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Hom DB, Davis ME. Reducing Risks for Poor Surgical Wound Healing. Facial Plast Surg Clin North Am 2023; 31:171-181. [PMID: 37001921 PMCID: PMC11081059 DOI: 10.1016/j.fsc.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
This review summarizes common risk factors for poor surgical healing on the face and neck and a generalized approach to treating a delayed healing wound. During the preoperative evaluation patients should be screened for prior irradiation, cigarette or e-cigarette use, chronic steroid use, alcoholism, diabetes, malnutrition, and other chronic medical conditions and medications. Despite the surgeon's best efforts to prevent poor surgical healing, some wounds may display signs of persistent inflammation. The facial plastic surgeon should be astute in recognizing delayed healing and identifying intrinsic and extrinsic risk factors so that timely intervention can be performed.
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Affiliation(s)
- David B Hom
- Department of Otolaryngology Head and Neck Surgery, University of California San Diego School of Medicine.
| | - Morgan E Davis
- Department of Otolaryngology Head and Neck Surgery, University of California San Diego School of Medicine
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Duman E, Ceylan KC, Akpınar D, Yücel N, Ünsal Ş, Duman S, Kaya ŞÖ. The effects of steroidal and non-steroidal anti-inflammatory drugs on tracheal wound healing in an experimental rat model. Interact Cardiovasc Thorac Surg 2020; 30:646-651. [PMID: 31953943 DOI: 10.1093/icvts/ivz309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 10/23/2019] [Accepted: 10/31/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The effect of non-steroidal anti-inflammatory drugs (NSAID), mostly used for postoperative analgesic purposes for wound healing, is still a matter of debate. Our goal was to evaluate the effects of the most widely used NSAID and corticosteroids after surgical operations on tracheal wound healing in an experimental rat model. METHODS Thirty-nine male Wistar albino rats were included in this study. Tracheotomy was performed in 32 rats; then they were divided into 3 groups. After the first day, the animals in group 1 were treated with an NSAID (diclofenac 10 mg/kg/day) (NSAID, n = 12) for 7 days; the animals in group 2 were treated with a corticosteroid (dexamethasone, 2 × 0.1 mg/kg/day) (steroid, n = 10) for 7 days; the animals in group 3 (control, n = 10) were not given any medications. For a fourth group (histological control, n = 7), in order to evaluate normal morphological and histological characteristics, neither surgery nor medication was used. Five rats were eliminated from the study (2 rats in the NSAID group died and 3 rats in the steroid group developed local wound infections). The drop-out rate was 12.8%. Histological characteristics, inflammation, fibrosis, necrosis, neochondrogenesis, neovascularization and epithelization were evaluated in 34 rats. Non-parametric tests were used for statistical analysis. RESULTS Inflammation, vascularization and number of fibroblasts and chondrocytes were significantly higher in the control group than in the histological control group. There was some reduction in all parameters except vascularization in the NSAID group (P > 0.05). When the steroid group was compared to the NSAID group, inflammation (P < 0.05), vascularization and number of chondrocytes (P > 0.05) were more suppressed in the steroid group. The number of fibroblasts increased in the steroid group (P > 0.05). CONCLUSIONS Steroids and NSAID may have negative effects on tracheal wound healing, probably by suppressing inflammation and fibroblast proliferation. NSAID was mostly used postoperatively for analgesic purposes and should be avoided.
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Affiliation(s)
- Elif Duman
- Bozyaka Teaching and Research Hospital, Thoracic Surgery Clinic, Izmir, Turkey
| | - Kenan Can Ceylan
- Dr. Suat Seren Chest Diseases and Chest Surgery Teaching Hospital, Thoracic Surgery Clinic, Izmir, Turkey
| | - Deniz Akpınar
- Tekirdag Government Hospital, Thoracic Surgery Clinic, Tekirdag, Turkey
| | - Nur Yücel
- Pathology Department, Dr. Suat Seren Chest Diseases and Chest Surgery Teaching Hospital, Izmir, Turkey
| | - Şaban Ünsal
- Dr. Suat Seren Chest Diseases and Chest Surgery Teaching Hospital, Thoracic Surgery Clinic, Izmir, Turkey
| | - Soner Duman
- Nephrology Department, Ege University Medical School, Faculty, Izmir, Turkey
| | - Şeyda Örs Kaya
- Dr. Suat Seren Chest Diseases and Chest Surgery Teaching Hospital, Thoracic Surgery Clinic, Izmir, Turkey
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Ekinci A, Koc S, Erdoğan AS, Kesici H. Profilactic role of simvastatin and mitomycin C in tracheal stenosis after tracheal damage: Study in rats. Int J Pediatr Otorhinolaryngol 2018; 105:79-84. [PMID: 29447825 DOI: 10.1016/j.ijporl.2017.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 09/28/2017] [Accepted: 10/03/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES We aimed to investigate the prophylactic effect simvastatin of and mitomycin C (MMC) on laryngeal and tracheal stenosis in tracheotomised rats by histopathological evaluation of laryngotracheal segment. Randomized prospective single-blind. MATERIAL AND METHOD Standard vertical tracheotomy was performed on 24 rats. Then the animals were randomly divided into three groups as A, B and C. In group A 0.4 mg/day once daily mitomycin C was injected to the paratracheal region for 14 days. In group B daily 30 mg/kg/day simvastatin was given via gavage to rats for 14 days. In group C 2 cc/day intraperitoneal saline given to rats and the created control group by 14 days follow up. After 10 days, tracheal cannulas were removed. Three weeks later, all animals were euthanized and trachea specimens were harvested. The present study investigates the effects of MMC and Simvastatin on fibrosis, inflammation, stenosis index and tracheal wall thickness in a tracheal injury model. RESULTS The difference between the groups in terms of degree of inflammation scores was statistically insignificant (P = 0,187). Differences between the groups were found to be insignificant in terms of the preventionof fibrosis (P = 0,993). There was no significant difference between groups in terms of stenosis index (P = 0.645). In terms of wall thickness, control, simvastatin and mitomycin C groups were statistically different (p = 0.038). The difference between post-hoc test results was between Mitomycin C and control groups (p = 0.036). Maximum wall thickness in the MMC group (0,299 mm) was significantly lower compared to the control group (0,382 mm)(P < 0,0001). Maximum wall thickness was statistically lower in the simvastatin (0.324 mm) group compared with the control group (0.382 mm) (P < 0.0001). There was no statistically significant difference between the simvastatin group (0,198 mm) and control group (0,200 mm) with respect to minimum wall thickness (P = 0.982). Minimum wall thickness was significantly lower in the mitomycin-C group (0,160 mm) comparison to the control group (0,200 mm) (P < 0.0001). CONCLUSION It was detected that the simvastatin and MMC is not effective in preventing the tracheal stenosis, inflammation and fibrosis formation.
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Affiliation(s)
- Adnan Ekinci
- HititUniversity, Faculty of Medicine, Otorhinolaryngology Department, Çorum, Turkey.
| | - Sema Koc
- Antalya Research and Training Hospital Department of Otolaryngology, Antalya, Turkey.
| | - Ahmet Serhat Erdoğan
- Gaziosmanpasa University, Faculty of Medicine, Otorhinolaryngology Department, Tokat, Turkey.
| | - Hakan Kesici
- Gaziosmanpasa University, Faculty of Medicine, Histology and Embryology Department, Tokat, Turkey.
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Resection of falx and parasagittal meningioma: complication avoidance. J Neurooncol 2016; 130:253-262. [DOI: 10.1007/s11060-016-2283-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 10/01/2016] [Indexed: 11/25/2022]
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Is Mycophenolate Mofetil an Alternative Agent to Corticosteroids in Traumatic Nerve Paralysis? J Craniofac Surg 2014; 25:e510-3. [DOI: 10.1097/scs.0000000000001012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Obesity and surgical wound healing: a current review. ISRN OBESITY 2014; 2014:638936. [PMID: 24701367 PMCID: PMC3950544 DOI: 10.1155/2014/638936] [Citation(s) in RCA: 127] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Accepted: 11/17/2013] [Indexed: 12/15/2022]
Abstract
Objective. The correlation between obesity and deficient wound healing has long been established. This review examines the current literature on the mechanisms involved in obesity-related perioperative morbidity. Methods. A literature search was performed using Medline, PubMed, Cochrane Library, and Internet searches. Keywords used include obesity, wound healing, adipose healing, and bariatric and surgical complications. Results. Substantial evidence exists demonstrating that obesity is associated with a number of postoperative complications. Specifically in relation to wound healing, explanations include inherent anatomic features of adipose tissue, vascular insufficiencies, cellular and composition modifications, oxidative stress, alterations in immune mediators, and nutritional deficiencies. Most recently, advances made in the field of gene array have allowed researchers to determine a few plausible alterations and deficiencies in obese individuals that contribute to their increased risk of morbidity and mortality, especially wound complications. Conclusion. While the literature discusses how obesity may negatively affect health on various of medical fronts, there is yet to be a comprehensive study detailing all the mechanisms involved in obesity-related morbidities in their entirety. Improved knowledge and understanding of obesity-induced physiological, cellular, molecular, and chemical changes will facilitate better assessments of surgical risks and outcomes and create efficient treatment protocols for improved patient care of the obese patient population.
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Bartlett R, Hartle AJ. Routine use of dexamethasone for postoperative nausea and vomiting: the case against. Anaesthesia 2013; 68:892-6. [DOI: 10.1111/anae.12309] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- R. Bartlett
- St Mary's Hospital; Imperial College Healthcare NHS Trust; London; UK
| | - A. J. Hartle
- St Mary's Hospital; Imperial College Healthcare NHS Trust; London; UK
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Gunes Bilgili S, Calka O, Akdeniz N, Bayram I, Metin A. The effects of retinoids on secondary wound healing: biometrical and histopathological study in rats. J DERMATOL TREAT 2012; 24:283-9. [PMID: 22646471 DOI: 10.3109/09546634.2012.697985] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE A wound healing is a complex process, and the role of retinoids in this process is debated and controversial. In this study, the effect of topical tretinoin and oral acitretin on wound healing process was investigated in full-thickness skin lesions on rat model. METHOD A circular full-thickness wound was created by 6 mm punch biopsy on the back side of 32 male rats. The rats were seperated into four equal. The first group was assigned as a control group and was observed with no treatment. The second group was administered dexpanthenol once a day over wound area. In the third group, 0.1% tretinoin cream was applied daily. In the fourth group, 2.5 mg/kg/day acitretin was given daily. Additionally, the biopsies were taken from wounds for the histopathologic examination. RESULTS The complete recovery time was remarkably longer in the tretionin group than the control group and the dexpantenol group (p < 0.05). The average complete recovery time was significantly longer in the acitretin group than the control and dexpanthenol groups whereas it was statistically shorter in the acitrein group than the tretionin group (p < 0.05). CONCLUSION Based on our findings, topical tretinoin and oral acitretin can delay secondary wound healing, epithelization and angiogenesis.
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Affiliation(s)
- Serap Gunes Bilgili
- Department of Dermatology, Yuzuncu Yil University Faculty of Medicine, Van, Turkey.
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Georgiev-Hristov T, García-Arranz M, García-Gómez I, García-Cabezas MA, Trébol J, Vega-Clemente L, Díaz-Agero P, García-Olmo D. Sutures enriched with adipose-derived stem cells decrease the local acute inflammation after tracheal anastomosis in a murine model. Eur J Cardiothorac Surg 2012; 42:e40-7. [PMID: 22689184 DOI: 10.1093/ejcts/ezs357] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES Local inflammatory reaction and tension are the main causes of postoperative complications after tracheal surgery. Adipose-derived stem cells (ASCs) are known to have immunomodulatory activity. The exact mechanism of this activity is not known, although it is possible that they modulate the function of different cells involved in the immune response. Little is known of their impact on acute inflammation, especially in the problematic tracheal area. We aimed to study the effect of ASCs applied locally in an animal model of tracheal resection and anastomosis. METHODS ASCs from the subcutaneous fat of BDIX rats were infected for expression of the enhanced green fluorescent protein (eGFP) and were cultured with Polyglactin 910 sutures to obtain biosutures (ASC-coated sutures). After tracheal resection, 90 BDIX rats (syngeneic, autologous model) underwent anastomosis with biosutures (1.5 10(6) cells/biosuture [Group 1] or 0.5 10(6) cells/biosuture [Group 2]) or conventional sutures (Group 3). The animals were killed after 1, 4, 10, 30 or 60 days and histological and immunofluorescence studies were performed on the anastomotic areas. Inflammatory cell densities were graded semiquantitatively by the pathologist in a blinded fashion. RESULTS In the early period (1 and 4 days), the biosuture groups presented an atypical pattern of acute inflammation, characterized by the almost complete absence of neutrophils, and the presence of abundant lymphocytes and plasma cells, compared with the control group (P < 0.05). Moreover, abundant macrophages/monocytes were immunolocated around blood vessels near the biosutures and between biosuture threads 1 day after anastomosis, whereas the presence of macrophages/monocytes in animals treated with conventional sutures was discrete (P < 0.05). No differences were observed in the later period. No side effects in the biosuture groups were found. CONCLUSIONS Biosutures are a comfortable way of stem cell delivery to the surgical field without modification of the operative protocol. ASCs suppress the local acute inflammatory reaction (increased macrophage migration and decreased neutrophil infiltration) in the tracheal anastomosis and cause an early switch from acute to chronic inflammation.
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Affiliation(s)
- Tihomir Georgiev-Hristov
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario La Paz, Madrid, Spain.
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Temiz A, Kazikdas KC, Ergur B, Tugyan K, Bozok S, Kaya D, Guneli E. Esterified hyaluronic acid improves cartilage viability in experimental tracheal reconstruction with an auricular graft. Otolaryngol Head Neck Surg 2010; 143:772-8. [DOI: 10.1016/j.otohns.2010.07.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Revised: 06/30/2010] [Accepted: 07/13/2010] [Indexed: 12/01/2022]
Abstract
OBJECTIVE: The aim of this study was to determine the efficacy of esterified hyaluronic acid (HYAFF) on the vitality of auricular cartilage grafts used for tracheoplasty, with respect to macroscopic and microscopic parameters. STUDY DESIGN: Prospective, controlled. SETTING: Academic research laboratory. SUBJECTS AND METHODS: The study included 14 New Zealand rabbits acquired specifically for the study. The rabbits were divided into two groups: the control group, in which free cartilage grafts were not exposed to any materials or additional procedures (n = 7), and the hyaluronic acid (HA) treatment group, in which auricular grafts and anastomosis lines were covered with HYAFF (n = 7). Free auricular cartilage grafts used for the reconstruction of experimentally created tracheal defects were anastomosed extraluminally. All the rabbits were sacrificed two months post surgery. Samples were collected and examined histopathologically. The sections were stained with hematoxylineosin, Masson's trichrome, and inducible nitric oxide synthase (iNOS) and examined under a light microscope. RESULTS: Fibrosis and cartilage mass significantly differed between the control and HYAFF group ( P < 0.05). Immunohistochemical examination showed that more chondrocytes stained with iNOS in the control group than in the HYAFF group, according to histologists' observations. CONCLUSION: HYAFF catalyzed wound healing with less fibrous tissue formation, had chondroprotective and stimulatory effects on chondrocyte metabolism, and decreased nitric oxide production and apoptosis via improving the nourishment of free auricular cartilage grafts, subsequently preventing hypoxia and oxidative stress, particularly in the early postimplantation period.
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Affiliation(s)
- Abdulkerim Temiz
- Department of Pediatric Surgery, Mustafa Kemal University, Faculty of Medicine Hatay, Turkey
| | - K. Cagdas Kazikdas
- Department of Otorhinolaryngology Rize University, Faculty of Medicine, Rize, Turkey
| | - Bekir Ergur
- Department of Histology and Embryology, Dokuz Eylul University, Faculty of Medicine Izmir, Turkey
| | - Kazim Tugyan
- Department of Histology and Embryology, Dokuz Eylul University, Faculty of Medicine Izmir, Turkey
| | - Sahin Bozok
- Department of Cardiovascular Surgery Rize University, Faculty of Medicine, Rize, Turkey
| | - Durdane Kaya
- The Department of Laboratory Animal Science, Dokuz Eylul University Izmir, Turkey
| | - Ensari Guneli
- The Department of Laboratory Animal Science, Dokuz Eylul University Izmir, Turkey
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Dabak H, Karlidag T, Akpolat N, Keles E, Alpay HC, Serin M, Kaygusuz I, Yalcin S, Isik O. The effects of methylprednisolone and halofuginone on preventing esophageal and hypopharyngeal fibrosis in delivered radiotherapy. Eur Arch Otorhinolaryngol 2010; 267:1429-35. [PMID: 20364346 DOI: 10.1007/s00405-010-1242-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2010] [Accepted: 03/22/2010] [Indexed: 12/20/2022]
Abstract
In this study, we assessed the effects of halofuginone and methylprednisolone on hypopharyngeal and esophageal stricture that can develop following radiation to the head and neck of rats. Rats were divided into four groups randomly and 18 Gy radiation was given to the head and neck regions of all rats except the control group. Group 1 (Control Group): No radiation or drugs were administered. Group 2 (Radiation Group): only radiation was applied without any drugs. Group 3 (Halofuginone Group): halofuginone 100 microg/kg per day was given intraperitoneally. Group 4 (Methylprednisolone Group): methylprednisolone 1 mg/kg per day was administered intramuscularly. In all groups, 90 days after application of radiation, sections of the proximal esophagus and hypopharynx were examined for fibrosis, fibroblast proliferation, vascularization, epithelial atypia, necrosis, polymorphonuclear leukocytes, mononuclear cells, and stenosis index by light microscope and the hydroxyproline levels were assessed biochemically. Fibrosis, epithelial atypia and hydroxyproline levels were found to be significantly higher in the radiation group compared to the control group (P < 0.05). We did not observe fibrosis in either the halofuginone or the control groups. Fibrosis was also significantly lower in the methylprednisolone group than the radiation group (P < 0.05). The differences of the stenosis index scores between the groups were not statistically significant (P < 0.05). Vascularization was similar in all groups. We think that especially halofuginone is a drug that can be used safely to prevent fibrosis due to radiotherapy, but further studies are needed.
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Affiliation(s)
- Hakan Dabak
- Department of Otorhinolaryngology, Medical Faculty, Firat University, 23119, Elazig, Turkey
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Warner RL, Bhagavathula N, Nerusu K, Hanosh A, McClintock SD, Naik MK, Johnson KJ, Ginsburg I, Varani J. MDI 301, a nonirritating retinoid, improves abrasion wound healing in damaged/atrophic skin. Wound Repair Regen 2008; 16:117-24. [PMID: 18211583 DOI: 10.1111/j.1524-475x.2007.00338.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
MDI 301 is a picolinic acid-substituted ester of 9-cis retinoic acid. It has been shown in the past that MDI 301 increases epidermal thickness, decreases matrix metalloproteinase (MMP) activity, and increases procollagen synthesis in organ-cultured human skin. Unlike all-trans retinoic acid (RA), MDI 301 does not induce expression of proinflammatory cytokines or induce expression of leukocyte adhesion molecules in human skin. In the present study we examined topical MDI 301 treatment for ability to improve the structure and function of skin in three models of skin damage in rodents and for ability to improve abrasion wound healing in these models. MDI 301 was applied daily to the skin of rats treated with the potent corticosteroid, clobetasol propionate, to the skin of diabetic rats (8 weeks posttreatment with streptozotocin) and to the skin of aged (14-16-month-old) rats. In all three models, subsequently induced abrasion wounds healed more rapidly in the retinoid-treated animals than in vehicle-treated controls. Immediately after complete wound closure, tissue from the wound site (as well as from a control site) was put into organ culture and maintained for 3 days. At the end of the incubation period, culture fluids were assessed for soluble type I collagen and for MMPs-2 and -9. In all three models, the level of type I collagen was increased and MMP levels were decreased by MDI 301. In all three models, skin irritation during the retinoid-treatment phase was virtually nonexistent.
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Affiliation(s)
- Roscoe L Warner
- Department of Pathology, University of Michigan, Ann Arbor, MI 48109, USA
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Goverman J, Garcia-Toca M, Sheridan RL, Ryan CM. Relative adrenal insufficiency in the adult burn intensive care unit: a report of four cases. Burns 2007; 34:421-4. [PMID: 17618053 DOI: 10.1016/j.burns.2007.01.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2006] [Accepted: 01/29/2007] [Indexed: 11/17/2022]
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Tenius FP, Biondo-Simões MDLP, Ioshii SO. Efeitos do uso crônico da dexametasona na cicatrização de feridas cutâneas em ratos. An Bras Dermatol 2007. [DOI: 10.1590/s0365-05962007000200005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
FUNDAMENTOS: Acredita-se que os glicocorticóides prejudiquem a cicatrização, causando decréscimo da proliferação celular, da neovascularização e da produção de matriz. OBJETIVO: Investigar os efeitos do uso crônico dos corticoesteróides na cicatrização de feridas cutâneas. MÉTODOS: Após injeções de dexametasona (0,1mg/kg/dia) por 30 dias, fez-se incisão no dorso de ratos e estudou-se a cicatrização no terceiro, sétimo e 14o dias. A resistência da cicatriz, a densidade do colágeno e a reação inflamatória foram avaliadas pela histometria. RESULTADOS: As cicatrizes do grupo tratado com dexametasona eram menos resistentes à tração em todos os tempos (p=0,008) e apresentavam menor densidade de colágeno. A do colágeno tipo III foi menor em todos os tempos estudados (p<0,0001), e a do colágeno tipo I foi menor apenas no 14º dia (p<0,0001). A infiltração de células inflamatórias foi menor no grupo tratado com dexametasona nas duas primeiras avaliações (p=0,001 e p=0,016), não sendo significativa a diferença no 14º dia (p=0,367). CONCLUSÕES: Verificou-se diminuição da resistência da cicatriz e baixa densidade do colágeno total em todos os tempos estudados. No início do processo observou-se baixa densidade do colágeno tipo III e mais tarde também baixa densidade do colágeno tipo I. Nos tempos iniciais houve redução do número de células inflamatórias.
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Affiliation(s)
- Fernando Pundek Tenius
- Instituto de Pesquisas Médicas (IPEM), Brasil; Sociedade Brasileira de Cirurgia Plástica, Brasil
| | - Maria de Lourdes Pessole Biondo-Simões
- Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina (EPM); Universidade Federal do Paraná (UFPR), Brasil; Pontifícia Universidade Católica do Paraná (PUC-PR), Brasil; Colégio Brasileiro de Cirurgiões (CBC), Brasil
| | - Sérgio Ossamu Ioshii
- Universidade Federal do Paraná (UFPR); Pontifícia Universidade Católica do Paraná (PUC-PR), Brasil
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Broughton G, Crosby MA, Coleman J, Rohrich RJ. Use of Herbal Supplements and Vitamins in Plastic Surgery: A Practical Review. Plast Reconstr Surg 2007; 119:48e-66e. [PMID: 17312476 DOI: 10.1097/01.prs.0000252661.72071.8d] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Explain what governmental regulations control the labeling and distribution of herbal supplements. 2. List the more commonly used supplements and their reported benefits. 3. List the possible postoperative complications from consumption of the more commonly used herbal supplements. 4. Explain the preoperative management of patients using herbal supplements. 5. Know additional resources to consult when unanswered questions arise. BACKGROUND The American public spends over $5 billion per year on herbal supplements, and approximately 20 percent of all Americans use prescription medications concurrently with herbal supplements. As the number of people who take alternative medicines rises, there is growing awareness among health care providers of the need to become educated and to educate their patients on the effects that such supplementation may have on their health. As plastic surgeons, we have an added responsibility to become informed because of potential adverse interactions with other medications and anesthesia in the elective surgical patient. METHODS Literature regarding commonly encountered herbal supplements and vitamins was reviewed and summarized to include reported indications for use and potential adverse effects and interactions specific to the perioperative patient. RESULTS Abundant literature exists regarding herbal supplementation, but very little scientific evidence exists to advocate the use of the majority of supplements available on the market. In addition, little is known about the positive and negative interactions that these supplements are capable of producing, and those interactions that are known are based on case reports. CONCLUSIONS With the lack of quality scientific studies to support the efficacy of most herbal products available and the limited regulation of these products by the government, health care providers are faced with a significant public health dilemma. This article provides a brief overview of information published on commonly encountered herbal supplements and vitamins taken by plastic surgery patients.
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Affiliation(s)
- George Broughton
- Department of Plastic Surgery, Nancy L & Perry Bass Advanced Wound Healing Laboratory, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9132, USA
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Liman ST, Kara CO, Bir F, Yildirim B, Topcu S, Sahin B. The effects of estradiol and progesterone on the synthesis of collagen in tracheal surgery. Int J Pediatr Otorhinolaryngol 2005; 69:1327-31. [PMID: 15869806 DOI: 10.1016/j.ijporl.2005.03.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2005] [Accepted: 03/21/2005] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Estrogen and progesterone have the decreasing effect on massive collagen synthesis in wound healing. Here, it is aimed to determine their decreasing effect on collagen accumulation and fibroblast proliferation in trachea histologically and to understand if they would be protective for tracheal stenosis. METHODS Thirteen male Winstar rats were divided randomly into two groups: estrogen-progesterone group (group 1, eight rats) and control group (group 2, five rats). Under general anesthesia, tracheas were incised vertically extending from second to fifth tracheal ring. Incision was closed with absorbable sutures. Estrodiol benzoat and progesterone was given intramuscularly to estrogen progesterone group, saline solution to control group. After 4 weeks they were sacrificed and tracheas were excised. Horizontal cross section of the narrowest part of the incised trachea was examined histologically. Epithelial regeneration, inflammatory cell infiltration, angiogenesis, fibroblast proliferation and collagen deposition were evaluated by histological grading. RESULTS Statistically significant difference was found between the groups in collagen deposition and fibroblast proliferation (p=0.011, <0.05). For epithelial regeneration, inflammatory cell infiltration, and angiogenesis there was no difference. CONCLUSION As a result, it was proved that sex hormones inhibit massive collagen deposition and fibroblast proliferation in wound healing of tracheal surgery. Hence, they may prevent tracheal stenosis.
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Affiliation(s)
- Serife Tuba Liman
- Thoracic Surgery Department, Kocaeli University, The Faculty of Medicine, Kocaeli, Turkey.
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Güngor IU, Beden Ü, Erkan D. Conjunctival Necrosis Due to Subconjunctival Injection of Betamethasone in Treatment of Graft Rejection After Penetrating Keratoplasty. Ophthalmic Surg Lasers Imaging Retina 2005. [DOI: 10.3928/1542-8877-20050701-19] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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