Showing papers in "Wounds-a Compendium of Clinical Research and Practice in 2008"

A Review of Collagen and Collagen-based Wound Dressings.

Abstract: Collagen is a key component of a healing wound. In this review, a general description of the wound healing process is provided focusing on collagen's unique role. The mode of action (MoA) of collagen-based dressings is also addressed. Due to a number of potential stimuli (local tissue ischemia, bioburden, necrotic tissue, repeated trauma, etc.), wounds can stall in the inflammatory phase contributing to the chronicity of the wound. One key component of chronic wounds is an elevated level of matrix metalloproteinases (MMPs). At elevated levels, MMPs not only degrade nonviable collagen but also viable collagen. In addition, fibroblasts in a chronic wound may not secrete tissue inhibitors of MMPs (TIMPs) at an adequate level to control the activity of MMPs. These events prevent the formation of the scaffold needed for cell migration and ultimately prevent the formation of the extracellular matrix (ECM) and granulation tissue. Collagen based wound dressings are uniquely suited to address the issue of elevated levels of MMPs by acting as a 'sacrificial substrate' in the wound. It has also been demonstrated that collagen breakdown products are chemotactic for a variety of cell types required for the formation of granulation tissue. In addition, collagen based dressings have the ability to absorb wound exudates and maintain a moist wound environment.

Assessment of a wound cleansing solution in the treatment of problem wounds.

Abstract: Chronic wounds will heal in most cases if provided an optimal local wound environment and therapy that addresses underlying disease. The quality of topical wound management will influence the speed of the wound healing process. The value of cleansing chronic wounds is considered a basic principle in modern wound management. Several methods are available for wound cleansing and debridement. Currently, there has been focus on measures of wound cleansing whereby debris and exudate are gently and continuously removed to prepare the wound bed for wound closure. For this purpose, physiological solutions or specific disinfectants may be used. This retrospective analysis of existing data was performed looking at the clinical efficacy and cost-effectiveness of using a wound antiseptic to treat problem wounds. Wound cleansing upon dressing changes using a polyhexanide containing solution (Prontosan®, B Braun, Melsungen AG, Germany) in venous leg ulcers was compared to cleansing with either Ringer's solution or saline. The wounds of the patients treated with polyhexanide solution healed faster and in more cases (97% versus 89%). The Kaplan-Meier mean estimate (and associated standard error [SE]) demonstrated a statistically significant difference between treatment groups (P < 0.0001) in time to healing. The Kaplan-Meier mean time to healing for the study group (SG) was 3.31 months (SE = 0.17) compared to 4.42 months (SE = 0.19) for the control group ([CG], saline/Ringer's solution). .

Calendula officinalis and Wound Healing: A Systematic Review.

Abstract: The treatment options available for the management of most types of wounds are both diverse and contentious. One agent that has been utilized for centuries for the treatment of dermatological disorders and possesses a number of pharmacological actions that are conducive to wound healing is Calendula officinalis, or pot marigold. To assess the effect of Calendula on wound healing, a systematic review of the literature was conducted. The search was limited to randomized controlled trials that used topically administered monopreparations of Calendula officinalis for wounds of any type. Although 6 trials were identified, only 1 trial was of good quality; hence, the statistical pooling of results was not appropriate. Therefore, a narrative review of these studies was conducted indicating that there is only weak evidence to support the topical administration of Calendula in acute and chronic wounds. Undoubtedly, further investigation is needed to establish whether Calendula has a place in mainstream wound care.

Surgical management of the diabetic foot.

Abstract: Wounds of the foot are the most common reason for diabetes-related hospital admissions. In many of these cases, surgical intervention is the best option. This article will review the risk factors for foot wounds in people with diabetes, discuss preventative and surgical strategies, and present surgical management techniques to treat ulceration and chronic infection in these wounds. .

The influence of gender as a risk factor in diabetic foot ulceration.

Abstract: UNLABELLED Objective. In a previous large, prospective trial, 29% of all patients with diabetes were shown to ulcerate over a 30-month period. The influence of gender on foot ulcers has been controversial, with some studies demonstrating male gender as a risk factor, while other studies have shown no difference. The authors hypothesized that gender may pose a significant risk factor for the development of diabetic foot ulcers. METHODS A total of 248 patients with diabetes were enrolled in a 30-month, multicenter, prospective study. There were 124 men (M) and 124 women (W). There were no differences between M and W in age (59 ± 12 years [mean ± SD]) versus 57 ± 13), duration of diabetes mellitus (15 ± 11 years versus 13 ± 11), or body mass index (BMI) (30.0 ± 7.7 versus 31.3 ± 6.2). The following known risk factors for diabetic foot ulceration were measured in both groups: Neuropathy Disability Score (NDS), Vibration Perception Threshold (VPT), Semmes Weinstein Monofilament (SWM), plantar peak foot pressures, and subtalar joint (STJ) and first metatarsal joint (MTPJ) mobility. RESULTS Men had higher NDS (13 ± 8 versus 8 ± 7, P < 0.0001), VPT (36 ± 17 V versus 23 ± 16, P < 0.0001), SWM (5.9 ± 1.4 versus 5.9 ± 1.3, P <0.0001), and plantar peak foot pressures (6.4 ± 3.4 kg/cm2 versus 5.0 ± 2.3, P < 0.0001), while women had higher MTPJ mobility (69 ± 24 degrees versus 77 ± 23, P < 0.0001) and STJ mobility (22 ± 10 degrees versus 26 ± 8, P < 0.0001). Plantar foot ulceration developed in 49 (40%) men compared to 24 (19%) women (P <0.0001). However, when men and women were analyzed separately, univariate logistical regression analysis yielded similar odds ration (OR) in both groups for high NDS (≥ 5, M 6.1, W 8.3), high VPT (≥ 25 V, M 6.0, W 8.9), SWM (M 6.6, W 3.7), high foot pressures (≥ 6 kg/cm2, M 2.7, W 3.0), and MTPJ mobility (M 0.96, W 0.97). CONCLUSION While women have a lower risk than men for foot ulceration, this appears to be the result of less severe neuropathy, increased joint mobility, and lower foot pressures. However, once neuropathy or other risk factors are present, women were found to have the same risk of developing a foot ulceration as men. Therefore, women with risk factors for foot ulceration should be considered to be at equal risk as men for developing future problems.

Relevance of animal models for wound healing.

Abstract: Animal models and in-vitro assays have become indispensable tools for researchers in nearly every scientific discipline. Although definitive studies, which are conducted on human subjects, are the final testimonial of product efficacy, such studies can present several practical, ethical, and moral concerns. In-vitro assays are extremely useful when examining the effect of agents on particular cell types or specific environmental factors that could be influential during repair or infection. Some of the attractive benefits of these studies include: 1) relatively inexpensive, 2) fast, 3) convenient, and 4) provide important information on their potential cell to cell function. However, in-vitro assays are incapable of completely reproducing biological conditions such as immune response, healing, and disease. Animal models are the next step when assessing product efficacy. Animal models are beneficial to wound research because of their compliance, and are ethical, easily manipulated, and flexible. Both small and animal large animal studies have their benefits and limitations. Pre-clinical testing should address toxicology, safety, and efficacy effects, preferable in a dose-response fashion. Ultimately well-controlled, randomized clinical trials are needed to finally demonstrate the true potential of any formulation. Overall, product development of wound healing/infection therapies is a progression of steps within each stage (in-vitro to in-vivo) and need to be carefully conducted to obtain an optimal product for the patient.

Classification, diagnosis, and treatment of diabetic foot ulcers.

Abstract: The diabetic foot is one of the most significant complications of diabetes and is considered to be a major medical, social, and economic problem worldwide. The risk for foot ulceration in patients with diabetes is close to 25% and is also closely related to risk of limb amputation. Diabetic neuropathy, limited joint mobility, micro- and macroangiopathy, and high plantar pressures have been described as the main risk factors for diabetic foot ulceration. Proper diagnosis and adequate therapeutic treatment are considered the cornerstones to prevention of limb amputation and preservation of quality of life in patients with diabetes. The following review focuses on the classification, diagnosis, and current trends in the treatment of diabetic foot ulceration.

Wound healing kinetics of the genetically diabetic mouse.

Abstract: The increased number of chronic nonhealing wounds mirrors the epidemic of type 2 diabetes. Diabetic animal models may allow for better understanding of the pathophysiology of wound healing and may lead to the pre-clinical testing of a variety of therapeutic modalities for this patient group. The authors present an overview of the literature on excisional wound mouse models and focus on the authors' experience with the db/db mouse. Excisional wounds in wild type mice heal quickly due primarily to wound contraction, which is delayed in the db/db mouse. In this animal model it is possible to study and quantify the main mechanisms of healing and produce highly reproducible information. Differences in methodologies, infection control, as well as fine details such as the dressing option, partially explain heterogeneous results in the literature. Given the increase of the diabetic population, the db/db mouse model provides a powerful tool to study the effects of therapeutics for improving wound healing. The standardization of this animal model represents an important aspect to improve in the wound care field.

The Japanese pressure ulcer surveillance study: a retrospective cohort study to determine prevalence of pressure ulcers in Japanese hospitals.

Abstract: UNLABELLED Aim. To evaluate the governmental regulation system introduced in October 2002 by investigating the prevalence of pressure ulcers (PUs) and to investigate the relationship between the change in prevalence and the structure and system within hospitals. METHODS This retrospective cohort study used 2582 randomly sampled hospitals in Japan. Questionnaires were mailed to each type of hospital, including university hospitals, acute hospitals, acute and long-term (mixed care) hospitals, long-term care hospitals, and psychiatric hospitals. Prevalence and severity of pressure ulcers over 4 consecutive periods (1 month before the introduction of regulation, immediately after the introduction, 6 months later, and 1 year later) and related factors for the improved prevalence were assessed. RESULTS The overall prevalence before the regulation was 4.26%, which decreased to 4.18% immediately after regulation, and to 3.95% and 3.64% 6 months and 1 year later, respectively. The overall proportion of Stage III and IV pressure ulcers acquired after admission was 23.9% and 10.9%, respectively, before introduction of regulation, and gradually decreased to 18.8% and 8.1%, respectively, after 1 year. The related factor for improved PU prevalence was sufficient distribution of alternating air mattresses (odds ratio = 2.259, 95% CI; 1.091-4.679, P = 0.028). CONCLUSION The governmental regulation had a clinically important effect on the decrease in PU prevalence. The regulation focused on the structure of hospitals was confirmed to influence the outcome of hospital care quality.

The Role of a Silver Releasing Lipido-colloid Contact Layer in Venous Leg Ulcers Presenting Inflammatory Signs Suggesting Heavy Bacterial Colonization: Results of a Randomized Controlled Study.

Abstract: Objective. Clinical interest of silver in the management of chron- ic wounds is not fully established. The main objective of this clinical study was to assess the ability of a new silver releasing lipido-colloid con- tact layer to promote the healing process of venous leg ulcers (VLU) pre- senting inflammatory signs suggesting a heavy bacteria colonization and then a delayed healing, in comparison to the same wound dressing not impregnated with silver salts. Methods. This was an open-labeled, ran- domized, controlled trial. VLU presenting at least 3 out of 5 clinical signs suggesting heavy bacterial colonization were recruited. Patients were treated with contact layer silver dressing ((CLS), Restore

Living cells or collagen matrix: which is more beneficial in the treatment of diabetic foot ulcers?

Abstract: In a randomized multicenter study, 26 subjects with diabetes, neuropathy, and foot ulceration were treated with standard local wound care and application of either a living skin equivalent [LSE] (Dermagraft®, Advanced BioHealing, La Jolla, Calif) or extracellular matrix [ECM] collagen wound dressing (OASIS® Wound Matrix, Healthpoint, Fort Worth, Tex). Subjects were analyzed to confirm that the wounds, demographics, and health characteristics of subjects in each group were equivalent. Depending on the randomization, subjects received up to 3 applications of LSE or 8 applications of ECM. Subjects received this treatment in conjunction with standard saline dressings for a maximum of 12 weeks, and were observed for 20 weeks. No statistically significant difference was found in the size, distribution, or characteristics of the wounds evaluated in each group. There was no statistically significant difference in the time to closure or the rate of closure between the two groups. Similarly, no significant adverse events were reported in either group. The results of this study show comparable healing rates with use of either material. Further, it was hypothesized that both collagen and cellular components are necessary, and it is suggested that various conditions may make one or the other material more desirable.

Importance of skin perfusion pressure in treatment of critical limb ischemia.

Abstract: UNLABELLED The authors studied whether skin perfusion pressure (SPP) measurements can be used to accurately predict wound healing in critical limb ischemia (CLI) and to select peripheral arterial reconstructive procedures. METHODS Forty-seven patients (33 men and 14 women, age 36-83 years) with 69 ischemic limbs with foot ulcers or gangrene were studied retrospectively. Skin perfusion pressure was compared to the treatment outcomes (ulcers healed and ulcers that failed to heal). As a diagnostic test for CLI, the sensitivity, specificity, and the positive and the negative predictive values (PPV, NPV) of SPP measurement were calculated; the data was then analyzed by the receiver operation characteristic (ROC) curve. RESULTS According to the ROC curve, the best SPP measurement performance was at 35 mmHg. CONCLUSION Wound healing at the appropriate amputation level must be predicted to minimize invasive debridement. Skin perfusion pressure measurement is useful for predicting wound healing in the presence of CLI. Skin perfusion pressure ≥ 35 mmHg is requisite for wound healing; at SPP <35 mmHg, peripheral arterial reconstruction is necessary before debridement.

Understanding pain and quality of life for patients with chronic venous ulcers.

Abstract: UNLABELLED Aim. To identify the impact of pain on quality of life (QOL) of patients with chronic venous ulcers. METHODS A cross-sectional study was performed on 40 outpatients with chronic venous ulcers who were recruited at one outpatient care center in Sao Paulo, Brazil. WHOQOL-Bref was used to assess QOL, the McGill Pain Questionnaire-Short Form (MPQ) to identify pain characteristics, and an 11-point numerical pain rating scale to measure pain intensity. Kruskall-Wallis or ANOVA test, with post-hoc correction (Tukey test) was applied to compare groups. Multiple linear regression models were used. RESULTS The mean age of the patients was 67 ± 11 years (range, 39-95 years), and 26 (65%) were women. The prevalence of pain was 90%, with worst pain mean intensity of 6.2 ± 3.5. Severe pain was the most prevalent (21 patients, 52.5%). Pain most frequently reported was sensory-discriminative and evaluative in quality. Pain was significantly and negatively correlated with physical (PY), environmental (EV), and overall QOL. Compared to a no-pain group, those with pain had lower overall QOL. On multiple analyses, pain remained as a predictor of overall QOL (b = -0.73, P = 0.03) and was also predictive of social QOL, whereas pain did not have any impact on physical, emotional, or social relationships QOL (b = -3.85, P = 0.00) when adjusted for age, number, duration and frequency of wounds, pain dimension (MPQ), partnership, and economic status. CONCLUSION To improve QOL of outpatients with chronic venous ulcers, the qualities and the intensity of pain must be considered differently.

Clinical evaluation of a wound measurement and documentation system.

Abstract: Wound measurement is essential in assessing the progress of wound healing. The most commonly used tools include wound tracings, width and length measurements, and digital photography. These methods have been useful in clinical practice but have some limitations, such as lack of accuracy, difficulty of use, and often entail wound contact. More advanced equipment tends to be bulky, heavy, and expensive. The following reviews the authors' experience with a new wound measurement and documentation system, the ARANZ Medical Silhouette Mobile™ (ARANZ Medical, Christchurch, New Zealand). This innovative device combines a digital camera and structured lighting in the form of 2 laser beams to automatically correct for image scale and skin curvature, allowing rapid and accurate measurements of the wound surface area and depth. The scanner unit plugs into a standard personal digital assistant to form a portable device that can be easily held and operated using 1 hand. The scanner has been used in clinical practice trials in patients with venous leg ulcers, diabetic foot ulcers, and in the community setting. The scanner was found to be accurate and reliable, easy to learn and use, portable, and compact. The results presented suggest that this device may be a viable choice in the management of different types of chronic wounds.

A Comparison of Three Silver-containing Dressings in the Treatment of Infected, Chronic Wounds.

Abstract: Objective. To compare 3 types of silver dressing in the typi- cal clinical conditions of a community health center, regarding the time to achieve resolution of clinical signs of local infection, and wound healing progress over 8 weeks. Methods. A prospective, com- parative study involving 75 patients with infected chronic wounds who were divided into 3 treatment groups: Acticoat ™ (group 1); Comfeel ®

Topical antimicrobials in burn wound care: a recent history.

Abstract: "It is nearly 100 years since antisepsis came to dominate the treatment of burns. All that has been accomplished, as far as we can see from the data available, has been to offset the good that sound physiological and surgical principles and modern aseptic technique should have afforded."1 Carl A. Moyer, MD, 1954 .

Effect of Hyaluronic Acid-carboxymethylcellulose Adhesion Barrier on Wound Healing: An Experimental Study.

Abstract: The aim of this study was to investigate the effects of hyaluronic acid-carboxymethylcellulose (HA-CMC) membrane on the healing process of wounds in rats. One hundred animals were assigned randomly into two equal groups. Midline laparotomies were performed. In group 1, a 5-cm x 3-cm piece of HA-CMC membrane was placed under the laparotomy incision. The same procedure was performed in group 2, but without the HA-CMC membrane. Ten animals from each group were euthanized on postoperative days (POD) 4, 7, 14, 21, and 35 after wounding. Breaking strength, histologic examination, and tissue hydroxyproline levels were analyzed. The tensiometric test showed that there was no significant difference in the breaking strengths between the two groups (P > 0.05). Statistical difference was found to be significant on POD 4, 14, 21, and 35 when the groups were compared with regard to average hydroxyproline levels (P < 0.05). Significant differences were found in the results of histologic examination of the tissue specimens between the two groups in terms of acute inflammation on POD 14, chronic inflammation, and granulation tissue fibroblast maturation on POD 35, collagen deposition on POD 21, and neovascularization on POD 7, 14, 21, and 35 (P < 0.05). The results show that the HA-CMC membrane did not negatively affect the mechanical strength and healing process of the laparotomy incisions.

Limited access dressing.

Abstract: The Limited Access Dressing (LAD) combines the principles of moist wound healing and topical negative pressure dressing along with a provision of an additional port (12-14 FR size tube) for instilling antimicrobial solution/gas of choice (to make wound environment aerobic/anaerobic) without any need to change the dressing. The efficacy of the dressing technique was proven by a study of 39 cases, including 12 cases with exposed bone and tendon (July 2004 to March 2005) where wounds were prepared by LAD II and split-thickness skin grafting with LAD II. Efficacy of LAD was assessed by observing the time to development of healthy granulation tissue and by the quantity of graft take under LAD by day 10. For the wounds studied, an average of 1.51 LAD (range 1-3) was required to develop granulation tissue fit for skin grafting. The average number of days required to prepare the wound under LAD was 17.05 days. An average of 1.03 LAD was required for covering the wound with skin graft (range 1 to 2; median 1) and overall graft take under LAD was 99.87%. In 24 of 39 wounds, an average of 33.83 days of treatment with conventional dressing (range 7 to 120 days; median 22.5 days) could not achieve healthy granulation. When these wounds were switched to LAD, wound preparation took an average of 13.2 days (range 3 to 32 days; median 12 days). It was concluded that LAD is a safe and effective alternative to conventional dressing methods. .

Topical captopril as a novel agent against hypertrophic scar formation in new zealand white rabbit skin.

Abstract: Collagen constitutes the majority of extracellular matrix in tissues such as bone, cartilage, and especially the skin. Over production and/or decreased degradation of collagen fibers could lead to an abnormal wound healing response resulting in hypertrophic scarring or keloid formation. Recently, angiotensin II has been shown to be present in several cutaneous cells and that it stimulates fibroblast proliferation, collagen synthesis, and suppresses matrix metalloproteinase activity. The following study examines the effect of topical captopril, an inhibitor of angiotensin II production, against hypertrophic scar formation in New Zealand white rabbits.Two dermal wounds were made over the ventral surface of the ears of each rabbit (n = 6). In each animal, separate wounds were treated once per day with either topical 5% captopril or the vehicle alone (70% ethanol and 30% propylene glycol) for 7 consecutive days. Wounds were harvested at postoperative day 28, and the scar elevation index (SEI) as well as collagen organization was evaluated. SEI was reduced from 3.06 in the vehicle-treated group to 1.94 in the captopril treated wounds (P < 0.05). However, an increase in collagen organization was achieved by captopril, while an 8.50% decrease in collagen organization scale was derived by captopril compared to the vehicle. Results of this study show, for the first time, the efficacy of topical captopril as a new agent for the prevention of hypertrophic scar formation in an animal model. Thus, captopril might represent the first angiotensin converting enzyme inhibitor with a novel pharmacologic application in dermatology.

Use of a Novel Hydrosurgery Device in Surgical Debridement of Difficult-to-heal Wounds.

Abstract: Debridement is a fundamental step in the management of all chronic and acute cutaneous wounds. Versajet™ Hydrosurgery System (Smith & Nephew, Hull, UK) is a novel waterjet dissection device designed to surgically debride difficult wounds. The authors used this new system on a variety of difficult chronic and acute lesions of different etiology (eg, necrotic infected traumatic and chronic wounds, burns, and post-surgical wounds), which were then managed with adequate dressings or different wound closure techniques such as skin grafting, use of dermal substitutes, negative pressure wound therapy (V.A.C.®, KCI, San Antonio, Tex), or treatment by secondary intention.Debridement can be safely accomplished in a brief operating time with sufficient tissue selectivity and eclecticism. Satisfactory results often were obtained with a single operating session. After debridement, the quality of the wound bed was ideal for accelerating endogenous wound healing or maximizing the effectiveness of other therapeutic measures. The authors believe this hydrosurgery device (Versajet) is a selective, safe, and innovative tool for debridement that allows for better control, can reduce collateral damage, and subsequently achieve overall better outcomes than conventional debridement techniques.

High rates of comorbid conditions in patients with type 2 diabetes and foot ulcers.

Abstract: UNLABELLED Background/Aim. Foot ulceration is one of the most important diabetic complications that results in major medical, social, and economic consequences for patients, their families, and society as a whole. Previous studies have shown increased mortality in patients with diabetes with foot ulcers; however, the reason for the high mortality in this group of patients is not known. The aim of this cross-sectional study was to investigate prevalence rates of comorbid conditions in patients with diabetes and foot ulcers. METHODS A total of 742 patients with type 2 diabetes (234 with foot ulcers and 508 without ulcers), consecutively attending the outpatient diabetes and diabetic foot clinics of the authors' hospital were reviewed. Clinical examination was performed to classify ulcers as neuropathic or neuroischemic, microvascular and macrovascular complications, as well as laboratory tests that were reviewed from medical records. RESULTS Patients with diabetes with and without foot ulcers did not differ significantly in terms of age, sex, smoking habits, glycemic control, and prevalence rates of hypertension, dyslipidemia, and cerebrovascular disease. Known duration of diabetes was longer (P < 0.001), while the values of body mass index (P = 0.03) and creatinine clearance (P = 0.003) were lower in the patients with foot ulcers than in those without ulcers. In addition, prevalence rates of coronary artery disease (P = 0.005), lower extremity arterial disease (P < 0.001), retinopathy (P < 0.001), and nephropathy (P = 0.04), were higher in the patients with foot ulcers compared to those without ulcers. Additionally, duration of diabetes was longer and the prevalence rates of microvascular and macrovascular complications as well as hypertension, dyslipidemia, and smoking were much higher in the patients with neuroischemic ulcers in comparison to those with neuropathic ulcers. CONCLUSION The high mortality rates in patients with diabetes and foot ulcers may be due to the high prevalence rates of comorbid conditions, especially coronary artery disease and nephropathy.

Mast cell morphometry and densitometry in experimental skin wounds treated with a gel containing adelmidrol: a placebo controlled study.

Abstract: The role of skin mast cells (MCs) in wound healing has been extensively investigated. The present study was designed to examine the effect of the aliamide adelmidrol on MCs during healing of experimental cutaneous wounds. Adelmidrol gel or the vehicle alone was applied 3 times daily on 5-mm punch biopsy wounds created on the thoracolumbar skin of 10 dogs. Wounds were allowed to heal by secondary intention. Eight-mm punch samples of the healing wounds were taken on days 1, 2, 4, 8, and 14, for histology. Mast cell numbers were counted and granular content assessed by densitometric analysis on toluidine blue-stained sections. The overall mean granule content wounds, whereas no statistically significant differences in MC counts were observed. These data indicate a reduction in MC degranulation in wounds topically treated with adelmidrol suggesting that the compound is able to down-modulate skin MC releasability without affecting their number.

An Unexpected Detrimental Effect on the Incidence of Heel Pressure Ulcers After Local 5% DMSO Cream Application: A Randomized, Double-blind Study in Patients at Risk for Pressure Ulcers.

Abstract: UNLABELLED Background. Ischemia-reperfusion injury and reactive oxygen species (ROS) are considered to play an important role in the pathogenesis of pressure ulcers (PU). Antioxidants may diminish the inflammation and damage of these ROS in pressure ulcer formation. Dimethyl sulfoxide (DMSO) is a hydroxyl antioxidant that inhibits leukocyte adherence. When used topically, DMSO is a safe and well-tolerated drug with excellent penetrating properties. In this prospective randomized study, the effect of topically applied DMSO on the prevention of PU formation is analyzed. METHODS In a randomized double-blinded study, the effects of massage with or without DMSO creams were assessed against controls for 2 locations (ie, heel and buttocks) in 79 patients prone for development of PU. RESULTS There was no difference in PU incidence between the 3 interventions on the buttocks. Surprisingly, the topical 5% DMSO cream group showed an increase in superficial pressure ulcers for the heel location. CONCLUSION This is the first study on the possible role of DMSO in the prevention of PU. The results suggest an adverse effect on PU incidence in heel, whereas on the buttocks the DMSO cream seems to have no effect. Possible explanations for this unexpected detrimental effect are discussed.

Efficiency of Therapeutic Ultrasound for Healing Venous Leg Ulcers in Surgically-treated Patients.

Abstract: The aim of this study was to evaluate the efficiency of therapeutic ultrasound (US) for healing of venous leg ulcers in surgically treated patients Study endpoints were the number of completely healed wounds and the clinical parameters predicting the outcome Seventy patients with venous leg ulcers were included in this study, and ultimately allocated into two comparative groups Group A consisted of 33 patients (21 women, 12 men) They were treated with the US, compression stockings, and drug therapy Group B (control) consisted of 37 patients (22 women, 15 men) They were treated with the compression stockings and drug therapy only, administered just as in group A Ten patients in group A and 12 in group B healed completely (P > 005) Comparison of Gilman Index and relative change of the total surface area, length, width, and volume did not demonstrate any difference (P > 005) between the groups A more statistically efficient decrease of pus (P = 003) and greater promotion of granulation (P = 003) were observed in group A compared to group B However, the noted changes did not have an influence on acceleration of therapy or final stage of the wound healing process because no differences were detected in the epidermization rate of the ulcers in either group There are no specific indications that US application promotes healing in patients after surgical operation

The effects of topical and systemic Beta glucan administration on wound healing impaired by corticosteroids.

Abstract: UNLABELLED Background. Corticosteroid hormones are widely used to treat a variety of diseases. Corticosteriods have been shown to impair wound healing, which has become a serious clinical problem in wound care. The present study was designed to evaluate the efficacy of topical and systemic beta glucan administration on wound healing impaired by corticosteroids. METHODS Wistar albino rats were used for the incision and excision wound models. Percentage of wound contraction, epithelialization period, hydroxyproline level, histopathological examination, and tensile strength were evaluated. RESULTS Although both systemic and local administration of beta glucan enhanced percentage wound contraction, improved epithelialization time, tensile strength, and elevated hydroxyproline level, systemic administration was found to be more effective. CONCLUSION These results indicate that systemic and topical beta glucan improve wound healing that has been impaired by corticosteroids, and that systemic administration is more effective than topical application.

Quantitation of bacteria in clean, nonhealing, chronic wounds.

Abstract: Quantitative swabs were obtained from 30 clean, chronic wounds on 30 different patients during one visit. The number of organisms and the predominant organism were determined. All samples were processed under both aerobic and anaerobic conditions. Nineteen (63%) of the 30 clean wounds had bacterial levels that were ≥ 105 cfu/cm2. There was no correlation between ≥ 105 cfu/cm2 and delayed wound healing. The most frequently isolated predominant organism was Staphylococcus aureus. In these clean, chronic wounds, an obligate anaerobic organism was identified as predominant or co-predominant in only 2 (6.7%) of 30 wounds.

New Topical Agents for Treatment of Partial-thickness Burns in Children: A Review of Published Outcome Studies.

Abstract: Evidence-based choices for treating burns in children are not well defined. Skin substitutes and contemporary dressings offer potential advantages over traditional treatment with topical antimicrobial agents in treating partial-thickness burns. Newer treatment modalities may reduce morbidity, financial burdens, and scarring by accelerating healing. Reports of pediatric burn management from 1997 to 2007 were reviewed to compare agent performance with outcome measures such as healing time, pain moderation, cosmetic results, and hospital costs. Transcyte™ (Smith & Nephew, London), Biobrane® (Bertek Pharmaceuticals Inc, Morgantown, WV), beta-glucan collagen, and Mepitel® (Molnlycke, Goteborg, Sweden) have been reported as superior to silver sulfadiazine (SSD) in achieving faster healing times and decreased pain in pediatric patients. Initial reports describing the outcomes achieved with these new agents indicate that they may offer clinical advantages in the treatment of partial-thickness burns in children. Increased costs of the new products appeared to be offset by decreases in hospital stay, nursing care time and pain medications. The existing literature is not conclusive, and prospective trials with standardized outcome measures are needed to better define the role of these agents. .

Animal models of tissue ischemia to evaluate the importance of oxygen in the wound healing environment.

Abstract: Localized tissue ischemia is a key factor in the development and poor prognosis of chronic wounds. The wide variety of wounds that occur in humans along with multiple comorbidities has precluded the ability to truly define, understand, and optimize treatment(s) for chronic wounds. As these difficult wounds appear to be uniquely human, investigators have had to create models of impaired wound healing for experimental manipulation. The ideal animal model would be relatively inexpensive, reproducible, and adaptable so that laboratories could use it to mimic the human condition. This article will review the current understanding of the effect of ischemia on wound healing and examine the features of currently available animal models that simulate ischemic wounds.

Skin substitutes in burn care.

Abstract: UNLABELLED The history on the use of graft material aside from skin for both partial- and full-thickness burns was sought. METHODS Medline and Google searches were performed using the key words: skin graft, skin substitute, allograft, homograft, xenograft, heterograft, autograft, burn grafting, and burn coverage. Articles retrieved were visually scanned for applicability and those thought to apply were reviewed as were appropriate references obtained within the articles. CONCLUSION There have been several technological advances in the grafting of burns with synthetic materials, but autograft remains the standard to which all other graft resources must be compared.

Surgical management of chronic wounds T.

Abstract: The management of chronic wounds poses a challenge to internists and surgeons alike. Chronic wounds are trapped in a nonadvancing phase of healing and are unable to progress through the sequential stages of tissue repair. The primary roles of surgery in managing these wounds are debridement and wound closure. Surgical debridement releases the chronic wound from its arrested state by removing nonviable tissue, bacteria, and other inhibitory factors, effectively converting it into an acute wound that can undergo healing more effectively. Debridement can be accomplished with a number of techniques, and recent innovations in the wound care industry have added invaluable tools to the wound healing armamentarium. While surgical debridement and closure provide definitive treatment, identifying and treating the underlying cause of a chronic wound is critical to promoting timely healing and preventing wound recurrence.