Extensive penile skin necrosis after surgery for Peyronie's disease

The clinical case represents the surgical correction of postoperative complications in a patient with Peyronie's disease. The patient underwent flap corporoplasty using an autovein. The late postoperative period in the patient was complicated by extensive necrosis of the penile skin, which required repeated surgery as follows. The first stage of surgical treatment was performed by excision of necrotic tissues of the penile skin. Within 10 days of the postoperative period, chymotrypsin with an ointment containing dioxomethyltetrahydropyrimidine with chloramphenicol was applied to the penile wound surface to prepare the wound for subsequent skin autotransplantation. Further, within 5 days, the polymeric drainage sorbent «Aseptisorb DT» was applied to the wound surface until the wound was cleansed and granulation tissue was formed. The second stage of the surgical treatment performed penile skin replacement plasty with a free perforated skin graft taken from the patient's femoral surface.

CONTENT OF GROWTH FACTORS AND HYPOXIA-INDUCIBLE FACTOR IN THE SKIN OF RATS OF DIFFERENT AGE AFTER WOUND HEALING

The aim of the study was to determine the content of vascular endothelial growth factor (VEGF), nerve growth factor (NGF) and hypoxia-inducible factor-1alpha (HIF- 1α) in the skin of 40 female rats of different ages (3 and 12 mo) after closure of the wound bed. In each age group composed of 20 rats, 10 rats served as a control group, and in remaining rats a facelift operation was performed and cut wounds on the anterior abdominal wall (5 cm × 0.5 cm) were simulated. The duration of wound surface healing in rats of different age groups was recorded. On the day of complete healing, the animals were killed, and the skin was cut in the areas of the former wound bed. In control rats, the skin was excised in the same places. The content of VEGF, NGF and HIF-1α was determined in the skin by enzyme- linked immunosorbent assay. It was found that in the group of young (3-month-old) rats, complete healing of the wound surface after facelift surgery occurred after 14.0 ± 1.0 days, and on the anterior abdominal wall - after 13.0 ± 1.0 days. In 12-month-old rats, the duration of wound surface healing after facelift surgery and incised wound on the anterior abdominal wall increased to 17.0 ± 1.5 days. In the former wound bed, the content of HIF-1α in young rats increased by 60.7%, and in 12-month-old rats - by 231.6%. In the former wound bed, the content of VEGF and NGF in young rats increased by 14.8 and 11.7%, respectively, and in 12-month-old rats - by 182.4 and 152.6%, respectively. It was concluded that more pronounced hypoxia in the skin after surgery in 12-month-old rats may be the cause of postoperative complications.

Cell Technologies in the Treatment of Chronic Wounds in Patients with Diabetes Mellitus

Materials and methods. The results of treatment of 8 patients with chronic wounds and diabetes mellitus (DM) type 2 and stage IV chronic ischemia of the lower extremities by Fontaine were analyzed, in 2 cases there was a combination of venous and arterial insufficiency. Revascularization of the lower extremities was performed through open (2), endovascular (4) and hybrid surgery (2). In case of venous insufficiency, sclerotherapy of perforator veins was performed. After surgical treatment of the purulent focus, specific bacteriophages were used (after microflora identification). Hydrogel dressings were applied daily, alongside with transplantation of 5,000,000 mesenchymal stem cells (MSC) (CD73+, CD90+, CD105+ and CD45-, CD34-, CD14-, CD79-) by injection into muscle tissue around the wound, then the wound surface was closed with hMSC-fibroblast matrix. Results. After the closure of the wound surface with fibroblast matrix, the patients noted the disappearance of the pain syndrome. The surface area of the wounds averaged 91.3 ± 30.42 cm 2 before the start of treatment, 89.8 ± 34.21 cm 2 on day 5 and – 73.95 ± 21.2 cm 2 on day 12. Spontaneous epithelialization was achieved in the period from 35 to 141 days (depending on the initial state of the wounds). The average hospital stay was 22.6 ± 2.4 days. Discussion. It is known that human epithelial cells (hECs) and human mesenchymal stem cells (hMSCs) suppress proliferation, production of inflammatory cytokines and differentiation of T cells. At the same time, they stimulate the formation of regulatory T cells (Tregs). Soluble factors secreted by hECs, including PGE2, TGF-β, Fas-L, AFP, MIF, TRAIL and HLA-G, block differentiation of dendritic cells and M1 macrophages and promote differentiation of monocytes into the anti-inflammatory M2 phenotype. Moreover, hECs and hMSCs are known to be responsible for modulating the host immune system, mainly by suppressing TNF-α, IFN-γ, MCP-1 and IL-6 and increasing the level of anti-inflammatory cytokines. In vitro and in vivo results show increased cell migration and epithelialization leading to accelerated wound healing.

Toll signalling promotes blastema cell proliferation during cricket leg regeneration via insect macrophages

Hemimetabolous insects, such as the two-spotted cricket Gryllus bimaculatus, can recover lost tissues in contrast to the limited regenerative abilities in human tissues. Following cricket leg amputation, the wound surface is covered by the wound epidermis, and plasmatocytes, which are insect macrophages, accumulate in the wound region. Here, we studied the function of Toll-related molecules identified by comparative RNA-seq during leg regeneration. Among 11 Toll genes in the Gryllus genome, expression of Gb'Toll2-1, Gb'Toll2-2, and Gb'Toll2-5 was upregulated during regeneration. RNA interference (RNAi) of Gb'Toll, Gb'Toll2-1, Gb'Toll2-2, Gb'Toll2-3, or Gb'Toll2-4 produced regeneration defects in more than 50% of crickets. RNAi of Gb'Toll2-2 decreased the ratios of S and M phase cells, expression of JAK/STAT signalling genes, and accumulation of plasmatocytes in the blastema. Depletion of plasmatocytes in crickets using clodronate also produced regeneration defects, along with reduced proliferating cells in the regenerating legs. Plasmatocyte depletion also downregulated the expression of Toll and JAK/STAT signalling genes in the regenerating legs. These results suggest that Spz-Toll-related signalling in plasmatocytes promotes leg regeneration through blastema cell proliferation by regulating the Upd-JAK/STAT signalling pathway.

Experimental model for assessing the readiness of the wound surface to accept skin grafts

The aim of the study, performed on 65 Wistar rats, was to develop a new model and, as an example, use it to identify the extent to which quercetin and the quercetin-2-hydroxypropyl-β-cyclodextrin nanocomplex, applied to the wound, affect the engraftment of skin autografts. Grafts were obtained from the ear shells of animals, and graft’s survival rate was assessed by the degree of inhibition of wound contraction. It is shown that the latter depends on the area of grafts and the time after which they were located on the wound surface after its creation. It was shown that quercetin worsens, and quercetin-2- hydroxypropyl-β-cyclodextrin does not impair the ability of the wound surface to accept the graft.

1026 Assessing the Reliability of 3D Imaging for Wound Measurements

Aim To investigate the inter and intra reliability of using 3D imaging to measure wounds. Method 20 wound models of 4 different shaped wounds in 5 different colours were created from plastic mouldable beads. 3D images were taken using the BlasterX Senz3D camera and measured using the GPC Wound Measure application (version 3.15.0.0, UK). Intra-user reliability was determined comparing 20 wound measurements of each wound model. Inter-user reliability was determined by 5 different clinicians photographing each model and independently measuring each wound photo. The inter- and intra-rater measurements for wound surface area and volume were compared using the ICC and differences from the overall mean plotted on Bland-Altman graphs. Results The interclass co-efficient (ICC) for inter-rater reliability in measuring surface area was 0.958 (95% CI 0.919-0.981, p < 0.005). The intra-rater reliability when measuring wound surface area was 0.996 (95% CI 0.993-0.998, p < 0.005). For wound volume, the ICC for inter-rater reliability was 0.925 (95% CI 0.857-0.967, p < 0.005) and 0.999 (95% CI 0.998-0.999, p < 0.005) for intra-user reliability. 5.5% of measurements were outside 2 SD of the mean for wound volume. Conclusions 3D imaging offers a quick, reliable, and easy to use solution to measuring wounds. We have shown it is a reliable and reproducible method of measuring wounds between different clinicians.

In vivo evaluation of wound healing properties of Platanus orientalis L.

Background: According to the Iranian Traditional Medicine (ITM) references, Platanus orientalis L. possesses wound healing properties. Herein, we developed different topical formulations based on the ethanolic extract of P. orientalis leaves and evaluated its wound healing effects through an in vivo model. Methods: Hydroalcoholic extract of the leaves was obtained from ethanol 80% and it was evaluated for DPPH radical scavenging activity, total phenolic and flavonoid contents as well as the presence of tannins. Different topical formulations including ointment (D-O) and polymer film (D-F), were prepared and an in vivo test was run for 14 days in an excision wound model consisting of 5 groups of 6 rats. Results: Our results indicated the higher efficacy of D-O comparing with D-F, as wound surface area remarkably reduced within 14 days post-injury. Also, histological features including epitheliogenesis score, neovascularization, and collagen density indicated the potential wound healing effect of D-O. Conclusion: Wound healing properties of the ethanolic extract of P. orientalis leaves depended on the type of formulation and D-O was found to be much more potent than D-F, from reducing wound surface area, maximum epitheliogenesis score, proper neovascularization pattern, and early type I collagenization points of view.

TREATMENT OF LONG-TERM NON-HEALING PURULENT WOUNDS OF THE LOWER LIMBS USING VAC-THERAPY

Summary. The purpose of the study is - To improve the results of treatment of patients with purulent long-term non-healing wounds of the lower extremities using the method of local negative pressure.in purulent long-term non-healing wounds (PLTNHW). Objectives of the research — according to the clinic’s data, to study the features of the course of the wound process and the microbiological characteristics of purulent long-term non-healing wounds of the lower extremities when exposed to the wound surface of local negative pressure. Conclusions. The use of the local negative pressure method in the complex treatment of patients with purulent long-term non-healing wounds of the lower extremities helps to reduce the duration of the phases of the course of the wound process, early tissue decontamination and a rapid reduction in the size of wound defects.

Management of Acute and Chronic Wounds Using Negative Pressure Wound Therapy With Instillation and Dwell Time: A Retrospective

Introduction: The presence of debris covering a wound surface significantly impedes progression toward closure. Negative pressure wound therapy with instillation and dwell time (NPWTi-d) of topical wound solutions is a versatile tool that can be applied to various wound types to promote wound healing. At the University Hospital of Padova in Padova, Italy, NPWTi-d has been incorporated into wound management plans that include debridement and antibiotic therapy, as necessary, for a diverse population of patients with open wounds, including acute, chronic, and infected wounds. Objective: A retrospective analysis of 100 patients (53 male, 47 female; age range, 22-95 years) who underwent NPWTi-d was performed, and key healing outcomes observed in subgroups differentiated by sex, wound etiology, initial wound size, and topical instillation solution were reported. Materials and methods: Wound types included vascular ulcers, surgical wounds, dehiscences, and trauma; anatomic location of the wounds varied. Negative pressure wound therapy with instillation (0.05% sodium hypochlorite, normal saline, or 0.25% acetic acid) was implemented with a dwell time of 3 minutes to 10 minutes, followed by a negative pressure cycle length of 2 hours to 3.5 hours at -75 mm Hg to -125 mm Hg. Dressings were changed approximately every 3 days. Results: After a median of 11 days (range, 1-35 days), the wound surface area significantly decreased (P <.0001), percentage of infected wounds declined from 72% to 46%, and wound closure was attained in 91% of cases. A significant reduction in wound surface area was detected in both sexes, small- and medium-sized wounds, vascular ulcers, surgical wounds, dehiscences, trauma wounds, and pressure ulcers (P <.05). This effect was detected in wounds regardless of topical instillation solution (P <.0001). Conclusions: This study showed that NPWTi-d is a valuable treatment option in a variety of circumstances and can help the clinician achieve a range of therapy goals based on individual patient needs.

Redefining Slough: A New Classification System to Improve Wound Bed Assessment and Management

Management of the wound bed to optimize healing accounts for a large portion of the considerable cost of wound management in the United States. Slough is a term that most clinicians use every day but is one that few truly understand. Most clinicians use slough to refer to any yellowish material noted on the wound surface. If the material is not red or black, it is classified as slough. In this article, new terminology and a clinically useful classification system for the various forms of slough are presented with the goal of helping clinicians better describe the wound bed appearance and choose appropriate interventions to maximize wound healing.