Role of a microbial factor, necrotic tissue and a foreign body in the development of wound suppuration

The effect of microorganisms, necrotic tissues and a foreign body on the development of festering process in rat wounds was studied. It was found that the presence of necrotic tissues is the necessary and sufficient condition for a clinical manifestation of infection in rat wounds. Additional infection of the wounds and introduction of a foreign body did not appreciably change the clinical picture. A model is suggested of a festering wound in rats without artificial infecting. In the festering wound, one could observe the replacement of the gram-positive coccal microflora by the gram-negative one. Meanwhile the gram-positive coccal microflora was predominant in the non-festering wound. The level of potential biochemical indicators of infection in the blood of animals with festering wounds was higher than in the blood of those with non-festering wounds. The morphology, and the content of microbial cells, the content of nucleic acids, and total proteolytic activity in festering wound tissues were examined over time.     

Elevation of thromboxane in pressure wounds

Arachidonic acid metabolites have been implicated as mediators of progressive dermal ischemia. Decubitus ulcer formation results from chronic mechanical pressure on the skin which results in a diminished blood supply to the skin and underlying tissues. To evaluate the role of thromboxanes in pressure wounds, we measured TxB2, a stable metabolite of TxA2, in spontaneously occurring pressure wounds on Greyhound dogs. In pressure wounds in which the skin was showing early signs of pressure necrosis but was still intact, elevated TxB2 concentrations were found in healthy appearing tissues immediately adjacent to the pressure wounds, in the inner edge of the wounds, and in the center of the wounds. Significantly greater TxB2 concentrations (P less than 0.05) were found in the center of the intact wounds versus the TxB2 concentrations in the inner edge of the wounds or in healthy appearing tissues adjacent to the wounds. In pressure wounds in which the center of the wound had ulcerated or had an eschar, elevated TxB2 concentrations were found in tissues in the inner edge of the wounds and in healthy appearing tissues immediately adjacent to the pressure wounds. These results demonstrate the occurrence of elevated thromboxane concentrations in and around spontaneously occurring pressure wounds.     

The clinical laboratory assessment of vancomycin (Edicin) efficacy in treating suppurative wounds of the skin and soft tissues, burn wounds and the infectious complications of burns]

Clinical and bacteriological efficacies of vancomycin (Edicin, LEK) in the treatment of 17 patients with wound infection and 13 patients with thermal affections were studied. The clinical efficacy in the group of the patients with purulent wounds of the soft tissues amounted to 94.1 per cent and that in the patients with thermal affections was 92.3 per cent. The bacteriological effect was recorded in 86.6 per cent of the patients with purulent wounds of the soft tissues and in 69.3 per cent of the patients with burn infections. The drug intolerability was observed in two cases.     

Regeneration Around Wounds and the Control of Vascular Differentiation

The question which was the basis of this work was whether (a)vascular regeneration around wounds includes a replacement ofdamaged tissues or (b) only new vascular strands, which arenormally formed from the cambium, are diverted around wounds.It was found that in Coleus and Cucumis no connections are formedto damaged sieve tubes and vessels, so that their continuityaround wounds is not restored. Pisum plants were wounded underconditions in which growth could not be influenced and the areaof the xylem in cross-section was measured 1 month later. Thewounds, which damaged the vascular tissues, significantly increasedvascular differentiation, indicating the replacement of a longnon-functional region of damaged tissues. The results indicatethat in the intact plant vascular differentiation is controllednot only by stimuli from the leaves but also by the capacityof the mature vascular system to transport these stimuli.     

Microcirculatory changes in the tissues surrounding a gunshot wound

An examination was carried out of microcirculation disorders as the main link of the pathogenetic process in the tissues surrounding a gunshot wound. Microcirculatory disorders were assessed in rabbits (924) with the help of radionuclide method (tissue radiometry and scannography) and the method of vital contact microscopy in gunshot wounds of posterior extremity soft tissues. After the injury the formation of four zones of tissue damage was revealed, with different character of microcirculatory changes in wound process dynamics. The obtained data may serve as the basis for working out zonal disorder classification and local treatment of gunshot wounds.     

The Genotoxic Effect of Gunshot Wounds

Evidence for alterations in chromosomes of experimental animals (rats) and humans after gunshot wounds is presented. The rate of chromatid exchanges induced by gunshot wounds in humans depends on the saturation of body tissues with ascorbic acid. It is assumed that free-radical processes underlie the deleterious effect of gunshot wounds on chromosomes.     

The genotoxic effect of gunshot wounds

Evidence for alterations in chromosomes of experimental animals (rats) and humans after gunshot wounds is presented. The rate of chromatid exchanges induced by gunshot wounds in humans depend on the saturation of body tissues with ascorbic acid. It is assumed that free-radical processes underlie the deleterious effect of gunshot wounds on chromosomes.     

Use of pefloxacin in the treatment of patients with purulent wounds of soft tissues]

Pefloxacin was used in the treatment of 25 patients with wound infection in a dose of 400 mg orally twice a day for 10-12 days. As the monotherapy it was applied to 15 patients. 7 patients with clinical signs of non-clostridial anaerobic infection were treated with pefloxacin in combination with intravenous metronidazole. Pefloxacin was highly efficient in 96 per cent of the cases with extensive posttraumatic purulent wounds with and without bone affection, acute purulent wounds of the soft tissue, purulent wounds of the soft tissues in diabetic patients, trophic or decubitus ulcer. 266 clinical isolates of Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli, Proteus mirabilis, Enterobacter spp. and Acinetobacter spp, were tested and 75 to 100 per cent of them was shown to be susceptible to pefloxacin and ciprofloxacin. At the same time the isolates of Pseudomonas aeruginosa and Klebsiella spp. were more susceptible to ciprofloxacin. The pathogen eradication and eradication with superinfection in the cases treated with pefloxacin amounted to 92 per cent. The drug tolerance was good. No clinically significant adverse events were recorded.     

Efficacy of l-proline administration on the early responses during cutaneous wound healing in rats

Proline (Pro) plays a versatile role in cell metabolism and physiology. Pro and hydroxypro are major imino acids present in collagen, an important connective tissue protein, essential for wound healing, which is a primary response to tissue injury. This study explains the role of l-pro on cutaneous wound healing in rats when administered both topically and orally. Open excision wounds were made on the back of rats, and 200 μl (200 mg) of pro was administered topically and orally once daily to the experimental rats until the wounds healed completely. The control wounds were left untreated. Granulation tissues formed were removed after day 4 and 8 of post excision wounding, and biochemical parameters such as total protein, collagen, hexosamine, and uronic acid were estimated. Levels of enzymatic and non-enzymatic antioxidants such as catalase, superoxide dismutase, glutathione peroxidase, ascorbic acid, and reduced glutathione were evaluated along with lipid peroxides in the granulation tissues. Tensile strength and period of epithelialization were also measured. It was observed that the treated wounds healed very fast as evidenced by augmented rates of epithelialization and wound contraction, which was also confirmed by histological examinations. The results strappingly authenticate the beneficial effects of the topical administration of l-proline in the acceleration of wound healing than the oral administration and control.     

Changes in the structure and antibiotic sensitivity of the wound microflora in suppurative surgical infection of the soft tissues

The results of the study on the composition, properties and antibiotic sensitivity of pathogenic microbes isolated from purulent wounds of the soft tissues of patients treated in the Institute clinic in 1977-1980 are presented. The frequency of secondary infection of the purulent wounds was estimated. During this period the percentage of gram-negative bacteria isolated from opened purulent foci increased. In some cases investigation of the time course of the purulent processes revealed new microbial strains, such as pathogenic staphylococci or opportunistic gram-negative bacteria. Sometimes replacement of the causative agent by new organisms was observed. The new strains were high- and multiple-resistant to the antibiotics.     

Ultrafast Mid-IR Laser Scalpel: Protein Signals of the Fundamental Limits to Minimally Invasive Surgery

Lasers have in principle the capability to cut at the level of a single cell, the fundamental limit to minimally invasive procedures and restructuring biological tissues. To date, this limit has not been achieved due to collateral damage on the macroscale that arises from thermal and shock wave induced collateral damage of surrounding tissue. Here, we report on a novel concept using a specifically designed Picosecond IR Laser (PIRL) that selectively energizes water molecules in the tissue to drive ablation or cutting process faster than thermal exchange of energy and shock wave propagation, without plasma formation or ionizing radiation effects. The targeted laser process imparts the least amount of energy in the remaining tissue without any of the deleterious photochemical or photothermal effects that accompanies other laser wavelengths and pulse parameters. Full thickness incisional and excisional wounds were generated in CD1 mice using the Picosecond IR Laser, a conventional surgical laser (DELight Er:YAG) or mechanical surgical tools. Transmission and scanning electron microscopy showed that the PIRL laser produced minimal tissue ablation with less damage of surrounding tissues than wounds formed using the other modalities. The width of scars formed by wounds made by the PIRL laser were half that of the scars produced using either a conventional surgical laser or a scalpel. Aniline blue staining showed higher levels of collagen in the early stage of the wounds produced using the PIRL laser, suggesting that these wounds mature faster. There were more viable cells extracted from skin using the PIRL laser, suggesting less cellular damage. β-catenin and TGF-β signalling, which are activated during the proliferative phase of wound healing, and whose level of activation correlates with the size of wounds was lower in wounds generated by the PIRL system. Wounds created with the PIRL systsem also showed a lower rate of cell proliferation. Direct comparison of wound healing responses to a conventional surgical laser, and standard mechanical instruments shows far less damage and near absence of scar formation by using PIRL laser. This new laser source appears to have achieved the long held promise of lasers in minimally invasive surgery.     

Immediate and long-term management of gunshot wounds to the lower face

The steadily increasing level of urban violence and attempted suicides in the recent past has resulted in large numbers of gunshot injuries to the face from small-caliber weapons. Our experience with 35 consecutive cases of civilian gunshot wounds involving primarily the lower face is presented. Initial management included securing of the airway, control of bleeding, and treatment of coexisting injuries. After clinical and radiologic evaluation and conservative debridement of all devitalized tissues, the mandibular fractures were reduced and stabilized appropriately. Large bony defects were treated by stabilization of the mandibular segments followed by secondary bone grafting. Intraoral soft tissues were then repaired with local mucosal flaps or tongue flaps when necessary. Finally, the soft tissues were repaired by primary closure or local flaps. Distant flaps were used only as a secondary procedure. Our results are presented, the differences between civilian and military injuries are discussed, and the principles of gunshot ballistics are described. We conclude that most of these wounds can be treated in a relatively conservative manner immediately after the injury with good functional and cosmetic results.     

Assay of radiation effects in mouse skin as expressed in wound healing

The effect of 150 kVp X irradiation on the healing of full depth surgical wounds in the lower dorsal skin of the mouse was assayed by measuring the wound strength of seven 2-mm-wide segments along each wound. The strength of unirradiated wounds increased with time in two phases: during the first 2 weeks it reached nearly half of the values recorded from unwounded skin, after which the rate of increase slowed for at least 2 weeks before beginning a second increase. By 150 days, the breaking strength of the wound was about 80% of that of unwounded skin. A single dose of 18 Gy prior to wounding reduced the strength of the wounds to about one-third to one-half that of an unirradiated wounds within the 3 months of follow-up. The effect of irradiation on wound strength did not change as the interval between exposure and wounding was increased to 2 months but decreased slightly when this interval was extended to 3 months. When the healing wound was irradiated within 5 days of surgery, the effect on healing was about the same as with preirradiation; if irradiation was delayed for 12 days after wounding the second phase of healing was only postponed and the wound strength ultimately approached the values recorded from unirradiated wounds. The wound strength of skin preirradiated by X rays and assayed 14 days after wounding showed a clear sigmoid dose response with a threshold between 8 and 10 Gy and a plateau at the maximum effect above 20 Gy. The persistence for at least 3 months of the effect of radiation on wound healing suggests that the tissues involved in the healing process are normally proliferating slowly. The accelerated expression of radiation injury through surgical wounding permits the early quantification of the radiation response of tissues that would normally be delayed in their expression of radiation damage.     

Penetration and colonization of unwounded maize tissues by the maize anthracnose pathogen Colletotrichum graminicola and the related nonpathogen C. sublineolum

The maize anthracnose stalk-rot fungus Colletotrichum graminicola infects its host primarily through wounds in the stalks that are caused by insects. However it also can cause stalk-rot disease without wounding. It is not known how the pathogen enters stalks in the absence of wounds. Studies have suggested that direct invasion through the highly lignified rind tissues is not a viable means of entry. A cytological approach was used to investigate the ability of C. graminicola to penetrate and colonize intact maize stalks. The pathogen had a significant capacity for direct penetration, but this mechanism of infection was much slower and less efficient than penetration through wounds. The fungus breached the lignified rind fibers by passing through small openings in the cell walls via narrow hyphal connections. Epidermal cells and rind fiber cells did not appear to become rotted. Rotting only occurred once the pathogen had penetrated into the pith parenchyma cells. To our surprise the closely related fungus C. sublineolum, which is not normally a pathogen of maize, also was capable of infecting intact maize stalks, although to a lesser degree than C. graminicola. The two species also were observed on intact roots and leaves, and C. sublineolum was incapable of infecting those tissues whereas C. graminicola efficiently colonized both. This suggests the interesting possibility that nonhost resistance to C. sublineolum is conditional and perhaps also tissue-specific.     

Freezing for postmortal storage influences the biomechanical properties of linear skin wounds.

Specimens for biomechanical investigations are often stored frozen between sampling and testing. Several authors have analysed the effects of freezing on a variety of intact tissues; while some have found mostly minor changes, others have reported no adverse effects. Healing wounds contain more fragile tissue components than other tissues and are therefore more sensitive to possible adverse effects. This study on rat skin wounds (healed for 10 and 20 days) demonstrates that freezing has a significant adverse influence on the mechanical properties. It is concluded that fresh tissue should be used whenever possible. In case storage in a freezer is necessary great care should be taken when designing the experimental protocol.     

Tissue dispersion and flow cytometry for the cellular analysis of wound healing

Injury induces a flux in the cellular composition of tissues as part of the wound healing response. There is no reliable and rapid method to quantify and characterize the cellular composition of the matrix-rich wound. Our aim was to develop a rapid method to quantify the cellular composition in wounds by tissue dispersion and flow cytometry. Age- and weight-matched mice were wounded on the dorsum using a 1.5 x 1.5 cm2 template, and the wounds were excised at predetermined time points. Tissues were dispersed into single-cell suspensions and labeled with antibodies to cell surfaces and intracellular antigens. Flow cytometry was performed to quantify the percentage of each cell population and cell death. We found that our tissue dispersion protocol resulted in low cell death (4%-6%) and very high yield (80-220 x 10(6) cells/g). Furthermore, cell surfaces and intracellular antigens were preserved to provide accurate identification of the different cell populations. With the appropriate modifications, this protocol is likely to be applicable for the viable retrieval and identification of cells from skin and other collagen-dense tissues.     

Type I and type III collagen content of healing wounds in fetal and adult rats

Full-thickness, dermal wounds were surgically created on the dorsa of fetal rats on the 17th day of gestation. The granulation tissue which developed after 2 days (19 days of gestation) was harvested from six to nine animals and pooled and the collagen was extracted with 0.5 M acetic acid and acetic acid plus pepsin. The ratio of type III:type I collagen was estimated from densitometer scans of electrophoretically separated alpha-chains. Full-thickness (to fascia depth) wounds were also produced on the dorsa of adult rats and granulation tissue which had developed for different periods of time up to 30 days was excised. Relative proportions of type III and type I collagen were assessed in normal and granulation tissues taken from the adult rats. Both fetal and adult granulation tissues have elevated type III collagen content but normal fetal tissue has a much higher content of type III than does normal adult tissue.     

The molecular characteristic of Staphylococcus aureus and Staphylococcus epidermidis strains isolated from clinical sources

The aim of study was the molecular characteristic of S. aureus and S. epidermidis isolates obtained from skin surface, wounds, deep tissues of hospitalized patients and from skin surface of non-hospitalized patients. Genes encoding virulence factors were examined using PCR reaction and specific primers. Genes encoding adhesinsfnbA and cna and gene eta for epidermolytic toxin were mostly present in S. aureus isolates coming from wounds and deep tissues compared to these from skin surface. Gene atlE encoding autolysin of S. epidermidis was detected in all studied isolates, whereas gene icaAB was present in almost all isolates. Comparison of results obtained by PCR and conventional method of the resistance to methicillin estimation showed discrepances suggesting the need for using of both methods in some clinically difficult cases of S. aureus infection.     

Dynamics of cAMP contents and cAMP-binding capacity of tissue in the healing of different types of wound in animal experiments

The paper considers the alterations in the cAMP and cAMP-binding capacity of proteins in the tissues of aseptic and infected wounds on 220 experimental Wistar male rats weighing 200-210 g. Variations of cyclic nucleotide levels in the time course of wound healing have been found to be dependent on the ratio between free and bound forms of cyclic nucleotides. There are stated the differences in the cAMP level range that arise from a variety of reasons during the healing of infected and aseptic wounds.     

The possible effect of the mechanical factor on the completeness of the regeneration of the spinal skin in mice

In mouse tissues, regenerates forming in the place of full-thickness skin wounds on the back, were exposed to dosed mechanical injuries. As a result the structure of final regenerates in some animals differed from the scar, that is usually formed after healing of this type of wound.