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Bioengineering
Special Issues
Surgical Wound Infections and Management
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Surgical Wound Infections and Management

A special issue of Bioengineering (ISSN 2306-5354). This special issue belongs to the section "Regenerative Engineering".

Deadline for manuscript submissions: closed (31 May 2025) | Viewed by 3384

Special Issue Editors

Prof. Dr. Sharon Henry

E-Mail Website
Guest Editor
Division of Trauma and Critical Care, R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD 21201, USA
Interests: soft tissue infections
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Marcelo A. F. Ribeiro Jr.

E-Mail Website
Guest Editor
Division of Trauma and Critical Care, R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD 21201, USA
Interests: trauma; acute care surgery; wounds; open abdomen
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Surgical wound infections represent a significant challenge in postoperative care, contributing to extended hospital stays, increased medical costs, and heightened patient morbidity and mortality. We will provide a review of the state of our current knowledge of this problem. This Special Issue will explore the multifaceted aspects of these infections, providing a comprehensive resource for medical professionals.

Epidemiology and Incidence:

This section will cover the global and regional prevalence of surgical wound infections, highlighting trends and incidences. Understanding the epidemiology is crucial for developing targeted prevention strategies.

Groups Affected:

Focus will be given to vulnerable populations, including the elderly, immunocompromised patients, and those with comorbidities such as diabetes. This will shed light on risk factors and the need for tailored preventive measures. Burn wound infections are a particularly vexing problem. Approaches to the diagnosis and management of this difficulty problem will also be explored.

Medical and Surgical Treatments:

We will delve into the latest advancements in medical and surgical treatments, including prophylactic antibiotics, antiseptic techniques, guidelines, protocols, and innovative surgical approaches. Articles will explore evidence-based practices and emerging therapies aimed at reducing infection rates.

Outcomes and Complications:

We will examine the short- and long-term outcomes of surgical wound infections, addressing potential complications such as sepsis, delayed wound healing, and chronic pain. Understanding these outcomes is essential for improving patient care and recovery processes.

You may choose our Joint Special Issue in Journal of Clinical Medicine.

Prof. Dr. Sharon Henry
Prof. Dr. Marcelo A. F. Ribeiro Jr.
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Bioengineering is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • surgical wound infections
  • epidemiology
  • incidence
  • risk factors
  • prophylactic antibiotics
  • antiseptic techniques
  • patient outcomes
  • complications
  • postoperative care
  • vulnerable populations
  • burn wound infection
  • antimicrobials
  • bioengineered materials for wounds and infections

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Published Papers (5 papers)

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Research

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13 pages, 322 KiB  
Article
Limited Diagnostic Value of Blood Cultures in Patients with Soft Tissue Infections Transferred to a Quaternary Care Center
by Mira H. Ghneim, Gregory M. Schrank, William Teeter, Brooke Andersen, Anna Brown and Quincy K. Tran
Bioengineering 2025, 12(6), 609; https://doi.org/10.3390/bioengineering12060609 - 3 Jun 2025
Viewed by 499
Abstract
Introduction: Patients with soft tissue infection are often encountered in clinical practice. The mainstay of treatment typically includes antimicrobial therapy, followed by surgical debridement when indicated. Blood cultures are often performed prior to starting the first dose of antibiotics. However, when patients require [...] Read more.
Introduction: Patients with soft tissue infection are often encountered in clinical practice. The mainstay of treatment typically includes antimicrobial therapy, followed by surgical debridement when indicated. Blood cultures are often performed prior to starting the first dose of antibiotics. However, when patients require transfer to tertiary/quaternary-level care for more advanced surgical interventions, blood cultures are often repeated despite patients being on broad-spectrum antibiotics. Our study aims to investigate the utility of blood cultures following transfer to a higher level of care. Methods: This is a retrospective study involving adult patients (≥18 years of age) who were transferred to a quaternary academic center with soft tissue infections between 15 June 2018 and 15 February 2022. Patients with incomplete medical records and/or without blood culture data after arrival were excluded. The primary outcome was the rate of positive blood cultures post-transfer. Descriptive analyses were performed, and comparisons between groups were expressed as absolute differences and 95% CI. Results: We analyzed 303 patients with a mean (+/−SD) age of 54 (14) years, and 199 (66%) were male. Necrotizing soft tissue infections (NSTIs) predominated, 198 patients (65%), with a majority of the NSTIs involving the perineum (112, 37%). The prevalence of positive blood cultures was 20 (7%) for pre-transfer and 14 (5%) for post-transfer. Among post-transfer positive blood cultures, 3 (21%) were coagulase-negative Staphylococcus aureus, with 2 (14%) cases each for the blood culture categories of polymicrobial, methicillin-sensitive Staphylococcus aureus, and Enterococcus faecalis, and 2 (14%) with Candida species. Among 112 patients with NSTIs of the perineum, 2 (14%) patients had positive blood cultures post-transfer, compared with 110 (38%) patients with negative blood cultures (difference 24%, 95% CI −0.40, −0.12, p < 0.001). Conclusions: For patients with soft tissue infection, the prevalence of positive blood culture after arrival at our quaternary care center was low at 5%. Pathogenic cases of positive blood cultures after transfer were polymicrobial, methicillin-sensitive Staphylococcus aureus and Candida species. However, the low number of post-transfer positive blood cultures limits the strength of the inference and should be interpreted cautiously. Further studies are necessary to confirm our observation. Clinicians at tertiary/quaternary care centers should consider the utility of obtaining blood cultures from patients with soft tissue infections transferred from other facilities. Full article
(This article belongs to the Special Issue Surgical Wound Infections and Management)
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Review

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12 pages, 2397 KiB  
Review
Plastic Reconstruction of Upper Extremity Defects in Necrotizing Soft Tissue Infections
by Karren M. Takamura and Jason J. Yoo
Bioengineering 2025, 12(7), 718; https://doi.org/10.3390/bioengineering12070718 - 30 Jun 2025
Viewed by 242
Abstract
Soft tissue reconstruction in patients with upper extremity necrotizing soft tissue infections (NSTIs) can be challenging; these defects can be large with exposed critical structures. Following appropriate source control and debridement, soft tissue reconstruction is based on size, exposed structures, medical co-morbidities and [...] Read more.
Soft tissue reconstruction in patients with upper extremity necrotizing soft tissue infections (NSTIs) can be challenging; these defects can be large with exposed critical structures. Following appropriate source control and debridement, soft tissue reconstruction is based on size, exposed structures, medical co-morbidities and the physiologic status of the patient. There are multiple options for soft tissue coverage from local wound care to free tissue transfer. Dermal substitutes can help prepare a healthy wound bed that can later accept a skin graft. Local rotational flaps, distant pedicled flaps and free flaps are also options depending on the patient and the defect. Patients can have good functional outcomes after soft tissue reconstruction after upper extremity NSTI. Full article
(This article belongs to the Special Issue Surgical Wound Infections and Management)
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11 pages, 218 KiB  
Review
Optimizing Antibiotic Choice, Administration, and Duration in NSTI Treatment
by Devorah Howell, Rachael Edgin, Aliya Rehman and Ronald Rabinowitz
Bioengineering 2025, 12(7), 691; https://doi.org/10.3390/bioengineering12070691 - 24 Jun 2025
Viewed by 335
Abstract
Necrotizing soft tissue infections (NSTIs) are serious and aggressive infections which can result in significant morbidity and mortality. Both prompt surgical intervention and early antibiotics can decrease patient mortality. Based on microbiology, NSTIs can be categorized into four different types. Type I is [...] Read more.
Necrotizing soft tissue infections (NSTIs) are serious and aggressive infections which can result in significant morbidity and mortality. Both prompt surgical intervention and early antibiotics can decrease patient mortality. Based on microbiology, NSTIs can be categorized into four different types. Type I is polymicrobial, caused by a mix of both anaerobic and aerobic bacteria. Type II is monomicrobial, usually caused by either Streptococcus or Staphylococcus. Type III infections are caused by Gram-negative bacteria, often marine-related organisms, such as Vibrio. Lastly, Type IV infections are caused by fungi, and they are often associated with trauma. Despite the possibility of all these different pathogens in NSTI, early therapy often consists of a broad Gram-positive antimicrobial such as linezolid or vancomycin, and a broad Gram-negative agent such as piperacillin/tazobactam. Multiple factors including patient comorbidities, environmental exposures, and clinical presentation must also be considered when choosing antimicrobial agents and dosing. Adjunct medical therapies such as intravenous immunoglobulin (IVIG) and the antibiotics clindamycin and linezolid that are aimed at toxin suppression may be utilized to improve outcomes. Microbiological data are critical for optimizing the antimicrobial regimen. Full article
(This article belongs to the Special Issue Surgical Wound Infections and Management)
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13 pages, 410 KiB  
Review
Steal Syndrome in Free Flap Microvascular Reconstruction of the Lower Extremity: Systematic Review of Incidence, Risk Factors, and Surgical Management
by Georgios Karamitros, Ilias Iliadis, Raymond A. Pensy and Gregory A. Lamaris
Bioengineering 2025, 12(6), 647; https://doi.org/10.3390/bioengineering12060647 - 12 Jun 2025
Viewed by 485
Abstract
Background: Steal syndrome in the setting of microvascular reconstruction refers to a phenomenon whereby blood flow is diverted from the native tissue to the free flap, leading to ischemia and potential limb loss. In the present study, we aim to comprehensively evaluate [...] Read more.
Background: Steal syndrome in the setting of microvascular reconstruction refers to a phenomenon whereby blood flow is diverted from the native tissue to the free flap, leading to ischemia and potential limb loss. In the present study, we aim to comprehensively evaluate the occurrence and management of steal syndrome in free flap reconstruction of the lower extremities. Methods: A thorough literature search was conducted across the MEDLINE, Embase, Cochrane Library, and Scopus databases up to 29 January 2025. Studies were selected based on predefined inclusion criteria focusing on free flap microvascular reconstruction in the lower extremities with a focus on steal syndrome. Two independent reviewers assessed and extracted data. Results: Three studies were included, involving seven patients, with a mean age of 65.66 ± 5.89 years, who developed steal syndrome following free flap microvascular reconstruction. The most common revision involved below-the-knee amputation (BKA) due to ischemic complications. Comorbidities such as peripheral vascular disease (PVD), diabetes, and hypertension were present in all cases. The majority of anastomoses (85.7%) were end-to-side (ETS), with only one case utilizing a flow-through configuration. The majority of cases (n = 5, 71.4%) were reconstructed using latissimus dorsi (LD) flaps, with the remaining two cases using rectus abdominis (n = 1) and gracilis (n = 1) flaps. The recipient vessel was the anterior tibial artery in two patients (28.6%), the dorsalis pedis artery in two patients (28.6%), and the popliteal artery in three patients (42.9%). The most common salvage procedure was below-the-knee amputation (BKA), performed in four patients (57.1%). One patient required revision of the venous anastomosis and flap debridement, followed by a Chopart amputation (n = 1, 14.3%). Conclusions: The occurrence of steal syndrome in free flap microvascular reconstruction of the lower extremities is rare but can lead to significant complications, including amputation. The findings indicate that steal syndrome is more likely in patients with pre-existing vascular conditions such as PVD and diabetes. While surgical technique and flap type may influence its development, further studies are needed to identify specific anatomical and clinical predictors. The absence of a unified treatment guideline underscores the need for further investigation into effective management strategies to prevent amputation and optimize patient outcomes. Full article
(This article belongs to the Special Issue Surgical Wound Infections and Management)
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12 pages, 238 KiB  
Review
Nanomedicine and Its Role in Surgical Wound Infections: A Practical Approach
by Malak Bentaleb, Mohammed Abdulrahman and Marcelo A. F. Ribeiro Jr
Bioengineering 2025, 12(2), 137; https://doi.org/10.3390/bioengineering12020137 - 31 Jan 2025
Cited by 2 | Viewed by 1332
Abstract
Surgical wound infections are a major cause of postoperative complications, contributing to surgical morbidity and mortality. With the rise of antibiotic-resistant pathogens, it is crucial to develop new innovative wound materials to manage surgical wound infections using methods that facilitate drug delivery agents [...] Read more.
Surgical wound infections are a major cause of postoperative complications, contributing to surgical morbidity and mortality. With the rise of antibiotic-resistant pathogens, it is crucial to develop new innovative wound materials to manage surgical wound infections using methods that facilitate drug delivery agents and rely on materials other than antimicrobials. Nanoparticles, in particular, have captured researchers’ interest in recent years due to their effectiveness in wound care. They can be classified into three main types: inorganic nanoparticles, lipid-based nanoparticles, and polymeric nanoparticles. Several studies have demonstrated the effectiveness of these new technologies in enhancing wound-healing times and reducing bacterial burden. However, further research is essential to thoroughly evaluate the safety and toxicity of these materials before they can be integrated into routine surgical practice. Full article
(This article belongs to the Special Issue Surgical Wound Infections and Management)
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