The wound environment, microbial virulence and postoperative infection: Practical lessons for the surgeon

Recent advancements in cellulose-based biomaterials for management of infected wounds

INTRODUCTION

Chronic wounds are a substantial burden on the healthcare system. Their treatment requires advanced dressings, which can provide a moist wound environment, prevent bacterial infiltration, and act as a drug carrier. Cellulose is biocompatible, biodegradable, and can be functionalized according to specific requirements, which makes it a highly versatile biomaterial. Antimicrobial cellulose dressings are proving to be highly effective against infected wounds.

AREAS COVERED

This review briefly addresses the mechanism of wound healing and its pathophysiology. It also discusses wound infections, biofilm formation, and progressive emergence of drug-resistant bacteria in chronic wounds and the treatment strategies for such types of infected wounds. It also summarizes the general properties, method of production, and types of cellulose wound dressings. It explores recent studies and advancements regarding the use of cellulose and its derivatives in wound management.

EXPERT OPINION

Cellulose and its various functionalized derivatives represent a promising choice of wound dressing material. Cellulose-based dressings loaded with antimicrobials are very useful in controlling infection in a chronic wound. Recent studies showing its efficacy against drug-resistant bacteria make it a favorable choice for chronic wound infections. Further research and large-scale clinical trials are required for better clinical evidence of its efficiency.

The role of lipid peroxidation products and antioxidant enzymes in the pathogenesis of aseptic and purulent inflammation in cats

Objective:

The work aimed to determine the state of lipid peroxidation products and the activity of the antioxidant system in cats with aseptic inflammation and purulent-inflammatory processes of varying severity.

Materials and Methods:

The intensity of the process of lipid peroxidation- antioxidant system processes in blood plasma was evaluated using commercial kits. The level of diene conjugates (DC), the content of malondialdehyde (MDA), the level of medium-weight molecules were determined from lipid peroxidation indices. The state of antioxidant protection was assessed by indicators of superoxide dismutase (SOD) activity, catalase (CT), ceruloplasmin (CP) concentration, glutathione peroxidase activity, glutathione reductase (GLR), and total antioxidant activity (AOA).

Results:

With aseptic inflammation in the blood of cats, a slow activation of peroxidation reactions occurred. The DC indicator increased by 1.4 times, the SOD level rose by 1.38 times, the amount of GLR by 1.04 times, and the activation of total AOA by 9.06. In sepsis, the values of DC, MDA, and medium-weight molecules increased by 4.4, 8.4, and 8.8 times, respectively. With abscesses in the blood of cats, an increase in CT, CP, and GLR is observed against a background of a decrease in glutathione peroxidase. With purulent wounds, the total AOA of plasma increases by 2.5 times; with abscesses, the total AOA increases by 1.9 times, and with sepsis, it decreases by 1.5 times.

Conclusion:

With surgical infections in cats, deep biochemical changes or irreversible biochemical changes (in sepsis) occur that indicate a significantly enhanced catabolic orientation of metabolic processes and the accumulation of toxic metabolites, which leads to damage and a decrease in tissue regenerative capacity.

Surgical site infection prevention measures in General Surgery: Position statement by the Surgical Infections Division of the Spanish Association of Surgery

Surgical site infection is associated with prolonged hospital stay and increased morbidity, mortality and healthcare costs, as well as a poorer patient quality of life. Many hospitals have adopted scientifically-validated guidelines for the prevention of surgical site infection. Most of these protocols have resulted in improved postoperative results. The Surgical Infection Division of the Spanish Association of Surgery conducted a critical review of the scientific evidence and the most recent international guidelines in order to select measures with the highest degree of evidence to be applied in Spanish surgical services. The best measures are: no removal or clipping of hair from the surgical field, skin decontamination with alcohol solutions, adequate systemic antibiotic prophylaxis (administration within 30-60minutes before the incision in a single preoperative dose; intraoperative re-dosing when indicated), maintenance of normothermia and perioperative maintenance of glucose levels.