Systematic review of the efficacy of topical haemoglobin therapy for wound healing

M.O.I.S.T. Concept for the Local Therapy of Chronic Wounds: An International Update

Chronic wounds remain a significant clinical challenge both for those affected and for healthcare systems. The treatment is often comprised and complex. All patients should receive wound care that is integrated into a holistic approach involving local management that addresses the underlying etiology and provides for gold standard therapy to support healing, avoid complications and be more cost effective. There have been significant advances in medicine over the last few decades. The development of new technologies and therapeutics for the local treatment of wounds is also constantly increasing. To help standardize clinical practice with regard to the multitude of wound products, the M.O.I.S.T. concept was developed by a multidisciplinary expert group. The M stands for moisture balance, O for oxygen balance, I for infection control, S for supporting strategies, and T for tissue management. Since the M.O.I.S.T. concept, which originated in the German-speaking countries, is now intended to provide healthcare professionals with an adapted instrument to be used in clinical practice, and a recent update to the concept has been undertaken by a group of interdisciplinary experts to align it with international standards. The M.O.I.S.T. concept can now be used internationally both as an educational tool and for the practical implementation of modern local treatment concepts for patients with chronic wounds and can also be used in routine clinical practice.

Adjunctive topical oxygen therapy in the management of complex diabetes-related wounds: A South African case study series

Diabetic foot ulcers (DFUs) are a prevalent complication of diabetes mellitus and are associated with significant morbidity and mortality. The essential role of oxygen in the treatment of DFUs is documented. Indicated for use on a variety of wound types, topical haemoglobin therapy (Granulox®) is a novel therapeutic technology that binds atmospheric oxygen and improves the availability of oxygen at the wound site. When used as part of the wound management strategy, this therapy helps to reduce inflammation, exudate and slough, and promotes wound healing. In South Africa, health resources, coordinated foot care and podiatry, and data on diabetic foot complications are limited. Twelve patient case studies assessing the impact of adding topical haemoglobin therapy to the management regimes for DFUs and surgical (post-amputation) wounds were undertaken in South Africa. Patients were aged 50-71 years, and all had diabetes mellitus. At baseline, the area of the wounds ranged from 10.2 to 149.6 cm2 with depths ranging from 0.2 to 0.9 cm. Clinical signs of wound infection and high levels of viscous exudate were recorded in all cases. Wound dressings were changed twice weekly and sharp debridement of the wound performed as necessary. The wounds were cleansed and then completely coated with a thin film of Granulox® and dressings applied. Treatment was monitored over periods ranging from 57 to 276 days, during which dressings were changed and Granulox® administered to the wounds, ranging from 16 to 79 times. During the period of evaluation, wound size steadily reduced (by 87.1-100%), the condition of the wound bed tissue and peri-wound skin improved, and clinical signs of wound infection steadily resolved. Wounds significantly improved in two patients, almost healed in six patients, and healed in four patients. All patients reported a reduction in malodour and pain; seven patients were pain-free at the final followup assessment. The overall impression of Granulox® was rated as 'very good' by the clinicians, who considered that Granulox® facilitated an increase in tissue viability, with the promotion of granulation tissue, and stimulated epithelialisation.

Topical administration of pterostilbene accelerates burn wound healing in diabetes through activation of the HIF1α signaling pathway

Impaired wound healing is one of a variety of severe diabetic complications and involves many factors, including consistent oxidative stress, prolonged inflammation, impaired angiogenesis, and delayed re-epithelialization. Despite the severe negative impacts that impaired wound healing has on patients' lives, detailed mechanisms and effective therapies are still not fully developed. In this study, we aim to investigate the potential effects and mechanisms of topical administration of pterostilbene and resveratrol on burn wound healing in diabetes. Our in vitro experiments in human umbilical vein endothelial cells showed that long term exposure of hyperglycemia induces oxidative stress and suppression of hypoxia inducible factor1α (HIF1α) signaling pathway, and pterostilbene treatment completely, while resveratrol treatment partly, reversed this effect. Further in vivo experiments in diabetic rats showed that topical administration of pterostilbene exhibited stronger efficacy than resveratrol in normalizing oxidative stress, HIF1α activity, and accelerating burn wound healing in diabetes. We conclude that topical administration of pterostilbene accelerates burn wound healing in diabetes through activation of the HIF1α signaling pathway; thus, pterostilbene may be a potential candidate for clinical treatment of burn wound healing in diabetes.

Shifting the distribution curve for healthcare resource use through topical oxygen therapy for wound healing

The clinical and economic burden associated with hard-to-heal wounds is high and evidence suggests that it continues to increase. Healthcare resources consumed during the provision of wound care can be saved by implementing strategies and actions aimed at promoting wound healing. When these are successful, the frequency distribution curve for time to healing and for the consumption of healthcare resources should 'move to the left' and the extent to which it is 'skewed to the right' would be reduced, resulting in a reduction in the population mean for time to wound healing, and correspondingly, healthcare resources. Not only would this release healthcare resources in the short term, but, if these changes are maintained, would render savings sustainable, thereby contributing to lowering the overall burden of wounds and wound care. In this article, we present evidence that suggests that the adoption of adjunct topical haemoglobin spray can effect these desired changes in the wound healing curve and, due to the nature of the technology, it can be easily and sustainably implemented within relevant whole populations requiring wound care. The ease of adoption and impact is further illustrated by a patient case study.

CONTRIBUIÇÕES DO ENFERMEIRO NA PESQUISA BÁSICA: MODELO DE FIXAÇÃO DE CURATIVO EM FERIDAS CUTÂNEAS EXCISIONAIS DE CAMUNDONGOS

Objetivo:validar método de fixação de curativos em feridas cutâneas excisionais de camundongos. Método: estudo pré-clínico. Amostra composta por animais da linhagem C57BL/6, que tiveram duas feridas excisionais confeccionadas na região dorsal. Foram avaliados diferentes métodos e produtos, amplamente aceitos na prática clínica, para fixação de curativos no modelo animal. Os desfechos avaliados foram tempo de permanência do curativo e ocorrência de eventos adversos. Resultados: atadura de crepom, fita microporosa e bandagem autoaderente apresentaram menor tempo de permanência quando comparadas ao filme de poliuretano. Esse, por sua vez, variou o tempo quando comparadas diferentes marcas (E, F, G e H) e número de voltas ao redor do corpo do animal. Com 1 volta, o tempo variou de < 24 a 36 horas. Com 2 voltas, as marcas E e G permaneceram 48 e 96 horas, respectivamente, e F e H tempo < 24 horas. Filme da marca G, cortado no tamanho 3 cm x 15 cm, dando 2 voltas no corpo do camundongo, manteve o curativo por 96 horas. A pele permaneceu íntegra, sem evento adverso. Conclusão: foi criado modelo de fixação de curativos para feridas em camundongos com produto disponível no Brasil e compatível com a estrutura copórea do animal.

CONTRIBUTIONS OF NURSES IN BASIC RESEARCH: DRESSING FIXATION MODEL FOR EXCISIONAL CUTANEOUS WOUNDS OF MICE

Objective: validate method of fixation of dressings on excisional cutaneous wounds of mice. Method: preclinical study. Sample made up of animals of the C57BL/6 strain, which had two excision wounds made in the dorsal region. Different methods and products, widely accepted in clinical practice, for fixing dressings in the animal model were evaluated. The evaluated outcomes were the length of stay of the dressing and the occurrence of adverse events. Results: crepe bandage, microporous tape and self adhesive bandage had a shorter residence time when compared to polyurethane film. This, in turn, varied the time when comparing different marks (E, F, G and H) and number of turns around the animal’s body. With 1 lap, the time varied from <24 to 36 hours. With 2 laps, the marks E and G remained 48 and 96 hours, respectively, and F and H time <24 hours. G-brand film, cut to size 3 cm x 15 cm, giving the mouse body 2 turns, kept the dressing for 96 hours. The skin remained intact, with no adverse event. Conclusion: a dressing fixation model for wounds in mice was created with a product available in Brazil and compatible with the animal’s body structure.

Systematic review of the efficacy of topical haemoglobin therapy for wound healing

Hypoxia is a common cause of poor wound healing, for which a variety of oxygen therapies have been developed. In order to overcome the limitations of traditional methods of treatment, namely the type of equipment, its setting, safety and cost, local haemoglobin therapy has been developed, although no reviews have so far been published. Here, we systematically review the current evidence to establish the efficacy, scope, adverse reactions, and required precautions of this new form of therapy. A search of the literature was conducted in the PubMed, Embase, Scopus, CENTRAL, CINAHL, and Web of science databases, with 17 studies meeting the eligibility criteria, comprising one animal model study and 16 clinical studies. Local haemoglobin therapy is able to safely and effectively promote the healing of a variety of wounds, especially those that are chronic and non-healing. However, premature discontinuation of this treatment can result in impediment to wound healing and even deterioration of the wound. The distinct benefit of the elimination of slough and relief of pain suggests that this technique may represent a new generation of debridement technology. Furthermore, its ease of use and convenience enables patient self-management, thereby greatly reducing health care costs.