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Schmiedova I, Slama P, Dembickaja A, Kozova B, Hyneckova V, Gogolkova S, Stastna E, Zahradnicek M, Savic S, Davani A, Hulo E, Martinka E. Clinical Evaluation of AMNIODERM+ ® Wound Dressing Containing Non-Viable Human Amniotic Membrane: Retrospective-Perspective Clinical Trial. BIOTECH 2024; 13:36. [PMID: 39311338 PMCID: PMC11417787 DOI: 10.3390/biotech13030036] [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: 07/31/2024] [Revised: 09/14/2024] [Accepted: 09/16/2024] [Indexed: 09/26/2024] Open
Abstract
Chronic wounds result from the body's inability to heal, causing pain, pathogen entry, limited treatment options, and societal burden. Diabetic foot ulcers are particularly challenging, often leading to severe complications like leg amputation. A clinical study tested AMNIODERM+®, a new device with a lyophilized human amniotic membrane (HAM), on chronic diabetic foot ulcers. Participants had diabetic neuropathic or neuroischemic leg wounds (2-16 cm2) unhealed by 20% after six weeks of standard care. This study showed significant wound healing improvements with AMNIODERM+®. The median wound size reduction after 12 weeks was 95.5%, far exceeding the null hypothesis of 20% change. Additionally, 65% of patients achieved complete ulceration healing, surpassing the 50% efficacy requirement. The median time to full closure was 11.4 weeks, with the proportion of completely healed patients rising progressively, reaching 55% by week 11. These findings, from the clinical trial "Freeze-dried amniotic membrane in the treatment of nonhealing wounds", suggest AMNIODERM+® as a promising future treatment for chronic diabetic foot ulcers. The published results were obtained as part of a clinical trial entitled "Freeze-dried amniotic membrane in the treatment of nonhealing wounds: a single-arm, retrospectively-perspective clinical trial", EUDAMED Nr. CIV-SK-22-10-041146.
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Affiliation(s)
- Iveta Schmiedova
- BioHealing s.r.o., Dr. Slabihoudka 6232/11, 708 00 Ostrava, Czech Republic
- Laboratory of Animal Immunology and Biotechnology, Department of Animal Morphology, Physiology and Genetics, Faculty of AgriSciences, Mendel University in Brno, Zemedelska 1, 613 00 Brno, Czech Republic
| | - Petr Slama
- Laboratory of Animal Immunology and Biotechnology, Department of Animal Morphology, Physiology and Genetics, Faculty of AgriSciences, Mendel University in Brno, Zemedelska 1, 613 00 Brno, Czech Republic
| | - Alena Dembickaja
- BioHealing s.r.o., Dr. Slabihoudka 6232/11, 708 00 Ostrava, Czech Republic
- Laboratory of Animal Immunology and Biotechnology, Department of Animal Morphology, Physiology and Genetics, Faculty of AgriSciences, Mendel University in Brno, Zemedelska 1, 613 00 Brno, Czech Republic
| | - Beata Kozova
- BioHealing s.r.o., Dr. Slabihoudka 6232/11, 708 00 Ostrava, Czech Republic
| | - Vendula Hyneckova
- BioHealing s.r.o., Dr. Slabihoudka 6232/11, 708 00 Ostrava, Czech Republic
| | - Sona Gogolkova
- BioHealing s.r.o., Dr. Slabihoudka 6232/11, 708 00 Ostrava, Czech Republic
| | - Elen Stastna
- BioHealing s.r.o., Dr. Slabihoudka 6232/11, 708 00 Ostrava, Czech Republic
| | - Michal Zahradnicek
- BioHealing s.r.o., Dr. Slabihoudka 6232/11, 708 00 Ostrava, Czech Republic
| | - Stefan Savic
- BioHealing s.r.o., Dr. Slabihoudka 6232/11, 708 00 Ostrava, Czech Republic
| | - Arash Davani
- National Institute of Endocrinology and Diabetology, Kollárová 282/3, 034 91 Ľubochňa, Slovakia
| | - Edward Hulo
- National Institute of Endocrinology and Diabetology, Kollárová 282/3, 034 91 Ľubochňa, Slovakia
| | - Emil Martinka
- National Institute of Endocrinology and Diabetology, Kollárová 282/3, 034 91 Ľubochňa, Slovakia
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Kang S, Woo Y, Seo Y, Yoo D, Kwon D, Park H, Lee SD, Yoo HY, Lee T. A Descriptive Review on the Potential Use of Diatom Biosilica as a Powerful Functional Biomaterial: A Natural Drug Delivery System. Pharmaceutics 2024; 16:1171. [PMID: 39339207 PMCID: PMC11434644 DOI: 10.3390/pharmaceutics16091171] [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: 07/24/2024] [Revised: 08/29/2024] [Accepted: 09/02/2024] [Indexed: 09/30/2024] Open
Abstract
Although various chemically synthesized materials are essential in medicine, food, and agriculture, they can exert unexpected side effects on the environment and human health by releasing certain toxic chemicals. Therefore, eco-friendly and biocompatible biomaterials based on natural resources are being actively explored. Recently, biosilica derived from diatoms has attracted attention in various biomedical fields, including drug delivery systems (DDS), due to its uniform porous nano-pattern, hierarchical structure, and abundant silanol functional groups. Importantly, the structural characteristics of diatom biosilica improve the solubility of poorly soluble substances and enable sustained release of loaded drugs. Additionally, diatom biosilica predominantly comprises SiO2, has high biocompatibility, and can easily hybridize with other DDS platforms, including hydrogels and cationic DDS, owing to its strong negative charge and abundant silanol groups. This review explores the potential applications of various diatom biosilica-based DDS in various biomedical fields, with a particular focus on hybrid DDS utilizing them.
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Affiliation(s)
- Sunggu Kang
- Department of Chemical Engineering, Kwangwoon University, 20 Kwangwoon-ro, Nowon-gu, Seoul 01897, Republic of Korea
| | - Yeeun Woo
- Department of Chemical Engineering, Kwangwoon University, 20 Kwangwoon-ro, Nowon-gu, Seoul 01897, Republic of Korea
| | - Yoseph Seo
- Department of Chemical Engineering, Kwangwoon University, 20 Kwangwoon-ro, Nowon-gu, Seoul 01897, Republic of Korea
| | - Daehyeon Yoo
- Department of Chemical Engineering, Kwangwoon University, 20 Kwangwoon-ro, Nowon-gu, Seoul 01897, Republic of Korea
| | - Daeryul Kwon
- Protist Research Division, Biological Resources Research Department, Nakdonggang National Institute of Biological Resources (NNIBR), 137, Donam 2-gil, Sangju-si 37242, Gyeongsangbuk-do, Republic of Korea
| | - Hyunjun Park
- Department of Chemical Engineering, Kwangwoon University, 20 Kwangwoon-ro, Nowon-gu, Seoul 01897, Republic of Korea
| | - Sang Deuk Lee
- Protist Research Division, Biological Resources Research Department, Nakdonggang National Institute of Biological Resources (NNIBR), 137, Donam 2-gil, Sangju-si 37242, Gyeongsangbuk-do, Republic of Korea
| | - Hah Young Yoo
- Department of Biotechnology, Sangmyung University, 20, Hongjimun 2-gil, Jongno-gu, Seoul 03016, Republic of Korea
| | - Taek Lee
- Department of Chemical Engineering, Kwangwoon University, 20 Kwangwoon-ro, Nowon-gu, Seoul 01897, Republic of Korea
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Grosu (Dumitrescu) C, Jîjie AR, Manea HC, Moacă EA, Iftode A, Minda D, Chioibaş R, Dehelean CA, Vlad CS. New Insights Concerning Phytophotodermatitis Induced by Phototoxic Plants. Life (Basel) 2024; 14:1019. [PMID: 39202761 PMCID: PMC11355232 DOI: 10.3390/life14081019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2024] [Revised: 08/11/2024] [Accepted: 08/14/2024] [Indexed: 09/03/2024] Open
Abstract
The present review explores the underlying mechanisms of phytophotodermatitis, a non-immunologic skin reaction triggered by certain plants followed by exposure to ultraviolet radiation emitted by sunlight. Recent research has advanced our understanding of the pathophysiology of phytophotodermatitis, highlighting the interaction between plant-derived photosensitizing compounds (e.g., furanocoumarins and psoralens) and ultraviolet light leading to skin damage (e.g., erythema, fluid blisters, edema, and hyperpigmentation), identifying these compounds as key contributors to the phototoxic reactions causing phytophotodermatitis. Progress in understanding the molecular pathways involved in the skin's response to these compounds has opened avenues for identifying potential therapeutic targets suitable for the management and prevention of this condition. The review emphasizes the importance of identifying the most common phototoxic plant families (e.g., Apiaceae, Rutaceae, and Moraceae) and plant species (e.g., Heracleum mantegazzianum, Ruta graveolens, Ficus carica, and Pastinaca sativa), as well as the specific phytochemical compounds responsible for inducing phytophototoxicity (e.g., limes containing furocoumarin have been linked to lime-induced photodermatitis), underscoring the significance of recognizing the dangerous plant sources. Moreover, the most used approaches and tests for accurate diagnosis such as patch testing, Wood's lamp examination, or skin biopsy are presented. Additionally, preventive measures such as adequate clothing (e.g., long-sleeved garments and gloves) and treatment strategies based on the current knowledge of phytophotodermatitis including topical and systemic therapies are discussed. Overall, the review consolidates recent findings in the field, covering a diverse array of phototoxic compounds in plants, the mechanisms by which they trigger skin reactions, and the implications for clinical management. By synthesizing these insights, we provide a comprehensive understanding of phytophotodermatitis, providing valuable information for both healthcare professionals and researchers working to address this condition.
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Affiliation(s)
- Cristina Grosu (Dumitrescu)
- Department of Toxicology, Drug Industry, Management and Legislation, Faculty of Pharmacy, “Victor Babeș” University of Medicine and Pharmacy Timisoara, 2nd Eftimie Murgu Square, 300041 Timisoara, Romania (A.-R.J.); (E.-A.M.); (A.I.); (C.-A.D.)
| | - Alex-Robert Jîjie
- Department of Toxicology, Drug Industry, Management and Legislation, Faculty of Pharmacy, “Victor Babeș” University of Medicine and Pharmacy Timisoara, 2nd Eftimie Murgu Square, 300041 Timisoara, Romania (A.-R.J.); (E.-A.M.); (A.I.); (C.-A.D.)
| | - Horaţiu Cristian Manea
- Faculty of Medicine, “Vasile Goldis” Western University of Arad, 94 Revolutiei Bv., 310025 Arad, Romania
- Timisoara Municipal Emergency Clinical Hospital, 5 Take Ionescu Bv., 300062 Timisoara, Romania
| | - Elena-Alina Moacă
- Department of Toxicology, Drug Industry, Management and Legislation, Faculty of Pharmacy, “Victor Babeș” University of Medicine and Pharmacy Timisoara, 2nd Eftimie Murgu Square, 300041 Timisoara, Romania (A.-R.J.); (E.-A.M.); (A.I.); (C.-A.D.)
- Research Centre for Pharmaco-Toxicological Evaluation, “Victor Babeș” University of Medicine and Pharmacy, 2nd Eftimie Murgu Square, 300041 Timisoara, Romania
| | - Andrada Iftode
- Department of Toxicology, Drug Industry, Management and Legislation, Faculty of Pharmacy, “Victor Babeș” University of Medicine and Pharmacy Timisoara, 2nd Eftimie Murgu Square, 300041 Timisoara, Romania (A.-R.J.); (E.-A.M.); (A.I.); (C.-A.D.)
- Research Centre for Pharmaco-Toxicological Evaluation, “Victor Babeș” University of Medicine and Pharmacy, 2nd Eftimie Murgu Square, 300041 Timisoara, Romania
| | - Daliana Minda
- Department of Pharmacognosy, “Victor Babes” University of Medicine and Pharmacy Timisoara, 2nd Eftimie Murgu Square, 300041 Timisoara, Romania;
- Research and Processing Center for Medical and Aromatic Plants (Plant-Med), “Victor Babeş” University of Medicine and Pharmacy, 2nd Eftimie Murgu Square, 300041 Timisoara, Romania
| | - Raul Chioibaş
- Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, 2nd Eftimie Murgu Square, 300041 Timisoara, Romania;
- CBS Medcom Hospital, 12th Popa Sapca Street, 300047 Timisoara, Romania
| | - Cristina-Adriana Dehelean
- Department of Toxicology, Drug Industry, Management and Legislation, Faculty of Pharmacy, “Victor Babeș” University of Medicine and Pharmacy Timisoara, 2nd Eftimie Murgu Square, 300041 Timisoara, Romania (A.-R.J.); (E.-A.M.); (A.I.); (C.-A.D.)
- Research Centre for Pharmaco-Toxicological Evaluation, “Victor Babeș” University of Medicine and Pharmacy, 2nd Eftimie Murgu Square, 300041 Timisoara, Romania
| | - Cristian Sebastian Vlad
- Department of Biochemistry and Pharmacology, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, 2nd Eftimie Murgu Square, 300041 Timisoara, Romania;
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Alam W. Wound Bed Preparation and Treatment Modalities. Clin Geriatr Med 2024; 40:375-384. [PMID: 38960531 DOI: 10.1016/j.cger.2023.12.011] [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: 07/05/2024]
Abstract
Wound healing is a highly complex natural process, and its failure results in chronic wounds. The causes of delayed wound healing include patient-related and local wound factors. The main local impediments to delayed healing are the presence of nonviable tissue, excessive inflammation, infection, and moisture imbalance. For wounds that can be healed with adequate blood supply, a stepwise approach to identify and treat these barriers is termed wound bed preparation. Currently, a combination of patient-related and local factors, including wound debridement, specialty dressings, and advanced technologies, is available and successfully used to facilitate the healing process.
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Affiliation(s)
- Wahila Alam
- Department of Geriatrics, University of Connecticut, 263 Farmington Avenue, Farmington, CT 06030, USA.
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Muller-Sloof E, de Laat E, Baljé-Volkers C, Hummelink S, Vermeulen H, Ulrich D. Inter-rater reliability among healthcare professionals in assessing postoperative wound photos for the presence or absence of surgical wound dehiscence: A Pretest - Posttest study. J Tissue Viability 2024:S0965-206X(24)00106-2. [PMID: 38991899 DOI: 10.1016/j.jtv.2024.07.001] [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: 12/04/2023] [Revised: 06/18/2024] [Accepted: 07/05/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND Surgical wound dehiscence (SWD) has various definitions, which complicates accurate and uniform diagnosis. To address this, the World Union Wound Healing Societies (WUWHS) presented a consensus based definition and classification for SWD (2018). AIM This quasi-experimental pretest-posttest study investigates the inter-rater reliability among healthcare professionals (HCP) and wound care professionals (WCP) when assessing wound photos on the presence or absence of SWD before and after training on the WUWHS-definition. METHODS Wound expert teams compiled a set of twenty photos (SWD+: nineteen, SWD-: one), and a video training. Subsequently, 262 healthcare professionals received the pretest link to assess wound photos. After completion, participants received the posttest link, including a (video) training on the WUWHS-definition, and reassessment of fourteen photos (SWD+: thirteen, SWD-: one). PRIMARY OUTCOMES 1) pretest-posttest inter-rater-reliability among participants in assessing photos in congruence with the WUWHS-definition 2) the impact of training on assessment scores. SECONDARY OUTCOME familiarity with the WUWHS-definition. RESULTS One hundred thirty-one participants (65 HCPs, 66 WCPs) completed both tests. The posttest inter-rater reliability among participants for correctly identifying SWD was increased from 67.6 % to 76.2 %, reaching statistical significance (p-value: 0.001; 95 % Confidence Interval [1.8-2.2]). Sub-analyses per photo showed improved SWD posttest scores in thirteen photos, while statistical significance was reached in seven photos. Thirty-three percent of participants knew the WUWHS-definition. CONCLUSION The inter-rater reliability among participants increases after training on the WUWHS-definition. The definition provides diagnostic criteria for accurate SWD diagnosis. Widespread use of the definition may improve uniformity in care for patients with SWD.
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Affiliation(s)
- Emmy Muller-Sloof
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, P/O Box 9101, 6500 HB, Nijmegen, (634), the Netherlands.
| | - Erik de Laat
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, P/O Box 9101, 6500 HB, Nijmegen, (634), the Netherlands.
| | | | - Stefan Hummelink
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, P/O Box 9101, 6500 HB, Nijmegen, (634), the Netherlands.
| | - Hester Vermeulen
- Radboud Institute for Health Sciences Scientific Center for Quality of Healthcare, Radboud University Medical Center, P/O Box 9101, 6500 HB, Nijmegen, the Netherlands; HAN University Applied Sciences, Institute of Health, Kapittelweg 54, 6525 EP, Nijmegen, the Netherlands.
| | - Dietmar Ulrich
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, P/O Box 9101, 6500 HB, Nijmegen, (634), the Netherlands.
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Doerfler P, Schoefmann N, Cabral G, Bauer W, Berli MC, Binder B, Borst C, Botter S, French LE, Goerge T, Hafner J, Hartmann D, Høgh A, Hoetzenecker W, Holzer-Geissler JCJ, Kamolz LP, Kofler K, Luger T, Nischwitz SP, Popovits M, Rappersberger K, Restivo G, Schlager JG, Schmuth M, Stingl G, Stockinger T, Stroelin A, Stuetz A, Umlauft J, Weninger WP, Wolff-Winiski B. Development of a Cellular Assay as a Personalized Model for Testing Chronic Wound Therapeutics. J Invest Dermatol 2024:S0022-202X(24)01866-9. [PMID: 38960086 DOI: 10.1016/j.jid.2024.05.029] [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: 08/25/2023] [Revised: 03/19/2024] [Accepted: 05/01/2024] [Indexed: 07/05/2024]
Abstract
Exudates of nonhealing wounds contain drivers of pathogenicity. We utilized >800 exudates from nonhealing and healing wounds of diverse etiologies, collected by 3 different methods, to develop a wound-specific, cell-based functional biomarker assay. Human dermal fibroblast proliferation served as readout to (i) differentiate between healing and nonhealing wounds, (ii) follow the healing process of individual patients, and (iii) assess the effects of therapeutics for chronic wounds ex vivo. We observed a strong correlation between wound chronicity and inhibitory effects of individual exudates on fibroblast proliferation, with good diagnostic sensitivity (76-90%, depending on the sample collection method). Transition of a clinically nonhealing to a healing phenotype restored fibroblast proliferation and extracellular matrix formation while reducing inflammatory cytokine production. Transcriptional analysis of fibroblasts exposed to ex vivo nonhealing wound exudates revealed an induction of inflammatory cytokine and chemokine pathways and the unfolded protein response, indicating that these changes may contribute to the pathology of nonhealing wounds. Testing the wound therapeutics, PDGF and silver sulfadiazine, yielded responses in line with clinical experience and indicates the usefulness of the assay to search for and profile new therapeutics.
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Affiliation(s)
| | | | | | - Wolfgang Bauer
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Martin C Berli
- Balgrist University Hospital, Zurich, Switzerland; Technical Orthopedics, Diabetic Foot Consultation, Wound Outpatient Clinic, Spital Limmattal, Schlieren, Switzerland
| | - Barbara Binder
- Department of Dermatology and Venerology, Medical University of Graz, Graz, Austria
| | - Carina Borst
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Sander Botter
- Swiss Center for Musculoskeletal Biobanking, Balgrist Campus AG, Zurich, Switzerland
| | - Lars E French
- Department of Dermatology and Allergology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Tobias Goerge
- Department of Dermatology, University of Münster, Muenster, Germany
| | - Juerg Hafner
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
| | - Daniela Hartmann
- Department of Dermatology and Allergology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Annette Høgh
- Department of Vascular Surgery, Regionshospitalet Viborg, Viborg, Denmark
| | | | - Judith C J Holzer-Geissler
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Lars P Kamolz
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Katrin Kofler
- Department of Dermatology, Medical University of Tübingen, Tuebingen, Germany
| | - Thomas Luger
- Department of Dermatology, University of Münster, Muenster, Germany
| | - Sebastian P Nischwitz
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Michael Popovits
- Department of Surgery, Barmherzige Brueder Hospital Graz, Graz, Austria; Privatklinik Graz Ragnitz, Graz, Austria
| | | | - Gaetana Restivo
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
| | - Justin G Schlager
- Department of Dermatology and Allergology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Matthias Schmuth
- Department of Dermatology, Venerology and Allergology, Medical University of Innsbruck, Innsbruck, Austria
| | - Georg Stingl
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | | | - Anke Stroelin
- Department of Dermatology, Medical University of Tübingen, Tuebingen, Germany
| | | | - Julian Umlauft
- Department of Dermatology, Venerology and Allergology, Medical University of Innsbruck, Innsbruck, Austria; Dermatology, Zellmed Medalp, Zell am Ziller, Austria
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Lev-Tov HA, Hermak S. Hydration response technology dressings for low to excessively exuding wounds: a systematic review. J Wound Care 2024; 33:383-392. [PMID: 38843010 DOI: 10.12968/jowc.2024.0088] [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: 06/14/2024]
Abstract
OBJECTIVE The aim of this systematic review was to identify and qualify the current available evidence of the wound exudate handling capabilities and the cost-effectiveness of hydration response technology (HRT). HRT combines physically modified cellulose fibres and gelling agents resulting in wound dressings that absorb and retain larger quantities of wound exudate. METHOD A systematic search was conducted in MEDLINE (via PubMed and PubMed Central) according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The search was conducted using an unlimited search period. Studies or reviews that evaluated effect on wound exudate and cost-effectiveness, as well as the impact on wound healing were considered. Records focusing on wound management using HRT devices were included. RESULTS The literature search identified four studies and one comparative analysis, ranging from low to moderate quality, that compared HRT dressings to other interventions (carboxymethyl cellulose dressing, other superabsorbent dressings, negative pressure wound therapy). CONCLUSION The analysed data supported the beneficial use of dressings with HRT for exuding wounds which was characterised by fewer dressing changes, improved periwound skin conditions and reduced costs.
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Affiliation(s)
- Hadar Avihai Lev-Tov
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida, US
| | - Sarah Hermak
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida, US
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Lazzari G, Cesa S, Lo Palo E. Clinical use of 0.1% polyhexanide and propylbetaine on acute and hard-to-heal wounds: a literature review. J Wound Care 2024; 33:cxl-cli. [PMID: 38850544 DOI: 10.12968/jowc.2019.0066] [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: 06/10/2024]
Abstract
OBJECTIVE To summarise the findings on the effect of the clinical use of 0.1% polyhexanide-propylbetaine (PHMB/betaine) solution/gel on acute and hard-to-heal (chronic) wound healing. METHOD A literature search was conducted in MEDLINE, CINAHL, Embase, Scopus and the CENTRAL Trials Registry of the Cochrane Collaboration. Paired reviewers conducted title and abstract screening and full-text screening to identify experimental, quasi-experimental and observational studies. Study quality and risk of bias were not formally evaluated. RESULTS A total of 17 studies met the eligibility criteria. The findings from 12 studies indicated that the use of 0.1% PHMB/betaine solution/gel had: a low risk of contact sensitivity; could help debridement during wound cleansing; aided effective wound bed preparation; reduced wound size, odour and exudate; improved pain control; reduced microbial load; and enhanced wound healing. The results of three studies indicated that both 0.1% PHMB and saline solution were effective in reducing bacterial load, while another showed that adding 0.1% PHMB to tie-over dressings had no effect on reducing bacterial loads in wounds. Another study concluded that disinfection and granulation of pressure ulcers with hydrobalance dressing with 0.3% PHMB was faster and more effective than using 0.1% PHMB/betaine. CONCLUSION The findings of this literature review showed that 0.1% PHMB/betaine solution/gel appeared to be useful and safe for wound cleansing, was effective in removing soft debris and slough from the wound bed, and created a wound environment optimal for healing. Although these actions cannot be attributed solely to this treatment modality, these results do highlight the unique action of this combined product. However, more robust studies are needed to confirm these results.
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Affiliation(s)
- Giuseppe Lazzari
- School of Nursing, UOS Formazione Universitaria, ASST Papa Giovanni XXIII - Università degli Studi di Milano Bicocca, Bergamo, Italy
| | - Simonetta Cesa
- Health and Social Care Directorate, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Emilia Lo Palo
- Ambulatory Wound Care Clinic, UOC Department of Healthcare and Social Professions, ASST Papa Giovanni XXIII, Bergamo, Italy
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Dissemond J, Chadwick P, Weir D, Alves P, Isoherranen K, Lázaro Martínez JL, Swanson T, Gledhill A, Malone M. M.O.I.S.T. Concept for the Local Therapy of Chronic Wounds: An International Update. INT J LOW EXTR WOUND 2024:15347346241245159. [PMID: 38571403 DOI: 10.1177/15347346241245159] [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: 04/05/2024]
Abstract
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.
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Affiliation(s)
- Joachim Dissemond
- Department of Dermatology, Venerology and Allergology, University of Essen, Essen, Germany
| | | | - Dot Weir
- Saratoga Hospital Center for Wound Healing and Hyperbaric Medicine, Saratoga Springs, NY, USA
| | - Paulo Alves
- Universidade Católica Portuguesa, Institute of Health Sciences - Wounds Research Lab, Lisboa, Portugal
| | - Kirsi Isoherranen
- Department of Dermatology and Allergology, University of Helsinki and Inflammation center, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | | | - Terry Swanson
- Wound Education Research Consultancy, Warrnambool, Victoria, Australia
| | - Andrea Gledhill
- Department of Podiatric Surgery, Trauma and Orthopaedics, Great Western Hospital NHSFT, Swindon, UK
| | - Matthew Malone
- Research and Development, Molnlycke Healthcare AB, Gothenburg, Sweden
- Infectious Diseases Microbiology, School of Medicine, Western Sydney University, Sydney, Australia
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10
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Chen N, Wang H, Shao Y, Yang J, Song G. A Comparative Study on Platelet-Rich Plasma From Elderly Individuals and Young Adults to Treat Pressure Ulcers in Mice. J Surg Res 2024; 294:198-210. [PMID: 37913727 DOI: 10.1016/j.jss.2023.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 07/25/2023] [Accepted: 08/28/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE The aim of the present study was to compare the therapeutic effects of activated platelet-rich plasma (PRP) prepared from elderly individuals and young adults to treat pressure ulcers (PUs), and to accumulate a theoretical basis for allogeneic PRP treatment of PUs in elderly patients. MATERIALS AND METHODS Whole blood was extracted from elderly individuals aged >65 y and young adult volunteers for PRP preparation, and platelet concentrations in whole blood and PRP were compared. Growth factors released from activated PRP were assayed using the enzyme-linked immunosorbent assay. C57BL/6 mice were divided into three groups: the control saline, elderly-PRP (Group A), and young adult-PRP (Group B). Ischemia-reperfusion injury-induced PUs were established on the backs of mice. PUs were photographed on days 0, 5, and 10 to assess their sizes. Specimens were collected on day 10 and subjected to hematoxylin and eosin and Masson's staining. Immunohistochemical staining for CD31 was conducted to evaluate vascular formation, and cell invasion was assessed using a Transwell assay. The action of PRP on transforming growth factor-beta (TGF-β)-dependent fibroblast activity and epithelial-mesenchymal transition was analyzed using immunofluorescence and Western blotting in vitro. RESULTS The platelet concentrations in whole blood and PRP of young adults were significantly higher than that in elderly individuals. The two PRP treatment groups had similar platelet enrichment coefficients of PRP. After activation, PRP from young adults produced significantly higher levels of platelet-derived growth factor, TGF-β, and vascular endothelial growth factor than PRP from elderly individuals (P < 0.05). The concentrations of platelet-derived growth factor, TGF-β, and vascular endothelial growth factor were positively correlated with the platelet concentrations in whole blood and PRP. The effects of PRP in regulating the expressions of TGF-β, α-smooth muscle actin, vimentin, and E-cadherin were observed in vivo and in vitro. The two PRP treatment groups exhibited better wound healing than the control group, as evidenced by more re-epithelialization, higher collagen content, skin fibrosis, and more blood vessel formation over time. Group B exhibited better wound healing than Group A (P < 0.05). CONCLUSION PRP exhibits potent wound healing ability in PU therapy, and PRP from young adults is seemingly superior to that from elderly individuals because of a higher concentration of platelets and increased production of growth factors.
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Affiliation(s)
- Ningjie Chen
- Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China; Department of Burns and Plastic Surgery, Weihai Municipal Hospital, Shandong University, Weihai, Shandong, China
| | - Haitao Wang
- Department of Burns and Plastic Surgery, Weihai Municipal Hospital, Shandong University, Weihai, Shandong, China
| | - Yang Shao
- Department of Burns and Orthopedic Surgery, Jinan Central Hospital, Shandong University, Jinan, Shandong, China
| | - Jincun Yang
- Department of Burns and Plastic Surgery, Weihai Municipal Hospital, Shandong University, Weihai, Shandong, China
| | - Guodong Song
- Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China; Department of Burns and Orthopedic Surgery, Jinan Central Hospital, Shandong University, Jinan, Shandong, China.
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11
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Salcedo Mercado AM, Rodríguez Cabrero RA, Lozano Corona R, Anaya-Ayala JE. Durometry for the Assessment of Severity of Post-thrombotic Syndrome and Possible Clinical Applications. Vasc Endovascular Surg 2024; 58:54-59. [PMID: 37429286 DOI: 10.1177/15385744231189023] [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: 07/12/2023]
Abstract
BACKGROUND Post-thrombotic syndrome (PTS) impacts the patient's quality of life. Available scales to determine its severity remain controversial, therefore, it is of importance to identify new auxiliary methods for the assessment of this sequelae. Measurement of skin hardness (MSH) might be decisive in tracking PTS. The purpose of this study is to assess if the use of durometry is an objective measure to evaluate prognosis of affected limbs in patients with PTS. We compared MSH of extremities with PTS vs healthy limbs, as well as their variation after 3 months of medical treatment to evaluate if durometry can be used to find differences. We strongly believe that measuring and keeping track of skin changes specifically skin hardness can be a useful factor in the prognosis and treatment of PTS. METHODS Prospective cohort study from January 2021 to February 2022 in patients with unilateral PTS. The MSH of the affected limb was compared to the healthy limb. A calibrated durometer was used, 4 measurements were completed at the time of diagnosis and subsequent follow-up were carried out after 3 months of treatment. The percentage of healing (in case of ulcers) and adherence to treatment was carefully monitored. The statistical program R was used. RESULTS A total of 1088 durometric measurements were performed on 17 patients, and 34 limbs. The MSH in limbs with PTS was 39.09 and in the control limbs (19.8) (P = <.00001). After 3 months of treatment, the MSH in PTS varied in PTS limbs (39.09 to 30.4) (P = <.000012). Adherence to treatment was 70.5%. CONCLUSIONS MSH varied between healthy limbs and the ones with PTS, before and after treatment. Durometry might represent a method for assessing skin changes in patients with PTS.
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Affiliation(s)
| | | | | | - Javier E Anaya-Ayala
- Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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12
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Wu YW, Wang CY, Cheng NC, Lin HJ, Huang HL, Huang JH, Chen CC, Lee JK, Chen PL, Hsu PC, Wu IH, Yeh JT, Tsai HY, Tzeng YS, Cheng CC, Lin CH, Wu SH, Tan JWH, Wu CH, Hsueh SK, Chang CH, Wu HP, Hsu CH, Yen HT, Lin PC, Lin CH, Tai HC, Chen WJ. 2024 TSOC/TSPS Joint Consensus: Strategies for Advanced Vascular Wound Management in Arterial and Venous Diseases. ACTA CARDIOLOGICA SINICA 2024; 40:1-44. [PMID: 38264067 PMCID: PMC10801419 DOI: 10.6515/acs.202401_40(1).20231220a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 12/20/2023] [Indexed: 01/25/2024]
Abstract
The Taiwan Society of Cardiology (TSOC) and Taiwan Society of Plastic Surgery (TSPS) have collaborated to develop a joint consensus for the management of patients with advanced vascular wounds. The taskforce comprises experts including preventive cardiologists, interventionists, and cardiovascular and plastic surgeons. The consensus focuses on addressing the challenges in diagnosing, treating, and managing complex wounds; incorporates the perfusion evaluation and the advanced vascular wound care team; and highlights the importance of cross-disciplinary teamwork. The aim of this joint consensus is to manage patients with advanced vascular wounds and encourage the adoption of these guidelines by healthcare professionals to improve patient care and outcomes. The guidelines encompass a range of topics, including the definition of advanced vascular wounds, increased awareness, team structure, epidemiology, clinical presentation, medical treatment, endovascular intervention, vascular surgery, infection control, advanced wound management, and evaluation of treatment results. It also outlines a detailed protocol for assessing patients with lower leg wounds, provides guidance on consultation and referral processes, and offers recommendations for various wound care devices, dressings, and products. The 2024 TSOC/TSPS consensus for the management of patients with advanced vascular wounds serves as a catalyst for international collaboration, promoting knowledge exchange and facilitating advancements in the field of advanced vascular wound management. By providing a comprehensive and evidence-based approach, this consensus aims to contribute to improved patient care and outcomes globally.
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Affiliation(s)
- Yen-Wen Wu
- Division of Cardiology, Cardiovascular Medical Center, and Department of Nuclear Medicine, Far Eastern Memorial Hospital, New Taipei City
- School of Medicine, National Yang Ming Chiao Tung University, Taipei
- Graduate Institute of Medicine, Yuan Ze University
| | - Chao-Yung Wang
- Division of Cardiology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan
- Institute of Cellular and System Medicine, National Health Research Institute, Zhunan
| | - Nai-Chen Cheng
- Division of Plastic Surgery, Department of Surgery, National Taiwan University Hospital and College of Medicine
| | - Hung-Ju Lin
- Division of Cardiology, Department of Internal Medicine
- Cardiovascular Center, National Taiwan University Hospital, Taipei
| | - Hsuan-Li Huang
- Division of Cardiology, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City
- School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien
| | - Jih-Hsin Huang
- Division of Cardiovascular Surgery, Cardiovascular Center, Far Eastern Memorial Hospital, New Taipei City
| | - Chun-Chi Chen
- Division of Cardiology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan
| | - Jen-Kuang Lee
- Division of Plastic Surgery, Department of Surgery, National Taiwan University Hospital and College of Medicine
- Division of Cardiology, Department of Internal Medicine
- Department of Internal Medicine
- Department of Laboratory Medicine, National Taiwan University College of Medicine
- Telehealth Center, National Taiwan University Hospital, Taipei
| | - Po-Lin Chen
- School of Medicine, National Yang Ming Chiao Tung University, Taipei
- Division of Cardiovascular Surgery, Department of Surgery, En Chu Kong Hospital, New Taipei City
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei
| | - Po-Chao Hsu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital
- Faculty of Medicine, Kaohsiung Medical University, Kaohsiung
| | - I-Hui Wu
- Department of Cardiovascular Surgery, National Taiwan University Hospital, College of Medicine, National Taiwan University
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University
- Department of Trauma Surgery, National Taiwan University Hospital, Taipei
| | - Jiun-Ting Yeh
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan
| | - Hao-Yuan Tsai
- Division of Cardiology, Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City
| | - Yuan-Sheng Tzeng
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei
- Department of Surgery, Zuoying Armed Forces General Hospital, Kaohsiung
| | - Cheng-Chung Cheng
- Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center
| | - Chia-Hsun Lin
- Division of Cardiovascular Surgery, Department of Surgery, Shin Kong Wu Ho-Su Memorial Hospital
| | - Szu-Hsien Wu
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital
- Department of Surgery, School of Medicine, National Yang Ming Chiao Tung University, Taipei
| | - Jimmy Wei Hwa Tan
- Department of Cardiovascular Surgery, An-Nan Hospital, China Medical University, Tainan
| | - Cheng-Hsueh Wu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei
- Department of Critical Care Medicine, Taipei Veterans General Hospital, Taipei
| | - Shu-Kai Hsueh
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung
| | - Chien-Hwa Chang
- Division of Cardiovascular Surgery, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi County
| | - Hsu-Ping Wu
- Cardiovascular Center, MacKay Memorial Hospital, Taipei
| | - Chung-Ho Hsu
- Section of Peripheral Artery Disease, Division of Cardiology, Department of Internal Medicine, China Medical University Hospital, Taichung
| | - Hsu-Ting Yen
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung
| | - Po-Chang Lin
- Department of Internal Medicine, China Medical University Hospital, Taichung
| | - Chih-Hung Lin
- Department of Plastic Reconstructive Surgery, Chang Gung University of Science and Technology, Taoyuan
| | - Hao-Chih Tai
- Institute of Cellular and System Medicine, National Health Research Institute, Zhunan
| | - Wen-Jone Chen
- Division of Plastic Surgery, Department of Surgery, National Taiwan University Hospital and College of Medicine
- Division of Cardiology, Department of Internal Medicine
- Department of Emergency Medicine, National Taiwan University College of Medicine and Hospital, Taipei
- Min-Sheng General Hospital, Taoyuan, Taiwan
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13
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Gieroń M, Żarnowiec P, Zegadło K, Gmiter D, Czerwonka G, Kaca W, Kręcisz B. Loop-Mediated Isothermal Amplification of DNA (LAMP) as an Alternative Method for Determining Bacteria in Wound Infections. Int J Mol Sci 2023; 25:411. [PMID: 38203582 PMCID: PMC10778741 DOI: 10.3390/ijms25010411] [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] [Received: 11/04/2023] [Revised: 12/23/2023] [Accepted: 12/25/2023] [Indexed: 01/12/2024] Open
Abstract
The increasing number of patients with chronic wounds requires the development of quick and accurate diagnostics methods. One of the key and challenging aspects of treating ulcers is to control wound infection. Early detection of infection is essential for the application of suitable treatment methods, such as systemic antibiotics or other antimicrobial agents. Clinically, the most frequently used method for detecting microorganisms in wounds is through a swab and culture on appropriate media. This test has major limitations, such as the long bacterial growth time and the selectivity of bacterial growth. This article presents an overview of molecular methods for detecting bacteria in wounds, including real-time polymerase chain reaction (rtPCR), quantitative polymerase chain reaction (qPCR), genotyping, next-generation sequencing (NGS), and loop-mediated isothermal amplification (LAMP). We focus on the LAMP method, which has not yet been widely used to detect bacteria in wounds, but it is an interesting alternative to conventional detection methods. LAMP does not require additional complicated equipment and provides the fastest detection time for microorganisms (approx. 30 min reaction). It also allows the use of many pairs of primers in one reaction and determination of up to 15 organisms in one sample. Isothermal amplification of DNA is currently the easiest and most economical method for microbial detection in wound infection. Direct visualization of the reaction with dyes, along with omitting DNA isolation, has increased the potential use of this method.
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Affiliation(s)
- Monika Gieroń
- Faculty of Medicine, Jan Kochanowski University in Kielce, 25-369 Kielce, Poland; (M.G.); (B.K.)
- Dermatology Department, Provincial General Hospital, 25-317 Kielce, Poland
| | - Paulina Żarnowiec
- Department of Microbiology, Institute of Biology, Jan Kochanowski University in Kielce, 25-406 Kielce, Poland; (P.Ż.); (K.Z.); (D.G.); (W.K.)
| | - Katarzyna Zegadło
- Department of Microbiology, Institute of Biology, Jan Kochanowski University in Kielce, 25-406 Kielce, Poland; (P.Ż.); (K.Z.); (D.G.); (W.K.)
| | - Dawid Gmiter
- Department of Microbiology, Institute of Biology, Jan Kochanowski University in Kielce, 25-406 Kielce, Poland; (P.Ż.); (K.Z.); (D.G.); (W.K.)
| | - Grzegorz Czerwonka
- Department of Microbiology, Institute of Biology, Jan Kochanowski University in Kielce, 25-406 Kielce, Poland; (P.Ż.); (K.Z.); (D.G.); (W.K.)
| | - Wiesław Kaca
- Department of Microbiology, Institute of Biology, Jan Kochanowski University in Kielce, 25-406 Kielce, Poland; (P.Ż.); (K.Z.); (D.G.); (W.K.)
| | - Beata Kręcisz
- Faculty of Medicine, Jan Kochanowski University in Kielce, 25-369 Kielce, Poland; (M.G.); (B.K.)
- Dermatology Department, Provincial General Hospital, 25-317 Kielce, Poland
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14
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Derwin R, Patton D, Strapp H, Moore Z. Integrating Point-of-Care Bacterial Fluorescence Imaging-Guided Care with Continued Wound Measurement for Enhanced Wound Area Reduction Monitoring. Diagnostics (Basel) 2023; 14:2. [PMID: 38201311 PMCID: PMC10802895 DOI: 10.3390/diagnostics14010002] [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: 11/10/2023] [Revised: 12/07/2023] [Accepted: 12/15/2023] [Indexed: 01/12/2024] Open
Abstract
AIM This prospective observational study investigated wound area reduction (WAR) outcomes in a complex wound population composed of non-healing acute and chronic wounds. The relationship between bacterial autofluorescence signals and WAR was investigated. Area measurements were collected both manually and digitally, and both methods were compared for accuracy. METHODS Twenty-six participants with 27 wounds of varying etiologies were observed twice weekly for two weeks. Digital wound measurement, wound bacterial status assessment, and targeted debridement were performed through a point-of-care fluorescence imaging device (MolecuLight® i: X, MolecuLight Inc, Toronto, Canada). The wound area reduction (WAR) rate was calculated using baseline and last visit measurements. Statistical analyses, including t-tests, Fisher exact tests, the Wilcoxon signed rank test for method comparison, and ANOVA for bacterial subgroups, were applied as pertinent. RESULTS The overall average WAR was -3.80 cm2, or a decrease of 46.88% (manual measurement), and -2.62 cm2, or a 46.05% decrease (digital measurement via MolecuLight® device). There were no statistically significant differences between the WAR of acute and chronic wounds (p = 0.7877). A stepwise correlation between the WAR and bacterial status classification per fluorescence findings was observed, where persistent bacteria resulted in worse WAR outcomes. An overestimation of wound area by manual measurement was 23% on average. CONCLUSION Fluorescence imaging signals were linked to WAR outcome and could be considered predictive. Wounds exhibiting bacterial loads that persisted at the end of the study period had worse WAR outcomes, while those for which management was able to effectively remove them demonstrated greater WAR. Manual measurement of the wound area consistently overestimated wound size when compared to digital measurement. However, if performed by the same operator, the overestimation was uniform enough that the WAR was calculated to be close to accurate. Notwithstanding, single wound measurements are likely to result in overestimation.
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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 D02 YN77, Ireland
| | - Declan Patton
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin D02 YN77, Ireland
- Fakeeh College of Health Sciences, Jeddah 23323, Saudi Arabia
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong NSW 2522, Australia
| | - Helen Strapp
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin D02 YN77, Ireland
| | - Zena Moore
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin D02 YN77, Ireland
- School of Nursing & Midwifery, Griffith University, Gold Coast, QLD 4222, Australia
- School of Health Sciences, Faculty of Life and Health Sciences, Ulster University, Belfast BT15 1AP, UK
- Department of Nursing, Fakeeh College for Medical Sciences, Jeddah 23323, Saudi Arabia
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, 9000 Gent, Belgium
- Lida Institute, Shanghai 201609, China
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15
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Deng Z, Long ZS, Chen G. Mini-Review: Tendon-Exposed Wound Treatments. J INVEST SURG 2023; 36:2266758. [PMID: 37813390 DOI: 10.1080/08941939.2023.2266758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 09/28/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND Tendon-exposed wounds are complex injuries with challenging reconstructions and no unified treatment mode. Furthermore, insufficient tissue volume and blood circulation disorders affect healing, which increases pain for the patient and affects their families and caretakers. REVIEW As modern medicine advances, considerable progress has been made in understanding and treating tendon-exposed wounds, and current research encompasses both macro-and micro-studies. Additionally, new treatment methods have emerged alongside the classic surgical methods, such as new dressing therapies, vacuum sealing drainage combination therapy, platelet-rich plasma therapy, and live-cell bioengineering. CONCLUSIONS This review summarizes the latest treatment methods for tendon-exposed wounds to provide ideas and improve their treatment.
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Affiliation(s)
- Zhuan Deng
- Department of Orthopedics, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Zhi-Sheng Long
- Department of Orthopedics, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Gang Chen
- Department of Orthopedics, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
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16
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Atkin L. Small intestinal submucosa extracellular matrix: advantages, evidence and application. J Wound Care 2023; 32:S4-S7. [PMID: 38175770 DOI: 10.12968/jowc.2023.32.sup12a.s4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Affiliation(s)
- Leanne Atkin
- Vascular Nurse Consultant/Research Fellow, University of Huddersfield and Mid Yorkshire Hospitals NHS Trust, UK
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17
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Zhu G, Gao B, Fan J, Chen J, Su S, Yang X, Li B, Fang C. ICG-mediated fluorescence-assisted debridement to promote wound healing. PLoS One 2023; 18:e0291508. [PMID: 37733658 PMCID: PMC10513195 DOI: 10.1371/journal.pone.0291508] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/30/2023] [Indexed: 09/23/2023] Open
Abstract
The purpose of this study was to examine the efficacy of ICG-mediated fluorescence molecular imaging (FMI) in debridement of necrotic tissue. 96 wound-infected rats were randomly divided into control group, ICG group, excitation light (EL)group and FMI group for debridement of necrotic tissue (n = 24). (I) Control group: only debridement; (II) ICG group: ICG injection before debridement; (III) EL group: Debridement under EL; (IV) FMI group: Debridement guided by ICG-mediated FMI. On the 3rd, 6th, and 9th days, the wound tissues of the rats in each group were collected for histological examination, and the levels of serum interleukin-4 (IL-4) and interferon-γ (INF-γ) were analyzed. The wound healing rate, wound score and body weight of the rats in each group were followed up until the wound healed. The results showed that the infected wounds of the rats in the FMI group had significant fluorescence development. The level of serum IL-4 in the FMI group was higher than that in the other three groups on the 6th day (p<0.01), while the level of INF-γ was lower than that in the other three groups on the 6th and 9th day (p<0.05). The results of dynamic wound tissue H&E staining indicated that the wound healing in the FMI group was better than the other three groups. The in vivo follow-up results showed that the wound healing rate and wound score of the FMI group were better than the other three groups, and the growth of rats had no difference with the other groups. ICG-mediated FMI can achieve accurate imaging of necrotic tissue for debridement, and so can accelerate wound healing, which has good clinical application prospects.
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Affiliation(s)
- Gang Zhu
- Department of General Surgery (Hepatobiliary Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China
- Department of Hepatobiliary Pancreatic and Splenic Surgery, Luzhou People’s Hospital, Luzhou, China
| | - Benjian Gao
- Department of General Surgery (Hepatobiliary Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China
- Academician (Expert) Workstation of Sichuan Province, Luzhou, China
| | - Jun Fan
- Department of General Surgery (Hepatobiliary Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China
- Academician (Expert) Workstation of Sichuan Province, Luzhou, China
| | - Jianfei Chen
- Department of General Surgery (Hepatobiliary Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China
- Academician (Expert) Workstation of Sichuan Province, Luzhou, China
| | - Song Su
- Department of General Surgery (Hepatobiliary Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China
- Academician (Expert) Workstation of Sichuan Province, Luzhou, China
| | - Xiaoli Yang
- Department of General Surgery (Hepatobiliary Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China
- Academician (Expert) Workstation of Sichuan Province, Luzhou, China
| | - Bo Li
- Department of General Surgery (Hepatobiliary Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China
- Academician (Expert) Workstation of Sichuan Province, Luzhou, China
| | - Cheng Fang
- Department of General Surgery (Hepatobiliary Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China
- Academician (Expert) Workstation of Sichuan Province, Luzhou, China
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18
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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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Chen CF, Chen SH, Chen RF, Liu KF, Kuo YR, Wang CK, Lee TM, Wang YH. A Multifunctional Polyethylene Glycol/Triethoxysilane-Modified Polyurethane Foam Dressing with High Absorbency and Antiadhesion Properties Promotes Diabetic Wound Healing. Int J Mol Sci 2023; 24:12506. [PMID: 37569881 PMCID: PMC10419382 DOI: 10.3390/ijms241512506] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 08/13/2023] Open
Abstract
The delayed healing of chronic wounds, such as diabetic foot ulcers (DFUs), is a clinical problem. Few dressings can promote wound healing by satisfying the demands of chronic wound exudate management and tissue granulation. Therefore, the aim of this study was to prepare a high-absorption polyurethane (PU) foam dressing modified by polyethylene glycol (PEG) and triethoxysilane (APTES) to promote wound healing. PEG-modified (PUE) and PEG/APTES-modified (PUESi) dressings were prepared by self-foaming reactions. Gauze and PolyMem were used as controls. Next, Fourier transform-infrared spectroscopy, thermomechanical analyses, scanning electron microscopy and tensile strength, water absorption, anti-protein absorption, surface dryness and biocompatibility tests were performed for in vitro characterization. Wound healing effects were further investigated in nondiabetic (non-DM) and diabetes mellitus (DM) rat models. The PUE and PUESi groups exhibited better physicochemical properties than the gauze and PolyMem groups. Moreover, PUESi dressing showed better anti-adhesion properties and absorption capacity with deformation. Furthermore, the PUESi dressing shortened the inflammatory phase and enhanced collagen deposition in both the non-DM and DM animal models. To conclude, the PUESi dressing not only was fabricated with a simple and effective strategy but also enhanced wound healing via micronegative-pressure generation by its high absorption compacity with deformation.
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Affiliation(s)
- Chiu-Fang Chen
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, 100, Shih-Chuan 1st Road, Kaohsiung 80708, Taiwan;
| | - Szu-Hsien Chen
- Institute of Polymer Science and Engineering, College of Engineering, National Taiwan University, Taipei 106216, Taiwan;
| | - Rong-Fu Chen
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan; (R.-F.C.); (K.-F.L.); (Y.-R.K.)
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Regenerative Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
- Orthopaedic Research Center, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Keng-Fan Liu
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan; (R.-F.C.); (K.-F.L.); (Y.-R.K.)
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Regenerative Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
- Orthopaedic Research Center, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Yur-Ren Kuo
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan; (R.-F.C.); (K.-F.L.); (Y.-R.K.)
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Regenerative Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
- Orthopaedic Research Center, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Department of Biological Sciences, National Sun Yat-Sen University, Kaohsiung 80424, Taiwan
- Academic Clinical Programme for Musculoskeletal Sciences, Duke-NUS Graduate Medical School, Singapore 169857, Singapore
| | - Chih-Kuang Wang
- Regenerative Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
- Orthopaedic Research Center, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Department of Medicinal and Applied Chemistry, College of Life Science, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- PhD Program in Life Sciences, College of Life Science, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Tzer-Min Lee
- Institute of Oral Medicine, National Cheng Kung University, No. 1, University Road, Tainan 701, Taiwan
- School of Dentistry, National Cheng Kung University, Tainan 701, Taiwan
- Taiwan Instrument Research Institute, National Applied Research Laboratories, Hsinchu 300092, Taiwan
| | - Yan-Hsiung Wang
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, 100, Shih-Chuan 1st Road, Kaohsiung 80708, Taiwan;
- Regenerative Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
- Orthopaedic Research Center, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan
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20
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Sussman G. An update on wound management. Aust Prescr 2023; 46:29-35. [PMID: 38053564 PMCID: PMC10664094 DOI: 10.18773/austprescr.2023.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023] Open
Abstract
Wound management involves an understanding of the aetiology and pathophysiology of a wound, the healing process and how best to manage both. Acute wounds can occur suddenly, such as burns and skin tears. Chronic wounds fail to progress through the normal stages of healing and can include ulcers, pressure injuries and infected wounds. Dressings and bandages provide the optimal environment for the healing of all wound types. It is important for healthcare practitioners to understand the key differences in their properties, uses and precautions. Selecting the ideal dressing or bandage can minimise the healing duration, reduce the bioburden, and improve a patient's quality of life.
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Affiliation(s)
- Geoffrey Sussman
- Faculty of Medicine, Nursing and Health Sciences, Monash University
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21
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Collier M. What is, how to manage, and what are the effects of wound exudate? Introducing the 3M Exudate Pathway. Br J Community Nurs 2023; 28:S27-S38. [PMID: 37262094 DOI: 10.12968/bjcn.2023.28.sup6.s27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Mark Collier
- Nurse Consultant and Associate Lecturer-Tissue Viability UK (Independent and University of Lincoln) and Chair of the Leg Ulcer Forum (England and Wales)
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22
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Zhao P, Dang Z, Liu M, Guo D, Luo R, Zhang M, Xie F, Zhang X, Wang Y, Pan S, Ma X. Molecular hydrogen promotes wound healing by inducing early epidermal stem cell proliferation and extracellular matrix deposition. Inflamm Regen 2023; 43:22. [PMID: 36973725 PMCID: PMC10044764 DOI: 10.1186/s41232-023-00271-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/26/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Despite progress in developing wound care strategies, there is currently no treatment that promotes the self-tissue repair capabilities. H2 has been shown to effectively protect cells and tissues from oxidative and inflammatory damage. While comprehensive effects and how H2 functions in wound healing remains unknown, especially for the link between H2 and extracellular matrix (ECM) deposition and epidermal stem cells (EpSCs) activation. METHODS Here, we established a cutaneous aseptic wound model and applied a high concentration of H2 (66% H2) in a treatment chamber. Molecular mechanisms and the effects of healing were evaluated by gene functional enrichment analysis, digital spatial profiler analysis, blood perfusion/oxygen detection assay, in vitro tube formation assay, enzyme-linked immunosorbent assay, immunofluorescent staining, non-targeted metabonomic analysis, flow cytometry, transmission electron microscope, and live-cell imaging. RESULTS We revealed that a high concentration of H2 (66% H2) greatly increased the healing rate (3 times higher than the control group) on day 11 post-wounding. The effect was not dependent on O2 or anti-reactive oxygen species functions. Histological and cellular experiments proved the fast re-epithelialization in the H2 group. ECM components early (3 days post-wounding) deposition were found in the H2 group of the proximal wound, especially for the dermal col-I, epidermal col-III, and dermis-epidermis-junction col-XVII. H2 accelerated early autologous EpSCs proliferation (1-2 days in advance) and then differentiation into myoepithelial cells. These epidermal myoepithelial cells could further contribute to ECM deposition. Other beneficial outcomes include sustained moist healing, greater vascularization, less T-helper-1 and T-helper-17 cell-related systemic inflammation, and better tissue remodelling. CONCLUSION We have discovered a novel pattern of wound healing induced by molecular hydrogen treatment. This is the first time to reveal the direct link between H2 and ECM deposition and EpSCs activation. These H2-induced multiple advantages in healing may be related to the enhancement of cell viability in various cells and the maintenance of mitochondrial functions at a basic level in the biological processes of life.
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Affiliation(s)
- Pengxiang Zhao
- Faculty of Environment and Life, Beijing University of Technology, Beijing, 100124, People's Republic of China
- Beijing Molecular Hydrogen Research Center, Beijing, 100124, People's Republic of China
- Beijing International Science and Technology Cooperation Base of Antivirus Drug, Beijing, 100124, People's Republic of China
| | - Zheng Dang
- Faculty of Environment and Life, Beijing University of Technology, Beijing, 100124, People's Republic of China
- Beijing Molecular Hydrogen Research Center, Beijing, 100124, People's Republic of China
- Beijing International Science and Technology Cooperation Base of Antivirus Drug, Beijing, 100124, People's Republic of China
| | - Mengyu Liu
- Faculty of Environment and Life, Beijing University of Technology, Beijing, 100124, People's Republic of China
- Beijing Molecular Hydrogen Research Center, Beijing, 100124, People's Republic of China
- Beijing International Science and Technology Cooperation Base of Antivirus Drug, Beijing, 100124, People's Republic of China
| | - Dazhi Guo
- Department of Hyperbaric Oxygen, Sixth Medical Center of PLA General Hospital, Beijing, 100048, People's Republic of China
| | - Ruiliu Luo
- Faculty of Environment and Life, Beijing University of Technology, Beijing, 100124, People's Republic of China
- Beijing Molecular Hydrogen Research Center, Beijing, 100124, People's Republic of China
- Beijing International Science and Technology Cooperation Base of Antivirus Drug, Beijing, 100124, People's Republic of China
| | - Mingzi Zhang
- Department of Plastic Surgery, Peking Union Medical College Hospital (Dongdan campus), No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, People's Republic of China
| | - Fei Xie
- Faculty of Environment and Life, Beijing University of Technology, Beijing, 100124, People's Republic of China
- Beijing Molecular Hydrogen Research Center, Beijing, 100124, People's Republic of China
- Beijing International Science and Technology Cooperation Base of Antivirus Drug, Beijing, 100124, People's Republic of China
| | - Xujuan Zhang
- Faculty of Environment and Life, Beijing University of Technology, Beijing, 100124, People's Republic of China
- Beijing Molecular Hydrogen Research Center, Beijing, 100124, People's Republic of China
- Beijing International Science and Technology Cooperation Base of Antivirus Drug, Beijing, 100124, People's Republic of China
| | - Youbin Wang
- Department of Plastic Surgery, Peking Union Medical College Hospital (Dongdan campus), No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, People's Republic of China
| | - Shuyi Pan
- Department of Hyperbaric Oxygen, Sixth Medical Center of PLA General Hospital, Beijing, 100048, People's Republic of China
| | - Xuemei Ma
- Faculty of Environment and Life, Beijing University of Technology, Beijing, 100124, People's Republic of China.
- Beijing Molecular Hydrogen Research Center, Beijing, 100124, People's Republic of China.
- Beijing International Science and Technology Cooperation Base of Antivirus Drug, Beijing, 100124, People's Republic of China.
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Minsart M, Deroose N, Parmentier L, Van Vlierberghe S, Mignon A, Dubruel P. Fine-Tuning the Endcap Chemistry of Acrylated Poly(Ethylene Glycol)-Based Hydrogels for Efficient Burn Wound Exudate Management. Macromol Biosci 2023; 23:e2200341. [PMID: 36404646 DOI: 10.1002/mabi.202200341] [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: 08/16/2022] [Revised: 11/04/2022] [Indexed: 11/22/2022]
Abstract
Most commercial dressings with moderate to high exudate uptake capacities are mechanically weaker and/or require a secondary dressing. The current research article focuses on the development of hydrogel-based wound dressings combining mechanical strength with high exudate absorption capacities using acrylate-endcapped urethane-based precursors (AUPs). AUPs with varying poly(ethylene glycol) backbone molar masses (10 and 20 kg mol-1 ) and endcap chemistries are successfully synthesized in toluene, subsequently processed into UV-cured hydrogel sheets and are benchmarked against several commercial wound dressings (Hydrosorb, Kaltostat, and Mepilex Ag). The AUP materials show high gel fractions (>90%) together with strong swelling degrees in water, phosphate buffered saline and simulated wound fluid (12.7-19.6 g g-1 ), as well as tunable mechanical properties (e.g., Young's modulus: 0.026-0.061 MPa). The AUPs have significantly (p < 0.05) higher swelling degrees than the tested commercial dressings, while also being mechanically resistant. The elasticity of the synthesized materials leads to an increased resistance against fatigue. The di- and hexa-acrylated AUPs show excellent in vitro biocompatibility against human foreskin fibroblasts, as evidenced by indirect MTS assays and live/dead cell assays. In conclusion, the processed AUP materials demonstrate high potential for wound healing application and can even compete with commercially available dressings.
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Affiliation(s)
- Manon Minsart
- Polymer Chemistry & Biomaterials Research Group, Centre of Macromolecular Chemistry, Department of Organic and Macromolecular Chemistry, Ghent University, Krijgslaan 281, Building S4-bis, Ghent, 9000, Belgium
| | - Nicolas Deroose
- Polymer Chemistry & Biomaterials Research Group, Centre of Macromolecular Chemistry, Department of Organic and Macromolecular Chemistry, Ghent University, Krijgslaan 281, Building S4-bis, Ghent, 9000, Belgium
| | - Laurens Parmentier
- Polymer Chemistry & Biomaterials Research Group, Centre of Macromolecular Chemistry, Department of Organic and Macromolecular Chemistry, Ghent University, Krijgslaan 281, Building S4-bis, Ghent, 9000, Belgium
| | - Sandra Van Vlierberghe
- Polymer Chemistry & Biomaterials Research Group, Centre of Macromolecular Chemistry, Department of Organic and Macromolecular Chemistry, Ghent University, Krijgslaan 281, Building S4-bis, Ghent, 9000, Belgium
| | - Arn Mignon
- Smart Polymeric Biomaterials Research Group, Biomaterials and Tissue Engineering (SIEM) @ Campus Group T Leuven, Andreas Vesaliusstraat 13, Leuven, 3000, Belgium
| | - Peter Dubruel
- Polymer Chemistry & Biomaterials Research Group, Centre of Macromolecular Chemistry, Department of Organic and Macromolecular Chemistry, Ghent University, Krijgslaan 281, Building S4-bis, Ghent, 9000, Belgium
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24
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Rayate AS, Nagoba BS, Mumbre SS, Mavani HB, Gavkare AM, Deshpande AS. Current scenario of traditional medicines in management of diabetic foot ulcers: A review. World J Diabetes 2023; 14:1-16. [PMID: 36684382 PMCID: PMC9850800 DOI: 10.4239/wjd.v14.i1.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/04/2022] [Accepted: 12/06/2022] [Indexed: 01/10/2023] Open
Abstract
Diabetic foot infections and diabetic foot ulcers (DFU) cause significant suffering and are often recurring. DFU have three important pathogenic factors, namely, microangiopathy causing local tissue anoxia, neuropathy making the foot prone to injuries from trivial trauma, and local tissue hyperglycaemia favouring infection and delaying the wound healing. DFU have been the leading cause for non-traumatic amputations of part or whole of the limb. Western medicines focus mainly on euglycaemia, antimicrobials, debridement and wound cover with grafts, and off-loading techniques. Advances in euglycaemic control, foot care and footwear, systemic antimicrobial therapy, and overall health care access and delivery, have resulted in an overall decrease in amputations. However, the process of wound care after adequate debridement remains a major cost burden globally, especially in developing nations. This process revolves around two basic concerns regarding control/eradication of local infection and promotion of faster healing in a chronic DFU without recurrence. Wound modulation with various dressings and techniques are often a costly affair. Some aspects of the topical therapy with modern/Western medicines are frequently not addressed. Cost of and compliance to these therapies are important as both the wounds and their treatment are “chronic.” Naturally occurring agents/medications from traditional medicine systems have been used frequently in different cultures and nations, though without adequate clinical base/relevance. Traditional Chinese medicine involves restoring yin-yang balance, regulating the ‘chi’, and promoting local blood circulation. Traditional medicines from India have been emphasizing on ‘naturally’ available products to control wound infection and promote all the aspects of wound healing. There is one more group of chemicals which are not pharmaceutical agents but can create acidic milieu in the wound to satisfy the above-mentioned basic concerns. Various natural and plant derived products (e.g., honey, aloe vera, oils, and calendula) and maggots are also used for wound healing purposes. We believe that patients with a chronic wound are so tired physically, emotionally, and financially that they usually accept native traditional medicine which has the same cultural base, belief, and faith. Many of these products have never been tested in accordance to “evidence-based medicine.” There are usually case reports and experience-based reports about these products. Recently, there have been some trials (in vitro and in vivo) to verify the claims of usage of traditional medicines in management of DFU. Such studies show that these natural products enhance the healing process by controlling infection, stimulating granulation tissue, antimicrobial action, promoting fibroblastic activity and collagen deposition, etc. In this review, we attempt to study and analyse the available literature on results of topical traditional medicines, which are usually advocated in the management of DFU. An integrated and ‘holistic’ approach of both modern and traditional medicine may be more acceptable to the patient, cost effective, and easy to administer and monitor. This may also nevertheless lead to further improvement in quality of life and decrease in the rates of amputations for DFU.
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Affiliation(s)
- Abhijit S Rayate
- Department of Surgery, Maharashtra Institute of Medical Sciences & Research (Medical College), Latur 413531, India
| | - Basavraj S Nagoba
- Department of Microbiology, Maharashtra Institute of Medical Sciences & Research (Medical College), Latur 413531, India
| | - Sachin S Mumbre
- Department of Community Medicine, Ashwini Rural Medical College, Solapur 413006, India
| | - Hardi B Mavani
- Department of Surgery, Maharashtra Institute of Medical Sciences & Research (Medical College), Latur 413531, India
| | - Ajay M Gavkare
- Department of Physiology, Maharashtra Institute of Medical Sciences & Research (Medical College), Latur 413531, India
| | - Advait S Deshpande
- Department of Surgery, Maharashtra Institute of Medical Sciences & Research (Medical College), Latur 413531, India
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25
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Serena TE, Snyder RJ, Bowler PG. Use of fluorescence imaging to optimize location of tissue sampling in hard-to-heal wounds. Front Cell Infect Microbiol 2023; 12:1070311. [PMID: 36710976 PMCID: PMC9878329 DOI: 10.3389/fcimb.2022.1070311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/20/2022] [Indexed: 01/14/2023] Open
Abstract
Introduction Wound microflora in hard-to-heal wounds is invariably complex and diverse. Determining the interfering organisms(s) is therefore challenging. Tissue sampling, particularly in large wounds, is subjective and, when performed, might involve swabbing or biopsy of several locations. Fluorescence (FL) imaging of bacterial loads is a rapid, non-invasive method to objectively locate microbial hotspots (loads >104 CFU/gr). When sampling is deemed clinically necessary, imaging may indicate an optimal site for tissue biopsy. This study aimed to investigate the microbiology of wound tissue incisional biopsies taken from sites identified by FL imaging compared with sites selected by clinical judgment. Methods A post hoc analysis of the 350-patient FLAAG wound trial was conducted; 78 wounds were included in the present study. All 78 wounds were biopsied at two sites: one at the center of the wound per standard of care (SoC) and one site guided by FL-imaging findings, allowing for comparison of total bacterial load (TBL) and species present. Results The comparison between the two biopsy sites revealed that clinical uncertainty was higher as wound surface area increased. The sensitivity of a FL-informed biopsy was 98.7% for accurately finding any bacterial loads >104 CFU/g, compared to 87.2% for SoC (p=0.0059; McNemar test). Regarding species detected, FL-informed biopsies detected an average of 3 bacterial species per biopsy versus 2.2 species with SoC (p < 0.001; t-test). Microbial hotspots with a higher number of pathogens also included the CDC's pathogens of interest. Conclusions & perspective FL imaging provides a more accurate and relevant microbiological profile that guides optimal wound sampling compared to clinical judgment. This is particularly interesting in large, complex wounds, as evidenced in the wounds studied in this post hoc analysis. In addition, fluorescence imaging enables earlier bacterial detection and intervention, guiding early and appropriate wound hygiene and potentially reducing the need for antibiotic use. When indicated, this diagnostic partnership with antibiotic stewardship initiatives is key to ameliorating the continuing threat of antibiotic resistance.
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Affiliation(s)
| | - Robert J. Snyder
- Foot and Ankle Institute, Barry University, Miami, FL, United States
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Altaweli R, Alzamanan M, Ashour Y, Aldawsari Z. Management of acute surgical wounds in Saudi Arabia: nursing staff knowledge and practice. J Wound Care 2023; 32:S9-S18. [PMID: 36630189 DOI: 10.12968/jowc.2023.32.sup1.s9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Nursing staff play a crucial role in postoperative wound care and management; it is therefore imperative that their knowledge is kept up to date to avoid complications. The overarching objective of this study was to assess the knowledge and practice of nursing staff regarding various aspects of the management of acute surgical wounds. METHOD We conducted a cross-sectional study to assess nurses' clinical knowledge and practices in the management of acute wounds in four large hospitals in Saudi Arabia. The eligible participants included nurses who were working in the medical or surgical departments and those who were employed by the Ministry of Health. We administered a study questionnaire and conducted descriptive analysis to report frequencies and proportions of knowledge and practice aspects. RESULTS A total of 360 nurses responded to the survey, giving a response rate of 70%. A total of 221 nurses completed all survey questions. Of the participants, 56.56% were ≥30 years old, 95.48% were female, and 50.02% had >6 years' working experience. With regards to nurses' knowledge: 71.9% of the participants had updated their knowledge about wound care in the past two years; 54.3% perceived their knowledge of the availability of wound products as good; 74.66% correctly reported the classic signs of inflammation; 66.97% correctly identified general signs of wound infection; 84.62% of the sample considered surgical site infection as one complication of surgical wound infection. Only 61.09% of the nurses reported following wound care guidelines, 48.42% considered wound appearance as a highly important factor that influences nurses' choice of surgical dressing products, and 41.63% considered hospital policies and practices as important in making evidence-based decisions in wound management. CONCLUSION This study found that nurses' knowledge about the management of wounds was generally good; however, there were gaps in the practical component which need to be filled to avoid wound complications.
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Affiliation(s)
- Roa Altaweli
- General Department of Nursing and Midwifery Affairs, Ministry of Health, Saudi Arabia
| | - Mahdi Alzamanan
- Maternity and Children Hospital, Ministry of Health, Najran, Saudi Arabia
| | - Yasir Ashour
- King Salman bin Abdulaziz Medical City. Ministry of Health, Medina, Saudi Arabia
| | - Zainab Aldawsari
- Al-Noor Specialist Hospital, Ministry of Health, Makkah, Saudi Arabia
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27
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Chen Y, Du P, Lv G. A meta‐analysis examined the effect of oxidised regenerated cellulose/collagen dressing on the management of chronic skin wounds. Int Wound J 2022; 20:1544-1551. [PMID: 36480562 PMCID: PMC10088825 DOI: 10.1111/iwj.14009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 10/21/2022] [Accepted: 10/22/2022] [Indexed: 12/13/2022] Open
Abstract
To assess the impact of oxidised regenerated cellulose/collagen dressing on the management of chronic skin wounds, we conducted a meta-analysis. A thorough review of the literature up to September 2022 revealed that 1521 participants had chronic skin wounds at the start of the investigations; 763 of them used oxidised regenerated cellulose/collagen dressing, while 758 received control. Using dichotomous or contentious methods and a random or fixed-effect model, odds ratios (OR) and mean difference (MD) with 95% confidence intervals (CIs) were estimated to evaluate the impact of oxidised regenerated cellulose/collagen dressing on the management of chronic skin wounds. The oxidised regenerated cellulose/collagen dressing had significantly higher complete wound healing (OR, 1.74; 95% CI, 1.06-2.85; P = .03), higher wound relative reduction percent (MD, 13.50; 95% CI, 2.39-24.61; P = .02), and lower adverse events in wound healing (OR, 0.63; 95% CI, 0.41-0.98; P = .04) compared with control in chronic skin wounds. The oxidised regenerated cellulose/collagen dressing had significantly higher complete wound healing, higher wound relative reduction percent and lower adverse events in wound healing compared with control in chronic skin wounds. The low sample size of 8 out of 10 researches in the meta-analysis and the small number of studies in several comparisons calls for care when analysing the results.
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Affiliation(s)
- Yang Chen
- Nanjing University of Traditional Chinese Medicine Nanjing Jiangsu China
| | - Pan Du
- Department of Wuxi School of Medicine Jiangnan University Wuxi China
| | - Guozhong Lv
- Nanjing University of Traditional Chinese Medicine Nanjing Jiangsu China
- Department of Burn and Plastic Surgery the Affiliated Hospital of Jiangnan University Wuxi China
- Engineering Research Center of the Ministry of Education for Wound repair Technology Jiangnan University Wuxi China
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Goedecke F, Bühring J, Kratz A, Schweiger W, Köhle C, Waidner U, Riedel T, Walter A, Skrowny P, Rothenaicher G, Segiet A, Rabczenko D, Rogers A, Rippon M. An observational study of wounds treated with hydro-responsive wound dressings. J Wound Care 2022; 31:1029-1038. [PMID: 36475853 DOI: 10.12968/jowc.2022.31.12.1029] [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: 12/12/2022]
Abstract
OBJECTIVE Acute and hard-to-heal wounds are a significant burden to both a patient's quality of life and resources in healthcare systems. Here, we evaluate the outcomes of a non-comparative case series study in which Ringer's solution-preactivated polyacrylate dressings were used to treat acute and hard-to-heal wounds (the presence of Ringer's solution provides a wound dressing that allows, upon application, the immediate hydration of the underlying wound tissue). METHOD Patients with acute and hard-to-heal wounds were enrolled into an open-labelled, non-comparative observational study. Patients were treated with Ringer's solution-preactivated polyacrylate dressings to enable wound debridement and wound cleansing for up to 12 weeks. RESULTS A total of 303 patients were enrolled in the study and 278 were included in the analysis. Wound size decreased, from a median of 3.6cm2 (interquartile range (IQR): 1.2-9.3] at baseline to a median of 2.6cm2 (IQR: 1.1-7.8] at 84 days. Relative wound area reduction (WAR) was 43.1% at 84 days and estimated probability of achievement of a WAR of ≥40% and ≥60% was 68.7% and 53.4%, respectively. Median time to achieve a WAR of ≥40% and ≥60% was 54 days and 75 days, respectively. The median percentage of wound area covered by fibrin had decreased from 50.0% to 10% and granulation tissue had increased from 25% to 50% after 84 days. In addition, periwound skin condition, local signs of infection and pain all showed improvement. The majority of the wounds were assessed as 'healed' or 'better' at the conclusion of the evaluation period. CONCLUSION Based on the findings of this study, the use of Ringer's solution-preactivated polyacrylate dressings in daily practice has the potential to improve clinical outcomes, including healing, in patients with acute and hard-to-heal wounds.
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Affiliation(s)
| | - Jan Bühring
- MVZ für Chirurgie und Orthopädie am Vincentinum PmbB, Augsburg, Germany
| | | | | | | | | | | | | | | | | | | | | | | | - Mark Rippon
- Huddersfield University, Huddersfield, UK.,Daneriver Consultancy Ltd, Holmes Chapel, UK
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Hossain ML, Hammer K, Lim LY, Hettiarachchi D, Locher C. Optimisation of an agar overlay assay for the assessment of the antimicrobial activity of topically applied semi-solid antiseptic products including honey-based formulations. METHODS IN MICROBIOLOGY 2022; 202:106596. [DOI: 10.1016/j.mimet.2022.106596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/08/2022] [Accepted: 10/02/2022] [Indexed: 10/31/2022]
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30
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Cogo A, Bignozzi AC, Hermans MHE, Quint BJ, Snels JP, Schultz G. A desiccation compound as a biofilm- and necrosis-removing agent: a case series. J Wound Care 2022; 31:816-822. [DOI: 10.12968/jowc.2022.31.10.816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Objective: A new compound, Debrichem (DEBx Medical BV, the Netherlands), a topical desiccation agent (TDA), is an active gel that contains an acidic species with a potent hygroscopic action. When in contact with microorganisms and necrosis, rapid desiccation and carbonisation of the proteins in these microorganisms, as well as of the extracellular matrix of biofilms and necrosis, occurs. The resulting ‘precipitate’ rapidly dislodges from the wound bed, resulting in a clean wound which granulates, which is a prerequisite for healing by secondary intention. Method: In a retrospective study, a series of mostly large and hard-to-heal lesions of different aetiologies were treated with a one-time application of the TDA, followed by weekly dressing changes. Results: Of the total of 54 lesions included in this case series, 22 were diagnosed as venous leg ulcers (VLUs), 20 as diabetic foot ulcers (DFUs), nine as post-traumatic, hard-to-heal lesions, two as vascular ulcers and one as an ischaemic ulcer. All of the VLUs, 75% of the DFUs and all of the other lesions reached complete granulation. Conclusion: The use of a TDA may contribute to the consistent, fast and easy removal of both biofilms and necrosis, and hence to wound healing.
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31
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Kone K, Mallikarjun NT, Philipraj J. Dilute povidone-iodine irrigation during percutaneous nephrolithotomy to reduce postoperative infective complications - Is there any benefit? Urol Ann 2022; 14:353-358. [PMID: 36505996 PMCID: PMC9731197 DOI: 10.4103/ua.ua_111_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 10/27/2021] [Accepted: 11/23/2021] [Indexed: 12/15/2022] Open
Abstract
Background and Objective Infectious complications following stone lithotripsy is a significant source of patient morbidity and mortality. Post percutaneous nephrolithotomy fever is reported in 37% of patients undergoing PCNL and sepsis is the most common cause of mortality following PCNL. Thus, there is an urgent need to tackle lithotripsy-associated bacteremia occurring intraoperatively, keeping in mind the threat of emerging global antibiotic resistance. The aim of our study was to study the efficacy of using intermittent 0.35% dilute Povidone-Iodine (PI) irrigation during PCNL in reducing postoperative infection rate. Materials and Methods This is a prospective observational study done in 24 patients diagnosed with Staghorn and matrix calculi requiring PCNL. All patients were taken up for the procedure with sterile urine culture or after treating them with culture-specific antibiotic with initial positive urine culture. Intraoperative pelvic urine was sent for culture and sensitivity. 0.35% dilute PI irrigation was used intermittently during the procedure. Patients were monitored and assessed for signs of post-PCNL infection and PI-related side effects. The results were compared with similar group of patients with similar stone characteristics who underwent PCNL before adopting the dilute PI irrigation protocol (non-PI irrigation group). Results Among 24 patients, 18 patients had partial or complete Staghorn and 6 had matrix calculi. Five patients with Staghorn and three patients with matrix calculi had positive renal pelvic urine culture. In the non-PI irrigation group, 19 patients had Staghorn stones and 5 had matrix calculi. Three patients with Staghorn and two patients with matrix calculi had positive renal pelvic urine culture. Three patients (12.5%) had postoperative fever in the dilute PI irrigation group, compared to 11 patients (45.8%) in the non-PI irrigation group. No patient had PI-related complications. Conclusion Our prospective study highlights that the use of 0.35% dilute PI irrigation intermittently during PCNL reduces the postoperative infection rate significantly.
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Affiliation(s)
- Kalyanaram Kone
- Department of Urology, Mahatma Gandhi Medical College, Puducherry, India
| | | | - Joseph Philipraj
- Department of Urology, Mahatma Gandhi Medical College, Puducherry, India
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32
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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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Scalise A, Falcone M, Avruscio G, Brocco E, Ciacco E, Parodi A, Tasinato R, Ricci E. What COVID-19 taught us: New opportunities and pathways from telemedicine and novel antiseptics in wound healing. Int Wound J 2022; 19:987-995. [PMID: 34599861 PMCID: PMC9284655 DOI: 10.1111/iwj.13695] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/07/2021] [Accepted: 09/14/2021] [Indexed: 12/12/2022] Open
Abstract
The COVID-19 pandemic deeply impacted the capacity of the health systems to maintain preventive and curative services, especially for the most vulnerable populations. During the pandemic, the wound healing centres in Italy assisted a significant reduction of the frequency of their hospital admission, since only urgencies, such as severe infections or wound haemorrhagic complications, were allowed to the hospital. The aim of this multidisciplinary work is to highlight the importance of a new pathway of wound care with patient-based therapeutic approach, tailored treatments based on the characteristics of the wound and fast tracks focused on the outpatient management, reserving hospital assessment only for patients with complicated or complex wounds. This analysis highlights the point that patients with chronic wounds need to be critically evaluated in order to find the best and most appropriate care pathway, which should vary according to the patient and, especially, to the characteristics of the wound. Moreover, the most adequate topic antiseptic should be started as soon as possible. An appropriate and correct management of the wound care will allow to link the knowledge based on years of clinical practice with the new challenges and the need to visit patients remotely, when possible.
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Affiliation(s)
- Alessandro Scalise
- Department of Plastic and Reconstructive SurgeryPolytechnical University, School of MedicineAnconaItaly
| | - Marco Falcone
- Department of Clinical and Experimental MedicineUniversity of Pisa, Azienda Ospedaliera Universitaria PisanaPisaItaly
| | - Giampiero Avruscio
- Angiology Unit, Department of Cardiac, Thoracic and Vascular SciencesHospital‐University of PaduaPaduaItaly
| | - Enrico Brocco
- Medicine‐Diabetic Foot UnitPoliclinico Abano TermePadovaItaly
| | - Eugenio Ciacco
- Pharmacy UnitSan Salvatore Hospital, ASL 1 AbruzzoL'AquilaItaly
| | - Aurora Parodi
- DiSSal Dermatologic ClinicUniversity of Genoa/Dermatologic Clinic Hospital‐Policlinic San Martino IRCCSGenoaItaly
| | - Rolando Tasinato
- General surgery DepartmentA.s.l. 3 Veneto, Mirano HospitalVeneziaItaly
| | - Elia Ricci
- Difficult Wounds ServiceCasa di Cura San LucaPecetto Torinese (TO)Italy
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Pen Hung DC, Yung Tan DH. Meticillin-susceptible Staphylococcus aureus pyomyositis and cellulitis in right thigh of a 15-year-old boy: a case study. J Wound Care 2022; 31:S22-S28. [PMID: 36004941 DOI: 10.12968/jowc.2022.31.sup8.s22] [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
Pyomyositis is a purulent infection of striated muscle and postoperative management remains the mainstay. If delayed primary wound closure is not managed in a timely manner, it often results in recurrent infection and sinus tract creation. Cavity wounds with sinus formation are known to complicate treatment, are problematic to manage and persist for long periods of time. The aim of this case report is to present the challenges in the assessment and management of a sinus tract with deep cavity wound, between the vastus lateralis and biceps femoris muscles, originating from liquefaction of a haematoma. Our review of the literature revealed limited research evidence in the management of deep cavity wounds. This is a rare case where the sinus tract route which leads to the rim-shaped cavity is embedded deep between the muscles, posing a high risk of recurrent infection from the premature closure of the wound tract. Successful management was attributed to: the accuracy in the initial wound assessment; appropriate dressing plans; the rationale for each action; and an outcome goal as each treatment progressed. Daily dressing change and reassessment of the wound was required to ensure progress and to address any complications in a timely manner. Finally, concerns of the patient and their family and regular discussions on the treatment plans are important to encourage adherence with management goals.
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Abstract
Debridement of devitalised tissue and wound biofilm is vital to promote healing. This article introduces an innovative debridement product, ChloraSolv Wound Debridement Gel, which is as effective as a blade but also selective, atraumatic and fast-acting and does not require specialist training. Its ease of use makes it suitable for all settings and staff.
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Affiliation(s)
- Leanne Atkin
- Vascular Nurse Consultant, Mid Yorkshire Hospitals NHS Trust and University of Huddersfield
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36
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Pérez-Acevedo G, Bosch-Alcaraz A, Torra-Bou JE. Larval Therapy for Treatment of Chronic Wounds Colonized by Multi-resistant Pathogens in a Pediatric Patient: A Case Study. J Wound Ostomy Continence Nurs 2022; 49:373-378. [PMID: 35809014 DOI: 10.1097/won.0000000000000893] [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: 11/26/2022]
Abstract
BACKGROUND Chronic wounds are susceptible to colonization with gram-positive and gram-negative bacteria that may be resistant to antimicrobial dressings and systemic antibiotics. In January 2004, the US Food and Drugs Administration approved use of medicinal larvae for use in humans and animals for resistant organisms. Despite use in adults, there is a paucity of evidence evaluating its efficacy and safety in the pediatric population. CASE T was a 5-year-old boy with several chronic wounds infected with multidrug-resistant Pseudomonas aeruginosa. The wounds were originally treated with chemical debridement, dressings containing ionic silver, negative-pressure wound therapy (NPWT), and antibiotics without success. Consequently, a multidisciplinary team implemented maggot debridement therapy (MDT). CONCLUSIONS After MDT, one wound completely epithelialized and the other wounds achieved a reduction in size with 70% epithelization. Therapy also led to a reduction in wound odor, exudate, and pain. The other wounds were closed after additional management with dressing containing nanocrystalline silver and NPWT.
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Affiliation(s)
- Gemma Pérez-Acevedo
- Gemma Pérez-Acevedo, RN, PNP, MSc, Sant Joan de Déu Hospital, Esplugues de Llobregat, Barcelona, Spain
- Alejandro Bosch-Alcaraz, PhD, RN, PNP, MSc, Sant Joan de Déu Hospital, Esplugues de Llobregat, Barcelona, Spain
- Joan Enric Torra-Bou, PhD, RN, PNP, MSc, Sant Joan de Déu Hospital, Esplugues de Llobregat, Barcelona, Spain
| | - Alejandro Bosch-Alcaraz
- Gemma Pérez-Acevedo, RN, PNP, MSc, Sant Joan de Déu Hospital, Esplugues de Llobregat, Barcelona, Spain
- Alejandro Bosch-Alcaraz, PhD, RN, PNP, MSc, Sant Joan de Déu Hospital, Esplugues de Llobregat, Barcelona, Spain
- Joan Enric Torra-Bou, PhD, RN, PNP, MSc, Sant Joan de Déu Hospital, Esplugues de Llobregat, Barcelona, Spain
| | - Joan Enric Torra-Bou
- Gemma Pérez-Acevedo, RN, PNP, MSc, Sant Joan de Déu Hospital, Esplugues de Llobregat, Barcelona, Spain
- Alejandro Bosch-Alcaraz, PhD, RN, PNP, MSc, Sant Joan de Déu Hospital, Esplugues de Llobregat, Barcelona, Spain
- Joan Enric Torra-Bou, PhD, RN, PNP, MSc, Sant Joan de Déu Hospital, Esplugues de Llobregat, Barcelona, Spain
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Minsart M, Van Vlierberghe S, Dubruel P, Mignon A. Commercial wound dressings for the treatment of exuding wounds: an in-depth physico-chemical comparative study. BURNS & TRAUMA 2022; 10:tkac024. [PMID: 35733649 PMCID: PMC9210940 DOI: 10.1093/burnst/tkac024] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/24/2022] [Indexed: 12/17/2022]
Abstract
Background Nowadays, a wide range of wound dressings is already commercially available. The selection of the dressing is of paramount importance as inappropriate wound management and dressing selection can delay the wound healing process. Not only can this be distressing for the patient, but it can also contribute to complications such as maceration and subsequent infection. Many researchers are targeting the design of dressings with superior properties over existing commercial dressings. However, reported results in the state-of-the-art are rarely benchmarked against commercial dressings. The aim of this study was to determine several characteristics of a large variety of the most frequently used commercial wound dressings, providing an overview for both practitioners and researchers. Methods For this comparative study, 11 frequently used commercial wound dressings were selected, representing the different types. The morphology was studied using scanning electron microscopy. The dressings were characterized in terms of swelling capacity (water, phosphate buffered saline and simulated wound fluid), moisture vapour transmission rate (MVTR) and moisture uptake capacity (via dynamic vapour sorption) as well as mechanical properties using tensile testing and texturometry. Results The selected dressings showed distinctive morphological differences (fibrous, porous and/or gel) which was reflected in the different properties. Indeed, the swelling capacities ranged between 1.5 and 23.2 g/g (water), 2.1 and 17.6 g/g (phosphate buffered saline) or 2.9 and 20.8 g/g (simulated wound fluid). The swelling capacity of the dressings in water increased even further upon freeze-drying, due to the formation of pores. The MVTR values varied between 40 and 930 g/m2/24 h. The maximal moisture uptake capacity varied between 5.8% and 105.7% at 95% relative humidity. Some commercial dressings exhibited a superior mechanical strength, due to either being hydrophobic or multi-layered. Conclusions The present work not only offers insight into a valuable toolbox of suitable wound dressing characterization techniques, but also provides an extensive landscaping of commercial dressings along with their physico-chemical properties, obtained through reproducible experimental protocols. Furthermore, it ensures appropriate benchmark values for commercial dressings in all forthcoming studies and could aid researchers with the development of novel modern wound dressings. The tested dressings either exhibited a high strength or a high swelling capacity, suggesting that there is still a strong potential in the wound dressings market for dressings that possess both.
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Affiliation(s)
- Manon Minsart
- Polymer Chemistry & Biomaterials Research Group, Centre of Macromolecular Chemistry, Department of Organic and Macromolecular Chemistry, Ghent University, Krijgslaan 281, Building S4-bis, 9000 Ghent, Belgium
| | - Sandra Van Vlierberghe
- Polymer Chemistry & Biomaterials Research Group, Centre of Macromolecular Chemistry, Department of Organic and Macromolecular Chemistry, Ghent University, Krijgslaan 281, Building S4-bis, 9000 Ghent, Belgium
| | - Peter Dubruel
- Polymer Chemistry & Biomaterials Research Group, Centre of Macromolecular Chemistry, Department of Organic and Macromolecular Chemistry, Ghent University, Krijgslaan 281, Building S4-bis, 9000 Ghent, Belgium
| | - Arn Mignon
- Smart Polymeric Biomaterials Research Group, Biomaterials and Tissue Engineering (SIEM) @ Campus Group T Leuven, Andreas Vesaliusstraat 13, 3000 Leuven, Belgium
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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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Is combined physical therapy more effective than topical hyperbaric oxygen therapy in the treatment of venous leg ulcers? Preliminary study. POSTEP HIG MED DOSW 2022. [DOI: 10.2478/ahem-2022-0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Introduction
Recently, increased frequency of chronic leg ulcers has been observed. The aim of the study was to compare therapeutic efficacy of combined physical therapy to topical hyperbaric oxygen therapy in the treatment of venous leg ulcers.
Materials and Methods
Participants included 36 patients (14 females and 22 males) between 18 and 80 years of age with chronic venous leg ulcers. They were randomly divided into two study groups. Group I underwent topical hyperbaric oxygen therapy; group II underwent combined physical therapy. Before and after the therapeutic cycle (15 procedures) measurement of ulceration size by planimetry and analysis of laboratory parameters of blood was performed.
Results
In both groups, a statistically significant reduction of ulcer surface area was obtained (25.11±17.8cm2 to 16.93±13.89cm2, p=0.000196) vs. (34.17±14.82cm2 to 23.99±15.15cm2, p=0.004337). Blood morphology revealed a statistically significant reduction in patients from group II who underwent combined physical therapy (p=0.01). In both groups, statistically significant reduction of fibrinogen level (p=0.01 and p<0.001), and total protein level (p=0.01) was achieved. In group II reduction of the inflammation marker C-reactive protein (CRP) was noted.
Conclusions
Topical hyperbaric oxygen therapy and combined physical therapy had statistically significant effects on the reduction of surface area of treated venous leg ulcers. The changes in morphological and biochemical parameters may indicate the anti-inflammatory and anti-clotting action effects of combined physical therapy.
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Hurlow J, Bowler PG. Acute and chronic wound infections: microbiological, immunological, clinical and therapeutic distinctions. J Wound Care 2022; 31:436-445. [PMID: 35579319 DOI: 10.12968/jowc.2022.31.5.436] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Wound infection is a complex pathology that may manifest either as a rapid onset acute condition, or as a prolonged chronic condition. Although systemic antibiotic therapy is often appropriate and necessary for acute wound infections, it is often used inappropriately, excessively and unsuccessfully in chronic wound infections. Overuse of antibiotics in chronic (hard-to-heal) wound management contributes to antibiotic resistance. This literature review confirms that acute and chronic wound infections are significantly differentiated by their cause (microbial phenotype), the subsequent host immune response and by the resulting clinical manifestations. Consequently, recognition of the type of wound infection followed by appropriate and timely therapy is required to improve wound healing outcomes while encouraging more judicious and responsible use of antibiotics.
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Gupta S, Shinde RK, Shinde S. Comparison of the Outcomes of Cadexomer Iodine and Povidone-Iodine Ointments in Wound Management. Cureus 2022; 14:e24667. [PMID: 35663699 PMCID: PMC9159290 DOI: 10.7759/cureus.24667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2022] [Indexed: 11/05/2022] Open
Abstract
Background In this era of upcoming newer formulations of topical ointments in the market, selecting an appropriate topical ointment for managing ulcers is challenging with regards to granulation tissue promotion, ulcer size reduction, and decrease in the amount of discharge from the ulcer. This study compares the outcomes of two topical iodine formulations, namely, cadexomer iodine ointment (0.9%) and povidone-iodine ointment (5%), for the management of various types of ulcers. Methodology This prospective, interventional study was conducted in a tertiary care hospital. After screening, 40 patients with ulcers (venous, arterial, diabetic, traumatic, infective) were subjected to simple randomization based on computer-generated random numbers at a ratio of 1:1 for the application of cadexomer (n = 20) (Group A) and povidone-iodine ointment (n = 20) (Group B). Selected patients were subjected to broad-spectrum antibiotics on admission and then shifted to special antibiotics based on the culture and sensitivity report of the wound. The application of these two formulations was done in three settings, each lasting 48 hours. The efficacy of these two formulations was assessed based on the following three parameters: (a) the percentage of granulation tissue promotion, (b) wound size reduction, and (c) decline in wound discharge. The study groups were compared using an unpaired t-test, while the association among the study groups was performed using Fishers' test, Student's t-test, and chi-square test. P-values less than 0.05 were considered significant. Results Significant improvement (p < 0.05) in granulation tissue was observed with cadexomer ointment application compared to povidone-iodine ointment. Statistically significant reductions in ulcer size and discharge from ulcers were seen in both groups; however, clinically, cadexomer ointment was found to be more effective compared to povidone-iodine ointment in reducing ulcer size as well as in reducing the amount of discharge from ulcers. Conclusions Cadexomer iodine ointment proved to be better than povidone-iodine ointment in the management of ulcers regarding the percentage of granulation tissue promotion, ulcer size reduction, and decrease in the amount of discharge from ulcers.
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Affiliation(s)
- Shubham Gupta
- General Surgery, Datta Meghe Institute of Medical Sciences, Deemed to be University, Wardha, IND
| | - Raju K Shinde
- General Surgery, Datta Meghe Institute of Medical Sciences, Deemed to be University, Wardha, IND
| | - Sangita Shinde
- Pharmacology, Datta Meghe Institute of Medical Sciences, Deemed to be University, Wardha, IND
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Mirhaj M, Labbaf S, Tavakoli M, Seifalian A. An Overview on the Recent Advances in the Treatment of Infected Wounds: Antibacterial Wound Dressings. Macromol Biosci 2022; 22:e2200014. [PMID: 35421269 DOI: 10.1002/mabi.202200014] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/20/2022] [Indexed: 11/11/2022]
Abstract
A wound can be surgical, cuts from an operation or due to accident and trauma. The infected wound, as a result of bacteria growth within the damaged skin, interrupts the natural wound healing process and significantly impacts the quality of life. Wound dressing is an important segment of the skincare industry with its economic burden estimated at $ 20.4 billion (in 2021) in the global market. The results of recent clinical trials suggest that the use of modern dressings can be the easiest, most accessible, and most cost-effective way to treat chronic wounds and, hence, holds significant promise. With the sheer number of dressings in the market, the selection of correct dressing is confusing for clinicians and healthcare workers. The aim of this research was to review widely used types of antibacterial wound dressings, as well as emerging products, for their efficiency and mode of action. In this review, we focus on introducing antibiotics and antibacterial nanoparticles as two important and clinically widely used categories of antibacterial agents. The perspectives and challenges for paving the way for future research in this field are also discussed. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Marjan Mirhaj
- Department of Materials Engineering, Isfahan University of Technology, Isfahan, Iran
| | - Sheyda Labbaf
- Department of Materials Engineering, Isfahan University of Technology, Isfahan, Iran
| | - Mohamadreza Tavakoli
- Department of Materials Engineering, Isfahan University of Technology, Isfahan, Iran
| | - Amelia Seifalian
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
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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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Spinella A, de Pinto M, Galluzzo C, Testoni S, Macripò P, Lumetti F, Parenti L, Magnani L, Sandri G, Bajocchi G, Starnoni M, De Santis G, Salvarani C, Giuggioli D. Photobiomodulation Therapy: A New Light in the Treatment of Systemic Sclerosis Skin Ulcers. Rheumatol Ther 2022; 9:891-905. [PMID: 35334095 PMCID: PMC9127012 DOI: 10.1007/s40744-022-00438-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/01/2022] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Skin ulcers (SU) represent one of the most frequent manifestations of systemic sclerosis (SSc), occurring in almost 50% of scleroderma patients. SSc-SU are often particularly difficult to treat with conventional systemic and local therapies. In this study, a preliminary evaluation of the role and effectiveness of blue light photobiomodulation (PBM) therapy with EmoLED® in the treatment of scleroderma skin ulcers (SSc-SU) was performed. METHODS We retrospectively analyzed 12 consecutive SSc patients with a total of 15 SU on finger hands. All patients were treated with adequate systemic therapy and local treatment for SU; after a standard skin ulcer bed preparation with debridement of all lesions, EmoLED® was performed. All patients were locally treated every week during 2 months of follow-up; SU data were collected after 4 weeks (T4) and 8 weeks (T8). Eight SSc patients with comparable SU were also evaluated as controls. RESULTS The application of EmoLED® in addition to debridement apparently produced faster healing of SU. Complete healing of SU was recorded in 41.6% cases during EmoLED® treatment. Significant improvements in SU area, length, and width, wound bed, and related pain were observed in EmoLED® patients from T0 to T8. Control subjects treated with standard systemic/local therapies merely showed an amelioration of SU area and width at the end of the follow-up. No procedural or post-procedural adverse events were reported. CONCLUSIONS The positive clinical results and the absence of side effects suggest that EmoLED® could be a promising tool in the management of SSc-SU, with an interesting role to play in the healing process in addition to conventional systemic and local treatments.
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Affiliation(s)
- Amelia Spinella
- Scleroderma Unit, Chair and Rheumatology Unit, Medical School, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria, Policlinico of Modena, Policlinico di Modena, Via del Pozzo, 71, 41125, Modena, Italy
| | - Marco de Pinto
- Scleroderma Unit, Chair and Rheumatology Unit, Medical School, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria, Policlinico of Modena, Policlinico di Modena, Via del Pozzo, 71, 41125, Modena, Italy
| | - Claudio Galluzzo
- Scleroderma Unit, Chair and Rheumatology Unit, Medical School, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria, Policlinico of Modena, Policlinico di Modena, Via del Pozzo, 71, 41125, Modena, Italy
| | - Sofia Testoni
- Scleroderma Unit, Chair and Rheumatology Unit, Medical School, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria, Policlinico of Modena, Policlinico di Modena, Via del Pozzo, 71, 41125, Modena, Italy
| | - Pierluca Macripò
- Scleroderma Unit, Chair and Rheumatology Unit, Medical School, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria, Policlinico of Modena, Policlinico di Modena, Via del Pozzo, 71, 41125, Modena, Italy
| | - Federica Lumetti
- Scleroderma Unit, Chair and Rheumatology Unit, Medical School, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria, Policlinico of Modena, Policlinico di Modena, Via del Pozzo, 71, 41125, Modena, Italy
| | - Luca Parenti
- Scleroderma Unit, Chair and Rheumatology Unit, Medical School, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria, Policlinico of Modena, Policlinico di Modena, Via del Pozzo, 71, 41125, Modena, Italy
| | - Luca Magnani
- Unit of Rheumatology, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Gilda Sandri
- Scleroderma Unit, Chair and Rheumatology Unit, Medical School, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria, Policlinico of Modena, Policlinico di Modena, Via del Pozzo, 71, 41125, Modena, Italy
| | | | - Marta Starnoni
- Division of Plastic Surgery, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria, Policlinico of Modena, Modena, Italy
| | - Giorgio De Santis
- Division of Plastic Surgery, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria, Policlinico of Modena, Modena, Italy
| | - Carlo Salvarani
- Unit of Rheumatology, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Dilia Giuggioli
- Scleroderma Unit, Chair and Rheumatology Unit, Medical School, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria, Policlinico of Modena, Policlinico di Modena, Via del Pozzo, 71, 41125, Modena, Italy.
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Jaber D, Younes N, Khalil E, Albsoul-Younes A, Mismar A, Nassar M, Al-Bakri AG. Effect of Diluted Dakin's Solution Versus Standard Care on Diabetic Foot Ulcer Management: A Randomized Controlled Trial. J Am Podiatr Med Assoc 2022; 112:20-213. [PMID: 34233350 DOI: 10.7547/20-213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Diabetic foot ulcers (DFUs) are the main cause of hospitalizations and amputations in diabetic patients. Failure of standard foot care is the most important cause of impaired DFU healing. Dakin's solution (DS) is a promising broad-spectrum bactericidal antiseptic for management of DFUs. Studies investigating the efficacy of using DS on the healing process of DFUs are scarce. Accordingly, this is the first evidence-based, randomized, controlled trial conducted to evaluate the effect of using diluted DS compared with the standard care in the management of infected DFUs. METHODS A randomized controlled trial was conducted to assess the efficacy of DS in the management of infected DFUs. Patients were distributed randomly to the control group (DFUs irrigated with normal saline) or the intervention group (DFUs irrigated with 0.1% DS). Patients were followed for at least 24 weeks for healing, reinfection, or amputations. In vitro antimicrobial testing on DS was performed, including determination of its minimum inhibitory concentration, minimum bactericidal concentration, minimum biofilm inhibitory concentration, minimum biofilm eradication concentration, and suspension test. RESULTS Replacing normal saline irrigation in DFU standard care with 0.1% DS followed by soaking the ulcer with commercial sodium hypochlorite (0.08%) after patient discharge significantly improved ulcer healing (P < .001) and decreased the number of amputations and hospitalizations (P < .001). The endpoint of death from any cause (risk ratio, 0.13; P = .029) and the amputation rate (risk ratio, 0.27; P < .001) were also significantly reduced. The effect on ulcer closure (OR, 11.9; P < .001) was significantly enhanced in comparison with the control group. Moreover, DS irrigation for inpatients significantly decreased bacterial load (P < .001). The highest values for the in-vitro analysis of DS were as follows: minimum inhibitory concentration (MIC), 1.44%; minimum bactericidal concentration (MBC), 1.44%; minimum biofilm inhibitory concentration (MBIC), 2.16%; and minimum biofilm eradication concentration (MBEC), 2.87%. CONCLUSIONS Compared with standard care, diluted DS (0.1%) was more effective in the management of infected DFUs. Dakin's solution (0.1%) irrigation with debridement followed by standard care is a promising method in the management of infected DFUs.
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Affiliation(s)
- Deema Jaber
- *Department of Clinical Pharmacy, School of Pharmacy, Zarqa University, Zarqa, Jordan.,†School of Pharmacy, The University of Jordan, Amman, Jordan
| | - Nidal Younes
- ‡School of Medicine, The University of Jordan, Amman, Jordan
| | - Enam Khalil
- †School of Pharmacy, The University of Jordan, Amman, Jordan
| | | | - Ayman Mismar
- ‡School of Medicine, The University of Jordan, Amman, Jordan
| | - Moayyad Nassar
- †School of Pharmacy, The University of Jordan, Amman, Jordan
| | - Amal G Al-Bakri
- †School of Pharmacy, The University of Jordan, Amman, Jordan
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Nizami MZI, Campéon BDL, Satoh A, Nishina Y. Graphene oxide-based multi-component antimicrobial hydrogels. BULLETIN OF THE CHEMICAL SOCIETY OF JAPAN 2022. [DOI: 10.1246/bcsj.20220017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Mohammed Zahedul Islam Nizami
- Research Core for Interdisciplinary Sciences, Okayama University, Okayama, Japan
- Restorative Dental Sciences, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | | | - Akira Satoh
- Research Core for Interdisciplinary Sciences, Okayama University, Okayama, Japan
- Graduate School of Natural Science and Technology, Okayama University, Okayama, Japan
| | - Yuta Nishina
- Research Core for Interdisciplinary Sciences, Okayama University, Okayama, Japan
- Graduate School of Natural Science and Technology, Okayama University, Okayama, Japan
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Kumar K S, S D, P S, A A, Ganesan N, C SK, Madhan B. Fabrication of hybrid povidone-iodine impregnated collagen-hydroxypropyl methylcellulose composite scaffolds for wound-healing application. J Drug Deliv Sci Technol 2022. [DOI: 10.1016/j.jddst.2022.103247] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Aloweni F, Mei CS, Lixuan NL, Fook-Chong S, Yobas P, Yuh AS, Xian TW, Maniya S. Healing outcomes and predictors among patients with venous leg ulcers treated with compression therapy. J Wound Care 2022; 31:S39-S50. [PMID: 35199559 DOI: 10.12968/jowc.2022.31.sup3.s39] [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 This study aimed to compare the healing outcomes between three types of compression therapy-two-layer bandage (2LB), four-layer bandage (4LB), and compression stockings, and to identify the predictors of venous leg ulcer (VLU) healing. METHOD A retrospective review of the medical records of patients diagnosed with VLU between 2011 and 2016 in Singapore was conducted. Univariate and multivariate analyses were done between healed and unhealed VLU patients at three and six months, based on potential factors, ranging from demographic profile to comorbidities and treatment-related variables. RESULTS Data from 377 patients' medical records were analysed. The healing rates with the three types of compression system, 4LB, 2LB and compression stockings, were 22.3%, 34.9% and 8.7% respectively at three months; at six months they were 44.2%, 41.9% and 34.8% respectively. Patients on 2LB reported a significantly higher proportion of healed ulcers at three months (p=0.003) but at six months there was no difference in healing rates between the three types of therapy. At three and six months, the duration of compression therapy was found to be an independent predictor of healing (p<0.001). CONCLUSION In this study, the 2LB appeared to show the most favourable healing outcome in the short-term but as VLUs persisted beyond the months, the type of compression system used did not make a difference in the healing outcome. Our findings suggested that, as the duration became more prolonged, VLUs became more resistant to healing despite compression therapy. Therefore, it may be necessary for clinicians to consider adjuvant therapies for hard-to-heal ulcers at an earlier stage.
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Affiliation(s)
| | - Chew Suet Mei
- Nursing Division, Singapore General Hospital, Singapore
| | | | | | - Piyanee Yobas
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore
| | - Ang Shin Yuh
- Nursing Division, Singapore General Hospital, Singapore
| | - Tan Wei Xian
- Nursing Division, Singapore General Hospital, Singapore
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De Maeseneer MG, Kakkos SK, Aherne T, Baekgaard N, Black S, Blomgren L, Giannoukas A, Gohel M, de Graaf R, Hamel-Desnos C, Jawien A, Jaworucka-Kaczorowska A, Lattimer CR, Mosti G, Noppeney T, van Rijn MJ, Stansby G, Esvs Guidelines Committee, Kolh P, Bastos Goncalves F, Chakfé N, Coscas R, de Borst GJ, Dias NV, Hinchliffe RJ, Koncar IB, Lindholt JS, Trimarchi S, Tulamo R, Twine CP, Vermassen F, Wanhainen A, Document Reviewers, Björck M, Labropoulos N, Lurie F, Mansilha A, Nyamekye IK, Ramirez Ortega M, Ulloa JH, Urbanek T, van Rij AM, Vuylsteke ME. Editor's Choice - European Society for Vascular Surgery (ESVS) 2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease of the Lower Limbs. Eur J Vasc Endovasc Surg 2022; 63:184-267. [PMID: 35027279 DOI: 10.1016/j.ejvs.2021.12.024] [Citation(s) in RCA: 242] [Impact Index Per Article: 121.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 11/12/2021] [Indexed: 01/12/2023]
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50
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Davis SC, Li J, Gil J, Valdes J, Solis M, Higa A. A novel dressing with silver to treat meticillin-resistant Staphylococcus aureus biofilm infection in a pig model. J Wound Care 2022; 31:S42-S48. [PMID: 35148641 DOI: 10.12968/jowc.2022.31.sup2.s42] [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 purpose of this study was to use an in vivo biofilm porcine model to examine a new polyvinyl alcohol-based gelling fibre dressing with silver and compare it to other commercial dressings containing: polyvinyl alcohol-based gelling fibre without silver; carboxymethyl cellulose-based fibre with silver, benzethonium chloride and ethylenediaminetetraacetic acid; and untreated control. METHODS A total of 52 deep partial-thickness wounds (10x7x0.5mm) were created on each of three animals and inoculated with 25µl of meticillin-resistant Staphylococcus aureus (MRSA) (106 colony forming units (CFU)/ml). Wounds were covered for 24 hours to allow biofilm formation and were randomly designated to one of the four treatments. Samples were recovered for microbiological and histological analysis on days 3, 5 and 7 post-treatment. RESULTS Polyvinyl alcohol-based gelling fibre dressing with silver was able to significantly reduce biofilm more effectively than the other treatment groups. By day 7, wounds treated with the dressing had a 2.72±0.01 log CFU/g reduction in MRSA count versus untreated control wounds and a 2.59±0.01 log CFU/g reduction versus baseline counts. For histology analysis, all wounds reached 100% re-epithelialisation by day 5. CONCLUSION The results of this study indicated that polyvinyl alcohol-based gelling fibre dressing with silver was effective against biofilm of antibiotic-resistant staphylococcal strains without inhibiting the wound healing process, and may have important clinical implications when treating acute and/or hard-to-heal wounds.
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Affiliation(s)
- Stephen C Davis
- University of Miami Miller School of Medicine, Department of Dermatology & Cutaneous Surgery, Miami, Florida, US
| | - Jie Li
- University of Miami Miller School of Medicine, Department of Dermatology & Cutaneous Surgery, Miami, Florida, US
| | - Joel Gil
- University of Miami Miller School of Medicine, Department of Dermatology & Cutaneous Surgery, Miami, Florida, US
| | - Jose Valdes
- University of Miami Miller School of Medicine, Department of Dermatology & Cutaneous Surgery, Miami, Florida, US
| | - Michael Solis
- University of Miami Miller School of Medicine, Department of Dermatology & Cutaneous Surgery, Miami, Florida, US
| | - Alex Higa
- University of Miami Miller School of Medicine, Department of Dermatology & Cutaneous Surgery, Miami, Florida, US
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