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We identified a high prevalence (46.4%) of wound colonization with methicillin-resistant Staphylococcus aureus (MRSA) in patients hospitalized in a center devoted to the treatment of cutaneous tropical diseases in Benin. The proportion of MRSA among S aureus isolates was 54.3%. Thirty percent of these MRSA were identified in outpatients. The analysis of pulsed-field gel electrophoresis demonstrated an important diversity of strains but also identified 8 small clusters containing between 2 and 4 isolates suggesting cross-transmission. • Almost half of patients' wounds were colonized with MRSA. • Total 30% of MRSA were identified in outpatients. • Diversity of MRSA isolates according to pulsed-field gel electrophoresis. • Several small clusters suggest direct or cross-transmission inside the center. • Need for rural African health care settings to refer to a microbiology laboratory. [ABSTRACT FROM AUTHOR]

Plastic surgery (PS) in Africa is a relatively young surgery specialty, and the number of available plastic surgeons on average is one or two surgeons per country in many African low-income countries. This systematic review aims to geographically map the research activities through scientific publications of African PS centres, between February 2012-February 2023. We searched four literature databases (Medline, Embase, Google Scholar and African Journal Online) and did a manual search. We included case reports, randomised controlled trials, and clinical, comparative, observational and multicentre studies conducted in Africa and published in English and French. In the Google Scholar database, we analysed the first 200 references (scientific articles) selected per relevance according to the Boolean terms. In the African Journals Online database, we analysed the references from the first five pages. The selected keywords were: burns, trauma reconstruction, pressure injuries, wound, cleft lip and palate, breast reconstruction, microsurgery, aesthetic surgery, face surgery, head and neck surgery, hand surgery, open fracture surgery, oculoplastic surgery, skin surgery, and soft tissue surgery. We retrieved a total of 228 articles. Out of the 73 African centres we identified, 27 were in the North, 22 in the West, 8 in the East, 3 in the Centre, and 14 in the South. Most of the retrieved 228 articles involved burns (60, 26.31%), congenital abnormalities (52, 22.80%) and reconstruction (28,12.80%); however, other conditions, such as breast or skin cancer, hand surgery, microsurgery or aesthetics are emerging. The studies were case reports/case series (93, 40.78%), retrospective (78, 34.21%), prospective (36, 15.78%), randomised controlled studies (10, 4.38%), cross-sectional (5, 2,19%) and cohort (2, 0.87%). Beyond burns, congenital abnormalities, or reconstructions, other PS indications are emerging, such as skin cancer, breast reconstruction, hand surgery, microsurgery, and aesthetics. [Display omitted] [ABSTRACT FROM AUTHOR]

Wound infections and abscesses in rabbits are a common problem in veterinary practice and their treatment can be challenging. Bacterial culture and antimicrobial susceptibility testing are important tools in these cases. While some studies are available on bacteria associated with wound infections and abscesses in rabbits, the numbers of animals included is generally limited. Monitoring of antibiotic resistance in clinical practice is also an important part of good antibiotic stewardship. Multiple antibiotic resistances are frequently encountered in Staphylococcus and Pseudomonas spp., 2 groups of bacteria commonly associated with abscesses in rabbits. This retrospective study evaluated the results of aerobic bacterial cultures and antibiotic susceptibility tests in swabs from abscesses (A) (n = 541) and from skin and wounds (SW) (n = 308) submitted to a commercial diagnostic laboratory. Samples submitted between January 2017 and October 2020 were included in the study. Antimicrobial susceptibility testing for Staphylococcus and Pseudomonas spp. was evaluated and compared. In A, 465 bacterial isolates including 35 different species were isolated while 394 bacterial isolates, including 35 different species, were found in SW. The most frequently isolated bacteria were Staphylococcus spp. (A = 21.7%, SW = 36.5%) followed by Pasteurella spp. in A (13.3%) and aerobic spore-forming bacteria in SW (11.2%). Pseudomonas spp. was the third most commonly isolated genus in both sample types (A = 11.6%, SW = 8.9%). Pseudomonas aeruginosa isolated from A were more often resistant to the tested antibiotics than other Pseudomonas species. These results support the need for bacterial culture and antibiotic susceptibility testing of wounds and abscesses from rabbits. [ABSTRACT FROM AUTHOR]

The health crisis related to the COVID-19 pandemic led to an unprecedented situation in France: complete lockdown. The population had to live confined with their families, which often meant that parents telecommuted while caring for their children. However, daily risks remained more than ever at the forefront. The aim of this study was to assess the epidemiology of burns among children during three different periods of family time: school time, vacation, and lockdown. A single-center retrospective study was conducted at Tours University Hospital. All pediatric surgical emergency room visits recorded from February 10, 2020 to March 31, 2020 were included. The three aforementioned periods were assessed. During lockdown there were significantly more burns compared to other injuries (p = 0.004). Preschool-age children suffered significantly more from burns during the same period (p = 0.029). There were no significant differences for nursery school (p = 0.522), primary school (p = 0.519), middle school (p = 0.613), and high school (p = N) children. This study underlines the need to establish a targeted prevention campaign geared toward a complicated geopolitical situation a pandemic that might occur again. [ABSTRACT FROM AUTHOR]

In 2018, the French "Yellow Vest" social protest movement spread with weekly demonstrations resulting in confrontations between protesters and law enforcement. Non-lethal weapons, such as defensive bullet launchers (DBL) were used, and significant injuries have been reported through media, leading to public controversy regarding their use. These injuries are not well-known to civilian emergency physicians. The aim of this study is to describe the injuries caused by DBL among Emergency Department (ED) patients during these demonstrations and to identify the characteristics that required specialized care and hospital admission. A multicenter retrospective study was conducted in 7 EDs of academic hospitals in Paris, France. Adult ED patients who presented with DBL injuries during "yellow vest" strikes between November 2018 and May 2019 were included. The primary outcome was the rate of DBL patients requiring hospital admission. We also compared the characteristics of the injuries and the care provided between the admitted patients and other DBL patients. 152 patients were included. 17% were admitted to hospital, with 19% of them being transferred to intensive care units. 49% of all patients had head, face, eye or neck injuries including 4 cases of intracranial hemorrhage, 1 carotide dissection, 1 laryngeal edema, 1 pneumencephalus. 11% of all patients presented with multiple wounds, and 28% had fractures (77% of admitted patients vs 18%, p < 0.001). Surgery was required for 20% of all patients (62% of admitted patients vs 10%, p < 0.001). Maxillofacial surgery was performed on 38% of admitted patients, orthopedic surgery on 25%, and neurosurgery on 13%. No death were reported. The use of DBL during the "yellow vest" civil strikes was associated with a high rate of head, face, eye or neck injuries among injured ED patients. Hospital admission was associated with a higher rate of fractures, with most of them requiring maxillofacial, orthopedic and neurosurgeries. • During the social protest movement of the French "Yellow vests", • H Half of the injuries caused by rubber bullets among Emergency Department patients were located in the head, face, eye or neck. • One-fifth of all patients needed surgery mostly in the fields of maxillofacial, orthopedic, and neurosurgery. • Hospital admission was necessary for 17% of all patients injured by rubber bullets. [ABSTRACT FROM AUTHOR]

Focused assessment sonography for trauma (FAST) performed in the prehospital setting may improve trauma care by influencing treatment decisions and reducing time to definitive care, but its accuracy and benefits remain uncertain. This systematic review evaluated the diagnostic accuracy of prehospital FAST in detecting hemoperitoneum and its effects on prehospital time and time to definitive diagnosis or treatment. We systematically searched PubMed, Embase, and Cochrane library up to November 11th, 2022. Studies investigating prehospital FAST and reporting at least one outcome of interest for this review were considered eligible. The primary outcome was prehospital FAST diagnostic accuracy for hemoperitoneum. A random-effect meta-analysis, including individual patient data, was performed to calculate the pooled outcomes with 95% confidence intervals (CI). Quality of studies was assessed using the QUADAS-2 tool for diagnostic accuracy. We included 21 studies enrolling 5790 patients. The pooled sensitivity and specificity of prehospital FAST for hemoperitoneum were 0.630 (0.454 – 0.777) and 0.970 (0.957–0.979), respectively. Prehospital FAST was performed in a median of 2.72 (2.12 – 3.31) minutes without increasing prehospital times (pooled median difference of 2.44 min [95% CI: -3.93 – 8.81]) compared to standard management. Prehospital FAST findings changed on-scene trauma care in 12–48% of cases, the choice of admitting hospital in 13–71%, the communication with the receiving hospital in 45–52%, and the transfer management in 52–86%. Patients with a positive prehospital FAST achieved definitive diagnosis or treatment more rapidly (severity-adjusted pooled time ratio = 0.63 [95% CI: 0.41 – 0.95]) compared with patients with a negative or not performed prehospital FAST. Prehospital FAST had a low sensitivity but a very high specificity to identify hemoperitoneum and reduced time-to-diagnostics or interventions, without increasing prehospital times, in patients with a high probability of abdominal bleeding. Its effect on mortality is still under-investigated. [ABSTRACT FROM AUTHOR]

Lower extremity wounds associated with fractures and bony defects often require secondary orthopedic procedures after flap coverage has been performed. In this study, we compare complications between muscle and fasciocutaneous flaps after secondary orthopedic procedures. A retrospective chart review study of all lower extremity soft tissue reconstructions by a single surgeon over seven years yielded a subgroup of patients who underwent secondary orthopedic procedures, including hardware removal, hardware revision, and bone grafting after flap reconstruction. Of 355 lower extremity, soft tissue reconstructions for orthopedic coverage performed in the time period studied, 102 patients underwent secondary orthopedic procedures after flap reconstruction. Of these, 54 received muscle flaps (52.94%), and 48 received fasciocutaneous flaps (47.06%). Using this subgroup of 102 patients, we compared muscle and fasciocutaneous flaps using three categories of wound complications following these secondary procedures: There were no superficial wounds requiring local wound care only in the muscle flap group (0%, n = 0) versus 4.17% (n = 2; p = 0.130) in the fasciocutaneous flap group. There were 2 lost flaps requiring surgical debridement and additional skin grafting in the muscle flaps group (3.70%) versus 2 (4.17%; p = 0.904) in the fasciocutaneous flap group. In the third category, flap loss requiring additional soft tissue reconstruction was 18.52% (n = 10) in the muscle group versus 2.08% (n = 1; p = 0.008) in the fasciocutaneous flap group. Our data support the existing literature indicating that fasciocutaneous flaps can tolerate secondary procedures better than muscle flaps and should initially be considered in patients with higher probability of needing additional orthopedic procedures after reconstruction. [ABSTRACT FROM AUTHOR]

The species Jatropha gossypiifolia, popularly known as "pinhão-roxo", is distributed throughout Brazil, is commonly employed for topical or oral administration in treating wounds, inflammations, and snake bites. Given the significant impact of snakebites on public health and the limitations of antivenom, coupled with the diverse molecular composition of this plant species, investigating its healing and antidermonecrotic capacities is relevant. This study aimed to develop a topical nanoemulsion incorporating the hydroethanolic extract of J. gossypiifolia leaves, to evaluate its therapeutic potential, particularly in terms of its efficacy in wound healing and inhibition of dermonecrosis induced by B. erythromelas venom (BeV). The extract of J. gossypiifolia (JgE) leaves was obtained by maceration and remaceration. The phytochemical analysis was conducted and J. gossypiifolia nanoemulsion (JgNe) was obtained, characterized and assessed for stability. The cytotoxicity was determined in normal cells (erythrocytes and 3T3) using hemolytic assay and cell viability assay using crystal violet staining. The antioxidant activity was evaluated by the reduction of ABTS and DPPH radicals. The evaluation of wound healing was conducted in vivo following treatment with JgNe, wherein the percentage of wound closure and inflammatory mediators. The skin irritation test was assessed in vivo by applying JgNe directly to the animal's skin. In vitro , the antivenom capacity was evaluated through enzymatic inhibition assays (phospholipase A 2 and hyaluronidase) of BeV. Additionally, the in vivo antidermonecrotic activity of JgNe was evaluated by measuring the reduction of the dermonecrotic halo. The HPLC-DAD analysis identified flavonoids, specifically vitexin, luteolin derivatives and apigenin derivatives. In addition, 95.08 ± 5.46 mg of gallic acid/g of extract and 137.92 ± 0.99 mg quercetin/g extract, was quantified. JgNe maintained stability over a 4-week period. Moreover, JgE and JgNe demonstrated no cytotoxicity in human erythrocytes and murine fibroblasts at tested concentrations (32.25–250 μg/mL). Additionally, exhibited significant antioxidant activity by reducing ABTS and DPPH radicals. The treatment with JgNe did not induce skin irritation and accelerated wound healing, with significant wound closure observed from 5th day and reduction in nitrite levels, myeloperoxidase activity, and cytokine. Both JgE and JgNe demonstrated in vitro inhibition of the phospholipase and hyaluronidase enzymes of BeV. Moreover, JgNe exhibited antidermonecrotic activity by reducing the dermonecrotic halo caused by BeV after 24 h. JgNe and JgE exhibited no cytotoxicity at the tested concentrations. Additionally, our findings demonstrate that JgNe has the ability to accelerate wound closure and reduce dermonecrosis caused by BeV, indicating to be promising formulation for complementary therapy to antivenom treatment. [Display omitted] [ABSTRACT FROM AUTHOR]

• Excellent antioxidant and scavenging activity displayed by majority of the extracts. • Most extracts displayed high anti-xanthine oxidase activity outperforming quercetin. • Moderate 15-LOX inhibition was displayed by extracts from four species. • At some degree, all tested extracts preserved the activity of the COX-1 enzyme. • Majority plants displayed selective inhibition against the COX-2 enzyme. Six indigenous medicinal plants species, Agapanthus inapertus, Cheilanthes hirta, Crassula capitella, Eriospermum flagelliforme, Euphorbia clavarioides and Pelargonium alchemilloides are used traditionally in South Africa to treat wounds without scientific evidence as wound healing agents. Consequently, this study sought to investigate the antioxidant and anti-inflammatory activities of these plants species as a first step towards their validation as wound healing agents. The 2,2-diphenyl-1-picrylhydrazyl (DPPH), nitric oxide (NO), ferric reducing antioxidant power (FRAP), and β-carotene-linoleic acid model system (β-CLAMS) assays were used to test for antioxidant activity. The inhibition of the xanthine oxidase (XO), cyclooxygenase -2 (COX-2) and 15- lipoxygenase (15-LOX) as well as the extracts' ability to preserve the cyclooxygenase-1 (COX-1) enzyme activity were used as anti-inflammatory models. Furthermore, the total phenolics, flavonoids and proanthocyanidins content were quantified using standard methods. Species, C. hirta displayed high flavonoid and proanthocyanidin content whilst C. capitella displayed high phenolic content, and good activity against the four used antioxidant models compared to standards, butylated hydroxytoluene and ascorbic acid. Majority of the extracts displayed significantly higher anti-xanthine oxidase activity, outperforming standard quercetin. The acetone extracts of A. inapertus (IC 50 = 57.33 ± 0.30 µg/mL), E. flagelliforme (IC 50 = 52.10 ± 0.98 µg/mL), P. alchemilloides (IC 50 = 58.28 ± 0.94 µg/mL) and E. clavarioides water (IC 50 = 50.53 ± 0.47 µg/mL) extract displayed moderate 15-LOX inhibition compared to standard, nordihydroguaiaretic acid (IC 50 = 0.45 ± 0.01 µg/mL). The acetone extracts of C. capitella (IC 50 = 3.16 ± 0.06 µg/mL), E. flagelliforme (IC 50 = 1.13 ± 0.09 µg/mL) , E. clavarioides (IC 50 = 1.84 ± 0.18 µg/mL), P. alchemilloides (IC 50 = 1.13 ± 0.14 µg/mL), and the E. clavarioides water extract (IC 50 = 1.18 ± 0.11 µg/mL) displayed COX-2 inhibition comparable to that of standard, aspirin (IC 50 = 1.11 ± 0.03 µg/mL). At some degree, all tested extracts preserved the activity of the COX-1 enzyme with the E. clavarioides acetone extract significantly preserving the activity of COX-1 (IC 50 = 96.21 ± 0.18 µg/mL), compared to standard, aspirin (IC 50 = 0.98 ± 0.06 µg/mL). The antioxidant and anti-inflammatory activities displayed by these medicinal plants support their application and beneficial effect in wounds healing and hold promising prospects as natural alternatives to the existing conventional treatments. [ABSTRACT FROM AUTHOR]

This project aimed to create and implement a safe and efficient role-based process to rapidly extricate traumatically injured persons transported to the emergency department via police transport or private vehicle. A simulation exercise was conducted with an interdisciplinary team of ED personnel, Philadelphia Police Department, and University of Pennsylvania police officers to identify the necessary steps to rapidly extricate traumatically injured individuals. The simulation exercise identified several new processes needed to complete rapid extrications of traumatically injured individuals from private and police vehicles. These included a safe drop-off location, ED personnel role identification, proper personal protective equipment donning, 2 rapid extrication techniques, and a hard stop for weapon check by security before entering the emergency department. Through simulation, the ED interdisciplinary team was able to develop a role-based safe and efficient rapid extrication process. Educating new ED personnel, security, and Pennsylvania police continues to facilitate ongoing safe rapid extrication practices in the emergency department. [ABSTRACT FROM AUTHOR]

Patients with penetrating head trauma that crosses the midline of the brain have a high mortality rate; most die in the prehospital setting or during initial resuscitative efforts. However, surviving patients are often neurologically intact and several factors other than bullet path, including post-resuscitation Glasgow Coma Scale, age, and pupillary abnormalities, must be considered in aggregate when prognosticating patients. We present a case of an 18-year-old man who presented unresponsive after a single gunshot wound to the head that traversed the bilateral hemispheres. The patient was managed with standard care and without surgical intervention. He was discharged from the hospital neurologically intact 2 weeks after his injury. Patients with such apparently devastating injuries are at risk of premature termination of aggressive resuscitative efforts based on clinician bias that these efforts are futile and that patients cannot recover to a neurologically meaningful outcome. Our case reminds clinicians that patients with severe injury patterns with bihemispheric involvement can recover with good outcomes, and that bullet path is only one variable among multiple that must be considered to predict clinical outcome. [ABSTRACT FROM AUTHOR]

[Display omitted] Diabetic wounds (DWs) pose a significant health burden worldwide, with their management presenting numerous challenges. Biopolymeric formulations have recently gained attention as promising therapeutic approaches for diabetic wound healing. These formulations, composed of biocompatible and biodegradable polymers, offer unique properties such as controlled drug release, enhanced wound closure, and reduced scarring. In this review, we aim to provide a comprehensive overview of the current state of research and future prospects regarding the application of biopolymeric formulations for diabetic wound healing. The review begins by highlighting the underlying pathophysiology of DWs, including impaired angiogenesis, chronic inflammation, and compromised extracellular matrix (ECM) formation. It further explores the key characteristics of biopolymeric materials, such as their biocompatibility, biodegradability, and tunable physicochemical properties, which make them suitable for diabetic wound healing applications. The discussion further delves into the types of biopolymeric formulations utilized in the treatment of DWs. These include hydrogels, nanoparticles (NP), scaffolds, films, and dressings. Furthermore, the review addresses the challenges associated with biopolymeric formulations for diabetic wound healing. In conclusion, biopolymeric formulations present a promising avenue for diabetic wound healing. Their unique properties and versatility allow for tailored approaches to address the specific challenges associated with DWs. However, further research and developments are required to optimize their therapeutic efficacy, stability, manufacturing processes, and regulatory considerations. With continued advancements in biopolymeric formulations, the future holds great promise for improving the management and outcomes of DWs. [ABSTRACT FROM AUTHOR]

This study presents a phytotherapeutic emulsion-filled gel design composed of Pluronic® F127, Carbopol® C934P, and high level of copaiba oil-resin (PHY-ECO). Mathematical modeling and response surface methodology (RSM) were employed to access the optimal ratio between the oil and the polymer gel-matrix constituents. The chemometric approach showed robust mechanical and thermoresponsive properties for emulsion gel. The model predicts viscosity parameters at 35.0°C (skin temperature) from PHY-ECOs. Optimized PHY-ECOs were described by 18-20% (w/w) F127, 0.25% (w/w) C934P, and 15% (w/w) copaiba oil-resin, and showed interfacial layers properties that led to high physicochemical stability. Besides, it had thermal stimuli-responsive that led large viscosity range before and after skin administration, observed by oscillatory rheology. These behaviors give the optimized smart PHY-ECO high design potential to be used as a pharmaceutical platform for CO delivery, focusing on the anti-inflammatory therapy and skin wound care. [ABSTRACT FROM AUTHOR]

The treatment and care of human wounds represent an enormous burden on the medical system and patients alike. Chronic or delayed healing wounds are characterized by the inability to form proper granulation tissue, followed by deficiencies in keratinocyte migration and wound re-epithelialization, leading to increased likelihood of infection and poor wound outcomes. Human reticular acellular dermal matrix (HR-ADM) is one type of tissue graft developed to enhance closure of delayed healing wounds that has demonstrated clinical utility through accelerating closure of lower extremity diabetic ulcers, but the mechanisms underlying this clinical success are not well understood. The authors utilized a diabetic murine splinted excisional wound model to investigate the effects of HR-ADM application on wound closure. The authors demonstrate that application of HR-ADM served as a dermal scaffold and promoted rapid re-epithelialization and keratinocyte proliferation, resulting in accelerated wound closure while minimizing granulation tissue formation. HR-ADM-applied wounds also demonstrated evidence of cellular infiltration, neovascularization and collagen remodeling by the host organism. These data suggest that HR-ADM supports epidermal closure in delayed healing wounds and remodeling of the matrix into host tissue, lending further support to the clinical success of HR-ADM described in clinical reports. [ABSTRACT FROM AUTHOR]

• Administrative health data was used to study rates of injury related hospitalization in children. • Rates of injuries resulting in hospitalization were higher for youth living with IDD. • Self-harm injuries were higher for youth living with IDD. Introduction: Children and adolescents living with intellectual and developmental disability (IDD) have a higher risk of experiencing morbidities and premature death when compared to children and adolescents living without IDD. Childhood injuries are a leading cause of morbidity and death, yet there are limited studies that explore the prevalence of childhood injuries for individuals living with IDD. The purpose of this study was to analyze Ontario health administrative data to identify and compare rates of injury resulting in hospitalization in children and adolescents living with and without IDD. Methods: This is a cross-sectional study of all Ontarians aged 0–19 years with and without IDD. The outcome of interest was the rate of injury resulting in hospitalization. Results: This study found that children and adolescents with IDD had 1.79 (CI 1.66, 1.92) times higher rates of both intentional and unintentional injuries that resulted in hospitalization when compared to children and adolescents without IDD. Hospitalizations for self-harm related injuries were 3.16 (CI 3.09, 3.23) times higher in the IDD group. Conclusion : Children and adolescents with IDD have a higher risk of sustaining serious injuries, particularly injuries resulting from self-harm. Practical Applications: This study provides evidence of increased injury related hospitalizations for children and adolescents with IDD when compared to their peers without IDD. [ABSTRACT FROM AUTHOR]

Smart wound dressings aim to enable early diagnosis and treatment of wound infections to accelerate wound healing. This paper summarizes the latest research progress of smart wound dressings, including smart dressings for monitoring different parameters of wounds, smart dressings that can realize wound management, and advanced smart wound dressings that integrate monitoring and treatment into one, and systematically discusses and analyzes them. [Display omitted] • A comprehensive review of the latest developments in intelligent wound dressings. • Explored various wound dressing design concepts and developed applications. • Discussed the future prospects and challenges of intelligent wound dressings. Wound management has long been a significant concern within the healthcare industry. However, conventional passive wound dressings often fail to meet the requirements for effective wound management. As a result, there is a growing emergence of intelligent wound dressings that aim to address this issue. These smart wound dressings incorporate one or more electrochemical or optical sensors, enabling real-time monitoring of wound conditions. Furthermore, they also integrate various stimulation techniques, including photostimulation, electrostimulation, and pharmacological stimulation, in order to facilitate accelerated wound healing. This integration of sensing and stimulation capabilities holds immense potential for personalized wound care. This paper offers a comprehensive review of recent advancements in the field of wearable, novel dressings designed for the purpose of chronic wound monitoring and management. It examines various design concepts and applications that have been developed. Additionally, the paper discusses the future prospects and challenges associated with wearable bioelectronics in wound care, as well as their potential for clinical utilization. Furthermore, it explores the areas in which further development and research are needed, with a focus on establishing the priorities for the next generation of wound dressings. [ABSTRACT FROM AUTHOR]

Current pre-clinical evidences of Centella focus on its pharmacological effects on normal wound healing but there are limited studies on the bioactivity of Centella in cellular dysfunction associated with diabetic wounds. Hence we planned to examine the potential of Centella cordifolia in inhibiting methylglyoxal (MGO)-induced extracellular matrix (ECM) glycation and promoting the related cellular functions. A Cell-ECM adhesion assay examined the ECM glycation induced by MGO. Different cell types that contribute to the healing process (fibroblasts, keratinocytes and endothelial cells) were evaluated for their ability to adhere to the glycated ECM. Methanolic extract of Centella species was prepared and partitioned to yield different solvent fractions which were further analysed by high performance liquid chromatography equipped with photodiode array detector (HPLC-PDA) method. Based on the antioxidant [2,2-diphenyl-1-picrylhydrazyl (DPPH) assay] screening, anti-glycation activity and total phenolic content (TPC) of the different Centella species and fractions, the ethyl acetate fraction of C. cordifolia was selected for further investigating its ability to inhibit MGO-induced ECM glycation and promote cellular distribution and adhesion. Out of the three Centella species (C. asiatica, C. cordifolia and C. erecta), the methanolic extract of C. cordifolia showed maximum inhibition of Advanced glycation end products (AGE) fluorescence (20.20 ± 4.69 %, 25.00 ± 3.58 % and 16.18 ± 1.40 %, respectively). Its ethyl acetate fraction was enriched with phenolic compounds (3.91 ± 0.12 mg CAE/μg fraction) and showed strong antioxidant (59.95 ± 7.18 μM TE/μg fraction) and antiglycation activities. Improvement of cells spreading and adhesion of endothelial cells, fibroblasts and keratinocytes was observed for ethyl acetate treated MGO-glycated extracellular matrix. Significant reduction in attachment capacity of EA.hy926 cells seeded on MGO-glycated fibronectin (41.2%) and attachment reduction of NIH3t3 and HaCaT cells seeded on MGO-glycated collagen (33.7% and 24.1%, respectively) were observed. Our findings demonstrate that ethyl acetate fraction of C. cordifolia was effective in attenuating MGO-induced glycation and cellular dysfunction in the in-vitro wound healing models suggesting that C. cordifolia could be a potential candidate for diabetic wound healing. It could be subjected for further isolation of new phytoconstituents having potential diabetic wound healing properties. [ABSTRACT FROM AUTHOR]

Background: Large studies that examine risk factors for first occurrence of venous leg ulcerations are needed to guide management.Objective: To investigate factors associated with development of first occurrence of venous leg ulcerations.Methods: A retrospective cohort study using a validated national commercial claims database of patients with venous insufficiency. Subjects were followed to determine whether they developed first occurrence of venous leg ulcerations, and risk and protective factors were analyzed.Results: Adjusted hazard ratio (AHR) for comorbidities demonstrated an increased risk in men (AHR 1.838; 95% confidence interval [CI] 1.798-1.880), older age (45-54 years: AHR 1.316, 95% CI 1.276-1.358; 55-64 years, AHR 1.596, 95% CI 1.546-1.648), history of nonvenous leg ulceration (AHR 3.923; 95% CI 3.699-4.161), anticoagulant use (AHR 1.199; 95% CI 1.152-1.249), antihypertensive use (AHR 1.067; 95% CI 1.040-1.093), and preexisting venous insufficiency including chronic venous insufficiency (AHR 1.244; 95% CI 1.193-1.298), edema (AHR 1.224; 95% CI 1.193-1.256), and chronic venous hypertension (AHR 1.671; 95% CI 1.440-1.939). Possible protective factors were having venous surgery (AHR 0.454; 95% CI 0.442-0.467), using compression stockings (AHR 0.728; 95% CI 0.705-0.753), using prescribed statin medications (AHR 0.721; 95% CI 0.700-0.743), and using pain medications (AHR 0.779; 95% CI 0.757-0.777).Limitations: Risk of misclassification, given the use of International Classification of Diseases, Ninth Revision codes. Possible confounding factors such as body mass index could not be adequately controlled with these codes.Conclusion: The new evidence presented supports a paradigm shift toward venous leg ulceration prevention. [ABSTRACT FROM AUTHOR]

Wounds and perforations of the upper gastrointestinal tract are serious and life-threatening. The hypopharynx and cervical esophagus, by their respective anatomical positions, are exposed to traumatic wounds, most often during diagnostic tests, but management such wounds remains a subject of discussion. The present article analyzes the current state of knowledge on epidemiology, etiologies, risk factors, diagnostic management, prognostic factors and available treatments. [ABSTRACT FROM AUTHOR]

Background: Open traumatic tendoachilles injuries due to toilet seats are least reported. The exact mechanism of such injuries is debatable. None of the studies have reported associated neurovascular injuries and the need for microvascular tissue transfer.Methods: It is a 5-year prospective observational study from Sep 2013 - Aug 2018 at a tertiary care center on 26 patients who had sustained foot injuries due to squatting type toilet seats. All the patients were managed by thorough wound irrigation and debridement followed by repair of cut tendoachilles, other tendons and neurovascular structures. All the complications and secondary procedures required were recorded. Functional outcome was assessed by Boyden clinical outcome score. Follow up ranged from 1 to 5 years.Results: All the 26 patients reported a particular mechanism of injury. Complete transection of tendoachilles was seen in 23 (88.5%) patients and partial transection in three (11.5%) patients. Microvascular repair of cut posterior tibial artery was undertaken in three and posterior tibial nerve in two cases and microvascular parascapular flap in one case for soft tissue reconstruction. Twenty-three (88.5%) patients had good to excellent Boyden score while three patients (11.5%) had fair to poor score at 1 year. Such severe injuries due to toilet seats have never been reported in literature.Conclusions: Squatting toilet seats can cause devastating foot injuries involving tendons and neurovascular structures and may require microvascular tissue transfer for definitive wound management. The risk of such injuries will continue unless some modifications are undertaken in the design of the seat. [ABSTRACT FROM AUTHOR]

Groin wound complications after femoral artery reconstructions are highly morbid and notoriously difficult to treat. Successful techniques include long-term antibiotic therapy, operative débridement, and muscle flap coverage. Historically, more complex muscle flap coverage, such as a rectus femoris muscle flap (RFF), has been performed by plastic and reconstructive surgeons. In this study, the experience of vascular surgeons performing RFF in the management of wound complications after femoral artery reconstructions is reported. Clinical data between 2012 and 2018 were retrospectively analyzed. Data were summarized, and standard statistical analysis was performed. There were 23 patients who underwent 24 RFFs for coverage of complex groin wounds after femoral artery reconstructions. One of the 23 patients underwent bilateral RFFs. In this study cohort, patients had a median age of 67.5 years, and 79% (n = 19) were male. Median body mass index was 28.0 kg/m2, and 38% of patients were classified as obese on the basis of body mass index criteria. A history of tobacco use was present in 88%; however, only 29% were current smokers. Diabetes was present in 38% of patients and chronic kidney disease in 29%. Of the 24 RFFs, 14 (58%) were constructed in patients with reoperative groin surgery resulting in the need for muscle flap coverage. Femoral endarterectomy was the most common index procedure (46%), followed by infrainguinal leg bypass surgery (17%) and aortobifemoral bypass (17%). Grafts used during the original reconstruction included 12 bovine pericardial patches (50%), 6 Dacron grafts (25%), 4 PTFE grafts (17%), and 2 autogenous reconstructions (8%). Microbiology data identified 33% of patients (n = 8) to have gram-positive bacterial infections alone, 21% (n = 5) to have gram-negative infections alone, and 29% (n = 7) to have polymicrobial infections; 4 patients (13%) had negative intraoperative culture data. Median hospital stay after RFF was 8 days, and median follow-up time was 29.3 months. Major amputation was avoided in 20 of 24 limbs (83%) undergoing RFF. Eight patients underwent intentional graft or patch explantation (33%) before RFF, whereas 14 of the remaining 15 patients (93%) had successful salvage of the graft or patch after RFF. Two of the patients (13%) who underwent RFF with the intention of salvaging a prosthetic graft or patch required later graft excision. After RFF, 30-day and 1-year survival was 96% and 87%, respectively. RFF coverage of complex groin wounds after femoral artery reconstructions may safely be performed by vascular surgeons with excellent outcomes. [ABSTRACT FROM AUTHOR]

To date, research into interventions to promote wound healing has been led by scientists, clinicians, industry and academics, each with their own particular area of interest. However, the real experts in this area are the people who live with wounds and their families and heretofore their voice has not influenced or shaped the research agenda. This event aimed to seek patient and carer involvement as experts due to their lived experience in wounds through a partnership approach to identify research priorities and address a lack of patient and carer involvement in wound care research. A roundtable discussion format guided by the Scottish Health Council Participation Toolkit Supporting Patient Focus and Public Involvement in NHS Scotland was utilised. The Guidance for Reporting Involvement of Patients and the Public 2 – Short Form (GRIPP2-SF) guided the reporting process. Key areas for future research were identified and included; Patients and carers prioritised the establishment of support groups and the development of educational resources. Research priorities that emerged included understanding the impact of wounds, pain management, addressing educational needs and quantifying the financial burden on patients and carers of living with a wound. A key conclusion from this roundtable was that patients and their carers expressed a strong interest in further wound care related public and patient involvement events and identified areas for future research. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this study is to profile the netball-specific sporting injuries from in a national community-level insurance claim database.Design: An audit of insurance injury claims.Methods: An electronic dataset containing successful injury insurance claim data from the 2016 netball season was retrospectively coded. Data were de-identified and coded to meet the Orchard Sports Injury Classification System. Descriptive data reported included age, injury date, activity type, anatomical injury location, nature of injury, weather conditions, indoor/outdoor surface, quarter injury occurred, and open text for injury description.Results: The dataset contained 1239 claims that were approved for payment by the insurance company. The overall incidence rate was 2.936 successful injury claims per 1000 participants. The average age of players with claims was 34years. The majority of successful claims came from players aged 22 to 29years (n=328; 27%) and 30-39years (n=279; 23%) age groups. Of the successful claims for injury, most occurred during matches (n=1116; 92%), and were for injuries to the knee (n=509; 42%) and ankle (n=356; 29%) and for sprains/ligament damage (n=687; 57%) or fractures (n=182; 15%).Conclusions: Netball injuries profiled by an injury insurance dataset of successful claims mostly occurred to the knee and ankle. Sprains and ligament damage were the most common type of injury. This study strengthens the evidence for national injury prevention policies and strategies. Findings from the current study could be used in future to expand into mechanisms of injury, and injury diagnoses. [ABSTRACT FROM AUTHOR]

Though preventable in most cases, pressure ulcers continue to pose a major burden to the individual and society, affecting ≤3 million adults annually in the United States alone. Despite increased national attention over the past 20 years, the prevalence of pressure ulcers has largely remained unchanged, while the associated costs of care continue to increase. Dermatologists can play a significant role in pressure ulcer prevention by becoming aware of at-risk populations and implementing suitable preventive strategies. Moreover, dermatologists should be able to recognize early changes that occur before skin breakdown and to properly identify and stage pressure ulcers to prevent delay of appropriate care. The aim of the first article in this continuing medical education series is to discuss the pathophysiology, risk factors, epidemiology, social and economic burdens, and clinical presentation of pressure ulcers. [ABSTRACT FROM AUTHOR]

Prevention has been a primary goal of pressure ulcer research. Despite such efforts, pressure ulcers remain common in hospitals and in the community. Moreover, pressure ulcers often become chronic wounds that are difficult to treat and that tend to recur after healing. Especially given these challenges, dermatologists should have the knowledge and skills to implement pressure ulcer prevention strategies and to effectively treat pressure ulcers in their patients. This continuing medical education article focuses on pressure ulcer prevention and management, with an emphasis on the evidence for commonly accepted practices. [ABSTRACT FROM AUTHOR]

The field of dermatology has seen numerous therapeutic innovations in the past decade with platelet-rich plasma (PRP), recently garnering significant interest in alopecia, acne scarring, and skin rejuvenation. In other conditions of dermatology, such as chronic wounds and vitiligo, PRP has been investigated but has received less attention. The objective of this literature review was to focus on conditions of medical dermatology and to consolidate the available evidence on PRP for the practicing dermatologist. This review evaluates the literature up to October 31, 2018, and a search was conducted in the PubMed database for "platelet-rich plasma," "platelet releasate," "platelet gel," "platelet-rich fibrin" or "PRP" and "dermatology," "skin," "cutaneous," "wound," or "ulcer." In total, 14 articles met the inclusion criteria for this review. In studies representing Levels of Evidence 1b-4 according to the Centre for Evidence-Based Medicine, Oxford, PRP significantly improved wound healing in chronic diabetic ulcers, venous ulcers, pressure ulcers, leprosy ulcers, acute traumatic wounds, and ulcers of multifactorial etiologies. Two studies also documented benefits of adjunctive PRP in stable vitiligo. In chronic wounds of multiple etiologies and vitiligo, PRP warrants further investigation because it represents a potential therapeutic adjunct or alternative with a favorable side effect profile. [ABSTRACT FROM AUTHOR]

Introduction: The development of antibiotic resistance demands for novel complementary therapies for wound care. We here present a case series on the use of medical grade honey (MGH) in pediatric wounds. We aim to illustrate the specific antimicrobial and pro-healing activity of MGH and support its easy and safe use.Methods: Four pediatric patients with wounds of different origin are discussed in this prospective observational case series. All wounds were treated via monotherapy with daily MGH application.Results and Discussion: Wound covering with MGH prevents pathogen infiltration and has antimicrobial activity. Moreover, MGH keeps the wound moist and possesses strong pro-healing effects, such as autolytic debridement of non-vital tissue and restoration of vascular structures. The anti-inflammatory and anti-oxidative action of MGH together with the supplemented vitamins C and E may inhibit scar formation.Conclusion: MGH is safe and easily applicable and can be recommended in all kinds of wounds. [ABSTRACT FROM AUTHOR]

• Usnic acid is a lichenic secondary metabolite useful for the treatment of burn wounds. • The poor solubility limits the use of usnic acid in health care products. • Usnic acid was formulated in adhesive polymeric films to improve wounds treatment. • Film F2 is the most effective against usnic acid sensitive bacteria. • Film F2 is safe towards human keratinocytes and fibroblasts. Usnic acid (UA) is a lichenic secondary metabolite useful for the treatment of burn wounds thanks to its antimicrobial activity, particularly toward strains responsible for their infections. However, the poor solubility is the main factor limiting the activity and thus its use in health care products. Adhesive polymeric films were designed to improve UA use by enhancing its bioavailability in the wounded tissues. Three different NaCMC hydrogel films, NaCMC 2% alone (F1), mixed to PVP K90 0.1% (F2) or to Carbopol 971 P 0.1% (F3), were prepared by casting method. Ex vivo experiments performed on pig skin samples showed their suitable adhesion capacity. in vitro release test, performed using the extraction cell, showed that film F2 provides the highest UA concentrations. Differential scanning calorimetry and X-ray analyses performed on the three films highlighted that UA is present in a more soluble form in F2. The in vitro antibacterial activity studies demonstrated that F2 is the most effective film against UA sensitive bacteria S. Epidermidis , E. Faecalis , B. Cereus and S. Pyogenes. In vitro cytotoxicity assays on human keratinocytes and fibroblasts showed that cells viability is not compromised. [ABSTRACT FROM AUTHOR]

Purpose: The technical factors which improve cosmetic outcomes and which need to be emphasized in education of junior residents have yet to be described. We compared cases in which suturing was performed by either junior emergency medicine residents or experts, in order to determine the focus of future education and training.Methods: Wound registry data was reviewed and retrospectively analyzed from September 2015 to February 2016. Only patients who visited the emergency room with facial lacerations were enrolled, and their wound registry data sheets were reviewed. Practitioners were divided into junior resident and expert groups. We assessed the progress using the Stony Brook Scar Evaluation Scale (SBSES) 5-10 days following suturing.Results: Sixty-six patients were enrolled; 43 (65.2%) were men. The median (interquartile range) cosmetic scores (SBSES scale) for suturing performed by junior residents or experts were 3 (2-4) and 5 (4-5), respectively (p = 0.001). The percentage of maximum scores for each SBSES category was significantly lower in the junior resident group than in the expert group for width (68% vs. 86%), hatch marks (68% vs. 93%), and overall appearance (41% vs. 80%) (all p < 0.001).Conclusions: There were significant differences in scar widths and hatch marks, which were attributable to the skill level of the practitioner who performed the suturing of facial lacerations. Junior residents should be educated about maintenance of proper tension, atraumatic technique, and performing appropriate trimming or debridement. [ABSTRACT FROM AUTHOR]

The European Pressure Ulcer Advisory Panel, the Pan Pacific Pressure Injury Alliance, and the National Pressure Ulcer Advisory Panel are updating the 'Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline' (CPG) in 2019. The aim of this contribution is to summarize and to discuss the guideline development protocol for the 2019 update. A guideline governance group determines and monitors all steps of the CPG development. An international survey of consumers will be undertaken to establish consumer needs and interests. Systematic evidence searches in relevant electronic databases cover the period from July 2013 through August 2018. Risk of bias of included studies will be assessed by two reviewers using established checklists and an overall strength of evidence assigned to the cumulative body of evidence. Small working groups review the evidence available for each topic, review and/or draft the guideline chapters and recommendations and/or good practice statements. Finally, strength of recommendation grades are assigned. The recommendations are rated based on their importance and their potential to improve individual patient outcomes using an international formal consensus process. Major methodological advantages of the current revision are a clear distinction between evidence-based recommendations and good practice statements and strong consumer involvement. The 2019 guideline update builds on the previous 2014 version to ensure consistency and comparability. Methodology changes will improve the guideline quality to increase clarity and to enhance implementation and compliance. The full guideline development protocol can be accessed from the guideline website (http://www.internationalguideline.com/). • The EPUAP, NPUAP and PPPIA are updating the the International Clinical Practice Guideline for the prevention and treatment of pressure injuries. • Fifteen Associate Organizations support the guideline development. • A distinction will be made between evidence based guideline recommendations and best practice statements. • Several measures are planned to engage consumers in the guideline development. [ABSTRACT FROM AUTHOR]

Every year millions of lacerations and incisions taken place and require an effective methodology to manage the wound for a better life. The primary causes include mechanical trauma and surgical procedures. The rapid healing of the wound is critical to prevent further infection and reduction pain etc. Current options comprise of sutures, staplers, surgical strips and glues, again the intervention depends on the type of wound and the surgeon preference. The current wound closure techniques pose various potent limitations and confronting the problems to create a desired wound closure technique is necessary for faster and effective wound healing management. The surgical staplers are fast and easy to use wound closure devices, which approximates the edges of the wounds together by staples. The staples are mostly made up of metals like titanium and stainless steel. By modifying the existing stapling method using biodegradable staples that are expected to have good mechanical properties, not require removal procedure, minimized scarring and an overall acceleration in wound healing with minimal complications. Present, the paper focuses on the novel hypothesis on natural fiber reinforced biodegradable polymer staples as wound enclosures with high strength and degradability. [ABSTRACT FROM AUTHOR]

Abstract Objective Analgesic topical options to perform wound debridement are scarce. The purpose of this study was to communicate our experience using topical sevoflurane as analgesic for wound debridement. Methods After approval by our institutional review board, medical records were reviewed for those patients who had previously accepted to be treated with off-label topical sevoflurane (1 mL/cm2) as an analgesic for sharp debridement of painful wounds, because it was previously approved by our institutional Pharmacy Regulatory Commission and Medical Management. According to this protocol, pain scores were measured by using a numerical rating scale (from 0 to 10 points) over a 10-hour period. Wound debridement was performed following routine procedures. Results Medical records from 152 patients were reviewed. Baseline pain was severe (median, 7 points). After topical sevoflurane application, the analgesic effect was rapid (median pain score of 2 points at 5 minutes), and full debridement was feasible in most wounds (93%). The initial intense analgesic effect lasted for 30 minutes and then it subsided gradually over time to nearly reach baseline values after 10 hours. The patients estimated that the analgesic effect lasted several hours (median, 9 hours), and their overall satisfaction was high (median of 8 points on a scale ranging from 0 to 10). Fifty-two patients (34%) experienced itching. Conclusions Topical application of sevoflurane to painful wounds produced a rapid, robust, and long-lasting analgesic effect, which allowed for a high degree of wound debridement. [ABSTRACT FROM AUTHOR]

Abstract The skin wounds cause serious burden to healthcare systems. The lack of sterility of the innate barrier function of the skin facilitates the development of microbial communities within the wound environment especially in biofilm form. Since biofilm is difficult to eradicate, new treatments have been established, such as silver nanoparticles (AgNPs), which antimicrobial and anti-biofilm properties have been studied, nevertheless, their toxic effects are known too. Different concentrations of AgNPs stabilized with a biocompatible and thermo-reversible vehicle as hydrogel Pluronic F-127 were synthesized, those formulations presented interesting thermo-reversibility which could be used to apply on wounds. The formulations (Gel 62.5, 125, and 250 ppm of AgNPs) proposed in this study showed in vitro a total inhibition of clinical strains ( Staphylococcus aureus and Pseudomonas aeruginosa ) in planktonic form, as well as, anti-biofilm activity was archived with the formulation of Gel 250 ppm, a total inhibition of biofilm formation with mixed culture was registered in the first 30 min of biofilm growth; even more, the viability of human fibroblasts with all gels formulations was >95%, in contrast to silver sulfadiazine cream 1% which showed the highest cytotoxic effect. PF-127 gel with AgNPs could be a prophylactic treatment for skin wounds, because its activity in critical steps on biofilm formation. Highlights • The formulations of the hydrogels designed showed engaging features with potential like prophylactic treatment • PF-127 – AgNPs gel had significant antibacterial effect against planktonic form and anti-biofilm activity in critical steps • PF-127 – AgNPs gel was less toxic to human fibroblasts than Silver sulfadiazine cream 1 % • PF-127 – AgNPs gel has outstanding features: thermo-reversibility, antimicrobial activities and cytotoxicity to wound healing [ABSTRACT FROM AUTHOR]

Turmeric has long been used not only as an indispensable part of Asian cuisine but as a medicinal herb for dressing wounds, bites, burns, treating eye infections and acne. Curcuminoids are the active substances and their synthetic derivatives (i.e. diacetylcurcumin (DAC) and metal-curcumin complexes) possess an incredibly wide range of medicinal properties that encompass chelation capacity for multiple heavy metals, antioxidant activity, anti-inflammatory properties, cytotoxicity against cancerous cells, antiviral and antibacterial effects, antihypertensive and insulin sensitizing role, and regulatory role on apoptosis. The aforementioned properties have put curcumin on spotlight as a potential treatment for ailments such as, hepatic diseases, neurodegenerative diseases, metabolic syndrome, dyslipidemia, cardiovascular disease, auto-immune diseases, malignancies and conditions associated with metal overload. Copper is essential for major biological functions, however, an excess causes chronic ailments including neurodegenerative disorders. The fascinating approach of curcumin could alleviate such effect by forming a complex. Thus, this review aims to present available data on the effect of copper-curcumin interaction in various in vitro, ex-vivo in vivo, and clinical studies. [Display omitted] [ABSTRACT FROM AUTHOR]

There are various treatment protocols to manage the increased bacterial load in plantar ulcers. Recently, Controlled-Flux Electrolyzed Acidic Solution (CFEAS), with a pH less than 3, has appeared to be an effective option since its antimicrobial effect could help in the healing of those ulcers. In order to evaluate its potential in this sense, the aim of the present study was to compare bacterial growth on healthy hallucal skin using two types of bandaging (control and Controlled-Flux Electrolysed Acidic Solution). In a sample of 19 healthy subjects, two experiments were performed. In the first, for each subject, two identical hallux bandages were applied in the early morning. At random between left and right foot, either physiological saline (wetting every 2 h) was applied or nothing (control). In the second, two days later, new bandages were applied as before, but now either wetting with Controlled-Flux Electrolysed Acidic Solution (experimental, again wetting every 2 h) or nothing (control). In each experiment, the bacterial load in the nail fold was assessed at the first moment and after 10 h from standard counts of bacterial colony forming units (CFU). In the first experiment, the CFU counts had increased significantly (p < 0.05) in both toes after the 10-h period. In the second experiment, while the bacterial load increased significantly (p = 0.001) from 0.68 ± 0.8 × 104 CFU/cm2 (the "pre" sample) to 1.3 ± 0.9 × 104 CFU/cm2 (the "post" sample) in the control toe, in the experimental CFEAS toe, the pre sample bacterial load was 0.61 ± 0.6 × 104 CFU/cm2, and the post sample 0.9 ± 0.8 × 104 CFU/cm2, with no significant difference between them (p = 0.221). Negative cultures were obtained in 3 cases (15.78%) of the experimental toe post sample, and equal post and pre counts in 2 cases (10.5%). Controlled-Flux Electrolyzed Acidic Solution has an effect on healthy hallucal skin that is bacteriostatic, and in some cases bactericidal. This effect could be very helpful in treating plantar ulcers when there is a greatly increased bacterial load in the wound, thus potentially favoring the normal formation of granulation tissue in the skin and normal healing and closure of the ulcer. • Controlled-Flux Electrolyzed Acidic Solution is used to treat plantar ulcers. • CFEAS is bacteriostatic, and in some cases bactericidal. • To ensure this effect, the bandage applied must be kept moist at all times. [ABSTRACT FROM AUTHOR]

Abstract The inhibition of reactive oxygen species (ROS) and the migration of fibroblasts are key processes involved in wound healing. In this study, the ability of aqueous ethnomedicinal plant extracts prepared from Aspilia africana CD Adams, Boerhavia diffusa L. and Erythrina senegalensis DC. to mediate fibroblast migration and ROS release was determined. Phytochemical composition was assessed using thin-layer chromatography (TLC), whereas phytochemical markers were detected using ultra-performance liquid chromatography coupled to time of flight mass spectrometry (UPLC-TOF-MS). Sulforhodamine B staining and morphological examination via microscopy was conducted to determine cytotoxic effects on SC-1 fibroblasts. The effect on AAPH-induced oxidative stress was assessed by measuring ROS release using dichlorofluorescein diacetate activation. The scratch wound assay was used to estimate the rate of cellular migration. Alkaloids, flavonoids and phenols were detected in all three extracts using TLC, whilst UPLC-TOF-MS revealed the presence of neobavaisoflavone in E. senegalensis. None of the extracts was cytotoxic to the SC-1 cells at the highest in-well concentration tested (100 μg/mL). E. senegalensis extract reduced intracellular ROS and cellular migration by 35% and 32.5%, respectively. Although these plant extracts have the potential to minimise oxidation, they do not facilitate fibroblast migration. Further investigation into their mechanism of wound healing is required. Highlights • UPLC-TOF-MS revealed presence of neobavaisoflavone in Erythrina senegalensis. • Extracts were not cytotoxic to SC-1 fibroblasts. • Aspilia africana and Erythrina senegalensis extracts reduced ROS release. • All extracts showed the tendency to hinder fibroblast migration. [ABSTRACT FROM AUTHOR]

Background: Among non-communicable diseases, diabetes represents a growing public health problem in Africa, where diabetes-related needs remain mostly unmet and the disabling features of foot are worsened by hygienic, cultural, and healthcare issues. We aimed to review clinical characteristics, prevalence, and outcomes of patients with diabetic foot ulcer in Africa.Methods: We searched the literature for cross-sectional and longitudinal studies reporting the characteristics of patients with diabetic foot in African countries, with a particular focus on ulcer prevalence, amputation rate, and mortality.Findings: Fifty-five full-text papers and ten abstracts were retrieved, reporting data from 19 African countries on 56,173 diabetic patients. According to the data collected, the overall prevalence of foot ulcers was 13% and increased over time, especially since 2001. Approximately 15% of patients with foot lesions underwent major amputation and 14.2% died during hospitalization. In patients with diabetic ulcers, insulin therapy was uncommon and neuropathy was the most common predisposing factor, but the prevalence of peripheral arterial disease correlated with amputation rates. Amputation and mortality decreased over time, probably as result of the implementation of screening programs in the last ten years. Mortality was directly related to previous amputation.Interpretation: The diabetic foot disease in Africa is a growing problem and is burden by high rate of in-hospital mortality. Educational interventions and screening programs including evaluation of the vascular status may play a crucial role to counter diabetic foot disease in Africa. [ABSTRACT FROM AUTHOR]

Ethnopharmacological relevance The World Health Organization (WHO) recognizes the potential of plants used in secular traditional medicine and considers this an important source of evidence to assess their effectiveness and safety. Brazil is rich in biodiversity and traditional uses based on the Amerindian culture. However, many processes started with the arrival of the Portuguese in the year 1500. The successive economic cycles, for example, led to destruction of native vegetation and an intense cultural erosion. As a consequence, the information about the use of plants in the past centuries are dispersed and without interpretation. In this study a methodology to evidence the traditionality of Brazilian plants was demonstrated using data about barbatimão barks ( Stryphnodendron adstringens (Mart.) Coville - Fabaceae) and Copaiba oleoresin ( Copaifera spp. - Fabaceae) in wound healing, was established. Material and methods Data about use of the plants were recovered from bibliography published between 1576 and 2011. The books (101) were classified using weights, considering the date of publication and the source of Information. Older books that describe primary information received weight 10, while books written more recently and with secondary information received weight 0.4. A score for each category of medicinal use was calculated based on the books weights and the frequency of citation. A review about the current use of both plants was also performed from ethnobotanical studies published in journals. Results and discussion The traditional secular use of barks of barbatimão and oleoresin of copaiba to treat wounds was confirmed based on the historic bibliographic research. The most frequent use of barbatimão in a timeline of 500 years of Brazil’s history, was as astringent, whereas for copaíba was as healing of skin and mucosal lesions. The continuous and current use of these plants to treat wounds, confirmed by recent ethnobotanical studies, is an indicative of the resilience of these remedies and their effectiveness. Conclusion The use of preparations containing barbatimão barks and copaiba oleoresin can be considered effective in the treatment of wounds. Nonetheless, it is necessary to improve the quality of the formulas as established by WHO. [ABSTRACT FROM AUTHOR]

Background: The nanocrystalline silver (NCS) dressing Acticoat is commonly used in clinical practice for the treatment of burns and other open wounds as a topical antimicrobial. The dressing may dry resulting in traumatic dressing changes; hence the variety of contact layer dressings used in conjunction with it. Dressing combinations that do not permit NCS penetration are not cost effective and deprives the wound of the needed anti-microbial.Methods: Common wound pathogens were subjected to a variety of contact layer dressings underlying the NCS dressings. The zone of inhibition (ZOI) obtained was measured and compared to a control.Results: Intrasite gel demonstrated a synergistic effect with Acticoat. Iruxol exhibits antagonism by preventing penetration and is known to be partially deactivated by NCS. Intrasite conformable and Adaptic allowed partial penetration while the discs of Biobrane, unstretched/non-fenestrated Pelnac and Telfa transparent film did not allow for sufficient penetration to inhibit the underlying bacteria in this study. The cadaver skin from the South African skin bank (Tshwane university of Technology) displayed a greater antimicrobial effect than even the Acticoat control.Conclusion: Our results illustrate that we should perhaps reconsider dressing combination choices with Acticoat in view of their redundancy or synergistic effect. [ABSTRACT FROM AUTHOR]

Electrical stimulation for delivery of biochemical agents such as genes, proteins and RNA molecules amongst others, holds great potential for controlled therapeutic delivery and in promoting tissue regeneration. Electroactive biomaterials have the capability of delivering these agents in a localized, controlled, responsive and efficient manner. These systems have also been combined for the delivery of both physical and biochemical cues and can be programmed to achieve enhanced effects on healing by establishing control over the microenvironment. This review focuses on current state-of-the-art research in electroactive-based materials towards the delivery of drugs and other therapeutic signalling agents for wound care treatment. Future directions and current challenges for developing effective electroactive approach based therapies for wound care are discussed. [ABSTRACT FROM AUTHOR]

Background At present there is no established national minimum data set (MDS) for generic wound assessment in England, which has led to a lack of standardisation and variable assessment criteria being used across the country. This hampers the quality and monitoring of wound healing progress and treatment. Aim To establish a generic wound assessment MDS to underpin clinical practice. Method The project comprised 1) a literature review to provide an overview of wound assessment best practice and identify potential assessment criteria for inclusion in the MDS and 2) a structured consensus study using an adapted Research and Development/University of California at Los Angeles Appropriateness method. This incorporated experts in the wound care field considering the evidence of a literature review and their experience to agree the assessment criteria to be included in the MDS. Results The literature review identified 24 papers that contained criteria which might be considered as part of generic wound assessment. From these papers 68 potential assessment items were identified and the expert group agreed that 37 (relating to general health information, baseline wound information, wound assessment parameters, wound symptoms and specialists) should be included in the MDS. Discussion Using a structured approach we have developed a generic wound assessment MDS to underpin wound assessment documentation and practice. It is anticipated that the MDS will facilitate a more consistent approach to generic wound assessment practice and support providers and commissioners of care to develop and re-focus services that promote improvements in wound care. [ABSTRACT FROM AUTHOR]

[Display omitted] Chronic wounds occur for several reasons, such as trauma, accidents, and diseases. Diabetes has been one of the primary causes of non-healing wounds, and the number of people with diabetes is increasing in most countries. Wounds in diabetic people have a complex and prolonged treatment process, with high treatment costs to both healthcare providers and patients. They often have severe consequences, such as pain, wound infection, tissue necrosis, and even limb amputation. Various methods have been used to treat chronic wounds, but clinical success has been limited due to inefficient delivery to the wound bed. Microneedles (MNs), as new platforms, can offer an effective treatment, easy to use and non-invasive with less tissue damage, capable of delivering a wide range of drugs to accelerate the wound healing process. Different methods and materials can be used for this technique, and there are different geometric parameters such as needle length, tip angle, shape and radius, together with needle array density to optimize for the most effective treatment. This review paper will investigate the role of MNs in healing chronic wounds and discuss the most recent development in MN-based devices in the field and their effectiveness. The manuscript will also discuss the various types of MNs and their potential applications for delivering therapeutic agents. Finally, the challenges associated with using MNs to heal chronic wounds and future directions in this field are discussed. [ABSTRACT FROM AUTHOR]

Chronic soft tissue wound infections due to multidrug-resistant bacteria are a clinical challenge. Methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus spp. (VRE), aminoglycoside-resistant Escherichia coli and Pseudomonas aeruginosa are examples of several problematic pathogens. A multipronged clinical approach is necessary for resolution of these chronic infections and a good medical outcome. [ABSTRACT FROM AUTHOR]

Most serious wound infections involve at least one, and usually a combination, of these factors: (1) extensive contamination or bacterial burden that overwhelms the patient's resources, (2) refugia which protect the bacteria from host defenses and antibiotic drugs, (3) immunocompromise, (4) poor perfusion, and (5) antibiotic resistance of the wound pathogen(s). In horses, wounds that involve bone, range in severity, complexity, and long-term impact from those containing a sequestrum, to septic osteomyelitis at the site of internal fixation. The principles of successful treatment are as follows: (1) debride the devitalized or irreparably damaged bone and soft tissue, (2) preserve and protect the vascular supply to bone and soft tissue, (3) maintain or restore structural integrity at the site, (4) control infection through appropriate local/regional and systemic antibiotic therapy and (5) protect the wound from further contamination, desiccation, maceration, and trauma. [ABSTRACT FROM AUTHOR]

Antibiotics may fail to abolish an infection in synovial structures for several reasons: (1) inherent antibiotic resistance; (2) acquired antibiotic resistance; (3) inappropriate drug dosage, route or treatment duration; and (4) refugia. A strategy to include surgical debridement and ancillary treatments are discussed in eliminating infections of joints and other synovial structures. [ABSTRACT FROM AUTHOR]

Pyocyanin, a toxin produced by Pseudomonas aeruginosa , offers potential as a biomarker for the indirect detection of this bacterium of major importance for infections in burns, woundcare and cystic fibrosis. Pad-printed carbon electrodes are herein explored using square wave voltammetry to detect pyocyanin in a range of buffered and biological media. Third-order polynomial baseline fitting was explored to enhance the analytical sensitivity and extend the linear range to submicromolar concentrations. These modelling baselines showed excellent correlation with the experimental data, confirmed by high Interclass Correlation Coefficients of 0.995–0.998, and enabled the quantification of pyocyanin – with linearity extended down to 0.18 μM in Human Serum and 0.336 μM in both Britton-Robinson buffer and Simulated Wound Fluid, and derived Limits of Detection of 0.17, 0.15 and 0.09 μM, respectively, in this proof-of-concept study. Therefore, the use of very simple, cost-effective printed carbon materials enabled the detection of clinically relevant concentrations of this important biomarker through a new baseline fitting model and offers a novel approach for point-of-care diagnostics where Pseudomonas aeruginosa infections are critical. [ABSTRACT FROM AUTHOR]

Background: Surfaces in the patient environment may play a role in microbial transmission if they become colonized by bacteria. Patient privacy curtains are one such surface that may pose a high risk for transmission because they are high-contact surfaces, are infrequently cleaned, and healthcare workers are less likely to wash their hands after contacting inanimate objects such as curtains.Aim: To determine the amount and type of bacterial colonization of patient privacy curtains at a regional burns/plastic surgery unit.Methods: Privacy curtain contamination on the burns/plastic surgery ward was determined for two separate occasions six months apart: 23 curtains on August 2015 and 26 curtains on January 2016. Dey-Engley neutralizing agar (DENA) replicate organism detection and counting (RODAC) contact plates were used daily to sample curtains near the edge hem where they are most frequently touched. Microbial contamination was reported as cfu/cm2 and the presence of meticillin-resistant Staphylococcus aureus (MRSA) was determined. Swabs were also taken of any open wounds and from tracheostomy sites on the ward.Findings: Curtain contamination in August 2015 was 0.7-4.7 cfu/cm2 with 22% testing positive for MRSA, whereas contamination on January 2016 was 0.6-13.3 cfu/cm2 with 31% of curtains testing positive for MRSA.Conclusion: Curtains on the burns/plastic surgery ward become colonized with significant quantities of bacteria. Future studies will need to address the rate of colonization and the clinical impact of this colonization to better inform cleaning protocols. [ABSTRACT FROM AUTHOR]

Background Negative pressure wound therapy (NPWT) is increasingly used prophylactically following surgery despite limited evidence of clinical or cost-effectiveness. Objective To evaluate whether NPWT is cost-effective compared to standard care, for the prevention of surgical site infection (SSI) in obese women undergoing elective caesarean section, and inform development of a larger trial. Methods An economic evaluation was conducted alongside a pilot randomised controlled trial at one Australian hospital, in which women were randomised to NPWT (n = 44) or standard care (n = 43). A public health care provider perspective and time horizon to four weeks post-discharge was adopted. Cost-effectiveness assessment was based on incremental cost per SSI prevented and per quality-adjusted life year (QALY) gained. Results Patients receiving NPWT each received health care costing AU$5887 (±1038) and reported 0.069 (±0.010) QALYs compared to AU$5754 (±1484) and 0.066 (±0.010) QALYs for patients receiving standard care. NPWT may be slightly more costly and more effective than standard care, with estimated incremental cost-effectiveness ratios (ICERs) of AU$1347 (95%CI dominant- $41,873) per SSI prevented and AU$42,340 (95%CI dominant- $884,019) per QALY gained. However, there was considerable uncertainty around these estimates. Conclusions NPWT may be cost-effective in the prophylactic treatment of surgical wounds following elective caesarean section in obese women. Larger trials could clarify the cost-effectiveness of NPWT as a prophylactic treatment for SSI. Sensitive capture of QALYs and cost offsets will be important given the high level of uncertainty around the point estimate cost-effectiveness ratio which was close to conventional thresholds. Australian and New Zealand trial registration number ACTRN12612000171819. [ABSTRACT FROM AUTHOR]

Résumé Les traumatismes de la face sont fréquents chez l’enfant et souvent banalisés. La face, très vascularisée, est le siège de saignements impressionnants sur le lieu de l’accident mais souvent sous-estimés chez l’enfant car il existe une vasoconstriction artérielle immédiate très développée. La masse sanguine est de 80 mL/kg chez le nouveau-né, soit 250 mL au total pour atteindre 70 mL/kg à partir de l’âge d’un an. L’évaluation doit être rigoureuse sous peine d’une décompensation brutale. Concernant les plaies, la réparation primaire doit être d’emblée parfaite ou optimale en cas de délabrement. Le dogme est d’être conservateur et le parage doit être minimaliste. La réparation minutieuse nécessite souvent une anesthésie générale, surtout chez les jeunes enfants afin de permettre un affrontement parfait des berges et des lignes cutanéo-muqueuses. Les pertes de substance doivent être traitées par cicatrisation dirigée. Il n’est jamais effectué de lambeaux immédiats chez l’enfant pour les raisons développées plus loin. Vu l’élasticité du squelette facial, les fractures nécessitent un choc violent pour survenir mais la clinique peut être trompeuse. Deux fractures sont souvent peu symptomatiques au niveau des signes faciaux et peuvent être méconnues : la fracture du condyle et sa complication l’ankylose osseuse temporomandibulaire, la fracture du plancher de l’orbite et sa diplopie définitive. Il faut savoir suspecter une maltraitance devant des lésions d’âges différents, et une discordance entre l’histoire racontée et les lésions constatées. Une fois éliminée l’urgence vitale, l’urgence faciale est d’abord à l’œil car les plaies et contusions du globe, souvent sous-évaluées, menacent la vision et relèvent de l’urgence ophtalmologique. L’urgence est ensuite la fracture du plancher de l’orbite sous sa forme dite « en trappe », apanage de l’enfant. La fracture du plancher de l’orbite associée à une immobilité de l’œil et des vomissements incoercibles est la 2 e vraie urgence car elle met en jeu le pronostic de la motricité de l’œil et nécessite une intervention en urgence. Enfin, les traumatismes dentaires de l’enfant ne doivent pas être négligés en raison de leurs conséquences fonctionnelles et esthétiques. La cicatrisation primaire est le plus souvent rapide mais les cicatrices restent longtemps inflammatoires. Le risque hypertrophique existe en cas de contusions et dilacérations associées aux plaies mais aussi pendant la période pubertaire et dans certaines localisations. L’âge interfère sur le résultat car la croissance va soit améliorer soit aggraver le résultat initial, en fonction de la localisation et du mécanisme. Le suivi spécialisé secondaire et prolongé est capital au plan fonctionnel, esthétique et psychologique. Summary Facial traumas are common in children but often unconsidered. Facial injury is responsible of impressive bleeding because of the rich vascularization of the face; this bleeding is often underestimated because of the immediate arterial vasoconstriction that is very strong for children. The blood volume is 80 ml/kg for a newborn, with a total of 250 ml, reaching 70 ml/kg at one year of age. The evaluation must be rigorously performed due to the risk of a sudden decompensation. Regarding the wounds, the primary repair must be performed directly neat or optimal in case of damaged tissues. The rule is to keep maximum of the integrity and to limit debridement. Careful repair often requires general anesthesia, especially in young children, to facilitate a perfect joining of the edges and of the mucocutaneous lines. Losses of substance should be treated by directed cicatrization. Flaps are never performed in children as a first intention for reasons developed below. Given the elasticity of the facial skeleton, fractures require a brutal shock to occur, but the clinical signs can be misleading. For instance, too specific and sometimes ignored, fractures can show weakly symptomatic signs : the fractures of the condylar and the orbital floor, with their respective complication that are temporomandibular bone ankylosis and definitive diplopia. Possible children abuse should be suspected in case of different age lesions and discrepancies between the told story and types of injuries. Once the vital urgency is eliminated, the orbital emergency should be first considered in facial traumas within the ophthalmology specialty because wounds and contusions of the globe are often under-evaluated and threaten the vision. The second emergency is the orbital floor fracture in its ‘trapdoor’ type, specific to the child. Combined with a motionless eye and uncontrollable vomiting, this is the second true urgency because it involves the prognosis of the oculomotricity and requires emergency surgery. Finally, dental trauma should not be overlooked because of their functional and aesthetic consequences. Primary cicatrization is usually rapid but scars remain inflammatory during a long time. The risk of hypertrophy exists in case of contusions and lacerations associated with wounds but also during puberty and in some locations. Age interfere with the result because growth will either improve or worsen the initial result, depending on the location and mechanism. The secondary specialized and prolonged managing and monitoring is capital on the functional, aesthetic and psychological points of view. [ABSTRACT FROM AUTHOR]