1
|
Iacopi E, Abbruzzese L, Goretti C, Riitano N, Piaggesi A. The Use of a Novel Super-Oxidized Solution on Top of Standard Treatment in the Home Care Management of Postsurgical Lesions of the Diabetic Foot Reduces Reinfections and Shortens Healing Time. INT J LOW EXTR WOUND 2018; 17:268-274. [PMID: 30282510 DOI: 10.1177/1534734618795593] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
There are still many unmet needs in the treatment of chronic wounds, especially regarding microenvironment modulation. Nexodyn is a novel super-oxidized solution capable of contrast bacterial proliferation. We aimed to evaluate if this solution, on top of standard of care, was safe and effective in improving diabetic foot outcome. We selected 50 patients admitted in our department to be submitted to surgery for acute diabetic foot infection. All patients were left open to heal for secondary intent. We divided patients into 2 groups: Group A (n = 25, male/female = 17/8, age = 67.3 ± 12.1 years, hemoglobin A1C = 7.9 ± 1.1%), patients treated with standard of care and, on top of this, Nexodyn solution, and Group B, treated only with standard of care. After discharge, patients continued Nexodyn application. We followed up patients until complete healing or up to 6 months. No differences between groups in healing rate, while time required for complete healing was significantly shorter in Group A (64.9 ± 12.1 days vs 147.4 ± 23.1 days, P < .01). During follow-up, the group treated with Nexodyn showed a reduced rate of reinfections (12 patients in Group B vs 3 patients in Group A, P < .05) and of further debridement procedures (1 patient in Group A vs 10 patients in Group B, P < .05). Nexodyn provided effective protection against reinfections in diabetic foot patients, thus reducing the necessity for debridement procedures and their healing time and presents a safety profile similar to saline solution.
Collapse
Affiliation(s)
| | | | - Chiara Goretti
- 1 Diabetic Foot Section, Pisa University Hospital, Pisa, Italy
| | - Nicola Riitano
- 1 Diabetic Foot Section, Pisa University Hospital, Pisa, Italy
| | | |
Collapse
|
2
|
Müller CSL, Burgard B, Zimmerman M, Vogt T, Pföhler C. On the significance of negative-pressure wound therapy with instillation in dermatology. J Dtsch Dermatol Ges 2018; 14:786-95. [PMID: 27509412 DOI: 10.1111/ddg.13038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Methods used in the treatment of acute and chronic wounds undergo constant evolution, reevaluation, and innovation. While negative-pressure wound therapy (NPWT) is an established treatment modality, the combination of NPWT and instillation of normal saline as well as solutions with active antiseptic components for topical treatment of the wound bed represents a novel approach. The well-known effects of NPWT may thus be combined with those of local antisepsis. They include a decrease in wound area, induction of granulation tissue, and reduction in bacterial colonization. To date, studies have focused on NPWT with instillation for orthopedic/surgical indications, whereas clinical data in dermatosurgery is limited to case reports or small case series. There are as yet no randomized prospective studies investigating NPWT with instillation in the treatment of skin disorders. The goal of this review is to present the method of NPWT with instillation, to highlight its mode of action as well as possible complications and contraindications, and to review the recent literature. In summary, there is increasing evidence that both simple and complicated wounds may be effectively treated with NPWT with instillation, resulting in markedly accelerated tissue granulation and thus earlier defect closure.
Collapse
Affiliation(s)
| | - Barbara Burgard
- Department of Dermatology, Allergology, and Venereology, University Hospital of Saarland, Homburg/Saar, Germany
| | - Monika Zimmerman
- Department of Dermatology, Allergology, and Venereology, University Hospital of Saarland, Homburg/Saar, Germany
| | - Thomas Vogt
- Department of Dermatology, Allergology, and Venereology, University Hospital of Saarland, Homburg/Saar, Germany
| | - Claudia Pföhler
- Department of Dermatology, Allergology, and Venereology, University Hospital of Saarland, Homburg/Saar, Germany
| |
Collapse
|
3
|
Gold MH, Andriessen A, Dayan SH, Fabi SG, Lorenc ZP, Henderson Berg MH. Hypochlorous acid gel technology-Its impact on postprocedure treatment and scar prevention. J Cosmet Dermatol 2017; 16:162-167. [PMID: 28370943 DOI: 10.1111/jocd.12330] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND A pre-and postprocedure regime aimed at prevention of infection, reduction of inflammation and risk of scarring, is to enable optimal outcomes. OBJECTIVES The role of a hypochlorous acid containing spray and translucent scar gel formulation that combines modified silicon oil with hypochlorous acid, was explored for pre- and postprocedure treatment and scar management. METHODS For this purpose a literature review was conducted to explore the value of the technology used in pre-and postprocedural regimes. A panel of dermatologists and plastic surgeons who practice in the United States discussed the summarized search results, taking into account their current clinical practice. A nominal group process for consensus was used, followed by online reviews of the manuscript. RESULTS Based on panel discussions, consensus was reached regarding clinical recommendations given for postprocedure treatment and scar management. The hypochlorous acid products are produced with electrolysis and are classified among biocidal substances. The technology has demonstrated efficacy and safety for pre-and postprocedure use. The safety of hypochlorous solution use demonstrated to be comparable to that of standard local antiseptics. Small studies demonstrated better results with the scar gel compared to silicone gel regarding the appearance of hypertrophic and keloid scars, relief of associated pruritus and pain. CONCLUSIONS A postprocedure regime using this technology, aimed at preventing infection, reducing inflammation, and promoting healing is proposed to have benefits over current regimes as it appears to be effective, safe, and well tolerated.
Collapse
Affiliation(s)
- Michael H Gold
- Gold Skin Care Center, Nashville, TN, USA.,Tennessee Clinical Research Center, Nashville, TN, USA.,Vanderbilt University School of Nursing, Nashville, TN, USA.,School of Medicine, Meharry Medical College, Nashville, TN, USA
| | | | - Steven H Dayan
- Department of Otolaryngology, Division of Facial Plastic and Reconstructive Surgery, University of Illinois, Chicago, IL, USA
| | | | - Z Paul Lorenc
- Lorenc Aesthetic Plastic Surgery Center, New York, NY, USA.,Department of Plastic Surgery, Lenox Hill Hospital, New York, NY, USA
| | | |
Collapse
|
4
|
Müller CSL, Burgard B, Zimmerman M, Vogt T, Pföhler C. Zum Stellenwert der Unterdruck-Instillationstherapie in der Dermatologie. J Dtsch Dermatol Ges 2016; 14:786-96. [PMID: 27509413 DOI: 10.1111/ddg.13038_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Die Methoden zur Behandlung akuter und chronischer Wunden unterliegen einer steten Weiterentwicklung, Reevaluierung und Anwendung innovativer Therapieformen. Die Vakuumtherapie zur Wundbehandlung gehört zu den etablierten Behandlungsmodalitäten. Ein innovatives Verfahren kombiniert die Vakuumtherapie mit der automatisierten, kontrollierten Zufuhr und Drainage wirkstoffhaltiger Lösungen zur topischen Wundbehandlung im Wundbett und auch wirkstofffrei durch Instillation physiologischer Kochsalzlösung (Unterdruck-Instillationstherapie). Hierdurch können die Effekte der konventionellen Vakuumtherapie mit denen der lokalen Antisepsis kombiniert werden. Hierdurch kommt es zu einer Reduktion der Wundfläche, einer Induktion von Granulationsgewebe sowie einer Reduktion der Keimbesiedelung der Wunden. Bisher publizierte Studien konzentrieren sich auf die Anwendung dieses Therapieverfahrens zur Behandlung orthopädisch-chirurgischer Krankheiten. Die Datenlage bezüglich der Vakuum-Instillationstherapie in der Dermatochirurgie beschränkt sich derzeit auf Fallberichte und Einzelfallerfahrungen. Randomisierte, prospektive Studien zum Vergleich der Vakuum-Instillationstherapie zur Behandlung dermatologischer Krankheitsbilder existieren bislang nicht. Ziele des vorliegenden Artikels sind die Vorstellung der Vakuumtherapie mit Instillation einschließlich ihres Wirkprinzips, deren mögliche Komplikationen, die Diskussion erdenklicher Kontraindikationen sowie eine Übersicht über die aktuell verfügbare Datenlage. Zusammenfassend scheint sich die Evidenz zu verdichten, dass mittels Unterdruck-Instillationstherapie sowohl einfache als auch komplizierte Wunden effizient behandelt werden können, was sich in einer deutlichen Beschleunigung der Wundgranulation mit konsekutiv früher möglichem Defektverschluss äußert.
Collapse
Affiliation(s)
| | - Barbara Burgard
- Klinik für Dermatologie, Allergologie und Venerologie, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - Monika Zimmerman
- Klinik für Dermatologie, Allergologie und Venerologie, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - Thomas Vogt
- Klinik für Dermatologie, Allergologie und Venerologie, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - Claudia Pföhler
- Klinik für Dermatologie, Allergologie und Venerologie, Universitätsklinikum des Saarlandes, Homburg/Saar
| |
Collapse
|
5
|
Kim PJ, Attinger CE, Steinberg JS, Evans KK, Lehner B, Willy C, Lavery L, Wolvos T, Orgill D, Ennis W, Lantis J, Gabriel A, Schultz G. Negative-pressure wound therapy with instillation: international consensus guidelines. Plast Reconstr Surg 2013; 132:1569-1579. [PMID: 24005370 DOI: 10.1097/prs.0b013e3182a80586] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Negative-pressure wound therapy with instillation is increasingly utilized as an adjunct therapy for a wide variety of wounds. Despite its growing popularity, there is a paucity of evidence and lack of guidance to provide effective use of this therapy. METHODS A panel of experts was convened to provide guidance regarding the appropriate use of negative-pressure wound therapy with instillation. A face-to-face meeting was held where the available evidence was discussed and individual clinical experience with this therapy was shared. Follow-up communication among the panelists continued until consensus was achieved. The final consensus recommendations were derived through more than 80 percent agreement among the panelists. RESULTS Nine consensus statements were generated that address the appropriate use of negative-pressure wound therapy with instillation. The question of clinical effectiveness of this therapy was not directly addressed by the consensus panel. CONCLUSION This document serves as preliminary guidelines until more robust evidence emerges that will support or modify these consensus recommendations.
Collapse
Affiliation(s)
- Paul J Kim
- Washington, D.C.; Heidelberg and Berlin, Germany; Dallas, Texas; Scottsdale, Ariz.; Boston, Mass.; Chicago, Ill.; New York, N.Y.; Vancouver, Wash.; Gainesville, Fla. From the Department of Plastic Surgery, Georgetown University Hospital; the Orthopedic and Trauma Clinic, Heidelberg University; Department of Trauma Senior Surgery and Orthopedics, Reconstructive, Septic, and Hand Surgery, Military Hospital Berlin; the Department of Plastic Surgery, University of Texas Southwestern; the Division of General Surgery, Scottsdale Healthcare Osborn Medical Center; the Department of Surgery, Harvard Medical School; the Department of Clinical Surgery, University of Illinois at Chicago; the Department of Surgery, Columbia University; the Department of Plastic and Maxillofacial Surgery, Southwest Washington Medical Center; and the Department of Wound Research, University of Florida
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Landsman A, Blume PA, Jordan DA, Vayser D, Gutierrez A. An open-label, three-arm pilot study of the safety and efficacy of topical Microcyn Rx wound care versus oral levofloxacin versus combined therapy for mild diabetic foot infections. J Am Podiatr Med Assoc 2012; 101:484-96. [PMID: 22106196 DOI: 10.7547/1010484] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND This randomized, prospective, multicenter, open-label study was designed to test whether a topical, electrolyzed, superoxidized solution (Microcyn Rx) is a safe and effective treatment for mildly infected diabetic foot ulcers. METHODS Sixty-seven patients with ulcers were randomized into three groups. Patients with wounds irrigated with Microcyn Rx alone were compared with patients treated with oral levofloxacin plus normal saline wound irrigation and with patients treated with oral levofloxacin plus Microcyn Rx wound irrigation. Patients were evaluated on day 3, at the end of treatment on day 10 (visit 3), and 14 days after completion of therapy for test of cure (visit 4). RESULTS In the intention-to-treat sample at visit 3, the clinical success rate was higher in the Microcyn Rx alone group (75.0%) than in the saline plus levofloxacin group (57.1%) or in the Microcyn Rx plus levofloxacin group (64.0%). Results at visit 4 were similar. In the clinically evaluable population, the clinical success rate at visit 3 (end of treatment) for patients treated with Microcyn Rx alone was 77.8% versus 61.1% for the levofloxacin group. The clinical success rate at visit 4 (test of cure) for patients treated with Microcyn Rx alone was 93.3% versus 56.3% for levofloxacin plus saline-treated patients. This study was not statistically powered, but the high clinical success rate (93.3%) and the P value (P = .033) suggest that the difference is meaningfully positive for Microcyn Rx-treated patients. CONCLUSIONS Microcyn Rx is safe and at least as effective as oral levofloxacin for mild diabetic foot infections.
Collapse
Affiliation(s)
- Adam Landsman
- Podiatric Surgery, Harvard Medical School/Cambridge Health Alliance, Cambridge, MA, USA.
| | | | | | | | | |
Collapse
|
7
|
Piaggesi A, Goretti C, Mazzurco S, Tascini C, Leonildi A, Rizzo L, Tedeschi A, Gemignani G, Menichetti F, Del Prato S. A Randomized Controlled Trial to Examine the Efficacy and Safety of a New Super-Oxidized Solution for the Management of Wide Postsurgical Lesions of the Diabetic Foot. INT J LOW EXTR WOUND 2010; 9:10-5. [DOI: 10.1177/1534734610361945] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This randomized trial was done to test the effectiveness and safety of using a novel antiseptic solution (Dermacyn® Wound Care [DWC], Oculus Innovative Sciences, Petaluma, CA) in the management of the postoperative lesions on the infected diabetic foot. 40 patients with postsurgical lesions wider than 5 cm2 left open to heal by secondary intention were randomized into 2 groups. Group A was locally treated with DWC, whereas group B received povidone iodine as local medication, both in adjunct to systemic antibiotic therapy and surgical debridement if needed. Ischemia, renal failure, bilateral lesions, or immunodepression were considered as exclusion criteria. Patients were followed up weekly for 6 months. The primary endpoint was healing rate at 6 months, while secondary endpoints were healing time, time to achieve negative cultures, duration of antibiotic therapy, number of reinterventions, and adverse events. Healing rates at 6 months were significantly shorter in group A (90%) than in group B (55%; P < .01). The time taken for cultures to become negative and duration of antibiotic therapy were also significantly (P < .05) shorter in group A than in group B, whereas the number of reinterventions was significantly higher in group B (P < .05). No difference was noted in the adverse events except that for reinfections, which were more frequent in group B than in group A (P < .01). DWC is as safe as and more effective than standard local antiseptics in the management of wide postsurgical lesions in the infected diabetic foot.
Collapse
Affiliation(s)
- A. Piaggesi
- Diabetic Foot Section, Department of Endocrinology and
Metabolism Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy,
| | - C. Goretti
- Diabetic Foot Section, Department of Endocrinology and
Metabolism Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - S. Mazzurco
- Diabetic Foot Section, Department of Endocrinology and
Metabolism Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - C. Tascini
- Department of Infectious Diseases, Azienda Ospedaliero-
Universitaria Pisana, Pisa, Italy
| | - A. Leonildi
- Department of Infectious Diseases, Azienda Ospedaliero-
Universitaria Pisana, Pisa, Italy
| | - L. Rizzo
- Diabetic Foot Section, Department of Endocrinology and
Metabolism Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - A. Tedeschi
- Diabetic Foot Section, Department of Endocrinology and
Metabolism Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - G. Gemignani
- Department of Infectious Diseases, Azienda Ospedaliero-
Universitaria Pisana, Pisa, Italy
| | - F. Menichetti
- Department of Infectious Diseases, Azienda Ospedaliero-
Universitaria Pisana, Pisa, Italy
| | - S. Del Prato
- Diabetic Foot Section, Department of Endocrinology and
Metabolism Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| |
Collapse
|
8
|
Abstract
Foot infections are common in persons with diabetes and are often the proximate cause of lower extremity amputation. There have been many publications in the past few years dealing with the appropriate ways to diagnose and treat diabetic foot infections. This review presents information gathered from a comprehensive, ongoing surveillance of the literature (published and abstracts) over the past 4 years. Prospective studies have now defined the epidemiology of diabetic foot infections, as well as methods to score and classify the wounds. Several recently published guidelines can assist clinicians in managing these infections. The etiologic agents of infection have been well-defined, and the prevalence of multi-drug-resistance pathogens is growing. Molecular methods offer great promise for quicker and more sensitive diagnosis of infection. New antimicrobial agents, both systemic and topical, as well as novel local treatments, have been shown to be effective in various studies. Improved methods of deploying older agents have added to the variety of treatment approaches now available. Several adjunctive treatments may benefit some patients but their role is as yet unclear. While there is much yet to learn about the most cost-effective ways to diagnose and treat diabetic foot infections the main effort is now to disseminate the available information and facilitate employing the evidence-based guideline recommendations.
Collapse
|
9
|
Abstract
Chronic wounds have traditionally been treated by conservative means. It was Winter's moist wound healing research, in 1962, that stimulated a proliferation of a moist interactive dressing technologies. Even considering this advancement in thinking, chronic wounds continue to be a problem for many clinicians. An increasing delineation of the science of healing in the past 20 years has redefined the way in which we both evaluate and treat wounds. This scientific understanding has raised wound care from the clinical problem arena to that of clinical specialty, where many now cross refer patients to specialists in this field. Wound bed preparation (WBP) has played a significant role in this change in practice. The concept has changed an 'art' of switching at random from one dressing to another, into a clinical science. WBP has come to the forefront as a major educational aid to help others develop appropriate treatment of the underlying disease causing the wound and patient requirements. The concept of WBP evolved over the recent years, becoming more and more sophisticated with time. Recent adaptations have brought together many of the current components. This article proposes yet another element of WBP, that of 'oxygen balance'.
Collapse
Affiliation(s)
- R Gary Sibbald
- R Gary Sibbald, MD, FRCPC, MEd, Women’s College Hospital, 76 Grenville Street, 10th Floor, Toronto, Ontario, Canada.
| | - Kevin Y Woo
- KY Woo, RN, PhD(C), ACNP, Women’s College Hospital, 76 Grenville Street, 10th Floor, Toronto, Ontario, Canada
| | - Douglas Queen
- D Queen, BSc, PhD, MBA, Women’s College Hospital, 76 Grenville Street, 10th Floor, Toronto, Ontario, Canada
| |
Collapse
|
10
|
Medina-Tamayo J, Sánchez-Miranda E, Balleza-Tapia H, Ambriz X, Cid ME, González-Espinosa D, Gutiérrez AA, González-Espinosa C. Super-oxidized solution inhibits IgE-antigen-induced degranulation and cytokine release in mast cells. Int Immunopharmacol 2007; 7:1013-24. [PMID: 17570318 DOI: 10.1016/j.intimp.2007.03.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2006] [Revised: 03/02/2007] [Accepted: 03/19/2007] [Indexed: 11/26/2022]
Abstract
Activation of the high affinity IgE receptor (Fc epsilonRI) through IgE-antigen complexes induces mast cell degranulation, synthesis of lipid mediators and cytokine production. These effects are involved in Type I hypersensitivity reactions and controlling them has been the main objective of many anti-allergic therapies. Here we report that pretreatment of murine bone marrow derived mast cells (BMMC) with super-oxidized solution (SOS) inhibits Fc epsilonRI dependent-beta hexosaminidase and cytokine release. This effect is exerted without altering total protein tyrosine phosphorylation, MAPK activation, cytokine mRNA accumulation or calcium mobilization after Fc epsilonRI triggering. Our data suggest that this neutral pH-SOS acts like a mast cell-membrane stabilizer inhibiting the cell machinery for granule secretion without altering the signal transduction pathways induced by IgE-antigen receptor crosslinking.
Collapse
Affiliation(s)
- J Medina-Tamayo
- Pharmacobiology Department, Cinvestav, South Campus, Mexico City, Mexico
| | | | | | | | | | | | | | | |
Collapse
|