A novel corneal adhesive based on functionally coupled PEG-lysozyme hydrogel for wound closure after surgical eye surgery

Corneal wound closure for surgical eye surgeries or accidents is typically performed to prevent pathogens from the sterile intraocular environment and avoid potential postoperative complications.Tissue adhesives are increasingly employed for corneal wound closure with superior treatment efficiency and less adverse effects.In this study,we successfully develop a novel corneal adhesive based on functionally coupled PEG-lysozyme(PEG-LZ)hydrogels for wound closure after surgical eye surgeries.PEG-LZ hydrogels have plenty of micropores and gradually decreased pore size with increasing concentration from 10%,15%to 20%(w/v),in which PEG-LZ(15%)represents the suitable pH value,gelation time and elastic modulus.PEG-LZ hydrogels have no in vitro cytotoxicity and excellent ex vivo wound closure effectiveness in porcine eyes.The in vivo wound sealant in rabbit eyes by PEG-LZ hydrogels presents a superior therapeutic effect compared with the conventional methods of stromal hydration and suture,in terms of the wound closure percent,mean corneal thickness,percent of wound gaping,and the Descemet membrane detachment.PEG-LZ hydrogels do not induce obvious histological pathology changes.The PEG-LZ corneal adhesive is considered as a tissue adhesive alternative for wound closure after surgical eye surgeries.

Colon perforation with severe peritonitis caused by erotic toy insertion and treated using vacuum-assisted closure:A case report

BACKGROUND Colorectal foreign bodies are commonly encountered during surgery.They are frequently observed in men 20 to 90 years of age and have bimodal age distribution.Surgical management is necessary for cases of rectal perforation.However,surgical site infections are the most common complications after colorectal surgery.CASE SUMMARY We discuss a case of rectal perforation in a patient who presented to our hospital 2 d after its occurrence.The perforation occurred as a result of the patient inserting a sex toy in his rectum.Severe peritonitis was attributable to delayed presentation.CONCLUSION Vacuum-assisted closure was performed to treat the wound,which healed well after therapy.No complications were noted.

Comparison of modified gunsight suture technique and traditional interrupted suture in enterostomy closure

BACKGROUND Prophylactic enterostomy surgery is a common surgical approach used to reduce the risk of anastomotic leakage in patients who have undergone partial intestinal resection due to trauma or tumors.However,the traditional interrupted suturing technique used in enterostomy closure surgery has several issues,including longer surgical incisions and higher incision tension,which can increase the risk of postoperative complications.To address these issues,scholars have proposed the use of a“gunsight suture”technique.This technique involves using a gunsight incision instead of a traditional linear incision,leaving a gap in the center for the drainage of blood and fluid to reduce the risk of infection.Building on this technique,we propose an improved gunsight suture technique.A drainage tube is placed at the lowest point of the incision and close the gap in the center of the gunsight suture,which theoretically facilitates early postoperative mobility and reduces the burden of dressing changes,thereby reducing the risk of postoperative complications.AIM To compare the effectiveness of improved gunsight suture technique with traditional interrupted suture in closing intestinal stomas.METHODS In this study,a retrospective,single-center case analysis was conducted on 270 patients who underwent prophylactic ileostomy closure surgery at the Department of Colorectal Surgery of Qilu Hospital from April 2017 to December 2021.The patients were divided into two groups:135 patients received sutures using the improved gunsight method,while the remaining 135 patients were sutured with the traditional interrupted suture method.We collected data on a variety of parameters,such as operation time,postoperative pain score,body temperature,length of hospital stays,laboratory indicators,incidence of incisional complications,number of wound dressing changes,and hospitalization costs.Non-parametric tests and chi-square tests were utilized for data analysis.RESULTS There were no statistically significant differences in general patient information between the two groups,including the interval between the first surgery and the stoma closure[132(105,184)d vs 134(109,181)d,P=0.63],gender ratio(0.64 vs 0.69,P=0.44),age[62(52,68)years vs 60(52,68)years,P=0.33],preoperative body mass index(BMI)[23.83(21.60,25.95)kg/m²vs 23.12(20.94,25.06)kg/m²,P=0.17].The incidence of incision infection in the improved gunsight suture group tended to be lower than that in the traditional interrupted suture group[(n=2/135,1.4%)vs(n=10/135,7.4%),P<0.05],and the postoperative hospital stay in the improved gunsight suture group was significantly shorter than that in the traditional interrupted suture group[5(4,7)d vs 7(6,8)d,P<0.05].Additionally,the surgical cost in the modified gunsight suture group was slightly lower than that in the traditional suture group[4840(4330,5138)yuan vs 4980(4726,5221)yuan,P>0.05],but there was no significant difference in the total hospitalization cost between the two groups.CONCLUSION In stoma closure surgery,the improved gunsight technique can reduce the incision infection rate,shorten the postoperative hospital stay,reduce wound tension,and provide better wound cosmetic effects compared to traditional interrupted suture.

Systematic review and meta-analysis of published randomized controlled trials comparing purse-string vs conventional linear closure of the wound following ileostomy(stoma)closure

Objective:The objective of this article is to systematically analyse the randomized,controlled trials comparing the effectiveness of purse-string closure(PSC)of an ileostomy wound with conventional linear closure(CLC).Methods:Randomized,controlled trials comparing the effectiveness of purse-string closure vs conventional linear closure(CLC)of ileostomy wound in patients undergoing ileostomy closure were analysed using RevMan-,and the combined outcomes were expressed as risk ratio(RR)and standardized mean difference(SMD).Results:Three randomized,controlled trials,recruiting 206 patients,were retrieved from medical electronic databases.There were 105 patients in the PSC group and 101 patients in the CLC group.There was no heterogeneity among included trials.Duration of operation(SMD:-0.18;95%CI:-0.45,0.09;z=1.28;P<0.20)and length of hospital stay(SMD:0.01;95%CI:-0.26,0.28;z=0.07;P<0.95)was statistically similar following both approaches of ileostomy wound closure.The risk of surgical site infection(OR,0.10;95%CI:0.03,0.33;z=3.78;P<0.0001)was significantly reduced when ileostomy wound was closed using PSC technique.Conclusion:PSC technique for ileostomy wound is associated with a reduced risk of surgical site infection apparently without influencing the duration of operation and length of hospital stay.

Rejection of Permacol~ mesh used in abdominal wall repair:A case report

Permacol mesh has shown promise when used in abdominal wall repair,especially in the presence of a contaminated surgical field.This biomaterial,derived from porcine dermis collagen,has proposed advantages over synthetic materials due to increased biocompatibility and reduced foreign body reaction within human tissues.However,we present a case report describing a patient who displayed rejection to a Permacol mesh when used in the repair of abdominal wound dehiscence following an emergency laparotomy.Review of the English language literature using PubMed and Medline, showed only two previously published cases of explantation of Permacoldue to sepsis or wound breakdown. The authors believe this is the first case of severe foreign body reaction leading to rejection of Permacol.Both animal and human studies show conflicting evidence of biocompatibility.There are several reports of successful use of Permacolto repair complex incisional herniae or abdominal walls in the presence of significant contamination.It appears from the literature that Permacolis a promising material,but as we have demonstrated,it has the potential to evoke a foreign body reaction and rejection in certain subjects.

Smart bioadhesives for wound healing and closure

The high demand for rapid wound healing has spurred the development of multifunctional and smart bioadhesives with strong bioadhesion,antibacterial effect,real-time sensing,wireless communication,and on-demand treatment capabilities.Bioadhesives with bio-inspired structures and chemicals have shown unprecedented adhesion strengths,as well as tunable optical,electrical,and bio-dissolvable properties.Accelerated wound healing has been achieved via directly released antibacterial and growth factors,material or drug-induced host immune responses,and delivery of curative cells.Most recently,the integration of biosensing and treatment modules with wireless units in a closed-loop system yielded smart bioadhesives,allowing real-time sensing of the physiological conditions(e.g.,pH,temperature,uric acid,glucose,and cytokine)with iterative feedback for drastically enhanced,stage-specific wound healing by triggering drug delivery and treatment to avoid infection or prolonged inflammation.Despite rapid advances in the burgeoning field,challenges still exist in the design and fabrication of integrated systems,particularly for chronic wounds,presenting significant opportunities for the future development of next-generation smart materials and systems.

Consensus on the application of negative pressure wound therapy of diabetic foot wounds

Because China is becoming an aging society,the incidence of diabetes and diabetic foot have been increasing.Diabetic foot has become one of the main health-related killers due to its high disability and mortality rates.Negative pressure wound therapy(NPWT)is one of the most effective techniques for the treatment of diabetic foot wounds and great progress,both in terms of research and its clinical application,has been made in the last 20 years of its development.However,due to the complex pathogenesis and management of diabetic foot,irregular application of NPWT often leads to complications,such as infection,bleeding and necrosis,that seriously affect its treatment outcomes.In 2020,under the leadership of Burns,Trauma and Tissue Repair Committee of the Cross-Straits Medicine Exchange Association,the writing group for‘Consensus on the application of negative pressure wound therapy of diabetic foot wounds’was established with the participation of scholars from the specialized areas of burns,endocrinology,vascular surgery,orthopedics and wound repair.Drawing on evidence-based practice suggested by the latest clinical research,this consensus proposes the best clinical practice guidelines for the application and prognostic evaluation of NPWT for diabetic foot.The consensus aims to support the formation of standardized treatment schemes that clinicians can refer to when treating cases of diabetic foot.

Use of antibacterial sutures for skin closure in controlling surgical site infections: a systematic review of published randomized, controlled trials

Objective:The objective of this article is to systematically analyse the randomized,controlled trials that compare the use of antibacterial sutures(ABS)for skin closure in controlling surgical site infections.Methods:Randomized,controlled trials on surgical patients comparing the use of ABS for skin closure in controlling the surgical site infections were analysed systematically using RevMan^(■)and combined outcomes were expressed as odds ratios(OR)and standardized mean differences(SMD).Results:Seven randomized,controlled trials evaluating 1631 patients were retrieved from electronic databases.There were 760 patients in the ABS group and 871 patients in the simple suture group.There was moderate heterogeneity among trials(Tau^(2)=0.12;chi^(2)=8.40,df=6[P<0.01];I^(2)=29%).Therefore in the random-effects model,the use of ABS for skin closure in surgical patients was associated with a reduced risk of developing surgical site infections(OR,0.16;95%CI,0.37,0.99;z=2.02;P<0.04)and postoperative complications(OR,0.56;95%CI,0.32,0.98 z=2.04;P=0.04).The durations of operation and lengths of hospital stay were similar following the use of ABS and SS for skin closure in patients undergoing various surgical procedures.Conclusion:Use of ABS for skin closure in surgical patients is effective in reducing the risk of surgical site infection and postoperative complications.ABS is comparable with SS in terms of length of hospital stay and duration of operation.

TLR3 activation induces S100A7 to regulate keratinocyte differentiation after skin injury

Human S100A7 (psoriasin) is highly expressed in psoriasis and other inflammatory diseases; however, the function of S100A7 in wound repair remains largely unknown. Here we demonstrated that skin injury increased the expression of S100A7. Damaged cells from wounded skin induced the expression of S100A7 via the activation of Toll-like receptor 3 (TLR3) followed by the activation of p38 MAPK. S100A7, in turn, acted on keratinocytes to induce the expression of terminal differentiation marker gene loricrin through the activation of p38 MAPK and caspase-1. The differentiation of keratinocytes induced by S100A7 resulted in skin stratification, thus efficiently promoting wound closure. Taken together, our results demonstrate that the activation of TLR3 accelerates wound closure via the induction of S100A7 to induce keratinocyte differentiation. These findings also provide new insights into the development of different forms of treatment with skin wounds.