MANAGEMENT OF POST-SURGICAL INFLAMMATION WITH PROTEOLYTIC ENZYME-BIOFLAVONOID COMBINATION

2021 ◽  
pp. 34-37
Author(s):  
Rajesh Dhadiwal ◽  
Shashank Tiwari ◽  
Ramendra Kumar Jauhari
Keyword(s):  
Wound Healing ◽  
Hospital Stay ◽  
Clinical Studies ◽  
Proteolytic Enzyme ◽  
Surgical Care ◽  
Length Of Hospital Stay ◽  
Enzyme Therapy ◽  
Surgical Wound ◽  
Delayed Wound Healing ◽  
Infective Complications

Surgical care is an integral component of health systems, and so is the appropriate management of the surgical wound. Excessive inammation and edema, in the post-surgical period, can result in delayed wound healing, infective complications and increased length of hospital stay, among other complications. Systemic enzyme therapy (SET) with trypsin and bromelain, in combination with the bioavonoid rutoside, has been extensively investigated as alternatives to conventional therapies for pain and swelling associated with many inammatory conditions. The multi-pronged pharmacodynamic action of these ingredients on different inammatory processes has been highlighted in this review. Additionally, clinical studies demonstrating the benecial effects of SET in multiple surgical settings, including general surgical, dental, orthopaedic, cosmetic surgeries, are also discussed

Comparison of topical honey and povidone iodine-based dressings for wound healing: a systematic review and meta-analysis

2021 ◽  
Vol 30 (Sup4) ◽  
pp. S28-S36
Author(s):  
Fujie Zhang ◽  
Zongnan Chen ◽  
Feng Su ◽  
Taijuan Zhang
Keyword(s):  
Wound Healing ◽  
Hospital Stay ◽  
Analogue Scale ◽  
Povidone Iodine ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Beneficial Effects ◽  
Vas Score ◽  
Wound Recovery ◽  
Hospital Stay Duration

Objectives: In this review and meta-analysis, we analyse the evidence to compare the efficacy of honey and povidone iodine-based dressings on the outcome of wound healing. Method: A systematic literature search was performed using PRISMA guidelines in academic databases including MEDLINE, Scopus, Embase and CENTRAL. A meta-analysis was carried out to assess the effect of honey and povidone iodine-based dressings on mean healing duration, mean hospital stay duration and visual analogue scale (VAS) score of pain. Results: From the search, 12 manuscripts with a total of 1236 participants (mean age: 40.7±11.7 years) were included. The honey-based dressings demonstrated a medium-to-large effect in reduction of mean healing duration (Hedge's g: –0.81), length of hospital stay (–3.1) and VAS score (–1.2) as compared with the povidone iodine-based dressings. We present evidence (level 1b) in favour of using honey for improvement of wound recovery as compared with povidone iodine. Conclusion: This review and meta-analysis demonstrate beneficial effects of honey-based dressings over povidone iodine-based dressings for wound recovery.

scholarly journals Role of early enteral feeding in mild and moderate acute pancreatitis

2021 ◽  
Vol 8 (11) ◽  
pp. 3387
Author(s):  
Aswin George Roy ◽  
Haridas T. V.
Keyword(s):  
Acute Pancreatitis ◽  
Hospital Stay ◽  
Enteral Feeding ◽  
Significant Risk ◽  
Length Of Hospital Stay ◽  
Advantages And Disadvantages ◽  
Early Enteral Feeding ◽  
Systemic Complication ◽  
Infective Complications

Background: Timing of enteral feeding in acute pancreatitis was always a matter of controversy. Increasing evidence suggests that early enteral feeding reduces systemic and local complications of pancreatitis and thereby hospital stay. Hence the study has been undertaken to determine the feasibility, advantages and disadvantages of early enteral feeding in mild and moderate acute pancreatitis. Methods: Patients admitted with symptoms and signs suggestive of mild and moderate acute pancreatitis who were started on early enteral feeding (within 48 hours of admission) were included in study. Blood investigation results are used to classify patients accordingly to mild and moderate acute pancreatitis based on Ransons’s score. Patients were followed up and categorized based on development of complications, length of hospital stay.Results: Majority of the patients who were started on early enteral feeding showed significant decrease in complications and hospital stay. Study also suggested that age is a significant risk in development of complications. Gender is not significant in the development of complications.Conclusions: There is significant decrease in rate of systemic complication, local infective and non-infective complications, length of hospital stay among acute pancreatitis patients who were started on early enteral feeding (within 48 hours).

Effect of Colostomy on Treatment Outcome in Fournier Gangrene: A Prospective Comparative Study

2021 ◽  
pp. 229255032110247
Author(s):  
Barakat Abdelreheem Mahmood ◽  
Emad Hussein ElSayed ◽  
Sherif Abdalla Ali
Keyword(s):  
Wound Healing ◽  
Comparative Study ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Wound Dehiscence ◽  
Inhospital Mortality ◽  
Perianal Region ◽  
Fournier Gangrene ◽  
Prospective Comparative Study ◽  
The Difference

Background and Aim: Value of colostomy in management of Fournier gangrene (FG) is a debatable issue. Almost all relevant studies are retrospective and included heterogeneous patients’ groups. The present prospective study aimed to evaluate the role of colostomy in management of FG affecting the perianal region in 2 well-matched FG groups. Patients and Methods: The present prospective comparative study included 30 patients with FG associated with extensive involvement of the perianal region. They comprised 15 patients subjected to colostomy and other 15 patients who refused to perform the procedure. Colostomy was performed after the first debridement. Outcome parameters in the present study included time to wound healing, length of hospital stay, and inhospital mortality. Results: Comparison between the studied groups regarding the preoperative characteristics revealed no statistically significant differences. Postoperatively, patients in the colostomy group had significantly fewer number of debridements (1.3 ± 0.5 vs 2.7 ± 1.2, P < .001), shorter hospital stay (9.5 ± 3.3 vs 29.9 ± 6.2 days, P < .001), and significantly shorter time to wound healing (16.5 ± 3.9 vs 42.9 ± 6.9 days, P < .001). Also, patients in the colostomy group had significantly lower rate of wound dehiscence, wound infection, and flap ischemia. However, the difference wasn’t statistically significant. Conclusions: Aggressive treatment of FG aided by colostomy after first debridement would result in better clinical outcome.

scholarly journals SURGICAL TREATMENT OF CHRONIC PILONIDAL SINUS

2019 ◽  
Vol 141 (3-4) ◽  
pp. 63-67
Keyword(s):  
Wound Healing ◽  
Hospital Stay ◽  
Pilonidal Sinus ◽  
Primary Closure ◽  
Average Length ◽  
Length Of Hospital Stay ◽  
Limberg Flap ◽  
Secondary Intention ◽  
One Year ◽  
Flap Closure

Chronic pilonidal sinus is an acquired skin disease resulting from chronic inflammation of an affected skin area. It creates a cyst with epithelized subcutaneous channels. The disease mostly affects younger men with elevated BMI and sedentary lifestyle being the main risk factors. The aim of this study was to compare wound healing times, seroma, wound infection and wound dehiscence frequency, average length of hospital stay and recurrence rate in patients undergoing first-time operation for chronic pilonidal sinus at the Surgery clinic of University hospital Mostar from June 2015 to June 2017, with recurrence rate monitoring for one one year after the operative procedure. The patients were divided into three groups by the type of operating procedure: excision with primary closure (23.0%), excision with healing by secondary intention (55.2%) and excision with Limberg flap closure (21.8%). Most of the patients included in this study had elevated BMI (72.4%). Patients who were operated using primary closure and Limberg flap closure had on average shorter wound healing times than patients operated with excision and secondary intention healing. Seroma frequency was highest in patients operated using primary closure (70.6%) and lowest in patients operated using Limberg flap closure (29.4%). Average length of hospital stay was 6.4 days (min 3, max 13; SD 1.919). There were no statistically significant differences in hospital stay between different types of operating procedures used. Patients operated using Limberg flap closure had two (10.5%) cases of recurrence in the one year period after the operation. There were seven (35.0%) recurrences of the disease in patients operated using primary closure and six (12.5%) recurrences in patients operated using healing with secondary intention. The difference in the number of recurrences between patients operated using primary closure, healing by secondary intention and Limberg flap closure was borderline statistically significant. We find that Limberg flap closure reduces postoperative complications and wound healing time which improves postoperative recovery.

scholarly journals Institutional Review of Laparoscopic Surgery during Coronavirus Disease - 2019: Recommendations for Developing Countries

2020 ◽  
Author(s):  
Md Jafrul Hannan ◽  
Mosammat Kohinoor Parveen ◽  
Alak Nady ◽  
Md Samiul Hasan
Keyword(s):  
Hospital Stay ◽  
Spinal Anaesthesia ◽  
Low Cost ◽  
Surgical Care ◽  
Length Of Hospital Stay ◽  
Anaesthetic Techniques ◽  
Continuous Variables ◽  
Institutional Review ◽  
Surgical Emergencies ◽  
Control And Prevention

Abstract Context: The outbreak of the Coronavirus disease 2019 (Covid-19) has posed new challenges to surgical care throughout the world. Laparoscopic guidelines were revised to address the theoretical risks associated with transmission of viral droplets and many elective surgeries were suspended.Aims: We aimed to describe strategies that lowered viral transmission risks such as alternative anaesthetic techniques and low-cost infection control and prevention practices for laparoscopic surgeries.Settings and Design: Seventy two patients who presented to hospital as acute surgical emergencies between April and July 2020 and analyzed clinical data of 50 patients who underwent laparoscopic surgeries. This was a prospective observational study.Methods and Material: Procedures were performed under spinal anaesthesia utilizing alternate electrosurgical units and simple smoke evacuation systems.Statistical analysis used: Continuous variables were summarized as mean and standard deviation (SD) or median and range. Discrete variables were summarized as frequencies and percentages. Univariate testing was performed using t test or Mann-Whitney U test. ANOVA or Kruskal-Wallis test was used for categorical data.Results: Of the 50 operated patients, the median age was 23 years with 54% females. The most frequently performed procedure was laparoscopic cholecystectomy, the overall median theatre time was 47 minutes, and 40% patients were managed as day cases with reduced hospital stay.Conclusions: Use of spinal anaesthesia, a simple smoke evacuator and some additional measures during laparoscopic surgeries reduce theatre time and length of hospital stay. These strategies could address and minimize the risks associated with Covid-19 transmission in surgical settings in low-resource countries.

scholarly journals Effect of intersphincteric fistula tract ligation versus anal fistulectomy on pain scores and serum levels of vascular endothelial growth factor and interleukin-2 in patients with simple anal fistulas

2020 ◽  
Vol 48 (9) ◽  
pp. 030006052094907
Author(s):  
Xin Dong ◽  
Zhanbo Jia ◽  
Bianfang Yu ◽  
Xuebin Zhang ◽  
Fagang Xu ◽  
...  
Keyword(s):  
Wound Healing ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Serum Levels ◽  
Fistula Tract ◽  
Control Group ◽  
Anal Continence ◽  
Anal Fistulas ◽  
Operation Conditions ◽  
Pain Scores

Objective This study was performed to explore the effects of ligation of the intersphincteric fistula tract (LIFT) on pain scores and serum levels of vascular endothelial growth factor (VEGF) and interleukin (IL)-2 in patients with simple anal fistulas. Methods Ninety patients with simple anal fistulas were evenly randomized into a study group (treated with LIFT) and a control group (treated with traditional anal fistulectomy) according to a random number table. The surgical outcomes, basic operation conditions (operation time, hospital stay, and anal continence), and postoperative wound healing rates were compared between the two groups. Results The study group had significantly better operation conditions (better anal continence and shorter length of hospital stay), a higher postoperative wound healing rate, lower pain scores, higher VEGF and IL-2 levels, and higher overall efficacy rate than the control group. However, the incidence of postoperative complications was not significantly different between the two groups. Conclusions Patients who underwent LIFT had better surgical outcomes, higher wound healing rates, better anal continence, a shorter length of hospital stay, and less severe postoperative pain than those who underwent simple anal fistulectomy. Increased levels of VEGF and IL-2 after surgery may promote wound healing.

scholarly journals Risk factors for delayed perineal wound healing and its impact on prolonged hospital stay after abdominoperineal resection

2019 ◽  
Vol 17 (1) ◽  
Author(s):  
Chu-Cheng Chang ◽  
Yuan-Tzu Lan ◽  
Jeng-Kai Jiang ◽  
Shih-Ching Chang ◽  
Shung-Haur Yang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Wound Healing ◽  
Hospital Stay ◽  
Independent Risk Factor ◽  
Perineal Wound ◽  
Prolonged Hospital Stay ◽  
Delayed Wound Healing ◽  
Perineal Wound Healing ◽  
Increased Risk ◽  
Prolonged Hospital

Abstract Background Perineal wound complications are a long-lasting issue for abdominoperineal resection (APR) patients. Complication rates as high as 60% have been reported, with the most common complication being delayed perineal wound healing. The aim of this study was to identify risk factors for delayed perineal wound healing and its impact on prolonged hospital stay. Methods We included low rectal tumor patients who underwent APR at a referral medical center from April 2002 to December 2017; a total of 229 patients were included. The basic characteristics and surgical outcomes of the patients were analyzed to identify risk factors for delayed perineal wound healing (> 30 days after APR) and prolonged hospital stay (post-APR hospital stay > 14 days). Results All patients received primary closure for their perineal wound. The majority of patients were diagnosed with adenocarcinoma (N = 213, 93.1%). In the univariate analysis, patients with hypoalbuminemia (albumin < 3.5 g/dL) had an increased risk of delayed wound healing (39.5% vs. 60.5%, P = 0.001), which was an independent risk factor in the multivariable analysis (OR 2.962, 95% CI 1.437–6.102, P = 0.003). Patients with delayed wound healing also had a significantly increased risk of prolonged hospital stay (OR 6.404, 95% CI 3.508–11.694, P < 0.001). Conclusions Hypoalbuminemia was an independent risk factor for delayed wound healing, which consequently led to a prolonged hospital stay. Further clinical trials are needed to reduce the incidence of delayed perineal wound healing by correcting albumin levels or nutritional status before APR.

scholarly journals Methotrexate delayed wound healing of a pyogenic granuloma in a child with juvenile idiopathic arthritis.

2019 ◽  
Vol 22 (4) ◽  
pp. 569-572
Author(s):  
Lígia Ângelo Tavares Schwarzmeier ◽  
Dárcio Kitakawa ◽  
Luiz Eduardo Blumer Rosa ◽  
Luiz Antonio Guimarães Cabral ◽  
Janete Dias Almeida
Keyword(s):  
Wound Healing ◽  
Juvenile Idiopathic Arthritis ◽  
Pyogenic Granuloma ◽  
Histopathological Analysis ◽  
Surgical Wound ◽  
Delayed Wound Healing ◽  
Lower Lip ◽  
Temporary Suspension ◽  
Complete Wound Healing

A nine-year-old girl with of juvenile idiopathic arthritis (JIA) in use of methotrexate complained of a self-bleeding ulcerated lesion exhibiting a red surface in the lower lip. Pyogenic granuloma was confirmed by histopathological analysis. After the 7th and 15th days, the lip where biopsy had been done exhibited a deficient healing. The case was discussed with the physician for temporary suspension of methotrexate. Complete wound healing of the biopsied site occurred after temporary interruption of the medication. Wound healing after methotrexate temporary suspension allowed concluding that the drug delayed surgical wound healing was a consequence of drug cytotoxicity.

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