Postoperative Wound Healing Research Articles

Сравнительная характеристика методик формирования глоточно-пищеводного анастомоза и бесканюльной трахеостомы у ларингэктомированных пациентов

Radical treatment of laryngeal cancer allows achieving good oncological results but leads to disability of patients. Restoration of voice function after laryngectomy is the main aspect of rehabilitation. The improvement of existing methods of pharyngeal reconstruction contributes to the creation of favorable conditions for subsequent rehabilitation. Objective. Improving the effectiveness of the results of the surgical stage of complex rehabilitation of laryngectomized patients. Materials and methods. The results of surgical treatment were analyzed in 70 patients diagnosed with stage III–IV laryngeal cancer. Patients were divided into 2 groups depending on the technique of suturing the pharynx and the formation of a tubeless tracheostomy. Results. The developed technique of pharyngeal reconstruction with simultaneous formation of anatomical and physiological prerequisites for early rehabilitation of patients after laryngectomy does not increase the total operation time and averages 25–30 minutes in 68.57% of cases, reduces the likelihood of complications in the postoperative period by 11.41%, reduces the incidence of scarring deformities of the pharyngeal-esophageal funnel by 11.43%, allows achieving the formation of a tubeless tracheostomy resistant to narrowing in 74.27%, and does not affect the oncological effectiveness of combined treatment of patients with stage III–IV laryngeal cancer. Conclusion. The developed method of closing the pharyngeal defect after laryngectomy showed high effectiveness and allowed improving the results of postoperative wound healing, reducing the number of local postoperative complications as well as improving functional results.

Subcutaneous Onlay Laparoscopic Approach versus Laparoscopic Intraperitoneal Onlay Mesh Repair for Paraumbilical Hernias: A Randomised Clinical Trial

Introduction: Paraumbilical hernias are currently treated most effectively with a minimally invasive strategy. After the introduction of Intraperitoneal Onlay Mesh Placement (IPOM), it has been performed as a traditional technique for paraumbilical hernias, though there are many techniques such as placement of mesh in the preperitoneal/retromuscular space or subcutaneous space. However, there has been a constant debate over the choice of a better approach. Aim: To compare the short-term outcomes of IPOM and Subcutaneous Onlay Laparoscopic Approach (SCOLA) repair (subcutaneous onlay mesh placement) for paraumbilical hernias. Materials and Methods: A randomised clinical trial was conducted in the Department of General Surgery, SRM medical college hospital and research centre, Chennai, Tamil Nadu, India, from March 2021 to August 2022. Study was conducted on patients undergoing laparoscopic hernia mesh repair for paraumbilical hernia. A total of 60 individuals were included in the study. They were placed in groups A and B according to block randomisation with concealed cover. Group A got laparoscopic SCOLA repair and group B got laparoscopic IPOM repair. The patients were tracked for a total of six months. A comparison of two groups was done to evaluate which technique is superior over the other in terms of duration of hospitalization, cost-effectiveness, duration of surgery, postoperative pain, postoperative complications, speed of recovery and returning to routine activity and recurrence. Results: Total 60 participants were divided into two groups, 30 subjects each in group A and group B with a mean±Standard Deviation (SD) age of the subjects in SCOLA group and IPOM group was 37.50±8.41 years and 37.87±9.18 years, respectively. Laparoscopic SCOLA repair for paraumbilical hernia has a comparable outcome to the traditional laparoscopic approach like IPOM in terms of postoperative wound healing (p-value=0.25). A 6-month follow-up revealed no recurrence in either group. Being a newer procedure that requires extensive dissection, the operating time (p-value=0.001), seroma formation (p-value=0.057) and number of hospital days (p-value=0.001) was higher for SCOLA. Also, it was noted that patients who underwent IPOM had significantly more pain experienced as compared to those undergoing SCOLA (p-value 0.45, 0.01 and 0.66 on postoperative days 1, 3 and 5, respectively). Moreover, a significant advantage of SCOLA is its cost-effectiveness. Conclusion: With the advantages of cost-effectiveness and lesser pain, SCOLA approach may be used more frequently in selected patients.

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Abstract. The number of patients with clinical manifestations of allergies demonstrates annual growth worldwide. The most common allergens are household and pollen ones, but there is growing evidence of increase in the number of people with hypersensitivity to metals. The main clinical symptoms are stomatitis, gingivitis, sinusitis, but in some patients we observe systemic manifestations: chronic urticaria, angioneurotic edema, bronchial asthma.The prevalence of allergy to metals is high in the general population, and it is estimated that up to 20 % of Europeans and up to 17 % of the US population suffer from nickel allergies, 4 % are hypersensitive to chromium and about 7-9 % of the population are sensitized to cobalt. Clinical manifestations of allergy to metals may not appear immediately in the first days or even weeks after the installation of metal structures. Due to the peculiarity of the immune response, the symptoms of the disease may manifest atypically and are difficult to diagnose. In patients after hip or knee replacement the allergic reaction may manifest itself not as urticaria or allergic rhinitis, but as aseptic bursitis or prolonged poor postoperative wound healing, muscle necrosis or pain at the site of surgery. Cobalt may induce local apoptosis and lymphocytosis, leading to marked local tissue damage. Our patient had symptoms of allergy to dental implants for two years, but they were disguised as laryngotracheitis, sinusitis, and obstructive bronchitis. After receiving the diagnostic results, it was decided to remove the implant and prescribe desensitizing therapy. After 2 weeks after the removal of the metal structure, and currently, the patient has no complaints and clinical manifestations of laryngotracheitis, sinusitis, and brochitis. So, patch testing is a simple and reliable method of contact allergy diagnosing. Key words: allergy to metals, dental implants, patch testing.

A Systematic Review and Meta-analysis of the Use of Simmering Pus and Growing Flesh Method to Promote Postoperative Wound Healing in Anorectal Diseases

Objective: To systematically review the clinical efficacy and progress of Chinese medicine's external treatment method guided by the theory of simmering pus and growing flesh to promote postoperative wound repair in anorectology. Methods: Clinical randomized controlled trials (RCTs) of simmering pus and growing flesh method to promote postoperative wound healing in anorectology were collected by a computer search of China Knowledge Network (CNKI), Wanfang (WANGFANG DATA), VIP (VIP), China Biomedical Literature Database (CBM) and other means, and the screening of articles and the extraction of article data were performed according to the inclusion and exclusion criteria.Meta-analysis of the extracted data was also performed using Stata14 software, to compare the overall efficacy, mean wound healing time, and other clinical observations of patients with postoperative wounds in anorectal medicine by the external Chinese medicine method of simmering pus and growing flesh with the non-simmering pus and growing flesh method. Results: The final 12 publications were included, with a total of 931 study participants, and the Meta results showed that the TCM external treatment of simmering pus and growing flesh method helped to shorten the mean wound healing time [WMD=-3.791 , 95% CI (-4.629 , 2.952), P<0.05], improve the 14-day wound healing rate [WMD=9.341 , 95% CI (6.951 , 11.731), P<0.05], and improved postoperative wound recovery efficiency in anal diseases [RR=3.099, 95% CI (1.898, 5.060), P<0.05].Conclusion: The simmering pus and growing flesh method helps to improve the average healing time and wound healing rate of postoperative wounds in anal diseases, thus improving the efficiency of postoperative wound repair in anal diseases.

A comparative study for assessment of post-operative sequelae following mandibular transalveolar molar extractions using ozone and dexamethasone

Objectives: Trans-alveolar extractions involve surgical removal of tooth that has its own postoperative sequelae, most commonly manifested as pain and swelling. This study aims to compare the efficacy of topical ozone and dexamethasone in management of post-operative sequelae after mandibular trans-alveolar molar extractions. Materials and Methods: Sixty patients requiring surgical removal of mandibular molars under local anesthesia were randomly allocated into two groups, each group consisting of 30 patients. Group 1 received Topical Ozonated Oil in the extraction socket post-operatively, while Group 2 was administered 8 mg dexamethasone injection post-operatively. The patients were checked for postoperative wound healing, pain and swelling on 1st, 3rd and 7th day. Results: The results showed comparatively similar results for the pain severity and swelling score at the 1st and 7th postoperative day in both the groups. A greater reduction of pain was noticed in Group 1 on 3rd postoperative day. Wound Healing was noted to be better in Group 1 at 3rd and 7th post-operative day. Conclusion: In conclusion, topical ozone therapy can be used as an effective alternative treatment modality, when compared to dexamethasone for better management of post-operative sequelae following mandibular trans-alveolar molar extractions.

An implantable composite scaffold for amplified chemodynamic therapy and tissue regeneration.

Tissue regeneration and tumor cell killing after surgical resection are the two keys to achieving effective tumor therapy. In this study, an implantable system with combined functions of tumor therapy and tissue repair was constructed. Tannic acid (TA)/Fe3+ nanoparticles with Fenton catalytic activity were loaded with GSH inhibitor BSO drug (BTF), and acted as the therapeutic factor to realize amplified chemodynamic tumor treatment. Bioactive glass (BG) fibers loaded with vascular endothelial growth factor (VEGF) were used as the drug carrier matrix with tissue repair function (BGV). Then the BGV@BTF composite fibers were obtained by anchoring BTF nanoparticles on the surface of BGV fibers. Under tumorous acidic conditions, BTF nanoparticles can be released from the composite fibers, and taken up by tumor cells. Facilitated by BSO with the GSH suppression effect and TA with Fe3+ reducing properties, BTF nanoparticles can realize high oxidative stress in tumor cells and subsequent cell death. In addition, BG fibers and VEGF can both promote tissue regeneration and accelerate postoperative wound healing. The simultaneous suppression of tumor growth and promotion of tissue repair in this work is inspiring in the field of postoperative tumor treatment and recovery.

Antibiotic artificial bone implantation for the treatment of infection after internal fixation of tibial plateau fractures

ObjectiveTo explore the clinical effect of antibiotic artificial bone (Calcium phosphate) in the treatment of infection after internal fixation of tibial plateau fractures.MethodsWe retrospectively reviewed the clinical data of 32 patients with infection after internal fixation of tibial plateau fractures treating from March 2010 to October 2021. There were 18 males and 14 females, aged from 23 to 70 (average 49.66 ± 10.49), 19 cases of the left side and 13 cases of the right side. Among them, 7 cases were open fractures with initial injury and 25 cases were closed fractures. On the basis of thorough debridement and implanting antibiotic artificial bone, the internal fixation of 18 patients were tried to be preserved and the internal fixation of 14 patients were removed completely. In order to provide effective fixation, 14 patients also received external fixation. Postoperative wound healing, infection control, Hospital for Special Surgery knee scores (HSS), related inflammatory indicators and bone healing time were recorded and followed up.ResultsThirty-two patients were followed up for 12 ~ 82 months (average 36.09 ± 19.47 months). The redness, swelling and pain of pin site occurred in 2 patients, which returned to normal after applying antibiotics and continuous dressing change. One patient retained the internal fixation during the first-stage operation. Redness and swelling of incision, subcutaneous undulation occurred after two months. In order to avoid the recurrence of infection, the internal fixation was removed completely and antibiotic artificial bone was filled again. The infection was controlled and fracture healed. Four patients’ wounds could not be closed directly due to soft tissue defect and was covered with skin flap. After the first-stage operation, 12 patients received second-stage autologous iliac bone grafting due to residual bone defects and poor healing of the fracture end. The bone healing time was 4 ~ 16 months (average 7.31 ± 2.79 months). Inflammatory indicators including CRP, ESR, and WBC returned to normal levels within 2 ~ 10 weeks (average 4.97 ± 2.58 weeks). The HSS of all patients were 54 ~ 86 points (average 73.06 ± 8.44 points) at the last follow-up.ConclusionImplantation of antibiotic artificial bone, retention or removal of internal fixation according to infection and fracture healing, application of external fixation timely is an effective method to treat infection after internal fixation of tibial plateau fractures, which can control infection effectively and promote functional recovery.

Ozone therapy, applications in surgical pathology.

The paper deals with a series of cases in the field of surgical pathology, surgically and non-surgically solved in the first private clinic with continuous hospitalisation in Oltenia region.&#x0D; &#x0D; THE RELATIONSHIP BETWEEN SURGERY AND OZONE THERAPY.&#x0D; The benefits are particularly seen in the postoperative period. A special category is wounds, as follows:&#x0D; A) Chronic, non-healing, refractory to conventional treatments or special dressings.&#x0D; - Local causes: resistant germs, circulatory disorders.&#x0D; - General causes: diabetes, neoplasia, immunosuppressed patients.&#x0D; B) Infected ulcerated mammary neoplasms&#x0D; C) Postoperative infiltration, before reaching the stage of suppuration&#x0D; D) Speeding up wound healing with high substance deficiency&#x0D; E) Post-operative wounds defectively healed&#x0D; A retrospective study conducted on 55 patients with various surgical pathologies treated with ozone for 20-40 days demonstrates the positive effect of the treatment, with an obvious improvement of symptoms and accelerated healing of postoperative wounds.&#x0D; The paper will detail cases with certain particularities: age, patient’s medical background, lesion itself, evolution under treatment.&#x0D; This work should awaken and propel medical specialists to reconsider ozone therapy more carefully.

RECONSTRUCTIVE PLASTIC SURGERY INVOLVING THE PECTORALIS MAJOR MUSCLE FOR BASAL CELL CARCINOMA OF THE FACIAL SKIN: A CLINICAL CASE

Relevance: Basal cell skin cancer is the most common malignant skin tumor originating from epithelial cells. Reconstruction of al-tered tissues and organs is an urgent and significant medical and social problem. In particular, head and neck injuries are complicated for functional, cosmetic, and aesthetic reconstruction.&#x0D; The study aimed to share the experience of performing reconstructive plastic surgery using the pectoralis major muscle at the Head and Neck Tumor Center of Kazakh Institute of Oncology and Radiology, JSC (KazIOR, Almaty, Kazakhstan).&#x0D; Methods: The article describes the experience, operation steps, and results of postoperative wound healing after reconstructive sur-gery for skin cancer progression. A split musculocutaneous flap with the inclusion of the pectoralis major on a vascular pedicle was used. The surgery was performed at the Center for Head and Neck Tumors of KazIOR.&#x0D; Results: Follow-up control 6 and 12 months after surgery showed that the musculocutaneous flap was intact. There was no evidence of recurrence or metastasis.&#x0D; Conclusion: Musculocutaneous flaps involving the pectoralis major can successfully reconstruct combined extensive head and neck injuries.

RECONSTRUCTIVE PLASTIC SURGERY INVOLVING THE PECTORALIS MAJOR MUSCLE FOR&#x0D; BASAL CELL CARCINOMA OF THE FACIAL SKIN:&#x0D; A CLINICAL CASE

Relevance: Basal cell skin cancer is the most common malignant skin tumor originating from epithelial cells. Reconstruction of altered tissues&#x0D; and organs is an urgent and significant medical and social problem. In particular, head and neck injuries are particularly difficult for functional,&#x0D; cosmetic, and aesthetic reconstruction.&#x0D; The article aimed to share the experience of performing reconstructive plastic surgery using the pectoralis major muscle at the Head and Neck&#x0D; Tumor Center of Kazakh Research Institute of Oncology and Radiology, JSC (KazIOR, Almaty, Kazakhstan).&#x0D; Methods: The article describes the experience, operation steps, and results of postoperative wound healing after reconstructive surgery for&#x0D; skin cancer progression. A split musculocutaneous flap with the inclusion of the pectoralis major on a vascular pedicle was used. The surgery was&#x0D; performed at the Center for Head and Neck Tumors of KazIOR.&#x0D; Results: Follow-up control 6 and 12 months after surgery showed that the musculocutaneous flap was intact. There was no evidence of recurrence or metastasis.&#x0D; Conclusion: Musculocutaneous flaps involving the pectoralis major can successfully reconstruct combined extensive head and neck injuries.

COMPARISON OF CONSERVATIVE METHODS OF PREVENTION OF PATHOLOGICAL SCARING OF THE HEAD AND NECK

Wound healing is one of the most common and complex processes, which includes five phases: hemostasis, inflammation, proliferation, re-epithelialization, and remodeling. Each stage of wound healing requires the complex synchronization and regulation of multiple cell populations. Violation of the link of any of these processes can lead to the appearance of complications and increase the likelihood of the formation of pathological scars. To study the research materials, we used the bibliosemantic and analytical method, with the help of which we processed the literary data, as well as the materials of clinical studies, which were posted on the Internet. There are many conservative methods of prevention of the pathological scars formation in the area of head and neck, one of the main links is occupied by ointments with different components. Thus, a clinical study by Marquardt Y showed that the local application of dexpanthenol in the form of an ointment contributes to better healing of superficial and postoperative wounds. According to foreign scientists, silicone products, both in the form of sheets and gel, are considered to be the first line in the prevention and treatment of hypertrophic and keloid scars. Goutos I., suggested the use of corticosteroid tape, which is a painless alternative to corticosteroid injections. Japanese scientists Ogawa R and co-authors note the good clinical experience and results of using corticosteroid tape and patch. Recent research by Powell HM., 2022 on the use of pressure therapy for lacerations has shown that tension relief is a powerful strategy to prevent scar formation in the head and neck area. Ud-Din S et al., proposed photodynamic therapy, which has a good evidence base for the effectiveness of this method. Over the past decade, many high-quality studies have been conducted, increasing the level of evidence base for many prevention or treatment regimens. The article reflects modern methods of conservative prevention, however, taking into account ethnic differences, predisposition to pathological scars, algorithms for prevention and treatment should be refined and optimized.

Relationship between periodontal disease and vitamin D

Vitamin D is a hormone synthesized by human skin cells or consumed through diet with immunomodulatory, anti-inflammatory, and antiproliferative effects. Vitamin D deficiency may increase the risk of periodontal disease by causing decreased bone mineral density, osteoporosis, progression of periodontal diseases, and resorption of the jawbone. In addition, vitamin D is important for bone metabolism, alveolar bone resorption, and the prevention of tooth loss. It increases the antibacterial defense of gingival epithelial cells, reduces gingival inflammation, accelerates postoperative wound healing after periodontal surgery, and is a key supplement functioning as a prophylaxis in periodontology. The present review study aims to highlight the role of vitamin D in periodontal disease.

Negative versus natural drainage after single-level posterior lumbar interbody fusion. A prospective randomized study

IntroductionDespite of their extensive use, drains remain controversial without clear guidelines, and there is unclear evidence on drain use in spine procedures. Negative pressure drainage is theoretically more effective in preventing postoperative hematomas. On the contrary, it may result in excessive drainage and blood loss.The aim of this study was to compare the outcome between the uses of negative versus natural drainage in single level posterior lumbar interbody fusion (PLIF). Research questionThe aim is to compare between negative versus natural drainage after single-level PLIF as regard to postoperative wound infection, wound healing, temperature, pain and neurological deficits. Materials and methodsA prospective randomized study of consecutive PLIF patients at a single level for lumbar disc prolapse was performed between January 2019 and January 2020. The patients were randomly assigned to either the negative suction drainage group or natural drainage group. Negative suction was created by maximum compression of the reservoir to create negative pressure. In the other group, natural pressure drainage was kept without any negative pressure.Our study included a total of 62 patients who met the inclusion criteria. They were divided into two groups; 33 patients had negative suction drains and 29 patients had natural drainage. There were 32 female (51.6%) and 30 male (48.4%). Their ages ranged between of 23–69 years, with a mean age of 42.11 ​± ​8.89 years. ResultsDrainage volume was statistically higher in the negative group on the day of surgery (day 0) as well as the 1st and second days after. However, no significant differences were observed as regards to postoperative temperature, pain, wound infection, temperature, or neurological deficits. Discussion &conclusionIn this prospective randomized study, our results revealed that natural drainage in short term can reduce the total amount of blood in the drain, and therefore the blood loss without significant differences in postoperative wound infection, wound healing, temperature, pain, or neurological deficits in single-level PLIF.

Association Between Wound Healing and Psycho-Emotional State Among Postoperative Patients

Wound healing is a difficult process, it can be complicated by experiences that can occur during pre-operative and post-operative periods. Emotions have a substantial influence on human behaviour and health. Therefore, it is important to study interaction of wound healing and psychoemotional state, in order to obtain efficient wound treatment and care in Lithuania.&#x0D; Aim of the work - to evaluate interface of postoperative patients of wound healing and psycho-emotional state.&#x0D; Methods. A mixed study was conducted, combining quantitative and qualitative research methods. Instruments used: questionnaire (Minnesota Multiphasic Personality Inventory (MMPI-2) test and the Lüscher color test) and medical document analysis (used to identify wound healing type). Statistical analysis of research data performed using statistical software package SPSS 17.0 and Microsoft Excel 2016. Research sample – 383 respondents. Research conducted in accordance with the principle of ethics.&#x0D; Results. The study revealed that women reported higher levels of post-operative state anxiety. Men tend to value their psycho-emotional stress levels more favourably. Also, data analysis revealed that there was an increase in men interaction with environment during post-operative period. Female respondent group showed statistically significant dependence between concomitant illnesses and wound healing, when concomitant illnesses affected wound healing in a negative way. There was a dominance of secondary intention wound healing in respondents (male and female) who had higher levels of post-operative psycho-emotional stress.&#x0D; Conclusions. Taken together, findings indicate that negative psycho-emotional experiences during post-operative period affect wound healing in a negative way, slowing down the healing process.

Pharmacokinetic/Pharmacodynamic Modeling and Simulation of the Analgesic Effects of Pentazocine Using Perioperative Real-World Data.

Pentazocine (PTZ) is a widely used drug for postoperative pain. It should be administered at appropriate dosing intervals not only because of its morphine-like side effects but also because frequent inappropriate dosing can lead to dependence. Although perioperative patients reportedly have nonnegligible effects on placebo drugs and postoperative wound healing, no pharmacokinetic (PK)/pharmacodynamic (PD) model has been established and simulated using real-world data for the perioperative period. This study aimed to perform PTZ modeling and simulation and to establish an indicator of the timing of drug efficacy evaluation in clinical practice. Participants were in-hospital orthopedic surgery patients who received 15 mg of PTZ within 48 h postoperatively. Pain severity was assessed using the numerical rating scale (NRS). A two-compartment model was selected for the population PK model and an indirect response model for the PK/PD model. Using these models, a virtual population of 1000 patients with Painbase NRS of 5 and 6 and body weights of 40, 80, and 120 kg were treated with single and multiple PTZ administrations (4, 8, and 24 h apart) of 15 mg. Simulation results indicate that its analgesic efficacy should be evaluated within 1 h after administration of 15 mg of PTZ. Additional doses should be considered every 8-12 h in postoperative patients with Painbase NRS of 5 weighing 40-80 kg. Simulation using the PK/PD model developed in this study may provide useful information for determining the analgesic effects and timing of the dosing interval after PTZ administration in perioperative patients.

Assessment of Pain, Healing Time, and Wound Contraction in Postoperative Auricular Defects Healing Secondarily With and Without the Use of a Porcine Xenograft, a Pilot Study.

Postoperative auricular defects heal well with secondary intention healing (SIH); however, potential complications include postoperative pain, perichondritis, and chondritis. To compare postoperative pain and wound healing in auricular defects healing by secondary intention with and without the placement of a porcine xenograft. Twenty-one subjects were enrolled in the study. The primary outcome was self-reported pain, measured on a 0 to 10 scale for 14 postprocedure days. Secondary outcomes included time to greater than 90% of reepithelialization and degree of wound contraction. There was a 1 to 2 point difference in median pain scores between the porcine graft and control groups during postoperative days 4 to 7, 12, and 13. Time to 90% or greater reepithelialization was not statistically different between groups (p = .94). The average wound contraction was 34.1% for the porcine group and 34.0% for the control group (p = .95). In this pilot study, overall pain scores were low in both groups. Placement of a porcine xenograft resulted in a slight reduction of median pain compared with traditional SIH. Patients in the control group were more likely to require analgesics. Similar rates of reepithelialization and degree of wound contracture were observed.

Features of Biomechanics and Rehabilitation of the Shoulder Joint after Reverse Arthroplasty: а Review

Reverse shoulder arthroplasty is one of the methods used to treat shoulder joint diseases. The indications for this type of surgery are as follows: clinically expressed arthrosis, including defect arthropathy, rheumatoid arthritis, fracture–dislocation and fractures of the humeral head, oncopathology of the shoulder joint, avascular necrosis, massive rotator cuff tear and dysfunction of the previously installed prosthesis. To date, various models of reverse endoprostheses based on the principles of P. Grammont are used in clinical practice. Shoulder joint arthroplasty is now being used more and more frequently worldwide. The number of shoulder joint replacement surgeries is expected to increase by more than 200% by 2025. One of the features of reverse arthroplasty is the change of the polarity of the articular surfaces. The design of the prosthetic implant significantly changes the biomechanics of the shoulder joint. Different variations of the design parameters affect the functioning of the joint. In order to achieve optimal volume of movement, it is necessary to carefully select the following characteristics of the implant: the diameter of the glenoidal sphere, the displacement of the scapular component, the displacement of the rotation center and the change in the angle of inclination of the neck of the shoulder component.Understanding the biomechanical features of the shoulder joint after reverse endoprosthetics makes it possible to determine the optimal approach to the rehabilitation treatment of patients after surgery. The main goals of rehabilitation after reverse arthroplasty are: pain minimization and ensuring the healing of postoperative wounds, prevention of postoperative complications (dislocations and periprosthetic fractures), gradual progress of the shoulder motion range, increasing the strength and endurance of the muscles of the shoulder girdle, especially the deltoid muscle. Despite the existence of standard protocols, there are differences in many issues related to postoperative management of patients. This topic needs further development.

Design of Near-Infrared-Triggered Cellulose Nanocrystal-Based In Situ Intelligent Wound Dressings for Drug-Resistant Bacteria-Infected Wound Healing

Postoperative infected wound complications caused by residual tumor cells, bacterial biofilms, and drug-resistant bacteria have become the main challenge in postsurgical skin regeneration. Herein, a bionic cellulose nanocrystal (CNC)-based in situ intelligent wound dressing with near-infrared (NIR)-, temperature-, and pH-responsive functions was designed by using NIR-responsive CNC as the network skeleton, dynamic imine bonds between dialdehyde cellulose nanocrystals and doxorubicin, chitosan oligosaccharide as the pH-responsive switch, and temperature-sensitive poly(N-isopropyl acrylamide) as the temperature-responsive in situ formation switch. The as-prepared wound dressing with the intertwining three-dimensional (3D) network structure possessed high drug loadability of indocyanine green (30 mg/g) and doxorubicin (420 mg/g) simultaneously. The temperature-, NIR-, and pH-responsive switches endowed the wound dressing with controllable on-demand drug release behavior. In particular, the temperature switch endowed the dressing with a shape-adaptable ability on irregularly infected wounds. Interestingly, the wound dressing showed excellent antitumor activity for A375 tumor cells, antibacterial activity against methicillin-resistant Staphylococcus aureus (MRSA) and bacterial biofilm removal ability. Therefore, the developed wound dressing can provide an ideal synergistic treatment strategy combined with chemotherapy and photodynamic and photothermal therapy for postoperative drug-resistant bacteria-infected wound healing.

Fibrin glue: an anti-fibrotic agent for contracted socket

Background: The contracted socket is caused by fibrosis leading to the shortening of the orbital tissue. Vascular endothelial growth factor (VEGF) is a profibrotic factor in postoperative wound healing. The novel option to prevent fibrosis is the use of fibrin glue. This study aims to evaluate the role of fibrin glue in reducing the VEGF expression in cells that cause post-socket surgery scar. Methods: An in vivo experimental study using an animal model was conducted. We used twenty eyes of white rabbit species as the study sample. The evisceration was carried out and distributed to the animals in four experimental groups consisting of the control group, the MMC group (0.1 ml of mitomycin-C (MMC) 0.4 mg/ml), the triamcinolone acetonide (TCA) group (0.1 ml of TCA 40 mg/ml), and the fibrin glue group (0,1 ml of fibrin glue). The treatment was performed through injection of the subconjunctival. After 14 days, rabbits were euthanized, and conjunctiva samples were cut. Immunoreactivity scores (IRS) were used to analyze the expression of VEGF in epithelia conjunctiva with a significant level of p &lt;0.05. Data were analyzed using SPSS version 26 for Windows. Results: All groups showed a statistically significant difference in VEGF expression with a p-value 0,000 (p&lt;0,05). The VEGF level was significantly lower in the three treatment groups compared with the control group. The VEGF expression was highest for the control group, followed by fibrin glue, TCA and MMC group. We found significant differences between the control group and the three treatment groups; the MMC group (p=0.001), the TCA group (p=0.002), and the fibrin glue group (p=0.005). While differences in VEGF expression between the three treatment groups could not be proven statistically. Conclusion: Fibrin glue is proven to reduce VEGF expression as a marker of fibrosis; thus, fibrin glue can be an alternative anti-fibrotic agent.

Does local vaginal estrogen after tension-free transobturator vaginal tape reduce overactive bladder symptoms in postmenopausal women? A prospective randomized, controlled study

ObjectiveWe aimed to evaluate the efficacy of topical estrogen after transvaginal tension-free vaginal tape-obturator (TVT-O) in the treatment of de novo overactive bladder symptoms that appear after surgery. MethodsThis is a prospective randomized controlled study performed in the Urology and Gynecology Departments, Kasr Al Ainy Hospital, Cairo University, Cairo, Egypt. Two hundred and ten postmenopausal females presenting during the period between January 2017 and November 2020 with stress urinary incontinence were included in the study. Patients were divided into two groups, 105 patients in Group A (treatment group) and 105 patients in Group B (control group). Patients in Group A underwent transvaginal TVT-O followed by local vaginal estrogen treatment for 6 months, while patients in Group B underwent transvaginal TVT-O only. The study included any postmenopausal female with urodynamic stress urinary incontinence. All patients had to fulfill a 3-day bladder diary, overactive bladder symptoms score, urine analysis, urodynamic study, and post-voiding residual urine measurement by abdominal ultrasound preoperatively and at 3-month and 6-month follow-ups. ResultsAt 6-month follow-up, daytime frequency was reduced to 8% in Group A (increased to 21% in Group B) with a statistically significant difference between both groups (p=0.009). At 6-month follow-up, nocturia was 8% in Group A (11% in Group B) with no statistically significant difference between both groups (p=0.469). There was a statistically significant difference between both groups as regards to urinary urgency at 6-month follow-up (p=0.024). There was a statistically significant difference in postoperative wound healing events as regards to cure, hyperemia, gapping, and wound infection 1 week after intervention between both groups (p=0.008). No local or systemic side-effects were reported from local estrogen use. ConclusionLocal vaginal estrogen treatment given to postmenopausal patients after midurethral sling procedures can reduce the symptoms of daytime frequency and urinary urgency. Long-term follow-up is needed.