1
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Haghdoost A, Mobayen M, Baghi I, Haghani‐Dogahe Z, Zarei R, Pirooz A, Balou HA, Feizkhah A. Potassium permanganate in treatment of diabetic foot ulcer: A randomized clinical trial. Health Sci Rep 2024; 7:e2073. [PMID: 38650725 PMCID: PMC11033332 DOI: 10.1002/hsr2.2073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 02/03/2024] [Accepted: 04/11/2024] [Indexed: 04/25/2024] Open
Abstract
Background and Aims Diabetic foot ulcers (DFU) are a severe complication in diabetes patients, often resulting in significant morbidity and mortality due to non-healing. This study investigated the effectiveness of 5% topical potassium permanganate on these ulcers. Methods A clinical trial was conducted on 23 patients with Wagner grade I and II DFU. Patients in the control group received standard treatment, while those in the intervention group also received 5% potassium permanganate topically. Data were recorded at 0, 7, 14, and 21 days for analysis. Results Among 23 patients studied, 7 (30.4%) were male and 16 (43.7%) female, with an average age of 59 ± 4 years. Both groups showed a statistically significant decrease in wound size and infection over time (p < 0.001). The intervention group, however, had a more substantial reduction in wound size and infection rate (p < 0.05). Conclusion Potassium permanganate, when applied topically, is both well-tolerated and effective in enhancing wound healing and reducing infection in DFU, suggesting its potential as a complementary treatment.
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Affiliation(s)
- Afrooz Haghdoost
- General Surgery DepartmentGuilan University of Medical SciencesRashtIran
| | - Mohammadreza Mobayen
- Burn and Regenerative Medicine Research CenterGuilan University of Medical SciencesRashtIran
| | - Iraj Baghi
- General Surgery DepartmentGuilan University of Medical SciencesRashtIran
| | - Zahra Haghani‐Dogahe
- Burn and Regenerative Medicine Research CenterGuilan University of Medical SciencesRashtIran
| | - Reza Zarei
- Department of Statistics, Faculty of Mathematical SciencesUniversity of GuilanRashtIran
| | - Amir Pirooz
- Clinical Research Development Unit of Poursina HospitalGuilan University of Medical SciencesRashtIran
| | - Heydar Ali Balou
- School of Medicine, Razi HospitalGuilan University of Medical SciencesRashtIran
| | - Alireza Feizkhah
- Burn and Regenerative Medicine Research CenterGuilan University of Medical SciencesRashtIran
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2
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Lu Y, Zhao D, Cao G, Yin S, Liu C, Song R, Ma J, Sun R, Wu Z, Liu J, Wu P, Wang Y. Research progress on and molecular mechanism of vacuum sealing drainage in the treatment of diabetic foot ulcers. Front Surg 2024; 11:1265360. [PMID: 38464666 PMCID: PMC10920358 DOI: 10.3389/fsurg.2024.1265360] [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: 07/22/2023] [Accepted: 01/05/2024] [Indexed: 03/12/2024] Open
Abstract
Diabetic foot ulcers (DFUs) are common chronic wounds and a common complication of diabetes. The foot is the main site of diabetic ulcers, which involve small and medium-sized arteries, peripheral nerves, and microcirculation, among others. DFUs are prone to coinfections and affect many diabetic patients. In recent years, interdisciplinary research combining medicine and material science has been increasing and has achieved significant clinical therapeutic effects, and the application of vacuum sealing drainage (VSD) in the treatment of DFUs is a typical representative of this progress, but the mechanism of action remains unclear. In this review, we integrated bioinformatics and literature and found that ferroptosis is an important signaling pathway through which VSD promotes the healing of DFUs and that System Xc-GSH-GPX4 and NAD(P)H-CoQ10-FSP1 are important axes in this signaling pathway, and we speculate that VSD is most likely to inhibit ferroptosis to promote DFU healing through the above axes. In addition, we found that some classical pathways, such as the TNF, NF-κB, and Wnt/β-catenin pathways, are also involved in the VSD-mediated promotion of DFU healing. We also compiled and reviewed the progress from clinical studies on VSD, and this information provides a reference for the study of VSD in the treatment of DFUs.
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Affiliation(s)
- Yongpan Lu
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
- Jinan Clinical Research Center for Tissue Engineering Skin Regeneration and Wound Repair, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Dejie Zhao
- Department of Vascular Surgery, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Guoqi Cao
- Jinan Clinical Research Center for Tissue Engineering Skin Regeneration and Wound Repair, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Department of Plastic Surgery, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Siyuan Yin
- Jinan Clinical Research Center for Tissue Engineering Skin Regeneration and Wound Repair, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Department of Plastic Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Chunyan Liu
- Jinan Clinical Research Center for Tissue Engineering Skin Regeneration and Wound Repair, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Department of Plastic Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Ru Song
- Jinan Clinical Research Center for Tissue Engineering Skin Regeneration and Wound Repair, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Department of Plastic Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Jiaxu Ma
- Jinan Clinical Research Center for Tissue Engineering Skin Regeneration and Wound Repair, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Department of Plastic Surgery, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Rui Sun
- Jinan Clinical Research Center for Tissue Engineering Skin Regeneration and Wound Repair, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Department of Plastic Surgery, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Zhenjie Wu
- Jinan Clinical Research Center for Tissue Engineering Skin Regeneration and Wound Repair, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Department of Plastic Surgery, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Jian Liu
- Jinan Clinical Research Center for Tissue Engineering Skin Regeneration and Wound Repair, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Department of Plastic Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Peng Wu
- Jinan Clinical Research Center for Tissue Engineering Skin Regeneration and Wound Repair, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Department of Plastic Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Yibing Wang
- Jinan Clinical Research Center for Tissue Engineering Skin Regeneration and Wound Repair, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Department of Plastic Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
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3
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Palaniappan V, Karthikeyan K. Potassium permanganate: A 'Desert Island drug' in Dermatology. Clin Exp Dermatol 2022; 47:1650-1657. [PMID: 35568998 DOI: 10.1111/ced.15261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2022] [Indexed: 11/26/2022]
Abstract
Potassium permanganate (KMnO4) is an over the-counter available astringent with oxidising and antiseptic property used by the dermatologists since ages. It is often used as compresses and baths for various exudative dermatoses. Its advantages include lower cost, good healing rate and reduced allergenic potential. Chemical burns and associated staining of cloths and ceramics are the two important cutaneous adverse effects encountered with its use. Due to the its easy availability, chances for homicidal or accidental ingestion of this drug are high. The focus of this article is to increase awareness among dermatologists about is clinical use, adverse effects, systemic toxicity and its management.
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Affiliation(s)
- Vijayasankar Palaniappan
- Department of Dermatology,Venereology and Leprosy, Sri Manakula Vinayagar Medical College and Hospital, Pondicherry, India
| | - Kaliaperumal Karthikeyan
- Department of Dermatology,Venereology and Leprosy, Sri Manakula Vinayagar Medical College and Hospital, Pondicherry, India
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4
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Christen SM, Gruenert JG, Winsauer S. Benign subcutaneous emphysema: a rare and challenging entity a case report and review of the literature. CASE REPORTS IN PLASTIC SURGERY AND HAND SURGERY 2021; 8:153-157. [PMID: 34621914 PMCID: PMC8491730 DOI: 10.1080/23320885.2021.1984922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We report the case of a craftsman who developed a rapidly progressive subcutaneous emphysema of his forearm after a minor stab injury into the palm of his hand. Based on our case report we discuss differential diagnosis and management of acute subcutaneous emphysema.
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Affiliation(s)
- Samuel M Christen
- Department of Hand, Plastic and Reconstructive Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Joerg G Gruenert
- Department of Hand, Plastic and Reconstructive Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Stefan Winsauer
- Department of Hand, Plastic and Reconstructive Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
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Lyons OT, Saha P, Smith A. Redox dysregulation in the pathogenesis of chronic venous ulceration. Free Radic Biol Med 2020; 149:23-29. [PMID: 31560951 DOI: 10.1016/j.freeradbiomed.2019.09.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/04/2019] [Accepted: 09/20/2019] [Indexed: 12/23/2022]
Abstract
In chronic venous ulcers (CVUs), which account for up to 75% of leg ulcers, the inflammatory stage of wound healing fails to down-regulate, preventing progression to proliferation, remodeling and eventual epithelialisation. The roles of reactive oxygen species (ROS) in the oxidative burst and pathogen killing are well known, but ROS also have important functions in extra-cellular and intra-cellular signalling. Iron deposition, resulting from venous reflux, primes macrophages towards a persistent inflammatory response, with ongoing stimulation by bacteria potentially playing a role. Generation of excessive ROS by activated inflammatory cells causes tissue destruction and disintegration of the dermis, and then at later stages, a failure to heal. Here, we review the evidence for ROS in CVU formation and in normal and delayed healing. We also discuss how ROS modulation might be used to influence the healing of these complex wounds, which cause long-term morbidity and are associated with a significant financial burden to healthcare systems.
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Affiliation(s)
- Oliver Ta Lyons
- Academic Department of Vascular Surgery, School of Cardiovascular Medicine and Sciences, BHF Centre of Research Excellence, King's College London, St Thomas' Hospital, United Kingdom; Basildon and Thurrock University Hospitals NHS Foundation Trust, United Kingdom
| | - Prakash Saha
- Academic Department of Vascular Surgery, School of Cardiovascular Medicine and Sciences, BHF Centre of Research Excellence, King's College London, St Thomas' Hospital, United Kingdom
| | - Alberto Smith
- Academic Department of Vascular Surgery, School of Cardiovascular Medicine and Sciences, BHF Centre of Research Excellence, King's College London, St Thomas' Hospital, United Kingdom.
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Agnihotri G, Gandhi S, Lio PA. Colorful dyes and other vibrant topical creams as treatments for dermatological conditions. DRUGS & THERAPY PERSPECTIVES 2019. [DOI: 10.1007/s40267-019-00665-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Apelqvist J, Willy C, Fagerdahl AM, Fraccalvieri M, Malmsjö M, Piaggesi A, Probst A, Vowden P. EWMA Document: Negative Pressure Wound Therapy. J Wound Care 2019; 26:S1-S154. [PMID: 28345371 DOI: 10.12968/jowc.2017.26.sup3.s1] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
1. Introduction Since its introduction in clinical practice in the early 1990's negative pressure wounds therapy (NPWT) has become widely used in the management of complex wounds in both inpatient and outpatient care.1 NPWT has been described as a effective treatment for wounds of many different aetiologies2,3 and suggested as a gold standard for treatment of wounds such as open abdominal wounds,4-6 dehisced sternal wounds following cardiac surgery7,8 and as a valuable agent in complex non-healing wounds.9,10 Increasingly, NPWT is being applied in the primary and home-care setting, where it is described as having the potential to improve the efficacy of wound management and help reduce the reliance on hospital-based care.11 While the potential of NPWT is promising and the clinical use of the treatment is widespread, highlevel evidence of its effectiveness and economic benefits remain sparse.12-14 The ongoing controversy regarding high-level evidence in wound care in general is well known. There is a consensus that clinical practice should be evidence-based, which can be difficult to achieve due to confusion about the value of the various approaches to wound management; however, we have to rely on the best available evidence. The need to review wound strategies and treatments in order to reduce the burden of care in an efficient way is urgent. If patients at risk of delayed wound healing are identified earlier and aggressive interventions are taken before the wound deteriorates and complications occur, both patient morbidity and health-care costs can be significantly reduced. There is further a fundamental confusion over the best way to evaluate the effectiveness of interventions in this complex patient population. This is illustrated by reviews of the value of various treatment strategies for non-healing wounds, which have highlighted methodological inconsistencies in primary research. This situation is confounded by differences in the advice given by regulatory and reimbursement bodies in various countries regarding both study design and the ways in which results are interpreted. In response to this confusion, the European Wound Management Association (EWMA) has been publishing a number of interdisciplinary documents15-19 with the intention of highlighting: The nature and extent of the problem for wound management: from the clinical perspective as well as that of care givers and the patients Evidence-based practice as an integration of clinical expertise with the best available clinical evidence from systematic research The nature and extent of the problem for wound management: from the policy maker and healthcare system perspectives The controversy regarding the value of various approaches to wound management and care is illustrated by the case of NPWT, synonymous with topical negative pressure or vacuum therapy and cited as branded VAC (vacuum-assisted closure) therapy. This is a mode of therapy used to encourage wound healing. It is used as a primary treatment of chronic wounds, in complex acute wounds and as an adjunct for temporary closure and wound bed preparation preceding surgical procedures such as skin grafts and flap surgery. Aim An increasing number of papers on the effect of NPWT are being published. However, due to the low evidence level the treatment remains controversial from the policy maker and health-care system's points of view-particularly with regard to evidence-based medicine. In response EWMA has established an interdisciplinary working group to describe the present knowledge with regard to NPWT and provide overview of its implications for organisation of care, documentation, communication, patient safety, and health economic aspects. These goals will be achieved by the following: Present the rational and scientific support for each delivered statement Uncover controversies and issues related to the use of NPWT in wound management Implications of implementing NPWT as a treatment strategy in the health-care system Provide information and offer perspectives of NPWT from the viewpoints of health-care staff, policy makers, politicians, industry, patients and hospital administrators who are indirectly or directly involved in wound management.
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Affiliation(s)
- Jan Apelqvist
- Department of Endocrinology, University Hospital of Malmö, 205 02 Malmö, Sweden and Division for Clinical Sciences, University of Lund, 221 00 Lund, Sweden
| | - Christian Willy
- Department of Trauma & Orthopedic Surgery, Septic & Reconstructive Surgery, Bundeswehr Hospital Berlin, Research and Treatment Center for Complex Combat Injuries, Federal Armed Forces of Germany, 10115 Berlin, Germany
| | - Ann-Mari Fagerdahl
- Department of Clinical Science and Education, Karolinska Institutet, and Wound Centre, Södersjukhuset AB, SE-118 83 Stockholm, Sweden
| | - Marco Fraccalvieri
- Plastic Surgery Unit, ASO Città della Salute e della Scienza of Turin, University of Turin, 10100 Turin, Italy
| | | | - Alberto Piaggesi
- Department of Endocrinology and Metabolism, Pisa University Hospital, 56125 Pisa, Italy
| | - Astrid Probst
- Kreiskliniken Reutlingen GmbH, 72764 Reutlingen, Germany
| | - Peter Vowden
- Faculty of Life Sciences, University of Bradford, and Honorary Consultant Vascular Surgeon, Bradford Royal Infirmary, Duckworth Lane, Bradford, BD9 6RJ, United Kingdom
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8
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Hu FX, Hu XX, Yang XL, Han XH, Xu YB, Li K, Yan L, Chu HB. Treatment of large avulsion injury in perianal, sacral, and perineal regions by island flaps or skin graft combined with vacuum assisted closure. BMC Surg 2019; 19:65. [PMID: 31215452 PMCID: PMC6582469 DOI: 10.1186/s12893-019-0529-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 06/09/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Traumatic avulsion injuries to the anus, although uncommon, can result in serious complications and even death. Management of anal avulsion injuries remains controversial and challenging. This study aimed to investigate the clinical effects of treating large skin and subcutaneous tissue avulsion injuries in the perianal, sacral, and perineal regions with island flaps or skin graft combined with vacuum assisted closure. METHODS Island flaps or skin graft combined with vacuum assisted closure, diverting ileostomy, the rectum packed with double-lumen tubes around Vaseline gauze, negative pressure drainage with continuous distal washing, wounds with skin grafting as well as specialized treatment were performed. RESULTS The injuries healed in all patients. Six cases had incomplete perianal avulsion without wound infection. Wound infection was seen in four cases with annular perianal avulsion and was controlled, and the separated prowl lacuna was closed. The survival rate in 10 patients who underwent skin grafting was higher than 90%. No anal stenosis was observed after surgery, and ileostomy closure was performed at 3 months (six cases) and 6 months (four cases) after surgery, respectively. CONCLUSIONS Covering a wound with an island flap or skin graft combined with vacuum assisted closure is successful in solving technical problems, protects the function of the anus and rapidly seals the wound at the same time.
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Affiliation(s)
- Fu Xing Hu
- Department of burn and plastic surgery, the 89th Hospital of PLA, Weifang, 261021, China
| | - Xiao Xuan Hu
- Department of Postgraduate, Ningxia Medical University, Yinchuan, 750004, China
| | - Xue Lin Yang
- Department of burn and plastic surgery, the 89th Hospital of PLA, Weifang, 261021, China
| | - Xing Hai Han
- Department of burn and plastic surgery, the 89th Hospital of PLA, Weifang, 261021, China
| | - Yong Bo Xu
- Department of general surgery, the 89th Hospital of PLA, Weifang, 261021, China
| | - Kun Li
- Department of general surgery, the 89th Hospital of PLA, Weifang, 261021, China
| | - Li Yan
- Department of general surgery, the 89th Hospital of PLA, Weifang, 261021, China.
| | - Hai Bo Chu
- Department of general surgery, the 89th Hospital of PLA, Weifang, 261021, China.
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Li J, Shi JB, Hong P, Wang YS, Ze HR, Lee RJ, Tang X. Combined treatment with vacuum sealing drainage, TopClosure device, and Ilizarov technique for traumatic hemipelvectomy: A rare case report of successful repairing of large-size soft tissue defects. Medicine (Baltimore) 2019; 98:e14205. [PMID: 30681595 PMCID: PMC6358379 DOI: 10.1097/md.0000000000014205] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
RATIONALE Traumatic hemipelvectomy is a rare but lethal catastrophic injury. PATIENT CONCERNS A case of a very young child with open fracture of left sacroiliac joint dislocation and pubic symphysis diastasis, suffered from a severe large-size soft tissue defects. DIAGNOSIS Traumatic hemipelvectomy. INTERVENTIONS Complete amputation was performed and three kinds of surgical techniques including regulated negative pressure-assisted wound therapy (RNPT), TopClosure device, and Ilizarov technique were jointly utilized to secure closure in the further revisions of the soft tissue injury and reconstruct reconstructive surgery. OUTCOMES Six months after hospital discharge, the patient was able to ambulate with a single limb and a prosthesis and she is independent in many activities of daily living currently. LESSONS We report this case to share experience with other clinicians in the management of this deadly extensive defects after traumatic hemipelvectomy in patients.
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Affiliation(s)
- Jin Li
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Jie Bao Shi
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Pan Hong
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Yu Shang Wang
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Hao Ren Ze
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Rushyuan Jay Lee
- Department of Orthopaedic Surgery, Bloomberg Children's Hospital, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Xin Tang
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
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Delgado-Enciso I, Madrigal-Perez VM, Lara-Esqueda A, Diaz-Sanchez MG, Guzman-Esquivel J, Rosas-Vizcaino LE, Virgen-Jimenez OO, Kleiman-Trujillo J, Lagarda-Canales MR, Ceja-Espiritu G, Rangel-Salgado V, Lopez-Lemus UA, Delgado-Enciso J, Lara-Basulto AD, Soriano Hernández AD. Topical 5% potassium permanganate solution accelerates the healing process in chronic diabetic foot ulcers. Biomed Rep 2018; 8:156-159. [PMID: 29435274 PMCID: PMC5778841 DOI: 10.3892/br.2018.1038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 12/01/2017] [Indexed: 12/26/2022] Open
Abstract
Potassium permanganate has been reported to be an effective treatment for certain types of wounds. The aim of the present study was to evaluate the use of potassium permanganate in the treatment of diabetic foot ulcers. A single-blind, randomized, controlled clinical trial was conducted on patients with type 2 diabetes mellitus that presented with a foot ulcer persisting for >3 months. The control group (n=10) was treated with the current standard treatment, which comprises of measures for reducing pressure in the ulcerated area, daily cleansing of the ulcer with potable water and antiseptic wash solution, and the application of a disinfectant solution on the entire surface area of the ulcer; while the intervention group (n=15) received the standard treatment plus 5% topical potassium permanganate solution applied once a day for 21 days. In the intervention group, 1 patient did not tolerate the treatment and was eliminated from the study on the first day. The remaining patients tolerated the interventions well. At the end of the treatment period, ulcers in the control group had decreased by 38% whereas those in the intervention group decreased by 73% (P<0.009). The degree of decrease was also investigated; the ulcer size was ≥50% decreased in 40% of patients in the control group and in 86% of patients in the intervention group (P=0.02). In conclusion, the results of the present study indicate that topical potassium permanganate is well tolerated and significantly accelerates the healing process of diabetic foot ulcers.
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Affiliation(s)
- Iván Delgado-Enciso
- Department of Research, Cancerology State Institute, Colima State Health Services, Colima 28085, Mexico.,Department of Public Health, School of Medicine, University of Colima, Las Víboras, Colima 28040, Mexico
| | - Violeta M Madrigal-Perez
- Department of Public Health, School of Medicine, University of Colima, Las Víboras, Colima 28040, Mexico
| | - Agustin Lara-Esqueda
- Department of Research, Cancerology State Institute, Colima State Health Services, Colima 28085, Mexico
| | - Martha G Diaz-Sanchez
- Department of Research, Cancerology State Institute, Colima State Health Services, Colima 28085, Mexico
| | - Jose Guzman-Esquivel
- Department of Research, Cancerology State Institute, Colima State Health Services, Colima 28085, Mexico
| | - Luis E Rosas-Vizcaino
- Department of Research, Cancerology State Institute, Colima State Health Services, Colima 28085, Mexico
| | - Oscar O Virgen-Jimenez
- Department of Research, Cancerology State Institute, Colima State Health Services, Colima 28085, Mexico
| | - Juleny Kleiman-Trujillo
- Department of Research, Cancerology State Institute, Colima State Health Services, Colima 28085, Mexico
| | - Maria R Lagarda-Canales
- Department of Research, Cancerology State Institute, Colima State Health Services, Colima 28085, Mexico
| | - Gabriel Ceja-Espiritu
- Department of Public Health, School of Medicine, University of Colima, Las Víboras, Colima 28040, Mexico
| | - Viridiana Rangel-Salgado
- Department of Research, Cancerology State Institute, Colima State Health Services, Colima 28085, Mexico
| | - Uriel A Lopez-Lemus
- Department of Public Health, School of Medicine, University of Colima, Las Víboras, Colima 28040, Mexico
| | - Josuel Delgado-Enciso
- Department of Research, Foundation for Cancer Ethics, Education and Research of the Cancerology State Institute, Colima 28085, Mexico
| | - Agustin D Lara-Basulto
- Department of Research, Cancerology State Institute, Colima State Health Services, Colima 28085, Mexico
| | - Alejandro D Soriano Hernández
- Department of Research, Cancerology State Institute, Colima State Health Services, Colima 28085, Mexico.,Department of Public Health, School of Medicine, University of Colima, Las Víboras, Colima 28040, Mexico
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11
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Zhai B, Jin X, Wang R, Fang T, Qu J, Wang Y, Liu M, Xu L. Applying negative pressure wound therapy in associating liver partition and portal vein ligation for staged hepatectomy: A case report. Exp Ther Med 2017; 14:642-646. [PMID: 28672979 PMCID: PMC5488412 DOI: 10.3892/etm.2017.4566] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 03/03/2017] [Indexed: 12/30/2022] Open
Abstract
Staged hepatectomy, particularly associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a recently developed advanced surgery for resecting liver tumors. However, large wound surfaces, incomplete drainage and high rates of mortality are vital limitations of ALPPS. The present case study describes a patient with liver cancer who underwent ALPPS surgery combined with negative pressure wound therapy. A 46-year-old male patient was hospitalized due to right upper abdominal pain. Computed tomography and magnetic resonance cholangiopancreatography scan results indicated gallbladder cancer, accompanied by multiple liver metastases. Resection of the right trisegment and partial resection of metastatic nodules in the left outer lobe were performed. Vacuum sealing drainage was pre-implanted at liver cross-sections with drainage tubes to drain the bile. The patient exhibited improved wound healing compared with conventional ALPPS.
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Affiliation(s)
- Bo Zhai
- Department of General Surgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
| | - Xin Jin
- Department of General Surgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
| | - Rui Wang
- Department of Gastroenterology, Heilongjiang Provincial Hospital, Harbin, Heilongjiang 150036, P.R. China
| | - Taishi Fang
- Department of General Surgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
| | - Jing Qu
- Department of Orthopedics, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
| | - Ying Wang
- Department of Anesthesiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
| | - Ming Liu
- Department of General Surgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
| | - Lishan Xu
- Department of General Surgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
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Abstract
BACKGROUND Gas gangrene is a rapidly progressive and severe disease that results from bacterial infection, usually as the result of an injury; it has a high incidence of amputation and a poor prognosis. It requires early diagnosis and comprehensive treatments, which may involve immediate wound debridement, antibiotic treatment, hyperbaric oxygen therapy, Chinese herbal medicine, systemic support, and other interventions. The efficacy and safety of many of the available therapies have not been confirmed. OBJECTIVES To evaluate the efficacy and safety of potential interventions in the treatment of gas gangrene compared with alternative interventions or no interventions. SEARCH METHODS In March 2015 we searched: The Cochrane Wounds Group Specialized Register, The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), Ovid MEDLINE, Ovid EMBASE, EBSCO CINAHL, Science Citation Index, the China Biological Medicine Database (CBM-disc), the China National Knowledge Infrastructure (CNKI), and the Chinese scientific periodical database of VIP INFORMATION (VIP) for relevant trials. We also searched reference lists of all identified trials and relevant reviews and four trials registries for eligible research. There were no restrictions with respect to language, date of publication or study setting. SELECTION CRITERIA We selected randomized controlled trials (RCTs) and quasi-RCTs that compared one treatment for gas gangrene with another treatment, or with no treatment. DATA COLLECTION AND ANALYSIS Independently, two review authors selected potentially eligible studies by reviewing their titles, abstracts and full-texts. The two review authors extracted data using a pre-designed extraction form and assessed the risk of bias of each included study. Any disagreement in this process was solved by the third reviewer via consensus. We could not perform a meta-analysis due to the small number of studies included in the review and the substantial clinical heterogeneity between them, so we produced a narrative review instead. MAIN RESULTS We included two RCTs with a total of 90 participants. Both RCTs assessed the effect of interventions on the 'cure rate' of gas gangrene; 'cure rate' was defined differently in each study, and differently to the way we defined it in this review.One trial compared the addition of Chinese herbs to standard treatment (debridement and antibiotic treatment; 26 participants) against standard treatment alone (20 participants). At the end of the trial the estimated risk ratio (RR) of 3.08 (95% confidence intervals (CI) 1.00 to 9.46) favoured Chinese herbs. The other trial compared standard treatment (debridement and antibiotic treatment) plus topical hyperbaric oxygen therapy (HBOT; 21 participants) with standard treatment plus systemic HBOT (23 participants). There was no evidence of difference between the two groups; RR of 1.10 (95% CI 0.25 to 4.84). For both comparisons the GRADE assessment was very low quality evidence due to risk of bias and imprecision so further trials are needed to confirm these results.Neither trial reported on this review's primary outcomes of quality of life, and amputation and death due to gas gangrene, or on adverse events. Trials that addressed other therapies such as immediate debridement, antibiotic treatment, systemic support, and other possible treatments were not available. AUTHORS' CONCLUSIONS Re-analysis of the cure rate based on the definition used in our review did not show beneficial effects of additional use of Chinese herbs or topical HBOT on treating gas gangrene. The absence of robust evidence meant we could not determine which interventions are safe and effective for treating gas gangrene. Further rigorous RCTs with appropriate randomisation, allocation concealment and blinding, which focus on cornerstone treatments and the most important clinical outcomes, are required to provide useful evidence in this area.
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Affiliation(s)
- Zhirong Yang
- School of Public Health, Peking UniversityCentre for Evidence Based Medicine and Clinical Research, Department of Epidemiology and Biostatistics38 Xueyuan Road, Haidian DistrictBeijingChina100191
- University of CambridgePrimary Care Unit, Department of Public Health and Primary CareCambridgeUKCB1 8RN
| | - Jing Hu
- School of Public Health, Peking UniversityCentre for Evidence Based Medicine and Clinical Research, Department of Epidemiology and Biostatistics38 Xueyuan Road, Haidian DistrictBeijingChina100191
| | - Yanji Qu
- School of Public Health, Peking UniversityCentre for Evidence Based Medicine and Clinical Research, Department of Epidemiology and Biostatistics38 Xueyuan Road, Haidian DistrictBeijingChina100191
| | - Feng Sun
- School of Public Health, Peking UniversityCentre for Evidence Based Medicine and Clinical Research, Department of Epidemiology and Biostatistics38 Xueyuan Road, Haidian DistrictBeijingChina100191
| | - Xisheng Leng
- Peking University People's HospitalDepartment of Surgery11 Xizhimen South StreetBeijingXicheng DistrictChina100044
| | - Hang Li
- Peking University First HospitalDermatologic Department8 Xishiku Main StreetBeijingXicheng DistrictChina100034
| | - Siyan Zhan
- School of Public Health, Peking UniversityCentre for Evidence Based Medicine and Clinical Research, Department of Epidemiology and Biostatistics38 Xueyuan Road, Haidian DistrictBeijingChina100191
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