Site Wound Healing Research Articles

Patient Experience and Wound Healing Outcomes Using Different Palatal Protection Methods After Free Gingival Grafts: A Systematic Review

(1) Background: A free gingival graft (FGG) is a common technique used to reconstruct or enhance the area of keratinized mucosa, while a connective tissue graft (CTG) is utilized to boost soft tissue thickness, thereby promoting stability in interproximal marginal bone levels. Most reported complications following FGG procedure are associated with the donor site. In addition to a painful, open wound in the palate, the most frequent complications linked to FGG harvesting include excessive bleeding, postoperative bone exposure, and recurrent herpes lesions. Numerous methods for securing the donor site after a free gingival graft surgery have been documented in research publications. The main objective of this systematic review was to assess various techniques for protecting the palate after graft harvesting and their impact on patient experience, with a focus on pain management. The secondary objective was to evaluate these techniques in relation to donor site wound healing. (2) Methods: The search was performed across four databases: Medline (PubMed Central), Scopus, Web of Science, and Embase, in accordance with PRISMA guidelines and the recommendations set forth in the Cochrane Handbook for Systematic Reviews of Interventions. The initial search took place on 9 October 2023, followed by an update on 28 June 2024. The search utilized the following keywords: (“wound” OR “injury”) AND (“graft” OR “free gingival graft” OR “graft harvesting”) AND (“healing” OR “recovery”) AND “palate”. (3) Results: After conducting the follow-up search, a total of 958 papers were identified: 193 from PubMed, 314 from Scopus, 101 from Web of Science, and 350 from Embase. Ultimately, of the 49 papers that remained, 11 were excluded due to not fulfilling the inclusion criteria, leaving 38 full-text papers on free gingival grafts (FGG) for qualitative analysis. (4) Conclusions: Various methods for palatal protection after free gingival grafts (FGG) are described in the literature, stemming from biological, physical, or chemical sources. Most studies in this review examined platelet-rich fibrin and suggested that it provides no benefits for patients’ subjective experiences or wound healing outcomes. While photobiomodulation appears to support wound epithelialization, it does not influence pain perception. Alternatives such as propolis, hyaluronic acid, and medicinal plant extracts show potential for palatal protection; however, further research is needed to thoroughly evaluate their effectiveness.

Role of Balanced Involvement of the ICOS/ICOSL/Osteopontin Network in Cutaneous Wound Healing.

Inducible T-cell costimulator (ICOS, CD278) is a costimulatory receptor primarily expressed by activated T cells. It binds to ICOS ligand (ICOSL, CD275), which is expressed by various immune and non-immune cell types, particularly in inflamed tissues. ICOSL can also bind to osteopontin (OPN), a protein that functions both as a component of the extracellular matrix and as a soluble pro-inflammatory cytokine. Previous studies, including ours, have shown that ICOS and ICOSL play a role in skin wound healing, as mice deficient in either ICOS or ICOSL exhibit delayed healing. The aim of this study was to investigate the involvement of the ICOS/ICOSL/OPN network in skin wound healing by analyzing mice that are single knockouts for ICOS, ICOSL, or OPN, or double knockouts for ICOS/OPN or ICOSL/OPN. Our results showed that wound healing is impaired in all single knockout strains, but not in the two double knockout strains. Cellular and molecular analyses of the wound healing sites revealed that the healing defect in the single knockout strains is associated with reduced neutrophil infiltration and decreased expression of α-SMA (a marker of myofibroblasts), IL-6, TNFα, and VEGF. In contrast, the normalization of wound closure observed in the double knockout strains was primarily linked to increased vessel formation. A local treatment with recombinant ICOS-Fc improved healing in all mouse strains expressing ICOSL, but not in those lacking ICOSL, and led to a local increase in vessel formation and macrophage recruitment, predominantly of the M2 type.

Perioperative Management of Takayasu Arteritis for Cardiac Surgery - Review and Single-Center Experience.

Takayasu arteritis (TAK) is classified as a large vessel vasculitis and often causes vascular stenosis, occlusion, and aneurysm formation. Although the principal treatment for TAK involves suppressing inflammation with glucocorticoids, the emergence of biological disease-modifying antirheumatic drugs has considerably changed the treatment landscape of TAK in recent years. Several biological disease-modifying antirheumatic drugs, such as tocilizumab (TCZ), have shown promising effects on TAK in clinical studies. Cardiologists and cardiovascular surgeons encounter patients receiving these drugs who require catheterization, endovascular treatment, or cardiovascular surgery. However, in patients treated with glucocorticoids and TCZ, there needs to be greater awareness of more complications than usual after surgery, such as delayed wound healing, systemic infection, and surgical site infection. In addition, in patients receiving TCZ, inflammatory markers, such as C-reactive protein, may not increase when complications arise from infection. Unfortunately, there are no guidelines or solid evidence that have clearly defined the optimal perioperative treatment strategy for patients with TAK who require cardiovascular surgery. This article reviews the evidence and our recent experience supporting the perioperative use of TCZ, and proposes a protocol that can reduce complications in patients with TAK undergoing invasive cardiovascular treatment.

Deficient functional wound closure as measured by elevated trans-epidermal water loss predicts chronic wound recurrence: An exploratory observational study

A single-center, prospective, observational pilot study was performed to evaluate wound healing endpoint and recurrence by measuring transepidermal water loss (TEWL) post-closure at the site of wound repair. Patients with clinically-defined chronic wounds (such as pressure ulcers, diabetic ulcers, and trauma wounds) who visited the Plastic Surgery outpatient department or were in-patients at the All India Institute of Medical Sciences, Rishikesh, India, and were referred for chronic wound management, were enrolled. Non-invasive point-of-care TEWL measurements were obtained, from closed wound-site and contralateral healthy skin site, starting from confirmation of closure (post-closure, V0) continuing every 2 weeks for a maximum of five visits or until the wound recurred. Statistical analyses of the data involved logistic regression and likelihood ratio chi-square tests to assess differences in TEWL at visit 0 (V0) between the closed wound site and reference skin, with the TEWL score as the sole predictor of recurrence. Of the 72 subjects that completed the study, 44 (61%) showed no recurrence and 28 (39%) had wounds that recurred over a period of 12 weeks. A significant association was found between the V0 (post-closure) TEWL score and the odds of wound recurrence, both in univariate analysis (OR [95%CI] = 1.26[1.14,1.42] (p < 0.001) and after adjusting for covariates in multivariable analysis (OR [95%CI] = 1.34[1.19,1.61] (p < 0.001). The likelihood ratio chi-square analysis demonstrated that the V0 TEWL score is a significant universal predictor of recurrence across all wound types studied. Cases of closed wounds with subsequent recurrence showed an overall higher post-closure V0 TEWL score, compared to those who did not have a wound recurrence, across visits. The TEWL score cut-off value predictive of recurrence was 24.1 g.m–2.h–1 (AUC = 0.967). The outcome of this pilot study on a wide range of chronic wounds leads to the hypothesis that post-closure TEWL at the site of wound healing is a reliable biomarker of wound recurrence. It also raises the question whether the clinical endpoint of wound closure should include re-establishment of skin barrier function as additional criterion. The current standard of care wound closure endpoint calls for re-epithelialization of the wound with no discharge for two consecutive weeks disregarding the functional parameter of restoration of skin barrier function at the wound-site.

Seasonal Impact on Wound Healing and Surgical Site Infections after Reduction Mammoplasty.

Background: The incidence of reduction mammoplasty has been steadily increasing over recent decades. Surgical site infections (SSIs) represent a common yet preventable complication across surgical disciplines. Studies across various surgical specialties have indicated a seasonal influence on SSIs, primarily correlated with higher temperatures and humidity. However, there remains a scarcity of clear data regarding the seasonal effects on complications specifically in breast surgery. Methods: We conducted a retrospective review encompassing all patients who underwent primary bilateral reduction mammoplasties at our institution between 1 June 2016, and 1 September 2019. The data collected included patient demographics, surgical details, and postoperative complications. The rates of SSIs and wound healing disturbances (WHDs) were correlated with local meteorological data at the time of surgery. Results: A total of 808 patients (1616 breasts) met the inclusion criteria. The mean age was 41 ± 14.8 years, with a mean BMI of 28.9 ± 5.2 kg/m2 and a mean follow-up duration of 8.9 ± 9.8 months. Nineteen cases (2.35%) of surgical site infections and 77 cases (9.52%) of wound healing disturbances were reported. No statistically significant increase in the risk of SSIs (p = 0.928) or WHDs (p = 0.078) was observed during the warmer months of the year. Although no specific risk factors were identified for surgical site infections, both resection weight (p < 0.001) and diabetes mellitus (p = 0.001) demonstrated increased risks for wound healing disturbances. Conclusions: While seasonal temperature variations have been shown to impact SSIs and WHDs in body contouring procedures, our findings suggest that breast reduction surgery may not be similarly affected.

Minimally invasive exoscope-assisted coccygectomy: A novel approach for chronic refractory coccydynia

BackgroundThis technical note presents a novel minimally invasive exoscope assisted coccygectomy to treat chronic refractory coccydynia. Traditional treatments often fail to provide adequate relief for this debilitating condition, prompting the need to explore surgical approaches. Case DescriptionA 40-year-old female patient with persistent pain unresponsive to conservative treatments underwent this advanced procedure. Utilizing the Synaptive exoscope-microscope system, the surgery allowed for precise dissection and removal of affected coccygeal segments, with a focus on minimizing skin and soft tissue disruption to optimize wound healing and surgical site pain. ConclusionPostoperative recovery showcased significant pain reduction and improved quality of life, emphasizing the method's potential for better outcomes and fewer complications. Despite the promising results, the limitations of a single-case study necessitate further research to establish long-term effectiveness across a broader patient population.

Vaping and Orthopedic Surgery: Perioperative Management

The growing use of electronic cigarettes (ECs) as a perceived safer alternative to traditional combustible smoking has significant implications for orthopedic surgery patients. Surgeons need to recognize the harms and risks associated with ECs beyond their nicotine content. EC aerosols contain cytotoxic elements, including harmful chemicals, carcinogens, heavy metals, and flavoring agents. They can induce oxidative stress, resulting from an imbalance between cell antioxidant defense and reactive oxygen species (ROS). These effects can compromise bone repair, particularly with skeletal system disorders. Furthermore, ECs’ impact on wound healing and surgical site infection (SSI) have been well-documented. Smoking can reduce the inflammatory healing response, impair oxidative bacterial killing mechanisms, delay the proliferation healing response, and alter collagen metabolism. Some surgical practices remain unchanged despite physicians’ efforts to inquire about EC use. Most orthopedic surgeons do not delay surgery due to nicotine consumption, and urine tests for nicotine are rarely used. However, preoperative smoking cessation interventions offer a unique opportunity to help patients stop consuming nicotine. Therefore, it is crucial for orthopedic surgeons to understand the harms of ECs and communicate the associated risks to patients.

Comparison of Microsurgical and Conventional Techniques for Augmentation of Keratinized Mucosa Around Dental İmplants

Objective: This study aims to compare the clinical outcomes of periodontal microsurgery with conventional periodontal surgery in keratinized mucosa augmentation around the implant. Materials and Methods: Ten patients with at least 2 implants with a keratinized mucosal width of &lt; 2 mm were included. Free gingival graft (FGG) was applied in the test group with the microsurgery technique whereas in the control group with the conventional periodontal surgery technique. Keratinized mucosa width (KMW) and palatal mucosal thickness (MT) were measured at baseline and 3rd month. Graft shrinkage(GS) was evaluated at the 3rd month. Donor site wound healing was evaluated at the 10th day and 3rd month. Feedback forms were collected on the 10th day. Results: KMW values increased significantly in both groups at 3rd month compared to baseline. The percentage of GS was lower in the test group at 3rd month, but this difference was not significant. MT values in the test group were closer to the baseline values at 3rd month compared to the control group. Wound healing scores were similar in both groups at the 10th day and 3rd month. Postoperative pain levels decreased more rapidly in the test group. Conclusion: The microsurgical technique provides a faster increase in palatal mucosal thickness and lower graft shrinkage during the healing period and an earlier reduction in postoperative pain levels.

Free vascularized medial femoral condyle periosteal flaps in the ankle and foot region: A narrative review.

The objective of this study was to determine the role and reliability of the free medial femoral condyle (MFC) flap (MFCF) in demanding foot and ankle reconstruction procedures. A search of the MEDLINE, PubMed, and Embase electronic databases was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines between January 2008 and September 2023. Articles concerning free MFC bone flaps for reconstruction of the foot and ankle regions were included. Outcomes of interest included flap failure, complications, union rate, time to union, and functional scores. Twenty studies involving 131 patients met the inclusion criteria. The most common clinical indications for the free MFCF were nonunion, avascular necrosis, and osteomyelitis. The most common sites of nonunion were tibiotalar arthrodesis (50%) and subtalar arthrodesis (33%). Overall, the bony union rate was 93.1%, with a mean time to union of 14.6±0.1 weeks. There were no flap failures reported. Postoperative complications were observed in 39 (29.7%) cases (e.g., delayed donor site wound healing, flap debulking, medial condyle osteonecrosis, and donor site numbness), with 21 (16%) patients requiring further operative intervention. No major donor or recipient site morbidity occurred, except for one case. Free MFCFs offer a versatile and dependable choice for cases of foot and ankle reconstruction, displaying favorable rates of bone fusion and acceptable complication rates. Existing literature indicates that MFC reconstruction in the foot and ankle is not associated with significant morbidity at the donor or recipient sites. The pooled data demonstrated a 93% success rate in achieving bone fusion in the foot and ankle region, supporting the view that it can be considered another option of treatment.

Donor site wound healing following free gingival graft surgery using platelet rich fibrin: A randomized controlled trial.

The primary purpose of this two-arm, parallel design, randomized controlled study is to compare healing of the palatal tissue donor site when platelet-rich fibrin (PRF) is used as a wound dressing compared to the use of a hemostatic agent. Secondary outcomes of patient pain perception and analgesic intake were also evaluated. Seventy-four patients receiving free gingival grafts were randomized to receive either PRF (test) or hemostatic agent (control) as a palatal wound dressing by patients selecting a sealed envelope containing their group assignment (initially 37 envelopes for PRF group and 37 for hemostatic agent group). Patient pain assessment and analgesic consumption were documented using a 21-point numerical scale (NMRS-21) at 24, 48, and 72hours post-surgery. At 1-, 2-, 3-, and 4-week follow-up appointments palatal early healing index (PEHI) scores including wound color, epithelialization, presence or absence of swelling, granulation tissue, and bleeding on gentle palpation were generated by direct intraoral examination by a blinded examiner unaware of the patients' treatment group. NMRS-21 pain scores showed a significant reduction in pain over time in both groups, with no significant difference between groups at any time point. No significant between-group difference was found in the amount of analgesics taken by patients at 24, 48, and 72hours. There was significant improvement in PEHI scores over the 4-week time period in both groups, but there was no significant difference in PEHI score at each time point (1, 2, 3, 4weeks) between groups. CONCLUSIONS: Study findings suggest that there is no difference in early palatal wound healing, patient pain perception, or analgesic consumption between use of PRF or a hemostatic agent as donor-site wound dressings.

Free fibula mandible reconstruction for osteoradionecrosis is more challenging than for primary cancer.

Osteoradionecrosis (ORN) of the mandible is an unfortunate potential sequela of radiotherapy for head and neck cancer. In advanced cases of ORN, mandibulectomy, and free fibula flap reconstruction are required. We hypothesized that patients undergoing fibula free flap reconstruction and mandibulectomy for ORN pose unique challenges and experience more complications than patients undergoing fibula free flaps after oncologic mandibulectomy. After IRB approval, we created a database of all free fibula flaps for mandible reconstruction from April 2005 through February 2019. Medical records were retrospectively reviewed for patient and surgical characteristics and postoperative outcomes. Four-hundred seventy-nine patients met the inclusion criteria (168 ORN vs. 311 non-ORN patients). Propensity-matching was performed based on age, BMI, smoking status, preoperative chemotherapy, and virtual surgery planning use, which yielded 159 patients in each group. ORN patients received more double-skin-island fibula flaps than non-OR patients (20.8% vs. 5.7%, p < 0.001). Recipient artery other than the facial artery was utilized more commonly in ORN patients (42.1% vs. 17.0%, p < 0.001). In the unmatched cohort, ORN patients had higher rates of delayed wound healing (26.2% vs. 16.8%, p = 0.01) and surgical site infections (21.4% vs. 13.2%, p = 0.02). Rates of flap loss, return to the operating room, hematoma, operative time, and length of stay were similar between the groups. On logistic regression analysis, osteoradionecrosis was an independent risk factor for delayed wound healing. Based on these data, mandibular reconstruction with fibula flaps for osteoradionecrosis appears more complicated than mandible reconstruction following de novo cancer resection. Surgeons should anticipate employing two skin islands for intraoral and extraoral resurfacing, utilizing unconventional recipient vessels, and managing the delayed wound healing that ensues more commonly than non-ORN patients.

Role of nutritional support in nursing practice for improving surgical site wound healing in patients post-surgery with risk of pressure ulcers.

To explore the role of nutritional support in nursing practice on postoperative surgical site wound healing in patients undergoing surgery at risk for pressure ulcers. This study adopted a retrospective experimental design and included a total of 60 patients at risk of pressure ulcers, divided into a nutritional support group and a control group, with 30 people in each group. The nutritional support group implemented specific nutritional support measures after surgery, while the control group received standard postoperative care. Outcome measures included redness and swelling scores, edema scores, anxiety assessments, pain scores, bleeding volume, recovery time and incidence of pressure ulcers. The result indicates that patients who received nutritional support exhibited lower postoperative wound redness and swelling scores compared to the control group (3.11 ± 0.45 vs. 4.85 ± 0.74, p < 0.05). Additionally, the nutritional support group showed significantly lower edema scores (2.75 ± 0.37 vs. 3.53 ± 0.62, p < 0.05). Anxiety levels, as measured by the anxiety assessment scale (SAS), were also lower in the nutritional support group (6.52 ± 1.19 vs. 7.60 ± 1.62, p < 0.05). Moreover, the average healing time was shorter for the nutritional support group (7.27 ± 1.36 days) compared to the control group (9.71 ± 1.84 days, p < 0.05). Postoperative pain scores were lower in the nutritional support group (4.13 ± 0.72 vs. 5.43 ± 0.62, p < 0.05), and patient satisfaction scores were higher (9.42 ± 0.76 vs. 7.25 ± 0.81, p < 0.05). Nutritional support has a positive effect on postoperative wound healing at surgical sites in patients at risk of pressure ulcers in nursing practice. It can significantly reduce redness, swelling, edema, anxiety, and pain scores, reduce bleeding, shorten recovery time, and reduce pressure ulcers. incidence rate.

Effects of Medicinal Plants Extracts in Healing Split-Thickness Skin Graft Donor Site Wounds: A Systematic Review of Randomized Clinical Trials

The literature on Split-Thickness Skin Graft (STSG) donor site dressings has not yet identified an ideal dressing, and most products tested by researchers for wound dressing are prohibitively expensive in Low- and Middle-income settings. Clinical trials using biological dressings have offered an alternative option for managing STSG donor sites wound. The aim of this systematic review is to find evidences regarding the effectiveness of medicinal plants on STSG donor site wound healing. A total of 249 papers were identified in the initial search. After removing duplicates and applying the inclusion and exclusion criteria, 6 Randomized Clinical Trials were deemed relevant and included in the final review. Over twenty years four medicinal plants have entered clinical trial to enhance STSG donor site wound healing. The medicinal plants reviewed have large effect size regarding time to complete wound healing and wound score. However, the effect size of Aloe vera regarding time to complete wound healing and pain control vary from study to study. No patient quality of life was assessed neither cost-effectiveness of these products. Medicinal plants are potential cost effective antimicrobial and wound healing products for STSG donor site wound dressing. However, more clinical researches including patient quality of life among outcome measures are needed.

Adverse events after surgery for injuries to the subaxial cervical spine: analysis of incidence and risk factors

PurposeTo determine the incidence of severe surgical adverse events (sSAE) after surgery of patients with subaxial cervical spine injury (sCS-Fx) and to identify patient, treatment, and injury-related risk factors.MethodsRetrospective analysis of clinical and radiological data of sCS-Fx patients treated surgically between 2010 and 2020 at a single national trauma center. Baseline characteristics of demographic data, preexisting conditions, treatment, and injury morphology were extracted. Incidences of sSAEs within 60 days after surgery were analyzed. Univariate analysis and binary logistic regression for the occurrence of one or more sSAEs were performed to identify risk factors. P-values < .05 were considered statistically significant.ResultsTwo hundred and ninety-two patients were included. At least one sSAE occurred in 49 patients (16.8%). Most frequent were sSAEs of the surgical site (wound healing disorder, infection, etc.) affecting 29 patients (9.9%). Independent potential risk factors in logistic regression were higher age (OR 1.02 [1.003–1.04], p = .022), the presence of one or more modifiers in the AO Spine Subaxial Injury Classification (OR 2.02 [1.03–3.96], p = .041), and potentially unstable or unstable facet injury (OR 2.49 [1.24–4.99], p = .010). Other suspected risk factors were not statistically significant, among these Injury Severity Score, the need for surgery for concomitant injuries, the primary injury type according to AO Spine, and preexisting medical conditions.ConclusionsSAE rates after treatment of sCS-Fx are high. The identified risk factors are not perioperatively modifiable, but their knowledge should guide intra and postoperative care and surgical technique.

Application of tensor fascia lata perforator flap in head and neck reconstruction

The aim of this study was to describe the authors’ experience in head and neck reconstruction with the tensor fascia lata perforator flap (TFLPF). Between April 2009 and August 2020, 16 patients underwent head and neck reconstruction with a TFLPF. The flaps were designed in a vertical or transverse fashion based on perforators traveling along the medial or lateral aspect of the posterior edge of the tensor fascia lata muscle. Clinical details and postoperative results were recorded and analyzed. The size of the flap ranged from 7 × 5 cm2 to 25 × 9 cm2. The perforators were mostly septocutaneous (11 patients), allowing a simple and straightforward dissection of the perforator and TFLPF in most patients. There were either one or two perforators in all cases. The overall flap survival rate was 100%. All of the flaps healed uneventfully with no delayed wound healing or donor site dysfunction. Follow-up ranged from 18 to 120 months, during which all patients experienced satisfactory functional and aesthetic results, without serious complications at either the recipient or donor site. The TFLPF is a pliable and reliable flap that could be a first choice in selected head and neck reconstruction cases.

A meta-analysis of topical Ketorolac's effect on surgical site wound healing post-cataract surgery.

This meta-analysis evaluates the impact of topical ketorolac on surgical site wound healing and scar formation after cataract surgery. A thorough literature search, adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, identified eight relevant studies from 2348 articles. The selected studies were analysed for wound healing efficacy, using the redness, edema, ecchymosis, discharge and approximation (REEDA) scale, and scar formation, assessed by the Manchester scar scale (MSS). Results indicated that ketorolac significantly improved wound healing, with lower REEDA scores 1 week post-surgery (I2 = 97%; Random: standardised mean difference (SMD): -10.93, 95% CI: -13.85 to -8.00, p < 0.01), and reduced scar formation, evidenced by lower MSS scores 3 months post-surgery (I2 = 74%; Random: SMD: -9.67, 95% CI: -11.03 to -8.30, p < 0.01). The findings suggest that topical ketorolac is beneficial in post-cataract surgery care, enhancing wound healing and reducing scarring.

Efficacy of platelet-rich plasma in alleviating split skin graft morbidities.

Skin grafting is a routinely employed technique to cover the skin defect. Though the skin grafts are technically effortless, they are tiresome because of the prolonged duration of hospital stay, labor-intensive, demanding repeated dressings, and also create a second wound. Platelet-rich plasma (PRP) is one that has a higher concentration of platelets than the blood. Alpha granules of the platelets are rich in growth factors. To assess the effect of PRP on split-thickness skin graft uptake and donor site healing. In a single-center-based prospective study done from August 2018 to June 2020, 60 patients with acute and chronic wounds were divided into two equal groups. Autologous PRP was applied on the recipient wound bed and donor site in PRP group, and conventional methods like staples/sutures were used to anchor the skin grafts and standard of care of the donor site in a control group. Instantaneous graft adhesion was observed in all patients of PRP group. The first graft inspection was delayed. Seroma, hematoma, total number of dressings, and duration of stay in hospital were significantly reduced in the PRP group. Donor site pain in the postoperative period was notably reduced in PRP group. PRP also remarkably hastened the donor site healing. The application of PRP promotes graft take, minimizes complications, enhances donor site wound healing, mitigates donor site pain, and has immense economic benefits due to the reduced number of dressing changes and shorter hospital stay.

Comparative study of wound outcomes and surgical strategies: Internal fixation versus external stabilization in rib fracture patients with traumatic chest wounds.

The clinical management of traumatic chest incisions accompanied by rib fractures presents the formidable challenge. The study was carried out to compare the outcomes of auscultatory triangle internal fixation (ATIF) and external fixation (EF) in such injuries. From June 2019 to June 2022, 105 patients with multiple rib fractures participated in the cohort study in which they were divided into two groups: 53 patients underwent ATIF and 52 patients underwent EF. The incidence of surgical site infection, wound healing time, incidence of wound dehiscence, number of dressing changes, pain as measured by the visual analogue scale (VAS), duration of hospitalization, period of return to work, pulmonary complications and functionality of the upper limbs as assessed by the Disability of Arm, Shoulder, and Hand (DASH) questionnaire were among the parameters evaluated. In comparison with EF, ATIF demonstrated the decreased incidence of wound dehiscence (1.9% vs. 9.6%) (p < 0.05), surgical site infection (3.8 vs. 11.5) and wound healing time (12.3 ± 2.1 vs. 18.5 ± 3.7 days) (p < 0.05). Furthermore, during their ATIF treatment, patients required fewer changes of dressing (3.5 ± 0.8 vs. 5.7 ± 1.2) and demonstrated enhanced pain management, reduced hospital stays and expedited return to work (p < 0.05). ATIF group demonstrated enhancements in both upper limb functionality and post-operative pulmonary function (p < 0.05). The utilization of ATIF as opposed to EF for the treatment of traumatic chest wounds accompanied by rib fractures yields superior outcomes in terms of wound healing, infection reduction and restoration of pulmonary and upper limb functionality.

The impact of psychological interventions on surgical site wound healing post-surgery in psoriasis patients: A meta-analysis.

This meta-analysis investigates the impact of psychological interventions on the wound healing process at surgical sites in patients with psoriasis who have undergone various surgical procedures. Following the PRISMA guidelines, an extensive database search was conducted, initially identifying 679 articles, with 6 studies ultimately meeting our rigorous selection criteria. These studies, which included both Randomized Controlled Trials and observational designs, utilized a range of scales, such as the REEDA and Manchester Scar Scale (MSS), to measure the healing of surgical wounds. Statistical analyses were performed using Review Manager and SPSS, revealing that psychological interventions significantly expedited wound healing as early as 1 week post-surgery (I2 = 93%; Random: SMD = -3.01, 95% CI: [-4.35, -1.66], p < 0.01), according to the REEDA scale. At the one-month follow-up, a continued positive effect was observed on the MSS (I2 = 69%; Random: SMD = 2.31, 95% CI: [1.54, 3.08], p < 0.01). The studies demonstrated a low risk of bias, and funnel plot analysis suggested no significant publication bias. These results highlight the beneficial role of psychological support in the postoperative recovery of psoriasis patients, suggesting a need for a more integrated approach to patient care that includes psychological well-being as a component of comprehensive treatment strategies.

Wound complication risk factors following open reduction and internal fixation of ankle fractures.

This study was designed to identify risk factors for wound complications including surgical site infection (SSI) and wound healing issues following open reduction and internal fixation (ORIF) of ankle fractures. A retrospective analysis of individuals with ankle fractures treated with ORIF was undertaken. Study subjects were divided into a wound complications (WC) group and a no wound complication (NWC) group. The WC group was further divided into an SSI group and wound healing issues group. Twenty-one potential risk factors associated with wound complications after ORIF were tracked. Uni- and multivariate binary logistical regression analyses were used to identify risk factors associated with wound complications, ISS and wound healing issues. In total, 613 individuals, who had undergone surgery for ankle fractures formed the study cohort. The incidence of postoperative wound complications was 10.3% (63 cases), including 5.2% of SSI (32 cases) and 5.1% of wound healing issues (31 cases). The independent risk factors for wound complications were age 65 years or older, preoperative serum albumin level below 35 g/L, peripheral neuropathy, open fracture, fewer than seven cases per year in surgical volume, and attending surgeon level. The independent risk factors for SSI were age 65 years or older, preoperative serum albumin level below 35 g/L, open fracture and fewer than seven cases per year in surgical volume. The independent risk factors for wound healing issues were preoperative serum albumin level below 35 g/L, peripheral neuropathy, open fracture and attending surgeon level. Herein we found both factors inherent to the injury and individual and those pertaining to the surgical team affected the frequency of wound complications after ORIF of ankle fractures. Specifically, advanced age and low surgical volume were associated with a greater risk of SSI. Peripheral neuropathy and the low expertise level on the part of the surgeon were associated with a greater risk of wound healing issues. Hypoproteinaemia and open fracture were both associated with a greater risk of both SSI and wound healing issues.