Bacterial biofilm is a formidable influencing factor affecting healing of chronic wound. The mechanisms are as diverse as the bacterial species contained in the biofilm. In an altered environment the biofilm accommodates polymicrobial colonies in which micro-organisms undergo phenotypic and genetic changes to sustain adverse environmental influence. Biofilm bacteria inhibits cell proliferation, prevents cell migration and cause cell kill in a number of ways. It is believed that different bacterium has different mode of action through elaboration of various bioactive factors leading to persistence of low-grade inflammation in the wound bed which is predominantly bacteria-centric. Their ability to survive in low oxygen tension allows them to persist in relatively hypoxic conditions in the wound bed and in presence of increased bioburden. Although the biochemical mechanisms of biofilm influence on chronic wound healing are unfolding slowly, it is difficult to develop clinical studies due to ethical concerns. Therefore, most of the accumulated evidence are based on animal models and in vitro studies. This narrative review attempts to focus on the various mechanisms responsible for delayed healing in presence of bacterial biofilms.

No abstract

A chronic leg ulcer is a debilitating illness, owing to the local condition of the wound and a decrease in physical activity and productivity, resulting in anxiety and depression among patients. The study aimed to find any association of anxiety and depression in the healing of chronic wounds. A total of 125 patients with chronic leg ulcers were enrolled in the study. HADS questionnaire assessment followed the local wound examination in all patients. A follow‐up assessment of the ulcer was done after appropriate local treatment, and data analysed with the HADS scale. In the present study, the ROC curve showed a cutoff value of 14 for the HADS score in predicting ulcer status (non‐healing vs healed) after 30 days. A total of 54.4% (68) patients had a HADS score ≥ 14 and 39% (49) were true positive for the non‐healing wound at a 1‐month follow‐up. This study revealed a sensitivity and specificity of 83.1% and 71.2%, respectively (P‐value <.001), and diagnostic accuracy of 76.8%, for HADS score > 14 in the detection of non‐healing ulcers. Chronic leg ulcers should be subjected to HADS assessment and if found significant corrective measures must be instituted for improving wound healing.

Gastrointestinal (GI) tract perforation is a surgical emergency. The epidemiology and etiology of perforation vary considerably across geography. Lower GI tract perforations in the elderly predominate in the West compared to upper GI perforations in the younger population in the tropics. Fungi and viruses have been reported to cause GI perforations in immuno-compromised individuals but it is rare in immuno-competent individuals. We report a very rare case of gastric perforation secondary to fungal gastritis in an immunocompetent 35-year-old female who presented with features of peritonitis. At emergency laparotomy, gastric perforation was found which was repaired by the Cellan-Jones method. Perforation edge biopsy findings were consistent with fungal etiology. She responded well to Antifungal therapy. We conclude that fungal etiology can be considered in patients with gastric perforation without any history of peptic ulcer disease (PUD) or use of oral non-steroidal anti-inflammatory drugs.

Introduction Many studies have been done comparing sutures versus skin staples in various wounds. To the author's knowledge, there is no study comparing these two in an laparoscopic cholecystectomy (LC) wound. Our study aims at comparing the clinical outcome of skin closure by monofilament nylon suture and stainlesssteel skin stapler in standard four-port LC. The results of this study can help in developing guidelines for skin closure in LC. Objective To compare the clinical outcome of skin closure by monofilament nylon suture and stainless-steel skin stapler in standard four-port LC. Methods The study was conducted as a time-bound prospective cohort study on diagnosed patients of cholelithiasis admitted in a single unit of the