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The first reported snakebite by an African snake-eater, Polemon spp. (Atractaspididae, Aparallactinae); Local envenoming by Reinhardt's snake-eater, Polemon acanthias (Reinhardt, 1860). Toxicon XX, xxx. A 51-yr-old male herpetologist was bitten on the left index finger by a captive male Polemon acanthias while manually removing fragments of incompletely shed skin from the specimen. The snake sustained its bite for approximately 2 mins, advancing its jaws several times. The victim rapidly developed moderate pain, erythema, progressive edema that ultimately extended to the left wrist; a blister later developed in the wound site, as well as joint stiffness in the bitten and adjacent two fingers that limited flexion and extension. These effects regressed during the week following the bite, but recurred thereafter and were similar to the effects that developed immediately post-envenoming. There were no systemic signs or symptoms. The victim sought medical advice and was treated with broad-spectrum antibiotics, antihistamines and wound care; no laboratory investigations were conducted. He improved during the subsequent month with complete resolution in 5 and one-half weeks. This is the first documented bite by a Polemon spp. and the victim's clinical course suggests the development of local effects from venom components. The phylogenetic relationship of Polemon spp. with the burrowing asps (Atractaspis spp.) and the similarity of some of the features of this local envenoming by P. acanthias with mild/moderate envenoming by some Atractaspis spp., suggests that none of these snakes should be handled; they should be considered capable of inflicting potentially serious envenoming.

Infection, the most common complication of chronic wounds, has placed tremendous burden on patients and society. Existing care strategies could hardly reflect in situ wound status, resulting in overly aggressive or conservative therapeutic options. Multiplexed tracking of wound markers to obtain diagnostic information in a more accurate way is highly promising and in great demand for the emerging development of personalized medicine. Here, an integrated multiplex sensing bandage (MSB) system, including a multiplex sensor array (MSA), a corresponding flexible circuit, and a mobile application, was developed for real-time monitoring of sodium, potassium, calcium, pH, uric acid, and temperature indicators in the wound site to provide a quantitative diagnostic basis. The MSB was optimized for wound-oriented management applications, which exhibits a broad linear response, excellent selectivity, temporal stability, mechanical stability, reproducibility, and reliable signal transmission performance on the aforementioned physiological indicators. The results of in vivo experiments demonstrate that the MSA is capable of real-time monitoring of actual wounds as well as early prediction of infection. The results ultimately point to the potential clinical applicability of the MSB, which might benefit the quantifications of the complexity and diversity of the wound healing process. This work provides a unique strategy that holds promise for broad application in optimizing wound management and even coping with other diseases.

Introduction: Bovine-derived collagen membrane is usually and regularly used as a temporary cover or dressing for extraoral wounds and burns. It has wide applications because of its usefulness and biocompatibility. This has provoked us to do a study with the use of collagen membrane even for minor intraoral surgical defects. The aim of this evaluative study was to evaluate the clinical efficacy of collagen membrane in intraoral wounds created by removal of various soft tissue lesions. Materials and Methods: A total of 25 healthy patients (16 males and 9 females) were taken for this study. This study was confined to secondary defects of the oral mucosa, which occur after excision of premalignant lesions and other conditions, such as benign lesions, reactive proliferations, and incisional biopsy wounds. Only those lesions that were sufficiently large and could not be closed primarily were included in the study. Results: The results were evaluated on the day of surgery and in the postoperative period. The usefulness of collagen membrane as an intraoral temporary wound dressing material to promote haemostasis, relieve pain, induce granulation, and assist in rapid epithelialization at the wound site and prevent infection, contracture, scarring, and donor-site morbidity was evaluated, and finally, the efficacy of collagen membrane was tested by the use of Chi-square test and P < 0.001, which is a statistically and clinically significant value. Discussion: Collagen membrane was observed as both biological dressing material and drug carrier. It was found to be a suitable alternative to other graft materials mentioned for the repair of defects in the mucous membrane created by surgical excision of lesions. Therefore, when used judiciously in a controlled clinical situation, collagen membrane is biologically acceptable in nature. It is an alternative to autologous grafts rather than a replacement of other grafts used in the oral cavity.

STUDY DESIGN This was a systematic review study. PURPOSE This study aims to review current literature to determine the rates of complications in relation to spine surgery in ambulatory surgery centers (ASC). BACKGROUND Recent improvements in anesthesia, surgical techniques, and technological advances have facilitated a rise in the use of ASC. Despite the benefits and lower costs associated with ASCs, there is inconsistent reporting of complication rates. METHODS This systematic review was completed utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Pertinent studies were identified through Embase and PubMed databases using the search string ((("ambulatory surgery center") AND "spine surgery") AND "complications"). Articles were excluded if they did not report outpatient surgery in an ASC, did not define complications, were in a language other than English, were non-human studies, or if the articles were classified as reviews, book chapters, single case reports, or small case series (≤10 patients). The primary outcome was the frequency of complications with respect to various categories. RESULTS Our query identified 150 articles. After filtering relevance by title, abstract, and full text, 22 articles were included. After accounting for 2 studies that were conducted on the same study sample, a total of 11,245 patients were analyzed in this study. The most recent study reported results from May 2019. While 5 studies did not list their surgical technique, studies reported techniques including open (6), minimally invasive surgery (2), endoscopic (4), microsurgery (1), and combined techniques (4). The following rates of complications were determined: cardiac 0.29% (3/1027), vascular 0.25% (18/7116), pulmonary 0.60% (11/1839), gastrointestinal 1.12% (2/179), musculoskeletal/spine/operative 0.59% (24/4053), urologic 0.80% (2/250), transient neurological 0.67% (31/4616), persistent neurological 0.61% (9/1479), pain related 0.57% (20/3479), and wound site 0.68% (28/4092). CONCLUSIONS After literature review, this is the first study to comprehensively analyze the current state of literature reporting on the complication profile of all ASC spine surgery procedures. The most common complications were gastrointestinal (1.12%) and the most infrequent were vascular (0.25%). Case reports varied significantly with regard to the type and rate of complications reported. This study provides complication profiles to assist surgeons in counseling patients on the most realistic expectations.

Personalized wound dressings provide enhanced healing for different wound types; however multicomponent wound dressings with discretely controllable delivery of different biologically active agents are yet to be developed. Here we report 3D-printed multicomponent biocomposite hydrogel wound dressings that have been selectively loaded with small molecules, metal nanoparticles, and proteins for independently controlled release at the wound site. Hydrogel wound dressings carrying antibacterial silver nanoparticles and vascular endothelial growth factor with predetermined release profiles were utilized to study the physiological response of the wound in a mouse model. Compared to controls, the application of dressings resulted in improvement in granulation tissue formation and differential levels of vascular density, dependent on the release profile of the growth factor. Our study demonstrates the versatility of the 3D-printed hydrogel dressings that can yield varied physiological responsesiin vivo/iand can further be adapted for personalized treatment of various wound types.

Background: Transversus abdominis plane (TAP) block has been described as an effective technique to reduce postoperative pain after caesarean section. Wound site infiltration (WSI) has been a traditional method for pain relief. In our study we attempt to compare the analgesic effect of TAP block with wound site infiltration after caesarean section. Materials and Methods: A randomized comparative study was conducted on 60 parturients. Patients were randomized into Group T (TAP block, n=30) and Group I (WSI, n=30). Spinal anaesthesia was administered and at the end of surgery, Group T was administered TAP block with 20 ml of 0.25% of bupivacaine on each side and in Group I, 20 ml of 0.25% bupivacaine was infiltrated along the wound site. Postoperatively parameters assessed were time to first rescue analgesia, postoperatively patient’s Numeric pain score (NPS) which was assessed periodically over 24hrs and if NPS >4 or patient demanded rescue analgesia, Inj diclofenac 75mg i/m was given as first rescue analgesic, total number of doses of first rescue analgesic given over 24hrs, total number of second rescue analgesic and complications were assessed. Results: The mean time to first rescue analgesia in Group T was 13.40±4.51 hours and in Group I was 6.20±4.25 hours (p-0.001). NPS at 2, 4,6,12 and 24 hours were lower in Group T compared to Group I. Also, analgesic requirement in first 24hours was significantly less in Group T (p-0.001). Conclusions: TAP block was found to be superior to wound site infiltration in providing effective postoperative pain relief in patients undergoing caesarean section. Keywords: Transversus abdominis plane block, Wound site infiltration, Caesarean section, Multimodal analgesia.

BACKGROUND Post-operative pain is a ubiquitous finding following any surgeries. It has physiological and psychological effect in patients. The source and degree of nociceptive stimulation differ among individuals and type of surgeries. In this regard, multimodal analgesic approach has been encouraged for post-operative pain relief, local infiltration of wound site being simplest among them. This procedure reduces the sensitisation and consequent hyperalgesia by cutting down afferent impulses from site of incision and injury. METHODS This is a single blind randomized clinical trial conducted at surgery main operation theatre, surgery indoor wards for a duration of 2 years. 60 patients posted for routine surgeries under general anaesthesia were taken as study subjects and were randomly divided into 2 groups of 30 each. Before skin closure, skin wound site was infiltrated at 1ml/cm according to the following schedule - Group B: received Inj. Bupivacaine plain (0.2 %), Group R: received Inj. Ropivacaine plain (0.2 %). All the patients were followed up for 24 hours and post-operative pain score parameters (Visual Analogue Score) were taken at 1 hour, 2-hour, 6-hour, 10 hour and 24 hours. The time duration till the requirement of first dose of rescue analgesia was noted down. Data was analysed using chi-square test, student t - test and statistical significance was set at P < 0.05. RESULTS Hemodynamic stability was more with Ropivacaine as the fall in blood pressure and heart rate was not drastic. Duration of analgesia was longer with Ropivacaine. Analgesia was better with Ropivacaine. Both the drugs caused analgesia of significant extent. No cardiotoxicity or any other adverse reaction was observed with either drug in this study. CONCLUSIONS Ropivacaine is having longer duration of analgesia and better analgesic effect than bupivacaine. KEYWORDS Postoperative, Analgesic, Wound, Infiltration, Bupivacaine, Ropivacaine

Surgical sutures are considered to be a medical device for wound closure in healthcare applications. Surgical sutures maybe cause natural body response and form inflammation at the wound site of skin or organs after surgery, which play a negative role on wound healing. Within this context, it is necessary to develop antimicrobial surgical sutures with infection prevention and wound healing which can effectively inhibit the bacterial multiplication and improve healing rate. Currently, function agents made from natural or synthetic are being loaded in suture devices by various technique (such as coating, melt spinning, wet-spinning, grafting, electrospinning and blending) to produce antimicrobial surgical sutures. However, the properties of suture material determine the different modification technique. In this Review, we elaborate the preparation of antimicrobial surgical sutures for infection prevention and wound healing. Currently, most of antimicrobial surgical sutures still at researching and developing stage and few applied in clinically trials. Therefore, it is necessary to develop better antimicrobial sutures for preventing wound infection and promoting wound healing. The antimicrobial surgical sutures as a medical device will play a crucial role in the field of the anti-inflammatory and wound healing which mainly attribute to its unique properties, such as good biocompatibility, excellent antimicrobial, effective drug carrier, and amenability to various materials-design and manufacturing requires.

Background There is still a lack of clarity about the benefits of preoperative biliary drainage (PBD), which was introduced to improve the perioperative outcome in patients with obstructive jaundice caused by a periampullary tumour. The aim of this study was to determine whether operative and postoperative complications increase in patients undergoing PBD during pancreatoduodenectomy (PD). Material and methods Retrospective examination was made of patients who underwent PBD for periampullary tumour in our hospital between 2006 and 2014. From these, the patients were identified who had PBD with endoscopic retrograde cholangiopancreatography and these patients were further separated into two groups, as one group of patients with plastic stents and the other group of patients with metallic stents. Patients with pancreas head cancer were also separated into two groups as those who were and were not applied with PBD. The preoperative, intraoperative and postoperative characteristics of the patients were evaluated. Results A total of 123 patients were retrospectively reviewed. Biliary stent placement with PBD was applied to 48 patients, of whom 31 had metallic stents and 17 had plastic stents. In general, there was no difference between the PBD and the non-PBD groups in respect of the preoperative, operative and postoperative results. When patients with tumour of the pancreas head only were examined, the rate of wound infection was higher in the PBD group and there was no difference in the other parameters. Moreover, there was no difference between the patients with metallic stents and those with plastic stents in respect of outcomes. Conclusions With the exception of wound site infection, although no difference was observed between the PBD and the non-PBD groups based on intraoperative and postoperative complications, because of the distinctive inherent complications of PBD it is essential to manage such patients properly and to carefully select the patients for the PBD procedure.

OBJECTIVE The present study aimed to compare the rate of wound site infection in patients

Meniscal injuries represent one of the most common orthopaedic injuries. The most frequent treatment is partial resection of the meniscus, or meniscectomy, which can affect joint mechanics and health. For this reason, the field has shifted gradually towards suture repair, with the intent of preservation of the tissue. "Save the Meniscus" is now a prolific theme in the field; however, meniscal repair can be challenging and ineffective in many scenarios. The objectives of this review are to present the current state of surgical management of meniscal injuries and to explore current approaches being developed to enhance meniscal repair. Through a systematic literature review, we identified meniscal tear classifications and prevalence, approaches being used to improve meniscal repair, and biological- and material- based systems being developed to promote meniscal healing. We found that biologic augmentation typically aims to improve cellular incorporation to the wound site, vascularization in the inner zones, matrix deposition, and inflammatory relief. Furthermore, materials can be used, both with and without contained biologics, to further support matrix deposition and tear integration, and novel tissue adhesives may provide the mechanical integrity that the meniscus requires. Altogether, evaluation of these approaches in relevant in vitro and in vivo models provides new insights into the mechanisms needed to salvage meniscal tissue, and along with regulatory considerations, may justify translation to the clinic. With the need to restore long-term function to injured menisci, biologists, engineers, and clinicians are developing novel approaches to enhance the future of robust and consistent meniscal reparative techniques. This article is protected by copyright. All rights reserved.

Despite the development of advanced tissue engineering substitutes, inflammation is still a significant problem that can arise from inflamed burn injuries, chronic wounds, or microbial diseases. Although topical wound dressing accelerates healing by minimizing or preventing the consequences of skin inflammation, there remains a need for the development of a novel substitute scaffold that can effectively eliminate immoderate inflammation and infection in the initial phase of the healing meachanism. In this study, an artificial skin substitute scaffold fabricated with asiaticoside (AS) and epsilon-poly-L-lysine (εPLL) was prepared. Upon the release of these bioactive compounds, they accelerate wound healing and inhibit any bacterial infection at the wound site. We determined whether AS and εPLL exhibit anti-inflammatory and bactericidal effects through different mechanisms. Collectively, the collagen-AS/εPLL artificial skin substitute could be a significant therapeutic agent for scar-less rapid wound healing (without infection and inflammation) of initially-inflamed full-thickness wounds.

Tyrosinase plays a pivotal role in the hyperpigmentation of wounds. Here, we develop a new fluorescent probe and with it, we reveal an increase of tyrosinase activity at the wound site in zebrafish.

INTRODUCTION: The split-thickness skin graft harvested donor site is associated with prolonged healing, discomfort, and pain. Platelet-rich plasma (PRP) contains platelet-derived growth factors and has been widely used in chronic wounds and skin graft donor sites. PRP application is known to accelerate wound epithelialization rates, and also reduce postoperative wound site pain. MATERIALS AND METHODS: We assessed 20 patients admitted to our hospital service who underwent split-thickness skin grafting (STSGs) with proximal half of the donor site treated with PRP. The dressing was conducted on postoperative day 7, 14, and 21. The donor site healing was assessed with serial photographs and donor site pain measured by numerical rating scale. RESULTS: Complete healing of wounds (epithelialization) was present in 12 (60%) patients dressed with PRP. Pain on opening dressing was an average of 3.5 in PRP dressed wounds and 6.35 in control wounds. Patients dressed without PRP, none of them had complete epithelialization. All patients had partial healing and were less than the donor site dressed with PRP. Based on these results, skin graft donor site with PRP showed accelerated healing and reduced pain and discomfort compared to control without PRP. CONCLUSION: PRP is a beneficial adjunct for reducing donor site pain and increased healing of donor site following STSG harvest.

Cell migration is a widespread form of live cell activity during complex dynamic process, which plays an important role in tissue regeneration and repairing. Tissue regenerative biomaterials provide the basic supporting for the growth of cells and tissues and maintain the shape and mechanical properties of the regenerated tissues. Cell recruitment and migration with the assistance of biomaterials is important for tissue regenerative process because cell directional migration to the wound site is a crucial prerequisite in tissue regeneration. In the case of injured tissue, migration and overgrowth of unexpected cells may cause severe diseases. Hence, cell-selective biomaterials have great significance in tissue regeneration and reconstruction. The design of cell-selective biomaterials for this purpose is based on the specific interactions between materials and cells by the physical, chemical, or biological cues, because they can directly affect the migration cells and further affect the process of tissue regeneration. The chemical and biological molecules (peptides, growth factors, adhesion molecules), physical properties (hardness, topography, hydrophilicity), physiological signals (cellular chemokines or cytokines) are all effective regulatory factors in the design of cell-selective biomaterials. This review combined the latest research, summarized systematically about the influential factors of cell migration, the design of biomaterials for selective cell adhesion and directional migration, and their applications in tissue regeneration. Furthermore, the challenge and perspectives of cell-selective migration biomaterials were also discussed.

In skin tissue engineering, a biodegradable scaffold is usually used where cells grow, produce its own cytokines, growth factors, and extracellular matrix, until the regenerated tissue gradually replaces the scaffold upon its degradation. However, the role of non-biodegradable scaffold remains unexplored. This study investigates the potential of a non-biodegradable bacterial nanocellulose/acrylic acid (BNC/AA) hydrogel to transfer human dermal fibroblasts (HDF) to the wound and the resulting healing effects of transferred HDF in athymic mice. Results demonstrated that the fabricated hydrogel successfully transferred >50% of HDF onto the wound site within 24 h, with evidence of HDF detected on day 7. The gene and protein study unveiled faster wound healing in the hydrogel with HDF group and characterized more mature newly formed skin microstructure on day 7, despite no visible differences. These findings give a new perspective regarding the role of non-biodegradable materials in skin tissue engineering, in the presence of exogenous cells, mainly at the molecular level.

Wound management is a crucial measure for skin wound healing and is significantly important to maintaining the integrity of skins and their functions. Electrical stimulation at the wound site is a compelling strategy for skin wound repair. However, there has been an urgent need for wearable and point-of-care electrical stimulation devices that have self-adhesive and mechanical properties comparable to wound tissue. Herein, we develop a bioinspired hybrid patch with self-adhesive and piezoelectric nanogenerator (HPSP) for promoting skin wound healing, which is composed of a mussel-inspired hydrogel matrix and a piezoelectric nanogenerator based on aligned electrospun poly(vinylidene fluoride) nanofibers. The device with optimized modulus and permeability for skin wear can self-adhere to the wound site and locally produce a dynamic voltage caused by motion. We show that the HPSP not only promotes fibroblast proliferation and migration in vitro, but also effectively facilitates the collagen deposition, angiogenesis, and re-epithelialization in vivo with the increased expressions of crucial growth factors. The HPSP reduces the wound closure time of full-thickness skin defects by about 1/3, greatly accelerating the healing process. This patch can serve as wearable and real-time electrical stimulation devices, potentially useful in clinical applications of skin wound healing.

The aim of this study was to develop a novel oil-in-water (o/w) nanoemulsion gel containing levofloxacin for enhanced topical efficacy. Average particle size of sesame oil nanoemulsion without (SONE) and containing levofloxacin (SONEL) was found as 25.2 and 26.3 nm, respectively. Results from scratch test showed that SONEL had better proliferation effect in comparison with negative control. Treated animals with SONEL showed significant reduction in period of epithelialization, wound contraction, and number of inflammatory cells among all groups. Also, SONEL-treated group had the greatest collagen synthesis. Immunohistochemical analysis showed high intensity of CD31 and TGF-β at wound site of treatment groups with SONEL on day 12 post-treatment (P < 0.05). Skin irritation test demonstrated safety of SONEL gel for skin topical application. In conclusion, our studies suggest that SONEL could be an effective formulation for treatment of diabetic wound infection by controlling infection and improving the healing process. Graphical Abstract .

Laceration closure is one of the most common procedures performed in the emergency department (ED). While sutures and staples have been the traditional wound closure device, topical skin adhesives (TSA) were introduced in the United States 20 years ago as a non-invasive alternative for simple, low-tension wounds. We determined which closure devices were used to close ED lacerations and explored patient and provider characteristics associated with choosing TSA. We also tested the hypothesis that use of TSA would be associated with shorter ED length of stay (LOS) than sutures/staples.We extracted demographic and clinical data on all patients with a laceration from the publicly available website of the National Hospital Ambulatory Medical Care Survey for the years 2012-2015. This database is provided by the National Center for Health Statistics of the CDC. Based on weighted sampling, national estimates are made for all ED visits in the US. We determined the association between patient characteristics (age, sex, insurance type, geographic location, laceration site, type of ED provider) and use of TSA. We also compared ED LOS between patients whose wounds were closed with TSA or sutures/staples using the t-test and a linear regression model.There were an estimated 540 million ED patient visits, and 26.1 million patients (4.8%) had at least one laceration. Of the 15.4 million patients with a single laceration, 9.2 million were closed with either sutures/staples (7.2 million), TSA (1.5 million), or both (0.5 million). Mean (SE) age was 30 (1) years, 63% were male and 42% were under age 18 years. Lacerations were on the upper extremity (42%), face (30%), lower extremity (14%) and scalp (8%). Of patients with a single laceration closed with either TSA or sutures/staples, use of TSA did not differ by age, sex, year, geographic location or wound site. ED LOS was significantly shorter in patients whose wounds were closed with TSA (101 ± 7 vs. 136 ± 4 min; P 0.001). After adjusting for potential confounding variables, use of TSA was associated with a 26 (95% CI 9-44) minute shorter ED LOS (P = 0.004) then sutures/staples.Topical skin adhesives are used in about 1 of 4 wound closures in the ED. Use of TSA did not differ based on demographic characteristics or wound site. Use of TSA is associated with a shorter ED LOS than sutures/staples.

Diabetic foot ulcers (DFUs) have significant clinical impact and carry a substantial economic burden. Patients with DFUs that are refractory to standard wound care are at risk for major complications, including infection and amputation and have an increased risk of mortality. This study evaluated the safety and preliminary efficacy of a novel decellularised purified reconstituted bilayer matrix (PRBM) in treating DFUs. Ten diabetic patients with refractory wounds that failed to heal after at least 4 weeks of standard wound care were studied in this Institutional Review Board approved trial. Ten consecutive wounds were treated weekly with the PRBM for up to 12 weeks. At each weekly visit, the wound was evaluated, photographed, and cleaned, followed by application of new graft if not completely epithelialised. Assessment included measurement of the wound area and inspection of the wound site for signs of complications. The primary outcome measure was wound closure, as adjudicated by independent reviewers. Secondary outcomes included assessment of overall adverse events, time to closure, percent area reduction, and the cost of product(s) used. Nine of 10 patients achieved complete wound closure within 4 weeks, and 1 did not heal completely within 12 weeks. The mean time to heal was 2.7 weeks. The mean wound area reduction at 12 weeks was 99%. No adverse events nor wound complications were observed. These early clinical findings suggest that the PRBM may be an effective tool in the treatment of diabetic foot ulcers.

Background: Surgical and wound site infections (SWSIs) are the second most frequent type of healthcare-associated Infection. One way of preventing SWSIs is by adhering to the principles of asepsis. However, many nurses struggle to apply the principles of aseptic non-touch technique (ANTT) during wound management. Aim: To identify the barriers and enablers that influence nurses' adherence to the principles of ANTT during wound care. Method: A literature search using a systematic approach was carried out. Four databases were searched to identify relevant studies published between January 1993 and December 2018. Titles and abstracts were reviewed. Studies that met the inclusion criteria were reviewed for quality. The extracted data were then synthesised. Findings: A total of seven studies fulfilled the requirements for inclusion. Three themes emerged and were found to be the most dominant factors influencing adherence to the principles of ANTT: material and resources, nurse education, and nurses' behaviour. Conclusion: Nurses' compliance with aseptic practice is directly influenced by environmental and psychological factors. Ensuring compliance to ANTT may require an integrated approach involving local, national and worldwide organisations, in collaboration with higher education institutions that teach nurses and similar healthcare professionals.

Wound healing is a complex cellular, pathophysiological and biochemical cascade of sequence resulting in reconstruction, remodeling as well as regeneration of injured tissues. The objective of the present study was to evaluate the efficacy of essential oil based polyherbal spray on wound repair. Seven horses with accidental wounds were treated with a topical application of an essential oil based polyherbal spray, under field conditions. When compared with a contra-lateral control (therapy regime included conventional topical antibiotic dressing), the phytogenic spray succeeded in an early and healthy reconstruction of the wound site. This phytogenic spray also worked as a fly repellent and prevented myiasis. It was concluded that the topical use of phytogenic spray is not only effective, safe and simple, but also reduces the otherwise physiological body burden of antibiotics in horses.

Aloe vera is an herbal plant that has been used extensively for centuries as a natural medicine. Aloe vera therapy activities can be used to treat skin lesions, such as burns. The gel has healing, analgesic, and anti-inflammatory activity, besides being a powerful moisturizing and protective skin agent. The speed of healing in the aloe vera group is better than the conventional group. Effects produced by aloe vera gel with reference to wound contraction, wound closure, decrease in wound surface area, tissue regeneration at the wound site. Aloe vera contains important nutrients such as vitamins A, C and E, which act as antioxidants, minerals (calcium, copper, magnesium, potassium, and zinc), enzymes, glycoproteins, amino acids, carbohydrate constituents, such as polysaccharides and salicylic acids

BackgroundOver the past decade, the treatment of midshaft clavicular fractures has increasingly shifted from conservative to operative therapy. The overall results seem to be better with surgery, although the problem of nonunion remains. The aim of this study was to report the functional results after operative revision of clavicular nonunions in two German level‑1 trauma centers.MethodsAll patients who underwent surgery for clavicular nonunions during the past 10 years were invited for a structured clinical follow-up examination. The major functional outcome parameter was the age- and gender-adjusted Constant score. Additionally, radiographic fracture union was assessed with the available X‑rays. Complications such as wound site infections were also monitored.ResultsIn total, 31 patients were available for assessment. The mean follow-up rate was 69.7 ± 31.2 months. The mean age of the patients was 52.3 ± 15.2 years. The nonunion was classified as atrophic in 26 cases and hypertrophic in five. A total of 25 (80.6%) patients were treated with angular stable plating combined with autologous bone grafting from the iliac crest. The age- and gender-adjusted Constant score was significantly decreased compared with the noninjured side (82.2 ± 17.1 vs. 95.6 ± 10). Radiographic union was achieved in 30 of the 31 patients (96.8%). Complications with need for surgical revision were recorded for two patients.ConclusionSurgery for clavicular nonunion is a safe and well-established procedure, which leads to radiographic union and good functional results for the majority of cases.

Background: The aim of this study was to examine the characteristics of patients presenting to a pediatric emergency department in a rural province of Turkey due to horse and donkey bites and to analyze whether these features differ from those of more common animal bites in rural areas. Materials and Methods: The records of patients presenting to the pediatric emergency department of a tertiary hospital due to horse and donkey bites over a 3-year period were examined retrospectively. Demographic data, month of presentation, animal species involved (horse or donkey), the body area bitten, treatment applied to the wound site, whether tetanus and rabies vaccinations were administered, and whether or not antibiotics were prescribed on discharge from the emergency department were recorded from these files. Results: The annual incidence of horse and donkey bites was determined as 7.8/100,000. Thirty-six patients, 24 (66.7%) boys and 12 (33.3%) girls, with a mean age of 95.6 ± 33.9 (48–190) months, were included in the study. Twenty-six patients (72.2%) were bitten by donkeys, and 10 (27.8%) by horses. Bites were most common in September (30.6%). The most commonly bitten areas were the back and/or upper extremities. Rabies vaccination was administered in all cases. Amoxicillin–clavulanic acid was prescribed in 28 (77.8%) cases. Conclusion: Horse and donkey bites are frequently observed in rural areas. The inhabitants of such areas should therefore be educated concerning horse and donkey bites. Health workers encountering such bites should behave in the same way as in more common animal bites in terms of patient management. Our results will be instructive for other developing countries similar to Turkey.

Introduction Cesarean section is one of the most commonly performed surgical procedures. Postoperative pain after cesarean section is moderate to severe, though it has been neglected due to several reasons. Systemic opoids, local wound infiltration, and abdominal nerve blocks are among popular techniques used for postoperative pain after cesarean section in an area where epidural analgesia is barely practiced. Thus, this study aimed to assess the analgesic effectiveness of II-IH nerve block and wound site infiltration for pain management after cesarean section. Method An institutional based prospective cohort study was conducted on 72 parturient scheduled for elective cesarean section. The parturients grouped based on whether they took II-IH, WSI or non-exposed groups. Data collection methods include preoperative chart review, intraoperative observation and postoperative patient interview starting from recovery room for 24 h. Time to first analgesic request, NRS score and total analgesic consumption were used as outcome variables. Continuous data were analyzed using one-way analysis of variance (ANOVA) or kuruska-walih H rank test depending on normality whereas categorical data analyzed by Pearson chi-square test. Result Time to first analgesic request was significantly prolonged in II-IH groups compared to WSI and Non-exposed groups with p-value 0.01. Similarly, NRS score within 24 h was significantly lower in II-IH groups compared to Non-exposed Group at all follow up periods except at 2 and 24 h. However, WSI reduced NRS score, in a comparison with non-exposed group, only at 4 and 6 h with p-value of 0.04 and 0.02 respectively. In addition, the post hoc comparison of total tramadol consumption revealed significant difference between all the possible three comparisons. Conclusion and Recommendation Although II-IH nerve block provides better and prolonged pain relief, WSI was also effective analgesic technique for post cesarean section pain. Therefore, we recommend use of either II-IH or WSI as a part of post-operative pain management for cesarean section. Further Randomized controlled trial studies were also recommended on similar area.

Nonhealing diabetic foot ulcers are a major health concern, reducing the quality of life of individuals and families. It is well-known that reduction and redistribution of plantar pressure prevents ulceration or its recurrence. However, studies regarding the use of customized insoles to off-load existing ulcers are limited. This case series highlights the potential of customized insoles in improving outcomes of diabetic plantar foot ulcers in three patients. Functional Ambulation Performance Score (FAPS) and plantar pressure readings obtained from barefooted gait analysis were noted. Customized insoles were crafted using fully customized insole (Boyner insole) technology at Advanced Wound Care Department, Deenanath Mangeshkar Hospital, Maharashtra, India for every subject as necessary. Gait analysis, wearing footwear with customized insoles, was performed immediately and repeated after 2 months for comparison. All three cases presented with improved FAPS, reduced plantar pressure at wound site, and accelerated healing after 4 months.

The aim of stem cell therapy is to repair damaged tissues. Some of the challenges facing its success include cell retention and survival at the wound site. While the retention of cells has been addressed by employing scaffolds, the survival of transplanted cells in the repair tissue is however low. It is hypothesized that the observed regeneration is more a result of migration of tissue repairing cells from adjoining tissues in response to paracrine factors secreted by implanted cells than by the implanted cells per se. In this study, we report the synthesis of a self-healing hybrid hydrogel that is injectable. The hybrid hydrogel was developed using the dynamic equilibrium of Schiff base linkage between the aldehyde groups on carboxymethyl cellulose dialdehyde (CMC-D) and amino groups on carboxymethyl chitosan (CMCh). The hydrogel stiffness and kinetics of gelation were observed to be modulated with different molecular weights of chitosan.

Delayed wound healing causes problems for many patients both physically and psychologically, contributing to pain, economic burden, loss of function, and even amputation. Although many factors affect the wound healing process, abnormally prolonged or augmented inflammation in the wound site is a common cause of poor wound healing. Excessive neutrophil extracellular trap (NET) formation during this phase may amplify inflammation and hinder wound healing. However, the roles of NETs in wound healing are still unclear. Herein, we briefly introduce NET formation and discuss the possible NET-related mechanisms in wound healing. We conclude with a discussion of current studies, focusing on the roles of NETs in diabetic and normoglycemic wounds and the effectiveness of NET-targeting treatments in wound healing.

Generally, the term wounds refer to the discontinuity in the skin. Wounds mainly occur due to minor accidents, surgery, skin infections, burns, and many other factors. Microbial pathogens such as Staphylococcus Aureus and Streptococcus sp. are commonly associated with infections. The main aim of proposed study is to provide an overview on wound healing using hydrogels made with natural plant extracts. Usage of natural plant extracts such as neem, tridax, and combination of neem and tridax for the synthesis of hydrogels. Hydrogels will create a moist environment in the wound site to remove exudates and clear infections by providing a smooth cooling effect. It is an ideal wound dressing method, which initiates the tissue regeneration process. The hydrogels are successful in the wound healing, when compared to other traditional methods.

Corresponding Background Wound healing Process and Scars are still a nightmare for the surgeon and the author: patient as well, because of the large number and wide variability of factors affecting the process itself. Plasma injection is a very promising futuristic therapy and can be superior to PRP injection having more abundant growth factors, fibrin and healing promoters. Aim of the Work to evaluate the effect of injection of the whole plasma components in the wound site intradermally immediately after primary wound closure on the process of wound healing. Patients and Methods This prospective co-operative study included 20 patients having wounds in different sites of the abdomen after approval of research ethical committee of the Faculty of Medicine, Ain Shams University at July 2018, The patients are divided into two groups: an interventional group (group A) 10 cases which are received plasma treatment together with the usual wound care, and a control group (group B) 10 cases which are received the usual wound care only without plasma treatment, in the period between August 2018 to March 2019. Results We have found a faster wound healing process, higher cosmetic results, better color match, more patients' satisfaction and lower susceptibility to complications in the interventional group (A) that received plasma injection than in the control group (B) which received only the usual wound care without plasma injection reflecting the positive impact of plasma injection on the wound healing process. Conclusion We concluded that there are reasonable amount of data that warrant continued research and usage of plasma in the process of wound healing.

Objective: Venous leg ulcers (VLUs) comprise 80% of leg ulcers. One of the key parameters that can promote healing of VLUs is tissue oxygenation. To date, clinicians have employed visual inspection of the wound site to determine the healing progression of a wound. Clinicians measure the wound size and check for epithelialization. Imaging for tissue oxygenation changes surrounding the wounds can objectively complement the subjective visual inspection approach. Herein, a handheld noncontact near-infrared optical scanner (NIROS) was developed to measure tissue oxygenation of VLUs during weeks of treatment. Approach: Continuous-wave-based diffuse reflectance measurements were processed using Modified Beer-Lambert's law to obtain changes in tissue oxygenation (in terms of oxy-, deoxy-, total hemoglobin, and oxygen saturation). The tissue oxygenation contrast obtained between the wound and surrounding tissue was longitudinally mapped across weeks of treatment of four VLUs (healing and nonhealing cases). Results: It was observed that wound to background tissue oxygenation contrasts in healing wounds diminished and/or stabilized, whereas in the nonhealing wounds it did not. In addition, in a very slow-healing wound, wound to background tissue oxygenation contrasts fluctuated and did not converge. Innovation: Near-infrared imaging of wounds to assess healing or nonhealing of VLUs from tissue oxygenation changes using a noncontact, handheld, and low-cost imager has been demonstrated for the first time. Conclusion: The tissue oxygenation changes in wound with respect to the surrounding tissue can provide an objective subclinical physiological assessment of VLUs during their treatment, along with the gold-standard visual clinical assessment.

WOS: 000488951800013 Helcococcus kunzii is a gram-positive and catalase negative cocci that can be pathogenic especially in lower extremity wounds and cellulite of diabetic patients. This study aimed to report the case of a diabetic patient with an advanced wound infection after bone fracture caused by H. kunzii with Staphylococcus aureus. Beta-haemolytic staphylococci-like colonies and alpha-haemolytic streptococci-like colonies were observed in the wound sample. Catalase and oxidase tests of alpha haemolytic colonies were found negative. In the identification with VITEK 2 (bioMerieux, France), the bacteria were identified as S. aureus and H. kunzii. H. kunzii isolate was susceptible to ampicillin, ceftriaxone, cefepime, cefotaxime and vancomycin; resistant to erythromycin and clindamycin. Amoxicillin-clavulanic acid was used for the treatment of the patient, and the patient recovered. This case supports the knowledge that H. kunzii can cause soft tissue infection with bacteria such as S. aureus.

Regenerative therapy with keratinocyte growth factor (KGF) is a novel therapeutic approach for treatment of chronic wounds. However, KGF cannot be used directly to the wound site due to its physicochemical instability. In previous study, sacran, a natural megamolecular polysaccharide, showed potential properties as a biomaterial for hydrogel film in wound healing. In this study, we fabricated sacran hydrogel film containing KGF (Sac/KGF-HF) and evaluated the effects of Sac/KGF-HF on fibroblasts migration and re-epithelialization process. We successfully prepared a homogenous and -amorphous Sac/KGF-HF by a casting method. In addition, Sac/KGF-HF had a high swelling ratio and flexibility. Sac/KGF-HF promoted a migration process of NIH3T3 cells and improved wound healing ability in mice with a percentage of wound closure reaching 90.4% at 9 d. Interestingly, the addition of KGF in Sac-HF considerably increased the number of epithelial cells compared to control, which is important in the re-epithelialization process. It could be concluded that KGF in Sac-HF has the potential for promoting Sac-HF abilities in wound healing process.

Munchausen syndrome is a rare type of mental disorder in which the patient fakes illness to gain attention and sympathy. Patients may lie about symptoms, make themselves appear sick, or make themselves purposely unwell. We describe a case of repeated enterocutaneous fistula in Munchausen syndrome. A 53-year-old Japanese male was admitted to our hospital for the treatment of a high-flow enterocutaneous fistula. Surgery was performed two times, but the fistula recurred each time. Chopsticks with blood on them were coincidentally detected in the trash in the patient’s room. It was revealed that the enterocutaneous fistula was caused by self-mutilation. A psychiatrist was consulted, and the patient was diagnosed with Munchausen syndrome. The psychiatrist initiated treatment and the patient admitted the self-harm. His prolonged wound site was closed and he was able to be discharged. There has been no recurrence of the self-harm as of this writing, 3 years later. The treatment of Munchausen syndrome is difficult and early detection is important.

In this article, novel antibacterial porous microcarriers with a pathological state responsive switch were developed to promote wound healing. The porous microcarrier includes an inverse opal scaffold generated by a temperature-responsive hydrogel that deforms according to different temperatures and a biodegradable sodium alginate hydrogel used as a vehicle to load drugs. Thus, the microcarrier is endowed with the ability of releasing loaded drugs when the temperature changes in the wound site due to an inflammation reaction. Without inflammation, the microcarriers will be locked and the release of drug molecules will not continue, which prevents the abuse of drugs and further improves the safety of the therapeutic treatment. The designed microcarriers could eliminate inflammation significantly and promote the formation of granulation tissue, angiogenesis, and collagen deposition in the wound site. These features indicate that these microcarriers with a pathological state responsive switch are ideal for promoting wound healing and will have a great potential in biomedical applications.

Myeloid-derived suppressor cells (MDSCs) have been identified in the burn wound, however their characterization is incomplete. To study this, mice were subjected to a major burn and skin cells were isolated 3 days thereafter for analysis. Significant infiltration of the burn wound with MDSCs was observed as compared with uninjured skin. The skin of naive mice did not contain MDSCs. Characterization of the cells showed that 33% of MDSCs in the wound were monocytic (M)-MDSCs, which was significantly less than that found in uninjured skin (52%). In contrast, polymorphonuclear (PMN)-MDSCs were greater in the burn wound as compared with uninjured skin. Burn wound TLR expression by both MDSCs subsets was decreased as compared with uninjured skin. Wound MDSCs produced pro- and anti-inflammatory cytokines and iNOS was present in both MDSC subsets, whereas ARG1 was only present in M-MDSCs. In conclusion, both M- and PMN-MDSCs infiltrate burn wound with after injury, however, they displayed decreased TLR expression, suggesting receptor down-regulation.