The wound management involves a comprehensive assessment of the patient and the wound to determine an optimal treatment plan. It is critical to identify and address factors that may impair wound healing, prior to selecting the most appropriate therapy for each patient. Negative pressure wound therapy (NPWT) is a well-established advanced therapy that has been successful in adjunctive management of acute and chronic wounds According Si Liu Chao-zhu He, eleven controlled randomized studies, that included 1,044 patients, from 691 identified studies, concluded that NPWT had higher rates of complete healing than standard dressings. From January to December 2018 we chose forty patients in our institution to receive NPWT as a adjunctive management. Twenty four patients (60%) had neuropatic foot, twelve patients (30%) had neuroischemic foot and four patients (10%) had ischemic foot. The mean wound depth at the beginning of the treatment was 3 cm and the mean area 20 cm2. Before the beginning of the NPWT, the lesions must show a transcutaneous oximetry (TCPO2 )greater than 40 mmhg in the neuroischemic and ischemic group. Some lesions had bone exposure and some tendons. We changed dressings in these patients six times as a mean, with a three –day interval. Granulation tissue formation in 90 % of the wound area and  a reduction of 80% of the wound depth were the criteria for good clinical response.  100% of the neuropatic group and 75% of the neuroischemic group reached the criteria described previously. On the other hand, only 25% (one patient) of the ischemic group reached these conditions and underwent amputation of the limb. Mild pain was the commonest symptom (20%). We didn´t find bleeding and infection signs in our patients chosen for NPWT.

Conclusion: Negative Pressure wound therapy is a very useful tool used in complex wounds in diabetic population.

We investigated the antimicrobial and wound healing properties of prototype wound dressings prepared by bio-inspired crosslinking in vitro and in vivo. We prepared the prototype dressings by electrospinning of gelatin nanofibers containing epsilon-poly-L-lysine (PL) and dopamine on a cotton bandage gauze. Subsequent crosslinking produced mats of mat density 460 g/m2 and labelled as PL_Gel_pDA mats. Antimicrobial properties and antimicrobial durability were studied against panels of bacteria and yeast strains. Mammalian cell biocompatibility and cell proliferative properties were determined for primary human dermal fibroblasts (hDFs) and keratinocytes (HaCaT) cell lines. PL_Gel_pDA mats displayed potent antimicrobial properties against common wound pathogens. The mats displayed excellent biocompatibility and cell proliferative properties for both the mammalian cells. In vivo biocompatibility of the mats was examined in juvenile pigs after cutaneous partial thickness burn injury. The results suggested comparable wound closure and re-epithelialization of the burns at 32 days post injury with silver based dressings. The antimicrobial efficacy of the mats in vivo was further examined by colonizing the partial thickness wounds with Staphylococcus aureus and Pseudomonas aeruginosa. Digital status of the wounds after treatment and silver dressings were assessed in terms of clinical examination (Bates- Jensen Wound Assessment Tool, BWAT), relative wound closure (SigmaScan Pro5), bacterial enumeration from swab culture and Hem atoxylin and Eosin (H & E) /Masson Trichrome staining. Infected burns treated with PL_Gel_pDA mats showed lower BWAT score and bacterial bioburden (>4log10 reduction), increased wound closure, higher keratinization and faster re-epithelialization when compared to silver dressings. This study identified the combined utility of bio-inspired crosslinker, biocompatible antiseptic polymer and hydrogel nanofibers as advanced prototype wound dressings and established its superiority over commercial silver based dressings in infected burns. The nanofibre dressings could potentially be useful for treating life-threatening burn injuries and burn-related infections.

Prolonged healing process and exposure of ulceration to non-sterile conditions causes a considerable risk of infections and their common relapses.  Bedsores covered with slough, ulceration covered with hard to remove bacterial biofilm and wounds without  causative medical treatment are the ones especially prone to a delay in healing process. Long-time experience has shown that removing slough from wound and, what is crucial, the order of combining together different  procedures of wound treatment play an important part in both tissue regeneration and preventing infections. Implemented by European experts TIME concept  is a set of rules connected to the right wound treatment systematising treatment regimen, however, a choice of methods will depend on knowledge and skills of a person in charge of therapy. Currently, therapeutic methods  possible to be used in lab conditions consist of larval therapy, hydrotherapy, negative-pressure wound therapy (NPWT), compression therapy and extracorporeal shockwave therapy (ESWT).  The aim of the thesis is to present good clinical practice boosting healing process of chronic wounds as well as possibilities of combining different therapeutic methods while taking into account a healing phase. The study included patients with chronic wounds receiving outpatient treatment. The thesis shows a possibility of combining  different methods of tissue regeneration through measures available in ambulatory settings.  It also suggests the possibility of combining special treatment while using dressings with physical methods such as negative-pressure wound therapy (NPWT) and extracorporeal shockwave therapy (ESWT) which result in an innovative treatment method.

Statement of the Problem: The prevalence of coronary artery disease (CAD) in patients with peripheral vascular disease (PVD) varies widely from 19%–42% in published reports.  Treatment of the same has always been controversial and challenging. The purpose of this study is to describe a technique of surgery for coronary artery disease and peripheral vascular disease using an artificial conduit from the ascending aorta to peripheral vessels in a single sitting.

Method:

Records of 47 patients above the age of 65 years who underwent cardiac and peripheral revascularisation between January 2009 and January 2017 were retrospectively analysed. All patients had a diseased abdominal aorta with claudication pain and a coronary angiogram showing either a triple vessel disease (30) or a double vessel disease (17). All patients underwent coronary artery bypass grafting and aorto-bifemoral grafting in a single sitting.

Results:

Post-operative Doppler study showed good peripheral blood flow in all the patients. Patients were relieved from rest pain and angina.  All ulcers had ultimately healed and limb salvage was possible in all cases. Four patients had pericardial effusion due to weeping of the graft, which was drained with the help of pig tail catheter. Seven patients had serous collection at the inguinal sites, which required drainage. One patient during follow up had developed graft infection and expired subsequently.

Conclusion & Significance:

Single sitting for CAD and PVD revascularization is easy to perform, reduces the morbidity, and avoids abdominal complications.  It also reduces hospital stay and thus is cost effective.

In short holistic medicine is the recognition of a patient as a person with a certain medical, psychological, social and private status, who needs to be assessed, analyzed and investigated. Meanwhile a circle of care should be formed according to the needs identified to provide the best of care, support and ultimately the optimal environment for a patient to manage his health and life while healing his chronic wound. The members making up this team are nurses, wound care specialists, podiatrists, orthotic and prosthetic specialists, as well as internists, neurologists and endocrinologists, surgeons – of the plastic, vascular, orthopedic and general surgical divisions. In addition, the interventional radiologists, psychologists, dieticians and social workers are to be included. All wounds start as an acute incident of tissue break down, whether due to external causes – cuts, sheer and tear, pressure or moisture or direct hits, or they are caused by internal causes as septic emboli to the skin, lack of blood or oxygen supply,  venous stasis, lack  of central nervous control either due to peripheral nerve injury or due to central stroke, as well as organ failure. When this wound cannot be healed within a definite frame of time, it is defined as chronic. It’s very important to investigate the cause of the wound initially, and as important to analyze why this wound became chronic. A wound may be considered a non-healable maintenance wound when the general condition of a patient including his social and psychological status do not allow favorable circumstances to change the wound status into a healable one. Once these indirect factors have been considered, healing is possible. Because the whole patient requires attention to all his problems, which need to be addressed, changed, improved - if possible, now the basis for healing is made. Contrary to the common believe, it is not the care giver, but the patient. The patient himself must be empowered to be able to give an informed consent, to accept treatment including possible invasive interventions, to ask for specific requirements and to work with the team for hidden obstacles to be identified and cleared out of the way.

Fournier's gangrene is a progressive necrotizing infection. The purpose of this subject was to assess the outcome of Fournier's gangrene infection in patients who received topical honey with their systematic medications. History: male, 52 years, diabetic, come to hospital with marked infected and gangrenous wound with extensive cellulitis in perianal subcutaneous tissue, scrotal edema.

Work plan: Surgical debridement, is necessary and extensive surgical incision of necrotic part under spinal anesthesia, the necrotic areas were debrided. First week NPWT (negative pressure wound therapy) is a must to eliminate the sloughed, infected discharges and in promoting healing. Medical pure honey dressing should be applied as a strong antimicrobial local dressing from the second week till fifth week. HBOT in accompanied therapy during our plan of treatment.

In this study, the author realized the using of antibiotics in all aspects should be avoided as possible as we could. Using antibiotics in all aspects irregularly will cause more antibiotic primary issue that is Antibiotics Resistance. Scientists, researchers, pharmacists and doctors are trying to find any solutions for antibiotics resistance not only with low dosage of antibiotic but figure out innovation. This study would be applied as alternative of antibiotics with natural compounds. The formula of silk and alginate created a natural bandage that could stimulate regeneration on wound. Silk had been chosen to be base of the formula because silk has very strong and very stable structure. Silk protein that usually called fibroin was used on this formula not because the perfection of its structure, as in Gita Cahya Eka Darma study about Self-Assembled Polyelectrolyte Complex of Silk Fibroin with Alginate as Drug Delivery Model (2015) that fibroin protein has a therapeutic effect in the treatment of wounds which increase the attachment of fibroblasts (factor in collagen synthesis) on the wound. Therefore, it may recover the wound faster and decrease bleeding time. This silk bandage formulated with combination of honey. Honey already known as super compound of nature that has many roles such as natural antibiotic, natural anti-inflammatory, etc. M. Aurongzeb and M. Kamran Azim (2011) said honey has a lot of interesting bioactivities including antinociceptive, immuno-modulatory and nematicidal activities with in vitro studies indicated potentially beneficial effects of honey on human platelets and blood coagulation proteins. Manisha and Shyamapada  reported on their journal (2011) that honey is an ancient remedy for the treatment of infected wounds which has recently been ‘rediscovered’ by the medical profession and Aristotle (384-322 BC), when discussing different honeys, referred to pale honey as being “good as a salve for sore eyes and wounds”. Allen KL et al (2000) honey is effective against methicillin-resistant S. aureus (MRSA), β-haemolytic streptococci and vancomycin-resistant Enterococci (VRE) that have been revealed by laboratory studies. Those cases supported this silk bandage formula to be combined with honey to press the number of using antibiotic drugs. Besides decrease the number of Antibiotics-Resistance.