Wound Medicine最新文献

Introduction

Venous ulcers are the most common type of non-healing ulcers. They constitute 70% of the chronic leg ulcers. They have significant socioeconomic and psychological consequences reducing the quality of life. There are few Indian studies documenting the extent of the disease

Methods

All patients with chronic venous ulcers of duration more than 6 months were included from January 2014 to July 2015. Their socio-demographic data such as age, sex, education, occupation, income, socioeconomic status and residential geographic location were documented. Clinical information included size of the ulcer, duplex findings were also noted.

Results

There were 217 patients. There was male preponderance m: f (8.4:1). Most of them belonged to the economically productive age group of 36 to 45 years and belonged to the middle socioeconomic group. Perforator incompetence was noted to be common in all patients.

Conclusions

Venous ulcers are common in India. They affect middle age group men predominantly and also belonging to the middle socio-economic group.

Multiple antibiotic resistant Pseudomonas aeruginosa is a significant cause of burn wound infections and, skin and soft tissue infections. Because of its resistance to commonly used antibiotics and antiseptics, there is a shortage of therapeutic options for effective treatment. The present review summarizes the use of citric acid as a most potential substitute for antiseptics to control pseudomonal wound infections and its role in the process of wound healing. The various studies show that citric acid can be used as one of the alternatives when infection is caused by multiple antibiotic resistant strains of P. aeruginosa not responding to conventional treatment modality. The results of various earlier studies show that when resistance to antibiotics and antiseptics is a matter of great concern, citric acid as one of the potential alternatives should always be kept in mind.

Objectives

Recent clinical reports showed excellent results when the lay open method was used for the treatment of chronic sacrococcygeal pilonidal sinus, despite keeping the wound open for a considerable time which increases the risk of infection, delayed closure, and recurrence. In this study, we aim to analyze the factors influencing the outcome of the laid open sacrococcygeal pilonidal wound regarding wound infection, complete wound closure, and recurrence.

Methods

A prospective cohort study of 472 patients with chronic sacrococcygeal pilonidal sinus who had the lay open procedure between January 2000 and December 2012 was done. 326 were male and 146 were female. Lay open was performed to all patients. Postoperative care and follow-up methods were similar in all patients. Preoperative, intraoperative, and postoperative factors affecting the outcome were analyzed.

Results

The mean age was 27.6 years. Male gender, smoking, BMI ≥ 30 kg/m², diabetes mellitus, the sinus number, wound depth of more than 3 cm, packing the wound, the cleaning material for wound irrigation, regular postoperative shaving of hair around the wound, postoperative complications mainly pus discharge from the wound, and poor postoperative body hygiene were the factors statistically found to represent a significant difference in association with longer wound healing time (P ≤ 0.01). The recurrence rate was 0% after four years of follow-up.

Conclusion

We concluded that many factors could affect the outcome of the laid open wound of the chronic sacrococcygeal pilonidal sinus. For the best outcome, careful consideration of these factors could help achieve an excellent result.

This work was initiated to develop a new form of curative film wound dressing, by the combination of silk fibroin, wool keratin, chitosan and honey act as a drug releasing agent on the wound surface for biodegradable wound dressings with desirable wound healing properties. The film formation was carried out using casting technique. The surface morphology of the films was carried out using Scanning Electron Microscope. The physical properties of film were assed as per standard methods The bio evaluation characteristics like antimicrobial efficacy were measured both in terms of zone of inhibition of the film samples against on Staphylococcus aureus and Escherichia coli. In another hand microbial penetration test, drug release activity, cytotoxicity test, contact dermatitis test were analyzed as per the standards.

HDNC (1-hydroxy-5, 7-dimethoxy-2 naphthalene-carboxaldehyde) is a bioactive compound derived from Aegle marmelos (Rutaceae, ‘Bael’). The current study was conducted to conclude the effect of HDNC on mechanical properties and collagen content of stomach and duodenal wounds in rats. This experiment included wound creation in rumen (non-glandular part) & corpus (oxyntic) part of stomach and duodenum. These wounds were analyzed after 0, 5, 15 & 30 days post-operation. HDNC treatment found to improve the mechanical strength of healing wounds of stomach and duodenum. Breaking strength and breaking energy were also augmented in presence of HDNC. Healing process was slower in initial post-operative phase (after 5 days). However in later days wound strength enhanced drastically. Direct relation was observed between total collagen content and mechanical strength. These findings point towards that the amplification of mechanical strength and collagen content in wounds has been the outcome of HDNC treatment.

This review inspects all the available report on association of honey and the epithelial mesenchymal transition (EMT) event in wound healing. A systematic review of the literature was conducted to identify relevant studies on honey and EMT. The search was done in Medline via Ebscohost and Scopus database to obtained relevant articles published between 1823 and 2017. The main inclusion criteria were research articles published in English that reported changes in the EMT markers in in vitro wound healing model when subjected to honey. The literature search identified 19 potentially relevant articles, whereby 8 met the inclusion criteria. Two types of in vitro wound healing model were included, cutaneous and corneal wound. All studies reported a positive effect of honey in wound healing. In terms of EMT markers, honey was shown to upregulate mesenchymal markers and downregulated epithelial markers providing the evidence of EMT activation by honey. However, the effects on EMT varied dependent on the floral origin of the honey. This review provides good evidence that honey regulates the process of EMT and has a positive impact on wound healing.

The authors propose a combined classification of diabetic foot syndrome, describing the localization (anatomical division of the foot), pathophysiological stage of the process in the bones, the clinical degree of deformation, the presence and depth of the wound and the infection process. This classification allows to determine the tactics of conducting the patient – the need for and type of surgical intervention, type and time of immobilization and unloading of the limb, indications for additional methods of treatment and to choose the most organ-preserving treatment tactics of each patient.

Leaves of Lawsonia inermis have long been used for several purposes in traditional herbal medicine. This report is to evaluate the effect of Lawsonia inermis on the wound healing in rats. Eight adult male rats were used. Animals have been anesthetized. A wound was created on the dorsal nape of the neck. Group 1 were left without treatment. Group 2 treated with 10% Iodine and vehicle. Group 3 and 4 were treated with a low dose and high dose of Henna respectively for 15 days. On the 1 ,5,10 and 15, the wound area of each animal was measured. Wound contraction was calculated. On the day 15, tissue samples were taken from the wound and examined by a histopathologist. At day 15, the average wound size decreased in group 1 and group 2 to 5.5 mm and 6.5 mm respectively and in group 3 and group 4 to 0 and 2.5 mm respectively. Histological results revealed that low dose and high dose produce better wound healing if compared with the control positive and control negative. The result of this pilot study has revealed that Henna extract leaves have remarkable effects on wound healing and warrents further studies.

Background

Treatment of pressure ulcer with necrotic tissue formation is challenging in old patients with severe comorbidities. Although indicated and recommended, surgical debridement cannot always be applied because of general conditions. Simple, convenient, and minimally invasive intervention is required to facilitate chemical debridement of necrotic tissue.

Methods

Seventeen patients suffering from intractable pressure ulcer complicated with necrotic tissue formation underwent conventional debridement (CD) or mango cut incision (MCI). Feasibility of MCI method was evaluated by comparing clinical outcomes between patients who underwent CD and MCI.

Results

Between patients undergoing CD and MCI, there was no significant difference in time for necrotic tissue clearance (3.1 ± 2.0 vs. 4.0 ± 1.5 weeks, P = 0.366), nor in time for pressure ulcer cure (14.7 ± 6.2 vs. 12.7 ± 5.6 weeks, P = 0.566). Time required for intervention was significantly longer in CD than that in MCI (173.8 ± 44.5 vs. 29.4 ± 13.3 s, P < 0.001). CD procedure was associated with significantly higher rate of bleeding compared with MCI (38% vs. 0%, P = 0.043).

Conclusions

MCI allows minimally invasive clearance of necrotic tissue with clinically acceptable outcomes compatible to CD, and can be a choice of method for necrosis-complicated pressure ulcers in patients with severe comorbidities.

Diabetic wound healing is one of the most universally acclaimed arduous medical challenges. In diabetics, once an ulcer gets evolved, there remains a heightened threat of wound progression and persistence. This review denatures the entangled helices of system pathology of diabetic wounds by providing explicit information regarding mechanobiological, oxidative stress related, growth factor associated episodes and also explores two unique pathophysiological events appellated ‘NETosis’ and ‘Metabolic Memory’. In this juncture, we further try to subsume the concept of contemporary alleviation via introducing age old natural medicine honey that may augment the inflows of regenerative windows in mammalian systems to restore homeostatic dimensions of healing in the wound bed.