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Li W, Zheng J. Negative Pressure Wound Therapy for Chronic Wounds. Ann Plast Surg 2024:00000637-990000000-00463. [PMID: 38896874 DOI: 10.1097/sap.0000000000003891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
ABSTRACT Chronic wounds, including those caused by venous and arterial insufficiency, diabetic complications, and pressure-induced ulcers, pose significant treatment challenges. Negative pressure wound therapy has been increasingly used for managing these wounds. This treatment aims to promote wound healing, prepare the wound bed for further surgical intervention, minimize the risk of infection, and potentially shorten the time to wound healing. Considering variances in techniques applied in different regions globally, there is an emerging need to comprehensively evaluate the effectiveness of negative pressure wound therapy on chronic wounds. Unfortunately, detailed descriptions of the techniques applied to achieve negative pressure are often lacking in existing literature abstracts, posing challenges for direct comparisons. This review aims to analyze the application of negative pressure wound therapy in the treatment of chronic wounds, summarize its advantages and disadvantages, and further explore the potential value and future research direction of negative pressure wound therapy in the repair of chronic wounds.
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Affiliation(s)
- Wenbo Li
- From the Plastic Surgery Department, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
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Liu Y. Chinese expert consensus on the Management of Pediatric Deep Partial-Thickness Burn Wounds (2023 edition). BURNS & TRAUMA 2023; 11:tkad053. [PMID: 37936895 PMCID: PMC10627016 DOI: 10.1093/burnst/tkad053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/21/2023] [Accepted: 10/21/2023] [Indexed: 11/09/2023]
Abstract
Burns are a main cause of accidental injuries among children in China. Because of the unique wound repair capacity and demand for growth in pediatric patients, the management of pediatric deep partial-thickness burn wounds involves a broader range of treatment options and controversy. We assembled experts from relevant fields in China to reach a consensus on the key points of thermal-induced pediatric deep partial-thickness burn-wound management, including definition and diagnosis, surgical treatments, nonsurgical treatment, choice of wound dressings, growth factor applications, infectious wound treatment, scar prevention and treatment. The committee members hope that the Expert Consensus will provide help and guiding recommendations for the treatment of pediatric deep partial-thickness burn wounds.
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Affiliation(s)
- Yan Liu
- Department of Burn, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Chinese Burn Association
- Department of Burn, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
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Palackic A, Jay JW, Duggan RP, Branski LK, Wolf SE, Ansari N, El Ayadi A. Therapeutic Strategies to Reduce Burn Wound Conversion. Medicina (B Aires) 2022; 58:medicina58070922. [PMID: 35888643 PMCID: PMC9315582 DOI: 10.3390/medicina58070922] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/02/2022] [Accepted: 07/08/2022] [Indexed: 11/16/2022] Open
Abstract
Burn wound conversion refers to the phenomenon whereby superficial burns that appear to retain the ability to spontaneously heal, convert later into deeper wounds in need of excision. While no current treatment can definitively stop burn wound conversion, attempts to slow tissue damage remain unsatisfactory, justifying the need for new therapeutic interventions. To attenuate burn wound conversion, various studies have targeted at least one of the molecular mechanisms underlying burn wound conversion, including ischemia, inflammation, apoptosis, autophagy, generation of reactive oxygen species, hypothermia, and wound rehydration. However, therapeutic strategies that can target various mechanisms involved in burn wound conversion are still lacking. This review highlights the pathophysiology of burn wound conversion and focuses on recent studies that have turned to the novel use of biologics such as mesenchymal stem cells, biomaterials, and immune regulators to mitigate wound conversion. Future research should investigate mechanistic pathways, side effects, safety, and efficacy of these different treatments before translation into clinical studies.
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Affiliation(s)
- Alen Palackic
- Department of Surgery, University of Texas Medical Branch, Galveston, TX 77555, USA; (A.P.); (J.W.J.); (R.P.D.); (L.K.B.); (S.E.W.)
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, A-8036 Graz, Austria
| | - Jayson W. Jay
- Department of Surgery, University of Texas Medical Branch, Galveston, TX 77555, USA; (A.P.); (J.W.J.); (R.P.D.); (L.K.B.); (S.E.W.)
| | - Robert P. Duggan
- Department of Surgery, University of Texas Medical Branch, Galveston, TX 77555, USA; (A.P.); (J.W.J.); (R.P.D.); (L.K.B.); (S.E.W.)
| | - Ludwik K. Branski
- Department of Surgery, University of Texas Medical Branch, Galveston, TX 77555, USA; (A.P.); (J.W.J.); (R.P.D.); (L.K.B.); (S.E.W.)
| | - Steven E. Wolf
- Department of Surgery, University of Texas Medical Branch, Galveston, TX 77555, USA; (A.P.); (J.W.J.); (R.P.D.); (L.K.B.); (S.E.W.)
| | - Naseem Ansari
- Department of Biochemistry and Molecular Biology, University of Texas Medical Branch, Galveston, TX 77555, USA;
| | - Amina El Ayadi
- Department of Surgery, University of Texas Medical Branch, Galveston, TX 77555, USA; (A.P.); (J.W.J.); (R.P.D.); (L.K.B.); (S.E.W.)
- Correspondence:
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Cost-effectiveness of adjunctive negative pressure wound therapy in paediatric burn care: evidence from the SONATA in C randomised controlled trial. Sci Rep 2021; 11:16650. [PMID: 34404842 PMCID: PMC8371025 DOI: 10.1038/s41598-021-95893-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 07/30/2021] [Indexed: 11/24/2022] Open
Abstract
Negative pressure wound therapy (NPWT) has been shown to improve clinical outcomes for children with burns by accelerating wound re-epithelialisation. Its effects on healthcare costs, however, remain poorly understood. The aim of this study was to evaluate the cost-effectiveness of NPWT from a healthcare provider perspective using evidence from the SONATA in C randomised controlled trial, in which 101 children with small-area burns were allocated to either standard care (silver-impregnated dressings) or standard care in combination with adjunctive NPWT. The primary outcome, time to re-epithelialisation, was assessed through a blinded photographic review. Resource usage and costs were prospectively recorded for each participant for up to 6 months. Incremental cost-effectiveness ratios and dominance probabilities were estimated and uncertainty quantified using bootstrap resampling. Mean costs per participant—including dressings, labour, medication, scar management, and theatre operations—were lower in the NPWT group (AUD $903.69) relative to the control group (AUD $1669.01). There was an 89% probability that NPWT was dominant, yielding both faster re-epithelialisation and lower overall costs. Findings remained robust to sensitivity analyses employing alternative theatre costs and time-to-re-epithelialisation estimates for grafted patients. In conclusion, adjunctive NPWT is likely to be a cost-effective and dominant treatment for small-area paediatric burns (ANZCTR.org.au:ACTRN12618000256279).
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Bairagi A, Frear C, Sweeting C, Kimble R, Griffin B. A pilot study comparing two burn wound stereophotogrammetry systems in a paediatric population. Burns 2021; 48:85-90. [PMID: 33934905 DOI: 10.1016/j.burns.2021.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 04/01/2021] [Accepted: 04/12/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Stereophotogrammetry (SPG) provides a more objective measurement of burn wound area than traditional clinical assessments. The recently developed Intel® RealSense™ D415/Wound Measure SPG system has yet to undergo formal evaluation in a paediatric population. METHODS A pilot study comparing the Intel® RealSense™ D415/Wound Measure to the previously validated LifeVizII®/DermaPix® SPG system, for burn assessment was conducted at a tertiary paediatric burn centre. Both systems were used to photograph and analyse the same acute wounds for each patient. Three independent raters measured wound area and perimeter. Level of agreement between systems and raters was estimated by calculating the intra-class correlation coefficient. RESULTS Wound area measurements were completed in both systems for 25 burns from 13 patients (median age, 2 years). The participants were mainly female (n = 9), with a median TBSA-B of 9% (IQR 3-20%). There was strong agreement between the systems 0.757 (95% CI 0.521, 0.885, p < 0.001). Within each SPG system, there was excellent inter-rater reliability. CONCLUSION The Intel® RealSense™ D415/Wound Measure system may be a viable addition to the clinician's toolkit in the assessment of paediatric burn wound area. As with other SPG systems, there were significant challenges measuring wounds to highly contoured surfaces.
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Affiliation(s)
- Anjana Bairagi
- Centre for Children's Burns and Trauma Research, Queensland Health Centre for Children's Health Research, Brisbane, Queensland, Australia; Queensland University of Technology, Brisbane, Queensland, Australia; Pegg Leditschke Children's Burns Centre, Queensland Children's Hospital, Brisbane, Queensland, Australia.
| | - Cody Frear
- Centre for Children's Burns and Trauma Research, Queensland Health Centre for Children's Health Research, Brisbane, Queensland, Australia; The University of Queensland, Brisbane, Queensland, Australia.
| | | | - Roy Kimble
- Centre for Children's Burns and Trauma Research, Queensland Health Centre for Children's Health Research, Brisbane, Queensland, Australia; Queensland University of Technology, Brisbane, Queensland, Australia; Pegg Leditschke Children's Burns Centre, Queensland Children's Hospital, Brisbane, Queensland, Australia; The University of Queensland, Brisbane, Queensland, Australia.
| | - Bronwyn Griffin
- Centre for Children's Burns and Trauma Research, Queensland Health Centre for Children's Health Research, Brisbane, Queensland, Australia; Pegg Leditschke Children's Burns Centre, Queensland Children's Hospital, Brisbane, Queensland, Australia; Griffith University, Menzies Health Institute of Queensland, Brisbane, Queensland, Australia.
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Abstract
Numerous individuals suffer from impaired wound healing, such as chronic ulcers, severe burns and immune disorders, resulting in both public health and economic burdens. Skin is the first line of defense and the largest organ of the human body, however, an incomplete understanding of underlying cellular and molecular mechanisms of dermal repair leads to a lack of effective therapy for healing impaired wounds. There are strong clinical and social needs for improved therapeutic approaches to enhance endogenous tissue repair and regenerative capacity. The purpose of this review is to illuminate the cellular and molecular aspects of the healing process and highlight potential therapeutic strategies to accelerate translational research and the development of clinical therapies in dermal wounds.
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Affiliation(s)
- Fan Yang
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Xiangjun Bai
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Xiaojing Dai
- MD Anderson Cancer Center, The Advanced Technology Genomics Core, Houston, TX 77030, USA
| | - Yong Li
- Department of Orthopedic Surgery & Biomedical Engineering, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI 49008, USA
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Frear CC, Zang T, Griffin BR, McPhail SM, Parker TJ, Kimble RM, Cuttle L. The modulation of the burn wound environment by negative pressure wound therapy: Insights from the proteome. Wound Repair Regen 2020; 29:288-297. [PMID: 33374033 DOI: 10.1111/wrr.12887] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 12/02/2020] [Indexed: 12/24/2022]
Abstract
Negative pressure wound therapy has been used to promote wound healing in a variety of settings, including as an adjunct to silver-impregnated dressings in the acute management of paediatric burns. Fluid aspirated by the negative pressure wound therapy system represents a potentially insightful research matrix for understanding the burn wound microenvironment and the intervention's biochemical mechanisms of action. The aim of this study was to characterize the proteome of wound fluid collected using negative pressure wound therapy from children with small-area thermal burns. Samples were obtained as part of a randomized controlled trial investigating the clinical efficacy of adjunctive negative pressure wound therapy. They were compared with blister fluid specimens from paediatric burn patients matched according to demographic and injury characteristics. Protein identification and quantification were performed via liquid chromatography tandem mass spectrometry and sequential window acquisition of all theoretical mass spectra data-independent acquisition. Proteins and biological pathways that were unique to or enriched in negative pressure wound therapy fluid samples were evaluated using principal components, partial least squares-discriminant, and gene ontology enrichment analyses. Eight viable samples of negative pressure wound therapy fluid were collected and analyzed with eight matched blister fluid samples. A total of 502 proteins were quantitatively profiled in the negative pressure wound therapy fluid, of which 444 (88.4%) were shared with blister fluid. Several proteins exhibited significant abundance differences between fluid types, with negative pressure wound therapy fluid showing a higher abundance of matrix metalloproteinase-9, arginase-1, low affinity immunoglobulin gamma Fc region receptor III-A, filamin-A, alpha-2-macroglobulin, and hemoglobin subunit alpha. The results lend support to the hypothesis that negative pressure wound therapy augments wound healing through the modulation of factors involved in the inflammatory response, granulation tissue synthesis, and extracellular matrix maintenance. Data are available via ProteomeXchange with identifier PXD023168.
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Affiliation(s)
- Cody C Frear
- Centre for Children's Burns and Trauma Research, South Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Tuo Zang
- Centre for Children's Burns and Trauma Research, South Brisbane, Queensland, Australia.,Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Bronwyn R Griffin
- Centre for Children's Burns and Trauma Research, South Brisbane, Queensland, Australia.,Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Steven M McPhail
- Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia.,Clinical Informatics Directorate, Metro South Health, Brisbane, Queensland, Australia
| | - Tony J Parker
- Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Roy M Kimble
- Centre for Children's Burns and Trauma Research, South Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Herston, Queensland, Australia.,Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Leila Cuttle
- Centre for Children's Burns and Trauma Research, South Brisbane, Queensland, Australia.,Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia
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Frear CC, Cuttle L, McPhail SM, Chatfield MD, Kimble RM, Griffin BR. Randomized clinical trial of negative pressure wound therapy as an adjunctive treatment for small-area thermal burns in children. Br J Surg 2020; 107:1741-1750. [PMID: 32926410 PMCID: PMC7692881 DOI: 10.1002/bjs.11993] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 04/17/2020] [Accepted: 07/21/2020] [Indexed: 12/03/2022]
Abstract
Background The efficacy of negative pressure wound therapy (NPWT) in the acute management of burns remains unclear. The purpose of this trial was to compare standard Acticoat™ and Mepitel™ dressings with combined Acticoat™, Mepitel™ and continuous NPWT to determine the effect of adjunctive NPWT on re‐epithelialization in paediatric burns. Methods This two‐arm, single‐centre RCT recruited children with acute thermal burns covering less than 5 per cent of their total body surface area. The primary outcome was time to re‐epithelialization. Blinded assessments were performed using photographs captured every 3–5 days until discharge. Secondary measures included pain, itch, grafting, perfusion and scar management referrals. Results Some 114 patients were randomized. Median time to re‐epithelialization was 8 (i.q.r. 7–11) days in the NPWT group and 10 (8–14) days in the control group. In a multivariable model, NPWT decreased the expected time to wound closure by 22 (95 per cent c.i. 7 to 34) per cent (P = 0·005). The risk of referral to scar management was reduced by 60 (18 to 81) per cent (P = 0·013). Four participants in the control group and one in the NPWT group underwent grafting. There were no statistically significant differences between groups in pain, itch or laser Doppler measures of perfusion. Adverse events were rare and minor, although NPWT carried a moderate treatment burden, with ten patients discontinuing early. Conclusion Adjunctive NPWT hastened re‐epithelialization in small‐area burn injuries in children, but had a greater treatment burden than standard dressings alone. Registration number: ACTRN12618000256279 (
http://ANZCTR.org.au).
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Affiliation(s)
- C C Frear
- Centre for Children's Burns and Trauma Research, South Brisbane, Australia.,Faculty of Medicine, University of Queensland, Herston, Australia
| | - L Cuttle
- Centre for Children's Burns and Trauma Research, South Brisbane, Australia.,School of Biomedical Sciences, Brisbane, Queensland, Australia
| | - S M McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Brisbane, Queensland, Australia.,Clinical Informatics Directorate, Metro South Health, Brisbane, Queensland, Australia
| | - M D Chatfield
- Faculty of Medicine, University of Queensland, Herston, Australia
| | - R M Kimble
- Centre for Children's Burns and Trauma Research, South Brisbane, Australia.,Queensland Children's Hospital, South Brisbane, Australia.,Faculty of Medicine, University of Queensland, Herston, Australia
| | - B R Griffin
- Centre for Children's Burns and Trauma Research, South Brisbane, Australia.,School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
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Chu H, Maklad M, Cobley T, Sen S. The use of negative pressure wound therapy (NPWT), as an adjunct for primary wound healing, in deep partial-thickness paediatric foot burns: A case report. BURNS OPEN 2020. [DOI: 10.1016/j.burnso.2020.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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