Wound Medicine最新文献

Autologous keratinocyte cultures and combinations of scaffolds, different cell types, solutions of macromolecules, or growth factors have contributed to the resurfacing of burns and large wounds. There are, however, significant limitations with these therapies. No tissue-engineered substitute can fully replace the split-thickness skin graft for permanent coverage of full-thickness skin loss in one step, and none contain a functional vascular plexus. Current research characterizes skin as more than a barrier with sensory function, but as an intricate biological factory participating in cell signaling, metabolism, and protein synthesis, and as a vital component of the nervous, immune and endocrine systems. This paper provides a comprehensive review of the structure and function of skin, highlighting the importance of regenerating an organ that will function physiologically.

Introduction

Type 2 diabetes is one of the most prevalent diseases throughout the world. The foot ulcers are severe complications of this disease. Foot ulcers induce the high rate of morbidity, impair quality of life, bring about extreme costs to health service providers, and give rise to waste of time. Recently, platelet-rich plasma (PRP) and platelet gel (PG) have been used for the treatment of chronic wounds. In the present randomized, double-blind, placebo-controlled study, platelet gel derived from umbilical cord blood (UCB) was used to heal the diabetic foot.

Method

The patients were randomly divided into three groups, under the categories of PG, platelet-poor plasma (PPP) and lubricant gel (placebo) (ratio 1:1:1). The processes of gels application were launched for the subject of each group twice per week with 3–4 days’ interval. This mechanism protracted for eight weeks. After completion of 8 weeks, the patients were followed up after two weeks and then continued for nine months with one-month interval.

Result

30 patients underwent statistical analysis. Except for diastolic blood pressure which was significant between groups, there were no statistically significant differences in patients’ baseline demographics. No significant differences were detected between groups at baseline of wounds (P = 0.09). The results revealed that there is no statistically significant interaction among three groups during follow-up time.

Conclusion

The present study provides evidence that there are no significant differences in the size of wound among PG, PPP, and placebo groups.

Acute and chronic wounds with signs of local infection or critical colonisation pose an interdisciplinary and interprofessional challenge in the fields of medicine. A national best practice recommendation for the use of silver dressings does not yet exist.

Therefore, it was the aim of this project to develop a collection of best practice statements on the basis of a structured survey. Overall, 49 statements were developed and presented to wound experts with the aim to find a consensus. For 29 statements an agreement rate of 75% or more was achieved.

Thus, for the first time a consensus-based collection of best practice statements for the use of silver dressings in the local antimicrobial therapy of wounds is available.

Wound healing is a complex process and has been the subject of intense research for a long time. Plants are natural sources which have been widely used for wound healing. The recent emergence of nanotechnology has provided a new pharmacological modality for silver nanoparticles to be used in wound healing process. Silver nanoparticles are a good source for drug targeting due to its high chemical stability, catalytic activity, wound healing activity and antimicrobial nature.

In this study Silver nanoparticles were synthesized using Tridax procumbens leaf extract. Nanoparticles were characterized using UV–vis absorption spectroscopy, and Scanning Electron Microscopy (SEM). The efficacy of the synthesized silver nanoparticles on wound healing was investigated in Pangasius hypohthalmus.

Biosynthesis of silver nanoparticles from the leaf extract of Tridax procumbens was found to be cost effective and time conserving. We compared the effectiveness of the synthesized silver nanoparticles from Tridax procumbens on wound healing with silver nitrate and leaf extract. Collagen deposition and fibrosis formation occurred much earlier on wounds treated with silver nanoparticles from Tridax procumbens.

The synthesized Silver nanoparticles from Tridax procumbens showed enhanced wound healing activity in fish, also improving the epithelialisation and appearance of the wound when compared to that of silver nitrate and leaf extracts of Tridax procumbens.

Background

Postoperative care for women with perineal trauma after post birth per vias naturaelеs vaginal delivery, is needed. We studied the effect of Theresienol - an natural product based on natural fats and pure herbal extracts on some of the short-term complications in cases of postpartum perineal tear. Theresienol is an all natural revolutionary skin care serum that works naturally with your body. It is a multi-purpose natural Skin Protectant serum for all skin types, all ages and all stages.

Methods

In a prospective, single-centre, cohort study conducted on 20 women with per vias naturales birth, with perineal trauma, we studied the effect of topical application of Theresienol surgically recovered tear. Patients were divided into two groups, Group A and Group B; Group A included birth mothers using Theresienol postnatally for treatment of surgically recovered wounds, Group B included patients not using the oil. The visual analogue scale (VAS) for pain was used on Group A, third and fifth day after birth. The primary outcome was reducing severity or lacking of some short-term complications, defined as lack of wound dehiscence and hematoma and reducing pain, swelling and redness in this area. The secondary outcome was the additional need of nonsteroidal anti-inflammatory drugs for analgesia in the early postpartum period.

Results

In Group A, using Theresienol natural oil, there was a reduction in pain symptoms in comparison to Group B, not using the oil. In the study group using herbal oil, Group A, no additional nonsteroidal anti- inflammatory drugs were needed compared to the group B, not using the oil.

Conclusions

Local therapy with Theresienol - an natural product based on natural fats and pure herbal extracts in the postoperative management of postpartum perineal tears significantly reduces the severity of clinical symptoms, and further monitoring and inclusion of new patients will show whether the risk of objective short-term and long-term complications is reduced.

Background

Amniotic membrane has been widely used in the treatment of several acute and chronic diseases, and surgical reconstructions. Here we report the successful application of a commercial lyophilized, powdered, amniotic membrane (AMX) to a patient with a treatment-refractory diabetic ulcer, with further investigations on AMX angiogenic and anti-inflammatory properties.

Objective

To investigate the topical, continuous, treatment with AMX on a chronic diabetic foot ulcer, along with its angiogenic in vitro properties and proteomic profile.

Methods

A 77-year old woman was treated with AMX 2–3 drops 4–6 times a day for 2 months. Amniotic fluid stem cells were tested for proliferation and angiogenesis potential with or without AMX. ELISA quantification was conducted on NGF, TGF-alpha, NT-3, and IL1-ra. Proteomic analysis was also performed on AMX.

Results

At 2-month follow-up, the ulcer was reduced by 60% and it remained steady after 3-months. At 4-month follow-up, the lesion showed signs of re-epithelization. Cells, with or without AMX, were prone to form endothelial tubules with similar characteristics. Proteomic analysis confirmed that AMX retains proteins involved in anti-inflammatory and angiogenesis pathways.

Conclusions

AMX ameliorated pain and extent of a chronic diabetic ulcer. The effect could be ascribed to angiogenesis and epithelium stimulation that was confirmed in in vitro. Multiple wound healing-involved proteins were detected but further studies are needed to assess their specific role.

Background

Fecal bacterial wound infection is common in both gastrointestinal surgery and decubitus ulcers. Various approaches have been developed to suppress bacterial growth. Antibacterial activity shown by the conventional assays using a few representative strains may not necessarily be similar to in vitro activity at infection sites.

Purpose

The purpose of the present study was to develop a simple and easy in vitro assay system to investigate antibacterial activity against fecal bacteria and to evaluate its validity.

Methods

The cultures contained Hank’s balanced salt solution containing 10% fetal calf serum as a culture medium and were incubated at 37 °C with constant stirring in room air. Fecal bacterial growth was evaluated by several methods, including optical density at 600 nm, analysis of bacterial DNAs, real time-polymerase chain reaction, and terminal restriction fragment length polymorphism. Four methods were investigated for inhibiting fecal bacterial growth.

Results

Facultative anaerobes, including E. coli, Enterococcus faecaliss, and Lactobacillus species, increased after culture in contrast to the decrease in obligate anaerobes, Clostridium coccoides, Clostridium leptum, Bactroides fragilis, Prevotella, and Bifidobacterium species. The addition of 5 mM EDTA, activated carbons, maintenance of the medium pH at 4.4, and the combination of the above inhibited the increase in optical density.

Conclusion

This in vitro assay is easy to use, partly simulates fecal bacterial growth in vivo, and can be used to measure fecal bacterial growth inhibition.

Acinetobacter baumannii is a multi-drug resistant, nosocomial pathogen causing a variety of disease conditions, especially wound infections in humans. A. baumannii’s ability to form biofilms and colonize epithelial cells potentially makes it difficult to treat skin and soft-tissue infections of this pathogen. Thus, in light of the multidrug resistance and biofilm producing capacity, new strategies for controlling A. baumannii wound infections are necessary. This study investigated the efficacy of the essential mineral, selenium (Se) in inhibiting skin-colonizing and biofilm forming abilities of A. baumannii in vitro.

The effect of Se on A. baumannii adhesion and invasion of human skin keratinocytes (HEK001) was studied. Additionally, the efficacy of Se in inhibiting A. baumannii biofilm formation was determined using an in vitro collagen matrix wound model, and scanning electron microscopy (SEM) was done to visualize its potential antibiofilm effect. The effect of Se on critical A. baumannii genes for biofilm synthesis was also determined using real-time qPCR (RT-qPCR).

Selenium inhibited A. baumannii biofilm formation in the collagen-based wound model and reduced bacterial adhesion and invasion of HEK001 (P < 0.05). Scanning electron microscopy revealed that Se disrupted A. baumannii biofilm architecture. RT-qPCR results indicated that Se significantly down-regulated the transcription of genes associated with A. baumannii biofilm production (P < 0.05). Results suggest that Se could potentially be used to control A. baumannii wound infections but follow up investigation in an appropriate mammalian model is warranted.

Background

Aegialitis rotundifolia Roxb., is a small mangrove tree or shrub used traditionally as a potent cure for pain arising from various injuries. Presently, there is a single scientific report on the wound healing property of this mangrove species which has been performed in-vitro but there is no in vivo scientific evidence of the wound healing properties. Further, few reports have claimed that reduction of pain could accelerate wound healing process and thus, the present work deals with the development of a topical ointment formulation incorporated with Aegialitis rotundifolia Roxb., ethanolic leaves extract (ARELE) which could potentially accelerate healing of excision, incision and burn wound models in Wistar rats.

Methods

Topical ointment containing ARELE was first tested for their stability (90 days) and possible dermal toxicity using standard procedures. In the excision wound model, parameters such as in-vivo antioxidant, acute inflammatory marker (myeloperoxidase), wound microbial load, connective tissue parameters, and histopathology of healed skin were performed. Incision and burn (thermal and chemical) wounds were conducted following the standard methods.

Results

The ointment formulations were found to be stable and dermatologically non-toxic. In the excision wound model, a significant increase in percent wound contraction was observed for ARELE ointment treated groups which are substantiated by strong in-vivo antioxidant activity, increased collagen formation, almost normal skin histology, and reduced myeloperoxidase and microbial colonies. Strong wound breaking strength was observed in incision wound repair and a significant increase in percent wound closure in both thermal and chemical burn wound model was recorded for ARELE ointment treated groups.

Conclusion

Therefore, the topical application of ARELE ointment formulations showed remarkable excision, incision and burn wound healing in Wistar rats thus showing its potential as a promising wound healing agent.

Introduction

There is no definitive method to determine infection status in non-healing wounds. Measurement of wound pH might be a promising indicator of infection as it is relatively easy to perform, provides objective results within a few seconds, and is inexpensive. The aim of this investigation was to determine if wound pH could be a potential indicator of early or established infection in non-healing wounds.

Methods

We explored the relationship between wound pH and two indicators of wound infection: expert clinical judgement and elevated neutrophil-derived enzyme activity. Data was used from 120 wound samples previously collected at Medisch Spectrum Twente hospital.

Results

With increasing wound pH, there was also an increase in the proportion of infected wounds as determined by expert clinical judgement. In addition, increases in the activities of myeloperoxidase, elastase and lysozyme were also associated with elevated pH.

Conclusions

The strength of the relationship between wound pH and clinical judgement or enzyme activities observed in this study is not sufficient to promote the use of elevated pH alone as an indicator for wound infection. However, the use of pH in combination with other indicators for wound infection, such as elevated neutrophil enzyme activity, warrants further research.