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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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Kondej K, Zawrzykraj M, Czerwiec K, Deptuła M, Tymińska A, Pikuła M. Bioengineering Skin Substitutes for Wound Management-Perspectives and Challenges. Int J Mol Sci 2024; 25:3702. [PMID: 38612513 PMCID: PMC11011330 DOI: 10.3390/ijms25073702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 03/22/2024] [Accepted: 03/23/2024] [Indexed: 04/14/2024] Open
Abstract
Non-healing wounds and skin losses constitute significant challenges for modern medicine and pharmacology. Conventional methods of wound treatment are effective in basic healthcare; however, they are insufficient in managing chronic wound and large skin defects, so novel, alternative methods of therapy are sought. Among the potentially innovative procedures, the use of skin substitutes may be a promising therapeutic method. Skin substitutes are a heterogeneous group of materials that are used to heal and close wounds and temporarily or permanently fulfill the functions of the skin. Classification can be based on the structure or type (biological and synthetic). Simple constructs (class I) have been widely researched over the years, and can be used in burns and ulcers. More complex substitutes (class II and III) are still studied, but these may be utilized in patients with deep skin defects. In addition, 3D bioprinting is a rapidly developing method used to create advanced skin constructs and their appendages. The aforementioned therapies represent an opportunity for treating patients with diabetic foot ulcers or deep skin burns. Despite these significant developments, further clinical trials are needed to allow the use skin substitutes in the personalized treatment of chronic wounds.
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Affiliation(s)
- Karolina Kondej
- Department of Plastic Surgery, Medical University of Gdansk, 80-214 Gdansk, Poland;
| | - Małgorzata Zawrzykraj
- Department of Clinical Anatomy, Medical University of Gdansk, 80-211 Gdansk, Poland; (M.Z.); (K.C.)
| | - Katarzyna Czerwiec
- Department of Clinical Anatomy, Medical University of Gdansk, 80-211 Gdansk, Poland; (M.Z.); (K.C.)
| | - Milena Deptuła
- Laboratory of Tissue Engineering and Regenerative Medicine, Department of Embryology, Medical University of Gdansk, 80-211 Gdansk, Poland; (M.D.); (A.T.)
| | - Agata Tymińska
- Laboratory of Tissue Engineering and Regenerative Medicine, Department of Embryology, Medical University of Gdansk, 80-211 Gdansk, Poland; (M.D.); (A.T.)
| | - Michał Pikuła
- Laboratory of Tissue Engineering and Regenerative Medicine, Department of Embryology, Medical University of Gdansk, 80-211 Gdansk, Poland; (M.D.); (A.T.)
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Lee KI, Lin YN. One-stage reconstruction of extensive exposed tibia on malnourished patient using single-layer Integra and amino acid supplements: A case report and literature review. Medicine (Baltimore) 2024; 103:e37098. [PMID: 38306507 PMCID: PMC10843514 DOI: 10.1097/md.0000000000037098] [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: 10/30/2023] [Accepted: 01/08/2024] [Indexed: 02/04/2024] Open
Abstract
RATIONALE Extremity injuries resulting from motor vehicle collisions, especially those leading to bone-exposed wounds, present challenges for achieving effective wound coverage. Such injuries are susceptible to complications including infections, osteomyelitis, and unexpected amputations due to inadequate blood supply. Severe traumatic degloving injuries often entail damage to the surrounding blood vessels, making local or free flaps impractical choices in many cases. Consequently, treatment options may vary based on distinct clinical scenarios, with no standardized guidelines available. Our study introduces an integrated approach utilizing dermal substitutes and skin grafts as a safer treatment modality for managing large-area tibial exposure resulting from traffic accidents. PATIENT CONCERNS A 66-year-old male with a compromised nutritional status was struck by a car while riding a motorcycle. Previous attempts using double-layer Integra and negative pressure wound therapy (NPWT) for two-stage reconstruction have been unsuccessful. DIAGNOSES Computed tomography imaging studies revealed multiple comminuted and displaced fractures involving the left femoral shaft, left proximal tibia, left patella, and proximal fibula, as well as a fracture of the right fibular shaft and an avulsion fracture of the right distal medial femur. The patient's condition corresponded to Type 3B in the Gustilo classification for open fractures, and the patient had an Injury Severity Score of 25. INTERVENTIONS We applied a one-stage reconstruction involving single-layer Integra, split-thickness skin grafts, NPWT, and nutritional supplements containing various amino acids. OUTCOMES By implementing an integrated treatment approach and providing diligent wound care over a total of 2 months, the patient achieved successful healing and expressed satisfaction with the postoperative results. LESSONS This study offers insights into the effectiveness of employing one-stage reconstruction for traumatic injuries with extensive exposed tibias. In addition, it underscores the impact of a patient's nutritional status on wound healing and introduces a potential solution for similar challenging cases.
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Affiliation(s)
- Kuan-I Lee
- School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (R.O.C.)
| | - Yun-Nan Lin
- Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (R.O.C.)
- School of Post-Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (R.O.C.)
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Deng Z, Long ZS, Chen G. Mini-Review: Tendon-Exposed Wound Treatments. J INVEST SURG 2023; 36:2266758. [PMID: 37813390 DOI: 10.1080/08941939.2023.2266758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 09/28/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND Tendon-exposed wounds are complex injuries with challenging reconstructions and no unified treatment mode. Furthermore, insufficient tissue volume and blood circulation disorders affect healing, which increases pain for the patient and affects their families and caretakers. REVIEW As modern medicine advances, considerable progress has been made in understanding and treating tendon-exposed wounds, and current research encompasses both macro-and micro-studies. Additionally, new treatment methods have emerged alongside the classic surgical methods, such as new dressing therapies, vacuum sealing drainage combination therapy, platelet-rich plasma therapy, and live-cell bioengineering. CONCLUSIONS This review summarizes the latest treatment methods for tendon-exposed wounds to provide ideas and improve their treatment.
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Affiliation(s)
- Zhuan Deng
- Department of Orthopedics, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Zhi-Sheng Long
- Department of Orthopedics, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Gang Chen
- Department of Orthopedics, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
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Vecin NM, Kirsner RS. Skin substitutes as treatment for chronic wounds: current and future directions. Front Med (Lausanne) 2023; 10:1154567. [PMID: 37711741 PMCID: PMC10498286 DOI: 10.3389/fmed.2023.1154567] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 07/21/2023] [Indexed: 09/16/2023] Open
Abstract
Chronic wounds such as diabetic foot ulcers and venous leg ulcers place a significant burden on the healthcare system and in some cases, have 5-year mortality rates comparable to cancer. They negatively impact patients' quality of life due to pain, odor, decreased mobility, and social isolation. Skin substitutes are an advanced therapy recommended for wounds that fail to show decrease in size with standard care. The choice of substitute used should be based on evidence, which often differs based on wound etiology. There are more than 75 skin substitutes currently available, and that number is rising. In this review, we discuss current management and future directions of chronic wounds while providing a review of available randomized control trial data for various skin substitutes.
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Affiliation(s)
- Nicole M. Vecin
- Departments of Medical Education and Public Health Sciences, University of Miami Leonard M. Miller School of Medicine, Miami, FL, United States
- Dr. Philip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, FL, United States
| | - Robert S. Kirsner
- Dr. Philip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, FL, United States
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Elfawy LA, Ng CY, Amirrah IN, Mazlan Z, Wen APY, Fadilah NIM, Maarof M, Lokanathan Y, Fauzi MB. Sustainable Approach of Functional Biomaterials-Tissue Engineering for Skin Burn Treatment: A Comprehensive Review. Pharmaceuticals (Basel) 2023; 16:ph16050701. [PMID: 37242483 DOI: 10.3390/ph16050701] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/21/2023] [Accepted: 04/25/2023] [Indexed: 05/28/2023] Open
Abstract
Burns are a widespread global public health traumatic injury affecting many people worldwide. Non-fatal burn injuries are a leading cause of morbidity, resulting in prolonged hospitalization, disfigurement, and disability, often with resulting stigma and rejection. The treatment of burns is aimed at controlling pain, removing dead tissue, preventing infection, reducing scarring risk, and tissue regeneration. Traditional burn wound treatment methods include the use of synthetic materials such as petroleum-based ointments and plastic films. However, these materials can be associated with negative environmental impacts and may not be biocompatible with the human body. Tissue engineering has emerged as a promising approach to treating burns, and sustainable biomaterials have been developed as an alternative treatment option. Green biomaterials such as collagen, cellulose, chitosan, and others are biocompatible, biodegradable, environment-friendly, and cost-effective, which reduces the environmental impact of their production and disposal. They are effective in promoting wound healing and reducing the risk of infection and have other benefits such as reducing inflammation and promoting angiogenesis. This comprehensive review focuses on the use of multifunctional green biomaterials that have the potential to revolutionize the way we treat skin burns, promoting faster and more efficient healing while minimizing scarring and tissue damage.
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Affiliation(s)
- Loai A Elfawy
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, University Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Chiew Yong Ng
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, University Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Ibrahim N Amirrah
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, University Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Zawani Mazlan
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, University Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Adzim Poh Yuen Wen
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, University Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
- Department of Surgery, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Nur Izzah Md Fadilah
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, University Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Manira Maarof
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, University Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Yogeswaran Lokanathan
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, University Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Mh Busra Fauzi
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, University Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
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Guerrero EM, Mastracci JC, Gart MS, Garcia RM, Loeffler BJ, Gaston RG. Soft Tissue Management of Partial Hand Amputation. J Hand Surg Am 2023:S0363-5023(23)00029-1. [PMID: 36894370 DOI: 10.1016/j.jhsa.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 11/28/2022] [Accepted: 01/13/2023] [Indexed: 03/11/2023]
Abstract
Conventional teaching in the management of partial hand amputations prioritizes residual limb length, often through local, regional, or distant flaps. While multiple options exist to provide durable soft tissue coverage, only a few flaps are thin and pliable enough to match that of the dorsal hand skin. Despite debulking, excessive soft tissues from previous flap reconstructions can interfere with residual limb function, prosthesis fit, and surface electrode recording for myoelectric prostheses. With rapid advances in prosthetic technology and nerve transfer techniques, patients can achieve very high levels of function following prosthetic rehabilitation that rival, or even outpace, traditional soft tissue reconstruction. Therefore, our reconstruction algorithm for partial hand amputations has evolved to the thinnest coverage possible, providing adequate durability. This evolution has provided our patients with faster and more secure prosthesis fitting with better surface electrode detection, enabling earlier and improved use of simple and advanced partial hand prostheses.
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Affiliation(s)
- Evan M Guerrero
- OrthoCarolina Hand Center, Charlotte, NC; OrthoCarolina Research Institute, Charlotte, NC
| | | | - Michael S Gart
- OrthoCarolina Hand Center, Charlotte, NC; OrthoCarolina Research Institute, Charlotte, NC
| | - Ryan M Garcia
- OrthoCarolina Hand Center, Charlotte, NC; OrthoCarolina Research Institute, Charlotte, NC
| | - Bryan J Loeffler
- OrthoCarolina Hand Center, Charlotte, NC; OrthoCarolina Research Institute, Charlotte, NC
| | - R Glenn Gaston
- OrthoCarolina Hand Center, Charlotte, NC; OrthoCarolina Research Institute, Charlotte, NC.
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Austin CL, Draper B, Larson KW, Thompson SJ. Biodegradable temporising matrix: use of negative pressure wound therapy shows a significantly higher success rate. J Wound Care 2023; 32:159-166. [PMID: 36930194 DOI: 10.12968/jowc.2023.32.3.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
OBJECTIVE The purpose of this case series was to evaluate the efficacy of a synthetic biodegradable temporising matrix (BTM; PolyNovo Biomaterials Pty Ltd, Australia) and compare the outcome of BTM patients with and without negative pressure wound therapy (NPWT). METHOD A retrospective chart review was conducted on patients admitted with deep full-thickness burns, traumatic or complex wound injuries treated with BTM. Electronic medical records and images were evaluated by a team of clinical professionals. Endpoints included: the measure of successful BTM integration; and comparison between patients treated with and without NPWT. Additional measures were BTM total surface area, BTM sites, timeliness of BTM application and any complications. RESULTS A total of 28 patients were evaluated and 23 (82.1%) demonstrated overall successful BTM integration. Patients treated with BTM in conjunction with NPWT (n=16) demonstrated a significantly higher (p=0.046) integration rate compared to patients treated without NPWT (n=12) (93.8% versus 58.3%, respectively). Patients treated with BTM with NPWT continued to successfully integrate and sustain favourable outcomes despite the presence of severe infection or the development of haematomas. CONCLUSION A significantly higher integration rate was demonstrated when BTM was used in conjunction with NPWT. The results of this study further support the efficacy of successful integration of BTM as a replacement for tissue loss in the treatment of deep, full-thickness burns, traumatic and complex wound injuries, and particularly favourable outcomes with the use of NPWT. To the best of our knowledge, this is the first reported case series comparing the clinical outcomes of BTM with and without the use of NPWT.
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Affiliation(s)
- Cindy L Austin
- Trauma & Burn Research, Mercy Hospital, Springfield, MO, US
| | - Brian Draper
- General & Trauma Surgery, Mercy Hospital, Springfield, MO, US
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A Comprehensive Review on Collagen Type I Development of Biomaterials for Tissue Engineering: From Biosynthesis to Bioscaffold. Biomedicines 2022; 10:biomedicines10092307. [PMID: 36140407 PMCID: PMC9496548 DOI: 10.3390/biomedicines10092307] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 11/29/2022] Open
Abstract
Collagen is the most abundant structural protein found in humans and mammals, particularly in the extracellular matrix (ECM). Its primary function is to hold the body together. The collagen superfamily of proteins includes over 20 types that have been identified. Yet, collagen type I is the major component in many tissues and can be extracted as a natural biomaterial for various medical and biological purposes. Collagen has multiple advantageous characteristics, including varied sources, biocompatibility, sustainability, low immunogenicity, porosity, and biodegradability. As such, collagen-type-I-based bioscaffolds have been widely used in tissue engineering. Biomaterials based on collagen type I can also be modified to improve their functions, such as by crosslinking to strengthen the mechanical property or adding biochemical factors to enhance their biological activity. This review discusses the complexities of collagen type I structure, biosynthesis, sources for collagen derivatives, methods of isolation and purification, physicochemical characteristics, and the current development of collagen-type-I-based scaffolds in tissue engineering applications. The advancement of additional novel tissue engineered bioproducts with refined techniques and continuous biomaterial augmentation is facilitated by understanding the conventional design and application of biomaterials based on collagen type I.
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