comparative Efficacy

Skin grafting is a critical procedure for treating skin defects from burns, trauma, and surgical interventions, yet complications such as ischemia, necrosis, and infection can limit graft success. Hyperbaric Oxygen Therapy (HBOT) has emerged as a promising adjunctive treatment that enhances skin graft viability through mechanisms including enhanced oxygenation, angiogenesis, reduced inflammation, and anti-infective effects. This review synthesizes findings from clinical studies, comparative analyses, and case reports to clarify HBOT’s efficacy in improving skin graft outcomes. Methods include a comprehensive analysis of HBOT’s impact on graft take rates, healing times, and complication rates. Results indicate that HBOT significantly improves graft survival by mitigating ischemia and infection, while comparative studies show a reduction in major amputations and improved healing in complex cases, such as diabetic foot ulcers and traumatic injuries. These findings suggest that HBOT can serve as a valuable adjunct to standard grafting procedures, offering a multifaceted approach to improve graft viability, especially in high-risk cases. This review highlights HBOT’s potential for integration into wound management protocols, providing a foundation for further exploration into its efficacy and applications in reconstructive surgery.

Preclinical Validation of MIN-T: A Novel Controlled-Released Formulation for the Adjunctive Local Application of Minocycline in Periodontitis

Background: Adjunctive treatment of periodontitis lacks solutions which allow for enough time for wound healing in the periodontal pockets by avoiding fast re-colonization. Such a solution might be an antibiotic-containing formulation with a controlled release over a period of weeks. Here, a recently described minocycline-containing approach is qualified for further clinical development by focusing on proof-of-concept, systemic burden, resistance development, and degradation studies. Methods: Animal studies were done in two different (mouse-chamber, rat Porphyromonas gingivalis challenging) models, including effects on inflammation markers, bone loss, and bone structure. Also, serum concentrations of minocycline after local application were determined by HPLC-MS/MS. The resistance status of bacterial clinical isolates against minocycline was investigated and the degradation of the formulation was characterized by laser scanning and scanning electron microscopy. Results: Animal studies clearly demonstrated the applicability of the new formulation in the investigated models. Inflammation markers decreased in a dose-dependent manner and reduced bone loss compared to non-treated group was observed. Therefore, the systemic burden of the antibiotic was neglectable. Minocycline is still effective against oral pathogens; resistance development was not seen. The biodegradable thread was first swollen and subsequently degraded over a period of weeks. Conclusions: The results support the continued clinical development of this new formulation. A phase I clinical trial is planned to further evaluate its safety and efficacy.

Emerging Technological Advancement for Chronic Wound Treatment and Their Role in Accelerating Wound Healing.

Chronic wounds are a major healthcare burden and may severely affect the social, mental, and economic status of the patients. Any impairment in wound healing stages due to underlying factors leads to a prolonged healing time and subsequently to chronic wounds. Traditional approaches for the treatment of chronic wounds include dressing free local therapy, dressing therapy, and tissue engineering based scaffold therapies. However, traditional therapies need improvisation and have been advanced through breakthrough technologies. The present review spans traditional therapies and further gives an extensive account of advancements in the treatment of chronic wounds. Cutting edge technologies, such as 3D printing, which includes inkjet printing, fused deposition modeling, digital light processing, extrusion-based printing, microneedle array-based therapies, gene therapy, which includes microRNAs (miRNAs) therapy, and smart wound dressings for real time monitoring of wound conditions through assessment of pH, temperature, oxygen, moisture, metabolites, and their use for planning of better treatment strategies have been discussed in detail. The review further gives the future direction of treatments that will aid in lowering the healthcare burden caused due to chronic wounds.