Physical reparative treatment in reptiles
© Rinaldi et al.; licensee BioMed Central Ltd. 2013
Received: 2 January 2013
Accepted: 11 February 2013
Published: 26 February 2013
The tissue growth necessary to achieve a complete or partial restitution ad integrum as a result of injury to soft tissue and/or hard times in reptiles is variable and often needs long time in relation to the species, to the habitat and to their intrinsic physiological characteristics. The purpose of this work was to see if the tissue optimization (TO) treatment with radio electric asymmetric conveyer (REAC) provided good results in these animals and whether its use translates into reduced time of tissue repair. This paper describes preliminary results with in promoting the tissue repair in reptiles.
A 5 year old male Testudo graeca (Leo) and Trachemys scripta scripta (Mir) and a 15 year old female Testudo hermanni (Juta) were evaluated because of soft tissue injuries. A female 25 year old Trachemys scripta elegans (Ice), a female 2.5 year old Trachemys scripta scripta (Penelope) as well as a 50 year old male Testudo graeca (Margherito) were evaluated because of wounds of the carapace. Following debridement and traditional therapies, Leo, Penelope and Margherito were exposed to the radio electric asymmetric conveyer (REAC) device, with a specific treatment protocol, named tissue optimization-basic (TO-B). Also Ice and Mir were subjected to REAC treatment after wounds debridement. Juta was treated only with REAC treatment.
Complete wound healing was evident after 17 days for Leo, 7 days for Penelope, 27 days for Mir, 78 days for Ice and after 14 days for Margherito. Juta showed a considerable tissue activation in 2 days and complete wound healing in 5 days.
Our findings suggest that REAC TO-B treatment may provide advantages over other traditional methods after complete wound healing in Leo, and also suitable healing in the other patients. Then REAC device with its specific treatment TO-B protocol, which induces tissue repair without causing severe stress to the patient, could be a potential therapy for tissue damage healing in reptiles. Further studies still need to be conducted to support our observations.
KeywordsTissue repair Tissue optimization Tortoise Turtle Radio electric asymmetric conveyer
Among the various methods used to treat wounds [1, 2] such as beds, compression, hydrotherapy, therapeutic ultrasound, negative pressure therapy, laser therapy, an increase in the rate of tissue repair has been obtained by other authors using electrical stimulation [3–5] and magnetic fields, both in humans and in animals [6–8]. More recently, an innovative technology, radio electric asymmetric conveyer (REAC), with its specifics treatment protocol defined with the general name of tissue optimization (TO) has proven efficacy in inducing cell pluripotency and differentiation in different cell lines, including embryonic stem cells  and human skin-derived fibroblasts,  representing a new tool for improving tissue regeneration. REAC TO has proven efficacy also in ameliorating tissues healing [11–15] and was also successfully used for the treatment of post-traumatic injury and surgical wounds both in humans and in animals [11–15]. Recent studies have demonstrated the efficacy of REAC TO also in the osteoarthritic chondrocytes repair . In the present clinical study we investigated if a protocol of this innovative treatment named REAC TO-base (TO-B) was able to ameliorate tissue repair in a Testudo graeca and a Trachemys scripta scripta with severe traumatic injuries which till this moment did not show a significant improvement of lesions with traditional treatments that in one case were applied for a long period. The REAC TO-B treatments were applied also in a Trachemys scripta elegans and in another Trachemys scripta scripta that did not received other traditional treatments. The purpose of this case report is to describe our observations using tissue optimization-basic (TO-B) treatment with a radio electric asymmetric conveyer (REAC) device and how this may translate into reduced time of tissue repair in this type of animal.
As previously described for Leo all the other turtles were exposed to 12 or more sessions of REAC TO-B treatment, by the aid of anesthesia or not along different period of time. The ameliorations of the shell of the animal after REAC TO-B treatments are reported in Figure 5. In particular the case of the animal showing a loss of the shell (Ice) was particularly evident because of the possibility of verifying the scarring and hardening of the tissue underlying the lesion. In fact, after 2.5 REAC TO-B treatment cycle, corresponding to 60 days, the animal showed a marked narrowing of the area of exposure of the peritoneal membrane. This resulted in a significant reduction in visibility of raising and lowering related to breathing, that were highly visible before treatment. Penelope (Figure 5) began REAC TO-B treatment after local disinfection was applied for four days. For this reason 18 sessions of REAC TO-B, corresponding to 7 days were enough to see evident wound healing (Figure 5B).
After 18 sessions of REAC TO-B, corresponding to 20 days, Mir showed wound reepithelization and necrosis disappearance, and a complete healing over the next 7 days (Figure 8D).
All the animals were monitored after REAC TO-B treatments; 2 of them for 18 months and 4 for 12 months and we didn’t see any long term disorder or problem.
Macroscopic and histological results underline a significant tissue repair based on clinical observation in Leo and other reptiles. Thereby wound healing also in tortoises proceeds by a process of granulation, epithelialization and wound contraction, [18, 19] which generally takes several weeks to heal, and has been shown to be temperature dependent.
In the present work we evidenced that Testudo graeca Leo, and 3 turtles with different injuries of soft and hard tissues treated with REAC-TO showed an evident amelioration of healing wounds. It is known that the reptilian epidermis is composed of a beta-keratin layer, the mesos layer and the alpha-keratin layer,  which is supported by the underlying stratum germinativum, whereas the chelonian shell is composed of a thick epithelium and contains layers of keratin . The deeper dermis, derived from embryonic mesoderm contains connective tissues, vascular tissues, sensory structures and dermal bone (osteodermis). We have previously demonstrated that REAC TO-B treatment induces cell proliferation and differentiation toward different lineages in vitro [9, 10]. In particular REAC-TO was found to have the ability to modulate the expression of genes and proteins involved in the differentiation of embryonic mouse cells in vitro . Moreover we recently observed that REAC-TO influenced the plasticity and differentiation capability of human skin derived fibroblasts toward different cellular lineages,  thus further demonstrating the modulatory effect of this device on cell fate and tissue regeneration. Therefore we can argue that the amelioration of wound healing and bone fracture of reptiles observed here may be due to a proliferation of the germinativum stratum of the epidermis and of the embryonic mesoderm responsible for the formation of connective tissues, vascular tissues, sensory structures and osteodermis. Osteodermis is composed of a mixture of spongy and compact bone and, in tortoises, is fused with the ribcage and spine, expanding to form the plates of bone that make up the chelonian carapace and plastron [20–22]. Our patients were subjected to different sessions of REAC-TO treatment, ranging from 12 (Leo) to 42 (Ice), considering the site and seriousness of injury. Therefore as supposed the number of REAC-TO sessions was higher in the patient exhibiting lesions of shell (Ice). The REAC-TO treatment, applied after the complete debridement of the necrotic tissues, did not cause a severe stress to patient and required only few anesthetic treatments (Leo). The positive action of REAC-TO treatment is further inferred by clinical results obtained by us in healthy human subjects, improving circulation, hydration, and the tropism of facial skin .
Since REAC-TO is able to activate the process of tissue repair by inducing cellular organization and a vascular network, activating and accelerating tissue recovery may represent a powerful approach that could pave new ways in veterinary and human healing, besides other physical and chemical treatments [23, 24].
In conclusion our data suggest that REAC TO-B could be a new tool for treating injuries in reptiles. More detailed studies are needed in order to confirm these results.
This study has been approved by Veterinary control officers of Animal protection in experimental and clinical studies made in University of Sassari, Italy (directive C.E.E. n.86/609). We have obtained the consent to treatment, from each owner, before starting the study.
We thank Prof. Giacomo Rossi D.V.M., Ph.D. School of Veterinary Medical Sciences, University of Camerino for histological analysis.
- Hess CL, Howard MA, Attinger CE: A review of mechanical adjuncts in wound healing: hydrotherapy, ultrasound, negative pressure therapy, hyperbaric oxygen, and electrostimulation. Ann Plast Surg. 2003, 51: 210-218. 10.1097/01.SAP.0000058513.10033.6B.PubMedView ArticleGoogle Scholar
- Cullum N, Nelson EA, Flemming K, Sheldon T: Systematic reviews of wound care management: (5) beds; (6) compression; (7) laser therapy, therapeutic ultrasound, electrotherapy and electromagnetic therapy. Health Technol Assess. 2001, 5: 1-221.PubMedView ArticleGoogle Scholar
- Bullock AJ, Barker AT, Coulton L, Macneil S: The effect of induced biphasic pulsed currents on re-epithelialization of a novel wound healing model. Bioelectromagnetics. 2007, 28: 31-41. 10.1002/bem.20267.PubMedView ArticleGoogle Scholar
- Cinar K, Comlekci S, Senol N: Effects of a specially pulsed electric field on an animal model of wound healing. Lasers Med Sci. 2009, 24: 735-740. 10.1007/s10103-008-0631-6.PubMedView ArticleGoogle Scholar
- Lauchli S: Alternative methods for wound treatment. MMW Fortschr Med. 2007, 149: 41-42.PubMedGoogle Scholar
- Aziz Z, Cullum NA, Flemming K: Electromagnetic therapy for treating venous leg ulcers. Cochrane Database Syst Rev. 2011, CD002933.Google Scholar
- Ravaghi H, Flemming K, Cullum N, Olyaee Manesh A: Electromagnetic therapy for treating venous leg ulcers. Cochrane Database Syst Rev. 2006, CD002933.Google Scholar
- Shen JG, Chen WS, Wang CX, Jiang T, Dong LQ: [Effect of static magnetic field on deep wound healing of SD rats]. Zhongguo Gu Shang. 2009, 22: 371-374.PubMedGoogle Scholar
- Maioli M, Rinaldi S, Santaniello S, Castagna A, Pigliaru G, Gualini S, Fontani V, Ventura C: Radiofrequency energy loop primes cardiac, neuronal, and skeletal muscle differentiation in mouse embryonic stem cells: a new tool for improving tissue regeneration. Cell Transplant. 2012, 21: 1225-1233. 10.3727/096368911X600966.PubMedView ArticleGoogle Scholar
- Maioli M, Rinaldi S, Santaniello S, Castagna A, Pigliaru G, Gualini S, Cavallini C, Fontani V, Ventura C: Radio electric conveyed fields directly reprogram human dermal-skin fibroblasts towards cardiac-, neuronal-, and skeletal muscle-like lineages. Cell Transplant 2012, Epub ahead of print.Google Scholar
- Castagna A, Fontani V, Rinaldi S, Mannu P: Radio electric tissue optimization in the treatment of surgical wounds. Clin Cosmet Investig Dermatol. 2011, 4: 133-137.PubMedPubMed CentralGoogle Scholar
- Fontani V, Castagna A, Mannu P, Rinaldi S: Radioelectric asymmetric stimulation of tissues as treatment for post-traumatic injury symptoms. International Journal of General Medicine. 2011, 4: 627-634.PubMedPubMed CentralGoogle Scholar
- Rinaldi S, Fontani V, Cupelli V, Arcangeli G, Aravagli L, Bini S, Ciuti V, Saragò G: Capillaroscopy changes of the face, induced by activation with REAC tissue stimulation, in the treatment of local adaptation syndrome. Dermatologia Ambulatoriale. 2007, XV: 29-35.Google Scholar
- Careddu GM, Cubeddu F, Cossu I, Cherchi R, Fontani V, Castagna A, Collodel G, Rinaldi S, Sanna Passino E: First experiences on the use of radio electric conveyer asymmetric (REAC) in stallion infertility. In XVI SIVE international congress. Marina di Carrara: Società Italiana Veterinari per Equini; 2010:288.Google Scholar
- Sanna Passino E, Careddu GM, Cubeddu F, Secci F, Rossi G, Columbano N,Masala G, Manunta ML, Fontani V, Castagna A, Rinaldi S: First experiences on the use of radio electric conveyer asymmetric (REAC) in equine medicine. In XVI SIVE international congress. Marina di Carrara: Società Italiana Veterinari per Equini; 2010:312.Google Scholar
- Collodel G, Fioravanti A, Pascarelli NA, Lamboglia A, Fontani V, Maioli M, Santaniello S, Pigliaru G, Castagna A, Moretti E, Iacoponi F, Rinaldi S, Ventura C: Effects of a regenerative radio electric asymmetric conveyer (REAC) treatment on human normal and osteoarthritic chondrocytes exposed to IL-1β. A biochemical and morphological stud. Clin Interv Aging. 2013, in pressGoogle Scholar
- Bertelsen MF, Sauer CD: Alfaxalone anaesthesia in the green iguana (Iguana iguana). Vet Anaesth Analg. 2011, 38: 461-466. 10.1111/j.1467-2995.2011.00640.x.PubMedView ArticleGoogle Scholar
- Bennet R, Mader DR: Soft tissue surgery. In Reptile medicine and surgery.Edited by Mader D. St.Louis: Elsevier; 1996:287–298.Google Scholar
- Mitchell MA, Diaz-Figueroa O: Wound management in reptiles. Vet Clin North Am Exot Anim Pract. 2004, 7: 123-140. 10.1016/j.cvex.2003.08.006.PubMedView ArticleGoogle Scholar
- Girling S, Raiti P, British Small Animal Veterinary Association: BSAVA manual of reptiles. 2nd edition. Quedgeley: British Small Animal Veterinary Association; 2004.Google Scholar
- Smith DA, Barker IK, Allen OB: The effect of ambient temperature and type of wound on healing of cutaneous wounds in the common garter snake (Thamnophis sirtalis). Can J Vet Res. 1988, 52: 120-128.PubMedPubMed CentralGoogle Scholar
- Beynon PH, Lawton MPC, Cooper JE, British Small Animal Veterinary Association: Manual of reptiles. Ames: Iowa State University Press; 1994.Google Scholar
- Adkesson MJ, Travis EK, Weber MA, Kirby JP, Junge RE: Vacuum-assisted closure for treatment of a deep shell abscess and osteomyelitis in a tortoise. J Am Vet Med Assoc. 2007, 231: 1249-1254. 10.2460/javma.231.8.1249.PubMedView ArticleGoogle Scholar
- Vella D: Management of freshwater turtle shell injuries. Lab Anim (NY). 2009, 38: 13-14. 10.1038/laban0109-13.View ArticleGoogle Scholar