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Vijayakumar G, Sundaram GA, Kumar SP, Lakshmanan S, Krishnan M, Krishna VK. Comparison of Efficacy of Topical Carica papaya Leaf Extract and Hemocoagulase in Postoperative Wound Healing After Therapeutic Orthodontic Premolar Extractions: a Split Mouth Study. Cureus 2024; 16:e61946. [PMID: 38978880 PMCID: PMC11230618 DOI: 10.7759/cureus.61946] [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: 04/06/2024] [Accepted: 06/08/2024] [Indexed: 07/10/2024] Open
Abstract
Introduction Postoperative wound healing is the most important factor in the outcome of any surgical procedure. Wound healing is a dynamic process involving inflammation, neovascularization, granulation, fibroblast proliferation, re-epithelization, and remodeling. It repairs tissue integrity, restoring the body's natural defense barrier. A hastened wound healing will help in the quicker re-establishment of the body's homeostasis. Carica papaya includes vital nutrients and bioactive substances such as minerals, vitamins, and antioxidants. Its primary active ingredient papain causes the enzymatic debridement of wounds. Hemocoagulase is a thrombin-like serine protease that is mostly employed for its procoagulant and wound-healing characteristics. It is derived from the venom of Bothrops species of snakes. This study aims to compare the wound-healing properties of topical Carica papaya leaf extract and Hemocoagulase after dental extractions. Materials & Methods For 48 patients requiring bilateral therapeutic dental extraction for orthodontic intervention, Carica papaya leaf extract (Caripill 275mg/5ml) was topically applied to the extraction socket on one side, and Hemocoagulase 0.2 CU solution (Botroclot) was applied to the extraction socket on the other side. The bilateral premolars were extracted for orthodontic treatment under local anesthesia. Patients were asked to apply the solution topically twice daily for seven days and were called for review on the seventh day. The assessment of the efficacy of both solutions in post-operative wound healing was the objective of the study. Healing was assessed by using a blinded single observer for all patients using Landry's healing index. Results A total of 48 subjects with 96 sites completed the study, with a mean age of 15.4 years. The study population consisted of 24 males and 24 females, which were evenly distributed among the two study groups. On comparison of wound healing index (WHI) scores between the two groups using the Wilcoxon signed rank test, Group A had a significantly higher mean rank than Group B with regards to the wound healing index score, and the results were statistically significant (p = 0.037). Conclusion It can be concluded from the study that Carica papaya leaf extract showed better wound healing in post-extraction sockets compared to Hemocoagulase. This study presents the promising use of natural extracts such as Carica papaya in wound healing because they are easily accessible to patients, more economical, and have no adverse reactions. More studies that focus on natural extracts to promote wound healing are required in the future.
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Affiliation(s)
- Goutham Vijayakumar
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Gidean A Sundaram
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Santhosh P Kumar
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Saravanan Lakshmanan
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Murugesan Krishnan
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Vinod K Krishna
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
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Janke TM, Kozon V, Barysch M, Valiukeviciene S, Rackauskaite L, Reich A, Stępień K, Jankechova M, van Montfrans C, Amesz S, Conde Montero E, Augustin M, Blome C. How does a chronic wound change a patient's social life? A European survey on social support and social participation. Int Wound J 2023; 20:4138-4150. [PMID: 37475498 PMCID: PMC10681541 DOI: 10.1111/iwj.14309] [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: 05/12/2023] [Accepted: 06/28/2023] [Indexed: 07/22/2023] Open
Abstract
Chronic wounds can severely limit patient's social life. This cross-sectional study investigated quantitatively social support of patients with chronic wounds, its association with health-related quality of life as well as qualitatively changes in social participation of these patients. Overall, 263 patients from seven countries participated. The most frequent wound class was leg ulcer (49.2%). Results revealed generally high levels of social support (mean global score: 5.5) as measured with the Multidimensional Scale of Perceived Social Support. However, individuals differed considerably (range 1.0-7.0). All dimensions of social support differed by patients' family and living situations (p < 0.001 to p = 0.040) and were positively correlated with generic health-related quality of life (r = 0.136-0.172). Having children, living with others and being in a relationship were significant predictors of having higher global social support. Patients reported great support from family members. Many participants reported no changes in relationships with friends. Wound care managers took an important role and provided additional emotional support. Patients reported a range of discontinued activities. Despite the high overall level of social support, inter-individual differences should be acknowledged. The importance of family carers should be acknowledged to be able to reduce caregiver burden and to ensure high-qualitative wound care.
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Affiliation(s)
- Toni Maria Janke
- Institute for Health Services Research in Dermatology and Nursing (IVDP)University Medical Center Hamburg‐Eppendorf (UKE)HamburgGermany
| | - Vlastimil Kozon
- Society Wound Diagnosis and Wound Management AustriaVienna Medical AcademyViennaAustria
| | - Marjam Barysch
- Department of DermatologyUniversity Hospital ZurichZürichSwitzerland
| | - Skaidra Valiukeviciene
- Department of Skin and Venereal Diseases, Lithuanian University of Health SciencesHospital of Lithuanian University of Health Sciences Kauno KlinikosKaunasLithuania
| | - Laura Rackauskaite
- Department of Skin and Venereal Diseases, Lithuanian University of Health SciencesHospital of Lithuanian University of Health Sciences Kauno KlinikosKaunasLithuania
| | - Adam Reich
- Department of Dermatology, Institute of Medical SciencesMedical College of Rzeszow UniversityRzeszówPoland
| | - Katarzyna Stępień
- Department of Dermatology, Institute of Medical SciencesMedical College of Rzeszow UniversityRzeszówPoland
| | - Monika Jankechova
- Faculty of Health and Social Work St. Ladislaw in Nove ZamkyUniversity of Health and Social Work St. Elisabeth in BratislavaBratislavaSlovakia
| | | | - Stella Amesz
- Department of Health Sciences, Section of Nursing ScienceUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
| | - Elena Conde Montero
- DermatologyHospital Universitario Infanta Leonor y Virgen de la TorreMadridSpain
| | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP)University Medical Center Hamburg‐Eppendorf (UKE)HamburgGermany
| | - Christine Blome
- Institute for Health Services Research in Dermatology and Nursing (IVDP)University Medical Center Hamburg‐Eppendorf (UKE)HamburgGermany
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Gwilym BL, Mazumdar E, Naik G, Tolley T, Harding K, Bosanquet DC. Initial Reduction in Ulcer Size As a Prognostic Indicator for Complete Wound Healing: A Systematic Review of Diabetic Foot and Venous Leg Ulcers. Adv Wound Care (New Rochelle) 2023; 12:327-338. [PMID: 35343244 DOI: 10.1089/wound.2021.0203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Significance: Percent area reduction (PAR) is commonly reported in trials including diabetic foot ulcers (DFUs) and venous leg ulcers (VLUs). It is unclear how well PAR performs as a surrogate marker for complete wound closure. This review aimed to summarize all available evidence evaluating PAR as a predictor of complete DFU and VLU healing. Recent Advances: A review searching the CENTRAL, MEDLINE, EMBASE, and EMCARE databases was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Randomized-controlled trials and observational studies reporting PAR and any measure of its predictive ability were included. Outcomes included performance measures of PAR, timing of PAR, outcome measurement, and specific PAR cutoffs. Critical Issues: Meta-analysis was not possible due to high variability in wound duration at study start (2-48 weeks), PAR timing (2-8 weeks), PAR cutoff (-3% to 90%; determined post hoc in most studies), and outcome assessment (10-24 weeks). Six studies (21,430 DFU patients) report PAR as having acceptable to outstanding discriminatory ability (C-statistic 0.720-0.910). Five studies (29,775 VLU patients) report PAR as having poor to excellent discriminatory ability (C-statistic 0.680-0.830). One study (241 DFU and VLU patients) reports PAR sensitivity and specificity of 58.5% and 90.5%, respectively. All studies were determined to have high risk of bias. Future Directions: Despite promising discriminatory ability, most studies report post hoc analysis of patients in randomized trials, are highly heterogenous in study design, and have high risk of bias. There is scant evidence to support PAR in isolation as a surrogate for complete DFU or VLU healing in routine clinical practice.
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Affiliation(s)
- Brenig Llwyd Gwilym
- South East Wales Vascular Network, Royal Gwent Hospital, Newport, United Kingdom
| | - Eshan Mazumdar
- Welsh Wound Innovation Centre (WWIC), Pontyclun, Wales, United Kingdom
| | - Gurudutt Naik
- Welsh Wound Innovation Centre (WWIC), Pontyclun, Wales, United Kingdom
| | - Thomas Tolley
- South East Wales Vascular Network, Royal Gwent Hospital, Newport, United Kingdom
| | - Keith Harding
- Welsh Wound Innovation Centre (WWIC), Pontyclun, Wales, United Kingdom
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Derwin R, Patton D, Strapp H, Moore Z. Wound pH and temperature as predictors of healing: an observational study. J Wound Care 2023; 32:302-310. [PMID: 37094930 DOI: 10.12968/jowc.2023.32.5.302] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
OBJECTIVE The aim of this study was to measure wound pH, wound temperature and wound size together to gain further understanding of their impact as predictors of wound healing outcomes. METHOD This study employed a quantitative non-comparative, prospective, descriptive observational design. Participants with both acute and hard-to-heal (chronic) wounds were observed weekly for four weeks. Wound pH was measured using pH indicator strips, wound temperature was measured using an infrared camera and wound size was measured using the ruler method. RESULTS Most of the 97 participants (65%, n=63) were male; participant's ages ranged between 18 and 77 years (mean: 42±17.10. Most of the wounds observed were surgical 60%, (n=58) and 72% (n=70) of the wounds were classified as acute, with 28% (n=27) classified as hard-to-heal wounds. At baseline, there was no significant difference in pH between acute and hard-to-heal wounds; overall the mean pH was 8.34±0.32, mean temperature was 32.86±1.78°C) and mean wound area was 910.50±1132.30mm2. In week 4, mean pH was 7.71±1.11, mean temperature was 31.90±1.76°C and mean wound area was 339.90±511.70mm2. Over the study follow-up period, wound pH ranged from 5-9, from week 1 to week 4, mean pH reduced by 0.63 units from 8.34 to 7.71. Furthermore, there was a mean 3% reduction in wound temperature and a mean 62% reduction in wound size. CONCLUSION The study demonstrated that a reduction in pH and temperature was associated with increased wound healing as evidenced by a corresponding reduction in wound size. Thus, measuring pH and temperature in clinical practice may provide clinically meaningful data pertaining to wound status.
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Affiliation(s)
- Rosemarie Derwin
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin
| | - Declan Patton
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin
- Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
- Faculty of Science, Medicine and Health, University of Wollongong, Australia
| | | | - Zena Moore
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin
- School of Nursing & Midwifery, Griffith University, Queensland, Australia
- School of Health Sciences, Faculty of Life and Health Sciences Ulster University, Northern Ireland
- Cardiff University, Cardiff, Wales
- Department of Nursing, Fakeeh College for Medical Sciences, Jeddah, KSA
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Belgium
- Lida Institute, Shanghai, China
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Derwin R, Patton D, Strapp H, Moore Z. The effect of inflammation management on pH, temperature, and bacterial burden. Int Wound J 2023; 20:1118-1129. [PMID: 36251505 PMCID: PMC10031221 DOI: 10.1111/iwj.13970] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 11/28/2022] Open
Abstract
The aim of this feasibility study was to investigate the impact of inflammation management on wound pH, temperature, and bacterial burden, using the principles of TIME and Wound Bed Preparation. A quantitative non-comparative, prospective, descriptive observational design. Following ethical approval, 26 participants with 27 wounds of varying aetiologies were observed twice weekly for 2 weeks. Wounds were treated with cleansing, repeated sharp debridement, and topical cadexomer iodine. Wound pH (pH indicator strips), temperature (infrared camera), bacterial burden (fluorescence imaging) and size (ruler method) was monitored at each visit. The mean age of all participants was 47 years (SD: 20.3 years), and 79% (n = 19) were male, and most wounds were acute (70%; n = 19) and included surgical and trauma wounds, the remaining (30%; n = 8) were chronic and included vascular ulcers and non-healing surgical wounds. Mean wound duration was 53.88 days (SD: 64.49 days). Over the follow up period, pH values ranged from 6 to 8.7, temperature (centre spot) ranged from 28.4°C to 36.4°C and there was an average 39% reduction in wound size. Inflammation management had a positive effect on pH, temperature, bacterial burden, and wound size. This study demonstrated that it was feasible to practice inflammation management using a structured approach to enhance wound outcomes.
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Affiliation(s)
- Rosemarie Derwin
- School of Nursing and Midwifery, Faculty of Medicine and Health, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland
| | - Declan Patton
- School of Nursing and Midwifery, Faculty of Medicine and Health, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland
- Department of Nursing, Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Helen Strapp
- Department of Surgery, Tallaght University Hospital, Dublin, Ireland
| | - Zena Moore
- School of Nursing and Midwifery, Faculty of Medicine and Health, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
- School of Health Sciences, Faculty of Life and Health Sciences Ulster University, Coleraine, UK
- School of Nursing and Midwifery, Cardiff University, Cardiff, UK
- Department of Nursing, Fakeeh College for Medical Sciences, Jeddah, Kingdom of Saudi Arabia
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Departmnet of Nursing, Lida Institute, Shanghai, China
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Barrett S, Rippon MJ, Rogers AA. [Treatment of 52 patients with a self-adhesive siliconised superabsorbent dressing: a multicentre observational study]. Khirurgiia (Mosk) 2023:59-71. [PMID: 36748871 DOI: 10.17116/hirurgia202302159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To provide 'in use' clinical data to support exudate management in patients with moderately to highly exuding wounds with bordered superabsorbent wound dressing with a silicone adhesive interface Zetuvit Plus Silicone Border (Paul Hartmann Ltd., Germany). MATERIALS AND METHODS This study was an open-labelled non-comparative study. Patients included in the study were selected by the clinical investigator(s) according to whether the patient required a dressing for the management of moderately to highly exuding wounds such as pressure ulcers, diabetic foot ulcers, venous leg ulcer and arterial ulcers The patients were treated with A superabsorbent sterile wound dressing with bordered superabsorbent wound dressing with a silicone adhesive interface Zetuvit Plus Silicone Border (Paul Hartmann Ltd., Germany). RESULTS The Zetuvit Plus Silicone Border dressing had met the clinical objectives relating to exudate management, affirmed by the health professionals with a yes response in 94% of cases. Additionally, the health professionals rated the handling of exudate as excellent/good (78%) and most (80%) reported that they would use the superabsorbent wound dressing with a silicone adhesive interface again. Allied to this was the fact that the dressing improved the wound edge and periwound skin conditions (29% and 36% of patients, respectively). The dressing retained its position in 72% of patients. For wear time, the largest proportion of dressing changes, both pre-study and during the evaluation period, was every third day (45% and 44%, respectively). But there was a shift to extended wear time with use of the superabsorbent wound dressing with a silicone adhesive interface with 72% of patients' dressing changes being every third day or longer. CONCLUSION The superabsorbent silicone border dressing was successful in managing wound exudate in moderately to highly exuding wounds and consequently this had a beneficial impact on the wound edge and periwound skin. Overall, there was a positive effect on wound bed preparation and in turn the healing response was progressive.
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Affiliation(s)
- S Barrett
- Humber NHS Foundation Trust, U, Humber NHS Foundation Trust, UK
| | - M J Rippon
- Huddersfield University, Huddersfield, UK.,Daneriver Consultancy Ltd, Holmes Chapel, UK
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Quality of Care and Cost-effectiveness: Optimizing Wound Care in the Netherlands. Adv Skin Wound Care 2022; 35:669-673. [PMID: 36179322 DOI: 10.1097/01.asw.0000874164.88278.70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Previously, the authors implemented a "fast-track protocol" in the Netherlands to shorten the time to referral for patients when diagnostic testing was deemed necessary given suspicion of underlying pathology preventing wound healing. This subanalysis of the cross-sectional study presents the cost reduction of using that fast-track protocol. METHODS The cross-sectional study data were collected at the Alrijne Wound Centre between January 2017 and January 2018 and included patients from two general practitioner practices and a large home-care organization who had a new occurrence of wounds. The cost-effectiveness analysis consisted of an analysis of the mean reduction in care, wound dressing materials, and reduction in unnecessary hospital referrals. RESULTS In 2017, a total of 415 patients received wound care of the general practitioners or home-care organization. By using the "fast-track" protocol, costs were reduced in all areas. After extrapolation, the minimum mean cost reduction in wound care was €129,949,638; on wound dressings, it was €2,623,920, and on the reduction of unnecessary hospital referrals, the average recovery was €2,436,000. CONCLUSIONS Prompt triage, analyses, and treatment of underlying causes by specialized doctors in a multidisciplinary setting offer enormous potential for cost savings. The conservative estimate is that approximately €135,000,000 to €293,000,000 can be saved in annual healthcare costs in the Netherlands using this protocol.
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8
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Landau Z, Whitacre KL, Leewood C, Hawkins J, Wachuku CD. Utilization of a topical autologous blood clot for treatment of pressure ulcers. Int Wound J 2022; 20:806-812. [PMID: 36054532 PMCID: PMC9927894 DOI: 10.1111/iwj.13927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/22/2022] [Accepted: 07/25/2022] [Indexed: 11/28/2022] Open
Abstract
Management and treatment of pressure ulcers (PUs) are met with great difficulty due to various factors that cause vulnerability of the soft tissue such as location, limited mobility, increased friction and shearing forces, as well as other comorbidities that may delay or halt wound healing. The topical autologous blood clot therapy (TABCT) is a point-of-care treatment used as a blood clot to assist in recreating and repairing the extracellular matrix (ECM). The mechanism of action consists of reconstruction of the ECM by incorporating into the ulcer, providing protection from further external destruction, while assisting in advancement through the wound healing phases via interaction of necessary growth factors, mediators, and chemokines. This study aims to assess the efficacy of the TABCT in the treatment of PUs in comparison to standard of care (SOC) treatment. Twenty-four patients, 18 years or older, with PUs ranging from stage 1 to 4, were included in this study. TABCT was created by using the patient's own peripheral blood in a point of care setting. Efficacy in percent area reduction (PAR) on weeks 4 and 12 with TABCT over SOC was assessed. Treatment using TABCT in PUs resulted in 77.9% of the patients achieving a 50% PAR on week 4. The mean PAR on week 12 was 96.23% with 45% of the wounds treated with TABCT achieving complete wound closure. TABCT exhibited efficacy in PAR of PUs. In addition, TABCT use prompted granulation tissue formation over vital structures, such as bone, which is often present in later stage PUs. The potential of bringing an affordable, cost-effective, advanced biologic bedside treatment that is efficacious in resolution of these complex wounds has the potential to drastically reduce the burden of treatment on the health system.
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Affiliation(s)
- Zvi Landau
- Medical Nursing and Rehibilitation CenterBeit HadarAshdodIsrael
| | | | - Charles Leewood
- Center for Hyperbarics and Wound CareCandler HospitalSavannahGeorgiaUSA
| | - Jessie Hawkins
- Clinical Research DepartmentFranklin Health Research CenterFranklinTennesseeUSA
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Ousey K, Stephenson J, Blackburn J. Sub-epidermal moisture assessment as an adjunct to visual assessment in the reduction of pressure ulcer incidence. J Wound Care 2022; 31:208-216. [PMID: 35199598 DOI: 10.12968/jowc.2022.31.3.208] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To assess the effectiveness of sub-epidermal moisture (SEM) assessment technology as an adjunct to visual assessment to reduce pressure ulcer (PU) incidence alongside standard PU care pathways. METHOD Data were obtained from wards located within 28 institutions in the UK, Canada, Belgium, Spain and Ireland. At each ward, the proportion of patients scanned who were observed to have one or more PUs of Category 2 or above during a pre-Pressure Ulcer Reduction Programme (PURP) implementation period starting between November 2017 and July 2018 was recorded. The proportion of patients scanned who were observed to have one or more PUs of Category 2 or above during a post-PURP implementation period starting between November 2018 and July 2019 was also recorded. A meta-analysis was conducted on the data using wards as the unit of analysis, to facilitate overall estimate of the PURP. A sensitivity study was also conducted to assess the sensitivity of results to data from specific institutions. RESULTS A synthesised estimate of the overall relative risk (RR) was calculated to be 0.38 (95% confidence interval 0.26 to 0.56). Hence the risk of PU in the post-PURP cohort was about one-third that of the corresponding risk in the pre-PURP cohort. The sensitivity analysis revealed no evidence that any individual ward exerted excessive influence on the findings. CONCLUSION The analysis has revealed strong evidence that implementation of the PURP was associated with reduction in incidence of Category 2 or above PUs across a wide range of clinical settings.
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Affiliation(s)
- Karen Ousey
- School of Human & Health Sciences, University of Huddersfield, UK.,Institute of Skin Integrity and Infection Prevention, University of Huddersfield, UK
| | - John Stephenson
- School of Human & Health Sciences, University of Huddersfield, UK.,Institute of Skin Integrity and Infection Prevention, University of Huddersfield, UK
| | - Joanna Blackburn
- School of Human & Health Sciences, University of Huddersfield, UK.,Institute of Skin Integrity and Infection Prevention, University of Huddersfield, UK
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Bosanquet DC, Laloo R, Sanders AJ, Ruge F, Lane J, Morris CA, Jiang WG, Harding KG. Sensitivity of the Wound Edge Gene Signature "WD14" in Responding to Clinical Change: A Longitudinal Cohort Study. INT J LOW EXTR WOUND 2021:15347346211056786. [PMID: 34791919 DOI: 10.1177/15347346211056786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: WounD14 (WD14) gene signature is a recently developed tool derived from genetic interrogation of wound edge biopsies of chronic venous leg ulcers to identify heard-to-heal wounds and enable clinicians to target aggressive therapies to promote wound healing. This study aimed to evaluate if changes in wound clinical healing status were detected by the WD14 gene signature over time as this is currently poorly understood. Material and methods: WD14 was developed through gene screening and subsequent validation in 3 patient cohorts involving 85 consecutive patients with chronic venous leg ulcers referred to a tertiary wound healing unit. Patients underwent a wound edge biopsy to interrogate for a "healing" or "non-healing" genotype. A smaller cohort (18%) underwent a second biopsy, which comprised this pilot cohort reported herein. Twelve weeks following biopsy, wounds were clinically assessed for healing status based on reduction in size and compared to WD14 genotype. Results: Sequential biopsies and WD14 scores were derived from 16 patients. WD14 signature predicted wound healing status among this cohort at either visit (32 wound edge biopsies) with a positive predictive value (PPV) of 85.2% (95% CI 74.1%-92.0%) and negative predictive value (NPV) of 80.0% (95% CI 34.2%-96.9%). A total of 6 wounds underwent altered clinical status between the 2 visits. In this cohort, WD14 has a PPV of 66.7% (95% CI 47.3%-81.7%) and NPV of 100%. Conclusion: Although the WD14 gene signature did change with wound healing status, larger studies are required to precisely clarify its role and ability to prognosticate wounds of differing clinical status over time.
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Affiliation(s)
| | - Ryan Laloo
- Leeds Vascular Institute, 4472Leeds General Infirmary, Leeds, UK
| | - Andrew J Sanders
- Cardiff China Medical Research Collaborative, 2111Cardiff University School of Medicine, Cardiff, UK
| | - Fiona Ruge
- Cardiff China Medical Research Collaborative, 2111Cardiff University School of Medicine, Cardiff, UK
| | - Jane Lane
- Cardiff China Medical Research Collaborative, 2111Cardiff University School of Medicine, Cardiff, UK
| | - Ceri A Morris
- Clinical Innovation Hub, 2111Cardiff University, Cardiff, UK
| | - Wen G Jiang
- Cardiff China Medical Research Collaborative, 2111Cardiff University School of Medicine, Cardiff, UK
| | - Keith G Harding
- Clinical Innovation Hub, 2111Cardiff University, Cardiff, UK
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11
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Paleczny J, Junka A, Brożyna M, Dydak K, Oleksy-Wawrzyniak M, Ciecholewska-Juśko D, Dziedzic E, Bartoszewicz M. The High Impact of Staphylococcus aureus Biofilm Culture Medium on In Vitro Outcomes of Antimicrobial Activity of Wound Antiseptics and Antibiotic. Pathogens 2021; 10:pathogens10111385. [PMID: 34832540 PMCID: PMC8626063 DOI: 10.3390/pathogens10111385] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/14/2021] [Accepted: 10/22/2021] [Indexed: 12/19/2022] Open
Abstract
The staphylococcal biofilm-based infections of wounds still pose a significant therapeutical challenge. Treated improperly, they increase the risk of limb amputation or even death of the patient. The present algorithms of infected wound treatment include, among others, the application of antiseptic substances. In vitro wound biofilm models are applied in order to scrutinize their activity. In the present work, using a spectrum of techniques, we showed how the change of a single variable (medium composition) in the standard in vitro model translates not only to shift in staphylococcal biofilm features but also to the change of efficacy of clinically applied wound antimicrobials such as octenidine, polyhexamethylene biguanide, chlorhexidine, hypochlorite solutions, and locally applied gentamycin. The data presented in this study may be of a pivotal nature, taking into consideration the fact that results of in vitro analyses are frequently used to propagate application of specific antimicrobials in hospitals and ambulatory care units.
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Affiliation(s)
- Justyna Paleczny
- Department of Pharmaceutical Microbiology and Parasitology, Faculty of Pharmacy, Wroclaw Medical University, 50-556 Wroclaw, Poland; (J.P.); (M.B.); (K.D.); (M.O.-W.); (M.B.)
| | - Adam Junka
- Department of Pharmaceutical Microbiology and Parasitology, Faculty of Pharmacy, Wroclaw Medical University, 50-556 Wroclaw, Poland; (J.P.); (M.B.); (K.D.); (M.O.-W.); (M.B.)
- Correspondence:
| | - Malwina Brożyna
- Department of Pharmaceutical Microbiology and Parasitology, Faculty of Pharmacy, Wroclaw Medical University, 50-556 Wroclaw, Poland; (J.P.); (M.B.); (K.D.); (M.O.-W.); (M.B.)
| | - Karolina Dydak
- Department of Pharmaceutical Microbiology and Parasitology, Faculty of Pharmacy, Wroclaw Medical University, 50-556 Wroclaw, Poland; (J.P.); (M.B.); (K.D.); (M.O.-W.); (M.B.)
| | - Monika Oleksy-Wawrzyniak
- Department of Pharmaceutical Microbiology and Parasitology, Faculty of Pharmacy, Wroclaw Medical University, 50-556 Wroclaw, Poland; (J.P.); (M.B.); (K.D.); (M.O.-W.); (M.B.)
| | - Daria Ciecholewska-Juśko
- Department of Microbiology and Biotechnology, Faculty of Biotechnology and Animal Husbandry, West Pomeranian University of Technology, 70-311 Szczecin, Poland;
| | - Ewelina Dziedzic
- Faculty of Medicine, Lazarski University, 02-662 Warszawa, Poland;
| | - Marzenna Bartoszewicz
- Department of Pharmaceutical Microbiology and Parasitology, Faculty of Pharmacy, Wroclaw Medical University, 50-556 Wroclaw, Poland; (J.P.); (M.B.); (K.D.); (M.O.-W.); (M.B.)
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12
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Ricci E, Pittarello M. Hard-to-heal ulcers treated with hypochlorous acid oxidising solution and standard of care: a 32-week follow-up. J Wound Care 2021; 30:840-844. [PMID: 34644135 DOI: 10.12968/jowc.2021.30.10.840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Immediately following a two-year prospective case series in which the wounds of 60 patients with hard-to-heal ulcers were treated with a hypochlorous acid oxidising solution (AOS) in addition to standard of care (SoC) for 70 days (T0-T70), a subset of 31 patients (51.7%) whose wounds had not fully healed by T70 opted to continue with treatment for a further 22 weeks (days T70-T224, a total treatment time of 32 weeks (224 days). The objective was to provide long-term evidence on the clinical performance and safety of AOS when used in association with the usual SoC in patients with stalled, hard-to-heal ulcers of various aetiologies. METHOD As per the main study, wounds were formally assessed by the study lead at 28 days (±14 days, depending on patient attendance). Parameters assessed at fortnightly visits included area, depth and duration of ulcer; pain; wound bed preparation (WBP) score; and infection status. Wounds were managed in accordance with the SoC protocol. RESULTS By T224, 35.5% (n=11) of wounds healed completely and 83.9% showed some types of improvement. All wounds were free of infection and colonisation, the WBP score improved (100% A1-A2 at T196), and pain scores fell. Use of AOS in combination with several types of dressing (SoC) for such a long period confirmed a good safety profile. CONCLUSION This follow-up evaluation, coupled with the primary study, suggests that AOS might represent a valuable therapeutic addition for the management of hard-to-heal ulcers for long periods of treatment. DECLARATION OF INTEREST ER worked as a consultant for APR Applied Pharma Research S.A. The authors have no other conflicts of interest.
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Affiliation(s)
- Elia Ricci
- St Luca Clinic, Department of Surgery A, Pecetto Torinese (TO), Piedmont, Italy
| | - Monica Pittarello
- St Luca Clinic, Department of Surgery A, Pecetto Torinese (TO), Piedmont, Italy
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13
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Pantoja JL, Patel RP, Ulloa JG, Farley SM. Deep venous stenting improves healing of lower extremity venous ulcers. Ann Vasc Surg 2021; 78:239-246. [PMID: 34416283 DOI: 10.1016/j.avsg.2021.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 04/24/2021] [Accepted: 05/09/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Long standing, recalcitrant venous ulcers fail to heal despite standard compression therapy and wound care. Stenting of central veins has been reported to assist in venous ulcer healing. This study reports outcomes of deep venous stenting for central venous obstruction in patients with recalcitrant venous ulcers at a single comprehensive wound care center. METHODS A single center retrospective analysis was conducted of patients with CEAP (Clinical, Etiology, Anatomy, and Pathophysiology) 6 disease that had undergone deep venous stenting in addition to wound care and compression therapy. Intra-operative details, wound healing, and stent patency rates were recorded. Stent patency and intra-operative details were compared between the healed and unhealed groups. RESULTS Between 2010 and 2019, 15 patients met inclusion criteria (mean age: 63 years old, 12 males). Pre-operative mean wound area was 14.1 cm2 with mean wound duration of 30 months. 93% of patients healed the ulcers at mean healing time of 10.6 months. Wound recurrence rate was 57% with mean recurrence time of 14.8 months. Ten patients presented with an inferior vena cava (IVC) filter, 4 in the healed group and 6 in the unhealed group. The common iliac vein was stented in all patients. Extension into the IVC was required in 4, the common femoral vein in 11, and femoral vein in 2 patients. The average stent length was 190cm. During the follow-up period, primary patency rates in healed patients (mean follow-up time: 19.2 months) was 83% and 59% in the unhealed group (mean follow-up time: 36.6 months); secondary patency rates were 83% and 89%, respectively. CONCLUSIONS In patients with recalcitrant venous ulcers with central venous obstruction, deep venous stenting resulted in a high rate of healing. However, a prolonged 10 month healing time was observed and despite high stent patency, wound recurrence rate was high.
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Affiliation(s)
- Joe L Pantoja
- University of California Los Angeles David Geffen School of Medicine, Division of Vascular Surgery, Los Angeles, CA.
| | - Rhusheet P Patel
- University of California Los Angeles David Geffen School of Medicine, Division of Vascular Surgery, Los Angeles, CA
| | - Jesus G Ulloa
- University of California Los Angeles David Geffen School of Medicine, Division of Vascular Surgery, Los Angeles, CA
| | - Steven M Farley
- University of California Los Angeles David Geffen School of Medicine, Division of Vascular Surgery, Los Angeles, CA
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14
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Bull RH, Staines KL, Collarte AJ, Bain DS, Ivins NM, Harding KG. Measuring progress to healing: A challenge and an opportunity. Int Wound J 2021; 19:734-740. [PMID: 34374499 PMCID: PMC9013582 DOI: 10.1111/iwj.13669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/22/2021] [Accepted: 07/25/2021] [Indexed: 11/28/2022] Open
Abstract
Complete healing is problematic as an endpoint for evaluating interventions for wound healing. The great heterogeneity of wounds makes it difficult to match groups, and this is only possible with multivariate stratification and/or very large numbers of subjects. The substantial time taken for wounds to heal necessitates a very lengthy study. Consequently, high quality randomised controlled trials demonstrating an effect of an intervention to a satisfactory level of statistical significance and with a satisfactory level of generalisability are extremely rare. This study determines that the healing of venous leg ulcers receiving multi‐component compression bandaging follows a linear trajectory over a 4‐week period, as measured by gross area healed, percentage area healed, and advance of the wound margin. The linear trajectories of these surrogates make it possible to identify an acceleration in healing resulting from an intervention, and allows self‐controlled or crossover designs with attendant advantages of statistical power and speed. Of the metrics investigated, wound margin advance was the most linear, and was also independent of initial ulcer size.
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Affiliation(s)
| | - Karen Louise Staines
- Education and Research/Clinical Lead Wound Care, Accelerate CIC, Centenary Wing, St Joseph's Hospice, London, UK
| | - Agnes Juguilon Collarte
- North West Division (Central London, Hammersmith & Fulham and West London), St Charles Centre for Health & Wellbeing, London, UK
| | | | | | - Keith Gordon Harding
- Wound Healing Research, WWII Ltd (Welsh Wound Innovation Initiative), Welsh Wound Innovation Centre, Pontyclun, UK
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15
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Zou ML, Teng YY, Wu JJ, Liu SY, Tang XY, Jia Y, Chen ZH, Zhang KW, Sun ZL, Li X, Ye JX, Xu RS, Yuan FL. Fibroblasts: Heterogeneous Cells With Potential in Regenerative Therapy for Scarless Wound Healing. Front Cell Dev Biol 2021; 9:713605. [PMID: 34354997 PMCID: PMC8329665 DOI: 10.3389/fcell.2021.713605] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 06/28/2021] [Indexed: 12/04/2022] Open
Abstract
In recent years, research on wound healing has become increasingly in-depth, but therapeutic effects are still not satisfactory. Occasionally, pathological tissue repair occurs. Influencing factors have been proposed, but finding the turning point between normal and pathological tissue repair is difficult. Therefore, we focused our attention on the most basic level of tissue repair: fibroblasts. Fibroblasts were once considered terminally differentiated cells that represent a single cell type, and their heterogeneity was not studied until recently. We believe that subpopulations of fibroblasts play different roles in tissue repair, resulting in different repair results, such as the formation of normal scars in physiological tissue repair and fibrosis or ulcers in pathological tissue repair. It is also proposed that scarless healing can be achieved by regulating fibroblast subpopulations.
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Affiliation(s)
- Ming-Li Zou
- Wuxi Clinical Medicine School of Integrated Chinese and Western Medicine, Nanjing University of Chinese Medicine, Wuxi, China
| | - Ying-Ying Teng
- Institute of Integrated Traditional Chinese and Western Medicine, The Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Jun-Jie Wu
- Institute of Integrated Traditional Chinese and Western Medicine, The Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Si-Yu Liu
- Wuxi Clinical Medicine School of Integrated Chinese and Western Medicine, Nanjing University of Chinese Medicine, Wuxi, China
| | - Xiao-Yu Tang
- Wuxi Clinical Medicine School of Integrated Chinese and Western Medicine, Nanjing University of Chinese Medicine, Wuxi, China
| | - Yuan Jia
- Wuxi Clinical Medicine School of Integrated Chinese and Western Medicine, Nanjing University of Chinese Medicine, Wuxi, China
| | - Zhong-Hua Chen
- Institute of Integrated Traditional Chinese and Western Medicine, The Third Hospital Affiliated to Nantong University, Wuxi, China
| | - Kai-Wen Zhang
- Wuxi Clinical Medicine School of Integrated Chinese and Western Medicine, Nanjing University of Chinese Medicine, Wuxi, China
| | - Zi-Li Sun
- Wuxi Clinical Medicine School of Integrated Chinese and Western Medicine, Nanjing University of Chinese Medicine, Wuxi, China
| | - Xia Li
- Institute of Integrated Traditional Chinese and Western Medicine, The Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Jun-Xing Ye
- Institute of Integrated Traditional Chinese and Western Medicine, The Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Rui-Sheng Xu
- Institute of Integrated Traditional Chinese and Western Medicine, The Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Feng-Lai Yuan
- Wuxi Clinical Medicine School of Integrated Chinese and Western Medicine, Nanjing University of Chinese Medicine, Wuxi, China.,Institute of Integrated Traditional Chinese and Western Medicine, The Affiliated Hospital of Jiangnan University, Wuxi, China
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Pârvănescu (Pană) RD, Watz CG, Moacă EA, Vlaia L, Marcovici I, Macașoi IG, Borcan F, Olariu I, Coneac G, Drăghici GA, Crăiniceanu Z, Flondor (Ionescu) D, Enache A, Dehelean CA. Oleogel Formulations for the Topical Delivery of Betulin and Lupeol in Skin Injuries-Preparation, Physicochemical Characterization, and Pharmaco-Toxicological Evaluation. Molecules 2021; 26:molecules26144174. [PMID: 34299450 PMCID: PMC8305438 DOI: 10.3390/molecules26144174] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 07/04/2021] [Accepted: 07/05/2021] [Indexed: 12/26/2022] Open
Abstract
The skin integrity is essential due to its pivotal role as a biological barrier against external noxious factors. Pentacyclic triterpenes stand as valuable plant-derived natural compounds in the treatment of skin injuries due to their anti-inflammatory, antioxidant, antimicrobial, and healing properties. Consequently, the primary aim of the current investigation was the development as well as the physicochemical and pharmaco-toxicological characterization of betulin- and lupeol-based oleogels (Bet OG and Lup OG) for topical application in skin injuries. The results revealed suitable pH as well as organoleptic, rheological, and textural properties. The penetration and permeation of Bet and Lup oleogels through porcine ear skin as well as the retention of both oleogels in the skin were demonstrated through ex vivo studies. In vitro, Bet OG and Lup OG showed good biocompatibility on HaCaT human immortalized cells. Moreover, Bet OG exerted a potent wound-healing property by stimulating the migration of the HaCaT cells. The in ovo results demonstrated the non-irritative potential of the developed formulations. Additionally, the undertaken in vivo investigation indicated a positive effect of oleogels treatment on skin parameters by increasing skin hydration and decreasing erythema. In conclusion, oleogel formulations are ideal for the local delivery of betulin and lupeol in skin disorders.
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Affiliation(s)
- Ramona Daniela Pârvănescu (Pană)
- Department VIII—Neuroscience, Discipline of Medical Deontology, Bioethics, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 2nd Eftimie Murgu Square, RO-300041 Timisoara, Romania;
| | - Claudia-Geanina Watz
- Department of Pharmaceutical Physics, Faculty of Pharmacy, “Victor Babeș” University of Medicine and Pharmacy Timisoara, 2nd Eftimie Murgu Square, RO-300041 Timisoara, Romania;
- Research Centre for Pharmaco-Toxicological Evaluation, “Victor Babeș” University of Medicine and Pharmacy, 2nd Eftimie Murgu Square, RO-300041 Timișoara, Romania; (I.M.); (I.G.M.); (G.-A.D.); (D.F.); (C.A.D.)
| | - Elena-Alina Moacă
- Research Centre for Pharmaco-Toxicological Evaluation, “Victor Babeș” University of Medicine and Pharmacy, 2nd Eftimie Murgu Square, RO-300041 Timișoara, Romania; (I.M.); (I.G.M.); (G.-A.D.); (D.F.); (C.A.D.)
- Department of Toxicology and Drug Industry, Faculty of Pharmacy, “Victor Babeș” University of Medicine and Pharmacy Timisoara, 2nd Eftimie Murgu Square, RO-300041 Timisoara, Romania
- Correspondence: (E.-A.M.); (L.V.); Tel.: +40-745-762-600 (E.-A.M.); +40-723-570-499 (L.V.)
| | - Lavinia Vlaia
- Department II—Pharmaceutical Technology, Faculty of Pharmacy, “Victor Babes” University of Medicine and Pharmacy, 2nd Eftimie Murgu Square, RO-300041 Timisoara, Romania; (I.O.); (G.C.)
- Formulation and Technology of Drugs Research Center, “Victor Babes” University of Medicine and Pharmacy, 2nd Eftimie Murgu Square, RO-300041 Timisoara, Romania
- Correspondence: (E.-A.M.); (L.V.); Tel.: +40-745-762-600 (E.-A.M.); +40-723-570-499 (L.V.)
| | - Iasmina Marcovici
- Research Centre for Pharmaco-Toxicological Evaluation, “Victor Babeș” University of Medicine and Pharmacy, 2nd Eftimie Murgu Square, RO-300041 Timișoara, Romania; (I.M.); (I.G.M.); (G.-A.D.); (D.F.); (C.A.D.)
- Department of Toxicology and Drug Industry, Faculty of Pharmacy, “Victor Babeș” University of Medicine and Pharmacy Timisoara, 2nd Eftimie Murgu Square, RO-300041 Timisoara, Romania
| | - Ioana Gabriela Macașoi
- Research Centre for Pharmaco-Toxicological Evaluation, “Victor Babeș” University of Medicine and Pharmacy, 2nd Eftimie Murgu Square, RO-300041 Timișoara, Romania; (I.M.); (I.G.M.); (G.-A.D.); (D.F.); (C.A.D.)
- Department of Toxicology and Drug Industry, Faculty of Pharmacy, “Victor Babeș” University of Medicine and Pharmacy Timisoara, 2nd Eftimie Murgu Square, RO-300041 Timisoara, Romania
| | - Florin Borcan
- Department of Analytical Chemistry, Faculty of Pharmacy, “Victor Babeș” University of Medicine and Pharmacy, 2nd Eftimie Murgu Square, RO-300041 Timișoara, Romania;
| | - Ioana Olariu
- Department II—Pharmaceutical Technology, Faculty of Pharmacy, “Victor Babes” University of Medicine and Pharmacy, 2nd Eftimie Murgu Square, RO-300041 Timisoara, Romania; (I.O.); (G.C.)
- Formulation and Technology of Drugs Research Center, “Victor Babes” University of Medicine and Pharmacy, 2nd Eftimie Murgu Square, RO-300041 Timisoara, Romania
| | - Georgeta Coneac
- Department II—Pharmaceutical Technology, Faculty of Pharmacy, “Victor Babes” University of Medicine and Pharmacy, 2nd Eftimie Murgu Square, RO-300041 Timisoara, Romania; (I.O.); (G.C.)
- Formulation and Technology of Drugs Research Center, “Victor Babes” University of Medicine and Pharmacy, 2nd Eftimie Murgu Square, RO-300041 Timisoara, Romania
| | - George-Andrei Drăghici
- Research Centre for Pharmaco-Toxicological Evaluation, “Victor Babeș” University of Medicine and Pharmacy, 2nd Eftimie Murgu Square, RO-300041 Timișoara, Romania; (I.M.); (I.G.M.); (G.-A.D.); (D.F.); (C.A.D.)
- Department of Toxicology and Drug Industry, Faculty of Pharmacy, “Victor Babeș” University of Medicine and Pharmacy Timisoara, 2nd Eftimie Murgu Square, RO-300041 Timisoara, Romania
| | - Zorin Crăiniceanu
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, “Victor Babeș” University of Medicine and Pharmacy, 2nd Eftimie Murgu Square, RO-300041 Timișoara, Romania;
| | - Daniela Flondor (Ionescu)
- Research Centre for Pharmaco-Toxicological Evaluation, “Victor Babeș” University of Medicine and Pharmacy, 2nd Eftimie Murgu Square, RO-300041 Timișoara, Romania; (I.M.); (I.G.M.); (G.-A.D.); (D.F.); (C.A.D.)
- Department of Toxicology and Drug Industry, Faculty of Pharmacy, “Victor Babeș” University of Medicine and Pharmacy Timisoara, 2nd Eftimie Murgu Square, RO-300041 Timisoara, Romania
| | - Alexandra Enache
- Department VIII—Neuroscience, Discipline of Forensic Medicine, Bioethics, Deontology and Medical Law, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 2nd Eftimie Murgu Square, RO-300041 Timisoara, Romania;
| | - Cristina Adriana Dehelean
- Research Centre for Pharmaco-Toxicological Evaluation, “Victor Babeș” University of Medicine and Pharmacy, 2nd Eftimie Murgu Square, RO-300041 Timișoara, Romania; (I.M.); (I.G.M.); (G.-A.D.); (D.F.); (C.A.D.)
- Department of Toxicology and Drug Industry, Faculty of Pharmacy, “Victor Babeș” University of Medicine and Pharmacy Timisoara, 2nd Eftimie Murgu Square, RO-300041 Timisoara, Romania
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Zhu B, Cao D, Xie J, Li H, Chen Z, Bao Q. Clinical experience of the use of Integra in combination with negative pressure wound therapy: an alternative method for the management of wounds with exposed bone or tendon. J Plast Surg Hand Surg 2021; 55:1-5. [PMID: 33433246 DOI: 10.1080/2000656x.2020.1781140] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The use of Integra has attracted great interest in the treatment of wounds with exposed bone or tendon, which may lead to associated morbidities. However, the use of Integra alone results in poor wound outcomes. We conducted a randomized clinical study to evaluate the combined effects of Integra and negative pressure wound therapy (NPWT). Thirty-six patients with wounds with exposed bone or tendons were treated with Integra alone and with a combination of Integra and NPWT (n = 18 respectively). Negative pressure (125 mm Hg) was applied intermittently till Integra was revascularized. The take rate of Integra and time taken from Integra coverage to skin transplantation was recorded for each case. The average take rate of Integra in the conventional treatment group (Integra with partial packing compression dressings) was lower than that for the new treatment group (Integra with NPWT) (p < 0.001, 95% CI: 6.44-0.20). The mean time period from Integra coverage to skin transplantation was longer for the conventional treatment group than for the new treatment group (p < 0.001, 95% CI: -13.18 to -11.24). The application of NPWT could potentially increase the take rate of Integra and shorten the duration of hospital stay. The use of Integra with NPWT could be a treatment option for wounds with exposed bone or tendon.
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Affiliation(s)
- BangZhong Zhu
- Department of Plastic and Reconstructive Surgery, The Second Affiliated Hospital of AnHui Medical University, Hefei, China
| | - DongSheng Cao
- Department of Plastic and Reconstructive Surgery, The Second Affiliated Hospital of AnHui Medical University, Hefei, China
| | - Juan Xie
- Department of Plastic and Reconstructive Surgery, The Second Affiliated Hospital of AnHui Medical University, Hefei, China
| | - HongHong Li
- Department of Plastic and Reconstructive Surgery, The Second Affiliated Hospital of AnHui Medical University, Hefei, China
| | - ZengHong Chen
- Department of Plastic and Reconstructive Surgery, The Second Affiliated Hospital of AnHui Medical University, Hefei, China
| | - Qiong Bao
- Department of Plastic and Reconstructive Surgery, The Second Affiliated Hospital of AnHui Medical University, Hefei, China
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18
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Barrett S, Rippon M, Rogers AA. Treatment of 52 patients with a self-adhesive siliconised superabsorbent dressing: a multicentre observational study. J Wound Care 2020; 29:340-349. [DOI: 10.12968/jowc.2020.29.6.340] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Objective: To provide ‘in use’ clinical data to support exudate management in patients with moderately to highly exuding wounds with bordered superabsorbent wound dressing with a silicone adhesive interface. Method: This study was an open-labelled non-comparative study. Patients included in the study were selected by the clinical investigator(s) according to whether the patient required a dressing for the management of moderately to highly exuding wounds. Results: The primary aim of this study was to evaluate the clinical objective in relation to exudate handling (moderate to high) with a superabsorbent silicone border dressing (Zetuvit Plus Silicone Border; SAP silicone border dressing; designated RespoSorb Silicone Border in some countries). The SAP border dressing had met the clinical objectives relating to exudate management, affirmed by the health professionals with a yes response in 94% of cases. Additionally, the health professionals rated the handling of exudate as excellent/good (78%) and most (80%) reported that they would use the SAP silicone border dressing again. Allied to this was the fact that the SAP silicone border dressing improved the wound edge and periwound skin conditions (29% and 36% of patients, respectively). Regarding dressing retention, the SAP silicone border dressing retained its position in 72% of patients. For wear time, the largest proportion of dressing changes, both pre-study and during the evaluation period, was every third day (45% and 44%, respectively). But there was a shift to extended wear time with use of the SAP silicone border dressing with 72% of patients' dressing changes being every third day or longer. Conclusion: The SAP silicone border dressing was successful in managing wound exudate in moderately to highly exuding wounds and consequently this had a beneficial impact on the wound edge and periwound skin. Overall, there was a positive effect on wound bed preparation and in turn the healing response was progressive. This study has shown that the SAP silicone border dressing successfully controlled exudate and provided positive benefits when used in the treatment of patients with moderately to highly exuding wounds.
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Affiliation(s)
| | - Mark Rippon
- Huddersfield University
- Daneriver Consultancy Ltd, Holmes Chapel
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19
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Fayne RA, Borda LJ, Egger AN, Tomic-Canic M. The Potential Impact of Social Genomics on Wound Healing. Adv Wound Care (New Rochelle) 2020; 9:325-331. [PMID: 32286204 DOI: 10.1089/wound.2019.1095] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Significance: Human skin wounds carry an immense epidemiologic and financial burden, and their impact will continue to grow with an aging population and rising incidence of comorbid conditions known to affect wound healing. To comprehensively address this growing clinical issue, physicians should also be aware of how conditions of the human social environment may affect wound healing. Here we provide a review of the emerging field of social genomics and its potential impact on the wound healing. Recent Advances: Multiple studies using human and animal models have correlated social influences and their contributing effects to acute and chronic stress with delays in wound healing. Furthermore, observations between nongenetic factors such as nutrition, socioeconomic, and educational status have also shown to have a direct or indirect impact on clinical outcomes of wound healing. Critical Issues: Nutrition, financial burden, socioeconomic and education status, and acute and chronic stress are variables that have either direct (epigenetic) or indirect impact on wound healing and patients' quality of life. Wound care is costly and remains a challenge placing economic burden on patients. Furthermore, poor clinical outcomes and complications including loss of mobility and disability may lead to job loss, further contributing to socioeconomic related stress. Thus, the economic burden and inadequate wound healing are intertwined, making each other worse. Future Directions: Although some evidence regarding the specific changes in genetic pathways imparted by conditions of the social environment exists, further studies are warranted to identify potential mechanisms, interventions, and prevention approaches.
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Affiliation(s)
- Rachel A. Fayne
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Luis J. Borda
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Andjela N. Egger
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
- Wound Healing and Regenerative Medicine Research Program, Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Marjana Tomic-Canic
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
- Wound Healing and Regenerative Medicine Research Program, Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida
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Scientific and Clinical Abstracts From WOCNext 2020 Reimagined. J Wound Ostomy Continence Nurs 2020. [DOI: 10.1097/won.0000000000000650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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21
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Shanmugapriya K, Kang HW. Engineering pharmaceutical nanocarriers for photodynamic therapy on wound healing: Review. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2019; 105:110110. [DOI: 10.1016/j.msec.2019.110110] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 07/25/2019] [Accepted: 08/20/2019] [Indexed: 12/25/2022]
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22
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Ousey K, Walker A, Brace J, Duteille F, Probst A, Hughes M, Milne C, Cole W. A multipurpose dressing: A clinical review of the absorption, debridement and healing properties of Aquacel Foam. J Wound Care 2019; 28:S1-S23. [DOI: 10.12968/jowc.2019.28.sup9a.s1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Karen Ousey
- Professor of Skin Integrity, Director for the Institute of Skin Integrity and Infection Prevention – University of Huddersfield Department of Nursing and Midwifery; Adjunct Professor – School of Nursing, Faculty of Health at the Queensland University of Technology, Australia; Visiting Professor, Royal College of Surgeons, Dublin, Republic of Ireland
| | - Angela Walker
- Podiatry Lead, Clinical Specialist, Birmingham Community Healthcare NHS Foundation Trust, UK
| | | | - Franck Duteille
- Professor of Plastic Surgery, Burn Centre, Centre Hospitalier Universitaire (CHU) de Nantes, France
| | - Astrid Probst
- Advanced Nurse Practitioner, Kreiskliniken Reutlingen, Germany
| | - Maria Hughes
- Independent Tissue Viability Consultant; Head of Medical Services and Wellbeing, and Queens Nurse, North Wales Police, UK
| | - Cathy Milne
- Advanced Practitioner, Wound Ostomy and Continence Nursing, Connecticut Clinical Nursing Associates, US
| | - Windy Cole
- Adjunct Professor and Director of Wound Care, Medical Director, UH Ahuja Wound Center, US
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23
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Akita S, Namiki T, Kawasaki Y, Rikihisa N, Ogata H, Tokumoto H, Tezuka T, Kubota Y, Kuriyama M, Nakamura M, Mitsukawa N. The beneficial effect of traditional Japanese herbal (Kampo) medicine, Hochu-ekki-to (Bu-Zhong-Yi-Qi-Tang), for patients with chronic wounds refractory to conventional therapies: A prospective, randomized trial. Wound Repair Regen 2019; 27:672-679. [PMID: 31350938 DOI: 10.1111/wrr.12753] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 07/16/2019] [Indexed: 12/20/2022]
Abstract
Hochu-ekki-to (HET) is a traditional Japanese herbal (Kampo) medicine for the treatment of severe weakness, loss of appetite, and indigestion in elderly patients and for the prevention of opportunistic infections. The impact of HET on patients with chronic wounds refractory to conventional therapies was investigated in a prospective, randomized trial, including 18 patients divided into medication (7.5 g oral HET per day, n = 9) and control (n = 9) groups. Wound healing during the 12-week study period was scored based on depth, exudate, size, inflammation/infection, granulation tissue, necrotic tissue, and pocket size. At 12 weeks, wound healing progressed in all nine patients in the medication group, whereas wound healing progressed in only three patients in the control group (significant difference, p < 0.01; relative risk: 3.00). In the medication group, the total score decreased significantly at 8 weeks and later. To the best of our knowledge, this study was the first to show that HET promoted the healing of chronic wounds resistant to conventional treatments. HET may be a choice as an adjunctive therapy for chronic wounds, particularly for patients with malnutrition. This trial was registered with the University Hospital Medical Information Network Clinical Trials Registry (UMIN000031620).
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Affiliation(s)
- Shinsuke Akita
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takao Namiki
- Department of Japanese-Oriental (Kampo) Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yohei Kawasaki
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Naoaki Rikihisa
- Division of Plastic and Reconstructive Surgery, Chiba Rosai Hospital, Chiba, Japan
| | - Hideyuki Ogata
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hideki Tokumoto
- Department of Plastic and Reconstructive Surgery, Chiba Cancer Center Hospital, Chiba, Japan
| | - Takafumi Tezuka
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yoshitaka Kubota
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Motone Kuriyama
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Michimi Nakamura
- Department of Japanese-Oriental (Kampo) Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Nobuyuki Mitsukawa
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
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24
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Haesler E, Swanson T, Ousey K, Carville K. Clinical indicators of wound infection and biofilm: reaching international consensus. J Wound Care 2019; 28:s4-s12. [PMID: 30840533 DOI: 10.12968/jowc.2019.28.sup3b.s4] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To achieve international consensus relating to clinical indicators for a chronic wound, wound infection and biofilm presence to inform the development of international clinical guidance for assessing and managing wound infection. METHOD An online Delphi consensus process of international key opinion leaders in infection was undertaken. A literature search underpinned the development of issue statements related to terminology, emerging topics and debate in the field of wound infection. Experts participated in three rounds of consensus voting, sharing their opinions and indicating their level of agreement with the issue statements. Votes were calculated using web-based software that implements a nominal group voting methodology previously published by Research and Development/University of California at Los Angeles. RESULTS A total of 14 experts took part in the development process. Consensus was reached on clinical indicators of wound chronicity, wound infection and biofilm presence. Agreement was also reached that the term 'critical colonisation' should no longer be used to refer to a stage in the wound infection continuum. CONCLUSION Outcomes from the consensus process were used to inform the development of international, evidence-informed guidance on the assessment and treatment of wound infection to promote improved outcomes for people with wounds.
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Affiliation(s)
- Emily Haesler
- Adjunct Associate Professor, School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia; Honorary Associate, School of Nursing and Midwifery, La Trobe University, Melbourne, Australia.,Honorary Senior Lecturer, Australian National University, ANU Medical School, Canberra, Australia.,Subcommittee Chair for Education of International Wound Infection Institute, UK
| | - Terry Swanson
- Nurse Practitioner, Warnambool, Victoria, Australia.,Vice Chair of International Wound Infection Institute, UK
| | - Karen Ousey
- Professor of Skin Integrity, Director for the Institute of Skin Integrity and Infection Prevention, University of Huddersfield, UK.,Chair of International Wound Infection Institute, UK
| | - Keryln Carville
- Professor of Primary Health Care and Community Nursing, Silver Chain Group and Curtin University, School of Nursing Midwifery and Paramedicine, Curtin University, Perth, Australia.,Subcommittee Chair for Evidence of International Wound Infection Institute, UK
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25
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Spruijt NE, Hoogbergen MM, Buijs SJE, Grosveld MJW, Buth J. Stratification of chronic and complex wounds according to healing characteristics: a retrospective study. J Wound Care 2019; 28:446-452. [PMID: 31295095 DOI: 10.12968/jowc.2019.28.7.446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Wound risk-stratified analyses are clinically relevant as they can assist in identifying hard-to-heal wounds. The aim of the study is to develop risk categories for wound healing based on a limited number of reliably recordable clinical data. METHOD This retrospective study used observational data. The primary outcome measure was wound healing at the end of treatment and the secondary outcome measure was the time to wound healing. A stratification model using regression analyses was developed to assign the patients to risk categories for wound healing and the time-to-heal. RESULTS The study cohort comprised of 540 patients. The most common wound diagnoses were diabetic ulcers, wounds in irradiated areas and wound dehiscence after surgery. Average wound duration before starting treatment at the wound centre was 11.7 months. Healing was achieved in 382 (71%) wounds, after an average treatment time of 4.4 months. A total of four risk categories for wound healing were developed by combining wound diagnosis (favourable versus unfavourable) and duration (<3 months versus >3 months). These risk categories demonstrated healing percentages ranging from 69-97% (p=0.0004) and mean time-to-healing varying from 2.7-5.9 months (p=0.01). CONCLUSION Using two clinical wound variables, diagnosis and duration, stratification categories were identified with significant associations with wound healing outcomes. Longer wound duration and unfavourable diagnoses, when combined into unfavourable risk categories, were associated with a lower percentage of wound healing and a longer treatment time until healing.
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Affiliation(s)
| | - Maarten M Hoogbergen
- Da Vinci Clinic, Geldrop, the Netherlands.,Plastic Surgeon, Catharina Hospital, Eindhoven, the Netherlands
| | | | - Marcel J W Grosveld
- Da Vinci Clinic, Geldrop, the Netherlands.,Bernhoven Hospital, Uden, the Netherlands
| | - Jaap Buth
- Da Vinci Clinic, Geldrop, the Netherlands
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26
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Carvalho MRD, Silveira IA, Oliveira BGRBD. Treatment of venous ulcers with growth factors: systematic review and meta-analysis. Rev Bras Enferm 2019; 72:200-210. [PMID: 30916287 DOI: 10.1590/0034-7167-2017-0865] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 06/08/2018] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To identify evidence about the effects of growth factor application on venous ulcer healing. METHOD Systematic review and meta-analysis, including Randomized Clinical Trials. Searches: Ovid MEDLINE, EMBASE, CINAHL, Cochrane CENTRAL, LILACS, Web of Science, Digital Library of Theses and Dissertations; Google Scholar and list of references. RESULTS 802 participants were recruited from the 10 included studies: 472 in the intervention group (growth factors) and 330 as control. The relative risk for the complete healing outcome was 1.06 [95% CI 0.92-1.22], p = 0.41. Participants who received Platelet-Rich Plasma and Epidermal Growth Factor showed a slight tendency to achieve complete healing, but without statistical relevance (p <0.05). Most of the studies were classified as moderate risk of bias. CONCLUSION The effect of the application of growth factors for complete healing in venous ulcers is not clear, and clinical trials with methodological quality are required for more accurate recommendations.
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Affiliation(s)
- Magali Rezende de Carvalho
- Universidade Federal Fluminense, Escola de Enfermagem Aurora de Afonso Costa. Niterói, Rio de Janeiro, Brazil
| | - Isabelle Andrade Silveira
- Universidade Federal Fluminense, Escola de Enfermagem Aurora de Afonso Costa. Niterói, Rio de Janeiro, Brazil
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27
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Bosanquet DC, Sanders AJ, Ruge F, Lane J, Morris CA, Jiang WG, Harding KG. Development and validation of a gene expression test to identify hard-to-heal chronic venous leg ulcers. Br J Surg 2019; 106:1035-1042. [DOI: 10.1002/bjs.11161] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 01/04/2019] [Accepted: 02/09/2019] [Indexed: 01/06/2023]
Abstract
Abstract
Background
Chronic venous leg ulcers pose a significant burden to healthcare systems, and predicting wound healing is challenging. The aim of this study was to develop a genetic test to evaluate the propensity of a chronic ulcer to heal.
Methods
Sequential refinement and testing of a gene expression signature was conducted using three distinct cohorts of human wound tissue. The expression of candidate genes was screened using a cohort of acute and chronic wound tissue and normal skin with quantitative transcript analysis. Genes showing significant expression differences were combined and examined, using receiver operating characteristic (ROC) curve analysis, in a controlled prospective study of patients with venous leg ulcers. A refined gene signature was evaluated using a prospective, blinded study of consecutive patients with venous ulcers.
Results
The initial gene signature, comprising 25 genes, could identify the outcome (healing versus non-healing) of chronic venous leg ulcers (area under the curve (AUC) 0·84, 95 per cent c.i. 0·73 to 0·94). Subsequent refinement resulted in a final 14-gene signature (WD14), which performed equally well (AUC 0·88, 0·80 to 0·97). When examined in a prospective blinded study, the WD14 signature could also identify wounds likely to demonstrate signs of healing (AUC 0·73, 0·62 to 0·84).
Conclusion
A gene signature can identify people with chronic venous leg ulcers that are unlikely to heal.
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Affiliation(s)
- D C Bosanquet
- Clinical Innovation Hub, Cardiff University, Cardiff, UK
- Gwent Vascular Institute, Aneurin Bevan University Health Board, Royal Gwent Hospital, Newport, UK
| | - A J Sanders
- Cardiff China Medical Research Collaborative, Cardiff University School of Medicine, Cardiff, UK
| | - F Ruge
- Cardiff China Medical Research Collaborative, Cardiff University School of Medicine, Cardiff, UK
| | - J Lane
- Cardiff China Medical Research Collaborative, Cardiff University School of Medicine, Cardiff, UK
| | - C A Morris
- Clinical Innovation Hub, Cardiff University, Cardiff, UK
| | - W G Jiang
- Cardiff China Medical Research Collaborative, Cardiff University School of Medicine, Cardiff, UK
| | - K G Harding
- Clinical Innovation Hub, Cardiff University, Cardiff, UK
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28
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Wang Q, Qian Z, Liu B, Liu J, Zhang L, Xu J. In vitro and in vivo evaluation of new PRP antibacterial moisturizing dressings for infectious wound repair. JOURNAL OF BIOMATERIALS SCIENCE-POLYMER EDITION 2019; 30:462-485. [PMID: 30755095 DOI: 10.1080/09205063.2019.1582270] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Qianxin Wang
- Medical School of Chinese PLA, Beijing, China
- Department of Stomatology, The Chinese PLA General Hospital, Beijing, China
| | - Zhiyong Qian
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Bo Liu
- Medical School of Chinese PLA, Beijing, China
| | - Jinglong Liu
- Former Lishi Road Outpatient Department, Chinese PLA Rocket Army General Hospital, Beijing, China
| | - Liang Zhang
- Medical School of Chinese PLA, Beijing, China
| | - Juan Xu
- Medical School of Chinese PLA, Beijing, China
- Department of Stomatology, The Chinese PLA General Hospital, Beijing, China
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29
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Smith F, Sharp A. Undertaking a person-centred assessment of patients with chronic wounds. Nurs Stand 2019; 34:77-82. [PMID: 31468929 DOI: 10.7748/ns.2019.e11305] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2018] [Indexed: 12/19/2022]
Abstract
Wounds have traditionally been classified as acute or chronic. While this classification is useful when attempting to estimate healing times, it might lead to an acceptance that some wounds will take longer to heal or might not heal at all. Chronic wounds can adversely affect patients' quality of life, and the management of these wounds may involve significant healthcare resources and costs. Chronic wounds rarely develop in healthy individuals and are often associated with pre-existing conditions that complicate wound healing, such as diabetes mellitus and vascular disease. This article discusses how acute wounds and chronic wounds are differentiated. It details the phases of wound healing and identifies potential barriers to progression through these phases. Enhancing nurses' understanding of chronic wounds will enable them to identify any potential barriers to wound healing early and remove or ameliorate them. While a holistic assessment should also include a thorough assessment of the wound itself, this is beyond the scope of this article.
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Affiliation(s)
- Fiona Smith
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, Scotland
| | - Ailsa Sharp
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, Scotland
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30
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El Masry MS, Chaffee S, Das Ghatak P, Mathew-Steiner SS, Das A, Higuita-Castro N, Roy S, Anani RA, Sen CK. Stabilized collagen matrix dressing improves wound macrophage function and epithelialization. FASEB J 2019; 33:2144-2155. [PMID: 30260708 PMCID: PMC6338656 DOI: 10.1096/fj.201800352r] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 08/27/2018] [Indexed: 12/26/2022]
Abstract
Decellularized matrices of biologic tissue have performed well as wound care dressings. Extracellular matrix-based dressings are subject to rapid degradation by excessive protease activity at the wound environment. Stabilized, acellular, equine pericardial collagen matrix (sPCM) wound care dressing is flexible cross-linked proteolytic enzyme degradation resistant. sPCM was structurally characterized utilizing scanning electron and atomic force microscopy. In murine excisional wounds, sPCM was effective in mounting an acute inflammatory response. Postwound inflammation resolved rapidly, as indicated by elevated levels of IL-10, arginase-1, and VEGF, and lowering of IL-1β and TNF-α. sPCM induced antimicrobial proteins S100A9 and β-defensin-1 in keratinocytes. Adherence of Pseudomonas aeruginosa and Staphylococcus aureus on sPCM pre-exposed to host immune cells in vivo was inhibited. Excisional wounds dressed with sPCM showed complete closure at d 14, while control wounds remained open. sPCM accelerated wound re-epithelialization. sPCM not only accelerated wound closure but also improved the quality of healing by increased collagen deposition and maturation. Thus, sPCM is capable of presenting scaffold functionality during the course of wound healing. In addition to inducing endogenous antimicrobial defense systems, the dressing itself has properties that minimize biofilm formation. It mounts robust inflammation, a process that rapidly resolves, making way for wound healing to advance.-El Masry, M. S., Chaffee, S., Das Ghatak, P., Mathew-Steiner, S. S., Das, A., Higuita-Castro, N., Roy, S., Anani, R. A., Sen, C. K. Stabilized collagen matrix dressing improves wound macrophage function and epithelialization.
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Affiliation(s)
- Mohamed S. El Masry
- Department of Surgery, Indiana University Health (IUH) Comprehensive Wound Center, Indiana Center for Regenerative Medicine and Engineering, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Surgery, The Ohio State University, Wexner Medical Center, Columbus, Ohio, USA
- Department of Plastic and Reconstructive Surgery, Zagazig University, Zagazig, Egypt
| | - Scott Chaffee
- Department of Surgery, The Ohio State University, Wexner Medical Center, Columbus, Ohio, USA
| | - Piya Das Ghatak
- Department of Surgery, Indiana University Health (IUH) Comprehensive Wound Center, Indiana Center for Regenerative Medicine and Engineering, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Surgery, The Ohio State University, Wexner Medical Center, Columbus, Ohio, USA
| | - Shomita S. Mathew-Steiner
- Department of Surgery, Indiana University Health (IUH) Comprehensive Wound Center, Indiana Center for Regenerative Medicine and Engineering, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Surgery, The Ohio State University, Wexner Medical Center, Columbus, Ohio, USA
| | - Amitava Das
- Department of Surgery, Indiana University Health (IUH) Comprehensive Wound Center, Indiana Center for Regenerative Medicine and Engineering, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Surgery, The Ohio State University, Wexner Medical Center, Columbus, Ohio, USA
| | - Natalia Higuita-Castro
- Department of Surgery, The Ohio State University, Wexner Medical Center, Columbus, Ohio, USA
| | - Sashwati Roy
- Department of Surgery, Indiana University Health (IUH) Comprehensive Wound Center, Indiana Center for Regenerative Medicine and Engineering, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Surgery, The Ohio State University, Wexner Medical Center, Columbus, Ohio, USA
| | - Raafat A. Anani
- Department of Plastic and Reconstructive Surgery, Zagazig University, Zagazig, Egypt
| | - Chandan K. Sen
- Department of Surgery, Indiana University Health (IUH) Comprehensive Wound Center, Indiana Center for Regenerative Medicine and Engineering, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Surgery, The Ohio State University, Wexner Medical Center, Columbus, Ohio, USA
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31
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Castiello G, Ghizzardi G, Dellafiore F, Turrini F, Caruso R. Treating a non-healing postoperative sternal wound in a woman with type 2 diabetes mellitus: A case report. Int Wound J 2019; 16:713-715. [PMID: 30697947 DOI: 10.1111/iwj.13085] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 01/04/2019] [Accepted: 01/08/2019] [Indexed: 12/26/2022] Open
Abstract
One of the leading causes of impaired chronic wound healing is diabetes mellitus because it involves many factors that influence the physiopathology of tissue healing. Therefore, it is strategic to analyse clinical cases of this population. We presented a clinical case report of a 51-year-old female with type 2 diabetes mellitus, presenting a non-healing sternal wound after open heart surgery. Appropriate dressing and assessment contributed to the healing of the sternal wound in 5 weeks.
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Affiliation(s)
- Gianluca Castiello
- Post-Operative Intensive Care Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Greta Ghizzardi
- Heart Failure Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Federica Dellafiore
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Francesca Turrini
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Rosario Caruso
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
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32
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Borda LJ, Jaller JA, Kallis PJ, MacQuhae FE, Herskovitz I, Fox JD, Baquerizo KL, Kirsner RS. Patients' prediction of their wound healing time. Wound Repair Regen 2018; 26:297-299. [PMID: 30118164 DOI: 10.1111/wrr.12663] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 07/18/2018] [Accepted: 07/21/2018] [Indexed: 12/01/2022]
Abstract
Understanding and managing patients' expectations can help improve their adherence to treatment for chronic wounds; however, little is known concerning about their expectations regarding healing time. Recruited subjects were asked to predict how long their wounds would take to heal and their charts were reviewed to retrieve real time of healing. We recruited 100 subjects from which 77% have healed. Fifty-three subjects (68.8%) had a longer healing time than they predicted (underestimated), and 17 (22.1%) had a shorter healing time than they predicted (overestimated). Subjects with shorter wound duration history tended to predict shorter healing time than subjects with longer wound duration (p < 0.01). However, wound duration did not affect prediction accuracy (p = 0.65). Subjects with chronic wounds seem more often to underestimate their time of healing. Wound duration significantly influenced patients' prediction time, although it did not make their prediction more accurate. Patient education about expectations may be important as patients often expect their wounds to heal faster than they actually do.
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Affiliation(s)
- Luis J Borda
- Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Jose A Jaller
- Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Penelope J Kallis
- Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Flor E MacQuhae
- Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Ingrid Herskovitz
- Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Joshua D Fox
- Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Katherine L Baquerizo
- Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Robert S Kirsner
- Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
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33
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Antimicrobial gelatin-based elastomer nanocomposite membrane loaded with ciprofloxacin and polymyxin B sulfate in halloysite nanotubes for wound dressing. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2018; 87:128-138. [PMID: 29549942 DOI: 10.1016/j.msec.2018.02.025] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 09/08/2017] [Accepted: 02/28/2018] [Indexed: 02/06/2023]
Abstract
Bacterial infection is a major problem world-wide, especially in wound treatment where it can severely prolong the healing process. In this study, a double drug co-delivery elastic antibacterial nanocomposite was developed by combining ciprofloxacin (CPX) and polymyxin B sulfate-loaded halloysite clay nanotubes (HNTs-B) into a gelatin elastomer. CPX nanoparticles which act against both gram positive and gram-negative bacterium were dispersed directly in the matrix, and polymyxin B sulfate was loaded in HNTs and then distributed into the matrix. The effect of CPX and HNTs-B content on the physical properties, cytotoxicity, fibroblast adhesion and proliferation, in vitro drug release behavior and anti-bacterial properties were systematically investigated. The ciprofloxacin crystals and HNT-B were distributed in the matrix uniformly. The HNTs in the drug loading system not only enhanced the matrix' tensile strength but also slowed down the release rate of the high dissoluble polymyxin B sulfate. When the amount of HNT in the matrix increased, the thermal stability and tensile strength also increased but the polymyxin B sulfate release rate decreased because the HNTs prevented the drug release inside. All the nanocomposites exhibited antimicrobial activity against both gram-negative and gram-positive bacteria with the dual combination of drugs released from the nanocomposites. Furthermore, this kind of gelatin-based nanocomposites possesses higher water-absorbing quality, low cytotoxicity, adaptable biodegradability and good elasticity which can satisfy the requirements for an ideal biomaterial for use in wound healing applications.
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34
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Klein P, Sojka M, Kucera J, Matonohova J, Pavlik V, Nemec J, Kubickova G, Slavkovsky R, Szuszkiewicz K, Danek P, Rozkot M, Velebny V. A porcine model of skin wound infected with a polybacterial biofilm. BIOFOULING 2018; 34:226-236. [PMID: 29405092 DOI: 10.1080/08927014.2018.1425684] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 01/02/2018] [Indexed: 06/07/2023]
Abstract
A clinically relevant porcine model of a biofilm-infected wound was established in 10 minipigs. The wounds of six experimental animals were infected with a modified polymicrobial Lubbock chronic wound biofilm consisting of Staphylococcus aureus, Enterococcus faecalis, Pseudomonas aeruginosa and Bacillus subtilis. Four animals served as uninfected controls. The wounds were monitored until they had healed for 24 days. The biofilm persisted in the wounds up to day 14 and significantly affected healing. The control to infected healed wound area ratios were: 45%/21%, 66%/37%, and 90%/57% on days 7, 10 and 14, respectively. The implanted biofilm prolonged inflammation, increased necrosis, delayed granulation and impaired development of the extracellular matrix as seen in histological and gene expression analyses. This model provides a therapeutic one-week window for testing of anti-biofilm treatments and for research on the pathogenesis of wound infections in pig that is clinically the most relevant animal wound healing model.
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Affiliation(s)
- Pavel Klein
- a Biomedical Center, Faculty of Medicine in Pilsen , Charles University , Pilsen , Czech Republic
- b R&D Department , Contipro, a.s. , Dolni Dobrouc , Czech Republic
| | - Martin Sojka
- b R&D Department , Contipro, a.s. , Dolni Dobrouc , Czech Republic
- c Faculty of Medicine , Slovak Medical University , Bratislava , Slovakia
| | - Jan Kucera
- b R&D Department , Contipro, a.s. , Dolni Dobrouc , Czech Republic
- d Institute of Histology and Embryology, Faculty of Medicine in Hradec Kralove , Charles University , Hradec Kralove , Czech Republic
- e Czech Centre for Phenogenomics , Institute of Molecular Genetics/BIOCEV , Vestec , Czech Republic
| | - Jana Matonohova
- b R&D Department , Contipro, a.s. , Dolni Dobrouc , Czech Republic
| | - Vojtech Pavlik
- b R&D Department , Contipro, a.s. , Dolni Dobrouc , Czech Republic
- f Department of Dermatology, Third Faculty of Medicine , Charles University , Prague , Czech Republic
| | - Jan Nemec
- b R&D Department , Contipro, a.s. , Dolni Dobrouc , Czech Republic
| | | | - Rastislav Slavkovsky
- b R&D Department , Contipro, a.s. , Dolni Dobrouc , Czech Republic
- g Institute of Molecular and Translational Medicine , Palacky University , Olomouc , Czech Republic
| | - Katarzyna Szuszkiewicz
- b R&D Department , Contipro, a.s. , Dolni Dobrouc , Czech Republic
- h Department of Analytical Chemistry, Faculty of Chemical Technology , University of Pardubice , Pardubice , Czech Republic
| | - Petr Danek
- i Department of Pig Breeding , Institute of Animal Science , Kostelec nad Orlici , Czech Republic
| | - Miroslav Rozkot
- i Department of Pig Breeding , Institute of Animal Science , Kostelec nad Orlici , Czech Republic
| | - Vladimir Velebny
- b R&D Department , Contipro, a.s. , Dolni Dobrouc , Czech Republic
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Shannon R, Nelson A. A single-arm trial indirect comparison investigation: a proof-of-concept method to predict venous leg ulcer healing time for a new acellular synthetic matrix matched to standard care control. Int Wound J 2017; 14:729-741. [PMID: 27868341 PMCID: PMC7949811 DOI: 10.1111/iwj.12687] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 09/21/2016] [Accepted: 10/06/2016] [Indexed: 11/27/2022] Open
Abstract
To compare data on time to healing from two separate cohorts: one treated with a new acellular synthetic matrix plus standard care (SC) and one matched from four large UK pragmatic, randomised controlled trials [venous leg ulcer (VLU) evidence network]. We introduce a new proof-of-concept strategy to a VLU clinical evidence network, propensity score matching and sensitivity analysis to predict the feasibility of the new acellular synthetic matrix plus SC for success in future randomised, controlled clinical trials. Prospective data on chronic VLUs from a safety and effectiveness study on an acellular synthetic matrix conducted in one wound centre in the UK (17 patients) and three wound centres in Australia (36 patients) were compared retrospectively to propensity score-matched data from patients with comparable leg ulcer disease aetiology, age, baseline ulcer area, ulcer duration, multi-layer compression bandaging and majority of care completed in specialist wound centres (average of 1 visit per week), with the outcome measures at comparable follow-up periods from patients enrolled in four prospective, multicentre, pragmatic, randomised studies of venous ulcers in the UK (the comparison group; VLU evidence network). Analysis using Kaplan-Meier survival curves showed a mean healing time of 73·1 days for ASM plus SC (ASM) treated ulcers in comparison with 83·5 days for comparison group ulcers treated with SC alone (Log rank test, χ2 5·779, P = 0·016) within 12 weeks. Sensitivity analysis indicates that an unobserved covariate would have to change the odds of healing for SC by a factor of 1·1 to impact the baseline results. Results from this study predict a significant effect on healing time when using a new ASM as an adjunct to SC in the treatment of non-healing venous ulcers in the UK, but results are sensitive to unobserved covariates that may be important in healing time comparison.
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Affiliation(s)
| | - Andrea Nelson
- Head of School, School of HealthcareUniversity of LeedsLeedsUK
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Lipoxin A4 encapsulated in PLGA microparticles accelerates wound healing of skin ulcers. PLoS One 2017; 12:e0182381. [PMID: 28753648 PMCID: PMC5533323 DOI: 10.1371/journal.pone.0182381] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 07/17/2017] [Indexed: 12/12/2022] Open
Abstract
Lipoxin A4 (LXA4) is involved in the resolution of inflammation and wound healing; however, it is extremely unstable. Thus, to preserve its biological activities and confer stability, we encapsulated LXA4 in poly-lactic-co-glycolic acid (PLGA) microparticles (LXA4-MS) and assessed its application in treating dorsal rat skin lesions. Ulcers were sealed with fibrin adhesive and treated with either LXA4-MS, unloaded microparticles (Un-MS), soluble LXA4, or PBS/glue (vehicle). All groups were compared at 0, 2, 7, and 14 days post-lesions. Our results revealed that LXA4-MS accelerated wound healing from day 7 and reduced initial ulcer diameters by 80%. Soluble LXA4, Un-MS, or PBS closed wounds by 60%, 45%, and 39%, respectively. LXA4-MS reduced IL-1β and TNF-α, but increased TGF-β, collagen deposition, and the number of blood vessels. Compared to other treatments, LXA4-MS reduced inflammatory cell numbers, myeloperoxidase (MPO) concentration, and metalloproteinase-8 (MMP8) mRNA in scar tissue, indicating decreased neutrophil chemotaxis. In addition, LXA4-MS treatment increased macrophages and IL-4, suggesting a positive impact on wound healing. Finally, we demonstrated that WRW4, a selective LXA4 receptor (ALX) antagonist, reversed healing by 50%, indicating that LXA4 must interact with ALX to induce wound healing. Our results show that LXA4-MS could be used as a pharmaceutical formulation for the treatment of skin ulcers.
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Harries RL, Bosanquet DC, Harding KG. Wound bed preparation: TIME for an update. Int Wound J 2017; 13 Suppl 3:8-14. [PMID: 27547958 DOI: 10.1111/iwj.12662] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 07/16/2016] [Indexed: 12/11/2022] Open
Abstract
While the overwhelming majority of wounds heal rapidly, a significant proportion fail to progress through the wound-healing process. These resultant chronic wounds cause considerable morbidity and are costly to treat. Wound bed preparation, summarised by the TIME (Tissue, Inflammation/infection, Moisture imbalance, Epithelial edge advancement) concept, is a systematic approach for assessing chronic wounds. Each of these components needs to be addressed and optimised to improve the chances of successful wound closure. We present an up-to-date literature review of the most important recent aspects of wound bed preparation. While there are many novel therapies that are available to the treating clinician, often, there are limited data on which to assess their clinical value, and a lack of appreciation for adequate wound bed preparation needed before expensive therapy is used to heal a wound.
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Affiliation(s)
- Rhiannon L Harries
- Royal College of Surgeons/Welsh Wound Initiative Research Fellow, Wound Healing Research Unit, School of Medicine, Cardiff University, Cardiff, UK
| | - David C Bosanquet
- South East Wales Vascular Network, University Hospital of Medicine, Cardiff, UK
| | - Keith G Harding
- Welsh Wound Innovation Initiative, Cardiff University, Cardiff, UK
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Mirasoglu B, Bagli BS, Aktas S. Hyperbaric oxygen therapy for chronic ulcers in systemic sclerosis - case series. Int J Dermatol 2017; 56:636-640. [PMID: 28233289 DOI: 10.1111/ijd.13570] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 12/20/2016] [Accepted: 01/09/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Digital and leg ulcers are extremely painful, hard to heal manifestations of systemic sclerosis (SSc). Many treatments have been tried for these challenging complications, but use of hyperbaric oxygen therapy (HBOT) is very limited. HBOT has been used as an adjunctive therapy for treating chronic wounds, and nonhealing SSc wounds, which have a hypoxic nature, may also benefit from it. METHODS This is a retrospective analysis of six SSc patients who underwent HBOT for their ulcers. Patient demographics, ulcer properties, and details of treatments were evaluated. RESULTS Three patients had digital ulcers, and the other three had leg ulcers. Three patients (two leg ulcers and one digital ulcer) had bilateral lesions. All patients had been treated for at least one and a half months with various modalities. After HBOT was applied, four patients' ulcers healed completely and two patients had near-complete healing. Amputation was not required for any. CONCLUSION This case series, which has the largest patient population up to present, shows adjunctive HBOT may be helpful in the treatment of SSc ulcers.
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Affiliation(s)
- Bengusu Mirasoglu
- Istanbul Faculty of Medicine, Underwater and Hyperbaric Medicine Department, Istanbul University, Istanbul, Turkey
| | - Bekir S Bagli
- Istanbul Faculty of Medicine, Underwater and Hyperbaric Medicine Department, Istanbul University, Istanbul, Turkey
| | - Samil Aktas
- Istanbul Faculty of Medicine, Underwater and Hyperbaric Medicine Department, Istanbul University, Istanbul, Turkey
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Crompton R, Williams H, Ansell D, Campbell L, Holden K, Cruickshank S, Hardman MJ. Oestrogen promotes healing in a bacterial LPS model of delayed cutaneous wound repair. J Transl Med 2016; 96:439-49. [PMID: 26855364 DOI: 10.1038/labinvest.2015.160] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 12/04/2015] [Accepted: 12/11/2015] [Indexed: 12/21/2022] Open
Abstract
Wound infection is a major clinical problem, yet understanding of bacterial host interactions in the skin remains limited. Microbe-derived molecules, known as pathogen-associated molecular patterns, are recognised in barrier tissues by pattern-recognition receptors. In particular, the pathogen-associated molecular pattern, lipopolysaccharide (LPS), a component of microbial cell walls and a specific ligand for Toll-like receptor 4, has been widely used to mimic systemic and local infection across a range of tissues. Here we administered LPS derived from Klebsiella pneumoniae, a species of bacteria that is emerging as a wound-associated pathogen, to full-thickness cutaneous wounds in C57/BL6 mice. Early in healing, LPS-treated wounds displayed increased local apoptosis and reduced proliferation. Subsequent healing progression was delayed with reduced re-epithelialisation, increased proliferation, a heightened inflammatory response and perturbed wound matrix deposition. Our group and others have previously demonstrated the beneficial effects of 17β-estradiol treatment across a range of preclinical wound models. Here we asked whether oestrogen would effectively promote healing in our LPS bacterial infection model. Intriguingly, co-treatment with 17β-estradiol was able to promote re-epithelialisation, dampen inflammation and induce collagen deposition in our LPS-delayed healing model. Collectively, these studies validate K. pneumoniae-derived LPS treatment as a simple yet effective model of bacterial wound infection, while providing the first indication that oestrogen could promote cutaneous healing in the presence of infection, further strengthening the case for its therapeutic use.
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Affiliation(s)
- Rachel Crompton
- The Healing Foundation Centre, Faculty of Life Sciences, The University of Manchester, Manchester, UK
| | - Helen Williams
- The Healing Foundation Centre, Faculty of Life Sciences, The University of Manchester, Manchester, UK
| | - David Ansell
- The Healing Foundation Centre, Faculty of Life Sciences, The University of Manchester, Manchester, UK.,The Centre for Dermatology Research, Institute of Inflammation and Repair, The University of Manchester, Manchester, UK
| | - Laura Campbell
- The Healing Foundation Centre, Faculty of Life Sciences, The University of Manchester, Manchester, UK
| | | | | | - Matthew J Hardman
- The Healing Foundation Centre, Faculty of Life Sciences, The University of Manchester, Manchester, UK
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Rondas AALM, Schols JMG, Halfens RJG, Hull HR, Stobberingh EE, Evers SMAA. Cost analysis of one of the first outpatient wound clinics in the Netherlands. J Wound Care 2015; 24:426-36. [PMID: 26349024 DOI: 10.12968/jowc.2015.24.9.426] [Citation(s) in RCA: 6] [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
OBJECTIVE To perform, from an insurance perspective, a cost analysis of one of the outpatient community wound care clinics in the Netherlands, the Knowledge Centre in Wound Care (KCWC) at Venray. METHOD This study involved a cost analysis based on an observational cohort study with a one-year pre-admission and a one-year post-admission comparison of costs. Patients were included when they first consulted the outpatient wound care clinic. Participants were all insured by the same health insurance company, Coöperatie Volksgezondheidszorg (VGZ). A standard six-step procedure for performing cost studies was used to calculate the costs. Given the skewed cost data, non-parametric bootstrapping was used to test for statistical differences. RESULTS There were 172 patients included in this study. The difference in costs related to wound care between the year before and the year after initial admission to the wound clinic amounted to an average reduction of €2621 (£1873) per patient in the base case analysis. The categories 'general practitioner', 'hospital care', 'mental health care' and 'transport' scored lower, indicating lower costs, in the year after admission to the wound clinic. CONCLUSION In this study, only the reimbursement data of patients of one health insurance company, and specifically only those made under the 2006 Dutch Health Insurance Act, were available. Because of the observational design, definitive conclusions cannot be made regarding a demonstrated reduction of costs in the year post admission. Nevertheless, this study is a first attempt of a cost analysis of an equipped outpatient wound clinic as an innovative way of responding to the increasing number of chronic wounds in the Netherlands. The calculations show that savings in wound care are possible. DECLARATION OF INTEREST A possible conflict of interest should be mentioned. First author AALM Rondas, PhD student at Maastricht University, is working at the KCWC wound clinic at Venray in the Netherlands as a physician. However, the research data were provided externally by Coöperatie Volksgezondheidszorg (VGZ) and checked by the academic co-authors, none of whom have a conflict of interest. The authors have no financial or commercial interest to declare.
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Affiliation(s)
- A A L M Rondas
- De Zorggroep, Knowledge Centre of Wound Care, Venlo, the Netherlands.,Maastricht University, Caphri-School of Public Health and Primary Care, Department of Family Medicine, Maastricht
| | - J M G Schols
- Maastricht University, Caphri-School for Public Health and Primary Care,, the Netherlands
| | - R J G Halfens
- Maastricht University, Caphri-School for Public Health and Primary Care,, the Netherlands
| | - H R Hull
- Health insurance company, Coöperatie Volksgezondheidszorg (VGZ), the Netherlands
| | - E E Stobberingh
- Centre for Infectious Disease Research, Diagnostics and Screening (RIVM), the Netherlands
| | - S M A A Evers
- Maastricht University, Caphri-School for Public Health and Primary Care,, the Netherlands
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41
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Martin P, Nunan R. Cellular and molecular mechanisms of repair in acute and chronic wound healing. Br J Dermatol 2015; 173:370-8. [PMID: 26175283 PMCID: PMC4671308 DOI: 10.1111/bjd.13954] [Citation(s) in RCA: 529] [Impact Index Per Article: 58.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2015] [Indexed: 12/12/2022]
Abstract
Summary A considerable understanding of the fundamental cellular and molecular mechanisms underpinning healthy acute wound healing has been gleaned from studying various animal models, and we are now unravelling the mechanisms that lead to chronic wounds and pathological healing including fibrosis. A small cut will normally heal in days through tight orchestration of cell migration and appropriate levels of inflammation, innervation and angiogenesis. Major surgeries may take several weeks to heal and leave behind a noticeable scar. At the extreme end, chronic wounds – defined as a barrier defect that has not healed in 3 months – have become a major therapeutic challenge throughout the Western world and will only increase as our populations advance in age, and with the increasing incidence of diabetes, obesity and vascular disorders. Here we describe the clinical problems and how, through better dialogue between basic researchers and clinicians, we may extend our current knowledge to enable the development of novel potential therapeutic treatments. What's already known about this topic? What does this study add?
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Affiliation(s)
- P Martin
- Schools of Biochemistry and Physiology & Pharmacology, University of Bristol, Bristol, U.K.,School of Medicine, University of Cardiff, Cardiff, U.K
| | - R Nunan
- School of Medicine, University of Cardiff, Cardiff, U.K
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Nunan R, Harding KG, Martin P. Clinical challenges of chronic wounds: searching for an optimal animal model to recapitulate their complexity. Dis Model Mech 2015; 7:1205-13. [PMID: 25359790 PMCID: PMC4213725 DOI: 10.1242/dmm.016782] [Citation(s) in RCA: 277] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The efficient healing of a skin wound is something that most of us take for granted but is essential for surviving day-to-day knocks and cuts, and is absolutely relied on clinically whenever a patient receives surgical intervention. However, the management of a chronic wound – defined as a barrier defect that has not healed in 3 months – has become a major therapeutic challenge throughout the Western world, and it is a problem that will only escalate with the increasing incidence of conditions that impede wound healing, such as diabetes, obesity and vascular disorders. Despite being clinically and molecularly heterogeneous, all chronic wounds are generally assigned to one of three major clinical categories: leg ulcers, diabetic foot ulcers or pressure ulcers. Although we have gleaned much knowledge about the fundamental cellular and molecular mechanisms that underpin healthy, acute wound healing from various animal models, we have learned much less about chronic wound repair pathology from these models. This might largely be because the animal models being used in this field of research have failed to recapitulate the clinical features of chronic wounds. In this Clinical Puzzle article, we discuss the clinical complexity of chronic wounds and describe the best currently available models for investigating chronic wound pathology. We also assess how such models could be optimised to become more useful tools for uncovering pathological mechanisms and potential therapeutic treatments.
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Affiliation(s)
- Robert Nunan
- Schools of Biochemistry and Physiology and Pharmacology, University of Bristol, Bristol, BS8 1TD, UK.
| | - Keith G Harding
- School of Medicine, University of Cardiff, Cardiff, CF14 4XN, UK
| | - Paul Martin
- Schools of Biochemistry and Physiology and Pharmacology, University of Bristol, Bristol, BS8 1TD, UK. School of Medicine, University of Cardiff, Cardiff, CF14 4XN, UK
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Bosanquet DC, Wright AM, White RD, Williams IM. A review of the surgical management of heel pressure ulcers in the 21st century. Int Wound J 2015; 13:9-16. [PMID: 25683573 DOI: 10.1111/iwj.12416] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 12/09/2014] [Indexed: 12/11/2022] Open
Abstract
Heel ulceration, most frequently the result of prolonged pressure because of patient immobility, can range from the trivial to the life threatening. Whilst the vast majority of heel pressure ulcers (PUs) are superficial and involve the skin (stages I and II) or underlying fat (stage III), between 10% and 20% will involve deeper tissues, either muscle, tendon or bone (stage IV). These stage IV heel PUs represent a major health and economic burden and can be difficult to treat. The worst outcomes are seen in those with large ulcers, compromised peripheral arterial supply, osteomyelitis and associated comorbidities. Whilst the mainstay of management of stage I-III heel pressure ulceration centres on offloading and appropriate wound care, successful healing in stage IV PUs is often only possible with surgical intervention. Such intervention includes simple debridement, partial or total calcanectomy, arterial revascularisation in the context of coexisting peripheral vascular disease or using free tissue flaps. Amputation may be required for failed surgical intervention, or as a definitive first-line procedure in certain high-risk or poor prognosis patient groups. This review provides an overview of heel PUs, alongside a comprehensive literature review detailing the surgical interventions available when managing such patients.
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Affiliation(s)
| | - Ann M Wright
- Department of Surgery, Royal Gwent Hospital, Newport, UK
| | - Richard D White
- Regional Vascular Unit, University Hospital of Wales, Cardiff, UK
| | - Ian M Williams
- Regional Vascular Unit, University Hospital of Wales, Cardiff, UK
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Negative pressure wound therapy of chronically infected wounds using 1% acetic Acid irrigation. Arch Plast Surg 2015; 42:59-67. [PMID: 25606491 PMCID: PMC4297808 DOI: 10.5999/aps.2015.42.1.59] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 12/03/2014] [Accepted: 12/15/2014] [Indexed: 11/08/2022] Open
Abstract
Background Negative-pressure wound therapy (NPWT) induces angiogenesis and collagen synthesis to promote tissue healing. Although acetic acid soaks normalize alkali wound conditions to raise tissue oxygen saturation and deconstruct the biofilms of chronic wounds, frequent dressing changes are required. Methods Combined use of NPWT and acetic acid irrigation was assessed in the treatment of chronic wounds, instilling acetic acid solution (1%) beneath polyurethane membranes twice daily for three weeks under continuous pressure (125 mm Hg). Clinical photographs, pH levels, cultures, and debrided fragments of wounds were obtained pre- and posttreatment. Tissue immunostaining (CD31, Ki-67, and CD45) and reverse transcription-polymerase chain reaction (vascular endothelial growth factor [VEGF], vascular endothelial growth factor receptor [VEGFR]; procollagen; hypoxia-inducible factor 1 alpha [HIF-1-alpha]; matrix metalloproteinase [MMP]-1,-3,-9; and tissue inhibitor of metalloproteinase [TIMP]) were also performed. Results Wound sizes tended to diminish with the combined therapy, accompanied by drops in wound pH (weakly acidic or neutral) and less evidence of infection. CD31 and Ki-67 immunostaining increased (P<0.05) post-treatment, as did the levels of VEGFR, procollagen, and MMP-1 (P<0.05), whereas the VEGF, HIF-1-alpha, and MMP-9/TIMP levels declined (P<0.05). Conclusions By combining acetic acid irrigation with negative-pressure dressings, both the pH and the size of chronic wounds can be reduced and infections be controlled. This approach may enhance angiogenesis and collagen synthesis in wounds, restoring the extracellular matrix.
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Shi Y, Truong VX, Kulkarni K, Qu Y, Simon GP, Boyd RL, Perlmutter P, Lithgow T, Forsythe JS. Light-triggered release of ciprofloxacin from an in situ forming click hydrogel for antibacterial wound dressings. J Mater Chem B 2015; 3:8771-8774. [DOI: 10.1039/c5tb01820j] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Light triggered release of an antibiotic from a click crosslinked hydrogel was developed by conjugating ciprofloxacin through a photo-cleavable linker to the hydrogel network structure.
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Affiliation(s)
- Yue Shi
- Department of Material Science and Engineering
- Monash Institute of Medical Engineering
- Monash University
- Victoria 3800
- Australia
| | - Vinh X. Truong
- Department of Material Science and Engineering
- Monash Institute of Medical Engineering
- Monash University
- Victoria 3800
- Australia
| | - Ketav Kulkarni
- Department of Chemistry
- Monash University
- Victoria 3800
- Australia
| | - Yue Qu
- Infection and Immunity Program
- Monash Biomedicine Discovery Institute and Department of Microbiology
- Monash University
- Victoria 3800
- Australia
| | - George P. Simon
- Department of Material Science and Engineering
- Monash Institute of Medical Engineering
- Monash University
- Victoria 3800
- Australia
| | - Richard L. Boyd
- Faculty of Medicine
- Nursing and Health Sciences Anatomy and Developmental Biology
- Monash University
- Australia
| | | | - Trevor Lithgow
- Infection and Immunity Program
- Monash Biomedicine Discovery Institute and Department of Microbiology
- Monash University
- Victoria 3800
- Australia
| | - John S. Forsythe
- Department of Material Science and Engineering
- Monash Institute of Medical Engineering
- Monash University
- Victoria 3800
- Australia
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