Suppressed recruitment of alternatively activated macrophages reduces TGF-β1 and impairs wound healing in streptozotocin-induced diabetic mice

BackgroundDiabetes mellitus inhibits wound-induced angiogenesis, impairing the wound healing process and leading to the development of chronic wounds. Impaired healing of diabetic wounds is caused by persistent pro-inflammatory macrophages recruited to the granulation tissue; however, little is known about the phenotype of the macrophages involved in diabetic wound healing. The present study was conducted to examine the involvement of macrophages in impaired wound healing using streptozotocin (STZ)-induced diabetic mice.MethodsFull-thickness skin wounds were created on the backs of mice treated with STZ or vehicle.ResultsCompared with controls, wound healing and angiogenesis were suppressed in STZ-treated mice, with attenuated expression of vascular endothelial growth factor (VEGF) and fibroblast growth factor (FGF)-2 in wound granulation tissue. STZ-treated mice exhibited enhanced recruitment of classically activated macrophages (M1) expressing inducible nitric oxide synthase (iNOS) and suppressed recruitment of alternatively activated macrophages (M2) expressing transforming growth factor-beta-1 (TGF-β1). Treatment of diabetic mice with TGF-β1 restored wound healing and angiogenesis and normalized M1/M2 macrophage polarization in the granulation tissue.ConclusionsThese results suggest that an imbalance of macrophage phenotypes contributes to impaired wound healing in STZ-induced diabetic mice, and treatment with cytokines derived from M2 macrophages may be an effective therapeutic strategy to increase angiogenesis and promote healing of diabetic wounds.     

Chronic wound infections: the role of Pseudomonas aeruginosa and Staphylococcus aureus

Chronic leg ulcers affect 1–2% of the general population and are related to increased morbidity and health costs. Staphylococcus aureus and Pseudomonas aeruginosa are the most common bacteria isolated from chronic wounds. They can express virulence factors and surface proteins affecting wound healing. The co-infection of S. aureus and P. aeruginosa is more virulent than single infection. In particular, S. aureus and P. aeruginosa have both intrinsic and acquired antibiotic resistance, making clinical management of infection a real challenge, particularly in patients with comorbidity. Therefore, a correct and prompt diagnosis of chronic wound infection requires a detailed knowledge of skin bacterial flora. This is a necessary prerequisite for tailored pharmacological treatment, improving symptoms, and reducing side effects and antibiotic resistance.     

免打结可吸收线减张缝合伤口在闭合四肢创面中的应用

目的：探讨免打结可吸收线减张缝合在闭合四肢创面中的疗效。方法：选择2012-02-2013-12我院手外科收治的37例四肢急慢性皮肤缺损患者,创面均使用免打结可吸收线进行减张缝合,使创面一次闭合。男25例,女12例;年龄4～72岁,平均（34±2）岁。车祸伤19例,机器损伤10例,重物砸伤4例,感染3例,刀砍伤1例;急性创面26例,慢性创面11例。观察伤口愈合过程和愈合时间,术后半年对患者进行主观和客观评价。评价方法包括视觉模拟评分和Vancouver疤痕评分。结果：术后随访6～19个月,平均10个月。35例创面一次减张缝合后愈合,拆线时间为15～25d,平均20d;2例二次手术后愈合。减张缝合的愈合率是97.3%,一次减张缝合的愈合率是94.6%,感染率是5.4%。疤痕疼痛VAS是0～5分,平均1.7分,疤痕外观VAS是0～8分,平均2.9分。Vancouver疤痕评价得分是1～8分,平均2.4分。结论：免打结可吸收线减张缝合可以直接闭合创面,显著降低术后皮肤坏死、二期缝合、游离植皮和皮瓣转移的可能,减少手术次数,缩短病程。     

A randomized controlled trial of topical tea tree preparation for MRSA colonized wounds

BackgroundThe prevalence of MRSA (Methicillin-resistant Staphylococcus aureus) colonized wounds in home care residents is expected to grow continuously as a result of the substantial proportion of older people requiring institutionalized care due to chronic disease and declining functional status, which contribute to more frequent skin breakdown and wound formation. Tea tree oil has been claimed to have anti-bacterial, analgesic and anti-inflammatory effects that have been suggested in many in-vitro studies to have good efficacy against MRSA. The aims of this study were to evaluate the effectiveness of 10% topical tea tree preparation to eradicate MRSA and to ascertain its influence on wound healing for MRSA-colonized wounds.MethodsIt was a randomized controlled trial, single-blind study. Those with stage II or above MRSA-colonized wounds and who had given their informed consent formed the sample. The determined sample size was based on the effect size of our previous pilot study, which was 0.46. Five outcome measurements were taken for the MRSA bacterial count and wound healing condition at baseline and at 1-week intervals during the 4-week dressing intervention period.ResultsThirty-two participants were recruited from two non-government nursing homes, 16 in the control group and 16 in the tea tree oil group. The control group residents received routine saline gauze dressing, while the tea tree oil group residents received the 10% topical tea tree preparation dressing. In the tea tree oil group, all chronic wounds that had previously been delayed in healing were healed within 28 days without adverse reaction. MRSA was also completely eradicated in 14 (87.5%) out of 16 wounds in the group receiving the 10% topical tea tree preparation.ConclusionThe 10% topical tea tree preparation was effective in reducing the quantity of colonized MRSA in and promoting healing of chronic wounds among elderly.     

1例Miles术后造口皮肤黏膜分离合并糖尿病患者的护理

总结1例经腹会阴直肠癌根治术（Miles）后造口皮肤黏膜分离糖尿病患者的护理过程,针对患者造口皮肤黏膜分离的情况,正确选择敷料及造口用品,正确粘贴造口袋,防止渗漏,做好排泄物的管理,防止粪便污染伤口,预防感染,同时定期监测血糖的变化及营养的支持,心理疏导;促使创面的良好愈合。6天后,造口黏膜血运恢复正常,8天后造口皮肤黏膜分离深度缩小2cm。     

细菌纤维素膜作为创伤性敷料的可行性(英文)

背景:细菌纤维素为纳米级纤维材料,具有良好的生物相容性、湿态时高的机械强度、良好的液体和气体透过性,有利于皮肤组织生长和限制感染,有可能成为一种临时皮肤代用品和有应用潜力的生物敷料.目的:通过动物实验观察细菌纤维素膜作为创伤敷料的可能性.方法:用自制创伤仪于大鼠背部脊柱两侧各制造2.0 cm×2.0 cm大小的皮肤伤口,深及真皮层,两个创面之间间隔1 cm.随机选择一侧为治疗组,表面敷以细菌纤维素膜,另一侧为对照组,敷以油纱布,用1号手术缝线缝扎固定于周围皮肤上.于术后4,7,14,21,28 d观察创面愈合情况,并进行光镜组织学观察.结果与结论:①所有实验动物无死亡.觅食饮水等活动正常,两组均未出现创面感染.②治疗组术后7,14,21,28 d伤口创面愈合率较对照组显著提高.③治疗组肉芽组织层形成较厚,成纤维细胞和血管内皮细胞增生活跃,胶原纤维束增多,真皮层内小血管增生明显.对照组肉芽组织层较薄,成纤维细胞和血管内皮细胞增生不活跃,胶原纤维含量较治疗组少,小血管数量少.结果提示细菌纤维素膜对皮肤创伤性损伤具有促进愈合和抗感染的作用.     

Autologous scalp skin grafting to treat toxic epidermal necrolysis in a patient with a large skin injury: A case report

BACKGROUNDToxic epidermal necrolysis (TEN) is often associated with skin wounds affecting large areas. Healing of this type of wound is difficult because of pressure, infection and other factors. It can increase the length of hospital stay and result in wound sepsis and even death.CASE SUMMARYA 49-year-old woman developed a skin lesion covering 80% of the total body surface area after using a kind of Chinese medicinal ointment on a burn wound on her back; she developed life-threatening wound sepsis and septic shock. Methicillin-resistant Staphylococcus aureus, carbapenem-resistant Acinetobacter baumannii, carbapenem-resistant Pseudomonas aeruginosa and other bacteria were cultured from wound tissue, deep venous catheter and blood samples. Imipenem cilastatin sodium, tigecycline and teicoplanin were used for anti-infection therapy. Finally, the patient was transferred to the burn department because of severe wound sepsis. In the burn intensive care unit, pain-free dressing changes and autologous scalp skin grafting were performed to heal the wound in addition to reasonable and effective antibacterial treatment according to microbial susceptibility test results. After three operations within 2 wk, the wound healed and sepsis resolved.CONCLUSIONTEN patients with large areas of skin injury may develop wound infection and life-threatening wound sepsis. Autologous scalp skin grafting may be beneficial for rapid wound healing and reducing the risk of sepsis in TEN patients, and it leaves no scar at the donor site.     

基于伤口护理研究的糖尿病大鼠难愈性溃疡模型的建立

目的为伤口护理研究建立一种稳定的糖尿病难愈性溃疡动物模型。方法选用240～260g雄性SD大鼠60只,以链脲佐菌素腹腔注射,1周后测血糖,将血糖〉16．7mmol／L大鼠纳入糖尿病溃疡造模组,给予普通饲料喂养16周,每周监测血糖及其他糖尿病表现。在大鼠脊柱腰背部两侧手术造成直径1．8cm的圆形缺损创面;连续3d用冰醋酸涂抹创面,2次／d;用钢针刺入创面5mm肉眼观察有无出血及脓性分泌物。结果2周后实验大鼠血糖升高,且稳定大于16．7mmol／L,体重较前明显下降（P〈0．01）;创面形成3d后,96个创面针刺无出血,49个针刺有脓性分泌物;最终,糖尿病大鼠皮肤溃疡模型成功48只,成功率为80％;结论采用腹腔注射链脲佐菌素、外科手术开创、冰醋酸涂抹创面可成功建立糖尿病大鼠难愈性溃疡模型,为伤口护理研究提供了动物模型支持。     

HONEY DRESSING IN WOUND TREATMENT: A SYSTEMATIC REVIEW

ObjectiveThe use of honey for wound treatment and care purposes is based on thousands of years of history. The development of science and in vitro/in vivo studies have demonstrated that honey contributes to wound healing by showing therapeutic effects by means of the bioactive compounds it contains. The aim of this systematic review was to evaluate the place of honey in wound treatment by investigating the randomized controlled studies.Method30 publications which were obtained as a result of the scans in the databases and which comply with the evaluation criteria were included in the review.ResultsIn the results of the study, it was reported that honey in acute and chronic wounds provided rapid epithelization and wound contraction in wound healing, had anti-inflammatory and debridement effect, decreased the pain, ensured infection control, shortened the time of wound healing and was cost-effective.     

Autologous platelet-rich plasma in the treatment of refractory wounds in cutaneous leukocytoclastic vasculitis complicated with hypertension (grade 2 moderate risk): A case report

IntroductionCutaneous leukocytoclastic vasculitis is an inflammatory variant of vasculitis with a variety of causes that only affects the skin. Its pathological manifestations include neutrophil infiltration and nuclear fragmentation. Clinically, it is characterised by a pleomorphic rash, including erythema, purpuric skin lesions, reticulocytosis, necrosis and ulceration. Once formed, local ulcerations are very difficult to heal.Case presentationA 46-year-old female was diagnosed with cutaneous leukocytoclastic vasculitis. The patient’s legs exhibited ulcers with a black eschar on the surface. The largest wound was 4.5 × 4.0 cm and the deepest wound was 1.7 × 1.8 × 1.0 cm. The ulcers had been present for 6 months and did not exhibit signs of healing. Treatment was commenced with platelet-rich plasma, and the wounds healed within 1 month.ConclusionTopical application of autologous platelet-rich plasma gel exerts beneficial effects in cutaneous leukocytoclastic vasculitis with regard to wound size reduction, and it induces granulation tissue formation. Platelet-rich plasma may represent a safe and cost-effective treatment for managing cutaneous wound healing to reduce the length of the recovery period.     

闭合式负压引流结合成纤维细胞生长因子在老年慢性难愈创面护理中的应用价值

目的探讨闭合式负压引流结合成纤维细胞生长因子在老年慢性难愈创面护理中的应用价值。方法选取2018年4月至2020年4月收治的70例老年慢性难愈创面患者,将其随机分为对照组和观察组,各35例。对照组护理中予以闭合式负压引流结合生理盐水冲洗,观察组护理中予以闭合式负压引流结合成纤维细胞生长因子冲洗。比较两组创面面积、创面愈合时间、2周肉芽生长评分、瘢痕面积、皮肤感觉功能和汗腺功能恢复情况。结果治疗后,观察组创面面积小于对照组(P<0.05)。观察组创面愈合时间短于对照组,2周肉芽生长评分高于对照组,瘢痕面积小于对照组(P<0.05)。观察组皮肤感觉功能及汗腺功能恢复效果优于对照组(P<0.05)。结论闭合式负压引流结合成纤维细胞生长因子在老年慢性难愈创面患者护理中的应用价值较高,其能够有效促进创面愈合及肉芽生长,缩小创面面积,提高感觉功能及汗腺功能恢复效果。     

Role of serum amyloid P in skin graft survival and wound healing in burned patients receiving skin grafts

BackgroundRecent studies in animal models suggest that serum amyloid P (SAP) can affect burn wound healing. However, the role of SAP in a clinical setting remains unknown.MethodsWe enrolled 88 patients with third degree burn wounds. All the patients were candidates for auto-skin graft procedure using stamp skin graft. The complete graft healing time and the number of survived grafts were recorded. Serum SAP levels were assessed 1 day before operation.ResultsThere was no significant difference in SAP level between controls and patients. There were no significant differences noted among the patients with different burn surface area. However, when the patients in each group were stratified by SAP levels, the mean complete healing time of grafted wound and the mean numbers of survived skin grafts were significantly different. Spearman's analyses showed that the serum SAP levels negatively correlated with the complete wound healing time and mean numbers of survived skin grafts. Logistic regression analysis showed that the serum SAP levels and mean numbers of survived skin grafts were potent independent factors contributing to wound healing.ConclusionsThe results of this study suggest that the serum SAP levels may be an easy detected predictor for the healing of burn wounds.     

Multimodal noninvasive monitoring of soft tissue wound healing

Here we report results of non-invasive measurements of indirect markers of soft tissue healing of traumatic wounds in an observational swine study and describe the quantification of analog physiological signals. The primary purpose of the study was to measure bone healing of fractures with four different wound treatments. A second purpose was to quantify soft tissue wound healing by measuring the following indirect markers: (1) tissue oxygenation, (2) fluid content, and (3) blood flow, which were all measured by non-invasive modalities, measured with available devices. Tissue oxygenation was measured by near infrared spectroscopy; fluid content was measured by bipolar bio-impedance; and blood flow was measured by Doppler ultrasound. Immediately after comminuted femur fractures were produced in the right hind legs of thirty anesthetized female Yorkshire swine, one of four wound treatments was instilled into each wound. The four wound treatments were as follows: salmon fibrinogen/thrombin—n = 8; commercial bone filler matrix—n = 7; bovine collagen—n = 8; porcine fibrinogen/thrombin—n = 7. Fractures were stabilized with an external fixation device. Immediately following wound treatments, measurements were made of tissue oxygenation, fluid content and blood flow; these measurements were repeated weekly for 3 weeks after surgery. Analog signals of each modality were recorded on both the wounded (right) hind leg and the healthy (left) hind leg, for comparison purposes. Data were processed off-line. The mean values of 10-s periods were calculated for right–left leg comparison. ANOVA was applied for statistical analysis. Results of the bone healing studies are published separately (Rothwell et al. in J Spec Oper Med 13:7–18, 2013). For soft tissue wounds, healing did not differ significantly among the four wound treatments; however, regional oxygenation of wounds treated with salmon fibrinogen/thrombin showed slightly different time trends. Further studies are needed to establish standards for healthy wound healing and for detection of pathological alterations such as infection. Non-invasive measurement and quantification of indirect markers of soft tissue wound healing support the goals and principles of evidence-based medicine and show potential as easy to administer tools for clinicians and battlefield medical personnel to apply when procedures such as the PET scan are not available or affordable. The method we developed for storing analog physiological signals could be used for maintaining electronic health records, by incorporating vital signs such as ECG and EEG, etc.     

VAC联合腓肠神经营养血管皮瓣修复足踝部创面的疗效观察

目的探讨封闭负压引流技术（vacuum—assisted closure,VAC）联合腓肠神经营养血管皮瓣修复足踝部损伤,皮肤缺损创面的临床疗效。方法2005年12月至2009年3月本科收治的22例腋部皮肤缺损的患者,男16例,女6例。年龄18～58岁;早期扩创后采用VAC待肉芽组织形成后,用腓肠神经营养血管皮瓣修复足踝部创面。皮瓣范围5cm×8cm至8cm×12cm。结果1例远端皮瓣下出现慢性瘘道,经换药后创口闭合,皮瓣成活良好。其余患者皮瓣成活,切口均一期愈合,小腿供区愈合良好。结论VAC促进创面局部血运,肉芽形成,清洁创面,抑制细菌生长,减少感染,为皮瓣修复提供了良好的组织床。VAC联合腓肠神经营养血管皮瓣是修复足踝部创面的良好方法之一。     

封闭负压引流干预慢性创面神经生长因子和微血管的变化

背景：随着老龄化程度的增加,慢性创面呈上升趋势,在治愈慢性创面方法匮乏的情况下,封闭负压引流技术开始应用于临床。目的：观察封闭负压引流技术对人慢性创面组织中神经生长因子表达及微血管数量的影响,探索促进慢性创面愈合的机制。方法：以10例慢性创面患者为观察对象,其中胸部软组织缺损、骨髓炎伴骨外露和截肢后残端大面积皮肤缺损各1例、皮肤撕脱伤后创面感染2例、胫骨骨髓炎2例、术后伤口感染3例。分别于封闭负压引流技术吸引前、吸引7 d和14 d切取创周皮肤和创面内肉芽组织,采用免疫组织化学技术检测神经生长因子表达和微血管数量变化,并观察伤口愈合情况。结果与结论：封闭负压引流技术治疗7 d和14 d后成纤维细胞及血管内皮细胞中的神经生长因子表达明显高于治疗前（P ＜0.001）。封闭负压引流治疗使微血管数量显著增加（P ＜0.05-0.01）。封闭负压引流治疗前创基内肉芽组织量少且较晦暗,存在坏死组织和较多脓性分泌物,伤口周围组织肿胀明显。经封闭负压引流治疗后,伤口内坏死组织和脓性分泌物逐渐减少,肉芽组织呈细颗粒状,鲜红色,触之易出血,伤口周围水肿消退。提示封闭负压引流技术可以提高慢性创面创周组织中神经生长因子表达和微血管数量,促进创面愈合。     

不同换药方式对糖尿病模型小鼠和正常小鼠创面愈合影响的实验研究

[目的]比较生理盐水、4%硼酸溶液、0.5%碘伏＋3%过氧化氢3种临床常用护理换药方式对糖尿病小鼠和正常小鼠创面愈合的影响,以期探索最适合糖尿病难愈性创面的护理换药方式。[方法]取雄性8周龄C57BL/6J小鼠30只,设糖尿病组与对照组小鼠各15只,糖尿病小鼠以链脲佐菌素（STZ诱导）在背部制作3个同等大小的全层皮肤创面后,每日1次分别以生理盐水（A处理）、4%硼酸溶液（B处理）和0.5%碘伏＋3%过氧化氢溶液（C处理）对创面换药,记录创面结痂及感染情况并计算创面愈合率。[结果]在同一时相点、A处理换药方式下,糖尿病组小鼠的创面愈合率明显低于对照组小鼠;对照组小鼠在3种不同换药处理方式下,其创面愈合率差异无统计学意义（P〉0.05）;糖尿病小鼠应用B处理的创面愈合率显著高于应用A和C处理法（P〈0.05）。[结论]正常小鼠创面应用3种换药方式对创面的愈合率无显著影响;糖尿病小鼠创面使用硼酸溶液换药较其他换药方式更有利于伤口愈合。     

Role of neuropeptides in skin inflammation and its involvement in diabetic wound healing

Importance of the field: In 2010, the world prevalence of diabetes is 6.4%, affecting 285 million adults. Diabetic patients are at risk of developing neuropathy and delayed wound healing that can culminate in incurable diabetic foot ulcerations (DFUs) or even foot amputation.

Areas covered in this review: The contrast between cellular and molecular events of wound healing and diabetic wound healing processes is characterized. Neuropeptides released from the autonomous nervous system and skin cells reveal a major role in the immunity of wound healing. Therefore, the signaling pathways that induce pro/anti-inflammatory cytokines expression and its involvement in diabetic wound healing are discussed. The involvement of neuropeptides in the activation, growth, migration and maturation of skin cells, like keratinocytes, Langerhans cells, macrophages and mast cells, are described.

What the reader will gain: This review attempts to address the role of neuropeptides in skin inflammation, focusing on signal transduction, inflammatory mediators and pro/anti-inflammatory function, occurring in each cell type, as well as, its connection with diabetic wound healing.

Take home message: Understanding the role of neuropeptides in the skin, their application on skin wounds could be a potential therapy for skin pathologies, like the problematic and prevalent DFUs.     

皮瓣移植结合封闭式负压引流修复下肢皮肤及软组织缺损

背景：各种创伤引起的下肢皮肤及软组织缺损十分常见,常伴有严重的血运破坏和创面感染,患肢感染率高,不易愈合。目的：系统回顾关于下肢皮肤及软组织感染性缺损治疗的相关文献,结合华中科技大学同济医学院附属普爱医院治疗的下肢皮肤及软组织感染性缺损23例患者治疗效果,探讨皮瓣移植结合封闭式负压引流治疗感染性下肢皮肤及软组织缺损的适应症、方法及临床应用价值。方法：文章选取2004年8月至2011年11月在华中科技大学同济医学院附属普爱医院治疗的下肢皮肤及软组织感染性缺损患者共23例,男15例,女8例;年龄17-56岁,平均31.4岁。对23例下肢皮肤及软组织感染性缺损患者采用皮瓣移植结合负压封闭引流治疗,随访时间为4-15个月,平均7.3个月,观察临床效果。同时检索下肢皮肤及软组织感染性缺损治疗的相关文献,找出治疗对象相似、疗效评价标准相同的病例进行比较。结果与结论：23例下肢皮肤及软组织感染性缺损患者伤口感染菌中革兰阳性菌占52.2%,革兰阴性菌占47.8%,多重耐药菌占43.5%,应用封闭式负压吸引技术处理后,创面感染得到有效的控制,创面肉芽组织生长良好,通过皮瓣移植修复创面均痊愈。结果显示,皮瓣移植结合封闭式负压引流治疗感染性下肢皮肤及软组织缺损,可缩短创面愈合时间。     

成纤维细胞生长因子治疗老年慢性难愈合创面的研究

目的探讨成纤维细胞生长因子治疗老年慢性难愈合创面的有效性。方法选取2013年6月-2015年6月我院骨科门诊及住院部慢性难愈合创面老年患者60例,分别给予成纤维细胞生长因子(观察组30例)和凡士林油纱贴敷创面(对照组30例),比较两组治疗后反映创面愈合治疗效果和皮肤功能恢复的相关指标的差异,并比较观察组不同病因患者疗效差异。结果观察组2周时肉芽生长评分、残余创面面积4周内愈合率。创面最终平均愈合时间、疤痕面积均优于对照组(P0.005)。观察组针刺感、轻触觉和温度觉的恢复率和对照组相比无差异(P0.05),但两点辨别觉优于对照组(P=0.038),汗腺再生方面优于对照组(P=0.028)。观察组不同病因患者的创面愈合时间比较,糖尿病患者明显长于压迫性溃疡患者(P=0.001)和创伤性溃疡患者(P=0.003),压迫性溃疡患者和创伤性溃疡患者之间无差异(P=0.238)。结论成纤维细胞生长因子比凡士林油纱的常规治疗能更有效的促进老年慢性难愈合创面愈合和皮肤功能的恢复,但对不同病因的患者疗效有差异。