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Emi Kanno,
Kazuyoshi Kawakami,
Shinichi Miyairi,
Hiromasa Tanno,
Hirono Otomaru,
Arina Hatanaka,
Shiori Sato,
Keiko Ishii,
Denso Hayashi,
Nobuhito Shibuya,
Yoshimichi Imai,
Naomasa Gotoh,
Ryoko Maruyama, Masahiro Tachi
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ABSTRACT: BACKGROUND: Pseudomonas aeruginosa is frequently isolated from chronic wounds and causes serious infection in immunocompromised hosts. N-(3-Oxododecanoyl)-l-homoserine lactone (3-oxo-C(12)-HSL) is synthesized by an autoinducer synthase encoded by the bacterial lasI gene in P. aeruginosa, which regulates the production of virulence factors and biofilm formation in this bacterium. Recent studies have suggested that 3-oxo-C(12)-HSL contributes to the modulation of immune responses. However, the effect of this molecule on wound healing in P. aeruginosa infection remains to be elucidated. OBJECTIVE: We used an animal model to study the effect of 3-oxo-C(12)-HSL on wound healing in skin infected with P. aeruginosa. METHODS: Wounds were created on the backs of Sprague-Dawley (SD) rats and the P. aeruginosa strain PAO1 (PAO1) or its lasI deletion mutant (ΔlasI) was inoculated onto the wound surface. To examine the biological activity of 3-oxo-C(12)-HSL, rats were injected intraperitoneally with anti-3-oxo-C(12)-HSL antiserum or administered 3-oxo-C(12)-HSL at the wound surface. The wound tissues were harvested for analysis of the healing process and inflammatory response. RESULTS: PAO1 inoculation significantly accelerated the wound healing and inflammatory response on day 3 post-wounding. These responses were reversed by inoculation with ΔlasI instead of PAO1 or treatment with anti-3-oxo-C(12)-HSL antiserum. In contrast, administration of 3-oxo-C(12)-HSL in the absence of PAO1 significantly promoted these responses, which were suppressed by the anti-TNF-α mAb. CONCLUSION: These results strongly suggest that 3-oxo-C(12)-HSL may be involved in healing wounds infected with P. aeruginosa through induction of inflammatory responses.
Journal of dermatological science 01/2013; · 3.71 Impact Factor
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ABSTRACT: Low-energy extracorporeal shock wave (LE-ESW) treatment has been shown to accelerate wound repair; however, the mechanisms of treatment remain unclear. In the present study, we addressed the role of endothelial nitric oxide synthase (eNOS). A single LE-ESW treatment accelerated the healing of wounds in diabetic mice caused by the injection of streptozotocin. This accelerated healing was accompanied by the increased expression of eNOS and vascular endothelial growth factor (VEGF) and the generation of new vessels at the wound tissues. These results raised the possibility that eNOS may be involved in the beneficial effects of LE-ESW treatment. To address this possibility, we compared the effects of this treatment between mice with a genetic disruption of eNOS knockout (eNOS-KO mice) and wild-type (WT) control mice. Interestingly, the LE-ESW-induced acceleration of wound closure and the increase in VEGF expression and neovascularization was significantly attenuated in eNOS-KO mice compared with WT mice. Considered collectively, these results showed that eNOS was induced at the wound tissues by LE-ESW treatment and played a critical role in the therapeutic effects of this treatment by accelerating the wound healing by promoting VEGF expression and neovascularization.
Wound Repair and Regeneration 10/2012; · 2.91 Impact Factor
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Nippon rinsho. Japanese journal of clinical medicine 09/2012; 70 Suppl 7:645-8.
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Shinji Iizaka,
Hiromi Sanada,
Yuko Matsui,
Masutaka Furue,
Takao Tachibana,
Takeo Nakayama,
Junko Sugama,
Katsunori Furuta, Masahiro Tachi,
Keiko Tokunaga,
Yoshiki Miyachi
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ABSTRACT: There are few studies on predictive validity of methods to monitor the healing process of pressure ulcers. We evaluated whether the change of DESIGN-R (rating) score could predict subsequent healing, and determined the optimal cutoff points. In a multicenter prospective cohort study, patients were followed until wound healing or censoring. Wound severity was evaluated by the DESIGN-R tool every week, and the score change was calculated over 1-4 weeks (n = 411, 286, 224, and 170, respectively). In the multivariate analyses stratified by depth, a one-point improvement in DESIGN-R score over any period was positively associated with healing within the next 30 days independent of initial wound severity (hazard ratios over each 1-4 weeks ranging from 1.16 to 1.33 for superficial ulcers and from 1.21 to 1.27 for deep ulcers; all p < 0.05). The optimal cutoff points over 1-4 weeks were set as negative change for superficial ulcers and as positive change of ≥two points for deep ulcers. Nonhealing rate was higher for ulcers with DESIGN-R score change below the cutoff points than that aforementioned for both depths. Weekly monitoring by the DESIGN-R tool will be advantageous for evaluating prognosis of pressure ulcers independent of initial wound severity and depth.
Wound Repair and Regeneration 07/2012; 20(4):473-81. · 2.91 Impact Factor
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ABSTRACT: A basic fibroblast growth factor (bFGF) case and a control case whose total scores of Pressure Ulcer Healing Process-Ohura (PUHP-Ohura) and risk factors for pressure ulcers, and level of care for pressure ulcers were equivalent were paired. Twenty-three such eligible pairs were enrolled in this study. Both cases in each pair were treated under conditions in which extrinsic factors such as the use of a pressure-relief mattress and the frequency of postural change were equivalent. The efficacy of bFGF was assessed by analyzing the data obtained over time as the scores of PUHP-Ohura for nine observation items using the SAS MIXED procedure. Treatment of pressure ulcers with bFGF accelerated wound healing over time more significantly than the control in six observation items (exudate volume, ulcer depth, granulation formation, wound edge, epithelialization, total score of the PUHP-Ohura). These data suggest that it may be possible to evaluate drugs for the treatment of pressure ulcers using the PUHP-Ohura wound-assessment tool.
Wound Repair and Regeneration 09/2011; 19(5):542-51. · 2.91 Impact Factor
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ABSTRACT: Wound healing is promoted by the presence of replicating microorganisms adhering to the wounded tissue, but the precise mechanism is not fully understood. In the present study, using a rat model with full-thickness dermal wounds, we examined the effect of Pseudomonas aeruginosa inoculation on wound healing and the role of neutrophils infiltrating the wound site. Within 3 days, inoculation with this bacterium had accelerated re-epithelialization, epidermal cell proliferation, and neo-vascularization, as well as the local infiltration of neutrophils, which reached a peak at 24 hours. Tumor necrosis factor (TNF)-α was detected in the wound tissues on the mRNA and protein levels within 24 hours. Flow cytometry and immunohistochemical analyses detected higher levels of TNF-α in the infiltrating neutrophils in rats inoculated with P. aeruginosa than in uninoculated rats. Neutropenic rats treated with anti-neutrophil mAb or cyclophosphamide exhibited significant attenuation in re-epithelialization, epidermal cell proliferation, neo-vascularization, and TNF-α synthesis compared with control; administration of TNF-α reversed these attenuations. These wound-healing responses were decelerated in rats treated with anti-TNF-α mAb, as was the infiltration of neutrophils. These results indicate that inoculation with P. aeruginosa promotes wound healing by inducing the infiltration of neutrophils, which play a critical role as a major source of TNF-α.
Wound Repair and Regeneration 09/2011; 19(5):608-21. · 2.91 Impact Factor
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Hiromi Sanada,
Shinji Iizaka,
Yuko Matsui,
Masutaka Furue,
Takao Tachibana,
Takeo Nakayama,
Junko Sugama,
Katsunori Furuta, Masahiro Tachi,
Keiko Tokunaga,
Yoshiki Miyachi
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ABSTRACT: There are few clinical tools with both predictive validity for pressure ulcer healing and availability in broad populations. We evaluated whether the total scores from DESIGN-R tool could predict pressure ulcer healing. We followed 3,196 patients with pressure ulcers from two multicenter cohort studies until wound healing, patient death, or discharge. Wound severity was evaluated by DESIGN-R tool from 0 (healed) to 66 (greatest severity). In the multivariate Cox proportional hazard model, higher DESIGN-R total scores at baseline were associated with lower healing rates (hazard ratio 0.90, 95% confidence interval 0.89-0.92), independent of the patient's characteristics, setting types, and wound depth or location. DESIGN-R had discriminative value for wound healing up to 90 days; the area under the receiver-operating characteristics curve from univariate analysis was 0.81 for healing within 30 days and 0.74 for healing within 30-90 days. The cutoff points were 9 for healing within 30 days and 18 within 30-90 days (positive and negative predictive value 78.8 and 74.1%; 63.9 and 81.1%, respectively). These points were validated for both superficial and deep ulcers. DESIGN-R can be a useful tool to predict pressure ulcer healing for a wide range of patient populations, settings, and wound locations.
Wound Repair and Regeneration 09/2011; 19(5):559-67. · 2.91 Impact Factor
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Shinji Iizaka,
Hiromi Sanada,
Yuko Matsui,
Masutaka Furue,
Takao Tachibana,
Takeo Nakayama,
Junko Sugama,
Katsunori Furuta, Masahiro Tachi,
Keiko Tokunaga,
Yoshiki Miyachi
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ABSTRACT: We aimed to investigate the predictive validity of serum albumin for pressure ulcer healing, according to patient condition and wound characteristics.
This study was a secondary analysis of pooled data from two multicentre cohort studies undertaken in 2005 and 2007. All adult patients with pressure ulcer were included and were tracked until wound healing or discharge from care. Baseline serum albumin data were obtained from medical charts.
A total of 2530 patients were analyzed. By multivariate Cox proportional hazards analysis, higher serum albumin level was associated with wound healing of only superficial pressure ulcers for patients in acute/postoperative conditions (hazard ratio 1.29, 95% confidence interval 1.13-1.46) and the cutoff point was 24/25 g/L. However, the addition of serum albumin level to other factors resulted in little increase in the ability to predict wound healing as measured by the overall C-statistics. For patients in chronic/palliative conditions, serum albumin level as the continuous variable was not significantly associated with ulcer healing.
The addition of serum albumin marker may not have much advantage to predict pressure ulcer healing although its level can be associated with ulcer healing, depending on patient condition and wound depth.
Clinical nutrition (Edinburgh, Scotland) 07/2011; 30(6):738-45. · 3.27 Impact Factor
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ABSTRACT: The purpose of this study was to investigate the changes in and stability of the maxilla and soft tissue profile achieved after the application of distraction osteogenesis (DO) by use of rigid external distraction (RED) with a retention plate system in unilateral cleft lip and palate (UCLP) adult patients. We compared 2 treatment methods in the management of maxillary hypoplasia: Le Fort I osteotomy and DO.
Six UCLP adult patients who underwent treatment with the RED retention plate system were examined (DO group). Changes in the positions of soft and hard tissue landmarks were calculated from lateral cephalograms taken before distraction, at the removal of the halo, and 1 year after surgery and were compared with those in 7 other UCLP patients who underwent Le Fort I osteotomy (LF1 group).
The mean maxillary advancement was significantly larger in the DO group than in the LF1 group after distraction. During the follow-up period, the relapse rate of the maxilla was significantly smaller in the DO group. An undesirable labial inclination of the upper incisors was found in the LF1 group, which may have been due to relapse. The DO group tended to have a higher soft tissue-to-hard tissue anterior movement ratio from the time of distraction to follow-up.
The RED retention plate system improved the midfacial profile by advancement of soft and hard tissue and minimized the risk of injury to the upper lip. Using the RED system with retention plates prevented the undesirable labial inclination of upper incisors that was found in the LF1 group.
Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons 04/2010; 68(7):1480-6. · 1.58 Impact Factor
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ABSTRACT: To treat lower-extremity osteomyelitis secondary to trauma, bone and soft tissue can be grafted at the same time using microsurgical techniques. We investigate the use of chimeric flaps based on thoracodorsal vessels incorporating vascularized scapular bone and latissimus dorsi myocutaneous flap to reconstruct bone and soft-tissue defects of the lower leg due to osteomyelitis. Ten patients with lower-extremity bone and soft-tissue defects due to osteomyelitis were treated. Vascularized scapular bones were raised on the angular branch of the thoracodorsal artery. Latissimus dorsi myocutaneous flaps were elevated simultaneously to reconstruct the soft tissue defects. All patients tolerated the procedure well. One patient developed an early venous thrombosis, which was successfully treated by thrombectomy. Mean follow-up time was 7 years and 8 months. Bone union without refracture was observed in all patients. The mean time required for bone union after surgery was 13.5 weeks. Donor-site morbidity was minimal. Chimeric flaps based on thoracodorsal vessels incorporating vascularized scapular bone and latissimus dorsi myocutaneous are safe and effective in the repair of lower-extremity bone and soft-tissue defects caused by osteomyelitis.
Journal of Reconstructive Microsurgery 03/2010; 26(6):417-24. · 1.43 Impact Factor
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ABSTRACT: Most chronic wounds are covered by biofilms. However, questions remain about whether biofilms are a causative factor in delayed wound healing and whether the biofilm state contributes to this pathology. The purpose of this study was to develop an experimental model for convenient observation of biofilm formation on skin wounds. Full-thickness wounds were created on the backs of SD rats. Suspensions of Pseudomonas aeruginosa carrying the gene encoding green fluorescent protein were then applied to the wounds. The wounds were harvested at 8 h, and at 1, 3 and 7 days postwounding for histological and immunohistochemical examinations. Fluorescence microscopy confirmed the presence of a biofilm as early as 8 h. Comparing with non-infected wounds, epithelialization was not delayed. In conclusion, wound healing of rat acute wounds was unaffected by biofilm formation.
Experimental Dermatology 08/2009; 19(2):154-6. · 3.54 Impact Factor
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ABSTRACT: Mass spectrometry (MS) with chemical ionization was found to be a useful tool for characterizing epidermal cholesterol esters (CE) and wax esters (WE), and was applied to analyse them in the epidermis of fetal, adult and keloidal human skin. Increases in the concentrations of CE and WE had occurred by 20 weeks of gestation in association with increasing concentrations of ceramides and cholesterol sulphate. Although adult epidermis contained them in similar concentrations at 25-28 weeks of gestation (13-14% of the total less polar lipids), the molecular species were shown to differ between fetal and adult epidermis by MS. Cholesterol oleate comprised 45% of the total molecular species in adult CE, whereas saturated fatty acids with chain lengths of 15-19 were abundant in fetal CE. Also, unsaturated and shorter chain WE were abundant in adult epidermis in comparison with that in the fetal epidermis, the total chain lengths of fetal and adult WE being 34-42 with a mean chain length of 38.6, and 27-41 with a mean chain length of 34.0, respectively, and the unsaturated molecules in fetal and adult WE amounting to 29% and 45%, respectively. Also, CE and WE in the epidermis of keloidal skin were reduced to 67% and 20% of the levels in normal skin, respectively. Thus, epidermal CE and WE were shown to carry eligible structures for construction of the hydrophobic barrier at the skin and amniotic fluid interface as well as that at the skin and air interface.
Experimental Dermatology 05/2008; 17(4):318-23. · 3.54 Impact Factor
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ABSTRACT: We describe cases of true and false median cleft combined with polyps. The polyp in the true median cleft was microscopically a skin polyp consisting of fatty tissue and was considered to be subsequent compensatory partial excess caused by impediment at the embryonic stage. The polyp in the false median cleft was considered to be a failure of the nasal septum derived from the nasal (ectethmoid) capsule. The features of these cases were considered of interest because they exhibited transient forms of the cleft. The histological findings of each polyp reflected the distinctive features of each median cleft.
The Cleft Palate-Craniofacial Journal 12/2007; 44(6):667-72. · 0.82 Impact Factor
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ABSTRACT: The optimal method for breast reconstruction should be safe, reliable, and accessible for every patient, and it should display little or no donor-site morbidity. After comparing mammary implants it has been found that autogenous breast reconstruction can create a ptotic, soft, symmetrical breast mound. The transverse rectus abdominis musculocutaneous flap (TRAM) remains the most popular method for autogenous reconstruction. Modern trends in breast reconstruction using the TRAM flap have promoted adequate blood supply to the flap while minimizing donor-site defects in the anterior abdominal wall. The pedicled TRAM flap remains one of the most frequently used flaps, but the indirect blood supply in this flap has required many modifications and refinements. Such modifications have included the bipedicled TRAM flap, the free TRAM flap, and the supercharged TRAM flap. To avoid donor-site morbidities, the muscle-sparing free TRAM, deep inferior epigastric perforator flap (DIEP), and superficial inferior epigastric artery (SIEA) flap were introduced. The DIEP perforator flap requires meticulous technique but offers proven reliability and a low rate of complications. As surgeons become more comfortable with harvesting DIEP flaps, the frequency of usage seems likely to increase. The latissimus dorsi musculocutaneous flap, gluteus maximus musculocutaneous flap, and others may be selected when these modifications of free TRAM flap are unavailable or unusable.
International Journal of Clinical Oncology 11/2005; 10(5):289-97. · 1.41 Impact Factor
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ABSTRACT: Zygomatic fractures can be associated with functional and esthetic problems. Recent improvements in surgical techniques and materials have enabled stable fixation of zygmomatic fractures. Multiple-point fixation is most commonly used for internal fixation. Generally, reduction and fixation are performed through lateral brow, subciliary, temporal, or intraoral incisions (three-point fixation). Our experience indicates that postoperative scarring and sensory disturbances are caused by a subciliary incision with inferior orbital rim fixation. It is thus recommended that inferior orbital rim fixation with mini- or microplates be avoided. In patients in whom the fracture does not involve the orbital floor, reduction of the zygoma and zygomatic arch through a temporal incision is performed at this institution. Fixation of the lateral zygomaticomaxillary buttress and anterior wall of the maxilla with miniplates through an intraoral incision is also performed. If necessary, zygomaticofrontal suture fixation with a miniplate or wire is performed through a lateral brow incision. The status of inferior orbital rim reduction is confirmed by palpitation. Inferior orbital rim fixation with mini- or microplates is recommended for reduction of comminuted fractures and orbital floor fractures with herniation of internal orbit components. Patients who did not undergo inferior orbital rim fixation were free of inferior orbital rim deformity, diplopia, and postreduction rotation.
Journal of Craniofacial Surgery 06/2005; 16(3):481-5. · 0.82 Impact Factor
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ABSTRACT: Topical negative pressure is gaining popularity as an acute and chronic wound management technique. In general, foam dressing is applied to the wound surface to maintain negative pressure. Due to the potential for clogging by the foam dressing, topical negative pressure cannot be used when there is a high volume of necrotic tissue or massive infection present. In this study, topical negative pressure was applied using a drainage pouch without any dressing. Topical negative pressure was applied to 8 patients with 9 pressure ulcers complicated by undermining. This approach was effective in the treatment of all 9 ulcers and allowed the wounds to be visualized while maintaining negative pressure. Since this technique can be performed without foam dressing, it can be used to treat early-stage infectious pressure ulcers in which there is a lot of necrotic tissue. CONCLUSION: Topical negative pressure without dressing is an extremely effective treatment of pressure ulcers complicated by undermining.
Annals of Plastic Surgery 11/2004; 53(4):338-42. · 1.32 Impact Factor
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ABSTRACT: Fibrous materials in some modern absorbent wound dressings have the ability to sequester and retain bacteria; however, this ability varies according to the nature of the fibres. We studied the bacterial retention capacity of alginate and carboxymethylcellulose dressings, using an infected skin ulcer model on the backs of rats. Wound surfaces were inoculated with either Staphylococcus aureus or Pseudomonas aeruginosa at a concentration of 1.5 x 10(6) colony-forming units per wound. AQUACEL; Hydrofiber;, Kaltostat; or Sorbsan; were applied to the contaminated wounds for 12 h. Each dressing was then divided into two pieces. Total viable bacterial count within the dressing was calculated using one piece, and bacterial count released from the dressing into physiological saline was determined using the other piece, enabling bacterial retention rate to be calculated. Bacterial counts in tissue were also determined. Each dressing was tested on each of 10 wounds contaminated with each bacterium. Statistical analyses were performed using one-way analysis of variance (ANOVA) for replicated measures combined with Duncan's multiple comparison test. AQUACEL; Hydrofiber; dressing was most effective in its ability to retain both Staphylococcus aureus and Pseudomonas aeruginosa (p < 0.05). Bacterial counts in tissue showed no significant change with respect to pathogen or the type of dressing used. It can be concluded that the bacterial retaining ability of AQUACEL; Hydrofiber; dressing was found to be significantly higher than that of alginate dressings in an infected animal wound model.
International Wound Journal 09/2004; 1(3):177-81. · 1.46 Impact Factor
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ABSTRACT: A model of infected skin ulceration could prove useful in assessing the clinical effectiveness of antimicrobial ointments and dressings. However, no such models have been previously established. Three types of wound were induced in rats: full-thickness wounds covered with gauze, burn wounds and wounds resulting from mechanical trauma. Wounds were inoculated with S. aureus or P. aeruginosa. Persistent infected wounds were observed only in full-thickness wounds covered with gauze. In a second experiment, colonies of P. aeruginosa or S. aureus were counted within 15 x 15 mm full-thickness wounds covered with gauze. Wounds were inoculated with 1.0 x 10(6) colony-forming units (CFU) of P. aeruginosa or S. aureus and then sealed to ensure an enclosed environment. Tissue bacterial counts exceeded 10(6) CFU/g from the next day until day 9 after infection. Bacterial counts exceeded 10(8) CFU/ml in wound exudate collected between days 1 and 7. We have developed a model of wound infection in which persistence of infection can be achieved for 9 days following ulceration due to the application of gauze to the base of a full-thickness wound.
International Wound Journal 05/2004; 1(1):49-55. · 1.46 Impact Factor
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ABSTRACT: In 1996 the authors performed the first fronto-orbital advancement by distraction osteogenesis in a patient with coronal synostosis, and they have refined the surgical technique since then. Their latest technique has the following features: 1) the osteotomy lines are almost identical to those of conventional fronto-orbital advancement except for the lack of supraorbital osteotomy and tongue-in-groove osteotomy; 2) burr holes are placed at the pterion just behind the sphenoid wing and at the bregma lateral to the anterior fontanel bilaterally, and another burr hole is placed on the glabella 1 cm above the nasion; 3) to gain access to the lateral portion of the anterior cranial base, a 7- to 10-mm-wide segment of bone is removed at the pterion using rongeurs; 4) the sphenoid ridge is widely removed; and 5) osteotomy is performed using a Gigli saw and rongeurs. They report their latest technique.
Annals of Plastic Surgery 12/2002; 49(5):447-50; discussion 450-1. · 1.32 Impact Factor
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ABSTRACT: A new surgical repair of enterocutaneous fistula associated with abdominal wound defects is presented. The authors turned over the fasciocutaneous flap from the surrounding skin and sutured the intestinal lumen directly to the cutaneous side of the flap. The method is a risk-free extraperitoneal approach that can be performed using local anesthesia.
Annals of Plastic Surgery 06/2002; 48(5):554-6. · 1.32 Impact Factor
