Wound Medicine最新文献

Keeping in view the wound healing potential of tragacanth gum and alginate, in the present work, an attempt has been made to explore the potential of these polysaccharides to prepare the moxifloxacin loaded hydrogel wound dressings for better wound care. These hydrogel dressings have been developed by dual crosslinking method. After forming the super-molecular interactions between tragacanth gum and alginate fiber by calcium ions, further crosslinking has been induced by gamma irradiation in the presence of PVA. Some important biomedical properties of these hydrogel dressings like wound fluid absorption, thrombogenecity, haemolysis, antioxidant activity, mechanical behavior and drug release properties have also been studied. Release of drug moxifloxacin occurred through Fickian diffusion mechanism and release profile was best fitted in to Kosmeyer Pappas model of drug release. Overall, these sterile, biocompatible, antioxidant and mucoadhesive hydrogel wound dressing could be used for the controlled and sustained release of antibiotic drug for better wound healing.

Background

Methicillin-resistant staphylococcus aureus (MRSA) causes surgical site infections (SSIs) and complicates the treatment of these infections. Vancomycin is the drug of choice for infections due to MRSA but creep MIC of vancomycin may be associated with failure in antibiotic therapy. The aim of the present study was to determinate the prevalence, antibiotic susceptibility patterns of MRSA in patients suffering from SSIs and determination of vancomycin MIC in these isolates.

Methods

Detection of S. aureus in 100 aspirated specimens from SSIs was performed by the standard microbiology tests. MRSA was detected by phenotypic and molecular methods. The disk diffusion, E-test and agar dilution methods were performed for determination of antibiotic susceptibility patterns, the vancomycin MIC and oxacillin MIC. The results were interpreted according to guidelines of the Clinical and Laboratory Standards Institute (CLSI).

Results

Of 24 S. aureus isolates, 20 (83.33%) were recognized as the MRSA by 30 μg cefoxitin disk from 100 specimens and all were confirmed by PCR. High frequency of resistance was observed to clindamycin, erythromycin, gentamicin, ciprofloxacin and chloramphenicol while all isolates were susceptible to vancomycin, linezolid, and mupirocin. The range of vancomycin and oxacillin MICs were 0.25 to 2 and 0.5 to 128 μg/ml, respectively. Vancomycin-creep MIC was detected in two isolates from the superficial wound and surgical respiratory tract infections, and one of the patients died.

Conclusion

The findings of this study show a high frequency of MRSA in SSIs. Due to the elevated MIC of vancomycin, we suggest consumption of other effective drugs for the treatment of SSIs.

Background

Veterans who use the Veterans Health Administration (VHA) also may use Medicare coverage for treatment outside VHA. Using multiple health care systems introduces fragmentation and may increase utilization. The purpose of this study was to compare chronic wound care utilization among VHA-Medicare dual system users and VHA-exclusive users.

Methods

Using data from VHA chart review and Medicare claims, we conducted a retrospective cohort study of 203 Medicare-enrolled VHA users with an incident, chronic lower limb wound between October 1, 2006 and September 30, 2007 and followed them for up to one year. We identified all VHA and Medicare wound-care visits during the wound episode.

Results

19.7% of the cohort was dual users. Dual users had higher observed wound care utilization than VHA-exclusive users (11.9 versus 7.6 outpatient visits [p = 0.002] and 1.6 versus 0.7 inpatient stays [p = 0.0008]). After adjusting for covariates including wound duration, dual users were predicted to have 8.6 outpatient wound care visits and 1.1 inpatient wound care stays while VHA-exclusive users were predicted to have 7.0 (p = 0.07) outpatient visits and 0.7 (p = 0.05) inpatient stays.

Conclusions

Dual use contributes to higher wound care utilization potentially because of longer wound duration.

Background

Although several studies have reported various adverse reactions associated with the use of bone wax in the clinical setting, the incidence of complications after using bone wax during maxillofacial surgery via a transoral approach remains unclear. We aimed to address this scarcity of data and describe the incidence and nature of postoperative infections associated with bone wax treatment during reduction mandibuloplasty.

Materials and methods

A retrospective chart-review study was conducted among patients who underwent reduction mandibuloplasty performed by the same surgeon between January 2010 and December 2014. Delayed postoperative infection was diagnosed based on clinical manifestations, associated treatment strategy (additional antibiotic treatment with or without revision surgery), and results of microbiological investigation. Patients were divided into 2 groups according to whether or not bone wax had been applied during the reduction mandibuloplasty procedure.

Results

A total of 355 patients (44 men; average age, 31.0 years; age range, 19–53 years) underwent reduction mandibuloplasty during the study period. Of these, 19 patients (1 men; age, 26.0 ± 6.62 years) were treated with bone wax applied to the cut surface of the mandibular cancellous bone for controlling bleeding. The infection rate among patients not treated with bone wax was 1.5% (5/336; acute infection), compared to 21.0% (4/19; delayed infection) among patients treated with bone wax. The use of bone wax contributed to an increased risk of developing infection (odds ratio, 14.87 [95% confidence interval, 3.22–68.70], P < 0.003).

Conclusion

This is the first report describing the incidence of infection associated with the use of bone wax for controlling bleeding from the cancellous bone during maxillofacial surgery via a transoral approach.

Iron is the most essential element found in the environment, but it is difficult to assimilate by microorganisms. Acquisition of iron from the environment became more complicated as iron (II) in the presence of oxygen oxidized to iron (III) oxide and hydroxide, becoming insoluble at neutral pH. To overcome this situation microorganisms produce organic molecules known as siderophore. The primary function of siderophore is to bind with iron (II) and making it soluble and enabling cellular uptake. Apart from iron molecules, these siderophore have an ability to chelate various other metal ions which paved a way to concentrate the application of siderophore towards wound care products. The trend of using siderophore and their derivatives received much attention for the few decades due its potential applications not only in wound care products, but also in various fields like environment, medicine and biotechnology. The antimicrobial activity and zinc²⁺ chelating activity of these siderophore correlated with reduction of microbial load and the inhibition of MMPs and at the wound sites. The aim of this literature survey is to discuss about siderophore and their importance as an MMP inhibitor on wound healing.

Background and objectives

Among the most important factors in wound healing pathways are transforming growth factor beta1 (TGFβ1) and vascular endothelial growth factor (VEGF). Botanicals are traditionally used for healing of different types of wounds. In this study, one mixture of plant materials such as Adiantum capillus-veneris, Commiphora molmol, Aloe Vera, and Henna were used to treatment of wound in diabetic and non-diabetic rats.

Methods

The dried leaves and resins were crumbled into a powder and mixed in equal parts with Vaseline. This mixture has been used as an ointment on the induced wounds in 60 diabetic and non-diabetic rats. Localization of TGFb1 and VEGF proteins as important healing markers were evaluated by immunohistochemistry and the level of TGFβ1 and VEGF proteins were detected by Western blotting.

Results

Immunohistochemical and Western blot analysis revealed that, VEGF in diabetic rats that treated with herbal mixture were significantly (p < 0.05) increased as compared with diabetic rats that treated with Vaseline at 7, 14, and 21 days after treatment. TGFβ1 in diabetic rats, treated with herbal mixture compared with diabetic rats treated via Vaseline showed no significant (p > 0.05) difference at 7, 14 and 21 days post wounding. TGFβ1 was significantly different (p < 0.05) between diabetic and non-diabetic rats treated with the herbal mixture at 7, 14 and 21 days after treatment.

Conclusions

The present study demonstrated that the mentioned herbal extracts might be effective in wound healing through the improvement in the amont of TGFβ1and VEGF-A proteins in wound site of diabetic rats.

In this study, blends of N-(2-hydroxyl) propyl-3-trimethylammonium chitosan chloride (HTCC), polyvinyl alcohol (PVA), and sodium carboxymethylcellulose (CMC) were prepared by the solution-casting method to develop films. The blend films were characterized by Fourier transform infrared spectroscopy, X-ray diffraction, scanning electron microscopy, and light-transmission measurements. The results revealed that in the blend films, HTCC, PVA, and CMC interacted by hydrogen bonding and were partly miscible. The effects of varying amounts of CMC on the mechanical properties, water absorption, swelling properties, and moisture permeability of HTCC/PVA blend films were also examined. Improved strength and flexibility of the blend films were observed with the inclusion of CMC. Moreover, the incorporation of CMC resulted in enhanced water absorption capacity, improved swelling ratio, and appropriate moisture permeability. Furthermore, all the ternary blend films showed good antibacterial activity against Escherichia coli and Staphylococcal aureus. Sponges of HTCC/PVA/CMC blend films with these properties have the potential to be used as biomaterials in medical applications.

Background and objectives

The lay open technique is well established as an efficient treatment for chronic sacrococcygeal pilonidal sinus, but the postoperative care of the laid open wound is not well studied. In our study, we aim to evaluate four wound care methods that we used in our protocol to treat chronic sacrococcygeal pilonidal sinus by the lay open technique.

Materials and methods

A retrospective cohort study of 800 patients with chronic sacrococcygeal pilonidal sinus who accepted the lay open procedure was done. Postoperative care consisted of four methods: sitz bath three times daily at home (using warm water and 20 g salt for 10 minutes), normal saline cleaning three times daily at home, povidone iodine cleaning three times daily at home, and 3% hydrogen peroxide cleaning three times daily at home.

Results

No major side effects related to the material used in the wound care requiring surgical, medical intervention, or necessitating change of method were reported by any patient. The recurrence rate was zero (0%) in the hydrogen peroxide and the povidone iodine group after five years follow-up, while it was (1%) in the sitz bath group, and (2.5%) in the normal saline group.

Conclusion

The lay open technique could successfully achieve a zero (0%) recurrence rate with a very low rate of postoperative complications. Special consideration should be attributed to the wound care methods and materials used because they play a major role in the outcome. Hydrogen peroxide showed a superior wound care efficacy.

The quest for evidence-based medicine leads one in search of best available evidence but what exactly is this? Convention guides us towards the putative gold standard of the randomised controlled trial (RCT) but this approach provides limited access to the gathering of evidence that is relevant to a ‘real world’ environment. Taking several examples from wound care including moist wound healing, negative pressure wound therapy and dressing wounds with gauze we show that if one takes biology into consideration, the “truth” becomes more relevant to everyday life. We suggest that solely relying on the RCT in the quest for truth is misguided and that the research community should embrace a circular model of evidence rather than a hierarchical one.

Background

In the care of people with chronic wounds, nursing includes, besides direct wound care, in particular the safeguarding and promotion of health-related self-management and well-being. Therefore, it is important to assess the health-related quality of life of patients or limitations and impairments in different areas of life to be able to take appropriate measures if necessary. The aim of this study was to assess the subjective impairments experienced by people with chronic wounds in different quality-of-life dimensions.

Material and methods

The study design was a quantitative cross-sectional survey. Data were collected by means of Wound-QoL (questionnaire on quality of life with chronic wounds). In total, 59 patients participated in the study.

Results

According to the results of this study, there is a need for action in all areas of Wound-QoL. Up to 64% of the participants felt moderately to severely impaired in the different QoL dimensions.

Conclusion

Despite the fact that the wound care situation seems to be optimal, the quality of life (QoL) of people with chronic wounds often is impaired. By using Wound-QoL in day-to-day wound care, the care of people with chronic wounds could be optimized on the basis of patient-related outcome factors.