Simultaneous, Asymmetrical, Comminuted and Bilateral Ballistic Fractures by Multiple Gunshot Wounds and a Review of Its Literature: A Case Report in Chad

Although open leg fractures are very common in orthopedics and traumatology, bilateral open leg fractures are extremely rare and are usually associated with an increased risk of complications. We report a case of a simultaneous, asymmetrical, comminuted and bilateral open fracture of the tibia and fibula by a firearm that occurred during an escape attempt in a 29-year-old prisoner. The pre-operative radiological assessment found an open fracture of both legs of the ballistic type;multiple traumatic gunshot wounds with a narrow entry hole and a wide exit hole. Early surgical intervention of intravenous antibiotics, tetanus prophylaxis and open fracture irrigation and debridement was performed within the 6 hour rule. The treatment consisted of a posterior splint followed by trimming andosteosynthesis using a FESSA external fixator from the military health service. A second operation was not needed. Evolution was favorable with ambulation starting from the 45th day. Simultaneous and bilateral tibia-fibula fractures by a firearm are exceptional, therefore, the treatment was surgical with the pre-operative and post-operative protocols well managed.

Establishment of a three-dimensional finite element model for gunshot wounds to the human mandible

Objective:To investigate the feasibility of a finite element model as an ideal research tool for human maxillofacial gunshot wounds.Methods:Mandible CT scan data on the Chinese Visible Human were imported into MIMICS software to obtain the surface mesh of the mandible.Then,these surface-meshed models were imported into ANSA software for automatic net generation.Elements and nodes were partitioned on the basis of the mesh to obtain a three-dimensional finite element model for the mandible with every internal parameter consistent with those of our previously developed model in the pig mandible.The finite element model was imported into LS-DYNA for computation.Finally,the LS-POST was used to complete the simulation and the measurements.Results:A three-dimensional finite element model was successfully established for gunshot wounds in the human mandible.The stress distribution and the degree of injury were simulated dynamically for shots from two types of projectiles in the mandible at one entry angle and at three impact velocities.Conclusion:Three-dimensional finite element models will become ideal research tools for treatment of ballistic wounds of the human maxillofacial region.Using this human mandibular model as a foundation,we will be able to successfully develop three-dimensional finite element models for human maxillofacial gunshot wounds.

Double-nylon purse-string suture in closing postoperative wounds following endoscopic resection of large(≥3 cm)gastric submucosal tumors

BACKGROUND Endoscopic full-thickness resection(EFTR)of gastric submucosal tumors(SMTs)is safe and effective;however,postoperative wound management is equally important.Literature on suturing following EFTR for large(≥3 cm)SMTs is scarce and limited.AIM To evaluate the efficacy and clinical value of double-nylon purse-string suture in closing postoperative wounds following EFTR of large(≥3 cm)SMTs.METHODS We retrospectively analyzed the data of 85 patients with gastric SMTs in the fundus of the stomach or in the lesser curvature of the gastric body whose wounds were treated with double-nylon purse-string sutures after successful tumor resection at the Endoscopy Center of Renmin Hospital of Wuhan University.The operative,postoperative,and follow-up conditions of the patients were evaluated.RESULTS All tumors were completely resected using EFTR.36(42.35%)patients had tumors located in the fundus of the stomach,and 49(57.65%)had tumors located in the body of the stomach.All patients underwent suturing with double-nylon sutures after EFTR without laparoscopic assistance or further surgical treatment.Postoperative fever and stomach pain were reported in 13(15.29%)and 14(16.47%)patients,respectively.No serious adverse events occurred during the intraoperative or postoperative periods.A postoperative review of all patients revealed no residual or recurrent lesions.CONCLUSION Double-nylon purse-string sutures can be used to successfully close wounds that cannot be completely closed with a single nylon suture,especially for large(≥3 cm)EFTR wounds in SMTs.

Tissue Regeneration in Infected Wounds of Albino Rats Using Ciprofloxacin-Loaded Gelatin Microspheres Incorporated Collagen Scaffold: A Histological Approach with H&E Staining

A wound care system consisting of ciprofloxacin-loaded gelatin microspheres impregnated in a macroporous collagen scaffold was created to effectively control wound infection and regenerate soft tissue at the wound site.Histological and biochemical alterations were observed in infected wounds treated with these scaffolds in Albino Wistar rats.Furthermore,the study examined the immediate and prolonged release of ciprofloxacin from the scaffolds,as well as their function in eliminating bacterial infections and expediting the process of skin healing and regeneration.The developed technique was followed in the streamlined process of creating these collagen scaffolds.Compared to untreated wounds,the group receiving scaffold treatment experienced a faster rate of wound closure.It was noted that the rate of infections was considerably reduced and that full soft tissue regeneration occurred within 12 days.The development of well-deposited collagen bundles in the treated groups was demonstrated by H&E staining,which verified the flawless regeneration of the dermis and epidermis.The antimicrobial agent-loaded gelatin microspheres impregnated into the porous collagen scaffold demonstrated remarkable soft tissue regeneration and efficient infection control at the wound site.

Management of Maxillofacial Gunshot Trauma in the Stomatology and Maxillofacial Surgery Departments of Ouagadougou

Introduction: Maxillofacial ballistic trauma is a serious injury that is difficult to manage, with significant complications and after-effects. The authors report their experience in managing this type of trauma in the context of insecurity linked to terrorism. Patients and Methods: This was a descriptive cross-sectional study with retrospective data collection covering the period from January 1, 2018 to December 31, 2022 in the stomatology and maxillofacial surgery departments of the university hospitals of Ouagadougou. Results: In 5 years, 52 patients were collected, i.e. 10.4 cases per year. The mean age of the patients was 31.46 ± 15.41 years, and the sex ratio was 3. In 67.31% of patients, these injuries were the result of shootings during terrorist attacks. The jugal (36.54%) and chin (32.69%) regions were the most affected. The mandible (36.54%) and zygomatic bones (28.85%) were the most injured bones in these traumas. All patients underwent surgical treatment, and 25% suffered secondary complications. All patients retained at least one sequela. Conclusion: Maxillofacial injuries caused by ballistic trauma are true emergencies that can be life-threatening and functionally disabling. Their management is delicate and the outcome is uncertain, hence, the prevention is important.

Zinc oxide nanoparticles accelerate the healing of methicillin-resistant Staphylococcus aureus(MRSA)-infected wounds in rabbits

Objective:To synthesize zinc oxide nanoparticles(ZnONPs)and evaluate their antibacterial and wound healing effects against wounds infected with methicillin-resistant Staphylococcus aureus(MRSA).Methods:ZnONPs were prepared by sol-gel method and characterized by X-ray diffraction(XRD)analysis and scanning electron microscopy(SEM).A total of 18 rabbits were divided into three groups:the ZnONPs group,the gentamicin group and the control group.A wound of 3 cm^(2) was inflicted on each rabbit and contaminated with MRSA inoculum.Treatment was started from the fourth day post-surgery.Wound healing,microbiological analysis,and histopathological analysis were performed to assess the efficacy of ZnONPs ointment.Results:XRD analysis confirmed the hexagonal wurtzite structure of the ZnONPs with an average crystallite size of 29.23 nm.SEM revealed discoid-shaped ZnONPs with a rough surface and an average size of 48.36 nm.Energy-dispersive X-ray analysis confirmed the purity of ZnONPs.Moreover,the particle size ranged from 100-700 nm with a high agglomeration trend.Treatment with ZnONPs promoted MRSA-infected wound healing.In addition,ZnONPs showed a good antibacterial effect as evidenced by a dose-dependent increase in the zone of inhibition.Conclusions:ZnONPs accelerate the healing of MRSA-infected wounds.Therefore,it can be explored for the treatment of MRSA infection.

Antibacterial Properties of Crateva adansonii (Capparidaceae) on Strains Isolated from Chronic Wounds Diagnosed in the Commune of Ouinhi in 2021

Plants have always been used by people for therapeutic purposes. They are still the main source of therapeutic substances in developing countries. Crateva adansonii, a member of the Capparidaceae family, is a medicinal plant with antibacterial properties used in Benin. The aim of this study was to assess the efficacy of an aqueous extract of C. adansonii on bacterial strains isolated from chronic wounds in the Ouinhi population. To achieve this, the bacterial flora present in chronic wounds was identified using the Ikram method (2014) coupled with the API Remoel One method. The antibacterial properties of the aqueous extract of C. adansonii on the microbial strains isolated were then assessed by determining the Inhibition Diameters (ID), the Minimum Inhibitory Concentrations (MIC) and finally the Minimum Bactericidal Concentrations (MBC). A total of eighty (80) strains were isolated and identified on the basis of morphological, cultural and biochemical characteristics. The species S. Aureus species accounted for the largest proportion (67.5%). Other species such as Listeria sp, Pseudomonas proteus, S. epidermidis and Bacillus cereus, Citrobacter freundii, Steno maltophila;Axin calcoaceticus, E. coli, K. pneumonia, Lem. richardii, Salmonella paratyphi A, Salmonella sp, Shigella sp were determined in variable proportions. At a concentration of 10 mg/ml, only S. aureus was sensitive to contact with the extract. However, at 20 mg/ml, 89% of strains were sensitive and 11% very sensitive. The highly sensitive strains are Salmonella sp and E. coli. The Minimum Inhibitory Concentration (MIC) and Minimum Bactericidal Concentration (MBC) are 20 mg/ml and 40 mg/ml respectively. The MBC/MIC ratio of the aqueous mixture of Crateva adansonii (Capparidaceae) varied from 1.2 to 2, with a bactericidal effect on 100% of the strains tested.

Diabetic wounds and artificial intelligence:A mini-review

Diabetic wound takes longer time to heal due to micro and macro-vascular ailment.This longer healing time can lead to infections and other health complications.Foot ulcers are one of the most common diabetic wounds.These are one of the leading cause of amputations.Medical science is continuously striving for improving quality of human life.A recent trend of amalgamation of knowledge,efforts and technological advancement of medical science experts and artificial intelligence researchers,has made tremendous success in diagnosis,prognosis and treatment of a variety of diseases.Diabetic wounds are no exception,as artificial intelligence experts are putting their research efforts to apply latest technological advancements in the field to help medical care personnel to deal with diabetic wounds in more effective manner.The presented study reviews the diagnostic and treatment research under the umbrella of Artificial Intelligence and computational science,for diabetic wound healing.Framework for diabetic wound assessment using artificial intelligence is presented.Moreover,this review is focused on existing and potential contribution of artificial intelligence to improve medical services for diabetic wound patients.The article also discusses the future directions for the betterment of the field that can lead to facilitate both,clinician and patients.

Management of Complex Wounds with Dermal Substitute Assisted by a Negative Pressure System

Introduction: The standard treatment for complex wound care is autografting. The advent of dermal substitutes has provided a novel tool for the preparation of the bed to be grafted. However, most types of dermal matrices require the application of a skin graft a second time. Currently, other strategies have been developed to improve the vascularization process, such as negative pressure wound therapy (NPWT), which has been reported to reduce the time required for vascular growth and dermal matrix integration and thus achieve a shorter waiting period for autologous graft application. The present study aims to evaluate the effectiveness and safety of dermal matrix management associated with NPWT in the treatment of complex wounds. Methods: Seven patients with a diagnosis of complex wounds were enrolled in this study between July 1, 2015, and June 31, 2016. After debridement and having an adequate wound bed, patients who met the criteria for the application of combined therapy were treated with dermal substitutes and a negative pressure system. The percentage of graft integration into the wound bed, complications, length of hospital stay, and duration of therapy were analyzed. Results: The mean age was 42.5 ± 16 (39 - 54) years old;three women and four men were included in the study. The approximate size of skin loss was 120.7 ± 75 cm2 (25 - 250 cm2). The combined therapy of dermal matrix plus NPWT was instituted in all cases for a period of 14 days. There were no complications, with 100% graft integration in 6 of 7 cases. Patients were discharged after a mean hospital stay of 5.4 days. Conclusions: This study demonstrates that the utilization of combined dermal matrix plus NPWT therapy can be performed safely and effectively in patients with complex wounds with low complication rates and a short hospital stay.

Combination of dura turning-over and decompressive craniectomy： a new pattern of surgery for cerebral infarction caused by craniocerebral gunshot injury

Background:Craniocerebral gunshot injury refers to a wound caused by a bullet passing through or lodged in brain tissue,resulting in the loss of function of a certain area or other fatal damage to the human brain.Craniocerebral gunshot injury is usually life-threatening and is very common in modern warfare,accounting for the majority of battle casualties.Most of the patients suffer from acute cerebral infarction caused by vascular injury.Lack of early and solid battlefield emergency medical interference adds to the risk of death among the wounded.Case presentation:We present a 24-year-old man who was shot with a shotgun from a distance of 15m in an accidental injury.Forty-seven grape shots were found on his body surface by physical examination.A computed tomography(CT)scan demonstrated large areas of low-density shadows in his right parietal lobe and right temporal lobe with the midline shifting to the left side 2 days later.Afterwards,the patient was transferred to our emergency medical center at Changzheng Hospital in Shanghai.Cranial computed tomography angiography(CTA)showed a high-density shadow in the initial part of the right middle cerebral artery.The branches after the initial part were obliterated.Prompt medical attention and decompressive craniotomy(DC)surgery contributed to the final recovery from cerebral infarction of this patient.Conclusion:Bullets can penetrate or be lodged in the brain,causing intracranial hypertension.The bullets lodged in the brain can result in stenosis and embolism of a cerebral artery,causing acute cerebral infarction.Combining dura turning-over surgery with DC surgery can not only decrease intracranial pressure,which can increase the blood supply for hypertension-induced vessel stenosis,but also help vessels outside the dura mater grow into ischemic areas of the cerebral cortex.However,this new pattern of surgery needs further support from evidence-based medicine.

Civilian gunshot wounds to the head:a case report,clinical management,and literature review

Background:Civilian gunshot wounds to the head refer to brain injury caused by projectiles such as gun projectiles and various fragments generated by explosives in a power launch or explosion.Gunshot wounds to the head are the deadliest of all gun injuries.According to literature statistics,the survival rate of patients with gunshot wounds to the head is only 9%.Due to the strict management of various types of firearms,they rarely occur,so the injury mechanism,injury and trauma analysis,clinical management,and surgical standards are almost entirely based on military experience,and there are few related reports,especially of the head,in which an individual suffered a fatal blow more than once in a short time.We report a case with a return to almost complete recovery despite the patient suffering two gunshot injuries to the head in a short period of time.Case presentations:We present a case of a 53-year-old man who suffered two gunshot injuries to the head under unknown circumstances.On initial presentation,the patient had a Glasgow Coma Scale score of 6,was unable to communicate,and had loss of consciousness.The first bullet penetrated the right frontal area and finally reached the right occipital lobe.When the patient reflexively shielded his head with his hand,the second bullet passed through the patient’s right palm bone,entered the right frontotemporal area,and came to rest deep in the lateral sulcus.The patient had a cerebral hernia when he was admitted to the hospital and immediately entered the operating room for rescue after a computed tomography scan.After two foreign body removals and skull repair,the patient recovered completely.Conclusions:Gunshot wounds to the head have a high mortality rate and usually require aggressive management.Evaluation of most gunshot injuries requires extremely fast imaging examination upon arrival at the hospital,followed by proactive treatment against infection,seizure,and increased intracranial pressure.Surgical intervention is usually necessary,and its key points include the timing,method,and scope of the operation.

Benefits of multidisciplinary collaborative care team-based nursing services in treating pressure injury wounds in cerebral infarction patients

BACKGROUND Cerebral infarction patients need to be bedridden for long periods of time often resulting in pressure injuries,which may represent a serious threat to patients'life and health.An effective nursing program should be adopted for timely intervention in patients with pressure wounds.AIM To explore the value of nursing services based on a multidisciplinary collaborative treatment team in patients with pressure injury wounds following cerebral infarction.METHODS Patients with cerebral infarction pressure injury wounds in our hospital from December 2016 to January 2021 were selected and divided into one study group and one control group based on the simple random number table method.The control group was treated with conventional nursing care(CNC),and the study group was treated with care services based on multidisciplinary collaborative care(MDCC).The Pressure Ulcer Scale for Healing(PUSH),healing effect,Self-Perceived Burden Score(SPBS),and satisfaction with the intervention were calculated before and after 2 and 4 wk of intervention in both groups.RESULTS Sixty-two patients were enrolled,and 31 patients were assigned to each group.The results of the interventions were as follows:(1)There was no significant difference between the PUSH scores of the MDCC group(11.19±2.46)and CNC group(12.01±2.79)before the intervention(P>0.05),and the PUSH scores were lower after 2 and 4 wk of intervention in the MDCC group(6.63±1.97 and 3.11±1.04)than in the CNC group(8.78±2.13 and 4.96±1.35 points)(P<0.05);(2)The rate of wound healing in the MDCC group(96.77%)was higher than that in the CNC group(80.65%)(P<0.05);(3)There was no significant difference between the SPBS scores of emotional factors(21.15±3.11),economic factors(9.88±2.15),and physical factors(8.19±2.23)in the two groups before the intervention.The scores of emotional factors(13.51±1.88),economic factors(6.38±1.44),and physical factors(5.37±1.08)were lower in the MDCC group than in the CNC group(16.89±2.05,7.99±1.68 and 7.06±1.19)after 4 wk of intervention(P<0.05);and(4)Satisfaction with the intervention was higher in the MDCC group(93.55%)than in the CNC group(74.19%)(P<0.05).CONCLUSION Interventions for patients with cerebral infarction pressure wounds based on an MDCC treatment team can effectively reduce patients'self-perceived burden,improve pressure wound conditions,facilitate wound healing,and increase patient satisfaction with the intervention.

Temporary Cavity Effects of High Velocity Spherical Steel Bullet Wounds in Maxillofacial Region of Dogs

Maxillofacial region wounds of dogs were inflicted by spherical steel bullets,0.7 g weight,with the muzzle velocity of 1.3 km/s.The photographs of the temporarycavity were taken with a high speed x-ray cine-camera,and local wounding conditionswere observed with the naked eye.The experimental results proved that a temporary ca-vity was formed in the maxillofacial region wound.The contusion zone of the maxillofa-cial soft tissue was smaller than that of the extremities.The contusion zone of the skinand oral mucous membrane was 1-2 mm,and that of muscle was 5-8 mm in thickness.In clinical situation,the tissues of the contusion zones should always be excised since itconsists of devitalized tissue.The temporary cavitation is an important factor in causingstructural injuries of tissues around the local wound track.

Evaluation of follow-up and long-term outcomes of gunshot and stab wounds in a French civilian population

Purpose The data concerning long-term follow-up and outcomes of penetrating trauma are poorly detailed in the literature.The main objective of our study was to analyze the hospital and extra-hospital follow-up of penetrating trauma victims and to evaluate the late complications and long-term consequences of these traumas.Methods This work was a retrospective longitudinal monocentric observational study conducted at Laveran Military Hospital,from January 2007 to January 2017.All patients hospitalized for gunshot wound or stab wound management during this period were identified via a retrospective systematic query in the hospital information system using the ICD-10 codes.Epidemiological data,traumatism characteristics,hospital management,follow-up and traumatism consequences(i.e.,persistent disability)were analyzed.To improve evaluation of traumatism long-term consequences,extra-hospital follow-up data from general physicians(GP)were collected by phone call.During this interview,9 closed questions were asked to the GP.The survey evaluated:the date of the last consultation related to injury with the GP,the specific follow-up carried out by the GP,traumatism consequences,and recurrence of traumatism.Descriptive,univariate and multivariate with regression analysis were used for statistical analysis.Results A total number of 165 patients were included.Median(Q1,Q3)of hospital follow-up was 28(4,66)days.One hundred one patients(61.2%)went to their one-month consultation at hospital.GP follow-up was achieved for 76 patients(55.2%).Median(Q1,Q3)of GP follow-up was 47(21,75)months.Twenty-four patients(14.5%)have been totally lost to follow up.The overall follow-up identified 54 patients(32.7%)with long-term consequences,20 being psychiatric disorders and 30 organic injuries.Organic consequences were mainly peripheral nerve damages(n=20;12.1%).Most of the psychiatric consequences were diagnosed during GP follow-up(n=14;70%).Seventeen cases(10.3%)of recurrence were found and late mortality occurred in 4 patients(2.4%).High injury severity score,older age and gunshot wound were significantly linked to long-term consequences.Data collection and analysis were carried out in accordance with MR004 reference methodology.Conclusion This study showed a high rate of long-term consequences among patients managed for penetrating injury.If all organic lesions are diagnosed during hospital follow-up and jointly managed by hospital and extra-hospital physicians,most socio-psychiatric consequences were detected and followed by extra-hospital workers.However,for half of the patients,the extra-hospital follow-up could not be assessed.Thus,these consequences are very probably underestimated.It appears imperative to strengthen the compliance and adherence of these patients to the care network.Awareness and involvement of medical,paramedical teams and GP role seems essential to screen and manage these consequences.

Experimental study on early repair of oromaxillofacial perforating soft tissue defect due to gunshot in dogs

The left cheek of 8 adult male mongrel dogs was shot with M1935.56mm bul-let fired through an US-made M16 rifle to result in a perforating soft tissue defect.Pri-mary debridement was performed immediately and the secondary debridement 72h alter in-jury.After the secondary thorough debridement,the cutaneous side of the defect was re-paired with a saphenous artery-vein free skin(muscular)flap using microvascularanastomosis,and the oral side of the defect was repaired by drawing the surroundingmucosa together and fixing with sutures or with a local sliding mucous membrane flap.All the animals were kept under observation for 2～6 months.It was believed that the pri-mary debridement and secondary thorough debridement were both essential. The survivalrate of the free tissue flap was 75%(6/8).These facts suggest that early repair ofthe oromaxillofacial perforating soft tissue defect due to gunshot is practicable.

Internal Fixation of Gunshot Induced Fractures in Civilians: Anatomic and Functional Results of a Standard Protocol at an Urban Trauma Center

Introduction: Despite extensive experience with civilian gunshot fractures or wounds, no consensus exists on a standard protocol to manage these injuries. Many authors recommended immediate debridement, but the optimal timing of internal fixation and the use of antibiotic have not been determined. The purpose of this paper is to present and discuss our experience. Material and methods: In January 2007, a treatment protocol was put in place for the evaluation and management of fractured extremities resulting from civilian gunshot wounds. Sixty-three patients with 64 fractures had been managed by this protocol for gunshot fractures between January 2005 and January 2012. There were 56 male and seven female. Their mean age was 33.1 years (range: 17 - 61 years). Thirteen patients (20.6%) were able to provide a description of the weapon. Only 15 patients had entry and exit wounds. The mean follow-up period was 27 (range, 20 - 58) months. The main factors assessed were the surgical site infection, the fracture union and the functional status. Results: Out of the 63 patients, 14 patients developed a wound infection (five superficial and seven deep infections). Wound infection was significantly associated with associated injuries (p = 0.0388), fractures sites requiring fixation (p = 0.024), the fracture pattern (p = 0.0412), operative modalities (p = 0.0400). There were nine cases (14.1%) of fracture non-union. The mean time to union was 15 weeks (range: 5 - 32 weeks). Five patients developed chronics osteomyelitis. The average SMFA score for all of the patients was 23.8 (range: 0 - 56.3). The mean dysfunctional and bother indexes were 18.3 (range: 0 - 52.7) and 22.6 (range: 0 - 66.1), respectively. The SMFA total score and dysfunction index had a significant correlation based on presence or absence of associated injuries (p < 0.0001). But bother index did not show the same correlation (p = 0.452). The average length of hospital stay was 11.3 days (range: 3 - 64). Conclusion: In civilian’s gunshot induced fractures, internal fixation can be made according to standard protocol, with acceptable result.

Gunshot Wound to the Head: Surgical Management and Cases Report in a Tertiary Care Center in Florencia, Colombia

The purpose of this research is to report 10 cases treated in a tertiary care center in the Florencia town in Colombia. The time frame to this intervention was from 1st June 2011 to 30th June 2012. The idea was to establish the type, age group, Matson’s classification schemes and mortality of the gunshot wound to the head in order to describe the neurological functional prognosis of these patients, made by The Modified Rankin scale (mRS) to 12 months postoperative.

OnabotulinumtoxinA in the Treatment of Occipital Neuralgia Following Gunshot Injury

Occipital neuralgia, while typically idiopathic in presentation, is a common form of posttraumatic headache. It is associated with severe pain in the greater, lesser, and/or third occipital nerves, and often accompanied by tenderness or trigger points in the surrounding musculature. OnabotulinumtoxinA (ONA) has been recently utilized in nerve blocks to treat occipital neuralgia, but current literature supporting such use is scarce. We describe a case of occipital neuralgia in a patient following C1 fracture and vertebral artery dissection due to gunshot injury. Successful treatment with bilateral ONA nerve blocks led to an 80% - 90% improvement in pain, with decreased Visual Analog Scale (VAS) pain scores immediately following treatment and upon follow-up 1 month later.

Antibacterial activities of selected medicinal plants in traditional treatment of human wounds in Ethiopia

Objective:To evaluate the activity of selected Ethiopian medicinal plants traditionally used for wound treatment against wound-causing bacteria.Methods:Samples of medicinal plants(Achyranthes aspera,Brucea antidysenteriea,Datura stramonium,Croton macrostachyus,Acokanthera xchimperi.,Phytolacca dodecandra,Milhttia ferruginea,and Solanum incanum)were extracted using absolute methanol and water and tested for their antimicrobial activities against clinical isolates and standard strains of wound-causing bacteria using agar well diffusion and micro titer plate methods.Results:Most of the plant extracts had antibacterial activities,among which Acokanthera schimperi and Brucea antidysenteriea inhibited growth of 100%and 35%of the test organisms,respectively.Methanolic extracts had higher activities compared with their corresponding aqueous extracts.The most susceptible organism to the extracts was Streptococcus pyogens while the most resistant were Escherichia coli and Proteus vulgaris.Conclusions:This finding justifies the use of the plants in wound healing and their potential activity against woundcausing bacteria.Their toxicity level and antimicrobial activity with different extraction solvents should further be studied to use them as sources and templates for the synthesis of drugs to control wound and other disease-causing bacteria.

Surgical treatment for rabbits' femoral arteries subjected to gunshot wounds combining with seawater immersion

Objective: To investigate the surgical treatment methods and evaluate the outcome of gunshot wounds combining with seawater immersion in rabbits’ femoral arteries. Methods: One hundred healthy New Zealand white rabbits (either sex, 3.14 kg± 0.61 kg in weight) were randomly divided into a seawater immersion group (n=50) and a simple injury group (n=50). The unilateral femoral arteries of all the rabbits were injured by 0.38 g steel spheres with velocity of 600-800 m/s fired by a 7.62 mm rifle. The rabbits in the seawater immersion group were immersed in seawater (saline content of 2.54%, pH 8.2- 8.4, and at 21℃) for 60 minutes but those in the simple injury group were not. After the injured segment (observed by naked eyes) of the femoral artery was excised, the blood flow restoration was reconstructed by direct end-to-end anastomosis, reversed autogenous venous grafting or cryopreserved arterial allografting, according to the length of the arterial defects. At 24 hours, and 7, 14 and 21 days after operation, the blood flow was examined. Operative exploration was performed for the animals with partly or fully obstructed blood flow. The tissues around the anastomosis sites and the grafts were harvested for pathological observation under a light microscope and an electron microscope. Results: In the rabbits with completely transected injury, the unobstructed rates in the first 3 weeks after operation were 80.00% in the seawater immersion group and 86.67% in the single injury group, and no significant difference was found between the two groups (P> 0.1). In the rabbits with arterial contusion injury, the unobstructed rates in the first 3 weeks after operation were 86.67% in the seawater immersion group and 82.35% in the single injury group, and no significant difference was found between the two groups (P> 0.1). Most thrombosis occurred in the first operative week. Atypical endothelial cells were detected at the anastomosis sites at the first operative week, and the anastomosis sites were lined with endothelial cells in 3 weeks postoperatively. Conclusions: During the surgical treatment for gunshot wounds combining with seawater immersion, resection of the grossly-injured artery and routine artery reconstruction can obtain satisfactory outcome. Homologous artery is a kind of vascular graft with certain applied value.