Discussion on the Application Effect of Simplified Vacuum Sealing Drainage(VSD)in the Treatment of Chronic Refractory Wounds

Objective:To analyze the effect of simplified vacuum sealing drainage(VSD)in the treatment of chronic refractory wounds.Methods:A total of 90 patients with chronic refractory wounds treated from May 2022 to May 2023 were randomly divided into groups.The simplified VSD treatment was employed in group A,and conventional treatment was employed in group B,and the wound healing of both groups were compared.Results:Group A showed better wound healing compared to group B,P<0.05;the wound healing rate,wound healing duration,visual analog scale(VAS)score,wound dressing times and other indicators in group A were better than those in group B,P<0.05.The SF-36 score of group A was higher than that of group B,P<0.05;the complication rate of chronic refractory wounds in group A was no different from that in group B,P>0.05.Conclusion:Simplified VSD treatment is effective in treating patients with chronic refractory wounds,and it reduces the number of wound dressing changes and promote wound healing.

Therapeutic effect of autologous concentrated growth factor on lower-extremity chronic refractory wounds:A case report

BACKGROUND Management of chronic refractory wounds is one of the toughest clinical challenges for surgeons.Because of poor blood supply,less tissue coverage,and easy exposure,the lower leg is a common site for chronic refractory wounds.The current therapeutic regimens often lead to prolonged hospital stay and higher healthcare costs.Concentrated growth factor(CGF)is a novel blood extract that contains various growth factors,platelets,and fibrins to promote wound healing process.However,there has been little research reported on the treatment of lower extremity wounds with CGF.CASE SUMMARY A 37-year-old man,without any past medical history,presented an ulcerated chronic wound on his right lower leg.The skin defect exhibited clear boundaries,with a size of 2.0 cm×3.5 cm.The depth of wound was up to the layer of deep fascia.Staphylococcus aureus was detected by bacterial culture.The final diagnosis was right lower extremity ulcers with infection.Cefathiamidine,silver sulfadiazine,and mupirocin cream were applied to control the infection.CGF gel was prepared from the patient’s blood sample,and was used to cover the wound after thorough debridement.The skin wound was successfully healed after three times of CGF treatment.CONCLUSION CGF displays an excellent wound healing promoting effect in patients with lowerextremity chronic refractory wounds.

Effect of hydrogen intervention on refractory wounds after radiotherapy:A case report

BACKGROUND Patients with keloids who receive radiotherapy(RT)after surgery can develop refractory wounds that cannot be healed by the patient's own repair system.Such chronic wounds are uneven and complex due to persistent abscess and ulceration.Without external intervention,they can easily result in local tissue necrosis or,in severe cases,large area tissue resection,amputation,and even death.CASE SUMMARY This article describes the use of hydrogen to treat a 42-year-old female patient with a chronic wound on her left shoulder.The patient had a skin graft that involved implanting a dilator under the skin of her left shoulder,and then transferring excess skin from her shoulder onto scar tissue on her chest.The skin grafting was followed by two rounds of RT,after which the shoulder wound had difficulty healing.For six months,the patient was treated with 2 h of hydrogen inhalation(HI)therapy per day,in addition to application of sterile gauze on the wound and periodic debridement.We also performed one deep,large,sharp debridement to enlarge the wound area.The wound healed completely within 6 mo of beginning the HI treatment.CONCLUSION After HI therapy,the patient showed superior progress in reepithelialization and wound repair,with eventual wound closure in 6 mo,in comparison with the previous failures of hyperbaric oxygen and recombinant bovine basic fibroblast growth factor therapies.Our work showed that HI therapy could be a new strategy for wound healing that is cleaner,more convenient,and less expensive than other therapies,as well as easily accessible for further application in clinical wound care.

To investigate the clinical effect of modified closed negative pressure suction technique combined with flap transplantation on the treatment of deep chronic refractory wounds

Objective:To investigate the clinical effect of modified closed negative pressure suction technique combined with flap transplantation on the treatment of deep chronic refractory wounds.Methods:During March of 2015 to April of 2018,52 cases of patients with deep chronic refractory wounds were selected as research objects.They were divided into the control group and the treatment group by use of the random number table method,with 26 cases in each group.Among them,the control group was given conventional debridement combined with flap reconstruction,and the treatment group was treated with modified closed negative pressure suction technique combined with flap transplantation to observe the clinical effect.Results:(1)According to the analysis on the effect of flap transplantation,the excellent and good rate of the treatment group was 92.3%,and in the control group,it was 76.9%(p<0.05).(2)According to the statistics,the incidence of complications in the treatment group was lower than that in the control group(p<0.05).Conclusions:Modified closed negative pressure suction technique combined with flap transplantation has a good effect on the treatment of deep chronic refractory wounds with fewer complications.

The mechanism of Jiuyi powder and its effective components in inhibiting the M1 phenotype polarization of macrophages on chronic and refractory wounds infected by MRSA

Objective:To observe the effect of Jiuyi powder and its active components on the bacterial culture and macrophage phenotypic factors of the chronic refractory wound rat model,and to explore its mechanism of removing decay and promoting muscle growth.Methods:SD rats were divided into control group,Jiuyi powder group,Shengdan group,and calcined gypsum group,with 8 rats in each group.MRSA-infected skin lesions and wounds were used to build a model of chronic and difficult-to-heal wounds in rats.After the model was formed,the control group was treated with daily routine nitrofural disinfection and replaced with sterile gauze.On the basis of the control group,quantitative Jiuyi powder,Shengdan powder,and calcined gypsum powder were used for dressing change,once a day for 7 consecutive days.Before and after the last administration,collect rat wound secretions for bacterial culture,inducible monoxide nitrogen synthase content.At the same time,after the last administration,the rat wound tissue was excised for histopathology and immunofluorescence double staining to label macrophages and their M1 phenotype.Results:After the last dressing change,the wound healing of Jiuyi powder group was better than the other groups,and the wound healing rate of each group had significant difference(P<0.05).The histomology showed that the inflammation of Jiuyi powder group was controlled and had a healing trend.After the last drug change,the contents of TNF-α,IL-6 and iNOS in serum of all groups decreased,and the contents of IL-6,TNF-αand iNOS in serum of Jiuyi powder group decreased significantly before and after medication(P<0.05).There was statistical significance in serum IL-6 content between calcined gypsum group and Shengdan group before and after medication(P<0.05).In addition,the results showed that the contents of IL-6 and iNOS in serum of Jiuyi powder group were statistically different from those of the control group(P<0.05).Tissue immunofluorescence double staining showed that the positive rate of M1 macrophages in Jiuyi powder group and Shengdan group was significantly lower than that in control group(P<0.05).The MRSA negative conversion rate of Jiuyi powder group and Shengdan group was better than that of the control group and calcined gypsum group(P<0.05).Conclusion:Jiuyi powder can improve the inflammation of chronic refractory wounds,and has antibacterial,anti-corrosion and myogenic effects.Its mechanism may be related to the inhibition of macrophage M1 phenotype polarization.

Experimental Study of Moist Exposed Burn Therapy/Moist Exposed Burn Ointment Combined with Zhuang Medicine Detoxification for Chronic Refractory Wound Healing

Background: This is still a public problem that needs to be solved urgently: chronic and refractory wound healing with long course and complex pathological mechanism. At present, there is still a lack of effective clinical treatment. This study, therefore, aims at exploring moist exposed burn therapy/moist exposed burn ointment (MEBT/MEBO) combined with Zhuang medicine detoxification in the treatment of chronic refractory wound healing. Methodology: 100 SPF Wistar rats were randomly divided into blank control group, model control group, MEBO group, Zhuang medicine group and Combined group, with 20 rats in each group. Open wound model was established in blank control group, and chronic refractory wound model was established in other groups. Black control group and model control group were given food and water freely, MEBO group was given dressing change once a day, Zhuang medicine group was given intragastric administration once a day, and combined group was given dressing change and intragastric administration once a day. The effective rate of wound healing was observed after 12 days of continuous intervention. Conclusion: Skin regeneration medical technique combined with Zhuang medicine poison theory can effectively reduce the symptoms of bleeding and exudation, reduce the area of wound, shorten the healing time of wound, and achieve physiological healing of wound. It has a good effect on chronic refractory wound.

Effects of platelet-rich plasma on in vitro proliferation and migration of fibroblasts from human chronic refractory wound granulation tissue

Objective:To observe the effects of platelet-rich plasma(PRP)on in vitro proliferation and migration of fibroblasts from human chronic refractory wound granulation tissue.Methods:Fibroblasts were separated from human chronic refractory wound granulation tissue and then were identified.The obtained fibroblasts were divided into fetal bovine serum(FBS)group,hydrogel group and PRP group,and the three groups were cultured with culture mediums containing FBS,hydrogel and PRP respectively,in order to observe the growth of fibroblasts.The wound scratch assay was used to observe the migration of fibroblasts.Results:PRP group had more fibroblasts than FBS group and hydrogel group since Day 5 of culture,and exhibited greater fibroblast scratch migration area than FBS group on 48 h and 72 h of wound scratch assay(all p<.05).Conclusions:Compared with FBS,human fibroblasts cultured by PRP can more effectively promote the proliferation and migration of fibroblasts.

Misdiagnosis of scalp angiosarcoma: A case report

BACKGROUND Angiosarcoma is a rare malignant tumor.Owing to the lack of specific clinical manifestations of this disease,it is difficult to achieve early diagnosis and start early treatment.CASE SUMMARY A 78-year-old male patient was admitted to the hospital because of a bump on his head that did not heal for 4 mo.The patient was diagnosed with a refractory head wound.The patient underwent neoplasm resection and skin grafting surgery in the Plastic Surgery.The neoplasm was sent for pathological examination during the operation.The final pathological results were confirmed scalp angiosarcoma.CONCLUSION Our research suggests that pathological examination should be performed for refractory ulcers of the scalp,and physical factor therapy should be used with caution before the diagnosis is clear.

Extracellular vesicles modulate key signalling pathways in refractory wound healing

Chronic wounds are wounds that cannot heal properly due to various factors,such as underlying diseases,infection or reinjury,and improper healing of skin wounds and ulcers can cause a serious economic burden.Numerous studies have shown that extracellular vesicles(EVs)derived from stem/progenitor cells promote wound healing,reduce scar formation and have significant advantages over traditional treatment methods.EVs are membranous particles that carry various bioactive molecules from their cellular origins,such as cytokines,nucleic acids,enzymes,lipids and proteins.EVs can mediate cell-to-cell communication and modulate various physiological processes,such as cell differentiation,angiogenesis,immune response and tissue remodelling.In this review,we summarize the recent advances in EV-based wound healing,focusing on the signalling pathways that are regulated by EVs and their cargos.We discuss how EVs derived from different types of stem/progenitor cells can promote wound healing and reduce scar formation by modulating the Wnt/β-catenin,phosphoinositide 3-kinase/protein kinase B/mammalian target of rapamycin,vascular endothelial growth factor,transforming growth factorβand JAK-STAT pathways.Moreover,we also highlight the challenges and opportunities for engineering or modifying EVs to enhance their efficacy and specificity for wound healing.