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Wound Closure (wound + closure)
Terms modified by Wound Closure Selected AbstractsCell proliferation during blastema formation in the regenerating teleost finDEVELOPMENTAL DYNAMICS, Issue 2 2002Leonor Santos-Ruiz Abstract Epimorphic regeneration in teleost fins occurs through the establishment of a balanced growth state in which a blastema gives rise to all the mesenchymal cells, whereas definite areas of the epidermis proliferate leading to its extension, thus, allowing the enlargement of the whole structure. This type of regeneration involves specific mechanisms that temporally and spatially regulate cell proliferation. To understand how the blastema is formed and how this growth situation is set up, we investigated cell proliferation patterns in the regenerating fin of the goldfish Carassius auratus from the time of amputation to that of blastema formation by using proliferating cell nuclear antigen immunostaining and bromodeoxyuridine labeling. Wound closure and apical epidermal cap formation took place by epidermal migration and re-arrangement, without the contribution of cell proliferation. As soon as the apical cap had formed, the epidermis started to proliferate at its lateral surfaces, in which all layers maintained cycling for the duration of the studied process. The distal epidermal cap, on the contrary, presented very few cycling cells, and its cytoarchitecture was indicative of continuous remodeling due to ray growth. The basal layer of this epidermal cap showed a typical morphology and remained nonproliferative whilst in contact with the proliferating blastema. Proliferation in the mesenchymal compartment of the ray started far from the amputation plane. Subsequently, cycling cells approached that location, until they formed the blastema in contact with the apical epidermal cap. Differences observed between the epidermis and mesenchyma, regarding activation of the cell cycle and the establishment of proliferative patterns, suggest that differential mechanisms regulate cell proliferation in each of these compartments during the initial stages of regeneration. © 2002 Wiley-Liss, Inc. [source] Contact lenses as a drug delivery device for epidermal growth factor in the treatment of ocular woundsCLINICAL AND EXPERIMENTAL OPTOMETRY, Issue 2 2010Clyde L Schultz PhD Background:, This work was conducted to investigate the uptake and release of epidermal growth factor (EGF) from hydrogel contact lenses and to determine whether the released protein would be therapeutically active in a rabbit corneal epithelial defect model of ocular trauma, prior to use in humans. Methods:, The uptake and release of EGF from hydrogel contact lens materials were determined by high-pressure liquid chromatography. Contact lenses composed of vasurfilcon A or lotrafilcon A (containing silicone) were incubated in a source solution containing 0.4 ppm EGF for seven hours. To determine the kinetics of drug uptake into the contact lens matrix, drug concentration in the source solution was measured at zero, one, 60, 240 and 420 minutes. To determine the kinetics of release, loaded contact lenses were immersed in a recipient solution of phosphate-buffered saline. Therapeutic activity in vivo was investigated by placing prepared lenses on the surface of abraded corneas of New Zealand White rabbits, with abraded corneas of contralateral eyes used as controls. Control eyes were treated with contact lenses placed in saline for injection. Wound closure was assessed hourly. Results:, Uptake and release of EGF were demonstrated for vasurfilcon A but not lotrafilcon A contact lens materials. The retention time of EGF released from vasurfilcon A contact lenses was similar to control EGF not exposed to contact lens polymers. The greatest adsorption of EGF into the lens material occurred within approximately 120 minutes, with a flattening of the rate of uptake thereafter. Abraded eyes in rabbits showed a significantly higher overall healing rate for EGF-treated contact lenses compared with control eyes (p < 0.0001). Conclusions:, EGF can be delivered from some but not all hydrogel materials. Lens materials composed of silicone may not be useful for delivering EGF to the eye. EGF-treated contact lenses may be a useful device to facilitate healing of ocular wounds. [source] Use of a Living Dermal Equivalent for a Refractory Abdominal Defect after Pediatric Multivisceral TransplantationDERMATOLOGIC SURGERY, Issue 9 2004Carlos A. Charles MD Background. Primary closure is not always possible after pediatric multivisceral transplantation. Reepithelialization may require extended periods of postoperative time, which can be associated with significant morbidity Objective. The objective was to accelerate secondary wound closure thereby minimizing infection or further complications in a pediatric multivisceral transplant patient. Methods. Five applications of human fibroblast-derived dermis (Dermagraft, Smith and Nephew) were applied to the postsurgical defect of a pediatric multivisceral transplant patient over the course of 8 months. Routine wound care and observation was performed between human fibroblast-derived dermis applications. Results. Human fibroblast-derived dermis stimulated healing and accelerated reepithelialization. Signs of clinical rejection or infection were not observed. Conclusion. Reepithelialization can be aided in the postoperative period in pediatric multivisceral transplant patients with human fibroblast-derived dermis, thereby helping to deter complications associated with secondary wound closure. We have illustrated the successful use of a human fibroblast-derived dermis as an adjunct for wound healing in a complicated surgical defect. [source] Healing of Venous Ulcers of Long Duration with a Bilayered Living Skin Substitute: Results from a General Surgery and Dermatology DepartmentDERMATOLOGIC SURGERY, Issue 11 2001Harold Brem MD Background. A laboratory-grown bilayered living skin substitute (LSS) has been shown to accelerate the healing of venous ulcers. However, issues related to optimal wound bed preparation prior to the application of LSS have not been addressed. Objective. When combined with standard compression therapy and near elimination of wound exudate, bioengineered skin can achieve complete closure of venous ulcers which have been present for more than a year and which are difficult to heal. Methods. In the general surgery (center A) and dermatology (center B) departments at two separate medical centers, LSS was used to treat venous ulcers of more than 1 year's duration and which had been unresponsive to conventional therapy. Wound bed preparation at both centers had as common goals the removal of necrotic tissue, optimal formation of granulation tissue, and elimination of wound exudate. Results. There was great comparability between the two centers in the patients being treated, wound size and duration, and number of LSS applications. Both centers achieved a frequency of complete wound closure of greater than 70% within 6 months. Conclusion. At two separate clinical and specialty sites having a common goal of optimal wound preparation, treatment with LSS was associated with a high rate of complete closure of hard to heal venous ulcers. [source] Double Butterfly Suture for High Tension: A Broadly Anchored, Horizontal, Buried Interrupted SutureDERMATOLOGIC SURGERY, Issue 3 2000Helmut Breuninger MD Background. The excision of skin lesions such as tumors, nevi, and scars frequently results in tension on surgical wound margins. This tension is commonly counteracted surgically with buried, intracutaneous, interrupted sutures of absorbable material which are anchored vertically in the corium. Method. The horizontal, buried, intracutaneous butterfly suture has been described elsewhere. It is firmly anchored in the corium, everts wound margins, and adapts them nearly as broadly as two vertical sutures. It can also be laid as a double butterfly suture, as described here, and then has the shape of an "8." This double butterfly suture is equivalent to three vertical sutures because of its broad base in the corium. Moreover, it can cope with much greater tension because of its "pulley" effect. A single double butterfly suture usually suffices for small defects, particularly when the wound edges are cut obliquely with a longer rim of epidermis. Materials. We have laid the traditional butterfly suture in more than 35,000 skin lesion excisions since 1985 and the double butterfly suture alone or as a supplement in more than 10,000 sutures since 1992. We use 2-0 to 6-0 polydioxanone for these procedures, since it has proven in trials to be the best-absorbed suture material. Results. In most cases, the resulting scars were narrow and smooth in spite of high tension. Results were unsatisfactory in only 6.2% of procedures. Conclusion. The double butterfly suture described here has the advantages of withstanding tension better while everting wound margins and requiring fewer stitches for wound closure. However, it is important that the suture knot be deeply anchored beneath the corium. [source] New and experimental approaches to treatment of diabetic foot ulcers: a comprehensive review of emerging treatment strategiesDIABETIC MEDICINE, Issue 11 2004R. Eldor Abstract Diabetic foot ulcers occur in up to 15% of all diabetic patients and are a leading cause of nontraumatic amputation worldwide. Neuropathy, abnormal foot biomechanics, peripheral vascular disease and external trauma are the major contributors to the development of a foot ulcer in the diabetic patient. Therapy today includes repeated debridement, offloading, and dressings, for lower grade ulcers, and broad spectrum antibiotics and occasionally limited or complete amputation for higher grades, requiring a team effort of health care workers from various specialties. The large population affected by diabetic foot ulcers and the high rates of failure ending with amputation even with the best therapeutic regimens, have resulted in the development of new therapies and are the focus of this review. These include new off loading techniques, dressings from various materials, methods to promote wound closure using artificial skin grafts, different growth factors or wound bed modulators and methods of debridement. These new techniques are promising but still mostly unproven and traditional approaches cannot be replaced. New and generally more expensive therapies should be seen as adding to traditional approaches. [source] Surgical treatment of acne inversa (hidradenitis suppurativa): a 20-year experienceEXPERIMENTAL DERMATOLOGY, Issue 6 2006Wolfgang Hartschuh Acne inversa (AI) is caused by follicular hyperkeratosis in intertriginous areas rich in apocrine glands followed by occlusion and rupture of the follicle and inflammation. Sinus tracts, scarring and often contraction with limitation in mobility may occur. There is a world-wide consensus that in chronic disease surgical removal of all involved tissue as early as possible is the most effective treatment modality. The aim of this study is to demonstrate our operative strategy, including postoperative wound care and prevention, the results and pitfalls in the treatment of AI. The operations are increasingly performed in tumescence anaesthesia, followed by secondary healing. Only removal of extended skin areas in the inguino-genital and ano-perineal regions demand general anaesthesia. In axillary regions, all hair-bearing skin including the sweat glands is removed to obtain a hair-free, dry skin area. In the other regions with ill-defined hair and apocrine gland areas, only involved indurated skin is excised. For early limited disease with fluctuant abscesses, unroofing instead of mere incision and drainage is a good first option. Professional wound care with shaving and stretching of the wound margins is very important to avoid premature wound closure. Locally applied disinfectant soaps and 2% triclosane ointments are effective in pre- and postoperative skin care. Follow-up evaluation and collaboration among surgeons and dermatologists and an improved insight in the pathogenesis of AI are mandatory for the successful long-term management of patients afflicted with this complex and debilitating disease. [source] Evaluation of postoperative drainage with application of platelet-rich and platelet-poor plasma following hemithyroidectomy: A randomized controlled clinical trial,,HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 12 2008John Yoo MD Abstract Background. Platelet-rich plasma (PRP) and platelet-poor plasma (PPP) have been used to improve hemostasis and wound healing after surgery; however, randomized controlled trials proving their efficacy are lacking. Methods. Hemithyroidectomy was performed on 52 patients. Autologous PRP and PPP were applied during wound closure in the treatment group, while saline was applied in the controls. Outcome measures were postoperative drainage, pain, analgesic use, and length of hospital stay. Results. The 24-hour cumulative drainage was reduced by 29.3% in the treatment group (44.9 mL vs 63.5 mL, p = .039). The treatment group required less analgesic medication despite similar pain scores; however, the difference was not significant. There was a trend toward decreased length of stay for thePRP/PPP group (p = .059). Conclusions. Hemithyroidectomy served as a stringent test to evaluate the wound-healing capacity of platelet-rich and platelet-poor plasma. This study provides evidence that PRP and PPP reduced postoperative drainage in soft-tissue surgery. © 2008 Wiley Periodicals, Inc. Head Neck, 2008 [source] Evaluation of the nano-oligosaccharide factor lipido-colloid matrix in the local management of venous leg ulcers: results of a randomised, controlled trialINTERNATIONAL WOUND JOURNAL, Issue 2 2008Jean-Luc Schmutz Abstract The nano-oligosaccharide factor (NOSF) is a new compound aiming to promote wound closure mainly through inhibition of matrix metalloproteinase (MMP) activity. This factor is incorporated within a lipido-colloid matrix (Techonology Lipido-Colloid-NOSF matrix) and locally released in the wound. The objective of this study was to document the performance (non inferiority or superiority) of the NOSF relative to the Promogran® matrix (oxidised regenerated cellulose, ORC) effect in the local management of venous leg ulcers (VLUs). This was a 12-week, open, two-arm, multicentre, randomised study. Patients were selected if the area of their VLU [ankle brachial pressure index ,0·80] ranged from 5 to 25 cm2 with a duration ,3 months. Ulcers had to be free from necrotic tissue. In addition to receiving compression bandage therapy, patients were randomly allocated to either NOSF matrix or ORC treatment for 12 weeks. The VLUs were assessed on a weekly basis and wound tracings were recorded. Percentage wound relative reduction (%RR) was the primary efficacy criterion. Secondary objectives were wound absolute reduction (AR), healing rate (HR) and % of wounds with ,40% reduction compared with baseline. A total of 117 patients were included (57 NOSF matrix and 60 ORC). Mean population age was 71·3 ± 13·5 years, body mass index was ,30 kg/m2 in 39·3% and 15·4% were diabetics. Fifty-six per cent of the VLUs were present for >6 months, 61% were recurrent and 68% were stagnating despite appropriate care. Mean wound area at baseline was 11·2 ± 7·4 cm2. At the last evaluation, mean difference between the groups for %RR was 33·6 ± 15·0% in favour of NOSF matrix with a unilateral 95% confidence interval (CI) lower limit of 8·6% not including the null value. Therefore, a superiority of NOSF matrix effect compared with ORC was concluded (P = 0·0059 for superiority test). The median of the wound area reduction was 61·1% and 7·7% in the NOSF matrix and control groups, respectively (per-protocol analysis), or 54·4% versus 12·9% in intent-to-treat analysis (p = 0·0286). Median AR was 4·2 cm2 in the NOSF group and 1·0 cm2 with ORC (P = 0·01). Median HR was ,0·056 and ,0·015 cm2/day in NOSF and ORC groups, respectively (P = 0·029). By logistic regression, the NOSF versus control odds ratio to reach 40% area reduction was 2·4 (95% CI: 1·1,5·3; P = 0·026). In the oldest and largest VLUs, a strong promotion of healing effect was particularly observed in the NOSF matrix group compared with the control group. NOSF matrix is a very promising option for the local management of chronic wounds, especially for VLUs with poor healing prognosis. [source] Low level laser therapy for healing acute and chronic wounds , the extendicare experienceINTERNATIONAL WOUND JOURNAL, Issue 2 2008Anita E Saltmarche Abstract The purpose of the study is to assess the effectiveness of low level laser therapy for wound healing when combined with the Extendicare Wound Prevention and Management Program. Sixteen residents at a Canadian Extendicare nursing home had a total of 27 sites treated consisting of 23 open wounds and 4 ,at risk' areas. Of the 23 open wounds, two wounds in between toes were not able to be ,traced' and deemed ,immeasurable' wounds, resulting in 21 open, measured wounds. The four ,at risk' (closed) areas were treated preventatively. Pressure, venous insufficiency and diabetic wounds were included. The majority (12/21) or 57·1%, of the wounds were chronic (,3 months duration) and 42·9% were acute (<3 months duration). The primary outcome measures included the PUSH Tool score, EZ GraphTM tracings and photographs. Secondary outcome measures were employed to better understand potential barriers to successful integration into clinical practice. Feedback on the effectiveness of low level laser therapy, the education program and determinations of hands-on relevance was sought from staff. At the end of the 9-week trial, the majority (61·9%) of the 21 wounds achieved significant improvement (,50% wound closure). Nine (42·8%) had 100% closure. Some improvement was seen in 14·3% and 23·8% of wounds demonstrated no change. Chronic and acute wounds had similar improvement. None of the wounds in this debilitated, frail population deteriorated during the study and no negative consequences of treatment were encountered. Without staff support, even if new technology has positive clinical outcomes, success would be limited. Staff rated low level laser, easy to learn and use, effective for the majority of their residents worth the additional time. Staff requested a continuation of low level laser even after study completion. [source] OASIS® wound matrix versus Hyaloskin® in the treatment of difficult-to-heal wounds of mixed arterial/venous aetiologyINTERNATIONAL WOUND JOURNAL, Issue 1 2007Marco Romanelli Abstract Mixed arterial/venous (A/V) ulcers are difficult to treat and slow to heal likely as a result of deficiencies in molecular and cellular elements in the wound bed. Recently, biomaterials have been developed that replace extracellular matrix (ECM) molecules and growth factors critical to the normal healing process. In this study, the effects of OASIS® and Hyaloskin® were evaluated to compare the effectiveness of these two ECM-based products in their ability to achieve complete wound healing of mixed A/V ulcers. After 16 weeks of treatment, patients in each group were evaluated on four criteria: complete wound healing, time to dressing change, pain and comfort. Complete wound closure was achieved in 82·6% of OASIS® -treated ulcers compared with 46·2% of Hyaloskin® -treated ulcers (P < 0·001). Statistically significant differences favouring the OASIS® treatment group were also reported for time to dressing change (P < 0·05), pain (P < 0·05) and patient comfort (P < 0·01). Overall, OASIS® was superior to Hyaloskin® for the treatment of patients with mixed A/V ulcers, a population in which standard treatment options largely consist of moist wound dressings and compression therapy is typically not an option. OASIS® is a useful and well-tolerated treatment for mixed A/V ulcers that has the potential to improve quality of life and reduce costs associated with standard of care. [source] The use of an acellular dermal regenerative tissue matrix in the treatment of lower extremity wounds: a prospective 16-week pilot studyINTERNATIONAL WOUND JOURNAL, Issue 3 2006Stephen A BrigidoArticle first published online: 19 SEP 200 Abstract A prospective, single-centre, randomized controlled study was performed to evaluate the effectiveness of Graftjacket, a human acellular regenerative tissue matrix as a treatment option for chronic non healing lower extremity wounds. Twenty-eight diabetic patients with full-thickness wounds that had been present for at least 6 weeks were treated with sharp debridement and randomized to a single application of Graftjacket tissue matrix plus mineral oil-soaked fluff compression dressing or to a control treatment of wound gel with gauze dressings. All patients were seen weekly. By week 16, 12 of 14 patients treated with Graftjacket tissue matrix demonstrated complete wound closure compared with 4 of 14 patients in the control group. Patients treated with Graftjacket tissue matrix showed a statistically significant higher percentage of wound healing with respect to wound area, and clinically significant differences in wound depth and wound volume. This comparison is not performed to demonstrate that the application of the Grafjacket is more effective than sharp debridement. This study is done to help assign a role to the use of Graftjacket matrix in lower extremity wound care. [source] Intravital insights in skin wound healing using the mouse dorsal skin fold chamberJOURNAL OF ANATOMY, Issue 6 2007Heiko Sorg Abstract The skin fold chamber is one of the most accepted animal models for studying the microcirculation both in health and disease. Here we describe for the first time the alternative use of the skin fold chamber in mice for intravital microscopic investigation of skin regeneration after creating a full dermal thickness wound. The dorsal skin fold chamber was implanted in hairless SKH1-hr mice and a full dermal thickness wound (area ~4 mm2) was created. By means of intravital fluorescence microscopy, the kinetics of wound healing were analyzed for 12 days post wounding with assessment of epithelialization and nutritive perfusion. The morphology of the regenerating skin was characterized by hematoxylin-eosin histology and immunohistochemistry for proliferation and microvessel density. The model allows the continuous visualization of wound closure with complete epithelialization at day 12. Furthermore, a sola cutis se reficientis could be described by an inner circular ring of vessels at the wound margin surrounded by outer radial passing vessels. Inner circular vessels presented initially with large diameters and matured towards diameters of less than 15 µm for conversion into radial spreading outer vessels. Furthermore, wound healing showed all diverse core issues of skin repair. In summary, we were able to establish a model for the analysis of microcirculation in the healing skin of the mouse. This versatile model allows distinct analysis of new vessel formation and maturation in regenerating skin as well as evaluation of skin healing under different pathologic conditions. [source] Does Mediastinitis Affect the Graft Patency?JOURNAL OF CARDIAC SURGERY, Issue 3 2005Denyan Mansuro, lu M.D. There are many studies that have focused on the graft patency. But, till now, no study has been done to detect the effects of mediastinitis to graft patency. So, we aimed to detect the effect of mediastinitis on the graft patency in patients who have undergone coronary artery bypass surgery. Sixteen of 45 patients who have been operated upon for coronary artery bypass surgery and developed mediastinitis, which was treated with open drainage and mediastinal irrigation with late wound closure, were included in the study. The mean age of the patients was 55 ± 11 (range 35,69) and nine of the patients were male. The graft patency was evaluated with control coronary angiographies after a mean period of 30.42 ± 43.17 months (range 1,132). The left internal thoracic artery was patent in all patients (100%). Right internal thoracic artery patency rate was 50% (1/2). One individual bypassed radial artery was patent, whereas the sequential bypassed graft was occluded. The patency ratio of radial artery anastomosis was 33% (1/3). Twelve of the 17 saphenous vein grafts were patent (70.58%). The total number of patent distal anastomosis was 30/38 (78.94%). When compared with the graft patency of patients without infection, it was found that mediastinitis does not affect the graft patency rates adversely. [source] Secretion of SDF-1, by bone marrow-derived stromal cells enhances skin wound healing of C57BL/6 mice exposed to ionizing radiationJOURNAL OF CELLULAR AND MOLECULAR MEDICINE, Issue 6b 2010Yannick Landry Abstract Patients treated for cancer therapy using ionizing radiation (IR) have delayed tissue repair and regeneration. The mechanisms mediating these defects remain largely unknown at present, thus limiting the development of therapeutic approaches. Using a wound healing model, we here investigate the mechanisms by which IR exposure limits skin regeneration. Our data show that induction of the stromal cell-derived growth factor 1, (SDF-1,) is severely impaired in the wounded skin of irradiated, compared to non-irradiated, mice. Hence, we evaluated the potential of bone marrow-derived multipotent stromal cells (MSCs), which secrete high levels of SDF-1,, to improve skin regeneration in irradiated mice. Injection of MSCs into the wound margin led to remarkable enhancement of skin healing in mice exposed to IR. Injection of irradiated MSCs into the wound periphery of non-irradiated mice delayed wound closure, also suggesting an important role for the stromal microenvironment in skin repair. The beneficial actions of MSCs were mainly paracrine, as the cells did not differentiate into keratinocytes. Specific knockdown of SDF-1, expression led to drastically reduced efficiency of MSCs in improving wound closure, indicating that SDF-1, secretion by MSCs is largely responsible for their beneficial action. We also found that one mechanism by which SDF-1, enhances wound closure likely involves increased skin vascularization. Our findings collectively indicate that SDF-1, is an important deregulated cytokine in irradiated wounded skin, and that the decline in tissue regeneration potential following IR can be reversed, given adequate microenvironmental support [source] Nicotine inhibits myofibroblast differentiation in human gingival fibroblastsJOURNAL OF CELLULAR BIOCHEMISTRY, Issue 6 2005Yiyu Fang Abstract Cigarette smoking has been suggested as a risk factor for several periodontal diseases. It has also been found that smokers respond less favorably than non-smokers to periodontal therapy. Previous work in our lab has shown that nicotine inhibits human gingival cell migration. Since myofibroblasts play an important role in wound closure, we asked if nicotine affects gingival wound healing process by regulating myofibroblast differentiation. Human gingival fibroblasts (HGFs) from two patients were cultured in 10% fetal bovine serum cell culture medium. Cells were pretreated with different doses of nicotine (0, 0.01, 0.1, and 1 mM) for 2 h, and then incubated with transforming growth factor beta (TGF-,1) (0, 0.25, 0.5, and 1 ng/ml) with or without nicotine for 30 h. The expression level of ,-smooth muscle actin (,-SMA), a specific marker for myofibroblasts, was analyzed by Western blots, immunocytochemistry, and real-time polymerase chain reaction (real-time PCR). Phosphorylated p38 mitogen-activated protein kinase (Phospho-p38 MAPK) activity was analyzed by Western blots. TGF-,1 induced an increase of ,-SMA protein and mRNA expression, while nicotine (1 mM) inhibited the TGF-,1-induced expression of ,-SMA but not ,-actin. Nicotine treatment down-regulated TGF-,1-induced p38 MAPK phosphorylation. Our results demonstrated for the first time that nicotine inhibits myofibroblast differentiation in human gingival fibroblasts in vitro; supporting the hypothesis that delayed wound healing in smokers may be due to decreased wound contraction by myofibroblasts. © 2005 Wiley-Liss, Inc. [source] The cyclic GMP-protein kinase G pathway regulates cytoskeleton dynamics and motility in astrocytesJOURNAL OF NEUROCHEMISTRY, Issue 1 2007Mariela Susana Borįn Abstract We have previously demonstrated that inflammatory compounds that increase nitric oxide (NO) synthase expression have a biphasic effect on the level of the NO messenger cGMP in astrocytes. In this work, we demonstrate that NO-dependent cGMP formation is involved in the morphological change induced by lipopolysaccharide (LPS) in cultured rat cerebellar astroglia. In agreement with this, dibutyryl-cGMP, a permeable cGMP analogue, and atrial natriuretic peptide, a ligand for particulate guanylyl cyclase, are both able to induce process elongation and branching in astrocytes resulting from a rapid, reversible and concentration-dependent redistribution of glial fibrillary acidic protein (GFAP) and actin filaments without significant change in protein levels. These effects are also observed in astrocytes co-cultured with neurons. The cytoskeleton rearrangement induced by cGMP is prevented by the specific protein kinase G inhibitor Rp-8Br-PET-cGMPS and involves downstream inhibition of RhoA GTPase since is not observed in cells transfected with constitutively active RhoA. Furthermore, dibutyryl-cGMP prevents RhoA-membrane association, a step necessary for its interaction with effectors. Stimulation of the cGMP-protein kinase G pathway also leads to increased astrocyte migration in an in vitro scratch-wound assay resulting in accelerated wound closure, as seen in reactive gliosis following brain injury. These results indicate that cGMP-mediated pathways may regulate physio-pathologically relevant responses in astroglial cells. [source] Ethanol Treatment Reduces Bovine Bronchial Epithelial Cell MigrationALCOHOLISM, Issue 4 2005John R. Spurzem Background: Chronic ethanol abuse is associated with significant lung disease. Excessive alcohol intake increases risk for a variety of respiratory tract diseases, including pneumonia and bronchitis. Damage to airway epithelium is critical to the pathogenesis of airway disorders such as chronic bronchitis and chronic obstructive pulmonary disease. The ability of the airway epithelium to repair itself is an important step in the resolution of airway inflammation and disease. Ethanol exposure is known to modulate signaling systems in bronchial epithelial cells. We hypothesize that chronic ethanol exposure down-regulates the adenosine 3,:5,-cyclic monophosphate signaling cascade in airway epithelial cells, resulting in decreased epithelial cell migration and repair. Methods: We evaluated the effect of ethanol on primary cultures of bovine bronchial epithelial cells in in vitro models of cell migration, wound repair, cell attachment, and cell spreading. Results: Ethanol causes a concentration-dependent effect on closure of mechanical wounds in cell monolayers. Pretreatment of cells with 100 mm ethanol for 24 hr further slows wound closure. Ethanol pretreatment also reduced the protein kinase A response to wounding and made the cells unresponsive to stimuli of protein kinase A that accelerate wound closure. The effects of ethanol on cell migration in wound closure were confirmed in another assay of migration, the Boyden chamber cell migration assay. Prolonged treatment with ethanol also reduced other cell functions, such as spreading and attachment, which are necessary for epithelial repair. Conclusions: Ethanol modulates signaling systems that are relevant to airway injury and repair, suggesting that chronic, heavy ethanol ingestion has a detrimental impact on airway repair. Impaired response to inflammation and injury may contribute to chronic airway disease. [source] Simultaneous use of bilateral caudal superficial epigastric axial pattern flaps for wound closure in a dogJOURNAL OF SMALL ANIMAL PRACTICE, Issue 12 2003P. D. Mayhew A neutered male German shorthaired pointer sustained severe bite wounds to the left caudal flank and thigh area. Thorough wound lavage and debrldement was performed immediately and also three days after presentation. Daily wound dressing resulted in the production of a mature granulation tissue bed. Prior to wound closure, colour flow Doppler ultrasonography was used to confirm blood flow through the right and left caudal superficial epigastric arteries and veins. Sixteen days after presentation, right and left caudal superficial epigastric axial pattern flaps were simultaneously elevated to cover the defect. The right flap was elevated as an island flap, rotated 120° and used to cover the caudodorsal aspect of the defect. The left flap was elevated and rotated dorsally to cover the cranioventral aspect of the defect. Ninety per cent wound coverage was achieved and flap survival was total. The donor site defect was closed primarily and no dehiscence occurred. Three months postsurgery, the entire defect was closed and limb function was normal. [source] The use of forearm free fillet flap in traumatic upper extremity amputationsMICROSURGERY, Issue 1 2009Isabel C. Oliveira M.D. Background: Complete traumatic upper extremity avulsions are an infrequent but devastating injury. These injuries are usually the result of massive blunt trauma to the upper limb. Intact issue from amputated or nonsalvageable limbs may be transferred for reconstruction of complex defects resulting from trauma when the indications for replantation are not met. This strategy allows preservation of stump length or coverage of exposed joints, and provides free flap harvest for reconstruction without additional donor-site morbidity. Methods: A retrospective review at Sćo Joćo Hospital was performed on seven patients who had undergone immediate reconstruction with forearm free fillet flaps between 1992 and 2007. Results: There were six men and one woman, with patient age ranging from 17 to 74 years (mean, 41 years). Amputation sites were at the humeral neck (n = 1), at the humeral shaft (n = 5), and below the elbow (n = 1). The area of the forearm free fillet flap skin paddle was 352.14 ± 145.48 cm (mean ± SD). The two major complications were the flap loss and the patient death on postoperative day 3 in other case. The postoperative course in the remaining five cases was uneventful with good healing of the wounds. Minor complications included two small residual defects treated by split-thickness skin grafting and one wound infection requiring drainage and revision. Conclusions: The forearm free fillet flap harvested from the amputated limb provides reliable and robust tissue for reconstruction of large defects of the residual limb without additional donor-site morbidity. Microsurgical free fillet flap transfer to amputation sites is valuable for achieving wound closure, improving stump durability, and maximizing function via preservation of length. © 2008 Wiley-Liss, Inc. Microsurgery, 2009. [source] Intraoperative loading attenuates nausea and vomiting of tramadol patient-controlled analgesia. (Show-Chwan Memorial Hospital, Changhua, Taiwan) Can J Anaesth 2000;47:968,973.PAIN PRACTICE, Issue 2 2001Wei-Wu Pang Sixty adult patients scheduled for elective abdominal surgery were enrolled into this prospective, randomized, double-blinded study. The patients were anesthetized in a similar manner. At the beginning of wound closure, the patients were randomly allocated to receive tramadol (Group 1) or normal saline (Group 2). Pain control and adverse effect assessments were done in the PACU and every 6 h for 48 h post drug by an independent observer. The loading dose was 290 ± 45 mg in Group 1 and 315 ± 148 mg in Group 2. In PACU, more nausea and vomiting both in terms of incidence and severity were observed in patients with postoperative loading than in those with intraoperative loading of tramadol. Conclude that administering the loading dose of tramadol during surgery decreases the nausea and vomiting associated with a high dose of tramadol and improves the quality of tramadol PCA in the relief of postoperative pain. Comment by Lian-Kah Ti, M.D. The clinical application and conclusions of this study have to be questioned. It was not surprising that a loading dose of tramadol could effectively be given intraoperatively. What was surprising was that the authors chose not to give any analgesics either preoperatively or intraoperatively for relatively major surgery in an older population, potentially risking morbidity. Indeed, analgesics were withheld in the control group until the patients were extubated, awake, responsive, and complained of pain. Another source of concern was the large loading dose used. Based on their own experience, the authors gave doses of 300 mg of tramadol, which far exceeded the maximum recommended single dose of 100 mg as stated in the manufacturer's instruction for use. The authors did not report any intraoperative hemodynamic consequences from the loading dose, although they noted that the amount of isoflurane required was decreased. The authors concluded that the decreased nausea and vomiting seen in the patients receiving tramadol intraoperatively resulted from the patients being anesthetized at the point when peak plasma levels were achieved. An alternative explanation could be that the patients in the control group had greater postoperative pain (initial VAS of 5.9), and that pain itself resulted in the increased nausea and vomiting. Therefore, the value of this study is doubtful. [source] Effects of dexmedetomidine on intraoperative motor and somatosensory evoked potential monitoring during spinal surgery in adolescentsPEDIATRIC ANESTHESIA, Issue 11 2008JOSEPH D. TOBIAS MD Summary Background:, Dexmedetomidine may be a useful agent as an adjunct to an opioid,propofol total intravenous anesthesia (TIVA) technique during posterior spinal fusion (PSF) surgery. There are limited data regarding its effects on somatosensory (SSEPs) and motor evoked potentials (MEPs). Methods:, The data presented represent a retrospective review of prospectively collected quality assurance data. When the decision was made to incorporate dexmedetomidine into the anesthetic regimen for intraoperative care of patients undergoing PSF, a prospective evaluation of its effects on SSEPs and MEPs was undertaken. SSEPs and MEPs were measured before and after the administration of dexmedetomidine in a cohort of pediatric patients undergoing PSF. Dexmedetomidine (1 ,g·kg,1 over 20 min followed by an infusion of 0.5 ,g·kg,1·h,1) was administered at the completion of the surgical procedure, but prior to wound closure as an adjunct to TIVA which included propofol and remifentanil, adjusted to maintain a constant depth of anesthesia as measured by a BIS of 45,60. Results:, The cohort for the study included nine patients, ranging in age from 12 to 17 years, anesthetized with remifentanil and propofol. In the first patient, dexmedetomidine was administered in conjunction with propofol at 110 ,g·kg,1·min,1 which resulted in a decrease in the bispectral index from 58 to 31. Although no significant effect was noted on the SSEPs (amplitude or latency) or the MEP duration, there was a decrease in the MEP amplitude. The protocol was modified so that the propofol infusion was incrementally decreased during the dexmedetomidine infusion to achieve the same depth of anesthesia. In the remaining eight patients, the bispectral index was 52 ± 6 at the start of the dexmedetomidine loading dose and 49 ± 4 at its completion (P = NS). There was no statistically significant difference in the MEPs and SSEPs obtained before and at completion of the dexmedetomidine loading dose. Conclusion:, Using the above-mentioned protocol, dexmedetomidine can be used as a component of TIVA during PSF without affecting neurophysiological monitoring. [source] Abdominal wound closure in liver,intestine pediatric transplantationPEDIATRIC TRANSPLANTATION, Issue 5 2009Fabrizio Panaro MD No abstract is available for this article. [source] Wound healing effects of noni (Morinda citrifolia L.) leaves: a mechanism involving its PDGF/A2A receptor ligand binding and promotion of wound closurePHYTOTHERAPY RESEARCH, Issue 10 2010Afa Palu Abstract Morinda citrifolia L. (Rubiaceae) commonly known as noni, has been used in Polynesia by traditional healers for the treatment of cuts, bruises and wounds. Our objective was to investigate the wound-healing mechanisms of the noni leaf. The investigations of its wound-healing mechanisms were carried out using fresh noni leaf juice (NLJ), noni leaf ethanol extract (NLEE) and its methanol (MFEE) and hexane (HFEE) fractions on the PDGF and A2A receptors in vitro and topically in mice. Fresh noni leaf juice showed significant affinity to PDGF receptors, and displayed 166% binding inhibition of the ligand binding to its receptors, while at the same concentration, it only had 7% inhibition of the ligand binding to the A2A receptors. NLEE, HFEE and MFEE showed significant affinity to A2A receptors, concentration dependently, with IC50 values of 34.1, 42.9 and 86.7,,g/mL, respectively. However, MFEE significantly increased wound closure and reduced the half closure time in mice with a CT50 of 5.4 ± 0.2 days compared with control (p < 0.05). These results suggest that noni leaf significantly accelerated wound healing in mice via its ligand binding to the PDGF and A2A receptors as its probable mechanisms of wound-healing and also support its traditional usage for wound-healing in Polynesia. Copyright © 2010 John Wiley & Sons, Ltd. [source] Proteomic analysis of rabbit tear fluid: Defensin levels after an experimental corneal wound are correlated to wound closurePROTEINS: STRUCTURE, FUNCTION AND BIOINFORMATICS, Issue 17 2007Lei Zhou Abstract The cornea is the major refracting optical element of the eye and therefore critical for forming a retinal image. The exposed surface of the eye is protected from pathogens by the innate immune system whose components include defensins, naturally occurring peptides with antimicrobial properties, and the physical barrier formed by the outer epithelial layer of the cornea. The proteomic approach has revealed that tear levels of defensins are correlated with the course of healing of an experimental corneal wound. Tears were collected from New Zealand White rabbits prior to (day 0) and daily for 5 days (days 1,5) following a standard unilateral 6,mm diameter corneal epithelial abrasion. Tear protein profiles obtained from wounded and contra-lateral control eyes were compared using SELDI ProteinChip technology. Peptides and proteins of interest were purified by RP-HPLC and characterized by nanoESI-MS/MS. Mass spectra of tears on post-wound day 1, revealed 13,peaks whose level decreased and five that increased. During wound healing the tear protein profile correlated with wound closure. An important finding was that the levels of rabbit defensins (NP-1 and NP-2), which were elevated after wounding returned to normal levels by the time the corneal abrasion healed. Relative quantification of NP-2 in tear fluid prior to (day 0) and after corneal wounding (days 1, 3) was determined using iTRAQ technology. A corneal wound eliminates the barrier function of innate immunity and puts the cornea at risk from microbial attack until the epithelial cells restore the surface barrier. The increased availability of defensins in the tears during healing suggests that these peptides could protect the cornea from microbial attack during a period of increased vulnerability. [source] Learning Curve for Translaryngeal Tracheotomy in Head and Neck SurgeryTHE LARYNGOSCOPE, Issue 4 2001Gioacchino Giugliano MD Abstract Objectives Translaryngeal tracheotomy (TLT) is a widely accepted procedure in intensive-care units for its simplicity of execution, low morbidity, rapid wound closure after cannula removal, good esthetic results, and lack of long-term sequelae. The aim of this study was to evaluate the feasibility and use of adopting TLT in patients with cancer undergoing major head and neck surgery. Study Design Prospective analysis of learning curve and incidence of complications in 41 patients with cancer who underwent TLT at the Division of Head and Neck Surgery of the European Institute of Oncology from November 1997 to June 1999. Methods Patient characteristics, pathology, anatomic characteristics of the neck, and surgical short-term and long-term complications were noted. The patients were divided into consecutive groups of six or seven patients, and time trends in occurrence of complications and time to execute the procedure were assessed. Results TLT performance time decreased from 50 minutes in the first seven patients to 24 minutes in the last group. The technique was easy to perform and safe, with only two minor complications during surgery. However, minor complications occurred in three and major complications in 17 patients in the days immediately following surgery, almost entirely attributable to lack of counter-cannu1a and stylet. Conclusions In view of the high proportion of major complications, TLT using the presently available kit is unsuitable for major head and neck surgery. However, the considerable advantages of the technique would recommend it as a valid alternative to surgical tracheotomy if the kit included a counter-cannu1a and stylet. [source] Inflammation and Epithelial to Mesenchymal Transition in Lung Transplant Recipients: Role in Dysregulated Epithelial Wound RepairAMERICAN JOURNAL OF TRANSPLANTATION, Issue 3 2010L. A. Borthwick Epithelial to mesenchymal transition (EMT) has been implicated in the pathogenesis of obliterative bronchiolitis (OB) after lung transplant. Although TNF-, accentuates TGF-,1 driven EMT in primary human bronchial epithelial cells (PBECs), we hypothesized that other acute pro-inflammatory cytokines elevated in the airways of patients with OB may also accentuate EMT and contribute to dysregulated epithelial wound repair. PBECs from lung transplant recipients were stimulated with TGF-,1 ± IL-1,, IL-8, TNF-, or activated macrophages in co-culture and EMT assessed. The quality and rate of wound closure in a standardized model of lung epithelial injury was assessed in response to above stimuli. Co-treatment with TGF-,1 + TNF-, or IL-1, significantly accentuates phenotypic and some functional features of EMT compared to TGF-,1 alone. Co-treatment with TGF-,1 + TNF-, or IL-1, accelerates epithelial wound closure however the quality of repair is highly dysregulated. Co-treatment with TGF-,1 + IL-8 has no significant effect on EMT or the speed or quality of wound healing. Activated macrophages dramatically accentuate TGF-,1-driven EMT and cause dysregulated wound repair. Crosstalk between macrophage-derived acute inflammation in the airway and elevated TGF-,1 may favor dysregulated airway epithelial repair and fibrosis in the lung allograft via EMT. [source] Tramadol for prevention of postanaesthetic shivering: a randomised double-blind comparison with pethidineANAESTHESIA, Issue 2 2009M. Mohta Summary The present study was conducted with the aims of comparing intravenous tramadol 1, 2 and 3 mg.kg,1 with pethidine 0.5 mg.kg,1 for prophylaxis of postanaesthetic shivering and to find a dose of tramadol that could provide the dual advantage of antishivering and analgesic effect in the postoperative period. The study included 165 patients, randomly allocated to five groups of 33 each. Tramadol in doses of 1, 2 and 3 mg.kg,1, pethidine 0.5 mg.kg,1 or normal saline were administered at the time of wound closure. All three doses of tramadol were effective and comparable to pethidine in preventing postanaesthetic shivering. Tramadol 2 mg.kg,1 had the best combination of antishivering and analgesic efficacy without excessive sedation and thus appeared to be a good choice to be administered at the time of wound closure to provide antishivering effect and analgesia without significant side effects in the postoperative period. [source] Use of adhesive surgical tape with the absorbable continuous subcuticular sutureANZ JOURNAL OF SURGERY, Issue 8 2003Jeremy D. Kolt Background: The absorbable continuous subcuticular suture is frequently used to close surgical incisions where the aim is healing by primary intention. A form of adhesive surgical tape is commonly also placed over the wound but this combination closure seems to have its development based on anecdotal, rather than experimental evidence. The present study reviews the scientific literature on the development of sutureless wound closure and presents the current evidence for the use of combination wound closure. Methods: Review was undertaken of the medical literature using the PubMed Internet database and cross-referencing major articles on the subject. The following combinations of key words were searched: skin closure, wound closure, suture technique, sutureless, adhesive tape, op-site, staples, subcuticular suture, complication, infection and scars. Results: Taped closure alone has advantages of lower wound infection rates and greater wound tensile strength, but disadvantages of epidermal reaction, skin edge inversion, doubtful safety and time required for meticulous surgical technique. The use of the continuous absorbable subcuticular suture allows accurate skin edge approximation, which increases the safety margin. The combination closure has a slightly superior cosmetic result to sutureless techniques but no study has been performed to compare the results of combination subcuticular suture and tape, with tape or subcuticular suture alone. Conclusions: There is no evidence in the scientific literature to justify or support the practice of closing a surgical wound with both subcuticular suture and adhesive surgical tape. [source] PILONIDAL DISEASE IN SINGAPORE: CLINICAL FEATURES AND MANAGEMENTANZ JOURNAL OF SURGERY, Issue 3 2000H. C. Lee Background: Pilonidal disease has not been well documented in Asian people. The aims of the present study were to investigate any variations in the clinical features and effectiveness of various surgical treatments in such a population. Methods: A prospectively collected computerized database of 61 consecutive patients admitted to a specialist colorectal unit over a 9-year period was studied. The five methods of surgical treatment used during this period (incision and drainage; laying open; marsupialization; primary closure; and the flap procedure) were compared. Results: There were 38 men and 23 women with a mean age of 27 ± 1.02 years. Pilonidal disease was significantly more common among the Indian people (52.5% of patients) than the other ethnic races in the Singaporean community (P < 0.001). Chronic discharging sinuses were the most common presentation (93.4%). There were no differences between the various surgical techniques employed with regard to the time required for wound healing (mean: 48 ± 21 days) and recurrence rates (4/61, 6.6%). Wound dehiscence after primary wound closure (10%) and flap procedures (42%) meant that the overall healing rate was not faster than when the wound was just laid open. Furthermore, flap procedures required a longer hospitalization than other procedures (P = 0.005). Conclusion: Pilonidal disease was more common among Indian people, the more hirsute among the Singaporean population. Primary closure and flap procedure did not improve overall wound healing because of dehiscence. [source] | ||||||||||||||||||||||||||||||||||