A new proposal to evaluate the healing of open skin wounds: volumetry / Nova proposta para avaliar cicatrização de ferida cutânea aberta: volumetria

PURPOSE: To present a new proposal to evaluate the healing of an open subcutaneous and skin wound, which we termed "volumetry". METHODS: A total of 32 circular wounds were performed in the subcutaneous tissues and skin of four feet of pigs (8 each). Each wound had about 1 cm in diameter and was 0.2 cm deep. Volume was calculated from the wound filled with saline and mass Xantopren. With the aid of a magnifying glass and local lighting, the liquid was dripped with a micropipette inside the wound until complete fullness. Volume repletion was calculated in microliters, corresponding to the volume of the wound. The mass of Xantopren was placed inside the wound to obtain a mold of the lesion. Mold volume was calculated using the formula of the volume of a cylinder closest resembling a geometric figure with mold. RESULTS: The calculation of wound volume was possible with both Xantopren and mold techniques. Volume as calculated by micropipette was 119.37 ± 30.87 microliters while the volume calculated by mold was 122.41 ± 33.90 mm3 (p=0.79). CONCLUSIONS: Volumetry in pig feet is simple and reproducible. Volumetry perfomed with saline did not differ from the volumetry with mass Xantopren. This method may be a useful tool to help evaluate the healing of open skin wounds in experimental and clinical research.

OBJETIVO: Apresentar nova proposta para avaliar a cicatrização de uma ferida cutânea aberta, denominada "volumetria." MÉTODOS: Foram provocadas 32 feridas circulares cutâneas, com cerca de 1 cm de diâmetro e 0.2 cm de profundidade, em quatro patas de suíno. O volume da ferida foi calculado com solução salina e massa de xantopren. O líquido foi gotejado com uma micropipeta no interior da ferida até sua completa repleção, o que foi auxiliado com uma lupa de aumento e iluminação local. O volume de repleção foi calculado em microlitros e correspondeu ao volume da ferida. A massa de xantopren foi colocada no interior da ferida para se obter um molde da lesão. O volume do molde foi calculado utilizando-se a fórmula do volume de um cilindro que foi a figura geométrica mais parecida com o molde. RESULTADOS: O cálculo do volume da ferida foi possível com as duas técnicas propostas. O volume calculado pela micropipeta foi 119.37 ± 30.8693 microlitros e o volume calculado pelo molde foi 122.4088 ± 33.8997 mm³ (p=0.79). CONCLUSÕES: A volumetria realizada em patas de suíno é um método simples, reprodutível. A volumetria realizada com líquido não diferiu da volumetria realizada com massa de Xantopren. Esse método poderá ser útil para auxiliar na análise da cicatrização da ferida cutânea aberta em trabalhos clínicos e experimentais.

Atypical presentation of an unusual foreign body.

A 14-year-old boy presented with intractable diplopia for 10 days following an assault. A thorough history revealed that he was unaware of any penetrating injury. However, imaging demonstrated a radiolucent foreign body between the globe and the orbital floor. On surgical exploration, it was found to be the proximal part of a ball point pen. Its removal resulted in complete resolution of diplopia. Thorough clinical and radiological examination is recommended when a foreign body is suspected in pediatric patients. Prompt diagnosis will aid in early intervention and prevention of long-term complications.

Effects of Adipose-derived Stromal Cells and of their Extract on Wound Healing in a Mouse Model

In this study, the authors investigated the effects of adipose-derived stromal cells (ADSCs) and of their extract on wound healing. After creating wound healing splint model on the backs of mice, ADSCs and their extract were applied. Wound healing rates were calculated at 3, 5, 7, 10, and 14 days after the wounding, and tissues were harvested at 7 and 14 days for histological analysis. Wound healing rates were significantly higher at 7, 10, and 14 days in the cell group than in the control, but in the cell extract group wound healing rates were significantly decreased (P<0.05). Histological scores and capillary densities in the cell group were significantly higher at 2 weeks (P<0.05). In the cell group, thick inflammatory cell infiltration and many capillaries were observed at 1 week, and thick epithelium and numerous large capillaries were observed at 2 weeks. The present study suggests that ADSCs accelerate wound healing as known, and the effects of ADSCs on wound healing may be due to replacing insufficient cells by differentiation of ADSCs in the wound and secreting growth factors by differentiated cells, and not due to the effect of factors within ADSCs.

Analysis on the characters of injuries in body surface and deduction of injury-causing instruments in 146 cases / 法医学杂志

OBJECTIVE@#To study the deduction of injury-causing instruments and its value as judicial evidence.@*METHODS@#To collect 146 cases involved in injury-causing instruments deduction, which accepted by Judicial Appraisal Center of Wannan Medical College during the period from 1998 to 2007, then to deduce the instrument by analyzing the characters of injuries in body surface. The accuracy of those deductions was evaluated by comparing the deduced instruments with the actual instruments.@*RESULTS@#The deduction from sharp injuries was more accurate than that from blunt injuries.@*CONCLUSION@#Sometimes the result of deduction about injury-causing instruments are uncertain, it may be accepted as judicial evidence when supported by other evidences.

Hepatic injury / Trauma hepático

Hepatic trauma occurs in approximately 5 percent of all admissions in emergency rooms. The anatomic location and the size of the liver make the organ even more susceptible to trauma and frequently in penetrating injuries. The American Association for the Surgery of Trauma established a detailed classification system that provides for uniform comparisons of hepatic injury. Diagnosis of hepatic injury can be sometimes easy; however the use diagnostic modalities as diagnostic peritoneal lavage, ultrasound and computed tomography allow faster and more accurate diagnosis. Nonoperative management of the hemodynamically stable patient with blunt injury has become the standard of care in most trauma centers. Few penetrating abdominal lesions allow conservative management; exceptions can be some penetrating wounds to right upper abdominal quadrant. Operative treatment of minor liver injuries requires no fixation or can only be managed with eletrocautery or little sutures. Major liver injuries continue, despite technical advances, a challenge to surgeons. Many procedures can be done as direct repair, debridement associated to resections, or even in more severe lesions, packing. This constitutes a damage control which can allow time to recovery of patient and decreasing mortality shortly after trauma.

O trauma hepático corresponde a aproximadamente 5 por cento das admissões das salas de urgência. A localização anatômica do fígado e o seu tamanho o tornam mais susceptível ao trauma contuso e freqüentemente às lesões penetrantes. A associação Americana para a Cirurgia do Trauma estabeleceu uma classificação detalhada, o que possibilita comparações uniformes do trauma hepático. O diagnóstico destas lesões pode ser muitas vezes fácil, contudo a utilização de modalidades diagnósticas como o lavado peritoneal, a ultrassonografia e a tomografia computadorizada, permite o diagnóstico mais rápido e acurado. O tratamento conservador não operatório do trauma hepático contuso em pacientes com estabilidade hemodinâmica tornou-se padrão na maioria dos centros de trauma. Poucas lesões penetrantes do abdome permitem o tratamento conservador. As exceções podem ser justamente aquelas localizadas no quadrante superior direito do abdome que atinjam apenas o fígado. O tratamento cirúrgico de pequenas lesões hepáticas geralmente necessita de nenhum reparo ou podem ser tratadas com cauterização ou pequenas suturas. As lesões mais graves, a despeito dos avanços tecnológicos, constituem ainda um desafio aos cirurgiões. Muitos procedimentos podem ser realizados como: simples suturas, ressecções associadas a desbridamentos ou mesmo em lesões ainda mais graves, o empacotamento. Este constitui o controle do dano, o qual pode permitir a recuperação do paciente com diminuição da mortalidade precoce após o trauma.

Management of hepatic trauma

A review of 32 consecutive patients with liver trauma admitted in two surgical units of Mayo Hospital, Lahore in the year 1994 is presented. Majority of patients were young [mean age 26.5 years] male [90.6%]. Penetrating injuries [81%] were far more common than blunt trauma. Firearm injury was later confirmed at laparotomy except in two stable patients where diagnosis was confirmed on ultrasonography. These patients were managed conservatively. Right lobe [59.4%] was primarily involved in trauma. According to Moore's classification of liver trauma, twenty two patients had Grade-1 and II injuries 9 had Grade III and IV and one had Grade V injury. Eighty percent of patients had associated injuries to other organs. Hepatorrhaphy [64.3%] was the commonest amongst the procedures carried out, others were Hepatoomentorrhaphy, [10.7%] resectional debridement with selective ligation of the vessels [14.3%] perihepatic packing [7.1%] and hepatic lobar resection [3.6%]. Morbidity in this series was 59.5% and mortality 12.5%

Neck injuries: one years experience in one trauma center

Neck injuries comprise a minor but important part of trauma surgical practice. Debate still exists about the best methods to handle some cases. Thirty-three cases of neck injuries admitted to the Trauma and Surgical Emergency Unit during the period from January 1993 to January 1994 were studied. Patients were classified according to type and site of injury, stability of the patient and seriousness of presenting symptoms and signs. After examination of the data and results, the authors recommended an early exploration for patients with penetrating injuries in zone II, or I and III with signs of major trauma. A watchful 72 hours surveillance should be considered for those with blunt trauma and for those with zone I and III penetrating injuries with signs of minor trauma

Aneurysms of the upper limb

Fiftyone aneurysms of the upper limb were studied prospectively in a four-year period between 1986 and 1990, in the Department of Vascular Surgery of Dow Medical College and Civil Hospital, Karachi. Most of these aneurysms had resulted from penetrating trauma and the majority of patients [98%] underwent angiography and operative treatment within one year of onset. The urban setting and criminal violence were the main reasons for male preponderance [92%]. Distal subclavian and Axillary arteries were most commonly involved, revealing a pulsatile lump in the majority [80%] of the patients. Most of these vascular injuries were associated with neurological trauma [68.6%] and the resultant decrements were produced by nerve divisions [57%] and neuropathy [43%]. Excision of the aneurysm and long saphenous vein interposition graft was the commonest procedure [82%] used. Patency rate of the anastomotic conduit was 96% at six weeks. This was an excellent result. Unfortunately poor reattendance of the patients at subsequent follow-ups has resulted in a great unreliability of this patency rate. Lack of education, lack of awareness and poor compliance were the main causes of failure to reattend after such a major injury and salvage, and it is hoped that in the future more of these patients can be traced to determine the outcome of the management

Cell Patterns in Open Wound Healing: Light and Electron Microscopic Observation

Cell patterns in open wound healing are studied by both light and electron microscopic examinations in regards to time sequence, metamorphosis, and functional aspects. Process of the open wound healing clearly exhibited not only time sequence of cllular appearance but also zonation of cells. In the initial stage, until the 3rd day, the neutrophilic polymorphonuclear leukocytes were predominant and particularly concentrated in the scab region. The mononuclear cells were active cells during the 1st to 7th day and were mainly concentrated in the subscab region. The fibroblastic activities started from the 3rd day and became very active during the 5th to the 10th day, and they were concentrated at granulation tissue region. During the process of wound healing, the cellular elements underwent metamorphosis; The neutrophils from normal to swollen and finally degenerating; the mononuclear to macrophages; the fibroblasts from immature to mature actively protein synthesizing cells. The functions of each cellular element can not be determined with certainty. However, the main function of neutrophils in wound healing is likely the formation of front line defense as a part of the scab formation on the surface. And the major function of mononuclear cells is to debride exudates and damaged tissue debris especially at the subscab area and that of the fibroblasts to replace the tissue defect by proliferation and production of fibrous proteins.