Method Of Wound Management Research Articles

A Review of Advanced and Smart Nano Wound Dressings Based on Investigating the Function of Hybrid Nanosystems in Wound Monitoring and Antimicrobial Activity

Introduction: By monitoring wound parameters and providing targeted therapies, smart dressings can optimize the healing process, reduce the risk of complications, and accelerate wound closure. Reducing health care costs, effective wound monitoring, and targeted drug delivery can reduce frequent wound dressing exchange and also lead to cost savings in the long term. Personalized wound care through smart dressings allows healthcare professionals to tailor treatment plans based on individual wound characteristics and responses. This capability will lead to more accurate and personalized patient care. Controlled drug release, infection detection, and moisture management, smart dressings can enhance patient health, reduce pain, and generally improve patient pain during wound healing. Conclusion: Hybrid nanosystems based on nanoparticles are one of the main components of advanced and smart wound dressings. Hybrid nanosystems show structural changes with changes in temperature and pH. These multiple systems are the main reason for the intelligence of smart wound dressing. Advanced and smart dressings with multiple functions and the ability to actively respond to wound conditions provide the potential to improve treatment for patients and change the method of wound management in health centers. As a result, examining the detailed classifications of advanced and smart dressings provides an efficient approach in wound care and treatment.

Evaluation of the efficacy of the Z-plasty surgical technique vs. secondary wound healing mechanism in the treatment of the pilonidal sinus: a clinical trial.

The most important step in treating a pilonidal sinus is eradication by surgical excision. Over the years, various surgical techniques have been reported for wound closure, yet their management still poses a challenge. The current study compares the results of two different methods of wound management: secondary wound healing versus the Z-plasty surgical technique. The current clinical trial recruited 84 uncomplicated pilonidal sinus patients who were to undergo complete surgical excision of the pilonidal sinus. For wound healing, the 84 subjects were equally divided into two groups of 42 patients each. One group was selected for Z-plasty surgical wound closure and the other for the secondary healing mechanism. Outcomes measured consisted of demographic data, length of operation, complications, severity of pain, number of dressings, recurrence, and complete healing time. Age or sex distribution and the median BMI (kg/m²) did not significantly differ between the two groups. The length of the operation for Z-plasty subjects was significantly longer (P <0.0001). The median number of dressing changes for secondary wound healing patients was 38.69, which was significantly higher than the 4.95 dressing changes for the Z-plasty group. The total time recorded for complete wound healing was 21.61±4.27 days in the Z-plasty group and 41.23±24.28 days for secondary wound healing subjects, which was statistically significant. Twenty-four hours postoperation, patients in the secondary wound healing group had significantly more pain, and the Visual Analogue Scale scores of the Z-plasty and secondary wound healing groups were 3.42±0.76 and 6.09±1.2, respectively. Concerning the recurrence rate, there were no significant differences between the two groups. SPSS version 22 performed the analyses, and the independent t-test compared the continuous variables. A P value less than 0.05 was considered statistically significant. Z-plasty is a safe and effective procedure in terms of wound complications and recurrence rate. This method is also cost-effective and better received by patients.

Multifunctional silk fibroin and cellulose acetate composite nanofibers incorporated with palladium and platinum nanoparticles for enhanced wound healing: Comprehensive characterization and in vivo assessment

Wound healing is a complex and dynamic process that relies on various factors for optimal tissue regeneration. Current wound management methods often lack the efficiency needed to address these challenges. In this study, we prepared and conducted a comprehensive analysis of silk fibroin and cellulose acetate composite nanofibers incorporated with palladium (Pd) and platinum (Pt) nanoparticles, emphasizing their potential as advanced materials for wound healing. Electron microscopy reveals nanofibrous scaffolds with interconnected fibers, an average diameter of 168.95 ± 135.79 nm, and Pd and Pt nanoparticles of 10.64 nm and 9.21 nm, with thicknesses ranging from 1.48 nm to 2.13 nm. The analysis of swelling, degradation, porosity, and mechanical strength highlights their capacity to absorb exudates from wound surfaces, promote cell adhesion, and support tissue regeneration. In vitro evaluation demonstrates significant antibacterial activity against Escherichia coli and Staphylococcus aureus, with inhibition zone values of 16 mm and 18 mm, respectively. Cell migration, proliferation, and biocompatibility are assessed using the L929 fibroblast cell line with the ethidium bromide (EtBr) dye. In vivo studies on Sprague-Dawley rats indicate SF/CA/Pd-Pt composite nanofibers have exceptional wound healing efficiency, reaching 99.31% compared to the SF/CA matrix. High hemocompatibility, with erythrocyte percentages ranging from 1.6% to 4.1%, further supports these nanofibers wound healing properties. Histopathological analysis, employing hematoxylin and eosin staining, provides valuable insights into tissue regeneration, assessing reepithelialization, granulation, angiogenesis, and reduced inflammation. These findings emphasize the potential of Pd and Pt nanoparticles incorporated into SF/CA composite nanofiber scaffolds as advanced biomedical materials, particularly for wound healing applications.

A review on wound management strategies in enhanced recovery after craniotomy: An in-depth analysis of their influence on patient recovery and surgical outcomes.

Craniotomy, an essential neurosurgical operation, poses distinct difficulties in the realm of post-operative care, specifically with regard to the management of wounds. Efficient wound management is critical in order to optimize the surgical outcomes, reduce complications and facilitate a speedier recovery. The purpose of this comprehensive review was to assess contemporary wound management approaches as they pertain to improved recovery following craniotomy. This was achieved by contrasting conventional methods with more recent and innovative techniques and analysing the effects of these approaches on patient recovery and surgical results. An exhaustive literature search was undertaken, comprising narrative reviews, clinical studies, peer-reviewed articles and expert opinions. The emphasis was on the evolution of wound management strategies and techniques utilized after cranial section, as well as their contributions to patient recovery. The analysis reveals that while conventional wound management methods, including suturing and antiseptics, continue to be essential, innovative strategies such as negative pressure wound therapy, skin adhesives and advanced pain management protocols are becoming increasingly recognized. It has been demonstrated that these novel approaches improve recovery by decreasing the incidence of infections, enhancing patient comfort and producing superior cosmetic results. Nevertheless, obstacles continue to endure, including patient-specific variables, technological and financial considerations and the enduring consequences of recovery. Thus the treatment of wounds during craniotomy recuperation necessitates an integrated strategy that incorporates conventional techniques alongside contemporary advancements. Progress in this domain necessitates the customization of approaches to suit the unique requirements of each patient, the resolution of identified obstacles and an emphasis on ongoing investigation and interdisciplinary cooperation. The ever-changing terrain of wound management approaches underscores the ever-changing character of neurosurgical treatment and the continuous endeavour to enhance patient results following cranial resection.

VACUUM ASSISTED CLOSURE THERAPY IN MANAGEMENT OF CHRONIC NONHEALING ULCER IN TERTIARY CARE CENTRE -A RANDOMIZED CONTROLLED STUDY

Background: Chronic non healing Ulcers pose a signicant and challenging health as well as economic problem, as it needs long term surgical and nursing care whether it is a Burn wound, Diabetic ulcer or pressure ulcer. Ulcers are also susceptible to complications like infection and thus sepsis and limb loss. Vacuum-assisted closure (VAC) is an alternative method of wound management, which uses the negative pressure to prepare the wound for spontaneous healing or by lesser reconstructive options. All this improves the possibility of primary closure of wounds and reduce the need for plastic procedures. To study about wound healing using Vacuum Assisted clos Aim: ure therapy in management of non-healing ulcer in tertiary care centre. 50 patients who are admitted with chronic foot ulcers Methods: in General surgery department, Kanyakumari medical college are included during the study period from July 2022-march 2023. The patients are randomized in to two group with 25 patient on conventional therapy and 25 patients as study group with V.A.C. The results were tabulated and analysed. Out of 25 non healing ulcer patients, in more Results: than 92 percent patients (23patients) granulation tissue was achieved by VAC dressing at the end of 5th Week. All 23 cases were discharged, 2 cases were followed by split skin graft and only one case was amputated .No mortality .However in the control group only 19 patients were healed, 4 cases went for amputation and there were two mortality. The V.A.C impact on Microbial ora is very signicant and duration of hospital stay is also signicant . VAC therapy appears to be an effective and feasible alternat Conclusion: ive method in the management of chronic non-healing ulcers

Review of methods of impact on the wound process animals (literary review)

The present work is devoted to the study of the course of the wound process in animals as well as possible factors influencing it. The topicality of the research in this topic consists in the fact that the experimental results help to increase the survival rate among the animals which have undergone the operation, to accelerate healing, to reduce the organism rehabilitation time, to avoid the bacterial contamination of wounds, purulent diseases and re-infection, to reduce the trauma level in animals, promote the introduction of new efficient pharmacological methods of prevention and suppression of surgical infections, application of laser and ultrasound equipment, discover and use new medicines. The aim of the study. The aim of this work is to conduct a general literature review on the methods of wound management in animals. This review focuses on papers from 2012 to 2022, citing various factors that influence the wound process in order to outline the need for wound management. To make it more manageable and to speed up wound healing in animals, as well as to point out the need for additional wound management models. Conclusion. The use of a complex graft and matrix based on dextran phosphate gel, stem cells and miliacyl has been shown by biological factors to promote healing. A positive alkaline environment has been shown to promote reepithelisation, as it has no adverse effect, in contrast to a strongly acidic environment. In addition, gamma radiation treatment was found to accelerate healing. From this we can conclude that the literature review conducted on this topic indicates the relevance of the area under consideration, and further developments and more in-depth studies are required, as wound processes are a scientific problem that needs to be solved.

Comparing Dermabond PRINEO versus Dermabond or staples for wound closure: a randomized control trial following total shoulder arthroplasty.

The method of surgical incision closure after total shoulder arthroplasty is an important factor to consider, as it affects operating room time, procedure cost, cosmetic outcomes, and patient satisfaction. The optimal method of wound management is unknown, but should be cost-effective, reproducible, and provide a reliable clinical result. This study aimed to compare the following wound closure methods after total shoulder arthroplasty: staples, Dermabond, and Dermabond PRINEO. We hypothesized that wound closure time for Dermabond PRINEO would be faster than Dermabond and comparable to that of staples, and Dermabond PRINEO would be more cost-effective than Dermabond and staples, and provide equal or superior closure outcomes to Dermabond and staples. A randomized, prospective clinical trial comparing wound closure time and cost for 2 surgeons' traditional technique with that of Dermabond PRINEO was conducted. This study included at least 18 subjects in each group. Surgeon 1's patients were randomized to traditional Dermabond or Dermabond PRINEO, whereas surgeon 2's patients were randomized to staples or Dermabond PRINEO. Cosmetic outcomes and satisfaction scores were collected at 6 weeks and 3 months, postoperatively. Incisions were photographed, at both the 6-week and 3-month visits, and subsequently evaluated by a plastic surgeon blinded to the treatment method. The wound closure time for surgeon 1 was significantly faster for Dermabond PRINEO vs. Dermabond, and surgeon 2 closed significantly faster with staples vs. Dermabond PRINEO. The mean cost of closure was significantly less with Dermabond PRINEO compared with Dermabond, whereas the mean cost of staples was significantly less than Dermabond PRINEO. For both surgeons 1and 2, there were no significant differences in patient satisfaction at 6 weeks or 3 months. In addition, the wound closure methods did not produce differing cosmetic outcomes. Although significant, the closing time for each method did not differ by a clinically relevant amount. Staples were the most cost-effective closing method, followed by Dermabond PRINEO. As neither method was superior over the other in terms of patient satisfaction, adverse events, and cosmetic outcomes, cost-effectiveness may be the greatest differentiator between the 3 methods.

NEGATIVE PRESSURE WOUND THERAPY (NPWT): OUR EXPERIENCE USING HOSPITAL WALL SUCTION

Study Design: Prospective case series Delayed wound healing is a signicant concern, particularly in Introduction: complex wounds and the elderly with co-morbidities. It leads to pain, morbidity, prolonged treatment, and requires major reconstructive surgery, which imposes an enormous social and nancial burden. Negative Pressure Wound Therapy (NPWT) was used to cover large wounds, decubitus ulcers, and open fractures that cannot be closed either primarily or secondarily and often require a complex reconstructive procedure to protect the injury. NPWT is an alternative method of wound management, which uses the negative pressure to prepare the wound for spontaneous healing or by lesser reconstructive options. We applied NPWT on pa Materials and Methodology: tients with open fractures, decubitus ulcers, neglected wounds, fasciotomies, and large wounds. Compared to the patented VAC system, ours include pre-sterilized PVA foam, cling drape (Surgiwear TM), nasogastric tube or an infant feeding tube, and a hospital wall suction. There Results: were three cases of soft tissue injury of the foot with wound defect, one case of fasciotomy for compartment syndrome, one case of the decubitus ulcer, one case of open fractures, and three cases of degloving injuries of the foot. In our study, the NPWT was changed every ve days, the average number of NPWT changes was 3-4, length of time NPWT applied before the closure was 14-21 days. The most frequent coverage mode is Split Thickness Skin Graft obviating the need for more complex aps and microvascular reconstructive procedures. Negative Conclusion: pressure therapy stabilizes the wound environment, reduces wound edema/bacterial load, improves tissue perfusion, and stimulates granulation tissue and angiogenesis. NPWT appears to be simple and more effective than conventional dressings for managing complex wounds, reducing wound volume, depth, treatment duration, and cost.

Outcomes of Deep Wound Management Methods During Total Knee Arthroplasty: A Systematic Review and Meta-Analysis.

Wound closure for total knee arthroplasty (TKA) typically focuses on promoting the most optimal healing, while preventing infection, allowing for functionality and immediate ambulation, as well as providing for excellent cosmesis. We have previously described four aspects of closure for TKA including the: (1) deep fascial layer; (2) subdermal layer; (3) intradermal layer, including the subcuticular region; and (4) a specific dressing. In this systematic review and meta-analysis of the literature, we will focus on closure of the deep fascial layer. Specifically, we assessed: (1) wound complication risks of different techniques; (2) closing times of different sutures; and (3) postoperative ranges of motion depending on varying levels of knee flexion or extension. There were 12 reports on wound complication risks, closing times, and positionings. The meta-analysis demonstrated overall lower wound complication risks with the use of barbed sutures (6 versus 13%, p<0.05). It also demonstrated overall significant closing time reductions with the use of barbed sutures (p<0.05). Additionally, three out of four reports showed the positive effects of closure in flexion for TKAs, while one report was inconclusive. In conclusion, this systematic review and meta-analysis demonstrated lower wound complications, decreased closing times for barbed sutures, as well as superior outcomes for closures in a semi-flexed knee position.

Does Wound Management Technique Impact Surgical Site Infection in Open Emergency Colon Procedures?

Emergency open large bowel procedures have higher rates of intraoperative contamination and increased risk of surgical site infection (SSI) than elective colon surgeries. Several wound management strategies have been proposed, such as vacuum-assisted closure (VAC) therapy and delayed primary closure to improve results. The purpose of this study is to evaluate the relationship between wound management technique and SSI and other quality measures. We performed a retrospective review of patients undergoing open emergency colon surgery from January 2017 to December 2018 by our acute care surgery service. The primary outcome measure was incidence of SSI. Secondary outcome measures included length of stay, reoperation, and 30-day readmission. A total of 118 patients were included in the study, with a mean age of 62.8years and mean BMI of 28.8. Overall incidence of SSI was 19.5%. There was no significant difference in incidence of SSI, reoperation, or 30-day readmission when stratifying by wound management technique or procedure type after controlling for confounding variables. Notably, patients managed with VAC therapy had a statistically significant longer average length of stay and higher total postoperative antibiotic days (both P = .001) than other techniques. We conclude from our data that wound management technique does not seem to influence rate of SSI, but wound management may influence length of stay or antibiotic duration. These findings suggest that there may not be an advantage to alternative methods of wound management in this high-risk population. Further prospective evaluation should be performed to confirm these findings.

Closed Incision Negative Pressure Therapy: Indications and Adherence to Protocol.

Complications associated with wound management not only increase the morbidity and mortality of surgical interventions but they also increase the cost and decrease the quality of care. Closed incision negative pressure therapy (CINPT) has been proposed as a superior method of wound care compared to the more traditional wound management methods. Since the Food and Drug Administration indications for using CINPT are broad and generally nonspecific, it is unclear whether patients are appropriately screened for and receive this treatment modality. To identify common clinical indications for CINPT, we conducted a literature review to define a consensus for CINPT candidates and used the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database to indicate if certain patient demographics impact decision-making. Based on the literature review, encompassing 57 articles, and the National Surgical Quality Improvement Program (NSQIP) database, over 11,000 patients received CINPT. Both the NSQIP data and the literature review commonly reported BMI >30 (47.1% and 39.6%), smoking (22.7% and 29.2%), and diabetes mellitus (22.7% and 47.9) as the most common clinical indications for using CINPT. The most common indications for using CINPT according to the literature review and the NSQIP database are BMI > 30, smoking status, and diabetes mellitus. Besides identifying patients who potentially benefit the most from CINPT, the results of this study suggest clinical adherence to the practice guidelines reported in the literature regarding wound management using this treatment modality.

Indigenous negative pressure wound treatment: Easy, effective and affordable

The purpose of this study was to evaluate the use of negative pressure wound therapy in traumatic injuries, post operative wound dehiscence and pressure sores. Negative-pressure wound therapy (NPWT) is believed to accelerate wound healing by increasing blood flow, promoting angiogenesis, suction removal of matrix metalloproteinases. In our study we have used cost effective material as an alternative to the more expensive commercial NPWT in the management of complex wounds. Material and Methods: This study is a prospective evaluation of NPWT in 70 patients with traumatic injuries, post operative wound dehiscence and pressure sores. In our study we have used low cost indigenous NPWT set for wound therapy. Dressing was changed for every 4 days till the desired granulations tissue is formed for skin cover.Results: Of the 70 patients treated with indigenous NPWT, 42 (60 %) patients achieved direct closure and 28 patients (40%) required split thickness skin grafting. Conclusion: Our study showed low cost indigenous NPWT system producing comparable results at meagre cost to commercially available NPWT. NPWT has now become an established method of wound management. Low cost Indigenous NPWT can be revolutionary in wound management urban as well as in rural areas of our country.

The Efficacy of Negative Pressure Wound Therapy and Antibiotic Beads in Lower Extremity Salvage

BackgroundAntibiotic beads and negative pressure wound therapy (NPWT) represent two methods of wound management used during staged debridement in the post-trauma limb salvage pathway. The efficacy of NPWT and antibiotic beads in preventing infection remains unclear. MethodsThis study is a retrospective review of patients with traumatic lower extremity open fractures who received NPWT and/or antibiotic beads before soft tissue reconstruction at an urban level 1 trauma center between August 2007 and December 2015. Patients with wound infections before application of NPWT and/or antibiotic beads were excluded. ResultsIn 73 lower extremities requiring soft tissue coverage, 46 received antibiotic beads and 48 received NPWT. Overall infection rate was 15.1%. Use of antibiotic beads was associated with a decreased risk of infection (6.4% versus 30.7%; P = 0.01). Use of NPWT was associated with an increased risk of one or more complications (45.7% versus 4.2%; P = 0.001). The development of infection was associated with a greater period of time between application of antibiotic beads (22 ± 13 versus 12 ± 6 d, P = 0.01) or NPWT (23 ± 15 versus 10 ± 11 d, P = 0.004) and soft tissue coverage. Overall limb salvage rate was 95.9%; secondary amputation was associated with development of infection (P = 0.001) but not with use of NPWT or antibiotic beads. ConclusionsAntibiotic beads may prevent infections in patients awaiting soft tissue coverage of wounds. NPWT may contribute to a greater rate of complication. Limb salvage was successful in most cases regardless of method of wound management.

Wound dressing techniques and costs at a county hospital

Background: Wound management is one of the commonest procedures conducted in surgical departments across health facilities in Kenya.Objective: This study aimed at exploring wound dressing techniques used at Migori County Referral Hospital (MCRH) and the cost of treatment to patients.Methods: Convenience sampling was used to select inpatients presenting with wounds undergoing treatment at the time of recruitment. Five patients (2 male and 3 female) were enrolled after obtaining informed consents. Wounds were examined during cleaning and dressing and healing process follow-ups made. Selection of wound dressing technique was done by the primary clinicians with no bias from the research team.Results: One patient’s wound was an open fracture resulting from a road traffic accident; three patients had pyomyositis following thorn pricks; and the last patient’s was sustained following a blast injury. Wound management methods employed at MCRH included cleaning with vinegar, irrigation with normal saline, dressing with honey, and improvised negative pressure wound therapy. Total cost incurred was affordable to patients, and ranged between Kenya shillings 100–360 (USD 1–3.60) weekly.Conclusion: Wound management techniques at MCRH were effective and affordable. Additional studies with a larger sample size are recommended.Keywords: Wound dressing, costs, NPWT, vinegar cleaning, honey dressing

Management of the Wound in Type IIIB Open Tibiofibular Fractures: The Role of Improvised Vacuum-assisted Closure Dressing

Background: The negative pressure used in vacuum-assisted closure (VAC) dressing helps to suck out fluid and bacteria from the wound and enhances granulation tissue formation and wound contraction, thus causing wound healing. Aim: The aim of the study is to demonstrate the effectiveness of VAC in extensive wound management when using local materials. Methods: This was a prospective study in which all consented patients who met the inclusion criteria within the study period were included in the study; suctioning machine, rubber tube, foam and cling film were adapted to make the local VAC which was used to manage the wound. The results were analysed by IBM SPSS Version 22. Results: Thirty-two wounds were managed with VAC, there were 28 males and four females, the mean age of patients was 33.7 ± 9.6 years, the mean length of wound managed was 10.6 ± 2.9 cm and the average number of dressing was five times. All wounds were culture positive at the beginning of the management, with Staphylococcus aureus being the most common organism. At the end of VAC treatment, 90.6% of the wound were negative for culture. Healing by secondary wound intension occurred in 50% of the wound, secondary suturing was done in 31.2% of the wound, while 18.8% of the wound had split-thickness skin grafting. The complications noted during the treatment are pain in 9.3% of the patients and skin excoriation in 3.1% of the patients. Conclusion: VAC method of wound management using local materials is effective in the treatment of extensive wound, and it is associated with less frequent dressing to achieve the desired result.

Wound-Healing Potential of Oil of Hypercium perforatum in Excision Wounds of Male Sprague Dawley Rats.

Objective: To evaluate the wound-healing activity of oil of Hypercium perforatum (St. John's wort), in excision wounds of male white rats. Approach: The current methods of wound management involve the use of antibiotic creams. The search for more natural materials for the purpose of healing of wounds has led to the discoveries of potential agents prepared from plant extracts. Hyperforin and Hypericin are important phytochemical constituents found in H. perforatum, which have been highlighted for their antimicrobial, antiviral, and anti-inflammatory properties in recent times. Therefore, we have attempted to explore the wound-healing activity of oil obtained from H. perforatum.Results:H. perforatum oil emulsion has been demonstrated to have significant wound-healing potential as compared with mupirocin ointment and petroleum jelly (Vaseline). Animals treated with H. perforatum showed a 97% (18.9 mm2/day) reduction in wound area as compared with animals treated with mupirocin (68%) (12.8 mm2/day) and animals treated with Vaseline (69%) (13.7 mm2/day). X-ray analysis of skin of animals treated with H. perforatum showed a significant increase in angiogenesis as compared with other groups in the study. Innovation: This study identified the wound-healing activity of oil of H. perforatum.Conclusion: The findings of this study support the wound-healing potential of H. perforatum along with other therapeutic uses.

Compartment Syndrome

Compartment syndrome is a process that can develop anywhere skeletal muscle or abdominal organs are encased by a rigid fascial layer. This review describes the different aspects of these conditions, including the epidemiology, pathophysiology, diagnosis, and management of compartment syndrome in the extremities and abdomen. Diagnosis is expanded on further to describe clinical signs in the alert patient and the different methods of compartment measurement in the obtunded patient or when a physical examination is inconclusive. The anatomy of the leg, thigh, buttocks, forearm, and arm is described, along with surgical techniques for fasciotomy. Postoperative care, the different methods of wound management and skin closure, and diagnostic criteria for the diagnosis and management of abdominal compartment syndrome are discussed. Treatment of abdominal compartment syndrome with decompressive laparotomy and temporary abdominal closure is also described. Figures depict various fasciotomies and an algorithmic approach to management. Tables show the contents and function of the compartments of the leg and forearm. Key words: abdominal compartment syndrome, compartment syndrome, decompressive laparotomy, extremity, fasciotomy, intra-abdominal hypertension, intra-abdominal pressure, temporary abdominal closure, tibia fracture

Compartment Syndrome

Compartment syndrome is a process that can develop anywhere skeletal muscle or abdominal organs are encased by a rigid fascial layer. This review describes the different aspects of these conditions, including the epidemiology, pathophysiology, diagnosis, and management of compartment syndrome in the extremities and abdomen. Diagnosis is expanded on further to describe clinical signs in the alert patient and the different methods of compartment measurement in the obtunded patient or when a physical examination is inconclusive. The anatomy of the leg, thigh, buttocks, forearm, and arm is described, along with surgical techniques for fasciotomy. Postoperative care, the different methods of wound management and skin closure, and diagnostic criteria for the diagnosis and management of abdominal compartment syndrome are discussed. Treatment of abdominal compartment syndrome with decompressive laparotomy and temporary abdominal closure is also described. Figures depict various fasciotomies and an algorithmic approach to management. Tables show the contents and function of the compartments of the leg and forearm. Key words: abdominal compartment syndrome, compartment syndrome, decompressive laparotomy, extremity, fasciotomy, intra-abdominal hypertension, intra-abdominal pressure, temporary abdominal closure, tibia fracture

Ionically Crosslinked Chitosan Hydrogels for the Controlled Release of Antimicrobial Essential Oils and Metal Ions for Wound Management Applications.

The emerging problems posed by antibiotic resistance complicate the treatment regime required for wound infections and are driving the need to develop more effective methods of wound management. There is growing interest in the use of alternative, broad spectrum, pre-antibiotic antimicrobial agents such as essential oils (e.g., tea tree oil, TTO) and metal ions (e.g., silver, Ag+). Both TTO and Ag+ have broad spectrum antimicrobial activity and act on multiple target sites, hence reducing the likelihood of developing resistance. Combining such agents with responsive, controlled release delivery systems such as hydrogels may enhance microbiocidal activity and promote wound healing. The advantages of using chitosan to formulate the hydrogels include its biocompatible, mucoadhesive and controlled release properties. In this study, hydrogels loaded with TTO and Ag+ exhibited antimicrobial activity against P. aeruginosa, S. aureus and C. albicans. Combining TTO and Ag+ into the hydrogel further improved antimicrobial activity by lowering the effective concentrations required, respectively. This has obvious advantages for reducing the potential toxic effects on the healthy tissues surrounding the wound. These studies highlight the feasibility of delivering lower effective concentrations of antimicrobial agents such as TTO and Ag+ in ionically crosslinked chitosan hydrogels to treat common wound-infecting pathogens.

Diabetic Foot Ulcer: Close Wound Early

SAN DIEGO — Early wound closure prior to hospital discharge after surgical debridement of infected diabetic foot ulcers yields higher ulcer healing rates and a shorter time to healing, compared with various nonclosure wound management methods, according to a propensity-matched study reported at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.Shey-Ying Chen, MD, presented a retrospective comparison between 179 diabetic foot ulcer (DFU) patients with early wound closure after surgical debridement and an equal number of matched controls treated with various nonclosure techniques, including negative pressure wound therapy and the repeated application of moist dressings.During 1 year of follow-up post-discharge, ulcer healing occurred in 75% of the early wound closure group, compared with 66% of the nonclosure patients. Readmission for further treatment of the index ulcer occurred in 33% of the early closure group and 52% of the nonclosure group.Ulcer healing was significantly less likely in patients with peripheral vascular disease, with an OR of 0.62; neuropathy, with an OR of 0.53; and methicillin-resistant Staphylococcus aureus wound infection, with an OR of 0.59, he said.Bruce Jancin is with the Denver bureau of Frontline Medical News. SAN DIEGO — Early wound closure prior to hospital discharge after surgical debridement of infected diabetic foot ulcers yields higher ulcer healing rates and a shorter time to healing, compared with various nonclosure wound management methods, according to a propensity-matched study reported at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy. Shey-Ying Chen, MD, presented a retrospective comparison between 179 diabetic foot ulcer (DFU) patients with early wound closure after surgical debridement and an equal number of matched controls treated with various nonclosure techniques, including negative pressure wound therapy and the repeated application of moist dressings. During 1 year of follow-up post-discharge, ulcer healing occurred in 75% of the early wound closure group, compared with 66% of the nonclosure patients. Readmission for further treatment of the index ulcer occurred in 33% of the early closure group and 52% of the nonclosure group. Ulcer healing was significantly less likely in patients with peripheral vascular disease, with an OR of 0.62; neuropathy, with an OR of 0.53; and methicillin-resistant Staphylococcus aureus wound infection, with an OR of 0.59, he said. Bruce Jancin is with the Denver bureau of Frontline Medical News.