Wound Healing Outcomes Research Articles

An Integrated Whole-Process Repair System with Programmed Regulation of Healing Performance Facilitates Urethral Wound Restoration and Scarless Reconstruction.

The harsh microenvironment of the urethral injury often carries high risks of early undesirable healing as well as late scar tissue formation. Indeed, the infection and inflammatory response in the early stages as well as blood vessel formation and tissue regeneration in the later stages fundamentally impact the outcomes of urethral wound healing. Innovatively, an integrated whole-process repair hydrogel (APF/C/L@dECM) is designed. After rigorous testing, it is found that hydrogels formed by hydrophobic association and double cross-linking of amide bonds can procedurally regulate wound healing in all phases to match the repair process. In rabbit models of urethral wound, APF/C/L@dECM hydrogel can achieve scarless reconstruction with significantly better results than other hydrogels. Noteworthily, multi-stage mechanistic explorations reveal the expression profiles of inflammation, vascularization, and extracellular matrix secretion-related genes in wound tissue at different times. In summary, this study develops an overall treatment for urethral injury through a whole-process repair system that promotes healthy healing of urethral wounds and prevents the formation of scar tissue.

First Experience with the NPseal®: A Novel Mechanically Powered Negative Pressure Dressing Applied to Colorectal Surgery Wounds.

The use of prophylactic closed-incisional negative pressure wound therapy after colorectal procedures has been shown to reduce postoperative wound complications and surgical site infection. We present our experience with a novel, closed-incision, mechanically powered negative pressure (MP-NPD) dressing after colorectal procedures. This was a prospective, single-center, single-arm observational study assessing patient reported and wound healing outcomes of colorectal surgical incisions dressed with a MP-NPD. Consecutive patients, 18years and older, that met inclusion criteria were enrolled between May 2021 and December 2021. Thirty patients were included (13 male/17 female) with a mean age of 62.7 ± 11.8years and mean body mass index of 25.5 ± 4.4kg/m2. The mean incision length covered was 3.0 ± 1.8cm. The median number of manual pinches required to initially activate the dressing with negative pressure within -75 to -125mmHg was 12 (range 7-20). Four dressings were changed (13.3%) after drainage was noted inside the pump; not including these, 88.5% (23/26) of dressings held pressure consistently without any re-pinching during the 72-h period since they were first applied in the operating room. 75.9% of patients reported the dressing was "very comfortable" and none reported the dressing restricted mobility. 79.3% of patients reported the dressing was "very easy" to use. There were no cases of major wound complication or surgical site infection within 30days. The use of MP-NPD appears to be feasible on primarily-closed colorectal incisions. Further randomized controlled study is warranted to ascertain its clinical efficacy.

A Layer-by-Layer Polycaprolactone/Chitosan-Based Biomimetic Hybrid Nanofibroporous Scaffold for Enhanced Skin Tissue Regeneration: Integrating Solution Blow Spinning and Freeze Casting Techniques.

Nanofibers, with their high surface area-to-volume ratio, elasticity, and mechanical strength, significantly enhance scaffold structures for skin tissue engineering. The present study introduces a unique method of combining solution blow spinning (SBS) and freeze casting to fabricate biomimetic hybrid nanofibroporous scaffolds (BHNS) using polycaprolactone (PCL) and chitosan (CH). The developed scaffolds mimic the fibrous porous natural extracellular matrix (ECM) architecture, promoting cell adhesion, proliferation, and matrix deposition. The combined SBS and freeze-casting processes resulted in scaffolds with high porosity and optimal mechanical strength, crucial for effective skin regeneration. Scanning electron microscopy (SEM) confirmed the uniform, nonwoven, and beadless architecture of the PCL fibers and the fibroporous nature of the PCL/CH scaffolds. The scaffolds exhibited excellent swelling behavior, controlled degradation rates, and enhanced mechanical properties. In vitro cell studies demonstrated scaffold cell-supportive properties in terms of cell attachment, proliferation, and migration. This innovative layer-by-layer fabrication technique, integrating nanofibers with freeze-cast scaffolds, represents a significant advancement in skin tissue engineering, promising improved outcomes in wound healing and regenerative medicine.

Surgeon experience affects perioperative pain in cats undergoing elective ovariohysterectomy: a randomized clinical trial.

This study aimed to compare the outcomes between surgeries performed by either experienced or inexperienced surgeons by assessing intraoperative nociception and perioperative analgesia. 16 healthy, client-owned female cats were randomly allocated into 2 groups of 8: one undergoing surgery by an experienced surgeon (GES group) and the other by inexperienced surgeons (GIS group). Both groups received IM premedication with acepromazine (0.05 mg/kg) and methadone (0.3 mg/kg). After 20 minutes, venipuncture and induction with propofol (dose-response, IV) were performed. Maintenance was achieved with inhaled isoflurane. Intraoperative vital parameters were monitored, and fentanyl (2.5 µg/kg, IV) was administered as rescue analgesia when needed. Postoperatively, pain was assessed with a visual analog scale and the multidimensional pain scale of the Universidade Estadual Paulista in Botucatu; morphine (0.2 mg/kg, IM) was used for rescue analgesia, as necessary. In the GIS group, significant increases in heart rate and systolic blood pressure were noted during surgery, especially during pedicle clamping. Respiratory rate and end-tidal isoflurane levels were higher in the GIS group at specific surgical stages. Survival analysis indicated that the GIS group had a greater need for fentanyl. Postoperative pain scores were generally low, but a higher proportion of GIS cats required rescue analgesia. Surgeon experience influences intraoperative parameters and fentanyl consumption. Inexperienced surgeons contribute to increased postoperative pain and poorer wound healing outcomes in cats undergoing elective ovariohysterectomy. Ovariohysterectomy is a common procedure in veterinary practice, and surgical expertise significantly impacts pain management and recovery. Yet, its effects have been underexplored, potentially compromising animal welfare.

Patient Experience and Wound Healing Outcomes Using Different Palatal Protection Methods After Free Gingival Grafts: A Systematic Review

(1) Background: A free gingival graft (FGG) is a common technique used to reconstruct or enhance the area of keratinized mucosa, while a connective tissue graft (CTG) is utilized to boost soft tissue thickness, thereby promoting stability in interproximal marginal bone levels. Most reported complications following FGG procedure are associated with the donor site. In addition to a painful, open wound in the palate, the most frequent complications linked to FGG harvesting include excessive bleeding, postoperative bone exposure, and recurrent herpes lesions. Numerous methods for securing the donor site after a free gingival graft surgery have been documented in research publications. The main objective of this systematic review was to assess various techniques for protecting the palate after graft harvesting and their impact on patient experience, with a focus on pain management. The secondary objective was to evaluate these techniques in relation to donor site wound healing. (2) Methods: The search was performed across four databases: Medline (PubMed Central), Scopus, Web of Science, and Embase, in accordance with PRISMA guidelines and the recommendations set forth in the Cochrane Handbook for Systematic Reviews of Interventions. The initial search took place on 9 October 2023, followed by an update on 28 June 2024. The search utilized the following keywords: (“wound” OR “injury”) AND (“graft” OR “free gingival graft” OR “graft harvesting”) AND (“healing” OR “recovery”) AND “palate”. (3) Results: After conducting the follow-up search, a total of 958 papers were identified: 193 from PubMed, 314 from Scopus, 101 from Web of Science, and 350 from Embase. Ultimately, of the 49 papers that remained, 11 were excluded due to not fulfilling the inclusion criteria, leaving 38 full-text papers on free gingival grafts (FGG) for qualitative analysis. (4) Conclusions: Various methods for palatal protection after free gingival grafts (FGG) are described in the literature, stemming from biological, physical, or chemical sources. Most studies in this review examined platelet-rich fibrin and suggested that it provides no benefits for patients’ subjective experiences or wound healing outcomes. While photobiomodulation appears to support wound epithelialization, it does not influence pain perception. Alternatives such as propolis, hyaluronic acid, and medicinal plant extracts show potential for palatal protection; however, further research is needed to thoroughly evaluate their effectiveness.

Comparison of Implant Precision with Robots, Navigation, or Static Guides

Comparison of Implant Precision with Robots, Navigation, or Static Guides

Schlafen5, regulated by the AP-1 family transcription factor c-Fos, affects diabetic wound healing through modulating PI3K/Akt/NRF2 axis

Diabetic ulcers (DUs) present significant physical and psychological challenges to patients, while placing a significant economic burden on healthcare systems. Promoting the blood vessel regeneration is critical for ensuring the delivery of essential nutrients and oxygen to the injured area, thereby supporting the healing process. To gain insight into the complex molecular mechanisms that drive DUs healing, we performed a comprehensive analysis of single-cell transcriptomic data from healing and non-healing DU states. This analysis revealed a key role of Schlafen5 (SLFN5) signal in modulating key healing processes. SLFN5, a protein known to regulate cellular processes like migration, invasion, inflammation, and cell death, emerged as an important player. Yet, although it is prominent, the specific function of SLFN5 in diabetic skin wounds remained unclear. Our study discovered a marked elevation of SLFN5 levels in endothelial cells within DUs and its suppression notably mitigates the oxidative stress and endoplasmic reticulum stress (ERS)-mediated cell death pathways, including pyroptosis and apoptosis. This finding implies that excessive SLFN5 activity might obstruct wound closure by intensifying cellular stress reactions. Upon further investigation, we found that the antioxidant and cytoprotective effects were mediated through enhanced NRF2 activity, facilitated by the PI3K/Akt signaling pathway. Moreover, our investigation identified that c-Fos as a pivotal transcription factor governing SLFN5 transcription during the development of DUs, offering valuable insights into the regulation of SLFN5 expression. In diabetic mice model, SLFN5 knockdown accelerating wound healing, which was intervened by PI3K/Akt inhibitor. These results hold significant therapeutic potential, indicating that targeting SLFN5 may represent a novel and effective strategy for improving wound healing outcomes in patients with DUs.

Advanced Secondary Intention Healing for Complex Soft-Tissue Defects Using Reprocessed Micronized Acellular Dermal Matrix.

Secondary intention healing offers an alternative when surgical options are infeasible. This study analyzed the effect of micronized acellular dermal matrices (mADMs; CGderm Matrix®, CG Bio, Seoul, Republic of Korea) on secondary intention healing in patients with complex soft-tissue defects and assessed mADMs' efficacy in promoting secondary healing and improving clinical outcomes in these challenging cases. This retrospective study included 26 patients treated with sheet-type reprocessed mADMs between August 2022 and December 2022 at Soonchunhyang University Cheonan Hospital. Patients with full-thickness skin defects classified as complex wounds were included. Data on demographics, wound characteristics, and treatment outcomes were collected and analyzed. Wound area was measured using ImageJ software, and statistical analyses were conducted using SPSS. The application of mADMs resulted in a median wound area reduction of 81.35%, demonstrating its significant efficacy in wound healing. Most patients presented with compromised vascular supply, significant tissue loss, or infections that precluded conventional surgical interventions. No significant correlations were observed between patient variables and wound-healing outcomes, indicating the complex nature of wound healing. mADMs effectively promote secondary intention healing by providing a supportive extracellular matrix scaffold that enhances epithelialization and angiogenesis. Their rapid absorption, ease of handling, and ability to improve wound tensile strength make them particularly suitable for complex wounds.

Recent advances in the application of functional hydrogels in skin wound healing

AbstractThe effective treatment of skin wounds has long posed a significant challenge in the medical field, impacting patient comfort, quality of life, and the rate and outcome of wound healing. With continuous advancements in science and technology, novel materials have emerged, providing new possibilities for skin wound treatment. Among these, multifunctional hydrogels have shown considerable potential in promoting skin wound healing as a type of wound dressing material. This review systematically examines the progress in the application of multifunctional hydrogels in skin wound healing. Initially, the structure and composition of the skin are introduced. Subsequently, skin wounds are classified, and the wound‐healing process is discussed in detail. Traditional and modern dressings are then categorized, with a particular emphasis on the characteristics and applications of hydrogel dressings. The various functions of hydrogels in skin wound healing, including antibacterial, antioxidant, hemostatic, adhesive, stimulus‐responsive, and wound status monitoring, are reviewed. The paper concludes with a summary of the existing research gaps and provides insights into the future development directions of multifunctional hydrogels. This review aims to guide the preparation of hydrogel wound dressings and offer theoretical references for the exploration of next‐generation functional hydrogels.

The perioperative nursing effect of VSD closed negative pressure drainage in the treatment of emergency traumatic wound infection.

This study aims to explore the perioperative nursing effect of vacuum sealing drainage closed negative pressure drainage in the treatment of emergency traumatic wound infection. A total of 116 patients with trauma-related wound infection were admitted to the Department of orthopedics and skin wound at our hospital from April 2021 to October 2022 were selected as the study subjects. They were divided into an observation group and a control group, with 58 patients in each group. Patients in the control group received traditional wound debridement, while patients in the observation group underwent debridement with the addition of vacuum-sealed drainage closed negative pressure. The treatment outcomes, pain levels, various treatment indicators, and wound healing conditions of the 2 groups were compared. The overall effective rate of treatment in the observation group was 93.10%, which was significantly higher than the control group's rate of 75.86% (P < .05). The Visual Analog Scale scores of patients in both groups were compared at 1 hour after treatment and 6 hours after treatment (P > .05). However, at 12 hours and 24 hours after treatment, the Visual Analog Scale scores of patients in the observation group were significantly lower than those in the control group (P < .05). The observation group of patients had fewer changes of dressings after treatment compared to the control group (P < .05). The wound healing time, antibiotic usage duration, and hospitalization time were all shorter in the observation group than in the control group (P < .05). The Bates-Jensen scores of both groups of patients before treatment were compared (P > .05). After treatment, the Bates-Jensen scores in both groups decreased, and the observation group had lower scores than the control group (P < .05). The use of vacuum sealing drainage closure therapy in patients with emergency trauma-related wound infections can alleviate pain, reduce the frequency of dressing changes, accelerate wound healing, and improve wound healing outcomes. It is worthy of clinical promotion.

A Prospective Observational Study to Evaluate the Effectiveness of Platelet-Rich Plasma Therapy for Complex Wounds: Influential Clinical Variables on Wound Healing Outcomes.

Objective: Autologous platelet-rich plasma (PRP) has shown promising outcomes in treating wounds, but the profile of patients benefiting most from this therapy is not known. This study aimed to identify influential variables in the success of this therapy, analyzing its personalized therapeutic potential for complex wounds. Approach: A prospective observational study was conducted in elderly patients with complex wounds receiving autologous PRP. Patient's data about sociodemographic parameters, comorbidities, frailty (FI-VIG score), complete blood count including albumin, wound depth, location, chronicity, and etiology were collected at the beginning of the study. The wound area was monitored weekly. The data were analyzed using descriptive and inferential statistics, longitudinal data analysis, and survival analysis. Results: Ninety-seven elderly patients were included. The FI-VIG, baseline wound area, depth, and etiology were significantly correlated with wound outcome. Strong differences in wound area variation from treatment initiation were observed in healed wounds (13% reduction/week) compared with stagnant and complicated wounds (1 and 2% reduction/week, respectively). The healing time analysis showed that nearly 80% of patients required at least 15 weeks for complete healing. In addition, patients with smaller wound sizes, younger age, or lower FI-VIG scores had shorter healing times. Innovation: This is the first study that identifies prognostic indicators for wound outcomes to guide clinician decision-making for using autologous PRP. It also highlights the relevance of patient health baseline and wound features and evolution for the success of this therapy. Conclusion: This study demonstrates that personalizing autologous PRP therapy to treat complex wounds in elderly patients is possible.

Capsaicin/silica-infused polygalacturonic acid/polyvinyl alcohol nano-matrix for enhanced wound healing in skin injuries

Wound healing is a complex physiological process, demanding advanced strategies for efficient tissue regeneration. To address this, we developed a novel nanofibrous matrix composed of polygalacturonic acid (PGA), polyvinyl alcohol (PVA), capsaicin, and zinc-doped mesoporous silica (Zn/MCM-41). This copolymeric matrix offers enhanced mechanical stability, controlled drug release, and improved cellular adhesion and proliferation, leading to effective tissue regeneration. Infusing capsaicin/Zn-MCM-41 confers synergistic advantages, including accelerated wound closure, diminished inflammation, and enhanced tissue regeneration, culminating in superior wound healing outcomes. Comprehensive physicochemical characterization of the nanofiber was conducted, employing techniques such as EDS, EDX, XRD, FESEM, HRTEM, FTIR, BET, TGA, DSC and Zeta potential, confirming the successful synthesis of Zn/MCM-41 at the nanoscale, exhibiting uniform porosity, colloidal stability, and thermal resilience. In vivo quantitative assessment demonstrates a significant acceleration in wound healing facilitated by the composite nanofibers. Furthermore, the incorporation of capsaicin into Zn/MCM-41 augments the wound healing process, as corroborated by histological evaluations. In summary, our investigation introduces an advanced composite nanofiber formulation that promotes accelerated wound healing quantitatively through the synergistic amalgamation of PVA, PGA, capsaicin, and Zn/MCM-41. The demonstrated efficacy of the nanofibers underscores their potential in translational regenerative medicine and wound healing applications.

EXOSOME-ENHANCED HYDROGEL DRESSINGS FOR ACCELERATED ACUTE SKIN WOUND HEALING

Background and Objectives: Acute skin wounds present significant challenges, necessitating effective therapeutic strategies. This study investigates the potential of extra­cellular vesicles (EVs) in combination with hydrogel matrices for improving wound healing outcomes. Materials and Methods: A literature review was conduc­ted following PRISMA guidelines to identify relevant studies. Inclusion criteria comprised prospective in-vivo trials utilizing standardized acute skin wounds on healthy subjects. Key treatments involved topical application of EVs incorporated into hydrogel matrices. Electronic literature searches were conducted in PubMed, Science Direct, and Cochrane Library using specific keywords. Results: Among 541 initially identified publications, 37 studies met inclusion criteria. After full-text analysis, six studies were included in the review. Findings revealed significant advancements in wound healing outcomes when EVs were combined with hydrogel matrices. These combinations demonstrated accelerated wound closure, enhanced tissue regeneration, and increased collagen deposition compared to controls. Conclusions: The integration of EVs with hydrogel matri­ces represents a promising approach for improving acute skin wound healing. Synergistic effects observed in the reviewed studies underscore the potential of this com­bination therapy. However, further research is needed to standardize protocols, optimize dosage and delivery mechanisms, and evaluate long-term safety and efficacy. Overall, this study highlights the potential of EVs and hydrogel matrices in addressing the unmet clinical needs associated with novel acute skin wound management.

The association of the perioperative neutrophil-to-lymphocyte ratio with wound healing in patients with Wagner grade 3 and 4 diabetic foot ulcers after tibial cortex transverse transport surgery: a prospective observational cohort study.

Diabetic foot ulcers (DFUs) are severe complications of diabetes, involving multiple etiological factors including neuropathy, vascular insufficiency, and impaired wound healing. The global burden of DFUs is substantial, with significant morbidity and high management costs. Recent advancements have introduced the tibial cortex transverse transport (TTT) technique, which has shown promising results in the management of severe DFUs by promoting angiogenesis and immunomodulation. This prospective cohort study enrolled patients with Wagner grade 3 and 4 DFUs, treated using the TTT technique from May 2022 to September 2023 at MianYang Central Hospital. The study assessed the influence of TTT on the perioperative neutrophil-to-lymphocyte ratio (NLR), an established biomarker of systemic inflammation, and its correlation with wound healing outcomes. A total of 82 patients were enrolled, with 66 completing the study. The survival analysis revealed that patients with a lower preoperative NLR experienced significantly faster wound healing compared with a high NLR (log rank test P< 0.05; hazard ratio (HR) = 0.46; 95% CI: 0.26-0.83). The optimal NLR cutoff values (4.25) were established to predict wound healing times for DFUs. The median NLR was significantly different before TTT surgery, 3 days after TTT surgery, and 1 month after TTT surgery (P<0.05). The TTT technique significantly influences the perioperative NLR and is associated with improved wound healing in DFU patients. The perioperative NLR serves as an effective predictive biomarker for wound healing outcomes, highlighting the significance of interventions targeting NLR values in perioperative management strategies and postoperative monitoring protocols for the treatment of diabetic foot ulcers (DFUs) in clinical practice.

Enhancing wound healing through innovative technologies: microneedle patches and iontophoresis.

Wound healing is a complex process involving multiple stages, including inflammation, proliferation, and remodeling. Effective wound management strategies are essential for accelerating healing and improving outcomes. The CELLADEEP patch, incorporating iontophoresis therapy and microneedle technology, was evaluated for its potential to enhance the wound healing process. This study utilized a full-thickness skin defect model in Sprague-Dawley rats, researchers compared wound healing outcomes between rats treated with the CELLADEEP Patch and those left untreated. Various histological staining techniques were employed to examine and assess the wound healing process, such as H&E, MT and immunofluorescence staining. Furthermore, the anti-inflammatory and proliferative capabilities were further investigated using biochemical assays. Macroscopic and microscopic analyses revealed that the CELLADEEP patch significantly accelerated wound closure, reduced wound width, and increased epidermal thickness and collagen deposition compared to an untreated group. The CELLADEEP patch decreased nitric oxide and reactive oxygen species levels, as well as pro-inflammatory cytokines IL-6 and TNF-α, indicating effective modulation of the inflammatory response. Immunofluorescence staining showed reduced markers of macrophage activity (CD68, F4/80, MCP-1) in the patch group, suggesting a controlled inflammation process. Increased levels of vimentin, α-SMA, VEGF, collagen I, and TGF-β1 were observed, indicating enhanced fibroblast activity, angiogenesis, and extracellular matrix production. The CELLADEEP patch demonstrated potential in promoting effective wound healing by accelerating wound closure, modulating the inflammatory response, and enhancing tissue proliferation and remodeling. The CELLADEEP patch offers a promising non-invasive treatment option for improving wound healing outcomes.

Outcomes of dermal substitutes in burns and burn scar reconstruction: A systematic review and meta-analysis.

Dermal substitutes have been introduced in burn care to improve wound healing outcomes; however, their use remains limited in standard treatments. This systematic review and meta-analysis aimed to evaluate the outcomes of dermal substitutes in patients with burns and patients requiring burn scar reconstruction and subsequently contribute to optimising the integration of dermal substitutes into clinical practice and reducing the knowledge gap. A comprehensive search across various databases included human studies from peer-reviewed journals on dermal substitutes for deep dermal and full-thickness burns, and scar reconstruction across all ages. Data from comparative trials were extracted, focusing on patient and wound characteristics, treatment specifics, and outcomes related to wound healing and scar quality. Meta-analysis was performed on trials reporting similar post-burn measures, with statistical heterogeneity assessed. Outcomes were presented using mean differences or odds ratios with 95% confidence intervals. A total of 31 comparative trials were included. The overall quality of the studies was considered moderate. The meta-analysis indicated delayed re-epithelialization 4-7 days after treatment with a collagen-elastin matrix compared to split-thickness skin graft in acute burns (-7.30%, p = 0.02). Significant improvement in subjective scar quality was observed with acellular dermal matrix compared to split-thickness skin graft in acute burn wounds 6 months post-operative (-1.95, p <0.01). While acknowledging the initially delayed wound healing, incorporating dermal substitutes into the surgical treatment of burn patients holds promise for enhancing scar quality. However, future research must prioritise outcome measure uniformity, address variations in dermal substitute application, and standardise indications for consistent and effective practices.

The Negative Pressure Wound Therapy for Flap Salvage

Negative Pressure Wound Therapy (NPWT) effectively manages complex wounds by promoting fluid drainage, stabilizing the wound environment, and reducing bacterial load. It aids in granulation tissue formation and modulation of inflammatory reactions. NPWT is increasingly used in reconstructive surgery, particularly in flap procedures, enhancing wound healing and cosmetic outcomes while reducing flap complications. Despite concerns about flap compromise, clinical trials demonstrate low flap loss rates with NPWT. Strategies like observation windows and implantable Doppler devices help overcome monitoring challenges. However, conclusive evidence regarding NPWT's safety and impact on flap vascularity is limited due to scarce studies. The study involved 40 healthy adult patients, mostly male, with soft tissue defects primarily caused by road traffic accidents. They were split into two groups: NPWT (25 patients) and conventional dressing (15 patients). The NPWT group was further categorized into high pressure (8 patients) and low pressure (17 patients) subgroups. Results showed lower flap edema in NPWT groups compared to controls, but high pressure NPWT led to higher flap ischemia and infection rates. Overall, low pressure NPWT yielded the best clinical and aesthetic outcomes with fewer complications. The study suggests a delayed NPWT approach and low-pressure settings for optimal vascular perfusion in Fasciocutaneous flaps, emphasizing the need for further trials to establish its efficacy and determine ideal pressure settings for different flap types.

TOpClass Class 4 Perineal Crohn's Disease: A Systematic Review and Meta-analysis of Perineal Wound Complication After Proctectomy in Crohn's Patients.

Nonhealing perineal wounds have been reported to be common after proctectomy for Crohn's disease (CD). We performed a systematic review and meta-analysis of perineal wound healing after proctectomy for CD and assessed the risk factors for nonhealing. A comprehensive literature search was conducted in PubMed, Embase, and Scopus databases from 2010 to 2023, and articles reporting perineal wound healing rates after proctectomy for CD were included. Data on study characteristics and proportion of healed wounds, and risk factors, were extracted. Random-effects meta-analysis was performed to estimate the pooled proportion and 95% CIs using the "meta" package in R. Heterogeneity was assessed using the I2 statistic. We identified 501 articles, of which 252 remained after de-duplication. After screening, 4 retrospective cohort studies involving 333 patients were included. Across the 4 studies, the pooled proportion of completely healed perineal wounds at 6 months was 65% (95% CI 52%-80%), and 70% (95% CI 60%-83%) at 12 months. Significant heterogeneity was found between studies (I2 = 86% at 6 months). Three studies examined risk factors for impaired healing after proctectomy. One study identified preoperative perineal sepsis as the only independent factor associated with impaired healing (P = .001) on multivariable analysis. In 1 study, male sex, shorter time from diversion to proctectomy, and higher preoperative C-reactive protein levels were all associated with delayed healing in univariate analysis. Another study found that close rectal dissection was associated with significantly lower healing rates than total mesorectal excision (P = .01). Prior use of tumor necrosis factor inhibitors was not associated with wound healing outcomes. This meta-analysis revealed complete perineal healing in only 70% of patients 12 months after proctectomy for CD. This highlights knowledge gaps, including the identification of modifiable risk factors and methods for preventing or as rescue therapy, such as vacuum-assisted closure and flap reconstruction, for nonhealing perineal wounds after proctectomy for CD. Poor perineal wound healing outcomes are likely related to imperfectly understood underlying inflammatory dysregulation and systemically impaired wound healing in patients with CD.

Comprehensive management of degloving soft tissue injuries of the extremity: A 12-year retrospective study

BackgroundDegloving soft tissue injuries (DSTIs) of the extremities, which are often underestimated in terms of their severity, present significant challenges to reconstructive surgeons. We propose a comprehensive management protocol to standardize the reconstructive approach, aiming for successful treatment of these devastating injuries. MethodsWe retrospectively analyzed data from consecutive patients with extremity DSTIs over a 12-year period. Patients were categorized into three age groups (0–17, 18–65, and >65 years) to highlight the different treatment options based on age. Various surgical techniques were employed depending on the injury pattern. Treatment strategies for each patient were individualized based on age, underlying conditions, and injury type. Wound healing, complications, and functional outcomes were recorded. ResultsOf the hospitalized patients, 20 were lost to follow-up, and 105 were included in the analysis. The mean age at the time of injury was 40 ± 44.9 years, with a mean follow-up of 30.1 ± 12.7 months. Furthermore, 19 % of patients were aged 0–17 years, 61 % were aged 18–65 years, and 20 % were aged >65 years. Treatment plans were personalized based on injury characteristics, with numerous patients being treated with a combination of multiple surgical techniques. Older patients had significantly longer wound healing times and delayed return to activities of daily living compared to the other age groups. Overall, patients were generally satisfied with their outcomes. The total complication rate was 46.7 %, with 79.5 % being categorized as major complications. Each complication was addressed with a tailored treatment plan. ConclusionThe management of DSTIs should be individualized, taking into account the specific characteristics of each injury. Age and medical fitness play crucial roles in determining both the surgical approach and prognosis. An accurate initial evaluation and thorough debridement are essential for optimal outcomes.

Surgical Management of Traumatic Bone Cyst Utilizing the Progressive Platelet-rich Fibrin Protocol

Traumatic Bone Cyst (TBC) is a rare and asymptomatic intraosseous lesion, often classified as a pseudocyst, affecting the jaws and long bones. Known by various names such as solitary bone cyst, hemorrhagic bone cyst, simple bone cyst, extravasation cyst, or progressive bone cyst, TBC’s etiopathogenesis remains elusive due to its diverse presentations. The standard treatment protocol for TBC involves surgical excision followed by curettage of the cystic cavity. This surgical intervention induces bleeding, leading to the formation of a blood clot within the cavity, which subsequently promotes the resolution of the lesion and regeneration of new bone. In this context, the use of third-generation Platelet-rich Fibrin (PRF) has emerged as a promising adjunctive therapy to enhance and accelerate the healing process of surgical wounds. PRF, a biomaterial derived from the patient’s own blood, is known for its ability to release growth factors that facilitate tissue regeneration and wound healing. This case report aims to present the surgical removal of a traumatic bone cyst in the anterior mandible of a pediatric patient, highlighting the efficacy of PRF in improving wound healing outcomes. Through this report, we seek to demonstrate the potential benefits of incorporating PRF into the surgical management of TBC, particularly in pediatric patients, to achieve faster and more effective healing.