Prevent Wound Healing Research Articles

Copper peroxide loaded gelatin/oxide dextran hydrogel with temperature and pH responsiveness for antibacterial and wound healing activity

Bacterial infection and tissue hypoxia always prevent wound healing, so multifunctional platforms with antimicrobial and oxygen-supplying functions were developed. However, they face many difficulties such as complex preparation and low oxygen release. To address this challenge, a copper peroxide loaded gelatin/oxide dextran hydrogel (CGO) was prepared. Surprisingly, CGO hydrogel as a wound dressing not only had good biocompatibility, injectivity, and mechanical properties, but also exhibited mild photothermal properties, temperature responsiveness, and pH responsiveness. After being applied to wounds infected with bacteria, CGO hydrogel released copper peroxide under near-infrared laser irradiation, which produced copper ions and hydrogen peroxide, combined with PTT to kill bacteria. After the bacteria were cleared from the wound and the pH of the wound was changed to be acidic, CGO hydrogel released copper peroxide via pH response. Copper ions and oxygen produced from copper peroxide accelerated wound healing by promoting angiogenesis. The multi-responsive and multi-mode treatment platform provided a potential strategy for treating bacteria-infected wounds.

Intraoperative radiotherapy combined with spinal stabilization surgery—a novel treatment strategy for spinal metastases based on a first single-center experiences

IntroductionCurrent treatment of spinal metastases (SM) aims on preserving spinal stability, neurological status, and functional status as well as achieving local control. It consists of spinal surgery followed by radiotherapy and/or systemic treatment. Adjuvant therapy usually starts with a delay of a few weeks to prevent wound healing issues. Intraoperative radiotherapy (IORT) has previously been successfully applied during brain tumor, breast and colorectal carcinoma surgery but not in SM, including unstable one, to date. In our case series, we describe the feasibility, morbidity and mortality of a novel treatment protocol for SM combining stabilization surgery with IORT.MethodsSingle center case series on patients with SM. Single session stabilization by navigated open or percutaneous procedure using a carbon screw-rod system followed by concurrent 50 kV photon-IORT (ZEISS Intrabeam). The IORT probe is placed via a guide canula using navigation, positioning is controlled by IOCT or 3D-fluroscopy enabling RT isodose planning in the OR.Results15 (8 female) patients (71 ± 10y) received this treatment between 07/22 and 09/23. Median Spinal Neoplastic Instability Score was 8 [7–10] IQR. Most metastasis were located in the thoracic (n = 11, 73.3%) and the rest in the lumbar (n = 4, 26.7%) spine. 9 (60%) patients received open, 5 (33%) percutaneous stabilization and 1 (7%) decompression only. Mean length of surgery was 157 ± 45 min. Eleven patients had 8 and 3 had 4 screws placed. In 2 patients radiotherapy was not completed due to bending of the guide canula with consecutive abortion of IORT. All other patients received 8 Gy isodoses at mdn. 1.5 cm [1.1–1.9, IQR] depth during 2-6 min. The patients had Epidural Spinal Cord Compression score 1a-3. Seven patients (46.7%) experienced adverse events including 2 surgical site infection (one 65 days after surgery).Conclusion50 kV photon IORT for SM and consecutive unstable spine needing surgical intervention is safe and feasible and can be a promising technique in selected cases.

118 Intraoperative Radiotherapy Combined With Spinal Stabilization Surgery. A Novel Treatment Strategy for Spinal Metastases. First Experiences at a Single Center

INTRODUCTION: Contemporary treatment of spinal metastases (SM) aims on preserving spinal stability, neurological status, local control and functional status. It consists of spinal surgery followed by radio- and chemotherapy. Adjuvant therapy is performed after several weeks to prevent wound healing issues. Intraoperative radiotherapy (ioRT) is a solution to shorten treatment time, successfully applied in brain tumor, breast and colorectal surgery but not SM to date. METHODS: Results on morbidity and mortality of ioRT combined with stabilization surgery in SM in a first single center series are described. Stabilization is performed as CT-navigated open or percutaneous procedure using a carbon screw-rod system followed by 50kV photon-ioRT using the ZEISS Intrabeam during a single session in prone position. The ioRT probe is placed through a guide canula via navigation and positioning is controlled by ioCT to enable RT isodose planning in the OR. Patient characteristics, perioperative specifications and postoperative follow up along with adverse events (AE) are reported. RESULTS: 11 (7 female) patients (69 ± 9.4y) received treatment from 07/22-04/23. Median SINS was 8 [7-10] IQR, with metastasis located in thoracic (n = 9) and lumbar (n = 2) spine. 6 patients receive open, 4 percutaneous stabilization and 1 decompression only. Mean length of surgery was 153±52 min. with 2 Patients receiving 4 and 8 patients receiving 8 screws respectively. In 2 Patients radiotherapy was not completed due to bending of the guide canula with consecutive security abortion of ioRT. All other patients received 8Gy isodoses during 2-6 min. Patients treated had ESCC 1a-2. Mean follow up was 63 ± 49 days. 4 patients experienced AEs including 1 case of fatal surgical site infection. CONCLUSIONS: 50 kV photon ioRT for SM can be a promising technique for selected cases of SM.

Preparation and characterization of unidirectional water-transported bilayer PLA/ZnO-PAN/SPA nanofibrous membrane for wound healing

Wound infection caused by excessive exudate leads to overhydration of wounds and prevents wound healing. Thus, there is a need for a wound dressing to be developed that can unidirectionally export excess biological fluid while inhibiting bacterial infection. Herein, a nanofibrous bilayer membrane with a unidirectional water transport function was fabricated by electrospinning as a novel wound dressing, which can export excess biological fluid efficiently and further inhibit bacterial infection. The inner layer of the bilayer nanofiber membrane is polylactic acid (PLA)-zinc oxide (ZnO) nanofibers, which are hydrophobic and antibacterial. The outer layer is polyacrylonitrile (PAN)-sodium polyacrylate (SPA) nanofibers, which are hydrophilic and liquid-absorbent. The bilayer nanofibrous membrane's morphology, mechanics, thermal stability, wettability, water absorption, gas permeability, and unidirectional water transport ability were characterized and evaluated. The study showed that the nanofibrous bilayer membrane exhibited excellent physicochemical properties and biological performance, and its mechanical properties can reach 4.6 MPa. In addition, when the thickness of the hydrophobic layer is 3 µm and the thickness of the hydrophilic layer is 44 µm, the double-layer fiber membrane can effectively export the excess biological fluid in 5.09 s and prevent the wound from wetting again. The nanofibrous bilayer membrane with excellent water absorption, air permeability, thermal stability, and mechanical strength provides a feasible solution for chronic wound healing.

Keratose Self-Cross-Linked Wound Dressing for Iron Sequestration in Chronic Wounds.

Chronic wound diseases affect a large part of the world population, and therefore, novel treatments are becoming fundamental. People with chronic wounds show high iron and protease levels due to genetic disorders or other comorbidities. Since it was demonstrated that iron plays an important role in chronic wounds, being responsible for oxidative processes (ROS generation), while metalloproteinases prevent wound healing by literally "eating" the growing skin, it is crucial to design an appropriate wound dressing. In this paper, a novel bioactive dressing for binding iron in chronic wounds has been produced. Wool-derived keratose wound dressing in the form of films has been prepared by casting an aqueous solution of keratoses. These films are water-soluble; therefore, in order to increase their stability, they have been made insoluble through a thermal cross-link treatment. Fourier transform infrared (FTIR), differential scanning calorimetry (DSC), and thermogravimetric analyzer (TGA) analyses clarified the structure and the properties of the keratose wound dressing films. The capability of this new biomaterial in iron sequestration has been investigated by testing the adsorption of Fe3+ by inductively coupled plasma-optical emission spectrometry (ICP-OES). The results suggest that the keratose cross-linked films can adsorb a large amount of iron (about 85% of the average amount usually present in chronic wounds) following pseudo-second-order kinetics and an intraparticle diffusion model, thus opening new perspectives in chronic wound care. Furthermore, the QSAR Toolbox was applied for conducting in silico tests and for predicting the chemical behavior of the C-Ker-film. All of the data suggest that the keratose bioactive dressing can significantly contribute to wound healing by mechanisms such as iron depletion, acting as a radical scavenger, diminishing the proteolytic damage, acting as a substrate in place of skin, and, finally, promoting tissue regeneration.

Topical application of Lactobacilli successfully eradicates Pseudomonas aeruginosa biofilms and promotes wound healing in chronic wounds

Chronic wounds are difficult to treat due to the presence of biofilm which prevents wound healing. Pseudomonas aeruginosa is one of the most common pathogens found in chronic wounds and conventional treatment strategies have been ineffective in the eradication of its biofilm, without harming the surrounding healthy tissue at the same time. Here, we introduced an innovative approach applying the probiotic product Bio-K+ (containing three lactobacilli) topically as an antimicrobial and antibiofilm agent. We identified lactic acid as the main active component. While antibiotics and antiseptics such as silver-ions only demonstrated limited efficacy, Bio-K+ was able to completely eradicate mature P. aeruginosa biofilms established in an in-vitro and ex-vivo human skin model. Furthermore, it demonstrated biocompatibility in the co-culture with human dermal fibroblasts and accelerated the migration of fibroblasts in a cell migration assay promoting wound healing. To enhance clinical practicability, we introduced Bio-K+ into the hydrocolloid dressing Aquacel, achieving sustained release of lactic acid and biofilm eradication. This new treatment approach applying probiotics could represent a major improvement in the management of chronic wounds and can be extended in treating other biofilm-associated infections.

Silver-doped bioactive glass fibres as a potential treatment for wound-associated bacterial biofilms

Chronic wounds are a drain on global health services and remain a major area of unmet clinical need. Chronic wounds are characterised by a stable and stubborn bacterial biofilm which hinders innate immune response and delays or prevents wound healing. Bioactive glass (BG) fibres offer a promising novel treatment for chronic wounds by targeting the wound-associated biofilm. In this study, the antimicrobial properties of silver-doped BG fibres were tested against Pseudomonas aeruginosa biofilms, which are commonly found in chronic wound infections. Results showed that BG fibres doped with silver resulted in a 5log10 reduction in biofilm formation whereas silver-free fibres only reduced formation by log10, therefore silver-doped fibres possess stronger antimicrobial effects. Moreover, there appeared to be a synergistic effect between the fibres and the silver as the application of the silver-doped fibres placed directly in contact with the forming biofilm resulted in a higher reduction in biofilm formation compared to treatments either: using the dissolution ions, using BG powder, or when the fibres were placed in an insert above the biofilm, inhibiting physical contact, instead. This suggests that the physical properties of the fibres, as well as silver, influence biofilm formation. Finally, results demonstrated that silver chloride, which is not antimicrobial, forms and the concentrations of antimicrobial silver species, namely silver ions and nanoparticles, reduce over time when fibres are soaked in cell culture media, which partially explains why the silver-doped dissolution ions contained lower antimicrobial activity compared to the fibres. As silver chloride is more likely to form with increased temperature and time, the antimicrobial activity of silver-containing dissolution ions is highly dependent on the length of ageing and storage conditions. Many studies investigate the antimicrobial and cytotoxic properties of biomaterials through their dissolution products. However, instability of antimicrobial silver species due to silver chloride formation and its effect on antimicrobial properties of silver-based biomaterials has not been reported before and could influence past and future dissolution-based assays as results showed that the antimicrobial activity of silver-based dissolution ions can vary greatly depending on post processing steps and can therefore produce misleading data.

Management of non-healing wound (in the stage of Kushta Purvaroopa) through Ayurveda - A case study

Non-healing wounds are a serious problem faced by many patients. Chronic non-healing wounds are those which fail to progress through a timely sequence of repair. Typically, there is a physiologic impairment that slows or prevents wound healing. The incidence of non-healing wounds is expected to increase as our population ages. The impact on the health and quality of life of the patient and the family cannot be underestimated. Ayurveda has mentioned this condition in the prodromal stage of skin manifestation (Kushta Purvaroopa) as a Chronic -non-healing wound (Vrananaam Chirasthithi). By applying Ati Desha Tantra Yukti (incorporation of useful knowledge from other sources, which are not described in the current science), in this condition, we can understand non-healing wounds and find an appropriate solution to this through Ayurveda. Hence Samprapti (pathology) of Kushta if analysed critically reveals the existence of non-healing wounds. Proceeding on these lines if treatment is started it would be logical. As the term Vrananaam Chirasthithi is not described elsewhere, similar other Samprapti of other Vyadhi (disease) are automatically ruled out. So keeping this assumption in mind the present study was designed for the addition of a new approach to already existing non-healing wounds. The patient was selected for treatment on the lines of Kushta. Based on the observations, the effects of the treatment were analyzed. Treatment modalities relate to Kustha Purvaroopa and mainly removing the Rasa Rakta Mamsagata Kleda (Body fluid, blood and muscle excessive wetness) resulting in wound healing and achievement of Shuddha Chikitsa (pure treatment) without any adverse drug reaction and cost-effectiveness.

Efficacy of Paracrine Factors from Mesenchymal Stem Cells for Treating Biofilm-Infected Wounds in a Murine Model

Background: Chronic wounds are a serious medical condition affecting over 6 million people in the United States. Biofilms, which alter the host immune response and establish a microenvironment that prevents wound healing, are intimately associated with the development of chronic wounds. Current treatment options do not specifically target the underlying molecular mechanisms of biofilm pathology. Paracrine factors secreted by mesenchymal stem cells (MSCs) have been demonstrated to play an important role in wound healing. The objective of this study was to examine the effects of the paracrine factors secreted from MSCs on reducing infection and accelerating wound closure in biofilm-infected wounds.Methods: MSCs were cultured by seeding on an extracellular matrix (ECM). The supernatant from MSCs containing paracrine factors were applied to mature <i>Pseudomonas aeruginosa</i> biofilms <i>in vitro</i> and the number of viable bacteria were quantitated. BALB/cJ mice were wounded and infected with <i>P. aeruginosa</i> biofilms and the paracrine factors from reprogrammed MSCs were applied topically. The wound surface area and colony forming units counts of the treatment group were compared to control (culture media) and biofilm (untreated) groups. Results: The paracrine factors from MSCs grown on ECM were found to reduce <i>P. aeruginosa</i> biofilm growth significantly (P<0.01). Wounds in the treatment group had lower bacterial counts and an increased rate of wound closure compared to non-treated mice wounds. Conclusion: The results indicate that paracrine factors from reprogrammed MSCs accelerated wound healing and reduced the bacterial burden in biofilm-infected wounds. Future studies are needed to further characterize this phenomenon.

Quality of Care and Cost-effectiveness: Optimizing Wound Care in the Netherlands.

Previously, the authors implemented a "fast-track protocol" in the Netherlands to shorten the time to referral for patients when diagnostic testing was deemed necessary given suspicion of underlying pathology preventing wound healing. This subanalysis of the cross-sectional study presents the cost reduction of using that fast-track protocol. The cross-sectional study data were collected at the Alrijne Wound Centre between January 2017 and January 2018 and included patients from two general practitioner practices and a large home-care organization who had a new occurrence of wounds. The cost-effectiveness analysis consisted of an analysis of the mean reduction in care, wound dressing materials, and reduction in unnecessary hospital referrals. In 2017, a total of 415 patients received wound care of the general practitioners or home-care organization. By using the "fast-track" protocol, costs were reduced in all areas. After extrapolation, the minimum mean cost reduction in wound care was €129,949,638; on wound dressings, it was €2,623,920, and on the reduction of unnecessary hospital referrals, the average recovery was €2,436,000. Prompt triage, analyses, and treatment of underlying causes by specialized doctors in a multidisciplinary setting offer enormous potential for cost savings. The conservative estimate is that approximately €135,000,000 to €293,000,000 can be saved in annual healthcare costs in the Netherlands using this protocol.

Apigenin inhibits migration and induces apoptosis of human endometrial carcinoma Ishikawa cells via PI3K-AKT-GSK-3β pathway and endoplasmic reticulum stress

Several experimental and biological studies have emphasized the tumor suppression efficacy and low toxicity of Apigenin (API); however, its exact underlying mechanism on human endometrial carcinoma Ishikawa cell line (EC) is still unknown. We found that API could inhibit the proliferation of Ishikawa cells at IC50 of 45.55 μM, arrest the cell cycle at G2/M phase, induce apoptosis by inhibiting Bcl-xl and increasing Bax, Bak and Caspases. Further, API could induce apoptosis by activating the endoplasmic reticulum (ER) stress pathway by increasing the Ca2+, ATF4, and CHOP. It could impede cell migration and invasion through PI3K-AKT-GSK-3β signaling pathway, preventing wound healing, restraining cells migration from the upper chamber to the lower chamber. This study demonstrated that API can be used as a promising dietary supplement and an adjuvant chemotherapeutic agent for cancer treatment.

Effects of Hypericum scabrum L. essential oil on wound healing in streptozotocin-induced diabetic rats

Background The purpose of this study was to see if the essential oil of Hypericum scabrum L. (H. scabrum L.) has a protective and therapeutic effect on the wound in streptozotocin-induced diabetic rats. Methods In the study, 63 Sprague-Dawley male rats weighing 250–300 g were divided into nine groups, each with seven rats (major groups: control group, diabetes group, and treatment group). For diabetes and treatment groups, streptozotocin (STZ) was given in a single dose of 60 mg/kg/i.p. In 7 days, the animals with diabetes (blood glucose level > 250 mg/dL) will be assigned to wound groups. All of the rats had circular full-thickness incisions in their dorsal skin caused by a 5 mm punch biopsy tool. The rats were slaughtered, blood was obtained, and their forwound tissues were dissected on the 3rd, 10th, and 14th post-wounding days. The levels of malondialdehyde (MDA) and glutathione (GSH), as well as the activities of glutathione peroxidase (GPx), superoxide dismutase (SOD), and catalase (CAT) in plasma and wound tissues, were all measured. Results While GSH level, GPx, SOD, and CAT activities were decreased in the plasma and wound tissues, MDA level increased in the diabetic group as compared to the control group. When compared to the diabetes group, GSH level, GPx, SOD, and CAT activities were increased in the H. scabrum L. essential oil treatments, but MDA levels were decreased. In comparison to the other groups, the wounds in the H. scabrum L. essential oil diabetic groups healed better and faster. H. scabrum L. essential oil can help to reduce lipid peroxidation, oxidative stress, and the associated complications that come with it, as well as play a beneficial role in the treatment of diabetic wounds. Conclusion Since no information was found in the literature search, future work would focus on new research examining H. scabrum L. essential oil applications to come up with new findings in determining the mechanisms of action of H. scabrum L. essential oil in diabetic wounds and preventing wound healing complications in diabetic rats.

EVALUATION of WOUND HEALING in EPISIOTOMY and CESAREAN INCISIONS USING REEDA SCALE

Some factors that prevent wound healing delay healing. Therefore, evaluation and monitoring of wounds is an important intervention. The use of scales in wound assessment is one of the factors that facilitate nursing care and increase the visibility of nursing functions. This descriptive and comparative study was conducted to evaluate wound healing in episiotomy and cesarean section incisions with the REEDA (Redness, Edema, Ecchymossıs, Discharge, Approximation) scale. The population of the study consisted of patients hospitalized in the gynecology and obstetrics clinic of a university hospital between 20.06.2019 and 02.08.2019, and the sample consisted of a total of 107 women, 53 of whom had a vaginal delivery with episiotomy and 54 who had a cesarean section. Research data were collected using the Patient and Wound Diagnosis Form, the REEDA Scale, and the Numerical Rating Scale. Statistical evaluation of the data was done using IBM SPSS 22 program and R programming language. On the 1st follow-up day of the study, it was determined that the REEDA scale total scores were higher in the episiotomy group and the difference was statistically significant (p<0.05). It was observed that the total scores of the scale did not create a significant difference between the groups on the 3rd and 7th follow-up days (p>0.05). In episiotomy incisions, the sub-subscale scores of the scale were higher on all follow-up days for redness, on the 1st and 3rd follow-up days for edema, and on the 1st follow-up day for discharge (p<0.05). The sub-subscale scores in cesarean section incisions were found to be higher and statistically significant on the 3rd and 7th follow-up days for ecchymosis and on the 7th follow-up day for discharge and approximation (p<0.05). According to REEDA scale scores, it was determined that the healing process in cesarean section wounds was longer than in episiotomy incision wounds.

Antimicrobial Nitric Oxide-Releasing Electrospun Dressings for Wound Healing Applications.

Nonhealing and chronic wounds represent a major problem for the quality of life of patients and have cost implications for healthcare systems. The pathophysiological mechanisms that prevent wound healing are usually multifactorial and relate to patient overall health and nutrition, vascularity of the wound bed, and coexisting infection/colonization. Bacterial infections are one of the predominant issues that can stall a wound, causing it to become chronic. Successful wound healing often depends on weeks or months of antimicrobial therapy, but this is problematic given the rise in multidrug-resistant bacteria. As such, alternatives to antibiotics are desperately needed to aid the healing of chronic, and even acutely infected wounds. Nitric oxide (NO) kills bacteria through a variety of mechanisms, and thus, bacteria have shown no tendency to develop resistance to NO as a therapeutic agent and therefore can be a good alternative to antibiotic therapy. In this paper, we report on the development of NO-releasing electrospun membranes fabricated from polycaprolactone (PCL)/gelatin blends and optimized to reduce bacterial infection. The NO payload in the membranes was directly related to the number of amines (and hence the amount of gelatin) in the blend. Higher NO payloads corresponded with a higher degree of antimicrobial efficacy. No cytotoxicity was observed for electrospun membranes, and an in vitro wound closure assay demonstrated closure within 16 h. The results presented here clearly indicate that these NO-releasing electrospun membranes hold significant promise as wound dressings due to their antimicrobial activity and biocompatibility.

A clinico-radiological study of bicondylar tibial plateau fractures managed with dual locking plates

BackgroundTreatment of bicondylar intra-articular tibial plateau fractures due to high energy trauma is complex and highly prone to complications due to fracture patterns and extensive soft tissue damage. AimThe study's objective was to evaluate the clinical, radiological and functional outcome, including the complications in closed Schatzker type V and VI tibial plateau fractures managed with dual locking plates using less extensile approaches and indirect reduction techniques. Materials and methodsThirty-four patients of closed Schatzker Type V and VI treated with pre-contoured locking plates were evaluated clinically and radiologically. Dual plating was done using a less extensile anterolateral approach for lateral plate and medial/open posteromedial approach for medial plate. Functional results were evaluated using the Knee Society Score (KSS) and radiological results by the Modified Rasmussen score (MRS) for radiological assessment. ResultsThe mean age of patients in our study was 45 years (range = 26–60 years) with a male predominance of 84.4%. The average time difference between trauma and surgery was 7.6 days (range = 5–14 days) with an average length of hospital stay of 8.5 days (range = 7–18 days). Autologous bone grafting from the iliac crest was done in 10 patients (29.4%) with a sizeable metaphyseal void. The study has a mean follow-up period of 22.6 months. The complete union was seen at an average of 17.4 weeks. The average knee ROM at the last follow-up was 110.75°. Three patients had complications, 2 with wound dehiscence and 1 with deep infection. ConclusionInternal fixation with dual locking plates is biomechanically strong and stable and gives excellent to good functional outcomes. However, the timing of internal fixation is essential in such complex injuries to prevent soft tissue complications and failure. The use of rigid fixation by less extensile approaches and indirect reduction techniques helps prevent wound healing problems and allows early knee mobilization.

Use of incisional preventive negative pressure wound therapy in open incisional hernia repair: Who benefits?

Complex surgery of abdominal wall hernia continues to bear the major concern of wound healing disorders. Technical modifications have not been able to sufficiently prevent wound healing impairments or infections, even in clean elective cases, especially when dealing with large-scale hernia defects. Incisional negative pressure wound therapy (iNPWT) in its intentional use as a preventive tool has recently found its way from theoretical and experimental advantages to the clinical routine. Different indications have been defined but evidence is lacking. We performed a retrospective analysis (1/2014-5/2019) of all ventral hernia repairs (n=386) done in our institution as open sublay mesh reinforcement, partially requiring component separation (CS), receiving iNPWT in selected cases based on single surgeon experience. Pre- and perioperative data included patient and hernia characteristics as well as the employed mesh sizes. Postoperative follow-up (median 38.5months [interquartile range: 23.4, 53.3]) extended beyond patient dismissal and included the rate of re-admission due to wound healing disorders. The primary outcome was the incidence of surgical site occurrences (SSO). Secondary endpoints included wound-related readmissions, reoperations and recurrences. Patients were matched based on propensity scores in a 1:1 ratio. Propensity scores were calculated based on five preoperative variables, including sex, body-mass-index, American Society of Anesthesiology classification, recurrent hernia repair and operation technique, to identify significant parameters. The rate of SSO was 12% (n=46) for all operated cases, and the rate of surgical site infection (SSI) was 8.8% (n=34). In the subgroup of CS (n=40), the rate increased to 15% (n=6). The usage of iNPWT (n=54) led to an in-hospital SSO rate of 14.8% (n=8) but increased to 33.3% (n=18) when including the re-admission rate. The SSI rate for the iNPWT cohort was 14.8% (n=8) with a consecutive need for reoperation (Clavien-Dindo IIIb) in 87.5% (n=7). In the matched-pair analysis, the hernia-size and mesh-size were the main risk factors for SSO. The use of iNPWT significantly reduced this statistical effect (p=0.405). In a large and representative patient cohort, we were able to demonstrate that the advantage of iNPWT used after complex abdominal wall repair does not come first hand. Especially in the follow-up, we found a relevant increase in wound healing problems after dismissal. To proof the benefit of iNPWT in these heterogeneous patients, we could identify hernia size and mesh size as individual risk factors that were nihilated by the use of iNPWT. We found it to be favourable to use iNPWT when mesh-size exceeded 450 cm2 .

Wound outcomes and factors associated with wound healing after first-time femoropopliteal artery intervention in patients with ischemic tissue loss

Background/objectiveThis study’s goal is to describe wound outcomes at 2 years following intervention for atherosclerotic femoropopliteal lesions in patients with ischemic tissue loss. MethodsA retrospective review of 135 first-time endovascular procedures for chronic femoropopliteal atherosclerotic lesions related to ischemic tissue loss was performed. The final wound outcomes were categorized according to the initial wound healing, recurrence and the need of major/minor amputation. ResultsAt 2-years of follow up, 76 limbs (56.3%) showed complete wound healing without recurrence, however, wound development occurred at other sites on the same foot following complete primary healing in 11 limbs (8.1%). Tolerable wounds persisted or wounds recurred at the same site in 30 limbs (22.2%), and 18 limbs (13.3%) needed major amputations. Independent factors that prevented wound healing without recurrence at 2 years were renal insufficiency (HR = 0.225, 95% C.I. = 0.091–0.556, p = 0.001), ankle pressure < 50 mmHg or flat forefoot PVR (HR = 0.328, 95% C.I. = 0.124–0.867, p = 0.025) and functional performance < 4 metabolic equivalents (MET) (HR = 0.150, 95% C.I. = 0.063–0.360, p < 0.001). ConclusionWound outcome classifications showed detailed information regarding clinical outcomes in patients with ischemic tissue loss. Renal insufficiency, ischemia grade 3 and poor functional performance were independent risk factors that prevented wound healing.

Fabrication of cellulose carbamate hydrogel-dressing with rarasaponin surfactant for enhancing adsorption of silver nanoparticles and antibacterial activity

Bacterial contamination on external wounds is known to be a factor that prevents wound healing and triggers tissue damage. Hydrogel-dressings with antibacterial activity is a useful medical device to avoid this contamination, wherein the antibacterial activity can be provided via incorporation of silver nanoparticles (AgNPs). Contrary to the conventional two-step preparation of an AgNPs-loaded hydrogel (AgNPs@hydrogel), this work aims to establish a new and facile synthesis method employing the adsorption principle. Once AgNO3 adsorbed into active sites of the hydrogels, in situ reductions using NaBH4 was employed to produce AgNPs@hydrogel. The effect of surfactant addition on the AgNO3 loading and the antibacterial activity of the resulting hydrogel dressing was investigated. The outcome of this work indicates that the addition of rarasaponin not only can increase the loading of AgNPs on cellulose carbamate hydrogel (CCH) but also significantly enhance the antibacterial activity of the resulted hydrogel-dressing. Superior to the other studied surfactant, the loading capacity (LC) of AgNPs is found to be 10.15, 9.94, and 7.53 mg/g for CCH modified with rarasaponin, CTAB, and Tween80, respectively. These findings conclude that the addition of surfactant, especially rarasaponin, can effectively improve the loading of AgNPs onto hydrogel-dressing via adsorption and promote the antibacterial activity. Furthermore, the cytotoxic test shows that the hydrogel-dressings have good biocompatibility toward skin fibroblast cells.

Effectiveness of a hydrophobic dressing for microorganisms' colonization of vascular ulcers: Protocol for a randomized controlled trial (CUCO-UV Study).

AimTo determine the effectiveness of a hydrophobic dressing (Cutimed Sorbact®) against a silver dressing (Aquacel® Ag Extra) in the level of colonization of chronic venous leg ulcers. The secondary endpoints are health‐related quality of life, level of pain, and time to complete healing.DesignOpen randomized controlled trial, with blinded endpoint.MethodsPatients with chronic venous leg ulcers with signs of critical colonization will be randomized in a concealed sequence using computer software to receive one of the alternative dressings. A total of 204 participants recruited in Primary Health Care and nursing homes will be necessary to assure statistical power. Measures will include sociodemographic variables, wound‐related variables (area, exudate, and time to healing), level of pain, adverse effects, and health‐related quality of life. Smear samples will be collected from the ulcers and will be subject to DNA‐typing technique through polymerase chain reaction to obtain the level of colony‐forming units. Measures will be collected at baseline, 4, 8, and 12 weeks.DiscussionElevated levels of microorganisms prevent wound healing and favour its chronification. The main target when colonization is present is to reduce the bacterial load to levels that promote immune system mobilization. Hydrophobic dressings prevent the formation of biofilm in the wound by means of physical effect, so that the possibility of antimicrobial resistance is significantly reduced.ImpactCurrent evidence about the effectiveness of dressings to minimize venous leg ulcers colonization is very limited. Previous studies have important methodological flaws. This study will permit to obtain the effectiveness of hydrophobic dressings against silver dressings with a robust design based on conditions of routine clinical practice in Primary Health Care and nursing homes.

Laryngotracheal Reconstruction in the Pediatric Burn Patient: Surgical Techniques and Decision Making.

The management of laryngotracheal stenosis (LTS) in the pediatric burn patient is complex and requires a multidisciplinary approach. The mainstay of treatment for LTS is laryngotracheal reconstruction (LTR), however, limited reports of burn-specific LTR techniques exist. Here, we provide insight into the initial airway evaluation, surgical decision making, anesthetic challenges, and incision modifications based on our experience in treating patients with this pathology. The initial airway evaluation can be complicated by microstomia, trismus, and neck contractures-the authors recommend treatment of these complications prior to initial airway evaluation to optimize safety. The surgical decision making regarding pursuing single-stage LTR, double-stage LTR, and 1.5-stage LTR can be challenging-the authors recommend 1.5-stage LTR when possible due to the extra safety of rescue tracheostomy and the decreased risk of granuloma, which is especially important in pro-inflammatory burn physiology. Anesthetic challenges include obtaining intravenous access, securing the airway, and intravenous induction-the authors recommend peripherally inserted central catheter when appropriate, utilizing information from the initial airway evaluation to secure the airway, and avoidance of succinylcholine upon induction. Neck and chest incisions are often within the TBSA covered by the burn injury-the authors recommend modifying typical incisions to cover unaffected skin whenever possible in order to limit infection and prevent wound healing complications. Pediatric LTR in the burn patient is challenging, but can be safe when the surgeon is thoughtful in their decision making.