Successful Management of Abdominal Wound Dehiscence with Bogota bag, Vacuum assisted Closure combined with Tension Sutures

The burst abdomen management has advanced significantly. Here we present a management of a burst abdomen of morbid obese patient with combination of modality including Bogota bag, vacuum assisted closure and tension suturing. The patient underwent laparotomy for removal of sigmoid tumor with local infiltration and had wound dehiscence associated with infection, tissue oedema and necrosis. As patient was morbidly obese and had large wound gap, we decided to manage it with Bogota bag principal and Vacuum Assisted Closing. After successful formation of granulation tissue, we were able to apply tension sutures. Hence using combination of above-mentioned options, the patient was successfully sent back to his normal routines without any complication.

Successful surgical management of primary abdominal wall mucormycosis in an immunocompetent patient

Primary abdominal wall mucormycosis rarely occur in immunocompetent, non-diabetic patients but may affectin patients with traumatic injury with contaminated wounds and patients underlying malignancies usually infiltrating into skin. Herein we are reporting a case of primary cutaneous mucormycosis in a 17-year-old male without immunodeficiency or any comorbidity. He was managed with multiple debridement of the wound and intravenous amphotericin B therapy with cumulative dose of 2000 mg of liposomal amphotericin B followed by split skin grafting. We would like to emphasize the importance of high index of suspicionof fungal sepsis and early start of antifungal therapy in this condition can reduce high rate of mortality and management of large wound with split skin grafting in same setting to avoid morbidity.

The common YAP activation mediates corneal epithelial regeneration and repair with different-sized wounds

Regeneration/repair after injury can be endowed by adult stem cells (ASCs) or lineage restricted and even terminally differentiated cells. In corneal epithelium, regeneration after a large wound depends on ASCs (limbal epithelial stem cells, LESCs), whereas repair after a small wound is LESCs-independent. Here, using rat corneal epithelial wounds with different sizes, we show that YAP activation promotes the activation and expansion of LESCs after a large wound, as well as the reprogramming of local epithelial cells (repairing epithelial cells) after a small wound, which contributes to LESCs-dependent and -independent wound healing, respectively. Mechanically, we highlight that the reciprocal regulation of YAP activity and the assembly of cell junction and cortical F-actin cytoskeleton accelerates corneal epithelial healing with different-sized wounds. Together, the common YAP activation and the underlying regulatory mechanism are harnessed by LESCs and lineage-restricted epithelial cells to cope with corneal epithelial wounds with different sizes.

HEALING OF A TRAUMATIC WOUND WITH HERBO-MEDICINAL OINTMENT; MARHAM-E-RAAL: A CASE STUDY

Introduction: A wound can be defined as the discontinuity in skin or mucus membrane. Healing is nothing but neogranulation in the depth and neo-epithelialization at the edges of the wound which ultimately results in the complete repair of such discontinuity. This case report deals with a patient of traumatic large wound at the heel who receives Unani management for wound healing. He was diagnosed as avulsion of pad of right heel with type-II diabetes mellitus. The treatment plan included mechanical debridement, cleaning with solution of alum powder (Sufuf-e-zaaj/alusol) and dressing with Marham-e-raal. The patient was advised to continue oral hypoglycemic agent with subcutaneous injection of insulin. On 85th day of treatment, the wound was healed by almost 98% and on subsequent 1st and 2nd follow up, each with a gap of 15 days, no recurrence of wound was recorded. Methodology: A male patient of traumatic wound was taken into study and given Unani management plan which included debridement, cleaning and washing with solution of Alum powder (Alusol)/ or, in Unani, Sufuf-e-zaaj and dressing of the wound with Marham-e-raal with full aseptic precautions for a period of about 3 months. Discussion: Wound healing is credited to muhallil(anti-inflammatory), daf’eta’ffun (antimicrobial), mujaffif (desiccant) and mundamil (wound healing) properties of Marham-e-raal due to presence of several phytoconstituents like camphor, linalool, borneol, cineole, terpenoids, Bergenin, Phenols and flavonoids, hopeaphenol, Oligostilbenoids, Monoterpenes, kaempferol, Quercetin and Catechin. Result: The wound completely healed at the end of 3 months with no recurrence noted on the 15th day of follow up after complete healing.

Severity of Penetrating Eye Trauma in Children in Tajikistan

Purpose. To assess the severity of penetrating eye trauma in children in Tajikistan. Material and methods. Retrospectively there was analyzed 277 case histories of children with a diagnosis of penetrating eye injury, admitted to the children’s department of the National Medical Centre of the Republic of Tajikistan for the provision of specialized ophthalmological care. Results. The average age of children at the time of injury to the organ of sight was 7.06 ± 3.01 years, mainly these were villagers (70%). Children under 7 years old accounted for 57.8% of those admitted to the hospital. The terms of admission to the hospital ranged from 1 to 14 days, an average of 43.02 ± 33.35 hours. The severity is caused by damage to 2 or more structures of the eyeball in 81,3%. Wounds larger than 6 mm prevailed and amounted to 63,5%. Endophthalmitis at admission was noted in 8,3% of cases. Enucleation was performed in 2 children; 244 children underwent primary surgical treatment. Visual acuity at discharge was higher than 0.1 in 72 of 275 children (26.2%), lower than 0,1 in 194 (70.7%). Conclusion. Almost every second child (43.0%) is admitted to the hospital for primary surgical treatment of an eyeball wound after 24 hours. About 2/3 of cases of eye damage are characterized by large wound sizes. Stab wounds were noted in 90.2% of cases. In 58.8% of cases, damage to the cornea was observed and in 68.6% – damage to the lens area.

The Application of 0.75% Metronidazole Gel for the Treatment of Chronic Wounds: Two Case Reports and Literature Review

Objective: To explore the application of metronidazole gel in the healing of chronic foot wounds.Methods: On the basis of reviewing the previous literature, routine debridement care and local application of metronidazole gel were applied to two patients with foot wounds and observations of wound healing were made. The wound of patient A was a deep wound, and the wound of patient B was a diabetic foot ulcer complicated by gangrene.Results: The bleeding and exudate of the patient with a deep wound gradually disappeared, and the wound healed. In the patient with the diabetic foot ulcer, the bleeding and exudate decreased. This was followed by the gradual size reduction of the wound and the formation of a scab over the large wound size.Conclusion: Metronidazole gel was effective in wound resolution of anaerobic bacteria infected wounds. It can serve as a way to relieve patients' pain with a promising therapeutic effect. The effectiveness of metronidazole in the treatment of deep wounds and diabetic foot patients requires further and larger-scale research studies to confirm the findings shown here.

Study of effects of negative pressure wound therapy in contaminated wounds

<p class="abstract"><strong>Background:</strong> Negative pressure wound therapy is an advanced wound therapy technique that helps in healing the wounds and accelerates granulation tissue as well as wound closure.</p><p class="abstract"><strong>Methods:</strong> Prospective randomized interventional study was done in Dept. of Orthopedics, Dr. BRAM Hospital, Pt. JNM Medical college, Raipur during period from January 2016 to December 2016 involving 25 patients with open fractures up to Gustilo Anderson grade IIIB. All were subjected to this wound technique and response was observed as granulation, size of wound and closure duration.<strong></strong></p><p class="abstract"><strong>Results:</strong> There was up to 10 to 20 mm reduction in wound size with each dressing in half the patients and up to 10 mm in other half of the patients. There was significant reduction in the bacterial growth in all patients and closure was attained in all the subjects after a few therapies.</p><p class="abstract"><strong>Conclusions:</strong> Negative pressure wound therapy is a promising technique to reduce the size of the wound in large wound associated with compound fractures and hasten the healing of wound and its closure.</p>