Routine Wound Care Research Articles

A novel chlorin derivative Shengtaibufen (STBF) mediated photodynamic therapy combined with iodophor for the treatment of chronic superficial leg wounds infected with methicillin-resistant Staphylococcus aureus: A retrospective clinical study

ObjectiveChronic wounds are costly and difficult to treat, resulting in morbidity and even mortality in some cases due to a high methicillin-resistant Staphylococcus aureus (MRSA) burden contributing to chronicity. We aimed to observe the antimicrobial activity and healing-promoting effect of a novel photosensitizer Shengtaibufen (STBF)-mediated antibacterial photodynamic therapy (PDT) on MRSA-infected chronic leg ulcers. Patients and methodsThis was a retrospective, comparative, single-center clinical study. A total of 32 patients with chronic lower limb wounds infected with MRSA from January 2022 to December 2023 were finally included in this study by searching the electronic medical records of the dermatology department of Huadong Hospital, including a group of red light combined with iodophor (control+iodophor, n=16, receiving red light once a week for 8 weeks and routine dressing change with iodophor once a day) and a group of STBF-mediated PDT (STBF-PDT) combined with iodophor (STBF-PDT+iodophor, n=16, receiving STBF-PDT and routine dressing change with iodophor once a day). STBF-PDT was performed once a week (1 mg/ml STBF, 1 h incubation, 630 nm red light, 80 J/cm2) for 8 weeks. The primary endpoints included wound clinical signs, wound size, wound-related pain, re-epithelialization score, MRSA load and wound-related quality of life (wound-QoL). Any adverse events were also recorded. ResultsWe found that STBF-PDT+iodophor could effectively alleviate clinical infection symptoms, accelerate wound closure, reduce average biological burden and improve wound-QoL without severe adverse events in comparison to the control+iodophor group. The STBF-PDT+iodophor group obtained a mean percentage reduction of 65.22% in wound size (from 18.96±11.18 cm2 to 6.59±7.94 cm2) and excellent re-epithelialization scores, as compared with a decrease of 30.17% (from 19.23±9.80 cm2 to 13.43±9.32 cm2) for the control+iodophor group. Significant differences in wound area were observed at week 6 (p=0.028*) and week 8 (p=0.002**). The bacterial load decreased by 99.86% (from 6.45 × 107±2.69 × 107 to 8.94 × 104±1.92 × 105 CFU/cm2, p<0.0001) in the STBF-PDT+iodophor group and 1.82% (from 6.61 × 107±2.13 × 107 to 6.49 × 107±2.01 × 107 CFU/cm2, p=0.029) in the control+iodophor group. The wound-QoL in STBF-PDT+iodophor group had a 51.62% decrease in overall score (from 29.65±9.33 at the initial to 14.34±5.17 at week 8, p<0.0001) compared to those receiving red light and routine wound care (from 30.73±17.16 to 29.32±15.89 at week 8, p=0.003). Moreover, patients undergoing STBF-PDT+iodophor exhibited great improvements in all domains of wound-QoL (physical, psychological and everyday-life), whereas the control+iodophor group ameliorated in only one field (everyday-life). ConclusionOur data confirmed that a novel photosensitizer, STBF-mediated PDT, when combined with iodophor, served as a potential modality for MRSA infection and a possible therapy for other drug-resistant microorganisms, and as a promising alternative for chronic cutaneous infectious diseases.

Therapeutic potential of cannabis for surgical wound healing in rats.

This study was conducted to evaluate the wound-healing activities of a Cannabis sativa L. plant extract and cannabidiol on incision wounds. An incision was created and sutured in rats under anaesthesia. Routine wound care procedures were applied for 10 days, followed by histological wound examinations. The cellular bioactivities of the hemp extract and CBD were assessed for MCP-1, EGF, BFGF, IL-8, and COL-1 using ELISA on the rat skin wound healing activity. A one-way ANOVA was used for the data analysis. The EGF values in the plasma were similar in the povidone-iodine, hemp seed oil, and hemp essential oil groups (P > 0.05). However, the EGF levels were lower in the CBD group compared to the other groups (P < 0.001, P < 0.005). The MCP-1 values in the hemp seed oil, hemp essential oil, and CBD were similar (P > 0.05), whereas povidone iodine exhibited lower MCP-1 levels compared to the other groups (P < 0.001, P < 0.005). It was determined that the plasma BFGF, IL-8, and COL 1 values of the groups were similar (P > 0.05). To our knowledge, this study is the first to evaluate the effects of CBD, seed oil, and hemp leaf extract on incision wound healing. It demonstrates that hemp extract holds greater potential benefits for wound healing compared to CBD.

Dynamic prediction of time to wound healing at routine wound care visits.

Objective Having a wound decreases patients' quality of life and brings uncertainty, especially if the wound does not show a healing tendency. The objective of this study was to develop and validate a model to dynamically predict time to wound healing at subsequent routine wound care visits. Approach A dynamic prediction model was developed in a cohort of wounds treated by nurse practitioners between 2017-2022. Potential predictors were selected based on literature, expert opinion, and availability in the routine care setting. To assess performance for future wound care visits, the model was validated in a new cohort of wounds visited in early 2023. Reporting followed TRIPOD guidelines. Results We analyzed data from 92,098 visits, corresponding to 14,248 wounds and 7,221 patients. At external validation, discriminative performance of our developed model was comparable to internal validation (c-statistic = 0.70 [95% CI 0.69, 0.71]) and the model remained well-calibrated. Strong predictors were wound-level characteristics and indicators of the healing process so far (e.g., wound surface area). Innovation Going beyond previous prediction studies in the field, the developed model dynamically predicts the remaining time to wound healing for many wound types at subsequent wound care visits, in line with the dynamic nature of wound care. In addition, the model was externally validated and showed stable performance. Conclusion: The developed model can potentially contribute to patient satisfaction and reduce uncertainty around wound healing times when implemented in practice. When the predicted time of wound healing remains high, practitioners can consider adapting their wound management.

SURGICAL MANAGEMENT OF GRANULOMA IN A 5-YEAR-OLD UDA EWE

Granuloma is a well-known inflammatory condition in veterinary and human medicine. It is a chronic inflammatory reaction triggered by a wide variety of persistent agents, characterized by the recruitment and activation of macrophages, occasionally presenting areas of central necrosis. The aim of the present report is to provide information regarding the manifestation, cytology, histology and management of granuloma in sheep. A five-year-old Uda ewe was presented to the Veterinary Teaching Hospital, University of Jos in September, 2023, with a large mass around the neck, extending towards the jugular furrow. Following cytological examination of the mass, surgical excision was undertaken under mild sedation (2% Xylazine) and local anaesthesia (1% Lidocaine hydrochloride). The mass was subjected to histopathological examination, while routine wound cleansing and care was instituted with post-operative administration of analgesic, anti-inflammatory agent, antibiotics, multivitamins and tetanus toxoid intramuscularly. Histopathological findings comprised of masses having necrotic centre with sulfur granules, area of macrophages, lymphocyte, plasma cell and zones of fibro-connective tissue with evidence of neo-vascularization and perivascular cuffing supporting the diagnosis of granuloma. Follow-up re-examinations of the Ewe were undertaken every other day with stitches removed on day 12 post-operation following complete apposition of the wound edges. After 14 days of management, the ewe was discharged following normal rectal temperature (39.0ºC), pulse rates (80.0 beats/minute) and respiratory rates (28.0 cycles/minute). Therefore, cases of granuloma could be satisfactorily managed by complete surgical excision with thorough post-operative care.

Effectiveness of continuous home wound care on patients with diabetic foot ulcers.

To explore the effectiveness of continuous home wound care on patients with diabetic foot ulcers (DFUs). A non-randomized parallel controlled non-inferiority trial. Patients with Wagner grade I-III DFUs hospitalized in two distant campuses of the same hospital were included. All patients received infection treatment and wound bed preparation during hospitalization; after discharge, patients in one of the campuses received routine outpatient wound care, and those treated in the other received continuous home wound care. The per-protocol analysis was performed to compare ulcer healing indicators, knowledge, health belief, self-management behaviour and medical expenses of the two groups. Between October 2021 and December 2022, 116 patients were enrolled in the study; 107 completed. The home care was not inferior in terms of ulcer healing rate and demonstrated significant enhancements in the understanding of warning signs, health belief and self-management behaviour. Additionally, the home care saved 220.38 yuan (24.32 UK pounds) in direct medical expenses for each additional one square centimetre of ulcer healing. The continuous home wound care enhanced self-management behaviour of the patients and saved their medical expenses while not compromising ulcer healing. This is to date the first study to conduct continuous home wound care practice for patients with DFUs and confirmed its safety and non-inferiority in ulcer healing, and supported its superiority in improving self-management behaviour and saving medical expenses. We have adhered to the transparent reporting of evaluations with nonrandomized designs statements and the corresponding checklist was followed. The patients and their primary caregivers were involved in intervention design, we received input from them about the factors that facilitate and hinder patient self-management behaviours to develop intervention strategies.

Development and use of a porcine model with clinically relevant chronic infected wounds

Chronic ischemic wounds affect millions of people causing significant pain and disability. They can be considered to be stalled in the inflammatory stage and cannot heal without additional measures. A valid animal model is necessary to evaluate the efficacy of topical wound healing therapies and wearable technologies. A porcine model, although higher in cost, maintenance, and space requirements, is superior to the commonly used rodent or rabbit model for wound healing. Previous studies have shown that pig wounds have greater similarity to human wounds in responses to a variety of treatments, including wound dressings and antibiotics. The current study created a porcine model of large chronic wounds to assess a wearable electroceutical technology, with monitoring of healing variables and infection. Electroceutical therapy is the only adjunctive treatment recommended for chronic wound therapy. A porcine model of large chronic wounds of clinically realistic size was created and utilized to evaluate a wearable electroceutical biotechnology. Multivariate non-invasive assessment was used to monitor wound progression over multiple timepoints. Outcomes suggest that a wearable electrostimulation bandage, has the potential to offer therapeutic benefit in human wounds. The tested wearable device provides the same proven effectiveness of traditional electroceutical therapy while mitigating commonly cited barriers, including substantial time requirements, and availability and complexity of currently available equipment, preventing its implementation in routine wound care. The model is also appropriate for evaluation of other wearables or topical therapeutics.

Comparison of Wound Debridement Pressures With Updated Tests

BACKGROUND: Wound debridement is one of the key treatment methods for chronic and acute wounds. Various tools are used to perform debridement, but the force applied to the tissue by these different instruments has been poorly documented in a limited number of past research efforts. PURPOSE: The aim of this study was to provide insight into the actual amount of pressure exerted on wound tissue. METHODS: We used a digital force transducer to measure the pressure applied by multiple combinations of angiocatheter needles (catheters), syringes, and other common debridement tools. The data obtained were compared with the pressure measurements reported by previous studies. The common standard used in research is a 35-mL syringe with a 19-gauge catheter with a pressure of 7 to 8 pounds per square inch (psi), which is regarded as the most effective for wound care. RESULTS: Many of the instruments measured in this experiment closely reflected the pressure measurements previously published in the research literature and are safe to use to properly irrigate wounds. However, some discrepancies were also found, ranging from a small psi variability to several psi. Further studies and testing may be beneficial to confirm the results of this experiment. CONCLUSION: Certain tools produced higher pressures that were not suitable for routine wound care. Findings from this study can also be used by clinicians to choose appropriate tools and to monitor pressure when they use various common irrigation tools.

Effect of educational interventions on wound healing in patients with venous leg ulceration: A systematic review and meta-analysis.

Educational interventions for patients with venous leg ulceration (VLU) may promote adherence and self-management, however, their effect on wound healing is unclear. A systematic literature search was performed and randomised controlled trials with a focus on educational interventions were included. Wound healing was analysed by assessing wound healing rate, ulcer size, and the PUSH Score. Additional outcomes comprised pain, quality of life, and functional ability. The study protocol for this work is registered at PROSPERO 2020 (ID: CRD42021286152). Nine studies were included in this meta-analysis. The odds ratio for wound healing was 1.91 (95% CI, 0.99-3.67, P=.053) in favour of educational interventions compared to usual care. Ulcer size reduction was higher (MD: -7.22; 95% CI, -11.91 to -2.53, P=.003) in patients following educational interventions. Included studies also showed significant effects on pain, quality of life, and functional analysis, though no quantitative synthesis was feasible. The overall risk of bias showed some concerns. Educational interventions aim to actively involve patients in their treatment, thereby appearing to be able to have a positive impact on wound healing within 12 weeks. Consequently, integrating educational approaches to routine wound care may be a promising strategy to improve treatment of VLU.

Uniportal Endoscopic Vein Harvest Using the Three-Step Haemostatic Technique—A Modified Approach

Endoscopic venous harvest (EVH) has become widely adopted in routine elective coronary artery bypass graft operations given it reduces surgical-site infections and improves wound cosmesis. The conventional EVH involves a 'stab and grab' incision at the inguinal crease, which is a hard-to-reach area for routine wound care. This paper describes the steps of the uniportal EVH, which transects the venous conduit, omitting the need for a stab incision at the groin.

Evaluation on the Improvement of Patients' Quality of Life in the Application of Routine Wound Care and Comprehensive Evaluation + Individualized Treatment in Diabetic Chronic Wounds

Evaluation on the Improvement of Patients' Quality of Life in the Application of Routine Wound Care and Comprehensive Evaluation + Individualized Treatment in Diabetic Chronic Wounds

The Effect of Plantago major Hydroalcoholic Extract on the Healing of Diabetic Foot and Pressure Ulcers: A Randomized Open-Label Controlled Clinical Trial.

Aims: Diabetic foot ulcer (DFU) and pressure ulcer (PU) both are common types of ulcers worldwide. The wound healing effect of Plantago major leaves has been shown in a few animal studies. This study aimed to evaluate the clinical efficacy of P. major hydroalcoholic extract on DFU and PU healing. Methods: In this clinical trial, patients with DFU or PU who met the inclusion criteria were randomly assigned to drug (P. major) or control groups. For patients in the drug group, Plantago extract 10% topical gel was applied on the wound once daily concurrent with dressing and routine wound care for two weeks, while for the control group, an appropriate novel dressing was used along with routine wound care for the same duration. The percentage of wound size reduction at the end of the seventh and 14th days of intervention was recorded and compared between the groups. Results: Fifty and 44 patients in drug and control groups, respectively, completed the interventions. Plantago extract gel significantly resulted in more reduction in the wound size compared to control at the end of the first (64.90 ± 29.75% vs. 33.11 ± 26.55%; P < 0.001) and second week (86.85 ± 24.34% vs. 52.87 ± 32.41%; P < 0.001). Furthermore, the number of patients with complete wound healing in the drug group (n = 32, 64%) was significantly more than the control group (n = 9, 20.45%; OR: 3.129, 95% CI: 1.685-5.809, P < 0.001). Conclusion: The use of 10% topical gel of P. major leaf extract results in the acceleration of DFU and PU healing. Key points: Application of P. major topical gel results in the acceleration of diabetic foot ulcer and pressure ulcer healing. - P. major extract helps reducing the wound's erythema.- P. major leaf extract assists decreasing the wound size.- The number of patients completing wound healing process is higher among whom undergoing P. major dressing.

Combined effect of negative pressure wound therapy and cryo-air therapy on diabetic wound healing

Background: Diabetic wounds and ulcers are serious complications in diabetic patients that need a long time and high-cost treatment. There are different physical therapy modalities used in wound care; as Laser therapy, magnetic therapy, negative pressure wound therapy and cryo-air therapy. Objectives: this study was conducted to investigate the effect of combining therapy between negative pressure wound therapy (NPWT) and cryo-air therapy on diabetic wound healing. Patients and Methods: Sixty diabetic patients with large infected diabetic wounds with age between 40-60 years, positive wound culture after surgical debridement selected and randomly divided into three equal groups, group A received routine medical wound care plus NPWT 3 times/ week for 8 weeks, group B received routine medical wound care plus cryotherapy air 3 times/ week for 8 weeks, group C received routine medical wound care plus NPWT followed by cryotherapy air application 3 times/ week for 8 weeks. The patients were assessed by wound surface area and wound culture before treatment, after 4 weeks of treatment, and at the end of treatment (after 8 weeks). Results: there was a significant decrease in wound volume at the post I and post II compared with that at pretreatment in the three groups. Also, there was a significant decrease in wound volume at post-II compared with that at the post I in the three groups. Also, there was a significant decrease in the positive culture at the post I compared with that pretreatment in group B and C and a significant decrease in the positive culture at the post II compared with pretreatment in group A, B and C. There was a significant decrease in positive wound culture of the group C at post I and post II compared with that of the group A and group B. There was a significant decrease in positive wound culture of the group B compared with that of the group A in the post I and at post II. Conclusion: cryo-air therapy and negative pressure wound therapy have a positive effect on wound healing but its combination is more effective.

Predicting Chronic Wound Healing Time Using Machine Learning

Objective: Chronic wounds have risen to epidemic proportions in the United States and can have an emotional, physical, and financial toll on patients. By leveraging data within the electronic health record (EHR), machine learning models offer the opportunity to facilitate earlier identification of wounds at risk of not healing or healing after an abnormally long time, which may improve treatment decisions and patient outcomes. Machine learning models in this study were built to predict chronic wound healing time. Approach: Machine learning models were developed using EHR data to predict patients at risk of having wounds not heal within 4, 8, and 12 weeks from the start of treatment. The models were trained on three data sets of 1,220,576 wounds, including 187 covariates describing patient demographics, comorbidities, and wound characteristics. The area under the receiver operating characteristic curve (AUC) was used to assess the accuracy of the models. Shapley Additive Explanations (SHAP) were used to analyze variable importance in predictions and enhance clinical interpretations. Results: The 4-, 8-, and 12-week gradient-boosted decision tree models achieved AUC's of 0.854, 0.855, and 0.853, respectively. Days in treatment, wound depth and location, and wound area were the most influential predictors of wounds at risk of not healing. Innovation: Machine learning models can accurately predict chronic wound healing time using EHR data. SHAP values can give insight into how patient-specific variables influenced predictions. Conclusion: Accurate models identifying patients with chronic wounds at risk of non or slow healing are feasible and can be incorporated into routine wound care.

Effect of Autologous Platelet–Rich Plasma on Cesarean Section Scar; A Randomized, Double-Blinded Pilot Study

Background: One of the complications of cesarean section (C/S) is related to the incision site. Considering the effectiveness of platelet–rich plasma (PRP) on healing of wounds and management of scars, the present study aimed to inquire the effect of PRP on the thickness and completeness of the uterine scar. Methods: In a randomized double-blinded, placebo-controlled clinical trial, the women who underwent C/S from November 2019 to 2020 were included and randomized into two studied groups, including the control (n = 15) and intervention (n = 15) groups. In the intervention group, PRP, extracted from patients’ blood samples, was injected to the incision site (between decidua and myometrium), while the control group did not receive this treatment. The scar thickness of C/S as the primary outcome and postpartum hemorrhage as the secondary outcome were compared between the groups. Both groups were followed for 12 weeks. Results: The two groups (intervention and control) were not significantly different in terms of weight, height, BMI, age, parity, gravidity, duration of surgery, and blood hemoglobin (HB) level (P &gt; 0.05). Comparison of scar characteristics showed the creation of a niche in the PRP group, which was almost one-fourth of that of the control group; a difference that was statistically significant (P = 0.002). The thickness of adjoining myometrium was comparable between the two groups. Mean uterine niche height in the intervention group was lower than in the control group, which was statistically significant (P = 0.048). The mean of residual myometrium thickness (RMT) in the intervention and control groups were 7.62 ± 0.95 and 5.6 ± 3.5 mm, respectively, a difference that was statistically significant (P &lt; 0.001). Conclusions: Local injection of PRP is an effective and viable measure for reducing the uterine niche; therefore, it is suggested to be included in the routine wound care of CS. Future studies are needed to confirm PRP efficacy in different settings.

Wound prevalence survey in a regional integrated care organisation in the midwest of Ireland

Background/aims: The aim of this clinical audit was to determine the point prevalence of wounds over a 1-week period during April 2019 in the midwest Regional Integrated Care Organisation (RICO), which has a population of 379 452. The RICO consists of six hospitals, a public health nursing service across three counties, community residential settings, nine older person's service sites, community health centres and one prison. Method: A peer-reviewed, purpose-designed data collection tool was used to gather demographic and wound data on each patient with a wound in the midwest RICO. Anonymised data were collected by the nurse undertaking routine wound care on one occasion during the 1-week study period. There were no exclusion criteria for this study; all patients with a wound were eligible for inclusion. Ethical approval was obtained. Results: Completed data collection forms were returned for 791 patients who had a combined total of 1164 wounds. Data were analysed using SPSS version 21 to produce descriptive statistics. A point prevalence of 0.2% of the total RICO population had a wound, with a mean of 1.47 wounds per patient. Some 51% of the cohort was female. The median age was 75 years (range 3–101 years, standard deviation=19.881). Leg ulcers were the most common wound type, with a prevalence of 0.07% (33.7% of the cohort). Conclusions: This clinical wound prevalence audit supports previous studies in relation to wound statistics in Ireland and will be useful for resource planning in an ageing population.

Ozone therapy as an alternative method for the treatment of diabetic foot ulcer: a case report

BackgroundDiabetic foot ulcer (DFU) is one of the most important complications of diabetes that can lead to amputation. Treatment of DFUs is a major challenge and places a heavy economic and social burden on patients and their families.Case presentationThe present case report is of a 52-year-old kurdish male patient with a 7-year history of type 2 diabetes. While on a bike ride, he sustained a traumatic injury to his right leg, which caused a deep gash measuring 14 × 5 cm on the tibia. During the hospital stay, no improvement was observed after routine wound care including suturing, antibiotic therapy, and dressing change. The patient was referred to our wound-care team. In the first step, the necrotic tissues of his foot ulcer were irrigated and then debrided using mechanical debridement and saline. Next, the patient underwent a 70 μg/dL dose of ozone therapy over a 30-day period in 10 sessions (one 20-minute session every 3 days). Between each session, the patient's wound was wrapped in silver-containing gauze bandages. After 1 month of wound-care using ozone therapy, the patient's foot ulcer had healed and he was discharged from our wound-care service with a stable and good general condition.ConclusionConsidering the effectiveness of ozone therapy along with silver-containing dressing in the treatment of DFUs, wound-care teams can utilize it as an adjunct to the standard methods of DFU treatment.

Congenital Inferior Vena Cava Agenesis with Ulceration and Deep Vein Thrombosis.

This is one of the few case reports of congenital inferior vena cava atresia (IVCA) with extensive bilateral lower extremity ulcers. IVCA is a congenital anomaly characterized by poor venous return in the lower extremities with increased risk of deep vein thrombi (DVTs) and, rarely, non-healing ulcers. A 45-year-old woman with history significant for DVTs presented with extensive bilateral lower extremity ulcers, and a CT scan revealed congenital IVCA. Oedema management, DVT prevention, routine wound care and skin grafts resolved the ulcers. Congenital venous abnormalities should be included in the differential diagnosis of multiple unprovoked DVTs and non-healing ulcers. There are very few reports in the English literature describing inferior vena cava atresia with extensive bilateral lower extremity ulcers.We present our findings as well as new insights into the congenital causes of bilateral lower extremity ulcers and deep vein thrombi (DVTs).Especially for young adults with a history of multiple DVTs and non-healing ulcers, venous abnormalities should be included in the differential diagnosis and advanced imaging should be utilized.

Use of Honey Versus Standard Care for Hospital-Acquired Pressure Injury in Critically Ill Children: A Multicenter Randomized Controlled Trial.

To examine if the use of honey (medicated) for dressing is superior to standard care in terms of time to complete wound healing in stages 1-3 of pressure injuries in children admitted to the PICU. Multicenter, open-label, parallel-group, randomized trial. Tertiary-care PICU from August 2017 to January 2019. Critically ill children, 2 months to 17 years old, who developed pressure injury (stages 1-3) were included; those on more than two inotropes or with signs of acute wound infection or wounds with greater than 5 cm diameter or known allergy to honey were excluded. Children were randomized to receive either medicated honey dressing or standard (routine) wound care for the management of their pressure injury. The primary outcome was the time to complete wound healing. Manuka or active Leptospermum honey dressing/gel was used in the intervention group. Enrolled children were followed up until death or discharge from the hospital. A total of 99 children were enrolled: 51 in the intervention group and 48 in the standard care group. Baseline characteristics, including the nutritional status, were comparable between the groups. The most common sites of injury were bony prominences at face mask contact points. The median time to complete healing was 7 days (95% CI, 6-7 d) versus 9 days (7-10 d) in the intervention and standard care groups, respectively (p = 0.002; log-rank test). At any random time, children in the intervention group were about 1.9-fold more likely to have their pressure injury completely healed than those in the standard care group (hazard ratio 1.86; 95% CI, 1.21-2.87). There were no allergic reactions or secondary wound infections in the intervention group. The use of medicated honey dressings decreased the time to wound healing in critically ill children with pressure injuries. There were no allergic reactions or secondary bacterial infections in any of these children.

Acromioclavicular Joint Separation: Repair Through Suture Anchors for Coracoclavicular Ligament and Nonabsorbable Suture Fixation for Acromioclavicular Joint.

ObjectiveTo evaluate the clinical and radiographic outcomes of patients undergoing coracoclavicular (CC) ligament repair by two suture anchors and acromioclavicular (AC) joint (ACJ) fixation using heavy nonabsorbable sutures for the treatment of types III–V ACJ injuries with a minimum of 1‐year follow‐up.MethodsThe clinical and radiographic outcomes of 36 consecutive patients (26 men and 10 women) who underwent anatomic reduction for acute ACJ dislocation using two suture anchors for CC ligament reconstruction and two strands of non‐absorbable stitches for ACJ fixation between December 2013 and December 2018 were reviewed. Two 3.5 mm suture anchors with double‐loaded sutures were separately inserted into the anterolateral and posteromedial portions of the coracoid process. The suture strands were passed through the hole created in the clavicle using 2.0 mm drill and tied over the clavicle. Additional ACJ augmentation using two strands of non‐absorbable heavy sutures was performed in all patients. At 3, 6, and 12 months and last follow‐up visit, the scores on the visual analog scale (VAS), the American Shoulder and Elbow Surgeons (ASES) score, Constant–Murley score, and simple shoulder test (SST) questionnaires were used to provide a final evaluation of shoulder function. Comparison between baseline and treatment results was performed. Radiographic analysis included vertical displacement and horizontal shift.ResultsA total of 29 patients (20 men and nine women) were included in the study. A total of seven, six, and 16 patients had Rockwood type III, type IV, and type V ACJ dislocations, respectively. The mean patient age was 42.8 ± 13.5 years, with a mean follow‐up of 28 months (range, 12–56 months). At the 12‐month follow‐up, the mean ASES score was 92.1 ± 3.5, with a mean pain score of 0.5 ± 0.7 on the VAS and mean Constant–Murley score of 93.0 ± 2.4. The new number of positive answers on the SST was 11.5 ± 0.6. Compared with the baseline, the clinical results improved significantly (P < 0.05). No significant difference could be found between the 6‐ and 12‐month follow‐up evaluations (P > 0.05). Radiographs showed two partial loss of reduction, whereas no horizontal displacement was found in all patients. One patient developed a superficial wound infection 3 weeks postoperation. The wound healed after routine wound care. No neurovascular complications were recorded.ConclusionsCC ligament reconstruction using two suture anchors and ACJ augmentation using two strands of non‐absorbable heavy sutures on high‐grade AC dislocation is a reliable technique for restoring stability to the ACJ and can obtain good to excellent clinical results.

The effect of hypericum perforatum oil on the healing process in the care of episiotomy wounds: A randomized controlled trial

IntroductionWomen, postpartum are especially vulnerable after an episiotomy. Several complications may develop such as perineal pain, discomfort, prolonged wound healing, and infection. This study investigated whether the use of Hypericum perforatum (HP) oil used for wound care for women who had received an episiotomy to facilitate labour could be effective in facilitating healing. MethodsThis controlled single-blind and randomized experimental study with a pretest-posttest design. was conducted in a Training and Research Hospital for Gynecology and Obstetrics in Northern Turkey. The 135 women agreeing to participate in the study were randomised into 3 groups: 45 women who used only Saline Solution (SS), 45 women who were treated with HP oil and 45 women who received routine clinical care after episiotomy, the latter constituted the control group 45 women. A structured information form, REEDA (Redness, Edema, Ecchymosis, Discharge, Approximation) scale and VAS (Visual Analogue Scale) were used for data collection. ResultsThe mean age of women was 22.75 ± 3.19 years. The examination of the REEDA scores showed that HP oil decreased the redness, edema, ecchymosis, and discharge in women with episiotomy. HP oil was also more effective regarding the approximation of the wound edges (p < .05). The women, using HP oil for wound care, statistically reported less pain when compared to the women managed with routine wound care or saline solution (p < .00). ConclusionHP oil may be an effective wound care product which may contributes to improving wound healing in women who have had an episiotomy.