Topical Aloe Vera Gel for Accelerated Wound Healing of Split-Thickness Skin Graft Donor Sites: A Double-Blind, Randomized, Controlled Trial and Systematic Review.

BACKGROUND: Aloe vera has been used to treat wounds since ancient times. However, data regarding the efficacy of aloe vera for burns and split-thickness skin graft donor sites are inconclusive. METHODS: A double-blind, randomized, controlled trial was conducted. Patients who underwent split-thickness skin graft harvesting from the thigh were included. Split-thickness skin graft donor sites were divided into two groups: the aloe vera group and the placebo group. The visual analogue scale score was used to evaluate pain, and complete epithelialization was assessed. The authors searched electronic databases and included only international clinical trials published in the English language. RESULTS: Twelve patients with 24 donor sites participated. Times to complete epithelization for the aloe vera and placebo groups were 11.5 ± 1.45 and 13.67 ± 1.61 days, respectively (p < 0.05). Visual analogue scale scores after wound dressing for the aloe vera and placebo groups were 17.18 ± 13.17 and 18.63 ± 11.20, respectively. No statistical significance was found between groups. Five articles met the inclusion criteria: four involved burns and one involved split-thickness skin graft donor sites. Three studies of burn wounds demonstrated improved epithelization and one did not. The split-thickness skin graft donor-site study indicated that wound healing time for the control group was significantly different from that of the aloe vera and placebo groups. The healing rate was not statistically different between groups. CONCLUSION: Topical aloe vera gel significantly demonstrated accelerated split-thickness skin graft donor-site healing but did not show significant pain relief. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, I.

Lateral Calcaneal Artery Flaps in Atherosclerosis: Cadaveric Study, Vascular Assessment and Clinical Applications.

BACKGROUND: Soft tissue defects of the lateral malleolus (LM) and Achilles tendon pose difficult reconstructive problems due to the bony prominence and limited local tissue available. The objectives were to study the anatomical landmarks of the lateral calcaneal artery (LCA) and patency of LCA in atherosclerotic patients. METHODS: Part I: Thirty-four cadaveric feet were dissected to identify the LCA. The distance between the LCA and the most prominent point of the LM was measured horizontally (LCAa-LM), obliquely (LCAb-LM), and vertically (LCAc-LM). Part II: Thirty-two patients were divided in 2 groups as nonatherosclerotic and atherosclerotic groups. The LCA was assessed by both Doppler ultrasonography and computed tomographic angiography (CTA). Part III: Clinical applications were demonstrated. RESULTS: Part I: Mean distances of LCAa-LM, LCAb-LM, and LCAc-LM were 24.76, 33.68, and 35.03 mm, respectively. The LCA originated 94.12% from the peroneal artery. Part II: Doppler ultrasonography detected the LCA at 90.62% and 87.50% in nonatherosclerotic and atherosclerotic groups, respectively, whereas 100.00% and 93.75%, respectively, were detected by CTA. No statistically significant difference was found in the patency of the LCA between nonatherosclerotic and atherosclerotic patients. Part III: Clinical applications were performed in atherosclerotic patients. CONCLUSIONS: The LM is a reliable point to identify the LCA, and the LCA flap can be raised safely in atherosclerotic patients. Preoperative CTA should be performed in severely atherosclerotic patients or cases of major lower extremity vascular injuries.

Comparing the effect between oral and injection form of carnitine on skin flap survival in rats.

BACKGROUND: Carnitine is an endogenous cofactor, having a regulatory action on the energy flow from different oxidative sources. Carnitine has been used for ischemic conditions such as coronary heart diseases, peripheral vascular diseases with satisfactory results. So ischemic skin flaps should obtain benefit from carnitine. OBJECTIVE: To determine the effect of oral and injection form of carnitine on skin flap survival in a rat model. MATERIAL AND METHOD: Twenty-one Sprague-Dawley rats were divided into 3 groups, each group had 7 rats; a control group and two carnitine-treated groups. Random skin flap was elevated on the backs of the rats. The control group was not given any pharmacologic agent. Two treated groups, group 1 received carnitine orally (150 mg/kg/day) for 3 days before flap elevation and continuing to 1 week after the procedure, Group 2 received carnitine intraperitoneally (100 mg/kg/day) for 1 week after flap elevation. The surface area of flap survival was measured in each group. RESULTS: The median areas of flap survival of the control groups and two carnitine treated groups were 65.89%, 69.03%, 77.47%, respectively. There was significant improvement of flaps survival in carnitine-treated groups, especially carnitine injected group was found to be significantly higher than the control group and carnitine-oral group (p < 0.05). The carnitine-oral group could slightly increase flap survival compared to the control group but was not statistically significant. CONCLUSION: Effect of carnitine has increased flap survival in random skin flap. Carnitine injection form is more effective than the oral one.