Wound Edge Research Articles

EFFECT OF INTEGRATED TREATMENT ON REPARATIVE REGENERATION OF WOUNDS AND BONE DEFECTS IN CHILDREN WITH ODONTOGENEOUS PHLEGMONS

The achievements of modern septic surgery are associated with the implementation of the latest technologies and new generations of pharmacological drugs, the action of which is aimed at correcting existing disorders. Recently, special literature has presented encouraging data regarding the effectiveness of placenta cryoextract in treating inflammatory processes of the maxillofacial area. However, little attention has been given to its application in children.
 Objective of this study is to investigate the effectiveness of comprehensive treatment on the processes of reparative regeneration in wound and bone tissue in children with odontogenic phlegmons.
 Subjects and methods. In order to assess the course of the wound process, 29 children with phlegmons localized directly in the submandibular area were selected; the length of the incision was 5 cm. In the first group, involving 16 people, a set of measures was carried out in accordance with the medical care protocol, and in the second group, consisting of 13 patients, on the second day after the operation, an aseptic bandage with "Levomekol" ointment was applied to the wound surface with the addition of cryoextract of the placenta in ratios of 5:1. In order to objectify the results, pH-metry of the wound exudate was performed, a planimetric study was performed to establish the speed of retraction of the wound edges, and the cellular composition of the wound exudate was analyzed for 1, 3, and 8 days. On the first day after surgery, changes in these parameters in both groups were of the same type. On the third day, in the second group of children, the pH level improved by 9.5%, and the speed of retraction of the wound edges increased by 9.0% compared to the first group. On the 8th day, the concentration of hydrogen ions in this group increased by 9.4%, and the average area of the wound surface became smaller by 8.2% compared to the previous values. The cellular composition of the cytograms also indicated the advantages of wound healing in this group of patients. In the first group, comprising 16 individuals, a standard set of measures was implemented following the medical care protocol. In the second group, consisting of 13 patients, an aseptic bandage with "Levomekol" ointment, supplemented with cryoextract of placenta at a ratio of 5:1, was applied to the wound surface on the second post-operation day. To objectively assess the outcomes, pH-metry of the wound exudate was conducted, alongside planimetric studies to determine the rate of wound edge retraction. Additionally, the cellular composition of the wound exudate was analyzed at 1, 3, and 8 days post-operation. On the first day after the operation, both groups exhibited similar changes in these parameters. However, by the third day, the second group demonstrated a 9.5% improvement in pH levels and a 9.0% increase in the speed of wound edge retraction compared to the first group. By the eighth day, the second group displayed a 9.4% rise in hydrogen ion concentration, and the average wound surface area decreased by 8.2% compared to previous measurements. Furthermore, cytogram analysis indicated superior wound healing advantages in this group of patients.
 Conclusion. The comparison of clinical and laboratory indicators at the observation stages allowed us to determine that the combined application of topical "Levomekol" ointment with the additional incorporation of placenta cryoextract in its composition improves the conditions of the wound healing process. This improvement is evidenced by the dynamics of changes in the pH indicator, the results of planimetry, and the cellular composition of the exudate.

Treatment with Wound Edges Marsupialization of Simple Anal Fistula: A Randomized Controlled Trial

Introduction: Simple anal fistula can be treated with fistulectomy or fistulotomy. Wound edges marsupialization is a part of treatment. Objectives: To find out the outcomes of the treatment with marsupialization. Methods: Sixty consecutive patients with simple anal fistula were included in this prospective randomized controlled trial study where 30 patients treated with fistulotomy were included group A & 30 patients treated with fistulotomy and marsupialization were included in group B. The primary outcome variable was wound healing time while secondary outcome variables were operating time, postoperative wound size, postoperative pain using visual analogue scale (VAS), post-operative bleeding, wound infection, anal incontinence, recurrence and patient satisfaction. Results: Thirty patients were randomized to group A and 30 to group B. The operating times were significantly different between two groups (21.00±6.35 minutes vs. 28.20±6.57 minutes, P=0.0001) and Postoperative wounds were larger in group A than group B (2.07±0.90 cm2 vs 1.03±0.87 cm2). Bleeding occurred less frequently in group B than group A (10% vs 53.33%, P=0.0003) and wound discharge was observed for a significantly longer duration in group A than group B (4.10±1.8 weeks vs. 2.05±1.71 weeks, P<0.0001). Postoperative wounds in group B healed earlier than group A wounds (3.85±1.19 weeks vs 6.55±1.3 weeks, P<0.0001). VAS scores for postoperative pain on the first postoperative day was (4.05±1.47 vs. 5.15±1.32, P=0.0035) for the two groups. Conclusion: Marsupialization after fistulectomy significantly reduces the healing time, the risk of post-operative bleeding and size of the wound without increasing postoperative anal incontinence, recurrence and sepsis. JAFMC Bangladesh. Vol 19, No 1 (June) 2023: 47-49

Bending of a lipid membrane edge by annexin A5 trimers

Plasma membrane damage occurs in healthy cells and more frequently in cancer cells where high growth rates and metastasis result in frequent membrane damage. The annexin family of proteins plays a key role in membrane repair. Annexins are recruited at the membrane injury site by Ca+2 and repair the damaged membrane in concert with several other proteins. Annexin A4 (ANXA4) and ANXA5 form trimers at the bilayer surface, and previous simulations show that the trimers induce high local negative membrane curvature on a flat bilayer. The membrane-curvature-inducing property of ANXA5 is presumed to be vital to the membrane repair mechanism. A previously proposed descriptive model hypothesizes that ANXA5-mediated curvature force is utilized at the free edge of the membrane at a wound site to pull the wound edges together, resulting in the formation of a “neck”-shaped structure, which, when combined with a constriction force exerted by ANXA6, leads to membrane repair. The molecular details and mechanisms of repair remain unknown, in part because the membrane edge is a transient structure that is difficult to investigate both experimentally and computationally. For the first time, we investigate the impact of ANXA5 near a membrane edge, which is modeled by a bicelle under periodic boundary conditions. ANXA5 trimers induce local curvature on the membrane leading to global bending of the bicelle. The global curvature depends on the density of annexins on the bicelle, and the curvature increases with the ANXA5 concentration until it reaches a plateau. The simulations suggest that not only do annexins induce local membrane curvature, but they can change the overall shape of a free-standing membrane. We also demonstrate that ANXA5 trimers reduce the rate of phosphatidylserine lipid diffusion from the cytoplasmic to the exoplasmic leaflet along the edge of the bicelle. In this way, membrane-bound annexins can potentially delay the apoptotic signal triggered by the presence of phosphatidylserine lipids in the outer leaflet, thus biding time for repair of the membrane hole. Our findings provide new insights into the role of ANXA5 at the edges of the membrane (the injury site) and support the curvature-constriction model of membrane repair.

УЛЬТРАСОНОГРАФИЧЕСКАЯ ОЦЕНКА ВОССТАНОВЛЕНИЯ ФУНКЦИИ МОЧЕВОГО ПУЗЫРЯ ПОСЛЕ ПРИМЕНЕНИЯ «БЕСШОВНОГО» ЗАКРЫТИЯ ЦИСТОТОМНОЙ РАНЫ У КОШЕК

The purpose of reseaech is to study the features of wound scar formation with “sutureless” and traditional (double-row suture) methods of closing a cystotomy wound, as well as to identify functional deviations of the operated organ through ultrasonographic studies in the early postoperative period. The study was carried out as part of the work of the Educational and Scientific Center of the Faculty of Veterinary Medicine of the Altai State Agrarian University. Surgical interventions and ultrasonographic studies were performed at the Department of Morphology, Surgery and Obstetrics in cats of British, Persian and outbred breeds (n = 19) admitted for clinical visits. In 8 animals, a “sutureless” connection of the edges of the surgical wound of the bladder was used, and in 11 cats, according to clinical indications, the traditional me¬thod of suturing was used. To determine the functionality of the operated bladder in the early postoperative period, all animals used in the experiment underwent ultrasound diagnostics on an HTI PU-2200 Vet apparatus with a 7Mz linear sensor. The use of an adhesive suture ensures correct reposition of the dissected layers of the bladder without entrapment of the mucous membrane, respectively, its subsequent necrobiosis, which ensures high biological tightness and rapid fusion of the edges of the surgical wound, resulting in the formation of a full-fledged elastic wound scar. The method of “sutureless” connection of the edges of a cystotomy wound cannot be used for degenerative changes in the tissues of the bladder. The use of a traditional double-row suture reduces the bladder cavity due to the massive tissue shaft that forms when the cystotomy wound is closed, leading to the formation of a massive postoperative scar and a decrease in the contractility of the operated organ. The choice of method for closing a surgical wound of the bladder depends on the morphofunctional state of the organ, the clinical status of the patient and the severity of the disease at the time of surgery.

Protease-activated receptor 2 drives migration in a colon cancer cell line but not in noncancerous human epithelial cells.

The inflamed mucosa contains a complex assortment of proteases that may participate in wound healing or the development of inflammation-associated colon cancer. We sought to determine the role of protease-activated receptor 2 (PAR2) in epithelial wound healing in both untransformed and transformed colonic epithelial cells. Monolayers of primary epithelial cells derived from organoids cultivated from patient colonic biopsies and of the T84 colon cancer cell line were grown to confluence, wounded in the presence of a selective PAR2-activating peptide, and healing was visualized by live cell microscopy. Inhibitors of various signaling molecules were used to assess the relevant pathways responsible for wound healing. Activation of PAR2 induced an enhanced wound-healing response in T84 cells but not primary cells. The PAR2-enhanced wound-healing response was associated with the development of lamellipodia in cells at the wound edge, consistent with sheet migration. The response to PAR2 activation in T84 cells was completely dependent on Src kinase activity and partially dependent on Rac1 activity. The Src-associated signaling molecules, focal adhesion kinase, and epidermal growth factor receptor, which typically mediate wound-healing responses, were not involved in the PAR2 response. Experiments repeated in the presence of the inflammatory cytokines TNF and IFNγ revealed a synergistically enhanced PAR2 wound-healing response in T84s but not primary cells. The epithelial response to proteases may be different between primary and cancer cells and is accentuated in the presence of inflammatory cytokines. Our findings have implications for understanding epithelial restitution in the context of inflammatory bowel disease (IBD) and inflammation-associated colon cancer.NEW & NOTEWORTHY Protease-activated receptor 2 enhances wound healing in the T84 colon cancer cell line, but not in primary cells derived from patient biopsies, an effect that is synergistically enhanced in the presence of the inflammatory cytokines TNF and IFNγ.

Self-Assembled DNA Composite-Engineered Mesenchymal Stem Cells for Improved Skin-Wound Repair.

The direct use of mesenchymal stem cells (MSCs) as therapeutics for skin injuries is a promising approach, yet it still faces several obstacles, including limited adhesion, retention, and engraftment of stem cells in the wound area, as well as impaired regenerative and healing functions. Here, DNA-based self-assembled composites are reported that can aid the adhesion of MSCs in skin wounds, enhance MSC viability, and accelerate wound closure and re-epithelialization. Rolling-circle amplification (RCA)-derived DNA flowers, equipped with multiple copies of cyclic Arg-Gly-Asp (cRGD) peptides and anti-von Willebrand factor (vWF) aptamers, act as robust scavengers of reactive oxygen species (ROS) and enable synergistic recognition and adhesion to stem cells and damaged vascular endothelial cells. These DNA structure-aided stem cells are retained at localized wound sites, maintain repair function, and promote angiogenesis and growth factor secretion. In both normal and diabetes-prone db/db mice models with excisional skin injuries, facile topical administration of DNA flower-MSCs elicits rapid blood vessel formation and enhances the sealing of the wound edges in a single dose. DNA composite-engineered stem cells warrant further exploration as a new strategy for the treatment of skin and tissue damage.

Evaluation of Esthetic Results after Mass Removal with Elliptical Skin Excision Using Ultrasonography to Measure Skin Thickness.

Background: The growth of benign cutaneous masses causes the overlaying skin to expand and become thinner, especially at the central, most projected point. In this retrospective study, a surgical technique comprising an elliptical skin excision was employed to account for these skin changes. Methods: This retrospective study enrolled 980 patients with benign masses. Preoperatively, all patients underwent ultrasonography to evaluate the mass depth and thickness of the attached skin, and mass excision was performed using the elliptical skin-excision method. The operative time was recorded, and complications and esthetic outcomes were assessed using the Cutometer® and the modified Vancouver Scar Scale (mVSS) during 1- and 3-month follow-up visits. Results: The mean operative time (17.48 ± 3.46 min) was significantly shorter than that of conventional methods (p < 0.05). Cutometer parameters showed no significant differences from those of intact skin. The average mVSS scores were 5.21 ± 1.42 and 3.50 ± 1.79 at 1- and 3-month follow-ups, respectively. Conclusions: Mass excision with an elliptical skin attachment resulted in improved esthetic results and easy removal. The attached skin enabled convenient handling without damaging the capsule or other adjacent structures, leaving a thick dermis on both wound edges. Thus, this technique resulted in minimal scarring.

Tracking cell layer contribution during repair of the tympanic membrane.

The tympanic membrane (i.e. eardrum) sits at the interface between the middle and external ear. The tympanic membrane is composed of three layers: an outer ectoderm-derived layer, a middle neural crest-derived fibroblast layer with contribution from the mesoderm-derived vasculature, and an inner endoderm-derived mucosal layer. These layers form a thin sandwich that is often perforated following trauma, pressure changes or middle ear inflammation. During healing, cells need to bridge the perforation in the absence of an initial scaffold. Here, we assessed the contribution, timing and interaction of the different layers during membrane repair by using markers and reporter mice. We showed that the ectodermal layer is retracted after perforation, before proliferating away from the wound edge, with keratin 5 basal cells migrating over the hole to bridge the gap. The mesenchymal and mucosal layers then used this scaffold to complete the repair, followed by advancement of the vasculature. Finally, differentiation of the epithelium led to formation of a scab. Our results reveal the dynamics and interconnections between the embryonic germ layers during repair and highlight how defects might occur.

Comparison between novel zipper device and conventional methods for skin closure: a systematic review and meta-analysis.

The zipper device is a wound closure device that can be directly applied over the intact skin on either side of the wound edges and does not need anchoring into the skin or subcutaneous plane. The noninvasive nature of the zipper device makes it less time-consuming and less painful, but its effectiveness and related complications need to be studied. Prospective registration of the protocol followed in this study was done. Electronic databases were searched for relevant articles, and their screening was completed, followed by data extraction and analysis. The odds ratio, mean difference, or standardised mean difference were used as an effect measure per the nature of the variables. Surgical site infection, wound dehiscence, skin closure time, scar score, and patient satisfaction were compared in this study. A total of 10 studies were identified, out of which eight compared zippers with sutures and two compared zippers with stapler devices. Compared to the suture, the zipper device took 4.9 min less to close the incision, and the scar scale outcome reported after one month was inferior, while other results were not significant. Staples showed a lower patient satisfaction level and no difference in complications. The zipper device is a less technically demanding and less time-consuming method of skin closure, with no significant difference in the complication rate compared to conventional methods. The zipper device is an effective measure to use in settings with less expertise or at health institutions after assessing the cost at the local level.

Diabetic foot and lower limb amputations at tertiary hospitals underscore the need for organised foot health services at primary healthcare level

An epidemiological link between diabetes and early mortality has been reported in literature with the cause of death being mainly ischaemic heart diseases. However, a diabetic foot is a common and serious complication of diabetes with a lifetime risk of developing a foot ulcer estimated at 15-25%. Therefore, local (foot disease) and systemic (cardiovascular disease) issues should be attended to in the management of diabetes, and this emphasizes the need for a multidisciplinary team approach. A diabetic foot is defined as worsening sepsis, ulcerations, necrosis or destruction of tissues of the foot in a diabetic patient due to a complex interaction of disorders in the immune function, in the nervous and vascular systems. An improved clinical outcome is associated with wound adjunctive treatments in complementing the standard management protocol which embodies the TIME principles (tissue debridement, infection control, adequate moisture balance to promote tissue granulation in the wound bed and edges of the wound should be free from undermining).

A Long-Lasting Triamcinolone-Loaded Microneedle Patch for Prolonged Dermal Delivery.

Scar is an unpleasant skin lesion that occurs following deep wounds or burns. The application of local triamcinolone is a common treatment for scar treatment and prevention, which should be repeated several times in conventional dosage forms. An effort has been made here to provide a prolonged triamcinolone dermal delivery by microneedle technology, which can also be used for wound closure. This study aimed to develop a long-lasting polylactic acid (PLA) microneedle patch for the prolonged release of triamcinolone acetonide (TrA) that could potentially be used for closure of wound edges and scar prevention and treatment. In this study, 3% and 10% TrA-containing polymeric microneedles were fabricated using the micro molding-solvent casting method. Optical microscopy, X-ray diffraction analysis (XRD), Fourier-transform infrared spectroscopy (FT-IR), and differential scanning calorimetry (DSC) were used for the characterization of microneedles. Mechanical strength was evaluated using a compression test and methylene blue staining. Additionally, the insertion depth was determined by histopathological sectioning of human skin samples and also insertion into Parafilm®M as a skin model. The in vitro drug release profile of the microneedles was studied over 34 days, and the kinetic model was determined. The ex-vivo skin permeation of TrA was studied using a Franz-diffusion cell. The TrA-containing PLA microneedles were fabricated with a uniform structure without any failure, deterioration, or loss of needles. Fourier-transform infrared spectroscopy and differential scanning calorimetry showed no interaction between TrA and PLA, and no effect on crystallinity and thermal behavior of TrA on polymer was detected. Microneedles showed appropriate mechanical properties, which were able to penetrate to about 900 - 1000 μm depth. Release profile from the whole body of 10% and 3% microneedle fitted to Higuchi model with cumulative amounts of 625 µg and 201.64 µg over 34 days. Release from the needles followed zero-order kinetic with cumulative amounts of 30.04 µg and 20.36 µg for 10% and 3%, respectively, for 34 days. Permeation was calculated to be 17 µg/day for 10% TrA-containing microneedle. The results suggested that suitable PLA microneedles containing TrA with prolonged release behavior can be successfully constructed with the solvent casting method.

Insights into the unique roles of dermal white adipose tissue (dWAT) in wound healing.

Dermal white adipose tissue (dWAT) is a newly recognized layer of adipocytes within the reticular dermis of the skin. In many mammals, this layer is clearly separated by panniculus carnosus from subcutaneous adipose tissue (sWAT). While, they concentrated around the hair shaft and follicle, sebaceous gland, and arrector pili muscle, and forms a very specific cone geometry in human. Both the anatomy and the histology indicate that dWAT has distinct development and functions. Different from sWAT, the developmental origin of dWAT shares a common precursor with dermal fibroblasts during embryogenesis. Therefore, when skin injury happens and mature adipocytes in dWAT are exposed, they may undergo lipolysis and dedifferentiate into fibroblasts to participate in wound healing as embryogenetic stage. Studies using genetic strategies to selectively ablate dermal adipocytes observed delayed revascularization and re-epithelialization in wound healing. This review specifically summarizes the hypotheses of the functions of dWAT in wound healing. First, lipolysis of dermal adipocytes could contribute to wound healing by regulating inflammatory macrophage infiltration. Second, loss of dermal adipocytes occurs at the wound edge, and adipocyte-derived cells then become ECM-producing wound bed myofibroblasts during the proliferative phase of repair. Third, mature dermal adipocytes are rich resources for adipokines and cytokines and could release them in response to injury. In addition, the dedifferentiated dermal adipocytes are more sensitive to redifferentiation protocol and could undergo expansion in infected wound. We then briefly introduce the roles of dWAT in protecting the skin from environmental challenges: production of an antimicrobial peptide against infection. In the future, we believe there may be great potential for research in these areas: (1) taking advantage of the plasticity of dermal adipocytes and manipulating them in wound healing; (2) investigating the precise mechanism of dWAT expansion in infected wound healing.

Inflammasome modulation with P2X7 inhibitor A438079-loaded dressings for diabetic wound healing.

The inflammasome is a multiprotein complex critical for the innate immune response to injury. Inflammasome activation initiates healthy wound healing, but comorbidities with poor healing, including diabetes, exhibit pathologic, sustained activation with delayed resolution that prevents healing progression. In prior work, we reported the allosteric P2X7 antagonist A438079 inhibits extracellular ATP-evoked NLRP3 signaling by preventing ion flux, mitochondrial reactive oxygen species generation, NLRP3 assembly, mature IL-1β release, and pyroptosis. However, the short half-life in vivo limits clinical translation of this promising molecule. Here, we develop a controlled release scaffold to deliver A438079 as an inflammasome-modulating wound dressing for applications in poorly healing wounds. We fabricated and characterized tunable thickness, long-lasting silk fibroin dressings and evaluated A438079 loading and release kinetics. We characterized A438079-loaded silk dressings in vitro by measuring IL-1β release and inflammasome assembly by perinuclear ASC speck formation. We further evaluated the performance of A438079-loaded silk dressings in a full-thickness model of wound healing in genetically diabetic mice and observed acceleration of wound closure by 10 days post-wounding with reduced levels of IL-1β at the wound edge. This work provides a proof-of-principle for translating pharmacologic inhibition of ATP-induced inflammation in diabetic wounds and represents a novel approach to therapeutically targeting a dysregulated mechanism in diabetic wound impairment.

The effectiveness of wound cleansing using &lt;i&gt;Cocor Bebek&lt;/i&gt; (&lt;i&gt;Kalanchoe pinnata&lt;/i&gt;) leaves in healing diabetic foot ulcers

This study aimed to evaluate the effectiveness of Cocor Bebek (Kalanchoe pinnata) leaves in wound cleaning for diabetic foot ulcers (DFU) and compare it with the use of NaCl solution. Diabetes mellitus (DM) and its complications, such as DFU, pose a global health problem with increasing prevalence. Given the escalating occurrence of DFU, timely and effective treatment is crucial to prevent severe complications, including amputation. This research employed a quasi-experimental design with a pretest-posttest control group and was conducted at Rumah Luka Surabaya, Indonesia. The sample comprised 40 respondents with DFU, divided into an intervention group (using Cocor Bebek leaves) and a control group (using NaCl solution). Respondents' characteristics, including age, sex, occupation, duration of diabetes, and other factors, were assessed to understand their impact on the response to treatment. The results demonstrated a significant improvement in DFU wound healing in the intervention group after using Cocor Bebek leaves (p&lt;0.05), along with reduced scores on Bates Jensen Wound Assessment Tool (BWAT) indicators such as wound edge, tunnel, and necrotic tissue type. Conversely, the control group using NaCl solution also exhibited significant improvement in wound healing (p&lt;0.05), with decreased scores on indicators such as the amount of necrotic tissue and the quantity of exudate. This study underscores the potential of Cocor Bebek leaves in aiding wound healing in DFU, evident from clinical improvements and reduced BWAT scores. However, further research and clinical trials are needed to comprehensively support these findings and understand the mechanism of action, as well as the safety of using Cocor Bebek leaves in diabetic patients.

Can Shockwave Treatment Elicit a Molecular Response to Enhance Clinical Outcomes in Pressure Ulcers? The SHOck Waves in wouNds Project.

Wound healing requires the coordinated interaction of dermis cells, the proper deposition of extracellular matrix, re-epithelialization, and angiogenesis. Extracorporeal shock wave (ESW) is a promising therapeutic modality for chronic wounds. This study determined the biological mechanisms activated under ESW, facilitating the healing of pressure ulcers (PUs). A group of 10 patients with PUs received two sessions of radial ESW (300 + 100 pulses, 2.5 bars, 0.15 mJ/mm2, 5 Hz). Histomorphological and immunocytochemical assessments were performed on tissue sections obtained from the wound edges before the ESW (M0) and after the first (M1) and second (M2) ESW. The proliferation index of keratinocytes and fibroblasts (Ki-67), the micro-vessels' density (CD31), and the number of myofibroblasts (α-SMA) were evaluated. The involvement of the yes-associated protein (YAP1) in sensing mechanical strain, and whether the nuclear localization of YAP1, was shown. The increased proliferative activity of epidermal cells and skin fibroblasts and the increased number of myofibroblasts, often visible as integrated cell bands, were also demonstrated as an effect of wound exposure to an ESW. The results indicate that the major skin cells, keratinocytes, and fibroblasts are mechanosensitive. They intensify proliferation and extracellular matrix remodeling in response to mechanical stress. A significant improvement in clinical wound parameters was also observed.

Suturing with or without surgical glue is superior to surgical glue alone for sealing ex vivo swine gallbladders.

To assess the effectiveness of various sealing techniques in cholecystotomies under maximum intraluminal pressure stress using an ex vivo swine model. 30 gallbladders from different animals were used. The experiment was conducted ex vivo, with the formation of 3 groups, each comprising 10 samples. Group 1 utilized a traditional single-layer Cushing suture made from polydioxanone material. Group 2 employed a single layer of Cushing suture, also made from polydioxanone material, but in conjunction with surgical glue (n-butyl cyanoacrylate). Group 3 relied solely on the use of surgical glue (n-butyl cyanoacrylate) for sealing the edges of the surgical wound. The intraluminal pressure was gauged with a pressure transducer. The maximum intraluminal pressures (mean ± SD) sustained in G1, G2, and G3 were, respectively, 48.70 ± 21.32 mm Hg, 110.90 ± 37.52 mm Hg, and 10.9 ± 4.07 mm Hg. Comparisons between groups showed that G2 supported significantly higher pressures (56.1% higher) than G1 (P < .001) and G3 (90.2% higher; P < .001). When G1 was compared with G3, a significantly higher pressure (77.6%) was also observed (P < .01). The study's conclusions demonstrated the safest suture techniques for the gallbladder and provided advice regarding the use of surgical glue.

An Update in the Management of “Frozen Abdomen”

With a 0.5–3% incidence following initial closure of a laparotomy incision, wound dehiscence is a significant postoperative complication that signifies an abrupt mechanical failure of wound healing. Both clinical entities have common pathophysiological and clinical processes, as recently as the idea of "intentional open abdomen" was defined ("postoperative open abdominal wall"). While early restoration is the goal, a considerable number of patients may experience adhesions between the anterolateral abdominal wall and abdominal viscera; this condition is commonly referred to as "frozen abdomen," and the only practical option seems to be to postpone wound closure. We provide the "Coliseum technique" as the last surgical approach to treat it. This new method offers a creative substitute for abdominal exploration in situations with frozen abdomen that is considered "malignant" because of peritoneal carcinomatosis. Lifting the surgical wound's edges upward and suspending them from a retractor above the abdomen with threads makes it easier to approach the peritoneal cavity, maximizes the exposure of internal organs, and reduces the risk of operating-related damage to the blood supply and innervation of the abdominal wall muscles, which is an essential step for hernia repair later on..

Do Intraoperative Platelet-Rich Plasma Injections Influence the Final Appearance of Vertical Scars after Breast Reduction? Spectrophotometric Analysis

Background: Platelet-rich plasma (PRP) has been shown to support wound healing and tissue regeneration due to its high concentration of growth factors and cytokines. This study aims to investigate the effect of intraoperative PRP injections on the final appearance of vertical scars after breast reduction, as well as to identify potential predictors of a scar’s aesthetic assessment using spectrophotometric parameters. Methods: In this prospective, randomized trial, 82 scars from 41 women who underwent bilateral breast reduction with an inverted T pattern were analyzed. PRP or a placebo substance (0.9% sodium chloride solution) was injected intraoperatively into the edges of vertical wounds. Spectrophotometric measurements of scar pigmentation were performed 3 and 6 months after surgery; additionally, two independent observers evaluated the aesthetic appearance of scars based on photographs. Results: The results showed that the use of intraoperative PRP injections did not significantly influence the final appearance of vertical scars after breast reduction. Conclusions: We indicated spectrophotometric variables (b) in the early stages of wound healing (after 3 months) that can be predictors of the final scar’s aesthetic outcome. This can be helpful in detecting scars that may need additional interventions to optimize the healing process.

A Review of Diabetic Foot Osteomyelitis: Focus on Diagnosis, Clinical Presentation, Management and Outcomes

Diabetic foot osteomyelitis (DFO) affects around 38.5 lakh patients in India. It is diagnosed using clinical and radiologicalapproaches. Polymicrobial etiology, peripheral artery disease (PAD) and peripheral neuropathy are commonly observed. Ahigh degree of clinical vigil is required to avoid underestimation of the extent of damage due to speed and spread of infectionand prevent chances of lower extremity amputation. ‘Time is Tissue’ (time taken to access multidisciplinary care) aptlyrepresents one of the critical factors affecting outcomes, along with anatomical location and presence of gangrenous tissues.Traditionally, DFO treatment is the most complex and controversial aspect of managing diabetic foot infections (DFIs). Thetherapeutic paradigm has evolved from high-level surgical resection of all necrotic and infected bone to the more refined andindividualized surgical interventions along with appropriate antibiotics and topical antimicrobials. It is necessary to have asurgeon available with diabetic foot expertise. The surgical outcome is facilitated with strict off-loading, wound management,agitation (freshening and scrapping of wound edges), biofilm disruption and negative pressure wound therapy (NPWT) toaccelerate healing. Formal protocol-driven treatment can be provided by a multidisciplinary team involving surgical, medicaland podiatric specialties to reduce hospital stay and the need for repeat debridement.This review aims to present a completeoverview of the diagnosis, clinical presentation, management and outcomes of DFO according to scientific recommendationsand our experience, along with few illustrative case reports.

Postoperative complications after displaced intra-articular calcaneal fracture operations

BackgroundThe objective was to compare postoperative complications in the management of displaced intra articular calcaneal fractures (DIACF) between two groups; the open reduction and internal fixation (ORIF) group versus the percutaneous fixation (PF) group. MethodsA total of 243 DIACFs were diagnosed and 127 of them received operations either with ORIF 75 (59.1 %) or PF 52 (40.9 %) between 2004 and 2018. Postoperative complications, radiological Sanders’s classification and improvement of Böhler’s angle were analyzed. ResultsEarly complication rate (<6 weeks), rate of deep wound infections and wound edge necrosis were significantly better in PF than in ORIF patient group. There were no significant differences in late complications (>6 weeks from operation) nor in improvement of Böhler’s angle. ConclusionComplication rate is lower when using PF technique while fracture reduction remains the same compared to the ORIF. Level of evidenceIV retrospective cohort study at a single institution.