Shorter Healing Time Research Articles

Associations between self-care advice and healing time in patients with venous leg ulcer– a Swedish registry-based study

BackgroundVenous leg ulcers take time to heal. It is advocated that physical activity plays a role in healing, and so does the patient’s nutritional status. Additionally, malnutrition influences the inflammatory processes, which extends the healing time. Therefore, the staff’s advising role is important for patient outcomes. Thus, this study aimed to investigate the associations between given self-care advice and healing time in patients with venous leg ulcers while controlling for demographic and ulcer-related factors.MethodsThe sample consisted of patients registered in the Registry of Ulcer Treatment (RUT) which includes patient and ulcer-related and healing variables. The data was analyzed with descriptive statistics. Logistic regression models were performed to investigate the influence of self-care advice on healing time.ResultsNo associations between shorter healing time (less than 70 days) and the staff´s self-care advice on physical activity was identified, whilst pain (OR 1.90, CI 1.32–2.42, p < 0.001) and giving of nutrition advice (OR 1.55, CI 1.12–2.15, p = 0.009) showed an association with longer healing time.ConclusionsNeither self-care advice on nutrition and/or physical activity indicated to have a positive association with shorter healing time. However, information and counseling might not be enough. We emphasize the importance of continuously and systematically following up given advice throughout ulcer management, not only when having complicated ulcers.

Diabetic Foot Ulcer on Coronavirus Patient

BACKGROUND: Corona virus (COVID 19) is an infection caused by a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The manifestation is from mild symptoms to severe symptoms such as respiratory failure and death. The severity of symptoms that arises in COVID-19 patients is influenced by the comorbidities they have. One of the comorbidities is diabetes. Increasing blood viscosity and severe inflammation occur in the body of COVID-19 patients. Meanwhile, problems such as coagulation factors, body blood flow, disorders of the nerves, lowering the immune response also occur in diabetic patients and etc. One of the complications of diabetes that often occurs is diabetic foot ulcers. The wound will be aggravated by a bacterial infection, such as hemolytic Streptococcus. Delay in diabetic ulcer treatment increases the incidence of amputation, sepsis and death. One of the therapies for diabetic foot ulcer is negative pressure wound therapy (NPWT). NPWT has a higher total cure rate, shorter healing time, and fewer amputations. If the wound is large, it can be continued with Split-Thickness skin graft (STSGs). CASE REPORT: A-54-year-old male patient, moderately confirmed COVID 19 with diabetes Mellitus comorbidty and diabetic foot ulcer. Around the wound there was a black tissue the base of which were muscles and tendons. The tissue culture examination found hemolytic streptococcus bacteria. Diabetic ulcers are given antibiotic therapy, NPWT and STSG. After the patient had been discharged from the hospital and then examined by the surgical clinic, the wound was closed completely. CONCLUSION: Diabetes is also a comorbid COVID-19 infection. Patients who are infected with COVID-19 and have uncontrolled blood sugar will prolong the treatment period for diabetic foot ulcers and can improve amputation therapy. Negative-Pressure Wound Therapy (NPWT) is a tool that is often and effective used for wound management.

Evaluation of the healing potential of short-term ozone therapy for the treatment of diabetic foot ulcers.

The availability of research on short-term ozone therapy for diabetic foot ulcers (DFUs) is limited, and even when it is accessible, it mainly comprises of basic analysis conducted during long-term ozone therapy. This study was to evaluate the efficacy of short-term ozone therapy in promoting wound healing in DFUs. A retrospective analysis was conducted on 89 patients with type 2 diabetes complicated by DFUs. The patients were divided into two groups: ozone therapy group (n=41) and control group (n=48). Wound condition, change of bacterial types, changes in inflammatory indicators (erythrocyte sedimentation rate [ESR], C-reactive protein [CRP], and procalcitonin [PCT]), vascular endothelial growth factor (VEGF), cytokines [Interleukin 6 (IL-6) and tumor necrosis factor-α(TNF-α)], and oxidative stress levels (superoxide dismutase [SOD], malondialdehyde [MDA], and total antioxidant capacity [T-AOC]) were observed pre-treatment and after 1 week. After a 12-week of follow-up, wound healing rate, amputation rate, inpatient day, duration of antibiotics, reinfection rate, incidence of new ulcers, readmission rate, and reoperation rate, and cumulative wound healing rate using Kaplan-Meier curves were assessed. After 1 week of treatment, the ozone therapy group showed higher VEGF, SOD, and T-AOC levels compared to the control group (P<0.05), while CRP, PCT, ESR, IL-6, TNF-α, MDA levels and bacterial types were lower (P<0.05). The ozone therapy group had a higher wound healing rate after a 12-week follow-up (P<0.05). Kaplan-Meier curves indicated a higher cumulative wound healing rate in the ozone therapy group (P<0.05). Additionally, the ozone therapy group had lower inpatient day, duration of antibiotics, reinfection rate, and readmission rate compared to the control group (P<0.05). Short-term ozone therapy is effective in promoting wound healing in DFUs by reducing inflammation, increasing growth factor levels, improving oxidative stress status, shortening healing time, and improving long-term prognosis. These findings suggest the potential of short-term ozone therapy as a valuable treatment modality for DFUs.

Electrospun radially oriented berberine-PHBV nanofiber dressing patches for accelerating diabetic wound healing.

A dressing patch made of radially oriented poly(3-hydroxybutyrate-co-3-hydroxyvalerate) (PHBV) nanofibers was successfully manufactured with a modified electrospinning strategy. The as-electrospun PHBV radially oriented nanofiber dressing patch exhibited uniform and bead-free nanofibrous morphology and innovative radially oriented arrangement, which was demonstrated to possess obviously improved mechanical property, increased surface hydrophilicity and enhanced biological properties compared to the PHBV nanofiber dressing patch control with traditionally randomly oriented pattern. Interestingly, it was found that the radially oriented pattern could induce the cell migration from the periphery to the center along the radially oriented nanofibers in a rapid manner. To further improve the biofunction of PHBV radially oriented nanofiber dressing patch, berberine (Beri, an isoquinoline alkaloid) with two different concentrations were encapsulated into PHBV nanofibers during electrospinning, which were found to present a sustained drug release behavior for nearly one month. Importantly, the addition of Beri could impart the dressing patch with excellent anti-inflammatory property by significantly inhibiting the secretion of pro-inflammatory factors of M1 macrophages, and also showed an additive influence on promoting the proliferation of human dermal fibroblasts (HDFs), as well as inhibiting the growth of E. coli, S. aureus and C. albicans, compared with the Beri-free dressing patch. In the animal studies, the electrospun PHBV radially oriented nanofiber dressing patch loading with high Beri content was found to obviously accelerate the healing process of diabetic mouse full-thickness skin wound with shortened healing time (100% wound closure rate after 18 days' treatment) and improved healing quality (improved collagen deposition, enhanced re-epithelialization and neovascularization and increased hair follicles). In all, this study reported an innovative therapeutic strategy integrating the excellent physical cues of electrospun PHBV radially oriented nanofiber dressing patch with the multiple biological cues of Beri for the effective treatment of hard-to-heal diabetic wounds.

Uncovering the Benefits of Povidone Iodine Compared to Other Therapeutic Agents in Wound Infection Prevention and Healing Outcomes: A Scoping Review.

The selection of an appropriate chemical solution in wound care reduces the severity of wounds and accelerates the healing process. Povidone-iodine (PV-I), a chemical solution popularly known as an antiseptic, is frequently used in studies of wound care to prevent wound infection and accelerate woud the process of wound healing. To identify the latest evidence on the benefits of PV-I in wound infection prevention and healing in all areas. This review is a scoping review by Arskey and O'Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) is used for reporting. The literature search used databases including PubMed, CINAHL, and search engines such as Scopus. This study was conducted using thematic analysis. This review yielded 19 out of 2109 studies that were identified in the initial search. Four outcomes comprised 20 sub-outcomes have been identified. Although strong evidence is lacking, PV-I in the form of foam is effective in improving wound healing, shortening healing time, and producing fewer adverse events than hydrocelluers. Moreover, saline and PV-I are effective as skin disinfectants when compared to saline alone in reducing surgical site infection (SSI), and they are also more effective than hypochlorous acid in improving wound healing. Nevertheless, there was no difference between PV-I and hypochlorous acid in the prevention of SSI and bacterial growth. In terms of healing time, silver foam and hyaluronic acid were more favorable than PV-I. Moreover, the use of chlorhexidine to improve SSI and silver dressing to improve hospital stay is more favorable than that of PV-I. There is limited evidence regarding the effectiveness of wound care outcomes, and the efficacy of PV-I as a surface disinfectant for wound infectionprevention remains controversial. Consequently, PV-I is not highly recommended for wound care, and further investigation into the effectiveness of PV-I as a surface disinfectant is required for various types of surgeries.

Bioactive electrospun nanoyarn-constructed textile dressing patches delivering Chinese herbal compound for accelerated diabetic wound healing

The treatment of tenacious diabetic wounds still remains an enormous challenge in clinics, originated from the complicated pathological microenvironment of wound sites. Therefore, it's urgently required to develop one type of innovative dressing patch with appropriate microstructure and multifunctions to regulate the pathological microenvironment and promote the regeneration of diabetic wounds. In this study, novel gelatin (Gel)/poly (L-lactic acid) (PLLA) nanofibrous yarns loading with or without Salvia miltiorrhiza Bunge-Radix Puerariae herbal compound (SRHC) are fabricated by using our modified electrospinning strategy, which are further interlaced into nanofibrous woven fabrics respectively, serving as biofunctional dressing patches for potential diabetic wound treatment application. The actual photographs and SEM images confirm that all the different nanofibrous textiles with or without SRHC exhibit a uniform interwoven structure of warp and weft, and the internal nanofibers present bead-free morphology and uniaxially oriented structure along the longitudinal axis of nanofibrous yarns. Moreover, all the different nanofibrous woven fabrics are demonstrated to possess strong mechanical properties and great surface wettability. The in vitro cell characterization shows that the addition of SRHC can significantly promote the attachment and proliferation of human dermal fibroblasts (HDFs), and also dramatically inhibit the secretion levels of proinflammatory factors of M1 macrophages. The in vivo diabetic mouse full-thickness skin model experiments reveal that the as-developed SRHC-loaded Gel/PLLA nanofibrous textile shows the best performances referring to shorten wound healing time (100 % wound closure after 18 days of treatment) and high-quality regeneration (i.e., enhance collagen deposition, improve re-epithelialization and neovascularization, and increase hair follicles), which assuredly finds great interests serving as an innovative dressing patch for the treatment of hard-to-heal diabetic wounds.

Wound healing efficacy of a polymeric spray film solution containing Centella asiatica leaf extract on acute wounds

Objective: To study the clinical efficacy of a polymeric spray film containing Centella asiatica extract to heal acute wounds. Method: A polymeric spray film solution for wound healing was formulated using Centella asiatica extract, which contained triterpenes, including asiatic acid, madecassic acid, asiaticoside and madecassoside. The stability and physicochemical properties of the formulation were evaluated, and a multicentre, randomised, controlled trial was conducted to assess its clinical wound-healing efficacy. The Pressure Ulcer Scale for Healing (PUSH Tool) score was used to evaluate wound healing on days 0, 3, 5 and 7. Results: The cohort consisted of 60 volunteers with clean-contaminated wounds (class 1), randomly assigned to the Control (n=30) and Testing (n=30) groups. The spray product contained asiatic acid, madecassic acid, asiaticoside and madecassoside at 0.20±0.02mg/ml, 0.16±0.01mg/ml, 0.32±0.03mg/ml and 0.10±0.00mg/ml, respectively. The pH value was 5.5±0.01, and the viscosity was 33±4cP. The product was stable for six months when stored at 30±2°C and at 40±2°C, in 75±5% relative humidity. The tested product significantly reduced the total PUSH and exudate scores, indicating that the polymeric spray film solution containing Centella asiatica improved wound healing. The average healing recovery times for the Testing and Control groups were 4.6±1.1 days and 4.87±1.0 days, respectively. Conclusion: In this study, Centella asiatica extract-containing polymeric spray film solution was beneficial as an acute wound medication, which could shorten healing time with no adverse effects.

An Innovative Dual-Wavelength Laser Technique for Atrophic Acne Scar Management: A Pilot Study.

Background and Objectives: Acne scars are one of the most disturbing and long-term symptoms of acne vulgaris, having a negative impact on a person's physical, emotional, and social well-being. Aim: the purpose of the study was to evaluate the efficacy and post-treatment outcomes of a dual-wavelength system combining the irradiation of two wavelengths at 10,600 nm and 1540 nm in the management of facial atrophic acne scars. Materials and Methods: Four healthy adult volunteers aged 24-53 years were enrolled. The areas treated were the full face (two patients), cheeks (one patient), and forehead (one patient). A dual-wavelength system (1540 nm and 10,600 nm) was used for this study. Patients underwent 2-4 treatment sessions, and the treatments were performed once every 45-90 days. All possible side effects such as burning sensation, dyschromia, mild to moderate post-treatment erythema, bleeding, itching, edema, and crusting were checked. The index to assess edema and erythema was based on a four-point scale (none, mild, moderate, and severe) and was applied before and at 3-month follow-up (3 MFU) after the last treatment session. In addition, a patient assessment was conducted before treatment and at 3 MFU after the last treatment session. Results: For all patients examined, the edema index was mild, while for the erythema index, 3/4 patients experienced moderate and 1/4 patients experienced mild symptoms. The mean patient downtime was 5.8 ± 0.5 days. Concerning the patient assessment, 2/4 subjects showed excellent improvement, 1/4 patients showed good improvement, and 1/4 patients showed slight improvement. As shown by the photographic assessment, a noticeable improvement in skin texture and a substantial reduction in acne scars were observed at the end of treatment. Conclusions: This dual-wavelength laser technology has the potential to be an interesting and safe approach for acne scar treatment, with a low risk of scarring/hypopigmentation and a shorter healing time.

Long-term efficacy and safety of dupilumab for severe bullous pemphigoid: A prospective cohort study

BackgroundBullous pemphigoid (BP) is a common subepidermal bullous disease. Dupilumab is a novel treatment for BP. However, its long-term efficacy and safety have not been demonstrated in prospective studies. ObjectiveEvaluate the long-term efficacy and safety of dupilumab in treating severe BP. MethodsPatients were divided into two groups: the methylprednisolone monotherapy group (M), and the methylprednisolone and dupilumab combination therapy group (D + M). This study consisted of two stages. The first stage focused on the initial treatment phase, where the early efficacy and safety was evaluated. The study then entered the 12-month maintenance treatment stage, where we assessed recurrence in both groups. Additionally, we evaluated the rate of healing of skin lesions, glucocorticoids burden and length of hospital stay and various laboratory test indicators. ResultsAfter four weeks of treatment, the Bullous Pemphigoid Disease Area Index (BPDAI) and pruritus Numerical Rating Scale scores of the D + M group decreased significantly more than those of the M group. The median BPDAI at week 4 was 0 (range: 0.0–3.0) in the D + M group and 10.0 (5.0–12.0) in the M group (P < 0.001). Patients treated with dupilumab experienced a faster cessation of new blisters, quicker glucocorticoid reduction, shorter healing times, and shorter hospital stays (P < 0.001). Additionally, after two weeks of treatment, the levels of eosinophils and immunoglobulin E also decreased (P < 0.001). Follow-up studies further demonstrated that dupilumab monotherapy was associated with a lower recurrence rate. Notably, no serious adverse effects were observed in the study. ConclusionsOur study provides evidence for the efficacy of dupilumab in the treatment of BP based on prospective studies. Additionally, our findings suggest that dupilumab can be considered a reliable single-agent maintenance treatment due to its good safety profile and lower relapse.

A Single-Center, Observational Experience With a Bovine Collagen Wound Dressing for Distal Lower Extremity Surgical Defects.

Biologic dressings help treat many dermatologic conditions. Their use in dermatologic surgery continues to expand as new dressings are developed. To discuss the authors' experience with a bovine-derived collagen wound dressing in surgical defects on the distal lower extremity. Over a 9-month period, 24 surgical defects in 20 patients were treated with a bovine-derived collagen wound dressing. All surgical defects were located below the knee. The average defect was 6.9 cm2 (range 1.0-18.0 cm2). The mean duration until healing completion was 117.3 days (range 63-183). The treated surgical defects demonstrated shortened healing time, improved cosmetic outcome, decreased wound drainage, and decreased pain compared with that traditionally seen in second intention healing. Bovine-derived collagen wound dressings should be considered to facilitate the healing of surgical defects on the distal lower extremity that would otherwise be left to heal by the second intention. J Drugs Dermatol. 2023;22(12):1149-1152. doi:10.36849/JDD.5404.

Laser Impacts on Skin Rejuvenation: The Use of a Synergistic Emission of CO2 and 1540 nm Wavelengths.

Background and Objectives: For nearly 15 years, carbon dioxide (CO2) laser has been the gold standard in skin rejuvenation. Aim: The purpose of this study was to assess the efficacy of a new laser device which combines CO2 and 1540 nm wavelengths in wrinkles reduction, using a recently developed scanning unit named the µScan DOT scanner. Materials and Methods: A total of 20 female patients underwent from two to four laser treatment sessions performed once every 45-90 days. Wrinkles reduction was evaluated using the Fitzpatrick Wrinkle Classification System (FWCS). Evaluations of five-point Global Patient's Assessment (PGA) and an Oedema and Erythema index based on a four-point scale were carried out. A careful photographic evaluation was performed to observe the patients' aesthetic improvements. All the assessments were performed before and at 3 months follow up (3 MFU) after the last treatment session. Results: The mean FWCS score significantly (p < 0.01) decreased from 5.45 ± 2.21 at baseline to 3.3 ± 1.78 at 3 MFU after the last treatment session. In total, 8/20 (40%) subjects reported excellent improvement, 7/20 (35%) subjects showed good improvement, 5/20 (25%) subjects showed slight improvement, and 0/20 (0%) subjects showed no improvement. Concerning the Oedema index, 15/20 subjects experienced a mild one, 5/20 subjects experienced a moderate one, and none of 20 experienced a severe one, while for the Erythema index, 1/20 patients experienced mild, 18/20 patients experienced moderate, and only 1/20 patient experienced severe erythema. No severe adverse events were observed. Conclusions: This dual-wavelength laser technique may become a promising new option for safe, nonsurgical improvement for skin rejuvenation with an extremely low risk of scarring or hypopigmentation and shorter healing times.

The Effect of Denatured Albumin with Concentrated Growth Factors in Minimally Invasive Sinus Piezosurgery: Preliminary Pilot Study Results.

A new protocol with albumin-concentrated growth factor (CGF) is investigated through Piezosurgery as a minimally invasive alternative to sinus-floor-augmentation that is associated with high morbidity and high incidence of sinusitis. The clinical sample consists of five patients (three men and two women) with an average age of 53.75 ± 3.59 years and a mean height of 3.7 ± 1.22 mm of residual bone. The Piezo-Alb-CGF protocol consists of a minimally invasive transcrestal approach with or without flap, piezosurgery preparation, applying the Schneiderian membrane's hydrodynamic detachment-elevation, injecting albumin-CGF into the sinus, optional bone grafting and implantation, and evaluation for 2 to 6 months postoperatively. Eight implants were placed without complications. After 4 to 6 months, cone-beam computed tomography and panoramic radiographs showed total osseointegration and the formation of new bone. In addition, a year of clinical follow-up was performed. There was a positive correlation between implant stability quotient values at all protocol stages. The significance level was 5%. Albumin-CGF regenerative protocol promotes new bone formation, reduces postoperative morbidity, and shortens healing time. It also offers a uniform and safe hydraulic membrane lift and bicortical implant fixation, even in cases with a residual bone height below 6 mm.

Compartive Study between Conventional Laying-Open Technique with Sphincter Repair and Ligation of Intersphincteric Fistula Tract (LIFT) in Treatment of High Trans-Sphincteric Perianal Fistula

Abstract Background Complex anal fistula has been a hot topic in clinic. Many surgical techniques have been described for the treatment of such anal fistula, including the use of seton, fibrin glue, collagen plugs, rectal advancement flaps, fistulotomy with sphincter repair, and rerouting the fistula tract. However, the results have been variable, and no one procedure is superior to the others absolutely. It is worth our concern that the goal of any treatment procedure is to obliterate the tract and to have low recurrence rates while maintaining full continence. A fistulotomy lays open the fistulous tract, thus leaving smaller unepithelized wounds, which hastens the wound healing. Until now, fistulotomy is still the most widely used. But, the high cure rate is limited by the fact that laying open a transsphincteric fistula tract and cutting both the internal and the external sphincter has the risk of fecal incontinence ranging up to 40%. Objective To retrospectively evaluate the success rate, the recurrence and incontinence when using the Conventional laying-open and sphincter Repair technique in comparison to Ligation of Intersphincteric Fistula Tract (LIFT) for treating high trans-shpincteric perianal fistula. Patients and Methods This was a cohort retrospective, comparative study that was conducted on cases of fistula in the anus, who were subjected to surgery in Ain Shams University Hospitals and Ain shams specialized hospitals in the period from October 2021 to March 2022 (at least 30 cases) to evaluate the success rate, the recurrence rate, and incontinence rate when using the conventional laying open with sphincter repair technique compared to ligation of inter-sphincteric fistula tract (LIFT) For High trans-sphincteric perianal fistula. Results Regarding Relation of recurrence with demographic data of the studied patients, de novo/recurrent, Wexner score before and after operation and complications. that there was no statistically significant relation found recurrence with demographic data of the studied patients, de novo/recurrent, Wexner score before and after operation while there was statistically significant relation found with complications. Conclusion LIFT procedure is an effective and preferred sphincter-saving technique for fistula-inano with shorter healing time and lower incidence of postoperative anal incontinence, but have higher incidence of recurrence as compared to conventional layopen with sphincter repair which have a lower incidence of recurrence but have a relatively longer Healing time and higher incidence of postoperative anal incontinence. Both techniques are effective, have post operative good results and safe in treatment of high transsphincteric perianal fistula but Further research work is still warranted to confirm the long term outcome of these 2 techniques with a larger sample size and a longer follow up period. To know which technique is superior over the other.

A novel PPARβ/FFA1 dual agonist Y8 promotes diabetic wound healing

BackgroundDiabetes ulcer is one of the leading causes of disability and death in diabetics. Y8 [(2-(2-fluoro-4-((4-methyl-2-(4-(trifluoromethyl)phenyl)thiazol-5-yl)methoxy) phenoxy)acetic acid)], a dual agonist of peroxisome proliferation activated receptorβ (PPARβ) and free fatty acid receptor 1 (FFA1/FFAR1/GPR40), a new compound molecule with the potential for diabetes ulcer treatment. ObjectiveTo research the effect of the dual target agonist Y8 and its mechanism of action in the treatment of diabetic ulcers. MethodsWe have established a wound model in diabetic mice. After treatment with Y8, wound healing was evaluated by tissue pathology, reactive oxygen species (ROS) levels, and gene expression testing. Under high sugar conditions, the mechanism of Y8 affecting fibroblasts' proliferation and keratinocytes' migration is further studied. ResultsWe found that Y8 accelerated wound healing and shortened healing time in diabetic mice. Granulation tissue generation and extracellular matrix (ECM) deposition were significantly increased in Y8-treated mice. Mechanistically, Y8 promotes keratinocyte proliferation by activating PPARβ and migration of keratinocytes by triggering FFA1 in vitro. In addition, Y8 also decreased ROS levels in fibroblasts in vitro and in vivo by activating PPARβ, reducing their release of superoxide anions. ConclusionOur results suggest that PPARβ/FFA1 dual agonist Y8 has the effect of promoting the healing of diabetic ulcer wounds in vivo and in vitro, and its therapeutic effect is better than that of single-target agonists.

Corneoconjunctival Transposition and Lyophilized porcine intestinal submucosal membrane graft in perforating or partial thickness in deep or perforating corneal lesions: evaluation of final corneal transparency and complications

To evaluate and compare the functional and cosmetic results of eyes submitted to two types of keratoplasty in dogs with deep or perforating corneal lesions, the medical records of three surgeons were reviewed. Seventy-five eyes were included, treated with corneoconjunctival transposition (CCT) or porcine intestinal submucosal membrane graft (MSIS). Data such as gender, age, breed, affected eye, healing time, complications, vision and corneal transparency were reviewed. Eighty-five percent of eyes remained visual; being 23/25 (92%) with CCT, and 9/50 (82%) with MSIS. The two techniques proved to be efficient, and CCT had a shorter healing time and a lower rate of complications when compared to MSIS. The chance of graft dehiscence was 6 times greater when using the membrane (OR = 18.36 with 95% Confidence Interval CI: 1.043 – 323.1); and postoperative granulation was 18 times greater on the membrane (p = 0.003). The TCC group had a greater number of eyes with grade 1 opacity after 60 days (44%), and 80% of the eyes obtained grades 1 and 2, giving greater final transparency compared to those operated on with membrane.

Leads towards non-invasive Ayurveda interventions in Stana vidradhi (~lactational breast abscess) management – An experience

Abstract A lactational breast abscess is the most common complication met in breastfeeding women, which serves as the common cause of discontinuation of breastfeeding. The conventional treatment choice for breast abscess is incisive drainage that is reportedly associated with few limitations. Ayurveda offers a multidimensional approach in the treatment of Vidradhi, which resembles abscess on clinical correlation. A case of a 25 year old multiparous woman, eight months postpartum with Stana vidradhi (~lactational breast abscess) in Pachyamanavastha (~transforming stage of disease) presented to the outpatient department. She was treated with Apatarpana (~depleting therapy), internal Ayurveda medicines, and in-situ non-invasive procedures for seven days. This intervention protocol resulted in a marked resolution of complaints along with a completely healed wound without a scar on the follow-up visit after one week. The present case offers a promising alternative for lactational breast abscess with the use of multidimensional noninvasive therapy resulting in shorter healing time and satisfactory cosmetic outcome.

Comparison of Cannulated Screw Combined with Medial Femoral Plate and Simple Cannulated Screw in the Treatment of Pauwels Type III Femoral Neck Fracture: A Meta-analysis with Trial Sequential Analysis.

This study aimed to compare the efficacy of cannulated screw combined with medial femoral plate and simple cannulated screw for Pauwels type III femoral neck fracture. In May 2022, relavent clinical trial articles were searched in seven online databases. After literature screening, quality evaluation, and data extraction according to the specific inclusion and exclusion criteria, the differences in therapeutic efficacy, complications, and intraoperative outcomes were compared between the two groups. A total of nine articles were finally included in the meta-analysis. The qualities of the nine articles were medium. Although the results showed that cannulated screw combined with medial femoral plate prolonged the operation time and increased blood loss (p <0.05), it demonstrated better fracture reduction and Harris score, shorter healing time and less internal fixation failure than in the simple cannulated screw in the treatment of Pauwels type III fracture (p <0.05). The sensitivity analysis, Egger's test, and trial sequential analysis (TSA) showed that the combination results were stable and reliable. This demonstrated that compared to that with the simple cannulated screw, the cannulated screw combined with medial femoral plate had better efficacy and less complication. Key Words: Femoral neck fracture, Therapy effect, Cannulated screw, Medial femoral plate, Trial sequential analysis.

The effectiveness of needle aspiration versus traditional incision and drainage in the treatment of breast abscess: a meta-analysis

Background Breast abscess is a common and intractable clinical condition and the use of needle aspiration (NA) or incision and drainage (ID) in treatment is controversial. This meta-analysis aimed to systematically compare the clinical effectiveness of NA and ID in treating breast abscesses. Methods The Web of Science, ScienceDirect, PubMed, Cochrane Library, EMBASE, China National Knowledge Infrastructure, and Wanfang Data were searched for randomized controlled trials (RCTs) published from inception to January 7, 2022. The ROB-2 tool assessed risk of bias; the GRADE methodology rated certainty in outcomes; and Stata 16.0 performed data analyses. Results Nine RCTs were included, including 703 patients. The results showed there was no significant difference in cure rate between the two groups (relative risk [RR] = 0.96, 95% confidence interval [CI] [0.86, 1.07]; p = .469), and after subgroup analysis, we found that it was not related to the use of ultrasound guidance or not. There was no significant difference in the recurrence rate (RR = 0.68, 95% CI [0.35, 1.30]; p = .241). Furthermore, the NA group was associated with shorter healing time (weighted mean differences = −11.02, 95% CI [−15.14, −6.90]; p < .001), lower incidence of breast fistula (RR = 0.21, 95% CI [0.06, 0.72]; p = .013), lower interrupted breastfeeding rate (RR = 0.28, 95% CI [0.20, 0.39]; p < .001), and higher satisfaction rate of appearance (RR = 1.51, 95% CI [1.03–2.21]; p = .035). Conclusion NA has better advantages in terms of healing time, avoidance of breast fistula, continuous breastfeeding, and patient satisfaction. Although NA and ID have similar cure and recurrence rates, NA, with or without ultrasound guidance, could be used as a first-line treatment for breast abscesses. Patients with large volumes, multicompartmental abscesses, or those who have been ineffective against multiple NA, should be considered for ID. KEY MESSAGES Breast abscess is a common and intractable clinical condition in general surgery. Compared with ID for breast abscesses, NA has better advantages in terms of healing time, avoidance of breast fistula, continuous breastfeeding, and patient satisfaction and could be used as a first-line treatment for breast abscesses. Patients with large volumes, multicompartmental abscesses, or those who have been ineffective against multiple NA, should be considered for ID.

101-OR: Systematic Intraoperative Bone Sampling Increases Healing Chances in Diabetic Foot Osteomyelitis

Aim: We aimed to evaluate if a proactive multidisciplinary diagnostic program could improve outcomes in the management of multidrug resistant (MDR) diabetic foot (DF) osteomyelitis (OM). Methods: We evaluated all the consecutive patients undergoing surgical procedure for OM July-December 2021 in our department (Group A). Intraoperative bone specimens were collected for microbiological and histological analysis on whose results antibacterial therapy was decided. Controls were patients admitted January-June 2021 with same indications (Group B) but with no systematic intraoperative bone sampling. Clinical and demographic characteristics, procedures, healing rate (HR) and healing time (HT), were compared between the groups. Results: We derived data from 89 patients: 46 in Group A [51.7%; age 68.8±13.5 yrs; diabetes duration (DD) 19.6±11.6 yrs Hba1c 8.7±4.8%] and 43 in Group B [48.3%; age 70.4±12.9 yrs; DD 18.8±12.1 yrs; Hba1c 8.4±5.1%]. No differences in demographic and clinical features, i.e. chronic kidney disease (39.1% vs 37.2%, p=ns), ischemic cardiac disease (41.3% vs 39.5%, p=ns), peripheral arterial disease (65.2% vs 67.4%, p=ns) and peripheral revascularizations (56.5% vs 53.4%, p=ns). Group A had a higher healing rate (80.4% vs 60.4%, p=0.0021) and a shorter healing time (67±41 days vs 134±92 days, p=0.020) compared to Group B. Conclusions: Systematic intraoperative bone sampling for culture and histology, and consequent antibiotic adjustment, increases healing rates and reduces healing times in DF patients undergoing surgical debridement for OM. Disclosure E.Iacopi: None. G.Naccarato: None. A.Piaggesi: None. F.Giangreco: None. A.Leonildi: None. V.Ortenzi: None. L.Suardi: None. L.Pieruzzi: None. C.Goretti: None. S.Barnini: None. M.Falcone: None.

Effect of tecovirimat on healing time and viral clearance by emulation of a target trial in patients hospitalized for mpox.

Tecovirimat is a treatment option for severe mpox, although randomized clinical trials are ongoing. The aim of the study is to assess the effect of tecovirimat on healing time and the extent of viral clearance by target trial emulation using observational data. Clinical and virological data of patients hospitalized for mpox were collected. Samples from the upper respiratory tract (URT) were grouped in two time points: T1 (median 6 days from symptoms onset) and T2 (median 5 days from T1). Patients were followed-up until recovery. Average treatment effect (ATE) in patients untreated versus treated with tecovirimat was estimated on time to healing and variation in viral load in URT, using a weighted and cloning analysis. Among the 41 patients included, 19 completed a course of tecovirimat. The median time from symptoms onset to hospitalization and to drug-starting was 4 days and 10 days, respectively. No improvement in healing time in treated versus untreated was observed. No difference by treatment group in time to viral clearance was detected by ATE fitted in a subset of 13 patients after controlling for confounders. We found no evidence for a large effect of tecovirimat in shortening healing time and viral clearance. While awaiting the results of randomized studies, the use of tecovirimat should be restricted to the clinical trial setting.