Pub Date : 2024-03-01Epub Date: 2021-09-17DOI: 10.1177/15347346211044295
Omid Dehghan, Seyed Mehdi Tabaie, Javad Rafinejad, Mehrangiz Toutounchi, Amir Tiyuri, Sahar Azarmi, Gholamreza Esmaeeli Djavid, Kamran Akbarzadeh
In the present study, the efficiency of two formulations of maggot therapy: free-range larvae on the wounds and larvae in a special bag (larval-bag), was compared for healing diabetic ulcers with Wagner 2 diabetic ulcer. This study was conducted as a parallel randomized clinical trial. Out of 281 patients with Wagner grade 2 diabetic ulcers referred to the wound clinic, 54 patients who met the inclusion criteria were randomly assigned to intervention groups. The disinfected larvae of Lucilia sericata were put on the wounds with 2 methods, free-range larvae and larval-bag. Follow up was done at every 48 h interval until the full appearance of granulated tissues. The main measures were wound bed preparation, removing of necrotic tissues, appearing of granulated tissues, and removing of bacterial infections in the wounds. Statistical analysis based on the Kaplan-Meier curve and the Wilcoxon (Breslow) test showed a significant reduction in wound healing time by using free-range larvae in comparison with larval-bag (P = .03). The median time to debridement was 4 days in the free-range larval group (95% confidence interval: 3-9 days) while it was 9 days in the larval-bag group (95% confidence interval: 5-16 days). Debridement rate (proportion of removed necrotic tissue surfaces) at any time in the free-ranged larvae group was 1.78 times that of the bagged larvae group (95% confidence interval 1.01-3.15, P = .036). There was no significant difference between free-range larval use and larval-bag in the acceptability of maggot therapy by patients (P = .48). It can be concluded that both of two formulations of the larval therapy (free-range larvae and larval-bag) could be recommended for cleaning out and bed preparation of diabetic ulcers. However, using free-range larvae is hardly recommended on the wounds which are eligible to use.
{"title":"A Parallel Randomized Clinical Trial for Comparison of Two Methods of Maggot Therapy, Free-Range Larvae and Larval-bag, in Diabetic Ulcer (Wagner 2).","authors":"Omid Dehghan, Seyed Mehdi Tabaie, Javad Rafinejad, Mehrangiz Toutounchi, Amir Tiyuri, Sahar Azarmi, Gholamreza Esmaeeli Djavid, Kamran Akbarzadeh","doi":"10.1177/15347346211044295","DOIUrl":"10.1177/15347346211044295","url":null,"abstract":"<p><p>In the present study, the efficiency of two formulations of maggot therapy: free-range larvae on the wounds and larvae in a special bag (larval-bag), was compared for healing diabetic ulcers with Wagner 2 diabetic ulcer. This study was conducted as a parallel randomized clinical trial. Out of 281 patients with Wagner grade 2 diabetic ulcers referred to the wound clinic, 54 patients who met the inclusion criteria were randomly assigned to intervention groups. The disinfected larvae of <i>Lucilia sericata</i> were put on the wounds with 2 methods, free-range larvae and larval-bag. Follow up was done at every 48 h interval until the full appearance of granulated tissues. The main measures were wound bed preparation, removing of necrotic tissues, appearing of granulated tissues, and removing of bacterial infections in the wounds. Statistical analysis based on the Kaplan-Meier curve and the Wilcoxon (Breslow) test showed a significant reduction in wound healing time by using free-range larvae in comparison with larval-bag (<i>P</i> = .03). The median time to debridement was 4 days in the free-range larval group (95% confidence interval: 3-9 days) while it was 9 days in the larval-bag group (95% confidence interval: 5-16 days). Debridement rate (proportion of removed necrotic tissue surfaces) at any time in the free-ranged larvae group was 1.78 times that of the bagged larvae group (95% confidence interval 1.01-3.15, <i>P</i> = .036). There was no significant difference between free-range larval use and larval-bag in the acceptability of maggot therapy by patients (<i>P</i> = .48). It can be concluded that both of two formulations of the larval therapy (free-range larvae and larval-bag) could be recommended for cleaning out and bed preparation of diabetic ulcers. However, using free-range larvae is hardly recommended on the wounds which are eligible to use.</p>","PeriodicalId":49181,"journal":{"name":"International Journal of Lower Extremity Wounds","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39445449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-01Epub Date: 2021-10-07DOI: 10.1177/15347346211047098
Vijay Viswanathan, Senthil Govindan, Bamila Selvaraj, Secunda Rupert, Raghul Kumar
Diabetic foot ulcers, with worldwide prevalence ranging from 12%-25%, are an important cause of nontraumatic lower limb amputation. Evidence-based assessment of early infection can help the clinician provide the right first line treatment thus helping improve the wound closure rate. Illuminate®, a novel point of care device working on multispectral autofluorescence imaging, helps in the rapid identification and classification of bacteria. This study was aimed to evaluate the diagnostic accuracy of the device in detecting bacterial gram type against standard culture methods. A total of 178 patients from a tertiary care center for diabetes was recruited and 203 tissue samples were obtained from the wound base by the plastic surgeon. The device was handled by the trained investigator to take wound images. The tissue samples were taken from the color-coded infected region as indicated by the device's Artificial Intelligence algorithm and sent for microbial assessment. The results were compared against the Gram type inferred by the device and the device was found to have an accuracy of 89.54%, a positive predictive value of 86.27% for detecting Gram-positive bacteria, 80.77% for Gram-negative bacteria, and 91.67% for no infection. The negative predictive value corresponded to 87.25% for Gram-positive, 92% for Gram-negative, and 96.12% for no infection. The Results exhibited the accuracy of this novel autofluorescence device in identifying and classifying the gram type of bacteria and its potential in significantly aiding clinicians towards early infection assessment and treatment.
{"title":"A Clinical Study to Evaluate Autofluorescence Imaging of Diabetic Foot Ulcers Using a Novel Artificial Intelligence Enabled Noninvasive Device.","authors":"Vijay Viswanathan, Senthil Govindan, Bamila Selvaraj, Secunda Rupert, Raghul Kumar","doi":"10.1177/15347346211047098","DOIUrl":"10.1177/15347346211047098","url":null,"abstract":"<p><p>Diabetic foot ulcers, with worldwide prevalence ranging from 12%-25%, are an important cause of nontraumatic lower limb amputation. Evidence-based assessment of early infection can help the clinician provide the right first line treatment thus helping improve the wound closure rate. Illuminate<sup>®</sup>, a novel point of care device working on multispectral autofluorescence imaging, helps in the rapid identification and classification of bacteria. This study was aimed to evaluate the diagnostic accuracy of the device in detecting bacterial gram type against standard culture methods. A total of 178 patients from a tertiary care center for diabetes was recruited and 203 tissue samples were obtained from the wound base by the plastic surgeon. The device was handled by the trained investigator to take wound images. The tissue samples were taken from the color-coded infected region as indicated by the device's Artificial Intelligence algorithm and sent for microbial assessment. The results were compared against the Gram type inferred by the device and the device was found to have an accuracy of 89.54%, a positive predictive value of 86.27% for detecting Gram-positive bacteria, 80.77% for Gram-negative bacteria, and 91.67% for no infection. The negative predictive value corresponded to 87.25% for Gram-positive, 92% for Gram-negative, and 96.12% for no infection. The Results exhibited the accuracy of this novel autofluorescence device in identifying and classifying the gram type of bacteria and its potential in significantly aiding clinicians towards early infection assessment and treatment.</p>","PeriodicalId":49181,"journal":{"name":"International Journal of Lower Extremity Wounds","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39492951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-01Epub Date: 2022-01-19DOI: 10.1177/15347346221074163
Xiaofang Sun, Pengwen Ni, Ting Xie, Shaohan Wu
Phosphaturic mesenchymal tumor (PMT) is a rare paraneoplastic syndrome characterized by renal phosphate wasting, hypophosphatemia, and bone calcification disorders. Complete surgical resection of the tumor is believed to be the most effective treatment measure. However, the diagnosis of PMT is very difficult because of its insidious and small size, especially, when it appears in subcutaneous tissue with a chronic non-healing wound. We report a rare case of a 38-year-old man with a chronic non-healing wound on the left hallux for approximately eight months. Plain radiographic images and magnetic resonance imaging (MRI) revealed a cystic radiolucent shadow in the left distal phalanx. Bone scan observations also showed increased uptake in the same location. Histologically, this tumor was composed of numerous spindle cells with clusters of giant cells. The serum FGF23 level was significantly higher before surgery, with higher FGF23 levels closer to the tumor. Reverse transcription polymerase chain reaction and immunohistochemistry further confirmed the high expression of FGF23 in tumors. These data suggest that FGF23 may be a potential causative factor of PMT. The serum FGF23 levels might be useful for the diagnosis of PMT and localization of the tumor. The tumor was CD56- and D2 to 40-positive and CD31-negative. The non-healing wound caused by PMT might be attributed to the invasive growth of the tumor, destruction of intercellular junctions, and decrease in the number of endothelial cells.
{"title":"Phosphaturic Mesenchymal Tumor Along the Hallux side Inducing a Chronic non-Healing Wound: A Case Report with Literature Review.","authors":"Xiaofang Sun, Pengwen Ni, Ting Xie, Shaohan Wu","doi":"10.1177/15347346221074163","DOIUrl":"10.1177/15347346221074163","url":null,"abstract":"<p><p>Phosphaturic mesenchymal tumor (PMT) is a rare paraneoplastic syndrome characterized by renal phosphate wasting, hypophosphatemia, and bone calcification disorders. Complete surgical resection of the tumor is believed to be the most effective treatment measure. However, the diagnosis of PMT is very difficult because of its insidious and small size, especially, when it appears in subcutaneous tissue with a chronic non-healing wound. We report a rare case of a 38-year-old man with a chronic non-healing wound on the left hallux for approximately eight months. Plain radiographic images and magnetic resonance imaging (MRI) revealed a cystic radiolucent shadow in the left distal phalanx. Bone scan observations also showed increased uptake in the same location. Histologically, this tumor was composed of numerous spindle cells with clusters of giant cells. The serum FGF23 level was significantly higher before surgery, with higher FGF23 levels closer to the tumor. Reverse transcription polymerase chain reaction and immunohistochemistry further confirmed the high expression of FGF23 in tumors. These data suggest that FGF23 may be a potential causative factor of PMT. The serum FGF23 levels might be useful for the diagnosis of PMT and localization of the tumor. The tumor was CD56- and D2 to 40-positive and CD31-negative. The non-healing wound caused by PMT might be attributed to the invasive growth of the tumor, destruction of intercellular junctions, and decrease in the number of endothelial cells.</p>","PeriodicalId":49181,"journal":{"name":"International Journal of Lower Extremity Wounds","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39707906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-01Epub Date: 2022-01-24DOI: 10.1177/15347346221075873
Yi-Jye Chen, Chih-Yi Hsu, Chih-Hsun Lin
Chronic leg ulcer occurs in up to 13% of the general population and leads to economic and health care burdens. Approximately 20% of chronic nonhealing wounds are related to autoimmune diseases or vasculitis. Of these, chronic wounds associated with IgG4-related disease, a group of fibroinflammatory disorders that can have cutaneous and systemic involvement, are rarely reported. This case report describes a chronic leg ulcer associated with cutaneous IgG4-related disease. In addition to disease control with anti-inflammatory agents, following the principles of wound management and providing adjuvant wound treatment (eg, debridement, dressing, photobiomodulation therapy, or hyperbaric oxygen therapy) can promote the wound healing process.
{"title":"Chronic Leg Ulcer Associated with Cutaneous IgG4-Related Disease.","authors":"Yi-Jye Chen, Chih-Yi Hsu, Chih-Hsun Lin","doi":"10.1177/15347346221075873","DOIUrl":"10.1177/15347346221075873","url":null,"abstract":"<p><p>Chronic leg ulcer occurs in up to 13% of the general population and leads to economic and health care burdens. Approximately 20% of chronic nonhealing wounds are related to autoimmune diseases or vasculitis. Of these, chronic wounds associated with IgG4-related disease, a group of fibroinflammatory disorders that can have cutaneous and systemic involvement, are rarely reported. This case report describes a chronic leg ulcer associated with cutaneous IgG4-related disease. In addition to disease control with anti-inflammatory agents, following the principles of wound management and providing adjuvant wound treatment (eg, debridement, dressing, photobiomodulation therapy, or hyperbaric oxygen therapy) can promote the wound healing process.</p>","PeriodicalId":49181,"journal":{"name":"International Journal of Lower Extremity Wounds","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39850934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-01Epub Date: 2021-08-02DOI: 10.1177/15347346211036530
Sadık Hançerlioğlu, İsmail Toygar, Ayşe Ayhan, İrem Yilmaz, Yavuz Orhan, Göksu S Özdemir, Ilgın Y Şimşir, Şevki Çetinkalp
With the increase in the diabetic foot patients in recent decades, the caregivers of diabetic foot patients increase too. Most of these caregivers are informal caregivers. However, the studies examining the burden of the caregivers and affecting factors are limited. This study was conducted to determine the burden of the caregivers of diabetic foot patients and affecting factors. This cross-sectional study was conducted between the January and October 2020 in a diabetic foot council of a university hospital. Zarit Caregiver Burden Scale and a participant identification form were used for data collection. Most of the caregivers were female (75.2%) and the mean age was 51.27 ± 11.48 years. The burden of the caregivers was at moderate level in the current study. Factors affecting the caregivers' burden were caregivers' age, patients' family structure, caregivers' education level, caregivers' income level, hours per week spending for the care of the patients, and lack of choice.
{"title":"Burden of Diabetic Foot Patients' Caregivers and Affecting Factors: A Cross-Sectional Study.","authors":"Sadık Hançerlioğlu, İsmail Toygar, Ayşe Ayhan, İrem Yilmaz, Yavuz Orhan, Göksu S Özdemir, Ilgın Y Şimşir, Şevki Çetinkalp","doi":"10.1177/15347346211036530","DOIUrl":"10.1177/15347346211036530","url":null,"abstract":"<p><p>With the increase in the diabetic foot patients in recent decades, the caregivers of diabetic foot patients increase too. Most of these caregivers are informal caregivers. However, the studies examining the burden of the caregivers and affecting factors are limited. This study was conducted to determine the burden of the caregivers of diabetic foot patients and affecting factors. This cross-sectional study was conducted between the January and October 2020 in a diabetic foot council of a university hospital. Zarit Caregiver Burden Scale and a participant identification form were used for data collection. Most of the caregivers were female (75.2%) and the mean age was 51.27 ± 11.48 years. The burden of the caregivers was at moderate level in the current study. Factors affecting the caregivers' burden were caregivers' age, patients' family structure, caregivers' education level, caregivers' income level, hours per week spending for the care of the patients, and lack of choice.</p>","PeriodicalId":49181,"journal":{"name":"International Journal of Lower Extremity Wounds","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/15347346211036530","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39267763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chronic limb-threatening ischemia (CLTI) is associated with a short-term risk of limb loss. Multidisciplinary teams are often involved in CLTI treatment; however, in Asian countries, multidisciplinary teams that include podiatrists specializing in foot wounds and vascular surgeons who can perform distal bypass surgery are lacking. We investigated predictive factors for limb salvage and foot ulcer recurrence in patients with CLTI treated by a Japanese single-center intensive multidisciplinary team over 6 years. We retrospectively investigated 84 patients with CLTI and foot ulcers who had undergone revascularization and wound treatment between October 2013 and December 2019. Following postrevascularization treatment, including undertaking minor amputations, the healing rate was 77.8%, and the average wound healing time was 75 ± 68 days. To achieve adequate blood supply, 17.7% of patients were treated using a combination of endovascular revascularization and bypass surgeries. Thirty-three (44%) patients had wound recurrence and there was wound recurrence within 6 months in 58.9% of these patients. Multivariate logistic regression analysis showed that postrevascularization skin perfusion pressure was significantly associated with wound healing (odds ratio [OR] 1.13, 95% confidence interval [CI] 1.033-1.243, P = .0078). Diabetes mellitus (OR 9.72, 95% CI 1.855-50.937, P = .0071), and heart disease (OR 3.51, 95% CI 1.052-11.693, P = .0411) were significantly associated with wound recurrence (P < .05). Treatment within a single-center intensive multidisciplinary team resulted in good patient outcomes. Our study indicates that the revascularization endpoint of CLTI treatment should be marked by attainment of adequate blood supply and wound healing. The timing of revascularization and debridement is of utmost importance for the successful treatment of CLTI wounds.
{"title":"Predictive Factors for Limb Salvage and Foot Ulcer Recurrence in Patients with Chronic Limb-Threatening Ischemia After Multidisciplinary Team Treatment: A 6-Year Japanese Single-Center Study.","authors":"Miki Fujii, Akitoshi Yamada, Kohei Yamawaki, Shigeyasu Tsuda, Naokazu Miyamoto, Kunio Gan, Hiroto Terashi","doi":"10.1177/15347346211041429","DOIUrl":"10.1177/15347346211041429","url":null,"abstract":"<p><p>Chronic limb-threatening ischemia (CLTI) is associated with a short-term risk of limb loss. Multidisciplinary teams are often involved in CLTI treatment; however, in Asian countries, multidisciplinary teams that include podiatrists specializing in foot wounds and vascular surgeons who can perform distal bypass surgery are lacking. We investigated predictive factors for limb salvage and foot ulcer recurrence in patients with CLTI treated by a Japanese single-center intensive multidisciplinary team over 6 years. We retrospectively investigated 84 patients with CLTI and foot ulcers who had undergone revascularization and wound treatment between October 2013 and December 2019. Following postrevascularization treatment, including undertaking minor amputations, the healing rate was 77.8%, and the average wound healing time was 75 ± 68 days. To achieve adequate blood supply, 17.7% of patients were treated using a combination of endovascular revascularization and bypass surgeries. Thirty-three (44%) patients had wound recurrence and there was wound recurrence within 6 months in 58.9% of these patients. Multivariate logistic regression analysis showed that postrevascularization skin perfusion pressure was significantly associated with wound healing (odds ratio [OR] 1.13, 95% confidence interval [CI] 1.033-1.243, <i>P</i> = .0078). Diabetes mellitus (OR 9.72, 95% CI 1.855-50.937, <i>P</i> = .0071), and heart disease (OR 3.51, 95% CI 1.052-11.693, <i>P</i> = .0411) were significantly associated with wound recurrence (<i>P</i> < .05). Treatment within a single-center intensive multidisciplinary team resulted in good patient outcomes. Our study indicates that the revascularization endpoint of CLTI treatment should be marked by attainment of adequate blood supply and wound healing. The timing of revascularization and debridement is of utmost importance for the successful treatment of CLTI wounds.</p>","PeriodicalId":49181,"journal":{"name":"International Journal of Lower Extremity Wounds","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39397728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-01Epub Date: 2023-08-09DOI: 10.1177/15347346231194417
Miltos K Lazarides, Kittipan Rerkasem, Nikolaos Papanas
Chronic wounds remain a substantial cause of morbidity and a health challenge.1 They are de fi ned as wounds failing to proceed through the normal phases of wound healing in an orderly and timely manner or in which the repair process fails to restore anatomic and functional integrity after 3 months. 1,2 Their etiology is diverse, including peripheral arterial disease, diabetic neuropathic ulcers, chronic venous insuf fi - ciency, decubitus ulcers, vasculitis, pyoderma gangreno-sum, infectious diseases
{"title":"Chronic Wound Management: New Knowledge Still Required for This Constant Challenge.","authors":"Miltos K Lazarides, Kittipan Rerkasem, Nikolaos Papanas","doi":"10.1177/15347346231194417","DOIUrl":"10.1177/15347346231194417","url":null,"abstract":"Chronic wounds remain a substantial cause of morbidity and a health challenge.1 They are de fi ned as wounds failing to proceed through the normal phases of wound healing in an orderly and timely manner or in which the repair process fails to restore anatomic and functional integrity after 3 months. 1,2 Their etiology is diverse, including peripheral arterial disease, diabetic neuropathic ulcers, chronic venous insuf fi - ciency, decubitus ulcers, vasculitis, pyoderma gangreno-sum, infectious diseases","PeriodicalId":49181,"journal":{"name":"International Journal of Lower Extremity Wounds","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9969273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-01Epub Date: 2021-08-31DOI: 10.1177/15347346211040593
A Nilhan Atsü Md, Zeynep Tosuner Md, Tayfun Bilgiç Md
The study aimed to evaluate the efficiency of pomegranate (Punica granatum) seed oil in wound healing in excised rats. Sixteen female young Wistar Albino Rats weighing approximately 300 to 320 g were randomly divided into 2 groups as the treatment (=pomegranate seed oil group) and control groups in this experiment. Six different wounds 1 cm apart from the midline and each other were formed with a 6 mm punch biopsy instrument. Three wounds were left open (open wound group) whereas 3 wounds were sutured with 4/0 vicryl (closed wound group). Punica granatum seed oil treatment was administered topically to the treatment group, both to open and closed wounds, once a day for 14 days. Parameters for healing were evaluated. Histopathologic examination was performed for the investigation of inflammation, neovascularization, granulation, and fibroblast generation in addition to serologic (enzyme-linked immunosorbent assay) evaluation of rat malondialchehyche, rat glutathione peroxidase, and rat superoxide dismutase. PeriScan PIM 3 System Laser Doppler Blood Perfusion Imager was used for the calculation of blood perfusion. There was a statistically significant difference between inflammation and neovascularization levels and group type on the 14th day in open wounds(P < .05). On the 21st day, the granulation tissue level in the closed wound group was found to be higher in the pomegranate group (P = 0.000).The results showed that PSE oil is partially effective, although it is not effective in every parameter examined, in the treatment of excised wounds in rats and may be suitable for clinical treatment in humans but large controlled studies are needed.
本研究旨在评价石榴籽油对离体大鼠伤口愈合的影响。16只雌性幼龄Wistar Albino大鼠,体重约300至320 g随机分为两组,分别为石榴籽油组和对照组。在距中线1cm处形成6个不同的伤口 mm打孔活检仪。三个伤口是开放的(开放伤口组),而三个伤口用4/0 vicryl缝合(闭合伤口组)。治疗组对开放性和闭合性伤口局部给予石榴籽油治疗,每天一次,持续14天。对愈合参数进行了评估。除了对大鼠丙二酸二乙酯、大鼠谷胱甘肽过氧化物酶和大鼠超氧化物歧化酶的血清学(酶联免疫吸附试验)评估外,还进行了组织病理学检查,以研究炎症、新生血管、肉芽和成纤维细胞的生成。PeriScan PIM 3系统激光多普勒血液灌注成像仪用于计算血液灌注。开放性创面第14天的炎症和新生血管生成水平与分组类型之间有统计学意义(P P = 0.000)。结果表明,PSE油在大鼠切除伤口的治疗中是部分有效的,尽管它在所检查的每个参数中都不是有效的,并且可能适用于人类的临床治疗,但需要进行大规模的对照研究。
{"title":"Evaluation of the Effect of Pomegranate Seed Oil on Healing in a Rat Wound Model With Antioxidant, Vascular, and Histopathological Parameters.","authors":"A Nilhan Atsü Md, Zeynep Tosuner Md, Tayfun Bilgiç Md","doi":"10.1177/15347346211040593","DOIUrl":"10.1177/15347346211040593","url":null,"abstract":"<p><p>The study aimed to evaluate the efficiency of pomegranate (<i>Punica granatum</i>) seed oil in wound healing in excised rats. Sixteen female young Wistar Albino Rats weighing approximately 300 to 320 g were randomly divided into 2 groups as the treatment (=pomegranate seed oil group) and control groups in this experiment. Six different wounds 1 cm apart from the midline and each other were formed with a 6 mm punch biopsy instrument. Three wounds were left open (open wound group) whereas 3 wounds were sutured with 4/0 vicryl (closed wound group). <i>Punica granatum</i> seed oil treatment was administered topically to the treatment group, both to open and closed wounds, once a day for 14 days. Parameters for healing were evaluated. Histopathologic examination was performed for the investigation of inflammation, neovascularization, granulation, and fibroblast generation in addition to serologic (enzyme-linked immunosorbent assay) evaluation of rat malondialchehyche, rat glutathione peroxidase, and rat superoxide dismutase. PeriScan PIM 3 System Laser Doppler Blood Perfusion Imager was used for the calculation of blood perfusion. There was a statistically significant difference between inflammation and neovascularization levels and group type on the 14th day in open wounds(<i>P</i> < .05). On the 21st day, the granulation tissue level in the closed wound group was found to be higher in the pomegranate group (<i>P</i> = 0.000).The results showed that PSE oil is partially effective, although it is not effective in every parameter examined, in the treatment of excised wounds in rats and may be suitable for clinical treatment in humans but large controlled studies are needed.</p>","PeriodicalId":49181,"journal":{"name":"International Journal of Lower Extremity Wounds","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39371524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-01Epub Date: 2021-10-04DOI: 10.1177/15347346211049881
Iván Copete González, Nieves Vanaclocha, Alberto Sánchez-García, Alessandro Thione, Alberto Pérez-García
Free fibula flap (FFF) is one of the reconstructive techniques to treat bone defects, although in septic conditions there are some limitations that have made it less popular. We present our experience with FFF for the reconstruction of lower limb infectious bone defects. From September 2015 to January 2020, 10 patients underwent reconstruction with FFF without rigid internal fixation of septic bone defects of the lower extremities. Demographic, clinical, and operative data were retrospectively collected. All the flaps survived and consolidated. The only major complication was a stress fracture of a fibula that required osteosynthesis. Median time to consolidation and full weight-bearing was 2.5 and 9.8 months, respectively. Bipedal gating was achieved in all the patients, 7 of them without walking aids. Despite it has some limitations and technical difficulties, in our experience FFF is an effective and reliable option in the reconstruction of septic bone defects of the lower limb.
{"title":"Free Vacularized Fibula Flap for Septic Bone Defects of the Lower Limb.","authors":"Iván Copete González, Nieves Vanaclocha, Alberto Sánchez-García, Alessandro Thione, Alberto Pérez-García","doi":"10.1177/15347346211049881","DOIUrl":"10.1177/15347346211049881","url":null,"abstract":"<p><p>Free fibula flap (FFF) is one of the reconstructive techniques to treat bone defects, although in septic conditions there are some limitations that have made it less popular. We present our experience with FFF for the reconstruction of lower limb infectious bone defects. From September 2015 to January 2020, 10 patients underwent reconstruction with FFF without rigid internal fixation of septic bone defects of the lower extremities. Demographic, clinical, and operative data were retrospectively collected. All the flaps survived and consolidated. The only major complication was a stress fracture of a fibula that required osteosynthesis. Median time to consolidation and full weight-bearing was 2.5 and 9.8 months, respectively. Bipedal gating was achieved in all the patients, 7 of them without walking aids. Despite it has some limitations and technical difficulties, in our experience FFF is an effective and reliable option in the reconstruction of septic bone defects of the lower limb.</p>","PeriodicalId":49181,"journal":{"name":"International Journal of Lower Extremity Wounds","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39485816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Foot infections are the most prevalent problem in persons with diabetes. The burden of multidrug resistant (MDR) microorganisms in diabetic foot infections (DFIs) is rising day by day. Given that, the present study aims to determine the variety of microorganisms isolated from the diabetic foot ulcers (DFUs), and their antibiotic sensitivity pattern. This prospective observational study was conducted for 1 year at Bharati Hospital and Research Centre, Pune, India. Clinically infected patients with DFU admitted to the surgery ward were included in this study. The specimen for microbiological studies is obtained from the wound swabs, soft tissue, and bone tissue as a part of routine clinical care. All demographic, clinical data, microbial culture results were collected, and evaluated for each case. Antimicrobial susceptibility testing to different agents was carried out using the VITEK-2® machine. A total of 110 microorganisms were isolated from 76 specimens, with an average of 1.4 organisms per lesion. Staphylococcus aureus (n = 27, 24.5%) and Escherichia coli (n = 17, 15.4%) were the most prevalent Gram-positive and Gram-negative organisms isolated, respectively. MDR organisms constituted up to 52 (47.2%), while 6 (5.4%) of the samples were extensively drug resistant (XDR). Methicillin-resistant S aureus (MRSA) accounted for up to 19 (70.3%) of the S aureus isolates, likewise extended-spectrum beta-lactamase producing microorganisms constituted 16 (14.5%) of total isolates in this study. Oxacillin and benzyl penicillin exhibited least susceptibility against Gram-positive bacteria, among Gram-negative organisms; cefuroxime, ceftriaxone, and ciprofloxacin were least sensitive. As most of the S aureus isolate in our study was MRSA, empirical antimicrobial therapy may include coverage for MRSA in a patient with risk factors associated with this pathogen. A crucial observation is the presence of XDR strains of Proteus mirabilis in DFIs, which is resistant to almost all the antimicrobials, tested. Appropriate antimicrobial selection may reduce the morbidity and the emergence of MDR organisms in DFIs.
{"title":"Microbiological Pattern, Antimicrobial Resistance and Prevalence of MDR/XDR Organisms in Patients With Diabetic Foot Infection in an Indian Tertiary Care Hospital.","authors":"Idris Dawaiwala, Snehal Awaghade, Pranjali Kolhatkar, Sunita Pawar, Supriya Barsode","doi":"10.1177/15347346211038090","DOIUrl":"10.1177/15347346211038090","url":null,"abstract":"<p><p>Foot infections are the most prevalent problem in persons with diabetes. The burden of multidrug resistant (MDR) microorganisms in diabetic foot infections (DFIs) is rising day by day. Given that, the present study aims to determine the variety of microorganisms isolated from the diabetic foot ulcers (DFUs), and their antibiotic sensitivity pattern. This prospective observational study was conducted for 1 year at Bharati Hospital and Research Centre, Pune, India. Clinically infected patients with DFU admitted to the surgery ward were included in this study. The specimen for microbiological studies is obtained from the wound swabs, soft tissue, and bone tissue as a part of routine clinical care. All demographic, clinical data, microbial culture results were collected, and evaluated for each case. Antimicrobial susceptibility testing to different agents was carried out using the VITEK-2<sup>®</sup> machine. A total of 110 microorganisms were isolated from 76 specimens, with an average of 1.4 organisms per lesion. <i>Staphylococcus aureus</i> (n = 27, 24.5%) and <i>Escherichia coli</i> (n = 17, 15.4%) were the most prevalent Gram-positive and Gram-negative organisms isolated, respectively. MDR organisms constituted up to 52 (47.2%), while 6 (5.4%) of the samples were extensively drug resistant (XDR). Methicillin-resistant <i>S aureus</i> (MRSA) accounted for up to 19 (70.3%) of the <i>S aureus</i> isolates, likewise extended-spectrum beta-lactamase producing microorganisms constituted 16 (14.5%) of total isolates in this study. Oxacillin and benzyl penicillin exhibited least susceptibility against Gram-positive bacteria, among Gram-negative organisms; cefuroxime, ceftriaxone, and ciprofloxacin were least sensitive. As most of the <i>S aureus</i> isolate in our study was MRSA, empirical antimicrobial therapy may include coverage for MRSA in a patient with risk factors associated with this pathogen. A crucial observation is the presence of XDR strains of <i>Proteus mirabilis</i> in DFIs, which is resistant to almost all the antimicrobials, tested. Appropriate antimicrobial selection may reduce the morbidity and the emergence of MDR organisms in DFIs.</p>","PeriodicalId":49181,"journal":{"name":"International Journal of Lower Extremity Wounds","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39303832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}