Mucosal vs. cutaneous advancement flaps for the treatment of chronic anal fissures: a randomized clinical trial.

PURPOSE: The aim of this study was to compare two surgical treatment methods for chronic anal fissures (CAF), mucosal advancement flap anoplasty (MAFA) and cutaneous advancement flap anoplasty (CAFA). METHODS: A randomized, blinded clinical trial was conducted on patients with CAF refractory to medical treatment referred to a tertiary-level hospital between January 2021 and December 2022. The patients were assigned to two groups by block randomization and were compared in terms of outcome, pain reduction, and complications. RESULTS: There were 30 patients (male to female ratio 2:3, median age 42 years [range 25-59 years]). Both techniques reduced anal pain significantly (p = 0.001); however, there were no significant differences between MAFA and CAFA groups in recurrence, duration of healing, postoperative pain, and postoperative bleeding. No patient suffered from fecal incontinence (Wexner score = 0) or flap necrosis postoperatively. Only two patients in the MAFA group (1 and 3 months after surgery) and one patient in the CAFA group (2 months after surgery) had recurrence (total recurrence rate = 10%, healing rate = 90%). All of the patients were satisfied with their surgical results. CONCLUSION: Mucosal and cutaneous anal advancement flap techniques are effective and comparable surgical procedures for the treatment of chronic anal fissures with minimal complications, fast healing process, and minimal postoperative pain and complications. CLINICAL TRIAL ID: IRCT20120129008861N4 ( www.irct.ir ).

Tragacanth gum/nano silver hydrogel on cotton fabric: In-situ synthesis and antibacterial properties.

This paper is mainly focused on introducing cotton fabric with hydrogel and antimicrobial properties using Tragacanth gum as a natural polymer with hydrogel properties, silver nitrate as silver precursor, citric acid as a cross-linking agent and sodium hypophosphite as catalyst. The water absorption behavior of the treated fabrics was investigated with moisture regain, water retention, drying time of wetted fabric at room condition and vertical wicking tests. Antibacterial properties of the samples were evaluated against Escherichia coli and Staphylococcous aureus. The SEM pictures confirmed formation of nano silver and hydrogel layer on the fabric surface and XRD performed the crystal and particle size of the nano silver. The chemical structure of the fabric samples was identified with FTIR spectra. The central composite design (CCD) was used for statistical modelling, evaluated effective parameters and created optimum conditions. The treated cotton fabrics showed good water absorption properties along with reasonable antibacterial effectiveness.