Wound Contamination Research Articles

Features of complex surgical treatment of gunshot wounds of major vessels’ combat trauma

Introduction. The frequency of wounds and injuries of the great vessels in modern military conflicts has increased significantly (7.5-9.0%). At the same time, 90% of combat vascular injuries are injuries to the arteries and veins of the extremities. During hostilities on the territory of Ukraine, gunshot wounds and closed injuries of the great vessels account for 4.5-8.0%. In more than 90% of cases, vascular injuries are classified as severe, and in 8% - as extremely severe. In particular, gunshot wounds to the arteries often have concomitant injuries to the great veins (40-50% of cases), nerve trunks (30-70%), and bone fractures (40-60%). Depending on the weapon used and the nature of the injuries, modern combat surgical trauma is characterized not only by damage to the great vessels, but also by massive bacterial contamination of gunshot wounds, damage to other important anatomical structures of the body, and the occurrence of early and late complications, which worsens the patient's clinical course and increases the duration of treatment. Purpose: to demonstrate the features of complex surgical treatment of gunshot wounds in combat trauma of the great vessels using a clinical example. Materials and methods. A retrospective analysis of the complex surgical treatment of 64 wounded with gunshot wounds in combat trauma of the great vessels in the period 2022-2023 was carried out. The analysis was carried out on wounded servicemen with the involvement and conduct of a certain amount of clinical and diagnostic examination and surgical interventions in complex surgical treatment on the basis of the National Military Medical Clinical Center “GVKG”. Two clinical observation groups were defined: the main group and the comparison group. The main clinical observation group included 42 patients who underwent various modes of negative pressure intensity of vacuum therapy during staged surgical procedures, and the comparison group included 22 patients who were treated according to the traditional scheme with emergency and planned surgical interventions with staged surgical procedures. Results. In the course of complex surgical treatment of patients with gunshot wounds in combat trauma of the great vessels, it was determined that during staged surgical procedures with the proper use of VAC therapy, it significantly contributes to better wound healing, reduction of the risk of arosive bleeding and further preservation of the restored blood flow of the injured limb. Conclusion. This clinical observation describes that gunshot wounds in combat trauma of the great vessels require timely diagnostic examination, as well as in the process of complex surgical treatment, repeated staged surgical procedures using low and medium intensity negative pressure vacuum therapy, constant bacterial cultures from gunshot wounds to determine the microflora and further selection of antibiotic therapy, which significantly reduces wound infection, improvement of their healing and, in the presence of massive defects, preparation for plastic closure. It was also determined that due to the reduction of the inflammatory process in the area of vascular reconstruction, the risk of arosive bleeding decreases and the process of preserving the restored blood flow of the injured limb improves.

Navigating Wound Closure Strategies: Primary Closure vs. Delayed Primary Closure in Digestive Surgery—A Systematic Review and Meta-Analysis on Surgical Site Infections

Introduction. Surgical site infection (SSI) is a significant concern following digestive surgery, with varying incidence rates based on wound contamination levels. The choice between Primary Closure (PC) and Delayed Primary Closure (DPC) impacts SSI occurrence, making it essential to evaluate their comparative effectiveness. DPC is hypothesized superior to PC to prevent SSI or wound infection after a contaminated abdominal surgery. Methods. This systematic review study was carried out through PubMed, Scopus, and Cochrane (CENTRAL). Quality was assessed using Risk of Bias (ROB-2) tool. All results were summarized, and quantitative analysis was performed using a random-effect model. This study is reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Eligibility criteria included adult patients undergoing abdominal gastrointestinal surgery, evaluating SSI and hospital stay, directly comparing PC and DPC, and randomized controlled trials (RCT) study. Results. Of 447 published studies, there were 10 eligible RCTs, consist of 672 subjects who received DPC and 668 subjects who received PC. We found no significant difference in SSI occurrence between PC and DPC (RR=0.62, 95%CI: 0.38–1.02; p=0.06) with high heterogeneity (I2=74%, p Conclusion. DPC tend to decrease SSI risk. Our findings revealed that PC is not inferior than DPC to prevent SSI and improve hospital stay in abdominal surgery. The choice between techniques should be individualized, considering patient characteristics and surgical context. Standardized criteria and further research are crucial for refining closure method selection, ultimately enhancing patient outcomes and reducing the burden of SSI.

Effects of GHK peptide and its structural analogues on dynamics of healing and bacterial contamination of infected wound

INTRODUCTION: Currently, a promising trend to accelerate wound process seems to be the use of NH2-Gly-L-His-L-Lys-COOH (GHK) tripeptide, which acts on the tissue regeneration, possesses antioxidant, immunotropic and anti-inflammatory effects. At the same time, the disadvantage of all peptides is their rapid degradation by proteolytic enzymes. One method to increase the stability of peptide molecules is the incorporation of D-isomers of amino acids in their structure. It was previously found by us that GHK-D-Ala produces a more marked effect on regenerative processes in the wound and facilitates increase in the number of fibroblast cells and macrophages in the wound with the underlying decrease in the number of granulocytes and lymphocytes; a significant effect of D-Ala-GHK and GHK-D-Ala on the parameters of the inborn immunity and lipid peroxidation was shown. AIM: To evaluate the healing dynamics and bacterial contamination of an infected wound when using Glycyl-Histidyl-Lysine (GHK) peptide and its structural modifications with D-alanine (D-Ala). MATERIALS AND METHODS: The experiments were conducted on Wistar rats. In the work, GHK peptide and its structural analogues D-Ala-GHK and GHK-D-Ala were used; they were administered intracutaneously around the wound at doses of 0.5 µg/kg and 1.5 µg/kg every 24 hours for 3rd, 7th and 10th days. The wound area with calculation of the relative wound healing coefficient (RWHC), the healing rate, the time of perifocal edema disappearance, wound cleansing, appearance of granulation and onset of marginal epithelialization were assessed. Bacterial contamination was determined by counting colonies on the nutrient media after inoculation of wound biopsy material on them. RESULTS: On day 3rd, RWHC increased 3.2–5.3 times (p 0.05–0.01) after the use of D-Ala-GHK and GHK-D-Ala peptides at both doses with no effect after the injection of GHK. On day 7th, the reduction of the wound area reached statistically significant differences in all experimental groups. By day 10th, the use of peptides resulted in decrease in the wound area most evident after the injection of GHK-D-Ala peptide (by 93%, p 0.001) in all groups. On days 7th–10th, GHK-D-Ala increased the healing rate 4.7–5.3 times (p 0.05-0.01) with no significant changes after the injection of GHK and D-Ala-GHK. Also, GHK-D-Ala at both doses resulted in the earliest disappearance of perifocal edema, wound cleansing, emergence of granulation and the onset of marginal epithelialization in all experimental groups. Significant reduction in bacterial contamination was observed after administration of all peptides on days 7th and 10th, being most pronounced after the use of GHK-D-Ala. CONCLUSION: The application of GHK peptide and its structural analogues D-Ala-GHK and GHK-D-Ala in infected skin wounds accelerated wound healing against the background reduction of bacterial contamination. The most pronounced changes of these parameters were observed after administration of GHK-D-Ala peptide, which indicates the importance of protecting GHK molecule against the impact of carboxypeptidases. A promising continuation of the research in this direction can be the development of local means with antibacterial effect for stimulation of the regeneration processes in the wound.

Infections and Infections and Spectrum of Pathogens in Patients with Malignant Tumors of the Liver and Biliary Tract with Biliary Obstruction after Extensive Liver Resections

A malignant tumor is an independent risk factor for the development of surgical site infections (SSIs), and the risk of postoperative complications in patients is 3 times higher than in patients without a malignant process. Unfortunately, even with perfect adherence to the rules of asepsis and antiseptics, the contamination of the surgical wound is inevitable during surgery. In patients with malignant liver tumors the infection can be caused by malignant obstruction, bile stasis, preoperative manipulations of the biliary tract (drainage or stenting). The objective: to analyze the spectrum of bacterial infections and their pathogens in patients with primary malignant tumors of the liver and biliary tract with obstruction of the biliary tract compared to patients without obstruction of the biliary tract after extended liver resections (ELRs). Materials and methods. 70 statistically homogeneous patients in terms of age and gender took part in the study: 32 persons with hepatocellular carcinoma (HCC) and 38 persons with cholangiocarcinoma (CC). Patients were divided into groups. The 1st (main one) group included 35 patients with primary liver tumors after ELRs with biliary obstruction, the 2nd (control one) group included 35 patients with primary liver tumors after ELRs without biliary obstruction. The age of the patients was 61.2 ± 10.7 years and 64.5 ± 11.4 years, respectively. Objective data, laboratory and instrumental examinations were used to establish the diagnosis and complications that occurred in patients after surgery. Results. In patients with HCC and CC with biliary obstruction after ELRs (main group) the infectious complications occurred in 100% of cases, versus to patients with HCC and CC without biliary obstruction (control group). Opportunistic microorganisms, which were represented by a sufficiently wide spectrum of gram-negative and gram-positive bacteria, were determined in patients after ELRs. Pneumonia (17.1% of cases), cholangitis (14.3%), SSIs (28.6%), SSIs com bined with cholangitis (11.4%), and SSIs in combination with infections of the central circulation (11.4%) were significantly more common in patients with HCC and CC with biliary obstruction after ELRs. Conclusions. The results of the study should be used to develop a strategy to reduce postoperative bacterial complications and additional financial costs after ELRs in the future.

The cost of saving lives: Complications arising from prehospital tourniquet application.

Uncontrolled hemorrhage is a leading cause of preventable death in trauma. Tourniquets (TQs) are commonly used to control bleeding in the prehospital setting, although their application is associated with risks. Therefore, this study aimed to identify complications arising from TQ use and to examine contributing risk factors. This retrospective observational study reviewed the medical records of adult trauma casualties (>18 years) hospitalized at Chaim Sheba Medical Center (SMC) between 2010 and 2020 who had a TQ applied in the prehospital setting. The primary outcome was the rate and type of complications. Logistic regression analyses identified risk factors using demographic, injury, and clinical data. From 2010 to 2020, a total of 84 trauma casualties with documented prehospital TQ application were hospitalized at SMC. Of these, 20 (23.81%) experienced TQ-related complications, including local infection, compartment syndrome, and thromboembolism. The average TQ application time was 44.2 min, with no significant difference between those with and without complications. However, significant differences were noted in the mechanism of injury (MOI), wound contamination levels, indications for TQ application, and initial blood test results (p < 0.05). Logistic regression analyses revealed length of stay (LOS) and injuries from falls were significantly associated with the development of complications. This study found that a significant trauma in prehospital settings requiring TQ application is associated with a high rate of complications. Early complications, including local infections and compartment syndrome, were more frequent, whereas late complications like thromboembolism and muscle atrophy were less common. The findings suggest that factors such as the MOI and wound contamination may contribute to these complications, yet after applying multivariate regression, LOS and falls were the only variables found to be significantly associated with the development of complications. These findings underscore the need for further research comparing casualties with and without TQ application.

Use of Biologic and Biosynthetic Mesh for Ventral Hernia Repair in Current Practice

Originally developed for use in contaminated fields, there is growing evidence against the use of biologic and biosynthetic mesh in ventral hernia repair. However, its prevalence and patterns of use in current practice are largely unknown. To describe the prevalence of biologic and biosynthetic mesh use in ventral hernia repair and to identify factors associated with its use. This retrospective cohort study used a statewide clinical registry in Michigan to identify adults who underwent mesh-based ventral hernia repair between January 1, 2021, and December 31, 2023. Data analysis was performed from February to May 2024. Use of biologic or biosynthetic mesh vs synthetic mesh. The main outcome was use of biologic or biosynthetic mesh, abstracted directly from the operative report. Multivariable logistic regression was used to identify factors associated with use of biologic or biosynthetic mesh. A total of 10 838 patients (mean [SD] age, 55.7 [14.0] years; 4619 [42.6%] female) who underwent mesh-based ventral hernia repair were identified, among whom 1174 repairs (10.8%) were performed with biologic or biosynthetic mesh and 9664 (89.2%) were performed with synthetic mesh. Of the 1174 cases using biologic or biosynthetic mesh, 1023 (87.1%) had a clean wound classification and 1039 (88.5%) were performed electively. In multivariable logistic regression, wound contamination was associated with increased odds of biologic or biosynthetic mesh use (clean-contaminated: adjusted odds ratio [aOR], 2.17 [95% CI, 1.62-2.89]; contaminated: aOR, 2.95 [95% CI, 1.63-5.34]; dirty or infected: aOR, 36.22 [95% CI, 12.20-107.56]). Other operative factors associated with increased odds of biologic or biosynthetic mesh use included urgent or emergent surgical priority (aOR, 1.69 [95% CI, 1.33-2.16]), laparoscopic or robotic approach (aOR, 1.31 [95% CI, 1.15-1.50]), larger hernia width (aOR, 1.03 [95% CI, 1.01-1.04] per centimeter), and use of myofascial release (aOR, 2.10 [95% CI, 1.64-2.70]). In this large cohort of patients undergoing ventral hernia repair, 1 in 10 mesh-based repairs was performed with biologic or biosynthetic mesh. Although urgent or emergent repair and wound contamination were associated with increased odds of biologic or biosynthetic mesh use, nearly 90% of biologic and biosynthetic mesh use occurred in elective repairs with clean wound classifications. These results raise questions regarding the appropriateness of its application in current practice.

Risk factors for poor outcomes in adult patients with lip through-and-through wounds

Risk factors associated with infection and traumatic lacerations affecting the face are still not fully understood. This study investigated risk factors for poor outcomes in adult patients with through-and-through lip wounds who underwent debridement and suturing. Patients with through-and-through lip wounds who underwent debridement in our emergency department between January 1, 2017, and December 31, 2021, were included. The effects of gender, age, wound age (time from injury to wound closure), antibiotic application, injury mechanism, diabetes, wound length, wound cleanliness, peripheral tissue damage, and postoperative wound blood scab on the poor outcome rate were assessed for all patients. Poor outcome was analyzed based on atraumatic wound dehiscence before suture removal, pus in the wound, and unhealed oral wounds with a length >1cm or deeper than the muscle layer 5-6 days after surgery. A total of 728 cases were included, with a poor outcome rate of 20.88%. The univariable analysis showed that the proportion of poor outcomes was significantly associated with male gender, age (65-79 years old), bicycle/electric bicyble, antibiotic use, wound length of 4-8cm, wound contamination, peripheral tissue damage, and scabs. Binary logistic analysis showed that the proportion of poor outcomes was significantly associated with older age (65-79 years old), wound length of 4-8cm, peripheral tissue damage and wounds covered by scabs. In the binary logistic regression analysis, poor outcomes were not associated with gender, injury mechanism, wound contamination or the use of antibiotics. Our findings provide valuable information on the risk factors for poor outcomes in adult patients with lip through-and-through wounds who underwent debridement and suturing.

Is the Orthopaedic Trauma Association-Open Fracture Classification Better Than the Gustilo-Anderson Classification at Predicting Fracture-Related Infections in the Tibia?

To investigate and compare the predictive ability of the Orthopaedic Trauma Association-Open Fracture Classification (OTA-OFC) and the Gustilo-Anderson classification systems for fracture-related infections (FRI) in patients with open tibia fractures. Retrospective cohort study. Academic trauma center. Patients aged 16 years or older with an operatively treated open tibia fracture (OTA-AO 41, 42, and 43) between 2010 and 2021. The primary outcome was FRI. The OTA-OFC and the Gustilo-Anderson classifications were compared in their ability to predict FRI. Eight hundred ninety patients (mean age, 43 years [range, 17 to 96]; 75% men) with 912 open tibia fractures were included. In total, 142 (16%) had an infection. The OTA-OFC was not significantly better at predicting FRI than the Gustilo-Anderson classification (area under the curve, 0.66 vs. 0.66; P = 0.89). The Gustilo-Anderson classification was a stronger predictor of FRI than any single OTA-OFC domain, explaining 72% of FRI variance. Only the addition of the OTA-OFC wound contamination domain to Gustilo-Anderson significantly increased the variance explained (72% vs. 84%, P = 0.04). Embedded contamination increased the risk of FRI by approximately 10% as the risk of FRI with embedded contamination was 16% for type I or type IIs, 26% for type IIIAs, 45% for type IIIBs, and 46% for type IIICs. The more complex OTA-OFC system was not better than the Gustilo-Anderson classification system in predicting FRIs in patients with open tibia fractures. Adding embedded wound contamination to the Gustilo-Anderson classification system significantly improved its prognostic ability. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Dressing Material With Halochromic Dye as an Information Source in Wound Healing Monitoring

Background: The percentage of clean-wound infection remains fairly high so far: 2% to 5%. Therefore, monitoring wound healing is a critical task in modern surgery.Objective: To develop and test a dressing material with halochromic dye in order to determine the suppuration of a clean wound of the skin and soft tissues.Material and methods: The experiment was conducted on 30 Wistar rats: clean wounds were formed and then covered with a dressing soaked in halochromic dye. During the experiment, we measured the pH of the wounds and wound area and determined the qualitative and quantitative composition of the wound microflora. Statistical analysis was conducted using the Wilcoxon test; the level of significance was taken at 0.05.Results: We found that the initial wound area was 253 (248; 257) mm2 and the surface pH, 5.80 (5.55; 5.90). Clean wounds covered with a dressing material were not treated with medication. It led to their infection and a change in the color of the dressing material on average on day 4 (4; 5) of the experiment. After removal of the dressing material, we noted that the pH of the wounds was 7.79 (7.68; 7.88) and the wound area, 238 (234.3; 242.5) mm2; the differences compared with the data on day 1 were statistically significant. When analyzing the degree of wound contamination after removal of the dressing material, we found that the wound contained aerobic and anaerobic microorganisms and microscopic fungi, the level of which statistically significantly exceeded the maximum permissible level, confirming development of the wound infection.Conclusions: The use of a dressing material with halochromic dye, which changes its color in response to the pH of the wound, facilitates timely detection of the development of the wound infection.

ETIOPATHOGENETIC MECHANISMS OF IMMUNE DYSFUNCTION IN COMBATANTS WITH LOWER LIMB SOFT TISSUE INJURIES UNDER CHRONIC STRESS

Introduction. Combat injuries, including gunshot, shrapnel, and mine-explosive wounds, affect a significant number of soldiers in modern warfare. Notably, most of these injuries involve damage to the soft tissues of the extremities. Surgeons have expressed concerns regarding the unsatisfactory treatment outcomes in this group of combatants, attributing one of the primary challenges to the limited understanding of immune dysfunction pathogenesis in military trauma cases. This study aims to address this gap by examining immune system dysfunctions in combat-related injuries. The objective of this study is to thoroughly analyze and synthesize the key stages of immune dysfunction occurring over extended periods post-combat trauma, including the subsequent development of traumatic disease and various wound complications. Materials and Methods. The rising prevalence of combat trauma among soldiers has intensified interest in studying this issue, prompting surgeons and traumatologists to address its various medical aspects comprehensively. The literature search focused on recent publications, allowing for a targeted analysis of the immunological aspects relevant to military medical traumatology. Results. In the initial stages of severe or combined injuries affecting various tissues—such as tubular bones, joints, blood vessels, and peripheral nerves—systemic inflammatory response syndrome (SIRS) commonly occurs. This stage is marked by an intense activation of innate antibacterial and immune-protective responses, leading to a significant increase in inflammation. This initial response is soon replaced by a prolonged phase known as compensatory anti-inflammatory response syndrome. During this period, immune-protective responses sharply decrease, certain immunocompetent cells become inhibited, and lymphopenia develops. This phase is often accompanied by infectious contamination of wounds with pathogenic and opportunistic microorganisms, resulting in both local purulent-necrotic processes and potentially severe systemic complications, such as septic shock, sepsis, multiple organ failure, and others. The final stage, known as persistent inflammatory, immunosuppressive, catabolic syndrome, is characterized by the chronic progression of traumatic disease, accompanied by ongoing immune system dysfunction in combatants. Conclusion. In the early period of traumatic injury, the wounded experience sharp inflammatory processes and activation of immune defense mechanisms. At subsequent stages, severe disruptions in the functioning of the immune system, damage to internal organs, and the development of catabolic syndrome are recorded. These changes, especially those resulted from exposure to chronic combat stress preceding the injury, aggravate the processes of infectious decontamination of wounds, regeneration of damaged tissues, and the general process of combatant rehabilitation.

Effect of Antiseptic Irrigation with 0.05% Chlorhexidine Gluconate (Irrisept) on the Incidence of Cutibacterium acnes in Primary Shoulder Arthroplasty

Previous literature has demonstrated high rates of Cutibacterium acnes (C. acnes) colonization in patients undergoing primary shoulder arthroplasty. Residing primarily within the dermal layer, C. acnes poses a major threat to intraoperative wound contamination with subsequent risk of developing periprosthetic joint infection. Discovering an effective perioperative prophylaxis strategy is imperative. To date, no such regimen has shown the ability to reliably suppress C. acnes from the deeper tissues. This study was designed to investigate whether intraoperative Irrisept irrigation would result in a lower positive culture rate of C. acnes versus standard prophylaxis alone in primary total shoulder arthroplasty. Patients undergoing primary shoulder arthroplasty were randomized to the standard control group or the experimental Irrisept group. Intraoperative cultures were obtained from the incision site, dermis, inferior glenohumeral recess, and sterile kidney basin (control). All specimens were collected by one surgeon at one institution. Samples were shipped to ACM Global Laboratories. All cultures were observed for 14 days. Statistical analysis of the control and experimental quantitative values were compared via Fisher's exact test. Nominal variables were evaluated using the chi-square test. Multivariate analysis was performed to evaluate for differences in age, body mass index, smoking history, diabetic status, VAS, and ASES scores. Significance for all comparisons was p ≤ 0.05. Final analysis included 56 patients and 223 cultured specimens. Baseline demographics were similar between cohorts, indicating successful randomization. C. acnes positive culture rate of the control group did not significantly differ from the Irrisept group (5.77% versus 10.08%; P=0.49). No differences were noted in subgroup analysis. The total positive culture rate of all specimens was 8.07% (18/223). Incision site cultures had the highest rate of positivity (14.2%), followed by the dermis (7.14%), deep tissue (5.5%), and control (5.4%). No difference in culture rates were detected regarding age, BMI, smoking history, diabetic status, VAS, or ASES scores. There was 98.2% follow-up at two weeks, 91.1% at six weeks, 83.9% at three months, and 71.4% at six months. No additional complications or adverse events were noted in either cohort. The addition of intraoperative Irrisept irrigation did not significantly differ from standard perioperative prophylaxis for C. acnes positive culture rates in patients undergoing primary shoulder arthroplasty. While the findings should be cautiously interpreted due to the limited sample size, this pilot study provides a useful framework to inform a larger randomized controlled trial, emphasizing the importance of perioperative infection prophylaxis.

Antimicrobial resistance: Biofilms, small colony variants, and intracellular bacteria

Soft tissue and bone infections continue to be a serious complication in orthopedic and trauma surgery. Both can lead to a high burden for the patients and the healthcare system. Musculoskeletal infections can be induced by intraoperative contamination, bacterial contamination of open wounds or hematogenous bacterial spread. During the recent decades, advances were achieved in the understanding of pathogenesis and antibiotic resistance. Despite some progress in the diagnosis and advancing of therapeutic concepts, groundbreaking successful improvement of treatment concepts is still missing. Current therapy concepts are based on the two pillars consisting of surgical debridement with joint or bone reconstruction as well as prolonged antibiotic therapy. An improved understanding of both host and pathogen-related factors leading to treatment failure is essential in musculoskeletal infections. Therefore, this review aims to give an overview of pathogen-related pathophysiology in musculoskeletal infections. It describes defense strategies of pathogens such as (1) biofilm, its development, characteristics, and treatment options. In addition, (2) characteristics of small colony variants and (3) intracellular bacteria are highlighted. Lastly (4) an outlook for potential and promising future therapeutic strategies is provided.

A Contemporary Approach: Presentation of 4 Cases with the Entire Papilla Preservation (EPP) Technique

Regeneration of periodontal tissue is a primary goal of periodontal treatment. Periodontal regeneration approaches are widely used in the treatment of intraosseous defects. However, the success of these techniques depends on many factors, including surgical considerations. Failures in wound closure in the interdental region, which are surgical factors, have led to the development of papilla preservation techniques. The entire papilla preservation technique (EPP) maintains the integrity of the papilla associated with the defect. This technique stabilizes the blood clot with intact gingiva, preventing wound exposure and contamination. EPP is performed in intra-osseous defects through a short buccal vertical incision, without incising the papilla of the involved tooth. A full-thickness buccal flap is lifted from the incision to the relevant papilla and a tunnel extending under the papilla is prepared. The papilla is also lifted to full thickness. The defect is cleaned of granulation tissue and the wound is closed primarily with or without biomaterial application. In this report, we present 4 cases, 3 in the anterior maxilla and 1 in the mandibular premolar region, undergoing periodontal surgery with EPP with biomaterial application with a 3-month follow-up. In all cases, soft tissue healing was uncomplicated and radiographs showed bone filling at 3 months. EPP has a high success rate in periodontal regeneration by providing complete nutrition of the interdental papilla through natural, continuous vascular support in intraosseous defects.

Clostridial Infections in Cattle: A Comprehensive Review with Emphasis on Current Data Gaps in Brazil.

Clostridial infections in cattle are a significant concern for Brazilian livestock. These diseases are caused by various species of Clostridium, which are known for their ability to produce potent toxins. Botulism in cattle is a serious and often fatal condition caused by the ingestion of neurotoxins produced by C. botulinum. This bacterium thrives in decomposing organic matter, such as spoiled feed, carcasses, and contaminated water. Tetanus is less common, but it is a serious disease that follows the contamination of wounds with Clostridium tetani spores. It results in muscle stiffness, spasms, and often death due to respiratory failure. Blackleg (C. chauvoei) is a disease that primarily affects young cattle, leading to acute lameness, swelling, and high fever. Malignant edema (C. septicum and others) is characterized by rapid onset of swelling at wound sites, and it can occur after injuries or surgical procedures. Enterotoxemia is triggered by the rapid growth of C. perfringens in the gut following excessive carbohydrate intake. This leads to toxin production that causes sudden death. In conclusion, clostridial bovine infections remain a persistent challenge for Brazilian cattle farmers. With continued focus on vaccination, good management practices, and research, the impact of these diseases can be minimized, safeguarding the livestock industry's economic viability.

The Effects of Marine Fungal Asterripeptides A-C on In Vitro and In Vivo Staphylococcus aureus Skin Infection.

Objectives: This study aimed to investigate the in vitro and in vivo antibacterial and cytoprotective activities of marine fungal tripeptide derivatives with cinnamic acid moiety asterripeptides A-C (1-3). Methods: The antimicrobial and antibiofilm activities of asterripeptides A-C were tested using the Staphylococcus aureus ATCC 21027 strain. Human HaCaT keratinocytes infected with S. aureus were used for the in vitro investigation of the various aspects of the influence of asterripeptides A-C by lumino- and fluorospectrometry, ELISA, flow cytometry, Western blotting, and microscopy techniques. In the in vivo experiments, mice with burns and scalped S. aureus-infected wounds were used according to ethical committee resolution. Results: Asterripeptides A-C (10 µM) inhibited S. aureus growth and biofilm formation. Asterripeptides A-C increased the viability, proliferation, and migration of S. aureus-infected HaCaT cells and reduced the release of reactive oxygen species (ROS), NO, TNF-α, and IL-18. Asterripeptides A-C protected HaCaT cells against TNF-α-induced inflammation, decreased the transcriptional level of NF-κB in JB6 Cl41 cells, and increased the protein levels of Nrf2 and glutathione synthetase in HaCaT cells. More active asterripeptide C was tested in in vivo burn wounds and S. aureus-infected incised wounds. Asterripeptide C significantly enhanced wound healing, normalized cytokine levels and profiles of peripheral blood samples, and decreased S. aureus contamination of wounds and blood in mice with infected incised wounds. Conclusions: Taken together, these results confirm the dual antibacterial and Nrf2-dependent anti-inflammatory activities of asterripeptides A-C in in vitro and in vivo assays.

NOVEL USE OF NILE TILAPIA FISH (OREOCHROMIS NILOTICUS) SKIN AS XENOGRAFT IN ZOOLOGICAL SPECIES.

Nile tilapia fish skin (Oreochromis niloticus) has been increasingly used in human and veterinary medicine in xenografts for treatment of burn wounds. The objective of this study was to self-prepare the graft using a Brazilian patent (WO2017/035615 A1) as a guide and apply it to full-thickness wounds in zoological species (n = 4). The wounds, which were all characterized as contaminated wounds in which the entire dermal layer was missing, had all previously been surgically debrided and treated with traditional wound-healing techniques without success. This graft technique was developed in response to the poor treatment success. The graft was prepared and sutured to the affected area, leading to complete contraction and epithelialization in all cases. The patients were concurrently placed on one course of systemic antibiotics because of the severity of wound contamination. The frequency of dressing changes varied between species and no adverse effects were apparent. This method of processing Nile tilapia fish skin proves promising for use in contaminated wounds, as it is inexpensive and easy to acquire and develop, mitigates stress in wildlife patients because of a decreased frequency of dressing changes and therefore handling, and can be utilized in clinical environments.

The role of microbial wound contamination in chronic pain development in patients with injuries

The role of microbial wound contamination in chronic pain development in patients with injuries

Multifunctional silver nanoparticle embedded eri silk cocoon scaffolds against burn wounds-associated infection.

Antimicrobial wound dressings offer enhanced efficacy compared to conventional dressing platforms by limiting bacterial infections, expediting the healing process, and creating a barrier against additional wound contamination. The use of silk derived from silkworm cocoons in wound healing applications is attributed to its exceptional characteristics. Compared to mulberry silk, sericin from non-mulberry cocoons has higher water exchange mobility and moisture retention. Eri, a non-mulberry silkworm, is an unexplored source of silk with an eco-friendly nature of production where the natural life cycle of silkworms is not disrupted, and no moths are sacrificed. This work reports on an eri silk cocoon-based scaffold decorated with silver nanoparticles as a wound dressing material effective against burn-wound-associated multiple-drug-resistant bacteria. The UV-vis spectroscopy showed maximum absorbance at 448 nm due to the surface plasmon resonance of silver nanoparticles. FT-IR spectra exhibited the functional groups in the eri silk proteins accountable for the reduction of Ag+ to Ag0 in the scaffold. SEM-EDX analysis revealed the presence of elemental silver, and XRD analysis confirmed their particle size of 5.66-8.82 nm. The wound dressing platform showed excellent thermal stability and hydrophobicity, fulfilling the criteria of a standard waterproof dressing material, and anticipating the prevention of bacterial biofilm formation in chronic wounds. The scaffold was found to be effective against both Staphylococcus aureus (MTCC 87) and Pseudomonas aeruginosa (MTCC 1688) multiple-drug-resistant pathogens. Electron microscopy revealed the bacterial cell damage, suggesting its bactericidal property. The results further revealed that the scaffold was both hemocompatible and cytocompatible, suggesting its potential application in chronic wounds such as burns. As an outcome, this study presents a straightforward, cost-effective, and sustainable way of developing a multifunctional wound dressing platform, suggesting its significant therapeutic potential in clinical and biomedical sectors and facile commercialization.

Risk factors for infection in severe open tibial shaft fractures

To evaluate risk factors for infection in severe open tibial shaft fractures. A secondary analysis of a multicenter prospective study investigated internal versus external fixation of severe open tibia fractures at 20 US Level I trauma centers. Adult patients, aged <65 years, with a Gustilo-Anderson Type IIIB or severe IIIA metaphyseal or diaphyseal tibia fracture were included. All fractures underwent definitive fixation with either a modern ring external fixator, intramedullary device, and/or plate. Fourteen variables previously identified as risk factors for infection were included in the analysis. Deep surgical site infection was defined as an infection treated with surgical debridement within 1 year of index surgery. The study cohort included 430 patients. Deep surgical site infection requiring reoperation occurred in 108 (25 %) patients. The final model identified four risk factors for infection: age >40 years (OR, 2.00; 95 % CI, 1.3-3.1), Gustilo-Anderson Type IIIB (OR, 1.80; 95 % CI, 1.1-3.0), embedded wound contamination (OR, 1.69; 95 % CI, 1.1-2.7), and wound length (OR, 1.02/cm; 95 % CI, 1.0-1.05). The model performed poorly at distinguishing infected from uninfected patients (Area Under the Curve=0.57; 95 % CI, 0.51-0.63). Surgeons can now counsel patients with these risk factors that they are at a markedly higher risk of infection. The identification of these risk factors may direct future research aimed at mitigating the risk of deep surgical site infection in this patient population.

Prussian Blue-Assisted NIR Triggered In-Situ Polymerized Nanocomposite Hydrogel for Wound Repair.

Hydrogels are commonly used as wound dressings to help maintain a moist environment around the wound and isolate contaminants, thus promoting healing. For irregular wounds, the slow healing process and even infection may occur due to the inability of dressings to adhere well to the wound. Prussian blue (PB) is a metal-organic framework (MOF) material with excellent photothermal conversion and superior stability. In this paper, a kind of near-infrared (NIR) light triggered in-situ polymerized antimicrobial hydrogel was prepared. The free radical initiator was encapsulated in the hollow PB by a phase change material (PCM) to maintain stability. The raised temperature triggered by NIR induced the release and decomposition of the initiator. The matrix was formed by the cross-linking of double bonds on modified chitosan. The quaternary amine groups of modified chitosan and the photothermal properties of PB enhanced the antimicrobial properties of the hydrogel. High-quality wound healing was demonstrated in the whole skin defect model. This study provides a new reference for the preparation of in-situ polymerized hydrogel dressings for irregular wounds.