Wound Length Research Articles

Prehabilitation and Nutrition in Hernia Surgery

AbstractVentral hernia repair (VHR) is among the most frequently performed surgical procedures in the United States. Despite advancements in surgical technique, a significant number of VHR patients experience postoperative complications and hernia recurrence. A key strategy to reduce VHR morbidity is patient optimization before surgery with prehabilitation protocols. Prehabilitation aims to improve patients' functional status with physical conditioning, nutritional intervention, and psychological support. In other surgical disciplines, prompt preoperative action has proven to significantly reduce the negative influence of modifiable comorbidities and accelerate recovery. In this article, we review the literature to assess the applicability and benefits of prehabilitation in elective VHR cases. A review of the available evidence identified obesity, hyperglycemia, and smoking as significant modifiable risk factors that negatively affect VHR outcomes. Prehabilitation has the potential to mitigate and control these comorbidities. Physical conditioning with aerobic, resistance, and inspiratory muscle training is beneficial. Nutritional intervention to control diabetes and in severely malnourished patients is especially important in patients undergoing concomitant gastrointestinal procedures with VHR. Reasonable targets for prehabilitation protocols in elective VHR include a body mass index of 35 kg/m2, HbA1C of 6.5% and tobacco abstinence for at least 4 weeks. Prophylactic measures to minimize the rates of incisional hernia after primary laparotomy repairs include mesh reinforcement and a suture to wound length ratio of at least 4:1.

Skin tumour specimen shrinkage with excision and formalin fixation-how much and why: a prospective study and discussion of the literature.

Surgical skin specimens are known to undergo significant shrinkage when excised and processed. The degree of shrinkage is important for medical care, research and third-party assessment. Studies to date have shown variable degrees of shrinkage. Most have included multiple and sometimes unspecified variables-different surgeons, varied sites, ill-defined excision patterns and/or multiple pathologies. This study tries to exclude many of these variables to try to ascertain a more accurate predictor of shrinkage with a single surgeon, lower limb only site using a controlled excision pattern and restricted pathology cohort. 100 previously untreated malignant BCC's and SCC's on the lower limb were excised and measurements made of the resulting wound and the specimen removed. Measurements were subsequently made after pathologic processing and statistically compared. With excision of lower limb skin tumours the surgical defect enlarges significantly (15%) and the specimen shrinks significantly (20%) in both length (12%) and width (9%). The specimen shrinks a further 11%-again shrinking in length (8%) and width (2.6%) with formalin processing. The pathology specimen is 28.6% smaller than the specimen marked for excision. Anatomical site contributes to the degree of shrinkage. The pathologic specimen is only 75% of the suture repaired wound length. Skin specimens shrink significantly both with excision and processing. Most shrinkage (70%) takes place with excision while the remaining 30% with processing. The shrinkage takes place disproportionately in the normal tissue component of the specimen. Age, anatomical location, and pathology appear to play a part.

Estimating the Volume of Equine Rabies Immunoglobulin (eRIG) Required for Local Infiltration in Soft Tissue Animal Bites in Children Using a Wound Size-Based Approach.

Post-exposure prophylaxis using rabies immunoglobulin (RIG) is universal recommendation for category III exposures. This study was conducted to determine quantity of RIG used to infiltrate animal bite wounds in relation to longest dimension and area of wound. Children aged 2-18 years reporting within 7 days of category III animal bite were included. eRIG (300 IU/ml) was used in all subjects. A predesigned proforma was filled for clinical and epidemiological details of subjects. Maximum length and width of wounds was measured by using non-stretchable measuring tape. RIG was infiltrated in wounds as per WHO recommendations and volume infiltrated was noted. A total of 100 subjects were enrolled. The mean (±SD) volume of RIG infiltrated in wounds per unit length was 0.75 (±0.21) ml/cm and per unit area was 3.18 (±1.75) ml/cm2. Regression equations were calculated. Proposed equations y = 0.6x + 0.3, where y is the volume of RIG (ml) and x is the length of the wound (cm) and y = 0.9x + 1.1, where y is the volume of RIG (ml) and x is the area of the wound (cm2) can prove to be a useful tool in RIG volume calculation for primary health care providers.

The impact of surgical training on early and long-term outcomes after isolated aortic valve surgery.

OBJECTIVESPatients presenting with more comorbidities, requiring more complex cardiac surgical procedures and an increase in public scrutiny are impacting on training programme because of the perceived risk of worse outcomes. Hence, we aimed to provide evidence that trainees as the first operator can achieve comparable results to consultants when performing isolated surgical aortic valve replacement. METHODSFrom 1996 to 2017, 2919 patients underwent surgical aortic valve replacement at the Bristol Heart Institute, operated on by either a consultant (n = 2220) or a trainee (n = 870) as the first operator. Propensity score matching was used to adjust for imbalance in the baseline characteristics of the 2 groups.RESULTSOver a 21-year period, the proportion of trainee cases dropped from 41.5% to 25.9%. No differences in the rates and risk of in-hospital mortality, new cerebrovascular accidents, re-exploration for bleeding, deep sternal wound infection and length of stay were found between patients operated on in the 2 groups. Also, there was a comparable risk of late death between the 2 groups (HR 0.88; 95% CI 0.73–1.06; P = 0.27) and this was present regardless of trainees career level and patients surgical risk based on the EuroSCORE. Finally, we showed an increase in patients risk profile in the latest year but, this was not associated with the worst outcomes when trainees performed the operation.CONCLUSIONSSurgical aortic valve replacement is a safe and reproducible technique and regardless of the patient’s risk profile, and no differences in the outcomes between trainees and consultant cases were found.

Cosmetic Outcome of Wound Closure between Steri-Strips (3M™ Steri-Strip) and Simple Interrupted Nylon 6-0 Sutures in Out-Patient Cervical Lymph Node Excision: A Randomized Controlled Trial

Objective: To compare the aesthetic outcome of cervical lymph node excision skin closure between Steri-Strips closure and simple interrupted sutures using Nylon 6-0. Materials and Methods: The present study was a single-blinded randomized controlled trial of forty patients with cervical lymph node excision. They were randomized into two groups of twenty. The first group was allocated to close the skin by simple interrupted sutures with Nylon 6-0, the other group received the Steri-Strips for skin closure. Complications were observed at the first and second week. The aesthetic outcomes for skin closure were evaluated at 12 weeks postoperatively using the predetermined Sakka’s cosmetic assessment criteria and scoring system. Results: There was no statistically significant difference between the two groups in terms of gender, age, length of surgical wound, and pathology. The Steri-Strips group showed significantly lower Sakka’s aesthetic score compared to the 6-0 Nylon sutures group (6.25±0.85 and 7.75 ±1.33, p<0.001). There was no significant difference in aesthetic outcomes between genders. Moreover, the operative time of the Steri-Strips group was significantly less than that of the 6-0 Nylon sutures group (2.2±0.41 and 4.75±0.44 minutes, p<0.001). Conclusion: Skin closure with Steri-Strips gave better aesthetic outcomes compared to the 6-0 Nylon sutures (p<0.001). However, the aesthetic outcomes were assessed by physicians, so the patients’satisfaction could not be assessed. Keywords: Lymph node biopsy; Hypertrophic scar; Keloid; Cosmetic outcome; Steri-strip

Comparison Between Topical Sucralfate, Topical Platelet-Rich Plasma and Topical Ozonated Virgin Coconut Oil to Enhance Wound Healing in Diabetic Ulcer Mice model

Diabetic ulcer is a serious complication of diabetes mellitus which can lead to further morbidity. Sucralfate, Platelet-rich plasma (PRP) and ozonated virgin coconut oil (VCO) has been shown to provide good clinical outcomes in chronic ulcer healing. This study compares the effectiveness of topical sucralfate, topical PRP and topical ozonated VCO therapy for diabetic ulcer treatment in Wistar mice by observing wound length and vascular endothelial growth factor (VEGF). Ninety Wistar mice with full-thickness ulcer model on the back were divided into 5 groups. Four groups of mice were receiving diabetic induction using streptozotocin injection and were allocated as topical sucralfate (TS), topical PRP (TP), and topical ozonated VCO (TO) group. The remaining diabetic-positive mice were allocated as the diabetic-positive control group (PC) which received standard therapy, and the other non-diabetic mice were allocated as the diabetic-negative control group (NC) which did not receive any therapy. Topical ozonated VCO enhances the wound healing process better with the greatest wound reduction area and highest VEGF expression compared to topical sucralfate and topical PRP. Topical ozonated VCO can potentially accelerate wound healing in diabetic ulcers better than topical sucralfate and topical PRP.

Potential Antiseptic of Rhodomyrtus tomentosa leaves extract on Healing wound in Male Wistar rats

Background: The process of wound healing is influenced by various factors such as age, hormones, and wound care. Wound care is done to accelerate wound healing which can be done by various methods, one of them is traditional care. Traditional wound care can use medicinal plants. Rhodomyrtus tomentosa is a medicinal plant that has an antioxidant, anti-inflammatory, antitumor and antibacterial content. Thus this study aims to evaluate the effectiveness of the antiseptic solution of the Rodhomyrtus tomentosa leaf extract on wound healing in male Wistar rats. Method: this research is pure experimental research with post test only control group design. Thirty male white rats were divided into five groups, namely negative control, positive control, Rhodomyrtus tomentosa leaf extract 15%, 30%, and 60%. Rhodomyrtus tomentosa leaf extraction was carried out by maceration method with 70% ethano solvent. The extraction results are divided into 3 concentrations (15%, 30% and 60%). The wound healing process was evaluated by measuring the length of the wound manually from 0 to 10 days in each group. Meanwhile, the number of fibroblast cells was calculated through hematoxylin eosin (HE) staining and observed using an Olympus CX41 microscope with a 10x magnification and objective lens magnification in 3 fields. Result: There was a significant difference in the reduction in wound length (p =< 0,000) between the five experimental groups (Rhodomyrtus tomentosa leaf extract solution 15%, 30% and 60%, negative control and positive control. Solution of rhodomyrtus tomentosa leaf extract accelerated the increase in the number of fibroblasts compared to the negative control group (p = 0.003), but did not make a difference (p = 0.403) with the positive control group. Rhodomyrtus tomentosa leaf extraction solution had the same microscopic effect on the number of fibroblasts with a positive control group given 0.9% NaCl solution. Conclusion: There was a significant difference in the number of fibroblasts between all groups, but no difference in wound healing length.

Intraocular Foreign Bodies: Clinical Characteristics and Factors Affecting Visual Outcome.

Objective To investigate the clinical characteristics and factors affecting visual outcome in patients with intraocular foreign bodies (IOFBs) and determine the risk factors for the development of endophthalmitis. Study Design. A retrospective case-series study design was adopted. Subjects In total, 242 patients (242 eyes) who were hospitalized and underwent surgical treatment for IOFB at the Second Hospital of Hebei Medical University between January 1, 2008, and December 31, 2019, were included. Methods The demographic data, cause of injury, characteristics of IOFBs, postinjury ocular manifestations, and surgical details of the subjects were collected, and the factors affecting visual outcome and endophthalmitis development were analyzed. Results The most common cause of IOFBs was the propulsion of foreign bodies into the eye due to hammering (149 cases, 61.57%), followed by foreign body penetration (57 cases, 23.55%). Most of the subjects were young adult men who sustained injuries in the work environment. Poorer visual outcomes were found in subjects with initial presenting symptoms visual acuity (PVA) < 0.1, largest IOFB diameter ≥ 3 mm, IOFBs located in the posterior segment, wound length > 5 mm, entrance wound length larger than the largest IOFB diameter, concomitant retinal detachment, concomitant vitreous hemorrhage, concomitant endophthalmitis, and concomitant proliferative vitreoretinopathy (PVR). Factors related to the development of endophthalmitis included lens capsule rupture, time of stage 1 repair surgery ≥ 24 h after trauma, removal of IOFBs ≥ 24 h after trauma, and nonadministration of intravitreal antibiotic injection. Conclusion Among patients with IOFBs, initial PVA < 0.1, entrance wound length larger than the largest IOFB diameter, concomitant endophthalmitis, and concomitant PVR were risk factors for poor visual outcomes. Lens capsule rupture was a risk factor for endophthalmitis development, and the administration of intravitreal antibiotic injection was a protective factor against endophthalmitis development.

Analysis of 85 Cases of Minimal Media Lower Hemisternotomy for Congenital Cardiac Surgery Under Cardiopulmonary Bypass in Infants.

To investigate the feasibility and effect of minimal media lower hemisternotomy for cardiac surgery under cardiopulmonary bypass (CPB) in infant congenital heart disease. In our hospital from May 2019 to October 2019, 170 infants with congenital heart disease underwent surgical treatment (median age 6.6 months; weight 6.0 kg). They were divided into 2 groups: those with conventional chest median incision and those with minimal sternotomy. Minimal lower hemisternotomy began from the third intercostal level and ended 0.5 cm above the xiphoid, just enough to insert a small sternal distractor. There was no significant difference between the 2 groups in CPB time. The operation time of small incision group was slightly longer (P < .05). There was no difference in prognosis between the 2 groups, but the wound length of the small incision group was significantly reduced (4.0 ± 0.5 versus 7.8 ± 0.8 cm, P < .05). Time of intensive care unit and hospital stay was shorter among hemisternotomy patients at a statistically significant level (P < .05). Minimal media lower hemisternotomy with the basic advantages of the sternal incision can expose the various parts of the heart, which meets most cardiac exploration and surgical operation needs, and the incision may still be extended if necessary. Lower hemisternotomy appears to be a safe, effective, and versatile alternative for many surgical interventions in infants with congenital heart disease.

Wind Turbine Power Calculations Using MATLAB-SIMULINK

In this paper modeling and simulation has been studied by means of impact of energy generated by using wind turbine. The strength conversion primarily depends on the wind velocity and swept area. When design wind structures it’s very important to recognize predicted electricity and electricity output for calculating financial viability. Wind turbine performance depends on wind speed, air density, air pressure, temperature and length of blade. The modeling and simulation method is used to analyze the overall performance of wind turbine.

A NEW TECHNIQUE FOR MASTECTOMY INCISION TO AVOID DOG EAR FORMATION IN LARGE SIZED BREASTS

Breast cancer has now surpassed lung cancer as the leading cause of global cancer incidence in 2020, Following a standard mastectomy for breast cancer in obese or large sized breast patients, Dog ear, a characteristic bunching up of excess tissue formed during wound closure.While it is not always possible to prevent dog ear deformity, over the past five decades, various surgical techniques have been reported. That functionally and aesthetically corrects dog ear without significantly extending the length of the original wound. No optimal technique is recommended for all cases. However, existing techniques are appropriate in specific context.Aim of the work:The aim of this study is to describe smiley mastectomy as a method to avoid lateral dog ear formation in patients with large breast size, and /or high BMI in comparison to other techniques.Methods:Our study included 60 patients, with breast cancer they were candidates for modified radical mastectomy, they had large breast size, thus prone to have lateral dog ear; 30 of them will undergo MRM using smiley incision (group A), and the other 30 patients will undergo MRM using the elliptical incision (group B).They were all submitted to: personal data, history, examination and investigations

Measuring the self-generated magnetic field and the velocity of plasma flow in a pulsed plasma accelerator

In phase of radial compression the unsteady plasma flow at the exit of a pulsed plasma accelerators is related to the generation of fast high-energy charged particle beams, to plasma density perturbations, to the internal plasma pressure is opposite to the external magnetic pressure (B2/2μ0) associated with plasma column’s self-generated magnetic field. The last one listed above is of particular interest. The investigation of the magnetic field of plasma flow relatively gives information about the above mutually close factors cause to plasma flow instability.In this paper a miniature high-frequency magnetic probe are made for measuring and further investigating the pulsed self-generated magnetic field of plasma flow, in particular, at the exit of the accelerator in an experimental setup of PPA (located in KazNU, IETP). The magnetic probe dimensions are following: coil diameter is 2,12 mm, number of turns is 7, copper wire diameter is 150 μm, and winding length is 1, 1 mm. The coil inductance is about 0,113 μH and the temporal resolution of the magnetic probe is 2,3 ns. The magnetic probe was calibrated using a Hall sensor on the magnetic field of a multi-layered solenoid connected to an alternating power source of 15 A. Thus, the evaluated measurement error of the probe was no more than 10%.

AMBON BANANA PEEL EXTRACT GEL (Musa paradisiaca var. Sapientum (L.) Kunt) ACCELARATES OF WISTAR RATS GINGIVA WOUND HEALING

A wound is a cut through the anatomical structure of tissue due to an incision of a sharp-edged object. Ambon banana peel contains tannins, flavonoids, and saponins which act as an anti-inflammatory antioxidant and antibacterial properties that facilitate the wound healing process. This research attempted to know the effect of ambon banana peel gel extract (Musa paradisiaca var. Sapientum (L.) Kunt) on wound length healing of gingiva mucosa cuts in Wistar rats. The was a pure experimental study with a sample size of 30 Wistar rats divided into three groups; the treatment group was given 10% ambon banana peel gel extract. The positive control group was assigned 10% povidone-iodine, and the negative control group was given aquades. The research was conducted by making an incision on maxillary gingival mucosa 3 mm wide in the horizontal direction with a depth of 0.25 mm using blade number 11. Observations were performed on days 0, 3, 7, and 14 after treatment using a digital calliper. Data were analyzed using the Kruskal Wallis test and then the post hoc test using the Mann Whitney test (p &lt;0.05 significant). The research results showed that the treatment group given 10% ambon banana peel gel extract had a significant difference with a p-value &lt;0.05 compared to the positive and negative control groups on days 3, 7, and 14. The research shows 10%. The concentration of ambon banana peel gel extract affects the accelerating wound healing process in the gingiva mucosa of Wistar rats.

The Kempe incision for decompressive craniectomy, craniotomy, and cranioplasty in traumatic brain injury and stroke.

Decompressive craniectomy (DC) is an effective, lifesaving option for reducing intracranial pressure (ICP) in traumatic brain injury (TBI), stroke, and other pathologies with elevated ICP. Most DCs are performed via a standard trauma flap shaped like a reverse question mark (RQM), which requires sacrificing the occipital and posterior auricular arteries and can be complicated by wound dehiscence and infections. The Ludwig Kempe hemispherectomy incision (Kempe) entails a T-shaped incision, one limb from the midline behind the hairline to the inion and the other limb from the root of the zygoma to the coronal suture. The authors' objective in this study was to define their implementation of the Kempe incision for DC and craniotomy, report clinical outcomes, and quantify the volume of bone removed compared with the RQM incision. A retrospective review of a single-surgeon experience with DC in TBI and stroke was performed. Patient demographics, imaging, and outcomes were collected for all DCs from 2015 to 2020, and the incisions were categorized as either Kempe or RQM. Preoperative and postoperative CT scans were obtained and processed using a combination of automatic segmentation (in Python and SimpleITK) with manual cleanup and further subselection in ITK-SNAP. The volume of bone removed was quantified, and the primary outcome was percentage of hemicranium removed. Postoperative surgical wound infections, estimated blood loss (EBL), and length of surgery were compared between the two groups as secondary outcomes. Cranioplasty data were collected. One hundred thirty-six patients were included in the analysis; there were 57 patients in the craniotomy group (44 patients with RQM incisions and 13 with Kempe incisions) and 79 in the craniectomy group (41 patients with RQM incisions and 38 Kempe incisions). The mean follow-up for the entire cohort was 251 ± 368 days. There was a difference in the amount of decompression between approaches in multivariate modeling (39% ± 11% of the hemicranium was removed via the Kempe incision vs 34% ± 10% via the RQM incision, p = 0.047), although this did not achieve significance in multivariate modeling. Wound infection rates, EBL, and length of surgery were comparable between the two incision types. No wound infections in either cohort were due to wound dehiscence. Cranioplasty outcomes were comparable between the two incision types. The Kempe incision for craniectomy or craniotomy is a safe, feasible, and effective alternative to the RQM. The authors advocate the Kempe incision in cases in which contralateral operative pathology or subsequent craniofacial/skull base repair is anticipated.

Factors Affecting Operation Duration in Posterior Spinal Fusion (PSF) Using Dual Attending Surgeon Strategy Among Lenke 1 and 2 Adolescent Idiopathic Scoliosis (AIS) Patients.

This was a retrospective study. Prolonged operation duration in adolescent idiopathic scoliosis (AIS) surgery was associated with increased perioperative complications. However, the factors affecting operation duration in AIS surgery were unknown. The aim of the study was to investigate the factors affecting operation duration in posterior spinal fusion (PSF) surgery using a dual attending surgeon strategy among Lenke 1 and 2 AIS patients. In all, 260 AIS patients with Lenke 1 and 2 curves who underwent PSF were retrospectively reviewed. Preoperative and intraoperative factors affecting operation duration such as age, sex, height, weight, body mass index, Risser grade, Lenke subtypes, number of fusion level, number of screws, screw density, wound length, upper and lowest instrumented vertebrae level, preoperative Cobb angle, and flexibility of the major curve were assessed using univariate and multivariate linear regression analyses. Independent factors were determined when P-value <0.05. The mean operation duration was 122.2±28.6 minutes. Significant independent factors affecting operation duration in PSF among Lenke 1 and 2 AIS patients were Lenke 2 subtypes (β=8.86, P=0.008), number of screws (β=7.01, P<0.001), wound length (β=1.14, P=0.009), and flexibility of the major curve (β=-0.25, P=0.005). The overall model fit was R2=0.525. Operation duration can be predicted using the formula: (8.86×Lenke subtypes)+(7.01×number of screws)+(1.14×wound length)-(0.25×flexibility)-0.54, where Lenke 2=1 and Lenke 1=0. The factors affecting operation duration in PSF among Lenke 1 and 2 AIS patients were Lenke 2 curves, number of screws, wound length, and curve flexibility. The knowledge of these factors enables the spinal deformity surgeons to plan and estimate the operation duration before AIS surgery.

Selection of retroperitoneal access during intervertebral disc endoprosthesis in lumbar spine

The morphometric parameters and surgical areas of risk of retroperitoneal approach were studied for endoprosthetics of intervertebral discs in the lumbar spine to reduce trauma and reduce the risk of complications. The study included 110 patients operated on in the period from 2017 to 2020 (72 men, 38 women) in the neurosurgical department of the 1586 Military Clinical Hospital. The average age of the patients was 44.9 15.4 years. According to the localization of access to the lumbar spine, the patients were distributed as follows: LIIILIV 8 (7.3%), LIVLV 46 (41.7%), LVSI 56 (51%). It was found that, for the intervertebral disc LV SI, the length of the skin incision was 92.5 (80; 100) mm, the length of the surgical wound was 80 (80; 110) mm, the thickness of the subcutaneous fat layer was 30 (15; 40) mm, the depth of the wound was to the spine 85 (70; 120) mm, the depth of the wound to the spinal canal 125 (107.5; 152.5) mm, the angle of operation in the horizontal plane at the level of the spine 52 (47; 59.5) degrees. On the basis of the anthropometric data of patients, the optimal length of the skin incision was determined for performing the retroperitoneal approach (120 mm for level LIIILIV, 100 mm for level LIVLV). Three variants of the inferior vena cava bifurcation have been identified for different levels of intervertebral discs in the lumbar spine: high bifurcation, left common iliac vein mainly overlaps the left half of the LIVLV intervertebral disc and does not overlap the LVSI intervertebral disc; middle bifurcation, left common iliac vein overlaps the central part of the intervertebral discs LIVLV and LVSI; low bifurcation, inferior vena cava overlaps the right side of the intervertebral disc LIVLV, inferior vena cava and left common iliac vein completely overlap the intervertebral disc LVSI. The data obtained can be used when planning retroperitoneal access to the lumbar spine in order to reduce the trauma of the operation.

Topical ozonated virgin coconut oil improves wound healing and increases HSP90α, VEGF-A, EGF, bFGF and CD34 in diabetic ulcer mouse model of wound healing

Background: Diabetes is a disease that affects people worldwide, including in Indonesia. The prevalence of diabetes in Indonesia is increasing from year to year. One of the most devastating complications of diabetes mellitus is diabetic ulcers, which is a limb-threatening complication. Over the past few decades, ozone generated using plasma medical technology has been investigated as an agent that helps wound healing. This study aims to evaluate the effects of topical ozonated virgin coconut oil (VCO) in a diabetic wound mouse model. Methods: This study was an experimental study with a post-test control design. An ulcer wound model was made in 50 diabetic male Wistar mice, divided into five groups, and a control group of 10 non-diabetic mice. The control groups were given conventional therapy only and the treatment groups were also given topical ozonated VCO with different flow durations (0 min, 90 min, 7 h, 14 h). Macroscopic appearance and wound contraction were observed. HSP90β, VEGF-A, EGF, bFGF and CD34 levels were measured from the immunostained slices of wound margins. Results: The reduction of wound length was proportionally related to the duration of ozone flow. Ozonated VCO with a longer duration of ozone flow healed the wound more quickly and had the shortest wound length. VCO with ozone flow for 14 hours (16837.10 µm) had the biggest reduction in wound length compared to other groups. The wounds treated with ozonated VCO showed an increase in HSP90β, VEGF-A, EGF, bFGF and CD34 levels that correlated to improved wound healing. A longer period of treatment resulted in higher levels of wound healing biomarkers compared to shorter therapeutic durations. Conclusions: Topical ozonated VCO improved the wound healing process in a diabetic ulcer mouse model by improving macroscopic wound appearance and increasing levels of wound healing biomarkers.

662 Single Surgeon Experience Using a Polyactide-based Copolymer Dressing to Over and Secure Split Thickness Skin Grafts in Burn Patients.

Abstract Introduction In both partial thickness burns and skin graft donor sites, coverage with Polylactide-based copolymer dressing (PLBC dressing) has been shown to result in expedited healing and improved pain outcomes when compared to more traditional techniques. These advantages are generally attributed to the way in which PLBC remains as an intact coating over the wound bed throughout the healing process, protecting wounds from the contamination and microtraumas associated with changes more conventional dressings. At our institution, we began selectively utilizing PLBC as a means of securing and protecting fresh skin graft, in hopes that we would find similar benefits in this application. Methods Clinical Protocol-- The PLBC dressing was used at the attending surgeon’s discretion. In these cases, meshed STSG was placed over prepared wound beds. Staples were not utilized. PLBC dressing was then placed over the entirety of the graft surface, securing graft in place by adhering to wound bed through intercises. (Staples were not used.) The graft and PLBC complex was further dressed with a layer of non-adherent cellulose based liner with petroleum based lubricant, and an outer layer of cotton gauze placed as a wrap or bolster. Post operatively, the outer layer (“wrap”) of gauze was replaced as needed for saturation. The PLBC and adherent “inner” liner were left in place until falling off naturally over the course of outpatient follow-up. Retrospective Review-- With IRB approval, patients treated PLBC over STSG between April 2018 to March 2019 were identified via surgeon’s log and pulled for review. Documentation gathered from operative notes, progress notes (inpatient and outpatient) and clinical photography was used to identify demographics, mechanism of injury, depth, total body surface area percentage (TBSA%), size of area treated with PLBC dressing, graft loss, need for re-grafting, signs of wound infection, antibiotic treatment, and length of stay. Results Twenty-two patients had STSG secured and dressed with PLBC. Median patient age was 36.5 years. Median TBSA was 5.1%, and median treated area 375 cm2. Follow up ranged from 21 to 232 days post-operatively, with two patients lost to follow up. All patients seen in outpatient follow up were noted to have “complete graft take” or “minimal” graft. None of the areas treated with PLBC dressing required re-grafting. There were no unplanned readmissions, and no wound infections were diagnosed or treated. Practitioners in in-patient setting and in follow up clinic reported satisfaction with the PLBC dressing. Conclusions The PLBC dressing was a feasible solution for securing and dressings STSGs. Future work is needed to determine whether its use is associated with an improvement in patient outcomes.

Repeat pulmonary resection for lung malignancies does not affect the postoperative complications: a retrospective study

BackgroundAlthough repeat pulmonary resection (RPR) for multiple lung cancer has been performed for non-small cell lung cancer and metastatic lung tumor, with the prognostic benefit detailed in several reports, the risk of RPR has not been well analyzed.MethodsPatients with lung malignancies who underwent complete resection at Kanazawa Medical University between January 2010 and October 2019 were analyzed. The relationship between postoperative complications and preoperative and perioperative factors was analyzed. Postoperative complications were categorized into five grades according to the Clavien–Dindo classification system.ResultsA total of 41 patients who were received RPR were enrolled in this study. Primary lung tumor was found in 31 patients, and metastatic lung tumor was found in 10 patients. The postoperative complication rate of the first operation was 29%, and that of the second operation was 29%. While there were no significant factors for an increased incidence of postoperative complication in a multivariate analysis, an operation time over 2 h at the second operation tended to affect the incidence of postoperative complication (p = 0.06). Furthermore, the operation time was significantly longer (p = 0.02) and wound length tended to be longer (p = 0.07) in the ipsilateral group than in the contralateral group. The rate of postoperative complications and the length of the postoperative hospital stay were not significantly different between the two groups.ConclusionRPR is safely feasible and is not associated with an increased rate of postoperative complications, even on the ipsilateral side.

Study of Wound Healing Activity and Skin Irritation of Chili Leaves (Capsicum frutescens L.) Gel in Rats (Rattus novergicus)

Chili pepper leaves have been used empirically as wound healing caused by sharp objects. Several studies show its antibacterial and wound healing activity. This study aims to make gel from chili leaves extract, then to determine its wound healing activity and its irritating properties on rat’s skin. Gel was made using variations type and concentration of gelling agent, consist of carbopol 0.5%, 0.75%, 1% and hydroxypropylmetlcellulose at 2.5%, 5% and 7.5% respectively. Cycling test then conducts to determined its physical stability. Gel that physically stable then evaluated its activity as a wound healer and skin irritation test. Results showed that all formula has no altered on organoleptic properties and pH value. Gel that made from 0.5% carbopol (F2) and 7.5% of HMPC (F5) has no change in spreadability and adhesion properties. Based on statistically analysis using paired t-test and one-way ANOVA, it concludes that F2 and F5 physically stable and could follow wound healer evaluation. Wound healer evaluation show that healing time (days) of carbopol base gel (F2) is 10.2±1.26, HPMC based gel is 8±0.82. Length of incision wound (cm) at the 8th day are 0.5±0.183 for F2 and 0.06±0.071 for F5. Statistically analysis of healing time (p&lt;0.01) and wound length (p&lt;0.05) show that F5 that contain 5% HPMC has significantly different compare to negative control. The results of the irritation test showed that gel formulas not caused erythema and edema on rat’s skin. It can be concluded that gel of chili pepper leave extract that made with 5% of HPMC has wound healing activity and safety to use.