Severe wound infection by MRCNS following bilateral inguinal herniorrhaphy

Yao Du1,2†, Song Han1†, Yue Zhou1†, Hai Feng Chen3†, Yao Liang Lu1 , Zhi Yuan Kong1 and Wei Ping Li1*iD

Abstract

Background Wound infection after inguinal hernia surgery is not uncommon in the clinical setting. The common microbial aetiology of postoperative inguinal hernia wound infection is Gram-positive bacteria. Staphylococcus aureus is a common pathogen causing wound infection while Staphylococcus epidermidis and Pseudomonas are rare. Staphylococcus epidermidis as a cause of severe wound infection is rarely described in literature. We herein present a case of a 79-year-old man with a rare wound infection after bilateral inguinal herniorrhaphy caused by MRCNS (Methicillin Resistant Coagulase Negative Staphylococcus).

Case presentation We present a case of wound infection accompanied by fever with a temperature of 38.8 °C after bilateral inguinal herniorrhaphy in a 79-year-old man. Bilateral inguinal wounds were marked by redness and swelling, with skin necrosis. In addition, an abscess of approximately 1.5 cm×1.5 cm was seen on the left wrist. A small amount of gas under the skin in the wound area was observed after pelvic computed tomography (CT) scans. No bacteria were cultured from the inguinal wound discharge, while blood culture detected MRCNS, and Acinetobacter lwoffi was cultured from the pus in the left wrist. We chose appropriate antibiotics based on the results of the bacterial culture and the drug susceptibility results. Vacuum assisted closure (VAC) therapy was used after debridement. The patient was discharged after the wounds improved. He was followed up for ten months and showed no signs of complications. We are sharing our experience along with literature review.

Conclusions We are presenting a rare case of MRCNS wound infection following open inguinal hernia surgery. Although a rarity, clinicians performing inguinal hernia surgery must consider this entity in an infected wound and follow up the patient for complications of MRCNS.

Keywords MRCNS, Wound infection, Hernia, Inguinal

† Yao Du, Song Han, Yue Zhou and Hai Feng Chen contributed equally to this

*Correspondence:

Wei Ping Li

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1 Department of General Surgery, The First People’s Hospital of Taicang City, Taicang Affiliated Hospital of Soochow University, Taicang City 215400, Jiangsu Province, China

2 Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang City 330006, Jiangxi Province, China

3 Department of Gastroenterology, The First People’s Hospital of Taicang City, Taicang Affiliated Hospital of Soochow University, Taicang City 215400, Jiangsu Province, China

© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativeco mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Intra-wound versus systemic vancomycin for preventing surgical site infection induced by methicillin-resistant S. aureus after spinal implant surgery in a rat model

Jian Wei1*† iD, Hanwen Gu2† and Kai Tong2

† Jian Wei and Hanwen Gu have contributed equally to this work

*Correspondence:

Jian Wei

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1 Department of Orthopedic Surgery, Liuzhou People’s Hospital Affiliated to Guangxi Medical University, Liuzhou 545006, China

2 Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China

Abstract

Background Systemic vancomycin administration pre-operatively for the infection prophylaxis of spinal implant surgery remains unsatisfactory. This study aimed to explore the efcacy and dosage of local use of vancomycin powder (VP) in preventing surgical site infections after spinal implant surgery in a rat model.

Methods Systemic vancomycin (SV; intraperitoneal injection, 88 mg/kg) or intraoperative intra-wound VP (VP0.5: 44 mg/kg, VP1.0: 88 mg/kg, VP2.0: 176 mg/kg) was applied after spinal implant surgery and methicillin-resistant S. aureus (MRSA; ATCC BAA-1026) inoculation in rats. General status, blood inflammatory biomarkers, microbiological and histopathological evaluation were performed during 2 weeks post-surgery.

Results No post-surgical deaths, wound complications and obvious signs of vancomycin adverse effects were observed. Bacterial counts, blood and tissue inflammation were reduced in the VP groups compared with the SV group. VP2.0 group showed better outcomes in weight gain and tissue inflammation than the VP0.5 and VP1.0 group. Microbial counts indicated that no bacteria survived in the VP2.0 group, whereas MRSA was detected in VP0.5 and VP1.0 groups.

Conclusions Intra-wound VP may be more effective than systemic administration in preventing infection caused by MRSA (ATCC BAA-1026) after spinal implant surgery in a rat model.

Keywords Postoperative infection, Spinal implant surgery, Intra-wound vancomycin powder, Infection prophylaxis, Rat model

© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Evaluation of the therapeutic efect of dressing containing Silver (Ag coat) in the process of healing skin blisters caused by limb fractures: a clinical trial study

Mehdi Teimouri1 and Sahar sadat Lalehzar2*

Abstract

Background The main activity of the skin is to create a protective barrier against damage. Loss of the skin due to injury or disease and failure to regenerate the affected area may result in disability, infection, or even death. We conducted a clinical trial to evaluate the therapeutic effect of dressing containing silver in process of healing skin blisters caused by limb fractures.

Method This is a pioneering randomized trial that compares the effectiveness of two dressings containing silver (Ag coat) and Gaz Vaseline among patients with skin blisters due to bone fractures who were randomly selected from patients referred to the Kashani Medical Training Center. There were two treatment groups containing 16 patients treated with Ag coat and 15 patients treated with Gaz Vaseline. Pictures were taken of blisters on days 0, 7, and 14 to evaluate the healing process. The amount of pain, duration of the visit (measured by minutes), and general condition of the wound were checked. The amount of pain, duration of visit (measured by minutes) and general condition of the wound was checked. All continuous and categorical data are presented as mean±standard deviation (SD) and frequency (percentage), respectively. Paired sample T-test and repeated measure analysis of variance (ANOVA), Chisquared test was used. All pictures were analyzed by Mosaic soft ward.

Result During this study, there was no significant difference between the mean of age and BMI and frequency of gender in the two study groups (P>0.05). There was a significant difference in mean between the duration of the visit, number of dressings, and net cost of dressing (p < 0.05). In the macroscopic study and analysis for evaluation and comparing wound area with the Mosaic soft ward, there was significant relation in time (p1=0.00). There is no significant difference between the groups (p2=0.84). There was a significant difference between time and group (p3 =0.00). On day 14 the wound area between groups had a significant difference (p4 =0.00) (Table 3). In the VAS score there was a significant difference in time, and group (p1,2 =0.00), there was no significant relation between time and group (p3=0.62). On all days the wound area between groups had a significant difference (p4=0.00).

Conclusion In conclusion, Ag coat dressing, not only has a significant effect on wound healing but also, decreases pain, shorter visit time, and its more cost-effective.

Keywords Blister, Bone fracture, Lower extremity, Silver

*Correspondence:

Sahar sadat Lalehzar

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Full list of author information is available at the end of the article

© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativeco mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Core decompression with β-tri-calcium phosphate grafts in combination with platelet-rich plasma for the treatment of avascular necrosis of femoral head

Jinyang Lyu1,2†, Tiancong Ma1,2†, Xin Huang1,2, Jingsheng Shi1 , Gangyong Huang1,3, Feiyan Chen1 , Yibing Wei1 ,Siqun Wang1 , Jun Xia1 , Guanglei Zhao1*† and Jie Chen1*†

† Jinyang Lyu and Tiancong Ma contributed equally to this work and share first

† Guanglei Zhao and Jie Chen contributed equally to this work and should be regarded as co-corresponding authors.

*Correspondence:

Guanglei Zhao

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Jie Chen

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Abstract
Background This study was aimed to investigate whether the application of platelet-rich plasma (PRP) combined with β-tri-calcium phosphate (β-TCP) grafts after core decompression (CD) could improve the clinical outcomes of early stage of avascular necrosis of femoral head.

Methods Forty-five (54 hips) patients with Ficat-Arlet classification stage |-II treated by CD with β-TCP grafts with or without the application of PRP from July 2015 to October 2020 were reviewed. Group A (CD+ β-TCP grafts) included 24 patients (29 hips), while group B (CD + β-TCP grafts + PRP) included 21 patients (25 hips). Visual analogue scale (VAS) score, Harris hip score (HHS), change in modified Kerboul angle and the hip joint survival were evaluated and compared between the groups. Patients had a mean follow-up period of 62.1士17.2 months and 59.3土14.8 months in group A and group B, respectively.

Results The mean VAS scores in group A was significantly higher than group B at the 6 months (2.9士0.7vs 1.9士0.6, p< 0.01) and final follow up postoperative (2.8士1.2 VS 2.2士0.7, p= 0.04). The mean HHS in group A was significantly lower than group B at the 6 months (80.5土13.8 VS 89.8士12.8, p= 0.02). However, at the final follow up, there is no
significant difference between the groups (77.0土12.4 VS 83.1土9.3, p=0.07). The mean change in modified Kerboul angle was -7.4士10.6 in group A and -19.9士13.9 in group B which is statistically significant (P <0.01). Survivorship from total hip arthroplasty were 86.2%/84% (p = 0.86) at the final follow up, which was not statistically significant. No serious complications were found in both groups.

Conclusions A single dose of PRP combined with CD and β-TCP grafts provided significant pain relief, better functional outcomes, and delayed progression in the short term compared to CD combined with β-TCP grafts. However, the prognosis of the femoral head did not improve significantly in the long term. In the future, designing new implants to achieve multiple PRP injections may improve the hip preservation rate.

Keywords Core decompression, Platelet-rich plasma, Avascular necrosis of femoral head, Hip-preserving strategy, β-tri-calcium phosphate

© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativeco mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Keloid treatments: an evidence-based systematic review of recent advances

Laura A. Walsh1,2, Ellen Wu1 , David Pontes1 , Kevin R. Kwan1 , Sneha Poondru2 , Corinne H. Miller1 and Roopal V. Kundu1,2*

*Correspondence:

Roopal V. Kundu 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。

1 Northwestern University Feinberg School of Medicine, Chicago, IL, USA

2 Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA

Abstract

Background Keloids are pathologic scars that pose a significant functional and cosmetic burden. They are challenging to treat, despite the multitude of treatment modalities currently available.

Objective The aim of this study was to conduct an evidence-based review of all prospective data regarding keloid treatments published between 2010 and 2020.

Methods A systematic literature search of PubMed (National Library of Medicine), Embase (Elsevier), and Cochrane Library (Wiley) was performed in November of 2020. Search strategies with the keywords “keloid” and “treatment” were performed by a medical librarian. The search was limited to prospective studies that were peer-reviewed, reported on clinical outcomes of keloid therapies, and were published in the English language between January 1, 2010, and November 24, 2020.

Results A total of 3462 unique citations were identified, of which 108 studies met inclusion criteria. Current literature supports silicone gel or sheeting with corticosteroid injections as first-line therapy for keloids. Adjuvant intralesional 5-fuorouracil (5-FU), bleomycin, or verapamil can be considered, although mixed results have been reported with each. Laser therapy can be used in combination with intralesional corticosteroids or topical steroids with occlusion to improve drug penetration. Excision of keloids with immediate post-excision radiation therapy is an effective option for recalcitrant lesions. Finally, silicone sheeting and pressure therapy have evidence for reducing keloid recurrence.

Conclusions This review was limited by heterogeneity of subject characteristics and study outcome measures, small sample sizes, and inconsistent study designs. Larger and more robust controlled studies are necessary to further understand the variety of existing and emerging keloid treatments, including corticosteroids, cryotherapy, intralesional injections, lasers, photodynamic therapy, excision and radiation, pressure dressings, and others.

Severe skin and soft tissue infection in the left upper limb caused by Aeromonas veronii: a case report

Linhui Li1†, Jie Huang1†, Long Xu1 , Guangyi Wang1 , Shichu Xiao1 , Zhaofan Xia1 , Qin Qin2 , Yazhou Li2 and Shizhao Ji1* iD

† Linhui Li and Jie Huang contributed equally to this work.

*Correspondence:

Shizhao Ji

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1 Department of Burns, Burn Institute of PLA, The First Affiliated Hospital of Naval Medical University, No. 168 Changhai Road, Yangpu District, Shanghai 200433, China

2 Department of Laboratory Diagnosis, The First Affiliated Hospital of Naval Medical University, No. 168 Changhai Road, Yangpu District,

Shanghai 200433, China

Abstract

Introduction Skin and soft tissue infections are common because of exposure to aquatic environment, while severe infections caused by Aeromonas veronii are rare.

Case presentation We report a case of severe skin and soft tissue infection of the left upper limb caused by Aeromonas veronii. A 50-year-old Chinese woman, who had a history of cardiac disease and type 2 diabetes mellitus, accidentally injured her left thumb while cutting a fish. Early antibiotic therapy and surgical debridement was performed before the result of bacterial culture came back. Whole-genome sequencing was further performed to confirm the pathogen and reveal the drug resistance and virulence genes. The wound was gradually repaired after 1 month of treatment, and the left hand recovered well in appearance and function after 3 months of rehabilitation.

Conclusion Early diagnosis, surgical intervention, and administration of appropriate antibiotics are crucial for patients who are suspected of having skin and soft tissue infection, or septicemia caused by Aeromonas veronii.

Keywords Aeromonas veronii, Wound infection, Antibiotic therapy, Whole-genome sequencing, Case report