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This study aimed to develop atorvastatin‐loaded emulgel and nano‐emulgel dosage forms and investigate their efficiency on surgical wound healing and reducing post‐operative pain. This double‐blind randomized clinical trial was conducted in a surgical ward of a tertiary care hospital affiliated with university of medical sciences. The eligible patients were adults aged 18 years or older who were undergoing laparotomy. The participants were randomized in a 1:1:1 ratio to one of three following groups of atorvastatin‐loaded emulgel 1% (n = 20), atorvastatin‐loaded nano‐emulgel 1% (n = 20), and placebo emulgel (n = 20) twice a day for 14 days. The primary outcome was the Redness, Edema, Ecchymosis, Discharge, and Approximation (REEDA) scores to determine the rate of wound healing. The Visual Analogue Scale (VAS) and quality of life were the secondary outcomes of this study. A total of 241 patients assessed for eligibility; of them, 60 patients completed the study and considered for final evaluation. A significant decrease in REEDA score was observed on Days 7 (63%) and 14 (93%) of treatment with atorvastatin nano‐emulgel (p‐value < 0.001). A significant decrease of 57% and 89% in REEDA score was reported at Days 7 and 14, respectively, in atorvastatin the emulgel group (p‐value < 0.001). Reduction in pain VAS in the atorvastatin nano‐emulgel was also recorded at Days 7 and 14 of the intervention. The results of the present study suggested that both topical atorvastatin‐loaded emulgel and nano‐emulgel 1% were effective in acceleration of wound healing and alleviation of pain of laparotomy surgical wounds, without causing intolerable side effects. [ABSTRACT FROM AUTHOR]

Introduction: Episiotomy is a usual midwifery surgery. Iran is a country with an abundant source of medicinal plants. This study aimed to investigate ginger extract ointment’s effects on the pain and recovery of episiotomy incisions in nulliparous women. Methods: This randomized clinical trial was conducted in a public hospital in Iran on 70 nulliparous women with an episiotomy incision. The women were randomly assigned to ginger extract ointment and placebo groups. The primary outcomes included pain and wound healing that were assessed using a visual analog scale (VAS), redness, edema, ecchymosis/bruising, discharge, and an approximation scale (REEDA). The participants were followed up before discharge from the hospital and 5×1 and 10×1 days after the intervention. The secondary outcome was the number of painkillers used during the study. Data were analyzed by chisquare, independent t test, and the Mann-Whitney U via SPSS-13. The significance levels were determined to be P≤0.05. Results: There was no significant difference between participants treated with ginger extract ointment and placebo in the pain and wound healing scores before the intervention, 5×1 and 10×1 days after the intervention. But, the pain intensity decreased, and the recovery speed increased clinically. Also, regarding the secondary outcome of this study, no significant difference between the placebo and intervention groups in the number of painkillers participants took. Conclusion: The ginger ointment could not significantly improve episiotomy wounds’ pain and healing rate, but it was clinically helpful. So more studies with different doses of this ointment are needed. [ABSTRACT FROM AUTHOR]

Background: Clear-cell carcinoma arising from the surgical cesarean section scar is very infrequent. The present study reports two patients with clear-cell carcinoma arising from an abdominal wall scar 20 and 23 years after their last cesarean section.Case Presentation: Both Iranian patients had prior cesarean sections nearly 20 years earlier. Patients 1 and 2 had transverse and vertical abdominal incisions, respectively. The initial clinical presentation was a huge lower abdominal mass at the site of the previous cesarean section scar. Both patients underwent abdominal wall mass biopsy. The histological analysis revealed the presence of malignancy. Both patients underwent full-thickness resection of the abdominal wall mass. All surgical margins were tumor-free; however, patient 1 had a very narrow tumor-free margin near the pubic symphysis. As the imaging report of patient 2 revealed the presence of a pelvic mass, the exploration of the intraperitoneal space, simple total abdominal hysterectomy (TAH), bilateral salpingo-oophorectomy (BSO), and the excision of enlarged pelvic lymph nodes were performed during the surgery. Six cycles of paclitaxel and carboplatin every 3 weeks as adjuvant chemotherapy was administered for both patients after the surgery. One of the patients had disease recurrence 5 months after the termination of chemotherapy, and the other is still disease-free. These two patients had similar pathology and received a similar initial adjuvant treatment; however, they were different in terms of the direction of tumor spread, tumor distance from the pubic symphysis, status of tumor margins, and surgical procedures.Conclusions: We encountered distinct prognoses in the clear-cell carcinoma of cesarean section scars presented herein. The researchers can recommend complete surgical excision of the abdominal wall mass with wide tumor-free margins, exploration of the abdominopelvic space, TAH, and BSO during the first surgery. [ABSTRACT FROM AUTHOR]

Objective: The type of suture material affects the quality of scars. The aim of this study was to find the superior suture material for reduction mammoplasty between Prolene and Monocryl based on the comparison of scars. Method: A prospective observational study was conducted at a university-based hospital in Mashhad, Iran between October 2015 and September 2017. Monocryl and Prolene suture materials, used for closing the outermost layer in mammoplasty, were compared. Patients' incision scars were assessed objectively according to the Patient and Observer Scar Assessment (POSAS) criteria. The relevant CONSORT guideline was used for reporting this study. Results: Seventy-eight women with a mean age of 36.8±9.5 years were entered into the study. The frequency of wound healing in both groups was 97.4% 1 month after surgery and by the third visit, 3 months after surgery, only one patient had a stretched scar. Moreover, wound inflammation in the first two visits was less frequent in the Prolene group that healed completely 3 months after surgery (after excluding the one patient with wide scar inflammation). The frequency of itching of the wound in the Monocryl group was 24.4%, 11.5% and 12.8% in the three follow-up visits, respectively, and the values for the Prolene group were 24.4%, 9.0% and 6.4%, respectively. No significant difference was seen between the two groups in terms of wound healing, inflammation and itching (p>0.05). Overall, 94.8% of patients were satisfied with the surgery. Conclusions: Our study revealed that there was no significant difference between Monocryl and Prolene. Hence, either of the two suture materials can be used for wound closure in reduction mammoplasty. Declaration of interest: Financial support of this study was provided by Mashhad University of Medical Sciences, Iran. The authors have no conflicts of interest to declare. [ABSTRACT FROM AUTHOR]

Background: The pain and discomfort caused by episiotomy affect the quality of life of the mothers, so rapid and complete repair of the episiotomy is very important. Due to the effective ingredients of Verbascum Thapsus, it has been used since ancient times to treat wounds. Therefore, this study aimed to evaluate the effect of Verbascum Thapsus on episiotomy wound healing. Methods: The study was designed as a randomized, double-blind, controlled clinical trial. Ninety-three primiparous women who were referred to Fatemeh Zahra Hospital in Saveh in 2015 were randomly divided into two groups of intervention (Verbascum Thapsus) and control (placebo). Both groups covered the episiotomy wound twice a day for 10 days with 2 cm of prescribed creams. Wound healing was assessed using the REEDA scale before the intervention and on days 1,3 and 10 after the intervention. Results: Before the intervention, there was no statistically significant difference in terms of demographic characteristics, obstetrics, and REEDA scores between the two groups (p < 0.05). The mean scores of REEDA on days 1 and 3 in the intervention group were better than the control group but were not statistically significant. However, on the tenth day after the intervention, the mean scores of REEDA were significantly better in the Verbascum group than the placebo (p = 0.01). Conclusions: According to the results of this study, it seems that Verbascum Thapsus is effective in repairing episiotomy wounds. The researchers hope that the results of this study can provide clinical evidence for the use of this herbal medicine in the wound healing process. Trial registration: This study was registered in the Iranian Registry of Clinical Trials (IRCT) with the code "IRCT201404073106N15" on 02/12/2015. [ABSTRACT FROM AUTHOR]

Background: Wound healing is a complex process and in some patients, it is a long process. Due to the presence of various underlying diseases in patients with cancer, this process is delayed, and as a result, the rate of complications increases. Therefore, some materials are needed to accelerate wound healing. Nowadays efficacy of dry human amniotic membrane in burn wounds and chronic wounds is proven; however, no studies have been performed on the effect of this tissue in the treatment of surgical wounds. Objectives: This study aimed at evaluating the efficacy of dry human amniotic membrane in the secondary repair of urological cancer surgery wounds. Methods: In this randomized clinical trial from January 2018 to June 2020, 40 patients who underwent urological cancer surgery and secondary intention wound healing were selected and randomly divided into 2 groups of 20 patients. In the case group, the dry human amniotic membrane was used for dressing wounds, and in the control group, normal dressing without an amniotic membrane was performed. Complications such as infection, sepsis, and reoperation, as well as the duration of wound healing and hospitalization of patients at intervals of 1 week, 1, and 3 months, were compared between the 2 groups. Results: The 2 groups matched in terms of gender, age, and wound location. The mean duration of hospitalization and wound healing was significantly lower in the case group (P < 0.05). The rate of complications was higher in the control group but was not significant. Conclusions: Dry human amniotic membranes due to the accelerated wound healing process and fewer complications could be a good choice for secondary healing of wounds after urological cancer surgery. [ABSTRACT FROM AUTHOR]

Background: Prostate cancer is a major malignancy worldwide among men; it is the fourth leading cancer in both genders. This study investigated the pathologic factors of radical prostatectomy (RP) specimens. Method: About 578 men underwent RP during five years in Shiraz University hospitals. We recorded the following clincopathological parameters: tumor type and stage, Gleason score (GS), grade, tertiary pattern, ISUP, surgical margin, lymph node (LN) involvement, lymphovascular invasion, seminal vesicle involvement, extraprostatic extension (EPE), vas deferens invasion, perineural and pseudocapsular invasion, bladder neck involvement, and age. Results: The mean age of participants was 63.87 ± 6.95 years. Most had pathologic T2N0Mx (73 %) diseases; the most GS was low-risk GS ≤ 6 (47.4%). Surgical margin status was free of tumors in 72.5% and among those with positive margins; the most involved site was the apex in 18.3%. Single and dual LN involvements were the most prevalent patterns. 5.9% of the patients had EPE. We found perineural and pseudocapsular invasions in 59.9% and 29.9%, respectively. There was a strong correlation between the clincopathological parameters, stage, and ISUP. Perineural invasion, pseudocapsular invasion, and tertiary pattern 5 increased with advanced age (P < 0.0001). The GS 8 to 10 increased with the increase in age (P =0.001). Conclusion: A strong correlation existed between the clincopathological parameters, stage, and ISUP. Additionally, perineural and pseudocapsular involvement and tertiary pattern 5 had a strong relationship with advanced age. [ABSTRACT FROM AUTHOR]

Background: Growing rods are increasingly used for treatment of early onset scoliosis (EOS) worldwide. Beside promising outcomes, some authors are concerned about high rates of complications. In the current clinical trial, complications of EOS surgery using dual growing rods were investigated. Methods: Between June 2006 and February 2017, twenty-two consecutive patients with a coronal curve >45 degrees underwent serial surgical correction using dual growing rods at Shafa Orthopedic hospital, Tehran, I.R. Iran. The rods were secured using hooks or screws or both. The patients were followed for 5.2 ± 1.7 years on average. Wilcoxon test was utilized to compare the pre- and post-operative values. P < 0.05 was considered significant. Results: The scoliotic and kyphotic curves decreased significantly from 52 ± 24° to 38 ± 19° and from 78 ± 22° to 60 ± 17°, respectively (P < 0.001). Total rate of implant-related complications (IRCs) and surgical site complications (SSCs) were 54.5% (12 patients) and 22.7% (5 patients), respectively. Malpositioned pedicular screw was found in 2 patients. Conclusion: EOS can be effectively corrected using dual growing rods, however, considerable rates of IRC are of concern (54.5%). It seems necessary to compare the efficacy and complication rate of newer devices with those of growing rods in future studies. [ABSTRACT FROM AUTHOR]

Background: Colorectal cancer is a highly prevalent cancer around the world and Iran. There are different criteria that can affect the survival rate of this disease. Surgical margin status is one of these criteria; there are still challenges about how it can change the surveillance of the disease. Objectives: In this study, we assessed the relativity between surgical margin status and the stage of disease in Iranian patients suffering from colorectal cancer. Methods: This is an observational cross-sectional study. A total of 797 patients with colorectal cancer were included and a checklist of demographic, clinical, and pathological data was filled for each one. Based on the pathology result of the biopsy, the patients were divided into different histological groups. Surgical margin status was defined individually. To declare the relativity between surgical margin status and independent variables, we used Spearman's rho test. Results: The stage of the disease and its histological type and grade were significantly correlated. There was also a significant correlation between histological grade and type of the disease. Conclusions: Surgical margin status and stage of the disease are challenging prognostic factors in disease recurrence and survival. The patients who participated in this study had meanly higher age and stage of diagnosis than earlier studies either global or local. It can be due to a lack of a systematic program for early detection of CR cancer in Iran that emphasizes the necessity of GI screening systems. [ABSTRACT FROM AUTHOR]

Introduction: Carcinomas are the most common head and neck cancers. Adequate resection of the margins is critical for the management and predicting the prognosis of patients with head and carcinomas. The aim of this study was to determine clinicopathological factors influencing final tumor margins in resected carcinomas. Materials & Methods: In this cross-sectional study, the records of all the patients with oral and maxillofacial carcinomas of soft tissue in 2006-2016, who had undergone surgical resection, were analyzed. Data on clinicopathological factors, including sex, age, type of tumor, tumor size and location, lymph node metastasis, the number of margins involved, tumor histological grade, tumor clinical stage, and the results of frozen section were collected and analyzed with descriptive statistics and chi-squared test. Results: A total of 53.5% of the subjects had positive pathological margins (p value = 0.5), 12.7% had close margins and 0.8% had tumor-free margins. Positive margins exhibited a significant relationship with tumor size (p value = 0.01) and location (p value = 0.03). There were no significant relationships between sex, age, type of tumor, lymph node metastasis, histopathological tumor grade, clinical stage and frozen section with final margin (p value > 0.05). Conclusion: In the present study, 66.2% of oral carcinomas showed final positive margins and the status of the final margin was associated with the tumor size and location. [ABSTRACT FROM AUTHOR]

Introduction: Trauma is considered as one of the major causes of mortality in the World and in Iran. Which, many people die each year. The aim of study we evaluated penetrating traumas as Specific reason of deaths among affected patients. Materials and Methods: In this crosssectional retrospective study, 73patients with penetrating traumas visiting Shahid Rajaee hospital of Tonekabon in 2015-16were evaluated, then, the files were extracted from hospital archive files and information of patients such as age, sex, The type of agent and the cause of the injury, the reasons for the surgery and the type of surgery were recorded from the archived files, then, The data were statistically analyzed by the SPSS software. Results: Based on the findings, over the 60 (80 %) of patients were males, that was a significant relationship between sex and penetrating trauma. Also, the most common were penetrating trauma in the age group of 21-35 years old. There was a significant relationship between age and penetrating traumas (p<0.05), itshould be noted that, other variables in this studies were not related significantly withthepenetrating trauma in patients. (p>0.05). Conclusion: The more common causes of penetrating traumas among young are Damage from driving accidents which require better Facilities to manage them. Also, the role of emergency rooms and the provision of equipment to reduce mortality from penetrating trauma can be mentioned. [ABSTRACT FROM AUTHOR]

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

Objective: Although there are various therapeutic modalities to manage patients suffering from sacrococcygeal pilonidal sinus disease, there remains controversy over a standard method to treat such patients. In this study the postoperative outcomes after three different surgical methods of wound repair in patients with sacrococcygeal pilonidal sinus were compared. Method: Patients were divided randomly into three different groups. All of the patients underwent a wide excision of their pilonidal sinus; the subsequent surgical wound was left open in the first group (lay open group) whereas it was repaired with a simple primary closure and a rhomboid flap in the second and third groups. Variables including length of hospitalisation, time for wound healing, time off work, recurrence and surgical complications were evaluated. Results: A total of 60 patients with an average age of 27.61 years were studied, including 47 (78.3%) men and 13 (21.7%) women. Postoperative hospitalisation time was significantly shorter in patients who were treated using the simple primary closure method than those with the rhomboid flaps. However, there were no differences in terms of postoperative hospitalisation time between the lay open and simple primary groups or the lay open and rhomboid groups. The period of absence from work was significantly shorter in patients who were managed by a simple primary closure or rhomboid flap technique comparing to those whose wound was left open (p<0.05). Complete wound healing had a significantly shorter course in the rhomboid flap and the simple primary closure techniques compared to those within the lay open group. In terms of complications, postoperative infection and haemorrhage were more common in the lay open group than in the other two. Recurrence was about 5% in patients who were treated with the lay open method in an 18-month follow-up period; however, no recurrence was observed in the other two groups. Conclusion: Considering the earlier wound healing period, less days absent from work, lower complication levels and recurrence rates, the simple primary closure or rhomboid flap techniques appear to be better options to treat the subsequent wound after a wide excision of pilonidal sinus when compared to the lay open method. The simple primary closure method causes no cosmetic disfiguration and the most promising option among the three techniques assessed. Declaration of interest: The authors have declared that no conflict of interest exists. [ABSTRACT FROM AUTHOR]

Background: Oropharyngeal malignancies represent management challenges for the head and neck surgeons. Tumor resection and reconstruction with graft is the standard treatment. Split-thickness skin grafts are routinely used to cover the mucosal defects arising from resections. As amniotic membrane (AM) is used as a dressing substitute in bum, we decided to evaluate the efficacy of AM as a biologic wound dressing material for surgical defects of mucosa in the oropharyngeal region. Methods: This was a single-institution prospective study which included 50 patients with primary oropharyngeal malignancy who underwent tumor resection between March 2010 and November 2011, and were up for two to 20 months after the surgical procedure. We used amniotic membrane (AM) for dressing of the defects in the oral cavity and pharynx under general anesthesia. Efficacy of this procedure was assessed by rating of the pain and granulation tissue formation with surface epithelialization at the site of graft. Results: The results were evaluated in the postoperative period. Forty males (80 %) and 10 females (20 %) were participated, age from 20 to 80 years with a mean age of 50 ± 10.41 years. The patients underwent partial glossectomy, or floor of mouth resection according to tumor location. Complete adherence of AM to the wound was detected in all cases. Allergy either systemic or local was not reported in any of the cases. The membrane was very effective in 40 patients, and effective in 10 cases. Conclusion: Amniotic membrane (AM) can be used as a biologic dressing material for covering the mucosal defects in the oropharynx. [ABSTRACT FROM AUTHOR]

Electrical stimulation (ES) profoundly affects angiogenesis by modulating the production of angiogenic factors. We evaluated the effect of sensory (direct current, 600 microamperes) and motor (monophasic pulse current, 2.5 to 3 milliamperes, 300-microsecond pulse duration, 100 Hz) intensities of cathodal current on the release of fibroblastic growth factor-2 (FGF-2) at the wound site and also the biomechanical and histological properties of healed skin. Ninety-six male, Sprague-Dawley rats were randomly assigned into one control and two experimental groups. A full-thickness skin incision was made on the dorsal region of each animal. The experimental groups received 10 sessions of ES (sensory or motor) for 1 hour per day every other day. The results showed that FGF-2 levels in the sensory group were significantly greater than in the other groups on the third day. In the motor group, FGF-2 levels were significantly decreased compared with the control group. There were no significant differences between the normalized ultimate strength and stiffness in the groups, but they tended to be higher in the motor ES group. We conclude that the application of sensory ES during the early stage of wound healing may have a beneficial effect on wound healing by inducing the release of angiogenic factors and decreasing the duration of the inflammation phase. [ABSTRACT FROM AUTHOR]

Aim: The aim of the present study was to evaluate pelvic adhesions, dehiscence and chronic pelvic pain in two groups of patients who underwent different cesarean section (CS) operations. Material and Methods: One hundred and twelve eligible patients who met our criteria were randomly divided into two groups. Group 1 consisted of 52 women who had been operated at their first CS by Misgav Ladach technique and had now undergone a second CS. Group 2 consisted of 60 women who had been operated at their first CS by traditional (Pfannenstiel) technique and had now undergone a second CS. The two groups were compared for long-term outcomes, including adhesion, pelvic pain and wound dehiscence. Results: The rate of adhesion in group 2 was 50% filmy type and 1.7% dense type. However, in group 1 the adhesion rate was 50% filmy and there was no dense type ( P = 0.12). The location of adhesions were significantly different ( P = 0.04). Dehiscence of uterine incision in the second group was seen in three patients but no dehiscence was found in the first group ( P = 0.012). The rate of chronic pelvic pain in Misgav Ladach group (group 1) was 17.2% versus 35% in the traditional method ( P = 0.01). Conclusion: The present results support the method of single layer suturing of the uterus and leaving the peritoneum intact in CS. [ABSTRACT FROM AUTHOR]

Background: Guided tissue regeneration (GTR) allows mesenchymal cells to repopulate the defects. However, there is limited information regarding the efficacy of different membranes. The present study was designed to histologically and histomorphometrically compare three collagen membranes in regenerative treatment of dehiscence defects in dogs. Materials and Methods: This 8 weeks experimental animal study comprised 4 healthy dogs. 5 x 5 mm periodontal dehiscences were created in each side of the mandible (4 dehiscences in each side of dogs' mandible). In each side, one dehiscence defect was left uncovered as a control site and three other sites were randomly covered with different collagen membranes (Biogide (BG), Biomend (BM), and Cytoplast (CYT)). Histomorphometric and histologic analysis were conducted at 4 and 8 weeks. Data were analyzed using ANOVA, Mann-Withney, Kruskal-Wallis and Fisher's exact tests (α = 0.05). Results: According to histomorphometric analysis there was a significant difference between treatment and control groups regarding the bone formation and the distance between the reference point and apical end of junctional epithelium (DJE) (P < 0.05). At 4 weeks, the maximum amount of bone thickness and height was observed in BG and CYT respectively, and this maximum rate was seen with the use of BG at 8 weeks. It was shown that DJE reached its highest rate in BM and CYT at 4 and 8 weeks, respectively. Organized PDL was formed in treatment groups. Conclusion: The membrane-treated groups had a statistically significant increase in bone formation and connective tissue attachment compared to control groups. However, there are some differences among experimental groups, which should be considered in GTR treatments. [ABSTRACT FROM AUTHOR]

Vascular endothelial growth factor (VEGF) is important in improving wound healing. We evaluated the effect of sensory (direct current, 600 microamperes) and motor (monophasic current, pulse duration 300 microseconds, 100 Hz, 2.5-3.0 mA) intensities of cathodal electrical stimulation (ES) current to release VEGF in muscle and skin in the wound site. We randomly assigned 48 male Sprague-Dawley rats into one control and two experimental groups (sensory and motor ESs). A full-thickness skin incision was made on each animal's dorsal region. The experimental groups received ES for 1 h/day every other day. In the control group, no current was applied. VEGF expression was measured in muscle and skin on the third and seventh days after surgical incision. Our outcomes demonstrated that no difference was found in the VEGF levels among groups on the third day. However, on the seventh day, the skin VEGF levels in the sensory group were significantly higher than those levels of the other groups (p < 0.05). No difference was found in the muscle VEGF levels on the third and seventh days. The results showed that sensory ES increases the release of more VEGF in skin. This mechanism may be one through which a sensory type of current is more effective in promoting wound healing. [ABSTRACT FROM AUTHOR]