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Qin W, Nie X, Su H, Ding Y, He L, Liu K, Hou J, Pan K, He L, Yang S, Li L, Yang S, Peng X, Zhao J, Guan J, Kuang X, Hua Q. Efficacy and safety of unilateral tibial cortex transverse transport on bilateral diabetic foot ulcers: A propensity score matching study. J Orthop Translat 2023; 42:137-146. [PMID: 37736148 PMCID: PMC10509564 DOI: 10.1016/j.jot.2023.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 07/12/2023] [Accepted: 08/02/2023] [Indexed: 09/23/2023] Open
Abstract
Background Tibial Cortex Transverse Transport (TTT) has been demonstrated to be an effective treatment for unilateral diabetic foot ulcers (UDFUs). However, this retrospective study was designed to compare the efficacy and safety of unilateral TTT on bilateral diabetic foot ulcers (BDFUs). Methods This retrospective study included a review of patients with TTT treated from January 2017 to August 2019, Propensity Score Matching (PSM) was performed to compare patients with BDFUs to those with UDFUs. Ulcer healing, recurrence, and major amputation rates were evaluated at 1-year follow-up. Changes in foot vessels were assessed in the BDFUs group using computed tomography angiography (CTA). Results A total of 140 patients with DFUs (106 UDFUs and 34 BDFUs) were included in the study. UDFUs and BDFUs were matched in a 1:1 ratio (34 in each group) using PSM. No significant difference was observed at 1-year-follow-up [91.2% (31/34) vs. 76.5% (26/34), OR 0.315 (95% CI 0.08 to 1.31), P = 0.10] and 6-month-follow-up [70.6% (24/34) vs. 50.0% (17/34), OR 0.85 (95% CI 0.15 to 1.13), P = 0.08] in two groups. Significant differences in rates of major amputation and recurrence between the groups (P > 0.05) were not observed. The BDFUs group appeared more angiogenesis of the foot by CTA after 8 weeks of operation. Conclusion Results of this study suggest that severe BDFUs can be effectively treated by unilateral TTT. TTT is easy to operate and effective, which may be a good alternative for treating severe BDFUs. The translational potential of this article In previous retrospective clinical studies, TTT has demonstrated promising clinical outcomes in the management of diabetic foot ulcers. In this current study, we aim to investigate the potential use of TTT in treating distant tissue defects by evaluating the limited availability and safety of TTT for the management of bilateral diabetic foot. While additional basic and clinical research is necessary to fully elucidate the underlying mechanisms, our study offers insight into the potential therapeutic use of TTT for this condition.
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Affiliation(s)
- Wencong Qin
- Department of Bone and Joint Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, China
- Guangxi Diabetic Foot Salvage Engineering Research Center, Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Xinyu Nie
- Guangxi Diabetic Foot Salvage Engineering Research Center, Guangxi Medical University, Nanning, Guangxi, 530021, China
- Research Centre for Regenerative Medicine, Guangxi Medical University, China
- Department of Orthopedics, The Second Hospital, Jilin University, Changchun, Jilin, 130042, China
| | - Hongjie Su
- Department of Bone and Joint Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, China
- Guangxi Diabetic Foot Salvage Engineering Research Center, Guangxi Medical University, Nanning, Guangxi, 530021, China
- Collaborative Innovation Centre of Regenerative Medicine and Medical Bio-Resource Development and Application Co-constructed by the Province and Ministry, Guangxi Medical University, Nanning, Guangxi, 530021, China
- Research Centre for Regenerative Medicine, Guangxi Medical University, China
| | - Yi Ding
- Department of Bone and Joint Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, China
- Guangxi Diabetic Foot Salvage Engineering Research Center, Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Lihuan He
- Guangxi Diabetic Foot Salvage Engineering Research Center, Guangxi Medical University, Nanning, Guangxi, 530021, China
- Department of Orthopedics, Sinopharm Dongfeng General Hospital of Hubei University of Medicine, Shiyan, 442000, Hubei, China
| | - Kaibing Liu
- Department of Bone and Joint Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, China
- Guangxi Diabetic Foot Salvage Engineering Research Center, Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Jun Hou
- Department of Bone and Joint Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, China
- Guangxi Diabetic Foot Salvage Engineering Research Center, Guangxi Medical University, Nanning, Guangxi, 530021, China
- Collaborative Innovation Centre of Regenerative Medicine and Medical Bio-Resource Development and Application Co-constructed by the Province and Ministry, Guangxi Medical University, Nanning, Guangxi, 530021, China
- Research Centre for Regenerative Medicine, Guangxi Medical University, China
| | - Kaixiang Pan
- Department of Bone and Joint Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, China
- Guangxi Diabetic Foot Salvage Engineering Research Center, Guangxi Medical University, Nanning, Guangxi, 530021, China
- Yulin Campus of Guangxi Medical University, Yulin, Guangxi, 537406, China
| | - Liexun He
- Guangxi Diabetic Foot Salvage Engineering Research Center, Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Sijie Yang
- Department of Bone and Joint Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, China
- Guangxi Diabetic Foot Salvage Engineering Research Center, Guangxi Medical University, Nanning, Guangxi, 530021, China
- Collaborative Innovation Centre of Regenerative Medicine and Medical Bio-Resource Development and Application Co-constructed by the Province and Ministry, Guangxi Medical University, Nanning, Guangxi, 530021, China
- Research Centre for Regenerative Medicine, Guangxi Medical University, China
| | - Lisha Li
- Guangxi Diabetic Foot Salvage Engineering Research Center, Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Shenghui Yang
- Department of Bone and Joint Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, China
- Guangxi Diabetic Foot Salvage Engineering Research Center, Guangxi Medical University, Nanning, Guangxi, 530021, China
- Collaborative Innovation Centre of Regenerative Medicine and Medical Bio-Resource Development and Application Co-constructed by the Province and Ministry, Guangxi Medical University, Nanning, Guangxi, 530021, China
- Research Centre for Regenerative Medicine, Guangxi Medical University, China
| | - Xiao Peng
- Department of Bone and Joint Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, China
- Guangxi Diabetic Foot Salvage Engineering Research Center, Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Jinming Zhao
- Department of Bone and Joint Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, China
- Guangxi Diabetic Foot Salvage Engineering Research Center, Guangxi Medical University, Nanning, Guangxi, 530021, China
- Collaborative Innovation Centre of Regenerative Medicine and Medical Bio-Resource Development and Application Co-constructed by the Province and Ministry, Guangxi Medical University, Nanning, Guangxi, 530021, China
- Research Centre for Regenerative Medicine, Guangxi Medical University, China
| | - Jack Guan
- Bay Area Foot and Ankle Medical Clinic, San Jose, 3150, California, USA
| | - Xiaocong Kuang
- Guangxi Diabetic Foot Salvage Engineering Research Center, Guangxi Medical University, Nanning, Guangxi, 530021, China
- Yulin Campus of Guangxi Medical University, Yulin, Guangxi, 537406, China
- Research Centre for Regenerative Medicine, Guangxi Medical University, China
| | - Qikai Hua
- Department of Bone and Joint Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, China
- Guangxi Diabetic Foot Salvage Engineering Research Center, Guangxi Medical University, Nanning, Guangxi, 530021, China
- Collaborative Innovation Centre of Regenerative Medicine and Medical Bio-Resource Development and Application Co-constructed by the Province and Ministry, Guangxi Medical University, Nanning, Guangxi, 530021, China
- Research Centre for Regenerative Medicine, Guangxi Medical University, China
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Goshchynsky V, Svidersky Y, Migenko B, Pyatnychka O. Radiofrequency ablation of varicose veins in combination with ultrasonic-assisted wound debridement and platelet-rich plasma as well as platelet-rich fibrin technologies in treatment of lower extremity venous ulcers in office-based surgery. Pan Afr Med J 2022; 42:154. [PMID: 36187047 PMCID: PMC9482222 DOI: 10.11604/pamj.2022.42.154.29834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 06/13/2022] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION for the treatment of varicose ulcer performed clinical and laboratory reasoning of the use of ultrasonic-assisted venous ulcer debridement and Platelet-rich plasma with radiofrequency ablation in an outpatient setting, was carried out. METHODS ultrasonic-assisted debridement of trophic ulcer were performed for 50 patients with lower extremity varicose veins at decompensation stage. The effectiveness of ultrasonic-assisted debridement was evaluated by indicators of bacteriological, morphological, cytological study and assessment of trophic ulcers according to the MEASURE system. After ultrasonic-assisted debridement, the patients were divided into two groups: 30 patients, who underwent combined Platelet-rich plasma to stimulate wound regeneration and 20 patients, for whom the Granuflex hydrocolloid bandage was applied for the same purpose. RESULTS a comparative analysis of ulcer regeneration in two groups of patients proved that in cases of platelet rich plasma the time of transition from inflammatory-regenerative type to regenerative one is much shorter than when using a hydrocolloid dressing. In 28 patients undergoing Platelet-rich plasma (PRP) and Platelet-rich fibrin (PRF), the radiofrequency ablation of the principal superficial and perforating veins was performed. Another 22 patients performed autodermoplasty of trophic ulcers after radiofrequency ablation. CONCLUSION our experience has shown that in a one-day inpatient surgical clinic such a multidisciplinary approach to treatment of venous ulcers, including ultrasonic-assisted debridement that is stimulation of wounded process by Platelet-rich plasma with further surgeries to remove the causes of decompensated chronic insufficiency, is promising regarding low costs of treatment and rehabilitation of these patients.
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Affiliation(s)
- Volodymyr Goshchynsky
- Department of Surgery, Institute of Postgraduate Education, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
| | - Yrij Svidersky
- Department of Surgery, Institute of Postgraduate Education, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
| | - Bogdan Migenko
- Department of Internal Medicine N 2, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine,Corresponding author: Bogdan Migenko, Department of Internal Medicine N 2, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine.
| | - Oleg Pyatnychka
- Department of Surgery, Institute of Postgraduate Education, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
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Silva LG, Albuquerque AV, Pinto FCM, Ferraz-Carvalho RS, Aguiar JLA, Lins EM. Bacterial cellulose an effective material in the treatment of chronic venous ulcers of the lower limbs. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2021; 32:79. [PMID: 34191140 PMCID: PMC8245359 DOI: 10.1007/s10856-021-06539-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 05/28/2021] [Indexed: 05/31/2023]
Abstract
Chronic venous ulcers (CVU) of the lower limbs (LL) are common and cause psychological changes and significant social impact, as they make the patient susceptible to pain, absence from work and social bonds. Some materials are suggested as dressings for the treatment of CVU, but they are expensive and are generally not available for use in public health services. To evaluate the efficacy of the treatment for lower limbs (LL) chronic venous ulcer (CVU) using bacterial cellulose (BC), gel and multi-perforated film associated. A randomized controlled clinical-intervention study was performed among participants with LL CVU, divided into two groups: experimental (EG), treated with BC wound dressing and control (CG), treated with a cellulose acetate mesh impregnated with essential fatty acids (Rayon®). The participants were followed for 180 days, evaluated according to the MEASURE methodology. Thirty-nine patients were treated, 20 from the EG and 19 from the CG. In both groups, the wound area decreased significantly (p < 0.001), the healing rate was similar to the CG. The mean number of dressing changes in the SG was 18.33 ± 11.78, while in the CG it was 55.24 ± 25.81, p < 0.001. The healing dressing of bacterial cellulose, gel and associated film, when stimulating the epithelization of the lesions, showed a significant reduction in the initial area, with a percentage of cure similar to the Rayon® coverage. In addition to requiring less direct manipulation of ulcers.
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Affiliation(s)
- Liliada G Silva
- Department of Angiology and Vascular Surgery, Clinics Hospital, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Amanda V Albuquerque
- Post-graduation Program in Surgery, Department of Surgery, Federal University of Pernambuco, Pernambuco, Brazil
| | - Flávia C M Pinto
- Post-graduation Program in Surgery, Department of Surgery, Federal University of Pernambuco, Pernambuco, Brazil
| | - Rafaela S Ferraz-Carvalho
- Post-graduation Program in Surgery, Department of Surgery, Federal University of Pernambuco, Pernambuco, Brazil
| | - José L A Aguiar
- Post-graduation Program in Surgery, Department of Surgery, Federal University of Pernambuco, Pernambuco, Brazil
| | - Esdras M Lins
- Department of Angiology and Vascular Surgery, Clinics Hospital, Federal University of Pernambuco, Recife, Pernambuco, Brazil.
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Schroeppel DeBacker SE, Bulman JC, Weinstein JL. Wound Care for Venous Ulceration. Semin Intervent Radiol 2021; 38:194-201. [PMID: 34108806 PMCID: PMC8175111 DOI: 10.1055/s-0041-1727161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Venous leg ulcers (VLUs) affect as many as 20% of patients with advanced chronic venous insufficiency and are associated with significant morbidity and health care costs. VLUs are the most common cause of leg ulcers; however, other etiologies of lower extremity ulcerations should be investigated, most notably arterial insufficiency, to ensure appropriate therapy. Careful clinical examination, standardized documentation, and ultrasound evaluation are needed for diagnosis and treatment success. Reduction of edema and venous hypertension through compression therapy, local wound care, and treatment of venous reflux or obstruction is the foundation of therapy. As key providers in venous disease, interventional radiologists should be aware of current standardized disease classification and scoring systems as well as treatment and wound care guidelines for venous ulcers.
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Affiliation(s)
| | - Julie C. Bulman
- Harvard Medical School, Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Jeffrey L. Weinstein
- Harvard Medical School, Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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5
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Hallas S, Nelson A, O'Meara S, Adderley U, Meskell P, Nixon J, O'Loughlin A, Probst S, Tawfick W, Wild T, Gethin G. Development of a core outcome set for venous leg ulceration (CoreVen) research evaluations (protocol). J Tissue Viability 2021; 30:317-323. [PMID: 33846059 DOI: 10.1016/j.jtv.2021.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 02/13/2021] [Accepted: 03/22/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND A venous leg ulcer is a chronic leg wound caused by poor venous blood circulation in the lower limbs. It is a recurring condition causing pain, malodour, reduced mobility, and depression. Randomised controlled trials evaluating treatments for venous leg ulcers provide important evidence to inform clinical decision-making. However, for findings to be useful, outcomes need to be clinically meaningful, consistently reported across trials, and fully reported. Research has identified the large number of outcomes reported in venous leg ulcer trials, impacting both synthesis of results, and clinical decision-making. To address this, a core outcome set will be developed. A core outcome set is an agreed standardised set of outcomes which should be, as a minimum, measured and reported in all trials which evaluate treatment effectiveness for a given indication. A core outcome set has the potential to reduce research waste, improve the utility of RCTs, reduce reporting bias, facilitate treatment comparisons across different sources of evidence and expedite the production of systematic reviews, meta-analyses and evidence-based clinical guidelines. AIM The aim of this project is to develop a core outcome set for research evaluating the effectiveness of interventions for treating venous leg ulceration. METHODS Through a scoping review of the literature on venous leg ulceration, we will firstly identify a list of candidate outcome domains (broad categories in relation to what is being measured) from randomised controlled trials and qualitative research, and outcomes (specific methods in relation to what is being measured). In two further stages, we will use the resulting lists of outcome domains and outcomes to design two online surveys. A range of stakeholders will be invited to participate in the surveys and they will be asked to indicate which outcome domains and outcomes are most important and should be considered as core in future research reports.
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Affiliation(s)
- Sarah Hallas
- Academic Unit of Ageing and Stroke Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK.
| | - Andrea Nelson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | | | - Una Adderley
- School of Healthcare, University of Leeds, Leeds, UK
| | - Pauline Meskell
- Department of Nursing & Midwifery, Faculty of Education & Health Sciences, University of Limerick, Limerick, Ireland
| | - Jane Nixon
- Leeds Institute Health Sciences, School of Medicine, University of Leeds, UK
| | - Aonghus O'Loughlin
- Alliance for Research and Innovation in Wounds, National University of Ireland Galway, Galway, Ireland; Saolta University Health Care Group, University Hospital Galway, Galway, Ireland; School of Medicine, National University of Ireland Galway, Galway, Ireland; Bon Secours Hospital, Galway, Ireland
| | - Sebastian Probst
- HES-SO University of Applied Sciences and Arts Western Switzerland, School of Health Sciences, Geneva, Switzerland; University Hospital Geneva, Geneva, Switzerland
| | - Wael Tawfick
- Alliance for Research and Innovation in Wounds, National University of Ireland Galway, Galway, Ireland; Saolta University Health Care Group, University Hospital Galway, Galway, Ireland; School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Thomas Wild
- University Medical Center Hamburg-Eppendorf, Germany; University of Applied Science Anhalt, Institute of Applied Bioscience and Process Management, Germany; Clinic of Plastic, Hand and Aesthetic Surgery, Medical Center Dessau, University of Applied Science Anhalt, Germany; Clinic of Dermatology, Immunology and Allergology, Medical Center Dessau, Medical University Brandenburg, Theodor Fontane, Medical Center Dessau, Germany
| | - Georgina Gethin
- Alliance for Research and Innovation in Wounds, National University of Ireland Galway, Galway, Ireland; School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
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Nie X, Kuang X, Liu G, Zhong Z, Ding Y, Yu J, Liu J, Li S, He L, Su H, Qin W, Zhao J, Hua Q, Chen Y. Tibial cortex transverse transport facilitating healing in patients with recalcitrant non-diabetic leg ulcers. J Orthop Translat 2021; 27:1-7. [PMID: 33344165 PMCID: PMC7726482 DOI: 10.1016/j.jot.2020.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 11/03/2020] [Accepted: 11/03/2020] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE The treatment of recalcitrant not-diabetic leg ulcers remains challenging. Distraction osteogenesis is accompanying by angiogenesis and neovascularization in the surrounding tissues. We previously applied tibial cortex transverse transport (TTT) to patients with recalcitrant diabetic foot ulcers and found neovascularization and increased perfusion in the foot and consequently enhanced healing and limb salvage and reduced recurrence. However, the effects of TTT on recalcitrant non-diabetic leg ulcer remains largely unknown. METHODS Consecutive patients (n = 85) with recalcitrant non-diabetic leg ulcers (University of Texas Grade 2-B to 3-D, ie, wound penetrating to the tendon, capsule, bone, or joint with infection and/or ischemia) were recruited and divided into TTT (n = 42) and control (n = 43) groups based on the treatment they received. There were 36 (85.7%) arterial ulcers, 4 (9.5%) venous ulcers and 2 (4.8%) mixed ulcers in the TTT group and 32 (74.4%) arterial ulcers, 7 (16.7%) venous ulcers and 4 (9.3%) mixed ulcers in the control group (p > 0.05). The two groups were matched on demographic and clinical characteristics. Patients in the TTT group underwent tibial corticotomy followed by 4 weeks of distraction medially then laterally, while those in the control group received conventional surgeries (debridements, revascularization, reconstruction with flaps, or skin grafts or equivalents). Ulcer healing and healing time, limb salvage, recurrence, and patient death were evaluated at a 1-year follow-up. Changes in leg small vessels were assessed in the TTT group using computed tomography angiography (CTA). RESULTS TTT group had higher healing rates at 1-year follow-up than the control group (78.6% [33/42] vs. 58.1% [25/43], OR 2.64 [95% CI 1.10 to 6.85], p = 0.04). The healing time of the TTT group was shorter than the control group (4.5 vs. 6.1 months, mean difference -1.60 [95% CI -2.93 to -0.26], p = 0.02). There were no significant differences in rates of major amputation, reulceration, or mortality between the groups (p > 0.05). TTT group displayed more small vessels 4 weeks postoperatively at the wound area, the foot, and the calf of the ipsilateral side in CTA. All patients in the TTT group achieved good union at the osteotomy site and had no skin or soft tissue necrosis or infection around the incision area. CONCLUSION The findings showed that TTT facilitated the healing of recalcitrant non-diabetic leg ulcers and reduced the healing time compared with conventional surgeries. They suggest that TTT is an effective procedure to treat recalcitrant non-diabetic foot ulcers compared with standard surgical therapy. The procedure of TTT is relatively simple. Randomized controlled trials are required to confirm these findings. THE TRANSLATIONAL POTENTIAL OF THIS ARTICLE TTT can be used as an effective treatment for recalcitrant non-diabetic leg ulcers in patients. The mechanism may be associated with the neovascularization in the ulcerated foot induced by TTT and consequently increased perfusion. Together with previous findings from recalcitrant diabetic leg ulcers, the findings suggest TTT as an effective procedure to treat recalcitrant chronic leg ulcers.
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Affiliation(s)
- Xinyu Nie
- Department of Bone and Joint Surgery, The First Affiliated Hospital of Guangxi Medical University, China
| | - Xiaocong Kuang
- Department of Physiopathology, Preclinical School of Guangxi Medical University, China
| | - Guangwei Liu
- Department of Bone and Joint Surgery, The First Affiliated Hospital of Guangxi Medical University, China
| | - Zhaowei Zhong
- Department of Bone and Joint Surgery, The First Affiliated Hospital of Guangxi Medical University, China
| | - Yi Ding
- Department of Bone and Joint Surgery, The First Affiliated Hospital of Guangxi Medical University, China
| | - Jie Yu
- Department of Bone and Joint Surgery, The First Affiliated Hospital of Guangxi Medical University, China
| | - Jie Liu
- Department of Bone and Joint Surgery, The First Affiliated Hospital of Guangxi Medical University, China
| | - Shanlang Li
- Department of Bone and Joint Surgery, The First Affiliated Hospital of Guangxi Medical University, China
| | - Liexun He
- Department of Bone and Joint Surgery, The First Affiliated Hospital of Guangxi Medical University, China
| | - Hongjie Su
- Department of Bone and Joint Surgery, The First Affiliated Hospital of Guangxi Medical University, China
| | - Wencong Qin
- Department of Bone and Joint Surgery, The First Affiliated Hospital of Guangxi Medical University, China
| | - Jinmin Zhao
- Department of Bone and Joint Surgery, The First Affiliated Hospital of Guangxi Medical University, China
| | - Qikai Hua
- Department of Bone and Joint Surgery, The First Affiliated Hospital of Guangxi Medical University, China
| | - Yan Chen
- Department of Bone and Joint Surgery, The First Affiliated Hospital of Guangxi Medical University, China
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7
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Ren SY, Liu YS, Zhu GJ, Liu M, Shi SH, Ren XD, Hao YG, Gao RD. Strategies and challenges in the treatment of chronic venous leg ulcers. World J Clin Cases 2020. [PMID: 33269244 DOI: 10.12998/wjcc.v8.i21.5070.pmid:] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Evaluating patients with chronic venous leg ulcers (CVLUs) is essential to find the underlying etiology. The basic tenets in managing CVLUs are to remove the etiological causes, to address systemic and metabolic conditions, to examine the ulcers and artery pulses, and to control wound infection with debridement and eliminating excessive pressure on the wound. The first-line treatments of CVLUs remain wound care, debridement, bed rest with leg elevation, and compression. Evidence to support the efficacy of silver-based dressings in healing CVLUs is unavailable. Hydrogen peroxide is harmful to the growth of granulation tissue in the wound. Surgery options include a high ligation with or without stripping or ablation of the GSVs depending on venous reflux or insufficiency. Yet, not all CVLUs are candidates for surgical treatment because of comorbidities. When standard care of wound for 4 wk failed to heal CVLUs effectively, use of advanced wound care should be considered based on the available evidence. Negative pressure wound therapy facilitates granulation tissue development, thereby helping closure of CVLUs. Autologous split-thickness skin grafting is still the gold standard approach to close huge CVLUs. Hair punch graft appears to have a better result than traditional hairless punch graft for CVLUs. Application of adipose tissue or placenta-derived mesenchymal stem cells is a promising therapy for wound healing. Autologous platelet-rich plasma provides an alternative strategy for surgery for safe and natural healing of the ulcer. The confirmative efficacy of current advanced ulcer therapies needs more robust evidence.
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Affiliation(s)
- Shi-Yan Ren
- Department of General Surgery and Vascular Surgery, Aviation General Hospital, China Medical University, Beijing 100012, China.
| | - Yong-Sheng Liu
- Department of Dermatology, Aviation General Hospital, Beijing 100012, China
| | - Guo-Jian Zhu
- Department of General Surgery, Taian Communications Hospital, Taian 271000, Shandong Province, China
| | - Meng Liu
- Department of Surgery, Tianjin Hexi Hospital, Tianjin 300202, Tianjin, China
| | - Shao-Hui Shi
- Department of Orthopaedic Surgery, Aviation General Hospital, China Medical University, Beijing 100012, China
| | - Xiao-Dong Ren
- Department of Surgery, Wanquanqu Zhongyi Hospital, Zhangjiakou 076250, Hebei Province, China
| | - Ya-Guang Hao
- Department of Medical Administrative, Aviation General Hospital, China Medical University, Beijing 100012, China
| | - Rong-Ding Gao
- Department of General Surgery, Aviation General Hospital, China Medical University, Beijing 100012, China
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8
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Ren SY, Liu YS, Zhu GJ, Liu M, Shi SH, Ren XD, Hao YG, Gao RD. Strategies and challenges in the treatment of chronic venous leg ulcers. World J Clin Cases 2020; 8:5070-5085. [PMID: 33269244 PMCID: PMC7674718 DOI: 10.12998/wjcc.v8.i21.5070] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 08/06/2020] [Accepted: 09/28/2020] [Indexed: 02/05/2023] Open
Abstract
Evaluating patients with chronic venous leg ulcers (CVLUs) is essential to find the underlying etiology. The basic tenets in managing CVLUs are to remove the etiological causes, to address systemic and metabolic conditions, to examine the ulcers and artery pulses, and to control wound infection with debridement and eliminating excessive pressure on the wound. The first-line treatments of CVLUs remain wound care, debridement, bed rest with leg elevation, and compression. Evidence to support the efficacy of silver-based dressings in healing CVLUs is unavailable. Hydrogen peroxide is harmful to the growth of granulation tissue in the wound. Surgery options include a high ligation with or without stripping or ablation of the GSVs depending on venous reflux or insufficiency. Yet, not all CVLUs are candidates for surgical treatment because of comorbidities. When standard care of wound for 4 wk failed to heal CVLUs effectively, use of advanced wound care should be considered based on the available evidence. Negative pressure wound therapy facilitates granulation tissue development, thereby helping closure of CVLUs. Autologous split-thickness skin grafting is still the gold standard approach to close huge CVLUs. Hair punch graft appears to have a better result than traditional hairless punch graft for CVLUs. Application of adipose tissue or placenta-derived mesenchymal stem cells is a promising therapy for wound healing. Autologous platelet-rich plasma provides an alternative strategy for surgery for safe and natural healing of the ulcer. The confirmative efficacy of current advanced ulcer therapies needs more robust evidence.
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Affiliation(s)
- Shi-Yan Ren
- Department of General Surgery and Vascular Surgery, Aviation General Hospital, China Medical University, Beijing 100012, China
| | - Yong-Sheng Liu
- Department of Dermatology, Aviation General Hospital, Beijing 100012, China
| | - Guo-Jian Zhu
- Department of General Surgery, Taian Communications Hospital, Taian 271000, Shandong Province, China
| | - Meng Liu
- Department of Surgery, Tianjin Hexi Hospital, Tianjin 300202, Tianjin, China
| | - Shao-Hui Shi
- Department of Orthopaedic Surgery, Aviation General Hospital, China Medical University, Beijing 100012, China
| | - Xiao-Dong Ren
- Department of Surgery, Wanquanqu Zhongyi Hospital, Zhangjiakou 076250, Hebei Province, China
| | - Ya-Guang Hao
- Department of Medical Administrative, Aviation General Hospital, China Medical University, Beijing 100012, China
| | - Rong-Ding Gao
- Department of General Surgery, Aviation General Hospital, China Medical University, Beijing 100012, China
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9
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Abbade LPF, Frade MAC, Pegas JRP, Dadalti-Granja P, Garcia LC, Bueno Filho R, Parenti CEF. Consensus on the diagnosis and management of chronic leg ulcers - Brazilian Society of Dermatology. An Bras Dermatol 2020; 95 Suppl 1:1-18. [PMID: 33371937 PMCID: PMC7772605 DOI: 10.1016/j.abd.2020.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 06/03/2020] [Accepted: 06/07/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Chronic leg ulcers affect a large portion of the adult population and cause a significant social and economic impact, related to outpatient and hospital care, absence from work, social security expenses, and reduced quality of life. The correct diagnosis and therapeutic approach are essential for a favorable evolution. OBJECTIVE To gather the experience of Brazilian dermatologists, reviewing the specialized literature to prepare recommendations for the diagnosis and treatment of the main types of chronic leg ulcers. METHODS Seven specialists from six university centers with experience in chronic leg ulcers were appointed by the Brazilian Society of Dermatology to reach a consensus on the diagnosis and therapeutic management of these ulcers. Based on the adapted DELPHI methodology, relevant elements were considered in the diagnosis and treatment of chronic leg ulcers of the most common causes; then, the recent literature was analyzed using the best scientific evidence. RESULTS The following themes were defined as relevant for this consensus - the most prevalent differential etiological diagnoses of chronic leg ulcers (venous, arterial, neuropathic, and hypertensive ulcers), as well as the management of each one. It also included the topic of general principles for local management, common to chronic ulcers, regardless of the etiology. CONCLUSION This consensus addressed the main etiologies of chronic leg ulcers and their management based on scientific evidence to assist dermatologists and other health professionals and benefit the greatest number of patients with this condition.
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Affiliation(s)
- Luciana Patricia Fernandes Abbade
- Department of Infectious Diseases, Dermatology, Diagnostic Imaging and Radiotherapy, Faculty of Medicine, Universidade Estadual Paulista, Botucatu, SP, Brazil.
| | - Marco Andrey Cipriani Frade
- Department of Internal Medicine (Dermatology Division), Faculty of Medicine, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - José Roberto Pereira Pegas
- Dermatology Service, Hospital Padre Bento de Guarulhos, Guarulhos, SP, Brazil; Discipline of Dermatology, Faculty of Medicine, Universidade da Cidade de São Paulo, São Paulo, SP, Brazil; Discipline of Dermatology, Faculty of Medicine, Jundiaí, SP, Brazil
| | - Paula Dadalti-Granja
- Department of Clinical Medicine (Discipline of Dermatology), Universidade Federal Fluminense, Niterói, RJ, Brazil
| | - Lucas Campos Garcia
- Dermatology Service, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Roberto Bueno Filho
- Dermatology Service, Hospital das Clínicas, Faculty of Medicine, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
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10
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Mohd Zubir MZ, Holloway S, Mohd Noor N. Maggot Therapy in Wound Healing: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176103. [PMID: 32825736 PMCID: PMC7504313 DOI: 10.3390/ijerph17176103] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 08/18/2020] [Accepted: 08/20/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND It is estimated that 2% of the population in developing countries suffer from a chronic wound, making it a hidden phenomenon that is increasing as populations age. The ease of access to maggot therapy has made it increasingly attractive for implementation. This study aimed to explore the effectiveness of maggot therapy as compared to hydrogel dressings in the healing of chronic wounds. METHODS An electronic literature search until October 2019 was performed using Medline, Embase, and Cumulative Index of Nursing and Allied Health Literature. The eligibility criteria were chronic wound patients with an intervention that involved a comparison of any maggot species with hydrogel dressings. RESULTS The full text of five studies, involving 580 patients with chronic wounds, was retrieved. Four studies used the Lucilia sericata species. The maggot therapy facilitated faster and more effective debridement of non-viable tissue. It enabled faster development of granulation tissue and increased reduction in the wound surface area compared to hydrogel dressings. Maggot therapy had no effect on disinfection or complete healing rate for the wound. CONCLUSION Maggot therapy should be considered for faster wound debridement, granulation tissue development, and wound surface area reduction as well as in surgical contraindications. This review can be used as a guide to assist clinicians in identifying patients who may benefit from maggot therapy.
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Affiliation(s)
| | - Samantha Holloway
- School of Medicine, Cardiff University, Cardiff CF14 4YS, UK; (M.Z.M.Z.); (S.H.)
| | - Norhayati Mohd Noor
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
- Correspondence: ; Tel.: +6-01-3938-8416; Fax: +60-9764-2172
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11
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Weller CD, Team V, Sussman G. First-Line Interactive Wound Dressing Update: A Comprehensive Review of the Evidence. Front Pharmacol 2020; 11:155. [PMID: 32180720 PMCID: PMC7059819 DOI: 10.3389/fphar.2020.00155] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 02/05/2020] [Indexed: 01/20/2023] Open
Abstract
Wound management is a significant and growing issue worldwide. Knowledge of dressing products and clinical expertise in dressing selection are two major components in holistic wound management to ensure evidence-based wound care. With expanding global market of dressing products, there is need to update clinician knowledge of dressing properties in wound care. Optimal wound management depends on accurate patient assessment, wound diagnosis, clinicians’ knowledge of the wound healing process and properties of wound dressings. We conducted a comprehensive review of the physical properties of wound dressing products, including the advantages and disadvantages, indications and contraindications and effectiveness of first-line interactive/bioactive dressing groups commonly used in clinical practice. These include semipermeable films, foams, hydroactives, alginates, hydrofibers, hydrocolloids, and hydrogels. In making decisions regarding dressing product selection, clinicians need to ensure a holistic assessment of patient and wound etiology, and understand dressing properties when making clinical decisions using wound management guidelines to ensure optimal patient outcomes. This review has highlighted there is lack of high quality evidence and the need for future well designed trials.
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Affiliation(s)
- Carolina D Weller
- Monash Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Victoria Team
- Monash Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Geoffrey Sussman
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
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12
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Jiménez-García JF, Aguilera-Manrique G, Arboledas-Bellón J, Gutiérrez-García M, González-Jiménez F, Lafuente-Robles N, Parra-Anguita L, García-Fernández FP. The Effectiveness of Advanced Practice Nurses with Respect to Complex Chronic Wounds in the Management of Venous Ulcers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E5037. [PMID: 31835653 PMCID: PMC6950269 DOI: 10.3390/ijerph16245037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 12/05/2019] [Accepted: 12/09/2019] [Indexed: 11/25/2022]
Abstract
This study aims to evaluate the effectiveness of advanced practice nurses with respect to complex chronic wounds (APN-CCWs) in the care of patients with venous ulcers. A multicentric, quasi-experimental pre-post study was conducted without a control group in the sanitary management areas where the APN-CCW program is being piloted. The intervention consisted of a mass training of clinical nurses from the participating districts on the proper management of injuries and the use of compression therapy. The data were collected through a specifically constructed questionnaire with questions regarding descriptive variables of injuries and their treatment. A total of 643 professionals responded (response rate of 89.1%), attending to a total population of 707,814 inhabitants. An increase in multilayer bandage use by 15.67%, an increase in elastic bandage use by 13.24%, and a significant decrease in the referral of patients to consultation with hospital specialists was achieved, from 21.08% to 12.34%. The number of patients referred to the APNs was 13.25%, which implied a resolution rate of 94.08% of their injuries. In conclusion, the coordination by the APN-CCWs in patients with venous ulcers was effective in improving the continuity of care, in the optimization of resources, and in their care role.
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Affiliation(s)
- Juan Francisco Jiménez-García
- Advanced Practice Nurse in Complex Chronic Wound, Sanitary District Poniente of Almería, 04746 Venta del Viso, Spain
| | - Gabriel Aguilera-Manrique
- Nursing Department, Dean of the Faculty of Health Sciences, University of Almería, 04120 Almería, Spain;
| | - Josefina Arboledas-Bellón
- Advanced Practice Nurse in Complex Chronic Wound, Sanitary District Jaén Northeast, 23400 Úbeda, Spain;
| | - María Gutiérrez-García
- Advanced Practice Nurse in Complex Chronic Wound, Sanitary District Serrania of Malaga, 29400 Ronda, Spain;
| | - Francisco González-Jiménez
- Advanced Practice Nurse in Complex Chronic Wound, Sanitary District Metropolitano of Granada, 18016 Granada, Spain;
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13
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Colenci R, Abbade LPF. Fundamental aspects of the local approach to cutaneous ulcers. An Bras Dermatol 2019; 93:859-870. [PMID: 30484531 PMCID: PMC6256234 DOI: 10.1590/abd1806-4841.20187812] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 03/31/2018] [Indexed: 01/13/2023] Open
Abstract
Ulcers or wounds can be classified as acute or chronic. Their treatment involves overall assessment of the patient and choice of suitable local therapy, and the appropriate indication and use of products. Technological progress in the field of wound treatment has increased rapidly. Constant updating, with emphasis on available scientific evidence, is necessary to offer the best approaches to patients with acute and chronic wounds. A qualitative analysis of literature was conducted to identify scientific publications that update the concepts involved in local wound treatment, to present some resources that can aid the healing process and describe the different types of dressings available. This review includes wound assessment using the acronym TIME (tissue, infection/inflammation, moisture balance and edge of wound), cleaning and debridement, infection/inflammation control, exudate control, dressing types and main indications.
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Affiliation(s)
- Raquel Colenci
- Technical Section of Nursing in Dermatology, Hospital das
Clínicas, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista,
Botucatu (SP), Brazil
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14
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McLeod K, Walker JT, Hamilton DW. Galectin-3 regulation of wound healing and fibrotic processes: insights for chronic skin wound therapeutics. J Cell Commun Signal 2018; 12:281-287. [PMID: 29372416 DOI: 10.1007/s12079-018-0453-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 01/17/2018] [Indexed: 12/19/2022] Open
Abstract
A member of the lectin family, galectin-3 is a 250 amino-acid protein that contains a C-terminus carbohydrate recognition domain (CRD) that recognizes β-galactosides. Considered to have certain common properties associated with matricellular proteins, galectin-3 is expressed in the dermis and epidermis in healthy skin and is upregulated in skin healing, peaking at day 1 post wounding in mice. Galectin-3 has been implicated in several processes central to the wound healing response, specifically in the regulation of inflammation, macrophage polarization, angiogenesis, fibroblast to myofibroblast transition and re-epithelialization. However, it appears that many of the effects of Galectin-3 are highly tissue specific and context dependent. Genetic deletion of galectin-3 shows different effects in skin compared to lung, heart, and kidney remodeling. In this review, we will compare galectin-3 functions in these tissues. Furthermore, we will discuss, based on its identified regulation of cell processes, whether in an exogenous form, galectin-3 could represent a novel therapeutic for impaired skin healing.
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Affiliation(s)
- Karrington McLeod
- Biomedical Engineering Graduate Program, Schulich School of Medicine and Dentistry, University of Western Ontario, 1151 Richmond St, London, Ontario, N6A 5C1, Canada
| | - John T Walker
- Department of Anatomy & Cell Biology, Schulich School of Medicine and Dentistry, University of Western Ontario, 1151 Richmond St, London, Ontario, N6A 5C1, Canada
| | - Douglas W Hamilton
- Biomedical Engineering Graduate Program, Schulich School of Medicine and Dentistry, University of Western Ontario, 1151 Richmond St, London, Ontario, N6A 5C1, Canada. .,Department of Anatomy & Cell Biology, Schulich School of Medicine and Dentistry, University of Western Ontario, 1151 Richmond St, London, Ontario, N6A 5C1, Canada. .,Division of Oral Biology, Schulich School of Medicine and Dentistry, University of Western Ontario, Dental Sciences Building, 1151 Richmond St, London, Ontario, N6A 5C1, Canada.
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15
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Patry J, Blanchette V. Enzymatic debridement with collagenase in wounds and ulcers: a systematic review and meta-analysis. Int Wound J 2017; 14:1055-1065. [PMID: 28440050 PMCID: PMC7950028 DOI: 10.1111/iwj.12760] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 03/31/2017] [Indexed: 01/22/2023] Open
Abstract
Enzymatic debridement with collagenase is a technique that is commonly used in clinical practice. This systematic review examines the effect of collagenase on all kinds of wounds, compared to an alternative therapy, on wound healing, wound bed characteristics, cost-effectiveness and the occurrence of adverse events. We conducted a systematic literature search on available literature in Cochrane databases, MEDLINE, EMBASE and CINAHL. Two investigators independently assessed the titles and abstracts of all randomised controlled trials obtained involving collagenase of all kinds of wounds based on inclusion criteria. Of the 1411 citations retrieved, 22 studies reported outcomes with the use of collagenase either for wound healing or wound debridement. Results support the use of collagenase for enzymatic debridement in pressure ulcers, diabetic foot ulcers and in conjunction with topical antibiotics for burns. However, studies presented a high risk of bias. Risk ratio of developing an adverse event related to collagenase versus the alternative treatment was statistically significant (for 10 studies, RR: 1·79, 95% CI 1·24-2·59, I2 =0%, P = 0·002). There is very limited data on the effect of collagenase as an enzymatic debridement technique on wounds. More independant research and adequate reporting of adverse events are warranted.
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Affiliation(s)
- Jérôme Patry
- Family Medicine and Emergency Medicine Department, Faculty of MedicineUniversité LavalQuébecCanada
- Complex Wound Care Clinic and Hyperbaric Unit, Centre Hospitalier Affilié Universitaire Hôtel‐Dieu de LévisLévisCanada
- Physical Activity Sciences Department, Podiatric Medicine UnitUniversité du Québec à Trois‐RivièresTrois‐RivièresCanada
| | - Virginie Blanchette
- Physical Activity Sciences Department, Podiatric Medicine UnitUniversité du Québec à Trois‐RivièresTrois‐RivièresCanada
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16
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Harries RL, Bosanquet DC, Harding KG. Wound bed preparation: TIME for an update. Int Wound J 2017; 13 Suppl 3:8-14. [PMID: 27547958 DOI: 10.1111/iwj.12662] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 07/16/2016] [Indexed: 12/11/2022] Open
Abstract
While the overwhelming majority of wounds heal rapidly, a significant proportion fail to progress through the wound-healing process. These resultant chronic wounds cause considerable morbidity and are costly to treat. Wound bed preparation, summarised by the TIME (Tissue, Inflammation/infection, Moisture imbalance, Epithelial edge advancement) concept, is a systematic approach for assessing chronic wounds. Each of these components needs to be addressed and optimised to improve the chances of successful wound closure. We present an up-to-date literature review of the most important recent aspects of wound bed preparation. While there are many novel therapies that are available to the treating clinician, often, there are limited data on which to assess their clinical value, and a lack of appreciation for adequate wound bed preparation needed before expensive therapy is used to heal a wound.
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Affiliation(s)
- Rhiannon L Harries
- Royal College of Surgeons/Welsh Wound Initiative Research Fellow, Wound Healing Research Unit, School of Medicine, Cardiff University, Cardiff, UK
| | - David C Bosanquet
- South East Wales Vascular Network, University Hospital of Medicine, Cardiff, UK
| | - Keith G Harding
- Welsh Wound Innovation Initiative, Cardiff University, Cardiff, UK
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