Objectives: To identify independent risk factors for abdominal wound dehiscence and develop a risk model to recognize high risk patients. Methods: The samples studied were patients who underwent midline laparotomy in ...Objectives: To identify independent risk factors for abdominal wound dehiscence and develop a risk model to recognize high risk patients. Methods: The samples studied were patients who underwent midline laparotomy in the department of surgery, SMHS Hospital Srinagar from March 2009 to April 2015. For each case of abdominal wound dehiscence, three controls were selected from a group of patients who had undergone open abdominal surgery as close as possible in time. Preoperative, perioperative, and postoperative variables and in-hospital mortality were studied for all patients. Cases were compared with controls using the chi-square test or the Mann-Whitney U-test for categorical or continuous data, respectively. Subsequently, multivariate stepwise logistic regression with backwards elimination test used to identify main independent risk factors of abdominal wound dehiscence. The resulting regression coefficients for the major risk factors were used as weights for these variables to calculate a risk score for abdominal wound dehiscence. Results: 140 cases of abdominal wound dehiscence were reported and compared with 420 selected controls. All variables that were significant in univariate analyses were entered in a multivariate stepwise logistic regression to determine which variables were significant independent risk factors. Major independent risk factors were male gender, chronic pulmonary disease, corticosteroid use, smoking, obesity, anemia, jaundice, ascites, and sepsis, type of surgery, postoperative coughing, and wound infection. Based on these findings, a risk model was developed. Conclusions: The model can give an estimate of the risk of abdominal wound dehiscence for individual patients. High-risk patients may be planned preventive wound closing with reinforcements as mesh.展开更多
Wound complications are estimated to be affected in about 9% of TKA patients, which may increase the risk of deep periprosthetic infection and results in re-operation, joint fusion, or amputation. Here we have reporte...Wound complications are estimated to be affected in about 9% of TKA patients, which may increase the risk of deep periprosthetic infection and results in re-operation, joint fusion, or amputation. Here we have reported a female patient who suffered wound rupture due to early post-operation mobilization and weight-bearing. The wound dehiscence was successfully managed by applying recombinant basic fibroblast growth factor-2 and anti-infective treatment without removing prosthetic joint.展开更多
Spontaneous wound separation may be developed even months after suture removal especially in the context of long-term corticosteroid therapy. A 68-yearold Caucasian woman presented to our cornea clinic with spontaneou...Spontaneous wound separation may be developed even months after suture removal especially in the context of long-term corticosteroid therapy. A 68-yearold Caucasian woman presented to our cornea clinic with spontaneous wound dehiscence after her third penetrating keratoplasty(PKP) which was performed three years ago. An Ahmed glaucoma valve(New World Medical, Ranchos Cucamonga, CA) was inserted ten months after the third PKP, which successfully controlled intraocular pressure(IOP). At the examination, the last sutures were removed eight months ago and she was using flourometholone 0.1%(Sina Darou, Tehran, Iran)with a dose of once a day. There was one quadrant of wound dehiscence from 8 to 11 o`clock associated with anterior wound gape and severe corneal edema.Resuturing was performed for the patient. At the one month examination, the corneal edema was resolved and best corrected visual acuity was 20/200 mainly due to previous glaucomatous optic neuropathy. Caution about the prolonged use of corticosteroids is necessary. Topical immunosuppressives could be a promising choice in this field.展开更多
Background: Midline incisions have advantage of rapid and wide access to the abdominal cavity with minimal damage to muscles, nerves and the vascular supply of the abdominal wall, hence causing minimal long term morbi...Background: Midline incisions have advantage of rapid and wide access to the abdominal cavity with minimal damage to muscles, nerves and the vascular supply of the abdominal wall, hence causing minimal long term morbidity. The techniques of wound closure after midline laparotomy differ among operating surgeons and institutions. Faulty techniques and suture materials used play a crucial role in post-operative wound complications like stich abscess, surgical site infections, wound burst and incisional hernia. Aims: The aim of this study is to assess the outcome of midline abdominal wound closure using small tissue bites versus large tissue bites with reference to surgical site infection and wound dehiscence. Materials and methods: The study is the prospective observational study conducted in the department of general surgery Government Medical College Srinagar. A total of 100 cases were enrolled and studied who underwent midline laparotomy in the elective as well as emergency settings from 2015 to 2018. In 50 patients midline incisions were closed with large tissue bites placed at least 10 mm from the wound edge and 10 mm apart and in another 50 patients small tissue bites were used placed 5 - 7 mm from the wound edge and 5 - 7 mm apart and included only the aponeurosis in the stitches without peritoneum. Results: In all, 100 patients, 50 patients were subjected to large tissue bites and another 50 patients to small tissue bites. 15 patients out of 50 patients (30%) in large tissue bites group and 10 patients (20%) in small tissue bites developed surgical site infection. 8 patients out of 50 patients (16%) in large tissue bites group and 4 patients (8%) in small tissue bites developed wound dehiscence. Conclusion: A total of 100 patients who underwent abdominal surgery through midline incision were divided into two groups. In 50 patients midline wound was closed using large tissue bites and in other 50 patients;small tissue bites was used to close midline incision including only aponeurosis. The research findings show that the small stitch length between 5 to 7 mm depending on the wound site is the ideal stitch length to close a midline incision. However, there was no statistical deference seen in both groups with reference to surgical site infection and wound dehiscence.展开更多
Aim: To evaluate the factors influencing fascial wound dehiscence after midline laparotomy in the patients of perforation peritonitis with an emphasis on measurement of “intra-abdominal” pressure (IAP) and fascial t...Aim: To evaluate the factors influencing fascial wound dehiscence after midline laparotomy in the patients of perforation peritonitis with an emphasis on measurement of “intra-abdominal” pressure (IAP) and fascial transforming growth factor-beta (TGF-beta). Methods: Hundred eligible adult patients with the diagnosis of perforation peritonitis who underwent emergency exploratory laparotomy were prospectively recruited. Forty five patients who developed midline abdominal wound dehiscence were compared with 55 patients without dehiscence. Results: The variables that were significantly associated with wound dehiscence include anemia, hypo proteinemia, duration of surgery, prolonged postoperative ileus, wound infection and postoperative pulmonary infection. Age, gender, jaundice, cause of peritonitis, wound contamination and types of surgery were non significant variables. The mean IAP value in the patients with dehiscence was significantly higher than “non-dehiscence” group (p = 0.000). The patients with wound dehiscence strongly expressed TGF-beta on the day of burst. Conclusion: The patients of peritonitis undergoing prolonged surgery in the presence of risk factors like anemia, hypo proteinemia, postoperative ileus, wound infection and postoperative pulmonary infection have high risk of abdominal wound dehiscence.展开更多
Utilization of negative pressure wound therapy with instillation (NPWTi) for sternal dehiscence wounds secondary to sternal wound infection after surgery has become an accepted therapy. NPWTi accelerates wound healing...Utilization of negative pressure wound therapy with instillation (NPWTi) for sternal dehiscence wounds secondary to sternal wound infection after surgery has become an accepted therapy. NPWTi accelerates wound healing through macrostrain, microstrain, and cyclic fluid instillation. Wounds benefit from additional superficial infection control with the removal of microorganisms, the release of proinflammatory mediators, stimulation of angiogenesis, as well as mechanical debridement. However, very few cases of utilizing NPWTi in the treatment of sternal wound infections have been reported in the literature. This case study describes the use of NPWTi with hypochlorous acid for the treatment of a sternal wound infection.展开更多
Lilies are widely cultivated for cut flowers,but their large anthers carry a considerable amount of colored pollen that is dispersed easily.Studying the molecular mechanism of anther development and dehiscence could h...Lilies are widely cultivated for cut flowers,but their large anthers carry a considerable amount of colored pollen that is dispersed easily.Studying the molecular mechanism of anther development and dehiscence could help solve this problem.LoMYB21,encoding a putative R2R3v-myb avian myeloblastosis viral oncogene homolog(MYB)transcription factor,was identified from oriental lilies(Lilium‘Siberia’).Real-time quantitative PCR analysis showed that LoMYB21 was mainly expressed in the anther,filament and stigma and had high expression during the late stages of lily anther development.LoMYB21 had transactivation activity and was located in the nucleus through yeast one-hybrid assays and transient expression in Nicotiana benthamiana.Suppression of LoMYB21 by virus-induced gene silencing(VIGS)in Lilium‘Siberia’led to anther indehiscence and reduced the expression of genes related to Jasmonate acid(JA)biosynthesis and signal transduction.Induction of LoMYB21 in DEX::LoMYB21 transgenic Arabidopsis caused procumbent inflorescences that became infertile,accompanied by higher expression of JA biosynthetic and signaling genes.These results demonstrated that JA content and signaling were abnormal in silenced lily and transgenic LoMYB21 Arabidopsis,which affected anther development.Our study indicated that LoMYB21 could regulate lily anther dehiscence through JA biosynthesis and signaling during the late stages of anther development.展开更多
Background: Bilayer artificial dermis promotes wound healing and offers a treatment option for chronic wounds. Aim: Examine the clinical efficacy of bilayer artificial dermis combined with Vacuum Sealing Drainage (VSD...Background: Bilayer artificial dermis promotes wound healing and offers a treatment option for chronic wounds. Aim: Examine the clinical efficacy of bilayer artificial dermis combined with Vacuum Sealing Drainage (VSD) technology in the treatment of chronic wounds. Method: From June 2021 to December 2023, our hospital treated 24 patients with chronic skin tissue wounds on their limbs using a novel tissue engineering product, the bilayer artificial dermis, in combination with VSD technology to repair the wounds. The bilayer artificial dermis protects subcutaneous tissue, blood vessels, nerves, muscles, and tendons, and also promotes the growth of granulation tissue and blood vessels to aid in wound healing when used in conjunction with VSD technology for wound dressing changes in chronic wounds. Results: In this study, 24 cases of chronic wounds with exposed bone or tendon larger than 1.0 cm2 were treated with a bilayer artificial skin combined with VSD dressing after wound debridement. The wounds were not suitable for immediate skin grafting. At 2 - 3 weeks post-treatment, good granulation tissue growth was observed. Subsequent procedures included thick skin grafting or wound dressing changes until complete wound healing. Patients were followed up on average for 3 months (range: 1 - 12 months) post-surgery. Comparative analysis of the appearance, function, skin color, elasticity, and sensation of the healed chronic wounds revealed superior outcomes compared to traditional skin fl repairs, resulting in significantly higher satisfaction levels among patients and their families. Conclusion: The application of bilayer artificial dermis combined with VSD technology for the repair of chronic wounds proves to be a viable method, yielding satisfactory therapeutic effects compared to traditional skin flap procedures.展开更多
Purpose: The aim is to show epidemiological, clinical and etiological characteristics of palpebral wounds. Methodology: This was a retrospective study focusing on patients with an eyelid wound, over a 10-year period f...Purpose: The aim is to show epidemiological, clinical and etiological characteristics of palpebral wounds. Methodology: This was a retrospective study focusing on patients with an eyelid wound, over a 10-year period from 2012 to 2021. We collected and analyzed the data using Excel. Results: The frequency of eyelid wounds was 0.1%. The average age of our patients was 19.38 years with a range of 1 and 62 years. The sex ratio was 3.7. Eighty-one percent of patients lived in Dakar. Fifty-seven percent (57%) of patients consulted less than 24 hours after the trauma and 7% of patients on D1. The circumstances were brawls (11%), domestic accidents (9%), road accidents (6%), and work accidents (6%). We noted 1 case of dog bite. Thirteen patients presented with post-traumatic decreased visual acuity. Involvement of the isolated upper eyelid was noted in 40% of cases and both eyelids in 15% of cases. Involvement of the lacrimal ducts was noted in 17% of cases, and that of the free edge in 21% of cases. Eyelid wounds were associated with eyeball damage in 21% of cases. Various associated lesions were observed. Ninety-one percent of patients received surgical treatment. Three cases of superinfections, 1 case of conjunctival granuloma and 1 case of phthysis of the eyeball with postoperative retinal detachment were noted. Conclusion: Eyelid sores are relatively common in our context. They require rapid surgical treatment in order to preserve the functional and aesthetic prognosis. .展开更多
BACKGROUND Endoscopic full-thickness resection(EFTR)of gastric submucosal tumors(SMTs)is safe and effective;however,postoperative wound management is equally important.Literature on suturing following EFTR for large(...BACKGROUND Endoscopic full-thickness resection(EFTR)of gastric submucosal tumors(SMTs)is safe and effective;however,postoperative wound management is equally important.Literature on suturing following EFTR for large(≥3 cm)SMTs is scarce and limited.AIM To evaluate the efficacy and clinical value of double-nylon purse-string suture in closing postoperative wounds following EFTR of large(≥3 cm)SMTs.METHODS We retrospectively analyzed the data of 85 patients with gastric SMTs in the fundus of the stomach or in the lesser curvature of the gastric body whose wounds were treated with double-nylon purse-string sutures after successful tumor resection at the Endoscopy Center of Renmin Hospital of Wuhan University.The operative,postoperative,and follow-up conditions of the patients were evaluated.RESULTS All tumors were completely resected using EFTR.36(42.35%)patients had tumors located in the fundus of the stomach,and 49(57.65%)had tumors located in the body of the stomach.All patients underwent suturing with double-nylon sutures after EFTR without laparoscopic assistance or further surgical treatment.Postoperative fever and stomach pain were reported in 13(15.29%)and 14(16.47%)patients,respectively.No serious adverse events occurred during the intraoperative or postoperative periods.A postoperative review of all patients revealed no residual or recurrent lesions.CONCLUSION Double-nylon purse-string sutures can be used to successfully close wounds that cannot be completely closed with a single nylon suture,especially for large(≥3 cm)EFTR wounds in SMTs.展开更多
Obesity has become more prevalent in the global population.It is associated with the development of several diseases including diabetes mellitus,coronary heart disease,and metabolic syndrome.There are a multitude of f...Obesity has become more prevalent in the global population.It is associated with the development of several diseases including diabetes mellitus,coronary heart disease,and metabolic syndrome.There are a multitude of factors impacted by obesity that may contribute to poor wound healing outcomes.With millions worldwide classified as obese,it is imperative to understand wound healing in these patients.Despite advances in the understanding of wound healing in both healthy and diabetic populations,much is unknown about wound healing in obese patients.This review examines the impact of obesity on wound healing and several animal models that may be used to broaden our understanding in this area.As a growing portion of the population identifies as obese,understanding the underlying mechanisms and how to overcome poor wound healing is of the utmost importance.展开更多
BACKGROUND Diabetic foot(DMF)complications are common and are increasing in incidence.Risk factors related to wound complications are yet to be established after transtibial amputation under the diagnosis of DMF infec...BACKGROUND Diabetic foot(DMF)complications are common and are increasing in incidence.Risk factors related to wound complications are yet to be established after transtibial amputation under the diagnosis of DMF infection.AIM To analyze the prognosis and risk factors related to wound complications after transtibial amputation in patients with diabetes.METHODS This retrospective cohort study included seventy-two patients with DMF complications who underwent transtibial amputation between April 2014 and March 2023.The groups were categorized based on the occurrence of wound complications,and we compared demographic data between the complication group and the non-complication group to analyze risk factors.Moreover,a multivariate logistic regression analysis was performed to identify risk factors.RESULTS The average follow-up period was 36.2 months.Among the 72 cases,31(43.1%)had wound complications.Of these,12 cases(16.7%)received further treatment,such as debridement,soft tissue stump revision,and re-amputation at the proximal level.In a group that required further management due to wound complications after transtibial amputation,the hemoglobin A1c(HbA1c)level was 9.32,while the other group that did not require any treatment had a 7.54 HbA1c level.The prevalence of a history of kidney transplantation with wound complications after transtibial amputation surgery in DMF patients was significantly greater than in cases without wound complications(P=0.02).Other factors did not show significant differences.CONCLUSION Approximately 43.1%of the patients with transtibial amputation surgery experienced wound complications,and 16.7%required additional surgical treatment.High HbA1c levels and kidney transplant history are risk factors for postoperative wound complications.展开更多
In this editorial,we comment on an article by Liao et al published in the current issue of the World Journal of Diabetes.We focus on the clinical significance of tibial transverse transport(TTT)as an effective treatme...In this editorial,we comment on an article by Liao et al published in the current issue of the World Journal of Diabetes.We focus on the clinical significance of tibial transverse transport(TTT)as an effective treatment for patients with diabetic foot ulcers(DFU).TTT has been associated with tissue regeneration,improved blood circulation,reduced amputation rates,and increased expression of early angiogenic factors.Mechanistically,TTT can influence macrophage polarization and growth factor upregulation.Despite this potential,the limitations and conflicting results of existing studies justify the need for further research into its optimal application and development.These clinical implications highlight the efficacy of TTT in recalcitrant DFU and provide lasting stimuli for tissue re-generation,and blood vessel and bone marrow improvement.Immunomodu-lation via systemic responses contributes to its therapeutic potential.Future studies should investigate the underlying molecular mechanisms to enhance our understanding and the efficacy of TTT.This manuscript emphasizes the potential of TTT in limb preservation and diabetic wound healing and suggests avenues for preventive measures against limb amputation in diabetes and peripheral artery disease.Here,we highlight the clinical significance of the TTT and its importance in healing DFU to promote the use of this technique in tissue regeneration.展开更多
Wound repair is a complex challenge for both clinical practitioners and researchers.Conventional approaches for wound repair have several limitations.Stem cell-based therapy has emerged as a novel strategy to address ...Wound repair is a complex challenge for both clinical practitioners and researchers.Conventional approaches for wound repair have several limitations.Stem cell-based therapy has emerged as a novel strategy to address this issue,exhibiting significant potential for enhancing wound healing rates,improving wound quality,and promoting skin regeneration.However,the use of stem cells in skin regeneration presents several challenges.Recently,stem cells and biomaterials have been identified as crucial components of the wound-healing process.Combination therapy involving the development of biocompatible scaffolds,accompanying cells,multiple biological factors,and structures resembling the natural extracellular matrix(ECM)has gained considerable attention.Biological scaffolds encompass a range of biomaterials that serve as platforms for seeding stem cells,providing them with an environment conducive to growth,similar to that of the ECM.These scaffolds facilitate the delivery and application of stem cells for tissue regeneration and wound healing.This article provides a comprehensive review of the current developments and applications of biological scaffolds for stem cells in wound healing,emphasizing their capacity to facilitate stem cell adhesion,proliferation,differentiation,and paracrine functions.Additionally,we identify the pivotal characteristics of the scaffolds that contribute to enhanced cellular activity.展开更多
This study was carried out to prepare ZnO nanoparticles incorporated acrylamide grafted chitosan composite film for possible biomedical application especially drug loading in wound healing. ZnO nanoparticles were prep...This study was carried out to prepare ZnO nanoparticles incorporated acrylamide grafted chitosan composite film for possible biomedical application especially drug loading in wound healing. ZnO nanoparticles were prepared by co-precipitation method from zinc acetate di-hydrate and incorporated in acrylamide grafted chitosan. FT-IR and TGA of the prepared composite film confirmed the successful incorporation of ZnO nanoparticles in the acrylamide-grafted polymer matrix. SEM images showed that the ZnO nanoparticles were homogeneously distributed on the porous matrix of the composite film. Water uptake and buffer uptake analysis revealed that the composite film could hold water and buffer sufficiently, which facilitated the absorption of exudate from the wound site. Amoxicillin was loaded in the prepared composite film and the maximum loading efficiency was found to be 67.33% with drug concentration of 300 ppm. In vitro studies showed greater antimicrobial activity of drug-loaded composite film compared to both pure film and standard antibiotic disc. Finally, the In vivo mouse model showed maximum healing efficiency compared to conventional gauge bandages because the loading of antibiotic in the film produced a synergistic effect and healing time was reduced.展开更多
Objective:In this study,we investigated the concept of empowerment in chronic wound care and propose to facilitate patient control by making use of degrees of freedom(DOF):that is,shaping of everyday wound care tasks ...Objective:In this study,we investigated the concept of empowerment in chronic wound care and propose to facilitate patient control by making use of degrees of freedom(DOF):that is,shaping of everyday wound care tasks initiated by patients and based on their wishes,mostly in terms of patients executing treatment steps,requesting or directing health care professionals to under take changes,or modifications of internal states.Methods:As a first step,we conducted a systematic literature search,followed by an inductive form of qualitative content analysis,which resulted in the identification of 5 dimensions as main elements of empowerment:education and shared decision making,adherence to self-care behaviors,responsibility and control,general call for empowerment,and DOF.However,the latter are noticeably absent in the literature.To investigate patients'freedom in shaping the wound care process,we conducted a second literature search.Results:A number of possibilities for patients to influence the wound care process could be identified,but experimental or clinical evidence about their effects is missing,their variety is limited,and they are only inadequately described.Conclusions:However,DOF should be an indispensable aspect of genuine empowerment,since they allow patients to occupy the role of the agent in the treatment process and give rise to the subjective experience of feeling empowered.Thus,in the third part,we develop a research proposal on how to investigate and include DOF in the clinical practice of wound care.Finally,limitations about implementations are discussed(e.g.,patients being reluctant to overcome their passive role,resulting in frustration for health care professionals).展开更多
Objective:To explore the effect of the Xian Fang Huo Ming Yin(XFHM)for treating cutaneous infections and promoting wound healing in patients with perianal abscesses.Methods:Sixty-one patients with perianal abscesses w...Objective:To explore the effect of the Xian Fang Huo Ming Yin(XFHM)for treating cutaneous infections and promoting wound healing in patients with perianal abscesses.Methods:Sixty-one patients with perianal abscesses who were admitted to our hospital(Xinghua City People’s Hospital)from May 2022 to May 2023 were selected and randomly divided into two groups,a control group(30 cases)and a study group(31 cases).Both groups received surgical treatment.The control group received conventional treatment and warm water fumigation,sitz bath,and surgical dressing change after surgery,while the research group received XFHM based on the control group.XFHM was taken orally and replaced with warm water for fumigation and sitz bathing.Both groups received treatment for 4 weeks but discontinued sitz bathing after 2 weeks.Various clinical indicators between the two groups were compared.Results:The total clinical effective rate and wound recovery rate of the study group were higher than that of the control group.There were differences in the wound pain scores,surrounding tissue edema,and wound secretions at different time points.Both groups experienced wound pain.The scores of wound pain,surrounding tissue edema,and wound secretions of the study group were lower than those of the control group,7 and 14 days after surgery.The serum interleukin 6(IL-6),tumor necrosis factor-alpha(TNF-α)levels,and pH values of the study group were lower than those of the control group 10 days after surgery(P<0.05).Conclusion:The application of XFHM for treating cutaneous infections and promoting wound healing in patients with perianal abscesses improved the treatment outcome,alleviated clinical symptoms,and promoted healing.展开更多
BACKGROUND Orthopedic surgeries after device implantation are susceptible to infections and may require device removal in the worst cases.For this reason,many efforts are being made to control infections after spinal ...BACKGROUND Orthopedic surgeries after device implantation are susceptible to infections and may require device removal in the worst cases.For this reason,many efforts are being made to control infections after spinal surgery;however,the number of infec-tion cases is increasing owing to the increasing number of elderly citizens.CASE SUMMARY A 75-year-old male with a chronic spinal defect due to previous spine surgery underwent reconstruction using a perforator-based island flap.After bursectomy and confirmation that there was no connection with the deep tissue,reconstruction was performed.However,wound disruption occurred with abscess formation on postoperative day 29,which led to an imaging workup revealing delayed deep tissue infection.CONCLUSION Infection is one of the most common causes of surgical wound dehiscence and is associated with devastating results if not controlled promptly and definitively.Surgeons should always suspect delayed infections when reconstructing chronic soft tissue defects.展开更多
Objective: It remains unknown whether calcium metabolism has any effect on the clinical presentation of superior semicircular canal dehiscence(SSCD). Our aim was to analyse the adjusted calcium and vitamin D levels in...Objective: It remains unknown whether calcium metabolism has any effect on the clinical presentation of superior semicircular canal dehiscence(SSCD). Our aim was to analyse the adjusted calcium and vitamin D levels in SSCD patients compared to a control group.Methods: This was a prospective case-control study performed in a tertiary referral center, university teaching hospital in the UK. It included all new patients with SSCD seen in a dedicated skull base clinic over a 5-year period(2015-2019) compared to a gender and age matched control group. The main outcome of the study was adjusted calcium and Vitamin D levels between the two groups.Results: A total of 31 SSCD patients were recruited with a matched number of control patients. The mean Vitamin D level on the SSCD group was 44.8 nmoL/l(SD: 20.8) compared to 47.5 nmoL/l(SD: 27.4) on the control group(p = 0.702). Mean Adjusted calcium level was 2.34 mmoL/l(SD: 0.7) for SSCD compared to2.41 mmoL/l(SD: 0.11) for controls(p = 0.01), being within normal limits for both the SSCD and the control group.Conclusion: Our study did not identify a link between Vitamin D levels and presence of SSCD. Normal adjusted calcium values were found in both groups. Despite that a statistically significant lower calcium level was found in the SSCD group which could indicate that suboptimal levels of calcium may affect the micro-environment of the otic capsule at the SSC region.展开更多
Dear Editor,The aim of the letter is to stress the need of creating unified recommendations concerning early burn wound excision in cases of mass casualty burns exclusively.There are several triage methods,both for ci...Dear Editor,The aim of the letter is to stress the need of creating unified recommendations concerning early burn wound excision in cases of mass casualty burns exclusively.There are several triage methods,both for civilian and military circumstances,that govern burn casualty triage and evacuation from the incident site,as well as hospital referral up to 120 h from the disaster.展开更多
文摘Objectives: To identify independent risk factors for abdominal wound dehiscence and develop a risk model to recognize high risk patients. Methods: The samples studied were patients who underwent midline laparotomy in the department of surgery, SMHS Hospital Srinagar from March 2009 to April 2015. For each case of abdominal wound dehiscence, three controls were selected from a group of patients who had undergone open abdominal surgery as close as possible in time. Preoperative, perioperative, and postoperative variables and in-hospital mortality were studied for all patients. Cases were compared with controls using the chi-square test or the Mann-Whitney U-test for categorical or continuous data, respectively. Subsequently, multivariate stepwise logistic regression with backwards elimination test used to identify main independent risk factors of abdominal wound dehiscence. The resulting regression coefficients for the major risk factors were used as weights for these variables to calculate a risk score for abdominal wound dehiscence. Results: 140 cases of abdominal wound dehiscence were reported and compared with 420 selected controls. All variables that were significant in univariate analyses were entered in a multivariate stepwise logistic regression to determine which variables were significant independent risk factors. Major independent risk factors were male gender, chronic pulmonary disease, corticosteroid use, smoking, obesity, anemia, jaundice, ascites, and sepsis, type of surgery, postoperative coughing, and wound infection. Based on these findings, a risk model was developed. Conclusions: The model can give an estimate of the risk of abdominal wound dehiscence for individual patients. High-risk patients may be planned preventive wound closing with reinforcements as mesh.
文摘Wound complications are estimated to be affected in about 9% of TKA patients, which may increase the risk of deep periprosthetic infection and results in re-operation, joint fusion, or amputation. Here we have reported a female patient who suffered wound rupture due to early post-operation mobilization and weight-bearing. The wound dehiscence was successfully managed by applying recombinant basic fibroblast growth factor-2 and anti-infective treatment without removing prosthetic joint.
文摘Spontaneous wound separation may be developed even months after suture removal especially in the context of long-term corticosteroid therapy. A 68-yearold Caucasian woman presented to our cornea clinic with spontaneous wound dehiscence after her third penetrating keratoplasty(PKP) which was performed three years ago. An Ahmed glaucoma valve(New World Medical, Ranchos Cucamonga, CA) was inserted ten months after the third PKP, which successfully controlled intraocular pressure(IOP). At the examination, the last sutures were removed eight months ago and she was using flourometholone 0.1%(Sina Darou, Tehran, Iran)with a dose of once a day. There was one quadrant of wound dehiscence from 8 to 11 o`clock associated with anterior wound gape and severe corneal edema.Resuturing was performed for the patient. At the one month examination, the corneal edema was resolved and best corrected visual acuity was 20/200 mainly due to previous glaucomatous optic neuropathy. Caution about the prolonged use of corticosteroids is necessary. Topical immunosuppressives could be a promising choice in this field.
文摘Background: Midline incisions have advantage of rapid and wide access to the abdominal cavity with minimal damage to muscles, nerves and the vascular supply of the abdominal wall, hence causing minimal long term morbidity. The techniques of wound closure after midline laparotomy differ among operating surgeons and institutions. Faulty techniques and suture materials used play a crucial role in post-operative wound complications like stich abscess, surgical site infections, wound burst and incisional hernia. Aims: The aim of this study is to assess the outcome of midline abdominal wound closure using small tissue bites versus large tissue bites with reference to surgical site infection and wound dehiscence. Materials and methods: The study is the prospective observational study conducted in the department of general surgery Government Medical College Srinagar. A total of 100 cases were enrolled and studied who underwent midline laparotomy in the elective as well as emergency settings from 2015 to 2018. In 50 patients midline incisions were closed with large tissue bites placed at least 10 mm from the wound edge and 10 mm apart and in another 50 patients small tissue bites were used placed 5 - 7 mm from the wound edge and 5 - 7 mm apart and included only the aponeurosis in the stitches without peritoneum. Results: In all, 100 patients, 50 patients were subjected to large tissue bites and another 50 patients to small tissue bites. 15 patients out of 50 patients (30%) in large tissue bites group and 10 patients (20%) in small tissue bites developed surgical site infection. 8 patients out of 50 patients (16%) in large tissue bites group and 4 patients (8%) in small tissue bites developed wound dehiscence. Conclusion: A total of 100 patients who underwent abdominal surgery through midline incision were divided into two groups. In 50 patients midline wound was closed using large tissue bites and in other 50 patients;small tissue bites was used to close midline incision including only aponeurosis. The research findings show that the small stitch length between 5 to 7 mm depending on the wound site is the ideal stitch length to close a midline incision. However, there was no statistical deference seen in both groups with reference to surgical site infection and wound dehiscence.
文摘Aim: To evaluate the factors influencing fascial wound dehiscence after midline laparotomy in the patients of perforation peritonitis with an emphasis on measurement of “intra-abdominal” pressure (IAP) and fascial transforming growth factor-beta (TGF-beta). Methods: Hundred eligible adult patients with the diagnosis of perforation peritonitis who underwent emergency exploratory laparotomy were prospectively recruited. Forty five patients who developed midline abdominal wound dehiscence were compared with 55 patients without dehiscence. Results: The variables that were significantly associated with wound dehiscence include anemia, hypo proteinemia, duration of surgery, prolonged postoperative ileus, wound infection and postoperative pulmonary infection. Age, gender, jaundice, cause of peritonitis, wound contamination and types of surgery were non significant variables. The mean IAP value in the patients with dehiscence was significantly higher than “non-dehiscence” group (p = 0.000). The patients with wound dehiscence strongly expressed TGF-beta on the day of burst. Conclusion: The patients of peritonitis undergoing prolonged surgery in the presence of risk factors like anemia, hypo proteinemia, postoperative ileus, wound infection and postoperative pulmonary infection have high risk of abdominal wound dehiscence.
文摘Utilization of negative pressure wound therapy with instillation (NPWTi) for sternal dehiscence wounds secondary to sternal wound infection after surgery has become an accepted therapy. NPWTi accelerates wound healing through macrostrain, microstrain, and cyclic fluid instillation. Wounds benefit from additional superficial infection control with the removal of microorganisms, the release of proinflammatory mediators, stimulation of angiogenesis, as well as mechanical debridement. However, very few cases of utilizing NPWTi in the treatment of sternal wound infections have been reported in the literature. This case study describes the use of NPWTi with hypochlorous acid for the treatment of a sternal wound infection.
基金funded by National Key R&D Program of China(Grant Nos.2020YFD1000402,2018YFD1000400)Chinese Universities Scientific Fund(Grant Nos.2021TC102,2018QC096).
文摘Lilies are widely cultivated for cut flowers,but their large anthers carry a considerable amount of colored pollen that is dispersed easily.Studying the molecular mechanism of anther development and dehiscence could help solve this problem.LoMYB21,encoding a putative R2R3v-myb avian myeloblastosis viral oncogene homolog(MYB)transcription factor,was identified from oriental lilies(Lilium‘Siberia’).Real-time quantitative PCR analysis showed that LoMYB21 was mainly expressed in the anther,filament and stigma and had high expression during the late stages of lily anther development.LoMYB21 had transactivation activity and was located in the nucleus through yeast one-hybrid assays and transient expression in Nicotiana benthamiana.Suppression of LoMYB21 by virus-induced gene silencing(VIGS)in Lilium‘Siberia’led to anther indehiscence and reduced the expression of genes related to Jasmonate acid(JA)biosynthesis and signal transduction.Induction of LoMYB21 in DEX::LoMYB21 transgenic Arabidopsis caused procumbent inflorescences that became infertile,accompanied by higher expression of JA biosynthetic and signaling genes.These results demonstrated that JA content and signaling were abnormal in silenced lily and transgenic LoMYB21 Arabidopsis,which affected anther development.Our study indicated that LoMYB21 could regulate lily anther dehiscence through JA biosynthesis and signaling during the late stages of anther development.
文摘Background: Bilayer artificial dermis promotes wound healing and offers a treatment option for chronic wounds. Aim: Examine the clinical efficacy of bilayer artificial dermis combined with Vacuum Sealing Drainage (VSD) technology in the treatment of chronic wounds. Method: From June 2021 to December 2023, our hospital treated 24 patients with chronic skin tissue wounds on their limbs using a novel tissue engineering product, the bilayer artificial dermis, in combination with VSD technology to repair the wounds. The bilayer artificial dermis protects subcutaneous tissue, blood vessels, nerves, muscles, and tendons, and also promotes the growth of granulation tissue and blood vessels to aid in wound healing when used in conjunction with VSD technology for wound dressing changes in chronic wounds. Results: In this study, 24 cases of chronic wounds with exposed bone or tendon larger than 1.0 cm2 were treated with a bilayer artificial skin combined with VSD dressing after wound debridement. The wounds were not suitable for immediate skin grafting. At 2 - 3 weeks post-treatment, good granulation tissue growth was observed. Subsequent procedures included thick skin grafting or wound dressing changes until complete wound healing. Patients were followed up on average for 3 months (range: 1 - 12 months) post-surgery. Comparative analysis of the appearance, function, skin color, elasticity, and sensation of the healed chronic wounds revealed superior outcomes compared to traditional skin fl repairs, resulting in significantly higher satisfaction levels among patients and their families. Conclusion: The application of bilayer artificial dermis combined with VSD technology for the repair of chronic wounds proves to be a viable method, yielding satisfactory therapeutic effects compared to traditional skin flap procedures.
文摘Purpose: The aim is to show epidemiological, clinical and etiological characteristics of palpebral wounds. Methodology: This was a retrospective study focusing on patients with an eyelid wound, over a 10-year period from 2012 to 2021. We collected and analyzed the data using Excel. Results: The frequency of eyelid wounds was 0.1%. The average age of our patients was 19.38 years with a range of 1 and 62 years. The sex ratio was 3.7. Eighty-one percent of patients lived in Dakar. Fifty-seven percent (57%) of patients consulted less than 24 hours after the trauma and 7% of patients on D1. The circumstances were brawls (11%), domestic accidents (9%), road accidents (6%), and work accidents (6%). We noted 1 case of dog bite. Thirteen patients presented with post-traumatic decreased visual acuity. Involvement of the isolated upper eyelid was noted in 40% of cases and both eyelids in 15% of cases. Involvement of the lacrimal ducts was noted in 17% of cases, and that of the free edge in 21% of cases. Eyelid wounds were associated with eyeball damage in 21% of cases. Various associated lesions were observed. Ninety-one percent of patients received surgical treatment. Three cases of superinfections, 1 case of conjunctival granuloma and 1 case of phthysis of the eyeball with postoperative retinal detachment were noted. Conclusion: Eyelid sores are relatively common in our context. They require rapid surgical treatment in order to preserve the functional and aesthetic prognosis. .
基金This observational study was approved by the Ethics Committee of Renmin Hospital of Wuhan University.
文摘BACKGROUND Endoscopic full-thickness resection(EFTR)of gastric submucosal tumors(SMTs)is safe and effective;however,postoperative wound management is equally important.Literature on suturing following EFTR for large(≥3 cm)SMTs is scarce and limited.AIM To evaluate the efficacy and clinical value of double-nylon purse-string suture in closing postoperative wounds following EFTR of large(≥3 cm)SMTs.METHODS We retrospectively analyzed the data of 85 patients with gastric SMTs in the fundus of the stomach or in the lesser curvature of the gastric body whose wounds were treated with double-nylon purse-string sutures after successful tumor resection at the Endoscopy Center of Renmin Hospital of Wuhan University.The operative,postoperative,and follow-up conditions of the patients were evaluated.RESULTS All tumors were completely resected using EFTR.36(42.35%)patients had tumors located in the fundus of the stomach,and 49(57.65%)had tumors located in the body of the stomach.All patients underwent suturing with double-nylon sutures after EFTR without laparoscopic assistance or further surgical treatment.Postoperative fever and stomach pain were reported in 13(15.29%)and 14(16.47%)patients,respectively.No serious adverse events occurred during the intraoperative or postoperative periods.A postoperative review of all patients revealed no residual or recurrent lesions.CONCLUSION Double-nylon purse-string sutures can be used to successfully close wounds that cannot be completely closed with a single nylon suture,especially for large(≥3 cm)EFTR wounds in SMTs.
文摘Obesity has become more prevalent in the global population.It is associated with the development of several diseases including diabetes mellitus,coronary heart disease,and metabolic syndrome.There are a multitude of factors impacted by obesity that may contribute to poor wound healing outcomes.With millions worldwide classified as obese,it is imperative to understand wound healing in these patients.Despite advances in the understanding of wound healing in both healthy and diabetic populations,much is unknown about wound healing in obese patients.This review examines the impact of obesity on wound healing and several animal models that may be used to broaden our understanding in this area.As a growing portion of the population identifies as obese,understanding the underlying mechanisms and how to overcome poor wound healing is of the utmost importance.
文摘BACKGROUND Diabetic foot(DMF)complications are common and are increasing in incidence.Risk factors related to wound complications are yet to be established after transtibial amputation under the diagnosis of DMF infection.AIM To analyze the prognosis and risk factors related to wound complications after transtibial amputation in patients with diabetes.METHODS This retrospective cohort study included seventy-two patients with DMF complications who underwent transtibial amputation between April 2014 and March 2023.The groups were categorized based on the occurrence of wound complications,and we compared demographic data between the complication group and the non-complication group to analyze risk factors.Moreover,a multivariate logistic regression analysis was performed to identify risk factors.RESULTS The average follow-up period was 36.2 months.Among the 72 cases,31(43.1%)had wound complications.Of these,12 cases(16.7%)received further treatment,such as debridement,soft tissue stump revision,and re-amputation at the proximal level.In a group that required further management due to wound complications after transtibial amputation,the hemoglobin A1c(HbA1c)level was 9.32,while the other group that did not require any treatment had a 7.54 HbA1c level.The prevalence of a history of kidney transplantation with wound complications after transtibial amputation surgery in DMF patients was significantly greater than in cases without wound complications(P=0.02).Other factors did not show significant differences.CONCLUSION Approximately 43.1%of the patients with transtibial amputation surgery experienced wound complications,and 16.7%required additional surgical treatment.High HbA1c levels and kidney transplant history are risk factors for postoperative wound complications.
基金Supported by Grants of the Korea Research Foundation,an NRF Grant Funded by the Korea Government,No.NRF-2023R1A2C3003717.
文摘In this editorial,we comment on an article by Liao et al published in the current issue of the World Journal of Diabetes.We focus on the clinical significance of tibial transverse transport(TTT)as an effective treatment for patients with diabetic foot ulcers(DFU).TTT has been associated with tissue regeneration,improved blood circulation,reduced amputation rates,and increased expression of early angiogenic factors.Mechanistically,TTT can influence macrophage polarization and growth factor upregulation.Despite this potential,the limitations and conflicting results of existing studies justify the need for further research into its optimal application and development.These clinical implications highlight the efficacy of TTT in recalcitrant DFU and provide lasting stimuli for tissue re-generation,and blood vessel and bone marrow improvement.Immunomodu-lation via systemic responses contributes to its therapeutic potential.Future studies should investigate the underlying molecular mechanisms to enhance our understanding and the efficacy of TTT.This manuscript emphasizes the potential of TTT in limb preservation and diabetic wound healing and suggests avenues for preventive measures against limb amputation in diabetes and peripheral artery disease.Here,we highlight the clinical significance of the TTT and its importance in healing DFU to promote the use of this technique in tissue regeneration.
基金Supported by CAMS Innovation Fund for Medical Sciences,No.2020-I2M-C&T-A-004National High Level Hospital Clinical Research Funding,No.2022-PUMCH-A-210,No.2022-PUMCH-B-041,and No.2022-PUMCH-C-025and National Key R&D Program of China,No.2020YFE0201600.
文摘Wound repair is a complex challenge for both clinical practitioners and researchers.Conventional approaches for wound repair have several limitations.Stem cell-based therapy has emerged as a novel strategy to address this issue,exhibiting significant potential for enhancing wound healing rates,improving wound quality,and promoting skin regeneration.However,the use of stem cells in skin regeneration presents several challenges.Recently,stem cells and biomaterials have been identified as crucial components of the wound-healing process.Combination therapy involving the development of biocompatible scaffolds,accompanying cells,multiple biological factors,and structures resembling the natural extracellular matrix(ECM)has gained considerable attention.Biological scaffolds encompass a range of biomaterials that serve as platforms for seeding stem cells,providing them with an environment conducive to growth,similar to that of the ECM.These scaffolds facilitate the delivery and application of stem cells for tissue regeneration and wound healing.This article provides a comprehensive review of the current developments and applications of biological scaffolds for stem cells in wound healing,emphasizing their capacity to facilitate stem cell adhesion,proliferation,differentiation,and paracrine functions.Additionally,we identify the pivotal characteristics of the scaffolds that contribute to enhanced cellular activity.
文摘This study was carried out to prepare ZnO nanoparticles incorporated acrylamide grafted chitosan composite film for possible biomedical application especially drug loading in wound healing. ZnO nanoparticles were prepared by co-precipitation method from zinc acetate di-hydrate and incorporated in acrylamide grafted chitosan. FT-IR and TGA of the prepared composite film confirmed the successful incorporation of ZnO nanoparticles in the acrylamide-grafted polymer matrix. SEM images showed that the ZnO nanoparticles were homogeneously distributed on the porous matrix of the composite film. Water uptake and buffer uptake analysis revealed that the composite film could hold water and buffer sufficiently, which facilitated the absorption of exudate from the wound site. Amoxicillin was loaded in the prepared composite film and the maximum loading efficiency was found to be 67.33% with drug concentration of 300 ppm. In vitro studies showed greater antimicrobial activity of drug-loaded composite film compared to both pure film and standard antibiotic disc. Finally, the In vivo mouse model showed maximum healing efficiency compared to conventional gauge bandages because the loading of antibiotic in the film produced a synergistic effect and healing time was reduced.
基金supported by Dr.Ausbüttel&Co.Gmb H,the University of Witten/Herdecke。
文摘Objective:In this study,we investigated the concept of empowerment in chronic wound care and propose to facilitate patient control by making use of degrees of freedom(DOF):that is,shaping of everyday wound care tasks initiated by patients and based on their wishes,mostly in terms of patients executing treatment steps,requesting or directing health care professionals to under take changes,or modifications of internal states.Methods:As a first step,we conducted a systematic literature search,followed by an inductive form of qualitative content analysis,which resulted in the identification of 5 dimensions as main elements of empowerment:education and shared decision making,adherence to self-care behaviors,responsibility and control,general call for empowerment,and DOF.However,the latter are noticeably absent in the literature.To investigate patients'freedom in shaping the wound care process,we conducted a second literature search.Results:A number of possibilities for patients to influence the wound care process could be identified,but experimental or clinical evidence about their effects is missing,their variety is limited,and they are only inadequately described.Conclusions:However,DOF should be an indispensable aspect of genuine empowerment,since they allow patients to occupy the role of the agent in the treatment process and give rise to the subjective experience of feeling empowered.Thus,in the third part,we develop a research proposal on how to investigate and include DOF in the clinical practice of wound care.Finally,limitations about implementations are discussed(e.g.,patients being reluctant to overcome their passive role,resulting in frustration for health care professionals).
文摘Objective:To explore the effect of the Xian Fang Huo Ming Yin(XFHM)for treating cutaneous infections and promoting wound healing in patients with perianal abscesses.Methods:Sixty-one patients with perianal abscesses who were admitted to our hospital(Xinghua City People’s Hospital)from May 2022 to May 2023 were selected and randomly divided into two groups,a control group(30 cases)and a study group(31 cases).Both groups received surgical treatment.The control group received conventional treatment and warm water fumigation,sitz bath,and surgical dressing change after surgery,while the research group received XFHM based on the control group.XFHM was taken orally and replaced with warm water for fumigation and sitz bathing.Both groups received treatment for 4 weeks but discontinued sitz bathing after 2 weeks.Various clinical indicators between the two groups were compared.Results:The total clinical effective rate and wound recovery rate of the study group were higher than that of the control group.There were differences in the wound pain scores,surrounding tissue edema,and wound secretions at different time points.Both groups experienced wound pain.The scores of wound pain,surrounding tissue edema,and wound secretions of the study group were lower than those of the control group,7 and 14 days after surgery.The serum interleukin 6(IL-6),tumor necrosis factor-alpha(TNF-α)levels,and pH values of the study group were lower than those of the control group 10 days after surgery(P<0.05).Conclusion:The application of XFHM for treating cutaneous infections and promoting wound healing in patients with perianal abscesses improved the treatment outcome,alleviated clinical symptoms,and promoted healing.
文摘BACKGROUND Orthopedic surgeries after device implantation are susceptible to infections and may require device removal in the worst cases.For this reason,many efforts are being made to control infections after spinal surgery;however,the number of infec-tion cases is increasing owing to the increasing number of elderly citizens.CASE SUMMARY A 75-year-old male with a chronic spinal defect due to previous spine surgery underwent reconstruction using a perforator-based island flap.After bursectomy and confirmation that there was no connection with the deep tissue,reconstruction was performed.However,wound disruption occurred with abscess formation on postoperative day 29,which led to an imaging workup revealing delayed deep tissue infection.CONCLUSION Infection is one of the most common causes of surgical wound dehiscence and is associated with devastating results if not controlled promptly and definitively.Surgeons should always suspect delayed infections when reconstructing chronic soft tissue defects.
文摘Objective: It remains unknown whether calcium metabolism has any effect on the clinical presentation of superior semicircular canal dehiscence(SSCD). Our aim was to analyse the adjusted calcium and vitamin D levels in SSCD patients compared to a control group.Methods: This was a prospective case-control study performed in a tertiary referral center, university teaching hospital in the UK. It included all new patients with SSCD seen in a dedicated skull base clinic over a 5-year period(2015-2019) compared to a gender and age matched control group. The main outcome of the study was adjusted calcium and Vitamin D levels between the two groups.Results: A total of 31 SSCD patients were recruited with a matched number of control patients. The mean Vitamin D level on the SSCD group was 44.8 nmoL/l(SD: 20.8) compared to 47.5 nmoL/l(SD: 27.4) on the control group(p = 0.702). Mean Adjusted calcium level was 2.34 mmoL/l(SD: 0.7) for SSCD compared to2.41 mmoL/l(SD: 0.11) for controls(p = 0.01), being within normal limits for both the SSCD and the control group.Conclusion: Our study did not identify a link between Vitamin D levels and presence of SSCD. Normal adjusted calcium values were found in both groups. Despite that a statistically significant lower calcium level was found in the SSCD group which could indicate that suboptimal levels of calcium may affect the micro-environment of the otic capsule at the SSC region.
文摘Dear Editor,The aim of the letter is to stress the need of creating unified recommendations concerning early burn wound excision in cases of mass casualty burns exclusively.There are several triage methods,both for civilian and military circumstances,that govern burn casualty triage and evacuation from the incident site,as well as hospital referral up to 120 h from the disaster.
