[Economic aspects of surgical wound therapies]

Cost-effectiveness analysis of superabsorbent wound dressings in patients with moderate-to-highly exuding leg ulcers in Germany

The study aims to estimate the cost-effectiveness of superabsorbent wound dressings compared to the standard-of-care (SoC) dressings mix for treatment of patients with moderate-to-highly exuding leg ulcers in the German healthcare settings. A model-based cost-effectiveness analysis was conducted from the German statutory health insurance perspective, following German specific and international recommendations of good research practice. An individual-level (microsimulation) state-transition model has been used with a cycle length of 1 week and time horizon of 6 months. Several comprehensive systematic reviews were conducted to inform all model inputs, including clinical parameters, efficacy, quality of life, resources utilisation, and cost inputs. In addition, primary data from two clinical trials were used. Based on this cost-effectiveness analysis, using superabsorbent wound dressings instead of the SoC dressings of patients with moderate-to-highly exuding leg ulcers in Germany can lead to an improved healing rate of 2.57% (benefit ratio 1.08), improved health-related quality of life of 0.152 quality-adjusted life weeks, and total direct cost savings of €771 per patient in 6 months. Robustness of results was confirmed in sensitivity and scenario analyses.

Topical negative-pressure wound therapy: emerging devices and techniques

Introduction: The treatment of chronic wounds constitutes a massive financial burden to society and our health-care system. Therefore, efficient wound care is of great importance to all kinds of medical fields. The implementation and modification of negative-pressure wound therapy can be seen as a major improvement in wound healing. Many different NPWT applications evolved trying to address various wound etiologies.Areas covered: This review aims to give an overview of various NPWT applications, show its effects on wound healing, and discuss future modifications.Expert opinion: NPWT as a delivery device for cold plasma, growth factors, or targeted stem cells to the wound bed and the ability to monitor the inflammatory activity, bacterial load and wound healing factors can be seen as possible future steps to individualized wound care. In addition, it requires high-quality experimental studies to develop the ideal foam in terms of microstructure, pore size, and material properties.

Negative pressure wound treatment with computer-controlled irrigation/instillation decreases bacterial load in contaminated wounds and facilitates wound closure

Microbial wound contamination is known to be a hindrance to wound healing. Negative pressure wound therapy (NPWT) with or without irrigation is known to optimise conditions in problem wounds. The aim of this study was to investigate the influence of computer-controlled wound irrigation with NPWT on the bacterial load in contaminated wounds. A total of 267 patients were treated with NPWT with automated instillation because of problematic wounds using an antiseptic instillation solution. In 111 patients, a minimum of 4 operative procedures were necessary, and swabs were taken at least at the first and at the fourth operation in a standardised procedure. The number of different bacteria and the amount of bacteria were analysed during the course. In a subgroup of 51 patients, swabs were taken at all 4 operative procedures and analysed separately. In an overall analysis, the number of different bacteria and the amount of bacteria significantly decreased independent of wound localisation and diagnosis. NPWT with automated instillation demonstrates a positive influence in the reduction of bacterial load in problem wounds. Thus, it may help to optimise wound conditions before definite wound closure.

[Hydroactive stage-adapted wound management]

The treatment of subacute and chronic wounds is not only a major medical challenge but because of demographic developments and the concurrent increase in predisposing diseases, such as diabetes mellitus and arterial occlusive disease is also a relevant socioeconomic challenge. The principle of modern, moist wound care can now be regarded as established. In daily practice there are nevertheless significant treatment problems which are, among other things due to the vast variety of products available. As evidence-based guidelines for the treatment of chronic wounds were until recently lacking and many question were left unanswered, standards of care represent an appropriate means of orientation. In addition to improved quality of care in this way costs can also be reduced. Furthermore, criteria can be illustrated by which the selection of appropriate wound dressings can be facilitated and established.

New strategies in clinical care of skin wound healing

The prevalence of chronic wounds is closely correlated to the aging population and so-called civilizational diseases. Therefore, they are causing morbidity and mortality of millions of patients worldwide, with an unbroken upward trend. As a consequence, chronic wounds induce enormous and rapidly growing costs for our health care systems and society in general. Thus, medically effective and cost-efficient treatment methods are urgently needed. Methods of 'regenerative medicine' might offer innovative scientific solutions, including the use of stem cells, growth factors and new bioactive materials. These tools are experimentally well described but clinically poorly performed. The main reasons for this are both legislative and economic. This review describes state-of-the-art techniques, up-to-date research projects, innovative preclinical and clinical approaches in wound care, and activities to translate these innovative techniques into clinical routine.

Changes of anabolic processes at the cellular and molecular level in chronic wounds under topical negative pressure can be revealed by transcriptome analysis

Chronic wounds--as defined by the World Union of Wound Healing Societies (WUWHS)--are a considerable worldwide health care expense and impair quality of life. In order for chronic wounds to heal, these wounds must be transformed to a more acute state to begin the healing process. Topical negative pressure (TNP) with reticulated open cell foam (ROCF) is known to promote healing in certain types of chronic wounds. However, little is known about changes at the cellular or molecular level in wounds under various treatments, especially under the physical forces induced to tissue by TNP. In the current study, chronic wound samples were obtained during routine wound debridements prior to treatment and 7-12 days after initiating TNP with a continuous setting at -125 mmHg. Whole genome transcriptome microarray analyses were performed on samples to better understand how TNP with ROCF affects these types of wounds. It was found that more genes were expressed following TNP with ROCF as compared to before therapy and to normal, non-wounded tissue. In this study, we show that TNP with ROCF transforms the chronic wound from its inflammation (non-healing) state into more of a progressive, healing phenotype from a molecular point of view with expression of genes that are commonly associated with these terms.

[The development of plastic surgery: retrospective view of 80 years of "Der Chirurg" (The Surgeon)]

The often groundbreaking developments of new methods in Plastic Surgery have been published in the journal "Der Chirurg" (The Surgeon) ever since its foundation in 1928, when it was established as a journal dealing with all aspects of surgery and containing many innovations and developments. Historically this is also reflected in the establishment of Plastic Surgery initially as a subspecialty and later on as a specialty within the German Society for Surgery. The interdisciplinary character of modern reconstructive and oncological concepts, not only with other specialties but also within various surgical specialties, raises further challenges and leads to new developments in reconstruction, which will definitely induce an increasing amount of knowledge to the advantage of our patients. Scientific and clinical advances over the last 80 years give rise to the hope that similar success will be attained for reconstruction of traumatic and oncological defects and malformations or disfigurations in the future. Consolidated findings from regenerative medicine and tissue engineering will enrich the daily practice of surgical reconstruction.