Search results for: incision wound

Authors: Kingkan Chumjamras

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There are permanent and temporary tracheostomies, and in a permanent tracheostomy, care giver are important persons to know and be able to care for the tracheostomy patient. The objective of this quasi-experimental study was to evaluate outcomes of educating care giver in tracheostomy wound care for discharge planning of tracheostomy patients. The subjects of the study were relatives who directly cared for tracheostomy patients. Thirty subjects were selected according to specified criteria. The research instruments consisted of practice guidelines, manual for relatives in caring for the tracheostomy wound, an assisted model with a tracheostomy wound, a test, an observation form, and a patient’s relative satisfaction questionnaire. The instrument validity was tested by three experts, and the questionnaire reliability was tested with Cronbach’s alpha, and the reliability coefficient was 0.83; the data were analyzed using descriptive statistics, and paired t-test. The results of the study on educating relatives in tracheostomy wound care for discharge planning of tracheostomy patients revealed that the score for knowledge and ability in caring for the tracheostomy wound before receiving the education was at a low level (M= 19.23, SD= 1.57) compared with the very high score (M= 36.40, SD= 19.23) after receiving the education. The difference was statistically significant (p < .05), and relatives’ satisfaction was at a high level (80 percent). Knowledge and ability in caring for tracheostomy patients among patients’ relatives could cause tracheostomy wound complications for tracheostomy patients. One way to control such complications and returns to hospital from infection, in addition to care by the health care team, is educating relatives in tracheostomy wound care for discharge planning of tracheostomy patients.

Keywords: outcomes, educating, care giver, Tracheostomy Wound Care, discharge planning

Procedia PDF Downloads 402

Authors: Beom-Seok Ko, Yoo-Seok Kim, Woo-Sung Lim, Ku-Sang Kim, Hyun-Ah Kim, Jin-Sun Lee, An-Bok Lee, Jin-Gu Bong, Tae-Hyun Kim, Sei-Hyun Ahn

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Background: Breast conserving surgery (BCS) followed by radiation therapy is today standard therapy for early breast cancer. It is safe therapeutic procedure in early breast cancers, because it provides the same level of overall survival as mastectomy. There are a number of different types of incisions used to BCS. Avoiding scars on the breast is women’s desire. Numerous minimal approaches have evolved due to this concern. Periareolar incision is often used when the small tumor relatively close to the nipple. But periareolar incision has a disadvantages include limited exposure of the surgical field. In plastic surgery, various methods such as zigzag incisions have been recommended to achieve satisfactory esthetic results. Periareolar zigzag incision has the advantage of not only good surgical field but also contributed to better surgical scars. The purpose of this study was to evaluate the oncological safety of procedures by studying the status of the surgical margins of the excised tumor specimen and reduces the need for further surgery. Methods: Between January 2016 and September 2016, 148 women with breast cancer underwent BCS or mastectomy by the same surgeon in ASAN medical center. Patients with exclusion criteria were excluded from this study if they had a bilateral breast cancer or underwent resection of the other tumors or taken axillary dissection or performed other incision methods. Periareolar zigzag incision was performed and excision margins of the specimen were identified frozen sections and paraffin-embedded or permanent sections in all patients in this study. We retrospectively analyzed tumor characteristics, the operative time, size of specimen, the distance from the tumor to nipple. Results: A total of 148 patients were reviewed, 72 included in the final analysis, 76 excluded. The mean age of the patients was 52.6 (range 25-19 years), median tumor size was 1.6 cm (range, 0.2-8.8), median tumor distance from the nipple was 4.0 cm (range, 1.0-9.0), median excised specimen sized was 5.1 cm (range, 2.8-15.0), median operation time was 70.0 minute (range, 39-138). All patients were discharged with no sign of infection or skin necrosis. Free resection margin was confirmed by frozen biopsy and permanent biopsy in all samples. There were no patients underwent reoperation. Conclusions: We suggest that periareolar zigzag incision can provide a good surgical field to remove a relatively large tumor and may provide cosmetically good outcomes.

Keywords: periareolar zigzag incision, breast conserving surgery, breast cancer, resection margin

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Authors: Eva Degraeuwe, Margo Vandenheede, Nicholas Rennie, Jolien Braem, Miryam Serry, Frederik Berrevoet, Piet Pattyn, Wouter Willaert, InciSioN Belgium Consortium

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Background: Worldwide, five billion people lack access to safe and affordable surgical care. An added 1.27 million surgeons, anesthesiologists, and obstetricians (SAO) are needed by 2030 to meet the target of 20 per 100,000 population and to reach the goal of the Lancet Commission on Global Surgery. A well-informed future generation exposed early on to the current challenges in global surgery (GS) is necessary to ensure a sustainable future. Methods: InciSioN, the International Student Surgical Network, is a non-profit organization by and for students, residents, and fellows in over 80 countries. InciSioN Belgium, one of the prominent national working groups, has made a vast progression and collaborated with other networks to fill the educational gap, stimulate advocacy efforts and increase interactions with the international network. This report describes a roadmap to achieve sustainable development and education within GS, with the example of InciSioN Belgium. Results: Since the establishment of the organization’s branch in 2019, it has hosted an educational workshop for first-year residents in surgery, engaging over 2500 participants, and established a recurring directing board of 15 members. In the year 2020-2021, InciSioN Ghent has organized three workshops combining educational and interactive sessions for future prime advocates and surgical candidates. InciSioN Belgium has set up a strong formal coalition with the Belgian Medical Students’ Association (BeMSA), with its own standing committee, reaching over 3000+ medical students annually. In 2021-2022, InciSioN Belgium broadened to a multidisciplinary approach, including dentistry and nursing students and graduates within workshops and research projects, leading to a member and exposure increase of 450%. This roadmap sets strategic goals and mechanisms for the GS community to achieve nationwide sustained improvements in the research and education of GS focused on future SAOs, in order to achieve the GS sustainable development goals. In the coming year, expansion is directed to a formal integration of GS into the medical curriculum and increased international advocacy whilst inspiring SAOs to integrate into GS in Belgium. Conclusion: The development and implementation of durable change for GS are necessary. The student organization InciSioN Belgium is growing and hopes to close the colossal gap in GS and inspire the growth of other branches while sharing the know-how of a student organization.

Keywords: advocacy, education, global surgery, InciSioN, student network

Procedia PDF Downloads 135

Authors: Xiaodi Su, Xin Ting Zheng, Laura Sutarlie, Nur Asinah binte Mohamed Salleh, Yong Yu

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Wound healing is a dynamic process with multiple phases. Rapid profiling and quantitative characterization of inflammation and infection remain challenging. We have developed paper-like battery-free multiplexed sensors for holistic wound assessment via quantitative detection of multiple inflammation and infection markers. In one of the designs, the sensor patch consists of a wax-printed paper panel with five colorimetric sensor channels arranged in a pattern resembling a five-petaled flower (denoted as a ‘Petal’ sensor). The five sensors are for temperature, pH, trimethylamine, uric acid, and moisture. The sensor patch is sandwiched between a top transparent silicone layer and a bottom adhesive wound contact layer. In the second design, a palm-like-shaped paper strip is fabricated by a paper-cutter printer (denoted as ‘Palm’ sensor). This sensor strip carries five sensor regions connected by a stem sampling entrance that enables rapid colorimetric detection of multiple bacteria metabolites (aldehyde, lactate, moisture, trimethylamine, tryptophan) from wound exudate. For both the “\’ Petal’ and ‘Palm’ sensors, color images can be captured by a mobile phone. According to the color changes, one can quantify the concentration of the biomarkers and then determine wound healing status and identify/quantify bacterial species in infected wounds. The ‘Petal’ and ‘Palm’ sensors are validated with in-situ animal and ex-situ skin wound models, respectively. These sensors have the potential for integration with wound dressing to allow early warning of adverse events without frequent removal of the plasters. Such in-situ and early detection of non-healing condition can trigger immediate clinical intervention to facilitate wound care management.

Keywords: wound infection, colorimetric sensor, paper fluidic sensor, wound care

Procedia PDF Downloads 47

Authors: Dylan Treger, Lujia Zhang, Xiaoxiao Jia, Jessica H. Hui, Munkh-Amgalan Gantumur, Mizhou Hui, Li Liu

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Hyaluronic acid (HA) is involved in wound healing via inflammation, granulation, and re-epithelialization mechanisms. The poor physical properties of natural high-molecular-weight polymers limit their direct use in the medical field. In this clinical study, we investigated whether the local injection of a tissue-permeable 35 kDa HA fragment (HA35) could favor the healing process in patients with chronic wounds accompanied by neuropathic pain. The HA35 fragments were freshly manufactured by degradation of high-molecular-weight HA with bovine testis-derived hyaluronidase PH20. Twenty patients in this study had nonhealing wounds and wound-related pain for more than 3 months. Freshly produced HA35 was locally injected into healthy skin immediately surrounding chronic wounds once a day for 10 days. Wound-associated pain and the degree of wound healing were evaluated. The injection of HA35 relieved the pain associated with chronic wounds in 24 hours. HA35 treatment significantly promoted the healing of chronic wounds, including expanded fresh granulation tissue on the wounds; reduced darkness or redness, dryness, and damaged areas on the surface of the skin surrounding the wounds; and decreased the size of the wound area. It can be concluded that the topical injection of tissue-permeable HA35 around chronic wounds has great potential to promote wound healing.

Keywords: 35 kDa hyaluronan fragment HA35, chronic wound, wound healing, tissue permeability

Procedia PDF Downloads 86

Authors: Nor Khaizan Anuar, Nur Karimah Aziz, Tin Wui Wong, Ahmad Sazali Hamzah, Wan Rozita Wan Engah

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The physicochemical attributes and wound healing activity of pectin hydrogel in rat models, following partial thickness thermal injury were investigated. The pectin hydrogel was prepared by solvent evaporation method with the aid of glutaraldehyde as crosslinking agent and glycerol as plasticizer. The physicochemical properties were mainly evaluated using differential scanning calorimetry (DSC) and Fourier transform infrared (FTIR) spectroscopy, while the wound healing activity was examined by the macroscopic images, wound size reduction and histological evaluation using haematoxylin and eosin (H&E) stain for 14 days. The DSC and FTIR analysis suggested that pectin hydrogel exhibited higher extent of polymer-polymer interaction at O-H functional group in comparison to the unprocessed pectin. This was indicated by the increase of endothermic enthalpy values from 139.35 ± 13.06 J/g of unprocessed pectin to 156.23 ± 2.86 J/g of pectin hydrogel, as well as the decrease of FTIR wavenumber corresponding to O-H at 3432.07 ± 0.49 cm-1 of unprocessed pectin to 3412.62 ± 13.06 cm-1 of pectin hydrogel. Rats treated with pectin hydrogel had significantly smaller wound size (Student’s t-test, p<0.05) when compared to the untreated group starting from day 7 until day 14. H&E staining indicated that wounds received pectin hydrogel had more fibroblasts, blood vessels and collagen bundles on day 14 in comparison to the untreated rats.

Keywords: pectin, physicochemical, rats, wound

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Authors: Rajni Kant Panik, Deependra Singh, Manju Singh

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Despite significant advances in the treatment of severe burn injury, infection and sepsis persist as frequent causes of morbidity and mortality for burn victims due to extensive compromise of the skin and contiguous tissue that serve as a protective barrier against microbial invasion. In the setting of a burn wound infection, Staphylococcus aureus is the most commonly isolated pathogens from bloodstream infections in burn care hospitals. We aimed to develop a biocompatible system of Poly vinyl alcohol (PVA)-sodium alginate hydrogel carrying multiple drugs- catalase and mupirocin in controlled manner for effective and complete burn wound healing. PLGA nanoparticles of Catalase and mupirocin were prepared by homogenization method and optimized system was incorporated in PVA-sodium alginate slurry. PVA-sodium alginate hydrogels were prepared by freeze thaw method. The prepared dispersion was casted into films to prepare multiphase hydrogel system and characterized by in vitro and in vivo studies. The study clearly showed the beneficial effect of antioxidant enzyme and antibiotic in the treatment of infected burn wound, as evidenced by the reduced incidence of wound infection and the shortening of healing time.

Keywords: burn wound, catalase, mupirocin, wound healing

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Authors: Piyachat Chuysinuan, Nitirat Chimnoi, Arthit Makarasen, Nanthawan Reuk-Ngam, Pitt Supaphol, Supanna Techasakul

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In this work, biomaterial wound dressings was developed based on gelatin containing herbal substances (essential oil), a substance from the plant Eupatorium adenophorum Spreng (Crofton weed) that used as traditional wound healers. Gelatin hydrogel was prepared from a 10 wt-% gelatin solution. The oil in water (o/w) emulsion Eupatorium adenophorum of essential oil were prepared and used Pluronic F68 as a surfactant. The 10, 20, and 30 % v/v emulsion were mixed with gelatin solution and cast into film. These hydrogels were tested for their gel fraction, swelling and weight loss behavior. With an increase in the emulsion concentration the emulsion-loaded in hydrogels, the gel fraction were decreased due to the crosslink density, while the swelling and weight loss behavior were increased with an increasing in the emulsion content. The potential to use the emulsion-containing gelatin hydrogels as wound dressing was assessed on investigation the release characteristics of the as-loaded hydrogels. The E. adenophorum essential oil was first identified the chemical composition by using GC-MS analysis. The principal components of the oil were p-cymene (16.23%), bornyl acetate (11.84%), and amorpha-4, 7(11)-diene (10.51%). The hydrogel wound dressing containing essential oil was then characterized for their antibacterial activity against Gram-positive and Gram-negative in order to elucidate their potential for use as antibacterial wound dressings by using agar disk diffusion methods. The result showed that E. adenophorum essential oil and the emulsion-loaded gelatin hydrogel inhibited the growth of the test pathogens, Staphylococcus aureus and Staphylococcus epidermidis and increased with increasing the initial amount of essential oil in the hydrogels which confirmed their application as antibacterial wound dressings. Furthermore, the potential use of these wound dressings was further assessed in terms of the indirect cytotoxicity, in vitro attachment and proliferation of dermal human fibroblasts cultured in the hydrogel wound dressings.

Keywords: hydrogel, antibacterial wound dressing, Eupatorium adenophorum essential oil, gelatin

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Authors: N. Choobkar, M. Rezaeimanesh, A. M. Emami Rad, M. Ghaeni, H. Norouzi, S. Pahlavani, M. S. Tamasoki, E. Nezafatian

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Antibiotics are used to increase the immune and wound healing in many animals . But due to the residual effects of a drug , researchers sought to replace them with natural materials such as Plant extracts. Falcaria vulgaris is the most attractive sources of the new drugs. Falcaria vulgaris (locally named Ghazzyaghi/Poghazeh) is a member of Umbelliferae family which grows near farmlands and is consumed as a vegetable in some regions of Iran. In the West of the country, in the wound healing and irregularities in the digestive system is also used. There were no scientific reports available in literature in support of the traditional claims of F. vulgaris in fish. The present study is therefore an attempt to assess the efficacy of this indigenous herb for its healing effect in common carp (Cyprinus carpio). Falcaria vulgaris at concentrations of 0, 2 and 10 % with Lophag foods used on wound healing of common carp and immune response, and weight grow and survival during periods of 21 days with feeding 2 times per day on the basis of body weight. The results showed that, compared with the control group, using of concentration 10 % F. vulgaris have significant effect on wound healing and stimulates the immune system by increasing white blood cells (WBC) and weight grow and survival of carp. The herb can used in wound healing, increased resistance to disease and weight grow in fish and the beneficial effects of this combination goes back to man.

Keywords: common carp, falcaria vulgaris, immune response, wound healing

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Authors: W. Khitri, J. Zenaki, A. Abi, N. Lachgueur, A. Lardjem

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Healing is a biological phenomenon that is automatically and immediately implemented by the body that is able to repair the physical damage of all tissues except nerve cells. Lot of medicinal plants is used for the treatment of a wound. Our ethnobotanical study has identified 19 species and 13 families of plants used in traditional medicine in Oran-Algeria for their healing activities. The Phlomis bovei De Noe was the species most recommended by herbalists. Its phytochemical study revealed different secondary metabolites such as terpenes, tannins, saponins and mucilage. The evaluation of the healing activity of Phlomis bovei in wistar albinos rats by excision wound model showed a significant amelioration with 5 % increase of the surface healing compared to the control group and a gain of three days of epithelialization time with a scar histologically better.

Keywords: Phlomis Bovei De Noe, ethnobanical study, wound healing, wistar albino rats

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Authors: Thangavelu Muthukumar, Thotapalli Parvathaleswara Sastry

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Collagen is the most abundantly available connective tissue protein, which is being used as a biomaterial for various biomedical applications. Presently, fish wastes are disposed improperly which is causing serious environmental pollution resulting in offensive odour. Fish scales are promising source of Type I collagen. Medicinal plants have been used since time immemorial for treatment of various ailments of skin and dermatological disorders especially cuts, wounds, and burns. Developing biomaterials from the natural sources which are having wound healing properties within the search of a common man is the need of hour, particularly in developing and third world countries. With these objectives in view we have developed a wound dressing material containing fish scale collagen (FSC) incorporated with Macrotyloma uniflorum plant extract (PE). The wound dressing composite was characterized for its physiochemical properties using conventional methods. SEM image revealed that the composite has fibrous and porous surface which helps in transportation of oxygen as well as absorbing wound fluids. The biomaterial has shown 95% biocompatibility with required mechanical strength and has exhibited antimicrobial properties. This biomaterial has been used as a wound dressing material in experimental wounds of rats. The healing pattern was evaluated by macroscopic observations, panimetric studies, biochemical, histopathological observations. The results showed faster healing pattern in the wounds treated with CSPE compared to the other composites used in this study and untreated control. These experiments clearly suggest that CSPE can be used as wound/burn dressing materials.

Keywords: collagen, wound dressing, Macrotyloma uniflorum, burn dressing

Procedia PDF Downloads 379

Authors: Amulya Srivatsa, Gayatri Prakash, Deeksha Sarda, Varshni Nandakumar, Duncan Salmon

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Delivery of Patient-Directed Wound Care Via Mobile Application-Based Qualitative Analysis Chronic wounds are difficult for patients to manage at-home due to their unpredictable healing process. These wounds are associated with increased morbidity and negatively affect physical and mental health. The solution is a mobile application that will have an algorithm-based checklist to determine the state of the wound based on different factors that vary from person to person. Once this information is gathered, the application will recommend a plan of care to the user and subsequent steps to be taken. The mobile application will allow users to perform a digital scan of the wound to extract quantitative information regarding wound width, length, and depth, which will then be uploaded to the EHR to notify the patient’s provider. This scan utilizes a photo taken by the user, who is prompted appropriately. Furthermore, users will enter demographic information and answer multiple choice and drop-down menus describing the wound state. The proposed solution can save patients from unnecessary trips to the hospital for chronic wound care. The next iteration of the application can incorporate AI to allow users to perform a digital scan of the wound to extract quantitative information regarding wound width, length, and depth, which can be shared with the patient’s provider to allow for more efficient treatment. Ultimately, this product can provide immediate and economical medical advice for patients that suffer from chronic wounds. Research Objectives: The application should be capable of qualitative analysis of a wound and recommend a plan of care to the user. Additionally, the results of the wound analysis should automatically upload to the patient’s EMR. Research Methodologies: The app has two components: the first is a checklist with tabs for varying factors that assists users in the assessment of their skin. Subsequently, the algorithm will create an at-home regimen for patients to follow to manage their wounds. Research Contributions: The app aims to return autonomy back to the patient and reduce the number of visits to a physician for chronic wound care. The app also serves to educate the patient on how best to care for their wounds.

Keywords: wound, app, qualitative, analysis, home, chronic

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Authors: Dylan Shiting Lu, Samson Okello, Anita Chunyan Wei, Daniel Xiao Li

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Mammotome vacuum-assisted breast biopsy (MVB) introduced in 1995 can be used for the removal of benign breast lesions. Whether or not MVB is a better option compared to conventional open surgery is inconclusive. We aim to compare the clinical and patient-related outcomes between MVB and open surgery to remove benign breast tumors less than 5 cm in women. We searched English and Chinese electronic databases with the keywords of Mammotome, clinical trial (CT), vacuum-assisted breast biopsy for studies comparing MVB and open surgery until May 2021. We performed a systematic review and random-effects meta-analysis to compare incision size, operation time, intraoperative blood loss, healing time, scar length, patient satisfaction, postoperative hematoma rate, wound infection rate, postoperative ecchymosis, and postoperative sunken skin among those who have Mammotome and those who have surgery. Our analysis included nine randomized CTs with 1155 total patients (575 Mammotome, 580 surgery) and mean age 40.32 years (standard deviation 3.69). We found statistically significant favorable outcomes for Mammotome including blood loss (ml) [standardized mean difference SMD -5.03, 95%CI (-7.30, -2.76)], incision size (cm) [SMD -12.22, 95%CI (-17.40, -7.04)], operation time (min) [SMD -6.66, 95%CI (-9.01, -4.31)], scar length (cm) [SMD -7.06, 95%CI (-10.76, -3.36)], healing time (days) [SMD -6.57, 95%CI (-10.18, -2.95)], and patient satisfaction [relative risk RR 0.38, 95%CI (0.13, 1.08)]. In conclusion, Mammotome vacuum-assisted breast biopsy compared to open surgery shows better clinical and patient-related outcomes. Further studies should be done on whether or not MVB is a better option for benign breast tumors excision.

Keywords: clinical and patient outcomes, open surgery, Mammotome vacuum-assisted breast biopsy, meta-analysis

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Authors: Zahra Tabarsi, Mehdi Marjani, Alireza Najafpour, Alborz Mirzade

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The aim of this study was to evaluate and compare the macroscopic effect of low level laser and plasma jet for wound healing in rats. The study was performed on 40 old male white rats with an average weight of 250 g and an average age of the same age. After preparing the rats from Ibn Sina Research Institute, they were kept the same for one week under environmental conditions such as temperature, humidity and light, and nutrition such as the type of diet and the number of meals. Then, to start the research, rats were randomly divided into two groups (A): laser treatment of wounds, group (B): plasma wound treatment. All rats were inhibited 4 hours before each anesthesia under conditions of abstinence and up to 2 hours after drinking water. Rats were anesthetized by intraperitoneal injection of ketamine 10% and xylazine 2%.After scrubbing between two shoulders of each rat, a circular wound was created by sterile 5 mm biopsy puncture. Group A rats were treated with low level laser in three sessions and group B in three sessions with argon plasma. Based on the observed results, it seems that Low level laser radiation has more acceptable and appropriate effects than cold plasma on the healing of rat skin wounds.

Keywords: low-level laser, plasma jet, rat, wound healing

Procedia PDF Downloads 80

Authors: Muhammad Naveed Ali, Hamad Bin Rashid, Muhammad Arif Khan, Abdul Basit, Hafiz Muhammad Arshad

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Abdominal defects are very common in pigeons. A new technique is known as intraabdominal mesh transplant that give better protection for herniorrhaphy. The aim of this study was to determine the performance of hernia mesh. In this study, an efficacy of two synthetic hernia mesh implants viz. conventional Prolene and a lightweight mesh monofilament polyester were assessed for the abdominal wall repair in pigeons. Twenty four healthy pigeons were selected and randomly distributed into three groups, A, B and C (n=8). In all groups, experimental laparotomy was performed; thereafter, abdominal muscles and peritoneum were sutured together, while, a 2 x 2 cm defect was created in the abdominal muscles. For onlay hernioplasty, the hernia mesh (Prolene mesh: group A; Polyester mesh: group B) was implanted over the external oblique muscles of the abdomen. In group C (control), the mesh was not implanted; instead, the laparotomy incision was closed after a herniorrhaphy. Post-operative pain wound healing, adhesion formation, histopathological findings and formation of hematoma, abscess and seroma were assessed as short-term complications. Post-operatively, pain at surgical site was significantly less (P < 0.001) in group B (Polyester mesh); wound healing was also significantly better and rapid in group B (P < 0.05) than in group A (Prolene mesh). Group B (Polyester mesh) also depicted less than 25% adhesions when assessed on the basis of a Quantitative Modified Diamond scale; a Qualitative Adhesion Tenacity scale also depicted either no adhesions or flimsy adhesions (n=2) in group B (Polyester mesh), in contrast to group A (Prolene), which manifested greater adhesion formation and presence of dense adhesions requiring blunt dissection. There were observed hematoma, seroma and abscess formations in birds treated by Prolene mesh only. Conclusively, the polyester mesh proved superior to the Prolene mesh regarding lesser adhesion, better in wound healing, and no short-term follow-up complications.

Keywords: adhesion, mesh, polyester, prolene

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Authors: Devendra Gupta, Sushilk K. Agarwal, Amit Kesari, P. K. Singh

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Objectives: Pediatric patients often may experience persistent respiratory failure that requires tracheostomy placement in Pediatric ICU. We have designed a technique of tracheostomy in pediatric patients with S-shaped incision on the tracheal wall with higher success rate and lower complication rate. Technique: Following general anesthesia and positioning of the patient, the trachea was exposed in midline by a vertical skin incision. In order to make S-shaped tracheostoma, second tracheal ring was identified. The conventional vertical incision was made in second tracheal ring and then extended at both its ends laterally in the inter-cartilaginous space parallel to the tracheal cartilage in the opposite direction to make the incision S-shaped. The trachea was dilated with tracheal dilator and appropriate size of tracheostomy tube was then placed into the trachea. Results: S-shaped tracheostomy was performed in 20 children with mean age of 6.25 years (age range is 2-7) requiring tracheostomy placement. The tracheostomy tubes were successfully placed in all the patients in single attempt. There was no incidence of significant intra-operative bleeding, subcutaneous emphysema, vocal cord palsy or pneumothorax. Two patients developed pneumonia and expired within a year. However, there was no incidence of tracheo-esophageal fistula, suprastomal collapse or difficulty in decannulation on one year of follow up related to our technique. One patient developed late trachietis managed conservatively. Conclusion: S-shaped tracheoplasty was associated with high success rate, reduced risk of the early and late complications in pediatric patients requiring tracheostomy.

Keywords: peatrics, tracheostomy, ICU, tracheostoma

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Authors: Sathish Sundar Dhilip Kumar, Nicolette Houreld, Heidi Abrahamse

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Silver nanoparticles (AgNPs) are classified as metal-based nanomaterials and have received considerable attention globally for wound healing and tissue engineering applications. Naturally available materials are a significant source of medicinal products to treat numerous diseases; polysaccharides are among them. Polysaccharides are non-toxic, safe, and inexpensive, and it has good biocompatibility and biodegradability. Most polysaccharides are shown to have a positive effect on wound healing processes, including chitosan and gum tragacanth. The present study evaluated the improvement of cellular wound healing by nanosilver-loaded polysaccharide-based biomaterial (CGT-NS) in WS1 cells. The physicochemical properties of prepared CGT-NS were studied using different characterization techniques, and it exhibited better stability and swelling properties in various pH conditions. Surface morphology was studied using scanning electron microscopy, and it revealed the porous morphology of the synthesized CGT-NS. The synthesized biomaterial displayed acceptable antibacterial properties against Gram-positive and Gram-negative bacterial strains, and it may prevent infection. The biocompatibility of the synthesized CGT-NS biomaterial was studied in WS1 cells, where it may lead to promote increased cell adhesion and proliferation properties. Thus, the CGT-NS biomaterial has good potential as a biomaterial in wound healing applications.

Keywords: biomaterial, wound healing, nano, silver nanoparticles

Procedia PDF Downloads 155

Authors: Fares Mahdi

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Background: Infection control is an important concern for all health care professionals, especially nurses. Nurses have a higher risk for both self-acquiring and transmitting infections to other patients. Aim of this study: to assess nurses' knowledge regarding infection control for wound care. Methodology: a descriptive research design was used in the study. The total number studied sample was 200 nurses, were conducting in Amran Public Hospitals in Amran City- Yemen. The study covered sample nurses in the hospital according to the study population; a standard closed-ended questionnaire was used to collect the data. Results: The results showed less than half (37.5 %) of nurses were from 22 May Hospital, also followed by (62.5%) of them were from Maternal and Child Hospital. Also according to the department name. Most (22.5%) of nurses worked in an intensive care unit, followed by (20%) of them were working in the pediatric world, also about (19%) of them were working in the surgical department. While in finally, only about (8.5%) of them worked from another department. According to course training, The results showed about (21%) of nurses had course training in wound care management. At the same time, others (79%) of them have not had course training in wound care management. According to the total nurse's knowledge of infection control for wound care, that find more than two-thirds (68%) of nurses had fair knowledge according to total all of nurse's knowledge of infection control wound care. Conclusion:The results showed that more than two-thirds (68%) of nurses had fair knowledge according to total all of the nurse's knowledge of infection control for wound care. Recommendations: There should be providing training program about infection control masseurs and it's important for new employees of nurses. Providing continuing refreshment training courses about infection control programs and about evidence-based practice in infection control for all health care teams.

Keywords: assessment, knowledge, infection control, wound care, nurses, amran hospitals

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Authors: Harpreet Kaur, Er. Arjun, Kirandeep Kaur, P. K. Mittal

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Simulation of a human body from a 20% gelatin & 80% water mixture is examined from a wound ballistics point of view. Parameters such as incapacitation energy & temporary to permanent cavity size & tools of hydrodynamics have been employed to arrive at a model of the human body similar to the one adopted by NATO. Calculations using equations of motion yield a value of 339 µs in which a temporary cavity with maximum size settles down to a permanent cavity. This occurs for 10mm size bullets & settles down to a permanent cavity in the case of 4 different bullets, i.e., 5.45, 5.56, 7.62,10 mm sizes. The obtained results are in excellent agreement with the body as a right circular cylinder of 15 cm height & 10 cm diameter. An effort is made here in this work to present a sound theoretical base to parameters commonly used in wound ballistics from field experience discussed by Col Coats & Major Beyer.

Keywords: gelatine, gunshot, hydrodynamic model, oscillation time, temporary and permanent cavity, wound ballistics

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Authors: Lukman Thalib, Luis Furuya-Kanamori, Rachel Walker, Brigid Gillespie, Suhail Doi

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Background and objectives: There are many topical treatments available for Pressure Injury (PI) treatment, yet there is a lack of evidence with regards to the most effective treatment. The objective of this study was to compare the effect of various topical treatments and identify the best treatment choice(s) for PI healing. Methods: Network meta-analysis of published randomized controlled trials that compared the two or more of the following dressing groups: basic, foam, active, hydroactive, and other wound dressings. The outcome complete healing following treatment and the generalised pair-wise modelling framework was used to generate mixed treatment effects against hydroactive wound dressing, currently the standard of treatment for PIs. All treatments were then ranked by their point estimates. Main Results: 40 studies (1,757 participants) comparing 5 dressing groups were included in the analysis. All dressings groups ranked better than basic (i.e. saline gauze or similar inert dressing). The foam (RR 1.18; 95%CI 0.95-1.48) and active wound dressing (RR 1.16; 95%CI 0.92-1.47) ranked better than hydroactive wound dressing in terms of healing of PIs when the latter was used as the reference group. Conclusion & Recommendations: There was considerable uncertainty around the estimates, yet, the use of hydroactive wound dressings appear to perform better than basic dressings. Foam and active wound dressing groups show promise and need further investigation. High-quality research on clinical effectiveness of the topical treatments are warranted to identify if foam and active wound dressings do provide advantages over hydroactive dressings.

Keywords: Net work Meta Analysis, Pressure Injury, Dresssing, Pressure Ulcer

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Authors: Sachin Latiyan, T. S. Sampath Kumar, Mukesh Doble

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Natural polymer based nanofibrous wound dressings have gained increased attention because of their high surface area, bioactivity, biodegradability and resemblance to extracellular matrix. Agarose (a natural polymer) have been used largely for angiogenesis, cartilage formation and wound healing applications. However, electrospinning of agarose is tedious thereby rendering limited studies on fabrication and evaluation of agarose based nanofibrous wound dressings. Thus, present study focuses on the fabrication of agarose (10% w/v)/ polyvinyl alcohol (12% w/v) based multifunctional nanofibrous scaffolds. Zinc citrate (1, 3 and 5% w/w of the polymer) was added as a potential antibacterial agent to combat wound infections. The fabricated scaffolds exhibit ~500% swelling (in phosphate buffer saline) with enhanced mechanical strength which is suitable for most of the wound healing applications. In vitro studies were found to reveal an increased migration and proliferation of L929 mouse fibroblasts with agarose blends w.r.t to the control. The fabricated dressings were found to be effective against both Escherichia coli (Gram-negative) and Staphylococcus aureus (Gram-positive) bacterial strains. Hence, a multifunctional (as provides effective swelling and mechanical support along with antibacterial property), natural product based, eco-friendly scaffold was successfully fabricated to serve as a potential wound dressing material.

Keywords: antibacterial dressings, benign solvent, nanofibrous agarose, biocompatibility, enhanced swelling and mechanical strength, biopolymeric dressings

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Authors: P. Akbartehrani, M. Khaledi Pour, M. Amini, M. Khani, M. Mohajeri Tehrani, E. Ghasemi, P. Charipoor, B. Shokri

Abstract:

A common problem between diabetic patients is foot ulcers which are chronic and require specialized treatment. Previous studies illustrate that Cold atmospheric plasma (CAP) has beneficial effects on wound healing and infection. Nevertheless, the comparison of different cap exposure protocols in diabetic ulcer wound healing remained to be studied. This study aims to determine the effect of two different exposure protocols on wound healing in diabetic ulcers. A prospective, randomized clinical trial was conducted at two clinics. Diabetic patients with G1 and G2 wanger classification diabetic foot ulcers were divided into two groups of study. One group was treated by the first protocol, which was treating wounds by argon-generated cold atmospheric plasma jet once a week for five weeks in a row. The other group was treated by the second protocol, which was treating wounds every three days for five weeks in a row. The wounds were treated for 40 seconds/cubic centimeter, while the nozzle tip was moved nonlocalized 1 cm above the wounds. A patient with one or more wounds could participate in different groups as wounds were separately randomized, which allow a participant to be treated several times during the study. The study's significant findings were two different reductions rate in wound size, microbial load, and two different healing speeds. This study concludes that CAP therapy by the second protocol yields more effective healing speeds, reduction in wound sizes, and microbial loads of foot ulcers in diabetic patients.

Keywords: wound healing, diabetic ulcers, cold atmospheric plasma, cold argon jet

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Authors: Jie Ding, Yingying Pan, Shammy Raj, Lindy Schaffrick, Jolene Wong, Antoinette Nguyen, Sharada Manchikanti, Larry Unsworth, Peter Kwan, Edward E. Tredget

Abstract:

Background: Exosomes (EXOs) have been considered a new target that is thought to be involved in and treat wound healing. More research is needed to fully understand the EXO characteristics and mechanisms of EXO-mediated wound healing, especially wound healing after burn injury. Methods: Total EXOs were isolated from 85 serum samples of 29 burn patients and 13 healthy individuals. We characterized the EXOs for morphology and density, serum concentration, protein level, marker expression, size distribution, and cytokine content. After confirmation of EXO uptake by dermal fibroblasts, we also explored functional regulation of primary human normal skin and hypertrophic scar fibroblast cell lines by the EXOs in vitro, including cell proliferation and apoptosis. Results: EXOs dynamically changed their morphology, density, size, and cytokine level during wound healing in burn patients, which were correlated with burn severity and the stages of wound healing. EXOs from both burn patients and healthy individuals stimulated dermal fibroblast proliferation and apoptosis. Conclusion: EXO features may be important signals that influence wound healing after burn injury; however, to understand the mechanisms by which EXOs regulated the fibroblasts in healing wounds, further studies will be required in the future.

Keywords: exosome, burn, wound healing, hypertrophic scarring, cytokines

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Authors: Rajendra Jangde, Deependra Singh

Abstract:

Present work was based with objective to release of the antimicrobial and debriding agent in sustained manner at the wound surface. In order to provide a long-lasting antimicrobial action and moist environment on wound space, Biocompatible moist system was developed for complete healing. In the present study, a biocompatible moist system of PVA-gelatin hydrogel was developed capable of carrying multiple drugs- Quercetin and Cabopol in controlled manner for effective and complete wound healing. Carbopol and Quercetin were prepared by thin film hydration techniques and optimized system was incorporated in PVA-Gelatin slurry. PVA-Gelatin hydrogels were prepared by freeze thaw method. The prepared dispersion was casted into films to prepare multiphase hydrogel system and characterized by in vitro and in vivo studies. Results revealed the uniform dispersion of microspheres in a three-dimensional matrix of the PVA-Gelatin hydrogel observed at different magnifications. The in vitro release data showed typical biphasic release pattern, i.e., a burst release followed by a slower sustained release for 5 days. Prepared system was found to be stable under both normal and accelerated conditions. Histopathological study showed significant (p<0.05) increase in fibroblast cells, collagen fibres and blood vessels formation. All parameters such as wound contraction, tensile strength, histopathological and biochemical parameters- hydroxyproline content, protein level, etc. were observed significant (p<0.05) in comparison to control group. Present results suggest an accelerated re-epithelialization under moist wound environment with delivery of multiple drugs effective at different stages of wound healing cascade with minimum disturbance of wound bed.

Keywords: multiphase hydrogel, optimization quercetin, wound healing

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Authors: Stephanie Cornish

Abstract:

The use of synthetic dermal templates, also known as dermal matrices, such as PolyNovo® Biodegradable Temporising Matrix (BTM), has been well established in the reconstruction of acute wounds with a full thickness defect of the skin. Its use has become common place in the treatment of full thickness burns and is not unfamiliar in the realm of necrotising fasciitis, free flap donor site reconstruction, and the management of acute traumatic wounds. However, the use of dermal templates for more chronic wounds is rare. The authors present the successful use of BTM in the reconstruction of a chronic scalp wound following the excision of a malignancy and multiple previous failed attempts at repair, thus demonstrating the potential for an increased scope of use.

Keywords: dermal template, BTM, chronic, scalp wound, reconstruction

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Authors: Rajni Kant Panik

Abstract:

The aim of the present study was to develop and evaluate mupirocin loaded nanoparticle incorporated into hydrogel as an infected wound healer. Incorporated Nanoparticle in hydrogel provides a barrier that effectively prevents the contamination of the wound and further progression of infection to deeper tissues. Hydrogel creates moist healing environment on wound space with good fluid absorbance. Nanoparticles were prepared by double emulsion solvent evaporation method using different ratios of PLGA polymer and the hydrogels was developed using sodium alginate and gelatin. Further prepared nanoparticles were then incorporated into the hydrogels. The formulations were characterized by FT-IR and DSC for drug and polymer compatibility and surface morphology was studied by TEM. Nanoparticle hydrogel were evaluated for their size, shape, encapsulation efficiency and for in vitro studies. The FT-IR and DSC confirmed the absence of any drug polymer interaction. The average size of Nanoparticle was found to be in range of 208.21-412.33 nm and shape was found to be spherical. The maximum encapsulation efficiency was found to be 69.03%. The in vitro release profile of Nanoparticle incorporated hydrogel formulation was found to give sustained release of drug. Antimicrobial activity testing confirmed that encapsulated drug preserve its effectiveness. The stability study confirmed that the formulation prepared were stable. Present study complements our finding that mupirocin loaded Nanoparticle incorporated into hydrogel has the potential to be an effective and safe novel addition for the release of mupirocin in sustained manner, which may be a better option for the management of wound. These finding also supports the progression of antibiotic via hydrogel delivery system is a novel topical dosage form for the management of wound.

Keywords: hydrogel, nanoparticle, PLGA, wound healing

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Authors: Nur Sarma, Paul M. Tuohy, Siniša Djurović

Abstract:

This paper presents an in-depth investigation of the effects of several grid supply harmonic voltages on the stator currents of an example wound rotor induction machine. The observed effects of higher order grid supply harmonics are identified using a finite element time stepping transient model, as well as a time-stepping electromagnetic model. In addition, a number of analytical equations to calculate the spectral content of the stator currents are presented in the paper. The presented equations are validated through comparison with the obtained spectra predicted using the finite element and electromagnetic models. The presented study provides a better understanding of the origin of supply harmonic effects identified in the stator currents of the example wound rotor induction machine. Furthermore, the study helps to understand the effects of higher order supply harmonics on the harmonic emissions of the wound rotor induction machine.  

Keywords: wound rotor induction machine, supply harmonics, current spectrum, power spectrum, power quality, harmonic emmisions, finite element analysis

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Authors: Vaibhav V. Dixit, Shubham Ajay Karwa

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Diabetic foot ulcers speak to a critical medical problem. Right now, clinicians and medical caretakers primarily construct their injury evaluation in light of visual examination of wound size and mending status, while the patients themselves rarely have a chance to play a dynamic part. Henceforth, love quantitative and practical examination technique that empowers the patients and their parental figures to take a more dynamic part in every day wound care possibly can quicken wound recuperating, spare travel cost and diminish human services costs. Considering the commonness of cell phones with a high-determination computerized camera, evaluating wounds by breaking down pictures of ceaseless foot ulcers is an alluring choice. In this paper, we propose a novel injury picture examination framework actualized using feature extraction and color segmentation. Here we are using the Normalized minimum distance classifier for classifying the output.

Keywords: diabetic, Gabor wavelet, normalized minimum distance classifier, quantiable parameters

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Authors: Isha Ranadive, Sonam Patel, Suresh Balakrishnan

Abstract:

It has been observed that in lizards wound can be healed by either a scar free mechanism or by scarring. The animal model used to study both these healing processes was Northern House Gecko. In lizard, the tail when amputated heals by scar free mechanism which allows it to regenerate, the same is not seen when the limb is amputated. Proliferation, apoptosis, and angiogenesis are the main events which succeed an injury. We observed that proliferation of the cells beneath the wound epidermis was much higher in case of wound healing in tail. This could be because after the wound gets covered by the epithelium, it enters in to a cross-talk with the underlying mesenchyme to recruit a pool of blastemal cells which proliferate and later differentiate to form the lost part through epimorphic regeneration. This was substantiated by mRNA expression levels of various FGFs which facilitate the cross-talk and also by PCNA which is a marker for proliferation. Western blot result reaffirms the same notion. However, in case of the limb, the rate of apoptosis was more than proliferation as there are a lot of debris that needs to be removed. We came to this conclusion as we observed that p53 the apoptotic gene was highly upregulated in case of the scarred tissue. Further, we confirmed this result by checking the anti-apoptotic gene bcl2 and found it to be significantly down-regulated. As we noticed heightened proliferation in the case of scar-free wound healing in tail, angiogenesis was targeted for the study. This is because, when the cells are proliferating they require constant supply of blood and hence neo-vascularization is inevitable. It was observed that the marker of angiogenesis, VEGF, was expressed more during wound healing as compared to the resting stage of tail. Moreover, a high up-regulation was seen in KDR, a receptor of VEGF. Thus, this study reveals how proliferation, apoptosis, and angiogenesis play a key role in the scar-free as well as scarred wound healing.

Keywords: epimorphic regeneration, injury, northern house gecko, wound healing

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Authors: Abir O. El Sadik

Abstract:

Introduction: Wound healing involves the interaction of multiple biological processes among different types of cells, intercellular matrix and specific signaling factors producing enhancement of cell proliferation of the epidermis over dermal granulation tissue. Several studies investigated multiple strategies to promote wound healing and to minimize infection and fluid losses. However, burn crisis, and its related morbidity and mortality are still elevated. The aim of the present study was to examine the effects of mesenchymal stem cells (MSCs) in accelerating wound healing and to compare the most efficient route of administration of MSCs, either intradermal or systemic injection, with focusing on the mechanisms producing epidermal and dermal cell regeneration. Material and methods: Forty-two adult male Sprague Dawley albino rats were divided into three equal groups (fourteen rats in each group): control group (group I); full thickness surgical skin wound model, Group II: Wound treated with systemic injection of MSCs and Group III: Wound treated with intradermal injection of MSCs. The healing ulcer was examined on day 2, 6, 10 and 15 for gross morphological evaluation and on day 10 and 15 for fluorescent, histological and immunohistochemical studies. Results: The wounds of the control group did not reach complete closure up to the end of the experiment. In MSCs treated groups, better and faster healing of wounds were detected more than the control group. Moreover, the intradermal route of administration of stem cells increased the rate of healing of the wounds more than the systemic injection. In addition, the wounds were found completely healed by the end of the fifteenth day of the experiment in all rats of the group injected intradermally. Microscopically, the wound areas of group III were hardly distinguished from the adjacent normal skin with complete regeneration of all skin layers; epidermis, dermis, hypodermis and underlying muscle layer. Fully regenerated hair follicles and sebaceous glands in the dermis of the healed areas surrounded by different arrangement of collagen fibers with a significant increase in their area percent were recorded in this group more than in other groups. Conclusion: MSCs accelerate the healing process of wound closure. The route of administration of MSCs has a great influence on wound healing as intradermal injection of MSCs was more effective in enhancement of wound healing than systemic injection.

Keywords: intradermal, mesenchymal stem cells, morphology, skin wound, systemic injection

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