Traumatic Wounds Research Articles

Severe Burn Injury Significantly Alters the Gene Expression and m6A Methylation Tagging of mRNAs and lncRNAs in Human Skin.

N6-methyladenosine (m6A) modulates RNA metabolism and functions in cell differentiation, tissue development, and immune response. After acute burns, skin wounds are highly susceptible to infection and poor healing. However, our understanding of the effect of burn injuries on m6A methylation and their potential mechanism is still limited. Human m6A-mRNA&lncRNA Epitranscriptomic microarray was used to obtain comprehensive mRNA and lncRNA transcriptome m6A profiling and gene expression patterns after burn injuries in human skin tissue. Bioinformatic and functional analyses were conducted to find molecular functions. Microarray profiling showed that 65 mRNAs and 39 lncRNAs were significantly hypermethylated; 5492 mRNAs and 754 lncRNAs were significantly hypomethylated. Notably, 3989 hypomethylated mRNAs were down-expressed and inhibited many wound healing biological processes and pathways including in the protein catabolic process and supramolecular fiber organization pathway; 39 hypermethylated mRNAs were up-expressed and influenced the cell surface receptor signaling pathway and inflammatory response. Moreover, we validated that m6A regulators (METTL14, METTL16, ALKBH5, FMR1, and HNRNPC) were significantly downregulated after burn injury which may be responsible for the alteration of m6A modification and gene expression. In summary, we found that homeostasis in the skin was disrupted and m6A modification may be a potential mechanism affecting trauma infection and wound healing.

Interpolation sural flap in acute trauma patients

Objectives: Distal lower leg wounds, regardless of cause, and acute trauma wounds, regardless of site, are difficult. Reconstruction of both situations are much more challenging. Interpolation sural flap is a good alternative for this type of reconstruction. Methods: Fourteen interpolation sural flap were harvested to reconstruct for distal leg region wounds due to acute trauma. Ten male and four female patients aged from 10 to 59 years old were included this study. Results: All flaps survived. No venous congestion and total flap necrosis was seen. There were 4 complications, and all of them were corrected with short interventions. After second stage, no complication was seen. Conclusions: Interpolation sural flap modification has many advantages including reliability, no venous congestion, immediate reconstruction without a surgical team. However, it is a two-staged reconstruction and its donor site scarring can be serious.

Physical violence against women in southern Tunisia: Epidemiology and risk factors

IntroductionViolence against women is a widespread offense worldwide. It causes serious physical, psychological, and medico-legal repercussions.We aim to specify the socio-demographic characteristics of female victims of physical violence well as the medical consequences and risk factors related to serious physical violence against women in Tunisia. MaterialsThis is a retrospective study including all women victims of physical violence, examined on judicial requisition at the Forensic Department of Habib Bourguiba University Hospital in Sfax, over two years (March 1st, 2018 to February 29th, 2020). Physical violence is considered serious whena forensic specialist predicts long term effects at the lesional stage (determining partial permanent disability: PPD). ResultsIn our study, 2909 women were victims of physical violence. The average age of the victims was 34 ± 13 years (extremes:2 and94 years). The majority of victims were married (83.3%), jobless (52.5%), and of an urban origin (72.7%). Physical violence predominated in summer and autumn with a peak in frequency in July and at weekends. The consultation delay ranged between 1 and 30 days in two-thirds of the cases. The perpetrator was an intimate partner in 38.2% of cases, a stranger in 11.1% of cases, and a family member in 5.9% of cases. The weapon used was a blunt object in 82.8% of cases. Injuries were preferentially located in the upper limbs (52.6%) followed by the head and face (42.7%), consisting essentially of bruising and abrasions. The median duration of the total temporary disability (TTD) was 5 days (extremes: 0–60 days).The duration of TTD was statistically correlated to the type and the site of the most serious injuries. Moreover, there was a statistically significant correlation between the duration of TTD and the PPD prediction (p < 0.001). A 9-day TTD represented the threshold to expect PPD.A total of 198 cases (6.8%) were considered serious. Serious physical violence was statistically correlated to the origin of the victim (urban), the relationship with the aggressor (stranger, or thief), the type of weapon used (sharp or thermal force), the type of injury (contused wound, sharp wound, penetrating wound, fracture-dislocation, or head trauma) and thesite of the injury (head and face). ConclusionViolence against women is a very widespread practice in our society. Despite legislative advances, Tunisian women remain victims of discrimination in several areas. A change in mentalities and an awareness of the need to respect women's rights are necessary and require collaboration between the various social, legal and medical stakeholders.

Hypertrophic Scar Formation and Wound Healing Modulation Fatty Acids as Modulators of Severe Scars

Scar tissue usually generates severe discomfort in the short and long term. Common symptoms include anesthetics sequelae, pruritus, joint malfunction, new wounds on the scar surface, and pain. There are several treatments for scars, like compression, topical or intralesional steroid infiltration, 5-fluorouracil, dermabrasion, and surgeries with new scar tissue. For adult patients, it is easier to choose the treatment. However, compression is commonly applied in children to prevent treatments that have adverse effects. This study reports the outcomes of 15 patients submitted to abdominoplasty, traumatic wounds and post-burn scar treatments, which showed significant changes after the continuous use of an ointment composed of petrolatum, cod liver oil, BHT, Chamomilla recutita (chamomile) oil, Helianthus annuus (sunflower) oil, and Prunus amygdalus dulcis (sweet almond) oil. As components of the stratum corneum, unsaturated fatty acids influence the cutaneous structural and immune status and permeability. They also interfere with the maturation and differentiation of the stratum corneum and inhibit the production of proinflammatory eicosanoids, reactive species (ROS and RNS), and cytokines, thereby influencing the inflammatory response and possibly wound healing. This article aims to share our experience with the regular use of an ointment in adult and pediatric patients for three months. The increase in proinflammatory cytokine production at wound sites, resulting in a noninvasive, therapeutical, and effective cutaneous wound healing and scarring modulation, may provide a physiopathological explanation for the fast improvement of scars.

Clinical benefits of small intestinal submucosa extracellular matrix and review of the evidence.

There is a clear scientific rationale for using cellular, acellular and matrix-like products (CAMPs), such as small intestinal submucosa extracellular matrix (SIS-ECM), in hard-to-heal wounds, such as diabetic foot ulcers (DFUs), venous leg ulcers (VLUs), pressure ulcers and arterial leg ulcers. The clinical evidence supporting the use of SIS-ECM has grown over the past several decades. This evidence base now encompasses a wide range of hard-to-heal wound indications, including DFUs and VLUs, as well as increasingly complex acute wound indications, such as delayed postoperative wounds, traumatic wounds and burns. The aim of this article is to review the steadily amassed body of evidence that describes the clinical outcomes associated with treatment with SIS-ECM and its potential implications for the overall costs of treatment.

Clinical benefits of small intestinal submucosa extracellular matrix and review of the evidence.

There is a clear scientific rationale for using cellular, acellular and matrix-like products (CAMPs), such as small intestinal submucosa extracellular matrix (SIS-ECM), in hard-to-heal wounds, such as diabetic foot ulcers (DFUs), venous leg ulcers (VLUs), pressure ulcers and arterial leg ulcers. The clinical evidence supporting the use of SIS-ECM has grown over the past several decades. This evidence base now encompasses a wide range of hard-to-heal wound indications, including DFUs and VLUs, as well as increasingly complex acute wound indications, such as delayed postoperative wounds, traumatic wounds and burns. The aim of this article is to review the steadily amassed body of evidence that describes the clinical outcomes associated with treatment with SIS-ECM and its potential implications for the overall costs of treatment.

Skin and Soft Tissue Infections due to Aeromonas spp.: An Emerging Pathogen

Introduction: Aeromonas spp., the emerging human pathogens, can cause various diseases like gastrointestinal infections, Skin and Soft-Tissue Infections (SSTIs), respiratory tract infections, urinary tract infection, hepatobiliary tract infection, blood stream infections etc. Aeromonas consists of important pathogenic species like Aeromonas hydrophila being the most common one followed by A.sobria, A.veroni, A.caviae and A.salmonicida. SSTIs due to Aeromonads are most often associated with preexisting ulcer, traumatic wound and exposure to water. Aim: The present study was carried out to analyse socioepidemiological factors, clinical features, risk factors and antibiotic resistance potential of Aeromonas spp., SSTIs. Materials and Methods: In this prospective study, all Gramnegative fermenting motile isolates which are positive for oxidase, H2 S production, indole reaction, lysine decarboxylase were further identified by Vitek 2 compact system (Biomerieux, France). The study period was 2 years. Results: A total of 39 patients with Aeromonas spp., SSTIs were identified during the period from 2020 to 2022. Majority of patients hailed from urban areas, were in middle age group and were farmers. A.hydrophila (n=24, 62%) was the predominant isolate. Majority of the infections were superinfection of wound (n=16, 41%) and chronic non healing ulcer (n=13, 33.3%). A total of 33.3% of infections were polymicrobial, common concomitant pathogens being, Pseudomonas aeruginosa and Methicillin Resistant Staphylococcus aureus (MRSA). Trauma and water exposure were main risk factors with co-morbidities like diabetes, hypertension and liver cirrhosis. A 20.5% of patients were immunocompromised. There was one case of Necrotising Fasciitis (NF) which resulted in patient’s death. Cotrimoxazole, 3rd and 4th generation cephalosporins. Aztreonam and Tigecycline were the most effective antibiotics while eight of the isolates were Multidrug Resistant (MDR). Thirty-three patients recovered completely and three patients died of complications. Conclusion: Aeromonas hydrophila must be regarded as an emerging pathogen of SSTIs mainly in patients with preexisting ulcers and can be MDR. Such infections have a good prognosis if prompt medical, surgical and supportive treatment is given.

Use of a Synthetic Hybrid-scale Fiber Matrix in the Management of Chronic and Complex Wounds: A Retrospective Case Series

Introduction. Chronic and complex wounds are often recalcitrant to treatment, regardless of etiology. These wounds are a burden to both the patient and the health care system. Advanced treatment options are needed to improve patient outcomes. An SHSFM has shown positive results in the management of complex and chronic wounds. Objective. In this retrospective case series, patients with chronic and complex wounds of various etiologies were treated with the SHSFM to assess its utility in the management of these wound types. Materials and Methods. A retrospective review of the charts of 18 patients with a total of 28 wounds was conducted. Healing was monitored at follow-up visits, and the SHSFM was reapplied as clinically indicated. Results. The average patient age was 59 years, and average initial wound surface area was 43.4 cm2. Wound types included ulcers, surgical and traumatic wounds, necrotic infections, and others. Complete healing was achieved in 89% of wounds. The average time to healing was 196 days ± 146.7 standard deviation, and the number of applications per wound ranged from 1 to 11. Conclusions. This case series demonstrates the unique versatility of the SHSFM in achieving appropriate clinical outcomes depending on wound and patient factors.

Организация оказания помощи раненым офтальмологического профиля в современных вооруженных конфликтах: состояние и перспективы

The main feature of modern armed conflicts is the use of new weapons and, as a result, changes in the nature and structure of eye injuries. This feature, on the one hand, and the rapid progress of medical science, on the other hand, require a rapid response to the changing operational situation using the resources of modern ophthalmology in order to provide care to wounded and injured ophthalmic patients efficiently and rationally. There are some differences in approaches to pre-hospital self- and mutual aid to the wounded with ophtalmic injuries on the battlefield in different schools of military medical training and tactical medicine. Some use a binocular bandage, while others use a rigid eye shield. The complexity and variety of visual injuries require good practical skills and experience in order to perform high-quality surgical treatment of perforated corneal and scleral wounds in open eye trauma. This necessitates a thorough training of specialists with practical skills. The issue of medical supply of units providing specialized care at the stages of medical evacuation, which includes a military ophthalmologist, is particularly significant. The problem of reasonable and rational update of the ophthalmological equipment at the stages of medical evacuation requires active discussion. There is still the question of the use of effective protective equipment for the eye during combat operations, which, without limiting visual function, could prevent combat eye injuries, most often caused by small fragments and secondary wounding projectiles.

Treatment of patients with traumatic gunshot wounds

Treatment of patients with traumatic gunshot wounds

Revisiting the Role of Amniotic Membrane Dressing in Acute Large Traumatic Wounds: A Randomized Feasibility Study at a Level 1 Trauma Centre.

Acute large traumatic wounds require temporary dressing prior to the definitive soft tissue reconstruction, as the physiological derangement during the immediate postinjury period delays the definitive surgical intervention. Selecting an ideal dressing material from numerous available synthetic dressings and skin substitutes poses a challenge. Although amniotic membrane (AM) scaffold has a definitive role in promoting wound healing in burns and chronic wounds, however, its efficacy in acute large traumatic wound is lacking. The present trial aimed to evaluate the safety and efficacy of AM in wound bed preparation before the definitive soft-tissue reconstruction in acute large traumatic wounds. Sixty patients with acute large traumatic wounds (>10 cm × 10 cm) were divided into two groups (conventional dressing and AM dressing) using simple mixed block randomization. Wounds were assessed using the Bates Jensen Score at various timelines for the signs of early wound healing. The primary outcome was to evaluate the time taken for the wound bed preparation for definitive soft-tissue reconstruction. The secondary outcome was the pain assessment and complications, if any. There was significant reduction in the wound exudate as well as peripheral tissue edema in the intervention group (P = 0.01). AM dressing was significantly less painful (P = 0.01). The incidence of wound infection and need for debridement was decreased in the intervention group. However, the time interval to definitive soft-tissue coverage was statistically insignificant and comparable in both the groups. No adverse reactions were seen in either group. AM dressings are safe and efficacious with significant reduction in wound exudates and peripheral edema. However, these dressings do not hasten the wound maturation as compared to conventional dressings. AM dressings can be used as a less painful alternative to conventional dressing in the management of large acute posttraumatic wounds.

Traumatic wounds to the hand and wrist treated at Brazzaville University Hospital

Traumatic wounds to the hand and wrist treated at Brazzaville University Hospital

Use of the DermaBlade for Debridement of Hypergranulatory Wound Tissue.

Use of the DermaBlade for Debridement of Hypergranulatory Wound Tissue.

Engineered Sandwich-Structured Composite Wound Dressings with Unidirectional Drainage and Anti-Adhesion Supporting Accelerated Wound Healing.

Proper management of exudate is of great clinical value for reducing wound infection and promoting wound healing, thus various dressings have been studied to address this widespread medical challenge. Herein, a novel sandwich-structured composite wound dressing (SCWD), integrating of a superlyophobic (SLO) polydimethylsiloxane (PDMS) layer, a superlyophilic gauze layer, and a lyophobic PDMS layer is presented, with particular unidirectional droplet drainage and stable anti-adhesion capabilities, which realizes effective management of wound exudate and provides a favorable environment for wound healing. Thanks to the stable SLO property on the PDMS surface with hierarchical micro/nanostructures, the continuously accumulated wound exudate at the interface between dressing and wound surface is gradually deformed, eventually passing through SLO PDMS layer through milli-scale channels and being absorbed by gauze layer. Experimental results show that the application of SCWD can significantly reduce the occurrence of wound infection, avoid the tearing of wound tissues when replacing dressings, and accelerate wound healing by ≈20%. The combination of SCWD and lyophilized powders of stem cells supernatant (LPSCS) is verified to better accelerate the healing process. The proposed method offers great potential in clinical applications, particularly for acute trauma wound treatments.

Role of Sromal Vascular Fraction in Wound Bed Preparation in Post Traumatic Wound

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 stromal vascular fraction as an adjunct in the management of post-traumatic degloving wounds of the lower extremity.

Gelatin Microspheres Loaded with Wharton's Jelly Mesenchymal Stem Cells Promote Acute Full-Thickness Skin Wound Healing and Regeneration in Mice.

Objective: At present, there is an urgent need to develop a novel and practical therapeutic approach to accelerate the healing of acute wounds. Mesenchymal stem cell (MSC)-based therapy is emerging as a promising therapeutic approach for acute skin wounds. However, there are still challenges in clinical application of this strategy, such as low survivability, low retention time, and less engraftment in skin wounds. Approach: Wharton's jelly mesenchymal stem cells (WJMSCs) were seeded into three-dimensional (3D) gelatin microspheres (GMs) to identify the biocompatibility of GMs. WJMSCs were embedded in GMs and then encapsulated with Pluronic F-127 (PF-127) and sodium ascorbyl phosphate (SAP) combination to transplant onto acute full-thickness skin wound in mice. Histology, immunohistochemistry, and immunofluorescence assay were used to investigate the skin wound healing, dermis regeneration, collagen deposition, cell proliferation, and neovascularization. Results: Three-dimensional GM had strong biocompatibility, compared with two-dimensional adherent culturing, GM loading increased the cell viability and proliferation ability of WJMSCs. WJMSCs+GM+PF-127+SAP transplantation increased skin wound healing rate, dermis regeneration, and type III collagen deposition through improving macrophage polarization, cell proliferation, neovascularization, cell retention, and engraftment at skin wound site. Innovation: The effective 3D encapsulation technology for WJMSCs solved the main problems of cell activity and residence time during MSC transplantation. WJMSCs+GM+PF-127+SAP transplantation will be a new and effective MSC biomaterials-based therapeutic strategy for acute skin traumatic wounds. Conclusion: WJMSCs+GM+PF-127+SAP transplantation facilitated acute full-thickness skin wound healing and regeneration and might be a new and effective therapy for acute skin traumatic wounds.

EE576 Potential Budget Impact of Negative Pressure Wound Therapy (NPWT) Versus Conventional Wound Treatment in Diabetic Foot Ulcers (DFU), Surgical and Trauma for Selected Countries in Latin America

This study was designed to estimate the potential budget impact of negative pressure wound therapy (NPWT) vs conventional wound treatment (CWT) in diabetic foot ulcers (DFU), surgical and traumatic wounds across select Latin American countries:

Lower extremity puncture wound.

A 58-year-old woman presented with pain after sustaining a right foot wound from a damaged wooden floor. Physical examination was remarkable for a 0.3-cm puncture wound between the first webspace on the plantar aspect of the foot with tenderness to palpation, but no visible or palpable foreign body. Plain radiographs were negative, and computed tomography of the foot noted the small puncture wound with a proximally extending linear tract. Orthopedic surgery was consulted but did not appreciate any foreign body and thus recommended conservative management without wound exploration in the emergency department (ED). Bedside ultrasound was then performed by emergency physicians that visualized a linear 4-cm hyperechoic foreign body with posterior acoustic shadowing (Figure 1, Video 1). Ultrasound-guided deep peroneal and posterior tibial nerve blocks were performed for anesthesia (Video 2). Under ultrasound guidance, curved forceps were used to grasp and remove a large wooden fragment (Figure 2, Video 3). The patient was discharged with oral antibiotics. Traumatic wounds are responsible for 11 million ED visits annually, and foreign bodies are involved in 7% to 15%.1 Many foreign bodies are missed on initial evaluation, and because of their risk for complications, they are frequently implicated in malpractice litigation.2 Plain film radiographs are considered first line and detect 80% of all foreign bodies but have a mere sensitivity of 15% for radiolucent objects, such as wood or other vegetative material.1, 3 Therefore, multimodal imaging is frequently necessary. Ultrasonography, performed in the ED setting, has an overall sensitivity and specificity of 91% for identifying foreign bodies.2 These will appear hyperechoic and may have additional clues, such as posterior acoustic shadowing, reverberation artifact, or hypoechoic halo. Using ultrasound to guide percutaneous foreign body removal can increase success in the ED to nearly 100%.4 Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Foot fracture may predict poor patient reported functional outcomes in lower extremity reconstruction of the traumatically injured lower extremity: A case–control study

A paucity of evidence currently exists regarding factors affecting the success of lower extremity reconstruction at restoring a functional limb. We aim to determine the effect of foot fracture on outcome measures of ambulatory success after lower extremity salvage in a trauma population. A retrospective chart review was performed on 63 patients presenting to an urban level 1 trauma center between 01/2007 and 01/2015 who received soft tissue coverage of a lower extremity traumatic wound. Demographics, injury, and perioperative data were recorded. Patients were administered the Lower Extremity Functional Scale (LEFS) questionnaire via phone. The LEFS is out of 80 possible points. Ambulatory success is measured on a scale of 0 to 4 across 20 activities, with 0 indicating “extreme difficulty or inability to perform activity”, and 4 indicating “no difficulty”. Functional outcomes were compared using a two-tailed two-sample unequal variances t-test. This study represents data on the 63 unique patients treated with vascularized flaps whom we attempted to contact. A total of 21 patients completed the LEFS questionnaire, representing an overall response rate of 33%. Responders to the surveys included 4 (19%) patients with foot fractures and 17 (81%) without foot fractures. Average total LEFS scores were significantly lower in patients with foot fractures (23.8 ± 5.9) than in patients without (36.2 ± 19.2) foot fractures (p = 0.04). With respect to the SF36 functional scale, patients with foot fractures paradoxically reported significantly higher measures of physical functioning (81 ± 11) in comparison to those without a foot fracture (59 ± 25) at a p-value of 0.02, and role limitation due to physical health (98 ± 3) versus those with no foot fracture (74 ± 37) at a p-value of 0.02. Sustaining a foot fracture during severe traumatic injury that necessitates lower extremity reconstruction may result in significantly decreased ambulatory success scores. Fractures of the foot may predict poor patient reported functional outcomes following lower extremity reconstruction and should be considered as a factor in the pre-operative risk and benefit assessment when deciding whether to attempt reconstruction of the mangled limb. • In trauma patients with injuries necessitating lower extremity reconstruction, patients with foot fractures report worse physical function, particularly in actions related to ambulation. • Patients with foot fractures may have delayed time to attempted ambulation, full weight bearing, or physical therapy. • Fractures of the foot may predict poor patient reported functional outcomes following lower extremity reconstruction and should be considered as a factor in the pre-operative risk and benefit assessment when deciding whether to attempt reconstruction and salvage of the mangled limb.

Silver Nanoparticle-Based Dressings for Various Wounds: Benefits and Adverse Effects.

Silver nanoparticles (AgNP) are a novel therapeutic approach to wound dressings because of their antibacterial properties. Silver has been used throughout history for many purposes. However, evidence-based information about the benefits of AgNP-based wound dressings and potential adverse effects is still required. This study is to comprehensively review the benefits and complications of AgNP-based wound dressings for different wound types and address the knowledge gaps. We collected and reviewed the relevant literature from available sources. AgNP-based dressings have antimicrobial activity and promote healing with only minor complications, making them suitable for several types of wounds. However, we could not identify any reports on AgNP-based wound dressings for common acute traumatic wounds, such as lacerations and abrasions; this includes comparative studies of AgNP-based and conventional wound dressings for such wound types. AgNP-based dressings benefit traumatic, cavity, dental, and burn wounds with only minor complications. However, further studies are needed to discern their benefits for specific traumatic wound types.