ADJUNCTIVE THERAPY FOR FETLOCK FLEXURAL DEFORMITIES ACCOMPANIED BY A DEEP TISSUE INJURY IN A CALF: A CASE REPORT

A five-day-old Holstein Friesian male calf was presented for the evaluation of severe fetlock flexural deformities with a large pressure ulcer over the right metacarpal bone. Superficial and deep digital flexor tenotomy was performed. The surgical wound recovered well, but 15 days after surgery, the skin over the pressure ulcer was starting to fall away and exposing tendon and muscle. A hoof toe-extension shoe was applied to decrease pressure on the wound. The wound had a moderate bacterial infection and slowly responded to cleansing twice a day with 0.9% normal saline, 10% povidone iodine and a topical antibiotic. Topical autologous platelet-rich plasma (PRP) was then applied to the lesion ([Formula: see text][Formula: see text]cm) twice. The wound showed rapid tissue regeneration, good quality wound healing and no complications. After PRP treatment, the lesion size decreased ([Formula: see text][Formula: see text]cm). At this point, 0.9% normal saline cleansing and a bandage were applied until the wound had completely healed. This case report suggests that the hoof toe-extension shoe and topical dressing with autologous PRP, as a combination treatment, could be effective for fetlock flexural deformities with skin defects or delayed wound healing in large animals.

132 Quality Improvement Project (QIP) On Compliance of Vascular Society’s Clinical Care Pathway for Patients with Critical Limb Ischaemia (CLI) Admitted to Vascular Ward At Worcestershire Royal Hospital (WRH)

Introduction Patients often present to the emergency department with critical limb ischaemia (CLI). According to the Vascular Society 2019 guidelines, these patients require. All metrics should be carried out >80% of the time. Method A QIP was conducted of all CLI patients admitted with rapid progression/ deep tissue injury/ rest pain at WRH between 23/01/2020-31/03/2020. Sources of data - Patient records, ICE and PACS Results Compliance target for below were not met. However, compliance for vascular surgeon face-to-face review within 14 hours stood at 100%. Conclusions Failure to fully comply could lead to poor prognostic outcomes such as loss of limb or death. Consequently, the WRH vascular governance board agreed to put the following measures in place.

Deep tissue injury: a narrative review on the aetiology of a controversial wound

Deep tissue injuries (DTIs) were added to pressure ulcer grading systems in 2009. Since then, they have been associated with the same aetiological processes as other forms of pressure injury (PI). This is despite notable clinical differences in their presentation along with variations in natural history that suggest they are the consequence of processes distinct from those that cause other PIs. Understanding the aetiology of DTIs is essential to guide prevention and treatment in addition to ensuring healthcare governance processes deeply tied to pressure injury are effective and efficient. Current understanding of the aetiology of DTI has significant gaps, with several key challenges impeding progress in this area of PI research, including inconsistent reporting by healthcare services and the limitations of animal and computer models in addition to the ethical barriers to conducting studies on human subjects. Synthesis of early studies with studies undertaken before 2009 is also limited by the variety in definitions of DTI used before that published by the European Pressure Ulcer Advisory Panel, the National Pressure Injury Advisory Panel and the Pan Pacific Pressure Injury Alliance in 2009. To date, few prospective clinical studies have been conducted. This article presents a narrative review on the clinical and animal study evidence indicating contemporary understanding of DTI.

Healing effects of curcumin nanoparticles in deep tissue injury mouse model.

Background: Chronic inflammation and lack of angiogenesis are the important pathological mechanisms in deep tissue injury (DTI). Curcumin is a well-known anti-inflammatory and antioxidant agent. However, curcumin is unstable under acidic and alkaline conditions, and can be rapidly metabolized and excreted in the bile, which shortens its bioactivity and efficacy. Objective: This study aimed to prepare curcumin-loaded poly (lactic-co-glycolic acid) nanoparticles (CPNPs) and to elucidate the protective effects and underlying mechanisms of wound healing in DTI models. Methods: CPNPs were evaluated for particle size, biocompatibility, in vitro drug release and their effect on in vivo wound healing. Results : The results of in vivo wound closure analysis revealed that CPNP treatments significantly improved wound contraction rates (p<0.01) at a faster rate than other three treatment groups. H&E staining revealed that CPNP treatments resulted in complete epithelialization and thick granulation tissue formation, whereas control groups resulted in a lack of compact epithelialization and persistence of inflammatory cells within the wound sites. Quantitative real-time PCR analysis showed that treatment with CPNPs suppressed IL-6 and TNF-α mRNA expression, and up-regulated TGF-β, VEGF-A and IL-10 mRNA expression. Western blot analysis showed up-regulated protein expression of TGF-β, VEGF-A and phosphorylatedSTAT3. Conclusion: Our results showed that CPNPs enhanced wound healing in DTI models, through modulation of the JAK2/STAT3 signalling pathway and subsequent upregulation of pro-healing factors.

536 Road Rash: Understanding a Challenging Form of Burn Injury

Introduction Road rash is a unique burn injury due to imbedded foreign debris and deeply seeded bacteria. Literature on this injury fails to address its unique mechanism and ways to reduce scarring and infection. Given the paucity of data, a retrospective review was performed at a single level 1 trauma center to study friction burn characteristics and outcomes from these injuries Methods We performed a systematic literature search with PubMed, Scopus, and OvidSP Medline databases using the following keywords: friction burn, traumatic tattoo, and road rash. Subsequently, we analyzed all patients treated by our ABA verified burn center for friction related injuries from January 1, 2015 to September 15, 2019 and evaluated demographics, interventions, and outcomes. Results Twenty-four pertinent articles were identified. Seven articles were included after full-text analysis. Analysis of 225 patients from these studies identified an average age of 23±7 years with 66% male. Most occurred from motor accidents (74%) with industrial (11%) and blast (10%) mechanisms accounting for the majority of the remaining cases. None of the studies recorded TBSA, but 49% were full thickness and 36% had associated injuries. Most patients (58%) required surgery. At our institution, 44 patients met inclusion criteria and the majority were young (25±18 years), men (75%), involved in motor accidents (75%), and low TBSA burns (6.3±5.6%). Over half (57%) had full thickness burns and 72% required surgery. Length of stay was 12±11 days. Of the 27% of patients with traumatic tattooing on admission, 92% successfully had all foreign debris removed by discharge. Eight (18%) patients had wound infections. Importantly, 75% of patients with wound infections had delayed evaluation by a burn practitioner; elucidating a strong and significant correlation (p&lt; 10–5, Cramer’s V 0.84). Conclusions While road rash injuries are often small TBSA, the majority tend to be full thickness, often involve underlying critical structures and frequently require operative intervention. Significantly, patients who developed wound infections were often not evaluated by a burn provider. Applicability of Research to Practice The unique trauma of road rash causes a high degree of superficial and deep tissue injury with high risk for contamination, infection, and scarring such that rapid debridement is critical for optimal care. Burn surgeons should be consulted early as these patients have a high risk of wound infection when not consulted by wound experts.