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Healing outcomes of periodontal and implant-related regenerative procedures are closely related to wound stability, which is partially determined by biomechanical properties and behaviors of oral mucosal tissues. Studies on soft tissue behavior under biomechanical forces in oral regeneration models are scarce. Thus, this review aims to (1) contrast the microstructural differences between the attached gingiva (AM) and lining (LM) mucosa; (2) evaluate biomechanical behaviors of the two mucosal types; and (3) relate residual flap tension to the prevalence of wound opening after regenerative procedures. Compositional and structural differences between the AM and LM explain their biomechanical property differences. Wound destabilizers, including tissue recoil stemming from its viscoelastic property, muscle pull, and inflammatory edema (created after the flap-releasing procedure for primary wound closure) interfere with wound stability. Residual flap tension < 0.05 N is a prerequisite for sustained wound closure. Tissues under stress can exert negative cellular changes, resulting in necrosis and wound dehiscence. Biomechanical properties and the variations between AM and LM dictate the degree of wound stability. Efforts should be made to reduce the negative impact of the potential destabilizers to optimize wound stability. [ABSTRACT FROM AUTHOR]

ObjectiveDiabetic foot ulcers (DFUs) present a significant global health challenge, resulting in high morbidity and economic costs. Current available treatments often fail to achieve satisfactory healing rates, highlighting the need for novel therapies. This study evaluated the safety and efficacy of a novel autologous whole blood clot (AWBC)-a blood-based, biodegradable provisional matrix-in conjunction with standard of care (SoC) when compared to SoC alone in the treatment of hard-to-heal DFUs.MethodA multicentre, prospective, blinded assessor, randomised controlled trial was conducted at 16 sites across the US, South Africa and Turkey. A cohort of patients with hard-to-heal DFUs was enrolled and randomised to either the AWBC group or the control group. The primary endpoint was complete wound closure at 12 weeks, while secondary endpoints included time to heal and percentage area reduction (PAR) at four and eight weeks. Data were analysed using both intention-to-treat (ITT) and per-protocol (PP) populations.ResultsThe cohort included 119 patients. AWBC treatment resulted in a significantly higher healing rate compared to the control in both ITT (41% versus 15%, respectively; p=0.002) and PP populations (51% versus 18%, respectively; p=0.0075). AWBC treatment also resulted in a shorter mean time to heal and higher durability of wound closure. Safety analysis showed a similar incidence of adverse events (AEs) between groups, with no device-related AEs.ConclusionThe AWBC system, by modulating the wound microenvironment and providing a functional extracellular matrix, offered a promising new approach to treating hard-to-heal DFUs, demonstrating superior healing outcomes compared to SoC alone in this study.

[Display omitted] • The pressure resistance and antibacterial property of hydrogel have been enhanced by silver coated calcium phosphate. • The textile-like structure can improve the gas permeability of the dressing and enhance its pressure monitoring sensitivity. • The wound healing can be promoted using the designed smart dressings, which provides a new treatment strategy. In the treatment of infected wounds in bedridden or lying chair patients with mobility problems, improper wound care can lead to wound deterioration, prolong disease pain, increase treatment and care costs, and bring heavier psychological, physical, and economic burdens to patients. In the process of wound recovery, patients with mobility problems mainly face the comprehensive problems of poor air permeability, wound pressure could not be monitored, wound infection and slow healing. Therefore, in the process of wound care for such patients, it is imperative to develop a gas permeable dressing that can monitor the patient's wound compression status in real time and promote wound healing. Here, we developed a textile-shaped gel dressing with pressure-responsive properties. Polydopamine (PDA)-silver coated calcium phosphate nanoparticles (CPNPs）and vascular endothelial growth factor (VEGF) were introduced into the gel to give the gel good antibacterial and therapeutic effects, while enhancing the pressure resistance of the gel to meet the needs of wound pressure monitoring. The textured gel morphology greatly improves the gas permeability of the gel and further improves the pressure sensitivity of the gel. This multifunctional textile-like gel dressing provides a new strategy for the development of treatment monitoring integrated dressing and has broad application prospects. [ABSTRACT FROM AUTHOR]

Background: In Mali, cancer patients are often diagnosed at stage III or IV. Tumor wounds are more frequent and associated with malodorous exudates, responsible for an altered quality of life and stigmatization of patients. Cinesteam® Cinnamon Dressing is an adsorbent dressing designed to reduce odors. This study aimed at demonstrating the feasibility of routine use of cinnamon dressing in the Malian context, and to assess its effect on tumor wound odors. Patients and methods: This is a prospective observational pilot study conducted jointly by the oncology department of the Point G University hospital in Bamako and Médecins Sans Frontières France. Included patients suffered from a malignant malodourous wound and were treated with cinnamon dressing. The primary endpoint was wound odor. Secondary endpoints were appetite, duration of dressing efficacy and ease of use. Results: Forty patients were included in this pilot study. Complete data and follow-up were available for 19 patients only. The odor score reported by patients was significantly decreased after 10 days of cinnamon dressing (odor score 1.7 versus 3.3, t-test 0.00003). Seventeen patients reported that the CINESTEAM® dressing was easy to use, even for patients receiving home-based palliative care in remote areas. The dressing provided an odor control that lasted more than 24 h. One year after inclusion, more than half of the patients had died of their cancer, indicating a very advanced stage at diagnosis. The cinnamon dressing had no effect on appetite, but most of the patients were undergoing palliative chemotherapy, which may account for this result. Conclusion: The use of innovative dressings is feasible, even in very deprived contexts, and might decrease the discomfort linked with unpleasant odors in tumoral wounds. Odor management is crucial to restore self-esteem and to prevent patients' stigma and isolation. [ABSTRACT FROM AUTHOR]

Background: In 2018, the U.S. Army Surgeon General created the Army Medical Department Military-Civilian Trauma Team Training (AMCT3) program to enhance the clinical proficiency of medical personnel serving on Army trauma teams called forward resuscitative surgical detachments (FRSDs). FRSDs provide resuscitative and surgical care to wounded patients in the deployed environment until they can be medically evacuated to a higher level of care. Through AMCT3, FRSD personnel work at civilian trauma centers while not deployed in order to maintain their combat casualty care competency. Purpose: This article describes an innovative nursing-specific AMCT3 program model in which Army nurses serving on an FRSD are embedded within a level 1 trauma center for a 3-year assignment. The goal of the program, which was established at Vanderbilt University Medical Center (VUMC) in Nashville, Tennessee, is to improve participants' clinical proficiency and skills in preparation for the next major military conflict, with the aim of reducing preventable battlefield deaths. Methods: The VUMC Military Affairs Committee, in consultation with Army medical leaders, developed a unique 3-part model for a nursing partnership program at VUMC. This model includes separate tracks for critical care and emergency nurses. The nurses receive training in their specialty, cross-training in the opposite track, and other professional development opportunities. A critical care nurse and an emergency nurse were assigned to the program in January 2022 and September 2022, respectively. Results: Between January 2022 and June 2023, the critical care nurse completed all the required individual critical task lists—specialty-specific clinical skills Army medical personnel must be competent in before deployment—except for 1, obtaining intra-abdominal pressure. Conclusion: The VUMC AMCT3 nursing partnership training model ensures that Army nurses are highly prepared to function as part of the FRSD and to provide superior combat casualty care in a resource-limited environment. The authors describe a training program at a civilian level 1 trauma center that aims to improve Army nurses' clinical proficiency and skills in preparation for their next major military conflict. [ABSTRACT FROM AUTHOR]

The article focuses on the critical care considerations in managing trauma patients after initial resuscitation, particularly in the intensive care unit. Topics discussed include ongoing resuscitation strategies, complications such as abdominal compartment syndrome and acute lung injury, and the challenges of trauma-induced coagulopathy and massive transfusion management.

Objective: Identification of early-stage pressure injuries (PIs) during visual skin assessment may be subjective and unreliable. An alternate light source (ALS) has been shown to increase the probability of detecting evidence of bruises on individuals with darker skin tones. Bruises and early-stage PIs are often difficult to identify, especially in those with darker skin tones, where melanin concentration is high. Given the effect skin pigmentation has on detecting both types of cutaneous injuries, this proof-of-concept study aimed to describe the characteristics of Stage 1 PIs and deep tissue PIs as viewed under an ALS. Method: Eligible participants were first examined by a certified wound ostomy continence nurse using environmentally available white light. A blinded second examiner then evaluated the size of the potential tissue impairment using violet (406nm) and blue (448nm) ALS viewed through yellow and orange goggles, respectively. Portable ultrasound was used to confirm tissue involvement. Data were summarised using descriptive statistics. Results: The study included 10 participants (40% of whom were from minority racial/ethnic groups) with a mean Braden Scale score of 11.1. The majority of PIs (80%) involved deep tissue and were located on lower extremities (60%). The median PI size was larger by 17.5cm2 and 13.7cm2, respectively, using ALS compared with white light when viewed under violet and blue wavelengths. Ultrasound data were limited to non-extremity regions (n=3 participants) with hypoechoic areas noted as being 10–13mm in thickness and up to 16.7mm deep. Conclusion: Evidence of tissue damage that extended beyond that visualised under white light was noted with ALS. Usefulness of ultrasound was limited over bony prominences where there was too little subcutaneous tissue. Further research is warranted to investigate the potential application of ALS for the early detection of PIs. [ABSTRACT FROM AUTHOR]

Objective: The prevention and treatment of burn wounds has improved over the years, leading to decreased incidence, severity and mortality. However, burn injuries, particularly partial-thickness burns, have a painful treatment course which, if not optimised, can cause undue suffering to patients and prolonged recovery. Although silver sulfadiazine has been the most commonly accepted treatment for partial-thickness burns due to its strong hindrance of infection, wide availability and low cost, it requires daily dressing changes which are labour intensive and painful. Exploring alternative techniques, such as using cultured keratinocytes, to prevent and treat burn wounds may provide a path to better optimising the path to recovery. Method: This paper presents two cases that use two alternative treatments, either PluroGel (a gel surfactant, Medline Industries, US) or cultured keratinocytes, in the treatment of partial-thickness burns to minimise pain and enhance treatment experience. Results: Using surfactant-based treatments, such as the gel surfactant, in partial-thickness burns exhibited prohealing outcomes via enhanced antimicrobial effects, a strengthened physical barrier and cell salvage. Conclusion: Using cultured keratinocytes and a highly concentrated surfactant may achieve more rapid re-epithelialisation of partial-thickness burn wounds. These alternative techniques may offer significant advancement in the quality of care in burn injury treatment. [ABSTRACT FROM AUTHOR]

Objective: Opioid tolerance is a criterion for opioid use disorder, which is currently an epidemic in the US. Individuals with open wounds are frequently administered opioids; however, the phenomenon of opioid tolerance has not been examined in the context of wounds. The purpose of this exploratory study was to compare patient/wound factors, wound microbiome and inflammatory mediators between individuals who were opioid-tolerant versus those who were not opioid-tolerant. Method: Patients with acute open wounds were enrolled in this cross-sectional study. All study data were collected before and during a one-time study dressing change. Results: The study included a total of 385 participants. Opioid-tolerant participants were significantly younger (p<0.0001); had higher levels of depression (p=0.0055) and anxiety (p=0.0118); had higher pain catastrophising scores (p=0.0035); reported higher resting wound pain (p<0.0001); had a higher number of wounds of <30 days' duration (p=0.0486); and had wounds with lower bacterial richness (p=0.0152) than participants who were not opioid-tolerant. A backward elimination logistic regression model showed that four predictors—resting wound pain, age, bacterial richness and depression—were the most important variables in predicting opioid-tolerance status. Conclusion: These findings provide the first insights into the phenomenon of opioid tolerance in the context of open wounds. This study provides findings from which to guide hypothesis-driven research in the future. [ABSTRACT FROM AUTHOR]

Objective: Hard-to-heal wounds present a significant healthcare challenge due to their complex aetiology, impact on quality of life (QoL) and consequent economic burden. The aim of this study was to assess the usability, safety and performance of a next-generation, multilayered foam dressing, ConvaFoam (Convatec Ltd., UK), in the management of indicated hard-to-heal wounds. Method: In this prospective, multicentre, interventional, non-comparator, open-label study, wounds included venous leg ulcers, arterial leg ulcers, diabetic foot ulcers and pressure injuries. The primary endpoint was percentage change in wound area at four weeks. Additional endpoints included percentage change in wound area at 12 weeks, satisfactory clinical progress (defined as ≥40% reduction in study wound area at four weeks), complete wound closure, adverse events, pain, QoL and health professional usability outcomes. Results: A total of 90 patients (109 wounds) were included in the full analysis set. The median percentage reduction in wound area from baseline was 47.88% (p<0.0001) at week 4 and 93.75% (p<0.0001) at week 12. Satisfactory clinical progress at four weeks was reported for 61 (55.96%) wounds. Complete wound closure by week 12 was observed in 43 (39.45%) wounds (p<0.0001). The median Wound Quality of Life-14 score improved from 55.36 at baseline, to 80.36 at week 12. Of the 2935 dressing applications, there were only two adverse events which were reported to be related to the study dressings. The majority of health professionals rated ease of application, exudate management, ease of removal and conformity as excellent. Conclusion: The ConvaFoam dressings were shown to be effective at reducing wound size and promoting healing in indicated hard-to-heal wounds, particularly diabetic foot and venous ulcers. [ABSTRACT FROM AUTHOR]

Objective: Although wound infection rates after stoma closure have decreased, they remain high. Negative pressure wound therapy (NPWT) for stoma closure wounds can shorten healing time for many wound types. The PICO (Smith+Nephew, UK) wound dressing, a single-use NPWT system that can be used for outpatients, was introduced at the Japan Community Health Care Organization Hokkaido Hospital, Japan in November 2017. We evaluated the effectiveness of this dressing in stoma closure wounds. Method: We retrospectively evaluated patients who underwent stoma closure between March 2012 and July 2021. We compared postoperative short-term outcomes (surgical site infection (SSI), number of pain medications, and postoperative hospital stay) by allocating the patients to one of two groups: purse-string closure or purse-string closure with PICO. The purse-string closure group (PC) underwent purse-string closure alone, while the other group underwent purse-string closure and PICO (PCP). Results: A total of 35 patients were evaluated; 20 in the PC group and 15 in the PCP group. No significant differences in characteristics were noted between the groups. Comparisons between stoma closure techniques revealed that the PCP group had shorter hospital stays (p=0.04), lower SSI rates (p=0.04), and less pain medication (p<0.01) than the PC group. Comparisons between SSI occurrence revealed that the group of patients with an SSI had a higher number of colostomies compared with ileostomies (37.5% versus 0%, p<0.01, respectively), used more pain medication (p<0.01), and had longer hospital stays (p=0.04) than patients who did not have an SSI. Conclusion: After stoma closure, combining PICO with purse-string closure may be effective in preventing SSI and controlling postoperative pain. [ABSTRACT FROM AUTHOR]

Objective: Infected wounds, refractory to conventional therapy, are a major burden on the healthcare system. Available data show that many commonly used antiseptic agents may be toxic to the cells involved in the healing process and may affect the normal tissue repair. The topical use of different acids to control wound infections effectively and promote healing is well known. The present review aims to summarise the safety and efficacy of various acids as topical agents for treating wound infections. Method: A literature search was performed in PubMed and manually from other sources (cross references and journal sites). Results: We reviewed 116 articles, from which data from 86 relevant articles were analysed. The studies showed that various organic acids were clinically effective in treating wound infections. Conclusion: This study found that various organic acids can act as a substitute for antiseptics to control wound infections refractory to conventional antibiotic therapy and local wound care. Various organic acids differ in efficacy, safety and limitations as topical agents to control wound infections and promote healing. Some acids deliver better results than others, particularly in those cases in which antibiotics and routine antiseptic agents yield little lasting success, especially in controlling hospital strains with multiple antibiotic resistance. Among topically used acids, citric acid and acetic acid are associated with better results. [ABSTRACT FROM AUTHOR]

Ulcerated tophaceous gout is an uncommon presentation of the lower limbs. Treatment of these wounds can be a challenge, as their optimal management remains to be determined. Therefore, a retrospective analysis of medical charts between 2015 and 2021 was conducted at a wound clinic of a university-affiliated hospital to determine the characteristics of patients treated for tophaceous wounds, their evolution and treatment. We report a total of five patients with ulcerated tophaceous gout of the foot who initially presented predominantly with soft tissue infection or osteomyelitis. All progressed well with local wound care, including conservative sharp debridement of the tophi and rapid initiation of urate-lowering therapy. Therefore, a diagnosis of tophi should be considered in an ulceration of the first metatarsophalangeal joint or other toes when whitish-chalky material is present, even if the patient was not previously known to have gout. Tophi ulceration is a rare complication; however, prompt diagnosis and management are important to avoid destruction of the underlying bone structures. [ABSTRACT FROM AUTHOR]

Objective: Venous leg ulcer (VLU) is a common complication which significantly reduces the patient's quality of life. Despite many effective treatment methods, such as compression therapy, which allow the wound to heal in a short time, it is important to maintain the long-term effects of the therapy. We present the case of a 67-year-old male patient with a trophic ulcer of his left leg. Method: The patient was treated with inelastic multicomponent compression bandages applied every day under Kikuhime pressure-measuring device (HPM-KH-01; TT Meditrade, Denmark) control and advised to wear a compression stocking. Results: The patient's wound closed within eight weeks. After five months, the patient returned to our clinic with a one-month-old wound due to non-adherence with medical recommendations. Conclusion: Key roles in recurrence prevention seem to be played not only by the patient's motivation and perseverance, but, more importantly, by the approach of the therapist. Health professionals should focus not only on one-time closure of the patient's wound, but on cooperation with the patient's family and caregivers, and instructing them on how to look after the patient on a daily basis, including with help to put on compression garments and with motivation to move and exercise. In many cases, with unaccompanied patients, rapid VLU recurrence is observed. [ABSTRACT FROM AUTHOR]

Objective: The combination of adalimumab and surgical interventions plays a crucial role in managing severe hidradenitis suppurativa (HS). However, there is still limited scientific evidence regarding administering adalimumab during the perioperative period. This study aimed to evaluate whether adalimumab could adversely affect postoperative complications and the total time of wound closure (TTWC) in patients undergoing cutaneous surgery for HS. Method: In this single-centre cohort study, patients with HS were allocated to two groups. Group 1 (biological cohort) consisted of patients with HS who had continuously received adalimumab for at least three months before the procedure. Group 2 (non-biological cohort) patients underwent cutaneous surgery after only four weeks of anti-inflammatory medication. All patients were left to secondary wound healing. Results: A total of 30 surgical sites in 20 patients were included in the study (Group 1: 15 surgical sites/nine patients; Group 2: 15 surgical sites/11 patients). Disease severity and excised skin areas were significantly higher in Group 1 (p<0.001 and p=0.042, respectively) than in Group 2. While the median TTWC was longer in Group 1 than in Group 2 (p=0.004), multivariate regression analysis showed that TTWC was associated with the excised skin area (p=0.016) and Hurley stage (p=0.032), but was not affected by the use of adalimumab (p=0.076). Conclusion: In this study, the use of adalimumab around surgery was not associated with an increased risk of postoperative complications or a prolonged course of wound closure. The results in this patient cohort suggest that adalimumab should not be discontinued during the perioperative period of HS surgery. [ABSTRACT FROM AUTHOR]

Objective: The present investigation was undertaken to determine the healing efficacy of Hippophae rhamnoides L. (sea buckthorn (SBT)) leaf aqueous lyophilised extract (SBTL-ALE) on a diabetic wound model in rats. The effect of SBTL-ALE was also evaluated on human epithelial cell lines (A431) by using in vitro wound closure and transwell migration assays. Method: A total of four full-thickness excision-type wounds were created on the dorsal surface of streptozocin-induced diabetic rats. The animals were divided into two groups: control rats treated with soft white petroleum jelly and experimental rats treated with SBTL-ALE (5.0%, weight/weight) ointment applied topically, twice daily for seven days. Results: SBTL-ALE significantly (p<0.05) accelerated the migration of epithelial cells in in vitro wound closure and transwell migration assays. Further, SBTL-ALE augmented the healing process by significantly (p<0.05) enhanced wound area contraction, faster complete epithelial closure, increased hydroxyproline (collagen) and hexosamine levels in diabetic rats. Histopathological findings confirmed the healing potential of SBTL-ALE. Immunohistochemical analyses showed increased expression of transforming growth factor (TGF)-β and α-smooth muscle actin in SBTL-ALE-treated wounds of diabetic rats. Superoxide dismutase, catalase and reduced glutathione levels increased, whereas reactive oxygen levels were decreased significantly (p<0.05) in SBTL-ALE-treated wounds compared to diabetic controls, which conferred redox homeostasis. Conclusion: Our results suggest that SBTL-ALE accelerated transdermal wound healing in diabetic rats by increasing the rate of wound contraction, enhancing levels of collagen, hexosamine and endogenous antioxidants, and reducing oxidative stress. [ABSTRACT FROM AUTHOR]

Objective: Tissue engineering, a novel approach in dermatology, has resulted in the development of scaffolds as skin substitutes that have accelerated wound healing. The aim of the present study was to synthesise acellular dermal matrix (ADM) as a dermal alternative and assess the effect of human epidermal growth factor (EGF) on the proliferation and migration of seeded fibroblast cells. Method: ADM from fresh, full-thickness human skin was developed and characterised. Next, foreskin fibroblast cells were isolated, cultured and characterised. The fibroblast cells were sown into the ADM in two groups: one with EGF and one without EGF. We assessed the adhesion and proliferation of the cells on the scaffold by scanning electron microscopy, and thiazolyl blue tetrazolium bromide and 4',6-diamidino-2-phenylindole staining. For the animal study, 30 rats were divided into two equal groups at random (ADM, ADM+EGF). Wound healing was assessed macroscopically, histologically and by real-time polymerase chain reaction for Bax and Bcl-2 gene expression. Results: The ADM characterisation results showed that the scaffold was dense and integral with good stretching. The morphology and phenotype of the isolated fibroblast cells confirmed their identity. The fibroblast cells cultured on the ADM showed proliferation, which improved with the addition of EGF. In the animal model, EGF addition caused significantly (p<0.05) improved wound healing compared with isolated ADM; it also resulted in increased Bcl-2 and reduced Bax expressions. Conclusion: A combination of ADM, fibroblast cells and EGFs could serve as skin substitutes and represent a novel therapeutic methodology for treating burns and hard-to-heal wounds. [ABSTRACT FROM AUTHOR]

This study assessed the impact of a DMT intervention in reducing aggression, depression, anxiety and increasing levels of self-esteem in adolescents who experienced trauma. Sixty females between the age of 13 & 18 participated in this study and were randomly assigned to either the experimental group or a wait-list group. The experimental group participated in 12 DMT sessions of 2 h each over a period of 2 months. The BP-AQ, RSES and the RCADS-25 were administered pre and post the intervention to measure the effects. The results of the MANOVA showed no significant difference between the overall pretest and post test scores of the experimental group. Separate ANOVAS with each of the dependent variables showed a significant difference between pre and post test scores. DMT may be effective in reducing aggression and depression. [ABSTRACT FROM AUTHOR]

Deer antlers are the only mammalian appendages that can fully regenerate from periosteum of pedicles (PP). This regeneration process starts from regenerative healing of wounds. Removal of PP abolishes antler regeneration, however, the regenerative cutaneous wound healing proceeds, indicating that some factors in the circulation contribute to this healing. In this study, we produced a wound in the scalp of deer either in antler regeneration period (ARP) (n = 3) or in non-ARP (n = 3). Results showed full regeneration took place only when the wound was created during ARP. Interestingly, topical application of systemic factors from ARP (n = 9) promoted regenerative wound healing in rats. Comparative proteomics analysis (n = 3) revealed that PRG4 and IGF-1 were high during ARP, and topical application of PRG4 + IGF-1 promoted restoration in rat FTE wounds. We believe that, ultimately, incorporating systemic factors into advanced wound care modalities could offer new opportunities for regenerative healing in the clinical setting. [ABSTRACT FROM AUTHOR]

Chronic wounds, especially non-healing wounds, significantly affect patients' quality of life and raise the costs of therapy. Wound healing is a complicated process involving interdependent stages, which may be impaired and delayed by infections with multi-drug resistant pathogens. Current medical strategies for wound healing, especially the treatment of non-healing wounds, exert limited therapeutic effects, thus become a dramatic challenge for modern medicine. There has been growing interest in exploring complementary approaches to enhance the wound healing process, and complementary therapy using herbs and their related products has gained increasing attention. Apart from skin wounds, dermal pathological changes caused by UV irradiation, may also benefit from such complementary therapy. The antimicrobial, anti-inflammatory, antioxidant, analgesic and collagen-promoting properties of extract from Rosmarinus officinalis L. (rosemary) have all been considered to contribute to the beneficial effects on different stages and multiple aspects of skin recovery after various wounds or UV irradiation. This review aims to summarize the applications and their underlying mechanisms of rosemary as part of the complementary therapy for injured and UV-irradiated skin based on the currently available evidence. The medicinal properties of rosemary and its application in wound dressing are first discussed, followed by summarization of its application in different types of wounds. A conclusion is reached and future directions are discussed. As research in this area continue to evolve, rosemary-derived products may become an integral part of holistic wound care strategies, offering a complementary approach to conventional treatments. The properties of REO for the enhancement of skin healing process. For the antimicrobial property, REO exhibited activity against Gram-positive, Gram-negative bacteria, virus and fungi, particularly having a high antibacterial potency against MDR pathogens. For the anti-inflammatory property, REO prevented phosphorylation of MAPKs, suppressed the activation of NF-κB and decreased expressions of iNOS and COX-2. The antioxidant activity is associated with direct elimination of ROS and a significant reduction in DNA lesions, caspase-3 and -9 activity and IL-6 secretion. The analgesic property was attributed to its anti-neuroinflammation and neuroprotection, as indicated by the attenuation of markers of glia activation (Iba1, GFAP), inflammatory factors (TNF-ɑ, iNOS, TLR4) and apoptotic mediators (Bax, cleaved caspase-3 and caspase-9) in spinal cords. The collagen-promoting property refers to the enhanced collagen fibers and reduced number of senescent cells, leading to an accelerated wound healing. So far, the application of REO has been tested in a wide range of wounds and UV-irradiated skin, including excisional and incisional wounds, burns, diabetic wounds, pressure ulcer and sunburn. [ABSTRACT FROM AUTHOR]

Although the advancements in craniomaxillofacial surgery have been significant, ischemic craniomaxillofacial diseases remain challenging to treat due to insufficient blood supply. Hyperbaric oxygen therapy (HBOT) has emerged as a promising adjunctive treatment, exhibiting the potential to promote angiogenesis, exert anti-inflammatory effects, enhance bone regeneration, and possess antibacterial properties. Numerous studies have demonstrated its efficacy in stimulating healing processes, particularly in cases such as medication-related osteonecrosis of the jaw, osteoradionecrosis, chronic jaw osteomyelitis, and refractory wounds. Hyperbaric oxygen therapy not only accelerates healing and shortens recovery times but also reduces postoperative complications, infection risks, and enhances patients' overall quality of life. This review aims to synthesize the research progress on the application of hyperbaric oxygen therapy in ischemic craniomaxillofacial diseases, providing a valuable reference for clinicians. [ABSTRACT FROM AUTHOR]

AbstractBackgroundMethodsResultsConclusionLactoferrin (Lf), a multifunctional glycoprotein known for its roles in immune modulation, iron metabolism, and antimicrobial activity, has limited therapeutic efficacy due to poor bioavailability. Liposomal encapsulation of lactoferrin (LLf) offers a potential solution by improving its stability, absorption, and sustained release, making it a promising candidate for various clinical applications. This study aims to compare the effectiveness of LLf and plain Lf in cellular uptake, proliferation, and wound healing using HEK-293T and Caco-2 cell lines.Cell uptake, proliferation, and wound healing assays were conducted using HEK-293T and Caco-2 cells to evaluate the bioavailability and therapeutic efficacy of LLf compared to plain Lf. The cellular uptake was assessed over a 24-h period using an indirect ELISA method. Cell proliferation was measured using the MTT assay, while wound healing was evaluated using a scratch assay to observe cell migration over 48 h.LLf demonstrated significantly higher cellular uptake in both HEK-293T and Caco-2 cells, with peak internalization at 4 h, compared to plain Lf. In proliferation studies, LLf showed a dose-dependent increase in cell growth, achieving a 71% proliferation rate at 75 µg/mL, while plain Lf reached only 53%. LLf also accelerated wound healing, with nearly complete closure by 48 h, compared to 51.3% closure with plain Lf.The results indicate that liposomal encapsulation significantly enhances lactoferrin’s bioavailability, proliferation-inducing capacity, and wound healing efficacy. LLf’s superior performance in these key areas suggests its potential for broader therapeutic applications, particularly in wound care, immune modulation, and tissue regeneration. Future clinical studies are warranted to validate the therapeutic benefits of LLf in vivo. [ABSTRACT FROM AUTHOR]

BACKGROUND: Nonhealing wounds are particularly prevalent in older adults and in patients with multiple comorbidities, and they represent a significant medicoeconomic burden. Autologous split-thickness skin grafts (STSGs) are considered the gold standard for wound closure but suffer from high failure rates and complications. Autologous skin cell suspension (ASCS) technology is an autografting technique able to significantly minimize donor site morbidity. This retrospective, propensity-matched cohort study compared outcomes of wounds treated with ASCS vs STSG. STUDY DESIGN: Seven patients treated with ASCS were propensity-matched to 7 control patients who received STSG according to age and sex. The ASCS was prepared using the RECELL System and applied either alone as spray only ("ASCS alone," off-label) or combined with a widely meshed STSG ("ASCS + STSG," 3:1). The primary outcome was time to complete wound healing. Secondary outcomes included donor site healing, pain, and total number of visits. Statistical analyses included descriptive statistics, univariate analyses, and mixed-effect regression modeling to assess the impact of treatment on wound healing. RESULTS: A total of 14 patients and 17 wounds (10 treatment vs 7 control) were included. Demographics were well-matched between cohorts. The overall mean wound healing time was 85.6 ± 11.2 days. Wounds treated with ASCS (both ASCS groups) healed faster than STSG (75.9 ± 4.5 vs 99.4 ± 26.7 days). Wounds treated with ASCS alone healed in 80.8 ± 5.1 days, whereas those treated with ASCS and STSG healed in 68.5 ± 7.6 days. CONCLUSIONS: This study suggests that ASCS may offer clinically significant improvements in wound and donor site healing, with significantly less donor skin requirements, and comparable pain levels, compared with traditional STSG. Further research with a prospective study and larger sample size is needed to validate these findings. [ABSTRACT FROM AUTHOR]

Introduction: Pit viper envenomation causes tissue damage that can persist for weeks to months despite antivenom. Many patients do not receive post-discharge care beyond testing for late coagulopathy and primary care follow-up. The aim of this report is to describe a snake envenomation patient cohort, complications, and management strategies after three years of operation of a specialized outpatient clinic offering post-discharge evaluation and wound care therapy. Methods: This was an observational study of patients treated in a newly established snakebite follow-up clinic from June 1, 2021 to November 30, 2023. Patient demographics, snake species, and hospital course were abstracted from poison center records. Persistent symptoms upon clinic evaluation were recorded as well as the therapies prescribed by the clinic wound care physicians. Results: Of the 465 snake envenomations reported to the state poison center, 52 patients presented to the clinic. The median patient age was 29 years (range 5–88 years), and the majority (65.4%) were male. Antivenom was given during hospitalization in 92.3% of cases. Agkistrodon spp. envenomations (including Agkistrodon contortrix and Agkistrodon piscivorus) were most common (n = 33) with a smaller number of Crotalus horridus (n = 7) and 12 unidentified pit viper envenomations. Persistent edema (61.5%) and bullae (38.5%) were common at follow-up. Interventions provided included compression (38.5%), physical therapy referral (32.7%), tissue debridement (9.6%), and antibiotics (5.8%). Rates of edema and bullae were numerically higher in patients envenomated by Agkistrodon spp. compared to those envenomated by Crotalus horridus. Discussion: In this primarily Agkistrodon spp.-envenomated cohort, persistent edema, wounds, and functional limitations were common in the post-discharge period. Our outpatient snake envenomation clinic leveraged the expertise of wound care physicians and the public health reach of the state poison center to address the significant morbidity seen on follow-up and provide interventions to facilitate recovery. Conclusion: This snake envenomation wound care clinic addressed a neglected aspect of pit viper envenomation by providing post-discharge management of enduring tissue damage and other complications. [ABSTRACT FROM AUTHOR]

Aim: To explore clinicians' and patients' perceptions of implementing evidence‐based practice to improve clinical practice for preventing and managing surgical site infections within hospital acute care settings. Design: A convergent integrated mixed‐methods systematic review using the Joanna Briggs Institute approach. Methods: Included studies reported (i) acute care hospital clinicians' and patients' experiences and preferences for preventing and managing surgical site infections and (ii) barriers and facilitators to implementing surgical site infection prevention and management guidelines. The Mixed Methods Appraisal Tool and the Quality Improvement Minimum Quality Criteria Set were used for critical appraisal. Quantitative data was transformed into qualitised data, then thematically synthesised with qualitative data and coded all findings into themes. Clinicians' and patients' views were also compared. Data Sources: English language peer‐reviewed studies published from 2009 to March 2023 were identified from Medline, EMBASE, CINAHL, PsycINFO and Cochrane Central Library. Results: Thirty‐seven studies (16 quantitative, 17 qualitative, 3 mixed‐methods and 1 quality improvement) met the inclusion criteria. Five main themes represent key factors believed to influence the implementation of evidence‐based surgical site infection prevention and management guidelines: (1) Intentional non‐adherence to insufficiently detailed and outdated guidelines, (2) Knowledge deficits on evidence‐based SSI care bring about inconsistent clinical practice, (3) Collaborative interdisciplinary and patient‐provider relationship to enhance guideline uptake, (4) Infection surveillance to improve patient safety and quality of life and (5) Negative physical and psychological impacts on patients. Conclusion: The five themes reflect a need for updated hospital guidelines as a medium to improve surgical site infection knowledge and ensure consistent and evidence‐based clinical practice. This review also highlights the significance of interdisciplinary and patient‐provider collaboration and infection surveillance to facilitate guideline uptake. The effectiveness of intervention bundles designed to improve these aspects of care will need to be evaluated in future research. Impact: A future intervention bundle that includes (1) ensuring up‐to‐date hospital guidelines/policies; (2) fostering collaborative interdisciplinary teamwork culture between physicians, nurses, podiatrists, pharmacists and allied health professionals; (3) encouraging patient or carer involvement in shared decision‐making and (4) implementing audit and feedback mechanism on infection surveillance is proposed to improve SSI prevention and management in acute care settings. Reporting Method: This paper followed the PRISMA 2020 checklist guideline for reporting systematic reviews. Patient or Public Contribution: This mixed‐methods systematic review collates evidence of clinicians' and patients' experiences and preferences for preventing and managing surgical site infections. The inclusion of hospital patients' perspectives supports the development of patient‐centred interventions. Trial Registration: The review protocol is registered on the International Prospective Register of Systematic Reviews (PROSPERO 2021 CRD42021250885). Available at: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021250885 [ABSTRACT FROM AUTHOR]

Morbidity and mortality rates are notably higher among individuals with severe mental illnesses (SMI). People with SMI often have lower access to healthcare services, and the medical care they receive is known to be suboptimal. Consequently, treatment in an acute care setting rather than a community setting is more common. We aim to explore medical care in the emergency department (ED) for people with SMI compared to a control population. In this matched cohort study, data on all adult Clalit Health Services (CHS) members who were referred to the general ED during the years 2018–2021 were extracted. Patients with SMI (ICD-10 codes for schizophrenia, schizoaffective disorder, and bipolar disorder) were matched with a control group of ED patients without SMI in a 1:3 ratio. The two groups were compared regarding ED admission reasons, management, and outcomes. The total sample (n = 92,848) included ED patients with SMI (n = 23,212) and without (n = 69,636). The most common ED admission reasons in both groups were pain, traumatic injury, and cardiac symptoms. Patients in the SMI group had higher rates of diagnosed diabetes mellitus and obstructive pulmonary disease. ED assessment, measured by resource allocation, was less comprehensive for patients with SMI who presented with subjective complaints such as pain and weakness, while it was comparable between patients with and without SMI for other main presenting complaints. Workup for patients with SMI lasted longer and necessitated hospitalization at higher rates for most admission reasons. Mortality during the study period was almost twice as high among the SMI group (5 % vs. 2.3 %, p < 0.001). Our findings indicate higher rates of morbidity and treatment complexity among patients with SMI. As expected, the mortality rate was higher in this group. An alarming gap in resource allocation for ED assessment was observed when patients presented with subjective complaints. Enhanced awareness and integrated resources in primary care are required to improve the management and physical healthcare of patients with SMI. • Most common emergency department (ED) admission reasons among patients with and without serious mental illness (SMI) were pain, traumatic injury, and cardiac symptoms. • Patients with SMI needed more resource allocation for some admission reasons. Yet, the workup in cases of subjective complaints was less thorough in the SMI group. • Mortality rates among patients with SMI were higher during both the 48 h following ED visits and during follow-up. • Special awareness and more integrated resources in the community are required in order to improve the management and the physical healthcare of people with SMI. [ABSTRACT FROM AUTHOR]

Domestic violence (DV) is a serious social problem that impacts significantly on communities globally. While dentists are uniquely positioned to identify patients who experience DV, there is limited content specifically addressing the issue in their undergraduate training. James Cook University (JCU) dental students revealed this gap, and, in response, an interprofessional collaboration between JCU Social Work, JCU Dentistry and the Cairns Regional Domestic Violence Service was established to codesign and deliver the Dentists and Domestic Violence—Recognise, Respond and Refer program, evaluated through Participatory Action Research (PAR) cycles. The program is informed by critical and feminist social work theory with a gendered analysis of DV. The authors present the program's evolution and examine the four elements identified as central to its success: interprofessional collaboration, critical and feminist theory and gendered analysis, scaffolded content, and skills-based activities. This article will provide a guide for others starting work in this space. IMPLICATIONS Designing and implementing an interprofessional domestic violence curriculum informed by critical theory and tailored for dental students' can help meet their learning needs. Collaboratively educating dental students to recognise and respond to domestic violence cases will enable appropriate clinical interactions with patients who are victim-survivors of domestic violence and improve the quality of referrals and interactions with community support services. Undertaking evaluation research that guides effective domestic violence training for students across disciplines contributes to addressing domestic violence. [ABSTRACT FROM AUTHOR]

Introduction: Appropriate malignant fungating wound (MFW) care is challenging for oncology nurses, leading to increased stress, compromised care quality, and poor patient outcomes. Objective: This study aimed to address best practice barriers and develop evidence-based guidelines for MFW care. Methods: This project was guided by the JBI Evidence Implementation Framework, which follows a seven-phase process. Both nurses' skills and patient charts were audited to determine compliance with best practices for comprehensive MFW assessment, wound photo records, use of validated wound assessment tools, appropriate wound care, and patient pain and satisfaction. Bandura's social learning theory was used to guide the development of an online education program and an objective structured clinical examination for skill improvement to prompt behavior change in nurses. A follow-up audit was conducted to measure improvements in knowledge, skills, and self-efficacy among nurses to validate the effectiveness of the intervention. Results: The project resulted in improvements in all four evidence-based practice criteria: (1) comprehensive MFW assessments increased from 27% to 98%; (2) the inclusion of wound photos in medical records increased from 50% to 100%; (3) use of a validated wound assessment tool increased from 0% to 100%; and (4) appropriate interventions to manage wounds and maintain patients' quality of life increased from 50% to 90%. Conclusions: The project integrated a flexible education program, multidisciplinary collaboration, and leadership support to empower nurses to effectively manage MFWs. In addition, Bandura's social learning theory was used to influence nurses' behavior and bring about sustainable changes to organizational culture and practices. http://links.lww.com/IJEBH/A205 [ABSTRACT FROM AUTHOR]

Cholesterol crystal embolism (CCE) accompanied by a lower extremity wound is occasionally difficult to differentiate from chronic limb-threatening ischemia (CLTI) and treat. The present multi-center retrospective observational study investigated the clinical characteristics and prognosis of CCE with lower extremity wounds. Consecutive patients (n = 58) clinically diagnosed as CCE with lower extremity wounds between April 2010 and December 2019 were studied. CCE was diagnosed using histological findings, foot condition, renal impairment, and eosinophilia. The primary outcome was 1-year wound healing rate. Patients with CCE were compared with 1309 patients diagnosed with CLTI with tissue loss during the same study period. The CCE group had a significantly more severe Wound, Ischemia, and foot Infection (WIfI) classification compared with the CLTI group. After Kaplan–Meier analysis, the CCE group had a similar 1-year wound healing (55.1 vs 58.3%, P =.096) as the CLTI group. In multivariate stratified Cox regression analysis by WIfI stages, CCE was significantly associated with poor wound healing compared with CLTI [hazard ratio.36 (95% confidence interval.21–.62)]. In conclusion, among the similar WIfI clinical stages, wound healing was significantly worse in the CCE group than in the CLTI group. [ABSTRACT FROM AUTHOR]

This study evaluated the prevalence and characteristics of advanced practice providers, including nurse practitioners and physician assistants, who provide care related to burns in the United States from 2013 to 2022 using national claims data. Our analysis was a retrospective, large cohort study evaluating debridement, wound care, and office-based services provided by advanced practice providers from 2013 to 2022 using the Medicare Provider Utilization and Payment Data Public Use Files from the CMS. The reported provider type and billing codes were used to identify healthcare professionals providing burn care. Trends over the study period and available data about care provided were analyzed. From 2013 to 2022, burn care providers included 6918 (43.3%) surgeons, 4264 (26.7%) other physicians, and 4783 (30.0%) advanced practice providers. Overall, the number of advanced practice providers who billed for burn care increased by 250.4% from 714 in 2013 to 2502 in 2022. Compared with physicians, advanced practice providers were more likely to be female and provide care in micropolitan areas with less than 50,000 people. Based on these trends, we project that the number of advanced practice providers providing services related to burns will increase by 56.7% from 2502 in 2022 to 3921 (95% CI, 3541–4303; R 2 = 0.97) in 2030. With a growing need for burn care and predicted shortages in the surgeon workforce, the scope of practice and integration of advanced practice providers merits further discussion and evaluation. [ABSTRACT FROM AUTHOR]

Introduction: Neoadjuvant radiotherapy (NART) is often used in the treatment of extremity soft tissue sarcomas (STS) including myxoid liposarcoma (MLS). Postoperative major wound complications (WC) are a well-recognised problem following NART. Aims: A review of the literature regarding the definition and incidence of WC following NART and surgery for STS and a retrospective review of a single surgeon series of 25 MLS. Methods: A literature search for papers focusing on MLS, NART and WC was performed, with 12 papers being reviewed. Retrospective data from a single surgeon series of 25 patients with MLS, treated with NART and surgery, were reviewed, focussing on WC. Results: The average rate of WC from the 12 papers included was 29·4% (20–47%), and the average rate of reoperation was 15·6% (7·3–24%). There were a range of definitions used for WC, most commonly O'Sullivan's definition. In the single surgeon series, two patients (8%) developed WC and were treated conservatively, and there were no reoperations within 120 days. Conclusion: This literature review identified that there was a lack of consistency between the definitions used for major WC. The single surgeon series of MLS showed WC that were lower when compared to the reviewed literature (8% versus 29·4%). [ABSTRACT FROM AUTHOR]