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Tian S, Tan S, Fan M, Gong W, Yang T, Jiao F, Qiao H. Hypoxic environment of wounds and photosynthesis-based oxygen therapy. BURNS & TRAUMA 2024; 12:tkae012. [PMID: 38860010 PMCID: PMC11163460 DOI: 10.1093/burnst/tkae012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 03/04/2024] [Accepted: 03/13/2024] [Indexed: 06/12/2024]
Abstract
The hypoxic environment is among the most important factors that complicates the healing of chronic wounds, such as venous leg ulcers, pressure injuries and diabetic foot ulcers, which seriously affects the quality of life of patients. Various oxygen supply treatments are used in clinical practice to improve the hypoxic environment at the wound site. However, problems still occur, such as insufficient oxygen supply, short oxygen infusion time and potential biosafety risks. In recent years, artificial photosynthetic systems have become a research hotspot in the fields of materials and energy. Photosynthesis is expected to improve the oxygen level at wound sites and promote wound healing because the method provides a continuous oxygen supply and has good biosafety. In this paper, oxygen treatment methods for wounds are reviewed, and the oxygen supply principle and construction of artificial photosynthesis systems are described. Finally, research progress on the photosynthetic oxygen production system to promote wound healing is summarized.
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Affiliation(s)
- Shuning Tian
- Jiangsu Engineering Research Center for Efficient Delivery System of TCM, School of Pharmacy, Nanjing University of Chinese Medicine, 138 Xianlin Avenue, Qixia District, Nanjing 210023, China
| | - Shenyu Tan
- Jiangsu Engineering Research Center for Efficient Delivery System of TCM, School of Pharmacy, Nanjing University of Chinese Medicine, 138 Xianlin Avenue, Qixia District, Nanjing 210023, China
| | - Mingjie Fan
- Jiangsu Engineering Research Center for Efficient Delivery System of TCM, School of Pharmacy, Nanjing University of Chinese Medicine, 138 Xianlin Avenue, Qixia District, Nanjing 210023, China
| | - Wenlin Gong
- Jiangsu Engineering Research Center for Efficient Delivery System of TCM, School of Pharmacy, Nanjing University of Chinese Medicine, 138 Xianlin Avenue, Qixia District, Nanjing 210023, China
| | - Tianchang Yang
- Jiangsu Engineering Research Center for Efficient Delivery System of TCM, School of Pharmacy, Nanjing University of Chinese Medicine, 138 Xianlin Avenue, Qixia District, Nanjing 210023, China
| | - Fangwen Jiao
- Department of Pathogen Biology, School of Medicine and Holistic Integrative Medicine, Nanjing University of Chinese Medicine, 138 Xianlin Avenue, Qixia District, Nanjing 210023, China
| | - Hongzhi Qiao
- Jiangsu Engineering Research Center for Efficient Delivery System of TCM, School of Pharmacy, Nanjing University of Chinese Medicine, 138 Xianlin Avenue, Qixia District, Nanjing 210023, China
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Tang TY, Mak MYQ, Yap CJQ, Boey JEC, Chan SL, Soon SXY, Ishak IAB, Lee RWL, Soh XJ, Goh WX. An Observational Clinical Trial Examining the Effect of Topical Oxygen Therapy (Natrox ™) on the Rates of Healing of Chronic DiAbetic Foot Ulcers (OTONAL Trial). INT J LOW EXTR WOUND 2024; 23:326-337. [PMID: 34747267 PMCID: PMC11059837 DOI: 10.1177/15347346211053694] [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: 08/15/2021] [Revised: 09/15/2021] [Accepted: 09/27/2021] [Indexed: 12/30/2022]
Abstract
Natrox™ topical oxygen therapy (TOT) (Inotec AMD Ltd, Cambridgeshire, UK) employs a small battery-powered "oxygen generator" to concentrate atmospheric oxygen and feeds pure, moist, oxygen through a fine, soft tube to a dressing-like "oxygen distribution system", which is placed over the wound and is held in place by a conventional dressing. The aim was to determine the effectiveness of Natrox™ for non-healing diabetic foot ulcers (DFU) over a 3-month period.Longitudinal, single-arm, open prospective registry study using 12 weeks of TOT using a 4 week run-in period. 20 patients recruited to OTONAL had chronic DFU greater than 3 months duration or minor amputation sites with less than 50% healing in 4 weeks.There were 13 (65%) males and the mean age was 65.7 (±11.6) years. The mean glycated haemoglobin (HbA1c) was 6.9 (±1.3) mmol mol-1 and mean wound duration before TOT was 114 (±79.1) days. 18/20 (90.0%) patients had concomitant lower limb revascularization angioplasty for chronic limb threatening ischaemia. The mean size of the foot ulcer at baseline was 11.3 ± 14.8 cm2 and mean transcutaneous oxygen measurement value was 34.1 (±19.6) mm Hg. Wound closure of >75% was observed in 14/20 (70.0%) patients. There was a 91.3% (±14.9%) wound area reduction by 3 months (P = .001) and mean time for 100% closure was 77.6 ± 32.5 days. Mean pain scores reduced from 2.4 (±1.8) at baseline to .5 (±1.0) at 3 months (P = .008). All patients were very satisfied using the ambulatory device. Use of TOT in chronic diabetic foot wounds stimulates a healing state, underpinning the concept that oxygen plays a central role in wound healing. Our results are more compelling if you consider they started with relatively large-sized DFUs and majority of patients were frail with underlying peripheral artery disease. (NCT03863054).
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Affiliation(s)
- Tjun Yip Tang
- Department of Vascular Surgery, Singapore General Hospital, Singapore
- Duke NUS Graduate Medical School, Singapore
| | | | - C. J. Q. Yap
- Department of Vascular Surgery, Singapore General Hospital, Singapore
| | - J. E. C. Boey
- Department of Podiatry, National University Hospital, Singapore
| | - Sze Ling Chan
- Health Services Research Center, SingHealth, Singapore
| | | | - I. A. B. Ishak
- Department of Podiatry, Singapore General Hospital, Singapore
| | - R. W. L. Lee
- Department of Podiatry, Singapore General Hospital, Singapore
| | - Xin Jie Soh
- Department of Podiatry, Singapore General Hospital, Singapore
| | - Wan Xi Goh
- Department of Podiatry, Singapore General Hospital, Singapore
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Mamun AA, Shao C, Geng P, Wang S, Xiao J. Recent advances in molecular mechanisms of skin wound healing and its treatments. Front Immunol 2024; 15:1395479. [PMID: 38835782 PMCID: PMC11148235 DOI: 10.3389/fimmu.2024.1395479] [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: 03/04/2024] [Accepted: 05/03/2024] [Indexed: 06/06/2024] Open
Abstract
The skin, being a multifaceted organ, performs a pivotal function in the complicated wound-healing procedure, which encompasses the triggering of several cellular entities and signaling cascades. Aberrations in the typical healing process of wounds may result in atypical scar development and the establishment of a persistent condition, rendering patients more vulnerable to infections. Chronic burns and wounds have a detrimental effect on the overall quality of life of patients, resulting in higher levels of physical discomfort and socio-economic complexities. The occurrence and frequency of prolonged wounds are on the rise as a result of aging people, hence contributing to escalated expenditures within the healthcare system. The clinical evaluation and treatment of chronic wounds continue to pose challenges despite the advancement of different therapeutic approaches. This is mainly owing to the prolonged treatment duration and intricate processes involved in wound healing. Many conventional methods, such as the administration of growth factors, the use of wound dressings, and the application of skin grafts, are used to ease the process of wound healing across diverse wound types. Nevertheless, these therapeutic approaches may only be practical for some wounds, highlighting the need to advance alternative treatment modalities. Novel wound care technologies, such as nanotherapeutics, stem cell treatment, and 3D bioprinting, aim to improve therapeutic efficacy, prioritize skin regeneration, and minimize adverse effects. This review provides an updated overview of recent advancements in chronic wound healing and therapeutic management using innovative approaches.
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Affiliation(s)
- Abdullah Al Mamun
- Central Laboratory of The Lishui Hospital of Wenzhou Medical University, Lishui People’s Hospital, Lishui, Zhejiang, China
| | - Chuxiao Shao
- Central Laboratory of The Lishui Hospital of Wenzhou Medical University, Lishui People’s Hospital, Lishui, Zhejiang, China
| | - Peiwu Geng
- Central Laboratory of The Lishui Hospital of Wenzhou Medical University, Lishui People’s Hospital, Lishui, Zhejiang, China
| | - Shuanghu Wang
- Central Laboratory of The Lishui Hospital of Wenzhou Medical University, Lishui People’s Hospital, Lishui, Zhejiang, China
| | - Jian Xiao
- Central Laboratory of The Lishui Hospital of Wenzhou Medical University, Lishui People’s Hospital, Lishui, Zhejiang, China
- Molecular Pharmacology Research Center, School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, China
- Department of Wound Healing, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Han X, Ju L, Saengow C, Ren W, Ewoldt R, Fan T, Irudayaraj J. Nano oxygen chamber by cascade reaction for hypoxia mitigation and reactive oxygen species scavenging in wound healing. Bioact Mater 2024; 35:67-81. [PMID: 38312517 PMCID: PMC10835133 DOI: 10.1016/j.bioactmat.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 12/26/2023] [Accepted: 01/11/2024] [Indexed: 02/06/2024] Open
Abstract
Hypoxia, excessive reactive oxygen species (ROS), and impaired angiogenesis are prominent obstacles to wound healing following trauma and surgical procedures, often leading to the development of keloids and hypertrophic scars. To address these challenges, a novel approach has been proposed, involving the development of a cascade enzymatic reaction-based nanocarriers-laden wound dressing. This advanced technology incorporates superoxide dismutase modified oxygen nanobubbles and catalase modified oxygen nanobubbles within an alginate hydrogel matrix. The oxygen nano chamber functions through a cascade reaction between superoxide dismutase and catalase, wherein excessive superoxide in the wound environment is enzymatically decomposed into hydrogen peroxide, and this hydrogen peroxide is subsequently converted into oxygen by catalase. This enzymatic cascade effectively controls wound inflammation and hypoxia, mitigating the risk of keloid formation. Concurrently, the oxygen nanobubbles release oxygen continuously, thus providing a sustained supply of oxygen to the wound site. The oxygen release from this dynamic system stimulates fibroblast proliferation, fosters the formation of new blood vessels, and contributes to the overall wound healing process. In the rat full-thickness wound model, the cascade reaction-based nano oxygen chamber displayed a notable capacity to expedite wound healing without scarring. Furthermore, in the pilot study of porcine full-thickness wound healing, a notable acceleration of tissue repair was observed in the conceived cascade reaction-based gel treated group within the 3 days post-surgery, which represents the proliferation stage of healing process. These achievements hold significant importance in ensuring the complete functional recovery of tissues, thereby highlighting its potential as a promising approach for enhancing wound healing outcomes.
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Affiliation(s)
- Xiaoxue Han
- Department of Bioengineering, 1102 Everitt Lab, 1406 W. Green St., University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA
- Biomedical Research Center, Mills Breast Cancer Institute, Carle Foundation Hospital, Urbana, IL, 61801, USA
- Cancer Center at Illinois, Beckman Institute, Urbana, IL, 61801, USA
| | - Leah Ju
- Department of Bioengineering, 1102 Everitt Lab, 1406 W. Green St., University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA
- Biomedical Research Center, Mills Breast Cancer Institute, Carle Foundation Hospital, Urbana, IL, 61801, USA
| | - Chai Saengow
- Department of Mechanical Science and Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Wen Ren
- Department of Bioengineering, 1102 Everitt Lab, 1406 W. Green St., University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA
- Biomedical Research Center, Mills Breast Cancer Institute, Carle Foundation Hospital, Urbana, IL, 61801, USA
- Cancer Center at Illinois, Beckman Institute, Urbana, IL, 61801, USA
| | - Randy Ewoldt
- Department of Mechanical Science and Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Timothy Fan
- Cancer Center at Illinois, Beckman Institute, Urbana, IL, 61801, USA
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA
| | - Joseph Irudayaraj
- Department of Bioengineering, 1102 Everitt Lab, 1406 W. Green St., University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA
- Biomedical Research Center, Mills Breast Cancer Institute, Carle Foundation Hospital, Urbana, IL, 61801, USA
- Cancer Center at Illinois, Beckman Institute, Urbana, IL, 61801, USA
- Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA
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Tan M, Chin JS, Madden LE, Knutsen MF, Ugland H, Karlsson MK, Amiry-Moghaddam M, Becker DL. Oxygenated Hydrogel Promotes Re-Epithelialization and Reduces Inflammation in a Perturbed Wound Model in Rat. J Pharm Sci 2024; 113:999-1006. [PMID: 38072116 DOI: 10.1016/j.xphs.2023.10.011] [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] [Received: 06/29/2023] [Revised: 10/06/2023] [Accepted: 10/06/2023] [Indexed: 12/31/2023]
Abstract
Chronic wounds can take months or even years to heal and require proper medical intervention. Normal wound healing processes require adequate oxygen supply. Accordingly, destroyed or inefficient vasculature leads to insufficient delivery to peripheral tissues and impair healing. Oxygen is critical for vital processes such as proliferation, collagen synthesis and antibacterial defense. Hyperbaric oxygen therapy (HBOT) is commonly used to accelerate healing however, this can be costly and requires specialized training and equipment. Efforts have turned to the development of topical oxygen delivery systems. Oxysolutions has developed oxygenated gels (P407, P407/P188, nanocellulose based gel (NCG)) with high levels of dissolved oxygen. This study aims to evaluate the efficacy of these newly developed oxygenated products by assessing their impact on healing rates in a rat perturbed wound model. Here, P407/P188 oxygenated gels demonstrated greater re-epithelialization distances compared to its controls at Day 3. In addition, all oxygenated gels had a higher proportion of wounds with complete wound closure. All three oxygenated gels also minimized further escalation in inflammation from Day 3 to Day 10. This highlights the potential of this newly-developed oxygenated gels as an alternative to existing oxygen therapies.
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Affiliation(s)
- Mandy Tan
- Nanyang Institute of Health Technologies, Interdisciplinary Graduate School, Nanyang Technological University, Singapore 639798, Republic of Singapore; A*STAR Skin Research Labs (A*SRL), Agency for Science, Technology and Research (A*STAR), 11 Mandalay Road, Singapore 308232, Republic of Singapore.
| | - Jiah Shin Chin
- A*STAR Skin Research Labs (A*SRL), Agency for Science, Technology and Research (A*STAR), 11 Mandalay Road, Singapore 308232, Republic of Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Republic of Singapore
| | - Leigh Edward Madden
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Republic of Singapore
| | | | - Hege Ugland
- Oxy Solutions, Gaustadalléen 21, 0349 Oslo, Norway
| | | | - Mahmood Amiry-Moghaddam
- Oxy Solutions, Gaustadalléen 21, 0349 Oslo, Norway; Laboratory of Molecular Neuroscience, Division of Anatomy, Department of Molecular Medicine, Institute of Basic Medical Sciences, University of Oslo, P.O. Box 1105, Blindern, 0317 Oslo, Norway
| | - David L Becker
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Republic of Singapore; A*STAR Skin Research Labs (A*SRL), Agency for Science, Technology and Research (A*STAR) & Skin Research Institute of Singapore (SRIS), 11 Mandalay Road, Singapore 308232, Republic of Singapore; National Skin Centre, 1 Mandalay Road, Singapore 308205, Republic of Singapore.
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Zulbaran-Rojas A, Bara RO, Lee M, Flores-Camargo A, Mishra R, Winocour S, Thompson A, Najafi B. Optimizing Tissue Oxygenation in Reduction Mammoplasty: The Role of Continuous Diffusion of Oxygen: A Feasibility Pilot Randomized Controlled Trial. J Surg Res 2023; 292:113-122. [PMID: 37611440 DOI: 10.1016/j.jss.2023.07.035] [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: 03/09/2023] [Revised: 06/05/2023] [Accepted: 07/20/2023] [Indexed: 08/25/2023]
Abstract
INTRODUCTION Bilateral reduction mammoplasty (BRM) aims to alleviate macromastia-related symptoms in women. This procedure involves a T-Junction suture at the medial inframammary fold that encompasses 12%-39% of wound breakdowns mainly due to reduced perfusion. Continuous diffusion of oxygen (CDO) may enhance breast tissue oxygenation to prevent such complication. We explored the feasibility of this therapy. METHODS A 4-wk feasibility-pilot randomized controlled trial of women undergoing BRM was conducted. By internal randomization (left/right side), participants received standard of care (SOC) in one breast using topical skin adhesive, while their other breast received SOC + CDO at the T-junction covered by a silicon sheet (sCDO), or CDO directly to the T-Junction skin (dCDO). Feasibility outcomes included protocol delivery, outcome measurement, device-related adverse events, and device acceptability. Exploratory outcomes were T-Junction SatO2 and deoxyhemoglobin assessed with near-infrared spectroscopy and wound dehiscence. RESULTS Sixteen participants (age = 33 ± 8 y; body mass index = 34.34 ± 5.85 kg/m2) were recruited, conforming n = 32 breasts (SOC, n = 16; dCDO, n = 10, sCDO, n = 6). At 4 wk, protocol delivery was 93.7%, outcome measuring 100%, and device-related adverse events 0%. Device acceptability showed an 85.4% strong agreement for attitude toward use, 78.2% perceived ease of use, and 77.7% perceived usefulness. Breasts undergoing sCDO showed higher SatO2 (P < 0.001), whereas lower deoxyhemoglobin (P < 0.001) compared to all other breast groups. However, wound dehiscence was not different between groups (P = 0.66). CONCLUSIONS Self-applied CDO to the T-Junction is feasible, safe, and acceptable, in patients undergoing BRM. In a proper wound environment, CDO may enhance breast tissue oxygenation. However, it is unclear whether CDO leads to decreased wound dehiscence. This study showed reproducibility for larger randomized trials.
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Affiliation(s)
- Alejandro Zulbaran-Rojas
- Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Rasha O Bara
- Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Myeounggon Lee
- Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Areli Flores-Camargo
- Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Ramkinker Mishra
- Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Sebastian Winocour
- Division of Adult Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Alastair Thompson
- Section of Breast Surgery, Division of Surgical Oncology, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Bijan Najafi
- Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
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Youssef K, Ullah A, Rezai P, Hasan A, Amirfazli A. Recent advances in biosensors for real time monitoring of pH, temperature, and oxygen in chronic wounds. Mater Today Bio 2023; 22:100764. [PMID: 37674780 PMCID: PMC10477692 DOI: 10.1016/j.mtbio.2023.100764] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 07/16/2023] [Accepted: 08/05/2023] [Indexed: 09/08/2023] Open
Abstract
Chronic wounds are among the major healthcare issues affecting millions of people worldwide with high rates of morbidity, losses of limbs and mortality. Microbial infection in wounds is a severe problem that can impede healing of chronic wounds. Accurate, timely and early detection of infections, and real time monitoring of various wound healing biomarkers related to infection can be significantly helpful in the treatment and care of chronic wounds. However, clinical methodologies of periodic assessment and care of wounds require physical visit to wound care clinics or hospitals and time-consuming frequent replacement of wound dressing patches, which also often adversely affect the healing process. Besides, frequent replacements of wound dressings are highly expensive, causing a huge amount of burden on the national health care systems. Smart bandages have emerged to provide in situ physiochemical surveillance in real time at the wound site. These bandages integrate smart sensors to detect the condition of wound infection based on various parameters, such as pH, temperature and oxygen level in the wound which reduces the frequency of changing the wound dressings and its associated complications. These devices can continually monitor the healing process, paving the way for tailored therapy and improved quality of patient's life. In this review, we present an overview of recent advances in biosensors for real time monitoring of pH, temperature, and oxygen in chronic wounds in order to assess infection status. We have elaborated the recent progress in quantitative monitoring of several biomarkers important for assessing wounds infection status and its detection using smart biosensors. The review shows that real-time monitoring of wound status by quantifying specific biomarkers, such as pH, temperature and tissue oxygenation to significantly aid the treatment and care of chronic infected wounds.
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Affiliation(s)
- Khaled Youssef
- Department of Mechanical Engineering, York University, Toronto, ON, Canada
| | - Asad Ullah
- Department of Mechanical and Industrial Engineering, Qatar University, Doha, 2713, Qatar
- Biomedical Research Center, Qatar University, Doha, 2713, Qatar
| | - Pouya Rezai
- Department of Mechanical Engineering, York University, Toronto, ON, Canada
| | - Anwarul Hasan
- Department of Mechanical and Industrial Engineering, Qatar University, Doha, 2713, Qatar
- Biomedical Research Center, Qatar University, Doha, 2713, Qatar
| | - Alidad Amirfazli
- Department of Mechanical Engineering, York University, Toronto, ON, Canada
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Lalieu RC, Bol Raap RD, Smit C, Dubois EFL, van Hulst RA. Hyperbaric Oxygen Therapy for Nonhealing Wounds-A Long-term Retrospective Cohort Study. Adv Skin Wound Care 2023; 36:304-310. [PMID: 37017408 DOI: 10.1097/01.asw.0000922696.61546.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
OBJECTIVE To analyze wound healing results of hyperbaric oxygen therapy (HBOT) for a variety of different wound types. METHODS This retrospective cohort study included all patients treated with HBOT and wound care at a single hyperbaric center between January 2017 and December 2020. The primary outcome was wound healing. Secondary outcome measures were quality of life (QoL), number of sessions, adverse effects, and treatment cost. Investigators also examined possible influencing factors, including age, sex, type and duration of wound, socioeconomic status, smoking status, and presence of peripheral vascular disease. RESULTS A total of 774 treatment series were recorded, with a median of 39 sessions per patient (interquartile range, 23-51 sessions). In total, 472 wounds (61.0%) healed, 177 (22.9%) partially healed, 41 (5.3%) deteriorated, and 39 (5.0%) minor and 45 (5.8%) major amputations were performed. Following HBOT, median wound surface area decreased from 4.4 cm 2 to 0.2 cm 2 ( P < .01), and patient QoL improved from 60 to 75 on a 100-point scale ( P < .01). The median cost of therapy was €9,188 (interquartile range, €5,947-€12,557). Frequently recorded adverse effects were fatigue, hyperoxic myopia, and middle ear barotrauma. Attending fewer than 30 sessions and having severe arterial disease were both associated with a negative outcome. CONCLUSIONS Adding HBOT to standard wound care increases wound healing and QoL in selected wounds. Patients with severe arterial disease should be screened for potential benefits. Most reported adverse effects are mild and transient.
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Affiliation(s)
- Rutger C Lalieu
- At Hyperbaric Medical Center, Rijswijk, South Holland, the Netherlands, Rutger C. Lalieu, MD, PhD, is Physician and René D. Bol Raap, MD, is Diving Medical Physician. Casper Smit, MD, PhD, is Vascular Surgeon, Reinier de Graaf Hospital, Delft, South Holland, and Vascular Surgeon at the Hyperbaric Medical Center, Rijswijk. Emile FL Dubois, MD, PhD, is Pulmonary Physician and Consultant, Hyperbaric Medical Center, Rijswijk. Rob A. van Hulst, MD, PhD, is Head of the Hyperbaric Department, Amsterdam University Medical Center
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9
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Liu T, Lu Y, Zhan R, Qian W, Luo G. Nanomaterials and nanomaterials-based drug delivery to promote cutaneous wound healing. Adv Drug Deliv Rev 2023; 193:114670. [PMID: 36538990 DOI: 10.1016/j.addr.2022.114670] [Citation(s) in RCA: 31] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/24/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
Abstract
Various factors could damage the structure and integrity of skin to cause wounds. Nonhealing or chronic wounds seriously affect the well-being of patients and bring heavy burdens to the society. The past few decades have witnessed application of numerous nanomaterials to promote wound healing. Owing to the unique physicochemical characteristics at nanoscale, nanomaterials-based therapy has been regarded as a potential approach to promote wound healing. In this review, we first overview the wound categories, wound healing process and critical influencing factors. Then applications of nanomaterials with intrinsic therapeutic effect and nanomaterials-based drug delivery systems to promote wound healing are addressed in detail. Finally, current limitations and future perspectives of nanomaterials in wound healing are discussed.
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Affiliation(s)
- Tengfei Liu
- Institute of Burn Research, Southwest Hospital, State Key Laboratory of Trauma, Burn and Combined Injury, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Yifei Lu
- Institute of Burn Research, Southwest Hospital, State Key Laboratory of Trauma, Burn and Combined Injury, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Rixing Zhan
- Institute of Burn Research, Southwest Hospital, State Key Laboratory of Trauma, Burn and Combined Injury, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Wei Qian
- Institute of Burn Research, Southwest Hospital, State Key Laboratory of Trauma, Burn and Combined Injury, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Gaoxing Luo
- Institute of Burn Research, Southwest Hospital, State Key Laboratory of Trauma, Burn and Combined Injury, Army Medical University (Third Military Medical University), Chongqing 400038, China.
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Fischer HG, Gey A, Fischer M, Plontke SK. [Hyperbaric oxygen therapy : Selected indications in the discipline of otorhinolaryngology]. HNO 2022; 70:848-860. [PMID: 36173420 DOI: 10.1007/s00106-022-01227-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2022] [Indexed: 11/29/2022]
Abstract
Hyperbaric oxygenation (HBO) represents the controlled exposure to positive pressure with simultaneous inhalation of pure oxygen. It is considered to be an effective treatment option for diseases with restricted blood flow as oxygen not only binds chemically to hemoglobin but also physically dissolves in blood plasma. With the help of a hyperbaric chamber the ambient pressure of a patient can be modified and the physiological characteristics in positive pressure can be medically used. The indications relevant to otorhinolaryngology are necrotizing otitis externa and skull base osteomyelitis, other forms of osteomyelitis, gangrene, wound healing disorders and sudden loss of hearing. When choosing a treatment, not only the availability and costs of HBO treatment play a role but also the patient's tolerance of overpressure. The risks of treatment, e.g., due to oxygen toxicity or barotrauma of the middle ear or the paranasal sinuses, must be weighed up against the potential benefits.
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Affiliation(s)
- Hans-Georg Fischer
- Praxis für Hals-Nasen-Ohrenheilkunde, Schlehenweg 30, 04329, Leipzig, Deutschland. .,Abteilung für Hals-Nasen-Ohrenheilkunde, Kopf- und Hals-Chirurgie, Bundeswehrkrankenhaus Hamburg, Hamburg, Deutschland. .,Universitätsklinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Universitätsmedizin Halle, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland.
| | - Alexandra Gey
- Universitätsklinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Universitätsmedizin Halle, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
| | - Martin Fischer
- Klinik für Allgemein‑, Viszeral- und Onkologische Chirurgie, Klinikum St. Georg, Leipzig, Deutschland
| | - Stefan K Plontke
- Universitätsklinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Universitätsmedizin Halle, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
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11
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Lalieu R, Raap RB, van Hulst R. Hyperbaric oxygen therapy: when pressure is good for diabetic foot ulcers. Br J Community Nurs 2022; 27:S6-S12. [PMID: 35274985 DOI: 10.12968/bjcn.2022.27.sup3.s6] [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: 11/12/2022]
Abstract
The diabetic foot ulcer (DFU) as a common complication of diabetes. Even with adequate treatment, up to 35% of these ulcers do not heal. This is due to the effect of aging, repeated ischemia-reperfusion (IR) injury, bacterial colonisation of the wound and chronic hypoxia. All wound-healing processes are highly dependent on oxygen, so hyperbaric oxygen therapy (HBOT) can be employed to improve wound healing and correct the four pathophysiological factors for chronic wounds. It is, in fact, internationally recognised as a treatment option for non-healing DFUs. Several trials and systematic reviews have been performed on its efficacy, which show a positive trend towards increased wound healing and reduced amputation risk. Some controversy exists due to contradictory results in these studies, which may be due to grouping patients with and without peripheral arterial occlusive disease (PAOD) together. Side effects are usually mild and transient, and the treatment is considered safe.
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Affiliation(s)
- Rutger Lalieu
- Hyperbaar Geneeskundig Centrum, Rijswijk, the Netherlands, and Amsterdam University Medical Centers, location AMC, Department of Anaesthesiology
| | - René Bol Raap
- Hyperbaar Geneeskundig Centrum, Rijswijk, the Netherlands
| | - Rob van Hulst
- Amsterdam University Medical Centers, location AMC, Department of Anaesthesiology and Hyperbaric Department
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12
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Mantri Y, Jokerst JV. Impact of skin tone on photoacoustic oximetry and tools to minimize bias. BIOMEDICAL OPTICS EXPRESS 2022; 13:875-887. [PMID: 35284157 PMCID: PMC8884230 DOI: 10.1364/boe.450224] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 05/02/2023]
Abstract
The major optical absorbers in tissue are melanin and oxy/deoxy-hemoglobin, but the impact of skin tone and pigmentation on biomedical optics is still not completely understood or adequately addressed. Melanin largely governs skin tone with higher melanin concentration in subjects with darker skin tones. Recently, there has been extensive debate on the bias of pulse oximeters when used with darker subjects. Photoacoustic (PA) imaging can measure oxygen saturation similarly as pulse oximeters and could have value in studying this bias. More importantly, it can deconvolute the signal from the skin and underlying tissue. Here, we studied the impact of skin tone on PA signal generation, depth penetration, and oximetry. Our results show that subjects with darker skin tones exhibit significantly higher PA signal at the skin surface, reduced penetration depth, and lower oxygen saturation compared to subjects with lighter skin tones. We then suggest a simple way to compensate for these signal differences.
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Affiliation(s)
- Yash Mantri
- Department of Bioengineering, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Jesse V. Jokerst
- Department of Nanoengineering, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
- Material Science Department, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
- Department of Radiology, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
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13
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Therapeutic strategies for chronic wound infection. Chin J Traumatol 2022; 25:11-16. [PMID: 34315658 PMCID: PMC8787234 DOI: 10.1016/j.cjtee.2021.07.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 05/31/2021] [Accepted: 06/29/2021] [Indexed: 02/04/2023] Open
Abstract
Chronic wounds have always been a tough fight in clinical practice, which can not only make patients suffer from pain physically and mentally but also impose a heavy burden on the society. More than one factor is relevant to each step of the development of chronic wounds. Along with the in-depth research, we have realized that figuring out the pathophysiological mechanism of chronic wounds is the foundation of treatment, while wound infection is the key point concerned. The cause of infection should be identified and prevented promptly once diagnosed. This paper mainly describes the mechanism, diagnosis and therapeutic strategies of chronic wound infection, and will put an emphasis on the principle of debridement.
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14
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Knutsen MF, Agrenius K, Ugland H, Petronis S, Haglerod C, Håkansson J, Chinga-Carrasco G. Oxygenated Nanocellulose-A Material Platform for Antibacterial Wound Dressing Devices. ACS APPLIED BIO MATERIALS 2021; 4:7554-7562. [PMID: 35006698 DOI: 10.1021/acsabm.1c00819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Both carboxylated cellulose nanofibrils (CNF) and dissolved oxygen (DO) have been reported to possess antibacterial properties. However, the combination for use as wound dressings against biofilm infections in chronic wounds is less known. The present study reports the development of oxygenated CNF dispersions that exhibit strong antibacterial effect. Carboxylated CNF dispersions with different oxidation levels were oxygenated by the OXY BIO System and tested for antibacterial activity against Pseudomonas aeruginosa and Staphylococcus aureus. The results reveal that the higher oxidation level of the CNFs, the better antibacterial effect. Scanning electron microscopy of bacterial biofilms revealed that a potential mechanism of action of the CNFs is the formation of a network surrounding and entrapping the bacteria. This effect is further potentiated by the oxygenation process. A CNF sample (concentration 0.6 wt %) that was oxygenated to a DO level of 46.4 mg/L demonstrated a strong antibacterial effect against S. aureus in vivo using a mouse model of surgical site infection. The oxygenated CNF dispersion reduced the bacterial survival by 71%, after 24 h treatment. The potent antibacterial effect indicates that oxygenated nanocellulose is a promising material for antibacterial wound dressings.
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Affiliation(s)
| | - Karin Agrenius
- Chemistry, Biomaterials and Textiles, RISE Research Institutes of Sweden, Box 857, SE-50115 Borås, Sweden
| | - Hege Ugland
- Oxy Solutions, Gaustadalléen 21, 0349 Oslo, Norway
| | - Sarunas Petronis
- Chemistry, Biomaterials and Textiles, RISE Research Institutes of Sweden, Box 857, SE-50115 Borås, Sweden
| | | | - Joakim Håkansson
- Chemistry, Biomaterials and Textiles, RISE Research Institutes of Sweden, Box 857, SE-50115 Borås, Sweden.,Department of Laboratory Medicine, Institute of Biomedicine, Gothenburg University, 405 30 Gothenburg, Sweden
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15
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Connaghan F, Avsar P, Patton D, O'Connor T, Moore Z. Impact of topical oxygen therapy on diabetic foot ulcer healing rates: a systematic review. J Wound Care 2021; 30:823-829. [PMID: 34644137 DOI: 10.12968/jowc.2021.30.10.823] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The aim of this systematic review was to determine the impact of topical oxygen therapy (TOT) on diabetic foot ulcer (DFU) healing. METHOD Using systematic review methodology, we considered randomised controlled trials (RCTs), controlled trials, pilot studies and observational studies. The search was conducted in January 2019, using PubMed, CINAHL, Ovid, Cochrane, Web of Science and EMBASE databases. Data analysis was undertaken using RevMan and a narrative synthesis. The article titles were assessed by two authors independently, and the abstracts (when available) of the studies identified by the search strategy were screened for their eligibility, according to the inclusion and exclusion criteria. The full-text version of potentially relevant studies was obtained and two authors independently screened this against the inclusion criteria. Data were extracted using a predesigned extraction tool and all included studies were quality appraised using the Evidence-Based Librarianship checklist. RESULTS The search returned 565 records of which eight met the inclusion criteria. Of the included studies, three were set in single centre outpatient wound clinics, two studies were set in an outpatient wound care research clinic and three studies were multisite. Meta-analysis of four studies was undertaken. DFUs are >2 times more likely to heal with TOT than with standard care alone. The odds ratio (OR)=2.49 (95% confidence interval (CI): 1.59-3.90, p=0.00001). The remaining four studies also showed that using TOT increased healing rates. An included study reported that time to 50% DFU closure was significantly shorter in participants who received the TOT, mean 18.4 days versus 28.9 days in the sham therapy group (p=0.001). However, the validity of 65.5% of the eight studies was assessed as low. CONCLUSION The findings suggest that TOT enhances healing for patients with hard-to-heal DFUs when used with standard care. The results from the trials reviewed also indicate a benefit for patients over standard care alone. However, the sample sizes in the studies were generally small, thus, more RCTs are warranted to further validate these findings. DECLARATION OF INTEREST The authors have no conflicts of interest to declare.
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Affiliation(s)
| | - Pinar Avsar
- Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - Declan Patton
- Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland.,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
| | - Tom O'Connor
- Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland.,Adjunct Professor, Griffith University, Australia.,Honorary Professor, Lida Institute, Shanghai, China.,Adjunct Professor, Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
| | - Zena Moore
- Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland.,Adjunct Professor, Griffith University, Australia.,Honorary Professor, Lida Institute, Shanghai, China.,Adjunct Professor, Fakeeh College of Health Sciences, Jeddah, Saudi Arabia.,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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16
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Affiliation(s)
- Mark Q Niederauer
- Biochemical engineer Chief Technical and Operating Officer, EO2 Concepts, San Antonio, TX, US
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17
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Oropallo AR, Serena TE, Armstrong DG, Niederauer MQ. Molecular Biomarkers of Oxygen Therapy in Patients with Diabetic Foot Ulcers. Biomolecules 2021; 11:biom11070925. [PMID: 34206433 PMCID: PMC8301753 DOI: 10.3390/biom11070925] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 06/13/2021] [Accepted: 06/19/2021] [Indexed: 12/28/2022] Open
Abstract
Hyperbaric oxygen therapy (HBOT) and topical oxygen therapy (TOT) including continuous diffuse oxygen therapy (CDOT) are often utilized to enhance wound healing in patients with diabetic foot ulcerations. High pressure pure oxygen assists in the oxygenation of hypoxic wounds to increase perfusion. Although oxygen therapy provides wound healing benefits to some patients with diabetic foot ulcers, it is currently performed from clinical examination and imaging. Data suggest that oxygen therapy promotes wound healing via angiogenesis, the creation of new blood vessels. Molecular biomarkers relating to tissue inflammation, repair, and healing have been identified. Predictive biomarkers can be used to identify patients who will most likely benefit from this specialized treatment. In diabetic foot ulcerations, specifically, certain biomarkers have been linked to factors involving angiogenesis and inflammation, two crucial aspects of wound healing. In this review, the mechanism of how oxygen works in wound healing on a physiological basis, such as cell metabolism and growth factor signaling transduction is detailed. Additionally, observable clinical outcomes such as collagen formation, angiogenesis, respiratory burst and cell proliferation are described. The scientific evidence for the impact of oxygen on biomolecular pathways and its relationship to the outcomes in clinical research is discussed in this narrative review.
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Affiliation(s)
- Alisha R. Oropallo
- Comprehensive Wound Healing Center and Hyperbarics, Department of Vascular Surgery, Zucker School of Medicine Hofstra/Northwell, Hempstead, NY 11549, USA
- Correspondence: ; Tel.: +1-516-233-3780
| | | | - David G. Armstrong
- Limb Preservation Program, Department of Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA 90033, USA;
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18
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He S, Liang C, Yi C, Wu M. Therapeutic effect of continuous diffusion of oxygen therapy combined with traditional moist wound dressing therapy in the treatment of diabetic foot ulcers. Diabetes Res Clin Pract 2021; 174:108743. [PMID: 33713718 DOI: 10.1016/j.diabres.2021.108743] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 01/13/2021] [Accepted: 03/02/2021] [Indexed: 11/16/2022]
Abstract
AIMS To investigate the therapeutic effect of continuous diffusion of oxygen (CDO) combined with traditional moist wound dressing (MWD) on the diabetic foot ulcers (DFUs) inpatients. METHODS The inpatients from May 2016 to April 2018 were enrolled and randomly divided into MWD, CDO and combination treatment groups (n = 40 each group). The moist dressing was used in the MWD group while a micro-oxygen supply device was used in the CDO group. The combination treatment group was given both MWD and CDO. All patients were treated for 8 weeks. The wound healing, amputation rate, and inflammatory control were evaluated. RESULTS Compared with MWD and CDO groups, the combination group showed a higher wound healing rate (P < 0.05), lower white blood cell count (P < 0.05) and lower high-sensitivity C-reactive protein level (P < 0.05). During 1-year follow-up, the amputation rate was 0% in combination group, which was significantly lower than that in other two groups (P < 0.05). CONCLUSIONS The combination of MWD and CDO was effective in promoting healing and preventing infection of DFUs, which holds a potential to be a new strategy for the treatment of this critical clinical condition.
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Affiliation(s)
- Shumin He
- Department of Wound Stoma Care Clinic, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou 510080, Guangdong, China
| | - Caiyi Liang
- Department of Wound Stoma Care Clinic, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou 510080, Guangdong, China
| | - Cailan Yi
- Department of Wound Stoma Care Clinic, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou 510080, Guangdong, China
| | - Miaoli Wu
- Department of Wound Stoma Care Clinic, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou 510080, Guangdong, China.
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19
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Lavery LA, Killeen AL, Farrar D, Akgul Y, Crisologo PA, Malone M, Davis KE. The effect of continuous diffusion of oxygen treatment on cytokines, perfusion, bacterial load, and healing in patients with diabetic foot ulcers. Int Wound J 2020; 17:1986-1995. [PMID: 32840063 PMCID: PMC7754349 DOI: 10.1111/iwj.13490] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/04/2020] [Accepted: 08/07/2020] [Indexed: 02/03/2023] Open
Abstract
To evaluate continuous diffusion of oxygen therapy (CDO) on cytokines, perfusion, and bacterial load in diabetic foot ulcers we evaluated 23 patients for 3 weeks. Tissues biopsies were obtained at each visit to evaluate cytokines and quantitative bacterial cultures. Perfusion was measured with hyperspectral imaging and transcutaneous oxygen. We used paired T tests to compare continuous variables and independent T tests to compare healers and nonhealers. There was an increase from baseline to week 1 in TGF-β (P = .008), TNF-α (P = .014), VEGF (P = .008), PDGF (P = .087), and IGF-1 (P = .058); baseline to week 2 in TGF-β (P = .010), VEGF (P = .051), and IL-6 (P = .031); and baseline to week 3 with TGF-β (P = .055) and IL-6 (P = .054). There was a significant increase in transcutaneous oxygen after 1 week of treatment on both medial and lateral foot (P = .086 and .025). Fifty-three percent of the patients had at least a 50% wound area reduction (healers). At baseline, there were no differences in cytokines between healers and nonhealers. However, there was an increase in CXCL8 after 1 week of treatment (P = .080) and IL-6 after 3 weeks of treatment in nonhealers (P = .099). There were no differences in quantitative cultures in healers and nonhealers.
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Affiliation(s)
- Lawrence A Lavery
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Amanda L Killeen
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - David Farrar
- Department of Immunology and Molecular Biology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Yucel Akgul
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Peter A Crisologo
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Matthew Malone
- South West Sydney Limb Preservation and Wound Research Academic Unit, Sydney, New South Wales, Australia
| | - Kathryn E Davis
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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20
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Bergkvist M, Henricson J, Bergstrand S, Strömberg T, Tesselaar E, Farnebo S. Assessment of oxygenation with polarized light spectroscopy enables new means for detecting vascular events in the skin. Microvasc Res 2020; 130:104000. [PMID: 32194082 DOI: 10.1016/j.mvr.2020.104000] [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: 09/01/2019] [Revised: 03/12/2020] [Accepted: 03/12/2020] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Impaired oxygenation in the skin may occur in disease states and after reconstructive surgery. We used tissue viability imaging (TiVi) to measure changes in oxygenation and deoxygenation of haemoglobin in an in vitro model and in the dermal microcirculation of healthy individuals. MATERIALS AND METHODS Oxygenation was measured in human whole blood with different levels of oxygenation. In healthy subjects, changes in red blood cell concentration (CRBC,TiVi), oxygenation (ΔCOH,TiVi) and deoxygenation (ΔCDOH,TiVi) of haemoglobin were measured during and after arterial and venous occlusion using TiVi and were compared with measurements from the enhanced perfusion and oxygen saturation system (EPOS). RESULTS During arterial occlusion, CRBC,TiVi remained unchanged while ΔCOH,TiVi decreased to -44.2 (10.4) AU (p = 0.04), as compared to baseline. After release, CRBC,TiVi increased to 39.2 (18.8) AU (p < 0.001), ΔCOH,TiVi increased to 38.5. During venous occlusion, CRBC,TiVi increased to 28.9 (11.2) AU (p < 0.001), ΔCOH,TiVi decreased to -52.2 (46.1) AU (p < 0.001) compared to baseline after 5 min of venous occlusion. There was a significant correlation between the TiVi Oxygen Mapper and EPOS, for arterial (r = 0.92, p < 0.001) and venous occlusion (r = 0.87, p < 0.001), respectively. CONCLUSION This study shows that TiVi can measure trends in oxygenation and deoxygenation of haemoglobin during arterial and venous stasis in healthy individuals.
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Affiliation(s)
- Max Bergkvist
- Department of Hand Surgery, Plastic Surgery and Burns, Linköping University, Linköping, Sweden; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
| | - Joakim Henricson
- Department of Biomedical and Clinical Sciences, Linköping University, Sweden; Departement of Emergency Medicine, Local Health Care Services in Central Östergötland, Linköping, Östergötland, Sweden
| | - Sara Bergstrand
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Tomas Strömberg
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden
| | - Erik Tesselaar
- Department of Medical Radiation Physics, Linköping University, Linköping, Sweden; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Simon Farnebo
- Department of Hand Surgery, Plastic Surgery and Burns, Linköping University, Linköping, Sweden; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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21
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Frykberg RG, Franks PJ, Edmonds M, Brantley JN, Téot L, Wild T, Garoufalis MG, Lee AM, Thompson JA, Reach G, Dove CR, Lachgar K, Grotemeyer D, Renton SC. A Multinational, Multicenter, Randomized, Double-Blinded, Placebo-Controlled Trial to Evaluate the Efficacy of Cyclical Topical Wound Oxygen (TWO2) Therapy in the Treatment of Chronic Diabetic Foot Ulcers: The TWO2 Study. Diabetes Care 2020; 43:616-624. [PMID: 31619393 DOI: 10.2337/dc19-0476] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 09/03/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Topical oxygen has been used for the treatment of chronic wounds for more than 50 years. Its effectiveness remains disputed due to the limited number of robust high-quality investigations. The aim of this study was to assess the efficacy of multimodality cyclical pressure Topical Wound Oxygen (TWO2) home care therapy in healing refractory diabetic foot ulcers (DFUs) that had failed to heal with standard of care (SOC) alone. RESEARCH DESIGN AND METHODS Patients with diabetes and chronic DFUs were randomized (double-blind) to either active TWO2 therapy or sham control therapy-both in addition to optimal SOC. The primary outcome was the percentage of ulcers in each group achieving 100% healing at 12 weeks. A group sequential design was used for the study with three predetermined analyses and hard stopping rules once 73, 146, and ultimately 220 patients completed the 12-week treatment phase. RESULTS At the first analysis point, the active TWO2 arm was found to be superior to the sham arm, with a closure rate of 41.7% compared with 13.5%. This difference in outcome produced an odds ratio (OR) of 4.57 (97.8% CI 1.19, 17.57), P = 0.010. After adjustment for University of Texas Classification (UTC) ulcer grade, the OR increased to 6.00 (97.8% CI 1.44, 24.93), P = 0.004. Cox proportional hazards modeling, also after adjustment for UTC grade, demonstrated >4.5 times the likelihood to heal DFUs over 12 weeks compared with the sham arm with a hazard ratio of 4.66 (97.8% CI 1.36, 15.98), P = 0.004. At 12 months postenrollment, 56% of active arm ulcers were closed compared with 27% of the sham arm ulcers (P = 0.013). CONCLUSIONS This sham-controlled, double-blind randomized controlled trial demonstrates that, at both 12 weeks and 12 months, adjunctive cyclical pressurized TWO2 therapy was superior in healing chronic DFUs compared with optimal SOC alone.
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Affiliation(s)
| | - Peter J Franks
- Centre for Research and Implementation of Clinical Practice, London, U.K
| | | | | | - Luc Téot
- Montpellier University Hospital, Montpellier, France
| | - Thomas Wild
- Medical Center Dessau, Brandenburg Medical School Theodor Fontane, Dessau, Germany
| | | | - Aliza M Lee
- Salem Veterans Affairs Medical Center, Salem, VA
| | | | - Gérard Reach
- Hôpital Avicenne and Paris 13 University, Bobigny, France
| | | | | | - Dirk Grotemeyer
- Hôpitaux Robert Schuman - Hôpital Kirchberg, Luxembourg City, Luxembourg
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22
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Affiliation(s)
- Magnus Löndahl
- Department of Endocrinology, Skåne University Hospital, Lund, Sweden .,Department of Clinical Sciences in Lund, Lund University, Lund, Sweden
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23
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Abstract
Wound healing is a complex physiological process that occurs in the human body involving the sequential activation of multiple cell types and signaling pathways in a coordinated manner. Chronic wounds and burns clearly decrease quality of life of the patients since they are associated with an increase in physical pain and socio-economical complications. Furthermore, incidence and prevalence of chronic wounds (unlike burns) have been increasing mainly due to population aging resulting in increased costs for national health systems. Thus, the development of new and more cost-effective technologies/therapies is not only of huge interest but also necessary to improve the long-term sustainability of national health systems. This review covers the current knowledge on recent technologies/therapies for skin regeneration, such as: wound dressings; skin substitutes; exogenous growth factor based therapy and systemic therapy; external tissue expanders; negative pressure; oxygen; shock wave, and photobiomodulation wound therapies. Associated benefits and risks as well as the clinical use and availability are all addressed for each therapy. Moreover, future trends in wound care including novel formulations using metallic nanoparticles and topical insulin are herein presented. These novel formulations have shown to be promising therapeutic options in the near future that may change the wound care paradigm.
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Affiliation(s)
- André Oliveira
- Faculty of Pharmacy, Universidade de Lisboa, Lisboa, Portugal
| | - Sandra Simões
- Faculty of Pharmacy, Research Institute for Medicines, iMed.ULisboa, Universidade de Lisboa, Lisboa, Portugal
| | - Andreia Ascenso
- Faculty of Pharmacy, Research Institute for Medicines, iMed.ULisboa, Universidade de Lisboa, Lisboa, Portugal
| | - Catarina Pinto Reis
- Faculty of Pharmacy, Research Institute for Medicines, iMed.ULisboa, Universidade de Lisboa, Lisboa, Portugal.,Faculty of Sciences, Biophysics and Biomedical Engineering, IBEB, Universidade de Lisboa, Lisboa, Portugal
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24
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Ochoa M, Rahimi R, Zhou J, Jiang H, Yoon CK, Maddipatla D, Narakathu BB, Jain V, Oscai MM, Morken TJ, Oliveira RH, Campana GL, Cummings OW, Zieger MA, Sood R, Atashbar MZ, Ziaie B. Integrated sensing and delivery of oxygen for next-generation smart wound dressings. MICROSYSTEMS & NANOENGINEERING 2020; 6:46. [PMID: 34567658 PMCID: PMC8433317 DOI: 10.1038/s41378-020-0141-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 12/16/2019] [Accepted: 12/30/2019] [Indexed: 05/05/2023]
Abstract
Chronic wounds affect over 6.5 million Americans and are notoriously difficult to treat. Suboptimal oxygenation of the wound bed is one of the most critical and treatable wound management factors, but existing oxygenation systems do not enable concurrent measurement and delivery of oxygen in a convenient wearable platform. Thus, we developed a low-cost alternative for continuous O2 delivery and sensing comprising of an inexpensive, paper-based, biocompatible, flexible platform for locally generating and measuring oxygen in a wound region. The platform takes advantage of recent developments in the fabrication of flexible microsystems including the incorporation of paper as a substrate and the use of a scalable manufacturing technology, inkjet printing. Here, we demonstrate the functionality of the oxygenation patch, capable of increasing oxygen concentration in a gel substrate by 13% (5 ppm) in 1 h. The platform is able to sense oxygen in a range of 5-26 ppm. In vivo studies demonstrate the biocompatibility of the patch and its ability to double or triple the oxygen level in the wound bed to clinically relevant levels.
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Affiliation(s)
- Manuel Ochoa
- School of Electrical and Computer Engineering, Purdue University, West Lafayette, 47907 IN USA
- Birck Nanotechnololgy Center, 1205W State Street, West Lafayette, 47907 IN USA
| | - Rahim Rahimi
- School of Electrical and Computer Engineering, Purdue University, West Lafayette, 47907 IN USA
- Birck Nanotechnololgy Center, 1205W State Street, West Lafayette, 47907 IN USA
- School of Material Science Engineering, Purdue University, West Lafayette, 47907 IN USA
| | - Jiawei Zhou
- School of Electrical and Computer Engineering, Purdue University, West Lafayette, 47907 IN USA
- Birck Nanotechnololgy Center, 1205W State Street, West Lafayette, 47907 IN USA
| | - Hongjie Jiang
- School of Electrical and Computer Engineering, Purdue University, West Lafayette, 47907 IN USA
- Birck Nanotechnololgy Center, 1205W State Street, West Lafayette, 47907 IN USA
- Present Address: Shenzhen MSU-BIT University, Shenzhen, China
| | - Chang Keun Yoon
- School of Electrical and Computer Engineering, Purdue University, West Lafayette, 47907 IN USA
- Birck Nanotechnololgy Center, 1205W State Street, West Lafayette, 47907 IN USA
| | - Dinesh Maddipatla
- Electrical and Computer Engineering Department, Western Michigan University, 4601 Campus Drive B-236, Kalamazoo, 49008 MI USA
| | - Binu Baby Narakathu
- Electrical and Computer Engineering Department, Western Michigan University, 4601 Campus Drive B-236, Kalamazoo, 49008 MI USA
| | - Vaibhav Jain
- Birck Nanotechnololgy Center, 1205W State Street, West Lafayette, 47907 IN USA
- School of Mechanical Engineering, Purdue University, West Lafayette, 47907 IN USA
| | - Mark Michael Oscai
- School of Electrical and Computer Engineering, Purdue University, West Lafayette, 47907 IN USA
- Birck Nanotechnololgy Center, 1205W State Street, West Lafayette, 47907 IN USA
| | - Thaddeus Joseph Morken
- School of Electrical and Computer Engineering, Purdue University, West Lafayette, 47907 IN USA
- Birck Nanotechnololgy Center, 1205W State Street, West Lafayette, 47907 IN USA
| | - Rebeca Hannah Oliveira
- School of Electrical and Computer Engineering, Purdue University, West Lafayette, 47907 IN USA
- Birck Nanotechnololgy Center, 1205W State Street, West Lafayette, 47907 IN USA
| | - Gonzalo L. Campana
- Indiana University School of Medicine, 980 West Walnut Street, Building R3 Room C634, Indianapolis, 46202 IN USA
| | - Oscar W. Cummings
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, IU Health Pathology Laboratory, 350W 11th Street, Room 4054, Indianapolis, IN 46202 USA
| | - Michael A. Zieger
- Indiana University School of Medicine, 980 West Walnut Street, Building R3 Room C634, Indianapolis, 46202 IN USA
| | - Rajiv Sood
- Indiana University School of Medicine, 980 West Walnut Street, Building R3 Room C634, Indianapolis, 46202 IN USA
| | - Massood Z. Atashbar
- Electrical and Computer Engineering Department, Western Michigan University, 4601 Campus Drive B-236, Kalamazoo, 49008 MI USA
| | - Babak Ziaie
- School of Electrical and Computer Engineering, Purdue University, West Lafayette, 47907 IN USA
- Birck Nanotechnololgy Center, 1205W State Street, West Lafayette, 47907 IN USA
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, 47907 IN USA
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Nataraj M, Maiya AG, Karkada G, Hande M, Rodrigues GS, Shenoy R, Prasad SS. Application of Topical Oxygen Therapy in Healing Dynamics of Diabetic Foot Ulcers - A Systematic Review. Rev Diabet Stud 2019; 15:74-82. [PMID: 31904759 DOI: 10.1900/rds.2019.15.74] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Individuals with diabetes may develop diabetic foot ulcers due to diabetic peripheral neuropathy. Multiple factors influence the ulcer healing process; oxygen helps in facilitating the different stages of wound healing. OBJECTIVE The objective of this systematic review was to analyze the different levels of evidence available in the application of topical oxygen therapy, warm oxygen therapy, or other modes of topical oxygen delivery in the healing dynamics of diabetic foot ulcers. METHODS Databases searched included Pubmed/Medline, Science Direct, Web of Science, Scopus, Cochrane, and CINAHL. The eligibility criteria of studies included participants ≥18 years with chronic non-healing diabetic foot ulcer (duration ≥3 months) receiving warm oxygen or topical oxygen therapy (TOT), and other modes of topical oxygen administration, which were compared with standard care group. Randomized and non-randomized studies were included. The primary outcome measure assessed was the rate of wound healing or wound closure. RESULTS The review included 5 studies which used different modes of topical oxygen administration. The healing trajectory of the wounds was completely achieved in low-grade ulcers (grade 1), whereas all high-grade ulcers (grades 2, 3, and above) showed either 100% or 50% healing with a reduction in ulcer size and ulcer tissue depth. CONCLUSION Topical oxygen therapy facilitates wound healing dynamics among individuals with chronic diabetic foot ulcers.
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Affiliation(s)
- Megha Nataraj
- Centre for Diabetic Foot Care and Research (CDFCR), Department of Physiotherapy, Manipal College of Health Professions (MCHP), Manipal Academy of Higher Education (MAHE), Madhav Nagar, Manipal 576104, Karnataka, India
| | - Arun G Maiya
- Centre for Diabetic Foot Care and Research (CDFCR), Department of Physiotherapy, Manipal College of Health Professions (MCHP), Manipal Academy of Higher Education (MAHE), Madhav Nagar, Manipal 576104, Karnataka, India
| | - Gagana Karkada
- Centre for Diabetic Foot Care and Research (CDFCR), Department of Physiotherapy, Manipal College of Health Professions (MCHP), Manipal Academy of Higher Education (MAHE), Madhav Nagar, Manipal 576104, Karnataka, India
| | - Manjunatha Hande
- Department of Medicine, Kasturba Medical College and Kasturba Hospital, Manipal Academy of Higher Education (MAHE), Madhav Nagar, Manipal 576104, Karnataka, India
| | - Gabriel S Rodrigues
- Department of Surgery, Kasturba Medical College and Kasturba Hospital, Manipal Academy of Higher Education (MAHE), Madhav Nagar, Manipal 576104, Karnataka, India
| | - Rajgopal Shenoy
- Department of Surgery, Kasturba Medical College and Kasturba Hospital, Manipal Academy of Higher Education (MAHE), Madhav Nagar, Manipal 576104, Karnataka, India
| | - Shiva S Prasad
- Department of Surgery, Kasturba Medical College and Kasturba Hospital, Manipal Academy of Higher Education (MAHE), Madhav Nagar, Manipal 576104, Karnataka, India
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Inglin RA, Brügger LE, Candinas D, Harrison BS, Eberli D. Effect of oxygen-producing suture material on hypoxic colonic anastomoses in an experimental model. BJS Open 2019; 3:872-881. [PMID: 31832595 PMCID: PMC6887904 DOI: 10.1002/bjs5.50220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 07/01/2019] [Indexed: 12/01/2022] Open
Abstract
Background Anastomotic leak remains a significant cause of morbidity and mortality after colorectal surgery. Among multiple risk factors considered, hypoxia–ischaemia is considered to be a primary cause of intestinal anastomotic leakage. The aim of this experimental study was to assess safety, usability for surgical tasks, and efficacy of a newly developed oxygen‐producing suture material in the healing of colonic anastomoses under critical conditions. Methods An oxygen‐producing suture material was produced that is capable of releasing oxygen directly into the surrounding tissue. Off‐the‐shelf sutures loaded with calcium peroxide nano‐crystals and covered with poly(d,l‐lactide‐co‐glycolide) were assessed in vitro and in a rat model of hypoxic colonic anastomosis. Results In vitro assessment showed that these sutures can increase oxygen levels in a hypoxic environment. Potential oxygen byproducts did not seem to have a negative impact on the viability of intestinal cells. The use of oxygen‐producing sutures in vivo resulted in increased tissue oxygen saturation, measured by visible light spectroscopy, and increased mechanical stability of the anastomosis. Conclusion Oxygen‐producing suture material increased tissue oxygen saturation and mechanical stability of colonic anastomosis in a rat model.Surgical relevance Leakage of anastomoses remains a significant problem after colorectal surgery. An oxygen‐producing suture material was produced that was shown to be safe in vitro and significantly improved several aspects of healing of colonic anastomoses in an animal model. Oxygen‐producing suture material or stapler devices might help to reduce the risk of anastomotic leak of intestinal anastomoses under physiological and critical conditions such as hypoxia.
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Affiliation(s)
- R. A. Inglin
- Laboratory of Tissue Engineering and Stem Cell Therapy, Department of UrologyUniversity Hospital ZurichZurichSwitzerland
- Department of Visceral Surgery and Medicine, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
| | - L. E. Brügger
- Laboratory of Tissue Engineering and Stem Cell Therapy, Department of UrologyUniversity Hospital ZurichZurichSwitzerland
- Department of Visceral Surgery and Medicine, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
| | - D. Candinas
- Department of Visceral Surgery and Medicine, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
| | - B. S. Harrison
- Wake Forest Institute for Regenerative MedicineWake Forest University, Medical Center BoulevardWinston‐SalemNorth CarolinaUSA
| | - D. Eberli
- Laboratory of Tissue Engineering and Stem Cell Therapy, Department of UrologyUniversity Hospital ZurichZurichSwitzerland
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Niederauer MQ, Michalek JE, Liu Q, Papas KK, Lavery LA, Armstrong DG. Continuous diffusion of oxygen improves diabetic foot ulcer healing when compared with a placebo control: a randomised, double-blind, multicentre study. J Wound Care 2019; 27:S30-S45. [PMID: 30207844 DOI: 10.12968/jowc.2018.27.sup9.s30] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The aim of this study was to assess whether continuous diffusion of oxygen improves healing in people receiving treatment for diabetic foot ulcers (DFU). METHOD A double-blind, placebo control randomised study to receive either active continuous diffusion of oxygen (CDO) therapy using an active CDO device, or a fully operational placebo device without delivering oxygen. Patients were followed until closure or 12 weeks. Patients, caretakers, treating physicians and independent evaluators were blinded to the study arm. All patients received identical offloading, debridement, dressings and follow-up. RESULTS We enrolled 146 people with DFUs (77% male, aged 56.3±12.4 years). A significantly higher proportion (195%) of DFUs healed in the CDO arm compared with placebo (32.4% versus 16.7%, p=0.033). The time to 50% DFU closure was significantly shorter in patients that received CDO therapy (mean 18.4 versus 28.9 days, p=0.001). There were no differences in overall adverse events (p=0.66) or ulcer-related adverse events (p=0.30) in the active and placebo treatment groups. The relative performance of active CDO over placebo became greater when used in larger wounds (273%), in more chronic wounds (334%) and in weight bearing wounds (465%). CONCLUSION The results of this study demonstrate that CDO leads to higher proportion of healed DFUs (p=0.033) and a faster time to closure compared with placebo in people with DFUs (p=0.015). Relative performance did not vary significantly with wound size (p=0.80), but revealed better relative performance in more chronic wounds (p=0.008) and in weight-bearing wounds (p=0.003).
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Affiliation(s)
| | - Joel E Michalek
- Professor and Vice-Chair of Department of Epidemiology and Biostatistics, UT Health, San Antonio, TX, US
| | - Qianqian Liu
- Biostatistician-Associate in Department of Epidemiology and Biostatistics, UT Health, San Antonio, TX, US
| | - Klearchos K Papas
- Scientific Director of Institute for Cellular Transplantation, University of Arizona, Tucson, AZ, US
| | - Lawrence A Lavery
- Professor of Plastic Surgery, Orthopaedic Surgery and Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX, US
| | - David G Armstrong
- Professor of Clinical Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, US
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Oh SE, Hu KS, Kim S. Eight-week healing of grafted calvarial bone defects with hyperbaric oxygen therapy in rats. J Periodontal Implant Sci 2019; 49:228-236. [PMID: 31485373 PMCID: PMC6713809 DOI: 10.5051/jpis.2019.49.4.228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 05/12/2019] [Accepted: 07/15/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the synergistic effect of adjunctive hyperbaric oxygen (HBO) therapy on new bone formation and angiogenesis after 8 weeks of healing. Methods Sprague-Dawley rats (n=28) were split into 2 groups according to the application of adjunctive HBO therapy: a group that received HBO therapy (HBO group [n=14]) and another group that did not receive HBO therapy (NHBO group [n=14]). Each group was divided into 2 subgroups according to the type of bone graft material: a biphasic calcium phosphate (BCP) subgroup and an Escherichia coli-derived recombinant human bone morphogenetic protein-2-/epigallocatechin-3-gallate-coated BCP (mBCP) subgroup. Two identical circular defects with a 6-mm diameter were made in the right and left parietal bones of each rat. One defect was grafted with bone graft material (BCP or mBCP). The other defect was not grafted. The HBO group received 2 weeks of adjunctive HBO therapy (1 hour, 5 times a week). The rats were euthanized 8 weeks after surgery. The specimens were prepared for histologic analysis. Results New bone (%) was higher in the NHBO-mBCP group than in the NHBO-BCP and control groups (P<0.05). Blood vessel count (%) and vascular endothelial growth factor staining (%) were higher in the HBO-mBCP group than in the NHBO-mBCP group (P<0.05). Conclusions HBO therapy did not have a positive influence on bone formation irrespective of the type of bone graft material applied after 8 weeks of healing. HBO therapy had a positive effect on angiogenic activity.
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Affiliation(s)
- Seo-Eun Oh
- Ministry of National Defense Agency for KIA Recovery & Identification, Seoul, Korea
| | - Kyung-Seok Hu
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 PLUS Project, Yonsei University College of Dentistry, Seoul, Korea
| | - Sungtae Kim
- Department of Periodontology, Dental Research Institute, Seoul National University School of Dentistry, Seoul, Korea
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Sato T, Arai K, Ichioka S. Hyperbaric oxygen therapy for digital ulcers due to Raynaud's disease. Case Reports Plast Surg Hand Surg 2018; 5:72-74. [PMID: 30397635 PMCID: PMC6211215 DOI: 10.1080/23320885.2018.1525684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 09/16/2018] [Indexed: 11/09/2022]
Abstract
We present a case of Raynaud's disease with digital ulcers that was successfully treated with hyperbaric oxygen therapy. Hyperbaric oxygen therapy can be considered as a safe and useful adjunct treatment for intractable digital ulcers in patients with Raynaud's disease.
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Affiliation(s)
- Tomoya Sato
- Department of Plastic and Reconstructive Surgery, Saitama Medical University, Moroyama, Japan
| | - Kiyohito Arai
- Department of Cardiology, Saiseikai Kurihasi Hospital, Kuki City, Japan
| | - Shigeru Ichioka
- Department of Plastic and Reconstructive Surgery, Saitama Medical University, Moroyama, Japan
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Moen I, Ugland H, Strömberg N, Sjöström E, Karlson A, Ringstad L, Bysell H, Amiry‐Moghaddam M, Haglerød C. Development of a novel in situ gelling skin dressing: Delivering high levels of dissolved oxygen at pH 5.5. Health Sci Rep 2018; 1:e57. [PMID: 30623087 PMCID: PMC6266454 DOI: 10.1002/hsr2.57] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 04/05/2018] [Accepted: 05/16/2018] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND AND AIMS Wound healing requires appropriate oxygen and pH levels. Oxygen therapy and pH-modulating treatments have shown positive effects on wound healing. Thus, a dressing, which combines high levels of dissolved oxygen (DO) with the pH of intact skin, may improve wound healing. Our aims were to (1) formulate an in situ gelling dressing with high levels of DO and with the pH level of intact skin, (2) evaluate physical and chemical properties of the dressing, and (3) elucidate basic effects of elevated levels of DO on human skin cells in vitro. METHODS A dressing was formulated with 15 to 16 wt% poloxamer 407, acetate buffer, and oxygenated water. Stability of pH and DO, rheology, and shelf life were analysed. Furthermore, in vitro studies of the effect of increased levels of DO were performed. RESULTS An in situ gelling wound dressing, with a DO concentration ranging between 25 and 35 mg/L and a pH of 5.5, was formulated. The DO concentration was stable above 22 mg/L for at least 30 hours when applied on a surface at 35°C and covered for directed diffusion into the intended wound area. At storage, the dressing had stable pH for 3 months and stable DO concentration over 30 mg/L for 7 weeks. Increasing DO significantly enhanced intracellular ATP in human skin cells, without changing reactive oxygen species production, proliferation rate, or viability. CONCLUSION The developed dressing may facilitate wound healing by delivering controlled and stable oxygen levels, providing adjustable pH for optimized healing, and increasing intracellular ATP availability.
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Affiliation(s)
| | | | | | | | | | | | | | - Mahmood Amiry‐Moghaddam
- Oxy Solutions ASOsloNorway
- Laboratory of Molecular Neuroscience, Department of Molecular Medicine, Institute of Basic Medical SciencesUniversity of OsloNorway
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Savvidou OD, Kaspiris A, Bolia IK, Chloros GD, Goumenos SD, Papagelopoulos PJ, Tsiodras S. Effectiveness of Hyperbaric Oxygen Therapy for the Management of Chronic Osteomyelitis: A Systematic Review of the Literature. Orthopedics 2018; 41:193-199. [PMID: 30035798 DOI: 10.3928/01477447-20180628-02] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Hyperbaric oxygen has been used as an adjunctive measure in the treatment of chronic osteomyelitis. The aim of this systematic literature review was to analyze the outcome and the complications of hyperbaric oxygen for chronic osteomyelitis. Forty-five of 96 studies reporting the use of hyper-baric oxygen for 460 patients with chronic osteomyelitis met the inclusion criteria and were analyzed qualitatively. All patients previously received antibiotics and surgical debridement. Mixed bacterial flora was detected in most of the studies. Staphylococcus aureus was the isolated pathogen in 12 (60%) of the 20 cohort and in 4 (20%) of the 20 case studies. Adjuvant hyperbaric oxygen was effective in 16 (80%) of the 20 cohort and 19 (95%) of the 20 case studies. Overall, 308 (73.5%) of 419 patients with complete data had a successful outcome and no reported relapse. Available evidence supports a potentially beneficial role of adjunctive hyperbaric oxygen, especially in refractory cases of chronic osteomyelitis. [Orthopedics. 2018; 41(4):193-199.].
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Gaitán-Tolosa IM, Montiel-Campos R, Flores-Estrada J, Domínguez-García MV, Flores-Merino MV. Characterization of ketoprofen-loaded PEG-CH semi-IPN system for wound dressing application. J Appl Polym Sci 2018. [DOI: 10.1002/app.46644] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Ibeth M. Gaitán-Tolosa
- Laboratorio de Biología Molecular y Celular, Centro de Investigación en Ciencias Médicas; Universidad Autónoma del Estado de México; Estado de México 50130 México
- Facultad de Enfermería y Obstetricia; Universidad Autónoma del Estado de México; Estado de México 50180 México
| | - Raúl Montiel-Campos
- Departamento de Física, Área de Polímeros; Universidad Autónoma Metropolitana Iztapalapa; Ciudad de México 09340 México
| | - Jaime Flores-Estrada
- Facultad de Química; Universidad Autónoma del Estado de México; Estado de México 50180 México
| | - Ma. Victoria Domínguez-García
- Laboratorio de Biología Molecular y Celular, Centro de Investigación en Ciencias Médicas; Universidad Autónoma del Estado de México; Estado de México 50130 México
| | - Miriam V. Flores-Merino
- Laboratorio de Biología Molecular y Celular, Centro de Investigación en Ciencias Médicas; Universidad Autónoma del Estado de México; Estado de México 50130 México
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Thomason HA, Lovett JM, Spina CJ, Stephenson C, McBain AJ, Hardman MJ. Silver oxysalts promote cutaneous wound healing independent of infection. Wound Repair Regen 2018. [DOI: 10.1111/wrr.12627] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Helen A. Thomason
- Crawford Healthcare Ltd.; Knutsford Cheshire United Kingdom
- Faculty of Biology, Medicine and Health; The University of Manchester; Manchester United Kingdom
| | | | | | | | - Andrew J. McBain
- Faculty of Biology, Medicine and Health; The University of Manchester; Manchester United Kingdom
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Instructive microenvironments in skin wound healing: Biomaterials as signal releasing platforms. Adv Drug Deliv Rev 2018; 129:95-117. [PMID: 29627369 DOI: 10.1016/j.addr.2018.03.012] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 03/16/2018] [Accepted: 03/27/2018] [Indexed: 12/16/2022]
Abstract
Skin wound healing aims to repair and restore tissue through a multistage process that involves different cells and signalling molecules that regulate the cellular response and the dynamic remodelling of the extracellular matrix. Nowadays, several therapies that combine biomolecule signals (growth factors and cytokines) and cells are being proposed. However, a lack of reliable evidence of their efficacy, together with associated issues such as high costs, a lack of standardization, no scalable processes, and storage and regulatory issues, are hampering their application. In situ tissue regeneration appears to be a feasible strategy that uses the body's own capacity for regeneration by mobilizing host endogenous stem cells or tissue-specific progenitor cells to the wound site to promote repair and regeneration. The aim is to engineer instructive systems to regulate the spatio-temporal delivery of proper signalling based on the biological mechanisms of the different events that occur in the host microenvironment. This review describes the current state of the different signal cues used in wound healing and skin regeneration, and their combination with biomaterial supports to create instructive microenvironments for wound healing.
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Naseri-Nosar M, Farzamfar S, Sahrapeyma H, Ghorbani S, Bastami F, Vaez A, Salehi M. Cerium oxide nanoparticle-containing poly (ε-caprolactone)/gelatin electrospun film as a potential wound dressing material: In vitro and in vivo evaluation. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2017; 81:366-372. [DOI: 10.1016/j.msec.2017.08.013] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 07/10/2017] [Accepted: 08/02/2017] [Indexed: 01/14/2023]
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André-Lévigne D, Modarressi A, Pepper MS, Pittet-Cuénod B. Reactive Oxygen Species and NOX Enzymes Are Emerging as Key Players in Cutaneous Wound Repair. Int J Mol Sci 2017; 18:ijms18102149. [PMID: 29036938 PMCID: PMC5666831 DOI: 10.3390/ijms18102149] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 10/09/2017] [Accepted: 10/10/2017] [Indexed: 02/07/2023] Open
Abstract
Our understanding of the role of oxygen in cell physiology has evolved from its long-recognized importance as an essential factor in oxidative metabolism to its recognition as an important player in cell signaling. With regard to the latter, oxygen is needed for the generation of reactive oxygen species (ROS), which regulate a number of different cellular functions including differentiation, proliferation, apoptosis, migration, and contraction. Data specifically concerning the role of ROS-dependent signaling in cutaneous wound repair are very limited, especially regarding wound contraction. In this review we provide an overview of the current literature on the role of molecular and reactive oxygen in the physiology of wound repair as well as in the pathophysiology and therapy of chronic wounds, especially under ischemic and hyperglycemic conditions.
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Affiliation(s)
- Dominik André-Lévigne
- Department of Plastic, Reconstructive & Aesthetic Surgery, University Hospitals of Geneva, 1205 Geneva, Switzerland.
| | - Ali Modarressi
- Department of Plastic, Reconstructive & Aesthetic Surgery, University Hospitals of Geneva, 1205 Geneva, Switzerland.
| | - Michael S Pepper
- Department of Human Genetics and Development, Faculty of Medicine, University of Geneva, 1206 Geneva, Switzerland.
- SAMRC Extramural Unit for Stem Cell Research and Therapy, and Institute for Cellular and Molecular Medicine, Department of Immunology, Faculty of Health Sciences, University of Pretoria, Pretoria 0002, South Africa.
| | - Brigitte Pittet-Cuénod
- Department of Plastic, Reconstructive & Aesthetic Surgery, University Hospitals of Geneva, 1205 Geneva, Switzerland.
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Managing Complications in Abdominoplasty: A Literature Review. Arch Plast Surg 2017; 44:457-468. [PMID: 28946731 PMCID: PMC5621815 DOI: 10.5999/aps.2017.44.5.457] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 06/01/2017] [Accepted: 06/13/2017] [Indexed: 11/08/2022] Open
Abstract
Background Abdominoplasty, with or without liposuction, is among the most frequently performed aesthetic procedures. Its main objective is to improve the body contour by means of excising redundant skin and fat tissue. Although abdominoplasty is considered a safe procedure with high satisfaction rates, intraoperative and postoperative complications can become a challenge for the surgical team. The aim of this article is to offer a synopsis of the most common complications arising after abdominoplasty, along with evidence-based guidelines about how to prevent and treat them. Methods A systematic MEDLINE search strategy was designed using appropriate Medical Subject Headings (MeSH) terms, and references were scanned for further relevant articles. Results According to the published case series, local complications are considerably more common than complications with systemic repercussions. Approximately 10% to 20% of patients suffer a local complication following abdominoplasty, while fewer than 1% suffer a systemic complication. Prevention and management strategies are critically discussed for complications including seroma, haematoma, infection, skin necrosis, suture extrusions, hypertrophic scars, neurological symptoms, umbilical anomalies, deep venous thrombosis and pulmonary thromboembolism, respiratory distress, and death. Conclusions The complications of abdominoplasty vary in severity and in the impact they have on the aesthetic outcomes. Recommendations for prevention and management are based on various levels of evidence, with a risk of observer bias. However, most complications can be treated appropriately following the current standards, with satisfactory results.
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Abstract
GENERAL PURPOSE To provide information about hyperbaric oxygen therapy (HBOT), its mechanisms, indications and safe applications based on clinical evidence. TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant should be better able to:1. Recall the physiology of wound healing and the mechanisms of action of HBOT.2. Identify current applications of HBOT based on clinical evidence as well as its risks and contraindications. ABSTRACT Treating chronic wounds and infections are challenging medical problems worldwide. Hyperbaric oxygen therapy (HBOT), the administration of 100% oxygen at pressures greater than 1.4 atmosphere absolute in a series of treatments, can be used as an adjunctive therapy in many wound care settings because it improves oxygenation and neovascularization and decreases inflammation in chronic wounds. A growing number of studies support the benefits of HBOT for enhancing wound healing and decreasing the likelihood of negative events such as amputation. However, many practitioners are unfamiliar with HBOT. This article provides a general introduction to HBOT, reviews the physiology and mechanisms of behind HBOT, discusses all the indications for HBOT, and explores in-depth the clinical evidence for HBOT in the treatment of arterial insufficiencies, diabetic ulcers, delayed radiation injury, and chronic refractory osteomyelitis.
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André-Lévigne D, Modarressi A, Pignel R, Bochaton-Piallat ML, Pittet-Cuénod B. Hyperbaric oxygen therapy promotes wound repair in ischemic and hyperglycemic conditions, increasing tissue perfusion and collagen deposition. Wound Repair Regen 2016; 24:954-965. [PMID: 27684570 DOI: 10.1111/wrr.12480] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 09/03/2016] [Indexed: 01/21/2023]
Abstract
The treatment of chronic wounds remains inconsistent and empirical. Hyperbaric oxygen therapy (HBOT) is a promising method to improve wound repair but there is still a lack of understanding of its mechanisms of action and its indications are not yet clearly defined. We studied the effects of HBOT in four different wound conditions by inflicting bilateral wounds on the dorsal aspect of the feet of nonischemic or ischemic limbs in normoglycemic or hyperglycemic rats. To create an ischemic condition, arterial resection was performed unilaterally. Forty-four animals received HBOT five times a week until complete wound closure. Wound repair was compared with 44 rats receiving standard dressing only. HBOT increased blood flow and accelerated wound closure in ischemic and hyperglycemic wounds, most significantly when the two conditions were combined. Wound contraction and reepithelialization were similarly stimulated by HBOT. The acceleration of wound contraction was not associated with increased myofibroblasts expression, nor fibroblast recruitment or higher cell count in the granulation tissue. Of note, we observed a significant increase in collagen deposition in early time points in ischemic wounds receiving HBOT. This data emphasizes that an early application of HBOT might be crucial to its efficacy. We concluded that wounds where ischemia and hyperglycemia are combined, as it is often the case in diabetic patients, have the best chance to benefit from HBOT.
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Affiliation(s)
- Dominik André-Lévigne
- Division of Plastic, Reconstructive & Aesthetic Surgery, Faculty of Medicine, University Hospitals of Geneva, University of Geneva, Geneva, Switzerland
| | - Ali Modarressi
- Division of Plastic, Reconstructive & Aesthetic Surgery, Faculty of Medicine, University Hospitals of Geneva, University of Geneva, Geneva, Switzerland
| | - Rodrigue Pignel
- Division of Hyperbaric Medicine, Department of Health and Community Medicine, University Hospitals of Geneva, Geneva, Switzerland'
| | | | - Brigitte Pittet-Cuénod
- Division of Plastic, Reconstructive & Aesthetic Surgery, Faculty of Medicine, University Hospitals of Geneva, University of Geneva, Geneva, Switzerland
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Chang H, Oh SE, Oh S, Hu KS, Kim S. Four-week histologic evaluation of grafted calvarial defects with adjunctive hyperbaric oxygen therapy in rats. J Periodontal Implant Sci 2016; 46:244-53. [PMID: 27588214 PMCID: PMC5005812 DOI: 10.5051/jpis.2016.46.4.244] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 07/03/2016] [Indexed: 11/10/2022] Open
Abstract
Purpose The aim of this study was to characterize the healing in the grafted calvarial defects of rats after adjunctive hyperbaric oxygen therapy. Methods Twenty-eight male Sprague-Dawley rats (body weight, 250–300 g) were randomly divided into two treatment groups: with hyperbaric oxygen therapy (HBO; n=14) and without HBO (NHBO; n=14). Each group was further subdivided according to the bone substitute applied: biphasic calcium phosphate (BCP; n=7) and surface-modified BCP (mBCP; n=7). The mBCP comprised BCP coated with Escherichia-coli-derived recombinant human bone morphogenetic protein-2 (ErhBMP-2) and epigallocatechin-3-gallate (EGCG). Two symmetrical circular defects (6-mm diameter) were created in the right and left parietal bones of each animal. One defect was assigned as a control defect and received no bone substitute, while the other defect was filled with either BCP or mBCP. The animals were allowed to heal for 4 weeks, during which those in the HBO group underwent 5 sessions of HBO. At 4 weeks, the animals were sacrificed, and the defects were harvested for histologic and histomorphometric analysis. Results Well-maintained space was found in the grafted groups. Woven bone connected to and away from the defect margin was formed. More angiogenesis was found with HBO and EGCG/BMP-2 (P<0.05). None of the defects achieved complete defect closure. Increased new bone formation with HBO or EGCG/BMP-2 was evident in histologic evaluation, but it did not reach statistical significance in histometric analysis. A synergic effect between HBO and EGCG/BMP-2 was not found. Conclusions Within the limitations of this study, the present findings indicate that adjunctive HBO and EGCG/BMP-2 could be beneficial for new bone formation in rat calvarial defects.
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Affiliation(s)
- Hyeyoon Chang
- Department of Periodontology, Dental Research Institute, Seoul National University School of Dentistry, Seoul, Korea
| | - Seo-Eun Oh
- Department of Periodontology, Dental Research Institute, Seoul National University School of Dentistry, Seoul, Korea.; Division of Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Center, BK21 PLUS Project, Yonsei University College of Dentistry, Seoul, Korea
| | - Seunghan Oh
- Department of Oral and Maxillofacial Surgery, Wonkwang University College of Dentistry, Iksan, Korea
| | - Kyung-Seok Hu
- Division of Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Center, BK21 PLUS Project, Yonsei University College of Dentistry, Seoul, Korea
| | - Sungtae Kim
- Department of Periodontology, Dental Research Institute, Seoul National University School of Dentistry, Seoul, Korea
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41
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Topical Administration of Oxygenated Hemoglobin Improved Wound Healing in an Ischemic Rabbit Ear Model. Plast Reconstr Surg 2016; 137:534-543. [PMID: 26818288 DOI: 10.1097/01.prs.0000475763.94203.52] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Localized oxygen deficiency plays a central role in the pathogenesis of chronic wounds; thus, rectifying localized ischemia with oxygen therapy has been postulated to be an integral aspect of the management of chronic wounds. The efficacy of a novel approach for oxygen therapy on chronic wound healing was evaluated. METHODS Oxygen was delivered to ischemic wounds by means of the topical application of oxygenated, chemically modified bovine hemoglobin (IKOR 2084) in a validated rabbit ear ischemic wound model. The wound healing was evaluated histologically by measuring epithelial gap and neo-granulation tissue area. In situ expression of endothelial cells (CD31) and proliferative cells (Ki-67) was examined by immunohistochemistry analysis. The mRNA of vascular endothelial growth factor, endothelial nitric oxide synthase, and matrix metalloproteinase-9 was quantified by real-time reverse-transcriptase polymerase chain reaction. The collagen was detected by Sirius red staining. RESULTS In comparison with topical application of saline, the administration of oxygenated IKOR 2084 increases wound reepithelialization and formation of neo-granulation tissue in a dose-dependent manner, and cellular proliferation (Ki-67). Conversely, the administration of deoxygenated IKOR 2084 aggravated the ischemic wound healing process. Moreover, the topical administration of oxygenated IKOR 2084 induces angiogenesis as evidenced by concomitant increases in CD31 protein and vascular endothelial growth factor and endothelial nitric oxide synthase mRNA expression in treated wounds. Oxygenated IKOR 2084 administration also increased collagen deposition in wounds, with decreases in the expression of matrix metalloproteinase-9 mRNA. CONCLUSION This study suggests that the topical application of oxygenated IKOR 2084 ameliorates the reparative progress of ischemic wounds through enhanced angiogenesis, cellular proliferation, and collagen deposition.
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42
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Mustafi N, Engels P. Post-surgical wound management of pilonidal cysts with a haemoglobin spray: a case series. J Wound Care 2016; 25:191-2, 194-8. [DOI: 10.12968/jowc.2016.25.4.191] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- N. Mustafi
- Krankenhaus Nordwest GmbH, Steinbacher Hohl 2-26, 60488 Frankfurt, Germany
| | - P. Engels
- Gartenstr. 25, 51429 Bergisch Gladbach, Germany
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43
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Lozano-Platonoff A, Mejía-Mendoza MDF, Ibáñez-Doria M, Contreras-Ruiz J. Assessment: Cornerstone in Wound Management. J Am Coll Surg 2015. [PMID: 26206653 DOI: 10.1016/j.jamcollsurg.2015.04.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Adriana Lozano-Platonoff
- Division of Dermatology, Interdisciplinary Wound and Ostomy Care Center, Dr Manuel Gea González General Hospital, México City, México
| | | | | | - José Contreras-Ruiz
- Division of Dermatology, Interdisciplinary Wound and Ostomy Care Center, Dr Manuel Gea González General Hospital, México City, México.
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Kruse CR, Nuutila K, Lee CCY, Kiwanuka E, Singh M, Caterson EJ, Eriksson E, Sørensen JA. The external microenvironment of healing skin wounds. Wound Repair Regen 2015; 23:456-64. [PMID: 25857996 DOI: 10.1111/wrr.12303] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 04/02/2015] [Indexed: 11/28/2022]
Abstract
The skin wound microenvironment can be divided into two main components that influence healing: the external wound microenvironment, which is outside the wound surface; and the internal wound microenvironment, underneath the surface, to which the cells within the wound are exposed. Treatment methods that directly alter the features of the external wound microenvironment indirectly affect the internal wound microenvironment due to the exchange between the two compartments. In this review, we focus on the effects of temperature, pressure (positive and negative), hydration, gases (oxygen and carbon dioxide), pH, and anti-microbial treatment on the wound. These factors are well described in the literature and can be modified with treatment methods available in the clinic. Understanding the roles of these factors in wound pathophysiology is of central importance in wound treatment.
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Affiliation(s)
- Carla R Kruse
- Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Plastic and Reconstructive Surgery, Odense University Hospital, Odense, Denmark
| | - Kristo Nuutila
- Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Cameron C Y Lee
- Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Elizabeth Kiwanuka
- Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mansher Singh
- Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Edward J Caterson
- Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Elof Eriksson
- Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jens A Sørensen
- Department of Plastic and Reconstructive Surgery, Odense University Hospital, Odense, Denmark
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45
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Staphylococcus aureus induces hypoxia and cellular damage in porcine dermal explants. Infect Immun 2015; 83:2531-41. [PMID: 25847960 DOI: 10.1128/iai.03075-14] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 03/27/2015] [Indexed: 01/04/2023] Open
Abstract
We developed a porcine dermal explant model to determine the extent to which Staphylococcus aureus biofilm communities deplete oxygen, change pH, and produce damage in underlying tissue. Microelectrode measurements demonstrated that dissolved oxygen (DO) in biofilm-free dermal tissue was 4.45 ± 1.17 mg/liter, while DO levels for biofilm-infected tissue declined sharply from the surface, with no measurable oxygen detectable in the underlying dermal tissue. Magnetic resonance imaging demonstrated that biofilm-free dermal tissue had a significantly lower relative effective diffusion coefficient (0.26 ± 0.09 to 0.30 ± 0.12) than biofilm-infected dermal tissue (0.40 ± 0.12 to 0.48 ± 0.12; P < 0.0001). Thus, the difference in DO level was attributable to biofilm-induced oxygen demand rather than changes in oxygen diffusivity. Microelectrode measures showed that pH within biofilm-infected explants was more alkaline than in biofilm-free explants (8.0 ± 0.17 versus 7.5 ± 0.15, respectively; P < 0.002). Cellular and nuclear details were lost in the infected explants, consistent with cell death. Quantitative label-free shotgun proteomics demonstrated that both proapoptotic programmed cell death protein 5 and antiapoptotic macrophage migration inhibitory factor accumulated in the infected-explant spent medium, compared with uninfected-explant spent media (1,351-fold and 58-fold, respectively), consistent with the cooccurrence of apoptosis and necrosis in the explants. Biofilm-origin proteins reflected an extracellular matrix-adapted lifestyle of S. aureus. S. aureus biofilms deplete oxygen, increase pH, and induce cell death, all factors that contribute to impede wound healing.
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Son JH, Cho YC, Sung IY, Kim IR, Park BS, Kim YD. Melatonin promotes osteoblast differentiation and mineralization of MC3T3-E1 cells under hypoxic conditions through activation of PKD/p38 pathways. J Pineal Res 2014; 57:385-92. [PMID: 25250639 DOI: 10.1111/jpi.12177] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2014] [Accepted: 09/12/2014] [Indexed: 11/30/2022]
Abstract
Osteoblastic differentiation and bone-forming capacity are known to be suppressed under hypoxic conditions. Melatonin has been shown to influence cell differentiation. A number of in vitro and in vivo studies have suggested that melatonin also has an anabolic effect on bone, by promoting osteoblastic differentiation. However, the precise mechanisms and the signaling pathways involved in this process, particularly under hypoxic conditions, are unknown. This study investigated whether melatonin could promote osteoblastic differentiation and mineralization of preosteoblastic MC3T3-E1 cells under hypoxic conditions. Additionally, we examined the molecular signaling pathways by which melatonin mediates this process. We found that melatonin is capable of promoting differentiation and mineralization of MC3T3-E1 cells cultured under hypoxic conditions. Melatonin upregulated ALP activity and mRNA levels of Alp, Osx, Col1, and Ocn in a time- and concentration-dependent manner. Alizarin red S staining showed that the mineralized matrix in hypoxic MC3T3-E1 cells formed in a manner that was dependent on melatonin concentration. Moreover, melatonin stimulated phosphorylation of p38 Mapk and Prkd1 in these MC3T3-E1 cells. We concluded that melatonin promotes osteoblastic differentiation of MC3T3-E1 cells under hypoxic conditions via the p38 Mapk and Prkd1 signaling pathways.
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Affiliation(s)
- Jang-Ho Son
- Department of Oral and Maxillofacial Surgery, Ulsan University Hospital, College of Medicine, Ulsan University, Ulsan, South Korea
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Helito CP, Junqueira JJM, Gobbi RG, Angelini FJ, Rezende MU, Tírico LEP, Demange MK, Mota e Albuquerque RFD, Pécora JR, Camanho GL. Effect of postoperative use of nasal oxygen catheter supplementation in wound healing following total knee arthroplasty. Clinics (Sao Paulo) 2014; 69:735-9. [PMID: 25518030 PMCID: PMC4255075 DOI: 10.6061/clinics/2014(11)05] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 08/12/2014] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES Healing is an event that is fundamental to the success of total knee arthroplasty. The aims of the present study were to compare the rates of complications related to wound healing between two groups of volunteers submitted to total knee arthroplasty and to evaluate the effects of postoperative oxygen supplementation by means of a nasal catheter. METHOD A total of 109 patients who underwent total knee arthroplasty were randomized into two groups, namely, groups that did and did not receive postoperative oxygen supplementation via a nasal catheter. The surgical wound was monitored every day during the hospital stay and on the 7th, 14th, 21st, 30th and 42nd postoperative days. Characteristics related to healing were observed, including hyperemia, dehiscence, necrosis, phlyctenules and deep and superficial infection. RESULTS There were no cases of deep infection. Hyperemia was statistically correlated with the total number of complications in the groups, with oxygen demonstrated to be a protective factor against hyperemia. Approximately 30% of the patients who exhibited hyperemia had other complications, independent of oxygen supplementation. CONCLUSION Oxygen supplementation following total knee arthroplasty was shown to be effective in diminishing hyperemia around the operative wound. The development of hyperemia was a precursor to other complications, irrespective of whether oxygen supplementation was used.
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Affiliation(s)
- Camilo Partezani Helito
- Knee Surgery Department, Orthopaedic and Traumatology Institute, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Jader Joel Machado Junqueira
- Knee Surgery Department, Orthopaedic and Traumatology Institute, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Ricardo Gomes Gobbi
- Knee Surgery Department, Orthopaedic and Traumatology Institute, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Fábio Janson Angelini
- Knee Surgery Department, Orthopaedic and Traumatology Institute, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marcia Uchoa Rezende
- Knee Surgery Department, Orthopaedic and Traumatology Institute, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Luis Eduardo Passarelli Tírico
- Knee Surgery Department, Orthopaedic and Traumatology Institute, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marco Kawamura Demange
- Knee Surgery Department, Orthopaedic and Traumatology Institute, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - José Ricardo Pécora
- Knee Surgery Department, Orthopaedic and Traumatology Institute, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Gilberto Luis Camanho
- Knee Surgery Department, Orthopaedic and Traumatology Institute, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
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Bober P, Liu J, Mikkonen KS, Ihalainen P, Pesonen M, Plumed-Ferrer C, von Wright A, Lindfors T, Xu C, Latonen RM. Biocomposites of Nanofibrillated Cellulose, Polypyrrole, and Silver Nanoparticles with Electroconductive and Antimicrobial Properties. Biomacromolecules 2014; 15:3655-63. [DOI: 10.1021/bm500939x] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Patrycja Bober
- Institute
of Macromolecular Chemistry, Academy of Sciences of the Czech Republic, 162 06 Prague 6, Czech Republic
| | | | - Kirsi S. Mikkonen
- Department
of Food and Environmental Sciences, University of Helsinki, FI-00014, Helsinki, Finland
| | | | | | - Carme Plumed-Ferrer
- Institute
of Public Health and Clinical Nutrition, University of Eastern Finland, FI-70211, Kuopio, Finland
| | - Atte von Wright
- Institute
of Public Health and Clinical Nutrition, University of Eastern Finland, FI-70211, Kuopio, Finland
| | - Tom Lindfors
- Academy of Finland, Hakaniemenranta
6, POB 131, FI-00531 Helsinki, Finland
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49
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Cahn A, Y K. A novel approach to the treatment of diabetic foot abscesses — a case series. J Wound Care 2014; 23:394, 396-9. [DOI: 10.12968/jowc.2014.23.8.394] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- A. Cahn
- The diabetes Research Center, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Kleinman Y
- The Diabetes Unit, Shaare Zedek Medical Center, Israel
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50
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Olczyk P, Mencner Ł, Komosinska-Vassev K. The role of the extracellular matrix components in cutaneous wound healing. BIOMED RESEARCH INTERNATIONAL 2014; 2014:747584. [PMID: 24772435 PMCID: PMC3977088 DOI: 10.1155/2014/747584] [Citation(s) in RCA: 201] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 02/13/2014] [Accepted: 02/17/2014] [Indexed: 11/25/2022]
Abstract
Wound healing is the physiologic response to tissue trauma proceeding as a complex pathway of biochemical reactions and cellular events, secreted growth factors, and cytokines. Extracellular matrix constituents are essential components of the wound repair phenomenon. Firstly, they create a provisional matrix, providing a structural integrity of matrix during each stage of healing process. Secondly, matrix molecules regulate cellular functions, mediate the cell-cell and cell-matrix interactions, and serve as a reservoir and modulator of cytokines and growth factors' action. Currently known mechanisms, by which extracellular matrix components modulate each stage of the process of soft tissue remodeling after injury, have been discussed.
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Affiliation(s)
- Pawel Olczyk
- Department of Community Pharmacy, Medical University of Silesia, ul. Kasztanowa 3, 41-200 Sosnowiec, Poland
| | - Łukasz Mencner
- Department of Clinical Chemistry and Laboratory Diagnostics, Medical University of Silesia, ul. Jednosci 8, 41-200 Sosnowiec, Poland
| | - Katarzyna Komosinska-Vassev
- Department of Clinical Chemistry and Laboratory Diagnostics, Medical University of Silesia, ul. Jednosci 8, 41-200 Sosnowiec, Poland
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