Recent Advancement in Novel Wound Healing Therapies by Using Antimicrobial Peptides Derived from Humans and Amphibians.

The skin is the biggest organ in the human body. It is the first line of protection against invading pathogens and the starting point for the immune system. The focus of this review is on the use of amphibian-derived peptides and antimicrobial peptides (AMPs) in the treatment of wound healing. When skin is injured, a chain reaction begins that includes inflammation, the formation of new tissue, and remodelling of existing tissue to aid in the healing process. Collaborating with non-immune cells, resident and recruited immune cells in the skin remove foreign invaders and debris, then direct the repair and regeneration of injured host tissues. Restoration of normal structure and function requires the healing of damaged tissues. However, a major issue that slows wound healing is infection. AMPs are just one type of host-defense chemicals that have developed in multicellular animals to regulate the immune response and limit microbial proliferation in response to various types of biological or physical stress. Therefore, peptides isolated from amphibians represent novel therapeutic tools and approaches for regenerating damaged skin. Peptides that speed up the healing process could be used as therapeutic lead molecules in future research into novel drugs. AMPs and amphibian-derived peptides may be endogenous mediators of wound healing and treat non-life-threatening skin and epithelial lesions. Thus, the present article was drafted with to incorporate different peptides used in wound healing, their method of preparation and routes of administration.

Comparative Analysis of Mathematical Models and App-Based Measurement for Estimating the Cutaneous Wound Areas of Captive Asian Elephants.

Objective To evaluate the variation in the area estimation under different mathematical calculations against measurement by a smartphone application in estimating the cutaneous wound areas in captive Asian elephants. Methods The study was conducted on captive Asian elephants (Elephas maximus) with cutaneous wounds reported to Veterinary Hospitals of Kerala Veterinary and Animal Sciences University and elephant camps within and outside Kerala state (mostly southern states of India, namely, Kerala and Tamil Nadu) over the period September 2019 to October 2022. Thirty-five clinical cases diagnosed with skin wounds of different aetiologies at various parts of the body were subjected to measurement, and 111 measurements were taken using a smartphone application, Imito Measure (Imito AG, Zurich, Switzerland). Based on the outer wound perimeters hand-marked on the mobile screen over the image taken, Imito Measure calculated the length, width, perimeter, and area. The length and width measurements from this were applied to four mathematical models of wound measurements. Wound surface area calculations were further done by these models and were compared. Results The observed results indicated no significant difference between the five methods of area measurement in all the studied cases since the P > 0.05. Conclusion The findings revealed no significant difference between the five techniques of wound area measurement. From the practical clinical utility point, the smartphone application has an edge over the mathematical methods in animals, especially captive Asian elephants, as it has the major advantage of being non-contact and thus addresses some major welfare concerns.

Obstructed vein delivery of ceftriaxone via poly(vinyl-pyrrolidone)-iodine-chitosan nanofibers for the management of diabetic foot infections and burn wounds.

Superficial skin injuries especially burn injuries and unhealed diabetic foot open wounds remain troubling for public health. The healing process is often interrupted by the invasion of resistant pathogens that results in the failure of conventional procedures outside the clinical settings. Herein, we designed nanofibers dressing with intrinsic antibacterial potential of poly(vinyl-pyrrolidone)-iodine/ poly (vinyl)-alcohol by electrospinning with chitosan encapsulating ceftriaxone (CPC/NFs). The optimized electrospun CPC/NFs exhibited smooth surface morphology with average diameter of 165 ± 7.1 nm, drug entrapment and loading efficiencies of 76.97 ± 4.7 % and 8.32 ± 1.73 %, respectively. The results displayed smooth and uniformed fibers with adequate thermal stability and ensured chemical doping. The enhanced in vitro antibacterial efficacy of CPC/NFs against resistant E. coli isolates and biosafety studies encourage the use of designed nanofibers dressing for burn injuries and diabetic foot injuries. In vivo studies proved the healing power of dressing for burn wounds model and diabetic infected wounds model. Immunofluorescence investigation of the wound tissue also suggested promising healing ability of CPC/NFs. The designed approach would be helpful to treat these infected skin open wounds in the hospitals and outside the clinical settings.

Case Report: Could topical epidermal growth factor be considered a new therapy for skin injuries in premature infants?

In this case report, we present the experience of a premature neonate born at 28 weeks of gestation who, following prolonged respiratory support, developed a pressure injury on the columella despite the implementation of all appropriate preventive techniques. This injury did not improve with standard therapies; therefore, it was necessary to apply a topical galenic therapy containing epidermal growth factor, resulting in complete healing of the lesion.

Effectiveness of breast milk in the healing of medical adhesive-related skin injuries in peripheral intravenous catheter securement: A randomized controlled trial.

BACKGROUND: Skin injuries, which are more prevalent among premature infants, can prolong the hospital stay of preterms in neonatal intensive care units. AIM: This study aimed to assess the effectiveness of breast milk in reducing the healing time of skin injuries caused using medical adhesive for securing peripheral intravenous catheters (PIVCs) in late preterm infants, which was evaluated using the Neonatal Skin Condition Scale (NSCS). A randomized controlled trial was conducted with two parallel groups in a 1:1 allocation ratio. STUDY DESIGN: It was conducted in the Neonatal Intensive Care Unit of a hospital in Karaman, Turkey between August and November 2022 with 72 preterm infants born at 35-36 weeks with stable health status and having intravenous catheter securement to the skin with medical adhesive tapes, with the tapes remaining on the skin for a minimum of 24 h and a maximum of 32 h. Preterm infants were randomly assigned to breast milk or routine care groups. The site of the skin injuries was evaluated by two independent observers using the NSCS once every 60 min until the injury was completely healed. A one-way ANOVA and repeated measures analysis of variance was used to analyse the data. RESULTS: The average postnatal age was 3.32 ± 0.99 days, and the total duration of medical adhesive tape on the skin was 28.21 ± 2.59 h. A significant difference was found between the mean skin condition scale scores of the infants in the breast milk group (F = 117.219, p < .001) and the routine care group (F = 122.247, p < .001) according to time within the group. The skin injuries of preterm infants in the breast milk group decreased significantly in the first 3 h after the procedure. CONCLUSION: Breast milk application was more effective than routine care in reducing the healing time of skin injuries. RELEVANCE TO CLINICAL PRACTICE: It can be recommended to use breast milk to heal skin injuries in preterm infants.

Medical Adhesive-related Skin Injuries Caused by Eye Taping: A Case Report.

This case report discusses medical adhesive-related skin injuries (MARSIs) caused by eye taping during an emergency open reduction internal fixation surgery under general anesthesia. The presented case involves a 72-year-old woman with a proximal humeral fracture, where 3M Transpore adhesive tape caused blisters on both eyelids. This tape is an acrylic-based medical adhesive and is commonly used to keep eyelids closed during general anesthesia. MARSIs can largely be prevented through evidence-based clinical guidance. Enhancing awareness of MARSIs among anesthesia providers and perianesthesia nurses is crucial to prevent and manage such injuries effectively.

Cage enrichment to minimize aggression in part-time group-housed female breeding rabbits.

In most rabbit farms, breeding does kindle and nurse their kits in single-litter cages throughout their entire reproduction cycle. However, the protective behavior can lead to aggressive displays and injuries when the does are housed in groups. This study aimed to evaluate cage enrichment for reducing the agonistic behavior in part-time group-housed does. A total of eighty does with their 22-day-old kits were allocated to 20 multi-litter cages, with each cage housing four does and their litters for 10 days. Each multi-litter group was subjected to one of four treatments: alfalfa blocks as distraction material (A), wooden panels underneath the platforms (P), both alfalfa and wooden panels (AP), or no extra enrichment (controls, C). This experiment was replicated for three consecutive reproduction cycles. The skin injuries of the does and the kits were scored with a tagged visual analog scale before grouping and at one, three, six, eight, and 10 days after grouping. Computer vision techniques were used to continuously monitor rabbit activity and agonistic behavior (aggression and fleeing/chasing) during the first 24 h after grouping, specifically during light hours. During the first day in the group, 67.2% of the does and 13.4% of the kits acquired new injuries. This increased to 82.0 and 33.2%, respectively after 10 days in the group relative to the onset of grouping. The injury scores of the does increased toward the sixth day after grouping compared to the first (p < 0.001) and were highest on the tenth day for the kits (p < 0.001). On all the observation days, the number of injured does was higher in C compared to A (p = 0.04) and AP treatment (p = 0.005). There were no other treatment effects observed on the doe or kit skin injuries. Rabbit activity was highest after grouping but decreased after the first and second days (p < 0.001). The agonistic interactions between the does involved more fleeing/chasing behavior (62.0%) rather than aggression (38.0%). Although hierarchy fights are likely when unacquainted does are group-housed, the many animals that sustained injuries and the high injury scores confirm that part-time group housing for does is challenging and possibly inevitable. This study has shown that alfalfa, with or without wooden panels, can slightly reduce the number of injured does.

Progress in Wound-Healing Products Based on Natural Compounds, Stem Cells, and MicroRNA-Based Biopolymers in the European, USA, and Asian Markets: Opportunities, Barriers, and Regulatory Issues.

Wounds are breaks in the continuity of the skin and underlying tissues, resulting from external causes such as cuts, blows, impacts, or surgical interventions. Countless individuals suffer minor to severe injuries, with unfortunate cases even leading to death. In today's scenario, several commercial products are available to facilitate the healing process of wounds, although chronic wounds still present more challenges than acute wounds. Nevertheless, the huge demand for wound-care products within the healthcare sector has given rise to a rapidly growing market, fostering continuous research and development endeavors for innovative wound-healing solutions. Today, there are many commercially available products including those based on natural biopolymers, stem cells, and microRNAs that promote healing from wounds. This article explores the recent breakthroughs in wound-healing products that harness the potential of natural biopolymers, stem cells, and microRNAs. A comprehensive exploration is undertaken, covering not only commercially available products but also those still in the research phase. Additionally, we provide a thorough examination of the opportunities, obstacles, and regulatory considerations influencing the potential commercialization of wound-healing products across the diverse markets of Europe, America, and Asia.

Prevalence of Skin Injuries in Beach Volleyball Athletes in Greece.

Background: Skin injuries often affect the sports community. Almost every type of athletic activity is associated with traumatic skin injuries, such as surface wounds, bruising, abrasions, subcutaneous hematomas, blunt trauma, nail injuries, friction burns, and blisters. Methods: The aim of this study was to assess the rates, location sites, and seasons of appearance of skin injuries in beach volleyball athletes in Greece. Seven hundred and eighty-five beach volleyball athletes participated in this study. The average age was 28.4 years. Skin injuries included superficial wounds (erosions, incisions, lacerations), deep wounds, hematomas, nail lacerations, friction burns, and friction blisters. The recorded variables encompassed gender, age, the time of year when athletes might be at higher risk of injuries, and the specific body regions affected. Additionally, data regarding training details such as years of practice, weekly training frequency, and daily training duration were also documented. Results: Incidence rates correlated to gender: (a) superficial wounds (p < 0.001), (b) years of training: hematomas (p < 0.001), and (c) average hours of daily training: superficial wounds (p < 0.001), deep wounds (p < 0.001), and friction blisters (p < 0.001). Conclusions: Although early detection, recognition, and treatment are essential, the prevention of skin injuries can also be linked to health and athletic performance.

Nursing care in patients with dependency-related skin injuries in the community: a scoping review.

PURPOSE: Dependency-related skin injuries (DRSI) occur in people who need a high level of support to carry out day-to-day activities. Owing to the ageing population, the number of people at risk of DRSI is increasing. Most wound care is performed by nurses in the community. This scoping review aimed to identify the extent of literature on nursing care for patients with or at risk of developing DRSI living in their own home. MATERIALS AND METHODS: A scoping review was conducted. RESULTS: A total of 28 studies met the inclusion criteria and four main themes emerged: features of the community setting; wound types, causes and management; prevention strategies around aetiology and holistic care; care management and local wound care. CONCLUSION: Although most wounds occur in and are treated in the community, there is a paucity of research on wounds in this setting. The care of patients with DRSI in the community is complex and prevention according to the individual aetiology of each lesion is the key factor in wound care.

Study of EGCG composite hydrogel for the treatment of radiation-induced skin injuries.

With the rising incidence of cancer, radiotherapy has become an increasingly popular treatment modality. However, radiation-induced skin injuries (RSIs) have emerged as a commonly reported side effect of radiotherapy, thereby presenting a significant challenge in the field of radiotherapy. In this study, we report the successful synthesis of a photosensitive hydrogel via amide reaction for grafting the photosensitive group, methacrylate anhydride (MA), onto chitosan (CHI) and gelatin (GEL), with subsequent physical incorporation of epigallocatechin gallate (EGCG). The resulting composite photosensitive hydrogels exhibited favorable swelling properties, rheological properties, and biocompatibility, which promote angiogenesis and demonstrate notable therapeutic efficacy against RSIs. These findings provide valuable insights into the clinical utility of EGCG composite hydrogels for the effective management of RSIs.

Technical Evaluation of a New Medical Device Based on Rigenase in the Treatment of Chronic Skin Lesions.

Chronic wound is characterized by slow healing time, persistence, and abnormal healing progress. Therefore, serious complications can lead at worst to the tissue removal. In this scenario, there is an urgent need for an ideal dressing capable of high absorbency, moisture retention and antimicrobial properties. Herein we investigate the technical properties of a novel advanced non-woven triple layer gauze imbibed with a cream containing Rigenase, an aqueous extract of Triticum vulgare used for the treatment of skin injuries. To assess the applicability of this system we analyzed the dressing properties by wettability, dehydration, absorbency, Water Vapor Transmission Rate (WVTR), lateral diffusion and microbiological tests. The dressing showed an exudate absorption up to 50%. It created a most environment allowing a proper gaseous exchange as attested by the WVTR and a controlled dehydration rate. The results candidate the new dressing as an ideal medical device for the treatment of the chronic wound repairing process. It acts as a mechanical barrier providing a good management of the bacterial load and proper absorption of abundant wound exudate. Finally, its vertical transmission minimizes horizontal diffusion and side effects on perilesional skin as maceration and bacterial infection.

Development of prone positioning and skin damage prevention digital education: the PRONEtect project.

OBJECTIVE: The incidence of skin/tissue damage, such as pressure ulcers, remains high in mechanically ventilated patients in the prone position. According to guidelines, critically ill patients with acute respiratory distress syndrome (ARDS) should be prone for at least 12-16 hours to improve oxygenation and decrease mortality. Therefore, educating clinicians on how to reposition and manage the patient safely in a prone position plays a vital role in preventing adverse events. This project aimed to develop accessible online educational content to assist clinicians in safely executing the prone manoeuvre and minimise skin/tissue damage. METHOD: The development of the educational content was based on: a gap analysis and comprehensive review of available educational resources; evidence-based scientific literature; advice from international experts; and a qualitative study exploring the learning needs of 20 clinicians in Belgium and Sweden between February-August 2022. RESULTS: Volunteer clinicians assisted with the creation of eight simulation videos which were professionally filmed and edited. The interactive videos included the supine-to-prone and prone-to-supine manoeuvres, endotracheal and nasogastric tube securement, eye care, stoma care, protecting high-risk areas from pressure damage, and incontinence-associated dermatitis prevention. A prone positioning protocol, a checklist summarising the key aspects of the protocol, and teaching aids (slide deck for didactic lecturing) were developed and validated by a review of the relevant evidence-based literature and the international expert panel. A website was designed to host the content, with free user access, at www.pronetection.com. CONCLUSION: Education is one strategy towards prevention of complications of prone positioning. Accessible education could assist clinicians unfamiliar with prone positioning or current clinicians requiring refresher training to safely manage patients in this position.

Risk factors for skin injuries in cancer patients with peripherally inserted central catheter: A prospective multicenter cohort study.

BACKGROUND: The risk factors for skin injuries remain poorly understood in cancer patients with peripherally inserted central catheters (PICC). We herein aimed at exploring the effect of clinical factors on the risk of PICC-related skin injuries. METHODS: We included 1245 cancer patients with PICC from 16 hospitals in Suzhou, China. The study outcome was in-hospital skin injuries, including contact dermatitis, skin (epidermal) stripping, tension injury, allergic dermatitis, skin tear, maceration, folliculitis, and pressure injury. RESULTS: During hospitalization, 274 patients (22.0%) developed skin injuries after prolonged use of an indwelling catheter. Univariable logistic regression analysis identified several risk factors for PICC-related skin injuries; multivariable logistic regression analysis showed that the following factors independently and significantly (p < 0.05) associated with the risk of PICC-related skin injuries: body mass index (BMI, >25 kg/m2 versus <18.5 kg/m2: odds ratio (OR), 1.79; 95% confidence interval (CI), 1.03-3.11), skin condition (humid vs normal: OR, 2.96; 95% CI, 1.62-5.43), skin indentation (OR, 4.67; 95% CI, 3.31-6.58), allergic history (OR, 2.11; 95% CI, 1.21-3.66), history of dermatitis (OR, 3.05; 95% CI, 1.00-9.28), history of eczema (OR, 3.36; 95% CI, 1.20-9.43), catheter insertion site (under elbow vs. upper arm: OR, 3.32; 95% CI, 1.12-9.90), and PICC maintenance interval (4-5 days vs ⩽3 days: OR, 0.06; 95% CI, 0.01-0.50; 5-7 days vs ⩽3 days: OR, 0.07; 95% CI, 0.02-0.31; 7-9 days vs ⩽3 days: OR, 0.10; 95% CI, 0.02-0.57). CONCLUSIONS: BMI, skin condition, skin indentation, allergic history, history of dermatitis, history of eczema, catheter insertion site, and PICC maintenance interval were independent risk factors for PICC-related skin injuries in cancer patients. This knowledge will guide future studies with formulating optimal treatment strategies for improving the skin health of cancer patients with PICC.

Bio-Inspired Antioxidant Heparin-Mimetic Peptide Hydrogel for Radiation-Induced Skin Injury Repair.

Radiotherapy is one of the most important means of cancer treatment, however, radiation can also cause adverse reactions and even serious injuries to the skin. Radiation-induced excess reactive oxygen species (ROS) production and inflammatory infiltration make skin wounds difficult to heal compared to normal skin injuries. Herein, an antioxidant heparin-mimetic peptide hydrogel (K16, KYKYEYEYAGEGDSS-4Sa) is designed for radiation-induced skin injury (RISI) repair. First, the K16 peptide can self-assemble into a hydrogel with a 3D mesh-like porous nanofiber structure, which can provide certain physical support for skin repair like extracellular matrix (ECM). Then, K16 hydrogel not only scavenges ROS and prevents radiation damage to cellular DNA, but also promotes cell proliferation, migration, and angiogenesis. Meanwhile, 4-sulfobenzoic acid (4Sa) modified at the N-terminal end of the K16 peptide can adsorb inflammatory cytokines, thus acting to eliminate inflammation at the wound site. In vivo experiments showed that K16 hydrogel can inhibit early wound degradation, reduce inflammatory infiltration, and promote angiogenesis and collagen deposition, thus promoting wound healing. Therefore, the K16 hydrogel designed in this study has good potential for application in the field of radiation-induced skin injury repair.

An objective comparison of two pulse oximetry sensors with different adhesive systems on healthy human volunteers based on biophysical assessments.

BACKGROUND: Medical Adhesive Related Skin Injuries can arise from topically applied medical devices, especially in those with fragile skin, including the elderly and premature infants. The purpose of this study was to compare gentleness and reapplication of two pulse oximetry sensors (OxySoftN and MaxN, Medtronic, Boulder, CO). MATERIALS AND METHODS: Eighteen healthy subjects aged 65 years and older were enrolled in the gentleness trial, and 20 healthy subjects (18-69 years) were enrolled in the reapplication trial. For the gentleness trial, trans-epidermal water loss (TEWL) measurements were made at five sites on each forearm at three time points (baseline [T0], 4-h postinitial wear [T1], 4-h postsecond wear [T2]). Total amount of protein adhered to each device was also determined. For the reapplication trial, a series of 180° peel tests were performed to observe the forces required to detach the sensor from the skin. RESULTS: TEWL rates in the tail region were significantly greater with MaxN compared to OxySoftN at T1 (p < 0.05). Both were significantly greater than control (p < 0.05). Further, protein analysis revealed that the amount of protein removed was significantly less with OxySoftN compared to MaxN (p < < 0.0001). Differences in loss of adhesion of the tail region between the two sensors were demonstrated, with OxySoftN depreciating at a much slower rate compared with MaxN. CONCLUSION: The OxySoftN sensor appears to be gentle, even on fragile skin, based on reduced strain on the skin during removal. Further, it demonstrated the ability to withstand several reapplications without functional loss in adhesion.

Characteristics of skin injuries caused by power drill.

Skin injuries caused by power drills have been rarely reported. A case is described of a 51-year-old woman who was found dead on a motorway after committing suicide by jumping from a bridge. The body showed a total of nine circular/oval penetrating injuries of the chest and abdomen with very regular, smooth margins, and particular features due to the presence of "skin islands" inside the lesion and "short radial linear abrasions" around the margins. These injuries were caused by a power drill, which was later found in the woman's apartment. For comparison, experimental tests were carried out with the same drill and different bits on pig skin, whose appearance resembled those found on the body. Especially skin islands were also reproduced in the experimental tests. The presented case shows the possibility of this rare method of suicide (or suicide attempt) and the typical characteristics of such peculiar skin lesions that pose problems of differential diagnosis with other injuries such as gunshot injuries.

Lesiones cutáneas en el personal sanitario secundarias al uso de equipo de protección personal frente al Covid-19 / Skin lesions in health personnel secondary to the use of personal protective equipment against Covid-19

Objetivo principal: Determinar la prevalencia de lesiones cutáneas en el personal sanitario relacionadas al uso del equipo de protección personal (EPP) durante la pandemia por SARS-CoV-2. Metodología: Se realizó un estudio transversal, descriptivo y cuantitativo; se aplicó un cuestionario a personal médico y de enfermería que atendieron pacientes con Covid-19, se cuantificaron las reacciones adversas más frecuentes ocasionadas por: mascarillas, guantes, lentes, ropa protectora y alcohol gel. Resultados principales: Participaron 90 personas, de las cuales 81 (90%) presentaron lesiones cutáneas asociadas al EPP. El accesorio que ocasionó más lesiones fue la mascarilla (87,7%), seguido de lentes (85,5%) y alcohol gel (82,2%). La reacción más frecuente por mascarillas fue úlcera en puente nasal (68,9%); en los lentes fue lesión por presión en frente (76,7%); y por el uso de alcohol gel fue resequedad (75,5%). Conclusión principal: El uso prolongado (>5 horas horas) del EPP puede ocasionar efectos adversos cutáneos en el personal sanitario. La mascarilla fue el aditamento que más generó lesiones cutáneas, siendo la úlcera por presión en puente nasal la más frecuente.(AU)

Objective: To measure the prevalence of skin lesions in health personnel related to the use of personal protective equipment (PPE) during the SARS-CoV-2 pandemic. Methods: A cross-sectional, descriptive and quantitative study was carried out; A questionnaire was applied to medical and nursing staff who treated patients with COVID-19, the most frequent adverse reactions caused by: masks, gloves, glasses, protective clothing and alcohol gel were quantified. Results: 90 people participated, of which 81 (90%) presented skin lesions associated with PPE. The accessory that caused the most injuries was the mask (87.7%), followed by glasses (85.5%) and alcohol gel (82.2%). The most frequent reaction to masks was nasal bridge ulcer (68.9%); in glasses it was pressure injury to the forehead (76.7%); and due to the use of alcohol gel it was dryness (75.5%). Conclusions: Prolonged use (>5 hours) of PPE can cause adverse skin effects in healthcare personnel. The mask was the accessory that generated the most skin lesions, with pressure ulcers on the nasal bridge being the most frequent.(AU)

Lesiones cutáneas por síndrome de disfunción multiorgánica: caso clínico / Skin injuries associated with multiple organ dysfunction syndrome: clinical case

Se presenta el caso de una mujer de 95 años, derivada a urgencias por presentar de forma súbita lesiones necróticas parcheadas en cuero cabelludo, que tras realización de analítica y pruebas complementarias se identifica como un cuadro de sepsis de origen multifactorial. Posteriormente, se realiza preparación del lecho de las heridas con desbridamiento cortante con bisturí, aplicando posteriormente colagenasa e hidrogel para continuar con desbridamiento enzimático y autolítico. La paciente fallece a las 4 h tras realizar el desbridamiento. Dado el cuadro de sepsis de origen multifactorial, muy probablemente se trate de lesiones cutáneas por compromiso vital grave, y dentro de ellas de lesiones cutáneas por síndrome de disfunción multiorgánica, que se puede confundir con lesiones por presión, pero dada la localización de las lesiones y el cuadro de sepsis de origen multifactorial, se descarta esta etiología. Los pacientes que sufren este tipo de lesiones tienen una condición clínica irreversible (AU)

A 95-year-old woman, brought to emergency department who suddenly present patchy necrotic skin injuries on the scalp, after performing laboratory tests and complementary tests, is associated with sepsis of multifactorial origin. Subsequently, the wound bed was prepared with sharp debridement with a scalpel, applying collagenase and hydrogel to continue with enzymatic and autolytic debridement. The patient died 4 h after debridement. Given the picture of sepsis of multifactorial origin, it is very likely to be skin injuries associated with serious life threatening situations, and within them skin injuries associated with multiple organ dysfunction syndrome, which could be confused with pressure skin injuries, but given the location of skin injuries and sepsis of multifactorial origin, this etiology is ruled out. Patients who suffer this type of skin injuries have an irreversible clinical condition (AU)

The GPI-Anchored Protein Thy-1/CD90 Promotes Wound Healing upon Injury to the Skin by Enhancing Skin Perfusion.

Wound healing is a highly regulated multi-step process that involves a plethora of signals. Blood perfusion is crucial in wound healing and abnormalities in the formation of new blood vessels define the outcome of the wound healing process. Thy-1 has been implicated in angiogenesis and silencing of the Thy-1 gene retards the wound healing process. However, the role of Thy-1 in blood perfusion during wound closure remains unclear. We proposed that Thy-1 regulates vascular perfusion, affecting the healing rate in mouse skin. We analyzed the time of recovery, blood perfusion using Laser Speckle Contrast Imaging, and tissue morphology from images acquired with a Nanozoomer tissue scanner. The latter was assessed in a tissue sample taken with a biopsy punch on several days during the wound healing process. Results obtained with the Thy-1 knockout (Thy-1-/-) mice were compared with control mice. Thy-1-/- mice showed at day seven, a delayed re-epithelialization, increased micro- to macro-circulation ratio, and lower blood perfusion in the wound area. In addition, skin morphology displayed a flatter epidermis, fewer ridges, and almost no stratum granulosum or corneum, while the dermis was thicker, showing more fibroblasts and fewer lymphocytes. Our results suggest a critical role for Thy-1 in wound healing, particularly in vascular dynamics.