Objective To explore the possible mechanism of nerve growth factor (NGF) mixed insul in on the angiogenesis of burn wounds and the effect on the expressions of Bcl-2 and Bax in diabetic rats. Methods A total of 75 SPF male Wistar rats, weighing 200-220 g, were selected randomly and divided into nomal control (group A, n=15), the rats with diabetic control (group B, n=15), insul in treatment (group C, n=15), NGF treatment (group D, n=15), NGF and insul in treatment (group E, n=15) groups. In groups B, C, D, and E, streptozotocin was given by intraperitoneal injection at dose of 10 mg/kg on the 1st day and 50 mg/kg on the 3rd day to prepare the diabetic rat models. In group A, citric acid buffer at the samedose was given. After 1 month of diabetic models, second degree scald was made on the back of the rats, and then wounds were treated with 3-layer normal sal ine gauze in groups A and B, with 3-layer gauze containing 5 U Novol in 30R and subcutaneous injection of Novol in 30R (4-6 U/kg) everyday in group C, with 3-layer gauze containing 5 mL NGF (25 U/mL) in group D, and with a combination of groups C and D in group E. At 7, 11, 15, and 21 days, the wound heal ing rate was calculated; at 3, 7, 11, 15, and 21 days, the expressions of Bcl-2, Bax, and CD34 were determined and the microvascular density was measured by immunohistochemistry staining. Results All rats survived till experiment was finished. The area of wounds became smaller gradually with time. Group E was better than other groups in the wound heal ing rate (P lt; 0.05), the skin keratosis, the hair growth, and the granulation tissue and collagen fibers growth. With time, the expressions of CD34 and Bcl-2 increased gradually, reached the peak at 15 days and decreased at 21 days; the expression was ber in group E than in other groups (P lt; 0.05). At 3 days, Bax did not express; at 7 days, Bax began to express in new vascular endothel ial cells and the expression increased gradually with time; the expression was weaker in group E than in other groups (P lt; 0.05). Conclusion A combination of NGF and insul in local appl ication can enhance the angiogenesis of the burn wound in diabetic rats and accelerate wound heal ing by increasing the expression of Bcl-2 and decreasing the expression of Bax and restraining apoptosis of the wounds vascular endothel ial cells of diabetic rats.
ObjectiveTo research on the types of pathogenic bacteria in wound infection and analyze the effectiveness of long-term use of nano-silver dressing in the treatment of pressure ulcers, in order to provide references for the management of pressure ulcer wound.
MethodsFifty-five patients (60 wounds) with stage Ⅲ-Ⅳ pressure ulcer wound treated in all departments between September 2011 and August 2015 were chosen to be our study subjects. Under overall intervention, all the wounds were assessed by the same method, cleansed and debrided, after which nano-silver antimicrobial dressing was used to intervene until the wound healed or the end of 8 weeks. The wounds which were not healed were treated with wet dressing therapy until wound healing. The detection rate of pathogenic bacteria before intervention and 2, 4 and 8 weeks after intervention, change of pressure ulcer healing score and the rate of wound healing were observed.
ResultsBefore the intervention, 12 kinds of pathogenic bacteria were detected, including mainly Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus, and coagulase negative Staphylococci. The detection rate of pathogenic bacteria was 92.73% (51/55). With the use of nano-silver dressing during different time periods, the detection rate of pathogenic bacteria and the total score of pressure ulcer were lowered by varying degrees (P<0.01). Four and 8 weeks after intervention, wound bed improved significantly and the detection rate of pathogenic bacteria decreased faster. The healing rate during the intervention period was 23.64% (13/55).
ConclusionThe incidence of pressure ulcer wound infection is high. The use of nano-silver wound dressing can effectively remove pathogenic bacteria and promote wound healing.
Objective To investigated the distribution of epidermal stem cells in rat fullthickness wound tissues during the wound healing process and toelucidate the roles of epidermal stem cells in wound repair in vivo.Methods Eighty circular fullthickness wounds were produced on both sides of the back in 20 male Wistar rats labeled with BrdU 60 days previously (4 wounds in each rat). BrdU, β1 integrin and keratin 19 (K19) were employed to determine the epidermal stem cells with SP immunohistochemical methods, and the epithelialization wasdetermined with routine histological methods of HE staining on the 3rd, 7th, 14th, and 21st days after operation.Results No cells with positive immunostaining for β1 integrin, K19 and BrdU were found in granulation tissue of woundin both groups during the healing process. However, a few scattered β1 integrin and K19 positive cells were found within the stratum spinosum and stratum granulosum of the epidermis on the wound edges on the 3rd day post-injury. And these positive cells gradually became more and more in number, and mostly concentrated on the border of wound edges till the wounds healed. In addition, the number of positive cells for β1 integrin and K19 in the infected wounds was less than that in non-infected wounds. These positive cells for β1 integrin and K19 staining on the wound edge were also positively stained with BrdU in the cellular nuclei. Conclusion The above results indicate that ectopia of epidermal stem cells present a major function during wound epithelialization.
Objective To explore the mechanism of full-thickness burn wound healing with autoskin grafting in fault hypodermis wound of granulation excision and to evaluate its effect.Methods By the techniques of clinical observation, histopathology, immunohistochemistry,TEM and FCM,we observed changes of the activity andstructure of grafted skin and the granulation tissue,collagnous fiber,microvessels,the ultramicrostructure of fibroblasts and the expression of basic fibroblast growth factor(bFGF) in the base of autoskin grafting in fault hypodermis wound in burned adult minipigs(Group A), and compared with traditional method of autoskingrafting on the basilar fibrous tissue wound of scraped partly granulation being(Group B) and control group (Group C, without treatment except de-fur).Results The grafted skin survived after 3 days of operation, and it had less injury and higher proliferative index(PI) in group A than in group B. The hyperplasiaof granulation tissue and vascular endothelial and the expression of bFGF were more evident in group A. After 5 days, the proliferation of endothelial cells and granulation and the protein synthesis of fibroblasts were more active in groupA, and at this moment, fresh collagen appeared and proliferated more actively in group B. After 7-14 days, epidermic structure and dermic microvascular density became normal gradually, the granulation on grafting base matured and transformed into fibrous connective tissue in group A. The same change deferred about 2 days in group B. After 21 days, the above pathologic change in group A was less than that in group B. After 3060 days of operation, Group A achieved much less contraction and transfiguration than Group B, and the grafted skin was tender and movable. Conclusion Autoskin grafting in fault hypodermis wound of granulation excision has a better effect than traditional operation.
ObjectiveTo study the inhibitory effect of Sommerlad technique on the growth of the maxilla by comparing the wound healing between Sommerlad and Von Langenbeck techniques in repair of isolated cleft palate.
MethodsA retrospective cohort study was conducted on 54 patients with isolated cleft palate who received palatoplasty with levator veli palatini retropositioning according to Sommerlad between June 2005 and August 2011 as trial group;89 cleft patients received Von Langenbeck technique repair between June 2003 and September 2006 as control group.There was no significant difference in gender and age between 2 groups (P>0.05).The operation time,intraoperative blood loss,body temperature,and fever were recorded and compared;the wound healing was observed,and the palatal mucosa was graded according to Karsten standard.
ResultsThe operation time of trial group [(72.2±5.5) minutes] was significantly longer than that of control group [(58.1±6.8) minutes] (t=4.494,P=0.000);the intraoperative blood loss of trial group [(18.6±6.5) mL] was significantly less than that of control group [(34.2±10.2) mL] (t=2.447,P=0.000).Within postoperative 48 hours,the highest body temperature was 36.6-37.6℃(mean,36.9℃) in trial group,and was 36.8-38.2℃(mean,37.3℃) in control group;fever occurred in 5 patients (9.3%) of trial group and 21 patients (23.6%) of control group,showing significant difference (χ2=4.640,P=0.030).The patients were followed up 3-18 months (mean,9 months) in the trial group,and 3-6 years (mean,4 years) in the control group.Scar was rated as level 0,level 1,and level 2 in 38,13,and 3 cases of trial group,and in 6,35,and 48 cases of control group,showing significant difference (Z=-7.785,P=0.000).
ConclusionThe isolated cleft palate repair using Sommerlad technique has the advantages of less injury and less scar tissue,indicating no inhibitory effect on the growth of the maxilla.
OBJECTIVE: To investigate the clinical effect of vacuum sealing in treatment of traumatic soft tissue defect. METHODS: From 1998. 8 to 2001. 2, 49 patients with 55 traumatic soft tissue defects were treated by vacuum sealing after debridement. Among them, there were 39 males and 10 females with mean age 38. 4 years. The wound area varied from 10 cm x 10 cm to 30 cm x 30 cm. In the experimental group, the wound surfaces or cavities were filled with polyvinyl alcohol foams with embedded drainage tubes connected with vacuum bottle (negative pressure of 50-60 kPa). Wound closure was performed with secondary suturing, or skin transplantation, or local flap grafting after 5-7 days. Besides, 126 patients were managed by traditional dressing as the control group. RESULTS: Out of 51 traumatic soft tissue defects (45 patients), the wound closure was performed with a free flap in 4, with local flap in 8, with skin grafting in 27, with secondary suturing in 6, and with vacuum sealing directly in the other 6 defects. Forty-five patients recovered and no complications (systemic and located) occurred. There were significant differences in time of secondary suturing, times of dressing, wound shrink and total therapeutic cost between two groups (P lt; 0.01). CONCLUSION: Vacuum sealing can protect the wound against contamination, evacuate the wound exudates completely, stimulate the growth of granulation tissue, and facilitate the wound healing; so vacuum sealing is a simple and effective method in treatment of traumatic soft tissue defect.
Objective To investigate the influence of lipopolysaccharide(LPS) on the proliferation and collagen synthesis of normal human skin fibroblasts so as to elucidate its relation with skin wound healing. Methods Fibroblasts wereisolated and cultured in vitro, and then exposed to different doses of LPS(0.005, 0.010, 0.050, 0.100, 0.500, and 1.000 μg/ml) from E.coli055∶B5 respectively. Then the absorbance (A) value of fibroblasts was determined with the colorirneteric thiazolylblue (MTT) assay, and the cell number was counted under inverted phase contrast microscope from the 1st day to the 9th day after LPS administration, and collagen synthesis of fibroblasts in culture medium was measured with the method of pepsin digestion after incorporation of 3Hproline into stable, single-layered, confluent fibroblasts at 7 days after LPS administration. Results Compared with control group, A value increased with the increasing concentration of LPS (0.005 μg/ml 0.500 μg/ml) and LPS of 0.100 μg/mlgroup had the best effect. The difference was remarkable from the 5th day to the 9th day(P＜0.05). A value decreased when challenged with the LPS of 1.000 μg/ml and the difference was remarkable from the 3rd day to the 9th day(P＜0.05). Cell number increased with theadministration of LPS of different concentrations (0.005 μg/ml 0.500 μg/ml) and LPS of 0.100 μg/mlgroup had the best effect. The difference was remarkable from the 1st day to the 6th day(P＜0.05). Cell number decreased remarkably when challenged with LPS of 1.000 μg/ml and the difference was remarkable from the 2nd day to the 9th day(P＜0.05). Collagen synthesis increased when challenged with LPS of different concentrations (0.005 μg/ml 0.500 μg/ml) and the 0.100 μg/ml group had the best effect. However, when the dose of LPS reached 1.000 μg/ml, it inhibited collagensynthesis. Conclusion LPS could promote the proliferation andcollagen synthesis of fibroblasts within a certain range of low doses, but over-high dose ofLPS might inhibit the proliferation and collagen synthesis of fibroblasts, suggesting that LPS of certain concentrations might contribute to wound healing, while excessive LPS has negative effect on wound healing.
Objective Extracorporeal shock wave (ESW) can promote angiogenesis and tissue repair. To investigate the influence of ESW therapy on the histological features of diabetic chronic wounds and wound healing. Methods Ninety-six male Sprague Dawley rats with weight (220 ± 20) g were divided into 3 groups (n=32): diabetic control group, ESW treatment group, and normal control group. The diabetic rats were prepared in diabetic control group and ESW treatment group by intraperitoneal injection of Streptozotocin (60 mg/kg). Then a circular full-thickness skin wound of 1.8 cm in diameter was made at the back of diabetic rats to establish the diabetic chronic wound model, and the same wound was made in normal control group. In ESW treatment group, ESW (0.11 mJ/mm2, 1.5 Hz energy, and 500 pulses) was applied to treat the wound at 1 day after wounding; in two control groups, no ESW treatment was given. The wound healing and histological changes were observed by HE and Masson staining at 3, 7, and 14 days after treatment; and the cell proliferation, angiogenesis, and collagen deposition were observed by CD31 and proliferating cell nuclear antigen (PCNA) immunohistochemical staining. Results The wound closure rate in diabetic control group was lower, and the healing time was significantly longer than those in normal control group (P lt; 0.05); at 3, 7, and 14 days after treatment, the inflammatory cell infiltration in wound tissue was obvious, and the relative area density of collagen fibers, wound microvessel density (MVD), and the relative density of PCNA-positive cells were significantly lower than those in normal control group (P lt; 0.05). The wound healing time was significantly shorter and the wound closure rate was significantly higher in ESW treatment group than those in the diabetic control group (P lt; 0.05). At different time points in ESW treatment group, the inflammatory cells signficantly reduced, while the relative area density of collagen fibers, MVD, and relative density of PCNA-positive cells significantly increased when compared with those in diabetic control group (P lt; 0.05). No significant difference in MVD and relative density of PCNA-positive cells was found between ESW treatment group and normal control group (P gt; 0.05). Conclusion Low-energy ESW treatment can inhibit the local inflammatory response, promote cell proliferation, increase angiogenesis and collagen deposition, and enhance granulation tissue formation, and so it can promote chronic wound healing in diabetic rats.
Hyaluronic acid (HA) is an extracellular matrix having a high molecular weight. This study is to investigate (1) whether the ultrapure HA had effect on the healing of full thickness skin wounds in animals, and (2) the relation between the effect of HA and the size of the molecular weight of HA. The ultrapure HA with different molecular weights and HA with intermediate molecular weight were applied topically to the wounds from removal of full thickness of skin and topical application of normal saline was used as control. At 21st, day after the topical application, the tensile strength was reduced in wounds of groups of HA with high and intermediate molecular weights, but not in the group of low molecular weight. Using laser-Doppler scanning of the dynamic changes of the wound perfusion, in the 3rd day the blood supply to the wound was reduced in HA groups of high and intermediate molecular weights, but at the 7th day, the blood supply of all wounds in the two groups was increased. The study revealed that HA with different molecular weights had different actions on the contraction of wounds, the angiogenesis of the granulation tissues and the healing strength of the wounds. It was indicated that hyaluronan could be used for wound treatment or as a carrier, but its accurate composition must be carefully noted.
OBJECTIVE: To investigate the effect of heterogeneous (swine) acellular dermal matrix (s-ADM) and autologous overthin split-thickness skin (auto-OTS) composite grafting in repair of deep burns at articular sites. METHODS: From May 1999 to April 2000, 19 articular sites in 16 patients, including 14 males and 2 females, were treated. In all the 19 sites of deep burn, the total burn area varied from 2% to 48% and the full-thickness burn area varied from 1% to 35%. After the primary escharectomy (1 to 5 days later) and complete hemostasis, the s-ADM was utilized to cover the exposed articular sites and the auto-OTS was transferred on the surface of sutured s-ADM. The size of s-ADM applied to each patient varied from 25 cm2 to 150 cm2. Regular skin grafting was adopted elsewhere other than the articular site. The survival rate of all skin grafting was evaluated and pathological examination was performed. RESULTS: The survival rate of the composite skin was (90.80 +/- 18.34)%, which was obvious higher than the survival rate of contiguous granulosum skin grafting (P lt; 0.05) and almost the same with that of snip skin grafting(P gt; 0.05). The survived composite skin appeared as smooth and soft as normal skin, and the function of articular site almost recovered with neglectable hypertrophic scar. The pathological examination revealed that the normal cell grew into s-ADM with regularly arranged collagen fiber and neovascularization in the matrix. CONCLUSION: The combination of s-ADM and auto-OTS graft is cheap and effective method to cover wound and minimize hypertrophic scar.
