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A 5-year-old male child presented with nonhealing wound on the left scapular region. He had a history of multiple abscesses 8 months back. Incision and drainage were done for all abscesses in the same sitting at another hospital. All wounds healed except one of the scapular regions. The wound was explored and there was large cotton gauze inside the wound. The common causes of nonhealing of wound are tuberculosis, malignancy, and immunodeficiency. However, iatrogenic foreign body is also an important cause and should be considered in differential diagnosis. Careful history, wound examination, and radiological investigations are an important tool for diagnosis of retained foreign bodies. The scientific term for the retained foreign body is gossypiboma or textiloma. [ABSTRACT FROM AUTHOR]

Pyoderma gangrenosum (PG) is a rare condition characterized by the development of aseptic, non-healing skin ulcers. Any skin trauma, such as a surgical incision, can trigger an outbreak of lesions. Our case and literature review show that a physician should consider PG in every event of a non-healing, aseptic wound after surgery. The treatment of PG requires collaboration within a multidisciplinary team and immunosuppressive therapy is the first line of treatment, while surgical interventions should be avoided in the active stage of PG.

Nonuremic calciphylaxis is a rare condition presenting with peripheral ischemic ulcerations. Calciphylaxis is the deposition of calcium and phosphate into arteriolar walls caused by exceeding their solubility range in the blood. It is most commonly seen in patients with end-stage renal disease; however, nonuremic calciphylaxis occurs in patients with normal or mildly impaired renal function. Risk factors for nonuremic calciphylaxis include Coumadin therapy, obesity, and diabetes mellitus. Histopathologic examination of deep skin biopsy containing subcutaneous adipose tissue reveals medial calcification of dermal and subcutaneous arterioles. This diagnosis must be managed locally with wound care and systemically by control of blood calcium solubility. Avoidance of infection is critical to survival. Here we report a case of calciphylaxis in a patient with normal renal function and serum levels of calcium and phosphorus who presented with gangrene of the extremities. Increased awareness of this debilitating disease will lead to earlier diagnosis, proper treatment and improved patient outcomes. [ABSTRACT FROM AUTHOR]

Pyoderma gangrenosum (PG) is a rare condition characterized by the development of aseptic, non-healing skin ulcers. Any skin trauma, such as a surgical incision, can trigger an outbreak of lesions. Our case and literature review show that a physician should consider PG in every event of a non-healing, aseptic wound after surgery. The treatment of PG requires collaboration within a multidisciplinary team and immunosuppressive therapy is the first line of treatment, while surgical interventions should be avoided in the active stage of PG. [ABSTRACT FROM AUTHOR]

Introduction: Impaired wound healing has a significant socio-economic impact. The introduction of Vacuum Assisted Closure (VAC) has been one of the major breakthroughs in the management of nonhealing wounds owing to its property of granulation tissue formation via effects related to local sub atmospheric pressure and fluid drainage. Aim: To study the efficacy of Negative Pressure Wound Therapy (NPWT) in wound healing. Materials and Methods: A pilot study was performed in 50 patients out of which 41 were males (n=82%) and 9 were females (18%) with chronic nonhealing wounds of different aetiologies between the age of 15-70 years. Eligible patients were treated with NPWT at two days interval for an average of two dressings. Patients were evaluated after two dressings for appearance of granulation tissue, reduction in wound size and decrease of bacterial load in the wound. Paired t-test and Chi-square tests were used. P

Introduction: Impaired wound healing has a significant socio-economic impact. The introduction of Vacuum Assisted Closure (VAC) has been one of the major breakthroughs in the management of nonhealing wounds owing to its property of granulation tissue formation via effects related to local sub atmospheric pressure and fluid drainage. Aim: To study the efficacy of Negative Pressure Wound Therapy (NPWT) in wound healing. Materials and Methods: A pilot study was performed in 50 patients out of which 41 were males (n=82%) and 9 were females (18%) with chronic nonhealing wounds of different aetiologies between the age of 15-70 years. Eligible patients were treated with NPWT at two days interval for an average of two dressings. Patients were evaluated after two dressings for appearance of granulation tissue, reduction in wound size and decrease of bacterial load in the wound. Paired t-test and Chi-square tests were used. P<0.05 is considered significant. Results: The use of NPWT in different types of open wounds, pressure sores, postoperative wounds resulted in reduction of wound size (p-value-0.001), infection rate (p-value-0.001) within a week after 2 dressings to finally be closed with split skin grafting or secondary suturing. Conclusion: NPWT dressing is a safe, reliable intervention for patients with chronic wounds associated with impaired wound healing, particularly with wounds larger in surface area which requires closure by split skin grafting or musculocutaneous flaps. [ABSTRACT FROM AUTHOR]

Objective: Postsurgical pyoderma gangrenosum is a rare but potentially devastating condition for surgical patients. While pyoderma gangrenosum has 2 subtypes, typical and atypical, each can be further classified by its heralding features. These include ulcerative, pustular, bullous, and vegetative. The presentation can be a result of trauma or, as mentioned before, postsurgical. The plastic and reconstructive surgeon most likely will encounter postsurgical pyoderma gangrenosum in practice, as it has been reported in patient populations frequently seen in plastic surgery clinics. Methods: We present a unique case of idiopathic postsurgical pyoderma gangrenosum in a patientwho presented after carpal tunnel release, the most common surgery of the hand and wrist performed in the United States annually. This is believed to be the first ever case reported in the literature of pyoderma gangrenosum following carpal tunnel release. Results: The patient's disease course was complicated by surgical debridement prior to diagnosis. Unfortunately, this condition necessitated mid-forearm amputation. The wound eventually healed with primary closure and appropriate medical therapy. Conclusion: Previous experience with this disease, a high index of suspicion, and general education regarding the disease process and its management could potentially have prevented this outcome. We hope to underscore that it is important to consider a patient's entire history and to have a high index of suspicion in unusual postsurgical wounds in order to adequately diagnose, treat, and manage patients who develop postsurgical pyoderma gangrenosum. [ABSTRACT FROM AUTHOR]

Abstract Although bone biopsy has historically been considered the "gold standard" or "standard reference" for the diagnosis of diabetic foot osteomyelitis, some contemporary investigations have provided evidence against this as a single diagnostic test and in support of a combination of clinical, laboratory, and radiographic findings. The objective of this investigation was to measure the level of agreement between several commonly used forms of diagnostic testing for diabetic foot osteomyelitis. A retrospective chart review was performed of 50 consecutive patients admitted to a single tertiary healthcare center with the documented performance of 1) a clinical probe-to-bone test on hospital admission; 2) plain film radiographs prior to any surgical intervention; 3) magnetic resonance imaging prior to any surgical intervention; and an intraoperative excisional bone debridement performed, with samples sent for both 4) histologic analysis and 5) microbiologic analysis. A frequency count of agreement among these 5 tests was performed, and the interobserver (or inter-test) agreement was measured using the kappa statistic. We observed low levels of inter-test agreement between the 5 diagnostic tests (range 42.0%–62.0%), and levels of chance-corrected agreement were well below what would be considered appropriate for a "gold standard" or "standard reference." Levels of the kappa statistic ranged from 0.0 to 0.220, with most inter-test comparisons falling in the "poor agreement" and "slight agreement" interpretation ranges. The highest level of agreement occurred between the plain film radiographs and magnetic resonance imaging (62.0% agreement and kappa statistic of 0.220). Although it is likely that a combination of clinical, radiographic, and laboratory tests provides the best diagnostic approach for diabetic foot osteomyelitis, the data provided herein indicate that the tests themselves might have high intrinsic levels of unreliability and that the specific combination of tests that might be best used remains unclear. [ABSTRACT FROM AUTHOR]

ABSTRACT Although advancements have been made with traditional therapies, the treatment of chronic nonhealing wounds still remains a tough challenge. In the past two decades, mesenchymal stem cell (MSC)-based therapy has emerged as a promising therapeutic strategy for nonhealing wounds because of their characteristics including self-renewal and a multidirectional differentiation ability and their easy collection and weak immunogenicity. There is a growing body of basic scientific studies that shed light on the functional mechanism of MSCs in modulating nonhealing wounds. Furthermore, critical advances have been achieved using MSC-based therapy in preclinical animal models as well as in clinics trials. In this present review, we summarize the mechanisms of MSCs and highlight the important preclinical and clinical trials of MSC therapy for nonhealing wounds. In particular, the combination of MSCs transplantation and tissue-engineered skin is addressed as a new strategy to optimize the delivery efficiency and therapeutic potential. Additionally, the current drawbacks of MSC therapy and the potential to further optimize the use of MSCs are implied. [ABSTRACT FROM AUTHOR]

The impairment of wound healing in diabetic patients is an important clinical problem. Proper keratinocyte migration and proliferation are the crucial steps during reepithelialization, and these steps may be impaired in diabetes mellitus (DM) due to hyperglycemia and chronic inflammation in wound site. In this study, we explored the effects of diabetes-like microenvironment with high glucose (HG) and intense inflammation on the migration and proliferation of keratinocytes in vitro. We found that the migration and proliferation of rat keratinocytes were reduced with HG and lipopolysaccharide (LPS) stimulation via Erk signaling pathway in a reactive oxygen species (ROS)-dependent manner. Nevertheless, mesenchymal stem cell–conditioned medium (MSC-CM) counteracts the effects of HG and LPS. Treatment of rat keratinocyte with MSC-CM decreased HG- and/or LPS-induced ROS overproduction. Furthermore, MSC-CM reversed the downregulation of phosphorylation of MEK1/2 and Erk 1/2, which was induced by HG and/or LPS without affecting total levels. Our results may provide a possible mechanism for delayed wound healing in DM and provide a foundation to develop MSC-CM as an alternative therapeutic strategy to ameliorate the poor wound-healing conditions. [ABSTRACT FROM PUBLISHER]

Primary cutaneous blastomycosis is a rare presentation of infection caused by direct inoculation of a wound. We present a 61-year-old male with an extensive history of wound dehiscence and wound care noncompliance after a bite from a brown recluse spider on the left thigh while on vacation in Cape Cod in September of 2020. After antibiotic therapy and culture, treatment involved debridement, split thickness skin grafting, strict wound vacuum-assisted closure care, and oral itraconazole. This brief demonstrates a case of blastomycosis arising from trauma in a non-endemic region for infection and serves as an example of successful management of the longstanding wound.

Abstract: In the field of wound care, the management of nonhealing wounds requires particular attention. Biopsy is often performed in such cases to rule out underlying malignancy; however, the differential remains broad. In the following case, we discuss a nonhealing post traumatic wound in a diabetic patient, secondary to unrecognized tophus. [Copyright &y& Elsevier]

In this review, the author summarizes the role of biofilm formation in chronic nonhealing wound infections along with characteristics of biofilm formation, diagnosis, detection, and treatment. Because biofilms are still not clearly understood, treatment and diagnosis are currently difficult., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Nonhealing wounds present a common challenge to the equine practitioner. An underlying source of inflammation and infection is almost always present and needs to be resolved for healing to proceed. Wound débridement is the mainstay for this resolution. In addition, wound closure, wound dressings, and skin grafts can be used to achieve successful wound healing., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: Low level light therapy (LLLT) has attracted attention in many clinical fields with a new generation of light-emitting diodes (LEDs) which can irradiate large targets. To pain control, the first main application of LLLT, have been added LED-LLLT in the accelerated healing of wounds, both traumatic and iatrogenic, inflammatory acne and the patient-driven application of skin rejuvenation. Rationale and Applications: The rationale behind LED-LLLT is underpinned by the reported efficacy of LED-LLLT at a cellular and subcellular level, particularly for the 633 nm and 830 nm wavelengths, and evidence for this is presented. Improved blood flow and neovascularization are associated with 830 nm. A large variety of cytokines, chemokines and macromolecules can be induced by LED phototherapy. Among the clinical applications, non-healing wounds can be healed through restoring the collagenesis/collagenase imbalance in such examples, and 'normal' wounds heal faster and better. Pain, including postoperative pain, postoperative edema and many types of inflammation can be significantly reduced. Experimental and clinical evidence: Some personal examples of evidence are offered by the first author, including controlled animal models demonstrating the systemic effect of 830 nm LED-LLLT on wound healing and on induced inflammation. Human patients are presented to illustrate the efficacy of LED phototherapy on treatment-resistant inflammatory disorders., Conclusions: Provided an LED phototherapy system has the correct wavelength for the target cells, delivers an appropriate power density and an adequate energy density, then it will be at least partly, if not significantly, effective. The use of LED-LLLT as an adjunct to conventional surgical or nonsurgical indications is an even more exciting prospect. LED-LLLT is here to stay.