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While “population aging” is an accomplishment that deserves acclamation, it is in itself a tremendous challenge. Age-related skin changes, impaired wound healing, and concurrent comorbidities are the deadly triad that contribute most to the development of nonhealing chronic wounds in the elderly. This imposes enormous medical, social, and financial burden. With the rising trend in the aging population, this problem is likely to exacerbate unless multidisciplinary, rapt wound care strategies are developed. The last decade was dedicated to understand the basic biology underlying the wound healing process but most in vitro and animal model studies translated poorly to human conditions. Forthcoming, the focus is on the development of diagnostic and therapeutic strategies to improve healing in this vulnerable age group. Further, understanding the complex pathobiology of cellular senescence and wound healing process is required to develop focused therapy for these “problem wounds” in the elderly.

Impaired wound healing is a major concern in diabetic patients due to unregulated chronic hyperglycemia which further may lead to ulcer, gangrene, and its complications. The present study unveils the accelerative effect of aqueous Anthocephalus cadamba leaf extract on wound healing in diabetic rats. Diabetes was induced in 30 Sprague Dawley female rats by using streptozotocin (except control group I) at the dose of 60 mg/kg intraperitoneally. Diabetic rats were randomized in 3 groups viz. diabetic control group (II), diabetes + Kadam plant leaf extract group (III), and diabetes + 5% povidone–iodine solution group (IV). Surgically sterile wound of 1.77 cm2 was created on the dorsal area of anaesthetized rats. The experimental parameters were assessed by hematobiochemical, histopathological, and western blot techniques. The A cadamba extract treatment group (III) (D + KPLE) showed a significant increase in the percentage of wound closure (82%) at day 21 as compared to the diabetic control group (42%), nondiabetic control group (I) (49%), and povidone–iodine treatment group (75%) group (IV). The findings of the present study suggest that the (D + KPLE) group (III) exhibited marked epithelial regeneration, neovascularization, collagen deposition, and fibroblast proliferation along with higher expression of vascular endothelial growth factor as compared to the diabetic control group (II), which was confirmed by histopathological examination and western blot analysis. The present study suggests that the topical application of aqueous A cadamba leaf extract exhibits accelerative wound-healing properties in diabetic rats.

Due to the microvascular effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), head and neck reconstructive surgeries utilizing free tissue transfers may be profoundly affected by SARS-CoV-2 infection in the immediate postoperative period. Our objective is to describe two adult patients who developed SARS-CoV-2 after undergoing relatively uncomplicated segmental mandibulectomies. In both cases, the patients were initially negative for SARS-CoV-2, underwent relatively uncomplicated segmental mandibulectomies with fibula free flap reconstructions, and were later discharged in stable conditions. Both patients subsequently experienced significant infectious sequelae at the donor and recipient sites with near-total split-thickness skin graft loss in the donor sites in the setting of postoperative SARS-CoV-2 infection. The first patient developed sepsis and gangrenous changes to his fibula donor site requiring four operative debridements and partial amputation with subsequent osteomyelitis of the remaining fibula. The second patient experienced dehiscence of the oral fibula free flap as well as a 22 cm phlegmon at the fibula donor site that required surgical debridement. In consideration of these cases, SARS-CoV-2 infection during the immediate postoperative period of head and neck reconstruction procedures may elevate the risk of major wound complications. Special consideration must be taken when performing free tissue transfers during the COVID-19 pandemic.

Recently, we reported that some wound dressings caused complement activation at the interface of wound dressing and blood. Since complement activation is associated with impaired wound healing, we investigated whether this activation of the complement cascade at the interface of wound dressings and blood does impair reepithelialization in a scratch wound healing assay. Although some samples showed higher levels of the complement activation marker SC5b-9 in our study, reepithelialization of the samples did not significantly differ from the control group. Further studies have to clarify if complement activation at the interface of wound dressings and blood plays a relevant role in the healing process especially in long-time experiments.

ntroduction: Lower limb amputation is a surgery performed as a last resort, when all other therapeutic options have been exhausted. The duration of treatment lasts from a few to several months and depends on the extent of amputation, the patientas overall health and the course of the stump healing process. Materials and methods A retrospective analysis was performed using the database of the General and Vascular Surgery Ward of the Nikolay Pirogov Regional Specialist Hospital in Łodź. Patients who underwent lower limb amputation at the transfemoral level in 2017 were analyzed. 92 patients undergoing surgery were qualified for the study. Patients were divided into two groups: those with no healing complications and those with stump healing complications. Medical records of both groups were analyzed for risk factors for impaired healing. The obtained data were subjected to statistical analysis. Results Patients with impaired stump healing most often had minimal bleeding and higher ASA scores compared to patients without healing complications. No differences between the two groups were found for the remaining parameters. Patients with complications needed an average of 28 days to heal the wound and spent an average of 40 days in hospital, compared to 14 and 21 days, respectively, for patients without complications. The percentage of deaths in the group of patients with complications was also significantly higher (35%) than in the group of patients without complications (5%). Conclusions Statistically significant factors increasing the risk of impaired stump healing include high ASA scale and minimal muscle bleeding during surgery. Patients who experienced this complication are at greater risk of prolonged hospitalization and death in the postoperative period. This study showed statistically significant risk factors for impaired stump healing following amputation and confirmed the negative impact of this complication on the length of hospitalization and risk of death.

Increased complications following failed hypospadias repairs suggest that impaired wound healing is a contributing factor. We used perioperative hyperbaric oxygen therapy to promote wound healing determined by graft take in staged tubularized autograft reoperations using oral graft.Hyperbaric oxygen therapy was recommended for patients with 3 or more failed hypospadias repairs, comprising 20 preoperative and 10 postoperative sessions. All patients underwent reoperative staged tubularized autograft repair using oral mucosa. Graft lengths and widths were measured at grafting and again at the second stage, from which graft area was calculated. The primary outcomes were percent graft contracture and graft failure, defined as contracture 50% or greater. Patients who received hyperbaric oxygen therapy were compared to other patients who underwent reoperative staged tubularized autograft who did not receive therapy.Among 57 patients 32 received hyperbaric oxygen therapy and 25 did not as they had fewer than 3 prior repairs, or were not able to receive treatment due to insurance issues or lack of local availability. Grafts were healthier in those receiving hyperbaric oxygen therapy, with significantly less percent area contracture (9% vs 26%, p=0.04) and graft failure (6% vs 28%, p=0.03) compared to those not receiving therapy, although treated patients had significantly more prior failed hypospadias repairs.Hyperbaric oxygen therapy improved graft take in hypospadias reoperations. This observation also calls attention to wound healing as another variable to consider in hypospadias surgery.

Impaired wound healing is an immense medical challenge, and while autologous skin grafting remains the “gold-standard” therapeutic option for repairing wounds that cannot be closed by primary or secondary intention, it is limited by substantial donor site morbidity. We previously developed the alternative approach of harvesting full-thickness skin tissue in the form of “micro skin tissue columns” (MSTCs), without causing scarring or any other long-term morbidity. In this study we investigated how MSTC treatment affects the different cellular processes involved in wound healing. We found that MSTC-derived cells were able to remodel and repopulate the wound volume, and positively impact multiple aspects of the wound healing process, including accelerating re-epithelialization by providing multiple cell sources throughout the wound area, increasing collagen deposition, enhancing dermal remodeling, and attenuating the inflammatory response. These effects combined to enhance both epidermal and dermal wound healing. This MSTC treatment approach was designed for practical clinical use, could convey many benefits of autologous skin grafting, and avoids the major drawback of donor site morbidity.

Hypergranulation and crust formation after cranial neurosurgery is rare. We report three patients with an uncommon form of hypergranulation with extensive crust formation after cranial neurosurgery, associated with a St. Aureus infection of the scalp, and propose that this is a form of pyogenic dermatitis, as is commonly seen among domestic animals with a coat of fur. It can be treated conservatively. We propose a treatment algorithm.

Background: Wound healing problems following abdominoplasty may be a result of impaired tissue perfusion. This study evaluated the impact a standard abdominoplasty may have on abdominal skin perfusion. Methods: A standard abdominoplasty was performed in 16 patients. Dynamic infrared thermography (DIRT) using a mild and a stronger cold challenge was performed pre-, intra-, and postoperatively on day 1, 2, and in week 6. The abdomen was divided into Huger’s vascular zones. A two-tailed t test was used to evaluate differences in mean temperature between zones. Statistical significance was defined as P < 0.05. Results: Two patients suffered wound healing problems. Abdominal skin perfusion showed a hyperaemic state on day 1, day 2, and week 6, postoperatively. Hotspots in zones I and II had all disappeared at the end of surgery and on day 1, except in the cranial part of zone I. Hotspots reappeared in zones I and II during day 2. A statistically significant difference between zones I and II was seen on day 1 and 2, with zone II being cooler. This difference had disappeared in week 6 for the mild cold challenge but not for the stronger cold challenge. Conclusions: A standard abdominoplasty has a significant impact on abdominal skin perfusion. The skin perfusion is a dynamic process with a gradual improvement over time. The strongest effect was seen in zone II near the lower transverse incision line, where skin perfusion was the least. Such may contribute to impaired wound healing at this site

Keloids are pathological scars that grow over time and extend beyond the initial site of injury after impaired wound healing. These scars frequently recur and rarely regress. They are aesthetically disfiguring, can cause pain, itching, discomfort as well as psychological stress, often affecting quality of life. Many treatment modalities, including surgical and non-surgical, have been explored and have been reported to be beneficial; however, none have been absolutely satisfactory or optimal for the treatment of all keloid subtypes to date. This poses a major challenge to clinicians. Often, a combinational therapeutic approach appears to offer the best results with higher patient satisfaction compared to monotherapy. The aetiopathogenesis of keloids is not fully elucidated; however, with recent advances in molecular biology and genetics, insight is being gained on the complex process of scar formation and hence new therapeutic and management options for keloids. In this paper, we explore the literature and summarise the general concepts surrounding keloid development and review both current (corticosteroids, surgical excision, silicone-based products, pressure therapy, radiotherapy, cryotherapy, laser therapy, imiquimod and 5-fluorouracil) and emerging (stem cell therapy, mitomycin C, verapamil, interferons, bleomycin, botulinum toxin type A and angiotensin-converting enzyme inhibitors) treatments. Increased knowledge and understanding in this area may potentially lead to the discovery and development of novel therapeutic options that are more efficacious for all keloid types. Lay Summary [Formula: see text] Keloids are problematic scars that are difficult to treat and manage. The aetiopathogenesis of keloids is not clear; however, recent advances in molecular biology and genetics are beginning to shed light on the underlying mechanisms implicated in keloid scar formation which will hopefully lead to the development of treatment options for all keloid types. This review summarises current and emerging therapies.

Clinical sequelae of irradiation result in tissue devitalization (e.g., ischemia, fibrosis, and atrophy) where wound healing capacity is impaired. Fat-derived products may work to treat such pathology.Nonlethal irradiation at various doses (5, 10, and 15 Gy) and frequencies (one to three times on sequential days) was delivered to dorsal skin of nude mice, and subsequent gross and microscopic changes were evaluated for up to 4 weeks. Cutaneous punch wounds were then created to compare wound healing in irradiated and nonirradiated states. Wounds were also locally injected with vehicle, cultured adipose-derived stem cells, centrifuged fat tissue, or micronized cellular adipose matrix, and the therapeutic impact was monitored for up to 15 days.Nude mice given total doses greater than 15 Gy spontaneously developed skin ulcers, and radiation damage was dose-dependent; however, a fractionated irradiation protocol was able to reduce the damage. Histologic assessment revealed dose-dependent dermal fibrosis/thickening and subcutaneous atrophy. Dose-dependent (5 to 15 Gy) impairment of wound healing was also evident. At the highest dosage (15 Gy three times), open wounds persisted on day 15. However, wounds injected with cultured adipose-derived stem cells were nearly healed on day 12, and those treated with injection of centrifuged fat or micronized tissue healed faster than untreated controls (p0.05). There was no significant differences between treated groups.Tissue devitalization by irradiation was dose-dependent, although fractionated protocols helped to reduce it. Adipose-derived stem cells and other fat-derived products harboring adipose-derived stem cells successfully revitalized irradiated tissues and accelerated wound healing.

Aims The classical longitudinal incision used for the direct anterior approach (DAA) to the hip does not follow the tension lines of the skin and can lead to impaired wound healing and poor cosmesis. The purpose of this retrospective study was to determine the satisfaction with the scar, and functional and radiographic outcomes comparing the classic longitudinal incision with a modified skin crease ‘bikini’ when the DAA is used for total hip arthroplasty (THA). Patients and Methods A total of 964 patients (51% female; 59% longitudinal, 41% ‘bikini’) completed a follow-up questionnaire between two and four years postoperatively, including the Oxford Hip Score (OHS), the University of North Carolina ‘4P’ scar scale (UNC4P) and two items for assessing the aesthetic appearance of the scar and symptoms of numbness. The positioning of the components, rates of heterotopic ossification (HO) and rates of revision were assessed. Results The mean OHS was similar in both groups (p = 0.41). The mean UNC4P total score was slightly better (p = 0.01) and the proportion of patients who were very satisfied with the cosmetic aspects of the scar was higher in the ‘bikini’ group (p Conclusion We found that a short oblique ‘bikini’ skin crease incision is safe when used for the DAA at THA, without compromising the positioning of the components or increasing the rate of lateral femoral cutaneous nerve dysaesthesia. Although it leads to a superior scar satisfaction, as it is less extensile, it should be used after having gained experience with the classic longitudinal incision. Cite this article: Bone Joint J 2018;100-B:853–61.

Delayed wound healing and the potentially resulting chronic wounds are a challenging clinical problem. Available therapeutic strategies are limited in both number and efficacy. For developing and establishing novel treatment approaches appropriate clinically relevant animal models are essential. The aim of the study was to establish a reliable and reproducible delayed wound healing model, which simulates the clinical scenario of compromised vascular tissue perfusion (hypoxia/ischemia). Therefore a standard rodent ischemic flap model was modified by challenging the tissue with ascending degrees of ischemia using different surgical approaches (minimal, mild, moderate, and severe ischemic invasive approach). Then a full-thickness circular wound was excised in both the non-/hypoperfused flap area and in the normally perfused contralateral region serving as an internal control. Wound healing progress was compared. Superficial tissue perfusion was measured by Laser Doppler imaging technique, which showed persis...

Impaired wound healing that mimics chronic human skin pathologies is difficult to achieve in current animal models, hindering testing and development of new therapeutic biomaterials that promote wound healing. In this article, we describe a refinement and simplification of the porcine ischemic wound model that increases the size and number of experimental sites per animal. By comparing three flap geometries, we adopted a superior configuration (15 × 10 cm) that enabled testing of twenty 1 cm2 wounds in each animal: 8 total ischemic wounds within 4 bipedicle flaps and 12 nonischemic wounds. The ischemic wounds exhibited impaired skin perfusion for ∼1 week. To demonstrate the utility of the model for comparative testing of tissue regenerative biomaterials, we evaluated the healing process in wounds implanted with highly porous poly (thioketal) urethane (PTK-UR) scaffolds that were fabricated through reaction of reactive oxygen species (ROS)-cleavable PTK macrodiols with isocyanates. PTK-lysine triisocyanate (LTI) scaffolds degraded significantly in vitro under both oxidative and hydrolytic conditions whereas PTK-hexamethylene diisocyanate trimer (HDIt) scaffolds were resistant to hydrolytic breakdown and degraded exclusively through an ROS-dependent mechanism. Upon placement into porcine wounds, both types of PTK-UR materials fostered new tissue ingrowth over 10 days in both ischemic and nonischemic tissue. However, wound perfusion, tissue infiltration and the abundance of pro-regenerative, M2-polarized macrophages were markedly lower in ischemic wounds independent of scaffold type. The PTK-LTI implants significantly improved tissue infiltration and perfusion compared with analogous PTK-HDIt scaffolds in ischemic wounds. Both LTI and HDIt-based PTK-UR implants enhanced M2 macrophage activity, and these cells were selectively localized at the scaffold/tissue interface. In sum, this modified porcine wound-healing model decreased animal usage, simplified procedures, and permitted a more robust evaluation of tissue engineering materials in preclinical wound healing research. Deployment of the model for a relevant biomaterial comparison yielded results that support the use of the PTK-LTI over the PTK-HDIt scaffold formulation for future advanced therapeutic studies.

Introduction It is known that systolic dysfunction (dilated cardiomyopathy) may occur in a high percentage of patients with large TBSA burns. The reversible myocardial depression may be due to many factors: thermal injury, sepsis, severe malnutrition. Malnutrition and delayed wound healing may occur with a combination of primary and secondary protein-energy undernutrition. Methods Serial transthoracic and transesophageal echocardiographic parameters were measured during perioperative care (ejection fraction, fractional shortening, pericardial fluid) in 8 patients with evidence of malnutrition (low BMI, low albumin and prealbumin, muscle wasting) and a delayed presentation to the hospital. Initial echocardiography was performed post-injury day 30 -142; follow-up exams were performed in some patients at 2 years post-injury. Acutely-injured patients or those with sepsis were excluded. Results From 2015–2017, echocardiographic measurements were obtained in 8 patients, ages 7–21. The presenting TBSA ranged from 30–82% and included flame injury, electrical burns, and 1 case of pemphigus vulgaris. The initial ejection fraction ranged from 12–45% in patients with a BMI range of 10–25. The mean initial albumin was 2g/dL; the mean prealbumin was 9.5mg/dL. Two patients had mild to moderate pericardial effusions, which resolved after 1 month of proper nutrition. Selenium deficiency was noted in 1 patient. Four patients required perioperative short-term dobutamine. Conclusions Patients presenting with malnutrition and impaired wound healing all had evidence of cardiomyopathy; however, the degrees of systolic dysfunction varied significantly. BMI, albumin, and prealbumin all had a strong correlation with the degree of myocardial depression. Despite the lower ejection fractions, many patients maintained an adequate cardiac index and did not require inotropic medications. With time and adequate nutrition, cardiac function improved, although many remained with mild dysfunction in the first year. Applicability of Research to Practice This case series demonstrates the continued need for early recognition of malnutrition and cardiomyopathy in this patient population and the need for early intervention. Echocardiographic diagnosis may improve acute perioperative care. In addition, future studies are needed to determine the chronic cardiac effects of reversible dilated cardiomyopathy. Nutrition, refeeding, and perioperative management require a multidisciplinary team.

Disturbed wound healing (DWH) following elective foot and ankle surgery is associated with a number of known risk factors. The purpose of this study was to determine if peripheral artery disease (PAD) is a potential risk factor that contributes to an increase in postoperative DWH. In a case–control study, we analyzed all patients undergoing elective foot and ankle surgery between January 1, 2014 and December 31, 2017 at two institutions and identified 51 patients with postoperative DWH. After matching with 51 control patients without DWH, all 102 patients were evaluated for PAD. The prevalence of PAD was significantly higher in the DWH group compared to the control group (41.2% vs 19.6%, p < 0.01). This difference was even more distinctive for patients with any abnormal ankle–brachial index (ABI) (51.0% vs 19.6%, p < 0.001). After adjustment for diabetes, hypertension, hypercholesterolemia, and smoking, any abnormal ABI or a history of PAD remained an independent risk factor for DWH (odds ratio 3.28; 95% CI 1.24–8.71). In this dual-center study, postoperative DWH was associated with significantly higher rates of PAD. These findings suggest that preoperative evaluation for PAD could be a helpful tool to identify patients at high risk for postoperative wound complications undergoing foot and ankle surgery. This trial is registered with drks.de, number DRKS00012580.

Category: General Health Introduction/Purpose: Smoking tobacco is a risk factor for impaired wound healing, infection, delayed fracture healing, and prolonged hospital stay. Smoking cessation prior to surgery has shown a 40% relative risk reduction in total perioperative complications. The primary purpose of this study is to evaluate the impact of preoperative smoking cessation on long-term smoking habits in patients undergoing elective lower extremity orthopaedic surgery. The secondary outcome is patient-reported effectiveness of smoking cessation method. Methods: A retrospective cohort study was performed by identifying all patients who were smokers that were required to quit and subsequently had a normal nicotine/cotinine serum test prior to lower extremity orthopaedic surgery. Attempts were made to contact all patients and administer a survey inquiring about demographics, medical history, smoking history, smoking cessation process, and current smoking status. Results: Of 36 eligible patients, 23 completed the survey. Eleven patients identified as current non-smokers (48%) at the time of survey follow-up (mean follow-up 55 months with a range of 12 to 88 months). Of these 11, 82% said they were very likely to continue to refrain from smoking. Twelve patients identified as current smokers at the time of survey, over half of whom ceased smoking for at least three months perioperatively. The reasons for resuming smoking were “stress” (45%), ”falling back into the habit” (37%), and due to “friends who smoke” (18%). The majority of smoking patients (92%) decreased the number of cigarettes they smoked regularly. The most effective smoking cessation techniques were ”cold turkey”, “non-nicotine medication”, and ”trans-dermal nicotine patches”. Conclusion: Elective surgery offers a unique opportunity for smoking cessation. Of 23 patients required to quit smoking prior to surgery, 48% maintained smoking cessation at least one year postoperatively. Of the 12 patients who relapsed, 55% stated that they did not resume smoking until at least three months postoperatively, suggesting that this particular period may be an important time for intensified smoking cessation counseling.

Suturing type is important because impaired wound healing can increase the cost of the treatment...

Treatment for diabetic foot ulcer (DFU) remains as one of the biggest clinical concerns in diabetic disease. DFU often causes a prolonged treatment and eventually leads to a non-healing wound ulcer. An impaired foot ulcer is often associated with a high number of amputation cases in diabetes patients. Owing to progress in the scientific research on DFU, better understanding of the mechanisms, pathophysiology of DFU has provided an insight into the advanced treatment of DFU. This includes the use of bioactive compounds and tissue engineering approach for the regeneration of damaged cells. Despite the availability of various wound treatments and dressing products in the market, most of the current products have drawbacks and limitations in terms of the pharmaceutics perspectives. Hence, pitfalls and challenges remain to develop an effective medicinal treatment product for DFU. In this paper, we discuss the current treatments available and the promising bioactive compounds for DFU. We also review advanced treatments for DFU and their limitations from the pharmaceutical point of views.

When given in conjunction with surgery for treating cancer, radiation therapy may result in impaired wound healing, which, in turn, could cause skin ulcers. In this study, bilayer and monolayer autologous skin substitutes were used to treat an irradiated wound.A single dose of 30 Gy of linear electron beam radiation was applied to the hind limb of nude mice before creating the skin lesion (area of 78.6 mm). Monolayer tissue-engineered skin substitutes (MTESSs) were prepared by entrapping cultured keratinocytes in fibrin matrix, and bilayer tissue-engineered skin substitutes (BTESSs) were prepared by entrapping keratinocytes and fibroblasts in separate layers. Bilayer tissue-engineered skin substitute and MTESS were implanted to the wound area. Gross appearance and wound area were analyzed to evaluate wound healing efficiency. Skin regeneration and morphological appearance were observed via histological and electron microscopy. Protein expressions of transforming growth factor β1 (TGF-β1), platelet-derived growth factor BB (PDGF-BB), and vascular endothelial growth factor (VEGF) in skin regeneration were evaluated by immunohistochemistry (IHC).Macroscopic observation revealed that at day 13, treatments with BTESS completely healed the irradiated wound, whereas wound sizes of 1.1 ± 0.05 and 6.8 ± 0.14 mm were measured in the MTESS-treated and untreated control groups, respectively. Hematoxylin-eosin (HE) analysis showed formation of compact and organized epidermal and dermal layers in the BTESS-treated group, as compared with MTESS-treated and untreated control groups. Ultrastructural analysis indicates maturation of skin in BTESS-treated wound evidenced by formation of intermediate filament bundles in the dermal layer and low intercellular space in the epidermal layer. Expressions of TGF-β1, PDGF-BB, and VEGF were also higher in BTESS-treated wounds, compared with MTESS-treated wounds.These results indicate that BTESS is the preferred treatment for irradiated wound ulcers.

Wound complications following total knee arthroplasty (TKA) can be a serious and challenging problem. As the number of TKAs increases annually, the number of complications is expected to rise. Impaired wound healing or soft tissue compromise can lead to more devastating complications, such as extensor mechanism disruption and infections. An organized approach to wound complications includes identification of the lesion, classifying the severity and depth of the defect, and initiating appropriate treatment [1]. Optimal treatment requires a comprehensive interdisciplinary approach with collaboration between orthopedic surgery and plastic surgery. Critical for a successful outcome and implant retention is timely reaction to the appearance of a wound problem and restoration of complete soft tissue coverage [2].

ZusammenfassungDie Sonographie stellt ein kostengünstiges, nicht invasives und am wachen Patienten durchführbares Verfahren dar, das bei einer Lahmheit der Hintergliedmaße mit Lokalisation im Bereich des Kniegelenks wertvolle Befunde liefern kann. Der erste Teil dieses Artikels beschrieb neben technischen Voraussetzungen und Limitationen die sonographische Anatomie und einen standardisierten Untersuchungsgang für das Kniegelenk und stellte sonomorphologische Veränderungen bei Gelenkerguss, Ruptur des kranialen Kreuzbands und Meniskuspathologien dar. Der zweite Teil dieser Arbeit befasst sich mit der sonographischen Diagnostik weiterer, weniger häufig auftretender Erkrankungen des Kniegelenks in Form von Wundheilungsstörungen, Neoplasien, kongenitalen, entwicklungsbedingten, degenerativen und traumatischen Veränderungen.

The association between malnutrition, impaired wound healing, and the presence of chronic wounds has been recognized for a long time. It is widely believed that the lack of adequate nutrition increases the risk of developing wounds which have a great likelihood of progressing to chronicity due to lack of appropriate healing responses. This risk is particularly high in the aging population. For the individual patient, as well as patient populations, the diagnosis of malnutrition has been in dispute; further, there is lack of agreement of when and how to intervene nutritionally in those with wounds or healing deficits. This article examines the relationship of nutritional status with the presence and clinical evolution of leg ulcers in humans, focusing on diabetic and venous leg ulcers; we will further review the effect of nutritional therapy on the outcome of these ulcers.

Whereas the physiologic wound healing (WH) successfully proceeds through the clearly defined sequence of the individual phases of wound healing, chronic non-healing wounds/ulcers fail to complete the individual stages and the entire healing process. There are many risk factors both modifiable (such as stress, smoking, inappropriate alcohol consumption, malnutrition, obesity, diabetes, cardio-vascular disease, etc.) and non-modifiable (such as genetic diseases and ageing) strongly contributing to the impaired WH. Current statistics demonstrate that both categories are increasingly presented in the populations, which causes dramatic socio-economic burden to the healthcare sector and society at large. Consequently, innovative concepts by predictive, preventive and personalised medicine are crucial to be implemented in the area. Individual risk factors, causality, functional interrelationships, molecular signature, predictive diagnosis, and primary and secondary prevention are thoroughly analysed followed by the expert recommendations in this paper.

Burns and other severe skin injuries alter cutaneous perception of pain, temperature, and touch. During skin wound healing, peripheral nerve regeneration can occur from nerve endings of the wound bed, however, a functional recovery after an injury is often not sufficient due to scar formation or impaired wound healing.

Background Since the middle of the 1990s vacuum-assisted closure (VAC) has been used in many areas of surgery to manage complex wounds and impaired wound healing. Until recently, little attention has been paid to this treatment modality in the field of head and neck surgery. The evaluation of its efficacy in wound healing disorders of the head and neck was the aim of this study. Material and methods Patients with complex wounds and impaired healing treated with VAC therapy between 2008 and 2011 were included into the study. VAC dressings were changed every 3 days and improvements in wound healing were documented. Results 23 patients were treated with VAC therapy, in 18 cases (78%) closure of the defect could be reached without any further surgical procedure. 5 patients needed subsequent regional flap reconstruction to close the remaining defect. All of these patients had undergone salvage surgery in a previously irradiated neck before. Conclusion Vacuum assisted closure is an effective treatment in the management of wound healing disorders and complex wounds in the head and neck. It offers a useful, non-invasive modality to close even large defects in the area. Previous irradiation seems to have a significant negative influence on the outcome of the therapy, but more data are required to assess these effects.

Impaired wound healing represents an enormous clinical and financial problem for companion animals and humans alike. Unfortunately, most models used to study healing rely on rodents, which have significant differences in the healing and scarring process and rarely develop complications. In order to better simulate impaired healing, the model should strive to reproduce the natural processes of healing and delayed healing. Wounds on the limbs of horses display similarities to wounds in humans in their epithelialization/contraction ratio, genetic influence as well as dysregulated cytokine profile and the spontaneous development of fibroproliferative disorders. Veterinarians have access to advanced wound therapies that are often identical to those provided to human patients. Wound research in large animals has resulted in new wound models as well as a better understanding of the physiology, immunology, and local environmental impact on both normal and aberrant wound healing. One such model reproduces the naturally occurring fibroproliferative disorder of horses known as exuberant granulation tissue. Comparisons between the normally healing and impaired wounds provide insight into the repair process and can facilitate product development. A better understanding of the wound healing physiopathology based on clinically accurate animal models should lead to the development of novel therapies thereby improving outcomes in both human and veterinary patients.

Background Diabetes mellitus is a disease lack of insulin, which has severely delayed and impaired wound healing capacity. In the previous studies, various types of scaffolds and growth factors were used in impaired wound healing. However, there were several limitations to use them such as short half-life of growth factors in vivo and inadequate experimental conditions of wound-dressing material. Thus, our study aimed to determine the biocompatibility and stability of the matrix containing structurally stabilized epidermal growth factor (S-EGF) and basic fibroblast growth factor (S-bFGF). Results and Discussion We stabilized EGF and bFGF that are structurally more stable than existing EGF and bFGF. We developed biocompatible matrix using S-EGF, S-bFGF, and hyaluronate– collagen dressing (HCD) matrix. The developed matrix, S-EGF and S-bFGF loaded on HCD matrix, had no cytotoxicity, in vitro. Also, these matrixes had longer releasing period that result in enhancement of half-life. Finally, when these matrixes were applied on the wound of diabetic mice, there were no inflammatory responses, in vivo. Thus, our results demonstrate that these matrixes are biologically safe and biocompatible as wound-dressing material. Conclusions Our stabilized EGF and bFGF was more stable than existing EGF and bFGF and the HCD matrix had the capacity to efficiently deliver growth factors. Thus, the S-EGF and S-bFGF loaded on HCD matrix had improved stability. Therefore, these matrixes may be suitable for impaired wound healing, resulting in application of clinical treatment. Electronic supplementary material The online version of this article (doi:10.1186/s40824-016-0056-4) contains supplementary material, which is available to authorized users.

Philippe Humbert,1 Brigitte Dréno,2 Jean Krutmann,3 Thomas Anton Luger,4 Raoul Triller,5 Sylvie Meaume,6 Sophie Seité71Research and Studies Centre on the Integument (CERT), Clinical Investigation Centre (CIC BT506), Department of Dermatology, Besançon University Hospital, University of Franche-Comté, Besançon, France; 2Department of Dermato-Cancerology, Nantes University Hospital, Nantes, France; 3IUF-Leibniz Research Institute for Environmental Medicine, Heinrich-Heine-University, Düsseldorf, Germany; 4Department of Dermatology, University of Münster, Münster, Germany; 5International Centre of Dermatology, Hertford British Hospital, Levallois, France; 6Geriatric Service, Wounds and Healing, Rothschild Hôspital, Paris, France; 7La Roche-Posay Dermatological Laboratories, Asnières, FranceAbstract: The increasingly aged population worldwide means more people are living with chronic diseases, reduced autonomy, and taking various medications. Health professionals should take these into consideration when managing dermatological problems in elderly patients. Accordingly, current research is investigating the dermatological problems associated with the loss of cutaneous function with age. As cell renewal slows, the physical and chemical barrier function declines, cutaneous permeability increases, and the skin becomes increasingly vulnerable to external factors. In geriatric dermatology, the consequences of cutaneous aging lead to xerosis, skin folding, moisture-associated skin damage, and impaired wound healing. These problems pose significant challenges for both the elderly and their carers. Most often, nurses manage skin care in the elderly. However, until recently, little attention has been paid to developing appropriate, evidence-based, skincare protocols. The objective of this paper is to highlight common clinical problems with aging skin and provide some appropriate advice on cosmetic protocols for managing them. A review of the literature from 2004 to 2014 using PubMed was performed by a working group of six European dermatologists with clinical and research experience in dermatology. Basic topical therapy can restore and protect skin barrier function, which relieves problems associated with xerosis, prevents aggravating moisture-associated skin damage, and enhances quality of life. In conclusion, the authors provide physicians with practical recommendations to assist them in implementing basic skin care for the elderly in an integrated care approach.Keywords: elderly, skin, cosmetic management

Wound reepithelialization is a cooperative multifactorial process dominated by keratinocyte migration, proliferation, and differentiation that restores the intact epidermal barrier to prevent infection and excessive moisture loss. However, in wounds that exhibit impaired wound healing, such as chronic nonhealing wounds or hypertrophic scars, the reepithelialization process has failed. Thus, it is necessary to explore a suitable way to mitigate these abnormalities to promote reepithelialization and achieve wound healing. Mesenchymal stem cells (MSCs) have the capacity for self-renewal as well as potential multipotency. These cells play important roles in many biological processes, including anti-inflammation, cell migration, proliferation, and differentiation, and signal pathway activation or inhibition. The mechanism of the involvement of MSCs in reepithelialization is still not fully understood. An abundance of evidence has shown that MSCs participate in reepithelialization by inhibiting excessive inflammatory responses, secreting important factors, differentiating into multiple skin cell types, and recruiting other host cells. This review describes the evidence for the roles that MSCs appear to play in the reepithelialization process.

Bisphosphonate related osteonecrosis of the jaw (BRONJ) is rare but potentially severe, and the etiopathology and risk factors are poorly defined. To date, it has not been possible to induce BRONJ in a large animal model, a shortfall this study aims to redress. Ten two-year-old adult Göttingen minipigs were split into two groups. Five pigs (group 1) were administered intravenously a weekly dose of a bisphosphonate (zoledonate 0.05mg/kg body weight, approximating the oncologic dose in humans) and five pigs (group 2) served as controls. After 6 weeks, tooth extractions were performed in the upper and lower jaw (both groups) and the bisphosphonate administration continued for a further 10 weeks (group 1 only). Clinical and blood parameters were monitored throughout the entire experiment; thereafter, the jaw-bones were subjected to macroscopic, radiological (CT) and histological investigations. Whilst the extraction sites in the control group healed within two weeks, all animals in the bisphosphonate group exhibited exposed bone and impaired wound healing, indicators that are synonymous of macroscopically advanced osteonecrosis. Radiological and in particular histological investigations confirmed the presence of BRONJ in the animals from group 1. This paper demonstrates that the administration of bisphosphonates, in combination with tooth extractions, induces BRONJ in a minipig model. The ability to study BRONJ in miniature pigs, animals with a bone structure not dissimilar to humans, may improve our knowledgebase regarding the etiopathology, the prophylaxis and potentially uncover new therapies of BRONJ.

There has been a renewed interest in the recent literature regarding the proposed benefits of systemic steroids in the perioperative period. Among these benefits are the relief of postoperative pain, the decrease in postoperative nausea, and a higher overall multiparameter quality of recovery. Perioperative steroids, however, are not without their potential drawbacks, including decreased immune function, hyperglycemia, and impaired wound healing. The use of perioperative steroids for brain tumor treatment and resection has been a component of therapy for approximately 50 years, owing primarily to their well-described, although poorly understood, effect in minimizing vasogenic peritumoral edema, and therefore intracranial pressure. This review seeks to highlight the history, mechanisms, therapeutic efficacy, and side effects of steroid use for brain tumors in the perioperative period.

This is the first installment of 2 articles that discuss the biology and pathophysiology of wound healing, review the role that growth factors play in this process, and describe current ways of growth factor delivery into the wound bed. Part 1 discusses the latest advances in clinicians' understanding of the control points that regulate wound healing. Importantly, biological similarities and differences between acute and chronic wounds are considered, including the signaling pathways that initiate cellular and tissue responses after injury, which may be impeded during chronic wound healing.

Wound healing is a critical process involved in the recovery from injury and surgical procedures. Poor healing increases the risk for wound infections or complications, lengthens hospital stays, magnifies patient discomfort, and slows return to activities of daily living. Converging evidence from different research paradigms suggests that psychological stress and other behavioral factors can affect wound healing. A meta-analytical study using diverse wound-healing models and outcomes found that across studies there was an average correlation of −0.42 between psychological stress and wound healing.1 This result suggests that the relationship between stress and wound repair is not only statistically significant but also clinically relevant. This review presents data and methods from observational, experimental, and interventional studies corroborating the impact of stress on wound healing. Potential behavioral and physiologic mechanisms explaining the association between stress and impaired wound healing are also discussed.

Radiotherapy forms an integral part in cancer treatment today. It is used alone or in combination with surgery and chemotherapy. Although radiotherapy is useful to effect tumour death, it also exerts a deleterious effect on surrounding normal tissues. These effects are either acute or can manifest months or years after the treatment. The chronic wounds are a result of impaired wound healing. This impairment results in fibrosis, nonhealing ulcers, lymphoedema and radionecrosis amongst others. This article will discuss the pathophysiology in brief, along with the manifestations of radiation-induced injury and the treatment available currently

Introduction: Extracellular matrix (ECM) remodeling involving matrix metalloproteinases (MMPs) and wound lactate accumulation are essential elements of tissue repair. The aim of this study was to investigate whether rapamycin-induced impaired healing is associated with compromised wound fluid lactate accumulation and altered ECM remodeling. Methods: Polyvinyl alcohol sponges were subcutaneously implanted in male C57/BL6 mice. Animals were randomized to daily intraperitoneal treatment with either vehicle or 1.5 mg/kg rapamycin. After 7 or 14 days, sponges were harvested to collect wound fluid for subsequent analyses. Wounds were excised for assessment of tensile strength. Results: After 7 days, wound hydroxyproline content was significantly decreased due to rapamycin therapy, whereas the observed difference in tensile strength marginally failed to show statistical significance. In addition, rapamycin reduced wound lactate accumulation and enhanced MMP-2 protein expression, and both MMP-2 and MMP-9 activity. At day 14, wound tensile strength and hydroxyproline content were significantly lower along with an increase in MMP-2 and MMP-9 activity in rapamycin-treated mice. Similarly, wound fluid lactate concentration and MMP-2 protein expression were found to be persistently decreased and increased, respectively. Conclusions: Rapamycin affects tissue repair by interfering with fundamental mechanisms involved in healing, namely lactate accumulation and ECM remodeling.

Background: The evolving state of technology in field of medicine has led to a plethora of new options in the realm of wound healing. The primary objective of present study was to assess the potential therapeutic effects of autologous platelet rich plasma in the healing of wound.Methods: A prospective clinical nonrandomized cohort study was performed in 50 patients (40 males, 10 females) with recalcitrant, chronic; non-healing wounds of different etiologies. Age ranged from 25 to 70 years (mean 39.14±13.38). Eligible patients were treated with autologous platelet rich plasma (PRP) at 4-days intervals for a maximum of 14 sessions. Patients were evaluated (reduction in size of the wound (area)) every week and continued until final healing has achieved. The primary outcome was positive response to therapy, defined as complete healing of the wound and absence of any raw area. Significance was set at pResults: The mean time duration to wound healing was 6.33 weeks (S.D±2.16). A statistically significant difference (pConclusions: There is considerable improvement in wound characteristics like healthy granulation tissue, healing edge, pain, slough, bleeding on touch and discharge after 7 days of PRP therapy and considerable improvement on follow up.

Patients with diabetes often have impaired wound healing and an increased rate of postoperative complications with surgery. Most research has focused on the effect of hyperglycemia in the postoperative period, but there is limited evidence to guide blood glucose (bG) control throughout the perioperative period. This retrospective study explored the effect of hyperglycemia in the PACU on postoperative complications, length of stay (LOS), and in-hospital mortality in patients with diabetes undergoing spine, colon, or joint surgery. Findings revealed that the total LOS for patients with a PACU bG >200 mg/dL was significantly longer than for patients with a maximum bG of 140 to 200 mg/dL. Further, the rate of total complications increased significantly as bG levels increased. More prospective, controlled studies on the management of perioperative hyperglycemia are recommended for consideration.

Background Proper wound healing is pivotal to successful surgical outcomes. Previous studies have shown that growth factors can be used to enhance tissue repair under impaired healing conditions. However, because of limited delivery methods, the growth factors in these studies were delivered either topically or as a single local administration. Methods Sixty Sprague-Dawley rats were divided equally into five groups and served as untreated normal controls or were implanted subcutaneously with a novel sustained-release drug delivery system through a dorsal incisional wound. This system delivered either transforming growth factor (TGF)-beta alone, platelet-derived growth factor (PDGF) alone, or TGF-beta and PDGF in combination, or served as unloaded sham controls. Wound healing was impaired in all treated rats by the administration of cyclophosphamide on days 1, 3, and 5. Wound tensile breaking strength was determined on days 4, 7, and 14. Results Sustained release of either TGF-beta or PDGF alone not only failed to improve the healing of cyclophosphamide-induced impaired wound healing but resulted in a paradoxical decrease in wound tensile breaking strength by day 7. However, the combined delivery of both TGF-beta and PDGF improved wound healing and significantly increased wound tensile breaking strength by day 7. Conclusions Sustained-release delivery of TGF-beta and PDGF in combination, but not separately, by a subcutaneously implanted drug delivery system significantly improves cyclophosphamide-induced impaired wound healing in rats.

Amputationen sind nicht nur für den Chirurgen ein relevantes Alltagsproblem. Insbesondere sind Internisten und Diabetologen speziell beim diabetischen Fußsyndrom in die Wundbehandlung, die Koordination der die Wundheilung beeinträchtigenden Begleitumstände (z.B. Hyperglykämie, Infektion, Durchblutungsstörung) und in die interdisziplinäre Entscheidungsfindung zur notwendigen Amputation aktiv mit eingebunden. Ein strukturiertes interdisziplinäres Procedere hilft die, gerade beim Diabetiker, auftretenden Wundheilungsstörungen zu beherrschen und auch mit minimal-chirurgischen Interventionen ein funktionell optimales Ergebnis für den Patienten zu erreichen.