Injury-International Journal of the Care of the Injured最新文献

{"title":"Construction and validation of a machine learning model based on clinical indicators: Risk of bloodstream infections in patients with deep second- and third-degree burns","authors":"Min Peng ,&nbsp;ShaSha Zhang ,&nbsp;DongFang Chang","doi":"10.1016/j.injury.2026.113046","DOIUrl":"10.1016/j.injury.2026.113046","url":null,"abstract":"<div><h3>Objective</h3><div>Patients with deep second- and third-degree burns are at high risk of bloodstream infections (BSIs) due to skin barrier disruption and immune suppression, with poor prognosis. Early risk identification is crucial for improving outcomes. This study aimed to construct and validate a machine learning model using multidimensional clinical indicators to accurately predict BSI risk in such patients.</div></div><div><h3>Methods</h3><div>A retrospective cohort study enrolled 301 patients with deep second- and third-degree burns (75 with BSIs) from Yongchuan Hospital Affiliated to Chongqing Medical University between January 2020 and January 2025. Multidimensional data on burn characteristics, laboratory indicators, and therapeutic measures were collected within 72 h of admission. After data preprocessing and feature screening, four models were built: logistic regression (LR), support vector machine (SVM), naive Bayes (NB), and back propagation artificial neural network (BP-ANN). Model performance was evaluated via stratified sampling and 5-fold cross-validation.</div></div><div><h3>Results</h3><div>Eight key predictors were identified: total body surface area, lymphocytes (LYM, most important), platelet crit, total bilirubin, creatinine, C-reactive protein, procalcitonin, and 24-hour rehydration. The BP-ANN model performed best in the test set, with accuracy, recall, precision, F1 value, and AUC all reaching 0.857, good calibration (Hosmer-Lemeshow test, <em>P</em> = 0.142), and significant net benefit in the 0–0.3 risk threshold interval (decision curve analysis). The LR model had an AUC of 0.891 and high generalization stability (0.999) but less balanced indicators. SVM was overfitted (limited practical value), and NB had insufficient generalization (test set AUC=0.775).</div></div><div><h3>Conclusion</h3><div>The BP-ANN model based on multidimensional clinical indicators accurately predicts BSI risk in patients with deep second- and third-degree burns, with good differentiation, calibration, and clinical utility, providing a reliable tool for early intervention.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113046"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146079378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of surgical timing on perioperative outcomes after open reduction and internal fixation of periprosthetic proximal femoral fractures","authors":"Christopher Lampert,&nbsp;Leon Faust,&nbsp;Tobias Helfen,&nbsp;Carl Neuerburg,&nbsp;Boris Michael Holzapfel,&nbsp;Wolfgang Böcker,&nbsp;Eduardo Suero ,&nbsp;Florian Pachmann","doi":"10.1016/j.injury.2026.113049","DOIUrl":"10.1016/j.injury.2026.113049","url":null,"abstract":"<div><h3>Background</h3><div>Periprosthetic proximal femoral fractures (PPFF) are expected to increase substantially due to demographic changes and the rising number of total hip arthroplasties. While early surgery is clearly recommended for native hip fractures, the optimal timing of surgery for PPFF remains controversial. The present study aimed to evaluate the effect of early versus delayed surgery on perioperative outcomes in patients with PPFF treated by open reduction and internal fixation (ORIF).</div></div><div><h3>Methods</h3><div>We conducted a retrospective analysis of 110 patients with PPFF who underwent ORIF at a Level 1 trauma center between January 2017 and August 2023. We analyzed the effect of early (within 24 hours) versus delayed (after 24 hours) surgical treatment after admission on the primary outcome measures: surgical and non-surgical complications, reoperation rate, in-hospital mortality, and postoperative immobility. Secondary outcome measures included the duration of surgery, length of hospital stay, and bleeding complications.</div></div><div><h3>Results</h3><div>Baseline demographics, comorbidities, and fracture patterns were comparable between the groups. No significant differences were observed in surgical (18.2 % vs. 14.6 %; p = 0.622) and non-surgical (27.3 % vs. 27.3 %; p = 0.992) complication rates, length of hospital stay (15.6 ± 13.5 vs. 15.4 ± 8.2 days; p = 0.747), reoperation rates (14.6 % vs. 10.9 %; p = 0.621). In-hospital mortality was low (7.3 % vs. 5.5 %; p = 0.672) and was not affected by the time of surgery. A longer operative time in patients undergoing surgery within 24 hours (150.5 ± 56.6 vs. 115.9 ± 54.6 min; p = 0.001) was not associated with an increase in morbidity or mortality.</div></div><div><h3>Conclusion</h3><div>Timing of surgical intervention had no impact on perioperative outcomes in patients with PPFF treated with ORIF. However, considering the elderly and frail nature of this patient population, timely surgery should be recommended to enable early mobilization, which is essential for preventing complications and may improve long-term functional outcomes.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113049"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145950139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Suture button versus syndesmotic screw fixation in acute ankle fractures with syndesmotic injury: An umbrella review of functional outcomes and clinical relevance based on the minimal clinically important difference","authors":"Carmen L. Nieuwenkamp,&nbsp;Jasper Tausendfreund,&nbsp;Tim Schepers","doi":"10.1016/j.injury.2026.113054","DOIUrl":"10.1016/j.injury.2026.113054","url":null,"abstract":"<div><h3>Background</h3><div>Literature increasingly suggests that suture button (SB) fixation yields higher functional outcome scores, specifically the American Orthopaedic Foot Ankle Society (AOFAS) Ankle-Hindfoot score and the Olerud-Molander Ankle Score (OMAS), compared with syndesmotic screws (SS). This umbrella review evaluates whether these differences extend beyond statistical significance and meet thresholds for clinical relevance, using the Minimal Clinically Important Difference (MCID) as reference standard.</div></div><div><h3>Method</h3><div>A comprehensive PubMed search identified systematic reviews and meta-analyses published between 2010 and 2025. The methodological quality was assessed using the Joanna Briggs Institute checklist. Reported AOFAS and OMAS outcomes, as well as mean differences between SB and SS fixation, were extracted or independently calculated. These values were evaluated against established MCID ranges (OMAS 7.5–11.4, AOFAS 4.1–7.8), to determine whether statistically significant findings corresponded to clinically meaningful improvements</div></div><div><h3>Results</h3><div>Nineteen systematic reviews were included, of which fifteen performed a meta-analysis. Across these reviews, SB fixation was reported 18 times to result in statistically higher AOFAS and/or OMAS compared with SS fixation. However, most weighted mean differences fell below the MCID thresholds: in 11 reviews for OMAS and in 12 reviews for the AOFAS did not reach clinical relevance. Only one review reported an OMAS difference within the MCID range, and seven reviews reported AOFAS differences within or above the MCID range. These findings indicate that, although statistically significant results were observed, the corresponding functional gains were generally too small to be clinically meaningful.</div></div><div><h3>Conclusion</h3><div>While SB fixation often demonstrates superior functional scores relative to SS fixation, these differences seldom exceed established MCID thresholds. The clinical relevance of these improvements therefore remains uncertain. As routine removal of syndesmotic screws is no longer advocated in the contemporary literature, and considering the findings of the present study, one could argue that the cost-effectiveness of using a suture-button in under scrutiny. Future studies should focus on refining MCID values for ankle-specific PROMs and improving methodological rigour in systematic reviews and meta-analyses to better determine whether SB fixation provides a meaningful advantage for patients.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113054"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146121478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to editor regarding “Discordance between surgeon opinion and institutional policy on explant handling after hardware removal”","authors":"Arman Vahabi,&nbsp;Ali Engin Daştan,&nbsp;Hüseyin Günay,&nbsp;Kemal Aktuğlu","doi":"10.1016/j.injury.2025.112869","DOIUrl":"10.1016/j.injury.2025.112869","url":null,"abstract":"","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 112869"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145472569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is percutaneous pelvic fixation becoming more prevalent among new orthopaedic trauma surgeons? - Trends in pelvic ring fixation","authors":"Thirushan Wignakumar ,&nbsp;Devon T. Brameier ,&nbsp;Christopher R. Leland ,&nbsp;Duco W.P.M. Laane ,&nbsp;Annabelle Swenson ,&nbsp;Eric H. Tischler ,&nbsp;Derek S. Stenquist ,&nbsp;Arvind G. Von Keudell ,&nbsp;Michael J. Weaver ,&nbsp;Nishant Suneja","doi":"10.1016/j.injury.2025.112960","DOIUrl":"10.1016/j.injury.2025.112960","url":null,"abstract":"<div><h3>Introduction</h3><div>The treatment paradigm of pelvic ring injuries has undulated over recent decades. Open reduction and internal fixation (ORIF) became more common in the 1990s and early 2000s followed by a decline in the late 2000s and 2010s, in favor of nonoperative management. Recently, minimally invasive pelvic stabilization using percutaneous pelvic fixation (PFF) has gained popularity. The trends of ORIF, PPF, and nonoperative management of pelvic ring injuries over the last decade is not well described. This study aims to characterize such trends among early-career orthopaedic trauma surgeons from 2003 to 2023.</div></div><div><h3>Methods</h3><div>Data was collected from the American Board of Orthopaedic Surgery (ABOS) Part II Oral Examination Case List database for Candidates who indicated that their subspecialty was trauma over a time period involving 20 years of Case List submissions (2003–2023). Pelvic ring fixation was identified using CPT codes for ORIF (27,217, 27,218) and PPF (27,216). Total case volumes and trends in fixation type were analyzed, including an age-based subgroup analysis of younger (age 18–50) and older (age ≥65) adults,</div></div><div><h3>Results</h3><div>Of 15,164 total ABOS Part II Candidates, 795 indicated a trauma subspecialty and performed at least one pelvic ring fixation, with a total of 7311 pelvic fixation cases (3317 ORIF; 3994 PPF). Annual pelvic ring injury fixations increased five-fold during the study period, from 110 in 2003 to 592 in 2023. The proportion of ORIF decreased from 70 % to 40 %, while PPF increased from 30 % to 60 %. The share of early-career surgeons' practice dedicated to percutaneous fixation tripled. Operative fixation (both PPF and ORIF) of pelvic ring injuries in older adult patients became more common over this period.</div></div><div><h3>Conclusion</h3><div>Percutaneous stabilization of pelvic ring injuries is increasing over time, reflecting evolving practice patterns among early-career trauma surgeons. Future studies should evaluate the clinical implications of this trend, including the impact on fellow and resident training.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 112960"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unstable Pelvic ring fractures managed surgically: A 13-year cohort study of patient characteristics, associated injuries, and predictors of early mortality","authors":"Sebastian Skovdal Winther ,&nbsp;Upender Martin Singh ,&nbsp;Allan Evald Nielsen ,&nbsp;Michael Mørk Petersen ,&nbsp;Arvind von Keudell","doi":"10.1016/j.injury.2026.113051","DOIUrl":"10.1016/j.injury.2026.113051","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Unstable pelvic ring fractures are severe injuries with substantial mortality and a high burden of associated injuries. Advances in trauma care have improved outcomes. However, recent data from high-volume centers remain scarce. We aimed to evaluate mortality, associated injuries, and predictors of mortality in surgically treated unstable pelvic ring fractures.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 451 consecutive patients with surgically treated Tile B or C pelvic ring fractures admitted to a Level 1 trauma center between 2008 and 2021. Patient demographics, injury characteristics, and associated injuries were recorded. Kaplan–Meier methods were used to estimate survival, and Cox regression for identifying independent predictors of mortality.</div></div><div><h3>Results</h3><div>Overall mortality at 3-month was 4.2% (95% CI 2.3–6.0) and at 1-year at 6.0% (95% CI 3.8–8.2). Tile C fractures had a higher early mortality than Tile B (3-month: 6.5% vs. 2.1%; 1-year: 7.4% vs. 4.7%). Associated injuries were common: 78% of patients had at least one and 66% had two or more injured regions. Patients with injuries in ≥2 regions had markedly higher intensive care unit (ICU) admission, transfusion requirements, and early mortality. In multivariable Cox regression, age (HR 1.06 per year), Glascow Coma Scale (GCS) ≤8 (HR 4.9), and Tile C (HR 3.6) were independently associated with 90-day mortality.</div></div><div><h3>Conclusion</h3><div>Mortality after surgically treated unstable pelvic ring fractures at 3- month and 1 year was 4.2% and 6.0%, respectively. Age, low GCS, and Tile C fracture pattern were independent predictors of early death. Associated injuries and overall trauma burden were strongly associated with ICU admission, transfusion, and early mortality.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113051"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146014114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic acromio-clavicular dislocation: Bi-modal stabilization","authors":"Ahmed Farid Mekky,&nbsp;Mohammed Sadakah,&nbsp;Hosam Mohamed Ghaly,&nbsp;Mohamed Rohayem,&nbsp;Mohammed Roshdy El-Tabbakh","doi":"10.1016/j.injury.2026.113035","DOIUrl":"10.1016/j.injury.2026.113035","url":null,"abstract":"<div><h3>Background:</h3><div>Chronic acromio-clavicular dislocation is a challenging injury to treat. Many surgical procedures are available for its management which may be anatomical or non-anatomical. The aim of this study was to assess the clinical and radiological outcome in the patients with chronic acromio-clavicular dislocation treated by hybrid biological semitendinosus autograft and synthetic non-absorbable sutures.</div></div><div><h3>Methods:</h3><div>From July 2021 to January 2025, 21 patients with chronic acromio-clavicular dislocation were treated by hybrid biological semitendinosus autograft and synthetic non-absorbable sutures. Grade III to VI chronic acromio-clavicular injuries were included. Post-operatively, the patients were clinically assessed using Constant shoulder and Acromio-clavicular joint instability scores. Acromio-clavicular arthritis, coraco-clavicular ossification, distal clavicle osteolysis, coraco-clavicular and acromio-clavicular distances were radiologically evaluated.</div></div><div><h3>Results:</h3><div>The mean age at time of surgery was 28.52 ± 8.0 (range: 19-45) years. The acromio-clavicular dislocation was type III in 7 patients (33.4 %), type IV in 12 patients ( %57.1) and type V in 2 patients (9.5 %). The mean follow-up period was 24.29 ± 3.51 (range: 18-30) months. The mean post-operative Acromio-clavicular joint instability and Constant shoulder scores were 93.14 ± 8.16 (range: 78-100) and 90.14 ± 8.16 (range: 80-100) points respectively. None of the patients showed recurrent dislocation, arthritis and distal clavicle osteolysis.</div></div><div><h3>Conclusion:</h3><div>Bi-modal stabilization using hybrid biological semitendinosus autograft and synthetic non-absorbable sutures is an effective and reliable surgical option to treat chronic acromio-clavicular dislocation. Most of the reported complications associated with this procedure didn’t affect the functional outcome.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113035"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146014128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative malnutrition is associated with increased early complications and higher two-year nonunion risk after Tibial shaft fracture fixation","authors":"Jawad Saad ,&nbsp;David Abdelnour ,&nbsp;Magd Boutany ,&nbsp;Alqasim Elnaggar ,&nbsp;Hadi Elmenini ,&nbsp;Ahmad Almaat ,&nbsp;Ali Mehaidli ,&nbsp;Rahul Vaidya","doi":"10.1016/j.injury.2026.113084","DOIUrl":"10.1016/j.injury.2026.113084","url":null,"abstract":"<div><h3>Background</h3><div>Malnutrition is a potentially modifiable risk factor that may influence perioperative complications and fracture healing. This study evaluated the association between preoperative laboratory-defined malnutrition and short-term complications and 2-year outcomes following operative fixation of tibial shaft fractures.</div></div><div><h3>Methods</h3><div>Using the TriNetX Research Network (112 healthcare organizations), adults (≥18 years) undergoing operative management for tibial shaft fracture were identified. Preoperative malnutrition was defined as albumin ≤3.5 g/dL and/or leukocytes ≤1.5 × 10³/µL within 1 year prior to the index event. Cohorts were propensity score matched 1:1 on demographics and comorbidities. Outcomes were assessed from day 1 post-index through 90 days (medical/surgical complications) and 730 days (healing-related and limb outcomes). Risk ratios (RR) and hazard ratios (HR) with 95% confidence intervals (CI) were reported.</div></div><div><h3>Results</h3><div>After matching, 44,780 patients were included in each cohort (89,560 total), with good balance across covariates (all SMDs &lt;0.10). At 90 days, malnutrition was associated with higher risk of acute respiratory failure/mechanical ventilation (13.9% vs 3.4%; RR 4.10 [95% CI 3.88–4.33].; HR 4.32 [4.09–4.57].), sepsis (5.2% vs 1.2%; RR 4.35 [3.97–4.77].; HR 4.47 [4.07–4.91].), postoperative infection (5.7% vs 1.8%; RR 3.14 [2.90–3.39].; HR 3.23 [2.99–3.50].), acute kidney injury (8.6% vs 3.0%; RR 2.90 [2.73–3.08].; HR 2.99 [2.81–3.18].), and DVT/PE (6.5% vs 2.7%; RR 2.36 [2.21–2.52].; HR 2.42 [2.26–2.59].) (all <em>p</em> &lt; 0.001). At 2 years, malnutrition was associated with increased nonunion (4.4% vs 1.6%; RR 2.69 [2.47–2.92].; HR 2.85 [2.62–3.10].), chronic osteomyelitis (12.5% vs 3.9%; RR 3.19 [3.02–3.36].; HR 3.50 [3.32–3.69].), hardware removal (10.1% vs 6.0%; RR 1.68 [1.61–1.76].; HR 1.83 [1.74–1.92].), and amputation (1.4% vs 0.4%; RR 3.47 [2.95–4.08].; HR 3.59 [3.05–4.23].) (all <em>p</em> &lt; 0.001). Revision fixation did not differ (8.4% vs 8.1%; <em>p</em> = 0.096).</div></div><div><h3>Conclusions</h3><div>Preoperative laboratory-defined malnutrition was independently associated with substantially higher 90-day morbidity and increased 2-year nonunion and limb-complication risk following operative tibial shaft fracture management. These findings support preoperative nutritional risk stratification and targeted optimization efforts in this population.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113084"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146115232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accelerating the healing of infected full thickness excision wounds through the topical use of Pluronic F127 copolymer and Polyglutamic acid","authors":"Ali Edalat Irani ,&nbsp;Mohammad Reza Farahpour ,&nbsp;Mohammad Reza Valilou ,&nbsp;Zohreh Ghazi Tabatabaei","doi":"10.1016/j.injury.2026.113028","DOIUrl":"10.1016/j.injury.2026.113028","url":null,"abstract":"<div><div>Hydrogels have emerged as effective tools in medication delivery and tissue engineering due to their adjustable characteristics and water retention capabilities. The purpose of this work was to investigate the potential of a novel thermosensitive hydrogel composed of Pluronic F127 and polyglutamic acid (PGA) to enhance the treatment of MRSA-infected full-thickness excision wounds. The viscosity and gelation temperature of the hydrogels were evaluated using viscometry and rheometry, while their injectability was assessed with a texture analyzer. Swelling and biodegradation were measured in PBS at 37 °C, and antibacterial and antioxidant activity was determined using MIC/MBC tests and DPPH radical scavenging. In mouse infected wound healing investigations, hydrogels were applied to wounds, and tissue examination was done with Masson's Trichrome staining and biochemical assays for TAC and MDA. The F127/PGA hydrogel converted from a liquid to a gel at body temperature more efficiently than F127 alone, with lower gelation temperatures and improved mechanical characteristics. F127/PGA had higher swelling capacity and a slower degradation rate than F127. In antibacterial assays, the F127/PGA hydrogel showed stronger inhibitory and bactericidal activity against MRSA, as reflected by its lower MIC and higher MBC values. In addition, the hydrogel showed increased antioxidant activity and lower oxidative stress during wound healing, resulting in much better wound contraction and tissue regeneration than F127 and control treatments. These characteristics make F127/PGA an attractive choice for improved drug delivery systems and wound healing applications.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113028"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146121349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ischemic skin flap viability: in vivo study of alginate-ZIF-8 hydrogel systems with Rhizophora mangle and tannic acid","authors":"Bianca Rocha da Silva Barreto ,&nbsp;Eduardo Carvalho Lira ,&nbsp;Severino Alves Júnior ,&nbsp;Luzia Abilio da Silva ,&nbsp;Yuri José de Albuquerque Silva ,&nbsp;Widarlane Ângela da Silva Alves ,&nbsp;Madson Manoel Nunes da Silva ,&nbsp;Rosallyne Hosana Vanderlei das Chagas ,&nbsp;Larissa Cardeal da Rocha Carvalho ,&nbsp;Jasmine Martins Vieira Cunha ,&nbsp;Jamily Isabel Viana de Lima ,&nbsp;Ester Francisca Gomes de Lima ,&nbsp;Ícaro Mota Oliveira ,&nbsp;Jeymesson Raphael Cardoso Vieira","doi":"10.1016/j.injury.2026.113043","DOIUrl":"10.1016/j.injury.2026.113043","url":null,"abstract":"<div><div>Skin flaps are widely used in plastic and reconstructive surgery. However, inadequate blood perfusion during flap mobilization can trigger an ischemic process that may lead to tissue necrosis in the absence of effective management of the inflammatory process. In this context, the search for new biocompatible strategies to ensure the viability of ischemic skin flaps (ISFs) remains necessary. Therefore, this study evaluated novel alginate-ZIF-8 (ALG-ZIF-8) hydrogel systems with <em>Rhizophora mangle</em> (<em>R. mangle</em>) extract and tannic acid (TA) to assess their potential in preventing necrosis in ISF. Twenty-two male Wistar rats underwent the surgical creation of ISF and were divided into four groups: 0.9% saline (negative control - NegC), placebo alginate hydrogel (pALGgel), ALG-ZIF-8 hydrogel system with 5% TA (ALGzTA), and finally, ALG-ZIF-8 hydrogel system with 5% <em>R. mangle</em> (ALGzRm). Flap outcomes were evaluated through macroscopic observation, followed by morphometric analysis of viable and necrotic areas, and histomorphometric analysis of fibroblasts, blood vessels, and leukocytes, using ImageJ and PrimeCam 5.1 software. Statistical analysis was performed using IBM SPSS software (version 27). The results suggest that the formulations produced divergent outcomes by differentially modulating inflammatory and angiogenic responses. The ALGzRm formulation tended to show a protective profile, associated with a significant reduction in leukocyte infiltration (<em>p</em> &lt; 0.001), while the ALGzTA formulation was linked to a detrimental response, including exacerbated inflammation and a pathologically high blood vessel count (<em>p</em> = 0.015). In conclusion, findings suggest that the ALGzRm-gel has a potential for tissue repair, mediated by the modulation of inflammatory and angiogenic responses.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113043"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}