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Ahmadieh-Yazdi A, Karimi M, Afkhami E, Hajizadeh-Tafti F, Kuchakzadeh F, Yang P, Sheykhhasan M. Unveiling therapeutic potential: Adipose tissue-derived mesenchymal stem cells and their exosomes in the management of diabetes mellitus, wound healing, and chronic ulcers. Biochem Pharmacol 2024; 226:116399. [PMID: 38944396 DOI: 10.1016/j.bcp.2024.116399] [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: 01/31/2024] [Revised: 05/30/2024] [Accepted: 06/26/2024] [Indexed: 07/01/2024]
Abstract
Diabetes mellitus (DM) is a pervasive global health issue with substantial morbidity and mortality, often resulting in secondary complications, including diabetic wounds (DWs). These wounds, arising from hyperglycemia, diabetic neuropathy, anemia, and ischemia, afflict approximately 15% of diabetic patients, with a considerable 25% at risk of lower limb amputations. The conventional approaches for chronic and diabetic wounds management involves utilizing various therapeutic substances and techniques, encompassing growth factors, skin substitutes and wound dressings. In parallel, emerging cell therapy approaches, notably involving adipose tissue-derived mesenchymal stem cells (ADMSCs), have demonstrated significant promise in addressing diabetes mellitus and its complications. ADMSCs play a pivotal role in wound repair, and their derived exosomes have garnered attention for their therapeutic potential. This review aimed to unravel the potential mechanisms and provide an updated overview of the role of ADMSCs and their exosomes in diabetes mellitus and its associated complications, with a specific focus on wound healing.
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Affiliation(s)
- Amirhossein Ahmadieh-Yazdi
- Stem Cell Biology Research Center, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mahdieh Karimi
- Stem Cell Biology Research Center, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Elham Afkhami
- Stem Cell Biology Research Center, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran; Department of Anatomical Sciences, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Fatemeh Hajizadeh-Tafti
- Stem Cell Biology Research Center, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Fatemeh Kuchakzadeh
- Stem Cell Biology Research Center, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran; Department of Tissue Engineering, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Piao Yang
- Department of Molecular Genetics, College of Arts and Sciences, The Ohio State University, Columbus, OH 43210, USA
| | - Mohsen Sheykhhasan
- Cellular and Molecular Research Center, Qom University of Medical Sciences, Qom, Iran.
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Zuniga J, Mungai M, Chism L, Frost L, Kakkar R, Kyololo O. Pressure ulcer prevention and treatment interventions in Sub-Saharan Africa: A systematic review. Nurs Outlook 2024; 72:102151. [PMID: 38490058 DOI: 10.1016/j.outlook.2024.102151] [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: 10/03/2023] [Revised: 01/24/2024] [Accepted: 02/11/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND The high burden of pressure ulcers (PUs) in Sub-Saharan Africa (SSA), coupled with the limited resources, underscores the need for preventive and context-specific treatment strategies. PURPOSE Therefore, the purpose of this systematic review was to establish and elucidate PU prevention and treatment interventions tested in SSA. METHODS This systematic review of the literature used, PRISMA to guide the search. FINDINGS The review identified nine studies on PU prevention (three) and treatment (six). Low-cost interventions assembled from locally available materials and multifaceted policies significantly prevented and treated PUs. The interventions included wound dressing agents, simple negative pressure suction devices that significantly treated PUs, and water-based bed surfaces. DISCUSSION There were gaps in the interventions that have been proven successful in other global settings. CONCLUSION In SSA, there is a need for nurses to tailor, test, and disseminate findings from evidence-based projects for PU prevention that have been successful in similar settings.
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Affiliation(s)
- Julie Zuniga
- School of Nursing, The University of Texas at Austin, Austin, TX.
| | | | - Lucy Chism
- School of Nursing, The University of Texas at Austin, Austin, TX
| | - Livia Frost
- School of Medicine, Baylor College of Medicine, Houston, TX
| | - Reha Kakkar
- College of Natural Sciences, The University of Texas at Austin, Austin, TX
| | - O'Brien Kyololo
- School of Nursing and Midwifery, Moi University, Eldoret, Kenya
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Taeger CD, Muehle C, Kruppa P, Prantl L, Biermann N. Negative Pressure Wound Therapy-A Vacuum-Mediated Positive Pressure Wound Therapy and a Closer Look at the Role of the Laser Doppler. J Clin Med 2024; 13:2351. [PMID: 38673623 PMCID: PMC11051509 DOI: 10.3390/jcm13082351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/04/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Negative pressure wound therapy (NPWT) is an intensely investigated topic, but its mechanism of action accounts for one of the least understood ones in the area of wound healing. Apart from a misleading nomenclature, by far the most used diagnostic tool to investigate NPWT, the laser Doppler, also has its weaknesses regarding the detection of changes in blood flow and velocity. The aim of the present study is to explain laser Doppler readings within the context of NPWT influence. Methods: The cutaneous microcirculation beneath an NPWT system of 10 healthy volunteers was assessed using two different laser Dopplers (O2C/Rad-97®). This was combined with an in vitro experiment simulating the compressing and displacing forces of NPWT on the arterial and venous system. Results: Using the O2C, a baseline value of 194 and 70 arbitrary units was measured for the flow and relative hemoglobin, respectively. There was an increase in flow to 230 arbitrary units (p = 0.09) when the NPWT device was switched on. No change was seen in the relative hemoglobin (p = 0.77). With the Rad-97®, a baseline of 92.91% and 0.17% was measured for the saturation and perfusion index, respectively. No significant change in saturation was noted during the NPWT treatment phase, but the perfusion index increased to 0.32% (p = 0.04). Applying NPWT compared to the arteriovenous-vessel model resulted in a 28 mm and 10 mm increase in the venous and arterial water column, respectively. Conclusions: We suspect the vacuum-mediated positive pressure of the NPWT results in a differential displacement of the venous and arterial blood column, with stronger displacement of the venous side. This ratio may explain the increased perfusion index of the laser Doppler. Our in vitro setup supports this finding as compressive forces on the bottom of two water columns within a manometer with different resistances results in unequal displacement.
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Affiliation(s)
- Christian D. Taeger
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany; (C.M.); (L.P.); (N.B.)
| | - Clemens Muehle
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany; (C.M.); (L.P.); (N.B.)
| | - Philipp Kruppa
- Department of Plastic, Hand and Reconstructive Surgery, Ernst von Bergmann Klinikum, 14467 Potsdam, Germany;
| | - Lukas Prantl
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany; (C.M.); (L.P.); (N.B.)
| | - Niklas Biermann
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany; (C.M.); (L.P.); (N.B.)
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Yadav JP, Singh AK, Grishina M, Pathak P, Verma A, Kumar V, Kumar P, Patel DK. Insights into the mechanisms of diabetic wounds: pathophysiology, molecular targets, and treatment strategies through conventional and alternative therapies. Inflammopharmacology 2024; 32:149-228. [PMID: 38212535 DOI: 10.1007/s10787-023-01407-6] [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: 09/14/2023] [Accepted: 11/27/2023] [Indexed: 01/13/2024]
Abstract
Diabetes mellitus is a prevalent cause of mortality worldwide and can lead to several secondary issues, including DWs, which are caused by hyperglycemia, diabetic neuropathy, anemia, and ischemia. Roughly 15% of diabetic patient's experience complications related to DWs, with 25% at risk of lower limb amputations. A conventional management protocol is currently used for treating diabetic foot syndrome, which involves therapy using various substances, such as bFGF, pDGF, VEGF, EGF, IGF-I, TGF-β, skin substitutes, cytokine stimulators, cytokine inhibitors, MMPs inhibitors, gene and stem cell therapies, ECM, and angiogenesis stimulators. The protocol also includes wound cleaning, laser therapy, antibiotics, skin substitutes, HOTC therapy, and removing dead tissue. It has been observed that treatment with numerous plants and their active constituents, including Globularia Arabica, Rhus coriaria L., Neolamarckia cadamba, Olea europaea, Salvia kronenburgii, Moringa oleifera, Syzygium aromaticum, Combretum molle, and Myrtus communis, has been found to promote wound healing, reduce inflammation, stimulate angiogenesis, and cytokines production, increase growth factors production, promote keratinocyte production, and encourage fibroblast proliferation. These therapies may also reduce the need for amputations. However, there is still limited information on how to prevent and manage DWs, and further research is needed to fully understand the role of alternative treatments in managing complications of DWs. The conventional management protocol for treating diabetic foot syndrome can be expensive and may cause adverse side effects. Alternative therapies, such as medicinal plants and green synthesis of nano-formulations, may provide efficient and affordable treatments for DWs.
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Affiliation(s)
- Jagat Pal Yadav
- Department of Pharmaceutical Sciences, Sam Higginbottom University of Agriculture, Technology and Sciences, Prayagraj, 211007, India.
- Pharmacology Research Laboratory, Faculty of Pharmaceutical Sciences, Rama University, Kanpur, 209217, India.
- Bioorganic and Medicinal Chemistry Research Laboratory, Department of Pharmaceutical Sciences, Sam Higginbottom University of Agriculture, Technology and Sciences, Prayagraj, 211007, India.
| | - Ankit Kumar Singh
- Department of Pharmaceutical Sciences and Natural Products, Central University of Punjab, Bathinda, 151401, India
| | - Maria Grishina
- Laboratory of Computational Modeling of Drugs, Higher Medical and Biological School, South Ural State University, Chelyabinsk, 454008, Russia
| | - Prateek Pathak
- Department of Pharmaceutical Analysis, Quality Assurance, and Pharmaceutical Chemistry, School of Pharmacy, GITAM (Deemed to Be University), Hyderabad, 502329, India
| | - Amita Verma
- Bioorganic and Medicinal Chemistry Research Laboratory, Department of Pharmaceutical Sciences, Sam Higginbottom University of Agriculture, Technology and Sciences, Prayagraj, 211007, India
| | - Vikas Kumar
- Natural Product Drug Discovery Laboratory, Department of Pharmaceutical Sciences, Sam Higginbottom University of Agriculture, Technology and Sciences, Prayagraj, 211007, India
| | - Pradeep Kumar
- Department of Pharmaceutical Sciences and Natural Products, Central University of Punjab, Bathinda, 151401, India
| | - Dinesh Kumar Patel
- Department of Pharmaceutical Sciences, Sam Higginbottom University of Agriculture, Technology and Sciences, Prayagraj, 211007, India.
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Veale RWF, Kollmetz T, Taghavi N, Duston-Fursman CG, Beeson MT, Asefi D, Chittock HD, Vikranth AS, Dowling SG, Dempsey SG, Rose HJ, Mason ITT, May BCH. Influence of advanced wound matrices on observed vacuum pressure during simulated negative pressure wound therapy. J Mech Behav Biomed Mater 2023; 138:105620. [PMID: 36543083 DOI: 10.1016/j.jmbbm.2022.105620] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/24/2022] [Accepted: 12/11/2022] [Indexed: 12/23/2022]
Abstract
Biomaterials and negative pressure wound therapy (NPWT) are treatment modalities regularly used together to accelerate soft-tissue regeneration. This study evaluated the impact of the design and composition of commercially available collagen-based matrices on the observed vacuum pressure delivered under NPWT using a custom test apparatus. Specifically, testing compared the effect of the commercial products; ovine forestomach matrix (OFM), collagen/oxidized regenerated cellulose (collagen/ORC) and a collagen-based dressing (CWD) on the observed vacuum pressure. OFM resulted in an ∼50% reduction in the observed target vacuum pressure at 75 mmHg and 125 mmHg, however, this effect was mitigated to a ∼0% reduction when fenestrations were introduced into the matrix. Both collagen/ORC and CWD reduced the observed vacuum pressure at 125 mmHg (∼15% and ∼50%, respectively), and this was more dramatic when a lower vacuum pressure of 75 mmHg was delivered (∼20% and ∼75%, respectively). The reduced performance of the reconstituted collagen products is thought to result from the gelling properties of these products that may cause occlusion of the delivered vacuum to the wound bed. These findings highlight the importance of in vitro testing to establish the impact of adjunctive therapies on NPWT, where effective delivery of vacuum pressure is paramount to the efficacy of this therapy.
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Affiliation(s)
- Robert W F Veale
- Aroa Biosurgery Limited, Airport Oaks, Auckland, 2022, New Zealand
| | - Tarek Kollmetz
- Aroa Biosurgery Limited, Airport Oaks, Auckland, 2022, New Zealand
| | - Navid Taghavi
- Aroa Biosurgery Limited, Airport Oaks, Auckland, 2022, New Zealand
| | | | - Matthew T Beeson
- Aroa Biosurgery Limited, Airport Oaks, Auckland, 2022, New Zealand
| | - Dorrin Asefi
- Aroa Biosurgery Limited, Airport Oaks, Auckland, 2022, New Zealand
| | - Henry D Chittock
- Aroa Biosurgery Limited, Airport Oaks, Auckland, 2022, New Zealand
| | | | - Shane G Dowling
- Aroa Biosurgery Limited, Airport Oaks, Auckland, 2022, New Zealand
| | - Sandi G Dempsey
- Aroa Biosurgery Limited, Airport Oaks, Auckland, 2022, New Zealand
| | - Hamish J Rose
- Aroa Biosurgery Limited, Airport Oaks, Auckland, 2022, New Zealand
| | - Isaac T T Mason
- Aroa Biosurgery Limited, Airport Oaks, Auckland, 2022, New Zealand
| | - Barnaby C H May
- Aroa Biosurgery Limited, Airport Oaks, Auckland, 2022, New Zealand.
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Biermann N, Wallner S, Martini T, Spoerl S, Prantl L, Taeger CD. Negative Pressure Wound Therapy with Instillation: Analysis of the Rinsing Fluid as a Monitoring Tool and Approach to the Inflammatory Process: A Pilot Study. J Clin Med 2023; 12:jcm12020711. [PMID: 36675638 PMCID: PMC9864079 DOI: 10.3390/jcm12020711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 01/02/2023] [Accepted: 01/05/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Negative pressure wound therapy with instillation (NPWTi) is an established wound conditioning tool. Previous investigations discovered that the rinsing fluid is a suitable monitoring tool containing various cells and cytokines. METHODS The aim of this pilot study was to analyze rinsing fluid samples from patients treated with NPWTi and link them to the clinical course, including microbiological contamination. In 31 consecutive patients with acute and chronic wounds, laboratory analysis was performed to evaluate IL-6, IL-8, bFGF, Tnf-a, and VEGF. RESULTS IL-6 showed a significant increase to 1540 pg/mL on day two and 860 pg/mL on day four (p = 0.01 and p = 0.04, resp.). IL-8 steadily increased from a median of 2370 pg/mL to a maximum of 19,400 pg/mL on day three (p = 0.01). The median bFGF showed a steady decline from 22 pg/mL to 10 pg/m (p = 0.35) on day three. The median Tnf-a increased from 11 pg/mL to 44 pg/mL (p = 001). The median VEGF values fluctuated but showed an overall increase from 35 pg/mL to 250 pg/mL (p = 0.07). Regarding IL-8, diabetic and non-diabetic patients both showed a gradual increase with non-significant higher median values for the diabetics. The subgroup analysis of IL-6 showed increasing and higher values in cases with bacterial superinfections (p = 0.07). CONCLUSION We were able to use an established wound conditioning tool to gather important information about the inflammatory response during NPWTi treatment. Cytokine and cell courses were mostly consistent with the literature, especially in diabetic patients, and should be further investigated.
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Affiliation(s)
- Niklas Biermann
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
- Correspondence:
| | - Stefan Wallner
- Department of Clinical Chemistry, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Teresa Martini
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Steffen Spoerl
- Clinic and Polyclinic for Oral and Maxillofacial Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Lukas Prantl
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Christian D. Taeger
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
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Singh D, Livingstone JP, Lautze J, Murray PC. Measuring In-Vivo Foot Perfusion Distal to a Near-Circumferential Negative Pressure Wound Therapy Dressing via Thermal Imaging. Cureus 2021; 13:e17720. [PMID: 34650894 PMCID: PMC8489966 DOI: 10.7759/cureus.17720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2021] [Indexed: 01/12/2023] Open
Abstract
Background Negative pressure wound therapy (NPWT) has been shown to promote the healing of acute and chronic wounds. In our previous study, we demonstrated that a near-circumferential NPWT dressing provided "lift-off" on an in-vitro extremity model resulting in decreased pressure. We hypothesized that this decrease in pressure may increase perfusion distal to the NPWT dressing by increasing lymphatic drainage and venous flow. Methods In this study, we tested if a near-circumferential NPWT dressing caused any appreciable skin movement around the dressing. We then used a thermal imaging camera to test if there was an increase in perfusion to the foot when a near-circumferential NPWT dressing was placed around the lower leg and tested at various negative pressures. Finally, we wanted to see if an artificial "lift-off" mechanism would lead to an increase in perfusion. Results The skin was noted to stretch between the short ends of the NPWT dressing, consistent with our previously described "lift-off" mechanism. However, there was no correlation between negative pressure and perfusion to the foot in the other experiments. Conclusion This study demonstrated that a near-circumferential NPWT dressing may not have any appreciable effects on perfusion when applied on a healthy patient, however, future studies are needed to determine if similar results would be seen on a traumatized or otherwise compromised extremity.
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Affiliation(s)
- Dylan Singh
- Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, USA
| | | | - Jacob Lautze
- Medicine, Homer Stryker School of Medicine, Western Michigan University, Kalamazoo, USA
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Burgess JL, Wyant WA, Abdo Abujamra B, Kirsner RS, Jozic I. Diabetic Wound-Healing Science. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:1072. [PMID: 34684109 PMCID: PMC8539411 DOI: 10.3390/medicina57101072] [Citation(s) in RCA: 145] [Impact Index Per Article: 48.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 09/28/2021] [Accepted: 10/04/2021] [Indexed: 12/15/2022]
Abstract
Diabetes mellitus is an increasingly prevalent chronic metabolic disease characterized by prolonged hyperglycemia that leads to long-term health consequences. It is estimated that impaired healing of diabetic wounds affects approximately 25% of all patients with diabetes mellitus, often resulting in lower limb amputation, with subsequent high economic and psychosocial costs. The hyperglycemic environment promotes the formation of biofilms and makes diabetic wounds difficult to treat. In this review, we present updates regarding recent advances in our understanding of the pathophysiology of diabetic wounds focusing on impaired angiogenesis, neuropathy, sub-optimal chronic inflammatory response, barrier disruption, and subsequent polymicrobial infection, followed by current and future treatment strategies designed to tackle the various pathologies associated with diabetic wounds. Given the alarming increase in the prevalence of diabetes, and subsequently diabetic wounds, it is imperative that future treatment strategies target multiple causes of impaired healing in diabetic wounds.
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Affiliation(s)
| | | | | | - Robert S. Kirsner
- Wound Healing and Regenerative Medicine Research Program, Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (J.L.B.); (W.A.W.); (B.A.A.)
| | - Ivan Jozic
- Wound Healing and Regenerative Medicine Research Program, Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (J.L.B.); (W.A.W.); (B.A.A.)
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Rother U, Theune M, Lang W, Meyer A. Pilot assessment of the effect of negative pressure wound therapy on microperfusion of chronic and acute wounds. Clin Hemorheol Microcirc 2021; 79:455-462. [PMID: 34057141 DOI: 10.3233/ch-211189] [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: 11/15/2022]
Abstract
BACKGROUND Negative pressure wound therapy (NPWT) has been established over years for treatment of chronic and complex wounds. OBJECTIVE Aim of this study was to investigate the effect NPWT on the microperfusion. METHODS Prospective single centre analysis of patients treated with NPWT due to acute (ACUTE) wounds after fasciotomy or patients with chronic wounds (CHRONIC) due to a chronic limb threatening ischemia was performed. NPWT was conducted through a three days sequence with a negative pressure of -120 mmHg. Before after and during the entire period of therapy the microperfusion was assessed (O2C™, LEA Medizintechnik). RESULTS Comparison of the perfusion values of 28 patients (CHRONIC/ACUTE 5/23, women/men 8/20) before and after the NPWT sequence showed a non-significant improvement in the CHRONIC group (supine position: p = 0.144, elevated position p = 0.068) and a significant decrease in the ACUTE group (supine position p = 0.012, elevated position p = 0.034). This effect could also been demonstrated during the NPWT over time (CHRONIC: supine position: p = 0.320, elevated position: p = 0.053, ACUTE: supine position: p = 0.021, elevated position: p = 0.012). CONCLUSION Microperfusion measurements showed alterations and differences in wound bed perfusion of acute and chronic wounds; acute wounds tended to a decrease of blood flow, whereas this effect was not seen in chronic wounds in peripheral artery disease.
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Affiliation(s)
- Ulrich Rother
- Department of Vascular Surgery, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Mona Theune
- Department of Vascular Surgery, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Werner Lang
- Department of Vascular Surgery, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Alexander Meyer
- Department of Vascular Surgery, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
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Livingstone JP, Singh D, Murray PC. An In Vitro Study Measuring the Effects of Circumferential and Near-Circumferential Closed Incisional Negative Pressure Wound Therapy Dressings. Cureus 2021; 13:e14389. [PMID: 33981509 PMCID: PMC8106949 DOI: 10.7759/cureus.14389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background Negative pressure wound therapy (NPWT) and closed incisional negative pressure wound therapy (ciNPWT) have been shown to promote the healing of acute and chronic wounds. Despite the growth in their usage, the mechanism by which they promote healing is not fully understood. Several studies have shown that NPWT results in a combination of microdeformation and macrodeformation, which may promote wound recovery. The macrodeformation forces have raised concerns about circumferential NPWT compressing the extremity and decreasing perfusion distal to the NPWT. The literature on circumferential NPWT is mixed, with some studies showing increased perfusion, while others have shown decreased perfusion. We hypothesized that a near-circumferential ciNPWT dressing applied over intact skin would provide a “lift-off” force rather than a compressive force. We also theorized that as the sponge contracts under negative pressure while in a near-circumferential setting, the dressing will pull on the surrounding skin and tissue, leading to a decrease in the pressure of the extremity. This could potentially translate to improved venous and lymphatic return, increasing perfusion to the tissue beneath the sponge as well as distal to the sponge. Methods This study consisted of three separate experiments. The first experiment measured the width and length of a ciNPWT dressing at various negative pressures. The second experiment utilized an in vitro model consisting of an elastic ball and tubing to examine the effects that circumferential and near-circumferential ciNPWT dressings may have on extremity pressure. Varying lengths of ciNPWT dressings were applied to the ball, ranging from 25% circumferential to 100% circumferential. The pressure within the ball was monitored as varying lengths of circumferential dressings were applied at various negative pressures. The third experiment utilized the same model as the second experiment but with a 66% circumferential dressing and various baseline ball pressures to see how extremity pressure may impact the ability of the ciNPWT dressing to alter extremity pressure. Results The first experiment demonstrated that a ciNPWT dressing decreased in length and width in a linear fashion as negative pressure was applied. The second experiment revealed that both fully circumferential and near-circumferential dressings resulted in a decrease in the pressure of the elastic ball at lower levels of suction. The greatest decrease in ball pressure was noted with the 66% near-circumferential dressing. With greater suction, however, the pressure within the ball was noted to increase above baseline. The third experiment illustrated that as the baseline pressure of a ball was increased, the dressing had less of an ability to change the pressure of the ball. Conclusions These results suggest that near-circumferential and circumferential ciNPWT systems may decrease the pressure of an extremity at certain negative pressures and that compression may be less likely to occur when used on a higher-pressure extremity.
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Affiliation(s)
| | - Dylan Singh
- John A. Burns School of Medicine, University of Hawaii, Honolulu, USA
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Zwanenburg PR, Sterenborg HJCM, Boermeester MA. Letter to the editor regarding 'Improvement of local microcirculation through intermittent Negative Pressure Wound Therapy (NPWT)'. J Tissue Viability 2018; 28:46-47. [PMID: 30377017 DOI: 10.1016/j.jtv.2018.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 10/17/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Pieter R Zwanenburg
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam Infection & Immunity, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Henricus J C M Sterenborg
- Department of Biomedical Engineering & Physics, Amsterdam UMC, University of Amsterdam, the Netherlands; Department of Surgery, Antoni van Leeuwenhoek Hospital-The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Marja A Boermeester
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam Infection & Immunity, Amsterdam UMC, University of Amsterdam, the Netherlands.
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Sogorski A, Lehnhardt M, Goertz O, Harati K, Kapalschinski N, Hirsch T, Daigeler A, Kolbenschlag J. Improvement of local microcirculation through intermittent Negative Pressure Wound Therapy (NPWT). J Tissue Viability 2018; 27:267-273. [DOI: 10.1016/j.jtv.2018.08.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 06/30/2018] [Accepted: 08/12/2018] [Indexed: 01/23/2023]
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Abstract
OBJECTIVE Negative-pressure wound therapy (NPWT) has become a common wound care treatment modality for a variety of wounds. Several previous studies have reported that NPWT increases blood flow in the wound bed. However, NPWT might decrease tissue oxygenation in the wound bed because the foam sponge of NPWT compresses the wound bed under the influence of the applied negative pressure. Adequate tissue oxygenation is an essential consideration during diabetic foot management, and the foot is more sensitive to ischemia than any other region. Furthermore, the issue as to whether NPWT reduces or increases tissue oxygenation in diabetic feet has never been correctly addressed. The aim of this study was to evaluate the influence of NPWT on tissue oxygenation in diabetic feet. PARTICIPANTS Transcutaneous partial oxygen pressures (TcPO2) were measured to determine tissue oxygenation levels beneath NPWT dressings on 21 feet of 21 diabetic foot ulcer patients. DESIGN A TcPO2 sensor was fixed at the tarsometatarsal area of contralateral unwounded feet. A suction pressure of -125 mm Hg was applied until TcPO2 reached a steady state. The TcPO2 values for diabetic feet were measured before, during, and after NPWT. MAIN RESULTS The TcPO2 levels decreased significantly after applying NPWT in all patients. Mean TcPO2 values before, during, and after therapy were 44.6 (SD, 15.2), 6.0 (SD, 7.1), and 40.3 (SD, 16.4) mm Hg (P < .01), respectively. CONCLUSION These results show that NPWT significantly reduces tissue oxygenation levels in diabetic feet.
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Does the Use of Incisional Negative-Pressure Wound Therapy Prevent Mastectomy Flap Necrosis in Immediate Expander-Based Breast Reconstruction? Plast Reconstr Surg 2017; 139:1203e-1204e. [DOI: 10.1097/prs.0000000000003320] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Rowan MP, Niece KL, Rizzo JA, Akers KS. Wound Penetration of Cefazolin, Ciprofloxacin, Piperacillin, Tazobactam, and Vancomycin During Negative Pressure Wound Therapy. Adv Wound Care (New Rochelle) 2017; 6:55-62. [PMID: 28224048 DOI: 10.1089/wound.2016.0698] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 08/05/2016] [Indexed: 12/16/2022] Open
Abstract
Objective: Negative pressure wound therapy (NPWT) uses subatmospheric pressure as a noninvasive adjunct to treat wounds and has demonstrated clinical efficacy by accelerating healing of a variety of acute and chronic wounds. NPWT may also play a role in preventing or treating wound infections, possibly by increasing wound penetration of antibiotics. However, clinical data in patients undergoing antibiotic and NPWT treatment are limited. Approach: To evaluate the wound penetration of antibiotics in NPWT patients, we conducted a prospective, observational study of burn and trauma patients treated with NPWT and systemic antibiotics. We evaluated the plasma pharmacokinetic profile of systemic vancomycin, ciprofloxacin, cefazolin, and piperacillin/tazobactam, as well as total and unbound antibiotic concentrations in wound exudate from the same patients. Results: Data from 32 patients with 37 wounds undergoing NPWT demonstrated that vancomycin, ciprofloxacin, and piperacillin/tazobactam all penetrated wounds with exudate to plasma concentration ratios more than 0.8. Cefazolin did not penetrate wounds in patients undergoing NPWT as effectively, with an average exudate to plasma concentration ratio of 0.51. Innovation: Clinical data on the wound penetration of antibiotics in patients undergoing NPWT are limited, but these data suggest that antibiotics have different capacities for wound penetration during NPWT that should be considered when making clinical decisions. Conclusion: This initial report suggests that (1) vancomycin, ciprofloxacin, and piperacillin/tazobactam effectively penetrate wounds during NPWT and (2) cefazolin as well as other antibiotics may not penetrate wounds during NPWT.
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Affiliation(s)
- Matthew P. Rowan
- United States Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
| | - Krista L. Niece
- United States Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
| | - Julie A. Rizzo
- United States Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Kevin S. Akers
- United States Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Infectious Disease Service, Department of Medicine, San Antonio Military Medical Center, JBSA Fort Sam Houston, Texas
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Staruch RMT, Glass GE, Rickard R, Hettiaratchy SP, Butler PEM. Injectable Pore-Forming Hydrogel Scaffolds for Complex Wound Tissue Engineering: Designing and Controlling Their Porosity and Mechanical Properties. TISSUE ENGINEERING PART B-REVIEWS 2016; 23:183-198. [PMID: 27824295 DOI: 10.1089/ten.teb.2016.0305] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Traumatic soft tissue wounds present a significant reconstructive challenge. The adoption of closed-circuit negative pressure wound therapy (NPWT) has enabled surgeons to temporize these wounds before reconstruction. Such systems use porous synthetic foam scaffolds as wound fillers at the interface between the negative pressure system and the wound bed. The idea of using a bespoke porous biomaterial that enhances wound healing, as filler for an NPWT system, is attractive as it circumvents concerns regarding reconstructive delay and the need for dressing changes that are features of the current systems. Porous foam biomaterials are mechanically robust and able to synthesize in situ. Hence, they exhibit potential to fulfill the niche for such a functionalized injectable material. Injectable scaffolds are currently in use for minimally invasive surgery, but the design parameters for large-volume expansive foams remain unclear. Potential platforms include hydrogel systems, (particularly superabsorbent, superporous, and nanocomposite systems), polyurethane-based moisture-cured foams, and high internal phase emulsion polymer systems. The aim of this review is to discuss the design parameters for such future biomaterials and review potential candidate materials for further research into this up and coming field.
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Affiliation(s)
- Robert M T Staruch
- 1 School of Engineering and Applied Sciences, Harvard University , Cambridge, Massachusetts
| | - Graeme E Glass
- 2 Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford , Oxford, United Kingdom
| | - Rory Rickard
- 3 Academic Department of Military Surgery and Trauma , ICT Business Park, Birmingham, United Kingdom
| | | | - Peter E M Butler
- 5 Department of Surgery and Interventional Sciences, The Royal Free Hospital, University College London , London, United Kingdom
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Harvin WH, Stannard JP. Negative-Pressure Wound Therapy in Acute Traumatic and Surgical Wounds in Orthopaedics. JBJS Rev 2016; 2:01874474-201404000-00004. [PMID: 27490869 DOI: 10.2106/jbjs.rvw.m.00087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- William H Harvin
- Department of Orthopaedic Surgery, University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, TX 77030
| | - James P Stannard
- Department of Orthopaedic Surgery, Missouri Orthopaedic Institute, 1100 Virginia Avenue, DC953.00, Columbia, MO 65212
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Anderson CA, Hare MA, Perdrizet GA. Wound Healing Devices Brief Vignettes. Adv Wound Care (New Rochelle) 2016; 5:185-190. [PMID: 27076996 DOI: 10.1089/wound.2015.0651] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Significance: The demand for wound care therapies is increasing. New wound care products and devices are marketed at a dizzying rate. Practitioners must make informed decisions about the use of medical devices for wound healing therapy. This paper provides updated evidence and recommendations based on a review of recent publications. Recent Advances: The published literature on the use of medical devices for wound healing continues to support the use of hyperbaric oxygen therapy, negative pressure wound therapy, and most recently electrical stimulation. Critical Issue: To inform wound healing practitioners of the evidence for or against the use of medical devices for wound healing. This information will aid the practitioner in deciding which technology should be accepted or rejected for clinical use. Future Directions: To produce high quality, randomized controlled trials or acquire outcome-based registry databases to further test and improve the knowledge base as it relates to the use of medical devices in wound care.
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Affiliation(s)
- Caesar A. Anderson
- Department of Emergency Medicine, Centers for Wound Healing and Hyperbaric Medicine, University of California, San Diego, San Diego, California
| | - Marc A. Hare
- Department of Emergency Medicine, Centers for Wound Healing and Hyperbaric Medicine, University of California, San Diego, San Diego, California
| | - George A. Perdrizet
- Department of Emergency Medicine, Centers for Wound Healing and Hyperbaric Medicine, University of California, San Diego, San Diego, California
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Holt R, Murphy J. PICO™ incision closure in oncoplastic breast surgery: a case series. Br J Hosp Med (Lond) 2015; 76:217-23. [PMID: 25853353 DOI: 10.12968/hmed.2015.76.4.217] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Single-use negative pressure wound therapy (PICO™) has been used on high-risk surgically incised wounds with encouraging results, but there is no evidence for its use in oncoplastic breast surgery. This article reports a case series with closed incisions in oncoplastic breast procedures following the introduction of PICO™.
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Affiliation(s)
- Rachel Holt
- ST8 Trainee in Plastic Surgery, University Hospital South Manchester NHS Foundation Trust, Manchester M23 9LT
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Kua EHJ, Tanri NP, Tan BK, Ng SW. Cryoinjury with compartment syndrome of bilateral hands secondary to Freon gas: a case report and review of current literature. EUROPEAN JOURNAL OF PLASTIC SURGERY 2015. [DOI: 10.1007/s00238-014-1017-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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