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Irani M, Kordestani SS. Psychological, behavioural and relevant factors affecting wound healing, and the buffering role of interventions. J Wound Care 2025; 34:i-xviii. [PMID: 39928511 DOI: 10.12968/jowc.2020.0222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2025]
Abstract
Wound healing is a complex process accompanying numerous health conditions, and millions of people across the world experience deleterious impacts caused by wounds. There are many non-biological factors that can directly or indirectly affect the health outcomes of patients with wounds. The purpose of this review was to investigate the effects of psychological, behavioural and other relevant factors on wound healing. In addition, as the possible associations among these factors have, in the authors' view, not been addressed appropriately, we also aimed to examine if there were specific relationships among these factors and between these factors and health outcomes. Finally, we reviewed the role of various interventions in buffering negative impacts during health procedures.
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Affiliation(s)
- Masoud Irani
- School of Communication and Creative Arts, Faculty of Arts and Education, Deakin University, Melbourne, Australia
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Oliveira JA, da Silveira MI, Soares LFF, Alves RDO, Carrera TMI, Azevedo MR, Oliveira GJPLD, Pigossi SC. Wound-healing agents for palatal donor area: A network meta-analysis. Clin Oral Implants Res 2024; 35:359-376. [PMID: 38315151 DOI: 10.1111/clr.14241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 12/18/2023] [Accepted: 01/13/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND The aim of this systematic review and network meta-analysis (NMA) was to assess the efficacy of different wound-healing agents for palatal donor area management after soft tissue graft harvesting. METHODS Electronic searches in six databases were conducted for publications up to October 2023. Studies with data from patients undergoing therapeutic approaches using agents for palatal healing after gingival graft harvesting were included. Data about postoperative pain, wound-healing and postoperative complications reported for each agent were extracted. Three different tools were used for the risk of bias within studies evaluation (Murad tool for case series and case report, RoB 2.0 tool for randomized studies and ROBINS-I tool for non-randomized studies). A Bayesian random effects NMA was conducted for postoperative pain levels and wound healing. RESULTS Eighty-four publications were included in the systematic review (qualitative analysis), with 14 of these subjected to NMA (quantitative analysis). The summarized results from the qualitative and quantitative analysis showed that all wound-healing agents evaluated promoted better pain control and wound healing compared to spontaneous healing and hemostatic sponges alone. The NMA outcomes reveal that leucocyte- and platelet-rich fibrin (L-PRF) was the most effective agent in reducing postoperative pain in all analyzed periods. Moreover, the L-PRF seems to accelerate wound healing and reduce postoperative complications compared to other agents. CONCLUSION In conclusion, the L-PRF was the most effective agent in reducing postoperative pain, accelerating wound healing and reducing postoperative complications after harvesting soft tissue grafts from the palatal area.
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Affiliation(s)
- Jovânia Alves Oliveira
- School of Dentistry, Alfenas Federal University (Unifal-MG), Alfenas, Minas Gerais, Brazil
- Department of Periodontology and Implantodontology, School of Dentistry, Federal University of Uberlandia - UFU, Uberlandia, Minas Gerais, Brazil
| | | | - Lélio Fernando Ferreira Soares
- Department of Diagnosis and Surgery, School of Dentistry at Araraquara, UNESP - São Paulo State University (FOAr/UNESP), Araraquara, São Paulo, Brazil
| | - Roberta de Oliveira Alves
- Department of Periodontology and Implantodontology, School of Dentistry, Federal University of Uberlandia - UFU, Uberlandia, Minas Gerais, Brazil
| | - Thaísa Macedo Iunes Carrera
- Department of Periodontology and Implantodontology, School of Dentistry, Federal University of Uberlandia - UFU, Uberlandia, Minas Gerais, Brazil
| | - Mayra Resende Azevedo
- Department of Periodontology and Implantodontology, School of Dentistry, Federal University of Uberlandia - UFU, Uberlandia, Minas Gerais, Brazil
| | | | - Suzane Cristina Pigossi
- Department of Periodontology and Implantodontology, School of Dentistry, Federal University of Uberlandia - UFU, Uberlandia, Minas Gerais, Brazil
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Chen Y, Qian H, Peng D, Jiang Y, Liu Q, Tan Y, Feng L, Cheng B, Li G. Antimicrobial peptide-modified AIE visual composite wound dressing for promoting rapid healing of infected wounds. Front Bioeng Biotechnol 2024; 11:1338172. [PMID: 38283168 PMCID: PMC10811172 DOI: 10.3389/fbioe.2023.1338172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 12/18/2023] [Indexed: 01/30/2024] Open
Abstract
Wound infection is a major problem faced during wound healing. Therefore, it is necessary to develop wound dressings with excellent antimicrobial properties. Here, a smart response system of PVA-TPE/HA-AMP/SF/ALG wound dressing was prepared by a combination of chemical cross-linking and freeze-drying methods. We grafted AMP onto HA to endow the wound dressing with bacterial resistance and slow release of AMP. At the same time, the system detects bacterial activity in real time for precise antimicrobial activity (through the use of PVA-TPE) and modulates inflammation to reduce bacterial infection (through the use of AMP). In addition, the PVA-TPE/HA-AMP/SF/ALG wound dressing has a good three-dimensional mesh structure, which promotes cell proliferation, enhances collagen deposition and angiogenesis, and thus effectively promotes rapid healing of infected wounds. Moreover, it can induce the expression of inflammatory factors such as VEGF, TNF-α, IFN-γ, IL-4 and TGF-β1 in infected wounds through the Wnt/CAMK/p-PKC signaling pathway, inhibit inflammatory responses, promote wound healing and reduce scar formation. Therefore, the PVA-TPE/HA-AMP/SF/ALG wound dressing smart response system shows great promise in infected wound healing.
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Affiliation(s)
- Yi Chen
- Department of Cadre Ward, General Hospital of Southern Theater Command, Guangzhou, China
| | - Hongjin Qian
- Department of Cadre Ward, General Hospital of Southern Theater Command, Guangzhou, China
| | - Dandan Peng
- Department of Oncology, General Hospital of Southern Theater Command, Guangzhou, China
| | - Yan Jiang
- Department of Cadre Ward, General Hospital of Southern Theater Command, Guangzhou, China
| | - Qiaolin Liu
- Department of Oncology, General Hospital of Southern Theater Command, Guangzhou, China
| | - Yan Tan
- Department of Cadre Ward, General Hospital of Southern Theater Command, Guangzhou, China
| | - Longbao Feng
- Key Laboratory of Biomaterials of Guangdong Higher Education Institutes, Department of Biomedical Engineering, Guangdong Provincial Engineering and Technological Research Centre for Drug Carrier Development, Jinan University, Guangzhou, China
| | - Biao Cheng
- Department of Burns and Plastic Surgery, General Hospital of Southern Theater Command, Guangzhou, China
| | - Guilan Li
- Department of Neurosurgery, General Hospital of Southern Theater Command, Guangzhou, China
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Moghimi V, Rahvarian J, Esmaeilzadeh Z, Mohammad-Pour N, Babaki D, Sadeghifar F, Esfehani RJ, Bidkhori HR, Roshan NM, Momeni-Moghaddam M, Naderi-Meshkin H. Adipose-derived human mesenchymal stem cells seeded on denuded or stromal sides of the amniotic membrane improve angiogenesis and collagen remodeling and accelerate healing of the full-thickness wound. Acta Histochem 2023; 125:152027. [PMID: 37062121 DOI: 10.1016/j.acthis.2023.152027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 04/06/2023] [Accepted: 04/08/2023] [Indexed: 04/18/2023]
Abstract
Several strategies have been proposed to enhance wound healing results. Along with other forms of wound dressing, the human amniotic membrane (HAM) has long been regarded as a biological wound dressing that decreases infection and enhances healing. This study investigates the feasibility and effectiveness of wound healing using decellularized HAM (dAM) and stromal HAM (sAM) in combination with adipose-derived human mesenchymal stem cells (AdMSCs). The dAM and sAM sides of HAM were employed as wound dressing scaffolds, and AdMSCs were seeded on top of either dAM or sAM. Sixty healthy Wistar rats were randomly divided into three groups: untreated wound, dAM/AdMSCs group, and sAM/AdMSCs group. The gene expression of VEGF and COL-I was measured in vitro. Wound healing was examined after wounding on days 3, 7, 14, and 21. The expression level of VEGF was significantly higher in sAM/AdMSCs than dAM/AdMSCs (P ≤ 0.05), but there was no significant difference in COL-I expression (P ≥ 0.05). In vivo research revealed that on day 14, wounds treated with sAM/AdMSCs had more vascularization than wounds treated with dAM/AdMSCs (P ≤ 0.01) and untreated wound groups on days 7 (P ≤ 0.05) and 14 (P ≤ 0.0001), respectively. On days 14 (P < 0.05 for sAM/AdMSCs, P < 0.01 for dAM/AdMSCs), and 21 (P < 0.05 for sAM/AdMSCs, P < 0.01 for dAM/AdMSCs), the collagen deposition in the wound bed was significantly thicker in the sAM/AdMSCs and dAM/AdMSCs groups compared to untreated wounds. The study demonstrated that the combination of sAM and AdMSCs promotes wound healing by enhancing angiogenesis and collagen remodeling.
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Affiliation(s)
- Vahid Moghimi
- Stem Cells and Regenerative Medicine Department, Academic Center for Education, Culture and Research (ACECR), Khorasan Razavi Branch, Mashhad, Iran; Department of Biology, Faculty of Science, Hakim Sabzevari University, Sabzevar, Iran
| | - Jeiran Rahvarian
- Stem Cells and Regenerative Medicine Department, Academic Center for Education, Culture and Research (ACECR), Khorasan Razavi Branch, Mashhad, Iran; Department of Clinical Sciences, Faculty of Veterinary Medicine, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Zohreh Esmaeilzadeh
- Stem Cells and Regenerative Medicine Department, Academic Center for Education, Culture and Research (ACECR), Khorasan Razavi Branch, Mashhad, Iran
| | - Najmeh Mohammad-Pour
- Stem Cells and Regenerative Medicine Department, Academic Center for Education, Culture and Research (ACECR), Khorasan Razavi Branch, Mashhad, Iran; Department of Biology, Faculty of Science, Hakim Sabzevari University, Sabzevar, Iran
| | - Danial Babaki
- Curriculum in Genetics and Molecular Biology, The University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Fatemeh Sadeghifar
- Department of Biology, Faculty of Science, Hakim Sabzevari University, Sabzevar, Iran
| | - Reza Jafarzadeh Esfehani
- Stem Cells and Regenerative Medicine Department, Academic Center for Education, Culture and Research (ACECR), Khorasan Razavi Branch, Mashhad, Iran; Blood Borne Infections Research Center, Academic Center for Education, Culture and Research (ACECR)- Khorasan Razavi, Mashhad, Iran
| | - Hamid Reza Bidkhori
- Stem Cells and Regenerative Medicine Department, Academic Center for Education, Culture and Research (ACECR), Khorasan Razavi Branch, Mashhad, Iran; Blood Borne Infections Research Center, Academic Center for Education, Culture and Research (ACECR)- Khorasan Razavi, Mashhad, Iran
| | | | | | - Hojjat Naderi-Meshkin
- Stem Cells and Regenerative Medicine Department, Academic Center for Education, Culture and Research (ACECR), Khorasan Razavi Branch, Mashhad, Iran; Wellcome-Wolfson Institute for Experimental Medicine, Belfast, UK.
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Gul R, Mir M, Ali MN. An Appraisal of pH triggered Bacitracin drug release, through composite hydrogel systems. J Biomater Appl 2023; 37:1699-1715. [PMID: 36977474 DOI: 10.1177/08853282231160212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
Comparative investigations on environmentally triggered drug delivery and wound healing characteristics of flexible hydrogel composites, Chitosan-Gelatin (C/G) and 2-Hydroxyethyl Methacrylate-Gelatin (H/G); are presented here. These composites, prepared through facile synthesis and curing methods, indicate the potential to smartly respond to the pH changes in wounds by releasing drug simultaneously and aiding in faster healing. An in-vitro investigation of the composite characteristics were included testing for Equilibrium Water Capacity Studies, Fourier Transform Infrared Spectroscopy (FTIR) investigations as well as UV based drug release and gravimetric hydrogel degradation profiles. This was followed by cutaneous application testing of the hydrogel systems in balb-c mice. Observations and testing results indicated the potential applicability of the hydrogel systems as dressings for topical/transdermal applications, provided that further detailed in-vivo characteristics are accounted for.
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Affiliation(s)
- Rabail Gul
- Biomedical Engineering and Sciences Department, School of Mechanical and Manufacturing Engineering (SMME), 66959National University of Sciences and Technology (NUST), Islamabad, Pakistan
- School of Mechanical and Manufacturing Engineering (SMME), National University of Sciences and Technology (NUST), Sector H-12, Islamabad, Pakistan
| | - Mariam Mir
- Biomedical Engineering and Sciences Department, School of Mechanical and Manufacturing Engineering (SMME), 66959National University of Sciences and Technology (NUST), Islamabad, Pakistan
- School of Mechanical and Manufacturing Engineering (SMME), National University of Sciences and Technology (NUST), Sector H-12, Islamabad, Pakistan
| | - Murtaza N Ali
- Biomedical Engineering and Sciences Department, School of Mechanical and Manufacturing Engineering (SMME), 66959National University of Sciences and Technology (NUST), Islamabad, Pakistan
- School of Mechanical and Manufacturing Engineering (SMME), National University of Sciences and Technology (NUST), Sector H-12, Islamabad, Pakistan
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Yildiz SC, Demir C, Ayhanci A. Examination of the effects of kefir on healing factors in a mice burn model infected with E.coli, S.aureus and P.aeruginosa using qRT-PCR. Burns 2023; 49:425-431. [PMID: 36064692 DOI: 10.1016/j.burns.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/02/2022] [Accepted: 08/09/2022] [Indexed: 11/21/2022]
Abstract
Burn areas are susceptible to bacterial growth and infections, particularly in cases with lengthy periods of hospital stay. Burn wound healing, which involves various molecular and cellular mechanisms, continues to be a significant problem. Growth factors and cytokines play an active and vital role in wound healing. In the present study, the effects of kefir on wound healing in a 2nd-degree mouse burn model infected with e.coli, s.aureus and p.aeruginosa were investigated in vitro. In order to clarify the effects of kefir in the wound healing process, the macroscopic changes in kefir-applied scar tissue as well as wound depth and width were examined and IL-1α, IL-1β, IL-6, IL-8, IL-10 and TNF-α, VEGF, TGF-β protein levels were determined using the qRT-PCR method. The findings of the present study show that kefir has a positive impact on the factors playing a role in wound healing and accelerates the healing process.
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Affiliation(s)
- Songul Cetik Yildiz
- Mardin Artuklu University, Vocational Higher School of Health Services, Department of Medical Services and Techniques, Mardin, Turkey.
| | - Cemil Demir
- Mardin Artuklu University, Vocational Higher School of Health Services, Department of Medical Services and Techniques, Mardin, Turkey.
| | - Adnan Ayhanci
- Department of Biology, Faculty of Arts and Science, Eskisehir Osmangazi University, Eskisehir, Turkey.
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Zhang Y, Demir B, Bertsch G, Qiao M. Zwitterion and N-halamine functionalized cotton wound dressing with enhanced antifouling, antibacterial, and hemostatic properties. Int J Biol Macromol 2023; 230:123121. [PMID: 36610571 DOI: 10.1016/j.ijbiomac.2022.123121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/28/2022] [Accepted: 12/29/2022] [Indexed: 01/06/2023]
Abstract
With emerging needs of wound care management, a multi-functional wound dressing is needed. To prevent infection and reduce patient suffering, antibacterial efficacy against a broad-spectrum of bacteria plus robust antifouling are among the most preferred properties. In this study, a wound dressing was created with antibacterial and anti-fouling capabilities is presented. The approaches used a synthesized tri-functional copolymer comprised of an N-halamine precursor moiety, a marine-inspired surface binding dopamine moiety, and a zwitterionic anti-adhesion moiety bonded onto a commercial cotton gauze. The resulting HaloCare™ wound dressing demonstrated >99.99 % inactivation within 5 min against E. coli and a panel of ESKAPE pathogens plus achieved 98.77 % reduction of non-specific protein binding. HaloCare was also shown to be compatible with hemostatic agents without impacting hemostatic efficacy. HaloCare shows great potential particularly in traumatic injury events as an infection preventing and hemostatic wound management system.
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Affiliation(s)
- Yidan Zhang
- Halomine Inc., 95 Brown Rd., Ithaca, NY, United States of America
| | - Buket Demir
- Halomine Inc., 95 Brown Rd., Ithaca, NY, United States of America
| | - Gregory Bertsch
- Halomine Inc., 95 Brown Rd., Ithaca, NY, United States of America
| | - Mingyu Qiao
- Halomine Inc., 95 Brown Rd., Ithaca, NY, United States of America.
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Evaluation of Wound Healing and Anti-Inflammatory Activities of 80% Methanol Crude Extract and Solvent Fractions of Trichilia dregeana Sond (Meliaceae) Leaves in Mice. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2023; 2023:9980866. [PMID: 36714535 PMCID: PMC9879677 DOI: 10.1155/2023/9980866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 11/30/2022] [Accepted: 12/02/2022] [Indexed: 01/21/2023]
Abstract
Introduction The leaves of Trichilia dregeana Sond are traditionally used to treat wounds. Even though there have been in vitro studies and claims supporting wound healing, there are no scientific data on in vivo wound healing and anti-inflammatory activities of the leaves of T. dregeana. Objective This study aimed to evaluate wound healing and anti-inflammatory activity of 80% methanol crude extract and solvent fractions of T. dregeana in mice. Method The leaves of T. dregeana were dried, ground, and macerated with 80% methanol three times successively. The crude extract was fractioned by water, ethyl acetate, and hexane separately. The acute dermal and oral toxicity tests were done by applying 2000 mg/kg of 10% (w/w) crude extract ointment (CEO) topically and 2000 mg/kg of crude extract orally, respectively. The wound healing activity of the crude extract was evaluated on excision, incision, and burn wound models while the fractions were evaluated only on excision wound model. The anti-inflammatory activity of the crude extract was evaluated on xylene-induced ear edema and cotton pellet granuloma tests. Result Both acute dermal and oral toxicity tests were found to be safe after topical application of 2000 mg/kg of 10% (w/w) CEO and oral administration of 2000 mg/kg of crude extract suspension, respectively. Both 5% and 10% (w/w) CEO produced significant (p < 0.001) wound contraction and period of epithelialization from day 4 onwards as compared to simple ointment (SO) on both excision and burn wounds. The tensile strength was increased significantly (p < 0.001) for the CEO-treated mice as compared to both untreated and SO groups. The crude extract also showed anti-inflammatory activity at 100, 200, and 400 mg/kg by inhibiting ear edema, exudate, and granuloma formation as compared to the SO group. Conclusion The increase in wound contraction, reduction in period of epithelialization, and increase in tensile strength support the traditional claims of T. dregeana for wound healing.
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Geropoulos G, Psarras K, Giannis D, Martzivanou EC, Papaioannou M, Kakos CD, Pavlidis ET, Symeonidis N, Koliakos G, Pavlidis TE. Platelet rich plasma effectiveness in bowel anastomoses: A systematic review. World J Gastrointest Surg 2021; 13:1736-1753. [PMID: 35070077 PMCID: PMC8727194 DOI: 10.4240/wjgs.v13.i12.1736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 08/11/2021] [Accepted: 11/18/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Anastomotic leak constitutes a major problem in abdominal surgery. Technical insufficiency, topical or systemic factors contribute to disrupted healing of the performed bowel anastomosis and result in anastomosis leakage, with detrimental effects on patient postoperative outcomes. Despite the investigation of several factors and the invention of protective materials, the ideal agent to prevent anastomotic leaks is yet to be determined. AIM To study the effect of platelet rich plasma (PRP) on the healing of bowel anastomoses. METHODS A systematic literature search was performed in PubMed, EMBASE, and Scopus databases to identify studies investigating the effect of PRP application on bowel anastomosis. RESULTS Eighteen studies were eligible with a total population of 712 animals including rats (14 studies), rabbits (2 studies) and pigs (2 studies). No postoperative complications were reported following PRP application. Fourteen out of 18 studies reported a statistically significant higher anastomosis bursting pressure in PRP groups compared to control either in healthy animals or animal models with underlying condition or intervention, such as intraperitoneal chemotherapy or peritonitis. Similar results were reported by ten studies in terms of tissue hydroxyproline levels. One study reported significant increase in collagen deposition in PRP groups. PRP application resulted in significantly decreased inflammatory cell infiltration in the presence of peritonitis or intraperitoneal chemotherapy (6 studies). CONCLUSION The application of PRP is associated with improved bowel anastomosis outcomes, especially in animal models having an underlying condition affecting the normal healing process. PRP application seems to augment the normal healing process under these circumstances. However, further studies are needed to investigate the potential role of PRP on bowel anastomosis healing, especially in clinical settings.
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Affiliation(s)
- Georgios Geropoulos
- Department of General Surgery, University College London Hospitals, London NW1 2BU, United Kingdom
- Laboratory of Scientific Research and Experimental Surgery, 2nd Propedeutic Department of Surgery, School of Medicine, Aristotle University, Thessaloniki 54642, Greece
- Surgery Working Group, Society of Junior Doctors, Athens 15123, Greece
| | - Kyriakos Psarras
- Laboratory of Scientific Research and Experimental Surgery, 2nd Propedeutic Department of Surgery, School of Medicine, Aristotle University, Thessaloniki 54642, Greece
| | - Dimitrios Giannis
- Institute of Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Manhasset, NY 11030, United States
| | - Eirini Chrysovalantou Martzivanou
- Laboratory of Scientific Research and Experimental Surgery, 2nd Propedeutic Department of Surgery, School of Medicine, Aristotle University, Thessaloniki 54642, Greece
| | - Maria Papaioannou
- Laboratory of Biological Chemistry, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
| | | | - Efstathios Theodoros Pavlidis
- Laboratory of Scientific Research and Experimental Surgery, 2nd Propedeutic Department of Surgery, School of Medicine, Aristotle University, Thessaloniki 54642, Greece
| | - Nikolaos Symeonidis
- Laboratory of Scientific Research and Experimental Surgery, 2nd Propedeutic Department of Surgery, School of Medicine, Aristotle University, Thessaloniki 54642, Greece
| | - Georgios Koliakos
- Laboratory of Biological Chemistry, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
| | - Theodoros Efstathios Pavlidis
- Laboratory of Scientific Research and Experimental Surgery, 2nd Propedeutic Department of Surgery, School of Medicine, Aristotle University, Thessaloniki 54642, Greece
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Comparison of Platelet-Rich Plasma-Impregnated Suture Material with Low and High Platelet Concentration to Improve Colonic Anastomotic Wound Healing in Rats. Gastroenterol Res Pract 2020; 2020:7386285. [PMID: 32565785 PMCID: PMC7271001 DOI: 10.1155/2020/7386285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 03/14/2020] [Accepted: 04/07/2020] [Indexed: 01/27/2023] Open
Abstract
Objective This study was designed to investigate the impact of using suture material impregnated with platelet-rich plasma (PRP) in different platelet concentrations on colonic anastomotic wound healing in rats. Methods A total of 24 Sprague Dawley female rats were separated into 3 groups (n = 8 for each) including the control group (CON; standard vicryl suture repair), the low platelet concentrate PRP group (L-PRP; suture material impregnated with PRP containing average 2.7-fold (range, 2.0 to 3.1) higher amount of platelets vs. control), and the high platelet concentrate PRP group (H-PRP; suture material impregnated with PRP containing average 5.1-fold (range, 4.8 to 5.4) higher amount of platelets vs. control). Rats were sacrificed on the postoperative 7th day for analysis of colonic anastomosis region including macroscopic observation, measurement of anastomotic bursting pressure (ABP), and the hydroxyproline levels and histopathological findings in colon tissue samples. Results Total injury scores were significantly lower in the L-PRP and H-PRP groups than those in the control group (median (range) 13.00 (7.00) and 11.50 (6.00) vs. 15.50 (4.00), p < 0.05 and p < 0.01, respectively). ABP values (180.00 (49.00) vs. 124.00 (62.00) and 121.00 (57.00) mmHg, p < 0.001 for each) and tissue hydroxyproline levels (0.56 (0.37) vs. 0.25 (0.17) and 0.39 (0.10) μg/mg tissue, p < 0.001 and p < 0.05, respectively) were significantly higher in the L-PRP group as compared with those in the control and H-PRP groups. Conclusion In conclusion, our findings revealed PRP application to colonic anastomosis sutures to promote the anastomotic healing process. The platelet concentration of PRP seems to have a significant impact on the outcome with superior efficacy of L-PRP over H-PRP in terms of bursting pressures and collagen concentration at the anastomotic site.
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Mahesh L, Kumar VR, Jain A, Shukla S, Aragoneses JM, Martínez González JM, Fernández-Domínguez M, Calvo-Guirado JL. Bacterial Adherence Around Sutures of Different Material at Grafted Site: A Microbiological Analysis. MATERIALS 2019; 12:ma12182848. [PMID: 31487852 PMCID: PMC6765980 DOI: 10.3390/ma12182848] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 08/21/2019] [Accepted: 08/31/2019] [Indexed: 01/08/2023]
Abstract
Closure of the surgical incision has been the primary function of sutures since their introduction. However, whatever the type, they are known to carry bacteria, which can be a source of infection. Five types of surgical sutures, Gut, Silk, Vicryl, PTFE, and Polyamide, were selected and tested on their ability to carry aerobic and anaerobic bacteria and were rated on the basis of forming colony-forming units (CFUs). Aerobic bacteria grown around gut sutures showed minimum CFUs (≈30 × 104/suture). Though very less anaerobic bacteria growth was seen among all tested suture materials, it was maximum around Vicryl and polyamide sutures. Every suture material is capable, albeit not equally, of holding bacterial biofilm formation, which can be a source of surgical site infection.
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Affiliation(s)
| | | | - Anshi Jain
- Department of Oral Pathology, ITS Dental College, Ghaziabad 201009, Uttar Pradesh, India
| | - Sagrika Shukla
- Private Practice in Periodontology, New Delhi 110001, India
| | - Juan Manuel Aragoneses
- Department of Dental Research in Universidad Federico Henríquez y Carvajal (UFHEC), Santo Domingo 10107, Dominican Republic
| | | | - Manuel Fernández-Domínguez
- Department of Oral Surgery and Implantology and Director of Research in Dentistry in the Doctoral Program of Translational Medicine, CEU San Pablo University, 28223 Madrid, Spain
| | - José Luis Calvo-Guirado
- Department of Oral Surgery and Implant Dentistry, Faculty of Health Sciences, Universidad Católica de Murcia, UCAM, 30107 Murcia, Spain.
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Abstract
Experiments were designed to test suture materials for their use in potentially infected abdominal wound closure. The nearest to the ideal, at present available, is a monofilament nonabsorbable suture, the one tested being monofilament nylon. The suture retained adequate strength in the infected and noninfected state over a 70-day period. This is particularly important as infection has been shown to result in low wound strength in the early phases of healing. The monofilamentous nature of this suture represented an advantage when sutures were examined electronmicroscopically. Infected, braided sutures viewed for the first time by electronmicroscopy were shown to contain bacteria and polymorphonuclear cells, even after 70 days implantation. The normal absorption and encapsulation of these sutures was delayed by the presence of infection. Polyglycolic acid had marked strength when new but rapidly weakened after implantation. This together with slowed absorption in the infected state is a disturbing feature in terms of wound failure and sinus formation respectively.
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Freeland RB, Morello SL, DeLombaert M, Rajamanickam V. Influence of intravenous regional limb perfusion with amikacin sulfate on Staphylococcus aureus
bioburden in distal limb wounds in horses. Vet Surg 2017; 46:663-674. [DOI: 10.1111/vsu.12638] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 11/30/2016] [Accepted: 12/13/2016] [Indexed: 12/27/2022]
Affiliation(s)
- Russell B. Freeland
- Department of Surgical Sciences; School of Veterinary Medicine, University of Wisconsin-Madison; Madison Wisconsin
| | - Samantha L. Morello
- Department of Surgical Sciences; School of Veterinary Medicine, University of Wisconsin-Madison; Madison Wisconsin
| | - Melissa DeLombaert
- Department of Surgical Sciences; School of Veterinary Medicine, University of Wisconsin-Madison; Madison Wisconsin
| | - Victora Rajamanickam
- Department of Biostatistics and Medical Informatics; School of Medicine and Public Health, Institute for Clinical and Translational Research, University of Wisconsin-Madison; Madison Wisconsin
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The effects of hyperthermic intraperitoneal chemoperfusion on colonic anastomosis: an experimental study in a rat model. TUMORI JOURNAL 2017; 103:307-313. [PMID: 28291907 DOI: 10.5301/tj.5000610] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2017] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Cytoreductive surgery (CRS) with subsequent hyperthermic intraperitoneal chemotherapy (HIPEC) is a promising modality to treat and prevent peritoneal metastases. However, this treatment is associated with signficant morbidity and mortality. Whether or not CRS with HIPEC interferes with anastomotic healing has also been debated. This study was designed to investigate the effects of mitomycin C, cisplatin, oxaliplatin, and doxorubicin used in HIPEC treatment on colonic anastomosis healing in a rat model. METHODS Sixty Wistar albino rats were employed in the study. Sigmoid resection and end-to-end colorectal anastomosis was performed in all rats. Group 1 rats underwent the surgical procedure alone, while group 2 rats were given hyperthermic intraperitoneal lavage with heated saline following surgery. Groups 3, 4, 5, and 6 had surgery with concomitant HIPEC treatment with mitomycin C, cisplatin, oxaliplatin, and doxorubicin, respectively. Anastomotic bursting pressures and hydroxyproline levels were evaluated. RESULTS Regarding the hydroxyproline levels, groups 1 and 2 showed significantly higher values than other groups (p<0.001). However, there was no significant difference between the HIPEC treatment groups (groups 3, 4, 5, and 6) (p>0.05). When groups were compared regarding bursting pressure values, no significant differences were observed (p = 0.81). CONCLUSIONS This study demonstrated that the HIPEC procedure with mitomycin C, cisplatin, oxaliplatin and doxorubicin had negative effects on hydroxyproline levels, but had no detrimental effect on anastomotic bursting pressure in a rat model.
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Macro-scale model study of a tunable drug dispensation mechanism for controlled drug delivery in potential wound-healing applications. J Appl Biomater Funct Mater 2016; 15:e63-e69. [PMID: 28058697 DOI: 10.5301/jabfm.5000280] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Auxetic materials tend to exhibit stretching in the direction of the applied load as well as in the perpendicular direction. This may be an inherent property of the material, or it might be a particular structural characteristic that confers it with auxetic properties. In this study, the auxetic properties of a rotating squares auxetic design were utilized in tandem with a stretching mechanism to manufacture a device that offers the advantages of adjustable pore size and hence tunable drug delivery characteristics. METHODS An auxetic polyurethane film was fabricated through the polymer casting technique. An acrylonitrile-butadiene-styrene (ABS) plastic mold for polymer casting was made through additive manufacturing. Stereolithography was used for fabrication of the mechanism that controlled pore size of the polymeric auxetic film. A laminate arrangement of the film and the mechanism was devised, through which movement of the mechanism controlled stretching of the auxetic film underneath. RESULTS Results were analyzed through image processing. It was observed that a 2-dimensional increase (in length and width) of the auxetic film took place that corresponded to an increase in pore size of the film. Several mathematical correlations were drawn up. CONCLUSIONS It may be concluded that the first factor controlling drug release kinetics is the pore size of the film. This study explored a prototype mechanism that has the potential for being used in devices for controlled drug delivery or in smart bandage systems that may enhance wound healing in chronic wound treatment.
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Abstract
This review covers the physiology of thermal injury and pathophysiology of burn wounds in terms of burn wound healing, wound infection, and strategies for controlling and preventing infection. Emerging trends relevant to wounds, such as the development of novel extrudable gel-forming bioabsorbable liquids, and tissue engineering are briefly discussed.
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Affiliation(s)
- Marc Shalaby
- University of North Carolina School of Medicine, Chapel Hill, NC 27599
| | - Shalaby W. Shalaby
- Poly-Med, Inc., R&D Laboratories, 511 Westinghouse Road, Pendleton, SC 29670
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17
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Habibi M, Oner OZ, Oruc MT, Bulbuller N, Ozdem S, Ozdemir S, Alikanooglu AS, Karakoyun R, Dogan U, Ongen A, Koc U. Effects of a Glutamine Enema on Anastomotic Healing in an Animal Colon Anastomosis Model. Ann Coloproctol 2015; 31:213-21. [PMID: 26817016 PMCID: PMC4724702 DOI: 10.3393/ac.2015.31.6.213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 10/16/2015] [Indexed: 12/17/2022] Open
Abstract
PURPOSE Anastomotic leakage in colorectal surgery is a very important issue. Although many studies have shown the positive effects of enteral glutamine (Gln) on anastomotic healing, none has assessed the effects of administering Gln via an enema for anastomotic healing. To fill this study gap, this study investigated the intraluminal effect of administration of Gln enema on the healing of colonic anastomosis in a rat model. METHODS Thirty Wistar albino rats were divided into three groups containing 10 rats each and were subjected to distal left colon transection and anastomosis. Postoperatively, group I (the control group) was administered no treatment, group II was administered daily placebo enemas containing physiological saline, and group III was administered daily 2% L-Gln enemas. After sacrifice on postoperative day 5, anastomotic healing, burst pressure, tissue hydroxyproline levels, and histological parameters were measured, and group values were compared via statistical analysis. RESULTS Group III was found to have the highest mean bursting pressure and tissue hydroxyproline levels and the lowest mean ischemia score. While the values of these parameters were not found to differ significantly among the groups, the lack of significance may have been due to the limited number of subjects examined. CONCLUSION Administration of a Gln enema may have a positive effect on anastomosis in terms of bursting pressure and histopathological parameters. Future research should examine administration of a preoperative Gln enema as a means of decreasing the traumatic effects of the enema and identifying its applicability in surgical practice.
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Affiliation(s)
- Mani Habibi
- Department of General Surgery, Esenler Maternity and Child Health Hospital, Istanbul, Turkey
| | - Osman Zekai Oner
- Department of General Surgery, Antalya Training and Research Hospital, Antalya, Turkey
| | - Mehmet Tahir Oruc
- Department of General Surgery, Antalya Training and Research Hospital, Antalya, Turkey
| | - Nurullah Bulbuller
- Department of General Surgery, Akdeniz University, School of Medicine, Antalya, Turkey
| | - Sebahat Ozdem
- Department of Biochemistry, Akdeniz University, School of Medicine, Antalya, Turkey
| | - Sukru Ozdemir
- Department of General Surgery, Karapınar State Hospital, Konya, Turkey
| | | | - Rojbin Karakoyun
- Department of General Surgery, Antalya Training and Research Hospital, Antalya, Turkey
| | - Ugur Dogan
- Department of General Surgery, Antalya Training and Research Hospital, Antalya, Turkey
| | - Ayper Ongen
- Department of General Surgery, Antalya Training and Research Hospital, Antalya, Turkey
| | - Umit Koc
- Department of General Surgery, Antalya Training and Research Hospital, Antalya, Turkey
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Baird JR, Friedman D, Cottam B, Dubensky TW, Kanne DB, Bambina S, Bahjat K, Crittenden MR, Gough MJ. Radiotherapy Combined with Novel STING-Targeting Oligonucleotides Results in Regression of Established Tumors. Cancer Res 2015; 76:50-61. [PMID: 26567136 DOI: 10.1158/0008-5472.can-14-3619] [Citation(s) in RCA: 195] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 09/23/2015] [Indexed: 12/25/2022]
Abstract
Cytotoxic therapies prime adaptive immune responses to cancer by stimulating the release of tumor-associated antigens. However, the tumor microenvironment into which these antigens are released is typically immunosuppressed, blunting the ability to initiate immune responses. Recently, activation of the DNA sensor molecule STING by cyclic dinucleotides was shown to stimulate infection-related inflammatory pathways in tumors. In this study, we report that the inflammatory pathways activated by STING ligands generate a powerful adjuvant activity for enhancing adaptive immune responses to tumor antigens released by radiotherapy. In a murine model of pancreatic cancer, we showed that combining CT-guided radiotherapy with a novel ligand of murine and human STING could synergize to control local and distant tumors. Mechanistic investigations revealed T-cell-independent and TNFα-dependent hemorrhagic necrosis at early times, followed by later CD8 T-cell-dependent control of residual disease. Clinically, STING was found to be expressed extensively in human pancreatic tumor and stromal cells. Our findings suggest that this novel STING ligand could offer a potent adjuvant for leveraging radiotherapeutic management of pancreatic cancer.
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Affiliation(s)
- Jason R Baird
- Earle A. Chiles Research Institute, Robert W. Franz Cancer Center, Providence Portland Medical Center, Portland, Oregon
| | - David Friedman
- Earle A. Chiles Research Institute, Robert W. Franz Cancer Center, Providence Portland Medical Center, Portland, Oregon
| | - Benjamin Cottam
- Earle A. Chiles Research Institute, Robert W. Franz Cancer Center, Providence Portland Medical Center, Portland, Oregon
| | | | | | - Shelly Bambina
- Earle A. Chiles Research Institute, Robert W. Franz Cancer Center, Providence Portland Medical Center, Portland, Oregon
| | - Keith Bahjat
- Earle A. Chiles Research Institute, Robert W. Franz Cancer Center, Providence Portland Medical Center, Portland, Oregon
| | - Marka R Crittenden
- Earle A. Chiles Research Institute, Robert W. Franz Cancer Center, Providence Portland Medical Center, Portland, Oregon. The Oregon Clinic, Portland, Oregon
| | - Michael J Gough
- Earle A. Chiles Research Institute, Robert W. Franz Cancer Center, Providence Portland Medical Center, Portland, Oregon.
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Development of an oral mucosa model to study host-microbiome interactions during wound healing. Appl Microbiol Biotechnol 2014; 98:6831-46. [PMID: 24917376 DOI: 10.1007/s00253-014-5841-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 05/14/2014] [Accepted: 05/16/2014] [Indexed: 12/22/2022]
Abstract
Crosstalk between the human host and its microbiota is reported to influence various diseases such as mucositis. Fundamental research in this area is however complicated by the time frame restrictions during which host-microbe interactions can be studied in vitro. The model proposed in this paper, consisting of an oral epithelium and biofilm, can be used to study microbe-host crosstalk in vitro in non-infectious conditions up to 72 h. Microbiota derived from oral swabs were cultured on an agar/mucin layer and challenged with monolayers of keratinocytes grown on plastic or collagen type I layers embedded with fibroblasts. The overall microbial biofilm composition in terms of diversity remained representative for the oral microbiome, whilst the epithelial cell morphology and viability were unaffected. Applying the model to investigate wound healing revealed a reduced healing of 30 % in the presence of microbiota, which was not caused by a reduction of the proliferation index (52.1-61.5) or a significantly increased number of apoptotic (1-1.13) or necrotic (32-30.5 %) cells. Since the model allows the separate study of the microbial and cellular exometabolome, the biofilm and epithelial characteristics after co-culturing, it is applicable for investigations within fundamental research and for the discovery and development of agents that promote wound healing.
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20
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The impact of the myeloid response to radiation therapy. Clin Dev Immunol 2013; 2013:281958. [PMID: 23653658 PMCID: PMC3638700 DOI: 10.1155/2013/281958] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 03/15/2013] [Accepted: 03/20/2013] [Indexed: 01/18/2023]
Abstract
Radiation therapy is showing potential as a partner for immunotherapies in preclinical cancer models and early clinical studies. As has been discussed elsewhere, radiation provides debulking, antigen and adjuvant release, and inflammatory targeting of effector cells to the treatment site, thereby assisting multiple critical checkpoints in antitumor adaptive immunity. Adaptive immunity is terminated by inflammatory resolution, an active process which ensures that inflammatory damage is repaired and tissue function is restored. We discuss how radiation therapy similarly triggers inflammation followed by repair, the consequences to adaptive immune responses in the treatment site, and how the myeloid response to radiation may impact immunotherapies designed to improve control of residual cancer cells.
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Scales BS, Huffnagle GB. The microbiome in wound repair and tissue fibrosis. J Pathol 2013; 229:323-31. [PMID: 23042513 PMCID: PMC3631561 DOI: 10.1002/path.4118] [Citation(s) in RCA: 100] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 09/22/2012] [Accepted: 09/24/2012] [Indexed: 02/06/2023]
Abstract
Bacterial colonization occurs in all wounds, chronic or acute, and the break in epithelium integrity that defines a wound impairs the forces that shape and constrain the microbiome at that site. This review highlights the interactions between bacterial communities in the wound and the ultimate resolution of the wound or development of fibrotic lesions. Chronic wounds support complex microbial communities comprising a wide variety of bacterial phyla, genera, and species, including some fastidious anaerobic bacteria not identified using culture-based methods. Thus, the complexity of bacterial communities in wounds has historically been underestimated. There are a number of intriguing possibilities to explain these results that may also provide novel insights into changes and adaptation of bacterial metabolic networks in inflamed and wounded mucosa, including the critical role of biofilm formation. It is well accepted that the heightened state of activation of host cells in a wound that is driven by the microbiota can certainly lead to detrimental effects on wound regeneration, but the microbiota of the wound may also have beneficial effects on wound healing. Studies in experimental systems have clearly demonstrated a beneficial effect for members of the gut microbiota on regulation of systemic inflammation, which could also impact wound healing at sites outside the gastrointestinal tract. The utilization of culture-independent microbiology to characterize the microbiome of wounds and surrounding mucosa has raised many intriguing questions regarding previously held notions about the cause and effect relationships between bacterial colonization and wound repair and mechanisms involved in this symbiotic relationship.
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Affiliation(s)
- Brittan S. Scales
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Gary B. Huffnagle
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, Michigan
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
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Holmes C, Wrobel JS, MacEachern MP, Boles BR. Collagen-based wound dressings for the treatment of diabetes-related foot ulcers: a systematic review. Diabetes Metab Syndr Obes 2013; 6:17-29. [PMID: 23357897 PMCID: PMC3555551 DOI: 10.2147/dmso.s36024] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Diabetic foot ulcers are a major source of morbidity, limb loss, and mortality. A prolonged inflammatory response, extracellular matrix degradation irregularities, and increased bacteria presence have all been hypothesized as major contributing factors in the delayed healing of diabetic wounds. Collagen components such as fibroblast and keratinocytes are fundamental to the process of wound healing and skin formation. Wound dressings that contain collagen products create a biological scaffold matrix that supports the regulation of extracellular components and promotes wound healing. METHODS A systematic review of studies reporting collagen wound dressings used in the treatment of Diabetic foot ulcers was conducted. Comprehensive searches were run in Ovid MEDLINE, PubMed, EMBASE, and ISI Web of Science to capture citations pertaining to the use of collagen wound dressings in the treatment of diabetic foot ulcers. The searches were limited to human studies reported in English. RESULTS Using our search strategy, 26 papers were discussed, and included 13 randomized designs, twelve prospective cohorts, and one retrospective cohort, representing 2386 patients with diabetic foot ulcers. Our design was not a formal meta-analysis. In those studies where complete epithelialization, 58% of collagen-treated wounds completely healed (weighted mean 67%). Only 23% of studies reported control group healing with 29% healing (weighted mean 11%) described for controls. CONCLUSION Collagen-based wound dressings can be an effective tool in the healing of diabetic foot wounds. The current studies show an overall increase in healing rates despite limitations in study designs. This study suggests that future works focus on biofilms and extracellular regulation, and include high risk patients.
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Affiliation(s)
- Crystal Holmes
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
- Correspondence: Crystal Holmes, The University of Michigan, Department of Internal Medicine, Dominos Farms (Lobby C, Suite 1300), 24 Frank Lloyd, Wright Drive, PO Box 451, Ann Arbor, MI 48106-0451, USA, Tel +1 734 647 5400, Fax +1 734 647 2145, Email
| | - James S Wrobel
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Mark P MacEachern
- A Alfred Taubman Health Sciences Library, University of Michigan, Ann Arbor, MI, USA
| | - Blaise R Boles
- Department of Molecular, Cellular, and Developmental Biology, University of Michigan, Ann Arbor, MI, USA
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Microbiology of explanted suture segments from infected and noninfected surgical patients. J Clin Microbiol 2012; 51:417-21. [PMID: 23175247 DOI: 10.1128/jcm.02442-12] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Sutures under selective host/environmental factors can potentiate postoperative surgical site infection (SSI). The present investigation characterized microbial recovery and biofilm formation from explanted absorbable (AB) and nonabsorbable (NAB) sutures from infected and noninfected sites. AB and NAB sutures were harvested from noninfected (70.9%) and infected (29.1%) sites in 158 patients. At explantation, devices were sonicated and processed for qualitative/quantitative bacteriology; selective sutures were processed for scanning electron microscopy (SEM). Bacteria were recovered from 85 (53.8%) explanted sites; 39 sites were noninfected, and 46 were infected. Suture recovery ranged from 11.1 to 574.6 days postinsertion. A significant difference in mean microbial recovery between noninfected (1.2 isolates) and infected (2.7 isolates) devices (P < 0.05) was noted. Staphylococcus epidermidis, Staphylococcus aureus, coagulase-negative staphylococci (CNS), Peptostreptococcus spp., Bacteroides fragilis, Escherichia coli, Enterococcus spp., Pseudomonas aeruginosa, and Serratia spp. were recovered from infected devices, while commensal skin flora was recovered from noninfected devices. No significant difference in quantitative microbial recovery between infected monofilament and multifilament sutures was noted. Biofilm was present in 100% and 66.6% of infected and noninfected devices, respectively (P < 0.042). We conclude that both monofilament and braided sutures provide a hospitable surface for microbial adherence: (i) a significant difference in microbial recovery from infected and noninfected sutures was noted, (ii) infected sutures harbored a mixed flora, including multidrug-resistant health care-associated pathogens, and (iii) a significant difference in the presence or absence of a biofilm in infected versus noninfected explanted devices was noted. Further studies to document the benefit of focused risk reduction strategies to minimize suture contamination and biofilm formation postimplantation are warranted.
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Kanno E, Kawakami K, Ritsu M, Ishii K, Tanno H, Toriyabe S, Imai Y, Maruyama R, Tachi M. Wound healing in skin promoted by inoculation with Pseudomonas aeruginosa PAO1: The critical role of tumor necrosis factor-α secreted from infiltrating neutrophils. Wound Repair Regen 2012; 19:608-21. [PMID: 22092799 DOI: 10.1111/j.1524-475x.2011.00721.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Wound healing is promoted by the presence of replicating microorganisms adhering to the wounded tissue, but the precise mechanism is not fully understood. In the present study, using a rat model with full-thickness dermal wounds, we examined the effect of Pseudomonas aeruginosa inoculation on wound healing and the role of neutrophils infiltrating the wound site. Within 3 days, inoculation with this bacterium had accelerated re-epithelialization, epidermal cell proliferation, and neo-vascularization, as well as the local infiltration of neutrophils, which reached a peak at 24 hours. Tumor necrosis factor (TNF)-α was detected in the wound tissues on the mRNA and protein levels within 24 hours. Flow cytometry and immunohistochemical analyses detected higher levels of TNF-α in the infiltrating neutrophils in rats inoculated with P. aeruginosa than in uninoculated rats. Neutropenic rats treated with anti-neutrophil mAb or cyclophosphamide exhibited significant attenuation in re-epithelialization, epidermal cell proliferation, neo-vascularization, and TNF-α synthesis compared with control; administration of TNF-α reversed these attenuations. These wound-healing responses were decelerated in rats treated with anti-TNF-α mAb, as was the infiltration of neutrophils. These results indicate that inoculation with P. aeruginosa promotes wound healing by inducing the infiltration of neutrophils, which play a critical role as a major source of TNF-α.
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Affiliation(s)
- Emi Kanno
- Department of Science of Nursing Practice, Tohoku University Graduate School of Medicine, Sendai, Japan
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Amsellem P. Complications of Reconstructive Surgery in Companion Animals. Vet Clin North Am Small Anim Pract 2011; 41:995-1006. vii. [DOI: 10.1016/j.cvsm.2011.05.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Eskan MA, Greenwell H. Theoretical and Clinical Considerations for Autologous Blood Preparations: Platelet-Rich Plasma, Fibrin Sealants, and Plasma-Rich Growth Factors. Clin Adv Periodontics 2011. [DOI: 10.1902/cap.2011.110034] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Patel PV, Kumar V, Kumar S, Gd V, Patel A. Therapeutic effect of topical ozonated oil on the epithelial healing of palatal wound sites: a planimetrical and cytological study. ACTA ACUST UNITED AC 2011; 2:248-58. [PMID: 25426896 DOI: 10.1111/j.2041-1626.2011.00072.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Punit Vaibhav Patel
- Department of Periodontology, Jagadguru Sri Shivarathreeshwara Dental College and Hospital (JSS University), Mysore, Karnataka, India Department of Oral Pathology and Microbiology, Jagadguru Sri Shivarathreeshwara Dental College and Hospital (JSS University), Mysore, Karnataka, India Kalindi Oro Care, Varanasi, Uttar Pradesh, India
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Olugbuyiro JAO, Abo KA, Leigh OO. Wound healing effect of Flabellaria paniculata leaf extracts. JOURNAL OF ETHNOPHARMACOLOGY 2010; 127:786-788. [PMID: 19833182 DOI: 10.1016/j.jep.2009.10.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2009] [Revised: 09/27/2009] [Accepted: 10/06/2009] [Indexed: 05/28/2023]
Abstract
AIM OF THE STUDY This study evaluated wound healing activity of the chloroform and aqueous fractions of the methanolic extract of Flabellaria paniculata leaf on infected wounds in rats as a follow up to an initial study of the crude extract. MATERIALS AND METHODS Wounds were inflicted on Wistar rats using excision model. Local infection was introduced into rat abdominal wounds with Staphylococcus aureus and Pseudomonas aeruginosa using a 10(8)cells/ml inoculum. Rate of wound healing was assessed by contraction and period of epithelization. RESULTS Chloroform fraction exhibited significant wound healing potency (p<0.05) as compared with controls. The test drug achieved 100% wound contraction on day 14 in non-infected group, on day 16 in Staphylococcus aureus infected group and on day 18 in Pseudomonas aeruginosa group. CONCLUSIONS Chloroform extract of Flabellaria paniculata proves to be a potential anti-infective and wound healing agent. Its in vitro antibacterial and in vivo wound healing activities are in good agreement with the local medicinal use of the plant for skin diseases and sores.
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Abstract
Because burns destroy the barrier against invading bacteria, topical antimicrobial agents have been developed to minimize the proliferation of bacteria and other microorganisms. The topical treatment depends on the depth of burns. The goal for superficial burns is to optimize re-epithelialization. For deep burns, topical antimicrobial agents should be used to minimize microbial growth until the wound is grafted. This article introduces a strategy for the rational use of these agents.
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Affiliation(s)
- David G Greenhalgh
- Shriners Hospitals for Children Northern California, Department of Surgery, University of California, Davis, Sacramento, 95817, USA.
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Gabriel A, Shores J, Bernstein B, De Leon J, Kamepalli R, Wolvos T, Baharestani MM, Gupta S. A clinical review of infected wound treatment with Vacuum Assisted Closure (V.A.C.) therapy: experience and case series. Int Wound J 2009; 6 Suppl 2:1-25. [PMID: 19811550 PMCID: PMC7951685 DOI: 10.1111/j.1742-481x.2009.00628.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Over the last decade Vacuum Assisted Closure((R)) (KCI Licensing, Inc., San Antonio, TX) has been established as an effective wound care modality for managing complex acute and chronic wounds. The therapy has been widely adopted by many institutions to treat a variety of wound types. Increasingly, the therapy is being used to manage infected and critically colonized, difficult-to-treat wounds. This growing interest coupled with practitioner uncertainty in using the therapy in the presence of infection prompted the convening of an interprofessional expert advisory panel to determine appropriate use of the different modalities of negative pressure wound therapy (NPWT) as delivered by V.A.C.((R)) Therapy and V.A.C. Instill((R)) with either GranuFoam() or GranuFoam Silver() Dressings. The panel reviewed infected wound treatment methods within the context of evidence-based medicine coupled with experiential insight using V.A.C.((R)) Therapy Systems to manage a variety of infected wounds. The primary objectives of the panel were 1) to exchange state-of-practice evidence, 2) to review and evaluate the strength of existing data, and 3) to develop practice recommendations based on published evidence and clinical experience regarding use of the V.A.C.((R)) Therapy Systems in infected wounds. These recommendations are meant to identify which infected wounds will benefit from the most appropriate V.A.C.((R)) Therapy System modality and provide an infected wound treatment algorithm that may lead to a better understanding of optimal treatment strategies.
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Affiliation(s)
- Allen Gabriel
- A Gabriel, MD, The Department of Plastic Surgery, Loma Linda University School of Medicine, Loma Linda, CA
| | - Jaimie Shores
- J Shores, MD, The Department of Plastic Surgery, Loma Linda University School of Medicine, Loma Linda, CA
| | | | - Jean De Leon
- J de Leon, MD, Baylor Specialty Hospital, Dallas, TX
| | - Ravi Kamepalli
- R. Kamepalli, MD, Regional Infectious Diseases‐Infusion Center, Lima, OH
| | - Tom Wolvos
- T Wolvos, MS, MD, FACS, Scottsdale Healthcare Hospitals, Scottsdale, AZ
| | - Mona M Baharestani
- MM Baharestani, PhD, ANP, CWON, CWS, East Tennessee State University and the James H. Quillen Veterans Affairs Medical Center, Johnson City, TN
| | - Subhas Gupta
- S Gupta, MD, PhD, FRCSC, FACS, The Department of Plastic Surgery, Loma Linda University School of Medicine, Loma Linda, CA
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Weaver KN, Alfano SE, Kronquist AR, Reeder DM. Healing Rates of Wing Punch Wounds in Free-Ranging Little Brown Myotis (Myotis lucifugus). ACTA CHIROPTEROLOGICA 2009. [DOI: 10.3161/150811009x465866] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Sucullu I, Akin ML, Yitgin S, Filiz AI, Kurt Y. Resterilized mesh in repair of abdominal wall defects in rats. J INVEST SURG 2008; 21:171-6. [PMID: 18615313 DOI: 10.1080/08941930802130115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
A variety of negative opinions about repeated usage of relatively expensive resterilized synthetic meshes have been considered. It had been stated that resterilized polypropylene meshes inhibits fibroblastic activity, decreases proliferative activity, and increases apoptosis in human fibroblast culture, in vitro. The purpose of this study is the in vivo evaluation of the resterilized mesh repairs of abdominal hernia defects in rat models of incisional hernia by comparing primer repair and original mesh repairs. The rats (n = 22) were separated into three groups. While the abdominal defect was repaired by primary suture in the control group (CG), the defects were repaired by original mesh (OG) or resterilized mesh (RG) in mesh-repaired groups. After 21 days, the rats were evaluated for tissue tensile strengths, tissue hydroxyproline levels, tissue inflammation, fibrosis, and apoptosis. Although the tensile strengths in OG and RG were significantly higher than those of CG (p < .05 and p < .05), there was no significant difference between two groups. The tissue hydroxyproline levels in OG and RG were also higher than those of CG. The difference was not significant between the two groups. The inflammation and fibrosis indexes in OG and RG were significantly higher than those of CG (p < .0001 for both), but there was no difference between groups. While the apoptosis index in OG and RG was also higher than that of CG (p < .0001 for both), there was no significant difference between OG and RG. The usage of resterilized mesh in abdominal wall repair did not reduce the tissue tensile strength, did not affect the tissue hydroxyproline levels, did not decrease the fibrosis, and did not increase the tissue inflammation and apoptosis. In conclusion, usage of resterilized meshes in abdominal wall defects was as safe as sterilized meshes.
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Affiliation(s)
- Ilker Sucullu
- General Surgery, Gulhane Military Medical Faculty Haydarpasa Training Hospital, Istanbul, Turkey
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33
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Management of skin ulcers: understanding the mechanism and selection of enzymatic debriding agents. Adv Skin Wound Care 2008; 21:72-4. [PMID: 18349733 DOI: 10.1097/01.asw.0000305418.96467.e9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Yol S, Tekin A, Yilmaz H, Küçükkartallar T, Esen H, Caglayan O, Tatkan Y. Effects of platelet rich plasma on colonic anastomosis. J Surg Res 2007; 146:190-4. [PMID: 18028949 DOI: 10.1016/j.jss.2007.05.015] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2007] [Revised: 04/30/2007] [Accepted: 05/01/2007] [Indexed: 12/12/2022]
Abstract
PURPOSE To investigate the effect of platelet-rich plasma (PRP) on tissue maturation and wound healing in experimental colonic anastomosis. MATERIALS AND METHODS Thirty Sprague Dawley rats were divided into three groups of 10 rats each. Group I (control group) was subjected to colon anastomosis only. Group II (PRP group) was subjected to colon anastomosis and topical PRP was applied. Group III (Bioglue group) was subjected to colon anastomosis and topical tissue sealant was applied (Bioglue; Cryolife, Kennesaw, GA). The rats were sacrificed on postoperative day 7, and the bursting pressure of the anastomosis and tissue hydroxyproline levels were measured; histopathological changes on the anastomosis line were also examined. RESULTS The bursting pressure was statistically higher in the PRP group than in the control and Bioglue groups (P < 0.05). The hydroxyproline levels were also statistically higher in the PRP group than in the control and Bioglue groups (P < 0.05). Histopathologically, there was less inflammatory cell infiltration, intensive fibroblast development, and rich collagen production in the PRP group. CONCLUSION PRP may be used in colon anastomosis, especially in patients with impaired wound healing, to obtain a better anastomotic strength.
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Affiliation(s)
- Serdar Yol
- Department of General Surgery, Selcuk University Meram Medical Faculty, Meram/Konya, Turkey
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35
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Kozlovsky A, Artzi Z, Hirshberg A, Israeli-Tobias C, Reich L. Effect of local antimicrobial agents on excisional palatal wound healing: a clinical and histomorphometric study in rats. J Clin Periodontol 2007; 34:164-71. [PMID: 17309591 DOI: 10.1111/j.1600-051x.2006.01033.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM To assess the effect of topically applied antimicrobial agents on palatal excisional wound in rats. MATERIALS AND METHODS Excisional wounds, 5 mm in diameter, were made in the centre of the palate of 125 Wistar male rats. In four experimental groups, chlorhexidine digluconate (CHX) 0.12% solution, 1% CHX gel, phenolic compounds solution (Listerine), amine/stannous fluoride solution (Meridol) and saline solution as a control group were applied daily for 1 min. The wound area was measured photographically and the epithelialization rate was determined histologically at 3, 7, 14 and 21 days post-surgery. RESULTS The mean wound area and mean distance between the epithelial margins decreased significantly with time (p<0.001) in experimental and control groups, with the greatest wound area reduction and rate of epithelialization on day 14. A significantly superior rate of wound epithelialization (p=0.03) was presented following use of 1% CHX gel and Listerine and a comparatively inferior one when the Meridol solution was applied. CONCLUSIONS Each tested antimicrobial agent when applied on an excisional wound with epithelial and connective tissue deficiency did not have a negative effect on the rate of wound closure. The best results were achieved with 1%CHX gel and Listerine.
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Affiliation(s)
- Avital Kozlovsky
- Department of Periodontology, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel.
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36
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Affiliation(s)
- Cynthia A Fleck
- Advanced Wound Care Division, Medline Industries, Mundelein, IL, USA.
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37
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Frykberg RG, Zgonis T, Armstrong DG, Driver VR, Giurini JM, Kravitz SR, Landsman AS, Lavery LA, Moore JC, Schuberth JM, Wukich DK, Andersen C, Vanore JV. Diabetic foot disorders. A clinical practice guideline (2006 revision). J Foot Ankle Surg 2006; 45:S1-66. [PMID: 17280936 DOI: 10.1016/s1067-2516(07)60001-5] [Citation(s) in RCA: 466] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The prevalence of diabetes mellitus is growing at epidemic proportions in the United States and worldwide. Most alarming is the steady increase in type 2 diabetes, especially among young and obese people. An estimated 7% of the US population has diabetes, and because of the increased longevity of this population, diabetes-associated complications are expected to rise in prevalence. Foot ulcerations, infections, Charcot neuroarthropathy, and peripheral arterial disease frequently result in gangrene and lower limb amputation. Consequently, foot disorders are leading causes of hospitalization for persons with diabetes and account for billion-dollar expenditures annually in the US. Although not all foot complications can be prevented, dramatic reductions in frequency have been achieved by taking a multidisciplinary approach to patient management. Using this concept, the authors present a clinical practice guideline for diabetic foot disorders based on currently available evidence, committee consensus, and current clinical practice. The pathophysiology and treatment of diabetic foot ulcers, infections, and the diabetic Charcot foot are reviewed. While these guidelines cannot and should not dictate the care of all affected patients, they provide evidence-based guidance for general patterns of practice. If these concepts are embraced and incorporated into patient management protocols, a major reduction in diabetic limb amputations is certainly an attainable goal.
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Affiliation(s)
- Robert G Frykberg
- Podiatric Surgery, Carl T. Hayden VA Medical Center, Phoenix, Arizona 85012, USA.
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Abstract
Management of chronic wounds has progressed from merely assessing the status of a wound to understanding the underlying molecular and cellular abnormalities that prevent the wound from healing. The concept of wound bed preparation has simultaneously evolved to provide a systematic approach to removing these barriers to natural healing and enhancing the effects of advanced therapies. This brief review of wound bed preparation traces the development of these concepts and explains how to apply systematic wound management using the TIME acronym - tissue (non viable or deficient), infection/inflammation, moisture (imbalance) and edge (non advancing or undermined).
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Affiliation(s)
- Gregory S Schultz
- Department Obstetrics and Gynecology, University of Florida, gainesville, FL 32610-0294, USA.
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Dogmuş M, Ersoy E, Anadol AZ, Ozel U, Bilgehan A. Effect of calcitonin gene-related peptide on anastomotic healing in the presence of endotoxin. ANZ J Surg 2006; 75:1106-10. [PMID: 16398820 DOI: 10.1111/j.1445-2197.2005.03616.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Intestinal anastomotic healing is a complex procedure in which several mediators, cytokines and other substances play roles, as well as calcitonin gene-related peptide (CGRP). CGRP is capable of stimulating DNA synthesis and cell proliferation in endothelial cells by increasing vasodilatation and inflammatory response and promoting epithelial, vascular and mesothelial cell proliferation. This study was undertaken to investigate whether CGRP has a beneficial effect on intestinal anastomotic healing, even in septic conditions. METHODS Four groups of 10 rats were administered normal saline (0.5 mL), lipopolysaccharide (LPS) (0.5 mg/kg), CGRP (0.5 mL 6.5 x 10(-10) mol/L) and LPS + CGRP (0.5 mg/kg + 0.5 mL 6.5 x 10(-10) mol/L) via intraperitoneal route, respectively, 24 h prior to operation and postoperatively. All rats underwent ileo-ileal end-to-end anastomosis. Anastomotic bursting pressure and tissue hydroxyproline levels were measured on postoperative day 7. RESULTS Calcitonin gene-related peptide was found to have positive effects on both parameters of healing. The LPS-injected group showed intestinal anastomotic healing disorder suggesting impaired collagen production, which showed improvement after CGRP administration. CONCLUSIONS Calcitonin gene-related peptide increases anastomotic wound healing in experimental intestinal anastomosis in the presence of endotoxin.
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Affiliation(s)
- Mehmet Dogmuş
- Department of Surgery, School of Medicine, Gazi University, Ankara, Turkey
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40
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Affiliation(s)
- David G Greenhalgh
- Shriners Hospitals for Children-Northern California, Sacramento, CA 95817, USA
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41
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Vincent JL, De Backer D. Does Disseminated Intravascular Coagulation Lead to Multiple Organ Failure? Crit Care Clin 2005; 21:469-77. [PMID: 15992668 DOI: 10.1016/j.ccc.2005.04.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Microvascular dysfunction with its associated impaired regional oxygen transport and use is believed to be the final common pathway in the development of multiple organ failure. The precise mechanisms underlying this dysfunction, however, are uncertain. Activation of the coagulation system is a key feature in the pathogenesis of sepsis, but whether it is also the cause of multiple organ failure is unclear. This article discusses the evidence for and against a key role for disseminated intravascular coagulation in the pathogenesis of multiple organ failure.
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Affiliation(s)
- Jean-Louis Vincent
- Department of Intensive Care, Erasme University Hospital, Free University of Brussels, Route de Lennik 808, Brussels 1070, Belgium.
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42
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Abstract
Chronic wounds are a challenge to treat for the clinician. We present a current overview of intrinsic and extrinsic factors in the development chronic nonhealing wounds. Solutions to some of these difficult problems are presented.
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Affiliation(s)
- Kouros Izadi
- Division of Plastic Surgery, Department of Surgery, New Jersey Medical School-UMDNJ, Newark, 07103, USA.
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43
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Penhallow K. A review of studies that examine the impact of infection on the normal wound-healing process. J Wound Care 2005; 14:123-6. [PMID: 15779643 DOI: 10.12968/jowc.2005.14.3.26747] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Wound infection disrupts the normal healing process, although to what extent is not proven. This review explores controversies in the literature surrounding the bacterial load of the chronic wound and its impact, if any, on this process.
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Affiliation(s)
- K Penhallow
- Worthing and Southlands Hospitals NHS Trust, UK.
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44
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Abstract
The acute inflammatory response to sepsis gives rise to significant morbidity and mortality. The mechanisms underlying this form of tissue injury are poorly understood. This review examines the evidence that tissue ischaemia due, to generalized microvascular thrombosis may play an important role. Microvascular thrombosis is probably an adaptive response that prevents bacteria in the tissues reaching the systemic circulation via the capillaries. In time, a definitive response by leucocytes removes the bacteria and repairs the damaged tissues. There is however evidence that if microvascular thrombosis becomes generalized, then extensive tissue ischaemia may precipitate organ failure and death. Post-mortem studies of patients with sepsis demonstrate microvascular thrombi in many organs including the kidney, liver, lung, gut, adrenals and brain, and the degree of organ injury is related to the quantity of thrombi. Furthermore studies in human and animal models of sepsis demonstrate therapies that inhibit coagulation or promote fibrinolysis reduce organ failure and mortality. In view of the personal and economic burdens that tissue injury associated with the acute inflammatory response places on the community, further studies to establish the role of microvascular thrombosis are clearly required. Such studies may lead to new therapies to limit or prevent this form of injury.
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Affiliation(s)
- B Dixon
- Intensive Care Centre, St Vincent's Hospital, Melbourne, Victoria
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45
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Abstract
PURPOSE OF REVIEW Wound healing is a complex process with many potential factors that can delay healing. There is increasing interest in the effects of bacteria on the processes of wound healing. All chronic wounds are colonized by bacteria, with low levels of bacteria being beneficial to the wound healing process. Wound infection is detrimental to wound healing, but the diagnosis and management of wound infection is controversial, and varies between clinicians. RECENT FINDINGS There is increasing recognition of the concept of critical colonization or local infection, when wound healing may be delayed in the absence of the typical clinical features of infection. The progression from wound colonization to infection depends not only on the bacterial count or the species present, but also on the host immune response, the number of different species present, the virulence of the organisms and synergistic interactions between the different species. There is increasing evidence that bacteria within chronic wounds live within biofilm communities, in which the bacteria are protected from host defences and develop resistance to antibiotic treatment. SUMMARY An appreciation of the factors affecting the progression from colonization to infection can help clinicians with the interpretation of clinical findings and microbiological investigations in patients with chronic wounds. An understanding of the physiology and interactions within multi-species biofilms may aid the development of more effective methods of treating infected and poorly healing wounds. The emergence of consensus guidelines has helped to optimize clinical management.
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Affiliation(s)
- Ruth Edwards
- Wound Healing Research Unit, University of Wales College of Medicine, Cardiff, UK.
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46
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Ritchie BW, Wooley RE, Kemp DT. Use of potentiated antibiotics in wound management. Vet Clin North Am Exot Anim Pract 2004; 7:169-89, vii. [PMID: 14768385 DOI: 10.1016/j.cvex.2003.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
Prevention or resolution of microbial colonization of wounds is critical to rapid and uneventful healing. The use and misuse of antimicrobial agents continues to support the evolution of multidrug resistant organisms that can cause severe or life-threatening infections. Chelating agents have been shown to potentiate the effects of antimicrobial compounds. The third generation chelating agent. Tricide has been shown to be effective against many multidrug resistant pathogens, prevents pathogens from development resistance to the antimicrobials with which it is mixed and substantially reduces the amount of antimicrobials needed to kill bacteria and fungi.
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Affiliation(s)
- Branson W Ritchie
- Departments of Small Animal Medicine and Medical Microbiology and Parasitology, University of Georgia, College of Veterinary Medicine, Athens, GA 30602, USA.
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47
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Storch M, Perry LC, Davidson JM, Ward JJ. A 28-day study of the effect of Coated VICRYL* Plus Antibacterial Suture (coated polyglactin 910 suture with triclosan) on wound healing in guinea pig linear incisional skin wounds. Surg Infect (Larchmt) 2003; 3 Suppl 1:S89-98. [PMID: 12573043 DOI: 10.1089/sur.2002.3.s1-89] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This study evaluated the effect of coated polyglactin 910 suture with triclosan on tissue response and wound healing over a 28-day period on full-thickness linear wounds in the hairless guinea pig model. METHODS In situ wound strength was assessed, and histopathologic effects on tissue response and wound healing were evaluated. Four (1.9 cm) full-thickness incisional wounds were created on the dorsolateral region (two left and two right, approximately 3 cm apart) in 40 Hartley male hairless guinea pigs (400-500 g). A 1.9-cm segment of suture material was implanted "length-wise" into the incision and the sites closed with simple interrupted closure with 3-0 nylon sutures. The test material was 2-0 coated polyglactin 910 suture with triclosan and the control material was 2-0 Coated VICRYL* Suture (coated polyglactin 910 suture). On days 3, 7, 14, and 28 postimplantation (n = 10/time interval), body weights were recorded, tissue specimens harvested, and bursting strength testing performed. RESULTS There was no significant difference (P > 0.05) in bursting strength between the study groups for any of the time intervals studied. The bursting strengths (mm Hg) for the sutures with triclosan were 95.8 (day 3), 268.8 (day 7), 542.6 (day 14), and 633.8 (day 28). Both materials demonstrated comparable tissue response to implantation, and there were no significant differences (P > 0.05) observed in wound healing based on cellular response and collagen formation and orientation. CONCLUSION Based on the in vivo biomechanical testing and histological results, no evidence of impedance to wound healing was detected.
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Affiliation(s)
- Mark Storch
- Ethicon, Inc, Somerville, New Jersey 08878, USA.
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48
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Storch M, Perry LC, Davidson JM, Ward JJ. A 28-Day Study of the Effect of Coated VICRYL* Plus Antibacterial Suture (Coated Polyglactin 910 Suture with Triclosan) on Wound Healing in Guinea Pig Linear Incisional Skin Wounds. Surg Infect (Larchmt) 2002. [DOI: 10.1089/10962960260496370] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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49
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Abstract
The relatively modern concept of wound-bed preparation draws together elements of current practice, including various methods of 'maintenance debridement' and the use of antibiotics and antiseptic agents, to speed up healing of chronic wounds.
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Affiliation(s)
- M Romanelli
- Wound Healing Unit, Department of Dermatology, University of Pisa, Pisa, Italy.
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50
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Singer AJ, Quinn JV, Thode HC, Hollander JE. Determinants of poor outcome after laceration and surgical incision repair. Plast Reconstr Surg 2002; 110:429-35; discussion 436-7. [PMID: 12142655 DOI: 10.1097/00006534-200208000-00008] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The most important outcomes after repair of traumatic lacerations and surgical incisions are their long-term cosmetic appearance and development of infection. However, few studies have attempted to identify patient and wound characteristics associated with increased infection rates and suboptimal scar appearance. The authors determined patient and wound characteristics associated with wound infection or suboptimal appearance after laceration or incision repair. A secondary analysis of data collected from a multicenter randomized clinical trial comparing the outcome of lacerations and incisions closed with tissue adhesive or standard closure methods conducted at 10 clinical inpatient and outpatient sites was performed. The presence of infection and scar appearance were prospectively determined using validated outcomes. Univariate and multivariate analyses were performed to identify patient and wound characteristics associated with poor wound outcome (wound infection at 5 to 10 days or suboptimal appearance at 3 months). Eight hundred fourteen patients with 924 wounds (383 lacerations, 541 incisions) were enrolled. Mean age was 32 years and 47 percent were female. Characteristics associated with suboptimal cosmetic appearance on multivariate analysis were presence of associated tissue trauma [odds ratio (OR), 3.9; 95 percent confidence interval (CI), 1.4 to 10.7], use of electrocautery (OR, 3.4; 95 percent CI, 1.8 to 6.5), incomplete wound edge apposition (OR, 2.9; 95 percent CI, 1.7 to 5.0); extremity location (OR, 2.1; 95 percent CI, 1.2 to 3.7), and wound width (OR, 1.08; 95 percent CI, 1.01 to 1.14). Characteristics associated with wound infection on univariate analysis included associated tissue trauma (8.7 percent versus 1.2 percent, p = 0.04) and incomplete wound apposition (6.6 percent versus 0.5 percent). Suboptimal appearance was more common in infected wounds (relative risk, 3.2; 95 percent CI, 1.8 to 5.6). Suboptimal wound appearance is increased with extremity wounds, wide wounds, incompletely apposed wounds, associated tissue trauma, use of electrocautery, and infection. Type of closure device and use of deep sutures had no effect on infection rates or cosmetic appearance.
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Affiliation(s)
- Adam J Singer
- Department of Emergency Medicine, University Hospital and Medical Center, State University of New York, Stony Brook 11794-7400, USA.
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