Fifteen million people in middle-and high-income settings develop pathological scars every year. 1 Such scars carry a heavy symptomatic, psychological, cosmetic and financial burden, requiring scar modulation therapy in a large proportion. 1,2 While there have been new innovations in available treatments, there is no panacea; often keloids need to be treated for months or years, and different treatment

Venous leg ulcer is a pathological condition afflicting prevalently elderly patients, which has been found to have a major impact on individuals' health and social aspects of quality of life. Actually, the best practice treatment is recommended to include wound dressing and multilayer compression therapy. In this study, we have tested the effectiveness and safety of Vulnamin(®), a novel dressing in the form of a metal cellulose gel containing the amino acids glycine, L: -lysine, L: -proline, L: -leucine, and hyaluronic acid, and elastic compressive bandages in the treatment of chronic venous ulcers of the lower limbs. The study has been conducted in two groups of patients, one treated with Vulnamin(®) plus Ca-alginate (ulcer duration = 25.4 ± 6.2 weeks; mean baseline ulcer area = 13.9 ± 4.5 cm(2)) and a control group treated with Ca-alginate alone (ulcer duration = 23.4 ± 4.2 weeks; mean baseline ulcer area = 15.1 ± 4.7 cm(2)). Results have shown that after 70 days of treatment patients significantly ameliorate their pathological condition if they are treated with Vulnamin(®), as compared with patients treated with Ca-alginate alone. In fact, at the end of the treatment, complete healing closure was 61% in the group treated with Vulnamin(®) and, respectively, 27% in the control group. Moreover, ulcer areas showed a significant reduction in patients treated with Vulnamin(®) (mean ulcer area = 3.04 ± 0.8 cm(2)), as compared with controls (mean ulcer area = 10.96 ± 3.8 cm(2)). Overall, the results of this study indicate that Vulnamin(®) together with elastocompression is safe and more effective than standard dressing together with elastocompression in inducing a faster healing in chronic venous ulcers of the lower limb.

Background: Perioperative fluid management is an important component of enhanced recovery pathways for microsurgical breast reconstruction. Historically, fluid management has been liberal. Little attention has been paid to the biochemical effects of different protocols. This study aims to reduce the risk of postoperative hyponatremia by introducing a new fluid management protocol. Methods: A single-institution cohort study comparing a prospective series of patients managed using a new ‘modestly restrictive’ fluid post-operative fluid management protocol to a control-group managed with a ‘liberal’ fluid management protocol. Results: 130-patients undergoing microsurgical breast reconstruction, at a single institution during 2021, are reported. Hyponatraemia is demonstrated to be a significant risk with the original liberal fluid management protocol. At the end of the first post-operative day, mean fluid balance was +2838 ml (+/- 1630ml). 24/65 (36%) patients had low blood sodium level, 14% classified as moderate to severe hyponatremia. Introducing a new, ‘modestly-restrictive’ protocol reduced mean fluid balance on day one to +844 ml (+/-700) (p=<0.0001). Incidence of hyponatraemia reduced from 36% to 14% (p=0.0005). No episodes of moderate or severe hyponatraemia were detected. Fluid intake, predominantly oral water, between 8am and 8pm on the first post operative day is identified as the main risk factor for developing hyponatremia (OR 7; p=0.019). Modest fluid restriction, as guided by the new protocol, protects patients from low sodium level (OR 0.25; CI 95%; 0.11-1.61; p=0.0014) Conclusion: The original ‘liberal’ fluid management protocol encouraged unrestricted post-operative oral-intake of water. Patients were often advised to consume in excess of 5-litres in the first 24-hours. This unintentionally, but frequently, was associated with moderate to severe hyponatraemia. We present a new protocol, characterised by early cessation of intravenous fluid and an oral fluid limit of 2100ml/day associated with a significant reduction in the incidence of hyponatraemia and fluid overload.

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