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Wound, healing, care, urgent

Anders Winther Voldby, Anne Albers Aaen, Ann Merete Møller, Birgitte Brandstrup
INTRODUCTION: Intravenous fluid therapy during gastrointestinal surgery is a life-saving part of the perioperative care. Too little fluid may lead to hypovolaemia, decreased organ perfusion and circulatory shock. Excessive fluid administration increases postoperative complications, worsens pulmonary and cardiac function as well as the healing of surgical wounds. Intraoperative individualised goal-directed fluid therapy (GDT) and zero-balance therapy (weight adjusted) has shown to reduce postoperative complications in elective surgery, but studies in urgent gastrointestinal surgery are sparse...
November 13, 2018: BMJ Open
Anke Schmidt, Sander Bekeschus
Chronic wounds and ulcers are major public health threats. Being a substantial burden for patients and health care systems alike, better understanding of wound pathophysiology and new avenues in the therapy of chronic wounds are urgently needed. Cold physical plasmas are particularly effective in promoting wound closure, irrespective of its etiology. These partially ionized gases deliver a therapeutic cocktail of reactive oxygen and nitrogen species safely at body temperature and without genotoxic side effects...
October 19, 2018: Antioxidants (Basel, Switzerland)
Giulia Suarato, Rosalia Bertorelli, Athanassia Athanassiou
Wound repair is a complex and tightly regulated physiological process, involving the activation of various cell types throughout each subsequent step (homeostasis, inflammation, proliferation, and tissue remodeling). Any impairment within the correct sequence of the healing events could lead to chronic wounds, with potential effects on the patience quality of life, and consequent fallouts on the wound care management. Nature itself can be of inspiration for the development of fully biodegradable materials, presenting enhanced bioactive potentialities, and sustainability...
2018: Frontiers in Bioengineering and Biotechnology
Daniel Cunningham, Vasili Karas, James DeOrio, James Nunley, Mark Easley, Samuel Adams
BACKGROUND: The Comprehensive Care for Joint Replacement (CJR) model provides bundled payments for in-hospital care and care within 90 days following discharge for Medicare beneficiaries undergoing lower-extremity joint replacement involving the hip, knee, or ankle (total hip arthroplasty, total knee arthroplasty, or total ankle arthroplasty [TAA]). The study hypothesis was that patient comorbidities are associated with readmissions, emergency department (ED) utilization, and subspecialist wound-healing consultation, which are examples of costly contributors to postoperative health-care spending...
August 1, 2018: Journal of Bone and Joint Surgery. American Volume
Tanzim Khan, Laura Shin, Stephanie Woelfel, Vincent Rowe, Brittany L Wilson, David G Armstrong
Over the past generation, limb preservation programs and diabetic foot services have begun to proliferate within academic health science centers as well as within health-care systems in general. We describe four key components for a successful program that, developed sequentially with temporal overlap, can allow the program to scale. The first component includes establishment of a 'hot foot line' for urgent emergency department/inpatient referral. The second includes development of a wound-healing clinic to address outpatient care through to remission...
2018: Diabetic Foot & Ankle
Jawad Salman, Felix Fleißner, Jamshid Naqizadah, Murat Avsar, Malakh Shrestha, Gregor Warnecke, Issam Ismail, Stefan Rümke, Serghei Cebotari, Axel Haverich, Igor Tudorache
BACKGROUND:  Minimally invasive mitral valve surgery (MIMVS) is superior to "classical" mitral valve surgery via a sternotomy regarding wound healing and postoperative pain. It is however a more challenging procedure. Patients' preference is leading clearly toward minimally invasive approaches, and surgeons are driven by upcoming new technologies in interventional procedures such as the MitraClip. Especially in re-do cases, the access via right mini-thoracotomy, as previously non-operated situs, is a possible advantage over a re-sternotomy...
October 2018: Thoracic and Cardiovascular Surgeon
Joyce C Zhang, John Matelski, Rajiv Gandhi, Timothy Jackson, David Urbach, Peter Cram
BACKGROUND: The "obesity paradox" is a phenomenon described in prior research in which patients who are obese have been shown to have lower postoperative mortality and morbidity compared with normal-weight individuals. The paradox is that clinical experience suggests that obesity is a risk factor for difficult wound healing and adverse cardiovascular outcomes. We suspect that the obesity paradox may reflect selection bias in which only the healthiest patients who are obese are offered surgery, whereas nonobese surgical patients are comprised of both healthy and unhealthy individuals...
May 2018: Clinical Orthopaedics and related Research
Reza Fekrazad, Arash Sarrafzadeh, Katayoun A M Kalhori, Imran Khan, Praveen R Arany, Alessio Giubellino
Diabetic wounds are a major cause of morbidity among patients with poorly controlled blood glucose levels. Conventional empirical wound care strategies have shown limited efficacy, and there is an urgent need to develop novel therapeutic strategies. Photobiomodulation treatments have shown positive therapeutic effects in several cell culture and animal models. In this study, we examined wound healing in diabetic rats following treatments with two laser wavelengths, namely red (660 nm) and infrared (808 nm) individually and in combination as compared to routine wound dressings...
July 2018: Photochemistry and Photobiology
Lei Wang, Xin Li, Tianyu Sun, Yung-Hao Tsou, Hong Chen, Xiaoyang Xu
Microbial infections continually present a major worldwide public healthcare threat, particularly in instances of impaired wound healing and biomedical implant fouling. The development of new materials with the desired antimicrobial property to avoid and treat wound infection is urgently needed in wound care management. This study reports a novel dual-functional biodegradable dextran-poly(ethylene glycol) (PEG) hydrogel covalently conjugated with antibacterial Polymyxin B and Vancomycin (Vanco). The hydrogel is designed as a specialized wound dressing that eradicates existing bacteria and inhibits further bacteria growth, while, ameliorating the side effects of antibiotics and accelerating tissue repair and regeneration...
February 2018: Macromolecular Bioscience
Rafael García Cañas, R Navarro Suay
INTRODUCTION: Operation 'Inherent Resolve' was approved by the United Nations in August 2014 with the objective of suppressing the Islamic State in Iraq and the Levant and increasing the region's stability. The mission of the Spanish military forces within this was to direct training missions for the Iraqi Army. The aim of this study is to analyse the medical care provided in the Spanish Role 1 deployed medical treatment facility during Operation 'Apoyo a Irak'. METHODS: A cross-sectional, descriptive and retrospective study was conducted between 15 December 2015 and 18 November 2016...
December 2017: Journal of the Royal Army Medical Corps
Juan P Barret, Fred Podmelle, Břetislav Lipový, Hans-Oliver Rennekampff, Hauke Schumann, Agnes Schwieger-Briel, Tobias R Zahn, Hans-Robert Metelmann
The clinical significance of timely re-epithelialization is obvious in burn care, since delayed wound closure is enhancing the risk of wound site infection and extensive scarring. Topical treatments that accelerate wound healing are urgently needed to reduce these sequelae. Evidence from preliminary studies suggests that betulin can accelerate the healing of different types of wounds, including second degree burns and split-thickness skin graft wounds. The goal of this combined study program consisting of two randomized phase III clinical trials in parallel is to evaluate whether a topical betulin gel (TBG) is accelerating re-epithelialization of split-thickness skin graft (STSG) donor site wounds compared to standard of care...
September 2017: Burns: Journal of the International Society for Burn Injuries
Yongjun Zheng, Shizhao Ji, Haibin Wu, Song Tian, Yunqing Zhang, Li Wang, He Fang, Pengfei Luo, Xingtong Wang, Xiaoyan Hu, Shichu Xiao, Zhaofan Xia
Approximately 25% of diabetic patients suffer from diabetic lower-extremity ulcer throughout their lives and 7%-20% of patients will eventually need an amputation despite standard care treatment. The development of new therapies to treat diabetic wounds is urgent. In this study, we used cryopreserved living micronized amnion (300-600 μm) to treat wounds in diabetic mice. Post-thaw micronized amnion retained high cell viability, as well as intact cell morphology and membrane structure. When transplanted onto the wounds of db/db mice, the cryopreserved living micronized amnion greatly promoted wound healing in diabetic mice mainly by secreting growth, inflammation, and chemotaxis-related factors that regulated macrophage migration and phenotype switch, recruited CD34+ progenitor cells, and increased neovascularization...
January 2017: Biomaterials
Frances L Game, William J Jeffcoate
BACKGROUND: The outcome of ulcers of the foot in diabetes is generally poor with around 1 in 10 resulting in the loss of a limb. There is an urgent need for the development of interventions to improve the outcome for patients. To date, however, the evidence base to support many of the interventions in common use, including wound dressings, is poor. METHODS: This article summarizes the findings of systematic reviews of the subject published between 2006 and 2014 and covers all relevant articles in any language, as well as comments on certain newer publications...
September 2016: Plastic and Reconstructive Surgery
V Langer
Traumatic injuries, especially in the combat setting, stress the surgical team that may be sited in a remote forward area, battling against paucity of time, resources and infrastructure. The lone surgeon may be faced with the arduous challenge of saving life. There is seldom thought given to reconstruction in this high-pressure situation. If the patient survives, morbidity for want of reconstruction can be severe and quality of life can suffer significantly. Reconstruction after 3 to 5 days is fraught with complications and usually does compromise outcome in the post-operative phase...
October 2010: Medical Journal, Armed Forces India
Jean Duplex Wansi, Jean Wandji, Norbert Sewald, Lutfun Nahar, Claire Martin, Satyajit Dey Sarker
AIMS: Traditional medicinal use of species of the genus Drypetes is widespread in the tropical regions. The aim of this review is to systematically appraise the literature available to date on phytochemistry, ethnopharmacology, toxicology and bioactivity (in vitro and in vivo) of crude extracts and purified compounds. ETHNOPHARMACOLOGICAL RELEVANCE: Plants of the genus Drypetes (Putranjivaceae) are used in the Subsaharan African and Asian traditional medicines to treat a multitude of disorders, like dysentery, gonorrhoea, malaria, rheumatism, sinusitis, tumours, as well as for the treatment of wounds, headache, urethral problems, fever in young children, typhoid and several other ailments...
August 22, 2016: Journal of Ethnopharmacology
T Bianchi, R D Wolcott, A Peghetti, D Leaper, K Cutting, R Polignano, Z Rosa Rita, A Moscatelli, A Greco, M Romanelli, S Pancani, A Bellingeri, V Ruggeri, L Postacchini, S Tedesco, L Manfredi, Maria Camerlingo, S Rowan, A Gabrielli, G Pomponio
The potential impact of biofilm on healing in acute and chronic wounds is one of the most controversial current issues in wound care. A significant amount of laboratory-based research has been carried out on this topic, however, in 2013 the European Wound Management Association (EWMA) pointed out the lack of guidance for managing biofilms in clinical practice and solicited the need for guidelines and further clinical research. In response to this challenge, the Italian Nursing Wound Healing Society (AISLeC) initiated a project which aimed to achieve consensus among a multidisciplinary and multiprofessional international panel of experts to identify what could be considered part of 'good clinical practice' with respect to the recognition and management of biofilms in acute and chronic wounds...
June 2016: Journal of Wound Care
Hosan Kim, Soon Park, Greggory Housler, Vanessa Marcel, Sue Cross, Mina Izadjoo
Novel approaches including nonpharmacological methodologies for prevention and control of microbial pathogens and emerging antibiotic resistance are urgently needed. Procellera is a wound care device consisting of a matrix of alternating silver (Ag) and zinc (Zn) dots held in position on a polyester substrate with a biocompatible binder. This electroceutical medical device is capable of generating a direct current voltage (0.5-0.9 Volts). Wound dressings containing metals such as Ag and/or Zn as active ingredients are being used for control of colonized and infected wounds...
May 2016: Military Medicine
Kathryn N Porter Starr, Shelley R McDonald, Julia A Weidner, Connie W Bales
The global prevalence of obesity in the older adult population is growing, an increasing concern in both the developed and developing countries of the world. The study of geriatric obesity and its management is a relatively new area of research, especially pertaining to those with elevated health risks. This review characterizes the state of science for this "fat and frail" population and identifies the many gaps in knowledge where future study is urgently needed. In community dwelling older adults, opportunities to improve both body weight and nutritional status are hampered by inadequate programs to identify and treat obesity, but where support programs exist, there are proven benefits...
May 4, 2016: Nutrients
Seth J Concors, Brett L Ecker, Richard Maduka, Alyssa Furukawa, Steven E Raper, Daniel D Dempsey, Noel N Williams, Kristoffel R Dumon
Bariatric surgery represents a durable and safe treatment modality for morbid obesity. Bariatric surgery results in weight loss by one of two-and possibly both-primary mechanisms, reducing the amount of tolerable intake (restrictive) and reducing the amount of nutrients absorbed by bypassing absorptive intestine (malabsorptive). These procedures have consistently demonstrated superior resolution of obesity and many associated co-morbid conditions as compared to medical management. Beyond the periprocedural complications of surgery, there are longitudinal risks such as weight regain, anatomic complications, and micronutrient deficiencies...
January 2016: Current Treatment Options in Neurology
Boris Kudumija, Mladen Knotek, Drasko Pavlović, Sonja Dits
Calcific uremic arteriolopathy or alciphylaxis is a malignant form of calcification of small arteries and arterioles, usually present in patients with chronic kidney disease and dialysis therapy. It causes high mortality. Histological distinctive feature are calcium deposits lining vascular intima. Calcification of medial muscle layer, inflammation and necrosis of subcutaneous adipose tissue are frequent. The disease begins with painful violaceous mottling, resembling livedo reticularis. Ths skin lesion progresses to ulcers and eschars, sometimes it becomes very vulnerable to secondary infection which can often develop into fatal sepsis...
March 2015: Lijec̆nic̆ki Vjesnik
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