Nhiễm trùng vết mổ, dùng cho các trường hợp bỏng, cấy ghép da, vết thương cấp tính, mãn tính, điều trị vết loét tiểu đường, loét tĩnh mạch. Loét xạ trị, Lazer. Loét do bỏng nặng Loét do bệnh lý mạch máu Loét sâu một phần hay toàn phần Vết thương do chấn thương lâu lành Nằm liệt, ngồi lâu ngày gây nên lỡ loét Vết mổ nhiễm trùng, vết phẫu thuật hậu môn Áp dụng cho việc hồi phục vết thương giữa giai đoạn thứ hai và thứ ba Loét chân, vết thương ở chân lâu lành do biến chứng của đái tháo đường (tiểu đường)
Trang 1Contents lists available atScienceDirect International Journal of Surgery journal homepage:www.elsevier.com/locate/ijsu Original Research
wound healing after anal surgery: A randomized study
Shuo Chena,1, Zhiguang Huanb,1, Lin Zhanga,∗, Jiang Changb,∗∗
a Department of Anorectal Surgery, Tianjin Union Medicine Centre, 190 Jieyuan Road, Tianjin 300121, China
b State Key Laboratory of High Performance Ceramics and Superfine Microstructure, Shanghai Institute of Ceramics, Chinese Academy of Sciences, 1295 Dingxi Road,
Shanghai 200050, China
A R T I C L E I N F O
Keywords:
Silicate-based wound dressing
DermFactor®
Anal surgery
Wound healing
A B S T R A C T
Background: The object of the present study is to evaluate the feasibility of a silicate-based wound dressing (DermFactor®) in treating the wound of the patients after anorectal surgery
Materials and Methods: The present study included 328 patients who received anal surgery during the period from March 2013 to June 2015 The patients were randomized to 2 groups The patients (n = 162) in the control group received conventional dressing therapy, while those in the observation group (n = 166) were treated with the combination of conventional dressing therapy and the use of a silicate-based wound dressing (DermFactor®) The wound healing outcomes of the two groups were observed and compared with each other by statistical analysis
Results: The average healing cycles in the observation group were 19.04 days for combined hemorrhoid patients, 23.72 days for analfistula patients and 21.14 days for anal fissure patients, respectively, which were shorter than those in the control group (23.25 days for mixed hemorrhoid patients, 27.76 days for analfistula patients and 24.32 days forfissure in ano patients, respectively) In addition, the observation group presented a significantly higher effective rate (80.4%) than the control group (70.4%)
Conclusion: Our data demonstrated that the wound after anorectal surgery could be more effectively treated by using silicate-containing DermFactor®
1 Introduction
Anal diseases, including hemorrhoid, analfistula and anal fissure, is
common all over the world and affecting people in all age groups [1,2]
The patients suffering from these diseases frequently require surgical
treatment, and the post-operative care has been considered as one of
the most important factors that determine the cosmetic and functional
outcome of the anal organ [3]
Wound healing is an essential step during the procedure of
post-operative care after anal surgery [3] For example, it is believed that a
desirable wound healing could help reduce the post-operative pain after
haemorrhoidectomy, which quite commonly causes delayed patient
discharge [4] However, due to the unusual circumstance, the wound
healing after anal surgery is frequently delayed by postoperative
com-plications, such as bleeding, infection and edema, despite the use of
wound healing cream Therefore, it is still necessary to investigate more
efficient therapeutic regimen to accelerate the postoperative wound
healing after anal surgery
DermFactor®is a silicate-based wound dressing that has been widely used for wound treatment in cases of burn, diabetic foot and bedsore [5], and its bioactive effect on wound healing is based on the fact that silicate materials can stimulate the vascularization that is essential for healing of soft tissue [6] This important feature makes DermFactor®a potential candidate as a wound dressing to accelerate wound healing during the postoperative care after anal surgery Therefore, during the period from March 2013 to June 2015, DermFactor®was used to treat
166 patients, who received anal surgery, aiming at improving the wound healing This study presented the clinical outcome of the ap-plication of DermFactor®as wound dressing for anal surgery, and also evaluated its benefit in terms of wound healing rate and efficiency
https://doi.org/10.1016/j.ijsu.2018.02.036
Received 30 August 2017; Received in revised form 4 February 2018; Accepted 14 February 2018
∗ Corresponding author.
∗∗ Corresponding author.
1 The two authors contributed to the work equally.
E-mail addresses: xz2013l@126.com (L Zhang), jchang@mail.sic.ac.cn (J Chang).
Available online 23 February 2018
1743-9191/ © 2018 IJS Publishing Group Ltd Published by Elsevier Ltd All rights reserved.
T
Trang 22 Materials and Methods
2.1 Patients
This study included 328 patients who received anal surgery at our
hospital from March 2013 to June 2015 The selection of the patient
was based on the following criteria:
The patients suffered from mixed hemorrhoid, anal fistula or fissure
in ano before receiving anal surgery
The patients were not allergic to any drug that was involved in this
study, and those suffering from serious mental sickness and
hematolo-gical diseases were excluded In addition, pregnant and lactating
tients were not included in this study The ages of all the selected
pa-tients in this study were over 18 years old All the papa-tients were fully
informed before voluntarily attending this study with the informed
consent signed precedent to the treatment
The patients (n = 328) randomized to 2 groups The patients
(n = 162) in the control group received conventional dressing therapy,
while those in the observation group (n = 166) were treated with the
combination of conventional dressing therapy and the use of
DermFactor® (Shanghai Gui-Jian Biomaterials Co., Ltd, Shanghai,
China) The patients' brief data was summarized and presented in
Table 1 The patient's data of the control group did not show significant
difference from that of the observation group, which allowed for
rea-sonable comparison between the groups
2.2 Methods of wound treatment
For the patients in the control group, the postoperative wound care
was carried out by means of routine sitz cleaning and dressing change
[7], until the wound was completely healed For the observation group,
the wound was first cleaned by means of routine sitz cleaning and
covered with the same dressing as that used in the control group
Subsequently, DermFactor®was sprayed on the wound area until it was
completely covered by the DermFactor®powder Finally, the wound
area was covered with axenic gauze After 24 h, the axenic gauze was
removed and the wound area was cleaned and observed for evaluation
of the wound healing progress The procedure as mentioned above was
repeated until the wound was completely healed
The affected areas of the patients were under close observation
during the postoperative care [8] Special attention was paid on the
surface area, exudate, color and healing time of the wound The total
follow up period for all the patients was set to 1 year Symptomatic
treatment was carried out in case that untoward reaction took place
2.3 Outcome measures
The criterion for the outcome measures in this study was as the
follows:
― The treatment was considered to be “significantly effective” (SE) if
the wound was completely cured
― The treatment was considered to be “effective” (E) if the cured part
of the wound surface area amounted to at least 50% of the overall wound surface
― It was noted as “improved” if 30%–50% of the wound was cured (IMP)
― It was noted as “ineffective” (INE) if the cured part of wound was less than 30%
The total effective rate (Et) was calculated according to Eq (1):
Et (%) NSE NE
where NSE and NE stand for the patients number of the SE and E groups after the treatment, and Nt is the total patients number
2.4 Statistical analysis All the data involved in this study was analyzed using SPSS 15.0 software The enumeration data was presented as number (n) and percentage (%), of which the comparison between the control and ob-servation was made using Chi-square test The measurement data was demonstrated as mean ± SD Comparisons between the measurement data of the control and observation groups was made using t-test
P < 0.05 was considered statistically significant
3 Results 3.1 The time of wound healing The wound healing of the patients in the control and observation groups was observed according to previous instruction [9], and the average healing time of the patients was presented in Fig 1 The average healing time of the patients in the observation was 21.86 days, which was significantly shorter than that in the control group (25.36 days, P < 0.05) For the patients suffering from different type of anal disease, the average healing time in the observation group (19.04, 23.72 and 21.14 days for mixed hemorrhoid, analfistula and fissure in ano, respectively) was also significantly lower than that in the control group (23.25, 27.76 and 24.32 days for mixed hemorrhoid, analfistula andfissure in ano, respectively)
3.2 Therapeutic effect After 21 days of treatment, the outcome in the control and ob-servation groups was measured and compared with each other, and the
Table 1
Patients' brief data.
Control group Observation group Patients number (n) 162 168
Average age (years) 43.5 ± 1.9 41.5 ± 2.3
Male/Female (n) 94/68 102/66
Type of disease
Mixed hemorrhoid (n) 65 78
Fissure in ano (n) 39 37 Fig 1 The wound healing time of the patients in the control and observation (* indicated
p < 0.05).
Trang 3results were presented inTable 2 No complication of wound healing
occurred in the patients In the control group, the number of the
pa-tients that were considered as SE, E, IMP and INE was 62, 52, 0 and 48,
respectively In contrast, the observation group has 74, 61, 0 and 33
patients who were consider as SE, E, IMP and INE, respectively The
number of SE and E is significantly higher than that in the control
group In addition, the observation group showed a higher total
effec-tive rate (80.4%) as compared with the control group (70.4%)
4 Discussion
Anal diseases, including mixed hemorrhoid, analfistula and fissure
in ano, are common disease all over the world, for which anal surgery is
a routine method of treatment However, the wound healing is a major
problem in the postoperative care of the anal surgery due to the fact
that the anal site is prone to bacterial infection The formation of
bacteriotoxin and enzyme induced by the bacterial infection could lead
to a series of serious consequence, such as necrosis of local tissue and
the dissolution of matrix and collagenfibrils [10], which subsequently
result in exacerbated tissue trauma and retarded wound healing In
addition, the wound exudation and increased necrotic tissue that are
induced by the infected wound could elevate the local strain in the
wound, which in turn allows for the diffusion of the infection and hence
hinders the wound healing process
Due to the unusual condition of the wound site in anal surgery as
above mentioned, the postoperative dressing change is crucial for the
wound healing, which is one of the most important factors that
de-termine the outcome of the treatment [11] However, the routine
treatment may not be adequate for desirable outcome of wound
healing In this study, it was clear that DermFactor® possessed the
ability of accelerating the wound healing process and improving the
therapeutic effectiveness, which was closely related to the
well-estab-lished physicochemical and biological characteristics of silicate-based
wound healing materials Containing silicate micro-particles as the
major component, DermFactor®was able to dissolve in a short period
once after contacting with the bodyfluid, when subsequently allowed
for the formation of a silica layer on the surface Due to its
character-istic surface chemistry, such a silica layer was capable of adsorbing the
surrounding biological molecules and hence accelerating the
penetra-tion of fibrocytes into the site [12] This process could consequently
contribute to the construction of collagen tissue along the surface of the
silicate-based micro-particles [13], and then a collagen matrix would be
formed in the wound site, which could consequently act as a temporary
extracellular matrix that supported the proliferation offibrocytes,
epi-cytes and endotheliocyte during the regeneration of soft tissue in the
wound site [14,15] The overall process enabled the accelerated wound
healing by the use of DermFactor®in this study, and the results of this
study suggested that DermFactor®is a beneficial wound dressing for the
postoperative care after anal surgery
5 Conclusion
In summary, we found in this study that the postoperative wound healing process of the patients after receiving anal surgery was sig-nificantly accelerated by the use of DermFactor®, which did not induce any adverse reaction to the patients Thereafter, the silicate based bioactive dressing DermFactor®seems to be an ideal supplement to the current routine postoperative wound care that would contribute to improved clinical outcome and patients comfort
Ethical approval The study protocol and the patient informed consent was reviewed and approved by the study review board in People's Hospital of Tianjin prior to study initiation
Author contribution Shuo Chen and Lin Zhang carried out the design, participated all the experiments andfinished the data collections Shuo Chen and Zhiguang Huan coordinately analyzed experimental data and prepared the manuscript Jiang Chang proposed the study, reviewed the experi-mental data and the manuscript and carried out the revision of the manuscript prior to the submission All authors have read and approved the content of the manuscript
Conflicts of interest None
Research Registration Unique Identifying Number (UIN) UIN: researchregistry2473
Guarantor Jiang Chang
Acknowledgment This study was supported by The National Key Research and Development Program of China (2016YFC1100201) and Shanghai S&T Innovation Action Plan Project (16441904500)
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Table 2
Comparison between the therapeutic effect in the control and observation group after 21
days of treatment.
Control group Observation group Total patients number (n) 162 168
Therapeutic effect
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E (patients number, n) 52 61
IMP (patients number, n) 0 0
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