Retrospective comparison of negative pressure wound therapy and silver-coated foam dressings in open-wound treatment in cats

Understanding and treating diabetic foot ulcers: Insights into the role of cutaneous microbiota and innovative therapies

Background

Notoriously known as the silent pandemic, chronic, non-healing diabetic foot ulcers (DFUs), pose a significant rate of incidence for amputation and are a major cause of morbidity. Alarmingly, the treatment and management strategies of chronic wounds represent a significant economic and health burden as well as a momentous drain on resources with billions per annum being spent in the US and UK alone. Defective wound healing is a major pathophysiological condition which propagates an acute wound to a chronic wound, further propelled by underlying conditions such as diabetes and vascular complications which are more prevalent amongst the elderly. Chronic wounds are prone to infection, which can exacerbate the condition, occasionally resulting in amputation for the patient, despite the intervention of modern therapies. However, amputation can only yield a 5-year survival rate for 50% of patients, highlighting the need for new treatments for chronic wounds.

Findings

The dynamic cutaneous microbiota is comprised of diverse microorganisms that often aid wound healing. Conversely, the chronic wound microbiome consists of a combination of common skin commensals such as Staphylococcus aureus and Staphylococcus epidermidis, as well as the opportunistic pathogen Pseudomonas aeruginosa. These bacteria have been identified as the most prevalent bacterial pathogens isolated from chronic wounds and contribute to prolific biofilm formation decreasing the efficiency of antimicrobials and further perpetuating a hyper-inflammatory state.

Discussion and Conclusion

Here, we review recent advances and provide a new perspective on alternative treatments including phage and microbiome transplant therapies and how the definitive role of the cutaneous microbiota impacts the aetiology of DFUs.

Wound healing in animals: a review of physiology and clinical evaluation

Wound healing is a complicated process consisting of overlapping phases directed and regulated by many mediators of healing produced locally at the wound. The end goal of wound healing is the production of tissue at the site of injury which has a similar structure and provides protection to the body. Any alterations in the normal healing process can lead to delayed healing or additional tissue damage. Factors that contribute to aberrant wound healing can be species-specific and include both intrinsic (systemic) factors and extrinsic (environmental) factors. Management of wounds and recognition of alterations can be optimised by adoption of a structured framework for wound assessment, such as the TIME principle (acronym referring to the following categories: tissue, inflammation or infection, moisture, and edge of wound or epithelial advancement). This review article provides an overview of the phases of wound healing, variation of healing among different species, factors reported to delay healing, and an introduction to the TIME principle as a structured approach to clinical evaluation of wounds.

Filling the vacuum: Role of negative pressure wound therapy in open wound management in cats

Practical relevance:

Open wounds and their treatment present a common challenge in veterinary practice. Approaching 15 years ago negative pressure wound therapy (NPWT) started to be incorporated into clinical veterinary medicine, and its availability is becoming more widespread in Europe and the USA. Use of this therapy has the potential to significantly increase the healing rate of open wounds as well as free skin grafts in small animals, and it has been occasionally described for the management of feline wounds.

Aim:

This review describes the mechanisms of action of, and indications for, NPWT, and offers recommendations for NPWT specific to feline patients.

Evidence base:

The information presented is based on the current evidence and the author’s clinical experience of the technique gained over the past 12 years. Comparative studies of different treatment options are lacking and, since wound healing in cats and dogs differs, cat-specific studies are especially needed. Well-designed wound healing studies comparing different advanced techniques will improve open wound healing in cats in the future, and potentially allow better understanding of the role of NPWT in this setting.

Feasibility of a disposable canister-free negative-pressure wound therapy (NPWT) device for treating open wounds in horses

BACKGROUND

Wounds are among the most common medical conditions affecting horses and have a major economic impact on the horse industry. Wound healing in horses is distinct to that documented in other species, and often results in delayed healing and extensive scarring, with compromised functional and aesthetic outcomes. To date, there is no conventional method objectively proven to accelerate healing or to successfully prevent complications associated with second intention healing. Several effects of Negative Pressure Wound Therapy (NPWT) may be particularly useful to the management of wounds in horses. However, cumbersome designs of classic NPWT devices render them unsuitable for equine practice. A new lightweight, portable and disposable unit of NPWT (PICO®), should facilitate the use of this modality by equine practitioners. The aim of this study was to evaluate the feasibility of using this canister-free system to treat experimental open wounds in horses.

RESULTS

No difficulties were encountered with the application or maintenance of the PICO® system during the ex vivo experiment or during the preliminary in vivo experiment conducted on intact skin. All horses readily tolerated the PICO® but difficulties with adhesion and seal prevented the completion of the experimental wound study despite the use of many adjunctive adhesives.

CONCLUSION

The current PICO® dressing design is not suitable to be used as a dressing for open wounds in horses though the device is well tolerated by equine patients. A dressing with a wider adhesive edge, a superior adhesive and a more flexible pad would likely be better adapted to enable its future use in equine practice.

Negative Pressure Wound Therapy in Maxillofacial Applications

Negative pressure wound therapy has greatly advanced the field of wound healing for nearly two decades, by providing a robust surgical adjunct technique for accelerating wound closure in acute and chronic wounds. However, the application of negative pressure wound therapy in maxillofacial applications has been relatively under utilized as a result of the physical articulations and contours of the head and neck that make it challenging to obtain an airtight seal for different negative pressure wound therapy systems. Adapting negative pressure wound therapies for maxillofacial applications could yield significant enhancement of wound closure in maxillofacial applications. The current review summarizes the basic science underlying negative pressure wound therapy, as well as specific maxillofacial procedures that could benefit from negative pressure wound therapy.