Wound Pain Research Articles

Evaluation the effect of Silybum marianum ointment on episiotomy wound healing and pain intensity in primiparous women: a randomized triple blind clinical trial

BackgroundEpisiotomy is the most commonn surgical procedure in midwifery which as any other wounds can cause infection or delay in healing.The current study aimed to determine effect of Silybum marianum ointment on pain severity and healing of episiotomy wound in primiparous women referring to Shahid Nourani Hospital at 2019.MethodsThis research was done as a randomized, triple-blind clinical trial on 87 priiparous women (44 indivdiuals in Silybum marianum ointment group and 43 indivdiuals in placebo group) referred to Shahid Nourani Hospital in Talesh (Guilan Province), Iran at September 2019.After labor and performing episiotomy, twice a day for 10 days as a fingertip size of the ointment was prescribed to be topically used on the episiotomy incision for both groups (Silybum marianum ointment or placebo ointment).Data gathering was done using demographic and midwifery information questionnaire, Episiotomy healing assessment: Redness, Edema, Ecchymosis, Discharge, Approximation)REEDA Scale (REEDA Scale: Redness(R); Edema (E), Ecchymosis(E), Discharge from the wound(D); Approximation of the perineal tissues(A))(scale, and visual analogue scale of pain. Examination of healing status of the perinea incision was performed during first 12 h, fifth day and tenth day after labor.Kolmogrov-Smirnov test was used in order to investiagte nomrality of data distribution of quantitative data, and two- independent samples t test, Chi square, repeated measures two factorial analysis of variance and Fischer’s exact test were used. SPSS software version 23 was used to analyze data and 0.05 was considered as signifcance level.ResultsBoth groups of Silybum marianum and placebo groups did not differ regarding demographic and midwifery characteristics, hygiene status prior to intervention (P > 0.05).Mean difference of pain severity and REEDA scale in Silybum marianum ointment group in 12 h after labor, at fifth day and tenth day after labor was significant comparing to control group which indicates decline in episiotomy pain severity and faster wound healing (P < 0.001).ConclusionsSilybum marianum ointment ointment accelerates episiotomy wound healing rate due to its healing properties and decreases pain severity.Trial registrationThis study was registered in Iranian Registry of Clinical Trials in 10/08/2019 with the IRCT ID: IRCT201811100411603N1.

Achieving effective patient outcomes with PolyMem® Silicone Border.

Clinicians are under increasing pressure to provide high-quality patient outcomes at a reduced cost. Increasingly, community staff must acquire knowledge on advanced wound care products to cope with the growing caseload demands. This article describes the use of PolyMem® dressings to reduce pain, inflammation, oedema and bruising and their ability to debride and absorb exudate while providing an optimum healing environment. The PolyMem range includes multifunctional dressings for various painful chronic wounds. This article also presents five case studies with particularly good patient outcomes where PolyMem dressings were the primary dressing. All five patients were holistically assessed to enable consistent evidence-based treatment decisions. In four cases, the new PolyMem Silicone Border dressing was used. The patients found the PolyMem Silicone Border dressing comfortable and gentle on removal even when the skin was extremely fragile. The right dressing used at the right time on the right patient can improve patient outcomes.

Healthcare practitioners’ views on the assessment and management of pain in chronic lower limb wounds

Healthcare practitioners’ views on the assessment and management of pain in chronic lower limb wounds

Fistulotomy with Primary Sphincter Repair in High Anal Fistula

Abstract Background Anal fistula is abnormal communication between the anal canal and the perianal skin or perineum or buttocks. Anal fistula is almost always a consequence of an anorectal abscess that was drained. While the abscess represents the acute phase of the disease, fistula represents the chronic phase as the fistulous pathway may persist in about 1/3 of cases. Aim of the Work In this study we will perform fistulotomy with primary sphincter repair in high cryptoglandular fistula with assessment of recurrence rate, incontinence rate and patient satisfaction according to pain score, wound healing, discharge and return to daily activity parameters. Methods This was prospective cohort study on 30 patients of high peri-anal fistulae and fistulotomy and reconstruction (primary suture repair) of anal sphincter was done., the patients were followed up 6 months postoperatively regarding their continence using Wexner score, recurrence, discharge and their return to work by scheduled outpatient clinical examination. Results Among 30 patients only three patients complaining usual incontinence mostly as post defecation soiling. Three patients reported anal fistula recurrence: One occurred at the 5th month, while the other two occurred at the 6th month after surgery. The procedure was well tolerated by the patients as most of them complaining only minimal pain and returned to work after two weeks without need of other stage like other procedures. Conclusion Fistulotomy with primary sphincter repair is an effective therapeutic option for patients with high anal fistula. Our study demonstrated that immediate reconstruction of the sphincters after fistulotomy achieved high success rates and low risk of postoperative fecal incontinence, compared to reported rates after simple fistulotomy.

COVID-19 INFECTION AND STEVENS-JOHNSON SYNDROME/TOXIC EPIDERMAL NECROLYSIS: ONE MORE THING TO WORRY ABOUT?

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Stevens-Johnson Syndrome/Toxic epidermal necrolysis (SJS/TEN) are fatal cutaneous side effects occasionally seen in the ICU. Although HIV is a known risk factor for SJS/TEN, we yet do not know the relation of COVID-19 infection to these severe cutaneous adverse reactions (SCAR) [1]. Here we present a case of a young man with COVID-19 and HIV infection who developed SCAR. CASE PRESENTATION: 40-year-old male with past medical history of substance abuse, HCV, HIV infection (not on ART) presented with odynophagia, voice change and drooling. COVID-19 testing in ED was positive. Head and neck CT scan revealed retropharyngeal abscess. He was intubated emergently due to inability to manage secretions and increased work of breathing. Abscess was managed conservatively with Ampicillin/Sulbactam and methylprednisone. On antibiotic day #3, he developed purple rashes with dark brown vesicles on his face, neck and anterior chest (Image 1). The following day, this evolved into an extensive bullous eruption with de-epithelization and epithelial loss, with lesions including face, eye lids, eyes, neck, upper trunk, bilateral upper extremities, back, genitalia and bilateral lower extremities (Image 2,3). Dermatology was consulted with concern for SJS/TEN and Ampicillin/Sulbactam was discontinued. His skin biopsy demonstrated full thickness epidermal necrosis. He was managed with pain medication, IV fluids, wound care and intravenous immunoglobulin.Meanwhile, his CD4 count was 65 with viral load of 174,000 which he was started on Atovaquone for PJP prophylaxis. COVID-19 markers were elevated on admission (CRP 2.49, Ferritin 546, D-dimer 0.69 LDH 299), and remained elevated throughout his hospital stay. Chest X-ray showed bibasilar hypoventilatory change with bilateral pleural effusions. Prophylactic low molecular weight heparin and methylprednisone were initiated.Patient was transferred to other facility burn ICU for further management. Despite full care, his skin lesions worsened, and patient passed away on hospital day 15. DISCUSSION: It has been reported that concomitant HIV and viral infections can precipitate SCAR [2]. However, we know little about COVID-19 infection and its relation to SCAR. There are few documented cases of COVID-19 associated SCAR but like other viral infections, SARS-COV-2 may be another risk factor for SCAR [3]. CONCLUSIONS: This case may lead clinicians to include SCAR as a differential when evaluating newly developed cutaneous lesions in COVID-19 patients. It is also essential to monitor the skin when COVID-19 patients are being treated with possible culprits. REFERENCE #1: Incidence of Toxic Epidermal Necrolysis and Stevens-Johnson Syndrome in an HIV Cohort. AM J Clin Dermatol. 2012 Feb 1;13(1):49-54. REFERENCE #2: Nonimmediate Allergic Reactions Induced by Drugs: Pathogenesis and Diagnostic Tests. J Investig Allergol Clin Immununol. 2009;19(2):80-90. REFERENCE #3: A case report of toxic epidermal necrolysis (TEN) in a patient with COVID-19 treated with hydroxychloroquine: are these two partners in crime? Clin Mol Allergy. 2020 Oct 6;18:19. DISCLOSURES: No relevant relationships by Gregory Bassmann, source=Web Response No relevant relationships by Vignesh Harish, source=Web Response No relevant relationships by Kyunghoon Rhee, source=Web Response No relevant relationships by Zainab Shafi, source=Web Response

Recovery after Critical Illness and Acute Kidney Injury.

AKI is a common complication in hospitalized and critically ill patients. Its incidence has steadily increased over the past decade. Whether transient or prolonged, AKI is an independent risk factor associated with poor short- and long-term outcomes, even if patients do not require KRT. Most patients with early AKI improve with conservative management; however, some will require dialysis for a few days, a few weeks, or even months. Approximately 10%-30% of AKI survivors may still need dialysis after hospital discharge. These patients have a higher associated risk of death, rehospitalization, recurrent AKI, and CKD, and a lower quality of life. Survivors of critical illness may also suffer from cognitive dysfunction, muscle weakness, prolonged ventilator dependence, malnutrition, infections, chronic pain, and poor wound healing. Collaboration and communication among nephrologists, primary care physicians, rehabilitation providers, physical therapists, nutritionists, nurses, pharmacists, and other members of the health care team are essential to create a holistic and patient-centric care plan for overall recovery. Integration of the patient and family members in health care decisions, and ongoing education throughout the process, are vital to improve patient well-being. From the nephrologist standpoint, assessing and promoting recovery of kidney function, and providing appropriate short- and long-term follow-up, are crucial to prevent rehospitalizations and to reduce complications. Return to baseline functional status is the ultimate goal for most patients, and dialysis independence is an important part of that goal. In this review, we seek to highlight the varying aspects and stages of recovery from AKI complicating critical illness, and propose viable strategies to promote recovery of kidney function and dialysis independence. We also emphasize the need for ongoing research and multidisciplinary collaboration to improve outcomes in this vulnerable population.

Endovascular Recanalization of the Chronically Occluded Native Superficial Artery After Failed Bypass Graft: Midterm Results

PurposeTo evaluate the safety, effectiveness, and outcomes of endovascular recanalization of chronic total occlusion (CTO) of the superficial femoral artery (SFA) in patients with critical limb ischemia (CLI) after failed surgical bypass graft. MethodsEndovascular recanalization of SFA CTO was performed for 26 consecutive CLI patients with failed bypass grafts from 2016 to 2020. Patient demographics, bypass and lesion characteristics, procedural data, technical, and clinical outcomes were evaluated. ResultsThe technical success rate was 96.2% (25/26). Retrograde arterial access was used in 16 (61.6%) patients. Additional tibial and iliac angioplasty was performed in 15 and 2 patients, respectively. Fifteen complications occurred in 10 patients, including thrombosis, embolism, vessel rupture, dissection, arteriovenous fistula, and pseudoaneurysm. Pain relief and wound healing were achieved in 22 patients. The primary, assisted primary, and secondary patency rates were 95.5%, 100%, and 100% at 6 months, 81.8%, 95.5%, and 100% at 12 months, and 76.7%, 82.7%, and 87.5% at 24 months, respectively. By univariate analysis, hyperlipidemia (hazard ratio = 7.82; 95% CI: 1.27–48.04, P = .026) was found to be the only significant risk factor related to primary patency loss. Amputation-free survival and limb salvage rates were 100% and 100% at 6 months, 100% and 100% at 12 months, and 87.1% and 93.8% at 24 months, respectively. ConclusionsEndovascular recanalization of SFA CTO in CLI patients with graft failures is effective with high technical success rates. Acceptable limb salvage and amputation-free survival rates make this technique a reasonable alternative to repeat surgery for high-risk patients.

Cost-effectiveness analysis of domiciliary topical sevoflurane for painful leg ulcers

The general anesthetic sevoflurane is being repurposed as a topical analgesic for painful chronic wounds. We conducted a Bayesian cost-effectiveness analysis (CEA) comparing the addition of domiciliary topical sevoflurane to conventional analgesics (SEVOFLURANE, n = 38) versus conventional analgesics alone (CONVENTIONAL, n = 26) for the treatment of nonrevascularizable painful leg ulcers in an outpatient Pain Clinic of a Spanish tertiary hospital. We used real-world data collected from charts to conduct this CEA from a public healthcare perspective and with a one-year time horizon. Costs of analgesics, visits and admissions were considered, expressed in €2016. Analgesic effectiveness was measured with SPID (Sum of Pain Intensity Difference). A Bayesian regression model was constructed, including "treatment" and baseline characteristics for patients ("arterial hypertension") and ulcers ("duration", "number", "depth", "pain") as covariates. The findings were summarized as a cost-effectiveness plane and a cost-effectiveness acceptability curve. One-way sensitivity analyses, a re-analysis excluding those patients who died or suffered from leg amputation, and an extreme scenario analysis were conducted to reduce uncertainty. Compared to CONVENTIONAL, SEVOFLURANE was associated with a 46% reduction in costs, and the mean incremental effectiveness (28.15±3.70 effectiveness units) was favorable to SEVOFLURANE. The estimated probability for SEVOFLURANE being dominant was 99%. The regression model showed that costs were barely influenced by any covariate, whereas effectiveness was noticeably influenced by "treatment". All sensitivity analyses showed the robustness of the model, even in the extreme scenario analysis against SEVOFLURANE. SEVOFLURANE was dominant over CONVENTIONAL as it was less expensive and much more effective.

The treatment of Covid tongue in an isolation unit

Background: In 2019, a viral disease spread from Wuhan, Hubei Province in China. The disease was caused by severe acute respiratory syndrome related to coronavirus 2 (SARS-CoV-2 virus), which was named by the Coronavirus Study Group of the International Committee on Taxonomy of Viruses. Purpose: This article reports the multi-discipline treatment of Covid tongue and exfoliative cheilitis with a main diagnosis of bilateral pneumonia caused by SARS-CoV-2 infection. Case: A female patient, 70 years old was referred with a diagnosis of bilateral pneumonia by a pulmonologist. She complained of painful wounds all over her mouth. An intraoral clinical examination revealed white-thick lesion and multiple ulcerations, whilst an extraoral exam for exfoliative dermatitis has not been described. The working diagnosis was Covid tongue mixed with exfoliative cheilitis. Case management: The procedure was performed by teledentistry and direct visits to implement oral health care by asepsis, debridement and the application of Oxygene gel. Conclusion: The lesion was treated successfully due to the multidisciplinary approaches by an internist and pulmonologist by implementing integrated knowledge and was supported hugely by patient cooperation.

Prophylactic Antibiotics and Surgical Site Infections: the Myths and the Realities

Background: Postoperative wound infections have an enormous impact on patient’s quality of life and contribute substantially to the financial cost of patient care. The potential consequences for patients range from increased pain and care of an open wound to sepsis and even death. Wound infections extend the average hospital stay by one week and increasing the cost of hospitalization by minimum of 20%. Appropriate antibiotics for prophylaxis in surgery depend on the most likely pathogens encountered during the surgical procedure and type of operative wound encountered during the surgical procedure. Inadvertent use of antibiotics is associated with Development of multi-agent drug resistance among nosocomial pathogens. The occurrence of new infections such as clostridium difficile colitis, respiratory tract infections Drug toxicity and allergy Enormous financial impact on health care costs. Objective: To know whether prophylactic dose of antibiotics is enough to prevent surgical siteinfections in post-operative period if there is no comorbidities and surgery is donewith complete aseptic precautions. Methodology: The patients who undergoes clean and clean contaminated surgeries in PK Das Institute of Medical Sciences, Vaniamkulam, Palakkad, Kerala over period of 2 years and who fulfill the criteria of study aredivided randomly into two different groups (70 cases and 70 controls). Routineinvestigations done in both groups. And all other parameters are kept similar like preoppreperations and intra-op strategies. Case group received only prophylacticantibiotic and control group received post-operative empirical antibiotics also. 70patients in case group contain 35 clean cases and 35 clean contaminated cases. 70patients in control group also divided like this. Results: Out of the 35 clean cases in study group 3 got SSI. Out of 35 clean contaminated cases in study group 7 got SSI Out of 35 clean cases in control group 4 got SSI Out of 35 clean contaminated cases in control group 8 got SSI Conclusion: The use of prophylactic antibiotics alone is as effective as post-op empirical therapy in preventing SSI. This will also avoid unnecessary antibiotic resistance and will reduce the cost of treatment.

Longitudinal peripheral tissue RNA-Seq transcriptomic profiling, hyperalgesia, and wound healing in the rat plantar surgical incision model.

Postoperative pain and delayed healing in surgical wounds, which require complex management strategies have understudied complicated mechanisms. Here we investigated temporal changes in behavior, tissue structure, and transcriptomic profiles in a rat model of a surgical incision, using hyperalgesic behavioral tests, histological analyses, and next‐generation RNA sequencing, respectively. The most rapidly (1 hour) expressed genes were the chemokines, Cxcl1 and Cxcl2. Consequently, infiltrating leukocytes were abundantly observed starting at 6 and peaking at 24 hours after incising which was supported by histological analysis and appearance of the neutrophil markers, S100a8 and S100a9. At this time, hyperalgesia was at a peak and overall transcriptional activity was most highly activated. At the 1‐day timepoint, Nppb, coding for natriuretic peptide precursor B, was the most strongly upregulated gene and was localized by in situ hybridization to the epidermal keratinocytes at the margins of the incision. Nppb was basically unaffected in a peripheral inflammation model transcriptomic dataset. At the late phase of wound healing, five secreted, incision‐specific peptidases, Mmp2, Aebp1, Mmp23, Adamts7, and Adamtsl1, showed increased expression, supporting the idea of a sustained tissue remodeling process. Transcripts that are specifically upregulated at each timepoint in the incision model may be potential candidates for either biomarkers or therapeutic targets for wound pain and wound healing. This study incorporates the examination of longitudinal temporal molecular responses, corresponding anatomical localization, and hyperalgesic behavioral alterations in the surgical incision model that together provide important and novel foundational knowledge to understand mechanisms of wound pain and wound healing.

Effect of Kangfuxin Solution Fumigation Bath on Postoperative Patients with Hemorrhoid PPH and Influence on the Postoperative Complications.

Surgery is now the main clinical treatment for hemorrhoids, and the procedure for prolapse and hemorrhoids (PPH) is the commonly used procedure. The key to evaluating the efficacy of surgery includes the quality of postoperative wound healing and the occurrence of complications, so it is especially important to enhance the postoperative rehabilitation of hemorrhoids. This study investigates the method of postoperative treatment with Kangfuxin solution fumigation bath to explore the role of this method in the efficacy of patients after hemorrhoid PHH surgery and its effect on postoperative complications. It will accumulate some relevant information to improve the efficacy of hemorrhoid surgery and postoperative complications and open new ideas for further postoperative rehabilitation of other diseases in the anal area. A total of 106 patients with hemorrhoids were included in this study, all of whom were treated with PHH surgery. After surgery, they were randomly divided into a control group treated with warm water sitz bath and an observation group treated with Kangfuxin solution fumigation bath, with 53 cases in each group. We observed all patients' postoperative pain, bleeding, and perianal edema on a daily basis after surgery; we recorded the time of wound healing and hospital stay. The maximum anal squeeze pressure (MASP), anal defecation diastole pressure (ADDP), anal resting pressure (ARP), and the length of the high-pressure zone (HPZ) were used as observation indicators to evaluate the anal function of the patients before and after treatment. The results of the evaluation of the efficacy of patients after the treatment period showed that the total effective rate of treatment in the observation group (92.45%) was significantly higher than that of the control group (77.36%). The postoperative recovery showed that the wound healing time, hospitalization time, pain, bleeding, and edema scores at 3 and 5 days after surgery were lower in the observation group than in the control group; MASP and ARP increased in both groups after treatment compared to before treatment, with more increase in the observation group. The results suggest that patients with hemorrhoids after PPH should pay attention to postoperative care and rehabilitation. It also reveals that the application of Kangfuxin solution fumigation treatment has a significant effect, which can effectively reduce the patient's wound healing and hospital stay, while improving the patient's anal function and reducing postoperative complications, and is worthy of clinical promotion and application.

Efficacy of photo bio-modulation therapy for pain relief and soft tissue wound healing after dental implant surgery: A double-blind randomized clinical trial

ObjectiveThis study aimed to investigate the effect of photo bio-modulation therapy (PBMT) on pain relief and wound healing after dental implant surgery. Background dataPhoto bio-modulation (PBM) has been used as a therapeutic method for the healing of wounds and controlling pain and inflammation. Materials and methodsIn this clinical trial, 21 patients including 12 men and 9 women were selected based on inclusion criteria. Forty-two implants were placed in the posterior regions of both sides of the mandible. Immediately after the surgery, 660 nm and 810 nm diode laser beams with an energy density of 6 J/cm2 were concurrently irradiated on three sides of the implant regions, buccal, occlusal, and lingual sides. After 48 h both two lasers were applied to patients without irradiation, as placebo devices in the control side. The severity of patients’ pain was examined after 12, 24, 48, and 72 h based on a visual analog scale (VAS). Wound healing score was also determined at 3, 7, and 14 days postoperatively using the Likert scale from 0 to 4. The data were analyzed with SPSS. Statistical significance was set at α = 0.05. ResultsThe laser side exhibited a significant improvement in wound healing and pain relief at all the intervals compared to baseline (p < 0.05). Wilcoxon test showed that the wound healing score on the laser side at 3 (p < 0.001), 7 (p < 0.001), and 14 (p = 0.03) days was significantly better than that on the placebo side. Paired t-test showed that at all the intervals of 12 h (p < 0.008), 24 h (p < 0.04), 48 h (p < 0.008), and 72 h (p < 0.02), the mean pain score on the laser side was significantly lower than that on the placebo side. ConclusionGiven the limitations of this study, the results showed that PBM enhanced wound healing and decreased pain after dental implant surgery.

Management of hard-to-heal leg ulcers with an acid-oxidising solution versus standard of care: the MACAN study.

The efficacy of available wound dressings in the treatment of hard-to-heal wounds is limited. A new therapeutic approach using an acid-oxidising solution (AOS) was developed. Its effect on healing progress, tolerability and safety properties were investigated in a clinical study, and compared with standard of care (SOC) wound dressings. The study aimed to demonstrate the non-inferiority of AOS to SOC in terms of wound healing progress. This open-label, randomised controlled trial was conducted at two study centres in Austria with patients with either infected or non-infected hard-to-heal leg ulcers of different aetiology. Patients were treated for six weeks either with AOS or SOC wound dressings. Outcome assessments included the percentage of granulation and re-epithelialisation tissue, wound size reduction, changes in wound pH, infection control and wound pain, local tolerability and adverse events (AEs). Healing time and rate were also assessed. A total of 50 patients took part. In the AOS group, wounds exhibited higher amounts of granulation and re-epithelialisation tissue, and a faster and more pronounced wound size reduction compared with wounds in the SOC group. In the AOS-treated versus SOC-treated patients, a greater percentage of complete healing of hard-to-heal ulcers was achieved by the end of the study period (32% versus 8%, respectively). Furthermore, the wound pH decreased significantly faster in these wounds (p<0.0001). In all patients with infected leg ulcers, local infection was overcome more rapidly under AOS treatment. In the AOS group, one AE and no serious adverse events (SAEs) were detected versus 24 AEs and two SAEs in the SOC group. In this study, AOS proved to be a highly effective treatment to support wound healing in infected or non-infected hard-to-heal leg ulcers of different aetiology. Efficacy was found to be not only non-inferior but superior to SOC wound dressings. Furthermore, tolerability and safety profiles were favourable for AOS.

Pengaruh pemberian minum jahe merah terhadap penurunan intensitas nyeri luka perineum pada ibu nifas di BPM Permata Bunda Tuban

One of the complications experienced by postpartum mothers is the presence of perineal wounds which can cause more severe pain effects (Sumiaty, 2017). One of the non-pharmacological ways to reduce pain is to drink red ginger. The purpose of this study was to determine the effect of drinking red ginger on reducing the intensity of perineal wound pain in postpartum women at BPM Permata Bunda Tuban. This research method is analytic experimental with a pre-experimental design (Static-group comparison design). The sample of this study was 44 postpartum mothers which were divided into 2 groups, namely the control and treatment groups, with a systematic random sampling technique. Data analysis used Sample t-Test (Independent sample t-Test). Based on the results of the study, it was obtained from 22 respondents (postpartum mothers) on the 5th day who were not given drinking red ginger, most of the respondents experienced moderate perineal wound pain as many as 13 (59.10%), while from 22 respondents (postpartum mothers) on the 5th day, most of those who were given red ginger had mild perineal wound pain as much as 12 (54.60%). The results of the analysis using the sample t-test test found that P of 0.000 is smaller than 0.05, then H1 was accepted that there was an effect of giving red ginger to decrease the intensity of perineal wound pain in postpartum mothers at BPM Permata Bunda Tuban

Abdominal drainage to prevent intra-peritoneal abscess after appendectomy for complicated appendicitis.

This is the second update of a Cochrane Review first published in 2015 and last updated in 2018. Appendectomy, the surgical removal of the appendix, is performed primarily for acute appendicitis. Patients who undergo appendectomy for complicated appendicitis, defined as gangrenous or perforated appendicitis, are more likely to suffer postoperative complications. The routine use of abdominal drainage to reduce postoperative complications after appendectomy for complicated appendicitis is controversial. To assess the safety and efficacy of abdominal drainage to prevent intraperitoneal abscess after appendectomy (irrespective of open or laparoscopic) for complicated appendicitis; to compare the effects of different types of surgical drains; and to evaluate the optimal time for drain removal. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE, Ovid Embase, Web of Science, the World Health Organization International Trials Registry Platform, ClinicalTrials.gov, Chinese Biomedical Literature Database, and three trials registers on 24 February 2020, together with reference checking, citation searching, and contact with study authors to identify additional studies. We included all randomised controlled trials (RCTs) that compared abdominal drainage versus no drainage in people undergoing emergency open or laparoscopic appendectomy for complicated appendicitis. We also included RCTs that compared different types of drains and different schedules for drain removal in people undergoing appendectomy for complicated appendicitis. We used standard methodological procedures expected by Cochrane. Two review authors independently identified the trials for inclusion, collected the data, and assessed the risk of bias. We used the GRADE approach to assess evidence certainty. We included intraperitoneal abscess as the primary outcome. Secondary outcomes were wound infection, morbidity, mortality, hospital stay, hospital costs, pain, and quality of life. Use of drain versus no drain We included six RCTs (521 participants) comparing abdominal drainage and no drainage in participants undergoing emergency open appendectomy for complicated appendicitis. The studies were conducted in North America, Asia, and Africa. The majority of participants had perforated appendicitis with local or general peritonitis. All participants received antibiotic regimens after open appendectomy. None of the trials was assessed as at low risk of bias. The evidence is very uncertain regarding the effects of abdominal drainage versus no drainage on intraperitoneal abscess at 30 days (risk ratio (RR) 1.23, 95% confidence interval (CI) 0.47 to 3.21; 5 RCTs; 453 participants; very low-certainty evidence) or wound infection at 30 days (RR 2.01, 95% CI 0.88 to 4.56; 5 RCTs; 478 participants; very low-certainty evidence). There were seven deaths in the drainage group (N = 183) compared to one in the no-drainage group (N = 180), equating to an increase in the risk of 30-day mortality from 0.6% to 2.7% (Peto odds ratio 4.88, 95% CI 1.18 to 20.09; 4 RCTs; 363 participants; low-certainty evidence). Abdominal drainage may increase 30-day overall complication rate (morbidity; RR 6.67, 95% CI 2.13 to 20.87; 1 RCT; 90 participants; low-certainty evidence) and hospital stay by 2.17 days (95% CI 1.76 to 2.58; 3 RCTs; 298 participants; low-certainty evidence) compared to no drainage. The outcomes hospital costs, pain, and quality of life were not reported in any of the included studies. There were no RCTs comparing the use of drain versus no drain in participants undergoing emergency laparoscopic appendectomy for complicated appendicitis. Open drain versus closed drain There were no RCTs comparing open drain versus closed drain for complicated appendicitis. Early versus late drain removal There were no RCTs comparing early versus late drain removal for complicated appendicitis. The certainty of the currently available evidence is low to very low. The effect of abdominal drainage on the prevention of intraperitoneal abscess or wound infection after open appendectomy is uncertain for patients with complicated appendicitis. The increased rates for overall complication rate and hospital stay for the drainage group compared to the no-drainage group are based on low-certainty evidence. Consequently, there is no evidence for any clinical improvement with the use of abdominal drainage in patients undergoing open appendectomy for complicated appendicitis. The increased risk of mortality with drainage comes from eight deaths observed in just under 400 recruited participants. Larger studies are needed to more reliably determine the effects of drainage on morbidity and mortality outcomes.

Clinical Comparison of MEBO and Hyaluronic Acid Gel in the Management of Pain after Free Gingival Graft Harvesting: A Randomized Clinical Trial.

Aim This study aimed to compare the effect of MEBO versus 0.2% hyaluronic acid gel (Gengigel®) applied to the palatal donor site on postoperative pain reduction and wound healing after free gingival graft harvesting. Methodology. Thirty-nine patients with different mucogingival defects were included in this study for harvesting a free gingival graft (FGG) for soft tissue augmentation. Patients were randomly assigned into three equal groups: group I (MEBO), group II (0.2% HA Gengigel®), and group III (control). Postoperative pain was recorded by using the Visual Analogue Scale (VAS). Analgesic consumption was recorded for 7 days postoperatively. Wound size was measured at baseline and on days 3, 7, 14, and 21. Postoperative healing of the palatal wound was assessed by the VAS score for color match on days 3, 7, 14, 21, and 42. Results Results of this study showed significant postoperative pain reduction for the three groups; MEBO showed statistically significant less VAS score compared to the other two groups, while HA showed statistically significant less VAS score compared to the control group. Both MEBO and HA showed statistically significant less total analgesic consumption. No statistically significant difference was observed between groups for wound size. MEBO showed statistically significant higher VAS for color match. Conclusions Both treatment modalities could reduce postoperative pain following harvesting of FGG and improve the palatal wound healing. However, MEBO showed better outcomes in terms of postoperative pain and color match.

Comparison of wound healing and patient comfort in partial-thickness burn wounds treated with SUPRATHEL and epictehydro wound dressings.

Among the available dressings for partial‐thickness burn wound treatment, SUPRATHEL has shown good usability and effectiveness for wound healing and patient comfort and has been used in many burn centres in the last decade. Recently, bacterial nanocellulose (BNC) has become popular for the treatment of wounds, and many studies have demonstrated its efficacy. epicitehydro, consisting of BNC and 95% water, is a promising product and has recently been introduced in numerous burn centres. To date, no studies including direct comparisons to existing products like SUPRATHEL have been conducted. Therefore, we aimed to compare epicitehydro to SUPRATHEL in the treatment of partial‐thickness burns. Twenty patients with partial‐thickness burns affecting more than 0.5% of their total body surface area (TBSA) were enrolled in this prospective, unicentric, open, comparative, intra‐individual clinical study. After debridement, the wounds were divided into two areas: one was treated with SUPRATHEL and the other with epicitehydro. Wound healing, infection, bleeding, exudation, dressing changes, and pain were documented. The quality of the scar tissue was assessed subjectively using the Patient and Observer Scar Scale. Wound healing in patients with a mean TBSA of 9.2% took 15 to 16 days for both treatments without dressing changes. All wounds showed minimal exudation, and patients reported decreased pain with the only significant difference between the two dressings on day 1. No infection or bleeding occurred in any of the wounds. Regarding scar evaluation, SUPRATHEL and epicitehydro did not differ significantly. Both wound dressings were easy to use, were highly flexible, created a safe healing environment, had similar effects on pain reduction, and showed good cosmetic and functional results without necessary dressing changes. Therefore, epicitehydro can be used as an alternative to SUPRATHEL for the treatment of partial‐thickness burn wounds.

Diabetic Foot Wounds Treated With Human Amniotic Membrane and Low-level Laser Therapy: A Pilot Clinical Study

Low-level laser therapy (LLLT) and human amniotic membrane (HAM) application have been shown to be viable options for use in wound healing. This study sought to compare LLLT and HAM to a control treatment (hydrogel, saline, and gauze) in persons with diabetes mellitus (DM) and foot ulcers. Using a prospective pilot clinical study design, patients receiving care at a health center that specializes in the treatment of diabetic foot wounds between November 2016 and August 2017 were recruited. Eligible patients had to be 30 to 59 years of age; diagnosed with type 2 DM (postprandial capillary glucose levels between 140 and 350 mg/dL); and have uninfected, granulating stage 2 or 3 foot ulcers measuring less than 7 cm by 3 cm. Immunosuppressed and malnourished patients or those with neoplasms or in critical condition were not eligible to participate. Patients received the control treatment (2 mg hydrogel, saline, and gauze), HAM (patches of thawed HAM, applied with overlapping edges), or LLLT (phototherapy session, 2 mg hydrogel, saline, and gauze) for 28 days. Variables, wound area measurements, Pressure Ulcer Scale for Healing (PUSH) scores, and Visual Analog Scale (VAS) scores were used to assess wound improvement progress and pain on days 7, 14, 21, and 28. Descriptive statistics were used to analyze the participant anthropometric and clinical profiles. The Kolmogorov-Smirnov test was used to analyze the sample distribution. The Kruskal-Wallis test with Dunn's post-test was used to evaluate differences in PUSH and VAS scores and wound size for intergroup analysis, and the Mann-Whitney U test was used for the same outcomes in intragroup analysis. The level of significance was 5% (P < .05). Twenty-seven (27) patients participated (mean age, 51.4 years; mean body mass index, 26.5 kg/m2), with 9 patients in each treatment group. No statistically significant differences were noted in clinical or anthropometric variables among the groups, but mean baseline wound areas were different (2.6 cm² for the control, 1.9 cm² for the LLLT, and 5.5 cm² for the HAM groups). Intragroup comparisons showed a significant reduction in PUSH score in the LLT group between days 0 and 21 (8.2 vs 4.9; P < .01) and days 21 to 28 (4.9 vs 3.2; P < .001). In all treatment groups the percent reduction was significantly different between days 7 and 28. No outcomes were significantly different between groups. Diabetic foot ulcer wound area as well as PUSH and VAS scores showed more improvement for patients with DM receiving LLLT or HAM than for the control group, but the differences were not significant. Larger studies are needed to compare these treatment modalities.

Rehabilitation of patients after diabetic foot amputation

Background: Diabetic foot is a diabetes-related complication that often requires amputation due to ulcer, necrosis, infection, and wound healing problems. Amputation decreases ambulation ability and worsens the patient’s general condition. Thus, active gait training is important after amputation.Current Concepts: The level of amputation depends on the anatomical position, for example, toe amputation and transfemoral amputation. The impairment of ambulatory function is also determined by the position of amputation. Continuous rehabilitation exercise is encouraged for ambulation before surgery. Wound management and pain control are needed for early rehabilitation exercise after surgery. The maturation of the amputation stump is especially important and needed for prosthesis wearing. If the general condition of the patient permits, muscle strengthening exercises, joint range of motion exercises, and ambulation exercises should be started as soon as possible.Discussion and Conclusion: Sufficient understanding of functional decline after amputation is required. The clear goal of ambulation should be set in consideration of the patient’s general condition and ability to walk before surgery. The ultimate goal of amputation is not only to remove necrosis, ulcers, and infected tissues but also to restore ambulatory function. Thus, expertise and significant effort before and after surgery are required.