Large Open Wounds Research Articles

Suprathel® and water-filtered infrared-A radiation (wIRA) as a new treatment strategy for toxic epidermal necrolysis (TEN): A prospective study

Toxic epidermal necrolysis (TEN) is a life-threatening condition with a mortality rate of approximately 25% to 30%. Early and adequate wound coverage is necessary due to largescale skin defects. Suprathel® is a modern wound dressing that shows promising results when treating superficial wounds such as scald, burns and abrasions. Previous reports on wound care in TEN patients using Suprathel® have described radical debridement of the entire affected body surface prior to the application of Suprathel®. However, the heavy wound secretion frequently results in the loss of a significant portions of Suprathel® over time. Prolonged operation time increases the risk of hypothermia. In addition, the large open wound areas result in an increased risk for hypovolemic shock, wound infection, and subsequent sepsis. This study presents a new strategy that involves serial hydrotherapeutic wound debridement and the stepwise application of Suprathel® to the affected areas. Water-filtered infrared A light (wIRA) was used to keep the Suprathel®-covered areas dry. Retrospective data from patients who received polyhexanide gel treatment (control group 1) and those who only received Suprathel® (control group 2) were collected for matched-pair analysis. The length of stay in the intensive care unit (ICU) and the need for catecholamines were compared among the three groups. By using serial debridement and combining wIRA treatment with Suprathel® dressings, we were able to significantly reduce the need for catecholamines, lower the risk of hypothermia and infection, and shorten ICU stay compared to the two control groups. We propose incorporating this methodology into the standard of care to promote wound closure and healing when treating TEN patients.

P024 Dermatomyositis, a blurred clinical picture

Abstract Background/Aims We present a case of MDA5 dermatomyositis(DM) in a 25-year-old male, initially presenting with seronegative inflammatory polyarthritis affecting the hands. No classic features of DM were noted and CK was normal. Sulfasalazine was started and subsequently stopped after an ALT rise. Lung-function performed prior to planned methotrexate was abnormal. A CT neck, thorax and abdomen showed unusual pulmonary appearances with focal basal ground glass opacities with reverse halo, without widespread interstitial lung disease(ILD). A bronchoscopy excluded atypical infection. He then developed scaly lesions over the extensor PIPJs, periungual lesions, periorbital swelling and sicca symptoms. CK remained normal, extended myositis screening was negative. LDH and troponins were elevated. A skin biopsy of the hand rash was consistent with dermatomyositis. Methods Muscle pain persisted and an MRI proximal muscles showed muscle oedema and inflammation. A muscle biopsy was requested but not performed as he developed an olecranon bursa with staphylococcal aureus infection. The bursa broke down, required wash-outs, antibiotics and was left to heal by secondary intention. A repeat myositis screen was positive for MDA5 antibody. Immunosuppression was delayed because of concerns that prednisolone, Mycophenolate mofetil(MMF) or Rituximab would cause further wound breakdown and increased risk of infection. The patient was monitored with serial lung-function but didn’t develop ILD. Dermatology confirmed there was active dermatomyositis in the wound edges. The wound only finally healed with additional IVIG therapy. The patient is now established on Rituximab, having been unable to tolerate MMF. Results This case highlights that continued reassessment of the evolving clinical picture is vital to reach the correct diagnosis, and that one should not be reassured by a normal CK. Instead the ALT rise (along with mild elevations of LDH and troponin) was likely reflecting muscle inflammation, not liver inflammation secondary to Sulfasalazine. The repeatedly infected olecranon bursa and large open wound raised concerns about immunosuppressive agents. However, the lack of healing was due to active DM and escalation of treatment was required rather than treatment delay. IVIG was given with excellent and rapid effect. This is licensed for refractory skin involvement in DM, to be considered when infection concern is high. Conclusion The pulmonary involvement with reverse halo sign was felt by the MDT to be nonspecific initially, with a wide differential. In the clinical context, this was reflecting an atypical presentation of MDA5 positive ILD. This antibody can be associated with rapidly progressive ILD and death in approximately one third of cases. Had our patient shown evidence of significant pulmonary progression, high dose immunosuppression would have been commenced despite potential infection risk. Not all patients testing positive for MDA5 develop rapidly progressive ILD but clinical suspicion should be high with frequent serial monitoring of lung function and radiology. Disclosure L. Maltas: None. J. Vila: None. A. Ray: None.

Large Penetrating Wounds to the Chest Managed With Immediate Chest Wall Reconstruction Using Biologic Mesh, Titanium Plates, and Rotational Tissue Flaps.

Large open chest wall wounds can be difficult to manage due to full-thickness tissue loss with underlying rib fractures and exposed lung parenchyma. Historically, the use of synthetic material has been discouraged in the traumatic setting with the concern that it may be associated with an increased risk of infection. We present 4 patients with large open injuries to the thorax-one from blunt and three from penetrating trauma. We describe our initial management followed by prompt surgical repair using biologic mesh, titanium rib spanning plates, and rotational tissue flaps with Z-plasty of the skin for definite closure. All patients did well post-operatively without complications or wound infections. With the appropriate management, we suspect there may be an advantage in performing immediate reconstruction and closure in large open thoracic injuries utilizing biologic mesh and titanium rib spanning plates with a lower risk of infection than previously believed.

Multi-omics analysis elucidates the host-microbiome interplay in severe udder cleft dermatitis lesions in dairy cows

Udder cleft dermatitis is a skin disease in dairy cattle that is characterized by painful, large open wounds between the udder halves or at the front udder attachment. Its impact on animal welfare and production warrants an in-depth investigation of its pathogenesis. The present study delves into the pathophysiology of severe udder cleft dermatitis, employing a multi-omics approach by integrating transcriptomic and metagenomic data obtained from samples of severe udder cleft dermatitis lesions and healthy udder skin of dairy cattle. All dominant features selected from the virulence factor, taxonomic and transcriptomic data sets, except for the facultative pathogen Streptococcus pyogenes, form a network which could be associated with the healthy udder skin. The severe udder cleft dermatitis-associated Streptococcus pyogenes exhibited a negative correlation with these virulence factors and genes, but was not correlated to the other commensal bacteria in the analysis. Examining the different components interacting with each other could advance our understanding of the pathogenesis of severe udder cleft dermatitis.

Achilles Tendon Rupture Treated with Flexor Digitorum Lateralis Tendon Transposition and Transarticular External Skeletal Fixator in Ouessant Sheep

Abstract Objective To describe the appositional augmentation of a complete Achilles tendon rupture in Ouessant sheep, using the intact flexor digitorum lateralis tendon, and immobilization with a type II transarticular external skeletal fixator. Clinical Report A 1-year-old neutered male Ouessant sheep was presented for Achilles tendon rupture and multiple bite wounds, secondary to a dog attack. The Achilles tendon was torn entirely, and a significant 3-cm gaping defect was present. The remnants of the Achilles tendon were debrided and attached using locking-loop and epitendinous sutures. The intact flexor digitorum lateralis tendon was then transposed and secured over the tendinous repair to increase the tendon strength. The bite wounds were closed with a primary repair. Finally, a type II transarticular external skeletal fixator was used to immobilize the tarsocrural joint for 6 weeks. Results A mild lameness, associated with a decreased range of motion of the tarsocrural joint, was present at the time of external skeletal fixator removal. Four months postoperatively, the lameness had completely resolved. A slight decrease in the range of motion of the tarsocrural joint was conserved. Clinical Significance In a small ruminant, transposition of the flexor digitorum lateralis was successful for the repair of an Achilles tendon rupture with a large musculotendinous gap and infected open wounds. To the authors' knowledge, this is the first such case described in sheep.

The comparative and correlation study of postmortem ethanol levels between axillosubclavian blood and femoral venous blood in forensic autopsy cases at Thammasat University Hospital, Thailand

BackgroundFemoral venous blood (FVB) is accepted as a standard sample for postmortem ethanol analysis, but owing to the nature of unnatural death cases, FVB may not always be obtainable, and subclavian blood might be used for alternative specimens. This study investigated the correlation between postmortem ethanol concentrations in FVB and axillosubclavian blood (ASB) from autopsy cases in the tropical climate of Central Thailand. Two other factors potentially affecting the correlation, the time of death and ethanol absorption state, were also investigated. FVB, ASB, and vitreous humor were collected from 100 subjects between May 2021 and May 2022. Subjects with decomposition signs and large open wounds were excluded. ASB was drawn from the axillosubclavian vein at the thoracic outlet. Ethanol concentrations in all samples were measured by headspace GC-FID.ResultsEthanol concentrations in ASB were statistically identical to those in FVB (p = 0.6761) and their relationship was statistically correlated (r = 0.9818, p < 0.001). The correlation was not statistically influenced by time since death or absorptive statuses. The diagnostic study to assess the practical application of ASB instead of FVB at a cut-off concentration above 50 mg/dL yielded an area under the ROC curve of 0.96.ConclusionsOur study indicated that ASB can be used as an alternative specimen for postmortem ethanol analysis when FVB is unavailable in dead bodies that are in a tropical climate.

Spiderplasty and Bow-tie Tension Relieving Suture Techniques for Large Skin Defects in Dogs

Background: In veterinary practice, cutaneous injuries are a very common occurrence. Various methods have been employed to close large skin defects like skin graft or flap often associated with relatively more complex surgical procedures. Use of tension relieving suture techniques like spider plasty and bow tie technique allow the mobilization of adjacent local tissue to cover large cutaneous defects which was thus utilised in the study. Methods: Twelve dogs brought to the Madras Veterinary College Teaching Hospital, Chennai,TANUVAS with large diameter open wounds were selected for the study. Irrespective of the stage of closure the two tension relieving suture techniques, i.e. Spiderplasty and Bow-tie, were performed for closure of the large wounds. The preoperative and postoperative wounds assessment were performed through subjective evaluation, planimetry, bacteriological examination and histopathological evaluation. Result: The Spiderplasty technique was more time consuming, required more surgical expertise and had slightly lower cost efficiency ratio. It could however be better utilised to close wounds located in confined anatomical areas, as compared to the Bow-tie procedure which was limited by its requirement to resect 36% of adjacent normal tissue.

Necrotizing Fasciitis Secondary to Emphysematous Cholecystitis and Cholecystocutaneous Fistula: A Rare Case Report Presentation

Emphysematous cholecystitis is a rare subtype of acute cholecystitis characterized by the presence of gas in the gallbladder wall secondary to ischemia. Typically, this is a result of cystic artery vascular compromise with a concomitant infection from gas-forming organisms such as Clostridium species, Klebsiella species, or Escherichia coli. The mortality rate of acute emphysematous cholecystitis is 15% - 20% compared with 1.4% in uncomplicated acute cholecystitis. The subsequent development of a cholecystocutaneous fistula, an abnormal connection between the gallbladder and the skin, is also a rare complication of gallbladder disease. We describe a case of a 77-year-old male who presented with right flank necrotizing fasciitis which developed from a cholecystocutaneous fistula secondary to emphysematous cholecystitis. Once the necrotic tissues were adequately debrided, the large open wound was treated with negative pressure wound therapy with instillation (NPWT-i) utilizing hypochlorous acid (HOCL). The wound was closed with a split-thickness skin graft.

Serial Application of Meshed Collagen-chondroitin Silicone Bilayer Matrix to Obtain Full Coverage over Bone and Tendon in Challenging Situations and Medically Compromised Patients: A Small Case Series

Introduction. Soft tissue defects in medically compromised patients present significant challenges to the reconstructive surgeon, particularly when vital structures are exposed. This case series reports clinical outcomes of 5 adult patients with challenging medical problems whose wounds were managed using a meshed collagen-chondroitin silicone bilayer matrix to obtain coverage over bone and tendon. Materials and Methods. Patient 1 had significant degloving of the scalp. Patient 2, who had a giant neglected tumor, had a defect comprising the entire occipital skull. Patients 3 and 4 had necrotizing infection in a lower extremity open wound and a pretibial wound (patient 3). Patient 5 sustained a severe crush injury of his forearm and had a large open wound. All the wounds had exposed structures. Results. The incorporation rate of the dermal matrix in the wound bed was 100% in patients 1 and 5, 75% in patient 2, and 90% in patients 3 and 4. Patients 2 and 4 received a second application of dermal matrix to obtain full coverage of the wounds. Each patient achieved stable soft tissue coverage and successful reconstruction. Conclusions. These 5 cases highlight the capacity and capability of this dermal matrix to allow coverage over exposed bone and tendon, as well as the clinical utility of the serial application of this matrix.

Multifunctional antibiotics-free hydrogel dressings with self-regulated nitric oxide-releasing kinetics for improving open wound healing.

Healing of large open wounds remains a major challenge in clinics due to the high risk of bacterial infection and slow healing rates, while excessive use of antibiotics would cause enhanced antibiotic resistance and reduced biocompatibility. Herein, we developed a multifunctional hydrogel dressing (GCNO) through embedding nitrosothiol-conjugated chitosan into a crosslinked gelatin methacrylate (GelMA) network via hydrogen bonding, which presented self-regulated nitric oxide (NO) release kinetics for temporally controlled bacterial elimination and wound repair. At early stages after implantation, the positively charged chitosan molecules of the GCNO hydrogel precursors and release of a high level of NO from the GCNO hydrogel demonstrated effective coordinated antimicrobial capability, thus preventing wound infection in the early stages of healing. While at later stages of wound healing, the hydrogel could sustainably release low levels of NO to stimulate the proliferation and migration of fibroblasts and endothelial cells, leading to accelerated angiogenesis and cell deposition at the wound area. GCNO hydrogels exhibited anti-bacterial and wound repair performance with excellent biocompatibility and biosafety. Overall, this antibiotic-free GCNO hydrogel could demonstrate self-adaptive NO release profiles to prevent bacterial infection in early stages of wound healing while accelerating skin regeneration at later stages, which may offer new insights for the clinical management of large open wounds in clinics.

1225. The Perfect Storm: A Hardy and Lethal Pathogen and a Unit Filled with Immunocompromised Patients with Large Open Wounds. Troubles with Candida Auris in a Burn Intensive Care Unit

Abstract Background C auris is an emerging often multidrug resistant pathogen capable of causing severe morbidity and mortality. C auris has been increasingly isolated from patients in skilled nursing facilities and hospitals, and has been associated with facility outbreaks. A resilient pathogen, C. auris survives harsh disinfectants, desiccation and readily colonizes the environment posing an especially great risk to immunocompromised patients with large open wounds and long lengths of stay. Methods From 7/1/21 - 8/30/21 we noted a cluster of 4 patients with C auris in clinical cultures from the Burn ICU (BICU). A multidisciplinary team involving infection prevention, nursing/medical directors, health and safety, engineering, environmental services, and hospital leadership investigated the cluster as a potential outbreak. Mitigation measures involved a multi-modal response of C auris admission screening, weekly point prevalence testing of all BICU patients, environmental surface cultures, enhanced room cleaning, staff education, hand hygiene and personal protective equipment usage audits. Results 11 cases of C auris were identified on our BICU from 7/1/21 - 2/28/22. 5 (45.5%) cases from clinical isolates, 1 (9.1%) from a BICU point prevalence screen on 12/15/21, 5 (45.5%) as a part of weekly point prevalence screens started on 1/1/22. 6 (54.5%) patients were admitted for burn related injuries, 2 (18.2%) for Steven Johnson Syndrome, 2 (18.2%) for necrotizing wounds, and 1 (9.1%) for COVID-19 pneumonia. Cases occurred in 6/10 rooms in the Burn ICU. One (9.1%) patient expired during this outbreak (not deemed to be from C auris infection). Conclusion Resilient infections like C auris pose a risk of nosocomial transmission and potential high morbidity and mortality to burn patients with impaired immune defense and large open wounds. A multidisciplinary team using targeted interventions including screening, education, enhanced cleaning eradicated the outbreak in our BICU. As of 5/1/22, we went 13 + weeks without identifying a new case. The last patient with C auris was discharged 3/16/22. To prevent future outbreaks, we created a standardized response plan and instituted a universal screening protocol for C auris targeting all patient admissions from skilled nursing facilities and admissions to all ICUs. Disclosures Jorge Paiva Parada, MD MPH, Shionogi: Honoraria.

A Case of a Curious Skin Lesion

Question: A 30-year-old previously healthy man presented as a transfer from an outside hospital for 2–3 weeks of bullous ankle rash and new migratory arthralgias, Three weeks before presentation, he developed severe nontraumatic left-side shoulder pain of unclear etiology. He denied any inciting triggers, though noted he had removed a tick of unknown duration from his leg a month earlier. There were no rashes noted at that time. His shoulder pain progressed, and he subsequently developed left ankle and back pain. Along with the progression of pain, he developed an erythematous raised rash above his left medial malleolus, which developed purple bullae (Figure A) and then ruptured into a large open wound with purulent discharge (Figure B). He developed another pustular lesion on the medial surface of his left thigh which increased in size before rupturing into a similar wound (Figure C). He developed associated fevers up to 104°F. He was subsequently admitted to the general medicine service.

Application of Umbilical Cord Tissue Allografts in Reduction Mammoplasty Wound: A Case Study

Nearly 15 million patients undergo cosmetic surgery in the United States each year, with breast augmentations such as implants, lifts, or reductions being some of the most common procedures. The most common complications of these procedures are scarring and infection at the incision site, which often necessitates expensive corrective surgery. After significant weight loss, the patient in this study underwent an elective lower body lift in conjunction with a breast reduction and nipple-areolar transplant. The patient experienced postoperative wound dehiscence, creating a large open wound, warranting rapid wound closure to avoid further pain and infection. The patient was treated for eight weeks with conservative measures. After eight weeks of failed attempts to close her wound, she was referred for specialist care. Upon initial examination, the donor site wound measured 3.5 cm x 3.5 cm x 1.25 cm deep with no sign of epithelialization. The patient received a single dose of Wharton’s jelly flowable perinatal tissue allograft and twelve hyperbaric oxygen therapy treatments over seven weeks. Upon inspection at the final examination, the wound was closed entirely with 100% epithelialization. This case study demonstrates a precedent for the application of Wharton’s jelly flowable allografts in complicated cosmetic post-surgical wounds. Future efforts will be directed at applying Wharton’s jelly allografts on a preventative basis. Preventative applications could be in stage 2 pressure sores, in the region of recurrent chronic venous insufficiency ulcers between stages of tenuous healing, prior to joint replacement in patients with immune compromised states, or prior to surgical intervention in patients with a known history of postoperative infections. The obvious goal is to prevent needless patient suffering and reduce unnecessary healthcare costs.

Alterations in the expression of IGF‑I isoforms and binding proteins during the wound healing process

There is increasing evidence to indicate that insulin‑like growth factor (IGF)‑1 plays a crucial role in the regeneration of different tissues following injury. Notably, despite the escalating number of animal studies, studies investigating the role of IGF‑1 in the wound healing process in humans are fewer. In this context, the aim of the present study was to evaluate the variations in the expression IGF‑1 isoforms (IGF1‑Ea, IGF1‑Eb and IGF1‑Ec), as well as its binding protein and receptor (IGF‑BP3 and IGF‑1R) during wound healing in patients. The study population comprised of 21 patients presenting with the first episode of sacrococcygeal pilonidal disease. Samples were obtained during surgery, as well as on days 2, 7 and 14 post‑operatively. The expression levels of IGF‑1 isoforms, as well as that of its binding protein and receptor were evaluated using reverse transcription‑quantitative PCR. Statistical analyses were performed using GraphPad Prism software. The Kruskal‑Wallis test and Dunn's post hoc test were utilized. The results revealed a statistically significant difference in the expression of IGF‑BP3 and IGF‑1R during wound healing (P=0.014 and P=0.018, respectively). Specifically, the pairwise post‑hoc Dunn test indicated that IGF‑BP3 expression was significantly decreased on the 2nd post‑operative day compared to the day of surgery, while IGF‑1R expression was significantly increased at 14 days post‑operatively. The expression of the remaining IGF‑1 isoforms was not significantly altered during wound healing. On the whole, as demonstrated herein, IGF‑BP3 and IGF‑1R appear to play a crucial role during the wound healing process, particularly in patients with large open wounds following pilonidal disease treatment. Further studies are warranted to evaluate the exact role, as well as the possible use of these proteins as enhancers of wound healing.

Above knee amputation due to necrotizing fasciitis caused by gas producing strain of Echerichia coli and negative pressure therapy assisted closure of large open wound

Introduction. Nonclostridial gas-forming soft tissue infections (NGSTI) are rare, rapid progressive infections that are caracterized by high mortality and high proportion of amputations. Surgical debridement is crucial in therapy and it results in complex wounds that need to be closed to prevent secondary morbidity. Case report. Herein we present a case of NGSTI in a 68-year-old patient with diabetes mellitus with acute thrombosis of popliteal artery aneurysm and radiological signs of gas in his right leg and in urine bladder wall. Infection was caused by gas-forming strain of Escherichia coli. The patient was early treated with femoral amputation and antibiotics. A vacuum asistet closure (VAC) treatment has been applied. Administered VAC therapy resulted in primary wound closure without complications 17 days after surgery. Conclusion. Negative pressure increase wound fluid removal and infection clerance while, also, increases wound contraction and aproximation of skin flaps. VAC therapy can be good adjunctive treatment for closure of large open wounds for the patients with NGSTI to avoid extensive reconstructive surgery.

Joint Healthcare Infection Society (HIS) and Infection Prevention Society (IPS) guidelines for the prevention and control of meticillin-resistant Staphylococcus aureus (MRSA) in healthcare facilities

Joint Healthcare Infection Society (HIS) and Infection Prevention Society (IPS) guidelines for the prevention and control of meticillin-resistant Staphylococcus aureus (MRSA) in healthcare facilities

TRAUMATIC CHEST WALL INJURY WITH DIAPHRAGMATIC RUPTURE AND LUNG HERNIATION

TOPIC: Cardiothoracic Surgery TYPE: Medical Student/Resident Case Reports INTRODUCTION: Traumatic diaphragmatic injuries are a rare injury that can occur after chest wall trauma. Injury to the diaphragm and its surrounding structures can easily be missed as the patients often have polytrauma. We present a case of a penetrating injury with blunt traumatic chest wall injury with diaphragm rupture and herniation of the left lung through the chest wall after a motorcycle collision. CASE PRESENTATION: A 24-year-old male presented to the hospital as a trauma alert after a motorcycle crash. The patient was found to have a large open chest wound with exposed lung and diaphragm. He was taken for CT imaging and found to have a left apical pneumothorax, left lung contusion, left rib fractures 2-10, and a grade 2 spleen laceration. The patient was taken for emergent exploration of his left chest wound. The patient was found to have disruption of his left chest wall and diaphragmatic attachments with rupture of the lateral aspect of his diaphragm at the level of rib 5-6. The wound was explored with evidence of injury to the left inferior lateral lobe of his lung. The lung did not require any resection. The entire left diaphragm was examined with the central tendon of the left diaphragm found to be intact, the diaphragm was repaired along the lateral edge and reattached to the costal cartilage laterally along the chest wall. The left chest was washed out and a chest tube was placed. The patients remaining hospital course was uneventful, and his chest tube was removed with no signs of air leaks. DISCUSSION: There are no specific signs of diaphragmatic injury or rupture on physical exam. Missed diaphragmatic injuries can result in major morbidity or mortality for the patient. All diaphragmatic injuries should be examined along with all surrounding structures at the time of diagnosis. Most diaphragmatic injuries occur on the left side as the right side is protected by the liver. We highly recommend CT imaging to examine the upper abdomen and chest. In the case of our patient which is rare, we were able to visualize his chest wall injury with his diaphragmatic injury on physical exam. When diagnosed early we recommend repair through the abdomen, but if found late repair through the chest is a better approach. In our case we were able to re-approximate the diaphragm to the chest wall. CONCLUSIONS: Traumatic injuries to the diaphragm can be tough to diagnose at times when there is not obvious injury noted to the diaphragm. We recommend full exposure of the diaphragmatic surface and examination of the surrounding organs and structures to rule out further injury that is not obvious on first examination. The diaphragm should be repaired and then reattached to the chest wall along its costal cartilage laterally. Complete repair with reattachment will allow the patient to avoid morbidity and mortality of a chronic diaphragmatic injury that could lead to impaired respiratory or chest wall function. REFERENCE #1: DeBarros, M., Martin, M.J. Penetrating Traumatic Diaphragm Injuries. Curr Trauma Rep 1, 91-101 DISCLOSURES: No relevant relationships by Michael Bishop, source=Web Response No relevant relationships by Alyssa Ritchie, source=Web Response

Study on hemostatic effect and mechanism of starch-based nano-microporous particles

The powdered hemostatic particles have broad application prospects in large open wounds, internal organ injuries and penetrating injuries of the body. In this study, nanoscale mescoporous and macroporous silica (MMSN), nanoscale mescoporous and macroporous bioactive glass (MBG), micron-scale cross-linked corn starch porous microspheres (CMS), MMSN@CMS and MBG@CMS starch-based nano-microporous particles were synthesized and their hemostatic effect and hemostatic mechanism were studied. The results showed that comparted with the single particle of CMS, the combination particles MBG@CMS and MMSN@CMS significantly increased the water absorption rate, activated both internal and external coagulation pathways, significantly shortened CBT, as well as the improved hemostatic effects in vitro. The immediately released Ca2+ from MBG@CMS in the blood to participate in the coagulation pathway, and MMSN@CMS activated platelets by concentrating blood coagulation factors, might be the main hemostatic mechanisms for the starch-based nano-microporous particles. Furthermore, the hemostatic efficacy of particles, both in the model of tail-amputation and liver injury in SD rats, showed the starch-based nano-microporous particles, especial MBG@CMS, could significantly reduce the weight of blood loss and shorten the bleeding time. Our research work stated that the starch-based nano-microporous particles MBG@CMS might be a hemostasis biomaterial with the potential applications for the emergency bleeding.

P0696 / #465: WHEN DIVERTING COLOSTOMY PERFORM TO CRITICAL ILLNES FOR SEVERE PERIANAL OPEN WOUNDS?

Aims & Objectives: The aim of the present study was to analyze the outcome after performing a diversion colostomy in children with severe perianal lesion. Methods: We are presenting to case series whose diverting colostomy was opened for large perianal open wounds and sepsis. Results: Our first patient was 6-month girl whose diagnosed with meningococcemia had extensive necrotizing wounds in the perianal region, a colostomy performed (on the 40th day hospitalization) to prevent stool passage and skin irritation. In the follow-up of the patient, wound healing was observed and no additional problem was observed. It was learned that the patient’s colostomy was closed in the 5th month. Second patient was 7-moth girl, also she was diagnosed meningococcemia along with severe purpura fulminans then extensive necrotizing wounds in the perianal region, a colostomy performed (on the 23th day of admission). The patient is still in our hospital and has colostomy. The patient was in good general condition. Third patient’s disorder was dilated cardiomopathy and then total artificial heart support implanted because of failure. He had extensive sacral decubitus ulcer and a colostomy performed (on the 58th day of hospitalization). After healing of the patient’s wound, colostomy was closed in the 10th month hospitalization. We achieved successful results in 3 patients.Conclusions: In conclusion, the present study is the first to case series the use of diverting colostomy method for critically ill children sever and large open perianal wounds. Colostomy may be good treatment option for perineal severe tissue lost.

Retrospective analysis of the lifetime endocrine response of southern right whale calves to gull wounding and harassment: A baleen hormone approach

Physiological measurements are informative in assessing the relative importance of stressors that potentially impact the health of wildlife. Kelp Gulls, Larus dominicanus (KG), resident to the region of Península Valdés, Argentina, have developed a unique behavior of landing on the backs of southern right whale adults and calves, Eubalaena australis (SRW), where they feed on their skin and blubber. This parasitic behavior results in large open wounds on the dorsal surface of the whale. Coincidently, the SRW population off the coast of Península Valdés has experienced elevated calf mortality. We quantified levels of glucocorticoids and thyroid hormone extracted from baleen of dead calves to evaluate, retrospectively, the endocrine response of whale calves to gull wounding and harassment. Baleen accumulates hormones as it grows, allowing evaluation of long-term trends in physiological condition. While glucocorticoids (GCs) are known to increase in response to stressors such as disturbance, the metabolic hormone triiodothyronine (T3) has been shown to decrease under sustained food deprivation but is largely unaffected by disturbance stress. We quantified lifetime patterns of GCs and T3 in baleen recovered at necropsy from 36 southern right whale calves with varying severity of wounding from KGs. GC levels in baleen correlated positively with the degree of wounding, while T3 levels remained stable irrespective of the severity of the wounding. Our results suggest no evidence of malnutrition in low vs. severely wounded whales. However, the positive correlation of GCs with wound severity indicates that heavily wounded calves are suffering high levels of physiological stress before they die. This suggests that KG wounding may have contributed to the high southern right whale calf mortality observed in the Península Valdés region of Argentina.