Background. Little is known about the bacteriology of the pericolostomic skin region. Identifying these bacteria is important to reduce the morbidity resulting from this procedure both to control local infection and to reduce the risk of infection in other surgical sites. Objective. The scope of this study was to determine the prevalence and type of peristomal skin bacteria in colostomy patients. Methods. Thirty-four patients with a temporary colostomy were included in the study. Their mean age was 51.6 years. All patients had been colostomized for more than 7 weeks. Results. Tissue samples were obtained from the peristomal skin and were cultured. Escherichia coli was present in the peristomal skin of 81.2% of patients with malignant colorectal disease and in all cases of benign colorectal disease. The proportion of patients with Bacteroides fragilis (P = 0.021) and Klebsiella spp (P = 0.003) was higher. The incidence of Peptococcus spp (P = 0.068) was lower in patients who had their c

Background. Ischemia-reperfusion injury and reactive oxygen species (ROS) are considered to play an important role in the pathogenesis of pressure ulcers (PU). Antioxidants may diminish the inflammation and damage of these ROS in pressure ulcer formation. Dimethyl sulfoxide (DMSO) is a hydroxyl antioxidant that inhibits leukocyte adherence. When used topically, DMSO is a safe and well-tolerated drug with excellent penetrating properties. In this prospective randomized study, the effect of topically applied DMSO on the prevention of PU formation is analyzed. Methods. In a randomized double-blinded study, the effects of massage with or without DMSO creams were assessed against controls for 2 locations (ie, heel and buttocks) in 79 patients prone for development of PU. Results. There was no difference in PU incidence between the 3 interventions on the buttocks. Surprisingly, the topical 5% DMSO cream group showed an increase in superficial pressure ulcers for the heel location. Conclusion

Many studies emphasize the efficacy of combined orthopedic and plastic management for coverage of tibia bone exposure. However, many general hospitals do not have resident plastic surgery services to do free tissue transfers. This study, therefore, assesses the feasibility of applying single or double local muscle flap transfer to reconstruct soft-tissue defects and enhance orthopedic management. From July 2002 to December 2004, 34 patients with the same number of soft-tissue defects requiring 42 local muscle flaps were enrolled in the study. In this case series, no microvascular surgical intervention was performed and no plastic surgeons participated. Medical records were analyzed for clinical features, treatment strategies, and clinical outcomes. Comparisons were made between the single flap group and double flap group. All patients received regular follow-up for a minimum of 12 months. The survival rate of local muscle flap transfer was 95.2%. The double flap transfer group had s

The authors studied whether skin perfusion pressure (SPP) measurements can be used to accurately predict wound healing in critical limb ischemia (CLI) and to select peripheral arterial reconstructive procedures. Methods. Forty-seven patients (33 men and 14 women, age 36–83 years) with 69 ischemic limbs with foot ulcers or gangrene were studied retrospectively. Skin perfusion pressure was compared to the treatment outcomes (ulcers healed and ulcers that failed to heal). As a diagnostic test for CLI, the sensitivity, specificity, and the positive and the negative predictive values (PPV, NPV) of SPP measurement were calculated; the data was then analyzed by the receiver operation characteristic (ROC) curve. Results. According to the ROC curve, the best SPP measurement performance was at 35 mmHg. Conclusion. Wound healing at the appropriate amputation level must be predicted to minimize invasive debridement. Skin perfusion pressure measurement is useful for predicting wound healing in the

Collagen constitutes the majority of extracellular matrix in tissues such as bone, cartilage, and especially the skin. Over production and/or decreased degradation of collagen fibers could lead to an abnormal wound healing response resulting in hypertrophic scarring or keloid formation. Recently, angiotensin II has been shown to be present in several cutaneous cells and that it stimulates fibroblast proliferation, collagen synthesis, and suppresses matrix metalloproteinase activity. The following study examines the effect of topical captopril, an inhibitor of angiotensin II production, against hypertrophic scar formation in New Zealand white rabbits.Two dermal wounds were made over the ventral surface of the ears of each rabbit (n = 6). In each animal, separate wounds were treated once per day with either topical 5% captopril or the vehicle alone (70% ethanol and 30% propylene glycol) for 7 consecutive days. Wounds were harvested at postoperative day 28, and the scar elevation index (S