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Soltani S, Zahedi A, Vergara AJS, Noli M, Soltysik FM, Pociot F, Yarani R. Preclinical Therapeutic Efficacy of Extracellular Vesicles Derived from Adipose-Derived Mesenchymal Stromal/Stem Cells in Diabetic Wounds: a Systematic Review and Meta-Analysis. Stem Cell Rev Rep 2024:10.1007/s12015-024-10753-z. [PMID: 38970763 DOI: 10.1007/s12015-024-10753-z] [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] [Accepted: 06/20/2024] [Indexed: 07/08/2024]
Abstract
Extracellular vesicles isolated from adipose tissue-derived mesenchymal stromal/stem cells (ADSC-EVs) have demonstrated promising potential in wound healing treatment. To determine the therapeutic efficacy of ADSC-EVs for diabetic wounds in preclinical models, we performed a meta-analysis of available studies. PubMed and Embase were searched (to April 23, 2023). All full-text articles describing the therapeutic application of ADSC-EVs in diabetic wounds were included. Study outcomes were pooled using a random effects meta-analysis, including wound closure, angiogenesis, and collagen deposition. Other outcomes were only discussed descriptively. Seventy unique records were identified from our search; 20 full-text articles were included for qualitative analysis. Twelve studies were eligible for quantitative meta-analysis. The results showed that ADSC-EVs accelerated diabetic wound healing compared to controls with a large effect (standardized mean difference (SMD) 4.22, 95% confidence interval (CI) 3.07 to 5.36). The administration of ADSC-EVs also improved neovascularization (SMD 9.27, 95% CI 4.70 to 13.83) and collagen deposition (SMD 2.19, 95% CI 0.94 to 3.44), with a large effect. The risk of bias was unclear in all included studies. Conclusively, ADSC-EV is an effective treatment for diabetic wounds in preclinical trials, and it appears justified for transfer into the clinical field.
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Affiliation(s)
- Setareh Soltani
- Clinical Research Development Center, Taleghani and Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ahora Zahedi
- Department of Artificial Intelligence in Medical Sciences, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - April Joy S Vergara
- Translational Type 1 Diabetes Research, Department of Clinical Research, Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Marta Noli
- Translational Type 1 Diabetes Research, Department of Clinical Research, Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Fumie Mitani Soltysik
- Translational Type 1 Diabetes Research, Department of Clinical Research, Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Flemming Pociot
- Translational Type 1 Diabetes Research, Department of Clinical Research, Steno Diabetes Center Copenhagen, Herlev, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Reza Yarani
- Translational Type 1 Diabetes Research, Department of Clinical Research, Steno Diabetes Center Copenhagen, Herlev, Denmark.
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Lin XP, Guo XL, Tian HF, Wu ZR, Yang WJ, Pan HY. Emergency rescue of a patient with hemorrhagic shock caused by superior mesenteric artery rupture: A case report. World J Clin Cases 2024; 12:3567-3574. [DOI: 10.12998/wjcc.v12.i18.3567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/13/2024] [Accepted: 05/06/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Superior mesenteric artery (SMA) injuries rarely occur during blunt abdominal injuries, with an incidence of < 1%. The clinical manifestations mainly include abdominal hemorrhage and peritoneal irritation, which progress rapidly and are easily misdiagnosed. Quick and accurate diagnosis and timely effective treatment are greatly significant in managing emergent cases. This report describes emergency rescue by a multidisciplinary team of a patient with hemorrhagic shock caused by SMA rupture.
CASE SUMMARY A 55-year-old man with hemorrhagic shock presented with SMA rupture. On admission, he showed extremely unstable vital signs and was unconscious with a laceration on his head, heart rate of 143 beats/min, shallow and fast breathing (frequency > 35 beats/min), and blood pressure as low as 20/10 mmHg (1 mmHg = 0.133 kPa). Computed tomography revealed abdominal and pelvic hematocele effusion, suggesting active bleeding. The patient was suspected of partial rupture of the distal SMA branch. The patient underwent emergency mesenteric artery ligation, scalp suture, and liver laceration closure. In view of conditions with acute onset, rapid progression, and high bleeding volume, key points of nursing were conducted, including activating emergency protocol, opening of the green channel, and arranging relevant examinations with various medical staff for quick diagnosis. The seamless collaboration of the multidisciplinary team helped shorten the preoperative preparation time. Emergency laparotomy exploration and mesenteric artery ligation were performed to mitigate hemorrhagic shock while establishing efficient venous accesses and closely monitoring the patient’s condition to ensure hemodynamic stability. Strict measures were taken to avoid intraoperative hypothermia and infection.
CONCLUSION After 3.5 h of emergency rescue and medical care, bleeding was successfully controlled, and the patient’s condition was stabilized. Subsequently, the patient was transferred to the intensive care unit for continuous monitoring and treatment. On the sixth day, the patient was weaned off the ventilator, extubated, and relocated to a specialized ward. Through diligent medical intervention and attentive nursing, the patient made a full recovery and was discharged on day 22. The follow-up visit confirmed the patient’s successful recovery.
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Affiliation(s)
- Xian-Ping Lin
- Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310020, Zhejiang Province, China
| | - Xin-Li Guo
- Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310020, Zhejiang Province, China
| | - He-Feng Tian
- Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310020, Zhejiang Province, China
| | - Zheng-Rong Wu
- Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310020, Zhejiang Province, China
| | - Wei-Jie Yang
- Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310020, Zhejiang Province, China
| | - Hong-Ying Pan
- Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310020, Zhejiang Province, China
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Takahashi J, Nakae K, Yokota O, Nakata R, Hasegawa H, Miyagawa M. Comparison of "semi-occlusive dressing" treatment using plastic wrap or low-adherent absorbent wound dressings versus occlusive dressing treatment for stage III/IV pressure injuries in the inflammatory phase: a randomized controlled trial. Adv Wound Care (New Rochelle) 2024. [PMID: 38874259 DOI: 10.1089/wound.2024.0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024] Open
Abstract
OBJECTIVE To compare the effectiveness of "semi-occlusive dressing (SOD)" treatment using plastic wrap or low-adherent absorbent wound dressings with that of occlusive dressing (OD) treatment for National Pressure Injury Advisory Panel stage III/IV pressure injuries in the inflammatory phase. APPROACH This 12-week, open-label, randomized, controlled trial was conducted at one hospital and three care facilities. Seventy-seven participants were enrolled; 40 comprised the SOD group and 37 comprised the OD group. The primary outcome was the surface area reduction. Secondary outcomes included the Bates-Jensen wound assessment tool (BWAT) score reductions, incidence of adverse events, and material cost. This trial met the recommendations of CONSORT 2010 statement. RESULTS The surface area reduction of the SOD group was greater than that of the OD group throughout the study period. The significant interaction was revealed between treatment and time course (P < 0.0001). The 95% confidence interval of the difference at 12 weeks was 3.4 to 21.9. The median BWAT score reduction of the SOD group at 12 weeks was 23, and that of the OD group was 18.5 (P = 0.0077). The incidence of adverse events was comparable between groups. The OD treatment cost was 3.0-times higher than the SOD treatment cost (P = 0.0012). INNOVATION Because the SOD does not completely occlude the wound, excess exudate drains from the wound. Therefore, SOD can treat the wound with abundant exudate effectively and safely. CONCLUSION SOD treatment is more effective and less expensive than OD treatment for stage III/IV pressure injuries.
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Affiliation(s)
- Jun Takahashi
- General Incorporated Association Minakuchi Hospital, Psychiatry, Koka, Shiga, Japan;
| | - Kayoko Nakae
- General Incorporated Association Minakuchi Hospital, Koka, Shiga, Japan;
| | - Osamu Yokota
- Kinoko Espoir Hospital, Psychiatry, Kasaoka, Okayama, Japan
- Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Neuropsychiatry, Okayama, Okayama, Japan;
| | - Rena Nakata
- General Incorporated Association Minakuchi Hospital, Psychiatry, Koka, Shiga, Japan;
| | - Hayato Hasegawa
- General Incorporated Association Minakuchi Hospital, Psychiatry, Koka, Shiga, Japan;
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De Francesco F, Ogawa R. From Time to Timer in Wound Healing Through the Regeneration. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2024. [PMID: 38842786 DOI: 10.1007/5584_2024_815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
Hard-to-heal wounds are an important public health issue worldwide, with a significant impact on the quality of life of patients. It is estimated that approximately 1-2% of the global population suffers from difficult wounds, which can be caused by a variety of factors such as trauma, infections, chronic diseases like diabetes or obesity, or poor health conditions. Hard-to-heal wounds are often characterized by a slow and complicated healing process, which can lead to serious complications such as infections, pressure ulcers, scar tissue formation, and even amputations. These complications can have a significant impact on the mobility, autonomy, and quality of life of patients, leading to an increase in healthcare and social costs associated with wound care. The preparation of the wound bed is a key concept in the management of hard-to-heal wounds, with the aim of promoting an optimal environment for healing. The TIME (Tissue, Infection/Inflammation, Moisture, Edge) model is a systematic approach used to assess and manage wounds in a targeted and personalized way. The concept of TIMER, expanding the TIME model, further focuses on regenerative processes, paying particular attention to promoting tissue regeneration and wound healing in a more effective and comprehensive way. The new element introduced in the TIMER model is "Regeneration", which highlights the importance of activating and supporting tissue regeneration processes to promote complete and lasting wound healing. Regenerative therapies can include a wide range of approaches, including cellular therapies, growth factors, bioactive biomaterials, stem cell therapies, and growth factor therapies. These therapies aim to promote the formation of new healthy tissues, reduce inflammation, improve vascularization, and stimulate cellular proliferation to accelerate wound closure and prevent complications. Thanks to continuous progress in research and development of regenerative therapies, more and more patients suffering from difficult wounds can benefit from innovative and promising solutions to promote faster and more effective healing, improve quality of life, and reduce the risk of long-term complications.
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Affiliation(s)
- Francesco De Francesco
- Department of Reconstructive Surgery and Hand Surgery, Azienda Ospedaliera Universitaria delle Marche, Ancona, Italy.
| | - Rei Ogawa
- Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School, Tokyo, Japan
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Jayram J, Kondaveeti SS, Gnanaraj Johnson C, Sampath PJ, Kalachaveedu M. Challenges and Prospects of Development of Herbal Biomaterial Based Ethical Wound Care Products-A Scoping Review. INT J LOW EXTR WOUND 2024; 23:291-305. [PMID: 34704490 DOI: 10.1177/15347346211052140] [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: 11/16/2022]
Abstract
Total wound care is an unmet therapeutic need considering the morbidity and mortality associated with the rising prevalence of nonhealing/chronic wounds. Current wound management fails to address all aspects/types of wounds despite the availability of scores of traditional and modern, investigational products. Traditional medicine drugs of wound healing repute validated to target multiple biological pathways and key events in the mammalian wound healing cascade, reportedly affecting wound healing phases. Advances in the development of biocomposite matrices and their analytical characterization warrant a relook at consolidating time-tested wound healing properties of herbal bioactives for prospective development as ethical wound care products. Aside from the bottlenecks of their multiconstituent profiling and clinical trial data generation, regulatory hurdles also cloister any systematic attempts at their re-engineering into clinical deliverables. In the context of national policy changes to bring in totally indigenous solutions, countries with a huge knowledge/material resource on wound healing bioactives need to essentially facilitate the same.
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Affiliation(s)
- Jayasutha Jayram
- Sri Ramachandra Faculty of Pharmacy, Sri Ramachandra Institute of Higher Education and Research, Chennai, TN, India
| | - Satish S Kondaveeti
- Sri Ramachandra Medical College and Research Institute, Sri Ramachandra Institute of Higher Education and Research, Chennai, TN, India
| | | | - Preethi J Sampath
- Sri Ramachandra Faculty of Pharmacy, Sri Ramachandra Institute of Higher Education and Research, Chennai, TN, India
| | - Mangathayaru Kalachaveedu
- Sri Ramachandra Faculty of Pharmacy, Sri Ramachandra Institute of Higher Education and Research, Chennai, TN, India
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Hecker A, Watzinger N, Pignet AL, Michelitsch B, Kotzbeck P, Kamolz LP. Ceramic Dressings-A New Non-Pharmacological Therapeutic Option in the Management of Chronic Wounds? J Pers Med 2024; 14:498. [PMID: 38793080 PMCID: PMC11122284 DOI: 10.3390/jpm14050498] [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: 04/16/2024] [Revised: 04/30/2024] [Accepted: 05/06/2024] [Indexed: 05/26/2024] Open
Abstract
A new ceramic dressing, free from active antimicrobial or pharmaceutical agents, uses physical binding mechanisms for its absorption capacities and bacterial-binding properties. The purpose of this study was to evaluate wound healing, bacterial-related retention, and diagnostic properties of ceramic dressings in patients with stagnated chronic wounds. METHODS In this monocentric, intra-individually controlled, prospective study, patients with conservatively treated refractory chronic wounds were enrolled. One week before the start of the application with ceramic dressing, it was ensured during a screening phase that chronic wounds showed less than a 10% reduction in wound size. During the 4-week ceramic dressing treatment wound size measurements, wound scoring, measurement of wound exudate amount, wound swabs, and ceramic dressing sonication (low-intensity ultrasound) were carried out. The sonication fluid of the removed ceramic dressing was used for analysis of bacterial retention and compared to wound swabs. RESULTS A total of 20 patients with a mean age of 64.6 years (±26.2) and 21 chronic wounds were included in this study. After a 4-week treatment, a significant reduction of median wound size from 1178 mm2 (range 104-6300) to 751.5 mm2 (range 16-4819) and better total wound scores were observed (p < 0.001). The sensitivity of bacteria detection was 90.7% in the sonication fluid from the ceramic dressings, while only 76.9% in the conventional wound swabs. CONCLUSION The new ceramic dressing seems to have a positive impact on wound healing in chronic wounds. Bacteria-binding characteristics of the investigated ceramic dressing, in combination with its debridement, absorption, and detoxification properties, could contribute to its healing abilities. Based on those results, the investigated ceramic dressing seems to be a promising new treatment option for chronic wounds without the use of any active antimicrobial or pharmacological agents. Moreover, ceramic dressings can also be considered for microbiological diagnostic purposes.
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Affiliation(s)
- Andrzej Hecker
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29/4, 8036 Graz, Austria; (A.H.); (L.-P.K.)
- COREMED—Centre for Regenerative Medicine and Precision Medicine, Joanneum Research Forschungsgesellschaft mbH, Neue Stiftingtalstraße 2, 8010 Graz, Austria
| | - Nikolaus Watzinger
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29/4, 8036 Graz, Austria; (A.H.); (L.-P.K.)
- COREMED—Centre for Regenerative Medicine and Precision Medicine, Joanneum Research Forschungsgesellschaft mbH, Neue Stiftingtalstraße 2, 8010 Graz, Austria
| | - Anna-Lisa Pignet
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29/4, 8036 Graz, Austria; (A.H.); (L.-P.K.)
- COREMED—Centre for Regenerative Medicine and Precision Medicine, Joanneum Research Forschungsgesellschaft mbH, Neue Stiftingtalstraße 2, 8010 Graz, Austria
| | - Birgit Michelitsch
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29/4, 8036 Graz, Austria; (A.H.); (L.-P.K.)
| | - Petra Kotzbeck
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29/4, 8036 Graz, Austria; (A.H.); (L.-P.K.)
- COREMED—Centre for Regenerative Medicine and Precision Medicine, Joanneum Research Forschungsgesellschaft mbH, Neue Stiftingtalstraße 2, 8010 Graz, Austria
| | - Lars-Peter Kamolz
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29/4, 8036 Graz, Austria; (A.H.); (L.-P.K.)
- COREMED—Centre for Regenerative Medicine and Precision Medicine, Joanneum Research Forschungsgesellschaft mbH, Neue Stiftingtalstraße 2, 8010 Graz, Austria
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Yilmaz Akyaz D, Cevizci T, Sengul T. Everyday Prevention: The Impact of Daily Comprehensive Skin Assessments on Pressure Injury Healing in the General ICU. Adv Skin Wound Care 2024; 37:248-253. [PMID: 38648237 DOI: 10.1097/asw.0000000000000143] [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: 04/25/2024]
Abstract
OBJECTIVE To investigate the effect of daily versus weekly comprehensive skin assessments on wound healing status in patients with pressure injuries (PIs) treated in the general ICU. METHODS This quasi-experimental study was conducted at a foundation hospital from November 15, 2022, to March 15, 2023. The sample consisted of 193 patients with PIs who met the inclusion criteria. The Braden Scale, Nutritional Risk Scale 2002 (NRS-2002), and Pressure Ulcer Scale for Healing (PUSH) were used. The intervention group (n = 98) underwent comprehensive skin assessment every day, whereas the control group (n = 95) followed routine procedures. The study findings were reported according to TREND (Transparent Reporting of Evaluations with Non-randomized Designs) guidelines. RESULTS Patients were older adults, with a mean age of 70 ± 15.45 years in the intervention group and 71 ± 13.20 years in the control group. The mean NRS-2002 score was 3 ± 2.01 in the intervention group and 2 ± 1.38 in the control group. Medical device-related PI incidence was high in both groups (intervention: 36.8%, control: 24.5%). In the intervention (14.3%) and control (50%) groups, PIs developed mostly due to antiembolic stockings. Deep-tissue PIs were the most common (intervention: 56.8%, control: 62.2%). The last PUSH scores decreased in both groups. The difference between the PUSH scores of the intervention and control groups was statistically significant (P < .05). CONCLUSIONS The findings of this study demonstrate the critical role of daily comprehensive skin assessment in the healing process of PIs. Especially in ICUs, the study provides compelling evidence for the need to prioritize and implement regular skin assessments to prevent PIs and support the healing process.
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Affiliation(s)
- Dilek Yilmaz Akyaz
- At Koç University Hospital, İstanbul, Turkey, Dilek Yilmaz Akyaz, MSc, RN, and Tugba Cevizci, RN, are Wound and Ostomy Care Nurses. Tuba Sengul, PhD, RN, CWON, is Associate Professor, Koç University. Acknowledgments: The authors thank all institutions and Sena Sukran Gura, Busra Serap Seyyar, and Nihan Tiryakioglu for their contributions to the study. The authors have disclosed no financial relationships related to this article. Submitted January 5, 2023; accepted in revised form March 14, 2023
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Dymarek R, Kuberka I, Walewicz K, Taradaj J, Rosińczuk J, Sopel M. Is Shock Wave Application Effective on Various Chronic Wounds in the Geriatric Population? Preliminary Clinical Study. Clin Interv Aging 2024; 19:665-679. [PMID: 38706636 PMCID: PMC11069372 DOI: 10.2147/cia.s448298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 04/01/2024] [Indexed: 05/07/2024] Open
Abstract
Purpose Extracorporeal shock wave therapy (ESWT) is a beneficial adjunct modality for chronic wounds. Limited research has been conducted on pressure ulcers (PUs), while the majority of studies have focused on diabetic foot ulcers (DFUs) and venous leg ulcers (VLUs). This study aimed to evaluate the short-term effects of radial ESWT in older adults with chronic wounds. Patients and Methods This study involved a total of 31 wounds: PUs (n=22), VLUs (n=7), and DFUs (n=2). A single radial ESWT was performed with 300 + 100 shocks per cm2, pressure of 2.5 bar, energy of 0.15 mJ/mm2, and frequency of 5 Hz. Assessments using digital planimetry and clinical methods, utilizing the Wound Bed Score (WBS) and the Bates-Jansen Wound Assessment Tool (BWAT) were performed before the radial ESWT application (M0) and one week after (M1). Results A significant wound decrease in planimetry was noted (pre-ESWT vs post-ESWT), with wound area from 9.4 cm2 to 6.2 cm2, length from 6.4 cm to 3.9 cm, and width from 2.8 cm to 2.1 cm (p<0.001). Additionally, a substantial clinical improvement was noted in both the WBS with a 31.25% increase and the BWAT with a 20.00% increase (p<0.001). It was also found a significant correlation between the planimetric and clinical outcomes for both tools: WBS (r=-0.446, p=0.012) and BWAT (r=0.327, p=0.073). Conclusion The ESWT application yields substantial immediate clinical effects that support the healing of chronic wounds in older adults. Even a single ESWT session can prove to be clinically effective and beneficial in the management of chronic wounds.
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Affiliation(s)
- Robert Dymarek
- Department of Physiotherapy, Wroclaw Medical University, Wroclaw, Poland
| | - Izabela Kuberka
- Division of Anaesthetic and Surgical Nursing, Wroclaw Medical University, Wroclaw, Poland
| | - Karolina Walewicz
- Medical Institute, Jan Grodek State University in Sanok, Sanok, Poland
| | - Jakub Taradaj
- Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education in Katowice, Katowice, Poland
| | - Joanna Rosińczuk
- Division of Internal Medicine Nursing, Wroclaw Medical University, Wroclaw, Poland
| | - Mirosław Sopel
- Faculty of Medicine, Wrocław University of Science and Technology, Wroclaw, Poland
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Richards SM, Gubser Keller C, Kreutzer R, Greiner G, Ley S, Doelemeyer A, Dubost V, Flandre T, Kirkland S, Carbone W, Pandya R, Knehr J, Roma G, Schuierer S, Bouchez L, Seuwen K, Aebi A, Westhead D, Hintzen G, Jurisic G, Hossain I, Neri M, Manevski N, Balavenkatraman KK, Moulin P, Begrich A, Bertschi B, Huber R, Bouwmeester T, Driver VR, von Schwabedissen M, Schaefer D, Wettstein B, Wettstein R, Ruffner H. Molecular characterization of chronic cutaneous wounds reveals subregion- and wound type-specific differential gene expression. Int Wound J 2024; 21:e14447. [PMID: 38149752 PMCID: PMC10958103 DOI: 10.1111/iwj.14447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 10/06/2023] [Accepted: 10/10/2023] [Indexed: 12/28/2023] Open
Abstract
A limited understanding of the pathology underlying chronic wounds has hindered the development of effective diagnostic markers and pharmaceutical interventions. This study aimed to elucidate the molecular composition of various common chronic ulcer types to facilitate drug discovery strategies. We conducted a comprehensive analysis of leg ulcers (LUs), encompassing venous and arterial ulcers, foot ulcers (FUs), pressure ulcers (PUs), and compared them with surgical wound healing complications (WHCs). To explore the pathophysiological mechanisms and identify similarities or differences within wounds, we dissected wounds into distinct subregions, including the wound bed, border, and peri-wound areas, and compared them against intact skin. By correlating histopathology, RNA sequencing (RNA-Seq), and immunohistochemistry (IHC), we identified unique genes, pathways, and cell type abundance patterns in each wound type and subregion. These correlations aim to aid clinicians in selecting targeted treatment options and informing the design of future preclinical and clinical studies in wound healing. Notably, specific genes, such as PITX1 and UPP1, exhibited exclusive upregulation in LUs and FUs, potentially offering significant benefits to specialists in limb preservation and clinical treatment decisions. In contrast, comparisons between different wound subregions, regardless of wound type, revealed distinct expression profiles. The pleiotropic chemokine-like ligand GPR15L (C10orf99) and transmembrane serine proteases TMPRSS11A/D were significantly upregulated in wound border subregions. Interestingly, WHCs exhibited a nearly identical transcriptome to PUs, indicating clinical relevance. Histological examination revealed blood vessel occlusions with impaired angiogenesis in chronic wounds, alongside elevated expression of genes and immunoreactive markers related to blood vessel and lymphatic epithelial cells in wound bed subregions. Additionally, inflammatory and epithelial markers indicated heightened inflammatory responses in wound bed and border subregions and reduced wound bed epithelialization. In summary, chronic wounds from diverse anatomical sites share common aspects of wound pathophysiology but also exhibit distinct molecular differences. These unique molecular characteristics present promising opportunities for drug discovery and treatment, particularly for patients suffering from chronic wounds. The identified diagnostic markers hold the potential to enhance preclinical and clinical trials in the field of wound healing.
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Affiliation(s)
| | | | - Robert Kreutzer
- Novartis Biomedical ResearchNovartis Pharma AGBaselSwitzerland
- Department of PathologyAnaPath Services GmbHLiestalSwitzerland
| | | | - Svenja Ley
- Novartis Biomedical ResearchNovartis Pharma AGBaselSwitzerland
| | - Arno Doelemeyer
- Novartis Biomedical ResearchNovartis Pharma AGBaselSwitzerland
| | - Valerie Dubost
- Novartis Biomedical ResearchNovartis Pharma AGBaselSwitzerland
| | - Thierry Flandre
- Novartis Biomedical ResearchNovartis Pharma AGBaselSwitzerland
| | - Susan Kirkland
- Novartis Biomedical ResearchNovartis Pharma AGBaselSwitzerland
- Harvantis Pharma Consulting LtdLondonUK
| | - Walter Carbone
- Novartis Biomedical ResearchNovartis Pharma AGBaselSwitzerland
- Research and Development CoordinatorELI TechGroup Corso SvizzeraTorinoItaly
| | - Rishika Pandya
- Novartis Biomedical ResearchNovartis Pharma AGBaselSwitzerland
| | - Judith Knehr
- Novartis Biomedical ResearchNovartis Pharma AGBaselSwitzerland
| | - Guglielmo Roma
- Novartis Biomedical ResearchNovartis Pharma AGBaselSwitzerland
- Discovery Data ScienceGSK VaccinesSienaItaly
| | - Sven Schuierer
- Novartis Biomedical ResearchNovartis Pharma AGBaselSwitzerland
| | - Laure Bouchez
- Novartis Biomedical ResearchNovartis Pharma AGBaselSwitzerland
- Therapeutics Department, Executive in ResidenceGeneral InceptionBaselSwitzerland
| | - Klaus Seuwen
- Novartis Biomedical ResearchNovartis Pharma AGBaselSwitzerland
| | - Alexandra Aebi
- Novartis Biomedical ResearchNovartis Pharma AGBaselSwitzerland
| | - David Westhead
- Leeds Institute of Data AnalyticsUniversity of LeedsLeedsUK
| | - Gabriele Hintzen
- Novartis Biomedical ResearchNovartis Pharma AGBaselSwitzerland
- Translational ScienceAffimed GmbHMannheimGermany
| | - Giorgia Jurisic
- Novartis Biomedical ResearchNovartis Pharma AGBaselSwitzerland
| | - Imtiaz Hossain
- Novartis Biomedical ResearchNovartis Pharma AGBaselSwitzerland
| | - Marilisa Neri
- Novartis Biomedical ResearchNovartis Pharma AGBaselSwitzerland
| | - Nenad Manevski
- Novartis Biomedical ResearchNovartis Pharma AGBaselSwitzerland
- Translational PKPD and Clinical Pharmacology, Pharmaceutical Sciences, pREDF. Hoffmann‐La Roche AGBaselSwitzerland
| | | | - Pierre Moulin
- Novartis Biomedical ResearchNovartis Pharma AGBaselSwitzerland
| | - Annette Begrich
- Novartis Biomedical ResearchNovartis Pharma AGBaselSwitzerland
| | | | - Roland Huber
- Novartis Biomedical ResearchNovartis Pharma AGBaselSwitzerland
| | | | - Vickie R. Driver
- Novartis Biomedical ResearchNovartis Pharma AGBaselSwitzerland
- INOVA HealthcareWound Healing and Hyperbaric CentersFalls ChurchVirginiaUSA
| | | | - Dirk Schaefer
- Plastic, Reconstructive, Aesthetic and Hand SurgeryUniversity Hospital BaselBaselSwitzerland
| | - Barbara Wettstein
- Plastic, Reconstructive, Aesthetic and Hand SurgeryUniversity Hospital BaselBaselSwitzerland
| | - Reto Wettstein
- Plastic, Reconstructive, Aesthetic and Hand SurgeryUniversity Hospital BaselBaselSwitzerland
| | - Heinz Ruffner
- Novartis Biomedical ResearchNovartis Pharma AGBaselSwitzerland
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10
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Richardson M, Mani R. Oxygen Saturation or Tissue Oxygen Determinations on Skin Whose Viability is at Risk. INT J LOW EXTR WOUND 2024; 23:55-62. [PMID: 37880945 DOI: 10.1177/15347346231206423] [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: 10/27/2023]
Abstract
The triad of ischaemia, neuropathy, and infection are among the principal causes of lower extremity wounds that are commonly prevalent in patients with diabetic foot (DF) a condition in which peripheral arterial disease commonly co-exists. The prevalence of this condition is increasing globally and with it, the mounting costs of its management. One aspect of management is saving limbs and or digits, a crucial part of this process is assessing tissue viability of skin which is a focus of this review: there are other aspects which are well described in the literature. Amputations are offered to limit the damage resulting from acute/chronic ischaemia. Holstein measured skin perfusion pressure using a radioisotope clearance technique to describe critically ischaemic skin; he found 30 mm Hg as the threshold above which healing may reliably be expected. Recent advances in vascular surgery and related technology have informed evidence-based advice to revascularize and save limbs; in practice, this may leave a wound in the distal skin unhealed; managing these raises questions of tissue viability. Much effort has been made to manage, prevent and to better understand these lower extremity wounds using measurements of tissue oxygen, oxygen saturation and skin imaging. The measurement techniques and their relevant merits are examined in this article. Advances in wound management systems and protocols can also facilitate the repair processes, and those which can have a particular impact on restoring or maintaining tissue perfusion are also discussed in the article.
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Affiliation(s)
| | - Raj Mani
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
- RIHES, Chiang Mai University, Chiang Mai, Thailand
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11
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Bazaliński D, Sieńczak K, Pytlak K, Przybek-Mita J, Pelczar K, Leppert W, Więch P. Pain Assessment in Patients Undergoing Maggot Debridement Therapy in the Process of Local Treatment of Chronic Wounds. J Clin Med 2024; 13:884. [PMID: 38337579 PMCID: PMC10856309 DOI: 10.3390/jcm13030884] [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: 12/21/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
(1) Background: Developing and implementing strategies for local wound care focused on improving the quality of life related to health status and reducing treatment costs for this patient group poses a challenge to contemporary healthcare systems. The utilization of Maggot Debridement Therapy (MDT) is one potential form of local therapy for preparing wounds for the healing process. The debridement of the wound bed with medical maggots is highly precise, and the defensins produced by the larvae eliminate bacteria and stimulate tissue regeneration. However, the presence of larvae in the wound may lead to the occurrence of pain symptoms. The aim of the study was to assess the intensity of pain during larval therapy in patients with chronic wounds treated in outpatient settings. (2) Patients and Methods: The study employed a diagnostic survey and estimation; the tool consisted of a research protocol comprising three parts (questionnaires). Inclusion criteria for the study were voluntary consent to participate (completion of the MDT acceptance questionnaire), chronic wounds of vascular etiology or pressure injuries, full-thickness skin or deep tissue damage, and pain intensity not exceeding four on the NRS (Numerical Rating Scale: 0-no pain, 10-the most severe pain) at the time of the study. Patient observation during the 3-day treatment was conducted by a wound care clinic nurse, assessing pain intensity once every 24 h during the larval dressing changes. (3) Results: Out of 348 individuals who qualified for MDT during the study period, 215 individuals participated in the study: 94 women (43.7%) and 121 men (56.3%). The age of the participants ranged from 28 to 97 years (mean 69.87 ± 12.95). Each participant experienced mild pain (2.26 ± 1.60 on the NRS) on the day of qualification for the study. An increase in pain intensity, according to subjective assessments, was reported by 29.3% of participants (n = 63). On the third day of MDT therapy, an increase in pain intensity was observed, reaching a mean value of 4.79 ± 2.12 (p < 0.0001). Participants with pressure injuries showed the lowest pain intensity, which increased in consecutive days for all types of wounds. Additionally, the increase in pain intensity in patients with vascular etiology wounds was greater compared to patients with pressure injuries (p < 0.001). (4) Conclusions: Local wound therapy with Lucilia sericata larvae increases pain intensity in the consecutive days of treatment. The wound area and the time since its occurrence may determine pain symptoms.
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Affiliation(s)
- Dariusz Bazaliński
- Institute of Health Sciences, College of Medical Sciences, University of Rzeszów, 35-959 Rzeszów, Poland; (D.B.); (K.P.); (J.P.-M.)
- Podkarpackie Specialist Oncology Centre, Father B. Markiewicz Specialist Hospital in Brzozów, 36-200 Brzozów, Poland;
| | - Karol Sieńczak
- Podkarpackie Specialist Oncology Centre, Father B. Markiewicz Specialist Hospital in Brzozów, 36-200 Brzozów, Poland;
- Institute of Medicine, Sanok State University, 38-500 Sanok, Poland
| | - Kamila Pytlak
- Institute of Health Sciences, College of Medical Sciences, University of Rzeszów, 35-959 Rzeszów, Poland; (D.B.); (K.P.); (J.P.-M.)
- Podkarpackie Specialist Oncology Centre, Father B. Markiewicz Specialist Hospital in Brzozów, 36-200 Brzozów, Poland;
| | - Joanna Przybek-Mita
- Institute of Health Sciences, College of Medical Sciences, University of Rzeszów, 35-959 Rzeszów, Poland; (D.B.); (K.P.); (J.P.-M.)
- Postgraduate Nursing and Midwifery Education Centre, 35-083 Rzeszów, Poland
| | - Klaudia Pelczar
- Independent Public Healthcare Institution, Ministry of Internal Affairs and Administration, 35-959 Rzeszów, Poland;
| | - Wojciech Leppert
- Institute of Medical Sciences, Collegium Medicum, University of Zielona Góra, 65-046 Zielona Góra, Poland;
- University Clinical Hospital in Poznań, 60-245 Poznań, Poland
| | - Paweł Więch
- Institute of Health Sciences, College of Medical Sciences, University of Rzeszów, 35-959 Rzeszów, Poland; (D.B.); (K.P.); (J.P.-M.)
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12
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Qiao B, Wang J, Qiao L, Maleki A, Liang Y, Guo B. ROS-responsive hydrogels with spatiotemporally sequential delivery of antibacterial and anti-inflammatory drugs for the repair of MRSA-infected wounds. Regen Biomater 2023; 11:rbad110. [PMID: 38173767 PMCID: PMC10761208 DOI: 10.1093/rb/rbad110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 11/15/2023] [Accepted: 12/02/2023] [Indexed: 01/05/2024] Open
Abstract
For the treatment of MRSA-infected wounds, the spatiotemporally sequential delivery of antibacterial and anti-inflammatory drugs is a promising strategy. In this study, ROS-responsive HA-PBA/PVA (HPA) hydrogel was prepared by phenylborate ester bond cross-linking between hyaluronic acid-grafted 3-amino phenylboronic acid (HA-PBA) and polyvinyl alcohol (PVA) to achieve spatiotemporally controlled release of two kinds of drug to treat MRSA-infected wound. The hydrophilic antibiotic moxifloxacin (M) was directly loaded in the hydrogel. And hydrophobic curcumin (Cur) with anti-inflammatory function was first mixed with Pluronic F127 (PF) to form Cur-encapsulated PF micelles (Cur-PF), and then loaded into the HPA hydrogel. Due to the different hydrophilic and hydrophobic nature of moxifloxacin and Cur and their different existing forms in the HPA hydrogel, the final HPA/M&Cur-PF hydrogel can achieve different spatiotemporally sequential delivery of the two drugs. In addition, the swelling, degradation, self-healing, antibacterial, anti-inflammatory, antioxidant property, and biocompatibility of hydrogels were tested. Finally, in the MRSA-infected mouse skin wound, the hydrogel-treated group showed faster wound closure, less inflammation and more collagen deposition. Immunofluorescence experiments further confirmed that the hydrogel promoted better repair by reducing inflammation (TNF-α) and promoting vascular (VEGF) regeneration. In conclusion, this HPA/M&Cur-PF hydrogel that can spatiotemporally sequential deliver antibacterial and anti-inflammatory drugs showed great potential for the repair of MRSA-infected skin wounds.
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Affiliation(s)
- Bowen Qiao
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi’an Jiaotong University, Xi’an 710049, China
- State Key Laboratory for Mechanical Behavior of Materials, Frontier Institute of Science and Technology, Xi’an Jiaotong University, Xi’an 710049, China
| | - Jiaxin Wang
- State Key Laboratory for Mechanical Behavior of Materials, Frontier Institute of Science and Technology, Xi’an Jiaotong University, Xi’an 710049, China
| | - Lipeng Qiao
- State Key Laboratory for Mechanical Behavior of Materials, Frontier Institute of Science and Technology, Xi’an Jiaotong University, Xi’an 710049, China
| | - Aziz Maleki
- Zanjan Pharmaceutical Nanotechnology Research Center (ZPNRC), Zanjan 45139-56184, Iran
| | - Yongping Liang
- State Key Laboratory for Mechanical Behavior of Materials, Frontier Institute of Science and Technology, Xi’an Jiaotong University, Xi’an 710049, China
| | - Baolin Guo
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi’an Jiaotong University, Xi’an 710049, China
- State Key Laboratory for Mechanical Behavior of Materials, Frontier Institute of Science and Technology, Xi’an Jiaotong University, Xi’an 710049, China
- Department of Orthopaedics, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, People’s Republic of China
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13
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Chuang ST, Lo SF, Liao PL, Lin PY, Tsay SF. Knowledge, attitude, perceived barriers of hard-to-healed wound care and the association with confidence: A cross-sectional study among community nurses. J Tissue Viability 2023; 32:487-492. [PMID: 37690960 DOI: 10.1016/j.jtv.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 08/16/2023] [Accepted: 08/24/2023] [Indexed: 09/12/2023]
Affiliation(s)
- Shu-Ting Chuang
- Taichung Tzu Chi Hospital and Department of Nursing, Tzu Chi University, Taiwan
| | - Shu-Fen Lo
- Department of Nursing, Tzu Chi University, Taiwan.
| | - Pei-Lin Liao
- Buddhist Tzu Chi Foundation Tzu Chi Taichung Home-Based Long-Term Care Facilities, Taiwan
| | - Pi-Yu Lin
- Buddhist Compassion Relief Tzu Chi Foundation, Taiwan
| | - Shwu-Feng Tsay
- General Department of Nursing and Health Care, Ministry of Health and Welfare, Taiwan; Department of Health Services Administration, College of Public Health, China Medical University, Taiwan
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14
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Luo Y, Mai L, Liu X, Yang C. Validity and reliability of Chinese version of the new diabetic foot ulcer assessment scale. Int Wound J 2023; 20:3724-3730. [PMID: 37264728 PMCID: PMC10588331 DOI: 10.1111/iwj.14266] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/20/2023] [Indexed: 06/03/2023] Open
Abstract
A specific assessment tool is urgently needed to guide effective wound care for diabetic foot ulcers. However, the tool has not been available in Chinese. We aimed to culturally translate and verify the validity and reliability of the new Diabetic Foot Ulcer Assessment Scale (DFUAS). The original scale was translated into Chinese according to the Brislin guidelines. Patients satisfying the inclusion and exclusion criteria were recruited. Each of the included foot ulcers was evaluated independently by two wound care specialists using the new DFUAS and by the third wound care specialists at the same time using the Bates-Jensen Wound Assessment Tool according to per guidelines. 210 diabetic foot ulcers were included for data analysis. The S-CVI of the Chinese version of the DFUAS was 0.96, and the I-CVIs ranged from 0.89 to 0.98. The total Cronbach's Alpha of the scale was 0.709, and the corrected item-total correlation of the items ranged from 0.4 to 0.872. The DFUAS had high inter-observer reliability of 0.997, and there were weak, moderate, and strong correlations between each pair of the items. The Bland-Altman plots showed a good agreement between the scale and the Bates-Jensen Wound Assessment Tool. We concluded that the Chinese version of the DFUAS showed good validity and reliability and is a reliable instrument for the assessment of diabetic foot ulcers.
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Affiliation(s)
- YiXin Luo
- School of NursingSun Yat‐sen UniversityGuangzhouChina
| | - LiFang Mai
- Department of Endocrinology, Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouChina
| | - XingZhou Liu
- Department of Endocrinology, Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Chuan Yang
- Department of Endocrinology, Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouChina
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15
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Mościcka P, Cwajda-Białasik J, Jawień A, Jaraczewski W, Szewczyk MT. Evaluation of factors affecting the healing process of venous ulcers: A 12-week longitudinal study. Wound Repair Regen 2023; 31:783-792. [PMID: 38073173 DOI: 10.1111/wrr.13140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 11/10/2023] [Accepted: 11/19/2023] [Indexed: 12/24/2023]
Abstract
The process of healing venous ulcers is complex and influenced by many factors. By identifying the risk factors that influence a slower healing process, it is possible to predict impending delays and plan an individualised care plan. We analysed our database of patients with venous ulcers and identified clinical and demographic factors that delay the healing process. The research analysed the medical records of 754 patients with VLUs at Chronic Wound Treatment Unit of the University Hospital treated between 2001 and 2019. In study, the majority (64.3%) were women, the mean age was 65.7 years. The median duration of Chronic Venous Insufficiency was 24 years, 52% patients had had the disease >20 years, and 296 (39.3%) had experienced ulceration >12 months. Most of the patients (85.8%) had comorbidities, 84% were obese. At 12-week follow-up, 432 of the 754 ulcers had healed. Identified independent predictors of slower ulcer healing rates: wound area greater than 8.25 cm2 , location of the ulceration other than the medial ankle area, underlying disease >20 years, the presence of multiple comorbidities, depth of the ulcer, the presence of an unpleasant smell and alert pathogens. The presence of redness resulted in faster healing of VLUc. Many factors influence the healing process of venous ulceration. The results of the study can help in planning patient care and implementing appropriate early strategies to promote healing.
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Affiliation(s)
- Paulina Mościcka
- Department of Perioperative Nursing, Department of Surgical Nursing and Chronic Wound Care, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
- Outpatient Department for Chronic Wound Management, Antoni Jurasz University Hospital No. 1, Bydgoszcz, Poland
| | - Justyna Cwajda-Białasik
- Department of Perioperative Nursing, Department of Surgical Nursing and Chronic Wound Care, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
- Outpatient Department for Chronic Wound Management, Antoni Jurasz University Hospital No. 1, Bydgoszcz, Poland
| | - Arkadiusz Jawień
- Department of Vascular Surgery and Angiology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
| | - Wojciech Jaraczewski
- Department of Vascular Surgery and Angiology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
| | - Maria T Szewczyk
- Department of Perioperative Nursing, Department of Surgical Nursing and Chronic Wound Care, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
- Outpatient Department for Chronic Wound Management, Antoni Jurasz University Hospital No. 1, Bydgoszcz, Poland
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16
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Oprita EI, Iosageanu A, Craciunescu O. Natural Polymeric Hydrogels Encapsulating Small Molecules for Diabetic Wound Healing. Gels 2023; 9:867. [PMID: 37998956 PMCID: PMC10671021 DOI: 10.3390/gels9110867] [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: 09/26/2023] [Revised: 10/18/2023] [Accepted: 10/26/2023] [Indexed: 11/25/2023] Open
Abstract
Diabetes is a condition correlated with a high number of diagnosed chronic wounds as a result of a complex pathophysiological mechanism. Diabetic chronic wounds are characterized by disorganized and longer stages, compared to normal wound healing. Natural polymer hydrogels can act as good wound dressings due to their versatile physicochemical properties, represented mainly by high water content and good biocompatibility. Natural bioactive hydrogels are polymers loaded with bioactive compounds providing antibacterial and antioxidant properties, modulation of inflammation and adherence to wounded tissue, compared to traditional dressings, which enables promising future applications for diabetic wound healing. Natural bioactive compounds, such as polyphenols, polysaccharides and proteins have great advantages in promoting chronic wound healing in diabetes due to their antioxidant, anti-inflammatory, antimicrobial, anti-allergic and wound healing properties. The present paper aims to review the wound healing mechanisms underlining the main issues of chronic wounds and those specifically occurring in diabetes. Also, the review highlights the recent state of the art related to the effect of hydrogels enriched with natural bioactive compounds developed as biocompatible functional materials for improving diabetic-related chronic wound healing and providing novel therapeutic strategies that could prevent limb amputation and increase the quality of life in diabetic patients.
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Grants
- Program Nucleu, project no. 23020101/2023 Ministry of Research, Innovation and Digitalization, Romania
- Program 1, Development of the National R&D System, Subprogram 1.2, Institutional Performance, Projects for Excellence Financing in RDI, contract no. 2PFE/2021. Ministry of Research, Innovation and Digitalization, Romania
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Affiliation(s)
- Elena Iulia Oprita
- National Institute of R&D for Biological Sciences, 296, Splaiul Independentei, 060031 Bucharest, Romania; (A.I.); (O.C.)
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17
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Michelucci A, Salvia G, Janowska A, Granieri G, Morganti R, Dini V, Romanelli M. Fluorescence-Based Evaluation of Bacterial Load in Perilesional Skin: A Comparison Between Short Stretch Bandage and Zinc Oxide Bandage. INT J LOW EXTR WOUND 2023:15347346231206449. [PMID: 37844622 DOI: 10.1177/15347346231206449] [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: 10/18/2023]
Abstract
Bacterial proliferation plays a well-known role in delayed tissue healing. To date, the presence of microorganisms on the wound bed can be detected by skin swabs or skin biopsies. A novel noninvasive fluorescence imaging device has recently allowed real-time detection of bacteria in different types of wounds through endogenous autofluorescence. The fluorescence signals detected by the device provide health workers with a visual indication of the presence, load, and distribution of bacteria. The aim of our study was to evaluate the level of bacterial colonization in perilesional skin of patients affected by venous leg ulcers treated with 2 different types of bandages: short stretch bandage and zinc oxide bandage. We conducted a monocentric prospective study, enrolling 30 patients with venous leg ulcers, divided into 2 groups: group A was treated with short stretch bandage and group B with zinc oxide bandage. A complete patient's assessment was performed once a week for 3 weeks. Levels of potentially harmful bacteria in perilesional skin were detected using a fluorescent device by 2 experienced operators on the frames taken at individual injuries, while pain was evaluated with the Numerical Rating Scale. After 3 weeks, we observed a reduction in the bacterial colonization levels of the perilesional skin by 68.67% for group A and 85.54% for group B. All the patients had a statistically significant reduction in bacterial load (P < .001), and a statistically significant difference was identified between the 2 groups (P = .043). No statistically significant differences were found between the 2 groups in terms of pain relief (P = .114). Our study demonstrated that the application of zinc oxide bandage provides a higher reduction in bacterial load perilesional skin. On the other hand, we found no difference between the 2 bandages in terms of pain symptom reduction.
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Affiliation(s)
| | - Giorgia Salvia
- Department of Dermatology, University of Pisa, Pisa, Italy
| | - Agata Janowska
- Department of Dermatology, University of Pisa, Pisa, Italy
| | | | - Riccardo Morganti
- Statistical Support to Clinical Trials Department, University of Pisa, Pisa, Italy
| | - Valentina Dini
- Department of Dermatology, University of Pisa, Pisa, Italy
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18
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Nnadozie UU, Maduba CC, Modekwe VI, Obayi NOK, Amu OC, Onyebum OV, Sunday-Nweke NA, Unigwe USD, Obasi UA. Wound bed preparation using nonsurgical methods: A prospective comparative study of honey versus unripe papaya ( Carica papaya). Ann Afr Med 2023; 22:515-519. [PMID: 38358154 PMCID: PMC10775929 DOI: 10.4103/aam.aam_10_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 02/24/2023] [Accepted: 07/31/2023] [Indexed: 02/16/2024] Open
Abstract
Background The rapidity of wound bed preparation is determined in part by the type of dressing agent employed. The extension phase in which the wound is characterized by the presence of sloughs and eschar and microbial invasion could be managed nonsurgically. Objective The objective of this study was to compare the rapidity of wound bed preparation using unripe papaya versus honey. Materials and Methods Sixty-four patients were assigned into two equal groups, each dressed, respectively, with unripe papaya or honey. All selected patients were monitored for eschar separation and bacterial clearance time. Data obtained with a pro forma were analyzed with SPSS version 25. Results Unripe papaya dressing had a mean eschar separation time of 5.53 ± 2.20 days and bacterial clearance time of 6.81 ± 3.64 days compared to the honey group which had an eschar separation time of 30.09 ± 27.90 days and bacterial clearance time of 15.33 ± 13.62 days. P <0.001 and P < 0.001, respectively, in comparing both outcome measures between the two groups. There was a statistically significant difference in both eschar/slough separation time and bacterial clearance time both in favor of the group prepared with unripe papaya. Conclusion The use of unripe papaya was superior to honey in wound bed preparation with respect to eschar/slough separation, bacterial clearance ultimately resulting in reduced length of hospital stay.
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Affiliation(s)
- Ugochukwu Uzodimma Nnadozie
- Division of Plastic Surgery, Department of Surgery, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi, Nigeria
- College of Health Sciences, Ebonyi State University, Abakaliki, Ebonyi, Nigeria
| | - Charles Chidiebele Maduba
- Division of Plastic Surgery, Department of Surgery, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi, Nigeria
| | - Victor Ifeanyichukwu Modekwe
- Pediatrics Surgery Unit, Department of Surgery, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra, Nigeria
| | | | | | | | - Nneka Alice Sunday-Nweke
- Department of Surgery, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi, Nigeria
| | - Uche S. D. Unigwe
- Infectious Disease Unit, Department of Medicine, University of Nigeria Teaching Hospital Enugu, Enugu, Nigeria
| | - Ulebe Augustine Obasi
- Department of Surgery, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi, Nigeria
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Popescu V, Cauni V, Petrutescu MS, Rustin MM, Bocai R, Turculet CR, Doran H, Patrascu T, Lazar AM, Cretoiu D, Varlas VN, Mastalier B. Chronic Wound Management: From Gauze to Homologous Cellular Matrix. Biomedicines 2023; 11:2457. [PMID: 37760898 PMCID: PMC10525626 DOI: 10.3390/biomedicines11092457] [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: 07/17/2023] [Revised: 08/18/2023] [Accepted: 08/25/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Chronic wounds are a significant health problem with devastating consequences for patients' physical, social, and mental health, increasing healthcare systems' costs. Their prolonged healing times, economic burden, diminished quality of life, increased infection risk, and impact on patients' mobility and functionality make them a major concern for healthcare professionals. PURPOSE This review offers a multi-perspective analysis of the medical literature focusing on chronic wound management. METHODS USED We evaluated 48 articles from the last 21 years registered in the MEDLINE and Global Health databases. The articles included in our study had a minimum of 20 citations, patients > 18 years old, and focused on chronic, complex, and hard-to-heal wounds. Extracted data were summarized into a narrative synthesis using the same health-related quality of life instrument. RESULTS We evaluated the efficacy of existing wound care therapies from classical methods to modern concepts, and wound care products to regenerative medicine that uses a patient's pluripotent stem cells and growth factors. Regenerative medicine and stem cell therapies, biologic dressings and scaffolds, negative pressure wound therapy (NPWT), electrical stimulation, topical growth factors and cytokines, hyperbaric oxygen therapy (HBOT), advanced wound dressings, artificial intelligence (AI), and digital wound management are all part of the new arsenal of wound healing. CONCLUSION Periodic medical evaluation and proper use of modern wound care therapies, including the use of plasma-derived products [such as platelet-rich plasma (PRP) and platelet-rich fibrin (PRF)] combined with proper systemic support (adequate protein levels, blood sugar, vitamins involved in tissue regeneration, etc.) are the key to a faster wound healing, and, with the help of AI, can reach the fastest healing rate possible.
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Affiliation(s)
- Valentin Popescu
- General Surgery Clinic, Colentina Clinical Hospital, 020125 Bucharest, Romania; (V.P.); (M.S.P.); (A.M.L.); (B.M.)
- General Surgery Department, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; (M.M.R.); (R.B.); (C.R.T.); (H.D.); (T.P.)
| | - Victor Cauni
- Urology Clinic, Colentina Clinical Hospital, 020125 Bucharest, Romania;
| | - Marius Septimiu Petrutescu
- General Surgery Clinic, Colentina Clinical Hospital, 020125 Bucharest, Romania; (V.P.); (M.S.P.); (A.M.L.); (B.M.)
| | - Maria Madalina Rustin
- General Surgery Department, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; (M.M.R.); (R.B.); (C.R.T.); (H.D.); (T.P.)
| | - Raluca Bocai
- General Surgery Department, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; (M.M.R.); (R.B.); (C.R.T.); (H.D.); (T.P.)
| | - Cristina Rachila Turculet
- General Surgery Department, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; (M.M.R.); (R.B.); (C.R.T.); (H.D.); (T.P.)
| | - Horia Doran
- General Surgery Department, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; (M.M.R.); (R.B.); (C.R.T.); (H.D.); (T.P.)
- Prof. I. Juvara General Surgery Clinic, Dr. I. Cantacuzino Clinical Hospital, 011437 Bucharest, Romania
| | - Traian Patrascu
- General Surgery Department, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; (M.M.R.); (R.B.); (C.R.T.); (H.D.); (T.P.)
- Prof. I. Juvara General Surgery Clinic, Dr. I. Cantacuzino Clinical Hospital, 011437 Bucharest, Romania
| | - Angela Madalina Lazar
- General Surgery Clinic, Colentina Clinical Hospital, 020125 Bucharest, Romania; (V.P.); (M.S.P.); (A.M.L.); (B.M.)
- General Surgery Department, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; (M.M.R.); (R.B.); (C.R.T.); (H.D.); (T.P.)
| | - Dragos Cretoiu
- Fetal Medicine Excellence Research Center, Alessandrescu-Rusescu National Institute for Mother and Child Health, 020395 Bucharest, Romania
- Department of Genetics, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania
| | - Valentin Nicolae Varlas
- Department of Obstetrics and Gynaecology, Filantropia Clinical Hospital, 011171 Bucharest, Romania
- Department of Obstetrics and Gynaecology, Carol Davila University of Medicine and Pharmacy, 37 Dionisie Lupu St., 020021 Bucharest, Romania
| | - Bogdan Mastalier
- General Surgery Clinic, Colentina Clinical Hospital, 020125 Bucharest, Romania; (V.P.); (M.S.P.); (A.M.L.); (B.M.)
- General Surgery Department, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; (M.M.R.); (R.B.); (C.R.T.); (H.D.); (T.P.)
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Somani AK, Atkin L, Bechara FG, Davidson JM, Jeffery S, Mostow E, Simman R, Armstrong DG, Karatzias A, Martínez JLL, Milne J, de Ceniga MV. Practical applications of small intestine submucosa extracellular matrix (SIS-ECM) an expert panel consensus. J Wound Care 2023; 32:S1-S16. [PMID: 37703212 DOI: 10.12968/jowc.2023.32.sup9b.s1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Affiliation(s)
- Ally-Khan Somani
- Director of Dermatologic Surgery and Cutaneous Oncology Division; Assistant Professor, Department of Dermatology; and Adjunct Assistant Professor of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, US
| | - Leanne Atkin
- Vascular Nurse Consultant, Mid Yorkshire Hospitals NHS Trust, Yorkshire, UK
| | - Falk G Bechara
- Head of the Department of Dermatologic Surgery, Ruhr-University, Bochum, Germany
| | - Jeffrey M Davidson
- Emeritus Professor of Pathology, Microbiology and Immunology, Vanderbilt University, School of Medicine, Nashville, Tennessee, US
| | - Steve Jeffery
- Professor of Wound Study, Birmingham, City University; Medical Director, Pioneer Wound, Telehealth, Birmingham, UK
| | - Eliot Mostow
- Head of the Dermatology Section, Northeast Ohio Medical University; Clinical Faculty, Case Western University, Ohio, US
| | - Richard Simman
- Professor of Plastic Surgery, University of Toledo College of Medicine and Life, Sciences; Jobst Vascular Institute, ProMedica Health, System, Toledo, Ohio, US
| | - David G Armstrong
- Professor of Surgery and Director of the Limb Preservation Program, University of Southern California, US
| | | | - José Luis Lázaro Martínez
- Tenured Professor and Clinical Director of the Diabetic Foot Unit, Complutense University of Madrid, Spain
| | - Jeanette Milne
- Clinical Lead for Tissue Viability, Northumbria Healthcare NHS Foundation Trust, UK
| | - Melina Vega de Ceniga
- Consultant Angiologist and Vascular and Endovascular Surgeon, Galdakao‑Usansolo Hospital, Bizkaia, Spain
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21
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Shi M, Lu Y, Mohyeddin A, Qi F, Pan Y. Preservation of Eschar Prevents Excessive Wound Healing by Reducing M2 Macrophages Polarization. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5238. [PMID: 37731728 PMCID: PMC10508428 DOI: 10.1097/gox.0000000000005238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/11/2023] [Indexed: 09/22/2023]
Abstract
Background Removal of the eschar has gradually become a consensus on treatments of deep dermal necrosis after skin trauma in recent years, whereas exaggerated scar contracture and tissue proliferation developed during healing have received little attention. Here, the authors investigated the effects of eschar on excessive wound healing of small dermal damage and focused on the role M2 macrophages played, hoping to offer a theoretical basis to improve patients' cosmetic satisfaction. Methods A mouse dorsal wound model (n = 12) was established by electric heating pads heating for 20 seconds on each side of the spine, and the left side was the preserved group. Macrophage numbers, expression of wound-healing-associated proteins, and inflammatory cytokine levels were assessed at different time points by immunohistochemistry and quantitative real-time polymerase chain reaction. A co-culture system of M2 macrophages and myofibroblasts was created in vitro. Immunohistochemistry, real-time polymerase chain reaction, and Western blot were performed to evaluate the proliferation, migration, and protein expression of myofibroblasts. Results Preserving eschar inhibited contraction-associated proteins (α-smooth muscle actin and vimentin) and collagen expression, inflammatory cytokine (IL-1β, IL-10, TFN-α, and IL-4) expression, and M2 macrophage infiltration. Mechanistically, M2 macrophages potentially contributed to excessive wound healing by promoting myofibroblasts proliferation, migration, and production of contraction-associated proteins. Conclusion Eschar preservation in wounds could reduce inflammation and negatively modulate myofibroblasts by inhibiting M2 macrophage polarization and infiltration, preventing excessive wound contraction and collagen deposition.
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Affiliation(s)
- Mingyue Shi
- From the Department of Plastic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yao Lu
- From the Department of Plastic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ali Mohyeddin
- From the Department of Plastic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Fazhi Qi
- From the Department of Plastic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yuyan Pan
- From the Department of Plastic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
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22
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Learned A, Robinson SA, Nguyen TT. Comprehensive Care of Lower-Extremity Wounds. Surg Clin North Am 2023; 103:745-765. [PMID: 37455035 DOI: 10.1016/j.suc.2023.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
There are 5 common types of chronic nonhealing lower-extremity wounds: arterial, venous, diabetic foot ulcer, pressure, and mixed or atypical. Each chronic wound type has distinct features, and understanding the underlying cause will dictate the wound treatment plan. Here, the authors review the distinguishing wound properties for these 5 common chronic nonhealing lower-extremity wounds and outline a comprehensive treatment plan that addresses wound perfusion, debridement, infection control, moisture balance, and use of complementary advanced wound care products.
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Affiliation(s)
- Allison Learned
- Department of Surgery, Division of Vascular Surgery, University of Massachusetts Chan Medical School, 55 North Lake Avenue, Worcester, MA 01655, USA
| | - Sudie-Ann Robinson
- Department of Surgery, Division of Vascular Surgery, University of Massachusetts Chan Medical School, 55 North Lake Avenue, Worcester, MA 01655, USA
| | - Tammy T Nguyen
- Department of Surgery, Division of Vascular Surgery, University of Massachusetts Chan Medical School, 55 North Lake Avenue, Worcester, MA 01655, USA; University of Massachusetts Diabetes Center of Excellence.
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23
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Xu X, Zhou Y, Huang Y, Le Q, Lin L, Yu Z. Nursing Management of Abdominal Wound Dehiscence of an Infant With Severe Undernutrition and Peristomal Moisture-Associated Dermatitis After Ileostomy Closure: A Case Study. J Wound Ostomy Continence Nurs 2023; 50:331-336. [PMID: 37467414 DOI: 10.1097/won.0000000000000987] [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: 07/21/2023]
Abstract
BACKGROUND Abdominal wound dehiscence (AWD) is a costly postoperative complication; its management is particularly challenging for WOC nurses when it occurs secondary to an ostomy closure. CASE We present a case of AWD secondary to ileostomy closure in Baby Q, a 9-month 19-day-old female infant. A silver wound contact dressing was used on her dehisced wound followed by negative pressure wound therapy and adhesive tape to pull the wound edge together and promote granulation. We used a combination of enteral nutrition, parenteral nutrition, total parenteral nutrition, and total enteral nutrition adjusting the feeding plan stepwise according to her nutritional status. CONCLUSIONS Malnutrition and severe peristomal skin complications may contribute to the risk of AWD in infants undergoing reversal of a temporary ostomy. Assessing and treating nutritional status and peristomal skin is imperative before performing ostomy closure.
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Affiliation(s)
- Xiaofeng Xu
- Xiaofeng Xu, BSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Yiwen Zhou, MSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Ying Huang, MD, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Qian Le, BSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Lili Lin, BSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Zhuowen Yu, RN, MSN, WON, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Yiwen Zhou
- Xiaofeng Xu, BSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Yiwen Zhou, MSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Ying Huang, MD, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Qian Le, BSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Lili Lin, BSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Zhuowen Yu, RN, MSN, WON, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Ying Huang
- Xiaofeng Xu, BSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Yiwen Zhou, MSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Ying Huang, MD, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Qian Le, BSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Lili Lin, BSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Zhuowen Yu, RN, MSN, WON, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Qian Le
- Xiaofeng Xu, BSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Yiwen Zhou, MSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Ying Huang, MD, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Qian Le, BSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Lili Lin, BSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Zhuowen Yu, RN, MSN, WON, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Lili Lin
- Xiaofeng Xu, BSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Yiwen Zhou, MSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Ying Huang, MD, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Qian Le, BSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Lili Lin, BSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Zhuowen Yu, RN, MSN, WON, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Zhuowen Yu
- Xiaofeng Xu, BSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Yiwen Zhou, MSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Ying Huang, MD, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Qian Le, BSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Lili Lin, BSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Zhuowen Yu, RN, MSN, WON, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
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Derwin R, Patton D, Strapp H, Moore Z. Wound pH and temperature as predictors of healing: an observational study. J Wound Care 2023; 32:302-310. [PMID: 37094930 DOI: 10.12968/jowc.2023.32.5.302] [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] [Indexed: 04/26/2023]
Abstract
OBJECTIVE The aim of this study was to measure wound pH, wound temperature and wound size together to gain further understanding of their impact as predictors of wound healing outcomes. METHOD This study employed a quantitative non-comparative, prospective, descriptive observational design. Participants with both acute and hard-to-heal (chronic) wounds were observed weekly for four weeks. Wound pH was measured using pH indicator strips, wound temperature was measured using an infrared camera and wound size was measured using the ruler method. RESULTS Most of the 97 participants (65%, n=63) were male; participant's ages ranged between 18 and 77 years (mean: 42±17.10. Most of the wounds observed were surgical 60%, (n=58) and 72% (n=70) of the wounds were classified as acute, with 28% (n=27) classified as hard-to-heal wounds. At baseline, there was no significant difference in pH between acute and hard-to-heal wounds; overall the mean pH was 8.34±0.32, mean temperature was 32.86±1.78°C) and mean wound area was 910.50±1132.30mm2. In week 4, mean pH was 7.71±1.11, mean temperature was 31.90±1.76°C and mean wound area was 339.90±511.70mm2. Over the study follow-up period, wound pH ranged from 5-9, from week 1 to week 4, mean pH reduced by 0.63 units from 8.34 to 7.71. Furthermore, there was a mean 3% reduction in wound temperature and a mean 62% reduction in wound size. CONCLUSION The study demonstrated that a reduction in pH and temperature was associated with increased wound healing as evidenced by a corresponding reduction in wound size. Thus, measuring pH and temperature in clinical practice may provide clinically meaningful data pertaining to wound status.
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Affiliation(s)
- Rosemarie Derwin
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin
| | - Declan Patton
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin
- Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
- Faculty of Science, Medicine and Health, University of Wollongong, Australia
| | | | - Zena Moore
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin
- School of Nursing & Midwifery, Griffith University, Queensland, Australia
- School of Health Sciences, Faculty of Life and Health Sciences Ulster University, Northern Ireland
- Cardiff University, Cardiff, Wales
- Department of Nursing, Fakeeh College for Medical Sciences, Jeddah, KSA
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Belgium
- Lida Institute, Shanghai, China
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25
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Derwin R, Patton D, Strapp H, Moore Z. The effect of inflammation management on pH, temperature, and bacterial burden. Int Wound J 2023; 20:1118-1129. [PMID: 36251505 PMCID: PMC10031221 DOI: 10.1111/iwj.13970] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 11/28/2022] Open
Abstract
The aim of this feasibility study was to investigate the impact of inflammation management on wound pH, temperature, and bacterial burden, using the principles of TIME and Wound Bed Preparation. A quantitative non-comparative, prospective, descriptive observational design. Following ethical approval, 26 participants with 27 wounds of varying aetiologies were observed twice weekly for 2 weeks. Wounds were treated with cleansing, repeated sharp debridement, and topical cadexomer iodine. Wound pH (pH indicator strips), temperature (infrared camera), bacterial burden (fluorescence imaging) and size (ruler method) was monitored at each visit. The mean age of all participants was 47 years (SD: 20.3 years), and 79% (n = 19) were male, and most wounds were acute (70%; n = 19) and included surgical and trauma wounds, the remaining (30%; n = 8) were chronic and included vascular ulcers and non-healing surgical wounds. Mean wound duration was 53.88 days (SD: 64.49 days). Over the follow up period, pH values ranged from 6 to 8.7, temperature (centre spot) ranged from 28.4°C to 36.4°C and there was an average 39% reduction in wound size. Inflammation management had a positive effect on pH, temperature, bacterial burden, and wound size. This study demonstrated that it was feasible to practice inflammation management using a structured approach to enhance wound outcomes.
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Affiliation(s)
- Rosemarie Derwin
- School of Nursing and Midwifery, Faculty of Medicine and Health, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland
| | - Declan Patton
- School of Nursing and Midwifery, Faculty of Medicine and Health, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland
- Department of Nursing, Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Helen Strapp
- Department of Surgery, Tallaght University Hospital, Dublin, Ireland
| | - Zena Moore
- School of Nursing and Midwifery, Faculty of Medicine and Health, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
- School of Health Sciences, Faculty of Life and Health Sciences Ulster University, Coleraine, UK
- School of Nursing and Midwifery, Cardiff University, Cardiff, UK
- Department of Nursing, Fakeeh College for Medical Sciences, Jeddah, Kingdom of Saudi Arabia
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Departmnet of Nursing, Lida Institute, Shanghai, China
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26
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Li H, Li B, Lv D, Li W, Lu Y, Luo G. Biomaterials releasing drug responsively to promote wound healing via regulation of pathological microenvironment. Adv Drug Deliv Rev 2023; 196:114778. [PMID: 36931347 DOI: 10.1016/j.addr.2023.114778] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/06/2022] [Accepted: 03/10/2023] [Indexed: 03/17/2023]
Abstract
Wound healing is characterized by complex, orchestrated, spatiotemporal dynamic processes. Recent findings demonstrated suitable local microenvironments were necessities for wound healing. Wound microenvironments include various biological, biochemical and physical factors, which are produced and regulated by endogenous biomediators, exogenous drugs, and external environment. Successful drug delivery to wound is complicated, and need to overcome the destroyed blood supply, persistent inflammation and enzymes, spatiotemporal requirements of special supplements, and easy deactivation of drugs. Triggered by various factors from wound microenvironment itself or external elements, stimuli-responsive biomaterials have tremendous advantages of precise drug delivery and release. Here, we discuss recent advances of stimuli-responsive biomaterials to regulate local microenvironments during wound healing, emphasizing on the design and application of different biomaterials which respond to wound biological/biochemical microenvironments (ROS, pH, enzymes, glucose and glutathione), physical microenvironments (mechanical force, temperature, light, ultrasound, magnetic and electric field), and the combination modes. Moreover, several novel promising drug carriers (microbiota, metal-organic frameworks and microneedles) are also discussed.
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Affiliation(s)
- Haisheng Li
- Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injury, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Buying Li
- Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injury, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Dalun Lv
- Department of Burn and Plastic Surgery, First Affiliated Hospital of Wannan Medical College, Wuhu City, China; Beijing Jayyalife Biological Technology Company, Beijing, China
| | - Wenhong Li
- Beijing Jayyalife Biological Technology Company, Beijing, China
| | - Yifei Lu
- Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injury, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.
| | - Gaoxing Luo
- Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injury, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.
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27
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Liao X, Li SH, El Akkawi MM, Fu XB, Liu HW, Huang YS. Surgical amputation for patients with diabetic foot ulcers: A Chinese expert panel consensus treatment guide. Front Surg 2022; 9:1003339. [PMID: 36425891 PMCID: PMC9679004 DOI: 10.3389/fsurg.2022.1003339] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/19/2022] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Diabetic foot disease is a serious complication of diabetes mellitus. Patients with diabetes mellitus have a 25% lifetime risk for developing a foot ulcer, and between 14% and 24% of patients require a major or minor lower limb amputation due to severe gangrene. However, decisions concerning whether to amputate or whether to perform a major or minor lower limb amputation, and how best to determine the amputation plane remain unclear. METHODS To consolidate the current literature with expert opinion to make recommendations that will guide surgical amputation for patients with diabetic foot ulcers. A total of 23 experts experienced in surgical treatment of patients with diabetic foot ulcers formed an expert consensus panel, and presented the relevant evidence, discussed clinical experiences, and derived consensus statements on surgical amputation for patients with diabetic foot ulcers. Each statement was discussed and revised until a unanimous consensus was achieved. RESULTS A total of 16 recommendations for surgical amputation for patients with diabetic foot ulcers were formulated. The experts believe that determination of the amputation plane should be comprehensively evaluated according to a patient's general health status, the degree of injury, and the severity of lower limb vasculopathy. The Wagner grading system and the severity of diabetic lower extremity artery disease are important criteria when determining the degree of amputation. The severity of both diabetic foot infection and systemic underlying diseases are important factors when considering appropriate treatment. Moreover, consideration should also be given to a patient's socioeconomic status. Given the complexities of treating the diabetic foot, relevant issues in which consensus could not be reached will be discussed and revised in future. CONCLUSION This expert consensus could be used to guide doctors in clinical practice, and help patients with diabetic foot ulcers gain access to appropriate amputation treatment.
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Affiliation(s)
- Xuan Liao
- Department of Plastic Surgery of the First Affiliated Hospital of Jinan University, Institute of New Technology of Plastic Surgery of Jinan University, Key Laboratory of Regenerative Medicine of Ministry of Education, Guangzhou, China
| | - Sheng-Hong Li
- Department of Plastic Surgery of the First Affiliated Hospital of Jinan University, Institute of New Technology of Plastic Surgery of Jinan University, Key Laboratory of Regenerative Medicine of Ministry of Education, Guangzhou, China
| | - Mariya Mohamad El Akkawi
- Department of Plastic Surgery of the First Affiliated Hospital of Jinan University, Institute of New Technology of Plastic Surgery of Jinan University, Key Laboratory of Regenerative Medicine of Ministry of Education, Guangzhou, China
| | - Xiao-bing Fu
- Wound Healing and Cell Biology Laboratory, Institute for Basic Research, Trauma Center of Postgraduate Medical College, General Hospital of PLA, Beijing, China
| | - Hong-wei Liu
- Department of Plastic Surgery of the First Affiliated Hospital of Jinan University, Institute of New Technology of Plastic Surgery of Jinan University, Key Laboratory of Regenerative Medicine of Ministry of Education, Guangzhou, China
| | - Yue-sheng Huang
- Department of Wound Repair; Institute of Wound Repair and Regeneration Medicine, Southern University of Science and Technology Hospital, Southern University of Science and Technology School of Medicine, Shenzhen, China
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28
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Markov PA, Vinogradov II, Kostromina E, Eremin PS, Gilmutdinova IR, Kudryashova IS, Greben A, Rachin AP, Nechaev AN. A wound dressing based on a track-etched membrane modified by a biopolymer nanoframe: physical, chemical, and biological characteristics. Eur Polym J 2022. [DOI: 10.1016/j.eurpolymj.2022.111709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Yang L, Guo J, He J, Shao J. Skin grafting treatment of adolescent lower limb avulsion injury. Front Surg 2022; 9:953038. [PMID: 36189402 PMCID: PMC9521200 DOI: 10.3389/fsurg.2022.953038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/30/2022] [Indexed: 11/25/2022] Open
Abstract
Background Under the influence of various factors, the number of lower extremity avulsion injuries in adolescents is increasing year by year. The main modality of treatment is skin grafting. There are many types of skin grafting. Although many studies on skin grafting after avulsion injuries have been published in the past few decades, there are differences in the treatment options for adolescents with post avulsion injuries. Main body Thorough debridement and appropriate skin grafts are essential for the surgical management of avulsion injuries for optimal prognosis. In the acquisition of grafts, progress has been made in equipment for how to obtain different depths of skin. The severity of the avulsion injury varies among patients on admission, and therefore the manner and type of skin grafting will vary. Especially in adolescents, graft survival and functional recovery are of great concern to both patients and physicians. Therefore, many efforts have been made to improve survival rate and activity. Conclusion This review summarizes the principles of treatment of avulsion injuries, the historical development of skin grafts, and the selection of skin grafts, hoping to be helpful for future research.
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30
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Patton D, Avsar P, Wilson P, Mairghani M, O'Connor T, Nugent L, Moore Z. Treatment of diabetic foot ulcers: review of the literature with regard to the TIME clinical decision support tool. J Wound Care 2022; 31:771-779. [PMID: 36113541 DOI: 10.12968/jowc.2022.31.9.771] [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 The aim of this clinically orientated paper is to offer an overview of diabetic foot ulcer (DFU) dressings generally, and more specifically, their use in the treatment of DFUs. METHOD The TIME clinical decision support tool (CDST) has been used as a clinical tool that can help clinicians bring together the different aspects of dressings for DFU treatment into a holistic approach to patient care. RESULTS DFUs are often difficult to heal, are painful and impact negatively on the individual's quality of life. Most DFU dressings are designed to support the healing of hard-to-heal wounds and represent one part of the management of DFUs. Apart from providing a moist environment, absorbing increased exudate, enhancing granulation and assisting in autolysis, the dressings need to be cost-effective. Wound dressing selection is based on clinical knowledge that ensures the dressing is most appropriate for the individual and the wound, taking into account the comorbidities that the individual may have. CONCLUSION This paper has highlighted how the use of the TIME CDST model can enhance clinical care and is a further tool clinicians should consider when developing and executing DFU treatment plans. Future research needs to focus on large multicentre studies using robust methodologies, given the current gaps in the evidence, to determine the effectiveness of dressing products for DFUs.
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Affiliation(s)
- Declan Patton
- School of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin.,Skin, Wounds and Trauma Research Centre, School of Nursing and Midwifery. RCSI University of Medicine and Health Sciences, Dublin.,Adjunct Associate Professor, Fakeeh College of Health Sciences, Jeddah, Saudi Arabia.,Honorary Senior Fellow, Faculty of Science, Medicine and Health, University of Wollongong, Australia.,Adjunct Professor, Griffith University, Australia
| | - Pinar Avsar
- Skin, Wounds and Trauma Research Centre, School of Nursing and Midwifery. RCSI University of Medicine and Health Sciences, Dublin
| | - Pauline Wilson
- Skin, Wounds and Trauma Research Centre, School of Nursing and Midwifery. RCSI University of Medicine and Health Sciences, Dublin
| | - Maisoon Mairghani
- Public Health and Epidemiology, RCSI University of Medicine and Health Sciences
| | - Tom O'Connor
- School of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin.,Skin, Wounds and Trauma Research Centre, School of Nursing and Midwifery. RCSI University of Medicine and Health Sciences, Dublin.,Adjunct Professor, Griffith University, Australia.,Honorary Professor, Lida Institute, Shanghai, China.,Professor, Fakeeh College of Health Sciences
| | - Linda Nugent
- School of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin.,Adjunct Assistant Professor, Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
| | - Zena Moore
- School of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin.,Skin, Wounds and Trauma Research Centre, School of Nursing and Midwifery. RCSI University of Medicine and Health Sciences, Dublin.,Honorary Professor, Lida Institute, Shanghai, China.,Professor, Fakeeh College of Health Sciences.,Professor, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Belgium.,Visiting Professor, University of Wales, Cardiff, UK
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Starace M, Carpanese MA, Pampaloni F, Dika E, Pileri A, Rubino D, Alessandrini A, Zamagni C, Baraldi C, Misciali C, Patrizi A, Bianchi T, Apalla Z, Piraccini BM. Management of malignant cutaneous wounds in oncologic patients. Support Care Cancer 2022; 30:7615-7623. [PMID: 35672478 PMCID: PMC9385755 DOI: 10.1007/s00520-022-07194-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 05/30/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE Neoplastic wounds may develop as a result of primary tumor growth in the skin, due to metastasis, or due to skin invasion by tumors emerging from deeper levels. Malignant wounds may present as a crater-like ulcer, or as raised nodules with a cauliflower-like appearance. They are associated with malodor, necrosis, pain, bleeding, and secondary infection. The aim of our study is to better characterize fungating wounds and their management. METHODS We retrospectively reviewed the database of the Wound Care Unit of the University of Bologna in order to identify individuals affected by neoplastic wound, between January 2019 and February 2021. RESULTS We identified 9 females and 2 males with a mean age of 63 years; all were referred by the Oncology Unit. Management differed depending on the characteristics of the patients and the ulcers. Complete healing of the wound, following the parallel complete remission of the lymphoproliferative neoplasia, was observed in one individual. Among the others, one died because of breast cancer, while cutaneous lesions in 2 individuals deteriorated after 1 year of follow-up. Remission/relapse of the ulcer following the treatment course administered for the lymphoma were observed in one patient. CONCLUSIONS Treatment of malignant fungating wounds is challenging. Considering the neoplastic nature of the wounds, complete healing or improvement cannot be expected with the application of classically prescribed dressing for wounds. A mostly palliative treatment, focusing on maintaining the patient's quality of life, is a reasonable choice.
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Affiliation(s)
- Michela Starace
- Dermatology - IRCCS Policlinico Di Sant'Orsola - Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Miriam Anna Carpanese
- Dermatology - IRCCS Policlinico Di Sant'Orsola - Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Francesca Pampaloni
- Dermatology Unit, Department of Medicine, University of Padova, Via Gallucci 4, 35121, Padua, Italy.
| | - Emi Dika
- Dermatology - IRCCS Policlinico Di Sant'Orsola - Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Alessandro Pileri
- Dermatology - IRCCS Policlinico Di Sant'Orsola - Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Daniela Rubino
- Addarii Medical Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Via Albertoni 15, Bologna, Italy
| | - Aurora Alessandrini
- Dermatology - IRCCS Policlinico Di Sant'Orsola - Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Claudio Zamagni
- Addarii Medical Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Via Albertoni 15, Bologna, Italy
| | - Carlotta Baraldi
- Dermatology - IRCCS Policlinico Di Sant'Orsola - Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Cosimo Misciali
- Dermatology - IRCCS Policlinico Di Sant'Orsola - Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Annalisa Patrizi
- Dermatology - IRCCS Policlinico Di Sant'Orsola - Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Tommaso Bianchi
- Dermatology - IRCCS Policlinico Di Sant'Orsola - Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Zoe Apalla
- Second Dermatology Department, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Bianca Maria Piraccini
- Dermatology - IRCCS Policlinico Di Sant'Orsola - Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
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Aisa J, Parlier M. Local wound management: A review of modern techniques and products. Vet Dermatol 2022; 33:463-478. [PMID: 35876262 DOI: 10.1111/vde.13104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 02/01/2022] [Accepted: 05/12/2022] [Indexed: 11/30/2022]
Abstract
Management of wounds is a commonly performed and essential aspect of small animal veterinary medicine. Appropriate wound management is a difficult art to master, due to the inherent complexity of the clinical scenario, as well as the ever-evolving nature of the field with the constant addition of new products and techniques. This article reviews key concepts that may help the practitioner better understand the natural process of wound healing, factors that delay healing and strategies to help improve the local wound environment to make it more conducive to healing during open wound management. The concept of wound bed preparation is defined before common local wound management strategies, such as wound lavage and debridement, are discussed in more detail. Key aspects of the management of biofilms and appropriate use of antimicrobial agents are also reviewed. Finally, the concept of moist wound healing and its impact in modern wound management is explained before a broad variety of types of wound dressings are reviewed, with a particular focus on active dressings.
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Affiliation(s)
- Josep Aisa
- Department of Small Animal Clinical Sciences, University of Tennessee College of Veterinary Medicine, Knoxville, TN, USA
| | - Mark Parlier
- Department of Small Animal Clinical Sciences, University of Tennessee College of Veterinary Medicine, Knoxville, TN, USA
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Pain Management in Older Adults with Chronic Wounds. Drugs Aging 2022; 39:619-629. [PMID: 35829959 DOI: 10.1007/s40266-022-00963-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2022] [Indexed: 11/03/2022]
Abstract
Older people often suffer from different types of ulcers, with the most prevalent being chronic leg ulcers (CLUs) and diabetic foot ulcers. There are major issues in the current medical approach because these ulcers are hard to heal, and, in the case of CLUs, very painful and with a high frequency of relapse. Older people complain of pain more frequently than young people, frequently due to a combination of painful chronic wounds with other comorbidities (e.g. arthritis, peripheral arterial disease, vertebrogenic pain syndrome). However, chronic pain appears to be managed better by older people because the pain sensitivity is downregulated and the pain threshold is higher in older people. Pain management of chronic wounds is often insufficient, especially in older individuals. It is highly important to use non-traumatic wound dressings and pay attention to patients' feelings and fears because pain in chronic ulcers can impair wound healing. Key factors include good preparation for dressing change and adequate analgesia, ideally a combination of topical and oral agents.
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Guan M, Chu G, Jin J, Liu C, Cheng L, Guo Y, Deng Z, Wang Y. A Combined Cyanine/Carbomer Gel Enhanced Photodynamic Antimicrobial Activity and Wound Healing. NANOMATERIALS 2022; 12:nano12132173. [PMID: 35808008 PMCID: PMC9268119 DOI: 10.3390/nano12132173] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/22/2022] [Accepted: 06/22/2022] [Indexed: 02/04/2023]
Abstract
As a non-invasive and non-specific therapeutic approach, photodynamic therapy (PDT) has been used to treat antibiotic-resistant bacteria with encouraging efficacy. Inspired by light, the photosensitizers can produce excessive reactive oxygen species (ROS) and, thus, effectively destroy or kill bacteria. Cyanine (Cy), a traditional photosensitizer for PDT, has the advantages of low cytotoxicity and high ROS yield. Yet, the water solubility and photostability for Cy are poor, which substantially limit its antibacterial efficiency and clinical translation. Herein, we combined Cy with carbomer gel (CBMG) to form a photodynamic Cy-CBMG hydrogel. In this system, Cy was evenly dispersed in CBMG, and CBMG significantly improved the water solubility and photostability of Cy via electrostatic interactions. The developed Cy-CBMG gel had less photodegradation under laser irradiation and thus can effectively elevate ROS accumulation in bacteria. The Cy-CBMG compound presented remarkable ROS-induced killing efficacy against methicillin-resistant Staphylococcus aureus (93.0%) and extended-spectrum β-lactamase-producing Escherichia coli (88.7%) in vitro. Moreover, as a potential wound dressing material, the Cy-CBMG hydrogel exhibited excellent biocompatibility and effective antimicrobial ability to promote wound healing in vivo. Overall, this work proposed a practical strategy to synthesize a photosensitizer–excipient compound to enhance the photophysical property and antibacterial efficacy for PDT.
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Affiliation(s)
- Ming Guan
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; (M.G.); (G.C.); (J.J.); (C.L.); (L.C.)
| | - Guangyu Chu
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; (M.G.); (G.C.); (J.J.); (C.L.); (L.C.)
| | - Jiale Jin
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; (M.G.); (G.C.); (J.J.); (C.L.); (L.C.)
| | - Can Liu
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; (M.G.); (G.C.); (J.J.); (C.L.); (L.C.)
| | - Linxiang Cheng
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; (M.G.); (G.C.); (J.J.); (C.L.); (L.C.)
| | - Yi Guo
- Shaanxi Key Laboratory of Brain Disorders, Xi’an Medical University, Xi’an 710021, China;
| | - Zexing Deng
- College of Materials Science and Engineering, Xi’an University of Science and Technology, Xi’an 710054, China
- Correspondence: (Z.D.); (Y.W.); Tel.: +86-136-79187589 (Z.D.); +86-0571-87236128 (Y.W.)
| | - Yue Wang
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; (M.G.); (G.C.); (J.J.); (C.L.); (L.C.)
- Correspondence: (Z.D.); (Y.W.); Tel.: +86-136-79187589 (Z.D.); +86-0571-87236128 (Y.W.)
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Goshchynsky V, Svidersky Y, Migenko B, Pyatnychka O. Radiofrequency ablation of varicose veins in combination with ultrasonic-assisted wound debridement and platelet-rich plasma as well as platelet-rich fibrin technologies in treatment of lower extremity venous ulcers in office-based surgery. Pan Afr Med J 2022; 42:154. [PMID: 36187047 PMCID: PMC9482222 DOI: 10.11604/pamj.2022.42.154.29834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 06/13/2022] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION for the treatment of varicose ulcer performed clinical and laboratory reasoning of the use of ultrasonic-assisted venous ulcer debridement and Platelet-rich plasma with radiofrequency ablation in an outpatient setting, was carried out. METHODS ultrasonic-assisted debridement of trophic ulcer were performed for 50 patients with lower extremity varicose veins at decompensation stage. The effectiveness of ultrasonic-assisted debridement was evaluated by indicators of bacteriological, morphological, cytological study and assessment of trophic ulcers according to the MEASURE system. After ultrasonic-assisted debridement, the patients were divided into two groups: 30 patients, who underwent combined Platelet-rich plasma to stimulate wound regeneration and 20 patients, for whom the Granuflex hydrocolloid bandage was applied for the same purpose. RESULTS a comparative analysis of ulcer regeneration in two groups of patients proved that in cases of platelet rich plasma the time of transition from inflammatory-regenerative type to regenerative one is much shorter than when using a hydrocolloid dressing. In 28 patients undergoing Platelet-rich plasma (PRP) and Platelet-rich fibrin (PRF), the radiofrequency ablation of the principal superficial and perforating veins was performed. Another 22 patients performed autodermoplasty of trophic ulcers after radiofrequency ablation. CONCLUSION our experience has shown that in a one-day inpatient surgical clinic such a multidisciplinary approach to treatment of venous ulcers, including ultrasonic-assisted debridement that is stimulation of wounded process by Platelet-rich plasma with further surgeries to remove the causes of decompensated chronic insufficiency, is promising regarding low costs of treatment and rehabilitation of these patients.
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Affiliation(s)
- Volodymyr Goshchynsky
- Department of Surgery, Institute of Postgraduate Education, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
| | - Yrij Svidersky
- Department of Surgery, Institute of Postgraduate Education, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
| | - Bogdan Migenko
- Department of Internal Medicine N 2, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine,Corresponding author: Bogdan Migenko, Department of Internal Medicine N 2, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine.
| | - Oleg Pyatnychka
- Department of Surgery, Institute of Postgraduate Education, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
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Contribution of Topical Agents such as Hyaluronic Acid and Silver Sulfadiazine to Wound Healing and Management of Bacterial Biofilm. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58060835. [PMID: 35744098 PMCID: PMC9230176 DOI: 10.3390/medicina58060835] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/10/2022] [Accepted: 06/15/2022] [Indexed: 11/24/2022]
Abstract
Background and Objectives: Wound healing is commonly associated with critical bacterial colonization or bacterial infection, which induces prolonged inflammation, resulting in delayed re-epithelialization. An appropriate wound dressing requires a humid environment, which also functions as a barrier against bacterial contamination and will accelerate a regenerative response of the wound. Silver sulfadiazine (SSD) is used to prevent wound infection. Hyaluronic acid (HA) is an extracellular matrix component involved in tissue regeneration. This retrospective study was conducted to evaluate the effectiveness of cream and gauze pads based on hyaluronic acid at low molecular weight (200 kDa) and silver sulfadiazine 1% in the wound healing process. In addition, we examined SSD action on biofilms in vitro and on animal wounds, obtaining positive outcomes therefrom. Materials and Methods: We selected 80 patients with complicated chronic wounds of different etiologies, including diabetes mellitus (10), post-traumatic ulcers (45), burns (15), and superficial abrasion (10). Results: After 8 weeks, ulcer size was decreased in 95 ± 2% of the treated patients; a significant reduction in the inflammatory process was observed from day 14 onwards (p < 0.01 vs. baseline), considering improvement of the surrounding skin and reduction of the bacterial load. The SSD treatment decreased bacterial colony proliferation, both in planktonic state and in biofilm, in a dose-dependent manner on the wound but inhibited the development of tissue granulation at the highest dose (800 μg/wound). Conclusions: In conclusion, the combined action of SSD and HA is clinically effective in improving wound healing.
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Arena R, Strazzeri MG, Bianchi T, Peghetti A, Merli Y, Abbenante D, Olivari D. Hypericum and neem oil for dehisced post-surgical wounds: a randomised, controlled, single-blinded phase III study. J Wound Care 2022; 31:492-500. [PMID: 35678785 DOI: 10.12968/jowc.2022.31.6.492] [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 To evaluate the clinical efficacy of a hypericum and neem oil dressing, Primary Wound Dressing [ONE] (1PWD) (Kerecis AG, Switzerland), in a patient population with dehiscence of surgical wounds with critical colonisation/infection. Efficacy was defined as resolution of inflammatory/infective symptoms. METHOD A randomised, controlled, single-blinded, parallel-arms phase III study was conducted comparing the experimental medication to silver-based dressings. All patients were evaluated at enrolment, on days 7, 14, 21 and 28. Improvement of inflammatory/infective symptoms was measured by detecting seven items of the Bates-Jensen Wound Assessment Tool (BWAT). Pain was assessed using the Numeric Rating Scale (NRS). RESULTS The study enrolled 99 patients. Follow-up was completed in 49 patients in the experimental group and 48 patients in the control group. Overall BWAT evaluation demonstrated similar outcomes between the groups: t=0.23, p-value=0.81, 95% confidence interval (CI): -13.3-10.8. Furthermore, when evaluating the seven items of the BWAT relating to inflammatory signs, there was not a significant difference between the groups: t=0.38, p=0.35, 95% CI: -2.8-2.7. However, when an analysis using the NRS pain scale was performed, a statistically significant pain reduction was demonstrated in favour of the experimental group: t=7.8, p<0.0001, 95% CI: 2.918-4.8819. CONCLUSION This randomised controlled trial confirmed the efficacy of 1PWD, an investigational product, in the management of surgical dehiscence with critical colonisation or infection, with the added benefit of significant pain reduction when compared with a silver-based dressing.
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Affiliation(s)
- Raimondo Arena
- Department of Oncology, Azienda Ospedaliera Garibaldi, Catania, Italy
| | | | - Tommaso Bianchi
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Angela Peghetti
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Yuri Merli
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Diego Abbenante
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Diletta Olivari
- Clinica Medica, Università Politecnica delle Marche, Ancona, Italy
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Scientific and Clinical Abstracts From WOCNext® 2022: Fort Worth, Texas ♦ June 5-8, 2022. J Wound Ostomy Continence Nurs 2022; 49:S1-S99. [PMID: 35639023 DOI: 10.1097/won.0000000000000882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Rippon MG, Forster J, Rogers AA. Hydro-responsive wound dressings for treating hard-to-heal wounds: a narrative review of the clinical evidence—part 2. J Wound Care 2022; 31:330-338. [DOI: 10.12968/jowc.2022.31.4.330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
This narrative clinical review summarises the key evidence in support for the use of a hydro-responsive wound dressing, HydroTac (HRWD-2, PAUL HARTMANN AG, Germany) to address key aspects associated with the treatment of both acute and hard-to-heal wounds. This review demonstrates how HRWD-2 can be used in general to address the challenges presented by a wide range of wound types and skin injuries. It highlights the ability of HRWD-2 to regulate an optimal moist wound environment that promotes wound progression and healing. Key aspects covered in this review include the dressing's ability to: promote certain phases of the wound healing response (for example, re-epithelialisation) address the concepts and needs for wound progression as set out in the TIME wound management framework provide an optimal hydration level reduce tissue trauma and pain at dressing change.
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Affiliation(s)
- Mark G Rippon
- University of Huddersfield, Queensgate, Huddersfield, UK
| | - Jan Forster
- Wound Center Links der Weser, 28277 Bremen, Germany
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Monaco D, Zaghini F, Fiorini J, Venturini G, Iovino P, Vellone E, Alvaro R, Sili A. Effect of a wound healing protocol on patients with stage III and IV pressure ulcers: a preliminary observational study. J Wound Care 2022; 31:322-328. [DOI: 10.12968/jowc.2022.31.4.322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Objective: To evaluate the influence of a wound healing protocol for stage III and IV pressure ulcers (PUs), and to determine the predictive power of specific sociodemographic and clinical characteristics on wound healing and infection. Method: This longitudinal study included participants with stage III and IV PUs who were recruited from 10 acute care settings of an Italian university hospital, and who were managed with a protocol inspired by the TIMECare model. Data were collected between October 2018 and March 2019. The National Pressure Ulcer Advisory Panel Staging System was used to stage the PUs. Wound healing was assessed with the Pressure Ulcer Scale for Healing (PUSH). Nutritional status was assessed with the Mini Nutritional Assessment Index. Data collection took place at admission and every seven days thereafter—a total of six times before discharge. The outcome and predictors of wound healing were assessed with Student's paired t-tests and multiple linear regressions, respectively. Results: Patients (n=126) were almost equally split between male and female, with a mean age of 78.17 years and who were all retired. Stage III and IV PUs were most prevalent at the sacrum (65.5% and 73.2%, respectively). PUSH wound healing scores improved significantly after six weeks in both stage III and IV PUs (p<0.001). Nutritional status was predictive of wound healing (R2=0.12). Conclusion: Our results showed that a good nutritional status and a protocol inspired by the TIMECare model were associated with wound healing improvements in stage III and IV PUs. We recommend this protocol in older patients with stage III and IV PUs.
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Affiliation(s)
- Dario Monaco
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | | | - Jacopo Fiorini
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | | | - Paolo Iovino
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
- Australian Catholic University, Melbourne, Australia
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Alessandro Sili
- Nursing Department, Tor Vergata University Hospital, Rome, Italy
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Guan T, Li J, Chen C, Liu Y. Self-Assembling Peptide-Based Hydrogels for Wound Tissue Repair. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2022; 9:e2104165. [PMID: 35142093 PMCID: PMC8981472 DOI: 10.1002/advs.202104165] [Citation(s) in RCA: 80] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 12/23/2021] [Indexed: 05/02/2023]
Abstract
Wound healing is a long-term, multistage biological process that includes hemostasis, inflammation, proliferation, and tissue remodeling and requires intelligent designs to provide comprehensive and convenient treatment. The complexity of wounds has led to a lack of adequate wound treatment materials, which must systematically regulate unique wound microenvironments. Hydrogels have significant advantages in wound treatment due to their ability to provide spatiotemporal control over the wound healing process. Self-assembling peptide-based hydrogels are particularly attractive due to their innate biocompatibility and biodegradability along with additional advantages including ligand-receptor recognition, stimulus-responsive self-assembly, and the ability to mimic the extracellular matrix. The ability of peptide-based materials to self-assemble in response to the physiological environment, resulting in functionalized microscopic structures, makes them conducive to wound treatment. This review introduces several self-assembling peptide-based systems with various advantages and emphasizes recent advances in self-assembling peptide-based hydrogels that allow for precise control during different stages of wound healing. Moreover, the development of multifunctional self-assembling peptide-based hydrogels that can regulate and remodel the wound immune microenvironment in wound therapy with spatiotemporal control has also been summarized. Overall, this review sheds light on the future clinical and practical applications of self-assembling peptide-based hydrogels.
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Affiliation(s)
- Tong Guan
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety & CAS Center for Excellence in NanoscienceNational Center for Nanoscience and Technology of ChinaBeijing100190P. R. China
- University of Chinese Academy of SciencesBeijing100049P. R. China
| | - Jiayang Li
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety & CAS Center for Excellence in NanoscienceNational Center for Nanoscience and Technology of ChinaBeijing100190P. R. China
| | - Chunying Chen
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety & CAS Center for Excellence in NanoscienceNational Center for Nanoscience and Technology of ChinaBeijing100190P. R. China
- University of Chinese Academy of SciencesBeijing100049P. R. China
- GBA National Institute for Nanotechnology InnovationGuangdong510700P. R. China
| | - Ying Liu
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety & CAS Center for Excellence in NanoscienceNational Center for Nanoscience and Technology of ChinaBeijing100190P. R. China
- GBA National Institute for Nanotechnology InnovationGuangdong510700P. R. China
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Kodama A, Komori K, Koyama A, Sato T, Ikeda S, Tsuruoka T, Kawai Y, Niimi K, Sugimoto M, Banno H, Nishida K. Impact of Serum Zinc Level and Oral Zinc Supplementation on Clinical Outcomes in Patients Undergoing Infrainguinal Bypass for Chronic Limb-Threatening Ischemia. Circ J 2022; 86:995-1006. [PMID: 35342125 DOI: 10.1253/circj.cj-21-0832] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Zinc (Zn) has been reported to play an important role in wound healing (WH). Nevertheless, the effect of Zn in chronic limb-threatening ischemia (CLTI) patients is unclear. This study investigated the effect of Zn on the clinical outcomes of CLTI patients undergoing bypass surgery.Methods and Results:This study reviewed 111 consecutive patients who underwent an infrainguinal bypass from 2012 to 2020. Patients with Zn deficiency (serum Zn level <60 μg/dL) received oral Zn supplementation and maintained a normal level until WH. This study aimed to explore: (1) the effect of Zn deficiency; and (2) Zn supplementation in Zn-deficient patients on the clinical outcomes of this cohort. Patients with Zn deficiency, Zn supplementation, and no Zn supplementation despite Zn deficiency accounted for 48, 21, and 42 patients, respectively. (1) Zn deficiency was associated with WH (HR, 0.47; 95% CI, 0.29-0.78: P=0.003), major adverse limb events (MALE) (HR, 2.53; 95% CI, 1.26-5.09: P=0.009), and major amputation or death (HR, 3.17; 95% CI, 1.51-6.63: P=0.002). (2) Zn supplementation was positively related to WH (HR, 2.30; 95% CI, 1.21-4.34: P=0.011). This result was confirmed using propensity score matching (HR, 2.24; 95% CI, 1.02-4.87: P=0.043). CONCLUSIONS The current study revealed that Zn level was associated with clinical outcomes in CLTI patients after bypass surgery. Oral Zn supplementation could improve WH in these patients.
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Affiliation(s)
- Akio Kodama
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University School of Medicine
| | - Kimihiro Komori
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University School of Medicine
| | - Akio Koyama
- Department of Vascular Surgery, Ichinomiya Municipal Hospital
| | - Tomohiro Sato
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University School of Medicine
| | - Shuta Ikeda
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University School of Medicine
| | - Takuya Tsuruoka
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University School of Medicine
| | - Yohei Kawai
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University School of Medicine
| | - Kiyoaki Niimi
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University School of Medicine
| | - Masayuki Sugimoto
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University School of Medicine
| | - Hiroshi Banno
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University School of Medicine
| | - Kazuki Nishida
- Biostatistics and Bioinformatics Section, Center for Advanced Medicine and Clinical Research, Nagoya University Hospital
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Comparison of clinical outcomes, including the wound healing rate, between inframalleolar bypass to the pedal artery and that to the pedal branch artery in the modern endovascular era. J Vasc Surg 2022; 75:2019-2029.e2. [PMID: 35182663 DOI: 10.1016/j.jvs.2022.01.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/30/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Inframalleolar (IM) bypass has been reported to demonstrate acceptable patency and limb salvage in chronic limb-threatening ischemia (CLTI) patients. However, wound healing after IM bypass and comparisons between pedal artery (PA) bypass and pedal branch artery (PBA) bypass are lacking. METHODS We reviewed prospectively collected data from 208 consecutive patients after IM bypass performed over a period of six years. Patients were divided into two groups based on the distal anastomotic artery: the PA group (dorsal pedis artery or common plantar artery) and the PBA group (medial tarsal, lateral tarsal, medial plantar, and lateral plantar artery). The primary outcome was wound healing, and secondary outcomes included loss of patency and limb and life prognosis. RESULTS Of the 208 patients, 174 (74%) had PA bypass, whereas 34 (16%) had PBA bypass. Patients in the PBA group were significantly younger than those in the PA group (69 ± 7 vs. 73 ± 9, P = .03). Although early (30-day) graft failure was more common in the PBA group, late clinical outcomes, including the wound healing rate (79% in the PA group and 84% in the PBA group, P=.74), were similar between the two groups. The Global Limb Anatomic Staging System (GLASS) IM grade (HR, 0.73; 95% confidence interval [CI], 0.58-0.93: P=.006); wound, ischemia, and foot infection (WIfI) wound grade (HR, 0.67; 95% CI, 0.51-0.89: P<.01); and WIfI foot infection grade (HR, 0.79; 95% CI, 0.65-0.96: P=.02) were independent predictors of wound healing. CONCLUSIONS The current study revealed that wound healing in patients following PBA bypass was acceptable and comparable to that following PA bypass. In the modern era, including high prevalence of infrapopliteal angioplasty, our results could provide useful information to clinicians in actual clinical settings. Moreover, PBA bypass may be an alternative revascularization procedure to avoid major amputation when the pedal artery is occluded, such as in the GVG IM P2 grade. Prospective multicenter larger studies are warranted to confirm the findings of this study and to compare PBA bypass and IM EVT in anatomical "no-option" CLTI.
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Qu S, Hu Z, Zhang Y, Wang P, Li S, Huang S, Dong Y, Xu H, Rong Y, Zhu W, Tang B, Zhu J. Clinical Studies on Platelet-Rich Plasma Therapy for Chronic Cutaneous Ulcers: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Adv Wound Care (New Rochelle) 2022; 11:56-69. [PMID: 33607926 PMCID: PMC9831249 DOI: 10.1089/wound.2020.1186] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Significance: Platelet-rich plasma (PRP) may be a potential drug for treatment of chronic refractory ulcers, which increase the risk of systemic infection and local canceration. However, the efficacy and safety of clinical application of PRP are still controversial. Thus, this study was aimed to assess the efficacy and safety of PRP in patients with chronic ulcers. Recent Advances: For this meta-analysis, Cochrane's Library, MEDLINE, EMBASE, PubMed, Web of Science, and CINAHL (Cumulate Index to Nursing and Allied Health Literature) databases were searched. Results were pooled using a random-effects model. The primary outcome was the proportion of completely healed chronic ulcers. Critical Issues: Seventeen randomized controlled trials were included. Compared with the control group, PRP significantly increased the fraction of healed ulcers (pooled risk ratio [RR] = 1.50; 95% confidence interval [CI] = 1.20 to 1.87; I2 = 47.8%). In autologous PRP (APRP) and homologous PRP (HPRP) subgroups, there were statistical differences between the control group versus treatment subgroup (pooled RR = 1.30, 95% CI = 1.10 to 1.54, I2 = 25.7%; pooled RR = 3.53, 95% CI = 1.94 to 6.43, I2 = 0.0%, respectively). In terms of percent of chronic ulcers area healed, there was a statistically significant difference between the PRP-treated group versus the control group (standard mean difference [SMD] = 1.37, 95% CI = 0.91 to 1.82, I2 = 22.1%). As for PRP safety, there existed a statistically significant difference between the APRP subgroup and the HPRP subgroup, respectively (pooled RR = 0.58; 95% CI = 0.35 to 0.98; I2 = 0.0%) and (pooled RR = 4.12; 95% CI = 1.55 to 10.96; I2 = 6.8%). Future Directions: Our findings shows that PRP may be a beneficial treatment of chronic skin ulcers and that APRP may be much safer than HPRP.
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Affiliation(s)
- Shanqiang Qu
- Department of Burn Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China.,Department of Neurosurgery, Nanfang Hospital of Southern Medical University, Guangzhou, People's Republic of China
| | - Zhicheng Hu
- Department of Burn Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Yi Zhang
- Department of Burn and Plastic Surgery, Affiliated Hospital of Nantong University, Nantong, People's Republic of China
| | - Peng Wang
- Department of Burn Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Shuting Li
- Department of Plastic Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Shaobin Huang
- Department of Burn Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Yunxian Dong
- Department of Burn Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Hailin Xu
- Department of Burn Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Yanchao Rong
- Department of Burn Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Wenkai Zhu
- Department of Chemistry, Portland State University, Portland, USA
| | - Bing Tang
- Department of Burn Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China.,Department of Burn Surgery, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan Road II, Guangzhou 510080, China,
| | - Jiayuan Zhu
- Department of Burn Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China.,Correspondence: Department of Burn Surgery, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan Road II, Guangzhou 510080, China,
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High-Intensity, Low-Frequency Pulsed Electromagnetic Field as an Odd Treatment in a Patient with Mixed Foot Ulcer: A Case Report. REPORTS 2022. [DOI: 10.3390/reports5010003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Lower-extremity ulcers are associated with an increasing prevalence and significant economic and social costs. To date, there is no high-quality evidence related to an optimal treatment algorithm. A multimodal approach is needed particularly in patients with comorbidity and polytherapy. Herein, we report the case of a 94-year-old Caucasian female with comorbidity and polytherapy who was admitted to our observation for a history (1 year) of chronic painful malleolar mixed ulcer. After clinical evaluation, she was treated with a twice daily pain relief therapy and with a weekly diamagnetic therapy protocol plus a local treatment. During the clinical examination, we documented a statistically significant improvement in both pain (VAS score from 8 to 2 p < 0.01) and foot ulcer (surface reduction from 6 cm × 4 cm to 2 cm × 2 cm, p < 0.01) at the sixth week of combined treatment. The ulcer completely healed at the ninth week. This is the first study to document the effect of diamagnetic therapy as an add-on therapy in the management of wound healing. In conclusion, even if high-quality evidence is still lacking, diamagnetic therapy might represent an interesting option as an add-on treatment for ulcer.
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Sterpione F, Mas K, Rippon MG, Rogers AA, Mayeux G, Rigaudier F, Chauvelot P, Robilliart L, Juhel C, Lecomte Y. The clinical impact of hydro-responsive dressings in dynamic wound healing: Part II. J Wound Care 2022; 31:56-67. [PMID: 35077216 DOI: 10.12968/jowc.2022.31.1.56] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Over the course of a wound's healing trajectory, whether the wound is acute or hard-to-heal, management is likely to involve the use of several different dressing types. Minimising the complexity of treatment (in terms of dressing usage) would aid clinicians in providing effective wound care but excellent clinical outcomes must remain the primary goal. METHOD This study was an open-labelled, non-comparative study assessing the clinical effectiveness of a coordinated wound dressing treatment regimen. After an initial phase of using a hydro-responsive wound dressing (HydroClean, HRWD-1, PAUL HARTMANN AG, Germany) to cleanse and debride hard-to-heal wounds, the wounds were subsequently treated with either HydroTac (HRWD-2, PAUL HARTMANN AG, Germany) (to maintain healing progression and re-epithelialisation) or RespoSorb (a superabsorbent dressing, PAUL HARTMANN AG, Germany) (to manage moderate-to-high levels of exudate). The Pressure Ulcer Scale for Healing (PUSH) assessment tool was used to measure the wound status over the course of the treatment period and to assess several wound status parameters (for example, wound area, exudate levels and wound characteristics such as level of re-epithelialisation). RESULTS The results from this study demonstrated that wounds treated with HRWD-2 showed a positive healing response when using the PUSH score assessment tool with a significant mean reduction (p<0.0001) in the PUSH score of wounds treated with HRWD-2, with >75% of wounds being closed by the end of the study. This result underlines the effectiveness of HRWD-2 in supporting healing progression. CONCLUSION The results from this study support the coordinated use of HRWDs for the effective management and treatment of a variety of hard-to-heal wounds.
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Affiliation(s)
| | | | - Mark G Rippon
- University of Huddersfield, Queensgate, Huddersfield, UK.,Medical Marketing Consultant Daneriver Consultancy Ltd, Holmes Chapel, UK
| | | | | | | | | | | | | | - Yann Lecomte
- CEN Biotech, Dijon, Bourgogne Franche-Comté, France
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Zhou L, Tang J, Bai JJ, Ming Y. Wound care in elderly diabetic patients after coronary artery bypass grafting: 3 case reports. Asian J Surg 2021; 45:759-760. [PMID: 34969572 DOI: 10.1016/j.asjsur.2021.11.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 11/26/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Lin Zhou
- Department of Nursing, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Jun Tang
- Department of Coronary Care Unit, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Jiao-Jiao Bai
- Department of Nursing, Huadong Hospital Affiliated to Fudan University, Shanghai, China.
| | - Yue Ming
- Department of Nursing, Huadong Hospital Affiliated to Fudan University, Shanghai, China
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Cwajda-Białasik J, Mościcka P, Jawień A, Szewczyk MT. Microbiological Status of Venous Leg Ulcers and Its Predictors: A Single-Center Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182412965. [PMID: 34948575 PMCID: PMC8700924 DOI: 10.3390/ijerph182412965] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/04/2021] [Accepted: 12/06/2021] [Indexed: 11/16/2022]
Abstract
Venous leg ulcers are frequently colonized by microbes. This can be particularly devastating if the ulcer is infected with alert pathogens, i.e., highly virulent microorganisms with well-developed mechanisms of antibiotic resistance. We analyzed the microbiological status of venous leg ulcers and identified the clinicodemographic predictors of culture-positive ulcers, especially in ulcers with colonization by alert pathogens. METHODS This study included 754 patients with chronic venous leg ulcers. Material for microbiological analysis was collected by swabbing only from patients who did not receive any antibiotic treatment. RESULTS A total of 636 (84.3%) patients presented with culture-positive ulcers. Alert pathogens, primarily Pseudomonas aeruginosa, were detected in 28.6% of the positive cultures. In a logistic regression model, culture-positive ulcers were predicted independently by age > 65 years, current ulcer duration > 12 months, and ulceration area greater than 8.25 cm2. Two of these factors, duration of current ulcer > 12 months and ulceration area > 8.25 cm2, were also identified as the independent predictors of colonization by alert pathogens. CONCLUSIONS Colonization/infection is particularly likely in older persons with chronic and/or large ulcers. Concomitant atherosclerosis was an independent predictor of culture-negative ulcers.
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Affiliation(s)
- Justyna Cwajda-Białasik
- Department of Perioperative Nursing, Department of Surgical Nursing and Chronic Wound Care, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-821 Bydgoszcz, Poland; (P.M.); (M.T.S.)
- Outpatient Department for Chronic Wound Management, Antoni Jurasz University Hospital No. 1, 85-094 Bydgoszcz, Poland
- Correspondence:
| | - Paulina Mościcka
- Department of Perioperative Nursing, Department of Surgical Nursing and Chronic Wound Care, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-821 Bydgoszcz, Poland; (P.M.); (M.T.S.)
- Outpatient Department for Chronic Wound Management, Antoni Jurasz University Hospital No. 1, 85-094 Bydgoszcz, Poland
| | - Arkadiusz Jawień
- Department of Vascular Surgery and Angiology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-094 Bydgoszcz, Poland;
| | - Maria Teresa Szewczyk
- Department of Perioperative Nursing, Department of Surgical Nursing and Chronic Wound Care, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-821 Bydgoszcz, Poland; (P.M.); (M.T.S.)
- Outpatient Department for Chronic Wound Management, Antoni Jurasz University Hospital No. 1, 85-094 Bydgoszcz, Poland
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Ousey K, Hodgson H, Rippon MG, Rogers AA. Hydro-responsive wound dressings for treating hard-to-heal wounds: a narrative review of the clinical evidence. J Wound Care 2021; 30:980-992. [PMID: 34881992 DOI: 10.12968/jowc.2021.30.12.980] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
A break in skin integrity must be repaired as quickly as possible to avoid excess blood and fluid loss, and to minimise the onset of infection. Hard-to-heal wounds, in which the progression of the wound healing response is compromised, present several challenges to healing (for example, the presence of devitalised tissue acting as a physical barrier to healing and as a focus for bacterial contamination with the potential for subsequent infection). The objective of this article is to present, as a narrative review, the clinical evidence supporting the use of a unique hydro-responsive wound dressing (HydroClean, HRWD1, PAUL HARTMANN AG, Germany). The dressing provides a simple treatment option to address a number of clinical challenges clinicians must overcome in order to facilitate wound healing progression. These studies demonstrated that this product supported successful debridement/cleansing of a wide variety of wounds, including hard-to-heal wounds, enabled wound bed preparation, and lead to positive healing outcomes, including in wounds that previously had failed to heal. The simplicity of using HRWD1 as a single dressing can help clinicians overcome a variety of challenges when treating both acute and hard-to-heal wounds, which, with the benefit of proven patient outcomes, could make it an ideal choice for a first-line treatment.
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Affiliation(s)
- Karen Ousey
- Institute of Skin Integrity and Infection Prevention, School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | | | - Mark G Rippon
- University of Huddersfield, Queensgate, Huddersfield, UK
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Bosanquet DC, Laloo R, Sanders AJ, Ruge F, Lane J, Morris CA, Jiang WG, Harding KG. Sensitivity of the Wound Edge Gene Signature "WD14" in Responding to Clinical Change: A Longitudinal Cohort Study. INT J LOW EXTR WOUND 2021:15347346211056786. [PMID: 34791919 DOI: 10.1177/15347346211056786] [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: 11/16/2022]
Abstract
Introduction: WounD14 (WD14) gene signature is a recently developed tool derived from genetic interrogation of wound edge biopsies of chronic venous leg ulcers to identify heard-to-heal wounds and enable clinicians to target aggressive therapies to promote wound healing. This study aimed to evaluate if changes in wound clinical healing status were detected by the WD14 gene signature over time as this is currently poorly understood. Material and methods: WD14 was developed through gene screening and subsequent validation in 3 patient cohorts involving 85 consecutive patients with chronic venous leg ulcers referred to a tertiary wound healing unit. Patients underwent a wound edge biopsy to interrogate for a "healing" or "non-healing" genotype. A smaller cohort (18%) underwent a second biopsy, which comprised this pilot cohort reported herein. Twelve weeks following biopsy, wounds were clinically assessed for healing status based on reduction in size and compared to WD14 genotype. Results: Sequential biopsies and WD14 scores were derived from 16 patients. WD14 signature predicted wound healing status among this cohort at either visit (32 wound edge biopsies) with a positive predictive value (PPV) of 85.2% (95% CI 74.1%-92.0%) and negative predictive value (NPV) of 80.0% (95% CI 34.2%-96.9%). A total of 6 wounds underwent altered clinical status between the 2 visits. In this cohort, WD14 has a PPV of 66.7% (95% CI 47.3%-81.7%) and NPV of 100%. Conclusion: Although the WD14 gene signature did change with wound healing status, larger studies are required to precisely clarify its role and ability to prognosticate wounds of differing clinical status over time.
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Affiliation(s)
| | - Ryan Laloo
- Leeds Vascular Institute, 4472Leeds General Infirmary, Leeds, UK
| | - Andrew J Sanders
- Cardiff China Medical Research Collaborative, 2111Cardiff University School of Medicine, Cardiff, UK
| | - Fiona Ruge
- Cardiff China Medical Research Collaborative, 2111Cardiff University School of Medicine, Cardiff, UK
| | - Jane Lane
- Cardiff China Medical Research Collaborative, 2111Cardiff University School of Medicine, Cardiff, UK
| | - Ceri A Morris
- Clinical Innovation Hub, 2111Cardiff University, Cardiff, UK
| | - Wen G Jiang
- Cardiff China Medical Research Collaborative, 2111Cardiff University School of Medicine, Cardiff, UK
| | - Keith G Harding
- Clinical Innovation Hub, 2111Cardiff University, Cardiff, UK
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