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Seretis K, Bounas N. Securing skin grafts: A network meta-analysis. J Plast Reconstr Aesthet Surg 2024; 96:146-157. [PMID: 39089211 DOI: 10.1016/j.bjps.2024.07.005] [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: 02/11/2024] [Revised: 05/11/2024] [Accepted: 07/08/2024] [Indexed: 08/03/2024]
Abstract
BACKGROUND Skin grafting is one of the most common procedures in plastic surgery. However, there are no defined guidelines for optimal fixation. The aim of this network meta-analysis (NMA) was to consolidate existing evidence by comparing various graft securing methods and determining the most effective approach for clinical practice. METHODS An NMA was conducted using a predetermined protocol after searching several electronic databases from inception to October 2023 for studies examining skin grafting fixation outcomes in adults. RESULTS A total of 27 studies were included in the analysis involving 1937 patients. Negative pressure wound therapy (NPWT) was the only method to significantly improve graft take percentages in comparison with the other modalities, whereas tie-over bolster (TOB) provided the worst results in take rates when examined as events. Fibrin glue (FIB) and TOB reduced hematoma and seroma rates when data were investigated in conjunction. CONCLUSIONS NPWT appears to be the most effective for skin graft adherence as opposed to traditional techniques. Its cost-effectiveness remains unclear, as NPWT is a relatively costly intervention compared with other methods. FIB and TOB are methods that can serve as a method of reducing hematoma and seroma rates in patients at high risk of bleeding. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Konstantinos Seretis
- Department of Plastic Surgery, Medical School, University of Ioannina, Ioannina, Greece.
| | - Nikolaos Bounas
- Department of Plastic Surgery, Medical School, University of Ioannina, Ioannina, Greece
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Wei P, Wu L, Xie H, Chen Z, Tan R, Xu Z. Application of a meshed artificial dermal scaffold and negative-pressure wound therapy in the treatment of full-thickness skin defects: a prospective in vivo study. Biomater Sci 2024; 12:1914-1923. [PMID: 38436071 DOI: 10.1039/d3bm01675g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Artificial dermal scaffolds (ADSs) have great value in repairing deep skin defects. However, problems such as unsatisfactory angiogenesis and local dropsy or empyema often occur, resulting in delayed or even failed wound healing. Negative pressure wound therapy (NPWT) is an effective therapy to promote wound healing or shorten wound bed preparation time. Studies on whether it can improve the effects of ADSs have never been interrupted, and no consensus has been reached. In this study, an improved ADS was prepared by mesh technology, physicochemical experiments were conducted, cell adhesion and proliferation were assessed with the meshed ADS, and in vivo experiments were conducted to investigate the effects of meshed ADS or ADS combined with NPWT in repairing full-thickness skin defects. The results showed that the meshed ADS showed through-layer channels arranged in parallel longitudinal and transverse intersections. The cell experiments confirmed the good cytocompatibility. The in vivo experiments showed that there were no differences in the take rate or contraction of grafted skin among all experiment groups. The meshed ADS exhibited good histocompatibility, and there were no differences in tissue inflammation, dermal angiogenesis, or degradation among all groups. In addition, necrosis, dropsy, or empyema of the dermal scaffold were found in all experiment groups except for the meshed ADS + NPWT group, which showed better wound repair results, including fewer scaffold-related complications and satisfactory skin graft survival and wound contraction. In conclusion, this novel meshed ADS, which has a regular through-layer mesh structure and possesses stable physicochemical properties and good biocompatibility, combined with NPWT can ensure adequate subdermal drainage and reduce the risk of scaffold-related complications, thereby improving the quality and efficiency of wound repair, promoting a broader application of biomaterials, and helping physicians and readers implement more effective wound management.
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Affiliation(s)
- Pei Wei
- Burn and Wound Repair Department, Fujian Medical University Union Hospital, Fuzhou 350001, China.
- Fujian Burn Institute, Fujian Medical University Union Hospital, Fuzhou 350001, China
- Fujian Provincial Key Laboratory of Burn and Trauma, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Lijiao Wu
- Department of Orthopedic Surgery, Fujian Provincial Hospital South Branch, Fuzhou 350001, China
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou 350001, China
| | - Hongteng Xie
- Burn and Wound Repair Department, Fujian Medical University Union Hospital, Fuzhou 350001, China.
- Fujian Burn Institute, Fujian Medical University Union Hospital, Fuzhou 350001, China
- Fujian Provincial Key Laboratory of Burn and Trauma, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Zhaohong Chen
- Burn and Wound Repair Department, Fujian Medical University Union Hospital, Fuzhou 350001, China.
- Fujian Burn Institute, Fujian Medical University Union Hospital, Fuzhou 350001, China
- Fujian Provincial Key Laboratory of Burn and Trauma, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Rongwei Tan
- GuangDong Engineering Technology Research Center of Implantable Medical Polymer, Shenzhen Lando Biomaterials Co., Ltd., Shenzhen 518107, China
| | - Zhaorong Xu
- Burn and Wound Repair Department, Fujian Medical University Union Hospital, Fuzhou 350001, China.
- Fujian Burn Institute, Fujian Medical University Union Hospital, Fuzhou 350001, China
- Fujian Provincial Key Laboratory of Burn and Trauma, Fujian Medical University Union Hospital, Fuzhou 350001, China
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Zhu J, Yan L, Hu R, Yang C, Wu M, An Y, Li S. Artificial dermis combined with negative pressure wound therapy and platelet-rich plasma to treat traumatic wounds: a retrospective study. J Wound Care 2024; 33:189-196. [PMID: 38451787 DOI: 10.12968/jowc.2024.33.3.189] [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: 03/09/2024]
Abstract
OBJECTIVE The reconstruction of complex soft tissue defects with exposure of bones and tendons represents an increasing challenge in wound care, especially in large extremity wounds. The aim of this study was to detect the clinical efficacy of combined use of negative pressure wound therapy (NPWT), artificial dermis (ADM), platelet-rich plasma (PRP) and split-thickness skin grafting (STSG) in the reconstruction of large traumatic extremity skin defects. METHOD In this study, eight cases were treated with combined therapies for repairing complex extremity wounds and the results were reviewed retrospectively. After surgical debridement, all wounds received ADM, PRP and delayed STSG, which were all aided with NPWT. RESULTS The patients consisted of five males and three females, with a mean age of 44 years. A total of six lower extremity wounds were located at the foot/ankle, with exposed tendon in five, bone exposure in three and both in two. Of the group, two patients had exposed tendon on arm/hand wounds. The size of wounds and ADM averaged 126cm2 and 42.3cm2, respectively. ADM was used to cover the exposed bone or tendon, the granulation and muscular tissue were covered with vacuum sealing drainage (VSD) directly, for NPWT. The survival rate of ADM averaged 98.9%. The average time for survival of ADM was 12.8 days and the mean uptake of autologous skin graft was 93.5%. Only one patient received repeated skin grafts. All patients achieved successful healing and reported no complications. The mean length of hospital stay was 36.1 days. CONCLUSION Our study revealed that ADM in conjunction with NPWT, PRP and STSG could be used for repairing large traumatic extremity wounds. Wound closure was achieved without flaps, the aesthetic and functional outcomes were acceptable, and only one patient developed a 35% loss of skin graft. DECLARATION OF INTEREST This work was supported by grants from the Natural Science Foundation of Hubei Province (grant no. 2020CFB464) and Youth Foundation of Wuhan Municipal Health Commission (grant no. WX20Q15). The authors have no conflicts of interest to declare.
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Affiliation(s)
- Jin Zhu
- Department of Orthopaedics, Wuhan Fourth Hospital, Wuhan, China
| | - Li Yan
- Department of Orthopaedics, Wuhan Fourth Hospital, Wuhan, China
| | - Rui Hu
- Department of Orthopaedics, Wuhan Fourth Hospital, Wuhan, China
| | - Chunbao Yang
- Department of Orthopaedics, Wuhan Fourth Hospital, Wuhan, China
| | - Mingzheng Wu
- Department of Orthopaedics, Wuhan Fourth Hospital, Wuhan, China
| | - Ying An
- Department of Orthopaedics, Wuhan Fourth Hospital, Wuhan, China
| | - Shanqing Li
- Department of Orthopaedics, Wuhan Fourth Hospital, Wuhan, China
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Lu Y, Zhao D, Cao G, Yin S, Liu C, Song R, Ma J, Sun R, Wu Z, Liu J, Wu P, Wang Y. Research progress on and molecular mechanism of vacuum sealing drainage in the treatment of diabetic foot ulcers. Front Surg 2024; 11:1265360. [PMID: 38464666 PMCID: PMC10920358 DOI: 10.3389/fsurg.2024.1265360] [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: 07/22/2023] [Accepted: 01/05/2024] [Indexed: 03/12/2024] Open
Abstract
Diabetic foot ulcers (DFUs) are common chronic wounds and a common complication of diabetes. The foot is the main site of diabetic ulcers, which involve small and medium-sized arteries, peripheral nerves, and microcirculation, among others. DFUs are prone to coinfections and affect many diabetic patients. In recent years, interdisciplinary research combining medicine and material science has been increasing and has achieved significant clinical therapeutic effects, and the application of vacuum sealing drainage (VSD) in the treatment of DFUs is a typical representative of this progress, but the mechanism of action remains unclear. In this review, we integrated bioinformatics and literature and found that ferroptosis is an important signaling pathway through which VSD promotes the healing of DFUs and that System Xc-GSH-GPX4 and NAD(P)H-CoQ10-FSP1 are important axes in this signaling pathway, and we speculate that VSD is most likely to inhibit ferroptosis to promote DFU healing through the above axes. In addition, we found that some classical pathways, such as the TNF, NF-κB, and Wnt/β-catenin pathways, are also involved in the VSD-mediated promotion of DFU healing. We also compiled and reviewed the progress from clinical studies on VSD, and this information provides a reference for the study of VSD in the treatment of DFUs.
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Affiliation(s)
- Yongpan Lu
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
- Jinan Clinical Research Center for Tissue Engineering Skin Regeneration and Wound Repair, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Dejie Zhao
- Department of Vascular Surgery, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Guoqi Cao
- Jinan Clinical Research Center for Tissue Engineering Skin Regeneration and Wound Repair, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Department of Plastic Surgery, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Siyuan Yin
- Jinan Clinical Research Center for Tissue Engineering Skin Regeneration and Wound Repair, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Department of Plastic Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Chunyan Liu
- Jinan Clinical Research Center for Tissue Engineering Skin Regeneration and Wound Repair, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Department of Plastic Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Ru Song
- Jinan Clinical Research Center for Tissue Engineering Skin Regeneration and Wound Repair, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Department of Plastic Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Jiaxu Ma
- Jinan Clinical Research Center for Tissue Engineering Skin Regeneration and Wound Repair, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Department of Plastic Surgery, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Rui Sun
- Jinan Clinical Research Center for Tissue Engineering Skin Regeneration and Wound Repair, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Department of Plastic Surgery, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Zhenjie Wu
- Jinan Clinical Research Center for Tissue Engineering Skin Regeneration and Wound Repair, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Department of Plastic Surgery, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Jian Liu
- Jinan Clinical Research Center for Tissue Engineering Skin Regeneration and Wound Repair, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Department of Plastic Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Peng Wu
- Jinan Clinical Research Center for Tissue Engineering Skin Regeneration and Wound Repair, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Department of Plastic Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Yibing Wang
- Jinan Clinical Research Center for Tissue Engineering Skin Regeneration and Wound Repair, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Department of Plastic Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
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Cao L, Zeng R, Sun K, Fan H. Ultrasound-guided percutaneous micro-drainage tube irrigation combined with high negative pressure tube drainage versus debridement with closed suction irrigation for treating deep surgical site infection after spinal surgery. Int Wound J 2023; 21:e14435. [PMID: 37878524 PMCID: PMC10828718 DOI: 10.1111/iwj.14435] [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: 09/01/2023] [Revised: 09/21/2023] [Accepted: 10/02/2023] [Indexed: 10/27/2023] Open
Abstract
It is difficult to avoid deep surgical site infection after spinal surgery. Debridement combined with closed suction irrigation (CSI) and other treatment methods lead to greater trauma and lower satisfaction. We developed a new method for the treatment of SSI, which has the advantages of less invasiveness and lower cost. The cohort of this retrospective study comprised 26 patients with SSI after undergoing spinal surgery in our hospital from August 2017 to March 2022. The patients were divided into CSI and microtube drainage group according to treatment methods. The durations of antibiotic use and hospital stay, hospitalization costs, and functional scores during follow-up were compared between the two groups. The only baseline characteristic that differed between the two groups was sex. Infection was controlled in both groups and there were no recurrences during follow-up. However, the length of hospital stay after the first operation and the total length of stay were significantly greater in the CSI group. Hospitalization costs and antibiotic costs were significantly higher in the CSI group. Additionally, the duration of intravenous antibiotic use was significantly longer in the CSI group. Both the CSI and microtube drainage groups had significantly improved of Short Form Health Survey (SF-36) scores 6 months postoperatively. However, 3 months postoperatively, SF-36 scores were significantly lower in the CSI group. Compared with debridement followed by CSI, percutaneous micro-drainage tube irrigation combined with high negative pressure tube drainage is a more efficient and economical means of treating SSI after spinal surgery.
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Affiliation(s)
- Le Cao
- Department of OrthopaedicsFuyang Hospital of Anhui Medical UniversityFuyangChina
| | - Ran Zeng
- Department of Intensive Care UnitFuyang Hospital of Anhui Medical UniversityFuyangChina
| | - Kai Sun
- Department of OrthopaedicsFuyang Hospital of Anhui Medical UniversityFuyangChina
| | - Haitao Fan
- Department of OrthopaedicsFuyang Hospital of Anhui Medical UniversityFuyangChina
- Department of OrthopaedicsThe First Affliated Hospital of Ningbo UniversityNingboChina
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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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Accelerated Angiogenesis of Human Umbilical Vein Endothelial Cells Under Negative Pressure Was Associated With the Regulation of Gene Expression Involved in the Proliferation and Migration. Ann Plast Surg 2022; 89:e51-e59. [DOI: 10.1097/sap.0000000000003298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Zhang S, Xie Y, Yan F, Zhang Y, Yang Z, Chen Z, Zhao Y, Huang Z, Cai L, Deng Z. Negative pressure wound therapy improves bone regeneration by promoting osteogenic differentiation via the AMPK-ULK1-autophagy axis. Autophagy 2022; 18:2229-2245. [PMID: 34964701 PMCID: PMC9466622 DOI: 10.1080/15548627.2021.2016231] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Deficient bone regeneration causes bone defects or nonunion in a substantial proportion of trauma patients that urges for novel therapies. To develop a reliable therapy, we investigated the effect of negative pressure wound therapy (NPWT) on bone regeneration in vivo in a rat calvarial defect model. Negative pressure (NP) treatment in vitro was mimicked to test its effect on osteoblast differentiation in rat mesenchymal stem cells (MSCs) and MC3T3-E1 cells. Transcriptomic analyses, pharmaceutical interventions, and shRNA knockdowns were conducted to explore the underlying mechanism and their clinical relevance was investigated in samples from patients with nonunion. The potential application of a combined therapy of MSCs in hydrogels with negative pressure was tested in the rat critical-size calvarial defect model. We found that NPWT promoted bone regeneration in vivo and NP treatment induced osteoblast differentiation in vitro. NP induced osteogenesis via activating macroautophagy/autophagy by AMPK-ULK1 signaling that was impaired in clinical samples from patients with nonunion. More importantly, the combined therapy involving MSCs in hydrogels with negative pressure significantly improved bone regeneration in rat critical-size calvarial defect model. Thus, our study identifies a novel AMPK-ULK1-autophagy axis by which negative pressure promotes osteoblast differentiation of MSCs and bone regeneration. NPWT treatment can potentially be adopted for therapy of bone defects.Abbreviations: ADP, adenosine diphosphate; AICAR/Aic, acadesine; ALP, alkaline phosphatase; ALPL, alkaline phosphatase, biomineralization associated; AMP, adenosine monophosphate; AMPK, AMP-activated protein kinase; ARS, alizarin red S staining; ATG7, autophagy related 7; ATP, adenosine triphosphate; BA1, bafilomycin A1; BGLAP/OCN, bone gamma-carboxyglutamate protein; BL, BL-918; BS, bone surface; BS/TV, bone surface per tissue volume; BV/TV, bone volume per tissue volume; C.C, compound C; CCN1, cellular communication network factor 1; COL1A1, collagen type I alpha 1 chain; COL4A3, collagen type IV alpha 3 chain; COL4A4, collagen type IV alpha 4 chain; COL18A1, collagen type XVIII alpha 1 chain; CQ, chloroquine; GelMA, gelatin methacryloyl hydrogel; GO, Gene Ontology; GSEA, gene set enrichment analysis; HIF1A, hypoxia inducible factor 1 subunit alpha; HPLC, high-performance liquid chromatography; ITGAM/CD11B, integrin subunit alpha M; ITGAX/CD11C, integrin subunit alpha X; ITGB1/CdD9, integrin subunit beta 1; KEGG, Kyoto Encyclopedia of Genes and Genomes; MAP1LC3B/LC3B, microtubule associated protein 1 light chain 3 beta; micro-CT, microcomputed tomography; MSCs, mesenchymal stem cells; MTOR, mechanistic target of rapamycin kinase; NP, negative pressure; NPWT, negative pressure wound therapy; PRKAA1/AMPKα1, protein kinase AMP-activated catalytic subunit alpha 1; PRKAA2, protein kinase AMP-activated catalytic subunit alpha 2; PTPRC/CD45, protein tyrosine phosphatase receptor type C; ROS, reactive oxygen species; RUNX2, RUNX family transcription factor 2; SBI, SBI-0206965; SPP1/OPN, secreted phosphoprotein 1; THY1/CD90, Thy-1 cell surface antigen; SQSTM1, sequestosome 1; TGFB3, transforming growth factor beta 3; ULK1/Atg1, unc-51 like autophagy activating kinase 1.
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Affiliation(s)
- Sheng Zhang
- Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
| | - Yuanlong Xie
- Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
| | - Feifei Yan
- Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
| | - Yufeng Zhang
- Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
| | - Zhiqiang Yang
- Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
| | - Zhe Chen
- Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
| | - Yong Zhao
- Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
| | - Zan Huang
- Department of Biochemistry in College of Life Sciences, Key Laboratory of Cell Hemostasis of Hubei Province, Wuhan University, Wuhan, Hubei, People’s Republic of China,Nhc Key Laboratory of Medical Embryogenesis and Developmental Molecular Biology, Shanghai Key Laboratory of Embryo and Reproduction Engineering, Shanghai Children’s Hospital, Shanghai, People’s Republic of China,CONTACT Zan Huang College of Life Sciences, Key Laboratory of Cell Hemostasis of Hubei Province, Wuhan University, No. 299 Bayi Road, Wuhan, Hubei430072, People’s Republic of China
| | - Lin Cai
- Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China,Lin Cai Department of Orthopedics, Zhongnan Hospital of Wuhan University, No. 163 Donghu Road, Wuhan, Hubei430071, People’s Republic of China
| | - Zhouming Deng
- Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China,Zhouming Deng Department of Orthopedics, Zhongnan Hospital of Wuhan University, No. 163 Donghu Road, Wuhan, Hubei430071, People’s Republic of China
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Shah S, Budania P, Shah A, Parmar U. Unique way of chest wall reconstruction using Integra Dermal Regeneration Template (IDRT) in a patient with post traumatic mucormycosis: A case report. Int J Surg Case Rep 2022; 95:107229. [PMID: 35617736 PMCID: PMC9133762 DOI: 10.1016/j.ijscr.2022.107229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/17/2022] [Accepted: 05/17/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Necrotizing soft tissue infections (NSTI) are caused by toxin-producing bacteria and fungi that results in rapid progression of disease with significant local tissue destruction. CASE PRESENTATION We present a case report of a 57-year-old male patient in line with the SCARE 2020 criteria. He was admitted to the emergency department with a small abrasion on the right antero-lateral chest wall, and a diffuse necrotic patch of skin and soft tissues with purulent discharge. CLINICAL DISCUSSION Clinical examination, routine blood investigations, CT scan chest, and chest x-ray were performed. Patient underwent debridement six times, followed by negative pressure wound therapy (NPWT). After negative culture report, Integra Meshed Dermal Regeneration Template (IMDRT), measuring 4 × 5 in. was applied and NPWT continued. The outer layer of IDRT was removed on Day 19. Split thickness skin grafting (STSG) was performed once neodermis formation was confirmed. NPWT was continued post skin grafting for a week. IDRT was successfully taken up over the raw area with exposed lung. Patient was discharged 10 days after STSG. The patient's condition improved remarkably and he was able to breathe normally. There was no puckering or tethering effect on the grafted area and not much fibrosis. He showed speedy recovery with healed donor site and 100% uptake of grafted tissue. CONCLUSION IDRT along with NPWT is an effective and useful technique for spontaneous regeneration of the dermis and basement membrane to promote wound healing in traumatic patients with NSTIs. LEVEL OF EVIDENCE Level V. STUDY TYPE Therapeutic.
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Affiliation(s)
- Sanjay Shah
- Consultant Trauma Surgeon and Head, Emergency Department, Apollo Hospitals International Ltd, Gandhinagar, Gujarat, India.
| | - Pushpa Budania
- Dept of General Surgery, Apollo Hospitals Int Ltd, Gandhinagar, Gujarat, India
| | - Akshay Shah
- Dept of General Surgery, Apollo Hospitals Int Ltd, Gandhinagar, Gujarat, India
| | - Uvaish Parmar
- Dept of General Surgery, Apollo Hospitals Int Ltd, Gandhinagar, Gujarat, India
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Abstract
Chronic skin wounds are commonly found in older individuals who have impaired circulation due to diabetes or are immobilized due to physical disability. Chronic wounds pose a severe burden to the health-care system and are likely to become increasingly prevalent in aging populations. Various treatment approaches exist to help the healing process, although the healed tissue does not generally recapitulate intact skin but rather forms a scar that has inferior mechanical properties and that lacks appendages such as hair or sweat glands. This article describes new experimental avenues for attempting to improve the regenerative response of skin using biophysical techniques as well as biochemical methods, in some cases by trying to harness the potential of stem cells, either endogenous to the host or provided exogenously, to regenerate the skin. These approaches primarily address the local wound environment and should likely be combined with other modalities to address regional and systemic disease, as well as social determinants of health. Expected final online publication date for the Annual Review of Biomedical Engineering, Volume 24 is June 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- François Berthiaume
- Department of Biomedical Engineering, Rutgers University, Piscataway, New Jersey, USA;
| | - Henry C Hsia
- Department of Surgery, Yale University School of Medicine, and Department of Biomedical Engineering, Yale University, New Haven, Connecticut, USA
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Dibbs RP, Depani M, Thornton JF. Technical Refinements with the Use of Biologic Healing Agents. Semin Plast Surg 2022; 36:8-16. [PMID: 35706558 PMCID: PMC9192159 DOI: 10.1055/s-0042-1742749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Soft tissue defects resulting from trauma, vascular disease, burns, and postoncologic resections require reconstructive surgery for appropriate wound coverage and support. Dermal substitutes have been applied to a vast array of reconstructive settings across nearly all anatomical areas with demonstrable success. However, they require meticulous handling and operative technical expertise to optimize management of these soft tissue defects. In this review, we will address three dermal substitutes, their operative techniques, and their surgical applications.
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Affiliation(s)
- Rami P. Dibbs
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas,Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Monal Depani
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - James F. Thornton
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas,Address for correspondence James F. Thornton, MD Department of Plastic Surgery, University of Texas Southwestern Medical Center1801 Inwood Road, Dallas, TX 75390
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12
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Chia-Jui H, Yu L, Jiang YQ, Tan W, Gao GM, Li HB, Han L. Negative pressure wound therapy, artificial skin and autogenous skin implantation in diabetic foot ulcers. J Wound Care 2022; 31:40-46. [PMID: 35077212 DOI: 10.12968/jowc.2022.31.1.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Diabetic foot ulcers (DFUs) are one of the most serious diabetic consequences, leading to amputations. Various therapies have been used to treat DFUs; however, a combination of negative pressure suction, artificial skin and autogenous skin implantation have never been investigated. This study aimed to evaluate the effectiveness of a novel three-step therapy protocol using negative pressure wound therapy (NPWT), artificial skin and autogenous skin implantation in patients with DFUs. METHOD At a single tertiary university hospital between 2015 and 2018, the three-step therapy protocol was applied to patients with DFUs and its safety and efficacy was investigated. RESULTS A total of 21 patients took part in the study. The majority of the patients were female (62%), with a mean age of 65 years and a mean body mass index of 21kg/m2. A third (n=7) of operative sites experienced minor complications, with two requiring re-operation. At a median follow up of 24 months, the average time of complete wound healing was 46 days, and the wound healing rate was 71%. The first-stage wound healing rate was 90%. All patients had achieved remission without any further recurrence of disease. CONCLUSION This comprehensive surgical technique for managing DFUs achieved a high local cure rate, minimal functional morbidity, and acceptable wound complication rates. The three-step therapy protocol has the potential to promote the healing process of DFUs, which is expected to serve as a new method for the treatment and cure of DFUs.
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Affiliation(s)
- Hu Chia-Jui
- Department of Orthopedics, Xiamen ChangGung Hospital, Xiamen City, Fujian Province, China
| | - Lai Yu
- Department of Orthopedics, Xiamen ChangGung Hospital, Xiamen City, Fujian Province, China
| | - Yu-Qing Jiang
- Department of Orthopedics, Xiamen ChangGung Hospital, Xiamen City, Fujian Province, China
| | - Wen Tan
- Department of Orthopedics, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou City, Jiangsu Province, China
| | - Gong-Ming Gao
- Department of Orthopedics, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou City, Jiangsu Province, China
| | - Hai-Bo Li
- Department of Orthopedics, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou City, Jiangsu Province, China
| | - Long Han
- Department of Orthopedics, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou City, Jiangsu Province, China
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13
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Patel BJ, Asher CM, Bystrzonowski N, Healy C. Safeguarding Skin Grafts: An Evidence-Based Summary of Fixation Techniques. Ann Plast Surg 2021; 87:e180-e188. [PMID: 34117134 DOI: 10.1097/sap.0000000000002937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Effective skin graft fixation is vital in preventing sheering forces, seroma, and hematoma from compromising graft take. Yet, selecting the ideal technique for securing skin grafts remains a contentious subject, with significant variation in practice existing between surgeons. There is, therefore, benefit to be derived from assessing the literature for evidence-based recommendations to guide the decision-making process. METHODS A search of Medline and Embase was performed using appropriate key terms, yielding 419 articles. Reference lists were analyzed. Inclusion and exclusion criteria were composed. Level I to III studies, as defined by the Centre for Evidence-Based Medicine, that compared skin graft fixation methods were analyzed. Rayyan QCRI was used for abstract and title screening. After full text screening, 41 studies were included for qualitative analysis. All included randomized control trials (RCTs) were assessed for risk of bias using the Cochrane Risk-of-Bias 2 (ROB2) tool. RESULTS We identified 4 groups of fixation technique: "tie-over bolster" (TOB), "no TOB," "adhesive glues," and "negative pressure wound therapy" (NPWT). Twelve studies compared TOB with no TOB, with no difference in graft take demonstrated. Sixteen studies compared adhesive glues with traditional methods, with no difference in graft take demonstrated. Thirteen studies compared NPWT with traditional methods, with enhanced graft take demonstrated. Risk of bias was deemed low in 1 of 13 RCTs. CONCLUSIONS Based on the current evidence, only NPWT is associated with enhanced graft take. However, there is a scarcity of robust level I evidence comparing different fixation techniques, meaning that strong recommendations cannot be made. We propose examples of hypothesis-driven RCTs, in predetermined clinical settings, based on the theoretical benefits of the techniques that would add value to clinical practice.
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Affiliation(s)
- Benjamin J Patel
- From the Department of Plastic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
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14
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The Combined Use of Negative-Pressure Wound Therapy and Dermal Substitutes for Tissue Repair and Regeneration. BIOMED RESEARCH INTERNATIONAL 2020; 2020:8824737. [PMID: 33344649 PMCID: PMC7732395 DOI: 10.1155/2020/8824737] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/04/2020] [Accepted: 11/29/2020] [Indexed: 11/18/2022]
Abstract
In clinical practice, skin defects occur frequently due to various kinds of acute and chronic diseases. The standard treatment for these wounds is autografting, which usually results in complications such as scar formation and new wounds at donor sites. The advent of dermal substitutes has provided a novel method for wound repair, and rapid angiogenesis of the dermal substitutes is crucial for the graft to take. At present, many strategies have been developed to improve the process of vascularisation, some of which have shown promising potentials, but they could be very far from clinical applications. Most recently, negative-pressure wound therapy (NPWT) has been used extensively in clinical practice for wound care and management. It has been reported that NPWT reduces the time required for vascular ingrowth into the dermal substitute and improves graft take, indicating great potentials for wound repair. This article presents a comprehensive overview of the combined use of NPWT and dermal substitutes for tissue repair and regeneration. Relative concerns and prospects are also discussed.
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15
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Gkotsoulias E. Split Thickness Skin Graft of the Foot and Ankle Bolstered With Negative Pressure Wound Therapy in a Diabetic Population: The Results of a Retrospective Review and Review of the Literature. Foot Ankle Spec 2020; 13:383-391. [PMID: 31370687 PMCID: PMC7493201 DOI: 10.1177/1938640019863267] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Split thickness skin graft (STSG) is a versatile procedure performed for the treatment of wounds resulting from varying pathology. This remains very useful because of its ability for quick healing and low complication rate. The surface of the foot and ankle is an area frequently affected by severe skin and soft tissue structure infections (SSTIs) whose treatment results in wounds. These infections and resultant surgical wounds are commonly seen patients with diabetes. The objective of the present study was to retrospectively evaluate initial healing and immediate post-operative outcomes following STSG application in a diabetic population when negative pressure wound therapy (NPWT) was used as a bolster. Ten patients were identified, including 11 surgical wounds, who underwent STSG bolstered with NPWT from January 2016 to October 2018. Mean follow-up was 13 months (range 1-33 months) with an average time to heal of 17 days (range 14-30 days) for 11 surgical wounds averaging 57 cm2 (range 6.3 - 91 cm2). Consistent improved outcomes have been demonstrated when compared to alternative bolstering techniques available in the literature making a STSG bolstered with NPWT a powerful tool in the reconstruction of diabetic foot wounds resulting from the treatment of infection.Levels of Evidence: Level IV.
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16
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Yoshino D, Funamoto K, Sato K, Kenry, Sato M, Lim CT. Hydrostatic pressure promotes endothelial tube formation through aquaporin 1 and Ras-ERK signaling. Commun Biol 2020; 3:152. [PMID: 32242084 PMCID: PMC7118103 DOI: 10.1038/s42003-020-0881-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 03/11/2020] [Indexed: 02/07/2023] Open
Abstract
Vascular tubulogenesis is tightly linked with physiological and pathological events in the living body. Endothelial cells (ECs), which are constantly exposed to hemodynamic forces, play a key role in tubulogenesis. Hydrostatic pressure in particular has been shown to elicit biophysical and biochemical responses leading to EC-mediated tubulogenesis. However, the relationship between tubulogenesis and hydrostatic pressure remains to be elucidated. Here, we propose a specific mechanism through which hydrostatic pressure promotes tubulogenesis. We show that pressure exposure transiently activates the Ras/extracellular signal-regulated kinase (ERK) pathway in ECs, inducing endothelial tubulogenic responses. Water efflux through aquaporin 1 and activation of protein kinase C via specific G protein–coupled receptors are essential to the pressure-induced transient activation of the Ras/ERK pathway. Our approach could provide a basis for elucidating the mechanopathology of tubulogenesis-related diseases and the development of mechanotherapies for improving human health. Yoshino et al. investigate the mechanism by which exposure to pressure promotes endothelial cells to form tubes and find that Aquaporin-mediated water efflux activates the Ras-ERK pathway via PKC and GPCR activation. These findings may be relevant to understand how blood pressure affects vascular tubulogenesis.
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Affiliation(s)
- Daisuke Yoshino
- Frontier Research Institute for Interdisciplinary Sciences, Tohoku University, 6-3 Aramaki-Aoba, Aoba-ku, Sendai, 980-8578, Japan. .,Mechanobiology Institute, National University of Singapore, #10-01 T-Lab, 5A Engineering Drive 1, Singapore, 117411, Singapore. .,Institute of Fluid Science, Tohoku University, 2-1-1 Katahira, Aoba-ku, Sendai, 980-8577, Japan. .,Institute of Engineering, Tokyo University of Agriculture and Technology, 2-24-16 Naka-cho, Koganei, Tokyo, 184-8588, Japan.
| | - Kenichi Funamoto
- Frontier Research Institute for Interdisciplinary Sciences, Tohoku University, 6-3 Aramaki-Aoba, Aoba-ku, Sendai, 980-8578, Japan.,Institute of Fluid Science, Tohoku University, 2-1-1 Katahira, Aoba-ku, Sendai, 980-8577, Japan
| | - Kakeru Sato
- Graduate School of Engineering, Tohoku University, 6-6-01 Aramaki-Aoba, Aoba-ku, Sendai, 980-8579, Japan.,Tokyo Gas Co., Ltd., 1-5-20 Kaigan, Minato-ku, Tokyo, 105-8527, Japan
| | - Kenry
- Department of Biomedical Engineering, National University of Singapore, 4 Engineering Drive 3, Singapore, 117583, Singapore
| | - Masaaki Sato
- Frontier Research Institute for Interdisciplinary Sciences, Tohoku University, 6-3 Aramaki-Aoba, Aoba-ku, Sendai, 980-8578, Japan
| | - Chwee Teck Lim
- Mechanobiology Institute, National University of Singapore, #10-01 T-Lab, 5A Engineering Drive 1, Singapore, 117411, Singapore. .,Department of Biomedical Engineering, National University of Singapore, 4 Engineering Drive 3, Singapore, 117583, Singapore. .,Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, #14-01 MD6, 14 Medical Drive, Singapore, 117599, Singapore.
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17
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Effects of intermittent negative pressure and active recovery therapies in the post-match period in elite soccer players: A randomized, parallel arm, comparative study. BIOMEDICAL HUMAN KINETICS 2020. [DOI: 10.2478/bhk-2020-0008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Summary
Study aim: This study compared the effects of intermittent negative pressure therapy (INPT) vs. active recovery therapy (ART) on post-match physiological parameters such as serum CK level and skin temperature of the lower limbs in elite soccer players.
Material and methods: Twenty healthy male professional soccer players from a Brazilian first division soccer club were enrolled in this randomized, parallel arm, open label, comparative study. After participating in 2 soccer matches, they were randomly assigned to two groups (n = 10) to receive a 30-min session of INPT (intermittent exchange of hypobaric pressure range 33 to 51 mmHg) or ART (self-myofascial release, mobility and stability exercises, and cycle ergometer exercise). The intervention was conducted after a match with assessments immediately before and after the intervention and again 24 h after the intervention.
Results: A significant interaction effect (F2,36 = 4.503, p = 0.018, η2 = 0.130) was observed, indicating that the decrease of CK from pre-intervention to 24 h post-intervention was greater in the INPT than in the ART group. Lower limb skin temperature was significantly lower after INPT than after ART (p < 0.003).
Conclusions: Serum CK level and skin temperature of lower limbs showed better recovery up to 24 h after the intervention with INPT in elite soccer players.
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18
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Single-stage Composite Skin Reconstruction Using a Dermal Regeneration Template. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2622. [PMID: 32309075 PMCID: PMC7159934 DOI: 10.1097/gox.0000000000002622] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 12/02/2019] [Indexed: 12/03/2022]
Abstract
Background: Composite reconstruction with a dermal substitute followed by skin graft is sometimes used for reconstructing high-quality skin while preserving donor sites. This often necessitates 2 separate procedures, additional general anesthetic, and longer hospitalization. Concurrent use of dermal substitutes and skin graft in a single stage has been previously reported in small series. Here, we report our experience with single-stage skin reconstruction with Integra and split-thickness skin graft for coverage of wounds post burn eschar excision and post burn scar contracture release. Methods: This is a retrospective review of consecutive operations from 2013 to 2017 in which single-stage bilayer reconstruction (SSBR) was performed. Data were obtained from electronic medical records and perioperative photographs. Results: In this 5-year period, 13 surgical sites were identified in which SSBR was used in 8 subjects. Average and median graft take was 86.2% and 95%, respectively. Graft take was over 90% in 10 out of 13 cases. One case required regrafting after initial graft failure. Conclusions: In the appropriate setting, SSBR is a practical technique in covering wounds post burn eschar excision and post burn scar contracture release resulting in reasonable graft take. Use of noncontaminated wound beds is crucial. Although there is risk of regrafting, it is not clear whether this risk is any higher than in split-thickness skin grafting alone. This study was unable to evaluate contribution of dermal substitute to contraction, function, and mobility, nor how hypothesized improvement of skin quality compares to the original thick dermal substitute. We recommend further investigation.
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19
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Vana LPM, Battlehner CN, Ferreira MA, Caldini EG, Gemperli R, Alonso N. Comparative long-term study between two dermal regeneration templates for the reconstruction of burn scar contractures in humans: Clinical and histological results. Burns 2019; 46:596-608. [PMID: 31645293 DOI: 10.1016/j.burns.2019.09.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 08/15/2019] [Accepted: 09/14/2019] [Indexed: 01/14/2023]
Abstract
The advent of dermal regeneration templates has fostered major advances in the treatment of acute burns and their sequelae, in the last three decades. Both data on morphological aspects of the newly-formed tissue, and clinical trials comparing different templates, are few. The goal of this study was to prospectively analyze the outcome of randomized patients treated with two of the existing templates, followed by thin skin autograft. They are both 2 mm-thick bovine collagen templates (Matriderm® and Integra®), the latter includes a superficial silicone layer. Surgery was performed on patients with impaired mobility resulting from burn sequelae (n = 12 per template) in a two-step procedure. Negative pressure therapy was applied after surgery; patients were monitored for 12 months. No intra or postoperative complications were observed. Data on scar skin quality (Vancouver scar scale), rate of mobility recovery, and graft contraction were recorded; as well as morphological analyses at light microscopical level. Improvement in mobility and skin quality were demonstrated along with graft contraction, in all patients. The double layer template showed the best performance in retraction rate, skin quality and mobility recovery. The subepidermal newly-formed connective tissue showed no histoarchitectural differences between the templates. The double layer template was not absorbed up to 12 months after placement.
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Affiliation(s)
- Luiz Philipe Molina Vana
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, BR. Divisao de Cirurgia Plastica e Queimaduras.
| | - Cláudia Naves Battlehner
- Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, BR. Laboratorio de Biologia Celular, LIM59, Departamento de Patologia
| | - Marcelo Alves Ferreira
- Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, BR. Laboratorio de Biologia Celular, LIM59, Departamento de Patologia
| | - Elia Garcia Caldini
- Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, BR. Laboratorio de Biologia Celular, LIM59, Departamento de Patologia
| | - Rolf Gemperli
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, BR. Divisao de Cirurgia Plastica e Queimaduras
| | - Nivaldo Alonso
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, BR. Divisao de Cirurgia Plastica e Queimaduras
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20
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Yoshino D, Sato M. Early-Stage Dynamics in Vascular Endothelial Cells Exposed to Hydrostatic Pressure. J Biomech Eng 2019; 141:2736603. [DOI: 10.1115/1.4044046] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Indexed: 12/21/2022]
Abstract
Blood pressure is an important factor both in maintaining body homeostasis and in its disruption. Vascular endothelial cells (ECs) are exposed to varying degrees of blood pressure and therefore play an important role in these physiological and pathological events. However, the effect of blood pressure on EC functions remains to be elucidated. In particular, we do not know how ECs sense and respond to changes in hydrostatic pressure even though the hydrostatic pressure is known to affect the EC functions. Here, we hypothesized that the cellular responses, leading to the reported pressure effects, occur at an early stage of pressure exposure and observed the early-stage dynamics in ECs to elucidate mechanisms through which ECs sense and respond to hydrostatic pressure. We found that exposure to hydrostatic pressure causes an early actomyosin-mediated contraction of ECs without a change in cell morphology. This response could be caused by water efflux from the ECs following exposure to hydrostatic pressure. Although only a limited study, these findings do explain a part of the mechanism through which ECs sense and respond to hydrostatic pressure.
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Affiliation(s)
- Daisuke Yoshino
- Frontier Research Institute for Interdisciplinary Sciences, Tohoku University, 6-3 Aramaki-Aoba, Aoba, Sendai 980-8578, Japan e-mail:
| | - Masaaki Sato
- Frontier Research Institute for Interdisciplinary Sciences, Tohoku University, 6-3 Aramaki-Aoba, Aoba, Sendai 980-8578, Japan
- Professor Emeritus Tohoku University, 2-1-1 Katahira, Aoba, Sendai 980-8577, Japan e-mail:
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21
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Liu S, Tao R, Wang M, Tian J, Genin GM, Lu TJ, Xu F. Regulation of Cell Behavior by Hydrostatic Pressure. APPLIED MECHANICS REVIEWS 2019; 71:0408031-4080313. [PMID: 31700195 PMCID: PMC6808007 DOI: 10.1115/1.4043947] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 05/18/2019] [Indexed: 06/10/2023]
Abstract
Hydrostatic pressure (HP) regulates diverse cell behaviors including differentiation, migration, apoptosis, and proliferation. Abnormal HP is associated with pathologies including glaucoma and hypertensive fibrotic remodeling. In this review, recent advances in quantifying and predicting how cells respond to HP across several tissue systems are presented, including tissues of the brain, eye, vasculature and bladder, as well as articular cartilage. Finally, some promising directions on the study of cell behaviors regulated by HP are proposed.
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Affiliation(s)
- Shaobao Liu
- State Key Laboratory of Mechanics andControl of Mechanical Structures,
Nanjing University of Aeronautics and Astronautics,
Nanjing 210016, China
- The Key Laboratory of Biomedical InformationEngineering of Ministry of Education,
School of Life Science and Technology,
Xi'an Jiaotong University,
Xi'an 710049, China
- Department of Biomedical Engineering,Bioinspired Engineering and Biomechanics Center (BEBC),
Xi'an Jiaotong University,
Xi'an 710049, China
| | - Ru Tao
- The Key Laboratory of Biomedical InformationEngineering of Ministry of Education,
School of Life Science and Technology,
Xi'an Jiaotong University,
Xi'an 710049, China
- Department of Biomedical Engineering,Bioinspired Engineering and Biomechanics Center (BEBC),
Xi'an Jiaotong University,
Xi'an 710049, China
| | - Ming Wang
- The Key Laboratory of Biomedical InformationEngineering of Ministry of Education,
School of Life Science and Technology,
Xi'an Jiaotong University,
Xi'an 710049, China
- Department of Biomedical Engineering,Bioinspired Engineering and Biomechanics Center (BEBC),
Xi'an Jiaotong University,
Xi'an 710049, China
| | - Jin Tian
- Department of Biomedical Engineering,Bioinspired Engineering and Biomechanics Center (BEBC),
Xi'an Jiaotong University,
Xi'an 710049, China
- State Key Laboratory for Strength andVibration of Mechanical Structures,
Xi'an Jiaotong University,
Xi'an 710049, China
| | - Guy M. Genin
- The Key Laboratory of Biomedical Information
Engineering of Ministry of Education,
School of Life Science and Technology,
Xi'an Jiaotong University,
Xi'an 710049, China
- Department of Biomedical Engineering,Bioinspired Engineering and Biomechanics Center (BEBC),
Xi'an Jiaotong University,
Xi'an 710049, China
- Department of Mechanical Engineering &
Materials Science,
National Science Foundation Science and
Technology Center for Engineering Mechanobiology,
Washington University,
St. Louis, MO 63130
| | - Tian Jian Lu
- State Key Laboratory of Mechanics andControl of Mechanical Structures,
Nanjing University of Aeronautics and Astronautics,
Nanjing 210016, China
- Department of Structural Engineering & Mechanics,
Nanjing Center for Multifunctional LightweightMaterials and Structures,
Nanjing University of Aeronautics and Astronautics,
Nanjing 21006, China;
State Key Laboratory for Strength andVibration of Mechanical Structures,
Xi'an Jiaotong University,
Xi'an 710049, China
| | - Feng Xu
- The Key Laboratory of Biomedical InformationEngineering of Ministry of Education,
School of Life Science and Technology,
Xi'an Jiaotong University,
Xi'an 710049, China
- Department of Biomedical Engineering,Bioinspired Engineering and Biomechanics Center (BEBC),
Xi'an Jiaotong University,
Xi'an 710049, China
e-mail:
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22
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Shine J, Efanov JI, Paek L, Coeugniet É, Danino MA, Izadpanah A. Negative pressure wound therapy as a definitive treatment for upper extremity wound defects: A systematic review. Int Wound J 2019; 16:960-967. [PMID: 30950218 DOI: 10.1111/iwj.13128] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 03/18/2019] [Accepted: 03/19/2019] [Indexed: 12/14/2022] Open
Abstract
Negative pressure wound therapy (NPWT) represents one of the many solutions for complex wounds of the upper extremity. The goal of this study was to investigate the most common indications for definitive treatment of wound defects in the upper extremity with NPWT and to report revision surgery outcomes after its use. A systematic review of the literature was performed. The following keywords and their combinations were used: "upper extremity," "arm," "forearm," "wrist," "hand," "finger" AND "negative-pressure wound therapy," "VAC therapy," "vacuum assisted closure." A total of 45 articles were included, regrouping 404 cases of NPWT in the upper extremity. The forearm was involved in 53% of cases, followed by hand (36%), fingers (10%), and arm (1%). Seventeen different indications were cited, the most common of which were radial forearm flap reconstruction (23%), burn wounds (18%), and compartment syndromes (17%). Of the cases, 90% did not require any subsequent surgical procedure, as opposed to 6% considered partial failures requiring minor revisions and 4% total failures requiring major revisions. Closure of radial forearm flap donor site required the most revision procedures when treated with NPWT. NPWT can be used for several indications pertaining to the reconstruction of the upper extremity. Positive outcomes as a definitive treatment are demonstrated in this systematic review, which reaffirms NPWT as a potent tool for reconstructive endeavours.
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Affiliation(s)
- Julien Shine
- Plastic and Reconstructive Surgery Service, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Johnny I Efanov
- Plastic and Reconstructive Surgery Service, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Laurence Paek
- Plastic and Reconstructive Surgery Service, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Édouard Coeugniet
- Plastic and Reconstructive Surgery Service, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Michel A Danino
- Plastic and Reconstructive Surgery Service, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Ali Izadpanah
- Plastic and Reconstructive Surgery Service, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
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23
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Staged Treatment of Chest Wall Radiation-Induced Ulcer With Negative Pressure Wound Therapy and Latissimus Dorsi Myocutaneous Flap Transplantation. J Craniofac Surg 2019; 30:e450-e453. [DOI: 10.1097/scs.0000000000005514] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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24
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Asif M, Ebrahim S, Major M, Caffrey J. The use of Integra TM as a novel technique in deep burn foot management. JPRAS Open 2018; 17:15-20. [PMID: 32158826 PMCID: PMC7061667 DOI: 10.1016/j.jpra.2018.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 04/22/2018] [Accepted: 04/29/2018] [Indexed: 01/10/2023] Open
Abstract
Deep burns in patients with co-morbidities carry a significant challenge for surgeons. The use of synthetic skin substitutes has played an increasingly important role in tissue reconstruction. IntegraTM is an artificial dermal substitute that allows temporary coverage after burn excision. The main advantages of this bi-layered template are its immediate availability, optimal scarring and decreased requirement for donor tissue. However, the downsides are the requirement for complex wound care, risk of infection and two stage procedure that can be both costly and prolong the stay in hospital. Here, we present the case of a patient with deep burns to the plantar aspect of both feet. Given the patient's medical history of diabetes, hypertension and peripheral neuropathy, we elected to use IntegraTM in combination with negative pressure wound therapy. Three weeks after the application of the IntegraTM matrix, the surface layer was replaced with autograft. At discharge, the patient was fully ambulatory and six months post-operatively this status was maintained without significant graft breakdown. To the best of our knowledge, the use of IntegraTM and split thickness skin graft in the management of full thickness burns to the plantar aspect of the feet has not been reported previously. Overall, our experience with IntegraTM in this setting was found to be satisfactory and can be considered as a promising treatment option in acute burn resurfacing.
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Tarassoli SP, Jessop ZM, Al-Sabah A, Gao N, Whitaker S, Doak S, Whitaker IS. Skin tissue engineering using 3D bioprinting: An evolving research field. J Plast Reconstr Aesthet Surg 2017; 71:615-623. [PMID: 29306639 DOI: 10.1016/j.bjps.2017.12.006] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 10/23/2017] [Accepted: 12/05/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Commercially available tissue engineered skin remains elusive despite extensive research because the multi-stratified anisotropic structure is difficult to replicate in vitro using traditional tissue engineering techniques. Bioprinting, involving computer-controlled deposition of cells and scaffolds into spatially controlled patterns, is able to control not only the macro but also micro and nanoarchitecture and could offer the potential to more faithfully replicate native skin. METHODS We conducted a literature review using PubMed, EMBASE and Web of Science for studies on skin 3D bioprinting between 2009 and 2016, evaluating the bioprinting technique, cell source, scaffold type and in vitro and in vivo outcomes. RESULTS We outline the evolution of biological skin replacements, principles of bioprinting and how they apply to the skin tissue engineering field, potential clinical applications as well the current limitations and future avenues for research. Of the studies analysed, the most common types of bioinks consisted of keratinocytes and fibroblasts combined with collagen, although stem cells are gaining increasing recognition. Laser assisted deposition was the most common printing modality, although ink-jet and pneumatic extrusion have also been tested. Bioprinted skin promoted accelerated wound healing, was able to mimic stratified epidermis but not the thick, elastic, vascular dermis. CONCLUSIONS Although 3D bioprinting shows promise in engineering skin, evidenced by large collective investments from the cosmetic industry, the research is still in its infancy. The resolution, vascularity, optimal cell and scaffold combinations and cost of bioprinted skin are hurdles that need to be overcome before the clinical applicability can be realised. Small scale 3D skin tissue models for cosmetics, drug and toxicity testing as well as tumour modelling are likely to be translated first before we see this technology used in reconstructive surgery patients.
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Affiliation(s)
- Sam P Tarassoli
- Reconstructive Surgery & Regenerative Medicine Research Group, Institute of Life Science, Swansea University Medical School, Swansea, UK
| | - Zita M Jessop
- Reconstructive Surgery & Regenerative Medicine Research Group, Institute of Life Science, Swansea University Medical School, Swansea, UK; Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
| | - Ayesha Al-Sabah
- Reconstructive Surgery & Regenerative Medicine Research Group, Institute of Life Science, Swansea University Medical School, Swansea, UK
| | - Neng Gao
- Reconstructive Surgery & Regenerative Medicine Research Group, Institute of Life Science, Swansea University Medical School, Swansea, UK
| | - Sairan Whitaker
- Department of Dermatology, Royal Gwent Hospital, Newport, UK
| | - Shareen Doak
- In Vitro Toxicology Research Group, Swansea University Medical School, Swansea, UK
| | - Iain S Whitaker
- Reconstructive Surgery & Regenerative Medicine Research Group, Institute of Life Science, Swansea University Medical School, Swansea, UK; Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK.
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Dong JY, Song F, Qing C, Lu SL. Histomorphological observation of surgical debridement combined with negative pressure therapy in treatment of diabetic foot. Chin J Traumatol 2017; 20:202-206. [PMID: 28526612 PMCID: PMC5555242 DOI: 10.1016/j.cjtee.2016.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 02/09/2017] [Accepted: 02/12/2017] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To further study the mechanism of epithelization on the fascia side of the flap after surgical incision and the treatment of the negative pressure therapy. METHODS With the patients' informed consent, parts of tissue samples were obtained from a 51-year-old diabetic patient who was suffering lower extremity ulcers. The samples were processed with hematoxylin and eosin (HE) staining and Masson trichrome staining. The keratin 19, keratin 15 and carcino-embryonic antigen (CEA) were immunohistochemically detected. RESULTS The results of HE staining showed that the specimen was divided into two regions, newborn area and original epithelial area. There were more inflammatory cells infiltrating in the dermis in the newborn epithelial area, compared with the original epithelial area. Cells in newborn epithelial area were more active and many dinuclear and polynuclear cells were observed in newborn epithelial area. But there were more cuticular layers and obvious rete pegs in original epithelial area. In addition, the cells with keratin 19 and CEA positive were found around hair follicle, while keratin 15 was negative. Masson trichrome staining showed that there was a lot of de novo collagen in newborn epithelial area. CONCLUSION Epidermal cells on the fascia side of the flap could be derived from the stem cells. Negative pressure wound therapy would attract not only cells but also other elements such as growth factors, cytokines, some nutrients and extracellular matrix. With the formation of the appropriate microenvironment after debridement, the migrated cells can grow, differentiate and spread, eventually leading to the epithelization on the fascia side of the flap in diabetic foot.
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Acceleration of tendon-bone healing of anterior cruciate ligament graft using intermittent negative pressure in rabbits. J Orthop Surg Res 2017; 12:60. [PMID: 28420425 PMCID: PMC5395760 DOI: 10.1186/s13018-017-0561-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 04/03/2017] [Indexed: 12/14/2022] Open
Abstract
Background The purpose of this study was to test effects of negative pressure on tendon–bone healing after reconstruction of anterior cruciate ligament (ACL) in rabbits. Methods Hind legs of 24 New Zealand White rabbits were randomly selected as negative pressure group and the contralateral hind legs as control. Reconstruction of the ACL was done. Joints of the negative pressure side were placed with drainage tubes connecting the micro-negative pressure aspirator. Control side was placed with ordinary drainage tubes. Drainage tubes on both sides were removed at the same time 5 days after operation. After 6 weeks, joint fluid was drawn to detect the expression levels of interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α); at the same time, femur–ligament–tibia complex was obtained to determine tendon graft tension and to observe the histomorphology, blood vessels of the tendon–bone interface, and expression of vascular endothelial growth factor (VEGF). Results The maximum load breakage of tendon graft was significantly greater in the negative pressure group than in the control group (P < 0.05). Histological studies of the tendon–bone interface found that there was more new bone formation containing chondroid cells and aligned connective tissue in the negative pressure group than in the control group. Expression of VEGF was higher in the negative pressure group than in the control group (P < 0.01). Content of IL-1β and TNF-α in synovial fluid is lower in the negative pressure group than in the control group (P < 0.01). Conclusions Intermittent negative pressure plays an active role in tendon–bone healing and creeping substitution of ACL reconstruction in the rabbits.
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Liu J, Hu F, Tang J, Tang S, Xia K, Wu S, Yin C, Wang S, He Q, Xie H, Zhou J. Homemade-device-induced negative pressure promotes wound healing more efficiently than VSD-induced positive pressure by regulating inflammation, proliferation and remodeling. Int J Mol Med 2017; 39:879-888. [PMID: 28290607 PMCID: PMC5360422 DOI: 10.3892/ijmm.2017.2919] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 02/22/2017] [Indexed: 02/05/2023] Open
Abstract
Vacuum sealing drainage (VSD) is an effective technique used to promote wound healing. However, recent studies have shown that it exerts positive pressure (PP) rather than negative pressure (NP) on skin. In this study, we created a homemade device that could maintain NP on the wound, and compared the therapeutic effects of VSD-induced PP to those of our homemade device which induced NP on wound healing. The NP induced by our device required less time for wound healing and decreased the wound area more efficiently than the PP induced by VSD. NP and PP both promoted the inflammatory response by upregulating neutrophil infiltration and interleukin (IL)‑1β expression, and downregulating IL‑10 expression. Higher levels of epidermal growth factor (EGF), transforming growth factor (TGF)‑β and platelet-derived growth factor (PDGF), and lower levels of basic fibroblast growth factor (bFGF) were observed in the wound tissue treated with NP compared to the wound tissue exposed to PP. Proliferation in the wound tissue exposed to NP on day 10 was significantly higher than that in wound tissue exposed to PP. NP generated more fibroblasts, keratinized stratified epithelium, and less epithelia with stemness than PP. The levels of ccollagen Ⅰ and Ⅲ were both decreased in both the NP and PP groups. NP induced a statistically significant increase in the expression of fibronectin (FN) on days 3 and 10 compared to PP. Furthermore, the level of matrix metalloproteinase (MMP)‑13 increased in the NP group, but decreased in the PP group on day 3. NP also induced a decrease in the levels of tissue inhibitor of metalloproteinase (TIMP)‑1 and TIMP‑2 during the early stages of wound healing, which was significantly different from the increasing effect of PP on TIMP‑1 and TIMP‑2 levels at the corresponding time points. On the whole, our data indicate that our homemade device which induced NP, was more efficient than VSD‑induced PP on wound healing by regulating inflammation, secretion, proliferation and the distribution of different cells in wound tissue.
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Affiliation(s)
- Jinyan Liu
- Department of Nuclear Medicine, The First Xiangya Hospital of Central South University, Changsha, Hunan 410008
| | - Feng Hu
- Department of Plastic Surgery, The Third Xiangya Hospital of Central South University, Changsha, Hunan 410013
| | - Jintian Tang
- Institute of Medical Physics and Engineering, Tsinghua University, Beijing 100084
| | - Shijie Tang
- Cleft Lip and Palate Treatment Center, Second Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong 515041
| | - Kun Xia
- Key Laboratory of Medical Information Research, Central South University, Changsha, Hunan
| | | | - Chaoqi Yin
- Department of Plastic Surgery, The Third Xiangya Hospital of Central South University, Changsha, Hunan 410013
| | - Shaohua Wang
- Department of Plastic Surgery, The Third Xiangya Hospital of Central South University, Changsha, Hunan 410013
| | - Quanyong He
- Department of Plastic Surgery, The Third Xiangya Hospital of Central South University, Changsha, Hunan 410013
| | - Huiqing Xie
- Rehabilitation Medicine, The Third Xiangya Hospital of Central South University, Changsha, Hunan 410013, P.R. China
| | - Jianda Zhou
- Department of Plastic Surgery, The Third Xiangya Hospital of Central South University, Changsha, Hunan 410013
- Correspondence to: Professor Jianda Zhou, Department of Plastic Surgery, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Changsha, Hunan 410013, P.R. China, E-mail:
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Panayi AC, Leavitt T, Orgill DP. Evidence based review of negative pressure wound therapy. World J Dermatol 2017; 6:1-16. [DOI: 10.5314/wjd.v6.i1.1] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 10/15/2016] [Accepted: 01/14/2017] [Indexed: 02/06/2023] Open
Abstract
Vacuum-assisted closure, sometimes referred to as microdeformational wound therapy or most commonly negative pressure wound therapy (NPWT), has significantly improved wound care over the past two decades. NPWT is known to affect wound healing through four primary mechanisms (macrodeformation, microdeformation, fluid removal, and alteration of the wound environment) and various secondary mechanisms (including neurogenesis, angiogenesis, modulation of inflammation, and alterations in bioburden) which are described in this review. In addition, the technique has many established uses, for example in wound healing of diabetic and pressure ulcers, as well as burn and blast wounds. This therapy also has many uses whose efficacy has yet to be confirmed, for example the use in digestive surgery. Modifications of the traditional NPWT have also been established and are described in detail. This therapy has various considerations and contraindications which are summarized in this review. Finally, future perspectives, such as the optimal cycling of the treatment and the most appropriate interface material, are touched upon in the final segment. Overall, despite the fact that questions remain to be answered about NPWT, this technology is a major breakthrough in wound healing with significant potential use both in the hospital but also in the community.
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Wang CY, Chiao HY, Chou CY, Wu CJ, Chang CK, Chu TS, Dai NT. Successful salvage and reconstruction of a finger threatened by Vibrio vulnificus necrotising fasciitis using fenestrated-type artificial dermis and three steps of topical negative pressure wound therapy. Int Wound J 2017; 14:818-822. [PMID: 28052529 DOI: 10.1111/iwj.12711] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 12/05/2016] [Accepted: 12/10/2016] [Indexed: 11/28/2022] Open
Abstract
Vibrio vulnificus can cause severe skin and soft tissue infection (SSTI). The pathogen is an opportunistic marine bacterium that is likely to infect patients with chronic liver disease, patients in an immunocompromised state, and those in end-stage renal disease. V. vulnificus gains entry through soft tissues by direct penetration of a wound by infected marine organisms, such as raw oysters, shellfish and other seafood, or by exposing a wound to contaminated water. Despite its ease of entry, V. vulnificus necrotising fasciitis with compartment syndrome has rarely been described. We report a case of an elderly patient with end-stage renal disease undergoing haemodialysis, who developed necrotising fasciitis following infection by V. vulnificus through a puncture injury while cleaning fish. A successful salvage and reconstruction surgery was performed using fenestrated-type artificial dermis followed by negative pressure wound therapy. This case presents a reasonable treatment option for threatening V. vulnificus necrotising fasciitis with compartment syndrome.
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Affiliation(s)
- Chi-Yu Wang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Division of Plastic and Reconstructive Surgery, Department of Surgery, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
| | - Hao-Yu Chiao
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chang-Yi Chou
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chien-Ju Wu
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chun-Kai Chang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Tzi-Shiang Chu
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Niann-Tzyy Dai
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Nie B, Yue B. Biological effects and clinical application of negative pressure wound therapy: a review. J Wound Care 2016; 25:617-626. [DOI: 10.12968/jowc.2016.25.11.617] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- B. Nie
- Associated Professor Shanghai Key Laboratory of Orthopedic Implants, Department of Orthopedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - B. Yue
- Associated Professor Shanghai Key Laboratory of Orthopedic Implants, Department of Orthopedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
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Maurya S, Bhandari PS. Negative Pressure Wound Therapy in the Management of Combat Wounds: A Critical Review. Adv Wound Care (New Rochelle) 2016; 5:379-389. [PMID: 27679749 DOI: 10.1089/wound.2014.0624] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Accepted: 03/03/2015] [Indexed: 01/09/2023] Open
Abstract
Significance: Wounds sustained in a combat trauma often result in a composite tissue loss. Combat injuries, due to high energy transfer to tissues, lead to trauma at multiple anatomical sites. An early wound cover is associated with lower rate of infections and a faster wound healing. The concept of negative pressure wound therapy (NPWT) in the management of combat-related wounds has evolved from the civilian trauma and the wounds from nontraumatic etiologies. Recent Advances: Encouraged by the results of NPWT in noncombat-related wounds, the military surgeons during Operation Iraqi Freedom and Operation Enduring Freedom used this novel method in a large percentage of combat wounds, with gratifying results. The mechanism of NPWT in wound healing is multifactorial and often complex reconstructive procedure can be avoided in a combat trauma setting. Critical Issues: Wounds sustained in military trauma are heavily contaminated with dirt, patient clothing, and frequently associated with extensive soft tissue loss and osseous destruction. Delay in evacuation during an ongoing conflict carries the risk of systemic infection. Early debridement is indicated followed by delayed closure of wounds. NPWT helps to provide temporary wound cover during the interim period of debridement and wound closure. Future Directions: Future area of research in combat wounds is related to abdominal trauma with loss of abdominal wall. The concept of negative pressure incisional management system in patients with a high risk of wound breakdown following surgery is under review, and may be of relevance in combat wounds.
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Affiliation(s)
- Sanjay Maurya
- Department of Plastic and Reconstructive Surgery, Command Hospital , Udhampur, India
| | - Prem Singh Bhandari
- Department of Plastic and Reconstructive Surgery, Command Hospital , Udhampur, India
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Huang CH, Hsu CC, Chen CPC, Chow SE, Wang JS, Shyu YC, Lu MJ. Negative pressure induces p120-catenin-dependent adherens junction disassembly in keratinocytes during wound healing. BIOCHIMICA ET BIOPHYSICA ACTA-MOLECULAR CELL RESEARCH 2016; 1863:2212-20. [PMID: 27220534 DOI: 10.1016/j.bbamcr.2016.05.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 05/17/2016] [Accepted: 05/19/2016] [Indexed: 01/08/2023]
Abstract
A negative-pressure of 125mmHg (NP) has been widely used to treat chronic wounds in modern medicine. Keratinocytes under NP treatment have shown accelerated cell movement and decreased E-cadherin expression. However, the molecular mechanism of E-cadherin regulation under NP remains incompletely understood. Therefore, we investigated the E-cadherin regulation in keratinocytes (HaCaT cells) under NP. HaCaT cells were treated at ambient pressure (AP) and NP for 12h. Cell movement was measured by traditional and electric wound healing assays at the 2 different pressures. Mutants with overexpression of p120-catenin (p120(ctn)) were used to observe the effect of NP on p120(ctn) and E-cadherin expression during wound healing. Cell fractionation and immunoblotting data showed that NP increased Y228-phosphorylated p120(ctn) level and resulted in the translocation of p120(ctn) from the plasma membrane to cytoplasm. Immunofluorescence images revealed that NP decreased the co-localization of p120(ctn) and E-cadherin on the plasma membrane. Knockdown of p120(ctn) reduced E-cadherin expression and accelerated cell movement under AP. Overexpression of the Y228-phosphorylation-mimic p120(ctn) decreased E-cadherin membrane expression under both AP and NP. Phosphorylation-deficient mutants conferred restored adherens junctions (AJs) under NP. The Src inhibitor blocked the phosphorylation of p120(ctn) and impeded cell migration under NP. In conclusion, Src-dependent phosphorylation of p120(ctn) can respond rapidly to NP and contribute to E-cadherin downregulation. The NP-induced disassembly of the AJ further accelerates wound healing.
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Affiliation(s)
- Ching-Hui Huang
- Healthy Aging Research Center, Graduate Institute of Rehabilitation Science, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Chin Hsu
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Keelung, Taiwan; School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Carl Pai-Chu Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Shu-Er Chow
- Center of General Studies, Chang Gung University, Taoyuan, Taiwan
| | - Jong-Shyan Wang
- Healthy Aging Research Center, Graduate Institute of Rehabilitation Science, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Chiau Shyu
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Taiwan; Institute of Molecular Biology, Academia Sinica, Nankang, Taipei, Taiwan
| | - Mu-Jie Lu
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Taiwan
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Chow SE, Chen CPC, Hsu CC, Tsai WC, Wang JS, Hsu NC. Quantifying cell behaviors in negative-pressure induced monolayer cell movement. Biomed J 2016; 39:50-9. [PMID: 27105598 PMCID: PMC6138425 DOI: 10.1016/j.bj.2015.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Accepted: 08/17/2015] [Indexed: 11/24/2022] Open
Abstract
Background Negative-pressure of 125 mmHg (NP) has been shown to accelerate wound healing. Effects of NP on human keratinocyte behaviors during wound healing process were highlighted in this study. Methods An NP incubator incorporating the electric cell–substrate impedance sensing (ECIS) technique has been built to quantify monolayer keratinocytes movement in serum-free media at the ambient pressure (AP) and NP for 12 h. Monolayer cell motions were continuously recorded by ECIS in the frequency range of 22.5–64 kHz. Membrane capacitance (Cm), cell–substratum resistance (α), and cell–cell junction resistance (Rb) were evaluated in cells at the different pressures. Results A greater monolayer cell migration distance was found in cells at NP. Decreased cell–substratum adhesion reflected in the significantly low α (AP:NP = ∼5 Ω0.5:∼3 Ω0.5⋅cm), decreased integrin expression, and increased cell–substratum distance were seen in cells at NP. A significantly increased Cm (AP:NP = ∼4:∼8 μF/cm2) in association with increased membrane ruffling and microtubule filaments were observed early in the monolayer cell movement at NP. A progressive drop in the Rb from 1.2 Ω·cm2 to 0.8 Ω·cm2 corresponding to the gradually decreased E-cadherin expressions were observed 6 h after wound closure after NP treatment. Conclusion A quick membrane ruffling formation, an early cell–substratum separation, and an ensuing decrease in the cellular interaction occur in cells at NP. These specific monolayer cell behaviors at NP have been quantified and possibly accelerate wound healing.
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Affiliation(s)
- Shu-Er Chow
- Department of Nature Science, Center for General Studies, Chang Gung University, Taoyuan, Taiwan
| | - Carl Pai-Chu Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Taipei, Taipei, Taiwan
| | - Chih-Chin Hsu
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan; School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Wen-Chung Tsai
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Jong-Shyan Wang
- Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ning-Chun Hsu
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
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Seavey JG, Masters ZA, Balazs GC, Tintle SM, Sabino J, Fleming ME, Valerio IL. Use of a bioartificial dermal regeneration template for skin restoration in combat casualty injuries. Regen Med 2016; 11:81-90. [DOI: 10.2217/rme.15.83] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Military personnel who survive combat injuries frequently have large soft tissue wounds complicated by concomitant injuries and contamination. These devastating wounds present a therapeutic challenge to not only restore the protective skin barrier but also to preserve tendon and muscle excursion, provide protective padding around nerves and restore adequate joint motion. Accordingly, regenerative medicine modalities that can accomplish these goals are of great interest. The use of bioartificial dermal regeneration templates (DRT), such as Integra DRT (Integra Lifesciences Corporation, Plainsboro, NJ, USA), in the management of complex soft tissue injuries has an important role in the reconstruction of war wounds. These DRTs provide initial wound coverage and help establish a well-vascularized wound bed suitable for definitive soft tissue coverage.
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Affiliation(s)
- Jonathan G Seavey
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, 8901 Wisconsin Ave., Bethesda, MD 20889 USA
| | - Zachary A Masters
- Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | - George C Balazs
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, 8901 Wisconsin Ave., Bethesda, MD 20889 USA
| | - Scott M Tintle
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, 8901 Wisconsin Ave., Bethesda, MD 20889 USA
- Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | - Jennifer Sabino
- Department of General Surgery, Walter Reed National Military Medical Center, 8901 Wisconsin Ave., Bethesda, MD 20889, USA
| | - Mark E Fleming
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, 8901 Wisconsin Ave., Bethesda, MD 20889 USA
- Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | - Ian L Valerio
- Department of Plastic Surgery, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Ste 2100, Columbus, OH 43212, USA
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Chen PY, Hsu CC, Yang KC, Wu CC, Wang CL. The effects of negative pressure treatment on the extracellular matrix gene expression and protein production of fibroblasts. Process Biochem 2015. [DOI: 10.1016/j.procbio.2015.06.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sridhar S, Venugopal JR, Ramakrishna S. Improved regeneration potential of fibroblasts using ascorbic acid-blended nanofibrous scaffolds. J Biomed Mater Res A 2015; 103:3431-40. [DOI: 10.1002/jbm.a.35486] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 03/22/2015] [Accepted: 04/14/2015] [Indexed: 01/09/2023]
Affiliation(s)
- Sreepathy Sridhar
- Center for Nanofibers and Nanotechnology, NUSNNI, Faculty of Engineering; National University of Singapore; Singapore
- Department of Genetic Engineering; SRM University, Kattankulathur; Chennai Tamilnadu India
| | - Jayarama Reddy Venugopal
- Center for Nanofibers and Nanotechnology, NUSNNI, Faculty of Engineering; National University of Singapore; Singapore
| | - Seeram Ramakrishna
- Center for Nanofibers and Nanotechnology, NUSNNI, Faculty of Engineering; National University of Singapore; Singapore
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Yoshino D, Sato K, Sato M. Endothelial Cell Response Under Hydrostatic Pressure Condition Mimicking Pressure Therapy. Cell Mol Bioeng 2015. [DOI: 10.1007/s12195-015-0385-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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Honnegowda TM, Kumar P, Padmanabha Udupa EG, Sharan A, Singh R, Prasad HK, Rao P. A comparative study to evaluate the effect of limited access dressing (LAD) on burn wound healing. Int Wound J 2015; 13:791-8. [PMID: 25689953 DOI: 10.1111/iwj.12384] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Accepted: 09/29/2014] [Indexed: 11/30/2022] Open
Abstract
Biochemical and histopathological analyses are commonly used objective parameters in research and clinical fields to assess the healing status of burn wounds. In this study, the effect of newer intermittent negative-pressure wound therapy in combination with moist environment [limited access dressing (LAD)] on burn wound healing is studied. Various biochemical parameters like hydroxyproline, hexosamine and total protein, and antioxidants like reduced glutathione (GSH), glutathione peroxidase (GPx) and oxidative biomarker malondialdhyde (MDA) were measured in the granulation tissue. Histopathologically, necrotic tissue, amount of inflammatory infiltrate, angiogenesis and extracellular matrix deposition (ECM) were studied to determine wound healing. A total of 55 patients were divided into two groups as follows: LAD group (n = 28) and conventional dressing group (n = 27). Patients treated with LAD have shown significant increase in the mean levels of (±SD) hydroxyproline (75·2 ± 26·30 versus 27·8 ± 15·5; P = 0·010), hexosamine (9·0 ± 1·99 versus 8·0 ± 1·18; P = 0·038), total protein (15·6 ± 8·23 versus 10·26 ± 4·94; P = 0·003), GSH (7·40 ± 1·91 versus 5·1 ± 1·28; P = 0·037), GPx (112·6 ± 46·4 versus 92 ± 32·4; P = 0·016), and decrease in MDA (6·5 ± 2·24 versus 1 0·6 ± 3·8; P = 0·002). Histopathologically, between LAD and conventional dressing groups, there was a significant difference after 10 days of treatment (mean±SE) in necrotic tissue of (LAD versus conventional dressing groups = 10 ± 1·8 versus 11·9 ± 2·6; P = 0·033), inflammatory cells (8·4 ± 1·9 versus 13 ± 3·46; P = 0·021), new blood vessels (12·5 ± 2·87 versus 9·4 ± 1·7; P = 0·047), ECM deposit (12·9 ± 2·41 versus 9·68 ± 1·3; P = 0·018) and showed comparatively fewer inflammatory cells, increased and well-organised extracellular matrix deposit, more angiogenesis in LAD group as compared with that in conventional dressing group. To conclude, LAD exerts its beneficial effects on wound healing by reducing oxidative stress, decreasing necrotic tissue and amount of inflammatory infiltrate, and increasing ECM deposition and angiogenesis.
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Affiliation(s)
| | - Pramod Kumar
- Department of Plastic Surgery and Burns, Kasturba Medical College, Manipal, India.
| | | | - Anurag Sharan
- Department of Plastic Surgery and Burns, Kasturba Medical College, Manipal, India
| | - Rekha Singh
- Department of Pathology, Vydehi Institute of Medical Sciences and Research Center, Bangalore, India
| | - Hemanth K Prasad
- Department of Biochemistry, Kasturba Medical College, Manipal, India
| | - Pragna Rao
- Department of Biochemistry, Kasturba Medical College, Manipal, India
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Morimoto N, Kuro A, Yamauchi T, Horiuchi A, Kakudo N, Sakamoto M, Suzuki K, Kusumoto K. Combined use of fenestrated-type artificial dermis and topical negative pressure wound therapy for the venous leg ulcer of a rheumatoid arthritis patient. Int Wound J 2015; 13:137-40. [PMID: 25650053 DOI: 10.1111/iwj.12422] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 12/24/2014] [Accepted: 12/30/2014] [Indexed: 11/29/2022] Open
Abstract
We report a case of circumferential venous leg ulcer in a rheumatoid arthritis patient. Mesh skin grafting was performed in another hospital, but the graft failed and the patient was referred to our hospital. This ulcer was treated by the combination therapy of a fenestrated-type artificial dermis with negative pressure wound therapy (NPWT) and secondary mesh grafting using our 'grip tape technique'. NPWT was started at -100 mmHg and continued until the formation of dermis-like tissue. A section stained using haematoxylin and eosin and an anti-αSMA (α smooth muscle actin) immunohistological section of the biopsy from dermis-like tissue showed an abundant infiltration of fibroblasts and capillary formation beneath the fenestration of the silicone sheet. Threefold mesh skin grafting was subsequently performed and it was taken up completely. The fenestrated-type artificial dermis in combination with NPWT produced good results without infection in the treatment of complex wounds. In addition, our 'grip tape technique' was useful to apply polyurethane foam to the entire surface of the lower leg.
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Affiliation(s)
- Naoki Morimoto
- Department of Plastic and Reconstructive Surgery, Kansai Medical University, Hirakata, Japan
| | - Atsuyuki Kuro
- Department of Plastic and Reconstructive Surgery, Kansai Medical University, Hirakata, Japan
| | - Takashi Yamauchi
- Department of Plastic and Reconstructive Surgery, Kansai Medical University, Hirakata, Japan
| | - Ai Horiuchi
- Department of Plastic and Reconstructive Surgery, Kansai Medical University, Hirakata, Japan
| | - Natsuko Kakudo
- Department of Plastic and Reconstructive Surgery, Kansai Medical University, Hirakata, Japan
| | - Michiharu Sakamoto
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kenji Suzuki
- Department of Plastic and Reconstructive Surgery, Kansai Medical University Takii Hospital, Moriguchi, Japan
| | - Kenji Kusumoto
- Department of Plastic and Reconstructive Surgery, Kansai Medical University, Hirakata, Japan
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Kuro A, Morimoto N, Ueda M, Horiuchi A, Yamauchi T, Sakamoto M, Suzuki K, Kusumoto K. Combined use of fenestrated-type artificial dermis and topical negative-pressure wound therapy to treat the complex wound in the lower leg. J Plast Reconstr Aesthet Surg 2015; 68:286-8. [DOI: 10.1016/j.bjps.2014.09.048] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 09/19/2014] [Accepted: 09/22/2014] [Indexed: 10/24/2022]
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Vacuum-Assisted Closure Device and Skin Substitutes for Complex Mohs Defects. Dermatol Surg 2014; 40 Suppl 9:S120-6. [DOI: 10.1097/dss.0000000000000113] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Penny HL, Spinazzola J, Green A, Rifkah M, Faretta M, Youshaw D, Weaver A, Zaki P. Negative pressure wound therapy with Bio-Dome dressing technology in the treatment of complex wounds: a case series. J Wound Care 2014; 23:S4, S6-9. [PMID: 24762555 DOI: 10.12968/jowc.2014.23.sup4.s4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The treatment of complex wounds is difficult and not always effective. Various treatment options are used with varying degrees of success. Negative pressure wound therapy (NPWT) is a cost-efficient and effective way to help treat these wounds. The use of a vacuum device applies the negative pressure to the site of the wound and promotes waste removal and increases circulation and tissue formation. While various NPWT systems are currently on the market, we utilised the ConvaTec Engenex® system with Bio-DomeTM technology; however, our case study is not intended to advocate the specific use of this system, but instead focuses on the use of NPWT as a viable option for wound healing. Each of the following case study patients presented with difficult-to-heal wounds that failed traditional therapeutic approaches. Through the use of NPWT, our patients saw major wound size reductions. Each patient exhibited at least a 94% reduction in wound area, wound volume or both.
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Affiliation(s)
- H L Penny
- DPM, DABPM, FAPWHc, Blair Medical Associates Podiatry Department, Altoona, US
| | - J Spinazzola
- DO, APWH Medical Resident, Penn State Hershey Medical Center, Hershey, US
| | - A Green
- MD, MBA, APWH Medical Resident, Hofstra North Shore LIJ School of Medicine, Hofstra University, Hempstead, US
| | - M Rifkah
- APWH Student Member, Marshall University School of Medicine, Huntington, US
| | - M Faretta
- APWH Student Member, The Commonwealth Medical College, Scranton, US
| | - D Youshaw
- MD, FACS, FAPWH, Blair Medical Associates Podiatry Department, Altoona, US
| | - A Weaver
- Pre-medical Student, Juniata College, Duncansville, US
| | - P Zaki
- Pre-medical Student, Penn State University, Hollidaysburg, US
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Huang C, Leavitt T, Bayer LR, Orgill DP. Effect of negative pressure wound therapy on wound healing. Curr Probl Surg 2014; 51:301-31. [PMID: 24935079 DOI: 10.1067/j.cpsurg.2014.04.001] [Citation(s) in RCA: 265] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 04/15/2014] [Indexed: 12/13/2022]
Abstract
The efficacy of NPWT in promoting wound healing has been largely accepted by clinicians, yet the number of high-level clinical studies demonstrating its effectiveness is small and much more can be learned about the mechanisms of action. In the future, hopefully we will have the data to assist clinicians in selecting optimal parameters for specific wounds including interface material, waveform of suction application, and the amount of suction to be applied. Further investigation into specific interface coatings and instillation therapy are also needed. We believe that advances in mechanobiology, the science of wound healing, the understanding of biofilms, and advances in cell therapy will lead to better care for our patients.
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Yao M, Attalla K, Ren Y, French MA, Driver VR. Ease of use, safety, and efficacy of integra bilayer wound matrix in the treatment of diabetic foot ulcers in an outpatient clinical setting: a prospective pilot study. J Am Podiatr Med Assoc 2014; 103:274-80. [PMID: 23878379 DOI: 10.7547/1030274] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Integra bilayer wound matrix (IBWM) is a bilayer skin replacement system composed of a dermal regeneration layer and a temporary epidermal layer. It is used to treat various types of deep, large wounds via an inpatient procedure in an operating room. We sought to determine ease of use and effectiveness of IBWM in an outpatient clinical setting when treating diabetic foot ulcers. In addition, no epidermal autografting was performed in conjunction with the IBWM after silicone release, as is common in the inpatient setting. METHODS This 12-week, single-arm, prospective pilot study was conducted in three outpatient clinics. Weekly evaluations included monitoring the wound for signs of infection during the 12-week follow-up phase. RESULTS Eleven patients with diabetic foot ulcers who met the inclusion and exclusion criteria were enrolled. One patient was discontinued from the study owing to noncompliance leading to a serious adverse event. Therefore, ten patients who received the study intervention were included in the per-protocol population reported herein. The mean patient age was 60.6 years, with an average 11-year history of diabetes mellitus. Each ulcer was located on the plantar aspect of the foot. No infection was reported during the study. Patients treated with IBWM showed progressive wound healing over time: the greatest mean wound reduction was approximately 95% in week 12. Seven of ten patients (70%) achieved complete wound closure by week 12. No recurrent ulcers were reported during follow-up. CONCLUSIONS These results are consistent with the hypothesis that IBWM is easy to use, safe, and effective when used on diabetic foot ulcers in an outpatient clinical setting without the secondary procedure of autografting for closure.
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Affiliation(s)
- Min Yao
- Limb Preservation and Wound Healing Clinical Research, Department of Surgery, Boston University Medical Center and Boston University School of Medicine, Boston, MA, USA
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Early kinetics of integration of collagen-glycosaminoglycan regenerative scaffolds in a diabetic mouse model. Plast Reconstr Surg 2014; 132:767e-776e. [PMID: 24165628 DOI: 10.1097/prs.0b013e3182a3c091] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Collagen-glycosaminoglycan scaffolds, originally designed to treat severe burns, are now commonly used in patients with complex wounds associated with diabetes mellitus. In this study, the authors investigated how the thickness of the scaffold would affect cellular integration with the diabetic host and whether this can be accelerated using subatmospheric pressure wound therapy devices. METHODS Collagen-glycosaminoglycan scaffolds, 500 to 2000-μm thick, were applied to dorsal wounds in genetically diabetic mice. In addition, 1000-μm collagen-glycosaminoglycan scaffolds with and without silicone were treated with a subatmospheric pressure device (-125 mmHg). On days 5 and 10, cellular and vascular integration of tissues was studied by histology, immunohistochemistry, corrosion casting, and qRT-polymerase chain reaction. RESULTS Cells and vessels from the wound surface populated the scaffold to form layers with varying cellular density. Areas of high cell density and proliferation were noted at the bottom of the scaffold. Increasing the thickness of the scaffold did not affect the extent of cellular ingrowth, so that thicker scaffolds had a thicker residual acellular layer on the surface. The thickness of cellular ingrowth was stable between days 5 and 10, whereas vessels seen in the scaffolds on day 10 were not yet present on day 5. Subatmospheric pressure devices applied to silicone-covered collagen-glycosaminoglycan scaffolds minimized the granulation tissue formation beneath the scaffold, which enhanced vessel ingrowth. CONCLUSIONS The early kinetics of cellular integration into collagen-glycosaminoglycan scaffolds is independent of scaffold thickness in a diabetic wound model. Scaffold adherence to the wound and integration can be improved using a subatmospheric pressure device.
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Davis K, Bills J, Barker J, Kim P, Lavery L. Simultaneous irrigation and negative pressure wound therapy enhances wound healing and reduces wound bioburden in a porcine model. Wound Repair Regen 2013; 21:869-75. [PMID: 24134060 DOI: 10.1111/wrr.12104] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2013] [Accepted: 07/16/2013] [Indexed: 12/29/2022]
Abstract
Infected foot wounds are one of the most common reasons for hospitalization and amputation among persons with diabetes. The objective of the study was to investigate a new wound therapy system that employs negative pressure wound therapy (NPWT) with simultaneous irrigation therapy. For this study, we used a porcine model with full-thickness excisional wounds, inoculated with Pseudomonas aeruginosa. Wounds were treated for 21 days of therapy with either NPWT, NPWT with simultaneous irrigation therapy using normal saline or polyhexanide biguanide (PHMB) at low or high flow rates, or control. Data show that NPWT with either irrigation condition improved wound healing rates over control-treated wounds, yet did not differ from NPWT alone. NPWT improved bioburden over control-treated wounds. NPWT with simultaneous irrigation further reduced bioburden over control and NPWT-treated wounds; however, flow rate did not affect these outcomes. Together, these data show that NPWT with simultaneous irrigation therapy with either normal saline or PHMB has a positive effect on bioburden in a porcine model, which may translate clinically to improved wound healing outcomes.
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Affiliation(s)
- Kathryn Davis
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
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Davis KE, Lafontaine J, Bills J, Noble D, Wight-Carter M, Oni G, Rohrich RJ, Lavery LA. The comparison of two negative-pressure wound therapy systems in a porcine model of wound healing. Wound Repair Regen 2013; 21:740-5. [DOI: 10.1111/wrr.12079] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 06/01/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Kathryn E. Davis
- Department of Plastic Surgery; University of Texas Southwestern Medical Center; Dallas; Texas
| | - Javier Lafontaine
- Department of Plastic Surgery; University of Texas Southwestern Medical Center; Dallas; Texas
| | - Jessica Bills
- Department of Plastic Surgery; University of Texas Southwestern Medical Center; Dallas; Texas
| | - Deborah Noble
- Department of Plastic Surgery; University of Texas Southwestern Medical Center; Dallas; Texas
| | - Mary Wight-Carter
- Department of Plastic Surgery; University of Texas Southwestern Medical Center; Dallas; Texas
| | - Georgette Oni
- Department of Plastic Surgery; University of Texas Southwestern Medical Center; Dallas; Texas
| | - Rod J. Rohrich
- Department of Plastic Surgery; University of Texas Southwestern Medical Center; Dallas; Texas
| | - Lawrence A. Lavery
- Department of Plastic Surgery; University of Texas Southwestern Medical Center; Dallas; Texas
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DENG KAI, YU AIXI, XIA CHENGYAN, LI ZONGHUAN, WANG WEIYANG. Combination of negative pressure wound therapy with open bone grafting for bone and soft tissue defects. Mol Med Rep 2013; 8:468-72. [DOI: 10.3892/mmr.2013.1536] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 06/11/2013] [Indexed: 11/06/2022] Open
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Negative pressure accelerated monolayer keratinocyte healing involves Cdc42 mediated cell podia formation. J Dermatol Sci 2013; 70:196-203. [PMID: 23622765 DOI: 10.1016/j.jdermsci.2013.03.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Revised: 03/06/2013] [Accepted: 03/12/2013] [Indexed: 01/13/2023]
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