Large Open Wounds Research Articles

Use of Cutis Graft as Biologic Prosthesis in Complicated Abdominal Closures: A Case Report

Background: Loss of domain, fascial separation, and wound contamination are all recognized challenges of complex abdominal wall reconstruction. Often, traditional therapies, such as fascial advancement, mesh reinforcement, and the use of bio-prostheses for infection are insufficient. Recently, we have investigated using cutis as an alternative therapy. We present the case of a 61-year old male treated in such a manner. Methods: Our patient presented to our facility with a fascial defect of 30 by 40 cm, and an infected skin graft after undergoing an exploratory laparotomy for a gunshot wound at an outside hospital. During his course, he failed multiple traditional therapies, leaving him with a large open wound, four paired enterocutaneous fistulae, and a cholecystocutaneous fistula. We repaired his fistulae, performed a staged fascial closure, and reinforced it by placing an autograft of de-epithelialized dermis over it, bridging some areas of fascia. Results: The patient had rapid incorporation of his cutis graft, with granulation over the graft within 72 hours. Within three months, all wounds had healed, and the patient had fully recovered. Conclusions: Cutis autograft as a means for reinforcing abdominal wall closure is a versatile tool in the armamentarium of the surgeon to treat complex abdominal wall reconstruction. In the setting of failure of traditional therapies for fascial closure, it can potentially help with simultaneous bridging and reinforcement, demonstrating the strength of this type of repair

Repeatedly Intrinsic Self-Healing of Millimeter-Scale Wounds in Polymer through Rapid Volume Expansion Aided Host-Guest Interaction.

Implantable and wearable materials, which are usually used in/on a biological body, are mostly needed with biomimetic self-healing function. To enable repeatable large-wound self-healing and volume/structure recovery, we verified a proof-of-concept approach in this work. We design a polymer hydrogel that combines temperature responsiveness with an intrinsic self-healing ability through host-guest orthogonal self-assembly between two types of poly(N-isopropylacrylamide) (PNIPAM) oligomers. The result is thermosensitive, capable of fast self-repair of microcracks based on reversible host-guest assembly. More importantly, when a large open wound appears, the hydrogel can first close the wound via volume swelling and then completely self-repair the damage in terms of intrinsic self-healing. Meanwhile, its original volume can be easily recovered by subsequent contraction. As demonstrated by the experimental data, such millimeter-level wound self-healing and volume recovery can be repeatedly carried out in response to the short-term cooling stimulus. With low cytotoxicity and good biocompatibility, moreover, this highly intelligent hydrogel is greatly promising for practical large-wound self-healing in wound dressing, electronic skins, wearable biosensors, and humanoid robotics, which can tolerate large-scale human motions.

Nurses' and surgeons' views and experiences of surgical wounds healing by secondary intention: A qualitative study.

To explore surgeons' and nurses' perspectives of managing surgical wounds healing by secondary intention. Every year, more than 10 million surgical operations are performed in the NHS in the UK. Most surgical wounds heal by primary intention, where the edges of the wound are brought together with staples, sutures, adhesive glue or clips. Sometimes wounds are deliberately left open to heal, from the base up, known as "healing by secondary intention." These wounds are often slow to heal, prone to infection and complex to manage. A qualitative, descriptive approach, using semi-structured interviews. Interviews with five (general, vascular and plastic) surgeons and 7 nurses (3 tissue viability nurses, 2 district and 1 community nurse, and 1 hospital nurse) working in hospital and community care settings in two locations in the north of England. Data analysis followed the recommended sequential steps of "Framework" approach. Consolidated criteria for reporting qualitative research guided the study report. Participants reported that the main types of wounds healing by secondary intention that they manage are extensive abdominal cavity wounds; open wounds relating to treatment for pilonidal sinus; large open wounds on the feet of patients with diabetes; and axilla and groin wounds, associated with removal of lymph nodes for cancer. Infection and prolonged time to healing were the main challenges. Negative pressure wound therapy was the most favoured treatment option. Negative pressure wound therapy was advocated by professionals despite a lack of research evidence indicating clinical or cost-effectiveness. Our findings underscore the need for rigorous evaluation of negative pressure wound therapy, and other wound care treatments, through studies that include economic evaluation. Clinical decision-making in wound care could be optimised through further robust studies to inform practitioners about the cost-effectiveness of available treatments.

Collagen Based Sponges for Wound Healing

Nowadays, wound healing is the common and simple problems occur in our society. Wound healing is the multi factorial process which includes inflammation, reepithelialisation, collagen deposition, and angiogenesis. Wound repair system is indispensable to enhance the proper functioning of skin. Normally, wound dressing is either momentary or lasting, wound dressings has been intended to improve the wound repair. Those wound dressing are required to wrap the large surfaced open wounds such as widespread burns, pressure ulcers, foot sores etc., wound healing substance should have some important features such as, high healing efficiency, anti-scar formation, providing favourable atmosphere for wound management. The collagen plays an important role in tissue formation and has more effect on wound healing. In this work collagen sponge is prepared from fish scales and to increase the antibacterial efficacy need extract has been added.

Surgical management of necrotizing fasciitis due to odontogenic infection with sepsis: a case report

Objective:To perform surgical operation on necrotizing fasciitis due to odontegenic infection with sepsis.Methods: In this case an odontogenic infection was accompanied by a large open wound on the face and sepsis. Patient was hospitalized in the Dr.HasanSadikin General Hospital. Management of this patient in the emergency room were administration of appropriate broad-spectrum empiric antibiotic, incision and pus drainage, and extraction of the infected tooth, followed by fluid resuscitation with strict observation. Surgical debridement was then performed.Results:After being treated for 12 days the patient’s condition improved. We planned closure of defects of the facial area, but the patient refused.Conclusion: Necrotizing fasciitis is an uncommon but potentially lethal condition associated with high rates of morbidity and mortality. Early diagnosis coupled with emergent surgical debridement, appropriate broad-spectrum empiric antibiotic treatment, and a multidisciplinary team approach is essential for successful treatment.

Temporary skin grafts based on hybrid graphene oxide-natural biopolymer nanofibers as effective wound healing substitutes: pre-clinical and pathological studies in animal models

In recent years, temporary skin grafts (TSG) based on natural biopolymers modified with carbon nanostructures have received considerable attention for wound healing. Developments are required to improve physico-mechanical properties of these materials to match to natural skins. Additionally, in-deep pre-clinical examinations are necessary to ensure biological performance and toxicity effect in vivo. In the present work, we show superior acute-wound healing effect of graphene oxide nanosheets embedded in ultrafine biopolymer fibers (60 nm) on adult male rats. Nano-fibrous chitosan-based skin grafts crosslinked by Genepin with physico-mechanical properties close to natural skins were prepared by electrospinning of highly concentrated chitosan- polyvinylpyrrolidone solutions containing graphene oxide (GO) nanosheets. No surfactants and organic solvents were utilized to ensure high biocompatibility of the fibrous structure. In vitro evaluations by human skin fibroblast cells including live and dead assay and MTT results show that GO promote cell viability of porous nanofibrous membrane while providing enhanced bactericidal capacity. In vivo studies on rat's skin determine accelerated healing effect, i.e. a large open wound (1.5 × 1.5 cm2) is fully regenerated after 14-day of post operation while healing is observed for sterile gauze sponge (as the control). Pathological studies support thick dermis formation and complete epithelialization in the presence of 1.5 wt% GO nanosheets. Over 99% wound healing occurs after 21 days for the injury covered with TSG containing 1.5 wt% GO while this would takes weeks for the control. Therefore, the developed materials have a high potential to be used as TSG as pre-clinical testing has shown.

Surgical Management of Necrotizing Fasciitis Due to Odontogenic Infection with Sepsis : Case Report

Necrotizing fasciitis in the face region is a rare case. This infection often occurs in patients who are chronically debilitated or with history of diabetes mellitus. We report a 51-year-old woman with necrotizing fasciitis due to odontogenic infection extended to the face and submandibular space. In this case an odontogenic infection was accompanied by a large open wound on the face and sepsis. Patient was hospitalized in the Dr Hasan Sadikin General Hospital. Management of this patient in the emergency room were administration of appropriate broad-spectrum empiric antibiotic, incision and pus drainage, and extraction of the infected tooth, followed by fluid resuscitation with strict observation. Surgical debridement was then performed. After being treated for 12 days the patient’s condition improved. We planned closure of defects of the facial area, but the patient refused.

Case of Necrotizing Fasciitis fromStreptococcus pyogenes(Group A) Treated Successfully with Negative-Pressure Wound Therapy

Background: Necrotizing fasciitis is an infection of the soft tissue marked by quickly spreading inflammation and subsequent necrosis of the skin, subcutaneous fat, muscle fascia, and in some cases, the epidermidis, associated with a fulminating septic process. Mortality is high without immediate surgical intervention. We report a case of a female exhibiting primary necrotizing fasciitis that was treated with a combination of conservative surgery and negative-pressure wound therapy. Case Presentation: A 78-year-old female was admitted to our emergency department complaining of left inguinal pain for two days. On arrival, the patient had an extensively spreading, well-demarcated section of purplish discoloration with associated skin peeling over her left lower abdomen and inguinal lesion. A diagnosis of sepsis secondary to necrotizing fasciitis of the left inguinal area was made. She was started immediately on empirical broad-spectrum antibiotics and surgical debridement of the necrotic tissue. Surgical incision culture was positive for Streptococcus pyogenes (group A β-hemolytic Streptococcus). In addition to using a device to divert stool, negative-pressure wound therapy was applied to the large open wound that successfully helped with wound bed cleansing, which was followed by skin grafting surgery. The patient recovered uneventfully. Conclusion: We treated a patient with acute necrotizing fasciitis by surgically removing the necrotized tissues, systemically administering broad-spectrum antimicrobial agents, and ameliorating underlying systemic disease processes. Negative-pressure wound therapy prior to definitive surgical management of skin grafting was effective in managing open surgical incisions resulting from surgical treatment for a patient with necrotizing fasciitis. Additionally, the Flexi-Seal® device (ConvaTec, Inc., Greensboro, NC) helped keep the wound clean and dry.

Perioperative Nutrition in Pediatric Surgical Patients

Abstract not availableJ. Paediatr. Surg. Bangladesh 5(2): 64-67, 2014 (July)

The use of a hydrocolloid dressing in the facial wound healing process of a horse - case report

Hydrocolloid dressing is a bioactive product used to improve the healing process of large open wounds. InMarch 2011, a horse was evaluated at the Veterinary Medical Teaching Hospital- UNICENTRO, Guarapuava,Brazil. The animal presented with epistaxis and inspiratory dyspnoea associated with fracture of the orbitalpart of the frontal bone with a comminuted fracture of the zygomatic process and bone loss of the articulartubercle of the temporal bone reaching the zygomatic process, tooth fracture and a partial laceration of theleft cheek with avulsion of the eyeball. After the reconstructive facial surgery and enucleation we used thehydrocolloid dressing during the repair phase. It helped re-establish the epithelial layer, avoided excessivegranulation tissue formation and decreased the healing time. Seven days after surgery and the use ofbiological membrane we verified the production of intense and controlled granulation tissue, beyond thatthe membrane was a viable and low cost alternative.

First Report of Chryseobacterium sp. from Koi (Cyprinus carpio) in Turkey

In this study, we isolated Chryseobacterium sp. from koi in Turkey. The disease outbreak occurred in fish weighing 10-300g (water temperature 9-10°C) in November 2011- February 2012. The cumulative mortality rate was approximately 55% over 4 months. Infected koi exhibited anorexia, weakness, emaciation, damage to dorsal and caudal fins, grey-white skin discoloration (1-1.5cm) in the head area, large open wounds in skin with disease progression, necropsy findings, paleness of the liver, enlarged spleen and kidney, acidic fluid in the body cavity. Samples for bacteriological examinations were collected from the kidney, liver, and spleen using sterile swabs; these samples were streaked onto Anacker ordal Agar and incubated at 18°C for 48 h. Five bacterial isolates were obtained from diseased fish. Phenotypic characteristics of the isolates were determined by conventional methods and rapid identification kits, API 20NE, and API ZYM. Comparative 16S rRNA gene sequence analysis demonstrated that isolate Sin57 belonged to the genus Chryseobacterium, with highest sequence similarity (98.5 %) to C. aahli T68T and C. limigenitum SUR2.

Simultaneous Reconstruction of Forefoot and Hindfoot Defects with a Thoracodorsal-Axis Chimeric Flap.

Simultaneous Reconstruction of Forefoot and Hindfoot Defects with a Thoracodorsal-Axis Chimeric Flap.

Fasciotomy Wound Management and Closure

While although full-compartment fasciotomy is unquestionably the best treatment for acute compartment syndrome, it is not a benign procedure. It leaves a large open wound that should be left open for at least 2 to 3 days. The outward pressure from swollen muscle and skin retraction serves to increase the dimensions of these wounds, which makes delayed primary closure challenging and often not possible in the most common fasciotomy site—the leg. This study discusses recent advances in the management of fasciotomy wounds that can reduce the morbidity of this procedure. Negative pressure wound therapy and dermatotraction are 2 important innovations, which improve overall outcomes.

Detection of grey seal Halichoerus grypus DNA in attack wounds on stranded harbour porpoises Phocoena phocoena

DNA was analysed from external wounds on 3 dead harbour porpoises Phocoena phocoena that were stranded in the Netherlands. Puncture wounds as well as the edges of large open wounds were sampled with sterile cotton swabs. With specific primers that target the mtDNA control region of grey seal Halichoerus grypus, a 196 bp DNA fragment was amplified from 4 puncture wounds. Sequencing of the fragments confirmed the presence of grey seal DNA in the puncture wounds. DNA sequences differed between the cases, implying that 3 individual grey seals were involved. As 8 control swabs from intact skin and the transport bag as well as 6 swabs from open wounds on the same harbour porpoises were all negative, contamination with environmental DNA is considered unlikely. The results provide a link between strandings of mutilated harbour porpoises and recent observations of grey seals attacking harbour porpoises. Ours is the first study to use forensic techniques to identify DNA in bite marks from carcasses recovered from the marine environment. This approach can be extended to identify other marine aggressors, including cases involving persons mutilated at sea.

Extended negative pressure wound therapy-assisted dermatotraction for the closure of large open fasciotomy wounds in necrotizing fasciitis patients.

BackgroundNecrotizing fasciitis (NF) is a rapid progressive infection of the subcutaneous tissue or fascia and may result in large open wounds. The surgical options to cover these wounds are often limited by the patient condition and result in suboptimal functional and cosmetic wound coverage. Dermatotraction can restore the function and appearance of the fasciotomy wound and is less invasive in patients with comorbidities. However, dermatotraction for scarred, stiff NF fasciotomy wounds is often ineffective, resulting in skin necrosis. The authors use extended negative pressure wound therapy (NPWT) as an assist in dermatotraction to close open NF fasciotomy wounds. The authors present the clinical results, followed by a discussion of the clinical basis of extended NPWT-assisted dermatotraction.MethodsA retrospective case series of eight patients with NF who underwent open fasciotomy was approved for the study. After serial wound preparation, dermatotraction was applied in a shoelace manner using elastic vessel loops. Next, the extended NPWT was applied over the wound. The sponge was three times wider than the wound width, and the transparent covering drape almost encircled the anatomical wound area. The negative pressure of the NPWT was set at a continuous 100 mmHg by suction barometer. The clinical outcome was assessed based on wound area reduction after treatment and by the achievement of direct wound closure.ResultsAfter the first set of extended NPWT-assisted dermatotraction procedures, the mean wound area was significantly decreased (658.12 cm2 to 29.37 cm2; p = 0.002), as five out of eight patients achieved direct wound closure. One patient with a chest wall defect underwent latissimus dorsi musculocutaneous flap coverage, with primary closure of the donor site. Two Fournier’s gangrene patients underwent multiple sets of treatment and finally achieved secondary wound closure with skin grafts. The patients were followed up for 18.3 months on average and showed satisfactory results without wound recurrence.ConclusionsExtended NPWT-assisted dermatotraction advances scarred, stiff fasciotomy wound margins synergistically in NF and allows direct closure of the wound without complications. This method can be another good treatment option for the NF patient with large open wounds whose general condition is unsuitable for extensive reconstructive surgery.

Bullhorn and bullfighting injuries

Our purpose was to present our hospital experience with bullhorn injuries. A retrospective analysis of patients in our Trauma Registry (1993-2012). Fifteen patients were included. All were hemodynamically stable on presentation, with a mean Glasgow Coma Scale (GCS) score and a Revised Trauma Score (RTS) of 15 and 11.9, respectively. The Injury Severity Score (ISS) and New Injury Severity Score were 13.6±6 and 15.9±9, respectively. Seven had an ISS>15. Injuries resulted from an isolated blunt trauma (BT) in four, penetrating trauma (PT) in seven, with extensive soft tissue injuries (STI) in three, and a combined BT+PT mechanism in four patients, with extensive STI in all. Three patients had injuries to vessels in the groin, two with prehospital vein ligation. Five patients had abdominal visceral injuries, and another had a sheathed goring, with a traumatic abdominal wall hernia and retroperitoneal hematoma. Four patients had thoracic injuries, and one of them had a traumatic thoracoplasty with a large open thoracic wound, a flail chest, and extensive STI. Two patients had traumatic brain injury, and six had bone fractures. Two-thirds of patients required a surgical procedure under general anesthesia. Morbidity included three surgical site infections, one leg compartment syndrome, and one persistent lymph drainage. There was no mortality, and the mean length of hospital stay was 16days. Bullhorn and bullfighting injuries frequently have a multimechanistic origin which goes beyond a pure penetrating trauma. Associated blunt and STI were common in our series, and the overall prognosis of patients admitted to hospital was good.

Effect of Mixed Transplantation of Autologous and Allogeneic Microskin Grafts on Wound Healing in a Rat Model of Acute Skin Defect

The treatment of extensive thermal injuries with insufficient autologous skin remains a great challenge to burn surgeons. In this study, we investigated the influence of the ratio of autologous and allogeneic tissue in mixed microskin grafts on wound healing in order to develop an effective method for using limited donor skin to cover a large open wound. Four different mixtures were tested: autologous microskin at an area expansion ratio of 10∶1 with allogeneic microskin at an area expansion ratio of 10∶1 or 10∶3 and autologous microskin at an expansion ratio of 20∶1 with allogeneic microskin at an expansion ratio of 20∶3 or 20∶6. Wound healing, wound contraction, and integrin β1 expression were measured. Mixed microskin grafting facilitated wound healing substantially. The mixture of autologous microskin at an expansion ratio of 10∶1 with the same amount of allogeneic microskin achieved the most satisfactory wound healing among the 4 tested mixtures. Histological examination revealed the presence of obviously thickened epidermis and ectopic integrin β1 expression. Keratinocytes expressing integrin β1 were scattered in the suprabasal layer. Higher levels of integrin β1 expression were associated with faster wound healing, implying that ectopic expression of integrin β1 in keratinocytes may play a pivotal role in wound healing. In conclusion, this study proves that this new skin grafting technique may improve wound healing.

Post-traumatic pulmonary hernia

Post-traumatic pulmonary hernia is a very rare occurrence of chest trauma, which however remains usually covered by the skin.1 ,2 A young 22-year-old male was recently admitted to our trauma...

Remembering the importance of preventing blood‐borne infections in the critical care setting

Remembering the importance of preventing blood‐borne infections in the critical care setting

Management of secondary hemorrhage from early graft failure in military extremity wounds

Secondary hemorrhage after a dehisced vascular reconstruction is a dreaded complication, yet few reports describe the initial management and outcome of casualties with ruptured grafts from military wounds. We aimed to report a single-center experience of graft ruptures after evacuation of casualties to a tertiary hospital in the continental United States. Trauma records of US combat casualties were retrospectively reviewed from April 2005 to August 2007. Casualties who underwent an extremity vascular reconstruction in Iraq or Afghanistan and experienced a ruptured graft were included. Ten graft ruptures (mean time, 14 days) occurred during the study period. All casualties were males with penetrating injuries by secondary blast effects (5, 50%) or gunshot wounds (5, 50%). Mean age and Injury Severity Score were 28.2 years (range, 20-41 years) and 21.1 (range 10-32), respectively. Repairs were performed on the superficial femoral (4, 40%), popliteal (2, 20%), brachial (1, 10%), axillary (1, 10%), iliac (1, 10%), and common femoral (1, 10%) arteries using reversed saphenous vein grafts (10, 100%). Initial management included control of hemorrhage and extra-anatomic reconstruction with a vein graft (4), prosthetic graft (4), end-to-end anatomosis (1), or primary amputation (1). Secondary complications in those 10 limbs requiring reintervention included 4 thrombotic graft failures (40%), and 1 transfemoral amputation from a graft infection. Ruptures were frequently associated with long-bone fractures (6, 60%), large soft tissue open wounds (5, 50%) and infection (7, 70%). At a mean follow-up of 37 months, the amputation rate in this series was 30%, with an amputation-free survival of 70%. Contaminated military wounds with bony fractures may predispose a graft of any type (vein or prosthetic) to anastomotic dehiscence. Wounds must be carefully debrided, and when grafts cannot be covered with viable muscle, they should be routed around the zone of injury. Therapeutic study, level V.