Wound Closure Time Research Articles

Novel through-the-scope twin clip for the closure of GI wounds: the first experimental survival study in pigs (with videos)

We developed a through-the-scope twin clip (TTS-TC) for closing GI wounds. The objective of this study was to evaluate the efficacy and safety of the TTS-TC in GI wound closure. GI nonperforating and perforating wounds (≥2.5 cm) were created in live pigs. TTS-TCs were used to convert the large wounds into small wounds. The remaining small wounds were closed using conventional through-the-scope clips (TTSCs). The follow-up period was 1 month. Location and size of the wound, time of wound closure, intraoperative and postoperative adverse events, and conditions of wound healing were investigated. Thirteen wounds were created in 5 live pigs, including 2 gastric nonperforating and 3 perforating wounds and 5 large intestinal nonperforating and 3 perforating wounds. The mean long and short diameters of the wounds were 4.1 (± .9) cm and 3.4 (± .7) cm, respectively. All wounds were successfully closed using the TTS-TCs combined with TTSCs. The total mean time for wound closure was 9.2 (± 5.3) minutes, and the mean time for using the TTS-TCs was 3.9 (± 4.7) minutes. During the 1-month follow-up period, no bleeding, perforation, or death occurred; all wounds healed with scar formation; and all TTS-TCs detached spontaneously. The TTS-TC was successfully used to close large-sized GI wounds. The TTS-TC is a promising tool for large-size wound closure under flexible endoscopy.

A pragmatic randomised controlled clinical study to evaluate the use of silicone dressings for the treatment of skin tears.

One of the most common types of skin breakdown in ageing populations is skin tears. The International Skin Tear Advisory Panel advocates for special attention to be paid to dressing selection related to skin tear management. The panel recommends choosing dressings that will promote the maintenance of moisture balance, suit the local wound environment, protect peri‐wound skin, control or manage exudate and infection, and optimise caregiver time. It is paramount that dressings protect the fragile nature of the skin associated with those who at heightened risk for skin tear development. To compare the effectiveness of soft silicone dressings (a contact layer and/or foam) for the healing of skin tears with local practices that do not include soft silicone dressings. The study was a pragmatic randomised controlled prospective study. One hundred and twenty‐six individuals from two long‐term care facilities in Ontario Canada who presented with skin tears were randomised into the treatment group using either soft silicone dressings (a contact layer and/or foam) or the control group using non‐adhesive dressings. The current study demonstrated that 96.9% (n = 63) of skin tears in the treatment group healed over a 3‐week period compared with 34.4% (n = 21) in the control group. The proportion of wound healing experienced at week 2 was 89.2% (n = 58) in the treatment group compared with 27.9% (n = 17) in the control group. There was a significantly greater reduction in wound surface area relative to baseline in the treatment group (2.9 cm2) compared with the control group (0.6 cm2) (χ 2 = 21.792 P < .0001) at week 1. Survival analysis data supported that skin tears healed 50% faster in the treatment group (11 days) compared with the control group (22 days) (χ 2 = 59.677 P < .0001). The expected healing trajectory of acute wounds, including skin tears, if proper wound bed preparation is realised and infection is controlled, is 7 to 21 days. Results of this study suggest the use of silicone dressings support wound healing and aid in wound closure within the expected healing trajectory, with faster complete wound closure and mean healing times compared with non‐silicone dressing for the treatment of STs.

Influence of the Obesity Phenotype on the Adequacy of Antibiotic Prophylaxis with Cefoxitin for Obese Patients Undergoing Bariatric Surgery: Lessons Learnt and Future Considerations.

A high inter-individual variability in pharmacokinetic parameters inobese patients is observed.The objective of this study was to evaluate the effect of obesity parameters on the pharmacokinetics of cefoxitin administered for antibiotic prophylaxis during bariatric surgery. This a secondary analysis of a pharmacokinetic study involving 174 obese patients scheduled for bariatric surgery and receiving a 4-g dose of cefoxitin. Blood samples were collected at incision and wound closure. The total plasma concentrations were assessed utilising a validated high-performance liquid chromatography-tandem mass spectrometry method. The pharmacokinetic and pharmacodynamic target was defined as an estimated free concentration of cefoxitin at the time of wound closure >8 mg/L. Specific evaluated obesity parameters were fat body mass, fat body mass/height2, lean body mass, lean body mass/height2, visceral adipose tissue and presence of a metabolic syndrome. A total of 174 patients (median age 47 years) with a majority of women (75.3%) and a median BMI of 44 kg/m2 were analysed. The percentage of patients who met the pharmacokinetic and pharmacodynamic target was 85.1%. In the whole population, a tendency to fail to reach the target was observed with a higher lean mass over height2 [OR = 0.79; 95% CI (0.62-1.01); P = 0.060]. In the female subgroup, higher lean mass over height2 [OR = 0.63; 95% CI (0.41-0.97); P = 0.037] and the presence of a metabolic syndrome [OR = 0.17; 95% CI (0.03-0.83); P = 0.030] were associated with failure to reach the pharmacokinetic and pharmacodynamic target. Obese patients with a higher lean mass and a metabolic syndrome could constitute a subgroup at risk for cefoxitin under-dosage.

Subcuticular sutures versus staples for skin closure in patients undergoing abdominal surgery: A meta-analysis of randomized controlled trials

BackgroundSurgical site infections (SSIs) are common postoperative complications. Whether the use of staples or sutures makes a difference in abdominal surgery’s infection rate remains elusive.MethodsA systematic review was performed to identify randomized clinical trials comparing staples and sutures after abdominal surgeries. Eligibility criteria involved the SSI occurrence as the primary outcome and the incidence of wound dehiscence, closure time, cosmesis, and patient satisfaction as the secondary outcomes.ResultsOf the 278 studies identified, seven randomized controlled trials representing 3705 patients were included in this review. There was no significant difference in SSI rates between sutures and staples in general (OR = 0.98, 95% CI = 0.79–1.22, I2 = 44%, P = 0.1) or in a subgroup of gastrointestinal surgery, where subcuticular suturing was found with a comparable SSI risk with skin stapling (OR = 0.85, 95% CI = 0.66–1.09). Staple closure was associated with a shorter surgery duration, whereas sutures appeared to provide better cosmesis and patient satisfaction. Sutures and staples achieved a comparable incidence of dehiscence. There was no significant between-study publication bias.ConclusionOur study demonstrated similar outcomes in SSI rate between subcuticular sutures and staples for skin closure in patients undergoing abdominal surgery.

A Dedicated Lightweight Titanized Mesh Prevents Incisional Hernias After Open Abdominal Aortic Aneurysm (AAA) Repair: Results of an Initial Prospective Cohort Study.

BackgroundIncisional hernia (IH) is a common, late complication of open repair of an abdominal aortic aneurysm (AAA), with a variable high incidence. A cohort study was conducted to investigate the role of a lightweight titanized mesh placed in the pre-peritoneal space after AAA repair. The primary endpoint was to determine the incidence of IH at eight weeks and 12 months.MethodsConsecutive patients who underwent open repair of AAA with the prophylactic implantation of a mesh after abdominal wall closure were recruited. The development of IH was evaluated using clinical examination, ultrasonography scan (USS), and computed tomography (CT) scan during the follow-up period.ResultsThirty-nine of 45 patients (34 male, 5 female, mean age 69.6 +/- 6.5 years) undergoing open repair of AAA over a five-year period via a preferred roof-top incision were analyzed for this study. One additional (2.5%) patient had the mesh explanted following a re-laparotomy for colonic ischemia and later developed an incisional hernia. There was no incidence of wound or mesh infection overall. One radiologically detected early IH closed spontaneously. There were five (12.8%) radiologically detected late cases of midline or paramedian defects beyond the one-year follow-up though this was not clinically significant; compared to this, there was no incidence of lateral defects in the wound (p<0.01, McNemar’s test).ConclusionThese preliminary results suggest that a dedicated lightweight titanized mesh is usable for primary reinforcement of rooftop incisions at the time of wound closure. Whilst this study supports the role of a mesh as a useful adjunct, larger studies and long-term follow-up would provide more sensitive assessments of its efficacy.

Octyl 2-cyanoacrylate versus conventional suturing of port site skin closure in laparoscopic appendicectomy: a prospective study

Background: With rapidly developing minimally invasive surgery, the laparoscopic appendectomy has become a preferred method for appendicectomy. Tissue adhesives have become an ideal alternative to conventional sutures and could possibly become the preferred standard of care in many procedures. However, this concept remains unexplored due to scanty data comparing the use of adhesive glues and sutures. The present prospective study was done to compare octyl-2-cyanoacrylate with conventional suturing of port site wound closure in laparoscopic appendicectomy in terms of wound complications, time taken for wound closure and cosmetic outcome.Methods: 60 patients diagnosed to have appendicitis (acute, chronic and recurrent) undergoing laparoscopic appendicectomy were divided into two groups (group A-octyl-2-cyanoacrylate) and (group B- conventional sutures) with 30 in each group. Time taken for wound closure, Wound complications and cosmetic outcome were compared in both groups.Results: Patient demographics were comparable in both the groups. The complications were significantly lower in group A compared to group B. Mean surgical time for wound closure in group A was less compared to group B (p&lt;0.001). Wound closure using octyl-2-cyanoacrylate had lower rate of complications compared to conventional suturing but results obtained were not statistically significant. No significant difference in cosmetic outcome was noted in both groups.Conclusions: Wound closure using octyl-2-cyanoacrylate required significantly less time for skin closure compared to conventional suturing in patients undergoing laparoscopic appendicectomy. However, wound complications and cosmetic outcome using octyl-2-cyanoacrylate did not show statistically significant results compared to conventional suture.

Peri-incisional perfusion does not differ between running versus interrupted Allgöwer-Donati suture technique in ankle fracture surgery: a pilot randomized controlled trial of wound perfusion

Objectives:To compare peri-incisional perfusion, perfusion impairment and wound closure time between the conventional interrupted Allgöwer-Donati (IAD) technique and a modified running Allgöwer-Donati (RAD) technique in ankle fracture surgery.Design:Prospective, randomized controlled clinical trial.Setting:Level I and II trauma centers.Patients:Twenty-five healthy adults with ankle fractures (AO/OTA 44-A, 44-B, or 44-C) between November 2017 and December 2018. (Of 26 patients enrolled in this study, 1 was lost to follow-up.)Intervention:Participants were randomized into the IAD or the RAD group (13 patients each). All participants were followed for at least 3 months after surgery to assess for wound complications.Main Outcome Measurements:Skin perfusion was assessed immediately after wound closure with laser-assisted indocyanine green angiography. Wound closure time, mean incision perfusion, and mean perfusion impairment were measured and compared with analysis of variance. Alpha = 0.05.Results:The RAD technique was significantly faster in terms of mean (± standard deviation) wound closure time (6.2 ± 1.4 minutes) compared with the IAD technique (7.3 ± 1.4 minutes) (P = 0.047). We found no differences in mean incision perfusion and mean perfusion impairment (all, P > 0.05).Conclusion:The IAD and RAD techniques resulted in similar peri-incisional perfusion and perfusion impairment. Closure time was significantly shorter for the RAD technique compared with the IAD technique.Level of Evidence:I

Therapeutic Targeting of Neutrophil Extracellular Traps Improves Primary and Secondary Intention Wound Healing in Mice.

BackgroundNeutrophils are the first responders in wound healing after injury that mediate pro- and anti-inflammatory activities i.a. through the formation of extracellular traps (NETs). However, excessive NETs presence in wound tissue can cause local hyperinflammation and -coagulation resulting in delayed wound healing. To improve wound healing, we aimed to examine the role of NETs and DNase1 on primary and secondary wound healing.MethodsThe study included 93 C57BL/6 mice, with 3 different genotypes: wildtype, Pad4-, and DNase1-Knockout (KO). Pad4-KO mice show limited NETs formation, while DNase1-KO mice cannot disintegrate them. All 3 genotypes were included in (1) a laparotomy group and (2) a thermal injury group. Animals in both groups either received DNase1 or a vehicle i.p. post wound induction and wound assessment and euthanasia were conducted. Laparotomy and burn scars were assessed using the stony brook scar evaluation scale and modified Yeong scale respectively. Tissue was analyzed histologically using H&E staining. Ly6g, Collagen I and III, SMA, and Fibrinogen were visualized and neutrophils activation (NE, MPO) and NETs (H3cit) formation assessed.ResultsAll animals survived with no complications. DNase1 treatment led to a significantly improved scar appearance in both groups, which was also seen in Pad4-KO mice. In the laparotomy group DNase1 improved collagen deposition and fibrin concentration was significantly reduced by DNase1 treatment. Markers of neutrophil activation were significantly reduced in the treatment and Pad4-KO group. In the thermal injury group wound closure time was significantly reduced after DNase1 treatment and in the Pad4-KO group. Even though inflammation remained high in the thermal injury model over time, neutrophil activation and NETs formation were significantly reduced by DNase1 treatment compared to controls.DiscussionPrimary and secondary intention wound healing is improved by targeting NETs through DNase1 treatment or genetic KO, as assessed by wound closure time and scar appearances. Additionally, wound stability was not affected by DNASE treatment. The results suggest that overall wound healing is accelerated and DNase1 appears to be a promising option to reduce scar formation; which should be evaluated in humans.

Expanded negative pressure wound therapy in healing diabetic foot ulcers: a prospective randomised study.

This study aims to evaluate the benefits of treating diabetic foot ulcers (DFU) through a revised procedure using the mechanisms underlying negative pressure wound therapy (NPWT) in such a way as to achieve reduced and more evenly distributed lateral tension lines across the wound. Patients with type 2 diabetes were assessed for elegibility. Included patients were divided randomly into two groups: the NPWT control group and the NPWT+ group. Patients in the NPWT control group were treated in the traditional manner: wounds were covered with foams shaped to fit the wound precisely. In the NPWT+ group, foams were shaped to fit the wound precisely, and an additional foam was then wrapped around the foot. Some 85 patients were assessed for eligibility; 59 were randomised into two groups: 29 patients in the NPWT+ group and 30 patients in the NPWT group. The primary objective was median healing time (NPWT+ 19 days, interquartile ratio (IQR) 7.5; NPWT 33 days, IQR 16; p<0.00001), and complete wound healing at three weeks (NPWT+ 55.20% NPWT 26.70% p=0.02). Secondary endpoints included number of major amputations (none in either group) and number of infections (NPWT+ 3.44% of patients, NPWT 6.66% of patients; p=0.57). Our initial findings show that this treatment significantly reduced wound closure times and accelerated healing in DFUs. It also demonstrated promising improvements in healing rates, with no significant increase in wound complications.

Evaluation of wound healing potentials of neem (Azadirachtaindica) leaf extract on excision wounds in Wistar albino rats

This study was carried out to evaluate the wound healing ability of ethanoic leaf extract of Azadirachta indica, incorporated into the feed of albino rats. Twenty-four (24) albino rats of both sexes weighing between 90 to 125g were randomly selected and divided into three (3) groups of 8 rats each. Animals in each group were divided into four (4) replicates of two (2) rats per replicate. Group A had penicillin, group B had neem ointment and group C had Neem incorporated in the feed. The ethanoic leaf extract of Azadirachta indica showed a significantly higher (p&lt;0.05) contraction rate and shortened wound closure time. The healing was 92% (p&lt;0.05) on 10th day compared to 75% and 82% of healing with ground leaf of A. indica incorporated into the feed (neem + feed) and procaine penicillin, respectively. The complete wound closure took place on the 12th day in the case of ethanoic leaf extract of Azadirachta indica while, neem + feed and procaine penicillin the wounds persisted than12th day. The study concluded that the ethanoic leaf extract of A. indica had better potential wound healing activity for excision wounds; justifying its use in the traditional and orthodox medicine.

Management of Acute and Traumatic Wounds With Negative-Pressure Wound Therapy With Instillation and Dwell Time.

A promising and useful development of negative-pressure wound therapy (NPWT) is the addition of instillation and dwell time of topical wound solutions (NPWTi-d). Uses of NPWTi-d include acute and traumatic wounds, whereby wound closure may be facilitated via wound cleansing and promotion of granulation tissue formation. This systematic review summarizes publications on NPWTi-d in the treatment of acute and traumatic wounds. A systematic review was performed analyzing articles from major clinical databases. Only clinical studies ≥10 patients reporting on the application of NPWTi-d in acute and traumatic wounds were included. One hundred ninety-two articles were retrieved, of which 10 articles met inclusion criteria. Of those, 2 were lesser-quality randomized controlled trials, comparative studies or prospective cohorts, 2 were retrospective studies, and 6 retrospective cohort studies. In total, included publications reported 109 patients with acute and traumatic wounds treated with NPWTi-d. Data from these studies indicated the potential for reduction in bacterial bioburden through wound cleansing and promotion of granulation tissue formation, thereby facilitating wound closure, reduced length of therapy and hospital time. However, for most publications, different wound causes and subsequently no isolated results for acute and traumatic wounds were reported. NPWTi-d has promise to be effective in facilitating wound closure and reducing the time for wound closure. The present systematic review demonstrates a relatively low level of evidence available to objectively support this effect. To underline these positive results, large prospective, randomized controlled trials are necessary to manifest the role of NPWTi-d in the daily clinical routine for this wound category.

Intraoperative Site Vancomycin Powder Application in Infected Diabetic Heel Ulcers With Calcaneal Osteomyelitis.

Intraoperative site application of vancomycin powder has been found to be beneficial in foot and ankle surgery among diabetic patients undergoing elective procedures. However, there are concerns for risks such as selection of multidrug-resistant bacteria, local tissue irritation, and increased wound complications. The clinical utility of intraoperative site vancomycin powder application in infected diabetic foot ulcer surgery is unknown. We aimed to report the clinical outcomes of partial or total calcanectomy for diabetic heel ulcer (DHU) and determine if intraoperative site application of vancomycin powder placement at the time of wound closure leads to improved clinical outcomes. A current procedural terminology query (CPT 28120: partial excision bone; talus or calcaneus) was run that identified 35 patients representing 38 calcanectomies performed secondary to infected DHU with calcaneal osteomyelitis. An initial group of 25 patients did not receive intraoperative site vancomycin powder, whereas the following 13 cases received intraoperative site vancomycin powder. Demographics, clinical characteristics, comorbidities, operative complications, unexpected return to the operating room (RTOR), and revision amputations were recorded for each patient. Average follow-up was 26.1 (6.5-51.6) months. There was a significantly higher rate of RTOR among the vancomycin powder cohort (VANC) relative to the no-vancomycin cohort (No-VANC) (84.6% vs 36.0%, P = .038). Of the 13 VANC patients, 3 healed the wound and did not require RTOR, 2 underwent below-knee amputation (BKA), 2 received irrigation and debridement (I&D), and 6 underwent revision or total calcanectomies. Of the 25 No-VANC patients, 17 healed the wound, 4 underwent BKAs, 1 received an I&D, and 2 required revision or total calcanectomy. There was a trend toward increased rates of revision calcanectomy and BKA among the VANC cohort, but this was not statistically significant (61.5% vs 28.0%, P = .079). Partial or total calcanectomies for the management of infected DHU resulted in an overall healing rate of 50.0%, unplanned RTOR and revision calcanectomy rate of 39.5%, and a limb salvage rate of 82.6%. We found no clinical benefit with the intraoperative site application of vancomycin powder. Level III, retrospective case control study.

EFEKTIVITAS SEDIAAN SALEP EKSTRAK BUNGA KECOMBRANG (Etlingera elatior) TERHADAP PENYEMBUHAN LUKA INSISI PADA TIKUS (Rattus norvegicus)

This study was conducted to determine the effect of ointment extract of kecombrang flower (Etlingera elatior) on healing incision wounds in white rats (Ratus norvegicus) in terms of the formation of wound scab, wound closure time and wound attachment. The experimental research used is Randomized complete design with 4 treatments with 6 replications. The treatments applied were P0 as a negative control, P1 (20% kecombrang flower extract ointment), P2 (30% kecombrang flower extract ointment) and P3 (40% kecombrang flower extract ointment). Parameters of this study were the wound caropeng, wound closure time and wound attachment. The results obtained were different median values in the four groups with p = 0,000 (p &lt;0.05) in the Kruskal Wallis test. In the Mann Whitney test were significant differences between the groups of 20% kecombrang flower extract ointment concentration, 30% concentration and 40% concentration in the negative control group. The most effective result is ointment extract of kecombrang flower 20% on healing incision wounds.

Skin stretch suturing with Nice knots in the treatment of small- or medium-sized wounds

BackgroundTo investigate the clinical efficacy and outcomes of skin stretch suturing with self-locking sliding Nice knots in the treatment of small- or medium-sized wounds.MethodsFrom June 2015 to May 2018, 26 patients with small- or medium-sized wounds were included in the present study. Skin stretch suturing with self-locking slide Nice knots was performed to gradually close the soft-tissue defects in these patients. The time of wound closure and healing was recorded. The color and blood supply of the skin, cutaneous sensation, the stretch of skin, and the hair growth situation of the skin wound were observed and recorded.ResultsThere were 17 males and 9 females with an average age of 30.65 years (range, 15–48 years). The areas of the soft-tissue defects were between 3.2 × 7.1 cm and 8.0 × 15.2 cm. All patients underwent stretch suturing with self-locking slide Nice knots to close the soft-tissue defects. All wounds were successfully closed and healed. The mean time of wound closure was 10.69 days (range, 5–20 days), and the mean time of wound healing was 16.85 days (range, 10–24 days). The cutaneous sensation of skin wound recovered normally, and the color of the skin wounds was the same as that of normal skin at the last follow-up. The hair growth situation of the skin wounds also returned to normal.ConclusionsThis study revealed that Nice knots yielded an accepted clinical result as a new method to close small- or medium-sized wounds that was simple and less minimally invasive, resulted in progressive tension, did not return to previous results, and partially replace flaps or free skin grafts.

Surgical management of idiopathic congenital talipes equinovarus by Carroll twin incision

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Surgery for congenital idiopathic clubfoot has a number of complications in the postoperative period such as delayed wound healing, gaping, infection, and recurrence of the deformity. The aim of this study is to evaluate the results of primary correction of clubfoot by modified Carroll’s double incision technique.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; It is a prospective interventional for a period of 2 years 5 months. 56 foot of which 21 pts have bilateral deformity and 14 pts with unilateral deformity. Patients of 3 months to 2 years age with idiopathic clubfoot, who did not respond to initial Ponseti casting; and were planned for Carroll double incision technique of surgery were included in this study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results&lt;/strong&gt;: In total 56 foot of which male are 23 and female children are 12 in number with male: female ratio of 1.9:1, showing male predominance, 21 pts have bilateral deformity and 14 pts with unilateral deformities. The mean change in radiographic parameters achieved by correction is as postoperative mean talocalcaneal index achieved was 42.6&lt;sup&gt;0&lt;/sup&gt; (Normal range &amp;gt;40°). The postoperative mean anteroposterior talo-calcaneal angle was 26.2&lt;sup&gt;0&lt;/sup&gt; (Normal range 30&lt;sup&gt;0&lt;/sup&gt; to 55&lt;sup&gt;0&lt;/sup&gt;). The Postoperative mean lateral talo-calcaneal angle was 24.4&lt;sup&gt;0&lt;/sup&gt; (normal 20&lt;sup&gt;0&lt;/sup&gt; to 40&lt;sup&gt;0&lt;/sup&gt;). Final outcome is 81% is good, 14 fair and 5% has poor outcome.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion&lt;/strong&gt;: Exposure and release by Carroll’s twin incision is good, no tension in sutures, especially medical incision at the time of wound closure.&lt;/p&gt;

Comparison of Topical Skin Adhesive and Simple Interrupted Nylon Sutures for Wound Closure in Forefoot Surgery: A Prospective Randomised Trial

Category:BunionIntroduction/Purpose:There are many options for wound closure in forefoot surgery. The purpose of this study was to compare topical skin adhesive (2-Octyl-cyanoacrylate) to standard simple interrupted nylon sutures with attention to the quality of wound healing and the acceptability to the patient.Methods:Patients undergoing elective 1st ray forefoot surgery utilising a medial incision, either Hallux Valgus correction or 1st Metotarsophalangeal joint arthrodesis, were recruited to this study. Patients were randomly allocated during surgery to final layer wound closure with either the intervention topical skin adhesive (TSA) or the control interrupted nylon sutures (INS). Practicality was assessed by time taken for wound closure and subsequent time to perform wound care at 2 weeks postoperatively, wound care pain (VAS) and quality of wound healing was assessed at this point with a dedicated scoring tool, patient satisfaction and acceptability was assessed at 6 weeks postoperative.Results:70 patients (18 bilateral) were recruited, resulting 42 feet in each study group (after 4 exclusions for incomplete data set). Mean age 61 (29-83). There were no statistical differences in the demographics or surgery performed between groups. Wound closure time was significantly slower for TSA (272 secs (SD 72.2) vs 229 secs (SD 58.8), p=0.0038). At 2 weeks postoperative wound care time was significantly faster for TSA (71 secs (SD 50.8) vs 120 Secs (SD 47.8), p<0.0001), and patient reported pain was significantly less with TSA (VAS 0 vs 2, p=0.025). Significantly more inflammation and wound edge separation was recorded with TSA (17 vs 5 cases, p=0.006) and (12 vs 3 cases, p=0.02) respectively. High satisfaction was reported in both groups with no signifcant difference.Conclusion:Topical skin adhesive and interrupted nylon sutures are both acceptable closure methods for forefoot surgery with high satisfaction rates, low pain scores and low complications. However, the observation of significantly more inflammation and areas of wound separation at the early post-operative period with topical skin adhesive is sufficient to recommend routine use of sutures.

A New Therapeutic Application of Platelet-Rich Plasma to Chronic Breast Wounds: A Prospective Observational Study.

The aim of this study was to investigate the usefulness of platelet-rich plasma (PRP) treatment for chronic wounds (CWs) of the breast. A prospective study was performed in 23 patients with CW of the breast who were treated with PRP. The procedure was repeated until the wound was closed completely. The study included patients with a history of breast cancer (n = 8) and patients without cancer (n = 15). The treatment with PRP was successful in all cases and observed in ≤4 weeks in 82.6% (19/23) of patients. The patients without breast cancer showed significantly less time for wound closure than the patients with a history of breast cancer. Moreover, a greater number of PRP treatments were necessary to achieve wound closure in patients undergoing conservative breast treatment. No patients had complications associated with the application of PRP. Conclusions: To the best of our knowledge, this is the first study to reveal that PRP treatment for CWs of the breast is safe, simple, useful and well-tolerated by patients.

The Difference in Incision Wound Closure Time Between 10% Povidone-iodine Solution and Chloramphenicol 2% Ointment in Swiss Webster Mice

Luka adalah cedera fisik yang mengakibatkan rusaknya kulit. Penanganan luka diperlukan untuk mencegah terjadinya infeksi. Agen topikal untuk luka insisi ekstraoral yang umumnya tersedia di puskesmas dan klinik-klinik kesehatan umum maupun gigi yaitu solutiopovidone iodine 10% dan unguentum kloramfenikol 2%. Tujuan penelitian ini adalah untuk mengetahui apakah terdapat perbedaan waktu penutupan luka insisi yang diaplikasikan solutiopovidone iodine 10% dengan unguentum kloramfenikol 2% pada mencit Swiss Webster. Penelitian ini bersifat eksperimental laboratorik, menggunakan 30 ekor mencit Swiss Webster yang dibagi menjadi 2 kelompok. Kelompok I adalah luka insisi pada paha kanan mencit dan diaplikasikan solutiopovidone iodine 10%. Kelompok II adalah luka insisi pada paha kiri mencit dan diaplikasikan unguentum kloramfenikol 2%. Data yang diukur adalah rerata waktu penutupan luka insisi untuk kedua kelompok, kemudian dianalisis menggunakan uji non parametrik Mann-Whitney. Rerata waktu penutupan luka insisi yang diaplikasikan solutiopovidone iodine 10% adalah 5,07±0,691 hari, dan yang diaplikasikan unguentum kloramfenikol 2% adalah 5,03±0,765 hari. Simpulan penelitian adalah tidak terdapat perbedaan waktu penutupan luka insisi yang diaplikasikan solutio povidone iodine 10% dengan unguentum kloramfenikol 2% pada mencit Swiss Webster.&#x0D; &#x0D; Kata kunci: waktu penutupan luka, luka insisi, solutio povidone iodine 10%, unguentum kloramfenikol 2%&#x0D;

A novel zipper device versus sutures for wound closure after surgery: a systematic review and meta-analysis.

We performed an updated meta-analysis to compare the efficacy of the zipper device and sutures for wound closure after surgery. A computerised literature search was performed for published trials in PubMed, Web of Science, the Cochrane Library, and Google Scholar. Two reviewers independently scrutinised the trials, extracted data, and assessed the quality of trials. The primary outcome was surgical site infections (SSI). The secondary outcomes were wound dehiscence, total wound complications, wound closure time, and scar score. Statistical analysis was performed in the Stata 12.0. Of the 130 citations, eight trials (1207 participants) met eligibility criteria and were included. The zipper device achieved a lower SSI rate (RR: 0.63, [95% CI: 0.41-0.96, P = 0.032]), a shorter wound closure time (SMD: -8.53 [95% CI: -11.93 to -5.13, P = 0.000]) and a better scar score (SMD: 0.42 [95% CI: 0.22-0.62, P = 0.000]) than sutures. No significant difference was shown in the incidence of wound dehiscence and total wound complications. Therefore, the zipper device provides the advantages of anti-infection, time-saving, and cosmesis for wound closure.

Wound Healing Activity of Crassocephalum crepidioides (Benth.) S. Moore. Leaf Hydroethanolic Extract.

Crassocephalum crepidioides (Benth.) S. Moore. has been used to treat small wounds by minority people in Lam Dong, Vietnam. However, there has been no scientific evidences about its wound healing activity. This study is aimed at evaluating the wound healing activity of Crassocephalum crepidioides hydroethanolic extract via its antioxidant and anti-inflammation activities and healing capability on a mouse excision wound model. Crassocephalum crepidioides hydroethanolic extract (CCLE) at a dose of 50 mg/kg/day reduced the wound closure time about 3.5 days, compared to vehicle treatment. The granulation tissue on day 7 after surgery from the treated group showed a 2.8-fold decrease in the density of inflammatory cells, 1.9-fold increase in the fibroblast density, and a higher number of blood vessels. Real-time PCR analysis indicated that the mRNA expression level of NF-κB1 and TNF-α mRNA in CCLE-treated wounds decreased by 4.6 and 3.3 times, respectively, while TGF-β1 and VEGF were found to increase by 3.3 and 2.4 times, respectively. Our experimental data provided proofs of Crassocephalum crepidioides leaf wound healing activity due to its antioxidant, anti-inflammation, fibroblast proliferation, wound contraction, and angiogenesis effects.