Open Wound Surface Research Articles

Liposomal SDF-1 Alpha Delivery in Nanocomposite Hydrogels Promotes Macrophage Phenotype Changes and Skin Tissue Regeneration.

Skin regeneration in chronic wounds is often delayed due to persistent inflammation induced by underlying conditions such as diabetes. This effect is mediated, in part, by macrophages present in the wound, which can be stimulated to adopt either pro- or anti-inflammatory phenotypes depending on the status of the local microenvironment. In this work, the prohealing chemokine stromal cell-derived factor-1 alpha (SDF-1α) is controllably released from a hydrogel-based biomaterial to promote skin tissue regeneration and wound closure. This innovative nanocomposite hydrogel system releases liposomal stromal cell-derived factor-1 alpha (lipoSDF) as a new treatment approach for dorsal full-thickness skin wounds in wild-type and diabetic mice. Using this strategy, the recruitment and polarization of macrophages primarily of the anti-inflammatory phenotype were observed, along with a decreased amount of open wound surface area in diabetic mice after 28 days. This was accompanied by histological observations of increased epidermal stratification and dermal angiogenesis. These findings represent an important step of investigation distinctive in its field for developing immunomodulatory biomaterials that are able to influence macrophage phenotype and promote healing as hydrogel-based wound dressings.

Evaluation of the Effectiveness of Mesenchymal Stem Cells of the Placenta and Their Conditioned Medium in Local Radiation Injuries.

Background: The search for an effective therapy for local radiation injuries (LRI) is urgent; one option is mesenchymal stem cells (MSC) derived from the placenta and their conditioned medium for the regenerative processes of the skin. Methods: We used 80 animals, randomly assigned to four groups: control (C) animals that did not receive therapy; control with the introduction of culture medium concentrate (CM); introduction of MSCs (PL); introduction of CMPL. LRI modeling was performed on an X-ray machine at a dose of 110 Gy. Histological and immunohistochemical tests were performed. Results: On the 112th day, the area of the open wound surface in the CMPL group was 6.7 times less than in the control group. Complete healing of the open wound surface of the skin in the CM group was observed in 40%, in CMPL 60%, in the PL group 20%, and in the C group there were no animals with a prolonged wound defect. A decrease in inflammatory processes was observed in the CMPL group. Conclusions: the use of a concentrate of conditioned MSCs (CMPL group) in severe LRI in laboratory animals accelerates the transition of the wound process to the stage of regeneration and epithelization.

Экспериментальное лечение местных лучевых поражений мезенхимальными стволовыми клетками и их кондиционированной средой

Purpose: To study the regeneration processes in the treatment of radiation skin lesions with the mesenchymal stem cells (MSC) derived from human gingiva and their conditional medium concentrate (CCM) during animal studies.
 Material and methods: The study includes 80 white male Wistar rats weighing 210 ± 30 g at the age of 8–12 weeks, randomized into 4 groups (20 animals in each): control group (C), animal did not receive treatment; control with the introduction of the conditional medium concentrate (CCM) three times on days 1, 14 and 21; the introduction of MSC in a dose of 2 million cells per 1 kg three times on days 1, 14 and 21; the introduction of CCM in the estimated dose of 2 million cells per 1 kg three times on days 1, 14 and 21. Radiation burn simulation was performed (using on an X-ray unit at a dose of 110 Gy) and each animal was observed 17 times: at days 1, 7, 14, 21, 28, 35, 42, 49, 56, 63, 70, 77, 84, 91, 98, 105 and 112. Histological (stained with hematoxylin-eosin) and immunohistochemical (CD31, CD68, and VEGF) studies were performed. MSC was cultivated according to the standard procedure up to passages 3–5, the conditioned medium was collected and concentrated 10 times. The MSC immunophenotype (CD34, CD45, CD90, CD105, CD73, HLA-DR) and viability (7-ADD) were determined using flow cytometry.
 Results: Under the assessment of the animal skin on the day 7 in the CCM group, the area was significantly larger compared to the C, MSC, CM groups (р ≤ 0.05). In the CM group on the day 14 the area of the open wound surface and ulcers from day 28 to day 42 was significantly less, compared with the C, MSC and CCM groups (р ≤ 0.05). In group C, from 42 to 77 days of observation, an increase in the area of skin ulcers was observed compared with the CM and CCM groups (р ≤ 0.05). On the day 112, healing of skin ulcers in the CM group was observed in 40 %, in the MSC group in 60 %, and only in 20 % of animals in the CCM group, and in the C group it was not registered. Expression of VEGF marker on endothelial cells and stromal cells was observed in groups C and CM on day 28 and in groups MSCs and CCM on day 112. On the 28th day in the MSC group, the average number of vessels (CD31) in the field of view was 6.0, and on day 112 it was 12.75, р ≤ 0.05, in the CCM group – 19.10 and 28.6, respectively, р ≤ 0.05. An increase in the number of macrophages (CD68) was found in group C from 28 to 112 days (11.6 and 24.73, р ≤ 0.05), and in the CM group the decrease was 22.1 and 13.07, respectively, р ≤ 0.05.
 Conclusion: Thus, all used treatment modes of radiation skin lesions, including 3-fold administration of CM, MSC and CCM at a dose of 2 million cells per 1 kg, were effective and resulted in a reduction in the damage area, accelerated ulcer healing, and improvement of the regenerative processes. In addition, the use of MSCs led to the improvement of inflammatory processes’ vascularization and reduction in the radiation skin lesions.

Pilot Study to Assess Safety and Usability of the Kyron NPWT System.

Background:There is an evident need for Negative Pressure Wound Therapy (NPWT) systems specifically designed for use in resource-constrained settings to aid in the treatment of open wounds.Methods:Prospective single-arm interventional pilot study of 14 patients with complex wounds was conducted at Kirtipur Hospital in Kathmandu, Nepal. A novel NPWT device, the Kyron Suction Unit, was used by 4 plastic surgeons. Primary outcomes were ease of use (10-point Likert scale) and device safety (adverse events recorded). Pain (Visual Analogue Scale score), quality of life (modified EuroQol Derived Single Index scores), and wound dimensions were recorded.Results:User ratings on the 10-point Likert scale indicated high confidence and ease of use: median confidence setting up the device of 1.0 [interquartile range (IQR), 1.0; mean 2.3], median confidence maintaining the device of 1.0 (IQR, 1.0; mean, 1.5), and median ease of disassembly of 1.0 (IQR, 1.0; mean, 1.4). Significant improvement in Visual Analogue Scale scores (P = 0.03), modified EuroQol Derived Single Index scores (P < 0.001), and a reduction in wound volume [median, 47.25–9.75 cm3 (P = 0.01)]. Image analysis of wounds pretreatment and posttreatment demonstrated increase in granulation tissue surface area [median, 7.6–28.7 cm2 (P = 0.003)] and decrease in open wound surface area [median, 48.33–33.6 cm2 (P = 0.01)].Conclusions:The Kyron Suction Unit was safe and easily managed by plastic surgeons. The device design promoted access to NPWT, a therapy proven to reduce healing time and decrease complications for patients with open wounds, in a resource-constrained setting.

A prospective comparative study of efficacy of pulse jet irrigation and conventional irrigation techniques in prevention of surgical site infections in laparotomy wounds

Background: Surgical Site Infections (SSIs) are infections of tissues, organs or spaces exposed by surgeons during performance of an invasive procedure and continue to be a major source of morbidity following operative procedures. Wound irrigation is the steady flow of a solution across an open wound surface meant to remove cellular debris and surface pathogens contained in wound exudates or residue from topically applied wound care products.Methods: This prospective comparative study was conducted to compare the effectiveness of Pressurized Pulse Irrigation (PPI) and Standard Irrigation Technique (SIT) in laparotomy wounds. Duration of the study was for a period of 12 months and included 100 consecutive patients undergoing laparotomy.Results: 13% of patients who underwent laparotomy had SSI out of which 9 patients had superficial infection only. 8% of 50 patients who had PPI developed SSI, whereas 18% of those who underwent SIT had SSI. Though PPI had less incidence of SSI, statistically it was insignificant.Conclusions: The study showed a decrease in the incidence of postoperative SSI in both elective and emergency laparotomy wounds irrigated with PPI compared to SIT, though the study was statistically insignificant since the p value was less than 0.005 with a odds ratio of 2.52. The study results suggested that there was decrease in the incidence of SSI in PPI patients and also that it decreases the postoperative stay, morbidity and cost.

Особливості хірурґічної обробки та фіксації шкірного клаптя після малих ампутацій у хворих з синдромом стопи діабетика

Aim.&nbsp;Based on the proposed methods, to improve the quality of surgical treatment of patients with diabetic foot syndrome by improving the method of surgical treatment of the stump and fixation of the skin after phalangeal amputation. Materials and Methods.&nbsp;The analysis of the results of treatment of 114 patients treated in the surgical department of the TL of Ternopil during 2014-18 years for purulent-necrotic lesions of toes in type II diabetes mellitus was carried out. The age of patients ranged from 44 to 75 years. The following methods are supported by patents for utility model. Results and Discussion.&nbsp;Usually, during small amputations, the necrotic part of the bone phalanx of the finger is removed with the help of Liuer or Liston cutters. The indicated methods have certain disadvantages, as they cause additional traumatization of healthy tissue within which amputation is carried out. Removing necrotic tissue with manual mechanical amputation tools requires the application of force and compression, which leaves microcracks and splinters at the immediate location of the instrument on the healthy residual bone tissue and also injures the surrounding tissue, adversely affecting the wound healing process and treatment as a whole. However, the fixation of the skin after the amputation of the phalanx of the finger is preceded by the removal of the necrotic part of the phalanx or the entire phalanx, the cleansing of the open wound surface of fine particles of destructive tissue, treatment of the wound with an antiseptic on a water basis (chlorhexidine, decasan), removal of liquid tissues, blood, lymph and amorphous component, wound tamponade, or seam fixation. The methods of surgical treatment of the foot and the fixation of the skin flap proposed by us improve the existing other methods, where the execution of amputation of the dead part of the phalanx of the finger or even the heads of the metatarsals is carried out using a cut-off metal disk rotating at a speed of 20,000 rpm (revolutions per minute), followed by gradual polishing of the cutoff point of healthy bone tissue. The fixation of the skin flap is carried out by seamless method after preliminary treatment with certain aqueous solutions of antiseptics and an even distribution of the amorphous component, which is formed as a result of mechanical treatment of the stump with a corundum grinding nozzle up to 10 mm in diameter in the form of a layer for 1-2 minutes at a speed of 10,000 rpm.&nbsp; Conclusion.&nbsp;The proposed method of amputation of the phalanx of the finger is characterized by rapid and qualitative cut off of the dead part of the phalanx, absence of additional traumatization of the stump of the bone and surrounding tissues. The method of fixing the skin flap after the amputation of the phalanx of the finger allows preserving the liquid tissues on the wound surface that provide nutrition and fixation of the transplanted skin flap closing the wound. This approach to treatment of purulent-necrotic wounds in patients with diabetic foot syndrome provides significant acceleration of wound healing, reduces the risk of implantation infection, eliminates additional tissue injuries during overlaying and sewing, and, accordingly, reduces the patient's stay in hospital treatment to 5 to10 &nbsp;days.

PRESENTATION OF A MODIFIED METHOD OF VESTIBULOPLASTY WITH AN EARLY PROSTHETIC LOADING

Experience reveals that preliminary surgical correction is quite often expedient in mounting dentures for edentulous jaws. The purpose of the investigation is to introduce a method of vestibuloplasty for edentulous jaws by which the dentures are better held in place and retained. The use of xenoderm grafts with early insertion of the prostheses subsequent to surgical manipulation shows excellent results. Materials and methods: Patients were divided into two groups - with the first group the prosthesis was made prior to surgery and placed on the 7th day after removal of sutures. With the second group the prostheses were made following a complete healing of soft tissue, i.e. 1 month after surgery. With both groups xenoderm grafts were applied to cover the open wound surface area. Results: The post-operative period for both groups of patients proceeded normally and without complications. For the group with early prosthetic loading due to the method of vestibuloplasty it was possible to maintain the depth of the vestibule. Conclusions: The method proposed by the authors using xenoderm grafts and early loading on the newlyformed vestibule has proved a success and implies further in-depth application with larger group of patients.

Autologous Platelet Gel to Treat Chronic Decubital Ulcers: A Randomized, Blind Controlled Clinical Trial in Dogs

To determine the efficacy of topical application of the autologous platelet gel (PG) in canine chronic protracted decubital ulcers. Prospective, randomized, blind controlled clinical trial. Dogs (n = 18) with bilateral chronic wounds caused by protracted decubitus ulcers. For each dog, wound side was randomized to receive either platelet gel (group PG) every 5 days for 5 dressing changes, or paraffin gauzes dressings (group C), as negative control. Wound healing and wound surfaces were compared at admission and then evaluated every 5th day, until day 25. Outcome variables were: open wound area, reduction of open wound surface compared to admission and to each preceding dressing change, time to complete epithelialization. Significant differences in healing process were observed at day 5 and continued throughout the entire study period (P < .00001). At 25 days, mean percent reduction in wound area was 93.5% in group PG and 13.2% in group C (P < .00001). Appropriately prepared autologous PG, an inexpensive, readily available blood derivative, applied topically results in more rapid healing of chronic non-healing decubital ulcers in dogs than those treated by use of paraffin-impregnated gauzes.

Use of macroporous gelatine spheres as a biodegradable scaffold for guided tissue regeneration of healthy dermis in humans: An in vivo study

If a biodegradable scaffold is applied, the dermis can be regenerated by guided tissue regeneration. Scaffolds can stimulate in-growth of cells from the surroundings that migrate into them and start to produce autologous extracellular matrix as the scaffold is degraded. Several materials are available, but most of them are in the form of sheets and need to be laid on an open wound surface. A number of injectable fillers have been developed to correct soft-tissue defects. However, none of these has been used for guided tissue regeneration. We present a new technique that could possibly be used to correct dermal defects by using macroporous gelatine spheres as a biodegradable scaffold for guided tissue regeneration. In eight healthy volunteers, intradermal injections of macroporous gelatine spheres were compared with injections of saline and hyaluronic acid (Restylane). Full-thickness skin biopsy specimens of the implants and surrounding tissue were removed 2, 8, 12 and 26 weeks after injection, and the (immuno)histological results were analysed. The Restylane merely occupied space. It shattered the dermal tissue and compressed collagen fibres and cells at the interface between the implant and the dermis. No regeneration of tissue was found with this material at any time. The macroporous gelatine spheres were populated with fibroblasts already after 2 weeks. After 8 weeks the spheres were completely populated by fibroblasts producing dermal tissue. After 12 and 26 weeks, the gelatine spheres had been more or less completely resorbed and replaced by vascularised neodermis. There were no signs of capsular formation, rejection or adverse events in any subject. Further in vivo studies in humans are needed to evaluate the effect of the macroporous spheres fully as a matrix for guided tissue regeneration with and without cellular pre-seeding. However, the results of this study indicate the possibility of using macroporous gelatine spheres as an injectable, three-dimensional, degradable matrix for guided tissue regeneration.

TIME-ACTION RELATIONSHIPS OF THE SPECIFIC INHIBITOR OF CAUDAL REGENERATION IN CLYMENELLA TORQUATA.

SummaryThese data suggest that one may extract from the anal collars of Clymenella torquata an inhibitor which acts within 3 hours, and whose effect lasts at least 8 days. The data furthermore suggest that the inhibitor is not easily metabolized, and that it blocks an initial step in regeneration. The data from the delayed treatment tests suggest that the inhibitor must enter an open wound surface, and that a closed wound is impermeable to inhibitor.