Large Wounds Research Articles

Relationship between gene expression associated with cellular senescence in cells from discarded wound dressings and wound healing: A retrospective cohort study

AimSenescent cells, inducing a senescence-associated secretory phenotype (SASP), lead to chronic inflammation in hard-to-heal wound tissue. However, eliminating senescent cells may impede normal wound healing due to their important role in the wound healing mechanism. Accordingly, we focused on wound exudates in hard-to-heal wounds, which contain many inflammation biomarkers consistent with SASP. Therefore, we hypothesized that senescent cells might be present in the exudates and induce chronic inflammation. This study investigated the relationship between gene expression associated with cellular senescence in exudates from pressure injuries and wound healing status. MethodsThis retrospective cohort study involved patients treated by a pressure injury team. We collected viable cells from wound dressings and analyzed gene expression. Pearson's correlation coefficient was calculated between cellular senescence and SASP expression. The relationship between the gene expression of cellular senescence and the wound area reduction rate by the following week was examined using a mixed-effects model. ResultsCDKN1A—related to cellular senescence—was expressed in 96.3 % of 54 samples, and CDKN1A expression and SASPs positively correlated (PLAU: r = 0.68 and TNF: r = 0.34). Low CDKN1A expression was statistically associated with a large wound area reduction rate (β = 0.83, p < 0.01). ConclusionsGene expression of both cellular senescence and SASP factor in wound dressings suggests the presence of cellular senescence. Senescent cells in wound dressings could be associated with delayed wound healing in the following week.

Parotideomasseteric fascia flap is an effective management for prevention of postoperative salivary collection arising from radical surgery of oral cancer

Salivary collection (SC) following surgery for oral cancer represents an underreported and unrecognized complication. Our study aimed to evaluate the efficacy of parotideomasseteric fascia flap (PFF) in preventing postoperative SC, comparing its effectiveness with other conventional methods.Between November 2019 and January 2023, 221 patients diagnosed with oral squamous cell carcinoma (OSCC) undergoing wide tumor ablation and neck dissection at Xiangya Hospital were included in the study. Patients were randomly allocated into four groups based on different intraoperative techniques to assess the preventive efficacy of PFF against SC.The incidence of SC in the PFF group was only 5.9%, which was significantly lower than the other three groups (p < 0.05). Among the 221 patients, the highest SC incidence occurred in buccal cancer cases (19.6%). However, in the PFF group, the incidence was not significantly different (9.5%; p > 0.05). Univariate analysis revealed a higher SC incidence associated with advanced clinical T stage (p = 0.02), N(+) stage (p = 0.01), low average serum albumin (SA) level (p = 0.00), and a large parotid wound (p = 0.00). In multivariate analysis, only average SA (p = 0.01; odds ratio [OR] 4.104; 95% CI 0.921–11.746) emerged as the most prevalent factor predisposing to SC.The utilization of PFF demonstrated a notable reduction in the incidence of postoperative SC, establishing it as a safe, effective, and convenient method for patients undergoing radical ablation for OSCC.

Outbreak of large skin wounds and necrotising soft tissue infection in Iberian pigs affected by Streptococcus dysgalactiae subspecies equisimilis

AbstractStreptococcus dysgalactiae subspecies equisimilis is an emerging pathogen in animals and humans. Herein, we describe an outbreak of S. dysgalactiae subspecies equisimilis infection in Iberian pigs with large skin ulcerations and necrotising soft tissue. Postmortem examination was performed on two animals that had larger chronic lesions and secondary myiasis. Swabs from the edges of wounds from animals with more acute injuries were collected. The β‐haemolytic colonies obtained from the skin wounds and lymph nodes were identified as S. dysgalactiae subspecies equisimilis. The isolate had low minimum inhibitory concentrations for β‐lactams. Stress due to the change of groups and the consequent increase in fights for the establishment of a new hierarchical order could be the reason why pigs that carry the bacteria in their gingival mucosa transmit them to other individuals through bites. This stressful situation could cause a certain immunosuppression, potentially favouring the exacerbation of S. dysgalactiae subspecies equisimilis and the development of the lesions observed.

Death of a one-armed blackback male due to severe injuries in a group of wild western lowland gorillas (Gorilla gorilla gorilla) in Moukalaba-Doudou National Park, Gabon.

The survival of limb-disabled primates in the wild has been widely reported. Nevertheless, their ultimate fate is little documented. It is important to understand the influence of limb disability on primate survival from a conservation perspective, as many African great apes suffer from limb injuries caused by entrapment in snares. Here, we report the death of a one-armed blackback male in a large one-male group of wild western lowland gorillas. The subject was a blackback male (14 years old) named Dodo, who lost his right forearm in August 2008. On 8 December 2019, Dodo was found to have suffered serious bleeding injuries to the front of his body, including large lacerations and puncture wounds. On 14 December his corpse was found in the forest. We provide evidence to suggest that his injuries were more likely caused by intraspecific aggression, though a predatory attack by a leopard could not be completely ruled out. His one-armed disability could have made him more vulnerable to attack from either a gorilla or leopard and led to his fatal injury. This report shows that a gorilla who had previously overcome a disability in one arm in childhood may die prematurely, in part, owing to this disability in young adulthood.

Mobilisasi Dini dan Proses Penyembuhan Luka Post Operasi Abdominal Pada Fase Inflamasi

Background: Abdominal surgery is a type of surgical operation performed on the abdominal area by making an incision in the lining of the abdominal wall to get parts of problematic organs such as bleeding, perforation, cancer, and obstruction. The incisions made during abdominal surgery cause large wounds and require a long recovery time and constant care, and are at risk of complications. The problem that often occurs in post-abdominal surgery patients is the lack of patient behavior to carry out early mobilization. Early mobilization is a series of light post-operative activities, starting from moving on the bed to being able to get out of bed, walk to the toilet, and get out of the toilet. Purpose: To determine the relationship between early mobilization and the wound healing process after abdominal surgery in the inflammatory phase. Methods: The quantitative research used a cross-sectional study method in the Surgical Ward of Meuraxa Hospital, Banda Aceh City from March 23 to May 20 2023. Data collected by interviewing and observe 30 postoperative patients who were selected according to the inclusion criteria and data analyzed by Chi-square test. Results: The results of the chi-square statistical test with CL=95% and α=0.05 showed a p-value of 0.032. This p value is &lt;0.05, which means there is a significant relationship between early mobilization and the healing process of post-abdominal surgery wounds in the inflammatory phase. Conclusion: There is a relationship between early mobilization and the healing process of post-abdominal surgery wounds in the inflammatory phase.

Case Report ‘Layer of Hope’: Managing Large Surface Wounds on Frontal Bare Bone in a Challenging Patient

This was a case of an elderly gentleman with large bleeding basal cell carcinoma occupying almost three quarter of the forehead managed with adjunct usage of integra acellular dermal regeneration template after lesion’s wide local excision despite challenged with patient’s newly diagnosed bicytopenia to rule out haematological malignancy. Standard management of tissue reconstruction with purely living tissue (split skin grafting) has higher risk of graft rejection due to bare bone as wound bed. This limits the neo-graft ability to achieve optimal potential of imbibition and inosculation. Thus, dermal matrix usage makes split skin grafting difficult wound bed has higher chance of surviving and hence shortens healing time and reduces hospital stay.

In vitro comparison of the leakage of carbon dioxide and iodine contrast media in a bleeding model

BackgroundWe aimed to compare the hydrodynamic values of carbon dioxide (CO2) and iodine contrast media for bleeding detection using an in vitro model.Materials and methodsWe created a bleeding model with large and small wounds in simulated blood vessels. We connected a syringe to the bleeding model and the blood pressure transducer, filling the circuit with CO2 and iodine contrast media. The syringe’s piston was pressed, and the flow rate and intravascular pressure of the CO2 and iodine contrast media leaking from the bleeding model were measured. We compared each leaked contrast medium’s volume, sphere-equivalent diameter, and sphere-equivalent area. These values were analyzed to compare the visibility of the leakage objectively.ResultsAt a constant flow rate, the intravascular pressure required for the model to leak was lower for the CO2 than that for the iodine contrast medium. The CO2 contrast medium leakage volume, equivalent circle diameter, and equivalent circle area were greater than those of the iodine one. These values indicate higher CO2 visibility during fluoroscopy.ConclusionsIn the bleeding model, a CO2 contrast medium may be more prone to leakage than the iodine one in large and small wounds. Regarding visibility, a CO2 contrast medium may be more likely to detect leakage than an iodine one.

Individualized design program of multiple flaps for adapting different zones to repair large irregular wounds in children

ObjectiveManagement of large irregular wounds in children had been confusing plastic and reconstructive surgeons. Herein, this study was aimed to propose a new treatment method based on the principle of adapting different recipient zones to overcome the intractable wounds, simplifying and programing the design process of targeted flaps for covering large irregular soft-tissue defects. Patients and methodsFrom January 2009 to December 2020, 31 children (9 girls and 22 boys) aged 3–16 years (mean 9.8 years) underwent multiple modular flaps with edge to edge splicing reconstruction of the lower extremities. All the wounds were large with non-adjacent defects and with or without a dead space. Several variants of flaps were harvested according to the needs and reconstruction requirements of patients. ResultsA total of 71 flaps were harvested from 31 patients and all flaps donor sites received primary closure. Nine patients underwent split-thickness skin grafting, and three cases of flaps survived from vascular crisis by rebuilding the vessels and the rest accepting LD flap transplants. And five partial necrosis of the distal epidermis flaps recovered using skin grafting and dressing change. No major complication was encountered in other patients and donor sites, except one heel ulcer. During the follow-up (ranging from 16 to 38 months, mean 27.7 months), aesthetic and functional results of reconstructed limbs were satisfactory in all patients. ConclusionsThe Individualized design program of multiple flaps for adapting different recipient zones is an alternative for repairing large irregular soft-tissue defects in children, beneficial for plastic and reconstructive surgeons to simplify and program the process of designing and perform multiple flaps to achieve this goal. Level of evidenceIII, Retrospective.

The Application of a Synthetic Biodegradable Temporizing Matrix in Extensive Burn Injury: A Unicenter Experience of 175 Cases.

Objectives: Addressing extensive and deep burn wounds poses considerable challenges for both patients and surgeons. The NovoSorb® Biodegradable Temporizing Matrix (BTM) emerged as a novel dermal substitute and has been subjected to evaluation in large burn wound cases, with a specific focus on identifying risk factors associated with suboptimal take rates. Methods: All patients with burn wounds greater than 10% body surface that underwent BTM treatment between March 2020 and November 2023 were eligible for inclusion. Univariate analyses and linear regression models were employed to discern risk factors and predictors influencing the take rates of both the BTM and split-thickness skin grafts (STSGs). Results: A total of 175 patients (mean age 56.2 ± 19.8 years, 70.3% male) were evaluated. The mean take rates of the BTM and STSGs were 82.0 ± 24.7% and 87.3 ± 19.0%, respectively. There were significant negative correlations between BTM take and the number of surgeries before BTM application (r = -0.19, p = 0.01), %TBSA and STSG take (r = -0.36, p = <0.001) and significant positive correlations between BTM and STSG take (r = 0.41, p ≤ 0.001) in addition to NPWT and STSG take (r = 0.21, p = 0.01). Multivariate regression analyses showed that a larger number of surgeries prior to BTM application (OR -3.41, 95% CI -6.82, -0.03, p = 0.04) was associated with poorer BTM take. Allograft treatment before BTM application (OR -14.7, 95% CI -23.0, -6.43,p = 0.01) and failed treatment with STSG before BTM application (OR -20.8, 95% CI -36.3, -5.23, p ≤ 0.01) were associated with poorer STSG take, whereas higher BTM take rates were associated with overall higher STSG take (OR -0.15, 95% 0.05, 0.26, p = 0.01). The Meek technique was used in 24 patients and showed similar take rates (BTM: 76.3 ± 28.0%, p = 0.22; STSG: 80.7 ± 21.1, p = 0.07). Conclusions: This study summarizes our findings on the application of a BTM in the context of large burn wounds. The results demonstrate that successful treatment can be achieved even in patients with extensive burns, resulting in satisfying take rates for both the BTM and STSG. The data underscore the importance of promptly applying a BTM to debrided wounds and indicate good results when using Meek.

Dermal β-Catenin Is Required for Hedgehog-Driven Hair Follicle Neogenesis

Hair follicle neogenesis (HFN) occurs following large skin excisions in mice, serving as a rare regenerative model in mammalian wound healing. Wound healing typically results in fibrosis in mice and humans. We previously showed small skin excisions in mice result in scarring devoid of HFN, displaying features of non-regenerative healing, and Hedgehog (Hh) activation in the dermis of such wounds can induce HFN. In this study, we sought to verify the role of dermal Wnt/β-catenin signaling in HFN, as this pathway is essential for HF development, but is also paradoxically well-characterized in fibrosis of adult wounds. By deletion of β-catenin in large wound myofibroblasts, we show Wnt/β-catenin signaling is required for endogenous mechanisms of HFN. Through utilizing a combined mouse model that simultaneously induces deletion of β-catenin and constitutive activation of Smoothened (Smo) in myofibroblasts, we also found β-catenin is required for Hh-driven DP formation. Transcriptome analysis confirms Wnt/β-catenin and Hh pathways are activated in dermal papilla (DP) cells. Our results indicate that Wnt-active fibrotic status may also create a permissive state for the regenerative function of Hh, suggesting that activation of both Wnt and Hh pathways in skin wound fibroblasts must be ensured in future strategies to promote HFN.

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.

PlasmaBlade versus Electrocautery for Deep Inferior Epigastric Perforator Flap Harvesting in Autologous Breast Reconstruction: A Comparative Clinical Outcome Study.

(1) Background: DIEP-based breast reconstruction necessitates wide undermining at the abdominal donor site, creating large wound areas. Flap harvesting is usually conducted using electrosurgical dissection devices. This study sought to compare the clinical outcomes in patients after using the PEAK PlasmaBlade (PPB) versus monopolar electrocautery (MPE). (2) Methods: This retrospective cohort study included 128 patients with DIEP-based breast reconstruction. Patient characteristics and information on the postoperative course were collected and a comparative evaluation was conducted. (3) Results: The MPE group exhibited significantly (p* = 0.0324) higher abdominal drainage volume (351.11 ± 185.96 mL) compared to the PPB group (279.38 ± 183.38 mL). A subgroup analysis demonstrated that PPB significantly reduced postoperative wound fluid in patients with BMI > 30 kg/m2 (p* = 0.0284), without prior neoadjuvant chemotherapy (p** = 0.0041), and among non-smokers (p = 0.0046). Furthermore, postoperative pain was significantly (p**** < 0.0001) lower in the PPB cohort. (4) Conclusions: This study confirms the non-inferiority of the PEAK PlasmaBlade to conventional electrocautery for abdominal flap harvesting. The PPB demonstrated advantages, notably reduced drainage volume and lower postoperative pain levels. Recognizing patient subsets that benefit more from the PPB highlights the importance of personalized device selection based on patient characteristics.

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.

Óleo de semente de uva no tratamento de ferida grave em cão - relato de caso

The aim of this study is to describe, for the first time, the use of grape seed oil in the treatment of a severe wound in a dog. A 10-year-old Dalmatian female dog presented with an abscess in the cervical region that progressed to cutaneous necrosis, resulting in a large wound. Samples were collected for culture and antimicrobial sensitivity testing (TSA). Staphylococcus pseudointermedius and multidrug-resistant Escherichia coli were isolated from the wound. The lesion was surgically debrided, and topical treatment with grape seed oil was initiated. The patient was followed until complete healing, which occurred in 28 days. The wound area was measured at seven-day intervals until complete healing (D0, D7, D14, D21, and D28), with the respective measurements being 11204.8 mm2, 4348.0 mm2, 2414.9 mm2, 120.2 mm2, and 0.00 mm2. The wound contraction potential was calculated for the intervals of 0 to 7, 7 to 14, 14 to 21, and 21 to 28 days, and it was -61.19%, -44.45%, -95.02%, and -100.00%, respectively. The complete healing of the wound at 28 days post-debridement indicates that grape seed oil is an alternative for wound treatment in dogs.

Duragen: A dermal substitute for the management of suboptimal wounds.

Using a flap in a large wound with a very small area of exposed vital structures may be an excessive intrusion and cause unnecessary donor site morbidity. Dermal matrix (DuraGen) was applied onto critical areas where bone or tendons were exposed and a split skin graft was placed thereon. All patients had satisfactory wound closure without the need for a flap. DuraGen appears to be a safe, single-stage alternative, to a flap for the healing of complex wounds.

SMOKING AND FLAP SURVIVAL: A COMPREHENSIVE SYSTEMATIC REVIEW

Background: Free flap reconstruction of complex and/or large wounds, whether traumatic, following cancer resection, or for other reconstructive needs has become a commonly accepted practice. Multiple different types of free flaps are utilized for varying needs based on the individual patient and the defect that requires coverage. active smokers who underwent a nonelective traumatic reconstruction with a perforator-based fasciocutaneous flap (anterolateral thigh [ALT] flap) will have a higher incidence of smoking-related complications compared to the use of a muscle-only flap. The aim: The aim of this study to show about smoking and flap survival. Methods: By the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020, this study was able to show that it met all of the requirements. This search approach, publications that came out between 2014 and 2024 were taken into account. Several different online reference sources, like Pubmed, SagePub, and Google Scholar were used to do this. It was decided not to take into account review pieces, works that had already been published, or works that were only half done. Result: In the PubMed database, the results of our search get 9 articles, whereas the results of our search on SagePub get 441 articles, on Google Scholar 4830 articles. Records remove before screening are 2771, so we get 2509 articles fos screening. After we screened based on record exclude, we compiled a total of 10 papers. We included five research that met the criteria. Conclusion: Smoking decreases the alveolar oxygen pressure and subcutaneous wound tissue oxygen, and nicotine causes vasoconstriction, smokers are more likely to experience flap loss, hematoma, or fat necrosis than non-smokers. Preoperative and post-operative abstinence period of at least 1 week is necessary for smokers who undergo flap operations.

Double-nylon purse-string suture in closing postoperative wounds following endoscopic resection of large (≥ 3 cm) gastric submucosal tumors.

Endoscopic full-thickness resection (EFTR) of gastric submucosal tumors (SMTs) is safe and effective; however, postoperative wound management is equally important. Literature on suturing following EFTR for large (≥ 3 cm) SMTs is scarce and limited. To evaluate the efficacy and clinical value of double-nylon purse-string suture in closing postoperative wounds following EFTR of large (≥ 3 cm) SMTs. We retrospectively analyzed the data of 85 patients with gastric SMTs in the fundus of the stomach or in the lesser curvature of the gastric body whose wounds were treated with double-nylon purse-string sutures after successful tumor resection at the Endoscopy Center of Renmin Hospital of Wuhan University. The operative, postoperative, and follow-up conditions of the patients were evaluated. All tumors were completely resected using EFTR. 36 (42.35%) patients had tumors located in the fundus of the stomach, and 49 (57.65%) had tumors located in the body of the stomach. All patients underwent suturing with double-nylon sutures after EFTR without laparoscopic assistance or further surgical treatment. Postoperative fever and stomach pain were reported in 13 (15.29%) and 14 (16.47%) patients, respectively. No serious adverse events occurred during the intraoperative or postoperative periods. A postoperative review of all patients revealed no residual or recurrent lesions. Double-nylon purse-string sutures can be used to successfully close wounds that cannot be completely closed with a single nylon suture, especially for large (≥ 3 cm) EFTR wounds in SMTs.

Artificial dermis combined with negative pressure wound therapy and platelet-rich plasma to treat traumatic wounds: a retrospective study.

The reconstruction of complex soft tissue defects with exposure of bones and tendons represents an increasing challenge in wound care, especially in large extremity wounds. The aim of this study was to detect the clinical efficacy of combined use of negative pressure wound therapy (NPWT), artificial dermis (ADM), platelet-rich plasma (PRP) and split-thickness skin grafting (STSG) in the reconstruction of large traumatic extremity skin defects. In this study, eight cases were treated with combined therapies for repairing complex extremity wounds and the results were reviewed retrospectively. After surgical debridement, all wounds received ADM, PRP and delayed STSG, which were all aided with NPWT. The patients consisted of five males and three females, with a mean age of 44 years. A total of six lower extremity wounds were located at the foot/ankle, with exposed tendon in five, bone exposure in three and both in two. Of the group, two patients had exposed tendon on arm/hand wounds. The size of wounds and ADM averaged 126cm2 and 42.3cm2, respectively. ADM was used to cover the exposed bone or tendon, the granulation and muscular tissue were covered with vacuum sealing drainage (VSD) directly, for NPWT. The survival rate of ADM averaged 98.9%. The average time for survival of ADM was 12.8 days and the mean uptake of autologous skin graft was 93.5%. Only one patient received repeated skin grafts. All patients achieved successful healing and reported no complications. The mean length of hospital stay was 36.1 days. Our study revealed that ADM in conjunction with NPWT, PRP and STSG could be used for repairing large traumatic extremity wounds. Wound closure was achieved without flaps, the aesthetic and functional outcomes were acceptable, and only one patient developed a 35% loss of skin graft. This work was supported by grants from the Natural Science Foundation of Hubei Province (grant no. 2020CFB464) and Youth Foundation of Wuhan Municipal Health Commission (grant no. WX20Q15). The authors have no conflicts of interest to declare.

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.

DermaClose: A Case Series in the Management of Large Soft Tissue Defects in Diabetic Foot Infection

Abstract: Diabetic foot infection poses a complex problem due to several interrelated issues, including rapidly spreading infection, poor vascular supply, and reduced healing ability. Management may require multiple operative procedures and prolonged treatment with a high risk of morbidity, such as amputation, and mortality. Debridement of infection commonly creates large wounds and soft tissue defects, with limited soft tissue reconstructive options due to adverse local and systemic factors. In this setting, treatment often consists of protracted periods of secondary wound healing by granulation, de-tensioning the tissues by removing bone, and minor or major amputation. Flaps and grafts may be considered but often carry unacceptable rates of failure. We present 3 cases in which DermaClose, an automated wound management system, was employed by a joint Orthopedic and Plastic Surgery team with excellent results and rapid closure of large soft tissue defects. Level of Evidence: Level IV.