Wound Adhesion Research Articles

Bio-hydrogel from RGD peptide/chitosan/β-glycerophosphate prevents postoperative wound adhesion

Wound adhesion after any abdominal and gastrointestinal surgery is as high as 90 %, and if the adhesion is severe, it will be fatal. During the operation, various methods are used to avoid the adhesion of organs, such as reducing surgical wound area and using hydrogel products with short gelation time. However, these gels might cause allergy, and the gels are unsuitable for long-lasting recovery processes because the body absorbs them too quickly to avoid sticking. Hence, we developed a long-lasting, temperature-sensitive hydrogel using arginyl-glycyl-aspartic acid to help heal postoperative wounds. The hydrogel formed at 37 °C, degraded in 7 days up to 50 % and provided a practicable anti-adhesion function. As the cell and animal tests indicated, the hydrogel exhibited preferable biocompatibility and was proven to effectively avoid adhesion behavior after abdominal surgery while boosting tissue proliferation; animal experiments have confirmed that hydrogel can effectively avoid adhesion after abdominal surgery and help tissue proliferation. This hydrogel inhibits SMAD, P38, and PI3K pathways by blocking fibrosis cytokines and TGF-β downstream signaling. This TGF-β inhibition promotes histoarchitecture remodeling and reduces cecum tissue fibrosis. Our hydrogel provides a new option for anti-sticking products and can be applied to versatile medical uses in the future.

A Dry Patch with In Situ Solid-to-Gel Transformation for All-in-One Skin Wound Care.

Hydrogel-based dressing materials offer significant potential in expediting skin wound healing. Nevertheless, they face several challenges: poor adhesion to wound tissues, difficulties in preservation under ambient conditions, and limited multifunctionality to support all wound healing stages. In this work, a dry patch is designed to address these persistent issues by featuring an in situ solid-to-gel transformation and Janus wet tissue adhesiveness. The HGP patch integrates a wet adhesive layer combining dopamine-conjugated hyaluronic acid (HD) and poly(acrylic acid) (PAA), a drug-loading layer comprising gelatin (Gel), and a nonadhesive gelation layer of poly(vinyl alcohol) (PVA) and sodium alginate (SA). This hierarchical structural design confers exceptional wound adhesion, hemostatic capabilities, and antibacterial and antioxidant activities, as well as immune regulatory properties. These attributes collectively support accelerated skin wound healing, particularly in cases complicated by bacterial infections. This research charts an approach to engineer hydrogel-based wound dressings through on-site hydrogel formation, thus advancing the treatment of wounds afflicted with complex infections.

Durable and biocompatible low adhesion wound dressing material based on interfacial behaviors for wound management

Wound-dressing adhesion is a problem that has not been effectively addressed in the field of wound care for bleeding or burn wounds. Design of low adhesion wound dressing materials by leveraging interfacial behaviors has been an effective solution to this problem. However, previously reported superhydrophobic low adhesion materials either had durability or biocompatibility issue. To bridge this gap, this study presents a durable and biocompatible superhydrophobic low adhesion wound dressing material, which is designed on a normal gauze substrate with biocompatible components using a hybrid coating strategy. Outstanding low adhesion properties have been verified in vivo with bleeding wound or burn wound, with a peeling force that is only 0.3 %-14.5 % of the conventional non-woven gauze. Prepared low adhesion materials can robustly retain their superhydrophobicity and blood-repelling properties against harsh tests. Moreover, their biocompatibility has been confirmed through a series of tests including cell biocompatibility, hemolysis and skin irritation tests. With these demonstrated merits, the durable and biocompatible low adhesion material developed in this study will provide an effective solution to the wound adhesion problem in the practice of wound management.

Hyaluronic Acid/Gelatin-Based Multifunctional Bioadhesive Hydrogel Loaded with a Broad-Spectrum Bacteriocin for Enhancing Diabetic Wound Healing.

The development of multifunctional wound adhesives is critical in clinical settings due to the scarcity of dressings with effective adhesive properties while protecting against infection by drug-resistant bacteria. Polysaccharide and gelatin-based hydrogels, known for their biocompatibility and bioactivity, assist in wound healing. This study introduces a multifunctional bioadhesive hydrogel developed through dynamic covalent bonding and light-triggered covalent bonding, comprising oxidized hyaluronic acid, methacrylated gelatin, and the bacteriocin recently discovered by our lab, named jileicin (JC). The adhesion strength of the hydrogel, measured at 180 kPa, was 4.35 times higher than that of the fibrin glue. Furthermore, the hydrogel demonstrated robust platelet adhesion, procoagulant activity, and outstanding hemostatic properties in a mouse liver injury model. Incorporating JC significantly enhanced the phagocytosis and bactericidal capabilities of the macrophages. This immunomodulatory function on host cells, coupled with its potent bacterial membrane-disrupting ability, makes JC an effective killer against methicillin-resistant Staphylococcus aureus. In wound repair experiments on diabetic mice with infected full-thickness skin defects, the hydrogel treatment group showed a notable reduction in bacterial load, accelerated M2-type macrophage polarization, diminished inflammation, and hastened wound healing. Owing to its outstanding biocompatibility, antibacterial activity, and controlled adhesion, this hydrogel presents a promising therapeutic option for treating infected skin wounds.

Multifunctional Bioactive Nanozyme Systems for Enhanced Diabetic Wound Healing.

The protracted transition from inflammation to proliferation in diabetic wound healing poses significant challenges, exacerbated by persistent inflammatory responses and inadequate vascularization. To address these issues, a novel nanozymatic therapeutic approach utilizing asymmetrically structured MnO₂-Au-mSiO₂@aFGF Janus nanoparticles is engineered. Nanozymes featuring a mSiO₂ head and MnO₂ extensions, into which acidic fibroblast growth factor (aFGF) is encapsulated, resulting in MnO₂-Au-mSiO₂@aFGF Janus nanoparticles (mSAM@aFGF), are synthesized. This nanozyme system effectively emulates enzymatic activities of catalase (CAT) and superoxide dismutase (SOD), catalyzing degradation of reactive oxygen species (ROS) and generating oxygen. In addition, controlled release of aFGF fosters tissue regeneration and vascularization. In vitro studies demonstrate that mSAM@aFGF significantly alleviates oxidative stress in cells, and enhances cell proliferation, migration, and angiogenesis. An injectable hydrogel based on photocrosslinked hyaluronic acid (HAMA), incorporating the nanozymatic ROS-scavenging and growth factor-releasing system, is developed. The HAMA-mSAM@aFGF hydrogel exhibits multifaceted benefits in a diabetic wound model, including injectability, wound adhesion, hemostasis, anti-inflammatory effects, macrophage polarization from M1 to M2 phenotype, and promotion of vascularization. These attributes underscore the potential of this system to facilitate transition from chronic inflammation to the proliferative phase of wound repair, offering a promising therapeutic strategy for diabetic wound management.

Sodium alginate-based multifunctional sandwich-like system for treating wound infections

Microbial colonization and development of infections in wounds is a sign of chronicity. The prevailing approach to manage and treat these wounds involves dressings. However, these often fail in effectively addressing infections, as they struggle to both absorb exudates and maintain optimal local moisture. The system here presented was conceptualized with a three-layer design: the outer layer made of a fibrous polycaprolactone (PCL) film, to act as a barrier for preventing microorganisms and impurities from reaching the wound; the intermediate layer formed of a sodium alginate (SA) hydrogel loaded with ampicillin (Amp) for fighting infections; and the inner layer comprised of a fibrous film of PCL and polyethylene glycol (PEG) for facilitating cell recognition and preventing wound adhesion. Thermal evaluations, degradation, wettability and release behavior testing confirmed the system resistance overtime. The sandwich demonstrated the capability for absorbing exudates (≈70 %) and exhibited a controlled release of Amp for up to 24 h. Antimicrobial testing was performed against Staphylococcus aureus and Escherichia coli, as representatives of Gram-positive and Gram-negative bacteria: >99 % elimination of bacteria. Cell cytotoxicity assessments showed high cytocompatibility levels, confirming the safety of the proposed sandwich system. Adhesion assays confirmed the system ease of detaching without mechanical effort (0.37 N). Data established the efficiency of the sandwich-like system, suggesting promising applications in infected wound care.

Biocompatible Tough Ionogels with Reversible Supramolecular Adhesion.

Cohesive and interfacial adhesion energies are difficult to balance to obtain reversible adhesives with both high mechanical strength and high adhesion strength, although various methods have been extensively investigated. Here, a biocompatible citric acid/L-(-)-carnitine (CAC)-based ionic liquid was developed as a solvent to prepare tough and high adhesion strength ionogels for reversible engineered and biological adhesives. The prepared ionogels exhibited good mechanical properties, including tensile strength (14.4 MPa), Young's modulus (48.1 MPa), toughness (115.2 MJ m-3), and high adhesion strength on the glass substrate (24.4 MPa). Furthermore, the ionogels can form mechanically matched tough adhesion at the interface of wet biological tissues (interfacial toughness about 191 J m-2) and can be detached by saline solution on demand, thus extending potential applications in various clinical scenarios such as wound adhesion and nondestructive transfer of organs.

Near-infrared radiation of gold–platinum submicron particle-decorated nonwoven mats enhances wound healing: In vitro and In vivo studies

Because of their biocompatibility and unique optical and electrical properties, Pt nanoparticles (NPs) have been extensively utilized in biomedical applications. However, the use of pure Pt NPs is hindered by the high costs of raw material and absorption at ultraviolet wavelengths. To leverage the benefits of Pt particles while mitigating their drawbacks, we applied electrospinning technology to prepare polyacrylonitrile (PAN) nonwoven mats decorated with gold and platinum submicron particles (Au5Pt3 submicron particle-decorated PAN). We examined the surface morphology, elemental composition, and chemical structure of the resultant Au5Pt3-decorated PAN nonwoven mats by field emission scanning electron microscopy (SEM), energy-dispersive X-ray (EDX) spectroscopy, and EDX elemental mapping. When subjected to near-infrared (NIR) illumination, the Au5Pt3-decorated PAN nonwoven mats showed a more stable temperature rise than pure PAN nonwoven mats or Au PAN nonwoven mats. Inductively coupled plasma spectrometry demonstrated that the Au5Pt3-decorated PAN nonwoven mats can release more Pt ions under NIR illumination, reaching concentrations of up to approximately 8 ppm. The Au5Pt3-decorated PAN nonwoven mats exerted positive effects in a wounded mouse model, with or without NIR irradiation: the films did not cause wound adhesion or fibrosis, and excellent skin tissue healing and collagen regeneration were observed. Moreover, when combined with NIR illumination, the Au5Pt3 submicron particle-decorated PAN nonwoven mats more strongly inhibited the growth of Gram-positive and Gram-negative bacteria and more strongly enhanced blood vessel generation, compared with the same mats in the absence of NIR illumination. Regardless of NIR irradiation, the Au5Pt3 submicron particle-decorated PAN nonwoven mats do not show significant damage to the liver or kidney in mice. Overall, treatment with these Au5Pt3 submicron particle-decorated PAN nonwoven mats does not result in toxicity in mice and exerts a positive effect on wound healing when combined with NIR irradiation, with enhanced angiogenesis and collagen regeneration.

A differential-targeting core-shell microneedle patch with coordinated and prolonged release of mangiferin and MSC-derived exosomes for scarless skin regeneration.

Microneedles for skin regeneration are conventionally restricted by uncontrollable multi-drug release, limited types of drugs, and poor wound adhesion. Here, a novel core-shell microneedle patch is developed for scarless skin repair, where the shell is composed of hydrophilic gelatin methacryloyl (GelMA) loaded with mangiferin, an anti-inflammatory small molecule, and the core is composed of hydrophobic poly (lactide-co-propylene glycol-co-lactide) dimethacrylates (PGLADMA) loaded with bioactive macromolecule and human mesenchymal stromal cell (hMSC)-derived exosomes. This material choice provides several benefits: the GelMA shell provides a swelling interface for tissue interlocking and rapid release of mangiferin at an early wound healing stage for anti-inflammation, whereas the PGLADMA core offers long-term encapsulation and release of exosomes (30% release in 3 weeks), promoting sustained angiogenesis and anti-inflammation. Our results demonstrate that the core-shell microneedle possesses anti-inflammatory properties and can induce angiogenesis both in vitro in terms of macrophage polarization and tube formation of human umbilical vein endothelial cells (HUVECs), and in vivo in terms of anti-inflammation, re-epithelization, and vessel formation. Importantly, we also observe reduced scar formation in vivo. Altogether, the degradation dynamics of our hydrophilic/hydrophobic materials enable the design of a core-shell microneedle for differential and prolonged release, promoting scarless skin regeneration, with potential for other therapies of long-term exosome release.

Antibacterial, anti-inflammatory, rapid hemostasis, and accelerated repair by multifunctional metal–organic frameworks fibrous scaffolds for diabetic wounds

Excessive inflammation, bacterial infection, persistent bleeding, and wound exudate accumulation are common in diabetic wounds, impeding cell proliferation and disturbing tissue remodeling, making it difficult for diabetic wounds to heal. The rapid hemostasis and reduction of bacterial infection, as well as the excessive infiltration of inflammatory factors, serve as key strategies for diabetic wound healing. In this study, Taxifolin (TAX) was loaded onto cyclodextrin metal–organic frameworks (CD-MOFs), which were subsequently loaded into polycaprolactone (PCL) scaffolds via electrostatic spinning to construct multifunctional electrospun fibrous membranes (EFMs) with antimicrobial, anti-inflammatory, hemostatic, and wound exudate-absorbent properties. The resulting EFMs exhibited a hydrophilic surface, which facilitated wound adhesion and enhanced its hemostatic properties. By aggregating the wound exudate and triggering a cascade release of TAX, bacterial infection in the wound was reduced, decreasing the expression of inflammatory factors. This also promoted collagen deposition, vascular regeneration, and myofibroblast contraction and migration and facilitated the remodeling and repair of the wound tissue. These results demonstrated that designed fibrous scaffolds could effectively accelerate the repair process of diabetic mice, providing a new strategy for the treatment of diabetic wounds.

Effect of Teaching Protocol of Neck Exercises and Wound Massage on Wound Adhesion and Voice Changes among Post-thyroidectomy Patients

Effect of Teaching Protocol of Neck Exercises and Wound Massage on Wound Adhesion and Voice Changes among Post-thyroidectomy Patients

Hemostasis Strategies and Recent Advances in Nanomaterials for Hemostasis.

The development of materials that effectively stop bleeding and prevent wound adhesion is essential in both military and medical fields. However, traditional hemostasis methods, such as cautery, tourniquets, and gauze, have limitations. In recent years, new nanomaterials have gained popularity in medical and health fields due to their unique microstructural advantages. Compared to traditional materials, nanomaterials offer better adhesion, versatility, and improved bioavailability of traditional medicines. Nanomaterials also possess advantages such as a high degree and stability, self-degradation, fewer side effects, and improved wound healing, which make them ideal for the development of new hemostatic materials. Our review provides an overview of the currently used hemostatic strategies and materials, followed by a review of the cutting-edge nanomaterials for hemostasis, including nanoparticles and nanocomposite hydrogels. The paper also briefly describes the challenges faced by the application of nanomaterials for hemostasis and the prospects for their future development.

Prevalence of work-related skin symptoms and associated factors among tertiary hospital workers exposed to cleaning agents in Southern Africa.

Working with cleaning products is associated with occupational contact dermatitis in health workers (HWs), but information on predictors for these outcomes is limited. This study investigated the prevalence of work-related skin symptoms (WRSS) and associated factors in HWs exposed to cleaning agents in two Southern African tertiary hospitals. A cross-sectional study of 697 HWs used an interviewer-administered questionnaire and assessed for atopy using Phadiatop. HWs' median age was 42 years, 77.0% were female and 42.5% were atopic. The prevalence of WRSS in the last 12 months was 14.8%, 12.3% had probable contact dermatitis (PCD) and 3.2% had probable contact urticaria (PCU). Technicians (ORadj 3.91) and tasks involving cleaning and disinfection of skin wounds (ORadj 1.98) were associated with WRSS in the past year. Factors associated with PCD included sterilizing instruments, disinfecting skin before procedures and use of wound adhesives. Factors associated with PCU included specimen preparation using formalin, medical instrument sterilization tasks, and skin/wound cleaning and disinfection. Appropriate glove use when performing patients' skin/wound care was protective against WRSS. Tasks involving cleaning and disinfecting patients' skin and wounds were associated with WRSS in HWs, especially when performed without gloves.

Tunicate-mimetic antibacterial hydrogel based on metal ion crosslinking and chitosan functionalization for wound healing

With the increasing prevalence of drug-resistant bacterial infections and frequent occurrences of slow wound healing, the development of novel antibacterial wound dressings has become a serious challenge. Hydrogel dressings have attracted extensive attention on wound healing due to their unique three-dimensional network structures and properties. However, it is a challenge to develop natural long-acting antibacterial hydrogels with multiple functions such as excellent cell affinity, wet adhesion and mechanical properties. Inspired by the wound healing mechanism and adhesion characteristics of tunicates, a series of biomimetic antibacterial hydrogels were prepared by utilizing pyrogallol-modified chitosan (GACS) and polyvinyl alcohol (PVA) as matrix, zinc ions (Zn2+) as crosslinking and antibacterial agents, and ethyl N-lauroyl l-arginate hydrochloride (LAE) as the antibacterial active ingredient. The morphology, swelling, water retention, degradability, wet adhesion, biocompatibility, mechanical and rheological properties of PVA/GACS/Zn2+/LAE hydrogels were evaluated. And the adhesion ability conferred by the pyrogallol structures enabled the hydrogel with enhanced antibacterial effect and hemostatic ability. Moreover, the in vivo experiments on rat models with full-thickness infected wounds confirmed that PVA/GACS/Zn2+/LAE hydrogels could efficiently kill bacteria, significantly improve the wound microenvironment, greatly promote fibroblast proliferation and collagen deposition and ultimately accelerate wound healing. In a word, this study provided a feasible and simple way for the development of biomimetic antibacterial hydrogel dressings applied in infected wounds, which could not only seal wounds with various shapes and provide a moist and antibacterial environment for wounds, but also have certain mechanical strength, excellent wound adhesion, good biocompatibility and hemostatic performance.

A photoactive self-healing carboxymethyl chitosan-based hydrogel for accelerated infected wound healing through simultaneously modulating multiple critical tissue repair factors

Infected wounds cause severe medical complications and even chronic mortality, leading to persistent health burdens. Therefore, the enhancement of wound healing has been a major goal of medical researchers. Herein, a photoactive self-healing hydrogel (termed as Macropatch), composed of carboxymethyl chitosan (CMCS), tannic acid (TA) and graphitic carbon nitride g-C3N4 (GCN), was developed to promote wound healing through simultaneously modulating pathological related factors. We identified that dynamic hydrogen bond, hydrophobic interaction and crosslinking between hydrogel backbones endowed Macropatch with good self-healing capability and mechanical property, allowing for protecting the wound from further injury. In addition, Macropatch exhibited superior tissue adhesiveness and cell affinity due to numerous catechol groups of TA chains, and enabled tight wound adhesion to seal organ bleeding. Specifically, GCN endowed Macropatch with improving mechanical strength, self-healing ability and especially visible light-induced antibacterial activity, leading to a fast recovery of bacteria-infected wounds. More remarkably, benefiting from inherent and photodynamic antibacterial properties, Macropatch could prevent bacterial infections under visible light irradiation, and consequently increase the collagen synthesis and re-epithelization, accelerating bacteria-infected wound healing process. Overall, photoactive Macropatch is a safe wound dressing with the potential of overcoming challenges in infectious wound healing, and might be applied in clinical condition.

Allergic Contact Dermatitis (ACD) to Topical Products in Orthopedic Surgery: Clinical Characteristics and Treatment Strategies.

The potential for many of the commonly used surgical site wound adhesives, skin antiseptic solutions, topical antibiotics, and suture materials to sensitize and subsequently result in allergic contact dermatitis (ACD) has become increasingly recognized within orthopedic surgery. Particularly with subsequent exposure to the offending allergen, the cutaneous allergic reaction may present in a similar fashion to cellulitis, thus making early differentiation between the two etiologies to initiate the appropriate and timely treatment crucial. Recognition of the characteristic appearance and severity of ACD surrounding a surgical wound often drives the initial management. This typically consists of anti-histamines, topical corticosteroids, and possible removal of the offending allergen for low grade findings and oral steroids and prophylactic oral antibiotics for the more severe reactions. Multidisciplinary care, including the expertise of a dermatologist or wound care specialist when faced with this challenging clinical scenario is critical and elective patch testing may be indicated to ascertain the exact allergen involved, particularly in patients with a prior history of wound issues. Finally, any clinical cases of ACD following an orthopedic procedure should be documented in the patient's chart so that exposure can be avoided with any future surgery.

A Randomized Controlled Trial of Three Advanced Wound Dressings in Split-Thickness Skin Grafting Donor Sites-A Personalized Approach?

Background: Split-thickness skin grafting (STSG) is a frequently used reconstructive technique, and its donor site represents a standardized clinical model to evaluate wound dressings. We compared hydroactive nanocellulose-based, silver-impregnated and ibuprofen-containing foam wound dressings. Methods: A total of 46 patients scheduled for elective surgery were evaluated on the STSG donor site for wound healing (time-to-healing, Hollander Wound Evaluation Scale), pain level (Visual Analogue Scale), and handling (ease of use), as well as scar quality (Patient Scar Assessment Scale, Vancouver Scar Scale) after 3, 6 and 12 months. Results: Almost all dressings compared equally well. We observed statistically relevant differences for pain level favoring the ibuprofen-containing dressing (p = 0.002, ΔAIC = 8.1), and user friendliness in favor of nanocellulose (dressing removal: p = 0.037, ΔAIC = 2.59; application on patient: p = 0.042, ΔAIC = 2.33; wound adhesion: p = 0.017, ΔAIC = 4.16; sensation on skin: p = 0.027, ΔAIC = 3.21). We did not observe any differences for wound healing across all groups. Treatment with hydroactive nanocellulose and the ibuprofen-containing foam revealed statistically relevant better scar appearances as compared to the silver wound dressing (p < 0.001, ΔAIC = 14.77). Conclusion: All wound dressings performed equally well, with the detected statistical differences hinting future directions of clinical relevance. These include the reserved use of silver containing dressings for contaminated or close to contaminated wounds, and the facilitated clinical application of the nanocellulose dressing, which was the only suitable candidate in this series to be impregnated with a range of additional therapeutic agents (e.g., disinfectants and pain-modulating drugs). Personalized donor site management with the tested dressings can meet individual clinical requirements after STSG and improve management strategies and ultimately patient outcomes.

Biomimetic small exosome with outstanding surgical applications for rapid large-scale wound healing and functional sweat gland restoration

The realization of coordinated infiltration of dermal and epidermal cell types, and the rapid deposition of extracellular matrix are the prerequisites for improved healing quality of large skin defects. However, presently used materials are limited for wound healing due to the inherent poor histocompatibility, low permeability, poor mechanical property and cytotoxicity. It is challenging to develop new therapeutic agents that enable timely and efficient wound healing and meanwhile there are minimal side effects to avoid chronic wounds, wound adhesions, and large scarring. Herein, we fabricated biomimetic exosomes (EMs) that enriched transforming growth factor β1 (TGF-β1) for the rapid healing of large-scale cutaneous wounds. The EM encapsulation allowed well-managed dosing of the TGF-β1 to effectively promote the wound healing process by endowing epidermal keratinocytes with a migratory feature, enhancing their stem cell properties, and resulting in accelerated in vivo wound re-epithelization. Specifically, the EMs could fast restore the function of sweat glands in a thermally injured mice model. Our work provides a promising strategy for improving the healing speed and healing quality for patients with large wounds.

Intraperitoneal microbial contamination drives post-surgical peritoneal adhesions by mesothelial EGFR-signaling

Abstract Objective Abdominal surgeries are lifesaving procedures but can be complicated by the formation of peritoneal adhesions, intra-abdominal scars that cause intestinal obstruction, pain, infertility, and significant health costs. Despite this burden, the mechanisms underlying adhesion formation remain unclear and no cure exists. Here, ask how contamination of gut microbes influences post-surgical adhesion formation. Methods We make use of an experimental mouse model that allows to investigate how wound repair and adhesion formation differs between sterile injury vs. sterile injury in combination with microbial contamination. We use genetic lineage tracing, bulk- and single-cell RNA-Sequencing to identify potential mechanisms of the observed differences. Next, we use two human cohort studies to confirm the target identified by RNA-Sequencing. Finally, the identified targets are experimentally confirmed by going back to the mouse model. Results We show that adhesion myofibroblasts arise from the mesothelium. This transformation is driven by epidermal growth factor receptor (EGFR) signaling. The EGFR ligands amphiregulin and heparin-binding epidermal growth factor, are sufficient to induce these changes. Correspondingly, EGFR inhibition leads to a significant reduction of adhesion formation in mice. Adhesions isolated from human patients are enriched in EGFR positive cells of mesothelial origin and human mesothelium shows an increase of mesothelial EGFR expression during bacterial peritonitis. Conclusion Bacterial contamination drives adhesion formation through mesothelial EGFR signaling. This mechanism may represent a therapeutic target for the prevention of adhesions after intra-abdominal surgery.

Evaluation of outcome after primary median and/or ulnar nerve(s) repair at wrist: clinical, functional, electrophysiologic, and ultrasound study

BackgroundA major problem in surgery of peripheral nerve injuries of the upper extremities is the unpredictable final outcome. More insight and understanding of the proper methods of outcome assessment and the prognostic factors is necessary to improve functional outcome after repair of peripheral nerves. The objective of this study is to assess the outcome and identify possible prognostic factors for functional recovery of median and/or ulnar nerves repairs at wrist. Forty patients with median, ulnar or combined median-ulnar nerve injuries were included. Smoking, age, sex, repaired nerve, associated artery and/ or tendon repairs, joint stiffness and scar tissue were analyzed as prognostic factors for functional outcome after repair. Outcome parameters were medical research counsel (MRC) scoring for sensory and motor recovery, grip and pinch strength, disability of arm, shoulder and hand (DASH) questionnaire, electrophysiology and ultrasonographic evaluation.ResultsThe mean age of the studied patients was 29.1 ± 8.3 and it was statistically correlated with grip strength (p = 0.045), DASH score (p = 0.046) and hyperesthesia score (p = 0.040). EMG results showed signs of regeneration in all patients in the form of small nascent MUAPs and polyphasic MUAPs. CMAP amplitudes of median and ulnar nerves positively correlated with the MRC scale for muscle strength (p = 0.001)There were statistically significant negative correlations between DASH score and MRC score for sensory evaluation (p = 0.016), grip (p = 0.001), and pinch strength (p = 0.001). There were statistically significant positive correlations between patient's opinion of recovery and MRC score for sensory evaluation (p = 0.029), grip (p = 0.001), and pinch strength (p = 0.001). The MRC score for muscle strength has statistical significant positive correlations with the MRC score for sensory evaluation, grip (p = 0.003), and pinch strength (p = 0.040)ConclusionsIt was concluded that; MRC scale for muscle power, MRC scale for sensory evaluation, functional scores, grip and pinch strength are valuable tools for evaluation of functional outcome. Age, smoking, associated tendon repair, damaged nerve, compliance to rehabilitation protocol, return to work, clinically visible wound adhesions, residual hand joint stiffness, and scar tissue detected by ultrasound were found to be prognostic factors for outcome after nerve repair.