Wound Medicine最新文献

Introduction

Burn care was revolutionized by critical care and excision surgeries which drastically improved the survival rates of the patients. Another cornerstone and basic surgery in all these patients is the skin grafting. Traditionally skin grafts are fixed using sutures, staplers and cyanoacrylate glue. The study was conducted to compare the efficacy and effects of fibrin sealant and cyanoacrylate glue in graft fixation and scar characteristics after skin grafting in post burn raw areas.

Materials and methods

The study was conducted as a retrospective comparative cohort study with prospective follow-up conducted at a tertiary burn care centre in India over a period of one year which included patients between 18–50 years who presented with post burn raw areas and underwent skin graft fixation with fibrin sealant or cyanoacrylate glue.

Results

Data from 40 patients were collected and analyzed in the study. Group 1 (Fibrin sealant) and group 2 (Cyanoacrylate glue) included 20 patients each. The percentage of graft take at the end of 15th post-operative day was higher in group 1 in comparison to group 2 (95 % and 90.2 % respectively). Two patients had graft failure (Mean - 26.75 %) in group 1 in comparison to five in group 2 (Mean - 38.16 %). At end of six months, on modified Vancouver scar scale in categories of pigmentation, vascularity, thickness and pliability - the subjective scorings were better in group 1 overall. Histopathological and immuno-histochemical staining showed better scar characteristics in group 1.

Conclusion

The use of fibrin sealant has shown better results when compared to cyanoacrylate glue in the fixation of skin grafts in post burn raw areas. The superior scores in clinical and histopathological scar characteristics in fibrin sealant group may indicate the role of Fibrin sealant in scar modulation.

Background

Biological membranes are widely used as dressings to prevent contamination during the open wound healing process. The amniotic membrane has been clinically demonstrated to be an accelerator of wound healing. However, this membrane is fragile and technically sensitive. The platelet-rich fibrin membrane has good physical properties and contains growth factors. However, few controlled studies have compared the effects of these membranes on wound healing, specifically during the proliferation phase. The proliferation phase is an important stage in the development of more effective therapeutic interventions. This study investigated the differences in the wound healing process during the proliferation phase after applying platelet-rich fibrin and amniotic membranes. This quasi-experimental study used 36 rabbits that were divided into three groups. A 4 mm x 4 mm section of the labial gingiva was de-epithelized using a scalpel. Gingival biopsies were taken on days one, three, five, and seven and stained with hematoxylin and eosin and Mallory’s trichrome stain. Observations were done in a double-blind manner. The number of fibroblasts and blood vessels, as well as epithelial thickness were tested using two-way analysis of variance followed by a post-hoc LSD test. Collagen density was tested with the Kruskal–Wallis test followed by the Mann–Whitney test using SPSS software.

Results

The number of fibroblasts, angiogenesis, collagen density, and epithelial thickness were higher in group II than in the other groups (P < 0.05).

Conclusions

Histological parameters measured during the proliferation phase showed that the platelet-rich fibrin membrane may accelerate wound healing better than the amniotic membrane.

Caiman yacare visceral fat oil was extracted, analyzed, and tested for healing potential. In vivo assays were performed by excisional wounds in rats and treated topically daily with Caiman oil for 10 days. The positive and negative controls were, respectively, with Dersani® (Essential Fatty Acids – EFA, reference substance) and saline solution (SS). The scattered area was measured daily, and at 3rd and 10th days the rats were euthanized and samples were processed for histological analyses. The cytotoxicity was evaluated by the MTT assay in non-tumor retinal pigment epithelium cells. The Caiman oil composition was 42.95 ± 1.03 % of saturated fatty acids and 43.74 ± 0.74 % of unsaturated ones. After 10 days of excisional wounds, the Caiman oil-treated animals present a larger scarred area than the negative control ones. Caiman oil and EFA treated animals present significantly more epidermal papillae than in SS-treated ones on day 10. Caiman oil treated animals, at 10th day, present a relative increased area of collagen fibers, as well as an elevated number of fibroblasts and monomorphonuclear cells in the wound region in comparison to both SS and EFA treated ones. The oil showed no significant cytotoxicity up to 500 μg/mL. Taken together, Caiman oil, extracted as a by-product of the C. yacare zootechnical disposal, demonstrated wound healing properties equal to the commercial available solution, subsidizing its ethnoknowledge.

Graphene and its derivatives have attracted much attention in recent years due to their unique properties and functionalization ability in tissue engineering. In this work, effect of biomolecule adding in three groups of Graphene family (consisting of Graphene, Graphene Oxide and reduced Graphene Oxide), their composites and modified forms are studied. Although the Graphene family induces differentiation of stem cells, adding appropriate factors (such as growth factors, inducers and gene activator proteins) helps improve the adhesion, proliferation and differentiation of cells. The novelty of this work is to verifying the capability of specifically-induced differentiation and bioactive controlled release of biomolecules on Graphene-based substrates, Graphene filled substrates or Graphene coated substrates and explaining the important role of biomolecules in stem cells fate. The study indicates that Graphene family can release biomolecules (including growth factors and proteins) in a controlled manner and these additives significantly enhance or accelerate the adhesion, proliferation and differentiation of stem cells and induce the differentiation of stem cells to specific cells.

Dimethyl sulfoxide (DMSO) is one of the commonly used vehicles to dissolve water insoluble drugs, including used for wound healing purposes, for different experiments. The present study was aimed to investigate the gross effects and histopathological changes produced by topical DMSO on granulation tissue at wound site. Open excision cutaneous wounds were created on the back of ten male rats and equally divided into two groups. Distilled water and DMSO (10 %) were topically applied once daily for 21 days on wounds of Group I (control group) and Group II, respectively. Grossly, wounds revealed that DMSO facilitated wound closure on day 7 and 12. On day 21, the wound was still not closed in DMSO treated group in comparison to control group. The H & E stained sections of control group showed formation of complete, immature and thin epithelial layer, collagen deposition and infiltration of abundant number of mononuclear cells. Sections of DMSO treated group showed blood vessels, scattered infiltration of inflammatory cells, collagen fibers and partially formed epithelial layer. Semi-quantitative score for inflammatory cells and epithelialization was significantly lower in DMSO treated group. Picrosirius red stained sections showed dominance of orange-red (thicker) collagen fibers in control group and yellow-green (thinner) collagen fibers in DMSO treated group. DMSO treated group showed higher and lower thin collagen and thick collagen fiber fraction, respectively in comparison to control group. Thus, it might be concluded that DMSO facilitates wound closure during the early stages and delays the wound closure during at later stages of wound healing.

Aim

Film dressings were one of the first modern wound-dressing products. During the removal of the dressing skin stress occurs. An essential role is shearing force between skin and wound dressing playing [3]. This problem includes missing elasticity, flexibility and too strong adhesion [3,4].

The present study was initiated to evaluate if the switchable formulation of the adhesive ensures a durable and strong enough adhesion. Illumination of the film dressing with the UV-A lamp irreversibly switches the adhesion from strong to weak and guarantees a painless/comfortable removal of the dressing.

Methods

The present study evaluated suitability for use as well as user and patient satisfaction during use of the tested film on patients with chronic wounds. The used film dressing consists of a thin film backing with a non‑latex adhesive. Before removal the adhesion is reduced by illuminating the dressing with the UV-A lamp.

Results

54 patients were included in the study. At each dressing change, pain level after dressing change was rated lower compared to the pain level before dressing change. Overall, pain level decreased over the study period. Reactions on the wound edge/wound surroundings have not been reported.

Discussion

The clinicians gave favourable scores for the tested film dressing. The overall satisfaction with the product was rated very good. Tolerability such as pain during wearing the dressing and upon removal were given good scores. Skin irritation caused in the use of the film dressing did not occur.

Conclusion

The switchable function of the adhesive allows the adhesion of the film dressing to the skin to be reduced when illuminated by the supplied UV-A lamp. The results of the present study show that the reduced adhesion upon illumination enables easy and comfortable removal of the dressing.

Objective

Our aim was to determine the treatment outcome using HBOT for both acute and chronic problematic wounds.

Methods

This was a case-control study conducted at Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand between 2012 and 2017. The inclusion criterion was all patients with either acute or chronic wounds with delayed wound healing treated with hyperbaric oxygen therapy (HBOT). Wound improvement was the primary outcome.

Results

Eighty-eight patients were included. Sixty-eight patients (77 %) had improved wound healing while 20 (23 %) had a poor treatment outcome. In the improved wound healing group, the outcome of wound healing was classified into 2 groups: Group 1–40 patients (58.8 %) experienced wound healing while Group 2–28 patients (41.2 %) experienced decreased wound size and reduced pain. The factors prognostic for a poor treatment outcome were arterial occlusion (OR 19.667, 95 % CI 5.740–67.378), diabetes (OR 3.405, 95 % CI 1.198–9.679), and bone exposure (OR 10.389, 95 % CI 2.763–39.058).

Conclusion

Among patients with problematic wounds undergoing HBOT, the factors associated with a poor prognosis were arterial occlusion, DM, and wound with bone exposure.

Background

The use of Theresienöl® (T.O.) a traditional Austrian natural product has been traced back to1350. Medical wound care has always been a major concern and problem for people, especially in the Middle Ages. Еven the smallest injuries or open wounds to become fatal due to poor hygienic conditions. Access to natural fats and vegetable ingredients made it possible to create a unique ointment named Theresienöl® which successfully treated multiple skin injuries including wounds, burns and scars.

Methods

1,354 patients suffering of therapy-refractory skin injuries treated with T.O. within 38 centers between 2004–2020 in a cohort study. These were used for this review. Patients were divided by clinical criteria based on application duration and daily rate of reapplication strictly individualized depending on the degree of damage and efficiency results depending on the duration of the problem and the presence of chronic concomitant diseases. With a simplified application process a fine film of 2 drops/1 cm of the product (Depending on the vehicle of choice) over the wound or the affected areas, with a waiting time until partial absorption takes place followed by the dressing. It can be applied directly over the wound or over sterile bandages. The Primary endpoints were pain reduction, patient satisfaction both physically and aesthetically. Additionally we performed dermatological testing for irritation and allergy potential and rule out further side effects.

Results

After further evaluation of the 1,354 cases, statistically it showed an averaged of 89 % improvement rate in inflammation, an 88 % reduction rate in pruritus, 87 % of improved epithelisation, 93 % in patient benefit, and 91 % show improvement in wound closure. The Visual Analogue Scale of pain started at 8.29 a marked reduction was noted in the first 24 h with an average of 2.41. followed by a stable slow reduction of 1.73 on the 7th day.

Conclusion

Treatment of Therapy-Refractory skin injuries including burns, scars, acute in addition to chronic wounds with T.O., which is nearly 700 years old has shown for the first time exceptional results in an outpatient setting and was successful in alleviating inflammation, pain, itching and discomfort associated with wound care, thus providing an optimal opportunity for the wound to heal sufficiently and quickly without reported side effects.

Background

Burns are one of the most common and devastating forms of trauma. Patients with serious thermal injury require immediate specialized care in order to minimize morbidity and mortality. The objective of this study was to evaluate the healing potential of porcine decellularized small intestinal submucosa (SIS) matrix and chitosan with mesenchymal stem cells (rMSC) and epidermal growth factor (mEGF) on the healing of full thickness burn wound in rat model.

Methods

One 2 × 2 cm² size full thickness burn wound was created on the dorsum of each animal under general anaesthesia. Burn wounds were treated with silver sulfadiazine; medical grade chitosan; chitosan with rMSC; chitosan with rMSC and mEGF; decellularized porcine SIS; rMSC seeded with SIS; rMSC seeded with SIS and mEGF in groups A, B, C, D, E, F and G, respectively. Healing was evaluated on the basis of percentage of wound contraction, colour digital imaging, immunological, histopathological, immunohistochemistry and gelatin zymography observations.

Results

A decrease in wound area was noticed in stem cell and m-EGF treated groups. Early angiogenesis and epithelialisation was observed in groups, where decellularized SIS matrix was combined with r-MSC and m-EGF. Type III collagen was found more in control group by immunohistochemistry which indicated abnormal collagen deposition. Gelatin zymography revealed expression of MMPs in the control group suggesting a chronic nature of wound. Chitosan in combination of rMSC and mEGF proved to be efficient for full-thickness burn wound healing.

Conclusion

Decellularized SIS matrix when combined with r-MSC and m-EGF has healing potential and showed best healing response than conventional treatment for the reconstruction of full-thickness skin burn wounds in rats.

The clinical use of honey has gained significant importance in regenerative medicine owing to its constructive properties that abets the rapid healing of broad-spectrum of injuries. The salient characteristics of honey are attributable to its active ingredients which include sugars, enzymes and vitamins. Moreover, the evidence based results exert that honey acts in synergy with its immunologic modulators and physiologic mediators in multitude of signalling pathways and molecular targets offering beneficial vigor effects in wound healing. The aim of this present study is to systematically review the literature in PubMed database in order to identify the available pre-clinical results in support to rational use of honey in wound management. The results revealed that the active biomolecules of honey assisted in improved autolytic debridement and tissue granulation. This review highlights the physiological basis for the use of honey in wound healing, its current pre-clinical uses and its future recommendations.