Wound Medicine最新文献

Wound healing is a series of complex coordinated events involving a number of cellular and molecular components. Dermal fibroblast is one of the key players in wound healing physiology, contributing in key processes within the phases of wound healing. Data on the clinical efficacy of honey in wound healing is well established. Stingless bee is a subspecies of honey-producing bee, abundant in warm humid climate. While majority of the research in wound healing, focus on the honey produced by the sting bee (Apis mellifera), little is known of the stingless bee (Trigona sp.) honey. This study seeks to evaluate the effect of freeze-dried stingless bee honey on the cell viability and proliferative capacity of dermal fibroblast. Dermal fibroblast viability and proliferation will be evaluated via MTT assay, microscopic evaluation and cell cycle analysis. Short-term exposure of dermal fibroblasts to different honey doses revealed a multimodal pattern of increase in cell viability at the honey dose of 0.024, 200, and 6400 μg/ml. Treatment of the selected honey dose to dermal fibroblast proves to be non-toxic under microscopic evaluation and MTT assay. The selected dose of honey improves proliferation and did not alter normal cell cycle progression in dermal fibroblast. The positive effect that honey has on the cell viability and proliferation of dermal fibroblast suggested the capability of stingless bee honey to improve wound healing.

Aim

To describe the indication and technique of microbiological wound investigation in treating infected or colonised wounds with or without multi-drug resistant microorganisms (MDROs). The clinical symptoms and criteria of locally or systemically infected wounds are summarized and described.

Method

An interdisciplinary consensus of microbiological wound diagnosis was elaborated between representatives of different medical specialities. Moreover, some perspectives on future wound diagnostics were presented.

Results

The panel agreed on ten clinical signs, situations and symptoms, which give the indication for further microbiological wound investigation: formation of pus, clinical signs or suspicion of an infection, suspicion or presence of a surgical site infection, localised progredient infection with or without systemic involvement (e.g. joint empyema, phlegmone), gangrene formation and necrotising fasciitis, ulcerative neoplasia, burn wounds with > 15% thermally injured surface area, exacerbation of dermatological disorders, localised wound infection without sign of systemic involvement after 3 days treatment with antiseptics without obvious clinical improvement, and chronic skin lesion with indication to screen for MDROs.

The panel agreed that no indication for microbiological investigation is given in acute wounds without signs of infection and uncomplicated superficial wounds.

Today, the gold standard for microbiological investigation is processing tissue biopsies in the laboratory. However, in many instances it may be easier and more rapid to perform a wound swab. If swabs are obtained, the Essener circle or the Levine technique shall be applied. Wound swabs, however, are the method of choice in screening for wound colonisation with MDROs. Additionally, information is summarised pertaining to transport and processing of microbiological wound specimens Also, potential applicability of future wound diagnostic methods based on genomic, metabolomic and proteomic approach are discussed.

Conclusion

Beside a full understanding of all clinical symptoms and clinical experience of wound experts the correct microbiological wound investigation will be the basis for a succesfull management of infected wounds.

Manuka honey, as a healer for vast variety of wounds, stimulated this present study and the advantages of chitosan and honey in wound healing is combined together to develop a chitosan-honey film wound contact layer. In this study, using solvent evaporation technique, chitosan-honey films were developed and the process parameters like concentration of chitosan, honey and glycerol were optimized using Response Surface Methodology (RSM) against the responses like Water Vapour Transmission Rate (WVTR), swelling ratio, antibacterial activity against Staphylococcus aureus and Escherichia coli, tensile strength and elongation. The effects of individual responses were discussed against all the variables using contour plots. The responses are optimized and the process parameters for achieving optimum responses to be used as a wound contact layers are chitosan concentration of 2%, honey concentration of 13% and glycerol concentration of 15%.

Objective

Wound healing is a complex, intricate process that amalgamates various cells and cellular processes. In a country like India which is credited to being as diabetic capital the challenge with diabetic ulcers is increasing day by day. Diabetic ulcers are quite difficult to treat as vasculopathy, neuropathy and immunopathy join hands to stymie the healing mechanisms. This study is conducted to assess the wound contraction rate, collagen content and histochemical evaluation in a diabetic foot ulcer.

Methods

A prospective study was done in 40 patients during the period of June 2012 to June 2017. 40 patients split into 20 each comprised the control and experimental group with control and experimental group treated with saline & collagen dressing respectively. Parameters used for assessment included wound contraction rate, quantitative collagen content and histochemical analysis. Wound Healing was evaluated on day 7, day 15 and day 30.

Results

There was statistically significant difference in wound contraction rate and increase in quantitative expression of collagen in patients treated with exogenous collagen particles. Abundant collagen matrix deposition was seen in histopathological studies with this group.

Conclusion

Collagen with its Triple helical structure aids in the healing mechanism by imparting tensile strength to the wound by bridging various processes resulting in fibroplasias and epidermal resurfacing. This could possibly aid in expediting the sequential but overlapping phases by cementing fruitful interactions between cellular and extracellular matrix interfaces.

Background

Weakly acidic hypochlorous acid (HOCl), a major inorganic bactericidal compound of innate immunity, is effective against a broad range of microorganisms. However, HOCl has never been described as a pharmaceutical drug for treatment of infected wounds. Here, we describe a study using HOCl solution, a reagent that has potential use in a clinical situation such as prevention and treatment of infection in chronic wounds.

Methods

HOCl solution (200 ppm, pH 6.5) was prepared by the in vitro addition of sodium hypochlorite to sterile water or saline at pH 6.5. The resulting solutions were used to evaluate in vitro cytotoxic and bacteriostatic properties against Pseudomonas aeruginosa. Furthermore, the bacteriostatic effect of the HOCl solutions was evaluated in vivo using P. aeruginosa-infected wounds on db/db diabetic mice.

Results

The HOCl solution exhibited concentration-dependent in vitro bacteriostatic activity against P. aeruginosa; HOCl in phosphate-buffered saline (PBS) also displayed in vitro cytotoxicity to human fibroblasts. Similarly, the cleansing of P. aeruginosa-infected wounds on db/db diabetic mice with HOCl solution yielded significantly decreased in vivo bacterial cell counts and there was no difference in granulation formation compared to cleansing with pure water.

Conclusion

Twelve days of once-daily cleansing of P. aeruginosa-infected wounds on db/db diabetic mice with HOCl solution resulted in significantly decreased P. aeruginosa bioburden, albeit with a minor delay in wound repair.

Objectives

To summarize prevalence and incidence of pressure injuries (PIs) in public hospitals on a global scale to guide the development of PI prevention, strategies and planning for efficient use health resources.

Design

A systematic literature review was conducted to examine the worldwide relevant literature published between 2000 and 2017 on the prevalence and incidence of PIs in hospitalised adult population.

Data sources

A systematic search of databases (MEDLINE (Ovid), EMBASE (Ovid), CINAHL (EBSCO), and EconLit (EBSCO) was undertaken for English language articles published between 1st January 2000 to 31st March 2017. A systematic literature search was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

Study selection

Peer-reviewed observational studies with reported data on the prevalence and incidence of PIs. The research articles selected for systematic review were assessed by two independent reviewers to check the methodological validity, using the Joanna Briggs Institute (JBI) Critical Appraisal Tools ‘Checklist for Prevalence Studies’.

Results

The final selection for prevalence and incidence of PIs had 39 studies. Most of the studies reported the point prevalence (n = 26, 66.7%), whereas period prevalence was reported in 20.5% of the studies (n = 8), and the incident rate was reported in 5 studies (12.8%). The majority (n = 32, 82.0%) of the studies used the skin assessment method to collect the data, reviews of the medical records and administrative data were used in 3 studies each (7.7%). The overall global prevalence of PIs using point prevalence and period prevalence was 14.8% and 11.6%, respectively. The overall mean incidence of PIs was 6.3%.

Conclusions

A careful and systematic review of all the retrieved citations yielded a rich source of evidence. In this systematic review of the literature, most of the studies employed the skin assessment technique to collate their data.

The present study explores the wound healing profile of the engineered protein based hydrogel in open wounds of Canine. In brief, fish scale gelatin has been tethered with di-hydroxy phenolic acids and the resultant product (Phenolic acid modified gelatin – PAMG) upon enzymatic oxidation transformed to a hydrogel with adhesive nature. The experimental study contains two groups: Group I – PAMG treated and Group – II standard cream treated. Each group contains six cases with wounds of ununiform size and area and the experimental period scheduled for 36 days. For Group I animals, PAMG solution (once in three days) applied to the wound site and which then transformed to adhesive hydrogel under in situ condition using tyrosinase enzyme. Group II animals received Loraxane cream every day. Despite different shapes and depth, wounds of Group I animals showed accelerated wound closure. Further, the percentage of wound contraction and H & E staining of sections of granulation tissue also support the faster healing of wounds of Group I animals. In conclusion, PAMG based adhesive hydrogel offers faster wound healing of open wounds of Canines.

Matrix Metalloproteinase 9 (MMP9) is one of the many zinc-dependent endopeptidases found in the body, which is also involved in delaying wound healing by degrading extracellular matrices associated with normal tissue remodelling processes. In Diabetic Foot Ulcer (DFU), this protein is highly expressed especially at the stage where wound healing is poor. Currently, MMP9 is becoming one of the interesting targets in the discovery and development of MMP inhibitors, mainly in cancer treatment. There are at least 18 MMP9 crystal structures that are available in protein data bank (PDB) which can be utilised for structure based drug design. This review will discuss the role of MMP9 in wound healing associated with DFU at molecular level, followed by the recent progress of MMP9 inhibitors that have been identified in the last two decades.

Background

Recently, platelet-rich plasma (PRP) has become popular in the tissue engineering field. PRP has a high concentration of platelets that is three to five times above that of normal plasma and contains several growth factors such as platelet-derived growth factor (PDGF), platelet-derived angiogenesis factor (PDAF), platelet-derived endothelial growth factor (PDEGF), transforming growth factor-beta (TGF-β), insulin-like growth factor (IGF), fibroblast growth factor (FGF), and vascular endothelial growth factor (VEGF). Standard reconstruction of cranial bone defects involves the use of auto- or allogenic biomaterial, such as carbonated hydroxyapatite (CHA) as a scaffold for the osteogenesis process. The purpose of this study is to investigate whether any additional compound may improve the bone healing process.

Methods

This study involved animal experiments on white male rats (Rattus norvegicus). Three millimetre diameter were created in rat cranium. Samples were divided into three groups: first group, the cranial defect was grafted with CHA combined with PRP; second group, with CHA alone; and third group, the defect was left as secondary healing wound (control group). The wound healing process was observed for the presence of inflammatory cells and the occurrence of woven bone and lamellar bone. The results among the groups were compared and analysed by the Mann Whitney test using SPSS Statistics Program Package Version 22.0.

Results

The experimental group of 2 weeks showed no difference between inflammatory response (p = 0.119), woven bone (p = 0094) and lamellar bone (p = 0130). At 4 weeks, a combination of PRP and CHA showed a superior growth of lamellar bone compared to CHA (p = 0008).

Conclusion

A combination of PRP and CHA as a bone regeneration scaffold showed a histologically increased bone formation.