scholarly journals Burn Care in the Era of Rapid Enzymatic Debridement: Challenging the Dogma that Healing Beyond 21 Days Results in Hypertrophic Scarring

2021 ◽  
Vol 15 (1) ◽  
pp. 66-77
Author(s):  
Lior Rosenberg ◽  
Yaron Shoham ◽  
Stan Monstrey ◽  
Henk Hoeksema ◽  
Jeremy Goverman ◽  
...  
Keyword(s):  
Inflammatory Response ◽  
Granulation Tissue ◽  
Wound Closure ◽  
Major Advance ◽  
Tissue Formation ◽  
Hypertrophic Scarring ◽  
Granulation Tissue Formation ◽  
Burn Care ◽  
Secondary Intention ◽  
Enzymatic Debridement

Deep burns are characterized by the presence of a necrotic eschar that delays healing and results in a local and systemic inflammatory response and following healing by secondary intention: heavy scarring. Early surgical debridement followed by grafting was a major advance in deep burn care and is now the standard of care, reducing mortality and hypertrophic scarring. Eschars have alternatively been managed by non-surgical, autolytic debridement, which often results in infection-inflammation, slow epithelialization, granulation tissue formation and subsequent scarring. Studies based on these traditional approaches have demonstrated an association between delayed wound closure (beyond 21 days) and scarring. Early enzymatic debridement with NexoBrid (NXB) followed by appropriate wound care is a novel minimally invasive modality that challenges the well-accepted dictum of a high risk of hypertrophic scarring associated with wound closure that extends beyond 21 days. This is not surprising since early and selective removal of only the necrotic eschar often leaves enough viable dermis and skin appendages to allow healing by epithelialization over the dermis. In the absence of necrotic tissue, healing is similar to epithelialization of clean dermal wounds (like many donor sites) and not healing by the secondary intention that is based on granulation tissue formation and subsequent scarring. If and when granulation islands start to appear on the epithelializing dermis, they and the inflammatory response generally can be controlled by short courses (1-3 days) of topically applied low strength corticosteroid ointments minimizing the risk of hypertrophic scarring, albeit with wound closure delayed beyond the magic number of 21 days. Results from multiple studies and field experience confirm that while deep burns managed with early enzymatic debridement often require more than 21 days to reepithelialize, long-term cosmetic results are at least as good as with excision and grafting.

scholarly journals Bilateral Choanal Atresia and Endoscopic Surgery: A Chance for CHARGE Patients

2021 ◽  
Vol 10 (13) ◽  
pp. 2951
Author(s):  
Maria Baldovin ◽  
Diego Cazzador ◽  
Claudia Zanotti ◽  
Giuliana Frasson ◽  
Athanasios Saratziotis ◽  
...  
Keyword(s):  
Congenital Malformation ◽  
Endoscopic Surgery ◽  
Granulation Tissue ◽  
Choanal Atresia ◽  
Tissue Formation ◽  
Endoscopic Repair ◽  
Granulation Tissue Formation ◽  
Charge Association ◽  
Cohort Data

Bilateral choanal atresia (CA) is a rare congenital malformation frequently associated with other anomalies. CHARGE association is closely linked to bilateral CA. The aim of this study was to describe the outcomes of the endoscopic repair in bilateral CA, and to assess the role of postoperative nasal stenting in two cohorts of CHARGE-associated and non-syndromic CA. Thirty-nine children were retrospectively analyzed (16 patients had CHARGE-associated CA). The rate of postoperative neochoanal restenosis was 31.3% in the CHARGE population, and 47.8% in the non-syndromic CA cohort. Data on postoperative synechiae and granulation tissue formation, need for endonasal toilette and dilation procedures, and number of procedures per patient were presented. Stent positioning led to a higher number of postoperative dilation procedures per patient in the non-syndromic cohort (p = 0.018), and to a higher rate of restenosis both in the CHARGE-associated, and non-syndromic CA populations. Children with CHARGE-associated and non-syndromic bilateral CA benefitted from endonasal endoscopic CA correction. The postoperative application of an endonasal stent should be carefully evaluated.

scholarly journals Paronychia and granulation tissue formation during treatment with isotretinoin

2016 ◽  
Vol 91 (2) ◽  
pp. 223-225 ◽  
Author(s):  
Daniela de Almeida Figueiras ◽  
Ticiana Batista Ramos ◽  
Ayana Karla de Oliveira Ferreira Marinho ◽  
Milena Soneley Mendonça Bezerra ◽  
Renata Cavalcanti Cauas
Keyword(s):  
Granulation Tissue ◽  
Tissue Formation ◽  
Granulation Tissue Formation

scholarly journals Therapeutic effect of local photothermal heating of gold nanoparticle-coated self-expandable metallic stents for suppressing granulation tissue formation in the mouse colon

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0249530
Author(s):  
Yeong-Cheol Heo ◽  
Dong-Kyoon Han ◽  
Min Tae Kim
Keyword(s):  
Therapeutic Effect ◽  
Granulation Tissue ◽  
Stent Placement ◽  
Local Heating ◽  
Tissue Formation ◽  
Sems Placement ◽  
Granulation Tissue Formation ◽  
Mouse Colon ◽  
Group A ◽  
Group B

Purpose To investigate the therapeutic effect of local photothermal (PT) heating on suppression of stent-induced granulation tissue formation in mouse colon. Materials and methods A gold nanoparticle (GNP)-coated self-expandable metallic stent (SEMS) was prepared using a two-step synthesis process for local PT heating under near-infrared laser irradiation. Twenty-four mice were randomly divided into two groups of 12 and subjected to SEMS placement in the colon. Group A received a GNP-coated SEMS without local heating and Group B received a GNP-coated SEMS and underwent local heating at 55°C after SEMS placement. The therapeutic effect of local heating was assessed by comparing the histopathological, immunohistochemical, and endoscopic results. Results Four mice were excluded because of stent migration (n = 3, group B) or death (n = 1, group A). Stent-induced granulation tissue-related variables were significantly lower in group B than in group A (p < 0.001). In vivo endoscopic images, 4 weeks after stent placement, showed granulation tissue formation over the wire mesh in group A and relatively good patency of the stented colon with no definite irregularities in group B. There was more vascular endothelial growth factor (VEGF) positivity in group A than in group B. Conclusion Local PT heating suppresses granulation tissue formation after stent placement in mouse colon.

Postoperative Inhaled Steroids Following Glottic Airway Surgery Reduces Granulation Tissue Formation

2021 ◽  
pp. 000348942110658
Author(s):  
Alison N. Hollis ◽  
Ameer Ghodke ◽  
Douglas Farquhar ◽  
Robert A. Buckmire ◽  
Rupali N. Shah
Keyword(s):  
Granulation Tissue ◽  
Laser Surgery ◽  
Vocal Fold ◽  
Inhaled Corticosteroids ◽  
Surgical Removal ◽  
Tissue Formation ◽  
Granulation Tissue Formation ◽  
Inhaled Steroids ◽  
Transoral Laser Surgery ◽  
Airway Surgery

Objectives: Transoral laser surgery for glottic stenosis (transverse cordotomy and anteromedial arytenoidectomy (TCAMA)) is often complicated by granulation tissue (GT) formation. GT can cause dyspnea and may require surgical removal to alleviate airway obstruction. Inhaled corticosteroids (ICS) have been shown to reduce benign vocal fold granulomas, however its use to prevent GT formation has not been described. We aimed to analyze the effect of immediate postoperative ICS on GT formation in patients undergoing transoral laser surgery for glottic stenosis. Methods: A retrospective analysis of patients that had transoral laser surgery for glottic stenosis from 2000 to 2019 was conducted. Surgical instances were grouped into those that received postoperative ICS and those that did not. Demographics, diagnosis, comorbidities, intraoperative adjuvant therapy, and perioperative medications were collected. Differences in GT formation and need for surgical removal were compared between groups. A multivariate exact logistic regression model was performed. Results: Forty-four patients were included; 16 required 2 glottic airway surgeries (60 surgical instances). Of the 23 instances where patients received immediate postoperative ICS, 0 patients developed GT; and of the 37 instances that did not receive postoperative ICS, 15 (40.5%) developed GT ( P < .0001). Eight (53.3%) of these cases returned to the OR for GT removal. ICS use was solely associated with the absence of GT formation ( P = .042) in the multivariate analysis. Conclusions: Immediate postoperative use of ICS seems to be a safe and effective method to prevent granulation tissue formation and subsequent surgery in patients following transoral laser airway surgery for glottic stenosis.

scholarly journals The Efficacy of Concentrated Growth Factor in the Healing of Alveolar Osteitis: A Clinical Study

2020 ◽  
Vol 2020 ◽  
pp. 1-9 ◽  
Author(s):  
Aqsa Kamal ◽  
Basheer Salman ◽  
Noor Hayati Abdul Razak ◽  
Ali Al Qabbani ◽  
A. R. Samsudin
Keyword(s):  
Growth Factor ◽  
Pain Score ◽  
Granulation Tissue ◽  
Conventional Treatment ◽  
Tooth Extraction ◽  
Tissue Formation ◽  
Granulation Tissue Formation ◽  
Dry Socket ◽  
Group I ◽  
Alveolar Osteitis

Background. A dry socket also referred to as alveolar osteitis (AO) is a common postoperative complication following tooth extraction, due to the disruption of the clot within the wound. This study aimed to evaluate the efficacy of concentrated growth factor (CGF) in the healing of alveolar osteitis following tooth extraction. Methods. The study was conducted at University Dental Hospital Sharjah, UAE. Patients undergoing tooth extraction at the oral surgery clinic were advised to return immediately if they suffer from pain. Over the following first week after tooth extraction, patients who reported pain symptoms were recalled and all dry sockets were identified. The patients were divided into two groups. Group I patients received conventional treatment with socket curettage and saline irrigation only, while in group II CGF was inserted into the socket. Both groups were observed for pain score and quantification of granulation tissue formation. Results. A total of 40 dry socket patients, aged between 18 and 60 years, from a total of 1,250 patients, were included in the study. 30 patients were given conventional treatment while another 10 patients were given CGF. Patients who received CGF had a pain score of 7–10 at presentation, and the pain score dropped to 0–3 on day 4 and further improved to 0-1 on day 7 (p=0.001). Granulation tissue formation appeared in the conventional group I on day 7 while the CGF group II showed earlier granulation tissue formation by day 4 (p=0.001). The posttreatment pain score is inversely proportional to the amount and rate of granulation tissue formation in the socket. Conclusion. The study suggests that delivery of CGF into a dry socket helps relieve pain and expedite the wound healing process as shown by a statistically much lower pain score and earlier and more rapid formation of granulation tissue when compared to the conventional alveolar osteitis therapy.

scholarly journals Effectivity of topical mangosteen pericarp extract cream on wound healing in Swiss albino mice

2019 ◽  
Vol 92 (2) ◽  
Author(s):  
Hilda Brigitta Sombolayuk ◽  
Khairuddin Djawad ◽  
Siswanto Wahab ◽  
Upik A. Miskad ◽  
Gemini Alam ◽  
...  
Keyword(s):  
Wound Healing ◽  
Granulation Tissue ◽  
Inflammatory Cells ◽  
Control Group ◽  
Tissue Formation ◽  
Granulation Tissue Formation ◽  
Swiss Albino Mice ◽  
Accelerate Wound Healing ◽  
Acute Wound ◽  
Albino Mice

Wound healing is a complex physiological process consisting of four phases: coagulation, inflammation, proliferation and migration, and remodeling, each with distinct characteristics. Studies have suggested that mangosteen pericarp extract (MPE) may accelerate wound healing. However, the mechanism has not been fully understood. This study aims to evaluate the effect of MPE cream in various concentrations in acute wound healing of albino mice, both histologically and macroscopically. Thirty-two healthy female Swiss albino mice, aged 6-9 weeks, weight 20-30 g, were included in this study. The samples were randomly divided into eight groups each consisting of 4 mice. The first four groups were treated with MPE cream 5%, 10%, and 20%, and no medication (control group), respectively, and were sacrificed after three days. The other four groups received the same application and were sacrificed after 8 days. Wound bed diameter was measured and biopsy from the skin lesion was performed for histopathologic examination. Mann-Whitney test was used to analyze the diameter of the wound bed and histopathological findings of granulation tissue formation, reepithelialization, and inflammation, with P<0.05 considered as significant. MPE cream significantly improved wound healing by increasing granulation tissue formation, and reepithelialization. In addition, MPE cream application was also shown to decrease the number of inflammatory cells, particularly in 5% and 10% concentrations, both in the 3-day and 8-day groups. MPE cream application can accelerate wound healing and thus can be used in acute wound treatment.

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