Wound Infection Research Articles (Page 1)

One-year clinical outcomes of delayed referral and subsequent management in chronic limb-threatening ischemia.

Percutaneous Fogarty thrombectomy is a novel and potentially less invasive alternative to surgical thrombectomy for the treatment of patients with acute limb ischemia (ALI). This study aimed to evaluate the effectiveness of percutaneous thrombectomy versus conventional surgical thrombectomy with respect to amputation-free survival (AFS) and periprocedural complications in patients with ALI. We conducted a multicenter, retrospective, observational study enrolling 148 patients with ALI who underwent percutaneous or surgical thrombectomy (percutaneous group, 44 patients; surgical group, 104 patients) between January 2014 and October 2023. The primary outcome measure was the 12-month AFS rate, and the secondary outcome measure was periprocedural complications. Propensity score matching analysis was applied to minimize baseline differences and to compare outcomes between the groups. After propensity score matching, 30 and 60 patients were allocated to the percutaneous and surgical groups, respectively. The 12-month AFS was not significantly different between the groups (percutaneous group: 73.6% vs. surgical group: 53.3%, log-rank p=0.16). The incidence of major access-site bleeding, vessel perforation, wound infection, and delayed wound healing was not significantly different between the 2 groups (all p>0.05). The current study revealed that AFS rate and perioperative complications were not significantly different between patients with ALI undergoing percutaneous and surgical thrombectomy.Clinical ImpactPercutaneous Fogarty thrombectomy is a novel and potentially less invasive alternative to surgical thrombectomy for the treatment of patients with lower extremity acute limb ischemia; however, its effectiveness and safety have not yet been fully established. This multicenter retrospective analysis found that amputation-free survival rates were not significantly different in patients undergoing the percutaneous thrombectomy, compared with those undergoing the conventional surgical thrombectomy. Future studies with a larger sample size are warranted to confirm the generalizability of the findings.

Infected wound healing is a clinical problem owing to excessive inflammatory responses. In this study, a multicomponent hydrogel GOP was prepared by employing salmon polydeoxyribonucleotide (PDRN), oxidized sodium alginate (OSA), and gelatin (Gel) as starting materials. The hydrogel with three-dimensional structure was synthesized through the Schiff-base cross-linking of PDRN, Gel, and OSA. Hydrogen bonding and electrostatic interaction also participated in the formation of the three-dimensional network. Hydrogel GOP demonstrated a good mechanical property and tissue adhesion ability. In vitro studies revealed the antibacterial activity of hydrogel GOP toward S. aureus and E. coli, along with remarkable antioxidant activity. Biocompatibility tests showed high cell viability (>80%) and good ability to promote cell migration. Hemolysis assay revealed minimal hemotoxicity (<2.1%). Using a murine full-thickness dermal injury model, GOP treatment achieved small residual wound area (2.3%) on day 14. Histological analyses demonstrated reduced inflammation cells and enhanced collagen deposition. Immunofluorescence analyses showed suppressed inflammation level (increased IL-10) and improved angiogenesis (upregulated CD31 and α-SMA). These results revealed that hydrogel GOP represented a promising multifunctional dressing for infected wound management.

Surgical site infections (SSIs) remain a significant cause of postoperative morbidity and are often associated with multidrug-resistant (MDR) organisms. This study aimed to isolate, identify, and evaluate the antibiotic susceptibility patterns of bacterial pathogens from postoperative wound infections in a tertiary care center. A postoperative cross-sectional study conducted on 104 wound swab samples were collected from patients aged 10-90 years who underwent surgeries including exploratory laparotomy, Laparoscopic cholecystectomy, and Colectomy, Hernia, Ulcer, and Cancer surgeries. Bacterial identification was carried out using selective culture media and biochemical tests, while antimicrobial susceptibility testing was performed by the Kirby-Bauer disc diffusion method in accordance with Clinical and laboratory standard institute (CLSI) guidelines. Out of 104 samples, 96 (92.31%) showed positive bacterial growth, while 8 exhibited no growth. Among the culture-positive samples, Staphylococcus aureus was isolated in 18 cases (13.10%) and Pseudomonas aeruginosa was isolated in 24 cases (17.40%). Further, 33.33% isolates of S. aureus and 37.50% isolates of the P. aeruginosa showed multidrug-resistant. However, antibiotic susceptibility testing revealed that S. aureus showed 100% sensitivity to linezolid and 72.22% sensitivity to tetracycline while P. aeruginosa showed 75% and 70.83% sensitive to ofloxacin and piperacillin, respectively. Linezolid and ofloxacin emerged as the most effective agents against S. aureus and P. aeruginosa respectively. These findings highlight the importance of continuous antimicrobial resistance surveillance to guide appropriate empirical therapy for SSIs.

Obesity's impact on postoperative outcomes in abdominoplasty remains poorly defined despite its rising prevalence. This study evaluates the effect of obesity on 30-day postoperative complications to inform risk assessment and management. Investigate the effect of obesity on 30-day postoperative complications following abdominoplasty. We analyzed data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) for patients who underwent abdominoplasty between 2008 and 2022. Patients were categorized into obese (BMI ≥30kg/m2) and non-obese (BMI <30kg/m2) groups. Univariate and multivariate analyses were performed to compare 30-day postoperative complication rates between the groups. A total of 1,778 patients were included; 618 (34.8%) had obesity (mean BMI 35.2±5.0kg/m2) and 1,160 (65.2%) did not (mean BMI 25.2 ± 2.9, p<0.001). Average age of patients with obesity (45.0 ± 10.4 years) was comparable to those without (45.8±11.4, p>0.99). Postoperative complications occurred in 107 cases (6.0%), with a significantly higher incidence in patients with obesity (8.9% vs. 4.5%, p=0.002). Deep vein thrombosis (DVT) occurred more frequently among patients with obesity (1.3% vs. 0.1%, p=0.04). Obesity was associated with significantly increased overall complications (OR 1.79, p=0.01), surgical complications (OR 1.68, p=0.046), superficial wound infections (OR 2.23, p=0.02), and unplanned readmissions (OR 2.75, p=0.01). Obesity is an independent risk factor for complications following abdominoplasty. Optimized preoperative screening, potentially including DVT prophylaxis for patients with obesity, and tailored perioperative care are essential to improving outcomes in this population. Evidence-based guidelines are needed to enhance surgical safety for obese patients. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Real-time Monitoring of Wound Infection Based on Multi-channel Biomedical Sensors

Sectio caesarean surgery is a surgical procedure that can effectively prevent ma- ternal and newborn deaths when used for reasons of medical indications. Post operative sectio caesarean can pose several risks of complications, one of which is pain and surgical wound infection. Non pharmacological approach aromatherapy as a complementary therapy to reduce postpartum pain. This case study aims to analyze the influence aromatherapy lavender on reducing pain levels in post sectio caesarean mothers by using the case study method pre and post test. The case study was carried out in 25 May 2025 – 07 June 2025. This type of case study is descriptive with the number of subjects used, namely three post partum mothers in the RSUD Batang private sector with pain assessment using a questionnaire Numeric Rating Scale (NRS). The results of the case study showed a change in pain intensity from a scale of 6-7 to a scale of 4-5. This shows an influence aromatherapy lavender on reducing pain levels in postpartum mothers caesarean section Giving innovation aromatherapy can be used as an independent nursing in- tervention so that it can be applied to patients regularly.

To determine whether high complexity pelvic exenterations alter perineal wound morbidity and to assess risk factors for perineal flap complications following complex rectal cancer surgery. A retrospective analysis of consecutive adults undergoing complex rectal cancer resections with immediate gluteal flap perineal reconstruction between January 2013-July 2021 at a tertiary referral centre. Conventional complex cancer resections were compared with "high complexity" exenterations, including en bloc sacrectomy and extended lateral pelvic side wall excision. Primary outcomes were short-term (wound infection, necrosis, dehiscence) and long-term (sinus, fistula, hernia) perineal flap complications. We identified 194 patients (median 56 years, 60% male) with gluteal flap reconstructions; 163 (84%) for advanced or recurrent rectal cancer. Gluteal artery perforator flaps were predominantly used (176, 92%). Wound infections were more common in the conventional group (23.2% vs. 6.3%, p = 0.001), but no other differences in complications were observed between groups. Obesity (HR 2.70, 95% CI 1.22-5.97, p = 0.014) and total pelvic exenteration (HR 2.13, 95% CI 1.07-4.23, p = 0.031) were associated with short-term complications. Age over 65 years predicted readmission/reoperation (HR 2.66, 95%CI 1.07-6.6, p = 0.040). Ureteric/ileal conduit leaks were associated with long-term complications (HR 3.37, 95% CI 1.21-9.34, p = 0.024). No flap losses occurred. Gluteal fasciocutaneous perforator flaps provide reliable perineal reconstruction after complex rectal cancer surgery. The extent of surgery and resulting defect size did not significantly influence perineal wound complication rates.

Diabetic wound healing remains a major challenge, as persistent bacterial infections and chronic inflammation can delay healing and lead to scar formation. Herein, a novel self-powered microneedle patch (SPMNP), combined with mild microwave thermal (MT) therapy, is developed to promote the scarless healing of infected diabetic wounds. The SPMNP is fabricated by integrating a piezoelectric nanogenerator (PENG) with a microneedle patch (CFeZ/MNP) loaded with Curcumin@Fe3O4-COOH@ZIF-8 nanoparticles (CFeZ NPs). The CFeZ NPs endow the CFeZ/MNP with a mild MT effect under microwave irradiation, enabling elimination of bacteria and biofilms. Owing to the boronic ester bonds and MT effect, CFeZ/MNP facilitates responsive release of curcumin under both the infected diabetic wound microenvironment and microwave irradiation. The PENG collects and converts biomechanical motion to electrical stimulation to further promote wound healing. In vitro experiments demonstrate that SPMNP synergizes with mild MT therapy to promote M2 macrophage polarization as well as enhance cell proliferation and migration. In a Staphylococcus aureus-infected diabetic wound model, the SPMNP combined with mild MT therapy can eliminate bacteria, inhibit inflammatory response and pro-fibrotic cytokines expression, promote tissue regeneration, and ultimately promote scarless healing of infected diabetic wound. This study provides a promising therapeutic strategy for the scarless healing of infected diabetic wounds.

BackgroundEarly weight bearing is frequently allowed and encouraged following fixation of hip and femoral and tibial shaft fractures, while pelvis, acetabulum, and lower extremity periarticular fractures are often prescribed 6–12 weeks of restricted weight bearing. Our objective was to perform a feasibility randomized trial of immediate versus delayed weight bearing as tolerated (WBAT) for fractures of the pelvis, acetabulum, distal femur, and proximal and distal tibia.MethodsA parallel two-arm pilot feasibility trial was performed at one academic level I trauma center in the United States. Patients with a fracture of the pelvis, acetabulum, distal femur, proximal tibia, or distal tibia were eligible. Patients were randomized to either immediate WBAT or delayed (≥ 6 weeks) weight bearing after surgery. Our feasibility criteria included the following: (1) 25% overall enrollment (surgeon and patient agreement to participate in 50% eligible cases), (2) > 90% follow-up at 3 months), (3) 100% correct documentation of weight bearing status, and (4) 100% correct documentation of secondary outcome (reoperation).ResultsSurgeons allowed inclusion of 64/133 (48.1%) of eligible patients (by fracture type, 76% of pelvis; 43% of acetabulum; 38% of distal femur; 45% of proximal tibia (39% of tibial plateau); and 56% of distal tibia fractures). 50/64 (78%) of these patients agreed to participate in the study, for an overall enrollment of 38% (50/133). The follow-up rate was 46/50 (92%) at the 3-month follow-up. Correct documentation of postoperative weight bearing status and the secondary outcome of reoperation was achieved in all cases 50/50 (100%). There were two reoperations (one hardware failure and one wound infection) in the immediate WBAT group, and none in the delayed weight bearing group.ConclusionAll four of the feasibility criteria were met. While we did not meet our target of 50% of patients whom surgeons were willing to randomize, we did exceed the target of 25% overall patient enrollment. This feasibility trial demonstrates that a randomized controlled trial of early versus delayed weight bearing would be feasible for certain fracture types, and these findings will be used to help design future studies in this realm.Trial registrationClinicalTrials.gov identifier: NCT05595148.Supplementary InformationThe online version contains supplementary material available at 10.1186/s40814-025-01708-3.

Retrospective cross-sectional study. We analyzed inpatient health care utilization, costs, and outcomes for pediatric neuromuscular scoliosis (NMS) in the US from 2003 to 2019. We describe hospitalization characteristics and identify predictors of perioperative complications. The Healthcare Cost and Utilization Project Kids' Inpatient Database (KID) collects nationally representative weighted data samples of pediatric hospital discharges. We identified hospitalizations related to spinal fusion procedures for NMS in children from 2003, 2006, 2009, 2012, 2016, and 2019. Hospitalizations were categorized as surgical (initial spinal fusion, wound dehiscence, wound infection) and complication related (pneumonia, urinary tract infection, paralytic ileus, respiratory failure). Weighted national estimates of admissions, inflation-adjusted charges (2019 USD), length of stay (LOS), and hospital days were calculated. Survey-weighted logistic regression identified independent predictors of perioperative complications. Admissions for NMS rose >30-fold from 235 in 2006 to 7,242 in 2019. Total charges increased from $22 million to $1.31 billion, and the mean charge per hospitalization increased from $99,700 to $182,100. Hospital days increased from 1,942 to 58,528, and median LOS remained consistent at 8 days. In 2019, NMS accounted for 0.1% of pediatric admissions, 0.25% of hospital days, and 0.6% of hospital charges in the US. Surgical wound complications were <0.5% of encounters but incurred mean charges exceeding $456,000 and median LOS of 30 days. Among 15,821 weighted encounters, overall mortality was 0.7%. The likelihood of perioperative complications was higher among children transferred from another facility or covered by public or "other" insurance, whereas age ≥10 years and Black race were associated with lower odds of complications (P<0.05). Over the past two decades, pediatric NMS has become substantially more resource intensive, driven particularly by rising procedure costs, despite stable LOS and low mortality. Strategies for reducing perioperative complications may mitigate the economic burden of this vulnerable population. 4.

Antimicrobial resistance poses a critical global threat, with carbapenem-resistant pathogens representing a significant challenge to healthcare systems. This study aimed to characterize carbapenem-resistant pathogens isolated from wound infections in patients from a major hospital in Trinidad using a combination of traditional microbiological and molecular techniques. A total of 25 Gram-negative bacterial isolates were analyzed phenotypically for antimicrobial resistance and genetically profiled for resistance mechanisms using polymerase chain reaction and whole genome sequencing. Analysis of the data revealed most of the isolates were Acinetobacter baumannii (A. baumannii) (56%; n = 14) and Klebsiella pneumoniae (K. pneumoniae) (28%; n = 7), but a small number of Enterobacter (12%; n = 3), and Pseudomonas (4%; n = 1) were also identified. While the isolates were determined to be carbapenem resistant, 32% (n = 8) also exhibited extended spectrum beta-lactamases characteristics. Key resistance determinants identified from whole genome sequencing included blaOXA-23 (n = 2), blaOXA-90 (n = 2), and blaOXA-72 (n = 1) in A. baumannii and blaNDM-5 (n = 1) in K. pneumoniae. The co-occurrence of carbapenemase and extended spectrum beta-lactamase genes, such as blaCTXM-124 in A. baumannii and blaTEM-1B and blaCMY-4 in K. pneumoniae, emphasized the complexity of resistance mechanisms that limits therapeutic options. Notably, this is the first study to report on the occurrence of blaSPM and blaSME in A. baumannii in Trinidad. By contributing critical insights into the molecular epidemiology of antimicrobial resistance in the setting of the Caribbean, this study offers a foundation for region-specific interventions to mitigate the clinical and economic impact of resistant infections. It will also help improve antimicrobial stewardship, and control efforts, and therefore supports the need for investment in diagnostic stewardship.

Lymphedema (LE) is chronic swelling due to inadequate lymphatic function, which can occur after therapeutic lymph node dissection (TLND) for melanoma. At our institution, the risk of LE is 12% for axillary and 38% for ilioinguinal lymph node dissection. This study investigated LE rates in patients undergoing TLND with immediate lymphatic reconstruction (ILR) using lymphaticovenous anastomosis (LVA), a microsurgical technique aimed at preventing LE. Patients with melanoma requiring TLND were recruited prospectively from the Tom Baker Cancer Center and were consented to undergo ILR at the time of their node dissection. Institutional ethics board approval was obtained (Ethics ID HREBA. cc-20-9426). This study was not a registered clinical trial; the ongoing randomized LYMbR trial (NCT05136079) is registered but does not include this cohort. The main objective was to assess the development of LE, which was defined as a 10% increase in postsurgical limb volume compared with the contralateral limb. In addition, participants completed the Lymphoedema Quality of Life Questionnaire (LYMQoL), a validated LE-specific quality of life patient-reported outcome measure (PROM) before surgery and at each 6-month assessment, to assess for any changes in quality of life related to LE. A direct comparison was made to historical institutional rates of LE after TLND without ILR. Kaplan-Meier analysis assessed overall survival and lymphedema-free survival, while Mann-Whitney U test compared quality of life between patients with and without lymphedema. Between August 2020 and October 2022, 22 patients (14 men and 8 women) with a median age of 68 (range 43-80) were included in the study and underwent TLND for melanoma with ILR. 16 patients underwent ALND, and 6 patients underwent ILND with ILR. There were no complications directly related to the ILR part of the procedure. All disease was at least stage III. At a median follow-up of 34 months (range: 0-51 months), three patients met the criteria for LE, one who underwent ALND and two ILND. Of these three patients, two had regional recurrence and one suffered from a DVT and a postoperative wound infection in the affected limb. LYMQoL scores were equal or better (p = NS) in patients without LE than those with LE across all domains except for mood: function (median IQR 1.0 vs 1.0, p = 0.78), appearance (1.0 vs 1.6, p = 0.19), symptom burden (1.1 vs 1.6, p = 0.52), and mood (1.1 vs 1.0, p = 0.87). This study aligns with other cohort studies demonstrating the usefulness of ILR in TLND patients with melanoma, which will be further examined in an ongoing randomized trial (LYMbR - NCT05136079).

Objective Multiple arterial grafting (MAG) has been suggested to confer long-term survival benefits for patients undergoing coronary artery bypass grafting (CABG), yet its short-term benefits remain uncertain. This study aims to analyze the impact of MAG on in-hospital outcomes and identify potential risk factors. Methods A retrospective analysis was conducted from all patients who underwent CABG surgery in our development from January 2022 to December 2024. A generalized mixed-effects model and sensitivity analysis were employed to evaluate the influence of the type of CABG bypass graft on in-hospital major adverse cardiac and cerebrovascular events (MACCEs), postoperative dialysis, intra-aortic balloon pump (IABP) use, re-thoracotomy for bleeding and sternal wound infection (SWI). Results A total of 960 patients were included in this study. Patients who received MAG surgeries had more coronary artery lesions observed preoperatively. Compared with patients who underwent single arterial grafting (SAG), those who received MAG surgery did not show significant differences in the incidence of in-hospital MACCEs, postoperative dialysis, IABP use, re-thoracotomy or SWI. Interestingly, good left ventricular function was associated with a reduced occurrence of postoperative dialysis, MACCEs, and IABP application. Chronic renal insufficiency emerged as a risk predictor of major in-hospital adverse events. Conclusion This single-center study did not find significant differences in short-term outcomes between MAG and SAG groups. However, caution should be exercised when applying these findings to other clinical environments and patient populations. Further multi-center, prospective randomized controlled trials (RCTs) are needed to validate and extend our results.

Despite the development of surgery, the problem of wound treatment remains relevant today. The effectiveness of therapy is usually assessed by a number of parameters, and the effect of the drug may not be the same in relation to each of them. Therefore, in this regard, it is necessary to apply statistical analysis methods that allow us to reduce the dimensionality of the studied indicators and to identify those that correlate with each other and play a key role in assessing the effectiveness of treatment. The aim of the study was to evaluate the effectiveness of wound treatment based on factor analysis in experiment. Material and methods . The course of the wound process was studied using the following parameters on the model of aseptic, infected and purulent-necrotic wounds in Wistar rats: local temperature, wound area, wound size reduction rate, content of creatinine, urea, alanine and aspartate aminotransferase activity, hydroxyproline level in wound tissues, wound morphometric parameters and contamination level. The efficacy of the proposed wound dressings was assessed using factor analysis, namely principal component analysis. The resulting principal components were standardized and subsequently categorized into quartiles. Results and discussion . It was found that the significance of the first factor was 1.9–4.2 times greater than the other factors, which made it the most significant in the subsequent ranking of the normalized variables. Thus, animals in the groups where the treatment was carried out with chitosan-collagen complexes with silver or with lidocaine and dioxidine (respectively in relation to the aseptic and infected wound) always fell into the group with excellent and good treatment results according to the first factor, and the animals receiving chitosan-collagen complexes with silver and chymotrypsin – in 70–100 %. Conclusions. The use of factor analysis allowed us to reduce the dimensionality of the parameters under study, identify the most important of them and group indicators according to the strength of their correlation. At different stages of the wound healing process, different parameters were combined into factors, which should also be considered when identifying significant markers at different stages of the wound healing process.

Wound infection complicated by excessive inflammation remains a persistent challenge in clinical healthcare. Curcumin (Cur), a natural diketone compound, holds therapeutic potential in treating infected wounds. However, its application is limited by poor aqueous dispersibility and low stability. To overcome this dilemma, a versatile capsule as an effective Cur carrier is developed by encapsulating Cur in succinic acid-modified cyclodextrin via hydrophobic interactions, and then loading it into a Zn2+-mediated crosslinked injectable hydrogel for infected wound healing. The composite hydrogel exhibits adjustable rheological properties, modulus, swelling ratios, and degradation rate by control over Zn2+ concentration. This unique tactic enables the sustained Cur release, ensuring long-term antioxidant activity and reactive oxygen species (ROS) scavenging. An in vivo experiment in a rat S. aureus-infected wound model demonstrates that the composite hydrogel significantly accelerates wound healing by massacring bacteria, inhibiting inflammation, as well as promoting collagen deposition and angiogenesis. Overall, this effort paves the way for arming Cur, offering a potent antibiotic-free candidate for bacteria-invaded wound management.

Background: The prevalence of peripheral arterial disease, including chronic limb-threatening ischemia (CLTI), is globally increasing due to the aging society and the pandemics of diabetes mellitus. Although managing elderly CLTI patients with non-ambulatory status is substantially common in clinical practice, determination of treatment planning remains clinically challenging. This study aimed to evaluate the mortality and prognostic factors in elderly CLTI patients with non-ambulatory. Methods: This was a multicenter retrospective observational study enrolling 2309 CLTI patients (age: 75.5 ± 10.2 years, male: 60.5%, diabetes mellitus: 61.9%, dialysis: 46.9%) who underwent endovascular therapy (EVT) between April 2010 and March 2024. Patients aged over 80 years old with non-ambulatory status including wheelchair or bedridden were defined as the vulnerable CLTI group. The primary outcome measure was all-cause mortality, and were analyzed by multivariate analysis. Results: A total of 443 patients (19.2%) were classified as vulnerable CLTI. The 5-year all-cause mortality rate was 76.4% in the vulnerable CLTI group and 49.9% in the non-vulnerable CLTI group (p&lt;0.001). The multivariate analysis revealed hemodialysis (hazard ratio [HR]: 1.83, p &lt; 0.001), wound, ischemia, and foot infection (WIfI) stage 4 (HR: 1.71, p = 0.002), left ventricular ejection fraction &lt; 50% (HR: 1.52, p = 0.04), and serum albumin level &lt; 3 g/dL (HR: 1.55, p = 0.009) were positively associated with mortality in vulnerable CLTI group, with no significant interactions. 12-month mortality rate was 71.6% in patients with three or more of these risk factors. Conclusions: The current study revealed that hemodialysis, wound severity, malnutrition, and cardiac dysfunction were significantly associated with mortality in vulnerable CLTI patients. Risk stratification based on these predictors allows estimation of prognosis in vulnerable CLTI patients, and would be clinically useful for determination of treatment planning including palliative care.

Introduction Wound breakdown and infection after spinal surgery can cause significant morbidity, often requiring multidisciplinary management and prolonged hospitalization. Aims This study aims to quantify and characterise all operatively managed wound issues managed at the National Spinal Injuries Unit for Ireland, over a 3-year period, and identify factors which predicted Plastic Surgery involvement. Methods Data was collected relating to operatively managed spinal wound complications in a tertiary referral centre for spinal surgery between 2022 and 2024 inclusive. Patient demographics, comorbidity, operative factors, antibiotic use, microbiological cultures, and outcomes were examined. Univariate and multivariate logistic regression was used to model the likelihood of Plastic Surgery involvement. Results In total, 101 patients had 156 procedures for wound breakdown. Most patients had an initial spinal instrumentation for degenerative disease ( n =65, 69.9%). The mean time from the index spinal procedure to the first wound washout was 7.32 weeks (SD = 19.10 weeks), with the range varying between 0 to 156 weeks. Most spinal washouts were for wound dehiscence ( n =67), followed by a dural tear/CSF leak in 17 patients. Microorganisms were cultured in 71 cases, but the number and sample types varied. Of these, 41 patients (56.9%) grew a single organism, and 30 patients (42.2%) grew multiple organisms. Plastic Surgery was consulted in 8.9% of all cases ( n =9). A flap reconstruction was used in all of these cases. The involvement of Plastic Surgery was associated with peripheral vascular disease (p=0.016), longer operative time of the index case (p=0.019) and an increased number of wound washouts (p=0.001). Conclusions The management of spinal wound breakdowns is complex and multidisciplinary. This study furthers our understanding of which patients may benefit from early Plastic Surgery input and flap reconstruction.

Neem gum, a biocompatible and biodegradable polysaccharide, has broad applications in drug delivery and tissue engineering. Its hydrophilic and bioadhesive properties make it ideal for controlled drug release and scaffold fabrication. This review examines the role of neem and its derivatives in pharmaceutical formulations, wound healing, and regenerative medicine, while addressing stability, scalability, and regulatory considerations. Future directions include the integration of nanotechnology and chemical modifications for enhanced biomedical applications. Neem gum has been developed into various forms, including hydrogels, nanoparticles, films, and coatings, for targeted drug delivery and tissue regeneration. Its antimicrobial, antioxidant, and anti-inflammatory properties enhance wound healing and infection control, but challenges like batch variability and mechanical limitations remain. Neem gum is a promising natural biomaterial for pharmaceutical and biomedical applications. Further research on stability, large-scale processing, and clinical validation is essential for commercialisation and clinical use.

Abstract Purpose of Review In this review, we aim to summarize the significance and key components of a multidisciplinary team approach to limb salvage. Recent Findings Each year in the United States, approximately 150,000 nontraumatic major lower extremity amputations occur, primarily due to peripheral artery disease and diabetic foot ulcers. Major amputations impose a significant burden on the healthcare system and negatively affect patients’ quality of life. Once on the decline, the rates of major amputations have seen a concerning resurgence and to combat this rise in amputations and advocate for effective limb salvage, we need a concerted effort that emphasizes awareness, patient education, early diagnosis and management of risk factors, provision of adequate wound care, facilitation of revascularization efforts, and post-procedure monitoring of patients. Summary A multidisciplinary limb salvage team—including vascular surgeons, interventionalists, infectious disease specialists, podiatrists, plastic surgeons and wound care experts—is essential to meet the goal of reducing amputation rates, improve wound healing, preserve function and mobility and improve overall quality of life for patients at risk for amputation.