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Su L, Jia Y, Fu L, Guo K, Xie S. The emerging progress on wound dressings and their application in clinic wound management. Heliyon 2023; 9:e22520. [PMID: 38076148 PMCID: PMC10709065 DOI: 10.1016/j.heliyon.2023.e22520] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 11/13/2023] [Accepted: 11/14/2023] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND In addition to its barrier function, the skin plays a crucial role in maintaining the stability of the body's internal environment and normal physiological functions. When the skin is damaged, it is important to select proper dressings as temporary barriers to cover the wound, which can exert significant effects on defence against microbial infection, maintaining normal tissue/cell functions, and coordinating the process of wound repair and regeneration. It now forms an important approach in clinic practice to facilitate wound repair. SEARCH STRATEGIES We conducted a comprehensive literature search using online databases including PubMed, Web of Science, MEDLINE, ScienceDirect, Wiley Online Library, CNKI, and Wanfang Data. In addition, information was obtained from local and foreign books on biomaterials science and traumatology. RESULTS This review focuses on the efficacy and principles of functional dressings for anti-bacteria, anti-infection, anti-inflammation, anti-oxidation, hemostasis, and wound healing facilitation; and analyses the research progress of dressings carrying living cells such as fibroblasts, keratinocytes, skin appendage cells, and stem cells from different origins. We also summarize the recent advances in intelligent wound dressings with respect to real-time monitoring, automatic drug delivery, and precise adjustment according to the actual wound microenvironment. In addition, this review explores and compares the characteristics, advantages and disadvantages, mechanisms of actions, and application scopes of dressings made from different materials. CONCLUSION The real-time and dynamic acquisition and analysis of wound conditions are crucial for wound management and prognostic evaluation. Therefore, the development of modern dressings that integrate multiple functions, have high similarity to the skin, and are highly intelligent will be the focus of future research, which could drive efficient wound management and personalized medicine, and ultimately facilitate the translation of health monitoring into clinical practice.
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Affiliation(s)
- Linlin Su
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi, 710032, China
| | - Yanhui Jia
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi, 710032, China
| | - Lanqing Fu
- Department of Orthopedics, Wuchang Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, Hubei, 430063, China
| | - Kai Guo
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi, 710032, China
| | - Songtao Xie
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi, 710032, China
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Cascales JP, Draghici AE, Keshishian H, Taylor JA, Evans CL. Calculation of Tissue Oxygenation via an Inverse Boundary Problem for Transcutaneous Oxygenation Wearable Applications. ACS MEASUREMENT SCIENCE AU 2023; 3:269-276. [PMID: 37600461 PMCID: PMC10436371 DOI: 10.1021/acsmeasuresciau.3c00013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/19/2023] [Accepted: 04/19/2023] [Indexed: 08/22/2023]
Abstract
In this article, we present a toolset to fully leverage a previously developed transcutaneous oxygenation monitor (TCOM) wearable technology to accurately measure skin oxygenation values. We describe numerical models and experimental characterization techniques that allow for the extraction of precise tissue oxygenation measurements. The numerical model is based on an inverse boundary problem of the parabolic equation with Dirichlet boundary conditions. To validate this model and characterize the diffusion of oxygen through the oxygen sensing materials, we designed a series of control/calibration experiments modeled after the device's clinical application using oxygenation values in the physiological range expected for healthy tissue. Our results demonstrate that it is possible to obtain accurate tissue pO2 measurements without the need for long equilibration times with a small wearable device.
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Affiliation(s)
- Juan Pedro Cascales
- Wellman
Center for Photomedicine, Massachusetts General Hospital, Harvard
Medical School, Charlestown, Massachusetts 02129, United States
- Departamento
de Química en Ciencias Farmacéuticas, Facultad de Farmacia, Universidad Complutense de Madrid, Plaza Ramón y Cajal S/N, Madrid 28040, Spain
| | - Adina E. Draghici
- Cardiovascular
Research Lab, Spaulding Rehabilitation Hospital,
Harvard Medical School, Cambridge, Massachusetts 02138, United States
| | - Helen Keshishian
- Wellman
Center for Photomedicine, Massachusetts General Hospital, Harvard
Medical School, Charlestown, Massachusetts 02129, United States
| | - J. Andrew Taylor
- Cardiovascular
Research Lab, Spaulding Rehabilitation Hospital,
Harvard Medical School, Cambridge, Massachusetts 02138, United States
| | - Conor L. Evans
- Wellman
Center for Photomedicine, Massachusetts General Hospital, Harvard
Medical School, Charlestown, Massachusetts 02129, United States
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Kutsenko O, Sommerset J, Chandra V, Bryce Y. Techniques Providing Endpoints for Revascularization in Chronic Limb-Threatening Ischemia. Semin Intervent Radiol 2023; 40:177-182. [PMID: 37333748 PMCID: PMC10275665 DOI: 10.1055/s-0043-1768608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
It is frequently difficult to estimate the revascularization endpoint in patients with chronic limb-threatening ischemia where there may be extensive multifocal multiarterial disease. There have been attempts to identify an endpoint for revascularization procedures, but none has become the standard of care. An ideal indicator of an endpoint can objectively quantify tissue perfusion, predict wound healing, and is easily and efficiently used intraprocedurally to assist real-time decision making on whether adequate perfusion has been reached. Candidate techniques to evaluate endpoints post-revascularization are discussed here.
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Affiliation(s)
- Oleksandra Kutsenko
- Department of Radiology, Miami Cardiac and Vascular Institute, Miami, Florida
| | | | - Venita Chandra
- Department of Vascular Surgery, Stanford University School of Medicine, Redwood City, California
| | - Yolanda Bryce
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
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Müller M, Cascales JP, Marks HL, Wang-Evers M, Manstein D, Evans CL. Phosphorescent Microneedle Array for the Measurement of Oxygen Partial Pressure in Tissue. ACS Sens 2022; 7:3440-3449. [PMID: 36305608 DOI: 10.1021/acssensors.2c01775] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The knowledge of the exact oxygen partial pressure in tissue is crucial for patient care and in the treatment of ischemic medical conditions. However, current methods to assess oxygen partial pressure in tissue suffer from a variety of disadvantages, including complex equipment and procedures that necessitate trained personnel. Additionally, the barrier function of the stratum corneum reduces oxygen exchange and can consequently hamper surface measurements of rapidly changing oxygen partial pressure in tissue. To overcome these challenges, a novel, easy-to-use technique to monitor the oxygen partial pressure in tissue using microneedle arrays (MNAs) has been developed. The MNAs can be made from poly(ethyl methacrylate) and poly(propyl methacrylate) and overcome the skin's barrier function to measure oxygen in the capillary bed and interstitial fluid of the skin. The MNAs' tips are embedded with an oxygen-sensitive phosphorescent metalloporphyrin, where the oxygen partial pressure inversely correlates to changes in both emission intensity and phosphorescence lifetime of the in-house developed red emitting Pt-core porphyrin. It was demonstrated that the oxygen-sensing MNAs are sufficiently robust to puncture human skin via rupture of the stratum corneum, and that the MNAs can detect changes in oxygen partial pressure in skin within the physiologically relevant range (0-160 mmHg). Additionally, the MNAs can be combined with a wearable wireless optical readout system, making these oxygen-sensing MNAs a novel wearable and portable method for user-friendly monitoring of oxygen partial pressure in skin.
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Affiliation(s)
- Matthias Müller
- Wellman Center for Photomedicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts02129, United States
| | - Juan Pedro Cascales
- Wellman Center for Photomedicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts02129, United States
| | - Haley L Marks
- Cutaneous Biology Research Center, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts02129, United States
| | - Michael Wang-Evers
- Cutaneous Biology Research Center, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts02129, United States
| | - Dieter Manstein
- Cutaneous Biology Research Center, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts02129, United States
| | - Conor L Evans
- Wellman Center for Photomedicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts02129, United States
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Goodeill T, Than J, Pipitone O, Lin J, Tedesco N. Effects of Hypercarbia on Lower Extremity Primary Total Joint Replacement Infections. Cureus 2022; 14:e26069. [PMID: 35865438 PMCID: PMC9293259 DOI: 10.7759/cureus.26069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction: Prosthetic joint infection (PJI) is a serious complication after total joint replacement (TJR). Adequate wound oxygenation is critical for wound healing and infection prevention. As carbon dioxide (CO2) is exchanged for oxygen (O2) in the lungs, serum bicarbonate (HCO3-) may be used as a marker for predicting relative serum O2 levels, and therefore, healing potential. No currently published literature explores the relationship between serum bicarbonate levels and PJI in TJR patients. Methods: We performed this retrospective review of lower extremity TJR patients to determine whether the risk of PJI and wound complications within one year was correlated with hypercarbia, which was defined as a preoperative serum bicarbonate level >30 mEq/L. Results: Out of 1,690 TJR procedures, 1.6% (N=27) had a PJI or superficial wound infection within one year postoperatively. The average preoperative serum bicarbonate was 26.9 (SD 2.6) among patients without PJI and 27.2 (SD 2.1) among patients with PJI (p=0.46). Hypercarbia was present in 9.2% of non-PJI patients and in 7.4% of PJI patients. The relative risk of PJI and wound complications did not differ for patients with vs without hypercarbia (RR = 0.79, 95% CI = 0.19-3.31, p=0.75). Conclusion: The results of this study provide preliminary evidence that preoperative hypercarbia may not be correlated with an increase in the risk of PJI or wound complications. However, due to the rarity of both PJI and hypercarbia, a larger patient population is needed to ensure adequate power to detect clinically meaningful effect sizes.
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Suo S, Tang H, Lu Q, Zhang L, Ni Q, Xu J. Response to letter to the editor: "Muscle blood flow, oxygen pressure, and hemoglobin/myoglobin saturation: The infernal triad". Magn Reson Med 2021; 86:15-16. [PMID: 33683729 DOI: 10.1002/mrm.28735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/21/2021] [Accepted: 01/25/2021] [Indexed: 11/10/2022]
Affiliation(s)
- Shiteng Suo
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Hui Tang
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qing Lu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lan Zhang
- Department of Vascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qihong Ni
- Department of Vascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jianrong Xu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Cascales JP, Roussakis E, Witthauer L, Goss A, Li X, Chen Y, Marks HL, Evans CL. Wearable device for remote monitoring of transcutaneous tissue oxygenation. BIOMEDICAL OPTICS EXPRESS 2020; 11:6989-7002. [PMID: 33408975 PMCID: PMC7747925 DOI: 10.1364/boe.408850] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/30/2020] [Accepted: 11/02/2020] [Indexed: 06/12/2023]
Abstract
Wearable devices have found widespread applications in recent years as both medical devices as well as consumer electronics for sports and health tracking. A metric of health that is often overlooked in currently available technology is the direct measurement of molecular oxygen in living tissue, a key component in cellular energy production. Here, we report on the development of a wireless wearable prototype for transcutaneous oxygenation monitoring based on quantifying the oxygen-dependent phosphorescence of a metalloporphyrin embedded within a highly breathable oxygen sensing film. The device is completely self-contained, weighs under 30 grams, performs on-board signal analysis, and can communicate with computers or smartphones. The wearable measures tissue oxygenation at the skin surface by detecting the lifetime and intensity of phosphorescence, which undergoes quenching in the presence of oxygen. As well as being insensitive to motion artifacts, it offers robust and reliable measurements even in variable atmospheric conditions related to temperature and humidity. Preliminary in vivo testing in a porcine ischemia model shows that the wearable is highly sensitive to changes in tissue oxygenation in the physiological range upon inducing a decrease in limb perfusion.
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Kanick SC, Schneider PA, Klitzman B, Wisniewski NA, Rebrin K. Continuous monitoring of interstitial tissue oxygen using subcutaneous oxygen microsensors: In vivo characterization in healthy volunteers. Microvasc Res 2019; 124:6-18. [PMID: 30742844 PMCID: PMC6570499 DOI: 10.1016/j.mvr.2019.02.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 02/04/2019] [Accepted: 02/05/2019] [Indexed: 11/19/2022]
Abstract
Measurements of regional tissue oxygen serve as a proxy to monitor local perfusion and have the potential to guide therapeutic decisions in multiple clinical disciplines. Transcutaneous oximetry (tcpO2) is a commercially available noninvasive technique that uses an electrode to warm underlying skin tissue and measure the resulting oxygen tension at the skin surface. A novel approach is to directly measure interstitial tissue oxygen using subcutaneous oxygen microsensors composed of a biocompatible hydrogel carrier platform with embedded oxygen sensing molecules. After initial injection of the hydrogel into subcutaneous tissue, noninvasive optical measurements of phosphorescence-based emissions at the skin surface are used to sense oxygen in the subcutaneous interstitial space. The object of the present study was to characterize the in vivo performance of subcutaneous microsensors and compare with transcutaneous oximetry (tcpO2). Vascular occlusion tests were performed on the arms of 7 healthy volunteers, with repeated tests occurring 1 to 10 weeks after sensor injection, yielding 95 total tests for analysis. Comparative analysis characterized the response of both devices to decreases in tissue oxygen during occlusion and to increases in tissue oxygen following release of the occlusion. Results indicated: (I) time traces returned by microsensors and tcpO2 were highly correlated, with the median (interquartile range) correlation coefficient of r = 0.93 (0.10); (II) both microsensors and tcpO2 sensed a statistically significant decrease in normalized oxygen during occlusion (p < 0.001 for each device); (III) microsensors detected faster rates change (p < 0.001) and detected overshoot during recovery more frequently (38% vs. 4% of tests); (IV) inter-measurement analysis showed no correlation of baseline values between microsensors and tcpO2 (r = 0.03), but comparison of integrated oxygen dynamics showed similar variation in the normalized response to occlusion between devices (p = 0.06), (V) intra-measurement analysis revealed that microsensors detect greater physiological fluctuations than tcpO2 (p < 0.001) and may provide enhanced sensitivity to processes such as vasomotion. Additionally, the functional response of microsensors was not significantly different across time groupings (per month) post-injection (p = 0.61). Although the compared devices have differences in the mechanisms used to sense oxygen, these findings demonstrate that subcutaneous oxygen microsensors measure changes in interstitial tissue oxygen in human subjects in vivo.
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Affiliation(s)
| | | | - Bruce Klitzman
- Kenan Plastic Surgery Research Labs and Biomedical Engineering, Duke University, Durham, NC, USA
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Chiang N, Jain JK, Sleigh J, Vasudevan T. Evaluation of hyperspectral imaging technology in patients with peripheral vascular disease. J Vasc Surg 2017; 66:1192-1201. [PMID: 28545710 DOI: 10.1016/j.jvs.2017.02.047] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 02/27/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Hyperspectral imaging technology is a novel method of using transcutaneous measurement of oxyhemoglobin (HT-Oxy) and deoxyhemoglobin (HT-Deoxy) concentrations to create a two-dimensional, color-coded "oxygen map." The aims of this study were to compare the use of a hyperspectral imaging device with the transcutaneous oxygen measurement (TCOM), ankle-brachial index (ABI), and severity of peripheral vascular disease (PVD) and to assess their correlations. METHODS This prospective study recruited 294 participants divided into three distinct groups composed of healthy volunteers and patients with PVD. Patients underwent measurements of lower limbs at a standardized point over the head of the first metatarsal on the plantar aspect using the hyperspectral imaging device, generating four outputs including HT-Oxy, HT-Deoxy, oxygen saturation (HT-Sat), and skin temperature, and the TCOM system, generating transcutaneous partial pressure of oxygen (TcpO2) and carbon dioxide (TcpCO2). Demographic data, severity of PVD, ABI, and other pertinent information were obtained from both the participants and medical records. RESULTS Interoperator reliability ranged from 86% to 94% across the four hyperspectral imaging device outputs, whereas intraoperator reliability ranged from 92% to 94%. The HT-Oxy, HT-Sat, TcpCO2, and ABI of the diseased limb correlated significantly with the severity of PVD. HT-Sat significantly correlated with TcpO2 (R = 0.19), TcpCO2 (R = -0.26), ABI (R = 0.42), and skin temperature (R = 0.56). HT-Deoxy also correlated with TcpCO2 (R = 0.27). CONCLUSIONS This study demonstrates the reliability of hyperspectral imaging in comparison to TCOM, ABI, skin temperature, and severity of PVD in a series of patients. Its correlation to other established modalities and low interoperator and intraoperator variability could enable this modality to be a useful screening tool in PVD.
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Affiliation(s)
- Nathaniel Chiang
- Department of Vascular Surgery, Waikato Hospital, Hamilton, New Zealand
| | - Jitendra K Jain
- The Royal Melbourne Hospital, Melbourne, Victoria, Australia.
| | - Jamie Sleigh
- Department of Vascular Surgery, Waikato Hospital, Hamilton, New Zealand
| | - Thodur Vasudevan
- Department of Vascular Surgery, Waikato Hospital, Hamilton, New Zealand
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Safety and Effectiveness of Bone Marrow Cell Concentrate in the Treatment of Chronic Critical Limb Ischemia Utilizing a Rapid Point-of-Care System. Stem Cells Int 2017; 2017:4137626. [PMID: 28194186 PMCID: PMC5282442 DOI: 10.1155/2017/4137626] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 12/14/2016] [Indexed: 01/09/2023] Open
Abstract
Critical limb ischemia (CLI) is the end stage of lower extremity peripheral vascular disease (PVD) in which severe obstruction of blood flow results in ischemic rest pain, ulcers and/or gangrene, and a significant risk of limb loss. This open-label, single-arm feasibility study evaluated the safety and therapeutic effectiveness of autologous bone marrow cell (aBMC) concentrate in revascularization of CLI patients utilizing a rapid point-of-care device. Seventeen (17) no-option CLI patients with ischemic rest pain were enrolled in the study. Single dose of aBMC, prepared utilizing an intraoperative point-of-care device, the Res-Q™ 60 BMC system, was injected intramuscularly into the afflicted limb and patients were followed up at regular intervals for 12 months. A statistically significant improvement in Ankle Brachial Index (ABI), Transcutaneous Oxygen Pressure (TcPO2), mean rest pain and intermittent claudication pain scores, wound/ ulcer healing, and 6-minute walking distance was observed following aBMC treatment. Major amputation-free survival (mAFS) rate and amputation-free rates (AFR) at 12 months were 70.6% and 82.3%, respectively. In conclusion, aBMC injections were well tolerated with improved tissue perfusion, confirming the safety, feasibility, and preliminary effectiveness of aBMC treatment in CLI patients.
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Silva H, Ferreira H, Bujan MJ, Rodrigues LM. Regarding the quantification of peripheral microcirculation--Comparing responses evoked in the in vivo human lower limb by postural changes, suprasystolic occlusion and oxygen breathing. Microvasc Res 2015; 99:110-7. [PMID: 25872021 DOI: 10.1016/j.mvr.2015.04.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 04/05/2015] [Accepted: 04/06/2015] [Indexed: 11/25/2022]
Abstract
The human skin is an interesting model to explore microcirculation, particularly if using noninvasive technologies such as LDF (Laser Doppler Flowmetry) and tc (transcutaneous) gasimetry and methods as near as possible from the normal physiological state. In this study, we combined those technologies with three classical approaches--leg raising from supine, suprasystolic occlusion (in the ankle), and normobaric oxygen breathing to explore distal peripheral circulation in the foot. These methods are often cited, but a comparative assessment has not been done. The goal of this study was to identify relevant flow related descriptors, method-related advantages and pitfalls, and eventually, to find the best experimental approach. Volunteers (both genders, 22.1 ± 3.7 years old) were subjected to these methods and variables registered during basal, challenge and stabilization phases. Descriptive and comparative statistics were obtained, adopting a 95% confidence level. All flow-related quantitative descriptors potentially useful for the analysis were identified and compared. As expected, male patients consistently showed higher LDF levels and transepidermal water loss (TEWL) and lower tcpO2 values. However, lower results were recorded in the supine position, suggesting a postural dependence. Both leg raising and suprasystolic occlusion produced a hyperemic response after provocation, although different in magnitude, significantly reducing LDF and tcpO2 during provocation. The oxygen breathing method provided the most patient-friendly protocol, consistently reducing LDF (potentially by the inhibition of production of local vasodilators). TEWL increased during the provocation phase in all protocols, although not significantly. Baseline tcpO2 was found to correlate positively with the peak tcpO2 during oxygen breathing and basal LDF with peak flow during leg raising and suprasystolic occlusion. No statistical correlation between TEWL and LDF could be demonstrated under the current experimental conditions. We conclude that although equally useful considering the purpose, these methods involve very different practicalities and do not provide the same information. Also noteworthy, LDF is a highly sensitive indicator that could be further explored to look deeper into blood flow regulating mechanisms.
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Affiliation(s)
- Henrique Silva
- CBIOS - Universidade Lusófona's Research Center for Biosciences and Health Technologies, Lisboa, Portugal; Pharmacol. Sc Depart - Universidade de Lisboa, Faculty of Pharmacy, Lisboa, Portugal
| | - Hugo Ferreira
- IBEB - Biophysics and Biomedical Engineering Institute, Universidade de Lisboa Faculty of Sciences, Lisboa, Portugal
| | - Ma Julia Bujan
- Dept Medicine and Medical Specialities, CIBER-BBN Alcalá de Henares, Madrid, Spain
| | - Luis Monteiro Rodrigues
- CBIOS - Universidade Lusófona's Research Center for Biosciences and Health Technologies, Lisboa, Portugal; Pharmacol. Sc Depart - Universidade de Lisboa, Faculty of Pharmacy, Lisboa, Portugal.
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Benitez E, Sumpio BJ, Chin J, Sumpio BE. Contemporary assessment of foot perfusion in patients with critical limb ischemia. Semin Vasc Surg 2014; 27:3-15. [PMID: 25812754 DOI: 10.1053/j.semvascsurg.2014.12.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Significant progress in limb salvage for patients with peripheral arterial disease and critical limb ischemia has occurred in the past 2 decades. Improved patient outcomes have resulted from increased knowledge and understanding of the disease processes, as well as efforts to improve revascularization techniques and enhance patient care after open and endovascular procedures. An imaging modality that is noninvasive, fast, and safe would be a useful tool for clinicians in assessing lower-extremity perfusion when planning interventions. Among the current and emerging regional perfusion imaging modalities are transcutaneous oxygen monitoring, hyperspectral imaging, indocyanine green dye-based fluorescent angiography, nuclear diagnostic imaging, and laser Doppler. These tests endeavor to delineate regional foot perfusion to guide directed revascularization therapy in patients with critical limb ischemia and foot ulceration.
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Affiliation(s)
- Erik Benitez
- Department of Vascular Surgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510
| | - Brandon J Sumpio
- Department of Vascular Surgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510
| | - Jason Chin
- Department of Vascular Surgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510
| | - Bauer E Sumpio
- Department of Vascular Surgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510.
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Common Femoral Artery Endarterectomy for Lower-Extremity Ischemia: Evaluating the Need for Additional Distal Limb Revascularization. Ann Vasc Surg 2012; 26:946-56. [DOI: 10.1016/j.avsg.2012.02.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Revised: 02/19/2012] [Accepted: 02/27/2012] [Indexed: 11/20/2022]
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Abstract
OBJECTIVE To review the evidence regarding the influence of oxygen as an intrinsic factor on cutaneous wound healing. METHOD A literature search was performed using Ovid and the Cochrane Database with the search terms: 'Wound healing', 'Oxygen', 'Collagen', 'Angiogenesis', 'Inflammation' and 'Surgical Site Infection'. Human and animal studies were included if relevant and examined for methodological quality. RESULTS There are no meta-analyses of the use of oxygen in wound healing and only two randomised controlled trials (RCTs). Studies vary in methodological quality. The majority of the data comes from animal models. In total 1568 studies on wound healing and oxygen were found. CONCLUSION Oxygen is vital throughout wound healing, especially in the inflammatory and proliferative phases. Research suggests that patient supplementation with oxygen could enhance bacterial killing and angiogenesis, reduce surgical site infection rates and increase wound tensile strength, facilitating improved healing. CONFLICT OF INTEREST None.
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Abstract
AIM: To investigate the expression of transforming growth factor -β1 (TGF-β1) during wound healing in rat bile duct and analyze its role and significance in the process of biliary stricture formation.
METHODS: A rat model of bile duct trauma was established by surgery. The expression of TGF-β1 in traumatic tissue at weeks 1, 2, 4 and 8 after operation was examined by immunohistochemistry.
RESULTS: TGF-β1 was highly expressed in granulation tissue, fibroblasts, macrophages and vascular endothelial cells. The counts of TGF-β1-positive cells in traumatic tissue at different time points were obviously higher than that in normal tissue (65.47% ± 5.52%, 63.80% ± 4.32%, 59.55% ± 5.30% and 58.17% ± 6.70% vs 12.35% ± 3.43%, respectively; all P < 0.01).
CONCLUSION: The high expression of TGF-β1 can induce vigorous proliferation of fibroblasts, oversynthesis of collagen, and fibrosis and thickening of the bile duct wall, thereby resulting in biliary stricture formation.
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Abstract
The state of wound oxygenation is a key determinant of healing outcomes. From a diagnostic standpoint, measurements of wound oxygenation are commonly used to guide treatment planning such as amputation decision. In preventive applications, optimizing wound perfusion and providing supplemental O(2) in the perioperative period reduces the incidence of postoperative infections. Correction of wound pO(2) may, by itself, trigger some healing responses. Importantly, approaches to correct wound pO(2) favorably influence outcomes of other therapies such as responsiveness to growth factors and acceptance of grafts. Chronic ischemic wounds are essentially hypoxic. Primarily based on the tumor literature, hypoxia is generally viewed as being angiogenic. This is true with the condition that hypoxia be acute and mild to modest in magnitude. Extreme near-anoxic hypoxia, as commonly noted in problem wounds, is not compatible with tissue repair. Adequate wound tissue oxygenation is required but may not be sufficient to favorably influence healing outcomes. Success in wound care may be improved by a personalized health care approach. The key lies in our ability to specifically identify the key limitations of a given wound and in developing a multifaceted strategy to specifically address those limitations. In considering approaches to oxygenate the wound tissue it is important to recognize that both too little as well as too much may impede the healing process. Oxygen dosing based on the specific need of a wound therefore seems prudent. Therapeutic approaches targeting the oxygen sensing and redox signaling pathways are promising.
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Affiliation(s)
- Chandan K Sen
- The Comprehensive Wound Center, Department of Surgery and Davis Heart and Lung Research Institute, The Ohio State University Medical Center, Columbus, Ohio, USA.
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Wong VK, Stotts NA, Hopf HW, Froelicher ES, Dowling GA. How heel oxygenation changes under pressure. Wound Repair Regen 2007; 15:786-94. [DOI: 10.1111/j.1524-475x.2007.00309.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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