This is a protocol for a Cochrane Review (intervention). The objectives are as follows:
To assess the effects of NPWT on primary fascial closure for managing the open abdomen in non‐trauma patients ...in any care setting.
Role of Surgical Drains in Orthopedics Goel, Aditya; Singh, Shivendra; Shukla, Navin K.
Journal of orthopaedic diseases and traumatology,
09/2023, Volume:
6, Issue:
3
Journal Article
Peer reviewed
Open access
Abstract
Introduction:
The use of drains in orthopedic practice has been affected by the concept of evidence-based medicine, which is accepted as the standard of care for all surgical or medical ...practices. This concept questions all care processes that cannot be backed by evidence to be beneficial to the patient. There have been a large number of multi-center meta-analytical studies that have found drains to be of little or no benefit in trauma and orthopedic surgeries. As a result of these studies, there are few situations where drains are routinely used, such as calcaneal fractures in developed countries. Even major procedures such as total knee and arthroplasties are being performed without drains. We aim to investigate whether similar evidence can be found in our practice.
Materials and Methods:
This sounds like the description of a prospective randomized controlled trial studying the use of drains in certain types of surgical procedures. The study population consisted of 86 patients matched for sex and type of injury, and they were assigned to either a group that used drains or a group that did not use drains during their operations. The study aimed to observe and compare the rates of complications, such as hematoma, drain migration, infection, and inadvertent drain stitching, between the two groups.
Results:
Eighty-six major orthopedic operations were studied. There was no evidence of the occurrence of complication arising from nonuse of drains in the undrained group. Those patients whose wounds were drained had no need for drain change, thus making the wound care less eventful.
Conclusion:
Wound drains can help reduce tissue swelling in the postoperative period, but there is no significant difference in infection rates, hematoma, or seroma formation between drained and undrained wounds.
Aims and Objectives
To explore surgeons’ and nurses’ perspectives of managing surgical wounds healing by secondary intention.
Background
Every year, more than 10 million surgical operations are ...performed in the NHS in the UK. Most surgical wounds heal by primary intention, where the edges of the wound are brought together with staples, sutures, adhesive glue or clips. Sometimes wounds are deliberately left open to heal, from the base up, known as “healing by secondary intention.” These wounds are often slow to heal, prone to infection and complex to manage.
Design
A qualitative, descriptive approach, using semi‐structured interviews.
Methods
Interviews with five (general, vascular and plastic) surgeons and 7 nurses (3 tissue viability nurses, 2 district and 1 community nurse, and 1 hospital nurse) working in hospital and community care settings in two locations in the north of England. Data analysis followed the recommended sequential steps of “Framework” approach. Consolidated criteria for reporting qualitative research guided the study report.
Results
Participants reported that the main types of wounds healing by secondary intention that they manage are extensive abdominal cavity wounds; open wounds relating to treatment for pilonidal sinus; large open wounds on the feet of patients with diabetes; and axilla and groin wounds, associated with removal of lymph nodes for cancer. Infection and prolonged time to healing were the main challenges. Negative pressure wound therapy was the most favoured treatment option.
Conclusions
Negative pressure wound therapy was advocated by professionals despite a lack of research evidence indicating clinical or cost‐effectiveness. Our findings underscore the need for rigorous evaluation of negative pressure wound therapy, and other wound care treatments, through studies that include economic evaluation.
Relevance for clinical practice
Clinical decision‐making in wound care could be optimised through further robust studies to inform practitioners about the cost‐effectiveness of available treatments.
Stability Evaluation of Royal Jelly Gel Rizki, Putri Anugrah; Krisnamurti, Desak Gede Budi; Reksodiputro, Mirta Hediyati ...
Acta Universitatis Agriculturae et Silviculturae Mendelianae Brunensis,
05/2023, Volume:
71, Issue:
2
Journal Article
Peer reviewed
Open access
Scars that occur in surgical wounds are still a health problem worldwide. Excessive scarring significantly affects the patientʹs quality of life, both physically and psychologically, and can also ...cause pain, pruritus, and contractures and cost a considerable amount of money. Therefore, it is essential to find dressings that improve a patient's prognosis. Topical therapy for treating scars is becoming popular because it is easy to use, convenient, non-invasive, and relatively inexpensive. However, no single therapy provides optimal results to eliminate hypertrophic scar formation. For most people in the world, herbs are easier to obtain because they are widely available at relatively affordable prices, so herbal therapy is still the main choice in wound healing management. Nowadays, the selection of natural ingredients such as Royal Jelly (RJ) has increased in popularity and is in demand by the public for improving the healing of surgical wounds. The study found that the flavonoid content in the sample was equivalent to quercetin and that the total phenol content in the royal jelly extract ranged from 1.41% to 1.66%. The stability test showed that the royal jelly was stable in different conditions for up to 28 days, with no significant changes observed in pH, color, smell, texture, or spreadability.
Dehiscence and infection of hard-to-heal surgical wounds results in an increased risk of complications and mortality. A hard-to-heal surgical wound will present decreased levels of growth factors ...along with increased levels of debris and matrix metalloproteinases, resulting in the destruction of the extracellular matrix (ECM). ActiGraft (RedDress Ltd., Israel) is an autologous whole blood clot treatment, created at a point of care, to promote wound healing. We hereby present the efficacy of ActiGraft in a case series of hard-to-heal surgical wounds.
A registry study of patients with surgical wounds was conducted in private clinics and hospitals across the US and Israel (NCT04699305). Autologous whole blood clot was created at point of care using the patient's own blood.
A total of 14 patients took part in the study. Autologous whole blood clot treatment resulted in a mean percent wound area reduction of 72.33% at four weeks, with 33.33% of wounds achieving complete closure by week 4. At week 12, 78.54% of the wounds achieved complete closure.
Surgical wounds in patients with comorbidities may fail to initiate the natural wound healing mechanism which in turn may cause deterioration of the wound into a hard-to-heal stage. In this case series, autologous whole blood clot treatment was able to restore wound healing, avoiding the risk of infection and amputation of an affected limb. The properties of autologous whole blood clot as an ECM reduce the risk of infection, causing the wound to progress from the inflammatory phase to the proliferative phase. Autologous whole blood clot treatment in hard-to-heal surgical wounds was found to be an effective approach, reducing the risk of infection and promoting cell granulation, resulting in wound closure.
The present study focuses on the preparation of nanoparticles-loaded ionic cross-linked films for the topical delivery of cefazolin. The aim of the study was to prepare a dosage form which can ...provide local effect of cefazolin along with sustained delivery at the site of application. Cefazolin was loaded into chitosan nanoparticles to mask the burst release of the drug and they were optimized based on particle size, PDI, % EE and zeta potential. Finally, the prepared nanoparticles were loaded into the films comprising of sodium alginate and pectin which were then subjected to cross-linking via calcium chloride to improve the mechanical strength of the hydrogel films upon exposure to wound fluid. The films were assessed for physical and mechanical properties, swelling behavior, water transmission rate, mucoadhesion, FTIR, DSC, percent inhibition assay and in vitro release profile. Optimized formulation with Cefazolin nanoparticles in the size range of 227 nm and 0.5% CL films showed significantly better results (p < 0.05) as compared to the films with increased cross-linker concentration. Therefore, 0.5% CL films were considered more suitable for the treatment of infections when applied as wound dressing.
The morbidity rate following a surgical procedure increasing rapidly in the cases associated with surgical site infections. Traditional sutures lack the ability to deliver drugs as the incorporation ...of the drug in their structure would hamper their mechanical properties. To prevent such infections, we developed an extracellular matrix mimicking electrospun nanofibrous yarns of poly-(D,L)-lactic acid and polyvinyl alcohol loaded with vancomycin and ferulic acid, prepared by uniaxial electrospinning technique.
characterization such as scanning electron microscopy, Fourier transform infrared spectroscopy, x-ray diffraction, tensile strength testing, degradation studies, and antimicrobial studies along with
evaluation done with help of incision wound healing rat model and simultaneous testing of microbial load in the incised tissue. The
studies indicated the nanofiber yarns have size range 200-300 nm with a tensile strength of 7.54 ± 0.58 MPa. The dual drug-loaded yarn showed sustained drug release over a period of 48 h.
water uptake and biodegradation data indicated optimum results suitable for suturing applications. Antimicrobial study showed excellent antimicrobial activity against both
Results obtained from
study suggested excellent wound healing potential of nanofiber yarns as compared with commercial silk sutures. The histopathological studies confirmed restoring ability of nanofiber yarn to the normal skin structure. Enzyme-linked immunosorbent assay (ELISA) study revealed the downregulation of inflammatory markers i.e. TNF-alpha and IL-6, making nanofibers sutures suitable for surgical wound healing applications. Overall, the present study may conclude that the developed dual drug-loaded nanofiber yarns have excellent potential in surgical wound healing applications.
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