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Sample records for surgical wound closure

  1. Abdominal wound closure: current perspectives

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    Williams ZF

    2015-12-01

    Full Text Available Zachary F Williams, William W Hope Department of Surgery, South East Area Health Education Center, New Hanover Regional Medical Center, Wilmington, NC, USA Abstract: This review examines both early and late wound complications following laparotomy closure, with particular emphasis on technical aspects that reduce hernia formation. Abdominal fascial closure is an area of considerable variation within the field of general surgery. The formation of hernias following abdominal wall incisions continues to be a challenging problem. Ventral hernia repairs are among the most common surgeries performed by general surgeons, and despite many technical advances in the field, incisional hernia rates remain high. Much attention and research has been directed to the surgical management of hernias. Less focus has been placed on prevention of hernia formation despite its obvious importance. This review examines the effects of factors such as the type of incision, suture type and size, closure method, patient risk factors, and the use of prophylactic mesh. Keywords: incisional, abdominal, hernia, prevention, wound closure techniques 

  2. Cyanoacrylate for Intraoral Wound Closure: A Possibility?

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    Parimala Sagar

    2015-01-01

    Full Text Available Wound closure is a part of any surgical procedure and the objective of laceration repair or incision closure is to approximate the edges of a wound so that natural healing process may occur. Over the years new biomaterials have been discovered as an alternate to conventional suture materials. Cyanoacrylate bioadhesives are one among them. They carry the advantages of rapid application, patient comfort, resistance to infection, hemostatic properties, and no suture removal anxiety. Hence this study was undertaken to study the effect of long chain cyanoacrylate as an adhesive for intraoral wound closure and also to explore its hemostatic and antibacterial effects. Isoamyl-2-cyanoacrylate (AMCRYLATE was used as the adhesive in the study. In conclusion isoamyl cyanoacrylate can be used for intraoral wound closure, as an alternative to sutures for gluing the mucoperiosteum to bone, for example, after impaction removal, periapical surgeries, and cleft repair. Its hemostatic and antibacterial activity has to be further evaluated.

  3. Clippers or the knife? The reform of surgical practice and the difficulty of early wound closure.

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    Stephens-Borg, Keith

    2009-09-01

    Salt, vinegar and wine sounds more like a recipe from the Saturday kitchen, but in 1667 it was all a surgeon could use to close wounds, along with silk and linen strips. In providing this service, barbers and surgeons found themselves confused and intertwined, struggling for professional recognition that was about to experience reform. Allegations of neglect in the aftermath of a major seafaring battle on the very shores of our capital city required the court of King Charles II to search for a solution of supreme magnitude to accommodate the hundreds of maimed sailors who were littering the streets of London. A campaign to conceal the horrors of warfare began which lead to the implementation of the Greenwich charter and the construction of a hospital which the architect Christopher Wren helped to design.

  4. Microwave Tissue Soldering for Immediate Wound Closure

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    Arndt, G. Dickey; Ngo, Phong H.; Phan, Chau T.; Byerly, Diane; Dusl, John; Sognier, Marguerite A.; Carl, James

    2011-01-01

    A novel approach for the immediate sealing of traumatic wounds is under development. A portable microwave generator and handheld antenna are used to seal wounds, binding the edges of the wound together using a biodegradable protein sealant or solder. This method could be used for repairing wounds in emergency settings by restoring the wound surface to its original strength within minutes. This technique could also be utilized for surgical purposes involving solid visceral organs (i.e., liver, spleen, and kidney) that currently do not respond well to ordinary surgical procedures. A miniaturized microwave generator and a handheld antenna are used to deliver microwave energy to the protein solder, which is applied to the wound. The antenna can be of several alternative designs optimized for placement either in contact with or in proximity to the protein solder covering the wound. In either case, optimization of the design includes the matching of impedances to maximize the energy delivered to the protein solder and wound at a chosen frequency. For certain applications, an antenna could be designed that would emit power only when it is in direct contact with the wound. The optimum frequency or frequencies for a specific application would depend on the required depth of penetration of the microwave energy. In fact, a computational simulation for each specific application could be performed, which would then match the characteristics of the antenna with the protein solder and tissue to best effect wound closure. An additional area of interest with potential benefit that remains to be validated is whether microwave energy can effectively kill bacteria in and around the wound. Thus, this may be an efficient method for simultaneously sterilizing and closing wounds.

  5. [Comparative description and retrospective analisis of modern methods of surgical wounds closure for intraoperative prophylaxis of development of pathologic cutaneous cicatrices].

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    Stavyts'kyĭ, S O; Avetikov, D S; Lokes, K P; Rozkolupa, O O; Boĭko, I V

    2014-05-01

    The experience of application of various methods of closure was presented for the head and neck cutaneous wound surfaces after elective operative interventions. The variant of the postoperative results estimation and optimization of the wounds healing by primary closure was proposed.

  6. Debridement for surgical wounds.

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    Dryburgh, Nancy; Smith, Fiona; Donaldson, Jayne; Mitchell, Melloney

    2008-07-16

    Surgical wounds that become infected are often debrided because clinicians believe that removal of this necrotic or infected tissue will expedite wound healing. There are numerous methods available but no consensus on which one is most effective for surgical wounds. The aim of this review is to determine the effect of different methods of debridement on the rate of debridement and healing of surgical wounds. We developed a search strategy to search the following electronic databases: Wounds Group Specialised Trials Register (searched 3/3/08) , Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2008, issue 1), MEDLINE (1950 to February Week 3 2008 ), EMBASE (1980 to 2008 Week 09) and CINHAL (1982 to February Week 4 2008). We checked the citations within obtained studies to identify additional papers and also relevant conference proceedings. We contacted manufactures of wound debridement agents to ascertain the existence of published, unpublished and ongoing trials. Our search was not limited by language or publication status. We included relevant randomised controlled trials (RCT) with outcomes including at least one of the following: time to complete debridement, or time to complete healing. Two authors independently reviewed the abstracts and titles obtained from the search, two extracted data independently using a standardised extraction sheet, and two independently assessed methodological quality. One author was involved in all stages of the data collection and extraction process, thus ensuring continuity. Five RCTs were eligible for inclusion; all compared treatments for infected surgical wounds and reported time required to achieve a clean wound bed (complete debridement). One trial compared an enzymatic agent (Streptokinase/streptodornase) with saline-soaked dressings and reported the time to complete debridement. Four of the trials compared the effectiveness of dextranomer beads or paste with other products (different comparator

  7. Primary and secondary closure of the surgical wound after removal of impacted mandibular third molars: a comparative study.

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    Pasqualini, D; Cocero, N; Castella, A; Mela, L; Bracco, P

    2005-01-01

    Primary and secondary closure techniques after removal of impacted third molars were compared in terms of post-operative pain and swelling. Two hundred patients with impacted third molars were randomly divided into two groups of 100. Panoramic radiographs were taken to assess degree of eruption and angulation of third molars. Teeth were extracted, and in Group 1 the socket was closed by hermetically suturing the flap. In Group 2 a 5-6 mm wedge of mucosa adjacent to the second molar was removed to obtain secondary healing. Swelling and pain were evaluated for 7 days after surgery with the VAS scale. The statistical analysis (*analysis of variance for repeated measures, P < 0.05) showed that pain was greater in Group 1, although it decreased over time similarly in the two groups (P = 0.081, F(6,198) = 3.073*). Swelling was significantly worse in Group 1 (P < 0.001, F(6,198) = 44.30*). In Group 1, dehiscence of the mucosa was present in 33% of patients at day 7, and 2% showed signs of re-infection with suppurative alveolitis at 30 days. Pain and swelling were less severe with secondary healing than with primary healing.

  8. Evidence-based surgical wound care on surgical wound infection.

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    Reilly, Jaqueline

    2002-09-01

    Surgical wound infection is an important outcome indicator in the postoperative period. A 3-year prospective cohort epidemiological study of 2202 surgical patients from seven surgical wards across two hospitals was carried out using gold standard surveillance methodology. This involved following patients up as inpatients and postdischarge surveillance to 30 days by an independent observer. The results led to the development of a mathematical model for risk of clean, elective surgical wound infection. Risk of surgical wound infection was increased by smoking, higher body mass index, presence of malignancy, haematoma formation, increasing numbers of people in theatre, adherent dressing usage, and higher times to suture removal (P<0.05). The results show that this type of surveillance is an effective way of collecting accurate data on wound infection rates. It was noted that patient care practices affected the surgical wound infection rate and the surveillance was used to facilitate the adoption of evidence-based practice, through recommendations for clean surgery, to reduce the risk from extrinsic risk factors for wound infection. As a result of the implementation of this evidence-based practice there was a significant reduction (P<0.05) in the clean wound infection rate.

  9. 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

  10. Surgical amputation of a digit and vacuum-assisted-closure (V.A.C.) management in a case of osteomyelitis and wound care in an eastern black rhinoceros (Diceros bicornis michaeli).

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    Harrison, Tara M; Stanley, Bryden J; Sikarskie, James G; Bohart, George; Ames, N Kent; Tomlian, Janice; Marquardt, Mark; Marcum, Annabel; Kiupel, Matti; Sledge, Dodd; Agnew, Dalen

    2011-06-01

    A 14-yr-old female eastern black rhinoceros (Diceros bicornis michaeli) presented with progressive suppurative osteomyelitis in her left hind lateral toe. beta-Hemolytic Streptococcus sp. was isolated. The animal was treated with multiple systemic antibiotics, and topical wound cleansing. Repeated debridements and nail trimmings were performed for 5 mo prior to electing amputation. The toe was surgically amputated under general anesthesia between the first and second phalanges. Analgesia was diffused into the wound topically via a catheter and elastomeric pump. The open amputation site was covered with adherent drapes and a negative-pressure wound therapy device provided vacuum-assisted closure (V.A.C.) for 72 hr. Three months later this animal developed a deep dermal ulcer on the lateral aspect of the right hind limb, at the level of the stifle. Methicillin-resistant Staphylococcus aureus was isolated. The wound was managed by initial daily lavage, followed by 1 mo of V.A.C. therapy, with 72 hr between dressing changes. Clinically, this therapy expedited the formation of healthy granulation tissue and overall healing was accelerated. The animal tolerated the machine and bandage changes well via operant conditioning. The use of negative-pressure wound therapy appeared to shorten time to resolution of slow-healing wounds in black rhinoceros.

  11. Surgical wound care

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    ... again after you take off the old dressing. Caring for the Wound You may use a gauze ... Bethesda, MD 20894 U.S. Department of Health and Human Services National Institutes of Health Page last updated: ...

  12. Successful closure of an open-window thoracostomy wound by negative-pressure wound therapy: report of a case.

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    Maeda, Sumiko; Sado, Tetsu; Sakurada, Akira; Okada, Yoshinori; Kondo, Takashi

    2012-02-01

    Negative-pressure wound therapy is a newly developed, noninvasive technique to manage a wide variety of wounds. This novel therapy was successfully used to heal the wound after open-window thoracostomy without surgical closure. A 46-year-old woman was admitted to hospital because of a painful mass on the right side of her chest. Radiological findings revealed an abscess on the right chest wall that had ruptured into the right lung and caused empyema. Antibiotic therapy did not yield sufficient improvement. Open-window thoracostomy was performed to achieve a sterile pleural space, and negative-pressure wound therapy was then applied. The pleural space was reduced, and the patient was discharged home with self-administered wound care. The wound healed completely in 5 months without any need for surgical closure.

  13. EPIDERMAL DELETION OF HIF-2α STIMULATES WOUND CLOSURE

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    Cowburn, Andrew S.; Crotty Alexander, Laura E.; Southwood, Mark; Nizet, Victor; Chilvers, Edwin R.; Johnson, Randall S.

    2013-01-01

    Wound closure requires a complex series of micro-environmentally influenced events. A key aspect of wound closure is the migration of keratinocytes across the open wound. It has been found previously that the response to hypoxia via the HIF-1α transcription factor is a key feature of wound closure. The need for hypoxic response is likely due to interrupted wound vasculature as well as infection, and in this work, we investigated the need for a highly related hypoxic response transcription factor, HIF-2α. This factor was deleted tissue-specifically in mice, and the resulting mice were found to have an accelerated rate of wound closure. This is correlated with a reduced bacterial load and inflammatory response in these mice. This indicates that manipulating or reducing the HIF-2α response in keratinocytes could be a useful means to accelerate wound healing and tissue repair. PMID:24037341

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

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    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.

  15. The use of paper tape in wound closures.

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    Danto, L A; Albertazzi, V J; Elliott, T E; Love, F G

    1986-12-01

    The techniques described using paper tape in wound closure have been found to be cosmetically equal to or better than other forms of wound closure. Paper tape provides better support, is more versatile and care free, while being easier to use and less expensive than Steri Strips.

  16. Successful closure of feline axillary wounds by reconstruction of the elbow skin fold.

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    Brinkley, C H

    2007-02-01

    This report describes the successful closure of five chronic feline axillary wounds. The aetiology was known to be forelimb entrapment in a neck collar in three cases and was suspected in the others. Each cat underwent a single surgical procedure during which the wound was debrided, the normal structure of the elbow skin fold was restored and the remaining skin defect was closed primarily. None of the cats had undergone any previous reconstruction attempts. No postoperative complications were observed and the wounds healed uneventfully. Cats have well-developed elbow skin folds, allowing a wide range of limb motion to occur. Having a forelimb trapped in a neck collar not only creates a wound in the axilla but also disrupts the normal anatomy of the skin fold. This report demonstrates that restoring the elbow skin fold before closing the wound may improve the chances of a successful reconstruction at the first surgical intervention.

  17. Wound healing ability of Xenopus laevis embryos. I. Rapid wound closure achieved by bisectional half embryos.

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    Yoshii, Yasuko; Noda, Masahiro; Matsuzaki, Takashi; Ihara, Setsunosuke

    2005-10-01

    We examined wound closure in 'half embryos' produced by the transverse bisection of Xenopus laevis embryos at the primary eye vesicle stage. Both the anterior- and posterior-half embryos survived for more than 6 days, and grew into 'half tadpoles'. Histology and videomicroscopy revealed that the open wound in the half embryo was rapidly closed by an epithelial sheet movement in the wound marginal zone. The time-course of wound closure showed a downward convex curve: the wound area decreased to one-fifth of the original area within 30 min, and the wound continued to contract slowly thereafter. The rapidity of closure of the epidermis as well as the absence of inflammatory cells are typical features of an embryonic type of wound healing. There was a dorso-ventral polarity in the motility of the epidermis: the wound was predominantly closed by the ventral and lateral epidermis. The change in the contour of the wound edge with time suggested a complex mechanism involved in the wound closure that could not be explained only by the purse-string theory. The present experimental system would be a unique and useful model for analyses of cellular movements in the embryonic epithelia.

  18. Trends in Surgical Wound Healing

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    Gottrup, F.

    2008-01-01

    The understanding of acute and chronic wound pathophysiology has progressed considerably over the past decades. Unfortunately, improvement in clinical practice has not followed suit, although new trends and developments have improved the outcome of wound treatment in many ways. This review focuses...

  19. Cutaneous wound closure materials: an overview and update.

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    Al-Mubarak, Luluah; Al-Haddab, Mohammed

    2013-10-01

    On a daily basis, dermasurgeons are faced with different kinds of wounds that have to be closed. With a plethora of skin closure materials currently available, choosing a solution that combines excellent and rapid cosmetic results with practicality and cost-effectiveness can be difficult, if not tricky. We aimed to review the available skin closure materials over the past 20 years and the scientific claims behind their effectiveness in repairing various kinds of wounds. The two authors independently searched and scrutinised the literature. The search was performed electronically using Pub Med, the Cochrane Database, Google Scholar and Ovid as search engines to find articles concerning skin closure materials written since 1990. Many factors are involved in the choice of skin closure material, including the type and place of the wound, available materials, physician expertise and preferences, and patient age and health. Evidence-based main uses of different skin closure materials are provided to help surgeons choose the appropriate material for different wounds.

  20. Cutaneous wound closure materials: An overview and update

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    Luluah Al-Mubarak

    2013-01-01

    Full Text Available Introduction: On a daily basis, dermasurgeons are faced with different kinds of wounds that have to be closed. With a plethora of skin closure materials currently available, choosing a solution that combines excellent and rapid cosmetic results with practicality and cost-effectiveness can be difficult, if not tricky. Objectives: We aimed to review the available skin closure materials over the past 20 years and the scientific claims behind their effectiveness in repairing various kinds of wounds. Materials and Methods: The two authors independently searched and scrutinised the literature. The search was performed electronically using Pub Med, the Cochrane Database, Google Scholar and Ovid as search engines to find articles concerning skin closure materials written since 1990. Conclusion: Many factors are involved in the choice of skin closure material, including the type and place of the wound, available materials, physician expertise and preferences, and patient age and health. Evidence-based main uses of different skin closure materials are provided to help surgeons choose the appropriate material for different wounds.

  1. Ozone mediators effect on "in vitro" scratch wound closure.

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    Valacchi, Giuseppe; Sticozzi, Claudia; Zanardi, Iacopo; Belmonte, Giuseppe; Cervellati, Franco; Bocci, Velio; Travagli, Valter

    2016-09-01

    The beneficial effect of low doses of ozone on wound healing has been well documented and attributed mainly to its bactericidal and pro-oxidant properties. Because ozone itself does not penetrate the cells but immediately reacts with polyunsaturated fatty acids, its effects are the results of oxidative mediators. Among the molecule produces by the interaction of ozone with biological systems, there are HNE and H2O2. At today, the cellular mechanisms accounting for the positive effects of mild ozonization on wound closure are still largely unexplored. The aim of the present study was to evaluate the effect of different non-toxic doses of ozonated saline ranging from 2 to 300 μM, in an in vitro wound scratch model by the use of human keratinocytes. The results showed that ozonated saline is able to improve in vitro wound healing by stimulating cell proliferation as measured by BrdU assay and PCNA protein levels. In order to better elucidate the molecules that play the main role in the beneficial effect of ozonated saline in wound healing, HNE and H2O2 were used alone or in combination to mimic ozonated saline effect. Surprisingly, keratinocytes treated with different doses of HNE and H2O2 did not significantly improve the wound closure, while the combination of the two compounds was able to improve wound closure. In addition, Nrf2 pathways were also activated as determined by its translocation to the nucleus and the increased HO1 gene expression. The present work suggests that ozonated saline effect on wound closure is the results of the combination of more molecules among which HNE and H2O2 play a key role.

  2. Abdominal wound closure. A randomized prospective study of 571 patients comparing continuous vs. interrupted suture techniques.

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    Richards, P C; Balch, C M; Aldrete, J S

    1983-01-01

    A randomized, prospective study was designed to compare a continuous with an interrupted technique for closing an abdominal incision. Five hundred seventy-one patients were randomized between the closure methods and stratified as to type of wound: clean, clean-contaminated, or contaminated. In mid-line incisions, the dehiscence rate was 2.0% (5/244) for the continuous group versus 0.9% (2/229) for the interrupted group. The difference was not statistically significant. Ventral hernias formed in 2.0% (4/201) of the continuous group vs. 0.5% (1/184) of the interrupted group. The type of wound had no influence on the results. In oblique incisions, 0% (0/39) of wounds closed continuously dehised while 2% (1/50) of incisions closed interruptedly dehised. No ventral hernias formed. Further analysis of the data indicated that dehiscence was more likely related to improper surgical technique than to the method of closure. An abdominal incision could be closed with a continuous suture in approximately half the time required for placing interrupted sutures (20 vs. 40 minutes). A continuous closure is preferred because it is more expedient and because it has the same incidence of wound disruption compared with an interrupted closure. PMID:6297417

  3. Cosmetic Surgical Repair of Contaminated Wounds Versus Traditional Loose Approximation: Does It Increase the Rate of Wound Infections?

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    P. Yavari

    2007-02-01

    Full Text Available Background:The cosmetic result of the surgical scar has long been considered by surgeons as an important factor for patient satisfaction.On the other hand,there has been an old teaching that perfect closure of contaminated wounds increases the rate of infection. We decided to look into this matter and see if this is a fact or a myth. Methods: In this prospective randomized study conducted on 200 patients with suppurative or gangrenous appendicitis,we closed the wounds with a cosmetic subcuticular suture of 4/0 nylon in 100 patients and in the other 100 patients the wound was approximated loosely with a few stitches of 3/0 nylon in vertical mattress fashion during a 14-month period.Results:There was no significant difference in the rate of wound infection between these two groups.Conclusions:This study shows that perfect closure of the wound with subcuticular closure,which gives a very good cosmetic result in comparison with traditional loose closure, does not increase the rate of wound infection.

  4. The Principles of Abdominal Wound Closure

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    Meijer, E. -T.; Timmermans, L.; Jeekel, J.; Lange, J. F.; Muysoms, F. E.

    2013-01-01

    Background : Incisional hernia (IH) is a common complication of abdominal surgery. Its incidence has been reported as high as 39.9%. Many factors influence IH rates. Of these, surgical technique is the only factor directly controlled by the surgeon. There is much evidence in the literature on the op

  5. Sutures versus staples for wound closure in orthopaedic surgery: a randomized controlled trial

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    Shantz Jesse A

    2012-06-01

    Full Text Available Abstract Background A recently published meta-analysis comparing metallic staples to sutures in orthopaedic procedures revealed three fold increase in risk for infection in stapled wounds. The studies included in the meta-analysis are at risk of bias due to experimental design limitations. A large randomized controlled trial is proposed to direct orthopaedic surgeons in their choice of wound closure material. Methods/Design A parallel group randomized controlled trial with institutional review board approval will be conducted. Patients will be randomized intraoperatively to have skin wounds closed with sutures or staples. Dressings will be used to maintain blinding outcome assessors. The primary outcome measure will be a composite all-cause wound complication outcome measure composed of: infection, wound drainage, wound necrosis, blistering, dehiscence, suture abscess and material sensitivity reaction. An independent review board blinded to treatment assignment will adjudicate suspected complications based on clinical data. All deceased patients will also be reviewed. An interim analysis of complications will take place after half of the patients have been recruited. All data will be analyzed by a blinded statistician. Dichotomous primary and secondary outcome measures will be analyzed using the Chi-squared statistic. Continuous outcome measures will be analyzed using Student's t-test. Subgroup analysis will compare infection rates using sutures versus staples in each anatomic area (upper extremity, pelvis/acetabulum, hip/femur, knee, ankle. A further subgroup analysis will be conducted comparing trauma patients to elective surgery patients. Non-infected revision surgery will also be compared to primary surgery. Discussion Wound closure material is an afterthought for many orthopaedic surgeons. The combined results of several comparative trials suggests that the choice of wound closure materials may have an impact on the rate of surgical site

  6. Teaching advanced wound closure techniques using cattle digits.

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    Khalil, Philipe N; Kanz, Karl-Georg; Siebeck, Matthias; Mutschler, Wolf

    2011-03-01

    To evaluate a model used to impart advanced wound closure skills because available models do not meet the necessary requirements to a substantial degree. Seventy-one residents were asked to evaluate a 75-minute-long skills course using cadaveric cattle digits to learn Z-plasty, V-Y-plasty, and oval-shaped rotational flaps. A short film and the course instructor demonstrated each technique first. A Likert rating scale ranging from 1 to 6 was used for questions in the survey given to the residents. There was strong agreement among residents (1.65 ± 1.17 years of experience) that advanced wound closure training courses are necessary (5.73 ± 0.73), which corresponded to the residents' low level of knowledge and self-assessment of practical skills and present experience (2.84 ± 1.01). The course was evaluated with high acceptance, even though it was found to be demanding for the trainees (5.84 ± 0.40). This might also be related to the high rating of the model itself, which was found to be a suitable method for teaching advanced wound closure techniques (5.50 ± 0.71) that was easily comprehensible (5.73 ± 0.53). Skills training courses for young trainees are warranted to impart advanced wound closure techniques. The curriculum using cattle digits presented here is recommended. The authors have indicated no significant interest with commercial supporters. © 2011 by the American Society for Dermatologic Surgery, Inc.

  7. The Golden Spiral Flap: A New Flap Design that allows for Closure of Larger Wounds under Reduced Tension --How Studying Nature’ s Own Design Led to the Development of a New Surgical Technique

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    Sharad P. Paul

    2016-11-01

    Full Text Available This paper details the study of biodynamic excisional skin tension lines on the scalp, and the development of a new flap technique for closure of scalp wounds. Recently, a study by this author, on pigskin, replicated whorls by placing tissue under rapid stretch using saline tissue expanders, by re-creating rapid dermo-epidermal shear of skin – thereby concluding that the golden spiral pattern is nature’s own pattern for rapid expansion. Given the relationship between tissue expansion and stretch have been shown to cause deformation gradients that have both elastic and growth factors, the author set out to test the hypothesis that a golden spiral pattern therefore would be more efficient at closing wounds under less tension when compared to standard semicircular rotational flap patterns. The author conducted a series of experiments, both on pigskin (to first confirm the hypothesis, using a recently developed computerized tensiometer and later a clinical study. This paper presents a new random pivotal flap technique for skin closures on the head and neck: The Golden Spiral Flap. Biomechanics, planning and advantages of this new flap are described in this paper.

  8. Systematic review of absorbable vs non-absorbable sutures used for the closure of surgical incisions

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    Muhammad; S; Sajid; Malcolm; R; Mc; Fall; Pauline; A; Whitehouse; Parv; S; Sains

    2014-01-01

    AIM: To report a systematic review of published randomized controlled trials(RCTs) investigating the role of absorbable suture(AS) against non-AS(NAS) used for the closure of surgical incisions.METHODS: RCTs investigating the use of AS vs NAS for the closure of surgical incisions were statistically analysed based upon the principles of meta-analysis and the summated outcomes were represented as OR.RESULTS: The systematic search of medical literature yielded 10 RCTs on 1354 patients. Prevalence of wound infection(OR = 0.97; 95%CI: 0.56, 1.69; Z = 0.11; P = 0.92) and operative morbidity(P = 0.45) was comparable in both groups. Nonetheless, the use of AS lead to lower risk of wound break-down(OR = 0.12; 95%CI: 0.04, 0.39; Z = 3.52; P < 0.0004).CONCLUSION: This meta-analysis of 10 RCTs demonstrates that the use of AS is similar to NAS for skin closure for surgical site infection and other operative morbidities. AS do not increase the risk of skin wound dehiscence,rather lead to a reduced risk of wound dehiscence compared to NAS.

  9. Influence of surgical sutures on wound healing

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    Mirković Siniša

    2010-01-01

    Full Text Available Historical data on closing and suturing of surgical wounds describe a wide range of various suture materials. The choice of the surgical catgut, i.e. the type and diameter, depends on the locality, characteristics and condition of the tissue to be treated. From the standpoint of oral-surgical practice the following clinical parameters are of outstanding importance with respect to the selection of suture material: accumulation of soft deposits on the sutures, score of the adjacent soft tissues and dehiscence of the operative wound. Our prospective clinical study included 150 patients distributed into three groups of 50 subjects. The surgical procedure performed on each patient involved resection (apicotomy of the tooth root end in the intercanine sector of the upper jaw. The following suture materials were applied: Black Silc 5-0, Nylon 5-0 and Vicryl 5-0. The effects of the selected sutures were evaluated according to the wound dehiscence. The effects of the applied sutures were recorded on Days 2, 5 and 7 after the surgery. The comparison of cited parameters of the investigated materials after suturing the oral mucosa revealed that none of the used material was ideal; however, a certain advantage might be given to the synthetic monofilament suture materials.

  10. [Surgical wound healing in oral surgery].

    Science.gov (United States)

    Bocca, M; Coscia, D; Bottalico, L; Libro, D

    1999-12-01

    Aim of this study is to improve the in vivo knowledge about the real effects and the physiologic repair by a detached stitches silk suture in the 8th zone. The study has been carried out on 44 patients submitted to surgical extraction of the impacted 8th (19 upper and 25 lower) teeth. Clinical and histological controls have demonstrated the usefulness of this suture procedure, since it gives a good histological reaction and in easy and safe. Histological and clinical results have confirmed the usefulness of silk suture, presenting however the inconvenience of stitches removal and bacterial plaque on the surgical wound.

  11. Mathematical models of wound healing and closure: a comprehensive review.

    Science.gov (United States)

    Jorgensen, Stephanie N; Sanders, Jonathan R

    2016-09-01

    Wound healing is a complex process comprised of overlapping phases and events that work to construct a new, functioning tissue. Mathematical models describe these events and yield understanding about the overall process of wound healing. Generally, these models are focused on only one phase (or a few phases) to explain healing for a specific system. A review of the literature reveals insights as reported on herein regarding the variety of overlapping inputs and outputs for any given type of model. Specifically, these models have been characterized with respect to the phases of healing and their mathematical/physical basis in an effort to shed light on new opportunities for model development. Though all phases of wound healing have been modeled, previous work has focused mostly on the proliferation and related contraction phases of healing with fewer results presented regarding other phases. As an example, a gap in the literature has been identified regarding models to describe facilitated wound closure techniques (e.g., suturing and its effect on resultant scarring). Thus, an opportunity exists to create models that tie the transient processes of wound healing, such as cell migration, to resultant scarring when considering tension applied to skin with given suturing techniques.

  12. Hyperbaric oxygen therapy for treating acute surgical and traumatic wounds

    NARCIS (Netherlands)

    A. Eskes; D.T. Ubbink; M. Lubbers; C. Lucas; H. Vermeulen

    2010-01-01

    Hyperbaric oxygen therapy (HBOT) is used as a treatment for acute wounds (such as those arising from surgery and trauma) however the effects of HBOT on wound healing are unclear. To determine the effects of HBOT on the healing of acute surgical and traumatic wounds. We searched the Cochrane Wounds G

  13. Vacuum-assisted wound closure in vascular surgery - clinical and cost benefits in a developing country

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    Končar Igor

    2016-01-01

    Full Text Available Background/Aim. Surgical and chronic wounds in vascular patients might contribute to limb loss and death. Vacuum-assisted closure (VAC - Kinetic Concepts, Inc. (KCI, has been increasingly used in Western Europe and the USA clinical practice for 15 years. Advantages of this method are faster wound healing, wound approximation, lower wound related treatment costs and improved quality of life during treatment. Evidence related to the usage of VAC therapy in vascular patients and cost effectiveness of VAC therapy in a developing country are lacking. The aim of this study was to explore results of VAC therapy in vascular surgery comparing to conventional methods and to test cost effects in a developing country like Serbia. Methods. All patients with wound infection or dehiscence operated at the tertiary vascular university clinic in the period from January 2011 - January 2012, were treated with VAC therapy. The primary endpoint was wound closure, while secondary endpoints were hospital stay, the number of weekly dressings, costs of wound care, working time of medical personnel. The patients were divided into groups according to the wound type and location: wound with exposed synthetic vascular implant (25%, laparotomy (13%, foot amputation (29%, major limb amputation (21%, fasciotomy (13%. The results of primary and secondary endpoint were compared with the results of conventional treatment during the previous year. Results. There was one death (1/42, 2.38% and one limb loss (1/12, 2.38% in the VAC group, and 8 deaths (8/38, 21.05% and 5 (5/38, 13.15% limb losses in the patients treated with conventional therapy. In the VAC group there was one groin bleeding (1/12, 2.38%, one groin reinfection (1/12, 2.38% and one resistance to therapy with a consequent limb loss. Costs of hospital stay (p < 0.001 and nursing time (p < 0.001 were reduced with VAC therapy in the group with exposed graft. Conclusion. VAC therapy is the effective method for care of

  14. 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

    2016-01-01

    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 i

  15. Effect of recombinant platelet-derived growth factor (Regranex) on wound closure in genetically diabetic mice.

    Science.gov (United States)

    Chan, Rodney K; Liu, Perry H; Pietramaggiori, Giorgio; Ibrahim, Shahrul I; Hechtman, Herbert B; Orgill, Dennis P

    2006-01-01

    Burns, especially those involving large surface areas, represent a complex wound healing problem. Platelet-derived growth factor (PDGF) is released by activated platelets to recruit inflammatory cells toward the wound bed. It has effects on promoting angiogenesis and granulation tissue formation. However, the effectiveness of topical PDGF on wound closure is variable, ranging from little improvement observed in pig models to dramatic improvement reported in a diabetic mouse model. Here, we sought to determine the effectiveness of commercially sold PDGF-BB (Regranex) on wound closure in genetically diabetic mice. C57BL/KsJ db+/db+ mice and its host strain bearing dorsal 1.5-cm wounds were divided into groups (n = 8 in each group) receiving topical application of either Regranex (10 microg/wound) or vehicle for 5 consecutive days after wounding. The rate of wound closure was analyzed using computerized planimetry. The amount of granulation tissue was determined histologically. Our data indicate that diabetic mice exhibit a significant delay in wound closure when compared with their host strain. Topical application of Regranex did not improve the time to wound closure but did significantly increase the amount of granulation tissue. Our current study using commercially available Regranex failed to reproduce the previously reported finding that PDGF improved wound closure in healing impaired genetically diabetic mice.

  16. A New Method for Closure of Total Laryngectomy Wound

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    M R Fathol Olomi

    2008-06-01

    Full Text Available Background: Total laryngectomy is the mainstay of treatment for laryngeal cancer. Fistula is one of the most common complications after total laryngectomy. In patients without risk factors such as prior radiotherapy, diabetes mellitus or chronic renal disease, the incidence of pharyngocutaneous fistula is related to wound healing and duration of operation. We have developed a new method that is both simple and without the complication of pharangocutaneous fistula. Herein, we report the efficacy of this innovative method for the closure of total laryngectomy compared to the conventional method for closure.Methods: In this clinical trial, we included 40 patients with grade T3 or T4 squamous cell carcinoma of the larynx. The total laryngectomy of all patients was performed by the standard method. Twenty patients (case group were repaired by the new method for closure and 20 patients (control group were repaired by the standard method. Duration of surgery and hospital stay, bleeding, hematoma, seroma and fistula formation were characterized for every patient and statistically analyzed.Results: The mean age was 59.8 ±7.8 years for the control group and 61.3 ±6.4 years for the case group. Duration of surgery was 150 ±23.2 minutes and 130 ±18.7 minutes for the control and case groups, respectively (p<0.001. Duration of hospital stay was 10.5 ±1.6 and 3.1 ±0.2 days in the control and case groups, respectively (p<0.002. Bleeding, hematoma or seroma were not seen in either group. Pharyngocutaneous fistula occurred in three patients in control group and was not observed in case group.Conclusion: This new method for closure shortens the duration of surgery and hospital stay. Furthermore, the patients in the case group avoided the psychological and traumatic side effects of tube feeding associated with fistula. In addition, no other complications were observed with this method. We recommend the use of this simple and efficient method for wound closure

  17. Cefazolin concentration in surgically created wounds treated with negative pressure wound therapy compared to surgically created wounds treated with nonadherent wound dressings.

    Science.gov (United States)

    Coutin, Julia V; Lanz, Otto I; Magnin-Bissel, Geraldine C; Ehrich, Marion F; Miller, Emily I; Werre, Stephen R; Riegel, Thomas O

    2015-01-01

    To compare cefazolin concentrations in biopsied tissue samples collected from surgically created wounds treated with negative pressure wound therapy to those collected from surgically created wounds treated with nonadherent dressings. Prospective, controlled, experimental study. Adult female spayed Beagles (n = 12). Full thickness cutaneous wounds were created on each antebrachium (n = 24). Immediately after surgery, cefazolin (22 mg/kg intravenously [IV]) was administered to each dog and continued every 8 hours during the study. The right wound was randomly assigned to group I or group II whereas the wound on the contralateral antebrachium was assigned to the other group. Group I wounds were treated with negative pressure wound therapy (NPWT) and group II wounds were treated with nonadherent dressings for 3 days. Dressings were changed and tissue biopsies obtained from wound beds at 24 hours intervals for both groups. Cefazolin wound tissue and plasma concentrations were measured by liquid chromatography mass spectrometry (LC-MS/MS). Blood samples for measuring plasma cefazolin concentrations were collected before biopsy sampling. At the time of surgery and at each subsequent bandage change, wound beds were swabbed and submitted for aerobic and anaerobic culture. After initiating cefazolin treatment, wound tissue antibiotic concentrations between treatment groups were not significantly different at any sampling time. Similarly, after initiating cefazolin treatment, plasma cefazolin concentrations were not significantly different at any sampling time for individual dogs. Using a canine experimental model, NPWT treatment of surgically created wounds does not statistically impact cefazolin tissue concentrations when compared with conventional nonadherent bandage therapy. © Copyright 2014 by The American College of Veterinary Surgeons.

  18. [Wound prevention in the surgical intensive care unit].

    Science.gov (United States)

    Le Moel, Carole; Mounier, Roman; Ardic-Pulas, Taline

    2012-11-01

    Literature reports a high prevalence of wounds in the hospital environment. A study devoted to wounds encountered in post-surgical intensive care has been carried out in a university hospital. This work highlighted the diversity of acute wounds mainly observed in intensive care and the difficulties nurses have in managing them.

  19. [Percutaneous closure of patent ductus arteriosus: results and costs compared to surgical closure].

    Science.gov (United States)

    Vieu, T; Beaurain, S; Angel, C; Leriche, H; Petit, J; Conso, J F; Planché, C; Losay, J

    1995-10-01

    The comparison of the clinical results and costs of the two methods of closure of patient ductus arteriosus was undertaken in two comparable groups of 40 patients treated in the same period in the same hospital. After transcatheter closure there was a 9% residual shunt rate at 3 years, the 2 patients with a residual continuous murmur being operated secondarily. The only complication was severe haemolysis which regressed after transcatheter ablation of the prosthesis. After surgical closure, there were no residual shunt. Some postoperative complications were observed in 20% of cases, usually benign (ventilatory problems, dysphonia or urinary infection), but occasionally more serious (peroperative lesion of the pulmonary artery). Morbidity, inherent to the technique of closure, was very different and much less in catheter closure. The average cost (daily cost x average length of hospital stay) was much less with transcatheter closure 38,558 francs versus 11,240 francs. On the other hand, the direct cost of transcatheter closure was greater than that of surgery: 32,798 francs versus 20,903 francs, the difference being related to the actual price of the prosthesis. The authors conclude that the 3 year results of transcatheter closure of patent ductus arterious make this technique a reasonable therapeutic alternative to surgery. From the safety point of view, the two techniques are comparable bu patient confort is greater with transcatheter closure for an increase in cost of the initial procedure which should decrease in relation to the types and prices of the prosthesis used.

  20. A finite-element model for healing of cutaneous wounds combining contraction, angiogenesis and closure

    NARCIS (Netherlands)

    Vermolen, F.J.; Javierre, E.

    2011-01-01

    A simplified finite-element model for wound healing is proposed. The model takes into account the sequential steps of dermal regeneration, wound contraction, angiogenesis and wound closure. An innovation in the present study is the combination of the aforementioned partially overlapping processes,

  1. A finite-element model for healing of cutaneous wounds combining contraction, angiogenesis and closure

    NARCIS (Netherlands)

    Vermolen, F.J.; Javierre, E.

    2011-01-01

    A simplified finite-element model for wound healing is proposed. The model takes into account the sequential steps of dermal regeneration, wound contraction, angiogenesis and wound closure. An innovation in the present study is the combination of the aforementioned partially overlapping processes, w

  2. Vacuum-assisted closure for complex cranial wounds involving the loss of dura mater.

    Science.gov (United States)

    Powers, Alexander K; Neal, Matthew T; Argenta, Louis C; Wilson, John A; DeFranzo, Anthony J; Tatter, Stephen B

    2013-02-01

    The aim in this study was to describe the safety and efficacy of vacuum-assisted closure (VAC) in patients with complex cranial wounds with extensive scalp, bone, and dural defects who were not candidates for immediate free tissue transfer. Five patients (4 men and 1 woman) ages 24-73 years with complex cranial wounds were treated with VAC at Wake Forest Baptist Medical Center. Etiologies included trauma, squamous cell carcinoma, and malignant meningioma. Cutaneous wound defects measured as large as 15 cm in diameter. Four of the 5 patients had open skull defects with concomitant dural defects, and 1 patient had dural dehiscence. After surgical debridement, all 5 patients were treated with the direct application of a VAC device to a reapproximated dura mater (1 patient), to a pericranial flap (1 patient), or to a regenerative tissue matrix overlying CNS tissue (3 patients). In all cases involving open cranial wounds, the VAC device promoted granulation tissue formation over the dural substitute, prevented CSF leakage, and kept the wounds free from local infection. The duration of VAC therapy ranged from 16 to 91 days. Although VAC therapy was intended as a temporary measure until these patients could be stabilized for larger tissue transfer procedures or they succumbed to their primary pathology, 1 patient had a successful skin graft following VAC therapy. Hydrocephalus requiring shunt placement developed in 2 patients during VAC therapy. The VAC dressings applied to a tissue matrix or other barrier over brain tissue in extensive cranial wounds are safe and well tolerated, providing a functional barrier and preventing infection.

  3. ABDOMINAL CLOSURE WITH ANTI BACTERIAL COATED SUTURE MATERIALS AND ITS RELATION TO THE INCIDENCE OF POST OPERATIVE SUPERFICIAL SURGICAL SITE INFECTION RATES

    OpenAIRE

    Josephine Pudumai Selvi; Celine Foustina Mary; Karthikeyan Rajashekar

    2017-01-01

    BACKGROUND Surgical site infection (SSI) is an immense burden on healthcare resources even in the modern era of immaculate sterilization approaches and highly effective antibiotics. An estimated 234 million various surgical procedures, involving skin incisions requiring various types of wound closure techniques, are performed in the world, with the majority resulting in a wound healing by primary intention. Triclosan (5-chloro-2-(2, 4-dichlorophenoxy) phenol) is a broad-spectrum b...

  4. Preliminary results from 28 cases of pilonidal cyst treated by excision and primary closure of the wound, reinforced with support suturing

    Directory of Open Access Journals (Sweden)

    Nelson de Souza Liboni

    2007-06-01

    Full Text Available Objectives: To describe the results of the surgical technique of pilonidalcyst excision with margins and primary closure of the operative woundwith support suturing. Methods: Twenty-eight patients with pilonidaldisease admitted to a private clinic between 1999 and 2006 underwentsurgical treatment by means of an elliptical longitudinal medial incisionproportional to the palpable tumor size and excision of cyst with 2-cmmargins above, below and laterally, and primary closure of the wound.To reduce the tension in the operative wound, suturing was performed,with a single support stitch of horizontal U-shape. The patients werefollowed up for periods ranging from 6 months to 3 years. Results:Two patients developed abscesses at the surgical site (7.1%, andone required complete opening of the operative wound for drainage.Both underwent excision and primary closure again. The pathologicalexamination demonstrated that these were not cases of relapse, butof recurrent abscess. No cases of non-infected collection (seroma andhematoma, spontaneous dehiscence of the operative wound or diseaserecurrence were recorded. Conclusions: The technique of pilonidal cystexcision with margins and primary closure of the wound reinforcedwith support suturing seems to be attractive, since it is characterizedby low complexity and low infection rate. Studies with larger samplesare needed to validate this surgical technique.

  5. Par3/Bazooka and phosphoinositides regulate actin protrusion formation during Drosophila dorsal closure and wound healing.

    Science.gov (United States)

    Pickering, Karen; Alves-Silva, Juliana; Goberdhan, Deborah; Millard, Tom H

    2013-02-01

    Effective wound closure mechanisms are essential for maintenance of epithelial structure and function. The repair of wounded epithelia is primarily driven by the cells bordering the wound, which become motile after wounding, forming dynamic actin protrusions along the wound edge. The molecular mechanisms that trigger wound edge cells to become motile following tissue damage are not well understood. Using wound healing and dorsal closure in Drosophila, we identify a direct molecular link between changes in cell-cell adhesion at epithelial edges and induction of actin protrusion formation. We find that the scaffolding protein Par3/Bazooka and the lipid phosphatase Pten are specifically lost from cell-cell junctions at epithelial edges. This results in a localized accumulation of phosphatidylinositol 3,4,5-trisphosphate (PIP3), which promotes the formation of actin protrusions along the epithelial edge. Depleting PIP3 results in defective epithelial closure during both dorsal closure and wound healing. These data reveal a novel mechanism that directly couples loss of epithelial integrity to activation of epithelial closure.

  6. 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.

  7. IMPORTANCE OF SOUTHAMPTON WOUND GRADING SYSTEM IN SURGICAL SITE INFECTION

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    Shaleen

    2014-05-01

    Full Text Available : Post-operative wound infection is defined as surgical site infection from 0-30 days after surgery, or infection to surgical site till one year in cases of implants like mesh, vascular grafts and prosthesis. This study was done to find out incidence of post-operative wound infection in surgical patients in rural setup. This study of post-operative wound infection was carried out from August 2008 to August 2010. The study is of 3275 patients who underwent surgery in the A.V.B.R.H. Significant association was observed between the nature of surgery and Southampton Wound Grading System. It concluded that severity rate of post-operative wound infection was increased from grade I to grade V which was found to be similar in clean to contaminated nature of surgery and that was found to be statistically significant at P value less than 0.001.

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

    Directory of Open Access Journals (Sweden)

    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.

  9. [Experience with the negative pressure closure system of chronic wounds in pediatric patients].

    Science.gov (United States)

    Dabaghi-Richerand, A; Gómez-Chavarría, J; González-Sánchez, M; Saleme-Cruz, J; Garavito, E

    2013-01-01

    To show the results and advantages of using the negative pressure closure system in a pediatric population with infections and wound closure defects. A retrospective analysis was conducted on pediatric patients in whom the VAC(®) negative pressure wound closure system was used in the Shriners Hospital for Children, Mexico, from January 2008 to December 2012. We were able to include 8 patients treated with this system. We evaluated the cause for use, wound colonizing microorganism, number of days of stay at the hospital, number of times applied, interval of application, and number of days in the hospital until discharge after VAC(®) application, and final treatment. The average days after VAC aplication till discharge was 13.7 days. The final treatment in 7 of the 8 patients was direct closure or application of skin grafts for closure of the wounds. Through this study we were able to observe that, after the application of this treatment, there was an increase in the granulation tissue at the wounds, as well as resolution of the infection. We were able to confirm the efficiency of this treatment in controlling the infection and decreasing skin defects, allowing an easier and earlier wound closure. Copyright © 2013 SECOT. Published by Elsevier Espana. All rights reserved.

  10. Purse-String Versus Linear Conventional Skin Wound Closure of an Ileostomy: A Randomized Clinical Trial

    Science.gov (United States)

    Alvandipour, Mina; Gharedaghi, Babak; Khodabakhsh, Hamed

    2016-01-01

    Purpose Infection is one of the most frequent complications that can occur after ileostomy closure. The incidence of wound infection depends on the skin closure technique, but there is no agreement on the perfect closure method for an ileostomy wound. The aim of this study was to evaluate the incidence of infection, the patient's approval, and the patient's pain between purse-string closure (PSC) and the usual linear closure (LC) of a stoma wound. Methods This randomized clinical trial enrolled 66 patients who underwent a stoma closure from February 2015 to May 2015 in Sari Emam Khomeini Hospital. Patients were divided into 2 groups according to the stoma closing method: the PSC group (n = 34) and the LC group (n = 32). The incidences of infection for the 2 groups were compared, and the patients' satisfaction and pain with the stoma were determined by using a questionnaire. Results Infection occurred in 1 of 34 PSC patients (2.9%) and in 7 of 32 LC patients (21.8%), and this difference was statistically significant (P = 0.021). Patients in the PSC group were more satisfied with the resulting wound scar and its cosmetic appearance at one month and three months after surgery (P = 0.043). Conclusion After stoma closure, PSC was associated with a significantly lower incidence of wound infection and greater patient satisfaction compared to LC. However, the healing period for patients who underwent PSC was longer than it was for those who underwent LC. PMID:27626025

  11. Prospective Randomized Study of the Effect of Music on the Efficiency of Surgical Closures.

    Science.gov (United States)

    Lies, Shelby R; Zhang, Andrew Y

    2015-09-01

    Music is commonly played in operating theaters. Some surgeons believe music reduces stress and operative time, while others think music is a distraction and should be avoided. There is limited published evidence evaluating the effects of music on surgical performance. The goal of this study is to evaluate the effect of music on simple wound closure. Plastic surgery residents were asked to perform layered closures on pigs' feet with and without their preferred music playing. Simple randomization was used to assign residents to the music playing first or music playing second group. The time to complete the repair was measured and repairs were graded by blinded faculty. Results were analyzed to determine significant differences in time to complete the task and quality of repair. Participants were retested in a second session with music played in the opposite order to evaluate consistency. Listening to preferred music decreased repair time by 8% for all plastic surgery residents (p = 0.009). Subgroup analysis demonstrated even more significant improvement in speed for senior residents (PGY 4-6), resulting in a 10% decrease in repair time (p = 0.006). The quality of repair was also better in the music group, at 3.3 versus 3.1 (p = 0.047). Retesting revealed results remained significant whether music was played first or second. Playing preferred music made plastic surgery residents faster in completing wound closure with a 10% improvement in senior residents. Music also improved quality of repair as judged by blinded faculty. Our study showed that music improves efficiency of wound closure, which may translate to healthcare cost savings. © 2015 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.

  12. 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.

  13. Inhibition of PAI-1 Via PAI-039 Improves Dermal Wound Closure in Diabetes.

    Science.gov (United States)

    Rebalka, Irena A; Raleigh, Matthew J; D'Souza, Donna M; Coleman, Samantha K; Rebalka, Alexandra N; Hawke, Thomas J

    2015-07-01

    Diabetes impairs the ability to heal cutaneous wounds, leading to hospitalization, amputations, and death. Patients with diabetes experience elevated levels of plasminogen activator inhibitor 1 (PAI-1), regardless of their glycemic control. It has been demonstrated that PAI-1-deficient mice exhibit improved cutaneous wound healing, and that PAI-1 inhibition improves skeletal muscle repair in mice with type 1 diabetes mellitus, leading us to hypothesize that pharmacologically mediated reductions in PAI-1 using PAI-039 would normalize cutaneous wound healing in streptozotocin (STZ)-induced diabetic (STZ-diabetic) mice. To simulate the human condition of variations in wound care, wounds were aggravated or minimally handled postinjury. Following cutaneous injury, PAI-039 was orally administered twice daily for 10 days. Compared with nondiabetic mice, wounds in STZ-diabetic mice healed more slowly. Wound site aggravation exacerbated this deficit. PAI-1 inhibition had no effect on dermal collagen levels or wound bed size. PAI-039 treatment failed to improve angiogenesis in the wounds of STZ-diabetic mice and blunted angiogenesis in the wounds of nondiabetic mice. Importantly, PAI-039 treatment significantly improved epidermal cellular migration and wound re-epithelialization compared with vehicle-treated STZ-diabetic mice. These findings support the use of PAI-039 as a novel therapeutic agent to improve diabetic wound closure and demonstrate the primary mechanism of its action to be related to epidermal closure.

  14. Medicare Payment: Surgical Dressings and Topical Wound Care Products.

    Science.gov (United States)

    Schaum, Kathleen D

    2014-08-01

    Medicare patients' access to surgical dressings and topical wound care products is greatly influenced by the Medicare payment system that exists in each site of care. Qualified healthcare professionals should consider these payment systems, as well as the medical necessity for surgical dressings and topical wound care products. Scientists and manufacturers should also consider these payment systems, in addition to the Food and Drug Administration requirements for clearance or approval, when they are developing new surgical dressings and topical wound care products. Due to the importance of the Medicare payment systems, this article reviews the Medicare payment systems in acute care hospitals, long-term acute care hospitals, skilled nursing facilities, home health agencies, durable medical equipment suppliers, hospital-based outpatient wound care departments, and qualified healthcare professional offices.

  15. Factors associated with the healing of complex surgical wounds in the breast and abdomen: retrospective cohort study

    Science.gov (United States)

    Borges, Eline Lima; Pires, José Ferreira; Abreu, Mery Natali Silva; Lima, Vera Lúcia de Araújo; Silva, Patrícia Aparecida Barbosa; Soares, Sônia Maria

    2016-01-01

    ABSTRACT Objective: to estimate the healing rate of complex surgical wounds and its associated factors. Method: retrospective cohort study from 2003 to 2014 with 160 outpatients of a Brazilian university hospital. Data were obtained through consultation of the medical records. Survival function was estimated using the Kaplan-Meier method and Cox regression model to estimate the likelihood of the occurrence of healing. Results: the complex surgical wound healing rate was 67.8% (95% CI: 60.8-74.9). Factors associated with a higher likelihood of wound healing were segmentectomy/quadrantectomy surgery, consumption of more than 20 grams/day of alcohol, wound extent of less that 17.3 cm2 and the length of existence of the wound prior to outpatient treatment of less than 15 days, while the use of hydrocolloid covering and Marlex mesh were associated with a lower likelihood of healing. Conclusion: the wound healing rate was considered high and was associated with the type of surgical intervention, alcohol consumption, type of covering, extent and length of wound existence. Preventive measures can be implemented during the monitoring of the evolution of the complex surgical wound closure, with possibilities of intervention in the modifiable risk factors. PMID:27737379

  16. Surgical staples compared with subcuticular suture for skin closure after cesarean delivery: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Sahar Assadi

    2016-03-01

    Full Text Available Background: Cesarean delivery is the most common surgical procedure and this prevalence is on the rise. Given these trends, cesarean wound complications, such as disruption or infection, remain an important cause of post-cesarean morbidity. Methods: We conducted a single-center randomized controlled trial that included women with viable pregnancies (≥24 weeks undergoing cesarean delivery at Motahary University Hospital, Urmia, Iran from April to November 2014. All cesarean types were included: scheduled or unscheduled and primary or repeat cesareans. Women were excluded for the following reasons: inability to obtain informed consent, immune compromising disease (e.g. AIDS, chronic steroid use, diabetic mellitus and BMI≥30. Of 266 women, 133 were randomized to staples and 133 women to suture group. Results: The mean±SD age of the staples group was 27.6±5.4 years and mean±SD age of suture was 28.7±5.9 years. Multiparity is the most frequent in both groups that by using Chi-square test, no significant differences were observed between the two groups (P=0.393. The most frequent indication for cesarean section in both groups was history of cesarean section in staple 40 cases (30.1% and suture 32 cases (24.1%. The survey was conducted using the Chi-square test was not significant (P=0.381. Pain at 6 weeks postoperatively was significantly less in the staple group (P=0.001. Operative time was longer with suture closure (4.68±0.67 versus 1.03±0.07 minute, P<0.001. The Vancouver scale score was significantly less in suture closure (6.6±0.8 versus 7.5±0.9, P=0.001. Wound disruption was significantly less in suture closure (3.8% versus 11.3%, P=0.017. Conclusion: The staple group had low pain and operation time but had a significant wound disruption and scar. The patients who have suffered a significant wound disruption were affected by age (P=0.022 and BMI (P=0.001 at compared those who were not affected by factors such as age or high BMI as

  17. 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.

  18. Improving wound healing and preventing surgical site complications of closed surgical incisions: a possible role of Incisional Negative Pressure Wound Therapy. A systematic review of the literature.

    Science.gov (United States)

    Scalise, Alessandro; Calamita, Roberto; Tartaglione, Caterina; Pierangeli, Marina; Bolletta, Elisa; Gioacchini, Matteo; Gesuita, Rosaria; Di Benedetto, Giovanni

    2016-12-01

    Advances in preoperative care, surgical techniques and technologies have enabled surgeons to achieve primary closure in a high percentage of surgical procedures. However, often, underlying patient comorbidities in addition to surgical-related factors make the management of surgical wounds primary closure challenging because of the higher risk of developing complications. To date, extensive evidence exists, which demonstrate the benefits of negative pressure dressing in the treatment of open wounds; recently, Incisional Negative Pressure Wound Therapy (INPWT) technology as delivered by Prevena™ (KCI USA, Inc., San Antonio, TX) and Pico (Smith & Nephew Inc, Andover, MA) systems has been the focus of a new investigation on possible prophylactic measures to prevent complications via application immediately after surgery in high-risk, clean, closed surgical incisions. A systematic review was performed to evaluate INPWT's effect on surgical sites healing by primary intention. The primary outcomes of interest are an understanding of INPWT functioning and mechanisms of action, extrapolated from animal and biomedical engineering studies and incidence of complications (infection, dehiscence, seroma, hematoma, skin and fat necrosis, skin and fascial dehiscence or blistering) and other variables influenced by applying INPWT (re-operation and re-hospitalization rates, time to dry wound, cost saving) extrapolated from human studies. A search was conducted for published articles in various databases including PubMed, Google Scholar and Scopus Database from 2006 to March 2014. Supplemental searches were performed using reference lists and conference proceedings. Studies selection was based on predetermined inclusion and exclusion criteria and data extraction regarding study quality, model investigated, epidemiological and clinical characteristics and type of surgery, and the outcomes were applied to all the articles included. 1 biomedical engineering study, 2 animal studies, 15

  19. Modelling wound closure in an epithelial cell sheet using the cellular Potts model.

    Science.gov (United States)

    Noppe, Adrian R; Roberts, Anthony P; Yap, Alpha S; Gomez, Guillermo A; Neufeld, Zoltan

    2015-10-01

    We use a two-dimensional cellular Potts model to represent the behavior of an epithelial cell layer and describe its dynamics in response to a microscopic wound. Using an energy function to describe properties of the cells, we found that the interaction between contractile tension along cell-cell junctions and cell-cell adhesion plays an important role not only in determining the dynamics and morphology of cells in the monolayer, but also in influencing whether or not a wound in the monolayer will close. Our results suggest that, depending on the balance between cell-cell adhesion and junctional tension, mechanics of the monolayer can either correspond to a hard or a soft regime that determines cell morphology and polygonal organization in the monolayer. Moreover, the presence of a wound in a hard regime, where junctional tension is significant, can lead to two results: (1) wound closure or (2) an initial increase and expansion of the wound area towards an equilibrium value. Theoretical approximations and simulations allowed us to determine the thresholds in the values of cell-cell adhesion and initial wound size that allow the system to lead to wound closure. Overall, our results suggest that around the site of injury, changes in the balance between contraction and adhesion determine whether or not non-monotonous wound closure occurs.

  20. A New Surgical Technique for Closure of Pilonidal Sinus Defects: Triangular Closure Technique

    Science.gov (United States)

    Mutaf, Mehmet; Temel, Metin; Koç, Mustafa Nihat

    2017-01-01

    Background We present a clinical experience with a new local flap procedure, namely the triangular closure technique, for reconstruction of sacrococcygeal skin defects resulting from excision of the pilonidal sinus. Material/Methods In this technique, the defect is surgically converted to a triangle in shape. Then, the triangular defect is closed by transposition of 2 skin flaps designed in an unequal z-plasty manner. Over 6 years, this technique has been used for closure of defects of chronic pilonidal sinus disease in 27 patients (6 females, 21 males). The size of the defect ranged between 3.5 cm and 12 cm in dimension. Results A tension-free defect closure was obtained in all patients. All flaps except one healed with no complications. A mean follow-up of 3.62±1.77 months revealed aesthetically and functionally acceptable results with the obliteration of the natal cleft in all patients. No recurrence was observed in the follow-up period. Conclusions The triangular closure technique was found to be a useful technique for the treatment of pilonidal sinus with favorable results regarding the time before return to work. PMID:28238003

  1. Accelerated wound closure in vitro by fibroblasts from a subgroup of cleft lip/palate patients: role of transforming growth factor-α.

    Directory of Open Access Journals (Sweden)

    Joël Beyeler

    Full Text Available In a fraction of patients surgically treated for cleft lip/palate, excessive scarring disturbs maxillary growth and dento-alveolar development. Since certain genes are involved in craniofacial morphogenesis as well as tissue repair, a primary defect causing cleft lip/palate could lead to altered wound healing. We performed in vitro wound healing assays with primary lip fibroblasts from 16 cleft lip/palate patients. Nine foreskin fibroblast strains were included for comparison. Cells were grown to confluency and scratch wounds were applied; wound closure was monitored morphometrically over time. Wound closure rate showed highly significant differences between fibroblast strains. Statistically, fibroblast strains from the 25 individuals could be divided into three migratory groups, namely "fast", "intermediate", and "slow". Most cleft lip/palate fibroblasts were distributed between the "fast" (5 strains and the "intermediate" group (10 strains. These phenotypes were stable over different cell passages from the same individual. Expression of genes involved in cleft lip/palate and wound repair was determined by quantitative PCR. Transforming growth factor-α mRNA was significantly up-regulated in the "fast" group. 5 ng/ml transforming growth factor-α added to the culture medium increased the wound closure rate of cleft lip/palate strains from the "intermediate" migratory group to the level of the "fast", but had no effect on the latter group. Conversely, antibody to transforming growth factor-α or a specific inhibitor of its receptor most effectively reduced the wound closure rate of "fast" cleft lip/palate strains. Thus, fibroblasts from a distinct subgroup of cleft lip/palate patients exhibit an increased migration rate into wounds in vitro, which is linked to higher transforming growth factor-α expression and attenuated by interfering with its signaling.

  2. The vacuum-assisted closure system for the treatment of deep sternal wound infections after cardiac surgery.

    Science.gov (United States)

    Fleck, Tatjana M; Fleck, Michael; Moidl, Reinhard; Czerny, Martin; Koller, Rupert; Giovanoli, Pietro; Hiesmayer, Michael J; Zimpfer, Daniel; Wolner, Ernst; Grabenwoger, Martin

    2002-11-01

    The VAC system (vacuum-assisted wound closure) is a noninvasive active therapy to promote healing in difficult wounds that fail to respond to established treatment modalities. The system is based on the application of negative pressure by controlled suction to the wound surface. The method was introduced into clinical practice in 1996. Since then, numerous studies proved the effectiveness of the VAC System on microcirculation and the promotion of granulation tissue proliferation. Eleven patients (5 men, 6 women) with a median age of 64.4 years (range 50 to 78 years) with sternal wound infection after cardiac surgery (coronary artery bypass grafting = 5, aortic valve replacement = 5, ascending aortic replacement = 1) were fitted with the VAC system by the time of initial surgical debridement. Complete healing was achieved in all patients. The VAC system was removed after a mean of 9.3 days (range 4 to 15 days), when systemic signs of infection resolved and quantitative cultures were negative. In 6 patients (54.5%), the VAC system was used as a bridge to reconstructive surgery with a pectoralis muscle flap, and in the remaining 5 patients (45.5%), primary wound closure could be achieved. Intensive care unit stay ranged from 1 to 4 days (median 1 day). Duration of hospital stay varied from 13 to 45 days (median 30 days). In-hospital mortality was 0%, and 30-day survival was 100%. The VAC system can be considered as an effective and safe adjunct to conventional and established treatment modalities for the therapy of sternal wound infections after cardiac surgery.

  3. The unnatural history of the ventricular septal defect : outcome up to 40 years after surgical closure

    NARCIS (Netherlands)

    Menting, Myrthe E; Cuypers, Judith A A E; Opić, Petra; Utens, Elisabeth M W J; Witsenburg, Maarten; van den Bosch, Annemien E; van Domburg, Ron T; Meijboom, Folkert J; Boersma, Eric; Bogers, Ad J J C; Roos-Hesselink, Jolien W

    2015-01-01

    BACKGROUND: Few prospective data are available regarding long-term outcomes after surgical closure of a ventricular septal defect (VSD). OBJECTIVES: The objective of this study was to investigate clinical outcomes>30 years after surgical VSD closure. METHODS: Patients who underwent surgical VSD clos

  4. Peripheral surgical wounding and age-dependent neuroinflammation in mice.

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    Zhipeng Xu

    Full Text Available Post-operative cognitive dysfunction is associated with morbidity and mortality. However, its neuropathogenesis remains largely to be determined. Neuroinflammation and accumulation of β-amyloid (Aβ have been reported to contribute to cognitive dysfunction in humans and cognitive impairment in animals. Our recent studies have established a pre-clinical model in mice, and have found that the peripheral surgical wounding without the influence of general anesthesia induces an age-dependent Aβ accumulation and cognitive impairment in mice. We therefore set out to assess the effects of peripheral surgical wounding, in the absence of general anesthesia, on neuroinflammation in mice with different ages. Abdominal surgery under local anesthesia was established in 9 and 18 month-old mice. The levels of tumor necrosis factor-α (TNF-α, interleukin-6 (IL-6, Iba1 positive cells (the marker of microglia activation, CD33, and cognitive function in mice were determined. The peripheral surgical wounding increased the levels of TNF-α, IL-6, and Iba1 positive cells in the hippocampus of both 9 and 18 month-old mice, and age potentiated these effects. The peripheral surgical wounding increased the levels of CD33 in the hippocampus of 18, but not 9, month-old mice. Finally, anti-inflammatory drug ibuprofen ameliorated the peripheral surgical wounding-induced cognitive impairment in 18 month-old mice. These data suggested that the peripheral surgical wounding could induce an age-dependent neuroinflammation and elevation of CD33 levels in the hippocampus of mice, which could lead to cognitive impairment in aged mice. Pending further studies, anti-inflammatory therapies may reduce the risk of postoperative cognitive dysfunction in elderly patients.

  5. [Perspective technologies of surgical care to the wounded].

    Science.gov (United States)

    Samokhvalov, I M; Badalov, V I; Reva, V A; Golovko, K P; Petrov, A N; Kaznacheev, M V; Rozov, A I

    2013-06-01

    A goal of this study is to review perspective technologies of surgical care to the wounded on the basis of an analysis of the experience in medical support in local armed conflicts and a study of the achievements of modern trauma surgery. The study is based on the analysis of personal experience, results of scientific researches being carried out in the Military Medical Academy and a comparison review of available papers and works in the field of our study. Perspective technologies of surgical care to the wounded are strongly dependent on the pre-hospital care: high technologies in personal medical equipment, special disposable devices used in case of life-threatening consequences of injuries and traumas during emergency medical care and advanced trauma management. The main innovation of the last ten years in war surgery is considered to be damage control surgery. Wide application of abbreviated surgical operations (the first phase of damage control surgery) makes the use of remote surgery (telesurgery) for treatment of the wounded more practicable. Increasing effectiveness of military surgeon education is based on the use of all possible achievements in education and information technologies. Feedback in surgical care to the wounded is supplied with analysis of its results in the medical Register of the wounded military.

  6. Evaluation of four suture materials for surgical incision closure in Siberian sturgeon

    Science.gov (United States)

    Boone, S. Shaun; Hernandez, Sonia M.; Camus, Alvin C.; Peterson, Douglas C.; Jennings, Cecil A.; Shelton, James L.; Divers, Stephen J.

    2015-01-01

    The visual and microscopic tissue reactions to the absorbable monofilament Monocryl, absorbable monofilament triclosan-coated Monocryl-Plus, absorbable multifilament Vicryl, and nonabsorbable monofilament Prolene were evaluated for their use of surgical closure in Siberian Sturgeon Acipenser baerii. Postoperative assessments were conducted at 1, 2, 8, 12, and 26 and 55 weeks to visually evaluate the surgical incision for suture retention, incision healing, erythema, and swelling. Incisions were also assessed microscopically at 1, 2, and 8 weeks for necrosis, inflammation, hemorrhage, and fibroplasia. The results indicated that incisions closed with either Vicryl or Prolene suture materials were more likely to exhibit more erythema or incomplete healing compared with those closed with Monocryl or Monocryl-Plus. The surgical implantation of a transmitter in the coelomic cavity did not significantly affect the response variables among the four suture materials. Monocryl or Monocryl-Plus were equally effective and superior to other suture materials used for closing surgical incisions in Siberian Sturgeon or closely related species of sturgeon. Furthermore, Monocryl or Monocryl-Plus may decrease the risk of transmitter expulsion through the incision, as surgical wounds appear to heal faster and exhibit less erythema compared with those closed with Vicryl.

  7. Use of cyanoacrylate in the coaptation of edges of surgical wounds*

    Science.gov (United States)

    Lins, Ruthinéia Diógenes Alves Uchôa; Gomes, Raquel Christina Barboza; dos Santos, Kátia Simone Alves; da Silva, Paula Vanessa; da Silva, Renata Torres Moreira; Ramos, Ianny Alves

    2012-01-01

    Cyanoacrylate has been used in several fields of different surgical specialties as an adhesive for closure of gingival flaps and in mucous and cutaneous lacerations. One of its advantages is that it has an excellent immunological response. In view of aesthetic needs, cyanoacrylate has been applied with satisfactory results, when compared with sutures. It presents better coaptation of edges of cutaneous and mucosal lesions, smaller residual scars, and biocompatibility. However, it is limited to areas of little tissue tension. This work attempts to provide a literature review with the aim of revealing the advantages of using tissue adhesives, especially cyanoacrylates, in wound coaptation in comparison with conventional methods. PMID:23197206

  8. Photobiomodulation of surgical wound dehiscence in a diabetic individual by low-level laser therapy following median sternotomy

    Directory of Open Access Journals (Sweden)

    Snehil Dixit

    2013-01-01

    Full Text Available In this single case study, we attempt to outline the possible effect of low-level laser therapy (LLLT on delayed wound healing and pain in chronic dehiscent sternotomy of a diabetic individual. The methods that were employed to evaluate changes pre and post irradiation were wound photography, wound area measurement, pressure ulcer scale of healing (PUSH, and visual analogue scale (VAS for pain. After irradiation, proliferation of healthy granulation tissue was observed with decrease in scores of PUSH for sternal dehiscence and VAS for bilateral shoulders and sternal dehiscence. We found that LLLT irradiation could be a novel method of treatment for chronic sternal dehiscence following coronary artery bypass grafting, as it augments wound healing with an early closure of the wound deficit. Hence, this might be translated into an early functional rehabilitation and decreased pain perception of an individual following surgical complication.

  9. Sandwich wound closure reduces the risk of cerebrospinal fluid leaks in posterior fossa surgery

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    Verena Heymanns

    2016-07-01

    Full Text Available Posterior fossa surgery is demanding and hides a significant number of obstacles starting from the approach to the wound closure. The risk of cerebrospinal fluid (CSF leakage in posterior fossa surgery given in the literature is around 8%. The present study aims to introduce a sandwich closure of the dura in posterior fossa surgery, which reduces significantly the number of CSF leaks (3.8% in the patients treated in our department. Three hundred and ten patients treated in our hospital in the years 2009-2013 for posterior fossa pathologies were retrospectively evaluated. The dura closure method was as following: lyophilized dura put under the dura and sealed with fibrin glue and sutures, dura adapting stitches, TachoSil® (Takeda Pharma A/S, Roskilde, Denmark, Gelfoam® (Pfizer Inc., New York, NY, USA and polymethylmethacrylate (osteoclastic craniotomy. The incidence of postsurgical complications associated with the dural closure like CSF leakage, infections, bleeding is evaluated. Only 3.8% of patients developed CSF leakage and only 0.5% needed a second surgery for CSF leakage closure. Two percent had a cerebellar bleeding with no need for re-operation and 3% had a wound infection treated with antibiotics. The sandwich wound closure we are applying for posterior fossa surgery in our patients correlates with a significant reduction of CSF leaks compared to the literature.

  10. Full-Thickness Thermal Injury Delays Wound Closure in a Murine Model

    Science.gov (United States)

    2015-01-01

    fibronectin, and periostin during the remodeling phase of tissue repair.7–10 CLINICAL PROBLEM ADDRESSED Current strategies to optimize the outcome...The control represents normal collagen architectures on POD 0, while both contact and scald burn groups demonstrated full-thickness burn marked by...vs. 76.78% early interval excision, p =0.08) (Fig. 3). Burn injury retards wound re-epithelialization, closure, and remodeling Wound histology

  11. Morphological Peculiarities Of Laser Surgical Wounds

    Science.gov (United States)

    Yeliseenko, Vladimir I.

    1988-06-01

    Under the laser continuous irradiation one can observe on tissues and organs a whole complex of dystrophic processes including the coagulation necrosis as well as impairements in hemo- and microcirculation. The peculiarity of the inflammatory reaction in the healing process in laser wounds lies in an absence of demarcation leucocytic infiltration and lack of edema on a border of intact tissues and those with thermal necrosis; the healing process is characterised as well as with early proliferative phase. The main role in the reparative process belongs to cells of mononuclear phagocytic system ( macrophages ), wich make the reparative process like an aseptic productive inflammation.

  12. Case 7: highly infected post-surgical wound.

    Science.gov (United States)

    von Hallern, Bernd

    2016-03-01

    Following treatment with antibiotics and surgical incision, which resulted in the release of putrid exudate, the wound was rinsed thoroughly with octenisept and covered with an antimicrobial dressing. This regimen successfully eradicated the infection, with full healing occurring in 6 weeks.

  13. Surgical closure of postlaryngectomy pharyngocutaneous fistula: a defect based approach.

    Science.gov (United States)

    Magdy, Emad A

    2008-01-01

    Surgical repair of postlaryngectomy pharyngocutaneous fistula (PCF) can be challenging. Although several studies describe separate reconstruction methods, only few address the variability in defect characteristics and hence flap selection. The current clinical study presents a retrospective review of 19 patients who underwent surgical repair of persistent PCFs, over a 4-year period in a tertiary referral institute by a single primary surgeon. All but one patient were men with a mean age of 61 +/- 10 years. Nine patients had previous unsuccessful attempts for surgical closure. Previous neck irradiation was the most common comorbid condition encountered (52.6%), followed by low hemoglobin level (47.4%), hepatic disease (36.8%) and diabetes mellitus (31.6%). According to defect characteristics, six patients received a local cervical skin procedure, ten patients had reconstructions using the pectoralis major musculocutaneous flap and three patients required a radial forearm free flap repair. All PCFs were eventually successfully closed with no major complications. Patients were followed-up for an average of 19.7 months (range, 5-38 months). Acceptable oral swallowing results were achieved in all but one patient. In conclusion, successful results are achievable in difficult persistent PCF cases with a defect based reconstruction approach kept in mind.

  14. Randomized comparison of polyglycolic acid and polyglyconate sutures for abdominal fascial closure after laparotomy in patients with suspected impaired wound healing

    DEFF Research Database (Denmark)

    Osther, P J; Gjøde, P; Mortensen, Sophie Berit Bondegaard

    1995-01-01

    A randomized study of abdominal fascial closure using interrupted polyglyconate and polyglycolic acid sutures after laparotomy was carried out in 204 consecutive patients with suspected impaired wound healing. There were no statistically significant differences between the two sutures with regard...... to the development of fascial disruption and incisional hernia. Wound infection demanding surgical intervention was found in 7 per cent of patients with polyglyconate sutures and in 16 per cent of those with polyglycolic acid sutures (P = 0.04). Monofilament polyglyconate suture does not reduce the incidence...

  15. Retrospective Study on the Treatment Outcome of Surgical Closure of Oroantral Communications

    NARCIS (Netherlands)

    Visscher, Susan H.; van Roon, Marije R. F.; Sluiter, Wim J.; van Minnen, Baucke; Bos, Ruud R. M.

    2011-01-01

    Purpose: A retrospective cohort study concerning the surgical closure of oroantral communications (OACs) was carried out to facilitate a comparison between treatment outcomes of conventional surgical treatment and new strategies for closure of OACs. Data were statistically analyzed to gather insight

  16. Targeted Inhibition of PAI-1 Activity Impairs Epithelial Migration and Wound Closure Following Cutaneous Injury.

    Science.gov (United States)

    Simone, Tessa M; Longmate, Whitney M; Law, Brian K; Higgins, Paul J

    2015-06-01

    Objective: Aberrant plasminogen activator inhibitor-1 (PAI-1) expression and activity have been implicated in bleeding disorders, multiorgan fibrosis, and wound healing anomalies. This study details the physiological consequences of targeted PAI-1 functional inhibition on cutaneous injury repair. Approach: Dorsal skin wounds from FVB/NJ mice, created with a 4 mm biopsy punch, were treated topically with the small-molecule PAI-1 antagonist tiplaxtinin (or vehicle control) for 5 days and then analyzed for markers of wound repair. Results: Compared to controls, tiplaxtinin-treated wounds displayed dramatic decreases in wound closure and re-epithelialization. PAI-1 immunoreactivity was evident at the migratory front in all injury sites indicating these effects were due to PAI-1 functional blockade and not PAI-1 expression changes. Stimulated HaCaT keratinocyte migration in response to recombinant PAI-1 in vitro was similarly attenuated by tiplaxtinin. While tiplaxtinin had no effect on keratinocyte proliferation, cell cycle progression, or apoptosis, it effectively reduced collagen deposition, the number of Ki-67(+) fibroblasts, and incidence of differentiated myofibroblasts (i.e., smooth muscle α-actin immunoreactive cells), but not fibroblast apoptosis. Innovation: The role for PAI-1 in hemostasis and fibrinolysis is established; involvement of PAI-1 in cutaneous wound healing, however, remains unclear. This study tests the effect of a small-molecule PAI-1 inhibitor in a murine model of skin wound repair. Conclusion: Loss of PAI-1 activity significantly impaired wound closure. Re-epithelialization and fibroblast recruitment/differentiation were both reduced in tiplaxtinin-treated mice. Therapies directed at manipulation of PAI-1 expression and/or activity may have applicability as a treatment option for chronic wounds and scarring disorders.

  17. Experimental closure of gunshot wounds by fibrin glue with antibiotics in pigs

    Directory of Open Access Journals (Sweden)

    Đenić Nebojša

    2015-01-01

    Full Text Available Background/Aim. Gunshot wounds caused by the automatic rifle M70AB2 (AK-47 7.62 mm, after the primary surgical management, were closed with delayed primary suture during the next four to seven days. This period coincides with the fibroblastic phase of wound healing. Fibrin glue is used as a local hemostatic and as a matrix for the local dosed release of antibiotics. Antibiotics addition to fibrin glue resulted in continuous diffusion into the surrounding next 4 to 7 days. The aim of this study was to create the preconditions for gunshot wounds closing without complications by the application of fibrin glue with antibiotics 24 h after primary surgical treatment. Methods. A total of 14 pigs were wounded in the gluteofemoral region by the bullet M67, initial velocity of 720 m/s. All wounded animals were surgically treated according to the principles of the warsurgery doctrine. Seven wounds were closed with primary delayed suture four days after the primary surgical treatment (traditional approach. Fibrin glue with antibiotics was introduced in seven wounds during the primary surgical treatment and primary delayed suture was done after 24 h. The macroscopic appearance and the clinical assessment of the wound were done during the primary surgical treatment and during its revision after 24 h, as well as histopathological findings at the days 4 and 7 after wounding. Results. Gunshot wounds caused by the automatic rifle M70AB2 (AK-47 7.62 mm, and treated with fibrin glue with antibiotics after primary surgical management, were closed with primary delayed suture after 24 h. In further wound evolution there were no complications. Conclusion. Uncomplicated soft-tissue wounds caused by an automatic M70AB2 rifle may be closed primarily with delayed suture without the risk of developing complications if on revision, 24 h after primary surgery, there were no present necrotic tissues, hematoma, and any signs of infection when fibrin glue with antibiotics

  18. An innovative method to evaluate the suture compliance in sealing the surgical wound lips

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    Farid Saleh, Beniamino Palmieri, Danielle Lodi, Khalid Al-Sebeih

    2008-01-01

    Full Text Available Background and aim: The increasing number of surgical procedures performed with local anesthesia, followed by immediate patient discharge from the hospital, emphasizes the need for a tight waterproof suture that is capable of maintaining its tensile strength in the postoperative phase when the wound tumescence, edema due to the anesthetic drug, and surgical trauma disappear. Moreover, the issue of having an accurate surgical wound closure is very relevant in vivo in order to prevent hemorrhage and exogenous microbial infections. This study aimed at designing a new a lab technique that could be used for evaluating the best surgical material. Using such a technique, we compared the wound-lip-sealing properties of three commonly-used suture threads, namely polyurethane, polypropylene, and polyamide. Materials and methods: The mechanical properties of same-size suture threads made from polyurethane, polypropylene, and polyamide, were compared in order to define the one that possess the best elastic properties by being able to counteract the tension-relaxation process in the first 12 hours following surgery. The tension holding capacity of the suture materials was measured in both in vivo and in vitro experiments. The surface area of the scar associated with the three different suture threads was measured and compared, and the permeability of the three different suture threads was assessed at 0 minute, 2 minute, 4 minute, 6 minute, and 8 minute- interval. Results: Results showed that polyurethane suture threads had significantly (P < 0.05 better tensile strength, elongation endurance before breakage, and better elasticity coefficient as compared to polypropylene and polyamide suture threads. Moreover, polyurethane suture threads were significantly (P < 0.05 more impermeable as compared to the other two suture thread types (polypropylene and polyamide. This impermeability was also associated with a tighter wound-lip-sealing ability, and with

  19. Improved Surgical Site Infection (SSI) rate through accurately assessed surgical wounds.

    Science.gov (United States)

    John, Honeymol; Nimeri, Abdelrahman; Ellahham, Samer

    2015-01-01

    Sheikh Khalifa Medical City's (SKMC) Surgery Institute was identified as a high outlier in Surgical Site Infections (SSI) based on the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) - Semi-Annual Report (SAR) in January 2012. The aim of this project was to improve SSI rates through accurate wound classification. We identified SSI rate reduction as a performance improvement and safety priority at SKMC, a tertiary referral center. We used the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) best practice guidelines as a guide. ACS NSQIP is a clinical registry that provides risk-adjusted clinical outcome reports every six months. The rates of SSI are reported in an observed/expected ratio. The expected ratio is calculated based on the risk factors of the patients which include wound classification. We established a multidisciplinary SSI taskforce. The members of the SSI taskforce included the ACS NSQIP team members, quality, surgeons, nurses, infection control, IT, pharmacy, microbiology, and it was chaired by a colorectal surgeon. The taskforce focused on five areas: pre-op showering and hair removal, skin antisepsis, prophylactic antibiotics, peri-operative maintenance of glycaemia, and normothermia. We planned audits to evaluate our wound classification and our SSI rates based on the SAR. Our expected SSI rates in general surgery and the whole department were 2.52% and 1.70% respectively, while our observed SSI rates were 4.68% and 3.57% respectively, giving us a high outlier status with an odd's ratio of 1.72 and 2.03. Wound classifications were identified as an area of concern. For example, wound classifications were preoperatively selected based on the default wound classification of the booked procedure in the Electronic Medical Record (EMR) which led to under classifying wounds in many occasions. A total of 998 cases were reviewed, our rate of incorrect wound classification

  20. Effect of Semi-quantitative Culture Results from Complex Host Surgical Wounds on Dehiscence Rates.

    Science.gov (United States)

    Elmarsafi, Tammer; Garwood, Caitlin S; Steinberg, John S; Evans, Karen K; Attinger, Christopher E; Kim, Paul J

    2017-01-16

    The primary aim of this study was to determine the effect of positive bacterial cultures at the time of closure on dehiscence rates. Pre and post-débridement wound cultures from patients undergoing serial surgical débridement of infected wounds were compared with outcomes 30 days postoperatively. One-hundred patients were enrolled; 35 were excluded for incomplete culture data. Sixty-five patients were evaluated for species counts, including Coagulase negative Staphylococcus, and semi-quantitative culture data for each débridement. The post-débridement cultures on the date of closure had no growth in 42 patients (64.6%) of which 6 dehisced (14.3%), and 36 remained closed; with no statistically significant difference in dehiscence rates (p=0.0664). Pre-débridement cultures from the 1(st) débridement of the 65 patients showed 8 patients had no growth, 29 grew 1 species, 19 grew 2 species, and 9 had 3-5 species. There was a reduction in the number of species and improvement of semi-quantitative cultures with each subsequent débridement. The dehiscence rate for those who had 2 débridements (n=42) was 21.4% at 30 day follow-up and 21.7% in those who had 3 débridements (n=23). The number of débridements had no statistical significance on dehiscence rates. The presence of Coagulase negative Staphylococcus (CoNS) on the day of closure was a statistically significant risk for dehiscence within 30 days (p=0.0091) postoperatively. This data demonstrates: (1) positive post-débridement cultures (scant/rare, growth in enrichment broth) at the time of closure did not affect overall dehiscence rates (p=0.0664), (2) the number of species and semi-quantitiative culture results both improved with each subsequent débridement, (3) the number of surgical débridement did not influence post-closure dehiscence rates. (4) Positive cultures containing Coagulase negative Staphylococcus at the time of closure is a risk factor for dehiscence (p=0.0091). This article is protected by

  1. [Wound microbial sampling methods in surgical practice, imprint techniques].

    Science.gov (United States)

    Chovanec, Z; Veverková, L; Votava, M; Svoboda, J; Peštál, A; Doležel, J; Jedlička, V; Veselý, M; Wechsler, J; Čapov, I

    2012-12-01

    The wound is a damage of tissue. The process of healing is influenced by many systemic and local factors. The most crucial and the most discussed local factor of wound healing is infection. Surgical site infection in the wound is caused by micro-organisms. This information is known for many years, however the conditions leading to an infection occurrence have not been sufficiently described yet. Correct sampling technique, correct storage, transportation, evaluation, and valid interpretation of these data are very important in clinical practice. There are many methods for microbiological sampling, but the best one has not been yet identified and validated. We aim to discuss the problem with the focus on the imprint technique.

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

    Directory of Open Access Journals (Sweden)

    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.

  3. Outcomes After Paravalvular Leak Closure: Transcatheter Versus Surgical Approaches.

    Science.gov (United States)

    Wells, John A; Condado, Jose F; Kamioka, Norihiko; Dong, Andy; Ritter, Andrew; Lerakis, Stamatios; Clements, Stephen; Stewart, James; Leshnower, Bradley; Guyton, Robert; Forcillo, Jessica; Patel, Ateet; Thourani, Vinod H; Block, Peter C; Babaliaros, Vasilis

    2017-03-13

    The aim of this study was to compare outcomes of transcatheter intervention (TI) versus surgical intervention (SI) for paravalvular leak (PVL). Data comparing the treatment of PVL with TI and SI are limited. A retrospective cohort study was conducted comparing baseline characteristics, procedural details, and 1-year survival in consecutive patients who underwent TI or SI for moderate or greater PVL from 2007 to 2016. The primary outcome was a composite of death, reintervention for PVL, or readmission for congestive heart failure-related symptoms at 1 year. Of 114 patients, 56 underwent TI and 58 underwent SI. PVL locations were mitral, aortic, and pulmonary in 69 (60.5%), 39 (34.2%), and 6 (5.3%) patients, respectively. At baseline, TI patients were older (age 71 vs. 62 years; p = 0.010) and had fewer cases of active endocarditis (0.0% vs. 25.9%, p < 0.001) than SI patients. The TI group had a shorter post-operative stay (4 vs. 8 days; p < 0.001), a shorter intensive care unit stay (0 vs. 3 days; p < 0.001), and fewer readmissions at 30 days (8.9% vs. 25.9%; p = 0.017). There were no differences in the primary endpoint (TI 33.9% vs. SI 39.7%; p = 0.526) or 1-year survival (TI 83.9% vs. SI 75.9%; p = 0.283) between groups. In this study, TI for PVL closure had comparable 1-year clinical outcomes with SI, even after adjusting for differences in baseline characteristics, with less in-hospital morbidity and 30-day rehospitalization. Although further study is needed, these findings support the increased implementation of TI for PVL closure at experienced institutions. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  4. LXA{sub 4} actions direct fibroblast function and wound closure

    Energy Technology Data Exchange (ETDEWEB)

    Herrera, Bruno S. [Department of Applied Oral Sciences, Center for Periodontology, The Forsyth Institute, Cambridge, MA (United States); Microbiology Branch, US Army Dental and Trauma Research Detachment, Institute of Surgical Research, JBSA Fort Sam Houston, TX (United States); Kantarci, Alpdogan; Zarrough, Ahmed; Hasturk, Hatice [Department of Applied Oral Sciences, Center for Periodontology, The Forsyth Institute, Cambridge, MA (United States); Leung, Kai P., E-mail: kai.p.leung.civ@mail.mil [Microbiology Branch, US Army Dental and Trauma Research Detachment, Institute of Surgical Research, JBSA Fort Sam Houston, TX (United States); Van Dyke, Thomas E., E-mail: tvandyke@forsyth.org [Department of Applied Oral Sciences, Center for Periodontology, The Forsyth Institute, Cambridge, MA (United States)

    2015-09-04

    Timely resolution of inflammation is crucial for normal wound healing. Resolution of inflammation is an active biological process regulated by specialized lipid mediators including the lipoxins and resolvins. Failure of resolution activity has a major negative impact on wound healing in chronic inflammatory diseases that is manifest as excess fibrosis and scarring. Lipoxins, including Lipoxin A{sub 4} (LXA{sub 4}), have known anti-fibrotic and anti-scarring properties. The goal of this study was to elucidate the impact of LXA{sub 4} on fibroblast function. Mouse fibroblasts (3T3 Mus musculus Swiss) were cultured for 72 h in the presence of TGF-β1, to induce fibroblast activation. The impact of exogenous TGF-β1 (1 ng/mL) on LXA{sub 4} receptor expression (ALX/FPR2) was determined by flow cytometry. Fibroblast proliferation was measured by bromodeoxyuridine (BrdU) labeling and migration in a “scratch” assay wound model. Expression of α-smooth muscle actin (α-SMA), and collagen types I and III were measured by Western blot. We observed that TGF-β1 up-regulates LXA{sub 4} receptor expression, enhances fibroblast proliferation, migration and scratch wound closure. α-SMA levels and Collagen type I and III deposition were also enhanced. LXA{sub 4} slowed fibroblast migration and scratch wound closure at early time points (24 h), but wound closure was equal to TGF-β1 alone at 48 and 72 h. LXA{sub 4} tended to slow fibroblast proliferation at both concentrations, but had no impact on α-SMA or collagen production by TGF-β1 stimulated fibroblasts. The generalizability of the actions of resolution molecules was examined in experiments repeated with resolvin D2 (RvD2) as the agonist. The activity of RvD2 mimicked the actions of LXA{sub 4} in all assays, through an as yet unidentified receptor. The results suggest that mediators of resolution of inflammation enhance wound healing and limit fibrosis in part by modulating fibroblast function. - Highlights: • TGF

  5. Surgical adhesives for laser-assisted wound closure

    Science.gov (United States)

    Hodges, Diane E.; McNally-Heintzelman, Karen M.; Welch, Ashley J.

    2001-10-01

    Solid protein solder-doped polymer membranes were developed for laser-assisted tissue repair. Biodegradable polymer membranes of controlled porosity were fabricated with poly(L-lactic-co-glycolic acid) (PLGA), poly(ethylene glycol) (PEG), and salt particles, using a solvent-casting and particulate-leaching technique. The membranes provided a porous scaffold that readily absorbed the traditional protein solder composed of serum albumin, indocyanine green dye, and de-ionized water. In vitro investigations were conducted to assess the influence of various processing parameters on the strength of tissue repairs formed using the new membranes. These parameters included PLGA copolymer and PLGA/PEG blend ratios, membrane pore size, initial albumin weight fraction, and laser irradiance used to denature the solder. Altering the PLGA copolymer ratio had little effect on repair strength, however such variations are known to influence the degradation rate of the membranes. The repair strength increased with increased membrane pore size and bovine serum albumin concentration. The addition of PEG during the membrane casting stage increased the flexibility of the membranes but not necessarily the repair strength. Typically, the repair strength increased with increasing irradiance from 12 to 18 W/cm2. The new solder-doped polymer membranes provided all of the benefits associated with solid protein solders including high repair strength and improved edge coaptation. In addition, the flexible, moldable nature of the new membranes offers the capability of tailoring the membranes to a wide range of clinically relevant geometries.

  6. [Surgical closure of patent ductus arteriosus in premature neonates: Does the surgical technique affect the outcome?

    Science.gov (United States)

    Avila-Alvarez, Alejandro; Serantes Lourido, Marta; Barriga Bujan, Rebeca; Blanco Rodriguez, Carolina; Portela-Torron, Francisco; Bautista-Hernandez, Victor

    2017-05-01

    Surgical closure of patent ductus arteriosus in premature neonates is an aggressive technique and is not free of complications. A study was designed with the aim of describing our experience with a less invasive technique, the extra-pleural approach via a posterior minithoracotomy, and to compare the results with the classic transpleural approach. A retrospective cohort study was conducted on premature neonates on whom surgical closure of the ductus was performed during a ten-year period (March 2005 to March 2015). A comparison was made of the acute complications, the outcomes on discharge, and follow-up, between the extra-pleural approach and the classic transpleural approach. The study included 48 patients, 30 in the classical approach and 18 in the extra-pleural group. The demographic and pre-operative characteristics were similar in both groups. No differences were found between the 2 groups in the incidence of acute post-operative complications (56.6 vs. 44.4%), on the dependence on oxygen at 36 weeks (33.3 vs. 55.5%), or in hospital mortality (10 vs. 16.6%). As regards the short-term progress, the extra-pleural group required fewer days until the withdrawal of supplementary oxygen (36.3 vs. 28.9) and until hospital discharge (67.5 vs. 53.2), although only the time until extubation achieved a statistically significant difference (11.5 vs. 2.7, P=.03). The extra-plural approach by posterior minithoracotomy for the surgical closure of ductus in the premature infant is viable and could bring some clinical benefits in the short-term. Copyright © 2015 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  7. Prophylactic plastic surgery closure of neurosurgical scalp incisions reduces the incidence of wound complications in previously-operated patients treated with bevacizumab (Avastin®) and radiation.

    Science.gov (United States)

    Golas, Alyssa Reiffel; Boyko, Tatiana; Schwartz, Theodore H; Stieg, Philip E; Boockvar, John A; Spector, Jason A

    2014-09-01

    Neurosurgical craniotomy, craniectomy, or other trans-galeal interventions are performed for a variety of indications, including the resection of benign or malignant tumors, hematoma evacuation, and for the management of intractable seizure disorders. Despite an overall low complication rate of intervention, wound healing complications such as dehiscence, surgical site infection, and cerebrospinal fluid leak are not uncommon. A retrospective review was performed of all patients who underwent scalp incision closure at a single institution by a single plastic surgeon between 2006 and 2013. Sixty patients (83 procedures) were included in the study. Fifty-seven patients (95.0 %) underwent previous craniotomy, craniectomy, or other trans-galeal procedure. Of the total 60 patients, 35 patients received preoperative radiation. Sixteen patients received bevacizumab prior to their index case, while 12 received bevacizumab postoperatively. Ten patients (16.7 %) required additional plastic surgical intervention for wound complications after their index plastic surgery procedure. Plastic surgery was consulted prophylactically in 34 patients (38 procedures). When plastic surgery was consulted prophylactically, 4 patients (11.8 %) required further wound revision. None of the 14 patients who underwent prophylactic plastic surgery closure for previous scalp incision, preoperative bevacizumab, and XRT administration required re-intervention. Plastic surgery closure of complex scalp incisions reduces the incidence of wound complications among patients who underwent previous neurosurgical intervention, XRT administration, and preoperative bevacizumab administration. This is particularly true when plastic surgery closure is performed "prophylactically." Further collaboration between the neurosurgical and plastic surgery teams is therefore warranted, particularly in the setting of these high-risk cases.

  8. A case of hybrid closure of a muscular ventricular septal defect: anatomical complexity and surgical management.

    Science.gov (United States)

    Karimi, Mohsen; Hulsebus, Elise; Murdison, Kenneth; Wiles, Henry

    2012-06-01

    Complex muscular ventricular septal defect poses difficult surgical management and is associated with high morbidity and mortality despite advancements in surgical therapy. Device closure of muscular ventricular septal defect has been encouraging and has been used in hybrid approach at a few centres. However, device closure has some limitations in patients with complex muscular ventricular septal defect. We report a case of perventricular device closure of a complex muscular ventricular septal defect in a beating heart with entrapped right ventricular disc and its surgical management.

  9. A new look at an old dogma: wound complications in two methods of skin closure in uncomplicated appendicitis

    Directory of Open Access Journals (Sweden)

    Hamid Ghaderi

    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: Appendicitis is more common during the second and third decade of life and appendectomy scar is important in terms of cosmetic issues. The scar is an important factor in the patient's satisfaction. Conventional teaching has an emphasis on the closure of skin incision with "separate" sutures. The aim of this study was to reconsider this dogma."n"nMethods: Among 321 patients with acute appendicitis who came to the emergency unit of Imam Khomeini Hospital in Tehran, Iran since april 2007 till april 2008, 278 (86.6% patients had uncomplicated appendicitis and were enrolled in our clinical trial. The patients were randomly assigned to two groups of interrupted suture closure (n=139 and subcuticular suture closure (n=139. Anesthesia method and surgical technique were similar between the two groups. All patients were followed up post-operatively (four weeks for the presence of infectious drainage, pain, erythema, swelling and warmness at the surgical site."n"nResults: The patients' sex and their mean age were not statistically different between the groups. There was no significant difference in the frequency of surgical site complications between the two groups (five cases in the "interrupted" group and

  10. Promising results after vacuum-assisted wound closure and mesh-mediated fascial traction

    DEFF Research Database (Denmark)

    Kleif, Jakob; Fabricius, Rasmus; Bertelsen, Claus Anders

    2012-01-01

    -mediated fascial traction (VAWCM) is a novel technique recently introduced for late fascial closure of the OA. In previous studies, the disease aetiologies were mainly vascular and visceral surgical disease and trauma. We report our results using VAWCM in a non-trauma patient population treated with an OA due...

  11. Cryopreserved cultured epithelial allografts for pediatric deep partial dermal burns: Early wound closure and suppression of scarring

    Directory of Open Access Journals (Sweden)

    Hiroko Yanaga

    2017-06-01

    Conclusion: Cryopreserved allo-CEG contains growth factors that promote wound healing and factors that suppress scarring. Three effects, namely (1 early wound closure, (2 scarring suppression, and (3 pain relief were seen with grafts of cryopreserved allo-CEG in cases of childhood DDB. These observations show that cryopreserved allo-CEG is clinically useful and effective for the treatment of childhood DDB.

  12. Transcatheter vs. surgical closure of patent ductus arteriosus: outcomes and cost analysis

    Directory of Open Access Journals (Sweden)

    Mulyadi M Djer

    2013-07-01

    Full Text Available Background Patent ductus arterious (PDA is a non-cyanotic congenital heart disease (CHD caused by the patency of the arterial duct after birth. For the last three decades, management of PDA with transcatheter closure has been gaining popularity, including in developing countries. However its effectiveness in terms of clinical outcomes and cost may vary among center and has not been thoroughly evaluated yet in Indonesia. Objectives To compare the cost and clinical effectiveness of PDA closure using transcatheter approach compared to surgical ligation. Methods We performed a retrospective review on patients underwent either transcatheter or surgical closure of PDA between January 2000 and December 2006 in Cipto Mangunkusumo Hospital, Jakarta, Indonesia. Clinical outcomes as well as cost were compared using the student T-test and Chi-square for numerical and categorical variables, respectively Results During the study period, 89 patients underwent transcatheter closure using an Amplatzer® device occluder (ADO device and 67 had surgical ligation. Successful PDA closure on first attempt was achieved in 87 (96% and 63 (94% children who underwent transcatheter and surgical closure, respectively (P=1.000. Two children with unsuccessful transcatheter closure eventually had their PDA closed by surgery, whereas one child with residual PDA after surgical closure had his PDA closed by coil. No residual PDA was found in the transcatheter closure group at one-week follow up. Duration of hospitalization was significantly less for patients having transcatheter closure compared to surgery [2.7 (SD 1.5 vs. 6.6 (SD 1.5 days, P<0.0001]. The cost for PDA closure with an Amplatzer® device was more expensive than surgical ligation [Rp. 29,930,000 (SD 57,200 vs. Rp. 12,205,000 (SD 89,300, P< 0.0001]. Conclusion Transcatheter closure is equally effective as surgical ligation in closing the PDA. Less hospitalization is required with transcatheter closure although the

  13. Aloe vera: an in vitro study of effects on corneal wound closure and collagenase activity.

    Science.gov (United States)

    Curto, Elizabeth M; Labelle, Amber; Chandler, Heather L

    2014-11-01

    To evaluate the in vitro effects of an aloe vera solution on (i) the viability and wound healing response of corneal cells and (ii) the ability to alter collagenase and gelatinase activities. Primary cultures of corneal epithelial cells and fibroblasts were prepared from grossly normal enucleated canine globes and treated with an aloe solution (doses ranging from 0.0-2 mg/mL). Cellular viability was evaluated using a colorimetric assay. A corneal wound healing model was used to quantify cellular ingrowth across a defect made on the confluent surface. Anticollagenase and antigelatinase activities were evaluated by incubating a bacterial collagenase/gelatinase with aloe solution (doses ranging from 0.0-500 μg/mL) and comparing outcome measures to a general metalloproteinase inhibitor, 1, 10-phenanthroline, and canine serum (doses ranging from 0.0-100%). None of the concentrations of aloe solution tested significantly affected the viability of corneal epithelial cells or fibroblasts. Concentrations ≤175 μg/mL slightly accelerated corneal epithelial cell wound closure; this change was not significant. Concentrations ≥175 μg/mL significantly (P ≤ 0.001) slowed the rate of corneal fibroblast wound closure, while aloe concentrations Aloe solution did not alter the ability for collagenase to degrade gelatin or collagen Type I but increased the ability for collagenase to degrade Type IV collagen. Although additional experiments are required, lower concentrations of aloe solution may be beneficial in healing of superficial corneal wounds to help decrease fibrosis and speed epithelialization. An increase in collagenase activity with aloe vera warrants further testing before considering in vivo studies. © 2014 American College of Veterinary Ophthalmologists.

  14. A comparative study of outcome of the absorbable suture polydioxanone and nonabsorbable suture polypropylene in laparotomy wound closure

    Directory of Open Access Journals (Sweden)

    Kiran Shankar H.

    2016-06-01

    Full Text Available Background: Abdominal wound closure is one of the common operations for a general surgeon. Prevention of complications is important to reduce post-operative morbidity and mortality. Post-operative wound pain, wound infection, wound dehiscence, suture sinus formation; palpable knots and incisional hernia are the parameters are to be studied. Therefore, the present study was undertaken to compare polydioxanone and polypropylene suture material for abdominal fascial closure regarding morbidity in terms of post-operative wound complications. Methods: Patients admitted in the department of surgery, who undergo laparotomy operations, with midline abdominal incisions were included in the study. The recruited subjects were divided into Group-A, whom abdominal incisions are closed with non-absorbable suture material polypropylene and Group-B whom abdominal incisions are closed with absorbable suture material polydioxanone. Data was expressed as percentages. Results: The incidence of wound pain was observed in all the patients in both immediate and delayed post-operative period in the polypropylene suture material compared to polydioxanone. The incidence of wound infection was higher in polypropylene (24% compared to PDS (2%. There were 4% cases of wound dehiscence in the present study. The incidence of suture sinus formation was higher in the polypropylene suture material (9% compared to the polydioxanone suture material (2% in the delayed postoperative period. The incidence of palpable knots was higher in the polypropylene suture material (23% compared to the polydioxanone suture material. No cases of incisional hernia were reported with polydioxanone suture material. Conclusions: The overall morbidity from abdominal closure was considerably reduced in the Polydioxanone group. We encountered reduction in wound complications like burst abdomen, wound infection, wound pain, suture sinus formation, palpable knots and incisional hernia. Therefore

  15. Post-Surgical Clinical Monitoring of Soft Tissue Wound Healing in Periodontal and Implant Surgery.

    Science.gov (United States)

    Pippi, Roberto

    2017-01-01

    Clinical features of surgical soft tissue wound healing in dentistry have been rarely discussed in the international literature. The aim of the present paper is to highlight both the main clinical findings of surgical wound healing, especially in periodontal and implant dentistry, and the wound healing monitoring procedures which should be followed. Wound inspection after careful food and plaque debridement is the essential part of wound healing monitoring. Periodontal and peri-implant probing should be performed only after tissue healing has been completed and not on a weekly basis in peri-implant tissue monitoring. Telephone follow-up and patient self-assessment scales can also be used the days following surgery to monitor the most common surgical complications such as pain, swelling, bleeding, and bruising. Wound healing monitoring is an important concern in all surgical procedures since it allows to identify signs or/and symptoms possibly related to surgical complications.

  16. Role of wound instillation with bupivacaine through surgical drains for postoperative analgesia in modified radical mastectomy

    Directory of Open Access Journals (Sweden)

    Nirmala Jonnavithula

    2015-01-01

    Full Text Available Background and Aims: Modified Radical Mastectomy (MRM is the commonly used surgical procedure for operable breast cancer, which involves extensive tissue dissection. Therefore, wound instillation with local anaesthetic may provide better postoperative analgesia than infiltration along the line of incision. We hypothesised that instillation of bupivacaine through chest and axillary drains into the wound may provide postoperative analgesia. Methods: In this prospective randomised controlled study 60 patients aged 45-60 years were divided into three groups. All patients were administered general anaesthesia. At the end of the surgical procedure, axillary and chest wall drains were placed before closure. Group C was the control with no instillation; Group S received 40 ml normal saline, 20 ml through each drain; and Group B received 40 ml of 0.25% bupivacaine and the drains were clamped for 10 min. After extubation, pain score for both static and dynamic pain was evaluated using visual analog scale and then 4 th hourly till 24 h. Rescue analgesia was injection tramadol, if the pain score exceeds 4. Statistical analysis was performed using SPSS version 13. Results : There was a significant difference in the cumulative analgesic requirement and the number of analgesic demands between the groups (P: 0.000. The mean duration of analgesia in the bupivacaine group was 14.6 h, 10.3 in the saline group and 4.3 h in the control group. Conclusion : Wound instillation with local anaesthetics is a simple and effective means of providing good analgesia without any major side-effects.

  17. Randomized controlled multicentre study comparing biological mesh closure of the pelvic floor with primary perineal wound closure after extralevator abdominoperineal resection for rectal cancer (BIOPEX-study)

    NARCIS (Netherlands)

    Musters, Gijsbert D.; Bemelman, Willem A.; Bosker, Robbert J. I.; Burger, Jacobus W. A.; van Duijvendijk, Peter; van Etten, Boudewijn; van Geloven, Anna A. W.; de Graaf, Eelco J. R.; Hoff, Christiaan; de Korte, Niels; Leijtens, Jeroen W. A.; Rutten, Harm J. T.; Singh, Baljit; van de Ven, Anthony; Vuylsteke, Ronald J. C. L. M.; de Wilt, Johannes H. W.; Dijkgraaf, Marcel G. W.; Tanis, Pieter J.

    2014-01-01

    Background: Primary perineal wound closure after conventional abdominoperineal resection (cAPR) for rectal cancer has been the standard of care for many years. Since the introduction of neo-adjuvant radiotherapy and the extralevator APR (eAPR), oncological outcome has been improved, but at the cost

  18. PED/PEA-15 controls fibroblast motility and wound closure by ERK1/2-dependent mechanisms.

    Science.gov (United States)

    Buonomo, Roberta; Giacco, Ferdinando; Vasaturo, Angela; Caserta, Sergio; Guido, Stefano; Pagliara, Valentina; Garbi, Corrado; Mansueto, Gelsomina; Cassese, Angela; Perruolo, Giuseppe; Oriente, Francesco; Miele, Claudia; Beguinot, Francesco; Formisano, Pietro

    2012-05-01

    Cell migration is dependent on the control of signaling events that play significant roles in creating contractile force and in contributing to wound closure. We evaluated wound closure in fibroblasts from mice overexpressing (TgPED) or lacking ped/pea-15 (KO), a gene overexpressed in patients with type 2 diabetes. Cultured skin fibroblasts isolated from TgPED mice showed a significant reduction in the ability to recolonize wounded area during scratch assay, compared to control fibroblasts. This difference was observed both in the absence and in the presence of mytomicin C, an inhibitor of mitosis. In time-lapse experiments, TgPED fibroblasts displayed about twofold lower velocity and diffusion coefficient, as compared to controls. These changes were accompanied by reduced spreading and decreased formation of stress fibers and focal adhesion plaques. At the molecular level, TgPED fibroblasts displayed decreased RhoA activation and increased abundance of phosphorylated extracellular signal-regulated kinase 1/2 (ERK1/2). Inhibition of ERK1/2 activity by PD98059 restored RhoA activation, cytoskeleton organization and cell motility, and almost completely rescued wound closure of TgPED fibroblasts. Interestingly, skin fibroblasts isolated from KO mice displayed an increased wound closure ability. In vivo, healing of dorsal wounds was delayed in TgPED and accelerated in KO mice. Thus, PED/PEA-15 may affect fibroblast motility by a mechanism, at least in part, mediated by ERK1/2.

  19. Impact of the controlled release of a connexin 43 peptide on corneal wound closure in an STZ model of type I diabetes.

    Directory of Open Access Journals (Sweden)

    Keith Moore

    Full Text Available The alpha-carboxy terminus 1 (αCT1 peptide is a synthetically produced mimetic modified from the DDLEI C-terminus sequence of connexin 43 (Cx43. Previous research using various wound healing models have found promising therapeutic effects when applying the drug, resulting in increased wound healing rates and reduced scarring. Previous data suggested a rapid metabolism rate in vitro, creating an interest in long term release. Using a streptozotocin (STZ type I diabetic rat model with a surgically induced corneal injury, we delivered αCT1 both directly, in a pluronic gel solution, and in a sustained system, using polymeric alginate-poly-l-ornithine (A-PLO microcapsules (MC. Fluorescent staining of wound area over a 5 day period indicated a significant increase in wound closure rates for both αCT1 and αCT1 MC treated groups, withαCT1 MC groups showing the most rapid wound closure overall. Analysis of inflammatory reaction to the treatment groups indicated significantly lower levels of both Interferon Inducible T-Cell Alpha Chemoattractant (ITAC and Tumor Necrosis Factor Alpha (TNFα markers using confocal quantification and ELISA assays. Additional analysis examining genes selected from the EMT pathway using RT-PCR and Western blotting suggested αCT1 modification of Transforming Growth Factor Beta 2 (TGFβ2, Keratin 8 (Krt8, Estrogen Receptor 1 (Esr1, and Glucose Transporter 4 (Glut4 over a 14 day period. Combined, this data indicated a possible suppression of the inflammatory response by αCT1, leading to increased wound healing rates.

  20. Percutaneous vascular plug for incomplete surgical left atrial appendage closure.

    Science.gov (United States)

    Levisay, Justin P; Sangodkar, Sandeep; Salinger, Michael H; Lampert, Mark; Feldman, Ted

    2014-04-01

    Surgical left atrial appendage (LAA) exclusion has a failure rate as high as 60% due to persistent residual flow in the LAA or large LAA remnants. We describe a novel technique for treatment of incomplete surgical LAA ligation, and define the mechanism that led to persistence of the remnant LAA without any thrombus formation.

  1. EASApprox® skin-stretching system: A secure and effective method to achieve wound closure

    Science.gov (United States)

    Song, Mingzhi; Zhang, Zhen; Liu, Tao; Liu, Song; Li, Gang; Liu, Zhaochang; Huang, Jingyang; Chen, Song; Li, Linan; Guo, Li; Qiu, Yang; Wan, Jiajia; Liu, Yuejian; Wu, Tao; Wang, Xiaoyong; Lu, Ming; Wang, Shouyu

    2017-01-01

    Large skin defects are commonly observed in the clinic and have attracted much attention recently. Therefore, finding an effective solution for large skin defects is a global problem. The objective of the present study was to assess the effectiveness of the EASApprox® skin-stretching system for closing large skin defects. Skin defects (5×5 cm) were created on the forearms of 9 Bama miniature pigs, which were randomly divided into the following three groups: Direct suture, the new EASApprox® skin-stretching device and Kirschner wires. Microcirculation was assessed before surgery and after wound closure. Following the different treatments, the defects were sutured, and wound healing was assessed based on a clinical score. Furthermore, microscopic and ultramicroscopic structures were evaluated, including collagen, elastic fibers and the microvessel density. Significant differences in the clinical score and microvessel density were observed among the groups. Additionally, the mean length obtained for elastic fibers was larger than that obtained for the other two groups. Finally, the new EASApprox® skin-stretching device resulted in successful wound management and with only minor side effects on skin histology and microcirculation. Therefore, this method has the potential to be used for healing large skin defects. PMID:28672963

  2. The quality of measurement of surgical wound infection as the basis for monitoring: a systematic review.

    Science.gov (United States)

    Bruce, J; Russell, E M; Mollison, J; Krukowski, Z H

    2001-10-01

    Comparison of postoperative surgical wound infection rates between institutions and over time is only valid if standard, valid and reliable definitions are used. The aim of this review was to assess evidence of validity and reliability of the definition and measurement of surgical wound infection. A systematic review was undertaken of prospective studies of surgical wound infection published over a seven-year period; 1993-1999. The information extracted from individual studies included: definition of surgical wound infection; details of wound assessment scale, scoring or grading scale systems; and evidence of assessment of validity, reliability and feasibility of identified definitions and grading systems. Two independent reviewers appraised 112 prospective studies, 90 of which were eligible for inclusion; eight studies assessed validity and/or reliability. Forty-one different definitions of surgical wound infection were identified, five of which were 'standard' definitions proposed by multi-disciplinary groups. Presence of pus was the most frequently used single component of any definition; the CDC definitions of 1988 and 1992 were the most widely implemented standard definitions; and the ASEPSIS wound assessment scale was the most frequently used quantitative grading tool. Only two formal validations of a definition were found, and six studies of reliability. This review highlights the extent of variation in definition of surgical wound infection used in clinical practice, and the need for validation of both content and organization of a surveillance system. However, realistically, there will have to be a balance between the quality of the measurement and the practicality of surveillance.

  3. Meta-analysis of negative-pressure wound therapy for closed surgical incisions

    DEFF Research Database (Denmark)

    Hyldig, N; Birke-Sorensen, H; Kruse, M

    2016-01-01

    BACKGROUND: Postoperative wound complications are common following surgical procedures. Negative-pressure wound therapy (NPWT) is well recognized for the management of open wounds and has been applied recently to closed surgical incisions. The evidence base to support this intervention is limited....... RESULTS: Ten studies met the inclusion criteria, reporting on 1311 incisions in 1089 patients. NPWT was associated with a significant reduction in wound infection (relative risk (RR) 0·54, 95 per cent c.i. 0·33 to 0·89) and seroma formation (RR 0·48, 0·27 to 0·84) compared with standard care...

  4. Effects of platelet-rich plasma gel on skin healing in surgical wound in horses

    OpenAIRE

    DeRossi, Rafael; Coelho,Anna Carolina Anciliero de Oliveira; Mello,Gisele Silveira de; Frazílio,Fabrício de Oliveira; Leal,Cássia Rejane Brito; Facco,Gilberto Gonçalves; Brum,Karine Bonucielli

    2009-01-01

    PURPOSE: To establish a low-cost method to prepare platelet-rich plasma (PRP) and evaluates the potential of platelet derived factors to enhance wound healing in the surgical wounds in equine. METHODS: To obtain a PRP gel, calcium gluconate and autologous thrombin were added to platelet-rich plasma. For the tests six saddle horses were used and two surgical incisions were made in each animal. Wounds were treated with PRP gel or untreated. Sequential wound biopsies collected at Treatment 1: at...

  5. [Treatment of surgical wound dehiscence by topical negative pressure therapy: Clinical case].

    Science.gov (United States)

    Fresno-García, Carmen; Alconero-Camarero, Ana Rosa; Fernández-Carro, Belén

    2015-01-01

    Topical negative pressure therapy is an alternative treatment for complex wounds that consists of the direct application of sub-atmospheric pressure, obtaining a number of effects that are beneficial for tissues, promoting the healing of both acute and chronic wounds and complementing surgical procedures. We report the case of a 75 year old man diagnosed with surgical wound dehiscence after a femorotibial bypass graft, who was hospitalized again with the aim to perform the implantation of a topical negative pressure therapy in the infected wound. We designed a care plan for this patient following the steps of the scientific method and basing ourselves on the NANDA, NIC, and NOC taxonomies.

  6. Supplementation with undenatured whey protein during diabetes mellitus improves the healing and closure of diabetic wounds through the rescue of functional long-lived wound macrophages.

    Science.gov (United States)

    Badr, Gamal

    2012-01-01

    Long and persistent uncontrolled diabetes tends to degenerate the immune system and increase the incidence of infections in diabetic patients. A serious complication of diabetes is impaired healing, which diminishes physical activity and, in some cases, leads to chronic wounds and limb amputation. Whey proteins (WPs) enhance immunity during early development and have a protective role in some immune disorders. The effect of camel WPs on wound healing in a streptozotocin-induced type 1 diabetic mice model was investigated. Sixty male mice were equally distributed into 3 experimental groups: group 1, non-diabetic control mice; group 2, diabetic mice; and group 3, diabetic mice that were orally supplemented with undenatured WP (100 mg/kg body weight/day for 1 month through oral gavage). We observed that the diabetic mice exhibited delayed wound closure characterized by a significant reduction in collagen deposition, prolonged elevation in inflammatory cytokines, aberrant activation of STAT3 and reduction in the activation of Akt and NF-κB when compared with the control mice. Moreover, in the diabetic mice, the wound-resident macrophages were dysfunctional and demonstrated increased apoptosis, a significant reduction in their phagocytotic ability, aberrant activation of STAT3 and a marked reduction in the activation of Akt. Interestingly, the supplementation of diabetic mice with WP significantly enhanced the collagen deposition, limited the inflammatory stimuli, restored the activation of STAT3, Akt and NF-κB and greatly improved the closure of diabetic wounds compared with the control mice. Most important, the supplementation of diabetic mice with WP rescued functional, long-lived wound-resident macrophages. Our data reveal the benefits of WP supplementation in improving the healing and closure of diabetic wounds.

  7. A STUDY OF NEGATIVE PRESSURE WOUND THERAPY: VACUUM ASSISTED CLOSURE IN CHRONIC NON-HEALING ULCERS

    Directory of Open Access Journals (Sweden)

    Dhamotharan Senraman

    2016-06-01

    Full Text Available BACKGROUND This study evaluates the advantage of Negative Pressure Wound Therapy-Vacuum Assisted Closure over Conventional Dressing in the management of chronic non-healing ulcers. METHODS From June 2014 to June 2015, 50 patients were selected (25 cases and 25 controls. After wound debridement, VAC dressing is applied. Pre VAC and post VAC culture and sensitivity is taken. Dressing is given for 72 hours and intermittent suction is given for 10 mins. in an hour, daily for 12 hours with negative pressure ranging from 100 to 125 mmHg. Rest of the time drain of the VAC dressing is connected to the Romovac suction drain. Doppler study to assess the vascularity of the limb before the procedure and X-ray is taken to rule out osteomyelitis. Control group patients are given conventional dressings. RESULTS The gender, age and ulcer distributions were almost equal in the case and control groups and were found to be statistically insignificant. Duration of hospital stay in days was found to be statistically significant between groups. Majority (52% of cases left hospital within 3 weeks’ time, while a major chunk (88% of control population stayed more than 3 weeks. VAC dressing shows better results in patients with normal Doppler study. VAC dressing have better results in patients with 48% undergoing split skin grafting and less rate (8% of amputation as against none undergoing split skin grafting and 24% needing amputation in the control group. Patients with sterile pre-VAC culture were not turning unsterile after VAC, but 90% unsterile turns sterile after VAC. CONCLUSION NPWT is a novel technique for managing an open wound by submitting the wound either to intermittent or continuous subatmospheric pressure. Here, we did a study to study the advantage of vacuum assisted closure over conventional dressing in the management of chronic non-healing ulcers and concluded that VAC decreases hospital stay, improves pus culture sterility, has better result in

  8. The acute effects of preoperative ozone theraphy on surgical wound healing

    OpenAIRE

    Sahin, Hasan; Simsek,Tuncer; Turkon, Hakan; Kalkan,Yıldıray; Ozkul, Faruk; Ozkan,M Turgut Alper; Erbas,Mesut; Altinisik, Ugur; Demiraran, Yavuz

    2016-01-01

    ABSTRACT PURPOSE: To investigate the effects of preoperative rectal ozone insufflation on surgical wound healing over the proinflammatory cytokines and histopathological changes. METHODS: Twenty one rabbits were divided into 3 groups. Sham, surgical wound, and ozone applied (6 sessions, every other day 70 µg/mL in 12 mL O2-O3 mixture rectally) surgical wound groups were created. TNF-alpha and IL-6 levels from all rabbits were studied at the basal, 24th hour, and 72nd hour. The histopatholog...

  9. e of the Surgical Glove in Modified Vacuum-Assisted Wound Healing

    Directory of Open Access Journals (Sweden)

    Shankar Ram Hemmanur

    2013-09-01

    Full Text Available Vacuum-assisted wound healing has been proven to be more efficacious than conventionaldressings. Vacuum dressing has been frequently modified given the restrictions in resourcesavailable. Here we present a modified method of vacuum dressing by using surgical orgynaecological gloves for lower and upper limb wounds. Vacuum dressing was applied withparts of a surgical or gynaecological glove and Opsite with T-tailing of the suction outlet.Vacuum-assisted wound healing using the surgical gloves showed relatively good woundhealing in the amputation stump, finger, arm, and leg in the cases studied.

  10. Comparative analysis of global gene expression profiles between diabetic rat wounds treated with vacuum-assisted closure therapy, moist wound healing or gauze under suction.

    Science.gov (United States)

    Derrick, Kathleen L; Norbury, Kenneth; Kieswetter, Kris; Skaf, Jihad; McNulty, Amy K

    2008-12-01

    How differential gene expression affects wound healing is not well understood. In this study, Zucker diabetic fatty (fa/fa) male inbred rats were used to investigate gene expression during wound healing in an impaired wound-healing model. Whole genome microarray surveys were used to gain insight into the biological pathways and healing processes in acute excisional wounds treated with vacuum-assisted closure (V.A.C.). Therapy, moist wound healing (MWH) or gauze under suction (GUS). Global gene expression analyses after 2 days of healing indicated major differences with respect to both number of genes showing fold changes and pathway regulation between the three different wound treatments. Statistical analysis of expression profiles indicated that 5072 genes showed a >1.6-fold change with V.A.C. Therapy compared with 3601 genes with MWH and 3952 genes with GUS. Pathways and related genes associated with the early phases of wound healing diverged between treatment groups. For example, pathways involving angiogenesis, cytoskeletal regulation and inflammation were associated with elevated gene expression following V.A.C. Therapy. This study is the first to assess wound healing by whole genome interrogation in a diabetic rat model treated with different healing modalities.

  11. Negative Pressure Wound Therapy on Surgical Site Infections in Women Undergoing Elective Caesarean Sections: A Pilot RCT.

    Science.gov (United States)

    Chaboyer, Wendy; Anderson, Vinah; Webster, Joan; Sneddon, Anne; Thalib, Lukman; Gillespie, Brigid M

    2014-09-30

    Obese women undergoing caesarean section (CS) are at increased risk of surgical site infection (SSI). Negative Pressure Wound Therapy (NPWT) is growing in use as a prophylactic approach to prevent wound complications such as SSI, yet there is little evidence of its benefits. This pilot randomized controlled trial (RCT) assessed the effect of NPWT on SSI and other wound complications in obese women undergoing elective caesarean sections (CS) and also the feasibility of conducting a definitive trial. Ninety-two obese women undergoing elective CS were randomized in theatre via a central web based system using a parallel 1:1 process to two groups i.e., 46 women received the intervention (NPWT PICO™ dressing) and 46 women received standard care (Comfeel Plus(®) dressing). All women received the intended dressing following wound closure. The relative risk of SSI in the intervention group was 0.81 (95% CI 0.38-1.68); for the number of complications excluding SSI it was 0.98 (95% CI 0.34-2.79). A sample size of 784 (392 per group) would be required to find a statistically significant difference in SSI between the two groups with 90% power. These results demonstrate that a larger definitive trial is feasible and that careful planning and site selection is critical to the success of the overall study.

  12. Negative Pressure Wound Therapy on Surgical Site Infections in Women Undergoing Elective Caesarean Sections: A Pilot RCT

    Directory of Open Access Journals (Sweden)

    Wendy Chaboyer

    2014-09-01

    Full Text Available Obese women undergoing caesarean section (CS are at increased risk of surgical site infection (SSI. Negative Pressure Wound Therapy (NPWT is growing in use as a prophylactic approach to prevent wound complications such as SSI, yet there is little evidence of its benefits. This pilot randomized controlled trial (RCT assessed the effect of NPWT on SSI and other wound complications in obese women undergoing elective caesarean sections (CS and also the feasibility of conducting a definitive trial. Ninety-two obese women undergoing elective CS were randomized in theatre via a central web based system using a parallel 1:1 process to two groups i.e., 46 women received the intervention (NPWT PICO™ dressing and 46 women received standard care (Comfeel Plus® dressing. All women received the intended dressing following wound closure. The relative risk of SSI in the intervention group was 0.81 (95% CI 0.38–1.68; for the number of complications excluding SSI it was 0.98 (95% CI 0.34–2.79. A sample size of 784 (392 per group would be required to find a statistically significant difference in SSI between the two groups with 90% power. These results demonstrate that a larger definitive trial is feasible and that careful planning and site selection is critical to the success of the overall study.

  13. Effect of the Lectin of Bauhinia variegata and Its Recombinant Isoform on Surgically Induced Skin Wounds in a Murine Model

    Directory of Open Access Journals (Sweden)

    Rodrigo Bainy Leal

    2011-11-01

    Full Text Available Lectins are a structurally heterogeneous group of highly specific carbohydrate-binding proteins. Due to their great biotechnological potential, lectins are widely used in biomedical research. The purpose of the present study was to evaluate the healing potential of the lectin of Bauhinia variegata (nBVL and its recombinant isoform (rBVL-1. Following surgical creation of dorsal skin wounds, seven groups of mice were submitted to topical treatment for 12 days with lectin, D-galactose, BSA and saline. The animals were anesthetized and euthanized on POD 2, 7 and 12 in order to evaluate the healing potential of each treatment. The parameters considered included wound size, contraction rate, epithelialization rate and histopathological findings. Wound closure was fastest in animals treated with rBVL-1 (POD 7. nBVL was more effective than the controls. All skin layers were reconstructed and keratin deposition increased. Our findings indicate that the lectin of Bauhinia variegata possesses pro-healing properties and may be employed in the treatment of acute skin wounds.

  14. Effect of the lectin of Bauhinia variegata and its recombinant isoform on surgically induced skin wounds in a murine model.

    Science.gov (United States)

    Neto, Luiz Gonzaga do Nascimento; Pinto, Luciano da Silva; Bastos, Rafaela Mesquita; Evaristo, Francisco Flávio Vasconcelos; Vasconcelos, Mayron Alves de; Carneiro, Victor Alves; Arruda, Francisco Vassiliepe Sousa; Porto, Ana Lúcia Figueiredo; Leal, Rodrigo Bainy; Júnior, Valdemiro Amaro da Silva; Cavada, Benildo Sousa; Teixeira, Edson Holanda

    2011-11-07

    Lectins are a structurally heterogeneous group of highly specific carbohydrate-binding proteins. Due to their great biotechnological potential, lectins are widely used in biomedical research. The purpose of the present study was to evaluate the healing potential of the lectin of Bauhinia variegata (nBVL) and its recombinant isoform (rBVL-1). Following surgical creation of dorsal skin wounds, seven groups of mice were submitted to topical treatment for 12 days with lectin, D-galactose, BSA and saline. The animals were anesthetized and euthanized on POD 2, 7 and 12 in order to evaluate the healing potential of each treatment. The parameters considered included wound size, contraction rate, epithelialization rate and histopathological findings. Wound closure was fastest in animals treated with rBVL-1 (POD 7). nBVL was more effective than the controls. All skin layers were reconstructed and keratin deposition increased. Our findings indicate that the lectin of Bauhinia variegata possesses pro-healing properties and may be employed in the treatment of acute skin wounds.

  15. The enhanced healing of a high-risk, clean, sutured surgical incision by prophylactic negative pressure wound therapy as delivered by Prevena™ Customizable™: cosmetic and therapeutic results.

    Science.gov (United States)

    Scalise, Alessandro; Tartaglione, Caterina; Bolletta, Elisa; Calamita, Roberto; Nicoletti, Giovanni; Pierangeli, Marina; Grassetti, Luca; Di Benedetto, Giovanni

    2015-04-01

    According to the literature, incisional closure complications may range from postoperative surgical site infections, representing 17-22% of health care-associated infections, surgical wound dehiscence and formation of haematomas or seromas, and can lead to delayed or impaired incision healing. These kinds of situations are more common when wounds are closed under tension or in specific patient morbidities. Obesity, in particular, is associated with an impaired blood flow to tissues, predisposing the patient to increased risk of wound complications by various mechanisms. Incisional complications can become relevant economic burdens for health care systems because of an increase in the average length of hospital stay and readmissions, and additional medical and surgical procedures. Thus, a preventive therapy may have a critical role in the management of healing. Negative pressure wound therapy (NPWT) technology as delivered by Prevena™ Customizable™ (Kinetic Concepts Inc., San Antonio, TX) has recently been the focus of a new investigation, as a prophylactic measure to prevent complications via immediate postoperative application in high-risk, clean, closed surgical incisions. The authors present a 62-year-old class II obese female, who underwent bilateral inguinal dermolipectomy. Prophylactic NPWT as delivered by Prevena™ was performed successfully over surgical incisions. Cosmetic and therapeutic results are shown.

  16. PREVENTION OF SURGICAL WOUND INFECTION IN OBESE WOMEN UNDERGOING CAESAREAN SECTION: A RANDOMISED CONTROLLED TRIAL

    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......: 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....

  17. Non-linear finite element simulations of injuries with free boundaries: application to surgical wounds

    Science.gov (United States)

    Valero, C.; Javierre, E.; García-Aznar, J. M.; Gómez-Benito, M. J.

    2015-01-01

    SUMMARY Wound healing is a process driven by biochemical and mechanical variables in which new tissue is synthesised to recover original tissue functionality. Wound morphology plays a crucial role in this process, as the skin behaviour is not uniform along different directions. In this work we simulate the contraction of surgical wounds, which can be characterised as elongated and deep wounds. Due to the regularity of this morphology, we approximate the evolution of the wound through its cross-section, adopting a plane strain hypothesis. This simplification reduces the complexity of the computational problem while maintaining allows for a thorough analysis of the role of wound depth in the healing process, an aspect of medical and computational relevance that has not yet been addressed. To reproduce wound contraction we consider the role of fibroblasts, myofibroblasts, collagen and a generic growth factor. The contraction phenomenon is driven by cell-generated forces. We postulate that these forces are adjusted to the mechanical environment of the tissue where cells are embedded through a mechanosensing and mechanotransduction mechanism. To solve the non-linear problem we use the Finite Element Method and an updated Lagrangian approach to represent the change in the geometry. To elucidate the role of wound depth and width on the contraction pattern and evolution of the involved species, we analyse different wound geometries with the same wound area. We find that deeper wounds contract less and reach a maximum contraction rate earlier than superficial wounds. PMID:24443355

  18. Nonlinear finite element simulations of injuries with free boundaries: application to surgical wounds.

    Science.gov (United States)

    Valero, C; Javierre, E; García-Aznar, J M; Gómez-Benito, M J

    2014-06-01

    Wound healing is a process driven by biochemical and mechanical variables in which a new tissue is synthesised to recover original tissue functionality. Wound morphology plays a crucial role in this process, as the skin behaviour is not uniform along different directions. In this work, we simulate the contraction of surgical wounds, which can be characterised as elongated and deep wounds. Because of the regularity of this morphology, we approximate the evolution of the wound through its cross section, adopting a plane strain hypothesis. This simplification reduces the complexity of the computational problem; while allows for a thorough analysis of the role of wound depth in the healing process, an aspect of medical and computational relevance that has not yet been addressed. To reproduce wound contraction, we consider the role of fibroblasts, myofibroblasts, collagen and a generic growth factor. The contraction phenomenon is driven by cell-generated forces. We postulate that these forces are adjusted to the mechanical environment of the tissue where cells are embedded through a mechanosensing and mechanotransduction mechanism. To solve the nonlinear problem, we use the finite element method (FEM) and an updated Lagrangian approach to represent the change in the geometry. To elucidate the role of wound depth and width on the contraction pattern and evolution of the involved species, we analyse different wound geometries with the same wound area. We find that deeper wounds contract less and reach a maximum contraction rate earlier than superficial wounds. Copyright © 2014 John Wiley & Sons, Ltd.

  19. The effect of pH on cell viability, cell migration, cell proliferation, wound closure, and wound reepithelialization

    DEFF Research Database (Denmark)

    Kruse, Carla R; Singh, Mansher; Targosinski, Stefan

    2017-01-01

    Wound microenvironment plays a major role in the process of wound healing. It contains various external and internal factors that participate in wound pathophysiology. The pH is an important factor that influences wound healing by changing throughout the healing process. Several previous studies...... have investigated the role of pH in relation to pathogens but studies concentrating on the effects of pH on wound healing itself are inconclusive. The purpose of this study was to comprehensively and in a controlled fashion investigate the effect of pH on wound healing by studying its effect on human...... primary keratinocyte and fibroblast function in vitro and on wound healing in vivo. In vitro, primary human keratinocytes and fibroblasts were cultured in different levels of pH (5.5-12.5) and the effect on cell viability, proliferation, and migration was studied. A rat full-thickness wound model was used...

  20. [Qualified and emergency specialized surgical care for those with wounds to the extremities].

    Science.gov (United States)

    Iurkevich, V V; Fidarov, E Z; Bauér, V A

    1997-06-01

    Experience of organization of the surgical care in the military hospital to 438 wounded in extremities during armed conflict in Republic of Chechnya is generalized. Maximum reduction of stages of medical evacuation of the wounded in extremities, approaching of the qualified and urgent specialized surgical care directly to the region of battle actions, use of opportunities for it one-moment rendering corresponded to principles of the modern military-medical doctrine. Due to realization of the requirements of the doctrine life of many wounded ++ was saved, terms of treatment, medical and social rehabilitation are reduced. Besides lethality, treatment cost and numbers of transferring to the reserve from the Armed Forces were reduced.

  1. The effect of surgical wounding on tumour development

    NARCIS (Netherlands)

    Hofer, SOP; Molema, G; Hermens, RAEC; Wanebo, HJ; Reichner, JS; Hoekstra, HJ

    1999-01-01

    For more than a century, a role for wound healing in the outgrowth of tumours has been implied based on observations in both experimental and clinical studies. Wound healing can be divided into stages of inflammatory, proliferative, repair and remodelling processes. Through proper regulation of acti

  2. The effect of surgical wounding on tumour development

    NARCIS (Netherlands)

    Hofer, SOP; Molema, G; Hermens, RAEC; Wanebo, HJ; Reichner, JS; Hoekstra, HJ

    For more than a century, a role for wound healing in the outgrowth of tumours has been implied based on observations in both experimental and clinical studies. Wound healing can be divided into stages of inflammatory, proliferative, repair and remodelling processes. Through proper regulation of

  3. A comparison of obsidian and surgical steel scalpel wound healing in rats.

    Science.gov (United States)

    Disa, J J; Vossoughi, J; Goldberg, N H

    1993-10-01

    There are several anecdotal clinical articles claiming wound healing and scar superiority using obsidian (volcanic glass) scalpels. In order to determine if skin incisions made with obsidian were superior to those made with standard surgical steel, wound tensile strength, scar width, and histology were assessed in 40 adult male Sprague-Dawley rats. Each rat received two parallel 8-cm dorsal skin incisions, one with an obsidian scalpel and the other with a surgical steel scalpel (no. 15 blade). Data were analyzed by ANOVA. Tensile strength of the two wound types was not different at 7, 14, 21, and 42 days. Scar width, however, was significantly less in the obsidian wounds at 7, 10, and 14 days (p obsidian wounds contained fewer inflammatory cells and less granulation tissue at 7 days.

  4. ROCK Inhibition Promotes Attachment, Proliferation, and Wound Closure in Human Embryonic Stem Cell-Derived Retinal Pigmented Epithelium.

    Science.gov (United States)

    Croze, Roxanne H; Thi, William J; Clegg, Dennis O

    2016-11-01

    Nonexudative (dry) age-related macular degeneration (AMD), a leading cause of blindness in the elderly, is associated with the loss of retinal pigmented epithelium (RPE) cells and the development of geographic atrophy, which are areas devoid of RPE cells and photoreceptors. One possible treatment option would be to stimulate RPE attachment and proliferation to replace dying/dysfunctional RPE and bring about wound repair. Clinical trials are underway testing injections of RPE cells derived from pluripotent stem cells to determine their safety and efficacy in treating AMD. However, the factors regulating RPE responses to AMD-associated lesions are not well understood. Here, we use cell culture to investigate the role of RhoA coiled coil kinases (ROCKs) in human embryonic stem cell-derived RPE (hESC-RPE) attachment, proliferation, and wound closure. H9 hESC were spontaneously differentiated into RPE cells. hESC-RPE cells were treated with a pan ROCK1/2 or a ROCK2 only inhibitor; attachment, and proliferation and cell size within an in vitro scratch assay were examined. Pharmacological inhibition of ROCKs promoted hESC-RPE attachment and proliferation, and increased the rate of closure of in vitro wounds. ROCK inhibition decreased phosphorylation of cofilin and myosin light chain, suggesting that regulation of the cytoskeleton underlies the mechanism of action of ROCK inhibition. ROCK inhibition promotes attachment, proliferation, and wound closure in H9 hESC-RPE cells. ROCK isoforms may have different roles in wound healing. Modulation of the ROCK-cytoskeletal axis has potential in stimulating wound repair in transplanted RPE cells and attachment in cellular therapies.

  5. ROCK Inhibition Promotes Attachment, Proliferation, and Wound Closure in Human Embryonic Stem Cell–Derived Retinal Pigmented Epithelium

    Science.gov (United States)

    Croze, Roxanne H.; Thi, William J.; Clegg, Dennis O.

    2016-01-01

    Purpose Nonexudative (dry) age-related macular degeneration (AMD), a leading cause of blindness in the elderly, is associated with the loss of retinal pigmented epithelium (RPE) cells and the development of geographic atrophy, which are areas devoid of RPE cells and photoreceptors. One possible treatment option would be to stimulate RPE attachment and proliferation to replace dying/dysfunctional RPE and bring about wound repair. Clinical trials are underway testing injections of RPE cells derived from pluripotent stem cells to determine their safety and efficacy in treating AMD. However, the factors regulating RPE responses to AMD-associated lesions are not well understood. Here, we use cell culture to investigate the role of RhoA coiled coil kinases (ROCKs) in human embryonic stem cell–derived RPE (hESC-RPE) attachment, proliferation, and wound closure. Methods H9 hESC were spontaneously differentiated into RPE cells. hESC-RPE cells were treated with a pan ROCK1/2 or a ROCK2 only inhibitor; attachment, and proliferation and cell size within an in vitro scratch assay were examined. Results Pharmacological inhibition of ROCKs promoted hESC-RPE attachment and proliferation, and increased the rate of closure of in vitro wounds. ROCK inhibition decreased phosphorylation of cofilin and myosin light chain, suggesting that regulation of the cytoskeleton underlies the mechanism of action of ROCK inhibition. Conclusions ROCK inhibition promotes attachment, proliferation, and wound closure in H9 hESC-RPE cells. ROCK isoforms may have different roles in wound healing. Translational Relevance Modulation of the ROCK-cytoskeletal axis has potential in stimulating wound repair in transplanted RPE cells and attachment in cellular therapies. PMID:27917311

  6. Platelet-rich plasma: a biomimetic approach to enhancement of surgical wound healing.

    Science.gov (United States)

    Fernandez-Moure, Joseph S; Van Eps, Jeffrey L; Cabrera, Fernando J; Barbosa, Zonia; Medrano Del Rosal, Guillermo; Weiner, Bradley K; Ellsworth, Warren A; Tasciotti, Ennio

    2017-01-01

    Platelets are small anucleate cytoplasmic cell bodies released by megakaryocytes in response to various physiologic triggers. Traditionally thought to be solely involved in the mechanisms of hemostasis, platelets have gained much attention due to their involvement wound healing, immunomodulation, and antiseptic properties. As the field of surgery continues to evolve so does the need for therapies to aid in treating the increasingly complex patients seen. With over 14 million obstetric, musculoskeletal, and urological and gastrointestinal surgeries performed annually, the healing of surgical wounds continues to be of upmost importance to the surgeon and patient. Platelet-rich plasma, or platelet concentrate, has emerged as a possible adjuvant therapy to aid in the healing of surgical wounds and injuries. In this review, we will discuss the wound healing properties of platelet-rich plasma and various surgical applications. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Postoperative washing of sutured wounds

    Directory of Open Access Journals (Sweden)

    Conrad Harrison

    2016-11-01

    Full Text Available A best evidence topic was written according to the structured protocol. The three part question addressed was: [In patients undergoing closure of surgical wounds with sutures] does [keeping the wound dry for the first 48 h after closure] [reduce the incidence of surgical site infections (SSIs]? 4 relevant papers were culled from the literature and appraised. The authors, date, country, population, study type, main outcomes, key results and study weaknesses were tabulated. Current NICE guidelines recommend cleaning surgical wounds with sterile saline only for the first 48 h following skin closure. We found no evidence that washing wounds with tap water during this period increases the incidence of SSIs compared to keeping them dry. Further randomised controlled trials will enable the construction of conclusive systematic reviews and meta-analyses.

  8. [Problems of organization of surgical care to the wounded in a modern armed conflict: surgical care to the walking wounded in armed conflicts (Report 2)].

    Science.gov (United States)

    Samokhvalov, I M; Kotenko, P K; Severin, V V

    2013-01-01

    There are two triage groups of the walking wounded in a medical company of a brigade/special-purpose medical team: those returning to fighting role and those who have to be evacuated to level 3 echelon of care. The main purposes of surgical care of the walking wounded in the 3rd echelon of care are the following: diagnosis of injury pattern ruling out severe damages and separation of the independent category of the walking wounded. There is medical evacuation of the walking wounded from the 3rd echelon to the 4th echelon deployed in a combat zone. The walking wounded who needs less than 30 days of staying in hospital are evacuated to the garrison military hospitals and medical treatment facilities subordinated to a district military hospital. The wounded with the prolonged period of hospitalization (more than 30 days) are evacuated toward the district military hospital. Treatment of the walking wounded should be accomplished in the military district where the armed conflict goes on.

  9. Flax Fiber Hydrophobic Extract Inhibits Human Skin Cells Inflammation and Causes Remodeling of Extracellular Matrix and Wound Closure Activation

    Directory of Open Access Journals (Sweden)

    Monika Styrczewska

    2015-01-01

    Full Text Available Inflammation is the basis of many diseases, with chronic wounds amongst them, limiting cell proliferation and tissue regeneration. Our previous preclinical study of flax fiber applied as a wound dressing and analysis of its components impact on the fibroblast transcriptome suggested flax fiber hydrophobic extract use as an anti-inflammatory and wound healing preparation. The extract contains cannabidiol (CBD, phytosterols, and unsaturated fatty acids, showing great promise in wound healing. In in vitro proliferation and wound closure tests the extract activated cell migration and proliferation. The activity of matrix metalloproteinases in skin cells was increased, suggesting activation of extracellular components remodeling. The expression of cytokines was diminished by the extract in a cannabidiol-dependent manner, but β-sitosterol can act synergistically with CBD in inflammation inhibition. Extracellular matrix related genes were also analyzed, considering their importance in further stages of wound healing. The extract activated skin cell matrix remodeling, but the changes were only partially cannabidiol- and β-sitosterol-dependent. The possible role of fatty acids also present in the extract is suggested. The study shows the hydrophobic flax fiber components as wound healing activators, with anti-inflammatory cannabidiol acting in synergy with sterols, and migration and proliferation promoting agents, some of which still require experimental identification.

  10. Flax Fiber Hydrophobic Extract Inhibits Human Skin Cells Inflammation and Causes Remodeling of Extracellular Matrix and Wound Closure Activation.

    Science.gov (United States)

    Styrczewska, Monika; Kostyn, Anna; Kulma, Anna; Majkowska-Skrobek, Grazyna; Augustyniak, Daria; Prescha, Anna; Czuj, Tadeusz; Szopa, Jan

    2015-01-01

    Inflammation is the basis of many diseases, with chronic wounds amongst them, limiting cell proliferation and tissue regeneration. Our previous preclinical study of flax fiber applied as a wound dressing and analysis of its components impact on the fibroblast transcriptome suggested flax fiber hydrophobic extract use as an anti-inflammatory and wound healing preparation. The extract contains cannabidiol (CBD), phytosterols, and unsaturated fatty acids, showing great promise in wound healing. In in vitro proliferation and wound closure tests the extract activated cell migration and proliferation. The activity of matrix metalloproteinases in skin cells was increased, suggesting activation of extracellular components remodeling. The expression of cytokines was diminished by the extract in a cannabidiol-dependent manner, but β-sitosterol can act synergistically with CBD in inflammation inhibition. Extracellular matrix related genes were also analyzed, considering their importance in further stages of wound healing. The extract activated skin cell matrix remodeling, but the changes were only partially cannabidiol- and β-sitosterol-dependent. The possible role of fatty acids also present in the extract is suggested. The study shows the hydrophobic flax fiber components as wound healing activators, with anti-inflammatory cannabidiol acting in synergy with sterols, and migration and proliferation promoting agents, some of which still require experimental identification.

  11. Surgical vacuum-assisted closure for treatment of dramatic case of stonefish envenomation

    Institute of Scientific and Technical Information of China (English)

    Alexandru Nistor; Olivier Giè; Paul Biegger; Cesare Fusetti; Stefano Lucchina

    2010-01-01

    Skin necrosis of the foot, oedema and lymphangitis from stonefish (Synanceia verrucosa) sting are complications well known for a long time and with potential long-term sequelae. Literature reports of stonefish envenomation give no specific reference on soft tissue management and surgical reconstruction. This is the first report describing a case of foot stonefish envenomation treated by vacuum-assisted closure therapy as an easy to use,accessible and simple adjuvant tool for management of large soft tissue necrosis.

  12. SURGICAL CLOSURE PADA DEFEK SEKAT ATRIUM USIA DEWASA: SEBUAH LAPORAN KASUS

    OpenAIRE

    Pande Ayu Naya Kasih Permatananda

    2014-01-01

    Defek Sekat Atrium merupakan penyakit jantung kongenital yang sering ditemukan pada usia dewasa, namun insidennya secara pasti sukar ditentukan karena penyakitini cenderung tidak bergejala dan sukar ditemukan dengan pemeriksaan fisik standar.Pada kasus ini dilaporkan seorang wanita berusia 27 tahun dengan diagnosis defeksekat atrium tipe II dengan ukuran defek sebesar 36,5 mm pada echocardiografi. Padapasien ini dilakukan surgical closure untuk menutup defek pada atrium danmencegah komplikasi...

  13. Enhanced healing of surgical wounds of the lower leg using weekly zinc oxide compression dressings.

    Science.gov (United States)

    Stebbins, William G; Hanke, C William; Petersen, Jeffrey

    2011-02-01

    Management of lower extremity wounds after Mohs micrographic surgery can pose a challenge to the surgeon. Postoperative reactive edema and inflammation can lead to a painful and protracted healing course. Unna boots deliver zinc oxide to the wound bed and surrounding skin while providing compression and occlusion of the wound. To evaluate the utility of weekly Unna boot therapy in decreasing postoperative edema, inflammation, and morbidity; minimizing postoperative wound care; and improving the rate of wound healing in patients with lower leg surgical defects. Ten patients (6 men, 4 women) aged 72 to 91 with postoperative defects on the distal lower extremity were treated with weekly Unna boots until wounds had sufficiently granulated or re-epithelialized. In all 10 patients, weekly Unna boot therapy was well tolerated, with high satisfaction levels relating to minimal postoperative wound care, rapid granulation, minimal pain, and excellent esthetic outcome of postoperative wounds. No infections or other complications were noted during the healing process. LIMITATIONS This was not a randomized, controlled trial. In patients with postoperative wounds of the lower leg, weekly Unna boots significantly improve the healing process, decrease postoperative pain, and minimize wound care. © 2011 by the American Society for Dermatologic Surgery, Inc.

  14. Negative Pressure Wound Therapy in Maxillofacial Applications

    Directory of Open Access Journals (Sweden)

    Adam J. Mellott

    2016-09-01

    Full Text Available Negative pressure wound therapy has greatly advanced the field of wound healing for nearly two decades, by providing a robust surgical adjunct technique for accelerating wound closure in acute and chronic wounds. However, the application of negative pressure wound therapy in maxillofacial applications has been relatively under utilized as a result of the physical articulations and contours of the head and neck that make it challenging to obtain an airtight seal for different negative pressure wound therapy systems. Adapting negative pressure wound therapies for maxillofacial applications could yield significant enhancement of wound closure in maxillofacial applications. The current review summarizes the basic science underlying negative pressure wound therapy, as well as specific maxillofacial procedures that could benefit from negative pressure wound therapy.

  15. The “excluding” suture technique for surgical closure of ventricular septal defects: A retrospective study comparing the standard technique

    Directory of Open Access Journals (Sweden)

    Roy Varghese

    2016-01-01

    Conclusion: Surgical closure of VSDs can be accomplished by placing sutures along the margins or away with comparable results. The incidence of CHB, however, seems to be less when the “excluding” technique is employed.

  16. ABDOMINAL CLOSURE WITH ANTI BACTERIAL COATED SUTURE MATERIALS AND ITS RELATION TO THE INCIDENCE OF POST OPERATIVE SUPERFICIAL SURGICAL SITE INFECTION RATES

    Directory of Open Access Journals (Sweden)

    Josephine Pudumai Selvi

    2017-07-01

    Full Text Available BACKGROUND Surgical site infection (SSI is an immense burden on healthcare resources even in the modern era of immaculate sterilization approaches and highly effective antibiotics. An estimated 234 million various surgical procedures, involving skin incisions requiring various types of wound closure techniques, are performed in the world, with the majority resulting in a wound healing by primary intention. Triclosan (5-chloro-2-(2, 4-dichlorophenoxy phenol is a broad-spectrum bactericidal agent that has been used for more than 40 years in various products, such as toothpaste and soaps. Higher concentrations of Triclosan work as a bactericide by attacking different structures in the bacterial cytoplasm and cell membrane. Use of Triclosan-coated sutures should theoretically result in the reduction of SSI. The aim of the study is to assess the abdominal closure with antibacterial coated suture materials and its relation to the incidence of post-operative superficial surgical site infection rates. MATERIALS AND METHODS The data will be collected from hospital records of surgery performed, post-operative daily progress notes and outpatient folders and telephonic conversations with patients after discharge. All patients undergoing laparotomy procedure for any cause. 100 patients divided as 50 in each group. RESULTS The positive outcome of infection (21.5% in patients using ordinary sutures was significantly differed with the positive outcome of infection (11.4% of Triclosan coated sutures. CONCLUSION In conclusion since there was a definite advantage inferred to the patients by using Triclosan coated polyglactin 910, it is the opinion of the researcher that Triclosan coated sutures has a role to play in reducing SSI in clean wounds and its use should be confined to areas where its application has proven benefits. However more studies should be done to clearly define its role and indications in surgery.

  17. Acute surgical wound care. 4: The importance of documentation.

    Science.gov (United States)

    Foster, L; Moore, P

    This article, the last in a series of four, discusses the importance of documenting wound care. Studies have shown that nurses do not document wound care as often, or as accurately, as they should in order to comply with the UKCC's (1998) Guidelines for Records and Record Keeping. Although some wound assessment charts have been published and are in use, there is still concern about the validity or reliability of some of these charts. Studies show that further research is necessary in order to validate the charts that are currently in use. An increase in litigation has placed more emphasis on accurate record keeping which shows, in detail, the wound care that is given to each patient. Patients also want to be more informed about their treatment, and this can be done through the use of clinical pathways or multidisciplinary documents. This article also discusses the factors that have to be considered when putting a wound care chart together and gives some examples of existing charts.

  18. Acute wound management: revisiting the approach to assessment, irrigation, and closure considerations

    OpenAIRE

    Nicks, Bret A.; Ayello, Elizabeth A.; Woo, Kevin; Nitzki-George, Diane; Sibbald, R. Gary

    2010-01-01

    Background As millions of emergency department (ED) visits each year include wound care, emergency care providers must remain experts in acute wound management. The variety of acute wounds presenting to the ED challenge the physician to select the most appropriate management to facilitate healing. A complete wound history along with anatomic and specific medical considerations for each patient provides the basis of decision making for wound management. It is essential to apply an evidence‐bas...

  19. [Surgical wound infection in patients undergoing extra-anatomical arterial surgery. A retrospective study].

    Science.gov (United States)

    Monreal, M; Callejas, J M; Lisbona, C; Martorell, A; Lerma, R; Boabaid, R; Mejía, S

    1993-01-01

    We present a retrospective review of a series of patients from our Service submitted to surgical extra-anatomical grafts. Correlation between diverse variants and ulterior obliteration by thrombosis or infection of the surgical wounds is analyzed. The series included 133 patients surgically treated between 1986 and 1991. The studied variants were: sex, age, type of graft, the material used, length and type of anesthesia, presentation of hypotension during the surgical intervention, diabetes, platelet recount. Fourteen patients (11%) presented early graft obliteration and 15 (11%) presented an infection of their surgical wound. Only the platelet variant showed statistical differences in patients presenting infection. A high recount of platelets could be a factor risk of infection.

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

    Directory of Open Access Journals (Sweden)

    Sivasankari

    2016-03-01

    Full Text Available 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 understanding of the pathogenesis of wound infections and wound healing, surgical site infections still remain a major source of morbidity and mortality. Hence, this study was done to identify the aetiological bacterial agents and their antibiogram pattern and the risk factors associated with surgical site infections. METHODS Wounds were examined for signs and symptoms of infection in postoperative ward. All the pus swabs were processed and identified as per standard methods of identification. Antibiogram was performed as per CLSI guidelines. The isolates were screened and confirmed with double disc diffusion method using CLSI guidelines. RESULTS The rate of surgical site infections in our study was 8.3%. The rate of surgical site infections was higher (73.3% in emergency surgeries than the elective surgeries. E. coli was the commonest isolate among gram negative bacilli; 33.3% isolates of E. coli were ESBL procedures. E. coli were sensitive to cefepime and ciprofloxacin and showed maximum resistance to ampicillin and ceftazidime. All the E. coli were sensitive to imipenem.

  1. Closure

    NARCIS (Netherlands)

    Stigter, C.J.

    1988-01-01

    At least an easier task than I have carried out the previous hour when we discussed the preliminary conclusions and recommendations has, as a compensation I guess, been given to me as well. To say a few words as a closure of this symposium. The beginning of such a series of closing statements is mos

  2. Surgical sutures filled with adipose-derived stem cells promote wound healing.

    Directory of Open Access Journals (Sweden)

    Ann Katharin Reckhenrich

    Full Text Available Delayed wound healing and scar formation are among the most frequent complications after surgical interventions. Although biodegradable surgical sutures present an excellent drug delivery opportunity, their primary function is tissue fixation. Mesenchymal stem cells (MSC act as trophic mediators and are successful in activating biomaterials. Here biodegradable sutures were filled with adipose-derived mesenchymal stem cells (ASC to provide a pro-regenerative environment at the injured site. Results showed that after filling, ASCs attach to the suture material, distribute equally throughout the filaments, and remain viable in the suture. Among a broad panel of cytokines, cell-filled sutures constantly release vascular endothelial growth factor to supernatants. Such conditioned media was evaluated in an in vitro wound healing assay and showed a significant decrease in the open wound area compared to controls. After suturing in an ex vivo wound model, cells remained in the suture and maintained their metabolic activity. Furthermore, cell-filled sutures can be cryopreserved without losing their viability. This study presents an innovative approach to equip surgical sutures with pro-regenerative features and allows the treatment and fixation of wounds in one step, therefore representing a promising tool to promote wound healing after injury.

  3. A homeopathic remedy from arnica, marigold, St. John’s wort and comfrey accelerates in vitro wound scratch closure of NIH 3T3 fibroblasts

    Science.gov (United States)

    2012-01-01

    Background Drugs of plant origin such as Arnica montana, Calendula officinalis or Hypericum perforatum have been frequently used to promote wound healing. While their effect on wound healing using preparations at pharmacological concentrations was supported by several in vitro and clinical studies, investigations of herbal homeopathic remedies on wound healing process are rare. The objective of this study was to investigate the effect of a commercial low potency homeopathic remedy Similasan® Arnica plus Spray on wound closure in a controlled, blind trial in vitro. Methods We investigated the effect of an ethanolic preparation composed of equal parts of Arnica montana 4x, Calendula officinalis 4x, Hypericum perforatum 4x and Symphytum officinale 6x (0712–2), its succussed hydroalcoholic solvent (0712–1) and unsuccussed solvent (0712–3) on NIH 3T3 fibroblasts. Cell viability was determined by WST-1 assay, cell growth using BrdU uptake, cell migration by chemotaxis assay and wound closure by CytoSelect ™Wound Healing Assay Kit which generated a defined “wound field”. All assays were performed in three independent controlled experiments. Results None of the three substances affected cell viability and none showed a stimulating effect on cell proliferation. Preparation (0712–2) exerted a stimulating effect on fibroblast migration (31.9%) vs 14.7% with succussed solvent (0712–1) at 1:100 dilutions (p  0.05). Preparation (0712–2) at a dilution of 1:100 promoted in vitro wound closure by 59.5% and differed significantly (p < 0.001) from succussed solvent (0712–1), which caused 22.1% wound closure. Conclusion Results of this study showed that the low potency homeopathic remedy (0712–2) exerted in vitro wound closure potential in NIH 3T3 fibroblasts. This effect resulted from stimulation of fibroblasts motility rather than of their mitosis. PMID:22809174

  4. [Plastic surgery in patients with surgical wound infection].

    Science.gov (United States)

    Gostishchev, V K; Lipatov, K V; Komarova, E A; Marakutsa, E V

    2009-01-01

    Results of various skin plastic operations performed in 312 patients with soft-tissue infection were analyzed. The choice of the method depended on size and site of the wound, predisposing pathological process, age and general patient's condition. Differential approach to the choice of reconstruction method allowed satisfactory short-term results in 91,4% of patients. 80% of patients demonstrated good long-term results.

  5. Predictors of Wound Complications following Radiation and Surgical Resection of Soft Tissue Sarcomas

    Directory of Open Access Journals (Sweden)

    Drake G. LeBrun

    2017-01-01

    Full Text Available Wound complications represent a major source of morbidity in patients undergoing radiation therapy (RT and surgical resection of soft tissue sarcomas (STS. We investigated whether factors related to RT, surgery, patient comorbidities, and tumor histopathology predict the development of wound complications. An observational study of patients who underwent STS resection and RT was performed. The primary outcome was the occurrence of any wound complication up to four months postoperatively. Significant predictors of wound complications were identified using multivariable logistic regression. Sixty-five patients representing 67 cases of STS were identified. Median age was 59 years (range 22–90 and 34 (52% patients were female. The rates of major wound complications and any wound complications were 21% and 33%, respectively. After adjusting for radiation timing, diabetes (OR 9.6; 95% CI 1.4–64.8; P=0.02, grade ≥2 radiation dermatitis (OR 4.8; 95% CI 1.2–19.2; P=0.03, and the use of 3D conformal RT (OR 4.6; 95% CI 1.1–20.0; P=0.04 were associated with an increased risk of any wound complication on multivariable analysis. These data suggest that radiation dermatitis and radiation modality are predictors of wound complications in patients with STS.

  6. The unnatural history of an atrial septal defect: Longitudinal 35 year follow up after surgical closure at young age

    NARCIS (Netherlands)

    J.A.A.E. Cuypers (Judith); P. Opic (Petra); M.E. Menting (Myrthe); E.M.W.J. Utens (Elisabeth); M. Witsenburg (Maarten); W.A. Helbing (Willem); A.E. van den Bosch (Annemien); M. Ouhlous (Mohamed); R.T. van Domburg (Ron); F.J. Meijboom (Folkert); A.J.J.C. Bogers (Ad); J.W. Roos-Hesselink (Jolien)

    2013-01-01

    markdownabstractABSTRACT Objective: To describe the very long-term outcome after surgical closure of an atrial septal defect (ASD). Design: Longitudinal cohort study of 135 consecutive patients who underwent surgical ASD repair at age <15 years between 1968 and 1980. The study protocol included EC

  7. Bluebelle study (phase A): a mixed-methods feasibility study to inform an RCT of surgical wound dressing strategies

    Science.gov (United States)

    2016-01-01

    Objectives Dressing primary surgical wounds is common, but the implications for surgical site infection (SSI) remain unknown. The Bluebelle study aimed to determine the feasibility of a randomised controlled trial (RCT) comparing ‘simple’, ‘complex’ or ‘no’ dressings on abdominal wounds, as prespecified in a funder's research brief. Bluebelle includes exploratory work (phase A) to inform a pilot version of the proposed RCT (phase B). Phase A aimed to investigate current dressing practices and perspectives on the proposed RCT, with a view to refining the forthcoming pilot. Design Mixed methods, including semi-structured interviews and document analysis. Setting 6 UK hospitals. Participants 51 patients and 92 clinical professionals from abdominal surgical specialities. Results Professionals had variable interpretations of what constitutes a ‘dressing’, particularly with respect to ‘glue’—a product listed under ‘wound-closure products’ in the British National Formulary, which some surgeons reportedly applied as a ‘wound covering’. Areas of ambiguity arising from interviews informed development of pragmatic definitions, including specification of conditions under which glue constituted a ‘dressing’. Professionals reported that ‘simple’ dressings were routinely used in practice, whereas ‘complex’ dressings were not. This raised questions about the relevance of comparison groups, prompting the design of a survey to determine the types/frequency of dressing use in abdominal surgery (reported elsewhere). This confirmed that complex dressings were rarely used, while ‘glue as a dressing’ was used relatively frequently. ‘Complex dressings’ were therefore substituted for ‘glue as a dressing’ (following an updated Cochrane review, which found insufficient evidence to determine the effectiveness of ‘glue as a dressing’). Patients and professionals acknowledged uncertainty around dressing use and SSI prevention, but felt

  8. Effect of surgical incision management on wound infections in a poststernotomy patient population.

    Science.gov (United States)

    Grauhan, Onnen; Navasardyan, Artashes; Tutkun, Baris; Hennig, Felix; Müller, Peter; Hummel, Manfred; Hetzer, Roland

    2014-06-01

    Skin breakdown and infiltration of skin flora are key causative elements in poststernotomy wound infections. We hypothesised that surgical incision management (SIM) using negative pressure wound therapy over closed surgical incisions for 6-7 days would reduce wound infections in a comprehensive poststernotomy patient population. 'All comers' undergoing median sternotomy at our institution were analysed prospectively from 1 September to 15 October 2013 (study group, n = 237) and retrospectively from January 2008 to December 2009 (historical control group, n = 3508). The study group had SIM (Prevena™ Therapy) placed immediately after skin suturing and applied at -125 mmHg for 6-7 days, whereas control group received conventional sterile wound tape dressings. Primary endpoint was wound infection within 30 days. Study group had a significantly lower infection rate than control group: 1·3% (3 patients) versus 3·4% (119 patients), respectively (P incision was primarily closed in 234 of 237 patients (98·7%). SIM over clean, closed incisions for the first 6-7 postoperative days significantly reduced the incidence of wound infection after median sternotomy. Based on these data SIM may be cost-effective in patients undergoing cardiac surgery.

  9. [Early specialized surgical care for gunshot wounds of major vessels in Donbas].

    Science.gov (United States)

    Rozin, Yu A; Ivanenko, A A

    2016-01-01

    The authors share their experience gained in rendering early specialized surgical care during combat operations in Donbas, having operated on a total of 139 wounded with lesions of large vessels, of these, 21 (15.1%) presenting with concomitant lesions of vessels. Reconstructive operations were carried out in 122 (87.8%) wounded, ligating operations - in 12 (8.6%), and primary amputations - in 5 (3.6%). Two (1.4%) patients died. Blood flow was restored in 117 (84.2%) patients, with six amputations performed after primary operations. The limb was saved in 116 (83.4%) wounded. Peculiarities of a vascular injury in Donbas comprise a large proportion of severe concomitant vascular wounds and lack of intermediate stages of evacuation. The prognosis of life and limb salvage largely depends on correctly chosen method of temporary arrest of bleeding at first stages of medical evacuation and shortening the terms of rendering first specialized surgical care. The variant of operation (reconstruction, ligation or primary amputation) in severe concomitant vascular wounds should be determined proceeding from the degree of ischaemia and severity of the condition of the wounded person, assessed by means of the Military Surgery - Mangled Extremity Severity Score.

  10. Honey and wound dehiscence: A study of surgical wounds in the ...

    African Journals Online (AJOL)

    2014-08-20

    Aug 20, 2014 ... Conclusion: Honey speeds up the healing of dehiscence wounds of resected mandible when used as dressing more than the control. .... using the ruler technique to measure the circumference .... that low concentrations of honey stimulate proliferation of ... [29,30] Honey supplies glucose that is essential.

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

    Science.gov (United States)

    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.

  12. The financial burden of surgical and endovascular treatment of diabetic foot wounds.

    Science.gov (United States)

    Joret, Maximilian O; Dean, Anastasia; Cao, Colin; Stewart, Joanna; Bhamidipaty, Venu

    2016-09-01

    The cost of treating diabetes-related disease in New Zealand is increasing and is expected to reach New Zealand dollars (NZD) 1.8 billion in 2021. The financial burden attached to the treatment of diabetic foot wounds is difficult to quantify and reported costs of treatment vary greatly in the literature. As of yet, no study has captured the true total cost of treating a diabetic foot wound. In this study, we investigate the total minimum cost of treating a diabetic foot ulcer at a tertiary institution. A retrospective audit of hospital and interhospital records was performed to identify adult patients with diabetes who were treated operatively for a diabetic foot wound by the department of vascular surgery at Auckland Hospital between January 2009 and June 2014. Costs from the patients' admissions and outpatient clinics from their first meeting to the achievement of a final outcome were tallied to calculate the total cost of healing the wound. The hospital's expenses were calculated using a fully absorbed activity-based costing methodology and correlated with a variety of demographic and clinical factors extracted from patients' electronic records using a general linear mixed model. We identified 225 patients accounting for 265 wound episodes, 700 inpatient admissions, 815 outpatient consultations, 367 surgical procedures, and 248 endovascular procedures. The total minimum cost to the Auckland city hospital was NZD 10,217,115 (NZD 9,886,963 inpatient costs; NZD 330,152 outpatient costs). The median cost per wound episode was NZD 29,537 (NZD 28,491 inpatient costs; NZD 834 outpatient cost). Wound healing was achieved in 70% of wound episodes (average length of healing, 9 months); 19% of wounds had not healed before the patient's death. Of every 3.5 wound episodes, one required a major amputation. Wound treatment modality, particularly surgical management, was the strongest predictor of high resource utilization. Wounds treated with endovascular intervention and no

  13. The effect of sutureless wound closure on postoperative pain and swelling after impacted mandibular third molar surgery.

    Science.gov (United States)

    Hashemi, Hamid Mahmood; Beshkar, Majid; Aghajani, Reihaneh

    2012-04-01

    Our aim was to assess the influence of sutureless and multiple-suture closure of wounds on postoperative complications after extraction of bilateral, impacted, mandibular third molars in 30 patients in a split mouth study. After the teeth had been removed, on one side the flap was replaced but with no suture to hold it in place (study side), and on the other side the wound was closed primarily with three sutures (control side). Recorded complications included pain, swelling, bleeding, and formation of periodontal pockets. The results showed that patients had significantly less postoperative pain and swelling when no sutures were used (p=0.005). There were no signs of excessive bleeding or oozing postoperatively on either side. Six months postoperatively there was no significant difference in the depth of the periodontal pocket around the second molar.

  14. Intestinal epithelial restitution. Involvement of specific laminin isoforms and integrin laminin receptors in wound closure of a transformed model epithelium

    DEFF Research Database (Denmark)

    Lotz, M M; Nusrat, A; Madara, J L;

    1997-01-01

    Disruptions in the mucosal lining of the gastrointestinal tract reseal by epithelial cell migration, a process termed restitution. We examined the involvement of laminin isoforms and their integrin receptors in restitution using the intestinal epithelial cell line T84. T84 cells express primarily...... laminins 5, 6, and 7 as indicated by immunostaining using laminin subunit-specific monoclonal antibodies (MAbs). A MAb (BM2) specific for the laminin alpha 3 subunit, a component of laminins 5, 6, and 7, completely inhibited the closure of mechanical wounds in T84 monolayers. Confocal microscopy using MAbs...... BM2 (laminin alpha 3 subunit) and 6F12 (laminin beta 3 subunit) revealed that laminin-5 is deposited in a basal matrix that extends into the wound. The MAbs 4E10 (laminin beta 1 subunit) and C4 (laminin beta 2 subunit) stained the lateral membranes between T84 cells. This staining was enhanced...

  15. Use of Adipose-Derived Stem Cells to Support Topical Skin Adhesive for Wound Closure: A Preliminary Report from Animal In Vivo Study

    Directory of Open Access Journals (Sweden)

    Maciej Nowacki

    2016-01-01

    Full Text Available The aim of this study was to determine the local and systemic effects of adipose-derived stem cells (ADSCs as a component of topical skin adhesive in an animal artificial wound closure model. In presented study the cosmetic effects, histological analysis, mechanical properties, and cell migration have been assessed to evaluate the usefulness of ADSCs as supporting factor for octyl blend cyanoacrylate adhesive. The total of 40 rats were used and divided into six groups. In the Study Group, ADSCs were administered by multipoint injection of the six surrounding intrawound areas with additional freely leaving procedure of the cells between the skin flaps just before applying adhesive to close the wound. Five control groups without using ADSCs, utilizing different types of standard wound closure, were created in order to check efficiency of experimental stem cell therapy. In our study, we proved that ADSCs could be used effectively also as a supportive tool in topical skin adhesive for wound closure. However we did not achieve any spectacular differences related to such aspects as better mechanical properties or special biological breakthroughs in wound healing properties. The use of stem cells, especially ADSCs for wound closure can provide an inspiring development in plastic and dermatologic surgery.

  16. Image-based mass-spring model of mitral valve closure for surgical planning

    Science.gov (United States)

    Hammer, Peter E.; Perrin, Douglas P.; del Nido, Pedro J.; Howe, Robert D.

    2008-03-01

    Surgical repair of the mitral valve is preferred in most cases over valve replacement, but replacement is often performed instead due to the technical difficulty of repair. A surgical planning system based on patient-specific medical images that allows surgeons to simulate and compare potential repair strategies could greatly improve surgical outcomes. In such a surgical simulator, the mathematical model of mechanics used to close the valve must be able to compute the closed state quickly and to handle the complex boundary conditions imposed by the chords that tether the valve leaflets. We have developed a system for generating a triangulated mesh of the valve surface from volumetric image data of the opened valve. We then compute the closed position of the mesh using a mass-spring model of dynamics. The triangulated mesh is produced by fitting an isosurface to the volumetric image data, and boundary conditions, including the valve annulus and chord endpoints, are identified in the image data using a graphical user interface. In the mass-spring model, triangle sides are treated as linear springs, and sides shared by two triangles are treated as bending springs. Chords are treated as nonlinear springs, and self-collisions are detected and resolved. Equations of motion are solved using implicit numerical integration. Accuracy was assessed by comparison of model results with an image of the same valve taken in the closed state. The model exhibited rapid valve closure and was able to reproduce important features of the closed valve.

  17. Source and route of methicillin-resistant Staphylococcus epidermidis transmitted to the surgical wound during cardio-thoracic surgery. Possibility of preventing wound contamination by use of special scrub suits.

    Science.gov (United States)

    Tammelin, A; Hambraeus, A; Ståhle, E

    2001-04-01

    The objective of this study was to trace the source and route of transmission of methicillin-resistant Staphylococcus epidermidis (MRSE) in the surgical wound during cardio-thoracic surgery, and to investigate the possibility of reducing wound contamination by wearing special scrub suits. In total 65 elective operations for coronary artery bypass grafting (CABG) with or without concomitant valve replacement were investigated. All staff present in the operating room wore conventional scrub suits during 33 operations and special scrub suits during 32 operations. Samples were taken from the hands of the scrubbed team after surgical scrub but before putting on sterile gowns and gloves, and from patients' skin (incisional area of sternum and vein harvesting area of legs) after preoperative skin preparation with chlorhexidine gluconate. Air samples were taken during operations. Samples were also taken from the wound just before closure. Total counts of bacteria on sternal skin and from the wound (cfu/cm2) were calculated as well as total counts of bacteria in the air (cfu/m3). Strains of MRSE recovered from the different sampling sites were compared by pulsed field gel electrophoresis (PFGE). It was found that wearing special scrub suits did not reduce the number of air-samples where MRSE was found compared with conventional scrub suits. The risk factor most strongly associated with MRSE in the wound at the end of the operation was preoperative carriage of MRSE on sternal skin; RR 2.42 [95% CI 1.43-4.10], P= 0.021. By use of PFGE, it was possible to identify the probable source for four MRSE isolates recovered from the wound. In three cases the source was the patients own skin. Finding MRSE in air-samples, or on the hands of the scrubbed team, were not risk factors for the recovery of MRSE in the wound at the end of operation. In conclusion, with a total bacterial air count around 20 cfu/m3 and a low proportion of MRSE, the reduction of total air counts by use of tightly

  18. A homeopathic remedy from arnica, marigold, St. John’s wort and comfrey accelerates in vitro wound scratch closure of NIH 3T3 fibroblasts

    Directory of Open Access Journals (Sweden)

    Hostanska Katarina

    2012-07-01

    Full Text Available Abstract Background Drugs of plant origin such as Arnica montana, Calendula officinalis or Hypericum perforatum have been frequently used to promote wound healing. While their effect on wound healing using preparations at pharmacological concentrations was supported by several in vitro and clinical studies, investigations of herbal homeopathic remedies on wound healing process are rare. The objective of this study was to investigate the effect of a commercial low potency homeopathic remedy Similasan® Arnica plus Spray on wound closure in a controlled, blind trial in vitro. Methods We investigated the effect of an ethanolic preparation composed of equal parts of Arnica montana 4x, Calendula officinalis 4x, Hypericum perforatum 4x and Symphytum officinale 6x (0712–2, its succussed hydroalcoholic solvent (0712–1 and unsuccussed solvent (0712–3 on NIH 3T3 fibroblasts. Cell viability was determined by WST-1 assay, cell growth using BrdU uptake, cell migration by chemotaxis assay and wound closure by CytoSelect ™Wound Healing Assay Kit which generated a defined “wound field”. All assays were performed in three independent controlled experiments. Results None of the three substances affected cell viability and none showed a stimulating effect on cell proliferation. Preparation (0712–2 exerted a stimulating effect on fibroblast migration (31.9% vs 14.7% with succussed solvent (0712–1 at 1:100 dilutions (p  0.05. Preparation (0712–2 at a dilution of 1:100 promoted in vitro wound closure by 59.5% and differed significantly (p  Conclusion Results of this study showed that the low potency homeopathic remedy (0712–2 exerted in vitro wound closure potential in NIH 3T3 fibroblasts. This effect resulted from stimulation of fibroblasts motility rather than of their mitosis.

  19. Delayed cutaneous wound closure in HO-2 deficient mice despite normal HO-1 expression

    NARCIS (Netherlands)

    Lundvig, D.M.S.; Scharstuhl, A.; Cremers, N.A.J.; Pennings, S.W.C.; Paske, J. Te; Rheden, R. van; Breda, C. van Run-van; Regan, R.F.; Russel, F.G.M.; Carels, C.E.L.; Maltha, J.C.; Wagener, F.A.D.T.G.

    2014-01-01

    Impaired wound healing can lead to scarring, and aesthetical and functional problems. The cytoprotective haem oxygenase (HO) enzymes degrade haem into iron, biliverdin and carbon monoxide. HO-1 deficient mice suffer from chronic inflammatory stress and delayed cutaneous wound healing, while corneal

  20. Delayed cutaneous wound closure in HO-2 deficient mice despite normal HO-1 expression

    NARCIS (Netherlands)

    Lundvig, D.M.S.; Scharstuhl, A.; Cremers, N.A.J.; Pennings, S.W.C.; Paske, J. Te; Rheden, R. van; Breda, C. van Run-van; Regan, R.F.; Russel, F.G.M.; Carels, C.E.L.; Maltha, J.C.; Wagener, F.A.D.T.G.

    2014-01-01

    Impaired wound healing can lead to scarring, and aesthetical and functional problems. The cytoprotective haem oxygenase (HO) enzymes degrade haem into iron, biliverdin and carbon monoxide. HO-1 deficient mice suffer from chronic inflammatory stress and delayed cutaneous wound healing, while corneal

  1. Review of Subcutaneous Wound Drainage in Reducing Surgical Site Infections after Laparotomy

    Directory of Open Access Journals (Sweden)

    B. Manzoor

    2015-01-01

    Full Text Available Purpose. Surgical site infections (SSIs remain a significant problem after laparotomies. The aim of this review was to assess the evidence on the efficacy of subcutaneous wound drainage in reducing SSI. Methods. MEDLINE database was searched. Studies were identified and screened according to criteria to determine their eligibility for meta-analysis. Meta-analysis was performed using the Mantel-Haenszel method and a fixed effects model. Results. Eleven studies were included with two thousand eight hundred and sixty-four patients. One thousand four hundred and fifty patients were in the control group and one thousand four hundred and fourteen patients were in the drain group. Wound drainage in all patients shows no statistically significant benefit in reducing SSI incidence. Use of drainage in high risk patients, contaminated wound types, and obese patients appears beneficial. Conclusion. Using subcutaneous wound drainage after laparotomy in all patients is unnecessary as it does not reduce SSI risk. Similarly, there seems to be no benefit in using it in clean and clean contaminated wounds. However, there may be benefit in using drains in patients who are at high risk, including patients who are obese and/or have contaminated wound types. A well designed trial is needed which examines these factors.

  2. Adhesive strip wound closure after thyroidectomy/parathyroidectomy: a prospective, randomized controlled trial.

    LENUS (Irish Health Repository)

    O'Leary, D Peter

    2013-03-01

    Conventional collar incision closure in thyroid and parathyroid surgery involves the insertion of an epidermal layer of subcutaneous absorbable sutures that are reinforced by a deep layer of sutures. Adhesive strips offer an alternative method to close the epidermal layer. The aim of this study was to compare adhesive strip closure with absorbable sutures for collar incisions in a prospective, single-blinded, randomized controlled trial.

  3. Surgical outcomes of the brachial plexus lesions caused by gunshot wounds in adults

    Directory of Open Access Journals (Sweden)

    Duz Bulent

    2009-07-01

    Full Text Available Abstract Background The management of brachial plexus injuries due to gunshot wounds is a surgical challenge. Better surgical strategies based on clinical and electrophysiological patterns are needed. The aim of this study is to clarify the factors which may influence the surgical technique and outcome of the brachial plexus lesions caused by gunshot injuries. Methods Two hundred and sixty five patients who had brachial plexus lesions caused by gunshot injuries were included in this study. All of them were male with a mean age of 22 years. Twenty-three patients were improved with conservative treatment while the others underwent surgical treatment. The patients were classified and managed according to the locations, clinical and electrophysiological findings, and coexisting lesions. Results The wounding agent was shrapnel in 106 patients and bullet in 159 patients. Surgical procedures were performed from 6 weeks to 10 months after the injury. The majority of the lesions were repaired within 4 months were improved successfully. Good results were obtained in upper trunk and lateral cord lesions. The outcome was satisfactory if the nerve was intact and only compressed by fibrosis or the nerve was in-contunuity with neuroma or fibrosis. Conclusion Appropriate surgical techniques help the recovery from the lesions, especially in patients with complete functional loss. Intraoperative nerve status and the type of surgery significantly affect the final clinical outcome of the patients.

  4. Coblation technology for surgical wound debridement: principle, experimental data, and technical data.

    Science.gov (United States)

    Trial, Chloé; Brancati, Antonio; Marnet, Olivier; Téot, Luc

    2012-12-01

    Debridement is required to prepare the wound bed, essentially in removing undesired tissues observed both in acute wound after burns or trauma and in chronic wounds such as pressure ulcers, leg ulcers, and diabetic foot ulcers. Surgical debridement has been described as one of the most effective methods but can be contraindicated in the elderly, arteriopathic context, or patients under effective anticoagulation. Recently described debridement technologies are based on application of important mechanical severing forces over the wound surface using high-power hydrojets. High water flux acts as a vector for separating necrotic and sloughy tissues from the wound bed and aspirates them out of the wound immediately. Electrical powered techniques and lasers were also scarcely described. The Coblation debridement technology presented here is based on the local induction of a focused plasma field chemically deleting undesired tissues. This technique is a modification of conventional electrosurgical devices, developed in 1928 where tissue excision and coagulation of tissues were observed. Principles of plasma-mediated debridement are based on a bipolar radiofrequency energizing the molecules, thus creating a plasma field. This glow discharge plasma produces chemically active radical species from dissociation of water, breaking molecular bonds, and causing tissue dissolution. The thermal effects are a by-product, which can be modulated by modifying the electrode construction, limiting the local temperature to less than 50°C in order not to induce wound bed renecrosis. The authors describe here the principle, the first technical adaptation for wound debridement, and the potential clinical interest of the Coblation technology.

  5. [Surgical site infections. Effectiveness of polyhexamethylene biguanide wound dressings].

    Science.gov (United States)

    Martín-Trapero, Carlos; Martín-Torrijos, María; Fernández-Conde, Lourdes; Torrijos-Torrijos, Manuela; Manzano-Martín, Elena; Pacheco-del Cerro, J Luis; Díez-Valladares, Luis I

    2013-01-01

    To analyze the effectiveness of a 0,2% polyhexamethylene biguanide dressing against the infection of a superficial surgical incision site (ISSIS) after a laparoscopic cholecystectomy. A randomized longitudinal single-blind study was conducted with two randomly assigned groups consisting of patients diagnosed with cholelithiasis soon to undergo an elective laparoscopic cholecystectomy. The dependent variable was ISSIS using the criteria of the Centre for Disease Control (CDC) (1999). The independent variables were the use of a 0,2% polyhexamethylene biguanide dressing (Group A), or a non occlusive dressing (Group B). The National Nosocomial Infections Surveillance (NNIS) index was used for assessing the risk of infection. The χ(2) test or Fisher test was used to evaluate the correlation between the independent variables. Of the total 197 cases, 96 (48.7%) were in group A and 101 (51.3%) in group B. No statistical differences were found between genders, duration of surgery (51.4 ± 21.2 vs 52.6 ± 23.4 minutes, in group A and B, respectively), or the NNIS index in either group. Six patients had an ISSIS (3.04%): 1 in group A (1.04%) and 5 in group B (4.95%), P=.212. The study was unable to correlate an ISSIS with the type of surgical dressing that was used, although it was not possible to rule out an association, as the study did not have sufficient statistical power. Copyright © 2012 Elsevier España, S.L. All rights reserved.

  6. Topical antibiotic prophylaxis for prevention of surgical wound infections from dermatologic procedures: a systematic review and meta-analysis.

    Science.gov (United States)

    Saco, Michael; Howe, Nicole; Nathoo, Rajiv; Cherpelis, Basil

    2015-04-01

    Topical antibiotics are not indicated for postsurgical wound infection prophylaxis in clean and clean-contaminated dermatologic surgeries, yet many dermatologists continue to prescribe them. The objective of our systematic review and meta-analysis was to critically assess the efficacy of topical antibiotics in terms of preventing postsurgical wound infections in the dermatology outpatient setting. PubMed, Embase, MD Consult, Science Direct, Springer Link, DynaMed and Cochrane online medical databases were searched from 1980 to 2013. Using random effects modeling, the pooled odds ratio of developing a postsurgical wound infection was 0.71 (95% CI, 0.42-1.19). Pooled data of the four trials in the meta-analysis did not show a statistically significant difference in incidence of postsurgical wound infections between topical antibiotics and petrolatum/paraffin. In the setting of moist occlusive dressings, there is no statistically significant difference in prophylactic efficacy between applying and not applying ointment to surgical wounds. Wounds at increased risk of developing surgical site infections include wounds in diabetics, wounds located in certain anatomic regions, and wounds created by some surgical procedures. Petrolatum should be used instead of topical antibiotics as a prophylactic measure to prevent postsurgical wound infections in the outpatient dermatologic setting.

  7. SURGICAL CLOSURE PADA DEFEK SEKAT ATRIUM USIA DEWASA: SEBUAH LAPORAN KASUS

    Directory of Open Access Journals (Sweden)

    Pande Ayu Naya Kasih Permatananda

    2014-08-01

    Full Text Available Defek Sekat Atrium merupakan penyakit jantung kongenital yang sering ditemukan pada usia dewasa, namun insidennya secara pasti sukar ditentukan karena penyakitini cenderung tidak bergejala dan sukar ditemukan dengan pemeriksaan fisik standar.Pada kasus ini dilaporkan seorang wanita berusia 27 tahun dengan diagnosis defeksekat atrium tipe II dengan ukuran defek sebesar 36,5 mm pada echocardiografi. Padapasien ini dilakukan surgical closure untuk menutup defek pada atrium danmencegah komplikasi jangka panjang. Tindakan ini diawali dengan sternotomy dandilakukan cardiopulmonary baypass di mana jantung diistirahatkan denganmenggunakan larutan cardioplegic dan defek kemudian ditutup secara langsungdengan penjahitan tipe continuos. Selama masa perawatan post operasi,hemodinamik pasien dinyatakan stabil, tidak ditemukan tanda aritmia maupunkebocoran, luka operasi pun terawat dengan baik.

  8. Reversible cortical blindness following successful surgical repair of two stab wounds in the heart.

    Science.gov (United States)

    El Gatit, A; Abdul Razeq, M; El Snaini, F; Saad, K; Zaiton, A

    2008-03-01

    This report describes a case of cortical blindness that followed successful surgical repair of two stab wounds in the heart in a 29-year old Libyan man. The patient presented in a state of pre cardiac arrest (shock and low cardiac output status), following multiple chest stab wounds. Chest tube was immediately inserted. Surgery was urgently performed suturing the two wounds; in the root of the aorta and in the left ventricle, and haemostasis was secured. Cardiac arrest was successfully prevented. The patient recovered smoothly, but 24 hours later he declared total blindness. Ophtalmic and neurological examinations and investigations that included fundoscopy, Electroencephalograms (EEGs) and Computed Tomography Scans revealed no abnormalities, apart from absence of alpha waves in the EEGs. We diagnosed the case as cortical blindness and continued caring for the patient conservatively. Three days later, the patient regained his vision gradually and was discharged on the 7(th) postoperative day without any remarks.

  9. Duration of smoking cessation for the prevention of surgical wound healing complications

    Directory of Open Access Journals (Sweden)

    Barbara Vieira Cavichio

    2014-02-01

    Full Text Available The study aimed to find scientific evidence about the duration of preoperative smoking cessation required to reduce surgical wound healing complications. An integrative review was performed in the databases, Latin American and Caribbean Literature on Health Sciences (LILACS and Medical Literature Analysis and Retrieval System Online (MEDLINE, from 08/17/2012 to 09/17/2012, using the keywords: tobacco use cessation and wound healing; tobacco use cessation and preoperative period; tobacco use cessation and perioperative period (LILACS and tobacco use cessation and perioperative period; tobacco use cessation and wound healing (MEDLINE. Out of the 81 eligible studies, 12 were included. The duration of smoking cessation needed to reduce healing complications was at least four weeks (four studies with level of evidence I, three studies with level of evidence II, two studies with level of evidence IV, and one study with level of evidence VII.

  10. Preoperative hair removal with clippers does not increase infection rate in clean surgical wounds.

    Science.gov (United States)

    Olson, M M; MacCallum, J; McQuarrie, D G

    1986-02-01

    For a one year period, hair was removed from the operative site with clippers rather than by shaving with a razor or by application of depilatories. The study involved comparison of clean (Class I) wound infection rates in 2,580 patients after clipping was instituted compared with 17,424 patients studied in seven preceding years. There was no significant change in the wound infection rate (1 per cent) when compared with the three years immediately preceding. There was no change in the identified distribution of the infecting organism. Failure to show a clear reduction in wound infection rate was probably related to the low historic base line rate. There were definite benefits achieved by avoiding cancellation of elective operations, by using operating room personnel more efficiently and by expediating the surgical schedule.

  11. REVERSIBLE CORTICAL BLINDNESS FOLLOWING SUCCESSFUL SURGICAL REPAIR OF TWO STAB WOUNDS IN THE HEART

    Directory of Open Access Journals (Sweden)

    Zaiton A

    2008-01-01

    Full Text Available This report describes a case of cortical blindness that followed successful surgical repair of two stab wounds in the heart in a 29-year old Libyan man. The patient presented in a state of pre cardiac arrest (shock and low cardiac output status, following multiple chest stab wounds. Chest tube was immediately inserted. Surgery was urgently performed suturing the two wounds; in the root of the aorta and in the left ventricle, and haemostasis was secured. Cardiac arrest was successfully prevented. The patient recovered smoothly, but 24 hours later he declared total blindness. Ophtalmic and neurological examinations and investigations that included fundoscopy, Electroencephalograms (EEGs and Computed Tomography Scans revealed no abnormalities, apart from absence of alpha waves in the EEGs. We diagnosed the case as cortical blindness and continued caring for the patient conservatively. Three days later, the patient regained his vision gradually and was discharged on the 7th postoperative day without any remarks.

  12. A Fibrocontractive Mechanochemical Model of Dermal Wound Closure Incorporating Realistic Growth Factor Kinetics

    KAUST Repository

    Murphy, Kelly E.

    2012-01-13

    Fibroblasts and their activated phenotype, myofibroblasts, are the primary cell types involved in the contraction associated with dermal wound healing. Recent experimental evidence indicates that the transformation from fibroblasts to myofibroblasts involves two distinct processes: The cells are stimulated to change phenotype by the combined actions of transforming growth factor β (TGFβ) and mechanical tension. This observation indicates a need for a detailed exploration of the effect of the strong interactions between the mechanical changes and growth factors in dermal wound healing. We review the experimental findings in detail and develop a model of dermal wound healing that incorporates these phenomena. Our model includes the interactions between TGFβ and collagenase, providing a more biologically realistic form for the growth factor kinetics than those included in previous mechanochemical descriptions. A comparison is made between the model predictions and experimental data on human dermal wound healing and all the essential features are well matched. © 2012 Society for Mathematical Biology.

  13. The Clinical Outcomes of Three Surgical Managements on Primary Angle-closure Glaucoma

    Institute of Scientific and Technical Information of China (English)

    Xiulan; Zhang; Leilei; Teng; Ang; Li; Shaolin; Du; Yunyun; Zhu; Jian; Ge

    2007-01-01

    Purpose: To investigate the efficacy of trabeculectomy, phacotrabeculectomy and phacoemulsification in the management of primary angle closure glaucoma (PACG).Methods: A prospective observational study was performed in 88 chronic PACG patients (97 eyes) who were divided into three groups following defined indications to receive different surgical interventions. The indications and clinical outcomes were evaluated. The mean follow-up was (17.7±4.9) months.Results: Success rate in trabeculectomy, phacotrabeculectomy and phacoemulsification group was 81.08%, 78.57‰ and 81.25‰, respectively. The anterior chamber depth was deeper and the angle was wider postoperatively vs. preoperatively both in phacotrabeculectomy and phacoemulsification group. No obvious changes were seen in trabeculectomy group. The coefficient of outflow facility of aqueous humor (C values)significantly increased in three groups postoperatively (P<0.01 ). No severe intraoperative complications were found and the incidence of postoperative complications was low. Five eyes sustained hypotony 3± 1.87 months in trabeculectomy group and 1 eye happened malignant glaucoma in phacotrabeculectomy group. The visual acuity in patients with phacotrabeculectomy plus intraocular lens implantation and those only with phacoemulsification plus intraocular lens implantation were improved 78.57% and 93.74%, respectively. No significant improvement was found in trabeculectomy group (x2 = 47.10, P<0.001).Conclusion: Three surgical interventions were beneficial to manage PACG and with co-existing cataract. The indication choosing was suggested according to visual acuity,angle closure circumference, cataract, medication requirements and optic nerve damage.Phacotrabeculectomy was recommended for angle closed ≥180° circumference while phacoemulsification for angle closed < 180°.

  14. Beneficial Effects of Applying Low-Level Laser Therapy to Surgical Wounds After Bariatric Surgery.

    Science.gov (United States)

    Ojea, Alecsander R; Madi, Otavio; Neto, Rafael Melillo L; Lima, Sizenando E; de Carvalho, Bruno T; Ojea, Maria Juliana M R; Marcos, Rodrigo L; da Silva, Fabricio S; Zamuner, Stella R; Chavantes, Maria Cristina

    2016-11-01

    Bariatric surgery is a successful method for weight loss in cases of morbid obesity; however, as an invasive procedure, surgical complications may occur. Low-level laser therapy (LLLT) has been increasingly used due to its effectiveness in controlling the inflammatory response, accelerating tissue repair, and reducing pain. The objective of this study was to investigate photobiomodulation effects after bariatric surgery and determine the laser actions during the inflammatory process, wound healing (clinical observation), and analgesia. This study was a randomized, placebo-controlled, clinical trial in which 85 patients underwent Roux en-Y gastric bypass (RYGB) by conventional techniques (i.e., open surgery). Patients were divided into two groups and were irradiated with LLLT at 10 different points through the surgical scar in three sessions of applications: the laser group (laser-on) consisted of 43 patients who received the CW diode laser (MMOptics), while the placebo group (laser-off) consisted of 42 patients who were treated by the same protocol but with a disabled laser. Temperature was measured by a digital thermometer in both groups, and pain was evaluated using the visual analogue scale for pain. Biochemical analysis and digital images were used to document and evaluate the inflammatory response as well as tissue repair process at the surgical wound site. Patients in the laser group demonstrated diminished wound temperature as erythrocyte sedimentation rate (ESR) compared with the placebo group, indicating better inflammatory process control as well as improved wound healing and reduced pain. LLLT applied with the described protocol led to a decrease by biochemical markers and wound temperature compared with the placebo, which indicated that LLLT was able to control the inflammatory process; in addition, seroma and pain were reduced and cicatrization was improved by this preventive procedure.

  15. Fluorescence imaging of tryptophan and collagen cross-links to evaluate wound closure ex vivo

    Science.gov (United States)

    Wang, Ying; Ortega-Martinez, Antonio; Farinelli, Bill; Anderson, R. R.; Franco, Walfre

    2016-02-01

    Wound size is a key parameter in monitoring healing. Current methods to measure wound size are often subjective, time-consuming and marginally invasive. Recently, we developed a non-invasive, non-contact, fast and simple but robust fluorescence imaging (u-FEI) method to monitor the healing of skin wounds. This method exploits the fluorescence of native molecules to tissue as functional and structural markers. The objective of the present study is to demonstrate the feasibility of using variations in the fluorescence intensity of tryptophan and cross-links of collagen to evaluate proliferation of keratinocyte cells and quantitate size of wound during healing, respectively. Circular dermal wounds were created in ex vivo human skin and cultured in different media. Two serial fluorescence images of tryptophan and collagen cross-links were acquired every two days. Histology and immunohistology were used to validate correlation between fluorescence and epithelialization. Images of collagen cross-links show fluorescence of the exposed dermis and, hence, are a measure of wound area. Images of tryptophan show higher fluorescence intensity of proliferating keratinocytes forming new epithelium, as compared to surrounding keratinocytes not involved in epithelialization. These images are complementary since collagen cross-links report on structure while tryptophan reports on function. HE and immunohistology show that tryptophan fluorescence correlates with newly formed epidermis. We have established a fluorescence imaging method for studying epithelialization processes during wound healing in a skin organ culture model, our approach has the potential to provide a non-invasive, non-contact, quick, objective and direct method for quantitative measurements in wound healing in vivo.

  16. Suction-irrigation drainage: an underestimated therapeutic option for surgical treatment of deep sternal wound infections†

    Science.gov (United States)

    Deschka, Heinz; Erler, Stefan; El-Ayoubi, Lemir; Vogel, Cordula; Vöhringer, Luise; Wimmer-Greinecker, Gerhard

    2013-01-01

    OBJECTIVES Deep sternal wound infections are significant and severe complications following cardiac surgery and substantially influence perioperative morbidity and mortality. We present the experience of our department using two different surgical treatments over a three-year period. METHODS Between January 2009 and December 2011, a total of 3274 cardiac procedures with complete median sternotomy were performed in our department. In 94 patients (3%), a deep sternal wound infection occurred, including sternal instability with consecutive surgical treatment. The patients either received wound debridement with sternum refixation and suction-irrigation drainage (SID; n = 72) or sternum refixation only (RF; n = 22) if there was sternal instability with limited signs of infection. SID was routinely installed for 7 days: the irrigation solution contained neomycin. In all cases, swabs were taken and analysed. The different methods were evaluated in respect of their clinical outcomes. RESULTS The success rate—defined as single, uncomplicated procedure—of the SID treatment was 74%, compared with 59% of the isolated sternum refixation. Complications included continuous infection, recurrence of sternal instability and wound necrosis. Eighty-eight percent of the swabs in the SID group were positive, compared with 32% in the sternal refixation only group. The dominating pathogenic germs were coagulase-negative staphylococci and staphylococcus aureus. Mortality was 10% for the SID group and 5% for the RF group. CONCLUSIONS Contrary to accepted opinion, the suction-irrigation drainage is an appropriate therapy for deep sternal wound infections. Nevertheless, deep sternal wound infections after cardiac surgery remain severe complications and are related to increased morbidity and mortality. PMID:23529753

  17. Suction-irrigation drainage: an underestimated therapeutic option for surgical treatment of deep sternal wound infections.

    Science.gov (United States)

    Deschka, Heinz; Erler, Stefan; El-Ayoubi, Lemir; Vogel, Cordula; Vöhringer, Luise; Wimmer-Greinecker, Gerhard

    2013-07-01

    Deep sternal wound infections are significant and severe complications following cardiac surgery and substantially influence perioperative morbidity and mortality. We present the experience of our department using two different surgical treatments over a three-year period. Between January 2009 and December 2011, a total of 3274 cardiac procedures with complete median sternotomy were performed in our department. In 94 patients (3%), a deep sternal wound infection occurred, including sternal instability with consecutive surgical treatment. The patients either received wound debridement with sternum refixation and suction-irrigation drainage (SID; n = 72) or sternum refixation only (RF; n = 22) if there was sternal instability with limited signs of infection. SID was routinely installed for 7 days: the irrigation solution contained neomycin. In all cases, swabs were taken and analysed. The different methods were evaluated in respect of their clinical outcomes. The success rate-defined as single, uncomplicated procedure-of the SID treatment was 74%, compared with 59% of the isolated sternum refixation. Complications included continuous infection, recurrence of sternal instability and wound necrosis. Eighty-eight percent of the swabs in the SID group were positive, compared with 32% in the sternal refixation only group. The dominating pathogenic germs were coagulase-negative staphylococci and staphylococcus aureus. Mortality was 10% for the SID group and 5% for the RF group. Contrary to accepted opinion, the suction-irrigation drainage is an appropriate therapy for deep sternal wound infections. Nevertheless, deep sternal wound infections after cardiac surgery remain severe complications and are related to increased morbidity and mortality.

  18. Perioperative hypothermia and incidence of surgical wound infection: a bibliographic study.

    Science.gov (United States)

    Silva, Aline Batista da; Peniche, Aparecida de Cassia Giani

    2014-01-01

    The purpose of this review article was to understand and analyze the scientific production related to the occurrence of perioperative hypothermia and the incidence of infection on the surgical site. For this purpose, a search was conducted in the databases LILACS, MEDLINE, PubMed, CINAHL and Cochrane, using the health science descriptors DECS, from 2004 to 2009. A total of 91 articles were found. After eliminating duplicate items and using selection criteria for inclusion, six manuscripts remained for analysis. The studies were classified as retrospective, prospective, case studies, and clinical trials. After analysis, the majority of studies showed that hypothermia must be prevented during the perioperative period to reduce complications in the healing process of the surgical incision. Therefore, unadverted hypothermia directly influences in surgical site healing, increasing the incidence of infection in the surgical wound.

  19. 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.

  20. Surgical wound irrigation: a call for evidence-based standardization of practice.

    Science.gov (United States)

    Barnes, Sue; Spencer, Maureen; Graham, Denise; Johnson, Helen Boehm

    2014-05-01

    Surgical wound irrigation has long been debated as a potentially critical intraoperative measure taken to prevent the development of surgical site infection (SSI). Unlike many other SSI prevention efforts, there are no official practice guidelines or recommendations from any major medical group for the practice of surgical irrigation. As a result, practitioner implementation of the 3 major irrigation variables (delivery method, volume, and solution additives) can differ significantly. A focus group of key thought leaders in infection prevention and epidemiology convened recently to address the implications of different surgical irrigation practices. They identified an urgent need for well-designed clinical trials investigating surgical irrigation practices, improved collaboration between surgical personnel and infection preventionists, and examination of existing evidence to standardize irrigation practices. The group agreed that current published data are sufficient to support the elimination of antibiotic solutions for surgical irrigation; the avoidance of surfactants for surgical irrigation; and the use of sterile normal saline, sterile water, and 1 medical device containing a sterile 0.05% chlorhexidine gluconate solution followed by sterile saline. Given the current lack of sufficient evidence identifying ideal delivery method and volume choices, expert opinion must be relied on to guide best practice.

  1. Effect of two homeopathic remedies at different degrees of dilutions on the wound closure of 3T3 fibroblasts in in vitro scratch assay

    Directory of Open Access Journals (Sweden)

    Reinhard Saller

    2012-09-01

    Full Text Available Background: Since ancient times, preparations from traditional medicinal plants e.g. Arnica montana, Calendula officinalis or Hypericum perforatum have been used for different wound healing purposes. The aim of this study was to investigate the efficacy of the commercial low dilution homeopathic remedy Similasan® Arnica plus Spray, a preparation of Arnica montana 4x, Calendula officinalis 4x, Hypericum perforatum 4x and Symphytum officinale 6x (0712-2 and medium diluted SIM WuS (Petroleum 15x, Arnica montana 15x, Calcium fluoratum 12x, Calendula officinalis 12x, Hepar sulfuris 12x and Mercurius solubilis 15x; 1101-4, on the wound healing in cultured NIH 3T3 fibroblasts. Both remedies were from Similasan AG (Jonen, Switzerland and prepared according the German Homoeopathic Pharmacopoeia (GHP following descriptions 4a for arnica, 3a for marigold and St. John’s wort, 2a for comfrey, 5a for petroleum, and 6 for calcium fluoride, hepar sulfuris and mercurius solubilis. Materials and Methods: Cell proliferation, migration and wound closure promoting effect of the preparations (0712-2, 1101- 4 and their succussed solvents (0712-1, 1101-3 were investigated on mouse NIH 3T3 fibroblasts. Cell viability was determined by WST-1 assay, cell growth using BrdU uptake, cell migration by chemotaxis assay and wound closure by CytoSelect ™Wound Healing Assay Kit which generated a defined wound area. All assays were performed in three independent controlled experiments. In some experiments diluted unsuccussed alcohol (0712-3 was also investigated. Results: Preparations (0712-1, (0712-2, (0712-3, (1101-3 and (1101-4 were investigated at decimal dilution steps from 1x to 4x. Cell viabilty was not affected by any of the substances and (0712-1 and (0712-2 showed no stimulating effect on cell proliferation. Preparation (0712-2 exerted a stimulating effect on fibroblast migration (31.7% vs 15% with succussed solvent (0712-1 at 1

  2. Virtual reality 3D echocardiography in the assessment of tricuspid valve function after surgical closure of ventricular septal defect

    NARCIS (Netherlands)

    G. Bol-Raap (Goris); A.H.J. Koning (Anton); T.V. Scohy (Thierry); A.D.J. ten Harkel (Arend); F.J. Meijboom (Folkert); A.P. Kappetein (Arie Pieter); P.J. van der Spek (Peter); A.J.J.C. Bogers (Ad)

    2007-01-01

    textabstractBackground. This study was done to investigate the potential additional role of virtual reality, using three-dimensional (3D) echocardiographic holograms, in the postoperative assessment of tricuspid valve function after surgical closure of ventricular septal defect (VSD). Methods. 12 da

  3. Accelerated Burn Wound Closure in Mice with a New Formula Based on Traditional Medicine.

    Science.gov (United States)

    Mehrabani, Mehrnaz; Seyyedkazemi, Seyyed Mohsen; Nematollahi, Mohammad Hadi; Jafari, Elham; Mehrabani, Mitra; Mehdipour, Mohammad; Sheikhshoaee, Zahra; Mandegary, Ali

    2016-11-01

    A combination of the oils of sesame, hemp, wild pistachio, and walnut has been used for treatment of skin disorders, including wound burns, in some parts of Kerman, Iran. Evaluation of this remedy in the form of a pharmaceutical formulation in animal models can pave the way for its future application in wound burn healing in humans. This experimental study investigated the healing potential of a new formula (NF) based on folk medicine from Iran for the treatment of third degree burns in mice. The formula was a combination of the oils of four plants: sesame (Sesamum indicum L.), wild pistachio (Pistacia atlantica Desf.), hemp (Cannabis sativa L.), and walnut (Juglans regia L.). Twenty-four mice were selected based on simple random sampling. Twenty-five percent of the total body surface area was burned by exposure to boiling water, according to the Walker-Mason method. NF and silver sulfadiazine (the positive control) were applied topically twice a day for 21 days. The burned area in the negative control group was left untreated. Epithelialization time and the percent of wound contraction were measured during the treatment period. The process of wound repairing was evaluated using histological (H and E and trichrome staining) and immunohistological (anti-pancytokeratin) methods. When compared to the controls, NF significantly improved wound contraction after day 10. Epithelialization time in the NF group was significantly faster than in the other groups (20 vs. 25.5 days) (P < 0.001). Histopathological and immunohistochemical findings confirmed the efficacy of the NF. A new therapeutic remedy was introduced for the treatment of burn wounds. Further clinical and molecular studies are suggested to determine the exact mechanism(s) involved in the burn wound healing effect of NF.

  4. Accelerated Burn Wound Closure in Mice with a New Formula Based on Traditional Medicine

    Science.gov (United States)

    Mehrabani, Mehrnaz; Seyyedkazemi, Seyyed Mohsen; Nematollahi, Mohammad Hadi; Jafari, Elham; Mehrabani, Mitra; Mehdipour, Mohammad; Sheikhshoaee, Zahra; Mandegary, Ali

    2016-01-01

    Background A combination of the oils of sesame, hemp, wild pistachio, and walnut has been used for treatment of skin disorders, including wound burns, in some parts of Kerman, Iran. Evaluation of this remedy in the form of a pharmaceutical formulation in animal models can pave the way for its future application in wound burn healing in humans. Objectives This experimental study investigated the healing potential of a new formula (NF) based on folk medicine from Iran for the treatment of third degree burns in mice. The formula was a combination of the oils of four plants: sesame (Sesamum indicum L.), wild pistachio (Pistacia atlantica Desf.), hemp (Cannabis sativa L.), and walnut (Juglans regia L.) Methods Twenty-four mice were selected based on simple random sampling. Twenty-five percent of the total body surface area was burned by exposure to boiling water, according to the Walker-Mason method. NF and silver sulfadiazine (the positive control) were applied topically twice a day for 21 days. The burned area in the negative control group was left untreated. Epithelialization time and the percent of wound contraction were measured during the treatment period. The process of wound repairing was evaluated using histological (H and E and trichrome staining) and immunohistological (anti-pancytokeratin) methods. Results When compared to the controls, NF significantly improved wound contraction after day 10. Epithelialization time in the NF group was significantly faster than in the other groups (20 vs. 25.5 days) (P < 0.001). Histopathological and immunohistochemical findings confirmed the efficacy of the NF. Conclusions A new therapeutic remedy was introduced for the treatment of burn wounds. Further clinical and molecular studies are suggested to determine the exact mechanism(s) involved in the burn wound healing effect of NF. PMID:28191338

  5. DYNAMICS OF WOUND HEALING AFTER SURGICAL INTERFERENCE ON PERIODONTAL TISSUES BY USING TRANSCRANIAL STIMULATION IN POSTOPERATIVE PERIOD

    OpenAIRE

    Kondrateva, A.

    2011-01-01

    Results of morphological research of marginal gingival tissues before surgical treatment and in process of wound healing in patients with traditional postoperative period and application of transcranial stimulation are presented. It is shown that transcranial stimulation accelerates wound healing and is an effective method of non-drug treatment of periodontal patients after surgery.

  6. [Wound closure after irrigation with Octenisept® without possibility for drainage].

    Science.gov (United States)

    Högele, A M; Neu, J

    2011-01-01

    A 39-year-old patient suffered a stab wound of the right thenar prominence after an accident with a screwdriver. In the first hospital the deep wound was irrigated with octenidine dihydrochloride/2-phenoxyethanol and closed by suture. During the further course pressure pain and numbness of the right thenar and swelling of the right hand occurred. Three weeks after the accident an operative revision of the wound in a second hospital was performed. The intraoperative findings showed inflammation and necrosis of the right m. abductor pollicis brevis, but no infection with pus.The patient accused the first hospital of irrigating the tissue of his right hand with Octenisept®. The expert option of the Arbitration Board identified improper care in the first hospital with insufficient excision of the wound and incorrect use of the Octenisept® solution. Against the explicit advice of the manufacturing company the wound had been sutured without the possibility of drainage for the Octenisept® solution.

  7. The Ability of Tissue Engineered Skin Accelerating the Closure of Different Wound

    Institute of Scientific and Technical Information of China (English)

    Yong-Jie ZHANG; Yan JIN; Xin NIE; Yuan LIU; Rui DONG; Xin-Wen WANG

    2005-01-01

    @@ 1 Introduction In the past several decades, a number of reseacher have described the principal efficacy of tissue engineered skin to promote wound healing of venous and diabetic ulcers. But the true value of tissue-engineered skin products in different wound care remains yet to be more clearly defined. In this trial, we analysis the effective of tissue-engineered skin (ActivSkin) in the management of burns,donor sites and ulcers, which were also the frequently injury caused with warfare, disaster and terrorist incident.

  8. The Ability of Tissue Engineered Skin Accelerating the Closure of Different Wound

    Institute of Scientific and Technical Information of China (English)

    2005-01-01

    1 IntroductionIn the past several decades, a number of reseacher have described the principal efficacy of tissue engineered skin to promote wound healing of venous and diabetic ulcers. But the true value of tissue-engineered skin products in different wound care remains yet to be more clearly defined. In this trial, we analysis the effective of tissue-engineered skin (ActivSkin) in the management of burns, donor sites and ulcers, which were also the frequently injury caused with warfare, disaster and terror...

  9. 5alpha-dihydrotestosterone (DHT) retards wound closure by inhibiting re-epithelialization.

    Science.gov (United States)

    Gilliver, S C; Ruckshanthi, J P D; Hardman, M J; Zeef, L A H; Ashcroft, G S

    2009-01-01

    The ongoing search for explanations as to why elderly males heal acute skin wounds more slowly than do their female counterparts (and are more strongly disposed to conditions of chronic ulceration) has identified endogenous oestrogens and androgens as being respectively enhancers and inhibitors of repair. We previously demonstrated that blocking the conversion of testosterone to 5alpha-dihydrotestosterone (DHT) limits its ability to impair healing, suggesting that DHT is a more potent inhibitor of repair than is testosterone. The present study aimed to delineate the central mechanisms by which androgens delay repair. Whilst the contractile properties of neither rat wounds in vivo nor fibroblast-impregnated collagenous discs in vitro appeared to be influenced by androgen manipulations, the global blockade of DHT biosynthesis markedly accelerated re-epithelialization of incisional and excisional wounds and reduced local expression of beta-catenin, a key inhibitor of repair. Moreover, DHT retarded the in vitro migration of epidermal keratinocytes following scratch wounding. By contrast, it failed to influence the migratory and proliferative properties of dermal fibroblasts, suggesting that its primary inhibitory effect is upon re-epithelialization. These novel findings may be of particular significance in the context of chronic ulceration, for which being male is a key risk factor.

  10. Factors associated with the healing of complex surgical wounds in the breast and abdomen: retrospective cohort study.

    Science.gov (United States)

    Borges, Eline Lima; Pires, José Ferreira; Abreu, Mery Natali Silva; Lima, Vera Lúcia de Araújo; Silva, Patrícia Aparecida Barbosa; Soares, Sônia Maria

    2016-10-10

    to estimate the healing rate of complex surgical wounds and its associated factors. retrospective cohort study from 2003 to 2014 with 160 outpatients of a Brazilian university hospital. Data were obtained through consultation of the medical records. Survival function was estimated using the Kaplan-Meier method and Cox regression model to estimate the likelihood of the occurrence of healing. the complex surgical wound healing rate was 67.8% (95% CI: 60.8-74.9). Factors associated with a higher likelihood of wound healing were segmentectomy/quadrantectomy surgery, consumption of more than 20 grams/day of alcohol, wound extent of less that 17.3 cm2 and the length of existence of the wound prior to outpatient treatment of less than 15 days, while the use of hydrocolloid covering and Marlex mesh were associated with a lower likelihood of healing. the wound healing rate was considered high and was associated with the type of surgical intervention, alcohol consumption, type of covering, extent and length of wound existence. Preventive measures can be implemented during the monitoring of the evolution of the complex surgical wound closure, with possibilities of intervention in the modifiable risk factors. estimar a taxa de cicatrização de ferida cirúrgica complexa e seus fatores associados. coorte retrospectiva de 2003 a 2014 com 160 pacientes ambulatoriais de um hospital universitário brasileiro. Os dados foram obtidos por meio de consulta aos prontuários médicos. Função de sobrevida foi estimada pelo método de Kaplan-Meier e modelo de regressão de Cox para estimação do risco de ocorrência da cicatrização. a taxa de cicatrização da ferida cirúrgica complexa foi 67,8% (IC 95%: 60,8-74,9). Os fatores associados a um maior risco de cicatrização da ferida foram cirurgia de setorectomia / quadrantectomia, consumo de mais de 20 gramas/dia de etanol, extensão da ferida menor que 17,3 cm2 e tempo de existência da ferida pré-tratamento ambulatorial inferior

  11. Two-Year Follow Up After Surgical Versus Percutaneous Paravalvular Leak Closure: A Non-Randomized Analysis.

    Science.gov (United States)

    Angulo-Llanos, Rocío; Sarnago-Cebada, Fernando; Rivera, Allan R; Elízaga Corrales, Jaime; Cuerpo, Gregorio; Solis, Jorge; Gutierrez-Ibañes, Enrique; Sanz-Ruiz, Ricardo; Vázquez Álvarez, M E; Fernandez-Avilés, Francisco

    2016-10-01

    Percutaneous closure of paravalvular leak (PVL) has emerged as an alternative treatment. Predictors of survival and procedural success are unknown. To review our experience in the treatment of PVL and evaluate efficacy, mortality, predictors of success, and outcomes. Retrospective review of percutaneous PVL procedures between years 2008 and 2014. Survival and results were compared with a control cohort of surgical patients. Percutaneous closure was attempted in 51 patients. The surgical group had 36 patients. Defects were perimitral in 67 patients (77%). Mean follow-up (FU) was 784.5 days. After propensity score analysis in-hospital mortality was higher in the surgical group (30.6% vs. 9.8%, OR 6, P 0.01). Clinical improvement was higher in the percutaneous group (71.4% vs. 36.4%, P 0.002). Multivariate analysis showed normal creatinine (OR 15, P < 0.001) as independent predictor of clinical improvement. For the composite end-point of all-cause mortality or readmission, older age (OR 10.7, P 0.001), renal failure, (OR 18, P < 0.01), poor functional class and the absence of clinical improvement (OR 3.9, P < 0.001) were related with a higher risk. There were no differences in survival free from the composite end-point according to the treatment received (surgical or percutaneous). Percutaneous PVL closure has a reasonable rate of success and low complication rates, and results compare favorably with surgical treatment. Older patients and those with poor functional class or renal failure (RF) showed a worse prognosis even after a successful closure. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  12. Surgical tip: Repair of acute Achilles rupture with Krackow suture through a 1.5 cm medial wound.

    Science.gov (United States)

    Lui, T H

    2010-03-01

    Acute Achilles tendon ruptures is one of the commonest tendon injury of the foot and ankle. The management of this problem is still controversial. Treatment can be classified into non-surgical and surgical types. Surgical management can be subdivided into open repair, percutaneous with or without adjunct of arthroscopy. In compare with non-surgical management, surgical management will decrease the tendon re-rupture rate. However, the possible surgical complications including wound breakdown and sural nerve injury are still quite significant. Percutaneous repair technique has the advantage of less chance of wound breakdown, but the rate of tendon re-rupture is higher than that after open tendon repair, because the repair is usually weaker than that achieved in open repair. Lui have described an endoscopic assisted repair with the Krackow locking suture. However, the technique is complicated and six portal wounds are needed. A simpler way of applying the Krackow suture through the portal wound has been described for reattachment of Achilles tendon insertion after endoscopic calcaneoplasty. We describe a mini-open approach of Achilles tendon repair with the Krackow locking suture. By means of release of the medial edge of the investing fascia, the Achilles tendon can be mobilized easily and the Krackow locking suture can be applied through a 1.5cm medial wound. Hopefully, this can improve the strength of repair and maintaining the advantage of minimally invasive tendon repair.

  13. Bronchopleural fistula after pneumonectomy: interdisciplinary surgical closure by an ipsilateral pedicled latissimus dorsi flap supported by video-assisted thoracoscopy.

    Science.gov (United States)

    Wolter, A; Scholz, T; Diedrichson, J; Arens-Landwehr, A; Schroeder-Finckh, R; Liebau, J

    2013-11-01

    Post-pneumonectomy bronchopleural fistula (BPF) remains a rare but often life-threatening complication and therapeutic challenge. Traditional surgical procedures include chronic open drainage, attempts at direct stump closure, thoracoplasty with or without chest wall muscle transposition and trans-sternal bronchial closure. We describe a case with successful closure of a chronic BPF after pneumonectomy by intrathoracic transposition of a pedicled latissimus dorsi muscle flap circumferentially fixed on the surrounding pleural tissue under continuous video-assisted thoracoscopic overview. The postoperative course was without complications; no tumour, empyema or fistula re-occurred. In this article we want to present the potential advantages of video-assisted thoracoscopic support and interdisciplinary teamwork to improve the outcome of patients with BPFs after pneumonectomy.

  14. Healing of surgical castration wounds: a description and an evaluation of flunixin.

    Science.gov (United States)

    Mintline, E M; Varga, A; Banuelos, J; Walker, K A; Hoar, B; Drake, Daniel; Weary, D M; Coetzee, J F; Stock, M L; Tucker, C B

    2014-12-01

    Previous studies have shown that surgical castration wounds take between 10 and 61 d to heal. The objectives of this work were to describe healing, inflammation, lying behavior, and serum concentration of substance P after surgical castration in beef calves and to evaluate the effect of a possible intervention, a single injection of flunixin meglumine (1.1 mg/kg IV, a NSAID), on the healing process. Calves (mean±SE: 25±2.0 d of age; 54±1.4 kg BW) were surgically castrated with or without an injection of flunixin immediately before the procedure (n=24/treatment). Healing was measured with a 5-point scale (1=fresh wound, 5=no visible incision or inflammation) as well as weight gain, scrotal size, and scrotal surface temperature, on d 1, 2, 3, 7, 14, 21, 28, 35, 49, and 63 after castration. Serum concentration of substance P was recorded on all d, including d 0, but not d 63. Lying behavior was recorded with loggers from 2 d before to 29 d after castration. Inflammation, as measured by scrotal size, peaked on d 2 and 3 after the procedure (e.g., 51±1.0 mm on d 2 versus 28±1.3 mm before castration) and then declined with time (Pflunixin had more lying bouts than those that received saline (flunixin by time interaction; P=0.052), but this pattern emerged on and after d 8, well after the 3 to 8 h half-life of this NSAID. In conclusion, castration caused inflammation in the days that followed, and the wounds required a minimum of 4 wk to heal. Provision of an NSAID had no effect on these outcomes.

  15. Evaluation of three suture techniques based on surgical wound assessment in Caprine

    Directory of Open Access Journals (Sweden)

    John Bayo Adeyanju

    2012-11-01

    Full Text Available Subcuticular, simple interrupted and ford interlocking suture patterns were used in closing skin incision at paralumbar fossa in fifteen apparently healthy male and female adult goats. The goats were randomly divided into three groups: A (Subcuticular; B(Ford interlocking and C(Simple interrupted. Clinical appearance of the surgical wound was scored twice post surgery at 18-24 hours and 10-14 days using swelling, erythema, dehiscence and discharge as the parameters. There were no statistical difference (P

  16. The effect of basic fibroblast growth factor on regeneration in a surgical wound model of rat submandibular glands

    Institute of Scientific and Technical Information of China (English)

    Fumitaka Kobayashi; Kenichi Matsuzaka; Takashi Inoue

    2016-01-01

    This study developed an animal model of surgically wounded submandibular glands (SMGs) and investigated the effects of collagen gel with basic fibroblast growth factor (bFGF) on tissue regeneration of surgically wounded SMGs in vivo. The animal model was produced by creating a surgical wound using a 3-mm diameter biopsy punch in SMGs. The wound was filled with collagen gel with bFGF (bFGF group) or without bFGF (control group). In the animal model of surgically wounded SMGs, salivary glands without scar tissue around the wound area were observed with smaller areas of collagen gel. Small round and spindle-shape cells invaded the collagen gel in both groups after operation day (AOD) 5, and this invasion dramatically increased at AOD 7. Host tissue completely replaced the collagen gel at AOD 21. The invading immune cells in the group treated with collagen gel with bFGF were positive for vimentin, a-smooth muscle actin (aSMA), CD49f, c-kit and AQP5 at AOD 7. Similarly, the mRNA expression of vimentin, aSMA, CD49f, keratin19 and AQP5 was also increased. This study suggests that the use of collagen gels with bFGF improves salivary gland regeneration.

  17. Simulation of carbon dioxide insufflation via a diffuser in an open surgical wound model.

    Science.gov (United States)

    Cater, John E; van der Linden, Jan

    2015-01-01

    Flow within a model surgical opening during insufflation with heated carbon dioxide was studied using computational fluid dynamics. A volume of fluid method was used to simulate the mixture of ambient air and carbon dioxide gas. The negative buoyancy of the carbon dioxide caused it to fill the wound and form a protective layer on the internal surfaces for a range of flow rates, temperatures, and angles of patient inclination. It was observed that the flow remained attached to the surface of the model due to the action of the Coanda effect. A flow rate of 10 L/min was sufficient to maintain a warm carbon dioxide barrier for a moderately sized surgical incision for all likely angles of inclination.

  18. Healing process in mice model of surgical wounds enhanced by Phyllocaulis boraceiensis mucus.

    Science.gov (United States)

    Toledo-Piza, Ana Rita de; Maria, Durvanei Augusto

    2014-12-01

    Phyllocaulis boraceiensis mucus has been studied as a potential source of new natural compounds that are capable of inducing proliferation and remodeling tissue. The aim of this study was to evaluate the clinical aspects of healing in the wounded mouse skin, which was treated with an ointment that was composed of mucus, which was released by P boraceiensis. Mice were submitted to a 1-cm dorsal excision. The control group (T1) was treated with papain; the T2 group was treated with papain that was associated with 0.18 μg/μL of mucus; and the T3 group was treated with papain that was associated with 0.012 μg/μL of mucus. Accelerated proliferation was observed after 3 days in the T3 group, presenting a high deposition of fibroblasts at the wound margin, whereas accelerated proliferation in the T1 group began 5 days after surgery. The T2 group presented inflammation during all periods of observation, and even when healing had already begun, the new tissue showed capillary fragility. Remodeling began after 4 days in the T3 group, whereas remodeling began after 6 days in the other groups. T3 showed edema, hyperemia, and bleeding only until the fifth day, and granulation and scar tissues intensely appeared from the 11th day forward. T1 and T2 groups exhibited edema, hyperemia, and bleeding until the 11th day, and granulation and scar tissues appeared after the 13th day. The healing process and wound closure were efficient after the daily application of 0.012 μg/μL P boraceiensis mucus.

  19. Composites containing albumin protein or cyanoacrylate adhesives and biodegradable scaffolds: I. Acute wound closure study in a rat model

    Science.gov (United States)

    Hoffman, Grant T.; Soller, Eric C.; Heintzelman, Douglas L.; Duffy, Mark T.; Bloom, Jeffrey N.; Gilmour, Travis M.; Gonnerman, Krista N.; McNally-Heintzelman, Karen M.

    2004-07-01

    Composite adhesives composed of biodegradable scaffolds impregnated with a biological or synthetic adhesive were investigated for use in wound closure as an alternative to using either one of the adhesives alone. Two different scaffold materials were investigated: (i) a synthetic biodegradable material fabricated from poly(L-lactic-co-glycolic acid); and (ii) a biological material, small intestinal sub mucosa, manufactured by Cook BioTech. The biological adhesive was composed of 50%(w/v) bovine serum albumin solder and 0.5mg/ml indocyanine green dye mixed in deionized water, and activated with an 808-nm diode laser. The synthetic adhesive was Ethicon's Dermabond, a 2-octyl-cyanoacrylate. The tensile strength of skin incisions repaired ex vivo in a rat model, by adhesive alone or in combination with a scaffold, as well as the time-to-failure, were measured and compared. The tensile strength of repairs formed using the scaffold-enhanced biological adhesives were on average, 80% stronger than their non-enhanced counterparts, with an accompanying increase in the time-to-failure of the repairs. These results support the theory that a scaffold material with an irregular surface that bridges the wound provides a stronger, more durable and consistent adhesion, due to the distribution of the tensile stress forces over the many micro-adhesions provided by the irregular surface, rather than the one large continuous adhesive contact. This theory is also supported by several previous ex vivo experiments demonstrating enhanced tensile strength of irregular versus smooth scaffold surfaces in identical tissue repairs performed on bovine thoracic aorta, liver, spleen, small intestine and lung tissue.

  20. Transdermal treatment of the surgical and burned wound skin via phytochemical-capped gold nanoparticles.

    Science.gov (United States)

    Lee, Jaewook; Kim, JiEun; Go, Jun; Lee, Jong Ho; Han, Dong-Wook; Hwang, DaeYoun; Lee, Jaebeom

    2015-11-01

    The biological activities and therapeutic potential of phytochemical-decorated Au nanoparticles (Phyto-AuNPs) were investigated through the treatment of Phyto-AuNPs on the dorsal skin of rats via transdermal drug delivery process in order to regenerate surgical wounded and burned skin. Two different Phyto-AuNPs were applied to the dorsal skin: gallic acid-isoflavone--covered AuNPs (GI-AuNPs) and protocatechuic acid-isoflavone--covered AuNPs (PI-AuNPs). From the biological activity monitoring, it has been resulted that 5-fold thicker epidermis (ER), 50% reduction of metalloproteinase-1 (MMP-1) level, 3-fold higher superoxide dismutase (SOD) activity were obtained in the Phyto-AuNP-treated group, compared with a vehicle group (deionized water (DI-water) treatment). Moreover, the Phyto-AuNPs treatment on the surgical and burn damaged Sprague-Dawley (SD) rats induced higher expression of vascular endothelial growth factor (VEGF) and angiopoietin-2 (Ang-2). It would be plausible that antioxidant property of Phyto-AuNPs assist the acceleration and activation of biomolecules in the healing mechanism, where Phyto-AuNPs can be potential candidates for skin regeneration and wound healing.

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

    Directory of Open Access Journals (Sweden)

    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

  2. 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

  3. Tracheocutaneous fistula closure using a Cartilo-musculo-cutaneous bilobed flap.

    Science.gov (United States)

    Petersen, Wiebke; Amr, Amro; Held, Manuel; Werner, Jan-Ole; Schaller, Hans-Eberhard; Rahmanian-Schwarz, Afshin

    2014-03-01

    In general, the development of a tracheocutaneous fistula (TCF) after tracheotomy is a seldom but recurrent clinical problem in long-term ventilated patients. In cases of prolonged wound healing with no spontaneous wound closure or insufficient later closure by secondary suture, different surgical procedures have been previously described for the closure of TCFs. Nonetheless, each procedure has its individually associated complications so that definite closure of TCFs still remains a challenge. The purpose of this case report is to present a unique case of a patient with a persistent TCF that was successfully closed using a local cartilo-musculo-cutaneous bilobed flap.

  4. Timing in resolution of left heart dilation according to the degree of mitral regurgitation in children with ventricular septal defect after surgical closure

    Directory of Open Access Journals (Sweden)

    Hwa Jin Cho

    2014-01-01

    Full Text Available OBJECTIVE: Children with ventricular septal defects (VSD can have chronic volume overload, which can result in changes of left heart echocardiographic parameters. To evaluate the changes before and after surgical closure, the children were divided into three groups according to the degree of mitral regurgitation (MR, and their echocardiographic characteristics were reviewed at serial follow-up after surgical closure. METHODS: The preoperative, and one-, three-, and 12-month postoperative echocardiographic data of 40 children who underwent surgical closure of VSD were retrospectively reviewed. Left ventricular end-diastolic volume (LVEDV, left ventricular end-diastolic dimension (LVEDD, left ventricular end-systolic dimension (LVESD, mitral valvular characteristics, including degree of MR and mitral valve annulus, and left atrial (LA characteristics, including volume and dimensions, were observed. RESULTS: Preoperative LVEDV, LVEDD, LVESD, mitral valvular annulus, LA volume, and LA dimensions were significantly larger in children with MR. Additionally, there were significant decreases in LVEDV, LVEDD, LA volume, and LA dimensions at one, three, and 12 months postoperatively. The degree of MR also improved to a lower grade after surgical closure of the VSD without additional mitral valve repair. CONCLUSION: The echocardiographic parameters of left heart dilation and MR in children with VSD improved within the first year after surgical closure without additional mitral valve repair. Furthermore, in all of the patients with VSD, regardless of MR, LA dilation was reduced within three months after surgical closure of the VSD; however, LV and mitral valve annular dilatation decreased within 12 months.

  5. Natural coniferous resin salve used to treat complicated surgical wounds: pilot clinical trial on healing and costs.

    Science.gov (United States)

    Sipponen, Arno; Kuokkanen, Opri; Tiihonen, Raine; Kauppinen, Harri; Jokinen, Janne J

    2012-06-01

    Resin is a natural product of coniferous trees. Salves manufactured from spruce resin (Picea abies) have been used for centuries to treat wounds and skin infections. We report a pilot clinical trial designed to investigate healing rates, factors that contribute to delayed wound healing, cost-effectiveness, and incidence of allergic reactions when resin salve is used to treat complicated surgical wounds. The trial involved 23 patients in whom wound healing after surgery was delayed. These patients were assigned to resin salve treatment. The primary outcome measure was the number of days to complete wound healing. Secondary objectives included an assessment of factors contributing to delayed wound healing, an estimation of associated costs, and an investigation into the occurrence of allergic reactions related to resin salve therapy. The study achieved a healing rate of 100%. The mean ± SD healing time was 43 ± 24 days. The mean ± SD wound size (length × width × depth) was (29 ± 19) × (12 ± 7) × (4 ± 3) mm. Wound size, use of corticosteroids or other immunosuppressants, and immobilization were statistically significant (P < 0.05) contributors to delayed wound healing and impaired re-epithelialization. The total mean ± SD costs of the resin salve treatment were €45.0 ± 26.0 per patient during the entire treatment period and €1.2 ± 0.5 per treatment day. The rate of allergic reactions was 0%. The results of this pilot trial indicate that complicated surgical wounds may be treated successfully with resin salve. The treatment method is clinically effective and cost-effective, and the rate of allergic reactions is low. © 2012 The International Society of Dermatology.

  6. Postoperative recovery after mandibular third molar surgery: a criteria for selection of type of surgical site closure.

    Science.gov (United States)

    Damodar, Neeliahgari Durga Akhila; Nandakumar, Hanumanthaiah; Srinath, Narashimha Murthy

    2013-01-01

    This study sought to evaluate postoperative recovery after mandibular third molar surgery, with and without the use of sutures. This study utilized 50 healthy subjects (19 females and 31 males, 18-40 years of age) with bilateral impacted third molars. Two impacted teeth were removed from each patient (60 min maximum operating time). For each patient, the surgical site on one side of the mouth was closed for primary healing by using nonresorbable sutures, while the surgical site on the other side of the mouth was left open for secondary healing. Postoperative recovery was assessed by determining pain (using a visual analog scale) and swelling (by measuring anatomical landmarks pre- and postoperatively on Days 2, 5, and 7) Any incidence of socket infection and hemorrhage were considered to be complications. Both statistical analysis and clinical observation showed that the surgical sites with nonresorbable sutures showed greater swelling and a higher intensity of pain than the surgical sites without sutures; however, there were no statistical or clinical differences in pain and swelling postsurgery at Day 7. The results suggest secondary closure (that is, without sutures) after third molar surgery will produce less postoperative discomfort than primary closure (with nonresorbable sutures).

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

    Directory of Open Access Journals (Sweden)

    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.

  8. [Plastic closure of wounds and trophic ulcers in patients with diabetic foot syndrome by relief autoshred].

    Science.gov (United States)

    Pavlyshin, A V; Shidlovskiĭ, V A; Gerasimchuk, P A

    2013-01-01

    This article describes the features of the surgical treatment of patients with diabetes mellitus complicated with diabetic foot syndrome. Results of autodermoplasty of acute and chronic skin damages with ripped and flat skin graft in 185 patients who were treated in the clinic of general surgery of I.Ya. Horbachevsky Ternopil State Medical University, Ukraine, in the period from 2007 to 2012 Using of this method leads to improved cosmetic and functional results in 81.7% of patients with reducing of treatment duration up to 12 days.

  9. 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....... No difference in the infection rate (13% vs. 11%, p=0.73), length of hospital stay, or wound complications was noted between the two groups. We conclude that although the Aquacel dressing needed significantly fewer changes than the conventional dressing, this did not influence the patient comfort. Moreover...

  10. Surgical repair of tricuspid valve leaflet tear following percutaneous closure of perimembranous ventricular septal defect using Amplatzer duct occluder I: Report of two cases

    Directory of Open Access Journals (Sweden)

    Saatchi Mahesh Kuwelker

    2017-01-01

    Full Text Available Tricuspid valve (TV injury following transcatheter closure of perimembranous ventricular septal defect (PMVSD with Amplatzer ductal occluder I (ADO I, requiring surgical repair, is rare. We report two cases of TV tear involving the anterior and septal leaflets following PMVSD closure using ADO I. In both the patients, the subvalvular apparatus remained unaffected. The patients presented with severe tricuspid regurgitation (TR 6 weeks and 3 months following the device closure. They underwent surgical repair with patch augmentation of the TV leaflets. Postoperatively, both are asymptomatic with a mild residual TR.

  11. Surgical repair of tricuspid valve leaflet tear following percutaneous closure of perimembranous ventricular septal defect using Amplatzer duct occluder I: Report of two cases

    Science.gov (United States)

    Kuwelker, Saatchi Mahesh; Shetty, Devi Prasad; Dalvi, Bharat

    2017-01-01

    Tricuspid valve (TV) injury following transcatheter closure of perimembranous ventricular septal defect (PMVSD) with Amplatzer ductal occluder I (ADO I), requiring surgical repair, is rare. We report two cases of TV tear involving the anterior and septal leaflets following PMVSD closure using ADO I. In both the patients, the subvalvular apparatus remained unaffected. The patients presented with severe tricuspid regurgitation (TR) 6 weeks and 3 months following the device closure. They underwent surgical repair with patch augmentation of the TV leaflets. Postoperatively, both are asymptomatic with a mild residual TR. PMID:28163430

  12. Evaluation of Wound Closure Activity of Nigella sativa, Melastoma malabathricum, Pluchea indica, and Piper sarmentosum Extracts on Scratched Monolayer of Human Gingival Fibroblasts

    Directory of Open Access Journals (Sweden)

    Mas Rizal Ab Rahman

    2014-01-01

    Full Text Available Nigella sativa, Melastoma malabathricum, Pluchea indica, and Piper sarmentosum are common Asian traditional medicines to treat minor wounds. This study aimed to investigate the in vitro wound healing properties of aqueous extracts of these plants using human gingival fibroblast (HGF monolayer as study model. DPPH scavenging activity of the extracts was evaluated and effect on HGF proliferation was determined. Their effect on HGF’s function to synthesize collagen was indicated by the level of hydroxyproline produced and effect on wound healing activity was assessed using an in vitro scratch assay. The influence of the extracts on expression of bFGF and TGF-β was also determined. Results revealed all four extracts to exhibit low free radical scavenging activity. The extract from N. sativa (NSSE compared to the others showed favourable enhancement of HGF proliferation with EC50 of 22.67±3.06 µg/mL (P<0.05 with accelerated wound closure activity despite its nonsignificant effect on collagen synthesis. In addition to the elevated level of bFGF by up to 15% at 100 µg/mL of NSSE, a slightly better effect was observed on the expression of TGF-β. NSSE thus showed that promising wound healing properties and data obtained may contribute towards validation of its traditional use for the healing of oral wounds.

  13. Stress Signals, Mediated by Membranous Glucocorticoid Receptor, Activate PLC/PKC/GSK-3β/β-catenin Pathway to Inhibit Wound Closure.

    Science.gov (United States)

    Jozic, Ivan; Vukelic, Sasa; Stojadinovic, Olivera; Liang, Liang; Ramirez, Horacio A; Pastar, Irena; Tomic Canic, Marjana

    2017-05-01

    Glucocorticoids (GCs), key mediators of stress signals, are also potent wound healing inhibitors. To understand how stress signals inhibit wound healing, we investigated the role of membranous glucocorticoid receptor (mbGR) by using cell-impermeable BSA-conjugated dexamethasone. We found that mbGR inhibits keratinocyte migration and wound closure by activating a Wnt-like phospholipase (PLC)/ protein kinase C (PKC) signaling cascade. Rapid activation of mbGR/PLC/PKC further leads to activation of known biomarkers of nonhealing found in patients, β-catenin and c-myc. Conversely, a selective inhibitor of PKC, calphostin C, blocks mbGR/PKC pathway, and rescues GC-mediated inhibition of keratinocyte migration in vitro and accelerates wound epithelialization of human wounds ex vivo. This novel signaling mechanism may have a major impact on understanding how stress response via GC signaling regulates homeostasis and its role in development and treatments of skin diseases, including wound healing. To test tissue specificity of this nongenomic signaling mechanism, we tested retinal and bronchial human epithelial cells and fibroblasts. We found that mbGR/PLC/PKC signaling cascade exists in all cell types tested, suggesting a more general role. The discovery of this nongenomic signaling pathway, in which glucocorticoids activate Wnt pathway via mbGR, provides new insights into how stress-mediated signals may activate growth signals in various epithelial and mesenchymal tissues. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  14. 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.

  15. ‘This wound has spoilt everything’: emotional capital and the experience of surgical site infections

    Science.gov (United States)

    Brown, Brian; Tanner, Judith; Padley, Wendy

    2014-01-01

    In this article we explore the experience of suffering from a surgical site infection, a common complication of surgery affecting around 5 per cent of surgical patients, via an interview study of 17 patients in the Midlands in the UK. Despite their prevalence, the experience of surgical site infections has received little attention so far. In spite of the impairment resulting from these iatrogenic problems, participants expressed considerable stoicism and we interpret this via the notion of emotional capital. This idea derives from the work of Pierre Bourdieu, Helga Nowotny and Diane Reay and helps us conceptualise the emotional resources accumulated and expended in managing illness and in gaining the most from healthcare services. Participants were frequently at pains not to blame healthcare personnel or hospitals, often discounting the infection's severity, and attributing it to chance, to ‘germs’ or to their own failure to buy and apply wound care products. The participants' stoicism was thus partly afforded by their refusal to blame healthcare institutions or personnel. Where anger was described, this was either defused or expressed on behalf of another person. Emotional capital is associated with deflecting the possibility of complaint and sustaining a deferential and grateful position in relation to the healthcare system. PMID:25470322

  16. 'This wound has spoilt everything': emotional capital and the experience of surgical site infections.

    Science.gov (United States)

    Brown, Brian; Tanner, Judith; Padley, Wendy

    2014-11-01

    In this article we explore the experience of suffering from a surgical site infection, a common complication of surgery affecting around 5 per cent of surgical patients, via an interview study of 17 patients in the Midlands in the UK. Despite their prevalence, the experience of surgical site infections has received little attention so far. In spite of the impairment resulting from these iatrogenic problems, participants expressed considerable stoicism and we interpret this via the notion of emotional capital. This idea derives from the work of Pierre Bourdieu, Helga Nowotny and Diane Reay and helps us conceptualise the emotional resources accumulated and expended in managing illness and in gaining the most from healthcare services. Participants were frequently at pains not to blame healthcare personnel or hospitals, often discounting the infection's severity, and attributing it to chance, to 'germs' or to their own failure to buy and apply wound care products. The participants' stoicism was thus partly afforded by their refusal to blame healthcare institutions or personnel. Where anger was described, this was either defused or expressed on behalf of another person. Emotional capital is associated with deflecting the possibility of complaint and sustaining a deferential and grateful position in relation to the healthcare system.

  17. The surgical team as a source of postoperative wound infections caused by Streptococcus pyogenes

    DEFF Research Database (Denmark)

    Kolmos, H J; Svendsen, R N; Nielsen, S V

    1997-01-01

    Postoperative wound infection, caused by Streptococcus pyogenes transmitted during the operation from members of the surgical team, is a rare but serious complication of surgery. This study describes three cases, which could be traced to an orthopaedic surgeon, who carried the epidemic strain...... in this throat. Epidemiological characteristics of 14 other outbreaks, published in the English-language literature, are summarized. In total, these 15 outbreaks involved 136 patients. The overall case fatality rate was 12%. Anaesthesiologists and other assisting staff members were involved more often than...... surgeons and obstetricians. In outbreaks where an attack rate could be calculated, it was at least 7%. T-28 was the most commonly involved T-type, accounting for seven outbreaks. The anus and vagina were the most common carrier sites in staff members. A combination of penicillin and oral vancomycin seemed...

  18. Bronchial fistula closure with negative pressure wound therapy: a feasible and cost-effective treatment.

    Science.gov (United States)

    Nunes, Rodrigo Barboza; Müller, Bruno Francisco; Cipriano, Federico Enrique Garcia; Coltro, Pedro Soler; Farina, Jayme Adriano

    2016-01-01

    Treatment of bronchial fistula (BF) after pulmonary lobectomy is a challenge. Often, patients require long hospital stay, have recurrent empyema and pneumonia, are susceptible to sepsis, often need broad-spectrum antibiotics, as well as various surgical approaches. With the advent and growing evidence of the benefits of negative pressure therapy (NPT), its use in some patients with BF has been reported with encouraging results concerning its feasibility and cost-effectiveness. The aim of this study was to demonstrate the application of NPT as a resource for BF treatment and comparatively analyze the overall cost of treatment. RESUMO O tratamento de fístula brônquica (FB) após lobectomia pulmonar é um desafio. Muitas vezes, o paciente demanda longo tempo de internação, apresenta recidivas de empiema e pneumonia, pode evoluir para sepse, frequentemente necessita de antibioticoterapia de amplo espectro, bem como de várias abordagens cirúrgicas. Com o advento e acúmulo de evidências dos benefícios da terapia por pressão negativa (TPN), seu uso em alguns pacientes com FB tem sido relatado com resultados animadores relativos à sua viabilidade e ao seu custo-efetividade. O objetivo deste estudo foi demonstrar a aplicação de TPN como recurso para tratamento da FB e analisar comparativamente o custo global do seu tratamento.

  19. Multidrug resistant Psudomonas aeruginosa infections complicating surgical wounds and the potential challenges in managing post-operative wound infections:University of Calabar Teaching Hospital experience

    Institute of Scientific and Technical Information of China (English)

    Jombo GT; Akpan S; Epoke J; Denen Akaa P; Odey F

    2010-01-01

    Objective:To ascertain the antimicrobial susceptibility profile of Pseudomonas aeruginosa (P. aeruginosa) recovered from surgical site infections (SSIs). Methods:The study was retrospective in nature and was compiled for a period of five years (1st February, 2004-31st January, 2009). Data were generated from the culture of post-operative wound swab specimens by the microbiology laboratory of University of Calabar Teaching Hospital. Relevant information from the patients’ records was compiled, such as age, gender, type of surgical procedure, microorganisms recovered and their antibiotic sensitivity patterns. Obtained data was analysed by using Epi Info 6 statistical software. Results:Of the 4 533 wound swab specimens processed, 673 were culture positive and P. aeruginosa was recovered from 13.1%of the culture positive specimens with its rate of recovery decreasing with age progression (P0.05). Most of the P. aeruginosa isolates were from general surgery wards and least from orthopaedic wards. Ofloxacin, ceftriaxone and augmentin were the most active antibiotics while ampicillin, tetracycline and co-trimoxazole were the least active antibiotics, with no antibiotic having a 100%activity against the organism. Conclusions:In view of the high resistance displayed by P. aeruginosa recovered from SSIs, adequate antiseptic procedures should be entrenched to avoid colonization of surgical wounds by this microorganism as well as others with similar sensitivity profile. Ofloxacin, ceftriaxone and augmentin may be considered for prevention of P.aeruginosa infection.

  20. The appendiceal stump closure during laparoscopy: historical, surgical, and future perspectives.

    Science.gov (United States)

    Gomes, Carlos Augusto; Nunes, Tarcizo Afonso; Soares, Cleber; Gomes, Camila Couto

    2012-02-01

    During a laparoscopic appendectomy, the closure of the appendiceal stump is an important step because of postoperative complications from its inappropriate management. The development of life-threatening events such as stercoral fistulas, postoperative peritonitis, and sepsis is feared and unwanted. The tactical modification of the appendiceal stump closure with a single endoligature, replacing the invaginating suture, adjusted very well to laparoscopic appendectomy, and nowadays is the procedure of choice, whenever possible. Among the alternatives that do not make use of an invaginating suture, studies advocate the use of an endostapler, endoligature (endo-loop), metal clips, bipolar endocoagulation, and polymeric clips. All alternatives have advantages and disadvantages against the different clinical stages of acute appendicitis, and it should be noted that the different forms of appendiceal stump closure have never been assessed in prospective randomized studies. Knowledge about and appropriate use of all of them are important for a safe and more cost-effective procedure.

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

    Science.gov (United States)

    Dhas, Sindhu Priya; Anbarasan, Suruthi; Mukherjee, Amitava; Chandrasekaran, Natarajan

    2015-01-01

    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.

  2. In vitro migration and adhesion of fibroblasts from different phases of palatal wound healing.

    NARCIS (Netherlands)

    Beurden, H.E. van; Snoek, P.A.; Hoff, J.W. Von den; Torensma, R.; Maltha, J.C.; Kuijpers-Jagtman, A.M.

    2006-01-01

    Cleft palate patients often show mid-facial growth impairment after surgical closure of the defect. This is a consequence of palatal wound healing, and more specifically of wound contraction and scar tissue formation. Cells of the fibroblast lineage are responsible for these processes and they displ

  3. In vitro migration and adhesion of fibroblasts from different phases of palatal wound healing.

    NARCIS (Netherlands)

    Beurden, H.E. van; Snoek, P.A.; Hoff, J.W. Von den; Torensma, R.; Maltha, J.C.; Kuijpers-Jagtman, A.M.

    2006-01-01

    Cleft palate patients often show mid-facial growth impairment after surgical closure of the defect. This is a consequence of palatal wound healing, and more specifically of wound contraction and scar tissue formation. Cells of the fibroblast lineage are responsible for these processes and they

  4. Open abdomen with vacuum-assisted wound closure and mesh-mediated fascial traction in patients with complicated diffuse secondary peritonitis: A single-center 8-year experience.

    Science.gov (United States)

    Tolonen, Matti; Mentula, Panu; Sallinen, Ville; Rasilainen, Suvi; Bäcklund, Minna; Leppäniemi, Ari

    2017-06-01

    Open abdomen (OA) treatment in patients with peritonitis is increasing worldwide. Various temporary abdominal closure devices are being used. This study included patients with complicated diffuse secondary peritonitis, OA, and vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM). The aim of this study was to describe mortality and major morbidity in terms of delayed primary fascial closure and enteroatmospheric fistula rates. This was a single-academic-center retrospective study of consecutive patients with diffuse peritonitis, OA, and VAWCM between years 2008 and 2016. Descriptive and univariate analyses were performed. Forty-one patients were identified and analyzed. Median age was 59 years, preoperative septic shock was diagnosed in 54% (n = 22), and 59% (n = 24) had a postoperative peritonitis. Mortality was 29% (n = 12), and 76% (n = 31) of patients were admitted in the intensive care unit. The median duration of OA was 7 days with a median of two dressing changes. Delayed primary fascial closure rate among survivors was 92% (n = 33), and enteroatmospheric fistulas developed in 7% (n = 3). In a subgroup analysis, patients with OA in the primary laparotomy for peritonitis (n = 27) were compared with patients with OA in the subsequent laparotomies (n = 14). There were no significant differences between groups. The VAWCM technique in patients with complicated secondary diffuse peritonitis and OA yields excellent results in terms of delayed primary fascial closure rate and a low number of enteroatmospheric fistulas. It seems to be safe to close the abdomen at the index laparotomy, if possible, even if there is a risk of a need of OA later. Therapeutic/care management study, level IV.

  5. Surgical site wound infection in relation to antibiotic prophylaxis given before skin incision and after cord clamping during cesarean delivery.

    Science.gov (United States)

    Shrestha, B; Marhatha, R; Giri, A; Jaisi, S; Maskey, U

    2014-12-01

    Surgical site infection is one of the most common complications following Lower Segment Cesarean Section, which accounts for prolonged hospital stay thereby increasing expense. Prophylactic antibiotics in cesarean section reduces surgical site infection significantly. The best protection is provided when tissue level of antibiotics are adequate before incision, without prejudice to neonatal infectious morbidity. The objective of this study was to compare the incidence of surgical site wound infection with prophylactic antibiotics given before skin incision and after cord clamping following delivery of baby. This was a prospective, hospital based study, in which hundred cases of cesarean deliveries who received antibiotics prophylaxis one hour before the skin incision were compared with another 100 cases where antibiotic was given after cord clamping following delivery of the baby. Surgical site infection occurred in 3% of women who received antibiotics prophylaxis before skin incision as compared to 6% in whom antibiotic was given after cord clamping. It was statistically not significant (p = 0.465).

  6. Prospective cohort study on surgical wounds comparing a polyhexanide-containing biocellulose dressing with a dialkyl-carbamoyl-chloride-containing hydrophobic dressing

    DEFF Research Database (Denmark)

    Nielsen, Anna Marie; Andriessen, Anneke

    2012-01-01

    Postsurgery dressing changes in diabetic foot amputation wounds and surgical wounds healing by secondary intention are often conducted in the operating room under general anesthesia. A prospective comparative cohort study was performed in 60 patients (n = 60: n = 30/n = 30) with secondary-intenti...

  7. Surgical wound segmentation based on adaptive threshold edge detection and genetic algorithm

    Science.gov (United States)

    Shih, Hsueh-Fu; Ho, Te-Wei; Hsu, Jui-Tse; Chang, Chun-Che; Lai, Feipei; Wu, Jin-Ming

    2017-02-01

    Postsurgical wound care has a great impact on patients' prognosis. It often takes few days, even few weeks, for the wound to stabilize, which incurs a great cost of health care and nursing resources. To assess the wound condition and diagnosis, it is important to segment out the wound region for further analysis. However, the scenario of this strategy often consists of complicated background and noise. In this study, we propose a wound segmentation algorithm based on Canny edge detector and genetic algorithm with an unsupervised evaluation function. The results were evaluated by the 112 clinical images, and 94.3% of images were correctly segmented. The judgment was based on the evaluation of experimented medical doctors. This capability to extract complete wound regions, makes it possible to conduct further image analysis such as intelligent recovery evaluation and automatic infection requirements.

  8. 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.

  9. Topical application of dressing with amino acids improves cutaneous wound healing in aged rats.

    Science.gov (United States)

    Corsetti, Giovanni; D'Antona, Giuseppe; Dioguardi, Francesco Saverio; Rezzani, Rita

    2010-09-01

    The principal goal in treating surgical and non-surgical wounds, in particular for aged skin, is the need for rapid closure of the lesion. Cutaneous wound healing processes involve four phases including an inflammatory response with the induction of pro-inflammatory cytokines. If inflammation develops in response to bacterial infection, it can create a problem for wound closure. Reduced inflammation accelerates wound closure with subsequent increased fibroblast function and collagen synthesis. On the contrary, prolonged chronic inflammation results in very limited wound healing. Using histological and immunohistochemical techniques, we investigated the effects of a new wound dressing called Vulnamin that contains four essential amino acids for collagen and elastin synthesis plus sodium ialuronate (Na-Ial), compared with Na-Ial alone, in closure of experimental cutaneous wounds of aged rats. Our results showed that the application of Vulnamin dressings modulated the inflammatory response with a reduction in the number of inflammatory cells and inducible nitric oxide synthase (iNOS) immunolocalisation, while increasing endothelial nitric oxide synthase (eNOS) and transforming growth factor-beta1 (TGF-beta1) immunolocalisation. Furthermore, the dressing increased the distribution density of fibroblasts and aided the synthesis of thin collagen fibers resulting in a reduction in healing time. The nutritive approach using this new wound dressing can provide an efficacious and safe strategy to accelerate wound healing in elderly subjects, simplifying therapeutic procedures and leading to an improved quality of life. 2009 Elsevier GmbH. All rights reserved.

  10. Virtual reality 3D echocardiography in the assessment of tricuspid valve function after surgical closure of ventricular septal defect

    Directory of Open Access Journals (Sweden)

    Kappetein A Pieter

    2007-02-01

    Full Text Available Abstract Background This study was done to investigate the potential additional role of virtual reality, using three-dimensional (3D echocardiographic holograms, in the postoperative assessment of tricuspid valve function after surgical closure of ventricular septal defect (VSD. Methods 12 data sets from intraoperative epicardial echocardiographic studies in 5 operations (patient age at operation 3 weeks to 4 years and bodyweight at operation 3.8 to 17.2 kg after surgical closure of VSD were included in the study. The data sets were analysed as two-dimensional (2D images on the screen of the ultrasound system as well as holograms in an I-space virtual reality (VR system. The 2D images were assessed for tricuspid valve function. In the I-Space, a 6 degrees-of-freedom controller was used to create the necessary projectory positions and cutting planes in the hologram. The holograms were used for additional assessment of tricuspid valve leaflet mobility. Results All data sets could be used for 2D as well as holographic analysis. In all data sets the area of interest could be identified. The 2D analysis showed no tricuspid valve stenosis or regurgitation. Leaflet mobility was considered normal. In the virtual reality of the I-Space, all data sets allowed to assess the tricuspid leaflet level in a single holographic representation. In 3 holograms the septal leaflet showed restricted mobility that was not appreciated in the 2D echocardiogram. In 4 data sets the posterior leaflet and the tricuspid papillary apparatus were not completely included. Conclusion This report shows that dynamic holographic imaging of intraoperative postoperative echocardiographic data regarding tricuspid valve function after VSD closure is feasible. Holographic analysis allows for additional tricuspid valve leaflet mobility analysis. The large size of the probe, in relation to small size of the patient, may preclude a complete data set. At the moment the requirement of an I

  11. 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

    , 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....... No difference in the infection rate (13% vs. 11%, p=0.73), length of hospital stay, or wound complications was noted between the two groups. We conclude that although the Aquacel dressing needed significantly fewer changes than the conventional dressing, this did not influence the patient comfort. Moreover......, the traditional dressing scheme was significantly less expensive....

  12. Surgical closure of the larynx for intractable aspiration pneumonia: cannula-free care and minimizing the risk of developing trachea-innominate artery fistula.

    Science.gov (United States)

    Ise, Kazuya; Kano, Makoto; Yamashita, Michitoshi; Ishii, Show; Shimizu, Hirofumi; Nakayama, Kei; Gotoh, Mitsukazu

    2015-10-01

    There is a risk of developing a fatal trachea-innominate artery fistula following laryngotracheal separation for the prevention of intractable aspiration pneumonia. We developed a novel technique of surgical closure of the larynx to avoid this complication and provide long-term cannula-free care.

  13. Subtotal cranial vault remodelling in anterior sagittal suture closure: impact of age on surgical outcome

    NARCIS (Netherlands)

    Engel, M.; Hoffmann, J.; Muhling, J.; Castrillon-Oberndorfer, G.; Seeberger, R.; Freudlsperger, C.

    2012-01-01

    Isolated fusion of the sagittal suture is usually treated before 1 year of age, but some patients present at a later age. The aim of this study was to evaluate the impact of children's age on the surgical outcome. The authors investigated 46 patients with isolated nonsyndromic sagittal craniosynosto

  14. Application of vacuum-assisted closure in the treatment of various complex wounds%封闭式负压引流技术在各种复杂创面治疗中的应用

    Institute of Scientific and Technical Information of China (English)

    刘飞; 曲振玲; 郭正东; 张陈威; 林海波; 秦王驰; 罗恺; 杨卫国; 梁智

    2016-01-01

    Objective To summarize the effect of surgical vacuum-assisted closure (VAC) in the treatment of vasious complex wounds, and to discuss the indications and contraindications of the technology. Methods A total of 357 patients with complex wounds, hospitalized from January 2004 to August 2015, were treated with VAC. There were 113 cases of post-traumatic soft tissue defects, 74 cases of diabetic foot ulcer and gangrene, 14 cases of osteomyelitis, 22 cases of postoprative poor wound healing, 37 cases of pressure ulcers, 18 cases of exposed Achilles tendon after opera-tion, 11 cases of sious, 15 cases ofⅢdegree burn with abscess and chronic ulcer formation, 8 cases ofⅢdegree electri-cal injury, 5 cases of donor site wounds, 2 cases of deep tissue necrosis after vascular leakage, 1 case of penetrationg wound, 2 cases of skin graft wounds, 7 cases of lower limb venous ulcers, 5 cases of osteofascial compartment syn-drome, 5 cases of hot crush injury, 2 cases of gouty ulcer, 5 cases of peripheral arterial ulcers, and 1 case of unexplained chronic ulcer. All the patients were given sysetemic supporting treatment in perioperative period and debridement, VAC treatment, with the fresh dressing for wounds changed 3~5 days after operation. Results After VAC treatment, the skin grafts all survived, and the wounds healed up nicely except for donor site wounds and arterial ulcers. The fresh granula-tion tissues were formed rapidly and had covered the deep tissue partially or totally, with the wounds shrinked. The pa-tients suffered self-healing (6 cases), direct debidement (34 cases), autologous skin grafting (167 cases), skin flap trans-plantation (128 cases), artificial dermis combined with autologous skin grafting (19 cases), and conventional dressing change after wound shrinking (3 cases). During the follow-up of 6 months to 3 years, no other case of relapse was found-ed except that 3 cases of diabetic foot showed wound in the same parts. Three patients still had residual

  15. Utility of pulmonary venous flow diastolic deceleration time in an adult patient undergoing surgical closure of atrial septal defect and coronary artery bypass grafting

    Directory of Open Access Journals (Sweden)

    Dharmesh R Agrawal

    2013-01-01

    Full Text Available Acute left ventricular (LV failure has been reported after surgical closure of atrial septal defect (ASD in adult patients. We report acute LV failure in a 56 year old gentleman following coronary artery bypass grafting (CABG and surgical closure of ASD. Transesophageal echocardiography examination of the patient following closure of ASD and CABG showed a residual ASD and a shunt (Qp :Qs = 1.5. The residual ASD was closed after re-institution of cardiopulmonary bypass (CPB under cardioplegic cardiac arrest. However, the patient did not tolerate closure of the residual ASD. The CPB was re-established and under cardioplegic cardiac arrest residual ASD was reopened to create a fenestration. This time patient was weaned easily from CPB. Postoperatively, 16 hours after extubation, patient became hemodynamically unstable, the patient was electively put on ventilator and intra-aortic balloon pump. Later the patient was weaned off successfully from ventilator. Retrospective analysis of pulmonary venous flow diastolic deceleration time (PVDT D recorded during prebypass period measured 102 msec suggestive of high left atrial pressure which indicate possibility of LV failure after ASD closure.

  16. Tacrolimus does not affect early wound healing in a rodent model of bowel anastomoses and abdominal wall closure.

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    Martine C M Willems

    Full Text Available BACKGROUND: Use of immunosuppressant drugs has been associated with complications in wound healing. The calcineurin inhibitor tacrolimus is thought to have a relatively low complication rate, but preclinical research has yielded contradictory data, prompting the current comprehensive study. METHODS: Three groups of 33 male Wistar rats received a daily subcutaneous dose of 0,5, 2 or 5 mg/kg tacrolimus. A control group received saline. On day 0 a resection of 1 cm ileum and 1 cm colon was performed, and end-to-end anastomoses were constructed. Ten rats of each group were killed on day 3 and day 5 and the remaining animals on day 7. Both anastomoses and the wound in the abdominal wall were analyzed. Wound strength was the primary outcome parameter. RESULTS: Mean strength of the abdominal wall increased significantly over time in all groups (p<0.0001. Both the breaking strength and the bursting pressure of the ileum and colon anastomoses followed the same pattern. No differences were observed between control and experimental groups. In addition, no consistent differences were found between groups regarding wound hydroxyproline content and the activities of matrix metalloproteinase-2 and -9. CONCLUSION: Tacrolimus does not affect early wound healing.

  17. Growth factor-enriched autologous plasma improves wound healing after surgical debridement in odontogenic necrotizing fasciitis: a case report

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    Martinez-Fong Daniel

    2011-03-01

    Full Text Available Abstract Background Odontogenic necrotizing fasciitis of the neck is a fulminant infection of odontogenic origin that quickly spreads along the fascial planes and results in necrosis of the affected tissues. It is usually polymicrobial, occurs frequently in immunocompromised patients, and has a high mortality rate. Case presentation A 69-year old Mexican male had a pain in the maxillar right-canine region and a swelling of the submental and submandibular regions. Our examination revealed local pain, tachycardia, hyperthermia (39°C, and the swelling of bilateral submental and submandibular regions, which also were erythematous, hyperthermic, crepitant, and with a positive Godet sign. Mobility and third-degree caries were seen in the right mandibular canine. Bacteriological cultures isolated streptococcus pyogenes and staphylococcus aureus. The histopathological diagnosis was odontogenic necrotizing fasciitis of the submental and submandibular regions. The initial treatment was surgical debridement and the administration of antibiotics. After cultures were negative, the surgical wound was treated with a growth factor-enriched autologous plasma eight times every third day until complete healing occurred. Conclusions The treatment with a growth factor-enriched autologous plasma caused a rapid healing of an extensive surgical wound in a patient with odontogenic necrotizing fasciitis. The benefits were rapid tissue regeneration, an aesthetic and a functional scar, and the avoidance of further surgery and possible complications.

  18. Surgical impact and speech outcome at 2.5 years after one- or two-stage cleft palate closure

    NARCIS (Netherlands)

    Randag, Anna C.; Dreise, Marieke M.; Ruettermann, Mike

    2014-01-01

    Objective: In the ongoing discussion about timing of palate closure, it is said that early closure is favorable for speech development, but can interfere with maxillary growth. On the other hand, beneficial results on both after one-stage palate closure have also been presented. The assumption that

  19. Surgical impact and speech outcome at 2.5 years after one- or two-stage cleft palate closure

    NARCIS (Netherlands)

    Randag, Anna C.; Dreise, Marieke M.; Ruettermann, Mike

    2014-01-01

    Objective: In the ongoing discussion about timing of palate closure, it is said that early closure is favorable for speech development, but can interfere with maxillary growth. On the other hand, beneficial results on both after one-stage palate closure have also been presented. The assumption that

  20. Platelet-rich fibrin versus albumin in surgical wound repair: a randomized trial with paired design

    DEFF Research Database (Denmark)

    Danielsen, Patricia L; Ågren, Sven Per Magnus; Jørgensen, Lars Nannestad

    2010-01-01

    To study the effects of autologous platelet-rich fibrin (PRF) versus human albumin on incisional wound breaking strength and subcutaneous collagen deposition in patients undergoing laparoscopic cholecystectomy in a randomized trial.......To study the effects of autologous platelet-rich fibrin (PRF) versus human albumin on incisional wound breaking strength and subcutaneous collagen deposition in patients undergoing laparoscopic cholecystectomy in a randomized trial....

  1. Platelet-rich fibrin versus albumin in surgical wound repair: a randomized trial with paired design

    DEFF Research Database (Denmark)

    Danielsen, Patricia L; Ågren, Sven Per Magnus; Jørgensen, Lars Nannestad

    2010-01-01

    To study the effects of autologous platelet-rich fibrin (PRF) versus human albumin on incisional wound breaking strength and subcutaneous collagen deposition in patients undergoing laparoscopic cholecystectomy in a randomized trial.......To study the effects of autologous platelet-rich fibrin (PRF) versus human albumin on incisional wound breaking strength and subcutaneous collagen deposition in patients undergoing laparoscopic cholecystectomy in a randomized trial....

  2. Salter-Harris II fractures of the distal tibia: does surgical management reduce the risk of premature physeal closure?

    Science.gov (United States)

    Russo, Franco; Moor, Molly A; Mubarak, Scott J; Pennock, Andrew T

    2013-01-01

    Premature physeal closure (PPC) is a common complication resulting from the management of a displaced Salter-Harris II (SH II) fracture of the distal tibia. The purpose of this study was to evaluate our institution's treatment approach to assess PPC and complication rates of fractures treated both surgically and nonsurgically. We performed a retrospective review of all patients presenting with a displaced SH II fracture between 2004 and 2010. Initial treatment was closed reduction in the emergency department. Further treatment and subsequent categorization was based on amount of residual displacement. Patients with 4 mm of residual displacement were treated with ORIF (group 4). Follow-up radiographs were performed for a minimum of 6 months. If there was clinical concern about PPC, computed tomography imaging was performed to assess for a bony bar. In total, 96 patients with a mean age of 12.6 years at presentation were included in the study. Among the 14 patients with 4 mm of displacement treated with ORIF had a PPC rate of 55% and 23% had a subsequent procedure. No statistical differences in PPC (P=0.19) or subsequent surgeries (P=0.57) were observed between groups. Among those with 2 to 4 mm of postreduction displacement, patient age (P=0.36), sex (P=0.39), mechanism of injury (P=0.13), time to fracture management (P=0.51), amount of initial displacement (P=0.34), number of reduction attempts (P=0.43), and operative treatment (P=0.47) did not significantly influence PPC. Patients with displaced SH II distal tibia fractures pose a challenging problem for the treating physician with a high rate of PPC (43% overall). Although surgical fixation with anatomic reduction and removal of interposed tissue may be necessary to improve joint alignment, it does not reduce the incidence of PPC and may increase the need for subsequent surgeries.

  3. Using portable negative pressure wound therapy devices in the home care setting

    Directory of Open Access Journals (Sweden)

    Burke JR

    2014-12-01

    Full Text Available Joshua R Burke, Rachael Morley, Mustafa Khanbhai Academic Surgery Unit, Education and Research Centre, University Hospital of South Manchester, Manchester, UK Abstract: Negative pressure wound therapy (NPWT is the continuous or intermittent application of subatmospheric pressure to the surface of a wound that improves the wound environment, accelerates healing, and reduces wound closure time. Since its first documented use, this technology has lent itself to a number of adaptations, most notably, the development of portable devices facilitating treatment in the home care setting. With advancing surgical standards, wound healing is an important rate-limiting factor in early patient discharge and often a major cost of inpatient treatment. The efficacy of NPWT in the home care setting has been investigated through rate of wound closure, time in care, and patient experience. Rate of wound closure is the most appropriate primary end point. Much can be gleaned from patient experience, but the future success of portable NPWT will be measured on time in care and therefore cost effectiveness. However, there is a lack of level 1a evidence demonstrating increased efficacy of portable over inpatient NPWT. The development of portable NPWT is an encouraging innovation in wound care technology, and extending the benefits to the home care setting is both possible and potentially more beneficial. Keywords: portable, negative pressure wound therapy, vacuum-assisted closure, topical negative pressure therapy

  4. War Wounded and Victims of Traffic Accidents in a Surgical Hospital in Africa: An Observation on Injuries.

    Science.gov (United States)

    Schneider, Martin

    2015-12-01

    Weapon injuries in armed conflict are likely to receive medical attention. Other types of injuries, like traffic accidents, continue to occur during armed conflict. Injuries caused by weapons and by traffic accidents require treatment, but reports and figures to help in prioritizing care are scarce. In a prospective observational study, all emergency patients admitted to the surgical ward in a public hospital of the Central African Republic were evaluated for the cause of their main injury. The proportion of patients injured by weapons and by traffic accidents was analyzed with respect to the level of violence. Seventy-eight patients were included in this study. Weapon injuries accounted for 50 (64%) admissions and traffic accidents for 28 (36%). These proportions varied significantly according to the weekly level of violence (χ(2)=46.8; Ptraffic accidents are an important, but overlooked, drain on surgical resources in low-income countries with armed conflict. Their proportion in relation to weapon wounded fluctuates with the level of violence. Humanitarian medical organizations might prepare themselves not only for weapon injuries, but also for wounds caused by traffic accidents.

  5. Treatment of postoperative lower extremity wounds using human fibroblast-derived dermis: a retrospective analysis.

    Science.gov (United States)

    Carlson, Russell M; Smith, Nicholas C; Dux, Katherine; Stuck, Rodney M

    2014-04-01

    Human fibroblast-derived dermis skin substitute is a well-studied treatment for diabetic foot ulcers; however, no case series currently exist for its use in healing postoperative wounds of the lower extremity. A retrospective analysis was conducted on 32 lower extremity postoperative wounds treated weekly with human fibroblast-derived dermis skin substitute. Postoperative wounds were defined as a wound resulting from an open partial foot amputation, surgical wound dehiscence, or nonhealing surgical wound of the lower extremity. Wound surface area was calculated at 4 and 12 weeks or until wound closure if prior to 12 weeks. Postoperative wounds treated with weekly applications showed mean improvement in surface area reduction of 63.6% at 4 weeks and 96.1% at 12 weeks. More than 56% of all wounds healed prior to the 12-week endpoint. Additionally, only one adverse event was noted in this group. This retrospective review supports the use of human fibroblast-derived dermis skin substitute in the treatment of postoperative lower extremity wounds. This advanced wound care therapy aids in decreased total healing time and increased rate of healing for not only diabetic foot wounds but also postoperative wounds of the lower extremity, as demonstrated by this retrospective review.

  6. Wound complications and surgical events in de novo heart transplant patients treated with everolimus

    DEFF Research Database (Denmark)

    Rashidi, Mitra; Esmaily, Sorosh; Fiane, Arnt E

    2016-01-01

    OBJECTIVES: The use of mammalian target of rapamycin (mTOR) inhibitors have been limited by adverse events (AE), including delayed wound healing. We retrospectively reviewed all AE and serious AE (SAE) in The Scandinavian heart transplant (HTx) everolimus (EVE) de novo trial with early calcineurin...

  7. Advantage of vacuum assisted closure on healing of wound associated with omentoplasty after abdominoperineal excision: a case report

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    Consentino Bernard

    2008-12-01

    Full Text Available Abstract Background Primary closure of the perineum with drainage after abdominoperineal excision of the rectum for carcinoma, is widely accepted. However hematoma, perineal abscess and re-operation are significantly more frequent after primary closure than after packing of the perineal cavity. Those complications are frequently related to the patients' clinical antecedent (i.e radiotherapy, diabetes, smoking. Case presentation In the present report, vacuum assisted drainage was used after abdominoperineal excision for carcinoma in the very first step due to intraoperative gross septic contamination during tumor resection. The first case: A 57-years old man with a 30-years history of peri-anal Crohn's disease, the adenocarcinoma of the lowest part of the rectum and Crohn colitis with multiple area of severe dysplasia required panproctocolectomy with a perineal resection. The VAC system was used during 12 days (changed every 3 days. We observed complete healing 18 days after surgery. The second case: A 51-year-old man, with AIDS. An abdominoperineal resection was performed for recurrence epidermoid anal cancer. The patient was discharged at day 25 and complete healing was achieved 30 days later after surgery. Conclusion The satisfactory results showed in the present report appear to be favored by association of omentoplasty and VAC system. Those findings led us to favor VAC system in the case of pelvic exenteration associated with high risk of infection.

  8. Composites containing albumin protein or cyanoacrylate adhesives and biodegradable scaffolds: II. In vivo wound closure study in a rat model

    Science.gov (United States)

    McNally-Heintzelman, Karen M.; Heintzelman, Douglas L.; Duffy, Mark T.; Bloom, Jeffrey N.; Soller, Eric C.; Gilmour, Travis M.; Hoffman, Grant T.; Edward, Deepak

    2004-07-01

    Our Scaffold-Enhanced Biological Adhesive (SEBA) system was investigated as an alternative to sutures or adhesives alone for repair of wounds. Two scaffold materials were investigated: (i) a synthetic biodegradable material fabricated from poly(L-lactic-co-glycolic acid); and (ii) a biologic material, small intestinal submucosa, manufactured by Cook BioTech. Two adhesive materials were also investigated: (i) a biologic adhesive composed of 50%(w/v) bovine serum albumin solder and 0.5mg/ml indocyanine green dye mixed in deionized water, and activated with an 808-nm diode laser; and (ii) Ethicon"s Dermabond, a 2-octyl-cyanoacrylate. The tensile strength and time-to-failure of skin incisions repaired in vivo in a rat model were measured at seven days postoperative. Incisions closed by protein solder alone, by Dermabond alone, or by suture, were also tested for comparison. The tensile strength of repairs formed using the SEBA system were 50% to 65% stronger than repairs formed by suture or either adhesive alone, with significantly less variations within each experimental group (average standard deviations of 15% for SEBA versus 38% for suture and 28% for adhesive alone). In addition, the time-to-failure curves showed a longevity not previously seen with the suture or adhesive alone techniques. The SEBA system acts to keep the dermis in tight apposition during the critical early phase of wound healing when tissue gaps are bridged by scar and granulation tissue. It has the property of being more flexible than either of the adhesives alone and may allow the apposed edges to move in conjunction with each other as a unit for a longer period of time and over a greater range of stresses than adhesives alone. This permits more rapid healing and establishment of integrity since the microgaps between the dermis edges are significantly reduced. By the time the scaffolds are sloughed from the wound site, there is greater strength and healing than that produced by adhesive alone or

  9. 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.

  10. Management of Open Lower Extremity Wounds With Concomitant Fracture Using a Porcine Urinary Bladder Matrix.

    Science.gov (United States)

    Kraemer, Bruce A; Geiger, Scott E; Deigni, Oliver A; Watson, John Tracy

    2016-11-01

    Open wounds of the distal third of the leg and foot with exposed bone, fractures, and hardware are challenging wounds for which to achieve stable coverage. The orthopedic advances in lower extremity fracture management over the last 30 years have allowed a rethinking of the standard operative approach to close these complex wounds. The ability of extracellular matrix (ECM) products to facilitate constructive remodeling of a wound seemed a reasonable approach for treatment, especially in patients who are often poor surgical candidates for more advanced reconstructive procedures. The authors reviewed 9 patients with 11 open fractures of the leg, ankle, or foot treated with a newer ECM wound healing device to total closure. The clinical course and patient management are reviewed. The authors conclude that newer ECM products can provide a reasonable method of management for patients who have wounds with exposed hardware, distal leg wounds, and open foot fractures compared to prolonged negative pressure wound therapy or complex reconstructive operative procedures.

  11. The combined use of NPWT and instillation using an octenidine based wound rinsing solution: a case study.

    Science.gov (United States)

    Matiasek, J; Djedovic, G; Mattesich, M; Morandi, E; Pauzenberger, R; Pikula, R; Verstappen, R; Pierer, G; Koller, R; Rieger, U M

    2014-11-01

    Effective wound bed preparation is an essential element in the healing of chronic wounds, including pressure ulcers (PUs). Negative pressure wound therapy (NPWT) reduces oedema, stimulates the formation of granulation tissue and helps remove wound exudate. This helps prepare the wound bed for secondary healing, skin grafting or coverage with flaps. Combining NPWT with an instillation phase using an antiseptic (octenidine based) irrigation solution is a novel approach to PU management. Three patients with Category 4 gluteal PUs were treated with NPWT and instillation fluid, following surgical debridement of necrotic tissue. The aim was to achieve optimal wound bed preparation prior to wound closure by local fasciocutaneous flap. The antiseptic efficacy of octenilin wound irrigation solution in microorganism eradication was quantified by in vitro tests simulating real conditions using leg ulcer vacuum exudates. All wounds completely healed after four weeks, and no adverse incidents occurred due to instillation of octenidine. No recurrence of the PU occurred during a one year follow-up.

  12. Management of contaminated and dirty surgical wounds with different local treatment modalities Manejo de heridas quirúrgicas contaminadas y sucias con cuatro modalidades de tratamiento local

    Directory of Open Access Journals (Sweden)

    Luis E. Rolong

    1990-01-01

    Full Text Available

    Between March and November 1986 we studled 216 men with potentially infected surgical wounds (either contaminated or diny. For the purpose of local treatment they were allocated to one of 4 groups, namely: 1 pressure irrigation with saline solution; 2 lodo-povidone solution; 3 application of panela (unrefined brown sugar; 4 no local treatment. infection indexes were 18% and 25% in patients with contaminated and diny wounds respectively; no differences attributable to the local treatment procedure were found. infection index was significantly lower In the following circumstances: a In patients that received antibiotics both before and after the operation; b In those with culture results that were either negative or lower than 105 bacteria per gram of tissue.

     

    Frequency of positive wound cultures was significantly lower in patients with saline pressure irrigation as compared to those treated with panela or left without treatment. However, the frequency of clinical evidences of infection was similar In the 4 groups. In patients with negative cultures late primary closure was achieved in 95% of the cases; the corresponding figure for those with positive results (but under 105 bacteria per gram was 56%. We conclude that pressure Irr1gatlon of the wound with saline solution is advantageous in relation to the other methods employed in this study.

    En el período comprendido entre marzo y noviembre de 1986 se estudiaron en el Servicio de Cirugía General del Hospital Universitario San Vicente de Paúl (HUSVP de Medellín, 216 pacientes de sexo masculino, con heridas quirúrgicas potencialmente Infectadas, clasificadas como sucias o contaminadas

  13. Rash with DERMABOND PRINEO Skin Closure System Use in Bilateral Reduction Mammoplasty: A Case Series

    Directory of Open Access Journals (Sweden)

    R. W. Knackstedt

    2015-01-01

    Full Text Available Background. Bilateral reduction mammoplasty is a common plastic surgery procedure that can be complicated by unfavorable scar formation along incision sites. Surgical adhesives can be utilized as an alternative or as an adjunct to conventional suture closures to help achieve good wound tension and provide an adequate barrier with excellent cosmesis. The recently introduced DERMABOND PRINEO Skin Closure System Skin Closure System combines the skin adhesive 2-octyl cyanoacrylate with a self-adhering polyester-based mesh. Proposed benefits of wound closure with DERMABOND PRINEO Skin Closure System, used with or without sutures, include its watertight seal, easy removal, microbial barrier, even distribution of tension, and reduction in wound closure time. Although allergic reactions to 2-octyl cyanoacrylate have been reported, few allergic reactions to DERMABOND PRINEO Skin Closure System have been noted in the literature. This case series describes three patients who experienced an allergic reaction to DERMABOND PRINEO Skin Closure System after undergoing elective bilateral reduction mammoplasties at our institution to further explore this topic. Methods. Retrospective chart review of bilateral reduction mammoplasty patients who received DERMABOND PRINEO Skin Closure System dressing at our institution was performed. Results. Three patients were identified as having a rash in reaction to DERMABOND PRINEO Skin Closure System after bilateral reduction mammoplasty. All three patients required systemic steroid treatment to resolve the rash. One patient was identified as having a prior adhesive reaction. Conclusions. DERMABOND PRINEO Skin Closure System has demonstrated its efficacy in optimizing scar healing and appearance. However, as we demonstrate these three allergic reactions to DERMABOND PRINEO Skin Closure System, caution must be utilized in its usage, namely, in patients with a prior adhesive allergy and in sites where moisture or friction may

  14. Manejo quirúrgico urgente de heridas faciales por mordedura humana Urgent surgical management of facial human bite wounds

    Directory of Open Access Journals (Sweden)

    A. Fernández García

    2011-09-01

    Full Text Available Las heridas por mordedura pueden generar algunas dificultades quirúrgicas en su manejo inicial debido a su especial predisposición a las complicaciones sépticas y la importante destrucción tisular frecuentemente asociada. Sin embargo, es importante su reparación inmediata, especialmente en el caso de amputaciones y colgajos por avulsión. Las mordeduras humanas se hallan envueltas además en consideraciones psicológicas que incrementan la dificultad del tratamiento debido a las espectativas estéticas de los pacientes que las sufren. Este trabajo analiza 7 casos de mordedura facial humana desde los puntos de vista epidemiológico y clínico. Presentamos y discutimos el uso de los tejidos amputados como fuente de injertos de piel, injertos condrales y el papel de los colgajos locales en dos tiempos en la cirugía de urgencia de estas lesiones.Bite wounds can create several surgical difficulties in their initial management due to the special facility for infectious complications and the frequent association with extensive tissue damage. However, the immediate repair its desirable, mainly in amputations and flap avulsions. The human bite wounds are also involved by psychological considerations that increase the difficulty of the treatment due to patient´s aesthetic expectations. This article analyzes 7 cases of facial human bites under the epidemiological and clinical points of view. The use of the amputated tissues to obtain skin grafts, condral grafts, and the role of local two stage flaps in the emergency surgery of these wounds are exposed and discussed.

  15. Raman spectroscopy and the spectral correlation index for predicting wound healing outcome: towards in vivo application

    Science.gov (United States)

    Berger, Adam G.; Crane, Nicole J.; Elster, Eric A.

    2016-03-01

    Combat wounds are sometimes confounded by healing complications that are not as prevalent in civilian wounds due to their high energy etiology. One complication of wound healing is dehiscence, where a surgically closed wound reopens after closure. This complication can have serious consequences for the patient, but knowledge about the molecular composition of the wound bed beyond what is readily visible may help clinicians mitigate these complications. It is necessary to develop techniques that can be used in vivo to assess and predict wound healing pointof- care so that care-takers can decide the best way to make informed clinical decisions regarding their patient's healing. Raman spectroscopy is a perfect candidate for predicting wound healing due to its ability to provide a detailed molecular fingerprint of the wound bed noninvasively. Here, we study the spectral correlation index, a measure of orthogonality, with ten reference tissue components to stratify wounds based on how they heal. We analyze these indexes over time to show the modulation of these tissue components over the wound healing process. Results show that qualitative observation of the spectra cannot reveal major differences between the dehisced and normal healing wounds, but the spectral correlation index can. Analysis of the spectral correlations across the wound healing process demonstrates the changes throughout the wound healing process, showing that early differences in tissue components may portend wound healing. Furthermore, Raman spectroscopy coupled with the spectral correlation index presents as a possible point-of-care tool for enabling discrimination of wounds with impaired healing.

  16. Assessment of MRI issues at 3-Tesla for metallic surgical implants: findings applied to 61 additional skin closure staples and vessel ligation clips

    Science.gov (United States)

    2012-01-01

    Purpose Metallic skin closure staples and vessel ligation clips should be tested at 3-Tesla to characterize MRI issues in order to ensure patient safety. Therefore, metallic surgical implants were assessed at 3-Tesla for magnetic field interactions, MRI-related heating, and artifacts. Methods A skin closure staple (Visistat Skin Stapler, staple, Polytetrafluoroethylene, PTFE, coated 316L/316LVM stainless steel; Teleflex Medical, Durham, NC) and a vessel ligation clip (Hemoclip Traditional, stainless steel; Teleflex Medical, Durham, NC) that represented the largest metallic sizes made from materials with the highest magnetic susceptibilities (i.e., based on material information) among 61 other surgical implants (52 metallic implants, 9 nonmetallic implants) underwent evaluation for magnetic field interactions, MRI-related heating, and artifacts using standardized techniques. MRI-related heating was assessed by placing each implant in a gelled-saline-filled phantom with MRI performed using a transmit/receive RF body coil at an MR system reported, whole body averaged SAR of 2.9-W/kg for 15-min. Artifacts were characterized using T1-weighted, SE and GRE pulse sequences. Results Each surgical implant showed minor magnetic field interactions (20- and 27-degrees, which is acceptable from a safety consideration). Heating was not substantial (highest temperature change, ≤ 1.6°C). Artifacts may create issues if the area of interest is in the same area or close to the respective surgical implant. Conclusions The results demonstrated that it would be acceptable for patients with these metallic surgical implants to undergo MRI at 3-Tesla or less. Because of the materials and dimensions of the surgical implants that underwent testing, these findings pertain to 61 additional similar implants. PMID:22230200

  17. Feasibility and safety of surgical wound remote follow-up by smart phone in appendectomy: A pilot study.

    Science.gov (United States)

    Segura-Sampedro, Juan José; Rivero-Belenchón, Inés; Pino-Díaz, Verónica; Rodríguez Sánchez, María Cristina; Pareja-Ciuró, Felipe; Padillo-Ruiz, Javier; Jimenez-Rodriguez, Rosa María

    2017-09-01

    The objective of the present study is to assess the safety and feasibility of the use of telemedicine-based services for surgical wound care and to measure patient satisfaction with telemedicine-based follow-up. 24 patients were included, they were provided with a corporate mail address. On day 7 after surgery patients sent, via email, an image of their surgical wound together with a completed questionnaire in order to obtain an early diagnosis. Two independent physicians studied this information and the histologic analysis of the specimen. On day 8, all patients underwent face-to-face office examination by a third physician and all of them completed a satisfaction questionnaire at the end of the study. The use of telemedicine-based services showed a sensitivity of 100%, a specificity of 91.6%, a positive predictive value of 75% and a negative predictive value of 100%. Degree of concordance between the two physicians, as regards the necessity of face-to-face follow-up yielded a kappa coefficient of 0.42 (standard error 0.25 and confidence interval 95% (0.92-0.08), which means a moderate agreement between the two evaluations. 94% of patients were satisfied with telemedicine-based follow-up and 93% showed their preference for this procedure over conventional methods. The telemedicine-based follow-up, has proven to be feasible and safe for the evaluation of early postoperative complications. Patients reported high levels of satisfaction with the procedure. Telemedicine-based follow-up could become standard practice with the development of a specific mobile application.

  18. Vacuum-assisted closure therapy in reconstructive surgery.

    Science.gov (United States)

    Benech, A; Arcuri, F; Poglio, G; Brucoli, M; Guglielmetti, R; Crespi, M C; Pia, F

    2012-06-01

    In 1997, supported by experimental work, Argenta published a clinical report describing a variety of complicated wounds whose treatment responded successfully to negative pressure dressings using a vacuum-assisted closure system (VAC) (Kinetic Concepts Inc., San Antonio, TX). This system has been successfully used in the fields of orthopaedics and traumatology, general surgery, plastic and reconstructive surgery and gynaecology/obstetrics for a large variety of complicated wounds located in several regions, particularly in the torso and extremities. To the best of our knowledge, the use of the VAC therapy in treating free flaps surgical wounds has not been discussed in the literature. Since 2009 at the Novara Major Hospital, we have been using the VAC therapy in selected cases for difficult and complicated wounds of the maxillofacial region. The purpose of this study is to describe and discuss three cases undergoing VAC therapy followed by loco-regional flaps in the management of exposed bone after fibular free flap. The advantages and disadvantages of VAC therapy in treating complicated wounds have been reported by several studies; compared with conventional wet-to-dry dressings, this system eliminates interstitial oedema, exudates and debrides while increasing blood perfusion leading to a more rapid promotion of wound healing with less bacterial loading. Although surgical debridement, wet-to-dry dressing changes and antibiotic treatment are the mainstay in managing maxillofacial wounds, VAC therapy can be used to obtain primary closure or to prepare the wound bed until definitive reconstruction is carried out. In our opinion, the VAC technique is an innovative therapy, and at our institution represents the standard of care for the majority of complicated wounds.

  19. Elastic suture (shoelace technique) for fasciotomy closure after treatment of compartmental syndrome associated to tibial fracture.

    Science.gov (United States)

    Branco, Paulo Sergio Martins Castelo; Cardoso Junior, Mauricio; Rotbande, Isaac; Ciraudo, José Antonio Fraga; Silva, Celso Ricardo Correa de Melo; Leal, Paulo Cesar Dos Santos

    2017-01-01

    This article reports the use of elastic suture as an adjuvant in surgical wound closure caused by decompressive fasciotomy after compartment syndrome associated with a compound fracture of the tibia. Widely used in other medico-surgical specialties, this technique is unusual in orthopedics surgery, but the simplicity of the procedure and the successful outcome observed in this case allows for its consideration as indicated for situations similar to that presented in this study.

  20. Surgical wound debridement sequentially characterized in a porcine burn model with multispectral imaging.

    Science.gov (United States)

    King, Darlene R; Li, Weizhi; Squiers, John J; Mohan, Rachit; Sellke, Eric; Mo, Weirong; Zhang, Xu; Fan, Wensheng; DiMaio, J Michael; Thatcher, Jeffrey E

    2015-11-01

    Multispectral imaging (MSI) is an optical technique that measures specific wavelengths of light reflected from wound site tissue to determine the severity of burn wounds. A rapid MSI device to measure burn depth and guide debridement will improve clinical decision making and diagnoses. We used a porcine burn model to study partial thickness burns of varying severity. We made eight 4 × 4 cm burns on the dorsum of one minipig. Four burns were studied intact, and four burns underwent serial tangential excision. We imaged the burn sites with 400-1000 nm wavelengths. Histology confirmed that we achieved various partial thickness burns. Analysis of spectral images show that MSI detects significant variations in the spectral profiles of healthy tissue, superficial partial thickness burns, and deep partial thickness burns. The absorbance spectra of 515, 542, 629, and 669 nm were the most accurate in distinguishing superficial from deep partial thickness burns, while the absorbance spectra of 972 nm was the most accurate in guiding the debridement process. The ability to distinguish between partial thickness burns of varying severity to assess whether a patient requires surgery could be improved with an MSI device in a clinical setting. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

  1. Efectividad del adhesivo tisular Tisuacryl en el cierre de heridas cutáneas Effectiveness of the Tisuacryl tissue adhesive in the closure of skin wounds

    Directory of Open Access Journals (Sweden)

    Rosa Mayelín Guerra Bretaña

    2005-04-01

    Full Text Available Se realizó un ensayo clínico para evaluar la efectividad y seguridad del adhesivo tisular Tisuacryl en el sellado de heridas cutáneas menores de 6 cm, tanto de origen traumático como quirúrgico. Participaron 77 especialistas de 9 instituciones de salud de las provincias habaneras y una población de 674 pacientes. Estos recibieron una aplicación única de Tisuacryl de forma tópica sobre los bordes de la herida, previamente afrontados. Este producto tiene una efectividad, referida a la no aparición de dehiscencias de un 94,6 %, siendo del 95,6 % en el caso de las heridas traumáticas tomadas separadamente. La insuficiente experiencia de los investigadores y la inadecuada conservación del producto son los factores que inciden en la aparición de dehiscencias. Por sus ventajas, tanto sociales como económicas, el Tisuacryl es la mejor opción para el tratamiento de heridas pequeñas y poco profundas, fundamentalmente en las urgencias pediátricas.A clinical trial was conducted to evaluate the effectiveness and safety of the Tisuacryl tissue adhesive in the sealing of skin wounds under 6 cm of traumatic and surgical origin. 77 specialists from 9 health institutions in Havana and Havana City provinces and a population of 674 patients participated in this assay. They were topically applied Tisuacryl only once in the borders of the wound previously faced. This product has an effectivity of 94.6 % as regards the absence of dehiscences. In the case of the traumatic wounds an effectivity of 95.5 % was reported. The insufficient experience of the researchers and the inadequate conservation of the product are the factors that influence on the appearance of dehiscences. Taking into account its social and economic advantages, Tisuacryl is the best option for the treatment of small and little deep wounds, mainly in pediatric emergencies.

  2. 水胶体拉合免缝法在老年患者腹部二期愈合切口中的应用%Hydrocolloid: application to phase Ⅱ abdominal wound closure without suture for elderly patients

    Institute of Scientific and Technical Information of China (English)

    杨静; 黄金

    2011-01-01

    目的探讨水胶体拉合免缝法在老年患者二期愈合切口中的应用效果.方法 将40例老年腹部手术后二期愈合切口患者随机分为观察组与对照组各20例,于二期愈合切口换药处理至红色期创面后,分别采用水胶体拉合免缝法和传统缝合处理,比较两组切口愈合时间、疼痛程度、换药费用.结果 两组愈合时间比较,差异无统计学意义(P>0.05),但观察组在切口处理过程中的疼痛程度及医疗费用显著低于对照组(均P<0.01).结论 水胶体拉合免缝法应用于老年患者腹部二期愈合切口效果优于传统缝合法,能减轻患者的疼痛,降低医疗费用,且切口更美观.%Objective To reveal effect of hydrocolloid on phase Ⅱ abdominal wound closure without suture for elderly patients.Methods Forty elderly patients with phase Ⅱ abdominal wound were randomly divided into two groups, with 20 cases in each group. When the wound surface became red after dressing change, they were treated either by hydrocolloid for closure without suture (the observation group) or traditional suture (the control group). Wound healing time, degree of pain, and expense of dressing change were compared between the two groups. Results There was no significant difference in wound healing time between the two groups (P>0.05) ; degree of pain during wound dressing and medical expense in the observation group were significantly lower than those in the control group (P<0.01 for both). Conclusion Hydrocolloid used in phase Ⅱ abdominal wound closure without suture for elderly patients is superior to traditional suture, which could relieve pain, decrease medical expense, and make the wound artistic.

  3. Risk factors for surgical site infection and delayed wound healing after orthopedic surgery in rheumatoid arthritis patients.

    Science.gov (United States)

    Kadota, Yasutaka; Nishida, Keiichiro; Hashizume, Kenzo; Nasu, Yoshihisa; Nakahara, Ryuichi; Kanazawa, Tomoko; Ozawa, Masatsugu; Harada, Ryozo; Machida, Takahiro; Ozaki, Toshifumi

    2016-01-01

    To investigate the prevalence and the risk factors of surgical-site infection (SSI) and delayed wound healing (DWH) in patients with rheumatoid arthritis (RA) underwent orthopedic surgery. We reviewed the records of 1036 elective orthopedic procedures undertaken in RA patients. Risk factors for SSI and DWH were assessed by logistic regression analysis using age, body mass index, disease duration, pre-operative laboratory data, surgical procedure, corticosteroid use, co-morbidity, and use of conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) and biological DMARDs (bDMARDs) as variables. SSI and DWH were identified in 19 cases and 15 cases, respectively. One case of SSI and three cases of DWH were recorded among 196 procedures in patients using bDMARDs. Foot and ankle surgery was associated with an increased risk of SSI (odds ratio (OR), 3.167; 95% confidence interval (CI), 1.256-7.986; p = 0.015). Total knee arthroplasty (TKA; OR, 4.044; 95% CI, 1.436-11.389; p = 0.008) and disease duration (OR, 1.004; 95% CI, 1.000-1.007; p = 0.029) were associated with an increased risk of DWH. Our results indicated foot and ankle surgery, and TKA and disease duration as risk factors for SSI and DWH, respectively. bDMARDs was not associated with an increased risk of SSI and DWH.

  4. False aneurysm of the left ventricle due to a penetrating chest wound.

    Science.gov (United States)

    Badui, E; Madrid, R; Ayala, F; Enciso, R; Verdin, R

    1991-11-01

    A 24-year-old white man had a knife chest wound, and four months after this event, manifested progressive dyspnea. A false aneurysm of the left ventricle was diagnosed by 2D echocardiogram. Surgical resection of the aneurysmal sac with closure of the orifice of the lateral wall of the left ventricle was performed successfully.

  5. A rare cause of wound infection after an open fracture: Shewanella putrefaciens.

    Science.gov (United States)

    Prinja, Aditya; Singh, Jagwant; Davis, Nwaka; Urwin, Gillian

    2013-02-15

    An elderly gentleman presented with an open fracture of the calcaneum and ankle, following a boating accident. Despite treatment with repeated surgical debridement, delayed closure, prolonged antibiotics and strict adherence to national guidelines on the management of open fractures, he developed a wound infection with a rare organism, Shewanella putrefaciens, that appears to be increasing in prevalence.

  6. 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

    2017-02-09

    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.

  7. Primary closure for postoperative mediastinitis in children.

    Science.gov (United States)

    Ohye, Richard G; Maniker, Robert B; Graves, Holly L; Devaney, Eric J; Bove, Edward L

    2004-09-01

    Mediastinitis affects approximately 1% of children undergoing median sternotomy. Conventional therapy involves debridement followed by open wound care with delayed closure, days to weeks of closed suction or antimicrobial irrigation, and vacuum-assisted closure or muscle flap closure. We hypothesized that primary closure without prolonged suction or irrigation is an effective, less traumatic treatment for mediastinitis in children. From January 1986 to July 2002, 6705 procedures involving median sternotomy were performed at the C. S. Mott Children's Hospital, resulting in 57 cases of mediastinitis (0.85%). Cases were divided into 2 groups, with 42 cases treated with primary closure and 15 cases treated with delayed or muscle flap closure. The 42 cases of primary closure comprised the primary study group of this institutional review board-approved, retrospective analysis. Patient demographics, surgical variables, mediastinitis-related parameters, and outcomes were evaluated. One patient had recurrent mediastinitis for an overall infection eradication rate of 97% (40/41). Three patients (7%) required re-exploration for suspected ongoing infection. Of these re-explorations, 1 patient had evidence of continued mediastinitis. The remaining 2 patients with sepsis of unclear cause had no clinical or culture evidence of recurrent infection. One of these patients ultimately died of sepsis without active mediastinitis for a hospital survival of 97% (41/42). No significant differences could be detected between the treatment successes and failures in this small cohort of patients. Simple primary closure is an effective means to treat selected cases of postoperative mediastinitis in children. The results compare favorably with other more lengthy or debilitating treatments.

  8. Performance Assessment of Bi-Directional Knotless Tissue-Closure Devices in Juvenile Chinook Salmon Surgically Implanted with Acoustic Transmitters, 2009 - Final Report

    Energy Technology Data Exchange (ETDEWEB)

    Woodley, Christa M.; Wagner, Katie A.; Bryson, Amanda J.

    2012-11-09

    The purpose of this report is to assess the performance of bi-directional knotless tissue-closure devices for use in tagging juvenile salmon. This study is part of an ongoing effort at Pacific Northwest National Laboratory (PNNL) to reduce unwanted effects of tags and tagging procedures on the survival and behavior of juvenile salmonids, by assessing and refining suturing techniques, suture materials, and tag burdens. The objective of this study was to compare the performance of the knotless (barbed) suture, using three different suture patterns (treatments: 6-point, Wide “N”, Wide “N” Knot), to the current method of suturing (MonocrylTM monofilament, discontinuous sutures with a 2×2×2×2 knot) used in monitoring and research programs with a novel antiseptic barrier on the wound (“Second Skin”).

  9. p70S6 kinase mediates breast cancer cell survival in response to surgical wound fluid stimulation.

    Science.gov (United States)

    Segatto, Ilenia; Berton, Stefania; Sonego, Maura; Massarut, Samuele; Fabris, Linda; Armenia, Joshua; Mileto, Mario; Colombatti, Alfonso; Vecchione, Andrea; Baldassarre, Gustavo; Belletti, Barbara

    2014-05-01

    In early breast cancer, local relapses represent a determinant and not simply an indicator of risk for distant relapse and death. Notably, 90% of local recurrences occur at or close to the same quadrant of the primary cancer. Relevance of PI3K/mTOR/p70S6K signaling in breast tumorigenesis is very well documented. However, the pathway/s involved in the process of breast cancer local relapse are not well understood. The ribosomal protein p70S6K has been implicated in breast cancer cell response to post-surgical inflammation, supporting the hypothesis that it may be crucial also for breast cancer recurrence. Here, we show that p70S6K activity is required for the survival of breast cancer cells challenged in "hostile" microenvironments. We found that impairment of p70S6K activity in breast cancer cells strongly decreased their tumor take rate in nude mice. In line with this observation, if cells were challenged to grow in anchorage independence or in clonogenic assay, growth of colonies was strongly dependent on an intact p70S6K signaling. This in vitro finding was particularly evident when breast cancer cells were grown in the presence of wound fluids harvested following surgery from breast cancer patients, suggesting that the stimuli present in the post-surgical setting at least partially relied on activity of p70S6K to stimulate breast cancer relapse. From a mechanistic point of view, our results indicated that p70S6K signaling was able to activate Gli1 and up-regulate the anti-apoptotic protein Bcl2, thereby activating a survival response in breast cancer cells challenged in hostile settings. Our work highlights a previously poorly recognized function of p70S6K in preserving breast cancer cell survival, which could eventually be responsible for local relapse and opens the way to the design of new and more specific therapies aiming to restrain the deleterious effects of wound response.

  10. Maltodextrin/ascorbic acid stimulates wound closure by increasing collagen turnover and TGF-β1 expression in vitro and changing the stage of inflammation from chronic to acute in vivo.

    Science.gov (United States)

    Salgado, Rosa M; Cruz-Castañeda, Otilia; Elizondo-Vázquez, Francisco; Pat, Lucia; De la Garza, Anabel; Cano-Colín, Saúl; Baena-Ocampo, Leticia; Krötzsch, Edgar

    2017-02-01

    It has been reported that carbohydrates confer physicochemical properties to the wound environment that improves tissue repair. We evaluated in vitro and in vivo wound healing during maltodextrin/ascorbic acid treatment. In a fibroblast monolayer scratch assay, we demonstrated that maltodextrin/ascorbic acid stimulated monolayer repair by increasing collagen turnover coordinately with TGF-β1 expression (rising TGF-β1 and MMP-1 expression, as well as gelatinase activity, while TIMP-1 was diminished), similar to in vivo trends. On the other hand, we observed that venous leg ulcers treated with maltodextrin/ascorbic acid diminished microorganism population and improved wound repair during a 12 week period. When maltodextrin/ascorbic acid treatment was compared with zinc oxide, almost four fold wound closure was evidenced. Tissue architecture and granulation were improved after the carbohydrate treatment also, since patients that received maltodextrin/ascorbic acid showed lower type I collagen fiber levels and increased extracellular alkaline phosphatase activity and blood vessels than those treated with zinc oxide. We hypothesize that maltodextrin/ascorbic acid treatment stimulated tissue repair of chronic wounds by changing the stage of inflammation and modifying collagen turnover directly through fibroblast response.

  11. Antimicrobial susceptibility pattern of bacterial isolates from surgical wound infections in Tertiary Care Hospital in Allahabad, India

    Directory of Open Access Journals (Sweden)

    A K Kapoor

    2012-01-01

    Full Text Available The aim of present study to analyze the occurrence and in-vitro antimicrobial susceptibility of bacterial pathogens isolated from surgical wound infections. Specimens from a total of 129 patients undergoing either emergency or elective surgery were collected from infected sites or stitch lines and inoculated onto appropriate media. The bacterial cultures were identified utilizing standard microbiological and biochemical methods. Isolates were tested for susceptibility to antimicrobials using the Kirby Bauer disk diffusion method. Statistical analysis was performed using the chi-square test. Of 129 patients investigated (62 emergency and 67 elective surgery cases, bacterial isolates were isolated with almost equal frequency both from emergency and elective surgery cases. Of 108 (83.72% culture positive samples, 62 (57.41% were Gram negative, 39 (36.11% Gram positive, and 7 (6.48% showed multiple organisms. Of total 115 bacteria isolated (101 single and 7 double organisms culture positive, 33 (28.69% were Escherichia coli and were also the commonest; followed by Staphylococcus aureus, 30 (26.09% cases. S. aureus and Streptococcus spp. showed maximum susceptibility (100% to linezolid and vancomycin. Maximum susceptibility of E. coli was observed to ciprofloxacin (75.7%, followed by gentamicin (54.5%; of Klebsiella spp. to ceftriaxone and gentamicin (66.6% each, of Proteus spp. to gentamicin (70% followed by ciprofloxacin (60%, and of Pseudomonas aeruginosa to piperacillin (100% and tobramycin (71.4%. E. coli and S. aureus were the most common and Salmonella spp. and Acinetobacter spp. were the least common organism causing surgical site infections. The definitive therapy included ciprofloxacin and gentamicin for E. coli; linezolid and vancomycin for S. aureus and Streptococcus spp; ceftriaxone and ciprofloxacin for Klebsiella spp., Citrobacter spp., acinetobacter spp and Salmonella spp.

  12. Late infectious endocarditis of surgical patch closure of atrial septal defects diagnosed by 18F-fluorodeoxyglucose gated cardiac computed tomography (18F-FDG-PET/CT): a case report.

    Science.gov (United States)

    Honnorat, Estelle; Seng, Piseth; Riberi, Alberto; Habib, Gilbert; Stein, Andreas

    2016-08-24

    In contrast to percutaneous atrial septal occluder device, surgical patch closure of atrial defects was known to be no infective endocarditis risk. We herein report the first case of late endocarditis of surgical patch closure of atrial septal defects occurred at 47-year after surgery. On September 2014, a 56-year-old immunocompetent French Caucasian man was admitted into the Emergency Department for 3-week history of headache, acute decrease of psychomotor performance and fever at 40 °C. The diagnosis has been evoked during his admission for the management of a brain abscess and confirmed using 18F-fluorodeoxyglucose gated cardiac computed tomography (18F-FDG-PET/CT). Bacterial cultures of surgical deep samples of brain abscess were positive for Streptococcus intermedius and Aggregatibacter aphrophilus as identified by the matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF) mass spectrometry and confirmed with 16S rRNA gene sequencing. The patient was treated by antibiotics for 8 weeks and surgical patch closure removal. In summary, late endocarditis on surgical patch and on percutaneous atrial septal occluder device of atrial septal defects is rare. Cardiac imaging by the 18F-fluorodeoxyglucose gated cardiac computed tomography (18F-FDG-PET/CT) could improve the diagnosis and care endocarditis on surgical patch closure of atrial septal defects while transthoracic and transesophageal echocardiography remained difficult to interpret.

  13. Surgical repair of true left ventricular aneurysm in an infant: a rare complication after unsuccessful perventricular VSD closure.

    Science.gov (United States)

    Ozyilmaz, Isa; Saygi, Murat; Yildiz, Okan; Erek, Ersin; Guzeltas, Alper

    2014-10-01

    A 2.5-month-old female patient presented for closure of a ventricular septal defect (VSD). Transthoracic echocardiography showed a large muscular ventricular septal defect. After perventricular closure of the defect was performed with an Amplatzer muscular VSD occluder, peroperative transesophageal echocardiography revealed that the device had been implanted in the wrong area of the ventricular septum. The device was retrieved and a large mid-muscular defect with extension to the outlet septum was closed with a patch of Dacron which was secured with 5-0 sutures. A perforation in the ventricular septum due to attempted perventricular device delivery was seen, and it was repaired primarily. In the eighth month of follow-up, transthoracic echocardiography revealed an aneurysm in the posterior wall of the left ventricle. The patient's electrocardiogram showed pathological Q waves and ST-segment elevation in leads DII, DIII, and aVF consistent with subacute inferior myocardial infarction. At subsequent surgery, this was found to be a true aneurysm, located in area of distribution of the obtuse marginal branch of the left circumflex coronary artery in the posterior wall of the left ventricle. The aneurysm was closed off using a Dacron patch, and the sac was resected. Development of a true aneurysm is a rare but important complication of attempted perventricular VSD closure.

  14. Impact of deep sternal wound infection management with vacuum-assisted closure therapy followed by sternal osteosynthesis: a 15-year review of 23,499 sternotomies.

    Science.gov (United States)

    Baillot, Richard; Cloutier, Daniel; Montalin, Livia; Côté, Louise; Lellouche, François; Houde, Chanel; Gaudreau, Geneviève; Voisine, Pierre

    2010-04-01

    This study was undertaken to examine the outcome of patients with deep sternal wound infection (DSWI) now treated with vacuum-assisted closure (VAC) therapy as a bridge to sternal osteosynthesis with horizontal titanium plate fixation. From 1992 to 2007, a consecutive cohort of 23,499 patients underwent open-heart surgery (OHS) in our institution. The period under study was divided in two according to the use of therapeutic modalities: conventional (1992-2001, N=118 DSWI): debridement/drainage with primary closure and irrigation (N=37), debridement/drainage, open packing followed by pectoralis myocutaneous flaps (PMFs) (N=81); contemporary (2002-2007, N=149 DSWI): conventional treatment (N=24) and VAC therapy (N=125/83.8%). VAC was followed by sternal osteosynthesis with horizontal titanium plates in 92 patients (61.7%). DSWI was diagnosed in 267 out of 23 499 (1.1%) patients of our entire series according to Center for Disease Control - Atlanta (CDC) criteria, 118 out of 13 180 (0.9%) in the first and 149 out of 10 319 (1.4%) in the second period (p=0.001). Hospital mortality (N=267/23,499) has been 10.25% for the entire cohort under study without any difference between groups (1992-2001: 11.4%; 2002-2007: 9.1%, p=0.67). More recently, VAC therapy (N=125) was associated with a lower mortality (4.8% vs 14.1%, p=0.01). Stepwise multivariable logistic regression analysis for both periods revealed that prolonged intubation in the intensive care unit (ICU), use of bilateral internal thoracic artery grafting (BIMA), diabetes, re-operation for bleeding and body mass index (BMI) >30 kgm(-2) are the most powerful predictors of DSWI. In the more recently treated patients using VAC therapy, combined procedures (valve and graft) also emerged as a significant predictor. For the entire study, Staphylococcus epidermidis (49.6%) has been the most frequently identified pathogen, followed by Staphylococcus aureus (38.8%). Methicillin-resistant S.aureus (MRSA) was observed in 4

  15. Hypothermia During Cardiopulmonary Bypass Increases Need for Inotropic Support but Does Not Impact Inflammation in Children Undergoing Surgical Ventricular Septal Defect Closure.

    Science.gov (United States)

    Schmitt, Katharina Rose Luise; Fedarava, Katsiaryna; Justus, Georgia; Redlin, Mathias; Böttcher, Wolfgang; Delmo Walter, Eva Maria; Hetzer, Roland; Berger, Felix; Miera, Oliver

    2016-05-01

    Minimizing the systemic inflammatory response caused by cardiopulmonary bypass is a major concern. It has been suggested that the perfusion temperature affects the inflammatory response. The aim of this prospective study was to compare the effects of moderate hypothermia (32°C) and normothermia (36°C) during cardiopulmonary bypass on markers of the inflammatory response and clinical outcomes (time on ventilator) after surgical closure of ventricular septal defects. During surgical closure of ventricular septal defects under cardiopulmonary bypass, 20 children (median age 4.9 months, range 2.3-38 months; median weight 7.2 kg, range 5.2-11.7 kg) were randomized to a perfusion temperature of either 32°C (Group 1, n = 10) or 36°C (Group 2, n = 10). The clinical data and blood samples were collected before cardiopulmonary bypass, directly after aortic cross-clamp release, and 4 and 24 h after weaning from cardiopulmonary bypass. Time on ventilation as primary outcome did not differ between the two groups. Other clinical outcome parameters like fluid balance or length of stay in the intensive care were also similar in the two groups. Compared with Group 2, Group 1 needed significantly higher and longer inotropic support (P bypass temperature does not influence time on ventilation or inflammatory marker release. However, in the present study, with a small patient cohort, patients operated under hypothermic bypass needed higher and longer inotropic support. The use of hypothermic cardiopulmonary bypass in infants and children should be approached with care.

  16. Development of Marjolin's ulcer following successful surgical treatment of chronic sacral pressure sore

    DEFF Research Database (Denmark)

    Knudsen, M.A.; Biering-Sørensen, Fin

    2008-01-01

    of surgical excision and successful closure of the wound, the patient developed Marjolin's ulcer 2.5 years later. Yet it illustrates the primary importance of preventing the development pressure sores, of aggressive (surgical) therapy with healing when they do arise and of taking frequent biopsies......, which more or less persisted for 38 years, despite several attempts of surgical and conservative treatment. At this time, the ulcer was finally excised and the wound closed successfully. Two and a half years later, however, the ulcer recurred. Biopsies showed squamous cell carcinoma and computed...

  17. Small Cytoskeleton-Associated Molecule, Fibroblast Growth Factor Receptor 1 Oncogene Partner 2/Wound Inducible Transcript-3.0 (FGFR1OP2/wit3.0), Facilitates Fibroblast-Driven Wound Closure

    OpenAIRE

    Lin, Audrey; Hokugo, Akishige; Choi, Jae; Nishimura, Ichiro

    2010-01-01

    Wounds created in the oral cavity heal rapidly and leave minimal scarring. We have examined a role of a previously isolated cDNA from oral wounds encoding wound inducible transcript-3.0 (wit3.0), also known as fibroblast growth factor receptor 1 oncogene partner 2 (FGFR1OP2). FGFR1OP2/wit3.0 was highly expressed in oral wound fibroblasts without noticeable up-regulation of α-smooth muscle actin. In silico analyses, denaturing and nondenaturing gel Western blot, and immunocytology together dem...

  18. [Application of therapy in negative pressure complex wounds in pediatrics].

    Science.gov (United States)

    Fernández Sánchez, Rosario; Muñoz-Miguelsanz, María Ángeles

    2016-01-01

    Negative pressure wound therapy (NPWT) has been widely used in the adult patient, contrary to what happens in children, with just a few long series papers. NPWT avoids long and expensive hospital admissions, reducing the hospital costs; it also decreases the family dynamics and allows for an early return to everyday activities. In this article, we present three clinical cases consisting of a toddler, a child and a teenager with complex wounds treated with NPWT in the pediatric surgery department of the Virgen de las Nieves University Hospital in Granada. The results were excellent, with a good adherence to treatment in all cases, achieving a complete closure in two cases; the third case needed a deferred surgical closure after surgical site preparation, and showed a decrease of the wound size after the NPWT. Moreover, successful pain management was achieved during the wound cleansing, which was done under an ambulatory regime. No general anesthesia was needed. From our experience, we propose the NPWT as an alternative therapy to the classic surgical approach for this type of complex lesions in children, which offers the same advantages and results than in adults. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  19. Tremendous bleeding complication after vacuum-assisted sternal closure

    Directory of Open Access Journals (Sweden)

    Isgro Frank

    2011-02-01

    Full Text Available Abstract Vacuum-assisted closure (VAC of complex infected wounds has recently gained popularity among various surgical specialties. The system is based on the application of negative pressure by controlled suction to the wound surface. The effectiveness of the VAC System on microcirculation and the promotion of granulation tissue proliferation are proved. No contraindications for the use in deep sternal wounds in cardiac surgery are described. In our case report we illustrate a scenario were a patient developed severe bleeding from the ascending aorta by penetration of wire fragments in the vessel. We conclude that all free particles in the sternum have to be removed completely before negative pressure is used.

  20. Excellent survival and low incidence of arrhythmias, stroke and heart failure long-term after surgical ASD closure at young age. A prospective follow-up study of 21-33 years

    NARCIS (Netherlands)

    J.W. Roos-Hesselink (Jolien); F.J. Meijboom (Folkert); S.E.C. Spitaels (Silja); E.M.W.J. Utens (Elisabeth); A.J.J.C. Bogers (Ad); M.L. Simoons (Maarten); E.H.M. van Rijen (Susan); R.T. van Domburg (Ron)

    2003-01-01

    textabstractAIMS: Although studies have suggested good long-term results, arrhythmias, pulmonary hypertension and left ventricular dysfunction are mentioned as sequelae long-term after surgical atrial septal defect closure at young age. Most studies were performed only by questionnaire and in a

  1. Excellent survival and low incidence of arrhythmias, stroke and heart failure long-term after surgical ASD closure at young age. A prospective follow-up study of 21-33 years

    NARCIS (Netherlands)

    J.W. Roos-Hesselink (Jolien); F.J. Meijboom (Folkert); S.E.C. Spitaels (Silja); E.M.W.J. Utens (Elisabeth); A.J.J.C. Bogers (Ad); M.L. Simoons (Maarten); E.H.M. van Rijen (Susan); R.T. van Domburg (Ron)

    2003-01-01

    textabstractAIMS: Although studies have suggested good long-term results, arrhythmias, pulmonary hypertension and left ventricular dysfunction are mentioned as sequelae long-term after surgical atrial septal defect closure at young age. Most studies were performed only by questionnaire and in a retr

  2. 应用皮肤牵张带延期闭合骨筋膜室减张切口%Secondary wound closure following fasciotomy with the external tissue extender

    Institute of Scientific and Technical Information of China (English)

    卫小春; 张志强; 王东; 马全平

    2001-01-01

    Objective To observe the effects of the external tissue extender (ETE) for secondary wound closure following fasciotomy after acute compartment syndrome. Methods Twenty one cases (age, 7- 36 years old) following fasciotomy were treated with the ETE for secondary wound closure. The wounds occurred in the leg in 17 cases, the forearm in 3 and the foot in 1. The largest wound measured 11 cm× 28 cm, the smallest 5 cm× 15 cm. One case was accompanied with exposure of the tibia, and the other with tendon. Placement of the ETE was carried out at 4- 7 days following fasciotomy. The secondary wound closure was done when the distance between the wound edges was smaller than 1 cm, usually at 3- 7 days after the ETE procedure. Results The wounds healed in 20 cases without skin grafting, forming a line like scar. In one case, part of the ETE had to be removed because of wound infection, and small skin grafting was done later. The wounds also healed well in those two cases with the exposure of the tibia and tendon after using the ETE. With 3- 15 months follow up, distant joints adjacent to the wounds showed good range of motion, without muscular contracture. Conclusion It is safe to use the ETE for secondary wound closure following fasciotomy after acute compartment syndrome. Wound closure with the ETE shows following advantages: 1) It is a simple, convenient and fast speed procedure, with a short stay of hospital and relatively low cost. 2) Skin graft is not needed, forming a line like scar after healing. It shows good skin quality and cosmetic appearance. 3) The procedure is also suitable for those cases with exposure of bone or tendon.%目的观察应用皮肤牵张带延期直接缝合骨筋膜室减张切口的效果。方法因骨筋膜室综合征而行切开减压术导致皮肤缺损患者21例,年龄7~36岁,小腿皮肤缺损17例、前臂皮肤缺损3例、足部皮肤缺损1例。缺损区最小5cm×15cm,最大11cm×28cm,合并

  3. Efectividad del adhesivo tisular Tisuacryl® para el cierre de heridas cutáneas en cirugía laparoscópica Effectiveness of the Tisuacryl® as tissue adhesive for closure of cutaneous wounds in laparoscopy surgery

    Directory of Open Access Journals (Sweden)

    Rosalba Roque González

    2011-06-01

    Full Text Available INTRODUCCIÓN. Uno de los beneficios de la utilización de procedimientos laparoscópicos en cirugía es reducir la morbilidad relacionada con el traumatismo quirúrgico. Es conocido que el empleo del adhesivo tisular Tisuacryl® en el cierre de heridas cutáneas favorece la hemostasia, la recuperación rápida del tejido y la disminución del edema posquirúrgico, y evita complicaciones como infección y reacción del tejido a un cuerpo extraño. Fue objetivo de esta investigación evaluar la efectividad y seguridad de la utilización del Tisuacryl® para la síntesis de los puertos de entrada en pacientes intervenidos por cirugías mínimamente invasivas, sin necesidad de aplicar sutura. MÉTODOS. Se aplicó el adhesivo tisular a 100 pacientes que acudieron al Centro Nacional de Cirugía de Mínimo Acceso para realizarse diferentes procedimientos quirúrgicos. Como variables para evaluar la efectividad y seguridad del tratamiento se tomaron la dehiscencia de la herida, aparición de infección, tiempo de síntesis de la herida y estética de la cicatriz. Los pacientes se evaluaron en el posoperatorio inmediato y en consulta externa a los 7 y 21 días de la cirugía. RESULTADOS. Se lograron excelentes resultados en cuanto al afrontamiento y la estética de las heridas. Además, los pacientes no refirieron molestias ocasionadas por el material, ni se produjeron casos de infección. CONCLUSIONES. Los resultados de la investigación realizada demuestran que el Tisuacryl® puede utilizarse con alta efectividad para el cierre de las heridas de 5 mm y 10 mm en la cirugía laparoscópica, sustituyendo a las suturas.INTRODUCTION. One of the more beneficial uses of laparoscopy procedures in surgery is to decrease the morbidity related to surgical trauma. It is known that the use of the Tisuacryl® tissue adhesive for closure of cutaneous wounds favors the hemostasis, a fast tissue recovery and decrease of postsurgical edema avoiding complications

  4. [Wound dressings].

    Science.gov (United States)

    Breuninger, H

    1988-01-01

    The wide variety of dermatologic surgical procedures has resulted in a corresponding choice of wound dressings. Considering the chemical and physical properties as well as the function of the dressings, standardized dressing techniques can be performed with relatively few materials. This saves both time and money.

  5. Surgical wound care - closed

    Science.gov (United States)

    ... before touching the dressing. Wash your hands with soap and warm water. Also clean under your nails. Rinse, then dry your hands with a clean towel . Make sure you have all the supplies handy. Have a clean work surface. Remove the old dressing. Put on clean ...

  6. Reconstruction of an emergency thoracotomy wound with free rectus abdominis flap: Anatomic and radiologic basis for the surgical technique.

    Science.gov (United States)

    Gilman, Kaitlyn; Ipaktchi, Kyros; Moore, Ernest E; Barnett, Carlton; Gurunluoglu, Raffi

    2010-05-07

    An alcoholic 50-year-old male patient with a history of schizophrenia sustained stab wounds into both ventricles and left lung, and survived following an emergency department thoracotomy. The EDT wound, however became infected requiring serial debridements of soft tissue, rib cartilage and sternum. Regional flap options such as pectoralis major and latissimus dorsi muscle flaps could not be employed due to inadequate reach of these flaps. Additionally, bilateral transection of the internal mammary arteries during emergency thoracotomy eliminated the use of rectus abdominis muscles as pedicled flaps based on the superior epigastric vasculature. Therefore, the EDT wound was reconstructed by using the right rectus abdominis muscle as a free flap. The deep inferior epigastric vessels of the flap were anastomosed to the right internal mammary vessels proximal to their transection level in the third-forth intercostal space. The flap healed with no further wound complications.

  7. Reconstruction of an emergency thoracotomy wound with free rectus abdominis flap: Anatomic and radiologic basis for the surgical technique

    Directory of Open Access Journals (Sweden)

    Barnett Carlton

    2010-05-01

    Full Text Available Abstract An alcoholic 50-year-old male patient with a history of schizophrenia sustained stab wounds into both ventricles and left lung, and survived following an emergency department thoracotomy. The EDT wound, however became infected requiring serial debridements of soft tissue, rib cartilage and sternum. Regional flap options such as pectoralis major and latissimus dorsi muscle flaps could not be employed due to inadequate reach of these flaps. Additionally, bilateral transection of the internal mammary arteries during emergency thoracotomy eliminated the use of rectus abdominis muscles as pedicled flaps based on the superior epigastric vasculature. Therefore, the EDT wound was reconstructed by using the right rectus abdominis muscle as a free flap. The deep inferior epigastric vessels of the flap were anastomosed to the right internal mammary vessels proximal to their transection level in the third-forth intercostal space. The flap healed with no further wound complications.

  8. Effect of surgical wound fluids after intraoperative electron radiotherapy on the cancer stem cell phenotype in a panel of human breast cancer cell lines

    Science.gov (United States)

    Zaleska, Karolina; Suchorska, Wiktoria Maria; Przybyła, Anna; Murawa, Dawid

    2016-01-01

    The wound healing process after surgery alters the area surrounding the original tumor and around the scar, and the modified microenvironment is more favorable for tumor recurrence. Intraoperative radiotherapy (IORT) is one of the more novel strategies in breast cancer (BC) treatment. Irradiation during surgery has effects on the tumor microenvironment, abrogating the proliferative cascade induced by surgical wound healing. The aim of the present study was to determine the effect of surgical wound fluids from IOERT treatment (RT-WF) compared with wound fluids from conservative-breast surgery only (WF) on the cancer stem cell phenotype in a panel of BC cell lines. Post-operative wound fluids were derived from patients with BC who underwent a tumor resection (quadrantectomy) plus intraoperative electron radiotherapy using a single dose of ≤10 Gy on the tumor bed and surrounding tissues, or from those who underwent a tumor resection without IOERT. Cell lines were incubated with 10% wound fluids, and after 4 days, the cluster of differentiation (CD)44+/CD24−/low phenotype and aldehyde dehydrogenase 1 (ALDH1) activity were determined by flow cytometry. The two types of fluid each affected the CD44+/CD24−/low phenotype. The results varied markedly between each cell line, even for the same histological subtypes. RT-WF decreased the CD44+/CD24−/low populations in the basal-like BT-549 and MDA-MB-468 cell lines, whereas in the luminal type MCF7 cell line, the two fluids inhibited these populations. The HER-OE subtypes harbored a minimal CD44+/CD24−/low population, but the growth of SK-BR-3 was stimulated by the two post-operative fluids. WF exhibited a stronger effect on ALDH1 activity compared with RT-WF. The stimulatory effect was dependent on the histological subtype of the cell line and the strongest dependence was observed in luminal subtypes characterized by low dehydrogenase activity in the control group. The present results enable a better understanding of

  9. Prevalence of Pathogenic Bacteria Isolated from Surgical Site and Wound Infection among Patients Admitted in some selected Hospitals in Sokoto Metropolis, Nigeria

    Directory of Open Access Journals (Sweden)

    UK Muhammad

    2014-09-01

    Full Text Available Surgical and open wounds are commonly encountered in clinical practice. This study was aim to determine the prevalence of pathogenic bacteria in surgical and open wound infection among patients admitted in some selected hospitals in Sokoto metropolis. A total of one hundred and fifty one (151 isolates were obtained from two hundred (200 surgical site and wound samples collected from patients in this study. The result showed that Usmanu Danfodiyo Teaching Hospital Sokoto (UDUTH had the highest number of clinical isolates with 64 gram positive and gram negative bacteria followed by Specialist Hospital Sokoto (S.H.S with 57 gram positive and gram negative bacteria and then Maryam Abacha Women and Children Hospital (MAWCH with 30 gram positive and gram negative bacteria. Gram positive cocci 108 (71.5% were more predominant pathogen isolated in the hospitals than gram negative bacilli 43 (28.5%. Staphylococcus aureus had the highest number of occurrence with 54(35.76% followed by Coagulate negative Staphylococci with 47(31.1% while Citrobacter freundii had the lowest number of occurrence with 2(1.32% isolates. Also, the susceptibility of the isolates to antimicrobial agents were carried out using Amoxacillin, Ampicillin, Erythromycin, Chloramphenicol, Ampiclox, Ciprofloxacin, Gentamycin, Tetracycline, Pefloxacin and Cotrimoxazole. The mean zone of inhibition recorded against Staphlococcus aureus by using Amoxacillin antibiotic is 2.20mm while with Citrobacter freundii is 1.00. DOI: http://dx.doi.org/10.3126/ije.v3i3.11066 International Journal of Environment Vol.3(3 2014: 89-103

  10. EFFICACY OF VACUUM ASSISTED CLOSURE DRESSINGS WHEN COMPARED TO MOIST WOUND DRESSINGS IN THE MANAGEMENT OF DIABETIC FOOT ULCERS : A PROSPECTIVE COMPARATIVE STUDY

    Directory of Open Access Journals (Sweden)

    Ballapalli Hari

    2015-10-01

    Full Text Available INTRODUCTION: F oot ulceration is mainly responsible for the morbidity of diabetes mellitus. They deprive the patient of quality working days and add to his financial burden. Several novel methods of wound healing came to vogue among which vacuum assisted dressing is becoming quite popular. Present study aim s to evaluate its efficacy when compared to regular moist wound dressings. OBJECTIVES: To study the effectiveness of vacuum assisted dressings in terms of Rate of wound healing. MATERIALS AND METHODS: we carried out a prospective study at Narayana medical college hospital on two groups (group A and group B of diabetic foot ulcer patients, whom we selected randomly after considering inclusion and exclusion criteria . Vacuum assisted dressings were done in group A patients and normal moist wound dressings in group B. At the start of the treatment and every week thereafter, size and depth of ulcers were recorded and results were compared at complete wound healing or at the end of 12 weeks of treatment whichever is earlier. S trict glycaemic control was maintaine d throughout the treatment period. RESULTS : significant healing was noticed in group A patients (vacuum assisted dressings group both in terms of ulcer size and depth. Wounds appeared more - healthy i.e. with less slough and more red granulation tissue in g roup A patients. CONCLUSION: vacuum assisted dressing is an efficacious method in the treatment of diabetic foot ulcers with significantly reduced hospital stay

  11. Experience with local negative pressure (vacuum method in the treatment of complex wounds

    Directory of Open Access Journals (Sweden)

    Alexandre Wada

    Full Text Available CONTEXT AND OBJECTIVE: Use of topical negative pressure over difficult-to-heal wounds has been studied. The objective of this study was to analyze the effects from negative pressure in the treatment of complex wounds. DESIGN AND SETTING: Case series developed at Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo. METHODS: Twenty-nine patients with complex wounds were treated with the vacuum system and then underwent a surgical procedure to close the wound. RESULTS: 85% of the skin grafts took well, and 87.5% of the local flaps were successful, thus demonstrating adequate wound preparation. The wounds were closed within shorter times than observed using other conventional treatments In two cases, the vacuum system was also used to stabilize the skin grafts over the wounds. CONCLUSIONS: Use of the vacuum method is safe and efficient for preparing wounds for surgical closure. It allows for an improvement of local wound conditions, and healthy granulation tissue develops with control over local infection.

  12. Incisional Negative Pressure Wound Therapy

    DEFF Research Database (Denmark)

    Hyldig, Nana

    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...

  13. Surgical Tips in Frozen Abdomen Management: Application of Coliseum Technique

    Directory of Open Access Journals (Sweden)

    Ioannis D. Kyriazanos

    2015-01-01

    Full Text Available Wound dehiscence is a serious postoperative complication, with an incidence of 0.5–3% after primary closure of a laparotomy incision, and represents an acute mechanical failure of wound healing. Relatively recently the concept of “intentional open abdomen” was described and both clinical entities share common pathophysiological and clinical pathways (“postoperative open abdominal wall”. Although early reconstruction is the target, a significant proportion of patients will develop adhesions between abdominal viscera and the anterolateral abdominal wall, a condition widely recognized as “frozen abdomen,” where delayed wound closure appears as the only realistic alternative. We report our experience with a patient who presented with frozen abdomen after wound dehiscence due to surgical site infection and application of the “Coliseum technique” for its definitive surgical management. This novel technique represents an innovative alternative to abdominal exploration, for cases of “malignant” frozen abdomen due to peritoneal carcinomatosis. Lifting the edges of the surgical wound upwards and suspending them under traction by threads from a retractor positioned above the abdomen facilitates approach to the peritoneal cavity, optimizes exposure of intra-abdominal organs, and prevents operative injury to the innervation and blood supply of abdominal wall musculature, a crucial step for subsequent hernia repair.

  14. Standard abdominal wound edge protection with surgical dressings vs coverage with a sterile circular polyethylene drape for prevention of surgical site infections (BaFO: study protocol for a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Mihaljevic André L

    2012-05-01

    Full Text Available Abstract Background Postoperative surgical site infections cause substantial morbidity, prolonged hospitalization, costs and even mortality and remain one of the most frequent surgical complications. Approximately 14% to 30% of all patients undergoing elective open abdominal surgery are affected and methods to reduce surgical site infection rates warrant further investigation and evaluation in randomized controlled trials. Methods/design To investigate whether the application of a circular plastic wound protector reduces the rate of surgical site infections in general and visceral surgical patients that undergo midline or transverse laparotomy by 50%. BaFO is a randomized, controlled, patient-blinded and observer-blinded multicenter clinical trial with two parallel surgical groups. The primary outcome measure will be the rate of surgical site infections within 45 days postoperative assessed according to the definition of the Center for Disease Control. Statistical analysis of the primary endpoint will be based on the intention-to-treat population. The global level of significance is set at 5% (2 sided and sample size (n = 258 per group is determined to assure a power of 80% with a planned interim analysis for the primary endpoint after the inclusion of 340 patients. Discussion The BaFO trial will explore if the rate of surgical site infections can be reduced by a single, simple, inexpensive intervention in patients undergoing open elective abdominal surgery. Its pragmatic design guarantees high external validity and clinical relevance. Trial registration http://www.clinicaltrials.gov NCT01181206. Date of registration: 11 August 2010; date of first patient randomized: 8 September 2010

  15. 胶原/壳聚糖止血敷料在外科伤口中的应用%Collagen/chitosan hemostatic dressings in surgical wounds

    Institute of Scientific and Technical Information of China (English)

    高文彪; 张岩睿; 张军

    2012-01-01

    BACKGROUND: Chitosan combined with collagen can be more effective to stop the bleeding. OBJECTIVE: To assess the material properties and biocompatibility of collagen/chitosan hemostatic dressing materials in surgical wounds. METHODS: A computer-based search was performed for articles addressing biological dressings, collagen/chitosan hemostatic materials in wounds or during wound hemostasis published from January 2000 to June 2010. The keywords were "biomaterial, hemostatic material, gauze, collagen/chitosan, biocompatibility" in Chinese and "biomaterial, hemostatic material, bioresorbable material, hemostasis effect, hemostatic mechanism" in English. RESULTS AND CONCLUSION: Chitosan has unique biological properties that are characterized to have a broad-spectrum antibacterial activity, to promote epithelial cell growth and hemostasis, promote wound healing, and have a good biodegradability and tissue compatibility, which can be used for treatment of fingertip injury and granulation wound. Chitosan can be applied to prepare wound dressings, absorbable sutures, hemostatic materials, anti-blocking aqent, druq delivery and tissue enqineerinq scaffolds for wound treatment under field conditions.%背景:壳聚糖与胶原联合可更有效地止血.目的:评价胶原/壳聚糖止血敷料的材料学性能及应用于外科伤口的生物相容性.方法:以"生物材料,止血敷料,纱布,胶原/壳聚糖,生物相容性"为中文关键词,以"biomaterial;hemostatic material;bioresorbable material ; hemostasis effect ; hemostatic mechanism " 为英文关键词,采用计算机检索2000-01/2010-06 与生物敷料、胶原/壳聚糖止血材料在伤口或创面止血过程中应用相关的文献.结果与结论:壳聚糖独特的生物学特性,具有广谱抑菌、促进上皮细胞生长及止血,促进创面愈合的作用,在体内具有良好的生物降解性与组织相容性,可用于指端损伤和肉芽创面的治疗,如制成伤口敷料、可吸收缝

  16. [Development and Validation of a Fully Automated, Experimental Set-Up for Ex-Vivo Burst Pressure Testing after Surgical Vessel Closure].

    Science.gov (United States)

    Wallimann, Herbert; Menges, Pia; Hausen, Bernard; Linder, Albert

    2017-06-20

    Background A growing number of operations are performed using minimally invasive techniques. Therefore, a lot of new requirements must be met by the staplers currently available. At the present time, the most widely used methods of minimally invasive vascular occlusion involve high-frequency energy, clips, and staplers. The most important quality parameter is burst pressure, which is measured with a variety of experimental set-ups, all of which are subject to criticism. With this study, we want to introduce a fully automated vascular burst pressure measuring system that largely mimics physiological conditions. An important feature of this set-up is the detection of very early leakage from the staple line (FAIR Leakage = First Appearance of Leakage requiring Intervention). Material and Methods Burst pressure was measured in vessel segments of porcine common carotid arteries. For vascular occlusion, we used the stapler device Micro Cutter XCHANGE(®) by DexteraSurgical. Prior to closure, the vessel was filled to a pressure of 80 mmHg. The pressure was increased at a defined flow rate. Burst pressure was defined as staple line leakage requiring intervention. Results and Validation 30 staple lines were examined. The average burst pressure visually determined by two independent investigators was 515.8 mmHg ± 236.3 mmHg. Maximal burst pressure was 911 mmHg, and minimal burst pressure 80 mmHg. The average burst pressure detected electronically was 511.8 mmHg ± 239.1 mmHg. Statistically, there was a highly significant correlation of visually and electronically detected burst pressures. Conclusion This is the first experimental set-up for a systematic burst pressure test that is fully automated and therefore eliminates any bias related to the investigator. The experimental set-up with a defined intravascular pressure prior to closure and the use of a liquid with blood-like viscosity enabled us to largely mimic intraoperative conditions. Since burst

  17. Meta-analysis of randomized and quasi-randomized clinical trials of topical antibiotics after primary closure for the prevention of surgical-site infection.

    Science.gov (United States)

    Heal, C F; Banks, J L; Lepper, P; Kontopantelis, E; van Driel, M L

    2017-08-01

    Surgical-site infections (SSIs) increase patient morbidity and costs. The aim was to identify and synthesize all RCTs evaluating the effect of topical antibiotics on SSI in wounds healing by primary intention. The search included Ovid MEDLINE, Ovid Embase, the Cochrane Wounds Specialized Register, Central Register of Controlled Trials and EBSCO CINAHL from inception to May 2016. There was no restriction of language, date or setting. Two authors independently selected studies, extracted data and assessed risk of bias. When sufficient numbers of comparable trials were available, data were pooled in meta-analysis. Fourteen RCTs with 6466 participants met the inclusion criteria. Pooling of eight trials (5427 participants) showed that topical antibiotics probably reduced the risk of SSI compared with no topical antibiotic (risk ratio (RR) 0·61, 95 per cent c.i. 0·42 to 0·87; moderate-quality evidence), equating to 20 fewer SSIs per 1000 patients treated. Pooling of three trials (3012 participants) for risk of allergic contact dermatitis found no clear difference between antibiotics and no antibiotic (RR 3·94, 0·46 to 34·00; very low-quality evidence). Pooling of five trials (1299 participants) indicated that topical antibiotics probably reduce the risk of SSI compared with topical antiseptics (RR 0·49, 0·30 to 0·80; moderate-quality evidence); 43 fewer SSIs per 1000 patients treated. Pooling of two trials (541 participants) showed no clear difference in the risk of allergic contact dermatitis with antibiotics or antiseptic agents (RR 0·97, 0·52 to 1·82; very low-quality evidence). Topical antibiotics probably prevent SSI compared with no topical antibiotic or antiseptic. No conclusion can be drawn regarding whether they cause allergic contact dermatitis. © 2017 BJS Society Ltd Published by John Wiley & Sons Ltd.

  18. [Wound healing and wound dressing].

    Science.gov (United States)

    Eitel, F; Sklarek, J

    1988-01-01

    This review article intends to discuss the clinical management of wounds in respect to a pathophysiological background. Recent results of research in the field of wound healing are demonstrated. Wound healing can be seen as aseptic inflammatory response to a traumatic stimulus. The activation of the clotting cascade by the trauma induces a sequence of humoral and cellular reactions. Platelets, granulocytes and macrophages are activated stepwisely. In the first phase of wound healing the wounded tissue area will be prepared for phagocytosis by enzymatic degradation of ground substance and depolymerisation of protein macromolecules (wound edema). Following the phagocytic microdebridement mesenchymal cells proliferate and produce matrix substance. Microcirculation within the traumatized area will be restored by angiogenesis, macroscopically observed as new formed granulation tissue. This leads to the wound healing phase of scar tissue formation. In this complexity of reactions naturally many possibilities of impairment are given. The most common complication during wound healing is the infection. It can be seen as self reinforcing process. The therapy of the impairment of wound healing consists in the disruption of the specific vicious circle, in the case of an osseus infection that would be a macrodebridement (that is necrectomy) and biomechanical stabilization. The surgical management of wounds principally consists in ensuring an undisturbed sequence of the healing process. This can be done by the wound excision that supports the phagocytic microdebridement. A further possibility is to avoid overwhelming formation of edema by eliminating the traumatic stimulus, by immobilization of the injured region and by ensuring a physiological microenvironment with a primary suture if possible. There are up to the present no drugs available to enhance cell proliferation and to regulate wound healing but it seems that experimental research is successful in characterizing

  19. Increased postoperative complications after protective ileostomy closure delay: An institutional study

    Institute of Scientific and Technical Information of China (English)

    Ines; Rubio-Perez; Miguel; Leon; Daniel; Pastor; Joaquin; Diaz; Dominguez; Ramon; Cantero

    2014-01-01

    AIM: To study the morbidity and complications as-sociated to ileostomy reversal in colorectal surgery pa-tients, and if these are related to the time of closure. METHODS: A retrospective analysis of 93 patients, who had undergone elective ileostomy closure between 2009 and 2013 was performed. Demographic, clinical and surgical variables were reviewed for analysis. All complications were recorded, and classified according to the Clavien-Dindo Classification. Statistical univariate and multivariate analysis was performed, setting a P value of 0.05 for significance.RESULTS: The patients had a mean age of 60.3 years, 58% male. The main procedure for ileostomy cre-ation was rectal cancer(56%), and 37% had received preoperative chemo-radiotherapy. The average delay from creation to closure of the ileostomy was 10.3 mo. Postoperative complications occurred in 40% of the pa-tients, with 1% mortality. The most frequent were ileus(13%) and wound infection(13%). Pseudomembra-nous colitis appeared in 4%. Increased postoperative complications were associated with delay in ileostomyclosure(P = 0.041). Male patients had more complica-tions(P = 0.042), mainly wound infections(P = 0.007). Pseudomembranous colitis was also associated with the delay in ileostomy closure(P = 0.003). End-to-end in-testinal anastomosis without resection was significantly associated with postoperative ileus(P = 0.037). CONCLUSION: Although closure of a protective il-eostomy is a fairly common surgical procedure, it has a high rate of complications, and this must be taken into account when the indication is made. The delay in stoma closure can increase the rate of complications in general, and specifically wound infections and colitis.

  20. Device Closure of Small Ventricular Septal Defects: When and Why?

    Directory of Open Access Journals (Sweden)

    IB Vijayalakshmi

    2014-10-01

    Full Text Available Ventricular septal defect (VSD accounts for approximately 20-30 % of all forms of congenital heart disease (CHD. They were traditionally closed surgically in the past. The surgery though safe carries the risk of morbidity, complete heart block, wound infection and thoracotomy scar on the chest. On weighing the risk and benefit, the small VSDs were not submitted to surgery in the past. So for many years it has been taught that the small VSDs are to be left alone and surgery is not recommended. Many clinicians believed in spontaneous closure of VSDs. Hence they advised the parents to wait for spontaneous closure till the child is 9 years old. But what if the VSD does not close by 10 years is the question. Are they normal as grown up congenital heart (GUCH. The Jane Somerville GUCH unit showed that spontaneous closure occurred only in 10% between the age of 17 and 45 (mean - 27 years in small VSDs in adults. What is worth noting is about 25% had serious complications: infective endocarditis (11%, progressive aortic regurgitation (5%, age-related symptomatic arrhythmias (8.5% like atrial fibrillation. This means that asymptomatic small VSDs in childhood is not necessarily benign during adult life. This raises the question, when we have a safe non-surgical device closure available to close the small VSDs, should we put the future lives of the young in danger by not giving the benefit of technology to them?

  1. Surgical safety checklist is associated with improved operating room safety culture, reduced wound complications, and unplanned readmissions in a pilot study in neurosurgery.

    Science.gov (United States)

    Lepänluoma, M; Takala, R; Kotkansalo, A; Rahi, M; Ikonen, T S

    2014-03-01

    The World Health Organization's surgical safety checklist is designed to improve adherence to operating room safety standards, and its use has been shown to reduce complications among surgical patients. The objective of our study was to assess the impact of the implementation of the checklist on safety-related issues in the operating room and on postoperative adverse events in neurosurgery. From structured questionnaires delivered to operating room personnel, answers were analyzed to evaluate communication and safety-related issues during 89 and 73 neurosurgical operations before and after the checklist implementation, respectively. From the analyzed operations, 83 and 67 patients, respectively, were included in a retrospective analysis of electronic patient records to compare the length of hospital stay, reported adverse events, and readmissions. In addition, the consistency of operating room documentation and patient records was assessed. Communication between the surgeon and the anesthesiologist was enhanced, and safety-related issues were better covered when the checklist was used. Unplanned readmissions fell from 25% to 10% after the checklist implementation (p = 0.02). Wound complications decreased from 19% to 8% (p = 0.04). The consistency of documentation of the diagnosis and the procedure improved. The use of the checklist improved safety-related performance and, contemporarily, reduced numbers of wound complications, and readmissions were observed.

  2. Surgical closure of apical multiple muscular septal defects via right ventriculotomy using a single patch with intermediate fixings

    Institute of Scientific and Technical Information of China (English)

    LI Gang; WANG Qiang; LIU Ying-long; XU Yu-lin; GUO Yan

    2013-01-01

    Background Multiple apical muscular ventricular septal defects (VSDs) remain a challenge for surgeons because of their anatomical features.We used single patch with intermediate fixations to repair multiple apical muscular VSDs through right ventriculotomy.Methods We analysed the data of 16 children (median age 8 months,range 2 months to 144 months) with multiple apical muscular VSDs who underwent a single patch technique via apical right ventriculotomy.Perioperative data were collected and analysed,and the patients were followed up for three months to 66 months (median,46 months) to investigate the outcomes.Results All patients recovered from cardiopulmonary bypass easily with median of cardiopulmonary bypass time 87 minutes and of aortic crossclamp time 53 minutes.No surgically related death occurred and no patient required reoperation.One patient died of pseudomonas pyocyanea infection on day 11 postoperatively.Residual shunt happened in one patient with a diameter of 2 mm and spontaneously closed in 12 months after operation.Two patients presented slightly reduced right ventricular volume and apical hypokinesia postoperatively and recovered 24 and 36 months later respectively.No other complication was found during the three months to 66 months follow-up.Conclusion Our experiences using a single patch technique with intermediate fixations via right ventriculotomy in the management of multiple muscular VSDs had favourable outcomes.

  3. Stepwise surgical approach to diabetic partial foot amputations with autogenous split thickness skin grafting

    Directory of Open Access Journals (Sweden)

    Crystal L. Ramanujam

    2016-06-01

    Full Text Available In the surgical treatment of severe diabetic foot infections, substantial soft tissue loss often accompanies partial foot amputations. These sizeable soft tissue defects require extensive care with the goal of expedited closure to inhibit further infection and to provide resilient surfaces capable of withstanding long-term ambulation. Definitive wound closure management in the diabetic population is dependent on multiple factors and can have a major impact on the risk of future diabetic foot complications. In this article, the authors provide an overview of autogenous skin grafting, including anatomical considerations, clinical conditions, surgical approach, and adjunctive treatments, for diabetic partial foot amputations.

  4. Prospective cohort study on surgical wounds comparing a polyhexanide-containing biocellulose dressing with a dialkyl-carbamoyl-chloride-containing hydrophobic dressing.

    Science.gov (United States)

    Nielsen, Anna Marie; Andriessen, Anneke

    2012-09-01

    Postsurgery dressing changes in diabetic foot amputation wounds and surgical wounds healing by secondary intention are often conducted in the operating room under general anesthesia. A prospective comparative cohort study was performed in 60 patients (n = 60: n = 30/n = 30) with secondary-intention surgical wounds (82% had forefoot and/or digit[s] amputations) to compare 2 different dressing types. Patients at the study center gave informed written consent, after which they were randomly allocated to one of the treatment groups. Group A received a biocellulose dressing with polyhexanide, and group B a hydrophobic dressing with dialkyl-carbamoyl-chloride. In both groups, gauze was used as secondary dressing and fixed with a film dressing. One day after surgery, the dressings were removed by the surgeon and patient-reported pain and dressing adherence/integrity were evaluated. The number of patients that required general anesthesia was determined during the procedure and afterward. All patients (n = 60; n = 30/n = 30) were included in the intention-to-treat analysis. Pain levels in group A were significantly (t (59) = 4.026, P < .000) lower upon dressing removal, when compared with group B; in group A, n = 21 reported no pain versus n = 8 (26%) for group B. In group A, the dressing adhered in 7 subjects (23%) versus n = 27 (90%) of cases in group B (P = .000). No anesthesia was required for the patients in group A, contrary to group B, where 16% of patients received general anesthesia for dressing removal. Pain levels were significantly lower and the dressing adhered significantly less in group A, compared with group B, demonstrating a better quality of life for the patients in group A.

  5. Comparison between stainless steel staples and silk sutures for primary closure of skin in patients undergoing neck dissection: A comparative clinical study

    Directory of Open Access Journals (Sweden)

    Abhishek Ghosh

    2015-01-01

    Full Text Available Introduction: Comparison between stainless steel staples and silk sutures for primary closure of skin in patients undergoing neck dissection, in context of rapid application, approximation of the skin edges, economy and aesthetics of the resultant scar. Aim: (1 To compare surgical stainless steel staples and silk sutures for primary wound closure, with respect to presence/absence of wound infection and dehiscence (2 To compare the resultant scar following the two different methods of the closure at 3 rd month postoperatively with the help of visual analog scale and analyze the result statistically Design: This study was designed to compare skin closure using staples and silk sutures in patients undergoing neck dissection, using both methods in one-half of the same wound; thus each wound affording its own control. Materials and Methods: The study was conducted on patients requiring collar line incision (high submandibular incision with or without a cephalad extension of midline lower lip split incision for surgical access, who presented to the Department of Oral and Maxillo-Facial Surgery. (1 Sample size: 10 (2 Study design: Prospective Comparative study (3 Study duration: One and half years (4 Surgical stainless steel staples: Proximate Plus MD 35 W, Ethicon Endo Surgery (5 Sutures: 3-0 Ethiprime NW 5003, Non-Absorbable Surgical Suture, Mersilk-90 cm, Ethicon, (16 mm 3/8 circle cutting needle. Conclusion: It wass concluded that there is no significant difference between the scars observed in the regions of incision which underwent primary closure by two different methods, that is surgical stainless steel staples and 3-0 Mersilk Sutures.

  6. Long-term calcium addition increases growth release, wound closure, and health of sugar maple (Acer saccharum) trees at the Hubbard Brook Experimental Forest

    Science.gov (United States)

    Brett A. Huggett; Paul G. Schaberg; Gary J. Hawley; Christopher Eager

    2007-01-01

    We surveyed and wounded forest-grown sugar maple (Acer saccharum Marsh.) trees in a long-term, replicated Ca manipulation study at the Hubbard Brook Experimental Forest in New Hampshire, USA. Plots received applications of Ca (to boost Ca availability above depleted ambient levels) or A1 (to compete with Ca uptake and further reduce Ca availability...

  7. Is time to closure a factor in the occurrence of infection in traumatic wounds? A prospective cohort study in a Dutch level 1 trauma centre

    NARCIS (Netherlands)

    van den Baar, M.T.M.; van der Palen, Jacobus Adrianus Maria; Vroon, M.I.; Bertelink, P.; Hendrix, Ron

    2010-01-01

    Background The dogma that traumatic wounds should not be sutured after 6 h is based on an animal experiment by P L Friedrich in 1898. There is no adequately powered prospective study on this cut-off of 6 h to confirm or disprove the dogma. The aim of this study was to provide evidence against the

  8. Negative pressure wound therapy: an evidence-based analysis.

    Science.gov (United States)

    2006-01-01

    Published in English Seven international health technology assessments on NPWT were identified. Included in this list of health technology assessments is the original health technology review on NPWT by the Medical Advisory Secretariat from 2004. The Medical Advisory Secretariat found that the health technology assessments consistently reported that NPWT may be useful for healing various types of wounds, but that its effectiveness could not be empirically quantified because the studies were poorly done, the patient populations and outcome measures could not be compared, and the sample sizes were small. Six RCTs were identified that compared NPWT to standard care. Five of the 6 studies were of low or very low quality according to Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. The low and very low quality RCTs were flawed owing to small sample sizes, inconsistent reporting of results, and patients lost to follow-up. The highest quality study, which forms the basis of this health technology policy assessment, found that: There was not a statistically significant difference (≥ 20%) between NPWT and standard care in the rate of complete wound closure in patients who had complete wound closure but did not undergo surgical wound closure (P = .15).The authors of this study did not report the length of time to complete wound closure between NPWT and standard care in patients who had complete wound closure but who did not undergo surgical wound closureThere was no statistically significant difference (≥ 20%) in the rate of secondary amputations between the patients that received NPWT and those that had standard care (P = .06)There may be an increased risk of wound infection in patients that receive NPWT compared with those that receive standard care. Based on the evidence to date, the clinical effectiveness of NPWT to heal wounds is unclear. Furthermore, saline dressings are not standard practice in Ontario, thereby rendering the literature base

  9. Development and characterization of cefazolin loaded zinc oxide nanoparticles composite gelatin nanofiber mats for postoperative surgical wounds

    Energy Technology Data Exchange (ETDEWEB)

    Rath, Goutam, E-mail: goutamrath123@gamil.com [Department of Pharmaceutics, ISF College of Pharmacy, Moga, Punjab (India); PhD Research Scholar at Punjab Technical University, Jalandhar, Punjab (India); Hussain, Taqadus, E-mail: taqadus.hussain@gmail.com [Department of Pharmaceutics, ISF College of Pharmacy, Moga, Punjab (India); Chauhan, Gaurav, E-mail: gauravpharmaorg@gmail.com [Department of Pharmaceutics, ISF College of Pharmacy, Moga, Punjab (India); Garg, Tarun, E-mail: tarun.garg9@gmail.com [Department of Pharmaceutics, ISF College of Pharmacy, Moga, Punjab (India); Goyal, Amit Kumar, E-mail: amitkumargoyal1979@gmail.com [Department of Pharmaceutics, ISF College of Pharmacy, Moga, Punjab (India)

    2016-01-01

    Systemic antibiotic therapy in post-operative wound care remain controversial leading to escalation in levels of multi-resistant bacteria with unwanted morbidity and mortality. Recently zinc (Zn) because of multiple biophysiological functions, gain considerable interest for wound care. Based on our current understanding, the present study was designed with an intent to produce improve therapeutic approaches for post-operative wound management using composite multi-functional antibiotic carrier. The study involved the fabrication, characterization and pre-clinical evaluation of cefazolin nanofiber mats loaded with zinc oxide (ZnO) and comparing co-formulated mats with individual component, enable a side by side comparison of the benefits of our intervention. Minimum inhibitory concentration (MIC) of the drug, ZnO nanoparticles (ZnONPs) and drug-ZnONP mixture against Staphylococcus aureus was determined using micro dilution assay. The fabricated nanofibers were then evaluated for in-vitro antimicrobial activity and the mechanism of inhibition was predicted by scanning electron microscopy (SEM). Further these nanofiber mats were evaluated in-vivo for wound healing efficacy in Wistar rats. Study revealed that the average diameter of the nanofibers is around 200–900 nm with high entrapment efficiency and display sustained drug release behavior. The combination of ZnO and cefazolin in 1:1 weight ratio showed higher anti-bacterial activity of 1.9 ± 0.2 μg/ml. Transmission electron microscopy of bacterial cells taken from the zone of inhibition revealed the phenomenon of cell lysis in tested combination related to cell wall disruption. Further composite medicated nanofiber mats showed an accelerated wound healing as compared to plain cefazolin and ZnONP loaded mats. Macroscopical and histological evaluations demonstrated that ZnONP hybrid cefazolin nanofiber showed enhanced cell adhesion, epithelial migration, leading to faster and more efficient collagen synthesis

  10. Production of vegetable oil blends and structured lipids and their effect on wound healing

    Directory of Open Access Journals (Sweden)

    Juliana Neves Rodrigues Ract

    2015-06-01

    Full Text Available Two oil blends (sunflower/canola oils 85/15 (BL1 and canola/linseed oils 70/30 (BL2, were prepared and enzymatically interesterified to be applied to surgically-induced wounds in rats. Following surgery, the animals were submitted to the Treatment with Physiological Saline (TPS (control group, Blends (TBL, and Structured Lipids (TSL. The control group (TPS received physiological saline solution for 15 days. In TBL, BL1 was administered during the inflammation phase (days 0-3 and BL2 in the tissue formation and remodeling phase (days 4-15. In TSL, Structured Lipid 1 (SL1 and Structured Lipid 2 (SL2 were used instead of BL1 and BL2, respectively. The aim of this study was to compare wound closure evolution among rats treated with the blends or structured lipids versus control rats treated with physiological saline. The wound healing process was evaluated by measuring the wound areas along the treatments and the concentrations of cytokines. An increase in the areas of wounds treated with the blends and structured lipids in the inflammatory phase was observed, followed by a steeper closure curve compared to wounds treated with physiological saline. The changes observed during the inflammatory phase suggest a potential therapeutic application in cutaneous wound healing which should be further investigated.

  11. Temporary Rectal Stenting for Management of Severe Perineal Wounds in Two Dogs.

    Science.gov (United States)

    Skinner, Owen T; Cuddy, Laura C; Coisman, James G; Covey, Jennifer L; Ellison, Gary W

    Perineal wounds in dogs present a challenge due to limited local availability of skin for closure and constant exposure to fecal contaminants. This report describes temporary rectal stenting in two dogs following severe perineal wounds. Dog 1 presented with a 4 × 4 cm full-thickness perineal slough secondary to multiple rectal perforations. A 12 mm internal diameter endotracheal tube was placed per-rectum as a temporary stent to minimize fecal contamination. The stent was removed 18 days after placement, and the perineal wound had healed at 32 days post-stent placement, when a minor rectal stricture associated with mild, intermittent tenesmus was detected. Long-term outcome was deemed good. Dog 2 presented with multiple necrotic wounds with myiasis, circumferentially surrounding the anus and extending along the tail. A 14 mm internal diameter endotracheal tube was placed per-rectum. The perineal and tail wounds were managed with surgical debridement and wet-to-dry and honey dressings prior to caudectomy and negative pressure wound therapy (NPWT). Delayed secondary wound closure and stent removal were performed on day six without complication. Long-term outcome was deemed excellent. Temporary rectal stenting may be a useful technique for fecal diversion to facilitate resolution of complex perineal injuries, including rectal perforation.

  12. Human cadaveric dermal matrix for management of challenging surgical defects on the scalp.

    Science.gov (United States)

    Stebbins, William G; Hanke, C William; Petersen, Jeffrey

    2011-03-01

    Biologic scaffolds have shown promise in patients unable to tolerate prolonged surgical closure or extensive wound care, but there has been little research in the field of Mohs micrographic surgery (MMS) on human cadaveric dermis in this capacity. To evaluate the utility of human cadaveric dermis as a means of decreasing operative time, minimizing postoperative wound care, and improving aesthetic outcomes in selected patients with deep surgical defects, including those with exposed bone. Fourteen patients (8 men, 6 women) with deep postoperative defects after MMS were treated with a cadaveric dermal allograft as part or all of their postoperative wound management. Allograft placement was well tolerated, with high satisfaction levels relating to minimal postoperative wound care and aesthetic outcome. Significantly shorter operative times were noted in all patients than with primary closure or grafting. In patients with significant comorbidities, inability to tolerate extended surgical repairs, or inability to perform extensive wound care, human cadaveric dermal allografts can decrease operative time and minimize wound care complexity while providing an excellent aesthetic outcome in many cases. Shorter healing times than expected were also noted in a number of patients. The authors have indicated no significant interest with commercial supporters. © 2011 by the American Society for Dermatologic Surgery, Inc.

  13. Incisional Negative Pressure Wound Therapy for Prevention of Postoperative Infections Following Caesarean Section

    Science.gov (United States)

    2017-01-30

    Surgical Wound Infection; Infection; Cesarean Section; Cesarean Section; Dehiscence; Complications; Cesarean Section; Complications; Cesarean Section, Wound, Dehiscence; Wound; Rupture, Surgery, Cesarean Section

  14. A Primer on Wound Bed Preparation

    OpenAIRE

    Gokoo, Chuck

    2009-01-01

    Successful wound closure and healing are a major concern for today's clinician. Determining if the wound will progress or not relies on a comprehensive assessment, recognition of wound characteristics that will promote or impede the healing process and preparing the wound bed such that pathological features are removed allowing the healing cascade to occur. When complications are no longer a roadblock the wound will achieve a stable microenvironment and progress through the normal repairative...

  15. Surgical treatment of tibial nonunion after wounding by high velocity missile and external fixators: A case report

    OpenAIRE

    2012-01-01

    Introduction. The missiles of modern firearms can cause severe fractures of the extremity. High velocity missile fractures of the tibia are characterized by massive tissue destruction and primary contamination with polymorphic bacteria. Treatment of these fractures is often complicated by delayed healing, poor position healing, nonhealing and bone tissue infection. Case Outline. We present the management of tibial nonunion after wounding by high velocity missile and primary treatment by...

  16. Clinical characteristics and treatment of burn wound sepsis in extensive burn patients: successful experience with eight cases

    Institute of Scientific and Technical Information of China (English)

    柴家科; 盛志勇; 杨红明

    2000-01-01

    Eight burn wound sepsis patients, in which 6 cases were diagnosed as MODS and two as septic shock, were treated consecutively in our hospital from September 1997 to October 1998. The plasma concentration of IL-6, IL-8, TNFα and LPS were assayed before and after surgical intervention, as well as when the patients' vital signs became stable. The results showed: ①The patients' conditions abruptly deteriorated when the burn wound sepsis emerged;②The major cause related to burn wound sepsis was extensive burn injuries, with large areas of deep burn remaining open; ③Although wound swabs taken on admission revealed the presence of colonization by many pathogenic bacteria, Pseudomonas aeruginosa was one of the most frequent bacteria isolated from the subeschar tissue; ④The plasma concentrations of IL-6, IL-8, TNF and LPS before surgical intervention were significantly higher than that after surgical intervention (P<0.05) ;⑤The lowest level of the inflammatory mediators was observed when the patients' conditions became stable, as compared with before surgical intervention (P<0. 001).These findings suggest that the clinical characteristics of burn wound sepsis are abrupt deterioration of the general condition and prominent septic symptoms, often complicated by MODS. The main cause of burn wound sepsis is the presence of a large area of open deep burn wounds, which should be excised and covered early. LPS and pro-inflammatory mediators play an important role in the pathogenesis of burn wound sepsis. Although success in treating these patients is the result of appropriate application of multiple treatments, early, aggressive and thorough surgical excision of invasive burn infectious tissue and closure of wound play a crucial role in the successful treatment of patients complicated by burn wound sepsis. Other treatments are adjuvant but also important.

  17. Surgical management of large scalp infantile hemangiomas

    Directory of Open Access Journals (Sweden)

    Imad S Khan

    2014-01-01

    Full Text Available Background: Infantile Hemangiomas (IH are the most common benign tumor of infancy, occurring in over 10% of newborns. While most IHs involute and never require intervention, some scalp IHs may cause severe cosmetic deformity and threaten tissue integrity that requires surgical excision. Case Description: We present our experience with two infants who presented with large scalp IH. After vascular imaging, the patients underwent surgical resection of the IH and primary wound closure with excellent cosmetic outcome. We detail the surgical management of these cases and review the relevant literature. Conclusion: In some cases the IHs leave behind fibro-fatty residuum causing contour deformity. Surgery is often required for very large lesions causing extensive anatomical and/or functional disruption. The goal of surgical intervention is to restore normal anatomic contour and shape while minimizing the size of the permanent scar.

  18. Use of platelet-rich fibrin over skin wounds: Modified secondary intention healing

    Directory of Open Access Journals (Sweden)

    Chirag B Desai

    2013-01-01

    Full Text Available The healing process after any surgical intervention has always posed a challenge for the surgeons. In spite of the advances in wound closure techniques and devices, there is a crucial need for newer methods of enhancing the healing process to achieve optimal outcomes. Fibrin adhesives and platelet concentrates have proven useful in various treatment modalities in the fields of microvascular and plastic surgery. This case report shows its unique use in the field of maxillofacial and cutaneous surgery. It shows an innovative technique of enhancement of skin wound healing by local application of platelet-rich fibrin.

  19. Wound healing, angiotensin-converting enzyme inhibition, and collagen-containing products: a case study.

    Science.gov (United States)

    Buscemi, Charles P; Romeo, CarolAnn

    2014-01-01

    The effects of multiple medications may impair or enhance wound healing. A review of the literature for drug side effects identified cell culture and case studies of angiotensin-converting enzyme inhibitors (ACEIs) impairing collagen deposition in cutaneous wounds; these medications have also been used to prevent or minimize keloid formation. A 71-year-old male patient presented with a venous leg ulcer (VLU), having incurred a crushing injury and fracture requiring surgical repair 16 years earlier. The patient's history was significant for obesity, smoking 1 cigar daily, hypertension, and lower extremity venous insufficiency; medications included amlodipine and lisinopril. The wound initially responded well to advanced wound products and compression, but wound healing subsequently stalled. A collagen-containing alginate dressing was added to the treatment regimen and the wound closed within 2 weeks. We postulate that lisinopril may have contributed to the observed delayed healing and targeted this potential impediment to wound healing with a readily available topical collagen-containing product resulting in a rapid wound closure after a significant delay in progress toward wound healing.

  20. The arterial supply of the cervical and thoracic spinal muscles and overlying skin: Anatomical study with implications for surgical wound complications.

    Science.gov (United States)

    Yue, Brian Yin Ting; le Roux, Cara Michelle; Corlett, Russell; De La Harpe, David; Richardson, Martin; Ashton, Mark

    2013-07-01

    Postoperative spinal wound dehiscence is a significant complication following the posterior midline approach. It is postulated that this approach disrupts the vasculature supplying the paraspinal muscles and overlying skin. Although the spinal vasculature has been investigated previously, the smaller arterioles have not been described in the context of the posterior midline approach. Eight cadaveric neck and posterior torso specimens were dissected after injection with a radio-opaque lead oxide mixture and subsequent radiographs taken were analyzed. The deep cervical, vertebral, superficial cervical, and occipital arteries consistently supplied the cervical paraspinal muscles. The latter two arteries also vascularized the overlying skin. The deep cervical arteries were found to be located lateral to the C3 to C6 vertebrae, vulnerable to damage with the posterior approach. In the thoracic region, the superior and posterior intercostal arteries consistently supplied the spinal muscles. In all specimens, two small anastomotic vessels posterior to the laminae were found connecting the intercostal artery perforators. Both the arterial perforators and their anastomotic channels were situated in the surgical field and susceptible to damage with the posterior approach. It is likely that the disruption in spinal vasculature contributes to the multifactorial problem of wound dehiscence with the posterior midline approach. Copyright © 2012 Wiley Periodicals, Inc.

  1. Assessment of platelet-derived growth factor using A splinted full thickness dermal wound model in bearded dragons (Pogona vitticeps).

    Science.gov (United States)

    Keller, Krista A; Paul-Murphy, Joanne; Weber, E P Scott; Kass, Philip H; Guzman, Sanchez-Migallon David; Park, Shin Ae; Raghunathan, Vijay Krishna; Gustavsen, Kate A; Murphy, Christopher J

    2014-12-01

    Wounds in reptiles are a common reason for presentation to a veterinarian. At this time there is limited information on effective topical medications to aid in wound closure. The objectives of this study were to translate the splinted, full-thickness dermal wound model, validated in mice, to the bearded dragon (Pogona vitticeps) and to determine the effect of topical becaplermin (BP), a platelet-derived growth factor (0.01%), on the rate of wound closure. Ten bearded dragons were anesthetized and two full-thickness cutaneous wounds were made on the dorsum of each lizard. Encircling splints were applied surrounding each wound and subsequently covered by a semi-occlusive dressing. Five lizards had one wound treated with BP and the adjacent wound treated with a vehicle control. Five additional lizards had one wound treated with saline and the second wound treated with a vehicle control. Wounds were imaged daily, and the wound area was measured using digital image analysis. The change in percentage wound closure over 17 days and the time to 50% wound closure was compared among the four treatment groups. There was no significant difference in wound closure rates between BP-treated and saline-treated wounds or in the time to 50% wound closure between any treatments. Vehicle-treated wounds adjacent to saline-treated wounds closed significantly slower than did BP (P < 0.010), saline (P < 0.001), and vehicle-treated wounds adjacent to BP-treated wounds (P < 0.013). Our preliminary study indicates that the splinted wound model, with modifications, may be used to determine wound closure rates in bearded dragons. When compared with saline, BP did not have a significant effect on wound closure rates, while the vehicle alone delayed wound closure. Histologic analysis of experimentally created wounds throughout the wound healing process is needed to further evaluate the effects of these treatments on reptile dermal wound healing.

  2. VAC therapy for the treatment of complex wounds after cardio-thoracic surgery.

    Science.gov (United States)

    De Caridi, Giovanni; Serra, Raffaele; Massara, Mafalda; Barone, Mario; Grande, Raffaele; Butrico, Lucia; Mastroroberto, Pasquale; de Franciscis, Stefano; Monaco, Francesco

    2016-10-01

    The aim of this study is to report our experience about the treatment of complex sternal and thoracic wounds following cardiothoracic surgery, using vacuum-assisted closure (VAC therapy. Twelve patients presenting with sternal (five cases) and thoracic (seven cases) wounds that were difficult to heal were treated through VAC therapy after the first surgical debridement. The duration of VAC application ranged from 12 to 36 days with an average hospital stay of 24·6 ± 11·4 days. During a mean follow-up of 12 months, we observed complete wound healing in seven cases (58·3%), in an average period of 25·5 ± 14·3 days; one patient died during follow-up, two patients were lost to follow-up and two patients required definitive surgical closure of the wound cavity. In conclusion, VAC therapy promotes faster wound healing, with shorter hospital stay and subsequent lesser in-hospital cost, reducing the mortality rate in the long run. It also promotes early rehabilitation and alleviates the need for a second procedure, thus improving patient satisfaction, with minimal discomfort or inconvenience.

  3. Role of recipient-site preparation techniques and post-operative wound dressing in the surgical management of vitiligo

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    Nour Al-Hadidi

    2015-01-01

    Full Text Available Vitiligo is an acquired skin disorder characterized by the destruction of melanocytes resulting in achromic macules and patches involving the affected skin. Multiple methods of treatments have emerged to manage vitiligo, including medical and surgical techniques. Among the surgical techniques described in the management of vitiligo are minipunch grafting, split-thickness skin grafting, hair follicle transplantation, suction blister grafting, and cultured and non-cultured autologous melanocyte transplantation. However, prior to grafting optimal recipient-site preparation is needed for graft survival and successful repigmentation outcomes. Similarly, post-operative care of the recipient site is vital to yielding a viable graft irrespective of the transplantation technique employed. This article reviews the multiple methods employed to prepare the recipient site in vitiligo surgeries and the post-surgical conditions which optimize graft viability. A pubmed search was conducted utilizing the key words listed below.

  4. Printing tattoo effect after use of Dermabond®Prineo® Skin closure system

    Directory of Open Access Journals (Sweden)

    Shabeer Ahmad Wani

    2017-03-01

    Full Text Available Abdominoplasty is a very common procedure in the plastic surgery practice and may lead to a variety of unfavorable results including incision site complications. The surgical adhesives system, which entered into daily practice to replace the need for subcuticular closure for skin, saves time and may have better wound appearance. Dermabond® Prineo® Skin Closure System (Ethicon Inc., Somerville, NJ, USA has two major components: 2–Octyl cyanoacrylate glue and a flexible, self-adhesive polyester mesh. It can be used with or without sutures, and has the added benefit of waterproofing, and microbial resistance. It also saves time. This case describes a male patient who experienced a “printing tattoo” effect following an elective procedure of abdominoplasty and the results after this closure system was used.

  5. Surgical treatment of tibial nonunion after wounding by high velocity missile and external fixators: A case report

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    Golubović Ivan

    2012-01-01

    Full Text Available Introduction. The missiles of modern firearms can cause severe fractures of the extremity. High velocity missile fractures of the tibia are characterized by massive tissue destruction and primary contamination with polymorphic bacteria. Treatment of these fractures is often complicated by delayed healing, poor position healing, nonhealing and bone tissue infection. Case Outline. We present the management of tibial nonunion after wounding by high velocity missile and primary treatment by external fixation in a 25-year-old patient. The patient was primarily treated with external fixation and reconstructive operations of the soft tissue without union of the fracture. Seven months after injury we placed a compression-distraction external fixator type Mitkovic and started with compression and distraction in the fracture focus after osteotomy of the fibula and autospongioplasty. We recorded satisfactory fracture healing and good functional outcome. Conclusion. Contamination and devitalization of the softtissue envelope increase the risk of infection and nonunion in fractures after wounding by high velocity missile. The use of the compression-distraction external fixator type Mitkovic may be an effective method in nonunions of the tibia after this kind of injury. [Projekat Ministarstva nauke Republike Srbije, br. III 41004

  6. 心血管外科医护一体化伤口治疗管理模式探讨%Investigation on the wound caring mode in the department of surgical cardiovascular

    Institute of Scientific and Technical Information of China (English)

    白阳静; 陈佳丽; 李梅; 陈红

    2012-01-01

    目的 探讨心血管外科医护一体化伤口治疗管理模式.方法 构建心血管外科医护一体化伤口治疗管理模式,对心血管外科伤口治疗进行规范化流程管理,实施12个月后,对比实施前246名患者和实施后271名患者的伤口愈合情况、平均住院日,同时单纯随机抽取60名患者进行模式实施前后的满意度调查,应用秩和检验、t检验进行模式实施前后效果比较.结果 应用医护一体化的伤口治疗管理模式12个月后,患者满意度及伤口愈合情况明显改善,患者平均住院日缩短,差异有统计学意义(P<0.05).结论 医护一体化伤口治疗管理模式有利于提高伤口治疗效果、促进医护合作,取得良好的社会效益.%OBJECTIVE To explore the implementation and effects of the Doctor-Nurse Integration Wound Caring Mode in the caring of surgical cardiovascular wound. METHODS We established the Doctor-Nurse Integration Wound Caring Mode in the surgical Cardiovascular wound caring for 12 months. The effects of this mode were evaluated by wound healing and patient satisfaction about wound care. Rank sura test was used to analyze data to compare the effect of the implementation of the Doctor-Nurse Integration Wound Caring Mode. 246 patients before implementation and 271 patients after implementation were compared to assess the effect of wound healing rate. Random sampling method was used to select 60 patients to assess patient satisfaction. RESULTS After implementation of the Doctor-Nurse Integration Wound Caring Mode for 12 months, the patients' satisfaction and the wound healing were statistically significantly improved (P< 0.05) , and the average inpalient day was significantly decreased (P< 0.05). CONCLUSION The Doctor-Nurse Integration Wound Caring Mode is useful to improve effectiveness of wound caring, patient satisfaction and efficiency of society.

  7. Triclosan-coated sutures and sternal wound infections: a prospective randomized clinical trial.

    Science.gov (United States)

    Steingrimsson, S; Thimour-Bergström, L; Roman-Emanuel, C; Scherstén, H; Friberg, Ö; Gudbjartsson, T; Jeppsson, A

    2015-12-01

    Surgical site infection is a common complication following cardiac surgery. Triclosan-coated sutures have been shown to reduce the rate of infections in various surgical wounds, including wounds after vein harvesting in coronary artery bypass grafting patients. Our purpose was to compare the rate of infections in sternotomy wounds closed with triclosan-coated or conventional sutures. A total of 357 patients that underwent coronary artery bypass grafting were included in a prospective randomized double-blind single-center study. The patients were randomized to closure of the sternal wound with either triclosan-coated sutures (Vicryl Plus and Monocryl Plus, Ethicon, Inc., Somerville, NJ, USA) (n = 179) or identical sutures without triclosan (n = 178). Patients were followed up after 30 days (clinical visit) and 60 days (telephone interview). The primary endpoint was the prevalence of sternal wound infection according to the Centers for Disease Control and Prevention (CDC) criteria. The demographics in both groups were comparable, including age, gender, body mass index, and rate of diabetes and smoking. Sternal wound infection was diagnosed in 43 patients; 23 (12.8%) sutured with triclosan-coated sutures compared to 20 (11.2%) sutured without triclosan (p = 0.640). Most infections were superficial (n = 36, 10.1%), while 7 (2.0%) were deep sternal wound infections. There were 16 positive cultures in the triclosan group and 17 in the non-coated suture group (p = 0.842). The most commonly identified main pathogens were Staphylococcus aureus (45.4%) and coagulase-negative staphylococci (36.4%). Skin closure with triclosan-coated sutures did not reduce the rate of sternal wound infection after coronary artery bypass grafting. (clinicaltrials.gov: NCT01212315).

  8. Saliva and wound healing.

    Science.gov (United States)

    Brand, Henk S; Ligtenberg, Antoon J M; Veerman, Enno C I

    2014-01-01

    Oral wounds heal faster and with less scar formation than skin wounds. One of the key factors involved is saliva, which promotes wound healing in several ways. Saliva creates a humid environment, thus improving the survival and functioning of inflammatory cells that are crucial for wound healing. In addition, saliva contains several proteins which play a role in the different stages of wound healing. Saliva contains substantial amounts of tissue factor, which dramatically accelerates blood clotting. Subsequently, epidermal growth factor in saliva promotes the proliferation of epithelial cells. Secretory leucocyte protease inhibitor inhibits the tissue-degrading activity of enzymes like elastase and trypsin. Absence of this protease inhibitor delays oral wound healing. Salivary histatins in vitro promote wound closure by enhancing cell spreading and cell migration, but do not stimulate cell proliferation. A synthetic cyclic variant of histatin exhibits a 1,000-fold higher activity than linear histatin, which makes this cyclic variant a promising agent for the development of a new wound healing medication. Conclusively, recognition of the many roles salivary proteins play in wound healing makes saliva a promising source for the development of new drugs involved in tissue regeneration.

  9. Does closure of chronic pilonidal sinus still remain a matter of debate after bilateral rotation flap? (N-shaped closure technique

    Directory of Open Access Journals (Sweden)

    Awad Mohamed

    2006-01-01

    Full Text Available Background: Controversy still exists about the exact cause of pilonidal sinus either acquired or congenital, and also about what is the best surgical technique for the treatment of the disease. We successfully treated chronic pilonidal sinus with a new flap technique {N-shaped bilateral rotation flap} for closure of the defect. Materials and Methods: Thirty-two patients (30 men and two women were treated by eccentric elliptical excision of the diseased tissues down to the postsacral fascia and closure of the defect with our flap [which is a random pattern flap], then a closed suction drain was placed at the base of the wound, with its tip being brought out in the gluteal region at least 5 cm lateral to the lower end of the suture line. Results: All our patients healed completely without recurrence during a period of average follow-up of two years. Mean hospital stay was 1.5 days (range 1-5 days. Mean time to complete healing was 11.9 days (range 6-18 days. Mean time off work was 13.7 days (range 10-21 days. Two patients had wound infection and one patient a partial breakdown. The recurrence rate was 0%. Conclusions: A tension-free suture via bilateral rotation flaps with a good suction at the button of the wound for drainage of blood from the bottom of the wound is the key to the success of repair without recurrence.

  10. Computed tomography scan to detect traumatic arthrotomies and identify periarticular wounds not requiring surgical intervention: an improvement over the saline load test.

    Science.gov (United States)

    Konda, Sanjit R; Davidovitch, Roy I; Egol, Kenneth A

    2013-09-01

    To report our experience with computed tomography (CT) scans to detect traumatic arthrotomies of the knee (TAK) joint based on the presence of intra-articular air. Retrospective review. Level I trauma center. Sixty-two consecutive patients (63 knees) underwent a CT scan of the knee in the emergency department and had a minimum of 14 days follow-up. Cohort of 37 patients (37 knees) from the original 62 patients who underwent a saline load test (SLT). CT scan and SLT. Positive traumatic arthrotomy of the knee (+TAK) was defined as operating room (OR) confirmation of an arthrotomy or no intra-articular air on CT scan (-iaCT) (and -SLT if performed) with follow-up revealing a septic knee. Periarticular wound equivalent to no traumatic arthrotomy (pw = (-TAK)) was defined as OR evaluation revealing no arthrotomy or -iaCT (and -SLT if performed) with follow-up revealing no septic knee. All 32 knees with intra-articular air on CT scan (+iaCT) had OR confirmation of a TAK and none of these patients had a knee infection at a mean follow-up of 140.0 ± 279.6 days. None of the 31 patients with -iaCT had a knee infection at a mean follow-up of 291.0 ± 548.1 days. Based on these results, the sensitivity and specificity of the CT scan to detect +TAK and pw = (-TAK) was 100%. In a subgroup of 37 patients that received both a CT scan and the conventional SLT, the sensitivity and specificity of the CT scan was 100% compared with 92% for the SLT (P wounds that do not require surgical intervention and should be considered a valid diagnostic test in the appropriate clinical setting. Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

  11. Combination of adrenomedullin with its binding protein accelerates cutaneous wound healing.

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    Juan-Pablo Idrovo

    Full Text Available Cutaneous wound continues to cause significant morbidity and mortality in the setting of diseases such as diabetes and cardiovascular diseases. Despite advances in wound care management, there is still an unmet medical need exists for efficient therapy for cutaneous wound. Combined treatment of adrenomedullin (AM and its binding protein-1 (AMBP-1 is protective in various disease conditions. To examine the effect of the combination treatment of AM and AMBP-1 on cutaneous wound healing, full-thickness 2.0-cm diameter circular excision wounds were surgically created on the dorsum of rats, saline (vehicle or AM/AMBP-1 (96/320 μg kg BW was topically applied to the wound daily and wound size measured. At days 3, 7, and 14, skin samples were collected from the wound sites. AM/AMBP-1 treated group had significantly smaller wound surface area than the vehicle group over the 14-day time course. At day 3, AM/AMBP-1 promoted neutrophil infiltration (MPO, increased cytokine levels (IL-6 and TNF-α, angiogenesis (CD31, VEGF and TGFβ-1 and cell proliferation (Ki67. By day 7 and 14, AM/AMBP-1 treatment decreased MPO, followed by a rapid resolution of inflammation characterized by a decrease in cytokines. At the matured stage, AM/AMBP-1 treatment increased the alpha smooth muscle actin expression (mature blood vessels and Masson-Trichrome staining (collagen deposition along the granulation area, and increased MMP-9 and decreased MMP-2 mRNA expressions. TGFβ-1 mRNA levels in AM/AMBP-1 group were 5.3 times lower than those in the vehicle group. AM/AMBP-1 accelerated wound healing by promoting angiogenesis, collagen deposition and remodeling. Treatment also shortened the days to reach plateau for wound closure. Thus, AM/AMBP-1 may be further developed as a therapeutic for cutaneous wound healing.

  12. [Stab wounds in emergency department].

    Science.gov (United States)

    Bège, T; Berdah, S V; Brunet, C

    2013-12-01

    Stab wounds represent the most common cause of penetrating wounds, occurring mainly in case of aggression or suicide attempt. Clinical severity depends on the superficial or penetrating aspect of the wound, its location and damaged organs. Medical management must be known because the vital risk is involved in penetrating wounds. Hemodynamically unstable patients should be operated without delay after performing a chest X-ray and ultrasound Focus assisted sonography for trauma (FAST) to guide the surgery. In the stable patients, the general clinical examination, exploration of the wound and medical imaging detect injuries requiring surgical management. Stab penetrating wounds require close and rapid collaboration between medical teams, tailored to the institution's resources.

  13. [Environmental hygiene of the surgery suites for the control of surgical wound infection: Italian legislation and international guidelines].

    Science.gov (United States)

    Charrier, L; Castella, A; Di Legami, V; Pastorino, F; Farina, E C; Argentero, P A; Zotti, C M

    2006-01-01

    Aim of the study is to describe the application of surgical site infection (SSI) control procedures in general surgery operating rooms of Piedmont region hospitals. A specific data collection form was designed to record information. 54 questionnaires were compiled. Piedmont legislation related to operating rooms' equipment is obeyed in more than 90% of hospitals. Nevertheless, there are some critical aspects than could be risk factors for SSI or that are not useful in order to prevent them: use of UV radiation (11.3%), use of tacky mats at the entrance of the operating room (5.7%), special cleaning of operating rooms after contaminated or dirty operations (73.6%) and routine environmental sampling (10%) that is strongly recommended by ISPESL guideline in disagreement with international recommendations. Steam autoclave is used for surgical instruments sterilization by 100% of hospitals, but only 50% of them performs an annual validation of both autoclave performance and sterilization procedures. The study gave useful information in order to promote some structural modifications and personnel education for efficacious SSI prevention and control.

  14. Continuous irrigation and drainage for early postoperative deep wound infection after posterior instrumented spinal fusion.

    Science.gov (United States)

    Lian, Xiao-Feng; Xu, Jian-Guang; Zeng, Bing-Fang; Liu, Xiao-Kang; Li, Hao; Qiu, Man-le; Yang, Er-Zhu

    2014-12-01

    A retrospective study of clinical cases. To evaluate the efficacy of continuous irrigation and drainage for early postoperative deep wound infection after posterior instrumented spinal fusion. Aggressive debridement and irrigation has been recommended to treat postoperative wound infections after instrumented spinal fusion. However, this method of management, indicating repeating visits to the operating room until the wound is clean enough for closure, often results in prolonged hospitalization, increased cost, and sometimes compromise of the desired outcome. We hypothesize that repeat visits to the operating room for debridements can be avoided by aggressive debridements and primary closure with continuous irrigation and drainage for postoperative wound infections. From 2004 to 2009, 23 patients with early postoperative deep wound infections after spinal fusion with instrumentation were surgically treated with thorough debridement and primary closure with continuous irrigation and drainage. All patients were followed up for 30.6 months (range, 24-54 mo). The mean duration of irrigation was 12.0 days (range, 7-16 d). In 21 patients (91.3%), the wound healed after continuous irrigation. The removal of the instrumentation or cages was not required in any case. Spinal fusion was achieved in all cases, except 1, where the patient developed a pseudoarthrosis at the L4-L5 level after L4-S1 fusion. The mean ODI for these 23 patients improved significantly from 53.4±18.7 preoperatively to 18.3±11.2 at the final follow-up visit (Pirrigation and drainage is an effective and safe method for the treatment of early postoperative deep wound infection after posterior instrumented spinal fusion.

  15. Comparison of suture materials for subcuticular skin closure at cesarean delivery.

    Science.gov (United States)

    Tuuli, Methodius G; Stout, Molly J; Martin, Shannon; Rampersad, Roxane M; Cahill, Alison G; Macones, George A

    2016-10-01

    Subcuticular skin closure with suture after cesarean has been shown to result in lower rates of wound complications than with staple closure. However, the optimal choice of suture material for subcuticular skin closure is unclear. Vicryl (a braided multifilament synthetic suture; Ethicon, Somerville, NJ) and Monocryl (a monofilament synthetic suture; Ethicon) are the commonly used suture materials for subcuticular closure of transverse skin incisions after cesarean in the United States. Whereas in vitro and animal studies suggest multifilament suture materials may be associated with a higher risk of wound infection than monofilament sutures, clinical data on their relative effectiveness are limited. We sought to test the hypothesis that Vicryl is associated with a higher rate of wound complications than Monocryl. This is a secondary analysis of data from a randomized trial in which pregnant women undergoing scheduled or unscheduled cesareans were randomly assigned to preoperative skin preparation with either chlorhexidine-alcohol or iodine-alcohol. Women with low transverse skin incisions who were closed with either 4-0 Monocryl or 4-0 Vicryl were included in this analysis. Choice of suture material was at the discretion of the operating physician. The primary outcome was superficial or deep surgical site infection within 30 days after cesarean. Secondary outcomes were other wound complications. Outcomes were compared between the 2 groups using univariable and multivariable statistics. Of 1082 patients who had follow-up after discharge in the primary trial, 871 had subcuticular suture: 180 with 4-0 Vicryl and 691 with 4-0 Monocryl. Skin closure with Vicryl or Monocryl did not significantly differ between women allocated to chlorhexidine-alcohol or iodine-alcohol (51.1% vs 49.4%, P = .67). There was no significant difference in the risk of surgical site infection in women closed with Vicryl compared with Monocryl (11 [6.1%] vs 35 [5.1%]; P = .58; adjusted odds

  16. Experimental study of vacuum-assisted closure on deep partial-thickness burn wound of pig%封闭负压治疗对猪深Ⅱ度烧伤创面的影响

    Institute of Scientific and Technical Information of China (English)

    陈斓; 谢卫国; 叶子青; 赵超莉; 栾夏刚

    2015-01-01

    Objective To investigate the effect of Vacuum-assisted closure(VAC)technology on deep partial-thickness burn wound of pigs.Methods A total of 1 8 deep partial-thickness burn wounds were established by the temperature and pressure controlled perm instrument on 3 ordinary pigs back symmetrically,6 per pig.The wounds were randomly divided into 3 groups:which were treated by vacuum-assisted closure therapy with continuous model,discontinuous model or treated by conventional dressing therapy corresponding.The wounds were placed without any treatment in 24 hours,after that,the two VAC therapy groups were given corresponding modes of vacuum-assisted closure treatment with the pressure of-1 25mmHg,while conventional dressing therapy group received iodophor vaseline gauze dressing treatment. The dates of wound area,wound healing rate were collected and analyzed at right away、3、6、9、1 4 days post treatment.Specimens from wounds were harvested for histopathology observation,including cell proliferation index and the number of vascular endothelial cells.The dates were analyzed by one way ANOVA and multiple group comparison with LSD-t test.Results (1 )On the third day after treatment,the healing rate of VAC therapy group with continuous model and discontinuous model were (1 8.51 ±4.38)%,(1 4.26 ± 5.98)%,which were higher than the conventional dressing therapy group(3.86 ±2.35)%(t =56.552、40.1 39,P ★ 0.05, =0.001 ).On 3 d,the healing rate of both VAC therapy group were (24.74 ± 3.25)%,20.55 ±3.43)%,which were still higher than the conventional dressing therapy group(1 3.41 ± 4.08)%(t =5.473,3.432,P ★ 0.05,=0.004).On 9 d,those were (49.81 ±3.88)%,(46.96 ± 3.1 6)%,which were higher than the conventional dressing therapy group(34.29 ±6.69)%(t =5.563, 4.541 ,P ★ 0.05).(2)The healing time of VAC therapy group of continuous model was (1 1 .67 ±0.52) d,while that discontinuous model was (1 1 .50 ±1 .05)d,both were statistically difference compared to the

  17. Puncture Wounds

    Science.gov (United States)

    ... page. Please enable Javascript in your browser. Puncture Wounds What Is a Puncture Wound? Puncture wounds are not the same as cuts. ... professional treatment right away. Foreign Bodies in Puncture Wounds A variety of foreign bodies can become embedded ...

  18. Wound Care.

    Science.gov (United States)

    Balsa, Ingrid M; Culp, William T N

    2015-09-01

    Wound care requires an understanding of normal wound healing, causes of delays of wound healing, and the management of wounds. Every wound must be treated as an individual with regard to cause, chronicity, location, and level of microbial contamination, as well as patient factors that affect wound healing. Knowledge of wound care products available and when negative pressure wound therapy and drain placement is appropriate can improve outcomes with wound healing. Inappropriate product use can cause delays in healing. As a wound healing progresses, management of a wound and the bandage material used must evolve.

  19. Thrombin as important factor for cutaneous wound healing: comparison of fibrin biomatrices in vitro and in a rat excisional wound healing model.

    Science.gov (United States)

    Gugerell, Alfred; Pasteiner, Waltraud; Nürnberger, Sylvia; Kober, Johanna; Meinl, Alexandra; Pfeifer, Sabine; Hartinger, Joachim; Wolbank, Susanne; Goppelt, Andreas; Redl, Heinz; Mittermayr, Rainer

    2014-01-01

    Fibrin biomatrices have been used for many years for hemostasis and sealing and are a well-established surgical tool. The objective of the present study was to compare two commercially available fibrin biomatrices regarding the effect of their thrombin concentration on keratinocytes and wound healing in vitro and in vivo. Keratinocytes showed significant differences in adhesion, viability, and morphology in the presence of the fibrin matrices in vitro. A high thrombin concentration (800-1,200 IU/mL) caused deteriorated cell compatibility. By using a thrombin inhibitor, those differences could be reversed. In a rat excisional wound healing model, we observed more rapid wound closure and less wound severity in wounds treated with a fibrin matrix containing a lower concentration of thrombin (4 IU/mL). Furthermore, fewer new functional vessels and a lower level of vascular endothelial growth factor were measured in wounds after 7 days treated with the matrix with higher thrombin concentration. These in vivo results may be partially explained by the in vitro biocompatibility data. Additionally, results show that low thrombin biomatrices were degraded faster than the high thrombin material. Hence, we conclude that the composition of fibrin biomatrices influences keratinocytes and therefore has an impact on wound healing.

  20. Surgical wound healing using hemostatic gauze scaffold loaded with nanoparticles containing sustained-release granulocyte colony-stimulating factor

    Directory of Open Access Journals (Sweden)

    Yuan W

    2011-12-01

    Full Text Available Weien Yuan1,2, Zhenguo Liu11Department of Neurology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 2School of Pharmacy, Shanghai Jiao Tong University, Shanghai, People's Republic of ChinaBackground: The therapeutic strategies for malignant melanoma are still cancer chemotherapy, radiotherapy, and tumor resection. However, these therapeutic strategies often lead to a reduced neutrophilic granulocyte count or loss of more blood after surgical tumor resection. In this study, we developed a formulation of hemostatic gauze impregnated with sustained-release granulocyte colony-stimulating factor (G-CSF with increasing of the neutrophilic granulocyte count in the blood following chemotherapy and decreasing blood loss after surgical tumor resection.Methods: We designed a formulation with both hemostatic properties and increased neutrophil content to be used in cancer chemotherapy, radiotherapy, and tumor resection, comprising a hemostatic gauze as a scaffold and (G-CSF-loaded dextran nanoparticles coated with polylactic-co-glycolic acid (PLGA solution fabricated by direct spray-painting onto the scaffold and then vacuum-dried at room temperature. The performance of this system was evaluated in vitro and in vivo.Results: Nearly zero-order release of G-CSF was recorded for 12–14 days, and the cumulative release of G-CSF retained over 90% of its bioactivity in a NFS-60 cell line proliferation assay when the scaffold was incubated in phosphate-buffered saline (pH 7.4 at 37°C. The in vivo hemostatic efficacy of this formulation was greater than that of native G-CSF, the scaffold directly spray-painted with G-CSF solution or PLGA organic solution as a coating, or when a blank scaffold was covered with the coating.Conclusion: Our results suggest that this formulation has both hemostatic properties and increased neutrophil activity.Keywords: hemostatic gauze scaffold, granulocyte colony-stimulating factor, bioactivity

  1. Do inflammatory markers portend heterotopic ossification and wound failure in combat wounds?

    Science.gov (United States)

    Forsberg, Jonathan A; Potter, Benjamin K; Polfer, Elizabeth M; Safford, Shawn D; Elster, Eric A

    2014-09-01

    After a decade of war in Iraq and Afghanistan, we have observed an increase in combat-related injury survival and a paradoxical increase in injury severity, mainly because of the effects of blasts. These severe injuries have a devastating effect on each patient's immune system resulting in massive upregulation of the systemic inflammatory response. By examining inflammatory mediators, preliminary data suggest that it may be possible to correlate complications such as wound failure and heterotopic ossification (HO) with distinct systemic and local inflammatory profiles, but this is a relatively new topic. We asked whether systemic or local markers of inflammation could be used as an objective means, independent of demographic and subjective factors, to estimate the likelihood of (1) HO and/or (2) wound failure (defined as wounds requiring surgical débridement after definitive closure, or wounds that were not closed or covered within 21 days of injury) in patients sustaining combat wounds. Two hundred combat wounded active-duty service members who sustained high-energy extremity injuries were prospectively enrolled between 2008 and 2012. Of these 200 patients, 189 had adequate followups to determine the presence or absence of HO, and 191 had adequate followups to determine the presence or absence of wound failure. In addition to injury-specific and demographic data, we quantified 24 cytokines and chemokines during each débridement. Patients were followed clinically for 6 weeks, and radiographs were obtained 3 months after definitive wound closure. Associations were investigated between these markers and wound failure or HO, while controlling for known confounders. The presence of an amputation (p wound surface area (p = 0.001; OR, 1.01; 95% CI, 1.002-1.009), serum interleukin (IL)-3 (p = 0.002; OR, 2.41; 95% CI, 1.5-4.5), serum IL-12p70 (p = 0.01; OR, 0.49; 95% CI, 0.27-0.81), effluent IL-3 (p = 0.02; OR, 1.75; 95% CI, 1.2-2.9), and effluent IL-13 (p = 0.006; OR, 0

  2. EWMA Document: Negative Pressure Wound Therapy.

    Science.gov (United States)

    Apelqvist, Jan; Willy, Christian; Fagerdahl, Ann-Mari; Fraccalvieri, Marco; Malmsjö, Malin; Piaggesi, Alberto; Probst, Astrid; Vowden, Peter

    2017-03-01

    regulatory and reimbursement bodies in various countries regarding both study design and the ways in which results are interpreted. In response to this confusion, the European Wound Management Association (EWMA) has been publishing a number of interdisciplinary documents(15-19) with the intention of highlighting: The nature and extent of the problem for wound management: from the clinical perspective as well as that of care givers and the patients Evidence-based practice as an integration of clinical expertise with the best available clinical evidence from systematic research The nature and extent of the problem for wound management: from the policy maker and healthcare system perspectives The controversy regarding the value of various approaches to wound management and care is illustrated by the case of NPWT, synonymous with topical negative pressure or vacuum therapy and cited as branded VAC (vacuum-assisted closure) therapy. This is a mode of therapy used to encourage wound healing. It is used as a primary treatment of chronic wounds, in complex acute wounds and as an adjunct for temporary closure and wound bed preparation preceding surgical procedures such as skin grafts and flap surgery. Aim An increasing number of papers on the effect of NPWT are being published. However, due to the low evidence level the treatment remains controversial from the policy maker and health-care system's points of view-particularly with regard to evidence-based medicine. In response EWMA has established an interdisciplinary working group to describe the present knowledge with regard to NPWT and provide overview of its implications for organisation of care, documentation, communication, patient safety, and health economic aspects. These goals will be achieved by the following: Present the rational and scientific support for each delivered statement Uncover controversies and issues related to the use of NPWT in wound management Implications of implementing NPWT as a treatment strategy in the

  3. Laser-assisted skin closure at 1.32 microns: the use of a software-driven medical laser system

    Science.gov (United States)

    Dew, Douglas K.; Hsu, Tung M.; Hsu, Long S.; Halpern, Steven J.; Michaels, Charles E.

    1991-06-01

    center of the 9 cm incision. Experimental wounds were approximated using two evenly spaced subdermal 3.0 Vicryl' sutures and the dermis closed by laser sealing using the DLS YAG laser. Wounds were examined daily for the first seven days and followed for up to 20 months postoperatively. To facilitate wound edge approximation, surgical tape that is relatively transparent to 1.3 micron irradiation was used to hold the wound edges approximated while laser application occurred. Surgical tape was also applied to the "no-repair" suture and staple closures at the end of each procedure.

  4. Incisional Negative Pressure Wound Therapy

    DEFF Research Database (Denmark)

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

    Aim: Postoperative wound complications make many surgical procedures unnecessarily complex, particularly in high-risk patients. Negative Pressure Wound Therapy is well recognized in the management of open wounds. In recent years, it has been introduced as well in the management of closed surgical...... incisions to reduce postoperative wound complications, though the evidence base to support this intervention is limited. The aim of this study was to assess if Negative Pressure Wound Therapy (NPWT) reduces postoperative complications when applied on closed surgical incisions. Method: A systematic review...... 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...

  5. Supportive treatment using a compression garment vest of painful sternal instability following deep surgical wound infection: a case report

    Directory of Open Access Journals (Sweden)

    Klement Andreas

    2010-08-01

    Full Text Available Abstract Introduction Sternal dehiscence and instability poses a significant cause of persistent pain and limited quality of life following hospital discharge for 0.2% to 5% of patients who have undergone median sternotomy for open heart surgery. We report a successful, conservative, supportive long-term therapy of painful sternal non-union using a customized compression garment vest. Case presentation We report a case of painful sternal instability following open heart surgery in a 74-year-old Caucasian man. The complicating factors of obesity (body mass index of 40, renal failure, insulin-dependent diabetes mellitus and absolute arrhythmia with atrial fibrillation were present. Conclusion A number of studies have demonstrated the efficacy of surgical interventions for secondary sternal stabilization, but individual patients may reject this option or may be, for other reasons, no longer operable. The task of primary care physicians and other health care providers is to offer this group of patients an alternative option for pragmatic, inexpensive and effective supportive therapy, of which compression garments are an example.

  6. Surgical Management of Significant Maxillary Anterior Vertical Ridge Defects.

    Science.gov (United States)

    Urban, Istvan A; Monje, Alberto; Nevins, Myron; Nevins, Marc L; Lozada, Jamie L; Wang, Hom-Lay

    2016-01-01

    Severe vertical ridge deficiency in the anterior maxilla represents one of the most challenging scenarios in bone regeneration. Under ideal circumstances, guided bone regeneration in combination with soft tissue management has shown predictable esthetic and functional outcomes. Success largely relies on primary wound closure during and after the surgical procedure. Surgical sites present different challenges that need to be considered when designing the flap. The goal of this article is to propose a classification of flap designs that considers vestibular depth and scar formation around the periosteum when performing vertical ridge augmentation in the atrophic anterior maxilla. The four clinical conditions proposed under this classification are (1) shallow vestibule with healthy periosteum, (2) deep vestibule with healthy periosteum, (3) shallow vestibule with scarred periosteum, and (4) deep vestibule with scarred periosteum. The classification will allow clinicians to achieve tension-free closure and more predictable vertical bone gain.

  7. Cytological characterization of wound healing in diabetic patients on the background of the VAC-therapy

    Directory of Open Access Journals (Sweden)

    Besedin A.M.

    2016-05-01

    Full Text Available Recently the vacuum therapy of wounds (Vacuum-assisted closure, VAC is traditionally used method of treatment of wound complications in patients with diabetes in the majority of surgical departments of relevant profile in Ukraine. Due to publications of Ukrainian authors including the popularization of this treatment method, its therapeutic effects and significant advantages as compared with the traditionally used method of treating wounds by dressing in a moist environment (Moist Wound Healing has led to a number of unresolved issues relating to the application VAC-therapy. One of those is the way of assessment of wound process course on a background of the VAC-therapy. One of the most accessible and easy means of diagnostics of wound healing course is the cytological smear of wounds. Despite the long-term use of cytological method of diagnosis of wounds, peculiarities of phase course of wound process in diabetic patients on the background of VAC-therapy remain poorly studied. As a result of our research it was determined that a statistically significant difference between the basic cytological indices in the vacuum group and conventional treatment are revealed by 9-10 days of treatment. A more favorable course of wound healing on the background of vacuum therapy of wounds was reflected in the reduction of neutrophils number from 186,2±10,13 in the first cytogram to 87,3±6,12 in the fourth, presence of fibroblasts on an average of 0.8 in the field of vision on 9-10 days of treatment, absence of a smear microflora print on 7-8 days of treatment. At the end of the treatment in the conventional treatment group degenerative-regenerative index was 0,65±0,37, in the vacuum group – 1,31±0,63.

  8. UTILIZAÇÃO DO ADESIVO METIL-2-CIANOACRILATO E FIO DE NÁILON NA REPARAÇÃO DE FERIDAS CUTÂNEAS DE CÃES E GATOS UTILIZATION OF THE METHYL-2-CYANOACRYLATE ADHESIVE AND THE NYLON SUTURE IN SURGICAL SKIN WOUNDS OF DOGS AND CATS

    Directory of Open Access Journals (Sweden)

    Vanja Andrade Gueiros

    2001-04-01

    Full Text Available Com o objetivo de avaliar e comparar clínica e histologicamente o uso do adesivo metil-2-cianoacrilato e do fio de náilon na reparação de feridas cirúrgicas de pele, foram utilizados cinco cães e cinco gatos adultos, clinicamente sadios. Seguindo o protocolo anestésico e cirúrgico habitual para cada espécie, foram feitas cinco incisões na pele da região costal do lado esquerdo e cinco do lado direito, com aproximadamente dois centímetros de comprimento. As feridas cirúrgicas do lado direito foram suturadas com fio de náilon cirúrgico 3-0 e as do lado esquerdo foram aproximadas e fixadas com o metil-2-cianoacrilato em ambas as espécies. Os animais foram submetidos a avaliações clínicas a cada três dias. Foram retirados fragmentos de pele para realização de biopsias aos três, seis, nove, doze e quinze dias após a cirurgia. Os resultados obtidos, tanto em cães quanto em gatos, não revelaram diferença clínica ou histológica entre os tratamentos utilizados.The purpose of this study is to evaluate and compare clinically and histologically the use of methyl-2-cyanoacrylate adhesive versus the nylon's suture in skin wounds closure. There were five adult mongrel dogs and cats, clinically healthy used. Following anaesthetical routine and surgical protocol, five incisions were made in the left costal region, and other five in right costal region, about 2cm in length, in both especies. The right side costal wounds were sutured with surgical nylon 3-0, and in the left side costal wounds methyl-2-cyanoacrylate was applied, in both species. The animals were submitted to clinical evaluation every three days, and a biopsy was realized at three, six, nine, twelve and fifteen days after the surgery. In both species, the results did not show any clinical or histologic difference when comparing the used treatments.

  9. Reducing the pathogen burden and promoting healing with polyhexanide in non-healing wounds: a prospective study.

    Science.gov (United States)

    Ceviker, K; Canikoglu, M; Tatlıoglu, S; Bagdatli, Y

    2015-12-01

    Polyhexamethylene biguanide (PHMB) is a novel wound antiseptic solution that has a broad antimicrobial spectrum and wound healing promoting effect, with minimal side effects. The aim of present study was to demonstrate the efficacy of the PHMB on the bacterial burden of non-healing wounds, the reduction in wound size or closure of the wound in comparison to Ringer's lactate solution (RLS) after 21 days of wound dressing. A second objective was to investigate the differences in the C-reactive protein (CRP) levels and white blood cell (WBC) counts between the two groups. In this prospective and open-cohort clinical study, patients who underwent cardiac surgery between July 2006 and August 2008 were included and placed in one of two groups, PHMB or RLS, by the block randomisation method. A wound care team, consisting of two surgeons, a wound care nurse and a microbiologist, was created. Classic moist dressings and wet compresses during dressing changes were applied at least once a day or as needed. During the 21 days of hospitalisation the team collected data on the wound healing status daily, on infection parameters every third day, and wound tissue for culture weekly. There were 40 patients recruited of which 9 were excluded, leaving 31 in the intention-to-treat analysis. Of these 15 received PHMB and 16 received RLS. Overall 17 of 31 (66.7% PHMB group, 43.8% RLS group, p=0.181) patients were treated successfully by closure of surgically sutured wounds or healing by secondary intention, the wound tissue cultures of 19 of 31 patients (47.4% PHMB, 52.6% RLS, p=0.886) were negative, and wound size of all the patients were significantly reduced in clinical observations. Although the CRP levels were reduced significantly within group comparisons in both groups (p<0.001), it was significantly lower after 12 days (p<0.05) in the PHMB group compared with the RLS group. The results of this study emphasise that the successful treatment of chronic non-healing wounds require a

  10. Early Healing Events after Periodontal Surgery: Observations on Soft Tissue Healing, Microcirculation, and Wound Fluid Cytokine Levels

    Science.gov (United States)

    Kaner, Doğan; Soudan, Mouaz; Zhao, Han; Gaßmann, Georg; Schönhauser, Anna; Friedmann, Anton

    2017-01-01

    Early wound healing after periodontal surgery with or without enamel matrix derivative/biphasic calcium phosphate (EMD/BCP) was characterized in terms of soft tissue closure, changes of microcirculation, and expression of pro- and anti-inflammatory cytokines in gingival crevicular fluid/wound fluid (GCF/WF). Periodontal surgery was carried out in 30 patients (18 patients: application of EMD/BCP for regeneration of bony defects; 12 patients: surgical crown lengthening (SCL)). Healthy sites were observed as untreated controls. GCF/WF samples were collected during two post-surgical weeks. Flap microcirculation was measured using laser Doppler flowmetry (LDF). Soft tissue healing was evaluated after two weeks. GCF/WF levels of interleukin 1β (IL-1β), tumour necrosis factor (TNF-α), IL-6, and IL-10 were determined using a multiplex immunoassay. Surgery caused similar reductions of flap microcirculation followed by recovery within two weeks in both EMD/BCP and SCL groups. GCF/WF and pro-inflammatory cytokine levels were immediately increased after surgery, and returned only partially to baseline levels within the two-week observation period. Levels of IL-10 were temporarily reduced in all surgical sites. Flap dehiscence caused prolonged elevated levels of GCF/WF, IL-1β, and TNF-α. These findings show that periodontal surgery triggers an immediate inflammatory reaction corresponding to the early inflammatory phase of wound healing, and these inflammation measures are temporary in case of maintained closure of the flap. However, flap dehiscence causes prolonged inflammatory exudation from the periodontal wound. If the biological pre-conditions for periodontal wound healing are considered important for the clinical outcome, care should be taken to maintain primary closure of the flap. PMID:28134829

  11. Wound healing in Mac-1 deficient mice.

    Science.gov (United States)

    Chen, Lin; Nagaraja, Sridevi; Zhou, Jian; Zhao, Yan; Fine, David; Mitrophanov, Alexander Y; Reifman, Jaques; DiPietro, Luisa A

    2017-05-01

    Mac-1 (CD11b/CD18) is a macrophage receptor that plays several critical roles in macrophage recruitment and activation. Because macrophages are essential for proper wound healing, the impact of Mac-1 deficiency on wound healing is of significant interest. Prior studies have shown that Mac-1(-/-) mice exhibit deficits in healing, including delayed wound closure in scalp and ear wounds. This study examined whether Mac-1 deficiency influences wound healing in small excisional and incisional skin wounds. Three millimeter diameter full thickness excisional wounds and incisional wounds were prepared on the dorsal skin of Mac-1 deficient (Mac-1(-/-) ) and wild type (WT) mice, and wound healing outcomes were examined. Mac-1 deficient mice exhibited a normal rate of wound closure, generally normal levels of total collagen, and nearly normal synthesis and distribution of collagens I and III. In incisional wounds, wound breaking strength was similar for Mac-1(-/-) and WT mice. Wounds of Mac-1 deficient mice displayed normal total macrophage content, although macrophage phenotype markers were skewed as compared to WT. Interestingly, amounts of TGF-β1 and its downstream signaling molecules, SMAD2 and SMAD3, were significantly decreased in the wounds of Mac-1 deficient mice compared to WT. The results suggest that Mac-1 deficiency has little impact on the healing of small excisional and incisional wounds. Moreover, the findings demonstrate that the effect of single genetic deficiencies on wound healing may markedly differ among wound models. These conclusions have implications for the interpretation of the many prior studies that utilize a single model system to examine wound healing outcomes in genetically deficient mice. © 2017 by the Wound Healing Society.

  12. Incidence of Ostomy Site Incisional Hernias after Stoma Closure.

    Science.gov (United States)

    Sharp, Stephen P; Francis, Jacquelyn K; Valerian, Brian T; Canete, Jonathan J; Chismark, A David; Lee, Edward C

    2015-12-01

    This study sought to evaluate the incidence of ostomy site incisional hernias after stoma reversal at a single institution. This is a retrospective analysis from 2001 to 2011 evaluating the following demographics: age, gender, indication for stoma, urgent versus elective operation, time to closure, total follow-up time, the incidence of and reoperation for stoma incisional hernia, diabetes, postoperative wound infection, smoking status within six months of surgery, body mass index, and any immunosuppressive medications. A total of 365 patients were evaluated. The median follow-up time was 30 months. The clinical hernia rate was 19 percent. Significant risk factors for hernia development were age, diabetes, end colostomies, loop colostomies, body mass index >30, and undergoing an urgent operation. The median time to clinical hernia detection was 32 months. Sixty-four percent of patients required surgical repair of their stoma incisional hernia. A significant number of patients undergoing stoma closure developed an incisional hernia at the prior stoma site with the majority requiring definitive repair. These hernias are a late complication after stoma closure and likely why they are under-reported in the literature.

  13. [Open digit amputation in cattle: Surgery, wound healing and follow-up].

    Science.gov (United States)

    Devaux, D; Steiner, A; Pipoz, F; Nuss, K

    2017-06-01

    The aim of this retrospective study was to document secondary wound healing and outcome in 20 cattle that had undergone digit amputation at the level of the distal metaphysis of the first phalanx between April 2009 and June 2015. The surgical technique for amputation was simple and fast, and granulation tissue covered the stump of the first phalanx 9 to 30 days postoperatively. Complications associated with wound healing were seen in 7 animals and in 3, a second surgery was required; all 20 cattle were discharged from the clinic. Epithelial closure was complete after a mean of 3 months (range, 2 to 7 months). The mean postoperative survival time was 15 months (range, 1 to 34 months), and 6 animals were still alive at the time of follow-up inquiry. Wound healing and long-term outcome did not differ between cattle that had undergone a more intensive aftercare regime than those with a less intensive postoperative treatment.

  14. Wound healing in urology.

    Science.gov (United States)

    Ninan, Neethu; Thomas, Sabu; Grohens, Yves

    2015-03-01

    Wound healing is a dynamic and complex phenomenon of replacing devitalized tissues in the body. Urethral healing takes place in four phases namely inflammation, proliferation, maturation and remodelling, similar to dermal healing. However, the duration of each phase of wound healing in urology is extended for a longer period when compared to that of dermatology. An ideal wound dressing material removes exudate, creates a moist environment, offers protection from foreign substances and promotes tissue regeneration. A single wound dressing material shall not be sufficient to treat all kinds of wounds as each wound is distinct. This review includes the recent attempts to explore the hidden potential of growth factors, stem cells, siRNA, miRNA and drugs for promoting wound healing in urology. The review also discusses the different technologies used in hospitals to treat wounds in urology, which make use of innovative biomaterials synthesised in regenerative medicines like hydrogels, hydrocolloids, foams, films etc., incorporated with growth factors, drug molecules or nanoparticles. These include surgical zippers, laser tissue welding, negative pressure wound therapy, and hyperbaric oxygen treatment.

  15. Telemedicine for wound management

    Directory of Open Access Journals (Sweden)

    Ravi K Chittoria

    2012-01-01

    Full Text Available The escalating physiological, psychological, social and financial burdens of wounds and wound care on patients, families and society demand the immediate attention of the health care sector. Many forces are affecting the changes in health care provision for patients with chronic wounds, including managed care, the limited number of wound care therapists, an increasingly ageing and disabled population, regulatory and malpractice issues, and compromised care. The physician is also faced with a number of difficult issues when caring for chronic wound patients because their conditions are time consuming and high risk, represent an unprofitable part of care practice and raise issues of liability. Telemedicine enhances communication with the surgical wound care specialist. Digital image for skin lesions is a safe, accurate and cost-effective referral pathway. The two basic modes of telemedicine applications, store and forward (asynchronous transfer and real-time transmission (synchronous transfer, e.g. video conference, are utilized in the wound care setting. Telemedicine technology in the hands of an experienced physician can streamline management of a problem wound. Although there is always an element of anxiety related to technical change, the evolution of wound care telemedicine technology has demonstrated a predictable maturation process.

  16. Use of a portable, single-use negative pressure wound therapy device in home care patients with low to moderately exuding wounds: a case series.

    Science.gov (United States)

    Hurd, Theresa; Trueman, Paul; Rossington, Alan

    2014-03-01

    Negative pressure wound therapy (NPWT) is widely used in the management of acute and chronic wounds. The purpose of this 8-week study was to evaluate outcomes of using a new canisterless, portable, single-use NPWT system in patients with wounds treated in a Canadian community healthcare setting. The device is designed to provide negative pressure at 80±20 mm Hg, 24 hours a day of continuous usage, for a maximum wear time of 7 days. Data on wound outcomes, including exudate levels, wound appearance, and wound area, were collected weekly by a Registered Nurse as part of routine practice. When treatment was discontinued, patients and nurses were asked to rate their satisfaction with the device. Data from patients who had used a conventional NPWT device to manage their wounds were retrospectively abstracted from their medical records. In the prospective study, conducted between October 2011 and July 2012, 326 patients (median age=61 years; range 17-91 years) with wounds of mixed etiology (53 pressure ulcers, 21 venous leg ulcers, 16 diabetic foot ulcers, and 15 traumatic and 221 surgical wounds) were treated for a maximum of 8 weeks with the portable NPWT device. The majority of patients (228 out of 326; 68%) achieved complete wound closure within 8 weeks of treatment. The Kaplan-Meier estimate of median time to healing of all wounds was 9 weeks. The majority of patients (318 patients, 97%) reported they were pleased or satisfied with the dressing performance. Nurses indicated satisfaction with the dressing performance for all but two patients (99%). The majority (89%) of patients managed with conventional NPWT (n=539) had an open surgical wound with moderate or high levels of exudate. Healing rates in the portable and conventional NPWT group were similar (10% to 11% per week). Portable, single-use NPWT has the potential to deliver good wound outcomes in community care settings and simplify the use of negative pressure for nurses and patients. Additional research is

  17. [Ozone-ultrasonic therapy in the treatment of purulent wounds].

    Science.gov (United States)

    Lipatov, K V; Sopromadze, M A; Shekhter, A B; Rudenko, T G; Emel'ianov, A Iu

    2002-01-01

    Based on planimetric, bacteriologic and histologic study high efficiency of local ozonotherapy of wound in combination with low-frequency ultrasound was demonstrated experimentally on rat model of infected purulent skin wound. This method was used in 45 patients with purulent wounds of soft tissues (postoperative, posttraumatic, burn, sore spot) that led to fast cleaning of wound surface, decrease of bacterial contamination and granulations. It permitted to eliminate inflammation and to create optimum conditions for wound closure.

  18. [Lincomycin applied to the alveolus on TCP carrier and its effect on wound healing after surgical extraction of a third molar].

    Science.gov (United States)

    Wiśniewska, Izabela; Slósarczyk, Anna; Myśliwiec, Leszek; Sporniak-Tutak, Katarzyna

    2009-01-01

    The dental surgeon is often confronted by complications particularly after extraction ofunerupted lower third molars. The most common complication is alveolar periostitis. The healing process after extraction is accompanied by physiologic atrophy of the alveolus involving on the average 30% of bone tissue. Beta-tricalcium phosphate (TCP) is a synthetic material used in medicine to fill up bone defects caused by pathologic processes. The properties of TCP are appropriate for the material to be used as a carrier for drugs, in particular antibiotics. This study was undertaken to determine whether lincomycin applied to the alveolus on TCP carrier can be used to accelerate wound healing and reduce inflammation after surgical extraction of a third molar. We enrolled 80 patients (males and females between the age of 18 and 50 years) who underwent extraction of a third molar at the Department of Dental Surgery, Pomeranian Medical University in Szczecin. Surgical difficulty in the patients according to the Pederson scale corresponded to grade 2 or 3 (medium or high difficulty). The study group consisted of 40 patients who received lincomycin on TCP. Beta-tricalcium phosphate (300-700 microm pores) obtained from the Department of Technology of Ceramics and Refractories, AGH University of Science and Technology in Cracow, was soaked with 500 mg of lincomycin in solution and applied to the dental alveolus after tooth extraction. The alveolus was tightly sutured. The control group comprised 40 patients not treated with lincomycin. The patients reappeared for examination on the first, third, and seventh day after surgery. Attention during follow-up was directed to alveolar periostitis, pain, and trismus. Pain intensity was assessed with the 10-degree Visual Analog Scale (VAS). We analyzed the subjective pain intensity reported during follow-up by the patients. In the study group, 20 patients reported no pain 24 hours after extraction. On the third day after surgery, alveolar

  19. Impact of single- vs double-layer closure on adverse outcomes and uterine scar defect: a systematic review and metaanalysis.

    Science.gov (United States)

    Roberge, Stéphanie; Demers, Suzanne; Berghella, Vincenzo; Chaillet, Nils; Moore, Lynne; Bujold, Emmanuel

    2014-11-01

    A systematic review and metaanalysis were performed through electronic database searches to estimate the effect of uterine closure at cesarean on the risk of adverse maternal outcome and on uterine scar evaluated by ultrasound. Randomized controlled trials, which compared single vs double layers and locking vs unlocking sutures for uterine closure of low transverse cesarean, were included. Outcomes were short-term complications (endometritis, wound infection, maternal infectious morbidity, blood transfusion, duration of surgical procedure, length of hospital stay, mean blood loss), uterine rupture or dehiscence at next pregnancy, and uterine scar evaluation by ultrasound. Twenty of 1278 citations were included in the analysis. We found that all types of closure were comparable for short-term maternal outcomes, except for single-layer closure, which had shorter operative time (-6.1 minutes; 95% confidence interval [CI], -8.7 to -3.4; P type of uterine closure for optimal maternal outcomes and is insufficient to conclude about the risk of uterine rupture. Single-layer closure and locked first layer are possibly coupled with thinner residual myometrium thickness.

  20. [Prophylactic Effectiveness of Vacuum-assisted Closure for High-risk Patients Undergoing Cardiovascular Surgery through Median Sternotomy].

    Science.gov (United States)

    Takazawa, Ippei; Misawa, Yoshio; Uesugi, Satoshi; Sugaya, Akira; Akutsu, Hirohiko; Kurumisawa, Souki; Satoh, Hirotaka; Muraoka, Arata; Aizawa, Kei; Ohki, Shinichi; Kawahito, Koji

    2017-08-01

    Vacuum-assisted closure(VAC) therapy is mainly used for tissue defects. VAC therapy can remove exudate that could impair the healing process. We applied VAC therapy in patients considered at high risk of surgical site infection who underwent cardiovascular surgery via standard median sternotomy. Risk factors included advanced heart failure, obesity, diabetes mellitus, steroid administration, immunosuppressant administration, and chronic renal failure, etc. VAC therapy was used in 134 patients. Only 3 of these patients (2.2%) developed surgical site infection caused by Staphylococcus epidermidis;2 patients fully recovered after prolonged VAC therapy for 2 weeks, and the other required an additional sternal fixation after the sternal wires were removed for wound infection control. No patient developed infective mediastinitis. Prophylactic VAC therapy can reduce postoperative wound infection in high risk patients undergoing open heart surgery via full sternotomy.

  1. Spontaneous closure of traumatic tympanic membrane perforations

    DEFF Research Database (Denmark)

    Jellinge, Marlene Ersgaard; Kristensen, S.; Larsen, K

    2015-01-01

    BACKGROUND: The treatment of traumatic tympanic membrane perforations varies in different investigations, ranging from observation to early surgical repair. The present study aimed to focus on the closure rate and the closure time in a group of patients treated with a watchful waiting policy. MET...

  2. The Role of Dermal Matrices in Treating Inflammatory and Diabetic Wounds.

    Science.gov (United States)

    Climov, Mihail; Bayer, Lauren R; Moscoso, Andrea V; Matsumine, Hajime; Orgill, Dennis P

    2016-09-01

    Dermal matrices are used to improve healing in both acute and chronic wounds including diabetic and lower extremity wounds, burns, trauma, and surgical reconstruction. The use of dermal matrices for the closure of inflammatory ulcerations is less frequent but growing. Currently available products include decellularized dermis and semisynthetic matrices. A review of the published literature was performed to identify reports that use acellular dermal matrices in diabetic and inflammatory wounds. Studies were evaluated for quality and outcomes, and a level of evidence was assigned according to the American Society of Plastic Surgeons' Rating Levels of Evidence. Case studies from the authors' experience are also presented. Seventeen primary studies evaluating the use of dermal matrices in diabetic ulcers were identified with 2 based on level I data. There are no prospective clinical trial reports of their use in atypical or inflammatory wounds, but there are several case studies. Treatment of diabetic and inflammatory wounds may include both medical and surgical modalities. The use of dermal matrices can be a useful adjunct, but their optimal use will require future clinical studies.

  3. Effects of platelet-rich plasma gel on skin healing in surgical wound in horses Efeitos do gel de plasma rico em plaquetas na cicatrização de feridas cirúrgicas na pele de cavalos

    Directory of Open Access Journals (Sweden)

    Rafael DeRossi

    2009-08-01

    Full Text Available PURPOSE: To establish a low-cost method to prepare platelet-rich plasma (PRP and evaluates the potential of platelet derived factors to enhance wound healing in the surgical wounds in equine. METHODS: To obtain a PRP gel, calcium gluconate and autologous thrombin were added to platelet-rich plasma. For the tests six saddle horses were used and two surgical incisions were made in each animal. Wounds were treated with PRP gel or untreated. Sequential wound biopsies collected at Treatment 1: at days 5 and 30 and Treatment 2: at days 15 and 45 post wounding permitted comparison of differentiation markers and wound repair. RESULTS: The optimal platelets enrichment over 4.0 time's baseline values was obtained using 300 g for 10 min on the first centrifugation and 640 g for 10 min on the second centrifugation. CONCLUSION: Wounds treated with PRP gel exhibit more rapid epithelial differentiation and enhanced organization of dermal collagen compared to controls in equineOBJETIVO: Estabelecer um método econômico na preparação de plasma rico em plaquetas (PRP e avaliar se os fatores derivados destas plaquetas aceleram a cicatrização de feridas cirúrgicas em cavalos. MÉTODOS: Gluconato de cálcio e trombina autógena foram adicionados ao PRP para a obtenção do gel de PRP. Foram usados seis cavalos de sela, cada um dos quais sofreu duas incisões cirúrgicas. Uma destas incisões foi tratada com gel de PRP e a outra suturada de maneira tradicional (controle. A biópsia das feridas foi coletada de maneira seqüencial; Tratamento 1. nos dias 5 e 30 e Tratamento 2. nos dias 15 e 45 do período pós-operatório permitindo uma comparação na diferenciação epitelial e no reparo das feridas. RESULTADOS: O enriquecimento das plaquetas obtido através de uma primeira centrifugação usando 300 g por 10 minutos e uma segunda 640 g por 10 minutos acelerou quatro vezes a reparação tecidual em relação ao controle. CONCLUSÃO: As feridas tratadas com gel

  4. Acceleration of cutaneous wound healing by brassinosteroids.

    Science.gov (United States)

    Esposito, Debora; Rathinasabapathy, Thirumurugan; Schmidt, Barbara; Shakarjian, Michael P; Komarnytsky, Slavko; Raskin, Ilya

    2013-01-01

    Brassinosteroids are plant growth hormones involved in cell growth, division, and differentiation. Their effects in animals are largely unknown, although recent studies showed that the anabolic properties of brassinosteroids are possibly mediated through the phosphoinositide 3-kinase/protein kinase B signaling pathway. Here, we examined biological activity of homobrassinolide (HB) and its synthetic analogues in in vitro proliferation and migration assays in murine fibroblast and primary keratinocyte cell culture. HB stimulated fibroblast proliferation and migration and weakly induced keratinocyte proliferation in vitro. The effects of topical HB administration on progression of wound closure were further tested in the mouse model of cutaneous wound healing. C57BL/6J mice were given a full-thickness dermal wound, and the rate of wound closure was assessed daily for 10 days, with adenosine receptor agonist CGS-21680 as a positive control. Topical application of brassinosteroid significantly reduced wound size and accelerated wound healing in treated animals. mRNA levels of transforming growth factor beta and intercellular adhesion molecule 1 were significantly lower, while tumor necrosis factor alpha was nearly suppressed in the wounds from treated mice. Our data suggest that topical application of brassinosteroids accelerates wound healing by positively modulating inflammatory and reepithelialization phases of the wound repair process, in part by enhancing Akt signaling in the skin at the edges of the wound and enhancing migration of fibroblasts in the wounded area. Targeting this signaling pathway with brassinosteroids may represent a promising approach to the therapy of delayed wound healing.

  5. 88例骨科手术切口感染手术护理要点分析%The nursing essentials for surgical wound infection after bone surgery in 88 patients

    Institute of Scientific and Technical Information of China (English)

    郭汉卿; 谢婉萍

    2012-01-01

    目的 探讨并分析骨科手术后切口的感染情况.方法 2008年3月至2011年3月于我院因骨科就诊并行手术的1884例中发生了感染88例,对其切口类型、患者情况进行问卷调查分类总结,同时,将伤口的感染部分送检区分感染细菌种类.结果 Ⅲ类切口的感染率最高,为2.49%;感染发生在手术的5~8天之间,为61.36%;感染的病原菌以G-杆菌为主,占77.27%.结论 改善手术切口的感染需要提高患者自身的健康卫生知识、加强医护人员对患者的关心及重视和提高院方的控制感染的管理.%Objective To investigate and analyze the occurrence of surgical wound incision after bone surgery.Methods 88 patients who had developed surgical wound infection after bone surgery during the period of March 2008 to March 201 1 were surveyed by questionnaires for types of incision and patient conditions.The infected parts of surgical wound was tested for identifying types of related bacteria.Results Type Ⅲ incision had the highest infection rate of 2.49%.61.36% of the wound infection eccurred 5 to 8 days after bone surgery.G- bacillus was the main pathogenic bacteria,accounting for 77.27%.Conclusions Control of surgical wound infection after bone surgery needs an increase in self knowledge of health,enhancement of patient care from medical staff,and strengthened management of infection control.

  6. Novel dural incision and closure procedure for preventing postoperative cerebrospinal fluid leakage during the surgical removal of dumbbell-shaped spinal tumors: technical note.

    Science.gov (United States)

    Ito, Kiyoshi; Aoyama, Tatsuro; Nakamura, Takuya; Hanaoka, Yoshiki; Horiuchi, Tetsuyoshi; Hongo, Kazuhiro

    2016-11-01

    The authors report on a new method for removing dumbbell-shaped spinal tumors that avoids the risk of postoperative cerebrospinal fluid (CSF) leakage. Adequate visualization of the intra- and extradural components of the tumor is achieved with the use of separate dural incisions. First, the dura mater is opened along the dural theca to provide adequate visualization of the intradural portion of the mass; then, a second incision is made along the nerve root to remove the extradural component. Meticulous suturing is essential in intradural lesion cases; however, the dura mater is usually thin and fragile in such cases. During suturing with a needle and thread, the dura mater can become lacerated proximal to the needle holes and result in CSF leakage. In the authors' technique, instead of using a needle and thread, nonpenetrating vascular clips were used to close the dural incisions. When operating on dumbbell-shaped spinal tumors, the authors found that the "separate-dural-incision method" was preferable to the conventional T-shaped dural incision method because no dural defects occurred after the intradural procedure and meticulous dural closure with vascular clips was achieved. The authors conclude that the novel separate-dural-incision method for removing dumbbell-shaped tumors and the use of nonpenetrating vascular clips permits reliable dural closure, prevents postoperative CSF leakage, and promises good postoperative clinical results.

  7. Quality improvement initiative: Preventative Surgical Site Infection Protocol in Vascular Surgery.

    Science.gov (United States)

    Parizh, David; Ascher, Enrico; Raza Rizvi, Syed Ali; Hingorani, Anil; Amaturo, Michael; Johnson, Eric

    2017-01-01

    Objective A quality improvement initiative was employed to decrease single institution surgical site infection rate in open lower extremity revascularization procedures. In an attempt to lower patient morbidity, we developed and implemented the Preventative Surgical Site Infection Protocol in Vascular Surgery. Surgical site infections lead to prolonged hospital stays, adjunctive procedure, and additive costs. We employed targeted interventions to address the common risk factors that predispose patients to post-operative complications. Methods Retrospective review was performed between 2012 and 2016 for all surgical site infections after revascularization procedures of the lower extremity. A quality improvement protocol was initiated in January 2015. Primary outcome was the assessment of surgical site infection rate reduction in the pre-protocol vs. post-protocol era. Secondary outcomes evaluated patient demographics, closure method, perioperative antibiotic coverage, and management outcomes. Results Implementation of the protocol decreased the surgical site infection rate from 6.4% to 1.6% p = 0.0137). Patient demographics and comorbidities were assessed and failed to demonstrate a statistically significant difference among the infection and no-infection groups. Wound closure with monocryl suture vs. staple proved to be associated with decreased surgical site infection rate ( p surgical site infections in the vascular surgery population are effective and necessary. Our data suggest that there may be benefit in the incorporation of MRSA and Gram-negative coverage as part of the Surgical Care Improvement Project perioperative guidelines.

  8. Use of vacuum assisted closure in instrumented spinal deformities for children with postoperative deep infections

    Directory of Open Access Journals (Sweden)

    Canavese Federico

    2010-01-01

    Full Text Available Background: Postoperative deep infections are relatively common in children with instrumented spinal deformities, whose healing potential is somewhat compromised. Children with underlying diagnosis of cerebral palsy, spina bifida and other chronic debilitating conditions are particularly susceptible. Vacuum-assisted closure (VAC is a newer technique to promote healing of wounds resistant to treatment by established methods. This article aims to review the efficacy of the VAC system in the treatment of deep spinal infections following spinal instrumentation and fusion in children and adolescents. Materials and Methods: We reviewed 33 patients with deep postoperative surgical site infection treated with wound VAC technique. We reviewed clinical and laboratory data, including the ability to retain the spinal hardware, loss of correction and recurrent infections. Results : All patients successfully completed their wound VAC treatment regime. None had significant loss of correction and one had persistent infection requiring partial hardware removal. The laboratory indices normalized in all but three patients. Conclusions: Wound VAC technique is a useful tool in the armamentarium of the spinal surgeon dealing with patients susceptible to wound infections, especially those with neuromuscular diseases. It allows for retention of the instrumentation and maintenance of the spinal correction. It is reliable and easy to use.

  9. WOUND INFECTION AFTER SCOLIOSIS SURGERY: AN ANALYSIS OF 15 CASES

    Institute of Scientific and Technical Information of China (English)

    李书纲; 仉建国; 李军伟; 林进; 田野; 翁习生; 邱贵兴

    2002-01-01

    Objective. To discuss the causes and treatments of wound infections after scoliosis surgery. Methods. Nine hundred and twenty-four cases of scoliosis were reviewed, and the clinical data of 15 cases of postoperative infection were analysed retrospectively. Results. All 15 cases underwent spinal posterior fusion with autologous bone graft using instrumentations. Seven were diagnosed as early infection, and 8 were delayed infection. Radical debridement was performed in all 15 cases. The duration of antibiotics administration was 10 to 34 days with continuous closed irrigation for 2~ 4 weeks and primary closure for the wounds. All patients were followed up for an average of 3.5 years (2 to 7.5 years) with good outcomes and no recurrence. Conclusion. Wound infection following surgical correction of scoliosis primarily results from intraoperative seeding, although host-related and operation-related factors may contribute to its development. Once the infections are diagnosed, good results can be achieved by prompt surgical debridement, irrigation and reasonably administered antibiotics. Removal of hardware may be necessary in deep infections.

  10. Comparing primary and secondary wound healing discomfort after mandibular third molar surgery: a randomized, double-blind clinical trial.

    Science.gov (United States)

    Refo'a, Youshiaho; Ouatik, Nabil; Golchin, Foroogh; Mahboobi, Nima

    2011-01-01

    Extraction of impacted mandibular third molars is one of the most common procedures in the oral cavity and often is followed by pain, swelling, and postextraction alveolitis and trismus. It has been suggested that postoperative discomfort is in relation to the type of surgical wound healing. The aim of this study was to compare pain, swelling, and maximum mouth opening in two groups of patients with primary and secondary wound healing after impacted mandibular third molar surgery. Thirty-two patients were enrolled in this study and randomly divided into two equal groups, quantitatively and by gender. After the surgical procedures, 16 patients received primary wound closure, while the other 16 participants received secondary wound closure. A visual analog scale was used to collect pain data three days after the surgeries. A checklist was used to record data regarding swelling size and maximum mouth opening before, immediately following, three days after, and one week after surgery. Frequency tests and a t-test were used for statistical analysis and a P value of complications such as pain, maximal mouth opening, and swelling size after impacted mandibular third molar extractions.

  11. Surgical procedures in pinniped and cetacean species.

    Science.gov (United States)

    Higgins, Jennifer L; Hendrickson, Dean A

    2013-12-01

    Significant advances in veterinary diagnostic and surgical techniques have been made over the past several decades. Many of these advances, however, have not reached the field of marine mammal medicine. A number of limitations exist: risks of anesthesia, anatomical challenges, difficulties with wound closure, environmental constraints, equipment limitations, and perceived risks. Despite these limitations, surgical treatments have been successfully utilized in marine mammals. While surgery is performed in pinnipeds more frequently than in cetaceans, studies conducted in the 1960s and 1970s on dolphin sleep and hearing demonstrated that general anesthesia can be successfully induced in cetaceans. Since this pioneering work, a small number of successful surgeries have been performed in dolphins under both general anesthesia and heavy sedation. While these surgical procedures in pinnipeds and cetaceans have typically been limited to wound management, dentistry, ophthalmic procedures, fracture repair, and superficial biopsy, a number of abdominal surgeries have also been performed. Recently there have been pioneering successes in the application of minimally invasive surgery in marine mammals. Many of the anatomical challenges that almost prohibit traditional laparotomies in cetacean species and present challenges in pinnipeds can be overcome through the use of laparoscopic techniques. Due to the limited number of pinnipeds and cetaceans in captivity and, thus, the limited case load for veterinarians serving marine mammal species, it is vital for knowledge of surgical procedures to be shared among those in the field. This paper reviews case reports of surgical procedures, both traditional and laparoscopic, in pinnipeds and cetaceans. Limitations to performing surgical procedures in marine mammals are discussed and surgical case reports analyzed in an effort to determine challenges that must be overcome in order to make surgery a more feasible diagnostic and treatment

  12. Vacuum Assisted Closure (VAC) therapyTM as a swiss knife multi-tool for enteric fistula closure: tips and tricks: a pilot study.

    Science.gov (United States)

    Pepe, G; Magalini, S; Callari, C; Persiani, R; Lodoli, C; Gui, D

    2014-01-01

    Enterocutaneous fistulas (ECFs) are an uncommon surgical problem, but they are characterized by a difficult management. Vacuum-assisted closure (VAC) therapy is a method utilized for chronic and traumatic wound healing. At first, VAC therapy had been contraindicated in the treatment of intestinal fistulas, but as time went by, VAC therapy revealed itself to be a "Swiss knife multi-tool". This paper presents some clinical cases of enterocutaneous (ECF) and enteroatmospheric fistulas (EAF) treated with VAC therapy™. The history of 8 patients treated for complex fistulas was revised. Four of them presented with enterocutaneous and four with enteroatmospheric fistulas. All were treated with VAC therapy with variations elaborated to help in accelerated closure of intestinal wall lesions. Four out of four ECFs closed spontaneously. In the EAF group, in three cases the fistula turned slowly into an entero-cutaneous fistula, and in one out of four it closed spontaneously. The mean length of VAC therapy™ was 35.5 days and that of spontaneous closure was 36.4 days. The results of our study encourage the use of VAC therapy™ for the treatment of enterocutaneous fistulas. VAC therapy™ use has a double therapeutic value: (1) it promotes the healing of the skin and allows also the management of EAFs; (2) in selected cases, those in which it is possible to create a deep fistula tract ("well") it is possible to assist to a complete healing with closure of the ECFs.

  13. Forces driving epithelial wound healing

    Science.gov (United States)

    Brugués, Agustí; Anon, Ester; Conte, Vito; Veldhuis, Jim H.; Gupta, Mukund; Colombelli, Julien; Muñoz, José J.; Brodland, G. Wayne; Ladoux, Benoit; Trepat, Xavier

    2014-09-01

    A fundamental feature of multicellular organisms is their ability to self-repair wounds through the movement of epithelial cells into the damaged area. This collective cellular movement is commonly attributed to a combination of cell crawling and `purse-string’ contraction of a supracellular actomyosin ring. Here we show by direct experimental measurement that these two mechanisms are insufficient to explain force patterns observed during wound closure. At early stages of the process, leading actin protrusions generate traction forces that point away from the wound, showing that wound closure is initially driven by cell crawling. At later stages, we observed unanticipated patterns of traction forces pointing towards the wound. Such patterns have strong force components that are both radial and tangential to the wound. We show that these force components arise from tensions transmitted by a heterogeneous actomyosin ring to the underlying substrate through focal adhesions. The structural and mechanical organization reported here provides cells with a mechanism to close the wound by cooperatively compressing the underlying substrate.

  14. Cell therapy for wound healing.

    Science.gov (United States)

    You, Hi-Jin; Han, Seung-Kyu

    2014-03-01

    In covering wounds, efforts should include utilization of the safest and least invasive methods with goals of achieving optimal functional and cosmetic outcome. The recent development of advanced wound healing technology has triggered the use of cells to improve wound healing conditions. The purpose of this review is to provide information on clinically available cell-based treatment options for healing of acute and chronic wounds. Compared with a variety of conventional methods, such as skin grafts and local flaps, the cell therapy technique is simple, less time-consuming, and reduces the surgical burden for patients in the repair of acute wounds. Cell therapy has also been developed for chronic wound healing. By transplanting cells with an excellent wound healing capacity profile to chronic wounds, in which wound healing cannot be achieved successfully, attempts are made to convert the wound bed into the environment where maximum wound healing can be achieved. Fibroblasts, keratinocytes, adipose-derived stromal vascular fraction cells, bone marrow stem cells, and platelets have been used for wound healing in clinical practice. Some formulations are commercially available. To establish the cell therapy as a standard treatment, however, further research is needed.

  15. Wound care dressings and choices for care of wounds in the home.

    Science.gov (United States)

    Adkins, Carrie L

    2013-05-01

    Statistics from various resources report that many patients in home healthcare settings have wounds. These vary from surgical, pressure, neuropathic, trauma, stasis, and venous wounds. These require the assessment, knowledge, and expertise of a clinician to assist them with wound care management. The purpose of this article is to identify and categorize types of wound care products appropriate for the various types of wounds that clinicians care for and manage in the home.

  16. Restaurant closures

    CERN Multimedia

    Novae Restauration

    2012-01-01

    Christmas Restaurant closures Please note that the Restaurant 1 and Restaurant 3 will be closed from Friday, 21 December at 5 p.m. to Sunday, 6 January, inclusive. They will reopen on Monday, 7 January 2013.   Restaurant 2 closure for renovation To meet greater demand and to modernize its infrastructure, Restaurant 2 will be closed from Monday, 17 December. On Monday, 14 January 2013, Sophie Vuetaz’s team will welcome you to a renovated self-service area on the 1st floor. The selections on the ground floor will also be expanded to include pasta and pizza, as well as snacks to eat in or take away. To ensure a continuity of service, we suggest you take your break at Restaurant 1 or Restaurant 3 (Prévessin).

  17. Endocytosis-dependent coordination of multiple actin regulators is required for wound healing.

    Science.gov (United States)

    Matsubayashi, Yutaka; Coulson-Gilmer, Camilla; Millard, Tom H

    2015-08-01

    The ability to heal wounds efficiently is essential for life. After wounding of an epithelium, the cells bordering the wound form dynamic actin protrusions and/or a contractile actomyosin cable, and these actin structures drive wound closure. Despite their importance in wound healing, the molecular mechanisms that regulate the assembly of these actin structures at wound edges are not well understood. In this paper, using Drosophila melanogaster embryos, we demonstrate that Diaphanous, SCAR, and WASp play distinct but overlapping roles in regulating actin assembly during wound healing. Moreover, we show that endocytosis is essential for wound edge actin assembly and wound closure. We identify adherens junctions (AJs) as a key target of endocytosis during wound healing and propose that endocytic remodeling of AJs is required to form "signaling centers" along the wound edge that control actin assembly. We conclude that coordination of actin assembly, AJ remodeling, and membrane traffic is required for the construction of a motile leading edge during wound healing.

  18. Vacuum-assisted closure : indications and clinical experience

    NARCIS (Netherlands)

    Schasfoort, RA; Obdeijn, MC; Nicolai, JPA; van der Werf, J.F.A.; de Lange, M.

    2000-01-01

    The use of subatmospheric pressure to promote wound healing has gradually found support in the past few years. The vacuum-assisted closure system uses a pump providing a continuous negative pressure of preferably 125 mmHg, which is distributed over the wound surface by an airtight covered foam. The

  19. Comparative study of the healing process of the aponeurosis of the anterior abdominal wall of rats after wound closure using 3-0 nylon suture and N-butil-2-cyanoacrylate tissue adhesive Estudo comparativo da cicatrização da aponeurose da parede abdominal anterior com a utilização do fio de poliamida monofilamentar 3-0 e o adesivo N-Butil-2-Cianoacrilato em ratos

    Directory of Open Access Journals (Sweden)

    Carlos Augusto Marques Batista

    2008-08-01

    Full Text Available PURPOSE: To investigate the healing process of the aponeurosis of the anterior abdominal wall of rats, comparing two different materials for wound closure: 3-0 nylon suture and tissue adhesive N-butyl-2-cyanoacrylate. METHODS: Forty-four Wistar rats were randomly divided into four groups according to the type of material used (suture or adhesive and the number of days until reoperation (seven or 14 days. After a 4 cm incision in the aponeurosis, 22 rats underwent wound closure using 3-0 nylon suture and the other 22, the tissue adhesive. After seven days, 11 rats from each group were weighed again, submitted to reoperation and then euthanized. The same procedure was carried out after 14 days with the remaining rats. The surgical wound was macroscopically examined, the tensile strength was measured and the tissue edges were histologically examined. The statistical analysis was performed using analysis of variance and Cox's proportional hazards model. Significance level was set at p OBJETIVO: Investigar o processo de cicatrização da aponeurose da parede abdominal anterior em ratos, comparando dois diferentes materiais de sutura: fio de poliamida monofilamentar 3-0 e adesivo N-butil-2-cianoacrilato. MÉTODOS: Quarenta e quatro ratos Wistar, foram divididos aleatoriamente em quatro grupos, de acordo com o material de síntese (fio e adesivo cirúrgico e o tempo de reoperação (7 e 14 dias. Após uma incisão de 4 cm na aponeurose, 22 animais foram submetidos à síntese com o fio de poliamida e os outros 22 animais com o adesivo proposto. Após o procedimento, aguardou-se um período de 7 e 14 dias, quando os animais, 11 de cada grupo, foram novamente pesados e submetidos à eutanásia, sendo realizada a avaliação macroscópica da ferida operatória, mensuração da força de ruptura da parede abdominal e estudo histológico das bordas da incisão. A análise estatística foi realizada através de um modelo de análise de variância e de riscos

  20. Incidence of surgical site infection in postoperative patients at a tertiary care centre in India.

    Science.gov (United States)

    Akhter, M Siddique J; Verma, R; Madhukar, K Premjeet; Vaishampayan, A Rajiv; Unadkat, P C

    2016-04-01

    A prospective observational was carried out to calculate the incidence of surgical site infections (SSI) along with the main risk factors and causative organisms in postoperative patients at a tertiary care setting in Mumbai. A total number of 1196 patients between June 2011 to March 2013 admitted to the general surgical ward or surgical ICU of our hospital were included in the study. Post laproscopy patients and organ space SSIs were excluded. Patient data were collected using a preformed pro forma and a wound Southampton score tabulated and checked repeatedly until suture removal of patient. Regular follow-up was maintained until at least 30 days postoperatively. The study showed a SSI rate of 11%. Risk factors associated with a higher incidence of SSI were found to be age (>55 years), diabetes mellitus (especially uncontrolled sugar in the perioperative period), immunocompromised patients (mainly HIV and immunosuppressive therapy patients), surgeon skill (higher in senior professors compared with junior residents), nature of the cases, (emergency surgeries), placement of drains, wound class (highest in dirty wounds), type of closure (multilayer closure), prolonged duration of hospital stay, longer duration of surgery (>2 hours), type of surgery (highest in cholecystectomy). The highest rates of causative organisms for SSIs found were Staphylococcus aureus, Escherichia coli and Klebsiella ssp. Prevention of SSIs requires a multipronged approach with particular emphasis on optimising preoperative issues, adhering religiously to strict protocols during the intraoperative period and addressing and optimising metabolic and nutritional status in postoperative period.

  1. 水胶体敷料预防Ⅰ期闭合结肠造瘘皮肤瘘口感染的效果%Effect of hydrocolloid dressings decreased the skin wound infected rate of theⅠstage colostomy closure

    Institute of Scientific and Technical Information of China (English)

    陶岚

    2011-01-01

    Objective To evaluate the effectiveness of the hydrocolloid dressings decreased the skin wound infected rate of theⅠ stage colostomy closure.Methods All of the forty-three patients with Ⅰ stage colostomy closure were randomly divided into two groups, study group (24 cases) received the hydrocolloid dressing care, and control group (19 cases) received the 3L adhesive wound dressing care. The skin wound infected rate, average postoperative hospital stay, and average postoperative change dressings cost were noted and compared between the two groups.Results The skin wound infected rate of the Ⅰstage colostomy closure in study group were significantly less than control group (4.16% vs 31.57%,χ2=5.8,P<0.05);the average hospital stay in study group were (6.03±1.17)d,it was significantly less than that the control group(13.64±4.09)d (t=-2.173,P<0.05);and the average postoperative change dressings cost in study group were significantly less than control group[(297.50±33.69)vs.(544.90±103.48)yuan, t=2.050,P<0.05].Conclusions Our study has demonstrated that the hydrocolloid dressings could decrease the skin wound infected rate, the average postoperative hospital stay, and the average postoperative change dressings cost of the Ⅰ stage colostomy closure. It would provide a new technique that could be used to treat this kind of wounds with high risk of infection.%目的 评价水胶体敷料预防Ⅰ期闭合结肠造瘘皮肤瘘口感染的效果.方法 将43例Ⅰ期闭合结肠造瘘皮肤瘘口患者随机分为实验组(24例)和对照组(19例),实验组使用水胶体敷料覆盖伤口,对照组使用3L商品切口敷贴,比较两组伤口感染率、平均住院日和术后伤口换药平均费用等指标.结果 实验组Ⅰ期闭合皮肤瘘口感染率4.16%,对照组为31.57%,差异有统计学意义(χ2=5.8,P<0.05);实验组术后平均住院(6.03±1.17)d,对照组(13.64±4.09)d,两组比较差异有统计学意义(t=-2.173,P<0.05);

  2. 简易封闭负压引流在足踝部软组织缺损治疗中的应用%Application of Simplified Vacuum-assisted Closure Wound Therapy in the Treatment of Ankle Soft Tissue Defect

    Institute of Scientific and Technical Information of China (English)

    陈淑贤; 李庐; 韦杏荣; 李文胜; 汪淼

    2016-01-01

    目的:探讨简易封闭式负压引流技术在足踝部软组织缺损治疗中的应用效果。方法选择我院骨科2013年1月至2015年5月收治的32例足踝部软组织缺损患者为实验组,并匹配2010年1月至2012年12月相同基线资料的30患者为对照组。对照组采用传统方法换药处理创面,实验组应用自制简易封闭式负压引流方法进行创面处理,待创面感染控制、创面肉芽组织新鲜后行二期缝合、植皮等方法修复创面,对比两组二期手术待术时间、二期手术前换药次数、住院天数及住院费用。结果实验组患者二期手术待术时间、二期手术前换药次数、住院天数及住院费用均低于对照组,差异均有统计学意义(均P<0.05)。结论应用简易封闭式负压引流技术治疗足踝部软组织缺损,能有效控制创面感染、促进肉芽组织生长、减少换药次数、减轻患者痛苦、缩短疗程、节约住院费用,提高社会、经济效益。%Objective To evaluate the clinical efficiency of simplified vacuum-assisted closure wound therapy in the treatment of foot and ankle soft tissue defect.Methods 32 cases of patients with foot and ankle soft tissue defect were selected as the experimental group from January 2013 to May 2015, while 30 cases of patients with the same baseline data were selected as the control group from January 2010 to December 2012.Patients in the control group were treated with the traditional method to deal with the wound, while those in the experimental group were treated with simplified vacuum-assisted closure wound therapy.All soft tissue defects were re-paired by means of skin-grafting or secondary closure after wound infection was eradicated and filled with fresh granulation tissue.Pre-operative interval time, frequency of dressing change, duration of hospitalization and hospital costs were compared.Results Preoper-ative interval time, frequency of dressing change

  3. Observation of Nursing Intervention on the Prevention of Surgical Wound Infection in Operation Room%护理干预对手术室外科伤口感染的预防效果观察

    Institute of Scientific and Technical Information of China (English)

    丛金萍

    2015-01-01

    目的:分析护理干预对手术室外科伤口感染的预防效果。方法将158例患者分为A、B两组各79例,分别给予护理干预及常规护理,分析两组护理效果。结果A组甲级愈合率高于B组,伤口感染率A组2.5%低于B组13.9%,P<0.05。结论护理干预可预防手术室外科伤口感染。%Objective To analyze the effect of nursing intervention on the prevention of surgical wound infection in operation room. Methods 158 patients were randomly divided into A,B two groups with 79 cases in each group,they were given nursing intervention and routine nursing care,the nursing effect of two groups were analyzed. Results In group A,Class-A healing rate was significantly higher than that of group B,wound infection in group A was 2.5%,lower than that in group B which was 13.9%,P<0.05. Conclusion Nursing intervention can prevent wound infection in operation room.

  4. Traumatic foot injuries in horses: surgical management.

    Science.gov (United States)

    Burba, Daniel J

    2013-01-01

    Managing traumatic foot wounds in horses may require surgical intervention. These wounds include coronary-band and heel-bulb lacerations, septic pedal osteitis, septic navicular bursitis, sepsis of the collateral cartilages, and hoof-wall injuries. This article provides a practical overview of the surgical management of these types of wounds.

  5. Surgical Closure of Patent Ductus Arteriosus via Left Subaxiliary Small Incision%左腋下小切口动脉导管夹闭术100例报告

    Institute of Scientific and Technical Information of China (English)

    刘勇; 刘健; 黄击修; 林小彬; 付建

    2011-01-01

    Objective To evaluate the value of surgical closure for patent ductus arteriosus (PDA) through a small left gubaxillary incision. Methods From January 2004 to January 2011, 100 patients who received Hetn-o-lok ligation for PDA were enrolled in this study. Results No perioperative death occurred in this series. The mean length of the small incision was (6. 5 ± 1. 8)cm, mean opration time (56 ±21) min, and mean hospital stay (9.7 ± 1.9) days. The patients were followed up for 2 months to 3 years with a mean of 2. 3 years, during which no re-patent or pseudo-aneurysma was detected. Conclusion Surgical closure through a small incision at the left subaxillary is safe, effective, and easy-to-perform for PDA with concealed incision and quick recovery.%目的 探讨左腋下小切口动脉导管夹闭术治疗动脉导管未闭(patent ductus arteriosus,PDA)的价值. 方法 2004年1月~2011年1月对100例PDA全麻下经左腋下小切口直视下借助Hem-o-lok结扎夹行动脉导管夹闭术. 结果 切口长度(6.5±1.8)cm,手术时间(56±21)min,术后住院时间(9.7±1.9)d.100例随访2个月~3年,平均2.3年,无再通及假性动脉瘤形成. 结论 经左腋下小切口动脉导管夹闭术是治疗PDA的有效方法,切口隐蔽,术后恢复快,安全可靠,操作简单,利于推广.

  6. Full-thickness splinted skin wound healing models in db/db and heterozygous mice: implications for wound healing impairment.

    Science.gov (United States)

    Park, Shin Ae; Teixeira, Leandro B C; Raghunathan, Vijay Krishna; Covert, Jill; Dubielzig, Richard R; Isseroff, Roslyn Rivkah; Schurr, Michael; Abbott, Nicholas L; McAnulty, Jonathan; Murphy, Christopher J

    2014-01-01

    The excisional dorsal full-thickness skin wound model with or without splinting is widely utilized in wound healing studies using diabetic or normal mice. However, the effects of splinting on dermal wound healing have not been fully characterized, and there are limited data on the direct comparison of wound parameters in the splinted model between diabetic and normal mice. We compared full-thickness excisional dermal wound healing in db/db and heterozygous mice by investigating the effects of splinting, semi-occlusive dressing, and poly(ethylene glycol) treatment. Two 8-mm full-thickness wounds were made with or without splinting in db/db and heterozygous mice. Body weights, splint maintenance, wound contraction, wound closure, and histopathological parameters including reepithelialization, wound bed collagen deposition, and inflammation were compared between groups. Our results show that silicone splint application effectively reduced wound contraction in heterozygous and db/db mice. Splinted wounds, as opposed to nonsplinted wounds, exhibited no significant differences in wound closure between heterozygous and db/db mice. Finally, polyethylene glycol and the noncontact dressing had no significant effect on wound healing in heterozygous or db/db mice. We believe these findings will help investigators in selection of the appropriate wound model and data interpretation with fully defined parameters.

  7. Autologous platelet concentrate and vacuum-assisted closure device use in a nonhealing total knee replacement.

    Science.gov (United States)

    Klayman, Myra H; Trowbridge, Cody C; Stammers, Alfred H; Wolfgang, Gary L; Zijerdi, David A; Bitterly, Thomas J

    2006-03-01

    Following a total knee replacement surgery, a 51-year-old insulin-dependent patient presented with complications of impaired healing and postoperative trauma to the wound site. The inability of this leg wound to heal placed this patient at risk of amputation. Vacuum-assisted closure therapy was initiated at postoperative day 53; after 100 days of protracted wound history a series of treatments with topical platelet concentrates were added to the vacuum assisted closure therapy and conventional wound care therapy. The previous nonhealing wound presented with good granulation and margination that enabled a skin graft with good take on postoperative day 150.

  8. Evaluation of Sternal Closure with Absorbable Polydioxanone Sutures in Children

    Directory of Open Access Journals (Sweden)

    Hamid Bigdelian

    2014-03-01

    Full Text Available Introduction: Sternal dehiscence, sternal wound infection and mediastinitis are troublesome complications following median sternotomy which are major causes of morbidity and mortality of patients. Synthetic polydioxanone absorbable suture seems effective in prevention of these complications in children undergoing open heart surgery.Methods: During 2 years period, 620 patients who underwent median sternotomy were studied. The efficacy of absorbable polydioxanone suture was tested on patients using figure-of-eight suture technique. The patients’ age ranged from newborn to 15 years old. All surgical interventions were performed according to a standard protocol.Results: No sternal sutures were broken during the sternal closure and no case of mediastinitis was seen. Two patients experienced sternal dehiscence (0.32%. Follow-up period of patients were established between 1 to 132 months after open heart surgery.Conclusion: Sternal closure with the polydioxanone suture in combination with figure-of-eight technique is a safe and suitable method in children with good clinical results.

  9. Wound healing and all-cause mortality in 958 wound patients treated in home care.

    Science.gov (United States)

    Zarchi, Kian; Martinussen, Torben; Jemec, Gregor B E

    2015-09-01

    Skin wounds are associated with significant morbidity and mortality. Data are, however, not readily available for benchmarking, to allow prognostic evaluation, and to suggest when involvement of wound-healing experts is indicated. We, therefore, conducted an observational cohort study to investigate wound healing and all-cause mortality associated with different types of skin wounds. Consecutive skin wound patients who received wound care by home-care nurses from January 2010 to December 2011 in a district in Eastern Denmark were included in this study. Patients were followed until wound healing, death, or the end of follow-up on December 2012. In total, 958 consecutive patients received wound care by home-care nurses, corresponding to a 1-year prevalence of 1.2% of the total population in the district. During the study, wound healing was achieved in 511 (53.3%), whereas 90 (9.4%) died. During the first 3 weeks of therapy, healing was most likely to occur in surgical wounds (surgical vs. other wounds: adjusted hazard ratio [AHR] 2.21, 95% confidence interval 1.50-3.23), while from 3 weeks to 3 months of therapy, cancer wounds, and pressure ulcers were least likely to heal (cancer vs. other wounds: AHR 0.12, 0.03-0.50; pressure vs. other wounds: AHR 0.44, 0.27-0.74). Cancer wounds and pressure ulcers were further associated with a three times increased probability of mortality compared with other wounds (cancer vs. other wounds: AHR 3.19, 1.35-7.50; pressure vs. other wounds: AHR 2.91, 1.56-5.42). In summary, the wound type was found to be a significant predictor of healing and mortality with cancer wounds and pressure ulcers being associated with poor prognosis. © 2015 by the Wound Healing Society.

  10. Management of postoperative instrumented spinal wound infection

    Institute of Scientific and Technical Information of China (English)

    FANG Xiu-tong; Kirkham B.Wood

    2013-01-01

    Background Wound infection following spinal instrumented surgery is a frequent complication.The optimal treatment of acute deep wound infection following spinal instrumentation fusion remains controversial because of variability in cohort identification,definition of an infection,and the instrument used to measure outcomes.This retrospective study evaluated the clinical curative effect for postoperative spinal infection after instrumented spine fusion with extensive debridement,or implant removal.Methods From January 2004 to October 2009,851 patients were identified who underwent surgical treatment of spinal diseases.The medical records of patients who developed infections were reviewed in detail.Results Of 851 patients,41 (4.9%) developed an infection.Thirty-three were acute,and eight were delayed.Acute infected cases were managed with antibiotic therapy,and aggressive debridement of the wound and soft tissues leaving all instrumentation in situ in all but one patient.The most common symptoms of acute infection included:posterior incisional drainage (26 of 33 patients),back pain (22 of 33 patients) and fever (13 of 33 patients).Among patients with delayed onset infection,five of eight patients had local pain,four of eight patients had incision drainage,and one patient had a prolonged period of intermittent fever.The most frequent causative organism for postoperative spinal infection following spine surgery is Staphylococcus aureus.Pseudarthrosis was noted in long-term follow-up in four of 41 patients.Conclusions We recommend irrigation and debridement,no instrumentation removal,and,if necessary,repeat debridement followed by delayed primary closure for the treatment of acute deep infection with instrumentation.

  11. Treatment of hypergranulation tissue in burn wounds with topical steroid dressings: a case series

    Directory of Open Access Journals (Sweden)

    Jaeger M

    2016-08-01

    Full Text Available Marie Jaeger,1,* Moti Harats,1,* Rachel Kornhaber,2 Uri Aviv,1 Amir Zerach,1 Josef Haik1,3 1Department of Plastic and Reconstructive Surgery, Sheba Medical Center, Tel Hashomer, Israel; 2School of Health Sciences, Faculty of Health, University of Tasmania, Sydney, NSW, Australia; 3Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel *These authors contributed equally to this work. Abstract: Hypergranulation tissue (or also known as overgranulation may negatively influence burn wound healing time and contribute to recurrence of contractures in burn wounds and grafts. Subsequently, the treatment of hypergranulation tissue remains controversial and problematic. In this case series, we aimed to examine the feasibility and document the use of topical hydrocortisone in the treatment of hypergranulation tissue formation resulting from burn wounds. We report five cases where hypergranulation tissue developed following deep dermal/full-thickness burns. Initial burn wound treatment included necrotic tissue debridement, wound cleansing, and Flaminal®. All five cases underwent surgical debridement and split-skin ­grafting. Upon identification of hypergranulation tissue, hydrocortisone acetate 0.25% was applied ­topically as usual care for the treatment of hypergranulation tissue. All five patients had deep dermal/full-thickness burns with a total body surface area ranging from 22% to 61% and were aged from 3–41 years. All five cases developed hypergranulation tissue during their admission after debridement and split-thickness skin grafts. All patients showed an improvement in the treated areas with a complete regression of hypergranulation tissue and closure of the burn wounds. No clinically apparent local or systemic side effects of the treatment were observed. Topical hydrocortisone can be utilized as an effective, inexpensive, and noninvasive practical option in the treatment of hypergranulation tissue resulting from burn wounds

  12. Design of closure works

    NARCIS (Netherlands)

    Verhagen, H.J.

    2007-01-01

    This chapter discusses the design aspects of estuary and river closures and those of reservoir dams and certain other hydraulic structures. The focus of this chapter is on closures, not on the situation after the closure has been completed.

  13. Surgical treatment and management of the severely burn patient: Review and update.

    Science.gov (United States)

    Gacto-Sanchez, P

    Since one of the main challenges in treating acute burn injuries is preventing infection, early excising of the eschar and covering of the wound becomes critical. Non-viable tissue is removed by initial aggressive surgical debridement. Many surgical options for covering the wound bed have been described, although split-thickness skin grafts remain the standard for the rapid and permanent closure of full-thickness burns. Significant advances made in the past decades have greatly improved burns patient care, as such that major future improvements in survival rates seem to be more difficult. Research into stem cells, grafting, biomarkers, inflammation control, and rehabilitation will continue to improve individualized care and create new treatment options for these patients. Copyright © 2017 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  14. Minimally invasive surgical technique for tethered surgical drains

    Directory of Open Access Journals (Sweden)

    Shane R Hess

    2017-01-01

    Full Text Available A feared complication of temporary surgical drain placement is from the technical error of accidentally suturing the surgical drain into the wound. Postoperative discovery of a tethered drain can frequently necessitate return to the operating room if it cannot be successfully removed with nonoperative techniques. Formal wound exploration increases anesthesia and infection risk as well as cost and is best avoided if possible. We present a minimally invasive surgical technique that can avoid the morbidity associated with a full surgical wound exploration to remove a tethered drain when other nonoperative techniques fail.

  15. Differential Regulation of a Fibroblast Growth Factor-Binding Protein during Skin Carcinogenesis and Wound Healing

    Directory of Open Access Journals (Sweden)

    Andreas Kurtz

    2004-09-01

    Full Text Available The initiation of premalignant lesions is associated with subtle cellular and gene expression changes. Here we describe a severe combined immunodeficient mouse xenograft model with human adult skin and compare chemical carcinogenesis and wound healing. We focus on a secreted binding protein for fibroblast growth factors (FGF-BP that enhances the activity of locally stored FGFs and is expressed at high levels in human epithelial cancers. Carcinogen treatment of murine skin induced papilloma within 6 weeks, whereas the human skin grafts displayed no obvious macroscopic alterations. Microscopic studies of the human skin, however, showed p53-positive keratinocytes in the epidermis, increased angiogenesis in the dermis of the treated skin, enhanced proliferation of keratinocytes in the basal layer, and an increase of FGF-BP protein and mRNA expression. In contrast, after surgical wounding of human skin grafts or of mouse skin, FGF-BP expression was upregulated within a few hours and returned to control levels after 2 days with wound closure. Enhanced motility of cultured keratinocytes and dermal fibroblasts by FGF-BP supports a role in wound healing. We conclude that adult human skin xenografts can be used to identify early molecular events during malignant transformation as well as transient changes during wound healing.

  16. Evidence-Based Medicine: Wound Management.

    Science.gov (United States)

    Jones, Christine M; Rothermel, Alexis T; Mackay, Donald R

    2017-07-01

    After reading this article, the participant should be able to: 1. Describe the basic science of chronic wounds. 2. Discuss the general and local factors that should be considered in any patient with a chronic wound. 3. Discuss the rationale of converting a chronic wound into an acute wound. 4. Describe techniques used to prepare chronic wounds. 5. Discuss the appropriate use of different dressings presented in this article. 6. Discuss the pros and cons of the adjuncts to wound healing discussed in this article. This is the second Maintenance of Certification article on wound healing. In the first, Buchanan, Kung, and Cederna dealt with the mechanism and reconstructive techniques for closing wounds. In this article, the authors have concentrated on the chronic wound. The authors present a summary of the basic science of chronic wounds and the general and local clinical factors important in assessing any chronic wound. The evidence for interventions of these conditions is presented. The surgical and nonsurgical methods of wound preparation and the evidence supporting the use of the popular wound dressings are presented. The authors then present the evidence for some of the popular adjuncts for wound healing, including hyperbaric oxygen, electrotherapy, and ultrasound. A number of excellent articles on negative-pressure wound therapy have been written, and are not covered in this article.

  17. Efficacy of Murva (Sansevieria roxburghiana Schult. and Schult.f.) as a suture material in closure of incisions in third molar surgeries: A prospective study.

    Science.gov (United States)

    Lambade, Pravin; Thorat, Ashutosh

    2017-01-01

    Adequate closure of the surgical wound is one of the most important aspects of surgery; improper suturing techniques or improper suturing materials sometimes compromise the success of surgery. Many synthetic materials have replaced the natural materials, which were once used for suturing in the ancient era, and Murva is one of them. There are references of Murva (Sansevieria roxburghiana Schult. and Schult.f.) at various contexts of "Sushruta Samhita" where it has been used as a suture material. It is a xerophytic herbaceous plant occurring abundantly in the eastern coastal region of India. The aim of this study is to evaluate the efficacy of Murva fibers as a suturing material in closure of intraoral incision in third molar surgeries. Fifty incisions (Wards incision) placed for the surgical removal of mandibular third molar were sutured with Murva, and follow-up was carried out postoperatively on 1(st), 2(nd), 3(rd), and 7(th) day. Patients were evaluated for pain, swelling, bleeding, infection, wound dehiscence, local tissue irritation, and bacterial colonization. On various follow-ups, progressively significant and predictable healing was observed without any uneventful evidence. The use of Murva as a suture material proved to be effective in closure of intraoral incisions.

  18. Experiences with waterjet hydrosurgery system in wound debridement

    Directory of Open Access Journals (Sweden)

    Gurunluoglu Raffi

    2007-05-01

    Full Text Available Abstract Background Recently, a new device, the Versajet™, involving "Hydrosurgery Technology" which combines lavage and sharp debridement instrumentation has been described for soft tissue debridement. Methods The Versajet™ Hydrosurgery System utilizes a reusable power console with foot pedal activation, disposable handpiece and tubing assembly in conjunction with sterile saline and standard waste receptacle. The purpose of this paper is to report our experiences with this instrument in debridement of a variety of wounds prior to final reconstructive surgery. Technical details and pitfalls are discussed to facilitate clinical use. Results Efficient, safe and fast debridement was achieved in all patients using the hydrosurgery system. The actual time the hydrosurgery system was used for debridement averaged as 15.5 minutes. In ten patients, an adequately debrided wound bed was achieved with a single operative procedure, in four patients; two stages were required prior to reconstructive surgery. In one patient with recurrent sacral-iscial pressure sore, two debridements were carried out followed by long term vacuum assisted closure. The postoperative course was uneventful in all patients, but in three with a minor breakdown of the skin graft, which eventually healed with no surgical intervention. Conclusion As a result of our clinical experience, the Versajet™ enables surgeon to precisely target damaged and necrotic tissue and spare viable tissue. This modality may be a useful alternative tool for soft tissue debridement in certain cases. However, further studies are required to investigate its cost-effectiveness in wound management.

  19. A Real World, Observational Registry of Chronic Wounds and Ulcers

    Science.gov (United States)

    2016-05-18

    Diabetic Foot; Varicose Ulcer; Pressure Ulcer; Surgical Wound Dehiscence; Vasculitis; Skin Ulcer; Leg Ulcer; Wounds and Injuries; Pyoderma; Peripheral Arterial Disease; Diabetic Neuropathies; Lymphedema; Venous Insufficiency; Diabetes Complications; Amputation Stump

  20. Vacuum-assisted closure versus conventional dressings in the management of diabetic foot ulcers: a prospective case–control study

    Directory of Open Access Journals (Sweden)

    Ali M. Lone

    2014-04-01

    Full Text Available Objective: To compare the effectiveness of vacuum-assisted closure (VAC versus conventional dressings in the healing of diabetic foot ulcerations (DFUs in terms of healing rate (time to prepare the wound for closure either spontaneously or by surgery, safety, and patient satisfaction. Methods: Randomized case–control study enrolling 56 patients, divided into two groups. Group A (patients treated with VAC and Group B (patients treated with conventional dressings, with an equal number of patients in each group. DFUs were treated until wound closure, either spontaneously, surgically, or until completion of the 8-week period. Results: Granulation tissue appeared in 26 (92.85% patients by the end of Week 2 in Group A, while it appeared in 15 (53.57% patients by that time in Group B. 100% granulation was achieved in 21 (77.78% patients by the end of Week 5 in Group A as compared to only 10 (40% patients by that time in Group B. Patients in Group A had fewer number of positive blood cultures, secondary amputations and were satisfied with treatment as compared to Group B. Conclusion: VAC appears to be more effective, safe, and patient satisfactory compared to conventional dressings for the treatment of DFUs.

  1. Bacterial wall products induce downregulation of vascular endothelial growth factor receptors on endothelial cells via a CD14-dependent mechanism: implications for surgical wound healing.

    LENUS (Irish Health Repository)

    Power, C

    2012-02-03

    INTRODUCTION: Vascular endothelial growth factor (VEGF) is a potent mitogenic cytokine which has been identified as the principal polypeptide growth factor influencing endothelial cell (EC) migration and proliferation. Ordered progression of these two processes is an absolute prerequisite for initiating and maintaining the proliferative phase of wound healing. The response of ECs to circulating VEGF is determined by, and directly proportional to, the functional expression of VEGF receptors (KDR\\/Flt-1) on the EC surface membrane. Systemic sepsis and wound contamination due to bacterial infection are associated with significant retardation of the proliferative phase of wound repair. The effects of the Gram-negative bacterial wall components lipopolysaccharide (LPS) and bacterial lipoprotein (BLP) on VEGF receptor function and expression are unknown and may represent an important biological mechanism predisposing to delayed wound healing in the presence of localized or systemic sepsis. MATERIALS AND METHODS: We designed a series of in vitro experiments investigating this phenomenon and its potential implications for infective wound repair. VEGF receptor density on ECs in the presence of LPS and BLP was assessed using flow cytometry. These parameters were assessed in hypoxic conditions as well as in normoxia. The contribution of CD14 was evaluated using recombinant human (rh) CD14. EC proliferation in response to VEGF was quantified in the presence and absence of LPS and BLP. RESULTS: Flow cytometric analysis revealed that LPS and BLP have profoundly repressive effects on VEGF receptor density in normoxic and, more pertinently, hypoxic conditions. The observed downregulation of constitutive and inducible VEGF receptor expression on ECs was not due to any directly cytotoxic effect of LPS and BLP on ECs, as measured by cell viability and apoptosis assays. We identified a pivotal role for soluble\\/serum CD14, a highly specific bacterial wall product receptor, in

  2. Totally robotic atrial septal defect closure using da vinci S surgical system on beating heart%全机器人心脏不停跳下房间隔缺损修补术

    Institute of Scientific and Technical Information of China (English)

    杨明; 高长青; 肖苍松; 王刚; 王加利

    2011-01-01

    目的 总结使用"达芬奇S"(da Vinci S)机器人手术系统,心脏不停跳下房间隔缺损修补或房间隔缺损修补+三尖瓣成形术的经验体会.方法 2009年3月至2010年12月,使用da Vinic S机器人系统,心脏不停跳下完成继发孔型房间隔缺损修补或房间隔缺损修补+三尖瓣成形术40例.患者女23例,男17例;年龄平均(38±13)岁.房间隔缺损直径为1.5~3.5 cm,平均(2.8±1.3)cm,无右向左分流,伴有或不伴有三尖瓣重度关闭不全.手术经股动、静脉及右侧颈内静脉插管建立体外循环.于右侧胸壁打直径为0.8 cm的器械臂孔3个,直径为2 cm工作孔1个,术中不阻断升主动脉,经内窥镜套管持续给予二氧化碳,心脏跳动下,术者于操作台前遥控机器人进行房间隔缺损修补,三尖瓣重度关闭不全患者同期行三尖瓣成形术.其中直接缝合房间隔缺损22例,心包补片修补房间隔缺损18例,同期三尖瓣成形9例.术中食管超声评估修补及三尖瓣成形效果.对比不停跳与心脏停跳下全机器人房间隔缺损修补术的手术时间及体外循环时间.结果 所有患者均成功接受全机器人心脏不停跳下房间隔缺损修补术或房间隔缺损修补+三尖瓣成形术,无体循环气体栓子及残余分流等并发症.不停跳组的手术时间、机器人使用时间或体外循环时间少于停跳组.结论 机器人心脏不停跳下房间隔缺损修补术无需阻断升主动脉,简化了全机器人手术过程,手术效果安全可靠.%Objective To Summary the first 40 cases underwent robotic atrial septal defect (ASD) closure or atrial septal defect closure combined bicuspid valve plasty (TVP) using "da Vinci S" surgical System on beating heart. Methods 40 cases of atrial septal defect or combined sever tricuspid valve regurgitation were repaired using "da Vinic S" surgical system on beating heart from March 2009 to December 2010 in cardiovascular department of PLA general

  3. Gunshot wounds: epidemiology, wound ballistics, and soft-tissue treatment.

    Science.gov (United States)

    Dougherty, Paul J; Najibi, Soheil; Silverton, Craig; Vaidya, Rahul

    2009-01-01

    The extremities are the most common anatomic location for gunshot wounds. Because of the prevalence of gunshot injuries, it is important that orthopaedic surgeons are knowledgeable about caring for them. The most common injuries seen with gunshot wounds are those of the soft tissues. Nonsurgical management of patients who have gunshot wounds with minimal soft-tissue disruption has been successfully accomplished in emergency departments for several years; this includes extremity wounds without nerve, intra-articular, or vascular injury. Stable, nonarticular fractures of an extremity have also been successfully treated with either minimal surgical or nonsurgical methods in the emergency department. Indications for surgical treatment include unstable fractures, intra-articular injuries, a significant soft-tissue injury (especially with skin loss), vascular injury, and/or a large or expanding hematoma.

  4. Surgical site infection in tibial plateau fractures with ipsilateral compartment syndrome.

    Science.gov (United States)

    Dubina, Andrew G; Paryavi, Ebrahim; Manson, Theodore T; Allmon, Christopher; O'Toole, Robert V

    2017-02-01

    The aim of this study was to investigate the effects of compartment syndrome and timing of fasciotomy wound closure on surgical site infection (SSI) after surgical fixation of tibial plateau fractures. Our primary hypothesis was that SSI rate is increased for fractures with compartment syndrome versus those without, even accounting for confounders associated with infection. Our secondary hypothesis was that infection rates are unrelated to timing of fasciotomy closure or fixation. We conducted a retrospective cohort study of operative tibial plateau fractures with ipsilateral compartment syndrome (n=71) treated with fasciotomy at our level I trauma center from 2003 through 2011. A control group consisted of 602 patients with 625 operatively treated tibial plateau fractures without diagnosis of compartment syndrome. The primary outcome measure was deep SSI after ORIF. Fractures with compartment syndrome had a higher rate of SSI (25% versus 8%, pcompartment syndrome have a significant increase in rates of SSI compared with those without compartment syndrome (p<0.001). Delays in fasciotomy wound closure were also associated with increased odds of SSI (p<0.05). Copyright © 2016 Elsevier Ltd. All rights reserved.

  5. [A case report of successful surgical management for a combined wound of the neck with a rare variant of an injury of the vertebral artery].

    Science.gov (United States)

    Zotov, S P; Zaĭtsev, S S; Fastakovskiĭ, V V; Orliakhin, A V; Chistiakova, A S

    2010-01-01

    Presented herein is a clinical case report regarding successful surgical management of a male patient presenting with a concomitant injury of the neck and involvement of the second portion of the contralateral vertebral artery.

  6. Ballistics and gunshot wounds: effects on musculoskeletal tissues.

    Science.gov (United States)

    Bartlett, C S; Helfet, D L; Hausman, M R; Strauss, E

    2000-01-01

    is required for wound closure, although other soft-tissue procedures, such as use of local rotation flaps or free tissue transfer, may be necessary, especially for shotgun wounds. Distal neurologic deficit alone is not an indication for exploration, as it often resolves without surgical intervention.

  7. G-CSF Administration after the Intraosseous Infusion of Hypertonic Hydroxyethyl Starches Accelerating Wound Healing Combined with Hemorrhagic Shock

    National Research Council Canada - National Science Library

    Huang, Hong; Liu, Jiejie; Hao, Haojie; Tong, Chuan; Ti, Dongdong; Liu, Huiling; Song, Haijing; Jiang, Chaoguang; Fu, Xiaobing; Han, Weidong

    2016-01-01

    ... (Unres/G-CSF). To estimate the treatment effects, the vital signs of alteration were first evaluated, and then wound closure rates and homing of MSCs and EPCs to the wound skins and vasculogenesis were measured...

  8. Dual therapeutic functions of F-5 fragment in burn wounds: preventing wound progression and promoting wound healing in pigs.

    Science.gov (United States)

    Bhatia, Ayesha; O'Brien, Kathryn; Chen, Mei; Wong, Alex; Garner, Warren; Woodley, David T; Li, Wei

    2016-01-01

    Burn injuries are a leading cause of morbidity including prolonged hospitalization, disfigurement, and disability. Currently there is no Food and Drug Administration-approved burn therapeutics. A clinical distinction of burn injuries from other acute wounds is the event of the so-called secondary burn wound progression within the first week of the injury, in which a burn expands horizontally and vertically from its initial boundary to a larger area. Therefore, an effective therapeutics for burns should show dual abilities to prevent the burn wound progression and thereafter promote burn wound healing. Herein we report that topically applied F-5 fragment of heat shock protein-90α is a dual functional agent to promote burn wound healing in pigs. First, F-5 prevents burn wound progression by protecting the surrounding cells from undergoing heat-induced caspase 3 activation and apoptosis with increased Akt activation. Accordingly, F-5-treated burn and excision wounds show a marked decline in inflammation. Thereafter, F-5 accelerates burn wound healing by stimulating the keratinocyte migration-led reepithelialization, leading to wound closure. This study addresses a topical agent that is capable of preventing burn wound progression and accelerating burn wound healing.

  9. 骨科手术患者切口感染的危险因素分析与预防对策%Analysis on risk factors and control measures for orthopedic surgical wound infections

    Institute of Scientific and Technical Information of China (English)

    杨群英; 杨园园; 陶树平; 陈红卫

    2014-01-01

    目的:调查分析骨科手术患者切口感染的主要影响因素,为骨科临床降低手术后感染率提供参考依据。方法选取2011年6月-2012年12月在医院骨科进行手术治疗的1816例患者,对其手术相关因素及术后感染情况进行统计分析,分析骨科无菌手术切口感染的危险因素,根据危险因素探讨防治切口感染的措施,采用SPSS 17.0软件包进行统计分析。结果1816例骨科手术患者中有16例发生切口感染,感染率为1.54%;老年患者、Ⅲ类手术切口、手术部位在腰腹以下、手术耗时长等因素可导致骨科手术患者切口感染,差异均有统计学意义(P<0.05)。结论导致骨科手术患者术后切口感染的影响因素较多,医护人员在对患者给予骨科手术治疗时,应综合评估患者自身情况、医院感染控制管理规范给予预防性的干预措施,尽可能减少骨科手术后切口感染的发生。%OBJECTIVE To analyze the risk factors for orthopedic surgical wound infections ,so as to provide refer-ence of reducing infection after orthopedic operation .METHODS A total of 1 816 cases with surgery from Jun . 2011 to Dec .2012 in our hospital were selected and statistically analyzed the operation-related factors and situation of postoperative infection .Risk factors of wound infections after aseptic orthopedic surgical were analyzed and based these factors to discuss about preventive measures .SPSS 17 .0 software was used for statistical analysis . RESULTS Among 1 816 patients with orthopedic surgery ,16 cases had wound infections ,accounting for 1 .54% . Elderly patients ,Ⅲ incision operation area ,surgery sites below the waist and abdomen ,long time-consuming operation were the factors that might cause wound infections after orthopedic surgery ,and the difference was sig-nificant (P<0 .05) .CONCLUSION Many factors can cause incision infections after the surgery ,the doctors and nurses

  10. Inhibition of Pseudomonas aeruginosa biofilm formation on wound dressings.

    Science.gov (United States)

    Brandenburg, Kenneth S; Calderon, Diego F; Kierski, Patricia R; Brown, Amanda L; Shah, Nihar M; Abbott, Nicholas L; Schurr, Michael J; Murphy, Christopher J; McAnulty, Jonathan F; Czuprynski, Charles J

    2015-01-01

    Chronic nonhealing skin wounds often contain bacterial biofilms that prevent normal wound healing and closure and present challenges to the use of conventional wound dressings. We investigated inhibition of Pseudomonas aeruginosa biofilm formation, a common pathogen of chronic skin wounds, on a commercially available biological wound dressing. Building on prior reports, we examined whether the amino acid tryptophan would inhibit P. aeruginosa biofilm formation on the three-dimensional surface of the biological dressing. Bacterial biomass and biofilm polysaccharides were quantified using crystal violet staining or an enzyme linked lectin, respectively. Bacterial cells and biofilm matrix adherent to the wound dressing were visualized through scanning electron microscopy. D-/L-tryptophan inhibited P. aeruginosa biofilm formation on the wound dressing in a dose dependent manner and was not directly cytotoxic to immortalized human keratinocytes although there was some reduction in cellular metabolism or enzymatic activity. More importantly, D-/L-tryptophan did not impair wound healing in a splinted skin wound murine model. Furthermore, wound closure was improved when D-/L-tryptophan treated wound dressing with P. aeruginosa biofilms were compared with untreated dressings. These findings indicate that tryptophan may prove useful for integration into wound dressings to inhibit biofilm formation and promote wound healing.

  11. Assessing and managing wounds of Buruli ulcer patients at the primary and secondary health care levels in Ghana

    Science.gov (United States)

    Koka, Eric; Aboagye, Samuel Yaw; Kpeli, Grace; Pluschke, Gerd; Yeboah-Manu, Dorothy; Junghanss, Thomas

    2017-01-01

    Background Beyond Mycobacterium ulcerans—specific therapy, sound general wound management is required for successful management of Buruli ulcer (BU) patients which places them among the large and diverse group of patients in poor countries with a broken skin barrier. Methods Clinically BU suspicious patients were enrolled between October 2013 and August 2015 at a primary health care (PHC) center and a municipal hospital, secondary health care (SHC) center in Ghana. All patients were IS2404 PCR tested and divided into IS2404 PCR positive and negative groups. The course of wound healing was prospectively investigated including predictors of wound closure and assessment of infrastructure, supply and health staff performance. Results 53 IS2404 PCR positive patients—31 at the PHC center and 22 at the SHC center were enrolled—and additionally, 80 clinically BU suspicious, IS2404 PCR negative patients at the PHC center. The majority of the skin ulcers at the PHC center closed, without the need for surgical intervention (86.7%) compared to 40% at the SHC center, where the majority required split-skin grafting (75%) or excision (12.5%). Only 9% of wounds at the PHC center, but 50% at the SHC center were complicated by bacterial infection. The majority of patients, 54.8% at the PHC center and 68.4% at the SHC center, experienced wound pain, mostly severe and associated with wound dressing. Failure of ulcers to heal was reliably predicted by wound area reduction between week 2 and 4 after initiation of treatment in 75% at the PHC center, and 90% at the SHC center. Obvious reasons for arrested wound healing or deterioration of wound were missed additional severe pathology; at the PHC center (chronic osteomyelitis, chronic lymphedema, squamous cell carcinoma) and at the SHC center (malignant ulceration, chronic lymphedema) in addition to hygiene and wound care deficiencies. When clinically suspicious, but IS2404 PCR negative patients were recaptured in the community, 76

  12. Abdomina l Surgical Wound Infection Related Factors Analysis and Prevention%腹部外科手术切口感染相关因素的分析及预防

    Institute of Scientific and Technical Information of China (English)

    赖进光

    2013-01-01

    Objective analysis of abdominal surgical wound infection associated risk factors, provide the basis for the development of effective preventive measures. Methods A retrospective analysis of our hospital in January 2010~January 2013 1720 routine abdominal surgery patients, including 26 cases of wound infection, 1,694 cases of wound infection did not occur. Read the literature and the use of self-hospital questionnaire on the patient's age, sex, weight, occupation, diet, general investigation. The col-lected data and clinical data were univariate analysis and multivariate Logistic regression analysis of factors affecting the risk of infection. Results The patient's age, operative time, hospital stay, surgical site, incision length, emergency surgery is affecting wound infection risk factors. Conclusion Abdomi-nal surgical incision infection is the result of a variety of risk factors. Therefore, for the prevention of infection generation, should be prepared adequately before surgery, do evaluate and improve surgical techniques, reasonable shorter operative time and hospital stay.%目的:探讨分析腹部外科手术切口感染的相关风险因素,为制定有效的预防措施提供依据。方法回顾性分析我院2010年1月~2013年1月1720例行腹部手术的患者,其中26例发生切口感染,1694例未发生切口感染。阅读相关文献并采用本院自制问卷调查表对患者年龄、性别、体重、职业、饮食等一般情况进行调查。将收集到的资料和临床资料进行单因素分析和多因素Logistic回归分析,分析影响感染的风险因素。结果患者的年龄、手术时间、住院时间、手术部位、切口长度、急诊手术都是影响切口感染的风险因素。结论腹部外科手术切口感染是多种风险因素作用的结果。因此为预防感染的产生,应在术前准备充分,做好评估,改善手术技术,合理缩短手术时间和住院时间。

  13. Requirement for Pak3 in Rac1-induced organization of actin and myosin during Drosophila larval wound healing

    National Research Council Canada - National Science Library

    Baek, Seung Hee; Cho, Hae Weon; Kwon, Young-Chang; Lee, Hyangkyu; Lee, Ji Hyun; Kim, Moon Jong; Choe, Kwang-Min

    2012-01-01

    .... In Drosophila embryos, Cdc42 mediates filopodial projection into the wound leading edge (LE) and is important for suturing of the wound hole, while Rho1 mediates actin cable formation, which is critical during the initial stage of wound contraction [10] . In Drosophila larvae, Rac1, Cdc42, and Rho1 are essential for wound closure and organi...

  14. The Electrical Response to Injury: Molecular Mechanisms and Wound Healing

    Science.gov (United States)

    Reid, Brian; Zhao, Min

    2014-01-01

    Significance: Natural, endogenous electric fields (EFs) and currents arise spontaneously after wounding of many tissues, especially epithelia, and are necessary for normal healing. This wound electrical activity is a long-lasting and regulated response. Enhancing or inhibiting this electrical activity increases or decreases wound healing, respectively. Cells that are responsible for wound closure such as corneal epithelial cells or skin keratinocytes migrate directionally in EFs of physiological magnitude. However, the mechanisms of how the wound electrical response is initiated and regulated remain unclear. Recent Advances: Wound EFs and currents appear to arise by ion channel up-regulation and redistribution, which are perhaps triggered by an intracellular calcium wave or cell depolarization. We discuss the possibility of stimulation of wound healing via pharmacological enhancement of the wound electric signal by stimulation of ion pumping. Critical Issues: Chronic wounds are a major problem in the elderly and diabetic patient. Any strategy to stimulate wound healing in these patients is desirable. Applying electrical stimulation directly is problematic, but pharmacological enhancement of the wound signal may be a promising strategy. Future Directions: Understanding the molecular regulation of wound electric signals may reveal some fundamental mechanisms in wound healing. Manipulating fluxes of ions and electric currents at wounds might offer new approaches to achieve better wound healing and to heal chronic wounds. PMID:24761358

  15. Pulsed electromagnetic fields (PEMF) promote early wound healing and myofibroblast proliferation in diabetic rats.

    Science.gov (United States)

    Cheing, Gladys Lai-Ying; Li, Xiaohui; Huang, Lin; Kwan, Rachel Lai-Chu; Cheung, Kwok-Kuen

    2014-04-01

    Reduced collagen deposition possibly leads to slow recovery of tensile strength in the healing process of diabetic cutaneous wounds. Myofibroblasts are transiently present during wound healing and play a key role in wound closure and collagen synthesis. Pulsed electromagnetic fields (PEMF) have been shown to enhance the tensile strength of diabetic wounds. In this study, we examined the effect of PEMF on wound closure and the presence of myofibroblasts in Sprague-Dawley rats after diabetic induction using streptozotocin. A full-thickness square-shaped dermal wound (2 cm × 2 cm) was excised aseptically on the shaved dorsum. The rats were randomly divided into PEMF-treated (5 mT, 25 Hz, 1 h daily) and control groups. The results indicated that there were no significant differences between the groups in blood glucose level and body weight. However, PEMF treatment significantly enhanced wound closure (days 10 and 14 post-wounding) and re-epithelialization (day 10 post-wounding), although these improvements were no longer observed at later stages of the wound healing process. Using immunohistochemistry against α-smooth muscle actin (α-SMA), we demonstrated that significantly more myofibroblasts were detected on days 7 and 10 post-wounding in the PEMF group when compared to the control group. We hypothesized that PEMF would increase the myofibroblast population, contributing to wound closure during diabetic wound healing.

  16. Effects of genistein on early-stage cutaneous wound healing

    Energy Technology Data Exchange (ETDEWEB)

    Park, Eunkyo [Department of Home Economics Education, Chung-Ang University, Seoul 156-756 (Korea, Republic of); Lee, Seung Min [Research Institute of Health Sciences, Korea University, Seoul 136-701 (Korea, Republic of); Jung, In-Kyung [Department of Home Economics Education, Chung-Ang University, Seoul 156-756 (Korea, Republic of); Lim, Yunsook [Department of Foods and Nutrition, Kyung Hee University, Seoul 130-701 (Korea, Republic of); Kim, Jung-Hyun, E-mail: jjhkim@cau.ac.kr [Department of Home Economics Education, Chung-Ang University, Seoul 156-756 (Korea, Republic of)

    2011-07-08

    Highlights: {yields} We examine the effect of genistein on cutaneous wound healing. {yields} Genistein enhanced wound closure during the early stage of wound healing. {yields} These genistein effects on wound closure were induced by reduction of oxidative stress through increasing antioxidant capacity and modulation of pro-inflammatory cytokine expression. -- Abstract: Wound healing occurs in three sequential phases: hemostasis and inflammation, proliferation, and remodeling. Inflammation, the earliest phase, is considered a critical period for wound healing because immune cells remove damaged tissues, foreign debris, and remaining dead tissue. Wound healing would be delayed without inflammation, and this phase is affected by antioxidation capacity. Therefore, we hypothesized that genistein, which has an antioxidant effect, might modulate the wound healing process by altering the inflammatory response. After three days of acclimation, mice were divided into three groups: control, 0.025% genistein, and 0.1% genistein. After two weeks of an experimental diet, skin wounds were induced. Wounded skin areas were imaged, and the healing rate calculated. To measure lipid peroxidation, antioxidant enzyme expression and activity, and pro-inflammatory cytokine expression, skin and liver tissues were harvested at 12, 24, 48, and 72 h. Genistein did not affect body weight. The rate of wound closure in mice fed genistein was significantly faster than in the control group during the early stage of wound healing, especially in first three days. Cu, Zn-SOD and Mn-SOD expression in wound skin tissue in the 0.1% genistein group was lower than in the control group. However, CAT expression did not differ among groups. We also found that genistein modulated NF-{kappa}B and TNF-{alpha} expression during the early stage of wound healing. The genistein group had significantly lower hepatic lipid peroxidation and higher SOD, CAT, and GPx activities than the control group. These results

  17. The prevalence, management and outcome for acute wounds identified in a wound care survey within one English health care district.

    Science.gov (United States)

    Vowden, Kathryn R; Vowden, Peter

    2009-02-01

    This paper reports the characteristics and local management of 826 acute wounds identified during an audit across all health care providers serving the population of Bradford, UK. Of the wounds encountered 303 were traumatic wounds and 237 primary closures with smaller numbers of other acute wound types. Of the 303 traumatic wounds 174 occurred in women (57.4%). Men predominated in the under 45s (65M:26F), this being largely accounted for by hand and finger trauma (n = 62) particularly in patients of working age (M32:F12). Women predominated in the over 65s (50M:130F), this being largely accounted for by lower limb traumatic wounds (M24:F91), the majority of these being in patients 65 and over (M14:F82). In this sub-group of 96 patients 25 had wounds of 6 weeks or longer duration, only 3 had undergone Doppler assessment and only 2 received compression bandaging. Typically these wounds were of recent origin and small in size (under 1 week and less than 5 cm2 in surface area) however exceptions occurred where 10 people had wounds over 25 cm2 in area while 3 wounds had been present for over 5 years. 101 (12.2%) of the encountered wounds were considered to be infected although the practice of wound swabbing in the presence of presumed infection seemed inadequate with 37.6% of all infected acute wounds not being swabbed while 97 non-infected wounds were swabbed. Where wounds were swabbed 4.5% were found to be MRSA positive. Across all acute wound types (with the sole exception of primary closures) antimicrobial wound dressings were the most prevalent form of dressing and covered 56 (55.4%) of all infected wounds.

  18. A case report of a 19-week gravid patient with a dehisced abdominal wound and treated with V.A.C. ATS(®) Therapy System.

    Science.gov (United States)

    Asukai, Kei; Kashiwazaki, Masaki; Koizumi, Kaori; Nobunaga, Toshikatsu; Yano, Hiroshi

    2016-10-01

    Negative pressure wound therapy (NPWT) is an effective treatment for various non-healing wounds, and V.A.C.(®) Therapy was the first-approved NPWT device by the Japanese government in 2009. We report the case of a 19-week pregnant patient where V.A.C.(®) Therapy was applied to her dehisced laparotomy wound with satisfactory results. The patient was a 30-year-old female who was referred to our hospital from her previous doctor because of the presence of an ovarian cyst on the left ovary. The patient presented at 14 weeks into her pregnancy, and surgery was considered because of no reduction in the size of the cyst. An oophorocystectomy was performed, and then the surgical incision was re-opened at postoperative day (POD) 10 due to a surgical site infection. V.A.C.(®) Therapy was initiated on POD 26 (20 weeks of pregnancy) and continued for 28 days. After 28 days of V.A.C.(®) Therapy (POD 54), the wound was sutured for complete closure. The foetus did not experience any adverse affects from the surgery and, subsequently, normal vaginal delivery was achieved. This case is the first report of the use of V.A.C.(®) Therapy over a dehisced abdominal wound on a pregnant patient in our country.

  19. Surgical Skills Beyond Scientific Management

    Science.gov (United States)

    Whitfield, Nicholas

    2015-01-01

    During the Great War, the French surgeon Alexis Carrel, in collaboration with the English chemist Henry Dakin, devised an antiseptic treatment for infected wounds. This paper focuses on Carrel’s attempt to standardise knowledge of infected wounds and their treatment, and looks closely at the vision of surgical skill he espoused and its difference from those associated with the doctrines of scientific management. Examining contemporary claims that the Carrel–Dakin method increased rather than diminished demands on surgical work, this paper further shows how debates about antiseptic wound treatment opened up a critical space for considering the nature of skill as a vital dynamic in surgical innovation and practice. PMID:26090737

  20. Wound healing activity of flower extract of Calendula officinalis.

    Science.gov (United States)

    Preethi, Korengath C; Kuttan, Ramadasan

    2009-01-01

    The effects of oral and topical application of Calendula officinalis flower extract on excision wounds made in rats were checked. The parameters assessed were the days needed for re-epithelization and percentage of wound closure. The hydroxy proline and hexosamine content in the granuloma tissue of the wound was also measured. The percentage of wound closure was 90.0% in the extract-treated group, whereas the control group showed only 51.1% on the eighth day of wounding (p < .01). The days needed for re-epithelization were 17.7 for the control animals; extract treatment at a dose of 20 or 100 mg/kg b.wt reduced the period to 14 and 13 days, respectively. A significant increase was observed in the hydroxy proline and hexosamine content in the extract-treated group compared with the untreated animals. The data indicate potent wound healing activity ofC. officinalis extract.

  1. Trehalose lyophilized platelets for wound healing.

    Science.gov (United States)

    Pietramaggiori, Giorgio; Kaipainen, Arja; Ho, David; Orser, Cindy; Pebley, Walter; Rudolph, Alan; Orgill, Dennis P

    2007-01-01

    Fresh platelet preparations are utilized to treat a wide variety of wounds, although storage limitations and mixed results have hampered their clinical use. We hypothesized that concentrated lyophilized and reconstituted platelet preparations, preserved with trehalose, maintain and possibly enhance fresh platelets' ability to improve wound healing. We studied the ability of a single dose of trehalose lyophilized and reconstituted platelets to enhance wound healing when topically applied on full-thickness wounds in the genetically diabetic mouse. We compared these results with the application of multiple doses of fresh platelet preparations and trehalose lyophilized and reconstituted platelets as well as multiple doses of vascular endothelial growth factor (VEGF) and wounds left untreated. Trehalose lyophilized and reconstituted platelets, in single and multiple applications, multiple applications of fresh platelets and multiple applications of VEGF increased granulation tissue deposition, vascularity, and proliferation when compared with untreated wounds, as assessed by histology and immunohistochemistry. Wounds treated with multiple doses of VEGF and a single dose of freeze-dried platelets reached 90% closure faster than wounds left untreated. A single administration of trehalose lyophilized and reconstituted platelet preparations enhanced diabetic wound healing, therefore representing a promising strategy for the treatment of nonhealing wounds.

  2. Effect of astaxanthin on cutaneous wound healing

    Directory of Open Access Journals (Sweden)

    Meephansan J

    2017-07-01

    Full Text Available Jitlada Meephansan,1 Atiya Rungjang,1 Werayut Yingmema,2 Raksawan Deenonpoe,3 Saranyoo Ponnikorn3 1Division of Dermatology, Chulabhorn International College of Medicine, Thammasat University, Pathum Thani, Thailand; 2Laboratory Animal Centers, Thammasat University, Pathum Thani, Thailand; 3Chulabhorn International College of Medicine, Thammasat University, Pathum Thani, Thailand Abstract: Wound healing consists of a complex series of convoluted processes which involve renewal of the skin after injury. ROS are involved in all phases of wound healing. A balance between oxidative and antioxidative forces is necessary for a favorable healing outcome. Astaxanthin, a member of the xanthophyll group, is considered a powerful antioxidant. In this study, we investigated the effect of topical astaxanthin on cutaneous wound healing. Full-thickness dermal wounds were created in 36 healthy female mice, which were divided into a control group and a group receiving 78.9 µM topical astaxanthin treatment twice daily for 15 days. Astaxanthin-treated wounds showed noticeable contraction by day 3 of treatment and complete wound closure by day 9, whereas the wounds of control mice revealed only partial epithelialization and still carried scabs. Wound healing biological markers including Col1A1 and bFGF were significantly increased in the astaxanthin-treated group since day 1. Interestingly, the oxidative stress marker iNOS showed a significantly lower expression in the study. The results indicate that astaxanthin is an effective compound for accelerating wound healing. Keywords: astaxanthin, wound healing, reactive oxygen species, antioxidant 

  3. WOUND INFECTION AFTER SCOLIOSIS SURGERY:AN ANALYSIS OF 15 CASES

    Institute of Scientific and Technical Information of China (English)

    李书纲; 仉建国; 等

    2002-01-01

    Objective:To discuss the causes and treatments of wound infections after scoliosis surgery.Methods:Nine hundred and twenty-four cases of scoliosis were reviewed,and the clinical data of 15 cases of postoperative infection were analysed retrospectively.Results:All 15 cases underwent spinal posterior fusion with autologous bone graft using instrumentations.Seven were diagnosed as early infection,and 8 were delayed infection.Radical debridement was performed in all 15 cases.The duration of antibiotics administration was 10 to 34 days with continuous closed irrigation for 2-4weeks and primary closure for the wounds.All patients were followed up for an average of 3.5years (2 to 7.5years) with good outcomes and no recurrence.Conclusion:Wound infection following surgical correction of scoliosis primarily results from intraoperative seeding,although host-related and operation-related factors may contribute to its development.Once the infections are diagnosed,good results can be achieved by prompt surgical debridement,irrigation and reasonably administered antibiotics.Removal of hardware may be necessary in deep infections.

  4. Microscope-integrated optical coherence tomography: A new surgical tool in vitreoretinal surgery

    Directory of Open Access Journals (Sweden)

    Chaitra Jayadev

    2015-01-01

    Full Text Available Optical coherence tomography (OCT has revolutionized imaging of ocular structures and various disease conditions. Though it has been used in the clinic for some decades, the OCT has only recently found its way into the operating theater. Early attempts at intraoperative OCT, hand-held and microscope mounted, have already improved our understanding of the surgical pathology and the role it might play in surgical decision-making. The microscope-integrated OCT now allows seamless, high-resolution, real-time imaging of surgical maneuvers from the incision to wound closure. Visualization of instruments and intraoperative tissue manipulation are possible with this in vivo modality and, therefore, help improve the outcome of surgery. In this article, we describe the advantages it offers during various vitreoretinal procedures.

  5. The role of thrombin-activatable fibrinolysis inhibitor in diabetic wound healing

    NARCIS (Netherlands)

    C.J.N. Verkleij; J.J.T.H. Roelofs; S.R. Havik; J.C.M. Meijers; P.F. Marx

    2010-01-01

    Introduction: One of the major complications in patients with diabetes mellitus is impaired wound healing. The fibrinolytic system is involved in parts of the wound healing process and deficiency of thrombin-activatable fibrinolysis inhibitor (TAFI) results in delayed wound closure. Moreover, levels

  6. Dead space closure with quilting suture versus conventional closure with drainage for the prevention of seroma after mastectomy for breast cancer (QUISERMAS): protocol for a multicentre randomised controlled trial.

    Science.gov (United States)

    Ouldamer, Lobna; Bonastre, Julia; Brunet-Houdard, Solène; Body, Gilles; Giraudeau, Bruno; Caille, Agnès

    2016-04-04

    Postoperative wound seroma is common after mastectomy. This complication is associated with significant impact on patient outcomes and healthcare costs. The optimal closure approach for seroma prevention remains unknown but some evidence suggests that quilting suture of the dead space could lower the incidence of seroma. The aim of this trial is to compare seroma formation using quilting suture versus conventional closure with drainage in patients undergoing mastectomy. This is a multicentre, superiority, randomised controlled trial in women undergoing mastectomy with or without axillary involvement. Exclusion criteria include indication of bilateral mastectomy or immediate reconstruction and any physical or psychiatric condition that could impair patient's ability to cooperate with postoperative data collection or that do not allow an informed consent. 320 participants will be randomised in a 1:1 ratio to receive either quilting suture or conventional wound closure with drain. The primary outcome is seroma requiring either aspiration or surgical intervention within 21 days following mastectomy. Secondary outcomes include seroma regardless of whether or not it requires an intervention, surgical site infection, pain score, cosmetic result, patient's quality of life, costs and cost-effectiveness. The primary analysis will be an intention-to treat analysis performed with a χ(2) test (or Fisher's exact test). Written informed consent will be obtained from all participants. This study was approved by Tours Research ethics committee (CPP TOURS-Region Centre-Ouest 1, 2014-R20, 16 December 2014). Study findings will be published in peer-reviewed journals and presented at relevant national and international breast cancer conferences. NCT02263651. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  7. Wound Healing Activity of Elaeis guineensis Leaf Extract Ointment

    Directory of Open Access Journals (Sweden)

    Sreenivasan Sasidharan

    2011-12-01

    Full Text Available Elaeis guineensis of the Arecaceae family is widely used in the traditional medicine of societies in West Africa for treating various ailments. To validate the ethnotherapeutic claims of the plant in skin diseases, wound healing activity was studied. The results showed that E. guineensis leaf extract had potent wound healing capacity as evident from the better wound closure (P < 0.05, improved tissue regeneration at the wound site, and supporting histopathological parameters pertaining to wound healing. Matrix metalloproteinases expression correlated well with the results thus confirming efficacy of E. guineensis in the treatment of the wound. E. guineensis accelerated wound healing in rats, thus supporting its traditional use. The result of this study suggested that, used efficiently, oil palm leaf extract is a renewable resource with wound healing properties.

  8. Wound healing activity of Elaeis guineensis leaf extract ointment.

    Science.gov (United States)

    Sasidharan, Sreenivasan; Logeswaran, Selvarasoo; Latha, Lachimanan Yoga

    2012-01-01

    Elaeis guineensis of the Arecaceae family is widely used in the traditional medicine of societies in West Africa for treating various ailments. To validate the ethnotherapeutic claims of the plant in skin diseases, wound healing activity was studied. The results showed that E. guineensis leaf extract had potent wound healing capacity as evident from the better wound closure (P < 0.05), improved tissue regeneration at the wound site, and supporting histopathological parameters pertaining to wound healing. Matrix metalloproteinases expression correlated well with the results thus confirming efficacy of E. guineensis in the treatment of the wound. E. guineensis accelerated wound healing in rats, thus supporting its traditional use. The result of this study suggested that, used efficiently, oil palm leaf extract is a renewable resource with wound healing properties.

  9. Skin grafting and wound healing-the "dermato-plastic team approach".

    Science.gov (United States)

    Hierner, Robert; Degreef, Hugo; Vranckx, Jan Jerome; Garmyn, Maria; Massagé, Patrick; van Brussel, Michel

    2005-01-01

    Autologous skin grafts are successfully used to close recalcitrant chronic wounds especially at the lower leg. If wound care is done in a dermato-plastic team approach using the "integrated concept," difficulties associated with harvesting the skin graft as well as the complexities associated with inducing closure at the donor and the recipient site can be minimized. In the context of wound healing, skin transplantation can be regarded as (1) a supportive procedure for epithelialization of the wound surface and (2) mechanical stability of the wound ground. By placing skin grafts on a surface, central parts are covered much faster with keratinocytes. Skin (wound) closure is the ultimate goal, as wound closure means resistance to infection. Depending on the thickness of the skin graft, different amounts of dermis are transplanted with the overlying keratinocytes. The dermal component determines the mechanical (resistance to pressure and shear forces, graft shrinkage), functional (sensibility), and aesthetic properties of the graft. Generally speaking, the thicker the graft the better the mechanical, functional, and aesthetic properties, however, the worse the neo- and revascularization. Skin grafts do depend entirely on the re- and neovascularization coming from the wound bed. If the wound bed is seen as a recipient site for tissue graft, the classification of Lexer (Die freien Transplantationen. Stuttgart: Enke; 1924) turned out to be of extreme value. Three grades can be distinguished: "good wound conditions," "moderate wound conditions," and "insufficient wound conditions." Given good wound conditions, skin grafting is feasible. Nevertheless, skin closure alone might not be sufficient to fulfill the criteria of successful defect reconstruction. In case of moderate or insufficient wound conditions, wound bed preparation is necessary. If wound bed preparation is successful and good wound conditions can be achieved, skin grafting is possible. If, however, this

  10. Immediate locally advanced breast cancer and chest wall reconstruction: surgical planning and reconstruction strategies with extended V-Y latissimus dorsi myocutaneous flap.

    Science.gov (United States)

    Munhoz, Alexandre Mendonça; Montag, Eduardo; Arruda, Eduardo; Okada, Alberto; Brasil, José Augusto; Gemperli, Rolf; Filassi, José Roberto; Ferreira, Marcus Castro

    2011-06-01

    Surgical resection in locally advanced breast cancer produces large defects that may not be suitable for primary closure. Immediate reconstruction is controversial and presents a complicated scenario for breast surgeons and plastic surgeons. In this study, a different design was planned for the latissimus dorsi musculocutaneous flap with primary closure in V-Y for the correction of major lesions in the anterior chest wall. Twenty-five patients underwent immediate locally advanced breast cancer reconstruction with a V-Y latissimus dorsi musculocutaneous flap. This flap was raised from adjacent tissue located on the lateral and posterior thoracic region and presented a triangular shape whose base was the lateral aspect of the mastectomy wound. The technique was indicated in patients with large thoracic wounds. Mean follow-up time was 16 months. Closure was obtained in the donor and recipient sites without the use of skin grafts or other more major procedures. Complications occurred in nine patients (36 percent), including dorsal wound dehiscence in five patients and seroma in three. All cases except one were treated by a conservative approach with a good result. No total flap loss was reported. All patients achieved a satisfactory thoracic reconstruction and adequate wound care. The V-Y latissimus dorsi musculocutaneous flap is a reliable technique for immediate locally advanced breast cancer reconstruction. The technique is advantageous because the V-Y design allows primary closure of the chest wound and donor defect. Success depends on patient selection, coordinated planning with the breast cancer surgeon, and careful intraoperative management.

  11. Entire Papilla Preservation Technique: A Novel Surgical Approach for Regenerative Treatment of Deep and Wide Intrabony Defects.

    Science.gov (United States)

    Aslan, Serhat; Buduneli, Nurcan; Cortellini, Pierpaolo

    Primary wound closure and uneventful early wound stability over the biomaterials are the most critical elements of successful periodontal regeneration. Yet the surgical elevation of the interdental papilla to access deep and wide intrabony defects entails an impairment of the papillary blood supply that can result in difficult healing due to a lack of primary closure in the early healing period. This negative event might complicate the healing process, favoring bacterial contamination. A novel modified tunnel surgical technique designed to maintain the integrity of the interdental papilla is presented in this article, with the aim of providing an optimal environment for wound healing in regenerative procedures. Entire papilla preservation is described and applied in three different cases, in association with the use of a combination of bone substitutes and enamel matrix derivative for periodontal regeneration. The entire papilla preservation technique was successfully applied to the three selected cases, resulting in an uneventful postsurgical period and a substantial defect fill over the 8-month follow-up. This tunnel-like technique can be recommended for further research to support the success identified in this case series.

  12. Repair of cutaneous wounds with the use of low cost surgical glue Reparo de feridas cutâneas usando cola cirúrgica de baixo custo

    Directory of Open Access Journals (Sweden)

    Sandro Cilindro de Souza

    2012-04-01

    Full Text Available BACKGROUND: The advantages of the cyanoacrylates in cutaneous synthesis have been often demonstrated in the literature. However, these products have been underutilized in Brazil due to the high costs of the 2-octil-cyanoacrylate. Besides, few studies have been done with the more economically accessible form, the 2-etil-cyanoacrylate, as a cutaneous tissue adhesive. OBJECTIVE: To evaluate the effectiveness of the closing of cutaneous lesions using ECA. METHOD: This was a prospective study in which 46 wounds were occluded using the low cost ECA as an alternative to intradermal suture. RESULTS: Excisions (97,8% and traumatic wounds (2,2% were treated with 2-etil-cyanoacrylate and deep relaxed sutures as synthesis method. Unaesthetic scars (22%, infection (2,1%, dehiscence (2,1% and contact allergic dermatitis (2,1% were the problems we found. There were no cases of necrosis or keloids. The results were considered satisfactory in most cases (97,3%. CONCLUSION: The use of 2-etil-cyanoacrylate was shown to be safe and with satisfactory cosmetic results in this group of patients.FUNDAMENTOS: As vantagens dos cianoacrilatos em síntese cutânea têm sido sobejamente mostradas na literatura. Entretanto, estes produtos têm sido subutilizados no Brazil devido aos elevados custos do 2-octilcianoacrilato. Ademais, a forma mais economicamente acessível, o 2-etilcianoacrilato, tem sido pouco estudada como adesivo cutâneo. OBJETIVO: Avaliação da eficácia do fechamento de lesões cutâneas usando o 2-etilcianoacrilato. MÉTODO: Estudo prospectivo no qual 46 feridas foram ocluídas usando o 2-etilcianoacrilato de baixo custo como alternativa a sutura intradérmica. RESULTADOS: Feridas excisionais (97,8% e traumática (2,2% foram tratadas com 2-etilcianoacrilato e suturas profundas relaxadoras como método de síntese. Cicatrizes inestéticas (22%, infecção (2,1%, deiscência (2,1% e dermatite alérgica de contato (2,1% foram os problemas encontrados. N

  13. Intraoperative technique as a factor in the prevention of surgical site infection.

    LENUS (Irish Health Repository)

    McHugh, S M

    2011-02-28

    Approximately five percent of patients who undergo surgery develop surgical site infections (SSIs) which are associated with an extra seven days as an inpatient and with increased postoperative mortality. The competence and technique of the surgeon is considered important in preventing SSI. We have reviewed the evidence on different aspects of surgical technique and its role in preventing SSI. The most recent guidelines from the National Institute for Health and Clinical Excellence in the UK recommend avoiding diathermy for skin incision even though this reduces incision time and blood loss, both associated with lower infection rates. Studies comparing different closure techniques, i.e. continuous versus interrupted sutures, have not found a statistically significant difference in the SSI rate, but using continuous sutures is quicker. For contaminated wounds, the surgical site should be left open for four days to allow for treatment of local infection before subsequent healing by primary intention. Surgical drains should be placed through separate incisions, closed suction drains are preferable to open drains, and all drains should be removed as soon as possible. There are relatively few large studies on the impact of surgical techniques on SSI rates. Larger multicentre prospective studies are required to define what aspects of surgical technique impact on SSI, to better inform surgical practice and support education programmes for surgical trainees.

  14. Intraoperative technique as a factor in the prevention of surgical site infection.

    LENUS (Irish Health Repository)

    McHugh, S M

    2012-02-01

    Approximately five percent of patients who undergo surgery develop surgical site infections (SSIs) which are associated with an extra seven days as an inpatient and with increased postoperative mortality. The competence and technique of the surgeon is considered important in preventing SSI. We have reviewed the evidence on different aspects of surgical technique and its role in preventing SSI. The most recent guidelines from the National Institute for Health and Clinical Excellence in the UK recommend avoiding diathermy for skin incision even though this reduces incision time and blood loss, both associated with lower infection rates. Studies comparing different closure techniques, i.e. continuous versus interrupted sutures, have not found a statistically significant difference in the SSI rate, but using continuous sutures is quicker. For contaminated wounds, the surgical site should be left open for four days to allow for treatment of local infection before subsequent healing by primary intention. Surgical drains should be placed through separate incisions, closed suction drains are preferable to open drains, and all drains should be removed as soon as possible. There are relatively few large studies on the impact of surgical techniques on SSI rates. Larger multicentre prospective studies are required to define what aspects of surgical technique impact on SSI, to better inform surgical practice and support education programmes for surgical trainees.

  15. Intraoperative technique as a factor in the prevention of surgical site infection.

    Science.gov (United States)

    McHugh, S M; Hill, A D K; Humphreys, H

    2011-05-01

    Approximately five percent of patients who undergo surgery develop surgical site infections (SSIs) which are associated with an extra seven days as an inpatient and with increased postoperative mortality. The competence and technique of the surgeon is considered important in preventing SSI. We have reviewed the evidence on different aspects of surgical technique and its role in preventing SSI. The most recent guidelines from the National Institute for Health and Clinical Excellence in the UK recommend avoiding diathermy for skin incision even though this reduces incision time and blood loss, both associated with lower infection rates. Studies comparing different closure techniques, i.e. continuous versus interrupted sutures, have not found a statistically significant difference in the SSI rate, but using continuous sutures is quicker. For contaminated wounds, the surgical site should be left open for four days to allow for treatment of local infection before subsequent healing by primary intention. Surgical drains should be placed through separate incisions, closed suction drains are preferable to open drains, and all drains should be removed as soon as possible. There are relatively few large studies on the impact of surgical techniques on SSI rates. Larger multicentre prospective studies are required to define what aspects of surgical technique impact on SSI, to better inform surgical practice and support education programmes for surgical trainees. Copyright © 2011 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  16. Closure Issues with Families.

    Science.gov (United States)

    Craig, Steven E.; Bischof, Gary H.

    Closure of the counseling relationship constitutes both an ending and a beginning. Although closure signifies the ending of the present counseling relationship, many family counselors conceptualize closure as the start of a working relationship between counselor and family that may be summoned in future times of crisis or during a difficult life…

  17. Surgical outcomes of mitomycin C combined with adjustable suture trabeculectomy for primary angle-closure glaucoma%丝裂霉素C联合可拆除缝线在小梁切除术中的临床应用

    Institute of Scientific and Technical Information of China (English)

    杨红艳

    2016-01-01

    目的:观察丝裂霉素 C 联合可拆除缝线在青光眼小梁切除术中的效果。方法对30例(35眼)青光眼患者进行丝裂霉素联合可拆除缝线的小梁切除术,术后随诊观察视力、眼压和滤过泡状况。结果手术后第1周眼压为(12.49±1.68) mmHg,第1个月眼压为(14.28±2.22)mmHg,第1年眼压为(17.29±2.87)mmHg 与手术前眼压相比较差异有统计学意义(P <0.05);术后1年功能型滤过泡35眼(82.86%)。结论丝裂霉素 C 联合可拆除缝线在小梁切除术中能有效降低眼压,减少术后并发症,提高手术成功率。%Objective To investigate the safety and efficacy of mitomycin C combined with adjustable suture trabeculectomyin treating primary angle-closure glaucoma.Methods This study included 30 patients(35 eyes)who underwent adjustable suture trabeculectomy combined with mitomycin C.Visual acuity,intraocular pressure and filtering blebs were measured.Results Mean postoperative intraoc-ular pressures were (12.49 ±1.68)mmHg at 1 week,(14.28 ±2.22)mmHg at 1 month and (17.29 ±2.87)mmHg at 1 year,re-spectively.There was significant difference between preoperation and postoperation(P <0.05).The rate of effective filtering bleb was 82.86% at 1 year.Conclusions Mitomycin C combined with adjustable suture trabeculectomy is a safe and effective surgical proce-dure to decrease intraocular pressure,reduce postoperative complications and raise success rate of the surgery.

  18. 21 CFR 878.4410 - Low energy ultrasound wound cleaner.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Low energy ultrasound wound cleaner. 878.4410... (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4410 Low energy ultrasound wound cleaner. (a) Identification. A low energy ultrasound wound cleaner is a device that...

  19. Polymeric hydrogels for burn wound care: Advanced skin wound dressings and regenerative templates

    Directory of Open Access Journals (Sweden)

    Marta Madaghiele

    2014-10-01

    Full Text Available Wound closure represents a primary goal in the treatment of very deep and/or large wounds, for which the mortality rate is particularly high. However, the spontaneous healing of adult skin eventually results in the formation of epithelialized scar and scar contracture (repair, which might distort the tissues and cause lifelong deformities and disabilities. This clinical evidence suggests that wound closure attained by means of skin regeneration, instead of repair, should be the true goal of burn wound management. The traditional concept of temporary wound dressings, able to stimulate skin healing by repair, is thus being increasingly replaced by the idea of temporary scaffolds, or regenerative templates, able to promote healing by regeneration. As wound dressings, polymeric hydrogels provide an ideal moisture environment for healing while protecting the wound, with the additional advantage of being comfortable to the patient, due to their cooling effect and non-adhesiveness to the wound tissue. More importantly, recent advances in regenerative medicine demonstrate that bioactive hydrogels can be properly designed to induce at least partial skin regeneration in vivo. The aim of this review is to provide a concise insight on the key properties of hydrogels for skin healing and regeneration, particularly highlighting the emerging role of hydrogels as next generation skin substitutes for the treatment of full-thickness burns.

  20. 带腓肠神经营养血管蒂逆行岛状皮瓣修复下肢软组织缺损的临床研究%The surgical effect of applying reverse sural neuro-fasciomusculocutaneous flap to rehabilitate limb parenchyma wound

    Institute of Scientific and Technical Information of China (English)

    李亮晖; 何问理; 曾浩

    2010-01-01

    Objective To evaluate the surgical effect of applying reverse sural neurofasciomusculocutaneous flap to rehabilitate limb parenchyma wound.Methods Assess the size of wound on limb,cut incisor flap from posterior crus,then use sural nerve and nutrient vessel as pedicel.The flag was reversely transfened to rehabilitate limb wound.There are 31 cases with parenchyma wounds,include in lower 1/3 crus wound,ankle wound,heel wound,and foot wound.The size of flap is range from 5cm×6cm to 12cm×17cm.Observe survival rate of surgical flap.Results 26 cases(83.9%)of surgical flag are alive,while 5 cases occurred necrosis on distal superficial flag or part of the flag.The five cases finally healing through secondary suture and skin-grafting.Conclusion As a new surgery therapy,applying reverse sural neuro-fasciomusculocutaneous flap to rehabilitate limb parenchyma wound is effective.It is character with simple,available,do not need to anastomose vessel,reserve main vessel and high survival rate.So it is worth recommend to widely use in clinical practice.%目的 探讨腓肠神经营养血管逆行岛状皮瓣修复小腿下1/3、踝、跟、足部软组织缺损的临床应用效果.方法 以腓肠神经及其营养血管为蒂,根据创面大小,在小腿后侧切取皮瓣,逆行转移修复小腿下1/3、踝、跟、足部软组织缺损31例,切取皮瓣范围5cm×6cm~12cm×17cm,观察术后皮瓣成活情况.结果 术后26例(83.9%)逆行皮瓣全部成活,5例远端浅表或部分坏死,经换药、Ⅱ期清创缝合或植皮后创面愈合.结论 腓肠神经营养血管逆行岛状皮瓣操作技术简便、易行、不需要吻合血管、不牺牲主要血管,成活率高,便于各级医院开展.

  1. Automatic wound infection interpretation for postoperative wound image

    Science.gov (United States)

    Hsu, Jui-Tse; Ho, Te-Wei; Shih, Hsueh-Fu; Chang, Chun-Che; Lai, Feipei; Wu, Jin-Ming

    2017-02-01

    With the growing demand for more efficient wound care after surgery, there is a necessity to develop a machine learning based image analysis approach to reduce the burden for health care professionals. The aim of this study was to propose a novel approach to recognize wound infection on the postsurgical site. Firstly, we proposed an optimal clustering method based on unimodal-rosin threshold algorithm to extract the feature points from a potential wound area into clusters for regions of interest (ROI). Each ROI was regarded as a suture site of the wound area. The automatic infection interpretation based on the support vector machine is available to assist physicians doing decision-making in clinical practice. According to clinical physicians' judgment criteria and the international guidelines for wound infection interpretation, we defined infection detector modules as the following: (1) Swelling Detector, (2) Blood Region Detector, (3) Infected Detector, and (4) Tissue Necrosis Detector. To validate the capability of the proposed system, a retrospective study using the confirmation wound pictures that were used for diagnosis by surgical physicians as the gold standard was conducted to verify the classification models. Currently, through cross validation of 42 wound images, our classifiers achieved 95.23% accuracy, 93.33% sensitivity, 100% specificity, and 100% positive predictive value. We believe this ability could help medical practitioners in decision making in clinical practice.

  2. Risk factors for nosocomial burn wound infection caused by multidrug resistant Acinetobacter baumannii.

    Science.gov (United States)

    Tekin, Recep; Dal, Tuba; Bozkurt, Fatma; Deveci, Ozcan; Palanc, Ylmaz; Arslan, Eyüp; Selçuk, Caferi Tayyar; Hoşoğlu, Salih

    2014-01-01

    Acinetobacter baumannii infections in burn patients may lead to delays in wound healing, graft losses, and development of sepsis. Determining the risk factors for multidrug resistant A. baumannii (MDR-AB) infections is essential for infection control. In the present study, the authors aimed to evaluate risk factors for wound infections caused by A. baumannii in burn patients. The study was conducted at Dicle University Hospital Burn Center, from April 2011 to July 2012, to investigate the risk factors for MDR-AB infections. The data of both the case and control group patients and the result of wound cultures were recorded on a daily basis, on individual forms given for each patient, and analyzed. A total of 30 cases infected with MDR-AB, and 60 uninfected control patients, were included in the study. The mean age (±SD) was 7.7 ± 15.4 years in infected patients and 11.4 ± 16.5 years in uninfected patients. The mean total burn surface area was 13.5 ± 10.9% in uninfected patients and 34.7 ± 16.2% in infected patients. The mean total burn surface area, the abbreviated burn severity index, acute physiological and chronic health evaluation II score, day of admission to hospital, length of hospital stay, first excision day, prior usage of third-generation cephalosporins, and stay in intensive care unit of the infected patients were significantly higher (P infection. Univariate analysis found that high acute physiological and chronic health evaluation II score, first excision time of wound, invasive device usage, admission day to hospital, and prior usage of broad-spectrum antibiotics were risk factors for nosocomial infections. This study showed that multiple factors contribute to multidrug resistance in A. baumannii. A combination of an early diagnosis of wound infections, appropriate antimicrobial treatments, surgical debridement, and early wound closure may be effective in the management.

  3. Effect of astaxanthin on cutaneous wound healing.

    Science.gov (United States)

    Meephansan, Jitlada; Rungjang, Atiya; Yingmema, Werayut; Deenonpoe, Raksawan; Ponnikorn, Saranyoo

    2017-01-01

    Wound healing consists of a complex series of convoluted processes which involve renewal of the skin after injury. ROS are involved in all phases of wound healing. A balance between oxidative and antioxidative forces is necessary for a favorable healing outcome. Astaxanthin, a member of the xanthophyll group, is considered a powerful antioxidant. In this study, we investigated the effect of topical astaxanthin on cutaneous wound healing. Full-thickness dermal wounds were created in 36 healthy female mice, which were divided into a control group and a group receiving 78.9 µM topical astaxanthin treatment twice daily for 15 days. Astaxanthin-treated wounds showed noticeable contraction by day 3 of treatment and complete wound closure by day 9, whereas the wounds of control mice revealed only partial epithelialization and still carried scabs. Wound healing biological markers including Col1A1 and bFGF were significantly increased in the astaxanthin-treated group since day 1. Interestingly, the oxidative stress marker iNOS showed a significantly lower expression in the study. The results indicate that astaxanthin is an effective compound for accelerating wound healing.

  4. Honey: an immunomodulator in wound healing.

    Science.gov (United States)

    Majtan, Juraj

    2014-01-01

    Honey is a popular natural product that is used in the treatment of burns and a broad spectrum of injuries, in particular chronic wounds. The antibacterial potential of honey has been considered the exclusive criterion for its wound healing properties. The antibacterial activity of honey has recently been fully characterized in medical-grade honeys. Recently, the multifunctional immunomodulatory properties of honey have attracted much attention. The aim of this review is to provide closer insight into the potential immunomodulatory effects of honey in wound healing. Honey and its components are able to either stimulate or inhibit the release of certain cytokines (tumor necrosis factor-α, interleukin-1β, interleukin-6) from human monocytes and macrophages, depending on wound condition. Similarly, honey seems to either reduce or activate the production of reactive oxygen species from neutrophils, also depending on the wound microenvironment. The honey-induced activation of both types of immune cells could promote debridement of a wound and speed up the repair process. Similarly, human keratinocytes, fibroblasts, and endothelial cell responses (e.g., cell migration and proliferation, collagen matrix production, chemotaxis) are positively affected in the presence of honey; thus, honey may accelerate reepithelization and wound closure. The immunomodulatory activity of honey is highly complex because of the involvement of multiple quantitatively variable compounds among honeys of different origins. The identification of these individual compounds and their contributions to wound healing is crucial for a better understanding of the mechanisms behind honey-mediated healing of chronic wounds.

  5. Closure The Definitive Guide

    CERN Document Server

    Bolin, Michael

    2010-01-01

    If you're ready to use Closure to build rich web applications with JavaScript, this hands-on guide has precisely what you need to learn this suite of tools in depth. Closure makes it easy for experienced JavaScript developers to write and maintain large and complex codebases -- as Google has demonstrated by using Closure with Gmail, Google Docs, and Google Maps. Author and Closure contributor Michael Bolin has included numerous code examples and best practices, as well as valuable information not available publicly until now. You'll learn all about Closure's Library, Compiler, Templates, tes

  6. Post-thoracotomy wound separation (DEHISCENCE: a disturbing complication

    Directory of Open Access Journals (Sweden)

    Aydin Nadir

    2013-01-01

    Full Text Available OBJECTIVES: We described the treatment of dehiscence of thoracotomy incisions in patients who underwent thoracic surgery in the present study. METHODS: Twenty-four patients with either partial or complete dehiscence of their thoracotomy incisions were included in the study from 2005 to 2010. The patients were evaluated regarding their age, sex, indication for thoracotomy, and surgical approaches. We also described our method of re-closure. RESULTS: The male/female ratio was 17/7. The youngest and oldest patients were 15 and 75 years old, respectively, and the mean age was 43 years. Among the indications for thoracotomy, empyema was the most common reason (determined in eight [33%] patients, followed by vertebral surgery (determined in six [25%] patients. Bacterial growth was detected in the wound site cultures from 13 (54% patients. For the patients with dehiscence of their thoracotomy incisions, an en block approximation technique with debridement was performed under general or local anesthesia in 16 (66% and eight (33% of the cases, respectively. Three patients exhibited an open thorax with dehiscence of the thoracotomy incision. Thoracoplasty was required in two patients. Using this method, successful closure was obtained in 91.7% (n = 22 of the patients with dehiscence of their thoracotomy incisions. CONCLUSION: Dehiscence of the thoracotomy incision is an important complication that causes concern in patients and their thoracic surgeons and strongly affects the success of the surgery. An en block approximation technique with significant debridement that enables removal of the necrotic tissues from the wound site can successfully be applied to patients with dehiscence of their thoracotomy incisions.

  7. Vacuum with mesh is a feasible temporary closure device after fascial dehiscence

    DEFF Research Database (Denmark)

    Bjørsum-Meyer, Thomas; Skarbye, Mona; Jensen, Kenneth Højsgaard

    2013-01-01

    INTRODUCTION: The open abdomen is a challenging condition and a temporary abdominal closure device is required in order to protect the intra-abdominal viscera. We aimed to evaluate the feasibility of a recent device: vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM) after f...

  8. Vacuum with mesh is a feasible temporary closure device after fascial dehiscence

    DEFF Research Database (Denmark)

    Bjørsum-Meyer, Thomas; Skarbye, Mona; Jensen, Kenneth Højsgaard

    2013-01-01

    INTRODUCTION: The open abdomen is a challenging condition and a temporary abdominal closure device is required in order to protect the intra-abdominal viscera. We aimed to evaluate the feasibility of a recent device: vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM) after f...

  9. Neutralisation of uPA with a monoclonal antibody reduces plasmin formation and delays skin wound healing in tPA-deficient mice

    DEFF Research Database (Denmark)

    Jögi, Annika; Rønø, Birgitte; Lund, Ida K

    2010-01-01

    Proteolytic degradation by plasmin and metalloproteinases is essential for epidermal regeneration in skin wound healing. Plasminogen deficient mice have severely delayed wound closure as have mice simultaneously lacking the two plasminogen activators, urokinase-type plasminogen activator (u......PA) and tissue-type plasminogen activator (tPA). In contrast, individual genetic deficiencies in either uPA or tPA lead to wound healing kinetics with no or only slightly delayed closure of skin wounds....

  10. An unusual stab wound to the buttock

    Directory of Open Access Journals (Sweden)

    Ashraf F Hefny

    2013-01-01

    Full Text Available Stab wounds to the buttock are uncommon injuries that are rarely seen in surgical civilian practice. Although, the wound appears trivial, it may cause major life-threatening visceral and vascular injuries. Failure to detect these injuries may lead to serious morbidity and mortality. Herein, we report a patient with a single gluteal stab wound, which was initially sutured and treated conservatively. Two days later, patient developed fever, lower abdominal pain and tenderness with leakage of fecal material from the wound. Exploratory laparotomy revealed an extraperitoneal rectal perforation for which a Hartmann′s procedure was performed. Computed tomography scanning is recommended as a diagnostic tool for stable patients having buttock stab wounds. Diverging colostomy is the standard surgical procedure for extraperitonal rectal injuries that cannot be properly visualized and repaired during a laparotomy. More evidence is needed to assess the fecal non-diversion approach in the treatment of these patients.

  11. Wound bed preparation from a clinical perspective

    Directory of Open Access Journals (Sweden)

    A S Halim

    2012-01-01

    Full Text Available Wound bed preparation has been performed for over two decades, and the concept is well accepted. The ′TIME′ acronym, consisting of tissue debridement, i nfection or inflammation, moisture balance and edge effect, has assisted clinicians systematically in wound assessment and management. While the focus has usually been concentrated around the wound, the evolving concept of wound bed preparation promotes the treatment of the patient as a whole. This article discusses wound bed preparation and its clinical management components along with the principles of advanced wound care management at the present time. Management of tissue necrosis can be tailored according to the wound and local expertise. It ranges from simple to modern techniques like wet to dry dressing, enzymatic, biological and surgical debridement. Restoration of the bacterial balance is also an important element in managing chronic wounds that are critically colonized. Achieving a balance moist wound will hasten healing and correct biochemical imbalance by removing the excessive enzymes and growth factors. This can be achieved will multitude of dressing materials. The negative pressure wound therapy being one of the great breakthroughs. The progress and understanding on scientific basis of the wound bed preparation over the last two decades are discussed further in this article in the clinical perspectives.

  12. 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.

  13. Complex wounds Feridas complexas

    Directory of Open Access Journals (Sweden)

    Marcus Castro Ferreira

    2006-01-01

    Full Text Available Complex wound is the term used more recently to group those well-known difficult wounds, either chronic or acute, that challenge medical and nursing teams. They defy cure using conventional and simple "dressings" therapy and currently have a major socioeconomic impact. The purpose of this review is to bring these wounds to the attention of the health-care community, suggesting that they should be treated by multidisciplinary teams in specialized hospital centers. In most cases, surgical treatment is unavoidable, because the extent of skin and subcutaneous tissue loss requires reconstruction with grafts and flaps. New technologies, such as the negative pressure device, should be introduced. A brief review is provided of the major groups of complex wounds-diabetic wounds, pressure sores, chronic venous ulcers, post-infection soft-tissue gangrenes, and ulcers resulting from vasculitis.Ferida complexa é uma nova definição para identificar aquelas feridas crônicas e algumas agudas já bem conhecidas e que desafiam equipes médicas e de enfermagem. São difíceis de serem resolvidas usando tratamentos convencionais e simples curativos. Têm atualmente grande impacto sócio-econômico. Esta revisão procura atrair atenção da comunidade de profissionais de saúde para estas feridas, sugerindo que devam ser tratadas por equipe multidisciplinar em centro hospitalar especializado. Na maioria dos casos o tratamento cirúrgico deve ser indicado, uma vez que a perda de pele e tecido subcutâneo é extensa, necessitando de reconstrução com enxertos e retalhos. Nova tecnologia, como uso da terapia por pressão negativa foi introduzido. Breves comentários sobre os principais grupos de feridas complexas: pé diabético, úlceras por pressão, úlceras venosas, síndrome de Fournier e vasculites.

  14. COMPARATIVE STUDY OF LAPAROSCOPIC CLOSURE OPEN PEPTIC PERFORATION CLOSURE

    Directory of Open Access Journals (Sweden)

    Vivek

    2015-10-01

    Full Text Available Laparoscopic closure of perforated duodenal ulcer was first performed in the year 1990 . Due to its advantage of better view of the peritoneal cavity an opportunity for thorough lavage and avoidance of upper abdominal incision, with its related complication, especially in high – ri sk patients, this procedure has gained popularity all over the world. Approximately 10 - 20% of patients suffering from peptic ulcer develop perforation of stomach or duodenum in which, chemical peritonitis develop initially from gastric secretion and duoden al secretion the condition is life threatening. Early diagnosis and treatment is extremely important. Mortality will increase up if perforation exists more than 24 to 48 hours. Usually surgical intervention of simple closure with omental patch of the perforation is required. this study aims at evaluating efficacy , safety and outcome of laparoscopic surgery for perforated duodenal ulcer patients admitted during period Jan 2009 to Dec 2012 at tertiary hospital in north Karnataka A total of 61cases diagnosed as peritonitis secondary to duodenal ulcer perforation were involved in the study 30underwent open perforation closure and 31 cases underwent lap closure. Peptic ulcers are focal defects in the gastric or duodenal mucosa which extend into the sub mucosa or deeper. they may be acute or chronic and ultimately are caused by on imbalance between the action of peptic acid and mucosal defenses peptic ulcer remains a common outpatient diagnosis, but the number of elective operations for peptic ul cer disease have decreased dramatically over the past 30 decades due to the advent of H2 blockers However the incidence of emergency surgeries, and death rate associated with peptic ulcer are same

  15. Epithelialization in Wound Healing: A Comprehensive Review

    Science.gov (United States)

    Pastar, Irena; Stojadinovic, Olivera; Yin, Natalie C.; Ramirez, Horacio; Nusbaum, Aron G.; Sawaya, Andrew; Patel, Shailee B.; Khalid, Laiqua; Isseroff, Rivkah R.; Tomic-Canic, Marjana

    2014-01-01

    Significance: Keratinocytes, a major cellular component of the epidermis, are responsible for restoring the epidermis after injury through a process termed epithelialization. This review will focus on the pivotal role of keratinocytes in epithelialization, including cellular processes and mechanisms of their regulation during re-epithelialization, and their cross talk with other cell types participating in wound healing. Recent Advances: Discoveries in epidermal stem cells, keratinocyte immune function, and the role of the epidermis as an independent neuroendocrine organ will be reviewed. Novel mechanisms of gene expression regulation important for re-epithelialization, including microRNAs and histone modifications, will also be discussed. Critical Issues: Epithelialization is an essential component of wound healing used as a defining parameter of a successful wound closure. A wound cannot be considered healed in the absence of re-epithelialization. The epithelialization process is impaired in all types of chronic wounds. Future Directions: A comprehensive understanding of the epithelialization process will ultimately lead to the development of novel therapeutic approaches to promote wound closure. PMID:25032064

  16. Prevalência de resistência bacteriana nas infecções de ferida operatória em cirurgia arterial periférica Prevalence of bacterial resistance in surgical wound infections in peripheral arterial surgery

    Directory of Open Access Journals (Sweden)

    Eduardo Lichtenfels

    2008-09-01

    Full Text Available CONTEXTO: A infecção de sítio cirúrgico é uma complicação grave da cirurgia vascular periférica. O recente aparecimento de microorganismos resistentes e agressivos gera uma nova preocupação com relação ao manejo dessas infecções. OBJETIVO: Verificar a prevalência de resistência bacteriana, a epidemiologia, os possíveis fatores associados e o padrão de resistência nas infecções de ferida operatória das cirurgias arteriais periféricas. MÉTODOS: Estudo de prevalência, envolvendo 40 pacientes portadores de infecção da ferida operatória e submetidos à cirurgia de revascularização arterial periférica no período de janeiro de 2007 a maio de 2008. RESULTADOS: Participaram do estudo pacientes com média de idade de 64,2 anos, predominantemente do sexo masculino (70%. A prevalência geral de resistência bacteriana foi 72,5%, e de multirresistência, 60%. O microorganismo mais freqüentemente isolado foi o Staphylococcus aureus (40%, sendo 11 das 16 culturas (68,7% resistentes à oxacilina. As taxas de resistência aos principais antimicrobianos testados foram: ampicilina, 85,7%; cefalosporina, 76,9%; oxacilina, 65%; e ciprofloxacina, 62,5%. Não foi identificada resistência à vancomicina e ao imipenem. CONCLUSÕES: Os achados deste estudo sugerem que a resistência bacteriana é um problema atual e muito prevalente nas cirurgias arteriais periféricas. O Staphylococcus aureus segue sendo o principal patógeno envolvido, demonstrando altas taxas de resistência. A vancomicina e o imipenem seguem sendo as principais opções terapêuticas para esse tipo de infecção.BACKGROUND: Surgical wound infection is a severe complication of peripheral vascular surgery. The recent appearance of resistant and aggressive pathogens brings new concerns related to the management of these infections. OBJECTIVE: To verify the prevalence of bacterial resistance, epidemiology, possibly associated factors and resistance patterns in wound

  17. Evaluation of ghee based formulation for wound healing activity.

    Science.gov (United States)

    Prasad, Vure; Dorle, Avinash Kumar

    2006-08-11

    Formulation containing neomycin and ghee was evaluated for wound-healing potential on different experimental models of wounds in rats. The rats were divided into six groups of group 1 as control, group 2 as treated with neomycin only, group 3 as treated only with ghee, group 4 treated with F-1 formulation containing ghee 40% and neomycin 0.5%, group 5 treated with F-2 formulation containing ghee 50% and neomycin 0.5% and group 6 treated with F-3 formulation containing ghee and ointment base in all two wound models, each group consisting of six rats. Wound contraction ability in excision wound model was measured at different time intervals and study was continued until wound is completely healed. Tensile strength was measured in 10-day-old incision wound and quantitative estimation of hydroxy proline content in the healed tissue was determined in 10-day-old excision wound. Histological studies were done on 10-day-old sections of regenerated tissue of incision wound. F-2 formulation containing ghee 50% and neomycin 0.5% showed statistically significant response, in terms of wound contracting ability, wound closure time, period of epithelization, tensile strength of the wound, regeneration of tissues at wound site when compared with the control group and these results were comparable to those of a reference neomycin ointment.

  18. A simple protocol for the management of deep sternal surgical site infection: a retrospective study of twenty-five cases.

    Science.gov (United States)

    Shih, Yu-Jen; Chang, Shun-Cheng; Wang, Chih-Hsin; Dai, Niann-Tzyy; Chen, Shyi-Gen; Chen, Tim-Mo; Tzeng, Yuan-Sheng

    2014-12-01

    Deep sternal incisional surgical site infection is a serious and potentially life-threatening complication after open heart surgery. Although a rare post-operative complication, the rates of post-operative morbidity and mortality are greater in patients who develop a deep sternal incisional surgical site infection than in those who do not. We evaluated retrospectively the results of patients who developed a deep sternal incisional surgical site infection who were treated with either a pectoralis major flap or delayed primary closure after previous negative-pressure wound therapy (NWPT). From July 2007 to July 2012, 25 patients had a deep sternal incisional surgical site infection after open heart surgery in the Departments of Plastic Surgery and Cardiac Surgery of the Tri-Service General Hospital Medical Center. Sternal refixation was not performed in our patients. In 15 patients, a unilateral or bilateral pectoralis major advancement flap with a myocutaneous or muscle flap was used. In seven patients, delayed primary closure was performed after NPWT. One patient received a rectus abdominis myocutaneous flap and another received a free anterior lateral thigh flap. One patient died after developing nosocomial pneumonia with severe sepsis after debridement. In our series, no patient required sternal re-fixation. Our findings suggest that delayed primary closure and use of a unilateral or bilateral pectoralis major flap following NPWT for a deep sternal incisional surgical site infection are simple and quick methods for managing such difficult surgical incisions even if the deep sternal surgical site infection is located in the lower one-third of the sternum.

  19. Cellular and Molecular Characteristics of Scarless versus Fibrotic Wound Healing

    Directory of Open Access Journals (Sweden)

    Latha Satish

    2010-01-01

    Full Text Available The purpose of this paper is to compare and contrast the discrete biology differentiating fetal wound repair from its adult counterpart. Integumentary wound healing in mammalian fetuses is essentially different from wound healing in adult skin. Adult (postnatal skin wound healing is a complex and well-orchestrated process spurred by attendant inflammation that leads to wound closure with scar formation. In contrast, fetal wound repair occurs with minimal inflammation, faster re-epithelialization, and without the accumulation of scar. Although research into scarless healing began decades ago, the critical molecular mechanisms driving the process of regenerative fetal healing remain uncertain. Understanding the molecular and cellular events during regenerative healing may provide clues that one day enable us to modulate adult wound healing and consequently reduce scarring.

  20. Wound care centers

    Science.gov (United States)

    ... wound from getting worse or becoming infected Preventing limb loss Preventing new wounds from occurring or old wounds ... Gauze Films Your provider may use one or multiple types of dressings as your wound heals. Hyperbaric ...

  1. Bacterial Wound Culture

    Science.gov (United States)

    ... and services. Advertising & Sponsorship: Policy | Opportunities Bacterial Wound Culture Share this page: Was this page helpful? Also known as: Aerobic Wound Culture; Anaerobic Wound Culture Formal name: Culture, wound Related ...

  2. Delayed cerebrospinal fluid leak after watertight dural closure with a polyethylene glycol hydrogel dural sealant in posterior fossa surgery: case report.

    Science.gov (United States)

    Jito, Junya; Nitta, Naoki; Nozaki, Kazuhiko

    2014-01-01

    A polyethylene glycol (PEG) hydrogel sealant recently has been approved as an adjunct to sutured dural closure in Japan. We treated consecutive six patients with PEG hydrogel sealant in posterior fossa operation. Three of six cases suffered delayed cerebrospinal fluid (CSF) leak after watertight dural closure with the PEG hydrogel sealant, although there was no leak case which was treated with fibrin glue, before 2 years until the adoption of the new material. These patients underwent posterior fossa craniotomy and discharged without remarkable CSF leak. The pseudomeningocele under the occipital wound caused the CSF leak occurr from 5th to 7th week postoperatively. All CSF leak cases needed surgical repair. At the repair, the PEG hydrogel was liquefied and almost absorbed. A fistula on the closure line and a dead space after the absorption of the PEG hydrogel was observed. When the absorbable PEG hydrogel sealant plugs in small gaps of sutured dura, its properties to prevent adhesion might suppress healing process of dural closure, so that CSF could leak through the gaps and collect as a pseudomeningocele in the dead space after absorption of the PEG hydrogel. In posterior fossa surgery a PEG hydrogel sealant should be applied when dural edges are closed tightly without any gaps.

  3. The Effects of Vacuum Assisted Closure on the Expression of S100A9 Protein in Human Pressure Ulcer Wound%封闭式负压引流对人压力性溃疡创面S100A9蛋白表达的影响

    Institute of Scientific and Technical Information of China (English)

    郑光辉; 张洁; 彭安萍; 蒋龙元

    2015-01-01

    目的:研究封闭式负压引流技术对人压力性溃疡S100A9蛋白的表达影响以探讨其促进创面愈合的可能机制。方法:将28例Ⅲ-Ⅳ期及不可分期的压力性溃疡患者随机分成实验组(14例)和对照组(14例),实验组患者创面应用封闭式负压引流治疗,对照组患者创面应用常规敷料换药治疗,两组患者分别于治疗前1 d,治疗后4 d、7 d、14 d取创面创缘全层皮肤组织,应用免疫组织化学染色法检测标本组织中的S100A9蛋白的表达情况。结果:随着治疗时间延长,实验组和对照组S100A9蛋白阳性表达细胞数开始增加,都表达于中性粒细胞及单核巨噬细胞的细胞质中,治疗第14天,实验组肉芽组织中表达S100A9蛋白的炎症细胞数高于对照组(75.93±1.88 vs 55.13±1.03, P<0.01)。结论:封闭式负压引流疗法较普通换药更能够上调创缘组织中与创面愈合密切相关的S100A9蛋白表达来促进创面愈合。%Objective: To investigate the expression of S100A9 in the pressure ulcer wound tissue with vacuum assisted closure (VAC) on pressure ulcer (PU), and to explore its further mechanism which can facilitate healing of PU wound. Methods: 28 patients with Stage Ⅲ-Ⅳ and unstageable pressure ulcer wounds were divided into the experimental group (n=14) and the control group (n=14) randomly. The experimental group was treated with VAC, while the control group was treated with dressings. The full-thickness skin tissues were selected from every patient for immunohistochemistry (IHC) to evaluating the expression of S100A9 protein at pre-treatment, and the 4th day, 7th day, 14th day after treatment with VAC and dressings. Results: With the treatment process developed, the positive staining of S100A9 protein were both located in the neutrophil and mononuclear macrophage , and the number of positive cells became increased. The expression of S100A9 protein in

  4. YAP and TAZ regulate skin wound healing.

    Science.gov (United States)

    Lee, Min-Jung; Ran Byun, Mi; Furutani-Seiki, Makoto; Hong, Jeong-Ho; Jung, Han-Sung

    2014-02-01

    The Hippo signaling pathway regulates organ size, tissue regeneration, and stem cell self-renewal. The two key downstream transcription coactivators in this pathway, Yes-associated protein (YAP) and transcriptional coactivator with PDZ-binding motif (TAZ), mediate the major gene regulation and biological functions of the Hippo pathway. The biological functions of YAP and TAZ in many tissues are known; however, their roles in skin wound healing remain unclear. To analyze whether YAP and/or TAZ are required for cutaneous wound healing, we performed small interfering RNA (siRNA)-mediated knockdown of YAP/TAZ in full-thickness skin wounds. YAP is strongly expressed in the nucleus and cytoplasm in the epidermis and hair follicle. Interestingly, YAP is expressed in the nucleus in the dermis at 2 and 7 days after wounding. TAZ normally localizes to the cytoplasm in the dermis but is distributed in both the nucleus and cytoplasm at 1 day after wounding. The knockdown of YAP and TAZ markedly delayed the rate of wound closure and reduced the transforming growth factor-β1 (TGF-β1) expression in the wound. YAP and TAZ also modulate the expression of TGF-β1 signaling pathway components such as Smad-2, p21, and Smad-7. These results suggest that YAP and TAZ localization to the nucleus is required for skin wound healing.

  5. Closure Operators and Closure Systems on Quantaloid-Enriched Categories

    Institute of Scientific and Technical Information of China (English)

    Min LIU; Bin ZHAO

    2013-01-01

    In this paper,we introduce the fundamental notions of closure operator and closure system in the framework of quantaloid-enriched category.We mainly discuss the relationship between closure operators and adjunctions and establish the one-to-one correspondence between closure operators and closure systems on quantaloid-enriched categories.