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Background: Diabetes-related foot disease (DFD) is a leading cause of the Australian disease burden. The 2011 Australian DFD guidelines were outdated. We aimed to develop methodology for systematically adapting suitable international guidelines to the Australian context to become the new Australian evidence-based guidelines for DFD. Methods: We followed the Australian National Health Medical Research Council (NHMRC) guidelines for adapting guidelines. We systematically searched for all international DFD guideline records. All identified records were independently screened and assessed for eligibility. Those deemed eligible were further assessed and included if scoring at least moderate quality, suitability and currency using AGREE II and NHMRC instruments. The included international guidelines had all recommendations extracted into six sub-fields: prevention, wound classification, peripheral artery disease, infection, offloading and wound healing. Six national panels, each comprising 6–8 multidisciplinary national experts, screened all recommendations within their sub-field for acceptability and applicability in Australia using an ADAPTE form. Where panels were unsure of any acceptability and applicability items, full assessments were undertaken using a GRADE Evidence to Decision tool. Recommendations were adopted, adapted, or excluded, based on the agreement between the panel's and international guideline's judgements. Each panel drafted a guideline that included all their recommendations, rationale, justifications, and implementation considerations. All underwent public consultation, final revision, and approval by national peak bodies. Results: We screened 182 identified records, assessed 24 full text records, and after further quality, suitability, and currency assessment, one record was deemed a suitable international guideline, the International Working Group Diabetic Foot Guidelines (IWGDF guidelines). The six panels collectively assessed 100 IWGDF recommendations, with 71 being adopted, 27 adapted, and two excluded for the Australian context. We received 47 public consultation responses with > 80% (strongly) agreeing that the guidelines should be approved, and ten national peak bodies endorsed the final six guidelines. The six guidelines and this protocol can be found at: https://www.diabetesfeetaustralia.org/new-guidelines/ Conclusion: New Australian evidence-based guidelines for DFD have been developed for the first time in a decade by adapting suitable international guidelines. The methodology developed for adaptation may be useful for other foot-related conditions. These new guidelines will now serve as the national multidisciplinary best practice standards of DFD care in Australia. [ABSTRACT FROM AUTHOR]

Delayed healing of traumatic wounds often stems from a dysregulated immune response initiated or exacerbated by existing comorbidities, multiple tissue injury or wound contamination. Over decades, approaches towards alleviating wound inflammation have been centered on interventions capable of a collective dampening of various inflammatory factors and/or cells. However, a progressive understanding of immune physiology has rendered deeper knowledge on the dynamic interplay of secreted factors and effector cells following an acute injury. There is a wide body of literature, both in vitro and in vivo, abstracted on the immunomodulatory approaches to control inflammation. Recently, targeted modulation of the immune response via biotechnological approaches and biomaterials has gained attention as a means to restore the pro-healing phenotype and promote tissue regeneration. In order to fully realize the potential of these approaches in traumatic wounds, a critical and nuanced understanding of the relationships between immune dysregulation and healing outcomes is needed. This review provides an insight on paradigm shift towards interventional approaches to control exacerbated immune response following a traumatic injury from an agonistic to a targeted path. We address such a need by (1) providing a targeted discussion of the wound healing processes to assist in the identification of novel therapeutic targets and (2) highlighting emerging technologies and interventions that utilize an immunoengineering-based approach. In addition, we have underscored the importance of immune engineering as an emerging tool to provide precision medicine as an option to modulate acute immune response following a traumatic injury. Finally, an overview is provided on how an intervention can follow through a successful clinical application and regulatory pathway following laboratory and animal model evaluation. [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]

Accidental foot injuries including metatarsal fractures commonly result from compressive loading. The ability of personal protective equipment to prevent these traumatic injuries depends on the understanding of metatarsal fracture tolerance. However, the in situ fracture tolerance of the metatarsals under direct compressive loading to the foot's dorsal surface remains unexplored, even though the metatarsals are the most commonly fractured bones in the foot. The goal of this study was to quantify the in situ fracture tolerance of the metatarsals under simulated quasi-static compressive loading. Fresh-frozen cadaveric feet (n = 10) were mounted into a testing apparatus to replicate a natural stance and loaded at the midmetatarsals with a cylindrical bar to simulate a crushing-type injury. A 900 N compressive force was initially applied, followed by 225 N successive load increments. Specimens were examined using X-ray imaging between load increments to assess for the presence of metatarsal fractures. Descriptive statistics were conducted for metatarsal fracture force and deformation. Pearson correlation tests were used to quantify the correlation between fracture force with age and body mass index (BMI). The force and deformation at fracture were 1861 ± 642 N (mean ± standard deviation) and 22.6 ± 3.4 mm, respectively. Fracture force was correlated with donor BMI (r = 0.90). Every fractured specimen experienced a transverse fracture in the second metatarsal. New biomechanical data from this study further quantify the metatarsal fracture risk under compressive loading and will help to improve the development and testing of improved personal protective equipment for the foot to avoid catastrophic injury. [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]

The Wound Healing Foundation (WHF) recognised a need for an unbiased consensus on the best treatment of chronic wounds. A panel of 13 experts were invited to a virtual meeting which took place on 27 March 2021. The proceedings were organised in the sub‐sections diagnosis, debridement, infection control, dressings, grafting, pain management, oxygen treatment, outcomes and future needs. Eighty percent or better concurrence among the panellists was considered a consensus. A large number of critical questions were discussed and agreed upon. Important takeaways included that wound care needs to be simplified to a point that it can be delivered by the patient or the patient's family. Another one was that telemonitoring, which has proved very useful during the COVID‐19 pandemic, can help reduce the frequency of interventions by a visiting nurse or a wound care center. Defining patient expectations is critical to designing a successful treatment. Patient outcomes might include wound specific outcomes such as time to heal, wound size reduction, as well as improvement in quality of life. For those patients with expectations of healing, an aggressive approach to achieve that goal is recommended. When healing is not an expectation, such as in patients receiving palliative wound care, outcomes might include pain reduction, exudate management, odour management and/or other quality of life benefits to wound care. [ABSTRACT FROM AUTHOR]

Triathlon´s popularity is rapidly increasing, and epidemiological data relating to its related medical conditions is crucial to the development of proper medical plans and safety guidelines for it. This study examined the data from the medical reports collected during three consecutive editions of Ironman Italy, from 2017 to 2019. Out of 10,653 race-starters, 3.3% required medical attention sustaining 472 medical conditions. A significantly higher injury risk was found for females versus males (χ2 = 9.78, p = 0.02) and in long-distance (IR: 4.09/1,000hours) rather than in Olympic/middle distance races (IR: 1.75/1,000hours). Most (68.4%) conditions (including muscular exhaustion, hypothermia, and dehydration) were systemic, whilst only 10.2% were acute traumatic injuries. Of a total of 357 triathletes requiring medical assistance, 8.1% were a candidate for hospitalisation. The equipment and personnel that are required for the medical assistance in future triathlon events were estimated based on Maurer's algorithm, and ten practical recommendations for triathlon medical support were formulated. [ABSTRACT FROM AUTHOR]

Surgical site infection (SSI) increases length of treatment, delays wound healing, increases antibiotic use and causes patient death in severe cases. This case was a boy aged 38 weeks and 4 days with a birthweight of 2100 g, a height of 42 cm and a head circumference of 32 cm. Twelve days after birth, he was admitted to hospital where a surgeon removed a sacrococcygeal teratoma. The surgical site became infected, and the infection failed to improve despite him receiving routine normal saline dressings twice a day and intravenous antibiotic therapy. The authors started treatment using an antibacterial wound dressing containing honey (Medihoney) on the SSI twice a day for a month. The infant's SSI was wholly healed after 3 months, and he was discharged from the wound treatment team in good general condition. This case shows that SSIs can be treated with honey-containing antibacterial wound gel, especially in infants who have weaker immune systems. [ABSTRACT FROM AUTHOR]

Background: Clinical outcomes after negative-pressure wound therapy (NPWT) and standard treatment of conflict-related extremity wounds are similar. In resource-limited settings, cost affects the choice of treatment. We aimed to estimate treatment-related costs of NPWT in comparison with standard treatment for conflict-related extremity wounds. Methods: We derived outcome data from a randomized, controlled superiority trial that enrolled adult (≥ 18 years) patients with acute (≤ 72 h) conflict-related extremity wounds at two civilian hospitals in Jordan and Iraq. Primary endpoint was mean treatment-related healthcare costs (adjusted to 2019 US dollars). Results: Patients were enrolled from June 9, 2015, to October 24, 2018. A total of 165 patients (155 men [93.9%]; 10 women [6.1%]; and median [IQR] age, 28 [21–34] years) were included in the analysis. The cost per patient treated with NPWT was $142 above that of standard treatment. Overall, results were robust in a sensitivity analysis. Conclusions: With similar clinical outcomes compared to standard care, our results do not support the use of NPWT in routine treatment of conflict-related extremity wounds at civilian hospitals in resource scarce settings. Trial registration NCT02444598. [ABSTRACT FROM AUTHOR]

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

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]

BACKGROUND: Tissue-engineered skin has a good application prospect in promoting skin tissue wound repair and scarless healing. OBJECTIVE: To review the current research progress, application and value of tissue-engineered skin in vivo and in vitro. METHODS: A computer was used to search the relevant articles in the CNKI database and PubMed database. The Chinese and English search terms were “mesenchymal stem cells; growth factors; skin; wounds; skin repair; wound healing; regenerative medicine; tissue engineering; scaffolds”. The domestic and foreign related application articles on tissue-engineered skin construction in the treatment of skin tissue injury in recent years were checked, and the research progress of mesenchymal stem cells, growth factors, scaffold materials and dressings for new treatment methods for tissue repair was also summarized. The articles irrelevant to the subject of this article were excluded, and 78 articles were finally included for the result analysis. RESULTS AND CONCLUSION: The construction of tissue-engineered skin involves the selection of seed cells, the application of growth factors, and the combination of multiple elements of scaffold materials. Mesenchymal stem cells are one of the important sources of tissue-engineered skin seed cells. Growth factors optimize the tissue culture environment, and scaffold materials provide appropriate mechanical support. Therefore, how to select appropriate seed cells, growth factors and scaffold materials to construct tissue-engineered skin to treat wounds and speed up repair is the focus and research direction that should be explored in the future. In addition, the development of wound materials is also a new field. [ABSTRACT FROM AUTHOR]

Objectives: To report the experience of civilian penetrating neck trauma (PNT) at a UK level I trauma centre, propose an initial management algorithm and assess the degree of correlation between clinical signs of injury, operative findings and radiological reports. Design: Retrospective case note review. Setting: UK level I trauma centre April 2012–November 2017. Participants: Three hundred ten cases of PNT were drawn from electronic patient records. Data were extracted on hard and soft signs of vascular or aerodigestive tract injury, clinical management, radiological imaging and patient outcomes. Main outcome measures: Patient demographics, mechanism of injury, morbidity and mortality. The correlation between clinical signs, and radiological reports to internal injury on surgical exploration. Results: Two hundred seventy‐one (87.4%) male and 39 (13.6%) female patients with a mean age of 36 years (16–87) were identified. The most common causes of injury were assault 171 (55.2%) and deliberate self‐harm 118 (38%). A knife was the most common instrument 240 (77.4%). Past psychiatric history was noted in 119 (38.4%), and 60 (19.4%) were intoxicated. 50% were definitively managed in theatre with a negative exploration rate of 38%, and 50% were managed in ED. Pre‐operative radiological reports correlated with operative reports in 62% of cases with venous injury the most common positive and negative finding. Multivariate correlation was r = 0.89, p = 0.045, between hard signs plus positive radiology findings and internal injury on neck exploration. Conclusions: Management of PNT by clinical and radiological signs is safe and effective, and can be streamlined by a decision‐making algorithm as proposed here. [ABSTRACT FROM AUTHOR]

Background: In recent years, resistance to antibiotics has become a global threat, and alternatives to antibiotics have become an area of research. The main alternative methods are briefly described in this review. However, the main focus is bacteriophage-related therapy. Bacteriophages are viruses which, due to the production of the enzyme endolysin, are able to kill bacterial host cells. Bacteriophage therapies have a long tradition. Their potential to function as antibiotics lies in their bactericidal activity and specificity in killing bacteria without infecting or affecting eukaryotic cells. Objective: To systematically review the outcomes of bacteriophage therapy in patients with bacterial infections. Methods: The MEDLINE, EMBASE, Web of Science and CENTRAL databases were searched electronically using search terms referring to bacteriophages, endolysins and antimicrobial resistance. After the literature was screened for their titles and abstracts, full-text reviews considering inclusion/exclusion criteria were performed. Data concerning patients with bacterial infections, treatment with either bacteriophages or its enzyme endolysin and their outcomes were extracted and analysed. Results: Thirteen publications were identified that met all inclusion criteria. Data extraction shows that bacteriophages or endolysins have the potential to combat bacterial infections and significantly reduce inflammatory mediators. However, 3 out of 4 randomized controlled trials revealed that there was no significant difference between phage/endolysin treated patients and control group. Significant clinical improvements were seen in cohort and case studies. A few minor side effects were reported. Conclusions: Although there are countries in which bacteriophages are prescribed as an alternative to established antibiotics, this valuable experience has yet to be examined sufficiently in clinical trials conducted to modern standards. Despite improvements in symptoms shown in the reviewed clinical trials, the infection and the bacteria themselves were rarely completely eradicated. Therefore, no definite answer can be given as to effectiveness, and further clinical trials are necessary. [ABSTRACT FROM AUTHOR]

Objective: Cardiac pacemakers must be regularly replaced due to depleted batteries. A possible alternative is proposed by subcutaneous photovoltaic energy harvesting. The body's reaction to an implant can cause device encapsulation. Potential changes in spectral light transmission of skin can influence the performance of subcutaneous photovoltaic cells and has not yet been studied in large animal studies. Methods: Subcutaneous implants measuring changes in the light reaching the implant were developed. Three pigs received those implants and were analyzed for seven weeks. Spectral measurements with known irradiation were performed to identify possible changes in the transparency of the tissues above the implant during the wound healing process. A histological analysis at the end of the trial investigated the skin tissue above the subcutaneous photovoltaic implants. Results: The implants measured decreasing light intensity and shifts in the light's spectrum during the initial wound healing phase. In a later stage of tissue recovery, the implants measured a generally reduced light intensity compared to the healthy tissue after implantation. The spectral distribution of the measured light at the end of the trial was similar to the first measurements. The histological analysis showed subcutaneous granulation tissue formation for all devices. Conclusion: The varying reduction of light intensity reaching the implants means that safety margins must be sufficiently high to ensure the power. At the end of the wound healing process, the spectral distribution of the light reaching the implant is similar to healthy tissue. Significance: Optimizations of spectral sensitivity of photovoltaic cells are possible. [ABSTRACT FROM AUTHOR]

Background: Healing involves complex processes that are not yet fully known. The wound healing process consists of three stages. In all these stages, normal wound healing requires platelet activation, release of cytokines and growth hormones, and chemotaxis and cell differentiation. Platelets play a key role in homeostasis and wound healing and growth factor production of more than 30 carried out by them. Platelets regulate the healing process with their chemotactic effect. Antilogous PRP platelet count in about 3 to 5 times increase and consequently also increases the number of growth factors, for this reason, they are being used in surgical procedures and clinical therapy. Methods: At Ilam Medical Center in Imam Khomeini Hospital, 20 patients with two similar donor graft sites were gradually selected to participate in a clinical trial from January to March 2017. The two regions have the same skin graft patients, an area of Honor conventional and other areas with the topical administration of platelet-rich plasma That immediately after surgery and in the days after the fifth and eleventh, eightieth and after washing the wound with a topical serum Physiology rubbed on the wound and thus treated The rate of wound healing clinically and using X-ray photochecked and compared. Results: Seven are male and thirteen are female and the age range of patients is between 17 and 67 years. After collecting wound healing times in two groups, we used the means comparison method to evaluate the effect of PRP on wound healing rate and analyzed the results (T-Test). Because the data followed a normal distribution, we used the Independent T-test method, which resulted in 0.416, which was higher than the alpha level equal to 0.05. Conclusion: In this study, we found that PRP had a positive effect on wound healing time and increased the speed of wound healing. It is suggested that the effect of the PRP method on various organs that have not been tested before, be discussed in future studies. [ABSTRACT FROM AUTHOR]

Objective: Verify the occurrence of depressive symptoms in the elderly with chronic wounds. Methodology: A descriptive, cross-sectional, quantitative study conducted with 40 elderly people at a University Hospital, using the Geriatric Depression Scale and a structured questionnaire with sociodemographic, clinical variables, lesion characteristics and a brief history of mental health. Results: There was a predominance of females (72.5%), brown (50.0%), Catholic (65.0%), married (50.0%), with incomplete primary education (55.0%), retired (92.5%), income between 1 and 2 minimum wages (62.5%), metabolic diseases (55.0%) and cardiac diseases (25.0%). The wounds were 55.0% venous ulcers, of which 85.0% are in the lower limb. Regarding the Scala scores, 40.0% presented symptoms suggestive of Depression. The elderly with venous wounds and located in the lower limb presented higher score of the depression median. Conclusion: Venous ulcers of the leg was a risk factor for the occurrence of Depression, which occurred in half of the elderly surveyed. [ABSTRACT FROM AUTHOR]

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

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

Chronic wounds are a common and debilitating condition associated with aging populations that impact more than 6.5 million patients in the United States. We have previously demonstrated the efficacy of daily topical 1% valsartan in treating wounds in diabetic mouse and pig models. Despite these promising results, there remains a need to develop an extended‐release formulation that would reduce patient burden by decreasing the frequency of daily applications. Here, we used nanotechnology to self‐assemble valsartan amphiphiles into a filamentous structure (val‐filaments) that would serve as a scaffold in wound beds and allow for steady, localised and tunable release of valsartan amphiphiles over 24 days. Two topical treatments of this peptide‐based hydrogel on full‐thickness wounds in Zucker Diabetic Fatty rats resulted in faster rates of wound closure. By day 23, all val‐filament treated wounds were completely closed, as compared to one wound closed in the placebo group. Mechanistically, we observed enrichment of proteins involved in cell adhesion and energetics pathways, downregulation of Tgf‐β signalling pathway mediators (pSmad2, pSmad3 and Smad4) and increased mitochondrial metabolic pathway intermediates. This study demonstrates the successful synthesis of a sustained‐release valsartan filament hydrogel, its impact on mitochondrial energetics and efficacy in treating diabetic wounds. [ABSTRACT FROM AUTHOR]

Brachial plexus (BP) birth injury has a reported incidence of 1 to 4 per 1000 live births. During complicated deliveries, neonatal, maternal, and other birth-related factors can cause over-stretching or avulsion of the neonatal brachial plexus leading to injury. Understanding biomechanical responses of the neonate brachial plexus when subjected to stretch can offer insight into the injury outcomes while guiding the development of preventative maneuvers that can help reduce the occurrence of neonatal brachial plexus injuries. This review article aims to offer a comprehensive overview of existing literature reporting biomechanical responses of the brachial plexus, in both adults and neonates, when subjected to stretch. Despite the discrepancies in the reported biomechanical properties of the brachial plexus, available studies confirm the loading rate and loading direction dependency of the brachial plexus tissue. Future studies, possibly in vivo, that utilize clinically relevant neonatal large animal models can provide translational failure values of the biomechanical parameters for the neonatal brachial plexus when subjected to stretch. [ABSTRACT FROM AUTHOR]

Pathogenic invasion of Staphylococcus aureus is a major concern in patients with chronic skin diseases like atopic dermatitis (AD), epidermolysis bullosa (EB), or chronic diabetic foot and venous leg ulcers, and can result in persistent and life‐threatening chronic non‐healing wounds. Staphylococcus aureus is generally recognized as extracellular pathogens. However, S. aureus can also invade, hide and persist in skin cells to contribute to wound chronicity. The intracellular life cycle of S. aureus is currently incompletely understood, although published studies indicate that its intracellular escape strategies play an important role in persistent cutaneous infections. This review provides current scientific knowledge about the intracellular life cycle of S. aureus in skin cells, which can be classified into professional and non‐professional antigen‐presenting cells, and its strategies to escape adaptive defense mechanisms. First, we discuss phenotypic switch of S. aureus, which affects intracellular routing and degradation. This review also evaluates potential intracellular escape mechanism of S. aureus to avoid intracellular degradation and antigen presentation, preventing an immune response. Furthermore, we discuss potential drug targets that can interfere with the intracellular life cycle of S. aureus. Taken together, this review aimed to increase scientific understanding about the intracellular life cycle of S. aureus into skin cells and its strategies to evade the host immune response, information that is crucial to reduce pathogenic invasion and life‐threatening persistence of S. aureus in chronic cutaneous infections. [ABSTRACT FROM AUTHOR]

Background: Epidermolysis bullosa (EB) patient anecdotes and case reports indicate that cannabinoid-based medicines (CBMs) may alleviate pain and pruritus and improve wound healing. CBM use has not been characterized in the EB patient population.Objectives: To evaluate CBM use among EB patients, including CBM types, effects on symptoms (e.g., pain and pruritus), disease process (e.g., blistering, wounds, and inflammation), well-being (e.g., sleep, appetite) and concomitant medications.Methods: English-speaking EB patients or caregivers completed an online international, anonymous, cross-sectional survey regarding CBM use. Respondents reported the types of CBMs, subsequent effects including perceived EB symptom alteration, changes in medication use, and side effects.Results: Seventy-one EB patients from five continents reported using or having used CBMs to treat their EB. Missing question responses ranged between 0 (0%) and 33 (46%). Most used more than one CBM preparation (mean: 2.4 ± 1.5) and route of administration (mean: 2.1 ± 1.1). Topical and ingested were the most common routes. Pain and pruritus were reported retrospectively to decrease by 3 points (scale: 0-10; p < 0.001 for both) after CBM use. Most reported that CBM use improved their overall EB symptoms (95%), pain (94%), pruritus (91%) and wound healing (81%). Most participants (79%) reported decreased use of pain medications. The most common side-effect was dry mouth (44%).Conclusions: CBMs improve the perception of pain, pruritus, wound healing, and well-being in EB patients and reduced concomitant medication use. Nevertheless, a direct relation between the use of CBMs and reduction of the above-mentioned symptoms cannot be proven by these data. Therefore, future controlled studies using pharmaceutically standardised CBM preparations in EB are warranted to delineate the risks and benefits of CBMs. [ABSTRACT FROM AUTHOR]

Intestinal mucosal healing is the primary therapeutic goal of medical treatments for inflammatory bowel disease (IBD). Epithelial stem cells are key players in the healing process. Lgr5+ stem cells maintain cellular turnover during homeostasis in the colonic crypt. However, they are lost and dispensable for repair in a wide variety of injury models, including dextran sulfate sodium (DSS) colitis, radiation, helminth infection, and T-cell activation. The direct loss of Lgr5+ cells activates a plasticity response in the epithelium in which other cell types can serve as stem cells. Whether this paradigm applies to mouse models of IBD remains unknown. In contrast to previously tested models, IBD models involve an inflammatory response rooted in the loss of immunologic tolerance to intestinal luminal contents including the microbiome. Here, we show the persistence of Lgr5+ cells in oxazolone, 2,4,6-trinitrobenzene sulfonic acid (TNBS), and Il10-/-, and Il10-/- Tnfr1-/- IBD models. This contrasts with results obtained from DSS-induced injury. Through high-throughput expression profiling, we find that these colitis models were associated with distinct patterns of cytokine expression. Direct exposure of colonic epithelial organoids to DSS, oxazolone, or TNBS resulted in increased apoptosis and loss of Lgr5+ cells. Targeted ablation of Lgr5+ cells resulted in severe exacerbation of chronic, antibody-induced IL-10-deficient colitis, but had only modest effects in TNBS-induced colitis. These results show that distinct mouse models of IBD-like colitis induce different patterns of Lgr5+ stem cell retention and function. [ABSTRACT FROM AUTHOR]

Wound bed preparation is the management of a wound in order to optimise healing and/or facilitate other therapeutic measures. It is the most pivotal step in healing wounds. Early referral to a specialist wound clinic can markedly improve the wound healing process. This overview will discuss the techniques involved in the preparation of the wound bed that will effectively accelerate the healing process. The process begins with a correct diagnosis of the wound and optimising the patient's medical condition. The TIMERS framework is discussed. Wound dressings, including the use of negative-pressure wound therapy, are discussed, along with debridement techniques and agents. The timing of wound intervention and evaluating progress will also be discussed, and wound bed preparation strategies will be included. There has been an added challenge of wound care in the community as a result of the COVID-19 pandemic. The present article provides an overview of how to prepare a wound bed in the community. [ABSTRACT FROM AUTHOR]

Analysis of the literature confirms the effectiveness of specialized silver dressings that maintain a moist environment in wound healing. These dressings prevent the development of infections, support the process of granulation and epithelialization, and the lack of resistance to silver is a promising prospect for antibacterial wound healing. Efficacy, good tolerance, and safety related to the use of agents from this group make them good candidates for in vitro research and clinical trials. Due to the content of ionic silver and the Safetac® soft silicone technology used in contact with the wound, the Mepilex® Ag foam dressing has an antibacterial effect, reduces pain during dressing changes, and accelerates wound healing. The aim of the study was to analyze the research done on the use of the Mepilex® Ag dressing in the treatment of wounds. [ABSTRACT FROM AUTHOR]

Globally, multidrug-resistant bacteria affects wound infections, both hospital-acquired infections and community-acquired infections. The main isolates cultured from 607 subjects with wound infections were methicillin-resistant Staphylococcus aureus (MRSA), Escherichia coli, Pseudomonas aeruginosa, and Acinetobacter spp. [multidrug resistant (MDR)]. Gram-negative bacteria caused most of the infections (67%) compared with gram-positive bacteria. Diabetic patients tend to have wound infections with mixed causative agents compared with non-diabetic patients. [ABSTRACT FROM AUTHOR]

Objective To analyze the debridement and promotion of collagenase on wounds in patients after thoracotomy through median sternotomy approach. Methods From January 2017 to August 2020, 30 patients with nonunion of incision after thoracotomy admitted in Friendship Cosmetic Plastic Surgery Hospital. All patients were divided into routine treatment group and collagenase treatment group, 15 patients in each group. The age, gender and area of wounds after debridement were recorded. The rate of debridement, wound healing time, length of stay, pain degree and satisfaction of both groups were statistically analyzed. Results The rate of debridement of collagenase treatment group was 21.56±0.70, 30.05±0.78 and 62.30±1.94 at 3, 7 and 14 days, which were significantly better than 16.58 ±0.44, 22.71 ±0.42 and 52.35 ±1.74 of routine treatment group. The differences were statistically significant between both groups (P<0.05). The wound healing time of routine treatment group was significantly longer than that of collagenase treatment group (P<0.05). The average length of stay of routine treatment group was significantly longer than that of collagenase treatment group (P<0.05). At 3, 7 and 14 days, the VAS score showed that collagenase treatment could relieve pain in the process of routine treatment. The differences were statistically significant between both groups (P<0.05). The satisfaction of collagenase treatment group was obviously higher than that of routine treatment group. Conclusion Collagenase can promote granulation tissue growth of wounds, accelerate healing, reduce pain and improve patients' satisfaction in the treatment of nonunion of incision after thoracotomy through median sternotomy approach. [ABSTRACT FROM AUTHOR]

Objective To explore the efficacy of plastic suture technique in the emergency surgical treatment of superficial facial trauma. Methods The clinical data of patients with superficial facial trauma underwent plastic suture technique treatment from January 2012 to January 2018 were retrospectively reviewed. Preoperative, seventh-day and sixth-month postoperative photographs were taken. The baseline information, type of trauma, location, length and depth of wounds, details of operative procedures, complications, appearance of scars and patients' satisfaction were recorded. Results A total of 720 patients were included in this study. The age of patients ranged from 2 to 76-year-old, with an average of 17.89-year-old. The follow-up period ranged from 6 to 11 months, with an average of (8.15± 3.21) months. The types of trauma were laceration (93.75%), contusion (2.50%), animal bite wounds (1.25%), human bite wounds (0.42%) and other wounds (2.08%). The forehead (20%), eyebrow and upper eyelid (20%), mandible and chin (20%) were the most common injury locations, followed by lip (15%), cheek (10%), nose (5%), temporal region (5%) and other parts (5%). The average length of wounds was (3.25±2.17) cm. The wounds of forehead and chin were deep to bony surface and other parts were deep to subcutaneous layer. The incidence rate of complications was 0.30%. The postoperative scar was not obvious in most patients. The efficacy was satisfactory. Conclusion The application of plastic suture technique in the treatment of emergency facial trauma could obtain good function and aesthetic effect. The postoperative complications are rare and the scars are not obvious. Patients' satisfaction is high. [ABSTRACT FROM AUTHOR]

Surgical incision infection of multidrug-resistant microorganisms (e.g., methicillin-resistant Staphylococcus aureus, MRSA) is a severe cause of poor wound healing, which is prevalent in healthcare facilities and constitutes a huge infectious disease burden in the world. The purpose of this study is to investigate the medical application and possible mechanisms of the cold atmospheric plasma jet on infected wounds. In this article, the New Zealand rabbit in vivo wound infected with MRSA is used as the wound healing animal model. The helium atmospheric-pressure dielectric-barrier-discharge (AP-DBD) plasma jet is employed to treat the wounds infected with MRSA. The wound healing, histological, and cytokine analyses are conducted to evaluate the efficacy of the helium AP-DBD plasma jet on the MRSA-infected wound healing process. The experimental results show that the helium AP-DBD plasma jet treatment on the wounds infected with MRSA can regulate the secretion of the cytokines, limit the inflammatory response and cell excessive proliferation, accelerate the process of re-epithelialization, and consequently, promote the wound healing process and the inactivation of the bacteria. [ABSTRACT FROM AUTHOR]

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

Older adults are at high risk of developing chronic wounds due to numerous changes that occur with aging. It is reasonable to consider chronic wounds as a geriatric syndrome—highly prevalent, multifactorial, and associated with substantial morbidity and mortality. Due to the morbidity and cost associated with chronic wounds, prevention, early diagnosis, and treatment are important. The most common chronic wounds presenting in older adults are pressure and vascular wounds, including those associated with diabetes. Atypical wounds are also common and should raise the suspicion for skin malignancy. Diagnosis is primarily clinical and assessment should include documentation of wound characteristics, such as location, size and depth, presence of slough, drainage, odor, and infection. The mainstay of treatment is based on the TIME principle: Tissue debridement, Infection control, Moisture balance, and optimal wound Edges. The use of protein supplements has been shown to improve wound healing in subsets of older adults. In addition to wound care and optimizing nutrition, disease‐specific wound therapy forms an integral part of wound management. Pressure reduction for pressure injury, compression therapy for venous wounds, evaluation of arterial circulation with ABI or arterial Doppler and iCC for diabetic ulcers form the mainstays of therapy. Atypical wounds may present as chronic ulcers and should be biopsied. The goals of treatment should be realistic and for some older adults, palliative wound management may be more appropriate. [ABSTRACT FROM AUTHOR]

Objective: Unusual clinical course Background: Traumatic spinal cord injuries are quite common; however, a rare form of incomplete spinal cord injury is Brown-Séquard syndrome. Brown-Séquard syndrome is defined by the National Institute of Neurological Disorders and Strokes as "a rare neurological condition characterized by a lesion in the spinal cord which results in weakness or paralysis (hemiparaplegia) on one side of the body and a loss of sensation (hemianesthesia) on the opposite side." Case Report: A 33-year-old man was brought to the Emergency Department by Saudi Red Crescent with multiple stab wounds on the left upper thoracic and lower cervical regions. He was tachycardic, but otherwise vitally stable. His Glasgow Coma Scale score was 15. The patient presented with bilateral lower limb weakness, more on the ipsilateral (left) side, and contralateral (right) hypoesthesia from the level of the nipple below. Cervical and thoracic magnetic resonance imaging revealed ligamentous injury defect at the posterior dura and indicating a dural tear with minor cerebrospinal fluid leak. Focal hyperintense signal intensity was noted on the left side of the spinal cord, representing contusion. The patient was managed conservatively with daily physical therapy. Strength had improved substantially by the time of discharge and sensation was improving. Conclusions: Brown-Séquard syndrome is associated with good prognosis. These patients require a multidisciplinary approach because it provides the best chance of recovery to pre-injury status. These injuries may cause disastrous neurological deficits; therefore, preventive strategies should be designated to decrease the incidence of such injuries. [ABSTRACT FROM AUTHOR]

The present study was conducted to estimate prevalence and nature of various musculoskeletal injuries in populations of free-ranging rhesus macaques in Shivalik Hills of Himachal Pradesh in Northern India. Data were collected over a period of 2 years and analyzed in relation to sex, age-group and season. In total, 1522 (44.6%) cases of musculoskeletal injuries were recorded; of these, 645 (47.1%) were males and 877 (43%) were females. Data revealed that differences observed between sex, season and age were statistically significant. Musculoskeletal injuries were more common during winter season followed by monsoon and then summer (27.4%). Males (47.1%) were injured more frequently than females (43.1%), while adults (47.9%) were injured more frequently than juvenile (42.8%) and young ones (28.8%). Of all the musculoskeletal injuries, wounds (84.5%) were most common followed by fractures (7.2%), amputations (4.5%) and snares/pellets (3.9%). The result from present study indicated that musculoskeletal injuries were frequent in rhesus macaque population studied. Musculoskeletal injuries occurring throughout year likely reflect the multiple causes viz predation, disease, vehicle trauma and electrocution, which may act independently or jointly. Understanding the role primates play in local culture and religion, therefore, is essential for understanding the underlying basis of commensalisms and conflict. [ABSTRACT FROM AUTHOR]

The keyhole lesion has been classically related to a tangential and superficial bullet strike to the cranium. A case of homicidal perforating gunshot wound to the head is described that showed an entrance keyhole defect over the left parietal bone while the corresponding exit defect was present over the ipsilateral sphenoid region. The lesion comprised of a roundish defect with internal beveling and a wedge-semicircular defect with external beveling that upon first inspection was present as a partly detached bone plug under the scalp and easily movable in a hinge-like manner. An autopsy reconstruction of the bullet track suggested an atypical and non- tangential strike over the cranium, causing through and through perforation of brain. An intact full metal jacket bullet was recovered from the scene. The traditional explanation of the keyhole lesion following a tangential strike has sometimes created difficulties in wound interpretation in the past. In the present case, the possible mode of the keyhole formation from a non-tangential strike is explained that may help the pathologist in ascertaining the shot direction, in case confusion arises during the autopsy. An appropriate observation can further help in avoiding a legal bearing that may possibly arise in the future. [ABSTRACT FROM AUTHOR]

Negative pressure wound therapy (NPWT) promotes healing by evenly applying negative pressure on the surface of the wound. The system consists of a sponge, a semiocclusive barrier, and a fluid collection system. Its effectiveness is explained by four main mechanisms of action, including macrodeformation of the tissues, drainage of extracellular inflammatory fluids, stabilization of the environment of the wound, and microdeformation. Rarely will complications linked to NPWT occur, but special care must be taken to prevent events such as toxic shock syndrome, fistulization, bleeding, and pain. New NPWT modalities have been recently developed to make NPWT suitable for a wider variety of wounds. These include NPWT with instillation therapy (NPWTi-d), different cleansing options, and application of NPWT on primarily closed incisions. Finally, vacuum-assisted wound closure therapy has been demonstrated to be efficient for various clinical settings, such as the management of diabetic foot ulcers, pressure ulcerations, chronic wounds, and skin grafts. [ABSTRACT FROM AUTHOR]

Introduction: The closure of wounds in diabetic foot patients, after amputation with esposure of bones, is difficult because of lack of blood supply to this area. The progressive suture with Ventrofil® is a good alternative. Aim: Report the technique of progressive closure of foot wounds in insulin-requiring diabetic patients. Materials and Method: 15 patients with diabetic foot were operated on in the Hospital del Salvador, between 2014 and 2019.The ages were among 45 and 70 years. 11 men and 4 women. In those patients two plaques of Ventrofil® were positioned in both borders of the wound an tied through a horizontal suture.This suture was tensioned every 3 days until get the complete wound healing. Results: 14 patients healed very well and in just only one patient there was suffering of the edges of the wound. The follow up was of 3 months without relapse. Discussion: In patients with diabetic foot with wounds after amputation the closure is difficult because of lack of adecuate blood supply. In these case the progressive suture with plaques of Ventrofil® is a good alternative to a more complex flaps like microsurgicals ones. Conclusion: This technique is sure, easy to perfom and safe. [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]

An increasing use of beta‐blockers in dermatology has been described over the last 10 years, despite the fact that their use in diseases other than infantile hemangiomas is off‐label. This review discusses the emerging role of topical beta‐blockers in the treatment of infantile hemangioma, but also pyogenic granuloma, Kaposi sarcoma, wounds and nail paronychia. Data in literature demonstrate that topical beta‐blockers are a safe and valid therapeutic option in numerous cutaneous diseases. Side effects are mainly restricted to the application site. Further studies and randomized trials may contribute to reinforce the role of topical beta‐blockers in the dermatological armamentarium. [ABSTRACT FROM AUTHOR]

The management of self-harm (SH) wounds requires a non-judgemental holistic approach on the part of the health professional. It is important that SH wounds are assessed, and that interventions are agreed between the health professional and the patient. This article looks at definitions of SH and provides guidance on how health professionals can make an accurate assessment of the wound and, in addition to agreement treatment with the patient, provide patient education and guidance on self-care. [ABSTRACT FROM AUTHOR]

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

Aim: Although most defects can close by primary suturing after radical surgery of gynecological malignancies, different reconstruction options are available when large defects that require reconstruction occur. In this study, we present the treatment strategy and results for patients who underwent reconstruction after resection for gynecological cancer in the vulva and perineum. Material and Methods: A total of 18 patients who underwent reconstruction between May 2018 and July 2020 were included in this retrospective study. Demographics and clinical data, the resection operation, characteristics of the defect, and the reconstruction methods applied were evaluated. Postoperative treatment strategy and complication rates were evaluated. Results: The mean age was 62.3±13.2 (42-83) years. 88.9% of the patients had additional diseases. Pelvic exentration was performed in 5 (27.8%) patients, anterior resection in 2 (11.1%) patients and vulvectomy in 11 (61.1%) patients. The most common malignancy was squamous cell carcinoma, and mean defect size was 106±97 (12-476) cm2. Reconstruction was performed with a local fasciocutaneous flap in 16 (88.9%) patients, pedicled rectus myocutaneous flap in one (5.6%) patient, and skin graft in one (5.6%) patient. Wound complications occurred in 5 (27.8%) patients, partial flap necrosis in one (5.6%) patient, and recurrence in one (5.6%) patient in the long term. Conclusion: It is possible to reconstruction most of the vulva and perineal defects with local flaps after oncological resections, Considering the characteristics of the area and patient comorbidities, it should be kept in mind that prolonged wound problems may be seen, especially in vulvectomy patients. [ABSTRACT FROM AUTHOR]

Objective: an innovative non−thermal plasma (NTP) system constituted by a radiofrequency (RF) power generator directly coupled to a treatment probe is described and characterized. This system is intended to be applied as a medical device for therapeutic treatments. Methods: electrical characterization of the radiofrequency power generator supplying the treatment probe was performed. Meanwhile, generated NTP was optically analyzed. Obtained data were studied to establish the safety profile of plasma application on heat sensitive matter. Results: the NTP system was validated through bacterial deactivation trials, as well as, of being capable of deactivating carcinogenic cells. Besides promoting and accelerating wound closure in vivo performed in mice, demonstrating faster healing than that done with conventional treatments. Conclusion: the NTP system's characterization is an essential stage to determine the adequate application of the generated plasma over organic media. The therapeutic benefits of the NTP system were proved by the development of in vivo experiences involving laboratory mice. Significance: the generated NTP interacts with surrounding air particles producing reactive oxygen and nitrogen species, which, exhibit bactericidal and antiseptic effects due to their strong biochemical reactivity; functioning like critical mediators in animal physiology and promoting wound healing processes. These properties make the NTP system a feasible technology intended for therapeutic treatments. [ABSTRACT FROM AUTHOR]

Background and Aim: Horse wounds can be easily infected with bacteria depending on the nature of its cause such as laceration, abrasion, or puncture as well as the nature of its environment. Various treatments are available in managing open wounds, including the usage of topical antibiotics and antiseptics. However, antibiotic resistance has been a major concern attributed with chronic wound infection. The aim of this study was to test the efficacy of ionized water at different pH against the growth of common bacteria from horse wounds. Materials and Methods: Ten swab samples from equine infected wounds were collected and bacteria isolation and identification were performed. The antibacterial effect of the ionized water of pH 2.5, 4.5, 7.0, and 11.5 was tested on Staphylococcus aureus, Staphylococcus pseudintermedius, Staphylococcus intermedius, Escherichia coli, Pantoea agglomerans, and Klebsiella pneumoniae. The time-kill profiles of the ionized waters were determined at time 0, 2, 4, 6, and 8 h. Results: Ionized water of pH 2.5 and 4.5 showed antibacterial activity against S. aureus, S. pseudintermedius, and S. intermedius with significant (p>0.05) reduction in colony-forming unit/mL within 2-8 h. The degree of bactericidal effect of the acidic ionized water differs between the species with S. intermedius more susceptible. However, there was no antibacterial effect at pH 2.5, 4.5, 7.0, and 11.5 on the Gram-negative bacteria tested. Conclusion: Ionized water of pH 2.5 and 4.5 is effective in minimizing the growth of Gram-positive bacteria; thus it could be of clinical importance as an antiseptic for surface wound lavage in horses. [ABSTRACT FROM AUTHOR]

Patients with chronic wounds (leg ulcers, decubitus, and diabetic foot ulcers) suffer from marked restrictions in their quality of life and can often no longer adequately carry out their everyday tasks. The need for nursing and medical care increases when other illnesses and complaints are present at the same time. Qualified wound care and the treatment of comorbidities are therefore of particular importance. The treatment of this disease, which is increasing in number, requires a holistic, multimodal treatment approach which, in addition to professional wound care, also includes comorbidities in the treatment. This case study describes an old treatment method for refractory wounds, the so-called “maggot therapy”, and shows how this is integrated into a holistic, multimodal therapeutic approach. [ABSTRACT FROM AUTHOR]

Objective To explore the effect of platelet rich fibrin （PRF）in the promotion of wound healing. Methods From June 2015 to October 2019, 30 patients with wounds were selected. All patients were divided into PRF treatment group and conventional dressing change group. All patients were followed up for 6 to 12 months after discharge. The treatment time, pain degree, satisfaction, total hospitalization expenses and complications of patients were recorded. Results In the PRF treatment group, the average treatment time were（20.53±12.69）days, the average frequency of dressing change were (3.76±1.66), the average treatment expenses were（19035.29±3993.07）yuan and the scores of pain were（3.01±1.63）. In the conventional dressing change group, the average treatment time（32.85±11.47）days, the average frequency of dressing change were（15.29±4.32）and the average treatment expenses were（25946.3±9425.1）yuan. Compared with the conventional dressing change group, the application of PRF can promote wound healing, reduce the frequency of dressing change, decrease the expenses of treatment and alleviate the pain during the therapeutic process. Conclusion The application of PRF is superior to the conventional dressing change in preventing wounds infection, shortening the treatment time, alleviating the pain and decreasing the expenses. The PRF has better therapeutic effect in the treatment of complex wounds. [ABSTRACT FROM AUTHOR]

Nail shaft infections are one of the most common infections in everyday podiatric practice. Patients often report after a few weeks or months with chronic paronychiae, which in advanced cases must be treated surgically, with earlier unspecific treatment resulting in the exacerbation of changes and a longer process of treatment and convalescence. The purpose of the paper was to present the therapeutic properties of Silveron® dressings in limiting local infection. [ABSTRACT FROM AUTHOR]

Background: Eucheuma Cottonii is a type of red algae obtained from Sabah with main active component, sulfated polysaccharide or k‐carrageenan. Aims: The objective of this research was to evaluate the antioxidant, antibacterial and potential wound‐healing properties in aqueous extraction of E cottonii in order to meet the increasing demand for halal and natural cosmeceutical products. Methods and Results: Aqueous extract of E cottonii was investigated for active compounds by phytochemical screening and IR spectroscopy. Antioxidant activity was carried out using DPPH method, and the IC50 value was 1.99 mg/mL. Antibacterial activity was examined against Staphylococcus Aureus using Kirby‐Bauer disk diffusion method and showed 10.03 ± 0.06 mm zone of inhibition, achieved by 200 mg/mL of extracts. A wound was made by skin excision of area around 100 mm2 on each mouse. Test group was treated with aqueous extract gel (10% w/w); meanwhile, the mice that were treated with honey acted as the positive control group and the untreated mice as negative control group. Results showed that the wound contraction rate inclined to aqueous extracts as compared to untreated group (P <.05). Percentage of wound healing for aqueous extracts and untreated group were 87.7% ± 2.0% and 57.6% ± 5.3%, respectively. Conclusion: Aqueous extract was found to be comparable to the honey in wound healing. [ABSTRACT FROM AUTHOR]