Treatment of wounds colonized by multidrug resistant organisms in immune-compromised patients: a retrospective case series

Surgical treatment of pressure injuries in children: A multicentre experience

Pressure injuries (PI) are infrequent in paediatric patients, prevalence estimates ranging from 1.4% to 8.2%, and reaching values as high as 43.1% in critical care areas. They can be associated with congenital neurological or metabolic disorders that cause reduced mobility or require the need for medical devices. In children, most pressure injuries heal spontaneously. However, a small percentage of ulcers that is refractory to conservative management or is too severe at presentation (Stage 3 or 4) will be candidates for surgery. We retrospectively reviewed the clinical history of paediatric patients affected by pressure injuries from four European Plastic Surgery Centres. Information was collected from clinical and radiology records, and laboratory reports. An accurate search of the literature revealed only two articles reporting on the surgical treatment of pressure injuries in children. After debridement, we performed surgical coverage of the pressure injuries. We report here our experience with 18 children aged 1–17 years, affected by pressure injury Stages 3 and 4. They were successfully treated with pedicled (17 patients) or free flaps (1 patient). The injuries involved the sacrum (6/18 patients), lower limb (3/18 patients), thoracic spine (2/18 patients), ischium (3/18 patients, bilateral in one patient), temporal area (3/18 patients), hypogastrium (1/18 patients) and were associated to medical devices in three cases. Flaps were followed for a minimum of 19 months and up to 13 years. Only two patients developed true recurrences that were treated again surgically. Pressure injuries are infrequent in children and rarely need surgical treatment. Pedicled flaps have a high success rate. Recurrences, contrary to what is reported in the literature, were rare.

Augmented Graphene Quantum Dot-Light Irradiation Therapy for Bacteria-Infected Wounds

This paper proposes a highly efficient antibacterial system based on a synergistic combination of photodynamic therapy, photothermal therapy, and chemotherapy. Chitosan oligosaccharide functionalized graphene quantum dots (GQDs-COS) with short-term exposure to 450 nm visible light are used to promote rapid healing in bacteria-infected wounds. The GQDs undergo strong photochemical transformation to rapidly produce radical oxygen species and heat under light illumination, while the COS has an innate antimicrobial ability. Moreover, the positively charged GQDs-COS can easily capture bacteria via electrostatic interactions and kill Gram-positive and Gram-negative bacteria by multivalent interactions and synergistic effects. The antibacterial action of this nanocomposite causes irreversible damage to outer and inner bacterial membranes, resulting in cytoplasm leakage and death. The system has good hemocompatibility and low cytotoxicity and can improve the healing of infected wounds, as demonstrated by the examination of pathological tissue sections and inflammatory markers. These results suggest that GQDs anchored with bioactive molecules are a potential photo-activated antimicrobial strategy for anti-infective therapy.