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Mihai MM, Bălăceanu-Gurău B, Ion A, Holban AM, Gurău CD, Popescu MN, Beiu C, Popa LG, Popa MI, Dragomirescu CC, Preda M, Muntean AA, Macovei IS, Lazăr V. Host-Microbiome Crosstalk in Chronic Wound Healing. Int J Mol Sci 2024; 25:4629. [PMID: 38731848 PMCID: PMC11083077 DOI: 10.3390/ijms25094629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 04/14/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024] Open
Abstract
The pathogenesis of chronic wounds (CW) involves a multifaceted interplay of biochemical, immunological, hematological, and microbiological interactions. Biofilm development is a significant virulence trait which enhances microbial survival and pathogenicity and has various implications on the development and management of CW. Biofilms induce a prolonged suboptimal inflammation in the wound microenvironment, associated with delayed healing. The composition of wound fluid (WF) adds more complexity to the subject, with proven pro-inflammatory properties and an intricate crosstalk among cytokines, chemokines, microRNAs, proteases, growth factors, and ECM components. One approach to achieve information on the mechanisms of disease progression and therapeutic response is the use of multiple high-throughput 'OMIC' modalities (genomic, proteomic, lipidomic, metabolomic assays), facilitating the discovery of potential biomarkers for wound healing, which may represent a breakthrough in this field and a major help in addressing delayed wound healing. In this review article, we aim to summarize the current progress achieved in host-microbiome crosstalk in the spectrum of CW healing and highlight future innovative strategies to boost the host immune response against infections, focusing on the interaction between pathogens and their hosts (for instance, by harnessing microorganisms like probiotics), which may serve as the prospective advancement of vaccines and treatments against infections.
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Affiliation(s)
- Mara Mădălina Mihai
- Department of Oncologic Dermatology, “Elias” Emergency University Hospital, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (M.M.M.); (C.B.); (L.G.P.)
- Clinic of Dermatology, “Elias” Emergency University Hospital, 011461 Bucharest, Romania
- Research Institute of the University of Bucharest, Department of Botany-Microbiology, Faculty of Biology, University of Bucharest, 050663 Bucharest, Romania; (A.M.H.); (V.L.)
| | | | - Ana Ion
- Clinic of Dermatology, “Elias” Emergency University Hospital, 011461 Bucharest, Romania
| | - Alina Maria Holban
- Research Institute of the University of Bucharest, Department of Botany-Microbiology, Faculty of Biology, University of Bucharest, 050663 Bucharest, Romania; (A.M.H.); (V.L.)
| | - Cristian-Dorin Gurău
- Orthopedics and Traumatology Clinic, Clinical Emergency Hospital, 014451 Bucharest, Romania;
| | - Marius Nicolae Popescu
- Department of Physical and Rehabilitation Medicine, “Elias” Emergency University Hospital, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Clinic of Physical and Rehabilitation Medicine, “Elias” Emergency University Hospital, 011461 Bucharest, Romania
| | - Cristina Beiu
- Department of Oncologic Dermatology, “Elias” Emergency University Hospital, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (M.M.M.); (C.B.); (L.G.P.)
- Clinic of Dermatology, “Elias” Emergency University Hospital, 011461 Bucharest, Romania
| | - Liliana Gabriela Popa
- Department of Oncologic Dermatology, “Elias” Emergency University Hospital, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (M.M.M.); (C.B.); (L.G.P.)
- Clinic of Dermatology, “Elias” Emergency University Hospital, 011461 Bucharest, Romania
| | - Mircea Ioan Popa
- Department of Microbiology, “Cantacuzino” Institute, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (M.I.P.); (C.C.D.); (A.-A.M.)
- Cantacuzino National Military Medical Institute for Research and Development, 050096 Bucharest, Romania; (M.P.); (I.S.M.)
| | - Cerasella Cristiana Dragomirescu
- Department of Microbiology, “Cantacuzino” Institute, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (M.I.P.); (C.C.D.); (A.-A.M.)
- Cantacuzino National Military Medical Institute for Research and Development, 050096 Bucharest, Romania; (M.P.); (I.S.M.)
| | - Mădălina Preda
- Cantacuzino National Military Medical Institute for Research and Development, 050096 Bucharest, Romania; (M.P.); (I.S.M.)
- Department of Microbiology, Parasitology and Virology, Faculty of Midwives and Nursing, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Alexandru-Andrei Muntean
- Department of Microbiology, “Cantacuzino” Institute, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (M.I.P.); (C.C.D.); (A.-A.M.)
- Cantacuzino National Military Medical Institute for Research and Development, 050096 Bucharest, Romania; (M.P.); (I.S.M.)
| | - Ioana Sabina Macovei
- Cantacuzino National Military Medical Institute for Research and Development, 050096 Bucharest, Romania; (M.P.); (I.S.M.)
| | - Veronica Lazăr
- Research Institute of the University of Bucharest, Department of Botany-Microbiology, Faculty of Biology, University of Bucharest, 050663 Bucharest, Romania; (A.M.H.); (V.L.)
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Koca F, Levent F, Tatlı AB, Demir M, Tenekecioglu E. The impact of invasive treatment of superficial venous insufficiency of the lower extremities on cardiac functions. Phlebology 2023; 38:561-569. [PMID: 37461132 DOI: 10.1177/02683555231190452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
OBJECTIVE The aim of the study was to investigate the effect of invasive treatment for chronic venous insufficiency (CVI) on cardiac hemodynamics. METHODS Fifty three patients diagnosed with saphenofemoral junction or great saphenous vein insufficiency in a level above C3 according to Clinical-Etiology-Anatomy-Pathophysiology classification were included in the study. All the patients underwent 2D echocardiography before and 3 months after the invasive treatment. RESULTS In postinvasive treatment echocardiographic assessment, significant decreases in right ventricular end-diastolic diameter (p = 0.006), TAPSE (p = 0.006), tricuspid E wave velocity (p = 0.004), tricuspid E/A ratio (p < 0.001), sPAB (p = 0.017), tricuspid lateral s' wave velocity (p = 0.004), and right ventricular free wall longitudinal strain rate (p = 0.011) were observed. CONCLUSIONS The invasive treatment of superficial venous insufficiency of the lower extremities may lead to reduction in the increased venous return in the supine position subclinically.
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Affiliation(s)
- Fatih Koca
- Department of Cardiology, Bursa Yüksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Fatih Levent
- Department of Cardiology, Bursa Yüksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Ahmet Burak Tatlı
- Department of Cardiovascular Surgery, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Mehmet Demir
- Department of Cardiology, Bursa Yüksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Erhan Tenekecioglu
- Department of Cardiology, Bursa Yüksek Ihtisas Training and Research Hospital, Bursa, Turkey
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Wong NSQ, Tan AHM, Chan KS, Goh KCC, Lai P, Muthuveerappa S, Mohamed Nasir MMB, Liang S, Hong Q, Yong E, Lo ZJ. A prospective study on the efficacy of sequential treatment of technology Lipido-Colloid Impregnated with Silver and Technology Lipido-Colloid Nano-Oligosaccharide Factor in the management of venous leg ulcers. Health Sci Rep 2023; 6:e1488. [PMID: 37636288 PMCID: PMC10447879 DOI: 10.1002/hsr2.1488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 04/24/2023] [Accepted: 07/31/2023] [Indexed: 08/29/2023] Open
Abstract
Background and Aims Venous leg ulcers (VLUs) are associated with significant morbidity and poor quality of life (QOL). Compression therapy and wound dressing are the mainstay treatment options. Technology Lipido-Colloid Impregnated with Silver (TLC-Ag) reduces bacterial load and Technology Lipido-Colloid Nano-Oligosaccharide Factor (TLC-NOSF) reduces elevated matrix metalloproteinases and improve wound healing. However, evidence is scarce on the role of sequential therapy. This study aims to evaluate if sequential treatment with TLC-Ag and TLC-NOSF improves VLU wound healing and QOL. Methods This is a prospective cohort study from May 2020 to October 2021 on patients with VLUs who received sequential therapy, consisting of 2 weeks of TLC-Ag followed by two-layer compression bandage (2LB) with TLC-NOSF until complete wound healing. Participants were followed-up with weekly dressing changes. Our primary outcomes were wound area reduction (WAR) and Pressure Ulcer Scale of Healing (PUSH) score. Our secondary outcomes were QOL measures. Results There were 28 patients with 57.1% males (n = 16) with a mean age of 65.3 years. Mean duration of VLU was 13.9 ± 11.7 weeks before the initiation of sequential therapy. Mean baseline wound area was 8.44 cm2. Median time to wound healing was 10 weeks. 57.1% of patients achieved complete wound closure at 3 months. There was significant WAR after 1 month (mean area 8.44-5.81 cm2, 31.2% decrease) and after 3 months (mean area 8.44-2.53 cm2, 70.0% decrease). Mean monthly WAR was 28.9%. PUSH score also decreased at 1 month (16.5% decrease, p < 0.001) and 3 months (63.3% decrease, p < 0.001) marks following the sequential therapy. EuroQol Visual Analog Scale (EQ-VAS) improved following sequential therapy (baseline: 69.0 ± 15.0, week 13: 80.2 ± 13.2, p < 0.001). Conclusion Sequential therapy with TLC-Ag followed by TLC-NOSF and 2LB is feasible, with good wound healing and improvement in QOL of patients with VLUs.
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Affiliation(s)
- Natalie Shi Qi Wong
- Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
| | - Audrey Hui Min Tan
- Wound and Stoma Care, Nursing SpecialtyTan Tock Seng HospitalSingaporeSingapore
| | - Kai Siang Chan
- Department of General SurgeryVascular Surgery Service, Tan Tock Seng HospitalSingaporeSingapore
| | - Karine C. C. Goh
- Wound and Stoma Care, Nursing SpecialtyTan Tock Seng HospitalSingaporeSingapore
| | - Peiting Lai
- Wound and Stoma Care, Nursing SpecialtyTan Tock Seng HospitalSingaporeSingapore
| | | | | | - Shanying Liang
- Department of Surgery, Vascular SurgeryWoodlands HealthSingaporeSingapore
| | - Qiantai Hong
- Department of General SurgeryVascular Surgery Service, Tan Tock Seng HospitalSingaporeSingapore
| | - Enming Yong
- Department of General SurgeryVascular Surgery Service, Tan Tock Seng HospitalSingaporeSingapore
| | - Zhiwen Joseph Lo
- Department of Surgery, Vascular SurgeryWoodlands HealthSingaporeSingapore
- Lee Kong Chian School of MedicineNanyang Technological UniversitySingaporeSingapore
- Skin Research Institute of SingaporeAgency for Science Technology and ResearchSingaporeSingapore
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Roehrs H, Stocco JG, Pott F, Blanc G, Meier MJ, Dias FA. Dressings and topical agents containing hyaluronic acid for chronic wound healing. Cochrane Database Syst Rev 2023; 7:CD012215. [PMID: 37497805 PMCID: PMC10373121 DOI: 10.1002/14651858.cd012215.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
BACKGROUND Hyaluronic acid is synthesised in plasma membranes and can be found in extracellular tissues. It has been suggested that the application of hyaluronic acid to chronic wounds may promote healing, and the mechanism may be due to its ability to maintain a moist wound environment which helps cell migration in the wound bed. OBJECTIVES To evaluate the effects of hyaluronic acid (and its derivatives) on the healing of chronic wounds. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was February 2022. SELECTION CRITERIA We included randomised controlled trials that compared the effects of hyaluronic acid (as a dressing or topical agent) with other dressings on the healing of pressure, venous, arterial, or mixed-aetiology ulcers and foot ulcers in people with diabetes. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS We included 12 trials (13 articles) in a qualitative synthesis, and were able to combine data from four trials in a quantitative analysis. Overall, the included trials involved 1108 participants (mean age 69.60 years) presenting 178 pressure ulcers, 54 diabetic foot ulcers, and 896 leg ulcers. Sex was reported for 1022 participants (57.24% female). Pressure ulcers It is uncertain whether there is a difference in complete healing (risk ratio (RR) 1.17, 95% confidence interval (CI) 0.58 to 2.35); change in ulcer size (mean difference (MD) 25.60, 95% CI 6.18 to 45.02); or adverse events (none reported) between platelet-rich growth factor (PRGF) + hyaluronic acid and PRGF because the certainty of evidence is very low (1 trial, 65 participants). It is also uncertain whether there is a difference in complete healing between lysine hyaluronate and sodium hyaluronate because the certainty of evidence is very low (RR 2.50, 95% CI 0.71 to 8.83; 1 trial, 14 ulcers from 10 participants). Foot ulcers in people with diabetes It is uncertain whether there is a difference in time to complete healing between hyaluronic acid and lyophilised collagen because the certainty of evidence is very low (MD 16.60, 95% CI 7.95 to 25.25; 1 study, 20 participants). It is uncertain whether there is a difference in complete ulcer healing (RR 2.20, 95% CI 0.97 to 4.97; 1 study, 34 participants) or change in ulcer size (MD -0.80, 95% CI -3.58 to 1.98; 1 study, 25 participants) between hyaluronic acid and conventional dressings because the certainty of evidence is very low. Leg ulcers We are uncertain whether there is a difference in complete wound healing (RR 0.98, 95% CI 0.26 to 3.76), percentage of adverse events (RR 0.79, 95% CI 0.22 to 2.80), pain (MD 2.10, 95% CI -5.81 to 10.01), or change in ulcer size (RR 2.11, 95% CI 0.92 to 4.82) between hyaluronic acid + hydrocolloid and hydrocolloid because the certainty of evidence is very low (1 study, 125 participants). It is uncertain whether there is a difference in change in ulcer size between hyaluronic acid and hydrocolloid because the certainty of evidence is very low (RR 1.02, 95% CI 0.84 to 1.25; 1 study, 143 participants). We are uncertain whether there is a difference in complete wound healing between hyaluronic acid and paraffin gauze because the certainty of evidence is very low (RR 2.00, 95% CI 0.21 to 19.23; 1 study, 24 ulcers from 17 participants). When compared with neutral vehicle, hyaluronic acid probably improves complete ulcer healing (RR 2.11, 95% CI 1.46 to 3.07; 4 studies, 526 participants; moderate-certainty evidence); may slightly increase the reduction in pain from baseline (MD -8.55, 95% CI -14.77 to -2.34; 3 studies, 337 participants); and may slightly increase change in ulcer size, measured as mean reduction from baseline to 45 days (MD 30.44%, 95% CI 15.57 to 45.31; 2 studies, 190 participants). It is uncertain if hyaluronic acid alters incidence of infection when compared with neutral vehicle (RR 0.89, 95% CI 0.53 to 1.49; 3 studies, 425 participants). We are uncertain whether there is a difference in change in ulcer size (cm2) between hyaluronic acid and dextranomer because the certainty of evidence is very low (MD 5.80, 95% CI -10.0 to 21.60; 1 study, 50 participants). We downgraded the certainty of evidence due to risk of bias or imprecision, or both, for all of the above comparisons. No trial reported health-related quality of life or wound recurrence. Measurement of change in ulcer size was not homogeneous among studies, and missing data precluded further analysis for some comparisons. AUTHORS' CONCLUSIONS There is currently insufficient evidence to determine the effectiveness of hyaluronic acid dressings in the healing of pressure ulcers or foot ulcers in people with diabetes. We found evidence that hyaluronic acid probably improves complete ulcer healing and may slightly decrease pain and increase change in ulcer size when compared with neutral vehicle. Future research into the effects of hyaluronic acid in the healing of chronic wounds should consider higher sample size and blinding to minimise bias and improve the quality of evidence.
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Affiliation(s)
- Hellen Roehrs
- Department of Nursing, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Janislei Gd Stocco
- Hospital Infection Control & Prevention, Clinical Hospital of Federal University of Paraná, Curitiba, Brazil
| | - Franciele Pott
- Department of Primary Care and Emergency, Hospital Polícia Militar do Paraná, São José dos Pinhais, Brazil
| | - Gisely Blanc
- Department of Primary Care and Emergency, Prefeitura de São José dos Pinhais, Curitiba, Brazil
| | - Marineli J Meier
- Department of Nursing and Postgraduate Nursing Program, Federal University of Paraná, Curitiba, Brazil
| | - Fernando Al Dias
- Department of Physiology, Federal University of Paraná, Curitiba, Brazil
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Shamloul G, Khachemoune A. Reappraisal and updated review of maggot debridement therapy in chronic lower extremity ulcers. Int J Dermatol 2023. [PMID: 36880424 DOI: 10.1111/ijd.16619] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 12/29/2022] [Accepted: 02/07/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND Dating back to the mid-1500s, maggot debridement therapy (MDT) has been a viable treatment modality for chronic wounds. In early 2004, the sterile larvae of Lucilia sericata received FDA approval for medical marketing for neuropathic, venous, and pressure ulcers, traumatic or surgical wounds, and nonhealing wounds that have not responded to standard care. However, it currently remains an under-utilized therapy. The proven efficacy of MDT begs the question if this treatment modality should be considered as a first-line option for all or a subset of chronic lower extremity ulcers. OBJECTIVE This article aims to address the history, production, and evidence of MDT and discuss future considerations for maggot therapy in the healthcare field. METHODS A literature search using the PubMed database was conducted using keywords, such as wound debridement, maggot therapy, diabetic ulcers, venous ulcers, among others. RESULTS MDT reduced short-term morbidity in non-ambulatory patients with neuroischemic diabetic ulcers and comorbidity with peripheral vascular disease. Larval therapy was associated with statistically significant bioburden reductions against both Staphylococcus aureus and Pseudomonas aeruginosa. Faster time to debridement was achieved when chronic venous or mixed venous and arterial ulcers were treated with maggot therapy versus hydrogels. CONCLUSIONS The literature supports the use of MDT in decreasing the significant costs of treating chronic lower extremity ulcers, with emphasis on those of diabetic origin. Additional studies with global standards for reporting outcomes are necessary to substantiate our results.
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Affiliation(s)
- Gelan Shamloul
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Amor Khachemoune
- Veterans Affairs Hospital and SUNY Downstate Dermatology Service, Brooklyn, NY, USA
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Reifs D, Casanova-Lozano L, Reig-Bolaño R, Grau-Carrion S. Clinical validation of computer vision and artificial intelligence algorithms for wound measurement and tissue classification in wound care. INFORMATICS IN MEDICINE UNLOCKED 2023. [DOI: 10.1016/j.imu.2023.101185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
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Reifs D, Reig-Bolaño R, Casals M, Grau-Carrion S. Interactive Medical Image Labeling Tool to Construct a Robust Convolutional Neural Network Training Data Set: Development and Validation Study. JMIR Med Inform 2022; 10:e37284. [PMID: 35994311 PMCID: PMC9446137 DOI: 10.2196/37284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/10/2022] [Accepted: 07/31/2022] [Indexed: 12/04/2022] Open
Abstract
Background Skin ulcers are an important cause of morbidity and mortality everywhere in the world and occur due to several causes, including diabetes mellitus, peripheral neuropathy, immobility, pressure, arteriosclerosis, infections, and venous insufficiency. Ulcers are lesions that fail to undergo an orderly healing process and produce functional and anatomical integrity in the expected time. In most cases, the methods of analysis used nowadays are rudimentary, which leads to errors and the use of invasive and uncomfortable techniques on patients. There are many studies that use a convolutional neural network to classify the different tissues in a wound. To obtain good results, the network must be trained with a correctly labeled data set by an expert in wound assessment. Typically, it is difficult to label pixel by pixel using a professional photo editor software, as this requires extensive time and effort from a health professional. Objective The aim of this paper is to implement a new, fast, and accurate method of labeling wound samples for training a neural network to classify different tissues. Methods We developed a support tool and evaluated its accuracy and reliability. We also compared the support tool classification with a digital gold standard (labeling the data with an image editing software). Results The obtained comparison between the gold standard and the proposed method was 0.9789 for background, 0.9842 for intact skin, 0.8426 for granulation tissue, 0.9309 for slough, and 0.9871 for necrotic. The obtained speed on average was 2.6, compared to that of an advanced image editing user. Conclusions This method increases tagging speed on average compared to an advanced image editing user. This increase is greater with untrained users. The samples obtained with the new system are indistinguishable from the samples made with the gold standard.
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Affiliation(s)
- David Reifs
- Digital Care Research Group, Centre for Health and Social Care, Universitat of Vic-Central University of Catalonia, Vic, Spain
| | - Ramon Reig-Bolaño
- Digital Care Research Group, Centre for Health and Social Care, Universitat of Vic-Central University of Catalonia, Vic, Spain
| | | | - Sergi Grau-Carrion
- Digital Care Research Group, Centre for Health and Social Care, Universitat of Vic-Central University of Catalonia, Vic, Spain
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Piamo A, García M, Romero D, Ferrer D. Healing of a chronic ulcer of the lower limb of venous origin with fresh human amniochorionic membrane allograft. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2022; 42:17-25. [PMID: 35866726 PMCID: PMC9365449 DOI: 10.7705/biomedica.6319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 04/04/2022] [Indexed: 11/21/2022]
Abstract
In its fresh state, the amniochorionic membrane contains various multipotential cells, growth factors, and extracellular matrix proteins that contribute to the healing of chronic vascular ulcers. To demonstrate its effectiveness, a fresh human placental membrane allograft was applied to a chronic venous ulcer in the lower limb of an 89-year-old female patient with a 12 x 10 cm ulcerated lesion of 40 years of evolution in the malleolar area of her left lower limb. Sixty days after the graft, the ulcer was healed in 100% of its surface and a light pink scar on the edges indicated possible pigmentation. Fresh human amniochorionic membrane allograft is a therapeutic alternative for the healing of refractory chronic vascular ulcers of the lower extremities.
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Affiliation(s)
- Alberto Piamo
- Servicio de Anatomía Patológica, Hospital Maternoinfantil de Amazonas, Puerto Ayacucho, Venezuela.
| | - Mayra García
- Servicio de Gineco-obstetricia, Hospital Maternoinfantil de Amazonas, Puerto Ayacucho, Venezuela.
| | - Dayset Romero
- Servicio de Enfermería, Ambulatorio "Jacinto Convit", San Antonio de Cúa, Venezuela.
| | - Daisy Ferrer
- Facultad de Ciencias Médicas "ICBP Victoria de Girón", Universidad de Ciencias Médicas, La Habana, Cuba.
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Holzer-Geissler JCJ, Schwingenschuh S, Zacharias M, Einsiedler J, Kainz S, Reisenegger P, Holecek C, Hofmann E, Wolff-Winiski B, Fahrngruber H, Birngruber T, Kamolz LP, Kotzbeck P. The Impact of Prolonged Inflammation on Wound Healing. Biomedicines 2022; 10:biomedicines10040856. [PMID: 35453606 PMCID: PMC9025535 DOI: 10.3390/biomedicines10040856] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/10/2022] [Accepted: 03/29/2022] [Indexed: 01/27/2023] Open
Abstract
The treatment of chronic wounds still challenges modern medicine because of these wounds’ heterogenic pathophysiology. Processes such as inflammation, ischemia and bacterial infection play major roles in the progression of a chronic wound. In recent years, preclinical wound models have been used to understand the underlying processes of chronic wound formation. However, the wound models used to investigate chronic wounds often lack translatability from preclinical models to patients, and often do not take exaggerated inflammation into consideration. Therefore, we aimed to investigate prolonged inflammation in a porcine wound model by using resiquimod, a TLR7 and TLR8 agonist. Pigs received full thickness excisional wounds, where resiquimod was applied daily for 6 days, and untreated wounds served as controls. Dressing change, visual documentation and wound scoring were performed daily. Biopsies were collected for histological as well as gene expression analysis. Resiquimod application on full thickness wounds induced a visible inflammation of wounds, resulting in delayed wound healing compared to non-treated control wounds. Gene expression analysis revealed high levels of IL6, MMP1 and CD68 expression after resiquimod application, and histological analysis showed increased immune cell infiltration. By using resiquimod, we were able to show that prolonged inflammation delayed wound healing, which is often observed in chronic wounds in patients. The model we used shows the importance of inflammation in wound healing and gives an insight into the progression of chronic wounds.
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Affiliation(s)
- Judith C. J. Holzer-Geissler
- Research Unit for Tissue Regeneration, Repair and Reconstruction, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria; (J.C.J.H.-G.); (E.H.); (L.-P.K.)
- COREMED-Cooperative Centre for Regenerative Medicine, Joanneum Research Forschungsgesellschaft mbH, 8010 Graz, Austria;
| | - Simon Schwingenschuh
- HEALTH-Institute for Biomedicine and Health Sciences, Joanneum Research Forschungsgesellschaft mbH, 8010 Graz, Austria; (S.S.); (S.K.); (P.R.); (C.H.); (T.B.)
| | - Martin Zacharias
- Diagnostic and Research Institute of Pathology, Medical University of Graz, 8010 Graz, Austria;
| | - Johanna Einsiedler
- COREMED-Cooperative Centre for Regenerative Medicine, Joanneum Research Forschungsgesellschaft mbH, 8010 Graz, Austria;
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria
| | - Sonja Kainz
- HEALTH-Institute for Biomedicine and Health Sciences, Joanneum Research Forschungsgesellschaft mbH, 8010 Graz, Austria; (S.S.); (S.K.); (P.R.); (C.H.); (T.B.)
| | - Peter Reisenegger
- HEALTH-Institute for Biomedicine and Health Sciences, Joanneum Research Forschungsgesellschaft mbH, 8010 Graz, Austria; (S.S.); (S.K.); (P.R.); (C.H.); (T.B.)
| | - Christian Holecek
- HEALTH-Institute for Biomedicine and Health Sciences, Joanneum Research Forschungsgesellschaft mbH, 8010 Graz, Austria; (S.S.); (S.K.); (P.R.); (C.H.); (T.B.)
| | - Elisabeth Hofmann
- Research Unit for Tissue Regeneration, Repair and Reconstruction, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria; (J.C.J.H.-G.); (E.H.); (L.-P.K.)
- COREMED-Cooperative Centre for Regenerative Medicine, Joanneum Research Forschungsgesellschaft mbH, 8010 Graz, Austria;
| | | | | | - Thomas Birngruber
- HEALTH-Institute for Biomedicine and Health Sciences, Joanneum Research Forschungsgesellschaft mbH, 8010 Graz, Austria; (S.S.); (S.K.); (P.R.); (C.H.); (T.B.)
| | - Lars-Peter Kamolz
- Research Unit for Tissue Regeneration, Repair and Reconstruction, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria; (J.C.J.H.-G.); (E.H.); (L.-P.K.)
- COREMED-Cooperative Centre for Regenerative Medicine, Joanneum Research Forschungsgesellschaft mbH, 8010 Graz, Austria;
| | - Petra Kotzbeck
- Research Unit for Tissue Regeneration, Repair and Reconstruction, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria; (J.C.J.H.-G.); (E.H.); (L.-P.K.)
- COREMED-Cooperative Centre for Regenerative Medicine, Joanneum Research Forschungsgesellschaft mbH, 8010 Graz, Austria;
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria
- Correspondence: or ; Tel.: +43-316-876-6000
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10
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Yang X, Fan W, Huang R, Liu G. β-acetoxyisovaleryl alkannin (AAN-II) from Alkanna tinctoria promotes the healing of pressure-induced venous ulcers in a rabbit model through the activation of TGF-β/Smad3 signaling. Cell Mol Biol Lett 2021; 26:35. [PMID: 34332546 PMCID: PMC8325215 DOI: 10.1186/s11658-021-00278-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/21/2021] [Indexed: 11/18/2022] Open
Abstract
Alkannin-based pharmaceutical formulations for improving wound healing have been on the market for several years. However, detailed molecular mechanisms of their action have yet to be elucidated. Here, we investigated the potential roles of AAN-II in improving the healing of pressure-induced venous ulcers using a rabbit model generated by combining deep vein thrombosis with a local skin defect/local skin defect. The extent of healing was evaluated using hematoxylin and eosin (HE) or vimentin staining. Rabbit skin fibroblasts were cultured for AAN-II treatment or TGFB1-sgRNA lentivirus transfection. ELISA was used to evaluate the levels of various cytokines, including IL-1β, IL-4, IL-6, TNF-α, VEGF, bFGF, TGF-β and PDGF. The protein levels of TGF-β sensors, including TGF-β, Smad7 and phosphor-Smad3, and total Smad3, were assayed via western blotting after TGF-β knockout or AAN-II treatment. The results show that, for this model, AAN-II facilitates ulcer healing by suppressing the development of inflammation and promoting fibroblast proliferation and secretion of proangiogenic factors. AAN-II enhances the activation of the TGF-β1-Smad3 signaling pathway during skin ulcer healing. In addition, the results demonstrate that AAN-II and TGF-β have synergistic effects on ulcer healing. Our findings indicate that AAN-II can promote healing of pressure-induced venous skin ulcers via activation of TGF-β-Smad3 signaling in fibroblast cells and provide evidence that could be used in the development of more effective treatments.
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Affiliation(s)
- Xiao Yang
- Peripheral Vascular Disease Unit of the TCM Department, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, 201203, Shanghai, China
| | - Weijing Fan
- Peripheral Vascular Disease Unit of the TCM Department, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, 201203, Shanghai, China
| | - Renyan Huang
- Peripheral Vascular Disease Unit of the TCM Department, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, 201203, Shanghai, China
| | - Guobin Liu
- Peripheral Vascular Disease Unit of the TCM Department, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, 201203, Shanghai, China. .,Disease Unit of the TCM Department, Shuguang Hospital, , Shanghai University of Traditional Chinese Medicine, Zhangheng Road No. 528, Pudong New Area, 201203, Shanghai, China.
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11
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Massand S, Lewcun JA, LaRosa CA. Clinical and cost efficacy of advanced wound care matrices in the treatment of venous leg ulcers: a systematic review. J Wound Care 2021; 30:553-561. [PMID: 34256600 DOI: 10.12968/jowc.2021.30.7.553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Venous leg ulcers (VLUs) are hard-to-heal, recurrent and challenging to treat. Advanced wound care matrices (AWCMs) have been developed to supplement conventional therapies. These costly AWCMs warrant careful comparison as healthcare expenditures are subjected to increasing scrutiny. AIM This study was designed to compare AWCMs in their ability to heal VLUs and their cost efficacy through a systematic review of randomised controlled trials (RCTs). METHOD An organised search of Medline, Cochrane Library, Central and CINAHL databases identified RCTs that compared AWCMs to standard compression therapy in the healing of VLUs. Bias was assessed using the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool for Quantitative Studies. Eight studies analysing bilayered skin substitute (BSS) (Apligraf), dehydrated human amnion/chorion membrane (dHACM) (Epifix), human fibroblast-derived dermal substitute (HFDDS) (Dermagraft), extracellular wound matrix (ECM) (Oasis), advanced matrix (AM) (Talymed) and matrix wound dressing (MWD) (Promogran) met the inclusion criteria. RESULTS Four studies reported significant improvement over standard therapy: BSS, dHACM, ECM and AM. Incremental cost per additional successful treatment was determined for each trial, ranging from $2593 (MWD) to $210,800 (HFDDS). CONCLUSION Our consolidated analysis of eight major RCTs of AWCMs in the treatment of VLUs revealed a great variation in clinical and cost efficacy among these products. The included trials were inconsistent in methodology, and these limitations should be noted, but, in the absence of RCTs to compare these products, our systematic review may serve as a guide for practitioners who seek to optimise wound healing while considering cost efficacy.
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Affiliation(s)
- Sameer Massand
- Penn State Hershey College of Medicine and Milton S. Hershey Medical Center, PA, US
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12
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Mahmoudi M, Gould L. Opportunities and Challenges of the Management of Chronic Wounds: A Multidisciplinary Viewpoint . CHRONIC WOUND CARE MANAGEMENT AND RESEARCH 2020. [DOI: 10.2147/cwcmr.s260136] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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13
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de Souza ML, Dos Santos WM, de Sousa ALMD, de Albuquerque Wanderley Sales V, Nóbrega FP, de Oliveira MVG, Rolim-Neto PJ. Lipid Nanoparticles as a Skin Wound Healing Drug Delivery System: Discoveries and Advances. Curr Pharm Des 2020; 26:4536-4550. [PMID: 32303163 DOI: 10.2174/1381612826666200417144530] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 04/11/2020] [Indexed: 12/12/2022]
Abstract
Chronic wounds are a remarkable cause of morbidity, requiring long-time treatments with a significant impact on the quality of life and high costs for public health. Although there are a variety of topical skin preparations commercially available, they have several limitations that frequently impair wound healing, such as drug instability, toxicity, limited time of action and ineffective skin permeation. In recent years, researchers have focused on the development of new effective treatments for wound healing and shown frequent interest in nanometric drug delivery systems to overcome such obstacles. In dermatology, lipid nanoparticles (LNPs) have received great attention from researchers due to their great functionalities, greater adhesion to the skin and film formation, enabling the hydration and maintenance of skin integrity, as well as present a more effective penetration through the skin barrier. This review provides an update on topical formulations based on Solid Lipid Nanoparticles (SLNs) and Nanostructured Lipid Carriers (NLCs) as wound healing treatments. Both SLNs and NLCs are able to increase solubility and stability of active pharmaceutical ingredients and increase skin penetration compared to the free drugs. Additionally, SLNs and NLCs can increase pharmacological activity, increase the release profile of the drugs, promote synergistic effects and improve the sensory properties of the final formulation. Topical dosage forms containing nanoparticles have been extensively evaluated for wound healing activity, mainly the dressings, films and scaffolds. Therefore, lipid nanoparticles have contributed in improving wound healing therapies when incorporated into other dosage forms with better efficacy and lesser adverse effects than conventional formulations.
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Affiliation(s)
- Myla Lôbo de Souza
- Laboratory of Drug Technology, Department of Pharmaceutical Sciences, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Widson Michael Dos Santos
- Laboratory of Drug Technology, Department of Pharmaceutical Sciences, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | | | | | - Fernanda Pontes Nóbrega
- Laboratory of Drug Technology, Department of Pharmaceutical Sciences, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | | | - Pedro José Rolim-Neto
- Laboratory of Drug Technology, Department of Pharmaceutical Sciences, Federal University of Pernambuco, Recife, Pernambuco, Brazil
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14
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Leren L, Johansen E, Eide H, Falk RS, Juvet LK, Ljoså TM. Pain in persons with chronic venous leg ulcers: A systematic review and meta-analysis. Int Wound J 2020; 17:466-484. [PMID: 31898398 PMCID: PMC7948710 DOI: 10.1111/iwj.13296] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 12/13/2019] [Accepted: 12/17/2019] [Indexed: 01/01/2023] Open
Abstract
Pain is a serious problem for patients with leg ulcers. Research mainly focuses on dressing‐related pain; however, chronic background pain may be just as devastating. Our main objective was to describe the prevalence and characteristics of wound‐related background pain in persons with chronic venous leg ulcers. We performed a systematic review to synthesise data from quantitative studies. Studies were eligible if they reported original baseline‐ or cross‐sectional data on background pain in chronic venous leg ulcers. The initial search identified 2454 publications. We included 36 descriptive and effect studies. The pooled prevalence of wound‐related background pain (from 10 studies) was 80% (95% CI 65‐92%). The mean pain intensity score (from 27 studies) was 4 (0‐10 numeric rating scale) (95% CI 3.4‐4.5). Other pain characteristics could not be synthesised. We identified few sufficiently high‐quality studies on prevalence and intensity of wound‐related background pain in patients with chronic venous leg ulcers. Four of five persons experience mild to moderate pain. Because of poor quality of pain assessment and report, we believe that the available research does not provide a sufficiently nuanced understanding of background pain in this patient group.
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Affiliation(s)
- Lena Leren
- University of South-Eastern Norway, Drammen, Norway
| | | | - Hilde Eide
- University of South-Eastern Norway, Drammen, Norway
| | - Ragnhild S Falk
- Oslo University Hospital, University of South-Eastern Norway, Oslo, Norway
| | - Lene K Juvet
- University of South-Eastern Norway, Drammen, Norway
| | - Tone M Ljoså
- University of South-Eastern Norway, Drammen, Norway
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15
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Ruohoniemi DM, Ross FL, Chiu ES, Taslakian B, Horn JC, Aaltonen EA, Kulkarni K, Browning A, Patel A, Sista AK. A Descriptive Revenue Analysis of a Wound-Center IR Collaboration to Treat Lower Extremity Venous Ulcers. J Vasc Interv Radiol 2019; 30:1988-1993.e1. [PMID: 31623925 DOI: 10.1016/j.jvir.2019.06.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/19/2019] [Accepted: 06/21/2019] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To describe the revenue from a collaboration between a dedicated wound care center and an interventional radiology (IR) practice for venous leg ulcer (VLU) management at a tertiary care center. MATERIALS AND METHODS This retrospective study included 36 patients with VLU referred from a wound care center to an IR division during the 10-month active study period (April 2017 to January 2018) with a 6-month surveillance period (January 2018 to June 2018). A total of 15 patients underwent endovascular therapy (intervention group), whereas 21 patients did not (nonintervention group). Work relative value units (wRVUs) and dollar revenue were calculated using the Centers for Medicare and Medicaid Services Physician Fee Schedule. RESULTS Three sources of revenue were identified: evaluation and management (E&M), diagnostic imaging, and procedures. The pathway generated 518.15 wRVUs, translating to $37,522. Procedures contributed the most revenue (342.27 wRVUs, $18,042), followed by E&M (124.23 wRVUs, $8,881), and diagnostic imaging (51.65 wRVUs, $10,599). Intervention patients accounted for 86.7% of wRVUs (449.48) and 80.0% of the revenue ($30,010). An average of 33 minutes (38.3 hours total) and 2.06 hours (36.8 hours total) were spent on E&M visits and procedures, respectively. CONCLUSIONS In this collaboration between the wound center and IR undertaken to treat VLU, IR and E&M visits generated revenue and enabled procedural and downstream imaging revenue.
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Affiliation(s)
- David M Ruohoniemi
- Department of Radiology, Division of Interventional Radiology, New York University School of Medicine, New York, New York
| | - Frank L Ross
- Department of Surgery, Helen L. and Martin S. Kimmel Hyperbaric and Advanced Wound Healing Center, New York University School of Medicine, New York, New York
| | - Ernest S Chiu
- Hansjörg Wyss Department of Plastic Surgery, Helen L. and Martin S. Kimmel Hyperbaric and Advanced Wound Healing Center, New York University School of Medicine, New York, New York
| | - Bedros Taslakian
- Department of Radiology, Division of Interventional Radiology, New York University School of Medicine, New York, New York
| | - Jeremy C Horn
- Department of Radiology, Division of Interventional Radiology, New York University School of Medicine, New York, New York
| | - Eric A Aaltonen
- Department of Radiology, Division of Interventional Radiology, New York University School of Medicine, New York, New York
| | - Kopal Kulkarni
- Department of Radiology, Division of Interventional Radiology, New York University School of Medicine, New York, New York
| | - Alexa Browning
- Department of Radiology, Division of Interventional Radiology, New York University School of Medicine, New York, New York
| | - Amish Patel
- Department of Radiology, Division of Interventional Radiology, New York University School of Medicine, New York, New York
| | - Akhilesh K Sista
- Department of Radiology, Division of Interventional Radiology, New York University School of Medicine, New York, New York.
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16
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Apte G, Repanas A, Willems C, Mujtaba A, Schmelzer CEH, Raichur A, Syrowatka F, Groth T. Effect of Different Crosslinking Strategies on Physical Properties and Biocompatibility of Freestanding Multilayer Films Made of Alginate and Chitosan. Macromol Biosci 2019; 19:e1900181. [PMID: 31531939 DOI: 10.1002/mabi.201900181] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 08/16/2019] [Indexed: 01/26/2023]
Abstract
Freestanding multilayer films prepared by layer-by-layer technique have attracted interest as promising materials for wound dressings. The goal is to fabricate freestanding films using chitosan (CHI) and alginate (ALG) including subsequent crosslinking to improve the mechanical properties of films while maintaining their biocompatibility. Three crosslinking strategies are investigated, namely use of calcium ions for crosslinking ALG, 1-ethyl-3-(-3-dimethylaminopropyl) carbodiimide combined with N-hydroxysuccinimide for crosslinking ALG with CHI, and Genipin for crosslinking chitosan inside the films. Different characteristics, such as surface morphology, wettability, swelling, roughness, and mechanical properties are investigated showing that films became thinner, exhibited rougher surfaces, had lower water uptake, and increased mechanical strength after crosslinking. Changes of wettability are moderate and dependent on the crosslinking method. In vitro cytotoxicity and cell attachment studies with human dermal fibroblasts show that freestanding CHI-ALG films represent a poorly adhesive substratum for fibroblasts, while studies using incubation of plastic-adherent fibroblast beneath floating films show no signs of cytotoxicity in a time frame of 7 days. Results from cell experiments combined with film characteristics after crosslinking, indicate that crosslinked freestanding films made of ALG and CHI may be interesting candidates for wound dressings.
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Affiliation(s)
- Gurunath Apte
- Department of Biomedical Materials, Institute of Pharmacy, Martin Luther University Halle-Wittenberg, Heinrich-Damerow-Strasse 4, 06120, Halle (Saale), Germany
| | - Alexandros Repanas
- Department of Biomedical Materials, Institute of Pharmacy, Martin Luther University Halle-Wittenberg, Heinrich-Damerow-Strasse 4, 06120, Halle (Saale), Germany
| | - Christian Willems
- Department of Biomedical Materials, Institute of Pharmacy, Martin Luther University Halle-Wittenberg, Heinrich-Damerow-Strasse 4, 06120, Halle (Saale), Germany
| | - Anas Mujtaba
- Fraunhofer Institute for Microstructure of Materials and Systems, Walter-Hülse-Strasse 1, 06120, Halle (Saale), Germany
| | - Christian E H Schmelzer
- Fraunhofer Institute for Microstructure of Materials and Systems, Walter-Hülse-Strasse 1, 06120, Halle (Saale), Germany
| | - Ashok Raichur
- Department of Materials Engineering, Indian Institute of Science, Bangalore, 560012, India.,Nanotechnology and Water Sustainability Unit, University of South Africa, Florida, 1710, Johannesburg, South Africa
| | - Frank Syrowatka
- Interdisciplinary Center of Materials Science, Martin Luther University Halle-Wittenberg, Heinrich-Damerow-Strasse 4, 06120, Halle (Saale), Germany
| | - Thomas Groth
- Department of Biomedical Materials, Institute of Pharmacy, Martin Luther University Halle-Wittenberg, Heinrich-Damerow-Strasse 4, 06120, Halle (Saale), Germany.,Interdisciplinary Center of Material Research, Martin Luther University Halle-Wittenberg, Heinrich-Damerow-Strasse 4, 06120, Halle (Saale), Germany
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17
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Pan W, Roccabianca S, Basson MD, Bush TR. Influences of sodium and glycosaminoglycans on skin oedema and the potential for ulceration: a finite-element approach. ROYAL SOCIETY OPEN SCIENCE 2019; 6:182076. [PMID: 31417698 PMCID: PMC6689624 DOI: 10.1098/rsos.182076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 06/03/2019] [Indexed: 06/10/2023]
Abstract
Venous ulcers are chronic transcutaneous wounds common in the lower legs. They are resistant to healing and have a 78% chance of recurrence within 2 years. It is commonly accepted that venous ulcers are caused by the insufficiency of the calf muscle pump, leading to blood pooling in the lower legs, resulting in inflammation, skin oedema, tissue necrosis and eventually skin ulceration. However, the detailed physiological events by which inflammation contributes to wound formation are poorly understood. We therefore sought to develop a model that simulated the inflammation, using it to determine the internal stresses and pressure on the skin that contribute to venous ulcer formation. A three-layer finite-element skin model (epidermis, dermis and hypodermis) was developed to explore the roles in wound formation of two inflammation identifiers: glycosaminoglycans (GAG) and sodium. A series of parametric studies showed that increased GAG and sodium content led to oedema and increased tissue stresses of 1.5 MPa, which was within the reported range of skin tissue ultimate tensile stress (0.1-40 MPa). These results suggested that both the oedema and increased fluid pressure could reach a threshold for tissue damage and eventual ulcer formation. The models presented here provide insights to the pathological events associated with venous insufficiency, including inflammation, oedema and skin ulceration.
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Affiliation(s)
- Wu Pan
- Department of Mechanical Engineering, Michigan State University, 428 South Shaw Lane, Room 2555, East Lansing, MI 48824, USA
| | - Sara Roccabianca
- Department of Mechanical Engineering, Michigan State University, 428 South Shaw Lane, Room 2555, East Lansing, MI 48824, USA
| | - Marc D. Basson
- Department of Surgery at the University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, USA
| | - Tamara Reid Bush
- Department of Mechanical Engineering, Michigan State University, 428 South Shaw Lane, Room 2555, East Lansing, MI 48824, USA
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18
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Stechmiller JK, Lyon D, Schultz G, Gibson DJ, Weaver MT, Wilkie D, Ferrell AV, Whitney J, Kim J, Millan SB. Biobehavioral Mechanisms Associated With Nonhealing Wounds and Psychoneurologic Symptoms (Pain, Cognitive Dysfunction, Fatigue, Depression, and Anxiety) in Older Individuals With Chronic Venous Leg Ulcers. Biol Res Nurs 2019; 21:407-419. [PMID: 31142148 DOI: 10.1177/1099800419853881] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The prevalence and incidence of chronic venous leg ulcers (CVLUs) are increasing worldwide, as are the associated financial costs. Although it has long been known that their underlying etiology is venous insufficiency, the molecular aspects of healing versus nonhealing, as well as the psychoneurologic symptoms (PNS; pain, cognitive dysfunction, fatigue, depression, and anxiety) associated with CVLUs remain understudied. In this biobehaviorally focused review, we aim to elucidate the complex mechanisms that link the biological and molecular aspects of CLVUs with their PNS. Innovations in "omics" research have increased our understanding of important wound microenvironmental factors (e.g., inflammation, microbial pathogenic biofilm, epigenetic processes) that may adversely alter the wound bed's molecular milieu so that microbes evade immune detection. Although these molecular factors are not singularly responsible for wound healing, they are major components of wound development, nonhealing, and PNS that, until now, have not been amenable to systematic study, especially over time. Further, this review explores our current understanding of the molecular mechanisms by which the immune activation that contributes to the development and persistence of CVLUs also leads to the development, persistence, and severity of wound-related PNS. We also make recommendations for future research that will expand the field of biobehavioral wound science. Biobehavioral research that focuses on the interrelated mechanisms of PNS will lead to symptom-management interventions that improve quality of life for the population burdened by CVLUs.
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Affiliation(s)
- Joyce K Stechmiller
- 1 Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL, USA
| | - Debra Lyon
- 2 College of Nursing, University of Florida, Gainesville, FL, USA
| | - Gregory Schultz
- 3 Department of Obstetrics and Gynecology, Institute for Wound Research, University of Florida, Gainesville, FL, USA
| | - Daniel J Gibson
- 3 Department of Obstetrics and Gynecology, Institute for Wound Research, University of Florida, Gainesville, FL, USA
| | - Michael T Weaver
- 2 College of Nursing, University of Florida, Gainesville, FL, USA
| | - Diana Wilkie
- 4 Center for Palliative Care Research and Education, University of Florida, Gainesville, FL, USA
| | | | - Joanne Whitney
- 5 School of Nursing, Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - Junglyun Kim
- 2 College of Nursing, University of Florida, Gainesville, FL, USA
| | - Susan B Millan
- 6 UF Health Wound Care and Hyperbaric Center, Gainesville, FL, USA
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19
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Zhang J, Chen X, Yu L, Xue J, Zhu Z, Wang C, Tang T, Feng Z, Yao C. The Treatment of Low Leg Nonischemic Ulcers With a Traditional Chinese-Pharmaceutical Medium: A Randomized Controlled Multicenter Clinical Study. INT J LOW EXTR WOUND 2019; 18:186-191. [PMID: 31111752 DOI: 10.1177/1534734619845953] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of this study was to observe the curative effect and mechanism of Shengji Yuhong ointment in the healing of chronic ulcer of lower limbs. 400 patients were equally divided into treatment group and control group. The treatment group was covered with a piece of Shengji Yuhong ointment gauze, while the control group was covered with a piece of Vaseline gauze. Both groups changed dressings every other day for 4 weeks. On the 3rd, 7th, 14th, 21st, and 28th days of treatment, the reduction rate of wound area and the growth of wound granulation were observed and the levels of hydroxyproline and hemoglobin in wound granulation tissue were measured. The total effective rate was 99.00% in the treatment group and 71.00% in the control group. The treatment group was significantly better than the control group ( P < .01). The ulcer area reduction rate of the treatment group was significantly higher than that of the control group ( P < .01). The scores of ulcer depth, granulation color, and coverage area on the 7th, 14th, 21st, and 28th days after treatment in the treatment group were significantly lower than those before treatment ( P < .05). After treatment, the levels of hydroxyproline and hemoglobin in granulation tissue of wounds in both groups were significantly higher than those before treatment ( P < .01), and the levels in the treatment group were significantly higher than those in the control group ( P < .01). Shengji Yuhong ointment can improve the healing rate of chronic ulcer of lower limbs.
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Affiliation(s)
- Jun Zhang
- Nanjing University of Chinese Medicine, Nanjing, China
- Wuxi Hospital Affiliated to Nanjing University of Chinese Medicine, Wuxi, China
| | - Xu Chen
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Linxiang Yu
- The First Affiliated Hospital of Nanjing University of TCM, Nanjing, China
| | - Jingxian Xue
- The First Affiliated Hospital of Nanjing University of TCM, Nanjing, China
| | - Zhiyuan Zhu
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Cong Wang
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Tian Tang
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Zeyu Feng
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Chang Yao
- The First Affiliated Hospital of Nanjing University of TCM, Nanjing, China
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20
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Uehara M, Shimizu F. Progress report for intractable ulcer and osteomyelitis cases using autologous micrografts. SAGE Open Med Case Rep 2019; 7:2050313X19848301. [PMID: 31105956 PMCID: PMC6503585 DOI: 10.1177/2050313x19848301] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 02/05/2019] [Indexed: 11/15/2022] Open
Abstract
Intractable ulcers often occur following primary diseases and have a significant impact on the quality of life of affected subjects. The medical treatments now available include compression and continuous debridement or additional interventions such as advanced wound dressings, local or systemic antibiotics with a mild benefit for the patients in the long term. In this report, we describe the use of autologous micrografts obtained by Rigenera® procedure in the management of two cases of intractable ulcers showing good outcomes for both patients approximately after 30 days from intervention. In the first case, a 74-year-old male with a diagnosis of Fournier's gangrene who underwent several interventions showed a rapid wound epithelization after micrografts application. In the second case, a 63-year-old male affected by a left hallux ulcer with a diagnosis of chronic osteomyelitis also showed a gradual reduction in the ulcer approximately after 1 month from micrografts application.
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Affiliation(s)
- Miyuki Uehara
- Department of Plastic and Reconstructive Surgery, Oita University School of Medicine, Oita, Japan
| | - Fumiaki Shimizu
- Department of Plastic and Reconstructive Surgery, Oita University School of Medicine, Oita, Japan.,Department of Plastic Surgery, Oita University Hospital, Yufu, Japan
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21
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Autogenously derived regenerative cell therapy for venous leg ulcers. ACTA ACUST UNITED AC 2018; 3:e156-e163. [PMID: 30775606 PMCID: PMC6374579 DOI: 10.5114/amsad.2018.81000] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 10/09/2018] [Indexed: 12/23/2022]
Abstract
Introduction Venous leg ulcers (VLUs), which arise from chronic venous insufficiency in the lower limbs, are a major cause of morbidity and significantly negatively impact patients’ health-related quality of life. Treatment of venous ulcers can be either conservative or surgical. Despite appropriate treatment, VLUs can be resistant to healing. Clinical results of treatment of venous foot ulcers with adipose-derived autologous stem cells, which did not improve despite the surgical treatment of the underlying venous pathology in the following case series, are reported. Material and methods Between April 2015 and January 2016, a total of 31 patients who had undergone surgery for underlying venous pathology but the venous ulcer had not healed were included in the study. The mean venous ulcer size was 3.6–6.2 cm (range: 2 to 8 cm by 3 to 9 cm). All patients were treated with adipose-derived autologous stem cells prepared using the MyStem Regenerative Adipose-Derived Stem Cell Purification Kit (MyStem LLC, USA). The ulcer diameter was measured and recorded in the third, sixth and twelfth months. The follow-up time was 12 months after ulcer healing. Results Eighteen ulcers demonstrated complete healing at the 12th month. Thirteen ulcers exhibited serious contraction and epithelialization even though the ulcer was not completely closed. At the 12th month, the ulcer size was reduced by 96.00 ±1.74% in these patients. The reduction in the ulcer area based on the month analyzed was significant (p = 0.001; p < 0.01). After the ulcers healed, the patients were followed for recurrence for one year. Recurrent ulcers were observed at the treated sites in 3 of 31 patients (9%). No adverse events, such as infection, inflammation, or tissue reactions, were observed. Conclusions Application of cell therapy in venous leg ulcer is currently used exclusively in patients not responding to the standard treatment. Autogenously derived regenerative cell therapy for VLUs can be considered as an additional treatment to primary surgical therapy.
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Berenguer Pérez M, López-Casanova P, Sarabia Lavín R, González de la Torre H, Verdú-Soriano J. Epidemiology of venous leg ulcers in primary health care: Incidence and prevalence in a health centre-A time series study (2010-2014). Int Wound J 2018; 16:256-265. [PMID: 30393963 DOI: 10.1111/iwj.13026] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 10/05/2018] [Accepted: 10/09/2018] [Indexed: 01/19/2023] Open
Abstract
The aims of the study were to describe and analyse the temporal trend of the prevalence and incidence of venous leg ulcers (VLU) over the years 2010 to 2014, to determine healing times and temporal trends in the study period, and to evaluate related aspects such as the use of the Ankle-Brachial Pressure Index (ABPI) in a primary care health centre. This was a retrospective study based on a time series (years 2010-2014) of the prevalence and incidence of VLUs in people aged over 40 years in a primary care centre in Barcelona City. We reviewed 3920 electronic health records selecting patients, per year (2010-2014), with VLUs based on the ICD-10 diagnoses. For prevalence, we took into account any patient with an active VLU in the year of study. For incidence, we took into account patients with a new VLU in the year of study. A descriptive analysis was carried out based on each of the collected variables. The variables were examined according to the years of study (time series) by one-factor analysis of variance (anova) or Kruskal-Wallis non-parametric test, as appropriate. A survival analysis by Kaplan-Meier curves and log-rank test was also performed. A total of 139 patients met the VLU criteria. Among them, only 79.2% were classified as having a VLU and had a correct ICD diagnosis. The prevalence and incidence increased over the years, doubling in patients aged over 65 years. Incidence increased from 0.5 new cases per 1000 people/year in 2010 to 1 new case for every 1000 people/year in 2014. Moreover, the prevalence ranged between 0.8 and 2.2 patients with VLU for every 1000 people/year. During the study period, a total of 84.2% of the VLUs healed (117/139 VLU). Regarding average annual time to healing, the trend indicates that lesions took less time to heal (Kruskal-Wallis test, P = 0.004), ranging between 453,9 weeks in 2005 to 19 weeks in 2014. The use of ABPI also evolved and was found to be increasingly performed prior to the appearance of the lesion. The epidemiological profile of people affected by VLUs continues to be, mainly, that of women of an advanced age, over 70 years. The frequency of VLU occurrence rose continually over the years, but healing took less time, and use of ABPI improved. Assigning a reference nurse in the wounds unit and the organisational structure around this problem may have an influence on improving care and the approach to these types of lesions.
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Affiliation(s)
- Miriam Berenguer Pérez
- Department of Community Nursing, Preventive Medicine, Public Health and History of Science, Faculty of Health Sciences, University of Alicante, Alicante, Spain
| | - Pablo López-Casanova
- Department of Community Nursing, Preventive Medicine, Public Health and History of Science, Faculty of Health Sciences, University of Alicante, Alicante, Spain.,Centro de Salud de Onil, Alicante, Spain
| | | | - Héctor González de la Torre
- Complejo Hospitalario Materno-Infantil Insular de Gran Canaria, Servicio Canario de Salud, Las Palmas de Gran Canaria, Spain
| | - José Verdú-Soriano
- Department of Community Nursing, Preventive Medicine, Public Health and History of Science, Faculty of Health Sciences, University of Alicante, Alicante, Spain
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Mutlak O, Aslam M, Standfield NJ. Chronic venous insufficiency: a new concept to understand pathophysiology at the microvascular level - a pilot study. Perfusion 2018; 34:84-89. [PMID: 30067139 DOI: 10.1177/0267659118791682] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The real mechanism for the development of the later stages of chronic venous insufficiency still remains unclear. Venous hypervolemia and microvascular ischemia have been reported to be the consequences of venous insufficiency. The aim of this study was to investigate the effects of induced venous hypovolemia by dorsiflexion exercise in patients with venous leg ulcers. METHODS Thirty-six participants, all of whom had an ankle brachial pressure index between 0.8 and 1.2 mmHg, were chosen for this study. The participants were divided into two groups: Group A, a non-exercise group and Group B which performed regular exercise in the form of dorsiflexion. The basic assessment, including the history and examination, ankle-brachial pressure index (ABPI), Duplex scan and tcPO2 measurements, was performed on two occasions at the beginning of the trial and after three months. RESULTS The tcPO2 level was low in the beginning in all the subjects, but the picture was different at the end of the trial. There was a significant increase in the tcPO2 level (p<0.001) in the patients who performed exercise while there was no difference in the measurements (p>0.05) in the non-exercise group. CONCLUSIONS Induced venous hypovolemia through regular evacuation of the peripheral venous system improved tissue oxygenation at skin level. Venous hypervolemia may be the main contributing factor for the development of venous hypoxia and microvascular ischemia.
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Affiliation(s)
- Omar Mutlak
- Vascular Department, Hammersmith Hospital, Imperial College London, London, UK
| | - Mohammed Aslam
- Vascular Department, Hammersmith Hospital, Imperial College London, London, UK
| | - Nigel J Standfield
- Vascular Department, Hammersmith Hospital, Imperial College London, London, UK
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Gloviczki P, Dalsing MC, Henke P, Lal BK, O'Donnell TF, Shortell CK, Huang Y, Markovic J, Wakefield TW. Report of the Society for Vascular Surgery and the American Venous Forum on the July 20, 2016 meeting of the Medicare Evidence Development and Coverage Advisory Committee panel on lower extremity chronic venous disease. J Vasc Surg Venous Lymphat Disord 2018; 5:378-398. [PMID: 28411706 DOI: 10.1016/j.jvsv.2017.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 02/04/2017] [Indexed: 12/21/2022]
Abstract
On July 20, 2016, a Medicare Evidence Development and Coverage Advisory Committee panel assessed the benefits and risks of currently used lower extremity chronic venous disease (CVD) treatments and their effects on health outcome of the American adult population. The main purpose of the meeting was to advise the Centers for Medicare & Medicaid Services on coverage determination for interventions used for treatment of CVD. A systematic review of the Agency for Healthcare Research and Quality was presented, followed by lectures of invited experts and a public hearing of representatives of professional societies and the industry. After discussing critical issues, the panel voted for key questions. This report summarizes the presented evidence to support recommendations of the Society for Vascular Surgery/American Venous Forum coalition and the presentations on selected discussion topics. These included important venous disease evidence gaps that have not been sufficiently addressed, venous disease treatment disparities and how they may affect the health outcomes of Medicare beneficiaries, and mechanisms that might be supported by the Centers for Medicare & Medicaid Services to improve the evidence base to optimize the care of patients with lower extremity CVD.
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Affiliation(s)
- Peter Gloviczki
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn.
| | - Michael C Dalsing
- Division of Vascular Surgery, Indiana University School of Medicine, Indianapolis, Ind
| | - Peter Henke
- Section of Vascular Surgery, University of Michigan, Ann Arbor, Mich
| | - Brajesh K Lal
- Department of Vascular Surgery, University of Maryland, Baltimore, Md
| | | | - Cynthia K Shortell
- Division of Vascular Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Ying Huang
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Jovan Markovic
- Division of Vascular Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
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Pan W, Drost JP, Roccabianca S, Baek S, Bush TR. A Potential Tool for the Study of Venous Ulcers: Blood Flow Responses to Load. J Biomech Eng 2018; 140:2666615. [DOI: 10.1115/1.4038742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Indexed: 11/08/2022]
Abstract
Venous ulcers are deep wounds that are located predominantly on the lower leg. They are prone to infection and once healed have a high probability of recurrence. Currently, there are no effective measures to predict and prevent venous ulcers from formation. Hence, the goal of this work was to develop a Windkessel-based model that can be used to identify hemodynamic parameters that change between healthy individuals and those with wounds. Once identified, these parameters have the potential to be used as indicators of when internal conditions change, putting the patient at higher risk for wound formation. In order to achieve this goal, blood flow responses in lower legs were measured experimentally by a laser Doppler perfusion monitor (LDPM) and simulated with a modeling approach. A circuit model was developed on the basis of the Windkessel theory. The hemodynamic parameters were extracted for three groups: legs with ulcers (“wounded”), legs without ulcers but from ulcer patients (“nonwounded”), and legs without vascular disease (“healthy”). The model was executed by two independent operators, and both operators reported significant differences between wounded and healthy legs in localized vascular resistance and compliance. The model successfully replicated the experimental blood flow profile. The global and local vascular resistances and compliance parameters rendered quantifiable differences between a population with venous ulcers and healthy individuals. This work supports that the Windkessel modeling approach has the potential to determine patient specific parameters that can be used to identify when conditions change making venous ulcer formation more likely.
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Affiliation(s)
- Wu Pan
- Fellow ASME Department of Mechanical Engineering, Michigan State University, 2555 Engineering Building, East Lansing, MI 48824-1226 e-mail:
| | - Joshua P. Drost
- Fellow ASME Department of Mechanical Engineering, Michigan State University, 2555 Engineering Building, East Lansing, MI 48824-1226 e-mail:
| | - Sara Roccabianca
- Fellow ASME Department of Mechanical Engineering, Michigan State University, 2555 Engineering Building, East Lansing, MI 48824-1226 e-mail:
| | - Seungik Baek
- Fellow ASME Department of Mechanical Engineering, Michigan State University, 2555 Engineering Building, East Lansing, MI 48824-1226 e-mail:
| | - Tamara Reid Bush
- Fellow ASME Chair of the Dynamics, Design and Rehabilitation (DDR) Committee, Bioengineering Technical Division, Department of Mechanical Engineering, Michigan State University, 2555 Engineering Building, East Lansing, MI 48824-1226 e-mail:
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Cerusico N, Aybar JP, Lopez S, Molina SG, Chavez Jara R, Sesto Cabral ME, Valdez JC, Ben Altabef A, Ramos AN. FTIR spectroscopy of chronic venous leg ulcer exudates: an approach to spectral healing marker identification. Analyst 2018. [DOI: 10.1039/c7an01909b] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Chronic venous leg ulcer arises as a venous insufficiency complication and is a cause of great morbidity.
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Affiliation(s)
- Nicolas Cerusico
- Laboratorio de Estudios Farmacéuticos y Biotecnología Farmacéutica
- Instituto de Biotecnología Farmacéutica y Alimentaria (INBIOFAL)
- San Miguel de Tucumán
- Tucumán
- Argentina
| | - Juan P. Aybar
- Laboratorio de Estudios Farmacéuticos y Biotecnología Farmacéutica
- Instituto de Biotecnología Farmacéutica y Alimentaria (INBIOFAL)
- San Miguel de Tucumán
- Tucumán
- Argentina
| | - Silvana Lopez
- Servicio de Dermatología
- Hospital de Clínicas Presidente Nicolás Avellaneda
- San Miguel de Tucumán
- Tucumán
- Argentina
| | - Silvia G. Molina
- Servicio de Dermatología
- Hospital de Clínicas Presidente Nicolás Avellaneda
- San Miguel de Tucumán
- Tucumán
- Argentina
| | - Romina Chavez Jara
- Laboratorio de Estudios Farmacéuticos y Biotecnología Farmacéutica
- Instituto de Biotecnología Farmacéutica y Alimentaria (INBIOFAL)
- San Miguel de Tucumán
- Tucumán
- Argentina
| | - Maria Eugenia Sesto Cabral
- Laboratorio de Estudios Farmacéuticos y Biotecnología Farmacéutica
- Instituto de Biotecnología Farmacéutica y Alimentaria (INBIOFAL)
- San Miguel de Tucumán
- Tucumán
- Argentina
| | - Juan C. Valdez
- Instituto de Microbiología
- Facultad de Bioquímica
- Química y Farmacia
- Universidad Nacional de Tucumán
- San Miguel de Tucumán
| | - Aida Ben Altabef
- INQUINOA-CONICET
- Instituto de Química Física
- Facultad de Bioquímica
- Química y Farmacia
- Universidad Nacional de Tucumán
| | - Alberto N. Ramos
- Laboratorio de Estudios Farmacéuticos y Biotecnología Farmacéutica
- Instituto de Biotecnología Farmacéutica y Alimentaria (INBIOFAL)
- San Miguel de Tucumán
- Tucumán
- Argentina
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Bianchi C, Cazzell S, Vayser D, Reyzelman AM, Dosluoglu H, Tovmassian G. A multicentre randomised controlled trial evaluating the efficacy of dehydrated human amnion/chorion membrane (EpiFix ® ) allograft for the treatment of venous leg ulcers. Int Wound J 2017; 15:114-122. [PMID: 29024419 PMCID: PMC7949978 DOI: 10.1111/iwj.12843] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 08/21/2017] [Accepted: 08/30/2017] [Indexed: 01/02/2023] Open
Abstract
A randomised, controlled, multicentre clinical trial was conducted to evaluate the efficacy of dehydrated human amnion/chorion membrane (EpiFix) allograft as an adjunct to multilayer compression therapy for the treatment of non-healing full-thickness venous leg ulcers. We randomly assigned 109 subjects to receive EpiFix and multilayer compression (n = 52) or dressings and multilayer compression therapy alone (n = 57). Patients were recruited from 15 centres around the USA and were followed up for 16 weeks. The primary end point of the study was defined as time to complete ulcer healing. Participants receiving weekly application of EpiFix and compression were significantly more likely to experience complete wound healing than those receiving standard wound care and compression (60% versus 35% at 12 weeks, P = 0·0128, and 71% versus 44% at 16 weeks, P = 0·0065). A Kaplan-Meier analysis was performed to compare the time-to-healing performance with or without EpiFix, showing a significantly improved time to healing using the allograft (log-rank P = 0·0110). Cox regression analysis showed that subjects treated with EpiFix had a significantly higher probability of complete healing within 12 weeks (HR: 2·26, 95% confidence interval 1·25-4·10, P = 0·01) versus without EpiFix. These results confirm the advantage of EpiFix allograft as an adjunct to multilayer compression therapy for the treatment of non-healing, full-thickness venous leg ulcers.
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Affiliation(s)
- Christian Bianchi
- Department of Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
| | | | | | | | | | - Gregory Tovmassian
- Center for Clinical Research, Inc. Sacramento Foot and Ankle Center, Sacramento, CA, USA
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Mutlak O, Aslam M, Standfield NJ. An investigation of skin perfusion in venous leg ulcer after exercise. Perfusion 2017; 33:25-29. [PMID: 28777054 DOI: 10.1177/0267659117723699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION A venous leg ulcer (VLU) has a major impact on the quality of life and functional ability of individuals, but no single treatment is yet effective. This study investigates the changes induced by dorsiflexion exercise on skin perfusion in VLU patients to achieve a better understanding of venous ulcer pathophysiology. METHODS Seventy-eight venous leg ulcer patients were randomised into four groups. The non-exercise groups included a control group (n = 18) and a compression therapy group (n = 20) and the exercise groups included an exercise-only group (n = 20) and a compression and exercise group (n = 20). The exercise groups were expected to perform exercise for three months. Measurements included transcutaneous oximetry (tcPO2) and laser Doppler flowmetry (LDF). Skin perfusion measurements for all groups were taken twice: at the beginning and end of the three-month period. RESULTS Initially, all participants showed a low level of tcPO2. The exercise groups showed a significant increase after three months of exercise (p<0.001), the tcPO2 level remained the same in the non-exercise groups. The LDF parameters decreased significantly (p<0.001) in the compression and exercise group and decreased to a lesser extent in the exercise-only group. There were no LDF changes in the non-exercise groups. CONCLUSIONS Perfusion measurements showed significant changes after three months of regular exercise. We conclude that exercise has a significant effect on tissue perfusion parameters in venous leg ulcer and this effect may play a role in understanding the pathophysiology of VLU.
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Affiliation(s)
- Omar Mutlak
- Vascular Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Mohammed Aslam
- Vascular Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Nigel J Standfield
- Vascular Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
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Moskvin SV, Geynitz AV, Askhadulin EV. Efficiency of a New Combined Laser Therapy in Patients With Trophic Ulcers of Lower Extremities and Chronic Venous Insufficiency. J Lasers Med Sci 2017; 8:132-135. [PMID: 29123633 DOI: 10.15171/jlms.2017.24] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Introduction: Treating patients with trophic ulcers (TUs) of venous etiology (VE) is a complicated socio-medical and economic problem. One of the ways to increase treatment efficiency can be a complex therapy, including combined laser action. Methods: The objective of this study was a comparative evaluation of the efficiency of traditional treatment methods in patients with chronic venous diseases of C6 class, and combined laser therapy (LT) according to a new method by LASMIK® device. External exposure was conducted on the 1-4 affected area during one session for 2 minutes per zone (pulsed mode, light pulse duration of 100-130 ns, wavelength 635 nm, by a matrix emitter consisting of eight laser diodes with a surface area of 8 cm2, at a distance of up to 7 cm, pulsed power 40 W). Intravenous laser blood illumination (ILBI) was conducted in continuous mode with a wavelength of 365-405 nm (UV-spectrum) and 520-525 nm (green spectrum) alternately, during 12 daily sessions, according to a special scheme. Results: The new method reduces time periods for wound surface cleansing from purulo-necrotic masses, stimulates proliferation and epithelialization processes by 2-2.7 times, compared with the conventional method. Conclusion: The high efficiency of a new combined LT has been demonstrated in the treatment of TU of VE in combination with traditional methods of patients' medical treatment.
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Aschermann I, Noor S, Venturelli S, Sinnberg T, Busch C, Mnich C. Extracorporal Shock Waves Activate Migration, Proliferation and Inflammatory Pathways in Fibroblasts and Keratinocytes, and Improve Wound Healing in an Open-Label, Single-Arm Study in Patients with Therapy-Refractory Chronic Leg Ulcers. Cell Physiol Biochem 2017; 41:890-906. [DOI: 10.1159/000460503] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 12/20/2016] [Indexed: 11/19/2022] Open
Abstract
Background/Aims: Chronic leg ulcers (CLUs) are globally a major cause of morbidity and mortality with increasing prevalence. Their treatment is highly challenging, and many conservative, surgical or advanced therapies have been suggested, but with little overall efficacy. Since the 1980s extracorporal shock wave therapy (ESWT) has gained interest as treatment for specific indications. Here, we report that patients with CLU showed wound healing after ESWT and investigated the underlying molecular mechanisms. Methods: We performed cell proliferation and migration assays, FACS- and Western blot analyses, RT-PCR, and Affymetrix gene expression analyses on human keratinocytes and fibroblasts, and a tube formation assay on human microvascular endothelial cells to assess the impact of shock waves in vitro. In vivo, chronic therapy-refractory leg ulcers were treated with ESWT, and wound healing was assessed. Results: Upon ESWT, we observed morphological changes and increased cell migration of keratinocytes. Cell-cycle regulatory genes were upregulated, and proliferation induced in fibroblasts. This was accompanied by secretion of pro-inflammatory cytokines from keratinocytes, which are known to drive wound healing, and a pro-angiogenic activity of endothelial cells. These observations were transferred “from bench to bedside”, and 60 consecutive patients with 75 CLUs with different pathophysiologies (e.g. venous, mixed arterial-venous, arterial) were treated with ESWT. In this setting, 41% of ESWT-treated CLUs showed complete healing, 16% significant improvement, 35% improvement, and 8% of the ulcers did not respond to ESWT. The induction of healing was independent of patient age, duration or size of the ulcer, and the underlying pathophysiology. Conclusions: The efficacy of ESWT needs to be confirmed in controlled trials to implement ESWT as an adjunct to standard therapy or as a stand-alone treatment. Our results suggest that EWST may advance the treatment of chronic, therapy-refractory ulcers.
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Leg Ulcers in Dermatology. CURRENT DERMATOLOGY REPORTS 2016. [DOI: 10.1007/s13671-016-0158-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abbade LPF, Wang M, Sriganesh K, Mbuagbaw L, Thabane L. Framing of research question using the PICOT format in randomised controlled trials of venous ulcer disease: a protocol for a systematic survey of the literature. BMJ Open 2016; 6:e013175. [PMID: 27836875 PMCID: PMC5129008 DOI: 10.1136/bmjopen-2016-013175] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 09/14/2016] [Accepted: 10/18/2016] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Although venous ulcers have a great social and economic impact, there is a lack of evidence from randomised controlled trials (RCTs) to support appropriate management for this disease. Framing the research question using the Population; Intervention; Comparator; Outcome; Time frame (PICOT) format in RCTs can improve the quality of the research design. OBJECTIVES To evaluate how the PICOT format is used to frame a research question in reports of RCTs of venous ulcer disease and to determine the factors associated with better adherence to the PICOT format in framing the research question. METHODS AND ANALYSES We will conduct a systematic survey of RCTs on venous ulcers published in the National Institute of Health, PubMed database between January 2009 and May 2016. We will include all RCTs addressing therapeutic intervention for venous ulcer disease involving human subjects, and published in the English language. The selection process will be carried out in duplicate by two independent investigators. First, titles and abstracts will be screened, then full-text articles. We will examine whether the five elements of the PICOT format are used in formulating the research question and give a score between 0 and 5. The primary outcome will be the proportion of studies that have adequately reported all five PICOT elements. DISSEMINATION This will be the first survey to assess how the PICOT format is used to frame research questions on the management of venous ulcers in reports of RCTs. On completion, this review will be submitted to a peer-reviewed biomedical journal for publication and the findings will also be presented at scientific conferences.
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Affiliation(s)
- Luciana P F Abbade
- Department of Dermatology and Radiotherapy, Botucatu Medical School, Universidade Estadual Paulista, UNESP, São Paulo, Brazil
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Mei Wang
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Kamath Sriganesh
- Department of Neuroanaesthesia, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - Lawrence Mbuagbaw
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, Ontario, Canada
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Lazarus GS, Kirsner RS, Zenilman J, Valle MF, Margolis DJ, Cullum N, Driver VR, Gould L, Lindsay E, Tunis S, Marston W, Bass E, Ennis W, Davidson J, Bowden J. Clinical interventions for venous leg ulcers: Proposals to improve the quality of clinical leg ulcer research. Wound Repair Regen 2016; 24:767-774. [PMID: 27487792 DOI: 10.1111/wrr.12466] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 07/29/2016] [Indexed: 11/26/2022]
Abstract
The present status of clinical leg ulcer healing research was reviewed by 25 experts over 2 days on September 28 and 29, 2015. Multiple clinical effectiveness reviews were presented suggesting that published clinical wound healing research often does not meet present (2015) evidence based standards. Specific areas requiring remediation were highlighted and approaches to overcoming existing challenges were proposed. Participants using anonymous voting technology developed an action plan to resolve perceived deficiencies. Statements were accepted if 75% of participants agreed. Older patients with a high frequency of comorbid conditions posed particular difficulties in designing clinical research protocols and better diagnostic categorization is necessary A standardized model template for collecting information about diagnosis and evaluation of the effect of interventions on healing of all types of leg ulcers was considered a high priority. Such a model template could be modified depending on the specific etiology of the leg ulcers. Generally agreed on quantifiable standards to establish degree of morbidity was considered a high priority. There was universal agreement that sources of funding and conflicts of interest needed to be disclosed in presentations and all publications. All clinical research studies should be registered with appropriate authorities. There was substantial enthusiasm for a clinical research network with quality standards for membership and an advisory research core available to investigators. Such a network should be funded and actively managed to insure long-term viability. The governance of such an entity needs to be established by the wound care community. The present trend to integrate patients into the clinical research process was endorsed and there was enthusiasm to develop patient advocacy for wound healing research.
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Affiliation(s)
- Gerald S Lazarus
- Professor of Dermatology and Medicine Johns Hopkins University School of Medicine, The Johns Hopkins Wound Center, Johns Hopkins Bayview Medical Center Baltimore, Maryland.
| | - Robert S Kirsner
- Chairman and Harvey Blank Professor, Department of Dermatology and Cutaneous Surgery, Professor of Epidemiology and Public Health, University of Miami, Miller School of Medicine, Miami, Florida
| | - Jonathan Zenilman
- Professor of Medicine, Johns Hopkins University School of Medicine, Johns Hopkins Bayview, Medical Center, and Chief of Infectious Disease, Johns Hopkins Bayview, Medical Center Baltimore, Maryland
| | - M Frances Valle
- Assistant Professor of Nursing, University of Maryland School of Nursing, Baltimore, Maryland
| | - David J Margolis
- Professor of Dermatology and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Nicky Cullum
- Head of the School of Nursings, Midwifery and Social Work, University of Manchester, Manchester, United Kingdom
| | - Vickie R Driver
- Professor of Orthopedic Surgery, Brown University (clinical), President, Association for the Advancement of Wound Care, Senior Medical Director Wound Healing, Novartis Institute for Bio-Medical Research, New Indications Discovery Unit, Providence, Rhode Island
| | - Lisa Gould
- President, Wound Recovery and Hyperbaric Medicine Center Kent Hospital, Warwick, Rhode Island
| | - Ellie Lindsay
- Founder and President, The Lindsay Leg Club Foundation, Suffolk, United Kingdom
| | - Sean Tunis
- Founder and President, Center for Medical Technology Programs, Baltimore, Maryland
| | - William Marston
- Professor and Chief, Division of Vascular Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Eric Bass
- Johns Hopkins Hospital, Director of the Johns Hopkins University Evidence-based Practice Center, Baltimore, Maryland
| | - William Ennis
- Director, Clinical Professor of Surgery, Wound Healing Research, University of Illinois, Chicago, Illinois
| | - Jeffrey Davidson
- Professor of Pathology and Senior Research Career Scientist, Departments of Pathology, Microbiology and Immunology, Vanderbilt University Nashville, Tennessee
| | - Jeremy Bowden
- HMP Communications, Group Publisher, Wound Care Division, Malvern, Pennsylvania
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Affiliation(s)
- E. Ricci
- Director of the Difficult Wound Healing Unit, St Luca Clinic, Department of Surgery A, Pecetto Torinese (TO), Piedmont, Italy
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Martis G, Laczik R. The role of radical surgery in the management of CEAP C5/6 and lipodermatosclerosis. Phlebology 2016; 31:753-768. [PMID: 27257053 DOI: 10.1177/0268355516652011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aim Analysis of the radical removing of the dermatosclerotic tissues and ulcer(s) with perforator veins dissection as well as local wound and standard compression treatment of CEAP C5/6 stage in a prospective comparative cohort study. Primary endpoint is to compare the results of the one-year follow-up regarding quality of life, vein clinical severity score, and ulcer healing process. Secondary endpoint is the precise presentation of the surgical technique. Tertiary endpoint is to demonstrate the photo-documented results of the postoperative wound treatment protocol. Method Clinical and statistical comparison of radical surgery versus solely wound care and compression in a cohort of 15 patients in each group (Groups 1, 2). In Group 1, radical removing of the dermatosclerotic pannicule and leg ulcer, perforator vein dissection, great saphenous vein, or small saphenous vein was performed. Quality of life , pain intensity, vein clinical severity score and patients' load capacity were compared. The tissue oxygen saturation changes were monitored via near infra-red spectroscopy. Results Both groups were statistically comparable. Wound healing in the operated group was 100% versus 60% in the second one, the difference was significant, p = 0.006. The quality of life: 45.33 versus 36.8, p < 0.001, intensity of leg restless and pain: 2.28 versus 5.3, p < 0.001, changes of vein clinical severity score: 5.27 versus 20.93, p < 0.001, changes of tO2sat: 19.00 versus 6.07 in the upper third of the leg p < 0.001, proved significantly better in group 1 compared to 2. Load capacity was significantly better in group 1 than 2 at the end of the study. The average wound healing time was 113 days in group 1. Conclusion The radical surgery provides significantly better results, considering quality of life, vein clinical severity score, load capacity than the conservative treatment in this study.
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Affiliation(s)
- Gábor Martis
- 1 Department of Vascular Surgery, Clinical and Health Science Centre, Institute of Surgery, University of Debrecen, Debrecen, Hungary
| | - Renáta Laczik
- 2 Department of Angiology, Clinical and Health Science Centre, Institute of Medicine, University of Debrecen, Debrecen, Hungary
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Roehrs H, Stocco JGD, Pott F, Blanc G, Crozeta K, Meier MJ, Dias FAL. Dressings and topical agents containing hyaluronic acid for chronic wound healing. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2016. [DOI: 10.1002/14651858.cd012215] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Hellen Roehrs
- Federal University of Paraná; Department of Nursing; Av. Lothario Meissner, 632 bloco Didático II Curitiba Paraná/Brazil Brazil 80210-170
| | - Janislei GD Stocco
- Clinical Hospital of Federal University of Paraná; Hospital Infection Control & Prevention; Av. Iguaçu, 2420 apto 32C, Agua Verde Curitiba Paraná Brazil 80240-030
| | - Franciele Pott
- Hospital Polícia Militar do Paraná; Department of Primary Care and Emergency; avenida Jão Fraga Neto 4906 jão jose dos Pinhais São José dos Pinhais Paraná Brazil 83060-540
| | - Gisely Blanc
- Prefeitura de São José dos Pinhais; Department of Primary Care and Emergency; João dembinski, 1003 Campo Comprido Curitiba Paraná Brazil 81270-330
| | - Karla Crozeta
- Federal University of Paraná; Department of Nursing; Av. Lothario Meissner, 632 bloco Didático II Curitiba Paraná/Brazil Brazil 80210-170
| | - Marineli J Meier
- Universidade Federal do Paraná; Department of Nursing and Program Postgraduation in Nursing; Av. Lothário Meissner, 632 Jardim Botânico Setor de Ciências da Saúde (Bloco Didático II - Campus Botânico) Curitiba Paraná Brazil 80.210-170
| | - Fernando AL Dias
- Federal University of Paraná; Department of Physiology; Centro Politécnico, Jardim das Américas Caixa Postal 19031 Curitiba Paraná Brazil 81531-980
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Sin TK, Yung BY, Yip SP, Chan LW, Wong CS, Tam EW, Siu PM. SIRT1-dependent myoprotective effects of resveratrol on muscle injury induced by compression. Front Physiol 2015; 6:293. [PMID: 26557094 PMCID: PMC4617057 DOI: 10.3389/fphys.2015.00293] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 10/05/2015] [Indexed: 01/01/2023] Open
Abstract
Our current understanding on the molecular mechanisms by which sustained compression induces skeletal muscle injury is very limited. This study aimed to test the hypothesis that activation of SIRT1 by the natural antioxidant resveratrol could deactivate apoptotic and catabolic signaling in skeletal muscle exposed to moderate compression. Two cycles of 6-h constant pressure at 100 mmHg was applied to the tibialis region of right, but not left hindlimbs of Sprague Dawley rats pre-treated with DMSO (vehicle control) or resveratrol with/without sirtinol. Skeletal muscle tissues lying underneath and spatially corresponding to the compressed sites were collected for analyses. Resveratrol prevented the compression-induced manifestations of pathohistological damages including elevations of the number of interstitial nuclei and area of interstitial space and ameliorated oxidative damages measured as 4-hydroxy-2-nonenal (4HNE) and nitrotyrosine in skeletal muscle. In parallel, resveratrol augmented the expression level and activity of SIRT1 and phosphorylation levels of Foxo3a and Akt while suppressed the increases in protein abundances of p53, Bax, MAFbx, and ubiquitin, enzymatic activities of caspase 3 and 20S proteasome, and apoptotic DNA fragmentation in the compressed muscle. These favorable myoprotective effects of resveratrol were diminished upon pharmacological blockade of SIRT1 by using sirtinol. These novel data support the hypothesis that the anti-apoptotic and anti-catabolic effects of resveratrol on compression injury in skeletal muscle required the action of SIRT1.
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Affiliation(s)
- Thomas K Sin
- Department of Health Technology and Informatics, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University Hong Kong, Hong Kong
| | - Benjamin Y Yung
- Department of Health Technology and Informatics, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University Hong Kong, Hong Kong
| | - Shea P Yip
- Department of Health Technology and Informatics, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University Hong Kong, Hong Kong
| | - Lawrence W Chan
- Department of Health Technology and Informatics, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University Hong Kong, Hong Kong
| | - Cesar S Wong
- Department of Health Technology and Informatics, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University Hong Kong, Hong Kong
| | - Eric W Tam
- Interdisciplinary Division of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University Hong Kong, Hong Kong
| | - Parco M Siu
- Department of Health Technology and Informatics, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University Hong Kong, Hong Kong
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Rodrigues ALS, de Oliveira BGRB, Futuro DO, Secoli SR. Effectiveness of papain gel in venous ulcer treatment: randomized clinical trial. Rev Lat Am Enfermagem 2015; 23:458-65. [PMID: 26155004 PMCID: PMC4547069 DOI: 10.1590/0104-1169.0381.2576] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 02/01/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE: to assess the effectiveness of 2% papain gel compared to 2% carboxymethyl
cellulose in the treatment of chronic venous ulcer patients. METHOD: randomized controlled clinical trial with 12-week follow-up. The sample consisted
of 18 volunteers and 28 venous ulcers. In the trial group, 2% papain gel was used
and, in the control group, 2% carboxymethyl cellulose gel. RESULTS: the trial group showed a significant reduction in the lesion area, especially
between the fifth and twelfth week of treatment, with two healed ulcers and a
considerable increase in the amount of epithelial tissue in the wound bed. CONCLUSION: 2% papain gel demonstrated greater effectiveness in the reduction of the lesion
area, but was similar to 2% carboxymethyl cellulose gel regarding the reduction in
the amount of exudate and devitalized tissue. Multicenter research is suggested to
evidence the effectiveness of 2% papain gel in the healing of venous ulcers. UTN
number: U1111-1157-2998
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Gethin G, Killeen F, Devane D. Heterogeneity of wound outcome measures in RCTs of treatments for VLUs: a systematic review. J Wound Care 2015; 24:211-2, 214, 216 passim. [PMID: 25970758 DOI: 10.12968/jowc.2015.24.5.211] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- G. Gethin
- Senior Lecturer, BNS 4th year Student, Professor of Midwifery, Director, Health Research Board – Trials Methodology Research Network (HRB-TMRN), School of Nursing and Midwifery, National University of Ireland Galway, Ireland
| | - F. Killeen
- Senior Lecturer, BNS 4th year Student, Professor of Midwifery, Director, Health Research Board – Trials Methodology Research Network (HRB-TMRN), School of Nursing and Midwifery, National University of Ireland Galway, Ireland
| | - D. Devane
- Senior Lecturer, BNS 4th year Student, Professor of Midwifery, Director, Health Research Board – Trials Methodology Research Network (HRB-TMRN), School of Nursing and Midwifery, National University of Ireland Galway, Ireland
- Professor of Midwifery, Director, Health Research Board – Trials Methodology Research Network (HRB-TMRN), HSE West North West Hospital groups
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White J, Ivins N, Wilkes A, Carolan-Rees G, Harding KG. Non-contact low-frequency ultrasound therapy compared with UK standard of care for venous leg ulcers: a single-centre, assessor-blinded, randomised controlled trial. Int Wound J 2015; 13:833-42. [PMID: 25619411 PMCID: PMC7949520 DOI: 10.1111/iwj.12389] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 09/29/2014] [Indexed: 11/30/2022] Open
Abstract
‘Hard‐to‐heal’ wounds are those which fail to heal with standard therapy in an orderly and timely manner and may warrant the use of advanced treatments such as non‐contact low‐frequency ultrasound (NLFU) therapy. This evaluator‐blinded, single‐site, randomised controlled trial, compared NLFU in addition to UK standard of care [SOC: (NLFU + SOC)] three times a week, with SOC alone at least once a week. Patients with chronic venous leg ulcers were eligible to participate. All 36 randomised patients completed treatment (17 NLFU + SOC, 19 SOC), and baseline demographics were comparable between groups. NLFU + SOC patients showed a −47% (SD: 38%) change in wound area; SOC, −39% (38%) change; and difference, −7·4% [95% confidence intervals (CIs) −33·4–18·6; P = 0·565]. The median number of infections per patient was two in both arms of the study and change in quality of life (QoL) scores was not significant (P = 0·490). NLFU + SOC patients reported a substantial mean (SD) reduction in pain score of −14·4 (14·9) points, SOC patients' pain scores reduced by −5·3 (14·8); the difference was −9·1 (P = 0·078). Results demonstrated the importance of high‐quality wound care. Outcome measures favoured NLFU + SOC over SOC, but the differences were not statistically significant. A larger sample size and longer follow‐up may reveal NLFU‐related improvements not identified in this study.
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Affiliation(s)
- Judith White
- Cedar, Cardiff and Vale University Health Board, Cardiff Medicentre, Cardiff, UK.
| | - Nicola Ivins
- Wound Healing Research Unit, Cardiff University, School of Medicine, Cardiff, UK
| | - Antony Wilkes
- Cedar, Cardiff and Vale University Health Board, Cardiff Medicentre, Cardiff, UK
| | - Grace Carolan-Rees
- Cedar, Cardiff and Vale University Health Board, Cardiff Medicentre, Cardiff, UK
| | - Keith G Harding
- Wound Healing Research Unit, Cardiff University, School of Medicine, Cardiff, UK
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Silva MHD, Jesus MCPD, Merighi MAB, Oliveira DMD. Limits and possibilities experienced by nurses in the treatment of women with chronic venous ulcers. Rev Esc Enferm USP 2014; 48 Spec No:53-8. [PMID: 25517835 DOI: 10.1590/s0080-623420140000600008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 07/06/2014] [Indexed: 11/21/2022] Open
Abstract
Objective To understand the experiences and expectations of nurses in the treatment of women with chronic venous ulcers. Method Phenomenological research was based on Alfred Schütz, whose statements were obtained in January, 2012, through semi-structured interviews with seven nurses. Results The nurse reveals the difficulties presented by the woman in performing self-care, the perceived limitations in the treatment anchored in motivation, and the values and beliefs of women. It showed professional frustration because venous leg ulcer recurrence, lack of inputs, interdisciplinary work and training of nursing staff. There was an expected adherence to the treatment of women, and it emphasized the need for ongoing care, supported self-care and standard practices in treatment. Conclusion That treatment of chronic venous leg ulcers constitutes a challenge that requires collective investment, involving women, professionals, managers and health institutions.
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Butler É, Oien RF, Lindholm C, Olofsson TC, Nilson B, Vásquez A. A pilot study investigating lactic acid bacterial symbionts from the honeybee in inhibiting human chronic wound pathogens. Int Wound J 2014; 13:729-37. [PMID: 25196349 DOI: 10.1111/iwj.12360] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 07/29/2014] [Accepted: 08/03/2014] [Indexed: 12/17/2022] Open
Abstract
Treatment and management of chronic wounds is a large burden on the health sector and causes substantial suffering for the patients. We believe that 13 lactic acid bacteria (LAB) symbionts isolated from the honey crop of the honeybee are important players in the antimicrobial action of honey, by producing antimicrobial substances and can be used in combination with heather honey as an effective treatment in wound management. A total of 22 patients with chronic ulcers were included; culture-dependent and molecular-based (MALDI-MS and 16S rRNA gene sequencing) techniques were used to identify bacteria from chronic wounds. These clinical isolates were used for in vitro antimicrobial testing with standardised viable LAB and sterilised heather honey mixture. Twenty of the patients' wounds were polymicrobial and 42 different species were isolated. Patient isolates that were tested in vitro were inhibited by the LAB and honey combination with inhibitory zones comparable with different antibiotics. LAB and heather honey in combination presents a new topical option in chronic wound management because of the healing properties of honey, antimicrobial metabolite production from the LAB and their bactericidal effect on common chronic wound pathogens. This new treatment may be a stepping stone towards an alternative solution to antibiotics.
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Affiliation(s)
- Éile Butler
- Department of Laboratory Medicine Lund, Section of Medical Microbiology, Lund University, Lund, Sweden.
| | - Rut F Oien
- Blekinge Wound Healing Centre, Blekinge Hospital, Karlshamn, Sweden
| | | | - Tobias C Olofsson
- Department of Laboratory Medicine Lund, Section of Medical Microbiology, Lund University, Lund, Sweden
| | - Bo Nilson
- Labmedicin, Region Skåne, Clinical Microbiology, Lund, Sweden
| | - Alejandra Vásquez
- Department of Laboratory Medicine Lund, Section of Medical Microbiology, Lund University, Lund, Sweden
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Carter MJ. Economic evaluations of guideline-based or strategic interventions for the prevention or treatment of chronic wounds. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2014; 12:373-389. [PMID: 24615160 PMCID: PMC4110411 DOI: 10.1007/s40258-014-0094-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Costs of chronic wound care are significant, but systematic reviews of cost-effectiveness studies regarding guideline-based or strategic interventions are scarce. OBJECTIVES Our objectives were to assess/compare the cost effectiveness of new interventions/systems designed to improve the prevention/treatment of chronic wounds in adult populations against current care and provide decision makers with information on which to base future interventions for chronic wound management. DATA SOURCES Data sources included PubMed, Scopus, HTA, and NHS EED. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS We included comparative health economic evaluations of interventions published in English designed to prevent or treat adult chronic wounds that were guideline-based or strategic in nature and from which an incremental cost-effectiveness ratio or incremental net health benefit was reported or could be calculated. STUDY APPRAISAL AND SYNTHESIS METHODS Study and model characteristics and outcomes were extracted into pre-designed tables. Quality assessment of studies was based on literature-reported methods. Studies were assigned strength of evidence ratings and recommendation level for decision makers. RESULTS A total of 16 health economic evaluations were included, of which ten were trial based and six were wholly model based. Only three studies had high, and five studies moderate, strength of evidence and were recommended for decision makers. All studies had some shortcomings regarding time horizon, costs, effectiveness units, and methodological reporting. Two studies had major flaws. LIMITATIONS Limitations include missed studies published in non-English languages or not cited in searched databases; judgment bias in assessing studies. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS Few well conducted cost-effectiveness studies exist to guide decision makers regarding guideline-based or strategic interventions for chronic wounds.
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Affiliation(s)
- Marissa J Carter
- Strategic Solutions, Inc., 1143 Salsbury Ave, Cody, WY, 82414, USA,
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O'Halloran PD, Winter PK, Otter JA, Adams NMT, Chewins J. Aqueous oxygen peroxide treatment of VLUs in a primary care-based randomised, double-blind, placebo-controlled trial. J Wound Care 2014; 23:176, 178, 180-1 passim. [PMID: 24762381 DOI: 10.12968/jowc.2014.23.4.176] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate a novel aqueous oxygen peroxide (AOP) wound therapy (BioxyQuell) in a multi-centre, primary care-based, randomised, double-blind, placebo-controlled, parallel-group trial, monitoring long-term healing outcomes over 12 months. METHOD Sixty-one patients with chronic, stable venous leg ulceration were treated with either AOP solution or sterile water placebo applied as a lavage over 2 weeks. The patients' wounds were dressed weekly and assessed fortnightly over the following 6 weeks. Patients who completed the initial 8-week trial were invited into a 10-month follow-up trial. The primary endpoints of the study were wound healing at 8 weeks, 12 weeks, 6 months and 12 months, and wound size reduction during the treatment phase. Secondary endpoints were reductions in wound bioburden and pain. RESULTS Patients treated with AOP were more likely to heal at 6 months (p=0.014) and 12 months (p=0.006), but not at 8 weeks (p=0.979) or 12 weeks (p=0.263). Patients treated with AOP had greater wound area reduction (p=0.015), reductions in pain measured on a 100-point scale (p=0.001) and wound bioburden reduction (p=0.005) during the treatment phase. CONCLUSION The addition of AOP treatment provides substantial benefits to patients with chronic venous leg ulceration compared with current best practice.
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Affiliation(s)
- P D O'Halloran
- MRCS, FRCGP, The Gratton Surgery, Sutton Scotney, Winchester, UK
| | | | - J A Otter
- PhD, Bioquell UK Ltd, Andover; UK. Centre for Clinical Infection and Diagnostics Research (CIDR), Department of Infectious Diseases, Kings College London and Guys & St Thomas NHS Trust, London, UK
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Valle MF, Maruthur NM, Wilson LM, Malas M, Qazi U, Haberl E, Bass EB, Zenilman J, Lazarus G. Comparative effectiveness of advanced wound dressings for patients with chronic venous leg ulcers: A systematic review. Wound Repair Regen 2014; 22:193-204. [DOI: 10.1111/wrr.12151] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 10/10/2013] [Indexed: 11/27/2022]
Affiliation(s)
| | - Nisa M. Maruthur
- Department of Medicine; Johns Hopkins University School of Medicine; Baltimore Maryland
- Department of Epidemiology; Johns Hopkins University Bloomberg School of Public Health; Baltimore Maryland
| | - Lisa M. Wilson
- Department of Health Policy and Management; Johns Hopkins University Bloomberg School of Public Health; Baltimore Maryland
| | - Mahmoud Malas
- Department of Surgery; Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Umair Qazi
- Department of Surgery; Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Elisabeth Haberl
- Department of Health Policy and Management; Johns Hopkins University Bloomberg School of Public Health; Baltimore Maryland
| | - Eric B. Bass
- Department of Medicine; Johns Hopkins University School of Medicine; Baltimore Maryland
- Department of Health Policy and Management; Johns Hopkins University Bloomberg School of Public Health; Baltimore Maryland
- Department of Health Systems and Outcomes; Johns Hopkins University School of Nursing; Baltimore Maryland
| | - Jonathan Zenilman
- Department of Epidemiology; Johns Hopkins University Bloomberg School of Public Health; Baltimore Maryland
- Division of Infectious Diseases; Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Gerald Lazarus
- Department of Dermatology; Johns Hopkins University School of Medicine; Baltimore Maryland
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Lazarus G, Valle MF, Malas M, Qazi U, Maruthur NM, Doggett D, Fawole OA, Bass EB, Zenilman J. Chronic venous leg ulcer treatment: future research needs. Wound Repair Regen 2013; 22:34-42. [PMID: 24134795 DOI: 10.1111/wrr.12102] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 07/31/2013] [Indexed: 11/30/2022]
Abstract
The prevalence and costs of chronic venous ulcer care in the US are increasing. The Johns Hopkins University Evidence-Based Practice Center recently completed a systematic review of the comparative effectiveness of advanced wound dressings, antibiotics, and surgical management of chronic venous ulcers. Of 10,066 citations identified in the literature search, only 66 (0.06%) met our liberal inclusion criteria for providing evidence on the effectiveness of interventions for chronic venous ulcers. Based on review of those studies, members of our team and a panel of informed stakeholders identified important research gaps and methodological deficiencies and prioritized specific future research needs. Based on that review, we provide the results of our assessment of future research needs for chronic venous ulcer care. Advanced wound dressings were considered to have the highest priority for future research, followed by venous surgery and antibiotics. An imperative from our assessment is that future research evaluating interventions for chronic venous ulcers meet quality standards. In a time of increasing cost pressure, the wound care community needs to develop high-quality evidence to justify the use of present and future therapeutic modalities.
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Affiliation(s)
- Gerald Lazarus
- Departments of Dermatology, Medicine and Surgery, School of Medicine, Johns Hopkins University, Queenstown, Maryland
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