Traumatic Wounds Research Articles

Role of platelet rich fibrin matrix in wound bed preparation in degloving injury

Degloving Injury are major debilitating conditions and its treatment is also challenging. The treatment of post traumatic degloving injury requires a multimodal approach. Adjuvant platelet rich fibrin matrix can be tried for post traumatic wounds as a modality for wound bed preparation. In this study we share our experience regarding the use of platelet rich fibrin matrix as an adjunct in the management of post traumatic degloving wounds of the lower extremity.

The boom is back — a flavour of BEVA Congress 2022

UK-Vet EquineVol. 6, No. 6 Conference ReportThe boom is back — a flavour of BEVA Congress 2022Euan LaidlawEuan LaidlawEquine vet, Scott Mitchell Veterinary Care, Hexham, NorthumberlandSearch for more papers by this authorEuan LaidlawPublished Online:9 Nov 2022https://doi.org/10.12968/ukve.2022.6.6.260AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Carslake HB. Should I place a subpalpebral lavage system in the upper or lower eyelid? Equine Vet Educ. 2019;31(6):335–6. Google ScholarMichotte M, Raes E, Oosterlinck M. Diagnostic accuracy of plain radiography to identify synovial penetration in horses with traumatic limb wounds. Proceedings of the British Equine Veterinary Association Congress, Liverpool, 2022 Google ScholarRossdale PD. Why the clinician should publish: publish and be praised. Equine Vet Educ. 2000;12(6):282-3. Google ScholarTatum RC, McGowan CM, Ireland JL. A cohort study of horses diagnosed with pituitary pars intermedia dysfunction in the United Kingdom. Proceedings of the British Equine Veterinary Association Congress, Liverpool, 2022 Google Scholar FiguresReferencesRelatedDetails 2 November 2022Volume 6Issue 6ISSN (print): 2516-0583ISSN (online): 2516-0591 Metrics History Published online 9 November 2022 Published in print 2 November 2022 Information© MA Healthcare LimitedPDF download

Maggot debridement therapy and complementary wound care: a case series from Nigeria.

Maggot debridement therapy (MDT) is an emerging procedure involving the application of sterile maggots of the Dipteran species (commonly Lucilia sericata) to effect debridement, disinfection and promote healing in wounds not responding to antimicrobial therapy. Data on MDT in sub-Saharan Africa (including Nigeria) are scarce. This study aimed to use medicinal grade maggots as a complementary method to debride hard-to-heal necrotic ulcers and thereby promote wound healing. In this descriptive study, we reported on the first group of patients who had MDT at Aminu Kano Teaching Hospital (AKTH), a tertiary hospital in northern Nigeria. The first instar larvae of Lucilia sericata were applied using the confinement (free-range) maggot therapy dressing method under aseptic conditions. Diabetic foot ulcer (DFU) grade III-IV constituted more than half of the wounds (53.3%), followed by necrotising fasciitis (30%), and post-traumatic wound infection (10%). Others (6.7%, included pyomyositis, surgical site infection and post traumatic wound infection). The median surface area of the wounds was 56cm2. Of the 30 patients, half (50%) had two MDT cycles with a median time of four days. Of the wounds, 22 (73%) were completely debrided using maggots alone while eight (27%) achieved complete debridement together with surgical debridement. Wound culture pre-MDT yielded bacterial growth for all the patients and Staphylococcus aureus was the predominant isolate in 17 wounds (56.7%) while Pseudomonas aeruginosa and Streptococcus pyogenes were predominant in five wounds (16.7%) each. Only four (13.3%) wound cultures yielded bacterial growth after MDT, all Staphylococcus aureus. A good prognosis was achieved post-MDT for various wounds. MDT effectively debrides and significantly disinfects wounds involving different anatomical sites, thus enhancing wound healing and recovery. MDT is recommended in such wounds.

Diagnostics of the prescription of damage to the pancreas in explosive trauma and gunshot wounds during a military conflict

Diagnostics of the prescription of damage to the pancreas in explosive trauma and gunshot wounds during a military conflict

Technique and Early Outcomes for High-Energy Calcaneus Fractures Treated With Staged External Fixation to Combined Open Reduction Internal Fixation and Subtalar Arthrodesis.

(1) To present an effective surgical technique for the treatment of open and high-energy calcaneal fractures with significant soft tissue injuries. (2) To present complications with this technique and to evaluate patient-reported outcomes of staged external fixation followed by delayed reconstruction with open reduction internal fixation (ORIF) and subtalar arthrodesis. Retrospective case series. Level I trauma center. Twelve patients with 13 calcaneus fractures associated with open traumatic wounds (10 patients) or other severe soft tissue injury (ie, fracture blisters) between April 2013 and December 2019. All patients were treated with staged ankle-spanning external fixation and delayed reconstruction with ORIF with subtalar arthrodesis. Patient-Reported Outcomes Measurement Information System (PROMIS) outcomes are presented via the domains of physical function (PF), pain interference (PI), and depression (D) in addition to visual analog score. Complications with the injury and surgical procedure were reported as well. Patients underwent initial stabilization on average 1.3 days (range, 0-12 days) from injury with stage II occurring on average 31.1 days (range, 18-42 days) from external fixation. Mean time to radiographic union was 5.6 months (range, 4-10 months). One-year mean PROMIS outcomes were as follows: PF final average of 37.4 with an average improvement of 12.2 (P < 0.01), PI final average of 62.2 with average improvement of 5.6 (P = 0.01), and D final average of 52.1 with average improvement of 6 (P = 0.12). Mean final visual analog score pain score was 3.6 with an average improvement of 2.25 (P = 0.01). Staged treatment with initial external fixation followed by ORIF and subtalar arthrodesis in the setting of highly comminuted calcaneus fractures with significant soft tissue compromise effectively addresses both bony and soft tissue concerns while providing for positive outcomes postoperatively with regards to pain and function. There were minimal complications noted for this complex injury. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Microfractured Adipose Tissue Graft for the Advanced Treatment of Non-Healing Cutaneous Fistulas

Chronic cutaneous non-healing fistulas very often are dehiscences of surgical or traumatic wounds that do not repair properly and progressively undergo intrafistular and perifistular fibrosis. The fibrous tissue constitutes a natural barrier to the progression of the fistula repair process and represents the major cause of non-healing and chronicization even in a context of proper vascularization. The microfractured autologous adipose graft allows to provide the tissues involved in the fibrotic process with a regenerative stimulus by MSCs (mesenchymal stem cells) contained in adipose clusters of 0.3 mm. In this context, MSCs are able to secrete cytokines with antibiotic, antifibrotic, angiogenic and analgesic effects. The micro-fragmentation technique guarantees a high regenerative effect, as the MSCs are not isolated enzymatically with the simultaneous destruction of the adipose tissue. The micro-fragmentation allows the maintainance of the structure of the adipose cluster including microvessels and allows it to amplify by 6000 times the active surface that exposes the MSCs. Our experience with the mechanical microfracturing method of lipoaspirate consists of 41 treatments. In 7 cases the graft was performed due to the presence of a non-healing cutaneous fistula, which lasted from 128 to 243 days. In 6 cases we achieved immediate repair and closure of the fistula while in one case the procedure failed. The purpose of the paper is to describe in detail our experience by an accurate description of the implemented method of the used device accompanied by the document with adequate photographic documentation.

Venom of the giant ant Dinoponera quadriceps attenuates inflammatory pain in mouse cutaneous wound healing model

Arthropod venoms are potential sources of bioactive substances, providing tools for the validation of popular use and new drugs design. Ants belonging to the genus Dinoponera are used in the folk medicine to treat inflammatory conditions. It was previously demonstrated that the venom of the giant ant Dinoponera quadriceps (DqV), containing a mixture of polypeptides, elicit antinociceptive effect in mice models of chemical, mechanical and thermal nociception. The aim of this study was to evaluate DqV antiinflammatory and antihypernociceptive effects in a mice model of traumatic cutaneous wound. Colonies of D. quadriceps were collected in the ‘Serra de Maranguape’ (State of Ceará, northeastern Brazil), a small mountain range located on the coastal zone, and the venom secreted by the ant glands was extracted with capillary tubes, further lyophilized and maintained at -20 ± 1ºC until use. Wounds were performed in the dorsum of Swiss mice. Animals received intravenous (i.v.) injection of DqV (50 µg kg-1 day-1) during 3 days for evaluation of inflammatory parameters present in the wounds: hypernociception, leukocyte infiltrate, myeloperoxidase activity, nitrite/nitrate content. Data was tested by two-way ANOVA and Bonferroni’s post-hoc test. DqV reduced (2.7 folds) hypernociception at 48 hours, leukocyte infiltration by 65% at 6 hours and myeloperoxidase activity by 60% at 0.5 hour after wound induction. In conclusion, the venom extracted from D. quadriceps glands attenuates inflammation and hypernociception in mice cutaneous wounds.

The effect of inflammation management on pH, temperature, and bacterial burden.

The aim of this feasibility study was to investigate the impact of inflammation management on wound pH, temperature, and bacterial burden, using the principles of TIME and Wound Bed Preparation. A quantitative non-comparative, prospective, descriptive observational design. Following ethical approval, 26 participants with 27 wounds of varying aetiologies were observed twice weekly for 2 weeks. Wounds were treated with cleansing, repeated sharp debridement, and topical cadexomer iodine. Wound pH (pH indicator strips), temperature (infrared camera), bacterial burden (fluorescence imaging) and size (ruler method) was monitored at each visit. The mean age of all participants was 47 years (SD: 20.3 years), and 79% (n=19) were male, and most wounds were acute (70%; n=19) and included surgical and trauma wounds, the remaining (30%; n=8) were chronic and included vascular ulcers and non-healing surgical wounds. Mean wound duration was 53.88 days (SD: 64.49 days). Over the follow up period, pH values ranged from 6 to 8.7, temperature (centre spot) ranged from 28.4°C to 36.4°C and there was an average 39% reduction in wound size. Inflammation management had a positive effect on pH, temperature, bacterial burden, and wound size. This study demonstrated that it was feasible to practice inflammation management using a structured approach to enhance wound outcomes.

Nonlung Solid Organ Transplantation from SARS-CoV-2–Positive Donors: Implications for Post-transplant Surveillance and Outcomes

INTRODUCTION: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has had a profound deleterious impact on solid organ transplantation (SOT) rates. There is limited evidence on the risk of donor-recipient SARS-CoV-2 transmission in nonlung SOT. METHODS: We performed a prospective IRB-approved descriptive study of nonlung SOT from SARS-CoV-2–positive donors to uninfected recipients between June 2021 and February 2022. We report donor and recipient characteristics, SARS-CoV-2–related testing and treatment, and short-term outcomes. RESULTS: Eighteen recipients had SOT from 17 SARS-CoV-2–positive donors, including 11 kidneys, 4 livers, and 4 hearts. Median follow-up was 63 days. Donors tested positive by lower respiratory or nasopharyngeal reverse transcriptase-polymerase chain reaction (RT-PCR). Cycle thresholds were reported for 59% of donors and ranged from 17.1 to 41.9. Causes of death were: drug intoxication (41%), cardiovascular (29%), blunt trauma (18%), stroke (6%), and gunshot wounds (6%). One donor was treated with monoclonal antibody casirivimab/imdevimab. All recipients had negative SARS-CoV-2 nasopharyngeal RT-PCR before SOT, and 17 of 18 patients had 2- or 3-dose mRNA vaccination pretransplant. Monoclonal antibody prophylaxis was given to 7 recipients. Routine RT-PCR testing was performed post-transplant in 17 of 18 patients. Two recipients tested positive on postoperative day 8 but developed no symptoms. All recipient grafts remain viable, and no recipients developed SARS-CoV-2–related illness. CONCLUSION: Transplantation of nonlung solid organs from SARS-CoV-2–positive donors to uninfected recipients can be performed safely.

Ethnobotanical, Phytochemical and Pharmacological Studies of Capsicum annuum L. (Solanaceae) in the Healing of Traumatic Wounds (Case of Eye Wounds): A Mini Review

Several studies have shown that the extracts of Capsicum annuum L. have been used in the treatment of various ailments (fever, colds, chest pain, cancer, cough, sore throat, toothache, cardiovascular disease, diabetes, wound healing Rheumatic wounds and inflammations, etc. It also inhibits bacterial growth and clumping of blood platelets.&#x0D; According to various bibliographical sources, Capsicum annuum L. is an excellent source of phytochemicals such as carotenoids, ascorbic acid, flavonoids, tocopherols and capsaïcinoïds which are very important in the prevention of chronic diseases mentioned above. This richness of the pigment in the possession of a diversity of bioactive molecules would constitute an excellent remedy in the healing of traumatic wounds of the eye and we predict that these compounds would prevent the development of cataracts of the eye. A situation contrary to the healing of eye wounds based on tetracycline and chloramphenicol, the healing of which leads to the formation of cataracts, the main cause of extensive eye operations aimed at "the destruction of this organ" d 'capital importance.&#x0D; Research methods: In this Bibliographic survey, our approach revolved around the literature on the Capsicum annuum L plant. Several results were retrieved from the Articles, Memoirs and Theses having addressed the study of Capsicum annuum L. And these results were retrieved using Google which was considered our search engine. In summary, it is the documentary technique that was at work.

Reconsidering trauma and symbolic wounds in times of online misogyny and platforms

This article provides an exploratory discussion of the misogynist online incel community and its discourses around mental health. Incels’ discussion of mental health conditions, trauma and victimhood is outlined in relation to Allen Meek’s development of the concept of the symbolic wound. It is argued that incels’ alleged trauma constitutes the construction of a symbolic wound as a marker of group identity as well as a means of shocking and potentially traumatising others. The concept of the symbolic wound is further developed through the psychoanalytic notion of dis/inhibition which shows how incels are torn between modes of desiring and symbolically destroying women. The collective identity of the symbolic wound and its (non)-relation to trauma can thus be more fragile and contradictory than has been discussed in the literature so far.

Using Absorbable Sutures for Traumatic Wound Closure to Avoid Additional Hospital Visits for Suture Removal During the COVID-19 Pandemic: A Randomized Controlled Trial.

Introduction The COVID-19 pandemic worldwide forced governments to undertake intervention measures to encourage social distancing. Meanwhile, traumatic skin lacerations require multiple hospital visits for dressing changing and suture removal since they are usually repaired with non-absorbable sutures. These visits can be avoided by using absorbable sutures instead. However, absorbable sutures carry the "potential" risk of wound infection. In the current study, our first objective was to determine the non-inferiority of absorbable sutures regarding infection rateafter repairing traumatic wound lacerations in comparisonto the conventional non-absorbable ones. Our secondobjective was to evaluate the superiority of absorbable sutures in regardto postoperative clinic visits for suture removal and wound dressing compared to the non-absorbable ones. Methods A sample of 471 patients with traumatic skin lacerations was analyzed during the COVID-19 pandemic in April 2020. In the control group, wounds were repaired using non-absorbable sutures, while rapid-onset absorbable sutures were used in the treatment group. By conducting a phone/video call follow-up after 21 days, several parameters regarding infection signs and clinic visits were compared between both groups. Results A significant decrease in total trauma patients (45.4%) and those who required suturing (51.2%) was observed in April 2020 compared to the same month of the previous four years (p = 0.001 (2016), p = 0.027 (2017), p = 0.027 (2018), and p = 0.001 (2019)). Regarding wound infection, no statistically significant difference(p = 0.623) was observed between the absorbable (3.2%) and non-absorbable (4.9%) groups. Using absorbable sutures resulted in significantly(p < 0.001) fewer postoperative hospital visits compared to using non-absorbable sutures (mean: one versus three visits). Conclusion Using absorbable sutures to repair traumatic wound lacerations is safe regarding wound healing and infection rates. They also reduce postoperative hospital visits since they are not intended to be removed. Therefore, they should be considered during a pandemic to reduce hospital visits for suture removal, which will subsequently enhance social distancing and relieve hospital load.

In vitro evaluation of the antimicrobial activity of antiseptics against clinical Acinetobacter baumannii strains isolated from combat wounds.

Healthcare-associated infections (HCAIs) are among the most prominent medical problems worldwide. In the context of increasing antibiotic resistance globally, the use of antiseptics as the main active agent and potentiator of antibiotics for the treatment of purulent-inflammatory complications of traumatic wounds, burns, and surgical wounds can be considered to tackle opportunistic infections and their prevention during war. This study presents a comparative investigation of the antimicrobial efficacy of antiseptics used for surgical antisepsis and antiseptic treatment of skin, mucous membranes, and wounds against multidrug-resistant clinical isolates of Acinetobacter baumannii as a wound pathogen of critical priority (according to the WHO). It was found that strains of A. baumannii, which have natural and acquired resistance to antimicrobial drugs, remain susceptible to modern antiseptics. Antiseptic drugs based on decamethoxine, chlorhexidine, octenidine, polyhexanide, and povidone-iodine 10% and 2% provide effective bactericidal activity against A. baumannii within the working concentrations of these drugs. Chlorhexidine and decamethoxine can inhibit biofilm formation by A. baumannii cells. In terms of bactericidal properties and biofilm formation inhibition, chlorhexidine and decamethoxine are the most effective of all tested antiseptics.

Management of wounds with exposed bone structures using an induced-membrane followed by polymethyl methacrylate and second-stage skin grafting in the elderly with a 3-year follow-up.

The treatment of traumatic wounds with exposed bone or tendons is often challenging. An induced membrane (IM) is used to reconstruct bone defects, as it provides an effective and sufficient blood supply for bone and soft-tissue reconstruction. This study explored a novel two-stage strategy for wound management, consisting of initial wound coverage with polymethyl methacrylate (PMMA) and an autologous split-thickness skin graft under the IM. Fifty inpatients were enrolled from December 2016 to December 2019. Each patient underwent reconstruction according to a two-stage process. In the first stage, the defect area was thoroughly debrided, and the freshly treated wound was then covered using PMMA cement. After 4-6 weeks, during the second stage, the PMMA cement was removed to reveal an IM covering the exposed bone and tendon. An autologous split-thickness skin graft was then performed. Haematoxylin and eosin (H&E) staining and immunohistochemical analysis of vascular endothelial growth factor (VEGF), CD31 and CD34 were used to evaluate the IM and compare it with the normal periosteal membrane (PM). The psychological status and the Lower Extremity Function Scale (LEFS) as well as any complications were recorded at follow-up. We found that all skin grafts survived and evidenced no necrosis or infection. H&E staining revealed vascularised tissue in the IM, and immunohistochemistry showed a larger number of VEGF-, CD31- and CD34-positive cells in the IM than in the normal PM. The duration of healing in the group was 5.40 ± 1.32 months with a mean number of debridement procedures of 1.92 ± 0.60. There were two patients with reulceration in the group. The self-rating anxiety scale scores ranged from 35 to 60 (mean 48.02 ± 8.12). Postoperatively, the LEFS score was 50.10 ± 9.77. Finally, our strategy for the management of a non-healing wound in the lower extremities, consisting of an IM in combination with skin grafting, was effective, especially in cases in which bony structures were exposed in the elderly. The morbidity rate was low.

Aqueous skin antisepsis before surgical fixation of open fractures (Aqueous-PREP): a multiple-period, cluster-randomised, crossover trial

Chlorhexidine skin antisepsis is frequently recommended for most surgical procedures; however, it is unclear if these recommendations should apply to surgery involving traumatic contaminated wounds where povidone-iodine has previously been preferred. We aimed to compare the effect of aqueous 10% povidone-iodine versus aqueous 4% chlorhexidine gluconate on the risk of surgical site infection in patients who required surgery for an open fracture. We conducted a multiple-period, cluster-randomised, crossover trial (Aqueous-PREP) at 14 hospitals in Canada, Spain, and the USA. Eligible patients were adults aged 18 years or older with an open extremity fracture treated with a surgical fixation implant. For inclusion, the open fracture required formal surgical debridement within 72 h of the injury. Participating sites were randomly assigned (1:1) to use either aqueous 10% povidone-iodine or aqueous 4% chlorhexidine gluconate immediately before surgical incision; sites then alternated between the study interventions every 2 months. Participants, health-care providers, and study personnel were aware of the treatment assignment due to the colour of the solutions. The outcome adjudicators and data analysts were masked to treatment allocation. The primary outcome was surgical site infection, guided by the 2017 US Centers for Disease Control and Prevention National Healthcare Safety Network reporting criteria, which included superficial incisional infection within 30 days or deep incisional or organ space infection within 90 days of surgery. The primary analyses followed the intention-to-treat principle and included all participants in the groups to which they were randomly assigned. This study is registered with ClinicalTrials.gov, NCT03385304. Between April 8, 2018, and June 8, 2021, 3619 patients were assessed for eligibility and 1683 were enrolled and randomly assigned to povidone-iodine (n=847) or chlorhexidine gluconate (n=836). The trial's adjudication committee determined that 45 participants were ineligible, leaving 1638 participants in the primary analysis, with 828 in the povidone-iodine group and 810 in the chlorhexidine gluconate group (mean age 44·9 years [SD 18·0]; 629 [38%] were female and 1009 [62%] were male). Among 1571 participants in whom the primary outcome was known, a surgical site infection occurred in 59 (7%) of 787 participants in the povidone-iodine group and 58 (7%) of 784 in the chlorhexidine gluconate group (odds ratio 1·11, 95% CI 0·74 to 1·65; p=0·61; risk difference 0·6%, 95% CI -1·4 to 3·4). For patients who require surgical fixation of an open fracture, either aqueous 10% povidone-iodine or aqueous 4% chlorhexidine gluconate can be selected for skin antisepsis on the basis of solution availability, patient contraindications, or product cost. These findings might also have implications for antisepsis of other traumatic wounds. US Department of Defense, Canadian Institutes of Health Research, McMaster University Surgical Associates, PSI Foundation.

Urinary Bladder Matrix Grafting Versus Flap Coverage for Acute or Infected Wound Defects in Patients With Orthopaedic Trauma.

Urinary bladder matrix (UBM) grafting of acute or infected wound defects has been reported to be successful in small case series. The purpose of this study was to compare the outcomes of UBM grafting with flap coverage. This is a retrospective comparative study. Level-1 trauma center. Orthopaedic trauma patients with wound defects not amenable to primary closure or skin grafting. Wound coverage with UBM grafting (n = 26) by orthopaedic trauma surgeons versus flap coverage (n = 26) by microvascular-trained plastic surgeons. Primary wound coverage success, complications, returns to the operating room, hospital length of stay, and time to wound healing. The UBM group was more likely to have an American Society of Anesthesiologist class ≥3 (58% vs. 23%, P = 0.02), a foot/ankle wound (77% vs. 12%, P &lt; 0.001), an infected wound defect (81% vs. 50%, P = 0.03), and smaller defects (21 vs. 100 cm 2 , P = 0.02). UBM grafting resulted in a longer time to wound healing (6 vs. 2 months, P = 0.002) and a shorter hospital length of stay (2 vs. 14 days, P &lt; 0.0001). UBM and flap groups had similarly high rates of failure of primary wound coverage (31% vs. 31%; P = 1.0), complications (46% vs. 62%, P = 0.4), and returns to the operating room (46% vs. 65%; P = 0.2). All 3 acute traumatic wounds undergoing UBM grafting concurrently with fracture fixation experienced graft failure and osteomyelitis. UBM grafting is an effective alternative to flap coverage for small traumatic or infected wounds but should be avoided in acute traumatic wounds undergoing fracture fixation. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Usage of Nanotechnology in Tissue Adhesives

With millions of people enduring traumatic or surgical wounds each year, establishing innovative approaches for proper wound closure has long been considered imperative research and clinical objective. The massive demand for improving wound-closing procedures and the disadvantages of conventional closure techniques foreshadow the robust investigation in the field and inspire researchers to combine more advanced technologies to develop clinically feasible approaches

FUNCTIONAL OUTCOME OF MEDIAL GASTROCNEMIUS MUSCLE PEDICLE FLAP FOR SOFT TISSUE RECONSTRUCTION AROUND THE KNEE AND PROXIMAL LEG

Background: Soft tissue coverage around the knee and a proximal third leg can be done using a medial Gastrocnemius Muscle Pedicle Flap (GMPF). There are variable results in the literature about its outcome and such study is lacking in our country. The present study was undertaken to evaluate the outcome of the medial GMPF to reconstruct the defect around the knee and proximal 3rd leg. Methods: It was a retrospective study of 21 cases of medial GMPF reconstruction to cover the defect around the knee and proximal third leg over 2 years in tertiary care hospital. The outcome variables measured were flap and graft take up, fracture union, knee range of motion, and complications. Data was analyzed using SPSS software version 20.0 with descriptive statistics for categorical and discrete variables. Results: The mean age of the patient was 37.19 years (range 21-65). Out of a total of 21 cases, 20 (95.2%) were traumatic wound defects, whereas 1 case was complications of necrotizing fasciitis. Flap and graft take-up was good in all the cases. The mean time for union of tibia fracture was 24.57 weeks (range 16-36). The mean knee range of motion was 125 degrees (range 90-145). Two cases had a superficial infection and one had a deep infection. Conclusions: Medial GMPF gives satisfactory results in soft tissue reconstruction about knee and proximal 3rd leg and it can be performed well by trained orthopedic surgeons also with consistently good results.

S2.4a Pythiosis: An emerging disease in Hong Kong

S2.4 Veterinary mycology research, September 21, 2022, 3:00 PM - 4:30 PMOomycosis is an emerging disease of humans and animals caused by oomycetes in the Stramenopiles-Alveolata-Rhizaria super group, mainly Pythium insidiosum and occasionally Lagenidium giganteum or Paralagenidum species. In surface freshwater, oomycetes produce motile biflagellate asexual zoospores with marked chemotactic attraction to epithelial surfaces of vertebrate hosts. Infection is the result of encystation and invasion of damaged skin or gastrointestinal mucosa.Of ∼ 4200 cases of pythiosis reported globally between 1980 and 2021 only ∼ 20% involved humans while 80% involved animals, mainly horses, dogs, and cattle. Most human cases occur in India and Thailand, whereas most animal infections were reported in the United States and Brazil. Pythiosis has been reported in mainland China, but the burden of the disease is low and comprises <1% of overall cases in humans.Neither pythiosis nor lagenidiosis has been previously reported in humans or animals in Hong Kong. From January 2018 to January 2022, the Veterinary Diagnostic Laboratory of City University of Hong Kong diagnosed 10 cases of oomycosis (5 canine, 5 feline) after identification of non-parallel walled, irregularly branching, and poorly septate hyphae in the center of necrotic regions of histological sections of formalin-fixed paraffin-embedded tissues (FFPET). Species identity was confirmed by PCR and sequencing of 28S rDNA from DNA extracts of FFPET. There were 8 cases of P. insidiosum and 2 of L. giganteum infection. Serum ELISA was positive for Pythium antibodies in 5/6 cases tested and negative for Pythium/Lagenidium/Paralagenidum antibodies in a German shepherd dog (GSD) with disseminated disease caused by L. giganteum.Affected dogs were young to middle-aged at presentation (9 months to 5 years old). Two dogs had focal cutaneous infections, two had extensive gastrointestinal involvement, and the GSD had disseminated disease with cutaneous, mediastinal, and abdominal involvement.Affected cats were young (8 weeks to 18 months) and presented with subcutaneous/cutaneous disease. Three cats had a distinctive perianal ring of bulging subcutaneous granulation tissue, including one that also had an ulcerated, proliferative and necrotic lesion involving two adjacent hind-limb digits. One cat had facial subcutaneous swelling with mandibular lymph node enlargement and the remaining cat presented with extensive circumferential swelling of one hind limb from the distal paw to the mid-stifle.All cats tested negative for the Feline leukemia virus and Feline immunodeficiency virus. Traumatic or surgical wounds preceding infection were identified in a kitten caught in a rodent glue-trap with skin wounds, in a cat with facial involvement that had an injured globe surgically enucleated, and in a dog with cutaneous pythiosis that had chronic dermatitis.Treatment data were available for one canine case. The GSD with lagenidiosis was treated with combination antimicrobial therapy including voriconazole, terbinafine, minocycline, and azithromycin. The dog responded poorly. Mefenoxam was substituted for voriconazole and hyperbaric oxygen therapy was administered. After initial response, the dog succumbed 4 months from diagnosis. We have had success with the treatment of four feline cases using combination therapy including surgical debridement, immunotherapy with a Pythium vaccine, and combinations of antifungal drugs (posaconazole and terbinafine), and/or antimicrobials (doxycycline/minocycline and azithromycin).

P213 Lasiodiplodia theobromae: an emerging human pathogen

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM Objectives Lasiodiplodia theobromae is a dematiaceous fungus, rarely reported to cause infections in humans. This case-series was conducted to identify the potential risk-factors and spectrum of diseases caused by L. theobromae.MethodsWe performed a retrospective analysis of all cases from which the isolates of the L. theobromae were accessioned at the National culture collection of pathogenic fungi (NCCPF), over the last 10 years (January 2012- March 2022). The isolates were retrieved and identified by conventional (colony morphology, color, and microscopic appearances) and molecular (sequencing of ITS1 region of ribosomal DNA) methods. In vitro antifungal susceptibility testing (AFST) was performed by microbroth dilution recommended by the Clinical and Laboratory Standards Institute (CLSI). (M38-A2). The clinical features, demographic details and outcome were recorded.ResultsIn 10 years, a total of 20 patients were identified. The median age of all cases was 39.5 (range: 13-71 years) and 75% were males. The most common clinical presentation was keratomycosis (12,68.6%), followed by soft tissue/sub-cutaneous infection (3,15%), rhinosinusitis (3,15%), onychomycosis (1, 5%), and pneumonia (1, 5%). Most patients were immunocompetent (85%). Among immunocompromised, two patients had acute myeloid leukemia and developed fungal rhinosinusitis while one patient of post-renal transplant on immunosuppressants developed subcutaneous tissue infection in the interscapular region. The fourth patient had decompensated alcoholic hepatitis, encephalopathy, sepsis, and developed pneumonia while he was on mechanical ventilation. Among the various potential risk factors associated with keratomycosis, the most common were, accidental trauma wounds (9, 45%), and mosquito bite in the eye in one patient. The culture on Sabouraud's dextrose agar (SDA) revealed the growth of black mycelial fungus (Fig. 1a). The lactophenol cotton blue (LCB) mount revealed the presence of only dematiaceous septate hyphae which failed to sporulate (Fig. 1b). All the isolates were confirmed by sequencing of ITS (internal transcribed spacer) region of the rDNA using universal primers ITS1 and ITS2. In vitro antifungal susceptibility testing (AFST) was performed using a broth microdilution (BMD) method which revealed variable MIC (μg/ml), i.e., amphotericin (1-2), voriconazole (0.25-2), itraconazole (8-16), posaconazole (1-2). All patients improved on therapy except one patient who succumbed to death due to pneumonia.Conclusion Lasiodiplodia theobromae is an emerging cause of human infections in both immunocompetent and immunosuppressed individuals. It is often difficult to identify due to lack of sporulation making morphological identification challenging. Hence, prompt suspicion and rapid diagnosis with guided therapy are necessary for a better outcome.