Study of Inflammatory and Infection Markers in Periprosthetic Fluid: Correlation with Blood Analysis in Retrospective and Prospective Studies.

BACKGROUND: Surgical site infection represents the most severe complication in prosthetic breast reconstruction. Risk profiling represents a useful tool for both clinicians and patients. MATERIALS AND METHODS: In our hospital, 534 breast reconstructions with tissue expander implants, in 500 patients, were performed. Several clinical variables were collected. In our study, we evaluated the different inflammatory markers present in the periprosthetic fluid and we compared them with the ones present in plasma. RESULTS: The surgical site infection rate resulted to be 10.5%, and reconstruction failed in 4.5% of the cases. The hazard ratio for complications was 2.3 in women over 60 (CI: 1.3-4.07; p = 0.004), 2.57 in patients with expander volume ≥ 500 cc (CI: 1.51-4.38; p < 0.001), 2.14 in patients submitted to previous radiotherapy (CI: 1.05-4.36; p < 0.037), and 1.05 in prolonged drain use (CI: 1.03-1.07; p < 0.001). 25-OH, PCT, and total protein were less concentrated, and ferritin and LDH were more concentrated in the periprosthetic fluid than in plasma (p < 0.001). CRP (p = 0.190) and ß-2 microglobulin (p = 0.344) did not change in the two fluids analyzed. PCT initial value is higher in patients who underwent radiotherapy, and it could be related to the higher rate of their postoperative complications. Patients with a tissue expander with a volume ≥ 500 cc show an increasing trend for CRP in time (p = 0.009). CONCLUSIONS: Several risk factors (prolonged time of drains, age older than 60 years, and radiotherapy) have been confirmed by our study. The study of markers in the periprosthetic fluid with respect to their study in plasma could point toward earlier infection detection and support early management.

Photobiomodulation plus Adipose-derived Stem Cells Improve Healing of Ischemic Infected Wounds in Type 2 Diabetic Rats.

In this study, we sought to investigate the impact of photobiomodulation and adipose-derived stem cells (ADS), alone and in combination, on the maturation step of wound healing in an ischemic infected delayed healing wound model in rats with type 2 diabetes mellitus (DM2). We randomly divided 24 adult male rats into 4 groups (n = 6 per group). DM2 plus an ischemic delayed healing wound were induced in all rats. The wounds were infected with methicillin-resistant Staphylococcus aureus. Group 1 was the control (placebo) group. Group 2 received only photobiomodulation (890 nm, 80 Hz, 0.324 J/cm2, and 0.001 W/cm2). Group 3 received only the allograft ADS. Group 4 received allograft ADS followed by photobiomodulation. On days 0, 4, 8, 12, and 16, we performed microbiological examination (colony forming units, [CFU]), wound area measurement, wound closure rate, wound strength, and histological and stereological examinations. The results indicated that at day 16, there was significantly decreased CFU (Analysis of variance, p = 0.001) in the photobiomodulation + ADS (0.0 ± 0.0), ADS (1350 ± 212), and photobiomodulation (0.0 ± 0.0) groups compared with the control group (27250 ± 1284). There was significantly decreased wound area (Analysis of variance, p = 0.000) in the photobiomodulation + ADS (7.4 ± 1.4 mm2), ADS (11 ± 2.2 mm2), and photobiomodulation (11.4 ± 1.4 mm2) groups compared with the control group (25.2 ± 1.7). There was a significantly increased tensiometeric property (stress maximal load, Analysis of variance, p = 0.000) in the photobiomodulation + ADS (0.99 ± 0.06 N/cm2), ADS (0.51 ± 0.12 N/cm2), and photobiomodulation (0.35 ± 0.15 N/cm2) groups compared with the control group (0.18 ± 0.04). There was a significantly modulated inflammatory response in (Analysis of variance, p = 0.049) in the photobiomodulation + ADS (337 ± 96), ADS (1175 ± 640), and photobiomodulation (69 ± 54) treatments compared to control group (7321 ± 4099). Photobiomodulation + ADS gave significantly better improvements in CFU, wound area, and wound strength compared to photobiomodulation or ADS alone. Photobiomodulation, ADS, and their combination significantly hastened healing in ischemic methicillin-resistant Staphylococcus aureus infected delayed healing wounds in rats with DM2. Combined application of photobiomodulation plus ADS demonstrated an additive effect.

Effect of Laser Radiation on Infected Sites for the Immediate Placement of Dental Implants.

Objective: The study aims to evaluate the feasibility of erbium-chromium: yttrium-scandium-gallium-garnet (ErCr:YSGG 2780 nm) laser irradiation on infected and/or inflamed post-extraction sites for the immediate placement, and when possible, immediate loading, of endosseous implants. Background: Post-extraction site infection is a serious complication. Surgical and nonsurgical options are available to treat such event, together with various decontamination methods. However, there is still no consensus on which treatment is the most effective. Materials and methods: Sixty-six patients were included in the study for a total of 94 post-extraction implants, inserted in the maxilla and mandible. All patients were eligible for implant therapy, having at least one compromised tooth requiring extraction, along with sign of inflammation and/or infection. Surgery and socket decontamination were performed using an ErCr:YSGG laser. To improve bone healing, Bio-Oss® and resorbable membrane were used in 57 patients. Eleven implants were immediately loaded, whereas 83 were loaded within 3-6 months, depending on the extraction site. Intraoral radiographs were taken at 1, 3, 6, 9, and 12 months from the implant placement to assess the alveolar bone level and treatment's outcome. Albrektsson criteria were chosen to evaluate the treatment success rate. Results: Follow-up went from 6 months to 4 years. Success rate was 94.6% (89/94): three implants failed to integrate due to poor patient compliance, being expelled during the second week, whereas two implants presented factory defects (abutment). No sockets presented signs of residual infection during follow-up. Conclusions: The combination of mechanical, chemical, and laser treatment was proven to be highly effective for the disinfection of post-extraction sites. The ErCr:YSGG laser is a useful tool, not only for his practicality as a surgical device but also as a disinfection tool, granting optimal results after implant surgery.

Chronic irradiation with 222-nm UVC light induces neither DNA damage nor epidermal lesions in mouse skin, even at high doses.

Surgical site infections (SSIs) represent an important clinical problem associated with increased levels of surgical morbidity and mortality. UVC irradiation during surgery has been considered to represent a possible strategy to prevent the development of SSI. 254-nm UVC induces marked levels of DNA damage by generating cyclobutyl pyrimidine dimers (CPD) in microorganisms. However, this effect is elicited not only in microorganisms, but also in human cells, and chronic exposure to 254-nm UVC has been established to represent a human health hazard. In contrast, despite short wavelength-UVC light, especially 222-nm UVC, having been demonstrated to elicit a bactericidal effect, single irradiation with a high dose of 222-nm UVC energy has been reported to not induce mutagenic or cytotoxic DNA lesions in mammalian cells. However, the effect of chronic irradiation with a high dose of 222-nm UVC to mammalian cells has not been determined. In this study, it was demonstrated that large numbers of CPD-expressing cells were induced in the epidermis of mice following treatment with a small amount of single exposure 254-nm UVC, and then less than half of these cells reduced within 24 h. Chronic 254-nm UVC irradiation was revealed to induce sunburn and desquamation in mouse skin. Histological analysis demonstrated that small numbers of CPD-expressing cells were detected only in hyperkeratotic stratum corneum after chronic irradiation with a high dose of 254-nm UVC, and that significant hyperplasia and intercellular edema were also induced in the epidermis of mice. In contrast, chronic irradiation with 222-nm UVC light was revealed not to induce mutagenic or cytotoxic effects in the epidermis of mice. These results indicated that 222-nm UVC light emitted from the lamp apparatus (or device), which was designed to attenuate harmful light present in wavelengths of more than 230 nm, represents a promising tool for the reduction of SSI incidence in patients and hospital staff.

The effects of photobiomodulation therapy on Staphylococcus aureus infected surgical wounds in diabetic rats. A microbiological, histopathological, and biomechanical study.

PURPOSE: To evaluate the effects of photobiomodulation therapy (PBMT) at 685 nm on diabetic wound healing in rats suffering from bacterial infection induced by Staphylococcus aureus (S. aureus). METHODS: Thirty streptozotocin-induced diabetic rats were allocated into two groups: control and PBMT. A 4-cm full-thickness linear-incision was made on the dorsal midline and was contaminated with S. aureus. The wounds in the PBMT group were irradiated daily for 5 consecutive days, starting 3 days after the induction and always in the mornings. RESULTS: The result revealed that PBMT resulted in a significant decrease in S. aureus CFU in the PBMT group in comparison to the control group (P<0.05). The length of wounds, in the 2nd and 3rd weeks, in the PBMT group were significantly shorter compared to the control group (P<0.05). PBMT caused a significant increase in the histological parameters in comparison to the control group (P<0.05). Moreover, PBMT significantly increased the breaking strength of the surgical scars produced in the skin of the PBMT group when compared to the control group (P<0.05). CONCLUSION: Photobiomodulation therapy may be useful in the management of wound infection through a significant bacterial growth inhibition and an acceleration of wound healing process.

The effects of photobiomodulation therapy on Staphylococcus aureus infected surgical wounds in diabetic rats. A microbiological, histopathological, and biomechanical study

ABSTRACT PURPOSE: To evaluate the effects of photobiomodulation therapy (PBMT) at 685 nm on diabetic wound healing in rats suffering from bacterial infection induced by Staphylococcus aureus (S. aureus). METHODS: Thirty streptozotocin-induced diabetic rats were allocated into two groups: control and PBMT. A 4-cm full-thickness linear-incision was made on the dorsal midline and was contaminated with S. aureus. The wounds in the PBMT group were irradiated daily for 5 consecutive days, starting 3 days after the induction and always in the mornings. RESULTS: The result revealed that PBMT resulted in a significant decrease in S. aureus CFU in the PBMT group in comparison to the control group (P<0.05). The length of wounds, in the 2nd and 3rd weeks, in the PBMT group were significantly shorter compared to the control group (P<0.05). PBMT caused a significant increase in the histological parameters in comparison to the control group (P<0.05). Moreover, PBMT significantly increased the breaking strength of the surgical scars produced in the skin of the PBMT group when compared to the control group (P<0.05). CONCLUSION: Photobiomodulation therapy may be useful in the management of wound infection through a significant bacterial growth inhibition and an acceleration of wound healing process.

[Rational prophylaxis of purulent-septic complications of the soft tissue in ambulatory-outpatient conditions].

The results of investigation are adduced, concerning impact of ultraviolet irradiation and electric field of ultrahigh frequency in conjunction with local application of 1% ethanol solution of chlorophyllipt, using bandage, on prevention of purulent-septic complications occurrence with the soft tissues affection. There were operated on 107 patients. In 56 patients the proposed scheme of purulent-septic complications prophylaxis was applied. This permits to exclude the systemic application of antibiotics for prophylaxis after "clean" operations performance.

Influence of the combination of infrared and red laser light on the healing of cutaneous wounds infected by Staphylococcus aureus.

AIM: We aimed to assess the use of two wavelengths on the healing of infected wounds. BACKGROUND: Infection is the most significant cause of impaired wound repair or healing. Several therapeutic approaches are used for improving wound healing including the use of different light sources, such as the laser. Some wavelengths yield positive photobiological effects on the healing process. MATERIAL AND METHODS: The backs of 24 young adult male Wistar rats under general anesthesia were shaved and cleaned, and a 1 by 1 cm cutaneous wound was created with a scalpel and left untreated. The wounds were infected with Staphylococcus aureus, and the rats were randomly divided into two sets of four subgroups with three animals in each subgroup: control, red laser light, infrared laser light, and red + infrared laser light. Laser phototherapy was carried out with a diode [λ680 nm/790 nm, power (P) = 30 mW/40 mW, continuous wave laser, Ø = 3 mm, power density (P) = 424 and 566 mW/cm(2), time = 11.8/8.8 sec, E = 0.35 J] and started immediately after surgery and repeated every other day for 7 d. Laser light was applied on four points around the wounded area (5 J/cm(2)). The animals were killed either 8 or 15 d after contamination. Specimens were taken, embedded in paraffin, and sectioned and stained for histological analysis. RESULTS: Histological analysis showed that control subjects had a lower amount of blood vessels when compared with irradiated subjects. Irradiated subjects had more advanced resolution of inflammation compared with controls. Irradiated subjects also showed a more intense expression of the collagen matrix. The collagen fibers were mostly mature and well organized in these subjects at the end of the experimental time especially when both wavelengths were used. CONCLUSION: The results of the present study indicate that laser phototherapy has a positive effect on the healing of infected wounds, particularly with the association of λ680 + λ790 nm.

The effect of preoperative radiotherapy and reconstructive surgery on wound complications after resection of extremity soft-tissue sarcomas.

BACKGROUND: Major wound complications (MWCs) are frequent after preoperative radiotherapy (RT) for extremity soft-tissue sarcoma (STS). We examined the rate of MWCs at a single institution with readily available reconstructive surgery. METHODS: The medical records of consecutively treated extremity STS patients treated with preoperative external-beam RT and surgical resection from June 1996 through February 2003 were reviewed. Patients underwent RT (median 50 Gy), followed by resection 4-8 weeks later. Patients believed to be at higher risk for MWC underwent wound closure by the reconstructive surgery service (RSS). MWCs included secondary operation, invasive procedure, hospital readmission, or persistent deep packing or dressing changes. RESULTS: A total of 173 patients underwent preoperative RT. Median age was 54 years; 51% were female; 80% had lower extremity STS. Wound closure was performed by the primary surgeon in 91 cases (53%). The RSS performed wound closure in the remaining 82 patients (47%). One or more MWCs occurred in 55 patients (32%). Wound complications were more likely in patients with lower extremity (49/138, 36%) than upper extremity (6/35, 17%) STS (P = 0.03). Among patients with lower-risk wounds closed by the primary surgical team, 29 (32%) experienced MWC, whereas in the higher-risk patients closed by the RSS, MWC occurred in 26 (32%). CONCLUSIONS: MWCs are frequent after preoperative RT and occur more commonly in patients with lower extremity tumors. The MWC rate observed in a single-institution setting was comparable to that observed in the preoperative therapy arm of a multicenter Canadian trial. Patients believed to be at higher risk for MWCs undergoing RSS closure have MWC rates comparable to those with lower-risk wounds closed by the primary team.

Salvage treatment of an irradiated, infected lumbosacral wound.

A 60-year-old male with lumbosacral multiple myeloma received 5100 cGy of external-beam radiation, thalidomide, and Decadron. He subsequently underwent excision of the epidural tumor, decompressive L4, L5, and S1 laminectomies, and bilateral L4-5 and L5-S1 medial facetectomies. The patient developed osteoradionecrosis, cerebrospinal fluid leak, wound infection, and sepsis. Debridement and bilateral V-Y fasciocutaneous advancement flaps failed. Pedicled omental transposition flap through a Petit triangle tunnel was successfully performed. Omental transposition provides a safe option for salvage treatment of irradiated, infected lumbosacral wounds. The plastic and trophic qualities of the omentum make it an excellent choice to fill poorly vascularized wounds. In addition to its immunologic and neoangiogenic properties, the omentum has a dense lymphatic network with tremendous absorptive potential. Its biologic advantages must be weighed against the need for celiotomy and available local options according to circumstances.

Laser-induced shock waves enhance sterilization of infected vascular prosthetic grafts.

BACKGROUND AND OBJECTIVE: Bacteria that cause infection of vascular prosthetic grafts produce an exopolysaccharide matrix known as biofilm. Growth in biofilms protects the bacteria from leukocytes, antibodies and antimicrobial drugs. Laser-generated shock waves (SW) can disrupt biofilms and increase drug penetration. This study investigates the possibility of increasing antibiotic delivery and sterilization of vascular prosthetic graft. STUDY DESIGN/MATERIALS AND METHODS: Strains of Staphylococcus epidermidis and S. aureus were isolated from infected prosthetic grafts obtained directly from patients. Dacron grafts were inoculated with the isolated bacteria, which were allowed to form adherent bacterial colonies. The colonized grafts underwent the following treatments: (a) antibiotic (vancomycin) alone; (b) antibiotic and SW (c) saline only; and (d) saline and SW. Six hours after treatment, the grafts were sonicated, the effluent was cultured and the colony forming units (CFU) were counted. RESULTS: CFU recovered from control grafts colonized by S. epidermidis were comparable: saline, 3.05 x 10(8) and saline+SW 3.31 x 10(8). The number of S. epidermidis CFU diminished to 7.61 x 10(6) after antibiotic treatment but the combined antibiotic+SW treatment synergistically decreased CFU number to 1.27 x 10(4) (P<0.001). S. aureus showed a higher susceptibility to the antibiotic: 2.26 x 10(6) CFU; antibiotic +SW treatment also had an incremental effect: 8.27 x 10(4) CFU (P<0.001). CONCLUSIONS: This study demonstrates that laser-generated shock waves have no effects alone, but can enhance the effectiveness of antibiotics against bacteria associated with prosthetic vascular graft biofilms, suggesting that this treatment may be of value as adjunctive therapy for prosthetic graft infections.

Clinical effects of continuous microwave for postoperative septic wound treatment: a double-blind controlled trial.

BACKGROUND: Continuous microwave (CM) has already been shown to be effective in treating various pathologic states. The aim of this trial was to study the curative effect of this new physical method on the course of postoperative suppurative and inflammatory processes in patients who underwent abdominal surgery. PATIENTS AND METHODS: In this study, 141 patients with postoperative purulent wounds (predominantly caused by pyogenic Staphylococcus aureus) were randomized into two groups: 71 patients received local CM therapy (group A), and the other 70 patients received a placebo treatment using a similar but ineffective device (group B, controls). In this double-blind study, criteria for wound healing in both patient groups were evaluated. RESULTS: Results demonstrated that wound clearance was significantly accelerated in group A (treated with CM) compared with group B (controls): 5.6 +/- 0.6 versus 10.2 +/- 0.5 days (mean +/- standard deviation), respectively. Similarly, initial epithelization was significantly forced in group A compared with group B: 7.0 +/- 0.4 versus 12.8 +/- 0.6 days, respectively; and granulation appeared after 4.9 +/- 0.2 versus 8.7 +/- 0.4 days of postoperative treatment, respectively. Daily decrease of wound surface area was significantly higher in group A than in group B (7.1% versus 3.2%). On the fifth postoperative day of treatment, the number of microorganisms was considerably lower (10(5) per gram of tissue) in patients treated with CM than in controls. CONCLUSIONS: The results of this controlled clinical trial suggest that low-intensity CM is an effective postoperative treatment of purulent wounds after abdominal surgery. Further investigations may elucidate the underlying mechanisms in detail and optimize the curative effects in surgical practice.

[Microbiology of suppurative wound in laser radiation]. / Mikrobiologicheskaia kharakteristika gnoinoi rany pri lazernom obluchenii.

Comparative quantitative and qualitative appraisal of purulent lesions of the soft tissues in surgical patients treated with the infrared lasers "Uzor" (pulse) and "Skalyar (continuous) and by the traditional methods (antibiotics, antiseptics, ointments) was conducted under clinical conditions. Abscesses, mastitis, and phlegmons were studied before and after the operation and on the 3rd, 6th, and 12th postoperative day. It was found that Staphylococcus aureus in a monoculture was the etiological cause of purulent infection in 75.2% of cases. The bactericidal effect of pulse and continuous infrared irradiation led to a decrease in the number of infected patients and more rapid cleansing of the wound. In treatment with Skalyar the focus of affection was cleaned completely by the 6th day. Qualitative improvement of the cultural, biochemical, and lysogenic properties and antibiotic sensitivity of the staphylococcus isolated from patients in dynamics during irradiation did not occur.

Chronic nonhematogenous osteomyelitis treated with adjuvant CO 2 laser sterilization: a preliminary report.

A CO 2 laser was used to sterilize wounds resulting from trauma injuries to bone on 12 sites in 11 patients. This treatment relieved chronic osteomyelitis and enabled most of the patients to function normally within 3 months of surgery.

[Photomodification of autologous blood in surgery]. / Fotomodifikatsiia autokrovi v khirurgii.

The use of the method of autologous blood photomodification in surgery is discussed on basis of generalized experience of the Leningrad Research-Practical Center of Blood Photomodification (3,000 procedures conducted in over 2,000 patients). The current state of the problem, the main mechanisms of the therapeutic action of the procedure, and the clinical efficacy of the method in various surgical diseases are dealt with. The possible complications and the means of their prevention are deal with. The methodological aspects of research are discussed. The authors define the main problems which must be solved in order to raise the efficacy of using photomodification of autologous blood in surgery.