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Ghanbari M, Salkovskiy Y, Carlson MA. The rat as an animal model in chronic wound research: An update. Life Sci 2024; 351:122783. [PMID: 38848945 DOI: 10.1016/j.lfs.2024.122783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/29/2024] [Accepted: 06/04/2024] [Indexed: 06/09/2024]
Abstract
The increasing global prevalence of chronic wounds underscores the growing importance of developing effective animal models for their study. This review offers a critical evaluation of the strengths and limitations of rat models frequently employed in chronic wound research and proposes potential improvements. It explores these models in the context of key comorbidities, including diabetes, venous and arterial insufficiency, pressure-induced blood flow obstruction, and infections. Additionally, the review examines important wound factors including age, sex, smoking, and the impact of anesthetic and analgesic drugs, acknowledging their substantial effects on research outcomes. A thorough understanding of these variables is crucial for refining animal models and can provide valuable insights for future research endeavors.
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Affiliation(s)
- Mahboubeh Ghanbari
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE, USA.
| | - Yury Salkovskiy
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE, USA.
| | - Mark A Carlson
- Department of Surgery, Department of Genetics, Cell Biology and Anatomy, University of Nebraska Medical Center, Omaha, NE, USA.
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Le YTT, Tran DNA, Nguyen BTT, Nguyen TT, Chen YP, Kuo YJ. Is smoking a risk factor for complications following total ankle arthroplasty? A meta-analysis. Foot Ankle Surg 2024:S1268-7731(24)00149-8. [PMID: 38987122 DOI: 10.1016/j.fas.2024.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 06/03/2024] [Accepted: 06/28/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND Smoking has long been recognized as a risk factor for impaired wound and bone healing, particularly in the context of ankle and foot surgery. Despite numerous studies exploring the association between smoking and complications following ankle replacement, there remains significant inconsistency in their findings. Therefore, this meta-analysis study aims to elucidate whether smoking increases the rate of complications after total ankle arthroplasty (TAA), providing valuable insights for clinical management. METHODS A comprehensive systematic search was conducted in the PubMed, Embase, and Wiley databases to identify relevant English studies on the influence of smoking on postoperative complications following ankle replacement without any restrictions on publication dates. The quality of the included studies was assessed using the Newcastle-Ottawa Scale. Random-effect models were used to calculate odds ratios (OR) and 95 % confidence intervals (CI). This study adhered to PRISMA guidelines for transparent reporting and was registered with PROSPERO. RESULTS The analysis incorporated data from 12 retrospective cohort studies, totaling 17331 subjects, 2580 of whom were smokers and 791 complications following TAA. The findings revealed a statistically significant disparity in wound-related complications (OR: 2.26; 95 % CI: 1.13-4.50; P = .02), particularly evident in current smokers with an OR of 3.30 (95 % CI: 2.12-5.14; P < .00001). However, we lacked sufficient evidence to substantiate an association between smoking and complications related to the prosthesis (OR: 1.09; 95 % CI: 0.77-1.53; P = .64) or systemic complications (OR: 1.18; 95 % CI: 0.10-14.13; P = .90) following TAA. CONCLUSIONS Smoking, especially current smoking, is associated with increased wound complication risk post-operation for total ankle arthroplasty. Despite a lack of definitive evidence on the optimal timeframe for smoking cessation before surgery, discontinuing smoking appears to be a prudent measure to mitigate these complications.
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Affiliation(s)
- Yen Thi Thao Le
- The International Master Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Ophthalmology, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Duy Nguyen Anh Tran
- The International PhD Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Orthopedics, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Bao Tu Thai Nguyen
- The International PhD Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Orthopedics, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Tan Thanh Nguyen
- Department of Orthopedics, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Yu-Pin Chen
- Department of Orthopedics, Taipei Municipal Wan-Fang Hospital, Taipei, Taiwan; Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yi-Jie Kuo
- Department of Orthopedics, Taipei Municipal Wan-Fang Hospital, Taipei, Taiwan; Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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Farley T, Stokke J, Goyal K, DeMicco R. Chronic Low Back Pain: History, Symptoms, Pain Mechanisms, and Treatment. Life (Basel) 2024; 14:812. [PMID: 39063567 PMCID: PMC11278085 DOI: 10.3390/life14070812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 06/20/2024] [Accepted: 06/24/2024] [Indexed: 07/28/2024] Open
Abstract
Chronic low back pain (cLBP) is the most frequently reported cause of years lived with disability. Identifying the anatomical structures or dysfunction contributing to patients' symptoms is critical to guiding treatment. The etiology of back pain and differential diagnosis is often broad, ranging from non-degenerative cLBP (trauma, tumor, inflammation, infection, etc.) to degenerative (also described as nonspecific) cLBP. After eliminating suspicion for more insidious causes of cLBP, a thorough investigation can be conducted in an attempt to identify a source of degenerative cLBP. Degenerative cLBP can originate from many sources, and a detailed understanding of the structures potentially involved is invaluable for an accurate diagnosis. This review article aims to provide a broad overview of the utility of clinical history, physical exam findings, imaging findings, and diagnostic procedures in identifying the cause of patients' cLBP. We provide a framework to help guide clinicians by dividing the structures into groups as follows: anterior vertebral column, posterior vertebral column, and extra-vertebral pain. For each condition listed, we touch on the treatment options that can be considered.
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Affiliation(s)
- Tyler Farley
- Center for Spine Health, Neurological Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA; (J.S.); (K.G.); (R.D.)
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Min S, Zhang G, Hu A, Petito GT, Tripathi SH, Shukla G, Kumar A, Shah S, Phillips KM, Forbes JA, Zuccarello M, Andaluz NO, Sedaghat AR. A Comprehensive Analysis of Tobacco Smoking History as a Risk for Outcomes after Endoscopic Transsphenoidal Resection of Pituitary Adenoma. J Neurol Surg B Skull Base 2024; 85:255-260. [PMID: 38778915 PMCID: PMC11111311 DOI: 10.1055/a-2043-0263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 02/21/2023] [Indexed: 02/27/2023] Open
Abstract
Objectives This study seeks to comprehensively analyze the impact of smoking history on outcomes after endoscopic transsphenoidal hypophysectomy (TSH) for pituitary adenoma. Design This was a retrospective study. Setting This study was done at the tertiary care center. Participants Three hundred and ninety-eight adult patients undergoing TSH for a pituitary adenoma. Main Outcome Measures Clinical and tumor characteristics and operative factors were collected. Patients were categorized as never, former, or active smokers, and the pack-years of smoking history was collected. Years since cessation of smoking was obtained for former smokers. Specific outcomes included postoperative cerebrospinal fluid (CSF) leak, length of hospitalization, 30-day return to the operating room, and 30-day readmission. Smoking history details were comprehensively analyzed for association with outcomes. Results Any history of smoking tobacco was associated with return to the operating room (odds ratio [OR] = 2.67, 95% confidence interval [CI]: 1.05-6.76, p = 0.039), which was for persistent CSF leak in 58.3%. Among patients with postoperative CSF leak, any history of smoking was associated with need for return to the operating room to repair the CSF leak (OR = 5.25, 95% CI: 1.07-25.79, p = 0.041). Pack-years of smoking was positively associated with a return to the operating room (OR = 1.03, 95% CI: 1.01-1.06, p = 0.048). In all multivariable models, all negative outcomes were significantly associated with the covariate: occurrence of intraoperative CSF leak. Conclusion This is the first study to show smoking may have a negative impact on healing of CSF leak repairs after TSH, requiring a return to the operating room. This effect appears to be dose dependent on the smoking history. Secondarily, intraoperative CSF leak as covariate in multivariable models was significantly associated with all negative outcomes.
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Affiliation(s)
- Susie Min
- Department of Otolaryngology—Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
| | - Grace Zhang
- Department of Otolaryngology—Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
| | - Alex Hu
- Department of Otolaryngology—Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
| | - Gabrielle T. Petito
- Department of Otolaryngology—Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
| | - Siddhant H. Tripathi
- Department of Otolaryngology—Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
| | - Geet Shukla
- Department of Otolaryngology—Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
| | - Adithya Kumar
- Department of Otolaryngology—Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
| | - Sanjit Shah
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
| | - Katie M. Phillips
- Department of Otolaryngology—Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
| | - Jonathan A. Forbes
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
| | - Mario Zuccarello
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
| | - Norberto O. Andaluz
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
| | - Ahmad R. Sedaghat
- Department of Otolaryngology—Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
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Mayr A, Ciper N, Wahl G, Wildenhof J, Frede S, Kirschneck C, Jäger A, Götz W, Beisel-Memmert S. Longitudinal analysis of microcirculatory parameters in gingival tissues after tooth extraction in patients with different risk profiles for wound healing disorders - a pilot study. Clin Oral Investig 2024; 28:303. [PMID: 38714559 PMCID: PMC11076346 DOI: 10.1007/s00784-024-05686-3] [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] [Received: 02/08/2024] [Accepted: 04/24/2024] [Indexed: 05/10/2024]
Abstract
OBJECTIVES We aimed to establish a risk profile for intraoral wound healing disorders based on measurements of microcirculation in gingival tissues. MATERIALS AND METHODS Oxygen saturation (SO2) and blood flow in gingival tissues were measured with tissue spectrometry and laser doppler spectroscopy in 37 patients before/after tooth extractions. Patients were assigned to four groups: anamnestically and periodontally healthy patients (n = 7), anamnestically healthy but suffering from periodontitis (n = 10), anamnestically healthy but smoking and suffering from periodontitis (n = 10) and suffering from diabetes and periodontitis (n = 10). Measurements were performed at three different time points: Baseline measurement (T0), one day post extractionem (p.e.) (T1) and seven days p.e. (T2). RESULTS Baseline SO2 values were higher in control patients (p = .038). This effect was most evident in comparison to smokers suffering from periodontitis (p = .042), followed by diabetics suffering from periodontitis (p = .09). An opposite trend was seen for blood flow. Patients suffering from periodontitis demonstrated higher blood flow values (p = .012). Five patients, which belonged to the group of smokers suffering from periodontitis, showed clinically a delayed wound healing. CONCLUSION Differences in SO2 and blood flow of gingival tissue could be detected in different groups of patients with existing periodontitis compared to control patients. CLINICAL RELEVANCE Lower baseline SO2 values could be a warning signal for possible wound healing disorders after oral surgery.
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Affiliation(s)
- Alexandra Mayr
- Department of Orthodontics, University Hospital Bonn, Medical Faculty, Bonn, Germany
| | - Nadja Ciper
- Center for Dental, Oral and Maxillofacial Medicine, University Hospital Bonn, Medical Faculty, Bonn, Germany
| | - Gerhard Wahl
- Center for Dental, Oral and Maxillofacial Medicine, University Hospital Bonn, Medical Faculty, Bonn, Germany
| | - Jan Wildenhof
- Private Clinic Schloss Schellenstein, Olsberg, Germany
| | - Stilla Frede
- Department of Anaesthesiology, University Hospital Bonn, Medical Faculty, Bonn, Germany
| | - Christian Kirschneck
- Department of Orthodontics, University Hospital Bonn, Medical Faculty, Bonn, Germany
| | - Andreas Jäger
- Department of Orthodontics, University Hospital Bonn, Medical Faculty, Bonn, Germany
| | - Werner Götz
- Department of Orthodontics, University Hospital Bonn, Medical Faculty, Bonn, Germany
| | - Svenja Beisel-Memmert
- Department of Orthodontics, University Hospital Bonn, Medical Faculty, Bonn, Germany.
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Temperley HC, Shokuhi P, O'Sullivan NJ, Mac Curtain B, Waters C, Murray A, Buckley CE, O'Neill M, Mehigan B, McCormick PH, Kelly ME, Larkin JO. Primary closure versus vertical rectus abdominis myocutaneous (VRAM) flap closure of perineal wound following abdominoperineal resection-a systematic review and meta-analysis. Ir J Med Sci 2024:10.1007/s11845-024-03651-3. [PMID: 38532236 DOI: 10.1007/s11845-024-03651-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 01/05/2024] [Indexed: 03/28/2024]
Abstract
PURPOSE/AIM Perianal wound healing and/or complications are common following abdominoperineal resection (APR). Although primary closure is commonly undertaken, myocutaneous flap closure such as vertical rectus abdominis myocutaneous flap (VRAM) is thought to improve wound healing process and outcome. A comprehensive meta-analysis was performed to compare outcomes of primary closure versus VRAM flap closure of perineal wound following APR. METHODS PubMed, MEDLINE, EMBASE, and Cochrane Central Registry of Controlled Trials were comprehensively searched until the 8th of August 2023. Included studies underwent meta-analysis to compare outcomes of primary closure versus VRAM flap closure of perineal wound following APR. The primary outcome of interest was perineal wound complications, and the secondary outcomes were abdominal wound complications, dehiscence, wound healing time, length of hospital stay, and mortality. RESULTS Ten studies with 1141 patients were included. Overall, 853 patients underwent primary closure (74.8%) and 288 patients underwent VRAM (25.2%). Eight studies reported on perineal wound complications after APR: 38.2% (n = 263/688) in the primary closure group versus 32.8% (n = 80/244) in the VRAM group. Perineal complication rates were statistically significantly lower in the VRAM group versus primary closure ((M-H OR, 1.61; 95% CI 1.04-2.49; CONCLUSION We highlight the advantage of VRAM flap closure over primary closure for perineal wounds following APR. However, tailoring operative strategy based on patient and disease factors remains important in optimising outcomes.
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Affiliation(s)
- Hugo C Temperley
- Department of Surgery, St. James's Hospital, Dublin, Ireland.
- Trinity St James's Cancer Institute, St. James's Hospital, Dublin, Ireland.
| | - Poorya Shokuhi
- Department of Surgery, St. James's Hospital, Dublin, Ireland
| | | | | | - Caitlin Waters
- Department of Surgery, Fiona Stanley Hospital, Perth, Australia
| | - Alannah Murray
- Department of Surgery, St. James's Hospital, Dublin, Ireland
| | | | - Maeve O'Neill
- Department of Surgery, St. James's Hospital, Dublin, Ireland
| | - Brian Mehigan
- Department of Surgery, St. James's Hospital, Dublin, Ireland
| | | | - Michael E Kelly
- Department of Surgery, St. James's Hospital, Dublin, Ireland
- Trinity St James's Cancer Institute, St. James's Hospital, Dublin, Ireland
| | - John O Larkin
- Department of Surgery, St. James's Hospital, Dublin, Ireland
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Gengler I, Min S, Jiang M, Zhang G, Altaye M, Radulesco T, Lechien JR, Hsieh TY. The Impact of the Post-Traumatic Facial Reconstruction on Postoperative Weight Loss. EAR, NOSE & THROAT JOURNAL 2024:1455613241241114. [PMID: 38509737 DOI: 10.1177/01455613241241114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024] Open
Abstract
Objectives: To identify risk factors and evaluate the impact of various facial fractures and reconstruction surgeries on postoperative weight change. Methods: Retrospective, monocentric study was performed at a tertiary care center. Medical history, type and mechanism of fracture, operative factors, and postoperative weights at follow-up appointments for 145 adult patients undergoing surgical repair for maxillofacial fractures were collected. Further information was obtained on postoperative diet and whether patients received maxillomandibular fixation (MMF). Univariate and multivariate analyses were utilized to evaluate effects of surgical reconstruction after facial trauma on postoperative weight loss. Results: Patients lost 3.2 ± 4.9 kg (95% confidence interval = 2.7-4.1, P < .0001) on average, with maximum loss between date of surgery and first follow-up. Univariate analysis demonstrated that intensive care unit admission (5.9 kg, SD 5.4, P = .001), nasogastric tube placement (5.1 kg, SD 4.6, P = .012), and MMF (4.4 kg, SD 5.4, P < .0001) were associated with more severe weight loss. Multivariate analyses showed that only MMF remained a significant risk factor for increased weight loss (avg. 6.0, standard error 1.93, t value 3.11, P = .0024). Conclusions: We report significant weight loss following facial trauma and reconstruction, which emphasizes the need to perform further studies on nutrition protocols for this patient population to optimize wound healing.
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Affiliation(s)
- Isabelle Gengler
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Young Otolaryngologists of International Federation of Otorhinolaryngological Societies (YO-IFOS), Paris, France
| | - Susie Min
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Megan Jiang
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Grace Zhang
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Mekibib Altaye
- Mekibib Altaye, Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Thomas Radulesco
- Young Otolaryngologists of International Federation of Otorhinolaryngological Societies (YO-IFOS), Paris, France
- Aix-Marseille Univ, APHM, IUSTI, CNRS, Department of Oto-Rhino-Laryngology and Head and Neck Surgery, La Conception University Hospital, Marseille Cedex, France
| | - Jerome R Lechien
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Young Otolaryngologists of International Federation of Otorhinolaryngological Societies (YO-IFOS), Paris, France
- Department of Laryngology and Bronchoesophagology, EpiCURA Hospital, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium
| | - Tsung-Yen Hsieh
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Fisher MH, Ohmes LB, Yang JH, Le E, Colakoglu S, French M, Siddikoglu D, Um G, Winocour J, Higdon K, Perdikis G, Inchauste S, Cohen J, Chong T, Kaoutzanis C, Mathes DW. Abdominal donor-site complications following autologous breast reconstruction: A multi-institutional multisurgeon study. J Plast Reconstr Aesthet Surg 2024; 90:88-94. [PMID: 38364673 DOI: 10.1016/j.bjps.2024.01.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/13/2023] [Accepted: 01/29/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND The deep inferior epigastric perforator (DIEP) free flap is the gold standard procedure for autologous breast reconstruction. Although breast-related complications have been well described, donor-site complications and contributing patient risk factors are poorly understood. METHODS We examined a multi-institutional, prospectively maintained database of patients undergoing DIEP free flap breast reconstruction between 2015 and 2020. We evaluated patient demographics, operative details, and abdominal donor-site complications. Logistic regression modeling was used to predict donor-site outcomes based on patient characteristics. RESULTS A total of 661 patients were identified who underwent DIEP free flap breast reconstruction across multiple institutions. Using logistic regression modeling, we found that body mass index (BMI) was an independent risk factor for umbilical complications (odds ratio [OR] 1.11, confidence interval [CI] 1.04-1.18, p = 0.001), seroma (OR 1.07, CI 1.01-1.13, p = 0.003), wound dehiscence (OR 1.10, CI 1.06-1.15, p = 0.001), and surgical site infection (OR 1.10, CI 1.05-1.15, p = 0.001) following DIEP free flap breast reconstruction. Further, immediate reconstruction decreases the risk of abdominal bulge formation (OR 0.22, CI 0.108-0.429, p = 0.001). Perforator selection was not associated with abdominal morbidity in our study population. CONCLUSIONS Higher BMI is associated with increased abdominal donor-site complications following DIEP free flap breast reconstruction. Efforts to lower preoperative BMI may help decrease donor-site complications.
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Affiliation(s)
- Marlie H Fisher
- Department of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Lucas B Ohmes
- Department of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Jerry H Yang
- Department of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Elliot Le
- Department of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Salih Colakoglu
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Medicine, Baltimore, MD, United States
| | - Mackenzie French
- Department of Plastic and Reconstructive Surgery, University of Washington, Seattle, WA, United States
| | - Duygu Siddikoglu
- Department of Biostatistics, Canakkale OnSekiz Mart Faculty of Medicine, Canakkale, Turkey
| | - Grace Um
- Department of Plastic and Reconstructive Surgery, University of Washington, Seattle, WA, United States
| | - Julian Winocour
- Department of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Kent Higdon
- Department of Plastic and Reconstructive Surgery, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Galen Perdikis
- Department of Plastic and Reconstructive Surgery, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Suzanne Inchauste
- Department of Plastic and Reconstructive Surgery, University of Washington, Seattle, WA, United States
| | - Justin Cohen
- Department of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Tae Chong
- Department of Plastic and Reconstructive Surgery, Virginia Commonwealth University, Richmond, VA, United States
| | - Christodoulos Kaoutzanis
- Department of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - David W Mathes
- Department of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.
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Seth I, Lim B, Cevik J, Gracias D, Chua M, Kenney PS, Rozen WM, Cuomo R. Impact of nutrition on skin wound healing and aesthetic outcomes: A comprehensive narrative review. JPRAS Open 2024; 39:291-302. [PMID: 38370002 PMCID: PMC10874171 DOI: 10.1016/j.jpra.2024.01.006] [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: 11/15/2023] [Accepted: 01/17/2024] [Indexed: 02/20/2024] Open
Abstract
Background While current wound treatment strategies often focus on antimicrobials and topical agents, the role of nutrition in wound healing and aesthetic outcomes is crucial but frequently overlooked. This review assesses the impact of specific nutrients and preoperative nutritional status on surgical outcomes. Methods A comprehensive search was conducted in PubMed, Scopus, Web of Science, and the Cochrane Library, from the inception of the study to October 2023. The study focused on the influence of macronutrients and micronutrients on aesthetic outcomes, the optimization of preoperative nutritional status, and the association between nutritional status and postoperative complications. Inclusion criteria were English language peer-reviewed articles, systematic reviews, meta-analyses, and clinical trials related to the impact of nutrition on skin wound healing and aesthetic outcomes. Exclusion criteria included non-English publications, non-peer-reviewed articles, opinion pieces, and animal studies. Results Omega-3 fatty acids and specific amino acids were linked to enhanced wound-healing and immune function. Vitamins A, B, and C and zinc positively influenced healing stages, while vitamin E showed variable results. Polyphenolic compounds showed anti-inflammatory effects beneficial for recovery. Malnutrition was associated with increased postoperative complications and infections, whereas preoperative nutritional support correlated with reduced hospital stays and complications. Conclusion Personalized nutritional plans are essential in surgical care, particularly for enhanced recovery after surgery protocols. Despite the demonstrated benefits of certain nutrients, gaps in research, particularly regarding elements such as iron, necessitate further studies. Nutritional assessments and interventions are vital for optimal preoperative care, underscoring the need for more comprehensive guidelines and research in nutritional management for surgical patients.
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Affiliation(s)
- Ishith Seth
- Department of Plastic Surgery, Peninsula Health, Melbourne, Victoria 3199, Australia
- Central Clinical School at Monash University, The Alfred Centre, 99 Commercial Rd, Melbourne, Victoria 3004, Australia
| | - Bryan Lim
- Department of Plastic Surgery, Peninsula Health, Melbourne, Victoria 3199, Australia
- Central Clinical School at Monash University, The Alfred Centre, 99 Commercial Rd, Melbourne, Victoria 3004, Australia
| | - Jevan Cevik
- Department of Plastic Surgery, Peninsula Health, Melbourne, Victoria 3199, Australia
| | - Dylan Gracias
- Department of Plastic Surgery, Peninsula Health, Melbourne, Victoria 3199, Australia
| | - Marcel Chua
- Department of Plastic Surgery, Peninsula Health, Melbourne, Victoria 3199, Australia
- Central Clinical School at Monash University, The Alfred Centre, 99 Commercial Rd, Melbourne, Victoria 3004, Australia
| | - Peter Sinkjaer Kenney
- Department of Plastic Surgery, Odense University Hospital, J. B. Winsløwsvej 4, Odense 5000, Denmark
- Department of Plastic and Breast Surgery, Aarhus University Hospital, Aarhus 8200, Denmark
| | - Warren M. Rozen
- Department of Plastic Surgery, Peninsula Health, Melbourne, Victoria 3199, Australia
- Central Clinical School at Monash University, The Alfred Centre, 99 Commercial Rd, Melbourne, Victoria 3004, Australia
| | - Roberto Cuomo
- Plastic Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena 53100, Italy
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Rich MD, Solaiman RH, Lamba A, Schubert W, Hillard C, Mahajan A. Comorbidities Associated With Increased Likelihood of Postoperative Surgical Site Infection in Patients Treated for Hand or Finger Fracture and/or Dislocations. Hand (N Y) 2024; 19:263-268. [PMID: 36113058 PMCID: PMC10953528 DOI: 10.1177/15589447221120847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
BACKGROUND We aimed to determine the relationship between common preoperative comorbidities and subsequent incidence of postoperative surgical site infections (SSIs) in hand and finger fractures and/or dislocations. METHODS We queried the American College of Surgeons National Safety and Quality Improvement Program from January 1, 2015 to December 31, 2019. Patients were included in our study if they were treated by open or percutaneous fixation for any hand or finger fracture and/or dislocation. Predictor variables were smoking status, diabetes mellitus status, and obesity (body mass index > 30) status. Primary outcome was incidence of postoperative SSI. RESULTS There were a total of 9245 patients included in our study, and 148 patients (1.6%) experienced postoperative SSI. Of these, 59 patients (39.9%) were only smokers, 7 patients (4.7%) only had diabetes mellitus, and 55 patients (37.2%) were only obese. Overall, patients experienced greater odds of sustaining a postoperative SSI if they were a smoker or diabetic compared to non-smokers and non-diabetics, respectively. Considering only open fixation modality, patients with comorbidities were not at significantly increased odds of sustaining postoperative SSI. Considering only percutaneous fixation modality, patients experienced significantly greater odds of sustaining postoperative SSI if they were a smoker compared to non-smoker. CONCLUSIONS Common preoperative comorbidities, including smoking status and diabetes mellitus, increase the likelihood of postoperative complication in patients with hand and finger fractures and/or dislocations undergoing surgical treatment. Further investigation into the different relationship of these comorbidities between open and closed fractures with larger sample sizes will be valuable.
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Affiliation(s)
| | | | | | - Warren Schubert
- University of Minnesota, Minneapolis, USA
- Regions Hospital, Saint Paul, MN, USA
| | - Christopher Hillard
- University of Minnesota, Minneapolis, USA
- Regions Hospital, Saint Paul, MN, USA
| | - Ashish Mahajan
- University of Minnesota, Minneapolis, USA
- Regions Hospital, Saint Paul, MN, USA
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11
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Coladonato C, Hanna AJ, Patel NK, Sonnier JH, Connors G, Sabitsky M, Johnson E, Mazur DW, Brahmabhatt S, Freedman KB. Risk Factors Associated With Poor Outcomes After Quadriceps Tendon Repair. Orthop J Sports Med 2024; 12:23259671241229105. [PMID: 38379579 PMCID: PMC10878232 DOI: 10.1177/23259671241229105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 08/21/2023] [Indexed: 02/22/2024] Open
Abstract
Background Ruptures of the quadriceps tendon present most frequently in older adults and individuals with underlying medical conditions. Purpose To examine the relationship between patient-specific factors and tear characteristics with outcomes after quadriceps tendon repair. Study Design Case-control study; Level of evidence, 3. Methods A retrospective review was conducted on all patients who underwent quadriceps tendon repair between January 1, 2016, and January 1, 2021, at a single institution. Patients <18 years and those with chronic quadriceps tendon tears (>6 weeks to surgery) were excluded. Information was collected regarding patient characteristics, presenting symptoms, tear characteristics, physical examination findings, and postoperative outcomes. Poor outcome was defined as a need for revision surgery, complications, postoperative range of motion of (ROM) <110° of knee flexion, and extensor lag of >5°. Results A total of 191 patients met the inclusion criteria. Patients were aged 58.5 ± 13.2 years at the time of surgery, were predominantly men (90.6%), and had a mean body mass index (BMI) of 32.2 ± 6.3 kg/m2. Patients underwent repair with either suture anchors (15.2%) or transosseous tunnels (84.8%). Postoperatively, 18.5% of patients experienced knee flexion ROM of <110°, 11.3% experienced extensor lag of >5°, 8.5% had complications, and 3.2% underwent revision. Increasing age (odds ratio [OR], 1.03 [95% CI, 1.004-1.07]) and female sex (OR, 3.82 [95% CI, 1.25-11.28]) were significantly associated with postoperative knee flexion of <110°, and increasing age (OR, 1.08 [95% CI, 1.04-1.14]) and greater BMI (OR, 1.14 [95% CI, 1.05-1.23]) were significantly associated with postoperative extensor lag of >5°. Current smoking status (OR, 15.44 [95% CI, 3.97-65.90]) and concomitant retinacular tears (OR, 9.62 (95% CI, 1.67-184.14]) were associated with postoperative complications, and increasing age (OR, 1.05 [95% CI, 1.02-1.08]) and greater BMI (OR, 1.08 [95% CI, 1.02-1.14]) were associated with risk of acquiring any poor outcome criteria. Conclusion Patient-specific characteristics-such as increasing age, greater BMI, female sex, retinacular involvement, and current smoking status-were found to be risk factors for poor outcomes after quadriceps tendon repair. Further studies are needed to identify potentially modifiable risk factors that can be used to set patient expectations and improve outcomes.
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Affiliation(s)
- Carlo Coladonato
- Rothman Orthopaedic Institute at the Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Adeeb Jacob Hanna
- Rothman Orthopaedic Institute at the Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Neel K. Patel
- Rothman Orthopaedic Institute at the Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - John Hayden Sonnier
- Rothman Orthopaedic Institute at the Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Gregory Connors
- Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Matthew Sabitsky
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Emma Johnson
- Rothman Orthopaedic Institute at the Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Donald W. Mazur
- Rothman Orthopaedic Institute at the Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Shyam Brahmabhatt
- Rothman Orthopaedic Institute at the Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Kevin B. Freedman
- Rothman Orthopaedic Institute at the Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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12
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Austin HK, Gamboa GM, Waters-Hollingsworth C. Excision of Invasive Squamous Cell Carcinoma Complicated by Osteomyelitis and Tobacco Use: A Case Report. Cureus 2024; 16:e54629. [PMID: 38524043 PMCID: PMC10959414 DOI: 10.7759/cureus.54629] [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] [Accepted: 02/20/2024] [Indexed: 03/26/2024] Open
Abstract
Squamous cell carcinoma (SCC) is a common type of skin cancer that can be treated through surgical excision using Mohs micrographic surgery (MMS) which results in minimal scarring and low complications. Soft tissue defects as a result of MMS that are too large to be primarily closed can be repaired with secondary intention healing through the use of biologic prosthetics that promote dermal regeneration and tissue remodeling with high success rates. Other non-surgical treatment options include chemotherapy (topical or systemic), radiation, or immunotherapy for advanced skin cancers. In this case, our patient is a 76-year-old male with a history of tobacco use who presented with ulcerative SCC and developed a necrotic soft-tissue infection of Pseudomonas aeruginosa complicated by calvarial osteomyelitis six weeks following wide excision of scalp SCC and wound defect repair with application of Integra® Bilayer Wound Matrix (Integra LifeSciences, Princeton, New Jersey, United States) to promote re-vascularization and tissue regrowth. The patient is currently recovering well after the excision of the necrotic scalp lesion and second-stage reconstruction with right scalp fasciocutaneous flap and full-thickness skin graft with proper antibiotic administration. Complications were likely due to delayed wound healing from post-operative cigar use increasing his risk for infection and application of biologic prosthetics that potentially served as a nidus for bacterial adherence and biofilm production of P. aeruginosa, which led to osteomyelitis, an exceedingly rare complication for patients that undergo MMS.
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Affiliation(s)
- Harriet Kaye Austin
- Plastic and Reconstructive Surgery, University of Central Florida College of Medicine, Orlando, USA
| | - Gloria M Gamboa
- Plastic and Reconstructive Surgery, Orlando Veterans Affairs Medical Center, Orlando, USA
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13
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Rodriguez-Materon S, Trynz S, Ahmed MA, SanGiovanni TP, Chapman C, Hodgkins CW. First 30 Days Wound-Related Complications in Young Smokers Following Primary Achilles Repair. J Foot Ankle Surg 2024; 63:9-12. [PMID: 37855794 DOI: 10.1053/j.jfas.2022.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 08/23/2022] [Accepted: 08/28/2022] [Indexed: 10/20/2023]
Abstract
The Achilles tendon is frequently injured in the young to middle aged population. Previous studies have shown that there is an increased risk of delay in postsurgical wound healing amongst tobacco smoking patients with Achilles tendon injury. This study utilized the American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) database. We included patients between the ages of 18 and 35 years who underwent primary Achilles tendon repair between years 2011 and 2020. The procedure type (with or without graft, CPT 27650 and 27652), patient demographics, and comorbidities were included. Primary outcomes of interest were 30-day readmission, minor complications, outcomes related to wound healing (wound disruption, superficial surgical site infection, deep incisional surgical site infection, organ-space site infections) and reoperations within 30 days of index surgery. A total of 1944 patients met the inclusion criteria for this study. One thousand six hundred and fifty-nine patients were nonsmokers, while 285 were smokers. Logistic regression showed no differences between smokers and nonsmokers (reference group) for 30-day readmission, reoperation, and minor complications. However, Black non-Hispanic patients were found to be 0.3 times (95% confidence interval: 0.1, 0.98) as likely to develop minor complications as compared to the White non-Hispanic patients. Wound-related complications after Achilles tendon repair remain low in younger (18-35 years) patients. When comparing clinical outcomes between nonsmokers and smokers, we found no statistically significant difference in this retrospective study.
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Affiliation(s)
| | - Samantha Trynz
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL
| | - Md Ashfaq Ahmed
- Center for Advanced Analytics, Baptist Health South Florida, Coral Gables, FL
| | - Thomas P SanGiovanni
- Orthopedic Surgeon, Foot and Ankle Specialist, Baptist Health Orthopaedic Care, Baptist Health South Florida, Coral Gables, FL
| | - Cary Chapman
- Orthopedic Surgeon, Foot and Ankle Specialist, Baptist Health Orthopaedic Care, Baptist Health South Florida, Coral Gables, FL
| | - Christopher W Hodgkins
- Orthopedic Surgeon, Foot and Ankle Specialist, Baptist Health Orthopaedic Care, Baptist Health South Florida, Coral Gables, FL
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14
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Buhalim MA, Albesher MA, Albesher MA, Alsultan NJ, Alessa HA, Aldossary FA. People's Knowledge and Attitudes About Factors That Can Impact Wound Healing in the Eastern Province, Saudi Arabia. Cureus 2023; 15:e50734. [PMID: 38234962 PMCID: PMC10793964 DOI: 10.7759/cureus.50734] [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] [Accepted: 12/18/2023] [Indexed: 01/19/2024] Open
Abstract
Background Wounds, ranging from acute to chronic, demand timely intervention to prevent complications. Infections can impede healing, leading to sepsis. Chronic wounds impact society, causing limitations in mobility and social exclusion. Early identification of infections is crucial for effective treatment, reducing unnecessary antibiotic use, and improving patient outcomes. Methodology This cross-sectional study was conducted from June to October 2023 in Saudi Arabia using a self-administered online questionnaire to assess wound healing knowledge and attitudes. Convenient random sampling via social media was employed to collect data. Data analysis was performed using SPSS version 23 (IBM Corp., Armonk, NY, USA). Results Our study predominantly featured female (67.1%), Saudi (94.8%), aged 18-25 years (42.0%), and married (51.1%) participants. Chronic illnesses were prevalent in 24.2%, with heart disease (5.7%) and hypertension (4.5%) being notable. Burn injuries (27.4%) and upper extremity wounds (40.9%) were common, prompting immediate medical care (54.1%). Internet sources (22.6%) and relatives/friends (18.4%) were key for wound care information. Participants displayed solid awareness of wound-related factors, with notable misconceptions regarding Zamzam water (44.4%) and coffee beans (39.3%). Participants prioritized stopping bleeding (41.1%) and using wound patches (42.1%) for home injuries. Age group, education, marital status, and occupation impacted knowledge about wound healing. Conclusions Our study highlights key demographics, prevalent chronic illnesses, common wound types, and crucial sources of wound care information. Participants' awareness, coupled with notable misconceptions, emphasizes the importance of tailored education. Factors such as age, education, marital status, and occupation impact knowledge about wound healing.
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Affiliation(s)
| | | | - Maitham A Albesher
- Medicine and Surgery, N.V. Sklifosovsky Institute of Clinical Medicine, Moscow, RUS
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15
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Shayea AMF, Alshatti AA, Alfadhli DH, Ibrahim AF, Almutairi MK, Nadar MS. Health-related factors and dysregulation of epigenetic related genes in metabolic syndrome trigger finger patients and smoker trigger finger patients: preliminary analysis of patient-derived sample. J Orthop Surg Res 2023; 18:785. [PMID: 37853419 PMCID: PMC10585746 DOI: 10.1186/s13018-023-04271-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 10/08/2023] [Indexed: 10/20/2023] Open
Abstract
PURPOSE To investigate the health-related factors and analyze the expression of epigenetic related genes and inflammatory genes in metabolic syndrome Trigger Finger (TF) and smoker TF. METHODS Samples from patients' fingers with symptomatic TF were collected. There were seven groups: healthy control group, carpal tunnel syndrome (as a control for gene expression analysis), TF, diabetic TF, hypertensive TF, dyslipidemic TF and smoker TF. The expression levels of epigenetic related genes and inflammatory genes in metabolic syndrome TF and smoker TF were evaluated by the reverse transcription-polymerase chain reaction (RT-PCR) technique. The Perceived Stress Scale (PSS), Pittsburgh Sleep Quality Index (PSQI) questionnaires, disability of the arm, shoulder and hand (DASH) and numeric pain rating scale were given to the participants to fill out. RESULTS There was a significant increase in hand dysfunction in the metabolic TF groups and smoker group compared to the TF group (p < 0.0001). The stress levels of the smoker TF group and TF with hypertension group were significantly increased compared with those in the TF group (p < 0.03) and (p < 0.021), respectively. On the other hand, there was a significant increase in the COL-I, COL-II and TNF-α gene expression of the metabolic TF groups and smoker group (p < 0.0001). CONCLUSIONS Health-related factors in the TF tendons was highly associated with the level of inflammation and genetic alteration in TF metabolic syndromes and smoker TF patients. Therefore, further investigation is required to examine the combination of occupational therapy, gene expression, and health-related factors as a promising method of managing TF.
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Affiliation(s)
- Abdulaziz M F Shayea
- Occupational Therapy Department, Faculty of Allied Health Science, Kuwait University, P.O. Box 24923, 13110, Safat, Kuwait.
- Anatomy Msc. in Neuroscience Felid, Departments of Anatomy, Faculty of Medicine, Kuwait University, P.O. Box 24923, 13110, Safat, Kuwait.
- Departments of Molecular Biology, Faculty of Graduate Studies, Kuwait University, P.O. Box 24923, 13110, Safat, Kuwait.
| | - Amna A Alshatti
- Occupational Therapy Department, Faculty of Allied Health Science, Kuwait University, P.O. Box 24923, 13110, Safat, Kuwait
| | - Danah H Alfadhli
- Occupational Therapy Department, Faculty of Allied Health Science, Kuwait University, P.O. Box 24923, 13110, Safat, Kuwait
| | - Almutairi Fatimah Ibrahim
- Occupational Therapy Department, Faculty of Allied Health Science, Kuwait University, P.O. Box 24923, 13110, Safat, Kuwait
| | - Mariam Kh Almutairi
- Occupational Therapy Department, Faculty of Allied Health Science, Kuwait University, P.O. Box 24923, 13110, Safat, Kuwait
| | - Mohammed Sh Nadar
- Occupational Therapy Department, Faculty of Allied Health Science, Kuwait University, P.O. Box 24923, 13110, Safat, Kuwait
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Pacheco YJ, Marin ELN, Ocampo DB, Gutiérrez CBB, Salom GAM, Ruiz JB, Garzon GFM, Casado JJP, Agudelo IMH, Mendez JAV, Lopez EHD, Bohorquez UM, Chamorro DR, Carrascal AO, Suarez EB, Cole W, Serena T, Marquez CA, Woodmansey E. Consenso de expertos sobre la eficacia clínica y directrices sobre la terapia de oxígeno transdérmico continuo para la cicatrización de las heridas complejas o difíciles de cicatrizar. J Wound Care 2023; 32:1-37. [PMID: 37934612 DOI: 10.12968/jowc.2023.32.latam_sup_10.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
INTRODUCTION Oxygen is pivotal for wound healing. Its lack or hypoxia can delay this process, especially in individuals with comorbidities, potentially resulting in complex or hard-to-heal wounds. The Colombian Association of Diabetes (ACD) and the Colombian Association of Internal Medicine (ACMI) collaborated with a diverse group of experts to provide recommendations on the efficacy and best practices of continuous transdermal oxygen therapy (TOTc) in the care of such wounds. METHOD A modified Delphi technique was employed to obtain controlled feedback and responses. Experts from various disciplines engaged in reviewing and discussing numerous relevant scientific studies, focusing on the role of TOTc in treating chronic ulcers. RESULTS Continuous transdermal oxygen therapy has proven to be an effective and safe treatment for chronic and/or hard-to-heal ulcers. This therapy directly addresses the wound's oxygen deficiency, providing an environment conducive to healing. Significant benefits were observed, including the acceleration of the healing process, wound size reduction, and an enhancement in patient quality of life. Its efficacy was found across various ulcer etiologies, underscoring its therapeutic versatility. CONCLUSIONS Continuous transdermal oxygen therapy is effective and safe for treating chronic and hard-to-heal ulcers. It's crucial to address each case individually and through a multidisciplinary approach to maximize this therapy's benefits. Both evidence and clinical experience back its utility across a variety of ulcer etiologies.
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Affiliation(s)
- Yamile Jubiz Pacheco
- Coordinadora zona norte de Suramérica ante el D-Foot International. Médico diabetóloga-experta en el cuidado del pie diabético y heridas complejas. Jefe unidad interdisciplinaria de pie diabético y heridas complejas
| | | | - Dora Bernal Ocampo
- Médica especialista en medicina familiar. Vicepresidenta confederación Iberoamericana de medicina familiar. Presidenta Asociación Colombiana de Sociedades Científicas
| | | | - Gustavo Adolfo Marquez Salom
- Médico especialista en medicina interna y clínica de hipertensión. Diabetólogo experto en pie diabético y heridas complejas. Director centro de atención integral de personas con diabetes y comorbilidades
| | - Jaime Brugés Ruiz
- Médico diabetólogo experto en pie diabético y heridas complejas. Director fundación Medicus - Cartagena
| | - Gary Fernando Monclou Garzon
- Médico especialista en ortopedia y traumatología. Especialista en cirugía de cadera reconstructiva. Magister en educación médica. Jefe del servicio de ortopedia Clínica Palermo - Bogotá
| | - John Jairo Perez Casado
- Médico especialista en ortopedia y traumatología. Reconstrucción, salvamento de extremidades y técnicas microquirúrgicas
| | - Iván Mauricio Hernández Agudelo
- Méico especialista en ortopedia y traumatología. Fellowship trauma y cirugía reconstructiva Medizinische Hochschule Hannover. Cirujano trauma y reconstructivo Clínica Palermo - Clínica Universidad La Sabana
| | | | - Enfermera Hilsen Duran Lopez
- Enfermera profesional especialista en cuidado de persona con heridas, ostomías, y lesiones de piel. Coordinadora de la unidad de heridas del Hospital Militar Central Colombia
| | - Ulises Múnera Bohorquez
- Médico experto en el cuidado de heridas complejas. Presidente Fundepiel Colombia 2022-2024. Autor del libro Introducción al mundo de las heridas, Editorial Bonaventuriano
| | - Damaris Romero Chamorro
- Médico especialista en cirugía plástica, Estética y reconstructiva. Miembro de la Federación IberoLatinoamericana de Cirugía Plástica FILACP. Secretaría ejecutiva, Sociedad Colombiana de Cirugía Plástica, Estética y Reconstructiva. Miembro Sociedad Americana de Cirugía Plástica
| | - Alexandra Otero Carrascal
- Médico especialista en cirugía plástica, Reconstructiva y estética. Subespecialista en mano. Miembro del Grupo Colombiano Interdisciplinario de Pie Diabético y Heridas Complejas
| | - Emerson Barajas Suarez
- Médico especialista en cirugía vascular y endovascular. Especialista en docencia universitaria
| | - Windy Cole
- Licenciatura en biología, Universidad de Cincinnati. Doctor en medicina podológica, Kent State University College. Médico especialista certificado en cuidado de heridas, American Board of Wound Management. Director de investigación de cuidado de heridas, Facultad de Medicina Podiátrica de la Universidad de Kent. Editor de la sección del consejo asesor editorial, cirugía podológica
| | - Thomas Serena
- Doctor en Medicina (MD), Universidad Estatal de Pensilvania. Vicepresidente Anterior, Colegio Americano de medicina hiperbárica. Presidente anterior, Asociación para el Avance del Cuidado de Heridas. Licenciatura en biología, pre-médica - The College of William and Mary
| | - Camilo Acosta Marquez
- MSc Magister Ingeniería Biomédica - Universidad de los Andes. Ingeniero Eléctrico - Universidad de los Andes. Doctor (PhD) en Robótica Abertay University, Dundee, Escocia. Postdoctorado en Robótica Aplicada a la Rehabilitación - Abertay University, Dundee, Escocia
| | - Emma Woodmansey
- Doctor of Philosophy (PhD), gut microbiology, University of Dundee. BSc (Hons) degree, medical microbiology, University of Dundee
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Knochenhauer HE, Lim SL, Brown DA, Darner G, Levinson H, Havrilesky LJ, Previs RA. An obstetrician-gynecologist's review of hernias: risk factors, diagnosis, prevention, and repair. Am J Obstet Gynecol 2023; 229:214-221. [PMID: 37120051 DOI: 10.1016/j.ajog.2023.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 04/18/2023] [Accepted: 04/20/2023] [Indexed: 05/01/2023]
Abstract
Management of obstetrical and gynecologic patients with hernias poses challenges to providers. Risks for hernia development include well-described factors that impair surgical wound healing and increase abdominal pressure. Among the diverse populations cared for by obstetricians and gynecologists, pregnant patients and those with gynecologic malignancies are at the highest risk for hernia formation. This article provides an overview of the existing literature, with a focus on patients cared for by obstetrician-gynecologists and commonly encountered preoperative and intraoperative scenarios. We highlight scenarios when a hernia repair is not commonly performed, including those of patients undergoing nonelective surgeries with known or suspected gynecologic cancers. Finally, we offer multidisciplinary recommendations on the timing of elective hernia repair with obstetrical and gynecologic procedures, with attention to the primary surgical procedure, the type of preexisting hernia, and patient characteristics.
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Affiliation(s)
| | - Stephanie L Lim
- Department of Obstetrics and Gynecology, Duke University Hospital, Durham, NC
| | - David A Brown
- Division of Plastic, Oral, and Maxillofacial Surgery, Department of Surgery, Duke University Hospital, Durham, NC
| | | | | | - Laura J Havrilesky
- Department of Obstetrics and Gynecology, Duke University Hospital, Durham, NC
| | - Rebecca A Previs
- Division of Gynecologic Oncology, Duke Cancer Institute, Durham, NC; LabCorp, Enterprise Oncology, Durham, NC.
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Learned A, Robinson SA, Nguyen TT. Comprehensive Care of Lower-Extremity Wounds. Surg Clin North Am 2023; 103:745-765. [PMID: 37455035 DOI: 10.1016/j.suc.2023.04.015] [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: 07/18/2023]
Abstract
There are 5 common types of chronic nonhealing lower-extremity wounds: arterial, venous, diabetic foot ulcer, pressure, and mixed or atypical. Each chronic wound type has distinct features, and understanding the underlying cause will dictate the wound treatment plan. Here, the authors review the distinguishing wound properties for these 5 common chronic nonhealing lower-extremity wounds and outline a comprehensive treatment plan that addresses wound perfusion, debridement, infection control, moisture balance, and use of complementary advanced wound care products.
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Affiliation(s)
- Allison Learned
- Department of Surgery, Division of Vascular Surgery, University of Massachusetts Chan Medical School, 55 North Lake Avenue, Worcester, MA 01655, USA
| | - Sudie-Ann Robinson
- Department of Surgery, Division of Vascular Surgery, University of Massachusetts Chan Medical School, 55 North Lake Avenue, Worcester, MA 01655, USA
| | - Tammy T Nguyen
- Department of Surgery, Division of Vascular Surgery, University of Massachusetts Chan Medical School, 55 North Lake Avenue, Worcester, MA 01655, USA; University of Massachusetts Diabetes Center of Excellence.
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Hanba C, Lewis C. Enhanced Recovery After Surgery for Head and Neck Oncologic Surgery Requiring Microvascular Reconstruction. Otolaryngol Clin North Am 2023; 56:801-812. [PMID: 37380326 DOI: 10.1016/j.otc.2023.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
It has been demonstrated since the 1990's that surgical outcomes can be improved through protocolized perioperative interventions. Since then, multiple surgical societies have engaged in adopting Enhanced Recovery After Surgery (ERAS) Societal recommendations to improve patient satisfaction, decrease the cost of interventions, and improve outcomes. In 2017, ERAS released consensus recommendations detailing the perioperative optimization of patients undergoing head and neck free flap reconstruction. This population was identified as a high resource demand, oftentimes burdened with challenging comorbidity, and poorly described cohort for which a perioperative management protocol could help to optimize outcomes. The following pages aim to further detail perioperative strategies to streamline patient recovery after head and neck reconstructive surgery.
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Affiliation(s)
- Curtis Hanba
- Department of Otolaryngology-Head and Neck Surgery, MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
| | - Carol Lewis
- Department of Otolaryngology-Head and Neck Surgery, MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
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Yang S, Bunn C, Kramer S, Thorpe E. The Dynamic Tracheoesophageal Prosthesis Length. J Voice 2023; 37:633.e1-633.e6. [PMID: 34024697 DOI: 10.1016/j.jvoice.2021.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 03/23/2021] [Accepted: 03/30/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE In a postlaryngectomy patient, tracheoesophageal (TE) speech is considered to be the most effective and preferred method of communication. Previous research has demonstrated that despite an appropriately sized TE prosthesis placement at the time of puncture, there are a portion of patients that require resizing postoperatively. The purpose of this study was to report on the variability of the tracheoesophageal prosthesis length. STUDY DESIGN Retrospective chart review. SETTING Tertiary care academic medical center. METHODS This was a retrospective chart review of 62 patients who underwent secondary tracheoesophageal puncture (TEP) at a tertiary care academic medical center from January 2008 to November 2019. Patient demographic information, average changes in prosthesis length, number of prosthesis adjustments, and timing of prosthesis exchanges were collected. RESULTS 62 patients met criteria for study inclusion. Mean age was 61.96 years old with 49 being male (79%) and 13 (21%) females. Overall change in prosthesis length was - 3.85 mm ± 3.58 with time to first prosthesis change at 2.29 months ± 2.73. There was an average of 4.37 changes ± 3.43 before reaching a stable length. Twenty-six patients (41.9%) had increases in their prosthesis length resulting in closure of the tracheoesophageal fistula requiring seven patients (11.3%) to return to the operating room for repuncturing. History of smoking (P = 0.02), Blom-Singer prosthesis type (P = 0.03), and larger diameter (P = 0.01) appeared to be predisposing factors for a fluctuating prosthesis length. CONCLUSION Tracheoesophageal prosthesis length decreases over time for secondary punctures, requiring adjustments with a speech language pathologist. There are a clinically significant portion that have fluctuations in prosthesis length resulting in an increased risk for requiring re-puncturing.
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Affiliation(s)
- Sara Yang
- Department of Otolaryngology Head and Neck Surgery, Loyola University Medical Center, 2160 S. First Ave, Maywood, Illinois.
| | - Corinne Bunn
- Department of Surgery, Loyola University Medical Center, 2160 S. First Ave, Maywood, Illinois; Burn and Shock Trauma Research Institute, Loyola University Chicago, 2160 S. First Ave, Maywood, Illinois
| | - Sarah Kramer
- Cardinal Bernardin Cancer Center, 2160 S. First Ave, Maywood, Illinois
| | - Eric Thorpe
- Department of Otolaryngology Head and Neck Surgery, Loyola University Medical Center, 2160 S. First Ave, Maywood, Illinois; Cardinal Bernardin Cancer Center, 2160 S. First Ave, Maywood, Illinois
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21
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Homer CJ, Richa T. Exophytic Squamous Cell Carcinoma of the Scalp: A Case Report. Cureus 2023; 15:e36741. [PMID: 37123783 PMCID: PMC10139673 DOI: 10.7759/cureus.36741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2023] [Indexed: 03/29/2023] Open
Abstract
Squamous cell carcinoma (SCC) is the second-most common clinical presentation of non-melanoma skin cancer. Despite its prevalence, the rate of growth and development of SCC lesions is low. We present a case report of an exophytic SCC of the midline scalp. Over approximately 18 months, the exophytic portion of this lesion grew to a size of 8.5 x 7 cm due to the fact that the patient did not seek medical attention. The patient suffered from many predisposing factors including active smoking status, type II diabetes, and significant previous sun exposure. In addition to these predisposing factors, the patient did not have comprehensive health insurance to cover outpatient medical care. This case highlights the importance of early intervention in the management of head and neck skin cancers and the negative impact of delayed treatment.
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22
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Lababidi S, Andrews B, Igeh A, Melero GH. The association between smoking status and post-operative complications in pelvic organ prolapse corrective surgeries. Int Urogynecol J 2023; 34:751-757. [PMID: 35674812 DOI: 10.1007/s00192-022-05255-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/24/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Tobacco is a known risk factor for pelvic organ prolapse (POP) as well as postoperative complications in general surgery procedures. Very little is known regarding the impact of tobacco use on postoperative outcomes in POP-correcting procedures, however. We hypothesize that tobacco use will be associated with an increased risk of postoperative complications in these procedures. METHODS This study utilized the National Surgical Quality Improvement Program (NSQIP) database for the years 2012-2020. Patients who underwent POP-correcting procedures were identified using current procedural terminology (CPT) codes. Baseline characteristics between the patient populations were compared using chi-square and one-way ANOVA tests as indicated. Binary logistic regression was used to evaluate the incidence of postoperative complications based on smoking status while controlling for demographic and clinical factors. RESULTS This study included 43,406 total patients, 39,614 non-smokers and 3792 smokers. Postoperative complications including deep wound infections (P < 0.001), intraperitoneal infections (P = 0.003), wound dehiscence (P = 0.014), urinary tract infections (P = 0.029), and hospital readmissions (P < 0.001) were significantly higher in patients who smoke than those who do not. Further evaluation of patients who did not undergo mesh placement intraoperatively and those who solely underwent vaginal procedures showed similar trends. CONCLUSIONS This study demonstrates a higher incidence of postoperative complications after POP-correcting procedures in patients with who smoke. Wound complications, urinary tract infections, and hospital readmission confer a considerable amount of risk to patient outcomes in addition to significant healthcare cost. Consideration should be given to smoking status in preoperative evaluation and counseling before these procedures.
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Affiliation(s)
- Suzanne Lababidi
- Texas Tech University Health Sciences Center El Paso, 4801 Alberta Ave, El Paso, TX, 79905, USA. .,University of Kentucky Medical Center, 1000 S Limestone St, Lexington, KY, 40536, USA.
| | - Brooke Andrews
- University of Kentucky Medical Center, 1000 S Limestone St, Lexington, KY, 40536, USA
| | - Amina Igeh
- Texas Tech University Health Sciences Center El Paso, 4801 Alberta Ave, El Paso, TX, 79905, USA
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Athanerey A, Verma NR, Bhargava P, Amle D, Patra PK, Kumar A. Biochemical aspects of effects of mesenchymal stem cell treatment in chronic wounds progressive healing. Cell Tissue Bank 2023; 24:211-220. [PMID: 35849224 DOI: 10.1007/s10561-022-10026-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 06/28/2022] [Indexed: 11/02/2022]
Abstract
Chronic wounds are a persistent burden for medical professionals. Despite developments and advancements in treatment, these wounds do not heal completely. Mesenchymal stem cells (MSCs) are the epicenter of regenerative medicine that have shown promising results in chronic wound regeneration. Autologous peripheral blood-derived MSCs (PB-MSCs) are comparatively new in wound healing treatment, bone-marrow-derived MSCs (BM-MSCs), and adipose-derived stem cells (ADSCs) are commonly being practiced. In the present study, PB-MSCs treatment was given to chronic wound patients. Various biochemical parameters like random blood glucose, serum urea, serum creatinine, bilirubin (total and direct), Aspartate Aminotransferase (AST), Alanine Aminotransferase (ALT), total protein, albumin levels, and association of other factors/conditions such as age, sex, addiction of drug/alcohol were also evaluated/compared with complete and without complete healing. The wound area of the ulcer was found to be significantly reduced and the wound was healthier after the treatment. These biochemical parameters could be certainly utilized as biomarkers to anticipate the risk of chronic wounds. These findings may contribute to the development of better wound care treatment strategies and drug discovery in the field of regenerative medicine.
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Affiliation(s)
- Anjali Athanerey
- Department of Biotechnology, National Institute of Technology Raipur, Raipur, Chhattisgarh, India
| | - Neha Rani Verma
- Department of Biochemistry, Pt JNM Medical College Raipur, Raipur, Chhattisgarh, India
| | - Piyush Bhargava
- Department of Biochemistry, Pt JNM Medical College Raipur, Raipur, Chhattisgarh, India
| | - Dnyanesh Amle
- Department of Biochemistry, AIIMS Nagpur, Sumthana, Maharastra, India
| | - P K Patra
- Department of Biochemistry, Pt JNM Medical College Raipur, Raipur, Chhattisgarh, India.
| | - Awanish Kumar
- Department of Biotechnology, National Institute of Technology Raipur, Raipur, Chhattisgarh, India.
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Postoperative Antibiotics Confer No Protective Association After Fat Grafting for Breast Reconstruction. Ann Plast Surg 2023:00000637-990000000-00160. [PMID: 36880783 DOI: 10.1097/sap.0000000000003420] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
INTRODUCTION Autologous fat grafting after breast reconstruction is a commonly used technique to address asymmetry and irregularities in breast contour. While many studies have attempted to optimize patient outcomes after fat grafting, a key postoperative protocol that lacks consensus is the optimal use of perioperative and postoperative antibiotics. Reports suggest that complication rates for fat grafting are low relative to rates after reconstruction and have been shown to not be correlated to antibiotic protocol. Studies have additionally demonstrated that the use of prolonged prophylactic antibiotics do not lower the complication rates, stressing the need for a more conservative, standardized antibiotic protocol. This study aims to identify the optimal use of perioperative and postoperative antibiotics that optimizes patient outcomes. METHODS Patients in the Optum Clinformatics Data Mart who underwent all billable forms of breast reconstruction followed by fat grafting were identified via Current Procedural Terminology codes. Patients meeting inclusion criteria had an index reconstructive procedure at least 90 days before fat grafting. Data concerning these patient's demographics, comorbidities, breast reconstructions, perioperative and postoperative antibiotics, and outcomes were collected via querying relevant reports of Current Procedural Terminology; International Classification of Diseases, Ninth Revision; International Classification of Diseases, Tenth Revision; National Drug Code Directory, and Healthcare Common Procedure Coding System codes. Antibiotics were classified by type and temporal delivery: perioperatively or postoperatively. If a patient received postoperative antibiotics, the duration of antibiotic exposure was recorded. Outcomes analysis was limited to the 90-day postoperative period. Multivariable logistic regression was performed to ascertain the effects of age, coexisting conditions, reconstruction type (autologous or implant-based), perioperative antibiotic class, postoperative antibiotic class, and postoperative antibiotic duration on the likelihood of any common postoperative complication occurring. All statistical assumptions made by logistic regression were met successfully. Odds ratios and corresponding 95% confidence intervals were calculated. RESULTS From more than 86 million longitudinal patient records between March 2004 and June 2019, our study population included 7456 unique records of reconstruction-fat grafting pairs, with 4661 of those pairs receiving some form of prophylactic antibiotics. Age, prior radiation, and perioperative antibiotic administration were consistent independent predictors of increased all-cause complication likelihood. However, administration of perioperative antibiotics approached a statistically significant protective association against infection likelihood. No postoperative antibiotics of any duration or class conferred a protective association against infections or all-cause complications. CONCLUSIONS This study provides national, claims-level support for antibiotic stewardship during and after fat grafting procedures. Postoperative antibiotics did not confer a protective benefit association against infection or all-cause complication likelihood, while administering perioperative antibiotics conferred a statistically significant increase in the likelihood that a patient experienced postoperative complication. However, perioperative antibiotics approach a significant protective association against postoperative infection likelihood, in line with current guidelines for infection prevention. These findings may encourage the adoption of more conservative postoperative prescription practices for clinicians who perform breast reconstruction, followed by fat grafting, reducing the nonindicated use of antibiotics.
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Morris D, Flores M, Harris L, Gammon J, Nigam Y. Larval Therapy and Larval Excretions/Secretions: A Potential Treatment for Biofilm in Chronic Wounds? A Systematic Review. Microorganisms 2023; 11:microorganisms11020457. [PMID: 36838422 PMCID: PMC9965881 DOI: 10.3390/microorganisms11020457] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/24/2023] [Accepted: 02/01/2023] [Indexed: 02/16/2023] Open
Abstract
Chronic wounds present a global healthcare challenge and are increasing in prevalence, with bacterial biofilms being the primary roadblock to healing in most cases. A systematic review of the to-date knowledge on larval therapy's interaction with chronic-wound biofilm is presented here. The findings detail how larval therapy-the controlled application of necrophagous blowfly larvae-acts on biofilms produced by chronic-wound-relevant bacteria through their principle pharmacological mode of action: the secretion and excretion of biologically active substances into the wound bed. A total of 12 inclusion-criteria-meeting publications were identified following the application of a PRISMA-guided methodology for a systematic review. The findings of these publications were qualitatively analyzed to provide a summary of the prevailing understanding of larval therapy's effects on bacterial biofilm. A further review assessed the quality of the existing evidence to identify knowledge gaps and suggest ways these may be bridged. In summary, larval therapy has a seemingly unarguable ability to inhibit and degrade bacterial biofilms associated with impaired wound healing. However, further research is needed to clarify and standardize the methodological approach in this area of investigation. Such research may lead to the clinical application of larval therapy or derivative treatments for the management of chronic-wound biofilms and improve patient healing outcomes at a time when alternative therapies are desperately needed.
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Affiliation(s)
- Daniel Morris
- Faculty of Medicine, Health, and Life Science, Swansea University, Swansea SA2 8PP, UK
- BioMonde, Bridgend CF31 3BG, UK
| | | | - Llinos Harris
- Faculty of Medicine, Health, and Life Science, Swansea University, Swansea SA2 8PP, UK
| | - John Gammon
- Faculty of Medicine, Health, and Life Science, Swansea University, Swansea SA2 8PP, UK
| | - Yamni Nigam
- Faculty of Medicine, Health, and Life Science, Swansea University, Swansea SA2 8PP, UK
- Correspondence:
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Cipres DT, Shim JY, Grimstad FW. Postoperative Vaginal Bleeding Concerns after Gender-Affirming Hysterectomy in Transgender Adolescents and Young Adults on Testosterone. J Pediatr Adolesc Gynecol 2023; 36:33-38. [PMID: 36089115 DOI: 10.1016/j.jpag.2022.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/05/2022] [Accepted: 09/02/2022] [Indexed: 01/18/2023]
Abstract
STUDY OBJECTIVE This study aimed to characterize the incidence and management of postoperative vaginal bleeding concerns experienced by transgender adolescents and young adults (AYA) on testosterone hormone therapy after gender-affirming hysterectomy (GAH). METHODS This was a retrospective cohort of transgender AYA, 18 years and older, using testosterone therapy who underwent a GAH between July 2020 and September 2021 at a tertiary care children's hospital. The incidence of patient-reported postoperative vaginal bleeding concerns and management of bleeding are described. RESULTS Patient ages ranged between 18 and 33 years. Among 25 patients who met the inclusion criteria, 13 (52.0%) reported vaginal bleeding concerns. No modifiable patient or operative characteristics reached statistical significance in association with postoperative bleeding concerns. Among patients with bleeding concerns, 10 (76.9%) experienced such concerns during the first 2 weeks after surgery, and 6 (46.2%) had resolution of bleeding without intervention. Among 11 patients who underwent an exam for evaluation of bleeding, findings included granulation tissue (n = 5, 45.5%), vaginal atrophy (n = 4, 36.4%), bleeding vessel (n = 1, 9.1%), mucosal separation (n = 1, 9.1%), or no cause of bleeding identified (n = 4, 36.4%). CONCLUSIONS Over half of transgender AYA on testosterone therapy in this cohort reported postoperative vaginal bleeding concerns that were most often secondary to atrophy and granulation tissue, suggesting possible susceptibility to vaginal tissue trauma at the time of GAH and granulation-susceptible healing in patients on testosterone. As vaginal bleeding could worsen gender dysphoria, these findings support the need for patient counseling on postoperative bleeding expectations and identification of interventions to reduce vaginal bleeding after GAH.
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Affiliation(s)
- Danielle T Cipres
- Division of Gynecology, Department of Surgery, Boston Children's Hospital, Boston, Massachusetts; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, Massachusetts.
| | - Jessica Y Shim
- Division of Gynecology, Department of Surgery, Boston Children's Hospital, Boston, Massachusetts; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, Massachusetts
| | - Frances W Grimstad
- Division of Gynecology, Department of Surgery, Boston Children's Hospital, Boston, Massachusetts; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, Massachusetts
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Healing after transoral carbon dioxide laser surgery for early glottic cancer. J Laryngol Otol 2023; 137:205-212. [PMID: 35094723 DOI: 10.1017/s0022215121004679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study aimed to evaluate the clinical significance of granulation tissue after endoscopic carbon dioxide laser surgery for glottic cancer. METHOD This was a retrospective review of 36 patients who underwent endoscopic carbon dioxide laser surgery for T1 and T2 glottic cancer. Post-operative, endoscopic examinations were rated by three blinded otolaryngologists for time to heal and presence of granulation. Patient and surgical factors were compared with time to heal and granulation. RESULTS A total of 16 of 36 wounds (44 per cent) developed granulation tissue, and 24 wounds (67 per cent) healed without requiring surgical intervention. A total of 7 of 8 wounds biopsied more than 3.5 months after surgery had persistent cancer versus 1 of 4 wounds biopsied at equal to or less than 3.5 months (85.7 per cent vs 25 per cent; p = 0.03). Biopsy at more than 3.5 months was associated with 28-fold increased odds of cancer in biopsy compared with biopsy at equal to or less than 3.5 months (odds ratio, 28.0; 95 per cent confidence interval, 1.088-373.3). CONCLUSION After carbon dioxide laser surgery for glottic cancer, development of granulation tissue is common. Granulation that persists for more than 3.5 months necessitates biopsy because of increased risk of persistent cancer.
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Kloss FR, Kämmerer PW, Kloss-Brandstätter A. Risk Factors for Complications Following Staged Alveolar Ridge Augmentation and Dental Implantation: A Retrospective Evaluation of 151 Cases with Allogeneic and 70 Cases with Autogenous Bone Blocks. J Clin Med 2022; 12:jcm12010006. [PMID: 36614811 PMCID: PMC9820942 DOI: 10.3390/jcm12010006] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
Purpose: the aim of this study was to identify potential risk factors favoring complications by assessing the number and types of complications associated with allogeneic or autogenous bone blocks applied as onlay grafts for alveolar ridge augmentation prior to implantation. Methods: A retrospective chart review on the success of 151 allogeneic and 70 autogenous bone blocks in a cohort of 164 consecutive patients, who were treated over a period of 6 years by the same surgeon, was conducted. Statistical conclusions were based on ROC curves and multiple logistic regression models. Results: Complications were observed more frequently with autogenous bone blocks (14 out of 70 cases; 20%) compared to allogeneic bone blocks (12 out of 151 cases; 7.9%; p = 0.013). However, these complications were minor and did not impact the successful dental rehabilitation. In a multiple logistic regression model, the risk of a complication was increased by the use of an autogenous bone block (OR = 3.2; p = 0.027), smoking (OR = 4.8; p = 0.007), vertical augmentation above a threshold of 2.55 mm (OR = 5.0; p = 0.002), and over-contouring (OR = 15.3; p < 0.001). Conclusions: Overall, the complication rate of ridge augmentations carried out with autogenous or allogeneic bone blocks was low. Despite previous recommendations, over-contouring and a vertical augmentation above a threshold of 2.55 mm should be avoided.
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Affiliation(s)
- Frank R. Kloss
- Oral- and Maxillofacial Surgeon, Private Clinic for Oral- and Maxillofacial Surgery, Kärntnerstraße 62, 9900 Lienz, Austria
- Correspondence: ; Tel.: +43-4852-64643
| | - Peer W. Kämmerer
- Department of Oral and Maxillofacial Surgery, University Medical Centre Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Anita Kloss-Brandstätter
- Department of Engineering & IT, Carinthia University of Applied Sciences, Europastraße 4, 9524 Villach, Austria
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Thibert A, Briche N, Vernizeau BD, Mougin-Guillaume F, Béliard S. Systematic review of adapted physical activity and therapeutic education of patients with chronic venous disease. J Vasc Surg Venous Lymphat Disord 2022; 10:1385-1400. [PMID: 35810994 DOI: 10.1016/j.jvsv.2022.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/04/2022] [Accepted: 05/03/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Chronic venous disease (CVD), comprising impaired lower limb venous return, will lead to chronic distal venous pressure overload manifested by various clinical signs and symptoms and resulting in diminished quality of life. The CEAP (Clinical, Etiology, Anatomy, and Pathophysiology) classification of CVD distinguishes six stages (C0-C6) using clinical, etiologic, anatomic, and pathophysiologic parameters. In the present study, we analyzed the effects of adapted physical activity (APA) and patient-oriented therapeutic education (PTE) programs on the clinical signs, symptoms, and quality of life of patients with CVD. METHODS Our analysis, in accordance with the PRISMA (preferred reporting items for systematic reviews and meta-analyses) recommendations, included a search of PubMed, CINAHL and LiSSa databases, using a single search equation. RESULTS A total of 21 studies were selected for analysis. The analysis revealed first, that patients at stage C0 to C5 had had access to an APA program. This therapy alleviated the clinical signs and symptoms and improved the patients' quality of life. The beneficial effects of APA were greater in the programs that had included aquatic activities than in the program that were exclusively dry-land programs. Second, patients at stage C6 had predominantly followed a PTE program. This therapy showed beneficial effects on the clinical signs and symptoms. However, the quality of life had rarely been assessed. CONCLUSIONS At present, APA and PTE programs comprise useful and complementary therapeutic options for the care of patients with CVD. Two of the studies included in our review had evaluated the effects of combining these two approaches, notably in the context of balneotherapy, and reported promising results.
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Affiliation(s)
- Axelle Thibert
- Independent Adapted Physical Activity Teacher, Dole, France; Functional Unit of Vascular Medicine, Hospital Centre Louis-Pasteur, Dole, France
| | - Nicolas Briche
- Functional Unit of Vascular Medicine, Hospital Centre Louis-Pasteur, Dole, France
| | | | - Fabienne Mougin-Guillaume
- EA3920, Platform Exercise Performance Health Innovation, University of Bourgogne Franche-Comté, CHRU Jean Minjoz, Besançon, France
| | - Samuel Béliard
- Functional Unit of Vascular Medicine, Hospital Centre Louis-Pasteur, Dole, France; EA3920, Platform Exercise Performance Health Innovation, University of Bourgogne Franche-Comté, CHRU Jean Minjoz, Besançon, France; PEPITE EA4267, Platform Exercise Performance Health Innovation, University of Bourgogne Franche-Comté, Besançon, France.
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Soft-Tissue Healing Assessment after Extraction and Socket Preservation Using Platelet-Rich Fibrin (PRF) in Smokers: A Single-Blinded, Randomized, Controlled Clinical Trial. Diagnostics (Basel) 2022; 12:diagnostics12102403. [PMID: 36292091 PMCID: PMC9600039 DOI: 10.3390/diagnostics12102403] [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: 08/23/2022] [Revised: 09/28/2022] [Accepted: 09/29/2022] [Indexed: 11/23/2022] Open
Abstract
Background: Wound healing is essential in any surgical procedure, and multiple factors, such as smoking, can impair it. The aim of this clinical trial was to evaluate the ability of platelet-rich fibrin to enhance socket wound healing in smokers. Methods: A total of 18 smoker participants with forty non-restorable upper molars indicated for extraction were recruited to the study and were randomly allocated to four different groups for the assessment of four techniques: advanced platelet-rich fibrin (A-PRF), factor-enriched bone graft matrix with advanced platelet-rich fibrin (A/S-PRF), freeze-dried bone allograft and crosslinked collagen membrane (FDBA/CM), and resorbable collagen plug (RCP). One examiner clinically measured soft-tissue closure and the healing pattern using a periodontal probe and a healing index. Each subject was given a questionnaire after each follow-up visit to record several patient-reported experience measures (PREMs). This was conducted at baseline and 10, 21, and 28 days after the extraction procedure. Results: Both A-PRF and A/S-PRF showed significant results in terms of mesio-distally (p = 0.012), and healing pattern parameters (p < 0.0001), while RCP showed the least favorable outcome. Conclusions: Different forms of PRF exhibited enhanced wound closure and healing patterns, as well as reduced post-operative complications among smokers.
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Fang K, Lee C, Chuang H, Huang T, Chien C, Tsai W, Fang F. Acute radiation dermatitis among patients with nasopharyngeal carcinoma treated with proton beam therapy: Prognostic factors and treatment outcomes. Int Wound J 2022; 20:499-507. [PMID: 35880316 PMCID: PMC9885453 DOI: 10.1111/iwj.13897] [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: 06/03/2022] [Revised: 07/02/2022] [Accepted: 07/04/2022] [Indexed: 02/03/2023] Open
Abstract
A high incidence of severe acute radiation dermatitis (ARD) has been reported for cancer patients treated by proton beam therapy (PBT). This observational study investigated the prognostic factors and treatment outcomes of ARD among patients with nasopharyngeal carcinoma (NPC) treated with PBT. Fifty-seven patients with newly diagnosed NPC and treated with PBT were enrolled. ARD was recorded weekly based on the criteria of Common Terminology Criteria for Adverse Events version 4.0 at treatment visits (1st to 7th weeks) and 1 week (8th week) and 1 month (11th week) after the completion of PBT. The maximum ARD grade was 1, 2, and 3 in 26 (45.6%), 24 (42.1%), and 7 (12.3%) of the patients, respectively. The peak incidence of grade 2 and 3 ARD was observed during the period of the 6th to 8th weeks. Treatment of ARD included topical corticosteroid alone in 24 (42.1%) patients, topical corticosteroid plus silver sulfadiazine in 33 (57.9%) patients, and non-adhering silicone dressing to cover severe skin wound area in 25 (43.8%) patients. In the 11th week, most grade 2 and 3 ARD had disappeared and 93.0% of the patients had ARD of grade 1 or lower. In the binary logistic regression model, we identified habitual smoking (odds ratio [OR]: 5.2, 95% confidence interval [CI]: 1.3-18.8, P = .012) and N2 to N3 nodal status (OR: 4.9, 95% CI: 1.6-15.4, P = .006) as independent predictors of grade 2 and 3 ARD. The results show ARD is a major concern for patients with NPC treated with PBT, especially those with habitual smoking or advanced nodal status. Topical corticosteroid, silver sulfadiazine, and non-adhering silicone dressing are effective for treating ARD induced by PBT.
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Affiliation(s)
- Ko‐Chun Fang
- Department of EducationKaohsiung Chang‐Gung Memorial Hospital and Chang Gung University College of MedicineKaohsiungTaiwan
| | - Chih‐Hung Lee
- Department of DermatologyKaohsiung Chang‐Gung Memorial Hospital and Chang Gung University College of MedicineKaohsiungTaiwan
| | - Hui‐Ching Chuang
- Department of OtolaryngologyKaohsiung Chang‐Gung Memorial Hospital and Chang Gung University College of MedicineKaohsiungTaiwan,Department of MedicineChang Gung University College of MedicineTaoyuanTaiwan
| | - Tai‐Lin Huang
- Department of Hematology and OncologyKaohsiung Chang Gung Memorial Hospital and Chang Gung University College of MedicineKaohsiungTaiwan
| | - Chih‐Yen Chien
- Department of OtolaryngologyKaohsiung Chang‐Gung Memorial Hospital and Chang Gung University College of MedicineKaohsiungTaiwan,Department of MedicineChang Gung University College of MedicineTaoyuanTaiwan
| | - Wen‐Ling Tsai
- Department of Cosmetics and Fashion StylingCenter for Environmental Toxin and Emerging‐Contaminant Research, Cheng Shiu UniversityKaohsiungTaiwan
| | - Fu‐Min Fang
- Department of MedicineChang Gung University College of MedicineTaoyuanTaiwan,Department of Radiation OncologyKaohsiung Chang‐Gung Memorial Hospital and Chang Gung University College of MedicineKaohsiungTaiwan
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Fan Chiang Y, Lee Y, Lam F, Liao C, Chang C, Lin C. Smoking increases the risk of postoperative wound complications: A propensity score-matched cohort study. Int Wound J 2022; 20:391-402. [PMID: 35808947 PMCID: PMC9885463 DOI: 10.1111/iwj.13887] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 06/25/2022] [Indexed: 02/03/2023] Open
Abstract
Cigarette smoking is associated with surgical complications, including wound healing and surgical site infection. However, the association between smoking status and postoperative wound complications is not completely understood. Our objective was to investigate the effect of smoking on postoperative wound complications for major surgeries. Data were collected from the 2013 to 2018 participant use files of the American College of Surgeons National Surgical Quality Improvement Program database. A propensity score matching procedure was used to create the balanced smoker and nonsmoker groups. Multivariable logistic regression was used to calculate the odds ratios (ORs) with 95% confidence intervals (CIs) for postoperative wound complications, pulmonary complications, and in-hospital mortality associated with smokers. A total of 1 156 002 patients (578 001 smokers and 578 001 nonsmokers) were included in the propensity score matching analysis. Smoking was associated with a significantly increased risk of postoperative wound disruption (OR 1.65, 95% CI 1.56-1.75), surgical site infection (OR 1.31, 95% CI 1.28-1.34), reintubation (OR 1.47, 95% CI 1.40-1.54), and in-hospital mortality (OR 1.13, 95% CI 1.07-1.19) compared with nonsmoking. The length of hospital stay was significantly increased in smokers compared with nonsmokers. Our analysis indicates that smoking is associated with an increased risk of surgical site infection, wound disruption, and postoperative pulmonary complications. The results may drive the clinicians to encourage patients to quit smoking before surgery.
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Affiliation(s)
| | - Yuan‐Wen Lee
- Department of AnesthesiologyTaipei Medical University HospitalTaipeiTaiwan,Department of Anesthesiology, School of Medicine, College of MedicineTaipei Medical UniversityTaipeiTaiwan,Anesthesiology and Health Policy Research CenterTaipei Medical University HospitalTaipeiTaiwan
| | - Fai Lam
- Department of AnesthesiologyTaipei Medical University HospitalTaipeiTaiwan
| | - Chien‐Chang Liao
- Department of AnesthesiologyTaipei Medical University HospitalTaipeiTaiwan,Department of Anesthesiology, School of Medicine, College of MedicineTaipei Medical UniversityTaipeiTaiwan,Anesthesiology and Health Policy Research CenterTaipei Medical University HospitalTaipeiTaiwan
| | - Chuen‐Chau Chang
- Department of AnesthesiologyTaipei Medical University HospitalTaipeiTaiwan,Department of Anesthesiology, School of Medicine, College of MedicineTaipei Medical UniversityTaipeiTaiwan,Anesthesiology and Health Policy Research CenterTaipei Medical University HospitalTaipeiTaiwan
| | - Chao‐Shun Lin
- Department of AnesthesiologyTaipei Medical University HospitalTaipeiTaiwan,Department of Anesthesiology, School of Medicine, College of MedicineTaipei Medical UniversityTaipeiTaiwan,Anesthesiology and Health Policy Research CenterTaipei Medical University HospitalTaipeiTaiwan
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Meltzer-Bruhn AT, Esper GW, Herbosa CG, Ganta A, Egol KA, Konda SR. The Role of Smoking and Body Mass Index in Mortality Risk Assessment for Geriatric Hip Fracture Patients. Cureus 2022; 14:e26666. [PMID: 35949773 PMCID: PMC9357434 DOI: 10.7759/cureus.26666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2022] [Indexed: 11/30/2022] Open
Abstract
Background Smoking, obesity, and being below a healthy body weight are known to increase all-cause mortality rates and are considered modifiable risk factors. The purpose of this study is to assess whether adding these risk factors to a validated geriatric inpatient mortality risk tool will improve the predictive capacity for hip fracture patients. We hypothesize that the predictive capacity of the Score for Trauma Triage in the Geriatric and Middle-Aged (STTGMA) tool will improve. Methodology Between October 2014 and August 2021, 2,421 patients >55-years-old treated for hip fractures caused by low-energy mechanisms were analyzed for demographics, injury details, hospital quality measures, and mortality. Smoking status was recorded as a current every-day smoker, former smoker, or never smoker. Smokers (current and former) were compared to non-smokers (never smokers). Body mass index (BMI) was defined as underweight (<18.5 kg/m2), healthy weight (18.5-24.9 kg/m2), overweight (25.0-24.9 kg/m2), or obese (>30 kg/m2). The baseline STTGMA tool for hip fractures (STTGMAHIP_FX_SCORE) was modified to include patients’ BMI and smoking status (STTGMA_MODIFIABLE), and new mortality risk scores were calculated. Each model’s predictive ability was compared using DeLong’s test by analyzing the area under the receiver operating curves (AUROCs). Comparative analyses were conducted on each risk quartile. Results A comparison of smokers versus non-smokers demonstrated that smokers experienced higher rates of inpatient (p = 0.025) and 30-day (p = 0.048) mortality, myocardial infarction (p < 0.01), acute respiratory failure (p < 0.01), and a longer length of stay (p = 0.014). Comparison among BMI cohorts demonstrated that underweight patients experienced higher rates of pneumonia (p = 0.033), decubitus ulcers (p = 0.046), and the need for an intensive care unit (ICU) (p < 0.01). AUROC comparison demonstrated that STTGMA_MODIFIABLE significantly improved the predictive capacity for inpatient mortality compared to STTGMAHIP_FX_SCORE (0.792 vs. 0.672, p = 0.0445). Quartile stratification demonstrated the highest risk cohort had a longer length of stay (p < 0.01), higher rates of inpatient (p < 0.01) and 30-day mortality (p < 0.01), and need for an ICU (p < 0.01) compared to the minimal risk cohort. Patients in the lowest risk quartile were most likely to be discharged home (p < 0.01). Conclusions Smoking, obesity, and being below a healthy body weight increase the risk of perioperative complications and poor outcomes. Including smoking and BMI improves the STTGMAHIP_FX_SCORE tool to predict mortality and risk stratify patient outcomes. Because smoking, obesity, and being below a healthy body weight are modifiable patient factors, providers can counsel patients and implement lifestyle changes to potentially decrease their risk of longer-term poor outcomes, especially in the setting of another fracture. For patients who are former smokers, providers can use this information to encourage continued restraint and healthy choices.
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Fereydooni A, Yawary F, Sen S, Chou L, Murphy M, Dalman RL, Stern JR, Chandra V. Multidisciplinary extremity preservation program improves quality of life for patients with advanced limb threat. Ann Vasc Surg 2022; 87:302-310. [PMID: 35803456 DOI: 10.1016/j.avsg.2022.05.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 05/14/2022] [Accepted: 05/23/2022] [Indexed: 11/01/2022]
Abstract
INTRODUCTION The need for multidisciplinary care of patients with advanced limb threat is well established. We examined patient reported outcomes and health-related quality of life (HR-QoL) for those who completed a multidisciplinary extremity preservation program (EPP) at our institution. METHODS Patients with advanced limb threat, who had previously failed standard management at a tertiary-care center, were referred to EPP for evaluation by a multidisciplinary panel of vascular, plastic, orthopedic and podiatric surgeons, along with infectious disease, prosthetics, orthotics, imaging, palliative care, social work and wound nursing specialists. HR-QoL was quantified before and after EPP participation with the RAND-36 questionnaire. The validated RAND-36 assesses physical function, role limitations caused by physical and emotional health problems, social functioning, emotional well-being, energy, pain and general health perceptions. RESULTS From 2018 to 2020, 185 patients were referred to EPP. After review by the multidisciplinary panel, 120 were accepted into the program, 63 of whom completed their course of care; 9 were one-time consultations. The median number of EPP in-person care visits was 23 (13-54) per participant; 87.3% of patients received one or more surgical procedure, including operative debridement (73%), revascularization (44%), soft tissue reconstruction or transplantation (46%), as well as hyperbaric oxygen therapy (11%) during their course of treatment. 85.7% of patients achieved complete wound healing, 41.5% occurring within 6 months. Ultimately, 14.3% required a major amputation. Graduates noted improvement in all categories of the HR-QoL upon completion, including those undergoing major amputation. On adjusted multivariate regression analysis, patients with immunocompromised status were more likely to show greater improvement in their social function (OR: 10.1; P<0.044) and emotional role limitation (OR:8.1; P=0.042), while patients with larger wound volume at presentation were more likely to have greater improvement in their general health (OR: 1.1; P<0.049). Conversely, patients with a smoking history had less improvement in energy level (OR:0.4; P=0.044) and patients with dialysis-dependence had less improvement in social function (OR:0.2; P=0.034). CONCLUSION Coordinated, multidisciplinary extremity preservation program improves HR-QoL of patients with complex limb threat, including those who are immunocompromised with impaired social function and emotional role limitations. Further study is warranted to better characterize the generalizability of this approach, including considerations of cost-effectiveness, wound recidivism, and limiting the number of in-person visits required to achieve complete healing.
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Affiliation(s)
- Arash Fereydooni
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stanford University, Stanford, CA
| | - Farishta Yawary
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stanford University, Stanford, CA
| | - Subhro Sen
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University, Stanford, CA
| | - Loretta Chou
- Department of Orthopedic Surgery, Stanford University, Stanford, CA
| | - Matthew Murphy
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University, Stanford, CA
| | - Ronald L Dalman
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stanford University, Stanford, CA
| | - Jordan R Stern
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stanford University, Stanford, CA
| | - Venita Chandra
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stanford University, Stanford, CA.
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Dosimetric Parameters Related to Acute Radiation Dermatitis of Patients with Nasopharyngeal Carcinoma Treated by Intensity-Modulated Proton Therapy. J Pers Med 2022; 12:jpm12071095. [PMID: 35887590 PMCID: PMC9318665 DOI: 10.3390/jpm12071095] [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: 05/23/2022] [Revised: 06/25/2022] [Accepted: 06/29/2022] [Indexed: 12/08/2022] Open
Abstract
Background: Growing patients with nasopharyngeal carcinoma (NPC) were treated with intensity-modulated proton therapy (IMPT). However, a high probability of severe acute radiation dermatitis (ARD) was observed. The objective of the study is to investigate the dosimetric parameters related to ARD for NPC patients treated with IMPT. Methods: Sixty-two patients with newly diagnosed NPC were analyzed. The ARD was recorded based on the criteria of Common Terminology Criteria for Adverse Events version 4.0. Logistic regression model was performed to identify the clinical and dosimetric parameters related to ARD. Receiver operating characteristic (ROC) curve analysis and the area under the curve (AUC) were used to evaluate the performance of the models. Results: The maximum ARD grade was 1, 2, and 3 in 27 (43.5%), 26 (42.0%), and 9 (14.5%) of the patients, respectively. Statistically significant differences (p < 0.01) in average volume to skin 5 mm with the respective doses were observed in the range 54−62 Cobalt Gray Equivalent (CGE) for grade 2 and 3 versus grade 1 ARD. Smoking habit and N2-N3 status were identified as significant predictors to develop grade 2 and 3 ARD in clinical model, and V58CGE to skin 5 mm as an independent predictor in dosimetric model. After adding the variable of V58CGE to the metric incorporating two parameters of smoking habit and N status, the AUC value of the metric increases from 0.78 (0.66−0.90) to 0.82 (0.72−0.93). The most appropriate cut-off value of V58CGE to skin 5 mm as determined by ROC curve was 5.0 cm3, with a predicted probability of 54% to develop grade 2 and 3 ARD. Conclusion: The dosimetric parameter of V58CGE to skin 5 mm < 5.0 cm3 could be used as a constraint in treatment planning for NPC patients treated by IMPT.
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Is combined physical therapy more effective than topical hyperbaric oxygen therapy in the treatment of venous leg ulcers? Preliminary study. POSTEP HIG MED DOSW 2022. [DOI: 10.2478/ahem-2022-0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Introduction
Recently, increased frequency of chronic leg ulcers has been observed. The aim of the study was to compare therapeutic efficacy of combined physical therapy to topical hyperbaric oxygen therapy in the treatment of venous leg ulcers.
Materials and Methods
Participants included 36 patients (14 females and 22 males) between 18 and 80 years of age with chronic venous leg ulcers. They were randomly divided into two study groups. Group I underwent topical hyperbaric oxygen therapy; group II underwent combined physical therapy. Before and after the therapeutic cycle (15 procedures) measurement of ulceration size by planimetry and analysis of laboratory parameters of blood was performed.
Results
In both groups, a statistically significant reduction of ulcer surface area was obtained (25.11±17.8cm2 to 16.93±13.89cm2, p=0.000196) vs. (34.17±14.82cm2 to 23.99±15.15cm2, p=0.004337). Blood morphology revealed a statistically significant reduction in patients from group II who underwent combined physical therapy (p=0.01). In both groups, statistically significant reduction of fibrinogen level (p=0.01 and p<0.001), and total protein level (p=0.01) was achieved. In group II reduction of the inflammation marker C-reactive protein (CRP) was noted.
Conclusions
Topical hyperbaric oxygen therapy and combined physical therapy had statistically significant effects on the reduction of surface area of treated venous leg ulcers. The changes in morphological and biochemical parameters may indicate the anti-inflammatory and anti-clotting action effects of combined physical therapy.
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Yamamoto K, Miwa S, Yamada T, Setozaki S, Hamuro M, Kurokawa S, Enomoto S. Feasibility of incompetent perforator vein excision using stab avulsion. Phlebology 2022; 37:393-399. [PMID: 35318865 PMCID: PMC9168896 DOI: 10.1177/02683555221081816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objectives Whether incompetent perforator veins (IPVs) require treatment remains controversial. We
retrospectively evaluated the feasibility of IPV excision performed using the stab
avulsion technique without ligation and sutures in patients undergoing endovenous
ablation (EA). Methods This was a single-center, retrospective, observational cohort study. EA was performed
in 1503 consecutive patients, including 33 patients with ulcers, between December 2014
and May 2021. Varicectomy was performed using the stab avulsion technique; IPV cases
were included. Results Stab avulsion was performed at a mean number of 11.4 ± 7.8 sites. No deep vein
thromboses or pulmonary emboli were noted. The incidence of nerve injury was 0.3%. All
33 (100%) patients with ulcers achieved healing by 1 year (median: 55.5 days; range:
13–365 days). Conclusions IPV excision via stab avulsion may be a viable option for treating varicose veins and
ulcers. This technique offers multiple advantages, including simplicity, safety, and
reduced healthcare costs.
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Affiliation(s)
- Kenji Yamamoto
- Department of Cardiovascular Surgery, Center of Varicose Veins, Okamura Memorial Hospital, Shizuoka, Japan
| | - Senri Miwa
- Department of Cardiovascular Surgery, Center of Varicose Veins, Okamura Memorial Hospital, Shizuoka, Japan
| | - Tomoyuki Yamada
- Department of Cardiovascular Surgery, Shiga General Hospital, Moriyama, Japan
| | - Shuji Setozaki
- Department of Cardiovascular Surgery, Shizuoka General Hospital, Shizuoka, Japan
| | - Mamoru Hamuro
- Department of Cardiovascular Surgery, Center of Varicose Veins, Okamura Memorial Hospital, Shizuoka, Japan
| | - Shunji Kurokawa
- Department of Cardiovascular Surgery, Center of Varicose Veins, Okamura Memorial Hospital, Shizuoka, Japan
| | - Sakae Enomoto
- Department of Cardiovascular Surgery, Center of Varicose Veins, Okamura Memorial Hospital, Shizuoka, Japan
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Jimenez AE, Lee MS, Owens JS, Maldonado DR, Saks BR, Lall AC, Domb BG. Effect of Cigarette Smoking on Midterm Outcomes After Arthroscopic Surgery for Femoroacetabular Impingement Syndrome: A Propensity-Matched Controlled Study With Minimum 5-Year Follow-up. Orthop J Sports Med 2022; 10:23259671221090905. [PMID: 35571968 PMCID: PMC9098985 DOI: 10.1177/23259671221090905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/08/2021] [Indexed: 12/02/2022] Open
Abstract
Background: There is limited literature evaluating patient-reported outcomes (PROs) in
cigarette smokers undergoing hip arthroscopy for femoroacetabular
impingement syndrome (FAIS) at midterm follow-up. Purpose: (1) To report minimum 5-year PROs for cigarette-smoking patients who
underwent primary hip arthroscopy for FAIS and (2) to compare these results
with a propensity-matched control group of never-smoking patients. Study Design: Cohort study; Level of evidence, 3. Methods: Data were collected for all patients who underwent primary hip arthroscopy
for FAIS between June 2009 and March 2016. Patients were eligible if they
indicated that they smoked cigarettes within 1 month of surgery and had
minimum 5-year postoperative outcomes for the modified Harris Hip Score,
Nonarthritic Hip Score, Hip Outcome Score–Sport Specific Subscale (HOS-SSS),
and International Hip Outcome Tool–12 (iHOT-12). The percentages of patients
achieving the Patient Acceptable Symptom State (PASS) and maximum outcome
improvement satisfaction threshold were recorded. The study group was then
propensity matched in a 1:2 ratio to patients who had never smoked for
comparison. Results: Included were 35 patients (35 hips) with a mean age of 39.4 ± 13.0 years and
mean follow-up of 64.6 ± 4.1 months. These patients demonstrated significant
improvement from preoperatively to a minimum 5-year follow-up for all
recorded PROs (P < .05). When compared with 70 control
patients (70 hips), smoking patients demonstrated significantly worse
preoperative scores for all PROs (P < .05). Study
patients also demonstrated worse minimum 5-year scores for all recorded PROs
compared with control patients, which did not reach statistical significance
but trended toward significance for HOS-SSS (70.4 vs 81.9;
P = .076) and iHOT-12 (74.7 vs 82.2; P
= .122). Smoking patients also trended toward lower rates of achieving PASS
for the iHOT-12 compared with never-smoking patients (50.0% vs 68.2%;
P = .120). Conclusion: Patients who smoked cigarettes and underwent primary hip arthroscopy for FAIS
demonstrated significant improvement in PROs at a minimum 5-year follow-up.
When compared with a propensity-matched control group of never-smokers, they
trended toward lower postoperative HOS-SSS and iHOT-12 scores and lower
rates of achieving PASS on the iHOT-12.
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Affiliation(s)
| | - Michael S. Lee
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Jade S. Owens
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | | | - Benjamin R. Saks
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Ajay C. Lall
- American Hip Institute Research Foundation, Chicago, Illinois, USA
- American Hip Institute, Chicago, Illinois, USA
| | - Benjamin G. Domb
- American Hip Institute Research Foundation, Chicago, Illinois, USA
- American Hip Institute, Chicago, Illinois, USA
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Simon S, Hollenbeck B. Risk factors for surgical site infections in knee and hip arthroplasty patients. Am J Infect Control 2022; 50:214-216. [PMID: 34793889 DOI: 10.1016/j.ajic.2021.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 11/03/2021] [Accepted: 11/05/2021] [Indexed: 01/04/2023]
Abstract
We performed a retrospective cohort study to identify risk factors for surgical site infection (SSI) in patients with hip and knee arthroplasty in a high-volume orthopedic center with low overall SSI rates. Active smoking and revision arthroplasty both increased the risk for SSI. Former smokers were seen to have a lower SSI risk, demonstrating a potential benefit in implementing mandated smoking secession programs.
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Głuszyńska P, Diemieszczyk I, Szczerbiński Ł, Krętowski A, Major P, Razak Hady H. Risk Factors for Early and Late Complications after Laparoscopic Sleeve Gastrectomy in One-Year Observation. J Clin Med 2022; 11:jcm11020436. [PMID: 35054132 PMCID: PMC8779692 DOI: 10.3390/jcm11020436] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/11/2022] [Accepted: 01/14/2022] [Indexed: 12/10/2022] Open
Abstract
BACKGROUND Although laparoscopic sleeve gastrectomy (LSG) is considered a safe bariatric procedure in the treatment of obesity, it still involves a risk of developing postoperative complications. Knowledge of risk factors for possible complications would allow appropriate preoperative planning, optimization of postoperative care, as well as early diagnosis and treatment. The aim of this study was to evaluate risk factors for complications after laparoscopic sleeve gastrectomy. METHODS A retrospective study of 610 patients who underwent LSG at a tertiary institution were included in the study through retrospective analysis of the medical data. Complications were categorized as early (<30 days) and late (≥30 days) and evaluated according to the Clavien-Dindo Classification. RESULTS Early complications were observed in 35 patients (5.74%) and late complications occurred in 10 patients (1.64%). Independent risk factors of early complications after laparoscopic sleeve gastrectomy included hypercholesterolemia (OR 3.73; p-value = 0.023) and smoking (OR = 274.66, p-value < 0.001). Other factors that may influence the postoperative course are length of hospital stay and operation time. Smoking, peptic ulcer diseases and co-existence of hiatal hernia were found to be an independent predictors of late complications. CONCLUSIONS Smoking is associated with the higher risk of both, early and late complications, while hypercholesterolemia with only <30 days complications after laparoscopic sleeve gastrectomy.
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Affiliation(s)
- Paulina Głuszyńska
- 1st Department of General and Endocrine Surgery, Medical University of Bialystok, 15-089 Bialystok, Poland; (I.D.); (H.R.H.)
- Correspondence: ; Tel.: +48-85-831-8279
| | - Inna Diemieszczyk
- 1st Department of General and Endocrine Surgery, Medical University of Bialystok, 15-089 Bialystok, Poland; (I.D.); (H.R.H.)
| | - Łukasz Szczerbiński
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Bialystok, 15-089 Bialystok, Poland; (Ł.S.); (A.K.)
| | - Adam Krętowski
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Bialystok, 15-089 Bialystok, Poland; (Ł.S.); (A.K.)
| | - Piotr Major
- 2nd Department of General Surgery, Jagiellonian University Medical College, 31-008 Krakow, Poland;
| | - Hady Razak Hady
- 1st Department of General and Endocrine Surgery, Medical University of Bialystok, 15-089 Bialystok, Poland; (I.D.); (H.R.H.)
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Mohamed Salleh NAB, Tanaka Y, Sutarlie L, Su X. Detecting bacterial infections in wounds: a review of biosensors and wearable sensors in comparison with conventional laboratory methods. Analyst 2022; 147:1756-1776. [DOI: 10.1039/d2an00157h] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Review on laboratory-based methods and biosensors and wearable sensors for detecting wound infection by aerobic and anaerobic bacteria.
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Affiliation(s)
- Nur Asinah binte Mohamed Salleh
- Institute of Materials Research and Engineering, A* Star (Agency for Science, Technology and Research), 2 Fusionopolis Way, Innovis, #08-03, Singapore 138634
| | - Yuki Tanaka
- Institute of Materials Research and Engineering, A* Star (Agency for Science, Technology and Research), 2 Fusionopolis Way, Innovis, #08-03, Singapore 138634
| | - Laura Sutarlie
- Institute of Materials Research and Engineering, A* Star (Agency for Science, Technology and Research), 2 Fusionopolis Way, Innovis, #08-03, Singapore 138634
| | - Xiaodi Su
- Institute of Materials Research and Engineering, A* Star (Agency for Science, Technology and Research), 2 Fusionopolis Way, Innovis, #08-03, Singapore 138634
- Department of Chemistry, National University of Singapore, Block S8, Level 3, 3 Science Drive 3, Singapore 117543
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Nasrallah AA, Mansour M, Abou Heidar NF, Ayoub C, Najdi JA, Tamim H, El Hajj A. Risk factors for wound dehiscence following radical cystectomy: a prediction model. Ther Adv Urol 2021; 13:17562872211060570. [PMID: 35173813 PMCID: PMC8842309 DOI: 10.1177/17562872211060570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 10/29/2021] [Indexed: 11/25/2022] Open
Abstract
Objectives: Radical cystectomy (RC) is a complex urologic procedure performed for the
treatment of bladder cancer and causes significant morbidity. Wound
dehiscence (WD) is a major complication associated with RC and is associated
with multiple risk factors. The objectives of this study are to identify
clinical risk factors for incidence of WD and develop a risk-prediction
model to aid in patient risk-stratification and improvement of perioperative
care. Materials and Methods: The American College of Surgeons – National Surgical Quality Improvement
Program (ACS-NSQIP) database was used to derive the study cohort. A
univariate analysis provided nine variables eligible for multivariate model
entry. A stepwise logistic regression analysis was conducted and refined
considering clinical relevance of the variables, and then bootstrapped with
1000 samples, resulting in a five-factor model. Model performance and
calibration were assessed by a receiver operated curve (ROC) analysis and
the Hosmer–Lemeshow test for goodness of fit, respectively. Results: A cohort of 11,703 patients was identified from years 2005 to 2017, with 342
(2.8%) incidences of WD within 30 days of operation. The final five-factor
model included male gender [odds ratio (OR) = 2.5, p <
0.001], surgical site infection (OR = 6.3, p < 0.001),
smoking (OR = 1.8, p < 0.001), chronic obstructive
pulmonary disease (COPD) (OR = 1.9, p < 0.001), and
weight class; morbidly obese patients had triple the odds of WD (OR = 2.9,
p < 0.001). The ROC analysis provided a C-statistic
of 0.76 and calibration R2 was 0.99. Conclusion: The study yields a statistically robust and clinically beneficial five-factor
model for estimation of WD incidence risk following RC, with good
performance and excellent calibration. These factors may assist in
identifying high-risk patients, providing preoperative counseling and thus
leading to improvement in perioperative care.
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Affiliation(s)
- Ali A. Nasrallah
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mazen Mansour
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nassib F. Abou Heidar
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Jad A. Najdi
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hani Tamim
- Clinical Research Institute, American University of Beirut, Beirut, Lebanon
| | - Albert El Hajj
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, P.O. Box 11-0236, Riad El-Solh, 1107 2020 Beirut, Lebanon
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Tudoroiu EE, Dinu-Pîrvu CE, Albu Kaya MG, Popa L, Anuța V, Prisada RM, Ghica MV. An Overview of Cellulose Derivatives-Based Dressings for Wound-Healing Management. Pharmaceuticals (Basel) 2021; 14:1215. [PMID: 34959615 PMCID: PMC8706040 DOI: 10.3390/ph14121215] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/17/2021] [Accepted: 11/18/2021] [Indexed: 12/23/2022] Open
Abstract
Presently, notwithstanding the progress regarding wound-healing management, the treatment of the majority of skin lesions still represents a serious challenge for biomedical and pharmaceutical industries. Thus, the attention of the researchers has turned to the development of novel materials based on cellulose derivatives. Cellulose derivatives are semi-synthetic biopolymers, which exhibit high solubility in water and represent an advantageous alternative to water-insoluble cellulose. These biopolymers possess excellent properties, such as biocompatibility, biodegradability, sustainability, non-toxicity, non-immunogenicity, thermo-gelling behavior, mechanical strength, abundance, low costs, antibacterial effect, and high hydrophilicity. They have an efficient ability to absorb and retain a large quantity of wound exudates in the interstitial sites of their networks and can maintain optimal local moisture. Cellulose derivatives also represent a proper scaffold to incorporate various bioactive agents with beneficial therapeutic effects on skin tissue restoration. Due to these suitable and versatile characteristics, cellulose derivatives are attractive and captivating materials for wound-healing applications. This review presents an extensive overview of recent research regarding promising cellulose derivatives-based materials for the development of multiple biomedical and pharmaceutical applications, such as wound dressings, drug delivery devices, and tissue engineering.
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Affiliation(s)
- Elena-Emilia Tudoroiu
- Department of Physical and Colloidal Chemistry, Faculty of Pharmacy, Carol Davila University of Medicine and Pharmacy Bucharest, 6 Traian Vuia Str., 020956 Bucharest, Romania; (E.-E.T.); (L.P.); (V.A.); (R.M.P.); (M.V.G.)
| | - Cristina-Elena Dinu-Pîrvu
- Department of Physical and Colloidal Chemistry, Faculty of Pharmacy, Carol Davila University of Medicine and Pharmacy Bucharest, 6 Traian Vuia Str., 020956 Bucharest, Romania; (E.-E.T.); (L.P.); (V.A.); (R.M.P.); (M.V.G.)
| | - Mădălina Georgiana Albu Kaya
- Department of Collagen, Division Leather and Footwear Research Institute, National Research and Development Institute for Textile and Leather, 93 Ion Minulescu Str., 031215 Bucharest, Romania
| | - Lăcrămioara Popa
- Department of Physical and Colloidal Chemistry, Faculty of Pharmacy, Carol Davila University of Medicine and Pharmacy Bucharest, 6 Traian Vuia Str., 020956 Bucharest, Romania; (E.-E.T.); (L.P.); (V.A.); (R.M.P.); (M.V.G.)
| | - Valentina Anuța
- Department of Physical and Colloidal Chemistry, Faculty of Pharmacy, Carol Davila University of Medicine and Pharmacy Bucharest, 6 Traian Vuia Str., 020956 Bucharest, Romania; (E.-E.T.); (L.P.); (V.A.); (R.M.P.); (M.V.G.)
| | - Răzvan Mihai Prisada
- Department of Physical and Colloidal Chemistry, Faculty of Pharmacy, Carol Davila University of Medicine and Pharmacy Bucharest, 6 Traian Vuia Str., 020956 Bucharest, Romania; (E.-E.T.); (L.P.); (V.A.); (R.M.P.); (M.V.G.)
| | - Mihaela Violeta Ghica
- Department of Physical and Colloidal Chemistry, Faculty of Pharmacy, Carol Davila University of Medicine and Pharmacy Bucharest, 6 Traian Vuia Str., 020956 Bucharest, Romania; (E.-E.T.); (L.P.); (V.A.); (R.M.P.); (M.V.G.)
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Kennedy P, Saloky K, Yadavalli A, Barlow E, Aynardi M, Garner M, Bible J, Lewis GS, Dhawan A. Nicotine Exposure Via Electronic Cigarettes Significantly Impedes Biomechanical Healing Properties of Tendon Healing in a Rat Model. Arthroscopy 2021; 37:3170-3176. [PMID: 33940121 DOI: 10.1016/j.arthro.2021.03.071] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 03/28/2021] [Accepted: 03/30/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the biomechanical and histologic effects on Achilles tendon repair of inhaled combusted tobacco versus nicotine exposure via electronic cigarette versus a control group in a small-animal model (Sprague-Dawley rat). METHODS Fifty-four Sprague-Dawley rats were randomized into 3 groups: combusted tobacco, e-cigarettes, or control. Experimental rats were exposed to research cigarettes or e-cigarette vapor in a smoking chamber for 4 weeks. Surgical transection and repair of the Achilles tendon were then completed, followed by 2 additional weeks of exposure. Achilles tendons were harvested, and biomechanical tensile testing was performed. Histologic evaluation was completed, including hematoxylin-eosin staining, trichrome staining, and immunohistochemistry analysis for type I and type III collagen. RESULTS The control group showed the highest mean tensile load to failure, at 41.0 ± 10.4 N (range, 18.3-55.1 N); the cigarette cohort had the second highest mean, at 37.3 ± 11.1 N (range, 14.0-54.7 N); and finally, the vaping group had the lowest mean, at 32.3 ± 8.4 N (range, 17.8-45.1 N). One-way analysis of variance showed a significant difference in load to failure when comparing the control group with the e-cigarette group (P = .026). No statistical difference was detected between the control group and cigarette group (P = .35) or between the e-cigarette group and cigarette group (P = .23). Stiffness and qualitative histologic analysis showed no difference among groups. CONCLUSIONS This investigation shows that in a rat model, nicotine exposure via e-cigarette significantly impedes the biomechanical healing properties of Achilles tendon surgical repair. CLINICAL RELEVANCE The results indicate that although e-cigarettes are often used as a perceived "safer" alternative to smoking, their use may have a detrimental effect on tendon load to failure.
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Affiliation(s)
- Patrick Kennedy
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania, U.S.A..
| | - Kaitlin Saloky
- Geisinger Commonwealth School of Medicine, Geisinger Health System, Scranton, Pennsylvania, U.S.A
| | - Aditya Yadavalli
- Department of Anesthesia and Perioperative Medicine, Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania, U.S.A. (d)Department of Emergency Medicine, Zucker School of Medicine, Northwell Southside Hospital, Bay Shore, New York, U.S.A
| | - Erin Barlow
- Department of Anesthesia and Perioperative Medicine, Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania, U.S.A. (d)Department of Emergency Medicine, Zucker School of Medicine, Northwell Southside Hospital, Bay Shore, New York, U.S.A
| | - Michael Aynardi
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania, U.S.A
| | - Matthew Garner
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania, U.S.A
| | - Jesse Bible
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania, U.S.A
| | - Gregory S Lewis
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania, U.S.A
| | - Aman Dhawan
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania, U.S.A
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Kay HG, Campbell B, Gallant JN, Carlile C, Wright P, Stephens B, Rohde SL. Delayed Upper Aerodigestive Tract Perforation from Anterior Cervical Spine Hardware: Treatment and Swallowing Outcomes. Dysphagia 2021; 37:988-994. [PMID: 34510250 DOI: 10.1007/s00455-021-10361-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 08/30/2021] [Indexed: 11/29/2022]
Abstract
Delayed upper aerodigestive tract (UADT) perforation is a rare complication of anterior cervical spinal hardware. The purpose of this study was to investigate swallowing outcomes between treatment approaches for delayed UADT perforation. A retrospective chart review was performed on patients with anterior cervical hardware and delayed UADT perforation who were treated at a single tertiary care center between 2000 and 2020. Of the twelve patients identified, most patients presented with dysphagia (n = 9, 75%) and/or neck pain (n = 7, 58%). Perforations generally occurred at the level of C6 (n = 6, 50%) and C7 (n = 4, 33%) and spanned only one spinal level (n = 8, 67%). The majority (n = 8, 67%) of patients were past or current cigarette users. Operative approaches included primary repair (n = 5, 42%) and rotational flap (n = 4, 33%); the rotational flap harvest sites included supraclavicular fasciocutaneous (n = 2), infrahyoid muscle (n = 1), and sternocleidomastoid muscle (n = 1). While most patients demonstrated penetration and/or aspiration on first post-operative swallow study (n = 6), this resolved completely within a median time of 31 days. There were no differences in swallowing outcomes between repair approaches. Patient smoking history appears to be a clear risk factor for the development of delayed UADT perforation from anterior cervical spine hardware. A variety of techniques can be used to repair these perforations, and there were no differences in swallowing outcomes between repair approaches.
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Affiliation(s)
- Hannah G Kay
- School of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Benjamin Campbell
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jean-Nicolas Gallant
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Catherine Carlile
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Patty Wright
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Byron Stephens
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sarah L Rohde
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
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Abdalla T, Lytvyn Y, McDonald KA, Mufti A, Alavi A. A response to "Cannabinoids in Dermatologic Surgery": The added considerations of factors affecting tissue perfusion, wound healing, and modes of administration in safety and efficacy of cannabinoids. J Am Acad Dermatol 2021; 85:e385-e386. [PMID: 33915241 DOI: 10.1016/j.jaad.2021.04.068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 04/09/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Tasnim Abdalla
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Yuliya Lytvyn
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | | | - Asfandyar Mufti
- Division of Dermatology, University of Toronto, Toronto, Canada
| | - Afsaneh Alavi
- Division of Dermatology, University of Toronto, Toronto, Canada; Mayo Clinic, Department of Dermatology, Rochester, Minnesota
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Knighton BJ, Ngaage LM, Calvert C, Niederhaus SV, Scalea JR, Rasko YM. Post-Abdominal Transplant Hernia: Can We Predict Size and Onset? Transplant Proc 2021; 53:730-736. [PMID: 33541717 DOI: 10.1016/j.transproceed.2020.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 09/03/2020] [Accepted: 10/01/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Abdominal organ transplant is a life-saving treatment. However, the resultant weakening of abdominal muscles leaves patients susceptible to incisional hernia. Obesity, smoking, and diabetes mellitus are common risk factors for post-transplant hernia. However, the literature is void on the impact these risk factors have on timing and size of hernia. METHODS We performed a retrospective review of all post-abdominal transplant patients who underwent hernia repair in 2010-2017 at a single institution. Primary outcomes were hernia size and time from transplant to hernia repair. RESULTS We identified 31 patients. The majority of patients were female (15 male, 16 female), and the average patient was 56 ± 8.7 years old and obese (body mass index 30.6). Smoking (26.7%, n = 8) and diabetes mellitus (51.6%, n = 16) were prevalent. Transplant types represented were renal (n = 24), simultaneous pancreas-kidney (n = 5), liver (n = 1), and liver with subsequent kidney (n = 1). The median size of hernia was 100.0 cm2 (interquartile range [IQR]: 78.5-234.0), and median time to hernia repair was 53.0 months (IQR: 12.5-110.0). Risk factors (obesity, smoking, and diabetes) did not influence hernia size, nor alter time to hernia repair. CONCLUSION Obesity, smoking, and diabetes mellitus are not prognostic of size or onset of post-transplant incisional hernia. Large cohort studies are needed to determine predictive factors of size and onset of hernia.
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Affiliation(s)
| | - Ledibabari M Ngaage
- Division of Plastic Surgery, Department of Surgery, University of Maryland Medical Center, Baltimore
| | - Catherine Calvert
- Department of Surgery, University of Maryland Medical Center, Baltimore
| | - Silke V Niederhaus
- Division of Transplantation, Department of Surgery, University of Maryland Medical Center, Baltimore
| | - Joseph R Scalea
- Division of Transplantation, Department of Surgery, University of Maryland Medical Center, Baltimore
| | - Yvonne M Rasko
- Division of Plastic Surgery, Department of Surgery, University of Maryland Medical Center, Baltimore.
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In Vitro Wound Healing Potential of Photobiomodulation Is Possibly Mediated by Its Stimulatory Effect on AKT Expression in Adipose-Derived Stem Cells. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2021; 2021:6664627. [PMID: 33505585 PMCID: PMC7811432 DOI: 10.1155/2021/6664627] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/02/2020] [Accepted: 12/19/2020] [Indexed: 02/07/2023]
Abstract
Increasing evidence suggests that adipose-derived stem cells (ADSCs) serve as a therapeutic approach for wound healing. The aim of this study was to determine the effect of photobiomodulation (PBM) on antioxidant enzymes in ADSCs. Four ADSC cell models, namely, normal, wounded, diabetic, and diabetic wounded, were irradiated with 660 nm (fluence of 5 J/cm2 and power density of 11.2 mW/cm2) or 830 nm (fluence of 5 J/cm2 and power density of 10.3 mW/cm2). Nonirradiated cells served as controls. Cell morphology and wound migration were determined using light microscopy. Cell viability was determined by the trypan blue exclusion assay. The enzyme-linked immunosorbent assay (ELISA) was used to measure the levels of antioxidants (superoxide dismutase (SOD), catalase (CAT), and heme oxygenase (HMOX1)). AKT activation and FOXO1 levels were determined by immunofluorescence and western blotting. The gaps (wound) in PBM-treated wounded and diabetic wounded cell models closed faster than the controls. PBM treatment significantly increased antioxidant levels in all cell models. This reflects that oxidative stress is reduced on the counterpart of increased antioxidant levels. This might be due to the activation of the AKT signaling pathway as evidenced by the increased AKT signals via western blotting and immunofluorescence. This data suggests that PBM promotes wound healing by increasing antioxidant levels by activating AKT signaling.
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Iyun A, Iyun O. Pattern of presentation in a community outpatient wound clinic. JOURNAL OF WEST AFRICAN COLLEGE OF SURGEONS 2021; 11:18-23. [PMID: 36132974 PMCID: PMC9484504 DOI: 10.4103/jwas.jwas_38_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/10/2022] [Indexed: 11/04/2022]
Abstract
Introduction: Materials and Methods: Results: Conclusion:
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50
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Pasaribu KM, Gea S, Ilyas S, Tamrin T, Radecka I. Characterization of Bacterial Cellulose-Based Wound Dressing in Different Order Impregnation of Chitosan and Collagen. Biomolecules 2020; 10:E1511. [PMID: 33153209 PMCID: PMC7693210 DOI: 10.3390/biom10111511] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/14/2020] [Accepted: 10/27/2020] [Indexed: 12/11/2022] Open
Abstract
Bacterial cellulose (BC), chitosan (Chi), and collagen (Col) are known as biopolymers which have met some properties that are required as wound dressing. This study focused on investigating the fabrication of BC-based wound dressing with chitosan and collagen, since chitosan has red blood cells binding and anti-bacterial properties, while collagen can support cell and tissue growth for skin wounds. The BC-based wound dressing was prepared by impregnating BC fibers in the chitosan and/or collagen solution for 24 h. FTIR was used to confirm the intermolecular interaction of amine and hydroxyl group of chitosan and/or collagen in BC-based wound dressing. Furthermore, the XRD diffractogram of the wound dressing show broader peaks at 14.2°, 16.6°, and 22.4° due to the presence of chitosan and collagen molecules in BC fibers. These results were then supported by SEM images which confirmed that chitosan and collagen were well penetrated into BC fibers. TGA curves revealed that BC/Chi/Col has better thermal properties based on the Tmax compare to BC/Col/Chi. Feasibility of the mats to be applied as wound dressing was also supported by other tests, i.e., water content, porosity, and hemocompatibility, which indicates that the wound dressing is classified as nonhemolytic materials. However, BC/Col/Chi was considered a more potential wound dressing to be applied compared to BC/Chi/Col since it has larger pores and showed better antibacterial properties (larger zones of inhibition) against S. aureus and E. coli via disk diffusion tests.
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Affiliation(s)
- Khatarina Meldawati Pasaribu
- Postgraduate School, Department of Chemistry, Faculty of Mathematics and Natural Sciences, Universitas Sumatera Utara, Jl. Bioteknologi No.1, Medan 20155, Indonesia;
- Department of Chemistry, Faculty of Mathematics and Natural Sciences, Universitas Sumatera Utara, Jl. Bioteknologi No. 1, Medan 20155, Indonesia;
| | - Saharman Gea
- Department of Chemistry, Faculty of Mathematics and Natural Sciences, Universitas Sumatera Utara, Jl. Bioteknologi No. 1, Medan 20155, Indonesia;
- Cellulosic and Functional Materials Research Centre, Universitas Sumatera Utara, Jl. Bioteknologi No.1, Medan 20155, Indonesia;
| | - Syafruddin Ilyas
- Cellulosic and Functional Materials Research Centre, Universitas Sumatera Utara, Jl. Bioteknologi No.1, Medan 20155, Indonesia;
- Department of Biology, Faculty of Mathematics and Natural Sciences, Universitas Sumatera Utara, Jl. Bioteknologi No. 1, Medan 20155, Indonesia
| | - Tamrin Tamrin
- Department of Chemistry, Faculty of Mathematics and Natural Sciences, Universitas Sumatera Utara, Jl. Bioteknologi No. 1, Medan 20155, Indonesia;
- Cellulosic and Functional Materials Research Centre, Universitas Sumatera Utara, Jl. Bioteknologi No.1, Medan 20155, Indonesia;
| | - Izabela Radecka
- Wolverhampton School of Sciences, Faculty of Science and Engineering, University of Wolverhampton, Wulfruna Street, Wolverhampton WV1 1LY, UK;
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