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Additional file 1: Supplementary figure 1. Changes in mean scores of FHC in the two groups of intervention and control in students and their mothers during the study.

Objective: Human amniotic membrane (HAM) used as a wound coverage for more than a century. The aim of this study is to evaluate the efficacy of amniotic membrane on wound healing and reduce post-operative complication. Study design: Randomized clinical trial study. Place and duration of study: Surgery Department, Shahid Faghihi Hospital, Shiraz, in the period of between Sep. 2014 and Nov. 2015. Methodology: 73 patients with anal fistula were divided into two groups. The patients suffered from simple perianal fistula (low type) without any past medical history. Fistulotomy were performed for all of them and in interventional group HAM were applied as biologic dressing. Their wound healing improvement was evaluated post-operative in two groups. Results: From 73 patients participated in the study, 36 patients were in control group and 37 patients were in intervention group. According to the analysis of images taken from the wound, the rate of wound healing was 67.39% in intervention group and 54.51% in control group (p

Background Many patients suffer from incisional hernia all over the world. Although various surgical techniques have been introduced in recent decades, the occurrence of this problem still remains as a challenge facing surgeons. Objectives To compare the modified sandwich technique (MST) to on-lay mesh repair technique (OMR) in the repair of huge incisional hernias. Patients and Methods In a randomized control clinical trial during 2004–2008 in Shiraz, Southern Iran, 90 patients with huge incisional hernias were randomly approached by two repair techniques namely MST and OMR. In MST group, polypropylene mesh was fixed in each side of fascia with nylon 2-0 and the wound closure was done with nylon loop 1 , while In OMR technique, the fascia was released 5 cm in each side and polypropylene mesh was fixed with nylon 2-0. The wound closure was identical to MST group. Results The mean age of patients in MST group was 49.3 years with a standard deviation (SD) of 11.8 years and 48 years with SD of 13.6 in OMR group. Recurrences occurred primarily during the first two postoperative years in both groups. Total recurrence rate following MST procedure was 2.2%, compared to 18.2% for OMR (P = 0.01). Mean of hospitalization was 3.4 days in MST group and 4 days in OMR (P = 0.6). The percentage of female patients was 69.6% in MST group and 77.3% in OMR. Mean operation time was 2.3 hours in MST comparing to 2.1 hours in OMR (P = 0.7). Conclusions Our results showed that in the repair of incisional hernias, MST led to a lower recurrence rate and fewer major complications in comparison to OMR.

Background: Radiotherapy is one of the most important factors which results in negative effects on wound healing and increases anastomosis leakage. Diverting loop ileostomy has been usually performed after colorectal anastomosis in cases of colorectal cancer with a history of neoadjuvant radiotherapy to decrease the chance of leakage. Considering the side effects of diverting loop ileostomy, the objective of the present study is to investigate the effect of human amniotic membrane (HAM) on colorectal anastomosis leakage after neo-adjuvant radiotherapy. Methods: In this experimental animal study, 20 crossbreed rabbits were randomly divided into two groups (case group: 13 rabbits, control group: 7 rabbits) after receiving an equal dose of external beam radiation. Four weeks after irradiation, resection of 4 cm of colorectal segment and end-to-end single layer anastomosis were conducted. In the case group, a 2×2 cm wrap of HAM applied around the site of anastomosis. Eight weeks later, all the survived rabbits were sacrificed. A segment of anastomotic sites was resected in all expired and survived rabbits and sent for pathological evaluation. Mann-Whitney U Test (SPSS for Windows, Ver. 16, Chicago, IL) was applied to analyze healing scores between the two groups. Results: Due to anastomosis dehiscence, 5 rabbits expired in the control group, but all the 13 rabbits (case group) survived after 8 weeks and showed no leakage. In addition, pathological evaluation revealed significant epithelialization and neovascularization in the case group. Statistically, healing score was higher in the case group rather than the control group (P

Background: On an average 30-50% of patients who undergo incision and drainage (I and D) of anal abscess will develop recurrence or fistula formation. It is claimed that finding the internal orifice of anal abscess to distract the corresponding anal gland duct; will decline the rate of future anal fistula. Surgeons supporting I and D alone claim that finding the internal opening is hazardous. This study is conducted to assess short-term results of optional method to manage patients with anal abscess and fitula-in-ano at the same time. Materials and Methods: In this cross-sectional descriptive study 49 from 77 patients with anal abscess whose internal orifice was not identified by pressing on the abscess, diluted hydrogen peroxide (2%) and methylene blue was injected into the abscess cavity and the anal canal was inspected to find out the internal opening. Once the opening was distinguished, an incision was given from the anal verge to the internal opening. Results: The internal orifice was identified in 44 out of 49 patients (90%) who underwent this new technique. Up to 18 months during follow-up, only 2.5% of patients with primary fistulotomy developed fistula on the site of a previous abscess. Conclusion: Conventional method to seek the internal orifice of anal abscesses is successful in about one-third of cases. By applying this new technique, surgeons would properly find the internal opening in >90% of patients. Needless to say, safe identification of the anal gland orifice in anal abscess disease best helps surgeons to do primary fistulotomy and in turn it would significantly decrease the rate of recurrence in anal abscess and fistula formation.