Minimal active domain of human salivary histatin 1 is efficacious in promoting acute skin wound healing

Dear Editor,The skin barrier can be impaired by acute skin wounds,which may lead to a series of complications.It is essential to accelerate wound healing and rapidly restore the structural integrity and functionality of skin.One of the promising bioactive agents is human salivary histatin 1(Hst1),a 38-amino acid histidine-rich peptide that functions to maintain the homeostasis of oral mucosa with a cellular mechanism of promoting the adhesion,spreading,migration of epithelial cells and thus re-epithelialization[1].In recent years,Hst1 has been shown to be effective against various skin-related cell types,such as fibroblasts,myo-fibroblasts,keratinocytes and endothelial cells.In our latest in-vivo study,Hst1 not only promotes angiogenesis,re-epithelialization and collagen production,but also suppresses inflammation,thereby significantly accelerating acute skin wound healing in mice[2].All these studies show that Hst1 is a potent bioactive agent for accelerating acute skin wound healing.

Vancomycin lavage for the incidence of acute surgical site infection following primary total hip arthroplasty and total knee arthroplasty

BACKGROUND Surgical site infection is a rare but serious complication associated with total joint arthroplasty(TJA).There are limited data on the effectiveness of intrawound irrigation with vancomycin solution(1000 mg/L;2 L)before wound closure for preventing acute surgical site infection following primary total hip arthroplasty(THA)and total knee arthroplasty(TKA).AIM To investigate the effectiveness of prophylactic intraoperative application of vancomycin(1000 mg/L;2 L)solution vs.plain irrigation in reducing the incidence of acute surgical site infection following primary THA and TKA.METHODS A retrospective review of 2725 consecutive patients undergoing THA or TKA from January 2012–December 2019 was performed.These patients received either intrawound irrigation with normal saline before wound closure between January 2012 and December 2015(group 1,1018 patients;453 undergoing THA and 565 undergoing TKA)or intrawound irrigation with vancomycin solution(1000 mg/L)before wound closure between January 2016 and December 2019(group 2,1175 patients;512 undergoing THA and 663 undergoing TKA).The outcomes were the incidences of postoperative surgical site infection and wound healing complications within 3 mo of primary TJA.RESULTS There were no significant demographic differences between the 2 groups.There was a significantly higher incidence of acute infection at the surgical site in patients who received intrawound irrigation with normal saline before wound closure than in those who received intrawound irrigation with vancomycin solution(1000 mg/L;2 L)before wound closure(overall incidence of infection:group 1,2.46%vs group 2,0.09%,P<0.001).There was no significant difference in the incidence of wound healing complications between the two groups.CONCLUSION Prophylactic irrigation with vancomycin solution(1000 mg/L;2 L)significantly decreases the incidence of acute surgical site infection after primary TJA.This strategy is a safe,efficacious,and inexpensive method for reducing the incidence of acute surgical site infection after TJA.

Technological Advances in Accelerated Wound Repair and Regeneration

We reviewed a number of wound repair, keloid and hypertrophic scar research methods that included lasers, microcurrent and ultra-low energy technologies. Laser research reports short-term improvement in wounds, keloid and hypertrophic scars, but without follow up to control for reoccurrence of keloids or diabetic lesions which generally reoccur following laser treatments. The microcurrent and ultra-low energy studies demonstrate significant healing where age is not a factor with no reoccurrence of diabetic wounds and other skin lesions. Our randomized, double-blind longitudinal research on eight wound repair clinical cases with an age range of 28 - 86, followed for one year, evidenced accelerated healing and no reoccurrence. The number of treatments required for substantial healing depended on the chronicity and severity of the lesion, with chronic severe lesions requiring more treatments, rather than age, a conclusion supported by ultra-low microcurrent research. These results on age-independent wound healing directly contradict a large body of literature postulating that healing is much slower with age due to immune insufficiency, age-accumulated oxidative stress, disrupted cell communications and sustained inflammation.

Clinical Safety and Efficacy of Platelet-Rich Plasma in Wound Healing

Background: Platelet-rich plasma has been extensively used in several clinical settings. However, there still a lack of conclusive evidence concerning the benefits of platelet-rich plasma in the field of wound healing. We aimed to evaluate the safety and the efficacy of autologous platelet-rich plasma in acute wound healing. Methods: This prospective study enrolled forty adult patients of both sexes and aged between 18 - 50 years. All patients in need for split-thickness skin graft were included in our study. The donor sites were randomly divided into two equal halves: the platelet-rich plasma side, which was injected with recently activated platelet-rich plasma;and the control side, in which the conventional method of dressing was used. Measurement of the platelet count and transforming growth factor-B1 concentration in each platelet-rich plasma preparation and the whole blood was done for all patients. Clinical monitoring of the donor sites was done every 7 days for 3 weeks, regarding pain perception, epithelialization surface area and possible side effects of the platelet-rich plasma. Histopathological monitoring was done on the 7th postoperative day. Results: The platelet count was increased about 3.5 folds and transforming growth factor-B1 was increased 2.4 folds in the platelet-rich plasma compared to the patients’ blood. The platelet-rich plasma side had significantly lower pain scores at day 7 (4.8 ± 0.18 vs 5.9 ± 0.07) and day 14 (1.4 ± 0.11 vs 1.9 ± 0.09) postoperative (p = 0.002 and p = 0.004, respectively) and had significantly higher rate of epithelialization at day 7 (9.8 ± 0.35 cm2 vs 7.5 ± 0.32 cm2) and day 14 (38.4 ± 0.36 cm2 vs 36.9 ± 0.42 cm2) postoperative (p p = 0.039, respectively), while at day 21 postoperative, there was no significant difference between both sides. There was no significant difference between both sides regarding the incidence of complications. The platelet-rich plasma side showed intact epithelium, differentiation of the cells in stratum spongiosum and stratum granulosum, neovascularization and earlier collagen deposition. Conclusion: The platelet-rich plasma is safe and effective adjuvant in the management of acute wounds. However, we recommend for larger clinical trials for standardized method for PRP preparation and better understanding of the efficacy of this blood product.