Search Results (118)

Objective: Sternum osteomyelitis and deep sternal wound infection (DSWI) are often used to describe the same clinical condition interchangeably. The aim of our current study is to investigate the prevalence of osteomyelitis in cardiac surgery patients with DSWI and its consequences in therapy and osteosynthetic reconstruction. Patients and Methods: This is a retrospective single-center observational study. All consecutive patients with DSWI after cardiac surgery between 01/2014 and 12/2019 were included. In all patients, the sternal wound was reopened, sternal closure material was removed, and negative pressure therapy was initiated. Wound swabs were taken for microbiological examination, and a bone biopsy was examined for the presence of osteomyelitis. In the presence of osteomyelitis, long-term antibiotics were administered. Results: A total of 130 patients were identified in whom DSWI occurred after sternotomy. In 102 patients (77%), osteomyelitis could be detected histopathologically. The frequency of transverse sternal fractures was lower (p < 0.05) in the osteomyelitis subgroup (63%) as compared to the non-osteomyelitis subgroup (93%). Pathogens were detected in all patients with osteomyelitis, but less frequently (p < 0.05) in the group with no osteomyelitis (64%). If osteomyelitis was treated with long-term antibiotics, there was no difference in the complication rate (reinfection) after sternal restabilization between the two groups. Conclusions: DSWI and osteomyelitis should not be used interchangeably. If osteomyelitis can be detected histopathologically, long-term antibiotic treatment should be consistently conducted. As DSWI, with or without osteomyelitis, has been suggested to be associated with inadequate or failed sternal osteosynthesis, a key strategy to reduce its risk is to ensure safe and reliable primary sternal fixation. Full article

Background: Personalized medicine in breast cancer surgery aims to tailor therapeutic strategies not only to tumor biology but also to patient-specific risk factors and surgical outcomes. The Alexis^® retractor, originally designed for abdominal and pelvic surgery, may represent an innovative tool to optimize axillary surgical procedures in selected patients. Its atraumatic design and protective sheath provide enhanced visibility, minimized tissue trauma, and a potentially lower risk of postoperative complications, thus contributing to individualized surgical care. Methods: We conducted a retrospective, single-center study at Fondazione Policlinico Universitario Agostino Gemelli IRCCS between January 2024 and April 2025. Patients undergoing breast-conserving surgery or mastectomy with axillary access were included. The Alexis^® retractor was used for axillary tissue retraction in procedures such as sentinel lymph node biopsy and axillary dissection. Outcomes were assessed at 7, 14, and 30 days postoperatively, with particular focus on complication rates and surgical efficiency. Results: Thirty-seven patients (38 procedures) were analyzed. Seromas occurred in four patients (10.8%) and were managed with ultrasound-guided aspiration. Wound dehiscence occurred in two patients (5.4%) and was treated with advanced dressings. No infections, hemorrhages, or flap necrosis were observed. No systemic complications occurred. Conclusions: The preliminary results suggest that the Alexis^® retractor may support a more personalized approach to axillary surgery in breast cancer, by reducing early postoperative complications and improving surgical ergonomics. Its atraumatic design and protective sheath may help tailor surgical management to individual patient risk profiles, minimizing tissue damage and infection risk while enhancing intraoperative visibility and efficiency. Further prospective, controlled studies with larger cohorts are needed to confirm its role in precision breast surgery and to define which patient subgroups may benefit the most. Full article

In reconstructive surgery, usage of different flaps is essential to cover tissue defects. Twisting, stretching or damaging the vascular pedicle may jeopardize the flaps’ viability. The aim of our experiment was to monitor tissue perfusion parameters of local versus rotated musculocutaneous flaps. In rats, musculus cutaneus maximus-based muscle–skin flaps were prepared bilaterally: one was sutured back to its original position, while the other flap was rotated to the ventral chest region (Flap group). In the Control group, flaps were not prepared. Tissue microcirculation was monitored intraoperatively, and on the 7th and 14th postoperative days. Blood samples were taken for testing hematological and hemorheological parameters. At the end of the observation period, biopsies were taken for biomechanical (tensile strengths) and histological investigations. We found that leukocyte and platelet counts significantly increased in the Flap group, while erythrocyte deformability decreased and aggregation increased. Although both local and rotated flaps survived and wound healing progressed well, in microcirculatory recordings, hypoperfusion and visible red blood cell aggregates were seen mostly in the rotated flaps. The rotated flaps were biomechanically weaker compared to local flaps or intact skin regions. This new model seems to be suitable for studying further flap pathophysiology focusing on tissue perfusion. Full article

Background: Calciphylaxis (calcific uremic arteriolopathy), is a rare disease characterized by subcutaneous vascular thrombosis and necrotic skin lesions, which mainly affects patients with kidney disease. This condition often has a poor prognosis, unclear pathophysiology, and lacks standardized treatment. Case Description: We present a case of calciphylaxis in a 53-year-old female patient who reported gradually worsening unbearable pain in her lower limbs and thighs, persisting for approximately 18 months. After appropriate examinations and biopsy of non-healing wounds, histopathology confirmed the diagnosis of calciphylaxis. The wounds were treated with dermo-epidermal (DE) grafts. Followingly, the patient underwent treatment in a hyperbaric chamber, after which the wounds decreased in size. Conclusions: Early diagnosis and a comprehensive approach to therapy are necessary to improve the management of calcification, a rare disease, and complications such as non-healing wounds. Full article

Split-thickness skin grafting (STSG) is the standard of care for skin replacement therapy. While STSG is a well-established technique, it has several limitations at both the donor and recipient sites. Full-thickness skin column (FTSC) grafting is an alternative approach that involves the orthogonal harvesting of small skin columns containing the epidermis, dermis, and associated skin appendages. Peptides have been shown to promote wound repair through various reparative and regenerative mechanisms. In this study, we aimed to evaluate the extent to which FTSCs and the matrix-derived peptide TSN6, individually or in combination, influenced the rate and quality of healing, as assessed by metrics such as epithelialization, epithelial thickness, and the presence of adnexal structures. TSN6 peptide and its scrambled form was synthetized in a laboratory and mixed with a carboxymethylcellulose (CMC) hydrogel. Up to 16 standardized full-thickness excisional wounds (∅ 5 cm) were created on the dorsum of two anesthetized pigs. FTSC biopsies (∅ 1.5 mm) were harvested from donor sites located on the rump of the pig at a ratio of up to eight 1.5 mm-diameter skin columns/1 cm². Subsequently, the wounds were randomized to receive either (1) FTSC + TSN6, (2) FTSC + scrambled peptide, (3) FTSC alone, and (4) blank CMC hydrogel. Healing was monitored for 14 or 28 days. After euthanasia, the wounds were excised and processed for histology. Additionally, non-invasive imaging systems were utilized to assess wound healing. By day 14, wounds treated with FTSC or FTSC + TSN6 were significantly more re-epithelialized compared to those treated with blank CMC hydrogel. By day 28, all FTSC-transplanted wounds were fully re-epithelialized. Notably, wounds treated with FTSC + TSN6 exhibited improved healing quality, characterized by a thicker neo-epidermis and increased rete ridges at day 28 post-transplantation. All FTSC-transplanted wounds healed better than the untransplanted controls. The TSN6 peptide further improved healing quality when applied in combination with FTSCs, particularly by enhancing epidermal maturation. Full article

Fluid resuscitation after thermal injury is paramount to avoid burn shock and restore organ perfusion. Both over- and under-resuscitation can lead to unintended consequences affecting patient outcomes. While many studies have examined systemic effects, limited data exist on how fluid resuscitation impacts burn wound progression in the acute period. Furthermore, the mechanisms underlying burn wound progression remain not fully understood. This study used a swine model to investigate how varying resuscitation levels affect peri-burn wound dynamics. Twenty-seven female Yorkshire pigs were anesthetized, subjected to 40% total body surface area burn and 15% hemorrhage, then randomized (n = 9) to receive decision-support-driven (adequate, 2–4 mL/kg/%TBSA), fluid-withholding (under, <1 mL/kg/%TBSA), or high-constant-rate (over, >>4 mL/kg/%TBSA) resuscitation. Pigs were monitored for 24 h in an intensive care setting prior to necropsy. Laser Doppler Imaging (LDI) was conducted pre-burn and at 2, 6, 12, and 24 h post burn to assess perfusion. Biopsies were taken from burn, peri-burn (within 2 cm), and normal skin. RNA was isolated at 24 h for the qRT-PCR analysis of IL-6, CXCL8, and IFN-γ. At hour 2, LDI revealed increased peri-burn perfusion in over-resuscitated animals vs. under-resuscitated animals (p = 0.0499). At hour 24, IL-6 (p = 0.0220) and IFN-γ (p = 0.0253) were elevated in over-resuscitated peri-burn skin. CXCL8 showed no significant change. TUNEL staining revealed increased apoptosis in over- and under-resuscitated peri-burn skin. Differences in perfusion and cytokine expression based on resuscitation strategy suggest that fluid levels may influence burn wound progression. Full article

Background/Objectives: The utility of various biocompatible biological and synthetic polymers as substrates to provide structural support, facilitate cell migration, and promote the healing of full-thickness wounds by secondary intention has been studied. This includes intelligent structures that enable the release of natural products or drugs for these and other purposes. In this study, the primary objective was to analyze and compare, from a macroscopic perspective, the individual behavior of the polymer poly (3-hydroxybutyrate-co-3-hydroxyvalerate) (PHBV), with Aloe vera (PHBV/Av) or honey (PHBV/Ho), in the healing process of a full-thickness skin wound over 40 days in a murine model, in addition to describing the microscopic ultrastructure of the nanofibers. Methods: Two experimental groups were established, PHVB/AV (n = 5) and PHVB/Ho (n = 5), along with one control group, PHBV (n = 5), all of which underwent biopsies that included the entire thickness of the skin and the panniculus carnosus of the mid-dorsal area of the mouse. Cylindrical pieces of each membrane, measuring approximately 7 × 0.2 mm, were placed in the wound bed and covered with a transparent dressing. No topical treatment was administered during the control process, nor were the implants changed during the healing period. Results: Univariate and multivariate analyses were performed. The data show that the PHBV/Ho scaffolds reduce the diameter of the wounds by 100% after 40 days (p < 0.001), compared with PHBV/Av (100%; p = 0.211) and the control group, PHBV. Conclusions: From a macroscopic perspective, the PHBV/Ho scaffold significantly accelerated wound healing when applied once to the wound bed, outperforming both the PHBV/Av composite and PHBV alone. Notably, this effect was achieved without the need for dressing changes or additional treatment during the healing period. Full article

Background: This study aims to evaluate the efficacy and safety of a minimally invasive technique (pit excision with a punch biopsy needle) using a 1470 nm diode laser in the treatment of pilonidal sinus disease. Methods: A prospective study conducted included 187 patients who underwent laser treatment for pilonidal sinus. Patients were divided into two groups based on the severity of the disease: Group 1 (simple group) included patients who had no prior abscess formation and had one or two sinus openings, while Group 2 (complicated group) comprised patients with a history of abscess drainage and more two extensive sinus openings. The surgical procedure was performed under local anesthesia. The sinus openings were excised using a punch biopsy needle and subsequently closed with a diode laser probe. Patients were followed up at regular intervals during the postoperative period. Results: The findings revealed that the operative time (12.22 ± 1.72 min), postoperative pain scores and wound-healing duration were significantly lower in the simple group compared to the complicated group (p < 0.001). The recurrence rates were 3.7% in the simple group and 14.1% in the complicated group. The return-to-work time was 1.06 ± 0.32 days in the simple group and 1.32 ± 0.90 days in the complicated group. Conclusions: In conclusion, the combination of punch biopsy and diode laser is considered a safe and effective method, particularly for simple pilonidal sinus cases, due to its low complication rates, short recovery time, and early return-to-work advantages. However, more advanced treatment approaches are required for complicated cases. Full article

Background/Objectives: Efficient wound treatment embraces the management of four overlapping phases, starting with hemostasis, an immediate physiological response aimed at stopping bleeding from damaged blood vessels caused by skin injury. This paper proposes an innovative, nature-based hemostatic biomaterial designed to assist natural self-healing regenerative mechanisms. Methods: Light, transparent, and skin-adhesive films based on κ-carrageenan, meadow polyfloral honey, and Calendula officinalis flower extract were fabricated via solution casting. Comprehensive characterization revealed the physicochemical, structural, swelling, and barrier properties and the influence of each bioactive compound utilized for film preparation. Results: The samples subcutaneously implanted in Wistar rats induced vascularization, deposition of collagen, and orientation of collagen fibers while being fully phagocytosed and gradually biodegraded. The rat tail-cut model demonstrated that the films significantly reduced blood loss (0.1875 ± 0.0732 g) compared to the control (0.7837 ± 0.3319 g), and hemostasis was achieved notably faster (355.75 ± 71.42 s) than in the control group (704.25 ± 85.29 s). The rat liver punch biopsy model confirmed reduced blood loss (2.8025 ± 1.5174 g) and shorter time to hemostasis (303.25 ± 77.90 s) compared to the control (3.1475 ± 1.5413 g, 383.00 ± 36.53 s). Conclusions: The results indicate the great potential of the fabricated films as hemostatic wound dressings. Full article

Bacterial contamination of the surgical site in horses is a major risk factor for the development of surgical site infections (SSIs), which increase morbidity, mortality, the hospitalisation period, antibiotic use, and management costs. While contamination is a prerequisite for infection, its progression to clinical infection depends on additional factors that compromise host defences. The present study, conducted at the Veterinary Teaching Hospital of the University of Perugia over an 11-month period, investigated bacterial contamination in 70 surgeries (53 clean and 17 clean-contaminated) at the end of the procedure. To exclude pre-existing contamination, a sterile swab was collected after surgical scrub, and only cases that entered surgery with a sterile operative field were considered. A swab, biopsy, and fine-needle aspiration from the wound margins were then performed at the end of the surgery to conduct a qualitative assessment of the bacterial contamination of the surgical sites. Risk factors for surgical field contamination were analysed separately for clean and clean-contaminated procedures. Specifically, for clean-contaminated surgeries, the presence of emergency conditions, surgery duration, and intra-operative complications were evaluated. For clean surgeries, risk factors included the type of operating room, surgical duration, tissue involved, use of local anaesthetics, and placement of surgical drapes. The results revealed bacterial contamination rates of 49.1% in clean surgeries and 41.2% in clean-contaminated surgeries. Coagulase-negative staphylococci were the most frequently isolated bacteria, followed by Burkholderia cepacia, Bacillus sp., and Stenotrophomonas maltophilia. A statistical analysis showed no significant results on the predictive factors of the contamination evaluated. However, the observed trends suggest the importance of further investigating these risk factors in a larger sample size. These results emphasise the importance of effective prophylactic measures to limit surgical site contamination. Future research will focus on optimising pre-operative and intra-operative prophylaxis strategies to reduce bacterial contamination to sub-pathogenic levels, thereby enhancing post-operative outcomes. Full article

Background/Objectives: There is a great demand for novel, multipurpose, natural skin-care products in the global skin repair and sun protection markets. Within this framework, the potential benefits of topical Vitamin D2 (VD2) administration in combination with silver nanoparticles (AgNPs) were examined. Methods: Evaluating the efficacy of the VD2+AgNP cream in wound healing, skin irritation and UVB irradiation protection necessitated preclinical testing using reconstructed human skin equivalent models (prepared from human foreskins) containing both a fully stratified epidermal layer and underlying dermis. Results: Application of the cream significantly improved wound healing by stimulating keratinocyte re-epithelialization and dermal fibroblast migration in models subjected to full-thickness (scratch and biopsy punch) wounds, compared to untreated models. The VD2+AgNP cream, administered prior to the induction of skin irritation by 5% sodium dodecyl sulfate (SDS) afforded protection by ameliorating cell viability epidermal thickness and interleukin-1alpha levels. UVB exposure (50 mJ/cm²) significantly reduced cell viability and epidermal thickness (associated with increased epidermal breakage), as well as basal layer Ki67 and supra-basal layer involucrin expression, compared to the CTRL sham-irradiated models. The cream administered prior to UVB irradiation (protective capacity) showed greater efficacy in minimizing epidermal damage. This was reflected by significantly higher Ki67 and involucrin expression, as well as lower epidermal breakage, compared to models where the cream was applied following UVB irradiation (curative capacity). Conclusions: The VD2+AgNP cream shows multipurpose potential in skin protection. The underlying molecular mechanisms remain to be investigated. Full article

Chronic wounds present a large burden to our healthcare system and are typically marked by a failure to transition out of the inflammatory phase of wound healing. Venous leg ulcers (VLUs) represent the largest portion of chronic wounds. A pilot study of eleven (11) patients with VLUs seen over a 12-week period was undertaken utilizing RNA sequencing of wound biopsies and plasma cytokine levels to determine if biomarkers could be identified that would distinguish between wounds which heal versus those that do not. Chronic wounds were found to have increased expression of genes relating to epithelial-to-mesenchymal transition (EMT), cartilage and bone formation, and regulation of apical junction. Plasma cytokine levels showed predictive potential for IL-15 and RANTES, which were found to increase over time in patients with healed wounds. Further research is needed to validate these biomarkers as well as additional study of other chronic wound models, such as diabetic foot ulcers (DFUs). Full article

Introduction: Calciphylaxis, also known as calcific uremic arteriolopathy (CUA), is a rare and potentially fatal condition primarily affecting patients with end-stage renal disease (ESRD) on hemodialysis (HD). It is characterized by calcification in small blood vessels, leading to painful skin ulcers and high mortality rates. Case Description: This is a case of a 42-year-old female with ESRD on HD who developed calciphylaxis, presenting with non-healing ulcers on her thighs. Discussion: Despite initial treatments, including wound care and pain management, her condition did not improve. A skin biopsy was inconclusive, highlighting the diagnostic challenges associated with calciphylaxis. Based on clinical judgment, warfarin and calcium-based therapies were discontinued, and the patient’s HD regimen was adjusted. Due to the persistence of symptoms, sodium thiosulfate (STS) therapy was initiated, leading to significant improvement in her ulcers after six months of treatment. Conclusions: This case highlights the importance of clinical judgment in the diagnosis and management of calciphylaxis, particularly when histopathological diagnostic methods yield inconclusive results. Clinical criteria, alongside a thorough assessment of the patient’s history and presentation, are vital for achieving a timely diagnosis in such challenging cases. The successful use of sodium thiosulfate in this patient adds to the growing body of evidence supporting its use as a potential treatment for calciphylaxis, especially in cases that do not respond to conventional therapy. Full article

Background/Objectives: Chlorhexidine digluconate (CHX) is widely regarded as the gold standard for oral mucosa antiseptic treatments but has been associated with delayed healing, scar formation, microbiome alterations, and fibroblast toxicity. Tocopherol, with its ability to accelerate tissue healing and minimal side effects, has emerged as a potential alternative. This randomized clinical trial aimed to compare the efficacy of topical tocopherol acetate and 0.2% chlorhexidine in managing postoperative pain and wound healing following oral cavity biopsies. Methods: Seventy-seven patients undergoing oral biopsies were divided into two groups: the test group (tocopherol acetate) and the control group (0.2% chlorhexidine). Pain was assessed using VAS (Visual Analogue Scale) scores on days 1 and 6 postoperatively, and wound healing was evaluated through measurements of the biopsy site’s height and width from standardized photographs analyzed with ImageJ. Painkiller use was also documented. The study followed CONSORT (Consolidated Standards of Reporting Trials) guidelines, with ethical approval from the Padua Ethics Committee and registration on ISRCTN. Results: No significant differences were found between the groups in VAS scores, wound dimensions, or painkiller use (p > 0.05). However, significant pain reduction within each group was observed (p < 0.0001). Conclusions: Tocopherol acetate showed comparable efficacy to chlorhexidine, suggesting it could be a viable alternative for postoperative care in oral surgery. Full article

Diabetic foot syndrome is often associated with inflammation. The aim of this study was to evaluate the impact of improved blood supply on the change in the clinical status and culturable bacteriota of chronic wounds. Patients with diabetic foot and peripheral arterial disease with a Rutherford score of 5 or 6 were included (n = 23). The blood supply to the limb was assessed with laboratory tests and two time-point qualitative cultures using a wound biopsy. The baseline parameters of the blood supply to the limb were Transcutaneous Oxygen Perfusion (TCPO2) of 15.0 mmHg, an Ankle Brachial Index (ABI) of 0.7, and a Toe Brachial Index (TBI) of 0.1, with an average Wound, Infection, Inflammation (WIfI) score of 5.7 (high). The most frequently isolated pathogens were Staphylococcus aureus (26.1%), followed by the Enterobacteriaceae family and Pseudomonas spp. (13.0%, each). Negative cultures were present in 47.8% (n = 11). The control parameters of blood supply improved; TCPO2 was 38.5 mmHg, the ABI was 0.9, and the TBI was 0.3, with a reduction in the average WIfI score to 3.7 (mild), while total colony-forming units (CFUs) increased by 13.5%. No cases of reocclusion or restenosis were observed during the study; however, small amputations were performed in two patients (8.7%). Five (21.7%) ulcers were significantly reduced and two (8.7%) progressed, while a negative culture at follow-up was obtained in five fewer patients than at baseline and nine patients presented growth despite having an initial negative result. Quantitative reduction was obtained in four (17.4%) cases. Pathogen distribution at follow-up resembled baseline findings. Optimizing clinical environments (enhancing blood flow and controlling inflammation) in general over focusing singularly on microbiota composition or revascularization seems to be crucial and arguably outweighed the impact of microbial change alone; in particular, reperfusion may increase the conditions to bacterial growth at the first stage. Full article