Secondary Wound Research Articles

A nationwide snapshot study on outcomes one year after surgery for chronic pilonidal sinus disease.

Managing pilonidal sinus disease (PSD) remains challenging due to high recurrence rates and morbidity associated with treatment. The aim of this study was to evaluate the outcomes one year after surgical treatment for chronic PSD in the Netherlands. Patients with PSD who underwent surgical treatment between March 1, 2020, and March 1, 2021, at 36 participating hospitals were included in a prospective observational cohort study. For the present study, only patients with chronic PSD were included for analysis. One-year after surgical treatment for PSD, all patients received questionnaires on wound healing, quality of life (QoL), and patient reported experience measures (PREMs). Primary outcome was recurrence rate. Secondary outcomes included QoL and PREMs. Of 681 included patients, 405 patients presented with chronic PSD and underwent surgical treatment. One-year questionnaires were completed by 289 out of 405 patients (71.4%). Patients underwent either excision with secondary wound healing (ESW, n = 73), excision with midline closure (EMC, n = 21), off-midline closure (OMC, n = 17), or a minimally invasive technique (MIT, n = 178). Patient-reported recurrence rates after ESW, EMC, OMC and MIT were 21.5%, 25%, 6.7% and 30.6%, respectively. Pain/discomfort and anxiety/depression were the most frequently reported problems affecting QoL. Patients that underwent OMC were satisfied the most with the care provided. This study demonstrates variation in recurrence rates among surgical procedures for PSD. The highest rates were observed in the MIT and EMC group, while the OMC group exhibited the lowest rate. QoL outcomes differed among the surgical techniques. Patient satisfaction appears highest in the OMC group.

Study on Adolescents Reproductive Health & Problems in a Tertiary Care Hospital, Chattogram

Background: Adolescence is a stage where the physical and psychological development of a child takes place. Inother words, teenagers passing the years between the puberty and adulthood, from ages 10-19 years. Adolescents are likely to face a range of health and social challenges, for instance initiation of sexual activity while there is still lack of adequate knowledge and skill. High prevalence of early marriage and child bearing are associated with higher rate of morbidity and mortality. They are also in higher risk of unwanted pregnancy, unsafe abortion and sexually transmitted infections. The main objective of this study is to suggest the strategies for improvement of adolescents reproductive health status in Bangladesh. Materials and methods: This retrospective observational study was conducted in the Obs and Gynae Department of Chattagram Maa-O-Shushu Hospital Medical College (CMOSHMC) from July to December 2022. Total 436 adolescents were included in this study who were admitted in Obs and Gynae Department instudy period. All cases reviewed retrospectively from in patients records. An inclusion criterion of age in this study is 10-19 years. Results: A Total 436 patients were enrolled in this study with age limit between 10- 19 years. Total Obstetric patients were 360 (82.57 %). Among them antenatal patients were 348 (97 %), postnatal patients were 12 (3%). Among antenatal patients primipara 344 (99 %), multi para (2nd pregnancy) 4 (1%). Total delivery occurred in 302 patients. Vaginal delivery occurred in 147 patients (49 %), cesarean section were needed in 140 patients (46%). Repair of perineal tear done in 2 post natal patients. Secondary wound closure was done in 1 patient. Conservative management was given to 70 patients. Sexual abuse in 3 patients, came with 14, 16 and 25 weeks of pregnancy and medical termination were done in all cases. Maternal death was 1 (4.2%) due to primary PPH following LSCS due to central placenta Previa with postoperative cardiac arrest. Total baby delivered 302, alive 287(95%), intrauterine death 15 (5%). LBW (Low Birth Weight) 49 (17 % of alive baby ), IUGR (Intrauterine Growth Restriction) 6 (2%), NND (Neonatal Death) 5 (1.7%). Total Gynae patients admitted were 76 (17.43%), abortion related complications were 52 (68%), menstrual abnormality were 7(9.2%), ruptured ectopic pregnancy following sexual abuse was 1 (0.92% of total patients ) . Conclusion: There is growing attention being paid to improving access to quality maternal care for pregnant and parenting adolescents preventing pregnancy among adolescents are fundamental to achieving positive health outcomes across the life course and imperative for achieving the SDGS (Sustainable Developmental Goals) related to maternal and newborn health. Chatt Maa Shi Hosp Med Coll J; Vol.22 (2); July 2023; Page 60-63

Preliminary Experience Using Axolotl (Ambystoma mexicanum) Dermis Patches as a Biologic Agent for Wound Management After Neurosurgical Procedures

In the US, chronic wounds affect more than 6.5 million people annually-a mean cost of $23,755 among neurosurgery patients. Current wound management solutions have disadvantages, including rejection, disease transmission from mammalian-sources, and cultural issues prohibiting some products. Here, we describe preliminary use of xenograft tissue derived from axolotl (Ambystoma mexicanum) dermis for use in wound management after neurosurgical procedures. Our prospective database was retrospectively searched for consecutive patients who underwent wound closures using axolotl dermis patches (NeoMatriX, NeXtGen Biologics, Alachua, FL). Patient demographics, daily alcohol and tobacco use, radiation history, operation type, and antibiotic regimens post-closure were collected. Rates of postoperative infection, wound dehiscence, and wound revision or repeated irrigation were collected for outcomes assessment. Twenty-three patients underwent wound closure with the patches. At least one comorbidity related to delayed wound closure was present in included patients: obesity=8(34.8%), diabetes=3(13%), chronic obstructive pulmonary disease=3(13%), hypertension=11(47.8%), hyperlipidemia=10(43.5%), hypothyroidism=3(13%), benign prostatic hyperplasia=3(13%), HIV=1(4.3%), cancer=7(30.4%), daily alcohol use=4(17.4%), and current smoking=7(30.4%). Wounds treated were from decompressive laminectomy, microvascular decompression, thoracolumbar instrumentation revision, and pseudoaneurysm ligation/resection in 1(4.3%) patient each. Three (13%) patients had wounds from aneurysm clippings, 6(26.1%) each from craniotomies and wound dehiscence treatments, and 4(17.4%) from cranioplasties. Patches were applied for primary wound closure in 14(60.9%) patients and secondary wound closure in 9(39.1%) patients. Post-application wound infection or wound dehiscence and/or revision occurred in 2(8.7%) patients. Axolotl dermis patches support mammalian wound management, demonstrating favorable potential in improving neurosurgical wound closure and healing and overall outcomes.

Repair of Radiation Ulcers After Breast Cancer Surgery With Simple Local Random Flaps.

Radiation ulcers that develop after breast cancer surgery are mainly repaired with pedicled flaps or free flaps rather than local random flaps or skin grafts due to large skin defects and poor wound healing. Complicated surgical techniques and donor site reconstruction increase the risk of failure. We report our experience of using the local random long neck reading man flap (LNRMF) to cover large chest wall radiation ulcers, achieving good outcomes. Eight patients who developed chest radiation ulcers after breast cancer surgery and were treated between January 2024 and June 2024 were included. The duration of the wounds ranged from 8 to 35 days. Necrotic and ischemic tissues were completely surgically removed, and subsequent wounds were repaired with LNRMFs. The wounds ranged from 6 cm × 8 cm to 15 cm × 16 cm in size. Visual analog scale scores were recorded during therapy. Eight patients healed well after the first stage. The sutures were removed 10-17 days (average, 12.63 days) after surgery, and no infections, necrosis, or necrotic skin flaps were observed. The average Visual analog scale score was 2.5. The follow-up period was 2-6 months (mean, 4.7 months). Slight linear scarring was observed, and no limitations in shoulder elevation were observed in seven patients; however, 1 patient had slightly limited shoulder elevation. The average SCAR scale score was 3.88, and all sensation scores (according to the Medical Research Council scale) were S3+. LNRMFs are easily created and effectively repair secondary wounds that develop after the resection of radiation ulcers that develop after breast cancer surgery and large skin defects. These flaps can be widely used and should be promoted at the grassroots level.

Linked Flaps of the Thoracodorsal Vascular Tree for Correcting Extensive Post-Burn Deformities and Achieving Optimal Reconstruction Outcomes.

Autologous skin grafting has been the popular method for reconstructing post-burn defects. However, this technique has limitations such as high contracture rates and inadequate volume coverage. This report aims to propose the principles and advantages of utilizing microsurgically linked perforator flaps for the reconstruction of extensive burn defects and associated post-burn scar contracture in the lower and upper extremities and trunk. Patients who underwent free tissue transfer for primary and secondary burn wound reconstruction at a single institution between 2016 and 2023 were included in the study. Patients received thoracodorsal vascular tree-linked flaps for the correction of post-burn deformities. Postoperative results were evaluated, including flap survival, complications, and the DASH self-report questionnaire for upper extremity reconstruction. Among the 20 patients, 12 required primary reconstruction, while 8 underwent secondary reconstruction using anastomotic chimeric free tissue transfer. The majority of burn injuries resulted from thermal contact (n = 8), followed by flames (n = 5), scalds (n = 4), electrical contact (n = 2), and friction (n = 1). The most frequently utilized combinations were the thoracodorsal artery perforator (TDAp) and anterolateral thigh (ALT) flap (11 cases). Additionally, four cases involved the pedicled TDAp flap in conjunction with the deep inferior epigastric artery perforator (DIEP) flap. The average DASH score for upper extremity burn patients was 10.58. Three-dimensional tissue coverage achieved through the linkage of two or even three independent free flaps is increasingly utilized in post-burn reconstruction. This approach offers multiple advantages and represents a viable option for burn reconstruction.

Innovations in Gritti-Stokes Amputation: A Focused Analysis of Immobile Patient Outcomes.

Background Major lower limb amputation is a surgical operation performed for different reasons, including life-threatening infection, ischemia, trauma, and tumors. This study aims to investigate the viability of Gritti-Stokes amputation as a suitable alternative for individuals with impaired mobility and peripheral vascular disease. Patients and methods This was a descriptive, retrospective, and observational study. All patients who met the criteria and underwent Gritti-Stokes amputation were included. The study had a duration of one year, commencing in December 2022 and concluding in December 2023. The data was processed using statistical software (SPSS, version 21; IBM Corp., Armonk, NY, US). Results Twenty-four patients were included. Concerning the complications, 16 patients (66.7%) did not experience any complications, while 7 patients (29.2%) had stump infections. Three of them ultimately required more extensive amputation. A phantom limb was observed in a single patient, accounting for a mere 4.2% of the total. Total of 21 patients, 87.5% reported great stability and lever motion when transitioning from bed to chair, as well as vice versa. Furthermore, wound healing was observed in 21 individuals (87.5%), encompassing both primary and secondary wound healing. Conclusion The Gritti-Stokes amputation provides patients with excellent stability and lever function to facilitate movement. The Gritti-Stokes amputation is a suitableoption for immobile and high-risk patients.

Can we use superglues for superfi cial lacerations?

Objectives: To compare the histopathological and cosmetic outcomes of ethyl-cyanoacrylate to n-butyl-2-cyanoacrylate in rats using an incision wound model. Methods: Two longitudinal incisions were made on the dorsal region of the back of 18 Wistar rats after ketamine anesthesia. Rats were divided into three groups of six: the incisions were closed either using medical tissue adhesive or superglue or were left for secondary wound healing. In each group, three rats were randomly euthanized on the 7th day. The rest were euthanized on the 21st day of the procedure. Tissue samples taken on days 7 and 21 were Histopathologically evaluated blindly by a histologist. The cosmetic appearance was evaluated by a plastic surgeon blinded to the method of closure using a visual analog scale. Results: Histopathological evaluation revealed impaired epithelialization, infl ammation, fi brosis, and dehiscence on connective tissue, and foreign substance reactions were worse in the ethyl-2-cyanoacrylate group when compared with the other groups. A statistically signifi cant diff erence was not found among groups regarding the cosmetic outcome. Conclusions: Cyanoacrylate glues produced for commercial purposes should not be used for the repair of skin lacerations due to their worse histopathological results of epithelialization, infl ammation, fi brosis, dehiscence on connective tissue, and foreign substance reaction. Keywords: Lacerations, Wound closure techniques, Tissue adhesives, Cyanoacrylates, Wound healing.

Secondary Healing Following Trauma-Induced Partial Glossectomy: Case Report of an Arabian Horse

The tongue serves as an organ of food prehension, mastication, grooming, deglutition, taste, and vocalization, and is suspected to play a role in upper airway stability. A seven-year-old riding horse, weighing 350 kg and employed for load-carrying purposes, was brought to Atatürk University Faculty of Veterinary Medicine Hospital due to a transversal injury in the rostral part of the tongue caused by trauma from the bridle's rope. During the general examination, it was observed that the tongue protruded outside the mouth, there was a presence of necrotic odor, paralysis in the apex lingualis region, and bloodstains on the mouth corner and front limbs. After the removal of the tongue tissue, debridement of the necrotic areas in the remaining caudal portion was performed, and it was left for secondary wound healing. Postoperatively, intramuscular injections of 200,000 IU benzylpenicillin procaine were administered every 24 hours for 7 days, along with flunixin meglumine given for 3 days. Additionally, a 0.12% chlorhexidine gluconate solution was used as an oral antiseptic three times daily for a duration of 7 days. Daily phone calls were made to the patient owner to inquire about the overall condition of the patient. Upon the follow-up appointment on the seventh day, improvement in the healing of the tongue was observed.

Immersive Virtual Reality for Pain and Anxiety Management Associated with Medical Procedures in Children and Adolescents: A Systematic Review.

(1) Objectives: The purpose of this study was to investigate the studies that evaluate the effectiveness of immersive virtual reality (VR) as a distraction technique for pain and anxiety associated with medical procedures in children and adolescents. (2) The methods involved a systematic review of randomized controlled trials retrieved from databases in health sciences (Pubmed, CINHAL, Scopus, WOS, ProQuest, Cuiden Plus, InDICEs-CSIC). PRISMA guidelines were followed. (3) Results: Twelve trials were included. Four involved venipuncture, four involved surgical procedures, one involved vaccination, one involved burn care, one involved secondary wound closure, and the last one involved subcutaneous port access. (4) Discussion: Children who undergo medical procedures often experience pain and anxiety, which affects their physical condition and their relationships with caregivers and health professionals. Immersive VR is an effective alternative to medications to help in these cases. No author found statistically significant differences against the use of VR for distraction and palliation of pain and anxiety, which seems to be more effective at a younger age. It is important to personalize the immersive VR experience and equipment. (5) Conclusions: VR, when used with analgesics and anesthetics, appears effective in managing pain and distress caused by medical procedures.

Temporary diverting loop ileostomy in Crohn's disease surgery; indications and outcome.

Crohn's disease can present with complex surgical pathologies, posing a significant risk of morbidity and mortality for patients. The implementation of a loop ileostomy for selected patients may help minimize associated risks. In this retrospective cohort study, we investigated the utilization of temporary fecal diversion through the creation of a loop ileostomy in Crohn's surgery. Closure of all ostomies involved a hand-sewn single-layer technique. We then conducted bivariate analysis on 30-day outcomes for closures, focusing on favorable recovery defined as the restoration of bowel continuity without the occurrence of two challenges in recovery: newly developed organ dysfunction or the necessity for reoperation. In total, 168 patients were included. The median age of the patients was 38 years (IQR 27-51). The most common indication for a loop ostomy was peritonitis (49%). After ileostomy closure, 163 patients (97%) achieved favorable recovery, while five encountered challenges; four (2.4%) underwent abdominal surgery, and one (0.6%) developed acute renal failure requiring dialysis. Two patients (1.2%) had a re-creation of ileostomy. Patients encountering challenges were older (56 [IQR 41-61] vs. 37 [IQR 27-50]; p 0.039) and more often required secondary intention wound healing (40% vs. 6.7%; p 0.049) and postoperative parenteral nutrition following their index surgery (83% vs. 26%; p 0.006). Selectively staging the Crohn's disease operations with a loop ileostomy is a reliable practice with low morbidity and high restoration rates of bowel continuity. Our hand-sewn single-layer technique proves effective in achieving successful surgical recovery.

Postoperative Outcomes of Bascom Cleft Lift Versus Excision With Secondary Wound Healing for Pilonidal Sinus Disease: A Multicenter Retrospective Analysis.

Pilonidal sinus disease impacts patient's quality of life. In the Netherlands, it is often treated with excision and secondary healing, which is associated with high recurrence rates and poor wound healing. The Bascom cleft lift, an alternative technique, has shown favorable healing times and recurrence rates. The present study aims to compare successful wound healing, time to healing, complications, and recurrence rate between excision with secondary wound healing and Bascom cleft lift. This is a multicenter retrospective study. Three institutions in the Rotterdam region of the Netherlands participated in the study. Patients who underwent excision with secondary healing or Bascom Cleft Lift between July 2015 and August 2021 were included. Primary endpoints included the rate of successful wound healing and the time to achieve healing. Secondary endpoints included postoperative complications and recurrence rate within twelve months after surgery. Out of 272 patients, 128 underwent Bascom cleft lift and 144 patients excision and secondary healing. Recurrent PSD (47.7% vs 22.2%) and abscess history (53.1% vs 40.3%) were more common in the Bascom cleft lift group compared to excision with secondary wound healing. The median follow-up period at the outpatient clinic was 43 days. Wound healing was 84.4% after Bascom cleft lift vs. 32.6% after excision and secondary healing (p < 0.001), with median time to wound healing of 55 days and 101 days, respectively (p < 0.001). Complications were 28.9% for Bascom cleft lift vs. 13.2% for excision and secondary healing (p = 0.003). Recurrent disease was 6.3% after Bascom Cleft Lift and 11.8% after excision and secondary healing (p = 0.113). It has a retrospective design which makes it prone to selection bias and residual confounding. Additionally, the study's short follow-up period further adds to these limitations as longer follow-up may better identify true recurrence rates. Finally, a deficiency is the absence of collected patient satisfaction data, which is nowadays a common scientific issue. This retrospective study shows that Bascom cleft lift is superior to excision and secondary healing given the higher percentage of patients with successful wound healing within a shorter time. See Video Abstract.

DS06 A multicentre qualitative study of patient perceptions and experiences with secondary intention wound healing and skin grafting

DS06 A multicentre qualitative study of patient perceptions and experiences with secondary intention wound healing and skin grafting

Peceleganan Spray for the Treatment of Skin Wound Infections

Peceleganan spray is a novel topical antimicrobial agent targeted for the treatment of skin wound infections. However, its efficacy and safety remain unclear. To assess the safety and efficacy of peceleganan spray for the treatment of wound infections. This multicenter, open-label, phase 3 randomized clinical trial recruited and followed up 570 adult patients diagnosed with secondary open wound infections from 37 hospitals in China from August 23, 2021, to July 16, 2022. Patients were randomized to 2 groups with a 2:1 allocation. One group received treatment with 2% peceleganan spray (n = 381) and the other with 1% silver sulfadiazine (SSD) cream (n = 189). The primary efficacy outcome was the clinical efficacy rate (the number of patients fulfilling the criteria for efficacy of the number of patients receiving the treatment) on the first day following the end of treatment (day 8). The secondary outcomes included the clinical efficacy rate on day 5 and the bacterial clearance rate (cases achieving negative bacteria cultures after treatment of all cases with positive bacteria cultures before treatment) on days 5 and 8. The safety outcomes included patients' vital signs, physical examination results, electrocardiographic findings, blood test results, and adverse reactions. Among the 570 patients randomized to 1 of the 2 groups, 375 (98.4%) in the 2% peceleganan treatment group and 183 (96.8%) in the 1% SSD control group completed the trial (n = 558). Of these, 361 (64.7%) were men, and the mean (SD) age was 48.6 (15.3) years. The demographic characteristics were similar between groups. On day 8, clinical efficacy was achieved by 339 patients (90.4%) in the treatment group and 144 (78.7%) in the control group (P < .001). On day 5, clinical efficacy was achieved by 222 patients (59.2%) in the treatment group and 90 (49.2%) in the control group (P = .03). On day 8, bacterial clearance was achieved by 80 of 334 patients (24.0%) in the treatment group and in 75 of 163 (46.0%) in the control group (P < .001). On day 5, bacterial clearance was achieved by 55 of 334 patients (16.5%) in the treatment group and 50 of 163 (30.7%) in the control group (P < .001). The adverse events related to the application of peceleganan spray and SSD cream were similar. This randomized clinical trial found that peceleganan spray is a safe topical antimicrobial agent with a satisfactory clinical efficacy rate for the treatment of skin wound infections, while the effectiveness of bacterial clearance remains uncertain. Chinese Clinical Trial Registry Identifier: ChiCTR2100047202.

Design of chitosan-based drug-loaded laminated materials with superhydrophilic/superhydrophobic properties for simultaneous effective hemostasis and antiadhesion

Hemostatic materials play a crucial role in trauma medicine. However, existing materials have poor hemostatic efficacy and a tendency to adhere to the wound surface, limiting their clinical effectiveness. Herein, a drug-loaded, superhydrophilic/superhydrophobic laminated material (DSLM), consisting of a superhydrophobic inner layer with a micropore array, a superhydrophilic chitosan-based sponge layer loaded with hemostatic/antimicrobial drugs, and a superhydrophobic outer layer, was developed. Furthermore, the DSLM allows unidirectional flow of blood and exudates from the wound bed through the superhydrophobic inner layer while facilitating efficient drug delivery. In addition, it possesses excellent biocompatibility and antiadhesion properties, as confirmed by in vivo and in vitro experiments. Compared with traditional hemostatic materials, the DSLM remarkably increased the survival time by over threefold in the acute femoral transaction wound bleeding model, and simultaneously prevented secondary wound damage by reducing peeling force to one-eighth incomparison to pristine gauze. The DSLM holds promise as a versatile clinical biomaterial for prehospital acute trauma treatment, with its simple structure facilitating manufacturing and expanding applications in biomedicine.

Primary vs. secondary wound closure following transvenous system explantation in CIED infection

Abstract Background &amp; Introduction Patients undergoing an explantation of cardiac implantable electronic devices (CIED) receive either a primary or secondary wound closure or open wound treatment depending on departmental practice. To date, there is limited data on whether secondary wound closure or open wound treatment has any benefit in terms of future complications although it requires a more intensive wound care. Material &amp; Methods Patients who underwent CIED explantation for system infection at our institution between 2016 and 2022 were retrospectively reviewed. From this cohort, patients diagnosed with pocket infection were isolated and divided into two groups: (i) Patients who underwent primary wound closure with or without temporary use of a drain (PG), and (ii) patients who underwent secondary wound closure or open wound management (SG). Patients were followed up by telephone contact for short and long term complications. Results 387 patients underwent CIED explantation due to local or system infection at a heart centre. Of this cohort, 205 patients (135 female; 74.4 ±11.4 y.o.) had a pocket infection. In addition to local infection, 25.9% of all patients presented with a pocket perforation. The onset of infection was early (within 28 days) in 16.1%, intermediate (29 days - 1 year) in 50.2% and late (after 1 year) in 33.2%. Wound swabs and blood cultures were positive for pathogens in 61.0% and 14.1% respectively. 136 (65.9%) underwent primary wound closure, 69 (34.1%) underwent secondary wound closure or open wound management. Post-operative (p.o.) hematoma was present in 12.2% of the cases (6.6% of PG and 24.6% of SG). The risk of developing a p.o. hematoma was significantly more likely in the SG (OR=4.61; IC95%: 1.93 − 11.01). Re-implantation occurred in 70.2%, including 25.7% of leadless pacemakers an 1.5% subcutaneous defibrillators. In 13.7% re-implantation was not indicated, 4.4% refused and 1.0% had contraindications. Mean length of hospitalization was 12.4 ±8.9 days in the PG and 15.7 ±9.6 days in the SG (ρ = 0.0083). A total of 24 (34.8%) patients were discharged with an open wound with or without vacuum treatment (0.74% of PG; 34.8% of SG). Mean telephonic follow-up was 27 ±18 months in 147 cases (n1 = 99; n2 = 48). 91.8% of the cases had no pathological findings at follow-up. 2.7% developed a wound healing disorder (WHD) which was treated conservatively, 4.1% required revision, 0.7% explantation and 0.7% endocarditis. No statistical difference of complication risk between both groups was found (OR=1.8; IC95%: 0.51 - 6.17). Summary &amp; Conclusions Management of CIED pocket infection with primary wound closure compared to secondary wound closure showed a statistically significant shorter hospital stay and reduced likelihood of post-operative hematoma, with no increase in long-term complication rates.

Limited debridement combined with ReCell® Techniques for deep second-degree burns.

The purpose of this article is to introduce a method that combines limited debridement and ReCell® autologous cell regeneration techniques for the treatment of deep second-degree burn wounds. A total of 20 patients suffered with deep second-degree burns less than 10% of total body surface area (TBSA) who were admitted to our department, from June 2019 to June 2021, participated in this study. These patients first underwent limited debridement with an electric/pneumatic dermatome, followed by the ReCell® technique for secondary wounds. Routine treatment was applied to prevent scarring after the wound healed. Clinical outcomes were scored using the Vancouver Scar Scale (VSS). All wounds of the patients healed completely. One patient developed an infection in the skin graft area and finally recovered by routine dressing changes. The average healing time was 12 days (range: 10-15 days). The new skin in the treated area was soft and matched the colour of the surrounding normal skin and the VSS score ranged from 3~5 for each patient. Of the 20 patients, 19 were very satisfied and 1 was satisfied. This article reports a useful treatment method that combines electric dermatome-dependent limited debridement and the ReCell® technique for the treatment of deep second-degree burn wounds. It is a feasible and effective strategy that is easy to implement and minimally invasive, and it is associated with a short healing time, mild scar formation and little damage to the donor skin area.

Mind the gap! Interdisciplinary approach to anterior chest wall reconstruction after total sternectomy

BackgroundThere are various reconstructive methods after total sternectomy. Reproducibility is scarce due to overall small patient numbers. Therefore we present a standardized, interdisciplinary approach for thoracic and plastic surgery.MethodsFour patients underwent interdisciplinary chest wall reconstruction with STRATOS® titanium bars and myocutaneous vastus lateralis muscle free flap in our center.ResultsAll patients reported chest wall stability after reconstruction. They reported good quality of life, no dyspnea, prolonged pain or impairment in lung function from rigid reconstruction. FEV1/FVC was overall better after surgery. Secondary wound healing was not impaired and there was no implant defect in follow up.ConclusionsWe recommend an interdisciplinary surgical approach in chest wall reconstruction after total sternectomy. The combination of rigid reconstruction with titanium bars and a myocutaneous vastus lateralis muscle free flap renders excellent results in patient satisfaction and is objectifiable via spirometry.

Analysis of Factors Influencing Trauma Healing in Children with Second-Degree Burns: A Single-Center Retrospective Study

Background: The complexity of studying secondary burn wound healing in children arises from the varying ability of skin tissue regeneration across different ages. Despite advancements, there are still gaps in our understanding. Objectives: This study aimed to explore factors influencing wound healing in children with second-degree burns to guide clinical treatment and nursing practices. Methods: We conducted a retrospective analysis of children with second-degree burns treated in our burn surgery department from January 2020 to December 2022. Based on the events per variable (EPV) rule, 220 children were included. They were categorized based on the quality of wound healing 14 days post-admission (good or poor), evaluated by the healing rate and scar formation. Children's clinical data were extracted from medical records for analysis. Binary logistic regression identified factors associated with poor healing outcomes in second-degree burns. Results: Among 220 patients with secondary burns, 166 (75.46%) experienced good wound healing, while 54 (24.54%) had poor outcomes. The Hosmer-Lemeshow test indicated a good model fit (χ2 = 9.739, P = 0.28). Significant variables included burn area (odds ratio [OR] = 1.217, 95% confidence interval [CI] = 1.109 - 1.335, P &lt; 0.05), number of drug changes (OR = 1.902, 95%CI = 1.392 - 2.599, P &lt; 0.05), white blood cell count (OR = 1.076, 95%CI = 1.008 - 1.150, P &lt; 0.05), neutrophil count (OR = 1.080, 95%CI = 1.018 - 1.146, P &lt; 0.05), and neutrophil ratio (OR = 1.040, 95%CI = 1.002 - 1.081, P &lt; 0.05). Conclusions: Effective treatment and nursing of children with second-degree burns should prioritize managing large burn areas and high levels of inflammatory markers. Additionally, minimizing drug changes during the nursing process can enhance wound healing in children.

Evaluation of the efficacy of the Z-plasty surgical technique vs. secondary wound healing mechanism in the treatment of the pilonidal sinus: a clinical trial.

The most important step in treating a pilonidal sinus is eradication by surgical excision. Over the years, various surgical techniques have been reported for wound closure, yet their management still poses a challenge. The current study compares the results of two different methods of wound management: secondary wound healing versus the Z-plasty surgical technique. The current clinical trial recruited 84 uncomplicated pilonidal sinus patients who were to undergo complete surgical excision of the pilonidal sinus. For wound healing, the 84 subjects were equally divided into two groups of 42 patients each. One group was selected for Z-plasty surgical wound closure and the other for the secondary healing mechanism. Outcomes measured consisted of demographic data, length of operation, complications, severity of pain, number of dressings, recurrence, and complete healing time. Age or sex distribution and the median BMI (kg/m²) did not significantly differ between the two groups. The length of the operation for Z-plasty subjects was significantly longer (P <0.0001). The median number of dressing changes for secondary wound healing patients was 38.69, which was significantly higher than the 4.95 dressing changes for the Z-plasty group. The total time recorded for complete wound healing was 21.61±4.27 days in the Z-plasty group and 41.23±24.28 days for secondary wound healing subjects, which was statistically significant. Twenty-four hours postoperation, patients in the secondary wound healing group had significantly more pain, and the Visual Analogue Scale scores of the Z-plasty and secondary wound healing groups were 3.42±0.76 and 6.09±1.2, respectively. Concerning the recurrence rate, there were no significant differences between the two groups. SPSS version 22 performed the analyses, and the independent t-test compared the continuous variables. A P value less than 0.05 was considered statistically significant. Z-plasty is a safe and effective procedure in terms of wound complications and recurrence rate. This method is also cost-effective and better received by patients.

Peri-wound skin lesions of allergic nature

Peri-wound dermatoses are a fairly common occurrence in clinical practice. In general, they are all allergic in nature and occur on the skin around the surface area of both primary and postoperative wounds. Peri-wound skin lesions can develop as paratraumatic eczema, simple contact or allergic dermatitis. All these dermatoses can be complicated by a secondary bacterial or mycotic infection, both exogenous and endogenous, which significantly complicates the course of the dermatitis itself and wound healing. The patient is exposed to a fairly large number of potential allergens in the course of surgical care provided at all stages: both in the pre- and postoperative period, and during the surgical intervention. Among them may be drugs and antiseptics, surgical sutures, implants, and even latex gloves of healthcare practitioners in some cases. When it comes to potential allergens, foci of chronic infection in the patient’s body, as well as secondary wound infections should be noted as a separate matter. The presence of peri-wound dermatoses is the most common cause of delayed surgical debridement, and can also become an obstacle to surgical treatment and healing of the wound surface. In addition, pre-existing paratraumatic eczema can progress to a chronic course and contribute to the further spread of the inflammatory process. Thus, peri-wound dermatoses are a pressing interdisciplinary issue. Patients with peri-wound dermatoses require a personalized selection of combination therapy and additional consultative assistance from highly specialized doctors. Fixed-dose topical glucocorticoids combined with antibiotics and antimycotics may be the drugs of choice for patients with peri-wound eczematous process, with due account for complex pathogenetic effects and ease of use. The article describes clinical cases of dermatoses developed in surgical patients.