Initial Wound Research Articles

Histomorphometric analysis of excisional cutaneous wounds with different diameters in an animal model.

The skin wound model in rats is a fundamental stage in preclinical trials, but there is a lack of standardization in these trials regarding the initial wound area, making analysis and comparison between studies difficult. Therefore, this study evaluates the healing progression of excisional skin lesions of varying diameters in Wistar rats, aiming to identify the optimal wound size for monitoring treatment effects on wound healing. Excisions of 0.8, 1.5, 2.0 and 3.0 cm in diameter were made on the back of the animals. Thirty animals were used per treatment and evaluated on days 3, 7, 10, 14 and 21 after surgery. The lesions were cleaned daily with saline solution until they were completely closed. The 0.8 cm group showed complete repair on D14, while in the other groups, the wounds persisted until day 21, with a reddened surface and no complete epidermal coverage, but with greater keratinization and presence of appendages in the 1.5 cm lesions. Therefore, as a standardization model for creating skin wounds, we suggest using 1.5 or 2.0 cm excisions, considering that 0.8 cm wounds close very early and 3.0 cm wounds, although behaving similarly to 2.0 cm wounds, are more invasive for the animals. The 1.5 cm model proved to be suitable for closure within 21 days. When evaluating a product intended to accelerate wound healing, 2.0 cm lesions are recommended to assess the effectiveness of the treatment.

CD74+ fibroblasts proliferate upon mechanical stretching to promote angiogenesis in keloids.

The healing of human skin wounds is susceptible to perturbation caused by excessive mechanical stretching, resulting in enlarged scars, hypertrophic scars, or even keloids in predisposed individuals. Keloids are fibro-proliferative scar tissues that extend beyond the initial wound boundary, consisting of the actively progressing periphery and the quiescent center. The stretch-associated outgrowth and enhanced angiogenesis are two features of the periphery of keloids. However, which cell population is responsible for transducing the mechanical stimulation to the progression of keloids remains unclear. Herein, through integrative analysis of single-cell RNA sequencing of keloids, we identified CD74+ fibroblasts, a previously unappreciated subset of fibroblasts with pro-angiogenic and stretch-induced proliferative capacities, as a key player in stretch-induced progression of keloids. Immunostaining of keloid cryosections depicted a predominant distribution of CD74+ fibroblasts in the periphery, interacting with the vasculature. Invitro tube formation assays on purified CD74+ fibroblasts ascertained their pro-angiogenic function. BrdU assays revealed that these cells proliferate upon stretching, through PIEZO1-mediated calcium influx and the downstream ERK and AKT signaling. Collectively, our findings propose a model wherein CD74+ fibroblasts serve as pivotal drivers of stretch-induced keloid progression, fueled by their proliferative and pro-angiogenic activities. Targeting the attributes of CD74+ fibroblasts holds promise as a therapeutic strategy for the management of keloids.

Identification of High-Risk Lower Extremity Wounds Using Point-of-Care Test for Bacterial Protease Activity; A Single-Centre, Single-Blinded, Prospective Study.

Clinician observation is the mainstay to determine if wound infection is present, and focuses on presence of erythema, purulence, and odour. However, non-visible bacterial protease activity can delay wound healing and lead to complications. In this study, a point-of-care test to detect the presence of bacterial protease activity (BPA, tested with Woundchek Bacterial Status test) was appraised. A total of 130 patients with lower extremity wounds were recruited in vascular and podiatry clinics, and across two time-points 182 BPA tests were conducted subsequent to initial (blinded) clinician's wound appraisal. Clinical opinion ('no infection', 'possible' or 'definite' infection) and BPA result (negative or positive test) had a moderate Kendall's tau-c rank correlation coefficient of 0.32 (P < 0.001). Binary logistic regression analysis and principal component analysis showed that infection determined by clinical opinion was significantly associated with abovementioned clinical signs and a positive BPA test. However, a positive BPA result was also significantly linked with wound severity, such as number of lesions, chronicity and size. Throughout a 12-week follow-up period, median ulcer size was larger for wounds positive for BPA test at baseline (P 0.001) and week-12 (P 0.036; both Mann-Whitney U-test) respectively. As a pilot initiative, clinical staff were allowed to act on the BPA result if they wished; in 11 out of 71 test-positive cases (15%) this happened and antimicrobial dressing was applied instead of planned standard dressing. These results show that protease-releasing bacteria may be active in ulcers that do not (yet) exhibit hallmark signs of infection, and are associated with delayed healing. Targeted point-of-care testing for bacterial protease activity may have the potential to identify and enable pro-active (antimicrobial) management of these high-risk wounds.

Physical therapy in burn care: Development of clinical prediction rules to determine the efficacy of low-level laser therapy

This study aimed to demonstrate the benefits of low-level laser therapy (LLLT) on burn healing and to investigate whether patients' age, burn wound size, wound stage, and total burned surface area influence the burn wound healing response to LLLT. This was a quasi-experimental study with a single-group design that included eighty male and female patients with partial-thickness burn wounds recruited from burn units. The participants were placed in a single intervention group receiving LLLT. The duration of the intervention was six weeks, divided into 18 sessions (three sessions per week). The statistical analysis was conducted using version 25 of the SPSS statistical package for Windows. The results showed a statistically significant negative relationship between wound improvement from LLLT and age (p &lt; 0.05) and between total body surface area (TBSA) and wound improvement (p &lt; 0.05). Additionally, a statistically significant positive relationship was found between initial wound size and wound improvement (p &lt; 0.05). There was no statistically significant relationship between wound improvement and wound stage (p &gt; 0.05). The current study revealed that age, TBSA, and initial wound size can predict the efficacy of low-level laser treatment for burn wounds.

EP202 - Mesh-Mediated Fascial Traction (MMFT) and Negative Pressure Abdominal Dressing (ABTHERA): Useful in Difficult Open Abdomens?

Abstract Background Challenging abdominal surgical emergencies may require an 'Open Abdomen (OA)' as a life-saving procedure. OA has serious complications: wound infection, fluid and protein loss, catabolic state, loss of abdominal domain, and entero-atmospheric fistula. To assess the efficacy of mesh-mediated fascial traction (MMFT) &amp; Abthera Dressing in achieving definitive abdominal closures. Patients and Method Retrospective analysis of prospectively collected data of 6 patients managed between August and November 23 in a large DGH. Following laparotomy and management of primary pathology, Abthera Dressing combined with bilateral continuous 2-0 PDS suture fixation at 0.5cm gap of macroporous Prolene (Merinium, Meril Life) meshes to each rectus sheath followed by sequential midline mesh traction closure over a time period that allowed subsequent definitive abdominal wound closure. Data collection included patient demographics (age, sex, BMI, ASA), intervention details for OA, wound characteristics, follow-up, and outcome. Results Six included M: F 4:2, age 61* (40-76 ) years, BMI 30* ( 24-35), ASA 3. Three were strangulated incisional hernia, 2 burst abdomens from faecal peritonitis, and 1 necrotizing fasciitis. Initial wound length 25*(20-32) cm, width 12.5* (4-17) cm after management of primary pathology reduced to width 4.5* (0-9) cm through MMFT and Abthera Dressing followed by definitive abdominal closure. Relook surgery required were 4* (1-9) with one full and 4 bridged mesh closures. Length of stay 39* (14-74) days. One death from respiratory failure. Conclusion The study highlights the benefit of MMFT &amp; Abthera Dressing in achieving definitive abdominal closure for challenging OA where primary abdominal closure was not possible. * Median

Open Fractures of the Hand: is there No Alternative to Definitive Osteosynthetic Treatment in an Emergency Situation?

There is an emergency indication for the treatment of open fractures. Fracture stabilisation and soft tissue care are equal prerequisites for an uncomplicated course of treatment and a good functional result. However, challenges arise in cases of extensive wound contamination and compromised perfusion, limiting options for stable osteosynthesis in emergency situations. Furthermore, resource constraints may pose a challenge to adhering strictly to the six-hour time window. This prompts deliberations on whether, under certain circumstances, a deviation from the conventional approach is feasible by exploring the possibility of prioritising immediate surgical wound care during emergencies, with definitive fracture care deferred to a later point in time. Between 2019 and 2021, 301 patients with open fractures of the hand skeleton were treated (median age 44 years, 85% male, 15% female). Definitive treatment was carried out as a primary emergency procedure in 215 patients (group A), whereas it was performed at an interval after an average of 3 days in 86 patients (group B), who had received surgical wound care, splint placement, and antibiotic coverage on the day of the injury. In a retrospective study, the following criteria were analysed: comorbidities, injury patterns, injury location, timing of treatment, number of follow-up procedures, infection rate, and duration of hospitalisation. The course was complicated by infection in six patients (1.9%). Five of these patients were in group A (infection rate 2.3%), and only one patient was in group B (infection rate 1.1%). All six infections occurred after crush injuries, all at the fingertip or end joint. These numbers underscore the relevance of soft tissue trauma and primary stump formation. Comorbidities were not statistically significant in our study with a view to the occurrence of infection. In conclusion, it can be stated that, with antibiotic protection, definitive treatment of an open fracture in an interval is possible if it is preceded by initial emergency surgical wound care with subsequent immobilisation.

Use of three-dimensional acellular collagen matrix in deep or tunnelling diabetic foot ulcers: a retrospective case series.

While most xenograft wound matrices are flat sheets not designed for deep or tunnelling wounds, three-dimensional acellular collagen matrices (3D-ACM) can fill deep wound beds and enable full wound wall apposition. This case series examines the use of 3D-ACM in treating diabetic foot ulcers (DFUs) that are deep, tunnelling, undermining, or irregularly shaped. We report outcomes of cases where 3D-ACM was applied to deep or tunnelling DFUs present for at least four weeks. In this retrospective case series, 3D-ACM was applied, healing was monitored and measurements were collected. Additional 3D-ACM was applied as needed. In total, 11 patients with 13 wounds were treated. Improved wound appearance and reduced size were observed at most follow-ups. Mean initial wound depth was 1.6cm, and several wounds showed significant depth reductions shortly after therapy initiation. In total, 62% of wounds (8/13) reached 50% closure by four weeks. Additionally, 54% (7/13) were fully closed by 12 weeks. The remaining 46% (6/13) took between 12-22.3 weeks to heal. Overall mean therapy time was 13.1 weeks (range: 2.0-22.3 weeks). Deeper wounds generally took longer to close. The findings of this case series showed that 3D-ACM could offer a protective microenvironment for wound management for deep or tunnelling DFUs. While some took >12 weeks to close, this may be attributable to large initial depths and volumes, rather than a failure to respond to the treatment modality. Other wounds that require a conforming 3D matrix, enabling full wound wall apposition, may benefit from 3D-ACM. Further investigations would be beneficial to understand the capabilities of this treatment modality.

Evaluation of sodium hyaluronate-based composite hydrogels for prevention of nasal adhesions.

During the healing process after intra-nasal surgery, the growth and repair of damaged tissues can result in the development of postoperative adhesions. Various techniques have been devised to minimize the occurrence of postoperative adhesions which include insertion of stents in the middle meatus, application of removable nasal packing, and utilizing biodegradable materials with antiadhesive properties. This study assesses the efficacy of two sodium hyaluronate (SH)-based freeze-dried hydrogel composites in preventing postoperative nasal adhesions, comparing them with commonly used biodegradable materials in nasal surgery. The freeze-dried hydrogels, sodium hyaluronate and collagen 1(SH-COL1) and sodium hyaluronate, carboxymethyl cellulose, and collagen 1 (SH-CMC-COL1), were evaluated for their ability to reduce bleeding time, promote wound healing, and minimize fibrous tissue formation. Results showed that SH-CMC-COL1 significantly reduced bleeding time compared to both biodegradable polyurethane foam and SH-COL1. Both SH-COL1 and SH-CMC-COL1 exhibited enhanced wound healing effects, as indicated by significantly greater wound size reduction after two weeks compared to the control. Histological analyses revealed significant differences in re-epithelialization and blood vessel count among all tested materials, suggesting variable initial wound tissue response. Although all treatment groups had more epithelial growth, with X-SCC having higher blood vessel count at 7 d post treatment, all treatment groups did not differ in all histomorphometric parameters by day 14. However, the long-term application of SH-COL1 demonstrated a notable advantage in reducing nasal adhesion formation compared to all other tested materials. This indicates the potential of SH-based hydrogels, particularly SH-COL1, in mitigating postoperative complications associated with nasal surgery. These findings underscore the versatility and efficacy of SH-based freeze-dried hydrogel composites for the management of short-term and long-term nasal bleeding with an anti-adhesion effect. Further research is warranted to optimize their clinical use, particularly in understanding the inflammatory factors influencing tissue adhesions and assessing material performance under conditions mimicking clinical settings. Such insights will be crucial for refining therapeutic approaches and optimizing biomaterial design, ultimately improving patient outcomes in nasal surgery.

Artificial dermal repair for larger finger pulp defects: Satisfactory coverage with limitations in sensation and inevitable scar formation

BackgroundThis prospective study aimed to evaluate the outcomes of the use of dermal templates for lengthy volar soft tissue defects (1.5–4 cm) in the fingers. MethodsThe volar soft tissue defects of 15 patients (19 fingers) were treated with Lando dermal template coverage between June 2022 and November 2022. We evaluated sensory recovery, scar formation, and overall appearance of the repair site at an average of 13 months (range, 12–17 months) of follow-up. ResultsThe defect healed in all cases. We found an average static 2-point discrimination of 7 mm (range 4 to 14 mm). Scar formation was evident in all cases. The repair did not restore the bulkiness of the volar finger, especially in the finger with the bony exposure. Nail deformities and joint contracture were observed in some cases. ConclusionDermal template repair does not restore normal sensation and inevitably leads to scar formation when the defect is longer (>1.5 cm). Bulkiness of the volar finger is not restored in most patients, especially when there was bone or tendon exposure in the initial wound site.

Effectiveness and safety of an innovative silicone extender in suture reinforcement or dermatotraction: a retrospective study.

Multiple techniques are available for closing skin defects, such as skin grafts, flaps and tissue expansion. The tissue extender MID SEW (MID, France) was developed to achieve dermatotraction or suture reinforcement. The aim of this study was to evaluate the effectiveness and safety of this innovative silicone extender for large surgical wounds. A single-centre retrospective and observational study on an unselected consecutive cohort of patients treated with a tissue extender was conducted. Indications, initial and final wound surfaces, and adverse events (AEs) were retrieved from electronic medical records. The main outcome measure was the time to complete wound closure. We identified 50 patients from July 2017 to December 2018. Patients underwent cutaneous tumour-wide excision (n=44), or pilonidal disease surgical treatment (n=6). The average initial wound area was 53.3±42.4cm2. Healing was complete, without secondary dehiscence, within the first seven days after device withdrawal for 41 patients (82%). At least one AE was experienced by eight patients (16%) during the study period: five inflammation; five wound dehiscence; two skin necrosis; and one pain. This case series suggests that the tissue extender may be effective and safe in its dermatotraction and suture reinforcement indications in the treatment of large wounds after wide excision of skin cancer or treatment of pilonidal disease. This work was supported in part by the Hospices Civils de Lyon, France and in part by the University Claude Bernard Lyon 1, France. OB co-owns the patent on the MID SEW system. The authors have no other conflicts of interest to declare.

Evaluation of White Blood Cell Count, Lymphocyte Percentage, Neutrophil Percentage, and Elevated Temperature as Predictors of Wound Infection in Burn Patients.

Infection remains a chief cause of morbidity and mortality among burn patients. The burn wound surface is initially sterile after a thermal injury but eventually gets colonized by microorganisms. A burn wound is considered infected upon the presence of high concentrations of microorganismsin the wound and scab. Burn wound infections can lead to a delay in epidermal maturation, higher scar formation, and sepsis. However, burn patients are commonly misclassified as septic due to the manifestation of systemic inflammatory response syndrome (SIRS) after their injury, despite the presence or absence of an infection. This is a retrospective review of medical records of patients admitted to the burn unit in Salmaniya Medical Complex in Manama, Bahrain, between the years 2018 and 2020. Demographic data, total body surface area (TBSA), initial temperature, white blood cell count, lymphocyte percentage, neutrophil percentage, and wound cultures were obtained for all subjects. Logistic regression analysis was performed to compare the presence or absence of wound infection by the aforementioned parameters. Of 412 cases, 68.2%were male patients, with a mean age for the studied population of 25.1 years (standard deviation (SD)=20.7). Staphylococcus aureus was the most prevalent organism across all of the study population (n=31)(34.4%). Staphylococcus aureus was the most prevalent organism in patients under the age of five, while Pseudomonas aeruginosa was the most common organism among adults older than 65 years of age. TBSAwas not found to be a good predictor of wound infection. There was no statistically significant relation between initial temperature and wound culture (p-value=0.056). However, logisticregression revealed that the initial temperature increases the likelihood of positive wound culture by almost three times. White blood cell count, lymphocyte percentage, and neutrophil percentagewere not clinically reliable in predicting burn wound infection. However, initial temperature might be a helpful predictor. Further research is needed to identify reliable clinical parameters of burn wound infections.

In vivo and in silico studies of the effects of oil extracted from Cannabis sativa L. seeds on healing of burned skin wounds in rats.

This study investigates the potential effects of cannabis seed oil (CSO) on the wound healing process. The aim was to assess the efficacy of CSO in treating skin wounds using an animal model and to explore its anti-inflammatory properties through in silico analysis. Eighteen male albino Wistar rats, weighing between 200 and 250g, were divided into three groups: an untreated negative control group, a group treated with the reference drug silver sulfadiazine (SSD) (0.01g/mL), and a group treated topically with CSO (0.962g/mL). The initial wound diameter for all groups was 1 cm. In silico studies were conducted using Maestro 11.5 to evaluate the anti-inflammatory effects of phytoconstituents against cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2). CSO and SSD treatments led to a significant reduction (p <0.05) in the size of burned skin wounds by day 5, with contraction rates of 53.95% and 45.94%, respectively, compared to the untreated negative control group. By day 15, wounds treated with CSO and SSD had nearly healed, showing contraction rates of 98.8% and 98.15%, respectively. By day 20, the wounds treated with CSO had fully healed (100%), while those treated with SSD had almost completely healed, with a contraction rate of 98.97%. Histological examination revealed granulated tissue, neo-blood vessels, fibroblasts, and collagen fibers in wounds treated with CSO. In silico studies identified arachidic acid, γ-linolenic acid, and linolenic acid as potent inhibitors of COX-1 and COX-2. Serum biochemical parameters indicated no significant changes (p > 0.05) in liver and kidney function in rats treated with CSO, whereas a significant increase (p < 0.01) in ALAT level was observed in rats treated with SSD. The findings demonstrate that CSO has a promising effect on wound healing. The CSO treatment resulted in significant wound contraction and histological improvements, with no adverse effects on liver and kidney function.However, the study's limitations, including the small sample size and the need for detailed elucidation of CSO's mechanism of action, suggest that further research is necessary. Future studies should focus on exploring the molecular pathways and signaling processes involved in CSO's pharmacological effects.

Topical insulin for refractory persistent corneal epithelial defects

The aim was clinical evaluation of the efficacy of topical insulin eye drops in patients with refractory persistent epithelial defects (PEDs). This prospective non-randomized investigation was conducted to examine the efficacy of insulin eye drops in treating patients with PEDs that did not respond to conventional therapy. A total of twenty-three patients were included in the study, and they were administered insulin eye drops formulated as 1 U/mL, four times a day. The rate of epithelial defect resolution and time to complete corneal re-epithelialization were considered primary outcome measures. The relative prognostic impact of initial wound size and other parameters, including age, sex, smoking, diabetes, and hypertension were also analyzed. The results showed that during follow-up (maximum 50 days), a total of 16 patients (69.6%) achieved improvement. Insulin eye drops significantly reduced the corneal wounding area in 75% of patients with small epithelial defects (5.5 mm2 or less) during 20 days. Only 61% of patients with moderate epithelial defects (5.51–16 mm2) showed a significant recovery in 20–30 days. Also, 71% of patients with a defect size greater than 16 mm2, demonstrated a significant improvement in the rate of corneal epithelial wound healing in about 50 days. In conclusion topical insulin reduces the PED area and accelerates the ocular surface epithelium wound healing.

Comparison of Intralesional Triamcinolone Acetonide Alone with Intralesional Triamcinolone Acetonide-5-Fluorouracil Combination Injection in Keloid: A Case Report

Keloids are abnormal cutaneous wound healing responses extending beyond the borders of the initial wound, usually appearing pink-purplish to hyperpigmented nodules or plaques with a hard consistency, irregular shape, uneven border, and smooth shiny surface. Most often occur on the chest, shoulder, upper arms, earlobes, and cheeks. This case report aims to compare a case of keloid treated with intralesional triamcinolone acetonide (TAC) alone with intralesional triamcinolone acetonide-5-fluorouracil (TAC + 5-FU) combination injection. A 21-year-old Minahasa male complains of growing pruritic scars in the back area and right and left upper arms since five years ago. Physical examination of the right and left upper arms revealed multiple hyperpigmented nodules and plaques, irregularly shaped, smooth, and shiny surfaces with defined borders and varying sizes. A clinical diagnosis of keloid was made. Treatment was initiated with weekly intralesional TAC alone on the left upper arm vs. intralesional TAC + 5-FU combination injection on the right upper arm. The evaluation was made based on the clinical and modified Vancouver scar scale. One of the most commonly used therapeutic options for keloid is TAC. However, the combination of TAC + 5-FU may be opted for due to its mechanism through the corticosteroid mechanism of action in conjunction with the antimetabolite activity of 5-FU. The combination may yield a more effective and faster outcome with fewer side effects. Intralesional combination TAC + 5-FU injection may be a therapeutic option for keloid with minimal side effects.

Fermented Polyherbal Formulation Ameliorates the Severity of Acute Multiple Antibiotics-Resistant Pseudomonas aeruginosa-Infected Burn Wound in a Rat Burn Model.

Pseudomonas aeruginosa, a Gram-negative opportunistic bacterium, has emerged as a cause of life-threatening infections in burn wounds. Current therapeutic approaches through wound dressings and systemic medicines are far from satisfactory; resistance to more than two antibiotics shown by pathogens contributes to failures of therapy causing mortality. This animal study was conducted to check the efficacy of one Ayurveda-based fermented polyherbal preparation (AP 01) against multiple antibiotics-resistant (MAR) P. aeruginosa HW01-infected rat burn wounds. AP-01 was applied on artificially infected burn wound on a rat model infected with MAR P. aeruginosa to register the healing effects in terms of reduction in residual wound area percentage, the presence of C-reactive protein in blood, and the presence of viable bacteria colony. Topical application with conventional antibiotics served as a positive control. The polyherbal preparation had reduced the infected residual burn wound area at 40.63% ± 0.69 from the initial burn wound area within two weeks after a single intervention, whereas residual burn wound area remained much higher in the case of animals left untreated and in the case of the animals treated with control drug. Restoration to the normalcy of serum C-reactive protein level was also achieved earlier in the case of polyherbal AP-01-treated groups than in other groups. Fermented formulations using components of AP-01 singly or in different combinations had never been tested earlier for topical application in infected burn wound. The formulation of AP-01 was found superior in terms of the rate of healing and control of infection by MAR P. aeruginosa strains in burn wounds in rat models.

Use of Cold Plasma in the Treatment of Infected Wounds

The fact that chronic and complex wounds are a serious problem, both for those affected and for the health care system, has been known for decades. Most chronic wounds can be healed through targeted treatment of the cause of the wound and optimal wound care. This includes not only phase-adapted modern wound care, but also, in particular, preparation for surgical coverage. The correct preparation of the wound bed, also known as conditioning, plays an important role in this. In recent years, the use of Cold Atmospheric Plasma (CAP) has emerged as a promising new option. Here, the wound is regularly treated with a partially ionized gas. According to studies, this active gas mixture has antimicrobial properties and promotes wound healing by activating cell regenerative processes. To test the efficacy of cold plasma therapy, for complex hard to heel wound with difficult conditions, 40 patients with 41 wounds were included in a retrospective, multicenter observational trial in Italy. The wounds were complex wounds of different genesis that had been present for at least 2 months (&gt; 60 days) were treated with cold atmospheric plasma, generated with the CE approved handheld plasma device plasma care®. The treatment, as an add on to standard wound therapy, was performed once a week and for 1 Minute per treated wound area for an intervention period of 4 weeks. In the intervention period, a total of 41 wounds from 40 patients were treated and measured. Two patients left the trial, the others showed an average wound size reduction of 28% within 30 days. Of all wounds, two were completely closed at the end and 10 wounds even achieved a reduction of at least 40%. Analyzed by initial wound size, 43% of wounds smaller than 18 cm² reduction of 40 %. No improvement or worsening of the wound size was only observed in five wounds. The observational trial showed a reduction in the bacterial load and accelerated wound healing. In addition to the bacterial load, improved wound bed conditioning was also demonstrated. Cold plasma therapy is well suited for locally targeted application to promote wound healing. It is an uncomplicated and quickly applicable method with no known side effects or risks at present.

Physical therapy in burn wound healing: Development of clinical prediction rules to identify the efficacy of pulsed electromagnetic therapy

Many studies have demonstrated the effect of pulsed electromagnetic therapy (PEMT) on wound healing. This study aimed to develop a clinical prediction rule (CPR) to assess PEMT's efficacy in burn healing, potentially enhancing treatment decisions and outcomes. It was a one-group intervention study with 46 patients (21 males, 25 females) aged 20 to 55 years, having partial-thickness burns in the first or second healing stage, and a total burned surface area (TBSA) over 15%. The intervention involved pulsed electromagnetic therapy (Fisioline, Italy) for up to six weeks, with 60-minute sessions at 12 Hz and 12 Gauss, three times per week. The statistical analysis was conducted using the SPSS. The study revealed a significant decline in wound surface area (WSA) post-intervention (p &lt; 0.05). A significant negative relationship was found between wound improvement and both age and total body surface area (TBSA) (p &lt; 0.05), while a significant positive relationship was observed between wound improvement and initial wound size (p &lt; 0.05). No significant relationship was found between wound improvement and wound stage (p &gt; 0.05). The study concluded that pulsed electromagnetic therapy significantly reduces wound surface area. Additionally, age, TBSA, and initial burn wound size are important predictors of the therapy's efficacy in treating burn wounds.

Fast skin healing chitosan/PEO hydrogels: In vitro and in vivo studies

Due to its outstanding qualities, particularly when it takes the shape of hydrogels, chitosan is a well-known biological macromolecule with many applications. When chitosan hydrogels are modified with other polymers, the desirable function as skin regeneration hydrogels is compromised; nevertheless, the mechanical properties can be improved, which is crucial for commercialization. In this study, for the first time, bimetallic zinc silver metal-organic frameworks (ZAg MOF) loaded with ascorbic acid were added to chitosan/polyethylene oxide (PEO) based interpenetrating polymer network (IPN) hydrogels that were crosslinked with biotin to improve their antimicrobial activity, mechanical characteristics, and sustainable treatment of wounds. Significant changes in the microstructure, hydrophilicity level, and mechanical properties were noticed. Ascorbic acid release patterns were upregulated in an acidic environment pH (5.5) that mimics the initial wound pH. Impressive cell viability (98 %), antimicrobial properties, and almost full skin healing in a short time were achieved for the non-replaceable chitosan/PEO developed hydrogels. Enhancing the wound healing of the treated animals using the prepared CS/PEO hydrogel dressing was found to be a result of the inhibition of dermal inflammation via decreasing IL-1β, suppressing ECM degradation (MMP9), stimulating proliferation through upregulation of TGF-β and increasing ECM synthesis as it elevates collagen 1 and α-SMA contents. The findings support the implementation of developed hydrogels as antimicrobial hydrogels dressing for fast skin regeneration.

Macrophage phenotype is determinant for fibrosis development in keloid disease

Keloid refers to a fibroproliferative disorder characterized by an accumulation of extracellular matrix (ECM) components at the dermis level, overgrowth beyond initial wound, and formation of tumor-like nodule areas. Treating keloid is still an unmet clinical need and the lack of an efficient therapy is clearly related to limited knowledge about keloid etiology, despite the growing interest of the scientific community in this pathology. In past decades, keloids were often studied in vitro through the sole prism of fibroblasts considered as the major effector of ECM deposition. Nevertheless, development of keloids results from cross-interactions of keloid fibroblasts (KFs) and their surrounding microenvironment, including immune cells such as macrophages. Our study aimed to evaluate the effect of M1 and M2 monocyte-derived macrophages on KFs in vitro. We focused on the effects of the macrophage secretome on fibrosis-related criteria in KFs, including proliferation, migration, differentiation, and ECM synthesis. First, we demonstrated that M2-like macrophages enhanced the fibrogenic profile of KFs in culture. Then, we surprisingly founded that M1-like macrophages can have an anti-fibrogenic effect on KFs, even in a pro-fibrotic environment. These results demonstrate, for the first time, that M1 and M2 macrophage subsets differentially impact the fibrotic fate of KFs in vitro, and suggest that restoring the M1/M2 balance to favor M1 in keloids could be an efficient therapeutic lever to prevent or treat keloid fibrosis.

Does Negative Pressure Wound Therapy Impact the Outcome for Patients With Necrotizing Soft Tissue Infection Infected With Anaerobic Bacteria?

Background: A notable improvement in the treatment of necrotizing soft tissue infections (NSTIs) is the development of negative pressure wound therapy (NPWT). Clinicians are still debating whether NPWT is as successful as conventional wet-to-dry dressings at removing bacteria. Recent research has revealed potential oxygen deprivation effects of NPWT in underlying wound tissues, although clinical trials regarding the effects of reduced oxygen on anaerobic bacterial soft tissue infections remain noticeably lacking. Hypothesis: We hypothesized that NPWT-treated patients with NSTIs who were solely infected by anaerobic bacteria would have worse outcomes than those who were infected with other bacterial species. Patients and Methods: Our study included a retrospective examination of the 2008-2022 period of our Acute and Critical Care Surgery database. Patients who had been identified as having necrotizing fasciitis, Fournier gangrene, or gas gangrene and who had their conditions verified by positive wound cultures acquired during the initial debridement and subsequently received NPWT made up the study cohort. Comorbidities, surgical techniques, and clinical results were all covered by the data. Based on their wound infections, patients were divided into two groups: those with exclusively anaerobic NSTIs and those with different bacterial groups (such as polymicrobial and aerobic). Multiple regression, χ2 analysis, and analysis of variance (ANOVA) were among the analytical methods used. Results: One hundred twelve patients with NSTI who had received NPWT comprised the study cohort. Sixteen of these patients (14.3%) had NSTIs that were exclusively anaerobic, whereas the remaining 96 (85.7%) had NSTIs that were mixed aerobic, facultative, or polymicrobial. Between the two groups, there was no difference in the initial wound size. Patients with anaerobic NSTI who underwent NPWT showed a statistically significant increase in the number of debridements (3 [interquartile range {IQR},1-9] vs. 2 [IQR, 1-4]; p = 0.012) and an increased 100-day re-admission rate (37.5% vs. 12.5%; p = 0.012) when compared with patients with non-anaerobic NSTI. The 100-day re-admission rate increased three-fold in NPWT-treated anaerobic NSTIs, according to a logistic regression analysis (odds ratio [OR], 3.63; 95% confidence interval [CI], 1.06-12.44; p = 0.04). Conclusions: In contrast to patients with other bacterial strains, our data show that patients with NSTI treated with NPWT who only have anaerobic bacterial infections have a larger number of debridements and are much more likely to require re-admission within 100 days. We call for additional prospective studies to be conducted to identify additional risk factors and consider alternate treatment options for individuals with exclusively anaerobic NSTIs in light of these findings.