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Pyoderma gangrenosum (PG) is a rare inflammatory condition with an immense disease burden that remains understudied. With limited approved treatments and low-quality clinical evidence, PG continues to have poor patient outcomes. Unfortunately, improvement in PG treatments and patient care is based on additional research endeavors that can only be developed from existing high-quality data. The following protocol outlines the development of the Minimum Data Set for Treatment Effectiveness in Pyoderma gangrenosum (MIDSTEP), a core set of domains and domain items for the Pyoderma Gangrenosum Treatment Effectiveness (PyGaTE) international registry. The outcomes and benefits are focused on providing real-world data for physicians to improve their clinical decisions on PG treatment and inform clinical trial design, promoting clinical research among the international scientific community. MIDSTEP is a multi-phase project. The first phase will produce a domain item list from a literature review to take into the second phase which would finalize the core data set by an e-Delphi exercise. There will be a single stakeholder group participating together in the e-Delphi consisting of PG experts (healthcare providers, researchers, methodologists, industry representatives, and regulators), ulcerative PG patients, and PG patient advocates. The methodology outlined in the protocol is a systematic method based on several guidelines through COMET and established dermatologic registries and outcome sets with systematic methodologies of their own. The third phase will identify the instruments for the items, the 'when to measure' the items, and the platform for the registry. The last phase is the implementation and continued maintenance of the international registry PyGaTE. By solidifying a consensus on standardized outcomes and collecting information on PG treatment effectiveness in a centralized database, existing treatments can be compared more systematically and analyzed with increased evidence. MIDSTEP and the PyGaTE international registry will have the ambitious goal to generate and disseminate real-world data that can be used by all stakeholders to improve health outcomes for PG patients. Future potential for the outcome of this project includes the development of a gold-standard PG treatment. [ABSTRACT FROM AUTHOR]

Purpose and background: To assess feasibility and functional acceptability of lateral calcaneal artery fascio-cutaneous flap (LCAFCF) in providing cover to posterior heel defects in single stage. Aims and objectives: To provide stable and sensate cover to small and moderate posterior heel defects. Materials and methods: This review was conducted in department of Burns & Plastic Surgery of Postgraduate Institute of Medical Sciences (PGIMS), Rohtak, Haryana between October 2021 and September 2022 to analyse the clinical outcome of LCAFCF in 24 patients (18 males, 6 females) aged between 20 and 35 years who had chronic dry wounds n = 9, failed primary reconstruction by reverse sural flap n = 1, granulated wounds n = 8, exposed achilles tendons n = 4 and scarred tissue restricting ankle joint movements n = 2 in region of posterior heel following trauma, while riding motor-cycle. Course of lateral calcaneal artery was marked with hand-held doppler. Flap size ranged from 3 to 3.5 cm in width and 5.5–7.5 cm length. The donor sites were split skin grafted. Sutures were removed on 22nd day of surgery. Mean follow up was 13 months. Results: All flaps survived. Two had partial loss of skin graft and two developed hyperkeratosis on grafted site. Sensations in flap, regain of movements of ankle joint, comfort of walking and driving were acceptable. Conclusions: LCAFCF is handy, safe and reliable flap for re-surfacing difficult wounds of posterior heel, therefore should be included in surgical armamentarium. [ABSTRACT FROM AUTHOR]

Surgical site infection (SSI) prolongs the treatment period, delays wound healing, increases antibiotic consumption, and leads to patient death in complicated cases. This case was a 10-day female infant born at 37-week- and 6-day of gestational age with a birth weight of 3700 g and Apgar 5/8 by emergency cesarean section due to spina bifida cystica with myelomeningocele (MMC). She was admitted to the neonatal intensive care unit (NICU) because of respiratory distress and hypotonic lower extremities on June 2, 2022. A cardiovascular and neurosurgery consult was okay for reconstructive surgery, and she had MMC repair surgery by a plastic surgeon on June 5, 2022. The surgical site was infected, and SSI had no improvement, despite regularly receiving wet and Vaseline gauze dressing and intravenous antibiotic therapy. We started the treatment using Medihoney™, honey antibacterial wound dressing, on SSI once a day for 2 weeks, then once every other day for the next 6 weeks. Her SSI was cured entirely after 2 months, and she was discharged from our wound treatment team in satisfactory general condition. Clinicians and wound care management teams could use honey antibacterial wound gel to treat SSI, particularly in newborns with weakened immune systems after spinal birth defects repair. [ABSTRACT FROM AUTHOR]

Forests provide multiple services, products and values and finding ways to preserve their multifunctionality is important. However, all of the currently used harvesting systems produce some degree of environmental damage, potentially affecting the provision services on the long term. Skidding operations are common in many regions of the world. Skidding may suppose three operational steps: winching, strip-road skidding and landing operations. By using cables for winching, wounds are commonly inflicted to the residual trees, while the mechanical traction of logs may cause damage to the residual trees and soil. This study was designed to check if the use of pans during winching deployed in thinning operations of coniferous forests may help lowering the environmental impact in terms of damage to residual trees and soil, while accounting for operational efficiency of such operations. Four treatments were considered and framed around the winching direction (uphill, downhill) and the use of protective devices (use, nonuse) and detailed data was collected on the residual stand damage, soil damage and time consumption. The main finding was that uphill winching by the use of a pan performed the best in terms of lowering the environmental damage. It shown the smallest wounds by their average area per tree, the lowest number of wounds per tree, the lowest rate of wounding per hectare, as well as one of the lowest rates of soil damage. By excluding delays, working with a pan did not cause additional time consumption, supporting acceptable rates of operational efficiency. Further experiments would be needed to validate and extend the results of this study, as the forests and their type of management are heterogeneous systems in terms of terrain configuration and slope, soil, species, stand density, removal intensity, operational timing and operational conditions. [ABSTRACT FROM AUTHOR]

Objective To study the outcomes in terms of airway, voice and swallowing as well as the economic impact of the trauma on patients' finances and the constrained health infrastructure due to the pandemic. Materials and methodsStudy design Retrospective study. Setting: Tertiary care teaching hospital. Subjects and methods: A retrospective study was done of the 19 subjects who sustained acute laryngotracheal trauma during the SARS CoV-2 pandemic and was managed at our institution from January 2020 to September 2021. Results Change in voice was the most common presenting symptom and thyroid cartilage fractures were the commonest cartilage injury noted. It was found that 93% (decannulated) of the patients had good functional outcome and 90% of them required financial support to meet the medical expenses. Conclusion During the COVID 19 pandemic, it was not only, early presentation, timely detection and intervention by the treating team, but also the multidisciplinary teamwork and the support system that facilitated the recuperation and restoration of these traumatized individuals back into society with good laryngeal function. [ABSTRACT FROM AUTHOR]

Results of an investigation of the wound-healing activity and toxicity parameters of a gel based on guanidine-containing pectin derivatives are presented. It is established that the developed 0.5% pectin guanidine gel exhibits a high rate of wound healing that reaches 82% on the 7th day of treatment. The gel belongs to class VI of relatively harmless compounds, with an LD50 value of >3000 mg/kg for cutaneous application to rats. There were no signs of skin irritation in the form of redness, peeling, or changes in the fur cover in local shaven and adjacent regions in rats. Chronic toxicity studies showed that daily skin application of the pectin guanidine gel for 30 d did not produce any toxic effects on the quantitative composition and morphology of peripheral blood in experimental animals. [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]

The primary goal of this systematic review article was to provide an outline of the use of diabetic autologous adipose-derived mesenchymal stem cells (DAAD-MSCs) in the treatment of wounds and ulcers in animal models and patients with diabetes mellitus (DM). The secondary goal was to present the outcomes of pretreatment of diabetic adipose-derived mesenchymal stem cells (DAD-MSCs) with probable different agents in the treatment of diabetic foot ulcers (DFUs) and wounds. In view of possible clinical applications of AD-MSC-mediated cell therapy for DFUs, it is essential to evaluate the influence of DM on AD-MSC functions. Nevertheless, there are conflicting results about the effects of DAAD-MSCs on accelerating wound healing in animals and DM patients. Multistep research of the MEDLINE, PubMed, Embase, Clinicaltrials.gov, Scopus database, and Cochrane databases was conducted for abstracts and full-text scientific papers published between 2000 and 2020. Finally, 5 articles confirmed that the usage of allogeneic or autologous AD-MSCs had encouraging outcomes on diabetic wound healing. One study reported that DM changes AD-MSC function and therapeutic potential, and one article recommended that the pretreatment of diabetic allogeneic adipose-derived mesenchymal stem cells (DAlD-MSCs) was more effective in accelerating diabetic wound healing. Recently, much work has concentrated on evolving innovative healing tactics for hastening the repair of DFUs. While DM alters the intrinsic properties of AD-MSCs and impairs their function, one animal study showed that the pretreatment of DAlD-MSCs in vitro significantly increased the function of DAlD-MSCs compared with DAlD-MSCs without any treatment. Preconditioning diabetic AD-MSCs with pretreatment agents like photobiomodulation (PBM) significantly hastened healing in delayed-healing wounds. It is suggested that further animal and human studies be conducted in order to provide more documentation. Hopefully, these outcomes will help the use of DAAD-MSCs plus PBM as a routine treatment protocol for healing severe DFUs in DM patients. [ABSTRACT FROM AUTHOR]

Introduction: Groin and lower trunk defects are common problems, especially for elderly patients. While groin defects are often due to prior vascular interventions, trochanteric defects are mainly caused by pressure sores. Plastic reconstructive methods are manifold; however, the pedicled anterolateral thigh (ALT) flap is supposed to be reliable with sustainable results. Objective: We present our experiences using the pedicled ALT flap for soft tissue reconstruction in patients with large wounds of the medial and lateral proximal thigh. Materials and methods: A total of 16 patients with groin and lower trunk defects due to prior vascular surgery or pressure sores received locoregional soft tissue reconstruction using a proximal pedicled ALT flap. Patient characteristics, defect size, surgery time, clinical outcome and complication rate were assessed. Results: With the exception of two cases, sufficient soft tissue reconstruction was achieved. In all, 81,3% of patients were categorized as ASA (American Society of Anesthesiologists) 3. The average duration of surgery was 149 min. Length of stay was 18,3 days. A total of 31% needed revision surgery due to limited wound healing problems. Two patients died. All patients showed healed wound conditions when they were discharged. Conclusion: The proximal pedicled ALT-flap is a reliable method for soft tissue reconstruction in groin and lower trunk defects. This reconstructive procedure enables reliable wound closure, especially in elderly patients with substantially reduced general health condition. [ABSTRACT FROM AUTHOR]

Introduction: Acute bacterial skin and skin structure infections (ABSSSI) represent one of the most common reasons for emergency department visits, and are frequent complications of intravenous drug use in persons who inject drugs (PWID). This study examined the efficacy and safety of omadacycline, versus linezolid, in PWID and persons who do not inject drugs, in the Phase 3 Omadacycline in Acute Skin and Skin Structure Infection (OASIS-1, OASIS-2) studies. Methods: Eligible participants were aged ≥ 18 years with qualifying skin infections: wound infection, cellulitis, erysipelas, or major abscess. The primary efficacy endpoint was early clinical response (ECR) in the modified intent-to-treat (mITT) population, defined as survival with ≥ 20% reduction in lesion size at 48–72 h after the first dose of omadacycline or linezolid. Key secondary endpoints included investigator-assessed clinical response at the post-treatment evaluation (PTE) in the mITT and clinical per-protocol populations, and clinical response at PTE in the micro-mITT population. Safety was assessed based on adverse events (AEs) and standard clinical laboratory tests. Efficacy endpoints of clinical response at ECR and PTE were analyzed for the mITT and clinically evaluable (CE) PTE populations. Results: In total, 1380 patients (822 PWID, 558 non-PWID) were included in this secondary analysis. Wound infections were reported more frequently in the PWID subgroup (72.8%) at baseline; cellulitis or erysipelas (43.9%) and major abscess (37.4%) were the most frequently reported baseline infections in the non-PWID subgroup. Clinical success rates at ECR and PTE in the mITT population, and at PTE in the CE population, were high for patients receiving omadacycline or linezolid. Severe or serious treatment-emergent AEs (TEAEs), and TEAEs leading to discontinuation, were infrequent. Conclusion: This subgroup analysis showed that omadacycline was effective and well tolerated, regardless of PWID status. [ABSTRACT FROM AUTHOR]

Background: Cerebral venous injury (CVI) includes injury to a dural venous sinus or major vein and leads to poorer outcomes for patients with blunt traumatic brain injury (TBI). We sought to identify the incidence, associated factors, and outcomes associated with CVI in a large national cohort. Methods: Adult patients with blunt TBI were identified from the National Trauma Databank (2013–2017). Outcomes included inpatient mortality, discharge disposition, stroke, length of stay (LOS), intensive care unit LOS, and duration of mechanical ventilation. Multivariate regression models were used to identify the association between exposure variables and CVI, as well as each outcome. Results: There were 619,659 patients with blunt TBI who met the inclusion criteria. CVI occurred in 1792 (0.3%) patients. Mixed intracranial injury type had the strongest association with CVI (odds ratio [OR] 2.89, 95% confidence interval [CI] 2.38–3.50), followed by isolated TBI (OR 1.76, 95% CI 1.54–2.02) and skull fracture (OR 1.72, 95% CI 1.55–1.91). CVI was associated with increased odds of mortality (OR 1.38, 95% CI 1.19–1.60), nonroutine discharge (OR 1.26, 95% CI 1.12–1.40), and stroke (OR 1.95, 95% CI 1.33–2.86). It was also associated with longer LOS (β 2.02, 95% CI 1.55–2.50) and intensive care unit LOS (β 0.14, 95% CI 0.13–0.16). Among locations of venous injury, superior sagittal sinus injury had significant associations with mortality (OR 2.93, 95% CI 1.62–5.30) and nonroutine discharge disposition (OR 1.94, 95% CI 1.12–3.35), whereas the others did not. Conclusions: We identified a 0.3% incidence of CVI in all-comers with blunt TBI as well as several injury-related variables that may be used to guide investigation for dural venous sinus injury. CVI was associated with poorer outcomes, with superior sagittal sinus injury having the strongest association. [ABSTRACT FROM AUTHOR]

Reconstruction of the lower extremity, especially the proximal lower leg, is known to be a challenge for reconstructive surgeons. When there is extensive vascular damage, the use of local flaps and microsurgical methods will be limited, so there are few reconstructive options available. We want to define the use of medial sural artery-based cross-leg flap for the reconstruction of the proximal lower leg. A 51-year-old male had a soft tissue defect on the proximal leg region because of a gun-shot injury. We observed that there was no chance of a local flap as a result of CT angiography. We considered free flap to be risky because of extensive vascular damage and medial sural artery-based cross-leg flap was planned. 12*20-cm-sized medial sural artery-based cross-leg flap was elevated from the contralateral leg and adapted to the defect without tension. Medial sural artery-based flap is mostly used as a vascular island for the reconstruction of knee defects. However, its use as a cross-leg flap has not been found in the literature. We believe that it is a safe option to consider in challenging cases such as after flap failure or patients not suitable for a free flap. [ABSTRACT FROM AUTHOR]

Background: Needlestick injuries have caused a deleterious effect on the physical and mental health of millions of health-care workers over the past decades, being responsible for occupational infections with viruses such as HIV or hepatis C. Despite this heavy burden of disease, no concise studies have been published on the global research landscape so far. Methods: We used the New Quality and Quantity Indices in Science platform to analyze global NSI research (n = 2987 articles) over the past 115 years using the Web of Science and parameters such as global versus country-specific research activities, semi-qualitative issues, and socioeconomic figures. Results: Density-equalizing mapping showed that although a total of n = 106 countries participated in NSI research, large parts of Africa and South America were almost invisible regarding global participation in NSI research. Average citation rate (cr) analysis indicated a high rate for Switzerland (cr = 25.1), Italy (cr = 23.5), and Japan (cr = 19.2). Socioeconomic analysis revealed that the UK had the highest quotient QGDP of 0.13 NSI-specific publications per bill. US-$ gross domestic product (GDP), followed by South Africa (QGDP = 0.12). Temporal analysis of HIV versus hepatitis research indicated that NSI-HIV research culminated in the early 1990s, whereas NSI-hepatitis research increased over the observed period from the 1980s until the last decade. Conclusion: Albeit NSI research activity is generally increasing, the growth is asymmetrical from a global viewpoint. International strategies should be followed that put a focus on NSI in non-industrialized areas of the world. [ABSTRACT FROM AUTHOR]

The use of topical antimicrobials is beneficial for infection control in wound care because wound infection is the major cause of delayed healing. The advantages of topical over systemic antimicrobials include a higher concentration at the target site, fewer systemic adverse effects, and a lower incidence of antimicrobial resistance. Nowadays, topical antimicrobials are divided into three groups: disinfectants, antiseptics, and antibiotics. Only antiseptics and antibiotics can be applied to living skin; therefore, this review will focus only on these groups. The advantages of each topical antimicrobial are well established; however, their disadvantages remain prominent. It is widely known that antiseptics show higher cytotoxicity and a broader spectrum of activity than antibiotics, whereas antibiotics show a higher probability of bacterial resistance development. However, there are still many adverse effects, resulting from each topical antimicrobial. This review aims to summarize the possible adverse effects of commonly used antiseptics (biguanide, silver, iodine, chlorine compounds, and other antiseptics), antibiotics (bacitracin, mafenide, mupirocin, neomycin, and silver sulfadiazine), and natural antimicrobials (curcumin and honey). Moreover, the antimicrobials that should be avoided in particular populations are also summarized in this review in order to increase awareness for antimicrobial selection in those populations. [ABSTRACT FROM AUTHOR]

Background: Split-thickness skin grafting (STSG) is the most commonly used technique in the treatment of traumatic, post-burn, and post-operative wounds, when direct wound edge closure is unavailable. There is currently no general agreement on the optimal thickness of skin grafts. We aimed to analyze the early results of recipient wound healing after STSG, using grafts of different thicknesses.Methods: This randomized, controlled, and parallel-group pilot clinical trial included 98 adult patients who underwent STSG transplantation surgery for post-burn, post-traumatic, or post-operative skin defects. Patients were randomized into three groups to receive a skin graft of 0.2, 0.3, or 0.4-mm thickness. After skin transplantation, the healing parameters of the recipient wounds were evaluated after 3 days, 7 days, 2 weeks, and 1 month. At each time, epithelialization and pain parameters were evaluated.Results: Our study showed that thinner split-thickness skin grafts had better epithelialization scores at the second post-operative week. However, thinner split-thickness skin grafts caused greater pain to the patients.Conclusions: Thickness of the skin graft is a significant factor affecting recipient wound healing parameters. It is necessary to evaluate healing of the donor wound, as well as distant treatment outcomes, such as scarring, pigmentation, and esthetic results of skin grafting with different thickness grafts.Level of Evidence: Level I, therapeutic study. [ABSTRACT FROM AUTHOR]

The aim of the present study was to assess two methods of mass abdominal closure with the fishing line as an alternative suture material for abdominal wall closure. Eighteen healthy male white rabbits weighing approximately 2.5 kg were used in this study. Animals were separated into three groups: control group (CG) (n = 06), interrupted pattern suture experimental group (IEG) (n = 06), and continuous pattern suture experimental group (CEG) (n = 06). Incisional wounds (4 cm) were performed in the right flank of abdominal wall. In control group (CG), the abdominal muscles and peritoneum were sutured in one layer with simple interrupted pattern using PGA resorbable suture and the skin with commercial synthetic suture (nylon). Then, in experimental groups, closure of peritoneum, abdominal muscles, and skin was performed with one-layer pattern using translucent nylon fishing line. Daily scores were allocated for signs of infection, wound healing, and wound adhesion. A faster wound closure time was recorded in control group (9 days) compared to experimental groups (13 days). All study animals showed low adhesion scores that were very important in the muscular wall. Almost similar histopathology profiles were observed in all groups. This study has demonstrated that fishing line, as suture material, is suitable for mass abdominal closure in rabbit model. [ABSTRACT FROM AUTHOR]

Andes virus (ANDV) is a hantavirus hosted by the sigmodontine rodent Oligoryzomys longicaudatus in southern Argentina, where it is responsible for most cases of hantavirus pulmonary syndrome (HPS). The purpose of this study is to elucidate the biological and ecological characteristics of the host that increase the probability of ANDV infection in a O. longicaudatus population. The study was performed from spring 2003 to winter 2008 at Cholila, Chubut Province, Argentina. Rodent populations were sampled in four habitat types. Species, sex, body measurements (mass, body and tail length) and presence of wounds were recorded and blood samples for seroprevalence determination were obtained from the retroorbital sinus. Logistic regression models were applied to identify variables associated with the probability of infection of an individual. The most parsimonious model included sex, mass, body size and wounds as explanatory variables. Our results suggest that population structure and composition (age and sex) of O. longicaudatus should be considered as fundamental indicators to model the probability that infection with ANDV appears and/or persists in a population. A high Odds ratio value also showed the presence of wounds as an important feature in the infection model. [ABSTRACT FROM AUTHOR]

Andes virus (ANDV) is a hantavirus hosted by the sigmodontine rodent Oligoryzomys longicaudatus in southern Argentina, where it is responsible for most cases of hantavirus pulmonary syndrome (HPS). The purpose of this study is to elucidate the biological and ecological characteristics of the host that increase the probability of ANDV infection in a O. longicaudatus population. The study was performed from spring 2003 to winter 2008 at Cholila, Chubut Province, Argentina. Rodent populations were sampled in four habitat types. Species, sex, body measurements (mass, body and tail length) and presence of wounds were recorded and blood samples for seroprevalence determination were obtained from the retroorbital sinus. Logistic regression models were applied to identify variables associated with the probability of infection of an individual. The most parsimonious model included sex, mass, body size and wounds as explanatory variables. Our results suggest that population structure and composition (age and sex) of O. longicaudatus should be considered as fundamental indicators to model the probability that infection with ANDV appears and/or persists in a population. A high Odds ratio value also showed the presence of wounds as an important feature in the infection model. [ABSTRACT FROM AUTHOR]

Pathogens currently threaten the existence of many amphibian species. In efforts to combat global declines, researchers have characterized the amphibian cutaneous microbiome as a resource for disease management. Characterization of microbial communities has become useful in studying the links between organismal health and the host microbiome. Hellbender salamanders ( Cryptobranchus alleganiensis) provide an ideal system to explore the cutaneous microbiome as this species requires extensive conservation management across its range. In addition, the Ozark hellbender subspecies ( Cryptobranchus alleganiensis bishopi) exhibits chronic wounds hypothesized to be caused by bacterial infections, whereas the eastern hellbender ( Cryptobranchus alleganiensis alleganiensis) does not. We assessed the cutaneous bacterial microbiome of both subspecies at two locations in the state of Missouri, USA. Through 16S rRNA gene-based amplicon sequencing, we detected more than 1000 distinct operational taxonomic units (OTUs) in the cutaneous and environmental bacterial microbiome. Phylogenetic and abundance-based dissimilarity matrices identified differences in the bacterial communities between the two subspecies, but only the abundance-based dissimilarity matrix identified differences between wounds and healthy skin on Ozark hellbenders. The higher abundance of OTUs on Ozark wounds suggests that commensal bacteria present on the skin and environment may be opportunistically colonizing the wounds. This brief exploration of the hellbender cutaneous bacterial microbiome provides foundational support for future studies seeking to understand the hellbender cutaneous bacterial microbiome and the role of the bacterial microbiota on chronic wounds of Ozark hellbenders. [ABSTRACT FROM AUTHOR]

Horses are usually at risk of physical injuries/wounds because of their typical flight and fright temperament. These wounds are readily infected because of the nature of work they do. This study was a 6-month survey of wound infections of horses at the Obollo-Afor Horse Lairage, Udenu Local Government area, Enugu State, Nigeria. Two hundred seven horses were sampled. They were physically examined, and those that had wounds were purposively selected for further study. Blood samples were collected from these horses that had wounds for haematological and serum biochemistry evaluations. Sterile swab sticks were used to collect samples from the wound edges after disinfection for microbiological examination. This showed that out of the 207 horses sampled, 21 had wounds. The horses with wounds had significantly ( p < 0.05) higher total leukocyte, band and segmented neutrophil, basophil and monocyte counts, serum alanine aminotransferase activity and globulin levels, than the apparently healthy horses. They also had significantly ( p < 0.05) lower serum albumin levels than those without wounds. Staphylococcus aureus was isolated from all the 21 horses with wounds while Escherichia coli were isolated from 19 of them. These two organisms were resistant to commonly used antibiotics (ampicillin, amoxicillin/clavulanic acid combination and tetracycline) but were sensitive to ciprofloxacin, ofloxacin, gentamycin and chloramphenicol. Wound infections in the horses studied were associated with leukocytosis, neutrophilia, monocytosis, basophilia, hypoalbuminemia and hyperglobulinemia, and that Staphylococcus aureus and Escherichia coli were the pathogens associated with wound infections in the horses. [ABSTRACT FROM AUTHOR]

Langerhans cells (LCs) are a specialized dendritic cell subset that resides in the epidermis and mucosal epithelia and is critical for the orchestration of skin immunity. Recent evidence suggest that LCs are involved in aberrant wound healing and in the development of hypertrophic scars and chronic wounds, which are characterized by a hypoxic environment. Understanding LCs biology under hypoxia may, thus, lead to the identification of novel pathogenetic mechanisms of wound repair disorders and open new therapeutic opportunities to improve wound healing. In this study, we characterize a previously unrecognized role for hypoxia in significantly affecting the phenotype and functional properties of human monocyte-derived LCs, impairing their ability to stimulate naive T cell responses, and identify the triggering receptor expressed on myeloid (TREM)-1, a member of the Ig immunoregulatory receptor family, as a new hypoxia-inducible gene in LCs and an activator of their proinflammatory and Th1-polarizing functions in a hypoxic environment. Furthermore, we provide the first evidence of TREM-1 expression in vivo in LCs infiltrating hypoxic areas of active hypertrophic scars and decubitous ulcers, pointing to a potential pathogenic role of this molecule in wound repair disorders. Key messages: [ABSTRACT FROM AUTHOR]

The need for treatment of chronic and infected wounds has increased during recent years due to demographic changes and the increasing number of patients with severe comorbidities. An increasingly larger selection of treatment options as well as wound dressings for the treatment of acute and chronic wounds have become available in recent years. Due to the diversity of increasingly specialized bandages and wound dressings, a standardized, phase-adapted treatment of acute, chronic and infected wounds is useful and recommended. The comprehensive treatment of problematic wounds should also include treatment of any comorbidities present as well as the elimination of noxious agents that may compromise wound healing. For these reasons, treatment of complicated wounds should be interdisciplinary and in close cooperation with the nursing staff. This article presents excerpts from our phase-adapted wound treatment concepts of the 'Wound Compendium Boberg', by which we are able to maintain a standardized and high quality treatment for problematic wounds. [ABSTRACT FROM AUTHOR]

The term perioperative antibiotic prophylaxis stands for a short-term, usually one-off administration of an antibiotic shortly before, at the beginning or at the latest during the operative procedure. A perioperative antibiotic prophylaxis should always be given in the surgical treatment of a patient with abdominal trauma. The optimal time of administration is 30-60 min before incision. For interventions lasting more than 2 h, a repeated dose should be given depending on the half-life of the substance being used. An extension of the antibiotic prophylaxis beyond 24 h does not reduce the postoperative infection rate and should only be continued in the sense of a therapy in the case of a surgically uncleansed infection focus. [ABSTRACT FROM AUTHOR]

The term perioperative antibiotic prophylaxis stands for a short-term, usually one-off administration of an antibiotic shortly before, at the beginning or at the latest during the operative procedure. A perioperative antibiotic prophylaxis should always be given in the surgical treatment of a patient with abdominal trauma. The optimal time of administration is 30-60 min before incision. For interventions lasting more than 2 h, a repeated dose should be given depending on the half-life of the substance being used. An extension of the antibiotic prophylaxis beyond 24 h does not reduce the postoperative infection rate and should only be continued in the sense of a therapy in the case of a surgically uncleansed infection focus. [ABSTRACT FROM AUTHOR]

Advertisements targeted at the elderly population suggest that antioxidant therapy will reduce free radicals and promote wound healing, yet few scientific studies substantiate these claims. To better understand the potential utility of supplemental antioxidant therapy for wound healing, we tested the hypothesis that age and tissue ischemia alter the balance of endogenous antioxidant enzymes. Using a bipedicled skin flap model, ischemic and non-ischemic wounds were created on young and aged rats. Wound closure and the balance of the critical antioxidants superoxide dismutase and glutathione in the wound bed were determined. Ischemia delayed wound closure significantly more in aged rats. Lower superoxide dismutase 2 and glutathione in non-ischemic wounds of aged rats indicate a basal deficit due to age alone. Ischemic wounds from aged rats had lower superoxide dismutase 2 protein and activity initially, coupled with decreased ratios of reduced/oxidized glutathione and lower glutathione peroxidase activity. De novo glutathione synthesis, to restore redox balance in aged ischemic wounds, was initiated as evidenced by increased glutamate cysteine ligase. Results demonstrate deficiencies in two antioxidant pathways in aged rats that become exaggerated in ischemic tissue, culminating in profoundly impaired wound healing and prolonged inflammation. [ABSTRACT FROM AUTHOR]

Pyoderma gangrenosum is rarely seen in the surgical disciplines. In the described case the patient was initially diagnosed with necrotizing fasciitis and admitted to the intensive care unit suffering from septic shock. The automated implantable cardioverter defibrillator (AICD), the suspected focus for infection, had already been removed. Following weeks of broad spectrum antibiotics and wound debridement without clinical improvement the alternative diagnosis of pyoderma gangrenosum was reached. Consequently the patient was treated with immunosuppressive therapy and his condition improved rapidly such that he was ultimately discharged to rehabilitation. [ABSTRACT FROM AUTHOR]

The purpose of the study was to examine the association between demographics, war-related factors, and psychosocial factors with mental health utilization among minorities in Israel. One thousand and sixty-eight participants filled a battery of self report questionnaires asking about demographics, psychosocial factors and war-related experience during the second Lebanon war, along with measurements of psychiatric symptoms. Logistic regression analyses revealed that injury of a relative during the war increased the probability to utilize mental health services (odds ratio, 3.854; 95% CI, 2.827-5.253). Our results support the importance of psychological first-aid to family members with relatives who were injured during war. [ABSTRACT FROM AUTHOR]

Introduction: Blunt trauma accounts for the majority of pediatric renal injuries. Most injuries are often minor and can be managed without surgical intervention. We have retrospectively reviewed our series of children with severe (grade IV/V) renal injuries, their management and outcome.Materials and Methods: Medical records of children less than 18 years with renal injuries were reviewed. The cause of injury, time following injury, management and outcome in these children were recorded. The outcome data were analyzed.Results: During the period between January 1996 and December 2008, 43 children with grade IV/V renal injuries were admitted with blunt abdominal trauma. Ten of these 43 children underwent exploration and 33 initially managed non-operatively. Two of these 33 children on non-operative management needed nephrectomy for vascular injury and delayed haemorrhage.Conclusions: Most children with grade IV/V renal injury following blunt trauma can be managed non-operatively. Management can be properly planned and executed based on clinical features, CT imaging and staging of renal injuries. Surgical intervention is needed for associated abdominal organ injuries and renal vascular injuries. [ABSTRACT FROM AUTHOR]

Introduction: In 2010, the world witnessed 32 wars and other armed conflicts. Epidemiological analyses of mechanisms and patterns of injury of soldiers sent into these conflicts can be utilised to identify the surgical expertise that is required in a combat setting providing important parameters to adjust medical infrastructure and training requirements for future Military Surgeons. Experiences: Today in 2011, the German Bundeswehr runs a combat support hospital (role 3) in Mazar-e-Sharif in Northern Afghanistan providing a multidisciplinary capability profile. Furthermore, there are two role 2 medical treatment facilities (rescue centres) in Kunduz and Feyzabad for life-saving procedures and damage control operations in order to enable rapid evacuation to a higher level of care. Epidemiological analyses of injury patterns and mechanisms have shown that 2,299 soldiers of the coalition forces have been killed in Afghanistan until January 15, 2011. Of these, 21.4% died in non-hostile action (2010). The leading causes of injury were explosive devices (up to 60%) followed by gunshot wounds. Chest or abdominal injuries (40%) and traumatic brain injuries (35%) were the main causes of death for soldiers killed in action. The analysis of all surgical procedures performed in Northern Afghanistan demonstrates that most of the patients who underwent surgery until 2009 were local civilians. Most of these operations involved osteosynthesis and soft tissue debridement. Due to the recently aggravated tactical situation within the theatre, a significant increase of mass casualty situations and combat-related injuries was noticed. Dicussion: The casualties in this military conflict present with injury patterns that are not seen in routine surgical practice at home. In an era of increasing surgical sub-specialisation, the deployed military surgeon needs to acquire and maintain a wide range of skills including a variety of surgical fields. In order to create this kind of military surgeon, the so-called DUO plus model for the training of military surgeons (specialisation general surgery plus a second sub-specialisation either in visceral surgery or orthopaedics/trauma surgery) has been developed in the Joint Medical Service of the German Bundeswehr. Other relevant skills, such as emergency neurotraumatology, battlefield surgery with integrated oral and craniomaxillofacial surgery, and emergency gynaecology are also integrated into this concept and will be addressed in special courses. On successful completion of this training programme, military surgeons will be officially appointed as 'Einsatzchirurg' for a duration of 5 years. After this time, it will be obligatory to renew this 'combat ready' status. Conclusion: The buildings and materials in German military medical treatment facilities provide for excellent working conditions. The training programme for military surgeons in its end-2010 version has been designed specifically with data about injury pattern and non-battle diseases as well as the political situation and professional requirements in the civilian sphere in mind. [ABSTRACT FROM AUTHOR]

Wounds expose a patient to serious hazards like wound infection, tissue destruction, disfiguring and disabling scars. Use of superoxidised solution (oxum) in infected wounds, ulcers, diabetic wounds, abcesses, burns reduced morbidity and hospital stay with its early wound healing effect. To evaluate the effect of superoxidised water (Oxum) V/s povidone iodine (Betadine) on similar types of wounds. We retrospectively analysed the records of two hundred patients with different types of wounds who attended Department of Surgery, Guru Nanak Dev Hospital/Govt. Medical College, Amritsar from January 2008 to January 2009. The patients were divided into two groups. Group A where topical management and dressing was done using oxum and group B where topical management and dressing was done using betadine. A standard grading in terms of percentage decrease in wound size, periwound oedema/erythema, pus discharge and percentage increase in granulation, fibrin and epithelisation was noted in various types of wounds in both groups. Oxum treated wounds showed reduction in inflammation and their healing earlier than betadine group. Oxum application was safe having no pain and allergic manifestation. [ABSTRACT FROM AUTHOR]

The already known benefits produced by the interaction of coherent light (laser) with biologic tissues determine its use as an adjuvant in the treatment of several complications associated with diabetes. Non-coherent light, such as that emitted by light emitting diodes (LEDs), becomes a promising alternative, because of its low cost and easy handling in these applications. Thirty-six rats were given surgical dorsum lesions. The lesions for the control group did not receive any supporting therapy. The other groups were irradiated only once, 30 min after the establishment of the lesion, with LED (640 nm with 40 nm full bandwidth at half maximum) or laser (660 nm). The histomorphological and histomorphometrical parameters were quantified. The coherent and non-coherent lights produced similar effects during a period of 168 h after the lesions had been made. For the group composed of diabetic animals, 72 h after creation of the lesion, it was observed that the therapy with LEDs had been more efficient than that with the laser in the reduction of the wounds' diameters. [ABSTRACT FROM AUTHOR]

The fundamental mechanism for hernia formation is loss of the mechanical integrity of abdominal wall structural tissue that results in the inability to offset and contain intra-abdominal forces during valsalva and loading of the torso. There is evidence that genetic or systemic extracellular matrix disorders may predispose patients to hernia formation. There is also evidence that acute laparotomy wound failure leads to hernia formation and increases the risk of recurrent hernia disease. It may be that hernia formation is a heterogeneous disease, not unlike cancer, where one population of patients express an extracellular matrix defect leading to primary hernia disease, while other subsets of patients acquire a defective, chronic wound phenotype following failed laparotomy and hernia repairs. It is evident that an improved understanding of structural tissue matrix biology will lead to improved results following abdominal wall reconstructions. [ABSTRACT FROM AUTHOR]

This study examines whether intense pulsed light (IPL) treatment has a carcinogenic potential itself or may influence ultraviolet (UV)-induced carcinogenesis. Secondly, it evaluates whether UV exposure may influence IPL-induced side effects. Hairless, lightly pigmented mice (n=144) received three IPL treatments at 2-week intervals. Simulated solar radiation was administered preoperatively [six standard erythema doses (SED) four times weekly for 11 weeks] as well as pre- and postoperatively (six SED four times weekly up to 26 weeks). Skin tumors were assessed weekly during a 12-month observation period. Side effects were evaluated clinically. No tumors appeared in untreated control mice or in just IPL-treated mice. Skin tumors developed in UV-exposed mice independently of IPL treatments. The time it took for 50% of the mice to first develop skin tumor ranged from 47 to 49 weeks in preoperative UV-exposed mice (p=0.94) and from 22 to 23 weeks in pre- and postoperative UV-exposed mice (p=0.11). IPL rejuvenation of lightly pigmented skin did not induce pigmentary changes (p=1.00). IPL rejuvenation of UV-pigmented skin resulted in an immediate increased skin pigmentation and a subsequent short-term reduced skin pigmentation (p<0.002). Postoperative UV radiation resulted in re-pigmentation of IPL-induced pigment reduction (p=0.12). No texture changes were observed. Postoperative edema and erythema were increased by preoperative UV exposure (p<0.002). IPL rejuvenation has no carcinogenic potential itself and does not influence UV-induced carcinogenesis. UV exposure influences the occurrence of side effects after IPL rejuvenation in an animal model. [ABSTRACT FROM AUTHOR]

There are many over-the-counter (OTC) bandage products available. In addition to their direct purchase by the public, many physicians provide OTC bandages to their patents after minor surgeries. The aim of this study was to evaluate in a well established porcine model the efficacy against Staphylococcus aureus of four OTC antimicrobial containing bandages as compared to two OTC ointments. Multiple partial thickness wounds were made on the backs of four pigs. The wounds were treated within 20 min after S. aureus inoculation. The wounds were cultured quantitatively at 24 and 48 h. Only one of the antibiotic bandages and one of the topical ointments were effective in reducing S. aureus proliferation in partial thickness wounds. The two treatments that were effective were the only treatments that contained neomycin. Although many OTC bandages and ointments contain antimicrobials, they may not be effective at reducing bacteria in wounds. [ABSTRACT FROM AUTHOR]

Pharyngeal perforations are uncommon in children and are usually secondary to instrumentation or external penetrating injuries. A delay in management can lead to life-threatening complications such as retropharyngeal abscess, mediastinitis, and airway compromise. We report three children who had pharyngeal perforation due to apparently innocuous injury and who developed serious complications. A high index of suspicion for a significant pharyngeal injury, use of lateral soft-tissue x-ray films of the neck, and flexible endoscopy in the emergency room can assist in early diagnosis when evaluating patients with oropharyngeal and penetrating neck injury. Prompt administration of broad-spectrum antibiotics, local drainage, and debridement can avert life-threatening complications. [ABSTRACT FROM AUTHOR]

Background.Reports on missile-caused radial nerve injuries are relatively rare in current literature. We present the outcome after repair of such injuries as well as the factors influencing the result of treatment.Methods.Prospective study included 131 complete missile-caused radial nerve severances repaired with nerve graft or direct suture. Final outcome was defined 4 years postoperatively at least, on the basis of motor recovery (M), EMNG recovery (E) and patient’s judgement on the quality of outcome (P). Recovery was estimated with 0-5 points and final outcome was defined according to the total sum (0-15 points) as: poor, insufficient, good or excellent. Both the good and the excellent outcomes were considered assuccessful, and both the poor and the insufficient outcome asunsuccessful.Results.Excellent outcome was noted in 38.2% and good outcome in 47.3% of all patients. Average point score was 9.9?±?3.3 points for the whole series (domain ofgoodoutcome) and 6.6?±?3.0, 10.1?±?3.2 and 10.9?±?2.2 points for high, intermediate and low repairs, respectively (p<0.01). Useful motor recovery (=M3), good EMNG recovery (=E3) and affirmative patient’s judgement on the outcome (=P3) had similar frequencies for intermediate (83.2-89.7%) and low repairs (85.7-92.8%), but for high repairs, good EMNG recovery was more frequent (70%) than were useful motor recovery and affirmative patient’s judgement (40%). Successful outcome was noted in 89.3% of direct sutures and in 82.7% of nerve grafts (p>0.05). Patients with a successful outcome had a significantly shorter nerve defect (p<0.001), shorter preoperative interval (p<0.001) and younger age (p<0.05) than patients with an unsuccessful outcome. Significant deterioration of results began with defects longer than 8?cm, preoperative interval longer than 6 months and age above 40 years.Conclusions.The outcome is significantly worse after high radial nerve repairs than after intermediate and low repairs. The length of nerve defect, duration of preoperative interval and age of the patient also influence the repair outcome. Correlation of motor recovery with EMNG recovery and with patient’s judgement on the outcome is relatively good, but depends on the level of the repair. [ABSTRACT FROM AUTHOR]

Between 1994 and 2001 we used the vacuum-sealing technique in 478 skin grafts. Indications included large soft-tissue defects resulting from trauma, skin loss due to degloving injuries, burns, and infected/contaminated wound surfaces. The technique involves direct placement of the white polyvinyl alcohol pad directly onto the transplanted skin. The necessary negative pressure is generated by redon flasks yielding a negative pressure of 60–80 kPa (high-pressure system). In extensive wounds a vacuum pump is used. The high pressure used does not result in necrosis. In 11 patients poor wound conditions resulted in only partial healing. Three patients with pseudomonas infections experienced complete loss of the graft. The vacuum-sealing technique permits a moderate moist and warm wound treatment with stable fixation of the transplant even in cases of large wounds or those with irregular contours. The method is not suitable in cases of infection or contamination with pseudomonas species. [ABSTRACT FROM AUTHOR]

Lasers are now widely used for treating numerous cutaneous lesions, for scar revision (hypertrophic and keloid scars), for tissue welding, and for skin resurfacing and remodeling (wrinkle removal). In these procedures lasers are used to generate heat. The modulation of the effect (volatilization, coagulation, hyperthermia) of the laser is obtained by using different wavelengths and laser parameters. The heat source obtained by conversion of light into heat can be very superficial, yet intense, if the laser light is well absorbed (far-infrared:CO or Erbium:Yttrium Aluminum Garnet [Er:YAG] lasers), or it can be much deeper and less intense if the laser light is less absorbed by the skin (visible or near-infrared). Lasers transfer energy, in the form of heat, to surrounding tissues and, regardless of the laser used, a 45-50°C temperature gradient will be obtained in the surrounding skin. If a wound healing process exists, it is a result of live cells reacting to this low temperature increase. The generated supraphysiologic level of heat is able to induce a heat shock response (HSR), which can be defined as the temporary changes in cellular metabolism. These changes are rapid and transient, and are characterized by the production of a small family of proteins termed the heat shock proteins (HSP). Recent experimental studies have clearly demonstrated that HSP 70, which is over-expressed following laser irradiation, could play a role with a coordinated expression of other growth factors such as transforming growth factor (TGF)-β. TGF-β is known to be a key element in the inflammatory response and the fibrogenic process. In this process, the fibroblasts are the key cells since they produce collagen and extracellular matrix. In conclusion, the analysis of the literature, and the fundamental considerations concerning the healing process when using thermal lasers, are in favor of a modification of the growth factors synthesis after laser irradiation, induced by an HSR. An extensive review of the different techniques and several clinical studies confirm that thermal lasers could effectively promote skin wound healing, if they are used in a controlled manner. [ABSTRACT FROM AUTHOR]