Autologous Fat Grafting – A Step Forward in Wound Management

Autologous fat grafting (AFG) is an emerging therapeutic option for wounds that are not ready for grafting. The regenerative potential of autologous fat lies in the adipose derived stem cells (ADSCs) contained within the stromal vascular fraction (SVF), which are capable of differentiating into multiple cell lineages. However to date, there has been no comprehensive evaluation of its efficacy in acute complicated wounds. This study aims to critically evaluate the efficacy and safety of AFG in cutaneous wound healing. Materials and Methods: This prospective, quasi experimental study was conducted in the Department Of Plastic Surgery, SIMS, Lahore, between June 2020 and June 2021. Thirty patients with pale granulation, not ready for grafting with no vital structure exposed were included in the study after detailed history, examination and were photographed pre and postoperatively. The procedure was performed under local anaesthesia. 40 to 80 ml fat was harvested from lower abdomen and after emulsification, placed over the wound wrapped in sufra tulle dressing. The dressing was changed on third postoperative day and outcome was assessed on clinical grounds. Results: Thirty patients (M:F Ratio 1.75:1) with mean age 30 years (Range 13-45 years) were included in this study with post traumatic (n = 23) and post infective (n = 7). Of 27 patients who completed their follow up, all had healthy granulation tissue which was later on grafted. Mean number of fat dressing sessions were 2 (Range 1-3). Conclusion: Autologous fat grafting has shown promising results for cutaneous wounds without any unacceptably high complication rates reported so far. Randomised controlled trials should be done on a larger scale to prove its efficacy in the management of complicated wounds.

Palestinian Experience in Stage Four Pressure Ulcer

Pressure ulcer (now called Pressure injury) happens when the bony prominence like the sacrum exposes to pressure for a long period and also can cause soft tissue injury. In order to prevent and cure pressure-induced wounds, continuous and attentive repositioning is necessary. Wound management begins with the identification and aggressive management of the modifiable factors, such as positioning, incontinence, spasticity, diet, devices, and medical comorbidity, which contribute to pressure injury formation. Initial interventions include washing, cleaning, and maintaining the surfaces of the wound. In certain cases, it may be sufficient to debride the non-viable or contaminated tissue; however, operational care in more severe cases or to encourage patient satisfaction may be necessary. Our patient is a 50-year-old overweighted man, nonsmoker, and confined to a wheelchair presented with a 20*20*8 stages 4 ulcers in the sacral area after multiple failed bedside debridement. When we use the fasciocutaneous we should consider the depth of the wound and fill dead space. Here we the local situation in Palestine as those patients are usually neglected and their management is restricted to bedside debridement, with no experience in flap reconstruction operations which would dramatically improve patients’ lives. We believe that further awareness is demanded for such procedures.

Comparative study of use of 32-F, multi-perforated tube drainage of subcutaneous plane versus no drainage, in laparotomy

Background: We are concerned about the wound management and wound healing amongst post-operative patients, as wound complications increase the morbidity of patients post-surgery. Most common wound complications post-surgery are wound seromas, hematomas and surgical site infections (SSIs). SSIs lead to increased hospital stay and increased morbidity alongside increasing unnecessary patient suffering and a decreased quality of life. The underlying principle for the use of subcutaneous drains is based on the belief that removal of serum or debris and eradication of dead space in subcutaneous plane will bring down the rate of infection and wound complications.Methods: A randomized control study was conducted at the General Surgery Department at SGT Medical College, Gurgoan, Haryana. In total, 60 patients were selected (after taking informed written consent) among those admitted to the Surgery Department for laparotomy procedure. Patients were divided randomly into two groups i.e., group-A (study group) and group-B (control group). In group-A patients, subcutaneous wounds were closed over a drain (32-F multi-perforated drain), while in group-B patients no drain was used. Intra-operative and post-operative findings were recorded and analysed to draw study conclusions.Results: SSIs were observed significantly higher among patients without subcutaneous drain (group-B). Patients of group-B had significantly higher incidence of seroma and pus as compared to group-A patients. Experience of pain was reported higher among the patients without subcutaneous drain (group-B).Conclusions: Subcutaneous drains play an important role in reducing the incidence of SSIs, wound complications, wound pain; thereby lead to better healing of the surgical wound.