Wound Cleansing Research Articles

A COMPARATIVE STUDY ON PRATHAMA AND DWITEEYA SINDHOORADHYA MALAHARA WITH SPECIAL REFERENCE TO ITS ANTIMICROBIAL ACTIVITY

Rasatarangini, one of the esteemed treatises of Ayurvediya Rasasastra has mentioned numerous malahara (ointment) preparations with herbal and herbo-mineral origin. The term malahara itself mean those which remove mala (impurities) from vrana (ulcers), vidradhi (abscesses), twak vikara (skin diseases) etc. Acharya Sadananda Sharma, author of Rasatarangini has mentioned Sindhooradhya malahara a preparation with potent action on vranashodhana ropana (wound cleansing and healing) and bhootasanga prashamana (antimicrobial) properties. Acharya has mentioned two malahara preparations named as Prathama and Dwiteeya Sindhooradhya malahara with only difference in single drug. Both preparations are indicated in skin manifestations like pama and kandu, which may be due to invasion of some external organisms or microbes. WHO has declared that antimicrobial resistance is one of the top 10 global public health threat facing humanity and thus the search for ayurvedic antimicrobials are progressing day by day. Since it is a topical antibiotic preparation, with very minimal ingredients proving its efficacy will be of great use for the society. The present study aims at the preparation and comparison between the antimicrobial activity of the two Sindhooradhya malahara named as Prathama and Dwiteeya respectively. The main findings are, antimicrobial study by both agar well diffusion and macro broth dilution showed that more action in Prathama Sindhooradhya malahara. Among the 4 tested strains, significant results are seen in case ofStreptococcus pyogenes and Candida albicans whereas Dwiteeya Sindhooradhya malahara had no action in the tested strains of microbes.

Effectiveness ofFDA-cleared Wound Cleansers forDisinfection ofSurgical Surfaces inResource Limited Environments.

Service members experience unique circumstances when providing medical care in austere environments. Some challenges include supply shortages and the need to perform surgery in extreme temperatures. As such, methods for the sanitization of medical tools are sought and efficacy of existing materiel sourced to austere medical facilities should be examined for this purpose. This study tested the efficacy of commercially available, FDA-approved wound cleansers for alternative use as a potential sanitizer of stainless-steel medical devices and instruments found at improvised medical facilities. Escherichia coli and Staphylococcus aureus cultures were inoculated onto sterile stainless-steel carriers. After cleanser treatment, samples were held for 2 h, 24 h, or 7 days to represent different turn-around times between uses at ambient (25°C), cold (-20°C) and hot (50°C) temperatures. Additional ex vivo challenges were performed using slurry harvested from porcine cecum. Colony-forming units and log reduction were calculated. Significance was determined using one-way ANOVA and multiple comparisons between treatment groups were calculated using Tukey's multiple comparison test. All wound cleansers demonstrated statistically significant bactericidal activity against lab bacteria and ex vivo cecal slurry. E. coli and S. aureus resulted in approximately a 5-6 log reduction on average, resulting in no growth after treatment for all cleaners at 2 and 24 h. Similarly, 7-day post exposure results in a 6-log reduction after treatment for all groups at 25°C and -25°C. While treatment of ex vivo samples did not result in total kill, significant reductions in bacterial load were observed in all groups. Wound cleansers cleared for use in surgical settings demonstrated antimicrobial effects against bacteria deposited on metal surfaces. These cleansers decreased bacterial viability when challenged against extreme temperatures and few bacteria were harvested from treated surfaces even after 7 days. FDA-approved wound cleaners show promise as a potential sanitizer in resource limited environments.

Clinical Efficacy of Andrographis paniculata Extracted Scrub Compared With 4% Chlorhexidine Scrub in Burn Wounds: A Prospective Randomized Controlled Trial

Objective: The primary objective of this study is to compare the healing rate between AP soap and 4% Chlorhexidine solution in superficial second-degree burn wounds. The secondary objectives include the analgesic effect and moisturization of these two products. Materials and Methods: Data was collected between 2019 and 2021. Patients aged 18 years and above, with superficial second-degree burns including at least 20% of TBSA, and admitted to the Burn Unit within 24 hours of injury were included. They were randomly assigned to two groups: Andrographis paniculata with Perilla oil liquid soap group (AP group) and 4% Chlorhexidine group (control group). The measurements included percentage of epithelialization, pain score during wound cleansing, itching score after wound cleansing, and dry skin specified symptoms. All patients received standard care for burn wound treatment. Results: A total enrollment was 23 patients in this study (12 in the AP group and 11 in the control group). The median age was 38.5 years. There were no statistically significant differences in age, %TBSA, and initial wound size between both groups (p > 0.05). Although the healing time was similar in both groups, (18.5 vs. 20.1, p=0.347), the AP group had a significantly lower pain score than the control group (4.7 vs. 5.4, p=0.020). Moreover, the AP group demonstrated significant improvements in itching score and SRRC score at 14 days compared to the control group (5.1 vs. 6.0, p 0.039 and 1.08 vs. 1.55, p 0.020, respectively). There were no adverse effects during this study. Conclusion: Patients treated with Andrographis paniculata with Perilla oil liquid soap experienced less pain and better moisturization compared to those treated with the standard 4% chlorhexidine solution, while achieving a comparable healing rate. A future large-scale prospective trial is recommended.

Reducing Surgical Site Infections Post-Caesarean Section.

Surgical Site Infections (SSI) are one of the most common complications after a caesarean with significant morbidity. Evidence suggests that SSI rates can be reduced post caesarean by using a Leukomed® Sorbact® (Essity) bacteria binding wound dressing, thereby reducing bacterial wound colonisation. Barking, Havering & Redbridge University Hospitals NHS Trust, London, UK (BHRUT) maternity unit sought change their clinical practice by using Leukomed Sorbact and evaluate if this reduced their SSI rate, SSI readmission rate, antibiotic usage and evaluate any associated cost savings. From January 1st 2022, Mepore® (Molnlycke) wound dressings were replaced with Leukomed Sorbact for all caesareans. Retrospective and prospective audits were undertaken to compare SSI incidence pre- and post- implementation of the dressing. No changes were made to wound cleaning products, prophylactic antibiotic use or surgical technique. Wound closure technique remained the choice of the individual surgeon. Prior to this practice change, the baseline SSI rate between January-December 2021 was 6.1% and the SSI readmission rate was 1.27%. Comparative data for January-December 2022 showed a 38% reduction in SSI rates (overall SSI rate = 3.8%), a 31% reduction in readmission rate for SSI (overall rate = 0.88%), a 38% reduction in readmission bed days and a 30% reduction in antibiotic use. There was a reduction in SSI rates in all body mass index (BMI) categories. Total savings due to the reduction in SSI rates over twelve months were £234,784. The cost savings to BHRUT solely attributable to the reduction in readmissions was £49,750 or £21 per Caesarean, which will be an ongoing saving. The use of Leukomed Sorbact dressings after Caesarean resulted in improved clinical outcomes with reduced SSI and readmission rates. Investment in the new dressing was cost effective when considering bed days freed, the reduction in antibiotic usage, reduced morbidity and improved patient experience.

Predicting Superficial Surgical Site Infections: A Study of the Risk Factors and an Assessment Scale From Western India.

Introduction Superficial surgical site infections (SSSIs) are very common nosocomial infections that can complicate a range of surgeries, resulting in increased morbidity and mortality, and an overall decreased benefit of surgical interventions, along with exorbitant expenditure of healthcare resources. An assessment scale could help in the segregation of the high-risk patient population, and appropriate resources could be directed toward them. Methods A prospective observational study was carried out in a tertiary care hospital in Western India with 200 participants. Certain probable preoperative, intraoperative, and postoperative risk factors for SSSIs were assessed for significance of association, and each patient was given a score according to the assessment scale. The predictive power of the scale was calculated. Results Body mass index (BMI), preoperative laboratory investigations, and preoperative hospital stay showed a significant association with the complication. Clean-contaminated wounds had a higher incidence of postoperative SSSIs as compared to clean wounds. Postoperatively, fever and the presence of open drains predisposed the patient to complications. The assessment scale was found to have a positive predictive value of 40.94% and a negative predictive value (NPV) of 86.30%. Conclusion The factors that could significantly prevent the development of SSSIs are normal preoperative laboratory investigations, less than three days of preoperative hospital stay, and avoiding the use of open drains. The high NPV of the assessment scale means that it can be used as a screening tool to segregate high-risk patients.

Disruption ofBiofilm by Bacteriophages inClinically Relevant Settings.

Antibiotic-resistant bacteria are a growing threat to civilian and military health today. Although infections were once easily treatable by antibiotics and wound cleaning, the frequent mutation of bacteria has created strains impermeable to antibiotics and physical attack. Bacteria further their pathogenicity because of their ability to form biofilms on wounds, medical devices, and implant surfaces. Methods for treating biofilms in clinical settings are limited, and when formed by antibiotic-resistant bacteria, can generate chronic infections that are recalcitrant to available therapies. Bacteriophages are natural viral predators of bacteria, and their ability to rapidly destroy their host has led to increased attention in potential phage therapy applications. The present article sought to address a knowledge gap in the available literature pertaining to the usage of bacteriophage in clinically relevant settings and the resolution of infections particular to military concerns. PRISMA guidelines were followed for a systematic review of available literature that met the criteria for analysis and inclusion. The research completed for this review article originated from the U.S. Military Academy's library "Scout" search engine, which complies results from 254 available databases (including PubMed, Google Scholar, and SciFinder). The search criteria included original studies that employed bacteriophage use against biofilms, as well as successful phage therapy strategies for combating chronic bacterial infections. We specifically explored the use of bacteriophage against antibiotic- and treatment-resistant bacteria. A total of 80 studies were identified that met the inclusion criteria following PRISMA guidelines. The application of bacteriophage has been demonstrated to robustly disrupt biofilm growth in wounds and on implant surfaces. When traditional therapies have failed to disrupt biofilms and chronic infections, a combination of these treatments with phage has proven to be effective, often leading to complete wound healing without reinfection. This review article examines the available literature where bacteriophages have been utilized to treat biofilms in clinically relevant settings. Specific attention is paid to biofilms on implant medical devices, biofilms formed on wounds, and clinical outcomes, where phage treatment has been efficacious. In addition to the clinical benefit of phage therapies, the military relevance and treatment of combat-related infections is also examined. Phages offer the ability to expand available treatment options in austere environments with relatively low cost and effort, allowing the impacted warfighter to return to duty quicker and healthier.

Intraoperative Wound Lavage System for Deep Neck Infection: A Retrospective Cohort Study.

Introduction Multiple solutions are currently used to cleanse a deep neck infection (DNI), and a variety of devices are available to deliver wound irrigation solutions. An essential difference between these devices is the pressure that the irrigation solution exerts over the wound tissue. Objective To compare low-pressure and high-pressure irrigation delivery systems for wound cleansing in DNI. Methods we designed a retrospective cohort study and reviewed the medical records of patients operated on due to DNI from June 2016 to December 2017 at our institution. One cohort included patients treated with an intraoperative irrigation method that exerts low pressure over the irrigated tissue, and the other cohort, to a system capable of generating higher pressure. The Pearson Chi-squared test was used to analyze the data. Results A total of 42 patients whose ages ranged from 16 months to 72 years were included. The low-pressure irrigation system was used in 18 patients, and the high-pressure system was used in 24 patients. No statistical differences were observed regarding the irrigation methods, the complexity of the DNI, and the overall outcomes. Conclusions The present is the first study in which low- and high-pressure systems for wound lavage were evaluated in the treatment of DNI. When comparing these methods, we did not find one to be superior to the other; however, the additional cost associated with the high-pressure devices may not justify their in head and neck procedures.

FRI699 Hyperphosphatemia In The Setting Of Sodium Hypochlorite Use

Abstract Disclosure: K. Champagne: None. A.D. Mooradian: None. N. Gupta: None. M.J. Haas: None. G.Y. Gandhi: None. M.M. Jurado-Flores: None. Introduction: Acute elevation of serum phosphorous occurs for various reasons, including cellular injury (hemolysis, rhabdomyolysis, tumor lysis syndrome), decreased excretion (acute renal injury), or increased absorption/intake. Case Description: A 20-year-old woman presented as a pedestrian struck by a car after a motor vehicle accident. She sustained significant injury to the left leg, including degloving injury, femur, and tibia fracture requiring intramedullary nailing, skin graft, and multiple debridements. A review of systems was positive for chronic constipation. Physical exam was remarkable for several large, deep wounds on the left leg with a wound vac. Her wound was treated with sodium hypochlorite 0.25% solution. Laboratory results revealed that serum CK was 2,903 U/L on admission, and serum phosphorous level was normal and only started to rise one month after admission. She was transfused for blood loss and received IV fluids intermittently. Serum ionized calcium was low on admission at 0.90 mmol/L, calcium supplement was started, and hypocalcemia resolved. GFR dropped twice (at 46 and 62 mL/min/1.73M2) during admission but recovered to normal within a day. Serum phosphorous was elevated and ranged from 4.7-8.0 mg/dL, magnesium level fluctuated between 1.5-2.5 mg/dL, the parathyroid hormone was low at 7.0 pg/ml, 25-hydroxy vitamin D was low at <5.0 ng/ml, 1,25-dihydroxy vitamin D was low at <5.0pg/ml, FGF-23 was high at 616 RU/ml. Sevelamer was given for 9 days and discontinued. Sodium hypochlorite 0.25% solution and calcium supplement were discontinued, and vitamin D supplementation was initiated. The fractional excretion of phosphorous calculated from spot urine phosphorous and creatinine was low at 3.03%. Seven days later, plasma phosphorous levels normalized. Discussion: Sodium hypochlorite is a strong alkali (pH ∼11) and is the active ingredient of bleach. When exposed to water, it forms hypochlorous acid that generates superoxide radicals, leading to oxidative injury and cell death. This solution is bactericidal and may cause some tissue injury as well. It is used in healthcare settings to disinfect dialysis machines and tunneled catheters, surgical equipment, wound cleaning, hand hygiene, and root canal sterilization. It may increase the risk of hyperphosphatemia when used in a patient with immobilization, bone fractures, hypoparathyroidism, low vitamin D, multiple blood transfusions, and wound debridements. There have been rare reports of acute kidney injury with an intravenous bleach injection. Presentation: Friday, June 16, 2023

Plus Sutures for preventing surgical site infection: a systematic review of clinical outcomes with economic and environmental models

BackgroundSurgical site infections (SSIs) represent ~ 20% of all hospital-acquired infections in surgical patients and are associated with prolonged hospital stay, admission to intensive care, and mortality. We conducted a systematic review with economic and environmental models to assess whether triclosan-coated sutures (Plus Sutures) provide benefits over non-coated sutures in the reduction of SSI risk.MethodsSearches were conducted in fifteen databases. A total of 1,991 records were retrieved. Following deduplication and screening by two independent reviewers, 31 randomized controlled trials in adults and children were included in the review.Similarity of the studies was assessed by narrative review and confirmed by quantitative assessment. A fixed effects meta-analysis of SSI incidence model including all groups of patients estimated a risk ratio of 0.71 (95% confidence interval: 0.64 to 0.79) indicating those in the Plus Sutures group had a 29% reduction in the risk of developing an SSI compared with those in the control group (p < 0.001). Safety outcomes were analysed qualitatively.ResultsThe economic model estimated the use of Plus Sutures to result in average cost savings of £13.63 per patient. Plus Sutures remained cost-saving in all subgroup analyses with cost-savings ranging between £11 (clean wounds) and £140 (non-clean wounds).The environmental impact of SSI is substantial, and the model suggests that the introduction of Plus Sutures could result in potential environmental benefits.ConclusionsThe evidence suggests that Plus Sutures are associated with a reduced incidence of SSI across all surgery types alongside cost savings when compared with standard sutures.

A Novel Treatment Protocol to Improve Outcomes with Transtibial Amputations

Category: Diabetes; Other Introduction/Purpose: A retrospective case series study was performed to evaluate the outcomes and risk factors of transtibial amputations (TTA) using a novel post operative treatment protocol. The study hypothesis is that a novel post operative treatment protocol could improve outcomes for TTAs. All patients who underwent a TTA from July 2019 through December 2022 were treated with this protocol. Outcomes identified included time to prosthetic fitting after surgery and complications including wound dehiscence and mortality at 30 days. Risk factors were also identified for the patients in this case series study. Methods: The novel post operative protocol includes a circumferential incisional negative pressure wound therapy (CiNPWT) dressing that covered with a novel residual limb shrinker (nRLS) and a limb protector (LP) applied after incision closure. The CiNPWT and nRLS were removed at the first follow up visit. Then the nRLS was applied as the primary dressing directly against the incision covering the residual limb. The nRLS was changed for wound cleansing and was sequentially decreased in size to facilitate consolidation of the residual limb. Results: There were 433 surgeries performed on 304 patients. This included 222 (73%) men and 81 (27%) women with an average age of 67 years (41-90 years). There were 129 revision surgeries including 25 above-the-knee amputations (AKA). The average time to prosthetic fitting for TTA was 8 weeks. The average study group BMI was 32 kg/m2, A1c 8.7%, albumin 2.6 g/dL and neutrophil to lymphocyte ratio (NLR) 4.9. Traumatic wound dehiscence from falls represented 26% of revision surgeries. Mortality at 30 days was 3.2% for all study participants. The early death average age was 70 years (41-90 years), 73% with end stage renal disease (ESRD) and 82% with diabetes mellitus (DM). Conclusion: The novel protocol for transtibial amputations decreased the 30 day mortality to 3.2% from a national average of 13.5%. The average time to prosthetic fitting was 8 weeks for the study group compared to 16 weeks for US Department of Veterans Affairs amputations. The early death group’s average albumin of 2.15 g/dL with a NLR of 8.9. The study demonstrated that a novel postoperative protocol may improve outcomes in transtibial amputations and that a few simple blood values may provide an indication of the diminished overall physiologic health of this patient population.

In English

This article analyses some literature data and the authors’ developments in the technology of creating of therapeutic depots in the form of films, dispersions of metal oxides and textiles with immobilized biocompatible silver nanoparticles (NPs) in the structure of SiO2, TiO2, cotton, biopolymers (alginate, chitosan, lignin, etc.), that have biocidal action, and future trends in this area. We and other researchers have developed methods for the synthesis of photocatalytically active TiO2 and SiO2 films, modified with gold/silver/copper NPs, suitable for medical use. An economical and simple low-temperature methods of manufacturing antimicrobial textiles by photo- or thermal activation and the possibility of their multiple use have been developed. The production of biomedical textiles is recently focused on the widespread use of non-toxic biopolymers, combined with textile. We have obtained compositions based on nanodispersed silica with polysaccharide sodium alginate and silver NPs with pronounced hemostatic and bactericidal properties. Obtaining a hybrid material based on a bactericidal textile combined with a dispersed oxide is promising for additional absorption of toxins and wound cleaning. The creation of such universal multifunctional materials includes their high bactericidal and antiviral multiply use. Hybrid materials based on metal NPs in the structure of carriers of different nature as films and dispersions of biocompatible oxides, biopolymers, textiles have a protection against possible toxic effects of nanoparticles and metal ions, self-cleaning capability, photocatalytic, hemostatic properties, temperature resistance, and other. The development and application of such materials is growing rapidly. So, materials based on Ag/SiO2 dispersions have high antibacterial and antiviral action (single application). Ag/SiO2 films can act as durable antibacterial cover. There is an enhancement in the antibacterial properties of Ag-TiO2 NPs under visible light irradiation and the photocatalytic effect under UV light (single application in the powder form). Self-cleaning, antimicrobial and UV-protective properties have Ag-TiO2 NPs in textile. Cotton modified with MeNPs demonstrates high efficiency of destruction of bacteria E. coli, K. pneumoniae, E. aerogenes, P. vulgaris, S. aureus, C. albicans, etc., with saving of biocidal activity after 5 cycles of washing. The dynamics of silver ions release from the surface of NPs in the structure of textile upon their contact with water for 72 hours have been studied. The number of irreversibly bound particles in textile structure is sufficient for subsequent use. Modified fabrics are reusable. Composites based on metal NPs in the structure of silica or titania in the presence of biopolymers are effective hemostatic agents with a bactericidal effect. Sodium alginate has a reducing and stabilizing effect on nanoparticles, and silica prevents agglomeration of metal NPs in the resulting composite. However, it is quite difficult to satisfy the numerous target requirements for biomedical nanomaterials based on metal NPs in the composition of dispersed oxides as well as textiles and/or biopolymers (“all in one”) to obtain a single universal multifunctional material that does not lose its properties during operation. It makes more sense to produce composites for purpose targeted applications, such as bactericidal and antiviral, hydrophobic coatings for laboratory surfaces, package and so on. Researches in this area are in progress.

Lower limb ulcers in people experiencing homelessness

The homelessness crisis in Poland poses a serious challenge to the state, with the number of homeless individuals exceeding 30,000 in 2019. In this paper we highlight one of the most common surgical issue of people experiencing homelessness – venous leg ulcers – and present current treatment guidelines. Homeless individuals, particularly exposed to inadequate living conditions, poor hygiene, and circulatory disorders, are at high risk of developing them. Venous ulcers are chronic wounds with prolonged and complex healing processes.They arise due to venous hypertension associated with chronic venous insufficiency and thrombosis. Often, specialized treatment is necessary, which is a challenge for homeless individuals due to difficulties in accessing regular care.The treatment of venous leg ulcers involves a multi-stage process. The gold standard for managing venous leg ulcers is compression therapy, which reduces edema and venous reflux. The TIME strategy outlines the approach to chronic wound management, emphasizing the importance of initial wound cleansing (surgically, enzymatically, or larvotherapy), infection prevention, maintaining proper moisture and wound edge preparation. This requires the use of suitable antiseptics, dressings, and wound hygiene.People experiencing homelessness face specific issues that necessitate a holistic approach, which includes health education, nutrition, and rehabilitation.

Satisfactory level of Hiperskin TR® transparent film dressings in post-operative patient: a primary hospital Indonesia experience at Tebet District general hospital

Background: Post operative wound always be a burden, especially in tropical countries. The needs of extra care, avoidance from water/liquid, and routine changing of the dressings were the main concerned of the patients. The invention of waterproof dressings could decrease the hustle of wound care and increasing the comfort of the patients. This study aims to present satisfactory experience using transparent film dressing for post operative cases in primary care hospital Indonesia Methods: A descriptive study, total population of clean post operative wound from September to November 2022. Hiperskin TR®, a transparent film dressing was applied after cleaning the remaining debris. A questionnaire based on Bluebell wound healing questionnaire® was given at day 1 and day 7, to measure the satisfactory level of patients, and wound healing process experience. Results: 54 participants qualified for this study, but 6 were drop out. All of them were grouped by gender, age, and satisfactory level. Mostly were female (58%), with age ranging from 15-68 years old. The overall satisfaction of wound healing was good (66%), they felt secured (83.33%) and more comfortable using transparent dressing (83.33%). 12 patients (25%) needed to be changed before day 7 by health workers due to detachment of the dressing related to excessive/vigorous activities. 8 patients felt discomfort, 6 (12.5%) complained reddish and 2 patients (4.16%) have significant exudate within 1 week of follow up. Conclusions: The use of transparent film dressing for clean post operative wound at tropical country could be recommended, as it may decrease the patient’s disability in doing their daily activity and increasing patient’s satisfactory level.

Homeopathic Sulphur Ointment as Adjuvant in the Treatment of Sheep with Myiasis by Cochliomyia hominivorax (Diptera: Calliphoridae): A Case Series.

Myiasis by Cochliomyia hominivorax (Diptera: Calliphoridae) is a serious problem in animal health. Homeopathic Sulphur presents similarity with the clinical presentation verified in these cases and has already shown in vitro efficacy on the blowfly that causes this pathology. This article presents the report of a series of clinical cases of myiasis by C. hominivorax in sheep that underwent adjuvant treatment with homeopathic Sulphur and presents a theoretical-scientific discussion of biological events related to the clinical treatment of the condition. Seven naturally occurring myiases affecting sheep from an experimental farm were treated by an ointment impregnated with the homeopathic medicine Sulph 12cH, used as adjuvant after the manual removal of accessible larvae from the wound during wound cleaning. The animals were treated daily and evaluated clinically until complete healing of the lesions. Clinical information on the evolution of the inflammatory and scarring process was collected. Blood counts and bacteriological examinations were performed before and after topical homeopathic treatment. The homeopathic ointment Sulph 12cH was able to inhibit the development of parasitic C. hominivorax larvae and promote tissue repair and healing in naturally occurring myiasis in the sheep of this study. The homeopathic medicine Sulphur, formulated as an ointment, may be a useful new and adjuvant therapeutic option for treating myiasis in animals.

Treatment of infected soft tissue loss

Hand coverage in infected soft tissue loss (STL) is a challenging clinical condition. Appropriate and well-timed antibiotic therapy and careful debridement are crucial for the success of the subsequent reconstructive procedure. Debridement must be radical, and all nonviable or infected tissue should be removed. Strict medical control and multiple procedures can be required when infection recurrence is observed after primary procedure. Secondary healing of STL is usually necessary in these complex conditions. Negative pressure wound therapy (NPWT) is often used as a temporary instrument to reduce oedema and drainage, facilitating the attainment of a clean wound for subsequent reconstruction. According to the type and size of the defect, multiple options ranging from skin grafts and substitutes to local and free flaps can be selected for the treatment of infected STL. A reconstructive ladder approach and case-by-case decision making should always be considered. Due to the unique function and role of the hand, the surgical strategy must also take into account aesthetic and functional factors. Orthopedic and Plastic surgeons should manage this wide variety of treatment options in a multidisciplinary and high-specialized context including radiologists, microbiologists, infectious disease specialists and physiotherapists, customizing the treatment path to the specific patient's situation.

A Conceptual Study on Role of Vimlapana Karma in Dustavrana (Varicose Ulcer): A Review Article

The discontinuity of body tissue is called Vrana. Vrana i.e, wound and its management has prime importance in surgical practice. Acharya Sushruta elaborately explained sixty types of procedure (Shashtiupakrama) and Seven types (Sapthopakrama) for the management of Vrana. His broadly classified Vrana Shodhana (wound cleaning) and Vrana Ropana (wound healing). Vimlapana Karma is the Upakrama for management of Vrana (Varicose Ulcer). Vimlapana is the upakrama advocated in the management of Vrana, that may work by dispersing the accumulated Doshas in the corresponding srotas so that srotosangha may be released and help for Vrana Ropana. Vimlapana karma is still a question thus in the present study the review has been done to understand the Possible mechanism of Vimlapana karma in the management of Dustavrana(Varicose ulcer).

Literature review on selected Ayurvedic formula in the management of wound healing

Wounds have been widespread issues since ancient times. Although the restoration of tissue is a normal reaction to any form of injury, the healing of an open wound is delayed by bacterial contamination. In the medical science of Ayurveda, there are numerous pearls that can be used to cure wounds without any complications. Our Āchāryās (teachers) categorized the medications related to Vrana Shōdhana (wound cleaning) and Vrana Rōpana (wound healing) and provided a general description of the treatment concepts of wound management. Six plants with various therapeutic properties, cow ghee, and rock salt make up a particular Ayurveda formula. In order to manage wound healing, this study reviewed a few Ayurvedic formulas that are mentioned in the Bhāvaprakāsha (classical text) based on their pharmacological and pharmacodynamics capabilities. The main goal of this investigation is to examine how the chemicals in this recipe affect wound healing. Information about wound was acquired from Ayurvedic scriptures, contemporary texts, and earlier research studies (from primary and secondary sources). Afterwards a survey of the literature was done on those six herbs. Also, these selected herbs were examined for their Pancha Padārtha (5 elements of the herb) and pharmacological qualities. Due to the fact that the chosen formula was primarily made up of Kapha, Pitta and Vāta Shamana (pacify humors of body) it was noted that the Ayurvedic pharmacodynamics qualities and actions (karmas) for wound healing were found. As a result, the effectiveness of the chosen Ayurvedic formula in managing wound healing can be demonstrated.

ThTP8.6 A novel method for stoma isolation in a complex abdominal wound treated with vacuum assisted closure

Abstract Introduction Vacuum assisted closure (VAC) is a well established method in the treatment of abdominal wounds where the fascia is intact. The presence of one or multiple intestinal stomas or fistulae may present challenges in successful application of VAC therapy. Key concerns with the presence of intestinal stomas alongside open abdominal wounds is the risk of contamination with stoma effluent or the potential for the negative pressure to create enterocutaneous fistulae. Here we describe a novel method for isolating a small bowel stoma existing within a large abdominal wound, allowing successful resolution having failed conventional management. Method No device currently exists to allow a functioning stoma to be isolated within an abdominal wound requiring VAC therapy. This method relies on modification of a standard silicone fistula crown, this is then integrated into the standard VAC dressing, using stoma seals to provide successful vacuum. Stoma output is then successfully isolated, protecting surrounding tissue and supporting wound granulation without concern of wound effluent contamination. Discussion Of key importance in this case is the proximity of clean wounds with skin grafts done by plastic surgeons also being managed with VAC therapy and the importance of preventing contamination to allow successful granulation without further debridement of an already large wound. Conclusion Although this situation is rare with the increasing use of vacuum assisted closure devices for the management of wounds across many specialities this scenario is certainly not unprecedented. The technique described allowed successful treatment of a complex wound with significant existing comorbidities allowing resolution of a very challenging situation.

Antimicrobial or Antiseptic Cleansers for Wounds

&#x0D; For chronic wound care, the majority of evidence suggested that antiseptic agents do not add additional clinical benefits compared with saline. No differences were observed between antiseptics and saline in the incidence of adverse events.&#x0D; For surgical wound care, irrigation with antibiotic agents is likely associated with lower rates of surgical site infections compared with saline irrigation. Depending on the type of antiseptic agent, type of surgery, and depth of infection, antiseptic irrigation may have superior or similar efficacy compared with saline in surgical site infection and wound healing rates. Indirect evidence suggested antibiotics were not superior to antiseptics for prevention of surgical site infections. No differences were observed between antiseptic irrigation and saline irrigation in the incidence of adverse events and length of hospital stay.&#x0D; For acute traumatic wound care, a limited number of studies provided mixed results on the effectiveness of povidone-iodine compared with saline for preventing infection. The effect of antiseptic agents on bacterial load was unclear. No robust conclusions could be drawn due to very low certainty of the evidence.&#x0D; The economic evaluation study showed that irrigation with hypochlorous acid preserved wound cleanser was a cost-effective strategy in the short term compared with saline for the treatment of severely complex wounds during ultrasonic debridement. However, we have little confidence in the findings due to several limitations in the methods of the study.&#x0D; We did not identify any studies that compared the clinical effectiveness and cost-effectiveness of antimicrobial or antiseptic wound cleansers with antimicrobial dressings or of different types of antimicrobial or antiseptic wound cleansers for the management of wounds.&#x0D; We did not identify any evidence-based guidelines regarding the use of antimicrobial or antiseptic wound cleansers for the management of wounds.&#x0D;

A Case Study of Karanja Tail in the Management of Dushta Vrana

Healing of Vrana is a physiological process of regeneration and repair after injury. Frequency of injury is more common and management of wound is basic surgical skill. The wound is the biggest challenge to medical profession since vedic era . The wound is healed by three way first is primary intention , second is secondary intention third is by tertiary intention .Sushruta Samhita classical text of Ayurveda has elaborately explained Shashthi ( sixty types of procedures) for the management of wounds to achieve good early healing without complication. His techniques are broadly classified as Vrana Shodhana (wound cleaning) and Vrana Ropana (wound healing). Karanja Taila due to its shodhana and ropana properties plays a important role in Dushta vrana . In Dushta vrana vata and kapha dosha has predominant and Karanja Taila has vataghana and kaphagna properties that help in dosha shamana in Dushta vrana.