Effects of He-Ne laser beam on mechanical, heat, chemical and superficial wounds

International Nuclear Information System (INIS)

Kakai, S.F.K.; Albarwari, S.E.; Alsenawi, T.A.

1988-02-01

This study summarizes the effects of low-doses of He-Ne laser radiation (λ = 6328 A), on healing of four types of wounds, including mechanical, heat, chemical and superficial wounds. The results revealed that variations between complete wound-closure in irradiated samples and that of control groups were statistically significant. Moreover, the results suggest that the stimulative action of laser is an accumulative phenomenon, that affects factors involved in the course of wound healing. The results also indicate that the skin epithelium is a highly responsive tissue towards this sort of radiation, which suggests that the stimulative action of He-Ne laser could be assayed easily by using such tissues as a test target. (author). 11 refs, 2 tabs

Wound management with vacuum assisted closure in surgical site infection after ankle surgery.

Science.gov (United States)

Zhou, Zhen-Yu; Liu, Ya-Ke; Chen, Hong-Lin; Liu, Fan

2015-05-01

The aim of this study was to compare the efficacy of vacuum assisted closure (VAC) with standard moist wound care (SMWC) in surgical site infection after ankle surgery. A prospective cohort was performed among patients with surgical site infection after ankle surgery between 2012 and 2013. The follow-up period was three month, and the efficacy end point was complete wound closure rate. Ninety-four patients were analyzed, with 61 patients in the VAC group and 33 in the SMWC group. The complete wound closure rate in the VAC group was higher than that in the SMWC group at 3 month follow up (90.2% Vs. 72.7%, p = 0.028). The median time to complete wound closure was 31 days (95% CI 20.2-41.8) for VAC, and 63 days (95% CI 46.9-79.1) for SMWC (χ(2) = 4.023, p = 0.045). In the superficial infection subgroup, the median times to complete wound closure were 20 days (95% CI 14.2-35.1) in the VAC group and 42 days (95% CI 35.4-69.4) in SMWC group (χ(2) = 4.331, p = 0.041). In the deep subgroup, the median times to complete wound closure were 46 days (95% CI 28.2-65.9) in the VAC group and 75 days (95% CI 43.2-79.6) in SMWC group (χ(2) = 6.475, p = 0.026). Our result showed that vacuum assisted closure was more effective than standard moist wound care in surgical site infection after ankle surgery. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

Biomechanical Skin Property Evaluation for Wounds Treated With Synthetic and Biosynthetic Wound Dressings and a Newly Developed Collagen Matrix During Healing of Superficial Skin Defects in a Rat Models.

Science.gov (United States)

Held, Manuel; Engelke, Anne-Sophie; Tolzmann, Dascha Sophie; Rahmanian-Schwarz, Afshin; Schaller, Hans-Eberhard; Rothenberger, Jens

2016-09-01

There is a high prevalence of superficial wounds such as partial-thickness burns. Treatment of these wounds frequently includes temporary application of wound dressings. The aim of this study was to compare a newly developed collagen matrix with commonly used temporary skin dressings for treatment of partial-thickness skin defects. Through a skin dermatome, 42 standardized superficial skin defects were generated on the back of 28 adult male Lewis rats. The wounds were treated with a synthetic wound dressing (Suprathel, Polymedics Innovations Inc, Woodstock, GA) (n = 14), a biosynthetic skin dressing (Biobrane, Smith & Nephew, Hull, UK) (n = 14), or a newly developed bovine collagen matrix, Collagen Cell Carrier (Viscofan BioEngineering, Weinheim, Germany) (n = 14). Biomechanical properties of the skin were determined and compared every 10 days over a 3-month period of using the Cutometer MPA 580 (Courage + Khazaka Electronic GmbH, Cologne, Germany). As opposed to healthy skin, statistically significant differences were detected between days 10 and 30, and between days 60 and 80, for calculated elasticity (Ue), firmness of skin (R0), and overall elasticity (R8). After 3 months, no statistically significant differences in skin elasticity were detected between the different wound dressings. The presented results give an opportunity to compare the wound dressings used for treatment with respect to skin elasticity and reveal the potential of the bovine collagen matrix in the treatment of superficial skin defects; therefore the results facilitate further evaluation of collagen matrix in surgical applications and regenerative medicine.

Systematic review of the use of honey as a wound dressing

Science.gov (United States)

Moore, Owen A; Smith, Lesley A; Campbell, Fiona; Seers, Kate; McQuay, Henry J; Moore, R Andrew

2001-01-01

Objective To investigate topical honey in superficial burns and wounds though a systematic review of randomised controlled trials. Data sources Cochrane Library, MEDLINE, EMBASE, PubMed, reference lists and databases were used to seek randomised controlled trials. Seven randomised trials involved superficial burns, partial thickness burns, moderate to severe burns that included full thickness injury, and infected postoperative wounds. Review methods Studies were randomised trials using honey, published papers, with a comparator. Main outcomes were relative benefit and number-needed-to-treat to prevent an outcome relating to wound healing time or infection rate. Results One study in infected postoperative wounds compared honey with antiseptics plus systemic antibiotics. The number needed to treat with honey for good wound healing compared with antiseptic was 2.9 (95% confidence interval 1.7 to 9.7). Five studies in patients with partial thickness or superficial burns involved less than 40% of the body surface. Comparators were polyurethane film, amniotic membrane, potato peel and silver sulphadiazine. The number needed to treat for seven days with honey to produce one patient with a healed burn was 2.6 (2.1 to 3.4) compared with any other treatment and 2.7 (2.0 to 4.1) compared with potato and amniotic membrane. For some or all outcomes honey was superior to all these treatments. Time for healing was significantly shorter for honey than all these treatments. The quality of studies was low. Conclusion Confidence in a conclusion that honey is a useful treatment for superficial wounds or burns is low. There is biological plausibility. PMID:11405898

Systematic review of the use of honey as a wound dressing

Directory of Open Access Journals (Sweden)

McQuay Henry J

2001-06-01

Full Text Available Abstract Objective To investigate topical honey in superficial burns and wounds though a systematic review of randomised controlled trials. Data sources Cochrane Library, MEDLINE, EMBASE, PubMed, reference lists and databases were used to seek randomised controlled trials. Seven randomised trials involved superficial burns, partial thickness burns, moderate to severe burns that included full thickness injury, and infected postoperative wounds. Review methods Studies were randomised trials using honey, published papers, with a comparator. Main outcomes were relative benefit and number-needed-to-treat to prevent an outcome relating to wound healing time or infection rate. Results One study in infected postoperative wounds compared honey with antiseptics plus systemic antibiotics. The number needed to treat with honey for good wound healing compared with antiseptic was 2.9 (95% confidence interval 1.7 to 9.7. Five studies in patients with partial thickness or superficial burns involved less than 40% of the body surface. Comparators were polyurethane film, amniotic membrane, potato peel and silver sulphadiazine. The number needed to treat for seven days with honey to produce one patient with a healed burn was 2.6 (2.1 to 3.4 compared with any other treatment and 2.7 (2.0 to 4.1 compared with potato and amniotic membrane. For some or all outcomes honey was superior to all these treatments. Time for healing was significantly shorter for honey than all these treatments. The quality of studies was low. Conclusion Confidence in a conclusion that honey is a useful treatment for superficial wounds or burns is low. There is biological plausibility.

Superficial fungal infections.

Science.gov (United States)

Schwartz, Robert A

Superficial fungal infections arise from a pathogen that is restricted to the stratum corneum, with little or no tissue reaction. In this Seminar, three types of infection will be covered: tinea versicolor, piedra, and tinea nigra. Tinea versicolor is common worldwide and is caused by Malassezia spp, which are human saprophytes that sometimes switch from yeast to pathogenic mycelial form. Malassezia furfur, Malassezia globosa, and Malassezia sympodialis are most closely linked to tinea versicolor. White and black piedra are both common in tropical regions of the world; white piedra is also endemic in temperate climates. Black piedra is caused by Piedraia hortae; white piedra is due to pathogenic species of the Trichosporon genus. Tinea nigra is also common in tropical areas and has been confused with melanoma.

Determinants of wound infections for breast procedures: assessment of the risk of wound infection posed by an invasive procedure for subsequent operation.

Science.gov (United States)

Ashraf, M; Biswas, J; Gupta, S; Alam, N

2009-12-01

Wound infection remains a major source of postoperative morbidity leading to prolonged hospital stays and increased total cost, including indirect expenses related to the wound infection. We examined whether there is any higher risk of wound infection in patients undergo a reoperation after an initial operation or excision/incision biopsy. A retrospective review of medical charts of patients with breast operations between January 1990 and July 2008 was carried out. The overall incidence of wound infection was 18.2% (231/1267). The rate of wound infection was (32%) when reoperation was done after previous modified radical mastectomy, 18.9% and 16.8% when the previous operations were lumpectomy/segmenectomy with axillary dissection and simple mastectomy without axillary dissection, respectively and (10.8%) when reoperation was performed after previous biopsy. Reoperation involving axillary dissection was associated with significantly higher rates of wound infection (pprocedure affects the risk of wound infection in subsequent operation in patients with breast cancer. Significantly higher risks of wound infection are seen in those patients who had undergone axillary dissection or modified radical mastectomy.

The use of negative pressure wound therapy in the treatment of infected wounds. Case studies

Directory of Open Access Journals (Sweden)

Daniel de Alcântara Jones

Full Text Available ABSTRACT OBJECTIVE: To evaluate the results and benefits obtained from the topical use of negative pressure wound therapy (NPWT in patients with infected wounds. METHODS: This was a retrospective study of 20 patients (17 males and three females, mean age 42 years with infected wounds treated using NPWT. The infected wounds were caused by trauma. The treatment system used was VAC.(r (Vacuum Assisted Closure, KCI, San Antonio, United States applied to the wound in continuous mode from 100 to 125 mmHg. The parameters related to the wounds (location, number of VAC changes, the size of the defects in the soft parts, and the evolution of the state of the wound, length of hospital stay, length of intravenous antibiotic therapy, and complications related to the use of this therapy were evaluated. RESULTS: The mean length of the hospital stay, use of NPWT, and antibacterial therapy were 41 days, 22.5 days, and 20 days respectively. The use of the VAC led to a mean reduction of 29% in the wound area (95.65-68.1 cm2; p < 0.05. Only one patient did not show any improvement in the final appearance of the wound with complete eradication of the infection. No complication directly caused by NPWT was observed. CONCLUSION: NPWT stimulates infection-free scar tissue formation in a short time, and is a quick and comfortable alternative to conventional infected wounds treatment methods.

Topical silver for preventing wound infection

NARCIS (Netherlands)

Storm-Versloot, Marja N.; Vos, Cornelis G.; Ubbink, Dirk T.; Vermeulen, Hester

2010-01-01

BACKGROUND: Silver-containing treatments are popular and used in wound treatments to combat a broad spectrum of pathogens, but evidence of their effectiveness in preventing wound infection or promoting healing is lacking. OBJECTIVES: To establish the effects of silver-containing wound dressings and

Microbiology of Animal Bite Wound Infections

Science.gov (United States)

Abrahamian, Fredrick M.; Goldstein, Ellie J. C.

2011-01-01

Summary: The microbiology of animal bite wound infections in humans is often polymicrobial, with a broad mixture of aerobic and anaerobic microorganisms. Bacteria recovered from infected bite wounds are most often reflective of the oral flora of the biting animal, which can also be influenced by the microbiome of their ingested prey and other foods. Bacteria may also originate from the victim's own skin or the physical environment at the time of injury. Our review has focused on bite wound infections in humans from dogs, cats, and a variety of other animals such as monkeys, bears, pigs, ferrets, horses, sheep, Tasmanian devils, snakes, Komodo dragons, monitor lizards, iguanas, alligators/crocodiles, rats, guinea pigs, hamsters, prairie dogs, swans, and sharks. The medical literature in this area has been made up mostly of small case series or case reports. Very few studies have been systematic and are often limited to dog or cat bite injuries. Limitations of studies include a lack of established or inconsistent criteria for an infected wound and a failure to utilize optimal techniques in pathogen isolation, especially for anaerobic organisms. There is also a lack of an understanding of the pathogenic significance of all cultured organisms. Gathering information and conducting research in a more systematic and methodical fashion through an organized research network, including zoos, veterinary practices, and rural clinics and hospitals, are needed to better define the microbiology of animal bite wound infections in humans. PMID:21482724

Current issues in burn wound infections.

Science.gov (United States)

Dodd, D; Stutman, H R

1991-01-01

As we have emphasized, the diagnosis of burn wound infections in the high-risk burned child can be difficult and depends on a very high degree of suspicion and daily clinical evaluation of the burn wound site by consistent observers. Appropriate precautions include meticulous hand-washing and the use of gloves when handling the wound site and prophylactic application of a topical antibacterial agent such as SSD cream. Wound therapy should include routine vigorous surgical débridement. Surveillance wound cultures should be done weekly to determine the emergency of colonization and aid in the selection of empiric antimicrobial regimens when these are appropriate. Wound biopsy for histological examination and quantitative culture is highly recommended in the severely ill child with an unclear etiology or site of infection. If, despite these measures, sepsis ensues, then systemic antibiotics must be started empirically as an adjuctive therapy to surgical débridement. Knowledge of the organisms colonizing a wound will prove useful in choosing an antibiotic regimen while awaiting definitive results of blood and wound biopsy cultures. Without this information, early burn sepsis therapy should focus on gram-positive organisms, while infection later in the course should raise suspicion of nosocomial pathogens such as P. aeruginosa, other enteric bacilli, and C. albicans. An initial regimen might include nafcillin plus ceftazidime or an aminoglycoside, with anaerobic coverage depending on considerations noted previously. Once the causative agent is identified, therapy must be modified accordingly. Amphotericin B and acyclovir use should be guided by positive cultures from the burn wound site along with systemic evidence of dissemination. Available studies do not yet make clear the role of empiric immunotherapy with intravenous gamma globulin in the burned child. Therefore, its use cannot be recommended at the present time, although the development of specific

Comparison of Laser Doppler Imaging (LDI) and clinical assessment in differentiating between superficial and deep partial thickness burn wounds.

Science.gov (United States)

Jan, Saadia Nosheen; Khan, Farid Ahmed; Bashir, Muhammad Mustehsan; Nasir, Muneeb; Ansari, Hamid Hussain; Shami, Hussan Birkhez; Nazir, Umer; Hanif, Asif; Sohail, Muhammad

2018-03-01

To compare the accuracy of Laser Doppler Imaging (LDI) and clinical assessment in differentiating between superficial and deep partial thickness burns to decide whether early tangential excision and grafting or conservative management should be employed to optimize burn and patient management. March 2015 to November 2016. Ninety two wounds in 34 patients reporting within 5days of less than 40% burn surface area were included. Unstable patients, pregnant females and those who expired were excluded. The wounds were clinically assessed and LDI done concomitantly Plastic Surgeons blinded to each other's findings. Wound appearance, color, blanching, pain, hair follicle dislodgement were the clinical parameters that distinguished between superficial and deep partial thickness burns. On day 21, the wounds were again assessed for the presence of healing by the same plastic surgeons. The findings were correlated with the initial findings on LDI and clinical assessment and the results statistically analyzed. The data of 92 burn wounds was analyzed using SPSS (ver. 17). Clinical assessment correctly identified the depth of 75 and LDI 83 wounds, giving diagnostic accuracies of 81.52% and 90.21% respectively. The sensitivity of clinical assessment was 81% and of LDI 92.75%, whereas the specificity was 82% for both. The positive predictive value was 93% for clinical assessment and 94% for LDI while the negative predictive value was 59% and 79% respectively. Predictive accuracy of LDI was found to be better than clinical assessment in the prediction of wound healing, the gold standard for wound healing being 21 days. As such it can prove to be a reliable and viable cost effective alternative per se to clinical assessment. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

Prophylactic Antibiotics and Wound Infection

OpenAIRE

Elbur, Abubaker Ibrahim; M.A., Yousif; El-Sayed, Ahmed S.A.; Abdel-Rahman, Manar E.

2013-01-01

Introduction: Surgical site infections account for 14%-25% of all nosocomial infections. The main aims of this study were to audit the use of prophylactic antibiotic, to quantify the rate of post-operative wound infection, and to identify risk factors for its occurrence in general surgery.

[Efficacy observation on application of negative pressure therapy in the treatment of superficial partial-thickness scald wound in children].

Science.gov (United States)

Shen, Chuan-an; Chai, Jia-ke; Tuo, Xiao-ye; Cai, Jian-hua; Li, Dong-jie; Zhang, Lin; Zhu, Hua; Cai, Jin-dong

2013-02-01

To observe the effect of negative pressure therapy in the treatment of superficial partial-thickness scald in children. Three hundred and seven children with superficial partial-thickness scald hospitalized from August 2009 to May 2012 were divided into negative pressure therapy group (NPT, n = 145) and control group (C, n = 162) according to the random number table. Patients in group NPT were treated with negative pressure from within post injury day (PID) 3 to PID 9 (with -16 kPa pressure), while traditional occlusive dressing method was used in group C. Changes in body temperature, wound healing condition, frequency of dressing change were compared between group NPT and group C. Bacterial culture results of wounds were compared before and after treatment in group NPT. Volume of drained transudate per one percent of wound area was recorded in group NPT on PID 1 to PID 3. Data were processed with t test or chi-square test. The incidence of high fever was significantly lower in group NPT (26.9%, 39/145) than in group C (63.6%, 103/162, χ(2) = 41.419, P partial-thickness scald.

Innate defense regulator peptide 1018 in wound healing and wound infection.

Directory of Open Access Journals (Sweden)

Lars Steinstraesser

Full Text Available Innate defense regulators (IDRs are synthetic immunomodulatory versions of natural host defense peptides (HDP. IDRs mediate protection against bacterial challenge in the absence of direct antimicrobial activity, representing a novel approach to anti-infective and anti-inflammatory therapy. Previously, we reported that IDR-1018 selectively induced chemokine responses and suppressed pro-inflammatory responses. As there has been an increasing appreciation for the ability of HDPs to modulate complex immune processes, including wound healing, we characterized the wound healing activities of IDR-1018 in vitro. Further, we investigated the efficacy of IDR-1018 in diabetic and non-diabetic wound healing models. In all experiments, IDR-1018 was compared to the human HDP LL-37 and HDP-derived wound healing peptide HB-107. IDR-1018 was significantly less cytotoxic in vitro as compared to either LL-37 or HB-107. Furthermore, administration of IDR-1018 resulted in a dose-dependent increase in fibroblast cellular respiration. In vivo, IDR-1018 demonstrated significantly accelerated wound healing in S. aureus infected porcine and non-diabetic but not in diabetic murine wounds. However, no significant differences in bacterial colonization were observed. Our investigation demonstrates that in addition to previously reported immunomodulatory activities IDR-1018 promotes wound healing independent of direct antibacterial activity. Interestingly, these effects were not observed in diabetic wounds. It is anticipated that the wound healing activities of IDR-1018 can be attributed to modulation of host immune pathways that are suppressed in diabetic wounds and provide further evidence of the multiple immunomodulatory activities of IDR-1018.

Application of VitaVallis dressing for infected wounds

International Nuclear Information System (INIS)

Kirilova, N. V.; Fomenko, A. N.; Korovin, M. S.

2015-01-01

Today there is a growing demand for safe and efficient antimicrobial dressings for infected wound treatment. The antimicrobial sorption material for VitaVallis dressings was produced by one-stage oxidation of aluminum nanopowder in water in the presence of fibrous acetylcellulose matrix. Scanning electron microscopy revealed that the material is made up of fibers of diameter 1.5–3.0 µm with adhered agglomerated alumina nanosheets. An antimicrobial study revealed a high inhibitory effect of VitaVallis against the growth of gram-negative (E.coli, P. aeruginosa) and gram-positive (S. aureus) strains. The antimicrobial activity of the dressing against microbial pathogens on the wound surface was demonstrated in in vivo experiments on male rats. The dressing was also tested on volunteer patients. The testing showed reduction of the wound healing period, accelerated cleaning of the infected wound and enhanced tissue regeneration in the wound. The results demonstrate that the VitaVallis dressing can be used for the treatment of deep infected wounds

Application of VitaVallis dressing for infected wounds

Energy Technology Data Exchange (ETDEWEB)

Kirilova, N. V., E-mail: n.kirilova@vitavallis.com; Fomenko, A. N., E-mail: alserova@ispms.tsc.ru; Korovin, M. S., E-mail: msk@ispms.tsc.ru [Institute of Strength Physics and Materials Science SB RAS, 2/4 Akademicheskii pr., Tomsk, 634055 (Russian Federation)

2015-11-17

Today there is a growing demand for safe and efficient antimicrobial dressings for infected wound treatment. The antimicrobial sorption material for VitaVallis dressings was produced by one-stage oxidation of aluminum nanopowder in water in the presence of fibrous acetylcellulose matrix. Scanning electron microscopy revealed that the material is made up of fibers of diameter 1.5–3.0 µm with adhered agglomerated alumina nanosheets. An antimicrobial study revealed a high inhibitory effect of VitaVallis against the growth of gram-negative (E.coli, P. aeruginosa) and gram-positive (S. aureus) strains. The antimicrobial activity of the dressing against microbial pathogens on the wound surface was demonstrated in in vivo experiments on male rats. The dressing was also tested on volunteer patients. The testing showed reduction of the wound healing period, accelerated cleaning of the infected wound and enhanced tissue regeneration in the wound. The results demonstrate that the VitaVallis dressing can be used for the treatment of deep infected wounds.

Innate Defense Regulator Peptide 1018 in Wound Healing and Wound Infection

DEFF Research Database (Denmark)

Steinstraesser, Lars; Hirsch, Tobias; Schulte, Matthias

2012-01-01

-37 or HB-107. Furthermore, administration of IDR-1018 resulted in a dose-dependent increase in fibroblast cellular respiration. In vivo, IDR-1018 demonstrated significantly accelerated wound healing in S. aureus infected porcine and non-diabetic but not in diabetic murine wounds. However...

Novel protease-based diagnostic devices for detection of wound infection

NARCIS (Netherlands)

Heinzle, A.; Papen-Botterhuis, N.E.; Schiffer, D.; Schneider, K.P.; Binder, B.; Schintler, M.; Haaksman, I.K.; Lenting, H.B.; Gübitz, G.M.; Sigl, E.

2013-01-01

A gelatinase-based device for fast detection of wound infection was developed. Collective gelatinolytic activity in infected wounds was 23 times higher (p ≤ 0.001) than in noninfected wounds and blisters according to the clinical and microbiological description of the wounds. Enzyme activities of

Silica Nanofibers with Immobilized Tetracycline for Wound Dressing

Directory of Open Access Journals (Sweden)

Irena Lovětinská-Šlamborová

2016-01-01

Full Text Available Local antibiotic treatment has its justification for superficial infections. The advantage of this treatment is that the antibiotic has effects on bacterial agent directly at the application site. Skin infections which are intended for the local antibiotic treatment are superficial pyoderma, some festering wounds, burns of second and third degree, infected leg ulcers, or decubitus of second and third degree. Tetracyclines are available topical antibiotics with a broad bacterial spectrum. At present, ointments containing tetracycline are also used for the treatment, which rarely can lead to skin sensitization. In this paper, a development of novel nanofibrous material with immobilized tetracycline is presented. Two different methods of immobilized tetracycline quantification onto silica nanofibers are employed. It was proven that the prevailing part of tetracycline was bound weakly by physisorption forces, while the minor part was covalently bound by NH2 groups formed by the preceding functionalization. The silica nanofibers with immobilized tetracycline are promising material for wound dressing applications due to its antibacterial activity; it was proved by tests.

Profiling wound healing with wound effluent: Raman spectroscopic indicators of infection

Science.gov (United States)

Crane, Nicole J.; Elster, Eric A.

2012-01-01

The care of modern traumatic war wounds remains a significant challenge for clinicians. Many of the extremity wounds inflicted during Operation Enduring Freedom and Operation Iraqi Freedom are colonized or infected with multi-drug resistant organisms, particularly Acinetobacter baumannii. Biofilm formation and resistance to current treatments can significantly confound the wound healing process. Accurate strain identification and targeted drug administration for the treatment of wound bioburden has become a priority for combat casualty care. In this study, we use vibrational spectroscopy to examine wound exudates for bacterial load. Inherent chemical differences in different bacterial species and strains make possible the high specificity of vibrational spectroscopy.

Fungal Wound Infection

Centers for Disease Control (CDC) Podcasts

2016-01-28

Dr. David Tribble, acting director of the infectious disease clinical research program at Uniformed Services University of the Health Sciences, discusses fungal wound infections after combat trauma.  Created: 1/28/2016 by National Center for Emerging and Zoonotic Infectious Diseases (NCEZID).   Date Released: 1/28/2016.

Superficial skin infections and the use of topical and systemic ...

African Journals Online (AJOL)

Superficial bacterial infections of the skin are very common. With the increasing burden of human immunodeficiency virus (HIV), this is likely to worsen. Examples of such infections include impetigo, erysipelas, cellulitis, ecthyma, furuncles, carbuncles and subcutaneous abscesses. Common causative organisms are ...

Wound Infections PSA (:30)

Centers for Disease Control (CDC) Podcasts

2017-10-25

This 30 second public service announcement is about how to avoid a wound infection after a disaster.  Created: 10/25/2017 by Centers for Disease Control and Prevention (CDC).   Date Released: 10/25/2017.

Assessment of Severe Extremity Wound Bioburden at the Time of Definitive Wound Closure or Coverage: Correlation With Subsequent Postclosure Deep Wound Infection (Bioburden Study).

Science.gov (United States)

Bosse, Michael J; Murray, Clinton K; Carlini, Anthony R; Firoozabadi, Reza; Manson, Theodore; Scharfstein, Daniel O; Wenke, Joseph C; Zadnik, Mary; Castillo, Renan C

2017-04-01

Infection remains the most common and significant complication after high-energy fractures. The Bioburden Study is a multicenter, prospective, observational cohort study of wound bacterial bioburden and antibiotic care in severe open lower extremity fractures. The aims of this study are to (1) characterize the contemporary extremity wound "bioburden" at the time of definitive wound closure; (2) determine the concordance between polymerase chain reaction results and hospital microbiology; (3) determine, among those who develop deep infections, the concordance between the pathogens at wound closure and at deep infection; and (4) compare the probability of deep infection between those who did and did not receive an appropriate course of antibiotics based on bioburden at the time of wound closure. To address these aims, sites collected tissue samples from severe lower extremity injuries at the time of wound closure and at first surgery for treatment of a deep infection, nonunion, flap failure, amputation, or other complications (because these surgeries may be due to undetected infection). Otherwise, if no further surgical treatment occurred, participants were followed for 12 months. The study was conducted at 38 US trauma centers and has enrolled 655 participants aged 18-64 years. This is the first large multi-institutional study evaluating the wound bioburden of severe open tibia fractures and correlating this bioburden with the risk of wound complications after definitive soft tissue closure.

Komodo dragon-inspired synthetic peptide DRGN-1 promotes wound-healing of a mixed-biofilm infected wound.

Science.gov (United States)

M C Chung, Ezra; Dean, Scott N; Propst, Crystal N; Bishop, Barney M; van Hoek, Monique L

2017-01-01

Cationic antimicrobial peptides are multifunctional molecules that have a high potential as therapeutic agents. We have identified a histone H1-derived peptide from the Komodo dragon ( Varanus komodoensis) , called VK25. Using this peptide as inspiration, we designed a synthetic peptide called DRGN-1. We evaluated the antimicrobial and anti-biofilm activity of both peptides against Pseudomonas aeruginosa and Staphylococcus aureus . DRGN-1, more than VK25, exhibited potent antimicrobial and anti-biofilm activity, and permeabilized bacterial membranes. Wound healing was significantly enhanced by DRGN-1 in both uninfected and mixed biofilm ( Pseudomonas aeruginosa and Staphylococcus aureus )-infected murine wounds. In a scratch wound closure assay used to elucidate the wound healing mechanism, the peptide promoted the migration of HEKa keratinocyte cells, which was inhibited by mitomycin C (proliferation inhibitor) and AG1478 (epidermal growth factor receptor inhibitor). DRGN-1 also activated the EGFR-STAT1/3 pathway. Thus, DRGN-1 is a candidate for use as a topical wound treatment. Wound infections are a major concern; made increasingly complicated by the emerging, rapid spread of bacterial resistance. The novel synthetic peptide DRGN-1 (inspired by a peptide identified from Komodo dragon) exhibits pathogen-directed and host-directed activities in promoting the clearance and healing of polymicrobial ( Pseudomonas aeruginosa & Staphylococcus aureus ) biofilm infected wounds. The effectiveness of this peptide cannot be attributed solely to its ability to act upon the bacteria and disrupt the biofilm, but also reflects the peptide's ability to promsote keratinocyte migration. When applied in a murine model, infected wounds treated with DRGN-1 healed significantly faster than did untreated wounds, or wounds treated with other peptides. The host-directed mechanism of action was determined to be via the EGFR-STAT1/3 pathway. The pathogen-directed mechanism of action was

Incidence and risk factors for caesarean wound infection in Lagos Nigeria

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Gab-Okafor Chidinma V

2009-09-01

Full Text Available Abstract Background Post caesarean wound infection is not only a leading cause of prolonged hospital stay but a major cause of the widespread aversion to caesarean delivery in developing countries. In order to control and prevent post caesarean wound infection in our environment there is the need to access the relative contribution of each aetiologic factor. Though some studies in our environment have identified factors associated with post caesarean wound infection, none was specifically designed to address these issues prospectively or assess the relative contribution of each of the risk factors. Findings Prospective multicentre study over a period of 56 months in Lagos Nigeria. All consecutive and consenting women scheduled for caesarean section and meeting the inclusion criteria were enrolled into the study. Cases were all subjects with post caesarean wound infection. Those without wound infection served as controls. Data entry and analysis were performed using EPI-Info programme version 6 and SPSS for windows version 10.0. Eight hundred and seventeen women were enrolled into the study. Seventy six (9.3% of these cases were complicated with wound infection. The proportion of subjects with body mass index greater than 25 was significantly higher among the subjects with wound infection (51.3% than in the subjects without wound infection (33.9% p = 0.011. There were also significantly higher proportions of subjects with prolonged rupture of membrane (p = 0.02, prolonged operation time (p = 0.001, anaemia (p = 0.031 and multiple vaginal examinations during labour (0.021 among the women that had wound infection compared to the women that did not have wound infection. After adjustment for confounders only prolonged rupture of membrane (OR = 4.45, prolonged operation time (OR = 2.87 and body max index > 25 (2.34 retained their association with post caesarean wound infection. Conclusion Effort should be geared towards the prevention of prolonged

Antiseptic wick: does it reduce the incidence of wound infection following appendectomy?

LENUS (Irish Health Repository)

McGreal, Gerald T

2012-02-03

The role of prophylactic antibiotics is well established for contaminated wounds, but the use of antiseptic wound wicks is controversial. The aim of this work was to study the potential use of wound wicks to reduce the rate of infection following appendectomy. This prospective randomized controlled clinical trial was conducted at a university hospital in the department of surgery. The subjects were patients undergoing appendectomy for definite acute appendicitis. They were randomized by computer to primary subcuticular wound closure or use of an antiseptic wound wick. For the latter, ribbon gauze soaked in povidone-iodine was placed between interrupted nylon skin sutures. Wicks were soaked daily and removed on the fourth postoperative day. All patients received antibiotic prophylaxis. They were reviewed while in hospital and 4 weeks following operation for evidence of wound infection. The main outcome measures were wound infection, wound discomfort, and cosmetic result. The overall wound infection rate was 8.6% (15\\/174). In patients with wound wicks it was 11.6% (10\\/86) compared to 5.6% (5\\/88) in those whose wounds were closed by subcuticular sutures (p = NS). We concluded that the use of wound wicks was not associated with decreased wound infection rates following appendectomy. Subcuticular closure is therefore appropriate in view of its greater convenience and safety.

Interdigital foot infections: Corynebacterium minutissimum and agents of superficial mycoses

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Fatma Mutlu Sariguzel

2014-09-01

Full Text Available Interdigital foot infections are mostly caused initially by dermatophytes, yeasts and less frequently by bacteria. Erythrasma caused by Corynebacterium minutissimum can be confused with superficial mycoses. The aim of the study was to determine the prevalence of the etiologic agents of superficial mycoses and the frequency of Corynebacterium minutissimum in interdigital foot infections. All the samples obtained from the 121 patients with interdigital foot infections were examined directly with the use of 20% potassium hydroxide mounts and Gram stain under the microscope and cultured on Sabouraud's dextrose agar plates. In identification of superficial mycoses, the rate was found to be 14% with the cultural method and 14% with direct microscopic examination. Using a combination of direct microscopic examination and culture, a 33.8% ratio was achieved. In the culture of these samples, the most isolated factor was Trichophyton rubrum (33.7%. In 24 of the patients (19.8% Corynebacterium minutissimum was detected by Gram staining, in 6 of these patients Trichophyton rubrum was found, Trichophyton mentagrophytes was found in 2 and Trichosporon spp. was found in 1. The examination of interdigital foot lesions in the laboratory, the coexistence of erythrasma with dermatophytes and yeast should be considered.

Wound Healing Potential of Formulated Extract from Hibiscus Sabdariffa Calyx

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Builders, P. F.; Kabele-Toge, B.; Builders, M.; Chindo, B. A.; Anwunobi, Patricia A.; Isimi, Yetunde C.

2013-01-01

Wound healing agents support the natural healing process, reduce trauma and likelihood of secondary infections and hasten wound closure. The wound healing activities of water in oil cream of the methanol extract of Hibiscus sabdariffa L. (Malvaceae) was evaluated in rats with superficial skin excision wounds. Antibacterial activities against Pseudomonas aeroginosa, Staphylococcus aureus and Echerichia coli were determined. The total flavonoid content, antioxidant properties and thin layer chromatographic fingerprints of the extract were also evaluated. The extract demonstrated antioxidant properties with a total flavonoid content of 12.30±0.09 mg/g. Six reproducible spots were obtained using methanol:water (95:5) as the mobile phase. The extract showed no antimicrobial activity on the selected microorganisms, which are known to infect and retard wound healing. Creams containing H. sabdariffa extract showed significant (Psabdariffa extract. This study, thus, provides evidence of the wound healing potentials of the formulated extract of the calyces of H. sabdariffa and synergism when co-formulated with gentamicin. PMID:23901160

Effects of prophylactic antibiotics on wound infection in elective laparoscopic cholecystectomy

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Hamid Reza Hemati

2008-11-01

Full Text Available Introduction: Wound infection is one of the most common complications of surgical procedures.At present, different procedures are used to reduce wound infection including prophylactic antibiotics.Since laparoscopy controls the most sources of wound infection such as mechanical factors, the role ofprophylactic antibiotic therapy may be in doubt. In this study, we evaluated the antibiotic effects inprevention of wound infection in laparoscopic cholecystectomy.Methods and Materials: In this double-blind clinical trial study, patients who were candidate forlaparoscopic cholecystectomy were divided randomly into two groups: antibiotic receivers (38patients and placebo (Normal Saline receivers (32 patients group. The patients were visited in 24hours, 4-7, 10-15 and 30 days after surgery for wound infection and then 2 groups compared.Results: The study showed that there were no significant differences between two groups withrespect to age, body mass index and smoking. In addition, no wound infection was observed in first 24hours, 4-7, 10-15 and 30 days after operation in both groups.Conclusion: The findings showed that prophylactic antibiotic therapy in laparoscopiccholecystectomy has no effect on the incidence of wound infection. Therefore, it is suggested thatprophylactic antibiotic therapy does not use in laparoscopic cholecystectomy because of producingantibiotic resistance, unnecessary complications and also reducing economical costs.

Acetic acid dressings: Finding the Holy Grail for infected wound management

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Kapil S Agrawal

2017-01-01

Full Text Available Background: Wounds have since long, contributed majorly to the health-care burden. Infected long-standing non-healing wounds place many demands on the treating surgeon and are devastating for the patients physically, nutritionally, vocationally, financially, psychologically and socially. Acetic acid has long been included among agents used in the treatment of infected wounds. In this study, we have evaluated the use of acetic acid for topical application in the treatment of infected wounds. Materials and Methods: A total of 100 patients with infected wounds were treated with topical application of 1% acetic acid as dressing material after appropriate cleaning. A specimen of wound swab was collected before first application and further on days 3, 7, 10 and 14. Daily dressings of wounds were done similarly. Minimum inhibitory concentration (MIC of acetic acid against various organisms isolated was determined. Results: The patients treated ranged between 9 and 60 years, with the mean age 33 years. Nearly 70% of patients were male. Aetiologies of wounds: infective 35, diabetic 25, trauma 20, burns 10, venous ulcers 5 and infected graft donor site 5. Various microorganisms isolated include Pseudomonas aeruginosa (40%, Staphylococcus aureus (2%, Acinetobacter (12%, Escherichia Coli (5%, Proteus mirabilis (3%, Klebsiella (18%, methicillin-resistant S. aureus (10%, Streptococcus (2% and Enterococcus (1%, Citrobacter (1%. Few wounds (6% also isolated fungi. About 28%, 64% and 8% of patients isolated no growth on culture after 7, 14 and 21 days, respectively. MIC of all isolated organisms was ≤0.5%. Conclusion: pH of the wound environment plays a pivotal role in wound healing. Acetic acid with concentration of 1% has shown to be efficacious against wide range of bacteria as well as fungi, simultaneously accelerating wound healing. Acetic acid is non-toxic, inexpensive, easily available and efficient topical agent for effective elimination of wound

Negative pressure wound therapy for the treatment of infected wounds with exposed knee joint after patellar fracture.

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Lee, Sang Yang; Niikura, Takahiro; Miwa, Masahiko; Sakai, Yoshitada; Oe, Keisuke; Fukazawa, Takahiro; Kawakami, Yohei; Kurosaka, Masahiro

2011-06-14

Treatment of soft tissue defects with exposed bones and joints, resulting from trauma, infection, and surgical complications, represents a major challenge. The introduction of negative pressure wound therapy has changed many wound management practices. Negative pressure wound therapy has recently been used in the orthopedic field for management of traumatic or open wounds with exposed bone, nerve, tendon, and orthopedic implants. This article describes a case of a patient with a large soft tissue defect and exposed knee joint, in which negative pressure wound therapy markedly improved wound healing. A 50-year-old man presented with an ulceration of his left knee with exposed joint, caused by severe wound infections after open reduction and internal fixation of a patellar fracture. After 20 days of negative pressure wound therapy, a granulated wound bed covered the exposed bones and joint.To our knowledge, this is the first report of negative pressure wound therapy used in a patient with a large soft tissue defect with exposed knee joint. Despite the chronic wound secondary to infection, healing was achieved through the use of the negative pressure wound therapy, thus promoting granulation tissue formation and closing the joint. We suggest negative pressure wound therapy as an alternative option for patients with lower limb wounds containing exposed bones and joints when free flap transfer is contraindicated. Our result added to the growing evidence that negative pressure wound therapy is a useful adjunctive treatment for open wounds around the knee joint. Copyright 2011, SLACK Incorporated.

Wound edge protectors in open abdominal surgery to reduce surgical site infections: a systematic review and meta-analysis.

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André L Mihaljevic

Full Text Available Surgical site infections remain one of the most frequent complications following abdominal surgery and cause substantial costs, morbidity and mortality.To assess the effectiveness of wound edge protectors in open abdominal surgery in reducing surgical site infections.A systematic literature search was conducted according to a prespecified review protocol in a variety of data-bases combined with hand-searches for randomized controlled trials on wound edge protectors in patients undergoing laparotomy. A qualitative and quantitative analysis of included trials was conducted.We identified 16 randomized controlled trials including 3695 patients investigating wound edge protectors published between 1972 and 2014. Critical appraisal uncovered a number of methodological flaws, predominantly in the older trials. Wound edge protectors significantly reduced the rate of surgical site infections (risk ratio 0.65; 95%CI, 0.51-0.83; p = 0.0007; I2 = 52%. The results were robust in a number of sensitivity analyses. A similar effect size was found in the subgroup of patients undergoing colorectal surgery (risk ratio 0.65; 95%CI, 0.44-0.97; p = 0.04; I2 = 56%. Of the two common types of wound protectors double ring devices were found to exhibit a greater protective effect (risk ratio 0.29; 95%CI, 0.15-0.55 than single-ring devices (risk ratio 0.71; 95%CI, 0.54-0.92, but this might largely be due to the lower quality of available data for double-ring devices. Exploratory subgroup analyses for the degree of contamination showed a larger protective effect in contaminated cases (0.44; 95%CI, 0.28-0.67; p = 0.0002, I2 = 23% than in clean-contaminated surgeries (0.72, 95%CI, 0.57-0.91; p = 0.005; I2 = 46% and a strong effect on the reduction of superficial surgical site infections (risk ratio 0.45; 95%CI, 0.24-0.82; p = 0.001; I2 = 72%.Wound edge protectors significantly reduce the rate of surgical site infections in open abdominal surgery. Further trials are needed to

Bioactive Antimicrobial Peptides as Therapeutics for Corneal Wounds and Infections.

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Griffith, Gina L; Kasus-Jacobi, Anne; Pereira, H Anne

2017-06-01

Significance: More than 2 million eye injuries and infections occur each year in the United States that leave civilians and military members with reduced or complete vision loss due to the lack of effective therapeutics. Severe ocular injuries and infections occur in varied settings including the home, workplace, and battlefields. In this review, we discuss the potential of developing antimicrobial peptides (AMPs) as therapeutics for the treatment of corneal wounds and infections for which the current treatment options are inadequate. Recent Advances: Standard-of-care employs the use of fluorescein dye for the diagnosis of ocular defects and is followed by the use of antibiotics and/or steroids to treat the infection and reduce inflammation. Recent advances for treating corneal wounds include the development of amniotic membrane therapies, wound chambers, and drug-loaded hydrogels. In this review, we will discuss an innovative approach using AMPs with the dual effect of promoting corneal wound healing and clearing infections. Critical Issues: An important aspect of treating ocular injuries is that treatments need to be effective and administered expeditiously. This is especially important for injuries that occur during combat and in individuals who demonstrate delayed wound healing. To overcome gaps in current treatment modalities, bioactive peptides based on naturally occurring cationic antimicrobial proteins are being investigated as new therapeutics. Future Directions: The development of new therapeutics that can treat ocular infections and promote corneal wound healing, including the healing of persistent corneal epithelial defects, would be of great clinical benefit.

Effects of Aloe Vera and Chitosan Nanoparticle Thin-Film Membranes on Wound Healing in Full Thickness Infected Wounds with Methicillin Resistant Staphylococcus Aureus.

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Ranjbar, Reza; Yousefi, Alireza

2018-01-01

To assess effect of Aleo vera with chitosan nanoparticle biofilm on wound healing in full thickness infected wounds with antibiotic resistant gram positive bacteria. Thirty rats were randomized into five groups of six rats each. Group I: Animals with uninfected wounds treated with 0.9% saline solution. Group II: Animals with infected wounds treated with saline. Group III: Animals with infected wounds were dressed with chitosan nanoparticle thin-film membranes. Group IV: Animals with infected wounds were treated topically with Aloe vera and Group V: Animals with infected wounds were treated topically with Aloe vera and dressed with chitosan nanoparticle thin-film membranes. Wound size was measured on 6, 9, 12, 15, 18 and 21days after surgery. Microbiology, reduction in wound area and hydroxyproline contents indicated that there was significant difference ( p vera with chitosan nanoparticle thin-film membranes had a reproducible wound healing potential and hereby justified its use in practice.

A prospective intra-individual evaluation of silk compared to Biobrane for the treatment of superficial burns of the hand and face.

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Schiefer, Jennifer Lynn; Arens, Elena; Grigutsch, Daniel; Rath, Rebekka; Hoffmann, Alexandra; Fuchs, Paul Christian; Schulz, Alexandra

2017-05-01

An ever-increasing number of commercially available dressings have been applied to treat superficial burns with the aim to reduce pain and inflammation and lead to a fast wound healing and scar reduction. Nevertheless the search for cheap and effective wound dressing proceeds. Dressilk ® consisting of silkworm silk showed good results for wound healing in regards to scarring, biocompatibility and reduction of inflammation and pain. Therefore it seemed to be an interesting product for the treatment of superficial burns. In a prospective intra-individual study the healing of superficial burns was evaluated after the treatment with Dressilk ® and Biobrane ® in 30 patients with burns of the hand and face. During wound healing pain, active bleeding, exudation, dressing change and inflammation were evaluated using the Verbal Rating Scale 1-10. Three months later scar appearance was assessed by VSS (Vancouver Scar Scale) and POSAS (Patient and Observer Scar Scale). With regard to re-epithelialization, pain, inflammation and acute bleeding both dressings were equivalent. High subjective satisfaction rates were reported for both Dressilk ® and Biobrane ® dressings in regard to comfort and mobility of the face. Biobrane ® , applied as a glove was subjectively preferred for burns of the hand. Regarding their cost efficiency Dressilk ® was clearly superior to Biobrane ® . Long-term results were similar. The "ideal" wound dressing maximizes patients' comfort while reducing pain and promoting wound healing. Dressilk ® and Biobrane ® both provided an effective and safe healing environment, showing low overall complication rates with respect to infection and exudation on superficial burns of the hand and face. Therefore Dressilk ® , being clearly superior to Biobrane ® in cost efficiency is an interesting alternative especially for the treatment of superficial burns of faces. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

Wound infection after median sternotomy during the war in Croatia.

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Jelić, I; Anić, D; Alfirević, I; Kalinić, S; Ugljen, R; Letica, D; Ante Korda, Z; Vucemilo, I; Bulat, C; Predrijevac, M; Corić, V; Husar, J; Jelic, M; Hulina, D; Depina, I; Dadić, D

1996-12-01

From 1990 to 1994 at Clinical Hospital Center, Zagreb, 1904 median sternotomies were performed for cardiac operations. Patients shared the same intensive care unit (ICU) with the wounded persons, admitted to the hospital from battlefield. Infection developed in 124 patients, an incidence of 6.51%. Methicillin resistant Staphylococcus aureus (MRSA) was isolated from 90, methicillin resistant Staphylococcus epidermidis (MRSE) from 19, and gram negative bacilli (GNB) from 56 patients, Pseudomonas aeruginosa in 2, and Clostridium pneumoniae in 1 case. Ninety-six patients (5.04%) developed superficial localized infection of subcutaneous tissues and they were treated with frequent dressing changes with antibiotic-soaked gauze in combination with systemic antibiotics. Twenty-eight patients (1.47%) developed mediastinitis and sternal dehiscence. They were treated by operative debridement followed by reclosure of the sternum with continuous antibiotic irrigation. We obtained satisfactory results with our method of closure of sternum which is a modification of Robicsek's technique. Nine of them required further operation. In seven cases we performed muscle flaps and in two omentoplasty. One hundred and twenty patients were discharged in satisfactory condition. The uncontrolled mediastinal sepsis caused death in 4 patients. Higher infection rate after median sternotomy during 1991 and 1992 could be possibly explained with the war circumstances in Croatia, and especially with MRSA strain becoming endemic in surgical ICU.

Role of Negative-Pressure Wound Therapy in Deep Sternal Wound Infection After Open Heart Surgery

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Cemalettin Aydın

2013-08-01

Full Text Available Introduction: Mediastinitis is a devastating complication in open heart surgery. The most common treatments after debridement are rewiring with antibiotic irrigation. Vacuum assisted closure therapy is a recently introduced technique that promotes the healing of difficult wounds, including post-sternotomy mediastinitis.Patients and Methods: Forty one patients with deep sternal wound infection were divided into two groups based on the treatment method used. Twenty two patients with post-cardio to my deep sternal wound infection were treated primarily by vacuum assisted closure method (group A and 19 patients with deep sternal wound infection who received closed mediastinal irrigation were treated with antibiotics (group B between January 2006 and January 2010.Results: The two groups were compared. Three patients died during treatment in group B. The median healing time was significantly shorter in group A (mean, 13.5 ± 3.2 days compared to 18 days (mean, 21.2 ± 16.4 days in group B (p< 0.001. Deep sternal wound infection showed no recurrences after the vacuum treatment, while 7 (24% patients in group B suffered recurrences. Hospital stay was significantly shorter in group A (median, 30.5 days; mean, 32.2 ± 11.3 days vs. median, 45 days; mean, 49.2 ± 19.3 days (p= 0.001.Conclusion: A significantly shorter healing time was confirmed with vacuum assisted closure. Hospital stay remained significantly shorter in group A (35 vs. 46 days.

Honey ointment': a natural remedy of skin wound infections

International Nuclear Information System (INIS)

Tasleem, S.; Naqvi, S.B.S.; Hashimi, K.

2011-01-01

Background: Honey is a gift of nature, principally identified and valued to possess antimicrobial and anti-inflammatory activity and has been used as a natural remedy of wounds since ancient times. The objectives of this study were to evaluate the antimicrobial activity of honey against micro-organisms, to formulate a honey ointment and to evaluate the efficacy of such ointment by conducting clinical trials on skin wound infection. Methods: This experimental study was conducted at Department of Pharmaceutics, Faculty of Pharmacy, University of Karachi and Out-patient Department of Dermatology, Fauji Foundation Hospital, Rawalpindi from November 2009 to October 2010. The antimicrobial activity of Pakistani floral sources (Trachysperm copticum, Acacia nilotica species indica, Zizyphus) honey samples was investigated by disc diffusion method against freshly isolated wound infecting bacteria (Staphylococci aureus, Staphylococci epidermidis, Streptococcus faecalis, Pseudomonas aeruginosa, Klebsiella pneumonia, Escherichia coli, Proteus vulgaris and Candida albicans), and Staphylococci aureus ATCC 6538, Pseudomonas aeruginosa ATCC 9022, Escherichia coli ATCC 25922, Candida albican ATCC 15146. An ointment containing 20% active antimicrobial honey was formulated. The efficacy of such ointment was evaluated by passing thought clinical trials. A total number of 27 patients (23 skin wound infection, and 4 diabetic foot ulcer) were involved in the study. Thin layer of newly formulated honey ointment on gauze were applied two to three times per day till complete healing. Results: In microbiological assay the honey samples were found to exhibit a very promising antimicrobial activity against all the micro-organisms tested. In clinical trial very significant results (99.15%) healing was observed in skin wound infections cases with mean healing time of 5.86 (2-20) days, and 95% diabetic foot ulcers healed with the mean healing time of 20 (8-40) days. Conclusion: Newly formulated

[Vacuum sealing drainage for infection wound in earthquake].

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Liao, Dengbin; Ning, Ning; Liu, Xiaoyan; Gan, Chunlan

2009-10-01

To investigate the effect of vacuum sealing drainage (VSD) technology on prevention and treatment of infection wound and to repair the infectious fracture wound in earthquake. Twenty-two patients with limb fractures and open infection wound received VSD from May 12, 2008 to June 19, 2008 in West China Hospital of Sichuan University. Before the VSD, we debrided all wounds and gave effective systemic antibiotics. A -18 ~ -14 kPa pressure was exerted to the wound, and the VSD was used for 8-10 days. We took a germiculture regularly. The capacity, color, and nature of negative pressure drainage, the regression of limb swelling, and systemic inflammatory responses were observed. There was no active bleeding wound or transparent film off in all patients. Three patients had drainage clogging, and were kept flowing freely using the sterile saline pipe to remove the blockage of necrotic tissues. During the VSD, granulation tissues grew well in the 13 patients with bone exposure of the wounded. Two patients whose symptom of inflammatory was not obviously eased had another debridement to completely remove the necrosis, and the symptom was relieved. After 3-5 days of VSD, swelling and fever in the other 20 patients significantly subsided. VSD can alleviate the wound inflammation, facilitate the growth of the fresh granulation tissue from the surrounding to the center, and reduce the flap transfer area for the Stage II coverage of the exposed bone.

PREPARATIVE SKIN PREPARATION AND SURGICAL WOUND INFECTION

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Anjanappa

2015-01-01

Full Text Available BACKGROUND AND OBJECTIVE: It is an established fact now that the normal skin of healthy human beings harbours a rich bacterial fl ora. Normally considered non - pathogenic , these organisms way be a potential source of infection of the surgical wound. Approximately 20% of the resident flora is beyond the reach of surgical scrubs and antiseptics. The goal of surgical preparation of the skin with antiseptics is to remove transient and pathogenic microorganisms on the skin surface and to reduce the resident flora to a low level. Povidone iodine (I odophors and chlorhexidine are most often used antiseptics for pre - operative skin preparation. OBJECTIVES : To evaluate the efficacy of povidone iodine alone and in combination with antiseptic agent containing alcoholic chlorhexidine in preoperative skin p reparation by taking swab culture. (2 To compare the rate of postoperative wound infection in both the groups. METHODS: One hundred patients (fifty in each group undergoing clean elective surgery with no focus of infection on the body were included in th e study. The pre - operative skin preparation in each group is done with the respective antiseptic regimen. In both the groups after application of antiseptics , sterile saline swab culture was taken immediately from site of incision. In cases which showed gr owth of organisms , the bacteria isolated were identified by their morphological and cultural characteristics. Grams staining , coagulase test and antibiotic sensitivity test were done wherever necessary and difference in colonization rates was determined as a measure of efficacy of antiseptic regimen. RESULTS: The results of the study showed that when compared to povidone iodine alone , using a combination of povidone iodine and alcoholic solution of chlorhexidine , the colonization rates of the site of incisi on were reduced significantly. As for the rate of post - operative wound infection , it is also proven that wound infections are also

Gram negative wound infection in hospitalised adult burn patients--systematic review and metanalysis-.

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Azzopardi, Ernest A; Azzopardi, Elayne; Camilleri, Liberato; Villapalos, Jorge; Boyce, Dean E; Dziewulski, Peter; Dickson, William A; Whitaker, Iain S

2014-01-01

Gram negative infection is a major determinant of morbidity and survival. Traditional teaching suggests that burn wound infections in different centres are caused by differing sets of causative organisms. This study established whether Gram-negative burn wound isolates associated to clinical wound infection differ between burn centres. Studies investigating adult hospitalised patients (2000-2010) were critically appraised and qualified to a levels of evidence hierarchy. The contribution of bacterial pathogen type, and burn centre to the variance in standardised incidence of Gram-negative burn wound infection was analysed using two-way analysis of variance. Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter baumanni, Enterobacter spp., Proteus spp. and Escherichia coli emerged as the commonest Gram-negative burn wound pathogens. Individual pathogens' incidence did not differ significantly between burn centres (F (4, 20) = 1.1, p = 0.3797; r2 = 9.84). Gram-negative infections predominate in burn surgery. This study is the first to establish that burn wound infections do not differ significantly between burn centres. It is the first study to report the pathogens responsible for the majority of Gram-negative infections in these patients. Whilst burn wound infection is not exclusive to these bacteria, it is hoped that reporting the presence of this group of common Gram-negative "target organisms" facilitate clinical practice and target research towards a defined clinical demand.

Pseudomonas aeruginosa in Post-operative Wound Infections in ...

African Journals Online (AJOL)

The occurrence of post-operative wound infections was studied over a period of five months in the University College Hospital, Ibadan between February to July, 2003. Two hundred Surgical wounds were collected and routinely processed by Gram staining and culture in the Microbiology Laboratory. Of the 200 samples ...

The Incidence of Infection After Early Closure of Evulsive Facial Wounds

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Hosseini-e- Todashki H

2000-06-01

Full Text Available The aim of this study was to evaluate the incidence of postoperative wound dehiscence and"ninfection after early closure of evulsive facial wounds. This treatment was conducted on 28 male patients"nwith evulsive facial wounds. The formation of these evulsive wounds was due to the rupture of"ntemporary cavitation caused by high and extra high velocity messiles. All patients with average age of 18"nyears old were treated 24-48 hrs afire accidents at base hospitals (1988-1990."nPrimary healing was achieved in 24 subjects from 7 tO 15 days after the standard operation. Wound"ndehiscences and bacterial infections were observed in 4 subjects."nThe conclusion can be made from the results is that the early closure of evulsive facial wounds may"nreduce the rate of wound dehiscence and infection because of high vascularity in this area.

Negative Pressure Wound Therapy in Infected Wound following Posterior Spinal Instrumentation using Simple Self-assembled System: A Case Report

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CW Chang

2014-07-01

Full Text Available Postoperative wound infection in an instrumented spine patient is often disastrous. Management includes implant removal leading to spine instability. Negative pressure wound therapy (NPWT applied to the spine surgical wound is one of the wound care technique with successful results. We report a case of a man who sustained Chance fracture of Lumbar 1 (L1 vertebra treated with long segment posterior instrumentation, who unfortunately developed Extended-spectrum beta-lactamase (ESBL positive E. coli infection one month after the operation. After careful debridement of the wound, the implant became exposed. Three cycles of NPWT were applied and the wound healed with granulation tissue completely covering the implant, and thus negating the need to remove the implant. In conclusion, the NPWT is a good alternative in postoperative wound management especially in an instrumented spine patient.

Gram negative wound infection in hospitalised adult burn patients--systematic review and metanalysis-.

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Ernest A Azzopardi

Full Text Available BACKGROUND: Gram negative infection is a major determinant of morbidity and survival. Traditional teaching suggests that burn wound infections in different centres are caused by differing sets of causative organisms. This study established whether Gram-negative burn wound isolates associated to clinical wound infection differ between burn centres. METHODS: Studies investigating adult hospitalised patients (2000-2010 were critically appraised and qualified to a levels of evidence hierarchy. The contribution of bacterial pathogen type, and burn centre to the variance in standardised incidence of Gram-negative burn wound infection was analysed using two-way analysis of variance. PRIMARY FINDINGS: Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter baumanni, Enterobacter spp., Proteus spp. and Escherichia coli emerged as the commonest Gram-negative burn wound pathogens. Individual pathogens' incidence did not differ significantly between burn centres (F (4, 20 = 1.1, p = 0.3797; r2 = 9.84. INTERPRETATION: Gram-negative infections predominate in burn surgery. This study is the first to establish that burn wound infections do not differ significantly between burn centres. It is the first study to report the pathogens responsible for the majority of Gram-negative infections in these patients. Whilst burn wound infection is not exclusive to these bacteria, it is hoped that reporting the presence of this group of common Gram-negative "target organisms" facilitate clinical practice and target research towards a defined clinical demand.

Vacuum-assisted closure therapy for infected perineal wounds after abdominoperineal resection. A retrospective cohort study.

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Walma, M S; Burbach, J P M; Verheijen, P M; Pronk, A; van Grevenstein, W M U

2016-02-01

Perineal wound complications are a main problem after abdominoperineal resection (APR). There is little evidence concerning perineal wound management. This study describes and evaluates the role of vacuum-assisted closure (VAC) therapy in wound management strategies of perineal wound infections after APR. Patients undergoing APR for malignant disease between January 2007 and January 2013 were identified retrospectively. Data regarding occurrence and management of perineal wound complications were collected. Perineal wound infections were classified into minor or major complications and time to wound healing was measured. Time to wound healing was compared between patients receiving routine care or with additional VAC therapy. Of 171 included patients, 76 (44.4%) had minor and 36 (21.1%) major perineal wound infections. Management of major infected perineal wounds consisted of drainage (n = 16), debridement (n = 4), drainage combined with debridement (n = 4), VAC therapy alone (n = 5), or VAC therapy combined with other treatments (n = 7). Median duration of perineal wound healing in major infected wounds was 141 days (range 17-739). Median time to wound healing was not different in patients treated with (172 days, range 23-368) or without VAC therapy (131 days, range 17-739). In this study, VAC therapy did not shorten time to wound healing. However, prospective studies are required to investigate the role of VAC therapy in management of infected perineal wounds after APR. Up to then, wound management will remain to be based on clinical perception and 'gut-feeling'. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

Prevention of surgical wound infection in obese women undergoing cesarean section

DEFF Research Database (Denmark)

Hyldig, Nana; Vinter, Christina Anne; Kruse, Marie

2016-01-01

Aim: Obese women undergoing caesarean section are at increased risk of surgical wound infection, which may lead to reduced quality of life, and increased health care cost. The aim is to evaluate the effect of incisional Negative Pressure Wound Therapy applied prophylactically in obese women under......: The study is on-going. We expect to find a 50% reduction of wound infection when using iNPWT compared to standard dressings in this high-risk subpopulation....

Liposome Entrapment of Bacteriophages Improves Wound Healing in a Diabetic Mouse MRSA Infection

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Sanjay Chhibber

2018-03-01

Full Text Available Diabetic populations are more prone to developing wound infections which results in poor and delayed wound healing. Infection with drug resistant organisms further worsen the situation, driving searches for alternative treatment approaches such as phage therapy. Major drawback of phage therapy, however, is low phage persistence in situ, suggesting further refinement of the approach. In the present work we address this issue by employing liposomes as delivery vehicles. A liposome entrapped phage cocktail was evaluated for its ability to resolve a Staphylococcus aureus-induced diabetic excission wound infection. Two characterized S. aureus specific lytic phages, MR-5 and MR-10 alone, in combination (cocktail, or entrapped in liposomes (versus as free phages were assesed for their therapeutic efficacy in resolving diabetic wound infection. Mice treated with free phage cocktail showed significant reduction in wound bioburden, greater wound contraction and faster tissue healing than with free monophage therapy. However, to further enhance the availability of viable phages the encapsulation of phage cocktail in the liposomes was done. Results of in vitro stability studies and in vivo phage titer determination, suggests that liposomal entrapment of phage cocktail can lead to better phage persistence at the wound site. A 2 log increase in phage titre, however, was observed at the wound site with liposome entrapped as compared to the free phage cocktail, and this was associaed with increased rates of infection resolution and wound healing. Entrapment of phage cocktails within liposomes thus could represent an attractive approach for treatment of bacterial infections, not responding to antibiotis as increased phage persistence in vitro and in vivo at the wound site was observed.

AEROBIC BACTERIAL ISOLATES FROM INFECTED WOUNDS

African Journals Online (AJOL)

boaz

most frequently reported as the cause of delay wound healing (6-9, 3). ... All isolates were resistant to Ampicillin, Amoxicillin- clavulanate and .... Ulcer bed infection. Report of a case of enlarging venous leg ulcer colonized by ... Ann. Burns Fire.

[Clinical study and pathological examination on the treatment of deep partial thickness burn wound with negative charge aerosol].

Science.gov (United States)

Li, Tian-zeng; Xu, Ying-bin; Hu, Xiao-gen; Shen, Rui; Peng, Xiao-dong; Wu, Wei-jiang; Luo, Lan; Dai, Xin-ming; Zou, Yong-tong; Qi, Shao-hai; Wu, Li-ping; Xie, Ju-lin; Deng, Xiao-xin; Chen, E; Zhang, Hui-Zhen

2005-08-01

To investigate the effect of negative charge aerosol (NCA) on the treatment of burn wound. Patients with superficial or deep partial thickness burn only were enrolled in the study, and they were randomly divided into trial group (T, including 180 cases of superficial thickness burn and 100 cases of deep partial thickness burn), control group (C, including 30 cases with superficial thickness burn and 30 with deep partial thickness burn), and self control group (SC, including 10 cases with superficial thickness burn and 10 with deep partial thickness burn). The patients in T and SC groups were treated with NCA for 1.5 hours, 1-2 times a day, from 6 postburn hour (PBH) to 2 postburn day (PBD), while those in C group received conventional treatment. For those in SC group, some of the wounds were covered with sterile schissel, while other wounds without schissel covering. The general changes in the wounds during NCA treatment were observed, and bacterial culture before and after NCA treatment was performed. The healing time was recorded and the blood biochemical parameters were determined. Rat model with deep partial thickness scald was established, and the rats were also divided into T and C groups, and received treatment as in human. Tissue samples were harvested from the wounds of rats in the 2 groups before and 1, 2, 3 weeks after treatment for pathological examination. There was no infection and little exudation in the patients in T group. No bacteria were found in the wound before and after NCA treatment. The healing time of the wounds of patients with superficial and deep partial thickness burn in T group was 6.3 +/- 1.6 d and 15.1 +/- 3.1 d, respectively, which was obviously shorter than those in C group (11.3 +/- 1.4 d and 21.2 +/- 1.4 d, P Negative charge aerosol is safe and effective in promoting wound healing of the patients with partial thickness burns.

Characterization of wound infections among patients injured during the 2011 Libyan conflict.

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Dau, A A; Tloba, S; Daw, M A

2013-04-01

Few studies have analysed the bacterial pathogenesis of infections associated with war-wound in the Eastern Mediterranean region. We analysed surgical wound infections of 1200 patients injured during the Libyan conflict in 2011 and admitted to the emergency services at Tripoli medical centre. Culture swabs or surgical wound debridement samples were collected and cultures were identified and tested for antimicrobial resistance. Of the 1200 patients studied, 498 (42%) were infected with at least 1 pathogen and 57 with >2 pathogens. The most common species were Acinetobacter spp. (isolated from 144 patients), coagulase-negative staphylococci (122), Escherichia coli (107), Pseudomnonas aeruginosa (92) and Klebsiella spp. (86). A high level of resistance to the antibiotics tested was found, especially among Acinetobacter spp. Multi-drug-resistant Gram-negative bacilli were an important complicating factor in wound infections associated with war injuries among injured patients in Libya. Effective policies are needed to control and treat such infections particularly in trauma and emergency services.

knowledge and practice of post-operative wound infection

African Journals Online (AJOL)

honey

2014-03-31

Mar 31, 2014 ... International Journal of Basic, Applied and Innovative Research ... AMONG NURSES IN THE SURGICAL UNIT OF A TEACHING ... 3Nursing Science, Faculty ... study suggest that nurses had poor knowledge and attitude of infection ... wound infection and evaluate their practice regarding postoperative.

Effect of bag extraction to prevent wound infection on umbilical port site wound on elective laparoscopic cholecystectomy: a prospective randomised clinical trial.

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Comajuncosas, Jordi; Hermoso, Judit; Jimeno, Jaime; Gris, Pere; Orbeal, Rolando; Cruz, Antonio; Parés, David

2017-01-01

Laparoscopic cholecystectomy is the gold standard treatment for gallbladder stones. Complications due to laparoscopic procedure are rare, but rate of wound infection in some studies is about 8 %. From January 2007 to December 2008, 320 laparoscopic cholecystectomies were performed at our hospital, and in 4.7 % of them, wound infection of the umbilical trocar was identified. We believe that this infection rate could be lower and that it is necessary to implement a new technique to reduce the wound infection. The aim of the study was to evaluate the benefits of bag extraction of gallbladder to prevent the wound infection. Two-arm, parallel, 1:1, randomised controlled trial (ISRCTN38095251). All patients suffering from symptomatic gallbladder stones of low risk were enrolled for this study and were divided into two groups in basics gallbladder extraction: with (80 patients) or, as usually, without bag (76 patients). All patients with cholecystitis or accidental gallbladder perforation were excluded. We compared all the results to establish whether meaningful differences were found. The final sample analysed (156 patients) consisted of 121 women and 35 men; there were 80 in the control group and 76 in the study group. There were 15 (9.6 %) diagnosed wound infections, eight cases in the study group and seven in the control group. There were no statistically significant differences. The determinant of wound infection in elective laparoscopic cholecystectomy is not the direct contact of the gallbladder with the wound; therefore, bag extraction is not necessary.

Management of wound infection after lumbar arthrodesis maintaining the instrumentation

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Asdrubal Falavigna

2015-06-01

Full Text Available OBJECTIVE: To determinate whether a surgical protocol with immediate extensive debridement, closed irrigation system and antibiotic therapy would be effective to achieve healing of deep wound infection without removing the instrumentation.METHODS: Prospective cohort study with 19 patients presenting degenerative spinal stenosis or degenerative spondylolisthesis, who developed infection after posterior lumbar arthrodesis. The diagnosis was confirmed by a microbial culture from subfascial lumbar fluid and/or blood. Patients were treated with a protocol of wound exploration, extensive flushing and debridement, placement of a closed irrigation system that was maintained for five days and intravenous antibiotics. The instrumentation system was not removed.RESULTS: Mean age was 59.31 (±13.17 years old and most patients were female (94.7%; 18/19. The mean period for the identification of the infection was 2 weeks and 57.9% underwent a single wound exploration. White blood count, erythrocyte sedimentation rate and C-reactive protein showed a significant decrease post-treatment when compared to pre-treatment values. A significant reduction of erythrocyte sedimentation rate and C-reactive protein was also observed at the final evaluation. No laboratory test was useful to predict the need for more than one debridement.CONCLUSION: Patients with wound infection after instrumentation can be treated without removal of the instrumentation through wound exploration, extensive flushing, debridement of necrotic tissue, closed irrigation system during 5 days and proper antibiotic therapy. The blood tests were not useful to predict surgical re-interventions.

Nanosilver-Silica Composite: Prolonged Antibacterial Effects and Bacterial Interaction Mechanisms for Wound Dressings.

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Mosselhy, Dina A; Granbohm, Henrika; Hynönen, Ulla; Ge, Yanling; Palva, Airi; Nordström, Katrina; Hannula, Simo-Pekka

2017-09-06

Infected superficial wounds were traditionally controlled by topical antibiotics until the emergence of antibiotic-resistant bacteria. Silver (Ag) is a kernel for alternative antibacterial agents to fight this resistance quandary. The present study demonstrates a method for immobilizing small-sized (~5 nm) silver nanoparticles on silica matrix to form a nanosilver-silica (Ag-SiO₂) composite and shows the prolonged antibacterial effects of the composite in vitro. The composite exhibited a rapid initial Ag release after 24 h and a slower leaching after 48 and 72 h and was effective against both methicillin-resistant Staphylococcus aureus (MRSA) and Escherichia coli ( E . coli ). Ultraviolet (UV)-irradiation was superior to filter-sterilization in retaining the antibacterial effects of the composite, through the higher remaining Ag concentration. A gauze, impregnated with the Ag-SiO₂ composite, showed higher antibacterial effects against MRSA and E . coli than a commercial Ag-containing dressing, indicating a potential for the management and infection control of superficial wounds. Transmission and scanning transmission electron microscope analyses of the composite-treated MRSA revealed an interaction of the released silver ions with the bacterial cytoplasmic constituents, causing ultimately the loss of bacterial membranes. The present results indicate that the Ag-SiO₂ composite, with prolonged antibacterial effects, is a promising candidate for wound dressing applications.

Occurrence of pseudomonas aeruginosa in post-operative wound infection

International Nuclear Information System (INIS)

Oguntibeju, O.O.; Nwobu, R.A.U.

2004-01-01

Objective: To determine the prevalence of Pseudomonas aeruginosa in post-operative wound infection. Results: Out of the 60 bacterial isolates found in post-operative wound infection, 20 (33.3%) were Pseudomonas aeruginosa, followed by Staphylococcus aureus 13(21.7%), Klebsiella species 10(16.7%), Escherichia coli 7(11.7%), Atypical coliform 4(6.7%), Proteus species 4(6.7%), Streptococcus pyogenes 1(1.7%) and Enterococcus faecalis 1(1.7%) in the order. Pseudomonas aeruginosa infections was higher in female than male, ratio 3:2 and was found more among young and elderly debilitated patients. The in vitro sensitivity pattern of 20 isolates of Pseudomonas aeruginosa showed colistin (100%), gentamicin (75%), streptomycin (30%), and tetracycline (10%). Conclusion: The role of Pseudomonas aeruginosa as an agent of nosocomial infection is re-emphasised. (author)

[Preoperative preparation, antibiotic prophylaxis and surgical wound infection in breast surgery].

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Rodríguez-Caravaca, Gil; de las Casas-Cámara, Gonzalo; Pita-López, María José; Robustillo-Rodela, Ana; Díaz-Agero, Cristina; Monge-Jodrá, Vicente; Fereres, José

2011-01-01

The impact of surgical wound infection on public health justifies its surveillance and prevention. Our objectives were to estimate the incidence of surgical wound infection in breast procedures and assess its protocol of antibiotic prophylaxis and preoperative preparation. Observational multicentre prospective cohort study of incidence of surgical wound infection. Incidence was evaluated, stratified by National Nosocomial Infection Surveillance (NNIS) risk index and we calculated the standardized incidence ratio (SIR). The SIR was compared with Spanish rates and U.S. rates. The compliance and performance of the antibiotic prophylaxis and preoperative preparation protocol were assessed and their influence in the incidence of infection with the relative risk. Ten hospitals from the Comunidad de Madrid were included, providing 592 procedures. The cumulative incidence of surgical wound infection was 3.89% (95% CI: 2.3-5.5). The SIR was 1.82 on the Spanish rate and 2.16 on the American. Antibiotic prophylaxis was applied in 97.81% of cases, when indicated. The overall performance of antibiotic prophylaxis was 75%, and 53% for preoperative preparation. No association was found between infection and performance of prophylaxis or preoperative preparation (P>.05). Our incidence is within those seen in the literature although it is somewhat higher than the national surveillance programs. The performance of prophylaxis antibiotic must be improved, as well as the recording of preoperative preparation data. Copyright © 2010 Elsevier España, S.L. All rights reserved.

Vacuum-assisted wound closure versus alginate for the treatment of deep perivascular wound infections in the groin after vascular surgery.

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Monsen, Christina; Wann-Hansson, Christine; Wictorsson, Catharina; Acosta, Stefan

2014-01-01

Vacuum-assisted wound closure (VAC) therapy may heal wounds faster than conventional dressings after surgical debridement of perivascular groin infections after vascular surgery. Patients with deep infected wounds (Szilagyi grade III) were surgically revised and left open for secondary healing, then randomized to either VAC or alginate (Sorbalgon) therapy, between February 2007 and November 2011. To test the hypothesis, it was calculated that 42 patients needed to be included (90% power, 5% level of significance). It was decided to perform an interim analysis after inclusion of 20 patients. Among 66 patients undergoing groin revision, 20 patients were included in this study. Patients were randomized to VAC (n = 10) or alginate (n = 10). The two groups were comparable in patient and wound characteristics. Time to full skin epithelialization was significantly shorter in the VAC group (median, 57 days) compared with the alginate group (median, 104 days; P = .026). The number of positive wound cultures of bacteria and C-reactive protein values decreased equally in both groups between surgical revision and day 21. One femur amputation was performed in each group as a consequence of the groin infection, one patient died during the in-hospital stay in the alginate group, and none died in the VAC group. VAC achieves faster healing than alginate therapy after wound debridement for deep perivascular wound infections in the groin after vascular surgery. This finding does not allow further inclusion of patients from an ethical point of view, and this study was, therefore, stopped prematurely. Copyright © 2014 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

Wound and soft tissue infections of Serratia marcescens in patients receiving wound care: A health care-associated outbreak.

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Us, Ebru; Kutlu, Huseyin H; Tekeli, Alper; Ocal, Duygu; Cirpan, Sevilay; Memikoglu, Kemal O

2017-04-01

We described a health care-associated Serratia marcescens outbreak of wound and soft tissue infection lasting approximately 11 months at Ankara University Ibni Sina Hospital. After identification of S marcescens strains from the clinical and environmental samples, and their susceptibility testing to antimicrobial agents, pulsed-field gel electrophoresis (PFGE) was performed to detect molecular epidemiologic relationships among these isolates. The strains which were isolated from the saline bottles used for wound cleansing in the wound care unit were found to be 100% interrelated by PFGE to the strains from the samples of the outbreak patients. Reuse of the emptied bottles has no longer been allowed since the outbreak occurred. Besides, more efficient and frequent infection control training for hospital staff has been conducted. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Major bleeding during negative pressure wound/V.A.C.® - therapy for postsurgical deep sternal wound infection - a critical appraisal

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Segers Patrique

2011-09-01

Full Text Available Abstract Negative-pressure wound therapy, commercially known as vacuum-assisted closure (V.A.C.® therapy, has become one of the most popular (and efficacious interim (prior to flap reconstruction or definite methods of managing deep sternal wound infection. Complications such as profuse bleeding, which may occur during negative-pressure therapy but not necessarily due to it, are often attributed to a single factor and reported as such. However, despite the wealth of clinical experience internationally available, information regarding certain simple considerations is still lacking. Garnering information on all the factors that could possibly influence the outcome has become more difficult due to a (fortunate decrease in the incidence of deep sternal wound infection. If more insight is to be gained from fewer clinical cases, then various potentially confounding factors should be fully disclosed before complications can be attributed to the technique itself or improvements to negative-pressure wound therapy for deep sternal wound infection can be accepted as evidence-based and the guidelines for its use adapted. The authors propose the adoption of a simple checklist in such cases.

Fast Blue RR—Siloxane Derivatized Materials Indicate Wound Infection Due to a Deep Blue Color Development

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Doris Schiffer

2015-09-01

Full Text Available There is a strong need for simple and fast methods for wound infection determination. Myeloperoxidase, an immune system-derived enzyme was found to be a suitable biomarker for wound infection. Hence, alkoxysilane-derivatized Fast Blue RR was immobilized via simple hydrolytic polymerization. The resulting enzyme-responsive siloxane layers were incubated with myeloperoxidase, wound fluid or hemoglobin. The reaction was monitored via HPLC measurements and the color development quantified spectrophotometrically. Myeloperoxidase was indeed able to oxidize immobilized Fast Blue RR leading to a blue colored product. No conversion was detected in non-infected wound fluids. The visible color changes of these novel materials towards blue enable an easy distinction between infected and non-infected wound fluids.

Pattern of pathogens and their sensitivity isolated from superficial surgical site infections in a tertiary care hospital

International Nuclear Information System (INIS)

Ali, S.A.; Tahir, S.M.; Shaikh, N.A.

2009-01-01

Infection is an important cause of morbidity and mortality in surgical patients. Rapidly emerging nosocomial pathogens and the problem of multi-drug resistance necessitates periodic review of isolation patterns and sensitivity in surgical practice. Surgical site infections (SSI) are defined as an infections that occurs at the incision site within thirty days after surgery. Objectives of the study were to determine the pattern of pathogens involved and their antibiotic sensitivity isolated from superficial surgical site infections in a teaching hospital. This observational study was conducted for 1 year from January 2008 to December 2008 in all 4 surgical units of Liaquat University Hospital Hyderabad which caters to patients from low socioeconomic status. Pus culture and sensitivity reports were collected prospectively from hospitalised patients who developed postoperative wound infection. The patients who developed fecal/biliary/urinary fistula or operated for malignancies, and with negative cultures were excluded from the study. Analysis was carried out using SPSS 10. During the study period 112 pus culture and sensitivity reports were analyzed. E. coli 68 (60.7%) was the most common organism isolated followed by Klebsiella 23 (20.5%). The least frequent organism was staph. Epidermidis 1 (0.9%). All isolates were sensitive to penicillin derivatives and carbapenem. Quinolones, Aminoglycosides and Monobactum were also showing some promise in our study. However, Cephalosporins were ineffective against most of the important isolates in our study. E. coli and klebsiella were the most important isolates form SSI in our study, and penicillin derivatives and carbapenem were showing 100% antibiotic sensitivity to all of the isolates. (author)

Study of Bacteriology of Post-Operative Wound Infection

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Neelam Abdulrauf Bagwan

2014-07-01

Full Text Available Background: While many patients are admitted to hospital for treatment of infections, some acquire infection during their stay in the hospital. These infections are called as nosocomial infections. Surgical site infection or post operative wound infection is one of them. It is defined as infection of previously sterile tissue incised to gain exposure for operating deeper spaces operatively exposed or organs manipulated by a surgeon. It is one of the feared complications of surgery as it increases morbidity as well as cost of medical care. Aims and Objectives: Study was conducted to find out incidence of surgical site infection rate in surgical ward, evaluate various factors contributing to infection and to identify causative pathogens and their antibiogram patterns. Material and Methods: All clean and clean contaminated operative cases admitted in surgery ward in study period of 18 months were included. Preoperative, operative and postoperative management protocols of the cases were recorded in detail. Results: A total of 1082 operated cases were studied among which 59 infected cases were found. Surgical Site Infection (SSI rate was 5.45%. E. coli and Staphylococcus aureus were the commonest pathogen isolated from the infected wound. 50 % were Methicillin Resistant Staphylococcus Aureus (MRSA among them and 50% of rd Enterobacteriaceae group were resistant to 3 generation Cephalosporins. Conclusion: Surgical site infection rate of a hospital can be reduced easily by following proper pre-operative protocol for the patients. Those patients with surgical site infection can be treated effectively by following the antibiotic policy as provided by the Department of Microbiology.

Frequency of wound infection in non-perforated appendicitis with use of single dose perforative antibiotics

International Nuclear Information System (INIS)

Ali, K.; Latif, H.; Ahmad, S.

2015-01-01

Antibiotics are used both pre and post-operatively in acute appendicitis for preventing wound infection. It has been observed that the routine use of post-operative antibiotics is not necessary in cases of non-perforated appendicitis as only prophylactic antibiotics are sufficient to prevent wound infection. The aim of this study was to see the frequency of wound infection in non-perforated appendicitis with single dose preoperative antibiotics only. Method: This observational study was conducted at the Department of Surgery, Ayub Medical College, Abbottabad from May to November 2014. A total of 121 patients with non-perforated appendicitis were included in the study. Only single dose preoperative antibiotics were used. The patients were followed for wound infection till 8th post-operative day. Results: 121 patients, 56(46.28%) male and 65(53.72%) female were included in the study. The mean age of patients was 27.41 ± 7.12 years with an age range of 18 to 45 years. In the entire series, 7(5.78%) patients developed wound infection. The infection was minor which settled with conservative therapy. Prophylactic antibiotics were found efficacious in 114(94.21%) patients. There was no significant association between wound infection and age and gender. Conclusion: Single dose preoperative antibiotics were found effective in controlling post-operative wound infection without the need of extending the antibiotics to post-operative period in cases of non-perforated appendicitis. (author)

Early wound infection identification using the WIRE tool in community health care settings: An audit report.

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Siaw-Sakyi, Vincent

2017-12-01

Wound infection is proving to be a challenge for health care professionals. The associated complications and cost of wound infection is immense and can lead to death in extreme cases. Current management of wound infection is largely subjective and relies on the knowledge of the health care professional to identify and initiate treatment. In response, we have developed an infection prediction and assessment tool. The Wound Infection Risk-Assessment and Evaluation tool (WIRE) and its management strategy is a tool with the aim to bring objectivity to infection prediction, assessment and management. A local audit carried out indicated a high infection prediction rate. More work is being done to improve its effectiveness.

Use of vacuum-assisted closure in pediatric open fractures with a focus on the rate of infection.

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Halvorson, Jason; Jinnah, Riyaz; Kulp, Brenda; Frino, John

2011-07-07

The use of the vacuum-assisted closure device (VAC; KCI, San Antonio, Texas) has given the orthopedist a new tool for the successful management of severe traumatic wounds and open fractures. While the VAC's role in the adult population is proving itself as an improved therapy compared to "traditional wound care," it's role within pediatric orthopedics remains less well defined. Questions remain whether VAC therapy provides benefit regarding decreased infection rates as well as decreased need for extensive soft tissue coverage procedures. A review was therefore performed of a pediatric level I trauma center's experience using the VAC therapy for pediatric open fractures with a focus on the rate of superficial, deep, and chronic infection. A retrospective chart review spanning 4.5 years of all pediatric patients younger than 18 years with an open fracture initially treated with VAC therapy was conducted at a level I pediatric trauma center. This yielded 28 patients with 37 open fractures aged 2 to 17 years who were initially treated with wound VAC therapy. Subsequent chart review of these patients was performed examining in-hospital records, operative notes, and clinical follow-up visits for documented cases of superficial, deep, or chronic infection. Of 37 open pediatric fractures treated with a wound VAC, there were no cases of superficial infection and 2 cases of deep infection for an overall infection rate of 5%. Both infections resolved with surgical intervention and antibiotics without chronic infection development. When compared with historical controls, the use of VAC therapy for pediatric open fractures appears to be an equally safe and effective modality to help reduce infection in pediatric open fractures and should be considered a valuable tool in treating these injuries. Copyright 2011, SLACK Incorporated.

Nanomedicine and advanced technologies for burns: Preventing infection and facilitating wound healing.

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Mofazzal Jahromi, Mirza Ali; Sahandi Zangabad, Parham; Moosavi Basri, Seyed Masoud; Sahandi Zangabad, Keyvan; Ghamarypour, Ameneh; Aref, Amir R; Karimi, Mahdi; Hamblin, Michael R

2018-01-01

According to the latest report from the World Health Organization, an estimated 265,000 deaths still occur every year as a direct result of burn injuries. A widespread range of these deaths induced by burn wound happens in low- and middle-income countries, where survivors face a lifetime of morbidity. Most of the deaths occur due to infections when a high percentage of the external regions of the body area is affected. Microbial nutrient availability, skin barrier disruption, and vascular supply destruction in burn injuries as well as systemic immunosuppression are important parameters that cause burns to be susceptible to infections. Topical antimicrobials and dressings are generally employed to inhibit burn infections followed by a burn wound therapy, because systemic antibiotics have problems in reaching the infected site, coupled with increasing microbial drug resistance. Nanotechnology has provided a range of molecular designed nanostructures (NS) that can be used in both therapeutic and diagnostic applications in burns. These NSs can be divided into organic and non-organic (such as polymeric nanoparticles (NPs) and silver NPs, respectively), and many have been designed to display multifunctional activity. The present review covers the physiology of skin, burn classification, burn wound pathogenesis, animal models of burn wound infection, and various topical therapeutic approaches designed to combat infection and stimulate healing. These include biological based approaches (e.g. immune-based antimicrobial molecules, therapeutic microorganisms, antimicrobial agents, etc.), antimicrobial photo- and ultrasound-therapy, as well as nanotechnology-based wound healing approaches as a revolutionizing area. Thus, we focus on organic and non-organic NSs designed to deliver growth factors to burned skin, and scaffolds, dressings, etc. for exogenous stem cells to aid skin regeneration. Eventually, recent breakthroughs and technologies with substantial potentials in tissue

[Vacuum-assisted closure therapy for the treatment of sternal wound infection after cardiac surgery].

Science.gov (United States)

Nishimura, K; Nakamura, Y; Harada, S; Saiki, M; Marumoto, A; Kanaoka, Y; Nishimura, M

2009-11-01

Sternal wound infection is still one of the critical and challenging complications after cardiac surgery. Vacuum-assisted closure (VAC) therapy is a unique and simple system that helps promote wound healing. We report 3 cases with the sternal wound infection after cardiac surgery, in which VAC therapy was applied between January, 2005 and April, 2007. Two of them had good response to VAC therapy and had their wound healed after 3 and 5 weeks, respectively. However, the remaining case, in which bilateral internal thoracic artery had been taken down for coronary artery bypass grafting (CABG) and osteomyelitis of the sternum was not well controlled, did not respond to VAC therapy. Our results suggested that VAC might facilitate wound healing of the patients with sternal wound infection only after abscess was drained and opened, while it might not be useful for the patents with osteomyelitis.

Wound healing without drains in posterior spinal fusion in idiopathic scoliosis

International Nuclear Information System (INIS)

Alsiddiky, A.; Nisar, K.A.; Alhuzaimi, F.; Albishi, W.; Alnuaim, B.; Albarrag, M.; Meo, S.A.

2013-01-01

To determine the frequency of wound infection and neurological injuries in patients with idiopathic scoliosis who underwent posterior spinal fusion without use of drains. Study Design: Case series. Place and Duration of Study: Department of Orthopaedics, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia, from February 2007 to June 2010. Methodology: Patients who underwent similar technique of posterior spinal fusion instrumentation for the correction of scoliosis without use of drain were included. Wound Demographics, wound healing, complications and duration of hospital stay were considered and described as frequency and mean values. Results: The average age at the time of surgery was 12.80 +- 1.30 years, duration of surgery was 3.80 +- 0.86 hours, hospital stay was 3.84 +- 0.78 days and patients were followed-up over the last 30 months. There was no incidence of any neurological complication and deep infection. However, only 2 (4.16%) cases with superficial skin infection were treated with dressing and antibiotics with full recovery. Conclusion: The wound healing is adequate without using drain for patients with idiopathic scoliosis who underwent posterior spinal fusion and instrumentation when good wash, watertight closure technique and appropriate antibiotics coverage is provided. (author)

Interactions of methicillin resistant Staphylococcus aureus USA300 and Pseudomonas aeruginosa in polymicrobial wound infection.

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Irena Pastar

Full Text Available Understanding the pathology resulting from Staphylococcus aureus and Pseudomonas aeruginosa polymicrobial wound infections is of great importance due to their ubiquitous nature, increasing prevalence, growing resistance to antimicrobial agents, and ability to delay healing. Methicillin-resistant S. aureus USA300 is the leading cause of community-associated bacterial infections resulting in increased morbidity and mortality. We utilized a well-established porcine partial thickness wound healing model to study the synergistic effects of USA300 and P. aeruginosa on wound healing. Wound re-epithelialization was significantly delayed by mixed-species biofilms through suppression of keratinocyte growth factor 1. Pseudomonas showed an inhibitory effect on USA300 growth in vitro while both species co-existed in cutaneous wounds in vivo. Polymicrobial wound infection in the presence of P. aeruginosa resulted in induced expression of USA300 virulence factors Panton-Valentine leukocidin and α-hemolysin. These results provide evidence for the interaction of bacterial species within mixed-species biofilms in vivo and for the first time, the contribution of virulence factors to the severity of polymicrobial wound infections.

A CLINICAL STUDY ON POSTOPERATIVE WOUND INFECTIONS IN RIMS, KADAPA- 3 YEARS EXPERIENCE

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J. Ramanaiah

2017-02-01

Full Text Available BACKGROUND Surgical wound infections continue to consume a considerable portion of healthcare finance. Even though, the complete elimination of wound infections is not possible, a reduction of the observed wound infection rate to a minimum level could have marked benefits in terms of both patient comfort and resources used. 1 MATERIALS AND METHODS The clinical study of postoperative wound infection conducted at RIMS General Hospital, Kadapa, during the period of 2013 to 2016. RESULTS In this clinical study, 150 patients were clinically diagnosed of having SSIs out of 925 patients who underwent major surgeries in Department of General Surgery, an incidence of 16.2%. Dirty type of surgeries have high incidence of SSI at 63.6%. SSI occurred more in patients who didn’t receive preoperative antibiotic within 2 hrs. prior to surgery, i.e. 32.1%. Most of the patients presented with discharge through the wound (81.3%. The most common type of discharge was purulent (52.5%. CONCLUSION Preoperative preparation <24 hrs., preoperative bathing and preoperative antibiotic within 2 hrs. before surgery help in reducing surgical site infections. Early diagnosis of SSI and prompt management by isolation of organism causing SSI using sensitive antibiotics and regular dressing help in reducing morbidity for the patients.

Impact of Mucorales and Other Invasive Molds on Clinical Outcomes of Polymicrobial Traumatic Wound Infections.

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Warkentien, Tyler E; Shaikh, Faraz; Weintrob, Amy C; Rodriguez, Carlos J; Murray, Clinton K; Lloyd, Bradley A; Ganesan, Anuradha; Aggarwal, Deepak; Carson, M Leigh; Tribble, David R

2015-07-01

Combat trauma wounds with invasive fungal infections (IFIs) are often polymicrobial with fungal and bacterial growth, but the impact of the wound microbiology on clinical outcomes is uncertain. Our objectives were to compare the microbiological features between IFI and non-IFI wounds and evaluate whether clinical outcomes differed among IFI wounds based upon mold type. Data from U.S. military personnel injured in Afghanistan with IFI wounds were examined. Controls were matched by the pattern/severity of injury, including blood transfusion requirements. Wound closure timing was compared between IFI and non-IFI control wounds (with/without bacterial infections). IFI wound closure was also assessed according to mold species isolation. Eighty-two IFI wounds and 136 non-IFI wounds (63 with skin and soft tissue infections [SSTIs] and 73 without) were examined. The time to wound closure was longer for the IFI wounds (median, 16 days) than for the non-IFI controls with/without SSTIs (medians, 12 and 9 days, respectively; P Mucorales growth than for wounds with non-Mucorales growth (median, 17 days versus 13 days; P Mucorales and Aspergillus spp. growth were compared, there was no significant difference in wound closure timing. Trauma wounds with SSTIs were often polymicrobial, yet the presence of invasive molds (predominant types: order Mucorales, Aspergillus spp., and Fusarium spp.) significantly prolonged the time to wound closure. Overall, the times to wound closure were longest for the IFI wounds with Mucorales growth. Copyright © 2015, American Society for Microbiology. All Rights Reserved.

Major bleeding during negative pressure wound/VAC (R) - therapy for postsurgical deep sternal wound infection - a critical appraisal

NARCIS (Netherlands)

van Wingerden, J.J.; Segers, P.; Jekel, L.

2011-01-01

Negative-pressure wound therapy, commercially known as vacuum-assisted closure (V.A.C.(R)) therapy, has become one of the most popular (and efficacious) interim (prior to flap reconstruction) or definite methods of managing deep sternal wound infection. Complications such as profuse bleeding, which

Impact of using prophylactic antibiotic on prevention of wound infection in inguinal herniorrhaphy

International Nuclear Information System (INIS)

Akhtar, K.; Khan, Z.; Bhatti, A.M.; Mahmood, K.

2015-01-01

To compare the effect of antibiotic prophylaxis with placebo in prevention of wound infection amongst patients undergoing clean open inguinal herniorrhaphy (without mesh). Study Design: Randomized Controlled Trial. Place and Duration of Study: Pakistan Air Force Hospital, Faisal Base Karachi from October 2009 to November 2011. Material and Methods: One hundred and fifty patients undergoing inguinal herniorrhaphy were included and randomly assigned to one of the two groups using random numbers table. Group A patients were given intravenous antibiotic while those in Group B were given equal volume of normal saline just before the induction of anaesthesia. Patients from both groups were observed for the presence of wound infection. Results: Total seven cases (4.7%) of surgical site infection were detected; two cases (2.7%) occurred in group A whereas five cases (6.7%) occurred in group B. The low frequency of post-operative wound infection was seen in group A as compared to group B but the difference was statistically insignificant. Conclusion: Antibiotic prophylaxis has no significant effect on prevention of wound infection in inguinal herniorrhaphy. (author)

Superficial skin ulcers

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Samaila, Modupeola O.; Rafindadi, Abdulmumini H.; Oluwole, Olabode P.; Adewuyi, Sunday A.

2007-01-01

Objective was to determine the underlying cause of superficial skin ulcers over a 15-year period. A retrospective histopathological analysis of 670 cases of superficial skin ulcers diagnosed in the Dept. of Pathology, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria from January 1991 to December 2005. A total of 670 superficial skin ulcers were analyzed. The mail to female gender ratio was 409:261(1.5:1.0) and a peakage frequency of 44.3 %( 297) in the 5th and 6th decades. Spectrum of lesions encountered was categorized into inflammatory, infections, benign and malignant diseases. The malignant lesions were 309 (46.1%), non-specific inflammation 302 (45.1%), granulation tissue 25 (3.7%) and pseudoepitheliomatous hyperplasia 14 (2.1%). A total of 18(2.7%) specific infections were encountered, which included bacterial, fungal and viral infection. Benign lesions were 2(0.3%), comprising of neurofibroma and Bowen's disease. The most common malignant lesion was squamous cell carcinoma 203 (30.3%) with a male to female ratio of 128:75 (1.7:1.0). Of these 161 were well differentiated tumors. The lower limb was the prevalent site distribution of all the ulcers. Superficial ulcers may be harbinger of malignant diseases. Squamous cell carcinoma remains the most common malignant lesion arising from chronic superficial ulcers from our setting. Adequate tissue biopsy and early diagnosis may reduce the attendant morbidity of these ulcers. (author)

Aquatically acquired Aeromonas hydrophila wound infection A ...

African Journals Online (AJOL)

The occurrence of Aeromonas hydrophila wound infections in healthy hosts after water-associated injury is being reported more frequently. This paper reports our experience with 3 such cases and outlines the importance of recognising the association between a water-related injury and, this organism.

Effect of hBD2 genetically modified dermal multipotent stem cells on repair of infected irradiated wounds

International Nuclear Information System (INIS)

Zong Zhaowen; Li Nan; Xiao Taoyuan

2010-01-01

Deficiencies in repair cells and infection are two of the main factors that can hinder the process of wound healing. In the present study, we investigated the ability of human beta-defensin-2 (hBD2) genetically modified dermal multipotent stem cells (dMSCs) to accelerate the healing irradiated wounds complicated by infections. An hBD2 adenovirus expression vector (Adv-hBD2) was firstly constructed and used to infect dMSCs. The antibacterial activity of the supernatant was determined by Kirby-Bauer method and macrodilution broth assay. Time to complete wound healing, residual percentage of wound area, and the number of bacteria under the scar were measured to assess the effects of Adv-hBD2-infected dMSC transplantation on the healing of irradiated wounds complicated by Pseudomonas aeruginosa infection. Results showed that the supernatant from Adv-hBD2-infected dMSCs had obvious antibacterial effects. Transplantation of Adv-hBD2-infected dMSCs killed bacteria in the wound. The complete wound healing time was 19.8±0.45 days, which was significantly shorter than in the control groups (P<0.05). From 14 days after transplantation, the residual wound area was smaller in the experimental group than in the control groups (P<0.05). In conculsion, we found that transplantation of hBD2 genetically modified dMSCs accelerated the healing of wounds complicated by P. aeruginosa infection in whole body irradiated rats. (author)

Tilapia Piscidin 4 (TP4 Stimulates Cell Proliferation and Wound Closure in MRSA-Infected Wounds in Mice

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Hang-Ning Huang

2015-05-01

Full Text Available Antimicrobial peptides (AMPs are endogenous antibiotics that directly affect microorganisms, and also have a variety of receptor-mediated functions. One such AMP, Tilapia piscidin 4 (TP4, was isolated from Nile tilapia (Oreochromis niloticus; TP4 has antibacterial effects and regulates the innate immune system. The aim of the present study was to characterize the role of TP4 in the regulation of wound closure in mice and proliferation of a keratinocyte cell line (HaCaT and fibroblast cell line (Hs-68. In vitro, TP4 stimulated cell proliferation and activated collagen I, collagen III, and keratinocyte growth factor (KGF gene expression in Hs-68 cells, which induces keratin production by HaCaT cells. This effect was detectable at TP4 concentrations of 6.25 µg/mL in both cell lines. In vivo, TP4 was found to be highly effective at combating peritonitis and wound infection caused by MRSA in mouse models, without inducing adverse behavioral effects or liver or kidney toxicity. Taken together, our results indicate that TP4 enhances the survival rate of mice infected with the bacterial pathogen MRSA through both antimicrobial and wound closure activities mediated by epidermal growth factor (EGF, transforming growth factor (TGF, and vascular endothelial growth factor (VEGF. The peptide is likely involved in antibacterial processes and regulation of tissue homeostasis in infected wounds in mice. Overall, these results suggest that TP4 may be suitable for development as a novel topical agent for wound dressing.

Is sternal rewiring mandatory in surgical treatment of deep sternal wound infections?

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Rashed, Aref; Gombocz, Karoly; Alotti, Nasri; Verzar, Zsofia

2018-04-01

Deep sternal wound infections (DSWIs) are a rare but serious complication after median sternotomy, and treatment success depends mainly on surgical experience. We compared treatment outcomes after conventional sternal rewiring and reconstruction with no sternal rewiring in patients with a sternal wound infection. We retrospectively enrolled patients who developed a DSWI after an open-heart procedure with median sternotomy at the Department of Cardiac Surgery, at the St. Rafael Hospital, Zalaegerszeg, Hungary, between 2012 and 2016. All patients received negative pressure wound and antibiotic therapy before surgical reconstruction. Patients were divided into groups determined by the reconstruction technique and compared. Subjects were followed up for 12 months, and the primary end-points were readmission and 90-day mortality. Among 3,177 median sternotomy cases, 60 patients developed a DSWI, 4 of whom died of sepsis before surgical treatment. Fifty-six patients underwent surgical reconstruction with conventional sternal rewiring (23 cases, 41%) or another interventions with no sternal refixation (33 cases, 59%). Eighty-one percent of sternal wound infections followed coronary bypass surgery (alone or combinated with another procedures), and 60% were diagnosed after hospital discharge. Staphylococcus aureus was cultured in 30% of all wounds and, 56.5% of cases reconstructed by sternal rewiring vs. 26.5% with no sternal rewiring, (P=0.022). Hospital readmission occurred in 63.6% of the sternal rewiring group vs. 14.7% of the no sternal rewiring group. The rate of death before wound healing or the 90 th postoperative day was 21.7% in the sternal rewiring group vs. 0% in the no sternal rewiring group. The median hospital stay was longer in the sternal rewiring group than in the other group (51 vs. 30 days, P=0.006). Sternal rewiring may be associated with a higher rate of treatment failure than other forms of treatment for sternal wound infections.

Fusarium musae as cause of superficial and deep-seated human infections.

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Esposto, M C; Prigitano, A; Tortorano, A M

2016-12-01

BLAST analysis in GenBank of 60 Fusarium verticillioides clinical isolates using the sequence of translation elongation factor 1-alpha allowed the identification of four F. musae confirming that this species is not a rare etiology of superficial and deep infections and that its habitat is not restricted to banana fruits. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Morbidity associated with 30-day surgical site infection following nonshunt pediatric neurosurgery

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Sherrod, Brandon A.; Rocque, Brandon G.

2017-01-01

Objective Morbidity associated with surgical site infection (SSI) following nonshunt pediatric neurosurgical procedures is poorly understood. The purpose of this study was to analyze acute morbidity and mortality associated with SSI after nonshunt pediatric neurosurgery using a nationwide cohort. Methods The authors reviewed data from the American College of Surgeons National Surgical Quality Improvement Program Pediatric (NSQIP-P) 2012–2014 database, including all neurosurgical procedures performed on pediatric patients. Procedures were categorized by Current Procedural Terminology (CPT) codes. CSF shunts were excluded. Deep and superficial SSIs occurring within 30 days of an index procedure were identified. Deep SSIs included deep wound infections, intracranial abscesses, meningitis, osteomyelitis, and ventriculitis. The following outcomes occurring within 30 days of an index procedure were analyzed, along with postoperative time to complication development: sepsis, wound disruption, length of postoperative stay, readmission, reoperation, and death. Results A total of 251 procedures associated with a 30-day SSI were identified (2.7% of 9296 procedures). Superficial SSIs were more common than deep SSIs (57.4% versus 42.6%). Deep SSIs occurred more frequently after epilepsy or intracranial tumor procedures. Superficial SSIs occurred more frequently after skin lesion, spine, Chiari decompression, craniofacial, and myelomeningocele closure procedures. The mean (± SD) postoperative length of stay for patients with any SSI was 9.6 ± 14.8 days (median 4 days). Post-SSI outcomes significantly associated with previous SSI included wound disruption (12.4%), sepsis (15.5%), readmission (36.7%), and reoperation (43.4%) (p neurosurgery. Rates of SSI-associated complications are significantly lower in patients with superficial infection than in those with deep infection. There were no cases of SSI-related mortality within 30 days of the index procedure. PMID:28186474

Intraoperative contamination influences wound discharge and periprosthetic infection

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Knobben, Bas A. S.; Engelsma, Yde; Neut, Danielle

Intraoperative bacterial contamination increases risk for postoperative wound-healing problems and periprosthetic infection, but to what extent remains unclear. We asked whether bacterial contamination of the instruments and bone during primary prosthesis insertion was associated with prolonged

Intraoperative contamination influences wound discharge and periprosthetic infection

NARCIS (Netherlands)

Knobben, Bas A. S.; Engelsma, Yde; Neut, Danielle

2006-01-01

Intraoperative bacterial contamination increases risk for postoperative wound-healing problems and periprosthetic infection, but to what extent remains unclear. We asked whether bacterial contamination of the instruments and bone during primary prosthesis insertion was associated with prolonged

Vacuum-assisted closure (VAC) therapy in the management of wound infection following renal transplantation.

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Shrestha, B M; Nathan, V C; Delbridge, M C; Parker, K; Throssell, D; McKane, W S; Karim, M S; Raftery, A T

2007-01-01

Wound infection in the setting of immunosuppressed state such as renal transplantation (RT) causes significant morbidity from sepsis, prolongs hospital stay and is expensive. Vacuum-assisted closure (VAC) therapy is a new technique of management of wound based on the principle of application of controlled negative pressure. The aim of this study was to assess the efficacy of VAC therapy in the management of wound infection following RT. This is a prospective study of a cohort of 180 consecutive RTs performed over a period of 4 years, where the data were retrieved from a prospectively maintained computerised database and case-notes. 9 of 180 (5%) patients developed wound infection following RT which led to cavitations and dehiscence with copious discharge, and refused to heal with conventional treatment. All 9 cases were treated with VAC therapy. The VAC system was removed after a median of 9 (range 3-30) days when discharge from the wound ceased. Four patients were discharged home with portable VAC device and managed on an outpatient basis, where the system was removed after a median 5.5 (range 3-7) days. The median hospital stay after initiation of VAC therapy was significantly shorter (5, range 2-12 days) than on conventional treatment prior to VAC therapy (11, range, 5-20 days) (p=0.003). Complete healing was achieved in all cases. The use of VAC therapy is an effective and safe adjunct to conventional and established treatment modalities for the management of wound infection and dehiscence following RT. Key words: Renal transplantation, wound infection, vacuum-assisted closure therapy.

Pseudomonas aeruginosa infection alters the macrophage phenotype switching process during wound healing in diabetic mice.

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Chen, Sinuo; Li, Renren; Cheng, Chun; Xu, Jing-Ying; Jin, Caixia; Gao, Furong; Wang, Juan; Zhang, Jieping; Zhang, Jingfa; Wang, Hong; Lu, Lixia; Xu, Guo-Tong; Tian, Haibin

2018-03-07

Macrophages play critical roles in wound healing process. They switch from "classically activated" (M1) phenotype in the early inflammatory phase to "alternatively activated" (M2) phenotype in the later healing phase. However, the dynamic process of macrophage phenotype switching in diabetic wounds burdened with bacteria is unclear. In this report, Pseudomonas aeruginosa, frequently detected in diabetic foot ulcers, was inoculated into cutaneous wounds of db/db diabetic mice to mimic bacterium-infected diabetic wound healing. We observed that P. aeruginosa infection impaired diabetic wound healing and quickly promoted the expression of pro-inflammatory genes (M1 macrophage markers) tumor necrosis factor-α (tnf-α), interleukin-1β (il-1β) and il-6 in wounds. The expression of markers of M2 macrophages, including il-10, arginase-1, and ym1 were also upregulated. In addition, similar gene expression patterns were observed in macrophages isolated directly from wounds. Immunostaining showed that P. aeruginosa infection increased both the ratios of M1 and M2 macrophages in wounds compared with that in control groups, which was further confirmed by in vitro culturing macrophages with P. aeruginosa and skin fibroblast conditioned medium. However, the ratios of the expression levels of pro-inflammatory genes to anti-inflammatory gene il-10 was increased markedly in P. aeruginosa infected wounds and macrophages compared with that in control groups, and P. aeruginosa prolonged the presence of M1 macrophages in the wounds. These data demonstrated that P. aeruginosa in diabetic wounds activates a mixed M1/M2 macrophage phenotype with an excessive activation of M1 phenotype or relatively inadequate activation of M2 phenotype. © 2018 International Federation for Cell Biology.

Wound-Healing Peptides for Treatment of Chronic Diabetic Foot Ulcers and Other Infected Skin Injuries

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Ana Gomes

2017-10-01

Full Text Available As the incidence of diabetes continues to increase in the western world, the prevalence of chronic wounds related to this condition continues to be a major focus of wound care research. Additionally, over 50% of chronic wounds exhibit signs and symptoms that are consistent with localized bacterial biofilms underlying severe infections that contribute to tissue destruction, delayed wound-healing and other serious complications. Most current biomedical approaches for advanced wound care aim at providing antimicrobial protection to the open wound together with a matrix scaffold (often collagen-based to boost reestablishment of the skin tissue. Therefore, the present review is focused on the efforts that have been made over the past years to find peptides possessing wound-healing properties, towards the development of new and effective wound care treatments for diabetic foot ulcers and other skin and soft tissue infections.

Wound-Healing Peptides for Treatment of Chronic Diabetic Foot Ulcers and Other Infected Skin Injuries.

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Gomes, Ana; Teixeira, Cátia; Ferraz, Ricardo; Prudêncio, Cristina; Gomes, Paula

2017-10-18

As the incidence of diabetes continues to increase in the western world, the prevalence of chronic wounds related to this condition continues to be a major focus of wound care research. Additionally, over 50% of chronic wounds exhibit signs and symptoms that are consistent with localized bacterial biofilms underlying severe infections that contribute to tissue destruction, delayed wound-healing and other serious complications. Most current biomedical approaches for advanced wound care aim at providing antimicrobial protection to the open wound together with a matrix scaffold (often collagen-based) to boost reestablishment of the skin tissue. Therefore, the present review is focused on the efforts that have been made over the past years to find peptides possessing wound-healing properties, towards the development of new and effective wound care treatments for diabetic foot ulcers and other skin and soft tissue infections.

Vacuum-assisted closure versus closure without vacuum assistance for preventing surgical site infections and infections of chronic wounds: a meta-analysis of randomized controlled trials.

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Tansarli, Giannoula S; Vardakas, Konstantinos Z; Stratoulias, Constantinos; Peppas, George; Kapaskelis, Anastasios; Falagas, Matthew E

2014-08-01

We sought to examine whether vacuum-assisted closure (VAC) is associated with fewer surgical site infections (SSIs) or infections of chronic wounds than other management procedures for surgical wounds. The PubMed and Scopus databases were searched systematically. Randomized controlled trials (RCTs) comparing the development of SSIs or infections of chronic wounds between patients treated with VAC for acute or chronic wounds and those whose wounds were treated without VAC were considered eligible for inclusion in the study. Eight RCTs met the inclusion criteria for the study. Four of the studies included chronic or diabetic lower extremity wounds and four included fractures. In three of four studies reporting on fractures, the wounds were not closed post-operatively, whereas in one study primary closure of the wound was performed. With regard to wounds left open after the stabilization of fractures, patients whose wounds were treated with VAC developed fewer SSIs than those whose wounds were treated without VAC ([367 patients (196 with VAC; 171 without VAC) relative risk [RR], 0.47; 95% CI 0.28-0.81]). On the contrary, no difference in the development of SSIs occurred among patients with chronic or diabetic lower-extremity wounds treated with VAC and those whose wounds were treated without VAC ([638 patients (320 with VAC; 318 without VAC) RR 1.67; 95% CI: 0.71-3.94]). The available evidence suggests that the development of infections in wounds treated with VAC depends on the type of wound being treated.

Wound infection prophylaxis in pediatric acute appendicitis: a 26-year prospective study.

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Ein, Sigmund H; Sandler, Anthony

2006-03-01

The purpose of this study was to determine the best wound infection prophylaxis in pediatric acute appendicitis. From 1969 to 1995 inclusive, 453 consecutive pediatric patients at the same children's hospital had an appendix with acute inflammation (acute appendicitis) removed by the same staff surgeon and his resident. The stump was not inverted, and chromic catgut was used throughout. No intraperitoneal antibiotics, irrigation, or drains were used, and the skin closure was with silk sutures initially and then with staples since 1986. The infants and children were divided into 6 consecutive groups of 52 to 96 patients, with each group lasting 2 to 5 years. The wound treatment groups were as follows: no treatment, drain or pack, drain or pack plus antibiotic powder, antibiotic powder, preoperative intravenous antibiotic plus antibiotic powder, and preoperative intravenous antibiotic. The wound Penrose drain, one half-inch gauze pack, and/or antibiotic powder (ampicillin, 1977-1981; cefoxitin, 1982-1995) were all placed in the subcutaneous space. There were a total of 50 (11%) wound infections (pus) that occurred between 4 and 40 days when no antibiotic powder was used and 2 to 14 days with antibiotic powder. In all 6 groups of patients, no organism was grown in most (80%) infections and Escherichia coli was the second commonest (12%). The serous ooze, which occurred only with the use of antibiotic powder (8%), was seen between 6 and 18 days, and no organism was ever cultured. The patients with preoperative (or intraoperative) intravenous antibiotics (cefoxitin) plus wound antibiotic powder (cefoxitin) had the lowest infection rate (2.5%). When this group was compared with the baseline group 1 (no treatment), it was the only group in which wound treatment made a significant difference (P = .003).

Major bleeding during negative pressure wound/V.A.C.®--therapy for postsurgical deep sternal wound infection--a critical appraisal

NARCIS (Netherlands)

van Wingerden, Jan J.; Segers, Patrique; Jekel, Lilian

2011-01-01

Negative-pressure wound therapy, commercially known as vacuum-assisted closure (V.A.C.®) therapy, has become one of the most popular (and efficacious) interim (prior to flap reconstruction) or definite methods of managing deep sternal wound infection. Complications such as profuse bleeding, which

Risk Factors for Complications after Reconstructive Surgery for Sternal Wound Infection

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Ichiro Hashimoto

2014-05-01

Full Text Available Background Although the utility of flaps for the treatment of sternal wound infections following median sternotomy has been reported for 30 years, there have been few reports on the risk factors for complications after reconstruction. The objective of this investigation was to identify factors related to complications after the reconstruction of sternal wound infections. Methods A retrospective analysis of 74 patients with reconstructive surgery after sternal wound infection over a 5-year period was performed. Clinical data including age, sex, body mass index (BMI, comorbidities, bacterial culture, previous cardiac surgery, wound depth, mortality rate, type of reconstructive procedure, and complication rate were collected. Results The patients' BMI ranged from 15.2 to 33.6 kg/m2 (mean, 23.1±3.74 kg/m2. Wound closure complications after reconstructive surgery were observed in 36.5% of the cases. The mortality rate was 2.7%. Diabetes mellitus significantly affected the rate of wound closure complications (P=0.041. A significant difference in the number of complications was seen between Staphylococcus aureus (S. aureus and coagulase-negative Staphylococci (P=0.011. There was a correlation between harvesting of the internal thoracic artery and postoperative complications (P=0.048. The complication rates of the pectoralis major flap, rectus abdominis flap, omentum flap, a combination of pectoralis major flap and rectus abdominis flap, and direct closure were 23.3%, 33.3%, 100%, 37.5%, and 35.7%, respectively. Conclusions Diabetes mellitus, S. aureus, harvesting of the internal thoracic artery, and omentum flap were significant factors for complications after reconstruction. The omentum flap volume may be related to the complications associated with the omentum flap transfer in the present study.

First case of Chlorella wound infection in a human in Australia

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J. Hart

2014-07-01

Full Text Available A 30-year-old man developed an infected knee wound 2 days after jumping his bicycle into a freshwater dam. He required repeated debridement and tissue grew bright green colonies typical of the alga Chlorella plus Aeromonas hydrophila. This, and one previously reported case, responded to surgical debridement and careful wound management.

Treating infected diabetic wounds with superoxidized water as anti-septic agent: a preliminary experience

International Nuclear Information System (INIS)

Hadi, S.F.; Khaliq, T.; Zubair, M.; Saaiq, M.; Sikandar, I.

2007-01-01

To evaluate the effectiveness of superoxidized water (MicrocynTM) in diabetic patients with different wounds. One hundred known diabetic patients were enrolled. Half were randomized to the intervention group (those whose wounds were managed with superoxidized water) and half to the control group (whose wounds were treated with normal saline) using a table of random numbers. The two groups were matched for age, gender, duration of diabetes and category of wound. All patients received appropriate surgical treatment for their wounds as required. Local wound treatment was carried out daily using superoxidized water soaked gauzes on twice daily basis in the intervention group and normal saline in the control group. The treatment was continued until wound healing. The main outcome measures were duration of hospital stay, downgrading of the wound category, wound healing time and need for interventions such as amputation. Statistically significant differences were found in favour of the superoxidized water group with respect to duration of hospital stay, downgrading of the wound category and wound healing time. Although the initial results of employing superoxidized water for the management of infected diabetic wounds are encouraging, further multicentre clinical trials are warranted before this antiseptic is recommended for general use. It may offer an economical alternative to other expensive antiseptics with positive impact on the prevailing infection rates, patient outcomes and patient satisfaction. (author)

Antibacterial properties and healing effects of Melipona scutellaris honey in MRSA-infected wounds of rats.

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Medeiros, Vanessa de Fátima Lima Paiva; Azevedo, Ítalo Medeiros; Rêgo, Amália Cínthia Meneses; Egito, Eryvaldo Sócrates Tabosa do; Araújo-Filho, Irami; Medeiros, Aldo Cunha

2016-05-01

To investigate the antimicrobial, immunological and healing effects of Melipona scutellaris honey on infected wounds of rat skin. Twenty four Wistar rats were distributed in four groups (6-each). The uninfected skin wounds of group I rats were treated daily with saline for 7 days. Uninfected wounds (group II) rats were treated with honey. In group III (treated with saline) and group IV (treated with honey) wounds were inoculated with MRSA ATTC43300. The first bacterial culture was performed 24 hours later. In the 7th day new culture was done, and wound biopsies were used for cytokines dosage and histopathology. In group I and III rats the CFU/g count of S. aureus in wounds was zero. In group II rats the CFU/g counts in the wound tissue were significantly higher than in wounds of group IV rats. The density histopathological parameters and the expression of TNF-α, IL1-β, Il-6 were significantly higher on wounds of group IV then in the other groups. Honey of Melipona scutellaris was effective in the management of infected wounds, by significant bacterial growth inhibition, enhancement of cytokine expression, and positively influenced the wound repair.

Omental Herniation: A Rare Complication of Vacuum-Assisted Closure of Infected Sternotomy Wound

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Philemon Gukop

2012-01-01

Full Text Available Vacuum-assisted closure (VAC has recently been adopted as an acceptable modality for management of sternotomy wound infections. Although generally efficacious, the use of negative pressure devices has been associated with complications such as bleeding, retention of sponge, and empyema. We report the first case of greater omental hernia as a rare complication of vacuum-assisted closure of sternal wound infection following coronary artery bypass grafting.

Wound management with vacuum-assisted closure in postoperative infections after surgery for spinal stenosis

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Karaaslan F

2014-12-01

Full Text Available Fatih Karaaslan,1 Şevki Erdem,2 Musa Ugur Mermerkaya11Department of Orthopaedics and Traumatology, Bozok University Medical School, Yozgat, Turkey; 2Department of Orthopaedics and Traumatology, Haydarpasa Numune Training Hospital, Istanbul, TurkeyObjective: To evaluate the results of negative-pressure wound therapy (NPWT in the treatment of surgical spinal site infections.Materials and methods: The use of NPWT in postoperative infections after dorsal spinal surgery (transforaminal lumbar interbody fusion plus posterior instrumentation was studied retrospectively. From February 2011 to January 2012, six patients (females out of 317 (209 females; 108 males were readmitted to our clinic with surgical site infections on postoperative day 14 (range 9–19 and were treated with debridement, NPWT, and antibiotics. We evaluated the clinical and laboratory data, including the ability to retain the spinal hardware and recurrent infections.Results: The incidence of deep postoperative surgical site infection was six (1.89% patients (females out of 317 patients (209 females; 108 males at 1 year. All patients completed their wound NPWT regimen successfully. An average of 5.1 (range 3–8 irrigation and debridement sessions was performed before definitive wound closure. The mean follow-up period was 13 (range 12–16 months. No patient had a persistent infection requiring partial or total hardware removal. The hospital stay infection parameters normalized within an average of 4.6 weeks.Conclusion: The study illustrates the usefulness of NPWT as an effective adjuvant treatment option for managing complicated deep spinal surgical wound infections.Keywords: surgical infection, NPWT, VAC, TLIF

Antimicrobial Peptides and Their Therapeutic Potential for Bacterial Skin Infections and Wounds

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Pfalzgraff, Anja; Brandenburg, Klaus; Weindl, Günther

2018-01-01

Alarming data about increasing resistance to conventional antibiotics are reported, while at the same time the development of new antibiotics is stagnating. Skin and soft tissue infections (SSTIs) are mainly caused by the so called ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species) which belong to the most recalcitrant bacteria and are resistant to almost all common antibiotics. S. aureus and P. aeruginosa are the most frequent pathogens isolated from chronic wounds and increasing resistance to topical antibiotics has become a major issue. Therefore, new treatment options are urgently needed. In recent years, research focused on the development of synthetic antimicrobial peptides (AMPs) with lower toxicity and improved activity compared to their endogenous counterparts. AMPs appear to be promising therapeutic options for the treatment of SSTIs and wounds as they show a broad spectrum of antimicrobial activity, low resistance rates and display pivotal immunomodulatory as well as wound healing promoting activities such as induction of cell migration and proliferation and angiogenesis. In this review, we evaluate the potential of AMPs for the treatment of bacterial SSTIs and wounds and provide an overview of the mechanisms of actions of AMPs that contribute to combat skin infections and to improve wound healing. Bacteria growing in biofilms are more resistant to conventional antibiotics than their planktonic counterparts due to limited biofilm penetration and distinct metabolic and physiological functions, and often result in chronification of infections and wounds. Thus, we further discuss the feasibility of AMPs as anti-biofilm agents. Finally, we highlight perspectives for future therapies and which issues remain to bring AMPs successfully to the market. PMID:29643807

Prevalence of Post-operative Wound Infections in Rural area of Latur District

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Vikram Rajput

2015-08-01

Full Text Available Background: Surgical site infection (SSI continues to be a major source of morbidity following operative procedures. The modern surgeon cannot escape the responsibility of dealing with infections, having the knowledge for the appropriate use of aseptic and antiseptic technique, proper use of prophylactic and therapeutic antibiotics, and adequate monitoring and support with novel surgical and pharmacologic as well as nonpharmacologic aids. Objective: To study the most common organisms encountered in postoperative wound infections and to find out the most effective Antibiotics in case of Post Operative Wound Infections. Methodology: It is an Observational study done on 50 operated cases of post operative wounds. Results: Most common microorganism encountered in present series was E. coli in 13 cases (26%. Least common micro organism was Proteus (2%. E. coli was also encountered in mixed culture with Kleibsiella, Pseudomonas and Citrobacter. Most effective antibiotic in present series was Imipenem. Other common effective antibiotics were Amikacin, Netillin, Piperacillin, Tetracycline and Gentamycin. Least effective antibiotics were Penicillin, Cefotaxime, Cefuroxime and Cefoxitin. Conclusion: E. coli was the most common organism cultured. Imipenem and Amikacin were the most effective antibiotics.

Topical petrolatum gel alone versus topical silver sulfadiazine with standard gauze dressings for the treatment of superficial partial thickness burns in adults: a randomized controlled trial.

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Genuino, Glenn Angelo S; Baluyut-Angeles, Kathrina Victoria; Espiritu, Andre Paolo T; Lapitan, Marie Carmela M; Buckley, Brian S

2014-11-01

Non-extensive superficial partial thickness burns constitute a major proportion of burns. Conventional treatment involves regular changing of absorptive dressings including the application of a topical antimicrobial, commonly silver sulfadiazine. A systematic review has found insufficient evidence to support or refute such antimicrobial prophylaxis. Another review compared silver sulfadiazine dressings with other occlusive and non-antimicrobial dressings and found insufficient evidence to guide practice. Other research has suggested that dressings with petrolatum gel are as effective as silver sulfadiazine. Single-center, randomized, controlled parallel group trial comparing conventional silver sulfadiazine dressings with treatment with petrolatum gel alone. Consenting adults 18-45 years old with superficial partial thickness burns≤10% total body surface area seen within 24h of the injury were randomized to daily dressing either with petrolatum gel without top dressings or conventional silver sulfadiazine treatment with gauze dressings. Primary outcomes were blinded assessment of time to complete re-epithelialization, wound infection or allergic contact dermatitis. Secondary outcomes included assessment of ease, time and pain of dressing changes. 26 patients were randomized to petrolatum and 24 to silver sulfadiazine dressings. Follow up data available for 19 in each group. Mean time to re-epithelialization was 6.2 days (SD 2.8) in the petrolatum group and 7.8 days (SD 2.1) in the silver sulfadiazine group (p=0.050). No wound infection or dermatitis was observed in either group. Scores for adherence to wound, ease of dressing removal and time required to change dressings were significantly better in the petrolatum treatment arm (ptreatment of minor superficial partial thickness burns in adults. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

Intracavity lavage and wound irrigation for prevention of surgical site infection

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Norman, Gill; Atkinson, Ross A; Smith, Tanya A; Rowlands, Ceri; Rithalia, Amber D; Crosbie, Emma J; Dumville, Jo C

2017-01-01

Background Surgical site infections (SSIs) are wound infections that occur after an operative procedure. A preventable complication, they are costly and associated with poorer patient outcomes, increased mortality, morbidity and reoperation rates. Surgical wound irrigation is an intraoperative technique, which may reduce the rate of SSIs through removal of dead or damaged tissue, metabolic waste, and wound exudate. Irrigation can be undertaken prior to wound closure or postoperatively. Intracavity lavage is a similar technique used in operations that expose a bodily cavity; such as procedures on the abdominal cavity and during joint replacement surgery. Objectives To assess the effects of wound irrigation and intracavity lavage on the prevention of surgical site infection (SSI). Search methods In February 2017 we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid Embase and EBSCO CINAHL Plus. We also searched three clinical trials registries and references of included studies and relevant systematic reviews. There were no restrictions on language, date of publication or study setting. Selection criteria We included all randomised controlled trials (RCTs) of participants undergoing surgical procedures in which the use of a particular type of intraoperative washout (irrigation or lavage) was the only systematic difference between groups, and in which wounds underwent primary closure. The primary outcomes were SSI and wound dehiscence. Secondary outcomes were mortality, use of systemic antibiotics, antibiotic resistance, adverse events, re-intervention, length of hospital stay, and readmissions. Data collection and analysis Two review authors independently assessed studies for inclusion at each stage. Two review authors also undertook data extraction, assessment of risk of bias and GRADE assessment. We calculated risk ratios or differences in means with 95% confidence intervals where

Wound complications following laparoscopic surgery in a Nigerian Hospital

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Adewale O Adisa

2014-01-01

Full Text Available Background: Different complications may occur at laparoscopic port sites. The incidence of these varies with the size of the ports and the types of procedure performed through them. Objectives: The aim was to observe the rate and types of complications attending laparoscopic port wounds and to identify risk factors for their occurrence. Patients and Methods: This is a prospective descriptive study of all patients who had laparoscopic operations in one general surgery unit of a University Teaching Hospital in Nigeria between January 2009 and December 2012. Results: A total of 236 (155 female and 81 male patients were included. The laparoscopic procedures include 63 cholecystectomies, 49 appendectomies, 62 diagnostic, biopsy and staging procedures, 22 adhesiolyses, six colonic surgeries, eight hernia repairs and 22 others. Port site complications occurred in 18 (2.8% ports on 16 (6.8% patients including port site infections in 12 (5.1% and hypertrophic scars in 4 (1.7% patients, while one patient each had port site bleeding and port site metastasis. Nine of 11 infections were superficial, while eight involved the umbilical port wound. Conclusion: Port site complications are few following laparoscopic surgeries in our setting. We advocate increased adoption of laparoscopic surgeries in Nigeria to reduce wound complications that commonly follow conventional open surgeries.

Chronic Open Infective Lateral Malleolus Bursitis Management Using Local Rotational Flap

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Yong-Beom Lee

2017-01-01

Full Text Available Background. Using a sinus tarsi rotational flap is an uncommon approach to treating chronic open infective lateral malleolus bursitis. Methods. We treated eight patients, including six males, using this approach. First, we debrided all the infected tissues and used a negative pressure wound closure system where needed. After acute infection had been controlled, the local rotational flap was used for cases where the wound could not be closed by a simple suture or bone exposure. The rotational flap was detached with a curved skin incision at the sinus tarsi next to the open wound and sutured to the defect, paying careful attention to the superficial peroneal nerve. The donor site was managed with a split-thickness skin graft. Results. The patients’ mean age was 74.1 years. Six patients had a wound after suppurative infection, but two patients had ulcer-type bursitis. Six patients demonstrated full flap healing, but two patients had venous congestion necrosis. Conclusion. A sinus tarsi rotational flap is a useful method to ensure healing and coverage of chronic open lateral malleolus bursitis, especially for small to medium wounds with cavity and bone exposure.

Bioactive Antimicrobial Peptides as Therapeutics for Corneal Wounds and Infections

OpenAIRE

Griffith, Gina L.; Kasus-Jacobi, Anne; Pereira, H. Anne

2017-01-01

Significance: More than 2 million eye injuries and infections occur each year in the United States that leave civilians and military members with reduced or complete vision loss due to the lack of effective therapeutics. Severe ocular injuries and infections occur in varied settings including the home, workplace, and battlefields. In this review, we discuss the potential of developing antimicrobial peptides (AMPs) as therapeutics for the treatment of corneal wounds and infections for which th...

Evaluation of antibiotic susceptibility in wound infections: A pilot study from Bangladesh [version 1; referees: 2 approved

OpenAIRE

Sushmita Roy; Mejbah Uddin Ahmed; Bhuiyan Mohammad Mahtab Uddin; Zubair Ahmed Ratan; Monali Rajawat; Varshil Mehta; Sojib Bin Zaman

2017-01-01

Introduction: Infections due to antibiotic resistant bacteria have increased alarmingly in both developed and developing countries. Unrestrained and rapidly spreading bacterial growth has turned the management of wound infections into a serious challenge. This study aimed to determine the prevalence of different bacterial pathogens and their antibiotic susceptibility in various types of wound infections. Methods:  A cross-sectional study was conducted to collect 105 wound swabs. All isolated ...

a profile of wound infections in national hospital abuja

African Journals Online (AJOL)

boaz

The current spread of multi -drug resistant bacteria has further heightened the need for regular bacteriological review of infected woundsand regular antibiotics ... Aim: To determine the distributionof theisolates from wound specimens submitted to the medical microbiology laboratory of National. Hospital Abuja for ...

Wagner classification and culture analysis of diabetic foot infection

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Fatma Bozkurt

2011-03-01

Full Text Available The aim of this study was to determine the concordance ratio between microorganisms isolated from deep tissue culture and those from superficial culture in patients with diabetic foot according to Wagner’s wound classification method.Materials and methods: A total of 63 patients with Diabetic foot infection, who were admitted to Dicle University Hospital between October 2006 and November 2007, were included into the study. Wagner’s classification method was used for wound classification. For microbiologic studies superficial and deep tissue specimens were obtained from each patient, and were rapidly sent to laboratory for aerob and anaerob cultures. Microbiologic data were analyzed and interpreted in line with sensitivity and specifity formula.Results: Thirty-eight (60% of the patients were in Wagner’s classification ≤2, while 25 (40% patients were Wagner’s classification ≥3. According to our culture results, 66 (69% Gr (+ and 30 (31% Gr (- microorganisms grew in Wagner classification ≤2 patients. While in Wagner classification ≥3; 25 (35% Gr (+ and 46 (65% Gr (- microorganisms grew. Microorganisms grew in 89% of superficial cultures and 64% of the deep tissue cultures in patients with Wagner classification ≤2, while microorganism grew in 64% of Wagner classification ≥3.Conclusion: In ulcers of diabetic food infections, initial treatment should be started according to result of sterile superficial culture, but deep tissue culture should be taken, if unresponsive to initial treatment.

Deep Sternal Wound Infection after Open-Heart Surgery: A 13-Year Single Institution Analysis.

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Juhl, Alexander Andersen; Hody, Sofie; Videbaek, Tina Senholt; Damsgaard, Tine Engberg; Nielsen, Per Hostrup

2017-04-20

The present study aimed to compare the clinical outcome for patients with or without muscle flap reconstruction after deep sternal wound infection due to open-heart surgery. The study was a retrospective cohort study, including patients who developed deep sternal wound infection after open-heart surgery in the Western Denmark Region from 1999 to 2011. Journals of included patients were reviewed for clinical data regarding the treatment of their sternal defect. Patients were divided into two groups depending on whether they received a muscle-flap-based sternal reconstruction or traditional rewiring of the sternum. A total of 130 patients developed deep sternal wound infection in the study period. In all, 12 patients died before being discharged, leaving a total of 118 patients for analysis. Of these, 50 (42%) patients received muscle flap reconstruction. Muscle flap recipients had significantly longer total hospital stays (p <0.001). However, after receiving muscle flap reconstruction, patients were discharged after a median of 14 days, with 74% not needing additional surgery. It is difficult to predict which patients eventually require muscle flap reconstruction after deep sternal wound infection. Although patients receiving muscle flap reconstructions have longer hospital stays, they are quickly discharged after the reconstruction.

[Infections after bite wounds : For example rat bite fever due to Streptobacillus moniliformis].

Science.gov (United States)

Hof, Herbert; Binder, Rudolf; Schäfer, Christian; Stuber, Madeleine; Licht, Andreas; Bozenhardt-Stavrakidis, Iris; Bode, Konrad

2018-04-11

Rat bite fever due to Streptobacillus moniliformis induces typical but not pathognomonic clinical signs, such as local purulent wound infection followed by maculopapular exanthema, myalgia as well as purulent joint infections. Severe complications, such as osteomyelitis and endocarditis are possible. it seems that this infection is rarely diagnosed but this infection could be much more common because the final diagnostic proof is difficult to achieve. Firstly, the culture of these bacteria is critical because the bacteria are fastidious and secondly the exact differentiation of the isolates is hardly possible by standard laboratory methods. Modern techniques such as mass spectroscopy (MALDI-TOF) and molecular biology allow a precise clarification. Surgical cleansing of infection sites in combination with a rational antibiotic therapy, for example with beta-lactam antibiotics, are generally able to cure the infection if treatment is started early enough. In addition, vaccinations, for example against tetanus and rabies have to be considered in this situation as for all other bite wound infections.

Impact of operative time on early joint infection and deep vein thrombosis in primary total hip arthroplasty.

Science.gov (United States)

Wills, B W; Sheppard, E D; Smith, W R; Staggers, J R; Li, P; Shah, A; Lee, S R; Naranje, S M

2018-03-22

Infections and deep vein thrombosis (DVT) after total hip arthroplasty (THA) are challenging problems for both the patient and surgeon. Previous studies have identified numerous risk factors for infections and DVT after THA but have often been limited by sample size. We aimed to evaluate the effect of operative time on early postoperative infection as well as DVT rates following THA. We hypothesized that an increase in operative time would result in increased odds of acquiring an infection as well as a DVT. We conducted a retrospective analysis of prospectively collected data using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database from 2006 to 2015 for all patients undergoing primary THA. Associations between operative time and infection or DVT were evaluated with multivariable logistic regressions controlling for demographics and several known risks factors for infection. Three different types of infections were evaluated: (1) superficial surgical site infection (SSI), an infection involving the skin or subcutaneous tissue, (2) deep SSI, an infection involving the muscle or fascial layers beneath the subcutaneous tissue, and (3) organ/space infection, an infection involving any part of the anatomy manipulated during surgery other than the incisional components. In total, 103,044 patients who underwent THA were included in our study. Our results suggested a significant association between superficial SSIs and operative time. Specifically, the adjusted odds of suffering a superficial SSI increased by 6% (CI=1.04-1.08, ptime. When using dichotomized operative time (90minutes), the adjusted odds of suffering a superficial SSI was 56% higher for patients with prolonged operative time (CI=1.05-2.32, p=0.0277). The adjusted odds of suffering a deep SSI increased by 7% for every 10-minute increase in operative time (CI=1.01-1.14, p=0.0335). No significant associations were detected between organ/space infection, wound

Comparison of primary and delayed primary closure in dirty abdominal wounds in terms of frequency of surgical site infection

International Nuclear Information System (INIS)

Aziz, O.B.A.; Ahmed, N.; Butt, M.W.U.D.; Saleem, M.R.

2013-01-01

Objective: Objective of this study was to compare primary and delayed primary wound closure for dirty abdominal wounds in terms of frequency of surgical site infection. Study Design: Randomized Controlled Trial. Place and Duration of Study: Combined Military Hospital, Multan. From 16 Sep 2010 to 15 Mar 2011. Patients and Methods: A total of 110 patients were randomly divided into two groups of 55 patients each using random numbers table. Abdominal wounds of one group were closed primarily and of other group were subjected to delayed primary wound closure. The wounds were then checked for surgical site infection for seven post operative days. Results: A higher frequency of surgical site infection was observed in primary closure group (27.3%) as compared to delayed primary closure group (9.1%) which was statistically significant (p=0.013). Conclusion: Delayed primary closure is superior to primary closure in dirty abdominal wounds in terms of frequency of surgical site infection. (author)

Drug resistance patterns of bacterial isolates from infected wounds ...

African Journals Online (AJOL)

unhcc

The resistance rate of S. aureus for penicillin was at 69.7%. Conclusions: High ... January 2013 to 30 December 2015 was conducted. BRHRLC is one of ... Wound infection, bacterial isolates, culture and antimicrobial susceptibility 113. Ethiop. J. Health ... Socio-demographic characteristic of patients and types of bacterial ...

Bacteriology of post–operative wound infections in the surgical ...

African Journals Online (AJOL)

A total of 248 swab specimens from post-operative wounds suspected to be infected were bacteriologically evaluated. Of these, bacterial growth was recorded in 204 specimens (82.3%) while 44 specimens (17.7%) yielded no growth. The bacteria isolated from the samples in decreasing order of prevalence were: ...

Targeted treatment of invasive fungal infections accelerates healing of foot wounds in patients with Type 2 diabetes.

Science.gov (United States)

Chellan, G; Neethu, K; Varma, A K; Mangalanandan, T S; Shashikala, S; Dinesh, K R; Sundaram, K R; Varma, N; Jayakumar, R V; Bal, A; Kumar, H

2012-09-01

To test the hypothesis that fluconazole plus standard care is superior to the standard care for diabetic foot wounds infected with deep-seated fungal infections. We carried out a randomized, controlled, open-label, parallel-arm study in 75 patients with both fungal and bacterial infections in deep tissues of diabetic foot wounds. Thirty-seven patients (control group) were given standard care (surgical debridement + culture-specific antibiotics + offloading + glycaemic control) and 38 patients (treatment group) were given fluconazole 150 mg daily plus standard care. Wound surface area was measured every 2 weeks until the endpoints (complete epithelialization or skin grafting) were met. By week 4, the mean wound surface area reduced to 27.3 from 111.5 cm(2) in the treatment group, as opposed to 67.1 from 87.3 cm(2) in the control group. Subsequently, the mean wound surface areas were remarkably smaller in the treatment group compared with the control group, and statistically significant differences (P ≤ 0.05) in mean wound surface area were observed between the treatment group and the control group at week 6. However, no statistically significant (P ≤ 0.47) difference in complete healing was observed between the treatment group and the control group, 20 vs. 24. The mean wound healing time for the treatment group was 7.3 weeks, whereas for the control group it was 11.3 weeks (P ≤ 0.022). Similarly, the probability of wound healing in the treatment group was 50 vs. 20% in the control group at week 10. Fluconazole plus standard care was superior to standard care alone in accelerating wound reduction among patients with diabetes with deep-seated fungal infections in diabetic foot wounds. Those in the treatment group who did heal, healed more quickly (P ≤ 0.022), but overall healing was not different. © 2012 The Authors. Diabetic Medicine © 2012 Diabetes UK.

Comparison of post-operative wound infection after inguinal hernia repair with polypropylene mesh and polyester mesh

International Nuclear Information System (INIS)

Mughal, M.A.; Ahmed, M.; Sajid, M.T.; Mustafa, Q.U.A.; Shukr, I.; Ahsan, J.

2012-01-01

Objective: To compare post operative wound infection frequency after inguinal hernia repair with polypropylene and polyester mesh using standard Lichtenstein hernioplasty technique. Study Design: Randomized controlled trial. Place and Duration: This study was conducted at general surgery department CMH/MH Rawalpindi from 8th April 2007 to 1st Jan 2008 over a period of 09 months. Patients and Materials: Sixty patients received through outpatient department with diagnosis of inguinal hernia satisfying inclusion/exclusion criteria were included. Patients were divided into two groups randomly. Group 1 included those patients in whom polypropylene mesh was used while group II patients were implanted with polyester mesh. Demographic as well as data concerning post operative wound infection was collected and analyzed. Results: Fifty seven patients (95%) were males while remaining (05%) were females. Mean age in group I was 41.17+-9.99 years while in group II was 41.47+-9.79 years (p=0.907). One patient (3.3%) in each group developed wound infection diagnosed by clinical evidence of pain at wound site, redness, induration and purulent discharge. Conclusion: There is no difference in post operative wound infection rate after inguinal Lichtenstein hernioplasty using either polypropylene or polyester mesh. (author)

Deep sternal wound infection after coronary artery bypass surgery: management and risk factor analysis for mortality.

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Yumun, Gunduz; Erdolu, Burak; Toktas, Faruk; Eris, Cuneyt; Ay, Derih; Turk, Tamer; As, Ahmet Kagan

2014-08-01

Deep sternal wound infection is a life-threatening complication after cardiac surgery. The aim of this study was to investigate the factors leading to mortality, and to explore wound management techniques on deep sternal wound infection after coronary artery bypass surgery. Between 2008 and 2013, 58 patients with deep sternal wound infection were analyzed. Risk factors for mortality and morbidity including age, gender, body mass index, smoking status, chronic renal failure, hypertension, diabetes, and treatment choice were investigated. In this study, 19 patients (32.7%) were treated by primary surgical closure (PSC), and 39 patients (67.3%) were treated by delayed surgical closure following a vacuum-assisted closure system (VAC). Preoperative patient characteristics were similar between the groups. Fourteen patients (24.1%) died in the postoperative first month. The mortality rate and mean duration of hospitalization in the PSC group was higher than in the VAC group (P = .026, P = .034). Significant risk factors for mortality were additional operation, diabetes mellitus, and a high level of EuroSCORE. Delayed surgical closure following VAC therapy may be associated with shorter hospitalization and lower mortality in patients with deep sternal wound infection. Additional operation, diabetes mellitus, and a high level of EuroSCORE were associated with mortality.

Secondary omental and pectoralis major double flap reconstruction following aggressive sternectomy for deep sternal wound infections after cardiac surgery

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Shirasawa Bungo

2011-04-01

Full Text Available Abstract Background Deep sternal wound infection after cardiac surgery carries high morbidity and mortality. Our strategy for deep sternal wound infection is aggressive strenal debridement followed by vacuum-assisted closure (VAC therapy and omental-muscle flap reconstrucion. We describe this strategy and examine the outcome and long-term quality of life (QOL it achieves. Methods We retrospectively examined 16 patients treated for deep sternal wound infection between 2001 and 2007. The most recent nine patients were treated with total sternal resection followed by VAC therapy and secondary closure with omental-muscle flap reconstruction (recent group; whereas the former seven patients were treated with sternal preservation if possible, without VAC therapy, and four of these patients underwent primary closure (former group. We assessed long-term quality of life after DSWI by using the Short Form 36-Item Health Survey, Version 2 (SF36v2. Results One patient died and four required further surgery for recurrence of deep sternal wound infection in the former group. The duration of treatment for deep sternal wound infection in the recent group was significantly shorter than that in previous group (63.4 ± 54.1 days vs. 120.0 ± 31.8 days, respectively; p = 0.039. Despite aggressive sternal resection, the QOL of patients treated for DSWI was only minimally compromised compared with age-, sex-, surgical procedures-matched patients without deep sternal wound infection. Conclusions Aggressive sternal debridement followed by VAC therapy and secondary closure with an omental-muscle flap is effective for deep sternal wound infection. In this series, it resulted in a lower incidence of recurrent infection, shorter hospitalization, and it did not compromise long-term QOL greatly.

year surveillance of wound infections at a rural tertiary hospital in ...

African Journals Online (AJOL)

EB

Conclusions: Staphylococcus aureus was the most predominant etiologic agent of wound infection among in and out patients. ... methicillin – resistant Staphylococus aureus (MRSA) and ... Northeast local government area of Edo State,.

Wound infection secondary to snakebite

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M Wagener

2017-04-01

Full Text Available Background. Snakebites can produce severe local and systemic septic complications as well as being associated with significant overall morbidity and even mortality. Objective. A prospective audit was undertaken to determine the bacterial causation of wound infection secondary to snakebite, and attempt to quantify the burden of disease. Methods. The audit was undertaken at Ngwelezane Hospital, which provides both regional and tertiary services for north-eastern KwaZulu-Natal Province, South Africa, over a 4-month period. Records of patients who required surgical debridement for extensive skin and soft-tissue necrosis were analysed. At the time of debridement, tissue samples of necrotic or infected tissue were sent for bacteriological analysis as standard of care. Microbiology results were analysed. Results. A total of 164 patients were admitted to hospital for management of snakebite, of whom 57 required surgical debridement and 42 were included in the final microbiological analysis. Children were found to be the most frequent victims of snakebite; 57.8% of patients in this study were aged ≤10 years and 73.7% ≤15 years. Culture showed a single organism in 32/42 cases, two organisms in 8 and no growth in 2. Eight different types of organisms were cultured, five of them more than once. Thirty-five specimens (83.3% grew Gram-negative Enterobacteriaceae, the most frequent being Morganella morganii and Proteus species. Thirteen specimens (31.0% grew Enterococcus faecalis. Gram-negative Enterobacteriaceae showed 31.4% sensitivity to ampicillin, 40.0% sensitivity to amoxicillin plus clavulanic acid, 34.3% sensitivity to cefuroxime, 97.1% sensitivity to ceftriaxone, and 100% sensitivity to ciprofloxacin, gentamicin and amikacin. E. faecalis was 92.3% sensitive to amoxicillin, 92.3% sensitive to amoxicillin plus clavulanic acid, 100% sensitive to ciprofloxacin, 92.3% resistant to erythromycin and 100% resistant to ceftriaxone. Conclusion. Children are

Wound infection secondary to snakebite.

Science.gov (United States)

Wagener, M; Naidoo, M; Aldous, C

2017-03-29

Snakebites can produce severe local and systemic septic complications as well as being associated with significant overall morbidity and even mortality. A prospective audit was undertaken to determine the bacterial causation of wound infection secondary to snakebite, and attempt to quantify the burden of disease. The audit was undertaken at Ngwelezane Hospital, which provides both regional and tertiary services for north-eastern KwaZulu-Natal Province, South Africa, over a 4-month period. Records of patients who required surgical debridement for extensive skin and soft-tissue necrosis were analysed. At the time of debridement, tissue samples of necrotic or infected tissue were sent for bacteriological analysis as standard of care. Microbiology results were analysed. A total of 164 patients were admitted to hospital for management of snakebite, of whom 57 required surgical debridement and 42 were included in the final microbiological analysis. Children were found to be the most frequent victims of snakebite; 57.8% of patients in this study were aged ≤10 years and 73.7% ≤15 years. Culture showed a single organism in 32/42 cases, two organisms in 8 and no growth in 2. Eight different types of organisms were cultured, five of them more than once. Thirty-five specimens (83.3%) grew Gram-negative Enterobacteriaceae, the most frequent being Morganella morganii and Proteus species. Thirteen specimens (31.0%) grew Enterococcus faecalis. Gram-negative Enterobacteriaceae showed 31.4% sensitivity to ampicillin, 40.0% sensitivity to amoxicillin plus clavulanic acid, 34.3% sensitivity to cefuroxime, 97.1% sensitivity to ceftriaxone, and 100% sensitivity to ciprofloxacin, gentamicin and amikacin. E. faecalis was 92.3% sensitive to amoxicillin, 92.3% sensitive to amoxicillin plus clavulanic acid, 100% sensitive to ciprofloxacin, 92.3% resistant to erythromycin and 100% resistant to ceftriaxone. Children are particularly vulnerable to snakebite, and the consequences can be

Human skin equivalents to study the prevention and treatment of wound infections

NARCIS (Netherlands)

Haisma, I.

2018-01-01

Infection of burn wounds remains the leading cause of death in burn patients. Topical treatment of such infections with conventional antibiotics is often unsuccessful due to the presence of drug-resistant bacteria and/or to the formation of bacterial biofilms. Taken together there is a clear

Visceral, vascular, and wound complications following over 13,000 lateral interbody fusions: a survey study and literature review.

Science.gov (United States)

Uribe, Juan S; Deukmedjian, Armen R

2015-04-01

Minimally invasive lateral interbody fusion (MIS-LIF) has become a popular less invasive treatment option for degenerative spinal disease, deformity, and trauma. While MIS-LIF offers several advantages over traditional anterior and posterior approaches, the procedure is not without risk. The purpose of this study was to evaluate the incidence of visceral, vascular, and wound complications following MIS-LIF performed by experienced surgeons. A survey was conducted by experienced (more than 100 case experience) MIS-LIF surgeons active in the society of lateral access surgery (SOLAS) to collect data on wound infections and visceral and vascular injuries. Of 77 spine surgeons surveyed, 40 (52 %) responded, including 25 (63 %) orthopedic surgeons and 15 (38 %) neurosurgeons, with 20 % practicing at an academic institution and 80 % in community practice. Between 2003 and 2013, 13,004 patients were treated with MIS-LIF by the 40 surgeons who responded to the survey. Of those patients, 0.08 % experienced a visceral complication (bowel injury), 0.10 % experienced a vascular injury, 0.27 % experienced a superficial wound infection, and 0.14 % experienced a deep wound infection. The incidence of surgical site infections and vascular and visceral complications following MIS-LIF in this large series was low and compared favorably with rates for alternative interbody fusion approaches. Although technically demanding, MIS-LIF is a reproducible approach for interbody fusion with a low risk of vascular and visceral complications and infections.

Treatment of gram-positive deep sternal wound infections in cardiac surgery -experiences with daptomycin-

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Coskun Kasim O

2011-09-01

Full Text Available Abstract The reported incidence of deep sternal wound infection (DSWI after cardiac surgery is 0.4-5% with Staphylococcus aureus being the most common pathogen isolated from infected wound sternotomies and bacteraemic blood cultures. This infection is associated with a higher morbidity and mortality than other known aetiologies. Little is reported about the optimal antibiotic management. The aim of the study is to quantify the application of daptomycin treatment of DSWI due to gram-positive organisms post cardiac surgery. We performed an observational analysis in 23 cases of post sternotomy DSWI with gram-positive organisms February 2009 and September 2010. When the wound appeared viable and the microbiological cultures were negative, the technique of chest closure was individualised to the patient. The incidence of DSWI was 1.46%. The mean dose of daptomycin application was 4.4 ± 0.9 mg/kg/d and the average duration of the daptomycin application was 14.47 ± 7.33 days. In 89% of the patients VAC therapy was used. The duration from daptomycin application to sternal closure was 18 ± 13.9 days. The parameters of infection including, fibrinogen (p = 0.03, white blood cell count (p = 0.001 and C-reactive protein (p = 0.0001 were significantly reduced after daptomycin application. We had no mortality and wound healing was successfully achieved in all patients. Treatment of DSWI due to gram-positive organisms with a daptomycin-containing antibiotic regimen is safe, effective and promotes immediate improvement of local wound conditions. Based on these observations, daptomycin may offer a new treatment option for expediting surgical management of DSWI after cardiac surgery.

The laparoscopically harvested omental flap for deep sternal wound infection

NARCIS (Netherlands)

van Wingerden, Jan J.; Coret, Matijn E. H.; van Nieuwenhoven, Christianne A.; Totté, Eric R.

2010-01-01

To report our experience with the laparoscopically harvested omental flap in the treatment of deep sternal wound infection, and to present a modification and introduce two supportive techniques in the perioperative management. Between June 2005 and September 2007, six patients with grade IV (El

Prophylactic Groin Wound Vacuum-assisted Therapy in Vascular Surgery Patients at Enhanced Risk for Postoperative Wound Infection.

Science.gov (United States)

Pesonen, Luke O; Halloran, Brian G; Aziz, Abdulhameed

2018-01-01

Vascular groin wounds have higher than expected surgical site infection (SSI) rates and some patients are at enhanced risk. The Wiseman et al. paper suggests an objective scoring system that identifies patients at enhanced risk of postdischarge SSI. We hypothesize that prophylactic groin wound vacuum-assisted closure (VAC) therapy in enhanced risk patients will decrease SSI and readmission and the Wiseman model provides potential evidence that enhanced risk patients can be objectively identified. A single institution, retrospective analysis was conducted from January 2013 to September 2016 utilizing procedure codes to identify patients with wound VACs placed in the operating room. Two distinct groups were identified. The first was a wound complication patient group with 15 limbs (13 patients) with a groin wound VAC placed within 45 days postoperatively for groin wound complications. Eleven of these limbs had the VAC placed at readmission. The second group was a prophylactic patient group that included 8 limbs (7 patients) who received a VAC prophylactically placed in the enhanced risk wounds. These wounds were determined to be enhanced risk based on clinical criteria judged by the operating surgeon such as a large overhanging panniculus and/or one of several ongoing medical issues. We calculated a Wiseman score for all patients, determined total cost of the readmissions, and determined 30-day postsurgical SSI incidence for the prophylactic VAC group. Per the Wiseman scores, 9 limbs with postoperative complications were high risk and 3 limbs were moderate/high risk. Eleven limbs had a VAC placed at readmission with an average readmission cost of $8876.77. For the prophylactic group, 8 limbs were high risk with no observed postdischarge SSI in the first 30 days from surgery. The Wiseman scores showed close correlation between the retrospective high and moderate/high risk groups versus the prophylactic VAC group (31.5 ± 7.3 vs. 32 ± 5.5, P = 0.87). The Wiseman

Disposable surgical face masks for preventing surgical wound infection in clean surgery

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Allyson Lipp

Full Text Available BACKGROUND: Surgical face masks were originally developed to contain and filter droplets containing microorganisms expelled from the mouth and nasopharynx of healthcare workers during surgery, thereby providing protection for the patient. However, there are several ways in which surgical face masks could potentially contribute to contamination of the surgical wound, e.g. by incorrect wear or by leaking air from the side of the mask due to poor string tension. OBJECTIVES: To determine whether disposable surgical face masks worn by the surgical team during clean surgery prevent postoperative surgical wound infection. SEARCH METHODS: We searched The Cochrane Wounds Group Specialised Register (searched 14 September 2011; The Cochrane Central Register of Controlled Trials (CENTRAL (The Cochrane Library 2011, Issue 3; Ovid MEDLINE (2008 to August Week 5 2011; Ovid MEDLINE (In-Process &Other Non-Indexed Citations September 13, 2011; Ovid EMBASE (2008 to 2011 Week 35; and EBSCO CINAHL (2008 to 9 September 2011. SELECTION CRITERIA: Randomized controlled trials (RCTs and quasi-randomized controlled trials comparing the use of disposable surgical masks with the use of no mask. DATA COLLECTION AND ANALYSIS: Two review authors extracted data independently. MAIN RESULTS: Three trials were included, involving a total of 2113 participants. There was no statistically significant difference in infection rates between the masked and unmasked group in any of the trials. AUTHORS' CONCLUSIONS: From the limited results it is unclear whether the wearing of surgical face masks by members of the surgical team has any impact on surgical wound infection rates for patients undergoing clean surgery.

Risk Factors For Wound Infections After Implant Surgery | Onche ...

African Journals Online (AJOL)

OBJECTIVE: Post-operative wound infection (POWI) rates for implant surgery are in the range of 0.08 to 13% in spite of the many advances in surgery in the past decades. It is therefore imperative that we develop a system of predicting the occurrence of POWI as a key to effective prevention. One approach is for each ...

Healing Potentials of Oral Moringa Oleifera Leaves Extract and Tetracycline on Methicillin Resistant Staphylococcus Aureus Infected Wounds of Wistar rats.

Science.gov (United States)

Eyarefe, Oghenemega D; Idowu, Aderayo; Afolabi, Jeremiah M

2015-12-20

The effects of oral dose of aqueous extract of Moringa oleifera and tetracycline antibiotics on cutaneous wounds infected with Staphylococcus aureus were studied in eighteen adult wistar rats (159±31.5g) randomized into three groups: Group A, n = 6, Moringa oleifera-(300 mg/kg). Group B, n = 6, tetracycline (9.4 mg/kg) and Group C, n = 6, Sterile water (control). Six millimetres diameter nape wound, created on each rat under 2% xylazine (5 mg/kg) and 5% ketamine (35 mg/kg), was contaminated with Staphylococcus aureus (108 Colony Forming Unit (CFU). Following infection, treatment was commenced with daily oral dose of test preparations and the wounds were evaluated every other day i.e., day 3, 5, 7, 9, 11, 13 and 15 for wetness (wound exudation), wound edge oedema, hyperaemia, granulation tissues and contraction (diameter). Severe wound exudation existed in all the groups between days 0-3 (p = 1.00). A significantly less wound exudation was observed at days 3-5 (p = 0.000) and 5-9 (p = 0.003) (ControlMoringa). Wound edge oedema was significantly less on days 5-9 (p = 0.000) and 9-15 (p = 0.001) (ControlMoringaMoringa Moringa> Tetracycline). Differences in wound diameter was not significant except at days 5-9 (p = 0.013) (Control> Moringa >Tetracycline). Oral doses of Moringa oleifera extract (300mg/kg) and tetracycline (9.4mg/kg) are not effective as antimicrobial or immune-boosting agents to enhance healing of wounds infected with Staphylococcus aureus and hence not recommended for rapid clearance of Staphylococcus aureus infected wounds.

Evaluation of antibiotic susceptibility in wound infections: A pilot study from Bangladesh

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Roy, Sushmita; Ahmed, Mejbah Uddin; Uddin, Bhuiyan Mohammad Mahtab; Ratan, Zubair Ahmed; Rajawat, Monali; Mehta, Varshil; Zaman, Sojib Bin

2017-01-01

Introduction: Infections due to antibiotic resistant bacteria have increased alarmingly in both developed and developing countries. Unrestrained and rapidly spreading bacterial growth has turned the management of wound infections into a serious challenge. This study aimed to determine the prevalence of different bacterial pathogens and their antibiotic susceptibility in various types of wound infections. Methods:  A cross-sectional study was conducted to collect 105 wound swabs. All isolated bacteria were identified based on colony characteristics, gram stain and standard biochemical tests, and antibiotic susceptibility testing (AST) with the disc diffusion method. Descriptive statistics were used to present the study findings, and all analyses were performed using Stata Version 13. Results:  The rate of isolation of bacteria was 92.3%. Staphylococcus aureus was found to be the most frequent isolate (55.7%), followed by Escherichia coli (23.7%), Pseudomonas spp. (8.2%), and Streptococcus pyogenes (7.2%). Gram-positive bacteria were mostly (60%) found sensitive to vancomycin, azithromycin, gentamicin, imipenem, cefixime, and ceftriaxone in this study. Among the Gram-negative bacteria, Escherichia coli (>60%) showed sensitivity to cefixime, azithromycin, cefuroxime, ceftriaxone, cefotaxime, gentamycin, and ceftazidime. Conclusions: The diversity of isolated bacteria and their susceptibility patterns signify a need to implement a proper infection control strategy, which can be achieved by carrying out antibiotic sensitivity tests of the isolates. PMID:29527295

Evaluation of Carbohydrate-Derived Fulvic Acid (CHD-FA) as a Topical Broad-Spectrum Antimicrobial for Drug-Resistant Wound Infections

Science.gov (United States)

2016-10-01

the newly formulated CHD-FA-Zn. Our initial results demonstrated that CHD-FA-Zn reduced microbial burdens of susceptible and drug- resistant planktonic...wound-associated drug resistant bacteria and fungi. Rat models of wound infection (open, and burn model) will be established with healthy animals ...Establish MIC90s for CHD-FA with clinical isolates of major drug resistant pathogens Assess CHD-FA in animal models of wound infection for major

Novel application of vacuum sealing drainage with continuous irrigation of potassium permanganate for managing infective wounds of gas gangrene.

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Hu, Ning; Wu, Xing-Huo; Liu, Rong; Yang, Shu-Hua; Huang, Wei; Jiang, Dian-Ming; Wu, Qiang; Xia, Tian; Shao, Zeng-Wu; Ye, Zhe-Wei

2015-08-01

Traumatic gas gangrene is a fatal infection mainly caused by Clostridium perfringens. It is a challenge to manage gas gangrene in open wounds and control infection after debridement or amputation. The aim of the present study was to use vacuum sealing drainage (VSD) with continuous irrigation of potassium permanganate to manage infective wounds of gas gangrene and observe its clinical efficacy. A total of 48 patients with open traumatic gas gangrene infection were included in this study. Amputations were done for 27 patients, and limb salvage procedures were performed for the others. After amputation or aggressive debridement, the VSD system, including polyvinyl alcohol (PVA) foam dressing and polyurethane (PU) film, with continuous irrigation of 1:5000 potassium permanganate solutions, was applied to the wounds. During the follow-up, all the patients healed without recurrence within 8-18 months. There were four complications. Cardiac arrest during amputation surgery occurred in one patient who suffered from severe septic shock. Emergent resuscitation was performed and the patient returned to stable condition. One patient suffered from mixed infection of Staphylococcal aureus, and a second-stage debridement was performed. One patient suffered from severe pain of the limb after the debridement. Exploratory operation was done and the possible reason was trauma of a local peripheral nerve. Three cases of crush syndrome had dialysis treatment for concomitant renal failure. In conclusion, VSD can convert open wound to closed wound, and evacuate necrotic tissues. Furthermore, potassium permanganate solutions help eliminate anaerobic microenvironment and achieve good therapeutic effect on gas gangrene and mixed infection. VSD with continuous irrigation of potassium permanganate is a novel, simple and feasible alternative for severe traumatic open wounds with gas gangrene infection.

Common Superficial Bursitis.

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Khodaee, Morteza

2017-02-15

Superficial bursitis most often occurs in the olecranon and prepatellar bursae. Less common locations are the superficial infrapatellar and subcutaneous (superficial) calcaneal bursae. Chronic microtrauma (e.g., kneeling on the prepatellar bursa) is the most common cause of superficial bursitis. Other causes include acute trauma/hemorrhage, inflammatory disorders such as gout or rheumatoid arthritis, and infection (septic bursitis). Diagnosis is usually based on clinical presentation, with a particular focus on signs of septic bursitis. Ultrasonography can help distinguish bursitis from cellulitis. Blood testing (white blood cell count, inflammatory markers) and magnetic resonance imaging can help distinguish infectious from noninfectious causes. If infection is suspected, bursal aspiration should be performed and fluid examined using Gram stain, crystal analysis, glucose measurement, blood cell count, and culture. Management depends on the type of bursitis. Acute traumatic/hemorrhagic bursitis is treated conservatively with ice, elevation, rest, and analgesics; aspiration may shorten the duration of symptoms. Chronic microtraumatic bursitis should be treated conservatively, and the underlying cause addressed. Bursal aspiration of microtraumatic bursitis is generally not recommended because of the risk of iatrogenic septic bursitis. Although intrabursal corticosteroid injections are sometimes used to treat microtraumatic bursitis, high-quality evidence demonstrating any benefit is unavailable. Chronic inflammatory bursitis (e.g., gout, rheumatoid arthritis) is treated by addressing the underlying condition, and intrabursal corticosteroid injections are often used. For septic bursitis, antibiotics effective against Staphylococcus aureus are generally the initial treatment, with surgery reserved for bursitis not responsive to antibiotics or for recurrent cases. Outpatient antibiotics may be considered in those who are not acutely ill; patients who are acutely ill

Microbiologic evaluation of skin wounds: alarming trend toward antibiotic resistance in an inpatient dermatology service during a 10-year period.

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Valencia, Isabel C; Kirsner, Robert S; Kerdel, Francisco A

2004-06-01

Increasing resistance to commonly used antibiotics has been seen for patients with superficial skin wounds and leg ulcers. We sought to evaluate bacterial isolates from leg ulcers and superficial wounds for resistance to commonly used antibiotics and to compare current data with previous data. We performed a chart review for patients admitted to a tertiary care dermatology inpatient unit from January to December 2001. Comparison was made with 2 previous surveys of the same inpatient service from 1992 and 1996. Bacterial isolates were cultured from 148 patients, 84% (72 of 86) with leg ulcers and 38% (76 of 202) with superficial wounds. Staphylococcus aureus and Pseudomonas aeruginosa were the most common bacterial isolates in both groups. For patients with leg ulcers, S aureus grew in 67% of isolates (48/72) of which 75% (36/48) were methicillin-resistant (MRSA). Of leg ulcers, 35% (25/72) grew P aeruginosa, which was resistant to quinolones in 56% of cultures (14/25). For patients with superficial wounds, S aureus was isolated in 75% (57/76) and 44% were MRSA (25/57). P aeruginosa grew in 17% of isolates (13/76) and was resistant to quinolones in 18%. We found a marked increase in antibiotic resistance for both leg ulcers and superficial wounds. Over time, MRSA increased in leg ulcers from 26% in 1992 to 75% in 2001. For superficial wounds, MRSA increased from 7% in 1992 to 44% in 2001. P aeruginosa resistance to quinolones in leg ulcers increased from 19% in 1992 to 56% in 2001, whereas for superficial wounds there was no resistance in 1992 and 18% resistance in 2001. Rapid emergence of antibiotic-resistant bacteria continues and is a problem of increasing significance in dermatology. Common pathogenic bacteria, S aureus and P aeruginosa, showed increased resistance to commonly used antibiotics. Selection of antibiotics should be on the basis of local surveillance programs.

Combination of ciclopirox olamine and sphingosine-1-phosphate as granulation enhancer in diabetic wounds.

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Lim, Natalie Sheng Jie; Sham, Adeline; Chee, Stella Min Ling; Chan, Casey; Raghunath, Michael

2016-09-01

Granulation tissue formation requires a robust angiogenic response. As granulation tissue develops, collagen fibers are deposited and compacted. Forces generated in the wake of this process drive wound contraction to reduce the wound area. In diabetics, both angiogenesis and wound contraction are diminished leading to impaired wound healing. To emulate this pathology and to address it pharmacologically, we developed a wound healing model in the diabetic Zucker fatty rat and tested a topical proangiogenic strategy combining antifungal agent ciclopirox olamine (CPX) and lysophospholipid sphingosine-1-phosphate (S1P) to promote diabetic wound closure. In vitro, we demonstrated that CPX + S1P up-regulates a crucial driver of angiogenesis, hypoxia-inducible factor-1, in endothelial cells. Injection of CPX + S1P into subcutaneously implanted sponges in experimental rats showed, in an additive manner, a fivefold increased endothelial infiltration and lectin-perfused vessel length. We developed a splinted diabetic rodent model to achieve low wound contraction rates that are characteristic for the healing mode of diabetic ulcers in humans. We discovered specific dorsal sites that allowed for incremental full-thickness excisional wound depths from 1 mm (superficial) to 3 mm (deep). This enabled us to bring down wound contraction from 51% in superficial wounds to 8% in deep wounds. While the effects of topical gel treatment of CPX + S1P were masked by the rodent-characteristic dominant contraction in superficial wounds, they became clearly evident in deep diabetic wounds. Here, a fivefold increase of functional large vessels resulted in accelerated granulation tissue formulation, accompanied by a 40% increase of compacted thick collagen fibers. This was associated with substantially reduced matrix metalloproteinase-3 and -13 expression. These findings translated into a fivefold increase in granulation-driven contraction, promoting diabetic wound closure. With CPX

The Wound Healing and Antibacterial Activity of Five Ethnomedical Calophyllum inophyllum Oils: An Alternative Therapeutic Strategy to Treat Infected Wounds.

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Teddy Léguillier

Full Text Available Calophyllum inophyllum L. (Calophyllaceae is an evergreen tree ethno-medically used along the seashores and islands of the Indian and Pacific Oceans, especially in Polynesia. Oil extracted from the seeds is traditionally used topically to treat a wide range of skin injuries from burn, scar and infected wounds to skin diseases such as dermatosis, urticaria and eczema. However, very few scientific studies reported and quantified the therapeutic properties of Calophyllum inophyllum oil (CIO. In this work, five CIO from Indonesia (CIO1, Tahiti (CIO2, 3, Fiji islands (CIO4 and New Caledonia (CIO5 were studied and their cytotoxic, wound healing, and antibacterial properties were presented in order to provide a scientific support to their traditional use and verify their safety.The safety of the five CIO was ascertained using the Alamar blue assay on human keratinocyte cells. CIO wound healing properties were determined using the scratch test assay on human keratinocyte cells. CIO-stimulated antibacterial innate immune response was evaluated using ELISA by measuring β defensin-2 release in human derivative macrophage cells. CIO antibacterial activity was tested using oilogramme against twenty aerobic Gram- bacteria species, twenty aerobic Gram+ bacteria species, including a multi-drug resistant Staphylococcus aureus strain and two anaerobic Gram+ bacteria species e.g. Propionibacterium acnes and Propionibacterium granulosum. To detect polarity profile of the components responsible of the antibacterial activity, we performed bioautography against a Staphylococcus aureus strain.Based on Alamar Blue assay, we showed that CIO can be safely used on keratinocyte cells between 2.7% and 11.2% depending on CIO origin. Concerning the healing activity, all the CIO tested accelerated in vitro wound closure, the healing factor being 1.3 to 2.1 higher compared to control when keratinocytes were incubated after scratch with CIO at 0.1%. Furthermore, our results

Treatment of hardware infection after osteosynthesis of lower leg using negative pressure wound therapy and transforming powder dressing.

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Marinović, Marin; Ivandcić, Aldo; Spanjol, Josip; Pina, Maja; Bakota, Bore; Bandalović, Ante; Cukeljs, Fabijan

2014-12-01

Fractures of the distal part of the lower leg are more common in everyday practice and traumatology. In young and active patients these injuries are mainly caused by high energy trauma. They are treated with external fixator in first step, and in second step, after sanation of the soft tissue, with open reduction and internal fixation (ORIF). It is very safe and effective method of treatment. Treatment of the infections that occur in the early postoperative period after open reduction and internal fixation represents a great problem and challenge for surgeons. It is widely accepted that the presence of deep infection can't be cured in the presence of hardware. However, removal of hardware in the presence of unhealed fractures significantly complicates sanation of infection and fracture itself We have decided to present a 35-years-old patient with a hardware infection with present chronic wound with hardware exposed eight months after the first operation and six months after second operation. The wound measured one centimeter in diameter with cell detritus and bad granulations tissue inside the wound. Hardwre was exposed in the depth of the wound.The secretion was minimal. Negative Pressure Wound Therapy (NPWT) was applicated after debridemet and lavage performed in ambulatory conditions. The starting therapy was continuously -125 mm Hg of vacuum. After five days of NPWT the defect was partially filled with granula- tion tissue. For another five days we continue with NPWT with the same values of-125 mm Hg pressure but in the inter- mitent mode. After that period we used transforming powder dressing for covering and protection of the wound with was filled with granulation tissue. Five days later, wound was completely healed with epithelisation. After four months of patient follow-up, we found the wound is completely repaired. The patient denies pain and has continued orderly flow of fracture healing, with no signs of infection.

Use of antibiotics in the management of postirradiation wound infection and sepsis

Energy Technology Data Exchange (ETDEWEB)

Brook, I.

1988-07-01

Ionizing gamma irradiation depresses the host defenses and enhances the susceptibility of the immunocompromised host to local and systemic infection due to endogenous or exogenous microorganisms. Trauma and wounding act synergistically and decrease the survival after exposure to irradiation. The current antimicrobial agents suitable for controlling serious infections and their use in post irradiation local and systemic infection with and without trauma are discussed. The experience gained in managing immunocompromised patients following chemotherapy is reviewed. Empiric single agent or combination agent therapy should be directed at the eradication of potential gram-negative as well as gram-positive pathogens. The most important organisms known to cause these infections are Pseudomonas sp. and Enterobacteriaceae. Management of intra-abdominal infections following trauma should include early surgical correlation and antimicrobials directed against the Bacteroides fragilis group and Enterobacteriaceae. Staphylococcus aureus and Streptococcus pyogenes cause most skin and soft tissue infections following trauma. Chemoprophylaxis of enteric sources of systemic infection can be achieved by antimicrobials that selectively inhibit the Enterobacteriaceae sp. and preserve the anaerobic flora. The management of infection in the injured and irradiated host includes supportive and restorative therapy. Supportive therapy includes debridement and cleansing of wounds, fluids, immunoglobulin, and antimicrobials. Restorative therapy includes definite surgery repair and replenishment of the immune system by use of immunomodulators, growth factors, and bone marrow transplantation. Further studies are needed to examine the usefulness of presently available drugs and experimental agents in the irradiated and traumatized host. 111 references.

Use of antibiotics in the management of postirradiation wound infection and sepsis

International Nuclear Information System (INIS)

Brook, I.

1988-01-01

Ionizing gamma irradiation depresses the host defenses and enhances the susceptibility of the immunocompromised host to local and systemic infection due to endogenous or exogenous microorganisms. Trauma and wounding act synergistically and decrease the survival after exposure to irradiation. The current antimicrobial agents suitable for controlling serious infections and their use in post irradiation local and systemic infection with and without trauma are discussed. The experience gained in managing immunocompromised patients following chemotherapy is reviewed. Empiric single agent or combination agent therapy should be directed at the eradication of potential gram-negative as well as gram-positive pathogens. The most important organisms known to cause these infections are Pseudomonas sp. and Enterobacteriaceae. Management of intra-abdominal infections following trauma should include early surgical correlation and antimicrobials directed against the Bacteroides fragilis group and Enterobacteriaceae. Staphylococcus aureus and Streptococcus pyogenes cause most skin and soft tissue infections following trauma. Chemoprophylaxis of enteric sources of systemic infection can be achieved by antimicrobials that selectively inhibit the Enterobacteriaceae sp. and preserve the anaerobic flora. The management of infection in the injured and irradiated host includes supportive and restorative therapy. Supportive therapy includes debridement and cleansing of wounds, fluids, immunoglobulin, and antimicrobials. Restorative therapy includes definite surgery repair and replenishment of the immune system by use of immunomodulators, growth factors, and bone marrow transplantation. Further studies are needed to examine the usefulness of presently available drugs and experimental agents in the irradiated and traumatized host. 111 references

Factors associated with methicillin-resistant coagulase-negative staphylococci as causing organisms in deep sternal wound infections after cardiac surgery

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R. Sommerstein

2015-07-01

Full Text Available Established preoperative antibiotic prophylaxis in cardiac surgery is ineffective against methicillin-resistant coagulase-negative staphylococci (CoNS. This case–control study aimed to determine factors predicting deep sternal wound infections due to methicillin-resistant CoNS. All cardiac surgery patients undergoing sternotomy between June 2009 and March 2013 prospectively documented in a Swiss tertiary care center were included. Among 1999 patients, 82 (4.1% developed deep sternal wound infection. CoNS were causal in 36 (44% patients, with 25/36 (69% being methicillin resistant. Early reintervention for noninfectious causes (odds ratio (OR 4.3; 95% confidence interval (CI 1.9–9.5 was associated with methicillin-resistant CoNS deep sternal wound infection. Among CoNS deep sternal wound infection, perioperative antimicrobial therapy (p 0.002, early reintervention for noninfectious causes (OR 7.9; 95% CI 0.9–71.1 and time between surgery and diagnosis of infection over 21 days (OR 10.8; 95% CI 1.2–97.8 were associated with methicillin resistance. These findings may help to better tailor preoperative antimicrobial prophylaxis.

Radiosterilization of freeze-dried human amniotic Membrane and its use in the treatment of burn wound. Algerian experience

International Nuclear Information System (INIS)

Djefal, A.; Mahlous, M.; Nacer Khodja, A.; Larbi, M.; Larbi Daho Bachir, M.

2001-01-01

The present study evaluates the usefulness of human amniotic membrane as biological dressing and its efficacy in the treatment of burns comparatively to the conventional dressing. We reported the practical methods of preparation, preservation and radiation sterilisation of amnion, and the clinical results of its successful use in the treatment of 80 cases of superficial and intermediate depth dermal burns. The increased rate of healing, pain relief, good adhesion to the bed wound and absence of infection were observed

Port Site Infections After Laparoscopic Cholecystectomy

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Mumtaz KH Al-Naser

2017-06-01

Full Text Available Background: Port site infection (PSI is an infrequent surgical site infection that complicates laparoscopic surgery but has a considerable influence in the overall outcome of laparoscopic cholecystectomy. The aim of this study was to evaluate factors that influence PSI after laparoscopic cholecystectomies and to analyze which of these factors can be modified to avoid PSI in a trail to achieve maximum laparoscopic advantages. Methods: A prospective descriptive qualitative study conducted on patients who underwent laparoscopic cholecystectomies. Swabs were taken for culture & sensitivity in all patients who developed PSI. Exploration under general anaesthesia, for patients, had deep surgical site infections and wound debridement was done, excisional biopsies had been taken for histopathological studies, and tissue samples for polymerase chain reaction for detection of mycobacterium tuberculosis was done. All patients were followed up for six months postoperatively. Factors as gender, site of infected port, type of microorganism, acute versus chronic cholecystitis, type of infection (superficial or deep infection and intraoperative spillage of stones, bile or pus were analyzed in our sample. Results: Port site infection rate was recorded in 40/889 procedures (4.5%, higher rates were observed in male patients 8/89 (8.9%, in acute cholecystitis 13/125 (10.4%, when spillage of bile, stones or pus occurred 24/80 (30%, and at epigastric port 32/40 (80%. Most of the PSI were superficial infections 77.5% with non-specific microorganism 34/40 (85%. Conclusion: There is a significant association of port site infection with spillage of bile, stones, or pus, with the port of gallbladder extraction and with acute cholecystitis. Especial consideration should be taken in chronic deep surgical site infection as mycobacterium tuberculosis could be the cause. Most of the PSIs are superficial and more common in males.

[Treatment of the infected wound with exposed silver-ring vascular graft and delayed Thiersch method of skin transplant covering ].

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Nenezić, Dragoslav; Pandaitan, Simon; Ilijevski, Nenad; Matić, Predrag; Gajin, Predag; Radak, Dorde

2005-01-01

Although the incidence of prosthetic infection is low (1%-6%), the consequences (limb loss or death) are dramatic for a patient, with high mortality rate (25%-75%) and limb loss in 40%-75% of cases. In case of Szilagyi's grade III infection, standard procedure consists of the excision of prosthesis and wound debridement. Alternative method is medical treatment. This is a case report of a patient with prosthetic infection of Silver-ring graft, used for femoropopliteal reconstruction, in whom an extreme skin necrosis developed in early postoperative period. This complication was successfully treated medically. After repeated debridement and wound-packing, the wound was covered using Thiersch skin graft.

Managing burn wounds with SMARTPORE Technology polyurethane foam: two case reports.

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Imran, Farrah-Hani; Karim, Rahamah; Maat, Noor Hidayah

2016-05-12

Successful wound healing depends on various factors, including exudate control, prevention of microbial contaminants, and moisture balance. We report two cases of managing burn wounds with SMARTPORE Technology polyurethane foam dressing. In Case 1, a 2-year-old Asian girl presented with a delayed (11 days) wound on her right leg. She sustained a thermal injury from a hot iron that was left idle on the floor. Clinical inspection revealed an infected wound with overlying eschar that traversed her knee joint. As her parents refused surgical debridement under general anesthesia, hydrotherapy and wound dressing using SMARTPORE Technology Polyurethane foam were used. Despite the delay in presentation of this linear thermal pediatric burn injury that crossed the knee joint, the patient's response to treatment and its outcome were highly encouraging. She was cooperative and tolerated each dressing change without the need of supplemental analgesia. Her wound was healed by 24 days post-admission. In Case 2, a 25-year-old Asian man presented with a mixed thickness thermal flame burn on his left leg. On examination, the injury was a mix of deep and superficial partial thickness burn, comprising approximately 3% of his total body surface area. SMARTPORE Technology polyurethane foam was used on his wound; his response to the treatment was very encouraging as the dressing facilitated physiotherapy and mobility. The patient rated the pain during dressing change as 2 on a scale of 10 and his pain score remained the same in every subsequent change. His wound showed evidence of epithelialization by day 7 post-burn. There were no adverse events reported. Managing burn wounds with SMARTPORE Technology polyurethane foam resulted in reduced pain during dressing changes and the successful healing of partial and mixed thickness wounds. The use of SMARTPORE Technology polyurethane foam dressings showed encouraging results and requires further research as a desirable management option in

The Vacuum-Assisted Closure (VAC) device for hastened attachment of a superficial inferior-epigastric flap to third-degree burns on hand and fingers.

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Weinand, Christian

2009-01-01

The vacuum-assisted closure (VAC) device has a wide range of clinical applications, including treatment of infected surgical wounds, traumatic wounds, pressure ulcers, wounds with exposed bone and hardware, diabetic foot ulcers, and venous stasis ulcers. Increased release of growth factors has been described, leading to improved vascularization and thereby formation of new tissue. The system is also used in burn surgery for reconstructive purposes. In this case report, a patient suffered from a third-degree burn injury to the dorsum of the hand with exposure of tendons, necessitating the use of a flap reconstruction. The patient was treated with a superficial inferior-epigastric artery-based flap and the VAC system was applied in a created glove-like shape. Hastened attachment of the flap onto the exposed fingers was observed after 4 days. The author reports on the additional use of the VAC system to hasten flap attachment in a patient with a burn injury to the dorsum of the hand.

Penile lesion from gunshot wound: a 43-case experience

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Cavalcanti Andre G.

2006-01-01

Full Text Available OBJECTIVE: To demonstrate the main aspects of diagnosis, treatment and follow-up of 43 patients with gunshot wounds to the penis. MATERIALS AND METHODS: The location of the lesion, the presence of associated lesions, the performance of complementary exams, surgical treatment, postoperative complications and long term follow-up of 43 patients with penile lesions from gunshot wounds were retrospectively analyzed. RESULTS: Of 43 cases assessed, 41 were submitted to surgical exploration (95.3% and 2 were submitted to conservative treatment (4.7%. We found penile lesions involving the corpus cavernosum in 37 cases; the remaining 4 patients presented no lesions involving the corpus cavernosum, urethra or testicles but did in the superficial structures. Ten cases presented an association with testicular lesions and 14 cases association with anterior urethral lesions. CONCLUSION: Penile lesions from gunshot wounds should be treated with immediate surgical intervention. In exceptional situations featuring superficial lesions only conservative treatment may be applied.

Treatment of Early Post-Op Wound Infection after Internal Fixation

Science.gov (United States)

2017-10-01

response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and...and challenging complications faced by orthopaedic surgeons and patients in both the military and civilian populations. The wounds are contaminated...or colonized at the time of injury, during the course of therapy, or both. Infection is always a possibility with any surgical intervention

Role of Daptomycin on Burn Wound Healing in an Animal Methicillin-Resistant Staphylococcus aureus Infection Model.

Science.gov (United States)

Simonetti, Oriana; Lucarini, Guendalina; Orlando, Fiorenza; Pierpaoli, Elisa; Ghiselli, Roberto; Provinciali, Mauro; Castelli, Pamela; Guerrieri, Mario; Di Primio, Roberto; Offidani, Annamaria; Giacometti, Andrea; Cirioni, Oscar

2017-09-01

Prolonged hospitalization and antibiotic therapy are risk factors for the development of methicillin-resistant Staphylococcus aureus (MRSA) infections in thermal burn patients. We used a rat model to study the in vivo efficacy of daptomycin in the treatment of burn wound infections by S. aureus , and we evaluated the wound healing process through morphological and immunohistochemical analysis. A copper bar heated in boiling water was applied on a paraspinal site of each rat, resulting in two full-thickness burns. A small gauze was placed over each burn and inoculated with 5 × 10 7 CFU of S. aureus ATCC 43300. The study included two uninfected control groups with and without daptomycin treatment, an infected control group that did not receive any treatment, and two infected groups treated, respectively, with intraperitoneal daptomycin and teicoplanin. The main outcome measures were quantitative culture, histological evaluation of tissue repair, and immunohistochemical expression of wound healing markers: epidermal growth factor receptor (EGFR) and fibroblast growth factor 2 (FGF-2). The highest inhibition of infection was achieved in the group that received daptomycin, which reduced the bacterial load from 10 7 CFU/ml to about 10 3 CFU/g ( P repair by possibly reducing hypertrophic burn scar formation. Copyright © 2017 American Society for Microbiology.

A STUDY ON THE POST SURGICAL WOUND INFECTIONS IN A TERTIARY CARE HOSPITAL IN KANCHIPURAM

OpenAIRE

Sivasankari; Thenmozhi Valli Pitchai; Anitha; Senthamarai; Venugopal

2016-01-01

BACKGROUND Surgical site infections are the infections that occur within thirty days after the operative procedure (Except in case of added implants). Surgical site infections are the 3rd most commonly reported nosocomial infections accounting for a quarter of all such infections. A wide range of organisms are known to infect wounds like gram positive cocci, gram negative bacilli, spore formers, aerobes and anaerobes. Despite the advances in operative technique and better unde...

The Efficacy, Safety and Tolerability of Retapamulin as a Treatment Option for Impetigo and Other Uncomplicated Superficial Skin Infections: A Meta-analysis

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Rudy Ciulianto

2015-04-01

Full Text Available BACKGROUND: The treatment of impetigo, secondarily infected dermatitis and infected traumatic lesions continue to develop as new generations of drugs are being formulated. Bacteria causing impetigo show growing resistance rates for commonly used antibiotics. Retapamulin being a new drug has been recently approved as topical antibiotic in children and adult. This study aimed to ascertain the efficacy, safety and tolerability of retapamulin as the treatment option for impetigo and other uncomplicated superficial skin infections. METHODS: A search for studies published from 2006-2014 was done in Pubmed, EBSCO, OVID, Science Direct, and Cochrane using the search strategy. The search was limited to studies conducted in human subjects and published in the English language. Randomized controlled trials evaluating the efficacy, safety and tolerability of retapamulin as treatment for impetigo and other uncomplicated superficial skin infections in children and adult were included and extracted independently and the qualities of the studies were appraised using critical appraisal tools. Data analysis was conducted by using RevMan 5. RESULTS: This study has high heterogeneity and found Retapamulin has no statistically significant difference in the clinical success after seven days and follow up among per-protocol-patients, bacteriogical confirmed patients and intention-to-treat patients with impetigo and other secondary infected traumatic lesions compared to other regimens. However, Retapamulin has beneficial effect in the clinical success, well tolerated and safe for children and adults. CONCLUSIONS: Retapamulin is comparably effective and safe as a treatment option for impetigo and other uncomplicated superficial skin infections. KEYWORDS: efficacy, safety, tolerability, retapamulin, impetigo, meta-analysis.

Reconstruction of Abdominal Wall of a Chronically Infected Postoperative Wound with a Rectus Abdominis Myofascial Splitting Flap

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Sung Kyu Bae

2013-01-01

Full Text Available BackgroundIf a chronically infected abdominal wound develops, complications such as peritonitis and an abdominal wall defect could occur. This could prolong the patient's hospital stay and increase the possibility of re-operation or another infection as well. For this reason, a solution for infection control is necessary. In this study, surgery using a rectus abdominis muscle myofascial splitting flap was performed on an abdominal wall defect.MethodsFrom 2009 to 2012, 5 patients who underwent surgery due to ovarian rupture, cesarean section, or uterine myoma were chosen. In each case, during the first week after operation, the wound showed signs of infection. Surgery was chosen because the wounds did not resolve with dressing. Debridement was performed along the previous operation wound and dissection of the skin was performed to separate the skin and subcutaneous tissue from the attenuated rectus muscle and Scarpa's fascial layers. Once the anterior rectus sheath and muscle were adequately mobilized, the fascia and muscle flap were advanced medially so that the skin defect could be covered for reconstruction.ResultsUpon 3-week follow-up after a rectus abdominis myofascial splitting flap operation, no major complication occurred. In addition, all of the patients showed satisfaction in terms of function and esthetics at 3 to 6 months post-surgery.ConclusionsUsing a rectus abdominis myofascial splitting flap has many esthetic and functional benefits over previous methods of abdominal defect treatment, and notably, it enabled infection control by reconstruction using muscle.

Ultraviolet C Light for Acinetobacter baumannii Wound Infections in Mice: Potential Use for Battlefield Wound Decontamination?

Science.gov (United States)

2012-01-01

al. Fiber optic microneedles for transdermal light delivery : ex vivo porcine skin penetration experiments. J Biomech Eng. 2010;132:091014. 24...critically ill patients often with limited treatment options because of drug resistance.1Y3 Since the beginning of the Middle East conflicts, the outbreak...of A. baumannii infections has been a threat to the health of wounded US soldiers.4Y7 The primary measures used in the military evacuation system to

The Use of Collatamp G, Local Gentamicin-Collagen Sponge, in Reducing Wound Infection

OpenAIRE

Chia, Clement L. K.; Shelat, Vishal G.; Low, Wilson; George, Sheena; Rao, Jaideepraj

2014-01-01

We conducted a retrospective study to examine the role of Collatamp G in reducing postoperative surgical site infection (SSI) in patients with different wound classes. Ninety-two patients (62 men and 30 women; mean age, 58 years; range, 29–88 years) who had undergone surgery between December 2009 and November 2011 in Tan Tock Seng Hospital and who had application of Collatamp G in their wound before closure were included in the study. The primary endpoint was the development of any superficia...

Preclinical advantages of intramuscularly administered peptide A3-APO over existing therapies in Acinetobacter baumannii wound infections.

Science.gov (United States)

Ostorhazi, Eszter; Rozgonyi, Ferenc; Sztodola, Andras; Harmos, Ferenc; Kovalszky, Ilona; Szabo, Dora; Knappe, Daniel; Hoffmann, Ralf; Cassone, Marco; Wade, John D; Bonomo, Robert A; Otvos, Laszlo

2010-11-01

The designer antibacterial peptide A3-APO is efficacious in mouse models of Escherichia coli and Acinetobacter baumannii systemic infections. Here we compare the efficacy of the peptide with that of imipenem and colistin in A. baumannii wound infections after burn injury. CD-1 mice were inflicted with burn wounds and different inocula of A. baumannii, isolated from an injured soldier, were placed into the wound sites. The antibiotics were given intramuscularly (im) one to five times. Available free peptide in the blood and the systemic toxicity of colistin and A3-APO were studied in healthy mice. While toxicity of colistin was observed at 25 mg/kg bolus drug administration, the lowest toxic dose of A3-APO was 75 mg/kg. In the A. baumannii blast injury models, 5 mg/kg A3-APO improved survival and reduced bacterial counts in the blood as well as in the wounds and improved wound appearance significantly better than any other antibiotic treatment. The free peptide concentration in the blood did not reach 1 µg/mL. Peptide A3-APO, with an intramuscular therapeutic index of 15, is more efficacious and less toxic than any existing burn injury infection therapy modality against multidrug-resistant Gram-negative pathogens. A3-APO administered by the im route probably binds to a biopolymer that promotes the peptide's biodistribution.

[Vacuum-assisted closure as a treatment modality for surgical site infection in cardiac surgery].

Science.gov (United States)

Simek, M; Nemec, P; Zálesák, B; Hájek, R; Kaláb, M; Fluger, I; Kolár, M; Jecmínková, L; Gráfová, P

2007-08-01

The vacuum-asssited closure has represented an encouraging treatment modality in treatment of surgical site infection in cardiac surgery, providing superior results compared with conventional treatment strategies, particularly in the treatment of deep sternal wound infection. From November 2004 to January 2007, 40 patients, undergoing VAC therapy (VAC system, KCI, Austria, Hartmann-Rico Inc., Czech Republic) for surgical site infection following cardiac surgery, were prospectively evaluated. Four patients (10%) were treated for extensive leg-wound infection, 10 (25%) were treated for superficial sternal wound infection and 26 (65%) for deep sternal wound infection. The median age was 69.9 +/- 9.7 years and the median BMI was 33.2 +/- 5.0 kg/m2. Twenty-three patients (57%) were women and diabetes was present in 22 patients (55%). The VAC was employed after the previous failure of the conventional treatment strategy in 7 patients (18%). Thirty-eight patients (95%) were successfully healed. Two patients (5%) died, both of deep sternal infetion consequences. The overall length of hospitalization was 36.4 +/- 22.6 days. The median number of dressing changes was 4.6 +/- 1.8. The median VAC treatment time until surgical closure was 9.7 +/- 3.9 days. The VAC therapy was solely used as a bridge to the definite wound closure. Four patients (10%) with a chronic fistula were re-admitted with the range of 1 to 12 months after the VAC therapy. The VAC therapy is a safe and reliable option in the treatment of surgical site infection in the field of cardiac surgery. The VAC therapy can be considered as an effective adjunct to convetional treatment modalities for the therapy of extensive and life-threatening wound infection following cardiac surgery, particurlarly in the group of high-risk patients.

Therapy of infections in mice irradiated in mixed neutron/photon fields and inflicted with wound trauma: a review of current work.

Science.gov (United States)

Ledney, G D; Madonna, G S; Elliott, T B; Moore, M M; Jackson, W E

1991-10-01

When host antimicrobial defenses are severely compromised by radiation or trauma in conjunction with radiation, death from sepsis results. To evaluate therapies for sepsis in radiation casualties, we developed models of acquired and induced bacterial infections in irradiated and irradiated-wounded mice. Animals were exposed to either a mixed radiation field of equal proportions of neutrons and gamma rays (n/gamma = 1) from a TRIGA reactor or pure gamma rays from 60[Co sources. Skin wounds (15% of total body surface area) were inflicted under methoxyflurane anesthesia 1 h after irradiation. In all mice, wounding after irradiation decreased resistance to infection. Treatments with the immunomodulator synthetic trehalose dicorynomycolate (S-TDCM) before or after mixed neutron-gamma irradiation or gamma irradiation increased survival. Therapy with S-TDCM for mice irradiated with either a mixed field or gamma rays increased resistance to Klebsiella pneumoniae-induced infections. Combined therapy with S-TDCM and ceftriaxone for K. pneumoniae infections in mice exposed to a mixed radiation field or to gamma rays was more effective than single-agent therapy. In all irradiated-wounded mice, single therapy of acquired infections with an antibiotic or S-TDCM did not increase survival. Survival of irradiated-wounded mice after topical application of gentamicin sulfate cream suggested that bacteria colonizing the wound disseminated systemically in untreated irradiated mice, resulting in death from sepsis. In lethal models of acquired infections in irradiated-wounded mice, significant increases in survival were achieved when systemic treatments with S-TDCM or gentamicin were combined with topical treatments of gentamicin cream. Therapies for sepsis in all mice exposed to a mixed field were less effective than in mice exposed to gamma rays. Nonetheless, the data show a principle by which successful therapy may be provided to individuals receiving tissue trauma in conjunction with

Development of Topical Treatment for Pseudomonas aeruginosa Wound Infections by Quorum-Sensing Inhibitors Mediated by Poly(amidoamine) (PAMAM) Dendrimers

Science.gov (United States)

2013-01-01

dendrimers would provide added benefits as a delivery vehicle of QSI compounds to inhibit PA biofilms, by both increasing the transport of QSI as drug...Pseudomonas aeruginosa Wound Infections by Quorum-Sensing Inhibitors Mediated by Poly(amidoamine) (PAMAM) Dendrimers PRINCIPAL INVESTIGATOR...Development of Topical Treatment for Pseudomonas aeruginosa Wound Infections by Quorum-Sensing Inhibitors Mediated by Poly(amidoamine) (PAMAM) Dendrimers

Helicobacter pylori infection, glandular atrophy and intestinal metaplasia in superficial gastritis, gastric erosion, erosive gastritis, gastric ulcer and early gastric cancer

OpenAIRE

Zhang, Chuan; Yamada, Nobutaka; Wu, Yun-Lin; Wen, Min; Matsuhisa, Takeshi; Matsukura, Norio

2005-01-01

AIM: To evaluate the histological features of gastric mucosa, including Helicobacter pylori infection in patients with early gastric cancer and endoscopically found superficial gastritis, gastric erosion, erosive gastritis, gastric ulcer.

Reduction of wound infections in laparoscopic-assisted colorectal resections by plastic wound ring drapes (REDWIL)?--A randomized controlled trial.

Science.gov (United States)

Lauscher, J C; Grittner, F; Stroux, A; Zimmermann, M; le Claire, M; Buhr, H J; Ritz, J P

2012-10-01

Surgical site infections (SSIs) are frequent complications in colorectal surgery and may lead to burst abdomen, incisional hernia, and increased perioperative costs. Plastic wound ring drapes (RD) were introduced some decades ago to protect the abdominal wound from bacteria and reduce SSIs. There have been no controlled trials examining the benefit of RD in laparoscopic colorectal surgery. The Reduction of wound infections in laparoscopic assisted colorectal resections by plastic wound ring drapes (REDWIL) trial was thus designed to assess their effectiveness in preventing SSIs after elective laparoscopic colorectal resections. REDWIL is a randomized controlled monocenter trial with two parallel groups (experimental group with RD and control group without RD). Patients undergoing elective laparoscopic colorectal resection were included. The primary endpoint was SSIs. Secondary outcomes were colonization of the abdominal wall with bacteria, reoperations/readmissions, early/late postoperative complications, and cost of hospital stay. The duration of follow-up was 6 months. Between January 2008 and October 2010, 109 patients were randomly assigned to the experimental or control group (with or without RD). Forty-six patients in the RD group and 47 patients in the control group completed follow-up. SSIs developed in ten patients with RD (21.7 %) and six patients without RD (12.8 %) (p = 0.28). An intraoperative swab taken from the abdominal wall was positive in 66.7 % of patients with RD and 57.5 % without RD (p = 0.46). The number of species cultured within one swab was significantly higher in those without RD (p = 0.03). The median total inpatient costs including emergency readmissions were 3,402 ± 4,038 in the RD group and 3,563 ± 1,735 in the control group (p = 0.869). RD do not reduce the rate of SSIs in laparoscopic colorectal surgery. The inpatient costs are similar with and without RD.

Evaluation of biocontrol agents for grapevine pruning wound protection against trunk pathogen infection.

Directory of Open Access Journals (Sweden)

Charl KOTZE

2011-12-01

Full Text Available Trunk diseases of grapevine are caused by numerous pathogens, including Eutypa lata, Phaeomoniella chlamydospora, and species of Botryosphaeriaceae (incl. Botryosphaeria and aggregate genera, Phomopsis and Phaeoacremonium. Since infections occur mainly through pruning wounds, that have been shown by previous research to stay susceptible for up to 16 weeks after pruning, long-term pruning wound protection is required for prevention of infection. This study evaluated several biocontrol agents against a range of trunk disease pathogens in dual plate laboratory trials to determine macroscopic and microscopic interactions. The biocontrol agents had a substantial effect on all the pathogens, with a wide range of macroscopic and microscopic interactions observed. The best performing biocontrol agents were tested in two field trials. Fresh pruning wounds were treated with benomyl, Trichoderma products (Biotricho®, Vinevax® and ECO 77® and isolates (USPP-T1 and -T2, identified as T. atroviride and Bacillus subtilis. Seven days after treatment the pruning wounds were inoculated by spraying with spore suspensions of Neofusicoccum australe, N. parvum, Diplodia seriata, Lasiodiplodia theobromae, Eutypa lata, Phaeomoniella chlamydospora or Phomopsis viticola. Eight months after inoculation, the treatments were evaluated by isolation onto potato dextrose agar. The efficacy of the biocontrol agents was in most cases similar or superior to that observed for benomyl. Isolate USPP-T1, in particular, was very effective, reducing incidence of Ph. viticola, E. lata, Pa. chlamydospora, N. australe, N. parvum, D. seriata and L. theobromae by 69, 76, 77, 78, 80, 85 and 92%, respectively. This is the first report of biological protection of grapevine pruning wounds against this group of grapevine trunk disease pathogens.

Incisional Negative Pressure Wound Therapy

DEFF Research Database (Denmark)

Hyldig, Nana

the rate of surgical wound infection and wound exudate post-caesarean and that wound infection had a negative impact on quality of life one month after surgery. Alongside the clinical trial, a trial-based cost-effectiveness analysis demonstrated that the treatment is cost-effective in a high......Women with a pre-gestational body mass index (BMI) above 30 kg/m2 giving birth by caesarean section are at high risk of surgical wound infection compared with women with a BMI below 30 kg/m2. Incisional Negative Pressure Wound Therapy (iNPWT) is one strategy to reduce the rate of surgical wound...... a randomised controlled trial in two tertiary and three teaching hospitals in three regions of Denmark, the Happy Belly Study, investigating the effectiveness of iNPWT in a population of obese women after caesarean section. The Happy Belly Study has demonstrated that prophylactic iNPWT significantly reduced...

The Society for Vascular Surgery Wound, Ischemia, and foot Infection (WIfI) classification independently predicts wound healing in diabetic foot ulcers.

Science.gov (United States)

Hicks, Caitlin W; Canner, Joseph K; Mathioudakis, Nestoras; Sherman, Ronald; Malas, Mahmoud B; Black, James H; Abularrage, Christopher J

2018-04-02

Previous studies have reported correlation between the Wound, Ischemia, and foot Infection (WIfI) classification system and wound healing time on unadjusted analyses. However, in the only multivariable analysis to date, WIfI stage was not predictive of wound healing. Our aim was to examine the association between WIfI classification and wound healing after risk adjustment in patients with diabetic foot ulcers (DFUs) treated in a multidisciplinary setting. All patients presenting to our multidisciplinary DFU clinic from June 2012 to July 2017 were enrolled in a prospective database. A Cox proportional hazards model accounting for patients' sociodemographics, comorbidities, medication profiles, and wound characteristics was used to assess the association between WIfI classification and likelihood of wound healing at 1 year. There were 310 DFU patients enrolled (mean age, 59.0 ± 0.7 years; 60.3% male; 60.0% black) with 709 wounds, including 32.4% WIfI stage 1, 19.9% stage 2, 25.2% stage 3, and 22.4% stage 4. Mean wound healing time increased with increasing WIfI stage (stage 1, 96.9 ± 8.3 days; stage 4, 195.1 ± 10.6 days; P healing at 1 year was 94.1% ± 2.0% for stage 1 wounds vs 67.4% ± 4.4% for stage 4 (P healing (stage 4 vs stage 1: hazard ratio, [HR] 0.44; 95% confidence interval, 0.33-0.59). Peripheral artery disease (HR, 0.73), increasing wound area (HR, 0.99 per square centimeter), and longer time from wound onset to first assessment (HR, 0.97 per month) also decreased the likelihood of wound healing, whereas use of clopidogrel was protective (HR, 1.39; all, P ≤ .04). The top three predictors of poor wound healing were WIfI stage 4 (z score, -5.40), increasing wound area (z score, -3.14), and WIfI stage 3 (z score, -3.11), respectively. Among patients with DFU, the WIfI classification system predicts wound healing at 1 year in both crude and risk-adjusted analyses. This is the first study to validate the WIfI score as an independent

Methods for identifying surgical wound infection after discharge from hospital: a systematic review

Directory of Open Access Journals (Sweden)

Moore Peter J

2006-11-01

Full Text Available Abstract Background Wound infections are a common complication of surgery that add significantly to the morbidity of patients and costs of treatment. The global trend towards reducing length of hospital stay post-surgery and the increase in day case surgery means that surgical site infections (SSI will increasingly occur after hospital discharge. Surveillance of SSIs is important because rates of SSI are viewed as a measure of hospital performance, however accurate detection of SSIs post-hospital discharge is not straightforward. Methods We conducted a systematic review of methods of post discharge surveillance for surgical wound infection and undertook a national audit of methods of post-discharge surveillance for surgical site infection currently used within United Kingdom NHS Trusts. Results Seven reports of six comparative studies which examined the validity of post-discharge surveillance methods were located; these involved different comparisons and some had methodological limitations, making it difficult to identify an optimal method. Several studies evaluated automated screening of electronic records and found this to be a useful strategy for the identification of SSIs that occurred post discharge. The audit identified a wide range of relevant post-discharge surveillance programmes in England, Scotland and Wales and Northern Ireland; however, these programmes used varying approaches for which there is little supporting evidence of validity and/or reliability. Conclusion In order to establish robust methods of surveillance for those surgical site infections that occur post discharge, there is a need to develop a method of case ascertainment that is valid and reliable post discharge. Existing research has not identified a valid and reliable method. A standardised definition of wound infection (e.g. that of the Centres for Disease Control should be used as a basis for developing a feasible, valid and reliable approach to defining post

Use of a copolymer dressing on superficial and partial-thickness burns in a paediatric population.

Science.gov (United States)

Everett, M; Massand, S; Davis, W; Burkey, B; Glat, P M

2015-07-01

Despite extensive research into the treatment of partial-thickness burns, to date there has not been the emergence of a preeminent modality. This pilot study, the first such study to be performed in a burn unit in the US, was designed to evaluate the efficacy and outcomes of the application of copolymer dressing (Suprathel; PolyMedics Innovations Corporation, Stuttgart, Germany) for both superficial and deeper partial-thickness burns. The copolymer dressing was used as a primary wound dressing to treat superficial and deep partial-thickness burns (average 5% total body surface area) in paediatric patients. Burns were debrided within 24 hours, at bedside, in the burn unit or in the operating room. The copolymer dressing was then applied directly to the wound and covered with a non-adherent second layer and an absorptive outer dressing. After discharge, patients were seen every 5-7 days until healed. Parameters evaluated included average hospital length of stay, average number of intravenous doses of narcotics administered, pain score at first follow-up visit, average time to complete re epithelialisation, incidence of burn wound infection, and patient/parent satisfaction on a 4-point scale. We also evaluated our experience with the dressing. Data were evaluated retrospectively under an Investigational Review Board approved protocol. Of the 17 patients assessed the average hospital length of stay was 1.4 days during which the average number of intravenous narcotic doses administered before copolymer dressing application was 1.5 and after was 0.1 doses. At the first follow-up visit, average pain score was 1.2 on a 10-point scale and the average time to re epithelialisation was 9.5 days. There was no incidence of burn wound infection. Patient/parent satisfaction was average of 3.66 on a 4-point scale. The staff had found that the self-adherence and elasticity of the dressing made it easy to apply and stay adherent, especially in areas of difficult contour. There were

The effect of clary sage oil on staphylococci responsible for wound infections.

Science.gov (United States)

Sienkiewicz, Monika; Głowacka, Anna; Poznańska-Kurowska, Katarzyna; Kaszuba, Andrzej; Urbaniak, Anna; Kowalczyk, Edward

2015-02-01

The spreading of bacterial antibiotic resistance among clinical strains of pathogenic bacteria has made investigators to search for other active antibacterial agents which could provide a valuable complement to the existing therapies. To determine the antibacterial activity of clary sage oil (Salvia sclarea L.) against Staphylococcus clinical strains which were isolated from patients with wound infections. A comprehensive evaluation of Staphylococcus clinical strain resistance to antibiotics was performed. The constituents of clary sage oil were assayed by GC-FID-MS analysis. The minimal inhibitory concentration (MIC) of the tested essential oil against staphylococci by the micro-dilution broth method was determined. The clary sage oil was active against Staphylococcus aureus, S. epidermidis and S. xylosus with MIC values ranging from 3.75 to 7.00 µl/ml. The results of the in vitro tests encourage to use formulations containing sage oil as the active natural antimicrobial agent. Because of its antimicrobial properties clary sage oil may be applied to treat wounds and skin infections.

Real-time monitoring of bacterial infection in vivo: development of bioluminescent staphylococcal foreign-body and deep-thigh-wound mouse infection models.

Science.gov (United States)

Kuklin, Nelly A; Pancari, Gregory D; Tobery, Timothy W; Cope, Leslie; Jackson, Jesse; Gill, Charles; Overbye, Karen; Francis, Kevin P; Yu, Jun; Montgomery, Donna; Anderson, Annaliesa S; McClements, William; Jansen, Kathrin U

2003-09-01

Staphylococcal infections associated with catheter and prosthetic implants are difficult to eradicate and often lead to chronic infections. Development of novel antibacterial therapies requires simple, reliable, and relevant models for infection. Using bioluminescent Staphylococcus aureus, we have adapted the existing foreign-body and deep-wound mouse models of staphylococcal infection to allow real-time monitoring of the bacterial colonization of catheters or tissues. This approach also enables kinetic measurements of bacterial growth and clearance in each infected animal. Persistence of infection was observed throughout the course of the study until termination of the experiment at day 16 in a deep-wound model and day 21 in the foreign-body model, providing sufficient time to test the effects of antibacterial compounds. The usefulness of both animal models was assessed by using linezolid as a test compound and comparing bioluminescent measurements to bacterial counts. In the foreign-body model, a three-dose antibiotic regimen (2, 5, and 24 h after infection) resulted in a decrease in both luminescence and bacterial counts recovered from the implant compared to those of the mock-treated infected mice. In addition, linezolid treatment prevented the formation of subcutaneous abscesses, although it did not completely resolve the infection. In the thigh model, the same treatment regimen resulted in complete resolution of the luminescent signal, which correlated with clearance of the bacteria from the thighs.

Scoring system to guide decision making for the use of gentamicin-impregnated collagen sponge to prevent deep sternal wound infection.

Science.gov (United States)

Benedetto, Umberto; Raja, Shahzad G

2014-11-01

The effectiveness of the routine retrosternal placement of a gentamicin-impregnated collagen sponge (GICS) implant before sternotomy closure is currently a matter of some controversy. We aimed to develop a scoring system to guide decision making for the use of GICS to prevent deep sternal wound infection. Fast backward elimination on predictors, including GICS, was performed using the Lawless and Singhal method. The scoring system was reported as a partial nomogram that can be used to manually obtain predicted individual risk of deep sternal wound infection from the regression model. Bootstrapping validation of the regression models was performed. The final populations consisted of 8750 adult patients undergoing cardiac surgery through full sternotomy during the study period. A total of 329 patients (3.8%) received GICS implant. The overall incidence of deep sternal wound infection was lower among patients who received GICS implant (0.6%) than patients who did not (2.01%) (P=.02). A nomogram to predict the individual risk for deep sternal wound infection was developed that included the use of GICS. Bootstrapping validation confirmed a good discriminative power of the models. The scoring system provides an impartial assessment of the decision-making process for clinicians to establish if GICS implant is effective in reducing the risk for deep sternal wound infection in individual patients undergoing cardiac surgery through full sternotomy. Copyright © 2014 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Image-Processing Scheme to Detect Superficial Fungal Infections of the Skin

Directory of Open Access Journals (Sweden)

Ulf Mäder

2015-01-01

Full Text Available The incidence of superficial fungal infections is assumed to be 20 to 25% of the global human population. Fluorescence microscopy of extracted skin samples is frequently used for a swift assessment of infections. To support the dermatologist, an image-analysis scheme has been developed that evaluates digital microscopic images to detect fungal hyphae. The aim of the study was to increase diagnostic quality and to shorten the time-to-diagnosis. The analysis, consisting of preprocessing, segmentation, parameterization, and classification of identified structures, was performed on digital microscopic images. A test dataset of hyphae and false-positive objects was created to evaluate the algorithm. Additionally, the performance for real clinical images was investigated using 415 images. The results show that the sensitivity for hyphae is 94% and 89% for singular and clustered hyphae, respectively. The mean exclusion rate is 91% for the false-positive objects. The sensitivity for clinical images was 83% and the specificity was 79%. Although the performance is lower for the clinical images than for the test dataset, a reliable and fast diagnosis can be achieved since it is not crucial to detect every hypha to conclude that a sample consisting of several images is infected. The proposed analysis therefore enables a high diagnostic quality and a fast sample assessment to be achieved.

Porous CS based membranes with improved antimicrobial properties for the treatment of infected wound in veterinary applications

International Nuclear Information System (INIS)

Tonda-Turo, C.; Ruini, F.; Argentati, M.; Di Girolamo, N.; Robino, P.; Nebbia, P.; Ciardelli, G.

2016-01-01

Recently, much attention has been given to the use of innovative solution for the treatment of infected wounds in animals. Current applied treatments are often un-effective leading to infection propagation and animal death. Novel engineered membranes based on chitosan (CS) can be prepared to combine local antimicrobial effect, high flexibility and easy manipulation. In this work, CS crosslinked porous membranes with improved antimicrobial properties were prepared via freeze-drying technique to promote wound healing and to reduce the bacterial proliferation in infected injuries. Silver nanoparticles (AgNPs) and gentamicin sulfate (GS) were incorporated into the CS matrices to impart antibacterial properties on a wild range of strains. CS based porous membranes were tested for their physicochemical, thermal, mechanical as well as swelling and degradation behavior at physiological condition. Additionally, GS release profile was investigated, showing a moderate burst effect in the first days followed by a decreasing release rate which it was maintained for at least 56 days. Moreover, porous membranes loaded with GS or AgNPs showed good bactericidal activity against both of Gram-positive and Gram-negative bacteria. The bacterial strains used in this work were collected in chelonians after carapace injuries to better mimic the environment after trauma. - Highlights: • Innovative scaffolds for wound healing in veterinary applications • Novel engineered membranes based on chitosan with improved antibacterial properties • Highly flexible and versatile membranes for infected wounds

Porous CS based membranes with improved antimicrobial properties for the treatment of infected wound in veterinary applications

Energy Technology Data Exchange (ETDEWEB)

Tonda-Turo, C., E-mail: chiara.tondaturo@polito.it [Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Corso Duca degli Abruzzi 24, 10129, Turin (Italy); Ruini, F. [Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Corso Duca degli Abruzzi 24, 10129, Turin (Italy); Argentati, M. [Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Corso Duca degli Abruzzi 24, 10129, Turin (Italy); Clinic for Exotic Animals, CVS, Via Sandro Giovannini 53, 00137 Rome (Italy); Di Girolamo, N. [Clinic for Exotic Animals, CVS, Via Sandro Giovannini 53, 00137 Rome (Italy); Robino, P.; Nebbia, P. [Department of Veterinary Sciences, University of Turin, Largo Braccini 2, 10095 Grugliasco, Turin (Italy); Ciardelli, G. [Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Corso Duca degli Abruzzi 24, 10129, Turin (Italy)

2016-03-01

Recently, much attention has been given to the use of innovative solution for the treatment of infected wounds in animals. Current applied treatments are often un-effective leading to infection propagation and animal death. Novel engineered membranes based on chitosan (CS) can be prepared to combine local antimicrobial effect, high flexibility and easy manipulation. In this work, CS crosslinked porous membranes with improved antimicrobial properties were prepared via freeze-drying technique to promote wound healing and to reduce the bacterial proliferation in infected injuries. Silver nanoparticles (AgNPs) and gentamicin sulfate (GS) were incorporated into the CS matrices to impart antibacterial properties on a wild range of strains. CS based porous membranes were tested for their physicochemical, thermal, mechanical as well as swelling and degradation behavior at physiological condition. Additionally, GS release profile was investigated, showing a moderate burst effect in the first days followed by a decreasing release rate which it was maintained for at least 56 days. Moreover, porous membranes loaded with GS or AgNPs showed good bactericidal activity against both of Gram-positive and Gram-negative bacteria. The bacterial strains used in this work were collected in chelonians after carapace injuries to better mimic the environment after trauma. - Highlights: • Innovative scaffolds for wound healing in veterinary applications • Novel engineered membranes based on chitosan with improved antibacterial properties • Highly flexible and versatile membranes for infected wounds.

Neonatal tetanus associated with skin infection.

Science.gov (United States)

Maharaj, M; Dungwa, N

2016-08-03

A 1-week-old infant was brought to a regional hospital with a history of recurrent seizures following lower abdominal septic skin infection. She was found to have neonatal tetanus, and a spatula test was positive. The tetanus infection was associated with a superficial skin infection, common in neonates. Treatment included sedatives (diazepam, chlorpromazine, phenobarbitone and morphine), muscle relaxants, antibiotics and ventilation in the neonatal intensive care unit. Intrathecal and intramuscular immunoglobulin were given, and the wound was treated. The infant recovered, with no seizures by the 16th day from admission, and was off the ventilator by the 18th day. This was shorter than the usual 3 - 4 weeks for neonates with tetanus at the hospital. The question arises whether tetanus immunisation should be considered in infants with skin infections, which frequently occur in the neonatal period.

Treatment of Early Post-Op Wound Infection after Internal Fixation

Science.gov (United States)

2016-10-01

Obremskey, M.D. CONTRACTING ORGANIZATION: Vanderbilt University Medical Center Nashville TN 37203 REPORT DATE: October 2016 TYPE OF REPORT: Annual...NOT RETURN YOUR FORM TO THE ABOVE ADDRESS. 1. REPORT DATE (DD-MM-YYYY) October 2016 2. REPORT TYPE Annual 3. DATES COVERED (From - To) 15Sep2015...effect of treatment of post-op wound infection in long bones after fracture fixation or joint fusion and either: (Group 1) operative debridement and

Can Methicillin-resistant Staphylococcus aureus Silently Travel From the Gut to the Wound and Cause Postoperative Infection? Modeling the "Trojan Horse Hypothesis".

Science.gov (United States)

Krezalek, Monika A; Hyoju, Sanjiv; Zaborin, Alexander; Okafor, Emeka; Chandrasekar, Laxmi; Bindokas, Vitas; Guyton, Kristina; Montgomery, Christopher P; Daum, Robert S; Zaborina, Olga; Boyle-Vavra, Susan; Alverdy, John C

2018-04-01

To determine whether intestinal colonization with methicillin-resistant Staphylococcus aureus (MRSA) can be the source of surgical site infections (SSIs). We hypothesized that gut-derived MRSA may cause SSIs via mechanisms in which circulating immune cells scavenge MRSA from the gut, home to surgical wounds, and cause infection (Trojan Horse Hypothesis). MRSA gut colonization was achieved by disrupting the microbiota with antibiotics, imposing a period of starvation and introducing MRSA via gavage. Next, mice were subjected to a surgical injury (30% hepatectomy) and rectus muscle injury and ischemia before skin closure. All wounds were cultured before skin closure. To control for postoperative wound contamination, reiterative experiments were performed in mice in which the closed wound was painted with live MRSA for 2 consecutive postoperative days. To rule out extracellular bacteremia as a cause of wound infection, MRSA was injected intravenously in mice subjected to rectus muscle ischemia and injury. All wound cultures were negative before skin closure, ruling out intraoperative contamination. Out of 40 mice, 4 (10%) developed visible abscesses. Nine mice (22.5%) had MRSA positive cultures of the rectus muscle without visible abscesses. No SSIs were observed in mice injected intravenously with MRSA. Wounds painted with MRSA after closure did not develop infections. Circulating neutrophils from mice captured by flow cytometry demonstrated MRSA in their cytoplasm. Immune cells as Trojan horses carrying gut-derived MRSA may be a plausible mechanism of SSIs in the absence of direct contamination.

Thermal injury induces impaired function in polymorphonuclear neutrophil granulocytes and reduced control of burn wound infection

DEFF Research Database (Denmark)

Calum, H.; Moser, C.; Jensen, P. O.

2009-01-01

Severe thermal injury induces immunosuppression, involving all parts of the immune system, especially when large fractions of the total body surface area are affected. An animal model was established to characterize the burn-induced immunosuppression. In our novel mouse model a 6% third-degree burn...... injury was induced in mice with a hot-air blower. The third-degree burn was confirmed histologically. The mice were allocated into five groups: control, shave, burn, infection and burn infection group. At 48 h, a decline in the concentration of peripheral blood leucocytes was observed in the group...... of mice with burn wound. The reduction was ascribed to the decline in concentration of polymorphonuclear neutrophil leucocytes and monocytes. When infecting the skin with Pseudomonas aeruginosa, a dissemination of bacteria was observed only in the burn wound group. Histological characterization...

Multispectral imaging of acute wound tissue oxygenation

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Audrey Huong

2017-05-01

Full Text Available This paper investigates the appropriate range of values for the transcutaneous blood oxygen saturation (StO2 of granulating tissues and the surrounding tissue that can ensure timely wound recovery. This work has used a multispectral imaging system to collect wound images at wavelengths ranging between 520nm and 600nm with a resolution of 10nm. As part of this research, a pilot study was conducted on three injured individuals with superficial wounds of different wound ages at different skin locations. The StO2 value predicted for the examined wounds using the Extended Modified Lambert–Beer model revealed a mean StO2 of 61±10.3% compared to 41.6±6.2% at the surrounding tissues, and 50.1±1.53% for control sites. These preliminary results contribute to the existing knowledge on the possible range and variation of wound bed StO2 that are to be used as indicators of the functioning of the vasomotion system and wound health. This study has concluded that a high StO2 of approximately 60% and a large fluctuation in this value should precede a good progression in wound healing.

Risk factors for intracranial infection secondary to penetrating craniocerebral gunshot wounds in civilian practice.

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Jimenez, Carlos Mario; Polo, Jonathan; España, Julian Andres

2013-01-01

To determine risk factors for intracranial infection secondary to penetrating craniocerebral gunshot wounds (PCGWs) in civilian practice, in patients who underwent surgery with removal of bullet fragments, wound debridement, and watertight dural closure. An observational, analytical, prospective, cohort-type study was conducted with follow-up in a group of patients with PCGWs caused by a low-velocity projectile admitted between January 2000 and November 2010. There were 160 patients, 59 of whom were administered prophylactic antibiotics based on the decision of the treating neurosurgeon. Average follow-up time was 39 months (range, 3-92 months). Infection occurred in 40 patients (25%); 20 patients received antibiotics (20 of 59 [33.9%]), and 20 patients did not receive antibiotics (20 of 101 [19.8%]). Three variables were independent risk factors for infection: (i) persistence of parenchymal osseous or metallic fragments after surgery (P projectile trajectory through a natural cavity with contaminating flora (P = 0.03, RR 2.84); and (iii) prolonged hospitalization time (P Projectile trajectory through potentially contaminating cavities, persistence of intraparenchymal osseous or metallic fragments after surgery, and prolonged hospital stay were independent risk factors for intracranial infection. Copyright © 2013 Elsevier Inc. All rights reserved.

Breast augmentation, antibiotic prophylaxis, and infection: comparative analysis of 1,628 primary augmentation mammoplasties assessing the role and efficacy of antibiotics prophylaxis duration.

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Khan, Umar Daraz

2010-02-01

Infections after augmentation mammoplasty are not uncommon, and prophylactic antibiotics are routinely administered to minimize infection. However, there is paucity of information on the relationship between the length of prophylaxis cover and its benefits in primary augmentation mammoplasty. A retrospective analysis of different antibiotic cover regimens, their effectiveness in preventing infections, and the management of infection in established cases is reviewed. A retrospective chart analysis of periprosthetic infections in primary augmentation mammoplasties performed over the past 10 years was conducted. Periprosthetic infection was determined by the presence of pain, swelling, redness, and discharge. Each breast was taken as an individual unit in 1,628 patients, and data for 3,256 breasts were analyzed. The patients had their augmentation in the partial submuscular plane (214 breasts in 107 patients), the subglandular plane (1,548 breasts in 774 patients), and the muscle-splitting biplane (1,494 breasts in 747 patients). All the patients had soft round cohesive gel silicone implants. Of the 3,256 implants, 3,218 were textured, and 38 were smooth surfaced. The patients received antibiotics as a single intravenous dose of cephalosporin (474 breasts in 237 patients), a single intravenous dose plus an oral dose for 24 h (344 breasts in 172 patients), or a single intravenous dose plus an oral course for 5 days (2,438 breasts in 1,219 patients). Infection was recorded as superficial (e.g., wound breakdown, stitch extrusion, stitch abscess) or deep (periprosthetic). The patients with established periprosthetic infections, determined clinically by the presence of pain, discharge, swelling, and redness of the breasts, were managed either conservatively using antibiotics, passive wound drainage, and healing of the wound with secondary intention or by explantation and replacement after 3 to 4 months. In selected cases of periprosthetic infection, the implants were

The tip of the iceberg: Post caesarean wound dehiscence presenting as abdominal wound sepsis

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Kaundinya Kiran Bharatam

2015-01-01

Conclusion: Uterine scar dehiscence with infection requires high index of suspicion as rare cause for post partum localized/generalized peritonitis with sepsis. Severe abdominal wound infection after caesarean section may be associated with uterine wound dehiscence, which poses a grave risk to the mother in a future pregnancy.

The use of liposomal solutions of antibiotics in treatment of infected and festering wounds in children

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Олег Владимирович Спахи

2015-06-01

Full Text Available Aim of research. To study the use of liposomal solutions of antibiotics in the complex treatment of infected and festering wounds in children.Materials and methods of research: The results of clinical and laboratory examinations of 77 children 3-18 years old with infected and festering wounds were analyzed. All children were distributed into groups of observation by the character of the treatment: in 37 sick children (the main group liposomal preparations were used in the complex treatment. Patients of the control group (40 children get the generally accepted complex treatment. The groups of comparison were statistically similar by the character and localization of pathological process, age, prescription of disease. In the main group an antibacterial-liposomal mixture was injected into the wound alongside with the generally accepted methods. The dynamics of the clinical, laboratory, cytological, bacteriological and morphological indicators was defined using the generally accepted technics. The general condition of patient’s organism was assessed with a help of laboratory methods of research (general clinical and biochemical analyses.Results. In the main group it was observed a persistent tendency to normalization of leukocytal formula and of the number of leukocytes in peripheral blood that reached normal values (p < 0,05 on 7th day. In 36 patients of the control group leukocytosis remained for 7 days. Evident differences of indicators of leukocytal index of intoxication and of an index of the shift of leukocytal formula in the main and the control groups were observed on 3-4th day. In addition its decrease was combined with diminution of an intensity of clinical symptoms and with decrease of manifestations of the local pathological process.Bacteriological examination of the nidus of inflammation in patients of examined groups revealed that in the main group the diminution of the degree of infectious contamination passed faster (p<0,05 – on

Comparison between primary closure with karydakis's technique versus open procedure in treatment of pilonidal sinus in terms of frequency of postoperative wound infection

International Nuclear Information System (INIS)

Nafees, A.U.A.; Ahmed, M.

2013-01-01

Objective: The purpose of this study is to compare between primary closure with Karydakis's technique versus open procedure in treatment of pilonidal sinus in terms of frequency of postoperative wound infection. Study Design: Randomized Clinical Trials (RCT). Place and Duration of Study: This study was carried out at Department of Surgery, CMH, Kharian over a period of 2 years from Sept 2010 to Oct 2012. Patients and Methods: Sixty patients were selected out of which 30 patients underwent open excision and secondary healing and 30 patients underwent Karydakis procedure. Post operatively these patients were observed for wound infection on date of discharge and weeks 1, 2 and 3. Results of both groups were compared for wound infection by applying chi-square test. Results: There was no statistically significant difference in the frequency of infection between the two groups when calculated during the complete course of study. Conclusion: Primary closure with Karydakis's technique and open procedure are satisfactory surgical procedures for pilonidal sinus disease in terms of post-operative wound infection. (author)

Improved wound care product

DEFF Research Database (Denmark)

2012-01-01

The present invention pertains to use of sodium diacetate (NaHAc 2) as an antimicrobial agent against bacteria growing in biofilms. The aspects of the invention include a wound care product comprising sodium diacetate, a kit comprising a wound care product,and a methodof treating an infected wound....

Biomaterials and Nanotherapeutics for Enhancing Skin Wound Healing

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Das, Subhamoy; Baker, Aaron B.

2016-01-01

Wound healing is an intricate process that requires complex coordination between many cell types and an appropriate extracellular microenvironment. Chronic wounds often suffer from high protease activity, persistent infection, excess inflammation, and hypoxia. While there has been intense investigation to find new methods to improve cutaneous wound care, the management of chronic wounds, burns, and skin wound infection remain challenging clinical problems. Ideally, advanced wound dressings can provide enhanced healing and bridge the gaps in the healing processes that prevent chronic wounds from healing. These technologies have great potential for improving outcomes in patients with poorly healing wounds but face significant barriers in addressing the heterogeneity and clinical complexity of chronic or severe wounds. Active wound dressings aim to enhance the natural healing process and work to counter many aspects that plague poorly healing wounds, including excessive inflammation, ischemia, scarring, and wound infection. This review paper discusses recent advances in the development of biomaterials and nanoparticle therapeutics to enhance wound healing. In particular, this review focuses on the novel cutaneous wound treatments that have undergone significant preclinical development or are currently used in clinical practice. PMID:27843895

Biomaterials and Nanotherapeutics for Enhancing Skin Wound Healing

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Subhamoy Das

2016-10-01

Full Text Available Wound healing is an intricate process that requires complex coordination between many cells and an appropriate extracellular microenvironment. Chronic wounds often suffer from high protease activity, persistent infection, excess inflammation, and hypoxia. While there has been intense investigation to find new methods to improve cutaneous wound care; the management of chronic wounds, burns, and skin wound infection remain challenging clinical problems. Ideally, advanced wound dressings can provide enhanced healing and bridge the gaps in the healing processes that prevent chronic wounds from healing. These technologies have great potential for improving outcomes in patients with poorly healing wounds but face significant barriers in addressing the heterogeneity and clinical complexity of chronic or severe wounds. Active wound dressings aim to enhance the natural healing process and work to counter many aspects that plague poorly healing wounds including excessive inflammation, ischemia, scarring and wound infection. This review paper discusses recent advances in the development of biomaterials and nanoparticle therapeutics to enhance wound healing. In particular, this review focuses on the novel cutaneous wound treatments that have undergone significant preclinical development or currently used in clinical practice.

Reduction in Surgical Wound Infection Rates Associated with Reporting Data to Surgeons

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GD Taylor

1994-01-01

Full Text Available Several studies have shown that wound infection (surgical site infection [ ssi ] rates fall when surgeons are provided with data on their performance. Since 1987, the authors have been performing concurrent surveillance of surgical patients and confidentially reporting surgeon-specific ssi rates to individual surgeons and their clinical directors, and providing surgeons with the mean rates of their peers. The program has been gradually refined and expanded. Data are now collected on wound infection risk and report risk adjusted rates compared with the mean for hospitals in the United States National Nosocomial Infections Surveillance (nnis data bank. Since inception through to December 1993, ssi rates have fallen 68% in clean contaminated general surgery cases (relative risk [rr] 0.36, 95% ci 0.2 to 0.6, P=0.0001, 64% in clean plastic surgery cases (rr 0.35, 95% ci 0.06 to 1.8, 72% in caesarean section cases (rr 0.23, 95% ci 0.03 to 1.96 and 42% in clean cardiovascular surgery cases (rr 0.59, 95% ci 0.34 to 1.0. In clean orthopedic surgery the ssi rate remained stable from 1987 through 1992. In 1993 a marked increase was experienced. Reasons for this are being explored. Overall there was a 32% decrease in ssi rate between the index year and 1993 or, in percentage terms, 2.8% to 1.9% (rr 0.65, 95% ci 0.51 to 0.86, P=0.002. ssi surveillance should become standard in Canadian hospitals interested in improving the quality of surgical care and reducing the clinical impact and cost associated with nosocomial infection.

Infecções hospitalares em 46 pacientes submetidos a artroplastia total do quadril Hospital infections in 46 patients submitted to total hip replacement

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Ana Lúcia Lei Munhoz Lima

2001-03-01

Full Text Available Foram estudados 46 pacientes submetidos a artroplastia total do quadril em um Instituto de Ortopedia de São Paulo, Brasil, no período de 1993 a 1995, com o objetivo de obter a real frequência das infecções hospitalares da ferida operatória superficial e profunda que ocorrem nessa cirurgia. O estudo baseou-se no acompanhamento pré-operatório, trans-operatório e pós-operatório com seguimento mínimo de três meses de todos os pacientes, no sentido de caracterizar os agentes etiológicos das infecções e os fatores de risco que contribuem para o seu desenvolvimento. Foi observada uma freqüência total de 15.1% de infecções hospitalares, sendo 6.5% de infecção superficial da ferida operatória, 6.5% de infecção profunda e 2.1% de infecção do trato urinário. Os agentes etiológicos encontrados foram Pseudomonas aeruginosa (2 casos, Staphylococcus coagulase negativo (2 casos, Morganella morgani (1 caso e associação de Acinetobacter calcoaceticus (2 casos. O fator de risco com significância estatística observado nesta casuística foi o tempo cirúrgico aumentado. Concluiu-se que a frequência de infecção da ferida cirúrgica superficial e profunda nas artroplastias totais de quadril foi maior, nesta casuística, do que a relatada na literatura internacional, com elevada participação de bacilos Gram-negativos como agentes etiológicos e tendo como principal fator de risco o tempo cirúrgico aumentado.We studied 46 patients submitted to total hip replacement at an Orthopaedics Institute in the city of São Paulo, Brazil, from 1993 to 1995, in order to determine the real frequency of hospital infections of the superficial and deep surgical wounds occurring in this operation. The study consisted of preoperative, transoperative and postoperative monitoring and a minimum follow-up period of three months for all patients in order to characterise the etiologic agents of the infections and risk factors contributing to the

Reconstruction of Abdominal Wall of a Chronically Infected Postoperative Wound with a Rectus Abdominis Myofascial Splitting Flap

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Sung Kyu Bae

2013-01-01

Full Text Available Background If a chronically infected abdominal wound develops, complications such asperitonitis and an abdominal wall defect could occur. This could prolong the patient’s hospitalstay and increase the possibility of re-operation or another infection as well. For this reason,a solution for infection control is necessary. In this study, surgery using a rectus abdominismuscle myofascial splitting flap was performed on an abdominal wall defect.Methods From 2009 to 2012, 5 patients who underwent surgery due to ovarian rupture,cesarean section, or uterine myoma were chosen. In each case, during the first week afteroperation, the wound showed signs of infection. Surgery was chosen because the wounds didnot resolve with dressing. Debridement was performed along the previous operation woundand dissection of the skin was performed to separate the skin and subcutaneous tissue fromthe attenuated rectus muscle and Scarpa’s fascial layers. Once the anterior rectus sheath andmuscle were adequately mobilized, the fascia and muscle flap were advanced medially sothat the skin defect could be covered for reconstruction.Results Upon 3-week follow-up after a rectus abdominis myofascial splitting flap operation,no major complication occurred. In addition, all of the patients showed satisfaction in termsof function and esthetics at 3 to 6 months post-surgery.Conclusions Using a rectus abdominis myofascial splitting flap has many esthetic andfunctional benefits over previous methods of abdominal defect treatment, and notably, itenabled infection control by reconstruction using muscle.

Negative pressure wound therapy for Gustilo Anderson grade IIIb open tibial fractures.

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Park, Chul Hyun; Shon, Oog Jin; Kim, Gi Beom

2016-09-01

Traditionally, Gustilo Anderson grade IIIb open tibial fractures have been treated by initial wide wound debridement, stabilization of fracture with external fixation, and delayed wound closure. The purpose of this study is to evaluate the clinical and radiological results of staged treatment using negative pressure wound therapy (NPWT) for Gustilo Anderson grade IIIb open tibial fractures. 15 patients with Gustilo Anderson grade IIIb open tibial fractures, treated using staged protocol by a single surgeon between January 2007 and December 2011 were reviewed in this retrospective study. The clinical results were assessed using a Puno scoring system for severe open fractures of the tibia at the last followup. The range of motion (ROM) of the knee and ankle joints and postoperative complication were evaluated at the last followup. The radiographic results were assessed using time to bone union, coronal and sagittal angulations and a shortening at the last followup. The mean score of Puno scoring system was 87.4 (range 67-94). The mean ROM of the knee and ankle joints was 121.3° (range 90°-130°) and 37.7° (range 15°-50°), respectively. Bone union developed in all patients and the mean time to union was 25.3 weeks (range 16-42 weeks). The mean coronal angulation was 2.1° (range 0-4°) and sagittal was 2.7° (range 1-4°). The mean shortening was 4.1 mm (range 0-8 mm). Three patients had partial flap necrosis and 1 patient had total flap necrosis. There was no superficial and deep wound infection. Staged treatment using NPWT decreased the risks of infection and requirement of flap surgeries in Gustilo Anderson grade IIIb open tibial fractures. Therefore, staged treatment using NPWT could be a useful treatment option for Gustilo Anderson grade IIIb open tibial fractures.

Treatment of inherently unstable open or infected fractures by open wound management and external skeletal fixation.

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Ness, M G

2006-02-01

To assess the use of external skeletal fixation with open wound management for the treatment of inherently unstable open or infected fractures in dogs. A retrospective review of 10 cases. Fracture stabilisation and wound management required only a single anaesthetic, and despite the challenging nature of these injuries, the final outcome was acceptable or good in every case. However, minor complications associated with the fixator pins were quite common, and two dogs developed complications which required additional surgery. Open management of wounds, even when bone was exposed, proved to be an effective technique, and external skeletal fixators were usually effective at maintaining stability throughout an inevitably extended fracture healing period.

Wound Disruption Following Colorectal Operations.

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Moghadamyeghaneh, Zhobin; Hanna, Mark H; Carmichael, Joseph C; Mills, Steven; Pigazzi, Alessio; Nguyen, Ninh T; Stamos, Michael J

2015-12-01

Postoperative wound disruption is associated with high morbidity and mortality. We sought to identify the risk factors and outcomes of wound disruption following colorectal resection. The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was used to examine the clinical data of patients who underwent colorectal resection from 2005 to 2013. Multivariate regression analysis was performed to identify risk factors of wound disruption. We sampled a total of 164,297 patients who underwent colorectal resection. Of these, 2073 (1.3 %) had wound disruption. Patients with wound disruption had significantly higher mortality (5.1 vs. 1.9 %, AOR: 1.46, P = 0.01). The highest risk of wound disruption was seen in patients with wound infection (4.8 vs. 0.9 %, AOR: 4.11, P disruption such as chronic steroid use (AOR: 1.71, P disruption compared to open surgery (AOR: 0.61, P disruption occurs in 1.3 % of colorectal resections, and it correlates with mortality of patients. Wound infection is the strongest predictor of wound disruption. Chronic steroid use, obesity, severe COPD, prolonged operation, non-elective admission, and serum albumin level are strongly associated with wound disruption. Utilization of the laparoscopic approach may decrease the risk of wound disruption when possible.

Novel biodegradable sandwich-structured nanofibrous drug-eluting membranes for repair of infected wounds: an in vitro and in vivo study

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Chan EC

2012-02-01

Full Text Available Dave Wei-Chih Chen1,2, Jun-Yi Liao3, Shih-Jung Liu2, Err-Cheng Chan41Department of Orthopedic Surgery, Chang Gung Memorial Hospital, 2Department of Mechanical Engineering, 3Graduate Institute of Medical Mechatronics, 4School of Medical Technology, Chang Gung University, Kwei-San, Tao-Yuan, TaiwanBackground: The purpose of this study was to develop novel sandwich-structured nanofibrous membranes to provide sustained-release delivery of vancomycin, gentamicin, and lidocaine for repair of infected wounds.Methods: To prepare the biodegradable membranes, poly(D, L-lactide-co-glycolide (PLGA, collagen, and various pharmaceuticals, including vancomycin, gentamicin, and lidocaine, were first dissolved in 1,1,1,3,3,3-hexafluoro-2-propanol. They were electrospun into sandwich-structured membranes with PLGA/collagen as the surface layers and PLGA/drugs as the core. An elution method and a high-pressure liquid chromatography assay were used to characterize in vivo and in vitro drug release from the membranes. In addition, repair of infected wounds in rats was studied. Histological examination of epithelialization and granulation at the wound site was also performed.Results: The biodegradable nanofibrous membranes released large amounts of vancomycin and gentamicin (well above the minimum inhibition concentration and lidocaine in vivo for more than 3 weeks. A bacterial inhibition test was carried out to determine the relative activity of the antibiotics released. The bioactivity ranged from 40% to 100%. The nanofibrous membranes were functionally active in treating infected wounds, and were very effective as accelerators in early-stage wound healing.Conclusion: Using the electrospinning technique, we will be able to manufacture biodegradable, biomimetic, nanofibrous, extracellular membranes for long-term delivery of various drugs.Keywords: nanofibrous, sandwich-structured, drug-eluting membranes, electrospinning, release characteristics, repair, wound

A Clinicoepidemiological Profile of Chronic Wounds in Wound Healing Department in Shanghai.

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Sun, Xiaofang; Ni, Pengwen; Wu, Minjie; Huang, Yao; Ye, Junna; Xie, Ting

2017-03-01

The aim of the study was to update the clinical database of chronic wounds in order to derive an evidence based understanding of the condition and hence to guide future clinical management in China. A total of 241 patients from January 1, 2011 to April 30, 2016 with chronic wounds of more than 2 weeks' duration were studied in wound healing department in Shanghai. Results revealed that among all the patients the mean age was 52.5 ± 20.2 years (range 2-92 years). The mean initial area of wounds was 30.3 ± 63.0 cm 2 (range 0.25-468 cm 2 ). The mean duration of wounds was 68.5 ± 175.2 months (range 0.5-840 months). The previously reported causes of chronic wounds were traumatic or surgical wounds (n = 82, 34.0%), followed by pressure ulcers (n = 59, 24.5%). To study the effects of age, patients were divided into 2 groups: less than 60 years (wounds etiology between the 2 age groups was analyzed, and there was significant statistical difference ( P wounds, chi-square test was used. There were significant differences in the factor of wound infection. ( P = .035, 95% CI = 0.031-0.038) Regarding therapies, 72.6% (n = 175) of the patients were treated with negative pressure wound therapy. Among all the patients, 29.9% (n = 72) of them were completely healed when discharged while 62.7% (n = 150) of them improved. The mean treatment cost was 12055.4 ± 9206.3 Chinese Yuan (range 891-63626 Chinese Yuan). In conclusion, traumatic or surgical wounds have recently become the leading cause of chronic wounds in Shanghai, China. Etiology of the 2 age groups was different. Infection could significantly influence the wound outcome.

Negative pressure wound therapy in the management of late deep infections after open reconstruction of achilles tendon rupture.

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Mosser, Philipp; Kelm, Jens; Anagnostakos, Konstantinos

2015-01-01

Infection is a major complication after open reconstruction of Achilles tendon ruptures. We report on the use of vacuum-assisted closure (VAC) therapy in the treatment of late deep infections after open Achilles tendon reconstruction. Six patients (5 males [83.33%], 1 female [16.67%]; mean age, 52.8 [range 37 to 66] years) were been treated using an identical protocol. Surgical management consisted of debridement, lavage, and necrectomy of infected tendon parts. The VAC therapy was used for local wound preconditioning and infection management. A continuous negative pressure of 125 mm Hg was applied on each wound. For final wound closure, a split-thickness skin graft was performed. The skin graft healing process was also supported by VAC therapy during the first 5 days. The VAC dressings were changed a mean average of 3 (range 1 to 4) times until split-thickness skin grafting could be performed. The mean total duration of the VAC therapy was 13.6 ± 5.9 days. The mean hospital stay was 31.2 ± 15.9 days. No complications with regard to bleeding, seroma, or hematoma formation beneath the skin graft were observed. At a mean follow-up duration of 29.9 (range 4 to 65) months, no re-infection or infection persistence was observed. The VAC device seems to be a valuable tool in the treatment of infected tendons. The generalization of these conclusions should await the results of future studies with larger patient series. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Role of different negative pressure values in the process of infected wounds treated by vacuum-assisted closure: an experimental study.

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Zhou, Min; Yu, Aixi; Wu, Gang; Xia, Chengyan; Hu, Xiang; Qi, Baiwen

2013-10-01

Vacuum-assisted closure (VAC) device is widely used to treat infected wounds in clinical work. Although the effect of VAC with different negative pressure values is well established, whether different negative pressures could result in varying modulation of wound relative cytokines was not clear. We hypothesise that instead of the highest negative pressure value the suitable value for VAC is the one which is the most effective on regulating wound relative cytokines. Infected wounds created on pigs' back were used to investigate the effects of varying negative pressure values of VAC devices. Wounds were treated with VAC of different negative pressure values or moist gauze, which was set as control. The VAC foam, semiocclusive dresses and moist gauze were changed on days 3, 5, 7 and 9 after wounds were created. When changing dressings, tissues from wounds were harvested for bacteria count and histology examination including Masson's trichrome stain and immunohistochemistry for microvessels. Western blot was carried out to test the expression of vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF). Results showed that on days 3 and 5 the number of bacteria in wounds treated by VAC with 75, 150, 225 and 300 mmHg was significantly decreased compared with that in wounds treated by gauze and 0 mmHg pressure value. However, there was no difference in wounds treated with negative pressure values of 75 , 150, 225 and 300 mmHg at any time spot. Immunohistochemistry showed that more microvessels were generated in wounds treated by VAC using 75 and 150 mmHg negative pressure comparing with that using 225 and 300 mmHg on days 3 and 5. However this difference vanished on days 7 and 9. Morphological evaluation by Masson's trichrome staining showed increased collagen deposition in VAC of 75 and 150 mmHg compared with that in VAC of 225 and 300 mmHg. Western blot showed that the expression of VEGF and bFGF significantly increased when the wounds

A case of deep infection after instrumentation in dorsal spinal surgery: the management with antibiotics and negative wound pressure without removal of fixation.

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Dobran, Mauro; Mancini, Fabrizio; Nasi, Davide; Scerrati, Massimo

2017-07-28

Until today the role of spinal instrumentation in the presence of a wound infection has been widely discussed and recently many authors leave the hardware in place with appropriate antibiotic therapy. This is a case of a 65-year-old woman suffering from degenerative scoliosis and osteoporotic multiple vertebral collapses treated with posterior dorsolumbar stabilisation with screws and rods. Four months later, skin necrosis and infection appeared in the cranial wound with exposure of the rods. A surgical procedure of debridement of the infected tissue and package with a myocutaneous trapezius muscle flap was performed. One week after surgery, negative pressure wound therapy was started on the residual skin defect. The wound healed after 2 months. The aim of this case report is to focus on the utility of this method even in the case of hardware exposure and infection. This may help avoid removing instrumentation and creating instability. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Wound healing and infection in surgery

DEFF Research Database (Denmark)

Sørensen, Lars Tue

2012-01-01

: The aim was to clarify how smoking and nicotine affects wound healing processes and to establish if smoking cessation and nicotine replacement therapy reverse the mechanisms involved.......: The aim was to clarify how smoking and nicotine affects wound healing processes and to establish if smoking cessation and nicotine replacement therapy reverse the mechanisms involved....

Diabetic foot wounds: the value of negative pressure wound therapy with instillation.

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Dalla Paola, Luca

2013-12-01

Chronic wounds such as diabetic foot wounds are a tremendous burden to the health care system and often require a multidisciplinary approach to prevent amputations. Advanced technologies such as negative pressure wound therapy (NPWT) and bioengineered tissues have been successfully used in the treatment of these types of complex wounds. However, the introduction of NPWT with instillation (NPWTi) has provided an alternative treatment for treating complex and difficult-to-heal wounds. This article provides an overview of NPWT and the new NPWTi system and describes preliminary experience using NPWTi on patients with complicated infected diabetic foot wounds after surgical debridement and in a multidisciplinary setting. © 2013 The Author. International Wound Journal © 2013 John Wiley & Sons Ltd and Medicalhelplines.com Inc.

Aging influences wound healing in patients with chronic lower extremity wounds treated in a specialized Wound Care Center.

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Wicke, Corinna; Bachinger, Andreas; Coerper, Stephan; Beckert, Stefan; Witte, Maria B; Königsrainer, Alfred

2009-01-01

With the dramatic increase in the aging population, the study and care of wounds in the elderly have become priority topics for both researchers and clinicians. The effects of aging on wound healing in humans have remained controversial. The study was a 5-year epidemiological evaluation of standardized data collected regularly during patients' visits at a specialized Wound Care Center with the aim to determine the key factors influencing the healing of chronic lower extremity wounds. In this analysis of 1,158 chronic wounds, the frequency of wound closure was statistically significantly lower in older patients compared with younger patients. The share of closed wounds decreased by nearly 25% in the elderly patients (>or=70 years). The relationship between the patient's age and the proportion of wound closure was nonlinear. The effect of aging on the frequency of wound closure of chronic wounds became clinically apparent after age 60. The chronicity of the wounds was illustrated by their recurrent nature, their long duration, the presence of multiple wounds, and the frequency of concurrent infection. Comorbidity was documented by the coprevalence of up to three underlying diseases related to impaired wound healing. The present study clearly showed that aging affects chronic wound healing negatively.

Update and validation of the Society for Vascular Surgery wound, ischemia, and foot infection threatened limb classification system.

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Mills, Joseph L

2014-03-01

The diagnosis of critical limb ischemia, first defined in 1982, was intended to delineate a patient cohort with a threatened limb and at risk for amputation due to severe peripheral arterial disease. The influence of diabetes and its associated neuropathy on the pathogenesis-threatened limb was an excluded comorbidity, despite its known contribution to amputation risk. The Fontaine and Rutherford classifications of limb ischemia severity have also been used to predict amputation risk and the likelihood of tissue healing. The dramatic increase in the prevalence of diabetes mellitus and the expanding techniques of arterial revascularization has prompted modification of peripheral arterial disease classification schemes to improve outcomes analysis for patients with threatened limbs. The diabetic patient with foot ulceration and infection is at risk for limb loss, with abnormal arterial perfusion as only one determinant of outcome. The wound extent and severity of infection also impact the likelihood of limb loss. To better predict amputation risk, the Society for Vascular Surgery Lower Extremity Guidelines Committee developed a classification of the threatened lower extremity that reflects these important clinical considerations. Risk stratification is based on three major factors that impact amputation risk and clinical management: wound, ischemia, and foot infection. This classification scheme is relevant to the patient with critical limb ischemia because many are also diabetic. Implementation of the wound, ischemia, and foot infection classification system in critical limb ischemia patients is recommended and should assist the clinician in more meaningful analysis of outcomes for various forms of wound and arterial revascularizations procedures required in this challenging, patient population. Copyright © 2014 Elsevier Inc. All rights reserved.

ROLE OF VACUUM ASSISTED CLOSURE (VAC - IN WOUND HEALING

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L. Lokanadha Rao

2016-09-01

Full Text Available BACKGROUND Large, complicated wounds pose a significant surgical problem. Negative pressure wound therapy is one of several methods enabling to obtain better treatment results in case of open infected wounds.1,2 The use of negative pressure therapy enables to obtain a reduction in the number of bacteria which significantly reduces the number of complications.3,4,5 AIMS AND OBJECTIVES: To review the Role of VAC in wound healing in Orthopaedics. MATERIALS AND METHODS The cases presented in this study are those who were admitted in King George Hospital in the time period from January 2014 to August 2015. This is a prospective interventional study. In this study, 15 patients were assigned to the study group (Negative Pressure Wound Therapy- NPWT based on their willingness for undergoing treatment. OBSERVATIONS AND RESULTS 12 males and 3 females are involved in the study. There is decrease in the mean wound area from 64 cm2 to 38 cm2 . There is decrease in the duration of hospital stay. Finally, wound is closed by SSG or secondary suturing. DISCUSSION NPWT is known to reduce bacterial counts, although they remain colonised with organisms. Wounds covered with NPW dressing are completely isolated from the environment, thereby reduces cross infection. In our series, we had 73.3% (11 cases excellent results and 26.7% (4 cases good results and no poor results. As interpretation with results, VAC therapy is effective mode of adjuvant therapy for the management of infected wounds. CONCLUSION VAC has been proven to be a reliable method of treating a variety of infected wounds. It greatly increases the rate of granulation tissue formation and lowers bacterial counts to accelerate wound healing. It can be used as a temporary dressing to prepare wounds optimally prior to closure or as a definitive treatment for nonsurgical and surgical wounds. VAC is now being used in a multitude of clinical settings, including the treatment of surgical wounds, infected wounds

[Antiseptic effect of compound lysostaphin disinfectant and its preventive effect on infection of artificial dermis after graft on full-thickness skin defect wound in rats].

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Jin, J; Zhou, H; Cui, Z C; Wang, L; Luo, P F; Ji, S Z; Hu, X Y; Ma, B; Wang, G Y; Zhu, S H; Xia, Z F

2018-04-20

Objective: To study the antiseptic effect of compound lysostaphin disinfectant and its preventive effect on infection of artificial dermis after graft on full-thickness skin defect wound in rats. Methods: (1) Each one standard strain of Klebsiella pneumoniae, Acinetobacter baumannii, and Staphylococcus aureus were selected. Each 20 clinical strains of Klebsiella pneumoniae, Acinetobacter baumannii, and Staphylococcus aureus were collected from those isolated from wound exudates of burn patients hospitalized in our wards from January 2014 to December 2016 according to the random number table. The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of compound lysostaphin disinfectant to above-mentioned strains were detected. The experiment was repeated 3 times. Compared with the corresponding standard strain, the clinical strain with higher MIC and/or MBC was considered as having decreased sensitivity to the disinfectant. The percentage of strains of each of the three kinds of bacteria with decreased sensitivity was calculated. (2) Artificial dermis pieces were soaked in compound lysostaphin disinfectant for 5 min, 1 h, 2 h, and 4 h, respectively, with 21 pieces at each time point. After standing for 0 (immediately), 12, 24, 36, 48, 60, 72 h (with 3 pieces at each time point), respectively, the diameters of their inhibition zones to standard strains of Klebsiella pneumoniae, Acinetobacter baumannii, and Staphylococcus aureus were measured. The experiment was repeated 3 times. The shortest soaking time corresponding to the longest standing time, after which the disinfectant-soaked artificial dermis could form an effective inhibition zone (with diameter more than 7 mm), was the sufficient soaking time of the disinfectant to the artificial dermis. (3) Forty Sprague-Dawley rats were divided into post injury day (PID) 3, 7, 14, and 21 sampling groups according to the random number table, with 10 rats in each group. A full-thickness skin

Evaluation of antibiotic susceptibility in wound infections: A pilot study from Bangladesh [version 1; referees: 2 approved

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Sushmita Roy

2017-12-01

Full Text Available Introduction: Infections due to antibiotic resistant bacteria have increased alarmingly in both developed and developing countries. Unrestrained and rapidly spreading bacterial growth has turned the management of wound infections into a serious challenge. This study aimed to determine the prevalence of different bacterial pathogens and their antibiotic susceptibility in various types of wound infections. Methods:  A cross-sectional study was conducted to collect 105 wound swabs. All isolated bacteria were identified based on colony characteristics, gram stain and standard biochemical tests, and antibiotic susceptibility testing (AST with the disc diffusion method. Descriptive statistics were used to present the study findings, and all analyses were performed using Stata Version 13. Results:  The rate of isolation of bacteria was 92.3%. Staphylococcus aureus was found to be the most frequent isolate (55.7%, followed by Escherichia coli (23.7%, Pseudomonas spp. (8.2%, and Streptococcus pyogenes (7.2%. Gram-positive bacteria were mostly (60% found sensitive to vancomycin, azithromycin, gentamicin, imipenem, cefixime, and ceftriaxone in this study. Among the Gram-negative bacteria, Escherichia coli (>60% showed sensitivity to cefixime, azithromycin, cefuroxime, ceftriaxone, cefotaxime, gentamycin, and ceftazidime. Conclusions: The diversity of isolated bacteria and their susceptibility patterns signify a need to implement a proper infection control strategy, which can be achieved by carrying out antibiotic sensitivity tests of the isolates.

Improved results of the vacuum assisted closure and Nitinol clips sternal closure after postoperative deep sternal wound infection.

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Tocco, Maria Pia; Costantino, Alberto; Ballardini, Milva; D'Andrea, Claudio; Masala, Marcello; Merico, Eusebio; Mosillo, Luigi; Sordini, Paolo

2009-05-01

Postoperative deep sternal wound infection is a severe complication of cardiac surgery, with a high mortality rate and a high morbidity rate. The objective of this prospective study is to report our experience with the vacuum assisted closure (VAC) system for the management of deep wound infection. We also devised an innovative closure technique post VAC therapy using thermo reactive clips. The advantage of this technique is that the posterior face of the sternum does not have to be separated from the mediastinal structures thus minimising the risk of damage. From October 2006 to October 2008, we prospectively evaluated 21 patients affected by mediastinitis after sternotomy. Nineteen patients had sternotomy for coronary artery bypass grafting (CABG), one patient for aortic valve replacement (AVR) and another one for ascending aortic replacement (AAR). All patients were treated with the VAC system at the time of infection diagnosis. When the wound tissue appeared viable and the microbiological cultures were negative, the chest was closed using the most suitable procedure for the patient in question; nine patients were closed using pectoralis flaps, nine patients using Nitinol clips, one patient with a combined technique (use of Nitinol clips and muscle flap), one patient with a direct wound closure and another patient, who needed AAR with a homograft performed in another institution, was closed using sternal wires. We had no mortality; wound healing was successfully achieved in all patients. In more than 50% of the patients, the VAC therapy allowed direct sternal resynthesis. The average duration of the vacuum therapy was 26 days (range 14-37 days). VAC is a safe and effective option in the treatment of post-sternotomy mediastinitis, with excellent survival and immediate improvement of local wound conditions; furthermore, the use of Nitinol clips after VAC therapy demonstrated to be a safe and non-invasive option for sternal resynthesis. After VAC therapy, a

Morphological analysis of three wound-cleaning processes on potentially contamined wounds in rats

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d'Acampora Armando José

2006-01-01

Full Text Available PURPOSE: To evaluate the inflammatory response of potentially infected wounds treated with isotonic saline solution, chlorhexidine and PVP-I, seven days after surgery. METHODS: Thirty-two male rats were used, divided into 4 groups. All animals had their surgical wounds infected with a standard bacterial inoculum. Control group (A: animals had their surgical wounds sutured without any kind of cleaning. Saline solution group (B: animals had their wounds cleaned with saline solution. Chlorhexidine group (C: animals had their wounds cleaned with chlorhexidine. PVP-I group (D: animals had their wounds cleaned with PVP-I. Seven days after surgery, all the animals had their skin submitted to microscopic and macroscopic evaluation. RESULTS: Edema was found on all histological slices analyzed, as well as vascular proliferation and congestion. Groups A and D showed presence of mild neutrophilic infiltrate, and moderate lymphocytic and macrophage infiltrate. Group B showed severe neutrophilic, macrophage, and lymphocytic infiltrate. Group C showed moderate neutrophilic, macrophage, and lymphocytic infiltrate. CONCLUSION: Group D was the group which showed inflammatory infiltrate most similar to the group that was not submitted to treatment.

Incisional Negative Pressure Wound Therapy

DEFF Research Database (Denmark)

Hyldig, Nana; Birke-Sorensen, Hanne; Kruse, Marie

and meta-analysis of randomized controlled trials of NPWT compared to standard postoperative dressings on closed incisions. Results: Ten studies met the inclusion criteria, reporting on 1344 incisions (1121 patients). NPWT was associated with a significant reduction of wound infection (46%), and seroma...... formation (52%) compared to standard care. The reduction in wound dehiscence was not statistically significant. The numbers needed to treat were 3 (seroma), 17 (dehiscence), and 25 (infection). Methodical heterogeneity across studies led to downgrading quality of evidence to moderate for infection...

Recent advances in topical wound care

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Sujata Sarabahi

2012-01-01

Full Text Available There are a wide variety of dressing techniques and materials available for management of both acute wounds and chronic non-healing wounds. The primary objective in both the cases is to achieve a healed closed wound. However, in a chronic wound the dressing may be required for preparing the wound bed for further operative procedures such as skin grafting. An ideal dressing material should not only accelerate wound healing but also reduce loss of protein, electrolytes and fluid from the wound, and help to minimize pain and infection. The present dictum is to promote the concept of moist wound healing. This is in sharp contrast to the earlier practice of exposure method of wound management wherein the wound was allowed to dry. It can be quite a challenge for any physician to choose an appropriate dressing material when faced with a wound. Since wound care is undergoing a constant change and new products are being introduced into the market frequently, one needs to keep abreast of their effect on wound healing. This article emphasizes on the importance of assessment of the wound bed, the amount of drainage, depth of damage, presence of infection and location of wound. These characteristics will help any clinician decide on which product to use and where,in order to get optimal wound healing. However, there are no ′magical dressings′. Dressings are one important aspect that promotes wound healing apart from treating the underlying cause and other supportive measures like nutrition and systemic antibiotics need to be given equal attention.

Early versus delayed dressing removal after primary closure of clean and clean-contaminated surgical wounds.

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Toon, Clare D; Lusuku, Charnelle; Ramamoorthy, Rajarajan; Davidson, Brian R; Gurusamy, Kurinchi Selvan

2015-09-03

early versus delayed dressing removal. We excluded trials that included people with contaminated or dirty wounds. We also excluded quasi-randomised studies, and other study designs. Two review authors independently extracted data on the characteristics of the trial participants, risk of bias in the trials and outcomes for each trial. We calculated risk ratios (RR) with 95% confidence intervals (CI) for binary outcomes and mean difference (MD) with 95% CI for continuous outcomes. We used RevMan 5 software to perform these calculations. Four trials were identified for inclusion in this review. All the trials were at high risk of bias. Three trials provided information for this review. Overall, this review included 280 people undergoing planned surgery. Participants were randomised to early dressing removal (removal of the wound dressing within the 48 hours following surgery) (n = 140) or delayed dressing removal (continued dressing of the wound beyond 48 hours) (n = 140) in the three trials. There were no statistically significant differences between the early dressing removal group and delayed dressing removal group in the proportion of people who developed superficial surgical site infection within 30 days (RR 0.64; 95% CI 0.32 to 1.28), superficial wound dehiscence within 30 days (RR 2.00; 95% CI 0.19 to 21.16) or serious adverse events within 30 days (RR 0.83; 95% CI 0.28 to 2.51). No deep wound infection or deep wound dehiscence occurred in any of the participants in the trials that reported this outcome. None of the trials reported quality of life. The hospital stay was significantly shorter (MD -2.00 days; 95% CI -2.82 to -1.18) and the total cost of treatment significantly less (MD EUR -36.00; 95% CI -59.81 to -12.19) in the early dressing removal group than in the delayed dressing removal group in the only trial that reported these outcomes. The early removal of dressings from clean or clean contaminated surgical wounds appears to have no detrimental effect on

Hyperbaric oxygen and wound healing

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Sourabh Bhutani

2012-01-01

Full Text Available Hyperbaric oxygen therapy (HBOT is the use of 100% oxygen at pressures greater than atmospheric pressure. Today several approved applications and indications exist for HBOT. HBOT has been successfully used as adjunctive therapy for wound healing. Non-healing wounds such as diabetic and vascular insufficiency ulcers have been one major area of study for hyperbaric physicians where use of HBOT as an adjunct has been approved for use by way of various studies and trials. HBOT is also indicated for infected wounds like clostridial myonecrosis, necrotising soft tissue infections, Fournier′s gangrene, as also for traumatic wounds, crush injury, compartment syndrome, compromised skin grafts and flaps and thermal burns. Another major area of application of HBOT is radiation-induced wounds, specifically osteoradionecrosis of mandible, radiation cystitis and radiation proctitis. With the increase in availability of chambers across the country, and with increasing number of studies proving the benefits of adjunctive use for various kinds of wounds and other indications, HBOT should be considered in these situations as an essential part of the overall management strategy for the treating surgeon.

Biofilm inhibitory and eradicating activity of wound care products against Staphylococcus aureus and Staphylococcus epidermidis biofilms in an in vitro chronic wound model.

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Brackman, G; De Meyer, L; Nelis, H J; Coenye, T

2013-06-01

Although several factors contribute to wound healing, bacterial infections and the presence of biofilm can significantly affect healing. Despite that this clearly indicates that therapies should address biofilm in wounds, only few wound care products have been evaluated for their antibiofilm effect. For this reason, we developed a rapid quantification approach to investigate the efficacy of wound care products on wounds infected with Staphylococcus spp. An in vitro chronic wound infection model was used in which a fluorescent Staph. aureus strain was used to allow the rapid quantification of the bacterial burden after treatment. A good correlation was observed between the fluorescence signal and the bacterial counts. When evaluated in this model, several commonly used wound dressings and wound care products inhibited biofilm formation resulting in a decrease between one and seven log CFU per biofilm compared with biofilm formed in the absence of products. In contrast, most dressings only moderately affected mature biofilms. Our model allowed the rapid quantification of the bacterial burden after treatment. However, the efficacy of treatment varied between the different types of dressings and/or wound care products. Our model can be used to compare the efficacy of wound care products to inhibit biofilm formation and/or eradicate mature biofilms. In addition, the results indicate that treatment of infected wounds should be started as soon as possible and that novel products with more potent antibiofilm activity are needed. © 2013 The Society for Applied Microbiology.

Wound and Sural Nerve Complications of the Sinus Tarsi Approach for Calcaneus Fractures.

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Li, Shaoliang

2018-05-01

Background The purpose of this study was to evaluate the optimal timing and measures of the sinus tarsi approach for calcaneus fractures to avoid iatrogenic injury of the sural nerve and to assess for wound complications. A case series of 53 patients with calcaneus fractures treated by a single surgeon with the sinus tarsi approach was retrospectively analyzed. On the basis of the delay time from injury to surgery, patients were classified into 4 groups: immediate (0-3 days), early (4-6 days), intermediate (7-14 days), and late (14-18 days). All patients were followed for at least 1 year to observe wound conditions. The rate of wound complications and iatrogenic sural nerve injury was described. Incisions were classified into 2 groups: group A included patients with incisions extending posterior to the lateral malleolus, and group B included patients with incisions confined anterior to the lateral malleolus. The rates of nerve injury were compared between both groups. Forty-three patients with 52 Sanders type II fractures were included. The average time to surgery from injury was 8.8 days (range, 0-18 days). The overall postoperative rate of wound complications was 5.8% (3 of 52). In the immediate group, deep infections and wound necrosis were found in 2 of 8 fractures (25%). In the early group, 1 of 15 fractures developed superficial infection (6.7%). In the intermediate and late groups, no wound complication was identified. Iatrogenic sural nerve injury was recorded in 5 of 52 patients (9.6%). Group A had 33% (4 of 12) nerve injuries and group B had 2.5% (1 of 40) ( P = .009). In 70% of cases, a main branch of the sural nerve was directly under the incision. The sinus tarsi approach was generally effective and safe for calcaneus fractures. However, it was relatively risky to perform open reduction and internal fixation by the sinus tarsi approach within 6 days of injury. Because the sural nerve is in the vicinity of the approach, iatrogenic injury should be

A Genetic Approach to the Development of New Therapeutic Phages to Fight Pseudomonas Aeruginosa in Wound Infections

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Elena Pleteneva

2012-12-01

Full Text Available Pseudomonas aeruginosa is a frequent participant in wound infections. Emergence of multiple antibiotic resistant strains has created significant problems in the treatment of infected wounds. Phage therapy (PT has been proposed as a possible alternative approach. Infected wounds are the perfect place for PT applications, since the basic condition for PT is ensured; namely, the direct contact of bacteria and their viruses. Plenty of virulent (“lytic” and temperate (“lysogenic” bacteriophages are known in P. aeruginosa. However, the number of virulent phage species acceptable for PT and their mutability are limited. Besides, there are different deviations in the behavior of virulent (and temperate phages from their expected canonical models of development. We consider some examples of non-canonical phage-bacterium interactions and the possibility of their use in PT. In addition, some optimal approaches to the development of phage therapy will be discussed from the point of view of a biologist, considering the danger of phage-assisted horizontal gene transfer (HGT, and from the point of view of a surgeon who has accepted the Hippocrates Oath to cure patients by all possible means. It is also time now to discuss the possible approaches in international cooperation for the development of PT. We think it would be advantageous to make phage therapy a kind of personalized medicine.

Wound Drainage Culture (For Parents)

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... Fitness Diseases & Conditions Infections Drugs & Alcohol School & Jobs Sports Expert Answers (Q&A) Staying Safe Videos for Educators Search English Español Wound Drainage Culture KidsHealth / For Parents / Wound Drainage Culture What's in ...

Vacuum-assisted closure for open perineal wound after abdominoperineal resection.

Science.gov (United States)

Fujino, Shiki; Miyoshi, Norikatsu; Ohue, Masayuki; Noura, Shingo; Fujiwara, Yoshiyuki; Yano, Masahiko; Higashiyama, Masahiko; Sakon, Masato

2015-01-01

In colorectal cancer surgery, surgical site infection (SSI) is a common complication, and especially, perineal wound complications after abdominoperineal resection (APR) remain to be serious clinical problems. Vacuum-assisted closure (VAC) therapy was first reported in another surgical field in 1997, and it is useful for treating complex wounds because it promotes granulation. VAC therapy has been recently used for open abdominal wounds. We introduced VAC for treating open perineal wound of APR and report the usefulness of it. We treated four patients. Firstly, in cases 1 and 2, we introduced VAC therapy to the management of SSI of the perineal wound after APR, and it was useful to control postoperative perineal wound infection. And also, in cases 3 and 4, we introduced VAC therapy to prevent perineal wound infection. Perineal wound infection did not happen. A vertical rectus abdominis myocutaneous flap has been reported to decrease perineal wound complications including pelvic abscess and open perineal wound; however it results in significant operative blood loss, increased operative time, and additional surgical complications. In our cases, there were no complications relating to VAC therapy and it promoted rapid wound healing. Our results suggested that it is an effective treatment for APR in a high-risk case of an open perineal wound. VAC therapy is a less invasive method and a useful treatment for open perineal wound of APR. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Burn wound: Pathophysiology and its management by herbal plants

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Dhirender Kaushik

2013-01-01

Full Text Available In human body, wound healing is a normal biological phenomenon. Burns may be acute or chronic depending upon the source and its time of exposure. Burn wounds may be superficial, partial or full thickness wounds. When skin comes in contact with higher temperature, protein denaturation takes place due to which the plasma membrane integrity is lost. When skin is burned, a number of inflammatory mediators and releasing agents such as histamine, nitric oxide, oxygen free radicals, eicosanoid products, tumor necrosis factors, and interleukins etc., are released at the site. For wound healing mechanism, the keratinocytes has to move from uninjured site to the burned area. For deeper burns this process takes a long time. By some unknown mechanisms, burn wounds may convert from one form to another form. So burn wound depth must be accurately measured before starting the treatment to prevent the complications. Burns can be induced in experimental animals by using different models. Many treatments such as herbal drugs, topical agents, gene therapy, volume therapy, and rehabilitation can be employed. This review article mainly deals with the theoretical and practical aspects of burn wound healing. Some burn wound healing plants with their chemical constituents, plant part used, uses and animal models are described here.

Association between elevated pre-operative glycosylated hemoglobin and post-operative infections after non-emergent surgery.

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Blankush, Joseph M; Leitman, I Michael; Soleiman, Aron; Tran, Trung

2016-09-01

A chronic state of impaired glucose metabolism affects multiple components of the immune system, possibly leading to an increased incidence of post-operative infections. Such infections increase morbidity, length of stay, and overall cost. This study evaluates the correlation between elevated pre-operative glycosylated hemoglobin (HbA1c) and post-operative infections. Adult patients undergoing non-emergent procedures across all surgical subspecialties from January 2010 to July 2014 had a preoperative HbA1c measured as part of their routine pre-surgical assessment. 2200 patient charts (1100 operative infection (superficial surgical site infection, deep wound/surgical space abscess, pneumonia, and/or urinary tract infection as defined by Centers for Disease Control criteria) within 30 days of surgery. Patients with HbA1c infection rate (3.8% in the HbA1c infection. Elevated HbA1c was, however, predictive of significantly increased risk of post-operative infection when associated with increased age (≥81 years of age) or dirty wounds. The risk factors of post-operative infection are multiple and likely synergistic. While pre-operative HbA1c level is not independently associated with risk of post-operative infection, there are scenarios and patient subgroups where pre-operative HbA1c is useful in predicting an increased risk of infectious complications in the post-operative period.

Biofilm Production in Carbapenem Resistant Isolates from Chronic Wound Infections

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Swarna SR

2017-02-01

Full Text Available Biofilms are communities of microorganisms covered with extracellular polymeric substances. Such biofilm phenotype makes the microorganism resistant to antibiotics and plays a role in wound chronicity. This results in prolonged hospital stays in ICU, greater cost, and increased mortality. Methods: Pus swabs (59 were collected from a tertiary care hospital near Chennai were processed and identified using standard procedure followed by antibiotic susceptibility testing and identification of carbapenem resistance by Modified Hodge test as per CLSI guidelines. The biofilm formation was tested using plastic microtiter plate method. Results: Out of 59 pus swabs, 51 yielded growth with 69 isolates and 8 yielded no growth. Among the 69 isolates, 51 were GNB and 18 were GPC. Biofilm detection was noted in 84.31% (43/51 GNB isolates with 0.1% crystal violet whereas 100% (51/51 showed biofilm positive with 0.1% safranin. About 74.50% (38/51 isolates of GNB were carbapenem resistant by screening with disk diffusion method. Only 24% (6/25 of GNB isolates among Enterobacteriaceae were positive by Modified Hodge test method. Conclusion: The result shows the association of biofilm production among carbapenem resistant isolates obtained from chronic wound infections.

A systematic review and meta-analysis on the use of prophylactic topical antibiotics for the prevention of uncomplicated wound infections

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Tong Q

2018-03-01

Full Text Available Qiao-Jing Tong,1 Kimberly DP Hammer,2,3 Erika M Johnson,4 Milagros Zegarra,2,3 Michihiko Goto,5,6 Tze Shien Lo3,7 1Department of Infection Control, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China; 2Research Service, Fargo VA Health Care System; 3Department of Internal Medicine, University of North Dakota, School of Medicine and Health Sciences, Fargo, ND, USA; 4Library Resources, University of North Dakota, School of Medicine and Health Sciences, Fargo, ND, USA; 5Center for Comprehensive Access & Delivery Research & Evaluation (CADRE, Iowa City VA Health Care System, West Iowa City, IA, USA; 6Department of Internal Medicine, University of Iowa, Carver College of Medicine, Iowa City, IA, USA; 7Infectious Disease Service, Fargo VA Health Care System, Fargo, ND, USA Background: The prescription of topical antibiotics for the prevention of infections in uncomplicated wounds is common. However, the efficacy is not well reported. Therefore, the objective of the study was to conduct a systematic review and meta-analysis of the available evidence on prevention of uncomplicated wound infections by prophylactic topical antibiotics. Materials and methods: The search included Pubmed, Google Scholar, SCOPUS, Embase, Cochrane, ClinicalTrials.gov, International Clinical Trials Registry Platform, National Technical Information Service, and the National Guidelines Clearinghouse. Results: We identified eight randomized controlled trials and four quasi-randomized trials that met the criteria for the systematic review. Of these trials, 11 studies were pooled for meta-analysis to compare the effects of topical antibiotics versus placebo and 4 studies were pooled for comparison of effects of topical antibiotics versus topical antiseptics on uncomplicated wounds. Fewer wound infections occurred in the topical antibiotic arms compared to placebo (pooled risk ratio: 0.57 [95% CI: 0.37 to 0.86]; p=0.01 and pooled risk

Antibacterial and Antifungal Potential of Himalayan Medicinal Plants for Treating Wound Infections

International Nuclear Information System (INIS)

Habiba, U.; Ahmad, M.; Shinwari, S.; Sultana, S.; Zafar, M.; Shinwari, Z. K.

2016-01-01

Many bacterial and fungal strains are involved in wound infectious diseases as most of these strains become resistant to the most commonly used synthetic drugs in Himalayan region. Plant based natural products seem to be an alternative to this problem. The aim of this investigation was to evaluate the In vitro antibacterial and antifungal activities of 30 medicinal plants used in folk recipes by Himalayan people to treat wound infections against multi-drug resistant pathogens. In total of six medically important Myco-bacterial strains Streptococcus pyogenes, Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa, Candida albicans and Aspergillus niger were tested against methanolic plant extracts at 5 mg/ml concentration using agar disc well diffusion method to determined Minimum inhibitory concentrations (MICs). The plant extracts showed varied levels of MICs against test microorganisms. The strongest antibacterial activity was reported in methanolic extract of Cynadon dactylon (L.) Pers. against Klebsiella pneumoniae with 20.67±1.36 mm MICs, while Candida albicans was considered to be the most resistant pathogen with MICs 9.6±0.57 mm. The findings were compared with results obtained using standard antibiotics, aminooxanilic, ciprofloxacin, cefotaxime, fluconazole and itraconazole at conc. 5mg/ ml. The results provide an evidence of folk medicinal uses of plants among the Himalayan communities to treat wounds. Further research needs to be carried out to identify the active molecules and evaluate the in vivo antibacterial and antifungal activities as well as toxicity level with clinical trials to use full potential of these plants for drug discovery development to control wounds globally. (author)

In vivo high-resolution 3D photoacoustic imaging of superficial vascular anatomy

International Nuclear Information System (INIS)

Zhang, E Z; Laufer, J G; Beard, P C; Pedley, R B

2009-01-01

The application of a photoacoustic imaging instrument based upon a Fabry-Perot polymer film ultrasound sensor to imaging the superficial vasculature is described. This approach provides a backward mode-sensing configuration that has the potential to overcome the limitations of current piezoelectric based detection systems used in superficial photoacoustic imaging. The system has been evaluated by obtaining non-invasive images of the vasculature in human and mouse skin as well as mouse models of human colorectal tumours. These studies showed that the system can provide high-resolution 3D images of vascular structures to depths of up to 5 mm. It is considered that this type of instrument may find a role in the clinical assessment of conditions characterized by changes in the vasculature such as skin tumours and superficial soft tissue damage due to burns, wounds or ulceration. It may also find application in the characterization of small animal cancer models where it is important to follow the tumour vasculature over time in order to study its development and/or response to therapy.

In vivo high-resolution 3D photoacoustic imaging of superficial vascular anatomy

Energy Technology Data Exchange (ETDEWEB)

Zhang, E Z; Laufer, J G; Beard, P C [Department of Medical Physics and Bioengineering, University College London, Gower Street, London, WC1E 6BT (United Kingdom); Pedley, R B [UCL Cancer Institute, Paul O' Gorman Building, University College London, 72 Huntley St, London WC1E 6BT (United Kingdom)

2009-02-21

The application of a photoacoustic imaging instrument based upon a Fabry-Perot polymer film ultrasound sensor to imaging the superficial vasculature is described. This approach provides a backward mode-sensing configuration that has the potential to overcome the limitations of current piezoelectric based detection systems used in superficial photoacoustic imaging. The system has been evaluated by obtaining non-invasive images of the vasculature in human and mouse skin as well as mouse models of human colorectal tumours. These studies showed that the system can provide high-resolution 3D images of vascular structures to depths of up to 5 mm. It is considered that this type of instrument may find a role in the clinical assessment of conditions characterized by changes in the vasculature such as skin tumours and superficial soft tissue damage due to burns, wounds or ulceration. It may also find application in the characterization of small animal cancer models where it is important to follow the tumour vasculature over time in order to study its development and/or response to therapy.

Stimulation of wound healing by helium atmospheric pressure plasma treatment

International Nuclear Information System (INIS)

Nastuta, Andrei Vasile; Topala, Ionut; Pohoata, Valentin; Popa, Gheorghe; Grigoras, Constantin

2011-01-01

New experiments using atmospheric pressure plasma have found large application in treatment of living cells or tissues, wound healing, cancerous cell apoptosis, blood coagulation on wounds, bone tissue modification, sterilization and decontamination. In this study an atmospheric pressure plasma jet generated using a cylindrical dielectric-barrier discharge was applied for treatment of burned wounds on Wistar rats' skin. The low temperature plasma jet works in helium and is driven by high voltage pulses. Oxygen and nitrogen based impurities are identified in the jet by emission spectroscopy. This paper analyses the natural epithelization of the rats' skin wounds and two methods of assisted epithelization, a classical one using polyurethane wound dressing and a new one using daily atmospheric pressure plasma treatment of wounds. Systemic and local medical data, such as haematological, biochemical and histological parameters, were monitored during entire period of study. Increased oxidative stress was observed for plasma treated wound. This result can be related to the presence in the plasma volume of active species, such as O and OH radicals. Both methods, wound dressing and plasma-assisted epithelization, provided positive medical results related to the recovery process of burned wounds. The dynamics of the skin regeneration process was modified: the epidermis re-epitelization was accelerated, while the recovery of superficial dermis was slowed down.

Antibacterial activity of extracts from five medicinal plants and their formula against bacteria that cause chronic wound infection.

Science.gov (United States)

Temrangsee, Pornthep; Kondo, Sumalee; Itharat, Arunporn

2011-12-01

Chronic wound is caused by various factors such as chemotherapy, gene damage, treatment with steroids, diabetes mellitus, renal failure, blood pressure, infection and nutritional factors. One of the most common causes is bacterial infection. Antibacterial activity of several herbal plants has been reported. Thai medicinal plants which possess biological activities are potential to develop an alternative treatment of bacterial infection. To study efficiency of extracts from medicinal plants and their formula against bacteria that cause chronic wound infection. Extraction of Thai medicinal plants including Curcuma longa Linn, Rhinacanthus nasutus Linn, Garcinia mangostana Linn, Caesalpinia sappan Linn and Centellia asiatica Linn was performed by maceration with 95% ethanol and decoction followed by freeze dry. Formulation was conducted by varying the ratio of each components. Antibacterial activity were determined disk diffusion and broth dilution against Staphylococcus aureus, Methicillin-resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa, Acinetobacter baumanii, Escherichia coli and Klebsiella pneumoniae. Ethanolic extracts exhibited better antibacterial activity against tested strains than water extracts. Antibacterial activity of Caesalpinia sappan Linn. against S. aureus and MRSA showed the most effective with MIC value of 0.625 mg/ml. One of the five different formulas which contained two times proportion of C. sappan revealed that this formula was able to inhibit all tested strains with the MIC ranging between 0.156 mg/ml and 10 mg/ml. C. sappan is the most effective herbal plant. The formula with two times proportion of C. sappan is potentially best formula for development of medicinal product of chronic wound infection. The potential active compound of C. sappan is suggested for further investigation of antimicrobial activity and other biological properties.

Prevention of abdominal wound infection (PROUD trial, DRKS00000390: study protocol for a randomized controlled trial

Directory of Open Access Journals (Sweden)

Heger Ulrike

2011-11-01

Full Text Available Abstract Background Wound infection affects a considerable portion of patients after abdominal operations, increasing health care costs and postoperative morbidity and affecting quality of life. Antibacterial coating has been suggested as an effective measure to decrease postoperative wound infections after laparotomies. The INLINE metaanalysis has recently shown the superiority of a slowly absorbable continuous suture for abdominal closure; with PDS plus® such a suture has now been made available with triclosan antibacterial coating. Methods/Design The PROUD trial is designed as a randomised, controlled, observer, surgeon and patient blinded multicenter superiority trial with two parallel groups and a primary endpoint of wound infection during 30 days after surgery. The intervention group will receive triclosan coated polydioxanone sutures, whereas the control group will receive the standard polydioxanone sutures; abdominal closure will otherwise be standardized in both groups. Statistical analysis is based on intention-to-treat population via binary logistic regression analysis, the total sample size of n = 750 is sufficient to ensure alpha = 5% and power = 80%, an interim analysis will be carried out after data of 375 patients are available. Discussion The PROUD trial will yield robust data to determine the effectiveness of antibacterial coating in one of the standard sutures for abdominal closure and potentially lead to amendment of current guidelines. The exploration of clinically objective parameters as well as quality of life holds immediate relevance for clinical management and the pragmatic trial design ensures high external validity. Trial Registration The trial protocol has been registered with the German Clinical Trials Register (DRKS00000390.

Factors Affecting Wound Healing

Science.gov (United States)

Guo, S.; DiPietro, L.A.

2010-01-01

Wound healing, as a normal biological process in the human body, is achieved through four precisely and highly programmed phases: hemostasis, inflammation, proliferation, and remodeling. For a wound to heal successfully, all four phases must occur in the proper sequence and time frame. Many factors can interfere with one or more phases of this process, thus causing improper or impaired wound healing. This article reviews the recent literature on the most significant factors that affect cutaneous wound healing and the potential cellular and/or molecular mechanisms involved. The factors discussed include oxygenation, infection, age and sex hormones, stress, diabetes, obesity, medications, alcoholism, smoking, and nutrition. A better understanding of the influence of these factors on repair may lead to therapeutics that improve wound healing and resolve impaired wounds. PMID:20139336

Primary closure versus non-closure of dog bite wounds. a randomised controlled trial.

Science.gov (United States)

Paschos, Nikolaos K; Makris, Eleftherios A; Gantsos, Apostolos; Georgoulis, Anastasios D

2014-01-01

Dog bite wounds represent a major health problem. Despite their importance, their management and especially the role of primary closure remain controversial. In this randomised controlled trial, the outcome between primary suturing and non-closure was compared. 168 consecutive patients with dog bite injuries were included in this study. The wounds were allocated randomly in two treatment approaches: Group 1, consisting of eighty-two patients, had their wound sutured, whilst Group 2, consisting of eighty-six patients, did not have their wounds sutured. All wounds were cleansed using high-pressure irrigation and povidone iodine. All patients received the same type of antibiotic treatment. Our measured outcomes included presence of infection and cosmetic appearance. Cosmetic outcome was evaluated using the Vancouver Scar Scale (VSS). Wound and patient characteristics, such as time of management, wound location and size, and patient age, were recorded and analysed for their potential role in the resulting outcome. The overall infection rate was 8.3%. No difference in the infection rate between primary suturing and non-suturing group was detected in the present study. The cosmetic appearance of the sutured wounds was significantly better (mean score 1.74) compared to the wounds that were left open (mean score 3.05) (p=0.0001). The infection rate was comparable among all age groups. Wounds treated within 8h of injury demonstrated an infection rate of 4.5%, which is lower compared to the 22.2% rate observed in wounds treated later than 8h. The wounds located at the head and neck exhibited better results in both infection rate and cosmetic outcome. Additionally, wounds >3 cm negatively affected the cosmetic appearance of the outcome. Primary suturing of wounds caused by dog bites resulted in similar infection rate compared to non-suturing. However, primary suturing exhibited improved cosmetic appearance. Time of management appeared to be critical, as early treatment

Predicting complex acute wound healing in patients from a wound expertise centre registry: a prognostic study.

Science.gov (United States)

Ubbink, Dirk T; Lindeboom, Robert; Eskes, Anne M; Brull, Huub; Legemate, Dink A; Vermeulen, Hester

2015-10-01

It is important for caregivers and patients to know which wounds are at risk of prolonged wound healing to enable timely communication and treatment. Available prognostic models predict wound healing in chronic ulcers, but not in acute wounds, that is, originating after trauma or surgery. We developed a model to detect which factors can predict (prolonged) healing of complex acute wounds in patients treated in a large wound expertise centre (WEC). Using Cox and linear regression analyses, we determined which patient- and wound-related characteristics best predict time to complete wound healing and derived a prediction formula to estimate how long this may take. We selected 563 patients with acute wounds, documented in the WEC registry between 2007 and 2012. Wounds had existed for a median of 19 days (range 6-46 days). The majority of these were located on the leg (52%). Five significant independent predictors of prolonged wound healing were identified: wound location on the trunk [hazard ratio (HR) 0·565, 95% confidence interval (CI) 0·405-0·788; P = 0·001], wound infection (HR 0·728, 95% CI 0·534-0·991; P = 0·044), wound size (HR 0·993, 95% CI 0·988-0·997; P = 0·001), wound duration (HR 0·998, 95% CI 0·996-0·999; P = 0·005) and patient's age (HR 1·009, 95% CI 1·001-1·018; P = 0·020), but not diabetes. Awareness of the five factors predicting the healing of complex acute wounds, particularly wound infection and location on the trunk, may help caregivers to predict wound healing time and to detect, refer and focus on patients who need additional attention. © 2013 The Authors. International Wound Journal © 2013 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

Partial Denervation of Subbasal Axons Persists Following Debridement Wounds to the Mouse Cornea

Science.gov (United States)

Pajoohesh-Ganji, Ahdeah; Pal-Ghosh, Sonali; Tadvalkar, Gauri; Kyne, Briana M.; Saban, Daniel R.; Stepp, Mary Ann

2015-01-01

Although sensory reinnervation occurs after injury in the PNS, poor reinnervation in the elderly and those with diabetes often leads to pathology. Here we quantify subbasal axon density in the central and peripheral mouse cornea over time after three different types of injury. The mouse cornea is highly innervated with a dense array of subbasal nerves that form a spiral called the vortex at the corneal center or apex; these nerves are readily detected within flat mounted corneas. After anesthesia, corneal epithelial cells were removed using either a dulled blade or a rotating burr within an area demarcated centrally with a 1.5 mm trephine. A third wound type, superficial trephination, involved demarcating the area with the 1.5 mm trephine but not removing cells. By 7d after superficial trephination, subbasal axon density returns to control levels; by 28d the vortex reforms. Although axon density is similar to control 14d after dulled blade and rotating burr wounding, defects in axon morphology at the corneal apex remain. After 14d, axons retract from the center leaving the subbasal axon density reduced by 37.2% and 36.8% at 28d after dulled blade and rotating burr wounding, respectively, compared to control. Assessment of inflammation using flow cytometry shows that persistent inflammation is not a factor in the incomplete reinnervation. Expression of mRNAs encoding 22 regeneration associated genes (RAGs) involved in axon targeting assessed by QPCR reveals that netrin-1 and ephrin signaling are altered after wounding. Subpopulations of corneal epithelial basal cells at the corneal apex stop expressing ki67 as early as 7d after injury and by 14d and 28d after wounding, many of these basal cells undergo apoptosis and die. While subbasal axons are restored to their normal density and morphology after superficial trephination, subbasal axon recovery is partial after debridement wounds. The increase in corneal epithelial basal cell apoptosis at the apex observed at 14d

Risk factors associated with acquiring superficial fungal infections in ...

African Journals Online (AJOL)

extensively documented. It is therefore imperative to identify the factors that predispose to the development of SFI so as to provide evidence-based and effective pre- ventive measures, thus reducing the prevalence and the attendant morbidity associated with superficial fungal in- fections and this was our aim in this present ...

Evaluation of fungicides to protect pruning wounds from Botryosphaeriaceae species infections on almond trees

Directory of Open Access Journals (Sweden)

Diego OLMO

2017-05-01

Full Text Available In vitro efficacy of ten fungicides was evaluated against four Botryosphaeriaceae spp. (Diplodia seriata, Neofusicoccum luteum, N. mediterraneum and N. parvum associated with branch cankers on almond trees. Cyproconazole, pyraclostrobin, tebuconazole, and thiophanate-methyl were effective for the inhibition of mycelial growth of most of these fungi. An experiment on 3-year-old almond trees evaluated boscalid, mancozeb, thiophanate-methyl, pyraclostrobin and tebuconazole for preventative ability against infections caused by the four pathogens. Five months after pruning and fungicide application, lesion length measurements and isolation percentages showed no significant differences among the four pathogens after they were inoculated onto the trees, and also between the two inoculation times tested (1 or 7 d after fungicide application. Thiophanate-methyl was the most effective fungicide, resulting in the shortest lesion lengths and the lowest isolation percentages from artificially inoculated pruning wounds. This chemical is therefore a candidate for inclusion in integrated disease management, to protect pruning wounds from infections caused by species of Botryosphaeriaceae. This study represents the first approach to development of chemical control strategies for the management of canker diseases caused by Botryosphaeriaceae fungi on almond trees. 

Fungal Burn Wound Infection

Science.gov (United States)

1991-01-01

Aspergillus), Blasto- T he use of effective topical chemotherapeutic agents to myces (Candida), and Zygomycetes ( Mucor , Rhizopus).6 reduce...species, 18%; Mucor species and Rhizopus species, acetate in the morning and silver sulfadiazine in the evening. Prophy- 9.1%; and Microspora species and...sensitivity reports, and the patient’s sue, including one patient who required a hip disarticulation response. to control an invasive Mucor burn wound

Current management of fungal infections.

NARCIS (Netherlands)

Meis, J.F.G.M.; Verweij, P.E.

2001-01-01

The management of superficial fungal infections differs significantly from the management of systemic fungal infections. Most superficial infections are treated with topical antifungal agents, the choice of agent being determined by the site and extent of the infection and by the causative organism,

Pseudomonas aeruginosa uses T3SS to inhibit diabetic wound healing.

Science.gov (United States)

Goldufsky, Josef; Wood, Stephen J; Jayaraman, Vijayakumar; Majdobeh, Omar; Chen, Lin; Qin, Shanshan; Zhang, Chunxiang; DiPietro, Luisa A; Shafikhani, Sasha H

2015-01-01

Diabetic foot ulcers are responsible for more hospitalizations than any other complication of diabetes. Bacterial infection is recognized as an important factor associated with impaired healing in diabetic ulcers. Pseudomonas aeruginosa is the most frequently detected Gram-negative pathogen in diabetic ulcers. P. aeruginosa infection has been shown to impair healing in diabetic wounds in a manner that correlates with its ability to form biofilm. While the majority of infections in diabetic ulcers are biofilm associated, 33% of infections are nonbiofilm in nature. P. aeruginosa is the most prevalent Gram-negative pathogen in all diabetic wound types, which suggests that the deleterious impact of P. aeruginosa on healing in diabetic wounds goes beyond its ability to form biofilm and likely involves other factors. The Type III Secretion System (T3SS) virulence structure is required for the pathogenesis of all P. aeruginosa clinical isolates, suggesting that it may also play a role in the inhibition of wound repair in diabetic skin ulcers. We evaluated the role of T3SS in mediating P. aeruginosa-induced tissue damage in the wounds of diabetic mice. Our data demonstrate that P. aeruginosa establishes a robust and persistent infection in diabetic wounds independent of its ability to form biofilm and causes severe wound damage in a manner that primarily depends on its T3SS. © 2015 by the Wound Healing Society.

The management of perineal wounds

Directory of Open Access Journals (Sweden)

Ramesh k Sharma

2012-01-01

Full Text Available Management of perineal wounds can be very frustrating as these invariably get contaminated from the ano-genital tracts. Moreover, the apparent skin defect may be associated with a significant three dimensional dead space in the pelvic region. Such wounds are likely to become chronic and recalcitrant if appropriate wound management is not instituted in a timely manner. These wounds usually result after tumor excision, following trauma or as a result of infective pathologies like hideradenitis suppurativa or following thermal burns. Many options are available for management of perineal wounds and these have been discussed with illustrative case examples. A review of literature has been done for listing commonly instituted options for management of the wounds in perineum.

Partial denervation of sub-basal axons persists following debridement wounds to the mouse cornea.

Science.gov (United States)

Pajoohesh-Ganji, Ahdeah; Pal-Ghosh, Sonali; Tadvalkar, Gauri; Kyne, Briana M; Saban, Daniel R; Stepp, Mary Ann

2015-11-01

Although sensory reinnervation occurs after injury in the peripheral nervous system, poor reinnervation in the elderly and those with diabetes often leads to pathology. Here we quantify sub-basal axon density in the central and peripheral mouse cornea over time after three different types of injury. The mouse cornea is highly innervated with a dense array of sub-basal nerves that form a spiral called the vortex at the corneal center or apex; these nerves are readily detected within flat mounted corneas. After anesthesia, corneal epithelial cells were removed using either a dulled blade or a rotating burr within an area demarcated centrally with a 1.5 mm trephine. A third wound type, superficial trephination, involved demarcating the area with the 1.5 mm trephine but not removing cells. By 7 days after superficial trephination, sub-basal axon density returns to control levels; by 28 days the vortex reforms. Although axon density is similar to control 14 days after dulled blade and rotating burr wounding, defects in axon morphology at the corneal apex remain. After 14 days, axons retract from the center leaving the sub-basal axon density reduced by 37.2 and 36.8% at 28 days after dulled blade and rotating burr wounding, respectively, compared with control. Assessment of inflammation using flow cytometry shows that persistent inflammation is not a factor in the incomplete reinnervation. Expression of mRNAs encoding 22 regeneration-associated genes involved in axon targeting assessed by QPCR reveals that netrin-1 and ephrin signaling are altered after wounding. Subpopulations of corneal epithelial basal cells at the corneal apex stop expressing ki67 as early as 7 days after injury and by 14 and 28 days after wounding, many of these basal cells undergo apoptosis and die. Although sub-basal axons are restored to their normal density and morphology after superficial trephination, sub-basal axon recovery is partial after debridement wounds. The increase in corneal

Pediatric burn wound impetigo after grafting.

Science.gov (United States)

Aikins, Kimberly; Prasad, Narayan; Menon, Seema; Harvey, John G; Holland, Andrew J A

2015-01-01

Modern burn care techniques have reduced the risk of infection of the acute burn wound, resulting in more rapid healing and a lower incidence of graft loss. Secondary breakdown may still occur. The loss of epithelium in association with multifocal superficial abscesses and ulceration has been termed burns impetigo. This may result in considerable morbidity and require prolonged treatment. The events preceding development, the impact on the patient, and the ideal treatment appear unclear and poorly reported. In 5 years, between 2006 and 2011, 406 pediatric burns were treated with skin grafts, with 7% developing burns impetigo. Time to resolution ranged from 5 to 241 days: the mean time to complete healing was greatest with conservative management (96 days), followed by antibacterial dressings (37 days), oral antibiotics (36 days), topical steroids (16 days), and oral antibiotics in combination with topical steroids (13.5 days). Burns impetigo resulted in significant morbidity, requiring multiple visits to the treatment center and prolonged symptoms. Delay in diagnosis and treatment resulted in worse outcomes. Prompt consideration of burns impetigo should occur when postgraft patients present with suggestive clinical signs and treatment with oral antibiotics plus topical steroids should be considered.

Chitosan preparations for wounds and burns: antimicrobial and wound-healing effects

Science.gov (United States)

Dai, Tianhong; Tanaka, Masamitsu; Huang, Ying-Ying; Hamblin, Michael R

2011-01-01

Since its discovery approximately 200 years ago, chitosan, as a cationic natural polymer, has been widely used as a topical dressing in wound management owing to its hemostatic, stimulation of healing, antimicrobial, nontoxic, biocompatible and biodegradable properties. This article covers the antimicrobial and wound-healing effects of chitosan, as well as its derivatives and complexes, and its use as a vehicle to deliver biopharmaceuticals, antimicrobials and growth factors into tissue. Studies covering applications of chitosan in wounds and burns can be classified into in vitro, animal and clinical studies. Chitosan preparations are classified into native chitosan, chitosan formulations, complexes and derivatives with other substances. Chitosan can be used to prevent or treat wound and burn infections not only because of its intrinsic antimicrobial properties, but also by virtue of its ability to deliver extrinsic antimicrobial agents to wounds and burns. It can also be used as a slow-release drug-delivery vehicle for growth factors to improve wound healing. The large number of publications in this area suggests that chitosan will continue to be an important agent in the management of wounds and burns. PMID:21810057

Penicillin-susceptible Staphylococcus aureus: susceptibility testing, resistance rates and outcome of infection.

Science.gov (United States)

Hagstrand Aldman, Malin; Skovby, Annette; I Påhlman, Lisa

2017-06-01

Staphylococcus aureus (SA) is an important human pathogen that causes both superficial and invasive infections. Penicillin is now rarely used in the treatment of SA infections due to widespread resistance and a concern about the accuracy of existing methods for penicillin susceptibility testing. The aims of the present study were to determine the frequency of penicillin-susceptible SA isolates from blood and wound cultures in Lund, Sweden, and to evaluate methods for penicillin testing in SA. We also wanted to investigate if penicillin-susceptible isolates are associated with higher mortality. Hundred blood culture isolates collected 2008/2009, 140 blood culture isolates from 2014/2015, and 141 superficial wound culture strains from 2015 were examined. Penicillin susceptibility was tested with disk diffusion according to EUCAST guidelines, and results were confirmed with a cloverleaf assay and PCR amplification of the BlaZ gene. Patient data for all bacteraemia cases were extracted from medical records. The disk diffusion method with assessment of both zone size and zone edge appearance had high accuracy in our study. About 57% of bacteraemia isolates from 2008/2009 were sensitive to penicillin compared to 29% in 2014/2015 (p penicillin susceptible. There was no difference in co-morbidity or mortality rates between patients with penicillin resistant and penicillin sensitive SA bacteraemia. Disk-diffusion is a simple and reliable method to detect penicillin resistance in SA, and susceptibility rates are significant. Penicillin has many theoretical advantages and should be considered in the treatment of SA bacteraemia when susceptible.

Wound infections after median sternotomy treated by VAC therapy, summary of results, and risk factor analysis.

Science.gov (United States)

Hulman, M; Bezak, B; Artemiou, P; Cikrai, R

2017-01-01

The aim of this study is to summarize results and analyze risk factors for the development of wound infection in heart surgery patients after median sternotomy. In this retrospective analysis with assessment of multiple risk factors, we examined 143 patients with infection after median sternotomy treated with VAC therapy from total of 4,650 patients operated in our department from 2012 to 2015. Total of 143 patients developed significant SSI treated by VAC therapy following cardiac surgery. Of these, only 14 patients developed DSWI and one patient was diagnosed with suspected osteomyelitis. BMI, female gender, and use of BIMA proved to be statistically significant risk factors in our study (p infection (p infection proved to be a significant prognostic factor for patients' outcome (p infection (Tab. 3, Ref. 30).

General concept of wound healing, revisited

Directory of Open Access Journals (Sweden)

Theddeus O.H. Prasetyono

2009-09-01

Full Text Available Wound healing is a transition of processes which is also recognized as one of the most complex processes in human physiology. Complex series of reactions and interactions among cells and mediators take place in the healing process of wound involving cellular and molecular events. The inflammatory phase is naturally intended to remove devitalized tissue and prevent invasive infection. The proliferative phase is characterized by the formation of granulation tissue within the wound bed, composed of new capillary network, fibroblast, and macrophages in a loose arrangement of supporting structure. This second phase lasts from day 8 to 21 after the injury is also the phase for epithelialisation. The natural period of proliferative phase is a reflection for us in treating wound to reach the goal which ultimately defines as closed wound. The final maturation phase is also characterized by the balancing between deposition of collagen and its degradation. There are at least three prerequisites which are ideal local conditions for the nature of wound to go on a normal process of healing i.e. 1 all tissue involved in the wound and surrounding should be vital, 2 no foreign bodies in the wound, and 3 free from excessive contamination/infection. The author formulated a step ladder of thinking in regards of healing intentions covering all acute and chronic wounds. Regarding the “hierarchy” of healing intention, the fi rst and ideal choice to heal wounds is by primary intention followed by tertiary intention and lastly the secondary intention. (Med J Indones 2009;18:206-14Key words: inflammatory mediator, epithelialisation, growth factor, wound healing

Evaluation of Novel Antimicrobial Peptides as Topical Anti-Infectives with Broad Spectrum Activity Against Combat-Related Bacterial and Fungal Wound Infections

Science.gov (United States)

2016-10-01

Inc. Vallejo, CA 94592 REPORT DATE: October 2016 TYPE OF REPORT: Annual PREPARED FOR: U.S. Army Medical Research and Materiel Command Fort...2016 2. REPORT TYPE Annual 3. DATES COVERED 30 Sep 2015 - 29 Sep 2016 4. TITLE AND SUBTITLE Evaluation of Novel Antimicrobial Peptides as Topical...antibiotics and early debridement has been associated with a large reduction in burn wound infections. Current topical antibiotics include

Antibiotic prophylaxis adequacy in knee arthroplasty and surgical wound infection: Prospective cohort study.

Science.gov (United States)

Del-Moral-Luque, J A; Checa-García, A; López-Hualda, Á; Villar-Del-Campo, M C; Martínez-Martín, J; Moreno-Coronas, F J; Montejo-Sancho, J; Rodríguez-Caravaca, G

Antibiotic prophylaxis is the most suitable tool for preventing surgical wound infection. This study evaluated adequacy of antibiotic prophylaxis in surgery for knee arthroplasty and its effect on surgical site infection. Prospective cohort study. We assessed the degree of adequacy of antibiotic prophylaxis, the causes of non-adequacy, and the effect of non-adequacy on surgical site infection. Incidence of surgical site infection was studied after a maximum incubation period of a year. To assess the effect of prophylaxis non-adequacy on surgical site infection we used the relative risk adjusted with the aid of a logistic regression model. The study covered a total of 1749 patients. Antibiotic prophylaxis was indicated in all patients and administered in 99.8% of cases, with an overall protocol adequacy of 77.6%. The principal cause of non-compliance was the duration of prescription of the antibiotics (46.5%). Cumulative incidence of surgical site infection was 1.43%. No relationship was found between prophylaxis adequacy and surgical infection (RR=1.15; 95% CI: .31-2.99) (P>.05). Surveillance and infection control programs enable risk factors of infection and improvement measures to be assessed. Monitoring infection rates enables us to reduce their incidence. Adequacy of antibiotic prophylaxis was high but could be improved. We did not find a relationship between prophylaxis adequacy and surgical site infection rate. Copyright © 2017 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

Disinfecting wounds with radiation

International Nuclear Information System (INIS)

Cuttler, J.M.

2002-01-01

Infection with clostridium bacteria, which live in the soil, is most often associated with war wounds, car accidents, complicated abortions, etc. The incidence is highest in areas with poor access to proper wound care. Such infections lead to gas gangrene, a deadly disease that spreads very quickly in the body and causes rapid death. Present-day treatment consists of administering antibiotics and surgical removal of dead, damaged and infected tissue. Amputation is usually necessary to control the spread of the infection, which can advance at the rate of six inches per hour. Before the 1940s, this disease was treated successfully with low doses (50 rad) of radiation (X-rays) in the area of infection. A review of 364 cases treated in this manner, from 1928 until 1940, indicated that patient mortality would be reduced from 50 percent (or higher) to ∼5 percent if patients were treated reasonably early and with the correct technique. X-ray therapy stopped the infection without the need for amputation to control its spread. Low-dose irradiation (LDI) therapy, given immediately, acted as a prophylaxis to prevent the onset of gas gangrene. This is but one example of the extensive use of radiation treatment of many types of infections, before the advent of antibiotics. Low doses are inadequate to kill invading bacteria directly, however, they will stimulate our defences to destroy the infection. The observed beneficial effects are consistent with the large amount of scientific evidence of radiation hormesis - the stimulation of an organism's own defences by low doses of radiation (to destroy invaders and heal wounds). In view of the ineffectiveness of antibiotics in many cases and the evolution of antibiotic-resistant strains of bacteria, physicians should start to use LDI therapies again. Many patients would benefit greatly. (author)

Risk factors for wound disruption following cesarean delivery.

Science.gov (United States)

Subramaniam, Akila; Jauk, Victoria C; Figueroa, Dana; Biggio, Joseph R; Owen, John; Tita, Alan T N

2014-08-01

Risk factors for post-cesarean wound infection, but not disruption, are well-described in the literature. The primary objective of this study was to identify risk factors for non-infectious post-cesarean wound disruption. Secondary analysis was conducted using data from a single-center randomized controlled trial of staple versus suture skin closure in women ≥24 weeks' gestation undergoing cesarean delivery. Wound disruption was defined as subcutaneous skin or fascial dehiscence excluding primary wound infections. Composite wound morbidity (disruption or infection) was examined as a secondary outcome. Patient demographics, medical co-morbidities, and intrapartum characteristics were evaluated as potential risk factors using multivariable logistic regression. Of the 398 randomized patients, 340, including 26 with disruptions (7.6%) met inclusion criteria and were analyzed. After multivariable adjustments, African-American race (aOR 3.9, 95% CI 1.1-13.8) and staple - as opposed to suture - wound closure (aOR 5.4, 95% CI 1.8-16.1) remained significant risk factors for disruption; non-significant increases were observed for body mass index ≥30 (aOR 2.1, 95% CI 0.6-7.5), but not for diabetes mellitus (aOR 0.9, 95% CI 0.3-2.9). RESULTS for composite wound morbidity were similar. Skin closure with staples, African-American race, and considering the relatively small sample size, potentially obesity are associated with increased risk of non-infectious post-cesarean wound disruption.

Bi-Layer Wound Dressing System for Combat Casualty Care

National Research Council Canada - National Science Library

Martineau, Lucie; Shek, Pang N

2004-01-01

.... Biopsies taken from full-thickness, pig wounds infected with Ps. aeruginosa and Staph. epidermidis showed a 2- to 5-log reduction in the bacterial load of antiseptic-treated wounds compared to those of control wounds...

Outbreak investigation for toxigenic Corynebacterium diphtheriae wound infections in refugees from Northeast Africa and Syria in Switzerland and Germany by whole genome sequencing.

Science.gov (United States)

Meinel, D M; Kuehl, R; Zbinden, R; Boskova, V; Garzoni, C; Fadini, D; Dolina, M; Blümel, B; Weibel, T; Tschudin-Sutter, S; Widmer, A F; Bielicki, J A; Dierig, A; Heininger, U; Konrad, R; Berger, A; Hinic, V; Goldenberger, D; Blaich, A; Stadler, T; Battegay, M; Sing, A; Egli, A

2016-12-01

Toxigenic Corynebacterium diphtheriae is an important and potentially fatal threat to patients and public health. During the current dramatic influx of refugees into Europe, our objective was to use whole genome sequencing for the characterization of a suspected outbreak of C. diphtheriae wound infections among refugees. After conventional culture, we identified C. diphtheriae using matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) and investigated toxigenicity by PCR. Whole genome sequencing was performed on a MiSeq Illumina with >70×coverage, 2×250 bp read length, and mapping against a reference genome. Twenty cases of cutaneous C. diphtheriae in refugees from East African countries and Syria identified between April and August 2015 were included. Patients presented with wound infections shortly after arrival in Switzerland and Germany. Toxin production was detected in 9/20 (45%) isolates. Whole genome sequencing-based typing revealed relatedness between isolates using neighbour-joining algorithms. We detected three separate clusters among epidemiologically related refugees. Although the isolates within a cluster showed strong relatedness, isolates differed by >50 nucleotide polymorphisms. Toxigenic C. diphtheriae associated wound infections are currently observed more frequently in Europe, due to refugees travelling under poor hygienic conditions. Close genetic relatedness of C. diphtheriae isolates from 20 refugees with wound infections indicates likely transmission between patients. However, the diversity within each cluster and phylogenetic time-tree analysis suggest that transmissions happened several months ago, most likely outside Europe. Whole genome sequencing offers the potential to describe outbreaks at very high resolution and is a helpful tool in infection tracking and identification of transmission routes. Copyright © 2016. Published by Elsevier Ltd.

Typhoid Intestinal Disease: Management of Patients With Multiple ...

African Journals Online (AJOL)

Seventeen patients had trimming of the ulcer edges and simple double layer closure, 2 had segmental resection and 8 had right hemicolectomy. The wounds of 5 patients healed primarily, 15 had superficial wound infection, 4 had wound dehiscence, 3 had faecal fistula. Three patients died as a result of late presentation ...

Intermittent negative pressure wound therapy with instillation for the treatment of persistent periprosthetic hip infections: a report of two cases

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Söylemez MS

2016-02-01

Full Text Available Mehmet Salih Söylemez,1 Korhan Özkan,2 Bülent Kılıç,3 Samet Erinç41Department of Orthopaedics and Traumatology, Bingöl State Hospital, Bingöl, 2Department of Orthopaedics and Traumatology, Faculty of Medicine, Medeniyet University, Istanbul, 3Department of Orthopaedics and Traumatology, Orthopaedic Surgery Clinic, Istanbul Gelişim University, Tekirdağ, 4Department of Orthopaedics and Traumatology, Istanbul Medeniyet University, Göztepe Training and Research Hospital, Istanbul, TurkeyAbstract: Intermittent negative pressure wound therapy with instillation (NPWTi is starting to be used successfully to treat early periprosthetic infections of endoprostheses. However, few articles have reported the outcome of treatment with intermittent NPWTi for late persistent periprosthetic infections of the hip. In this study, we report two cases who underwent several rounds of radical wound debridement for the treatment of a late persistent periprosthetic infection of the hip. Intermittent NPWTi was used in both cases. Patients were treated successfully and there was no recurrence after 3 and 1 years of follow-up, respectively.Keywords: negative pressure, vacuum-assisted, periprosthetic infection, hip

Surgical Site Infections Following Spine Surgery: Eliminating the Controversies in the Diagnosis

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Jad eChahoud

2014-03-01

Full Text Available Surgical site infection (SSI following spine surgery is a dreaded complication with significant morbidity and economic burden. SSIs following spine surgery can be superficial, characterized by obvious wound drainage, or deep-seated with a healed wound. Staphylococcus aureus remains the principal causal agent. There are certain pre-operative risk factors that increase the risk of SSI, mainly diabetes, smoking, steroids, and peri-operative transfusions. Additionally, intra-operative risk factors include surgical invasiveness, type of fusion, implant use, and traditional instead of minimally invasive approach. A high level of suspicion is crucial to attaining an early definitive diagnosis and initiating appropriate management. The most common presenting symptom is back pain, usually manifesting 2 to 4 weeks and up to 3 months after a spinal procedure. Scheduling a follow-up visit between weeks 2 to 4 after surgery is therefore necessary for early detection. Inflammatory markers are important diagnostic tools, and comparing pre-operative with post-operative levels should be done when suspecting SSIs following spine surgery. Particularly, Serum Amyloid A (SAA is a novel inflammatory marker that can expedite the diagnosis of SSIs. Magnetic resonance imaging remains the diagnostic modality of choice when suspecting a SSI following spine surgery. While 18F-fluorodeoxyglucose-positron emission tomography is not widely used, it may be useful in challenging cases. Despite their low yield, blood cultures should be collected before initiating antibiotic therapy. Samples from wound drainage should be sent for Gram stain and cultures. When there is a high clinical suspicion of SSI and in the absence of superficial wound drainage, CT guided aspiration of paraspinal collections is warranted. Unless the patient is hemodynamically compromised, antibiotics should be deferred until proper specimens for culture are secured.

Psoriasis and wound healing outcomes: A retrospective cohort study examining wound complications and antibiotic use.

Science.gov (United States)

Young, Paulina M; Parsi, Kory K; Schupp, Clayton W; Armstrong, April W

2017-11-15

Little is known about wound healing in psoriasis. We performed a cohort study examining differences in wound healing complications between patients with and without psoriasis. Psoriasis patients with traumatic wounds were matched 1:3 to non-psoriasis patients with traumatic wounds based on age, gender, and body mass index (BMI). We examined theincidence of wound complications including infection, necrosis, and hematoma as well as incident antibiotic use within three months following diagnosis of a traumatic wound. The study included 164 patients with traumatic wounds, comprised of 41 patients with psoriasis matched to 123 patients without psoriasis. No statistically significant differences were detected in the incidence of overall wound complications between wound patients with psoriasis and wound patients without psoriasis (14.6% versus. 13.0%, HR 1.18, CI 0.39-3.56). After adjustment for diabetes, peripheral vascular disease, and smoking, no statistically significant differences were detected in the incidence of overall wound complications between patients with and without psoriasis (HR 1.11, CI 0.34-3.58). Specifically, the adjusted rates of antibiotic use were not significantly different between those with and without psoriasis (HR 0.65, CI 0.29-1.46). The incidence of wound complications following traumatic wounds of the skin was found to be similar between patients with and without psoriasis.

Low molecular weight chitosan-coated silver nanoparticles are effective for the treatment of MRSA-infected wounds

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Peng Y

2017-01-01

Full Text Available Yinbo Peng,1 Chenlu Song,1 Chuanfeng Yang,1 Qige Guo,1 Min Yao1,2 1Department of Burns and Plastic Surgery, Shanghai Ninth People’s Hospital, Institute of Traumatic Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China; 2Department of Dermatology, Wellman Center for Photomedicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA Abstract: Silver nanoparticles (AgNPs are being widely applied as topical wound materials; however, accumulated deposition of silver in the liver, spleen, and other main organs may lead to organ damage and dysfunction. We report here that low molecular weight chitosan-coated silver nanoparticles (LMWC-AgNPs are effective against methicillin-resistant Staphylococcus aureus (MRSA, have better biocompatibility, and have lower body absorption characteristics when compared with polyvinylpyrrolidone-coated silver nanoparticles (PVP-AgNPs and silver nanoparticles without surface stabilizer (uncoated-AgNPs in a dorsal MRSA wound infection mouse model. LMWC-AgNPs were synthesized by reducing silver nitrate with low molecular weight chitosan as a stabilizer and reducing agent, while PVP-AgNPs were synthesized using polyvinylpyrrolidone as a stabilizer and ethanol as a reducing agent. AgNPs with different surface stabilizers were identified by UV-visible absorption spectrometry, and particle size was determined by transmission electron microscopy. UV-visible absorption spectra of LMWC-AgNPs, PVP-AgNPs and uncoated-AgNPs were similar and their sizes were in the range of 10–30 nm. In vitro experiments showed that the three types of AgNPs had similar MRSA-killing effects, with obvious effect at 4 µg/mL and 100% effect at 8 µg/mL. Bacteriostatic annulus experiments also showed that all the three types of AgNPs had similar antibacterial inhibitory effect at 10 µg/mL. Cell counting kit-8 assay and Hoechst/propidium iodide (PI staining showed that LMWC-AgNPs were

Systematic Review and Meta-Analysis of Randomized Controlled Trials Evaluating Prophylactic Intra-Operative Wound Irrigation for the Prevention of Surgical Site Infections

NARCIS (Netherlands)

de Jonge, Stijn W.; Boldingh, Quirine J. J.; Solomkin, Joseph S.; Allegranzi, Benedetta; Egger, Matthias; Dellinger, E. Patchen; Boermeester, Marja A.

2017-01-01

Surgical site infections (SSIs) are one of the most common hospital-acquired infections. To reduce SSIs, prophylactic intra-operative wound irrigation (pIOWI) has been advocated, although the results to date are equivocal. To develop recommendations for the new World Health Organization (WHO) SSI

A comparative study of histopathological effects of aqueous extract of cinnamon and honey with sulfadiazine on skin burn wound healing in rats infected with Pseudomonas aeuroginosa

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Mohammadreza Valilou

2017-11-01

Full Text Available Pseudomonas aeruginosa, a ubiquitous opportunistic pathogen, is the most common infective agent of burn wounds. The aim of this study was to compare the histopathological effect of a mixture of aqueous extract of cinnamon and honey with silver sulfadiazine on the healing of Pseudomonas aeruginosa infected second grade skin burn wounds in rats. To this end, 60 male rats were randomly assigned to four experimental groups (15 rats in each group. After inducing anesthesia, second grade burn wound with the diameter of 12 mm was created in the dorsal region of rats. Then, 1.5×108 cfu/ml P. aeruginosa PA01was equally bestrewed on the wound of all rats. Every 12 hours, silver sulfadiazine (group 1, honey (group 2 and aqueous extract of cinnamon and honey (group 3 were applied to the wounds and group 4 was kept as control. On days 7, 14, and 21, five rats were selected from each group at each time point and after inducing anesthesia and measuring the diameter of the wound by coliseum, microbial and histopathological samples were taken from the wounds. Microbial studies showed that in all groups except the control group, the growth of the microbe was stopped. Histopathological observations regarding wound healing and diameter showed that there was a significant difference between treatment groups and the control group on days 7, 14 and 21 (p

Pseudomonas aeruginosa biofilm hampers murine central wound healing by suppression of vascular epithelial growth factor

DEFF Research Database (Denmark)

Trøstrup, Hannah; Lerche, Christian J; Christophersen, Lars J

2018-01-01

-wounded, infection-susceptible BALB/c mice, which display delayed wound closure compared to C3H/HeN mice. Wounds were evaluated histopathologically 4, 7 or 10 days post-infection. Photoplanimetry evaluated necrotic areas. P. aeruginosa biofilm suppressed vascular endothelial growth factor levels centrally in BALB....../c wounds but increased peripheral levels 4-7 days post-infection. Central zones of the burn wound displayed lower levels of central vascular endothelial growth factor as observed 4 and 7 days post-infection in BALB/c mice compared to their C3H/HeN counterparts. Biofilm suppressed early, centrally located S......100A8/A9 in BALB/c and centrally and peripherally later on in C3H/HeN wounds as compared to uninfected mice. Peripheral polymorphonuclear-dominated inflammation and larger necrosis were observed in BALB/c wounds. In conclusion, P. aeruginosa biofilm modulates wounds by suppressing central...

Common drug-drug interactions in antifungal treatments for superficial fungal infections.

Science.gov (United States)

Gupta, Aditya K; Versteeg, Sarah G; Shear, Neil H

2018-04-01

Antifungal agents can be co-administered alongside several other medications for a variety of reasons such as the presence of comorbidities. Pharmacodynamic interactions such as synergistic and antagonistic interactions could be the result of co-administered medications. Pharmacokinetic interactions could also transpire through the inhibition of metabolizing enzymes and drug transport systems, altering the absorption, metabolism and excretion of co-administered medications. Both pharmacodynamic and pharmacokinetic interactions can result in hospitalization due to serious adverse effects associated with antifungal agents, lower therapeutic doses required to achieve desired antifungal activity, and prevent antifungal resistance. Areas covered: The objective of this review is to summarize pharmacodynamic and pharmacokinetic interactions associated with common antifungal agents used to treat superficial fungal infections. Pharmacodynamic and pharmacokinetic interactions that impact the therapeutic effects of antifungal agents and drugs that are influenced by the presence of antifungal agents was the context to which these antifungal agents were addressed. Expert opinion: The potential for drug-drug interactions is minimal for topical antifungals as opposed to oral antifungals as they have minimal exposure to other co-administered medications. Developing non-lipophilic antifungals that have unique metabolizing pathways and are topical applied are suggested properties that could help limit drug-drug interactions associated with future treatments.

Clinicomycological Characterization of Superficial Mycoses from a Tertiary Care Hospital in Nepal

OpenAIRE

Khadka, Sundar; Sherchand, Jeevan Bahadur; Pokharel, Dinesh Binod; Pokhrel, Bharat Mani; Mishra, Shyam Kumar; Dhital, Subhash; Rijal, Basista

2016-01-01

Background. Superficial mycosis is a common fungal infection worldwide, mainly caused by dermatophytes. However, the prevalence of species varies geographically. In addition, fungal treatment is best guided according to species isolated. This study was carried out to determine the clinical as well as mycological profile of superficial mycoses in a tertiary care hospital, Nepal. Methods. This was a prospective case-control laboratory based study conducted over a period of six months from Janua...

Clinico Mycological Study of Superficial Mycoses

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Rachana J. Magdum

2016-10-01

Full Text Available Background: Generally it is well established fact that geographical distribution of the fungi may change from time to time; hence this study was planned. Aim and Objectives: To analyze the prevalence of superficial mycoses, its clinical presentation and species identification of the fungal isolates responsible for the disease. Material and Methods: A total 125 clinically diagnosed cases of superficial mycoses visiting Dermatology and Venereology outpatient department of Bharati Hospital, Sangli, for a period of one year were included in the study. Specimens like skin scrapping, nail clipping, hair were collected and subjected to KOH mount and culture. Identification of species was done by macroscopic examination of culture, tease mount and other physiological tests including Urease test, Hair perforation tests and Germ tube test. Results: Superficial mycosis was more common in the age group of 21-30 years (28% and in males (60.8%. The infection was more common in students (29.6%. Tinea corporis (42.4% was the commonest clinical type followed by tinea cruris (22.4%. 61.6% cases were positive by direct microscopy and 60.8% cases showed culture positive. Out of 125 samples, dermatophytes were grown in 63 cases (82.89% followed by non dermatophytic moulds in 10 cases (13.16% and Candida albicans in 3 cases (3.95%. The most common isolate among dermtophytosis was T. rubrum (46.05% followed by T. mentagrophyte (25%. Conclusion: It was concluded that along with dermatophytes, non dermatophytic moulds are also important to cause of superficial mycoses

Debridement and wound bed preparation.

Science.gov (United States)

Falabella, Anna F

2006-01-01

Debridement can play a vital role in wound bed preparation and the removal of barriers that impair wound healing. In accordance with the TIME principles, debridement can help remove nonviable tissue, control inflammation or infection, decrease excess moisture, and stimulate a nonadvancing wound edge. There are many types of debridement, each with a set of advantages and disadvantages that must be clearly understood by the healthcare team. Failure to use the correct debridement method for a given type of wound may lead to further delays in healing, increase patient suffering, and unnecessarily increase the cost of care. This review article discusses the various methods of debridement, describes currently available debriding agents, evaluates the clinical data regarding their efficacy and safety, and describes strategies for the management of problematic nonhealing wounds.

Gene expression profiling in gastric mucosa from Helicobacter pylori-infected and uninfected patients undergoing chronic superficial gastritis.

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Ze-Min Yang

Full Text Available Helicobacter pylori infection reprograms host gene expression and influences various cellular processes, which have been investigated by cDNA microarray using in vitro culture cells and in vivo gastric biopsies from patients of the Chronic Abdominal Complaint. To further explore the effects of H. pylori infection on host gene expression, we have collected the gastric antral mucosa samples from 6 untreated patients with gastroscopic and pathologic confirmation of chronic superficial gastritis. Among them three patients were infected by H. pylori and the other three patients were not. These samples were analyzed by a microarray chip which contains 14,112 cloned cDNAs, and microarray data were analyzed via BRB ArrayTools software and Ingenuity Pathways Analysis (IPA website. The results showed 34 genes of 38 differentially expressed genes regulated by H. pylori infection had been annotated. The annotated genes were involved in protein metabolism, inflammatory and immunological reaction, signal transduction, gene transcription, trace element metabolism, and so on. The 82% of these genes (28/34 were categorized in three molecular interaction networks involved in gene expression, cancer progress, antigen presentation and inflammatory response. The expression data of the array hybridization was confirmed by quantitative real-time PCR assays. Taken together, these data indicated that H. pylori infection could alter cellular gene expression processes, escape host defense mechanism, increase inflammatory and immune responses, activate NF-κB and Wnt/β-catenin signaling pathway, disturb metal ion homeostasis, and induce carcinogenesis. All of these might help to explain H. pylori pathogenic mechanism and the gastroduodenal pathogenesis induced by H. pylori infection.

Late Complication after Superficial Femoral Artery (SFA) Aneurysm: Stent-graft Expulsion Outside the Skin

Energy Technology Data Exchange (ETDEWEB)

Pecoraro, Felice, E-mail: felicepecoraro@libero.it; Sabatino, Ermanno R.; Dinoto, Ettore; Rosa, Giuliana La; Corte, Giuseppe; Bajardi, Guido [University of Palermo, Vascular Surgery Unit (Italy)

2015-10-15

A 78-year-old man presented with a 7-cm aneurysm in the left superficial femoral artery, which was considered unfit and anatomically unsuitable for conventional open surgery for multiple comorbidities. The patient was treated with stent-graft [Viabhan stent-graft (WL Gore and Associates, Flagstaff, AZ)]. Two years from stent-graft implantation, the patient presented a purulent secretion and a spontaneous external expulsion through a fistulous channel. No claudication symptoms or hemorrhagic signs were present. The pus and device cultures were positive for Staphylococcus aureus sensitive to piperacillin/tazobactam. Patient management consisted of fistula drainage, systemic antibiotic therapy, and daily wound dressing. At 1-month follow-up, the wound was closed. To our knowledge, this is the first case of this type of stent-graft complication presenting with external expulsion.

Scintigraphic imaging with technetium-99M-labelled ceftizoxime is a reliable technique for the diagnosis of deep sternal wound infection in rats

Energy Technology Data Exchange (ETDEWEB)

Costa, Paulo Henrique Nogueira; Diniz, Simone Odilia Fernandes; Cardoso, Valbert Nascimento; Tarabal, Bernardo; Takenaka, Isabella; Braga, Otavio; Vidigal, Paula Vieira Teixeira; Gelape, Claudio Leo; Araujo, Ivana Duval, E-mail: phnc@uol.com.br [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil)

2015-07-01

Purpose: to evaluate whether scintigraphy with technetium-99m-labeled ceftizoxime ({sup 99m}Tc-CFT) can differentiate mediastinitis from aseptic inflammation associated with sternotomy. Methods: twenty female Wistar rats were randomly distributed into four groups: S (control) -partial upper median sternotomy with no treatment; SW (control) - sternotomy and treatment of sternal wounds with bone wax; SB - sternotomy and infection with Staphylococcus aureus; SWB - sternotomy with bone wax treatment and bacterial infection. Scintigraphy with {sup 99m}Tc-CFT was performed eight days after surgery and images were collected 210 and 360 min after infusion of the radiopharmaceutical. Results: no animals exhibited clinical signs of wound infection at the end of the experiment, although histological data verified acute inflammatory response in those experimentally infected with bacteria. Scintigraphic images revealed that tropism of {sup 99m}Tc-CFT to infected sternums was greater than to their non-infected counterparts. Mean counts of radioactivity in bacteria-infected sternal regions (SB and SWB) were significantly higher (p = 0.0007) than those of the respective controls (S and SW).Conclusion: scintigraphy with technetium-99m-labeled ceftizoxime is a method that can potentially detect infection post sternotomy and differentiate from aseptic inflammation in animals experimentally inoculated with S. aureus (author)

Clinical evaluation of a dressing with poly absorbent fibres and a silver matrix for managing chronic wounds at risk of infection: a non comparative trial.

Science.gov (United States)

Dalac, S; Sigal, L; Addala, A; Chahim, M; Faivre-Carrere, C; Lemdjadi, Z; Bohbot, S

2016-09-01

To assess the efficacy, safety and acceptability of a new silver poly absorbent dressing (UrgoCleanAg) in the local management of exudative chronic wounds at risk of infection, with inflammatory signs suggesting heavy bacterial load. This prospective, multicentre, non-comparative clinical trial was conducted in French hospital wards (dermatology and vascular medicine) or specialised private-practice physicians. Patients were considered at high-risk of infection when presenting with at least three of five selected inflammatory clinical signs, suggesting a heavy bacterial load (pain between two dressing changes, erythema, oedema, malodorous wound and presence of a heavy exudate). They were treated for a maximum period of four weeks, and followed by the physician on a weekly basis, including a clinical examination, area tracings and photographs. The primary efficacy criterion of the trial was the relative wound surface area reduction at the end of the four weeks of treatment. Acceptability was documented by the nursing staff at each dressing change between the weekly evaluations. We recruited 37 patients with chronic wounds. Wound surface area, mostly covered by sloughy tissue, was reduced by 32.5% at the end of the treatment (median value), while the clinical score (maximum value of 5, based on inflammatory clinical signs) decreased from 4.0 to 2.0. Effective debridement properties were documented (62.5% relative reduction of sloughy tissue at week 4; 58.8% of debrided wounds at week 4) and improvement of the periwound skin status was noted (healthy for 28.6% of the patients at week 4 versus 2.7% at baseline). In addition, the tested wound dressing presented a good safety profile associated to a high level of acceptability, noted by both patients and nursing staff. These clinical data support that the tested dressing is a credible therapeutic alternative for the management of chronic wounds at risk of infection with inflammatory signs suggesting heavy bacterial load.

Bacteriophage Therapy for Staphylococcus aureus Biofilm-Infected Wounds: A New Approach to Chronic Wound Care

Science.gov (United States)

2013-02-01

lidocaine and 1:100,000 epineph- rine at the planned wound sites. Six full-thickness dermal wounds, 6 mm in diameter, were created on the ventral ear...action were ineffective against S. aureus biofilm, as was seen with P. aeruginosa biofilm.22 Given the durability of biofilm in the face of a harsh

Surgical wound infection rates in Spain: data summary, January 1997 through June 2012.

Science.gov (United States)

Díaz-Agero Pérez, Cristina; Robustillo Rodela, Ana; Pita López, María José; López Fresneña, Nieves; Monge Jodrá, Vicente

2014-05-01

The Indicadores Clínicos de Mejora Continua de la Calidad (INCLIMECC) program was established in Spain in 1997. INCLIMECC is a prospective system of health care-associated infection (HAI) surveillance that collects incidence data in surgical and intensive care unit patients. The protocol is based on the National Healthcare Safety Network (NHSN) surveillance system, formerly known as the National Nosocomial Infection Surveillance (NNIS) system, and uses standard infection definitions from the US Centers for Disease Control and Prevention. Each hospital takes part voluntarily and selects the units and surgical procedures to be surveyed. This report is a summary of the data collected between January 1997 and June 2012. A total of 370,015 patients were included, and the overall incidence of surgical wound infection (SWI) was 4.51%. SWI rates are provided by NHSN operating procedure category and NNIS risk index category. More than 27% of the patients received inadequate antibiotic prophylaxis, the main reason being unsuitable duration (57.05% of cases). Today, the INCLIMECC network includes 64 Spanish hospitals. We believe that an HAI surveillance system with trained personnel external to the surveyed unit is a key component not only in infection control and prevention, but also in a quality improvement system. Copyright © 2014. Published by Mosby, Inc.

Biobased silver nanocolloid coating on silk fibers for prevention of post-surgical wound infections

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Dhas SP

2015-10-01

Full Text Available Sindhu Priya Dhas, Suruthi Anbarasan, Amitava Mukherjee, Natarajan Chandrasekaran Center for Nanobiotechnology, VIT University, Vellore, India Abstract: Bombyx mori silk fibers are an important biomaterial and are used in surgical sutures due to their remarkable biocompatibility. The major drawback to the application of biomaterials is the risk of bacterial invasion, leading to clinical complications. We have developed an easy and cost-effective method for fabrication of antibacterial silk fibers loaded with silver nanoparticles (AgNPs by an in situ and ex situ process using an aqueous extract of Rhizophora apiculata leaf. Scanning electron microscopy revealed that well dispersed nanoparticles impregnated the silk fibers both in situ and ex situ. The crystalline nature of the AgNPs in the silk fibers was demonstrated by X-ray diffraction. The thermal and mechanical properties of the silk fibers were enhanced after they were impregnated with AgNPs. The silver-coated silk fibers fabricated by the in situ and ex situ method exhibited more than 90% inhibition against Pseudomonas aeruginosa and Staphylococcus aureus. Silk fibers doped with AgNPs were found to be biocompatible with 3T3 fibroblasts. The results obtained represent an important advance towards the clinical application of biocompatible AgNP-loaded silk fibers for prevention of surgical wound infections. Keywords: silk fibers, silver nanoparticles, antibacterial activity, wound infections, cytotoxicity, 3T3 fibroblast cells

Synergistic interaction of Helichrysum pedunculatum leaf extracts with antibiotics against wound infection associated bacteria

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OLAYINKA A AIYEGORO

2009-01-01

Full Text Available The effect of combinations of the crude methanolic extract of the leaves of Helichrysum pedunculatum and eight first-line antibiotics were investigated by time kill assays against a panel of bacterial strains that have been implicated in wound infections. The plant extract showed appreciable antibacterial activities against the test bacteria with zones of inhibition ranging between 18 and 27 mm, and minimum inhibitory concentrations (MICs varying between 0.1 and 5.0 mg/ml. The MICs of the test antibiotics range between 0.001 and 0.412 mg/ml, and combination of the plant extract and the antibiotics resulted in reduction of bacterial counts by between 0 and 6.63 Log10 cfu/ml. At V2 MIC, 56.81% synergy; 43.19% indifference and no antagonism were observed, and at MIC levels, 55.68% synergy; 44.32% indifference and no antagonism were observed when the extracts were combined with eight different antibiotics. In all, 60% of the interactions were synergistic. All combination regimes on Staphylococcus aureus ATCC 6538 yielded no synergy, neither was antagonism detected in any of the assays. We propose that extracts of the leaves of Helichrysum pedunculatum could be of relevance in combination therapy and as a source of resistance modifying principies that could be useful as treatment options for persistent wound infections.

Synergistic interaction of Helichrysum pedunculatum leaf extracts with antibiotics against wound infection associated bacteria.

Science.gov (United States)

Aiyegoro, Olayinka A; Afolayan, Anthony J; Okoh, Anthony I

2009-01-01

The effect of combinations of the crude methanolic extract of the leaves of Helichrysum pedunculatum and eight first-line antibiotics were investigated by time kill assays against a panel of bacterial strains that have been implicated in wound infections. The plant extract showed appreciable antibacterial activities against the test bacteria with zones of inhibition ranging between 18 and 27 mm, and minimum inhibitory concentrations (MICs) varying between 0.1 and 5.0 mg/ml. The MICs of the test antibiotics range between 0.001 and 0.412 mg/ml, and combination of the plant extract and the antibiotics resulted in reduction of bacterial counts by between 0 and 6.63 Log10 cfu/ml. At V2 MIC, 56.81% synergy; 43.19% indifference and no antagonism were observed, and at MIC levels, 55.68% synergy; 44.32% indifference and no antagonism were observed when the extracts were combined with eight different antibiotics. In all, 60% of the interactions were synergistic. All combination regimes on Staphylococcus aureus ATCC 6538 yielded no synergy, neither was antagonism detected in any of the assays. We propose that extracts of the leaves of Helichrysum pedunculatum could be of relevance in combination therapy and as a source of resistance modifying principies that could be useful as treatment options for persistent wound infections.

Antimicrobial susceptibility pattern of Acinetobacter species isolated from infected wounds at a tertiary care hospital

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Rosić Ivana

2013-01-01

Full Text Available Bacteria of the genus Acinetobacter, especially species Acinetobacter baumanii, is one of the most important causes of infection in immunocompromised patients in hospital. The aim of this study was to determine susceptibility of Acinetobacter species isolated from swabs of inflamed wounds to antibiotics. The study was conducted in several departments of the Clinical Centre 'Kragujevac' through retrospective analysis of 220 Acinetobacter species isolates from surgical wounds in 2011. The isolates of Acinetobaster species were mostly sensitive to ampicillin-sulbactam, colistin and tigecycline in all hospital departments that were surveyed. Only minority of the isolated Acinetobacter species were susceptible to cotrimoxazole, amikacin, imipenem and/or meropenem. Antibiotics with the highest in vitro efficacy against Acinetobacter species were ampicillinsulbactam, colistin and tigecycline. Highly resistant Acinetobacter species were more frequently isolated from patients in Intensive Care Unit.

Wound healing with honey - a randomised controlled trial

African Journals Online (AJOL)

and calculate the cost-effectiveness of the honey used. Design and ... Natural honey is extremely cost- effective. ... surrounding wound infection, genital or malignant ulcers, wounds ... body mass index, systolic and diastolic blood pressure, and.

The application of the modified surgical wound dressing in wound care after tracheotomy

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Feng Mei

2017-01-01

Discussion: The design of the herein-described modified surgical wound dressing is based on a butterfly shaped adhesive and mirrors the advantages of a modern surgical wound dressing. Its shape is suitable for the physiological structure of the neck, making it more comfortable to use. Aseptic packaging and a high degree of adhesiveness guarantee continuous fixation and pulling. At the same time, the design of the dressing decreases the chance of infection.

Pneumodissection for skin protection in image-guided cryoablation of superficial musculoskeletal tumours.

Science.gov (United States)

Maybody, Majid; Tang, Peter Q; Moskowitz, Chaya S; Hsu, Meier; Yarmohammadi, Hooman; Boas, F Edward

2017-03-01

Pneumodissection is described as a simple method for preventing skin injury during cryoablation of superficial musculoskeletal tumours. Superficial tumour cryoablations performed from 2009 to 2015 were retrospectively reviewed. Pneumodissection was performed in 13 patients when the shortest tumour-skin distance was less than 25 mm. Indications were pain palliation (n = 9) and local tumour control (n = 4). Patients, target tumours, technical characteristics and complications up to 60 days post ablation were reviewed. The ice ball-skin distances with and without pneumodissection were compared by a paired t-test and further assessed for association with covariates using ANCOVA. Technical success for ablation was 12 of 13. The mean shortest tumour-skin distance was 15.0 mm (3.2-24.5 mm). The mean thickness of pneumodissection was 9.6 mm (5.2-16.6 mm) resulting in mean elevation of skin of 3.4 mm (1.2-5.3 mm). Mean shortest ice ball-skin distance after pneumodissection was 10.5 mm (4.2-19.7 mm). No infection or systemic air embolism was noted. No intraprocedural frostbite was observed. Pneumodissection is feasible, effective and safe in protecting the skin during image-guided cryoablation of superficial tumours. • Frostbite during image-guided cryoablation of superficial tumours is commonly under-reported. • Frostbites are painful and may introduce infection into the superficial ablation zone. • Warm compress, saline and CO 2 have shortcomings in protecting the skin. • Pneumodissection is free, readily available, easy to use and safe and effective.

Nanocoatings for Chronic Wound Repair—Modulation of Microbial Colonization and Biofilm Formation

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Mara Mădălina Mihai

2018-04-01

Full Text Available Wound healing involves a complex interaction between immunity and other natural host processes, and to succeed it requires a well-defined cascade of events. Chronic wound infections can be mono- or polymicrobial but their major characteristic is their ability to develop a biofilm. A biofilm reduces the effectiveness of treatment and increases resistance. A biofilm is an ecosystem on its own, enabling the bacteria and the host to establish different social interactions, such as competition or cooperation. With an increasing incidence of chronic wounds and, implicitly, of chronic biofilm infections, there is a need for alternative therapeutic agents. Nanotechnology shows promising openings, either by the intrinsic antimicrobial properties of nanoparticles or their function as drug carriers. Nanoparticles and nanostructured coatings can be active at low concentrations toward a large variety of infectious agents; thus, they are unlikely to elicit emergence of resistance. Nanoparticles might contribute to the modulation of microbial colonization and biofilm formation in wounds. This comprehensive review comprises the pathogenesis of chronic wounds, the role of chronic wound colonization and infection in the healing process, the conventional and alternative topical therapeutic approaches designed to combat infection and stimulate healing, as well as revolutionizing therapies such as nanotechnology-based wound healing approaches.

The bacteria profiles of wounds in diabetic patients hospitalized in ...

African Journals Online (AJOL)

Diabetic wound infections still remain a health concern such that correct identification of bacteria is essential in monitoring the spread of the infections as well as in the administration of the correct treatment. This study therefore focuses on isolating and identifying bacteria present in diabetic wounds of hospitalized patients in ...

Calmodulin Gene Expression in Response to Mechanical Wounding and Botrytis cinerea Infection in Tomato Fruit

OpenAIRE

Peng, Hui; Yang, Tianbao; Jurick, Wayne M.

2014-01-01

Calmodulin, a ubiquitous calcium sensor, plays an important role in decoding stress-triggered intracellular calcium changes and regulates the functions of numerous target proteins involved in various plant physiological responses. To determine the functions of calmodulin in fleshy fruit, expression studies were performed on a family of six calmodulin genes (SlCaMs) in mature-green stage tomato fruit in response to mechanical injury and Botrytis cinerea infection. Both wounding and pathogen in...

CLINICAL EFFICIENCY OF APITHERAPY IN TREATMENT OF UDDER WOUNDS IN HOLSTEIN-FRIESIAN COWS

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Benjamin Čengić

2013-02-01

Full Text Available Honey, pollen and propolis have been used since the ancient times in the treatment of infected wounds. These substances express antimicrobial activity even against microorganisms resistant to conventional antibiotics and antiseptics. The goal of the research is to answer the question of whether these substances could help in healing of the udder wounds under the real field conditions. Substances subject to research were mixed in a remedy, which was applied directly into the udder wounds once daily.The wounds were treated with “Apimelem” during May and June, 2012. “Apimelem” applied into the udder wounds gave good results in elimination of infection, prevention of reinfection and faster tissue healing. Prepared “Apimelem” proved efficient, nontoxic and financially affordable, this is especially important for poor or natural disaster- affected areas.Key words: infected wound, “Apimelem”, antimicrobic activity, udder, cow

Svin som smittekilde til infektioner med methicillinresistente Staphylococcus aureus hos mennesker

DEFF Research Database (Denmark)

Ruhlmann, Christina H; Kolmos, Hans Jørn J; Kristiansen, Jette E

2008-01-01

occupational contact with pigs. One infection presented as a severe surgical wound infection, following knee surgery, the other as a superficial ear lobe infection. Both MRSA strains were multiresistant, sequence type 398, Spa-type t034, and Panton-Valentine leukocidin-encoding gene negative. Udgivelsesdato...

Antibiofilm Efficacy of DispersinB Wound Spray Used in Combination with a Silver Wound Dressing

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Purushottam V. Gawande

2014-01-01

Full Text Available Chronic wounds including diabetic foot ulcers, pressure ulcers, and venous leg ulcers are a worldwide health problem. As the traditional methods of treatment have proven ineffective against chronic wounds involving biofilms, there is an unmet clinical need for developing products with an antibiofilm component that inhibits and/or disrupts biofilms and thus make the biofilm-embedded bacteria more susceptible to antimicrobial therapy. We developed a DispersinB® antibiofilm enzyme-based wound spray for treating chronic wounds in conjunction with an antimicrobial. Under in vitro conditions, the DispersinB® and Acticoat™ combination performed significantly better ( P < 0.05 than Acticoat™ alone, indicating the synergy between the two compounds because of DispersinB® enhancing the antimicrobial activity of Acticoat™. Furthermore, DispersinB® wound spray enhanced the antimicrobial activity of Acticoat™ in a chronic wound mouse model of methicillin-resistant Staphylococcus aureus (MRSA infection. Thus, this novel combination of DispersinB® and Acticoat™, an antimicrobial dressing, prompts clinical evaluation for potential applications in biofilm-based chronic wound management.

Tolerance and safety of superficial chemical peeling with salicylic acid in various facial dermatoses

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Iqbal Zafar

2005-03-01

Full Text Available BACKGROUND: Chemical peeling is a skin-wounding procedure that may have some potentially undesirable side-effects. AIMS: The present study is directed towards safety concerns associated with superficial chemical peeling with salicylic acid in various facial dermatoses. METHODS: The study was a non-comparative and a prospective one. Two hundred and sixty-eight patients of either sex, aged between 10 to 60 years, undergoing superficial chemical peeling for various facial dermatoses (melasma, acne vulgaris, freckles, post-inflammatory scars/pigmentation, actinic keratoses, plane facial warts, etc. were included in the study. Eight weekly peeling sessions were carried out in each patient. Tolerance to the procedure and any undesirable effects noted during these sessions were recorded. RESULTS: Almost all the patients tolerated the procedure well. Mild discomfort, burning, irritation and erythema were quite common but the incidence of major side-effects was very low and these too, were easily manageable. There was no significant difference in the incidence of side-effects between facial dermatoses (melasma, acne and other pigmentary disorders. CONCLUSION: Chemical peeling with salicylic acid is a well tolerated and safe treatment modality in many superficial facial dermatoses.

Effectiveness of Aloe Vera gel compared with 1% silver sulphadiazine cream as burn wound dressing in second degree burns.

Science.gov (United States)

Shahzad, Muhammad Naveed; Ahmed, Naheed

2013-02-01

To assess the efficacy of Aloe Vera gel compared with 1% silver sulfadiazine cream as a burn dressing for the treatment of superficial and partial thickness burns. This Interventional Comparative study was carried out at the Burn unit and Plastic surgery department, Nishtar Hospital Multan, Pakistan from July 2008 to December 2010. A total of 50 patients with superficial and partial thickness burns were divided into two equal groups randomly by consecutive sampling method, one group was dressed with Aloe Vera gel while the other was treated with 1% silversulphadiazine cream, and the results regarding duration of wound epithelialization, pain relief and cost of treatment were compared. In patients treated with Aloe Vera gel, healing of burn wounds were remarkably early than those patients treated with 1% silver sulfadiazine. All the patients of Aloe Vera group were relieved of pain earlier than those patients who were treated with SSD. Thermal burns patients dressed with Aloe Vera gel showed advantage compared to those dressed with SSD regarding early wound epithelialization, earlier pain relief and cost-effectiveness.

[Superficial venous thrombosis. A state of art].

Science.gov (United States)

Sándor, Tamás

2017-01-01

For a long time superficial thrombophlebitis has been thought to be a rather benign condition. Recently, when duplex ultrasound technique is used for the diagnosis more and more often, the disease is proved to be more dangerous than anticipated. Thrombosis propagates to the deep veins in 6-44% and pulmonary embolism was observed on the patients in 1,5-33%. We can calculate venous thromboembolic complications on every fourth patient. Diagnosis is clinical, but duplex ultrasound examination is mandatory, for estimation of the thrombus extent, for exclusion of the deep venous thrombosis and for follow up. Both legs should be checked with ultrasound, because simultaneous deep venous thrombosis can develop on the contralateral limb. Two different forms can be distinguished: superficial venous thrombosis with, or without varicose veins. In cases of spontaneous, non varicous form, especially when the process is migrating or recurrent, a careful clinical examination is necessery for exclusion of malignant diseases and thrombophilia. The treatment options are summarised on the basis of recent international consensus statements. The American and German guidelines are similar. Compression and mobilisation are cornerstones of the therapy. For a short segment thrombosis non steroidal antiinflammatory drugs are effective. For longer segments low molecular-weight heparins are preferred. Information on the effect of the novel oral anticoagulants for the therapy is lacking but they may appear to be effective in the future for this indication. When thrombus is close to the sapheno-femoral or sapheno-popliteal junction crossectomy (high ligation), or low molecular-weight heparin in therapeutic doses are indicated. The term superficial thrombophlebitis should be discouraged, because inflammation and infection is not the primary pathology. It should be called correctly superficial venous thrombosis in order to avoid the unnecessary administration of antibiotics and the misconception

Using vacuum in the treatment of surgical wounds complications

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Drašković Miroljub

2011-01-01

Full Text Available Background/Aim. Using vacuum in medicine has been known from long ago, however, it has not been used for the treatment of wounds. The first experiments in this field were performed by Wagner Fleischmann, University of Ulm, Ulm, West Germany, in 1993. The aim of this study was to present our clinical experience with the treatment of surgical wounds complications in vascular patients by the use of controled vacuum. Method. In a period October 2006 - December 2009 a total of 18 patients with infection and surgical wound dehiscence were treated by the use of vacuum. Vacuum was applied to wounds by placing a polyurethane sponge on them and by fixing a polyurethane foil and a sponge to the surrounding healthy skin so to completely airtight wounds. Over a foil vacuum of - 150 mmHg was applied for a 5-day period, and on the day 6 a foil and a sponge were removed. Results. In all the 18 wounds treated by the use of vacuum secondary wound closing was achieved with no complications and with a significantly shortened time period treatment. Wound infections were healed using this method and only in 2 patients antibiotics were used at the same time. Conclusion. The use of vacuum in the treatment of operative wounds complications is an easy and reliable method contributing significantly to wounds better healing.

[Wound healing in the elderly].

Science.gov (United States)

Eming, S A; Wlaschek, M; Scharffetter-Kochanek, K

2016-02-01

Restoration of tissue integrity is essential for host defense and protection of the organism. The efficacy and quality of skin repair varies significantly over a person's lifetime. Whereas prenatal wound healing is characterized by regeneration and scarless healing, scarring, fibrosis, and loss of function are features of postnatal repair. In fact, aging is the prominent risk factor for chronic wounds, skin fragility, infections, comorbidities, and decreased quality of life. Current strategies for restoration of tissue integrity and wound therapy are not sufficient and require further investigation of the underlying pathomechanisms and the development of causal-based concepts.

Changes in levels of cytokines in the treatment of infected wounds and festering in children

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O. V. Spakhi

2016-12-01

Full Text Available Informative and prognostic significance of cytokines in assessing the effectiveness of treatment tactics no doubt. The aim was to study the levels of pro- and anti-inflammatory cytokines in the dynamics of the treatment of infected wounds and purulent (IWP in children using the proposed optimized local treatment compared with standard procedure. Materials and methods. 45 children with IWP who were treated in the department of purulent surgery of Zaporozhye Regional Children's Hospital during the period of 2015-2016 years were divided into main (n = 26 and control groups (n = 19 depending on the tactics of treatment. The therapy of the main group patients were added by optimized integrated local treatment, which included a combination of magnetic therapy, antibacterial drug liposomal solutions and hirudotherapy. Efficacy of treatment was assessed by clinical characteristics and serum levels of IL-1β and IL-10 on the 1st and the 7th day of treatment. Results. The highest levels of pro-inflammatory IL-1β were defined in children with lymphadenitis on the first day of treatment. Common trends in the dynamics of cytokines content changes on the 7th day were in the line with generally accepted: decreased in IL-1β and increased in IL-10 levels. The level of IL-1β was not statistically different on the 7th day only in children with phlegmon. The most significant changes in IL-10 were observed in children with abscesses and lymphadenitis than in children with infected wound and phlegmon. Changes in markers of inflammation conform to positive changes in the clinical course of wound healing in children at the study. Generally, there was a lag dynamics of cytokines changes in the children who received standard therapy compared with the children who received the proposed optimized local treatment. Conclusions. The use of proposed IWP complex treatment in children showed the most significant effect on the anti-inflammatory IL-10 level in children with

Atypical Exit Wound in High-Voltage Electrocution.

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Parakkattil, Jamshid; Kandasamy, Shanmugam; Das, Siddhartha; Devnath, Gerard Pradeep; Chaudhari, Vinod Ashok; Shaha, Kusa Kumar

2017-12-01

Electrocution fatality cases are difficult to investigate. High-voltage electrocution burns resemble burns caused by other sources, especially if the person survives for few days. In that case, circumstantial evidence if correlated with the autopsy findings helps in determining the cause and manner of death. In addition, the crime scene findings also help to explain the pattern of injuries observed at autopsy. A farmer came in contact with a high-voltage transmission wire and sustained superficial to deep burns over his body. A charred and deeply scorched area was seen over the face, which was suggestive of the electric entry wound. The exit wound was present over both feet and lower leg and was atypical in the form of a burnt area of peeled blistered skin, charring, and deep scorching. The injuries were correlated with crime scene findings, and the circumstances that lead to his electrocution are discussed here.

Local irrigation of the surgical field with antibiotics in the end of procedure reduces the infection rate in herniated lumbar disc surgery.

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Kërveshi, Armend; Halili, Nehat; Kastrati, Bujar; Qosja, Faik; Kabashi, Serbeze; Muçaj, Sefedin

2014-12-01

Reported rate of infections after lumbar discectomy is 1%-15 %. This complication may result in disability or even the death. The aim of the study is to assess the rate of infection associated with lumbar discectomies when combined systemic and local antibiotic prophylaxis was employed. In this retrospective study we analyzed all patients operated for herniated lumbar disc from 2009 -2012 in our institute. Beside of receiving systemic prophylaxis with 2g of Cefazoline, all patients had their operative field irrigated at the end of operation with Amikacin sulfate injection. Wound was considered infected when local and systemic signs of infection were revealed and were associated with elevated ESR, leukocytosis and elevated CRP. Assessment of infection is done by neurosurgeon during the hospitalization and later at outpatient's clinic along postoperative course of three months. A total of 604 patients were operated, of those 285 patients (47.2 %) females and 319 males (52.8 %), 12 patients were operated on two levels (1.98 %). Average patient age was 32.5 years (range 20-65 years) Localization of herniated disc was: in L/2-L/3 20 patients or 3.3 %, the L/3-L/4 level 42 patients or 7 % , the L/4 -L /5 262 patients or 43.3 % at the level L/V- S/1 280 patients or 46.3 %. Three patients (0.49%) developed wound infection, two of them superficial infection only with local signs: local pain, redness and leakage. They were treated with oral antibiotics. One with deep wound infection. He presented with local and systemic signs and treated with i.v antibiotics. All the cultures from wound swab revealed staphylococcus aureus. Prophylaxis with systemic antibiotic (Cefazoline 2.0) intravenous administration 30 minutes before the incision and irrigation of operative field with local antibiotic Amikacine sulfate at the end of procedure reduces the infection rate in patients operated for herniated lumbar disc when compared with systemic antibiotic prophylaxis only.

Negative pressure wound therapy versus standard wound care on quality of life: a systematic review.

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Janssen, A H J; Mommers, E H H; Notter, J; de Vries Reilingh, T S; Wegdam, J A

2016-03-01

Negative pressure wound therapy (NPWT) is a widely accepted treatment modality for open or infected wounds. Premature ending of NPWT occasionally occurs due to negative effects on the quality of life (QoL), however, the actual impact on QoL is unknown. The aim of this review is to analyse the effect of NPWT versus standard wound care (SWC) on QoL when used for the treatment of open or infected wounds. A systematic literature search in a range of databases (PubMed, CINAHL, Medline, Web of Science, Science Direct Freedom Collection, SwetsWise, PSYCArticles and Infrotrac Custom Journals) using the following search terms; 'standard wound care', 'wound dressing', 'dressing', 'treatment', OR 'negative pressure wound therapy [MESH]', OR 'vacuum assisted closure' AND 'quality of life [MESH]', 'patient-satisfaction', OR 'experiences' was performed. Methodological quality was assessed using the methodological index for non-randomised studies (MINORS) checklist. There were 42 studies identified, five matched the inclusion criteria: two randomised clinical trials (RCTs), one clinical comparative study, one exploratory prospective cohort study and one quasi experimental pilot study. Median MINORS-score was 75% (58%-96%). There were seven different questionnaires used to measure QoL or a subsidiary outcome. QoL in the NPWT group was lower in the first week, though no difference in QoL was observed thereafter. This systematic review observed that QoL improved at the end of therapy independent of which therapy was used. NPWT led to a lower QoL during the first week of treatment, possible due to aniexty, after which a similar or better QoL was reported when compared with SWC. It could be suggested that NPWT might be associated with increased anxiety. All authors of this publication have received no financial support or have personal interests conflicting with the objectivity of this manuscript.

Enzymatic wound debridement; role of papaya in the management of post cesarean gaped wounds

International Nuclear Information System (INIS)

Nisa, M.U.

2012-01-01

Background: Enzymatic wound debridement is an emerging concept in facilitating the wound healing process. Papaya has de-sloughing, antibacterial and wound healing properties. It has been used in African countries since centuries for different medicinal pur-poses. Apart from anecdotal reports and few studies on chronic ulcers and burns, no planned studies are available to support its action in postoperative wound infection.Objectives: To compare efficacy and safety of papaya dressing with conventional wound dressing with povidone iodine in post cesarean section gaped wounds. Setting: Gynecology Unit 3, Sir Ganga Ram Hospital Lahore - Pakistan, over a period of six months(June 2012 to Nov 2012). Study Design: Randomized, quasi experimental stu-dy. Materials and Methods: The study sample included 60 patients with post cesarean section gaped wounds. The sample was divided into two groups; thirty patients as Group A or the study group received Papaya dressing and rest of thirty patients as Group B or the control group received Povidone iodine dressing. Wounds were thoroughly washed with saline and then mashed unripe papaya was spread over the whole area of wound in the study group and povidone iodine in the control group. Wounds were covered with sterile bandage for at least 48 hours in study group and 24 hours in the control group. The process was repeated till a clean base of wound with healthy granulation tis-sue was achieved suitable for secondary suture. The efficacy parameters studied were the duration of time needed to develop healthy granulation tissue and total duration of hospital stay which were compared bet-ween the two groups. Safety factors studied were the adverse effects of medications used in the study. Results: Out of 1200 cesarean sections done during study period, sixty (5%) were gaped in the post-operative period. Out of 60, 55 (90%) were emergency and only 5 (10%) were elective cesarean sections. All the sixty patients with postoperative gaped

Management of small fragment wounds in war: current research.

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Bowyer, G W; Cooper, G J; Rice, P

1995-03-01

The majority of war wounds are caused by antipersonnel fragments from munitions such as mortars and bomblets. Modern munitions aim to incapacitate soldiers with multiple wounds from very small fragments of low available kinetic energy. Many of these fragments may be stopped by helmets and body armour and this has led to a predominance of multiple wounds to limbs in those casualties requiring surgery. The development of an appropriate management strategy for these multiple wounds requires knowledge of the contamination and extent of soft tissue injury; conservative management may be appropriate. The extent of skin and muscle damage associated with a small fragment wound, the way in which these wounds may progress without intervention and their colonisation by bacteria has been determined in an experimental animal model. Results from 12 animals are presented. There was a very small (approximately 1 mm) margin of nonviable skin around the entrance wound. The amount of devitalised muscle in the wound tract was a few hundred milligrams. Some muscles peripheral to the wound track also showed signs of damage 1 h after wounding, but this improved over 24 h; the proportion of fragmented muscle fibres in the tissue around the track decreased as time went on. There was no clinical sign or bacteriological evidence of the track becoming infected up to 24 h after wounding. This preliminary work suggests that, in the absence of infection, the amount of muscle damage caused by small fragment wounds begins to resolve in the first 24 h after injury, even without surgical intervention.

[Antisepsis of wounds: when and what?].

Science.gov (United States)

Mulaj, Ryve Ramosaj; Mühlstädt, Michael; Barouti, Neda

2015-04-01

Bacterial colonisation of a wound is a normal process and usually not dangerous. The role of micro-organisms in the healing process is not fully elucidated, however it is well known that infection interrupts healing and even worse can severely threaten the organism. We present the different types of antiseptics that are used in treating wounds as well as their interactions. We would like to remind the reader that antiseptics are more effective than antibiotics with much fewer resistances. Finally, we provide a flow chart for a reasonable treatment of chronic wounds.

News in wound healing and management

DEFF Research Database (Denmark)

Gottrup, Finn; Jørgensen, Bo; Karlsmark, Tonny

2009-01-01

-TNFalpha) and Lactobacillus plantarum cultures have also been successfully used in hard to heal, atypical wounds. Knowledge on influencing factors as smoking and biofilm on the healing process has also been improved. Smoking results in delayed healing and increased risk of postoperative infection, whereas the role of biofilm...... is still at an exploratory level. Organizing models for optimal wound management are constantly being developed and refined. SUMMARY: Recent knowledge on the importance of new dressing materials containing active substances, new treatments for atypical wounds, influencing factors on the healing process...

Clinical outcome and microvascular blood flow in VAC® - and Sorbalgon® -treated peri-vascular infected wounds in the groin after vascular surgery - an early interim analysis.

Science.gov (United States)

Acosta, Stefan; Monsen, Christina; Dencker, Magnus

2013-08-01

Vacuum-assisted wound closure (VAC(®)) therapy is considered to be superior to conventional dressings in the treatment of peri-vascular groin infections after vascular surgery at our department. Therefore, we performed an early interim analysis of the clinical outcomes in these seriously ill patients at risk of amputation and death. Patients were randomised to either VAC(®) (n = 5) or Sorbalgon(®) (n = 5; best alternative treatment) therapy after surgical debridement. Non-invasive, laser Doppler perfusion imaging (LDPI) studies of the skin adjacent to the undressed wound were performed after 14 days of wound treatment. There was no difference in LDPI values in VAC(®) versus Sorbalgon(®) treated patients (P = 0·46). One patient in the VAC(®) group suffered from two re-bleeding episodes, leading to vascular resection and transfemoral amputation and in the Sorbalgon(®) group two had a complete wound healing time of more than 4 months and one had a visible interposition bypass graft in the groin after 1 month of treatment. No patient died of the groin infection. Although not statistically proven, fewer wound treatment failures were recorded in the VAC(®) group, justifying this early interim analysis. LDPI studies were feasible. © 2012 The Authors. International Wound Journal © 2012 John Wiley & Sons Ltd and Medicalhelplines.com Inc.

Clinical observation of corneal lamellar debridement combined with sutureless amniotic membrane transplantation for the treatment of superficial fungal keratitis

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Huang Zhang

2014-09-01

Full Text Available AIM:To evaluate the clinical efficacy of corneal lamellar debridement combined with sutureless amniotic membrane transplantation for the treatment of superficial fungal keratitis.METHODS:Totally 22 cases(22 eyeswith superficial fungal keratitis were referred to our hospital from April 2012 to October 2013. The patients with persistent cornea ulcer after treatment of local and systemic antifungal drugs underwent corneal lamellar debridement combined with sutureless amniotic membrane transplantation, and the recipient bed was covered with an amniotic membrane using fibrin sealant during the operation. All patients were still given topical antifungal therapy for 1-2mo after operation. The followed-up time was 3mo or above. We observed the corneal healing and amniotic membrane adhesion by split lamp microscope, and investigated the transformation of amniotic membrane and fungal infection recurrence with confocal microscope. RESULTS: Corneal edema and anterior chamber reaction of 21 patients disappeared gradually, and no amniotic membrane graft dissolved and shed off within 1-2wk postoperatively. Two weeks after operation, the graft integrated into the corneal and the corneal wounds' thickness increased gradually, the corneal epithelium reconstructed and corneas became clear. Four weeks after operation, the corneal scarring developed gradually and fluorescence staining was negative. Nineteen cases' amniotic membranes that adhered with the cornea dissolved 4wk after operation. There were different degrees of corneal nebula or macula remained 3mo postoperatively. All patients' vision improved in varying degrees, except in 1 case with fungal keratitis who had been cured by lamellar keratoplasty.CONCLUSION:Corneal lamellar debridement combined with sutureless amniotic membrane transplantation can effectively remove the foci of inflammation, improve the local efficacy, shorten the operation time, relieve the postoperative reaction, and promote cornea

Improved wound management by regulated negative pressure-assisted wound therapy and regulated, oxygen- enriched negative pressure-assisted wound therapy through basic science research and clinical assessment

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Moris Topaz

2012-01-01

Full Text Available Regulated negative pressure-assisted wound therapy (RNPT should be regarded as a state-of-the-art technology in wound treatment and the most important physical, nonpharmaceutical, platform technology developed and applied for wound healing in the last two decades. RNPT systems maintain the treated wound′s environment as a semi-closed, semi-isolated system applying external physical stimulations to the wound, leading to biological and biochemical effects, with the potential to substantially influence wound-host interactions, and when properly applied may enhance wound healing. RNPT is a simple, safe, and affordable tool that can be utilized in a wide range of acute and chronic conditions, with reduced need for complicated surgical procedures, and antibiotic treatment. This technology has been shown to be effective and safe, saving limbs and lives on a global scale. Regulated, oxygen-enriched negative pressure-assisted wound therapy (RO-NPT is an innovative technology, whereby supplemental oxygen is concurrently administered with RNPT for their synergistic effect on treatment and prophylaxis of anaerobic wound infection and promotion of wound healing. Understanding the basic science, modes of operation and the associated risks of these technologies through their fundamental clinical mechanisms is the main objective of this review.

The natural history of pedal puncture wounds in diabetics: a cross-sectional survey

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East Jeffrey M

2011-10-01

Full Text Available Abstract Background Surgeons usually witness only the limb-threatening stages of infected, closed pedal puncture wounds in diabetics. Given that this catastrophic outcome often represents failure of conservative management of pre-infected wounds, some suggest consideration of invasive intervention (coring or laying-open for pre-infected wounds in hope of preventing contamination from evolving into infection, there being no evidence based guidelines. However, an invasive pre-emptive approach is only justifiable if the probability of progression to catastrophic infection is very high. Literature search revealed no prior studies on the natural history of closed pedal puncture wounds in diabetics. Methods A survey was conducted via an interviewer-administered questionnaire on 198 adult diabetics resident in the parish of St. James, Jamaica. The sample was selected using a purposive technique designed to mirror the social gradient and residential distribution of the target population and is twice the number needed to detect a prevalence of puncture wounds of 14% with a range of 7-21% in a random sample of the estimated adult diabetic population. Results The prevalence of a history of at least one closed pedal puncture wound since diagnosis of diabetes was 25.8% (CI; 19.6-31.9%. The only modifiable variable associated at the 5% level of significance with risk of pedal puncture wound, after adjustment by multivariable logistic regression, was site of interview/paying status, a variable substantially reflective of income more so than quality-of-care. Of 77 reported episodes of closed pedal puncture wound among 51 participants, 45.4% healed without medical intervention, 27.3% healed after non-surgical treatment by a doctor and 27.3% required surgical intervention ranging from debridement to below-knee amputation. Anesthetic foot (failure to feel the puncture and sole of the forefoot as site of puncture were the variables significantly associated with

Clinicomycological Characterization of Superficial Mycoses from a Tertiary Care Hospital in Nepal.

Science.gov (United States)

Khadka, Sundar; Sherchand, Jeevan Bahadur; Pokharel, Dinesh Binod; Pokhrel, Bharat Mani; Mishra, Shyam Kumar; Dhital, Subhash; Rijal, Basista

2016-01-01

Background . Superficial mycosis is a common fungal infection worldwide, mainly caused by dermatophytes. However, the prevalence of species varies geographically. In addition, fungal treatment is best guided according to species isolated. This study was carried out to determine the clinical as well as mycological profile of superficial mycoses in a tertiary care hospital, Nepal. Methods . This was a prospective case-control laboratory based study conducted over a period of six months from January to June 2014 at Tribhuvan University Teaching Hospital, Nepal. A total of 200 specimens were collected from the patients suspected of superficial mycoses. The specimens were macroscopically as well as microscopically examined. The growth was observed up to 4 weeks. Results. Out of total 200 specimens from the patients suspected of superficial mycoses, tinea corporis 50 (25%) was most common clinical types. KOH mount was positive in 89 (44.5%) and culture was positive in 111 (55.5%). Trichophyton mentagrophytes 44 (39.6%) was the most common isolate. Conclusions. The diagnostic yields of KOH mount and culture were found to be complementary to each other. Thus both the methods added with clinical findings are equally important to establish superficial mycosis.

Clinicomycological Characterization of Superficial Mycoses from a Tertiary Care Hospital in Nepal

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Sundar Khadka

2016-01-01

Full Text Available Background. Superficial mycosis is a common fungal infection worldwide, mainly caused by dermatophytes. However, the prevalence of species varies geographically. In addition, fungal treatment is best guided according to species isolated. This study was carried out to determine the clinical as well as mycological profile of superficial mycoses in a tertiary care hospital, Nepal. Methods. This was a prospective case-control laboratory based study conducted over a period of six months from January to June 2014 at Tribhuvan University Teaching Hospital, Nepal. A total of 200 specimens were collected from the patients suspected of superficial mycoses. The specimens were macroscopically as well as microscopically examined. The growth was observed up to 4 weeks. Results. Out of total 200 specimens from the patients suspected of superficial mycoses, tinea corporis 50 (25% was most common clinical types. KOH mount was positive in 89 (44.5% and culture was positive in 111 (55.5%. Trichophyton mentagrophytes 44 (39.6% was the most common isolate. Conclusions. The diagnostic yields of KOH mount and culture were found to be complementary to each other. Thus both the methods added with clinical findings are equally important to establish superficial mycosis.

The Pre - Eminence of Staphylococcus Aureus as The Causative ...

African Journals Online (AJOL)

A range of infections is caused by Staphylococcal organisms prominent among them are nosocomial superficial infections manifesting as abscesses, furuncles, and wound infections. The study objective is to determine the degree to which Staphylococcus aureus is a cause of such lesions in a tertiary health care institution ...

Bio-Conjugated Polycaprolactone Membranes: A Novel Wound Dressing

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Elijah Zhengyang Cai

2014-11-01

Full Text Available BackgroundThe combination of polycaprolactone and hyaluronic acid creates an ideal environment for wound healing. Hyaluronic acid maintains a moist wound environment and accelerates the in-growth of granulation tissue. Polycaprolactone has excellent mechanical strength, limits inflammation and is biocompatible. This study evaluates the safety and efficacy of bio-conjugated polycaprolactone membranes (BPM as a wound dressing.Methods16 New Zealand white rabbits were sedated and local anaesthesia was administered. Two 3.0×3.0 cm full-thickness wounds were created on the dorsum of each rabbit, between the lowest rib and the pelvic bone. The wounds were dressed with either BPM (n=12 or Mepitel (n=12 (control, a polyamide-silicon wound dressing. These were evaluated macroscopically on the 7th, 14th, 21st, and 28th postoperative days for granulation, re-epithelialization, infection, and wound size, and histologically for epidermal and dermal regeneration.ResultsBoth groups showed a comparable extent of granulation and re-epithelialization. No signs of infection were observed. There was no significant difference (P>0.05 in wound size between the two groups. BPM (n=6: 8.33 cm2, 4.90 cm2, 3.12 cm2, 1.84 cm2; Mepitel (n=6: 10.29 cm2, 5.53 cm2, 3.63 cm2, 2.02 cm2; at the 7th, 14th, 21st, and 28th postoperative days. The extents of epidermal and dermal regeneration were comparable between the two groups.ConclusionsBPM is comparable to Mepitel as a safe and efficacious wound dressing.

In vivo Antibacterial and Wound Healing Activities of Roman Chamomile (Chamaemelum nobile).

Science.gov (United States)

Kazemian, Hossein; Ghafourian, Sobhan; Sadeghifard, Nourkhoda; Houshmandfar, Reza; Badakhsh, Behzad; Taji, Asieh; Shavalipour, Aref; Mohebi, Reza; Ebrahim-Saraie, Hadi Sedigh; Houri, Hamidreza; Heidari, Hamid

2018-01-01

Today considerable number of drugs are produced from plants. Several plants with antibacterial and healing applications are used in medicine such as Roman chamomile (Chamaemelum nobile L.). Wound infection is one of the most prevalent infections among infectious diseases around the world. Due to appearance of drug resistance, researchers are now paying attention to medicinal plants. Therefore, this study was designed to investigate the antimicrobial and wound healing properties of C. nobile against Pseudomonas aeruginosa using in vivo conditions. Ethanolic extract of C. nobile was provided using standard method. The 5% C. nobile ointment was prepared by dissolving lyophilized extract in eucerin. Forty five male rats were obtained from Ilam university. After anesthetization and wound creation, wounds were infected by P. aeruginosa. The rats were divided into three groups, group I was treated with C. nobile ointment, group II was treated with tetracycline ointment and the third group was treated with base gel as control group. Antibacterial and wound healing activities of C. nobile ointment were more than tetracycline ointment significantly. Our results indicated that extract of C. nobile had effective antibacterial activity and accelerated the progression of wound healing. Our study indicated that antibacterial and wound healing activities of C. nobile ointment were notable. C. nobile therapy in combination with antibiotics can also be useful because medicinal plants contents operate in synergy with antibiotics. These results revealed the value of plant extracts to control antibiotic resistant bacteria in wound infections. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Modality of wound closure after total knee replacement: are staples as safe as sutures? A retrospective study of 181 patients

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Hammerberg E Mark

2011-10-01

Full Text Available Abstract Background Surgical site wound closure plays a vital role in post-operative success. This effect is magnified in regard to commonly performed elective procedures such as total knee arthroplasty. The use of either sutures or staples for skin re-approximation remains a contested subject, which may have a significant impact on both patient safety and surgical outcome. The literature remains divided on this topic. Methods Two cohorts of patients at a level one trauma and regional referral center were reviewed. Cohorts consisted of consecutive total knee arthroplasties performed by two surgeons who achieved surgical wound re-approximation by either staples or absorbable subcuticular sutures. Outcome variables included time of surgery, wound dehiscence, surgical site infection per Center for Disease Control criteria and repeat procedures for debridement and re-closure. Results 181 patients qualified for study inclusion. Staples were employed in 82 cases (45.3% of total and sutures in 99 cases (54.7%. The staples group had no complications while the sutures group had 9 (9.1%. These consisted of: 4 infections (2 superficial, one deep, one organ/space; three patients required re-suturing for dehiscence; one allergic type reaction to suture material; and one gout flare resulting in dehiscence. The mean surgical time with sutures was 122.3 minutes (sd = 33.4 and with staples was 114 minutes (sd = 24.4. Conclusion This study demonstrated significantly fewer complications with staple use than with suture use. While all complications found in this study cannot be directly attributed to skin re-approximation method, the need for further prospective, randomized trials is established.

A multi-centre clinical evaluation of reactive oxygen topical wound gel in 114 wounds.

Science.gov (United States)

Dryden, M; Dickinson, A; Brooks, J; Hudgell, L; Saeed, K; Cutting, K F

2016-03-01

This article reports the outcomes of the use of Surgihoney RO (SHRO), topical wound dressing in a multi-centre, international setting. The aims were to explore the clinical effects of SHRO, including a reduction in bacterial load and biofilm and improvement in healing in a variety of challenging non-healing and clinically infected wounds. This was a non-comparative evaluation, where both acute and chronic wounds with established delayed healing were treated with the dressing. Clinicians prospectively recorded wound improvement or deterioration, level of wound exudate, presence of pain, and presence of slough and necrosis. Analysis of this data provided information on clinical performance of the dressing. Semi-quantitative culture to assess bacterial bioburden was performed where possible. We recruited 104 patients, mean age 61 years old, with 114 wounds. The mean duration of wounds before treatment was 3.7 months and the mean duration of treatment was 25.7 days. During treatment 24 wounds (21%) healed and the remaining 90 (79%) wounds improved following application of the dressing. No deterioration in any wound was observed. A reduction in patient pain, level of wound exudate and in devitalised tissue were consistently reported. These positive improvements in wound progress were reflected in the wound cultures that showed a reduction in bacterial load in 39 out of the 40 swabs taken. There were two adverse events recorded: a stinging sensation following application of the dressing was experienced by 2 patients, and 2 elderly patients died of causes unrelated to the dressing or to the chronic wound. These patients' wounds and their response to SHRO have been included in the analysis. SHRO was well tolerated and shows great promise as an effective potent topical antimicrobial in the healing of challenging wounds. Matthew Dryden has become a shareholder in Matoke Holdings, the manufacturer of Surgihoney RO, since the completion of this study. Keith Cutting is a

Postoperative spine infections

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Paolo Domenico Parchi

2015-09-01

Full Text Available Postoperative spinal wound infection is a potentially devastating complication after operative spinal procedures. Despite the utilization of perioperative prophylactic antibiotics in recent years and improvements in surgical technique and postoperative care, wound infection continues to compromise patients’ outcome after spinal surgery. In the modern era of pending health care reform with increasing financial constraints, the financial burden of post-operative spinal infections also deserves consideration. The aim of our work is to give to the reader an updated review of the latest achievements in prevention, risk factors, diagnosis, microbiology and treatment of post-operative spinal wound infections. A review of the scientific literature was carried out using electronic medical databases Pubmed, Google Scholar, Web of Science and Scopus for the years 1973-2012 to obtain access to all publications involving the incidence, risk factors, prevention, diagnosis, treatment of postoperative spinal wound infections. We initially identified 119 studies; of these 60 were selected. Despite all the measures intended to reduce the incidence of surgical site infections in spine surgery, these remain a common and potentially dangerous complication.

Biliary bacteria, antibiotic use, and wound infection in surgery of the gallbladder and common bile duct.

Science.gov (United States)

Lewis, R T; Goodall, R G; Marien, B; Park, M; Lloyd-Smith, W; Wiegand, F M

1987-01-01

That clinical risk groups predict postoperative infection in biliary operations has recently been challenged. To reevaluate the risk of infection, we studied 215 patients stratified by clinical risk factors. Of 100 patients having simple "low-risk" cholecystectomy, 11 had positive bile cultures (90% pure), and one with sterile bile got a staphylococcal wound infection (WI). Among 92 "high-risk" patients with acute cholecystitis, obstructive jaundice, or choledochal stones, 42 had positive bile cultures (44% pure, 12% anaerobes). One of 52 patients who received preoperative cefazolin got a staphylococcal WI, but ten of 40 patients without antibiotic therapy developed WIs, nine caused by organisms that also grew from the bile. Of 23 patients with obstructive cholangitis, 22 had positive bile cultures (88% mixed, 23% anaerobes). Despite antibiotic therapy, four developed WIs caused by these organisms. The concept of clinical risk factors is validated.

Distinction of infected and non-infected post-surgical incisions with In-111-WBC scintigraphy

International Nuclear Information System (INIS)

Abdel-Nabi, H.; Hinkle, G.H.; Olsen, J.O.

1985-01-01

To determine if In-111-WBCs scintigraphy can distinguish between healing and infection in post-surgical wounds, a prospective study was performed in patients with 3-14 day old surgical incisions. Eighteen patients (11 males and 7 females) were scanned 24 hrs after injection of 0.5 mCi of In-111 labeled autologous leukocytes. The scan findings were correlated with blood and/wound cultures results and diagnosis at time of discharge. Incisional uptake of In-111-WBCs was noted in 9 patients with infected surgical wounds and was absent in those 9 patients with non-infected surgical wounds. The results of the authors' study show that In-111-WBCs do not accumulate in non-infected surgical incisions. This confirms their previous findings in rats. The high specificity of In-111 leukocytes imaging makes it a valuable study in the evaluation of post-operative patients with suspected surgical wound infections. In-111 WBCs scintigraphy can distinguish between normal healing and infection at the site of recent (3-14 days) surgical incisions

Clinical relevance and effect of surgical wound classification in appendicitis: Retrospective evaluation of wound classification discrepancies between surgeons, Swissnoso-trained infection control nurse, and histology as well as surgical site infection rates by wound class.

Science.gov (United States)

Wang-Chan, Anastasija; Gingert, Christian; Angst, Eliane; Hetzer, Franc Heinrich

2017-07-01

Surgical wound classification (SWC) is used for risk stratification of surgical site infection (SSI) and serves as the basis for measuring quality of care. The objective was to examine the accuracy and reliability of SWC. This study was purposed to evaluate the discrepancies in SWC as assessed by three groups: surgeons, an infection control nurse, and histopathologic evaluation. The secondary aim was to compare the risk-stratified SSI rates using the different SWC methods for 30 d postoperatively. An analysis was performed of the appendectomies from January 2013 to June 2014 in the Cantonal Hospital of Schaffhausen. SWC was assigned by the operating surgeon at the end of the procedure and retrospectively reviewed by a Swissnoso-trained infection control nurse after reading the operative and pathology report. The level of agreement among the three different SWC assessment groups was determined using kappa statistic. SSI rates were analyzed using a chi-square test. In 246 evaluated cases, the kappa scores for interrater reliability among the SWC assessments across the three groups ranged from 0.05 to 0.2 signifying slight agreement between the groups. SSIs were more frequently associated with trained infection control nurse-assigned SWC than with surgeons based SWC. Our study demonstrated a considerable discordance in the SWC assessments performed by the three groups. Unfortunately, the currently practiced SWC system suffers from ambiguity in definition and/or implementation of these definitions is not clearly stated. This lack of reliability is problematic and may lead to inappropriate comparisons within and between hospitals and surgeons. Copyright © 2017 The Author(s). Published by Elsevier Inc. All rights reserved.

MANAGEMENT OF A CHRONIC NECROTIZING WOUND IN A DOG USING NATURAL HONEY THERAPY

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Adeyemi A.B.

2017-12-01

Full Text Available Infected skin wounds are common in pet animals. Following an infected severe bite wound in a dog with marked necrotic aftermath, natural honey was successfully used alongside systemic antibiotic therapy to hasten healing. The condition improved with speed and regeneration of skin tissue, avoiding sloughing. The wound took 168 days to heal and to form a scar. Natural honey can be considered as a wound management tool, as it is both highly effective, can render a low cost therapy and less managemental expenditure compared to other specialized therapies and techniques.

Factors affecting wound ooze in total knee replacement

Science.gov (United States)

Butt, U; Ahmad, R; Aspros, D; Bannister, GC

2010-01-01

INTRODUCTION Wound ooze is common following total knee arthroplasty (TKA) and persistent wound infection is a risk factor for infection, and increased length and cost of hospitalisation. PATIENTS AND METHODS We undertook a prospective study to assess the effect of tourniquet time, peri-articular local anaesthesia and surgical approach on wound oozing after TKA. RESULTS The medial parapatellar approach was used in 59 patients (77%) and subvastus in 18 patients (23%). Peri-articular local anaesthesia (0.25% Bupivacaine with 1:1,000,000 adrenalin) was used in 34 patients (44%). The mean tourniquet time was 83 min (range, 38–125 min). We found a significant association between cessation of oozing and peri-articular local anaesthesia (P = 0.003), length of the tourniquet time (P = 0.03) and the subvastus approach (P = 0.01). CONCLUSIONS Peri-articular local anaesthesia, the subvastus approach and shorter tourniquet time were all associated with less wound oozing after total knee arthroplasty. PMID:20836920

Adjuvant combined ozone therapy for extensive wound over tibia

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Prasham Shah

2011-01-01

Full Text Available Disinfectant and antibacterial properties of ozone are utilized in the treatment of nonhealing or ischemic wounds. We present here a case of 59 years old woman with compartment syndrome following surgical treatment of stress fracture of proximal tibia with extensively infected wound and exposed tibia to about 4/5 of its extent. The knee joint was also infected with active pus draining from a medial wound. At presentation the patient had already taken treatment for 15 days in the form of repeated wound debridements and parenteral antibiotics, which failed to heal the wound and she was advised amputation. Topical ozone therapy twice daily and ozone autohemotherapy once daily were given to the patient along with daily dressings and parenteral antibiotics. Within 5 days, the wound was healthy enough for spilt thickness skin graft to provide biological dressing to the exposed tibia bone. Topical ozone therapy was continued for further 5 days till the knee wound healed. On the 15th day, implant removal, intramedullary nailing, and latissimus dorsi pedicle flap were performed. Both the bone and the soft tissue healed without further complications and at 20 months follow-up, the patient was walking independently with minimal disability.

Wounding in the plant tissue: the defense of a dangerous passage

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Daniel Valentin Savatin

2014-09-01

Full Text Available Plants are continuously exposed to agents such as herbivores and environmental mechanical stresses that cause wounding and open the way to the invasion by microbial pathogens. Wounding provides nutrients to pathogens and facilitates their entry into the tissue and subsequent infection. Plants have evolved constitutive and induced defense mechanisms to properly respond to wounding and prevent infection. The constitutive defenses are represented by physical barriers, i.e. the presence of cuticle or lignin, or by metabolites that act as toxins or deterrents for herbivores. Plants are also able to sense the injured tissue as an altered self and induce responses similar to those activated by pathogen infection. Endogenous molecules released from wounded tissue may act as Damage-Associated Molecular Patterns (DAMPs that activate the plant innate immunity. Wound-induced responses are both rapid, such as the oxidative burst and the expression of defense-related genes, and late, such as the callose deposition, the accumulation of proteinase inhibitors and of hydrolytic enzymes (i.e. chitinases and gluganases. Typical examples of DAMPs involved in the response to wounding are the peptide systemin and the oligogalacturonides, which are oligosaccharides released from the pectic component of the cell wall. Responses to wounding take place both at the site of damage (local response and systemically (systemic response and are mediated by hormones such as jasmonic acid, ethylene, salicylic acid and abscisic acid.

Systematic Review and Meta-Analysis of Randomized Controlled Trials Evaluating Prophylactic Intra-Operative Wound Irrigation for the Prevention of Surgical Site Infections.

Science.gov (United States)

de Jonge, Stijn W; Boldingh, Quirine J J; Solomkin, Joseph S; Allegranzi, Benedetta; Egger, Matthias; Dellinger, E Patchen; Boermeester, Marja A

Surgical site infections (SSIs) are one of the most common hospital-acquired infections. To reduce SSIs, prophylactic intra-operative wound irrigation (pIOWI) has been advocated, although the results to date are equivocal. To develop recommendations for the new World Health Organization (WHO) SSI prevention guidelines, a systematic literature review and a meta-analysis were conducted on the effectiveness of pIOWI using different agents as a means of reducing SSI. The PUBMED, Embase, CENTRAL, CINAHL, and WHO databases were searched. Randomized controlled trials (RCTs) comparing either pIOWI with no pIOWI or with pIOWI using different solutions and techniques were retrieved with SSI as the primary outcome. Meta-analyses were performed, and odds ratios (OR) and the mean difference with 95% confidence intervals (CI) were extracted and pooled with a random effects model. Twenty-one studies were suitable for analysis, and a distinction was made between intra-peritoneal, mediastinal, and incisional wound irrigation. A low quality of evidence demonstrated a statistically significant benefit for incisional wound irrigation with an aqueous povidone-iodine (PVP-I) solution in clean and clean contaminated wounds (OR 0.31; 95% CI 0.13-0.73; p = 0.007); 50 fewer SSIs per 1,000 procedures (from 19 fewer to 64 fewer)). Antibiotic irrigation had no significant effect in reducing SSIs (OR 1.16; 95% CI 0.64-2.12; p = 0.63). Low-quality evidence suggests considering the use of prophylactic incisional wound irrigation to prevent SSI with an aqueous povidone-iodine solution. Antibiotic irrigation does not show a benefit and therefore is discouraged.

Isolation and in vitro evaluation of bacteriophages against MDR-bacterial isolates from septic wound infections.

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Roja Rani Pallavali

Full Text Available Multi-drug resistance has become a major problem for the treatment of pathogenic bacterial infections. The use of bacteriophages is an attractive approach to overcome the problem of drug resistance in several pathogens that cause fatal diseases. Our study aimed to isolate multi drug resistant bacteria from patients with septic wounds and then isolate and apply bacteriophages in vitro as alternative therapeutic agents. Pus samples were aseptically collected from Rajiv Gandhi Institute of Medical Science (RIMS, Kadapa, A.P., and samples were analyzed by gram staining, evaluating morphological characteristics, and biochemical methods. MDR-bacterial strains were collected using the Kirby-Bauer disk diffusion method against a variety of antibiotics. Bacteriophages were collected and tested in vitro for lytic activity against MDR-bacterial isolates. Analysis of the pus swab samples revealed that the most of the isolates detected had Pseudomonas aeruginosa as the predominant bacterium, followed by Staphylococcus aureus, Klebsiella pneumoniae and Escherichia coli. Our results suggested that gram-negative bacteria were more predominant than gram-positive bacteria in septic wounds; most of these isolates were resistant to ampicillin, amoxicillin, penicillin, vancomycin and tetracycline. All the gram-positive isolates (100% were multi-drug resistant, whereas 86% of the gram-negative isolates had a drug resistant nature. Further bacteriophages isolated from sewage demonstrated perfect lytic activity against the multi-drug resistant bacteria causing septic wounds. In vitro analysis of the isolated bacteriophages demonstrated perfect lysis against the corresponding MDR-bacteria, and these isolated phages may be promising as a first choice for prophylaxis against wound sepsis, Moreover, phage therapy does not enhance multi-drug resistance in bacteria and could work simultaneously on a wide variety of MDR-bacteria when used in a bacteriophage cocktail. Hence

Frequency and risk factor of abdominal wound dehiscence

International Nuclear Information System (INIS)

Khan, M.N.S.; Naqvi, A.H.; Irshad, K.; Chaudhary, A.R.

2004-01-01

Objective: To find out the frequency of abdominal wound dehiscence (AWD) in a tertiary care hospital and the assessment of associated risk factors. Subjects and Methods: This study was carried out on 406 patients who underwent laparotomy for intra peritoneal procedure and complied with inclusion criteria. Demographic features were recorded and any complications documented. Results: Out of a total of 406 patients, 32 showed wound dehiscence giving an over all frequency of 7.8%. The male to female ratio was 2.8:1. The frequency was greater in males than in females. Majority patients suffered from an underlying malignancy. Malignant intestinal obstruction was the leading cause of wound dehiscence. Forty three patients had hypoalbuminemia(serum albumin <35 gm/l) and 09 of them had AWD. Emergency surgery showed a higher frequency of AWD(12.5%), as compared to elective surgery (18/143 and 14/263 respectively). Wound infection was a major contributor to AWD as out of 406, 76 patients developed infection and then 21 manifested AWD. Older age was also associated with greater frequency. The overall mortality of AWD in this study was 28.1 %. Conclusion: AWD still continues to be major post operative complication, with a high morbidity and mortality. The significant risk factors in this study were age more than 55 years, male gender, underlying malignancy, wound infection, jaundice, use of steroids, emergency surgery, uraemia and technique of closure. (author)

Use of a new silver barrier dressing, ALLEVYN Ag in exuding chronic wounds.

LENUS (Irish Health Repository)

Kotz, Paula

2009-06-01

Recognising and managing wounds at risk of infection is vital in wound management. ALLEVYN Ag dressings have been designed to manage exudate in chronic wounds that are at risk of infection; are displaying signs of local infection; or where a suspected increase in bacterial colonisation is delaying healing. They combine an absorbent silver sulfadiazine containing hydrocellular foam layer, with a perforated wound contact layer and highly breathable top film. The results presented are from a multi-centre clinical evaluation of 126 patients conducted to assess the performance of ALLEVYN Ag (Adhesive, Non Adhesive and Sacrum dressings) in a range of indications. Clinicians rated the dressings as acceptable for use in various wound types in 88% of patients. The majority of clinical signs of infection reduced between the initial and the final assessment. The condition of wound tissue and surrounding skin was observed to improve, and there was significant evidence of a reduction in the level of exudate from initial to final assessment (p < 0.001). Clinicians rated ALLEVYN Ag as satisfying or exceeding expectations in over 90% of patients. The evaluation showed the dressings to offer real benefits to patients and clinicians across multiple indications when used in conjunction with local protocols.

A Critical Review on HIV/AIDS and Wound Care | Weledji | African ...

African Journals Online (AJOL)

Wound infections in AIDS patients increase discomfort, prolong hospital stay, render an additional burden upon an already debilitated patient and weaken the immune system further. Treatment must relate to the aetiology of the wound and take into account the patients underlying health problems. The treatment of wounds ...

early operative management of pilon fractures using the ...

African Journals Online (AJOL)

Background: Pilon fractures is a management challenge due to complexity of fracture pattern and ... excellent exposure for accurate fracture reduction and no wound complications in our case ... dehiscence, superficial infection, osteomyelitis,.

Spontaneous Rupture of Superficial Femoral Artery Repaired with Endovascular Stent-Grafting with use of Rendez-Vous Technique, Followed by Delayed Infection

International Nuclear Information System (INIS)

Fanelli, Fabrizio; Cannavale, Alessandro; Gazzetti, Marianna; Fantozzi, Cristiano; Taurino, Maurizio; Speziale, Francesco

2013-01-01

This is the case of a 72-year-old man with lower limb ischemia due to spontaneous rupture of nonaneurysmal superficial femoral artery that developed into thigh hematoma. After failure of a Fogarty revascularization, an emergency endovascular procedure was performed to restore the arterial continuity. A rendezvous procedure was performed with a double femoral and popliteal approach and two covered stent-grafts were deployed. Patient’s clinical conditions immediately improved, but 4 months later the stent-grafts were surgically removed for infection and exteriorization. A femoropopliteal bypass was performed. After 1 year follow-up, the patient is in good clinical condition.

Spontaneous Rupture of Superficial Femoral Artery Repaired with Endovascular Stent-Grafting with use of Rendez-Vous Technique, Followed by Delayed Infection

Energy Technology Data Exchange (ETDEWEB)

Fanelli, Fabrizio, E-mail: fabrizio.fanelli@uniroma1.it; Cannavale, Alessandro [University of Rome ' Sapienza,' , Department of Radiological Sciences, Vascular and Interventional Radiology Unit (Italy); Gazzetti, Marianna [Sapienza University of Rome ' Sapienza,' , Department of Surgery Paride Stefanini, Vascular Surgery Division, Policlinico Umberto I (Italy); Fantozzi, Cristiano; Taurino, Maurizio [University of Rome ' Sapienza,' , Department of Vascular Surgery (Italy); Speziale, Francesco [Sapienza University of Rome ' Sapienza,' , Department of Surgery Paride Stefanini, Vascular Surgery Division, Policlinico Umberto I (Italy)

2013-02-15

This is the case of a 72-year-old man with lower limb ischemia due to spontaneous rupture of nonaneurysmal superficial femoral artery that developed into thigh hematoma. After failure of a Fogarty revascularization, an emergency endovascular procedure was performed to restore the arterial continuity. A rendezvous procedure was performed with a double femoral and popliteal approach and two covered stent-grafts were deployed. Patient's clinical conditions immediately improved, but 4 months later the stent-grafts were surgically removed for infection and exteriorization. A femoropopliteal bypass was performed. After 1 year follow-up, the patient is in good clinical condition.

Studies on Wound Healing Activity of Heliotropium indicum Linn. Leaves on Rats

OpenAIRE

Dash, G. K.; Murthy, P. N.

2011-01-01

The petroleum ether, chloroform, methanol, and aqueous extracts of Heliotropium indicum Linn. (Family: Boraginaceae) were separately evaluated for their wound healing activity in rats using excision (normal and infected), incision, and dead space wound models. The effects of test samples on the rate of wound healing were assessed by the rate of wound closure, period of epithelialisation, wound breaking strength, weights of the granulation tissue, determination of hydroxyproline, super oxide d...

Negative pressure therapy for the treatment of complex wounds

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RENAN VICTOR KÜMPEL SCHMIDT LIMA

Full Text Available ABSTRACT The objective of this study is to evaluate the effectiveness of negative pressure therapy (NPT in the treatment of complex wounds, with emphasis on its mechanisms of action and main therapeutic indications. We searched the Pubmed / Medline database for articles published from 1997 to 2016, and selected the most relevant ones. The mechanisms of action of NPT involveboth physical effects, such as increased perfusion, control of edema and exudate, reduction of wound dimensions and bacterial clearance, and biological ones, such as the stimulation of granulation tissue formation, microdeformations and reduction of Inflammatory response. The main indications of NPT are complex wounds, such as pressure ulcers, traumatic wounds, operative wound dehiscences, burns, necrotizing wounds, venous ulcers, diabetic wounds, skin grafts, open abdomen, prevention of complications in closed incisions and in the association with instillation of solutions in infected wounds.

Negative Pressure Wound Therapy With Instillation (NPWTi) Better Reduces Post-debridement Bioburden in Chronically Infected Lower Extremity Wounds Than NPWT Alone.

Science.gov (United States)

Goss, S G; Schwartz, J A; Facchin, F; Avdagic, E; Gendics, C; Lantis, J C

2012-12-01

An overabundance of bacteria in the chronic wound plays a significant role in the decreased ability for primary closure. One means of decreasing the bioburden in a wound is to operatively debride the wound for wound bed optimization prior to application of other therapy, such as Negative Pressure Wound Therapy (NPWT). We undertook a prospective pilot study to assess the efficacy of wound bed preparation for a standard algorithm (sharp surgical debridement followed by NPWT) versus one employing sharp surgical debridement followed by Negative Pressure Wound Therapy with Instillation (NPWTi). Thirteen patients, corresponding to 16 chronic lower leg and foot wounds were taken to the operating room for debridement. The patients were sequentially enrolled in 2 treatment groups: the first receiving treatment with operative debridement followed by 1 week of NPWT with the instillation of quarter strength bleach solution; the other receiving a standard algorithm consisting of operative debridement and 1 week of NPWT. Quantitative cultures were taken pre-operatively after sterile preparation and draping of the wound site (POD # 0, pre-op), post-operatively once debridement was completed (POD # 0, post-op), and on post-operative day 7 after operative debridement (POD # 7, post-op). After operative debridement (post-operative day 0) there was a mean of 3 (±1) types of bacteria per wound. The mean CFU/gram tissue culture was statistically greater - 3.7 × 10(6) (±4 × 10(6)) in the NPWTi group, while in the standard group (NPWT) the mean was 1.8 × 10(6) (±2.36 × 10(6)) CFU/gram tissue culture (p = 0.016); at the end of therapy there was no statistical difference between the two groups (p = 0.44). Wounds treated with NPWTi had a mean of 2.6 × 10(5) (±3 × 10(5)) CFU/gram of tissue culture while wounds treated with NPWT had a mean of 2.79 × 10(6) (±3.18 × 10(6)) CFU/gram of tissue culture (p = 0.43). The mean absolute reduction in bacteria for the

Efficacy of topical and systemic antibiotic treatment of meticillin-resistant Staphylococcus aureus in a murine superficial skin wound infection model

DEFF Research Database (Denmark)

Vingsbo Lundberg, Carina; Frimodt-Møller, Niels

2013-01-01

Meticillin-resistant Staphylococcus aureus (MRSA) is a rapidly spreading pathogen associated predominantly with skin infections. The lack of clinical evidence indicating the best treatment strategy to combat MRSA skin infections prompted us to investigate the efficacy of available treatment options...... were determined. Retapamulin, fusidic acid and mupirocin treatment for 3 days reduced the bacterial loads by 2.5, 2.9 and 2.0 log(10) CFU, respectively, and treatment for 6 days by 5.0, 4.2 and 5.1 log(10) CFU, respectively, compared with non-treated controls (P...

Noninvasive measurement of burn wound depth applying infrared thermal imaging (Conference Presentation)

Science.gov (United States)

Jaspers, Mariëlle E.; Maltha, Ilse M.; Klaessens, John H.; Vet, Henrica C.; Verdaasdonk, Rudolf M.; Zuijlen, Paul P.

2016-02-01

In burn wounds early discrimination between the different depths plays an important role in the treatment strategy. The remaining vasculature in the wound determines its healing potential. Non-invasive measurement tools that can identify the vascularization are therefore considered to be of high diagnostic importance. Thermography is a non-invasive technique that can accurately measure the temperature distribution over a large skin or tissue area, the temperature is a measure of the perfusion of that area. The aim of this study was to investigate the clinimetric properties (i.e. reliability and validity) of thermography for measuring burn wound depth. In a cross-sectional study with 50 burn wounds of 35 patients, the inter-observer reliability and the validity between thermography and Laser Doppler Imaging were studied. With ROC curve analyses the ΔT cut-off point for different burn wound depths were determined. The inter-observer reliability, expressed by an intra-class correlation coefficient of 0.99, was found to be excellent. In terms of validity, a ΔT cut-off point of 0.96°C (sensitivity 71%; specificity 79%) differentiates between a superficial partial-thickness and deep partial-thickness burn. A ΔT cut-off point of -0.80°C (sensitivity 70%; specificity 74%) could differentiate between a deep partial-thickness and a full-thickness burn wound. This study demonstrates that thermography is a reliable method in the assessment of burn wound depths. In addition, thermography was reasonably able to discriminate among different burn wound depths, indicating its potential use as a diagnostic tool in clinical burn practice.

Bacterial Contribution in Chronicity of Wounds.

Science.gov (United States)

Rahim, Kashif; Saleha, Shamim; Zhu, Xudong; Huo, Liang; Basit, Abdul; Franco, Octavio Luiz

2017-04-01

A wound is damage of a tissue usually caused by laceration of a membrane, generally the skin. Wound healing is accomplished in three stages in healthy individuals, including inflammatory, proliferative, and remodeling stages. Healing of wounds normally starts from the inflammatory phase and ends up in the remodeling phase, but chronic wounds remain in an inflammatory stage and do not show progression due to some specific reasons. Chronic wounds are classified in different categories, such as diabetic foot ulcer (DFU), venous leg ulcers (VLU) and pressure ulcer (PU), surgical site infection (SSI), abscess, or trauma ulcers. Globally, the incidence rate of DFU is 1-4 % and prevalence rate is 5.3-10.5 %. However, colonization of pathogenic bacteria at the wound site is associated with wound chronicity. Most chronic wounds contain more than one bacterial species and produce a synergetic effect that results in previously non-virulent bacterial species becoming virulent and causing damage to the host. While investigating bacterial diversity in chronic wounds, Staphylococcus, Pseudomonas, Peptoniphilus, Enterobacter, Stenotrophomonas, Finegoldia, and Serratia were found most frequently in chronic wounds. Recently, it has been observed that bacteria in chronic wounds develop biofilms that contribute to a delay in healing. In a mature biofilm, bacteria grow slowly due to deficiency of nutrients that results in the resistance of bacteria to antibiotics. The present review reflects the reasons why acute wounds become chronic. Interesting findings include the bacterial load, which forms biofilms and shows high-level resistance toward antibiotics, which is a threat to human health in general and particularly to some patients who have acute wounds.

The Society for Vascular Surgery Wound, Ischemia, and foot Infection (WIfI) classification system predicts wound healing but not major amputation in patients with diabetic foot ulcers treated in a multidisciplinary setting.

Science.gov (United States)

Mathioudakis, Nestoras; Hicks, Caitlin W; Canner, Joseph K; Sherman, Ronald L; Hines, Kathryn F; Lum, Ying W; Perler, Bruce A; Abularrage, Christopher J

2017-06-01

The Society for Vascular Surgery Wound, Ischemia, and foot Infection (WIfI) threatened limb classification has been shown to correlate well with risk of major amputation and time to wound healing in heterogeneous diabetic and nondiabetic populations. Major amputation continues to plague the most severe stage 4 WIfI patients, with 1-year amputation rates of 20% to 64%. Our aim was to determine the association between WIfI stage and wound healing and major amputation among patients with diabetic foot ulcers (DFUs) treated in a multidisciplinary setting. All patients presenting to our multidisciplinary DFU clinic from July 2012 to December 2015 were enrolled in a prospective database. Wound healing and major amputation were compared for patients stratified by WIfI classification. There were 217 DFU patients with 439 wounds (mean age, 58.3 ± 0.8 years; 58% male, 63% black) enrolled, including 28% WIfI stage 1, 11% stage 2, 33% stage 3, and 28% stage 4. Peripheral arterial disease and dialysis were more common in patients with advanced (stage 3 or 4) wounds (P ≤ .05). Demographics of the patients, socioeconomic status, and comorbidities were otherwise similar between groups. There was a significant increase in the number of active wounds per limb at presentation with increasing WIfI stage (stage 1, 1.1 ± 0.1; stage 4, 1.4 ± 0.1; P = .03). Mean wound area (stage 1, 2.6 ± 0.6 cm 2 ; stage 4, 15.3 ± 2.8 cm 2 ) and depth (stage 1, 0.2 ± 0.0 cm; stage 4, 0.8 ± 0.1 cm) also increased progressively with increasing wound stage (P healing (P healing time was 190 ± 17 days, and risk of major amputation at 1 year was 5.7% ± 3.2%. Among patients with DFU, the WIfI classification system correlated well with wound healing but was not associated with risk of major amputation at 1 year. Although further prospective research is warranted, our results suggest that use of a multidisciplinary approach for DFUs may augment healing time and reduce amputation

Preclinical Evaluation of Tegaderm™ Supported Nanofibrous Wound Matrix Dressing on Porcine Wound Healing Model.

Science.gov (United States)

Ong, Chee Tian; Zhang, Yanzhong; Lim, Raymond; Samsonraj, Rebekah; Masilamani, Jeyakumar; Phan, Tran Hong Ha; Ramakrishna, Seeram; Lim, Ivor; Kee, Irene; Fahamy, Mohammad; Templonuevo, Vilma; Lim, Chwee Teck; Phan, Toan Thang

2015-02-01

Objective: Nanofibers for tissue scaffolding and wound dressings hold great potential in realizing enhanced healing of wounds in comparison with conventional counterparts. Previously, we demonstrated good fibroblast adherence and growth on a newly developed scaffold, Tegaderm™-Nanofiber (TG-NF), made from poly ɛ-caprolactone (PCL)/gelatin nanofibers electrospun onto Tegaderm (TG). The purpose of this study is to evaluate the performance and safety of TG-NF dressings in partial-thickness wound in a pig healing model. Approach: To evaluate the rate of reepithelialization, control TG, human dermal fibroblast-seeded TG-NF(+) and -unseeded TG-NF(-) were randomly dressed onto 80 partial-thickness burns created on four female and four male pigs. Wound inspections and dressings were done after burns on day 7, 14, 21, and 28. On day 28, full-thickness biopsies were taken for histopathological evaluation by Masson-Trichrome staining for collagen and hematoxylin-eosin staining for cell counting. Results: No infection and severe inflammation were recorded. Wounds treated with TG-NF(+) reepithelialized significantly faster than TG-NF(-) and control. Wound site inflammatory responses to study groups were similar as total cell counts on granulation tissues show no significant differences. Most of the wounds completely reepithelialized by day 28, except for two wounds in control and TG-NF(-). A higher collagen coverage was also recorded in the granulation tissues treated with TG-NF(+). Innovation and Conclusion: With better reepithelialization achieved by TG-NF(+) and similar rates of wound closure by TG-NF(-) and control, and the absence of elevated inflammatory responses to TG-NF constructs, TG-NF constructs are safe and demonstrated good healing potentials that are comparable to Tegaderm.

A systematic review of maggot debridement therapy for chronically infected wounds and ulcers.

Science.gov (United States)

Sun, Xinjuan; Jiang, Kechun; Chen, Jingan; Wu, Liang; Lu, Hui; Wang, Aiping; Wang, Jianming

2014-08-01

This study aimed to systematically evaluate maggot debridement therapy (MDT) in the treatment of chronically infected wounds and ulcers. We performed a meta-analysis referring to the PRISMA statement (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). We searched for published articles in the following databases: PubMed, Web of Science, Embase, Wanfang (Chinese), and the China National Knowledge Infrastructure (CNKI). The latest search was updated on March 14, 2014. For dichotomous outcomes, the effects of MDT were expressed as the relative risk (RR) and 95% confidence interval (CI). For continuous outcomes with different measurement scales, we calculated the standardized mean difference (SMD). The pooled effects were estimated using a fixed effect model or random effect model based on the heterogeneity test. Subgroup analyses were performed according to the types of wounds or ulcers. MDT had a significantly increased positive effect on wound healing compared with conventional therapies, with a pooled RR of 1.80 (95% CI 1.24-2.60). The subgroup analysis revealed that the combined RRs were 1.79 (95% CI 0.95-3.38) for patients with diabetic foot ulcers (DFU) and 1.70 (95% CI 1.28-2.27) for patients with other types of ulcers. The time to healing of the ulcers was significantly shorter among patients treated with MDT, with a pooled SMD of -0.95 (95% CI -1.24, -0.65). For patients with DFU, the SMD was -0.79 (95% CI -1.18, -0.41), and for patients with other types of ulcers, the SMD was -1.16 (95% CI -1.63, -0.69). MDT not only shortened the healing time but also improved the healing rate of chronic ulcers. Therefore, MDT may be a feasible alternative in the treatment of chronic ulcers. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

Clinical identification of bacteria in human chronic wound infections: culturing vs. 16S ribosomal DNA sequencing

Directory of Open Access Journals (Sweden)

Rhoads Daniel D

2012-11-01

Full Text Available Abstract Background Chronic wounds affect millions of people and cost billions of dollars in the United States each year. These wounds harbor polymicrobial biofilm communities, which can be difficult to elucidate using culturing methods. Clinical molecular microbiological methods are increasingly being employed to investigate the microbiota of chronic infections, including wounds, as part of standard patient care. However, molecular testing is more sensitive than culturing, which results in markedly different results being reported to clinicians. This study compares the results of aerobic culturing and molecular testing (culture-free 16S ribosomal DNA sequencing, and it examines the relative abundance score that is generated by the molecular test and the usefulness of the relative abundance score in predicting the likelihood that the same organism would be detected by culture. Methods Parallel samples from 51 chronic wounds were studied using aerobic culturing and 16S DNA sequencing for the identification of bacteria. Results One hundred forty-five (145 unique genera were identified using molecular methods, and 68 of these genera were aerotolerant. Fourteen (14 unique genera were identified using aerobic culture methods. One-third (31/92 of the cultures were determined to be Staphylococcus aureus, Pseudomonas aeruginosa, and Enterococcus faecalis with higher relative abundance scores were more likely to be detected by culture as demonstrated with regression modeling. Conclusion Discordance between molecular and culture testing is often observed. However, culture-free 16S ribosomal DNA sequencing and its relative abundance score can provide clinicians with insight into which bacteria are most abundant in a sample and which are most likely to be detected by culture.

Total Hip Replacement in Sickle Cell Disorder: A Preliminary report ...

African Journals Online (AJOL)

2018-04-04

Apr 4, 2018 ... as follows: periprosthetic fracture 1, superficial wound infection 1, pulmonary complication ... of intraoperative fractures as well as treatment of acetabular defects. A detailed ..... exposure and coagulation activation. Blood 2000 ...

Superficial basal cell carcinoma: A comparison of superficial only subtype with superficial combined with other subtypes by age, sex and anatomic site in 3150 cases.

Science.gov (United States)

Pyne, John H; Myint, Esther; Barr, Elizabeth M; Clark, Simon P; David, Michael; Na, Renua; Hou, Ruihang

2017-08-01

Basal cell carcinoma (BCC) may present as superficial subtype alone (sBCC) or superficial combined with other subtypes. The objective of this study was to compare sBCC without or with other BCC subtypes by age, sex and anatomic site. We retrospectively collected superficial BCC with the above characteristics from an Australian center during 2009 to 2014. We recorded 1528 sBCC and 1622 superficial BCC combined with other BCC subtype cases. Males numbered 2007 and females 1140. On males, head sites (forehead, cheek, nose and ear combined) compared to limb plus trunk sites displayed a higher incidence of superficial BCC combined with either nodular and or aggressive BCC subtypes (OR 13.15 CI 95% 8.9-19.5 P < .0001). On females a similar comparison also found a higher incidence of superficial BCC combined with solid subtype BCC on head sites compared to trunk and limb sites (OR 9.66 CI 95% 5.8-16.1 P < .0001). Superficial BCC alone is more likely on younger females on trunk and limb sites. Small partial biopsies reported as sBCC may miss other BCC subtypes present with higher risk on facial sites for males and females. Males had smaller proportions of superficial only subtype BCC on facial and ear sites compared to females. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Moist wound healing compared with standard care of treatment of primary closed vascular surgical wounds: a prospective randomized controlled study

DEFF Research Database (Denmark)

Vogt, Katja C; Uhlyarik, M; Schroeder, Torben V

2007-01-01

This study was a randomized-controlled trial comparing the standard type of dry dressing, Mepore, with moist wound healing, using a hydrofiber dressing, Aquacel, in primary closed wounds after vascular surgery. The endpoints were patient comfort, cost-effectiveness, infections, wound complications......, and length of hospital stay. One hundred and sixty patients were randomized to receive either Mepore or Aquacel dressing. There was no significant difference in patient comfort between the two groups, but a higher cost in the Aquacel group despite significantly fewer changes of dressings in these patients...

Multicenter Quality Improvement Project to Prevent Sternal Wound Infections in Pediatric Cardiac Surgery Patients.

Science.gov (United States)

Woodward, Cathy; Taylor, Richard; Son, Minnette; Taeed, Roozbeh; Jacobs, Marshall L; Kane, Lauren; Jacobs, Jeffrey P; Husain, S Adil

2017-07-01

Children undergoing cardiac surgery are at risk for sternal wound infections (SWIs) leading to increased morbidity and mortality. Single-center quality improvement (QI) initiatives have demonstrated decreased infection rates utilizing a bundled approach. This multicenter project was designed to assess the efficacy of a protocolized approach to decrease SWI. Pediatric cardiac programs joined a collaborative effort to prevent SWI. Programs implemented the protocol, collected compliance data, and provided data points from local clinical registries using Society of Thoracic Surgery Congenital Heart Surgery Database harvest-compliant software or from other registries. Nine programs prospectively collected compliance data on 4,198 children. Days between infections were extended from 68.2 days (range: 25-82) to 130 days (range: 43-412). Protocol compliance increased from 76.7% (first quarter) to 91.3% (final quarter). Ninety (1.9%) children developed an SWI preprotocol and 64 (1.5%) postprotocol, P = .18. The 657 (15%) delayed sternal closure patients had a 5% infection rate with 18 (5.7%) in year 1 and 14 (4.3%) in year 2 P = .43. Delayed sternal closure patients demonstrated a trend toward increased risk for SWI of 1.046 for each day the sternum remained open, P = .067. Children who received appropriately timed preop antibiotics developed less infections than those who did not, 1.9% versus 4.1%, P = .007. A multicenter QI project to reduce pediatric SWIs demonstrated an extension of days between infections and a decrease in SWIs. Patients who received preop antibiotics on time had lower SWI rates than those who did not.

Fournier's gangrene secondary to appendicectomy | Onyenyirionwu ...

African Journals Online (AJOL)

Background: Fournier's gangrene is predominantly an infectious process involving the superficial and deep fascial planes in the perineal area. Aim: To highlight the existence of a potential space between the Scarpa's and Camper's fascia which allows for spread of infection from an infected appendicectomy wound to the ...

Wound ventilation : A new concept for prevention of complications in cardiac surgery

OpenAIRE

Persson, Mikael

2003-01-01

Cardiac surgery through an open chest wound is a major operation both in size and duration. The wound exposure to ambient air implies considerable risks. 1) Air may enter the heart and great vessels and embolize to the brain or cardiac muscle where it may cause dysfunction or permanent damage. 2) The wound is exposed to airborne bacterial contamination, which may lead to postoperative wound infection. 3) The wound is subjected to desiccation, which may lead to serious adhesi...

Wound healing complications in brain tumor patients on Bevacizumab.

Science.gov (United States)

Ladha, Harshad; Pawar, Tushar; Gilbert, Mark R; Mandel, Jacob; O-Brien, Barbara; Conrad, Charles; Fields, Margaret; Hanna, Teresa; Loch, Carolyn; Armstrong, Terri S

2015-09-01

Bevacizumab (BEV) is commonly used for treating recurrent glioblastoma (GBM), and wound healing is a well-established adverse event. Retrospective analysis of GBM patients with and without wound healing complications while on BEV treatment is reported. 287 patients identified, majority were males (60 %) with median age of 52.5 years. 14 cases identified with wound healing problems, related to either craniotomy (n = 8) or other soft tissue wounds (n = 6). Median duration of BEV treatment to complication was 62 days (range 6-559). Majority received 10 mg/kg (n = 11) and nine (64.3 %) were on corticosteroids, with median daily dose of 6 mg (range 1-16 mg) for median of 473 days before starting BEV. For dehisced craniotomy wounds, median time for starting BEV from last surgery was 29 days (range 27-345). Median time from starting BEV to developing wound complication was 47 days (range 16-173). Seven (87.5 %) had infected wounds requiring antibiotics, hospitalization. Four (50 %) required plastic surgery. BEV stopped and safely resumed in 6 (75 %) patients; median delay was 70 days (range 34-346). Soft tissue wounds included decubitus ulcer, dehisced striae, herpes simplex, trauma to hand and back, and abscess. Median time from starting BEV to wound issues was 72 days (range 6-559). Five (83.3 %) were infected, requiring antibiotics. While three (50 %) required hospitalization, none required plastic surgery. Treatment stopped in five (83.3 %) and restarted in two (median delay 48 days, range 26-69). Wound healing complications are uncommon but associated with significant morbidity. Identifying those at risk and contributing factors warrants further investigation.

Studies on Wound Healing Activity of Heliotropium indicum Linn. Leaves on Rats.

Science.gov (United States)

Dash, G K; Murthy, P N

2011-01-01

The petroleum ether, chloroform, methanol, and aqueous extracts of Heliotropium indicum Linn. (Family: Boraginaceae) were separately evaluated for their wound healing activity in rats using excision (normal and infected), incision, and dead space wound models. The effects of test samples on the rate of wound healing were assessed by the rate of wound closure, period of epithelialisation, wound breaking strength, weights of the granulation tissue, determination of hydroxyproline, super oxide dismutase (SOD), catalase, and histopathology of the granulation tissues. Nitrofurazone (0.2% w/w) in simple ointment I. P. was used as reference standard for the activity comparison. The results revealed significant promotion of wound healing with both methanol and aqueous extracts with more promising activity with the methanol extract compared to other extracts under study. In the wound infection model (with S. aureus and P. aeruginosa), the methanol extract showed significant healing activity similar to the reference standard nitrofurazone. Significant increase in the granulation tissue weight, increased hydroxyproline content, and increased activity of SOD and catalase level with the animals treated with methanol extract in dead space wound model further augmented the wound healing potential of H. indicum. The present work substantiates its validity of the folklore use.

The use of a micropore particle technology in the treatment of acute wounds.

Science.gov (United States)

Ryan, E

2017-07-02

A clinical audit was performed to evaluate whether Acapsil micropore particle technology (MPPT) powder could improve the management of acute wounds to heal by secondary intention. Wounds, which could be characterised as sloughy, wet and probably infected, normally managed by debridement followed by negative pressure wound therapy (NPWT), were included in the evaluation. The MPPT powder was applied topically to the wound surface either once daily or on alternate days, with each wound receiving a total of two to five applications. Most patients had NPWT after the MPPT powder treatment had finished to assist healing. The study included nine patients with dehisced surgical wounds and one with a category IV pressure ulcer (PU). The wounds were generally covered in slough, exudate and showing signs of local infection. The topical MPPT powder rapidly desloughed the wounds, controlled exudate levels, promoted granulation and was well tolerated. All wounds proceeded towards closure. Comparison of the present data with MPPT powder to standard treatment suggests that the speed of healing using MPPT was improved. Further examination is required to determine if this reduces dressing changes, nursing time, and financial cost.

PSEUDOMONAS AERUGINOSA BIOFILM INFECTION SUPPRESSES LOCAL HOST RESPONSE IN BURN WOUNDS

DEFF Research Database (Denmark)

Trostrup, H.; Lerche, C. J.; Christophersen, L.

2015-01-01

Introduction: Non-invasive monitoring of wound healing is warranted. Opticalcoherence tomography (OCT) enables instant visualization of the epidermis andupper dermis. We have studied the healing of uniform epidermal wounds inhumans using OCT. Methods: Thirty-two, 16 females and 16 males, non-smok...

Prospective Randomized Evaluation of Intraoperative Application of Autologous Platelet-Rich Plasma on Surgical Site Infection or Delayed Wound Healing.

Science.gov (United States)

SanGiovanni, Thomas P; Kiebzak, Gary M

2016-05-01

Prevention of surgical site infections and the reduction of wound-related complication rates have become increasingly emphasized by hospital task groups and government agencies given the degree of economic burden it places on the health care system. Platelet-rich plasma (PRP) contains growth factors and other biomolecules that promote endogenous microbicidal activity. We hypothesized that PRP would help prevent postoperative infection and delayed wound healing (DWH). We randomized patients having foot or ankle surgery to the treatment group receiving intraoperative PRP (applied to operative field) and platelet-poor plasma at closing (PPP, on the sutured skin) or the control group (no PRP/PPP). The incidence of deep surgical site infection and DWH (collectively called endpoints) was compared between groups (n = 250/group). PRP had a mean 5.3-fold platelet concentration compared to whole blood, with concentrated white blood cells. Mean age (±SD) of patients was 52 years (±15), 65% were women. Minor and major operative procedures were included. Patients were followed for 60 days. Seventy controls had PRP prepared for assay of growth factors. Procedure mix, ASA scores, mean operative times, and comorbidity mix were similar between groups. The primary result was no difference in number of endpoints between groups: 19 patients in the PRP group (7.6%) versus 18 controls (7.2%). Endpoints were deep surgical site infections in 2 PRP/PPP patients and 1 control, and DWH in 17 PRP/PPP patients and 17 controls. Analysis of PRP samples revealed a large variation in growth factor concentrations between patients. Intraoperative application of PRP/PPP did not reduce the incidence of postoperative infection or DWH. Growth factor profiles varied greatly between patients, suggesting that the potentially therapeutic treatment delivered was not consistent from patient-to-patient. Level I, prospective randomized trial. © The Author(s) 2015.

Efficacy and safety of superficial chemical peeling in treatment of active acne vulgaris.

Science.gov (United States)

Al-Talib, Hassanain; Al-Khateeb, Alyaa; Hameed, Ayad; Murugaiah, Chandrika

2017-01-01

Acne vulgaris is an extremely common condition affecting the pilosebaceous unit of the skin and characterized by presence of comedones, papules, pustules, nodules, cysts, which might result in permanent scars. Acne vulgaris commonly involve adolescents and young age groups. Active acne vulgaris is usually associated with several complications like hyper or hypopigmentation, scar formation and skin disfigurement. Previous studies have targeted the efficiency and safety of local and systemic agents in the treatment of active acne vulgaris. Superficial chemical peeling is a skin-wounding procedure which might cause some potentially undesirable adverse events. This study was conducted to review the efficacy and safety of superficial chemical peeling in the treatment of active acne vulgaris. It is a structured review of an earlier seven articles meeting the inclusion and exclusion criteria. The clinical assessments were based on pretreatment and post-treatment comparisons and the role of superficial chemical peeling in reduction of papules, pustules and comedones in active acne vulgaris. This study showed that almost all patients tolerated well the chemical peeling procedures despite a mild discomfort, burning, irritation and erythema have been reported; also the incidence of major adverse events was very low and easily manageable. In conclusion, chemical peeling with glycolic acid is a well-tolerated and safe treatment modality in active acne vulgaris while salicylic acid peels is a more convenient for treatment of darker skin patients and it showed significant and earlier improvement than glycolic acid.

Risk Assessment of Abdominal Wall Thickness Measured on Pre-Operative Computerized Tomography for Incisional Surgical Site Infection after Abdominal Surgery.

Science.gov (United States)

Tongyoo, Assanee; Chatthamrak, Putipan; Sriussadaporn, Ekkapak; Limpavitayaporn, Palin; Mingmalairak, Chatchai

2015-07-01

The surgical site infection (SSI) is a common complication of abdominal operation. It relates to increased hospital stay, increased healthcare cost, and decreased patient's quality of life. Obesity, usually defined by BMI, is known as one of the risks of SSI. However, the thickness of subcutaneous layers of abdominal wall might be an important local factor affecting the rate of SSI after the abdominal operations. The objective of this study is to assess the importance of the abdominal wall thickness on incisional SSI rate. The subjects of the present study were patients who had undergone major abdominal operations at Thammasat University Hospital between June 2013 and May 2014, and had been investigated with CT scans before their operations. The demographic data and clinical information of these patients were recorded. The thickness ofsubcutaneous fatty tissue from skin down to the most superficial layer of abdominal wall muscle at the surgical site was measured on CT images. The wound infectious complication was reviewed and categorized as superficial and deep incisional SSIfollowing the definition from Centersfor Disease Control and Prevention (CDC) guidelines. The significance ofeach potentialfactors on SSI rates was determined separately with student t-test for quantitative data and χ2-test for categorical data. Then all factors, which had p operative CTscans. Post-operative SSI was 25.2% (35/139), superficial and deep types in 27 and 8 patients, respectively. The comparison of abdominal wall thickness between patients with and without infection was significantly different (20.0 ± 8.4 mm and 16.0 ± 7.2 mm, respectively). When the thickness at 20 mm was used as the cut-off value, 43 of 139 patients had abdominal wall thickness ≥ 20 mm. The incidence of SSI of the thickness ±20 mm group was 37.2% (16/43) and of the less thickness group was 19.8% (19/96), with p operation. However, only abdominal wall thickness and wound classification were still significant

Clinical management of maggot wounds in Bengal Tigers (Panthera tigris tigris

Directory of Open Access Journals (Sweden)

Anup Kumar Talukder

2017-03-01

Full Text Available Objecitve: Maggot wound is common in domestic and pet animals but report on maggot wound treatment in wildlife species is scanty. The study reported here the surgical and conservative management of maggot wounds including anesthetic protocol and postoperative care in two Bengal tigers (Panthera tigris tigris. Materials and methods: One female and one male tiger were presented with maggot wounds for treatment at the Bangabandhu Sheikh Mujib Safari Park, Gazipur, Bangladesh. Tigers were anesthetized with combined injection of xylazine (dosed at 1.0 mg/kg bwt, IM and ketamine hydrochloride (dosed at 3.5 mg/kg bwt, IM. Superficial maggots were removed from wounds using sterile tissue forceps. Gauze soaked in oil of turpentine was allowed to remain in each wound pocket for 5 min for the removal of deep-seated maggots. Finally, wounds were dressed with tincture iodine to clean out the dead tissue debris and to induce inflammation for rapid healing. A single subcutaneous injection of ivermectin (dosed at 200 µg/kg bwt, IM was given in each tiger. In addition, long acting oxytetracycline (dosed at 10 mg/kg bwt, IM on 48 h interval for six days, chlorpheniramine maleate (dosed at 1 mg/kg bwt, IM once daily for three days, and ascorbic acid (dosed at 250 mg/tiger, IM once daily for seven days were administered in both tigers. Results: The tigers were recovered successfully without any complications in two weeks following treatment. Conclusion: Surgical management using oil of turpentine and tincture iodine along with parenteral administration of ivermectin, long acting oxytetracycline and chlorpheniramine maleate are effective for successful management of maggot wounds in Bengal tigers. [J Adv Vet Anim Res 2017; 4(1.000: 104-109

Effect of auto-skin grafting on bacterial infection of wound in rats inflicted with combined radiation-burn injury

International Nuclear Information System (INIS)

Ran Xinze; Yan Yongtang; Wei Shuqing

1992-01-01

Rats were exposed to 6 Gy whole body γ-ray irradiation from a 60 Co source followed by light radiation burn (15% TBSA, full thickness burn) from a 5 kw bromo-tungsten lamp. The effect of auto-skin grafting on invasive bacterial infection of wound in the rats with combined radiation-burn injury was studied, In the control group inflicted with combined radiation-burn injury but without skin grafting, bacteria were found on and in the eschars at 24th hour after injury, and in the subeschar tissue on 3rd day. Tremendous bacterial multiplication occurred from 7th to 15th day, and the amount of bacteria in the internal organs increased along with the increase of subeschar infection. At the same time, no bacterial infection was found in internal organs in auto-skin grafted group at 24th hour after injury. The results show that skin grafting can decrease or prevent bacterial infection in both subeschar tissue and internal organs

Epidemiology of superficial and cutaneous mycosis in 5500 suspected patients in Tehran

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Ayatollah Nasrollahi Omran

2010-04-01

Full Text Available "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Identification of the determatophytosis species and superficial mycosis agents may be useful in directing the survey for environmental and animal sources of infection to educate the danger of acquiring infections from infected persons and other animals. Based on this background the identification of cutaneous mycosis distribution was the main purpose."n"nMethods: From March 2005 to Feb 2009 we examined 5500 patients suspected to superficial and cutaneous mycosis referred to medical mycology labs in Tehran, Iran for Medical Mycology examination. Skin, hair and nail sampling were taken by scraping from patients and collected for diagnosis. Diagnosis was confirmed by direct microscopy and culture according to the mycology routine laboratory methods."n"nResults: A total of 2271 cases (41.3% suffered from superficial and cutaneous mycosis. The most common infections were dermatophytosis 1279 cases (56.31%, Tinea Versicolor 356 cases (15.47%, Erythersma 283 cases (12.46%, cutaneous candidiosis 243 cases (10.7% and sacrophytic cutaneous mycosis 110 cases (4.83%. Tichophyton mentagrophytes was the most common etiological agent with 198 cases (41.56%. The most common clinical type of cutaneous candidiasis was

Daptomycin as a possible new treatment option for surgical management of Methicillin-Resistant Staphylococcus aureus sternal wound infection after cardiac surgery

Directory of Open Access Journals (Sweden)

Emmert Alexander

2010-08-01

Full Text Available Abstract We present a case of a 77-year old female who had undergone a coronary artery bypass grafting with an aortic valve replacement and developed three month later a Methicillin-Resistant Staphylococcus aureus (MRSA sternal wound infection which was successful treated with Daptomycin combined with vacuum-assisted closure (VAC.

Predictive ability of the Society for Vascular Surgery Wound, Ischemia, and foot Infection (WIfI) classification system after first-time lower extremity revascularizations

NARCIS (Netherlands)

J. Darling (Jeremy); J.C. McCallum (John C.); P.A. Soden (Peter A.); Guzman, R.J. (Raul J.); Wyers, M.C. (Mark C.); Hamdan, A.D. (Allen D.); H.J.M. Verhagen (Hence); M.L. Schermerhorn (Marc)

2017-01-01

markdownabstract__Objective:__ The Society for Vascular Surgery (SVS) Wound, Ischemia and foot Infection (WIfI) classification system was proposed to predict 1-year amputation risk and potential benefit from revascularization. Our goal was to evaluate the predictive ability of this scale in a

Lower limb revascularisation preceding surgical wound coverage - an interdisciplinary algorithm for chronic wound closure.

Science.gov (United States)

Aust, M C; Spies, M; Guggenheim, M; Gohritz, A; Kall, S; Rosenthal, H; Pichlmaier, M; Oehlert, G; Vogt, P M

2008-08-01

intervention. Vacuum-assisted closure (VAC) therapy was applied in 15 cases. Postoperatively, three cases of impaired wound healing and one infection occurred. Arterial insufficiency can be diagnosed safely by simple clinical examination. All clinically pathological results were successfully confirmed by angiography, allowing for a targeted peripheral vessel reopening to improve wound perfusion before surgery. This straightforward algorithm helped to improve the success of surgical therapy of chronic lower extremity wounds.

Electrospun polymeric dressings functionalized with antimicrobial peptides and collagen type I for enhanced wound healing

Science.gov (United States)

Felgueiras, H. P.; Amorim, M. T. P.

2017-10-01

Modern wound dressings combine medical textiles with active compounds that stimulate wound healing while protecting against infection. Electrospun wound dressings have been extensively studied and the electrospinning technique recognized as an efficient approach for the production of nanoscale fibrous mats. The unique diverse function and architecture of antimicrobial peptides (AMPs) has attracted considerable attention as a tool for the design of new anti-infective drugs. Functionalizing electrospun wound dressings with these AMPs is nowadays being researched. In the present work, we explore these new systems by highlighting the most important characteristics of electropsun wound dressings, revealing the importance of AMPs to wound healing, and the methods available to functionalize the electrospun mats with these molecules. The combined therapeutic potential of collagen type I and these AMP functionalized dressings will be highlighted as well; the significance of these new strategies for the future of wound healing will be clarified.

Chronic Pseudomonas aeruginosa biofilm infection impairs murine S100A8/A9 and neutrophil effector cytokines—implications for delayed wound closure?

DEFF Research Database (Denmark)

Trøstrup, Hannah; Lerche, Christian Johann; Christophersen, Lars Jackie

2017-01-01

The impact of Pseudomonas aeruginosa biofilm infections in chronic wounds and clinical implication for healing is receiving increased attention. However, the pathophysiology of host/pathogen interplay is not fully understood. By further revealing the mechanisms, necessary new treatment strategies...

Emergency wounds treated with cyanoacrylate and long-term results in pediatrics: a series of cases; what are the advantages and boards?

Directory of Open Access Journals (Sweden)

Gursoy Sonnur

2009-07-01

Full Text Available Abstract Background Ethyl-2-cyanoacrylate (ECA is a tissue adhesive material applied to close superficial wounds. The aim of this study was to explore the benefits of cyanoacrylates in the emergency department in children with current application with regard to cost-effectiveness, satisfaction and long follow up. Findings Patients were treated after assignment of the consent with an explanation by the relatives in a tertiary emergency department (ED, 2007. The evaluation was based on different superficial wound repairs due to blunt trauma within a 2-hour time period ( A total of 9 patients were evaluated and followed for 6 months. Except for one, all children were treated without any serious complications. ECA was cost-effective, time-saving, and provided successful repair satisfaction by a blinded plastic surgeon and patient/parents. Conclusion This report displayed the pediatric effective use of cyanoacrylates, even in non- traditional repairs in the emergency departments.

Waist-Hip Ratio Surrogate Is More Predictive Than Body Mass Index of Wound Complications After Pelvic and Acetabulum Surgery.

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Jaeblon, Todd; Perry, Kevin J; Kufera, Joseph A

2018-04-01

To determine whether a novel surrogate of waist-hip ratio (WHR) is more predictive of wound complications after pelvis or acetabulum stabilization than body mass index (BMI) and describe the method of measuring a WHR proxy (WHRp). Retrospective review. One Level 1 Trauma Center. One hundred sixty-one patients after operative repair of pelvis and acetabulum fractures. Operative stabilization of a pelvic ring injury or acetabular fracture. Infection (pin, superficial, and deep) and wound healing complication. We retrospectively reviewed 161 subjects after operative repair of pelvic and acetabular fractures. Primary outcome was any wound complication. BMI was acquired from medical records. WHRp was derived from anteroposterior and lateral computed tomography scout images. BMI and WHRp results were analyzed as continuous and categorical variables. BMI was grouped into high-risk categories of ≥30 and ≥40. WHRp data were grouped utilizing the WHO's high-risk profile for females (>0.85) and males (>0.90). An alternative optimal WHR was also assessed. Covariate analysis included demographic data, Injury Severity Score, mechanism, tobacco use, presence and types of open approach, injury type, associated injuries and comorbidities, failure of fixation, and thromboembolism. The mean follow-up was 15.9 months. Twenty-four (15%) patients developed wound complications. Increasing BMI (P < 0.007) and WHRp (P < 0.001) as continuous variables and female sex (P < 0.009) were associated with wound complications. Applying unadjusted continuous data to a receiver operating characteristic curve revealed a greater area under the curve for WHRp than for BMI (P < 0.001). The optimal predictive WHRp was ≥1.0 (P < 0.001, odds ratio 43.11). The receiver operating characteristic curve from adjusted data demonstrated a greater area under the curve for WHRp ≥1.0 (0.93) compared with BMI ≥30 (0.78) or ≥40 (0.75) and WHO WHRp (0.82). Computed tomography generated WHRp demonstrated

[ALEA study. Treatment of chronic wounds infected by the application of silver dressings nanocrystalline combined with dressings hydrocellular].

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Verdú Soriano, José; Nolasco Bonmati, Andreu

2010-10-01

This study was conducted with the objective to assess, in real clinical conditions in primary care and geriatric centers, application and utility of nanocrystalline silver dressings dressings combined with hydrocellular in relation to the development during 20 shifts dressing or complete healing of the characteristics of the lesions included in the study Prospective observational multicenter open, repeated measures. It could include injuries of different etiologies (pressure ulcers stage 11-111, lower limb and traumatic wounds or surgical origin), with clinical signs of local infection (at least three of the following: redness, purulent discharge, heat, edema and pain). Only one wound was included per patient. An analysis of effectiveness by intention to treat all lesions included. We recruited 103 patients who met the inclusion criteria but were collected in which 77 patients were used for nanocrystalline silver dressings in some phase of the study, They had a median of 80 years of age and 58.4% were women. By type of injury: 53.2% pressure ulcers, 31.2% lower extremity ulcers and 14.3% traumatic or surgical wounds. Over 50% of the lesions was older than eight months and a larger area of 22.75 cm2. At first, 70.1% had redness, purulent discharge 64.9%, 37.7% heat edema 42.9% and 65.8% pain. Remained in the study a median of 42.5 days at a rate of change of dressing every 2.5. During this time in 96.1% of the lesions were removed for clinical signs of local infection in a statistically significant (p < or = 0.001). 27.3% healed from injuries and those not healed, 92.9% experienced improvement, and its healing curves were statistically significant (p < 0.05). 92.2% of clinicians assessed treatment with these products as good or excellent. The use of the products used in this study consistent with the concept and PLH TIME, has proved useful in this type of injury reducing the clinical signs of infection, promoting granulation tissue and necrotic removing the burden

"Healing Effect of Topical Nifedipine on Skin Wounds of Diabetic Rats "

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Abbas Ebadi

2003-07-01

Full Text Available Non-healing foot ulcers in patients with diabetes are the leading causes of complications such as infection and amputation. Ulceration is the most common single precursor to amputation and has been identified as a causative factor in 85% of lower extremity amputations. It seems that poor outcomes are generally associated with infection, peripheral vascular disease and wounds of increasing depth. Nifedipine, a calcium channel blocker that is mainly used for the treatment of cardiovascular disorders has recently been used to treat wounds caused by peripheral vascular disorders. In present study topical Nifedipine 3% has been used to treat skin wounds in normal and diabetic rats. Effects of Nifedipine were evaluated in three different phases of wound healing process. In both experiments (normal and diabetic rats topical Nifedipine significantly improved inflammatory phase. However, maturation phase was only significantly improved in diabetic rats. Nifedipine did not affect proliferation phase in either group significantly. Overall results of this study showed topical Nifedipine improved skin wound healing process in normal and diabetic rats.

Impact of vacuum-assisted closure (VAC) therapy on clinical outcomes of patients with sternal wound infections: a meta-analysis of non-randomized studies.

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Falagas, Matthew E; Tansarli, Giannoula S; Kapaskelis, Anastasios; Vardakas, Konstantinos Z

2013-01-01

To examine the impact of VAC therapy on mortality of patients with sternal wound infections after cardiothoracic surgery. Controversial results regarding mortality of patients with sternal wound infections were published. We performed a systematic search in PubMed and Scopus. Mortality was the primary outcome of the meta-analysis. Recurrences, complications and length of stay were secondary outcomes. Twenty-two retrospective studies including 2467 patients were eligible for inclusion. Patients treated with VAC had significantly lower mortality compared to those treated without VAC [2233 patients, RR = 0.40, (95% CI 0.28, 0.57)]. This finding was consistent regardless of the study design, the exclusion of studies with positive findings, the criteria for establishment of the compared groups, the time of mortality assessment or the type of infections under study, provided that adequate data was available. VAC therapy was associated with fewer recurrences (RR = 0.34, 95% CI: 0.19-0.59). The meta-analysis did not show any difference in the length of stay (RR = -2.25, 95% CI: -7.52-3.02). VAC therapy was associated with lower mortality than other surgical techniques in retrospective cohorts of patients with DSWIs following cardiothoracic surgery.

Pseudomonas aeruginosa biofilm aggravates skin inflammatory response in BALB/c mice in a novel chronic wound model

DEFF Research Database (Denmark)

Trøstrup, Hannah; Thomsen, Kim; Christophersen, Lars J

2013-01-01

model in C3H/HeN and BALB/c mice. The chronic wound was established by an injection of seaweed alginate-embedded P. aeruginosa PAO1 beneath a third-degree thermal lesion providing full thickness skin necrosis, as in human chronic wounds. Cultures revealed growth of PA, and both alginate with or without......Chronic wounds are presumed to persist in the inflammatory state, preventing healing. Emerging evidence indicates a clinical impact of bacterial biofilms in soft tissues, including Pseudomonas aeruginosa (PA) biofilms. To further investigate this, we developed a chronic PA biofilm wound infection...... bacteria organized in clusters, resembling biofilms, and inflammation located adjacent to the PA. The chronic wound infection showed a higher number of PAO1 in the BALB/c mice at day 4 after infection as compared to C3H/HeN mice (p

Surgical site infection in lumbar surgeries, pre and postoperative antibiotics and length of stay: a case study

International Nuclear Information System (INIS)

Khan, I.U.; Janjua, M.B.; Hasan, S.; Shah, S.

2009-01-01

Postoperative wound infection also called as surgical site infection (SSI), is a trouble some complication of lumbar spine surgeries and they can be associated with serious morbidities, mortalities and increase resource utilization. With the improvement in diagnostic modalities, proper surgical techniques, antibiotic therapy and postoperative care, infectious complications can result in various compromises afterwards. The objective was to study the relation of surgical site infection in clean lumbar surgeries with the doses of antibiotics. This Retrospective study was conducted at Shifa International Hospital, from January 2006 to March 2008. Methods: Hundred post operated cases of lumber disc prolapse, lumbar stenosis or both studied retrospectively by tracing their operated data from hospital record section for the development of surgical site infection (SSI). The patients were divided into three groups depending upon whether they received single, three or more than three doses of antibiotics respectively. Complete data analyses and cross tabulation done with SPSS version 16. Result: Of 100 cases, only 6% had superficial surgical site infection; only 1 case with co morbidity of hypertension was detected. Twenty-one cases had single dose of antibiotic (Group-I), 59 cases had 3 doses (Group-II) and 20 cases received multiple doses (Group-III). There was no infection in Group-I. Only one patient in Group-II and 5 patients in Group-III developed superficial SSI. While 4 in Group-II, 3 in Group-III, and none of Group-I had >6 days length of stay (LOS). Conclusion The dose of antibiotic directly correlates with the surgical site infection in clean lumbar surgeries. When compared with multiple doses of antibiotics a single preoperative shot of antibiotic is equally effective for patients with SSI. (author)

The efficacy of normal saline irrigation to prevent surgical site infection

International Nuclear Information System (INIS)

Ashraf, V.; Awan, A.S.

2015-01-01

The efficacy of normal saline irrigation to prevent surgical site Infection The aim of the study was to evaluate the efficacy of normal saline irrigations to prevent surgical site infection (SSI). Study Design: A comparative study. Place and Duration of Study: The study was conducted at surgery and gynecology Dept CMH Chunian from 1st Jan 2012 to 1st Nov 2012. Patients and Methods: Two hundred clean surgical and gynecological cases were included in the study. Hundred cases which were randomly selected had their wound washed with warm normal saline for 60 sec and then mopped dry with clean swabs. Subcuticular Stitches were applied to all the 200 cases. The surgical wounds were examined on 3rd post operative day and then finally on 15th post operative day. Patients with wound infection developed pain at the operation site and fever on third post operative day. Wounds were examined for swelling, redness, discharge and stitch abscess. Routine investigations were done as per protocol. Wound swabs were taken for culture and sensitivity. Results: The study was carried out on 200 clean cases (general and gynecological). They were 130 females and 70 males. The 100 cases whose wounds were washed with normal saline only 1 patient developed wound infection while in the other group who did not had saline irrigations 8 patients out of 100 developed wound infection. The commonest infective organisms were staphylococcus aureus and the other organisms were streptococcus pyogenes, proteus, Klaebsiella, E coli and pseudomonas. No MRSA was detected. Conclusion: In our study washing the wound with warm normal saline for 60 seconds resulted in the wound being infection free. Wound infection is associated with delayed wound healing, prolonged hospital stay and increased economic pressure on the patient and on the state. (author)

Elements affecting wound healing time: An evidence based analysis.

Science.gov (United States)

Khalil, Hanan; Cullen, Marianne; Chambers, Helen; Carroll, Matthew; Walker, Judi

2015-01-01

The purpose of this study was to identify the predominant client factors and comorbidities that affected the time taken for wounds to heal. A prospective study design used the Mobile Wound Care (MWC) database to capture and collate detailed medical histories, comorbidities, healing times and consumable costs for clients with wounds in Gippsland, Victoria. There were 3,726 wounds documented from 2,350 clients, so an average of 1.6 wounds per client. Half (49.6%) of all clients were females, indicating that there were no gender differences in terms of wound prevalence. The clients were primarily older people, with an average age of 64.3 years (ranging between 0.7 and 102.9 years). The majority of the wounds (56%) were acute and described as surgical, crush and trauma. The MWC database categorized the elements that influenced wound healing into 3 groups--factors affecting healing (FAH), comorbidities, and medications known to affect wound healing. While there were a multitude of significant associations, multiple linear regression identified the following key elements: age over 65 years, obesity, nonadherence to treatment plan, peripheral vascular disease, specific wounds associated with pressure/friction/shear, confirmed infection, and cerebrovascular accident (stroke). Wound healing is a complex process that requires a thorough understanding of influencing elements to improve healing times.© 2015 by the Wound Healing Society. © 2015 by the Wound Healing Society.

A reliable approach to the closure of large acquired midline defects of the back

International Nuclear Information System (INIS)

Casas, L.A.; Lewis, V.L. Jr.

1989-01-01

A systematic regionalized approach for the reconstruction of acquired thoracic and lumbar midline defects of the back is described. Twenty-three patients with wounds resulting from pressure necrosis, radiation injury, and postoperative wound infection and dehiscence were successfully reconstructed. The latissimus dorsi, trapezius, gluteus maximus, and paraspinous muscles are utilized individually or in combination as advancement, rotation, island, unipedicle, turnover, or bipedicle flaps. All flaps are designed so that their vascular pedicles are out of the field of injury. After thorough debridement, large, deep wounds are closed with two layers of muscle, while smaller, more superficial wounds are reconstructed with one layer. The trapezius muscle is utilized in the high thoracic area for the deep wound layer, while the paraspinous muscle is used for this layer in the thoracic and lumbar regions. Superficial layer and small wounds in the high thoracic area are reconstructed with either latissimus dorsi or trapezius muscle. Corresponding wounds in the thoracic and lumbar areas are closed with latissimus dorsi muscle alone or in combination with gluteus maximus muscle. The rationale for systematic regionalized reconstruction of acquired midline back wounds is described

Dermal Wound Transcriptomic Responses to Infection with Pseudomonas aeruginosa versus Klebsiella pneumoniae in a Rabbit Ear Wound Model

Science.gov (United States)

2014-05-02

intradermally with 1% lidocaine /1:100,000 epinephrine at the wound sites. A total of 18 rabbits were used. Four, 6-mm diameter, full-thickness dermal wounds...based on literature compiled in the Ingenuity® Knowledge Base, to include: ‘adhesion of immune cells’, ‘ synthesis of reactive oxygen species... synthesis of specific transcription factors and their target genes that support recovery from the stress (e.g., ER chaperones, oxidoreductases, and ERAD

Hydrodebridement of wounds: effectiveness in reducing wound bacterial contamination and potential for air bacterial contamination.

Science.gov (United States)

Bowling, Frank L; Stickings, Daryl S; Edwards-Jones, Valerie; Armstrong, David G; Boulton, Andrew Jm

2009-05-08

The purpose of this study was to assess the level of air contamination with bacteria after surgical hydrodebridement and to determine the effectiveness of hydro surgery on bacterial reduction of a simulated infected wound. Four porcine samples were scored then infected with a broth culture containing a variety of organisms and incubated at 37 degrees C for 24 hours. The infected samples were then debrided with the hydro surgery tool (Versajet, Smith and Nephew, Largo, Florida, USA). Samples were taken for microbiology, histology and scanning electron microscopy pre-infection, post infection and post debridement. Air bacterial contamination was evaluated before, during and after debridement by using active and passive methods; for active sampling the SAS-Super 90 air sampler was used, for passive sampling settle plates were located at set distances around the clinic room. There was no statistically significant reduction in bacterial contamination of the porcine samples post hydrodebridement. Analysis of the passive sampling showed a significant (p air whilst using hydro surgery equipment compared with a basal count of 582 CFUs/m3. During removal of the wound dressing, a significant increase was observed relative to basal counts (p air samples was still significantly raised 1 hour post-therapy. The results suggest a significant increase in bacterial air contamination both by active sampling and passive sampling. We believe that action might be taken to mitigate fallout in the settings in which this technique is used.

Vacuum-assisted closure therapy for infected perineal wounds after abdominoperineal resection. A retrospective cohort study

NARCIS (Netherlands)

Walma, M S; Burbach, J P M; Verheijen, P M; Pronk, A; van Grevenstein, W M U

INTRODUCTION: Perineal wound complications are a main problem after abdominoperineal resection (APR). There is little evidence concerning perineal wound management. This study describes and evaluates the role of vacuum-assisted closure (VAC) therapy in wound management strategies of perineal wound

CLINICAL STUDY OF POST LAPAROTOMY WOUND DEHISCENCE

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Chanda Ramanachalam

2017-04-01

undergone secondary suturings, 10 patients had undergone complete wound dehiscence, i.e. tension suturing. CONCLUSION Surgical factors like midline incisions, improper suture technique and improper aseptic precautions may lead to wound infection and then wound dehiscence.