Assessment of Antimicrobial Agents, Analgesics, and Epidermal Growth Factors-Embedded Anti-Adhesive Poly(Lactic-Co-Glycolic Acid) Nanofibrous Membranes: In vitro and in vivo Studies.

BACKGROUND: Postoperative tissue adhesion is a major concern for most surgeons and is a nearly unpreventable complication after abdominal or pelvic surgeries. This study explored the use of sandwich-structured antimicrobial agents, analgesics, and human epidermal growth factor (hEGF)-incorporated anti-adhesive poly(lactic-co-glycolic acid) nanofibrous membranes for surgical wounds. MATERIALS AND METHODS: Electrospinning and co-axial electrospinning techniques were utilized in fabricating the membranes. After spinning, the properties of the prepared membranes were assessed. Additionally, high-performance liquid chromatography and enzyme-linked immunosorbent assays were utilized in assessing the in vitro and in vivo liberation profiles of the pharmaceuticals and the hEGF from the membranes. RESULTS: The measured data suggest that the degradable anti-adhesive membranes discharged high levels of vancomycin/ceftazidime, ketorolac, and hEGF in vitro for more than 30, 24, and 27 days, respectively. The in vivo assessment in a rat laparotomy model indicated no adhesion in the peritoneal cavity at 14 days post-operation, demonstrating the anti-adhesive capability of the sandwich-structured nanofibrous membranes. The nanofibers also released effective levels of vancomycin, ceftazidime, and ketorolac for more than 28 days in vivo. Histological examination revealed no adverse effects. CONCLUSION: The outcomes of this study implied that the anti-adhesive nanofibers with sustained release of antimicrobial agents, analgesics, and growth factors might offer postoperative pain relief and infection control, as well as promote postoperative healing of surgical wounds.

Surgical Wound Complications after Colorectal Surgery with Single-Use Negative-Pressure Wound Therapy Versus Surgical Dressing over Closed Incisions: A Randomized Controlled Trial.

BACKGROUND: Global studies indicate that surgical site infections (SSIs) are a major healthcare challenge within hospitals and can have a profound impact on patient quality of life and healthcare costs. Closed-incision negative-pressure therapy (ciNPT) has been reported to provide positive clinical benefits for patients with various incisions, including those following colorectal surgeries. METHODS: Investigators performed a prospective, randomized, multicenter trial to evaluate complications of surgical incisions in patients who received a ciNPT dressing versus a conventional surgical dressing (control) over their closed incision following colorectal surgery. The incidence of SSI was determined at 7, 15, and 30 days postsurgery. RESULTS: A total of 148 patients participated in the study. Results showed that the SSI rate on day 7 was lower in the ciNPT group versus the control group (10/75 [13.3%] vs 17/73 [23.3%]), but this difference was not statistically significant. On day 15, the SSI rate was 12/75 (16.0%) in the ciNPT group versus 21/73 (28.8%) in the control group; however, this difference was only marginally statistically significant (P = .0621). At 1 month, the SSI rate remained lower in the ciNPT group (13/75 [17.3%] vs 21/73 [28.8%], P = .0983) compared with the control group. CONCLUSIONS: Future studies with larger population sizes are necessary to determine the impact of ciNPT on patients' incisions after colorectal surgery.

Prediction of blood pressure change during surgical incision under opioid analgesia using sympathetic response evoking threshold.

Opioid inhibition of nociceptive stimuli varies in individuals and is difficult to titrate. We have reported the vascular stiffness value (K) as a standard monitor to quantify sympathetic response with high accuracy. On the contrary, among individuals, a considerable variation in the rate of change in K for constant pain has been observed. In this study, we proposed a new index, the minimum stimulus intensity value that evoked the response on K (MECK: Minimum Evoked Current of K), and evaluated its accuracy in predicting sympathetic response to nociceptive stimuli under constant opioid administration. Thirty patients undergoing open surgery under general anesthesia were included. After anesthetic induction, remifentanil was administered at a constant concentration of 2 ng/ml at the effect site followed by tetanus stimulation. MECK was defined as the minimal current needed to produce a change in K. MECK significantly (P < 0.001) correlated with the rate of change of systolic blood pressure during skin incision (ROCBP). Bland-Altman plot analysis using the predicted ROCBP calculated from MECK and the measured ROCBP showed that the prediction equation for ROCBP was highly accurate. This study showed the potential of MECK to predict blood pressure change during surgical incision under opioid analgesia.Clinical trial registration Registry: University hospital medical information network; Registration number: UMIN000041816; Principal investigator's name: Satoshi Kamiya; Date of registration: July 9th, 2019.

Thoracolumbar interfascial plane block for postoperative analgesia in spine surgery: A systematic review and meta-analysis.

INTRODUCTION: Thoracolumbar interfascial plane (TLIP) block has been discussed widely in spine surgery. The aim of our study is to evaluate analgesic efficacy and safety of TLIP block in spine surgery. METHOD: We performed a quantitative systematic review. Randomized controlled trials that compared TLIP block to non-block care or wound infiltration for patients undergoing spine surgery and took the pain or morphine consumption as a primary or secondary outcome were included. The primary outcome was cumulative opioid consumption during 0-24-hour. Secondary outcomes included postoperative pain intensity, rescue analgesia requirement, and adverse events. RESULT: 9 randomized controlled trials with 539 patients were included for analysis. Compared with non-block care, TLIP block was effective to decrease the opioid consumption (WMD -16.00; 95%CI -19.19, -12.81; p<0.001; I2 = 71.6%) for the first 24 hours after the surgery. TLIP block significantly reduced postoperative pain intensity at rest or movement at various time points compared with non-block care, and reduced rescue analgesia requirement ((RR 0.47; 95%CI 0.30, 0.74; p = 0.001; I2 = 0.0%) and postoperative nausea and vomiting (RR 0.58; 95%CI 0.39, 0.86; p = 0.006; I2 = 25.1%). Besides, TLIP block is superior to wound infiltration in terms of opioid consumption (WMD -17.23, 95%CI -21.62, -12.86; p<0.001; I2 = 63.8%), and the postoperative pain intensity at rest was comparable between TLIP block and wound infiltration. CONCLUSION: TLIP block improved analgesic efficacy in spine surgery compared with non-block care. Furthermore, current literature supported the TLIP block was superior to wound infiltration in terms of opioid consumption.

The effect of platelet-rich fibrin (PRF) on wound healing, adhesion, and hemostasis after endoscopic sinus surgery in patients with nasal polyposis.

PURPOSE: Chronic rhinosinusitis (CRS) is one of the most common chronic diseases seen worldwide. Endoscopic sinus surgery (ESS) has become a widely accepted procedure for medically refractory chronic rhinosinusitis and nasal polyps. Prevention of revision surgery often depends on good wound healing and less adhesion formation. In recent years, the effects of platelet-rich fibrin (PRF) on tissue healing have been addressed in many surgical branches, especially for dental implant surgery and plastic surgery. METHODS: This prospective study was conducted with 50 patients who underwent endoscopic sinus surgery for the diagnosis of nasal polyposis. While the middle meatus in one nasal cavity was filled with PRF and supported with Nasopore, only Nasopore was used in the other nasal cavity middle meatus. The patients were followed up clinically at weeks 1, 2, 3, 4, 8, and 12 postoperatively. The assessor determined the presence of adhesion, crusting, bleeding, frontal ostium stenosis, granulation, and infection, and if present, the grades of these complications were scored according to a questionnaire. RESULTS: In our study, adhesion, infection, bleeding, granulation, and frontal ostium stenosis were less common in the PRF group, and a statistically significant difference was found between the groups. CONCLUSION: In our study, better results were obtained in terms of adhesion, infection, bleeding, granulation, and frontal ostium stenosis after ESS as a result of the effects of PRF on wound healing. The application of PRF is an inexpensive and easy procedure. PRF can be a good alternative to other types of tampons after ESS.

Which determinants are considered to be important for adherence to Negative Pressure Wound Therapy: A multimethods study.

AIM: To explore the extent of patients that choose to cease Negative Pressure Wound Therapy (NPWT) prematurely in a clinical setting, and to explore the determinants of nonadherence. METHOD: This study exists out of: (1) a retrospective study to assess the number of patients who ceased NPWT prematurely; (2) a narrative review (NR) to identify determinants of nonadherence; and (3) a survey among wound care specialists to explore specific determinants of nonadherence to NPWT. RESULTS: (1) Based on the retrospective study, 20% ceased NPWT prematurely because of experienced limitations in daily activities. (2) Based on 22 studies, 23 determinants that might influence nonadherence were identified and added as questions in the survey. (3) Twenty-two percent (n = 136) wound care specialists completed the survey. Confidence with the healthcare team, consistency in therapy advices, coping with pain, former negative experiences with NPWT, a normal activity pattern, social support from family or friends, and support from the healthcare team were identified as highly relevant determinants of nonadherence to NPWT. Only religion scored distinctively lower. CONCLUSION: This study is a first step in exploring the determinants of nonadherence to NPWT. In 20% NPWT was prematurely ceased at the request of the patient, this means that this therapy may have not been the best choice of therapy for this particular patient. The identification of potential determinants of nonadherence may help healthcare professionals in their dialogue with patients. The next step should be a prognostic study to assess which determinants best predict adherence to NPWT.

Stretching Force of Incision Affects Early Clinical Results After Primary Total Knee Arthroplasty: A Retrospective Study.

OBJECTIVE: To investigate the impact of different skin incisions on recovery from total knee arthroplasty (TKA). METHODS: This is a retrospective study conducted in a tertiary hospital. A total of 1210 patients accepted primary and unilateral total knee arthroplasty (TKA) at the authors' affiliated institutions between January 2015 and January 2019. Patients who accepted primary and unilateral TKA due to OA under epidural anesthesia were included. Excluded cases included patients who had no completed follow-up; preoperative flexion contracture greater than 15° and preoperative flexion less than 90°; paresthesia in lower limb; scar within the knee area; patella alta or baja. We recorded and analyzed the following data, including each patient's characteristics, incision stretching index (IS index), perioperative information, and follow-up assessments. Patients were grouped by trisecting the range of IS index we observed in the present study. The primary outcome measure was the visual analog scale (VAS) pain score rated on a scale of 0-10 from no pain to severe pain. Secondary outcome measures include knee girth reflecting postoperative swelling, knee range of motion (ROM), sensory testing, and the strength of quadriceps. These measures were completed 2 weeks postoperatively. RESULTS: A total of 1089 patients undergoing primary and unilateral TKA in our two institutions were screened for final analysis, and 121 ones were excluded. The patients were followed up for an average of 13.3 months postoperatively. The mean length of FL was 28.3 cm (range: 21.0-38.8 cm). The mean IS index was 2.7 cm (range: 0.4-5.1 cm). We found no significant difference in those data among groups (P > 0.05). VAS pain scores among group IS A, IS B, and IS C were significantly different (2.3 ± 0.6 vs 3.4 ± 1.6 vs 3.9 ± 1.5, P = 0.0001). Similar situations were seen in knee circumference, ROM, area of abnormal sensation, and quadriceps strength among groups (all P < 0.05). With the increase in the IS index, VAS pain score, knee circumference, area of abnormal sensation, and incision problems were significantly increased (P < 0.05). At the same time, ROM and the strength of quadriceps decreased (P < 0.05). With the increase in the IS index, the number of patients with incision problems was increased significantly (P < 0.05). Besides, no significant difference in PJI and DVT among groups was observed (P > 0.05). CONCLUSIONS: Proper incision stretching can improve postoperative pain relief, surgical swelling, ROM, sensory disturbance of the knee, and the strength of quadriceps with reduced risk of incision complications.

Adipocyte lipolysis drives acute stress-induced insulin resistance.

Stress hyperglycemia and insulin resistance are evolutionarily conserved metabolic adaptations to severe injury including major trauma, burns, or hemorrhagic shock (HS). In response to injury, the neuroendocrine system increases secretion of counterregulatory hormones that promote rapid mobilization of nutrient stores, impair insulin action, and ultimately cause hyperglycemia, a condition known to impair recovery from injury in the clinical setting. We investigated the contributions of adipocyte lipolysis to the metabolic response to acute stress. Both surgical injury with HS and counterregulatory hormone (epinephrine) infusion profoundly stimulated adipocyte lipolysis and simultaneously triggered insulin resistance and hyperglycemia. When lipolysis was inhibited, the stress-induced insulin resistance and hyperglycemia were largely abolished demonstrating an essential requirement for adipocyte lipolysis in promoting stress-induced insulin resistance. Interestingly, circulating non-esterified fatty acid levels did not increase with lipolysis or correlate with insulin resistance during acute stress. Instead, we show that impaired insulin sensitivity correlated with circulating levels of the adipokine resistin in a lipolysis-dependent manner. Our findings demonstrate the central importance of adipocyte lipolysis in the metabolic response to injury. This insight suggests new approaches to prevent insulin resistance and stress hyperglycemia in trauma and surgery patients and thereby improve outcomes.

Fasciotomy through multiple small skin incisions for the treatment of early acute osteofascial compartment syndrome in children.

BACKGROUND: The purpose of the present study is to investigate the therapeutic effect of fasciotomy through multiple small skin incisions for the treatment of early osteofascial compartment syndrome in children. METHODS: From January 2009 to May 2017, 56 pediatric patients with early osteofascial compartment syndrome in their limbs were admitted into our department and treated with multiple small skin incisions for decompression at the early stage. The skin incisions, function, and sensation of the limbs were followed up. RESULTS: The osteofascial compartment syndrome was diagnosed at 7.4 ± 2.1 h after injury, and then fasciotomy was performed at 1.4 ± 0.4 h later. The average procedure time of fasciotomy was 12.7 ± 4.8 min. No postoperative incision infections or neurovascular injuries were observed in all the patients. The incisions completely healed in 7-10 days with an average healing time of 8 days without secondary suture. The patients were followed up for an average of 5.1 years. No Volkmann's contractures in the injured limbs were found. The appearance, electromyography, and nerve conduction velocity of the affected limbs were not significantly different from that of the contralateral limbs. All the patients were free of symptoms and were fully recovered of sensation and function, being an "excellent" outcome at the latest follow-up. CONCLUSION: Fasciotomy through multiple small skin incisions, which can be useful to decompress the compartment pressure with fewer complications, is a simple and effective strategy for the treatment of early osteofascial compartment syndrome in children.

Expression of Metalloproteinases and Type I and III Collagens during Healing of Excisional Skin Wound on the Abdomen and Back in Rats.

The study was carried out using a novel rat model developed in our laboratory, namely16 mm diameter circular excisional wounds were generated on the abdomen which resulted in minimal scarring. Restoration of the skin integrity was completed by day 60 after the wounding surgery. By this time, regenerates on the abdomen were stronger than on the back (at, respectively, 58 and 17.4 % of the tensile strength of the intact skin at corresponding location) and the ratio of type I and type III collagens in regenerates on the abdomen reached the level of intact skin at the same location. On days 3 to 14, the ratio of Mmp9/Timp1 expression levels on the abdomen was higher than on the back. On days 20 and 30, the Mmp9/Timp1 ratio on the abdomen was identical to the level of intact skin, whereas the increased MMPs expression levels on the back were maintained until day 30. It has been shown for the first time that according to functional and molecular characteristics, wound healing on the abdomen of an adult rat is more similar to complete regeneration than scarring repair of the back skin.

Practical Things You Should Know about Wound Healing and Vacuum-Assisted Closure Management.

LEARNING OBJECTIVES: After reading this article, the participant should be able to: 1. Understand the basics of negative-pressure wound therapy and practical uses of various vacuum-assisted closure dressings. 2. Understand the mechanisms of action of negative-pressure therapies and other important adjuncts, such as perfusion imaging. 3. Discuss the evidence for hyperbaric oxygen therapy in wound care. SUMMARY: Wound healing requires creating an environment that supports the healing process while decreasing inflammation and infection. Negative-pressure wound therapy has changed the way physicians manage acute and chronic wounds for more than 20 years. It contracts wound edges, removes exudate, including inflammatory and infectious material, and promotes angiogenesis and granulation tissue formation. These effects have been consistently demonstrated in multiple animal and human randomized controlled trials. Recent innovations that include instillation therapy and closed incision have further increased our arsenal against difficult-to-treat wounds and incisions at high risk of complications. Instillation of topical wound solutions allows physicians to cleanse the wound without return to the operating room, resulting in fewer debridements, shorter hospital stays, and faster time to wound closure. Other concepts have yielded negative-pressure therapy on top of closed surgical incisions, which holds incision edges together, reduces edema, promotes angiogenesis, and creates a barrier to protect incisions during the critical healing period, thereby reducing surgical-site complications, especially infection. Other practical adjuncts to the modern-day treatment of acute and chronic wounds include indocyanine green angiography, which allows real-time assessment of perfusion, and hyperbaric oxygen treatment, which has been suggested to augment healing in acute, chronic, specifically diabetic foot ulcers and radiation-related wounds.

Lesional skin in vitiligo exhibits delayed in vivo reepithelialization compared to the nonlesional skin.

Vitiligo, a common skin disorder, is characterized by the loss of functional melanocytes resulting in the depigmentation of skin. Previous studies have demonstrated molecular and architectural alterations in the epidermal keratinocytes upon loss of melanocytes. The physiological implications of these "altered" keratinocytes are yet not known. We investigated the wound healing efficiency of lesional vs nonlesional skin in 12 subjects with stable nonsegmental vitiligo using histological and ultrastructural evaluation of partial-thickness wounds. The wounds were examined 12 days postinjury, coinciding with the reepithelialization phase of healing marked primarily by keratinocyte migration and proliferation. This study demonstrated a significant difference in the reepithelialization potential between the lesional and nonlesional skin. While all 12 nonlesional wounds demonstrated considerable neoepidermis formation on the 12th day post wound, only four of the corresponding lesional samples showed comparable reepithelialization; the rest remaining in the inflammatory phase. Ultrastructural studies using transmission electron microscopy as well as immunohistochemical staining revealed a reduced number of desmosomes, shorter keratin tonofilaments and an increase in myofibroblast population in the dermis of lesional reepithelialized tissue compared to the nonlesional reepithelialized samples. This study implicates gross functional perturbations in the lesional skin during physiological wound healing in vitiligo, suggesting that the breakdown of keratinocyte-melanocyte network results in delayed wound repair kinetics in the lesional skin when compared to patient-matched nonlesional skin.

Use of Nevelia Dermal-Epidermal Regenerative Template in the Management of Ischemic Diabetic Foot Postsurgical Wounds.

The purpose of this cross-sectional study is evaluate the effectiveness of a dermal-epidermal substitute (DES) composed of 3-dimensional porous matrix of type 1, purified, stabilized, bovin-origin collagen (Nevelia, SYMATESE, Chaponost, France) without a subsequent skin graft in the treatment ischemic postsurgical diabetic foot ulcers. This study group was composed of a sample of consecutive diabetic patients with critical limb ischemia and postsurgical wounds. All patients received a preset limb salvage protocol including the application of the DES, but none received a skin graft. Patients were closely followed until wound healing or different outcome. The outcome measures were healing, nonhealing, major amputation, and death evaluated at 1 and 2 years of follow-up. Forty-one patients were included. The average postsurgical wound area was 69.6 ± 50 cm2. Twenty-one patients (51%) healed; 10 patients (24%) did not heal after 1 year of follow-up; however, all of them achieved a mean ulcer size reduction >50%; 7 patients (17%) were amputees; 3 patients (7.3%) died. In a later follow-up (2 years), wounds in 8 additional patients healed. Successful revascularization was an independent predictor of healing (hazard ratio = 5.1, 95% confidence interval [CI] = 2.5-14-9; P = .0001), the postsurgical ulcer size (>50 cm2) was an independent predictor of nonhealing (hazard ratio = 6.2, 95% CI = 2.1-38.4; P = .0001) while recurrence of critical limb ischemia was an independent predictor of major amputation (odds ratio = 3.4, 95% CI = 1.1-4.5; P = .002). The DES composed of type 1 bovin-origin collagen is useful in the treatment of large postsurgical diabetic foot ulcers, even when the skin graft is not a suitable therapeutic option.

Variability in Wound Care Recommendations Following Dermatologic Procedures.

BACKGROUND: Dermatologists routinely perform office-based surgical procedures that result in cutaneous wounds. Wound care instructions are an important resource for postoperative patients. As there is no consensus on the ideal wound care regimen after dermatologic procedures, recommendations may vary. OBJECTIVE: To evaluate the current recommendations for wound care following dermatologic procedures. METHODS: The authors conducted a cross-sectional assessment of dermatology wound care handouts available online. The handouts were evaluated based on predefined parameters: topical agent recommendations for wound healing, caution against topical antibiotic use, and discussion of scarring, infection, bleeding, analgesia, and lifestyle considerations. RESULTS: A total of 169 handouts were evaluated. The majority (84%) recommended the application of petrolatum-based products, specifically Vaseline (75%) and Aquaphor (43%). Nearly half (43%) recommended the use of topical antibiotics, whereas 24% advised patients to avoid antibiotic ointments. Handouts variably addressed scarring (36%), infection (72%), bleeding (69%), pain (66%), and lifestyle modifications (64%). CONCLUSION: The instructions provided in dermatology patient handouts are highly variable, with various topical agents being recommended for wound healing. Topical antibiotics are not indicated for prophylaxis in clean dermatologic procedures but are still widely used. Greater efforts should be made to ensure that patients receive consistent and evidence-based wound care guidance.

Prospective comparison of perioperative wound and pain score parameters in cats undergoing flank vs midline ovariectomy.

OBJECTIVES: The aim of this study was to prospectively compare perioperative pain score and wound parameters, inclusive of postoperative swelling and erythema, between flank and midline ovariectomy (OVE) in cats, performed by final-year veterinary students. METHODS: Healthy cats presented for routine OVE were randomly assigned to either the midline or flank group after owner consent to participate in the study. Perioperative protocols were standardised for both groups. Clinical data were collected prior to surgery, intraoperatively, at 1 h postoperatively, at the time of discharge, and at 3 and 10 day postoperative re-examination appointments. Data recorded included duration of surgery and anaesthesia, intraoperative complications, Feline Acute Pain Scale (FAPS) scores, a simple descriptive scale of reaction to wound palpation (SDSwound), a dynamic and interactive visual analogue scale assessment of pain (DIVAS), and both a simple descriptive scale (SDSswelling) and a visual analogue scale (VASswelling) of surgical wound swelling. RESULTS: Thirty-eight cats received a flank OVE and 37 received a midline OVE. Duration of surgery, duration of anaesthesia and intraoperative complications did not vary significantly between the two groups. Cats in both groups had significantly higher FAPS scores after surgery (P = 0.0002), with cats receiving a flank OVE having significantly higher pain scores compared with a midline OVE at 1 h postoperatively (P = 0.0004) and at discharge (P = 0.002). Swelling of the surgical wound (SDSswelling) was significantly higher in cats receiving a midline OVE at the time of discharge (P = 0.048), as well as at the 3 day (P <0.0001) and 10 day (P = 0.001) postoperative re-examinations. FAPS scores were significantly higher in cats receiving a midline OVE at the 3 day (P = 0.016) and 10 day re-examinations (P = 0.045). No cats in either group suffered a wound breakdown or infection. CONCLUSIONS AND RELEVANCE: Our study does not support advocating a preferred surgical approach for feline OVE within a teaching environment.

The impact of surgical chest wall damage caused by classic thoracotomy on pulmonary function and morphology.

OBJECTIVES: Postoperative changes in pulmonary function (PF) and morphology due to surgical chest wall damage by thoracotomy with rib resection are unclear. Therefore, we evaluated the effects of surgical damage on PF and morphology at > 6 months postoperatively by comparing different lung lobectomy approaches. METHODS: A total of 140 patients who underwent lobectomy for lung diseases between January 2006 and March 2016 were analyzed. Patients who underwent PF tests and computed tomography (CT) scans preoperatively and postoperatively were divided into posterolateral thoracotomy with one rib resection (PT) group and video-assisted thoracoscopic surgery (VATS) group. A 1:1 propensity score-matched (PSM) analysis was used to balance clinically important confounders between the groups. Regarding morphology, lung volume was measured semi-automatically using image analysis software and reconstructed three-dimensional (3D) images. RESULTS: After PSM, 31 patients in each group were compared. Perioperative reduction ratios in forced vital capacity (FVC) (- 23% vs. - 13%; P = 0.006) and forced expiratory volume in 1 s (FEV1) (- 19% vs. - 12%; P = 0.02) were significantly larger for the PT group. No significant differences in lung volume values based on 3D CT volumetry (PT vs. VATS; total lung volume: - 7.9% vs. - 7.2%, P = 0.82; non-resected ipsilateral lung volume: + 36% vs. + 40%, P = 0.69; contralateral lung volume: + 9.3% vs. + 9.4%, P = 0.98) were found in either group. CONCLUSIONS: Among the patients underwent lobectomy, classic thoracotomy decreased PF by an additional FVC loss of 10% and FEV1 loss of 7% compared with VATS, without affecting residual lung volume.

Chitosan-calcium alginate dressing promotes wound healing: A preliminary study.

Dressings are necessary during the process of wound healing. Since the early 1980s, several types of wound dressings have been produced, but they cannot always take into account some effects include antibacterial effect, wound healing promotion, and other properties. In this study, we would like to develop an effective dressing with the above properties, especially accelerating wound healing effect. A chitosan-calcium alginate dressing (CCAD) was developed by coating mixture of chitosan with high-low molecular weight on calcium alginate dressing (CAD). We investigated the structural characteristics of CCAD with Fourier-transform infrared spectroscopy (FTIR) and electron microscopy. The cytotoxicity and antibacterial property were evaluated in vitro using CCK-8 and inhibition zone method. Moisture retention was tested on the skin of Sprague-Dawley (SD) rats, and wound healing studies were performed on a full-thickness skin wound model in SD rats. CCAD showed good moisturizing and antibacterial properties with no cytotoxicity. CCAD could inhibit inflammation by decreasing IL-6, and it could also promote angiogenesis by increasing VEGF, resulting in better wound healing than CAD. CCAD is a better choice in wound care due to its antibacterial property, biocompatibility, moisture retention, healing promotion, and non-cytotoxicity characteristics.

Comparison of uterine scarring between robot-assisted laparoscopic myomectomy and conventional laparoscopic myomectomy.

This study compared uterine wound healing after robot-assisted laparoscopic myomectomy (RM) and laparoscopic myomectomy (LM). Ultrasound was used to evaluate the scar repair of uterine wounds at 1, 3, and 6 months postoperatively. Ninety-three RM and 110 LM patients were enrolled. More myomas excised using RM were type 1∼type 3(51.1%) and more myomas excised using LM were type 4∼type 6(54.2%), p < .001. Both groups had myomas of similar size (RM vs. LM, 9.0 vs. 8.4 cm, p = .115) and weight (RM vs. LM, 322 vs. 274 g, p = .102). The mean myoma number was significantly larger in RM patients than LM patients (RM vs. LM, 3.3 vs. 1.8, p < .001). Significantly more patients were found to have haematomas in the LM than the RM group (RM vs. LM, 0 vs. 6, p = .032); two in type 3, two in type 4 and two in type 8 myomas. Four small haematomas spontaneously resolved at the 3rd month, and a large one resolved at the 9th month postoperatively. One haematoma caused pelvic infection and a 7-cm peritoneal inclusion cyst during sonographic follow up. RM resulted in fewer postoperative haematomas and may result in superior uterine repair relative to LM after excision of symptomatic type 3, type 4 and type 8 myomas. RM is suggested for these patients, especially those considering future pregnancy.IMPACT STATEMENTWhat is already known on this subject? Reconstructive suturing and uterine wound healing are the main challenges when performing laparoscopic myomectomy (LM), and spontaneous uterine rupture during pregnancy following LM has been reported because of its limitations in multilayer closure of the myoma bed. Robot-assisted laparoscopic myomectomy (RM) has improved visualisation and EndoWrist movements resulted in adequate multilayered suturing, which may overcome the technical limitations of reconstructive suturing in conventional LM.What do the results of this study add? We evaluated postoperative uterine scarring after RM and LM using ultrasound and found RM resulted in fewer postoperative haematomas, which result in superior uterine wound repair, relative to LM after excision of symptomatic type 3, type 4 and type 8 myomas.What are the implications of these findings for clinical practice and/or further research? RM is suggested for symptomatic type 3, type 4 and type 8 myomas because of superior uterine wound repair, especially those considering future pregnancy.

Assessment of post-operative healing following endoscopic, transnasal, transsphenoidal pituitary surgery without formal sellar grafting.

INTRODUCTION: Multiple options exist for sellar reconstruction after endoscopic transnasal, transsphenoidal surgery (TSS) including free mucosa, fat, bone and synthetic materials. The objective of this study was to assess healing and mucosalization of the sellar face following TSS without formal sellar grafting or reconstruction. METHODS: Single institution retrospective chart review was conducted for patients undergoing TSS without intraoperative CSF leaks between January 2014 and March 2017 at Rush University Medical Center. No formal sellar reconstruction was performed for the entire patient group. Follow-up endoscopic data and clinical notes were coded for time to mucosalization of the sella as well as degree of abnormal mucosal healing, epistaxis, crusting and scarring. RESULTS: 83 patients were included in this study. Mean time to mucosalization was 119 days (range, 17 to 402 days). Incidence of abnormal mucosal healing, epistaxis, crusting and scarring increased from the first to the second postoperative visit but trended down by the third visit. Nasal crusting was the most common finding, followed by abnormal mucosal healing. Chi square analysis showed smoking to be associated with prolonged time to full mucosalization of the sella. Two patients (2.4%) had post-operative CSF leaks requiring lumbar drain placement. CONCLUSION: Adequate sellar healing is achievable in all cases without formal grafting or reconstruction after TSS. Great care must be exercised given the small inherent risk of unmasking a subclinical intraoperative CSF leak. Patients should be followed closely endoscopically during the first four months after TSS to minimize the impact of crusting.

Changes in total, anterior, and posterior corneal surface higher-order aberrations after 1.8 mm incision and 2.8 mm incision cataract surgery.

PURPOSE: To evaluate changes in corneal higher-order aberrations (HOAs) on the anterior and posterior corneal surfaces after 1.8 mm microincision cataract surgery (MICS) and 2.8 mm small-incision cataract surgery (SICS). SETTING: Eye Department, First Affiliated Hospital, School of Medicine, Zhejiang University, China. DESIGN: Prospective case series. METHODS: Right eyes of patients had MICS or SICS. The preoperative and 1-week and 3-month postoperative distance visual acuity (CDVA) and dry eye-related indices were determined. The corneal total HOAs and Zernike coefficients (3rd and 4th order) over 4.0 and 6.0 mm zones, corneal volume, central corneal thickness (CCT), and anterior and posterior corneal astigmatism were measured using a Pentacam HR analyzer. RESULTS: The MICS group comprised 126 eyes and the SICS group 70 eyes. The MICS and SICS groups had similar postoperative CDVA; however, the MICS group had quicker recovery of CCT, corneal volume, and corneal astigmatism. Significantly increased anterior corneal total HOAs were observed in the SICS group over a 6.0 mm zone (P < .001). Both groups showed significantly increased posterior corneal total HOAs over both zones (P < .001). Similar changing patterns in individual Zernike terms were observed. The MICS group had quicker recovery of posterior corneal surface coma and trefoil than the SICS group, especially over the 6.0 mm zone. Changes in posterior corneal surface total HOAs were correlated with corneal volume changes (P < .01). CONCLUSIONS: The data suggest quicker corneal recovery and less change in total and anterior corneal surface corneal HOAs after MICS. Changes in posterior corneal surface HOAs were more pronounced in both surgical groups.