Management of Wounds of Peripheral Arterial Disease Using Platelet Rich Plasma.

Arterial ulcers are caused by inadequate perfusion of skin and subcutaneous tissues. The key treatment is correcting the underlying medical problem and re-perfusion of the affected tissue. Interventional procedures like angiography, transluminal angioplasty, and stenting have hazards like bleeding, hematoma formation, false aneurysm formation etc. This study was conducted to investigate the effect of platelet-rich plasma (PRP) on the rate of healing of peripheral arterial wounds. MethodsA randomized controlled trial was conducted with 80 participants admitted with peripheral arterial disease in Acharya Vinoba Bhave Rural Hospital, Wardha district, Maharashtra, from September 2017 - August 2019. Data was entered into MS Excel and was analysed for descriptive statistics. 40 patients each were allotted randomly to control group and treatment group. In the control group, conventional dressings was done with hydrogen peroxide and betadine. Wounds were treated with PRP infiltration in the treatment group. Outcome was compared between both groups. ResultsMean surface area of wound in control group reduced from baseline 2262.5 mm2 to 1758.4 mm2 (29.89% reduction) in ulcer surface area, and 2298.9 mm2 to 1158.1 mm2 (66.22% reduction) in treatment group (p= 0 at the end of study) at the end of two months. Standard deviation of the same (Control: 1739.2 mm2 to 1566.3 mm2 vs Treatment: 1906.5 mm2 to 1402.4 mm2). Rate of epithelization was faster in treatment group (8.92 mm2/day vs 17.27 mm2/day, p=0 at the end of study). PRP resulted in early healing of ulcers with earlier reduction in wound surface area. ConclusionsPRP is an effective method for healing of wounds resulting from peripheral arterial disease.

Characterization and evaluation for wound healing of chitosan extracted from the exoskeleton of freshwater crab Potamonautes niloticus

The freshwater crab Potamonautes niloticus (Potamonautidae: Decapoda: Crustacea) is common in River Nile andits tributaries but has no commercial value as edible crab for human beings. Therefore, the present study aims toevaluate the role of chitosan extracted from its exoskeleton for wound healing process as a medical application. Thestructure of chitosan has been physically investigated by using fourier transformer infrared spectroscopy to reveal thevibrational frequencies of different structural functional groups, such as primary amine groups, hydroxyl groups andamide groups. The efficiency of the extracted chitosan was assessed by morphological and histological examinationof wound healing in albino rats. Sections of isolated wounds were stained with hematoxylin and eosin to evaluate thehistological changes during the wound healing process. Chitosan was yielded 30.64% from the crab shells and theresults of wound healing assessments showed that the chitosan treated group (Ch 1%) was more efficient and fasterthan other groups (Ch 2, 3%) versus control groups. Also, the total leucocyte counts showed shortened inflammatoryphase in chitosan-treated groups. The present results showed the efficiency of extracted chitosan in wound healingprocess and can be used in medical applications.

Effects of recombinant human epidermal growth factor on wound healing after endoscopic sinus surgery / 中国耳鼻咽喉头颈外科

OBJECTIVE To investigate the effects of recombinant human epidermal growth factor (rhEGF) on wound healing of chronic sinusitis patients after functional endoscopic sinus surgery. METHODS A total of 110 patients with chronic sinusitis underwent functional endoscopic sinus surgery with both sides of their nose. The right side of their nasal cavity (control group) treated by nasal irrigation and steroid nasal spray, the left side of their nasal cavity (study group) treated by nasal irrigation and the nasal spray of steroid hormones and rhEGF. Surgical effect was evaluated under nasal endoscope at 2, 4, 12 and 24 weeks after surgery, while subjective symptom was evaluated depending on visual analogue scale (VAS). Both the score of endoscopic examination and VAS, also the rates of epithelization of the two groups were compared. RESULTS The score of endoscopic examination of the study group at 2 weeks after surgery was better than that of the control group, which had statistical significance, while the score of VAS had no statistical difference. The score of endoscopic examination and VAS, the rate of epithelization in study group at 4 and 12 weeks after surgery were better than those in control group, and the difference was statistically significant, but they were no statistical difference at 24 weeks after surgery. CONCLUSION The using of rhEGF nasal spray on chronic sinusitis patients with functional endoscopic sinus surgery can shorten the time of epithelization, improve the situation of nasal mucosa and patients' subjective symptoms, it is worthy of clinical application.

Evaluation of wound healing activity of topical phenytoin in an excision wound model in rats.

Background: Wound healing is a significant healthcare problem in today’s medical practice. Despite extensive treatment modalities that are supposed to hasten the wound healing process, the outcomes of existing methods are far from optimal. One such agent that has been tried previously and found controversial in wound healing is phenytoin. Therefore, this study was planned to evaluate and compare wound healing effect of topical phenytoin with povidone iodine ointment in rats. Methods: This study was conducted after approval from Institutional Animal Ethics Committee (IAEC). Wound healing activity of topical phenytoin (1 g% and 2 g%) was assessed in excision wound model in Sprague Dawley rats (n=8), which was compared with topical petroleum jelly and povidone iodine ointment. Parameters studied included wound area on day 0, 4, 8, 12, 16, 20, percentage wound contraction, percentage wound healing from day 0 to day 20 and period of re-epithelisation. Results: Wound surface area decreased in all treatment groups from day 0 through day 20 and the percentage wound closure was better in both the preparations (1% and 2%) of phenytoin when compared wih control and povidone iodine, but this was not statistically significant. Furthermore, the days required for complete re-epithelisation were less with phenytoin treated groups. There was no statistical difference between both the preparations of phenytoin. Conclusion: In this study, it was found that topical phenytoin accelerates wound healing process in an excision wound model.

Effect of ethanolic extract of plectranthus amboinicus leaf on healing of burn wound in wistar rats.

Objectives: To study the effect of ethanolic extract of the leaf of Plectranthus amboinicus on the healing of burn wounds in wistar rats and compare it with silver sulfadiazine treated group.Materials and Methods: Five groups of rats were used in the study. Partial thickness burn wounds were made on each rat under ketamine anesthesia.The wounds in the five groups of rats were treated topically with petroleum base, silver sulfadiazine,1%, 2% and 3% ointment of ethanolic extract of Plectranthus amboinicus, respectively, once daily for 21 days or till complete healing whichever was earlier. The wound contraction rate and period of epithelization were monitored. Results: The rate of wound contraction was significantly more in Plectranthusamboinicustreated groups in comparison to the control. The mean period of epithelization was significantly decreased in Plectranthus amboinicus treated group when compared to control (P < 0.01) and silver sulfadiazine (P =0.02) treated group. Conclusion: The ethanolic extract of Plectranthusamboinicuspromoted healing of burn wound in wistar rats.

Effect of punica granatum peel extract on burn wound healing in albino wistar rats.

Introduction: Punica granatum is known to have long history of medicinal use. Aqueous fractions prepared from pomegranate peel extract has been found to stimulate type 1 procollagen synthesis and inhibit matrix metalloproteinase (which breaks down skin protein) produced by dermal fibroblasts. Objectives: To study the effect of a topical Punica granatum peel extract on healing of burn wound and to compare its effect with that of standard (silver sulfadiazine). Materials and Methods: Partial thickness burn wounds were inflicted upon wistar rats by pouring hot molten wax at 80˚C in to a metal cylinder with 300mm square circular opening, placed on the back of the animal. There were four groups in the study viz. control (topical petroleum jelly), standard (topical Silver Sulphadiazine Cream) and test groups (topical Punica granatum peel extract 10% and 20 %). The parameters measured were wound contraction and epithelization period in this burn wound model. Results & Discussion: The percentage of wound contraction was significantly increased in the topical Punica granatum extract (10% and 20%) and silver sulfadiazine group compared to control group. The mean period of epithelization was significantly reduced in topical Punica granatum extract (10% and 20%) group and silver sulfadiazine group as compared to the control. Conclusion: Punica granatum peel extract is effective in healing burn wound and the effect was comparable to the standard drug silver sulfadiazine.

Reversal of dexamethasone suppressed wound healing with ethanolic extract of leaves of hyptis suaveolens (L) poit.

The dexamethasone suppressed and normal wound healing effect of ethanolic extract of leaves of Hyptis suaveolens (L) poit. (EEHS) at 400mg/kg and 800mg/kg was studied in Wistar rats. Two wound models viz. incision and excision wounds were used in this study. The parameters studied were breaking strength in case of incision wounds, period of epithelization and wound contraction in case of excision wound. The dexamethasone treated group showed a significant (P<0.05) reduction in the wound breaking strength in incision type of wound model and significant increase in epithelization period and reduction in percentage of wound contraction in excision type of wound model as compared to control group. Extract treated groups showed significant (P<0.05) improvement in all the wound healing parameters of incision and excision wound models as compared to control. In incision wound model, Co administration of EEHS at both the dosage levels with dexamethasone had significantly (P<0.05) increased the wound breaking strength as compared to dexamethasone only treated group and was seen more at dosage level of 400mg/kg. Similarly, in excision wound model, there was significant improvement (P<0.05) in both the parameters when EEHS was co administered with dexamethasone as compared to dexamethasone only treated group but improvement was more at dosage level of 800mg/kg.

Ocular Reconstruction Using Autologous Tragal Perichondrium for a Refractory Necrotizing Scleral Perforation: A Case Report

PURPOSE: To report the effectiveness of an autologous tragal perichondrium graft for a necrotizing scleritis case which was refractory to conventional surgery. CASE SUMMARY: A 75-year-old woman was referred to our clinic with recurrent necrotizing scleritis of the left eye which occurred after pterygium removal five years earlier. The patient underwent scleral graft, pericardium graft, and amniotic membrane graft in other clinics; however, necrosis of the sclera progressed. The best corrected visual acuity was 0.06, and choroidal tissue was nearly exposed below the melted pericardium graft in the nasal area. The authors harvested tragal perichondrium from the right ear, and the scleral defect was successfully reconstructed with an autologous tragal perichondium graft. The graft showed rapid epithelization and neovascularization within a week and conjunctivalization after three months. No complications have been observed up to one year after surgery. CONCLUSIONS: Autologous tragal perichondrium graft is an effective treatment to alter necrotized sclera via neovascularization and rapid epithelization in refractory necrotizing scleritis cases.

Effect of Transplantation of Human Bone Marrow Stromal Cells or Dermal Fibroblasts on Wound Healing

PURPOSE: The aim of this study is to compare the effects of bone marrow stromal cells(BSCs) and fibroblasts on wound healing activity in vivo, especially on epithelization. METHODS: The fibroblasts and BSCs were harvested from patients and cultured. Ten Spague-Dawley white rats were used. A 5 mm punches were made to excise skin and subcutaneous tissue in a round fashion at six sites on the back area of each rat. Four hundred thousand cells suspended in 0.05 ml fibrinogen were applied to the created wounds. The cells in group I, II, and III were no cells, fibroblasts and BSCs. The lengths of epithelial gap at the widest wound site were compared with autopsy specimens obtained on the 6th day after cell therapy under light microscope. Statistical comparisons were performed using the Mann-Whitney U-test, and the p value<0.05 was considered statistically significant. RESULTS: The best epithelization was also seen in the BSC group, followed by fibroblast and no cell groups. CONCLUSION: These results demonstrate that BSC has superior effect on stimulating wound healing than fibroblast, which is currently used for wound healing.

The Efficacy of Amniotic Membrane Graft in the Treatment of Symptomatic Bullous Keratopathy

PURPOSE: To evaluate the efficacy of amniotic membrane (AM) transplantation in symptomatic bullous keratopathy using cryo-preserved or lyophilized AM. METHODS: Eight bullous keratopathic patients, who experienced intractable pain despite medication and the application of a therapeutic lens, underwent permanent AM transplantation with 5 cryo-preserved and 3 lyophilized AMs following removal of epithelium using a trephine. The time to re-epithelization and the subsidence of pain were evaluated retrospectively. RESULTS: Mean follow-up was 252+/-171.0 days. Pain relief and re-epithelization were obtained in all eight patients. The times to complete relief of pain was 32.2+/-22.7 days in patients with cryo-preserved AM transplantations (n=5) and 22.0+/-18.0 days in those with lyophilized AM transplantations (n=3) (p=0.549, Mann-Whitney U test). Respective times to re-epithelization were 25.4+/-20.7 days and 23.0+/-25.2 days (p=0.297). There were no significant differences in the diameter of transplanted AMs between the two groups (7.6+/-0.2 vs. 7.3+/-0.3 mm, p=0.172). CONCLUSIONS: Permanent AM transplantation effectively reduced the intractable pain caused by epithelial bulla. Whether the AM was cryo-preserved or lyophilized did not affect the efficacy of the treatment.

Clinical Obervation of Effect of Budesonide on Epithelization in Surgical Cavities Following Endoscopic Sinuous Surgery / 药物流行病学杂志

Objective:To explore the therapeutic effect of the use of budesonide for externally-used budesonide in the surgical cavities following endoscopic sinuous surgery(ESS).Method:122 cases with chronic sinusitis were randomly divided into two groups treated by the routine procedures after endoscopic sinuous surgery but the treatment group with 61 cases were treated by the addition of budesonide suspension for inhalation in the surgical cavities.The process of the epithelization in the surgical cavities by endoscopy was investigated.Result:The process of cleaning in 15 days in the surgical cavities was better in the budesonide-using group than in the controlled group.A significant difference was found(P

The Effect of Amniotic Membrane Transplantation on the Treatment of Necrotizing Scleritis after Pterygium Excision

PURPOSE: To investigate the efficacy of amniotic membrane transplantation (AMT) in patients who were diagnosed with necrotizing scleritis after pterygium excision and who were refractory to systemic corticosteroid and immunosuppressive therapy. METHODS: Six patients who had persistent scleral melting with systemic corticosteroid or immunosuppressive agents underwent double AMT as a permanent patch graft and temporary overlying barrier. Postoperatively, the symptom improvements, reepithelization times and visual acuity changes were evaluated. RESULTS: Choroidal detachment was detected in two patients preoperatively. In all patients, ocular pain improved at 4.7 +/- 3.1 days, and reepithelization of the scleral lesions was completed at 13.2 +/- 8.1 days postoperatively. Choroidal detachment in two patients disappeared at postoperative 2 and 8 days. Complete remission was found in 5 of the 6 eyes (83.3%). One eye which achieved full epithelization in the necrotic area experienced recurrent nodular scleritis in another quadrant, resulting in remission after changing the regimen of immunosuppressive agents. Mean values of initial and final visual acuities were 0.898 logMAR and 0.428 logMAR, respectively, and the visual acuities improved in all patients. CONCLUSIONS: AMT is effective in promoting reepithelization of the necrotic area, resulting in complete remission of necrotizing scleritis in patients who were refractory to systemic corticosteroid or immunosuppressive therapy.

Replacement of partial esophageal defect with pulmonary tissue with vascular pedicle / 中华胸心血管外科杂志

Objective: The purpose of our experiment is to use new type esophageal prosthesis, which is pulmonary tissue with vascular pedicle, to repair the partial esophageal defect. Methods: Twelve adult mongrel dogs were used for the study. Middle lobar bronchus of right lung was ligated and incised, so the pulmonary tissue with vascular pedicle was made. A 4 cm long and 1/2～2/3 circled esophageal wall, and full-thickness defect was created. The defect was patched by pulmonary tissue with vascular pedicle. Results: Seven dogs were put to death at planned times after the reconstructive operation. One dog is still alive without any problems for more than 12 months. One dog survived 38 days and then died of chronic empyema. The other three dogs died of anastomotic leak at 5～7 days after operation. The living dogs could be fed orally at seventh day after operation. Epithelization was found in the luminal surface of the defect. Conclusion: It was feasible that the partial esophageal defect was replaced by pulmonary tissue with vascular pedicle.

An Experimental Study on the Wound Healing Effects of Recombinant Human Epidermal Growth Factors According to Poloxamer Concentrations in Full-thickness Excisional Wound Models of Rats

This study was designed to investigate the optimal poloxamer concentration in the mixed solution of recombinant human epidermal growth factor and poloxamer which can be effective in the wound healing process. Two full-thickness excisions were made on the back of the experimental animals. Recombinant human epidermal growth factors(RhEGF) containing different poloxamer concentrations were applied twice a day and the rates of wound closure were measured every day for 14 days. On the 7th and 14th postoperative day, the histological analysis for epithelization and granulation were performed using computerized imaging analysis system after Masson's trichrome stains. The healing times 50% were significantly reduced in the RhEGF containing 0, 3 and 6% poloxamer treated groups as compared with both the non treated control and vehicle control group(p < 0.05). However, there were no statistical differences in the healing times 50% in the RhEGF containing 10, 15 and 20% poloxamer treated groups as compared with both the non treated control and vehicle control group. Histological examinations revealed that epithelization and granulation were increased significantly in the RhEGF containing 0, 3 and 6% poloxamer treated groups as compared with control group and vehicle control group at the 7th day after operation(p < 0.05). In conclusion, these findings suggest that RhEGF may enhance the epithelial wound healing process through stimulating cell proliferation. The concentration of 0, 3 and 6% of poloxamers can be applied to stabilize and enhance the wound healing effect of RhEGF for clinical application.

Epithelial invasion of the anterior chamber - a clinico-pathologic report of three cases

1. Three cases demonstrating two forms of epithelial invasion of the anterior chamber are presented. In all the cases it is believed that inadequate wound closure was the main factor in the causation of the condition2. Differential and clinical diagnosis of epithelization of the anterior chamber is emphasized3. Preventive and therapeutic measures are suggested. (Summary)