Secondary Wound Research Articles

Single centre analysis of perioperative complications in trans-oral robotic surgery for oropharyngeal carcinomas.

Trans Oral Robotic Surgery (TORS) is a modality in the management of oropharyngeal squamous cell carcinoma(OPSCC). This study was conducted to show the rates of peri-operative complications after TORS for OPSCC in our experience. Single centre retrospective analysis of consecutive OPSCC treated with TORS. The surgical complication severity was recorded according to Clavien-Dindo criteria (CDC). Eighty-seven OPSCC were operated with TORS. According to CDC, grade I, grade II and IIIb were registered in 8%, 4.6% and 11.5% of cases, respectively. The postoperative pain, registered with visual-analogue scale (VAS) score, was 8 ± 1.2 for the secondary healing wounds and 6.2 ± 1.5 for the flap reconstructions (p < 0.01). The impact on swallowing function was not significant between secondary healing and flap reconstructions(p = 0.96). Any major or life-threatening intraoperative complications have not been recorded. Only one patient had postoperative bleeding into the neck whilst 13.3% of patients had postoperative bleeding from the primary tumor. No total local or free flap failure were registered. The mean duration of tracheostomy use was 7.4 ± 2.6days, and nasogastric tube 14.3 ± 6.9days. Only one patient, who had also reconstruction with flap, experienced a postoperative severe dysphagia with severe aspiration, needing a permanent tracheostomy tube and percutaneous endoscopic gastrostomy feeding. TORS for OPSCC showed less morbidity, lower risk of severe complication and mortality. Thus, this treatment modality could be offered as first line treatment in selected cases.

Comment on “Cutaneous adverse reactions of COVID‐19 vaccines: A systematic review”

We read with interest the article published by Shafie'ei et al.1 regarding a systematic review and meta-analysis of all reported cutaneous side effects of COVID-19 vaccines. Our experience with COVID-19 cutaneous reactions is largely consistent with prior reports of mild, self-limiting cutaneous reactions.2-4 We note reports describing cutaneous vasculitis following COVID-19 vaccination.5 In contrast to the reported mild cutaneous reactions following COVID-19 vaccination, we report the case of a severe prolonged IgA vasculitis following the single dose Janssen COVID-19 vaccine—Ad.26.COV2.S. A 60-year-old Caucasian woman self-presented to the emergency department due to an extensive painful rash affecting her bilateral lower limbs. She described a petechial rash affecting her lower limbs 8 h post the single dose COVID-19 vaccine 11 days prior. Within 10 days, she had developed extensive palpable purpura circumferentially at both lower limbs from the knee distally as well as affecting her thighs and lower abdomen and was referred to dermatology by the emergency physicians (Figure 1A). This was on a background of psoriasis, psoriatic arthritis and hypertension. Her longstanding medications included naproxen, amlodipine, and fexofenadine, and she denied any symptoms of infection. She was apyrexial, and her systems review and examination were unremarkable. Blood tests taken revealed a mildly elevated c-reactive protein of 14 mg/L (normal: <7 mg/L) and erythrocyte sedimentation rate of 26 mm within the first hour (normal: <13 mm) and a normal white blood cell count of 6.41 × 109/L (normal: 3.5–10.5 × 109/L). A chest x-ray and midstream urine showed no evidence of infection. At this time, super-potent topical steroids were prescribed. A punch biopsy taken from her right lower limb demonstrated findings consistent with a leukocytoclastic vasculitis (Figure 2). Direct immunofluorescence demonstrated IgA deposits within vasculature. On follow-up review, tense bullae were seen at her bilateral ankles. Treatment prescribed at this time consisted of tapering oral steroids, oral antibiotics for secondary infection and wound care. The bullae ruptured to leave multiple punched-out and exquisitely painful ulcers (Figure 1B). It was noted that her urinary protein creatinine (UPCR) ratio was uptrending and rose to a value in excess of 100 mg/mmol (normal 0–15 mg/mmol). Complete resolution of the aforementioned lower limb ulceration was noted following 5 months of oral steroid treatment (Figure 1C). Imaging, colonoscopy, and mammography were negative for malignancy. IgA vasculitis represents a small vessel vasculitis brought about by the activation of neutrophils and deposition of IgA at perivascular sites.6 We note a prior case report of postvaccination IgA vasculitis resolving 4 weeks after onset.5 In our case, the complete resolution of the vasculitis and secondary ulceration were noted following 5 months of treatment with oral corticosteroids, which represents the longest reported case. Additionally, our patient had secondary renal involvement with preserved renal function. Her regular medications of naproxen and amlodipine were commenced 5 years prior to this presentation and so were deemed unlikely to be causative. Malignancy and infection were out-ruled. While this presentation may have been coincidental, the relationship between immune complex vasculitis and vaccination has been reported5 and represents the most likely pathophysiological explanation in our patient's case. We feel this case is worth highlighting as it demonstrates a prolonged and severe cutaneous reaction to COVID-19 vaccination. All authors contributed to the editing and execution of this piece. None. The authors report no conflict of interest. The data that support the findings of this study are openly available in Pubmed at https://pubmed.ncbi.nlm.nih.gov/. The patient reported in this article has provided written consent for clinical images to be used in publication.

Tonsillectomy Outcomes in Children After Solid-Organ Transplantation: A 15-Year Single-Center Experience.

Solid-organ transplantation (SOT) has become the standard of care for children with terminal organ failure. Long-term immunosuppression has improved survival substantially but is associated with secondary malignancies and impaired wound healing. Our goal was to review the incidence, outcomes, complications, and rate of posttransplant lymphoproliferative disorder on pathologic examination following tonsillectomy/adenotonsillectomy (T/AT) in children after SOT. A retrospective cohort study. Tertiary care children's hospital. Data were extracted from charts of children with a history of kidney, heart, or liver transplantation, who underwent T/AT between 2006 and 2021. A total of 110 patients met the inclusion criteria, including 46 hearts, 41 kidneys, 19 livers, and 4 liver-and-kidney transplants. The mean age at transplantation was 4.2 years, and the mean transplantation-to-T/AT time interval was 28.8 months. The posttransplantlymphoproliferative disorder was diagnosed in 52 (47.3%) patients, and 25% of these had no tonsillar hypertrophy. There was no difference in age at transplantation, organ received, transplantation-to-T/AT time interval, immunosuppressive medications, tonsil size, or tonsillar asymmetry between patients diagnosed with the posttransplant lymphoproliferative disorder and patients with benign tonsillar/adenotonsillar hypertrophy. Posttonsillectomy complications were similar between the groups. The incidence of posttransplant lymphoproliferative disorder undergoing tonsillectomy for any indication was 47.3%. There was no association between preoperative signs and symptoms and the histopathological diagnosis of posttransplant lymphoproliferative disorder. Stratification by organ received and immunosuppressive medications did not identify differences among the groups relative to the incidence of posttransplant lymphoproliferative disorder and other postoperative complications.

Bisacurone gel ameliorated burn wounds in experimental rats via its anti-inflammatory, antioxidant, and angiogenic properties.

To investigate putative mechanism of wound healing for chitosan-based bisacurone gel against secondary burn wounds in rats. A second-degree burn wound with an open flame using mixed fuel (2 mL, 20 seconds) was induced in Sprague Dawley rats (male, 180-220 g, n = 15, each) followed by topical treatments with either vehicle control (white petroleum gel, 1%), silver sulfadiazine (1%) or bisacurone gel (2.5, 5, or 10%) for 20 days. Wound contraction rate and paw withdrawal threshold were monitored on various days. Oxidative stress (superoxide dismutase, glutathione, malondialdehyde, and nitric oxide), pro-inflammatory cytokines (tumour necrosis factor-alpha, interleukins by enzyme-linked immunosorbent assay), growth factors (transforming growth factor-β, vascular endothelial growth factor C using real time polymerase chain reaction and Western blot assay) levels, and histology of wound skin were assessed at the end. Bisacurone gel showed 98.72% drug release with a 420.90-442.70 cps viscosity. Bisacurone gel (5 and 10%) significantly (p < 0.05) improved wound contraction rate and paw withdrawal threshold. Bisacurone gel attenuated oxidative stress, pro-inflammatory cytokines, and water content. It also enhanced angiogenesis (hydroxyproline and growth factor) and granulation in wound tissue than vehicle control. These findings suggested that bisacurone gel can be a potential candidate to treat burn wounds via its anti-inflammatory, antioxidant, and angiogenic properties.

Carotid EndoVAC: a novel hybrid technique for carotid Dacron patch infection

This paper reports the use of the EndoVAC technique in a case of left carotid artery Dacron patch infection. The EndoVAC technique involves a sequence of endovascular relining with a stent graft, surgical debridement with explantation of infected graft material and secondary intention wound healing with a vacuum-assisted closure (VAC) device and long-term antibiotic treatment. Our patient was considered a high-risk surgical candidate due to previous cranial nerve injury, high carotid stent graft positioned in zone 3 of the neck, and high stroke risk due to aberrant cerebrovascular anatomy. The carotid EndoVAC technique was performed without complication and a successful outcome was observed at 1-year follow-up. Although currently not recommended as first-line management in treating vascular graft and endograft infections of the carotid vessels, the EndoVAC approach should be considered in a select cohort of patients when neither traditional radical surgery nor conservative simple VAC therapy are considered feasible or safe.

Electrospun Nanofiber: Application in Tissue Regeneration

Abstract: An injury to the human body is classified as a wound if it results in a cut or a break in the skin. Depending on the depth of the skin layer, a wound can either be limited to the epidermal layer, which heals via re-epithelialization without the need for skin grafts, or full-thickness wounds, which result in the loss of both the epidermis and dermis (FTW). A full-thickness wound cannot heal on its own and needs a skin graft or tissue regeneration product to heal quickly. This paper provides a comprehensive overview of the properties of electrospun nanofibers and their application as skin regeneration products rapid healing of the full-thickness wound. The paper first introduces the skin, its layers, and various problems associated with human skin. In the next part, a wound is discussed in terms of acute and chronic wounds. Primary, secondary and tertiary clinical wound healing has also been discussed. The next part briefly introduces the four different phases of healing, i.e. hemostasis, inflammation, proliferative and maturation of newly deposited collagen into tissues. The effect of superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPx) on reactive oxygen species, reactive nitrogen species and reactive sulphur species, and their effect on healing time was discussed. The electrospinning process's evolution and setup, properties of electrospun nanofibers, a component of electrospinning solution, and various parameters affecting electrospinning were discussed. Application on nanofiber scaffold in terms of drug delivery and tissue regeneration was highlighted. In the end, improvement in the existing nanofibrous scaffold was briefly highlighted.

A Risk-Benefit Review of Currently Used Dermal Substitutes for Burn Wounds.

While split-thickness autologous skin grafts remain the most common method of definitive burn wound closure, dermal substitutes have emerged as an attractive option. There are many advantages of utilizing a dermal substitute, notably reducing the need for donor tissue and subsequent iatrogenic creation of a secondary wound. However, there are disadvantages with each that most be weighed and factored into the decision. And most come at a high initial financial cost. There is little comparative literature of the various available and emerging products. This analysis was performed to objectively present risks and benefits of each option.

Primary Closure of Pilonidal Sinus With Slide-Swing Skin Flap Compared With the Secondary Closure: A Single-Blinded Randomized Controlled Trial.

There are many surgical approaches for sacrococcygeal pilonidal sinus disease (PSD) therapy, ranging from wide excision repair to less morbid excisions with primary/flap closure. The off-midline flaps, which shift the incision line away from the midline natal cleft, have been associated with lower recurrence rates than the conventional mid-line closure techniques. This single-blinded randomized controlled trial aims to compare the short/long-term efficacy and outcome of the slide-swing flap technique with the conventional secondary wound closure. This study was a prospective randomized controlled trial conducted on patients with PSD. Patients were assigned into two groups: secondary closure (control) and slide-swing flap (trial). Patients were advised to visit the surgical clinic two times weekly for the two weeks after the operation for at least six months. In this study, 100 patients were enrolled. They were assigned into two groups of control, and trial. The mean age of all participants was 29.15 ± 8.36 years old (age range: 18-62 years old). The mean operation time was 39.65 ± 12.63 for both groups, with the control group being 29.70 ± 7.71 and the swing flap group 46.90 ± 7.81. Patient visual analog scale (VAS) scores in both groups revealed that the trial group was associated with lower VAS scores compared with patients who underwent secondary closure (p-value = 0.006). Also, the trial group demonstrated a higher rate of healing, better cosmetic outcomes, and quicker recovery time compared with the controls. Compared with secondary closure, the slide-swing flap was associated with excellent cosmetic outcomes, disease recurrence, and recovery time. Also, the post-operative complications were significantly lower compared with the traditional method.

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

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

Highly antibacterial electrospun double-layer mats for preventing secondary wound damage and promoting unidirectional water conduction in wound dressings

The efficient absorption of wound exudate and the prevention of soft tissue infection are major concerns in wound repair. Good antibacterial agents and unique wound dressing structures can effectively reduce wound infection, thereby accelerating wound healing. In some double-layer asymmetric wound dressings, antimicrobial agents are incorporated in the hydrophilic layer, and only a small fraction of the antimicrobial agent penetrates the hydrophobic fibre layer towards the interior of the wound. Therefore, in this study, we chose curcumin (Cur.)/cellulose acetate (CA) as the hydrophobic inner layer. Not only does this effectively allow Cur. to make contact with the lining of the wound but it also prevents the wound from sticking. However, the mechanical properties of a single CA/Cur. layer are not ideal. Using polyacrylonitrile as the outer hydrophilic substrate improves the fibre mat mechanical properties. In addition, to further improve the hydrophilicity, the water contact angle was reduced by introducing a hydrophilic group (2-hydroxypropyl-β-cyclodextrin, β-CD) and changing the fibre roughness (nano-TiO2). Thus, wound dressings with high biocompatibility, excellent antibacterial properties, and unidirectional water conduction were constructed for preventing secondary wound damage. In terms of performance, it took 40 minutes for water to enter the hydrophilic fibre layer from the hydrophobic fibre layer (the water contact angle decreased from 121.24° to 85.42°), and it took 25 minutes for water to completely enter the fibre mats (the water contact angle decreased from 85.42°-0°), which is effective for draining wound exudate. In terms of antibacterial properties, the antibacterial rates of Cur. (8 wt%) against Escherichia coli and Staphylococcus aureus were 82.4% and 92.57%, respectively. The Cur./CA@PAN/β-CD/TiO2 bilayer asymmetric nanofibrous mats mimic the semipermeability of the extracellular matrix (ECM) and have high biocompatibility, which is effective for preventing secondary wound damage. It can be used as a low-cost, high-performance wound dressing with medical material potential.

90.10. MedBed and its Effect on Cultivated Intestinal Epithelial Cells and Functional Neutrophils

Background: Quantum entanglement is a phenomenon in theoretical physics that happens when pairs or groups of particles are generated in such a way that the quantum state of each particle cannot be described independently of the others even when the particles are separated by a large distance. Material and methods: The 90.10. MedBed is a virtual bed that is quantum entangled with a 90.10.-CUBE by a quantum processor, the 9010MedBedOS. The 90.10.-CUBE was located in Akumal Quintana Roo, Mexico, 8,603 kilometers air-line distance from the cell culture laboratory conducting the tests. The 90.10. MedBed is a virtual bed that is quantum entangled with a 90.10.-CUBE by a quantum processor, the 9010MedBedOS. By the process of 90.10. quantum entanglement, the 90.10. CUBE’s basic potential is transferred to the 90.10. MedBed. For the present in vitro-study with intestinal epithelial cells and functional neutrophils – at laboratory conditions instead of a bed – seeded cells in the culture dishes were quantum entangled with the 90.10. MedBed, i.e. the system was installed on the dishes and activated in the laboratory to conduct the study. Control dishes were not treated and were incubated in the same incubator with a distance of at least 30 to 40 cm to the treated dishes. Results: For intestinal epithelial cells, a better regeneration process was determined demonstrating that 90.10. MedBed was able to promote healing processes of the intestinal cell layer and, thus, to promote intestinal and systemic health and wellbeing. The second experimental series with functional neutrophils as inflammationmediating cells demonstrated a marked decrease in the generation of reactive superoxide anion radicals by exposure to 90.10. MedBed quantum entanglement. In vivo, this influence might have a positive impact on the healing process of complicated secondary wounds or on (chronic) inflammatory processes directly. Conclusions: The results clearly demonstrate the effectiveness of the 90.10. MedBed which was quantum entangled with a 90.10.-CUBE by a quantum processor, the 9010MedBedOS, on the cellular level. The results confirm and complement previous findings on the effect of 90.10. quantum entanglement on cultured organ-specific cells in which we demonstrated an increased regeneration of cultured connective tissue fibroblasts. Keywords: Quantum energy; 90.10. MedBed; Quantum entanglement; Intestinal epithelial cells; IPEC-J2; Cell regeneration Functional neutrophils; HL-60; Oxidative burst; Cell culture

Solid PRF Serves as Basis for Guided Open Wound Healing of the Ridge after Tooth Extraction by Accelerating the Wound Healing Time Course-A Prospective Parallel Arm Randomized Controlled Single Blind Trial.

Systematic evaluations regarding the influence of PRF in ridge sealing are still lacking. To the best of our knowledge, this is the first systemic randomized, controlled, clinical approach dealing with the potential of a systematic applied solid PRF on soft tissue socket healing of molar and premolar extraction sockets with evaluation for up to 90 days. Qualitative and quantitative image analysis showed that PRF contributed to a significantly faster ridge sealing, within the period of 7-10 days in both tooth types. This led to a visibly less contraction at the PRF-treated group sites at day 90. Patients' pain perception demonstrated no statistic significance between both groups (PRF vs. natural healing), but the patients in PRF group seemed to have had less pain throughout the observational period. It becomes evident that PRF is able to serve as a promotor of the secondary wound healing cascade. The guiding capacity of PRF accelerating the process of open ridge healing makes it possible to act as a natural growth factor drug delivery system, providing a more predictable guided open wound healing of the ridge with less contraction of the soft tissue, the latter being a key factor for the subsequent successful dental implantation and oral rehabilitation.

Surgical Management of Peripheral Vein Thrombophlebitis in the Upper Extremity

Peripheral vein thrombophlebitis has a reported overall incidence ranging from 20% to 80%. Thrombophlebitis can progress despite antibiotic therapy to become a challenging clinical problem requiring surgical intervention. There is currently no consensus on its optimal management. We reviewed our experience of surgical intervention with analyses of the indications for intervention, descriptions of the surgical procedures, and outcomes. We aimed to provide guidance on the management of this potentially serious complication. This is a retrospective review of 51 patients with thrombophlebitis refractory to conservative management between January 2017 and August2020. Analyses revealed a high prevalence of comorbidities, including diabetes mellitus, malignancy, and chronic kidney disease. A total of 60% of patients had concurrent bacteremia, and the decision to operate had a low threshold in the presence of these factors. On exploration, 80% of patients had intraluminal thrombus, 47% had intraluminal pus, and 29% had pus beyond the veins or extending proximally. The surgical approach employed in 98% of patients involved an extensile incision in those with several morbidity factors (diabetes mellitus, chronic kidney disease, or bacteremia). One patient presented with severe clinical signs of local infection, and on exploration, there was intraluminal pus and thrombus up to 10 cm. A novel technique of a minimally invasive approach of intermittent stab incisions was employed in a young and healthy patient without comorbidities. We developed an algorithm to guide the indications for intervention and surgical approach to thrombophlebitis. The threshold for intervening surgically should be lowered by the presence of comorbidities. The failure of antibiotics to resolve the clinical signs of infection or the suspicion of abscess formation should mandate intervention. Thrombosed sections of the vein should be ligated proximally and distally and excised and surrounding collections of pus drained. Delayed secondary wound closure is usual. Stab incisions may limit surgical dissection and subsequent scarring in less severe cases. Prognostic IV.

Autogenous bone-guided induced membrane technique in closed/small-sized open high-energy fractures in benign inflammatory environment: a case series.

Infection and nonunion are the two most challenging issues for high-energy fractures. This study aimed to explore the clinical effect of benign inflammation-cultivated bone growth activity in the treatment of closed/small-sized open and high-energy fractures. This study is a case series of closed/small-sized open and high-energy fractures of the lower limbs treated at our hospital from April 2009 to February 2017. All patients underwent debridement and external fixation in the early stage, followed by internal fixation in the second stage. After the operation, fracture healing was monitored by X-ray, and early-stage knee function training was initiated. Also, bone grafting was performed to stimulate the healing reaction, eliminating the atrophic nonunion factors. The operation in all 75 cases was carried out after the inflammatory responses completely subsided, leading to secondary wound healing. Bony union appeared in 71 patients who did not suffer from any pain and could stand up and walk without any restriction. Among them, 68 patients could flex their knee > 100°, and three patients had knee flexion ranging from 80 to 100°. No infections occurred after the second operation. This two-stage treatment for high-energy fractures could avoid the damage caused by excessive inflammatory responses that occurred following early-stage one-time internal fixation. This method protected benign inflammatory-callus reactions induced by the primary injury and utilized the advantages of closed reduction in AO fixation with open reduction, thereby avoiding potential infection and nonunion caused by one-time fixation during the early stage.

Outcomes and Reliability of Perforator Flaps in the Reconstruction of Hidradenitis Suppurativa Defects: A Systemic Review and Meta-Analysis.

Introduction: Hidradenitis suppurativa (HS) is a common and debilitating disease, in which the only effective treatment involves a wide excision of the affected skin. Secondary wound healing and skin grafting are two well-known options for managing these defects, but perforator flaps provide a new therapeutic alternative by ensuring reconstructions of large defects, reducing donor site morbidity, and enhancing functional recovery. The aim of this study was to achieve a systematic review of perforator flaps use in HS. Patients and Methods: PubMed and Cochrane databases were searched from 1989 to 2021. The PRISMA statement was used in the study selection process and the review was registered on PROSPERO. Furthermore, patient characteristics, operative technique, complications, and recurrences were searched. Results: Thirty-six articles were selected including 286 patients and 387 flaps. Axillary localization was mostly represented (83.2%). Direct donor site closure was achieved in 99.1% of cases. In total, 15.1% of the flaps presented at least one of the following complications: wound dehiscence (5.5%), partial necrosis (2.9%), hematoma or seroma (2.1%), infection (2.1%), venous congestion (1.8%), and nerve injury (0.3%). Two cases of total necrosis were recorded. Recurrence of the disease was observed in 2.7% of the defects. Conclusions: Pedicled perforator flaps are a reliable and reproducible technique in the reconstruction of HS defects. They are associated with a low recurrence rate while ensuring an effective reconstruction with reduced morbidity and faster recovery compared to the techniques classically used in this indication.

Modified Borggreve–Van Nes-Winkelmann rotationplasty for surgery in developing countries

BackgroundAmputation is still the most common therapy for patients suffering from osteosarcoma in Myanmar, despite the fact that limb salvage surgery e.g. Borggreve–Van Nes-Winkelmann rotationplasty for malignant tumors located within the distal femur or proximal tibia is the current state-of-the-art reconstructive procedure. A safe and reliable operation technique is crucial in order to perform a complex surgical procedure like the rotationplasty in lower-middle income economies with limited infrastructure and resources. The authors present seven cases of patients with osteosarcomas that received a Borggreve–Van Nes-Winkelmann rotationplasty with an evaluation of the procedures focusing on safety and sustainability.MethodsFrom 2019 until 2020, seven young patients with osteosarcomas of the distal femur or proximal tibia were treated with Borggreve–Van Nes-Winkelmann rotationplasties in the Orthopaedic Hospital in Mandalay, Myanmar. As modification of the standard procedure the dissection and subsequent clamping of the femoral artery in order to minimize blood loss as well as the formation of an adipocutaneous flap that minimizes swelling and decreases the pressure on the vessels were successfully performed. This modified procedure resembles a safe and simplified surgical technique that is feasible under the circumstances of lower-middle income economies with good outcomes.ResultsAll patients showed good functional and aesthetic results. One of the seven patients needed secondary wound closure due to wound dehiscence.ConclusionsA simplified and safe operation technique for the performance of the Van Nes-Borggreve rotationplasty was adapted to the given constraints in lower-middle income economies and proved to be successful.Trial registration All patients approved to participate in the study and have given consent to publication.

A Comparison between the Outcomes of Wound Closure by Primary and Secondary Healing after Mandibular 3rd Molar Impaction Surgery

Background: The one of the most frequently performed procedure by the surgeon in the oral and maxillofacial surgeries is removal of mandibular third molar. Objective: The study aimed to compare the process of primary and secondary wound closure outcomes after the surgical removal of impacted mandibular third molar. Study design: It is a comparative study conducted at Armed Forces Institute of Dentistry, Rawalpindi for the duration of six months from Jan 2022 to June 2022. Material and Methods: The 65 patients visited the oral and maxillofacial surgery department of hospital were included in the study. According to the inclusion criteria, these patients had impacted their third molar and they were medically fit and ready to come for follow ups after the operation as well. The patients were divided into two groups. The group A had 33 patients, the average age of these patients was 30 years and proportion of male and female among these 33 patients was 40% male (13) and 60% female (20). Group B had 32 patients and among those 32 patients there were 46% male (14) and 53% female (18) and the average age of the participants was 27. Results: The percentage incidence of swelling and pain was higher in the group A. The values was statistically significant. The mouth opening was highly observed in the group B patients. The post-operative pain was measured at first day, third day and 7th day by making use of the visual analog scale. The comparison was made. The mean pain score on third day was 4.9 and 3.5 and on the seventh day the mean pain score was 3.2 and 1.5 respectively for group A and B. the overall variation in pain scores were significantly high. Conclusion: In this study, the conclusion is made that the secondary closure was a suitable option then the primary closure for the post-operative pain and swelling. There was no variation found in case of periodontal healing irrespective of the closure procedure used, but the risk of infection and food impaction is more in case of secondary closure. Therefore, if patients have poor hygiene conditions secondary closure is not suitable for them. Keywords: wound closure, healing type and mandibular third molar.

Debonding-On-Demand Polymeric Wound Patches for Minimal Adhesion and Clinical Communication.

Herein, a multifunctional bilayer wound patch is developed by integrating a debonding‐on‐demand polymeric tissue adhesive (DDPTA) with an ionic conducting elastomer (ICE). As a skin adhesive layer, the DDPTA is soft and adherent at skin temperature but hard and non‐tacky when cooled, so it provides unique temperature‐triggered quick adhesion and non‐forced detachment from the skin. During use, the dense surface of the DDPTA prevents blood infiltration and reduces unnecessary blood loss with gentle pressing. Moreover, its hydrophobic matrix helps to repel blood and prevents the formation of clots, thus precluding wound tearing during its removal. This unique feature enables the DDPTA to avoid the severe deficiencies of hydrophilic adhesives, providing a reliable solution for a wide range of secondary wound injuries. The DDPTA is versatile in that it can be covered with ICE to configure a DDPTA@ICE patch for initiating non‐verbal communication systems by the fingers, leading toward sign language recognition and a remote clinical alarm system. This multifunctional wound patch with debonding‐on‐demand can promote a new style of tissue sealant for convenient clinical communication.

Development and evaluation of a novel topically applied sildenafil citrate hydrogel and its influence on wound healing in dogs.

To develop a topical sildenafil hydrogel and evaluate its effect on wound healing in dogs. 6 purpose-bred, sexually intact, adult Beagles. Hydrogels containing sildenafil citrate, N-methyl-2-pyrrolidone, propylene glycol, and poloxamer 407 were developed. Four excision wounds were created along the dorsum of the dogs. Each wound was treated for 21 days with a nonadherent bandage (C) or with a hydrogel containing 0% (G), 5% (5S), or 10% (10S) sildenafil. Daily bandage changes with wound imaging were performed. Biopsy specimens were collected 5 times. Hydrogels were homogenous at room temperature and released > 90% of the sildenafil within 8 hours in vitro. Time to first granulation tissue was significantly shorter for the sildenafil groups (mean ± SD, 2.8 ± 0.8 days [5S and 10S]), compared with the control groups (5.2 ± 0.4 days [C] and 6.3 ± 1.4 days [G]). The G wounds had a 10% to 14% lower contraction rate, compared with the C, 5S, and 10S wounds. 5S wounds had a total wound area 0.7 ± 0.3 cm2 larger than 10S wounds. No significant differences were present when C wounds were compared with 5S and 10S wounds for total wound area, contraction, or epithelialization. Histologic acute inflammatory scores were higher for 5S and 10S wounds in the early and late stages of wound healing, with higher reparative scores on day 7. Neovascularization was higher for 10S wounds on day 7 and 14. The topical sildenafil hydrogel promoted early granulation tissue, which may be beneficial for secondary wound closure in clinical settings.

Incision wound healing test ethanolic extract gel from Ekor Naga (Rhaphidophora pinnata (L.f) Schott) leaves in white male rats

Ekor naga (Rhaphidophora pinnata (L.f) Schott ) leaves have been researched and tested. So, it was known that the chemical content of secondary metabolites effect wound healing. This study aimed to determine the gel effect of ekor naga leaves extracts as a wound healing medicine. The research method evaluated organoleptic, pH, spreadability, and adhesion of gel preparations which were measured every week for four weeks. The testing of gel effect on the wound healing medicine was being performed. In 5 treatment groups namely positive control: Bioplasenton, Formula 0: negative control, Formula 1: 10% extract concentration, Formula 2: 15% extract concentration, and Formula 3: 20% extract concentration. The result obtained were analyzed by one-way ANOVA and continued by the Duncan test with a level of 95% confidence. The research results showed that formula 3 has the best wound healing effect, followed by formulas 2 and 1. The statistical results have a significant difference (p&lt;0,05), but the results of stability observations of the formula two preparation have a stable. Evaluation value for four weeks of observation with a care effect of 95.3%. So, formula 2 is the best formula for stability and testing wound healing effectiveness.