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Yadav R, Kumar R, Kathpalia M, Ahmed B, Dua K, Gulati M, Singh S, Singh PJ, Kumar S, Shah RM, Deol PK, Kaur IP. Innovative approaches to wound healing: insights into interactive dressings and future directions. J Mater Chem B 2024. [PMID: 38946466 DOI: 10.1039/d3tb02912c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
The objective of this review is to provide an up-to-date and all-encompassing account of the recent advancements in the domain of interactive wound dressings. Considering the gap between the achieved and desired clinical outcomes with currently available or under-study wound healing therapies, newer more specific options based on the wound type and healing phase are reviewed. Starting from the comprehensive description of the wound healing process, a detailed classification of wound dressings is presented. Subsequently, we present an elaborate and significant discussion describing interactive (unconventional) wound dressings. Latter includes biopolymer-based, bioactive-containing and biosensor-based smart dressings, which are discussed in separate sections together with their applications and limitations. Moreover, recent (2-5 years) clinical trials, patents on unconventional dressings, marketed products, and other information on advanced wound care designs and techniques are discussed. Subsequently, the future research direction is highlighted, describing peptides, proteins, and human amniotic membranes as potential wound dressings. Finally, we conclude that this field needs further development and offers scope for integrating information on the healing process with newer technologies.
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Affiliation(s)
- Radhika Yadav
- University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh 160014, India.
| | - Rohtash Kumar
- University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh 160014, India.
| | - Muskan Kathpalia
- University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh 160014, India.
| | - Bakr Ahmed
- University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh 160014, India.
| | - Kamal Dua
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Ultimo, NSW 2007, Australia
| | - Monica Gulati
- Discipline of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab, India
| | - Sachin Singh
- Discipline of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab, India
| | - Pushvinder Jit Singh
- Tynor Orthotics Private Limited, Janta Industrial Estate, Mohali 160082, Punjab, India
| | - Suneel Kumar
- Department of Biomedical Engineering, Rutgers the State University of New Jersey, Piscataway, NJ 08854, USA
| | - Rohan M Shah
- Department of Chemistry and Biotechnology, School of Science, Computing and Engineering Technologies, Swinburne University of Technology, Hawthorn, VIC 3122, Australia
- School of Health and Biomedical Sciences, STEM College, RMIT University, Bundoora West, VIC 3083, Australia
| | - Parneet Kaur Deol
- GHG Khalsa College of Pharmacy, Gurusar Sadhar, Ludhiana, Punjab, India.
| | - Indu Pal Kaur
- University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh 160014, India.
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2
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Shyu YC, Huang TS, Chiu HS, Sumazin P, Lin XY, Liao PC, Liou CC, Hsu FC, Lin JS, Hsu CC, Hsu PH, Sun CC, Chen CT. Deciphering Early-Stage Molecular Mechanisms of Negative Pressure Wound Therapy in a Murine Model. Int J Mol Sci 2024; 25:2373. [PMID: 38397048 PMCID: PMC10888958 DOI: 10.3390/ijms25042373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/13/2024] [Accepted: 02/15/2024] [Indexed: 02/25/2024] Open
Abstract
Negative Pressure Wound Therapy (NPWT) is a commonly employed clinical strategy for wound healing, yet its early-stage mechanisms remain poorly understood. To address this knowledge gap and overcome the limitations of human trials, we establish an NPWT C57BL/6JNarl mouse model to investigate the molecular mechanisms involved in NPWT. In this study, we investigate the intricate molecular mechanisms through which NPWT expedites wound healing. Our focus is on NPWT's modulation of inflammatory immune responses and the concurrent orchestration of multiple signal transduction pathways, resulting in shortened coagulation time and reduced inflammation. Notably, we observe a significant rise in dickkopf-related protein 1 (DKK-1) concentration during NPWT, promoting the differentiation of Hair Follicle Stem Cells (HFSCs) into epidermal cells, expediting wound closure. Under negative pressure, macrophages express and release DKK-1 cytokines, crucial for stimulating HFSC differentiation, as validated in animal experiments and in vitro studies. Our findings illuminate the inflammatory dynamics under NPWT, revealing potential signal transduction pathways. The proposed framework, involving early hemostasis, balanced inflammation, and macrophage-mediated DKK-1 induction, provides a novel perspective on enhancing wound healing during NPWT. Furthermore, these insights lay the groundwork for future pharmacological advancements in managing extensive wounds, opening avenues for targeted therapeutic interventions in wound care.
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Affiliation(s)
- Yu-Chiau Shyu
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung Branch, Keelung 204, Taiwan; (X.-Y.L.); (P.-C.L.); (C.-C.L.); (F.-C.H.); (J.-S.L.)
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan 333, Taiwan
| | - Ting-Shuo Huang
- Department of General Surgery, Jen Ai Hospital, Taichung 400, Taiwan;
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Hua-Sheng Chiu
- Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital Cancer Center, Houston, TX 77030, USA; (H.-S.C.); (P.S.)
| | - Pavel Sumazin
- Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital Cancer Center, Houston, TX 77030, USA; (H.-S.C.); (P.S.)
| | - Xin-Yu Lin
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung Branch, Keelung 204, Taiwan; (X.-Y.L.); (P.-C.L.); (C.-C.L.); (F.-C.H.); (J.-S.L.)
| | - Po-Cheng Liao
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung Branch, Keelung 204, Taiwan; (X.-Y.L.); (P.-C.L.); (C.-C.L.); (F.-C.H.); (J.-S.L.)
| | - Cai-Cin Liou
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung Branch, Keelung 204, Taiwan; (X.-Y.L.); (P.-C.L.); (C.-C.L.); (F.-C.H.); (J.-S.L.)
| | - Fang-Chia Hsu
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung Branch, Keelung 204, Taiwan; (X.-Y.L.); (P.-C.L.); (C.-C.L.); (F.-C.H.); (J.-S.L.)
| | - Jyuan-Siou Lin
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung Branch, Keelung 204, Taiwan; (X.-Y.L.); (P.-C.L.); (C.-C.L.); (F.-C.H.); (J.-S.L.)
| | - Chih-Chin Hsu
- Department of Medicine, School of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Keelung Branch, Keelung 204, Taiwan
| | - Pang-Hung Hsu
- Department of Bioscience and Biotechnology, National Taiwan Ocean University, Keelung 202, Taiwan;
| | - Chi-Chin Sun
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung Branch, Keelung 204, Taiwan;
| | - Chien-Tzung Chen
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan
- Craniofacial Research Center, Chang Gung University, Taoyuan 333, Taiwan
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3
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Gesundheitsökonomische Aspekte der Kaltplasmatherapie:
exemplarische Betrachtung der Versorgung chronischer Wunden mithilfe des
Plasmajet kINPen® MED. GESUNDHEITSÖKONOMIE & QUALITÄTSMANAGEMENT 2023. [DOI: 10.1055/a-2001-1879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
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4
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Recent progress in polymeric biomaterials and their potential applications in skin regeneration and wound care management. J Drug Deliv Sci Technol 2023. [DOI: 10.1016/j.jddst.2023.104319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Ren S, Guo S, Yang L, Wang C. Effect of composite biodegradable biomaterials on wound healing in diabetes. Front Bioeng Biotechnol 2022; 10:1060026. [PMID: 36507270 PMCID: PMC9732485 DOI: 10.3389/fbioe.2022.1060026] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 11/14/2022] [Indexed: 11/27/2022] Open
Abstract
The repair of diabetic wounds has always been a job that doctors could not tackle quickly in plastic surgery. To solve this problem, it has become an important direction to use biocompatible biodegradable biomaterials as scaffolds or dressing loaded with a variety of active substances or cells, to construct a wound repair system integrating materials, cells, and growth factors. In terms of wound healing, composite biodegradable biomaterials show strong biocompatibility and the ability to promote wound healing. This review describes the multifaceted integration of biomaterials with drugs, stem cells, and active agents. In wounds, stem cells and their secreted exosomes regulate immune responses and inflammation. They promote angiogenesis, accelerate skin cell proliferation and re-epithelialization, and regulate collagen remodeling that inhibits scar hyperplasia. In the process of continuous combination with new materials, a series of materials that can be well matched with active ingredients such as cells or drugs are derived for precise delivery and controlled release of drugs. The ultimate goal of material development is clinical transformation. At present, the types of materials for clinical application are still relatively single, and the bottleneck is that the functions of emerging materials have not yet reached a stable and effective degree. The development of biomaterials that can be further translated into clinical practice will become the focus of research.
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Affiliation(s)
- Sihang Ren
- NHC Key Laboratory of Reproductive Health and Medical Genetics (Liaoning Research Institute of Family Planning), The Affiliated Reproductive Hospital of China Medical University, Shenyang, China,Department of Plastic Surgery, The First Hospital of China Medical University, Shenyang, China,The First Clinical College of China Medical UniversityChina Medical University, Shenyang, China,Department of Plastic Surgery, The Second Hospital of Dalian Medical University, Dalian, China
| | - Shuaichen Guo
- The First Clinical College of China Medical UniversityChina Medical University, Shenyang, China
| | - Liqun Yang
- NHC Key Laboratory of Reproductive Health and Medical Genetics (Liaoning Research Institute of Family Planning), The Affiliated Reproductive Hospital of China Medical University, Shenyang, China,*Correspondence: Liqun Yang, ; Chenchao Wang,
| | - Chenchao Wang
- Department of Plastic Surgery, The First Hospital of China Medical University, Shenyang, China,*Correspondence: Liqun Yang, ; Chenchao Wang,
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Barsky D, Ben Ya’acov A, Avraham LW, Nachman D, Eisenkraft A, Mintz Y, Shteyer E. A feasibility study using sodium alginate injection for penetrating abdominal trauma in a swine model. Sci Rep 2022; 12:17132. [PMID: 36224357 PMCID: PMC9556518 DOI: 10.1038/s41598-022-22186-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 10/11/2022] [Indexed: 01/04/2023] Open
Abstract
Penetrating abdominal injury is a major cause of death in trauma. Sodium alginate hydrogel, a hemostatic agent, offers a platform for targeting both mechanical and biological injuries. The current study assessed the effect of Very Low Viscosity (high) G (VLVG) alginate following abdominal trauma in a swine model of penetrating abdominal injury. Seven anesthetized pigs were instrumented with invasive monitoring catheters and abdominal trauma was introduced by laparoscopic hepatectomy. Ten minutes after the induction of hypovolemic shock, three animals were intra-abdominally administered with VLVG alginate (study group) and four animals with saline (control group). During 8 h of continuous monitoring, various hemodynamic and biochemical variables were measured and liver biopsies for histological evaluation were taken. Hemodynamically, VLVG alginate-treated animals were more stable than controls, as reflected by their lower heart rate and higher blood pressure (p < 0.05 for both). They also had lower levels of liver enzymes and lactate, and less histopathological damage. We show that VLVG alginate might be a promising new agent for reducing penetrating intra-abdominal injury, with hemostatic and biocompatibility efficiency, and tissue preserving properties. Future effort of integrating it with a dispersal device may turn it into a valuable pre-hospital emergency tool to improve survival of trauma casualties.
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Affiliation(s)
- Daniel Barsky
- grid.9619.70000 0004 1937 0538Faculty of Medicine, Hebrew University of Jerusalem, Ein Kerem, P.O. Box 12271, Jerusalem, Israel
| | - Ami Ben Ya’acov
- grid.9619.70000 0004 1937 0538Juliet Keidan Pediatric Gastroenterology Institute, Shaare Zedek Medical Center and the Hebrew University of Jerusalem, Shmuel Bait St 12, Jerusalem, Israel
| | - Linn Wagnert Avraham
- grid.9619.70000 0004 1937 0538Institute for Research in Military Medicine, the Hebrew University Faculty of Medicine, Ein Kerem, P.O. Box 12271, Jerusalem, Israel
| | - Dean Nachman
- grid.9619.70000 0004 1937 0538Institute for Research in Military Medicine, the Hebrew University Faculty of Medicine, Ein Kerem, P.O. Box 12271, Jerusalem, Israel ,grid.17788.310000 0001 2221 2926Department of Internal Medicine, Hadassah Medical Center, Ein Kerem, P.O. Box 91120, Jerusalem, Israel
| | - Arik Eisenkraft
- grid.9619.70000 0004 1937 0538Institute for Research in Military Medicine, the Hebrew University Faculty of Medicine, Ein Kerem, P.O. Box 12271, Jerusalem, Israel ,Faculty of Medicine, Institute for Research in Military Medicine, POB 12272, 91120 Jerusalem, Israel
| | - Yoav Mintz
- grid.9619.70000 0004 1937 0538Faculty of Medicine, Hebrew University of Jerusalem, Ein Kerem, P.O. Box 12271, Jerusalem, Israel ,grid.17788.310000 0001 2221 2926Department of General Surgery, Hadassah Hebrew University Medical Center, Ein Kerem, P.O. Box 91120, Jerusalem, Israel
| | - Eyal Shteyer
- grid.9619.70000 0004 1937 0538Juliet Keidan Pediatric Gastroenterology Institute, Shaare Zedek Medical Center and the Hebrew University of Jerusalem, Shmuel Bait St 12, Jerusalem, Israel
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7
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Electrospun multifaceted nanocomposites for promoting angiogenesis in curing burn wound. J Drug Deliv Sci Technol 2022. [DOI: 10.1016/j.jddst.2022.103425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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8
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M P, P SL, Balan Y, Pyati AK. A Comparative Study Between Vacuum Dressing and Normal Saline Dressing for Chronic Non-Healing Ulcers. Cureus 2022; 14:e23870. [PMID: 35530827 PMCID: PMC9074094 DOI: 10.7759/cureus.23870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction Isn’t it a boon that all living organisms possess the ability to heal their injuries? The wound healing is faster when the normal physiology of the wound healing is maintained. Our understanding of wound healing has undergone dramatic changes in the recent past. Almost all materials and methods available on earth have been used and tested to facilitate the process of wound healing. The mental agony and the disability suffered by patients with chronic ulcers have led to the reappraisal of the basic components of the wound healing process and how they are influenced by biological, mechanical, and physical forces. The Department of General Surgery in our Government Chengalpattu Medical College and Hospital, Chengalpattu, Tamil Nadu, India, admits and treats a large volume of patients with wounds and ulcers. Here many materials are being used regularly for dressing to make wound healing faster. Vacuum dressings were also done on many patients, and promising results were observed. This kindled our interest in conducting this prospective study and comparing wound healing with vacuum dressing versus normal saline dressing. Materials and methods A total of 74 patients were included in the study, out of which 37 patients were randomly included in the experimental group and vacuum dressing was done, while the other 37 included in the control group were treated with dressing done with normal saline moistened gauze and bandage roll. Rates at which the wound healed were compared. Results We were able to observe a statistically significant difference in the rate of appearance of granulation tissue between the two and increased clearance of bacteria and toxins. The study group promised better progress as compared to the control group in various aspects. Conclusion Vacuum dressing brings an obvious improvement in the healing of non-healing ulcers and decreases the overall duration of stay in the hospital.
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9
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Grimstad Ø. Single use negative-pressure wound therapy compared to standard care in patients after carbon dioxide laser surgery for hidradenitis suppurativa. Dermatol Ther 2022; 35:e15483. [PMID: 35373495 PMCID: PMC9285713 DOI: 10.1111/dth.15483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/02/2022] [Accepted: 03/31/2022] [Indexed: 11/28/2022]
Abstract
Negative pressure wound therapy is a commonly used treatment modality for surgical wounds healing by secondary intention. In an open, split side study with 12 patients, we compared low negative pressure wound therapy to conventional foam dressing the first postoperative week after carbon dioxide laser vaporization of hidradenitis suppurativa lesions. The primary outcome was time to complete wound healing, comparing the two intervention sites. Secondary endpoints included perception of pain during intervention period and patient registered impact of the regimes on daily life activities. Low negative pressure wound therapy the first postoperative week tended to reduce the time to complete wound healing. Patients reported significant lower pain levels from wounds treated with a negative pressure wound device the first postoperative week. Eleven out of 12 study participants had a preference to the negative pressure wound therapy regime to a conventional regime with foam dressings.
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Affiliation(s)
- Øystein Grimstad
- Department of Dermatology, University Hospital of North Norway, Tromsø, Norway.,Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
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10
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Mamaloudis I, Perivoliotis K, Zlatanos C, Baloyiannis I, Spyridakis M, Kouvata E, Samara AA, Christodoulidis G, Tepetes K. The role of alginate dressings in wound healing and quality of life after pilonidal sinus resection: A randomised controlled trial. Int Wound J 2022; 19:1528-1538. [PMID: 35043571 PMCID: PMC9493221 DOI: 10.1111/iwj.13752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 12/19/2021] [Accepted: 01/06/2022] [Indexed: 11/29/2022] Open
Abstract
In this trial, we evaluated the role of alginate dressings in the secondary intention wound healing and quality of life (QoL) after pilonidal sinus resection. The study was designed as a prospective randomised controlled trial (RCT). In the experimental group, alginate dressings with silver and high‐G cellulose were introduced after elective pilonidal cyst excision, whereas in the control group, simple gauges were used. The primary end point was the difference in terms of the wound healing period. Blinding existed at the level of the investigator. Overall, 65 patients were included during the study period. Wound healing duration was comparable between the two groups (P = .381). No difference in postoperative pain scores or recovery outcomes was found. The experimental group was associated with reduced wound secretions at specific time end points. Similarly, no effect was identified, on overall Wound‐QoL or SF‐36 scores. Alginate dressings do not accelerate wound healing or improve QoL. Due to suboptimal sample size and several study limitations, further RCTs are required to confirm our findings.
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Affiliation(s)
| | | | - Christos Zlatanos
- Department of Surgery, University Hospital of Larissa, Larissa, Greece
| | | | | | - Evangelia Kouvata
- Department of Surgery, University Hospital of Larissa, Larissa, Greece
| | - Athina A Samara
- Department of Surgery, University Hospital of Larissa, Larissa, Greece
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11
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Salehi V, Yavari Barhaghtalab MJ, Mehrabi S, Iraji A, Sadat SA, Yusefi SH, Malekzadeh JM. Does application of honey improve surgical outcome in pilonidal cyst excision with secondary intention healing? A prospective randomized placebo-controlled clinical trial. Perioper Med (Lond) 2022; 11:1. [PMID: 35000582 PMCID: PMC8744332 DOI: 10.1186/s13741-021-00237-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 12/13/2021] [Indexed: 11/10/2022] Open
Abstract
Background Pilonidal sinus disease (PSD) is a common chronic inflammatory debilitating illness caused by ingrowth of hair into the skin. Excision and healing by secondary intention is one of the acceptable managements. The post-operative wound care needs frequent and time-consuming follow-ups. Honey is considered to be a traditional remedy for wound healing. The current study aimed at finding if application of honey could improve surgical outcome in pilonidal cyst excision with secondary intention healing. Methods This study was designed as a randomized placebo-controlled parallel assignment interventional (clinical trial) study conducted at the surgical ward of Shahid Beheshti Hospital affiliated to the Yasuj University of Medical sciences, Yasuj, Iran, and was consisted of the 48 patients who underwent surgical resection for PSD with secondary intention healing (24 patients in intervention and placebo-controlled groups). The main element of honey medicinal gel was the unheated natural honey of Dena Biosphere Reserve within the Zagros Mountains. Patients' wounds were visited by a surgeon and a nurse on the days 7, 15, 30, 45, 60, and 90 post-operation. The surgical outcomes including the time to complete wound healing, pain intensity, odor, discharge at the site of surgery, use of analgesics, the time of to return to the daily activities, and occurring of any side effects including infection, erythema, and bleeding were all recorded. Results In intervention group, there was significantly lower wound healing time, the lower time to return to the daily activities, lower mean wound volume at the days of 30, 45, 60, and 90 of the follow-up, higher mean post-operative pain level at the days of 15, 30, 45, 60, and 90 of the follow-up, and more usage of analgesics at the days of 15, 30, 45, and 60 of the follow-up. There was no significant difference between intervention and placebo-controlled groups according to the foul smell and fluid discharge at the site of the operation. There were no side effects and complications in both groups of the study. Conclusions Application of honey after resection surgery with secondary wound healing is associated with a better surgical outcome and could eventually decrease healing time and reduce duration of return to normal activities, but could increase post-operation pain and analgesic consumption, and no effect on foul smell and discharge. Trial registration The project was found to be in accordance to the ethical principles and the national norms and standards for conducting research in Iran with the approval ID and date of IR.YUMS.REC.1399.088 and 2020.05.30 respectively, and is the result of a residency dissertation to get the specialty in general surgery, which has been registered with the research project number 960508 in the Vice Chancellor for Research and Technology Development of Yasuj University of Medical Sciences, Yasuj, Iran, URL: https://ethics.research.ac.ir/EthicsProposalViewEn.php?id=144742
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Affiliation(s)
- Vahid Salehi
- Department of General Surgery, Shahid Beheshti Hospital, Yasuj University of Medical Sciences, Yasuj, Iran
| | | | - Saadat Mehrabi
- Department of General Surgery, Shahid Beheshti Hospital, Yasuj University of Medical Sciences, Yasuj, Iran.
| | - Aida Iraji
- Stem Cells Technology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Alimohammad Sadat
- Department of General Surgery, Shahid Beheshti Hospital, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Seyed Hadi Yusefi
- School of Nursing, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Jan Mohamad Malekzadeh
- Department of Nutrition, School of Health, Yasuj University of Medical Sciences, Yasuj, Iran
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12
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Derwin R, Patton D, Avsar P, Strapp H, Moore Z. The impact of topical agents and dressing on pH and temperature on wound healing: A systematic, narrative review. Int Wound J 2021; 19:1397-1408. [PMID: 34931445 PMCID: PMC9493238 DOI: 10.1111/iwj.13733] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 11/14/2021] [Accepted: 12/01/2021] [Indexed: 11/27/2022] Open
Abstract
To assess the impact of topical agents and dressings on surface wound pH, temperature, and subsequent wound healing. This was a systematic, narrative review of the literature, following the PRISMA (2020) guidelines. The databases searched were Medline PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, Embase, Web of Science, and Scopus. Data synthesis and analysis were conducted using a structured narrative synthesis. The quality of the included clinical studies was appraised using the Evidence-Based Literature (EBL) Critical Appraisal Tool. A total of six clinical studies were assessed as eligible for inclusion, A total of six dressings/topical agents were assessed and the types of wounds included non-healing chronic wounds. Of the studies, five explored pH and one explored temperature. The EBL validity of the clinical studies was low (mean quality score was 51.3%). The five clinical studies that explored pH investigated different dressings and topical agents reporting an associated reduction in pH and improved wound outcomes. One clinical study investigated the impact of topical sodium nitrite on temperature and found that sodium nitrite increased peri-wound skin temperature and improved wound outcomes with a reduction in leg ulcer size. Given the low certainty of the evidence, we cannot confidently recommend the use of any particular topical agent or dressing to manipulate pH, or temperature to improve wound outcomes. Thus, there is a need for further research to develop a greater understanding of this topic. Irish Research Council, Enterprise Partnership Scheme.
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Affiliation(s)
- Rosemarie Derwin
- School of Nursing and Midwifery, The Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland
| | - Declan Patton
- Wounds and Trauma Research Centre, School of Nursing and Midwifery, The Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland.,Department of Nursing, Fakeeh College of Health Sciences, Jeddah, Saudi Arabia.,Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Pinar Avsar
- Skin Wounds and Trauma Research Centre, The Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland
| | - Helen Strapp
- Department of Surgery, Tallaght University Hospital, Dublin, Ireland
| | - Zena Moore
- Department of Nursing, Fakeeh College of Health Sciences, Jeddah, Saudi Arabia.,Head of School of Nursing and Midwifery and Director of the Skin Wounds and Trauma Research Centre, The Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland.,Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Department of Nursing, Lida Institute, Shanghai, China.,School of Nursing and Midwifery, University of Wales, Cardiff, UK
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13
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Jensen NM, Steenstrup S, Ravn C, Schmal H, Viberg B. The use of negative pressure wound therapy for fracture-related infections following internal osteosynthesis of the extremity: A systematic review. J Clin Orthop Trauma 2021; 24:101710. [PMID: 34881170 PMCID: PMC8627993 DOI: 10.1016/j.jcot.2021.101710] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 10/22/2021] [Accepted: 11/13/2021] [Indexed: 11/28/2022] Open
Abstract
This study aimed to systematically review the current literature on studies using negative pressure wound therapy (NPWT) or dressings following fracture-related infection (FRI) in internal osteosynthesis of the extremity. Articles were analyzed on fracture and wound healing and included when comparing or describing the use of either NPWT or dressings in FRI. We conducted a systematic literature search in four electronic databases: Embase, Medline, the Cochrane Library, and Scopus. The studies were screened by two authors using Covidence.org and evaluated for risk of bias. A total of 8576 records were identified. No articles compared NPWT to dressings. Seven case reports and three case series included a total of 115 patients treated for FRI. Fracture healing was achieved in 21 out of 67 patients treated with NPWT (4 amputations and 46 not described) and all 48 patients in the dressing group (4 patients needed additional sequestrectomy procedures). Five studies did not describe fracture healing. In 57 out of 67 patients treated with NPWT, the wounds were described as healed, closed, or requiring soft tissue reconstruction (4 amputations and six lacking description). The dressing group had complete wound coverage in 18 patients and partial coverage in 30 patients. Studies were generally at high risk of bias because of insufficient descriptions of both patient demographics and outcomes. No studies compared NPWT to dressings, and the existing literature is at high risk of bias. The included studies were of low-level evidence. NPWT can be neither recommended nor advised against to cover infected osteosynthesis.
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Affiliation(s)
- Niels Martin Jensen
- Department of Orthopaedic Surgery and Traumatology, Kolding Hospital Part of Lillebaelt Hospital, Sygehusvej 22, 6000, Kolding, Denmark,Corresponding author. Pilevangen 15, 5450, Otterup, Denmark.
| | - Signe Steenstrup
- Department of Orthopaedic Surgery and Traumatology, Kolding Hospital Part of Lillebaelt Hospital, Sygehusvej 22, 6000, Kolding, Denmark
| | - Christen Ravn
- Department of Orthopaedic Surgery and Traumatology, Kolding Hospital Part of Lillebaelt Hospital, Sygehusvej 22, 6000, Kolding, Denmark
| | - Hagen Schmal
- Department of Orthopaedic Surgery and Traumatology, Freiburg University Hospital, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Bjarke Viberg
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, J. B. Winsloewsvej 4, 5000, Odense C, Denmark
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14
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Chetter I, Arundel C, Martin BC, Hewitt C, Fairhurst C, Joshi K, Mott A, Rodgers S, Goncalves PS, Torgerson D, Wilkinson J, Blazeby J, Macefield R, Dixon S, Henderson E, Oswald A, Dumville J, Lee M, Pinkney T, Stubbs N, Wilson L. Negative pressure wound therapy versus usual care for surgical wounds healing by secondary intention (SWHSI-2 trial): study protocol for a pragmatic, multicentre, cross surgical specialty, randomised controlled trial. Trials 2021; 22:739. [PMID: 34696784 PMCID: PMC8543414 DOI: 10.1186/s13063-021-05662-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 09/27/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The majority of surgical wounds are closed (for example with sutures or staples) and so heal by primary intention. Where closure is not possible, or the wound subsequently breaks down, wounds may be left to heal from the bottom up (healing by secondary intention). Surgical wound healing by secondary intention (SWHSI) frequently presents a significant management challenge. Additional treatments are often required during the course of healing, and thus a significant financial burden is associated with treating these wounds. Increasingly, negative pressure wound therapy (NPWT) is used in the management of SWHSI. This wound dressing system provides a negative pressure (vacuum) to the wound, removing fluid into a canister, which is believed to be conducive to wound healing. Despite the increasing use of NPWT, there is limited robust evidence for the effectiveness of this device. A well-designed and conducted randomised controlled trial is now required to ascertain if NPWT is a clinically and cost-effective treatment for SWHSI. METHODS SWHSI-2 is a pragmatic, multi-centre, cross surgical specialty, two arm, parallel group, randomised controlled superiority trial. Adult patients with a SWHSI will be randomised to receive either NPWT or usual care (no NPWT) and will be followed up for 12 months. The primary outcome will be time to healing (defined as full epithelial cover in absence of a scab) in number of days since randomisation. Secondary outcomes will include key clinical events (hospital admission or discharge, treatment status, reoperation, amputation, antibiotic use and death), wound infection, wound pain, health-related quality of life, health utility and resource use. DISCUSSION Given the increasing use of NPWT, despite limited high-quality supporting evidence, the SWHSI-2 Trial will provide robust evidence on the clinical and cost-effectiveness of NPWT in the management of SWHSI. The SWHSI-2 Trial opened to recruitment in May 2019 and is currently recruiting across 20 participating centres. TRIAL REGISTRATION ISRCTN 26277546 . Prospectively registered on 25 March 2019.
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Affiliation(s)
- Ian Chetter
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Catherine Arundel
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK.
| | - Belen Corbacho Martin
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Catherine Hewitt
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Caroline Fairhurst
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Kalpita Joshi
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Andrew Mott
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Sara Rodgers
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Pedro Saramago Goncalves
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - David Torgerson
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Jacqueline Wilkinson
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Jane Blazeby
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Rhiannon Macefield
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Stephen Dixon
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Eileen Henderson
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Angela Oswald
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Jo Dumville
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Matthew Lee
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Thomas Pinkney
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Nikki Stubbs
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Lyn Wilson
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
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15
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Nonwoven Releasing Propolis as a Potential New Wound Healing Method-A Review. Molecules 2021; 26:molecules26185701. [PMID: 34577172 PMCID: PMC8471897 DOI: 10.3390/molecules26185701] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 09/17/2021] [Accepted: 09/18/2021] [Indexed: 01/22/2023] Open
Abstract
Wound healing poses a serious therapeutic problem. Methods which accelerate tissue regeneration and minimize or eliminate complications are constantly being sought. This paper is aimed at evaluation of the potential use of biodegradable polymer nonwovens releasing propolis as wound healing dressings, based on the literature data. Propolis is honeybee product with antioxidant, antibacterial, antifungal, anticancer, anti-inflammatory, analgesic, and regenerative properties. Controlled release of this substance throughout the healing should promote healing process, reduce the risk of wound infection, and improve aesthetic effect. The use of biodegradable aliphatic polyesters and polyester carbonates as a propolis carrier eliminates the problem of local drug administration and dressing changes. Well-known degradation processes and kinetics of the active substance release allows the selection of the material composition appropriate to the therapy. The electrospinning method allows the production of nonwovens that protect the wound against mechanical damage. Moreover, this processing technique enables adjusting product properties by modifying the production parameters. It can be concluded that biodegradable polymer dressings, releasing a propolis, may find potential application in the treatment of complicated wounds, as they may increase the effectiveness of treatment, as well as improve the patient’s life quality.
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16
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Preman NK, E S SP, Prabhu A, Shaikh SB, C V, Barki RR, Bhandary YP, Rekha PD, Johnson RP. Bioresponsive supramolecular hydrogels for hemostasis, infection control and accelerated dermal wound healing. J Mater Chem B 2021; 8:8585-8598. [PMID: 32820296 DOI: 10.1039/d0tb01468k] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Injectable, drug-releasing hydrogel scaffolds with multifunctional properties including hemostasis and anti-bacterial activity are essential for successful wound healing; however, designing ideal materials is still challenging. Herein, we demonstrate the fabrication of a biodegradable, temperature-pH dual responsive supramolecular hydrogel (SHG) scaffold based on sodium alginate/poly(N-vinyl caprolactam) (AG/PVCL) through free radical polymerization and the subsequent chemical and ionic cross-linking. A natural therapeutic molecule, tannic acid (TA)-incorporated SHG (AG/PVCL-TA), was also fabricated and its hemostatic and wound healing efficiency were studied. In the AG/PVCL-TA system, TA acts as a therapeutic molecule and also substitutes as an effective gelation binder. Notably, the polyphenol-arm structure and diverse bonding abilities of TA can hold polymer chains through multiple bonding and co-ordinate cross-linking, which were vital in the formation of the mechanically robust AG/PVCL-TA. The SHG formation was successfully balanced by varying the composition of SA, VCL, TA and cross-linkers. The AG/PVCL-TA scaffold was capable of releasing a therapeutic dose of TA in a sustained manner under physiological temperature-pH conditions. AG/PVCL-TA displayed excellent free radical scavenging, anti-inflammatory, anti-bacterial, and cell proliferation activity towards the 3T3 fibroblast cell line. The wound healing performance of AG/PVCL-TA was further confirmed in skin excision wound models, which demonstrated the potential application of AG/PVCL-TA for skin regeneration and rapid wound healing.
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Affiliation(s)
- Namitha K Preman
- Polymer Nanobiomaterial Research Laboratory, Yenepoya Research Centre, Yenepoya (Deemed to be University), Mangalore, India.
| | - Sindhu Priya E S
- Yenepoya Pharmacy College and Research Centre, Yenepoya (Deemed to be University), Mangalore, India
| | - Ashwini Prabhu
- Division of Cell and Molecular Biology, Yenepoya Research Centre, Yenepoya (Deemed to be University), Mangalore, India
| | - Sadiya Bi Shaikh
- Division of Cell and Molecular Biology, Yenepoya Research Centre, Yenepoya (Deemed to be University), Mangalore, India
| | - Vipin C
- Division of Biotechnology, Microbiology and Infectious Diseases, Yenepoya Research Centre, Yenepoya (Deemed to be University), Mangalore, India and Relicus Bio Pvt. Ltd, Technology Business Incubator, Anna University, Chennai, 600025-Tamilnadu, India
| | - Rashmi R Barki
- Division of Cell and Molecular Biology, Yenepoya Research Centre, Yenepoya (Deemed to be University), Mangalore, India
| | - Yashodhar P Bhandary
- Division of Cell and Molecular Biology, Yenepoya Research Centre, Yenepoya (Deemed to be University), Mangalore, India
| | - P D Rekha
- Division of Biotechnology, Microbiology and Infectious Diseases, Yenepoya Research Centre, Yenepoya (Deemed to be University), Mangalore, India
| | - Renjith P Johnson
- Polymer Nanobiomaterial Research Laboratory, Yenepoya Research Centre, Yenepoya (Deemed to be University), Mangalore, India.
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17
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Nair H, Venkateshwaran N, Seetharaman S S, Deng W, Uthaipaisanwong A, Galea E. Benefits of sucrose octasulfate (TLC-NOSF) dressings in the treatment of chronic wounds: a systematic review. J Wound Care 2021; 30:S42-S52. [PMID: 33856929 DOI: 10.12968/jowc.2021.30.sup4.s42] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Management of chronic wounds remains one of the major challenges for health professionals and patients. An evidence-based decision is important to ensure that patients are receiving the best treatment proven to reduce healing time and improve outcomes, including economic benefits and patients' health-related quality of life (HRQoL). Due to recent restrictions because of the COVID-19 pandemic, including closure of wound care centres within hospitals and a drop in patient volume, chronic wound management needs simple-to-use dressings which are still effective and evidence-based solutions. This systematic review was conducted to identify the clinical evidence available on a sucrose octasulfate dressing (TLC-NOSF, UrgoStart dressing range, Laboratoires Urgo, France) to explore its efficacy in the management of chronic wounds, particularly lower limb ulcers, diabetic foot ulcers and pressure ulcers. METHOD A literature search of PubMed, Cochrane Library and Google Scholar was conducted based on the PICO model (patient/population, intervention, comparison and outcomes) to retrieve publications of different levels of evidence in order to evaluate outcomes of the use of TLC-NOSF dressings. RESULTS A total of 21 publications of different levels, ranging from double-blind randomised control trials to case reports, involving over 12,000 patients, were identified through PubMed, with a further eight publications through Google Scholar and two publications through Cochrane Library. A total of seven results were omitted due to the lack of relevance or repetition. CONCLUSION All the evidence provided suggest that these dressings provide clinicians with an evidence-based option for the management of chronic wounds; that the TLC-NOSF dressings are beneficial in promoting the healing process, reducing healing times, enhancing patients' HRQoL, and in allowing a more cost-effective procedure.
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Affiliation(s)
- Harikrishna Nair
- Head and Consultant, Wound Care Unit, Department of Internal Medicine, Kuala Lumpur Hospital, Malaysia
| | - N Venkateshwaran
- Consultant Plastic and Cosmetic Surgery, Jupiter Hospital, Mumbai, India
| | - Selva Seetharaman S
- Consultant and Head of Department of Plastic and Reconstructive Surgery, Gleneagles Global Hospital, Chennai, India
| | - Wuquan Deng
- Head of Endocrinology Department. Chongqing Emergency Medical Centre, Chongqing University Central Hospital, Chongqing, China
| | - Apinan Uthaipaisanwong
- Department of Surgery, King Chulalongkorn Memorial Hospital, Patumwan, Bangkok, Thailand
| | - Emilio Galea
- International Medical Director, Urgo Education and Training Alliance, Singapore
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18
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Feng J, Niu Y, Zhang Y, Zuo H, Wang S, Liu X. Ficus carica extract impregnated amphiphilic polymer scaffold for diabetic wound tissue regenerations. ARTIFICIAL CELLS NANOMEDICINE AND BIOTECHNOLOGY 2021; 49:219-229. [PMID: 33666536 DOI: 10.1080/21691401.2021.1890610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Diabetes associated injury healing and other tissue irregularities are viewed as a significant concern. The purpose of the study is to design the wound regeneration activity of Ficus carica extract (FFE) loaded amphiphilic polymeric scaffold of poly(xylitol-g-adipate-co-glutamide) (PXAG)-polyhydroxybutyrate (PHB) for potential diabetic affected wound regeneration. The PXAG copolymer was prepared by the condensation method, and the polymeric scaffolds of PXAG-PHB, PXAG-PHB/FFE were developed through the ultra-sonication process and magnetic stirrer processes. The chemical structure, crystalline nature, thermal stability, size, surface charge and surface morphology of PXAG-PHB and PXAG-PHB/FFE polymeric scaffolds were investigated. The PXAG-PHB/FFE exhibits 99.0% free radical scavenging activity which was determined by the DPPH method. The inhibition zones by the PXAG-PHB/FFE indicate it had a higher antibacterial activity with the Escherichia coli (gram-negative) and Staphylococcus aureus (gram-positive) pathogens. The PXAG, PXAG-PHB and PXAG-PHB/FFE polymeric scaffolds exhibited good viability against diabetic induced wound cells (WS1) in 100 μg/mL concentrations up to 72 h incubation. Since the synthesized PXAG-PHB/FFE polymeric scaffolds possess excellent thermal stability, bioactivity, biocompatibility and antioxidant activity along with potent antimicrobial activity, they play a potential role in diabetic wound tissue regenerations.
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Affiliation(s)
- Jia Feng
- Department of Endocrinology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of Endocrinology, Ninth Hospital of Xi'an, Xi'an, China
| | - Yu Niu
- Department of Endocrinology, Ninth Hospital of Xi'an, Xi'an, China
| | - Yi Zhang
- Department of Endocrinology, Ninth Hospital of Xi'an, Xi'an, China
| | - Hong Zuo
- Department of Endocrinology, Ninth Hospital of Xi'an, Xi'an, China
| | - Shujin Wang
- Department of Endocrinology, Ninth Hospital of Xi'an, Xi'an, China
| | - Xufeng Liu
- Department of Endocrinology, Ninth Hospital of Xi'an, Xi'an, China
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19
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Amaral B, Krause A, Pasini J, Silva Á, Inkelmann M, Müller D. Hyperbaric oxygen therapy in wound healing in mice. ARQ BRAS MED VET ZOO 2021. [DOI: 10.1590/1678-4162-11638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT We investigated the local and systemic effects of hyperbaric oxygen therapy in BALB/C mice, exposed to two different exposure times, under 2.4 atmosphere (ATM). Fifteen animals were divided into three groups (GI, GII and Control) and underwent a surgical excision of a skin fragment of approximately one square centimeter of the dorsal region. The wounds were treated and monitored for 21 days. In the control group, the wound was cleaned once a day with sterile 0.9% NaCl solution. GI and GII mice were submitted to daily hyperbaric oxygen therapy of 30 or 60minutes sessions, respectively. The wounds were photographed every three days and their surfaces were analyzed by an image analyzer. At 21 days, all animals were euthanatized for histopathological analysis of the skin, lungs and liver in order to identify eventual alterations in wound healing or in the analyzed organs. Animals belonging to GI showed a faster skin wound healing in comparison to the other groups. Animals from GII, however, showed a delayed wound healing process and exhibited lung and microcirculatory alterations. These findings allow us to conclude that the exposure time to the oxygen in hyperbaric environment is crucial and can help or disturb skin wound healing or even be deleterious to other organs.
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Affiliation(s)
| | - A. Krause
- Universidade Federal de Santa Maria, Brazil
| | | | - Á.J.C. Silva
- National Autonomous University of Nicaragua, Nicaragua
| | - M.A. Inkelmann
- Universidade Regional do Noroeste do Estado do Rio Grande do Sul, Brazil
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20
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Chetter I, Arundel C, Bell K, Buckley H, Claxton K, Corbacho Martin B, Cullum N, Dumville J, Fairhurst C, Henderson E, Lamb K, Long J, McCaughan D, McGinnis E, Oswald A, Goncalves PS, Sheard L, Soares MO, Stubbs N, Torgerson D, Welton N. The epidemiology, management and impact of surgical wounds healing by secondary intention: a research programme including the SWHSI feasibility RCT. PROGRAMME GRANTS FOR APPLIED RESEARCH 2020. [DOI: 10.3310/pgfar08070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background
Most surgical incisions heal by primary intention (i.e. wound edges are apposed with sutures, clips or glue); however, some heal by secondary intention (i.e. the wound is left open and heals by formation of granulation tissue). There is, however, a lack of evidence regarding the epidemiology, management and impact on patients’ quality of life of these surgical wounds healing by secondary intention, resulting in uncertainty regarding effective treatments and difficulty in planning care and research.
Objectives
To derive a better understanding of the nature, extent, costs, impact and outcomes of surgical wounds healing by secondary intention, effective treatments, and the value and nature of further research.
Design
Cross-sectional survey; inception cohort; cost-effectiveness and value of implementation analyses; qualitative interviews; and pilot, feasibility randomised controlled trial.
Setting
Acute and community care settings in Leeds and Hull, Yorkshire, UK.
Participants
Adults (or for qualitative interviews, patients or practitioners) with previous experience of a surgical wound healing by secondary intention. Inclusion criteria varied between the individual workstreams.
Interventions
The pilot, feasibility randomised controlled trial compared negative-pressure wound therapy – a device applying a controlled vacuum to a wound via a dressing – with usual care (no negative-pressure wound therapy).
Results
Survey data estimated that treated surgical wounds healing by secondary intention have a point prevalence of 4.1 per 10,000 population (95% confidence interval 3.5 to 4.7 per 10,000 population). Surgical wounds healing by secondary intention most frequently occurred following colorectal surgery (n = 80, 42.8% cross-sectional survey; n = 136, 39.7% inception cohort) and were often planned before surgery (n = 89, 47.6% cross-sectional survey; n = 236, 60.1% inception cohort). Wound care was frequently delivered in community settings (n = 109, 58.3%) and most patients (n = 184, 98.4%) received active wound treatment. Cohort data identified hydrofibre dressings (n = 259, 65.9%) as the most common treatment, although 29.3% (n = 115) of participants used negative-pressure wound therapy at some time during the study. Surgical wounds healing by secondary intention occurred in 81.4% (n = 320) of participants at a median of 86 days (95% confidence interval 75 to 103 days). Baseline wound area (p ≤ 0.01), surgical wound contamination (determined during surgery; p = 0.04) and wound infection at any time (p ≤ 0.01) (i.e. at baseline or postoperatively) were found to be predictors of prolonged healing. Econometric models, using observational, cohort study data, identified that, with little uncertainty, negative-pressure wound therapy treatment is more costly and less effective than standard dressing treatment for the healing of open surgical wounds. Model A (ordinary least squares with imputation) effectiveness: 73 days longer than those who did not receive negative-pressure wound therapy (95% credible interval 33.8 to 112.8 days longer). Model A cost-effectiveness (associated incremental quality-adjusted life-years): observables –0.012 (standard error 0.005) and unobservables –0.008 (standard error 0.011). Model B (two-stage model, logistic and linear regression) effectiveness: 46 days longer than those who did not receive negative-pressure wound therapy (95% credible interval 19.6 to 72.5 days longer). Model B cost-effectiveness (associated incremental quality-adjusted life-years): observables –0.007 (standard error 0.004) and unobservables –0.027 (standard error 0.017). Patient interviews (n = 20) identified initial reactions to surgical wounds healing by secondary intention of shock and disbelief. Impaired quality of life characterised the long healing process, with particular impact on daily living for patients with families or in paid employment. Patients were willing to try any treatment promising wound healing. Health professionals (n = 12) had variable knowledge of surgical wound healing by secondary intention treatments and, frequently, favoured negative-pressure wound therapy, despite the lack of robust evidence. The pilot feasibility randomised controlled trial screened 248 patients for eligibility and subsequently recruited and randomised 40 participants to receive negative-pressure wound therapy or usual care (no negative-pressure wound therapy). Data indicated that it was feasible to complete a full randomised controlled trial to provide definitive evidence for the clinical effectiveness and cost-effectiveness of negative-pressure wound therapy as a treatment for surgical wounds healing by secondary intention. Key elements and recommendations for a larger randomised controlled trial were identified.
Limitations
This research programme was conducted in a single geographical area (i.e. Yorkshire and the Humber, UK) and local guidelines and practices may have affected treatment availability, and so may not represent UK-wide treatment choices. A wide range of wound types were included; however, some wound types may be under-represented, meaning that this research may not represent the overall surgical wound healing by secondary intention population. The lack of randomised controlled trial data on the relative effects of negative-pressure wound therapy in surgical wounds healing by secondary intention resulted in much of the economic modelling being based on observational data. Observational data, even with extensive adjustment, do not negate the potential for unresolved confounding to affect the results, which can reduce confidence in conclusions drawn from observational data. Definitive evidence from a randomised controlled trial may be the only way to overcome this lack of confidence.
Conclusions
This research has provided new information regarding the nature, extent, costs, impacts and outcomes of surgical wounds healing by secondary intention, treatment effectiveness, and the value and nature of future research, while addressing previous uncertainties regarding the problem of surgical wounds healing by secondary intention. Aspects of our research indicate that negative-pressure wound therapy is more costly and less effective than standard dressing for the healing of open surgical wounds. However, because this conclusion is based solely on observational data, it may be affected by unresolved confounding. Should a future randomised controlled trial be considered necessary, its design should reflect careful consideration of the findings of this programme of research.
Future work
This research signals the importance of further research on surgical wound healing by secondary intention. Key research questions raised by this programme of research include (1) which treatments are clinically effective and cost-effective for surgical wound healing by secondary intention for all patients or for particular patient subgroups? (2) Can particular prognostic factors predict time to healing of surgical wound healing by secondary intention? And (3) do psychosocial interventions have the potential to improve quality of life in people with hard-to-heal surgical wound healing by secondary intention? Given that negative-pressure wound therapy has been widely adopted, with relatively little evidence to support its use, the design and outcomes of a randomised controlled trial would need to be carefully considered. We focused in this research on wound healing, and maintain, based on the findings of patient interviews, that this is a key outcome for future research. Impacts of negative-pressure wound therapy on outcomes such as infection and reoperation should also be considered, as should patients’ views of the treatment. The type of patient group recruited and the outcomes of interest will all influence the duration of follow-up of any planned study. The comparator in any future study will also need careful consideration.
Trial registration
Current Controlled Trials ISRCTN12761776.
Funding
This project was funded by the National Institute for Health Research Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 8, No. 7. See the National Institute for Health Research Journals Library website for further project information.
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Affiliation(s)
- Ian Chetter
- Hull York Medical School, University of York, York, UK
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Catherine Arundel
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Kerry Bell
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Hannah Buckley
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Karl Claxton
- Centre for Health Economics, University of York, York, UK
| | | | - Nicky Cullum
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
| | - Jo Dumville
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
| | - Caroline Fairhurst
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | | | - Karen Lamb
- Leeds Community Healthcare NHS Trust, Leeds, UK
| | - Judith Long
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | | | | | - Angela Oswald
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | | | - Laura Sheard
- Department of Health Sciences, University of York, York, UK
| | - Marta O Soares
- Centre for Health Economics, University of York, York, UK
| | | | - David Torgerson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Nicky Welton
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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Chin JS, Madden L, Chew SY, Becker DL. Drug therapies and delivery mechanisms to treat perturbed skin wound healing. Adv Drug Deliv Rev 2019; 149-150:2-18. [PMID: 30959068 DOI: 10.1016/j.addr.2019.03.006] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/29/2019] [Accepted: 03/29/2019] [Indexed: 12/15/2022]
Abstract
Acute wound healing is an orderly process of four overlapping events: haemostasis, inflammation, proliferation and remodelling. A drug delivery system with a temporal control of release could promote each of these events sequentially. However, acute wound healing normally proceeds very well in healthy individuals and there is little need to promote it. In the elderly and diabetics however, healing is often slow and wounds can become chronic and we need to promote their healing. Targeting the events of acute wound healing would not be appropriate for a chronic wound, which have stalled in the proinflammatory phase. They also have many additional problems such as poor circulation, low oxygen, high levels of leukocytes, high reactive oxygen species, high levels of proteolytic enzymes, high levels of proinflammatory cytokines, bacterial infection and high pH. The future challenge will be to tackle each of these negative factors to create a wound environment conducive to healing.
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Patients with surgical wounds healing by secondary intention: A prospective, cohort study. Int J Nurs Stud 2019; 89:62-71. [DOI: 10.1016/j.ijnurstu.2018.09.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 09/14/2018] [Accepted: 09/14/2018] [Indexed: 11/20/2022]
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Negut I, Grumezescu V, Grumezescu AM. Treatment Strategies for Infected Wounds. Molecules 2018; 23:E2392. [PMID: 30231567 PMCID: PMC6225154 DOI: 10.3390/molecules23092392] [Citation(s) in RCA: 313] [Impact Index Per Article: 52.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 09/12/2018] [Accepted: 09/14/2018] [Indexed: 12/22/2022] Open
Abstract
The treatment of skin wounds is a key research domain owing to the important functional and aesthetic role of this tissue. When the skin is impaired, bacteria can soon infiltrate into underlying tissues which can lead to life-threatening infections. Consequently, effective treatments are necessary to deal with such pathological conditions. Recently, wound dressings loaded with antimicrobial agents have emerged as viable options to reduce wound bacterial colonization and infection, in order to improve the healing process. In this paper, we present an overview of the most prominent antibiotic-embedded wound dressings, as well as the limitations of their use. A promising, but still an underrated group of potential antibacterial agents that can be integrated into wound dressings are natural products, especially essential oils. Some of the most commonly used essential oils against multidrug-resistant microorganisms, such as tea tree, St. John's Wort, lavender and oregano, together with their incorporation into wound dressings are presented. In addition, another natural product that exhibits encouraging antibacterial activity is honey. We highlight recent results of several studies carried out by researchers from different regions of the world on wound dressings impregnated with honey, with a special emphasis on Manuka honey. Finally, we highlight recent advances in using nanoparticles as platforms to increase the effect of pharmaceutical formulations aimed at wound healing. Silver, gold, and zinc nanoparticles alone or functionalized with diverse antimicrobial compounds have been integrated into wound dressings and demonstrated therapeutic effects on wounds.
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Affiliation(s)
- Irina Negut
- National Institute for Lasers, Plasma and Radiation Physics, Magurele RO-77125, Romania.
- Faculty of Physics, University of Bucharest, Magurele 077125, Romania.
| | - Valentina Grumezescu
- National Institute for Lasers, Plasma and Radiation Physics, Magurele RO-77125, Romania.
- Faculty of Applied Chemistry and Materials Science, Politehnica University of Bucharest, Bucharest 011061, Romania.
| | - Alexandru Mihai Grumezescu
- Faculty of Applied Chemistry and Materials Science, Politehnica University of Bucharest, Bucharest 011061, Romania.
- Research Institute of University of Bucharest, ICUB, Bucharest 050107, Romania.
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Yong AA, Goh CL. Use of silicone gel to enhance skin wound healing by secondary intention following tumour excision on the scalp and extremities. Clin Exp Dermatol 2018; 43:723-725. [PMID: 29785779 DOI: 10.1111/ced.13571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2017] [Indexed: 11/28/2022]
Affiliation(s)
- A A Yong
- National Skin Centre, 1 Mandalay Road, Singapore, 308205
| | - C L Goh
- National Skin Centre, 1 Mandalay Road, Singapore, 308205
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Arundel C, Fairhurst C, Corbacho-Martin B, Buckley H, Clarke E, Cullum N, Dixon S, Dumville J, Firth A, Henderson E, Lamb K, McGinnis E, Oswald A, Saramago Goncalves P, Soares MO, Stubbs N, Chetter I. Pilot feasibility randomized clinical trial of negative-pressure wound therapy versus usual care in patients with surgical wounds healing by secondary intention. BJS Open 2018; 2:99-111. [PMID: 29951633 PMCID: PMC5989956 DOI: 10.1002/bjs5.49] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 12/13/2017] [Indexed: 01/09/2023] Open
Abstract
Background Surgical wounds healing by secondary intention (SWHSI) are increasingly being treated with negative-pressure wound therapy (NPWT) despite a lack of high-quality research evidence regarding its clinical and cost-effectiveness. This pilot feasibility RCT aimed to assess the methods for and feasibility of conducting a future definitive RCT of NPWT for the treatment of SWHSI. Methods Eligible consenting adult patients receiving care at the study sites (2 acute and 1 community) and with a SWHSI appropriate for NPWT or wound dressing treatment were randomized 1 : 1 centrally to receive NPWT or usual care (no NPWT). Participants were followed up every 1-2 weeks for 3 months. Feasibility (recruitment rate, time to intervention delivery) and clinical (time to wound healing) outcomes were assessed. Results A total of 248 participants were screened for eligibility; 40 (16·1 per cent) were randomized, 19 to NPWT and 21 to usual care. Twenty-four of the 40 wounds were located on the foot. Participants received NPWT for a median of 18 (range 0-72) days. Two participants in the NPWT group never received the intervention and 14 received NPWT within 48 h of randomization. Five participants in the usual care group received NPWT during the study. Ten of the 40 wounds were deemed to have healed during the study. Conclusion A full-scale RCT to investigate the clinical and cost-effectiveness of NPWT for SWHSI is feasible. This study identified crucial information on recruitment rates and data collection methods to consider during the design of a definitive RCT. Registration number: ISRCTN12761776 (http://www.iscrtn.com).
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Affiliation(s)
- C Arundel
- York Trials Unit, Department of Health Sciences University of York York UK
| | - C Fairhurst
- York Trials Unit, Department of Health Sciences University of York York UK
| | - B Corbacho-Martin
- York Trials Unit, Department of Health Sciences University of York York UK
| | - H Buckley
- York Trials Unit, Department of Health Sciences University of York York UK
| | - E Clarke
- Academic Vascular Surgical Unit Hull and East Yorkshire Hospitals NHS Trust Hull UK
| | - N Cullum
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health University of Manchester Manchester UK.,Research and Innovation Division, Central Manchester University Hospitals NHS Foundation Trust Manchester Academic Health Science Centre Manchester UK
| | - S Dixon
- Patient and Public Involvement Group Hull UK
| | - J Dumville
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health University of Manchester Manchester UK
| | - A Firth
- Academic Vascular Surgical Unit Hull and East Yorkshire Hospitals NHS Trust Hull UK
| | - E Henderson
- Outpatient Services Hull and East Yorkshire Hospitals NHS Trust Hull UK
| | - K Lamb
- Leeds Wound Research Unit Leeds Community Healthcare NHS Trust Leeds UK
| | - E McGinnis
- Department for Tissue Viability Leeds Teaching Hospitals NHS Trust Leeds UK
| | - A Oswald
- Academic Vascular Surgical Unit Hull and East Yorkshire Hospitals NHS Trust Hull UK
| | | | - M O Soares
- Centre for Health Economics University of York York UK
| | - N Stubbs
- Leeds Wound Research Unit Leeds Community Healthcare NHS Trust Leeds UK
| | - I Chetter
- Centre for Health Economics University of York York UK.,Research Office Hull York Medical School Hull UK
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Saghazadeh S, Rinoldi C, Schot M, Kashaf SS, Sharifi F, Jalilian E, Nuutila K, Giatsidis G, Mostafalu P, Derakhshandeh H, Yue K, Swieszkowski W, Memic A, Tamayol A, Khademhosseini A. Drug delivery systems and materials for wound healing applications. Adv Drug Deliv Rev 2018; 127:138-166. [PMID: 29626550 PMCID: PMC6003879 DOI: 10.1016/j.addr.2018.04.008] [Citation(s) in RCA: 380] [Impact Index Per Article: 63.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 04/01/2018] [Accepted: 04/03/2018] [Indexed: 01/22/2023]
Abstract
Chronic, non-healing wounds place a significant burden on patients and healthcare systems, resulting in impaired mobility, limb amputation, or even death. Chronic wounds result from a disruption in the highly orchestrated cascade of events involved in wound closure. Significant advances in our understanding of the pathophysiology of chronic wounds have resulted in the development of drugs designed to target different aspects of the impaired processes. However, the hostility of the wound environment rich in degradative enzymes and its elevated pH, combined with differences in the time scales of different physiological processes involved in tissue regeneration require the use of effective drug delivery systems. In this review, we will first discuss the pathophysiology of chronic wounds and then the materials used for engineering drug delivery systems. Different passive and active drug delivery systems used in wound care will be reviewed. In addition, the architecture of the delivery platform and its ability to modulate drug delivery are discussed. Emerging technologies and the opportunities for engineering more effective wound care devices are also highlighted.
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Affiliation(s)
- Saghi Saghazadeh
- Biomaterials Innovation Research Center, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School. Boston, MA 02139, USA
- Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology. Cambridge, MA 02139, USA
| | - Chiara Rinoldi
- Biomaterials Innovation Research Center, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School. Boston, MA 02139, USA
- Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology. Cambridge, MA 02139, USA
- Materials Design Division, Faculty of Materials Science and Engineering, Warsaw University of Technology. Warsaw 02-507, Poland
| | - Maik Schot
- Biomaterials Innovation Research Center, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School. Boston, MA 02139, USA
- Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology. Cambridge, MA 02139, USA
- MIRA Institute of Biomedical Technology and Technical Medicine, Department of Developmental BioEngineering, University of Twente, Enschede, The Netherlands
| | - Sara Saheb Kashaf
- Biomaterials Innovation Research Center, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School. Boston, MA 02139, USA
- Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology. Cambridge, MA 02139, USA
- The University of Chicago Medical Scientist Training Program, Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Fatemeh Sharifi
- Biomaterials Innovation Research Center, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School. Boston, MA 02139, USA
- Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology. Cambridge, MA 02139, USA
- School of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Elmira Jalilian
- Biomaterials Innovation Research Center, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School. Boston, MA 02139, USA
- Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology. Cambridge, MA 02139, USA
| | - Kristo Nuutila
- Division of Plastic Surgery, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Giorgio Giatsidis
- Division of Plastic Surgery, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Pooria Mostafalu
- Biomaterials Innovation Research Center, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School. Boston, MA 02139, USA
- Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology. Cambridge, MA 02139, USA
| | - Hossein Derakhshandeh
- Department of Mechanical and Materials Engineering, University of Nebraska, Lincoln, NE, 68508, USA
| | - Kan Yue
- Biomaterials Innovation Research Center, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School. Boston, MA 02139, USA
- Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology. Cambridge, MA 02139, USA
| | - Wojciech Swieszkowski
- Materials Design Division, Faculty of Materials Science and Engineering, Warsaw University of Technology. Warsaw 02-507, Poland
| | - Adnan Memic
- Center of Nanotechnology, Department of Physics, King Abdulaziz University, Jeddah 21569, Saudi Arabia
| | - Ali Tamayol
- Biomaterials Innovation Research Center, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School. Boston, MA 02139, USA
- Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology. Cambridge, MA 02139, USA
- Department of Mechanical and Materials Engineering, University of Nebraska, Lincoln, NE, 68508, USA
| | - Ali Khademhosseini
- Biomaterials Innovation Research Center, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School. Boston, MA 02139, USA
- Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology. Cambridge, MA 02139, USA
- Center of Nanotechnology, Department of Physics, King Abdulaziz University, Jeddah 21569, Saudi Arabia
- Department of Chemical and Biomolecular Engineering, Department of Bioengineering, Department of Radiology, California NanoSystems Institute (CNSI), University of California, Los Angeles, CA, 90095, USA
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McCaughan D, Sheard L, Cullum N, Dumville J, Chetter I. Patients' perceptions and experiences of living with a surgical wound healing by secondary intention: A qualitative study. Int J Nurs Stud 2018; 77:29-38. [PMID: 29031127 PMCID: PMC5744862 DOI: 10.1016/j.ijnurstu.2017.09.015] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 08/14/2017] [Accepted: 09/23/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Most surgical wounds heal by primary intention, that is to say, the edges of the wound are brought together with sutures, staples, adhesive glue or clips. However, some wounds may be left open to heal (if there is a risk of infection, or if there has been significant tissue loss), and are known as 'surgical wounds healing by secondary intention'. They are estimated to comprise approximately 28% of all surgical wounds and are frequently complex to manage. However, they are under researched and little is known of their impact on patients' lives. OBJECTIVES To explore patients' views and experiences of living with a surgical wound healing by secondary intention. DESIGN A qualitative, descriptive approach. SETTINGS Participants were recruited from acute and community nursing services in two locations in the North of England characterised by high levels of deprivation and diverse populations. PARTICIPANTS Participants were aged 18 years or older and had at least one surgical wound healing by secondary intention, which was slow to heal. Purposeful sampling was used to include patients of different gender, age, wound duration and type of surgery (general, vascular and orthopaedic). Twenty people were interviewed between January and July 2012. METHODS Semi-structured interviews were conducted, guided by use of a topic guide developed with input from patient advisors. Data were thematically analysed using steps integral to the 'Framework' approach to analysis, including familiarisation with data; development of a coding scheme; coding, charting and cross comparison of data; interpretation of identified themes. FINDINGS Alarm, shock and disbelief were frequently expressed initial reactions, particularly to "unexpected" surgical wounds healing by secondary intention. Wound associated factors almost universally had a profound negative impact on daily life, physical and psychosocial functioning, and wellbeing. Feelings of frustration, powerlessness and guilt were common and debilitating. Patients' hopes for healing were often unrealistic, posing challenges for the clinicians caring for them. Participants expressed dissatisfaction with a perceived lack of continuity and consistency of care in relation to wound management. CONCLUSIONS Surgical wounds healing by secondary intention can have a devastating effect on patients, both physical and psychosocial. Repercussions for patients' family members can also be extremely detrimental, including financial pressures. Health care professionals involved in the care of patients with these wounds face multiple, complex challenges, compounded by the limited evidence base regarding cost-effectiveness of different treatment regimens for these types of wounds.
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Affiliation(s)
- Dorothy McCaughan
- University of York, Department of Health Sciences, University of York, York, YO10 5DD, UK.
| | - Laura Sheard
- Bradford Institute for Health Research, Bradford, BD9 6RJ, UK
| | - Nicky Cullum
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, UK; Research and Innovation Division, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre; Jean McFarlane Building, Manchester M13 9PL, UK
| | - Jo Dumville
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, UK
| | - Ian Chetter
- Academic Vascular Surgical Unit, Hull York Medical School, University of Hull, Hull and East Yorkshire NHS trust, Hull, HU3 2JZ, UK
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Pasupuleti VR, Sammugam L, Ramesh N, Gan SH. Honey, Propolis, and Royal Jelly: A Comprehensive Review of Their Biological Actions and Health Benefits. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2017; 2017:1259510. [PMID: 28814983 PMCID: PMC5549483 DOI: 10.1155/2017/1259510] [Citation(s) in RCA: 337] [Impact Index Per Article: 48.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 04/09/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND There are several health benefits that honeybee products such as honey, propolis, and royal jelly claim toward various types of diseases in addition to being food. SCOPE AND APPROACH In this paper, the effects of honey, propolis, and royal jelly on different metabolic diseases, cancers, and other diseases have been reviewed. The modes of actions of these products have also been illustrated for purposes of better understanding. KEY FINDINGS AND CONCLUSIONS An overview of honey, propolis, and royal jelly and their biological potentials was highlighted. The potential health benefits of honey, such as microbial inhibition, wound healing, and its effects on other diseases, are described. Propolis has been reported to have various health benefits related to gastrointestinal disorders, allergies, and gynecological, oral, and dermatological problems. Royal jelly is well known for its protective effects on reproductive health, neurodegenerative disorders, wound healing, and aging. Nevertheless, the exact mechanisms of action of honey, propolis, and royal jelly on the abovementioned diseases and activities have not been not fully elucidated, and further research is warranted to explain their exact contributions.
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Affiliation(s)
- Visweswara Rao Pasupuleti
- Institute of Food Security and Sustainable Agriculture, Universiti Malaysia Kelantan, Campus Jeli, 17600 Jeli, Malaysia
- Faculty of Agro-Based Industry, Universiti Malaysia Kelantan, Campus Jeli, 17600 Jeli, Malaysia
| | - Lakhsmi Sammugam
- Faculty of Agro-Based Industry, Universiti Malaysia Kelantan, Campus Jeli, 17600 Jeli, Malaysia
| | - Nagesvari Ramesh
- Faculty of Agro-Based Industry, Universiti Malaysia Kelantan, Campus Jeli, 17600 Jeli, Malaysia
| | - Siew Hua Gan
- Human Genome Center, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, 16150 Kelantan, Malaysia
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Seidel D, Bunse J. [Postoperative wound infections : Diagnosis, classification and treatment]. Chirurg 2017; 88:385-394. [PMID: 28127654 DOI: 10.1007/s00104-017-0368-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Surgical site infections are a frequent complication of surgery and a severe burden for the patient as well as for the healthcare system. Sound knowledge of the disease pattern is an essential prerequisite for effective therapy. OBJECTIVE This article presents an overview of the diagnosis, classification and treatment options for surgical site infections. MATERIAL AND METHODS Based on the existing experience, the currently available evidence and pathophysiological considerations, an overview of the diagnostic possibilities, the existing classification systems and the treatment options is presented. RESULTS The diagnosis of surgical site infections is based on the clinical symptoms and can particularly be supported by the microbiological analysis of wound samples. There is no validated classification system but the definition of the Centers for Disease Control and Prevention is most commonly used. After initial bedside processing, debridement and wound cleansing are the basis for the further treatment, which is supplemented by the rational use of antiseptics and antibiotics. The use of modern dressings with the aim of maintaining a physiological moist wound environment promotes wound healing. The negative pressure wound therapy is an available treatment option. Rare diseases need to be considered. CONCLUSION The low level of evidence and critical consideration of the treatment options have been discussed in many guidelines, consensus documents and systematic reviews on the basis of which this article was written. Strengthening the evidence situation through intensive, targeted research should be the goal.
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Affiliation(s)
- D Seidel
- Institut für Forschung in der Operativen Medizin (IFOM), Private Universität Witten/Herdecke gGmbH, Ostmerheimerstraße 200 Haus 38, 51109, Köln, Deutschland.
| | - J Bunse
- Klinik für Allgemein- und Viszeralchirurgie, Sana-Klinikum Lichtenberg, Berlin, Deutschland
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Medeiros VDFLP, Azevedo ÍM, Rêgo ACM, Egito ESTD, Araújo-Filho I, Medeiros AC. Antibacterial properties and healing effects of Melipona scutellaris honey in MRSA-infected wounds of rats. Acta Cir Bras 2016; 31:327-32. [DOI: 10.1590/s0102-865020160050000006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 04/18/2016] [Indexed: 01/22/2023] Open
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Abstract
BACKGROUND Secondary intention healing and purse-string closures are simple but extremely useful methods for the dermatologic surgeon to master. OBJECTIVE To review the literature on the use of these two types of closures and offer recommendations based on our collective experiences. METHODS A literature review was performed using the terms "secondary intention healing" and "purse-string closure." The evidence and recommendations from the resultant references were summarized in our article and synthesized with our own experiences. RESULTS Twenty-eight sources were cited overall with fifteen related to secondary intention healing, eleven pertaining to purse-string closures, and one randomized, blind clinical trial comparing the two modalities. CONCLUSION The art of dermatologic surgery often requires a tailored approach to the patient and can involve a spectrum of closures, from the simplest to most complex. This variety not only provides more reconstruction options, but are also necessary to keep dermatologic surgery cost-effective. Certain locations or situations are more amenable for these two types of closures than others. The use of secondary intention healing, either alone or in conjunction with purse-string closures, should be in every dermatologic surgeon's armamentarium.
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Deng W, Lei Y, Zhou S, Zhang A, Lin Y. Absorptive supramolecular elastomer wound dressing based on polydimethylsiloxane–(polyethylene glycol)–polydimethylsiloxane copolymer: preparation and characterization. RSC Adv 2016. [DOI: 10.1039/c6ra07146e] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The introducing of polyethylene glycol block could effectively enhance the hydrophilicity, water-absorbing rate, ability of cohesion and water vapor permeating rate of ESESi film, and help to promoting the wound healing processing.
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Affiliation(s)
- Wenwen Deng
- College of Material Science and Engineering
- South China University of Technology
- Guangzhou 510641
- China
| | - Yufeng Lei
- College of Material Science and Engineering
- South China University of Technology
- Guangzhou 510641
- China
| | - Shengwen Zhou
- College of Material Science and Engineering
- South China University of Technology
- Guangzhou 510641
- China
| | - Anqiang Zhang
- College of Material Science and Engineering
- South China University of Technology
- Guangzhou 510641
- China
| | - Yaling Lin
- College of Materials and Energy
- South China Agricultural University
- Guangzhou 510642
- China
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Zahmatkesh M, Manesh MJ, Babashahabi R. Effect of Olea ointment and Acetate Mafenide on burn wounds - A randomized clinical trial. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2015; 20:599-603. [PMID: 26457099 PMCID: PMC4598908 DOI: 10.4103/1735-9066.164507] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: The main goals in treating burns are to accelerate tissue renovation and prevent infection. Topical antibiotics are used in the treatment of burns, but they can cause side effects. Recently, a traditional ointment (Olea) has been used in Iran in the treatment of burns. This study examines the effect of topical honey ointment in healing of burn patients. Materials and Methods: In this randomized controlled trial (RCT), 30 hospitalized patients selected by conventional sampling (10 in Olea group and 20 in Acetate Mafenide ointment group) were evaluated. Inclusion criteria were: having second-degree burns and body surface area equal to or < 40%. One group was treated using topical Olea ointment and the other with Acetate Mafenide ointment (8.5%). Chi-square, Fisher exact test, and Kaplan–Meier were used. Significance level was considered as P < 0.05. Results: None of the patients in the Olea group needed surgery for debridement, while in the second group, 13 patients (65%) needed debridement (P = 0.001). In the Olea group, 1 patient (10%) and in the second group, 19 patients (95%) had positive cultures after 7 days (P < 0.001). The mean time of granulation tissue formation in the Olea group was 12 days (10.3–13.6) and in the other group, it was 17 days (13.3–20.6) (P < 0.001). Conclusions: Olea ointment is a useful treatment for burns, and it can prevent infections, accelerate tissue repair, and facilitate debridement. Therefore, using this ointment is recommended for the treatment of burns.
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Affiliation(s)
- Mohsen Zahmatkesh
- Department of Research and Development, Farateb Science and Research Co., Yazd, Iran
| | | | - Ronak Babashahabi
- Department of Surgery, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
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Ubbink DT, Brölmann FE, Go PMNYH, Vermeulen H. Evidence-Based Care of Acute Wounds: A Perspective. Adv Wound Care (New Rochelle) 2015; 4:286-294. [PMID: 26005594 PMCID: PMC4432965 DOI: 10.1089/wound.2014.0592] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 09/19/2014] [Indexed: 11/12/2022] Open
Abstract
Significance: Large variation and many controversies exist regarding the treatment of, and care for, acute wounds, especially regarding wound cleansing, pain relief, dressing choice, patient instructions, and organizational aspects. Recent Advances: A multidisciplinary team developed evidence-based guidelines for the Netherlands using the AGREE-II and GRADE instruments. A working group, consisting of 17 representatives from all professional societies involved in wound care, tackled five controversial issues in acute-wound care, as provided by any caregiver throughout the whole chain of care. Critical Issues: The guidelines contain 38 recommendations, based on best available evidence, additional expert considerations, and patient experiences. In summary, primarily closed wounds need no cleansing; acute open wounds are best cleansed with lukewarm (drinkable) water; apply the WHO pain ladder to choose analgesics against continuous wound pain; use lidocaine or prilocaine infiltration anesthesia for wound manipulations or closure; primarily closed wounds may not require coverage with a dressing; use simple dressings for open wounds; and give your patient clear instructions about how to handle the wound. Future Directions: These evidence-based guidelines on acute wound care may help achieve a more uniform policy to treat acute wounds in all settings and an improved effectiveness and quality of wound care.
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Affiliation(s)
- Dirk T. Ubbink
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Fleur E. Brölmann
- Department of Surgery, Lucas Andreas Hospital, Amsterdam, The Netherlands
| | | | - Hester Vermeulen
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
- School for Health Professions, Amsterdam, The Netherlands
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Tricco AC, Antony J, Vafaei A, Khan PA, Harrington A, Cogo E, Wilson C, Perrier L, Hui W, Straus SE. Seeking effective interventions to treat complex wounds: an overview of systematic reviews. BMC Med 2015; 13:89. [PMID: 25899006 PMCID: PMC4406332 DOI: 10.1186/s12916-015-0288-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Accepted: 02/03/2015] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Numerous, often multi-faceted regimens are available for treating complex wounds, yet the evidence of these interventions is recondite across the literature. We aimed to identify effective interventions to treat complex wounds through an overview of systematic reviews. METHODS MEDLINE (OVID interface, 1946 until October 26, 2012), EMBASE (OVID interface, 1947 until October 26, 2012), and the Cochrane Database of Systematic Reviews (Issue 10 of 12, 2012) were searched on October 26, 2012. Systematic reviews that examined adults receiving care for their complex wounds were included. Two reviewers independently screened the literature, abstracted data, and assessed study quality using the Assessment of Multiple Systematic Reviews (AMSTAR) tool. RESULTS Overall, 99 systematic reviews were included after screening 6,200 titles and abstracts and 422 full-texts; 54 were systematic reviews with a meta-analysis (including data on over 54,000 patients) and 45 were systematic reviews without a meta-analysis. Overall, 44% of included reviews were rated as being of high quality (AMSTAR score ≥ 8). Based on data from systematic reviews including a meta-analysis with an AMSTAR score ≥ 8, promising interventions for complex wounds were identified. These included bandages or stockings (multi-layer, high compression) and wound cleansing for venous leg ulcers; four-layer bandages for mixed arterial/venous leg ulcers; biologics, ultrasound, and hydrogel dressings for diabetic leg/foot ulcers; hydrocolloid dressings, electrotherapy, air-fluidized beds, and alternate foam mattresses for pressure ulcers; and silver dressings and ultrasound for unspecified mixed complex wounds. For surgical wound infections, topical negative pressure and vacuum-assisted closure were promising interventions, but this was based on evidence from moderate to low quality systematic reviews. CONCLUSIONS Numerous interventions can be utilized for patients with varying types of complex wounds, yet few treatments were consistently effective across all outcomes throughout the literature. Clinicians and patients can use our results to tailor effective treatment according to type of complex wound. Network meta-analysis will be of benefit to decision-makers, as it will permit multiple treatment comparisons and ranking of the effectiveness of all interventions. Please see related article: http://dx.doi.org/10.1186/s12916-015-0326-3.
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Affiliation(s)
- Andrea C Tricco
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, Ontario, M5B 1W8, Canada.
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, M5T 3M7, Canada.
| | - Jesmin Antony
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, Ontario, M5B 1W8, Canada.
| | - Afshin Vafaei
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, Ontario, M5B 1W8, Canada.
| | - Paul A Khan
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, Ontario, M5B 1W8, Canada.
| | - Alana Harrington
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, Ontario, M5B 1W8, Canada.
| | - Elise Cogo
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, Ontario, M5B 1W8, Canada.
| | - Charlotte Wilson
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, Ontario, M5B 1W8, Canada.
| | - Laure Perrier
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, Ontario, M5B 1W8, Canada.
| | - Wing Hui
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, Ontario, M5B 1W8, Canada.
| | - Sharon E Straus
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, Ontario, M5B 1W8, Canada.
- Department of Geriatric Medicine, University of Toronto, 27 Kings College Circle, Toronto, Ontario, M5S 1A1, Canada.
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Nogueira VC, Coelho NPMDF, Barros TLD, Silva SMMDS, Martins M, Arisawa EAL. Biomodulation effects of LED and therapeutic ultrasound combined with semipermeable dressing in the repair process of cutaneous lesions in rats. Acta Cir Bras 2015; 29:588-95. [PMID: 25252205 DOI: 10.1590/s0102-8650201400150006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 07/18/2014] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To compare the biomodulatory effects of LED and ultrasound combined with semipermeable dressing in the repair of cutaneous lesions. METHODS Eighty-four Wistar rats were submitted to surgical injury (2.5 cm) and divided into four groups (n=21): Group I (control), Group II (LED therapy, LED), Group III (LED therapy + dressing, LED+D) and Group IV (ultrasound + dressing, US+D). At seven, 14 and 21 days, the animals were euthanized, and the specimens of interest removed for histological analysis. RESULTS Histological and histomorphometric analysis revealed a greater percent wound regression in animals receiving the dressing (group III: 55.97; group IV: 53.06), as well as a greater reduction in the inflammatory infiltrate (group III: 29.14; group IV: 31.71) since day 7. A later effect, with progression of the tissue repair process only after 14 and 21 days, was observed in the LED group intense fibroblast proliferation and greater collagen fiber production and organization were seen in the LED+D and US+D groups compared to the other groups. CONCLUSION LED combined with a dressing was more effective at accelerating in the repair of cutaneous lesions.
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Seidel D, Mathes T, Lefering R, Storck M, Lawall H, Neugebauer EAM. Negative pressure wound therapy versus standard wound care in chronic diabetic foot wounds: study protocol for a randomized controlled trial. Trials 2014; 15:334. [PMID: 25158846 PMCID: PMC4156638 DOI: 10.1186/1745-6215-15-334] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 08/11/2014] [Indexed: 12/17/2022] Open
Abstract
Background In August 2010, the Federal Joint Committee (G-BA) decided that negative pressure wound therapy (NPWT) would not be reimbursable in German ambulatory care. This decision was based on reports from the Institute for Quality and Efficiency in Health Care (IQWiG), which concluded that there is no convincing evidence in favor of NPWT. The aim of this diabetic foot study (DiaFu study) is to evaluate whether the clinical, safety and economic results of NPWT are superior to the results of standard wound treatment. Methods/Design The DiaFu study is designed as a national, multicenter, randomized controlled clinical superiority trial with a special focus on outpatient care in Germany. Competent patients in inpatient and outpatient care suffering from a chronic diabetic foot wound for a minimum of four weeks may be included in the study. The trial evaluates the treatment outcome of the application of a technical medical device which is based on the principle of NPWT (intervention group) in comparison to standard moist wound therapy (control group). All treatment systems used in the intervention group bear the symbol of free trade capacity in the European Union (CE mark) and will be operated within normal conditions of clinical routine and according to manufacturer’s instructions. Primary endpoints are the time to complete wound healing and the rate of wound healing achieved in each group within the maximum study treatment time of 16 weeks. Primary endpoints will be confirmed by blinded assessment of wound photographs. Discussion The DiaFu study will provide solid evidence regarding the efficacy and effectiveness of NPWT until 31 December 2014, the date when G-BA plans to decide on future reimbursement of NPWT in both ambulatory and in-hospital care. The study is designed to comply with all quality requirements of G-BA and IQWiG and will contribute to evidence-based wound care in Germany. The study has been initiated by the statutory health insurance companies in Germany and is co-funded by two manufacturers of NPWT systems. Trial registration Clinical Trials.gov registration number: NCT01480362 (date of registration: 23 November 2011). German Clinical Trials Register number: DRKS00003347 (date of registration: 22 November 2011).
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Affiliation(s)
- Dörthe Seidel
- Institute for Research in Operative Medicine (IFOM), Faculty of Health - School of Medicine, University of Witten/Herdecke, Ostmerheimer Str, 200, Building 38, 51109 Cologne, Germany.
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Carlson RM, Smith NC, Dux K, Stuck RM. Treatment of postoperative lower extremity wounds using human fibroblast-derived dermis: a retrospective analysis. Foot Ankle Spec 2014; 7:102-7. [PMID: 24521756 DOI: 10.1177/1938640014522097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Human fibroblast-derived dermis skin substitute is a well-studied treatment for diabetic foot ulcers; however, no case series currently exist for its use in healing postoperative wounds of the lower extremity. A retrospective analysis was conducted on 32 lower extremity postoperative wounds treated weekly with human fibroblast-derived dermis skin substitute. Postoperative wounds were defined as a wound resulting from an open partial foot amputation, surgical wound dehiscence, or nonhealing surgical wound of the lower extremity. Wound surface area was calculated at 4 and 12 weeks or until wound closure if prior to 12 weeks. Postoperative wounds treated with weekly applications showed mean improvement in surface area reduction of 63.6% at 4 weeks and 96.1% at 12 weeks. More than 56% of all wounds healed prior to the 12-week endpoint. Additionally, only one adverse event was noted in this group. This retrospective review supports the use of human fibroblast-derived dermis skin substitute in the treatment of postoperative lower extremity wounds. This advanced wound care therapy aids in decreased total healing time and increased rate of healing for not only diabetic foot wounds but also postoperative wounds of the lower extremity, as demonstrated by this retrospective review.
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Affiliation(s)
- Russell M Carlson
- ORA Orthopedics, Moline, Illinois, and Genesis Wound and Hyperbaric Medicine Institute, Davenport, Iowa (RMC)
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Results of vacuum assisted wound closure application. Indian J Surg 2014; 75:302-5. [PMID: 24426458 DOI: 10.1007/s12262-012-0490-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Accepted: 04/04/2012] [Indexed: 10/28/2022] Open
Abstract
In recent past, various methods have been used for wound treatment purpose. In this study, we aimed to compare our results established from the vacuum-assisted wound closure method, which has gained popularity day by day, with the literature. A total of 48 patients, who received vacuum-assisted wound closure treatment in our clinic between 2007and 2010, were included in this study. Etiological distribution of the patients was as follows: 32 traumatic, 6 pressure sore, 9 diabetic, and 1 iliac disarticulation. All cases were evaluated in terms of age, gender, etiology, period of treatment, and size of the wound. In the patients studied, 42 were men (87.5 %) and 6 were women (12.5 %). Mean age of the patients was 39.6 years (11-61 years). All of our traumatic patients suffered from open fracture. After the vacuum-assisted wound closure application, wound size reduced by 28.8 %, while the mean area of the surface of the wound was 94.7 cm(2) (13.7-216.3 cm(2)) on average. After the wounds became ready for surgery, 15 of them were treated with split-thickness grafting, 9 of them were treated with secondary suture, 18 of them were treated with full-thickness grafting, and 6 of them were treated with flap. Average period of the application of vacuum-assisted wound closure was 11.6 days (7-15 days). Results of vacuum-assisted wound closure can be regarded as satisfactory when cases are selected properly. This system has three different effect mechanisms. Firstly, it increases local blood flow on the wound bed. Secondly, cell proliferation is triggered following the mechanic stress. Thirdly, vacuum removes the proteases from the environment which obstructs healing. Therefore, it is intended to prepare alive wound bed which is required for subsequent soft tissue reconstructions.
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Abstract
Appropriate wound dressing selection is guided by an understanding of wound dressing properties and an ability to match the level of drainage and depth of a wound. Wounds should be assessed for necrosis and infection, which need to be addressed prior to selecting an ideal dressing. Moisture-retentive dressings include films, hydrogels, hydrocolloids, foams, alginates, and hydrofibers and are useful in a variety of clinical settings. Antimicrobial-impregnated dressings can be useful in wounds that are superficially infected or are at higher risk for infection. For refractory wounds that need more growth stimulation, tissue-engineered dressings have become a viable option in the past few decades, especially those that have been approved for burns, venous ulcers, and diabetic ulcers. As wounds heal, the ideal dressing type may change, depending on the amount of exudate and depth of the wound; thus success in wound dressing selection hinges on recognition of the changing healing environment.
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Pinheiro LDS, Borges EL, Donoso MTV. Uso de hidrocolóide e alginato de cálcio no tratamento de lesões cutâneas. Rev Bras Enferm 2013; 66:760-70. [DOI: 10.1590/s0034-71672013000500018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Accepted: 08/27/2013] [Indexed: 11/22/2022] Open
Abstract
Hidrocolóide e alginato de cálcio são utilizados no tratamento de lesões cutâneas e muitos profissionais da saúde desconhecem as evidências que sustentam sua indicação na cicatrização. Objetivou-se nesse estudo identificar evidências da ação da placa de hidrocolóide e alginato de cálcio no tratamento de lesão cutânea. Utilizou-se o método de revisão integrativa da literatura. Fizeram parte da amostra 12 estudos com nível de evidências I, II, III e IV, formados por pacientes com lesão cutânea tratada durante qualquer período de tempo com hidrocolóide placa ou alginato de cálcio. Os desfechos avaliados foram redução da área, cicatrização da lesão, taxa de cicatrização, tempo e infecção. Os resultados permitiram estabelecer três recomendações para o uso de hidrocolóide e nenhuma para uso de alginato de cálcio no tratamento de lesão crônica.
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Lateo SA, Langtry JAA. A prospective case series of secondary intention healing for surgical wounds on the dorsum of the hand. Clin Exp Dermatol 2013; 38:606-11. [PMID: 23758530 DOI: 10.1111/ced.12044] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND The dorsum of the hand is a common site for squamous cell carcinoma, and excision with appropriate margins often results in surgical defects that cannot be repaired by primary side-to-side closure. AIM To assess healing time, complications and resulting scars when surgical wounds on the dorsum of the hand were allowed to heal by secondary intention. METHODS This was a prospective study of 28 surgical defects on the dorsum of the hand, which were allowed to heal by secondary intention. Patients were followed up on days 2, 7 and 14, and then every 2 weeks until the wounds healed. Wound dressings were changed 2-3 times per week. Patients' tolerance of this treatment and their degree of satisfaction with the final results was determined. RESULTS The defect diameters ranged from 15 to 46 mm (median 24 mm). The time to heal was determined in 24 patients, and ranged from 22 to 63 days (median 44 days). There were no cases of postoperative bleeding. Two patients developed erythema of the wound edge; wound swabs for culture were negative in both cases. Overgranulation developed in 12 of 28 wounds, which settled with the application of a potent topical steroid and discontinuation of the hydrocolloid dressing. Patients were either 'very satisfied' (12/18) or 'satisfied' (6/18) with the resulting scar. CONCLUSIONS Secondary intention healing of surgical wounds on the dorsum of the hand is a useful management option, which is well tolerated by patients, has a low rate of complications, and gives good cosmetic results.
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Affiliation(s)
- S A Lateo
- Department of Dermatology, Sunderland Royal Hospital, Sunderland, UK.
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Mirastschijski U, Martin A, Jorgensen LN, Sampson B, Ågren MS. Zinc, copper, and selenium tissue levels and their relation to subcutaneous abscess, minor surgery, and wound healing in humans. Biol Trace Elem Res 2013; 153:76-83. [PMID: 23595590 DOI: 10.1007/s12011-013-9658-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Accepted: 03/27/2013] [Indexed: 11/25/2022]
Abstract
Trace element involvement in wounds left to heal by secondary intention needs clarification. We have previously reported faster healing of wounds following acute surgery compared with elective excision of pilonidal sinus disease. The effect of topical zinc on the closure of the excisional wounds was mediocre compared with placebo. In contrast, parenteral zinc, copper, and selenium combined appear effective for wound healing in humans. We have investigated zinc, copper, and selenium with respect to (a) impact of acute versus chronic pilonidal sinus and (b) regional concentrations within granulating wounds treated topically with placebo or zinc in 42 (33 males) pilonidal disease patients. Baseline serum and skin concentrations of copper correlated (r S = 0.351, p = 0.033, n = 37), but not of zinc or selenium. Patients with abscesses had elevated serum C-reactive protein (CRP) and copper levels (+29 %; p < 0.001) compared with the elective patients consistent with the strong correlation between serum copper and CRP (r S = 0.715, p < 0.0005, n = 41). Seven days after elective surgery, serum CRP and copper levels were elevated (p = 0.010) versus preoperative values. The copper concentration in wound edges was higher than in periwound skin (p < 0.0005) and wound base (p = 0.010). Selenium levels were increased in wound edge compared to wound base (p = 0.003). Topical zinc oxide treatment doubled (p < 0.050) zinc concentrations in the three tissue localizations without concomitant significant changes of copper or selenium levels. In conclusion, copper and selenium are mobilized to injured sites possibly to enhance host defense and early wound healing mechanisms that are complementary to the necessity of zinc for matrix metalloproteinase activity.
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Affiliation(s)
- Ursula Mirastschijski
- Department of Surgery K, Bispebjerg Hospital, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
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Sweeney IR, Miraftab M, Collyer G. A critical review of modern and emerging absorbent dressings used to treat exuding wounds. Int Wound J 2012; 9:601-12. [PMID: 22248337 PMCID: PMC7950558 DOI: 10.1111/j.1742-481x.2011.00923.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Wound management has progressed significantly over the last five decades. This emanates from a greater understanding of wound healing, technological progression and improved clinical and scientific research. There are currently a plethora of absorbent dressings on the wound care market which claim to have the ability to manage exudates whilst encouraging healing. However, it is becoming clear, from analysing randomised controlled trials, that some of these absorbent dressings are not meeting their expectations when applied in a clinical setting. Many clinicians now feel that there should be more focus, not only on a dressing's ability to manage exudate efficiently, but on a dressing's ability to proactively encourage healing and thus exudate reduction will ensue. This paper proposes to critically review modern and emerging absorbent wound care dressings used to manage exuding wounds and discuses some advances in this area.
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Affiliation(s)
- India R Sweeney
- Insitute for Materials Research and Innovation, University of Bolton, Deane Road, Bolton, UK.
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Baldelli CMF, Ruella M, Scuderi S, Monni M, Passera R, Omedè P, Tarella C. A short course of granulocyte–colony-stimulating factor to accelerate wound repair in patients undergoing surgery for sacrococcygeal pilonidal cyst: proof of concept. Cytotherapy 2012; 14:1101-9. [DOI: 10.3109/14653249.2012.697147] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Abstract
Obesity has been linked as a risk factor for wound complications and is becoming a more common occurrence. We reviewed the risk factors, preventive strategies, and recommended management of wound complications in obese women undergoing cesarean delivery. The limited available data support the use of prophylactic antibiotic before cesarean delivery, closure of subcutaneous space >2 cm, and maintaining normothermia intraoperatively to help reduce the incidence of postoperative wound complications. Data regarding management of cesarean wound complications in the obese patient are sparse, but they do suggest either primary or secondary closure of wounds is preferred to healing by secondary intention. Antibiotics should be administered in the presence of cellulitis or systemic toxicity. Use of vacuum-assisted wound closure devices may be useful in wound management. There is a need for randomized controlled trials which evaluate the prevention and management of wound complications in obese women undergoing cesarean delivery.
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Affiliation(s)
- Amanda M Tipton
- Department of Obstetrics and Gynecology, Virginia Commonwealth University Medical Center, Richmond, VA 23298, USA
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Siddique K, Mirza S, Housden P. Effectiveness of hydrocolloid dressing in postoperative hip and knee surgery: literature review and our experience. J Perioper Pract 2011; 21:275-8. [PMID: 22029208 DOI: 10.1177/175045891102100803] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hydrocolloid dressings are impermeable dressings that provide an optimal environment for wound healing. These dressings are very effective in healing chronic wounds but evidence regarding their use for the post-operative knee and hip surgery is scarce. Our experience shows that hydrocolloid dressing (Duoderm) helps in preventing not only superficial surgical site infection (SSSI) but also blister formation in patients undergoing lower limb orthopaedic surgery.
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Affiliation(s)
- Khurram Siddique
- General Surgery, East Kent Hospitals University NHS Foundation Trust, Kent, CT1 3NG.
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Driver VR, Yao M, Miller CJ. Noncontact low-frequency ultrasound therapy in the treatment of chronic wounds: a meta-analysis. Wound Repair Regen 2011; 19:475-80. [PMID: 21649783 DOI: 10.1111/j.1524-475x.2011.00701.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Our objective was to summarize and quantify the effects of a noncontact low-frequency ultrasound (NLFU) therapy on healing of chronic wounds. We performed a meta-analysis of eight published studies reporting effects of NLFU on wound size and healing rate of chronic wounds in 444 NLFU-treated patients. A search of the PubMed database was conducted in January 2010 and updated in October 2010. We used random-effects linear regression models to estimate the proportional reductions in wound area and volume and the proportion of wounds healed from baseline to last follow-up. In four studies (N=188) reporting change in wound area from baseline, NLFU was associated with 85.2% area reduction (95% CI 64.7%-97.6%) over a mean 7 weeks. In four studies (N=278) reporting reduction in wound volume, NLFU was associated with 79.7% volume reduction (95% CI 46.1%-98.8%) over a mean 12 weeks. In seven studies (N=429) reporting proportion of wounds healing by study end (mean time to healing 8.2 weeks; median 6.8 weeks), meta-analyzed healing rates over time suggest 32.7% of wounds healed on average by 6 weeks (95% CI 23.3%-42.1%) and 41.7% by 12 weeks. NLFU for treatment of chronic wounds was associated with consistent and substantial wound size reductions, as well as favorable rates of healing.
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Affiliation(s)
- Vickie R Driver
- Clinical Research Limb Preservation and Tissue Repair, Department of Surgery, Boston University School of Medicine and Boston University Medical Center, Massachusetts, USA.
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