Abstract
Context:
Panchavalkala extract has anti-inflammatory properties and has been tested in gynecological wounds, especially in cesearian wounds. The study aims at the extract being used for maxillofacial wounds, especially in lateral eyebrow incisions, which is the approach for the reduction of frontozygomatic fractures.
Aim:
The study aims at evaluating the soft tissue wound healing in lateral eyebrow incisions with 5% w/v Panchavalkala water extract, 5% w/v Panchavalkala alcohol extract, and 5% w/v Panchavalkalahydroalcohol extract.
Settings and Design:
The randomized interventional study according to consort guidelines and ethical clearance, parallel-group design, and allocation groups (1:1:1) with four groups. Group 1: 11 patients having frontozygomatic fractures was applied with 5% w/v Panchavalkala water extract. Group 2: 11 patients with frontozygomatic fractures were applied with 5% w/v Panchavalkala alcohol extract. Group 3: 11 patients with frontozygomatic fractures were applied with 5% w/v Panchavalkala hydroalcohol extract. Group 4: 11 patients with frontozygomatic fractures were applied with Neosporin ointment (control).
Materials and Methods:
The Panchavalkala quath and its various group preparations were used, and preparation was applied in the lateral eyebrow incisions of isolated frontozygomatic fractures and evaluated. Evaluation involved measuring various parameters such as slough, swelling, redness, pain, discharge, tenderness, and malodor at specific intervals postoperatively (day 1, day 7, day 15, and day 30).
Statistical Design:
The groups were evaluated with Kruskal-Wallis analysis of variance (ANOVA) tests. Group 3, which received the 5% w/v panchavalkahydroalcohol extract, exhibited the highest level of improvement, followed by group 2 (5% w/v panchavalka alcohol extract), group 1 (5% w/v panchavalka water extract), and finally group 4 (Neosporin ointment).
Results:
These findings strongly support the superior healing properties of the 5% w/v panchavalkahydroalcohol extract for soft tissue wound healing.
Conclusion:
The 5% v/w hydroxyalcohol extract of Panchavalkala gave excellent results in terms of all parameters of healing compared to the other two groups and hence can be the future for many studies.
Keywords: Fracture, herbal extract, isolated frontal zygomatic, Panchavalkala
INTRODUCTION
The face, being the most visible part of the human body, makes it more susceptible to harm, especially the zygomatic region. This region is essential for protecting the eye and is prone to facial trauma, contributing to various structures like the orbital cavity and zygomatic arch.[1]
The frontozygomatic (FZ) suture, also known as the zygomaticofrontal suture, links the frontal process of the zygomatic bone and the zygomatic process of the frontal bone. Approximately 15.2% of zygomaticomaxillary complex (ZMC) fractures involve fractures of the FZ suture.[2]
Around 1000 B.C., Sushruta, considered the father of Indian surgery, emphasized the significance of wound healing in both humans and animals. This process involves hemostasis/inflammation, proliferation, and remodeling, initiated by platelet aggregation and growth factor secretion after a skin injury.[3,4]
Sushruta advocated using various external medications like NyagrodhadiVarga, which contains Panchavalkala, a potent botanical formulation derived from the barks of five trees. Panchavalkala has shown remarkable efficacy in wound healing.[5]
For effective wound healing, a medication should possess antibacterial, anti-inflammatory, and free radical-scavenging properties and promote collagen production.[6,7,8,9] Different formulations of Panchavalkala, including gel, decoction, ointment, sanitizer, Ghanasatwa, Taila, Ghrita, and cream, have been studied and shown to be effective in wound healing. It is important to compare their efficacy.[4,5,6]
The study’s main objective was to compare the healing of soft tissue wounds in lateral eyebrow incisions using Panchavalkala water extract, Panchavalkala alcohol extract, and Panchavalkalahydroalcohol extract. The assessment was to assess the reduction in wound length and various factors like slough, swelling, redness, discomfort, discharge, tenderness, and odor at different time points [24 hours, 7 days, 15 days, and 1 month after suturing].
MATERIALS AND METHODS
The research was carried out on a sample of 44 patients divided equally into four groups. Group 1: 11 patients having FZ fractures was applied with 5% w/v Panchavalkala water extract. Group 2: 11 patients having FZ fractures was applied with 5% w/v Panchavalkala alcohol extract. Group 3: 11 patients having FZ fractures was applied with 5% w/v Panchavalkala hydroalcohol extract. Group 4: 11 patients having FZ fractures was applied with Neosporin ointment (control). The patients were divided into four groups using computer-generated random numbering. Each group received the extracts and ointment on the lateral eyebrow incision wound, respectively.
These patients underwent open reduction and internal fixation (ORIF). The surgeries were performed under general anesthesia (GA) to ensure the patient’s comfort and safety during the procedure.
The study was conducted during the period from October 2021 to May 2022. The research was conducted after obtaining approval from the institutional ethics committee [Ref. No. DYPDCH/EC/DPU/299/91/2021]. Feasibility certificates were obtained from the department of oral and maxillofacial surgery and the department of Ayurveda (Rasashastra Evam Bhaishajya Kalpana).
A sample size of 44 was calculated using G. Power V.3.1.9.7, using calculated effect size from the previous literature (Bhat et al.)[5] Effect size: 1.24 alpha; error: 0.05; power: 95%. The statistical test used for evaluation was Kruskal-Wallis analysis of variance (ANOVA). The patients were allocated with an allocation ratio of 1:1:1 in a parallel study group design of a randomized control trial. The respective groups were assigned as per a computer-generated random numbering and both the investigator and the study analyst were blinded. The study was conducted according to the consort guidelines (Suppl 1).
Ethics approval
Ethical clearance was obtained from Institutionalmethical committee DYPDCH/EC/DPU/299/91/2021 dated 20.10.21
Inclusion criteria
Patients with isolated FZ fractures.
Patients above 18 years of age.
Healthy patients without systemic diseases such as uncontrolled diabetes, uncontrolled hypertension, those on steroid therapy, a history of chemotherapy/radiotherapy, or bleeding disorders.
Patients willing to participate in the study.
Exclusion criteria
Patients below 18 years of age.
Pregnancy.
Patients with other fractures other than isolated FZ fractures.
Known hypersensitivity to 5% w/v Panchavalkala water extract, 5% w/v Panchavalkala alcohol extract, or 5% w/v Panchavalkalahydroalcohol extract.
Patients with keloid tendency were excluded from the study.
METHODOLOGY
A total of 44 patients meeting the inclusion criteria were selected for this study. Panchavalkala Quath (Churna: LION Shree narnarayan ayurvedic) contains Vata (20%), Udumbara (20 g%), Ashwattha (20%), Parisha (20 g%), and Plaksha (20 g%). The quath was then prepared to deliver the 5% v/w Panchavalkala extract. The extraction of 5% w/v Panchavalkala water extract, 5% w/v Panchavalkala alcohol extract, and 5% w/v Panchavalkalahydroalcohol extract was performed as follows: the ingredients were extracted using a Soxhlet apparatus. Distilled water was used as the solvent for the extraction of 5% w/v Panchavalkala water extract, 95% ethanol for the extraction of 5% w/v Panchavalkala alcohol extract, and 20% ethanol for the extraction of 5% w/v Panchavalkalahydroalcohol extract. Panchavalkalachurna (powder) was used in the process, and the extraction took 24 hours to complete. 100% Panchavalkala extract was obtained and subsequently converted into 5% w/v Panchavalkala water extract, 5% w/v Panchavalkala alcohol extract, and 5% w/v Panchavalkalahydroalcohol extract [Figure 1].
Figure 1.
5% w/v Panchavalkalahydroalcohol extract preparation
All patients were provided with detailed information about the procedure, and written informed consent was obtained. The case history was recorded, and preoperative photographs were taken. Routine preoperative investigations, including blood tests, were conducted, and preoperative fitness was confirmed by an anesthesiologist.
Standard scrubbing, painting, and draping were performed. The technique involved marking the lateral eyebrow incision, followed by the infiltration of local anesthesia (2% lignocaine hydrochloride with 1:200,000 adrenaline). An incision was made, and subperiosteal dissection was carried out to explore the FZ fracture. ORIF under GA were performed. Closure was done in layers using 4-0 Vicryl, and the outer layer was sutured using 5-0 Prolene. The assigned treatment, either 5% w/v Panchavalkala water extract, 5% w/v Panchavalkala alcohol extract, 5% w/v Panchavalkalahydroalcohol extract, or Neosporin ointment, was applied every 12 hours on the lateral eyebrow incision wound for a healing period of 21 days. Closed dressing was provided for the first 24 hours [Figures 2 and 3]. There were two observers, and standardization and calibration were done at the department with a kappa coefficient of 0.95.
Figure 2.
Post operative day 15 using 5% w/v Panchavalkalahydroalcohol extract
Figure 3.
Post operative day 30 using 5% w/v Panchavalkalahydroalcohol extract
Patients were recalled for evaluation of soft tissue wound healing (surgical incision line only) using the scale of Bhat et al.[5] for a month [Figures 4 and 5] and then every 3 months follow up for a year. Only the surgical incision line was evaluated on the basis of the scale of Bhat et al.[5] Any associated soft tissue abrasions or contusions were not evaluated as part of healing in this study.
Figure 4.
Post-operative follow up 5% w/v Panchavalkala water extract
Figure 5.
Post-operative follow up 5% w/v Panchavalkala alcohol extract
RESULTS
The study included 44 patients with FZ fractures who met the inclusion and exclusion criteria. Among them, 35 were males and nine were females. The majority of patients were in the age group of 24–38 years. Data were recorded in an Excel spreadsheet (version 2000) and analyzed using IBM Statistical Package for the Social Sciences (SPSS) software (version 21). Day 1, comparison between all four groups showed statistically insignificant results among all the variables: slough (P = .643), swelling (P = .110), redness (P = .557), pain (P = .109), discharge (P = .304), tenderness (P = .087), and malodor (P = .054) at a daytime interval [Table 1]. On day 7, a comparison between all four groups showed statistically significant results among all the variables: slough (P < 0.001), swelling (P = .023), redness (P < .001), and pain (P = .003). However, variables like discharge (P = .100), tenderness (P = .062), and malodor (P = .110) at day 7 time intervals showed statistically insignificant results [Table 2]. On day 15, a comparison between all four groups showed statistically significant results among all the variables: slough (P = .016), swelling (P < 0.001), redness (P = .001), pain (P = .002), tenderness (P = .005), and malodor (P = .001) but discharge showed statistically insignificant results at day 15 time interval [Table 3]. On day 30, a comparison between all four groups showed statistically insignificant results among all the variables: slough (P = .294), swelling (P = .484), redness (P = .890), pain (P = .767), discharge (P = .234), and tenderness (P = .801) at day 30 time interval [Table 4].
Table 1.
Comparison of slough, swelling, redness, pain, discharge, tenderness, and malodor among all the four groups at post-op day 1
| Descriptives | ||||||||
|---|---|---|---|---|---|---|---|---|
| n | Mean | Std. deviation | Std. error | 95% confidence interval for mean |
Kruskal-Wallis ANOVA | P | ||
| Lower bound | Upper bound | |||||||
| Slough 1 | ||||||||
| 1 | 11 | 3.36 | 0.505 | 0.152 | 3.02 | 3.70 | 0.563 | 0.643 |
| 2 | 11 | 3.09 | 0.831 | 0.251 | 2.53 | 3.65 | ||
| 3 | 11 | 3.36 | 0.505 | 0.152 | 3.02 | 3.70 | ||
| 4 | 11 | 3.36 | 0.505 | 0.152 | 3.02 | 3.70 | ||
| Total | 44 | 3.30 | 0.594 | 0.090 | 3.11 | 3.48 | ||
| Swelling | ||||||||
| 1 | 11 | 2.73 | 0.467 | 0.141 | 2.41 | 3.04 | 2.143 | 0.110 |
| 2 | 11 | 3.00 | 0.000 | 0.000 | 3.00 | 3.00 | ||
| 3 | 11 | 3.00 | 0.000 | 0.000 | 3.00 | 3.00 | ||
| 4 | 11 | 2.82 | 0.405 | 0.122 | 2.55 | 3.09 | ||
| Total | 44 | 2.89 | 0.321 | 0.048 | 2.79 | 2.98 | 0.702 | 0.557 |
| Redness | ||||||||
| 1 | 11 | 2.91 | 0.302 | 0.091 | 2.71 | 3.11 | ||
| 2 | 11 | 2.82 | 0.405 | 0.122 | 2.55 | 3.09 | ||
| 3 | 11 | 2.91 | 0.302 | 0.091 | 2.71 | 3.11 | ||
| 4 | 11 | 3.00 | 0.000 | 0.000 | 3.00 | 3.00 | ||
| Total | 44 | 2.91 | 0.291 | 0.044 | 2.82 | 3.00 | 2.151 | 0.109 |
| Pain | ||||||||
| 1 | 11 | 2.91 | 0.302 | 0.091 | 2.71 | 3.11 | ||
| 2 | 11 | 2.64 | 0.505 | 0.152 | 2.30 | 2.98 | ||
| 3 | 11 | 2.73 | 0.467 | 0.141 | 2.41 | 3.04 | ||
| 4 | 11 | 3.00 | 0.000 | 0.000 | 3.00 | 3.00 | ||
| Total | 44 | 2.82 | 0.390 | 0.059 | 2.70 | 2.94 | ||
| Discharge | ||||||||
| 1 | 11 | 2.91 | 0.302 | 0.091 | 2.71 | 3.11 | 1.250 | 0.304 |
| 2 | 11 | 2.73 | 0.467 | 0.141 | 2.41 | 3.04 | ||
| 3 | 11 | 2.64 | 0.505 | 0.152 | 2.30 | 2.98 | ||
| 4 | 11 | 2.91 | 0.302 | 0.091 | 2.71 | 3.11 | ||
| Total | 44 | 2.80 | 0.408 | 0.062 | 2.67 | 2.92 | ||
| Tenderness | ||||||||
| 1 | 11 | 3.00 | 0.000 | 0.000 | 3.00 | 3.00 | 2.353 | 0.087 |
| 2 | 11 | 2.73 | 0.467 | 0.141 | 2.41 | 3.04 | ||
| 3 | 11 | 2.91 | 0.302 | 0.091 | 2.71 | 3.11 | ||
| 4 | 11 | 3.00 | 0.000 | 0.000 | 3.00 | 3.00 | ||
| Total | 44 | 2.91 | 0.291 | 0.044 | 2.82 | 3.00 | ||
| Malodor | ||||||||
| 1 | 11 | 2.82 | 0.405 | 0.122 | 2.55 | 3.09 | 3.188 | 0.054 |
| 2 | 11 | 2.64 | 0.505 | 0.152 | 2.30 | 2.98 | ||
| 3 | 11 | 3.00 | 0.000 | 0.000 | 3.00 | 3.00 | ||
| 4 | 11 | 3.00 | 0.000 | 0.000 | 3.00 | 3.00 | ||
| Total | 44 | 2.86 | 0.347 | 0.052 | 2.76 | 2.97 | ||
Table 2.
Comparison of slough, swelling, redness, pain, discharge, tenderness, and malodor among all the four groups at post-op day 7
| Descriptives | ||||||||
|---|---|---|---|---|---|---|---|---|
| n | Mean | Std. deviation | Std. error | 95% confidence interval for mean |
Kruskal-Wallis ANOVA | P | ||
| Lower bound | Upper bound | |||||||
| Slough 7 | ||||||||
| 1 | 11 | 1.82 | 0.405 | 0.122 | 1.55 | 2.09 | 18.048 | <.001 |
| 2 | 11 | 2.36 | 0.505 | 0.152 | 2.02 | 2.70 | ||
| 3 | 11 | 2.73 | 0.467 | 0.141 | 2.41 | 3.04 | ||
| 4 | 11 | 3.00 | 0.000 | 0.000 | 3.00 | 3.00 | ||
| Total | 44 | 2.48 | 0.590 | 0.089 | 2.30 | 2.66 | ||
| Swelling | ||||||||
| 1 | 11 | 1.82 | 0.405 | 0.122 | 1.55 | 2.09 | 3.542 | 0.023 |
| 2 | 11 | 2.36 | 0.674 | 0.203 | 1.91 | 2.82 | ||
| 3 | 11 | 2.45 | 0.522 | 0.157 | 2.10 | 2.81 | ||
| 4 | 11 | 2.45 | 0.522 | 0.157 | 2.10 | 2.81 | ||
| Total | 44 | 2.27 | 0.585 | 0.088 | 2.09 | 2.45 | ||
| Redness | ||||||||
| 1 | 11 | 1.73 | 0.467 | 0.141 | 1.41 | 2.04 | 12.528 | <.001 |
| 2 | 11 | 2.00 | 0.447 | 0.135 | 1.70 | 2.30 | ||
| 3 | 11 | 2.45 | 0.522 | 0.157 | 2.10 | 2.81 | ||
| 4 | 11 | 3.00 | 0.632 | 0.191 | 2.58 | 3.42 | ||
| Total | 44 | 2.30 | 0.701 | 0.106 | 2.08 | 2.51 | ||
| Pain | ||||||||
| 1 | 11 | 1.73 | 0.467 | 0.141 | 1.41 | 2.04 | 5.588 | 0.003 |
| 2 | 11 | 2.18 | 0.405 | 0.122 | 1.91 | 2.45 | ||
| 3 | 11 | 2.45 | 0.522 | 0.157 | 2.10 | 2.81 | ||
| 4 | 11 | 2.45 | 0.522 | 0.157 | 2.10 | 2.81 | ||
| Total | 44 | 2.20 | 0.553 | 0.083 | 2.04 | 2.37 | ||
| Discharge | ||||||||
| 1 | 11 | 1.82 | 0.405 | 0.122 | 1.55 | 2.09 | 2.222 | 0.100 |
| 2 | 11 | 2.00 | 0.000 | 0.000 | 2.00 | 2.00 | ||
| 3 | 11 | 2.00 | 0.000 | 0.000 | 2.00 | 2.00 | ||
| 4 | 11 | 2.00 | 0.000 | 0.000 | 2.00 | 2.00 | ||
| Total | 44 | 1.95 | 0.211 | 0.032 | 1.89 | 2.02 | ||
| Tenderness | ||||||||
| 1 | 11 | 1.91 | 0.302 | 0.091 | 1.71 | 2.11 | 2.652 | 0.062 |
| 2 | 11 | 2.00 | 0.000 | 0.000 | 2.00 | 2.00 | ||
| 3 | 11 | 2.09 | 0.302 | 0.091 | 1.89 | 2.29 | ||
| 4 | 11 | 2.27 | 0.467 | 0.141 | 1.96 | 2.59 | ||
| Total | 44 | 2.07 | 0.334 | 0.050 | 1.97 | 2.17 | ||
| Malodor | ||||||||
| 1 | 11 | 1.73 | 0.467 | 0.141 | 1.41 | 2.04 | 2.143 | 0.110 |
| 2 | 11 | 2.00 | 0.000 | 0.000 | 2.00 | 2.00 | ||
| 3 | 11 | 1.82 | 0.405 | 0.122 | 1.55 | 2.09 | ||
| 4 | 11 | 2.00 | 0.000 | 0.000 | 2.00 | 2.00 | ||
| Total | 44 | 1.89 | 0.321 | 0.048 | 1.79 | 1.98 | ||
Table 3.
Comparison of slough, swelling, redness, pain, discharge, tenderness, and malodor among all the four groups at post-op day 15
| Descriptives | ||||||||
|---|---|---|---|---|---|---|---|---|
| n | Mean | Std. deviation | Std. error | 95% confidence interval for mean |
Kruskal-Wallis ANOVA | P | ||
| Lower bound | Upper bound | |||||||
| Slough 15 | ||||||||
| 1 | 11 | 0.82 | 0.405 | 0.122 | 0.55 | 1.09 | 3.899 | 0.016 |
| 2 | 11 | 1.27 | 0.467 | 0.141 | 0.96 | 1.59 | ||
| 3 | 11 | 1.18 | 0.603 | 0.182 | 0.78 | 1.59 | ||
| 4 | 11 | 1.55 | 0.522 | 0.157 | 1.19 | 1.90 | ||
| Total | 44 | 1.20 | 0.553 | 0.083 | 1.04 | 1.37 | ||
| Swelling | ||||||||
| 1 | 11 | 0.55 | 0.522 | 0.157 | 0.19 | 0.90 | 12.292 | <0.001 |
| 2 | 11 | 1.18 | 0.751 | 0.226 | 0.68 | 1.69 | ||
| 3 | 11 | 1.45 | 0.688 | 0.207 | 0.99 | 1.92 | ||
| 4 | 11 | 2.00 | 0.000 | 0.000 | 2.00 | 2.00 | ||
| Total | 44 | 1.30 | 0.765 | 0.115 | 1.06 | 1.53 | ||
| Redness | ||||||||
| 1 | 11 | 0.45 | 0.522 | 0.157 | 0.10 | 0.81 | 7.326 | 0.001 |
| 2 | 11 | 1.00 | 0.632 | 0.191 | 0.58 | 1.42 | ||
| 3 | 11 | 1.18 | 0.603 | 0.182 | 0.78 | 1.59 | ||
| 4 | 11 | 1.73 | 0.786 | 0.237 | 1.20 | 2.26 | ||
| Total | 44 | 1.09 | 0.772 | 0.116 | 0.86 | 1.33 | ||
| Pain | ||||||||
| 1 | 11 | 0.64 | 0.505 | 0.152 | 0.30 | 0.98 | 5.746 | 0.002 |
| 2 | 11 | 0.55 | 0.522 | 0.157 | 0.19 | 0.90 | ||
| 3 | 11 | 1.00 | 0.000 | 0.000 | 1.00 | 1.00 | ||
| 4 | 11 | 1.18 | 0.405 | 0.122 | 0.91 | 1.45 | ||
| Total | 44 | 0.84 | 0.479 | 0.072 | 0.70 | 0.99 | ||
| Discharge | ||||||||
| 1 | 11 | 0.55 | 0.522 | 0.157 | 0.19 | 0.90 | 2.619 | 0.064 |
| 2 | 11 | 0.45 | 0.688 | 0.207 | -0.01 | 0.92 | ||
| 3 | 11 | 0.55 | 0.522 | 0.157 | 0.19 | 0.90 | ||
| 4 | 11 | 1.00 | 0.000 | 0.000 | 1.00 | 1.00 | ||
| Total | 44 | 0.64 | 0.532 | 0.080 | 0.47 | 0.80 | ||
| Tenderness | ||||||||
| 1 | 11 | 0.45 | 0.522 | 0.157 | 0.10 | 0.81 | 4.924 | 0.005 |
| 2 | 11 | 0.73 | 0.647 | 0.195 | 0.29 | 1.16 | ||
| 3 | 11 | 1.09 | 0.539 | 0.163 | 0.73 | 1.45 | ||
| 4 | 11 | 1.27 | 0.467 | 0.141 | 0.96 | 1.59 | ||
| Total | 44 | 0.89 | 0.618 | 0.093 | 0.70 | 1.07 | ||
| Malodor | ||||||||
| 1 | 11 | 0.36 | 0.505 | 0.152 | 0.02 | 0.70 | 6.847 | 0.001 |
| 2 | 11 | 0.36 | 0.505 | 0.152 | 0.02 | 0.70 | ||
| 3 | 11 | 0.82 | 0.405 | 0.122 | 0.55 | 1.09 | ||
| 4 | 11 | 1.00 | 0.000 | 0.000 | 1.00 | 1.00 | ||
| Total | 44 | 0.64 | 0.487 | 0.073 | 0.49 | 0.78 | ||
Table 4.
Comparison of slough, swelling, redness, pain, discharge, tenderness, and malodor among all the four groups at post-op day 30
| Descriptives | ||||||||
|---|---|---|---|---|---|---|---|---|
| n | Mean | Std. deviation | Std. error | 95% confidence interval for mean |
Kruskal-Wallis ANOVA | P | ||
| Lower bound | Upper bound | |||||||
| Slough 30 | ||||||||
| 1 | 11 | 0.00 | 0.000 | 0.000 | 0.00 | 0.00 | 1.282 | 0.294 |
| 2 | 11 | 0.09 | 0.302 | 0.091 | -0.11 | 0.29 | ||
| 3 | 11 | 0.18 | 0.405 | 0.122 | -0.09 | 0.45 | ||
| 4 | 11 | 0.27 | 0.467 | 0.141 | -0.04 | 0.59 | ||
| Total | 44 | 0.14 | 0.347 | 0.052 | 0.03 | 0.24 | ||
| Swelling | ||||||||
| 1 | 11 | 0.09 | 0.302 | 0.091 | -0.11 | 0.29 | 0.833 | 0.484 |
| 2 | 11 | 0.18 | 0.405 | 0.122 | -0.09 | 0.45 | ||
| 3 | 11 | 0.27 | 0.467 | 0.141 | -0.04 | 0.59 | ||
| 4 | 11 | 0.36 | 0.505 | 0.152 | 0.02 | 0.70 | ||
| Total | 44 | 0.23 | 0.424 | 0.064 | 0.10 | 0.36 | ||
| Redness | ||||||||
| 1 | 11 | 0.09 | 0.302 | 0.091 | -0.11 | 0.29 | 0.208 | 0.890 |
| 2 | 11 | 0.09 | 0.302 | 0.091 | -0.11 | 0.29 | ||
| 3 | 11 | 0.18 | 0.405 | 0.122 | -0.09 | 0.45 | ||
| 4 | 11 | 0.09 | 0.302 | 0.091 | -0.11 | 0.29 | ||
| Total | 44 | 0.11 | 0.321 | 0.048 | 0.02 | 0.21 | ||
| Pain | ||||||||
| 1 | 11 | 0.18 | 0.405 | 0.122 | -0.09 | 0.45 | 0.381 | 0.767 |
| 2 | 11 | 0.27 | 0.467 | 0.141 | -0.04 | 0.59 | ||
| 3 | 11 | 0.09 | 0.302 | 0.091 | -0.11 | 0.29 | ||
| 4 | 11 | 0.18 | 0.405 | 0.122 | -0.09 | 0.45 | ||
| Total | 44 | 0.18 | 0.390 | 0.059 | 0.06 | 0.30 | ||
| Discharge | ||||||||
| 1 | 11 | 0.00 | 0.000 | 0.000 | 0.00 | 0.00 | 1.481 | 0.234 |
| 2 | 11 | 0.18 | 0.405 | 0.122 | -0.09 | 0.45 | ||
| 3 | 11 | 0.00 | 0.000 | 0.000 | 0.00 | 0.00 | ||
| 4 | 11 | 0.18 | 0.405 | 0.122 | -0.09 | 0.45 | ||
| Total | 44 | 0.09 | 0.291 | 0.044 | 0.00 | 0.18 | ||
| Tenderness | ||||||||
| 1 | 11 | 0.00 | 0.000 | 0.000 | 0.00 | 0.00 | 0.333 | 0.801 |
| 2 | 11 | 0.09 | 0.302 | 0.091 | -0.11 | 0.29 | ||
| 3 | 11 | 0.09 | 0.302 | 0.091 | -0.11 | 0.29 | ||
| 4 | 11 | 0.09 | 0.302 | 0.091 | -0.11 | 0.29 | ||
| Total | 44 | 0.07 | 0.255 | 0.038 | -0.01 | 0.15 | ||
| Malodor | ||||||||
| 1 | 11 | 0.00 | 0.000 | 0.000 | 0.00 | 0.00 | -- | -- |
| 2 | 11 | 0.00 | 0.000 | 0.000 | 0.00 | 0.00 | ||
| 3 | 11 | 0.00 | 0.000 | 0.000 | 0.00 | 0.00 | ||
| 4 | 11 | 0.00 | 0.000 | 0.000 | 0.00 | 0.00 | ||
| Total | 44 | 0.00 | 0.000 | 0.000 | 0.00 | 0.00 | ||
DISCUSSION
The ZMC is a crucial facial structure responsible for mid-facial width and accentuating the cheek. It connects with various bones through four sutures: the FZ suture, zygomaticotemporal (ZT) suture, zygomaticomaxillary buttress (ZMB), and zygomaticosphenoid (ZS) suture.[10]
Zygomatic bone fractures are commonly seen in individuals in their third decade of life, and diagnosis typically involves using CT scans and 3D reconstruction techniques.[11]
Treatment options for zygomatic bone fractures vary based on the extent of displacement and aesthetic/functional concerns, ranging from observation to ORIF.[12,13]
Notably, the FZ suture is commonly used for ZMC fixation due to its stable anchoring site.[13] In our study, we utilized a titanium plate and screws to stabilize the FZ suture.[14]
For the study, Panchavalkala, a combination of barks from five medicinal plants (Ficus bengalensis, Ficus glomerata, Ficus religiosa, Thespesia populnea, and Ficus lecor) was used. Three extracts were prepared: 5% w/v Panchavalkala water extract, 5% w/v Panchavalkala alcohol extract, and 5% w/v Panchavalkalahydroalcohol extract. Neosporin ointment was used for comparison. Soft tissue wound healing (surgical incision line only) was evaluated using the Bhat et al. scale.[4,5]
Research by Hameed I indicated that Panchavalkala possesses various pharmacological properties, such as anti-inflammatory, analgesic, antibacterial, and wound-healing capabilities.[15] Flavonoids from the barks exhibit antioxidant properties, while tannins, phytosterols, and flavonoids contribute to anti-inflammatory effects and wound contraction. Tannins also enhance collagen production, promoting wound healing. Additionally, vitamins A and K play essential roles in epithelialization and healing.[16]
In our study, we assessed the efficacy of soft tissue wound healing using 5% w/v Panchavalkala water extract, 5% w/v Panchavalkala alcohol extract, 5% w/v Panchavalkalahydroalcohol extract, and Neosporin ointment. The evaluation involved measuring various parameters such as slough, swelling, redness, pain, discharge, tenderness, and malodor at specific intervals postoperatively (day 1, day 7, day 15, and day 30).
The statistical analysis revealed significant improvements in slough, swelling, redness, discomfort, discharge, soreness, and malodor across all groups. Group 3, which received the 5% w/v panchavalkahydroalcohol extract, exhibited the highest level of improvement, followed by group 2 (5% w/v panchavalka alcohol extract), group 1 (5% w/v panchavalka water extract), and finally group 4 (Neosporin ointment). These findings strongly support the superior healing properties of the 5% w/v panchavalkahydroalcohol extract for soft tissue wound healing [Tables 1–4].
CONCLUSION
The statistical data obtained from the study demonstrates that the use of 5% w/v panchavalkahydroalcohol extract leads to the most significant improvements in terms of reducing slough, swelling, redness, discomfort, discharge, soreness, and malodor in the context of soft tissue wound healing. This is followed by the 5% w/v panchavalka alcohol extract, 5% w/v panchavalka water extract, and Neosporin ointment, in descending order of effectiveness. These findings highlight the superior healing properties of the panchavalka extracts, particularly the hydroalcohol extract, and suggest their potential as effective treatments for promoting wound healing.
Limitations
The limitations of the study include a small sample size of 44 patients, a limited follow-up period, potential bias in data collection and analysis, and a lack of generalizability to broader populations. Future research with larger, controlled, and more diverse samples could further strengthen the evidence for the effectiveness of panchavalka extracts in wound healing.
Declarations
Ethical statement: institutional ethical clearance was obtained.
Consent for publication: informed, valid written consent was obtained.
Conflicts of interest
There are no conflicts of interest.
Funding Statement
This study was self-funded.
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