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Ali A, Abdullah M, Shiraz MI, Amir MA, Shahid AR, Naseer BB, Larik MO, Baloch SA, Mumtaz ANM, Waseem AM. The efficacy of wound edge protectors in reducing surgical site infections in gastrointestinal surgeries: An updated systematic review and meta-analysis. Curr Probl Surg 2024; 61:101552. [PMID: 39168538 DOI: 10.1016/j.cpsurg.2024.101552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Accepted: 06/25/2024] [Indexed: 08/23/2024]
Affiliation(s)
- Asad Ali
- Department of Surgery, Dow International Medical College, Ojha Campus, Dow University of Health Sciences, Karachi, Pakistan
| | - Muhammad Abdullah
- Department of Surgery, Dow International Medical College, Ojha Campus, Dow University of Health Sciences, Karachi, Pakistan
| | - Moeez Ibrahim Shiraz
- Department of Surgery, Dow International Medical College, Ojha Campus, Dow University of Health Sciences, Karachi, Pakistan
| | - Muhammad Ali Amir
- Department of Surgery, Dow International Medical College, Ojha Campus, Dow University of Health Sciences, Karachi, Pakistan
| | - Abdul Rehman Shahid
- Department of Surgery, Dow International Medical College, Ojha Campus, Dow University of Health Sciences, Karachi, Pakistan.
| | - Bilal Bin Naseer
- Department of Surgery, Dow International Medical College, Ojha Campus, Dow University of Health Sciences, Karachi, Pakistan
| | - Muhammad Omar Larik
- Department of Surgery, Dow International Medical College, Ojha Campus, Dow University of Health Sciences, Karachi, Pakistan
| | - Salman Akbar Baloch
- Department of Surgery, Dow International Medical College, Ojha Campus, Dow University of Health Sciences, Karachi, Pakistan
| | - Ameer Noor Mehdi Mumtaz
- Department of Surgery, Dow International Medical College, Ojha Campus, Dow University of Health Sciences, Karachi, Pakistan
| | - Ali Mustafa Waseem
- Department of Surgery, Dow International Medical College, Ojha Campus, Dow University of Health Sciences, Karachi, Pakistan
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Sanchez-Puigdollers A, Toll A, Morgado-Carrasco D. Postoperative Wound Care in Dermatologic Surgery: Update And Narrative Review. ACTAS DERMO-SIFILIOGRAFICAS 2024:S0001-7310(24)00488-5. [PMID: 38857845 DOI: 10.1016/j.ad.2024.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 04/24/2024] [Accepted: 05/08/2024] [Indexed: 06/12/2024] Open
Abstract
Dermatologic surgery is associated with a very low risk of complications. There is no widely accepted, evidence-based protocol with recommendations for postoperative wound care after dermatologic surgery. In this narrative review, we will be discussing the evidence on surgical wound care products and procedures. Overall, we found relatively few studies and, in many cases, a lack of statistically significant differences, possibly because of the low rate of complications. We'll be discussing the evidence on when we should initiate wound care procedures and their frequency, the type of ointment and antiseptics that should be applied, and the type of dressings that should be used. Despite the very few studies available on postoperative wound care following dermatologic surgery, there is sufficient evidence as to not recommend the use of prophylactic topical antibiotics. We also analyze the currently available evidence on surgical wound care in special situations, such as management of skin grafts, partial skin graft donor sites, xenografts/biomembranes, and surgical wounds to the legs.
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Affiliation(s)
- A Sanchez-Puigdollers
- Servicio de Dermatología, Hospital Sagrat Cor, Barcelona, España; Servicio de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, España
| | - A Toll
- Servicio de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, España
| | - D Morgado-Carrasco
- Servicio de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, España; Servicio de Dermatología, Hospital de Figueres, Fundació Salut Empordà, Figueres, Girona, España.
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Shin SE, Spoer D, Franzoni G, Berger L, Hill A, Sayyed AA, Noe N, Steinberg JS, Attinger CE, Evans KK. To Mesh or Not to Mesh: What Is the Ideal Meshing Ratio for Split Thickness Skin Grafting of the Lower Extremity? J Foot Ankle Surg 2024; 63:13-17. [PMID: 37619700 DOI: 10.1053/j.jfas.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 04/06/2023] [Accepted: 05/09/2023] [Indexed: 08/26/2023]
Abstract
Split-thickness skin grafts can provide effective autologous wound closure in patients with dysvascular comorbidities. Meshing the graft allows for reduced donor site morbidity and expanded coverage. This study directly compares outcomes across varying meshing ratios used to treat chronic lower extremity wounds. Patients who received split-thickness skin grafts to their lower extremity for chronic ulcers from December 2014 to December 2019 at a single center were retrospectively reviewed. Patients were stratified by meshing ratios: nonmeshed (including pie crusting), 1.5:1, and 3:1. The primary outcome was clinical "healing" as determined by surgeon discretion at 30 days, 60 days, and the latest follow-up. Secondary outcomes included postoperative complications, graft loss, ulcer recurrence, progression to amputation, and mortality. A total of 321 patients were identified. Wound sizes and location differed significantly, with 3:1 meshing applied to the largest wounds (187.8 ± 157.6 cm2; 1.5:1 meshed, 110.4 ± 103.9 cm2; nonmeshed 38.7 ± 55.5 cm2; p < .0001) mostly of the lower leg (n = 18, 75%; 1.5:1 meshed, n = 23, 43.4%; nonmeshed n = 62, 25.7%; p < .0001). Meshed grafts displayed a significantly higher proportion of healing at 30 and 60 days, but no differences persisted by the final follow-up (16.5 ± 20.5 months). Longitudinally, nonmeshed STSG was associated with most graft loss (46, 19.1%; p = .011) and ulcer recurrence (44, 18.3%; p = .011). Of the 3 meshing ratios, 3:1 exhibited the lowest rates of complications. Our results suggest that 3:1 meshing is a safe option for coverage of large lower extremity wounds to minimize donor site morbidity.
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Affiliation(s)
| | - Daisy Spoer
- Georgetown University School of Medicine, Washington, DC; Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC
| | | | - Lauren Berger
- Plastic and Reconstructive Surgery Division, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Alison Hill
- Georgetown University School of Medicine, Washington, DC
| | - Adaah A Sayyed
- Georgetown University School of Medicine, Washington, DC; Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC
| | - Niki Noe
- Georgetown University School of Medicine, Washington, DC
| | - John S Steinberg
- Department of Podiatric Surgery, MedStar Georgetown University Hospital, Washington, DC
| | - Christopher E Attinger
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC
| | - Karen K Evans
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC.
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Peters E, Hanssens V, De Henau M, Dupont Y, Spinnael J, Giunta G, Zeltzer A, De Baerdemaeker R, Hamdi M. Using an Elastomeric Skin Protectant to Manage Donor Site Wounds of Split-thickness Skin Grafts: A Case Series. Adv Skin Wound Care 2023; 36:1-5. [PMID: 37530580 DOI: 10.1097/asw.0000000000000021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
ABSTRACT Split-thickness skin grafting (STSG) is a common surgical procedure to manage acute and chronic wounds. A plethora of dressings exists to treat STSG donor site wounds (DSWs). Recently, a new elastomeric skin protectant was adopted (Cavilon Advanced Skin Protectant; 3M) in the treatment of incontinence-associated dermatitis. In this report, the authors assess the effects of this elastomeric skin protectant as an alternative wound dressing for STSG donor sites.The authors report a single-center prospective case series that was performed to establish a treatment protocol. Nine consecutive patients with different indications for treatment with an STSG from May to September 2018 were included. Collected data included general patient information, comorbidities, complications, blood loss, pain during dressing change, and the duration of DSW healing.This case series showed promising results in terms of duration of DSW healing when applying the elastomeric skin protectant. The authors also observed less blood loss and less pain during dressing changes. No infections were seen during the trial.
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Affiliation(s)
- Ellen Peters
- At Universitair Ziekenhuis Brussels, Belgium, Ellen Peters, MD, is Resident, Plastic, Reconstructive, and Aesthetic Surgery; Valerie Hanssens, MSc, is Nurse Specialist Wound Care; Melissa De Henau, MD, is Medical Doctor; Yamina Dupont, MD, is Resident, Plastic, Reconstructive, and Aesthetic Surgery; Jeannine Spinnael, BSN, is Nurse Specialist Wound Care; Gabriele Giunta, MD, Assaf Zeltzer, MD, PhD, and Randy De Baerdemaeker, MD, are Staff Members, Plastic, Reconstructive, and Aesthetic Surgery; and Moustapha Hamdi, MD, PhD, is Chief, Department of Plastic, Reconstructive, and Aesthetic Surgery. The authors have disclosed no financial relationships related to this article. Submitted February 8, 2022; accepted in revised form October 21, 2022; Published ahead of print July 31, 2023
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Chowdhry SA. Comparison of skin graft donor site management using oxidised regenerated cellulose (ORC)/collagen/silver-ORC with absorptive silicone adhesive border and transparent film dressing vs semi-occlusive dressings. Int Wound J 2023; 20:1112-1117. [PMID: 36151766 PMCID: PMC10030937 DOI: 10.1111/iwj.13968] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/07/2022] [Accepted: 09/11/2022] [Indexed: 11/28/2022] Open
Abstract
Split-thickness skin grafts (STSG) are widely used in wound reconstruction. However, donor site wounds are created as a result. Traditionally, moist wound healing and transparent film dressings have been used to promote donor site wound healing. This retrospective study evaluated the use of oxidised regenerated cellulose (ORC)/collagen/silver-ORC dressing (ORC/C/Ag-ORC) with an absorptive silicone adhesive border dressing and transparent film dressing (treatment) compared with petrolatum-based gauze dressing (control) over donor site wounds. Patients underwent an STSG procedure between January and December 2020. Donor sites received treatment (n = 10) or control (n = 10) dressings. Dressing changes occurred as necessary. Time to epithelialisation, narcotic pain medication requirements, and the number of office/hospital visits were examined. Twenty patients were managed (9 males, 11 females, average age: 49.7 ± 13.9 y). Patient comorbidities included hypertension, diabetes, and hyperlipidemia. Wound types included traumatic and cancer excision. Time to epithelialisation was significantly reduced in the treatment group (11.1 ± 1.4 d vs 18 ± 2.4 d, P < 0.0001). The number of office visits for dressing changes was significantly lower in the treatment group (0.1 ± 0.3 vs 2 ± 0.7, P < 0.0001). No patients in the treatment group required a hospital visit, compared with 3 patients in the control group. One patient in the treatment group required narcotic pain medication, compared with 5 in the control group. In this patient population, the use of ORC/C/Ag-ORC, an absorptive silicone adhesive border dressing, and transparent film dressing resulted in a shorter time to epithelialisation and less analgesic requirement compared with petrolatum-based gauze dressing use.
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Affiliation(s)
- Saeed A Chowdhry
- Rosalind Franklin University of Medicine and Science, Chicago Medical School, North Chicago, Illinois, USA
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Hahn H, Yu TC, Teng CC, Tan H. Holistic View of Autografting Patients by Percentage of Total Body Surface Area Burned: Medical Record Abstraction Integrated with Administrative Claims. CLINICOECONOMICS AND OUTCOMES RESEARCH 2023; 15:251-267. [PMID: 37064295 PMCID: PMC10094521 DOI: 10.2147/ceor.s401003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/23/2023] [Indexed: 04/18/2023] Open
Abstract
Aim This retrospective observational study provides a holistic view of the clinical and economic characteristics of inpatient treatment of patients with thermal burns undergoing autografting, by integrating real-world data (RWD) from medical records from healthcare providers (HCPs) and administrative claims. Methods We identified eligible patients between July 1, 2010, and November 30, 2019, from the HealthCore Integrated Research Database® (HIRD®) and obtained their medical records from HCPs. We abstracted data from medical records to describe patient demographics and clinical characteristics and obtained costs of treatment from claims. Results Two hundred patients were stratified into cohorts based on the percentage of total body surface area (%TBSA) burned: minor (< 10%), moderate (10%-24%), and major (≥ 25%). Data obtained from medical records and administrative claims were comparable to previous findings from administrative claims data. This privately insured study cohort predominantly consisted of White men. Diabetes mellitus and hypertension were frequently reported in a relatively young population. Key clinical characteristics that could influence burn treatment decisions and long-term outcomes, such as body mass index, size of autograft donor site, and mesh ratio, were frequently underdocumented in patients' medical records. Conclusion Evidence generated from 2 orthogonal RWD sources confirmed that patients with larger %TBSA burned required more intensive care, thereby incurring higher costs. This study highlights considerable incompleteness in many critical fields in medical records, which limits the ability to generate broader insights. More comprehensive documentation of clinical characteristics and outcomes of autografts and donor sites in the operative and medical notes is critical to appropriately evaluate their impact on outcomes of burn treatments in future research using RWD.
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Affiliation(s)
- Helen Hahn
- Mallinckrodt Pharmaceuticals, Hampton, NJ, USA
| | - Tzy-Chyi Yu
- Mallinckrodt Pharmaceuticals, Hampton, NJ, USA
- Correspondence: Tzy-Chyi Yu, Mallinckrodt Pharmaceuticals, Shelbourne Building, 53 Frontage Road, Suite 300, Hampton, NJ, 08827, USA, Tel +1 908 238 6884, Email
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MIKOSIŃSKI J, KALOGEROPOULOS K, BUNDGAARD L, LARSEN CA, SAVICKAS S, HAACK AM, PAŃCZAK K, RYBOŁOWICZ K, GRZELA T, OLSZEWSKI M, CISZEWSKI P, SITEK-ZIÓŁKOWSKA K, TWARDOWSKA-SAUCHA K, KARCZEWSKI M, RABCZENKO D, SEGIET A, BUCZAK-KULA P, SCHOOF EM, EMING SA, SMOLA H, AUF DEM KELLER U. Longitudinal Evaluation of Biomarkers in Wound Fluids from Venous Leg Ulcers and Split-thickness Skin Graft Donor Site Wounds Treated with a Protease-modulating Wound Dressing. Acta Derm Venereol 2022; 102:adv00834. [PMID: 36250733 PMCID: PMC9811302 DOI: 10.2340/actadv.v102.325] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Venous leg ulcers represent a clinical challenge and impair the quality of life of patients. This study examines impaired wound healing in venous leg ulcers at the molecular level. Protein expression patterns for biomarkers were analysed in venous leg ulcer wound fluids from 57 patients treated with a protease-modulating polyacrylate wound dressing for 12 weeks, and compared with exudates from 10 acute split-thickness wounds. Wound healing improved in the venous leg ulcer wounds: 61.4% of the 57 patients with venous leg ulcer achieved a relative wound area reduction of ≥ 40%, and 50.9% of the total 57 patients achieved a relative wound area reduction of ≥ 60%. Within the first 14 days, abundances of S100A8, S100A9, neutrophil elastase, matrix metalloproteinase-2, and fibronectin in venous leg ulcer exudates decreased significantly and remained stable, yet higher than in acute wounds. Interleukin-1β, tumour necrosis factor alpha, and matrix metalloproteinase-9 abundance ranges were similar in venous leg ulcers and acute wound fluids. Collagen (I) α1 abundance was higher in venous leg ulcer wound fluids and was not significantly regulated. Overall, significant biomarker changes occurred in the first 14 days before a clinically robust healing response in the venous leg ulcer cohort.
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Affiliation(s)
- Jacek MIKOSIŃSKI
- “MIKOMED”, Clinic for Peripheral Vascular Diseases, Łódź, Poland
| | - Konstantinos KALOGEROPOULOS
- DTU Bioengineering, Section for Protein Science and Biotherapeutics, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Louise BUNDGAARD
- DTU Bioengineering, Section for Protein Science and Biotherapeutics, Technical University of Denmark, Kgs. Lyngby, Denmark,Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Taastrup, Denmark
| | - Cathrine Agnete LARSEN
- DTU Bioengineering, Section for Protein Science and Biotherapeutics, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Simonas SAVICKAS
- DTU Bioengineering, Section for Protein Science and Biotherapeutics, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Aleksander Moldt HAACK
- DTU Bioengineering, Section for Protein Science and Biotherapeutics, Technical University of Denmark, Kgs. Lyngby, Denmark
| | | | | | - Tomasz GRZELA
- Clinic of Phlebology,Medical University of Warsaw, Warsaw
| | - Michał OLSZEWSKI
- Pratia Ostrołęka Embedded Hospital Clinical Research Site, Ostrołęka
| | - Piotr CISZEWSKI
- WILMED Specialist Medical Clinic Non-public Healthcare Centre, Warszaw
| | | | | | - Marek KARCZEWSKI
- CSOLUMED Medical Centre,Poland Department of General and Transplant Surgery, Poznan University of Medical Sciences, Poznan
| | | | | | | | - Erwin M. SCHOOF
- DTU Bioengineering, Section for Protein Science and Biotherapeutics, Technical University of Denmark, Kgs. Lyngby, Denmark
| | | | - Hans SMOLA
- Department of Dermatology, University of Cologne, Cologne,PAUL HARTMANN AG, Heidenheim, Germany
| | - Ulrich AUF DEM KELLER
- DTU Bioengineering, Section for Protein Science and Biotherapeutics, Technical University of Denmark, Kgs. Lyngby, Denmark
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desJardins-Park HE, Gurtner GC, Wan DC, Longaker MT. From Chronic Wounds to Scarring: The Growing Health Care Burden of Under- and Over-Healing Wounds. Adv Wound Care (New Rochelle) 2022; 11:496-510. [PMID: 34521257 PMCID: PMC9634983 DOI: 10.1089/wound.2021.0039] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 09/03/2021] [Indexed: 12/26/2022] Open
Abstract
Significance: Wound healing is the largest medical market without an existing small molecule/drug treatment. Both "under-healing" (chronic wounds) and "over-healing" (scarring) cause a substantial biomedical burden and lifelong consequences for patients. These problems cost tens of billions of dollars per year in the United States alone, a number expected to grow as the population ages and the prevalence of common comorbidities (e.g., diabetes) rises. However, no therapies currently exist to produce the "ideal" healing outcome: efficient wound repair through regeneration of normal tissue. Recent Advances: Ongoing research continues to illuminate possible therapeutic avenues for wound healing. By identifying underlying mechanisms of wound repair-for instance, tissue mechanics' role in fibrosis or cell populations that modulate wound healing and scarring-novel molecular targets may be defined. This Advances in Wound Care Forum issue includes reviews of scientific literature and original research from the Hagey Laboratory for Pediatric Regenerative Medicine at Stanford and its alumni, including developing approaches for encouraging wound healing, minimizing fibrosis, and coaxing regeneration. Critical Issues: Wound healing problems reflect an enormous and rapidly expanding clinical burden. The issues of both under- and over-healing wound outcomes will continue to expand as their underlying causes (e.g., diabetes) grow. Targeted treatments are needed to enable wound repair with functional tissue restoration and decreased scarring. Future Directions: Basic scientists will continue to refine understanding of factors driving undesirable wound outcomes. These discoveries are beginning to be translated and, in the coming years, will hopefully form the foundation for antiscarring drugs and other wound therapeutics.
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Affiliation(s)
- Heather E. desJardins-Park
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery; Stanford, California, USA
- Institute for Stem Cell Biology and Regenerative Medicine; Stanford University School of Medicine, Stanford, California, USA
| | - Geoffrey C. Gurtner
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery; Stanford, California, USA
| | - Derrick C. Wan
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery; Stanford, California, USA
| | - Michael T. Longaker
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery; Stanford, California, USA
- Institute for Stem Cell Biology and Regenerative Medicine; Stanford University School of Medicine, Stanford, California, USA
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Chan S, Cherian P. Skin grafts: A survey study of Australasian Mohs surgeons. Australas J Dermatol 2022; 63:e265-e268. [DOI: 10.1111/ajd.13871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/25/2022] [Accepted: 05/04/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Su‐Lin Chan
- Oxford Dermatology Perth Western Australia Australia
| | - Paul Cherian
- Oxford Dermatology Perth Western Australia Australia
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López JF, Mikkola A, Sarkanen JR, Kaartinen IS, Kuokkanen HO, Ylikomi T. Adipose tissue as a source of growth factors to promote wound healing: a human study of skin graft donor sites. J Wound Care 2022; 31:282-292. [DOI: 10.12968/jowc.2022.31.4.282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Objective: In the microenvironment of wound sites, naturally occurring growth factors are crucial for cell migration, opsonisation, chemotaxis, differentiation and angiogenesis. Exogenous growth factors, such as platelet-rich plasma (PRP) and adipose tissue, also improve healing. Method: In the present within-subject study, we described the effects of PRP and adipose tissue extract (ATE) on skin graft donor site wound healing in patients requiring split-thickness skin grafts. Each patient, having at least two donor sites, received both control (no growth factor) and experimental (PRP or ATE) treatments. Wounds were evaluated on days 5, 7, 10, 15, 30 and 60. Digital photography and spectral images were used to analyse haemoglobin and melanin content, and re-epithelialisation area. Pain was assessed by visual analogue scale. Scar characteristics were scored on days 30 and 60. Biomaterial samples were analysed for growth factor and protein content. Results: The study included 24 patients (18 male and six female; mean age: 59.1 years). PRP was topically applied to wounds in 11 patients (13 donor sites) and ATE in 13 patients (15 sites). ATE-treated donor sites exhibited significantly accelerated wound re-epithelialisation on days 5 and 7 compared with control sites (p=0.003 and 0.04, respectively). PRP accelerated healing on day 7 compared with control sites (p=0.001). Additionally, the application of ATE improved scar quality on days 30 and 60 (p=0.0005 and 0.02, respectively). Pain scores did not differ significantly between treatments. Conclusion: In this study, both growth factor sources stimulated wound healing. ATE is an alternative source of growth factors that promote early wound healing and improve scar quality.
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Affiliation(s)
- Jenny F López
- Department of Cell Biology, School of Medicine (currently Faculty of Medicine and Health Technology), Tampere University, Tampere, Finland
- Department of Plastic Surgery, Unit of Musculoskeletal Diseases, Tampere University Hospital, Pirkanmaa Hospital District, Tampere, Finland
| | - Antti Mikkola
- Department of Plastic Surgery, Unit of Musculoskeletal Diseases, Tampere University Hospital, Pirkanmaa Hospital District, Tampere, Finland
| | - Jertta-Riina Sarkanen
- Department of Cell Biology, School of Medicine (currently Faculty of Medicine and Health Technology), Tampere University, Tampere, Finland
- FICAM, Finnish Centre for Alternative Methods, School of Medicine, University of Tampere, Tampere, Finland
- Science Center, Pirkanmaa Hospital District, Finland
| | - Ilkka S Kaartinen
- Department of Plastic Surgery, Unit of Musculoskeletal Diseases, Tampere University Hospital, Pirkanmaa Hospital District, Tampere, Finland
- Science Center, Pirkanmaa Hospital District, Finland
| | - Hannu O Kuokkanen
- Department of Plastic Surgery, Unit of Musculoskeletal Diseases, Tampere University Hospital, Pirkanmaa Hospital District, Tampere, Finland
- Science Center, Pirkanmaa Hospital District, Finland
| | - Timo Ylikomi
- Department of Cell Biology, School of Medicine (currently Faculty of Medicine and Health Technology), Tampere University, Tampere, Finland
- FICAM, Finnish Centre for Alternative Methods, School of Medicine, University of Tampere, Tampere, Finland
- Science Center, Pirkanmaa Hospital District, Finland
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Anagnostakos K, Thiery A, Sahan I. Retained Negative Pressure Wound Therapy Foams as a Cause of Infection Persistence. Adv Wound Care (New Rochelle) 2021; 10:699-710. [PMID: 32870776 DOI: 10.1089/wound.2019.1088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Significance: Negative pressure wound therapy (NPWT) has become a valuable adjunct in the treatment of acute and chronic wounds in several surgical disciplines. Retained foams are among its side effects, and they pose a rare but devastating complication at the site of this therapy, which might be associated with wound-healing complications, infection persistence, repeated surgical revisions, and prolonged antibiotic courses. Recent Advances: In the past 15 years, an increasing number of studies have identified this potential problem. Although the exact incidence remains unknown, initial studies have indicated rates of up to 10% in large collectives being treated by NPWT. Critical Issues: The lack of radiopaque markers does not allow for the visual control of retained foams using plain radiographs. Further imaging methods (e.g., CT and MRI) also do not help in adequate differential diagnosis. The lack of routine documentation of the number, type, and localization of the inserted foam(s) and unplanned surgery with a different surgical team pose risk factors for foam retainment. Future Directions: Introducing new documentation records for wounds treated with NPWT is recommended. At foam removal, all dressing materials should be examined for integrity. The development of foams with radiopaque markers by the industry, such as those routinely used in surgical gauze swabs, might also be a useful step to minimize the risk of foam retainment within wounds.
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Affiliation(s)
- Konstantinos Anagnostakos
- Department of Orthopedics, Center for Orthopedic and Trauma Surgery, Klinikum Saarbrücken, Saarbrücken, Germany
| | - Andreas Thiery
- Department of Orthopedics, Center for Orthopedic and Trauma Surgery, Klinikum Saarbrücken, Saarbrücken, Germany
| | - Ismail Sahan
- Department of Orthopedics, Center for Orthopedic and Trauma Surgery, Klinikum Saarbrücken, Saarbrücken, Germany
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Haik J, Ullman Y, Gur E, Ad-El D, Egozi D, Kruchevsky D, Zissman S, Biros E, Nir RR, Kornhaber R, Cleary M, Harats M. Advances in the use of electrospun nanofibrous polymeric matrix for dermal healing at the donor site after the split-thickness skin graft excision: a prospective, randomized, controlled, open-label, multicenter study. J Burn Care Res 2021; 43:889-898. [PMID: 34751384 DOI: 10.1093/jbcr/irab216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Dressings used to manage donor site wounds have up to 40% of patients experiencing complications that may cause suboptimal scarring. We evaluated the efficacy and safety of a portable electrospun nanofibrous matrix that provides contactless management of donor site wounds compared with standard dressing techniques. This study included adult patients who underwent an excised split-thickness skin graft with a donor site wound area of 10-200 cm 2. Patients were allocated into two groups; i.e., the nanofiber group managed with a nanofibrous polymer-based matrix, and the control group managed using the standard of care such as Jelonet® or Biatain® Ibu dressing. Primary outcomes were postoperative dermal healing efficacy assessed by Draize scores. The time to complete re-epithelialization was also recorded. Secondary outcomes included postoperative adverse events, pain, and infections during the first 21-days and extended 12-month follow-up. The itching and scarring were recorded during the extended follow-up (months 1,3,6,9,12) using Numerical-Analogue-Score and Vancouver scores, respectively. The nanofiber and control groups included 21 and 20 patients, respectively. The Draize dermal irritation scores were significantly lower in the nanofiber vs. control group (Z=-2.509; P=0.028) on the first postoperative day but became similar afterward (Z≥-1.62; P≥0.198). In addition, the average time to re-epithelialization was similar in the nanofiber (17.9±4.4 days) and control group (18.3±4.5 days) (Z=-0.299; P=0.764), so were postoperative adverse events, pain, and infection incidence, itching and scarring. The safety and efficacy of electrospun nanofibrous matrix are similar to standard wound care allowing its use as an alternative donor site dressing following the split-thickness skin graft excision.
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Affiliation(s)
- Josef Haik
- Department of Plastic and Reconstructive Surgery, Sheba Medical Center, Ramat-Gan, affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Talpiot Leadership Program, Sheba Medical Center, Tel-Hashomer, Israel.,Institute for Health Research, University of Notre Dame, Western Australia.,College of Health and Medicine, University of Tasmania, Sydney, NSW, Australia
| | - Yehuda Ullman
- Department of Plastic and Reconstructive Surgery, Rambam Health Care Campus, affiliated with the Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Eyal Gur
- Department of Plastic and Reconstructive Surgery, Sourasky Medical Center, affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Dean Ad-El
- Department of Plastic and Reconstructive Surgery, Rabin Medical Center, Petah-Tikva, affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Dana Egozi
- Department of Plastic and Reconstructive Surgery, Kaplan Medical Center, Rehovot, Israel
| | - Dani Kruchevsky
- Department of Plastic and Reconstructive Surgery, Rambam Health Care Campus, affiliated with the Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Sivan Zissman
- Department of Plastic and Reconstructive Surgery, Sourasky Medical Center, affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Erik Biros
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Rony-Reuven Nir
- Department of Plastic and Reconstructive Surgery, Sheba Medical Center, Ramat-Gan, affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Rachel Kornhaber
- Department of Plastic and Reconstructive Surgery, Sheba Medical Center, Ramat-Gan, affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,College of Health and Medicine, University of Tasmania, Sydney, NSW, Australia
| | - Michelle Cleary
- School of Nursing, Midwifery and Social Sciences, CQUniversity Australia
| | - Moti Harats
- Department of Plastic and Reconstructive Surgery, Sheba Medical Center, Ramat-Gan, affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Talpiot Leadership Program, Sheba Medical Center, Tel-Hashomer, Israel.,Institute for Health Research, University of Notre Dame, Western Australia
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The effects of photobiomodulation using LED on the repair process of skin graft donor sites. Lasers Med Sci 2021; 37:1881-1890. [PMID: 34713365 DOI: 10.1007/s10103-021-03447-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 10/15/2021] [Indexed: 10/20/2022]
Abstract
The benefits of photobiomodulation (PBM) applied to wounds are well-described in the literature; however, its effects in skin graft donor sites have been poorly studied. The aim of this study is to evaluate the effects of LED PBM on re-epithelialization and wound quality of the skin donor site and on pain during repair process. This is a case series study that part of the patients received standard treatment and the others received standard treatment combined with PBM. Data collection was performed at the Burn Unit at a Public Hospital, Brazil. The study had 21 participants and 25 donor sites, 13 in the control group (conventional treatment with Membracel® bandage) and 12 in the experimental group (Membracel® + LED). Irradiation parameters were 1.53 J/cm2, 2.55 mW/cm2, 660 nm, 600 s in the immediate postoperative period as well as on the 1st, 3rd, 5th, and 7th days postoperatively. Pain was measured using the visual analog scale. The Bates-Jensen scale was used to monitor the re-epithelialization process and measurements were performed of donor skin sites in the postoperative period. Quantitative variables were expressed as mean ± standard deviation or median and interquartile range [p25; p75]. The comparison of the distribution of these variables between groups was performed using the Mann-Whitney test. No differences between groups were found for re-epithelialization time, area or quality of the wound. Regarding pain, a significant reduction was found on the 5th postoperative day in the experimental group compared to the control group. PBM did not induce changes in the re-epithelialization period, wound area or wound quality scores of the Bates-Jensen Scale but did induce a reduction in pain compared to the group treated with Membracel® alone.
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García-Sánchez JM, Mirabet Lis V, Ruiz-Valls A, Pérez-Plaza A, Sepúlveda Sanchis P, Pérez-Del-Caz MD. Platelet rich plasma and plasma rich in growth factors for split-thickness skin graft donor site treatment in the burn patient setting: A randomized clinical trial. Burns 2021; 48:1662-1670. [PMID: 34952738 DOI: 10.1016/j.burns.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/26/2021] [Accepted: 10/05/2021] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Management of donor site morbidity in the setting of split thickness skin graft (STSG) is of crucial importance with no superior wound dressing described to date and the growing need of decreasing epithelializing time. The purpose of the study was to compare the standard of care using a hydrocolloid dressing to platelet rich plasma (PRP) and plasma rich in growth factors (PRGF) in order to determine its therapeutic potential in this setting. METHODS A randomized clinical trial was conducted in which each patient served as its own control. PRGF was obtained by means of freeze-thaw out of the PRP from the subject of the study. Patients from the study had three donor sites and each donor site received either to PRP, PRGF or the standard of care, hydrocolloid. The main variable was time to epithelialization, and secondary variables subject to study were pain, quality of the scar, complications and cost. RESULTS 20 patients were recruited with a total number of 60 donor sites to study. On the 8th post-operative day 55% and 45% of the sites treated with PRP and PRGF, respectively, complete epithelialization was observed as compared to 20% of the sites treated with hydrocolloid, statistical significance was achieved between the latter two (p = 0.036). The areas treated with PRP and PRGF received inferior values on the visual analog scale on post-op day 5 and 8 compared to hydrocolloid. Values on wound healing metrics were lower in the PRP when compared to hydrocolloid. No adverse effects were recorded. CONCLUSION Donor site of STSG treated with PRP in the setting of the burn patient decreased time to epithelialization. In our study a better pain control and in scar quality was observed in both, the PRP and PRGF group.
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Affiliation(s)
| | - Vicente Mirabet Lis
- Center for Blood Transfusion and Tissue Bank of Valencian Community, Valencia, Spain
| | - Alejandro Ruiz-Valls
- Department of Plastic and Reconstructive Surgery and Burns, La Fe Hospital, Valencia, Spain.
| | - Aranzazu Pérez-Plaza
- Department of Plastic and Reconstructive Surgery and Burns, La Fe Hospital, Valencia, Spain
| | - Pilar Sepúlveda Sanchis
- Regenerative Medicine and Heart Transplantation Unit, Health Research Institute Hospital La Fe, Valencia, Spain
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15
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Split-Thickness Skin Grafting: A Primer for Orthopaedic Surgeons. J Am Acad Orthop Surg 2021; 29:855-861. [PMID: 34547758 DOI: 10.5435/jaaos-d-20-01389] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 05/18/2021] [Indexed: 02/01/2023] Open
Abstract
Soft-tissue defects pose a unique challenge to the treating orthopaedic surgeon. Such defects are commonly encountered after orthopaedic injuries or infection, and the management of these wounds varies significantly. Skin grafting has gained popularity in the management of such soft-tissue defects due to its ability to provide coverage, re-epithelialize, and have a relatively high success rate. One of the most frequently used types of skin graft in orthopaedics is the split-thickness skin graft (STSG). Understanding the proper indications, technique, and management of the STSG foreshadows its success or failure. This review focuses on the indications, technique, alternatives, and complications surrounding the utilization of the STSG in the management of orthopaedic injuries.
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Sathe PS, Prabhu DV, Ravikumar P, Bolton LL. Alternative Wound Management: Translating Science into Practice. Adv Skin Wound Care 2021; 34:517-524. [PMID: 34546202 DOI: 10.1097/01.asw.0000772872.03584.ae] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
GENERAL PURPOSE To present a scoping review of preclinical and clinical trial evidence supporting the efficacy and/or safety of major alternative wound care agents to summarize their effects on validated elements of wound bed preparation and wound management paradigms. TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant will:1. Differentiate the effectiveness of the topical wound care agents included in this review.2. Compare the preventive efficacy of intravenous agents administered to trauma and surgical patients.3. Select the effectiveness of products in this review that are left in place after surgical procedures.4. Identify an oral agent that can be helpful in mitigating the effects of COVID-19.
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17
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Burian EA, Sabah L, Kirketerp-Møller K, Ibstedt E, Fazli MM, Gundersen G. The Safety and Antimicrobial Properties of Stabilized Hypochlorous Acid in Acetic Acid Buffer for the Treatment of Acute Wounds-a Human Pilot Study and In Vitro Data. INT J LOW EXTR WOUND 2021; 22:369-377. [PMID: 33949232 DOI: 10.1177/15347346211015656] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Acute wounds may require cleansing to reduce the risk of infection. Stabilized hypochlorous acid in acetic buffer (HOCl + buffer) is a novel wound irrigation solution with antimicrobial properties. We performed a first-in-man, prospective, open-label pilot study to document preliminary safety and performance in the treatment of acute wounds. The study enrolled 12 subjects scheduled for a split-skin graft transplantation, where the donor site was used as a model of an acute wound. The treatment time was 75 s, given on 6 occasions. A total of 7 adverse events were regarded as related to the treatment; all registered as pain during the procedure for 2 subjects. One subject had a wound infection at the donor site. The mean colony-forming unit (CFU) decreased by 41% after the treatment, and the mean epithelialization was 96% on both days 14 (standard deviation [SD] 8%) and 21 (SD 10%). The study provides preliminary support for the safety, well-tolerance, and efficacy of HOCl + buffer for acute wounds. The pain was frequent although resolved quickly. Excellent wound healing and satisfying antimicrobial properties were observed. A subsequent in vitro biofilm study also indicated good antimicrobial activity against Pseudomonas aeruginosa with a 96% mean reduction of CFU, when used for a treatment duration of 15 min (P < .0001), and a 50% decrease for Staphylococcus aureus (P = .1010). Future larger studies are needed to evaluate the safety and performance of HOCl + buffer in acute wounds, including the promising antimicrobial effect by prolonged treatment on bacterial biofilms.
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Affiliation(s)
- Ewa A Burian
- Department of Dermato-Venereology & Wound Healing Center, Bispebjerg Hospital, Copenhagen, Denmark
| | - Lubna Sabah
- Department of Dermato-Venereology & Wound Healing Center, Bispebjerg Hospital, Copenhagen, Denmark
| | - Klaus Kirketerp-Møller
- Department of Dermato-Venereology & Wound Healing Center, Bispebjerg Hospital, Copenhagen, Denmark
| | | | - Magnus M Fazli
- 53139Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark.,SoftOx Solutions AS, Oslo, Norway
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Abstract
GENERAL PURPOSE To present a comprehensive review of patient-centered outcomes of topical or systemic interventions applied to those with shingles or postherpetic neuralgia to inform clinical practice and identify related research needs. TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant will be able to:1. Explain the importance of early diagnosis and treatment of herpes zoster (HZ).2. Identify interventions that have resulted in documented improvement of validated patient-centered outcomes in patients with HZ or postherpetic neuralgia.3. Recognize the average per patient medical costs of HZ in the US.
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19
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Asuku M, Yu TC, Yan Q, Böing E, Hahn H, Hovland S, Donelan MB. Split-thickness skin graft donor-site morbidity: A systematic literature review. Burns 2021; 47:1525-1546. [PMID: 33781633 DOI: 10.1016/j.burns.2021.02.014] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 12/08/2020] [Accepted: 02/02/2021] [Indexed: 12/21/2022]
Abstract
The purpose of this systematic literature review is to critically evaluate split-thickness skin graft (STSG) donor-site morbidities. The search of peer-reviewed articles in three databases from January 2009 to July 2019 identified 4271 English-language publications reporting STSG donor-site clinical outcomes, complications, or quality of life. Of these studies, 77 met inclusion criteria for analysis. Mean time to donor-site epithelialization ranged from 4.7 to 35.0 days. Mean pain scores (0-10 scale) ranged from 1.24 to 6.38 on postoperative Day 3. Mean scar scores (0-13 scale) ranged from 0 to 10.9 at Year 1. One study reported 28% of patients had donor-site scar hypertrophy at 8 years. Infection rates were generally low but ranged from 0 to 56%. Less frequently reported outcomes included pruritus, wound exudation, and esthetic dissatisfaction. Donor-site wounds underwent days of wound care and were frequently associated with pain and scarring. Widespread variations were noted in STSG donor-site outcomes likely due to inconsistencies in the definition of outcomes and utilization of various assessment tools. Understanding the true burden of donor sites may drive innovative treatments that would reduce the use of STSGs and address the associated morbidities.
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Affiliation(s)
- Malachy Asuku
- Mallinckrodt Pharmaceuticals, Shelbourne Building, 53 Frontage Rd Suite 300, Hampton, NJ, 08827, USA
| | - Tzy-Chyi Yu
- Mallinckrodt Pharmaceuticals, Shelbourne Building, 53 Frontage Rd Suite 300, Hampton, NJ, 08827, USA.
| | - Qi Yan
- Oxford PharmaGenesis Inc., 4 Caufield Place, Suite 201, Newtown, PA, 18940, USA
| | - Elaine Böing
- Mallinckrodt Pharmaceuticals, Shelbourne Building, 53 Frontage Rd Suite 300, Hampton, NJ, 08827, USA
| | - Helen Hahn
- Mallinckrodt Pharmaceuticals, Shelbourne Building, 53 Frontage Rd Suite 300, Hampton, NJ, 08827, USA
| | - Sara Hovland
- Mallinckrodt Pharmaceuticals, Shelbourne Building, 53 Frontage Rd Suite 300, Hampton, NJ, 08827, USA
| | - Matthias B Donelan
- Shriners Hospital for Children-Boston, 51 Blossom Street, Suite 930, Boston, MA, 02114, USA; Harvard Medical School, 25 Shattuck St, Boston, MA, 02114, USA; Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
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20
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Srivastava A, Maniakas A, Myers J, Chambers MS, Cardoso R. Reconstruction of intraoral oncologic surgical defects with Integra ® bilayer wound matrix. Clin Case Rep 2021; 9:213-219. [PMID: 33489162 PMCID: PMC7813028 DOI: 10.1002/ccr3.3501] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 10/05/2020] [Accepted: 10/19/2020] [Indexed: 12/01/2022] Open
Abstract
Utilization of biologic skin substitutes for the management of soft tissue defects as an alternative to autologous skin grafts has expanded over the past 2 decades. The purpose of this case series study was to report our experience with Integra® bilayer wound matrix for reconstruction of intraoral oncologic defects. Case records of 6 patients with intraoral oncologic defects reconstructed with Integra® bilayer wound matrix were retrospectively reviewed. The surgical defect location, size, and time to removal of surgical splint varied. Clinically, normal oral epithelialization was noted for all patients. One patient demonstrated a small area of dehiscence and bone exposure after adjuvant radiation therapy which resolved with minimal intervention. Integra bilayer wound matrix is a viable and versatile option for reconstruction of intraoral oncologic surgical defects. Further exploration of wound healing with Integra® matrix, surgical techniques, and cost-effectiveness is advocated.
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Affiliation(s)
- Akanksha Srivastava
- Department of Restorative Dentistry and ProsthodonticsThe University of Texas School of DentistryHoustonTXUSA
| | - Anastasios Maniakas
- Department of Head and Neck SurgeryDivision of SurgeryThe University of Texas M.D. Anderson Cancer CenterHoustonTXUSA
| | - Jeffrey Myers
- Department of Head and Neck SurgeryDivision of SurgeryThe University of Texas M.D. Anderson Cancer CenterHoustonTXUSA
| | - Mark S. Chambers
- Section of Oral Oncology and Maxillofacial ProsthodonticsDepartment of Head and Neck SurgeryDivision of SurgeryThe University of Texas MD Anderson Cancer CenterHoustonTXUSA
| | - Richard Cardoso
- Section of Oral Oncology and Maxillofacial ProsthodonticsDepartment of Head and Neck SurgeryDivision of SurgeryThe University of Texas MD Anderson Cancer CenterHoustonTXUSA
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21
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Zajicek R, Kubok R, Petrova N, Tokarik M, Matouskova E, Gal P. Complex approach to skin repair in an extensively burned child: a case study. J Wound Care 2020; 29:458-463. [PMID: 32804031 DOI: 10.12968/jowc.2020.29.8.458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The limited amount of donor sites and loss of dermis are major challenges in the therapy of extensively burned patients. Here, we present a complex treatment approach of an eight-year-old boy with full-thickness burns on 90% of the total body surface area, using simple and efficient techniques of tissue engineering. To obtain sufficient skin for grafting we repeatedly harvested the same anatomical areas. Acceleration of donor site healing was achieved by treatment with a suspension of noncultured autologous skin cells (NASC) and acellular porcine dermis (Xe-Derma (XD), Czech Republic). Moreover, such wound management allowed up to six reharvestings, compared with one-to-three procedures following routine treatment. Bilayer Integra template (Integra LifeSciences Corp., US) was used as the dermal substitute in over 60% of full-thickness burns. Following successful vascularisation of the neodermis in 3-4 weeks, the templates were covered with meshed split-thickness skin grafts (STSG), or Meek autografts, and facilitated by NASC/XD. We may conclude that such a 'sandwich' technique approach, combining four biological covers (Integra, STSG, NASC and XD), significantly contributed to the successful skin repair of the patient.
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Affiliation(s)
- Robert Zajicek
- Prague Burn Centre, Third Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Richard Kubok
- Prague Burn Centre, Third Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Nikola Petrova
- Prague Burn Centre, Third Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Monika Tokarik
- Prague Burn Centre, Third Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Eva Matouskova
- Prague Burn Centre, Third Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Peter Gal
- Prague Burn Centre, Third Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic.,Department of Biomedical Research, East-Slovak Institute of Cardiovascular Diseases, Kosice, Slovak Republic.,Laboratory of Cell Interactions, MediPark, Pavol Jozef Safarik University, Kosice, Slovak Republic
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22
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Shi C, Wang C, Liu H, Li Q, Li R, Zhang Y, Liu Y, Shao Y, Wang J. Selection of Appropriate Wound Dressing for Various Wounds. Front Bioeng Biotechnol 2020; 8:182. [PMID: 32266224 PMCID: PMC7096556 DOI: 10.3389/fbioe.2020.00182] [Citation(s) in RCA: 186] [Impact Index Per Article: 46.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 02/24/2020] [Indexed: 12/30/2022] Open
Abstract
There are many factors involved in wound healing, and the healing process is not static. The therapeutic effect of modern wound dressings in the clinical management of wounds is documented. However, there are few reports regarding the reasonable selection of dressings for certain types of wounds in the clinic. In this article, we retrospect the history of wound dressing development and the classification of modern wound dressings. In addition, the pros and cons of mainstream modern wound dressings for the healing of different wounds, such as diabetic foot ulcers, pressure ulcers, burns and scalds, and chronic leg ulcers, as well as the physiological mechanisms involved in wound healing are summarized. This article provides a clinical guideline for selecting suitable wound dressings according to the types of wounds.
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Affiliation(s)
- Chenyu Shi
- School of Nursing, Jilin University, Changchun, China.,Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China
| | - Chenyu Wang
- Department of Plastic and Reconstructive Surgery, The First Hospital of Jilin University, Changchun, China
| | - He Liu
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China
| | - Qiuju Li
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China
| | - Ronghang Li
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China
| | - Yan Zhang
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China
| | - Yuzhe Liu
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China
| | - Ying Shao
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China.,Department of Plastic and Reconstructive Surgery, The First Hospital of Jilin University, Changchun, China
| | - Jincheng Wang
- School of Nursing, Jilin University, Changchun, China.,Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China
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23
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Weller CD, Team V, Sussman G. First-Line Interactive Wound Dressing Update: A Comprehensive Review of the Evidence. Front Pharmacol 2020; 11:155. [PMID: 32180720 PMCID: PMC7059819 DOI: 10.3389/fphar.2020.00155] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 02/05/2020] [Indexed: 01/20/2023] Open
Abstract
Wound management is a significant and growing issue worldwide. Knowledge of dressing products and clinical expertise in dressing selection are two major components in holistic wound management to ensure evidence-based wound care. With expanding global market of dressing products, there is need to update clinician knowledge of dressing properties in wound care. Optimal wound management depends on accurate patient assessment, wound diagnosis, clinicians’ knowledge of the wound healing process and properties of wound dressings. We conducted a comprehensive review of the physical properties of wound dressing products, including the advantages and disadvantages, indications and contraindications and effectiveness of first-line interactive/bioactive dressing groups commonly used in clinical practice. These include semipermeable films, foams, hydroactives, alginates, hydrofibers, hydrocolloids, and hydrogels. In making decisions regarding dressing product selection, clinicians need to ensure a holistic assessment of patient and wound etiology, and understand dressing properties when making clinical decisions using wound management guidelines to ensure optimal patient outcomes. This review has highlighted there is lack of high quality evidence and the need for future well designed trials.
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Affiliation(s)
- Carolina D Weller
- Monash Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Victoria Team
- Monash Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Geoffrey Sussman
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
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24
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Chowdhry SA. Use of oxidized regenerated cellulose (ORC)/collagen/silver-ORC dressings to help manage skin graft donor site wounds. JPRAS Open 2019; 22:33-40. [PMID: 32158895 PMCID: PMC7061655 DOI: 10.1016/j.jpra.2019.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 08/08/2019] [Indexed: 11/24/2022] Open
Abstract
Harvesting donor site explants for split-thickness skin grafting creates an iatrogenic wound that presents additional challenges to clinicians due to morbidities such as persistent bleeding, pain, infection, and delayed epithelialization. Although there have been several randomized controlled trials to compare wound dressing effectiveness, there is still a lack of standardization for donor site wound dressings. A retrospective comparison of 59 patients that underwent split-thickness skin graft reconstructions between January 2017 and September 2018 was performed. Donor sites of Group 1 patients (n = 29) were treated with a transparent film dressing and transitioned to petrolatum gauze dressings if exudate management became problematic; Group 2 patients (n = 30) were treated with oxidized regenerated cellulose/collagen/silver-oxidized regenerated cellulose (ORC/C/Ag-ORC) dressings. Evaluations of time to epithelialization, number of dressings required, signs of inflammation, and objective pain were compared between groups. Group 1 was comprised of 18 female and 11 male patients, whereas Group 2 was comprised of 14 females and 16 males. There were no significant differences between groups when comparing age, sex, comorbidities, or donor site size (area or depth). Patients in Group 2 had a significantly shorter time to complete re-epithelialization (P < .0001), fewer dressing changes (P < .0001), and less objective pain as measured by the need for opioid pain mediation (P < .0001) when compared to Group 1. The percentage of patients with signs of inflammation was also lower for Group 2, although this difference was not statistically significant (P = .0797). Although prospective, controlled studies are still needed, data from this study suggest that ORC/C/Ag-ORC dressings could become a more effective alternative for the management of donor site wounds, especially in patients with known risk factors for wound healing.
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Affiliation(s)
- Saeed A Chowdhry
- Rosalind Franklin University of Medicine and Science, Chicago Medical School, 4400W 95th St, Suite 102, Oak Lawn, Chicago, IL 60453, United States
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Alam K, Jeffery SLA. Acellular Fish Skin Grafts for Management of Split Thickness Donor Sites and Partial Thickness Burns: A Case Series. Mil Med 2019; 184:16-20. [PMID: 30901429 DOI: 10.1093/milmed/usy280] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 09/17/2018] [Indexed: 12/31/2022] Open
Abstract
METHODS Ten patients having split-thickness skin grafting for burn injury were treated with the fish skin xenografts. RESULTS There were no adverse reactions noted on the use of the fish skin grafts. No patient had any reaction to the fish skin and there was a zero incidence of infection. The handling of the fish skin was excellent, a robust and pliable xenograft that was easy to apply.The quality of donor site healing was judged to be good in all cases. Both the analgesic effect noted and the relatively short average times until 100% re-epithelialization are promising. We also illustrate two cases where the dressing was used to treat superficial burns.
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Affiliation(s)
- Khurshid Alam
- North Middlesex University Hospital, Sterling Way, London, UK
| | - Steven L A Jeffery
- The Royal Centre for Defence Medicine, The Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham, UK.,Birmingham City University, Westbourne Road, Birmingham, UK
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26
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Ki SH, Ma SH, Choi JH, Sim SH, Kim HM. Treating skin graft donor sites: a comparative study between remnant skin use and polyurethane foam. J Wound Care 2019; 28:469-477. [DOI: 10.12968/jowc.2019.28.7.469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Objective: Excess remnant skin is retained for use in additional grafting in case of split-thickness skin graft (STSG) failure. We hypothesise that regrafting with remnant skin offers greater efficacy and advantages in wound healing and donor site appearance. Methods: Skin graft donor sites were assessed by comparing those regrafted with remnant skin with those treated with polyurethane foam dressing. Healing time, pain, patient satisfaction, itching sensation, skin stiffness and irregularity between regrafting and foam dressing were compared. The aesthetic satisfaction of donor site was evaluated by four board-certified plastic surgeons. The differences were tested statistically. Results: A total of 39 patients received a STSG due to skin or soft tissue wounds caused by burn, trauma and cancer reconstruction. The donor site healing time was shorter with remnant skin regrafting compared with foam dressing. There was no difference with respect to donor site pain between the two treatment groups. At two weeks after skin graft, patient satisfaction was higher in those treated with remnant skin than in those treated with foam dressing. Aesthetic assessment was improved after 12 weeks. Conclusion: Donor site dressing using remnant skin appears to improve wound healing and enhance the aesthetic outcome of donor sites.
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Affiliation(s)
- Sae Hwi Ki
- Department of Plastic Surgery, Inha University Hospital, Incheon, Korea
- Department of Plastic Surgery, Inha University School of Medicine, Incheon, Korea
| | - Sung Hwan Ma
- Department of Plastic Surgery, Inha University Hospital, Incheon, Korea
| | - Jong Hwan Choi
- Department of Plastic Surgery, Inha University Hospital, Incheon, Korea
| | - Seung Hyun Sim
- Department of Plastic Surgery, Inha University Hospital, Incheon, Korea
| | - Hyung Muk Kim
- Department of Plastic Surgery, Inha University Hospital, Incheon, Korea
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Gao AL, Cole JG, Woolsey ZT, Stoecker WV. Structured zinc oxide dressing for secondary intention wounds. J Wound Care 2019; 26:S30-S36. [PMID: 28976831 DOI: 10.12968/jowc.2017.26.sup10.s30] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Inexpensive methods for more rapid healing of secondary intention wounds are sought. This pilot study measured the wound healing rate for a new zinc oxide structured dressing technique. METHOD In this study, we included the three patients with the largest wounds with onset during a one month period. A 3-ply gauze was cut and placed in the centre of each wound, leaving a 3-5mm rim of the wound exposed to the zinc gauze. The central gauze was soaked with 0.9% saline solution and the entire wound area was covered with 3 layers of Unna zinc oxide dressing. The central gauze size was modified to fit as the wound healed and the size changed. The wound was photographed at each visit and wound areas were obtained using best-fit ellipses. RESULTS The average wound closure rate is reported in the three wounds as 21.73mm2 per day. The scalp wound healed at a rate of 21.45mm2 per day.; the spider bite wound healed at a rate of 28.92mm2 per day; and the thigh wound healed at a rate of 14.81mm2 per day. CONCLUSION Healing rates for the zinc gauze method exceed those previously reported for full-thickness wounds healing by secondary intention. Additional study of the new technique with more patients is needed before conclusions relevant to clinical practice can be made.
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Affiliation(s)
- A L Gao
- UCLA Department of Life Sciences, UCLA, LA, California, US
| | - J G Cole
- S&A Indiana University School of Medicine, Indianapolis, IN, US
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Gupta A, Kowalczuk M, Heaselgrave W, Britland ST, Martin C, Radecka I. The production and application of hydrogels for wound management: A review. Eur Polym J 2019. [DOI: 10.1016/j.eurpolymj.2018.12.019] [Citation(s) in RCA: 125] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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30
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Momeni M, Fallah N, Bajouri A, Bagheri T, Orouji Z, Pahlevanpour P, Shafieyan S, Sodeifi N, Alizadeh A, Aghdami N, Fatemi MJ. A randomized, double-blind, phase I clinical trial of fetal cell-based skin substitutes on healing of donor sites in burn patients. Burns 2018; 45:914-922. [PMID: 30559055 DOI: 10.1016/j.burns.2018.10.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 09/23/2018] [Accepted: 10/19/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Due to limited graft donor sites in extensive burns, re-harvesting of a single donor area is very common. Given the importance of fetal fibroblasts in accelerating fetal wound healing, fetal cell-based skin substitutes have emerged as a novel therapeutic modality for regenerating damaged skin. In this trial, we aimed to evaluate the safety, feasibility and potential efficacy of application of amniotic membranes seeded with fetal fibroblasts for accelerating donor sites healing in burn patients. METHODS In this randomized, double-blind, phase I clinical trial, 10 patients with total burn surface area of 10-55% were enrolled. Three equal parts (10×10cm) were selected in donor site of each patient and covered by Vaseline gauze (control group), amniotic membrane (AM group), or amniotic membrane seeded with fetal fibroblasts (AM-F group). Adverse events, pain intensity scores, and wound sizes were recorded on days 4, 8, 11, 14, and 20 post-treatment. Also, histological assessments were done on days 0 and 14 after the surgery. RESULTS All patients underwent surgery, and no adverse events occurred during the procedure and follow-up period. Significantly lower pain intensity and higher healing rates were observed in AM-F and AM groups compared to the control group. Moreover, mean complete re-epithelializatin in AM-F and AM groups were 10.1±2.4 and 11.3±2.9 days, showing that the healing process was significantly accelerated compared to the control group with mean closure time of 14.8±1.6 days. Histological assessment showed lower inflammatory cells infiltration in AM-F and AM groups compared to control group. CONCLUSIONS This study indicated the safety of transplantation of amniotic membrane seeded with fetal fibroblasts for treatment of donor sites in burn patients; however, preliminary assessments showed no benefits for this therapeutic modality over amniotic membrane alone. Thus, to draw accurate conclusions, further trials in larger populations should be conducted. LEVEL OF EVIDENCE This study is assigned as level I.
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Affiliation(s)
- Mahnoush Momeni
- Burn Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Nasrin Fallah
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Amir Bajouri
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Tooran Bagheri
- Burn Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Orouji
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | | | - Saeed Shafieyan
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Niloofar Sodeifi
- Department of Pathology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Ahad Alizadeh
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Nasser Aghdami
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran.
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Poh Yuen Wen A, Halim AS, Mat Saad AZ, Mohd Nor F, Wan Sulaiman WA. A prospective study evaluating wound healing with sea cucumber gel compared with hydrogel in treatment of skin graft donor sites. Complement Ther Med 2018; 41:261-266. [DOI: 10.1016/j.ctim.2018.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 09/13/2018] [Accepted: 10/03/2018] [Indexed: 02/07/2023] Open
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Brown JE, Holloway SL. An evidence-based review of split-thickness skin graft donor site dressings. Int Wound J 2018; 15:1000-1009. [PMID: 30117716 PMCID: PMC7949554 DOI: 10.1111/iwj.12967] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 06/15/2018] [Accepted: 06/24/2018] [Indexed: 11/26/2022] Open
Abstract
This evidence-based review aimed to identify and evaluate current existing evidence relating to the efficacy of dressing materials for spit-thickness skin graft donor site wounds in relation to promoting rapid healing and reducing patient pain. A comprehensive systematic search of the literature between 2006 and 2016 identified 35 publications that were included in the review. Based on the results of the review, it was found that moist wound-healing products have a clear advantage over non-moist products in the reduction of pain and increased healing rates. This review concluded that moist wound-healing products are more effective than non-moist wound-healing products in reducing pain and promoting healing in split-thickness skin graft donor site wounds. A recommendation based on this review is that further research examine the role of secondary dressing usage in donor site wound management, and the consideration of using more than one primary dressing product during the donor site wound-healing process should be undertaken.
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Affiliation(s)
- Julie E Brown
- Tissue Viability ServiceOxford University Hospitals NHS Foundation TrustOxfordUK
| | - Samantha L Holloway
- Centre for Medical Education, School of Medicine, College of Biomedical and Life SciencesCardiff UniversityWalesUK
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33
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Kanapathy M, Mosahebi A. Comparative study on the donor site aesthetic outcome between epidermal graft and split-thickness skin graft. Int Wound J 2018; 16:354-359. [PMID: 30440106 DOI: 10.1111/iwj.13039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 10/17/2018] [Accepted: 10/24/2018] [Indexed: 11/29/2022] Open
Abstract
Donor site aesthetic outcomes of epidermal graft (EG) vs split-thickness skin graft (SSG) have yet to be objectively compared. Here, we evaluate donor site healing using a validated scar assessment tool and digital colorimetric technique, which compares colour in a consistent and objective manner. Ten patients (SSG (n = 5) and EG (n = 5)) were included. Donor site scarring was evaluated using the Vancouver Scar Scale (VSS) at Week 6 and Month 3. Colorimetric measurement was performed at Weeks 3 and 6 and Month 3. The mean donor site healing time for EG was significantly shorter (EG: 4.6 days (95% c.i. 3.8-5.3), SSG: 16.8 days (95% c.i. 13.3-20.1) (P = 0.003)). The VSS scores of the EG donor site were lower at Week 6 and Month 3(P < 0.001). The colour match between the donor site and surrounding skin for EG was better compared with SSG at all time points and was almost identical to their surrounding healthy skin at Month 3. This study is the first to objectively measure the clinical appearance of the EG donor site against SSG. EG donor site has faster healing with excellent scarring and good colour match with its surrounding normal skin at all time points compared with SSG.
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Affiliation(s)
- Muholan Kanapathy
- Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust Hospital, London, UK.,Division of Surgery & Interventional Science, University College London, London, UK
| | - Afshin Mosahebi
- Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust Hospital, London, UK.,Division of Surgery & Interventional Science, University College London, London, UK
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Meta-analysis and Systematic Review of Skin Graft Donor-site Dressings with Future Guidelines. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1928. [PMID: 30349793 PMCID: PMC6191241 DOI: 10.1097/gox.0000000000001928] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 07/11/2018] [Indexed: 11/26/2022]
Abstract
Background: Many types of split-thickness skin graft (STSG) donor-site dressings are available with little consensus from the literature on the optimal dressing type. The purpose of this systematic review was to analyze the most recent outcomes regarding moist and nonmoist dressings for STSG donor sites. Methods: A comprehensive systematic review was conducted across PubMed/MEDLINE, EMBASE, and Cochrane Library databases to search for comparative studies evaluating different STSG donor-site dressings in adult subjects published between 2008 and 2017. The quality of randomized controlled trials was assessed using the Jadad scale. Data were collected on donor-site pain, rate of epithelialization, infection rate, cosmetic appearance, and cost. Meta-analysis was performed for reported pain scores. Results: A total of 41 articles were included comparing 44 dressings. Selected studies included analysis of donor-site pain (36 of 41 articles), rate of epithelialization (38 of 41), infection rate (25 of 41), cosmetic appearance (20 of 41), and cost (10 of 41). Meta-analysis revealed moist dressings result in lower pain (pooled effect size = 1.44). A majority of articles (73%) reported better reepithelialization rates with moist dressings. Conclusion: The literature on STSG donor-site dressings has not yet identified an ideal dressing. Although moist dressings provide superior outcomes with regard to pain control and wound healing, there continues to be a lack of standardization. The increasing commercial availability and marketing of novel dressings necessitates the development of standardized research protocols to design better comparison studies and assess true efficacy.
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35
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Varon DE, Smith JD, Bharadia DR, Shafique N, Sakthivel D, Halvorson EG, Nuutila K, Sinha I. Use of a novel chitosan-based dressing on split-thickness skin graft donor sites: a pilot study. J Wound Care 2018; 27:S12-S18. [PMID: 30008255 DOI: 10.12968/jowc.2018.27.sup7.s12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Split-thickness skin graft (STSG) donor site dressings can play an integral role in reducing donor site morbidity. This study tested a novel, chitosan-based wound dressing, Opticell Ag, as an STSG donor site dressing for wounds <10% total body surface area (TBSA). METHOD Between January and December 2016, the chitosan-based dressing was placed on participating patients' donor sites immediately following graft harvest and covered with a transparent occlusive dressing. Pain was evaluated on postoperative day one, before dressing change between days 5-7, and before and after dressing removal between days 10-14 using the Visual Analog Scale (VAS). The extent of re-epithelialisation was determined between day 10-14 and at one month, and healing quality was also evaluated at one month post-operatively using the Vancouver Scar Scale (VSS). RESULTS A total of 19 patients were recruited, of which 16 completed the study. Patients experienced mild-to-moderate pain in their donor sites when the chitosan-based dressing was used. Pain decreased significantly between postoperative day one and days 10-14, as well as between days 5-7 and 10-14. The mean percentage of re-epithelialisation on days 10-14 was 92% and by one month was 99%. The mean VSS at one month was 3.2±1.4. There were no statistically significant differences between patients' re-epithelialisation rates or VSS scores. There were unplanned dressing changes in four patients. No donor site infections or other adverse events were identified. CONCLUSION The chitosan-based dressing tested in this study is safe, effective, and associated with reasonable pain control and acceptable healing quality. The results suggest that it is a promising STSG donor site dressing.
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Affiliation(s)
- David E Varon
- Research Assistant; Division of Plastic Surgery, Brigham and Women's Hospital, Boston, US., Harvard Medical School, Boston, US
| | - Jessica D Smith
- Research Assistant; Division of Plastic Surgery, Brigham and Women's Hospital, Boston, US., Harvard Medical School, Boston, US
| | - Deepak R Bharadia
- Plastic Surgery Resident UCSF; Division of Plastic and Reconstructive Surgery, University of California, San Francisco, US
| | - Neha Shafique
- Research Assistant; Division of Plastic Surgery, Brigham and Women's Hospital, Boston, US., Harvard Medical School, Boston, US
| | - Dharaniya Sakthivel
- Research Assistant; Division of Plastic Surgery, Brigham and Women's Hospital, Boston, US., Harvard Medical School, Boston, US
| | - Eric G Halvorson
- Plastic Surgeon; Division of Plastic Surgery, Brigham and Women's Hospital, Boston, US., Harvard Medical School, Boston, US
| | - Kristo Nuutila
- Instructor; Division of Plastic Surgery, Brigham and Women's Hospital, Boston, US., Harvard Medical School, Boston, US
| | - Indranil Sinha
- Plastic Surgeon Division of Plastic Surgery, Brigham and Women's Hospital, Boston, US., Harvard Medical School, Boston, US
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Piaggesi A, Låuchli S, Bassetto F, Biedermann T, Marques A, Najafi B, Palla I, Scarpa C, Seimetz D, Triulzi I, Turchetti G, Vaggelas A. Advanced therapies in wound management: cell and tissue based therapies, physical and bio-physical therapies smart and IT based technologies. J Wound Care 2018; 27:S1-S137. [DOI: 10.12968/jowc.2018.27.sup6a.s1] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Alberto Piaggesi
- Prof, Director, EWMA Scientific Recorder (Editor), Diabetic Foot Section of the Pisa University Hospital, Department of Endocrinology and Metabolism, University of Pisa, Lungarno Pacinotti 43, 56126 Pisa, Italy
| | - Severin Låuchli
- Chief of Dermatosurgery and Woundcare, EWMA Immediate Past President (Co-editor), Department of Dermatology, University Hospital, Zurich, Råmistrasse 100, 8091 Zärich, Schwitzerland
| | - Franco Bassetto
- Prof, Head of Department, Clinic of Plastic and Reconstructive Surgery, University of Padova, Via Giustiniani, 35100 Padova
| | - Thomas Biedermann
- Tissue Biology Research Unit, Department of Surgery, University Children's Hospital Zurich, August Forel-Strasse 7, 8008 Zürich, Switzerland
| | - Alexandra Marques
- University of Minho, 3B's Research Group in Biomaterials, Biodegradables and Biomimetics, Avepark - Parque de Ciência e Tecnologia, Zona Industrial da Gandra, 4805-017 Barco GMR, Portugal
| | - Bijan Najafi
- Professor of Surgery, Director of Clinical Research, Division of Vascular Surgery and Endovascular Therapy, Director of Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, One Baylor Plaza, MS: BCM390, Houston, TX 77030-3411, US
| | - Ilaria Palla
- Institute of Management, Sant'Anna School of Advanced Studies, Piazza Martiri della Libertà, 33, 56127 Pisa, Italy
| | - Carlotta Scarpa
- Clinic of Plastic and Reconstructive Surgery, University of Padova, Via Giustiniani, 35100 Padova
| | - Diane Seimetz
- Founding Partner, Biopharma Excellence, c/o Munich Technology Center, Agnes-Pockels-Bogen 1, 80992 Munich, Germany
| | - Isotta Triulzi
- Institute of Management, Sant'Anna School of Advanced Studies, Piazza Martiri della Libertà, 33, 56127 Pisa, Italy
| | - Giuseppe Turchetti
- Fulbright Scholar, Institute of Management, Sant'Anna School of Advanced Studies, Piazza Martiri della Libertà, 33, 56127 Pisa, Italy
| | - Annegret Vaggelas
- Consultant, Biopharma Excellence, c/o Munich Technology Center, Agnes-Pockels-Bogen 1, 80992 Munich, Germany
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Healing Time Correlates With the Quality of Scaring: Results From a Prospective Randomized Control Donor Site Trial. Dermatol Surg 2018; 44:521-527. [DOI: 10.1097/dss.0000000000001345] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Jansen P, Stoffels I, Klode J, Jockenhöfer F, Augustin M, Schadendorf D, Dissemond J. Postsurgical Treatment of Split Skin Graft Donor Sites in Dermatological Departments. INT J LOW EXTR WOUND 2018; 17:22-29. [PMID: 29502480 DOI: 10.1177/1534734617747685] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The surgical removal of split skin grafts (SSGs) leads to superficial wounds that can be covered with different wound dressings. Currently, international guidelines that recommend a standard treatment of the donor sites are not yet established. We developed a questionnaire to evaluate the treatment of SSG donor sites and sent it to all dermatological departments in Germany. Altogether 78 of the 115 contacted departments in Germany participated in our cross-sectional trial. Our analysis reveals that multiple wound dressings with different frequencies of replacement are used. On an average, complete reepithelialization of the donor site takes 14-21 days. Foams and coated gauzes are used in 73% of all surgical procedures for postsurgical treatment of SSG donor sites. Still, neither a significant faster reepithelialization nor a lower rate of wound healing disorders can be assigned to any of the wound dressings. The results of our study indicate that a large number of wound care products and treatment strategies are currently applied on SSG donor sites in dermatological departments in Germany. The selection of the wound dressing is not based on scientific data but rather on the experience of individual experts.
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Affiliation(s)
- Philipp Jansen
- Department of Dermatology, Venerology and Allergology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- West German Cancer Center, University Duisburg-Essen, Essen, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Ingo Stoffels
- Department of Dermatology, Venerology and Allergology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- West German Cancer Center, University Duisburg-Essen, Essen, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Joachim Klode
- Department of Dermatology, Venerology and Allergology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- West German Cancer Center, University Duisburg-Essen, Essen, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Finja Jockenhöfer
- Department of Dermatology, Venerology and Allergology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- West German Cancer Center, University Duisburg-Essen, Essen, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Matthias Augustin
- Center for Psychosocial Medicine, Institute of Health Care Research in Dermatology and Nursing (IVDP), University Hamburg, Hamburg, Germany
| | - Dirk Schadendorf
- Department of Dermatology, Venerology and Allergology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- West German Cancer Center, University Duisburg-Essen, Essen, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Joachim Dissemond
- Department of Dermatology, Venerology and Allergology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- West German Cancer Center, University Duisburg-Essen, Essen, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
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Goverman J, Kraft CT, Fagan S, Levi B. Back Grafting the Split-Thickness Skin Graft Donor Site. J Burn Care Res 2018; 38:e443-e449. [PMID: 27003740 DOI: 10.1097/bcr.0000000000000314] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Split-thickness skin grafting is a useful method of wound repair in burn and reconstructive operations. However, skin grafts require a donor site injury that creates a secondary wound at risk for delayed wound healing. Though in young healthy patients such donor sites have minimal risk, patients with risk factors for delayed wound healing are more challenging. We present a method for graft donor site management that offers an alternative to healing by secondary intention for patients with higher risk of poor wound healing. In those patients considered to be at high risk for donor site healing complications, we chose to treat the donor site with a split-thickness skin graft, or "graft back" procedure. An additional graft is taken adjacent to the initial donor site, and meshed 4:1 to cover both donor sites at once. Out of the 17 patients who received this procedure, 1 patient had a complication from the procedure that did not require an operation, and all patients appear to have good functional and cosmetic outcomes. No patients had any graft loss or graft infection. Histologic analysis showed complete epithelialization of the back-grafted area. The graft back method converts an open wound to a covered wound and may result in decreased wound healing time, improved cosmetic outcomes, and fewer complications, particularly in patients where wound healing is a concern. Importantly, it seems to have minimal morbidity. More detailed prospective studies are needed to ensure no additional risk is incurred by this procedure.
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Affiliation(s)
- Jeremy Goverman
- From the *Division of Burn Surgery, Department of Surgery, Harvard Medical School, Boston, Massachusetts; †University of Michigan Medical School, Ann Arbor; and ‡Division of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor
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Clinical Evaluation of Wound Healing in Split-Skin Graft Donor Sites Using Microscopic Quantification of Reepithelialization. Adv Skin Wound Care 2018; 29:254-60. [PMID: 27171253 DOI: 10.1097/01.asw.0000481179.88936.d4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Impaired or delayed wound healing is a common health problem. However, it remains challenging to predict whether wounds in patients will heal without complication or will have a prolonged healing time. In this study, the authors developed an objective screening tool to assess wound healing using microscopic quantification of reepithelialization in a split-thickness skin graft wound model and used this tool to identify risk factors for defective wound healing. DESIGN Thirty patients (16 male and 14 female) were included in this prospective study. Anterior thigh skin biopsies from the donor site region of partial-thickness skin grafts were dressed with moisture-retentive dressings, and biopsies were examined on days 0, 2, 5, and 10 postoperatively by microscopy. Images were then transferred to a computer for image analysis and epithelial measurements (epithelial thickness and total reepithelialized surface). The effects of gender, age, body mass index, and smoking behavior on these wound healing parameters were determined. RESULTS The authors found comparable results for the computer and traditional measure methods. However, the time required to perform the measurements using the semiautomated computer method was less than half the time of the traditional method. Image capturing, enhancing, and analysis with the new method required approximately 2 minutes 30 seconds, whereas the traditional methods took up to 7 minutes per image. The total size of the reepithelialized surface (P = .047) and percentage of the biopsy resurfaced with epithelia (P = .011) at day 10 were both significantly higher in male patients compared with female patients. In patients younger than 55 years, reepithelialized areas were significantly thicker than in patients older than 55 years (P = .008), whereas the size of the reepithelialized surface showed no differences. No significant differences in reepithelialization parameters were found concerning body mass index and smoking behavior. CONCLUSIONS Both male gender and older age impair reepithelialization rate and epithelial thickness in partial-thickness skin graft donor site wounds. In contrast, body mass index and smoking behavior have not been shown to be influencing factors on reepithelialization. Thus, microscopic quantification of reepithelialization might be a suitable method for predicting complications associated with wound healing.
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Lee JW, Park SH, Suh IS, Jeong HS. A comparison between DACC with chlorhexidine acetate-soaked paraffin gauze and foam dressing for skin graft donor sites. J Wound Care 2018; 27:28-35. [DOI: 10.12968/jowc.2018.27.1.28] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jun Won Lee
- Plastic Surgery Resident; Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Seong Hoon Park
- Plastic Surgery Chief Resident; Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - In Suck Suh
- Professor; Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Hii Sun Jeong
- Associate Professor; Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
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Pripotnev S, Papp A. Split thickness skin graft meshing ratio indications and common practices. Burns 2017; 43:1775-1781. [DOI: 10.1016/j.burns.2017.04.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Revised: 04/15/2017] [Accepted: 04/20/2017] [Indexed: 10/19/2022]
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von Cramon L, Markowicz M, Nebendahl J, Buchinger-Kähler VC, Noah EM, Narwan M, Behrendt A, Pallua N, Steinhoff A. A clinical evaluation of a transparent, absorbent, adhesive wound dressing. ACTA ACUST UNITED AC 2017; 26:S46-S53. [PMID: 29120680 DOI: 10.12968/bjon.2017.26.sup20.s46] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The performance of a transparent absorbent adhesive wound dressing (TAAWD) was observed over 7 days in five plastic surgery clinics across Germany. The study included 47 diverse postoperative linear wounds and donor sites with dry or minimal exudate levels. Data on ease of application and removal, adhesive strength, skin compatibility, conformability to the body, visual wound inspection and parameters of wound assessment were collected and analysed. At the end of the observation period, 100% of wounds were recorded as healing with no reported complications. Clinicians considered that the new dressing had predominantly met clinical needs in 89% of cases. The dressing was shown to be skin friendly, easy to apply, adhere and conform to the skin while protecting the wound and allowing the patient to shower. Due to its transparency, the dressing enabled direct wound surveillance without potential disruption to the wound and healing process.
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Affiliation(s)
- Lotta von Cramon
- Consultant Surgeon, Rotherbaum Plastic Surgery Clinic, Hamburg, Germany
| | | | - Jan Nebendahl
- Consultant Surgeon, Dermatologikum Clinic, Hamburg, Germany
| | | | - Ernst Magnus Noah
- Professor and Consultant Surgeon, Noahklinik for Plastic Surgery, Kassel, Germany
| | - Mustafa Narwan
- Consultant Surgeon, Difine Plastic Surgery Clinic, Essen, Germany
| | - Anika Behrendt
- Clinical Research Associate, BSN medical GmbH, Hamburg, Germany
| | - Norbert Pallua
- Professor and Consultant Surgeon, Head of Department of Plastic Surgery, Hand Surgery, Burn Center, University Hospital Aachen, Aachen, Germany
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Treating pain on skin graft donor sites: Review and clinical recommendations. J Trauma Acute Care Surg 2017; 83:954-964. [DOI: 10.1097/ta.0000000000001615] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cuomo R, Grimaldi L, Brandi C, Nisi G, D'Aniello C. Skin graft donor site: a procedure for a faster healing. ACTA BIO-MEDICA : ATENEI PARMENSIS 2017; 88:310-314. [PMID: 29083336 PMCID: PMC6142839 DOI: 10.23750/abm.v88i3.5736] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 09/28/2017] [Accepted: 09/15/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND The authors want to evaluate the efficacy of fibrillary tabotamp dressing in skin graft-donor site. A comparison was made with Vaseline gauzes. Tabotamp is an absorbable haemostatic product of Ethicon (Johnson and Johnson) obtained by sterile and oxidized regenerated cellulose (Rayon). It is used for mild to moderate bleeding. MATERIALS AND METHODS 276 patients were subject to skin graft and divided into two group: Group A and Group B. The donor site of patients in Group A was medicated with fibrillary tabotamp, while the patients of Group B were medicated only with Vaseline gauze. We recorded infection, timing of healing, number of dressing change, the pain felt during and after the dressing change with visual analog scale (VAS) and a questionnaire. RESULTS Patients allocated in Group A healed faster than the Group B. Questionnaires and VAS analysis showed lower pain felt, lower intake of pain drugs and lower infection rate in the Group A than the Group B. Analysis of coast showed lower dressing change in Group A than the Group B. CONCLUSION We believe that the use of tabotamp is a very viable alternative to improve healing.
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Konstantinow A, Fischer TV, Ring J. Effectiveness of collagen/oxidised regenerated cellulose/silver-containing composite wound dressing for the treatment of medium-depth split-thickness skin graft donor site wounds in multi-morbid patients: a prospective, non-comparative, single-centre study. Int Wound J 2017; 14:791-800. [PMID: 27905181 PMCID: PMC7949593 DOI: 10.1111/iwj.12698] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 11/03/2016] [Accepted: 11/06/2016] [Indexed: 12/27/2022] Open
Abstract
Split-thickness skin grafting (STSG) is a widely used method in reconstructive surgery, but donor site wounds (DSWs) are often slow healing and painful. This prospective study evaluated the performance of a composite wound dressing containing collagen/oxidised regenerated cellulose in the treatment of medium-depth (0·4 mm) DSWs in 25 multi-morbid patients with chronic leg ulcers requiring STSG. The range of patients' ages was 44-84 years (mean 71·6 years) with DSW sizes ranging between 12 and 162 cm2 (mean 78 cm2 ). Comorbidities included anticoagulation therapy (15 patients), anaemia (11 patients), diabetes (6 patients) and methicillin-resistant Staphylococcus aureus (MRSA) ulcer colonisation (6 patients). The first dressing change was performed after 10 days. Complete reepithelialisation was observed between the 10th and 34th day (mean 17·2, median 14 days). Postoperative medium to strong bleeding occurred in only five patients (four with anticoagulation). Wound pain levels one day after harvesting were only moderate (range 0-1·5, mean 0·5, median 0·5 on a six-item scale). No wound infection was observed during the first dressing. The composite dressing used allowed for the fast healing of medium-depth DSWs with minimal or no postoperative pain and bleeding in older multi-morbid patients under anticoagulation treatment.
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Affiliation(s)
- Alexander Konstantinow
- Department of Dermatology and Allergology BiedersteinTechnical University MunichMunichGermany
| | - Tatjana V Fischer
- Department of Dermatology and Allergology BiedersteinTechnical University MunichMunichGermany
| | - Johannes Ring
- Department of Dermatology and Allergology BiedersteinTechnical University MunichMunichGermany
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Kazanavičius M, Cepas A, Kolaityte V, Simoliuniene R, Rimdeika R. The use of modern dressings in managing split-thickness skin graft donor sites: a single-centre randomised controlled trial. J Wound Care 2017; 26:281-291. [DOI: 10.12968/jowc.2017.26.6.281] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- M. Kazanavičius
- Department of Plastic and Reconstructive Surgery, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - A. Cepas
- Student; Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - V. Kolaityte
- Student; Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - R. Simoliuniene
- Associate Professor; Department of Physics, Mathematics and Biophysics, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - R. Rimdeika
- Professor, Head of the Department; Department of Plastic and Reconstructive Surgery, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Kheiri A, Amini S, Javidan AN, Saghafi MM, Khorasani G. The effects of Alkanna tinctoria Tausch on split-thickness skin graft donor site management: a randomized, blinded placebo-controlled trial. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 17:253. [PMID: 28482839 PMCID: PMC5422894 DOI: 10.1186/s12906-017-1741-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 04/13/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND A prospective, randomized, placebo-controlled clinical trial was conducted to compare the healing effectiveness of Alkanna tinctoria (L.) Tausch (Boraginaceae) with standard dressing on wound healing at the donor site after removal of the skin graft. METHODS Enrolled patients were randomly allocated to receive topicalA. tinctoria extract ointment (20%) or standard dressing (dressing with base ointment) daily. Wound healing was assessed using the Bates-Jenson assessment tool at the 2nd and 4th weeks after intervention. RESULTS Decreases in wound score were significantly greater in the A. tinctoria group compared with the placebo group (P <0.05). The surface areas of graft donor sites in the A. tinctoria group were significantly reduced as compared with the control group at day 28 of the intervention (P < 0.05). The proportion of patients in the A. tinctoria group achieving complete wound healing within 2 to 4 weeks was 50% and 96.66%, respectively, significantly higher than in patients receiving standard care: 0% and 23.3%, respectively. CONCLUSIONS This clinical study showed that A. tinctoria dressing accelerates wound healing after graft harvesting. TRIAL REGISTRATION IRCT ID: IRCT201511165781N2 .
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49
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Derwin R, Moore ZEH, Webster J. Hydrocolloid dressings for donor sites of split thickness skin grafts. Hippokratia 2017. [DOI: 10.1002/14651858.cd012634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Rosemarie Derwin
- Royal College of Surgeons in Ireland; School of Nursing & Midwifery; 123 St Stephens Green Dublin Ireland D.2
| | - Zena EH Moore
- Royal College of Surgeons in Ireland; School of Nursing & Midwifery; 123 St Stephens Green Dublin Ireland D.2
| | - Joan Webster
- Royal Brisbane and Women's Hospital; Nursing and Midwifery Research Centre; Butterfield Street Herston Queensland Australia 4029
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50
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Hu Z, Guo D, Liu P, Cao X, Li S, Zhu J, Tang B. Randomized clinical trial of autologous skin cell suspension for accelerating re-epithelialization of split-thickness donor sites. Br J Surg 2017; 104:836-842. [PMID: 28379607 DOI: 10.1002/bjs.10508] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 11/08/2016] [Accepted: 01/11/2017] [Indexed: 11/12/2022]
Abstract
BACKGROUND Split-thickness skin graft (STSG) is used frequently, but may result in complications at the donor site. Rapid healing of donor-site wounds is critical to relieving morbidity. This study investigated whether autologous skin cell suspension could improve healing of STSG donor-site wounds. METHODS Between September 2014 and February 2016, patients requiring STSGs were randomized to receive autologous skin cell suspension plus hydrocolloid dressings (experimental group) or hydrocolloid dressings alone (control group) for the donor site. The primary outcome was time to complete re-epithelialization. Secondary outcomes included pain and itching scores measured on a visual analogue scale, and adverse events. Patients were followed for 12 weeks to evaluate quality of healing. Analysis was by intention to treat. RESULTS Some 106 patients were included, 53 in each group. Median time to complete re-epithelialization was 9·0 (95 per cent c.i. 8·3 to 9·7) days in the experimental group, compared with 13·0 (12·4 to 13·6) days in the control group (P < 0·001). Overall postoperative pain and itching scores were similar in both groups. No between-group differences in treatment-related complications were observed. Both patients and observers were more satisfied with healing quality after autologous skin cell suspension had been used. CONCLUSION The use of autologous skin cell suspension with hydrocolloid dressings accelerated epithelialization and improved healing quality of the donor site compared with hydrocolloid dressings alone. Registration number: UMIN000015000 ( http://www.umin.ac.jp/ctr).
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Affiliation(s)
- Z Hu
- Department of Burn Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - D Guo
- Department of Plastic Surgery, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - P Liu
- Department of Burn Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - X Cao
- Department of Burn Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - S Li
- Department of Plastic Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - J Zhu
- Department of Burn Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - B Tang
- Department of Burn Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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