Search

Significance: The development of an imaging technique to accurately identify biofilm regions on tissues and in wounds is crucial for the implementation of precise surface-based treatments, leading to better patient outcomes and reduced chances of infection. Aim: The goal of this study was to develop an imaging technique that relies on selective trypan blue (TB) staining of dead cells, necrotic tissues, and bacterial biofilms, to identify biofilm regions on tissues and wounds. Approach: The study explored combinations of ambient multi-colored LED lights to obtain maximum differentiation between stained biofilm regions and the underlying chicken tissue or glass substrate during image acquisition. The TB imaging results were then visually and statistically compared to fluorescence images using a shape similarity measure. Results: The comparisons between the proposed TB staining method and the fluorescence standard used to detect biofilms on tissues and glass substrates showed up to 97 percent similarity, suggesting that the TB staining method is a promising technique for identifying biofilm regions. Conclusions: The TB staining method demonstrates significant potential as an effective imaging technique for the identification of fluorescing and non-fluorescing biofilms on tissues and in wounds. This approach could lead to improved precision in surface-based treatments and better patient outcomes.

Muslims regard Islam as a complete code of conduct because it provides guidance in all aspects of life. Islamic teachings cover nearly all areas of knowledge, including medical sciences. Islam offers a unique perspective on how to treat wounds and illnesses. Islamic wound treatment methods are distinct and recognized by modern science. For Muslims, the only true treatment for illnesses and injuries is that mentioned in the Holy Quran and practiced by the Holy Prophet himself throughout his lifetime. Islamic treatments for various internal and external wounds and illnesses, such as the use of honey, black cumin, Indian incense, cupping, and cauterization, are extremely beneficial in treating both internal and external wounds. Islamic diets are high in beneficial nutrients for the body, such as ginger, figs, dates, and olive oil, and Islamic rituals such as five daily prayers, ablution, and fasting are very effective at keeping the body wound resistant. A healthy body has a strong immune system that can fight off various illnesses and injuries. To reach a definitive conclusion, a thorough examination of Islam’s original and fundamental sources, such as the Holy Quran and the sayings of the Holy Prophet, was carried out. Although modern science has validated the majority of the approaches emphasized by Islamic teachings, much more research is needed to validate Islamic sayings about medical sciences.

Hazelnut shells, the main waste deriving from hazelnut processing, represent an interesting source of active molecules useful in pharmaceutics, although they have not yet been examined in depth. A hydrosoluble extract (hazelnut shell extract, HSE) was prepared by the maceration method using a hydroalcoholic solution and used as the active ingredient of patches (prepared by casting method) consisting of composites of highly deacetylated chitosan and green clay. In vitro studies showed that the formulation containing HSE is able to stimulate keratinocyte growth, which is useful for healing purposes, and to inhibit the growth of S. aureus (Log CFU/mL 0.95 vs. 8.85 of the control after 48 h); this bacterium is often responsible for wound infections and is difficult to treat by conventional antibiotics due to its antibiotic resistance. The produced patches showed suitable tensile properties that are necessary to withstand mechanical stress during both the removal from the packaging and application. The obtained results suggest that the developed patch could be a suitable product to treat wounds.

BackgroundSerial hemoglobin measurement (ΔHgb) is intended to aid in the early identification of blunt trauma patients who have significant blood loss requiring intervention. However, the utility of ΔHgb has yet to be rigorously studied.ObjectiveWe sought to determine if ΔHgb is a reliable diagnostic tool in assessing blood loss in blunt trauma patients.MethodsWe enrolled consecutive blunt trauma patients ≥18 years of age who presented to a level I trauma center. We measured 2 hemoglobin levels spaced 5 min apart and calculated the difference (ΔHgb) for each patient. We also recorded whether each patient required any of the following interventions to treat their injuries: 1) operation or procedure to control hemorrhage; 2) radiographic embolization; 3) administration of blood and blood products; 4) administration of ≥3 liters of intravenous fluids; and 5) exsanguination. Our primary outcome was the area under the receiver operating characteristic (ROC) curve.ResultsWe enrolled 251 patients, including 192 males and 59 females with a mean age of 40 years. Interventions occurred in 56 patients and were withheld in 195. The median ΔHgb was -0.1 gm/dL (interquartile range -0.5 to 0.1 gm/dL) for patients requiring intervention and 0.0 gm/dL (interquartile range -0.6 to 0.3 gm/dL) for patients not requiring intervention. We found the area under the ROC curve to be 0.53 (95% confidence interval 0.44-0.62).ConclusionsOur results indicated that ΔHgb does not reliably distinguish between blunt trauma patients who require intervention and those who do not.

BackgroundThe risk of radiation exposure from computed tomography (CT) imaging in children is well recognized. Patient history and physical examination findings, including costal margin tenderness (CMT), influence a physician's decision to image a child with blunt torso trauma. The objective of this study was to determine the importance of CMT for identifying children with intraabdominal injuries (IAI) found on CT and IAI undergoing acute intervention.MethodsWe conducted an analysis of the Pediatric Emergency Care Applied Research Network (PECARN) IAI public use data set, representing a large prospective multicenter cohort study from May 2007 to January 2010. Isolated CMT was defined as CMT without other identified PECARN risk factors for IAI (i.e., abdominal or thoracic wall trauma, abdominal tenderness or pain, decreased breath sounds, or vomiting). Logistic regression was used to calculate adjusted odds of IAI in children presenting with isolated and nonisolated CMT. Risk differences were calculated to estimate the risk of IAI independently attributable to CMT in the setting of isolated PECARN risk factors. Finally, CT use among exposure groups was estimated to quantify potentially avoidable imaging.ResultsAmong 9,174 children with Glasgow Coma Scale scores of 14 or 15 who sustained blunt torso trauma, 1,267 (13.8%) had CMT. Among those with CMT, 177 (14.0%) had isolated CMT and 1,090 (86.0%) had nonisolated CMT. No children (0/177; 0%, 95% confidence interval [CI] = 0.0%-2.1%) with isolated CMT had IAI, compared to 17.2% (187/1,090; 95% CI = 15.0%-19.5%) of those with nonisolated CMT. The risk differences were not statistically significant. 36/177 (20.3%; 95% CI = 14.7%-27.0%) children with isolated CMT underwent abdominal CT scans.ConclusionsThe risk of IAI associated with isolated CMT is minimal. For children with blunt abdominal trauma and isolated CMT, abdominal CT scan is of low yield.

OBJECTIVE:To determine if traumatic renal injuries or computed tomography (CT) findings are predictive of hypertension (HTN) development following injury. METHODS:A retrospective review of a renal trauma database was performed from 1995 to 2015. Renal injuries were graded by the American Association for the Surgery of Trauma system, with high-grade defined as IV or V. Nonrenal genitourinary trauma (ie bladder, penile, urethral, and testicular) patients were selected as controls. Patients with a diagnosis of HTN before their trauma or those lacking follow-up were excluded. Risk factors associated with HTN following trauma were identified using multivariable regression with propensity scoring. RESULTS:In total, 163 patients had a renal injury and 60 had nonrenal, genitourinary injuries. The median age was 31 years (interquartile range 23-43) with median follow-up of 4.7 years (interquartile range 1.9-8.5). Twenty-three (14%) patients with renal trauma were newly diagnosed with HTN on follow-up, compared with 2 (3%) in the control groups. (P = .02) After propensity quartile adjustment, patients with high-grade trauma had higher odds of developing HTN compared with low-grade renal trauma patients and controls (adjusted odds ratio 3.5, 95% confidence interval 1.3-9.3, P = .01). Patients with a midpole medial laceration and medial blood on CT had higher odds of developing HTN compared with patients without these characteristics (odds ratio 5.36, 95% confidence interval 1.3-22.6, P = .02). CONCLUSION:Increasing renal trauma grade is a risk factor for future development of HTN. CT findings at trauma presentation may be useful in stratifying patients who are at increased risk.

OBJECTIVE:To evaluate the effect of conservative management of high-grade renal trauma on length of hospitalization, we aim to describe characteristics of patients with high-grade renal trauma that are associated with an increased length of stay (LOS) and the effect of conservative vs surgical management on hospital LOS. METHODS:A retrospective review of all patients who suffered unilateral high-grade renal trauma (grade 3 or higher) from September 1977 to August 2012 at San Francisco General Hospital in San Francisco, CA was performed. Patients' demographic information, mechanism of injury, injury grade, data about associated injuries, hospital LOS, and management were collected. Descriptive analysis was performed using chi-square, ordered logistic regression, and linear regression analysis. Multivariable analysis was performed using a Fine-Gray model of competing risks survival analysis, adjusting for trauma type, grade, surgery, associated injury, and complications. RESULTS:The cohort consisted of 408 patients with high-grade unilateral renal trauma of which 257 patients underwent renal exploration. The adjusted multivariable analysis revealed that trauma type, injury grades, nongenitourinary surgery, associated injuries, and complications were associated with increased hospital LOS (P

BackgroundThe rarity of renal trauma limits its study and the strength of evidence-based guidelines. Although management of renal injuries has shifted toward a nonoperative approach, nephrectomy remains the most common intervention for high-grade renal trauma (HGRT). We aimed to describe the contemporary management of HGRT in the United States and also evaluate clinical factors associated with nephrectomy after HGRT.MethodsFrom 2014 to 2017, data on HGRT (American Association for the Surgery of Trauma grades III-V) were collected from 14 participating Level-1 trauma centers. Data were gathered on demographics, injury characteristics, management, and short-term outcomes. Management was classified into three groups-expectant, conservative/minimally invasive, and open operative. Descriptive statistics were used to report management of renal trauma. Univariate and multivariate logistic mixed effect models with clustering by facility were used to look at associations between proposed risk factors and nephrectomy.ResultsA total of 431 adult HGRT were recorded; 79% were male, and mechanism of injury was blunt in 71%. Injuries were graded as III, IV, and V in 236 (55%), 142 (33%), and 53 (12%), respectively. Laparotomy was performed in 169 (39%) patients. Overall, 300 (70%) patients were managed expectantly and 47 (11%) underwent conservative/minimally invasive management. Eighty-four (19%) underwent renal-related open operative management with 55 (67%) of them undergoing nephrectomy. Nephrectomy rates were 15% and 62% for grades IV and V, respectively. Penetrating injuries had significantly higher American Association for the Surgery of Trauma grades and higher rates of nephrectomy. In multivariable analysis, only renal injury grade and penetrating mechanism of injury were significantly associated with undergoing nephrectomy.ConclusionExpectant and conservative management is currently utilized in 80% of HGRT; however, the rate of nephrectomy remains high. Clinical factors, such as surrogates of hemodynamic instability and metabolic acidosis, are associated with nephrectomy for HGRT; however, higher renal injury grade and penetrating trauma remain the strongest associations.Level of evidencePrognostic/epidemiologic study, level III; Therapeutic study, level IV.

RationaleCigarette smoking is associated with increased risk of acute respiratory distress syndrome (ARDS) in patients after severe trauma; however, the mechanisms underlying this association are unknown.ObjectivesTo determine whether cigarette smoking contributes to ARDS development after trauma by altering community composition of the lung microbiota.MethodsWe studied the lung microbiota of mechanically ventilated patients admitted to the ICU after severe blunt trauma. To do so, we used 16S ribosomal RNA gene amplicon sequencing of endotracheal aspirate samples obtained on ICU admission (n = 74) and at 48 hours after admission (n = 30). Cigarette smoke exposure (quantified using plasma cotinine), ARDS development, and other clinical parameters were correlated with lung microbiota composition.Measurements and main resultsSmoking status was significantly associated with lung bacterial community composition at ICU admission (P = 0.007 by permutational multivariate ANOVA [PERMANOVA]) and at 48 hours (P = 0.03 by PERMANOVA), as well as with significant enrichment of potential pathogens, including Streptococcus, Fusobacterium, Prevotella, Haemophilus, and Treponema. ARDS development was associated with lung community composition at 48 hours (P = 0.04 by PERMANOVA) and was characterized by relative enrichment of Enterobacteriaceae and of specific taxa enriched at baseline in smokers, including Prevotella and Fusobacterium.ConclusionsAfter severe blunt trauma, a history of smoking is related to lung microbiota composition, both at the time of ICU admission and at 48 hours. ARDS development is also correlated with respiratory microbial community structure at 48 hours and with taxa that are relatively enriched in smokers at ICU admission. The data derived from this pilot study suggest that smoking-related changes in the lung microbiota could be related to ARDS development after severe trauma.

PurposeEfforts have been made to reduce use of computerized tomography in children with blunt abdominal injury. Computerized tomography may be overused in pediatric patients with renal trauma.Materials and methodsWe performed a retrospective chart review of all renal trauma patients younger than 18 years old treated at 2 urban trauma centers from 2002 to 2016. We collected demographic and clinical characteristics, renal trauma grades, urological interventions, and timing and use of computerized tomography and renal ultrasound.ResultsDuring the study period 145 patients presented with blunt renal trauma. During hospitalization 46 patients (32%) underwent repeat computerized tomography. About 20% of repeat computerized tomograms were performed less than 48 hours after the first scan. After controlling for center, isolated injury (yes/no), stent placement, age and surgical interventions (yes/no) patients who underwent delayed imaging on their first scan had decreased odds of undergoing a second computerized tomogram (adjusted OR 0.2, 95% CI 0.05-0.9, p = 0.04). Number needed to treat to prevent 1 repeat scan in high grade renal trauma patients was 3 (95% CI 2-4). Estimated sensitivity and specificity for ultrasound monitoring to detect an abnormality requiring urological intervention are 50% and 94%, respectively.ConclusionsRepeat computerized tomography in pediatric patients with renal trauma is common. Obtaining delayed imaging on the initial scan in patients with high grade renal trauma may prevent repeat scans. Renal ultrasound provides diagnostic usefulness in monitoring kidney injuries and should be considered before repeating computerized tomography.

BackgroundIncreased knowledge of the temporal patterns in the distribution of trauma admissions could be beneficial to staffing and resource allocation efforts. However, little work has been done to understand how this distribution varies based on patient acuity, trauma mechanism or need for intervention. We hypothesize that temporal patterns exist in the distribution of trauma admissions, and that deep patterns exist when traumas are analyzed by their type and severity.Study designWe conducted a cross-sectional observational study of adult patient flow at a level one trauma center over three years, 7/1/2013-6/30/2016. Primary thermal injuries were excluded. Frequency analysis was performed for patients grouped by ED disposition and mechanism against timing of admission; in subgroup analysis additional exclusion criteria were imposed.Results10,684 trauma contacts were analyzed. Trauma contacts were more frequent on Saturdays and Sundays than on weekdays (p

Catecholamines play an important regulatory role in cutaneous wound healing. The exact role of dopamine in human epidermis has yet to be fully elucidated. Current published evidence describes its differential effects on two separate families of G protein coupled receptors: D1-like and D2-like dopamine receptors. Dopamine may enhance angiogenesis and wound healing through its action on dopamine D1 receptors, while impairing wound healing when activating D2 receptors. This review summarizes the evidence for the role of dopamine in wound healing and describes potential mechanisms behind its action on D1 versus D2-like receptors in the skin.

Introduction: Venous ulcers are the most common type of leg wounds (80%) and the main cause is chronic venous insufficiency. Autologous platelet-rich plasma (PRP) is a potential wound healing treatment due to its great variety of growth factors. The aim of this study was to describe in a case series the results of poor-leukocyte PRP (P-PRP) or saline for the treatment of chronic non-healing ulcers of the lower extremity. Methods: Eight patients were treated according to the topical therapy: saline solution or P-PRP gel. All patients used double compression stocks and were assisted by a vascular practitioner for up to 12 months or until wound healing. The treatment was performed weekly with cleaning of the affected area, macroscopic evaluation (area measurement and photos) and P-PRP or saline application, and closure with Tegaderm®. Trial Registration: Retrospectively approved by Brazilian Clinical Trials, register number RBR-7zhgb3 (http://www.ensaiosclinicos.gov.br/rg/RBR-7zhgb3/). Results: All patients showed signs of wound healing with a reduction in wound size and ulcer numbers, but more evident with P-PRP application. Conclusions: The results suggested that P-PRP presented a better result when compared to saline solution in the healing process of long clinical course chronic venous ulcers, when associated to compressive stocks and topical care.

Aims: The primary objective of this study was to compare the postoperative infection rate between negative pressure wound therapy (NPWT) and conventional dressings for closed incisions following soft-tissue sarcoma (STS) surgery. Secondary objectives were to compare rates of adverse wound events and functional scores. Methods: In this prospective, single-centre, randomized controlled trial (RCT), patients were randomized to either NPWT or conventional sterile occlusive dressings. A total of 17 patients, with a mean age of 54 years (21 to 81), were successfully recruited and none were lost to follow-up. Wound reviews were undertaken to identify any surgical site infection (SSI) or adverse wound events within 30 days. The Toronto Extremity Salvage Score (TESS) and Musculoskeletal Tumor Society (MSTS) score were recorded as patient-reported outcome measures (PROMs). Results: There were two out of seven patients in the control group (28.6%), and two out of ten patients in the intervention group (20%) who were diagnosed with a SSI (p > 0.999), while one additional adverse wound event was identified in the control group (p = 0.593). No significant differences in PROMs were identified between the groups at either 30 days (TESS, p = 0.987; MSTS, p = 0.951) or six-month (TESS, p = 0.400) follow-up. However, neoadjuvant radiotherapy was significantly associated with a SSI within 30 days of surgery, across all patients (p = 0.029). The mean preoperative modified Glasgow Prognostic Score (mGPS) was also significantly higher among patients who developed a postoperative adverse wound event (p = 0.028), including a SSI (p = 0.008), across both groups. Conclusion: This is the first RCT comparing NPWT with conventional dressings following musculoskeletal tumour surgery. Postoperative wound complications are common in this group of patients and we observed an overall SSI rate of 23.5%. We propose proceeding to a multicentre trial, which will help more clearly define the role of closed incision NPWT in STS surgery. Cite this article: Bone Jt Open 2021;2(12):1049–1056.

Abstract To explore the practical application and effect of the management plan for cancer patients with wounds/stomas based on the “Internet+” model during the coronavirus disease 2019 (COVID‐19) pandemic. Based on the specific situation during the COVID‐19 pandemic, we established the “Internet+” management team for cancer patients with wounds/stomas. After systematical literature search and brainstorming analysis, we developed a management plan for cancer patients with wounds/stomas based on the “Internet+” model. Then, we included cancer patients with wounds/stomas who needed follow‐up visits or consultations at Jiangsu Cancer Hospital from January 25 to April 30, 2020. A total of 304 patients were participated in the study. The effects of the plan were evaluated including patient satisfaction, the proportion of patients who did not need to go to the hospital for treatment, the proportion of patients with improved symptoms and the rate of the patients or nurses contracted COVID‐19. After the implementation of the plan, 56.3% of the patients mastered the relevant self‐care methods under the guidance of specialist nurses and did not need to go to the hospital for treatment. A total of 89.5% of the patients showed improvement in symptoms, and 99.4% of the patients were satisfied with the online treatment. None of the patients or nurses contracted COVID‐19. The “Internet+” management plan for cancer patients with wounds/stomas during the COVID‐19 pandemic had supported epidemic prevention and control in medical institutions and reduced the risk of cross infection. In addition, this type of plan effectively improved disease symptoms in the patients, and their level of satisfaction was high.

Abstract Tissue‐adhesive materials are emerging biomaterials with potential applications in wound healing patches, tissue sealants, and haemostat materials. Tissue adhesives based on synthetic polymers generally have good adhesion but are not biodegradable. However, the long‐term presence of non‐biodegradable adhesives in the body can cause secondary harm to the patient. An ideal tissue adhesive should meet the following requirements: good adhesiveness, biodegradability, low cytotoxicity, and minimal inflammatory response. Natural polymers with inherent biodegradation and biocompatibility show great potentials in biomedical engineering, and the development of tissue adhesives based on natural polymers has become a hot topic in biomaterials science. This review systematically summarises the latest progresses in biodegradable tissue adhesives based on natural polymers, such as chitosan, hyaluronic acid, alginate, gelatin, dextran, and cellulose. Methods for preparing natural polymer tissue adhesives are summarised and their advantages and disadvantages are discussed. Finally, potential trends in the future direction of biodegradable tissue adhesives are discussed.

Non-operative management of blunt liver injury has been demonstrated as a safe and effective treatment for most grades of injury. As the severity of liver injury increases, so does the risk of complications. A 21-year-old male was brought to the trauma center following a high speed motorbike accident. He underwent a laparotomy and angioembolization for a Grade 4 liver injury. A biloma was diagnosed on Day 18 post injury, and he underwent Endoscopic Retrograde Cholangiopancreatography and biliary stenting which were unsuccessful. There were 2 re-admissions for infected perihepatic collections. In this case, an Endoscopic Retrograde Cholangiopancreatography was not a helpful procedure due to a disconnected liver segment, and morbidity occurred due to instrumentation of the biliary tree (the likely cause of infected biloma). Hepatic resection should be considered for patients who fail non-operative management. Further assessment of efficacy using a larger dataset for analysis is required.

Biofilms in wounds typically consist of aggregates of bacteria, most often Pseudomonas aeruginosa and Staphylococcus aureus, in close association with each other and the host microenvironment. Given this, the interplay across host and microbial elements, including the biochemical and nutrient profile of the microenvironment, likely influences the structure and organization of wound biofilms. While clinical studies, in vivo and ex vivo model systems have provided insights into the distribution of P. aeruginosa and S. aureus in wounds, they are limited in their ability to provide a detailed characterization of biofilm structure and organization across the host-microbial interface. On the other hand, biomimetic in vitro systems, such as host cell surfaces and simulant media conditions, albeit reductionist, have been shown to support the co-existence of P. aeruginosa and S. aureus biofilms, with species-dependent localization patterns and interspecies interactions. Therefore, composite in vitro models that bring together key features of the wound microenvironment could provide unprecedented insights into the structure and organization of mixed-species biofilms. We have built a four-dimensional (4-D) wound microenvironment consisting of a 3-D host cell scaffold of co-cultured human epidermal keratinocytes and dermal fibroblasts, and an in vitro wound milieu (IVWM); the IVWM provides the fourth dimension that represents the biochemical and nutrient profile of the wound infection state. We leveraged this 4-D wound microenvironment, in comparison with biofilms in IVWM alone and standard laboratory media, to probe the structure of mixed-species P. aeruginosa and S. aureus biofilms across multiple levels of organization such as aggregate dimensions and biomass thickness, species co-localization and spatial organization within the biomass, overall biomass composition and interspecies interactions. In doing so, the 4-D wound microenvironment platform provides multi-level insights into the structure of mixed-species biofilms, which we incorporate into the current understanding of P. aeruginosa and S. aureus organization in the wound bed.

Background: Wound complications are major morbidities after orthopedic surgery, and thrombo-prophylactic drugs may increase the likelihood of such complications. In this regard, our study has evaluated the possible effects of rivaroxaban on wound complication issues following spinal canal stenosis surgery. Methods: This prospective cohort study was conducted on 40 patients suffering from spinal canal stenosis secondary to degenerative lumbar spine changes. The eligible patients included those patients receiving rivaroxaban to prevent thrombo-emboli post-operatively. The patients were followed up for three months and assessed for postoperative wound-related complications. Results: None of the patients suffered vascular and thromboembolic complications. Regarding wound complications, these events are mostly limited to the first week post-operatively, including wound dehiscence in 5.0%, serosanguineous discharge in 25.0%, erythema in 35.0%, superficial infection in 10.0%, requiring surgical debridement in 5.0%, cellulitis in 10.0%, and wound induration in 30.0%. Deep infection or hematoma was not reported in our patients. Erythema and wound induration remained 10.0% and 15.0% within the second week, respectively. The hypertrophic scar was a delayed complication that appeared in 15.0% of patients within 1 to 3 months post-operatively. Conclusion: The main risk profiles related to wound complications, especially infections, were a history of hypertension (HTN), uncontrolled diabetes mellitus (DM), and renal insufficiency. The use of rivaroxaban may be accompanied by temporary and minor wound complications and not with potentially debilitating morbidity in patients undergoing spinal canal stenosis surgery. Therefore, its prescription as a safe thrombo-prophylactic drug in patients undergoing spinal canal stenosis surgery is confidently recommended.

Background. Wounds, despite the diversified development of modern medicine, remain one of the main problems in surgery due to their frequent occurrence, as well as due to the high costs of working time and material resources for their treatment. The wound process is a complex set of body responses to damage and is characterized by a certain phase of its course. Materials and methods. Despite the variety of existing means and methods of treatment, generally accepted recommendations for the management of patients with wounds have not yet been developed. However, one should take into account the diversity of types of wounds, which necessitates an individual approach to the choice of therapy for each patient. Thanks to a more detailed study of the pathophysiology and pathogenesis of the wound process, it became possible not only to prescribe more effective and pathogenetically substantiated treatment to patients, but also to search, develop and implement new modern highly effective methods in the process of wound treatment. Results and conclusions. The review discusses in detail the issues of classifications of wounds, the pathogenesis of the wound process, as well as an analytical study regarding the treatment of wounds, depending on the phase of the wound process, based on modern literature data.

BackgroundWound repair is a new field that has emerged in China in the last 5 years. Exposed tendon wounds are one of the most common problems faced in wound treatment today, as the poor blood supply leads to low survival rates of skin grafts. This paper explores the feasibility of applying the Masquelet technique to repair tendon-exposed wounds.MethodWe examined 12 patients with tendon-exposed wounds, 5 males and 7 females, from January 2021 to November 2021, including 2 patients with post-traumatic wounds, 8 diabetic patients with dorsal wounds, and 2 patients with various chronic infections. The Masquelet technique was employed to treat these wounds. The wound surface was sealed with antibiotic bone cement to form an induction membrane, the cement was removed after 3–4 weeks, and the wound was repaired with skin grafts to observe survival, appearance, texture, healing, and related functions.ResultsAll wounds were covered with antibiotic bone cement, and after 3–4 weeks, an induction membrane was applied, and in 10 out of 12 patients, full-thickness skin grafts were applied, and the patients survived. However, in 2 patients, the skin became partially necrotic, but these patients recovered by changing medications.ConclusionThe current study found that direct skin grafting may effectively treat exposed tendon wounds once the Masquelet approach generates the induction membrane. Further, this method is less difficult, less expensive, and easier to care for the procedure that deserves to be used more frequently.

Background and Objectives: Phage therapy has gained interest as an alternative treatment for methicillin-resistant Staphylococcus aureus (MRSA) infections. The purpose of this study was to isolate and characterize an effective bacteriophage against isolates of MRSA. Materials and Methods: Bacteriophage was isolated from hospital sewage. Lytic activity and the titers of phage lysates were measured using spot test and double-layer plaque assay. The phage characterization was determined through transmission electron microscopy. Adsorption rate, host range and stability tests were investigated. The latent period and burst size were estimated from a one-step growth curve. The effect of bacteriophage against MRSA biofilms was determined and Real-time PCR was used to assess the effects of the bacteriophage on the expression of the biofilm-associated genes. Results: TEM results showed that the phage resembled the Cystoviridae family. Its latent period was 30 min, corresponding to about 71/43 phage particles per infected cell. The phage had a broad host range and it was most stable at 37°C and pH 7. It was sensitive to NaCl concentrations. The expressions of the biofilm-associated genes were significantly reduced in the presence of the phage. Conclusion: The isolated phage was effective against MRSA strains and it can be an optional strategy of controlling biofilm development.

Grapevine grafting is an essential practice in viticulture and over the years, various bench grafting techniques have been developed to mechanize the nursery process and to increase the yield in number of viable cuttings. Bench grafting is a fundamental nursery practice that can potentially affect the quality of propagation material also in young decline associated to grapevine trunk diseases and has been recently reported to influence leaf symptoms development associated with diseases of Esca complex. The study aimed to investigate how three bench grafting methods [i.e., (i) Omega graft as mechanical technique, (ii) Whip and Tongue graft as manual technique and (iii) Full Cleft graft as semi-mechanical technique] can influence these phenomena. Specifically, the different methods were compared for their effect on the anatomical development of the grafting point and the functionality of the xylem, also considering two factors: the grapevine cultivar (Cabernet Sauvignon, Glera and Teroldego) and the scion/rootstock diameter (thin and large). Observations by light microscopy on the anatomical evolution and measurements on the xylem morphology and hydraulic traits were correlated with the grafting methods and the investigated varieties. The anatomical observations revealed that the mechanical (Omega) and semi-mechanical (Full Cleft) grafting methods have a faster callusing response while the manual technique (Whip and Tongue) has a slower but greater vascularization of the differentiated callus. Significant differences between cultivars and/or grafting types were also detected in necrotic area on the grafted tissues. Statistical analysis of the grapevine vessels suggested differences in xylem parameters between cultivars, while grafting type had no significant effects. On the other hand, the grafting type significantly affected the intrinsic growth rate. The study confirms the potential incidence of lesions and dysfunctionalities correlated with the grafting method applied, which can potentially induce grafted vine declines in vineyards due to the necrotic area detected on the grafted tissues.

Catecholamines play an important regulatory role in cutaneous wound healing. The exact role of dopamine in human epidermis has yet to be fully elucidated. Current published evidence describes its differential effects on two separate families of G protein coupled receptors: D1-like and D2-like dopamine receptors. Dopamine may enhance angiogenesis and wound healing through its action on dopamine D1 receptors, while impairing wound healing when activating D2 receptors. This review summarizes the evidence for the role of dopamine in wound healing and describes potential mechanisms behind its action on D1 versus D2-like receptors in the skin.

BackgroundGun shows are an important source of firearms, but no adequately powered studies have examined whether they are associated with increases in firearm injuries.ObjectiveTo determine whether gun shows are associated with short-term increases in local firearm injuries and whether this association differs by the state in which the gun show is held.DesignQuasi-experimental.SettingCalifornia.ParticipantsPersons in California within driving distance of gun shows.MeasurementsGun shows in California and Nevada between 2005 and 2013 (n = 915 shows) and rates of firearm-related deaths, emergency department visits, and inpatient hospitalizations in California.ResultsCompared with the 2 weeks before, postshow firearm injury rates remained stable in regions near California gun shows but increased from 0.67 injuries (95% CI, 0.55 to 0.80 injuries) to 1.14 injuries (CI, 0.97 to 1.30 injuries) per 100 000 persons in regions near Nevada shows. After adjustment for seasonality and clustering, California shows were not associated with increases in local firearm injuries (rate ratio [RR], 0.99 [CI, 0.97 to 1.02]) but Nevada shows were associated with increased injuries in California (RR, 1.69 [CI, 1.16 to 2.45]). The pre-post difference was significantly higher for Nevada shows than California shows (ratio of RRs, 1.70 [CI, 1.17 to 2.47]). The Nevada association was driven by significant increases in firearm injuries from interpersonal violence (RR, 2.23 [CI, 1.01 to 4.89]) but corresponded to a small increase in absolute numbers. Nonfirearm injuries served as a negative control and were not associated with California or Nevada gun shows. Results were robust to sensitivity analyses.LimitationFirearm injuries were examined only in California, and gun show occurrence was not randomized.ConclusionGun shows in Nevada, but not California, were associated with local, short-term increases in firearm injuries in California. Differing associations for California versus Nevada gun shows may be due to California's stricter firearm regulations.Primary funding sourceNational Institutes of Health; University of California, Berkeley; and Heising-Simons Foundation.

Study objectiveWith increased use of chest computed tomography (CT) in trauma evaluation, traditional teachings in regard to rib fracture morbidity and mortality may no longer be accurate. We seek to determine rates of rib fracture observed on chest CT only; admission and mortality of patients with isolated rib fractures, rib fractures observed on CT only, and first or second rib fractures; and first or second rib fracture-associated great vessel injury.MethodsWe conducted a planned secondary analysis of 2 prospectively enrolled cohorts of the National Emergency X-Radiography Utilization Study chest studies, which evaluated patients with blunt trauma who were older than 14 years and received chest imaging in the emergency department. We defined rib fractures and other thoracic injuries according to CT reports and followed patients through their hospital course to determine outcomes.ResultsOf 8,661 patients who had both chest radiograph and chest CT, 2,071 (23.9%) had rib fractures, and rib fractures were observed on chest CT only in 1,368 cases (66.1%). Rib fracture patients had higher admission rates (88.7% versus 45.8%; mean difference 42.9%; 95% confidence interval [CI] 41.4% to 44.4%) and mortality (5.6% versus 2.7%; mean difference 2.9%; 95% CI 1.8% to 4.0%) than patients without rib fracture. The mortality of patients with rib fracture observed on chest CT only was not statistically significantly different from that of patients with fractures also observed on chest radiograph (4.8% versus 5.7%; mean difference -0.9%; 95% CI -3.1% to 1.1%). Patients with first or second rib fractures had significantly higher mortality (7.4% versus 4.1%; mean difference 3.3%; 95% CI 0.2% to 7.1%) and prevalence of concomitant great vessel injury (2.8% versus 0.6%; mean difference 2.2%; 95% CI 0.6% to 4.9%) than patients with fractures of ribs 3 to 12, and the odds ratio of great vessel injury with first or second rib fracture was 4.4 (95% CI 1.8 to 10.4).ConclusionUnder trauma imaging protocols that commonly incorporate chest CT, two thirds of rib fractures were observed on chest CT only. Patients with rib fractures had higher admission rates and mortality than those without rib fractures. First or second rib fractures were associated with significantly higher mortality and great vessel injury.

Macroalgae provide food and habitat to a diversity of organisms in marine systems, so structural damage and breakage of thallus tissue can have important ecological consequences for the composition and dynamics of marine communities. Common sources of macroalgal damage include breakage by hydrodynamic forces imposed by ambient water currents and waves, tissue consumption by herbivores, and injuries due to epibionts. Many macroalgal species have biomechanical designs that minimize damage by these sources, such as flexibly reconfiguring into streamlined shapes in flow, having either strong or extensible tissues that are tough, and having chemical and morphological defenses against herbivores and epibionts. If damage occurs, some macroalgae have tissue properties that prevent cracks from propagating or that facilitate tissue breakage in certain places, allowing the remainder of the thallus to survive. In contrast to these mechanisms of damage control, some macroalgae use breakage to aid dispersal, while others simply complete their reproduction prior to seasonally-predictable periods of damage (e.g., storm seasons). Once damage occurs, macroalgae have a variety of biomechanical responses, including increasing tissue strength, thickening support structures, or altering thallus shape. Thus, macroalgae have myriad biomechanical strategies for preventing, controlling, and responding to structural damage that can occur throughout their lives. [ABSTRACT FROM AUTHOR]

Most commercialized wound dressings are polymer-based. Synthetic and natural polymers have been utilized widely for the development of wound dressings. However, the use of natural polymers is limited by their poor mechanical properties, resulting in their combination with synthetic polymers and other materials to enhance their mechanical properties. Natural polymers are mostly affordable, biocompatible, and biodegradable with promising antimicrobial activity. They have been further tailored into unique hybrid wound dressings when combined with synthetic polymers and selected biomaterials. Some important features required in an ideal wound dressing include the capability to prevent bacteria invasion, reduce odor, absorb exudates, be comfortable, facilitate easy application and removal as well as frequent changing, prevent further skin tear and irritation when applied or removed, and provide a moist environment and soothing effect, be permeable to gases, etc. The efficacy of polymers in the design of wound dressings cannot be overemphasized. This review article reports the efficacy of wound dressings prepared from a combination of synthetic and natural polymers. [ABSTRACT FROM AUTHOR]

Background: Penetrating diaphragmatic injuries are associated with a high incidence of posttraumatic empyema. We analyzed the contribution of trauma severity, specific organ injury, contamination severity, and surgical management to the risk of posttraumatic empyema in patients who underwent surgical repair of diaphragmatic injuries at a level 1 trauma center. Methods: This is a retrospective review of the patients who survived more than 48 h. Univariate OR calculations were performed to identify potential risk factors. Multiple logistic regression was used to calculate adjusted ORs and identify independent risk factors. Results: We included 192 patients treated from 2011 to 2020. There were 169 (88.0) males. The mean interquartile range, (IQR) of age, was 27 (22–35) years. Gunshot injuries occurred in 155 subjects (80.7%). Mean (IQR) NISS and ATI were 29 (18–44) and 17 (10–27), respectively. Thoracic AIS was > 3 in 38 patients (19.8%). Hollow viscus was injured in 105 cases (54.7%): stomach in 65 (33.9%), colon in 52 (27.1%), small bowel in 42 (21.9%), and duodenum in 10 (5.2%). Visible contamination was found in 76 patients (39.6%). Potential thoracic contamination was managed with a chest tube in 128 cases (66.7%), with transdiaphragmatic pleural lavage in 42 (21.9%), and with video-assisted thoracoscopy surgery or thoracotomy in 22 (11.5%). Empyema occurred in 11 patients (5.7%). Multiple logistic regression identified thoracic AIS > 3 (OR 6.4, 95% CI 1.77–23. 43), and visible contamination (OR 5.13, 95% IC 1.26–20.90) as independent risk factors. The individual organ injured, or the method used to manage the thoracic contamination did not affect the risk of posttraumatic empyema. Conclusion: The severity of the thoracic injury and the presence of visible abdominal contamination were identified as independent risk factors for empyema after penetrating diaphragmatic trauma. [ABSTRACT FROM AUTHOR]

Introduction. Thumb fingertip injuries, often combined with phalanx fracture or torn ligament, are very common. The focus of treatment is on how to rebuild the function and shape of the thumb. Single thumb fingertip pulp injury is more common. However, due to the diverse type of injury, no uniform treatment guideline is described in the literature. Case report. A patient with extensive thumb fingertip pulp incisions, which looked like multiple parallel wounds, was admitted to our Emergency Department. We used the method of bundling to maintain the shape of the fingertip. A single suture to pass through all the incisions was performed and then the suture was tied outside the skin. After that, we bandaged them with sterile bandages. Finally, good contour and fingertip function were restored. Conclusion. We successfully used the bundling method to treat patient with extensive thumb fingertip pulp incisions. [ABSTRACT FROM AUTHOR]

This study evaluated the acceptability of thickened ice cream with added whey protein to improve protein and fluid intake in long‐term care (LTC) residents living with dysphagia and wounds. Two samples of ice cream were produced, the control sample of thickened ice cream, and thickened ice cream with added whey protein. The International Dysphagia Diet Standardization Initiative (IDDSI) Spoon Tilt Test assessed the consistency of the ice cream samples. A sensory trial asked participants (n = 56) to evaluate the samples for their liking of the appearance, texture, flavor, and overall liking using nine‐point hedonic scales, followed by a check‐all‐that‐apply question. The whey protein sample consistently passed the IDDSI Spoon Tilt Test whereas the control sample did not. The mean hedonic scores across all categories for both samples were not significantly different. The whey protein sample was associated with natural vanilla, creamy flavor, milk/dairy flavor, and buttery attributes which were important drivers of liking, and was not associated with the gumminess which decreased the liking. Findings indicate that whey protein addition to ice cream did not impact the acceptability of the thickened ice cream. This work is relevant to dietetic practice and those working in LTC as this ice cream will help improve quality of life by supporting wound management and safe swallowing. Furthermore, whey protein can be added to ice cream without negatively affecting its' sensory properties. [ABSTRACT FROM AUTHOR]

Purpose: Free flaps play an important role in the reconstruction of chronic wounds in the lower extremities. Nonetheless, the use of free flaps for chronic wound reconstruction tends to be challenging. A considerable number of patients with chronic wounds have noteworthy medical histories, such as chronic kidney disease or endstage renal disease (ESRD). This study aimed to determine the relationship between the success rate and complications of free flap surgery according to the degree of kidney disease from normal renal function to ESRD. Methods: A retrospective study of all patients who underwent free tissue transfer procedures due to chronic wounds in the lower-extremity area over a 9-year period, between October 2011 and February 2020, was conducted. The primary outcome was flap failure, and major complications were set as the secondary outcome. Results: Sixty-seven consecutive free flaps were used for chronic wounds of the lower extremities at our institution. Flap failure occurred in six patients (9.0%), resulting in a total flap survival rate of 91.0%. Sixteen patients (23.9%) experienced major complications. Flap failure was correlated with the presence of ESRD and renal transplantation. Conclusion: There are several limiting factors for the reconstruction of chronic wounds in the lower extremity. In particular, ESRD and renal transplantation were significantly correlated with flap failure. [ABSTRACT FROM AUTHOR]

A quantitative determination method for metronidazole, chlorhexidine, and methylparaben in commercial Timogel gel for the treatment of wounds and burns is presented. The analyses were carried out using an HPLC method on a Hewlett Packard chromatograph with a spectrophotometric detector. The conditions for the maximum sensitivity for determining the active substances in the medical product were selected. The proposed technique could be used to estimate the quantitative content of metronidazole, chlorhexidine, and methylparaben in combined external drugs. All procedures tested on laboratory batches of gel showed reproducible results and could be recommended for inclusion in regulations on the technology and quality control of the wound-healing gel. [ABSTRACT FROM AUTHOR]

Copper has intrinsic antimicrobial properties. Wound dressings impregnated with cuprous oxide microparticles (hereafter termed COD) have been cleared for the management of acute and chronic wounds by the FDA and other regulatory bodies. The COD reduced the viable microbial titers of a wide spectrum of microbes by more than 10,000-fold (4-logs) within 3 h of exposure at 37 °C (p < 0.001). Similar microbial titer reductions were achieved by 3-year naturally aged COD dressings, showing the stability of the biocidal efficacy over time. The potent biocidal efficacy of the COD was maintained even after 7 daily consecutive inoculations of the dressings with ~106 CFU. COD with an adhesive contour blocked the passage of bacteria from the exterior environment to the wound bed side of the dressing even after 7 daily consecutive inoculations of different bacteria on the outer surface of the dressings. Taken together, the study demonstrates the wide spectrum potent in vitro biocidal efficacy of the cuprous oxide impregnated dressings against a wide panel of microorganisms. [ABSTRACT FROM AUTHOR]

Background: Workplaces play a critical role in developing ocular diseases, owing to the risk of accidents. This study aimed to evaluate the ocular health of industrial workers by determining the prevalence of foreign body injury, refractive error, dry eye, and pterygium/pingueculae, as well as the factors influencing these diseases. Methods: This study involved on-site examinations of workers from an industrial area hosting marble processing factories and metal sectors. Data such as refractive error, foreign body injury-related corneal nephelium, pterygium/pingueculae presence, and Schirmer test-assisted dry eye evaluation were all collected. Results: The average age of workers was 35.78±10.05 years, with a female-to-male ratio of 20:220. The majority of workers had completed primary school (56.3%), smoked >1 cigarette/day (57.6%), and did not use any assistive devices for bodily functions (88.3%). On average, working hours/week were 55.07±8.79, and working years were 5.99±7.00. Dry eyes were found in 31(22%), and 35(34%) marble and metal workers, respectively (p=0.042). 11(7.9%) marble workers and 29(28%) metal workers had foreign body ocular injury-related corneal nephelium (p=0.0001). Furthermore, pterygium/pingueculae were revealed in 17 marble workers (12.3%) and three metal workers (3%) (p=0.009). Conclusions: Ocular health is essential, and routine ocular health screening in industrial workers, as well as workplace safety measures, should be implemented to prevent potential occupational accidents. [ABSTRACT FROM AUTHOR]

Introduction: Hyperbaric oxygen treatment (HBOT) is sometimes used in the management of open fractures and severe soft tissue crush injury, aiming to reduce complications and improve outcomes. Methods: Patients with open tibial fractures were randomly assigned within 48 hours of injury to receive standard trauma care or standard care plus 12 sessions of HBOT. The primary outcome was the incidence of necrosis or infection or both occurring within 14 days of injury. Results: One-hundred and twenty patients were enrolled. Intention to treat primary outcome occurred in 25/58 HBOT assigned patients and 34/59 controls (43% vs 58%, odds ratio (OR) 0.55, 95% confidence interval (CI) 0.25 to 1.18, P = 0.12). Tissue necrosis occurred in 29% of HBOT patients and 53% of controls (OR 0.35, 95% CI 0.16 to 0.78, P = 0.01). There were fewer late complications in patients receiving HBOT (6/53 vs 18/52, OR 0.22, 95% CI 0.08 to 0.64, P = 0.007) including delayed fracture union (5/53 vs 13/52, OR 0.31, 95% CI 0.10 to 0.95, P = 0.04). Quality of life measures at one and two years were superior in HBOT patients. The mean score difference in short form 36 was 2.90, 95% CI 1.03 to 4.77, P = 0.002, in the short musculoskeletal function assessment (SMFA) was 2.54, 95% CI 0.62 to 4.46, P = 0.01; and in SMFA daily activities was 19.51, 95% CI 0.06 to 21.08, P = 0.05. Conclusions: In severe lower limb trauma, early HBOT reduces tissue necrosis and the likelihood of long-term complications, and improves functional outcomes. Future research should focus on optimal dosage and whether HBOT has benefits for other injury types. [ABSTRACT FROM AUTHOR]

Copyright of Universidad Médica Pinareña is the property of Editorial Ciencias Medicas and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Wounds are a major public health challenge for nurses, and poor wound care has important implications for patients and health care systems. The aim of this study is to assess the Italian registered nurses' (RNs) perception in the area of wound care, regarding their knowledge, tasks of care delivery, wound management, values, and attitudes, exploring also the previous specific education received during nursing education. An observational online web-based survey was used to assess learning goals and content for wound care education in undergraduate nursing education and the skills and level of self-efficacy in this area during clinical practice. The data were collected between April and May 2022. A total of 210 RNs were interviewed and divided into five national geographic areas. Northwestern RNs showed a better education about the wound care area during university courses: the rate of RNs that did not receive any training in the wound care area was lower than in other Italian geographical areas. Southern RNs presented a better knowledge about factors that expose the wound to becoming chronic, wound drains care, and the ability to assess diabetic foot. This study showed that, in Italy, education in wound care among nursing students is relatively poor, and many skills are achieved during an RN's career in an empirical way. [ABSTRACT FROM AUTHOR]

Cancer is a devastating and life-threatening disease. It is the second leading cause of death worldwide after heart diseases. While science has significantly advanced to improve the treatment outcome and quality of life in cancer patients, there are still many issues with the current therapies, such as toxicity and the development of resistance to treatment. Among the novel tools to overcome these limitations is nonthermal plasma (NTP) and its treatment regimens. Recent progress in NTP devices with ion temperatures close to room temperature demonstrated significant potential in cancer therapy. NTP devices provide a unique combination of reactive oxygen species (ROS), reactive nitrogen species (RNS), photons, and electric fields that exhibit desirable properties of triggering cell death pathways, selectively for cancer cells. While in principle NTP is nonnecrotic and gentle to the tissue, but reactive oxygen and nitrogen species (RONS)-triggered tumor cell death exhibited to have pro-immunogenic properties. Many in vitro and in vivo experiments have demonstrated antitumor effects of direct NTP, synergistic applications of NTP with anticancer drugs/treatments, and plasma-conditioned medium (PCM) applications against a variety of cancer cells. The latest results and findings in this field are the subject of this review along with a brief lay-reader-explanation of cancer and immunology. In this review, initially, we give an overview of the literature that deals with studies on the use of NTP for cancer treatment. Subsequently, we present typical results from that literature to illustrate the advances of NTP in oncology. Finally, we discuss some challenges and future scopes offered by NTP for cancer treatment. [ABSTRACT FROM AUTHOR]

Pressure ulcers are ailments that require constant care and monitoring. They are painful and sometimes life-threatening. Evaluation of pressure ulcers is an important step towards treatment and healing. Presently, evaluation is carried out invasively using methods like PUSH and Bates-Jensen Wound Assessment Tool, that is not comfortable to the patient. Wounds present themselves with altered thermal profile as the activity of degrading or healing cause changes in the temperature of the affected skin/tissues. Infrared thermography is emerging as a viable medical imaging modality. The major upsides of infrared imaging are it being non-radiating and non-contact. Advances in the field of artificial intelligence, and specifically, deep learning, has widened the application domain of thermal imaging in healthcare. In this study, participants (n $=10$) with pre-existing pressure ulcers were recruited and imaged using a FLIR IR thermal camera. The acquired images were used to train an object detection model that successfully detected the existing pressure ulcers by drawing a bounding box over them. This allows the region of interest to contain the wound along with surrounding healthy skin for thermal reference. The developed model detected the pressure ulcers with a confidence level of 96-100% in the test images. The present study promises the potential application of IR-based thermal imaging in automated detection and segmentation of pressure ulcers. [ABSTRACT FROM AUTHOR]

Negative‐pressure‐wound‐therapy is commonly used in clinical routine for wound management. Aim of the present study was to assess the feasibility and safety of using an additional container to collect wound fluid during ongoing negative‐pressure‐wound‐therapy. In this present prospective observational study, patients with negative‐pressure‐wound‐therapy were included. An additional container was inserted in the connecting tube between the wound and the vacuum generating device. The following 3 days, the container was changed daily and replaced by a new one. Further safety outcome parameters were assessed. A questionnaire was answered by the responsible surgeon. Twenty‐two patients with negative‐pressure‐wound‐therapy with a median (IQR) age of 58.5 (53.0‐70.0) years were included in the present study. In median, the duration of negative‐pressure‐wound‐therapy was 5.0 (4.6‐5.5) days. In mean ± SD the collected volume of the wound fluid in millilitres (mL) was on day one 7 ± 4 on day two 8 ± 7 and 10 ± 11 on day three. In one patient, there was <0.1 mL of clear water in the additional container. No safety concerns due to the additional container were observed. This study demonstrates that collecting wound fluid during ongoing negative‐pressure‐wound‐therapy over a time period of 3 days is feasible and safe. No safety concerns were observed. [ABSTRACT FROM AUTHOR]

Early diagnosis of wound‐related cellulitis is challenging as many classical signs and symptoms of infection (erythema, pain, tenderness, or fever) may be absent. In addition, other conditions (ie, chronic stasis dermatitis) may present with similar clinical findings. Point‐of‐care fluorescence imaging detects elevated bacterial burden in and around wounds with high sensitivity. This prospective observational study examined the impact of incorporating fluorescence imaging into standard care for diagnosis and management of wound‐related cellulitis. Two hundred thirty‐six patients visiting an outpatient wound care centre between January 2020 and April 2021 were included in this study. Patients underwent routine fluorescence scans for bacteria (range: 1‐48 scans/patient). Wound‐related cellulitis was diagnosed in 6.4% (15/236) of patients. In these patients, fluorescence scans showed an irregular pattern of red (bacterial) fluorescence extending beyond the wound bed and periwound that could not be removed through cleansing or debridement, indicating the invasive extension of bacteria (wound‐related cellulitis). Point‐of‐care identification facilitated rapid initiation of treatments (source control and antibiotics, when warranted) that resolved the fluorescence. No patients had worsening of cellulitis requiring intravenous antibiotics and/or hospitalisation. These findings demonstrate the utility of point‐of‐care fluorescence imaging for efficient detection and proactive, targeted management of wound‐related cellulitis. [ABSTRACT FROM AUTHOR]

In traditional African medicine, herbal medicines are at the centre of various interventions in wound management and are known to achieve this through various mechanisms. This study evaluated the wound healing activity of the extract and fractions of Barteria nigritiana stem bark in excision and incision wound models. The extract and fractions were formulated in the ointment at 10 and 5% (w/w). The stability of the stressed formulations was evaluated by the Arrhenius accelerated stability method. Only the ointments containing the crude extract and ethyl acetate fraction were degraded by first-order kinetics (R2 > 0.9) with shelf-lives of 24 and 33 days when stressed to 70 °C. In the excision rat model, the extract, n-hexane, ethyl acetate and butanol fractions caused wound contraction of 8.2-96.9%, 2.1-53.1%, 8.0-100% and 2.6-57.6% respectively compared with blank ointment (2.6-13.9%) and standard control (8.9-100%) from days 4-20 post-wounding. The ointment of the ethyl acetate fraction elicited significantly wound contraction and a decrease in the epithelialization period. The ethyl acetate ointment also caused a significant (p < 0.05) increase in ascorbic acid and hydroxyproline content of the wounded tissues. All the extract and fractions ointments elicited a time-dependent decrease in malondialdehyde levels. In the incision wound model, there was a significant increase (p<0.05) in the tensile strength of the 10-20 day-old wound when treated with the ointment containing extract and fractions. The study identified the wound healing activity of the herbal ointment formulation of B. nigritiana as a validation of its vital role in folk medicine. [ABSTRACT FROM AUTHOR]

Introduction. Marjolin's ulcer is a skin malignancy that occurs on a scar or chronic wound. It most commonly occurs on a burn scar. Squamous cell carcinoma is the most common type of this tumor in more than 90% of cases. The rate of this rare malignant transformation is 1-2%. Marjolin's ulcer is more aggressive than other skin cancers. Wide excision is the treatment of choice. Recurrences are common. We present a large exophytic carcinoma of the lower leg as a rare form of this tumor according to the size and type together with reconstruction results. Case report. A 52-year-old man was presented with a large exophytic tumor on the left lower leg. The tumor was located at the site of the previous gunshot injury. The latent period w as 2 2 y ears. T umor s ize w as 14 × 12 cm. Wide excision was performed (2-cm surgical margin), including the deep fascia, and the defect was closed by a split-thickness skin graft from the opposite thigh. Histology showed well-differentiated squamous cell carcinoma. There were no regional or distant metastases. One year after surgery, there was no recurrence of the tumor. Conclusion. Early diagnosis of Marjolin's ulcer and wide excision are mandatory. Surgical margins for excision should be 2 cm, and excision should include deep fascia. Multiple and repeated biopsies of chronic wounds are advised. There is no consensus on the staging of Marjolin's ulcer and lymph node dissection. [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]

Wound infection, especially the development of bacterial biofilms, delays wound healing and is a major public health concern. Bacteria in biofilms are more tolerant to antimicrobial agents, and new treatments to eradicate mature biofilms are needed. Combining antimicrobial molecules with different mechanisms of action is an attractive strategy to tackle the heterogeneous nature of microbial communities in biofilms. This study focused on three molecules of natural origin: gallic acid (G), carvacrol (K) and curcumin (Q). Their abilities, individually or in combination, to eradicate biofilms were quantified on mono- and dual-species mature biofilms of Pseudomonas aeruginosa and Staphylococcus aureus, the strains most commonly found in infected wounds. G presented biofilm eradicating activity on P. aeruginosa, whereas K had biofilm eradicating activity on S. aureus and P. aeruginosa. Q had no potent biofilm eradicating activity. The combination of G and K increased the effects previously observed on P. aeruginosa biofilm and led to complete eradication of S. aureus biofilm. This combination was also efficient in eradicating a dual-species biofilm of S. aureus and P. aeruginosa. This work demonstrates that K and G used in combination have a strong and synergistic eradicating activity on both mono- and dual-species mature biofilms of S. aureus and P. aeruginosa and may therefore represent an efficient alternative for the treatment of biofilms in wounds. [ABSTRACT FROM AUTHOR]

Purpose: Fournier's gangrene (FG) is a serious, aggressive, and often fatal multi-organism infection that affects the soft tissues of the perineum, rectum, and external genitalia. This study aimed to analyse the treatment's strategies of FG.Materials and Methods: This was a retrospective study of 35 patients with a diagnosis of FG admitted between 2016 and 2021. The diagnosis of FG was established on a clinical basis. Data on patient's age, sex, comorbidities, laboratory results (C-reactive protein (CRP), white blood cell (WBC), hematocrit (HCT), platelets (PLT), sodium, potassium, creatinine, procalcitonin, international normalized ratio (INR), and gangrene culture), extent of resection, antibiotics used, and hospitalisation time were obtained. The extent of resection was assessed on a scale of 1-5.Results: The study group consisted of all men (n=35) aged 24-85 (mean, 58) years. In 13/35 (37%) patients, hyperbaric oxygen therapy (HBOT) combined with negative-pressure wound therapy (NPWT) was used as a treatment for wound healing in Fournier's syndrome (group 1), and in 22/35 (63%) patients, open standard wound care was used (group 2). There were no fatalities in group 1, but four deaths (18%) were noted in group 2. The median extent of resection was 3 in group 1 and 2 in group 2. There was a correlation between the extent of resection and use of HBOT combined with NPWT. The hospitalisation time was much shorter in group 2 (mean, 23 days) than in group 1 (mean, 26 days).Conclusion: HBOT and NPWT (group 1) showed advanced wound healing with a high efficiency rate. The longer median hospitalisation time in this group may be related to the severity of injury. [ABSTRACT FROM AUTHOR]

Copyright of Saúde Coletiva is the property of MPM Comunicacao and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)