Wounds Group Research Articles

Pullulan-Collagen Hydrogel Wound Dressing Promotes Dermal Remodeling and Wound Healing Compared to Commercially Available Collagen Dressings

PURPOSE: Developing new therapies to promote wound healing and mitigate scarring has the potential to significantly impact patient morbidity, particularly for those who suffer from chronic non-healing wounds and burns. The primary objectives for any therapy that aims to improve wound healing are to provide protection against external factors and to sustain optimal moisture levels within the wound bed. Biologic scaffolds such as hydrogels provide an ideal, physio-mimetic of native ECM that can improve wound healing outcomes after cutaneous injury. While most studies have focused on the benefits of hydrogels in accelerating wound healing, there is minimal data directly comparing the relative efficacies among different hydrogel material compositions. METHODS: In this study we utilized a splinted excisional wound model that recapitulates human-like wound healing in mice, and treated wounds with three different collagen hydrogel dressings. The first dressing was composed of 90% collagen and 10% alginate. The second dressing was composed of 55% collagen and 44% cellulose. Finally, the third dressing was composed of 5% collagen and 95% pullulan. We assessed the feasibility of applying each dressing during standard dressing changes and measured wound areas over time to determine the relative rate of wound closure. We then performed histologic and histopathologic analysis on the explanted scar tissues to assess the effects each hydrogel dressing on collagen architecture, fiber alignment, and cellular response. RESULTS: The days to closure of wounds treated the collagen-pullulan hydrogel (~11.2 days) was significantly shorter than the collagen-cellulose treated (~13.2 days; *p<0.05) and control (~13.8 days; *p<0.01) wounds. Quantitative analysis of collagen architecture demonstrated that collagen-pullulan treated wounds had a lower proportion of mature collagen within the healed scar and significantly more randomly aligned collagen fibers compared to collagen-cellulose treated wounds. Furthermore, we found that collagen-pullulan hydrogel treated wounds displayed significantly shorter fiber length and greater tissue porosity compared to the other wound groups. Finally, histopathologic analysis revealed lower levels of immune cell infiltration and overall tissue response in collagen-pullulan hydrogel treated wounds relative to other groups. CONCLUSION: Our data indicate that the material composition of hydrogel dressings can significantly influence healing time, cellular response, and the resulting architecture of healed scars. Collagen-pullulan hydrogel therapy accelerated wound closure and promoted tissue with less dense, more randomly aligned, and shorter collagen fibers with lower collagen intensity, similar to the natural ‘basket-weave’ architecture of unwounded skin. Further understanding of how specific hydrogel properties affect healing and the resulting tissue architecture of wounds may lead to novel insights and further optimization of the material properties of wound dressings.

Challenges of Large-scale Patient-reported Outcome Measures Collection in a Multidisciplinary Limb Salvage Center.

Challenges of Large-scale Patient-reported Outcome Measures Collection in a Multidisciplinary Limb Salvage Center.

Comparison of the effectiveness between single and repeated administration of topical Tretinoin 0.05% on full-thickness acute wound healing

Background: A wound is a discontinuity of any bodily tissue due to various causes. Every wound of any severity could result in problems related to its healing process, such as scar tissue formation. According to the duration of its healing process, wound is divided into 2 categories: acute wound that takes approximately 3-4 weeks to heal and chronic wound that needs 4-6 weeks and resulted from inappropriate healing of the acute wound. Tretinoin's use in wound healing has been controversial for more than 40 years. Topical Tretinoin has keratolytic effect that stimulates fibroplasia and epithelization on full-thickness wounds. On the other hand, single administration along with long-contact topical Tretinoin has an irritative effect that could delay healing due to continuous inflammation. This study aims to explore the effectiveness of single administration compared to repeated administration of topical Tretinoin in full-thickness acute wound healing on rats at Faculty of Veterinary Medicine, Airlangga University, Surabaya. Methods: This experimental study involved 27 male rats which were randomly divided into 3 groups: control (A), single-administration (B), and repeated-administration (C). Full-thickness wound size 20 mm in diameter was made on the skin of each rat. On group A, wounds were covered with Tulle and transparent dressing. On group B, wounds were treated with lidocaine 2% and tretinoin solution 0,05% in single administration, while the same treatment was given repeatedly on group C for 4 days straight. Evaluation was done microscopically on day 5 according to epithelization phase on wound healing with hematoxylin and eosin (H&amp;E) staining. Results: The result from the calculation showed that group C obtained a significantly higher average number of fibroblast cells count compared to the treatment group A and B. The average number of fibroblast cells in treatment group B was three times higher than the number of fibroblast cells in treatment group A, while the average number of fibroblast cells in treatment group C was three times the number of fibroblast cells in treatment group B. From the statistic, it was proven that the regular application of 0.05% topical tretinoin solution in a full-thickness wound (Group C) has shown a significant increase in the number of fibroblasts during the proliferative phase. Conclusion: A frequent administration of 0.05% topical tretinoin solution resulted in a higher number of fibroplasia improvements compared to once administered in full thickness acute wound healing, however it did not result in epithelialization on day 5.

Insomnia Complaints and Perceived Immune Fitness in Young Adults with and without Self-Reported Impaired Wound Healing.

Background and Objectives: Adequate sleep and an effective immune system are both essential to maintain a good health status. The current study aimed to determine the nature of insomnia complaints and perceived immune fitness among Dutch young adults with and without self-reported impaired wound healing. Materials and Methods: A total of (n = 2033) Dutch students (83.8% women) completed an online survey. Perceived immune fitness was assessed with a single-item scale and insomnia complaints with the SLEEP-50 insomnia subscale. The sample comprised a control group without self-reported impaired wound healing (n = 1622), a wound infection (WI) group (n = 69), a slow healing wounds (SHW) group (n = 250), and a COMBI group that experienced both WI and SHW (n = 92). Results: Comparisons with the control group revealed that individuals of the SHW and COMBI groups reported significantly poorer perceived immune functioning, increased insomnia complaints and daytime fatigue, and poorer sleep quality. Conclusions: Individuals with self-reported impaired wound healing have a poorer perceived immune functioning, increased insomnia complaints, daytime fatigue, and poorer sleep quality.

Bacillus subtilis WB800N alleviates diabetic wounds in mice by regulating gut microbiota homeostasis and TLR2.

This study aims to investigate the effect of Bacillus subtilis WB800N on diabetic wounds. Haematoxylin & eosin (H&E) staining was used to observe the healing of skin wounds. Collagen deposition was assessed by Masson staining. Western blotting and qRT-PCR were used to detect vascular endothelial-related factors (VWF), CD31, TLR2, NLRP3, ASC and Caspase-1 expression. 16S rDNA sequencing detected microbiota distribution. The concentrations of IL-1β and IL-37 were measured by ELISA. Apoptosis was measured by the TUNEL assay. Compared with the control group, wound healing was delayed in diabetic mice. The wound area in the Bacillus subtilis group decreased more significantly than the diabetic wound group. H&E staining showed that Bacillus subtilis WB800N promoted wound healing and increased re-epithelialization. Masson staining showed that Bacillus subtilis WB800N increased collagen deposition in mice with diabetic wounds. Bacillus subtilis WB800N upregulated VWF and CD31 protein expression in diabetic wounds mice. The 16S rDNA results showed that Bacillus subtilis WB800N reduced the diversity of the gut microbiota of diabetic wounds mice and regulated the microbial composition. At the genus level, Bacillus subtilis WB800N reduced the relative abundance of Muribaculaceae and CG - 005 in diabetic wounds mice, whilst increasing the relative abundance of Lactobacillus. Bacillus subtilis WB800N increased the expression of TLR2, NLRP3, ASC and Caspase-1. Bacillus subtilis WB800N increased the concentrations of IL-1β and IL-37 in serum. Bacillus subtilis WB800N upregulated cell apoptosis. The TLR2 antagonist Sparstolonin B (SsnB) reduced the expression of TLR2, NLRP3, ASC, Caspase-1, IL-1β and IL-37 and the apoptosis in diabetic wounds mice, whilst the combined intervention of Bacillus subtilis and SsnB reversed the effect of SsnB treatment alone. Bacillus subtilis WB800N alleviated diabetic wound healing by regulating gut microbiota homeostasis and TLR2. Our findings might provide potential therapeutic targets for diabetic wounds.

Silk fibroin and Nettle extract promote wound healing in a rat model: A histological and morphometrical study

IntroductionConsidering the anti-inflammatory, antimicrobial ability, and antioxidant effects besides stimulating ability of silk fibroin (SF) in cell migration and proliferation of Nettle, the current study aimed to investigate the effect of Nettle leaf extract (NLE) and SF on histology, morphometrical parameters and apoptosis on the wound in the rat model. Materials and methodsWistar rats are divided into 5 groups, including 1-control (rats with healthy skin and no treatment); 2-wound (without any treatment); 3-SF (administration of silk fibroin solution for 14 consecutive days); 4- Nettle (administration of Nettle ointment for 14 consecutive days), and 5- Eucerin group (administration of Eucerin substance for 14 consecutive days) and then assessed wound area by photography, angiogenesis, inflammation, and thickness of epidermis using hematoxylin and eosin (H&E) staining, collagen deposition, and structure of dermis layers evaluated by Masson's trichrome staining and the apoptosis index determined by tunnel assay on days 7, 14 and 21. Resultsphotographic illustrations showed that the wound surface environment on the seventh day in group 4 was significantly different from group 2 (p < 0.002). The rate of wound healing on the fourteenth day was higher in groups 3 and 4 than in group 2 (p < 0.001). Also, at this time, group 4 was significantly different from group 3 and group 5 (p = 0.003 and p = 0.000, respectively). There was a significant difference in epidermal thickness between the wound group and other experimental groups (p < 0.05). The number of apoptotic cells at the wound edges on the seventh day in both group 3 and group 4 had a significant decrease compared to other groups of wounds (p = 0.000), but there was a significant increase on the fourteenth day. Also, on the 21st day, a significant decrease in apoptotic cells was observed in both group 3 and group 4 compared to other wound groups (p = 0.000). Discussion and ConclusionNettle and SF maintain cell homeostasis and accelerate wound closure by reducing cell apoptosis and enhancing cell proliferation on the seventh day, but by increasing the apoptosis of fibroblast cells on the fourteenth day, they lead to remodeling and keratinocytes migration to epidermis formation. Increased apoptosis also seems to be one of the pathophysiological mechanisms to prevent the formation of keloid and hypertrophic scar tissue. SF and Nettle extract, by increasing cell proliferation and migration of different cell types to the site of injury, control the remodeling process by inducing and regulating apoptosis in the first two weeks of wound healing and accelerating the process of collagen deposition and epithelialization.

The effect of hydroalcoholic extract of Psidium guajava L. on experimentally induced oral mucosal wound in rat

BackgroundThe aim of this study was to evaluate the biological effects of hydroalcoholic extract of Psidium guajava L leaves and phenytoin as a standard agent on the induced oral mucosal wound.MethodsHundred seventy Sprague Dawley rats were grouped in 5 clusters randomly. Oral mucosal wounds were induced in all rats except for the control group. Phenytoin and guajava leaf extract were used as a mouthwash. Twelve rats from the 5 groups were euthanized on day 7th and 10th, and 10 rats from each group were sacrificed on the 14th day. Interleukin-6 and total antioxidant capacity were determined in the serum. The tissues were evaluated for pathological and stereological assessments. Phytochemical analyses were performed on the hydroalcoholic extract of Psidium guajava L to determine the antioxidant potency.ResultsTotal phenolic content test and DPPH analysis demonstrated the high potential of antioxidant capacity of Psidium guajava L. Decreasing IL-6 and increasing TAC were seen in the guajava hydroalcoholic extract and phenytoin groups. The difference of IL-6 between the wound treated guajava group and the wounded group was significant. The wound treated guajava group and wound treated phenytoin group on the 14th day increased the number of fibroblast cells and volume density of sub-mucosae effectively to the same thickness to be considered as a healed sub-mucosae layer. The volume density of the epithelium changes showed statistically significant different responses based on gender.ConclusionIn conclusion, hydroalcoholic extract of Psidium guajava L leaves might exert theraputic effects on oral mucositis.

Application of a traction metal clip with a fishhook-like device in wound sutures after endoscopic resection.

Background/AimsEndoscopic wound suturing is an important factor that affects the ability to remove large and full-thickness lesions during endoscopic resection. We aimed to evaluate the effect of a traction metal clip with a fishhook-like device on wound sutures after endoscopic resection. MethodsFrom July 2020 to April 2021, patients who met the enrollment criteria were treated with a fishhook-like device during the operation to suture the postoperative wound (group A). Patients with similar conditions and similar size wounds who were treated with a “purse-string suture” to suture the wounds were retrospectively analyzed as the control group (group B). Difference in the suture rate, adverse events, time required for suturing, and number of metal clips were compared between the two groups. ResultsThe time required for suturing was 7.72±0.51 minutes in group A and 11.50±0.91 minutes in group B. This difference was statistically significant (F=13.071, p=0.001). The number of metal clamps used in group A averaged 8.1 pieces/case, and the number of metal clamps used in group B averaged 7.3 pieces/case. This difference was not statistically significant (F=0.971, p=0.331). ConclusionsThe traction metal clip with the fishhook-like device is ingeniously designed and easy to operate. It has a good suture effect on the wound after endoscopic submucosal dissection and effectively prevents postoperative adverse events.

Pathomorphological characteristics of the wound bed prior to skin autografting

Objective: to conduct a comparative pathomorphological analysis of wounds of various origins requiring full-thickness skin autografting. Materials and Methods. Histomorphological comparison of the wound bed prior to plastic surgery with full-thickness skin autografts was performed in three groups of patients: (1) during excision of scar tissue in elective surgery; (2) in case of traumatic skin detachments with autografting sensu Krasovitov; (3) when excising the granulation tissue to the fibrous layer. The object of the study included biopsy specimens from patients of three study groups. Results. The histological picture of wounds after removal of scars was characterized by well-developed dense fibrocellular connective tissue and had signs of chronic inflammation. In contrast to the cicatricial wound, acute lesions were characterized by granulation and mature dense fibrous connective tissues with pronounced inflammatory changes, each of which had its own characteristics. Conclusion. The results of the comparative analysis revealed the features of the morphological picture of wounds depending on the type of damage. In the group of acute injuries, traumatic and burn wounds, the most pronounced tissue damage was revealed. Given the obtained data, it should be assumed that full-thickness skin autografting will yield the best result in the group of patients after the planned excision of scar tissue.

Effect of chronic ethanol ingestion on dendritic cell population during oral mucosal repair: An experimental study.

The aim of this study was to analyze the effect of chronic ethanol ingestion on dendritic cell repopulation during the repair process of rat oral mucosa and in the rat spleen by analyzing the immunohistochemical expression of dendritic cell markers. Wistar rats ingested 20% ethanol solution for 28 days; a surgical wound was performed on the rat tongue after this period. The repair process and the number of CD1a+, CD11c+, and CD207+ cells in the regions adjacent to the wound were determined at day 1, 3, and 7 following the wound as well as in the rat spleen. The wound-only group (no ethanol exposure) had complete reepithelization after 7 days, but this did not occur in the ethanol + wound group at this time point. The inflammatory infiltrate was significantly reduced in animals exposed to ethanol, which also showed significantly lower counts of CD1a+, CD11c+, and CD207+ cells than the wound-only group at all experimental time points. In addition, ethanol exposure also resulted in lower densities of CD11c+ and CD207+ cells in the rat spleen. In conclusion, chronic ethanol intake had a negative impact on dendritic cell numbers, a fact that may contribute to delay in oral mucosa repair.

Assessment of Bundle of Measures Perioperatively to Decrease the Incidence of Surgical Site Wound Infection in Patients Undergoing Abdominal Hysterectomies

Background: Surgical site infections (SSIs) are the second most common reason for unplanned hospital readmissions after hysterectomy and result in increased morbidity and health care costs. The estimated rate of SSI after hysterectomy varies between 1% and 4%. The objective of the study is to investigate if a bundle of perioperative measures (as stated earlier) reduces down the incidence of post-operative surgical site wound infection after abdominal hysterectomy. Materials and Methods: The present prospective study was carried out on total 200 women who were undergo hysterectomy in the operation theater of Department of Obstetrics and Gynecology of IPGMER and SSKM Hospital due to gynecological conditions requiring hysterectomy. Four perioperative bundles of measures are considered – 1. chlorhexidine gluconate and Cetrimide solution (Savlon) wash of the operative field 1 h before the operation, 2. administration of single dose antibiotic (Inj. Ceftriaxone 1 g intravenous) 1 h or less before the incision, 3. vaginal wash with povidone-iodine, and 4. sterile dressing is to be maintained and removed postoperatively after 48 h. Result: We found that in case, 94 (94.0%) patients had Ceftriaxone and 6 (6.0%) patients had clindamycin and gentamicin. In control, 96 (96.0%) patients had ceftriaxone and 4 (4.0%) patients had clindamycin and gentamicin. Association of choice of antibiotic versus group was not statistically significant (P = 0.5164). In case, 6 (6.0%) patients had wound gaping. In control, 11 (11.0%) patients had wound gaping. Association of wound gaping versus group was statistically significant (P = 0.048). Conclusion: The present study found that hospital stay was more in control compared to case which was statistically significant. Fever was more in control compared to case which was statistically significant. In this study, local wound discharge was more in control compared to case which was statistically significant. It was found that wound gaping was more in control compared to case which was statistically significant.

Effects of Hypericum scabrum L. essential oil on wound healing in streptozotocin-induced diabetic rats

Background The purpose of this study was to see if the essential oil of Hypericum scabrum L. (H. scabrum L.) has a protective and therapeutic effect on the wound in streptozotocin-induced diabetic rats. Methods In the study, 63 Sprague-Dawley male rats weighing 250–300 g were divided into nine groups, each with seven rats (major groups: control group, diabetes group, and treatment group). For diabetes and treatment groups, streptozotocin (STZ) was given in a single dose of 60 mg/kg/i.p. In 7 days, the animals with diabetes (blood glucose level > 250 mg/dL) will be assigned to wound groups. All of the rats had circular full-thickness incisions in their dorsal skin caused by a 5 mm punch biopsy tool. The rats were slaughtered, blood was obtained, and their forwound tissues were dissected on the 3rd, 10th, and 14th post-wounding days. The levels of malondialdehyde (MDA) and glutathione (GSH), as well as the activities of glutathione peroxidase (GPx), superoxide dismutase (SOD), and catalase (CAT) in plasma and wound tissues, were all measured. Results While GSH level, GPx, SOD, and CAT activities were decreased in the plasma and wound tissues, MDA level increased in the diabetic group as compared to the control group. When compared to the diabetes group, GSH level, GPx, SOD, and CAT activities were increased in the H. scabrum L. essential oil treatments, but MDA levels were decreased. In comparison to the other groups, the wounds in the H. scabrum L. essential oil diabetic groups healed better and faster. H. scabrum L. essential oil can help to reduce lipid peroxidation, oxidative stress, and the associated complications that come with it, as well as play a beneficial role in the treatment of diabetic wounds. Conclusion Since no information was found in the literature search, future work would focus on new research examining H. scabrum L. essential oil applications to come up with new findings in determining the mechanisms of action of H. scabrum L. essential oil in diabetic wounds and preventing wound healing complications in diabetic rats.

Efficacy of Human Adipose Derived Mesenchymal Stem Cells in Promoting Skin Wound Healing.

Background The aim of this pilot clinical study is to evaluate the efficacy of human adipose derived mesenchymal stem cells (HAMSCs) treatment for the wound healing with patients. Methods This study was a clinical trial to investigate the efficacy of human adipose derived mesenchymal stem cells treatment for the wound healing with patients. 346 patients with skin wounds attending the central hospital of Yue Yang were enrolled in the study, setting in the period from January 2016 to January 2021. Patients were randomly allocated into two groups: experimental group received treatment with human adipose derived mesenchymal stem cells for each 10 cm2 of wound and control group received conventional dressing with normal saline for each 10 cm2 of wound. Results No adverse events were recorded during the period of treatment. The granulation tissue coverage rate and thickness of granulation tissue after 10 days of treatment in experimental group were significantly improved compared with control group. Furthermore, the occurrence of bleeding of wound and suppurative wounds between two groups had significant difference (P < 0.05). Conclusion The data in this pilot study indicated that human adipose derived mesenchymal stem cells may be a safe and effective alternative therapy for wound healing. Moreover, larger, placebo-controlled, perspective studies are necessity to evaluate the efficacy and safety of human adipose derived mesenchymal stem cells treatment for wound healing patients.

Mental Resilience, Mood, and Quality of Life in Young Adults with Self-Reported Impaired Wound Healing.

The purpose of this study was to evaluate the impact of self-reported impaired wound healing on quality of life, wellbeing, and mood. It was hypothesized that individuals with impaired wound healing report significantly poorer mood compared to healthy controls. An online survey was conducted among 2173 Dutch young adults (18–30 years old) to investigate mood, neuroticism, and mental resilience. Participants were allocated to a healthy control group (N = 1728) or impaired wound healing groups comprising a wound infection group (WI, N = 76), a slow-healing wounds group (SHW, N = 272), and a group that experienced both WI and SHW (the COMBI group, N = 97). The Kruskal–Wallis test was used to compare outcomes the groups. Compared to the healthy control group, the SHW and COMBI groups, but not the WI group, reported significantly poorer mood, increased neuroticism, reduced mental resilience, and reduced quality of life. An analysis evaluating sex differences found that negative effects on stress, mental resilience, and neuroticism were significantly more pronounced among women than among men. In conclusion, self-reported impaired wound healing is associated with poorer mood and reduced quality of life. To improve future wound care, these findings advocate for an interdisciplinary approach taking into account mood effects accompanying having impaired wound healing.

Effects of oral wound on the neutrophil lineage in murine bone-marrow: Modulation mechanism hindered by chlorhexidine

ObjectiveThe oral cavity undergoes frequent stress caused by repeated mechanical trauma, and the constant contact of the injured oral mucosa with bacteria leads to the production of various pro-inflammatory cytokines and chemokines. Neutrophils play essential roles in the acute inflammation against the invasive microbiota, and compromised neutrophil recruitment hinders the bacterial clearance and worsens periodontitis. In this study, we aimed to explore whether wounding at the oral cavity would have an impact on the neutrophil lineage, and, if so, whether microbial contamination of the wounded surface plays significant roles. MethodsWe developed a surgical model of an oral wound (palate wound), by a small incision in the hard palate of the mice. We also evaluated the effect of chlorhexidine on oral wound-induced neutrophilia of bone-marrow. ResultsWe demonstrated an increased neutrophilia in the bone-marrow of the oral wound group, as well as decreasedex vivoneutropoietic potential, in both IL-3 and GM-CSF-driven bone-marrow cultures. Washing of the entire oral cavity with chlorhexidine before surgery abolished the bone-marrow neutrophilia in the oral wound group and increased neutropoiesis in culture, relative to the saline-treated oral wound control group. Co-located treatment (both chlorhexidine treatment and wound on the right side of the palate) resulted in significantly reduced bone-marrow neutrophilia, compared to the mismatched treatment (chlorhexidine treatment and wound on opposite sides of the palate). Neither neutrophilia nor decreased neutropoiesis were dependent on glucocorticoid signaling. ConclusionsThe prophylactic use of chlorhexidine ameliorates the neutrophilic response on the bone marrow, restoring the neutrophil numbers.

Доклиническая оценка лечения на модели хронического остеомиелита у кроликов

Introduction. Chronic osteomyelitis is one of the problems in orthopedic surgery. Recently, in the treatment of chronic osteomyelitis, biodegradable materials are increasingly used as a local antibiotic carrier. In our study, we used bone allograft, which prepared by Marburg system. The purpose of the study was to evaluate preclinical changes of use the antibiotic-impregnated bone allograft on osteomyelitis model in rabbit. Materials and methods. Osteomyelitis was caused in rabbits by the human strain Staphylococcus aureus, which is introduced into bone defects created in the distal femur. Three groups were selected depending on the filling: group 1 - antibiotic impregnated biodegradable material “PerOssal”, group 2 –whole bone allograft soaked in antibiotic, group 3 - perforated bone allograft soaked in antibiotic. We used a clinical examination for the evaluating decreasing of chronic osteomyelitis process.Results. The body temperature of all experimental animals was measured with a non-contact thermometer during the entire observation period, which was 42 days. The average temperature in rabbits in groups before surgery was 36.90 in-group 1; in-group 2 - 36.40; in-group 3 - 36.20. On the first day after the operation, in groups 1 and 3, there was no significant difference with the initial body temperature in rabbits before the operation, while in-group 2, the body temperature on the first day after the operation was 39.00. In the early postoperative period, the maximum increase in body temperature is observed on the 3rd day in-group 1 up to 39.20 and in-group 3 38.20. In-group 2, the maximum rise in temperature was on the 2nd day after surgery up to 38.60. The average weight in operated rabbits before surgery was 2983.3 g in-group 1; in-group 2 - 3206.7 gr; in-group 3 - 2300.0 gr. In the 1st group in the postoperative period in the 1st group there is a deficit on the early postoperative day amounted to 1.3 g in dynamics decreased up to 5 days and then there was a stable increase in weight, which in general by the 42nd day was 783, 4 grams. In-group 2, on the first day, there was a maximum body weight deficit of up to 92.3 g, with a subsequent increase, and in general, for the entire observation period, the increase was 200 g. In-group 3, on the first postoperative day, the body weight deficit was 13.9 grams. In the dynamics, there was a slight instability in weight, for example, on day 5, body weight was 3284.6 g, with a decrease on day 6 to 3169.2 g. Visually assessing the wound in-group 1, wound suppuration, divergence or instability of the sutures were not noted. In-group 3, on the 28th day after the operation, there was a slight infiltration of soft tissues in the area after the surgical wound. In the 2nd group on the 14th day there was a slight infiltration of soft tissues in the area after the surgical wound, and on the 28th and 42nd days there was suppuration of the postoperative wound.Conclusion. Thus, in this study we showed, that perforated bone allograft is an available biomaterial can be used in bone regenerative surgery.Key words: Preclinical evaluation algorithm, chronic osteomyelitis, rabbits model, preclinical study

RETALHO SURAL REVERSO NA RECONSTRUÇÃO DE MEMBROS INFERIORES

ABSTRACTIntroduction: Reconstruction of distal wounds in lower extremities can be challenging due to the lack of tissue to perform local flaps. Fasciocutaneous and muscular flaps are some options for coverage, such as the reverse-flow fasciocutaneous sural flap.Objective: To present an 18-month experience on ankle, calcaneus, and foot reconstruction using the reverse-flow sural flap, performed by the Complex Wounds Group of the Plastic Surgery Department of the University of São Paulo Medical School.Methods: An observational, retrospective and descriptive study was performed through data survey on medical records of all patients treated between November 2018 and June 2020.Results: Nine reverse-flow fasciocutaneous sural flaps were performed. All patients were men. The mean age was 38 years old. Five patients had acute wounds for traffic collision, one electrical trauma and three chronic post-traumatic injuries. The ankle was the most common injury site (6), followed by foot (2) and calcaneus (1). Four patients had complications, three of which were partial necrosis and one distal epitheliosis. No case of total necrosis was recorded. The average hospital stay was 30.1 days.Conclusion: The reverse-flow fasciocutaneous sural flap proved to be a viable, reproducible, and reliable option for distal lower limb reconstruction. Level of Evidence IV, Case Series.

Application of traction metal clip with fishhook-like device in endoscopic resection

From July 2020 to June 2021, patients in Jiangyin Hospital Affiliated to Nantong University who met the enrollment criteria were treated with the fishhook-like device during the operation to suture the postoperative wound (group A). Patients with similar conditions and similar size wounds who were treated with a "purse-string suture" to suture the wounds were retrospectively analyzed as the control group (group B). Difference in the suture rate, adverse events, time required for suturing, and number of metal clips were compared between the two groups. The time required for suturing was (7.83±2.41) min in group A and (11.00±3.31) min in group B. The difference was statistically significant (P=0.002). The number of metal clamps used in group A averaged 7.17 pieces/case, and the number of metal clamps used in group B averaged 7.06 pieces/case. The difference was not statistically significant (P>0.05).The traction metal clip with the fishhook-like device is ingeniously designed and easy to operate. It has a good suture effect on the wound after endoscopic resection and effectively prevents postoperative adverse events.

Safety and Efficacy of Collagen-Based Biological Dressings in the Management of Chronic Superficial Skin Wounds in Non-Complex Trauma: A Post-Marketing Surveillance Study

Biological dressings such as collagen and hyaluronic acid represent the main advanced tools that plastic surgeons, dermatologists and vulnologists use today to treat chronic wounds or ulcers that do not tend to heal. These types of dressings are important because they create a moist and physiological interface at the wound level, are of natural origin, easy to use, hypo-allergenic, economical and do not create discomfort for the patient during dressing changes. We treated 128 patients (divided into four groups based on type of dressing) with non-complex superficial chronic wounds in comparison with a traditional dressing (fitostimoline gauze or polyurethane foam). We analyzed wound characteristics, healing time, and operator and patient satisfaction. A significantly higher recovery rate was observed in the “Collagen-coated plates” treatment group compared to Standard Treatment. Additionally, a significantly higher probability of recovery was observed compared to the alternative two experimental devices (Collagen-coated plates + HA and Collagen-based spray). However, the main limitation of the randomization of this study is the presence in the “Collagen-based spray” group of localized wounds, mainly in the fingers and hand. No side effects were reported in relation to the procedures or the experimental products. Collagen may be considered as a valuable therapeutic tool in non-complex chronic wounds by virtue of its low immunogenicity, flexibility and applicability in biocompatible scaffolds, and represents driving force toward enhanced wound care.

The healing dynamics of non‐healing wounds using cryo‐preserved amniotic membrane

We evaluated the effect of the application of cryo‐preserved amniotic membrane on the healing of 26 non‐healing wounds (18 patients) with varying aetiologies and baseline sizes (average of 15.4 cm2), which had resisted the standard of care treatment for 6 to 456 weeks (average 88.8 weeks). Based on their average general responses to the application of cryo‐preserved AM, we could differentiate three wound groups. The first healed group was characterised by complete healing (100% wound closure, maximum treatment period 38 weeks) and represented 62% of treated wounds. The wound area reduction of at least 50% was reached for all wounds in this group within the first 10 weeks of treatment. Exactly 19% of the studied wounds responded partially to the treatment (partially healed group), reaching less than 25% of closure in the first 10 weeks and 90% at maximum for extended treatment period (up to 78 weeks). The remaining 19% of treated wounds did not show any reaction to the AM application (unhealed defects). The three groups have different profiles of wound area reduction, which can be used as a guideline in predicting the healing prognosis of non‐healing wounds treated with a cryo‐preserved amniotic membrane.