Wound Healing Scores Research Articles

Utility of Perioperative Warming for the Prevention of Surgical Site Infection and Patient Rehabilitative Complications: A Systematic Review

Overview: Surgical site infection (SSI) is a leading cause of postoperative complication, rehospitalisation, and patient mortality after invasive clinical interventions. Surgical risks compounded by SSI introduce greater medical, economic, and quality-of-life challenges for both patients and providers alike, and to better inform clinical practice, empirical evaluation of modern surgical warming techniques is relevant. This systematic review and meta-analysis qualitatively examined the efficacy of both active and passive perioperative warming interventions upon SSI presentation versus standardised (i.e., non-warming) care. Methods: This review analysed available literature on active and passive warming application across general anaesthesia procedures, containing longitudinal data on patient outcomes and SSI. The primary outcome studied was occurrence of post-surgical SSI; secondary outcomes included rehabilitative length of stay, attributable SSI-related mortality, and incidence of re-admittance. Results: Meta-analysis demonstrated a significantly reduced risk ratio for SSI in patients receiving any surgical warming intervention (odds ratio: 0.36; 95% confidence interval: 0.18–0.87; p<0.01) compared to individuals treated under standard care conditions, with limited further data supporting improved active warming effect in contrast with passive implementation. Secondary postoperative outcomes, including length of rehabilitative stay or wound healing score (ASEPSIS), correspondingly demonstrated greater outcomes for surgical patients receiving perioperative warming. Introduction of warming interventions consistently correlated with reduced patient-reported pain experiences (p<0.05) and downstream care expenditures (p<0.01). Conclusion: The present review identified evidence supporting a statistically significant correlation between both active and passive perioperative warming interventions to SSI prevention. These findings strongly support the recommendation of standardised perioperative warming implementation with continued investigation of relative efficacy contrasting active and passive methodologies, and across more diverse and substantial patient population sizes.

Arthroscopic ankle arthrodesis: the technique to do

Background End-stage ankle arthritis severely affects patients’ health-related quality of life. When nonoperative treatments fail, ankle arthrodesis surgery or total ankle arthroplasty can improve pain, function, and health-related quality of life. For patients with isolated end-stage ankle arthritis and minimal deformity outside the ankle requiring osteotomies or fusions, ankle arthrodesis remains the mainstay of operative treatment. Open ankle arthrodesis has been the standard operative treatment for advanced osteoarthritis ankle not responsive to any nonoperative measures, but arthroscopic technique gained high popularity owing to high rate of fusion with a low incidence of complications. Aim This study aims to evaluate the role and results of arthroscopic assisted ankle arthrodesis in advanced ankle osteoarthritis (AOS). Patients and methods A total of 40 patients with post-traumatic arthritis, primary osteoarthritis, and rheumatoid arthritis were treated by ankle arthroscopic arthrodesis between January 2011 and January 2016 in Suez Canal University Hospital. The ankle was fixed with two cannulated percutaneous screws. The wound healing, complications, postoperative radiographs, and AOS score were evaluated. Both the pain and disability components were used to calculate the total score. Results All the cases united, with the average time for union being 12.8±1.19 weeks. The average duration of the surgery was 85.55±17.31 min (67–134). The mean hospital stay postoperatively was 1.2±0.52 days. The mean follow-up period was 36.4±4.38 weeks. The early results showed major decrease in AOS from 116±8.6 preoperatively to 19.4±2.3 postoperatively. This shows that the arthroscopic fusion was able to decrease the score by an average of 97.7±10.2 points. No incidences of deep infections, deep venous thrombosis, or revision surgery were observed. Screws’ length had been changed in four patients because of prominence. Conclusion Arthroscopic ankle arthrodesis could be considered as an alternative method for traditional open techniques for the management of severe ankle arthritis.

The effect of Silver Nanoparticle Induced Diabetic on Wound Healing Full Thickness Pseudomonas aeruginosa Contaminated Mouse Skin Wound Models

This research was considered to evaluate the antidiabetic effect of silver nanoparticle (AgNps)and following experimental diabetic. In the present study. Thirty healthy swiss mice aged between 7-8 weeks, old male mice and divided into six groups of five animals. Diabetic induced mice by using intraperitoneal (IP) injection of alloxan (180 mg lkg). Group 1 included non diabetic control, Group 2 Diabetic, Group 3 Diabetic +0.01 mg AgNps Group 4 Diabetic +0.05 AgNps, Group 5 Diabetic+ wound contaminated with Pseudomonas aeruginosa. Group 6 ( diabetic +contaminated wound + silver nanoparticle (Ag Nps). Silver nanoparticle show ample antibacterial activities. The result of the current study introduced an invivo silvernanoparticle accelerate by effects on the treatment of Pseudomonas aeruginosa infected skin wound. The present study was conducted to synthesis the AgNps biologically and evaluate its antibacterial activity against Pseudomonas aeruginosa diabetes induced by Alloxan in mice. Adminstration of silver nanoparticle resulted in significance antidiabetic effects that is is improved glucose tolerance higher source. The current study results are presented for the first time which suggest for the development of AgNps as anantdiabetic factor in future. The broad spectrum of bioactivity of AgNPs makes them promising agent not only to fight infection, but to sterile the wound and accelerate wound healing. There were significant higher wound healing scores in Nanoparticle treated group. Compared with control group. These result suggest that nanoparticle may be useful in diabetic wound healing. Treatment with asingle dose of AGNPs produced amild reduction in blood glucose and some reduction in plasma insulin at 2 h.The present results revealed the potential of the synthesized Ag-NPs as safer bactericidal agents for the treatment of diabetes induced wound contaminated with P.aeruginosa.

Application of small-bore pigtail catheter to improve pleural drainage after single-incision thoracoscopic lobectomy for lung cancer.

In order to overcome the problems associated with the drainage of single-incision thoracoscopic surgery, we investigated the efficiency of applying an 8-Fr pigtail catheter in addition to the conventional 26-Fr chest tube. This prospective study includes 88 consecutive patients who underwent single-incision thoracoscopic lobectomy between July 2017 and March 2018. Patients were treated either with (smaller pigtail group) or without (larger drain group) 8-Fr pigtail catheter in addition to conventional 26-Fr chest tube. Post-operative recovery was assessed by analysing the post-operative drainage volume on the first 2 days, the duration (days) of drainage, re-intubation after 2 weeks, air leak time, length of stay, subcutaneous emphysema, pleural effusion after 2 weeks and pain score. The patients in the pigtail tube group had a significantly shorter drainage time and higher drainage volume on the first 2 days than those in the larger drain group. The percentage of patients that developed pleural effusion after 2 weeks was 4.54% in the smaller pigtail group and 25% in the larger drain group (P = 0.007). The pain score in the smaller pigtail tube group decreased significantly on the third day after surgery compared with larger drain group (P < 0.001). There were no significant differences between the two groups in the air leak time, subcutaneous emphysema, wound healing and pain score on the first day. Application of 8-Fr pigtail catheter after single-incision thoracoscopic lobectomy for primary lung cancer can accelerate the post-operative recovery of patients.

Protein expressions of matrix metalloproteinase-9 and its inhibitor and their ratio changes in wound healing of patients with stages Ⅲ and Ⅳ pressure ulcers

Objective: To explore the expression levels of matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of metalloproteinase-1 (TIMP-1) protein and the change of MMP-9/TIMP-1 ratio in wound exudates of patients with stages Ⅲ and Ⅳ pressure ulcers during wound healing. Methods: From July 2017 to July 2018, 30 patients with stage Ⅲ pressure ulcers [30 wounds, 16 males and 14 females, aged (65±10) years] and 34 patients with stage Ⅳ pressure ulcers [50 wounds, 17 males and 17 females, aged (65±9) years] admitted to Hebei General Hospital who met the inclusion criteria were enrolled in this prospective cohort study. According to the principle of wound treatment and the characteristics and needs of wound in different periods, individualized intervention measures were formulated for patients and appropriate dressings were selected. At the time of admission and on 7, 14, 21, 28 days of treatment, the healing of pressure ulcer wounds was evaluated by Pressure Ulcer Healing Scale. Afterwards, the wound exudate was collected at each time point to detect the expression levels of MMP-9 and TIMP-1 protein by enzyme-linked immunosorbent assay, and the MMP-9/TIMP-1 ratio was calculated. Data were processed with analysis of variance for repeated measurements of single group and linear trend test. Results: (1) There were significantly statistical differences in wound healing scores of patients with stages Ⅲ and Ⅳ pressure ulcers among the time of admission and on 7, 14, 21, 28 days of treatment within each stage (F=145.382, 153.234, P<0.01), and they all showed a gradually decreasing trend (F=170.466, 284.585, P<0.01). (2) At the time of admission and on 7, 14, 21, 28 days of treatment, the expression levels of MMP-9 protein in wound exudates of patients with stages Ⅲ and Ⅳ pressure ulcers were (171±104), (138±88), (110±70), (85±55), (62±41) ng/L and (193±107), (173±104), (139±83), (114±70), (89±56) ng/L, respectively. There were significantly statistical differences within each stage (F=58.007, 111.680, P<0.01), and they all showed a gradually decreasing trend (F=62.901, 134.628, P<0.01). At the time of admission and on 7, 14, 21, 28 days of treatment, the expression levels of TIMP-1 protein in wound exudates of patients with stages Ⅲ and Ⅳ pressure ulcers were (6.2±3.9), (5.6±3.4), (5.1±3.1), (4.4±2.5), (3.8±2.3) ng/L and (4.8±2.5), (4.7±2.6), (4.4±2.6), (4.6±2.7), (4.1±2.4) ng/L, respectively. There were significantly statistical differences within each stage (F=25.479, 7.778, P<0.01), and there was a gradually decreasing trend in stage Ⅲ (F=62.901, P<0.01) and a decreasing trend in stage Ⅳ (F=134.628, P<0.01). At the time of admission, the expression levels of MMP-9 and TIMP-1 in wound exudates of patients with stage Ⅲ pressure ulcers were similar to those of patients with stage Ⅳ pressure ulcers (t=-1.03, 1.47, P>0.05). (3) At the time of admission and on 7, 14, 21, 28 days of treatment, the MMP-9/TIMP-1 ratios in the wound exudates of patients with pressure ulcers of stages Ⅲ and Ⅳ were 30±13, 25±9, 22±9, 20±8, 17±6 and 43±19, 37±13, 32±10, 26±9, 22±9, respectively. There were significantly statistical differences within each stage (F=37.173, 97.191, P<0.01), and they all showed a gradually decreasing trend (F=54.183, 130.088, P<0.01). At the time of admission, the MMP-9/TIMP-1 ratio in wound exudates of patients with stage Ⅳ pressure ulcers was significantly higher than that of patients with stage Ⅲ pressure ulcers (t=-3.42, P<0.01). Conclusions: During the wound healing process of patients with stages Ⅲ and Ⅳ pressure ulcers, the expression levels of MMP-9 and TIMP-1 protein and the MMP-9/TIMP-1 ratio in wound exudates show a decreasing trend. The stage of wound healing can be predicted according to the expression level of MMP-9 protein and the MMP-9/TIMP-1 ratio.

The Wound Healing Effect of Doxycycline after Corneal Alkali Burn in Rats.

Purpose To evaluate the wound healing effect of doxycycline and its underlying mechanisms in a rat model of corneal alkali burn. Methods Male SD rats were administered 1.0 N NaOH in the right cornea for 25 seconds and randomly divided into the doxycycline group and the control group, with 84 rats in each group. 1.0 g·L−1 doxycycline eye drops (doxycycline group) or vehicle (control group) was topically instilled onto the rat cornea after chemical injury. Three days, 7 days, and 14 days after alkali burn, microscopy was used to observe corneal wound healing by fluorescein staining and the degree of corneal opacity. The expression of transforming growth factor-beta 1 (TGF-β1) and matrix metalloproteinase-9 (MMP-9) was detected by RT-PCR and ELISA, alpha-smooth muscle actin (a-SMA) levels were measured by immunofluorescent staining, and Western blot assays for TGF-β1, a-SMA, and nuclear factor-kappa B (NF-κB) were also performed. Results Corneal wound healing and corneal opacity scores were better in the doxycycline group than in the control group. Three, 7, and 14 days after corneal alkali burn, a significant increase in TGF-β1 was observed in corneas from the control group, compared with the corneas from the doxycycline group (P < 0.05). The corneal levels of MMP-9 in the doxycycline group were lower than those in the control group 3 days and 7 days after alkali burn (P < 0.05). In addition, doxycycline inhibited α-SMA expression and suppressed NF-κB expression. Conclusion Doxycycline treatment promoted corneal healing and reduced corneal opacity in SD rats. Doxycycline protected the cornea from alkali burn injury by reducing TGF-β1, MMP-9, NF-κB, and α-SMA expression.

Therapeutic potential of green synthesized silver nanoparticles loaded PVA hydrogel patches for wound healing

Silver nanoparticles were synthesized from cabbage (Brassica oleracia capitate) extract following green chemistry approach and characterized by UV–Vis spectroscopy, DLS, SEM and FT-IR. Furthermore, PVA hydrogel patches loaded with these green synthesized AgNPs and AgNP/clay/activated carbon biocomposites were designed and developed by Freeze-thaw method and their characterization was done by FT-IR and SEM. Swelling studies for these hydrogel patches were performed and overall thickness of these hydrogel patches lied between 0.34 and 0.36 mm. Antibacterial activity of hydrogel patches (10% aqueous soln.) was checked against two representative bacterial strains (Staphylococcus aureus and Escherichia coli) using microdilution method. The minimum inhibitory concentration (MIC) of AgNP-HP and AgNP-Bc-HP for Staphylococcus aureus was 25 μg/mL and 12.5 μg/mL respectively whereas for Escherichia coli it was 3.13 μg/mL and 6.3 μg/mL respectively. Wound healing study was carried out using rabbits as experimental models after giving wound incision on the dorsal skin of these rabbits. Wounds were grossly observed for wound healing over a period of 20 days after application of hydrogel patches on regular basis. Wound healing score was recorded after every 5 days and skin biopsies were taken at 2nd and 3rd weeks of study for histopathological examination. These PVA hydrogel patches proved to be an excellent candidate for wound healing.

Early Wound Healing Score (EHS): An Intra- and Inter-Examiner Reliability Study.

The early wound healing score (EHS) was introduced to assess early wound healing of periodontal soft tissues after surgical incision. The purpose of this study is to evaluate the intra- and inter-examiner reliability of the EHS. Six examiners with different levels of training and clinical focus were enrolled. Each examiner was trained on the use of the EHS before starting the study. Thereafter, 63 photographs of three different types of surgical incisions taken at day 1, 3 or 7 post-operatively were independently evaluated according to the proposed assessment method. A two-way random intra-class correlation coefficient (ICC) and 95% confidence interval (CI) were used to analyze the intra- and inter-examiner reliability for the EHS. The inter-examiner reliability for the EHS was 0.828 (95% CI: 0.767–0.881). The intra-examiner reliability ranged between 0.826 (95% CI: 0.728–0.891) and 0.915 (95% CI: 0.856–0.950). The results therefore show an “almost perfect agreement” for intra- and inter-examiner reliability. The EHS provides a system for reproducible repeated ratings for the early healing assessment of incisions of periodontal soft tissues. Even when used by examiners with different clinical experience and specialty, it shows a high correlation coefficient.

Comparison of wound healing time post odontectomy surgery using silk and catgut sutures In Pirngadi Hospital

Objective: To compare post-odontectomy wound healing time using silk and catgut sutures at Pirngadi Hospital from May to June 2018.Material and Methods: This is anon-laboratory experimental study with a “post-test only”design. Wound healing scores was assessed on the first and seventh days post odotectomy by seeing signs of inflammation. The number of patients studied was 30 people which 15 people used silk and 15 people used catgut.Results: The results were statistically analyzed using Mann-Whitney Test. There was no significant relationship (p&gt; 0.05) between the wound healing time to the suture type on the first day post odontectomy. On the seventh day, it was found that there was a significant relationship (p &lt;0.05) which silk had a score of 1.40 ± 0.507 while catgut had a score of 1.07 ± 0.258.Conclusion: Catgut has a better wound healing time than silk.

Effect of Red Fruit Oil Soap (Pandanus Conoideus Lam.) as Wound Cleansing on Wound Healing and the Number of Bacterial Colonies among Grade II Diabetic Ulcer Patients at Griya Wound Care Clinic Kudus, Indonesia

Background: Diabetic ulcer is an open wound on the skin layer to the dermis due to hyperglycemia and neuropathy. This condition often causes infection and becomes an inhibitor in the wound healing process. Red fruit oil soap can be used as an alternative cleansing to reduce the number of bacterial colonies and accelerate the wound healing process.Aims: This present study aimed to observe the effect of red fruit oil soap in the cleansing process to reduce the number of bacterial colonies and the wound healing process in grade II Diabetic ulcer patientsMethods: This is a quasi-experimental study with the pre-test post-test non-equivalent control group design. Wound cleansing in the intervention group used 0.9% NaCl solution and red fruit oil soap with a pH of 5.74, while the wound cleansing in the control group used 0.9% NaCl solution. Bacterial colonies were assessed and the type of bacteria was observed by the swab method. The wound healing was assessed with Bates-Jensen Wound Assessment Tool (BWAT) instrument for 14 days with observations every 3 days. Analysis test used Mann Whitney and Repeated Measure ANOVA.Results: There was no difference in the mean of the number of bacterial colonies between the wounds that were cleansed with 0.9% NaCl solution and red fruit oil soap and the wounds which were cleansed by using 0.9% NaCl solution (p&gt; 0.05). The mean of the number of colonies in the intervention group until the 14th day reduced by 3.14x106 and in the control group was reduced h 1.40x106. There was a significant decrease in the wound healing scores in each group, in each assessment for 14 days.Conclusion: This study found that the wound cleansing using red fruit oil soap and 0.9% NaCl solution could reduce the number of bacterial colonies on the wound surface and accelerate the wound healing process among patients with grade II diabetic ulcer.

Effect of red fruit oil soap (Pandanus conoideus LAM) as wound cleansing on wound healing and the number of bacterial colonies among Grade II Diabetic Ulcer Patients at Griya Qound Care Clinic Kudus, Indonesia

Background: Diabetic ulcer is an open wound on the skin layer to the dermis due to hyperglycemia and neuropathy. This condition often causes infection and becomes an inhibitor in the wound healing process. Red fruit oil soap can be used as an alternative cleansing to reduce the number of bacterial colonies and accelerate the wound healing process. This present study aimed to observe the effect of red fruit oil soap in the cleansing process to reduce the number of bacterial colonies and the wound healing process in grade II Diabetic ulcer patientsMethods: This is a quasi-experimental study with the pre-test post-test non-equivalent control group design. Wound cleansing in the intervention group used 0.9% NaCl solution and red fruit oil soap with a pH of 5.74, while the wound cleansing in the control group used 0.9% NaCl solution. Bacterial colonies were assessed and the type of bacteria was observed by the swab method. The wound healing was assessed with Bates-Jensen Wound Assessment Tool (BWAT) instrument for 14 days with observations every 3 days. Analysis test used Mann Whitney and Repeated Measure ANOVA.Results: There was no difference in the mean of the number of bacterial colonies between the wounds that were cleansed with 0.9% NaCl solution and red fruit oil soap and the wounds which were cleansed by using 0.9% NaCl solution (p&gt; 0.05). The mean of the number of colonies in the intervention group until the 14th day reduced by 3.14x106 and in the control group was reduced h 1.40x106. There was a significant decrease in the wound healing scores in each group, in each assessment for 14 days.Conclusion: This study found that the wound cleansing using red fruit oil soap and 0.9% NaCl solution could reduce the number of bacterial colonies on the wound surface and accelerate the wound healing process among patients with grade II diabetic ulcer. Keywords: Red fruit oil soap, Wound cleansing, Wound healing, Diabetic ulcerReceived: 25 August 2018; Reviewed: 4 September 2018; Revised: 24 June 2019; Accepted: 28 June 2019 DOI: 10.35898/ghmj-32542

SURGICAL SITE INFECTION;

Objectives: Efficacy of postoperative Povidone-Iodine pro­phylaxis and surgical site infection in appendectomy surgery. Study Design: Randomized clinical trial. Place and Duration: Department of Surgery, Liaquat University Hospital Jamshoro/Hyderabad from March 2016 to November 2017. Subjects and Methods: Diagnosed cases of acute appendicitis with classical clinical presentation were included in the study protocol. 60 patients were those, who were applied 1% povidone-iodine solution (cases) to wound post operatively versus 60 patients (control) were those in whom wound not irrigated with Povidone- Iodine. Ethical approval and consent were taken. Data was noted in a proforma and analyzed on SPSS 22.0 (P≤0.05). Results: Age (mean ± SD) in control and cases was observed as 25.5 ± 8.5 and 24.5 ± 9.5 years respectively (P=0.76). Male and female were noted as 43 (%) and 17 (%) &amp; 45 (%) and 15 (%) in control and cases respectively (P &gt;0.05). Wound healing score by Southampton classification of wound healing shows lesser frequency of surgical site infection in cases compared to controls (P &lt;0.05). Grade 4 pus discharging wound infection was noted in 2 (3.33%) control versus 3 (5.0%) in cases (P=0.021). Conclusion: It is concluded that the 1% Povidone- Iodine solution is effective in preventing the post appendectomy surgical site infection.

Effect of two post-surgical cleansing protocols on early periodontal wound healing and cytokine levels following osseous resective surgery: A randomized controlled study.

The aim of this RCT study was to compare early wound healing and gingival crevicular fluid cytokine levels of patients treated with two different post-surgical cleansing protocols. A total of 30 chronic periodontitis patients scheduled for osseous resective surgery with fibre retention technique were randomly assigned to follow one of two post-surgical protocols. Patients assigned to the test protocol (n=15) were instructed to brush the surgical area with a sonic toothbrush starting the day after surgery in addition to 0.12% chlorhexidine (CHX) rinsing, while patients following the control protocol (n=15) rinsed only with 0.12% CHX solution and resumed mechanical cleansing with a manual toothbrush on day 14 after surgery. Interleukin (IL)-1β and IL-8 levels were assessed before and 14days post-operatively in gingival crevicular fluid. Patients were recalled on day 7, 14, 21 and 28 after surgery for clinical assessment. Pain was self-reported by a visual analogue scale. Lower early wound healing scores, higher bacterial plaque reduction and milder inflammatory response were observed at the surgical sites in the test group on day 7, 14 and 28 when compared to the control group (P<0.01). The faster wound healing process was modulated by a statistically significant decrease in IL-1β and IL-8 levels on day 14 in the sonic group. The intensity of pain was similar between groups. The introduction of sonic toothbrush on the first post-operative day as an adjunct of daily CHX rinsing would seem to accelerate early wound healing.

Studying the Effect of Aloe Vera Ointment on Wound Healing of CABG Surgery in Diabetic Patients

Background and Purpose: one of morbidities of diabetes is delay in wound healing. Among treatment common procedures in diabetic patients with coronary artery bypass graft. Therefore, delay in CABG wound healing is one of common problems of diabetic patients. Aloe vera plant contains collagen which heightens the tissue granules and contributes in wound healing process with its anti-inflammatory properties. Thus, the researcher tries to examine the effect of Aloe vera on wound healing. Methodology: the study was random clinical trial with intervention and control groups. 60 diabetic patients who attended to Imam Ali Hospital, Kermanshah for CABG surgery have been assigned to two 30-person groups as intervention and control groups. From second day after surgery, after putting out the sternum area chip pipe of intervention group patients, after washing with betadine they were bandaged by 2% aloe vera ointment which was made by Karaj academic Jihad organization medicinal herbs research center in a daily basis. In control group only daily washing with betadine and bandage has been done. This has been conducted till 14 days after surgery. Wound healing in days 7, 4 and 14 after surgery has been evaluated by Bates Jenson wound healing scale. One used SPSS version 16 for analyzing the data. In this study, for describing the samples, one used descriptive statistical methods including tables of frequency distribution, determining average, SD and when it comes to study objectives and hypothesis, determining the homogeneity of samples one uses Chi two and Mann Whitman non-parametric test. Findings: mean and SD of total score of wound healing of two groups is calculated at day 4 after intervention by independent Mann Whitman test that P>0,5 therefore two groups had no significant different in wound healing, in day 7 after intervention the mean and SD of wound healing score had significant different based on Mann Whitman test P<0.001 at day 14 after intervention based on Mann Whitman test, there was a significant different between two groups in terms of wound healing p<0.001. Conclusion: 2% Aloe vera ointment can speed up the healing of wound of CABG surgery in diabetic patients after at least one week use.

Assessment of Patient Perception, Healing Outcomes and Gained Vestibular Depth of Er: Yag Laser Versus Conventional Surgical Mandibular Vestibuloplasty

Background: Insufficient sulcular depth dramatically affects denture retention and stability. Preprosthetic sulcular deepening could be carried out either with lasers, conventional surgeries or, electrocautery to afford the required sulcular length. Purpose: compare pain, discomfort, wound healing results and gained vestibular depth of Er: YAG laser and the conventional surgical vestibuloplasty techniques. Materials and Methods: 18 patients who suffered from severely atrophic mandibular ridge were randomly allocated to go through vestibuloplasty either by laser (L) or conventional surgery (S). Visual analysis scale (VAS) of pain and discomfort used to assess pain and discomfort along the 1st. 3rd. 7th. days and three pointer scale for healing to assess healing process at the 1st. 3rd. 7th. and 21st. day. The gained vestibular depth was measured immediately after surgery, one month, 3 and six months postoperatively. The obtained data were investigated for intergroup and intragroup comparison using an independent t-test and a student paired t-test and Friedman tests. Results: VAS scores of pain and discomfort within the laser group in the 1st, 3rd and the 7th days exhibited a significant difference (pst, 3rd and the 7th days results of the 3-pointer scale exposed better wound healing scores in the laser group compared to the conventional surgical group. The gained ridge height of the mandible in laser group was more stable without rebound on the 1st. 3rd. and 6th. months compared to the conventional surgical group. Conclusion: Er: Yag laser vestibuloplasty has better patient’s perception, healing outcomes and improvement of the vestibular depth than conventional surgical vestibuloplasty.

Posterior pillar mucosal suspension technique for posttonsillectomy pain and wound healing: a prospective, randomized, controlled trial.

To investigate the efficacy of a simple and feasible suturing technique on posttonsillectomy pain control and wound healing. A prospective, randomized, controlled trial was conducted on a sample of 121 children between 3 and 10years of age. Group A comprised children undergoing surgery with bipolar cautery and the posterior pillar mucosal suspension technique. Bipolar alone (Group B) and cold dissection tonsillectomy (Group C) were used as control groups. Pain was assessed at 1, 3, 5, 7, and 10days postoperatively via visual analog scale scores. Peritonsillar edema, erythema, and granulation tissue in the tonsillar fossa were evaluated by direct visual examination for wound healing on days 1, 3, 5, 7, and 10. There were consecutive 121 patients which were included, with mean ages being 6.2 ± 2.5, 6.1 ± 2.4, and 6.1 ± 2.6 in groups A, B, and C, respectively. Postoperative pain scores on days 1 and 3 were significantly lower in Group A than Group B and C (P < .001) and scores were 0.87 ± 1.1, 3.83 ± 2.29, and 4.29 ± 2.48 on day 1 and 0.38 ± 0.88, 2.25 ± 2.13, and 2.76 ± 2.12 on day 3 respectively. The wound-healing scores on postoperative 1st, 3rd, 5th, and 7th days were significantly lower in Group A than control groups (P < .001). The wound-healing score on postoperative day 10 was only different than Group C (P = .020). The posterior pillar mucosal suspension technique is an effective and comparable method in terms of wound healing, maintains the preoperative anatomical structures, and enables a better pain control with reduced analgesic/opioid usage.

Oral flurbiprofen spray for mucosal graft harvesting at the palatal area: A randomized placebo-controlled study.

Flurbiprofen which is a non-steroidal anti-inflammatory drug (NSAID), has been safely used for the control of postoperative patient's morbidity after periodontal plastic surgeries requiring palatal graft harvesting, but there is little information on the efficacy of topical use. The aim of the study was to evaluate whether patient pain perception was reduced and patient morbidity was improved by using oral spray of flurbiprofen after palatal graft harvesting. Forty-eight patients (21 males and 27 females), scheduled for subepithelial connective tissue graft (SCTG) and free gingival graft (FGG) requiring periodontal plastic surgeries were selected. The patients were randomly assigned to each group and used oral spray of flurbiprofen or placebo three times a day for a week. The palatal donor area was evaluated at 1, 3, 7, 14, 21, 28, 42, and 56-day follow-up after the surgery for postoperative pain, patients' discomfort, complete epithelialization, changes in dietary habits, burning sensation, color match, the amount of systemic analgesic consumption and the presence of delayed bleeding. Wound healing scores were recorded at 14-day follow up. The prevalance of complete epithelialization was significantly higher in the placebo-FGG group than flurbiprofen-FGG group at 21 days postoperatively (P<0.05), while there was no significant alteration for both flurbiprofen-SCTG and placebo-SCTG groups at any follow-up periods. In flurbiprofen-FGG group, significant improvements were observed for postoperative pain, patients' discomfort and burning sensation at 14 days postoperatively (P<0.05). Oral flurbiprofen spray reduces patient's morbidity, however it might have negative effects on epithelialization of secondary wound healing after FGG operations.

Amputation stump perfusion is predictive of post-operative necrotic eschar formation

BackgroundA large proportion of patients develop poor amputation stump healing. We hypothesize that Laser-Assisted Fluorescent Angiography (LAFA) can predict inadequate tissue perfusion and healing. MethodsOver an 8-month period we reviewed all patients who underwent lower extremity amputation and LAFA. We evaluated intra-operative LAFA global and segmental stump perfusion, and post-operative modified Bates-Jensen (mBJS) wound healing scores. ResultsIn 15 patients, amputation stumps with lower global perfusion demonstrated higher mBJS (P = 0.01). Lower suture-line perfusion also correlated with more eschar formation (P < 0.001). Diabetic patients had higher mBJS (P = 0.009), lower stump perfusion (P = 0.02), and increased eschar volume (P < 0.001). ConclusionLAFA is a useful adjunct for intra-operative stump perfusion assessment and can predict areas of poor stump healing and eschar formation. Diabetic patients seem to be at higher risk of stump eschar formation.

Plasma Malondialdehid and Histopatology Healing Score Differences in Incised Old and Young Mice Zinc with Zinc Administration

Free radical plays role in wound healing. This study was conducted to determinedifferences in level of plasma malondialdehyde (MDA), and histopathological score of woundhealing by administering zinc in old and young mice. We used 24 old mice and 24 young miceincision wound model, randomized into two groups, with and without zinc administration. Wefound plasma MDA level was lower in old mice with zinc administration but not statisticallysignificant. The plasma MDA level was significantly higher by administering zinc in young mice(p=0.004). The plasma MDA level of young mice was higher than old mice in zincadministration group (p=0.010). Reepitelialization, inflammatory cells, fibroblasts andangiogenesis did not differ by administering zinc both in old mice and young mice.Reepitelialization, inflammatory cells and angiogenesis did not differ between old and youngmice in mice that were given zinc; while fibroblast of young mice is more than old mice(p=0.010). We concluded plasma MDA level is higher in young mice with zincadministration. Plasma MDA level in young mice is higher than old mice with zincadministration. Young mice with zinc administration have higher fibroblast than oldmice.Keywords: aging, free radical, histopathologic score, malondialdehid, wound healing, zinc

Wound Healing and Bone Regeneration in Postextraction Sockets with and without Platelet-rich Fibrin.

Context and Aim:In today's world of advanced dentistry, there are various aspects of restorative, esthetic, and surgical processes. Healing of an extraction socket comprises of bone as well as soft-tissue remodeling with maximum dimensional changes occurring during the first 3 months. Platelet-rich fibrin (PRF) was first developed in France as a therapeutic alternative to platelet-rich plasma to overcome many of its limitations. The present study was planned to evaluate and compare wound healing and bone regeneration in extraction sockets with and without PRF.Materials and Methods:The present study was carried out on 30 patients selected from the outpatient department over a period of 2½ years starting from May 2013 undergoing extraction of maxillary or mandibular teeth simultaneously to conduct a split-mouth study. The research protocol was approved by the Institutional Ethics Committee governing the use of human subjects in clinical experimentation.Statistical Analysis Used:Descriptive and analytical statistics were calculated using Statistical Package for Social Sciences version 19. Chi-square test was used to assess wound healing score in the two groups while paired t-test was used to compare the bone density in the socket and periapical regions at different time intervals, and unpaired t-test was used for the intergroup comparisons. P < 0.05 was considered to be significant while P < 0.001 was considered highly significant.Results:Patients in PRF group had better healing index when compared to without PRF group. Use of PRF showed a comparable increase in bone density too.Conclusion:An appreciable wound healing and bone regeneration was seen in the experimental group when compared to the control sites where no PRF was used substantiating the use of PRF as an inexpensive autologous material for socket preservation and future rehabilitation. The present study, also, showed that minimal operator expertise was required to conduct the procedure of PRF preparation and grafting when compared to bone harvesting from distant sites. The shorter duration between extractions and further rehabilitation obviates the need for a second procedure.