Amnion membrane hydrogel and amnion membrane powder accelerate wound healing in a full thickness porcine skin wound model.
Murphy Sean V,Skardal Aleksander,Nelson Ronald A,Sunnon Khiry,Reid Tanya,Clouse Cara,Kock Nancy D,Jackson John,Soker Shay,Atala Anthony
Stem cells translational medicine
There is a need for effective wound treatments that retain the bioactivity of a cellular treatment, but without the high costs and complexities associated with manufacturing, storing, and applying living biological products. Previously, we developed an amnion membrane-derived hydrogel and evaluated its wound healing properties using a mouse wound model. In this study, we used a full thickness porcine skin wound model to evaluate the wound-healing efficacy of the amnion hydrogel and a less-processed amnion product comprising a lyophilized amnion membrane powder. These products were compared with commercially available amnion and nonamnion wound healing products. We found that the amnion hydrogel and amnion powder treatments demonstrated significant and rapid wound healing, driven primarily by new epithelialization versus closure by contraction. Histological analysis demonstrated that these treatments promote the formation of a mature epidermis and dermis with similar composition to healthy skin. The positive skin regenerative outcomes using amnion hydrogel and amnion powder treatments in a large animal model further demonstrate their potential translational value for human wound treatments.
Hemiacidrin irrigation in the management of struvite calculi: long-term results.
Sant G R,Blaivas J G,Meares E M
The Journal of urology
Renacidin (10 per cent hemiacidrin) irrigation has been used in the management of renal struvite calculi in 25 patients. Of these patients 22 were free of stone after irrigation: 16 after dissolution of residual stone fragments postoperatively, 4 after prophylactic postoperative irrigation and 2 after primary, nonsurgical percutaneous dissolution. Recurrent urinary tract infections owing to the original urease-producing bacteria occurred in 14 per cent of these patients and recurrent nephrolithiasis occurred in 9 per cent during an average followup period of 66 months.
Dissolution of struvite urinary stones. Experimental studies in vitro.
Griffith D P,Bragin S,Musher D M
Previous studies from our laboratory have shown that struvite crystals form primarily as a result of urease-induced alkalinity and supersaturation. In vitro perfusion of struvite crystals with undersaturated urine caused crystal dissolution. The investigations reported herein demonstrate complete dissolution of human struvite urinary stones during 6 weeks of perfusion in vitro with undersaturated human urine. Human hydroxyapatite stones perfused similarly underwent only slight dissolution. A glycoprotein precipitated as the stones dissolved; the pathogenic significance of the glycoprotein is unknown.
Dissolution of struvite calculi by hemiacidrin solution.
Massaro F J,Weiner B,Sant G R,Meares E M
Struvite calculi result from urinary tract infections secondary to urease-producing bacteria. To prevent recurrent infection and stone formation complete removal of struvite calculi is recommended. Two illustrative reports of patients with renal struvite calculi are presented in which 10% hemiacidrin (Renacidin) irrigation was instituted for stone dissolution. After surgical removal of the calculi a nephrostomy tube was placed in the renal pelvis. With confirmation of residual struvite calculi, 10% hemiacidrin irrigation was initiated. Urine cultures, electrolytes and nephrotomograms were performed and adverse effects monitored. Using strict aseptic technique and appropriate precautions, hemiacidrin irrigation safely dissolves struvite calculi.
In vitro dissolution of calcium oxalate stones with ethylenediaminetetraacetic acid and snake venom thrombin-like enzyme.
Zhou Xiang-Jun,Zhang Jie,Zhang Ci,Xu Chang-Geng
OBJECTIVE:The aim of this study was to determine the feasibility of using snake venom thrombin-like enzyme (SVTLE) and/or ethylenediaminetetraacetic acid (EDTA) to dissolve calcium oxalate stones in vitro. METHODS:Seven calcium oxalate stones were incubated with various chemolytic agents [EDTA, Tris-HCl/EDTA (TE) buffer or SVTLE diluted in TE buffer]. The pH, calcium concentration, stone weight and stone surface integrity were recorded, as well as related pathological changes to bladder mucosae. RESULTS:Compared to all other solutions, those containing SVTLE and buffered EDTA had higher concentrations of mobilized calcium and caused significantly more stone weight loss, stone fragility and gaps in the calcium crystals. Also, there were no adverse pathological effects on rabbit bladder mucosae from any of the solutions. CONCLUSIONS:The data indicate that buffered EDTA and SVTLE can be used to dissolve calcium oxalate stones and, at the concentrations used here, do not damage tissue.
Diagnosis, medical treatment, and prognosis of feline urolithiasis.
Osborne C A,Lulich J P,Thumchai R,Bartges J W,Sanderson S L,Ulrich L K,Koehler L A,Bird K A,Swanson L L
The Veterinary clinics of North America. Small animal practice
Radiographic or ultrasonographic evaluation of the urinary tract is required to consistently detect feline uroliths. Evaluation of clinical, laboratory, and radiographic findings facilitate "guesstimation" of the mineral composition of uroliths. Therapy should not be initiated before appropriate samples have been collected for diagnosis. The objectives of medical management of uroliths are to arrest further growth and to promote urolith dissolution by correcting or controlling underlying abnormalities. For therapy to be effective, it must induce undersaturation of urine with calculogenic crystalloids by (1) increasing the solubility of crystalloids in urine, (2) increasing the volume of urine in which crystalloids are dissolved or suspended, and (3) reducing the quantity of calculogenic crystalloids in urine.
Medical dissolution of feline struvite urocystoliths.
Osborne C A,Lulich J P,Kruger J M,Polzin D J,Johnston G R,Kroll R A
Journal of the American Veterinary Medical Association
The efficacy of a diet designed to facilitate dissolution of feline magnesium ammonium phosphate (struvite) uroliths was evaluated in 30 cases of urolithiasis, sterile struvite uroliths dissolved in a mean of 36 days after initiation of dietary treatment. In 5 cases of urolithiasis, struvite urocystoliths associated with urease-negative bacterial urinary tract infection dissolved in a mean of 23 days after initiation of dietary and antimicrobial treatment. In 3 cases of urolithiasis, struvite urocystoliths associated with urease-positive staphylococcal urinary tract infection dissolved in a mean of 79 days after initiation of dietary and antimicrobial treatment. Dissolution of uroliths in cats fed the treatment diet was associated with concomitant remission of dysuria, hematuria, and pyuria, and reduction in urine pH and struvite crystalluria. In one case, a urocystolith composed of 100% ammonium urate, and in another case, a urolith composed of 60% calcium phosphate, 20% calcium oxalate, and 20% magnesium ammonium phosphate did not dissolve.
The various types of parenteral fluids and their indications.
Mathews K A
The Veterinary clinics of North America. Small animal practice
Assessment of hydration and perfusion is essential in patient evaluation. The acid-base and electrolyte disturbances that accompany many illnesses should also be considered. The duration of illness and body systems involved are also of major importance in patient evaluation. Fluid therapy is an important and potentially life-saving treatment of many and varied problems. The clinician must be able to assess the patient and determine whether the intravascular or extravascular compartments, or both, are deficient. Of primary concern is the status of the intravascular volume, then restoration of total body water and electrolytes. Fluid therapy is divided into three phases; the emergency phase, the rehydration phase, and the maintenance phase; not all patients require the three-phase therapy. The clinician must also be able to select (1) the appropriate solution to treat the volume deficit and correct the acid-base and electrolyte abnormalities and (2) the rate of administration to optimize outcome. Therefore, knowledge of electrolyte composition in plasma and of the various types of commercially available fluids is essential in order to select the appropriate therapy for the individual animal. In addition to the therapeutic aspects of fluid therapy, a knowledge of the side effects and complications of inappropriate fluid selection and rate of delivery is also important. With the individual requirements of each patient seen in a practice, the prescription approach to parenteral fluid therapy will optimize patient response to this extremely important aspect of overall patient management as well as make the practice of fluid therapy intellectually stimulating. This article has introduced the clinician to the parenteral fluids available and their indications in veterinary patients; it also contains a discussion of how to utilize preferred solutions for treatment of specific diseased states. Although there are definite "right" and "wrong" fluids to select for specific problems, there also remains individual preference in fluid choice, which is based on appropriate laboratory data and the practitioner's clinical judgment of the status of the individual patient vis-à-vis the spectrum of its disease. Recommendations for selection of different fluid types to treat similar conditions are usually based on these variables.
The phospholipid composition of plasma in various mammalian species.
Nelson G J
Plasma phospholipids in several common mammalian species, including cat, cow, dog, goat, guinea pig, horse, pig, rabbit, rat, and sheep, were analyzed by using chromatographic and spectrophotometric methods. Lipids were extracted from plasma with chloroform-methanol 2ratio1 (v/v) and freed of nonlipid material by passage through a Sephadex column. The phospholipids were separated by two-dimensional thin-layer chromatography (TLC). Spots were identified by spray reagents, also by infrared spectrophotometry. The relative distribution of the phospholipids was determined by phosphorus analysis on the spot scraped off the TLC plate.Lecithin, lysolecithin, and sphingomyelin were found in the plasma of all species and accounted for more than 95% of the phospholipids except in the rodents. Lecithin was without exception the major phospholipid in plasma (56 to 83%). Lysolecithin and sphingomyelin content varied between 8 and 23% and 6 and 15% respectively. Phosphatidyl ethanolamine and phosphatidyl inositol were the only noncholine-containing phospholipids detected (detection limits 0.2%) in the plasma of these species. Together these compounds usually made up less than 5% of the total phospholipid. Rodents were an exception, especially the guinea pig, which had 21.7% phosphatidyl ethanolamine.
Antibacterial and Cellular Response Toward a Gasotransmitter-Based Hybrid Wound Dressing.
Pant Jitendra,Pedaparthi Shriya,Hopkins Sean P,Goudie Marcus J,Douglass Megan E,Handa Hitesh
ACS biomaterials science & engineering
Biological processes such as infection, angiogenesis, and fibroblast proliferation and migration need to be regulated for effective healing of a wound. Failing to do so can delay the overall wound healing and add to the suffering and healthcare cost. Endogenous nitric oxide (NO) is a well-known gasotransmitter in the natural healing process in humans and other mammals. To utilize its inherent ability in the current study, an exogenous NO donor (-nitroso-glutathione, GSNO) was integrated into a hybrid formulation consisting of a natural polymer (alginate) and a synthetic polymer (poly(vinyl alcohol) (PVA)). The alginate-PVA-GSNO dressings showed a sustained NO release for 72 h that resulted in 99.89 ± 0.40% and 98.93 ± 0.69% eradication of and , respectively, which are among the most common causal agents of wound infections. The designed dressings resulted in a 3-fold increase in the proliferation of human endothelial cells when compared with control without GSNO showing its angiogenic potential. In addition, mouse fibroblast cells exposed to leachates from alginate-PVA-GSNO dressings showed significantly higher proliferation when compared to control alginate-PVA showing the NO release from exogenous GSNO in fibroblast proliferation. Fibroblast migration was shown to be much faster with GSNO-based dressings when compared to corresponding control dressings resulting in complete closure of an in vitro wound model within 48 h. The porous dressings also possessed important physical properties such as swelling, water vapor transmission, and moisture content that are desirable for effective wound healing. Overall, this study supports the possibility of using therapeutic alginate-PVA-GSNO dressing to provide a supportive environment for accelerated wound healing.
A novel lignin-based nanofibrous dressing containing arginine for wound-healing applications.
Reesi Fatemeh,Minaiyan Mohsen,Taheri Azade
Drug delivery and translational research
Nanofiber-based wound dressings have attracted much attention in wound care owing to their unique properties such as high aspect ratio and three-dimensional structure. Arginine is a precursor of nitric oxide that plays an important role in the wound-healing process. Therefore, in this study, we have developed a gel which contains lignin nanofibers (Lig-NFs) that were surface modified by arginine molecules via electrostatic interaction (Arg-Lig-NF gel). The effect of pH on the amount of arginine attached on Lig-NF surface was evaluated at three different pH values-5, 6, and 7. Fourier transform infrared spectroscopy and zeta potential of Lig-NFs before and after surface modification confirmed the surface modification of Lig-NFs with arginine molecules. The optimum gel composed of uniform Arg-Lig-NFs with diameter ranging from 100 to 250 nm. There was 184.60 ± 4.85 mg arginine in each gram of optimum gel. The release of arginine from Arg-Lig-NF gel showed a sustained release manner, and about 86.28 ± 3.50% of attached arginine were released after 24 h. Moreover, the optimum gel presented suitable viscosity and spreadability for topical application. The in vivo full thickness wound-healing assay carried out in rats demonstrated that the optimum Arg-Lig-NF gel can accelerate wound closure and increase re-epithelialization, collagen deposition, and angiogenesis significantly in Arg-Lig-NF gel-treated wounds compared to Lig-NF gel and arginine solution. Overall, these findings demonstrate that Arg-Lig-NF gel can be a promising material for the future development of effective hydrocolloid wound dressings used in the treatment of acute and chronic wounds.
In Situ Hydrogel-Forming/Nitric Oxide-Releasing Wound Dressing for Enhanced Antibacterial Activity and Healing in Mice with Infected Wounds.
Lee Juho,Hlaing Shwe Phyu,Cao Jiafu,Hasan Nurhasni,Ahn Hye-Jin,Song Ki-Won,Yoo Jin-Wook
The eradication of bacteria from wound sites and promotion of healing are essential for treating infected wounds. Nitric oxide (NO) is desirable for these purposes due to its ability to accelerate wound healing and its broad-spectrum antibacterial effects. We developed an in situ hydrogel-forming/NO-releasing powder dressing (NO/GP), which is a powder during storage and forms a hydrogel when applied to wounds, as a novel NO-releasing formulation to treat infected wounds. An NO/GP fine powder (51.5 μm) was fabricated by blending and micronizing S-nitrosoglutathione (GSNO), alginate, pectin, and polyethylene glycol (PEG). NO/GP remained stable for more than four months when stored at 4 or 37 °C. When applied to wounds, NO/GP absorbed wound fluid and immediately converted to a hydrogel. Additionally, wound fluid triggered a NO release from NO/GP for more than 18 h. The rheological properties of hydrogel-transformed NO/GP indicated that NO/GP possesses similar adhesive properties to marketed products (Vaseline). NO/GP resulted in a 6-log reduction in colony forming units (CFUs) of methicillin resistant (MRSA) and which are representative drug-resistant gram-positive and -negative bacteria, respectively. The promotion of wound healing by NO/GP was demonstrated in mice with full-thickness wounds challenged with MRSA and . Thus, NO/GP is a promising formulation for the treatment of infected wounds.
[How I treat... minor superficial wounds].
Hermanns-Lê T,Nizet J-L,Piérard-Franchimont C,Piérard G E
Revue medicale de Liege
Superficial minor wounds represent frequent events in daily practice. Their evolution is often favourable and without any mishap. However, they possibly evolve to some serious episodes. Normal healing develops in three successive phases. They correspond to the inflammatory, proliferative and remodeling phases, respectively. Their treatments are distinct. The major active agents are cleaning products, antiseptics, corticosteroids and silicone gels. By contrast products claiming some healing properties are disappointing in most cases, and in some instances, they are of no use.
Granulox-The Use of Topical Hemoglobin to Aid Wound Healing: A Literature Review and Case Series From Singapore.
Loh Clement,Tan Qian Ying,Eng Diane L K,Walsh Stewart R,Chong Tze Tec,Tang Tjun Yip
The international journal of lower extremity wounds
Chronic wounds are an increasing burden on health care globally, and tissue hypoxia is a common issue in such wounds. Granulox (SastoMed GmbH, Georgsmarienhütte, Germany) is designed to provide wound bases with supplemental oxygen through facilitated diffusion and aid the physiological wound-healing process. It is a topical hemoglobin wound spray that is applied after wound cleaning and debridement to ensure continuous oxygen supplementation for up to 72 hours. Compared with other forms of topical oxygen therapy that require portable devices, Granulox is a spray-on application and the patient experience is similar to the use of a conventional dressing. Current clinical evidence suggests that Granulox aids with both wound healing and with symptom relief in chronic wounds, but current literature is limited by small study populations and further larger studies are required.
Mode of action of poloxamer-based surfactants in wound care and efficacy on biofilms.
Percival Steven L,Chen Rui,Mayer Dieter,Salisbury Anne-Marie
International wound journal
Surfactants are widely used as detergents, emulsifiers, wetting agents, foaming agents, and dispersants in both the food and oil industry. Their use in a clinical setting is also common, particularly in wound care. Complicated or chronic wounds show clinical signs of delayed healing, persistent inflammation, and the production of non-viable tissue. These types of wounds also present challenges such as infection and potentially house antimicrobial-tolerant biofilms. The use of wound cleansers to aid cleaning and debridement of the wound is essential. A large proportion of skin and wound cleansers contain surfactants but there is only a small amount of data that shows the effectiveness of them in the enhancement of wound closure. This review paper aims to explore the available literature surrounding the use and mode of action of surfactants in wound healing, in particular Poloxamer 188 (Pluronic F-68) and Poloxamer 407 (Pluronic F-127), and also uncover the potential mechanisms behind the enhancement of wound healing and comparison to other surfactants used in wound care. Furthermore, the presence of a microbial biofilm in the wound is a significant factor in delayed wound healing. Therefore, the effect of clinically used surfactants on biofilms will be discussed, with emphasis on poloxamer-based surfactants.
Fatty acid potassium improves human dermal fibroblast viability and cytotoxicity, accelerating human epidermal keratinocyte wound healing in vitro and in human chronic wounds.
Masunaga Akihiro,Kawahara Takayoshi,Morita Hayato,Nakazawa Kohji,Tokunaga Yuto,Akita Sadanori
International wound journal
Effective cleaning of a wound promotes wound healing and favours wound care as it can prevent and control biofilms. The presence of biofilm is associated with prolonged wound healing, increased wound propensity to infection, and delayed wound closure. Anionic potassium salts of fatty acids are tested with commonly used anionic surfactants, such as sodium laureth sulphate (SLES) and sodium lauryl sulphate/sodium dodecyl sulphate (SLS/SDS). The normal human dermal cells demonstrated significantly greater viability in fatty acid potassium, including caprylic acid (C8), capric acid (C10), lauric acid (C12), oleic acid (C18:1), and linoleic acid (C18:2), than in SLES or SLS after a 24-hour incubation. Cytotoxicity by LDH assay in a 5-minute culture in fatty acid potassium was significantly lower than in SLES or SLS. in vitro wound healing of human epidermal keratinocytes during the scratch assay in 24-hour culture was more significantly improved by fatty acid treatment than by SLES or SLS/SDS. In a live/dead assay of human epidermal keratinocytes, C8K and C18:1K demonstrated only green fluorescence, indicating live cells, whereas synthetic surfactants, SLES and SLS, demonstrated red fluorescence on staining with propidium iodide, indicating dead cells after SLES and SLS/SDS treatment. Potassium salts of fatty acids are useful wound cleaning detergents that do not interfere with wound healing, as observed in the scratch assay using human epidermal keratinocytes. As potassium salts of fatty acids are major components of natural soap, which are produced by natural oil and caustic potash using a saponification method, this may be clinically important in wound and peri-wound skin cleaning. In human chronic wounds, natural soap containing fatty acid potassium increased tissue blood flow based on laser speckle flowgraphs after 2 weeks (P < .05), in addition to removing the eschars and debris. Wound cleansing by natural soap of fatty acid potassium is beneficial for wound healing.
[Application of modern wound dressings in the treatment of chronic wounds].
Triller Ciril,Huljev Dubravko,Smrke Dragica Maja
Acta medica Croatica : casopis Hravatske akademije medicinskih znanosti
Chronic and acute infected wounds can pose a major clinical problem because of associated complications and slow healing. In addition to classic preparations for wound treatment, an array of modern dressings for chronic wound care are currently available on the market. These dressings are intended for the wounds due to intralesional physiological, pathophysiological and pathological causes and which failed to heal as expected upon the use of standard procedures. Classic materials such as gauze and bandage are now considered obsolete and of just historical relevance because modern materials employed in wound treatment, such as moisture, warmth and appropriate pH are known to ensure optimal conditions for wound healing. Modern wound dressings absorb wound discharge, reduce bacterial contamination, while protecting wound surrounding from secondary infection and preventing transfer of infection from the surrounding area onto the wound surface. The use of modern wound dressings is only justified when the cause of wound development has been established or chronic wound due to the underlying disease has been diagnosed. Wound dressing is chosen according to wound characteristics and by experience. We believe that the main advantages of modern wound dressings versus classic materials include more efficient wound cleaning, simpler placement of the dressing, reduced pain to touch, decreased sticking to the wound surface, and increased capacity of absorbing wound exudate. Modern wound dressings accelerate the formation of granulation tissue, reduce the length of possible hospital stay and facilitate personnel work. Thus, the overall cost of treatment is reduced, although the price of modern wound dressings is higher than that of classic materials. All types of modern wound dressings, their characteristics and indications for use are described.
Surfactants and their role in wound cleansing and biofilm management.
Percival S L,Mayer D,Malone M,Swanson T,Gibson D,Schultz G
Journal of wound care
Surfactants are widely used as detergents, emulsifiers, wetting agents, foaming agents and dispersants in the cosmetics, hygiene, food and oil industries. Their use in a clinical setting is also common, particularly within the field of wound care. Many wound cleansers contain surfactants and subsequently there is available data that shows the growing potential of these wound cleansers in the enhancement of wound closure. The presence of microorganisms in wounds has been recognised as a significant factor that delay healing. In complex or chronic wounds that are complicated by biofilms, persistent inflammation or the production of non-viable tissue and slough, the use of surfactants has been shown to aid in the removal of these barriers to wound healing. The use of concentrated surfactant(poloxamer) based wound dressings represent an important component of wound management. Consequently, this article will discuss the effect of clinically used surfactants, with specific focus on a concentrated poloxamer for use against wound biofilm.
Effect of Polyhexamethylene Biguanide Solution on Bacterial Load and Biofilm in Venous Leg Ulcers: A Randomized Controlled Trial.
Borges Eline Lima,Frison Susiane Sucasas,Honorato-Sampaio Kinulpe,Guedes Antônio Carlos Martins,Lima Vera Lúcia de Araújo Nogueira,Oliveira Olga Maria Medeiros de,Ferraz Aidê Ferreira,Tyrone Ana Carolina
Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society
PURPOSE:The purpose of this study was to investigate the effect of polyhexamethylene biguanide (PHMB) solution as a wound cleanser on bacterial load and bacterial biofilm in venous leg ulcers. DESIGN:Randomized controlled trial. SUBJECTS AND SETTING:The target population was adults attending the dermatology outpatient clinic of the Clinical Hospital of the Federal University of Minas Gerais, Brazil. The sample comprised 44 patients with venous leg ulcers recruited over a 6-month period. METHODS:Participants were divided into 2 groups: the intervention group had their wounds cleansed with PHMB, and the control group had their wound cleansed with a 0.9% saline solution. Tissue fragments of the wounds were collected for bacteriological analysis; transmission electron microscopy was used to identify the presence of biofilm. RESULTS:The bacterial load was reduced in both groups compared to baseline values; no significant difference was found when groups were compared. Correlation analysis between wound duration (months), wound area (cm²), necrosis (%), variables, and bacterial count (colony forming units [CFUs]/g) after cleansing showed a significant relationship between area of the wound and CFUs/g (P = .0070, r = 0.51). Transmission electron microscopy revealed the presence of bacterial biofilm in the wounds after cleansing with both solutions. CONCLUSIONS:The results of this study indicate that both PHMB and saline solution are effective in reducing the bacterial load in venous leg ulcers. However, bacterial biofilm was present after cleansing with both solutions. These findings provide important evidence regarding effectiveness of 2 common wound cleansers on bacterial presence in wounds.
Wound cleansing: a key player in the implementation of the TIME paradigm.
Journal of wound care
The concept of wound bed preparation can be implemented using the TIME paradigm. Chronic wounds are mostly characterised by prolonged inflammation and increased bioburden. Removal of wound biofilm and devitalised tissue, which is an ideal environment for bacterial growth, can help address the I in TIME. Wound cleansing aims to remove contaminants, debris, dressing remnants and superficial slough from the wound. Some wound cleansers contain surfactants, which reduce the surface tension of a liquid, enabling it to spread further over a surface. This article describes how these solutions can be used to debride the wound surface without damaging healthy cells.
Use of wet-to-moist cleansing with different irrigation solutions to reduce bacterial bioburden in chronic wounds.
Assadian Ojan,Kammerlander Gerhard,Geyrhofer Claudia,Luch Gerlinde,Doppler Stefan,Tuchmann Felix,Eberlein Thomas,Leaper David
Journal of wound care
OBJECTIVE::The influence of different irrigation solutions, in conjunction with wet-to-moist cleansing, on the reduction of sessile, non-planktonic bacteria which colonise wounds, has not been investigated. In this study, the antibacterial effect of different irrigation solutions, during a 20-minute wet-to-moist cleansing, has been evaluated in chronic wounds. METHODS::This study was designed as a prospective cohort study with 12 study arms and was conducted between June 2011 and April 2016. Patients with chronic wounds present for more than three months, irrespective of previous treatments, were recruited into this study. Quantitative wound swabs were obtained before and after a 20-minute, wet-to-moist cleansing, using different wound irrigation solutions. Sterile 0.9% saline served as a control. RESULTS::We recruited 308 patients, of which 260 patients with 299 chronic wounds were eligible for analysis. Staphylococcus aureus was the most common recovered (25.5%) microorganism, of which 8% were meticillin-resistant Staphylococcus aureus (MRSA) strains. Although 0.9% saline supported cleansing of the wound bed, it did not significantly reduce the bacterial burden. The highest reduction of bacterial burden was achieved with an aqueous solution containing betaine, zinc and polyhexamethylene biguanide (polihexanide; ln RF=3.72), followed by a 3% saline solution containing 0.2% sodium hypochlorite (ln RF=3.40). The most statistically significant reduction of bacterial burden, although not the highest, was achieved with povidone-iodine (ln RF=2.98; p=0.001) and an irrigation solution containing sea salt 1.2% and NaOCl 0.4% (ln RF=2.51; p=0.002). CONCLUSION::If a reduction of bacterial burden is warranted, wound irrigation solutions containing a combination of hypochlorite/hypochlorous acid, or antiseptics such as polihexanide, octenidine or povidone-iodine, ought to be considered.
Evaluation of three experimental in vitro models for the assessment of the mechanical cleansing efficacy of wound irrigation solutions.
Klasinc Romana,Augustin Lee Ann,Below Harald,Baguhl Romy,Assadian Ojan,Presterl Elisabeth,Kramer Axel
International wound journal
The aim of this study was to compare different wound-rinsing solutions to determine differences in the efficiency and to evaluate three different in vitro models for wound cleansing. Different wound-rinsing solutions (physiological saline solution, ringer lactate solution for wound irrigation, water and a solution containing polihexanide and the surfactant undecylenamidopropyl-betain) were applied on standardised test models (one- and three-chamber model, flow-cell method and a biofilm model), each challenged with three different standardised wound test soils. In the one-chamber model saline showed a better effect on decontaminating proteins than the ringer lactate solution. In the flow-cell method, water performed better than physiological saline solution, whereas ringer lactate solution demonstrated the lowest cleansing effect. No obvious superiority between the two electrolyte-containing solutions was detectable in the biofilm model. Unfortunately, it was not possible to assess the protein decontamination qualities of the surfactant-containing solution because of the interference with the protein measurement. The flow-cell method was able to detect differences between different rinse solutions because it works at constant flow mechanics, imitating a wound-rinsing procedure. The three-chamber and the less-pronounced modified one-chamber method as well as the biofilm model had generated inhomogeneous results.
Simplification of glutathione-bicarbonate-Ringer solution: its effect on corneal thickness.
McEnerney J K,Peyman G A
Investigative ophthalmology & visual science
Glutathione and adenosine can safely be omitted from glutathione-bicarbonate-Ringer solution (GBR) which is used as an irrigating solution during vitrectomy, without significant reduction in the solution's efficacy or increase in corneal toxicity. Bicarbonate appears to be an essential ingredient and should not be omitted from the Ringer solution.
BSS Plus: a potential irrigating solution for neurosurgery.
Meyer G A,Maiman D J,Edelhauser H F,Lorenzetti O J,Garancis J
Journal of neurosurgery
BSS Plus is a pH-stable balanced salt solution similar to glutathione bicarbonate Ringer's solution. Extensively used in ophthalmology, it is of potential value in neurosurgery. In comparative tests of its effectiveness, 28 cats underwent bilateral irrigation of the surface of the cerebral cortex with normal saline on one side and BSS Plus on the other. After 2 hours, a marked decrease was seen in the surface pH of the hemisphere irrigated with normal saline but not of the hemisphere treated with BSS Plus. Blood-brain barrier changes (measured with Evans blue dye techniques) were more evident following saline irrigation. Somatosensory evoked potentials and cerebral blood flow were not significantly altered. Conventional light microscopy using three standard stains did not reveal a significant difference. Transmission electron microscopy studies were performed in 14 animals and scanning electron microscopy in six. In five animals both transmission and scanning electron microscopy studies were conducted after irrigation with both agents without a cottonoid cover and with immediate harvest of superficial layers from the living brain and immersion-fixation in glutaraldehyde. Tissue preservation was superior on the BSS Plus side in all studies. This agent may represent an improved irrigation solution for neurosurgery, but further studies are required.
Testing the biocompatibility of a glutathione-containing intra-ocular irrigation solution by using an isolated perfused bovine retina organ culture model - an alternative to animal testing.
Januschowski Kai,Zhour Ahmad,Lee Albert,Maddani Ramin,Mueller Sebastien,Spitzer Martin S,Schnichels Sven,Schultheiss Maximilian,Doycheva Deshka,Bartz-Schmidt Karl-Ulrich,Szurman Peter
Alternatives to laboratory animals : ATLA
The effects of a glutathione-containing intra-ocular irrigation solution, BSS Plus©, on retinal function and on the survival of ganglion cells in whole-mount retinal explants were studied. Evidence is provided that the perfused ex vivo bovine retina can serve as an alternative to in vivo animal testing. Isolated bovine retinas were prepared and perfused with an oxygen-saturated standard irrigation solution, and an electroretinogram was recorded to assess retinal function. After stable b-waves were detected, the isolated retinas were perfused with BSS Plus for 45 minutes. To investigate the effects of BSS Plus on photoreceptor function, 1mM aspartate was added to the irrigation solution in order to obtain a-waves, and the ERG trace was monitored for 75 minutes. For histological analysis, isolated whole retinal mounts were stored for 24 hours at 4°C, in the dark. The percentages of cell death in the retinal ganglion cell layer and in the outer and inner nuclear layers were estimated by using an ethidium homodimer-1 stain and the TUNEL assay. General swelling of the retina was examined with high-resolution optical coherence tomography. During perfusion with BSS Plus, no significant changes in a-wave and b-wave amplitudes were recorded. Retinas stored for 24 hours in BSS Plus showed a statistically significant smaller percentage (52.6%, standard deviation [SD] = 16.1%) of cell death in the retinal ganglion cell layer compared to the control group (69.6%, SD = 3.9, p = 0.0031). BSS Plus did not seem to affect short-term retinal function, and had a beneficial effect on the survival of retinal ganglion cells. This method for analysing the isolated perfused retina represents a valuable alternative for testing substances for their retinal biocompatibility and toxicity.
Comparison of corneal changes after phacoemulsification using BSS Plus versus Lactated Ringer's irrigating solution: a prospective randomised trial.
Lucena David R,Ribeiro Maria S A,Messias André,Bicas Harley E A,Scott Ingrid U,Jorge Rodrigo
The British journal of ophthalmology
BACKGROUND/AIMS:To compare two intraocular irrigating solutions, Balanced Salt Solution Plus (BSS Plus) versus Lactated Ringer's (Ringer), for the preservation of corneal integrity after phacoemulsification. METHODS:110 patients undergoing phacoemulsification were randomised to either BSS Plus (n=55) or Ringer (n=55) as the irrigating solution. Patients were examined at baseline and at 1, 8, 15, 30 and 60 days postoperatively. Evaluations included specular microscopy to evaluate endothelial cell density (ECD) and endothelial cell size variability (CV), and corneal pachymetry for central corneal thickness (CCT) measurement. RESULTS:Groups were well balanced regarding baseline ECD, CV and CCT (p>0.05). There was no statistically significant difference between ECD reduction in group BSS Plus 13.1 ± 2.0% and Ringer 9.2 ± 1.9% (p<0.05) at day 60 or in any study visit. There was no statistically significant difference between CV increase in group BSS Plus 23.0 ± 3.0% and Ringer 20.2 ± 4.0% (p<0.05) at day 60 or in any study visit. CCT was significantly increased (p<0.05) at 1, 8, 15 and 30 days postoperatively, returning to baseline at 60 days in both groups. There was no significant difference in CCT increase in both groups at any visit. Interestingly, there were statistically significant correlations between ECD loss and phacoemulsification time (p<0.0001) and ECD loss and irrigation solution volume (p<0.0001) in the Ringer group, but not in the BSS Plus group. CONCLUSIONS:Ringers solution was similar to BSS Plus for corneal preservation in atraumatic cataract surgery. However, our study demonstrates that there is a trend towards lower postoperative endothelial cell density for surgeries with longer phacoemulsification time and higher irrigation volumes if Ringer is used. Trial registration number NCT00801358.
Effect of low molecular weight heparin (enoxaparin) on congenital cataract surgery.
Caça Ihsan,Sahin Alparslan,Cingü Abdullah Kürsat,Ari Seyhmus,Alakuş Fuat,Cinar Yasin
International journal of ophthalmology
AIM:To assess the efficacy of intracameral enoxaparin (a low-molecular-weight heparin) infusion, in variable doses on postoperative inflammatory response in congenital cataract surgery. METHODS:It is a prospective, randomized controlled trial. Eighty eyes of 53 children with congenital cataract were enrolled in this study. Every eye had primary posterior capsulorrhexis and intraocular lens (IOL) implantation after lens aspiration. The eyes were divided into 4 equal groups. In group 1 balanced salt solution (BSS) without enoxaparin was used as an irrigation solution. Whereas in group 2, 3 and 4, 40mg, 20mg and 10mg enoxaparin in 500mL BSS was used respectively. The inflammatory response in the anterior chamber was compared among the groups with slit-lamp biomicroscopy. RESULTS:The mean follow-up period was (17.75±3.95) months in group 1, (18.00±5.15) months in group 2, (19.20±5.47) months in group 3 and (18.65±5.16) months in group 4. Mean number of inflammatory cells in the anterior chamber in group 1 was significantly higher than that of group 2, 3, 4 (P<0.001). There was fibrin formation in the anterior chambers of 3 eyes in group 1 and one eye in group 4. There was synechiae formation in 3 eyes of group 1 and one eye of group 4. There was no significant difference among the groups by means of fibrin or synechiae formation (P>0.05). There were IOL precipitates in 4 eyes of group 1 and 2 eyes of group 4. IOL precipitate formation was significantly higher in group 1 than that of group 2 and 3 in which there was no IOL precipitate (P=0.048). There was IOL subluxation in only one eye of group 1, 3 and 4 while no subluxation was observed in group 2 (P>0.05). There was no statistically significant difference detected about IOL subluxation occurance in all 4 groups (P>0.05). CONCLUSION:Complications of cataract surgery in congenital cataract patients associated with postoperative inflammatory response found to be decreased with the use of enoxaparin in intraocular infusion solutions. Furthermore according to our results the anti-inflammatory effect of enoxaparin was dose dependant.
Intraocular irrigating solutions. Their effect on the corneal endothelium.
Edelhauser H F,Van Horn D L,Hyndiuk R A,Schultz R O
Archives of ophthalmology (Chicago, Ill. : 1960)
The effects of several intraocular irrigating solutions on the corneal endothelium of rabbit and monkey corneas were evaluated, utilizing a specular microscope perfusion system with both scanning and transmission electron microscopy. Corneas perfused with 0.9% sterile isotonic physiological saline swell at a rate of 60mum to 90mum/hr; endothelial cells separate from each other and show extensive degenerative changes. Corneas perfused with lactated Ringer solution swell at a rate of 37mum to 40mum/hr, and the endothelial cells show slower, but progressive degeneration. Corneas perfused with balanced salt solution swell at 24mum to 31mum/hr, and degenerative changes become severe only after two hours. Corneas perfused with Ringer solution containing bicarbonate, reduced glutathione, and adenosine do not increase in thickness, and there is minimal deterioration of endothelial ultrastructure for periods of up to six hours.
Effect of heparin in the intraocular irrigating solution on postoperative inflammation in the pediatric cataract surgery.
Ozkurt Yelda B,Taşkiran Arzu,Erdogan Nadire,Kandemir Baran,Doğan Omer K
Clinical ophthalmology (Auckland, N.Z.)
PURPOSE:To evaluate the influence of irrigation of the anterior chamber with heparin sodium on postoperative inflammation after pediatric cataract surgery. SETTING:Kartal Training and Research Hospital, First Eye Clinic, Istanbul, Turkey. DESIGN:Randomized prospective double-blind study. METHODS:Fourteen consecutive eyes from 14 patients aged 8.9 +/- 5.9 years, (range 3-18 years) (group 1) and 19 eyes from 19 patients aged 9.1 +/- 5.2 (range 1.5-18 years) (group 2) underwent pediatric cataract surgery. Five patients in group 1 were between three and five years old. One patient was 1.5 years old and six patients in group 2 were between three and five years old. During the procedure, group 1 received anterior chamber irrigation with heparin sodium (5 IU/cc) and 1 ml of heparin sodium (concentration 10 IU/ml) added to the irrigating balanced salt solution (BSS Plus; Alcon Laboratories, Inc., Fort Worth, TX, USA) while group 2 received BSS without heparin sodium only. Cases aged under three years received anterior vitrectomy in addition to posterior capsulorrhexis. One eye received anterior vitrectomy in group 1 and two eyes received anterior vitrectomy in group 2. Cases with preoperative complications were not included in the study. Early and late postoperative inflammatory complications, including fibrin formation, anterior and posterior synechia, cyclitic and pupillary membrane formation were recorded and compared. RESULTS:Mild anterior chamber reaction was observed in three patients in Group 1, while nine cases in group 2 experienced marked anterior chamber reaction. In four of nine patients from group 2, anterior chamber reaction was severe and resulted in pupillary membrane and synechia despite treatment in the postoperative 7th day, while in all three cases in group 1, reaction disappeared by the 7th day. CONCLUSION:Anterior chamber irrigation with heparin during pediatric cataract surgery may minimize early inflammatory reaction and decrease the number of postoperative inflammatory related complications.
Balanced physiological saline in the treatment of chronic rhinitis.
Nuutinen J,Holopainen E,Haahtela T,Ruoppi P,Silvasti M
The effects of a special balanced physiological saline on nasal symptoms of 93 patients with chronic rhinitis were studied. The main diagnoses of the patients were allergic rhinitis, atrophic rhinitis and ozaena, rhinitis sicca, chronic sinusitis, nasal polyposis and postoperative condition after nasal surgery. The tested solution was administered by a simple metered dose pump. 85 (91%) of the patients reported beneficial effects of the tested solution on nasal symptoms. In addition, 22 (71%) of those patients who used continuous anti-allergic medication, mainly intranasal steroids, reported that the tested solution improved the efficacy of their ordinary drug. So the tested solution proved to be beneficial in humidifying atrophic or otherwise dry mucosa, douching crusty nose and as adjuvant therapy in the treatment of allergic rhinitis.
[A new enriched balanced irrigation solution for intraocular surgery (experimental study)].
Brikman I V,Ibadova S I,Ilatovskaia L V,Ioshin I E,Rebrik T I
Experimental trials of a new intraocular irrigation solution, one of the enriched balanced salines, were carried out. A comprehensive morphologic study has revealed the protector characteristics of lactosol plus (lactosol + taurin) used in the management of irrigation injury to the posterior epithelium of the cornea in the course of experimental intrachamber perfusion. The protective properties of lactosol + taurin, a new enriched balanced saline, are explained by the similarity of its chemical composition to that of the intraocular fluid and by the presence of a stable polyfunctional bioprotector, taurin amino acid.
Effect of irrigating solution and irrigation temperature on the cornea and pupil during phacoemulsification.
Joussen A M,Barth U,Cubuk H,Koch H
Journal of cataract and refractive surgery
PURPOSE:To evaluate the effect of irrigation solution and temperature on pupil diameter, corneal endothelium, and corneal pachymetry during and after phacoemulsification. SETTING:Klinik Dardenne, Bonn, Germany. METHODS:Eighty patients who had cataract surgery by phacoemulsification were assigned to 1 of 4 cross-classified groups and had intraoperative irrigation with room-temperature or refrigerated fortified balanced salt solution (BSS Plus) or modified Ringer's solution. Pupil diameters were recorded at different stages during the surgery. Epithelial cell counts and pachymetry were determined before and 1 day after surgery. RESULTS:The solution temperature did not affect any parameter. The type of solution did not influence endothelial cell loss; however, the solution had a significant effect on corneal pachymetry 1 day postoperatively. The corneas irrigated with BSS Plus were less swollen than the corneas irrigated with Ringer's solution. By day 14, corneal thickness was equal among all groups. CONCLUSION:Long-term results were equally favorable in all 4 groups. However BSS Plus induced less short-term corneal swelling than Ringer's solution. From these findings, it appears that BSS Plus may decrease corneal risk in cases with compromised corneas or prolonged surgery.
Intraocular irrigating solutions. A clinical study of BSS Plus and dextrose bicarbonate fortified BSS as an infusate during pars plana vitrectomy.
Samuel Michael A,Desai Uday R,Strassman Israel,Abusamak Mohammed
Indian journal of ophthalmology
PURPOSE:To compare the effect of Balanced Salt Solution Plus (BSS Plus, Alcon Laboratories, Fort Worth, Texas, USA) and fortified regular BSS on the cornea and lens, when used for continuous irrigation in pars plana vitrectomy (PPV) surgery. METHODS:Prospective, investigator masked, randomised study. Forty patients were randomly assigned to undergo PPV using BSS Plus (n=20) or fortified BSS (n=20) [regular BSS, fortified with 10.5 cc. of dextrose in water (D5W) and 13.1 cc. of 8.4% sodium bicarbonate]. Intraoperative features of the corneal epithelium, postoperative changes in the corneal endothelial cell denstiy (ECD) at 3 months, and clarity of the lens during surgery and postoperatively were evaluated. RESULTS:Intraoperative epithelial changes were similar in both groups with 7 (35%) of the cases having the epithelium removed in the BSS Plus group and 8 (40%) in the BSS fortified group (P=0.23). The mean differences in ECD (3 months versus preoperative) in the operated eyes when adjusted for changes in the control eye showed no difference with the type of BSS (P=0.98). Intraoperative lens changes were more significant (P=0.018) in the BSS fortified group. Postoperative lens status at 3 months was similar for both groups. Though there was a trend towards worse postoperative nuclear sclerosis change in the BSS fortified group, it was not significant (P=0.160). CONCLUSION:Standard BSS fortified with dextrose and bicarbonate is an efficacious infusion fluid during pars plana vitrectomy. Both solutions showed comparable effects on postoperative corneal endothelial cell density and corneal epithelial changes intraoperatively. BSS fortified has more lenticular changes intraoperatively than BSS Plus although no lens had to be removed in either group. The study implications are important since BSS fortified is significantly less expensive than BSS Plus.
Response of the canine corneal endothelium to intraocular irrigation with saline solution, balanced salt solution, and balanced salt solution with glutathione.
Nasisse M P,Cook C S,Harling D E
American journal of veterinary research
The right or left anterior chamber of 12 dogs (ie, 24 eyes) was irrigated with 100 ml of 0.9% saline solution, balanced salt solution, or balanced salt solution with glutathione (8 eyes/solution) for 22 minutes. Changes in endothelial cell density and corneal thickness from pretreatment values were evaluated immediately after, and at 2 and 7 days after irrigation. Using specular microscopy and scanning and transmission electron microscopy, corneas were examined immediately after and at 2, 7, and 14 days after irrigation. Changes were not seen in endothelial cell density after irrigation with any of the solutions evaluated. Corneal thickness increased 4% immediately after irrigation with 0.9% saline solution and returned to normal by 1 week after irrigation; treatment with 0.9% saline solution was not associated with visible corneal edema. Ultrastructural changes attributable to differences in irrigating solution composition were not observed. The difference between the endothelium's response to limited irrigation with saline solution, balanced salt solution, and balanced salt solution with glutathione was small and irrigation with these solutions was not associated with permanent endothelial damage.
Effect on corneal endothelial cell loss during phacoemulsification: fortified balanced salt solution versus Ringer lactate.
Nayak Barun K,Shukla Rashmi O
Journal of cataract and refractive surgery
PURPOSE:To compare the effect of phacoemulsification on the corneal endothelium using fortified balanced salt solution (BSS Plus) and Ringer lactate as the intraocular irrigating solution. SETTING:P.D. Hinduja Hospital, Mumbai, India. DESIGN:Prospective randomized controlled double-blinded clinical study. METHODS:Patients with senile cataract up to nuclear grade III were randomized to have phacoemulsification with posterior chamber intraocular lens implantation performed using fortified balanced salt solution (Group A) or Ringer lactate (Group B) as the intraocular irrigating solution. The corneal endothelial cell density (primary outcome) and pachymetry were measured preoperatively and 1 week and 1 and 6 months postoperatively. RESULTS:Each group comprised 35 eyes (35 patients). The postoperative percentage of endothelial cell loss was not significantly different between the 2 groups at 1 week (P=.582), 1 month (P=.668), or 6 months (5.03% and 8.35% in Group A and Group B, respectively) (P=.483) and was within the limits reported in the literature. The postoperative percentage change in pachymetry was not significantly different between the 2 groups at 1 week (P=.179) or 1 month (P=.170) but was significant at 6 months (P<.001) (-1.59% and 0.54% in Group A and Group B, respectively); however, the mean pachymetry value was near baseline in both groups at 6 months. CONCLUSION:Corneal endothelial cell loss after phacoemulsification with Ringer lactate was similar to that with fortified balanced salt solution over the long term.
Comparison between Ringer's lactate and balanced salt solution on postoperative outcomes after phacoemulsfication: a randomized clinical trial.
Vasavada Viraj,Vasavada Vaishali,Dixit Nirmit V,Raj Shetal M,Vasavada Abhay R
Indian journal of ophthalmology
AIM:To compare the effects of balanced salt solution (BSS) and Ringer's lactate (RL) on corneal thickness, endothelial morphology, and postoperative anterior chamber inflammation in eyes undergoing phacoemulsification. SETTING:Iladevi cataract and IOL research center, Ahmedabad, India. MATERIALS AND METHODS:This prospective randomized study comprised 90 consecutive patients with age-related cataract who were randomly assigned to either Group 1 (n = 45) with BSS or Group 2 (n = 45) with RL. Observations made included measurement of central corneal thickness (CCT), presence of anterior chamber flare and cells, endothelial cell loss, and change in coefficient of variation (CV). Data was analyzed using Mann Whitney test and test of proportion. RESULTS:Mean increase in CCT on postoperative Day 1 was 58microm and 97microm in Groups 1 and 2 respectively ( P = 0.01). Increase in CCT at one month was 10microm and 11microm in Groups 1 and 2 respectively ( P = 0.99); increase in CCT at three months was 3microm and 6microm in Groups 1 and 2 respectively ( P = 0.86). Number of eyes with flare grades in a range of 0 to 3 was statistically higher in Group 2 on postoperative Day 1 ( P = 0.004, 0.016, < 0.001, 0.047 for Grade 0, 1, 2 and 3 respectively). Number of eyes with cells of Grade 3 on first postoperative day was significantly higher in Group 2 as compared to Group 1 ( P = 0.004). Three months postoperatively, endothelial cell loss was 5.5% and 7.8% in Groups 1 and 2 ( P = 0.21) and change in CV was 3 and 5.4 in Groups 1 and 2 ( P = 0.20) respectively. CONCLUSION:BSS offers a significant advantage over RL in terms of increase in corneal thickness and postoperative inflammation on the first postoperative day in patients undergoing phacoemulsification.
Capsular bag irrigation using 0.025% povidone-iodine in balanced salt solution PLUS for the treatment of postoperative endophthalmitis.
Otani Kyuen,Shimada Hiroyuki,Nakashizuka Hiroyuki,Okubo Hirofumi
We examined the effectiveness and adverse events of using balanced salt solution (BSS) PLUS containing 0.025% povidone-iodine, a non-oculotoxic concentration, for capsular bag irrigation in a case of endophthalmitis mainly involving the anterior chamber. A 57-year-old female underwent cataract surgery and developed hypopyon on day 3 after surgery, with mainly anterior chamber inflammation. The capsular bag was irrigated with BSS PLUS containing 0.025% povidone-iodine. Gram-negative rods were detected from the anterior chamber fluid. Post-procedural visual acuity was 24/20. In a case, endophthalmitis was resolved and there were no adverse events. With the recent increase in multidrug-resistant bacteria, use of 0.025% povidone-iodine in BSS PLUS for anterior chamber irrigation is expected to be useful.
Wound cleansing: the evidence for the techniques and solutions used.
Cunliffe Philippa J,Fawcett Tonks N
Professional nurse (London, England)
Nurses are constantly urged to back up their practice with research-based evidence. In the field of tissue viability and wound cleansing, however, it can be difficult to evaluate the research and expert opinion published. In this paper, the authors summarise the evidence on wound cleansing techniques, choice of equipment and cleansing agents in the ward setting.
A comparison of wound irrigation solutions used in the emergency department.
Dire D J,Welsh A P
Annals of emergency medicine
The purpose of our study was to examine which of the wound irrigants commonly used in the emergency department is the most efficacious in reducing the risk of wound infection. Five hundred thirty-one patients were randomized into three groups. All patients had their wounds irrigated using a 20-mL syringe with a 20-gauge IV catheter. Patients received irrigation with normal saline (NS), 1% povidone-iodine solution (PI), or pluronic F-68 (Shur-Clens) (SC). Treatment was assigned by month; all wounds were treated with one solution during each of the three months of the study. The wounds were closed with interrupted, simple nylon sutures. The number of wound infections was 13 (6.9%), eight (4.3%), and nine (5.6%) for groups receiving NS, PI, and SC, respectively. This was not statistically significant. We conclude that there is not a significant difference in infection rates among sutured wounds irrigated with NS, PI, or SC. The cost of NS was the lowest of the three treatments in our ED.
Can povidone-iodine solution be used safely in a spinal surgery?
Chang Fang-Yeng,Chang Ming-Chau,Wang Shih-Tien,Yu Wing-Kwang,Liu Chien-Lin,Chen Tain-Hsiung
European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
UNLABELLED:Intra-operative incidental contamination of surgical wounds is not rare. Povidone-iodine solution can be used to disinfect surgical wounds. Although povidone-iodine is a good broad-spectrum disinfecting agent, it has occasionally been reported to have a negative effect on wound healing and bone union. Therefore, its safety in a spinal surgery is unclear. A prospective, single-blinded, randomized study was accordingly conducted to evaluate the safety of povidone-iodine solution in spinal surgeries. Ascertained herein was the effect of wound irrigation with diluted povidone-iodine solution on wound healing, infection rate, fusion status and clinical outcome of spinal surgeries. MATERIALS AND METHODS:From January 2002 to August 2003, 244 consecutive cases undergoing primary instrumented lumbosacral posterolateral fusion due to degenerative spinal disorder with segmental instability had been collected and randomly divided into two groups: the study group (120 cases, 212 fusion levels) and the control group (124 cases, 223 fusion levels). Excluded were those patients with a prior spinal surgery, spinal trauma, malignant tumor, infectious spondylitis, rheumatoid arthritis, ankylosing spondylitis, metabolic bone disease, skeletal immaturity or with an immunosuppressive treatment. In the former group, wounds were irrigated with 0.35% povidone-iodine solution followed by normal saline solution just before the bone-grafting and instrumentation procedure. However, only with normal saline solution in the latter. All the operations were done by the same surgeon with a standard technique. All the patients were treated in the same postoperative fashion as well. Later on, wound healing, infection rate, spinal bone fusion and clinical outcome were evaluated in both groups. RESULTS:A significant improvement of back and leg pain scores, modified Japanese Orthopedic Association function scores (JOA) and ambulatory capacity have been observed in both groups. One hundred and seven patients in the study group and one hundred and nine in the control group achieved solid union. There was no infection in the study group but six deep infections in the control group. Wound dehiscence was noted in one group 1 and two group 2 patients. A subsequent statistical analysis revealed higher infection rate in the control group (P<0.05), but no significant difference in fusion rate, wound healing, improvement of pain score, function score and ambulatory capacity between the two groups. CONCLUSION:Diluted povidone-iodine solution can be used safely in spinal surgeries, and it will not influence wound healing, bone union and clinical outcome.
Active wound dressing with artificial capillaries for temporary wound irrigation and skin cell supply.
Plettig Jörn,Johnen Christa M,Bräutigam Kirsten,Zeilinger Katrin,Borneman Reinhard,Gerlach Jörg C
Medical treatment of burns and chronic wounds remains a challenge. We discussed a therapy concept that combines skin cell spray transplantation with a novel wound dressing based on artificial hollow fiber membrane capillaries. In skin cell-based therapy development, autologous skin progenitor cells are isolated from a healthy skin area and sprayed onto the wound. A medical device was introduced that uses perfused capillaries, known from clinical plasma separation, as a temporarily applied extracorporeal wound capillary bed. The functions of the dressing are comparable with those of dialysis; the capillaries, however, are applied externally onto the wound. Perfusion with a clinical peripheral nutrition and buffer solution can provide wound irrigation, wound debris removal, cell nutrition, pH regulation, and electrolyte balance while potentially serving to address delivery of regenerative factors and antibiosis. An innovative active skin wound dressing that provides cell support and stimulates regeneration by wound irrigation is discussed.
Wound bed preparation: a case series using polyhexanide and betaine solution and gel-a UK perspective.
Atkin Leanne,Stephenson John,Cooper Dawn M
Journal of wound care
OBJECTIVE:The burden of wound care within the NHS is estimated at a cost of £5.3 billion per year and is set to rise annually by 30%. This case series describes the results of using polyhexanide (PHMB) and betaine wound irrigation solution and gels (Prontosan, B.Braun Medical Ltd., UK) across the UK in hard-to-heal (also described as chronic) wounds up to 20 years' duration, with an observation period of greater than one month. Over half of the hard-to-heal wounds were healed and vast improvements to all other wounds were observed. Improvements to wound bed condition were reported as early as two days after commencing initial treatment, with decreases in malodour, exudate, slough and pain reported across the case series. In addition to wound bed improvements, a reduction in dressing change frequency of 55% was observed in hard-to-heal wounds under the new treatment regime.
Comparison of castile soap, benzalkonium chloride, and bacitracin as irrigation solutions for complex contaminated orthopaedic wounds.
Conroy B P,Anglen J O,Simpson W A,Christensen G,Phaup G,Yeager R,Gainor B J
Journal of orthopaedic trauma
OBJECTIVE:The purpose of the present study was to determine the effects of cleaning a contaminated orthopaedic wound with different classes of wound irrigation solutions. STUDY DESIGN:Rats with a contaminated orthopaedic wound were randomized into treatment groups: normal saline (NS), castile soap (CS), benzalkonium chloride (BzC), bacitracin (Abx), or sequential irrigation with BzC, CS, and NS. INTERVENTION:Pseudomonas aeruginosa [P. aeruginosa; 1 x 10(6) colony-forming units (CFU)], or Staphylococcus aureus (S. aureus; 1 x 10(6) CFU) were placed into a paravertebral wound (containing a wire implant placed through a spinous process) and allowed to incubate for fifteen minutes. The wound was then irrigated with three liters of either NS, 0.05 percent CS, 0.03 percent BzC, Abx (33,000 units per liter) or underwent a sequential irrigation treatment (one liter each of BzC, CS, NS). MAIN OUTCOME MEASUREMENTS:The animals were observed daily for wound complications for fourteen days and then killed, and cultures of the wound were obtained. RESULTS:Pseudomonas aeruginosa: Both CS and the sequential irrigation treatment significantly lowered the rate of positive wound cultures when compared with NS (p < 0.05). Irrigation with BzC resulted in a higher rate of positive wound cultures and complications. The sequential irrigation treatment prevented the wound complications associated with irrigation with BzC alone. Staphylococcus aureus: Only BzC irrigation significantly lowered the rate of positive wound cultures when compared with NS (p < 0.05). CONCLUSION:The rate of positive wound cultures due to P. aeruginosa is effectively reduced by irrigation with CS alone or by the sequential irrigation treatment. When used alone, the antiseptic BzC results in a higher rate of positive wound cultures and wound complications. The wound complications seen with irrigation with BzC alone are prevented by the sequential irrigation treatment (BzC followed by CS and NS). The rate of positive wound cultures in this model due to S. aureus is not decreased by irrigation with CS; however, the rate of positive wound cultures is safely and effectively decreased with the use of BzC.
Wound cleaning and wound healing: a concise review.
Wilkins Robert G,Unverdorben Martin
Advances in skin & wound care
Chronic wounds present a significant societal burden in their cost of care, and they reduce patient quality of life. Key components of wound care include such measures as debridement, irrigation, and wound cleaning. Appropriate care removes necrotic tissue and reduces wound bioburden to enhance wound healing. Physical cleaning with debridement and irrigation is of documented efficacy. Wounds may be washed with water, saline, or Ringer's solution or cleaned with active ingredients, such as hydrogen peroxide, sodium hypochlorite, acetic acid, alcohol, ionized silver preparations, chlorhexidine, polyhexanide/betaine solution, or povidone-iodine--the majority of which are locally toxic and of limited or no proven efficacy in enhancing wound healing. Although the consensus opinion is that these topical cleaning agents should not be routinely used, recent clinical evidence suggests that polyhexanide/betaine may be nontoxic and effective in enhancing wound healing. Further well-designed studies are needed.
Wound Irrigation in Orthopedic Open Fractures: A Review.
Gardezi Mursal,Roque Daniel,Barber Douglas,Spake Carole S L,Glasser Jillian,Berns Ellis,Antoci Valentin,Born Christopher,Garcia Dioscaris R
Management of open fractures remains a major clinical challenge because of the higher energy involved in the injury, the greater local trauma, tissue necrosis, and extensive contamination. Even though early surgical debridement was thought to be critical, limited available operative techniques have minimized surgery in favor of early antibiotic administration. No clear agreement on the surgical approach, debridement, or irrigation technique exists. Surgeons continue to argue about the use of various fluids, the appropriate pressure of irrigation, antiseptics, and other factors. The current work reviews the available data and summarizes the capabilities of modern orthopedic irrigation solutions. To delineate available research on the topic, the PubMed database was queried for the most common techniques, fluid variables, and chemical adjuvants utilized in current open fracture and wound irrigation methodologies. Modes of delivery, volume, pressure, temperature, timing, solution type, and additives are evaluated in the context of known outcomes to determine which solutions may be preferable. Various methods have been described with their own advantages as well as limitations. Particular solutions may apply to specific clinical scenarios, presence of implants, and degree of tissue contamination. Desired irrigation solutions are isotonic, non-toxic, non-hemolytic, transparent, sterilizable, efficient in removing debris and pathogens, as well as affordable; however, no current irrigant achieves all these desired characteristics. Despite being crucial for the healing of open fractures, there is no clear gold standard for irrigation. Although there are some novel irrigation solutions, there has been a paucity of research on finding new, safer, and more effective irrigation solutions that will promote wound healing and reduce infection.
Antimicrobial and antiseptic strategies in wound management.
International wound journal
Wounds, especially chronic wounds, represent a global problem costing millions of dollars per year in developed countries and are characterised by microbial complications including local or overt infection, delayed healing and spread of multiresistant germs. Therefore, antimicrobial wound management is a major challenge that continues to require new solutions against microbes and their biofilms. As systemic antibiotics can barely penetrate into wound biofilms and topically applied ones can easily lead to sensitisation, antisepsis is the method of choice to treat germs in wounds. This brief review discusses the role of antiseptics in reducing bioburden in chronic wounds. Balancing antimicrobial potency and tolerability of antiseptic procedures is critical in wound therapy. However, antiseptics alone may not be able to achieve wound healing without addressing other factors regarding the patient's general health or the wound's physical environment. Although the precise role of bioburden in chronic wounds remains to be evaluated, planktonic as well as biofilm-bound microbes are indications for antiseptic intervention. Octenidine dihydrochloride and polyhexanide are the most effective, as well as best tolerated, antiseptics in wound management today, and new strategies to reduce bacterial wound burden and support the body's immune response are being developed.
Evaluation of the efficacy and tolerability of a solution containing propyl betaine and polihexanide for wound irrigation.
Romanelli M,Dini V,Barbanera S,Bertone M S
Skin pharmacology and physiology
Wound cleansing represents a fundamental step in chronic wound management. Several investigations in recent years have led to a refinement of the wound cleansing protocol in order to obtain a better control of the bacterial burden during wound bed preparation and to avoid further cell and tissue damage. The aim of the present randomized controlled trial was to investigate the effects of a wound cleansing solution containing polihexanide and betaine in venous leg ulcers by means of clinical and instrumental assessment. A portable device was used on the wound bed to assess surface pH, which has been shown to be one of the most useful non-invasive biophysical parameters in order to correlate the level of bacterial burden in different types of chronic wounds. Baseline pH on the wound surface (median range) was initially 8.9, and after 4 weeks of cleansing treatment and moist wound dressing was reduced and stable at 7.0 in the group treated with active cleanser. The pH value was significantly lower (p < 0.05) in this group compared to the control group at the end of the study. The treatment with the solution containing polihexanide and betaine was well tolerated by the patients and was found useful in the absorption of wound odours.
Irrigation with thrombin solution reduces recurrence of chronic subdural hematoma in high-risk patients: preliminary report.
Shimamura Norihito,Ogasawara Yukari,Naraoka Masato,Ohnkuma Hiroki
Journal of neurotrauma
Abstract Chronic subdural hematoma (CSH) is a disease frequently seen in the neurosurgical department. CSH also has a high rate of recurrence. Our hypothesis is that thrombin solution irrigation reduces recurrence in high-risk CSH patients. We define high risk as follows: use of anti-platelets, use of anticoagulants, recurrent CSH, renal failure, liver cirrhosis, and hematological disease. From January 1, 1998, to March 31, 2008, we compared a saline solution irrigation group (43 patients) and a thrombin solution (100 unit/ml) irrigation group (36 patients) prospectively and randomly. Surgical procedures were the same: one burr hole craniostomy, drainage of hematoma, irrigation of cavity, frontal insertion of silicon tube, replacement of air with solution, and removal of tube at 24 h after surgery. We define recurrence as an additional drainage operation due to neurological deficit within six months of surgery. Recurrences of CSH arose in two patients (5.5%) with thrombin irrigation and in 11 patients (25.6%) with saline irrigation (p < 0.05). Saline irrigation patients with anti-platelet medication experienced recurrence in five of 19 patients, although no thrombin-irrigated side recurred with the same drug. No complication occurred in relation to thrombin irrigation. Irrigation of CSH with thrombin solution is an effective treatment option for high-risk cases of CSH without complication.
In-vitro test for comparing the efficacy of wound rinsing solutions.
Kaehn Kurt,Eberlein Thomas
British journal of nursing (Mark Allen Publishing)
Wound coatings can severely delay chronic wound healing by inducing ischaemia and degradation of viable tissue and increasing susceptibility to infection. It is, therefore, essential to cleanse wounds gently and thoroughly to remove the detrimental coatings. In this study, an in-vitro model that mimics wound coatings (human plasma dried onto adhesive glass slides) was used to compare the efficacy of four sterile solutions used to cleanse wounds: saline and Ringer's (both salt solutions), a betaine surfactant-containing wound rinsing solution (Prontosan B. Braun) and an antiseptic solution (Octenisept Schülke & Mayr). Both salt solutions and the wound rinsing solution were found to remove protein from the test wound coatings, whereas the test coatings became fixed and insoluble when immersed in antiseptic solution.
Surgical Site Irrigation in Plastic Surgery.
Zhadan Olga,Becker Hilton
Aesthetic surgery journal
Background:The incidence of infection following breast implant reconstruction remains high at the level of 24%. Surgical site irrigation is commonly used for its prevention. However, the lack of evidence-based guidelines for antibiotic prophylaxis in breast implant surgery necessitates research for optimal irrigation technique. Objectives:composition and exposure time of irrigation solution for surgical site infection (SSI) prophylaxis using an in vitro model of a surgical site. Methods:The study design was an in vitro model to assess antibiotic irrigation of a surgical site. Strains of Staphylococcus aureus, Methicillin-resistant Staphylococcus aureus, Group A Streptococcus, and Pseudomonas aeruginosa were seeded on blood agar growth medium and irrigated with various antibiotic and antiseptic solutions under different exposure times. The presence and quantity of the colonies grown were estimated after 24-hour incubation. Repetition of the studies for 5 times with each investigated irrigation solution and microorganism was performed. Optimal irrigation agents were chosen based on the ability to achieve sterility with minimal tissue toxicity. Results:The optimal wound irrigation agents for SSI prophylaxis in our study were found to be 0.05% chlorhexidine or triple antibiotic antibiotic solutions. Adding of vancomycin to the irrigation solutions did not show an increase in their effectiveness. Prolonged irrigation exposure time was necessary to achieve sterility of the in vitro model of a surgical site. Conclusions:We recommend 0.05% chlorhexidine or triple antibiotic solution for topical SSI prophylaxis in breast implant surgery. Sufficient time of irrigation can be achieved by maintaining some of the solution in the pocket and delaying drainage for at least 30 minutes. Level of Evidence 5:
Effectiveness of a polyhexanide irrigation solution on methicillin-resistant Staphylococcus aureus biofilms in a porcine wound model.
Davis Stephen C,Harding Andrew,Gil Joel,Parajon Fernando,Valdes Jose,Solis Michael,Higa Alex
International wound journal
Irrigation and removal of necrotic debris can be beneficial for proper healing. It is becoming increasingly evident that wounds colonized with biofilm forming bacteria, such as Staphylococcus aureus (SA), can be more difficult to eradicate. Here we report our findings of the effects of an irrigation solution containing propyl-betaine and polyhexanide (PHMB) on methicillin-resistant Staphylococcus aureus (MRSA) biofilms in a porcine wound model. Thirty-nine deep partial thickness wounds were created with six wounds assigned to one of six treatment groups: (i) PHMB, (ii) Ringer's solution, (iii) hypochlorous acid/sodium hypochlorite, (iv) sterile water, (v) octenidine dihydrochloride, and (vi) octenilin. Wounds were inoculated with MRSA and covered with a polyurethane dressing for 24 hours to allow biofilm formation. The dressings were then removed and the wounds were irrigated twice daily for 3 days with the appropriate solution. MRSA from four wounds were recovered from each treatment group at 3 days and 6 days hours after initial treatment. Irrigation of wounds with the PHMB solution resulted in 97·85% and 99·64% reductions of MRSA at the respective 3 days and 6 days assessment times when compared to the untreated group. Both of these reductions were statistically significant compared to all other treatment groups (P values <0·05).
Effect of antiseptic irrigation on infection rates of traumatic soft tissue wounds: a longitudinal cohort study.
Roth B,Neuenschwander R,Brill F,Wurmitzer F,Wegner C,Assadian O,Kramer A
Journal of wound care
OBJECTIVE:Acute traumatic wounds are contaminated with bacteria and therefore an infection risk. Antiseptic wound irrigation before surgical intervention is routinely performed for contaminated wounds. However, a broad variety of different irrigation solutions are in use. The aim of this retrospective, non-randomised, controlled longitudinal cohort study was to assess the preventive effect of four different irrigation solutions before surgical treatment, on wound infection in traumatic soft tissue wounds. METHOD:Over a period of three decades, the prophylactic application of wound irrigation was studied in patients with contaminated traumatic wounds requiring surgical treatment, with or without primary wound closure. The main outcome measure was development of wound infection. From 1974-1983, either 0.04 % polihexanide (PHMB), 1 % povidone-iodine (PVP-I), 4 % hydrogen peroxide, or undiluted Ringer's solution were concurrently in use. From 1984-1996, only 0.04 % PHMB or 1 % PVP-I were applied. From 1997, 0.04 % PHMB was used until the end of the study period in 2005. RESULTS:The combined rate for superficial and deep wound infection was 1.7 % in the 0.04 % PHMB group (n=3264), 4.8 % in the 1 % PVP-I group (n=2552), 5.9 % in the Ringer's group (n=645), and 11.7 % in the 4 % hydrogen peroxide group (n=643). Compared with all other treatment arms, PHMB showed the highest efficacy in preventing infection in traumatic soft tissue wounds (p<0.001). However, compared with PVP-I, the difference was only significant for superficial infections. CONCLUSION:The large patient numbers in this study demonstrated a robust superiority of 0.04 % PHMB to prevent infection in traumatic soft tissue wounds. These retrospective results may further provide important information as the basis for power calculations for the urgently needed prospective clinical trials in the evolving field of wound antisepsis.
Saline irrigation for the management of skin extravasation injury in neonates.
Gopalakrishnan P N,Goel N,Banerjee Sujoy
The Cochrane database of systematic reviews
BACKGROUND:Extravasation injury is a common complication of neonatal intensive care and can result in scarring with cosmetic and functional sequelae. A wide variety of treatments are used in practice including subcutaneous irrigation with saline (with or without hyaluronidase), liposuction, use of specific antidotes, different topical applications and normal wound care with dry or wet dressings. All such treatments aim to prevent or reduce the severity of complications. OBJECTIVES:To determine the efficacy and safety of saline irrigation or saline irrigation with prior hyaluronidase infiltration on tissue healing in neonates with extravasation injury when compared to no intervention or normal wound care. SEARCH METHODS:We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 2), MEDLINE (1950 to June 2011), EMBASE (Jan 1980 to June 2011), CINAHL (Jan 1988 to June 2011) and the Web of Science (up to July 2011). SELECTION CRITERIA:Randomised controlled trials (RCT) and quasi-randomised controlled trials comparing saline irrigation with or without hyaluronidase infiltration with no intervention or normal wound care in the management of extravasation injury in neonates. DATA COLLECTION AND ANALYSIS:Three review authors independently reviewed and identified articles for possible inclusion in this review. MAIN RESULTS:No eligible studies were found. There were a few case reports and case series describing successful outcomes with different interventions in this condition. AUTHORS' CONCLUSIONS:To date, no randomised controlled trial is available that examines the effects of saline irrigation with or without prior hyaluronidase infiltration in the management of extravasation injury in neonates. Saline irrigation is a frequently reported intervention in the literature that is used in the management of extravasation injury in neonates. Research should be initially directed at evaluating the efficacy and safety of this intervention through randomised controlled trials. It will also be important to determine the size of the effect according to timing of intervention, nature of the infusate and the severity of injury at the time of intervention.
A systematic review of methods of eye irrigation for adults and children with ocular chemical burns.
Chau Janita P C,Lee Diana T F,Lo Suzanne H S
Worldviews on evidence-based nursing
AIM:To present the best available research evidence on eye irrigation methods for ocular chemical burns to facilitate better-informed clinical decisions. METHODS:Randomized, quasi-randomized controlled trials and observational studies comparing the effectiveness of eye irrigation methods among adults or children as an active form of emergency treatment for ocular chemical burns were reviewed. Electronic databases in English and Chinese were searched from inception to June 2010. Two reviewers made independent decisions on whether to include each publication in the review and critically appraised the study quality independently. Given the clinical and methodological diversity among the studies, the review findings are presented in a narrative form. RESULTS AND DISCUSSION:Four studies involving 302 adults and children were identified. The results of this review indicate that patients who underwent irrigation with tap water immediately following alkali burns at the scene of injury had significantly better clinical and ocular outcomes. The evidence also suggests that in hospital settings, more patients preferred balanced saline solution (BSS) plus than other irrigation fluids. Irrigation with diphoterine was found in one study that resulted in better ocular outcomes following grade 1 and 2 ocular burns. With regard to duration of eye irrigation, patients with ocular chemical burns treated with prolonged irrigation reported shorter duration of treatment at hospital and absence from work. The results should be treated with caution, as there were significant differences between the comparison groups in some studies. IMPLICATIONS AND CONCLUSIONS:As prompt eye irrigation with tap water immediately after alkali burns had better outcomes, it would be important to commence eye irrigation immediately after burns are sustained. In this review, irrigating fluids including normal saline, lactated Ringer's, normal saline with sodium bicarbonate added, BSS Plus, and diphoterine solutions all yielded positive ocular outcomes suggesting for its use in hospital settings.
Feasibility study of an active wound dressing based on hollow fiber membranes in a porcine wound model.
Plettig Jörn,Johnen Christa M,Bräutigam Kirsten,Knöspel Fanny,Wönne Eva C,Schubert Frank,Plöger Frank,Unger Juliane K,Reutzel-Selke Anja,Bornemann Reinhard,Zeilinger Katrin,Gerlach Jörg C
Burns : journal of the International Society for Burn Injuries
INVESTIGATION:A novel active wound dressing (AWD) concept based on a microporous hollow fiber membrane network was investigated in an animal model. It provides a local solution-perfused environment for regenerative cell nutrition, wound irrigation, debris removal, electrolyte balancing, pH regulation, and topical antibiosis. The device is capable of supplying soluble factors, as tested experimentally for the recombinant human growth and differentiation factor-5 (rhGDF-5). METHODS:Following in vitro studies for rhGDF-5 using primary human keratinocytes and dermal fibroblasts, we employed a porcine partial thickness wound model with five distinct wounds on each back of n=8 pigs. Four wound groups were perfused differently over 9 days and compared with a negative control wound without perfusion: (1) 1% trehalose solution, pH 5.5; (2) rhGDF-5 (150 ng/ml) in 1% trehalose solution, pH 5.5; (3) nutrition solution; and (4) rhGDF-5 (150 ng/ml) in nutrition solution with 1% trehalose, pH 5.5. RESULTS:Promoted wound healing was observed within group 1 and more pronounced within group 2. Groups 3 and 4, with nutrition solution, showed significant adverse effects on wound healing (p<0.05). CONCLUSIONS:The investigated AWD concept appears to be an interesting therapeutic tool to study further wound healing support. Additionally, topical application of rhGDF-5 could be promising.
Clinical management of the avulsed tooth.
Dental clinics of North America
Treatment outside the dental office: Replant immediately after gentle washing if practical. If replantation is not practical, store the tooth in the best medium available. Storage media in order of preference are Hank's Balanced Salt Solution (HBSS), milk, saline, and saliva (buccal vestibule). Water is the least desirable storage medium. Treatment in the office: Emergency visit; Place tooth in HBSS while exam is conducted and history is taken. Prepare socket for gentle repositioning of the tooth. Prepare the root. Extraoral dry time < 20 minutes: Closed apex--replant immediately after gentle washing. Open apex--soak in 1 mg doxycycline in 20 mg saline for 5 minutes. Extraoral dry time 20 to 60 minutes: Soak in HBSS for 30 minutes and replant. Extraoral dry time > 60 minutes: soak in citric acid, 2% stannous fluoride, and doxycycline and replant. Endodontics can be done extraorally. Semirigid splint for 7 to 10 days. (If alveolar fracture is present, rigid splint for 4 to 8 weeks). Suture soft-tissue lacerations, particularly in the cervical area. Administer systemic antibiotics (penicillin V potassium if possible) Chlorhexidine rinses and stringent oral hygiene while the splint is in place (7 to 10 days). Analgesics as required. Second visit after 7 to 10 days: Endodontic treatment: Tooth with open apex and extraoral dry time of < 60 minutes: No endodontic treatment initially. Recall every 3 to 4 weeks to examine for evidence of pathosis. If pathosis is noted, disinfect the pulp space and start apexification procedure. Tooth with open apex and extraoral dry time > 60 minutes: If endodontics was not completed in the emergency visit, start endodontics and follow apexification procedure. Tooth with closed apex: Endodontics should be initiated after 7 to 10 days. Careful chemomechanical instrumentation under strict asepsis. Splint removed at end of visit. Obturation visit: If endodontics was initiated 7 to 10 days after the avulsion, obturation can take place after short-term calcium hydroxide treatment. If endodontics was initiated more than 14 days after the avulsion or inflammatory resorption, long-term calcium hydroxide for 6 to 24 months, obturated when an intact lamina dura is traced. Restorations: Temporary restorations: Should be 4 mm deep. Reinforced zinc-oxide-eugenol, acid-etch composite resin, glass-ionomer cement. Permanent restoration: Placed immediately after obturation. Acid-etch resin and dentin bonding agents. Follow-up care: Twice per year for 3 years and yearly for as long as possible. Late complications are common.
Fluid management in perioperative and critically ill patients.
Kang Dongho,Yoo Kyung Yeon
Acute and critical care
Fluid therapy to restore and/or maintain tissue perfusion may affect patient outcomes in perioperative, emergency, and intensive care. Kinetic analyses and outcome-oriented studies have provided more insight into fluid management. Crystalloids are slowly distributed to the interstitial space, and the efficiency (proportion of infused fluid retained in the bloodstream) is 50%-75% as long as infusion continues and may increase up to 100% when the arterial pressure has decreased. Elimination of the infused fluid during general anesthesia and surgery is very slow, amounting to only 10%-20% compared with that in conscious patients. When the endothelial glycocalyx layer is degraded in sepsis or trauma-induced systemic inflammation, turnover of colloids and crystalloids is accelerated and the efficiency is reduced, which may lead to tissue edema, inflammation, poor wound healing, and organ dysfunction. Balanced crystalloids are pragmatic initial resuscitation fluids and improve patient outcomes compared to saline (0.9% sodium chloride). Albumin may be beneficial, but other synthetic colloids appear to increase the risk of acute kidney injury and death among patients in the intensive care unit. Fluid kinetics is likely to change based on patient physiological conditions (e.g., general anesthesia, surgery, stress, dehydration, blood pressure, or inflammation) and fluid types. To maximize efficacy and minimize iatrogenic side effects, fluids should be prescribed based on individual patient factors, disease states, and other treatment remedies.
Is sodium chloride worth its salt?
McIntosh Euan,Andrews Peter J
Critical care (London, England)
The choice of fluid for resuscitation of the brain-injured patient remains controversial, and the 'ideal' resuscitation fluid has yet to be identified. Large volumes of hypotonic solutions must be avoided because of the risk of cerebral swelling and intracranial hypertension. Traditionally, 0.9% sodium chloride has been used in patients at risk of intracranial hypertension, but there is increasing recognition that 0.9% saline is not without its problems. Roquilly and colleagues show a reduction in the development of hyperchloremic acidosis in brain-injured patients given 'balanced' solutions for maintenance and resuscitation compared with 0.9% sodium chloride. In this commentary, we explore the idea that we should move away from 0.9% sodium chloride in favor of a more 'physiological' solution.
Effect of topical anesthetic agents and ethanol on corneoepithelial wound healing in an ex vivo whole-globe porcine model.
Tappeiner Christoph,Flueckiger Franziska,Boehnke Matthias,Goldblum David,Garweg Justus G
Journal of cataract and refractive surgery
PURPOSE:To assess the impact of topical anesthetic agents and ethanol on ocular surface wound healing using an ex vivo whole-globe porcine model. SETTING:Department of Ophthalmology, Inselspital, University of Bern, Bern, Switzerland. DESIGN:Experimental study. METHODS:Standardized corneoepithelial lesions (5.0 mm diameter, 40 μm depth) were created with excimer laser light in freshly enucleated porcine eyes. The globes (6 per group) were exposed to different concentrations of ethanol (2.0% to 99.0%), cocaine (2.0% to 10.0%), procaine hydrochloride (0.4%), tetracaine (0.5% to 1.0%), or lidocaine (2.0%), 3 drops/hour for 3 hours. Control solutions were physiologic saline, balanced salt solution, and tissue-culture medium. After 20 to 26 hours, wound-healing response was compared by measuring the diameter of each corneoepithelial lesion. RESULTS:The mean diameter of corneoepithelial lesions exposed to physiologic saline decreased from 4.78 mm ± 0.19 (SD) to 4.44 ± 0.17 mm between 20 and 26 hours. After 24 hours, the mean lesion size, compared with physiological saline, was larger after cocaine 5.0% (5.20 ± 0.26 mm) and 10.0% (5.39 ± 0.12 mm), tetracaine 0.5% (5.59 ± 0.35 mm) and 1.0% (5.55 ± 0.27 mm), and procaine hydrochloride 0.4% (5.76 ± 0.12 mm), but not after lidocaine 2.0% (5.01 ± 0.17 mm). Balanced salt solution, tissue-culture medium, ethanol 2.0% to 99.0%, and cocaine 2.0% did not inhibit the wound-healing response. CONCLUSIONS:In an ex vivo whole-globe porcine model, lidocaine 2.0% and cocaine 2.0% were the least toxic anesthetic agents. At all concentrations, ethanol had no impact on wound healing. FINANCIAL DISCLOSURE:No author has a financial or proprietary interest in any material or method mentioned.
Effect of zwitterionic polymers on wound healing.
Fujishita Shigeto,Inaba Chika,Tada Susumu,Gemmei-Ide Makoto,Kitano Hiromi,Saruwatari Yoshiyuki
Biological & pharmaceutical bulletin
The effect of a thin film of a zwitterionic random copolymer composed of carboxybetaine [1-carboxy-N,N-dimethyl-N-(2'-methacryloyloxyethyl)methanaminium inner salt] (CMB) and n-butyl methacrylate (BMA), poly(CMB-r-BMA) (CMB, 30 mol%), on the healing of a full-thickness excisional and incisional wound in hairless rats was examined. The poly(CMB-r-BMA) film significantly enhanced wound closure and complete healing of a full-thickness excisional wound compared with the effect of the poly(n-butyl methacrylate) (PBMA) and the poly(ethylene terephthalate) (PET) films. However, the poly(CMB-r-BMA) film did not enhance healing of a full-thickness incisional wound in hairless rats. The amount of proteins adsorbed and that of neutrophiles adhered onto the poly(CMB-r-BMA) film were significantly smaller than those onto the PBMA and PET films. The results suggested that various cells and growth factors in the wound exudate are utilized effectively by covering an excisional wound with the poly(CMB-r-BMA) film, resulting in acceleration of healing. In addition, the poly(CMB-r-BMA) film significantly enhanced healing of a full-thickness excisional wound in hairless rats compared with the effect of Tegaderm as wound dressings. The poly(CMB-r-BMA) film has potential as a new wound dressing.
Effect of hydrogel grafting, water and surfactant wetting on the adherence of PET wound dressings.
Ning Chenxi Coco,Logsetty Sarvesh,Ghughare Shivkumar,Liu Song
Burns : journal of the International Society for Burn Injuries
Traditional wound dressings, including cotton gauze, absorbent pads and bandages, can cause trauma and pain to wounds during dressing changes, leading to a variety of physical and psychosocial sequelae. The aim of this study was to adapt an in vitro model of adherence to evaluate the effects of various methods to theoretically reduce the adherence of wound dressings. Gelatin in liquid form was cast onto poly(ethylene terephthalate) (PET) fabric and allowed to solidify and progressively dry to simulate wound desiccation in the clinical setting. A 180° peel test of PET from the gelatin slab yielded adherence data of peeling energy. The peeling energy of PET increased with the drying time. It was possible to reduce the force by drying at 75% relative humidity (RH). After drying for 24h, either 500μL of water or surfactant solution was added onto the PET surface (16×60mm(2)). The peeling energy decreased dramatically with wetting and there was no significant difference between water and surfactant. As a long-term strategy for decreasing adherence, a thin layer of polyacrylamide (PAM) hydrogel was deposited onto PET fabric via UV irradiation. This resulted in a much lower peeling energy without severely compromising fabric flexibility. This hydrogel layer could also serve as a reservoir for bioactive and antimicrobial agents which could be sustainably released to create a microbe-free microenvironment for optimized wound healing.
Technological Advances in Wound Treatment of Exotic Pets.
Sabater González Mikel,Mayer Jörg
The veterinary clinics of North America. Exotic animal practice
Although most research about the use of technological advances for wound healing was performed in laboratory animals but oriented to human medicine, recent technological advances allowed its application not only to small animals but also to exotic pets. This article reviews the literature available about some of these techniques (negative wound pressure therapy, photobiomodulation [laser therapy], electrical stimulation therapy, therapeutic ultrasonography, hyperbaric oxygen therapy), and other advances in wound management (skin expanders, xenografts, and bioengineered autologous skin substitutes) in exotic pet species.
Bioelectric Dressing Supports Complex Wound Healing in Small Animal Patients.
Maijer Amanda,Gessner April,Trumpatori Brian,Varhus Janet D
Topics in companion animal medicine
It is well documented that physiological electric fields provide the earliest signals necessary to initiate cell proliferation, migration, and ultimately reepithelialization of wounds. Additionally, electricity is known to exert an antimicrobial effect. An electric field-generating wound dressing designed to mimic physiological electric fields has not been described in the small animal clinic. This article retrospectively reviews the use of a microcell battery-impregnated bioelectric dressing (BED) in 5 small animal patients with complex wounds. For each patient, product application and wound healing progress was monitored and documented over several weeks. Despite the severity of the wounds and being at high risk for infection, all presenting wounds treated with BED achieved complete closure within 4 weeks without becoming infected or requiring grafting. These cases provide early evidence that the use of the BED is feasible in a small animal clinic and may support healing while providing topical, nonantibiotic activity against wound pathogens.
Effect of different irrigating solutions on aqueous humour pH changes, intraocular pressure and histological findings after induced alkali burns.
Kompa Sirpa,Redbrake Claudia,Hilgers Christoph,Wüstemeyer Henrike,Schrage Norbert,Remky Andreas
Acta ophthalmologica Scandinavica
PURPOSE:To evaluate the effects of hypo-osmolar tap water and isotonic saline solution on the intracameral pH, intraocular pressure and histological changes in alkali burned rabbit eyes. METHODS:Four groups of four rabbit corneas each were burned with 2 N sodium hydroxide, and then rinsed with 0.5 l or 1.5 l of saline solution or tap water, respectively. Changes in pH were monitored with an intracameral microelectrode. Intraocular pressure (IOP) was monitored by a transducer placed in the vitreous cavity. After enucleation, histology was performed. RESULTS:The pH increased after 1.5 min following alkali application. Irrigation with different solutions affected the maximum pH levels reached. Following the tap water rinse, the maximum rise was significantly lower than after the saline solution rinse. The maximum rise following rinsing with 1.5 l of tap water showed a significant delay. The increase in IOP was 23 +/- 10 mmHg without differences between the groups; the original pressure was recovered after 18 +/- 9 min. Histology of the eyes revealed a significant oedema in all corneas. Other ocular structures appeared unchanged. CONCLUSIONS:The hypo-osmolarity of tap water led to remarkable corneal oedema. Enlargement of the diffusion barrier and intracorneal dilution inhibit elevated intracameral pH levels. The difference in maximum pH levels reached may influence the degree of subsequent intraocular structure injury. Therefore, the use of iso-osmolar saline solution proves to be less efficacious than tap water as an irrigation agent for ocular burns.
Topical Selenium Sulfide for the Treatment of Hyperkeratosis.
Cohen Philip R,Anderson Caesar A
Dermatology and therapy
Hyperkeratosis presents as thickened skin. It can be congenital or acquired. Typically, it affects the palms and soles; the distribution of epidermal involvement is either diffuse, focal, or punctate. Microscopically, the pathologic signature of hyperkeratosis is marked orthokeratosis of the stratum corneum. Topical treatments provide the mainstay of therapy for hyperkeratosis. These include keratolytics (such as urea, salicylic acid, and lactic acid) and retinoids; physical debridement, topical corticosteroids, and phototherapy (using topical psoralen and ultraviolet A phototherapy) are other local therapeutic modalities. Selenium is a non-metallic essential element; its water-insoluble salt, selenium sulfide, is an active ingredient that is used (in either a foam, lotion, or shampoo) to treat not only seborrheic dermatitis but also tinea versicolor. Three individuals with hyperkeratosis involving their palms and/or soles are described; the hyperkeratosis was successful treated with topical selenium sulfide in either a 2.5% lotion/shampoo or a 2.75% foam. The response to topical selenium sulfide was not only rapid but also complete and sustained; none of the patients experienced any adverse events secondary to the therapy. In conclusion, we recommend that topical selenium sulfide be added to the therapeutic armamentarium for congenital or acquired hyperkeratosis-particularly for those patients with involvement of their palms and soles.
Metal chelation reduces skin epithelial inflammation and rescues epithelial cells from toxicity due to thermal injury in a rat model.
El Ayadi Amina,Wang Cheng Z,Zhang Min,Wetzel Michael,Prasai Anesh,Finnerty Celeste C,Enkhbaatar Perenlei,Herndon David N,Ansari Naseem H
Burns & trauma
Background:One of the most pervasive complications of burn injury is wound progression, characterized by continuous tissue destruction in untreated wounds, which leads to wound infection, inflammation, oxidative stress and excessive scar formation. We determined whether additional tissue destruction could be attenuated with Livionex formulation (LF) lotion, which contains a metal-chelating agent and reduces inflammation in burn wounds. Methods:We subjected male Sprague Dawley rats to a 2% total body surface area (TBSA) burn using a brass comb model and topically applied LF lotion (containing ethylenediaminetetraacetic acid and methyl sulfonyl methane) to the affected area every 8 hours over 3 days. Inflammatory cytokine levels, cell apoptosis and wound healing were compared in LF lotion-treated and untreated rats. Statistical analysis was performed using a one-way analysis of variance in conjunction with Tukey's post-hoc test. Results:Serum inflammatory cytokines were not detectable after 3 days, suggesting that small burn wounds induce only an immediate, localized inflammatory response. Microscopy revealed that LF lotion improved burn site pathology. Deoxynucleotidyl transferase biotin-d-UTP nick-end labeling staining showed reduced cell death in the LF-treated samples. LF lotion prevented the spread of tissue damage, as seen by increased amounts of Ki-67-positive nuclei in the adjacent epidermis and hair follicles. Tumor necrosis factor-alpha, interleukin-6 and inducible nitric oxide synthase levels in LF-treated skin sections from burned rats were comparable to the levels observed in unburned control sections, indicating that LF lotion reduces inflammation in and around the burn site. Conclusions:These results establish LF lotion as a therapeutic agent for reducing inflammatory stress, cell death and tissue destruction when applied immediately after a burn injury. Further studies of LF lotion on large TBSA burns will determine its efficacy as an emergency treatment for reducing long-term morbidity and scarring.
In vivo wound healing effects of Symphytum officinale L. leaves extract in different topical formulations.
Araújo L U,Reis P G,Barbosa L C O,Saúde-Guimarães D A,Grabe-Guimarães A,Mosqueira V C F,Carneiro C M,Silva-Barcellos N M
The present work evaluates wound healing activity of leaves extracts of Symphytum officinale L. (comfrey) incorporated in three pharmaceutical formulations. Wound healing activity of comfrey was determined by qualitative and quantitative histological analysis of open wound in rat model, using allantoin as positive control. Three topical formulations, carbomer gel, glycero-alcoholic solution and O/W emulsion (soft lotion) were compared. The histological analysis of the healing process shows significant differences in treatment, particularly on its intensity and rate. The results indicate that emulsion containing both extracts, commercial and prepared, induced the largest and furthest repair of damaged tissue. This could be evidenced from day 3 to 28 by increase in collagen deposition from 40% to 240% and reduction on cellular inflammatory infiltrate from 3% to 46%. However, 8% prepared extract in emulsion presented the best efficacy. This work clearly demonstrates that comfrey leaves have a wound healing activity. The O/W emulsion showed to be the vehicle most effective to induce healing activity, particularly with extracts obtained from comfrey leaves collected in Minas Gerais state in Brazil. It shows the best efficacy to control the inflammatory process and to induce collagen deposition at 8% concentration.
Effect of reactive skin decontamination lotion on skin wound healing in laboratory rats.
Walters Thomas J,Kauvar David S,Reeder Joanna,Baer David G
Reactive skin decontamination lotion (RSDL) is a proposed replacement for the existing skin and equipment decontamination kit. Because RSDL may need to be used to decontaminate wounded personnel, we conducted an assessment of the effect of this agent on wound healing. A skin incision model using male Sprague Dawley rats (n = 19 rats/group) was used. A 7.0-cm incision was made through the skin, and RSDL was (experimental group) or was not (control group) applied to the open wound; the wound edges were then approximated with sutures. Seven days later, animals were euthanized and wound samples were taken. Healing was assessed by measuring mechanical strength, collagen content, and histological appearance. RSDL-treated wounds had 23% lower tensile strength (p < 0.05) and 11% lower collagen content (p < 0.05) than did the untreated control wounds. Histological assessments did not differ significantly between groups. The results of this investigation demonstrate that the application of RSDL directly to an open wound impairs wound strength and decreases collagen content in the early phases of wound healing. This may have clinical implications for the treatment and outcomes of chemical casualty combat trauma.
Impairment of wound healing by reactive skin decontamination lotion (RSDL) in a Göttingen minipig model.
Connolly Jessica M,Stevenson Robert S,Railer Roy F,Clark Offie E,Whitten Kimberly A,Lee-Stubbs Robyn B,Anderson Dana R
Cutaneous and ocular toxicology
Reactive Skin Decontamination Lotion (RSDL) is an FDA-approved skin decontamination kit carried by service members for removal and neutralisation of vesicants and nerve agents. The RSDL kit, comprised of a lotion-impregnated sponge, was shown to be the superior medical decontamination device for chemical warfare agent (CWA) exposure on intact skin. In the event of a chemical exposure situation (i.e. terrorism, battlefield) physical injuries are probable, and preservation of life will outweigh the risk associated with application of RSDL to compromised skin. The purpose of this study was to quantify the rate and quality of wound healing in epidermal skin wounds treated with RSDL in a porcine model. Degree of wound healing was assessed using bioengineering methods to include ballistometry, colorimetry, evaporimetry, and high-frequency ultrasonography. Clinical observation, histopathology and immunohistochemistry were also utilised. All pigs received four bilateral superficial abdominal wounds via a pneumatic dermatome on their ventral abdomen, then were treated with the following dressings over a seven-day period: RSDL sponge, petroleum based Xeroform gauze, 3 M™ Tegaderm™ Film, and 3 M™ Tegaderm™ Foam. Two additional non-wounded sites on the flank were used as controls. Two groups of pigs were then evaluated for a 21- or 56-day time period, representing short- and long-term wound-healing progression. Our findings indicated RSDL had a negative impact on wound-healing progression at both 21 and 56 days post-injury. Wounds receiving RSDL demonstrated a decreased skin elasticity, significant transepidermal water loss, and altered skin colouration and thickness. In addition, the rate of wound healing was delayed, and return to a functional skin barrier was altered when compared to non-RSDL-treated wounds. In conclusion, wound management care and clinical therapeutic intervention plans should be established to account for a prolonged duration of healing in patients with RSDL-contaminated wounds.
Optimal concentration of ethylenediaminetetraacetic acid as an irrigation solution additive to reduce infection rates in rat models of contaminated wound.
Lin Junqing,Gao Tao,Wei Haifeng,Zhu Hongyi,Zheng Xianyou
Bone & joint research
AIMS:In wound irrigation, 1 mM ethylenediaminetetraacetic acid (EDTA) is more efficacious than normal saline (NS) in removing bacteria from a contaminated wound. However, the optimal EDTA concentration remains unknown for different animal wound models. METHODS:The cell toxicity of different concentrations of EDTA dissolved in NS (EDTA-NS) was assessed by Cell Counting Kit-8 (CCK-8). Various concentrations of EDTA-NS irrigation solution were compared in three female Sprague-Dawley rat models: 1) a skin defect; 2) a bone exposed; and 3) a wound with an intra-articular implant. All three models were contaminated with or . EDTA was dissolved at a concentration of 0 (as control), 0.1, 0.5, 1, 2, 5, 10, 50, and 100 mM in sterile NS. Samples were collected from the wounds and cultured. The bacterial culture-positive rate (colony formation) and infection rate (pus formation) of each treatment group were compared after irrigation and debridement. RESULTS:Cell viability intervened below 10 mM concentrations of EDTA-NS showed no cytotoxicity. Concentrations of 1, 2, and 5 mM EDTA-NS had lower rates of infection and positive cultures for and compared with other concentrations in the skin defect model. For the bone exposed model, 0.5, 1, and 2 mM EDTA-NS had lower rates of infection and positive cultures. For intra-articular implant models 10 and 50 mM, EDTA-NS had the lowest rates of infection and positive cultures. CONCLUSION:The concentrations of EDTA-NS below 10 mM are safe for irrigation. The optimal concentration of EDTA-NS varies by type of wound after experimental inoculation of three types of wound. Cite this article: 2021;10(1):68-76.
Therapeutic effect of ethylenediaminetetraacetic acid irrigation solution against wound infection with drug-resistant bacteria in a rat model: an animal study.
Deng Z,Liu F,Li C
Bone & joint research
Objectives:Irrigation is the cornerstone of treating skeletal infection by eliminating pathogens in wounds. A previous study shows that irrigation with normal saline (0.9%) and ethylenediaminetetraacetic acid (EDTA) could improve the removal of () and () compared with normal saline (NS) alone. However, it is still unclear whether EDTA solution is effective against infection with drug-resistant bacteria. Methods:We established three wound infection models (skin defect, bone-exposed, implant-exposed) by inoculating the wounds with a variety of representative drug-resistant bacteria including methicillin-resistant (MRSA), extended spectrum beta-lactamase-producing (ESBL-EC), multidrug-resistant (MRPA), vancomycin-resistant (VRE), multidrug-resistant (MRAB), multidrug-resistant (MRE), and multidrug-resistant (MRPM). Irrigation and debridement were repeated until the wound culture became negative. The operating times required to eliminate pathogens in wounds were compared through survival analysis. Results:Compared with other groups (NS, castile soap, benzalkonium chloride, and bacitracin), the EDTA group required fewer debridement and irrigation operations to achieve pathogen eradication in all three models of wound infection. Conclusion:Irrigation with EDTA solution was more effective than the other irrigation fluids used in the treatment of wound infections caused by drug-resistant pathogens.: Z. Deng, F. Liu, C. Li. Therapeutic effect of ethylenediaminetetraacetic acid irrigation solution against wound infection with drug-resistant bacteria in a rat model: an animal study. 2019;8:189-198. DOI: 10.1302/2046-3758.85.BJR-2018-0280.R3.
Principles of Wound Management and Wound Healing in Exotic Pets.
Mickelson Megan A,Mans Christoph,Colopy Sara A
The veterinary clinics of North America. Exotic animal practice
The care of wounds in exotic animal species can be a challenging endeavor. Special considerations must be made in regard to the animal's temperament and behavior, unique anatomy and small size, and tendency toward secondary stress-related health problems. It is important to assess the entire patient with adequate systemic evaluation and consideration of proper nutrition and husbandry, which could ultimately affect wound healing. This article summarizes the general phases of wound healing, factors that affect healing, and principles of wound management. Emphasis is placed on novel methods of treating wounds and species differences in wound management and healing.