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Álvaro-Afonso FJ, Flores-Escobar S, Sevillano-Fernández D, García-Álvarez Y, García-Madrid M, Lázaro-Martínez JL. A deeper look at low-frequency contact ultrasonic debridement in the clinical management of patients with diabetic foot ulcers. Wound Repair Regen 2023; 31:745-751. [PMID: 37955618 DOI: 10.1111/wrr.13124] [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: 04/11/2023] [Revised: 07/20/2023] [Accepted: 10/23/2023] [Indexed: 11/14/2023]
Abstract
The current study aimed to evaluate the dispersal of solution and microbes (aerosol) in the clinical environment during treatment with Low-frequency contact ultrasonic debridement (LFCUD) with or without suction attachment in patients with diabetic foot ulcers (DFUs). We performed 20 treatments in 10 patients divided into two groups to receive the proposed LFCUD modalities. We measured the microbial load of the environment pre-treatment (sample M1), during treatment with each LFCUD modality (sample M2) and post-treatment (sample M3). The use of LFCUD debridement without a suction attachment results in significantly higher immediate contamination of the clinic environment than the suction attachment, particularly during the procedure (1.70 ± 0.98 log 10 CFU/mL versus 0.77 ± 0.85 log 10 CFU/mL, p = 0.035). When suction is not applied, there are statistically significant differences depending on whether the DFUs are neuropathic or neuroischemic, finding a greater number of microorganisms with high loads in neuropathic DFUs. We found a statistically significant positive correlation between wound area (r = 0.450, p = 0.047) and TBI (r = 0.651, p = 0.006) with the bacterial load during the LFCUD. Based on our results, we recommend using the personal protective equipment required to protect staff members and patients during treatment with LFCUD and using a suction attachment where clinically possible to reduce clinic environmental pollution, especially in neuropathic DFUs and those with larger areas.
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Affiliation(s)
- Francisco J Álvaro-Afonso
- Complutense University of Madrid, University Podiatric Clinic, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Sebastián Flores-Escobar
- Complutense University of Madrid, University Podiatric Clinic, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | | | - Yolanda García-Álvarez
- Complutense University of Madrid, University Podiatric Clinic, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Marta García-Madrid
- Complutense University of Madrid, University Podiatric Clinic, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - José L Lázaro-Martínez
- Complutense University of Madrid, University Podiatric Clinic, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
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Wang SH, Shyu VBH, Chiu WK, Huang RW, Lai BR, Tsai CH. An Overview of Clinical Examinations in the Evaluation and Assessment of Arterial and Venous Insufficiency Wounds. Diagnostics (Basel) 2023; 13:2494. [PMID: 37568858 PMCID: PMC10417660 DOI: 10.3390/diagnostics13152494] [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: 06/10/2023] [Revised: 07/11/2023] [Accepted: 07/17/2023] [Indexed: 08/13/2023] Open
Abstract
Arterial and venous insufficiency are two major causes of chronic wounds with different etiology, pathophysiology, and clinical manifestations. With recent advancements in clinical examination, clinicians are able to obtain an accurate diagnosis of the underlying disease, which plays an important role in the treatment planning and management of patients. Arterial ulcers are mainly caused by peripheral artery diseases (PADs), which are traditionally examined by physical examination and non-invasive arterial Doppler studies. However, advanced imaging modalities, such as computed tomography angiography (CTA) and indocyanine green (ICG) angiography, have become important studies as part of a comprehensive diagnostic process. On the other hand, chronic wounds caused by venous insufficiency are mainly evaluated by duplex ultrasonography and venography. Several scoring systems, including Clinical-Etiology-Anatomy-Pathophysiology (CEAP) classification, the Venous Clinical Severity Score (VCSS), the Venous Disability Score, and the Venous Segmental Disease Score (VSDS) are useful in defining disease progression. In this review, we provide a comprehensive overlook of the most widely used and available clinical examinations for arterial and venous insufficiency wounds.
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Affiliation(s)
- Szu-Han Wang
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Keelung Branch, Keelung 204, Taiwan; (S.-H.W.); (V.B.-H.S.); (B.-R.L.)
- Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei 110, Taiwan
| | - Victor Bong-Hang Shyu
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Keelung Branch, Keelung 204, Taiwan; (S.-H.W.); (V.B.-H.S.); (B.-R.L.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
| | - Wen-Kuan Chiu
- Division of Plastic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan;
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Ren-Wen Huang
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
- Division of Trauma Plastic Surgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Bo-Ru Lai
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Keelung Branch, Keelung 204, Taiwan; (S.-H.W.); (V.B.-H.S.); (B.-R.L.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
| | - Chia-Hsuan Tsai
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Keelung Branch, Keelung 204, Taiwan; (S.-H.W.); (V.B.-H.S.); (B.-R.L.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
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Pressure Injuries and Management after Spinal Cord Injury. J Pers Med 2022; 12:jpm12071130. [PMID: 35887627 PMCID: PMC9325194 DOI: 10.3390/jpm12071130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/30/2022] [Accepted: 07/08/2022] [Indexed: 11/17/2022] Open
Abstract
Spinal cord injury (SCI) results in motor paralysis and sensory loss that places individuals at particularly high risk of pressure injuries. Multiple comorbidities associated with autonomic, cardiovascular, pulmonary, endocrine, gastrointestinal, genitourinary, neurological, and musculoskeletal dysfunction makes it even more likely that pressure injuries will occur. This manuscript will review the structure and function of the integumentary system, and address the multidisciplinary approach required to prevent and manage pressure injuries in this vulnerable population.
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Song M, Zong J, Zou L, Fu Z, Liu J, Wang S. Biological debridement combined with stem cell therapy will be a convenient and efficient method for treating chronic wounds in the future. Med Hypotheses 2022. [DOI: 10.1016/j.mehy.2022.110905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Landry GJ, Louie D, Giraud D, Ammi AY, Kaul S. Ultrasound therapy for treatment of lower extremity intermittent claudication. Am J Surg 2021; 221:1271-1275. [PMID: 33750572 DOI: 10.1016/j.amjsurg.2021.02.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 01/29/2021] [Accepted: 02/17/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND While often thought of as a diagnostic tool, ultrasound (US) can also potentially be used as a therapeutic modality. US applies mechanical stress on endothelial cells and induces nitric oxide synthase, which regulates the secretion of nitric oxide, a potent vasodilator. In animal ischemic models, US has been shown to improve hindlimb, myocardial, and cerebral perfusion. We performed a pilot trial of US therapy in the lower extremities of human subjects with intermittent claudication. METHODS 10 subjects (5 male, 5 female, mean age 69.7 ± 10.3) with intermittent claudication were recruited. Both legs were placed in a specially designed boot with a water interface between US transducers and the legs. Subjects underwent pulsed US therapy at 250 kHz frequency for 30 min for three treatments a week for six weeks. Pre and post treatment ankle:brachial index (ABI), 6-min walk (6 MW), Walking Impairment Questionnaire (WIQ), and Short Form 36 (SF36) were performed. Pre and post-treatment results were compared with paired t-test. RESULTS Six minute walking distance at baseline was 352 ± 70 m, after one treatment session 353 ± 70 m (p = 0.99), and at completion 372 ± 71 m (p = 0.015). There was a trend toward improved ABI after 6 weeks of treatment (0.53 ± 0.17 vs 0.64 ± 0.12, p = 0.083). After six weeks, significant improvements were noted in overall WIQ score (2.00 ± 1.48 vs 2.63 ± 1.38, p = 0.0001), WIQ (distance) 2.07 ± 1.54 vs 2.73 ± 1.42 (p = 0.036), and WIQ (stair) 2.00 ± 1.67 vs 2.62 ± 1.24, p = 0.034, with a trend in WIQ (speed), 1.89 ± 1.26 vs 2.46 ± 1.43, p = 0.069. In the SF-36, significant improvements were noted in the domains of physical functioning (44.0 ± 41.6 vs 50.5 ± 41.1, p = 0.009) and role limitations - physical (35.0 ± 48.3 vs 60.0 ± 49.6, p = 0.006) after six weeks. CONCLUSIONS Therapeutic US is a potential noninvasive treatment for intermittent claudication. Pilot study patients noted significant improvements in 6 MW and WIQ results after 6 weeks of treatment. A nonsignificant improvement in ABI was noted. Further research will be needed to clarify optimal treatment frequency and duration.
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Affiliation(s)
- Gregory J Landry
- Knight Cardiovascular Institute, Oregon Health & Science University, USA.
| | - David Louie
- Knight Cardiovascular Institute, Oregon Health & Science University, USA
| | - David Giraud
- Knight Cardiovascular Institute, Oregon Health & Science University, USA
| | - Azzdine Y Ammi
- Knight Cardiovascular Institute, Oregon Health & Science University, USA
| | - Sanjiv Kaul
- Knight Cardiovascular Institute, Oregon Health & Science University, USA
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Las Heras K, Igartua M, Santos-Vizcaino E, Hernandez RM. Chronic wounds: Current status, available strategies and emerging therapeutic solutions. J Control Release 2020; 328:532-550. [DOI: 10.1016/j.jconrel.2020.09.039] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 09/17/2020] [Accepted: 09/18/2020] [Indexed: 02/07/2023]
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Izzetti R, Oranges T, Janowska A, Gabriele M, Graziani F, Romanelli M. The Application of Ultra-High-Frequency Ultrasound in Dermatology and Wound Management. INT J LOW EXTR WOUND 2020; 19:334-340. [DOI: 10.1177/1534734620972815] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The management of lower extremity wounds is frequently performed by means of clinical examination, representing a challenge for the clinician due to the various conditions that can potentially enter differential diagnosis. Several diagnostic techniques are available in the dermatologist’s arsenal as a support to diagnosis confirmation, including dermoscopy and ultrasonography. Recently, a novel ultrasonographic technique involving the use of ultra-high ultrasound frequencies has entered the scene, and appears a promising tool in the diagnostic workup of skin ulcerative lesions. The focus of this review is to discuss the potential role of ultra-high-frequency ultrasonography in the diagnostic workup of wounds in the light of the current applications of the technique.
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Hoversten KP, Kiemele LJ, Stolp AM, Takahashi PY, Verdoorn BP. Prevention, Diagnosis, and Management of Chronic Wounds in Older Adults. Mayo Clin Proc 2020; 95:2021-2034. [PMID: 32276784 DOI: 10.1016/j.mayocp.2019.10.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 10/11/2019] [Accepted: 10/17/2019] [Indexed: 11/18/2022]
Abstract
Chronic wounds are common, disproportionately affect older adults, and are likely to be encountered by providers across all specialties and care settings. All providers should be familiar with basic wound prevention, identification, classification, and treatment approach, all of which are outlined in this article.
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Affiliation(s)
| | | | - Anne M Stolp
- Department of Medicine, Division of Community Internal Medicine, Mayo Clinic, Rochester, MN
| | - Paul Y Takahashi
- Department of Medicine, Divisions of Community Internal Medicine and Geriatric Medicine/Gerontology, Mayo Clinic, Rochester, MN
| | - Brandon P Verdoorn
- Department of Medicine, Divisions of Community Internal Medicine and Geriatric Medicine/Gerontology, Mayo Clinic, Rochester, MN.
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Palmieri B, Vadalà M, Laurino C. Electromedical devices in wound healing management: a narrative review. J Wound Care 2020; 29:408-418. [PMID: 32654604 DOI: 10.12968/jowc.2020.29.7.408] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Wound healing is the sum of physiological sequential steps, leading to skin restoration. However, in some conditions, such as diabetes, pressure ulcers (PU) and venous legs ulcers (VLU), healing is a major challenge and requires multiple strategies. In this context, some electromedical devices may accelerate and/or support wound healing, modulating the inflammatory, proliferation (granulation) and tissue-remodelling phases. This review describes some helpful electromedical devices including: ultrasonic-assisted wound debridement; electrotherapy; combined ultrasound and electric field stimulation; low-frequency pulsed electromagnetic fields; phototherapy (for example, laser therapy and light-emitting diode (LED) therapy); biophotonic therapies, and pressure therapies (for example, negative pressure wound therapy, and high pressure and intermittent pneumatic compression) The review focuses on the evidence-based medicine and adequate clinical trial design in relation to these devices.
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Affiliation(s)
- Beniamino Palmieri
- Department of General Surgery and Surgical Specialties, University of Modena and Reggio Emilia Medical School, Surgical Clinic, Via del Pozzo, 71, 41124, Modena, Italy.,Second Opinion Medical Network, Via Ciro Bisi, 125, Modena, Italy
| | - Maria Vadalà
- Department of General Surgery and Surgical Specialties, University of Modena and Reggio Emilia Medical School, Surgical Clinic, Via del Pozzo, 71, 41124, Modena, Italy.,Second Opinion Medical Network, Via Ciro Bisi, 125, Modena, Italy
| | - Carmen Laurino
- Department of General Surgery and Surgical Specialties, University of Modena and Reggio Emilia Medical School, Surgical Clinic, Via del Pozzo, 71, 41124, Modena, Italy.,Second Opinion Medical Network, Via Ciro Bisi, 125, Modena, Italy
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Dong J, Tian M, Song F, Tang J, Liu Y, Wu M, Li J, Zhou J, Huang L, Dong W, Lu S. Epidemiological investigation of vascular etiological examinations in the diagnosis and treatment of lower-extremity ulcers in China. Wound Repair Regen 2020; 28:532-538. [PMID: 32386345 DOI: 10.1111/wrr.12810] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 11/27/2022]
Abstract
The vascular causes of lower-extremity ulcers cannot be neglected because they can directly affect treatment methods. No detailed epidemiological statistics have described vascular etiological diagnosis in China. This study aimed to explore the prevalence of clinical vascular etiological examination of lower-extremity ulcers and improve the diagnosis and treatment effectiveness of lower-extremity ulcers. Data were collected from the WoundCareLog database, which includes 2413 cases of lower-extremity ulcers from 478 hospitals nationwide. Data analysis revealed that 1698 (70.4%) lower-extremity blood flow examinations (including physical examination [PE] and assistant examinations [AE]) were performed, of which 61.7% were PE, 10.4% were AE only, and 27.9% were the combined PE and AE[PAE]. The proportion of nonexaminations was higher in the nondiabetic group than in the diabetic group (χ2 = 34.5; P < .01). The positive rates of vascular etiological examination in the diabetic and nondiabetic groups were 69.7% and 70.7%, respectively. Among the four economic regions of China, there were statistically significant differences in the use of the different examination methods. The examination of vascular diseases in lower-extremity ulcers in China has not been fully popularized and requires improvement; there was no statistically significant difference between examination rates by doctors and nurses, which is mainly based on PE. However, PE has certain rates of misdiagnosis and missed diagnosis. The false-positive and false-negative rates were 25.7% and 57.6%, respectively. The use of an AE can compensate for this deficiency by making diagnosis more precise, while the quantitative diagnostic criteria allow disease diagnosis to transcend geographical and operator differences and maximize uniformity. The vascular B-ultrasound examination is more suitable for the medical environment in China because of its mature technology, high hospital penetration rate, and low cost.
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Affiliation(s)
- Jiaoyun Dong
- Wound Healing Center, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ming Tian
- Wound Healing Center, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Fei Song
- Wound Healing Center, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jiajun Tang
- Wound Healing Center, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yingkai Liu
- Wound Healing Center, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Minjie Wu
- Wound Healing Center, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jian Li
- Wound Healing Center, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jingqi Zhou
- Wound Healing Center, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lifang Huang
- Wound Healing Center, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wei Dong
- Department of Plastic Surgery, The First Affiliated Hospital of Jinan University, Key Laboratory of Regenerative Medicine, Ministry of Education, Guangzhou, Guangdong, China
| | - Shuliang Lu
- Wound Healing Center, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Kaile K, Godavarty A. Development and Validation of a Smartphone-Based Near-Infrared Optical Imaging Device to Measure Physiological Changes In-Vivo. MICROMACHINES 2019; 10:E180. [PMID: 30857323 PMCID: PMC6471700 DOI: 10.3390/mi10030180] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 02/23/2019] [Accepted: 03/05/2019] [Indexed: 12/11/2022]
Abstract
Smartphone-based technologies for medical imaging purposes are limited, especially when it involves the measurement of physiological information of the tissues. Herein, a smartphone-based near-infrared (NIR) imaging device was developed to measure physiological changes in tissues across a wide area and without contact. A custom attachment containing multiple multi-wavelength LED light sources (690, 800, and 840 nm; and <4 mW of optical power per LED), source driver, and optical filters and lenses was clipped onto a smartphone that served as the detector during data acquisition. The ability of the device to measure physiological changes was validated via occlusion studies on control subjects. Noise removal techniques using singular value decomposition algorithms effectively removed surface noise and distinctly differentiated the physiological changes in response to occlusion. In the long term, the developed smartphone-based NIR imaging device with capabilities to capture physiological changes will be a great low-cost alternative for clinicians and eventually for patients with chronic ulcers and bed sores, and/or in pre-screening for potential ulcers in diabetic subjects.
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Affiliation(s)
- Kacie Kaile
- Optical Imaging Laboratory, Department of Biomedical Engineering, Florida International University, Miami, FL 33174, USA.
| | - Anuradha Godavarty
- Optical Imaging Laboratory, Department of Biomedical Engineering, Florida International University, Miami, FL 33174, USA.
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