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Dissertation submitted to the Faculty of Health Sciences of the University of the Witwatersrand, Johannesburg in fulfilment of the requirement for the degree of Master of Science in Medicine Johannesburg 2014 / silver (NCS) dressings have antimicrobial and anti-inflammatory effects which aid healing, particularly in burns and chronic wounds. However, they are cytotoxic and may delay healing in acute wounds. Therefore, this study aimed to assess the effect of a NCS dressing on wound healing in full-thickness excisional wounds in a porcine model. Healing of porcine skin was assessed on day 3, 6, 9 and 15 post-wounding. Five wounds dressed with NCS and five untreated wounds dressed with polyurethane film (the control) were assessed per day (n=40 wounds). The rate of healing was measured using digital photographs. The inflammatory response, restoration of the epithelium and blood vessel formation were evaluated using haematoxylin and eosin stained sections. Picrosirius red staining and confocal microscopy were used to assess collagen formation. Proliferation of keratinocytes was calculated using sections immunolabelled for Ki-67. Additionally, the quality of the re-epithelialised wounds was assessed using a Clinical Assessment Score. There was no difference in the rate of healing between wounds treated with NCS and those dressed with polyurethane film. Inflammation was increased in NCS-treated wounds on day 3 post-wounding. However, compared to controls, on day 15 post-wounding the epithelium of NCS-treated wounds more closely resembled normal epithelium. Additionally, a greater number of mature blood vessels were seen in NCS-treated wounds. Differences were also observed in the deposition of collagen in NCS-treated wounds compared to controls. These results suggest that NCS may be beneficial for scar formation. Further investigation is needed into the effect of NCS and its role in the treatment of wounds, including novel uses such as the prevention of scarring.

Yes / Non-healing wounds are a major area of unmet clinical need remaining problematic to treat. Improved understanding of pro-healing mechanisms is invaluable. The enzyme arginase1 is involved in pro-healing responses with its role in macrophages best characterized. Arginase1 is also expressed by keratinocytes; however, arginase1 function in these critical wound repair cells is not understood. We characterized arginase1 expression in keratinocytes during normal cutaneous repair and reveal de novo temporal and spatial expression at the epidermal wound edge. Interestingly, epidermal arginase1 expression was decreased in both human and murine delayed healing wounds. We therefore generated a keratinocyte specific arginase1-null mouse model (K14-cre;Arg1fl/fl) to explore arginase function. Wound repair, linked to changes in keratinocyte proliferation, migration and differentiation, was significantly delayed in K14-cre;Arg1fl/fl mice. Similarly, using the arginase inhibitor nor-NOHA, human in vitro and ex vivo models further confirmed this finding, revealing the importance of the downstream polyamine pathway in repair. Indeed, restoring the balance in arginase1 activity via addition of putrescine, proved beneficial in wound closure. In summary, we demonstrate that epidermal arginase1 plays a, to our knowledge, previously unreported intrinsic role in cutaneous healing, highlighting epidermal arginase1 and downstream mediators as potential targets for the therapeutic modulation of wound repair.

The material characteristics play a role in the suitability of chitosan for biomedical applications. This is not surprising since the degree of deacetylation of chitosan influences antimicrobial activity, degradation rate, immune reaction and mechanical properties such as strength and elongation. This study examines chitosans of variable material characteristics for wound and bone healing applications. Chitosan films of 76, 78, 80, 87, 91, 92, and 95% degree of deacetylation were tested in vitro for cellular responses by fibroblast and bone cell lines. The in vitro responses were compared to the material characteristics of molecular weight, degree of deacetylation, swelling index, and ash content.

No / This paper provides an overview of cavity wounds, focusing on the definition, assessment and management of a common clinical problem in wound care. The term cavity wound is applied widely to a diverse range of acute and chronic wound types and, although each type requires a specific wound management approach reflecting the causation, the overall principles of cavity wound assessment and management remain the same. The extent of a cavity wounds can be difficult to visualise and such wounds require precise documentation and wound measurement if progress is to be accurately monitored and patient safety maintained.

Objective: To assess the safety and efficacy of lyophilized milled human amnion as a wound dressing of experimentally created equine distal limb wounds. Animals: Four clinically normal adult horses (3 Thoroughbred and 1 Paint, median age 11 years) obtained via donation. Procedures: One forelimb of each horse was randomly assigned to the treatment group, and the contralateral limb was assigned as the control. Full-thickness skin wounds were created on each metacarpus. Treatment limb wounds were dressed with lyophilized, milled, human-derived amnion material delivered under triple antibiotic ointment. Control wounds were dressed with triple antibiotic ointment. All wounds were covered in non-adherent dressings and distal limb bandages were applied. Digital photographs were taken of the wounds at each bandage change, performed every 2-4 days throughout a 98-day study period. Biopsies were collected at days 7, 21, 35, and 84. Results: One horse developed unilateral cellulitis that resolved with additional treatment. All treatment limbs exhibited an inflammatory response characterized by focal edema and discharge from the wounds. Wounds were completely epithelialized in control limbs sooner than treatment limbs in all horses, although there was no statistical difference between control (mean 46.8 days) and treatment (mean 51.8 days) wounds. Histologic scores were better in control wounds than in amnion-treated wounds at all time points. Conclusions and Clinical Relevance: Because wounds treated with amnion material in this study exhibited an inappropriate inflammatory response that resulted in delayed time to wound closure, human lyophilized milled amnion is not recommended for use in equine wound management. / Master of Science

Diabetes is a growing public health problem that can lead to serious complications for the pa-tient such as foot ulcers and amputations. For affected patients the foot ulcers causes suffer-ing, pain and impaired health. The foot ulcers also contribute to major costs to the society and affects healthcare resources hard. A large part of the district nurse's work consists of wound care. Therefore it is important that the district nurse possess adequate knowledge of wound dressings to promote wound healing and thereby shorten the wound healing time. The aim of the study was to examine the wound healing time due to treatment with antiseptic or non-antiseptic dressings in elderly patients with diabetes and foot ulcers. The method used was a quantitative register study with a retrospective and descriptive design. Patients included in the study were 241 men and women aged ≥ 65 years with diabetes and healed foot ulcers. Men were represented by 68 % (n=164) and women by 32 % (n=77). The results showed no signif-icant difference in wound healing time due to treatment with antiseptic or non-antiseptic dressings. The most common non-antiseptic dressing used was polyurethane foam and the most common antiseptic dressing used was silver dressing. More research to compare wound healing time between non-antiseptic and antiseptic dressings in elderly patients with diabetes and foot ulcers are needed. District nurses need to increase their knowledge within different dressings and its positive and negative effects.

Submitted in partial compliance with the requirements of the Master’s Degree in Technology: Homoeopathy, Department of Homeopathy, Durban University of Technology, Durban, South Africa, 2016. / Introduction This research study investigated the efficacy of a homoeopathic protocol in the post-surgical wound management of medical male circumcision (MMC) in the KwaZulu-Natal region. The study had 30 male participants from 10 of the 11 district municipalities of the KwaZulu-Natal province. The study consultations took place at the Durban University of Technology Health Sciences Clinic. Aim of the study The aim of the study was to determine the efficacy of a topical application of a homoeopathic protocol using; Calendula officinalis (mother tincture (M.T.)), Hypericum perforatum (M.T.) and Delphinum staphysagria 30CH (orally) as an adjunct to the standard care of the post-surgical effects of circumcision and to assess the wounds post-surgically in terms of time taken to heal and associated signs and symptoms. Methodology The data for this study was collected from 30 male participants who had undergone MMC from various hospitals within KwaZulu-Natal. The participants were aged between 18 to 30 years. All participants underwent a medical examination and were given a pain rating scale and a pain and sleep diary. They were instructed to keep a daily record using the data collection tools mentioned above for the study period of six weeks. Descriptive statistics were employed in the form of tables and graphs. The data analysis methods used in the study are: independent samples t-test and the non-parametric Spearman’s Correlation test. Results Group statistics in relation to ‘time to heal’ showed a statistically significant reduction in the time taken for the group on the homoeopathic protocol. Analysis of ‘time to heal’ by group shows that on average, Group 1 (active group: homoeopathic protocol + standard care) (M = 31.4, SD = 7.49) healed in a significantly shorter time than Group 2 (control group: standard care) (M = 38.6667, SD = 1.99), t (28) = -2.617, p=.014. There was no other statistical significance noted except for the results of the Spearman’s rho, where table 4.8 shows there is a significant positive correlation between average quality sleep until healing and the proportion of days across healing NOT feeling refreshed (rho = .676, p<.0005). / M

Thesis (M.S.)--University of Michigan, 1981.

Thesis (M.S.)--University of Michigan, 1989.