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Jones JD, Chaple M, Rozen S, DelaCuesta C, Sosa ES, Bryant K. Empirical assessment of wounds among people who use substances. Drug Alcohol Depend 2024; 262:111375. [PMID: 38971028 DOI: 10.1016/j.drugalcdep.2024.111375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 06/17/2024] [Accepted: 06/18/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND Wounds are a significant source of morbidity among people who use substances (PWUS). This project sought to identify the incidence and severity of wounds among PWUS in the South Bronx, a region of New York City with one of the highest morbidities of substance use disorder. METHODS This study recruited PWUS within the past 30 days. Research staff were trained to document the presence and severity of wounds. The primary outcome measure was the incidence of wounds. Acceptability of on-the-street wound care was assessed by the number of participants encountered. The association between participant characteristics and wounds was also evaluated. RESULTS In total, 586 PWUS were assessed (19.4 % female: 69 % Hispanic; 23 % Black; 5 % White). Heroin (65.7 %) and psychostimulants (58.3 %) were the most commonly used drugs. Approximately 23 % of outreach recipients disclosed a wound. Among those with a wound, 60.9 % reported one wound, 27.8 % had two wounds, and 11.3 % had three or more wounds. Small wounds (approximately the size of a cherry) were the most common (78.6 %). Recent use of stimulants or heroin, along with intravenous use of any substance were significantly associated with having a wound. CONCLUSIONS This study found that drug-related wounds were common among PWUS. Toxicology data from other sources indicate that xylazine was present in the NYC market at the time, though its prevalence among the current sample is difficult to determine. The occurrence and severity of substance-related wounds in NYC should continue to be monitored as a function of changes in the xylazine adulteration.
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Affiliation(s)
- Jermaine D Jones
- Columbia University Irving Medical Center, 630 W. 168th St, New York, NY 10032, United States; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States.
| | - Michael Chaple
- Columbia University Irving Medical Center, 630 W. 168th St, New York, NY 10032, United States; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States
| | - Stephanie Rozen
- Columbia University Irving Medical Center, 630 W. 168th St, New York, NY 10032, United States
| | - Courtney DelaCuesta
- Columbia University Irving Medical Center, 630 W. 168th St, New York, NY 10032, United States; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States
| | - Emely Santiago Sosa
- Columbia University Irving Medical Center, 630 W. 168th St, New York, NY 10032, United States; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States
| | - Kellie Bryant
- Columbia University School of Nursing, 560 W 168th St, New York, NY 10032, United States
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2
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Map Schuh C, Ezquer F, Mamani S, Campodónico PR, Cárcamo C, Martinez-Gómez F, Aburto I, Ezquer M, Morales B, Olivares B. A Natural deep eutectic solvent as an effective material for dual debridement and antibiofilm effects in chronic wound treatment. Int J Pharm 2024; 663:124553. [PMID: 39103063 DOI: 10.1016/j.ijpharm.2024.124553] [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: 06/23/2024] [Revised: 07/28/2024] [Accepted: 08/02/2024] [Indexed: 08/07/2024]
Abstract
In chronic wound treatment, the debridement of devitalized tissue and the eradication of the biofilm must balance aggressiveness with care to protect regenerating tissues. In this study, urea, a potent chaotropic molecule, was modulated through the formation of a Natural Deep Eutectic Solvent (NADES) with betaine to develop a new debriding material (BU) suitable for application into injured dermal tissues. To evaluate BU's debriding capacity, along with its antibiofilm effect and biocompatibility, pre-clinical to clinical methods were employed. In vitro determinations using artificial and clinical slough samples indicate that BU has a high debriding capacity. Additionally, BU's de-structuring effects lead to a strong antibiofilm capability, demonstrated by a reduced bacterial load compared to the antiseptic PHMB-Betaine or medical honey, evaluated in artificial slough and ex vivo human skin. Furthermore, BU's efficacy was evaluated in a murine model of diabetic wound, demonstrating significant effects on debriding and antibiofilm capacity, similar to those observed in PHMB-Betaine and medical honey-treated animals. Finally, BU was clinically evaluated in leg ulcers, showing superiority in reduction of bacterial load and wound area compared to honey, with no adverse effects. Thus, BU represents a simple and non-biocidal option that could contributes to chronic wound care.
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Affiliation(s)
- Christina Map Schuh
- Centro de Medicina Regenerativa, Facultad de Medicina, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
| | - Fernando Ezquer
- Centro de Medicina Regenerativa, Facultad de Medicina, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
| | - Sigde Mamani
- Centro de Química Medica, Facultad de Medicina, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
| | - Paola R Campodónico
- Centro de Química Medica, Facultad de Medicina, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
| | - Constanza Cárcamo
- Centro de Química Medica, Facultad de Medicina, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
| | - Fabián Martinez-Gómez
- Laboratorio de Resonancia Magnética Nuclear, Universidad de Santiago de Chile, Santiago, Chile
| | - Isabel Aburto
- Fundación Instituto Nacional de Heridas, Santiago, Chile
| | - Marcelo Ezquer
- Centro de Medicina Regenerativa, Facultad de Medicina, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
| | | | - Belén Olivares
- Centro de Química Medica, Facultad de Medicina, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile.
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Bhatt P. Quality of life case series review: wound bed preparation from a UK perspective. Br J Community Nurs 2024; 29:S8-S14. [PMID: 38814846 DOI: 10.12968/bjcn.2024.29.sup6.s8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Previous studies have reported that polyhexamethylene biguanide (PHMB) and betaine solution and gels remove biofilm, improve wound healing and reduce infection rates. Quality of life (QoL) outcomes are not commonly reported on when it comes to wound care. This review aims to summarise QoL data from a cohort of case studies previously published on chronic lower limb ulcers using PHMB products (Prontosan® Solution, Prontosan® Wound Gel X and Prontosan® Debridement Pad). Here, we report on and review a total of 38 case studies describing 56 wounds. From these 38 case studies, 36 reported that all the wounds involved had either healed or improved by the end of their respective study period. QoL themes explore malodour, slough, and exudate, pain, mobility, hair growth, antibiotic intake, return to work, social life and mood. This case series demonstrates that treatment with Prontosan® products improves many QoL outcomes for patients with non-healing wounds.
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Affiliation(s)
- Priti Bhatt
- Community Tissue Viability Lead, Guy's and St Thomas's NHS Foundation Trust, London, UK
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4
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Mayer DO, Tettelbach WH, Ciprandi G, Downie F, Hampton J, Hodgson H, Lazaro-Martinez JL, Probst A, Schultz G, Stürmer EK, Parnham A, Frescos N, Stang D, Holloway S, Percival SL. Best practice for wound debridement. J Wound Care 2024; 33:S1-S32. [PMID: 38829182 DOI: 10.12968/jowc.2024.33.sup6b.s1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Affiliation(s)
- Dieter O Mayer
- General and Vascular Surgeon, Institute for Advanced Wound Care and Education, Hausen am Albis, Switzerland
| | - William H Tettelbach
- Chief Medical Officer, RestorixHealth, Metairie, LA; Adjunct Assistant Professor, Duke University School of Medicine, Durham, NC, US
| | - Guido Ciprandi
- Plastic and Paediatric Surgeon, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Fiona Downie
- Senior Lecturer Advanced Practice, Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, UK
| | - Jane Hampton
- Consultant Nurse, Aarhus Kommune, Middle Jutland, Denmark
| | - Heather Hodgson
- Lead Nurse, Tissue Viability, Acute and Partnerships, NHS Greater Glasgow and Clyde, UK
| | | | - Astrid Probst
- ANP Woundmanagement, Kreiskliniken Reutlingen gGmbH, Germany
| | - Greg Schultz
- Professor of Obstetrics and Gynecology, Director, Institute for Wound Research, University of Florida, US
| | - Ewa Klara Stürmer
- Surgical Head of the Comprehensive Wound Centre UKE, Head of Translational Wound Research, Department of Vascular Medicine, University Medical Center Hamburg-Eppendorf, Germany
| | - Alison Parnham
- Teaching Associate, Clinical Nurse specialist, Tissue Viability, University of Nottingham, UK
| | | | - Duncan Stang
- Podiatrist and Diabetes Foot Coordinator for Scotland, UK
| | - Samantha Holloway
- Reader and Programme Director, Masters in Wound Healing and Tissue Repair, Centre for Medical Education, School of Medicine, Cardiff University, UK
| | - Steve L Percival
- CEO and Director, Biofilm Centre, 5D Health Protection Group and Professor (Hon), Faculty of Biology, Medicine and Health, University of Manchester, UK
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5
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Li KR, Lava CX, Neughebauer MB, Rohrich RN, Atves J, Steinberg J, Akbari CM, Youn RC, Attinger CE, Evans KK. A Multidisciplinary Approach to End-Stage Limb Salvage in the Highly Comorbid Atraumatic Population: An Observational Study. J Clin Med 2024; 13:2406. [PMID: 38673679 PMCID: PMC11050798 DOI: 10.3390/jcm13082406] [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: 03/22/2024] [Revised: 04/09/2024] [Accepted: 04/14/2024] [Indexed: 04/28/2024] Open
Abstract
Background: The use of free tissue transfer (FTT) is efficacious for chronic, non-healing lower extremity (LE) wounds. The four pillars of managing patient comorbidities, infection control, blood flow status, and biomechanical function are critical in achieving successful limb salvage. The authors present their multidisciplinary institutional experience with a review of 300 FTTs performed for the complex LE limb salvage of chronic LE wounds. Methods: A single-institution, retrospective review of atraumatic LE FTTs performed by a single surgeon from July 2011 to January 2023 was reviewed. Data on patient demographics, comorbidities, preoperative management, intraoperative details, flap outcomes, postoperative complications, and long-term outcomes were collected. Results: A total of 300 patients who underwent LE FTT were included in our retrospective review. Patients were on average 55.9 ± 13.6 years old with a median Charlson Comorbidity Index of 4 (IQR: 3). The majority of patients were male (70.7%). The overall hospital length of stay (LOS) was 27 days (IQR: 16), with a postoperative LOS of 14 days (IQR: 9.5). The most prevalent comorbidities were diabetes (54.7%), followed by peripheral vascular disease (PVD: 35%) and chronic kidney disease (CKD: 15.7%). The average operative LE FTT time was 416 ± 115 min. The majority of flaps were anterolateral thigh (ALT) flaps (52.7%), followed by vastus lateralis (VL) flaps (25.3%). The immediate flap success rate was 96.3%. The postoperative ipsilateral amputation rate was 12.7%. Conclusions: Successful limb salvage is possible in a highly comorbid patient population with a high prevalence of diabetes mellitus, peripheral vascular disease, and end-stage renal disease. In order to optimize patients prior to their LE FTT, extensive laboratory, arterial, and venous preoperative testing and diabetes management are needed preoperatively. Postoperative monitoring and long-term follow-up with a multidisciplinary team are also crucial for long-term limb salvage success.
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Affiliation(s)
- Karen R. Li
- Georgetown University School of Medicine, Washington, DC 20007, USA
| | | | | | | | - Jayson Atves
- Department of Podiatry, MedStar Georgetown University Hospital, Washington, DC 20007, USA
| | - John Steinberg
- Department of Podiatry, MedStar Georgetown University Hospital, Washington, DC 20007, USA
| | - Cameron M. Akbari
- Department of Vascular Surgery, MedStar Georgetown University Hospital, Washington, DC 20007, USA
| | - Richard C. Youn
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC 20007, USA
| | - Christopher E. Attinger
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC 20007, USA
| | - Karen K. Evans
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC 20007, USA
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6
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Townsend EC, Cheong JZA, Radzietza M, Fritz B, Malone M, Bjarnsholt T, Ousey K, Swanson T, Schultz G, Gibson ALF, Kalan LR. What is slough? Defining the proteomic and microbial composition of slough and its implications for wound healing. Wound Repair Regen 2024. [PMID: 38558438 DOI: 10.1111/wrr.13170] [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] [Received: 12/06/2023] [Revised: 02/06/2024] [Accepted: 02/19/2024] [Indexed: 04/04/2024]
Abstract
Slough is a well-known feature of non-healing wounds. This pilot study aims to determine the proteomic and microbiologic components of slough as well as interrogate the associations between wound slough components and wound healing. Ten subjects with slow-to-heal wounds and visible slough were enrolled. Aetiologies included venous stasis ulcers, post-surgical site infections and pressure ulcers. Patient co-morbidities and wound healing outcome at 3-months post-sample collection was recorded. Debrided slough was analysed microscopically, through untargeted proteomics, and high-throughput bacterial 16S-ribosomal gene sequencing. Microscopic imaging revealed wound slough to be amorphous in structure and highly variable. 16S-profiling found slough microbial communities to associate with wound aetiology and location on the body. Across all subjects, slough largely consisted of proteins involved in skin structure and formation, blood-clot formation and immune processes. To predict variables associated with wound healing, protein, microbial and clinical datasets were integrated into a supervised discriminant analysis. This analysis revealed that healing wounds were enriched for proteins involved in skin barrier development and negative regulation of immune responses. While wounds that deteriorated over time started off with a higher baseline Bates-Jensen Wound Assessment Score and were enriched for anaerobic bacterial taxa and chronic inflammatory proteins. To our knowledge, this is the first study to integrate clinical, microbiome, and proteomic data to systematically characterise wound slough and integrate it into a single assessment to predict wound healing outcome. Collectively, our findings underscore how slough components can help identify wounds at risk of continued impaired healing and serves as an underutilised biomarker.
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Affiliation(s)
- Elizabeth C Townsend
- Department of Medical Microbiology and Immunology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Microbiology Doctoral Training Program, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Medical Scientist Training Program, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - J Z Alex Cheong
- Department of Medical Microbiology and Immunology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Microbiology Doctoral Training Program, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Michael Radzietza
- Infectious Diseases and Microbiology, Western Sydney University, Sydney, Australia
| | - Blaine Fritz
- Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Matthew Malone
- Infectious Diseases and Microbiology, Western Sydney University, Sydney, Australia
| | - Thomas Bjarnsholt
- Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Microbiology, Copenhagen University Hospital, Copenhagen, Denmark
- International Wound Infection Institute, London, UK
| | - Karen Ousey
- International Wound Infection Institute, London, UK
- Institute of Skin Integrity and Infection Prevention, University of Huddersfield, West Yorkshire, UK
| | | | - Gregory Schultz
- International Wound Infection Institute, London, UK
- Department of Obstetrics and Gynecology, University of Florida, Gainesville, Florida, USA
| | - Angela L F Gibson
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Lindsay R Kalan
- Department of Medical Microbiology and Immunology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- International Wound Infection Institute, London, UK
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Ontario, Canada
- M.G. DeGroote Institute for Infectious Disease Research, McMaster University, Hamilton, Ontario, Canada
- David Braley Centre for Antibiotic Discovery, McMaster University, Hamilton, Ontario, Canada
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7
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Budini V, Bassetto F, Scarpa C, Vindigni V. Silver nanoparticle dressing: The knowledge of advantages and limits improves the indications in clinical practice. Int Wound J 2024; 21:e14872. [PMID: 38629691 PMCID: PMC11022613 DOI: 10.1111/iwj.14872] [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] [Received: 02/19/2024] [Revised: 03/21/2024] [Accepted: 03/21/2024] [Indexed: 04/19/2024] Open
Abstract
Silver nanoparticle dressings have gained popularity recently as a way to treat challenging wounds. Notwithstanding the properties of Ag-NPS (silver nanoparticles) described by several articles, there is a lack of clinical studies that guide healthcare professionals to specific and conscious use. In this case series, Ag-NPS dressing was tested on a randomized group of 10 patients with complex wounds requiring conservative treatment. Each case was analysed, recording the patient's history, the peculiar characteristics and the progressive changes in the wound. The wound bed and the quality of the peri-wound skin improved and a decrease in signs of infection was observed. The application of the dressing was simple and comfortable for the patient and it was appreciated for its sealing ability. A few capacity restrictions showed up: those should be read as elements to improve the indications for this peculiar dressing. The thin tissue matrix of the Ag-NPS dressing does not allow for massive absorption and also performs poorly in reducing little exudate. The reduction in wound width is also limited: reconstructive surgery was required in half of the enrolled patients to achieve wound healing.
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Affiliation(s)
- Valentina Budini
- Reconstructive and Aesthetic SurgeryPadua University HospitalPadovaItaly
| | - Franco Bassetto
- Reconstructive and Aesthetic SurgeryPadua University HospitalPadovaItaly
| | - Carlotta Scarpa
- Reconstructive and Aesthetic SurgeryPadua University HospitalPadovaItaly
| | - Vincenzo Vindigni
- Reconstructive and Aesthetic SurgeryPadua University HospitalPadovaItaly
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8
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Liu Y, Long S, Wang H, Wang Y. Biofilm therapy for chronic wounds. Int Wound J 2024; 21:e14667. [PMID: 38339793 PMCID: PMC10858329 DOI: 10.1111/iwj.14667] [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: 09/23/2023] [Revised: 12/24/2023] [Accepted: 12/29/2023] [Indexed: 02/12/2024] Open
Abstract
Chronic wounds have been a major factor of serious harm to global public health. At present, it is known that almost all chronic wounds contain biofilms, which seriously hinder the healing process. Removal of biofilms can effectively promote the healing of chronic wounds. As the study of wound biofilms deepens, many new treatment methods have emerged, thus bringing revolutionary means for the treatment of chronic wound biofilm. This review summarizes various methods for the treatment of chronic wound biofilm worldwide to provide a theoretical summary and practical basis for the selection of suitable wound biofilm treatment methods in clinical practice.
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Affiliation(s)
- Yang Liu
- Center of Gastrointestinal and Minimally Invasive Surgery, Department of General Surgery, The Third People's Hospital of ChengduAffiliated Hospital of Southwest Jiaotong UniversityChengduChina
| | - Shengyong Long
- Department of TraumatologyTongren People's HospitalTongrenChina
| | - Hanfeng Wang
- Plastic Surgery DepartmentXi'an International Medical Center HospitalXi'anChina
| | - Yan Wang
- Center of Gastrointestinal and Minimally Invasive Surgery, Department of General Surgery, The Third People's Hospital of ChengduAffiliated Hospital of Southwest Jiaotong UniversityChengduChina
- Medical Research Center, The Third People's Hospital of ChengduAffiliated Hospital of Southwest Jiaotong UniversityChengduChina
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9
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Stryja J, Teplá K, Routek M, Pavlík V, Perutková D. Octenidine with hyaluronan dressing versus a silver dressing in hard-to-heal wounds: a post-marketing study. J Wound Care 2023; 32:480-491. [PMID: 37572339 DOI: 10.12968/jowc.2023.32.8.480] [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: 08/14/2023]
Abstract
OBJECTIVE This study was conducted to provide comparative data on the clinical efficacy and safety of a novel hard-to-heal wound dressing (Sorelex; Contipro a.s., Czech Republic) that combines octenidine and hyaluronan, compared with a silver-based dressing. METHOD This multicentre, open-label, randomised, post-market, clinical follow-up study provides a comparison of a octenidine and hyaluronan combination with a standard-of-care (SoC) silver-containing dressing. The investigators evaluated the management of infection in the hard-to-heal wounds based on recorded changes in the appearance of the wound bed tissue and the presence of clinical signs of infection after three weeks of treatment. Other relevant assessed parameters of wound healing were: wound size; exudation level; wound pain level; and surrounding skin appearance. RESULTS The study cohort included 48 patients in the Sorelex arm and 39 patients in the SoC arm. Both products evinced numerous parameters of wound infection management: reductions in the wound bed slough; marked decreases in wound size; the formation of re-epithelialisation and granulation tissue; and improved pain management. Sorelex significantly improved the condition of surrounding skin after three weeks of treatment, unlike SoC. Sorelex reduced wound area significantly more than SoC (p=0.04). No statistically significant differences were detected in other assessed parameters between the two study arms. All the participating investigators expressed their satisfaction with both products. No adverse reactions to Sorelex were recorded over the mean treatment period of 53 days. CONCLUSION The octenidine and hyaluronan combination provides a new alternative choice of dressing for the treatment of infected hard-to-heal wounds when compared with a silver-based product.
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Affiliation(s)
- Jan Stryja
- Centre of Vascular and Miniinvasive Surgery, Hospital Agel, Trinec Podlesi, The Czech Republic; Salvatella Ltd., Centre of Non-healing Wounds Treatment, Podiatric Outpatients' Department, Trinec, The Czech Republic
| | | | - Miroslav Routek
- Ambulance for Treatment of Chronic Wounds, Regional Hospital Nachod, Broumov, The Czech Republic
| | - Vojtech Pavlík
- Department of Dermatology, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Darja Perutková
- Department of dermatology, Military hospital, Olomouc, The Czech Republic
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10
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Rippon M, Rogers AA, Westgate S, Ousey K. Effectiveness of a polyhexamethylene biguanide-containing wound cleansing solution using experimental biofilm models. J Wound Care 2023; 32:359-367. [PMID: 37300862 DOI: 10.12968/jowc.2023.32.6.359] [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: 06/12/2023]
Abstract
OBJECTIVE Antiseptics are widely used in wound management to prevent or treat wound infections, and have been shown to have antibiofilm efficacy. The objective of this study was to assess the effectiveness of a polyhexamethylene biguanide (PHMB)-containing wound cleansing and irrigation solution on model biofilm of pathogens known to cause wound infections compared with a number of other antimicrobial wound cleansing and irrigation solutions. METHOD Staphylococcus aureus and Pseudomonas aeruginosa single-species biofilms were cultured using microtitre plate and Centers for Disease Control and Prevention (CDC) biofilm reactor methods. Following a 24-hour incubation period, the biofilms were rinsed to remove planktonic microorganisms and then challenged with wound cleansing and irrigation solutions. Following incubation of the biofilms with a variety of concentrations of the test solutions (50%, 75% or 100%) for 20, 30, 40, 50 or 60 minutes, remaining viable organisms from the treated biofilms were quantified. RESULTS The six antimicrobial wound cleansing and irrigation solutions used were all effective in eradicating Staphylococcus aureus biofilm bacteria in both test models. However, the results were more variable for the more tolerant Pseudomonas aeruginosa biofilm. Only one of the six solutions (sea salt and oxychlorite/NaOCl-containing solution) was able to eradicate Pseudomonas aeruginosa biofilm using the microtitre plate assay. Of the six solutions, three (a solution containing PHMB and poloxamer 188 surfactant, a solution containing hypochlorous acid (HOCl) and a solution containing NaOCl/HOCl) showed increasing levels of eradication of Pseudomonas aeruginosa biofilm microorganisms with increasing concentration and exposure time. Using the CDC biofilm reactor model, all six cleansing and irrigation solutions, except for the solution containing HOCl, were able to eradicate Pseudomonas aeruginosa biofilms such that no viable microorganisms were recovered. CONCLUSION This study demonstrated that a PHMB-containing wound cleansing and irrigation solution was as effective as other antimicrobial wound irrigation solutions for antibiofilm efficacy. Together with the low toxicity, good safety profile and absence of any reported acquisition of bacterial resistance to PHMB, the antibiofilm effectiveness data support the alignment of this cleansing and irrigation solution with antimicrobial stewardship (AMS) strategies.
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Affiliation(s)
- Mark Rippon
- Visiting Clinical Research Associate, Huddersfield University, Huddersfield, UK
- Medical Marketing Consultant, Daneriver Consultancy Ltd, Holmes Chapel, Cheshire, UK
| | - Alan A Rogers
- Independent Wound Care Consultant, Flintshire, North Wales, UK
| | | | - Karen Ousey
- Professor of Skin Integrity, Director for the Institute of Skin Integrity and Infection Prevention, University of Huddersfield Department of Nursing and Midwifery, Huddersfield, UK
- Adjunct Professor, School of Nursing, Faculty of Health at the Queensland University of Technology, Australia
- Visiting Professor, RCSI, Dublin, Ireland
- Chair IWII
- President Elect ISTAP
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11
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Cooper DM, Bojke C, Ghosh P. Cost-Effectiveness of PHMB & betaine wound bed preparation compared with standard care in venous leg ulcers: A cost-utility analysis in the United Kingdom. J Tissue Viability 2023; 32:262-269. [PMID: 36990897 DOI: 10.1016/j.jtv.2023.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 11/03/2022] [Accepted: 03/09/2023] [Indexed: 03/17/2023]
Abstract
BACKGROUND Wounds cost £8.3 billion per year in the United Kingdom (UK) annually. Venous leg ulcers (VLUs) account for 15% of wounds and can be complicated to heal, increasing nurse visits and resource costs. Recent wound bed preparation consensus recommends wound cleansing and biofilm disrupting agents. However, inert cleansers such as tap water or saline are inexpensive, an evaluation of evidence is required to justify the higher upfront costs of treatment with active cleansers. We undertook a cost-effectiveness analysis of the use of a biofilm disrupting and cleansing solution and gel, Prontosan® Solution and Gel X, (PSGX) (B Braun Medical), as compared to the standard practice of using saline solution, for treating VLUs. METHODS A Markov model was parameterised to one-year costs and health-related quality of life consequences of treating chronic VLUs with PSGX versus saline solution. Costs are viewed from a UK healthcare payer perspective, include routine care and management of complications. A systematic literature search was performed to inform the clinical parameters of the economic model. Deterministic univariate sensitivity analysis (DSA) and probabilistic sensitivity analysis (PSA) were undertaken. RESULTS For PSGX an Incremental Net Monetary Benefit (INMB) of £1,129.65 to £1,042.39 per patient (with a Maximum Willingness to Pay of £30k and £20k per QALY respectively), of which cost savings are £867.87 and 0.0087 quality-adjusted life years (QALYs) gain per patient. PSA indicates a 99.3% probability of PSGX being cost-effective over saline. CONCLUSIONS PSGX for the treatment of VLUs is dominant compared with saline solution in the UK with expected cost-savings within a year and improved patient outcomes.
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Affiliation(s)
- Dawn M Cooper
- Centre for Health Social Care, Faculty of Health and Wellbeing, Sheffield Hallam University, UK; B. Braun Medical UK, Sheffield, UK
| | - Chris Bojke
- Leeds Institute of Health Sciences, University of Leeds, UK
| | - Pinaki Ghosh
- B. Braun Medical Industries, Pulau Pinang, Malaysia.
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12
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Ousey K, Ovens L. Comparing methods of debridement for removing biofilm in hard-to-heal wounds. J Wound Care 2023; 32:S4-S10. [PMID: 36971485 DOI: 10.12968/jowc.2023.32.sup3b.s4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Affiliation(s)
- Karen Ousey
- Professor and Director of the Institute of Skin Integrity and Infection Prevention, University of Huddersfield
| | - Liz Ovens
- Independent Tissue Viability Specialist Nurse
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13
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Morris D, Flores M, Harris L, Gammon J, Nigam Y. Larval Therapy and Larval Excretions/Secretions: A Potential Treatment for Biofilm in Chronic Wounds? A Systematic Review. Microorganisms 2023; 11:microorganisms11020457. [PMID: 36838422 PMCID: PMC9965881 DOI: 10.3390/microorganisms11020457] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/24/2023] [Accepted: 02/01/2023] [Indexed: 02/16/2023] Open
Abstract
Chronic wounds present a global healthcare challenge and are increasing in prevalence, with bacterial biofilms being the primary roadblock to healing in most cases. A systematic review of the to-date knowledge on larval therapy's interaction with chronic-wound biofilm is presented here. The findings detail how larval therapy-the controlled application of necrophagous blowfly larvae-acts on biofilms produced by chronic-wound-relevant bacteria through their principle pharmacological mode of action: the secretion and excretion of biologically active substances into the wound bed. A total of 12 inclusion-criteria-meeting publications were identified following the application of a PRISMA-guided methodology for a systematic review. The findings of these publications were qualitatively analyzed to provide a summary of the prevailing understanding of larval therapy's effects on bacterial biofilm. A further review assessed the quality of the existing evidence to identify knowledge gaps and suggest ways these may be bridged. In summary, larval therapy has a seemingly unarguable ability to inhibit and degrade bacterial biofilms associated with impaired wound healing. However, further research is needed to clarify and standardize the methodological approach in this area of investigation. Such research may lead to the clinical application of larval therapy or derivative treatments for the management of chronic-wound biofilms and improve patient healing outcomes at a time when alternative therapies are desperately needed.
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Affiliation(s)
- Daniel Morris
- Faculty of Medicine, Health, and Life Science, Swansea University, Swansea SA2 8PP, UK
- BioMonde, Bridgend CF31 3BG, UK
| | | | - Llinos Harris
- Faculty of Medicine, Health, and Life Science, Swansea University, Swansea SA2 8PP, UK
| | - John Gammon
- Faculty of Medicine, Health, and Life Science, Swansea University, Swansea SA2 8PP, UK
| | - Yamni Nigam
- Faculty of Medicine, Health, and Life Science, Swansea University, Swansea SA2 8PP, UK
- Correspondence:
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14
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Fairlamb DM, Kelety B, Bachert A, Scholtissek A, Jones RD, Davis SC, Kirsner RS. Preliminary evidence supporting a new enzymatic debridement product for use in chronic wounds. Int Wound J 2023. [PMID: 36625224 DOI: 10.1111/iwj.14079] [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: 11/11/2022] [Accepted: 12/22/2022] [Indexed: 01/11/2023] Open
Abstract
A new recombinant proteolytic enzyme, isolated from maggot saliva, with fibrinolytic action has been investigated through a series of non-clinical toxicology and in-vitro/in-vivo pharmacology studies to explore its potential safety and efficacy as an enzymatic debridement agent for use in chronic wounds. Studies indicate that the enzyme has a good safety profile. When locally administered, it is not detrimental to wound healing, is non-sensitising and is rapidly inactivated in the systemic circulation. Adverse effects are limited, at very high concentrations, to transient erythema at the site of application. In-vitro testing indicates that the enzyme, whilst selective for fibrin, has additional proteolytic action against collagen and elastin, with enzymatic action for all three substrates being dose dependent. In-vivo, we used an established MRSA biofilm model, in which microbiological counts were used as a surrogate for debridement efficacy. Here, we showed that higher concentrations of the enzyme in a formulated proprietary gel, significantly reduced MRSA counts over a period of 2 to 14 days, and significantly improved the vascularity of the wound at 14 days. Together, these data support the potential for this maggot-derived proteolytic enzyme as a clinically effective debriding agent.
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Affiliation(s)
| | - Bela Kelety
- SolasCure Limited, Cambridge, UK.,BRAIN Biotech AG, Zwingenberg, Germany
| | | | | | | | - Stephen C Davis
- Miller School of Medicine, Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami, Miami, Florida, USA
| | - Robert S Kirsner
- Miller School of Medicine, Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami, Miami, Florida, USA
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15
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Cogo A, Bignozzi AC, Hermans MHE, Quint BJ, Snels JP, Schultz G. A desiccation compound as a biofilm- and necrosis-removing agent: a case series. J Wound Care 2022; 31:816-822. [DOI: 10.12968/jowc.2022.31.10.816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Objective: A new compound, Debrichem (DEBx Medical BV, the Netherlands), a topical desiccation agent (TDA), is an active gel that contains an acidic species with a potent hygroscopic action. When in contact with microorganisms and necrosis, rapid desiccation and carbonisation of the proteins in these microorganisms, as well as of the extracellular matrix of biofilms and necrosis, occurs. The resulting ‘precipitate’ rapidly dislodges from the wound bed, resulting in a clean wound which granulates, which is a prerequisite for healing by secondary intention. Method: In a retrospective study, a series of mostly large and hard-to-heal lesions of different aetiologies were treated with a one-time application of the TDA, followed by weekly dressing changes. Results: Of the total of 54 lesions included in this case series, 22 were diagnosed as venous leg ulcers (VLUs), 20 as diabetic foot ulcers (DFUs), nine as post-traumatic, hard-to-heal lesions, two as vascular ulcers and one as an ischaemic ulcer. All of the VLUs, 75% of the DFUs and all of the other lesions reached complete granulation. Conclusion: The use of a TDA may contribute to the consistent, fast and easy removal of both biofilms and necrosis, and hence to wound healing.
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16
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Su Y, Yrastorza JT, Matis M, Cusick J, Zhao S, Wang G, Xie J. Biofilms: Formation, Research Models, Potential Targets, and Methods for Prevention and Treatment. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2022; 9:e2203291. [PMID: 36031384 PMCID: PMC9561771 DOI: 10.1002/advs.202203291] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/31/2022] [Indexed: 05/28/2023]
Abstract
Due to the continuous rise in biofilm-related infections, biofilms seriously threaten human health. The formation of biofilms makes conventional antibiotics ineffective and dampens immune clearance. Therefore, it is important to understand the mechanisms of biofilm formation and develop novel strategies to treat biofilms more effectively. This review article begins with an introduction to biofilm formation in various clinical scenarios and their corresponding therapy. Established biofilm models used in research are then summarized. The potential targets which may assist in the development of new strategies for combating biofilms are further discussed. The novel technologies developed recently for the prevention and treatment of biofilms including antimicrobial surface coatings, physical removal of biofilms, development of new antimicrobial molecules, and delivery of antimicrobial agents are subsequently presented. Finally, directions for future studies are pointed out.
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Affiliation(s)
- Yajuan Su
- Department of Surgery‐Transplant and Mary & Dick Holland Regenerative Medicine ProgramCollege of MedicineUniversity of Nebraska Medical CenterOmahaNE68198USA
| | - Jaime T. Yrastorza
- Department of Surgery‐Transplant and Mary & Dick Holland Regenerative Medicine ProgramCollege of MedicineUniversity of Nebraska Medical CenterOmahaNE68198USA
| | - Mitchell Matis
- Department of Surgery‐Transplant and Mary & Dick Holland Regenerative Medicine ProgramCollege of MedicineUniversity of Nebraska Medical CenterOmahaNE68198USA
| | - Jenna Cusick
- Department of Surgery‐Transplant and Mary & Dick Holland Regenerative Medicine ProgramCollege of MedicineUniversity of Nebraska Medical CenterOmahaNE68198USA
| | - Siwei Zhao
- Department of Surgery‐Transplant and Mary & Dick Holland Regenerative Medicine ProgramCollege of MedicineUniversity of Nebraska Medical CenterOmahaNE68198USA
| | - Guangshun Wang
- Department of Pathology and MicrobiologyCollege of MedicineUniversity of Nebraska Medical CenterOmahaNE68198USA
| | - Jingwei Xie
- Department of Surgery‐Transplant and Mary & Dick Holland Regenerative Medicine ProgramCollege of MedicineUniversity of Nebraska Medical CenterOmahaNE68198USA
- Department of Mechanical and Materials EngineeringCollege of EngineeringUniversity of Nebraska‐LincolnLincolnNE68588USA
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17
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Leow LJ, Zubrzycki N. Recalcitrant Ulcerative Pyoderma Gangrenosum of the Leg Responsive to Tildrakizumab: A Case Report. Clin Cosmet Investig Dermatol 2022; 15:1729-1736. [PMID: 36039180 PMCID: PMC9419888 DOI: 10.2147/ccid.s374534] [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: 05/26/2022] [Accepted: 08/12/2022] [Indexed: 12/03/2022]
Abstract
Elevated levels of inflammatory mediators—including the interleukin IL-23—are implicated in the pathogenesis of pyoderma gangrenosum (PG), an autoinflammatory neutrophilic dermatosis characterized by rapidly enlarging, suppurative ulcers and cribriform scarring. Here, we present the first case report of significant response of isolated ulcerative PG with tildrakizumab, a biologic agent directed against the p19 subunit of IL-23, in an elderly woman with extensive treatment-refractory PG on her left leg. Tildrakizumab (100 mg subcutaneously at weeks 0 and 4, then every 8 weeks, and eventually increased in frequency to every 6 weeks), combined with acetic acid soaks each morning and chemical debridement every evening with 3% hydrogen peroxide, resulted in progressive decrease in ulcer size and depth, re-epithelialization, and recovery of sensory perception. This report describes the dramatic clinical response of ulcerative PG on the leg with tildrakizumab.
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Affiliation(s)
- Liang Joo Leow
- Aesthetic Dermatology, Sydney, NSW, Australia.,Department of Dermatology, St Vincent's Private Hospital, Sydney, NSW, Australia.,St Vincent's & Mater Clinical School, University of Notre Dame Australia, Sydney, NSW, Australia
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18
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Clancy C, Dunne SS, Baban C, Tormey S, Merrigan A, O'Connell NH, Coffey JC, Dunne CP. A hypothesis for association between electrical surgical incision techniques and surgical site infection. J Hosp Infect 2022; 128:36-38. [PMID: 35853544 DOI: 10.1016/j.jhin.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/07/2022] [Accepted: 07/08/2022] [Indexed: 11/30/2022]
Affiliation(s)
- C Clancy
- School of Medicine, University of Limerick, Limerick, Ireland
| | - S S Dunne
- School of Medicine, University of Limerick, Limerick, Ireland
| | - C Baban
- School of Medicine, University of Limerick, Limerick, Ireland; Department of Surgery, University Hospital Limerick
| | - S Tormey
- School of Medicine, University of Limerick, Limerick, Ireland; Department of Surgery, University Hospital Limerick
| | - A Merrigan
- Department of Surgery, University Hospital Limerick
| | - N H O'Connell
- School of Medicine, University of Limerick, Limerick, Ireland; Department of Clinical Microbiology, University of Limerick Hospitals Group, Limerick, Ireland; Centre for Interventions in Infection, Inflammation & Immunity (4i), University of Limerick, Limerick, Ireland
| | - J C Coffey
- School of Medicine, University of Limerick, Limerick, Ireland; Department of Surgery, University Hospital Limerick; Centre for Interventions in Infection, Inflammation & Immunity (4i), University of Limerick, Limerick, Ireland
| | - C P Dunne
- School of Medicine, University of Limerick, Limerick, Ireland; Centre for Interventions in Infection, Inflammation & Immunity (4i), University of Limerick, Limerick, Ireland.
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19
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Chen Q, Zhou K. Acetic Acid Use in Chronic Wound Healing: A Multiple Case Series. J Wound Ostomy Continence Nurs 2022; 49:286-289. [PMID: 35255076 DOI: 10.1097/won.0000000000000863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Acetic acid is bacteriostatic or bactericidal to many gram-negative and gram-positive microorganisms, especially Pseudomonas. Nevertheless, it has also been found to possess cytotoxic effects in concentrations as low as 0.25% inhibiting the epithelialization process during wound healing. CASES In this multiple case series, we present 2 cases of chronic traumatic leg wounds treated with gauze moistened with acetic acid (0.25%), which were covered with a securing dressing and compression stockinet. Both patients were told to apply gauze moistened with acetic acid (0.25%) twice daily. In both cases, the wound progressed to blue-green drainage and wet yellow slough tissue to near-complete beefy granulation tissue. At this point, acetic acid was replaced with collagen or petrolatum dressing until complete wound closure was achieved. The treatment of these wounds illustrated successful use of acetic acid for chronic wound care. CONCLUSION Our experience with these cases suggests that appearance of blue-green wound drainage and wet yellow slough tissue is a reasonable indication for the use of gauze moistened with acetic acid (0.25%). Further research is needed to test the efficacy of these principles in guiding acetic acid use in wound care.
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Affiliation(s)
- Qiuyun Chen
- Qiuyun Chen, MA, BA, School of Humanities, Beijing University of Chinese Medicine, Beijing, China
- Kehua Zhou, MD, DPT, Department of Hospital Medicine, ThedaCare Regional Medical Center-Appleton, Appleton, Wisconsin
| | - Kehua Zhou
- Qiuyun Chen, MA, BA, School of Humanities, Beijing University of Chinese Medicine, Beijing, China
- Kehua Zhou, MD, DPT, Department of Hospital Medicine, ThedaCare Regional Medical Center-Appleton, Appleton, Wisconsin
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20
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Eriksson E, Liu PY, Schultz GS, Martins‐Green MM, Tanaka R, Weir D, Gould LJ, Armstrong DG, Gibbons GW, Wolcott R, Olutoye OO, Kirsner RS, Gurtner GC. Chronic wounds: Treatment consensus. Wound Repair Regen 2022; 30:156-171. [PMID: 35130362 PMCID: PMC9305950 DOI: 10.1111/wrr.12994] [Citation(s) in RCA: 79] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 12/23/2021] [Accepted: 01/09/2022] [Indexed: 12/17/2022]
Abstract
The Wound Healing Foundation (WHF) recognised a need for an unbiased consensus on the best treatment of chronic wounds. A panel of 13 experts were invited to a virtual meeting which took place on 27 March 2021. The proceedings were organised in the sub-sections diagnosis, debridement, infection control, dressings, grafting, pain management, oxygen treatment, outcomes and future needs. Eighty percent or better concurrence among the panellists was considered a consensus. A large number of critical questions were discussed and agreed upon. Important takeaways included that wound care needs to be simplified to a point that it can be delivered by the patient or the patient's family. Another one was that telemonitoring, which has proved very useful during the COVID-19 pandemic, can help reduce the frequency of interventions by a visiting nurse or a wound care center. Defining patient expectations is critical to designing a successful treatment. Patient outcomes might include wound specific outcomes such as time to heal, wound size reduction, as well as improvement in quality of life. For those patients with expectations of healing, an aggressive approach to achieve that goal is recommended. When healing is not an expectation, such as in patients receiving palliative wound care, outcomes might include pain reduction, exudate management, odour management and/or other quality of life benefits to wound care.
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Affiliation(s)
| | - Paul Y. Liu
- Department of Plastic Surgery, Rhode Island HospitalAlpert Medical School of Brown UniversityProvidenceRIUSA
| | - Gregory S. Schultz
- Department of Obstetrics and Gynecology and Institute for Wound ResearchUniversity of FloridaGainesvilleFAUSA
| | - Manuela M. Martins‐Green
- Department of Molecular, Cell and Systems BiologyLaboratory of Wound Healing Biology, University of CaliforniaRiversideCAUSA
| | - Rica Tanaka
- Juntendo University School of MedicineTokyoJapan
| | - Dot Weir
- Saratoga Hospital Center for Wound Healing and Hyperbaric MedicineSaratoga SpringsNew YorkUSA
| | - Lisa J. Gould
- Department of SurgerySouth Shore HospitalSouth WeymouthMassachusettsUSA
| | - David G. Armstrong
- Keck School of Medicine of University of Southern CaliforniaLos AngelesCAUSA
| | - Gary W. Gibbons
- Boston University School of Medicine, Center for Wound Healing South Shore HealthWeymouthMAUSA
| | | | - Oluyinka O. Olutoye
- Center for Regenerative MedicineAbigail Wexner Research Institute, Nationwide Children's HospitalColumbusOHUSA
- Department of SurgeryThe Ohio State UniversityColumbusOHUSA
| | - Robert S. Kirsner
- Dr Philip Frost Department of Dermatology and Cutaneous SurgeryUniversity of Miami Miller School of MedicineMiamiFAUSA
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21
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Davis SC, Li J, Gil J, Valdes J, Solis M, Higa A. A novel dressing with silver to treat meticillin-resistant Staphylococcus aureus biofilm infection in a pig model. J Wound Care 2022; 31:S42-S48. [PMID: 35148641 DOI: 10.12968/jowc.2022.31.sup2.s42] [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 The purpose of this study was to use an in vivo biofilm porcine model to examine a new polyvinyl alcohol-based gelling fibre dressing with silver and compare it to other commercial dressings containing: polyvinyl alcohol-based gelling fibre without silver; carboxymethyl cellulose-based fibre with silver, benzethonium chloride and ethylenediaminetetraacetic acid; and untreated control. METHODS A total of 52 deep partial-thickness wounds (10x7x0.5mm) were created on each of three animals and inoculated with 25µl of meticillin-resistant Staphylococcus aureus (MRSA) (106 colony forming units (CFU)/ml). Wounds were covered for 24 hours to allow biofilm formation and were randomly designated to one of the four treatments. Samples were recovered for microbiological and histological analysis on days 3, 5 and 7 post-treatment. RESULTS Polyvinyl alcohol-based gelling fibre dressing with silver was able to significantly reduce biofilm more effectively than the other treatment groups. By day 7, wounds treated with the dressing had a 2.72±0.01 log CFU/g reduction in MRSA count versus untreated control wounds and a 2.59±0.01 log CFU/g reduction versus baseline counts. For histology analysis, all wounds reached 100% re-epithelialisation by day 5. CONCLUSION The results of this study indicated that polyvinyl alcohol-based gelling fibre dressing with silver was effective against biofilm of antibiotic-resistant staphylococcal strains without inhibiting the wound healing process, and may have important clinical implications when treating acute and/or hard-to-heal wounds.
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Affiliation(s)
- Stephen C Davis
- University of Miami Miller School of Medicine, Department of Dermatology & Cutaneous Surgery, Miami, Florida, US
| | - Jie Li
- University of Miami Miller School of Medicine, Department of Dermatology & Cutaneous Surgery, Miami, Florida, US
| | - Joel Gil
- University of Miami Miller School of Medicine, Department of Dermatology & Cutaneous Surgery, Miami, Florida, US
| | - Jose Valdes
- University of Miami Miller School of Medicine, Department of Dermatology & Cutaneous Surgery, Miami, Florida, US
| | - Michael Solis
- University of Miami Miller School of Medicine, Department of Dermatology & Cutaneous Surgery, Miami, Florida, US
| | - Alex Higa
- University of Miami Miller School of Medicine, Department of Dermatology & Cutaneous Surgery, Miami, Florida, US
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22
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Sterpione F, Mas K, Rippon MG, Rogers AA, Mayeux G, Rigaudier F, Chauvelot P, Robilliart L, Juhel C, Lecomte Y. The clinical impact of hydro-responsive dressings in dynamic wound healing: Part II. J Wound Care 2022; 31:56-67. [PMID: 35077216 DOI: 10.12968/jowc.2022.31.1.56] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Over the course of a wound's healing trajectory, whether the wound is acute or hard-to-heal, management is likely to involve the use of several different dressing types. Minimising the complexity of treatment (in terms of dressing usage) would aid clinicians in providing effective wound care but excellent clinical outcomes must remain the primary goal. METHOD This study was an open-labelled, non-comparative study assessing the clinical effectiveness of a coordinated wound dressing treatment regimen. After an initial phase of using a hydro-responsive wound dressing (HydroClean, HRWD-1, PAUL HARTMANN AG, Germany) to cleanse and debride hard-to-heal wounds, the wounds were subsequently treated with either HydroTac (HRWD-2, PAUL HARTMANN AG, Germany) (to maintain healing progression and re-epithelialisation) or RespoSorb (a superabsorbent dressing, PAUL HARTMANN AG, Germany) (to manage moderate-to-high levels of exudate). The Pressure Ulcer Scale for Healing (PUSH) assessment tool was used to measure the wound status over the course of the treatment period and to assess several wound status parameters (for example, wound area, exudate levels and wound characteristics such as level of re-epithelialisation). RESULTS The results from this study demonstrated that wounds treated with HRWD-2 showed a positive healing response when using the PUSH score assessment tool with a significant mean reduction (p<0.0001) in the PUSH score of wounds treated with HRWD-2, with >75% of wounds being closed by the end of the study. This result underlines the effectiveness of HRWD-2 in supporting healing progression. CONCLUSION The results from this study support the coordinated use of HRWDs for the effective management and treatment of a variety of hard-to-heal wounds.
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Affiliation(s)
| | | | - Mark G Rippon
- University of Huddersfield, Queensgate, Huddersfield, UK.,Medical Marketing Consultant Daneriver Consultancy Ltd, Holmes Chapel, UK
| | | | | | | | | | | | | | - Yann Lecomte
- CEN Biotech, Dijon, Bourgogne Franche-Comté, France
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23
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Histopathological Analysis of Decellularized Porcine Small Intestinal Submucosa after Treatment of Skin Ulcer. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3967. [PMID: 34938643 PMCID: PMC8687724 DOI: 10.1097/gox.0000000000003967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 10/04/2021] [Indexed: 11/25/2022]
Abstract
Background: Decellularized porcine small intestinal submucosa (SIS), commercialized as an extracellular matrix rich in cell-inducing substrates and factors, has been clinically applied to treat intractable skin ulcers and has shown therapeutic effects. The SIS reportedly induces cell infiltration and integrates with the ulcer bed after 3–7 days of application. The attached SIS degenerates over time, and the remaining mass appears as slough, below which is granulation tissue that is essential for healing. This study aimed to determine whether the slough should be removed in clinical settings. Methods: Five patients with intractable skin ulcers were included in this case series. Seven days after applying a two-layer fenestrated-type SIS to the ulcer, the removed slough was histopathologically examined. Results: The collagen fibers of the SIS somewhat degenerated, and inflammatory cell infiltration was observed from the ulcer side to the surface side of the SIS. Neovascularization was similarly observed on the ulcer side. The degree of inflammatory cell infiltration decreased from the ulcer side to the surface side, whereas pus (ie, aggregates of neutrophils) was observed on the surface and ulcer edges. Additionally, the removed slough contained regenerative epithelium on the ulcer side of the remaining collagen fibers. Conclusions: After treating intractable skin ulcers using SIS, we recommend removal of the upper surface and ulcer edge of the degenerated SIS or slough to prevent infection and preservation of the lower side of the degenerated SIS to maintain the granulation tissue and regenerative epithelium.
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24
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Ousey K, Hodgson H, Rippon MG, Rogers AA. Hydro-responsive wound dressings for treating hard-to-heal wounds: a narrative review of the clinical evidence. J Wound Care 2021; 30:980-992. [PMID: 34881992 DOI: 10.12968/jowc.2021.30.12.980] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
A break in skin integrity must be repaired as quickly as possible to avoid excess blood and fluid loss, and to minimise the onset of infection. Hard-to-heal wounds, in which the progression of the wound healing response is compromised, present several challenges to healing (for example, the presence of devitalised tissue acting as a physical barrier to healing and as a focus for bacterial contamination with the potential for subsequent infection). The objective of this article is to present, as a narrative review, the clinical evidence supporting the use of a unique hydro-responsive wound dressing (HydroClean, HRWD1, PAUL HARTMANN AG, Germany). The dressing provides a simple treatment option to address a number of clinical challenges clinicians must overcome in order to facilitate wound healing progression. These studies demonstrated that this product supported successful debridement/cleansing of a wide variety of wounds, including hard-to-heal wounds, enabled wound bed preparation, and lead to positive healing outcomes, including in wounds that previously had failed to heal. The simplicity of using HRWD1 as a single dressing can help clinicians overcome a variety of challenges when treating both acute and hard-to-heal wounds, which, with the benefit of proven patient outcomes, could make it an ideal choice for a first-line treatment.
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Affiliation(s)
- Karen Ousey
- Institute of Skin Integrity and Infection Prevention, School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | | | - Mark G Rippon
- University of Huddersfield, Queensgate, Huddersfield, UK
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25
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26
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Sterpione F, Mas K, Rippon M, Rogers A, Mayeux G, Rigaudier F, Chauvelot P, Robilliart L, Juhel C, Lecomte Y. The clinical impact of hydroresponsive dressings in dynamic wound healing: Part I. J Wound Care 2021; 30:15-24. [PMID: 33439084 DOI: 10.12968/jowc.2021.30.1.15] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Management of any wound, either acute or hard-to-heal, might involve the use of multiple and different wound dressings in its treatment. This approach is necessary to overcome the myriad of clinical challenges the wound presents, as well as any underlying comorbidities that might affect the clinical outcomes. This article describes the clinical effectiveness of a coordinated wound dressing treatment regimen. METHOD This was an open-labelled non-comparative study involving patients with a variety of hard-to-heal and acute wounds of differing levels of severity, but all of which required removal of devitalised tissue to enable wound healing to progress. The first phase used the hydroresponsive wound dressing HydroClean (PAUL HARTMANN AG, Germany). The PUSH score was used as the primary measurement parameter. RESULTS A total of 86 patients (38 male/48 female), with a mean age of 67.7±21.7 years, took part in the study. The results showed that the hydroresponsive dressing was effective in managing wound exudate production and promoting wound cleansing and debridement, supporting good wound bed preparation. Wound closure was observed in 16/86 (18.6%) wounds at the end of the study (20 weeks). This enabled clinicians to switch to alternative wound dressings to promote subsequent clinical healing outcomes. CONCLUSION In this study, the hydroresponsive wound dressing was highly effective in preparing a clean wound bed such that the next stage of wound healing could be supported.
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Affiliation(s)
| | - Karine Mas
- Infirmière, 19 rue Paul Broca, 66100 Perpignan, France
| | - Mark Rippon
- Huddersfield University, Huddersfield, UK.,Daneriver Consultancy Ltd, Holmes Chapel, UK
| | | | | | | | | | | | | | - Yann Lecomte
- CEN Biotech, Dijon, Bourgogne-Franche-Comté, France
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Kataoka Y, Kunimitsu M, Nakagami G, Koudounas S, Weller CD, Sanada H. Effectiveness of ultrasonic debridement on reduction of bacteria and biofilm in patients with chronic wounds: A scoping review. Int Wound J 2020; 18:176-186. [PMID: 33236843 PMCID: PMC8244003 DOI: 10.1111/iwj.13509] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 09/15/2020] [Accepted: 09/21/2020] [Indexed: 01/18/2023] Open
Abstract
Chronic wounds are defined as “hard‐to‐heal” wounds that are caused by disordered mechanisms of wound healing. Chronic wounds have a high risk of infection and can form biofilms, leading to the release of planktonic bacteria, which causes persistent infections locally or remotely. Therefore, infection control and removal of the biofilm in chronic wounds are essential. Recently, ultrasonic debridement was introduced as a new method to reduce infection and promote the healing of chronic wounds. This scoping review aimed to evaluate the effectiveness of ultrasonic debridement on the changes in bacteria and biofilms, and consequently the wound healing rate of chronic wounds. A total of 1021 articles were identified through the database search, and nine papers were eligible for inclusion. Findings suggest that non‐contact devices are useful for wound healing as they reduce the inflammatory response, although the bacterial load is not significantly changed. Ultrasonic debridement devices that require direct contact with the wound promote wound healing through reduction of biofilm or bacterial load. The optimum settings for ultrasonic debridement using a non‐contact device are relatively consistent, but the settings for devices that require direct contact are diverse. Further studies on ultrasonic debridement in chronic wounds are required.
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Affiliation(s)
- Yukie Kataoka
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mao Kunimitsu
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Japan Society for the Promotion of Science, Tokyo, Japan
| | - Gojiro Nakagami
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Division of Care Innovation, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sofoklis Koudounas
- Division of Care Innovation, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Carolina D Weller
- Monash Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
| | - Hiromi Sanada
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Division of Care Innovation, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Rembe JD, Huelsboemer L, Plattfaut I, Besser M, Stuermer EK. Antimicrobial Hypochlorous Wound Irrigation Solutions Demonstrate Lower Anti-biofilm Efficacy Against Bacterial Biofilm in a Complex in-vitro Human Plasma Biofilm Model (hpBIOM) Than Common Wound Antimicrobials. Front Microbiol 2020; 11:564513. [PMID: 33162949 PMCID: PMC7583357 DOI: 10.3389/fmicb.2020.564513] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 09/11/2020] [Indexed: 12/21/2022] Open
Abstract
Biofilms pose a relevant factor for wound healing impairment in chronic wounds. With 78% of all chronic wounds being affected by biofilms, research in this area is of high priority, especially since data for evidence-based selection of appropriate antimicrobials and antiseptics is scarce. Therefore, the objective of this study was to evaluate the anti-biofilm efficacy of commercially available hypochlorous wound irrigation solutions compared to established antimicrobials. Using an innovative complex in-vitro human plasma biofilm model (hpBIOM), quantitative reduction of Pseudomonas aeruginosa, Staphylococcus aureus, and Methicillin-resistant S. aureus (MRSA) biofilms by three hypochlorous irrigation solutions [two <0.08% and one 0.2% sodium hypochlorite (NaClO)] was compared to a 0.04% polyhexanide (PHMB) irrigation solution and 0.1% octenidine-dihydrochloride/phenoxyethanol (OCT/PE). Efficacy was compared to a non-challenged planktonic approach, as well as with increased substance volume over a prolonged exposure (up to 72 h). Qualitative visualization of biofilms was performed by scanning electron microscopy (SEM). Both reference agents (OCT/PE and PHMB) induced significant biofilm reductions within 72 h, whereby high volume OCT/PE even managed complete eradication of P. aeruginosa and MRSA biofilms after 72 h. The tested hypochlorous wound irrigation solutions achieved no relevant penetration and eradication of biofilms despite increased volume and exposure. Only 0.2% NaClO managed a low reduction under prolonged exposure. The results demonstrate that low-dosed hypochlorous wound irrigation solutions are significantly less effective than PHMB-based irrigation solution and OCT/PE, thus unsuitable for biofilm eradication on their own. The used complex hpBIOM thereby mimics the highly challenging clinical wound micro-environment, providing a more profound base for future clinical translation.
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Affiliation(s)
- Julian-Dario Rembe
- Department of Vascular and Endovascular Surgery, University Hospital Düsseldorf, Heinrich-Heine-University of Düsseldorf, Düsseldorf, Germany
| | - Lioba Huelsboemer
- Chair for Translational Wound Research, Centre for Biomedical Education and Research, Witten/Herdecke University, Witten, Germany
| | - Isabell Plattfaut
- Chair for Translational Wound Research, Centre for Biomedical Education and Research, Witten/Herdecke University, Witten, Germany
| | - Manuela Besser
- Chair for Translational Wound Research, Centre for Biomedical Education and Research, Witten/Herdecke University, Witten, Germany
| | - Ewa K. Stuermer
- Department of Vascular Medicine, University Heart and Vascular Center Hamburg, Translational Wound Research, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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29
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Hu J, Guo S, Hu H, Sun J. Systematic review of the efficacy of topical haemoglobin therapy for wound healing. Int Wound J 2020; 17:1323-1330. [PMID: 32427424 PMCID: PMC7948847 DOI: 10.1111/iwj.13392] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 04/17/2020] [Accepted: 04/19/2020] [Indexed: 12/19/2022] Open
Abstract
Hypoxia is a common cause of poor wound healing, for which a variety of oxygen therapies have been developed. In order to overcome the limitations of traditional methods of treatment, namely the type of equipment, its setting, safety and cost, local haemoglobin therapy has been developed, although no reviews have so far been published. Here, we systematically review the current evidence to establish the efficacy, scope, adverse reactions, and required precautions of this new form of therapy. A search of the literature was conducted in the PubMed, Embase, Scopus, CENTRAL, CINAHL, and Web of science databases, with 17 studies meeting the eligibility criteria, comprising one animal model study and 16 clinical studies. Local haemoglobin therapy is able to safely and effectively promote the healing of a variety of wounds, especially those that are chronic and non-healing. However, premature discontinuation of this treatment can result in impediment to wound healing and even deterioration of the wound. The distinct benefit of the elimination of slough and relief of pain suggests that this technique may represent a new generation of debridement technology. Furthermore, its ease of use and convenience enables patient self-management, thereby greatly reducing health care costs.
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Affiliation(s)
- Jieman Hu
- Department of Gastrointestinal Colorectal and Anal Surgerythe First Hospital of Jilin UniversityChangchunChina
- School of Nursing, Jilin UniversityChangchunChina
| | - Shaoning Guo
- School of Nursing, Jilin UniversityChangchunChina
- Department of AnesthesiologyThe First Hospital of Jilin UniversityChangchunChina
| | - Haiyan Hu
- Department of Gastrointestinal Colorectal and Anal Surgerythe First Hospital of Jilin UniversityChangchunChina
| | - Jianan Sun
- Department of Gastrointestinal Colorectal and Anal Surgerythe First Hospital of Jilin UniversityChangchunChina
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30
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Thibodeaux KT, Speyrer MS, Thibodeaux RP, Rogers AA, Rippon MG. Management of postoperative bleeding in surgically debrided wounds: topical haemostat versus electrocautery. J Wound Care 2020; 29:444-451. [PMID: 32804032 DOI: 10.12968/jowc.2020.29.8.444] [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 To compare the effectiveness of a temporary topical external haemostat (OMNI-STAT Granules, Omni-stat Medical Inc., US) versus the use of electrocautery for bleeding control in patients who have undergone surgical wound debridement. Time saved in the operating room (OR) was evaluated. METHOD A prospective evaluation of use of a topical haemostat in an OR setting was compared with retrospective data collected using electrocautery to understand the time-saving benefits of using a topical haemostat versus electrocautery. RESULTS A total of 52 patients were treated with the topical haemostat, and 89 patients with electrocautery. The topical haemostat was shown to be as effective in achieving haemostasis post-surgical debridement as electrocautery, with the added benefits of significant time savings in the OR (reducing the mean total OR time by 19.1%). Additionally, preprocedure and surgical procedure times in patients treated with the topical haemostat were significantly reduced. The results showed that wounds treated with the topical haemostat demonstrated a more advanced stage of healing, which may be a result of the lack of tissue damage demonstrated with the topical haemostat compared with electrocautery. CONCLUSION This study found that the temporary topical haemostat was equally as effective as cauterisation in achieving haemostasis. In addition, significant saving in OR time was demonstrated relative to electrocautery. The improved OR times may translate into increased cost-effectiveness, relative to electrocautery, by increasing the number of surgical cases per day and/or using resources more effectively to treat more patients. It may also enable bleeding control in the outpatient clinic or at the bedside, freeing up costly OR time and enabling more effective management of healthcare resources.
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Affiliation(s)
| | | | - Ryan P Thibodeaux
- Medical Data Generation, Medical Management Ink, Opelousas, Louisiana, US
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31
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Chen R, Salisbury AM, Percival SL. A comparative study on the cellular viability and debridement efficiency of antimicrobial-based wound dressings. Int Wound J 2019; 17:73-82. [PMID: 31657125 DOI: 10.1111/iwj.13234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 09/12/2019] [Accepted: 09/13/2019] [Indexed: 12/14/2022] Open
Abstract
A concentrated surfactant gel containing polyhexamethylene biguanide (CSG-PHMB) (CSG: Plurogel) was evaluated for in vitro cell cytotoxicity using the direct contact, extraction, and cell insert assays, along with its ability to breakdown artificial wound eschar and slough, compared with other clinically available wound gels: a wound gel loaded with 0.13% benzalkonium chloride (BXG) and a highly viscous gel loaded with 0.1% polyhexamethylene biguanide (PXG). Following treatment with CSG-PHMB, BXG, and PXG at day 1, the viability of L929 and HDFa cells sharply decreased to lower than 20% of the culture media control in the direct contact assay; however, cell viability of L929 was 128.65 ± 1.41%, 99.90 ± 2.84%*, and 64.08 ± 5.99%* respectively; HDFa was 84.58 ± 10.41%, 19.54 ± 3.06%**, and 96.28 ± 33.67%, respectively, in the extraction assay. In the cell insert model, cell viability of L929 cells were 95.25 ± 0.96%, 47.49 ± 5.37%**, and 48.63 ± 7.00%**, respectively; HDFa cell viability were 92.80 ± 1.29%, 38.86 ± 4.28%**, and 49.90 ± 2.55%** (*: P < .01; **P < .001 compared with CSG-PHMB; cell viability of culture medium without treatment at day 1 was 100%). The cell extraction model on day 1 indicated that CSG-PHMB had higher viability of L929 cells compared with BXG. In addition, the cellular viability results indicated that CSG-PHMB gel exhibited lower cytotoxicity when compared with BXG and PXG in the cell insert model assay. Within the in vitro debridement model, CSG-PHMB exhibited an ability to potentially increase the loosening of the collagen matrix. The reason for this may be because of the concentrated surfactant found within the CSG-PHMB, which has the ability to lower the surface tension, aiding in the movements of fragments and debris in the fluorescent artificial wound eschar model (fAWE).
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Affiliation(s)
- Rui Chen
- Centre of Excellence for Biofilm Science (CEBS), 5D Health Protection Group Ltd., Liverpool Bio-Innovation Hub, Liverpool, UK
| | - Anne-Marie Salisbury
- Centre of Excellence for Biofilm Science (CEBS), 5D Health Protection Group Ltd., Liverpool Bio-Innovation Hub, Liverpool, UK
| | - Steven L Percival
- Centre of Excellence for Biofilm Science (CEBS), 5D Health Protection Group Ltd., Liverpool Bio-Innovation Hub, Liverpool, UK
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32
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Abstract
Biofilms are responsible for stimulating and maintaining wound inflammation, increasing infection risk and delaying wound closure. Appropriate biofilm management is required to fight against local and systemic infection and to restore balance to the wound environment. The most effective way to remove biofilms involves the use of mechanical techniques, with the wound dressing representing an important component of this strategy. Wound dressing fibres, such as polyacrylate fibres, have been shown to be effective in affecting biofilm architecture by disrupting the biofilm matrix. This helps enhance the efficacy of antimicrobials, such as silver. Focusing an antibiofilm strategy on active agents alone does not constitute a sustainable approach to biofilm management. Furthermore, adding too many active chemicals into a wound can be highly detrimental to the wound bed, and potentially may have both short- and long-term biological concerns. Particular attention on the characteristics and key features of wound dressings is discussed in this paper. The aim of the paper is to review the ideal characteristics of wound dressings, in conjunction with antimicrobials, that are considered a fundamental part of an antibiofilm strategy and growing requirement for enhanced wound healing.
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Affiliation(s)
- Steven L Percival
- 5D Health Protection Group Ltd, Liverpool Bio-innovation Hub, Liverpool, UK
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33
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Milne J. The importance of skin cleansing in wound care. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2019; 28:S20-S22. [PMID: 31242107 DOI: 10.12968/bjon.2019.28.12.s20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jeanette Milne
- Lead Nurse Tissue Viability Northumbria Healthcare NHS Foundation Trust
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34
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Percival SL, Mayer D, Kirsner RS, Schultz G, Weir D, Roy S, Alavi A, Romanelli M. Surfactants: Role in biofilm management and cellular behaviour. Int Wound J 2019; 16:753-760. [PMID: 30883044 DOI: 10.1111/iwj.13093] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 01/17/2019] [Accepted: 01/21/2019] [Indexed: 01/08/2023] Open
Abstract
Appropriate and effective wound cleaning represents an important process that is necessary for preparing the wound for improved wound healing and for helping to dislodge biofilms. Wound cleaning is of paramount importance to wound bed preparation for helping to enhance wound healing. Surfactant applications in wound care may represent an important area in the cleaning continuum. However, understanding of the role and significance of surfactants in wound cleansing, biofilm prevention and control, and enhancing cellular viability and proliferation is currently lacking. Despite this, some recent evidence on poloxamer-based surfactants where the surfactants are present in high concentration have been shown to have an important role to play in biofilm management; matrix metalloproteinase modulation; reducing inflammation; and enhancing cellular proliferation, behaviour, and viability. Consequently, this review aims to discuss the role, mode of action, and clinical significance of the use of medically accepted surfactants, with a focus on concentrated poloxamer-based surfactants, to wound healing but, more specifically, the role they may play in biofilm management and effects on cellular repair.
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Affiliation(s)
- Steven L Percival
- 5D Health Protection Group Ltd, Liverpool Bio-Innovation Hub, Liverpool, UK.,Department of Research and Development, Centre of Excellence in Biofilm science (CEBS), Liverpool Bio-Innovation Hub, Liverpool, UK
| | - Dieter Mayer
- Department of Surgery, HFR Fribourg - Cantonal Hospital, Fribourg, Switzerland
| | - Robert S Kirsner
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami, Miami, Florida
| | - Greg Schultz
- Institute for Wound Research, University of Florida, Gainesville, Florida
| | - Dot Weir
- Catholic Health Advanced Wound Healing Centers, Buffalo, New York
| | - Sashwati Roy
- Department of Surgery, Indiana Center for Regenerative Medicine and Engineering, Indiana University School of Medicine, Indianapolis, Indiana
| | - Afsaneh Alavi
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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35
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Sigal ML, Addala A, Maillard H, Chahim M, Sala F, Blaise S, Dalac S, Meaume S, Bohbot S, Tumba C, Tacca O. Evaluation of TLC-NOSF dressing with poly-absorbent fibres in exuding leg ulcers: two multicentric, single-arm, prospective, open-label clinical trials. J Wound Care 2019; 28:164-175. [DOI: 10.12968/jowc.2019.28.3.164] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Azeddine Addala
- Vascular Medicine Department, Edouard Herriot Hospital, Lyon, France
| | - Hervé Maillard
- Dermatology Department, Le Mans Hospital, Le Mans, France
| | - Maxime Chahim
- Department of Vascular Medicine, Corentin Celton Hospital, Issy Les Moulineaux, France
| | - Florent Sala
- Vascular Surgery Department, Montréal Polyclinic, Carcassonne, France
| | - Sophie Blaise
- Department of Vascular Medicine, Albert Michalon University Hospital, Grenoble, France
| | - Sophie Dalac
- Dermatology Department, Dijon University Hospital, Dijon, France
| | - Sylvie Meaume
- Geriatric Department, Rotschild University Hospital, Paris, France
| | - Serge Bohbot
- Medical Affair Department, Laboratoires Urgo, Paris, France
| | - Clémence Tumba
- Clinical Research Department, Laboratoires Urgo, Chenôve, France
| | - Olivier Tacca
- Clinical Research Department, Laboratoires Urgo, Chenôve, France
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36
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Lombardi L, Shi Y, Falanga A, Galdiero E, de Alteriis E, Franci G, Chourpa I, Azevedo HS, Galdiero S. Enhancing the Potency of Antimicrobial Peptides through Molecular Engineering and Self-Assembly. Biomacromolecules 2019; 20:1362-1374. [PMID: 30735368 DOI: 10.1021/acs.biomac.8b01740] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Healthcare-associated infections resulting from bacterial attachment and biofilm formation on medical implants are posing significant challenges in particular with the emergence of bacterial resistance to antibiotics. Here, we report the design, synthesis and characterization of self-assembled nanostructures, which integrate on their surface antibacterial peptides. The antibacterial WMR peptide, which is a modification of the native sequence of the myxinidin, a marine peptide isolated from the epidermal mucus of hagfish, was used considering its enhanced activity against Gram-negative bacteria. WMR was linked to a peptide segment of aliphatic residues (AAAAAAA) containing a lipidic tail (C19H38O2) attached to the ε-amino of a terminal lysine to generate a peptide amphiphile (WMR PA). The self-assembly of the WMR PA alone, or combined with coassembling shorter PAs, was studied using spectroscopy and microscopy techniques. The designed PAs were shown to self-assemble into stable nanofiber structures and these nanoassemblies significantly inhibit biofilm formation and eradicate the already formed biofilms of Pseudomonas aeruginosa (Gram-negative bacteria) and Candida albicans (pathogenic fungus) when compared to the native WMR peptide. Our results provide insights into the design of peptide based supramolecular assemblies with antibacterial activity, and establish an innovative strategy to develop self-assembled antimicrobial materials for biomedical applications.
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Affiliation(s)
- Lucia Lombardi
- Department of Pharmacy, School of Medicine , University of Naples Federico II , Via Mezzocannone 16 , 80134 Naples , Italy.,School of Engineering and Materials Science , Queen Mary, University of London , Mile End Road , London E1 4NS , United Kingdom
| | - Yejiao Shi
- School of Engineering and Materials Science , Queen Mary, University of London , Mile End Road , London E1 4NS , United Kingdom
| | - Annarita Falanga
- CIRPEB, University of Naples Federico II , Via Mezzocannone 16 , 80134 Naples , Italy.,Department of Agricultural Science , University of Naples Federico II , via Università 100 , 80055 Naples , Italy
| | - Emilia Galdiero
- Department of Biology , University of Naples Federico II , via Cinthia , 80100 Naples , Italy
| | - Elisabetta de Alteriis
- Department of Biology , University of Naples Federico II , via Cinthia , 80100 Naples , Italy
| | - Gianluigi Franci
- Department of Experimental Medicine , University of Campania Luigi Vanvitelli , via Costantinopoli 16 , 80138 Naples , Italy
| | - Igor Chourpa
- EA 6295 Nanomédicaments et Nanosondes, Université François-Rabelais de Tours , 31 avenue Monge , 37000 Tours , France
| | - Helena S Azevedo
- School of Engineering and Materials Science , Queen Mary, University of London , Mile End Road , London E1 4NS , United Kingdom
| | - Stefania Galdiero
- Department of Pharmacy, School of Medicine , University of Naples Federico II , Via Mezzocannone 16 , 80134 Naples , Italy.,CIRPEB, University of Naples Federico II , Via Mezzocannone 16 , 80134 Naples , Italy
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37
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Abstract
Silver is added to an array of commercially available healthcare products including wound dressings. However, overuse of silver is being raised as a potential health concern due to the possible selection of tolerant or resistant bacteria and as a factor that may induce cross resistance to antibiotics. To date, there are only a limited number of studies that have documented evidence of silver resistance in bacteria isolated from medical situations. These studies have indicated low levels of silver resistance in bacteria. However, in comparison to antibiotics, only a small number of studies have been undertaken to investigate silver resistance. It is clear that more studies are required to confirm the most effective therapeutic levels of silver that are needed to kill microbes. In addition, it is probable that sub-therapeutic levels of silver may potentially select for enhanced microbial tolerance. Nevertheless, to date, there still remains very little evidence that silver resistance is a growing health concern in wound care; more studies are clearly needed to substantiate this concern, which has not been observed clinically to any major degree. The issue of biofilm tolerance to silver is more complicated and data on the effect of silver on biofilms is sparse at present.
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Affiliation(s)
- Steven L Percival
- a R&D Department, Centre of Excellence in Biofilm Science (CEBS) , 5D Health Protection Group Ltd , Liverpool Bio-Innovation Hub , Liverpool , UK
| | - Anne-Marie Salisbury
- a R&D Department, Centre of Excellence in Biofilm Science (CEBS) , 5D Health Protection Group Ltd , Liverpool Bio-Innovation Hub , Liverpool , UK
| | - Rui Chen
- a R&D Department, Centre of Excellence in Biofilm Science (CEBS) , 5D Health Protection Group Ltd , Liverpool Bio-Innovation Hub , Liverpool , UK
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38
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McElroy EF. Use of negative pressure wound therapy with instillation and a reticulated open cell foam dressing with through holes in the acute care setting. Int Wound J 2019; 16:781-787. [PMID: 30784210 DOI: 10.1111/iwj.13097] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/22/2019] [Accepted: 01/26/2019] [Indexed: 12/23/2022] Open
Abstract
Negative pressure wound therapy with instillation and dwell time (NPWTi-d) is an automated system used to deliver, dwell, and remove topical solutions from the wound bed. Recently, a reticulated open cell foam dressing with through holes (ROCF-CC) was developed, which assists with wound cleansing by removing thick exudate and infectious materials. We present our experience using NPWTi-d with ROCF-CC on complex wounds when complete surgical debridement was inappropriate because of medical instability, recurrent non-viable tissue, or palliative treatment plan. For all wounds, NPWTi-d with ROCF-CC was initiated by instilling normal saline, acetic acid, or hypochlorous acid with 2 to 10 minutes of dwell time, followed by 0.5 to 4 hours of negative pressure. Dressings were changed every 2 to 3 days. Fourteen patients with multiple comorbidities were treated for wound types including diabetic foot ulcers, necrotising fasciitis, dehisced wounds, and pressure injuries. Duration of NPWTi-d with ROCF-CC ranged from 1 to 15 days, and at dressing changes, wounds showed improved granulation tissue formation, less malodour, less surrounding erythema, and demarcation of healthy skin from devitalised tissue. Based on these patients, adjunctive use of NPWTi-d with ROCF-CC provided a practical option for improving tissue quality in wounds for patients in whom surgical debridement was not possible or desired.
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39
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Regeneration of Diabetic Foot Ulcers Based on Therapy with Red LED Light and a Natural Latex Biomembrane. Ann Biomed Eng 2019; 47:1153-1164. [DOI: 10.1007/s10439-019-02220-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 01/24/2019] [Indexed: 12/25/2022]
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40
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Bui UT, Finlayson K, Edwards H. Risk factors for infection in patients with chronic leg ulcers: A survival analysis. Int J Clin Pract 2018; 72:e13263. [PMID: 30239088 DOI: 10.1111/ijcp.13263] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 07/30/2018] [Accepted: 08/27/2018] [Indexed: 12/25/2022] Open
Abstract
AIM This study aimed to validate the relationships between possible predictive factors and clinically diagnosed infection in adult patients with chronic leg ulcers. METHODS This study used a sample of 636 adult participants whose ulcers were diagnosed as either venous, arterial or mixed aetiology leg ulcers and had no clinical signs of infection at recruitment. Data were extracted from recruitment to 12 weeks from six longitudinal prospective studies from 2004 to 2015. Survival analysis was used to investigate mean time-to-infection, including the Kaplan-Meier method and the Cox proportional-hazards regression model. RESULTS The sample included 74.7% venous, 19.6% mixed and 5.7% arterial leg ulcers. There were 101 (15.9%) participants diagnosed with infection at least once within 12 weeks of follow-up. Mean time-to-infection was 10.89 weeks (95% CI = 10.66-11.12). After adjustment for potential confounders, a Cox proportional hazards regression model found that depression, using walking aids, calf ankle ratio <1.3, wound area ≥10 cm2 and ulcers with slough tissue at recruitment were significant risk factors for wound infection. CONCLUSION This study has validated the predictive ability of factors which have been found in a cross-sectional study to be significantly associated with infection in patients with leg ulcers, including venous leg ulcers, arterial leg ulcers and mixed aetiology leg ulcers. Results showed that patients with chronic leg ulcers, who either presented with depression, used walking aids, had a calf ankle ratio <1.3, a wound area ≥10 cm2 or an ulcer with slough tissue, had greater likelihood of developing infection compared to those without these factors.
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Affiliation(s)
- Ut T Bui
- Faculty of Health, School of Nursing, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Qld, Australia
- Wound Management Innovation Cooperative Research Centre, West End, Qld, Australia
| | - Kathleen Finlayson
- Faculty of Health, School of Nursing, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Qld, Australia
- Wound Management Innovation Cooperative Research Centre, West End, Qld, Australia
| | - Helen Edwards
- Faculty of Health, School of Nursing, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Qld, Australia
- Wound Management Innovation Cooperative Research Centre, West End, Qld, Australia
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41
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Wu YK, Cheng NC, Cheng CM. Biofilms in Chronic Wounds: Pathogenesis and Diagnosis. Trends Biotechnol 2018; 37:505-517. [PMID: 30497871 DOI: 10.1016/j.tibtech.2018.10.011] [Citation(s) in RCA: 211] [Impact Index Per Article: 35.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 10/27/2018] [Accepted: 10/29/2018] [Indexed: 12/17/2022]
Abstract
Chronic non-healing wounds have become a major worldwide healthcare burden. The impact of biofilms on chronic wound infection is well established. Despite increasing understanding of the underlying mechanism of biofilm formation in chronic wounds, current strategies for biofilm diagnosis in chronic wounds are still far from ideal. In this review, we briefly summarize the mechanism of biofilm formation and focus on current diagnostic approaches of chronic wound biofilms based on morphology, microbiology, and molecular assays. Innovative biotechnological approaches, such as wound blotting and transcriptomic analysis, may further shed light on this unmet clinical need. The continuous development of these sophisticated diagnostic approaches can markedly contribute to the future implementation of point-of-care biofilm detection in chronic wound care.
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Affiliation(s)
- Yuan-Kun Wu
- Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei 100, Taiwan; These authors contributed equally
| | - Nai-Chen Cheng
- Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei 100, Taiwan; These authors contributed equally.
| | - Chao-Min Cheng
- Institute of Biomedical Engineering and Frontier Research Center on Fundamental and Applied Sciences of Matters, National Tsing Hua University, Hsinchu 300, Taiwan.
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Management of a Groin Wound Using a Concentrated Surfactant-Based Gel Dressing. J Wound Ostomy Continence Nurs 2018; 45:465-467. [PMID: 30086104 DOI: 10.1097/won.0000000000000467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND A groin wound associated with a vascular graft infection is associated with significant morbidity. Management of groin wounds is often challenging due to their anatomical location that renders them difficult to visualize and keep clean. CASE This case report describes the use of a concentrated surfactant-based gel dressing for an infected groin wound. CONCLUSIONS Because of their location and complex topography, groin wounds are difficult to keep clean and maintain dressing integrity. This case study describes the use of a concentrated surfactant-based gel dressing that remained in place and promoted healing of an infected groin wound.
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Elg F, Hunt S. Hemoglobin spray as adjunct therapy in complex wounds: Meta-analysis versus standard care alone in pooled data by wound type across three retrospective cohort controlled evaluations. SAGE Open Med 2018; 6:2050312118784313. [PMID: 30013783 PMCID: PMC6041853 DOI: 10.1177/2050312118784313] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 05/30/2018] [Indexed: 11/19/2022] Open
Abstract
Objectives: Low tissue oxygenation is a predictor of healing outcomes in complex wounds. Adjunct hemoglobin to aid oxygen diffusion has been demonstrated to achieve superior healing outcomes; however, the relative healing benefit across different wound types and evaluations has not yet been estimated. This article does this for the first time. Methods: Data were pooled from previously published real world controlled evaluations, three retrospective cohort controlled studies of a variety of wounds within standard care across hospital and primary care in the North of England in patients with diabetic foot ulcers (n = 40), chronic wounds (n = 100), and sloughy wounds (n = 200). Wounds were equally distributed between adjunct hemoglobin and control and the hemoglobin spray was used as per instructions for use and applied twice weekly, mostly for the duration of the wounds in all three evaluations. Wound healing over 26 weeks was the primary outcome in each of the evaluations, with additional healing and quality of life indicators including pain, wound size, slough coverage, wound exudate levels, adverse events, and dressing regimen used, over time. Each wound type with 10 or more patients in both the standard care alone and adjunctive hemoglobin groups (n = 257/73% of patients) was evaluated. Results: Cox proportional hazards log-rank regressions demonstrated significantly higher weekly chance of healing in each wound type (β, 95% range, sample, p): trauma 1.55 (1.23–1.96, n = 110, p < 0.001), diabetic foot ulcers 2.39 (1.52–3.75, n = 60, p = 0.01), venous leg ulcers 4.98 (1.69–14.7, n = 33, p = 0.04), burns 1.82 (1.11–2.99, n = 30, p = 0.02), and post-surgical wounds 2.75 (1.53–4.96, n = 24, p = 0.001). Results on additional healing indicators were consistent with the main findings. Notably, controlling for ischemia in diabetic foot ulcers resulted in an increased β of 5.68 (2.33–13.86, n = 29, p < 0.001). Conclusion: Adjunct hemoglobin spray, when implemented within standard care, is likely to achieve substantial healing benefits to patients, in particular for diabetic foot ulcers, venous leg ulcers, and post-surgical wounds.
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Hunt SD, Elg F, Percival SL. Assessment of clinical effectiveness of haemoglobin spray as adjunctive therapy in the treatment of sloughy wounds. J Wound Care 2018; 27:210-219. [PMID: 29637828 DOI: 10.12968/jowc.2018.27.4.210] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To assess use of an adjunctive topical haemoglobin spray in the treatment of sloughy wounds. METHOD In addition to a standard wound care regimen, consecutive patients with sloughy wounds self-administered haemoglobin spray treatment twice a week until the wound was healed. All patients were followed-up for 26 weeks. Results were compared with a retrospective cohort of 100 consecutive patients, treated during the same period the previous year with standard wound care alone. Data were collected on wound characteristics including percentage of slough, exudate levels, wound pain, and wound size. RESULTS After 26 weeks, 94/100 patients (94%) treated with haemoglobin spray were completely healed compared with 63/100 control patients (63%). Positive results were evident as early as week one with 52% mean wound size reduction using the heamoglobin spray versus 11% in the retrospective control (p<0.001). At baseline, mean slough coverage was higher in the haemoglobin group, 58% versus 44% in the control group (p<0.001). By week four, mean slough coverage was 1% in the haemoglobin versus 29% in the control group (p<0.001). Reductions in exudate and pain levels (p<0.001) were also observed. CONCLUSION Overall, results of this evaluation showed the addition of adjunctive haemoglobin spray to standard wound care treatment achieved positive clinical outcomes for patients self-managing complicated sloughy wounds, by supporting reduction of wound exudate and slough within the complex multifaceted process of wound healing.
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Affiliation(s)
- Sharon D Hunt
- Lead Nurse, Advanced Nurse Practitioner, Wellway Medical Group, Independent Specialist Wound Care, Northumberland, Berwick Upon Tweed
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45
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Schultz GS, Woo K, Weir D, Yang Q. Effectiveness of a monofilament wound debridement pad at removing biofilm and slough: ex vivo and clinical performance. J Wound Care 2018; 27:80-90. [DOI: 10.12968/jowc.2018.27.2.80] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Gregory S. Schultz
- Department of Obstetrics & Gynecology, University of Florida, Gainesville, Florida, US
| | - Kevin Woo
- Associate Professor, School of Nursing, School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Dot Weir
- Catholic Health Advanced Wound Healing Centers, Buffalo, NY, US
| | - Qingping Yang
- The Institute for Wound Research at the University of Florida, Department of Obstetrics & Gynecology, University of Florida, Gainesville, FL, US
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Schultz G, Bjarnsholt T, James GA, Leaper DJ, McBain AJ, Malone M, Stoodley P, Swanson T, Tachi M, Wolcott RD. Consensus guidelines for the identification and treatment of biofilms in chronic nonhealing wounds. Wound Repair Regen 2017; 25:744-757. [PMID: 28960634 DOI: 10.1111/wrr.12590] [Citation(s) in RCA: 189] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 09/11/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Despite a growing consensus that biofilms contribute to a delay in the healing of chronic wounds, conflicting evidence pertaining to their identification and management can lead to uncertainty regarding treatment. This, in part, has been driven by reliance on in vitro data or animal models, which may not directly correlate to clinical evidence on the importance of biofilms. Limited data presented in human studies have further contributed to the uncertainty. Guidelines for care of chronic wounds with a focus on biofilms are needed to help aid the identification and management of biofilms, providing a clinical focus to support clinicians in improving patient care through evidence-based medicine. METHODS A Global Wound Biofilm Expert Panel, comprising 10 clinicians and researchers with expertise in laboratory and clinical aspects of biofilms, was identified and convened. A modified Delphi process, based on published scientific data and expert opinion, was used to develop consensus statements that could help identify and treat biofilms as part of the management of chronic nonhealing wounds. Using an electronic survey, panel members rated their agreement with statements about biofilm identification and treatment, and the management of chronic nonhealing wounds. Final consensus statements were agreed on in a face-to-face meeting. RESULTS Participants reached consensus on 61 statements in the following topic areas: understanding biofilms and the problems they cause clinicians; current diagnostic options; clinical indicators of biofilms; future options for diagnostic tests; treatment strategies; mechanical debridement; topical antiseptics; screening antibiofilm agents; and levels of evidence when choosing antibiofilm treatments. CONCLUSION This consensus document attempts to clarify misunderstandings about the role of biofilms in clinical practice, and provides a basis for clinicians to recognize biofilms in chronic nonhealing wounds and manage patients optimally. A new paradigm for wound care, based on a stepped-down treatment approach, was derived from the consensus statements.
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Affiliation(s)
- Gregory Schultz
- Department of Obstetrics & Gynecology, Institute for Wound Research, University of Florida, Gainesville, Florida
| | - Thomas Bjarnsholt
- Department of Immunology and Microbiology, Costerton Biofilm Center, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Microbiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Garth A James
- Center for Biofilm Engineering, Montana State University, Bozeman, Montana
| | - David J Leaper
- Clinical Sciences, University of Huddersfield, Huddersfield, United Kingdom
| | - Andrew J McBain
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Matthew Malone
- Liverpool Hospital, South West Sydney LHD, Sydney, New South Wales, Australia.,LIVEDIAB, Ingham Institute of Applied Medical Research, Sydney, New South Wales, Australia
| | - Paul Stoodley
- Departments of Microbial Infection and Immunity, and Orthopaedics, Ohio State University, Columbus, Ohio
| | | | - Masahiro Tachi
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Tohoku University, Sendai, Japan
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47
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Greener M. UrgoClean Ag: evidence base and mode of action. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2017; 26:S12-S15. [PMID: 29144777 DOI: 10.12968/bjon.2017.26.sup20a.s12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
UrgoClean Ag is indicated for all exuding wounds with signs of increased bioburden and biofilm. This article describes the evidence base supporting its efficacy.
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Affiliation(s)
- Mark Greener
- Freelance Medical Writer, Cottenham, Cambridgeshire
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48
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Newton H, Edwards J, Mitchell L, Percival SL. Role of slough and biofilm in delaying healing in chronic wounds. ACTA ACUST UNITED AC 2017; 26:S4-S11. [PMID: 29144785 DOI: 10.12968/bjon.2017.26.sup20a.s4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The management of biofilms with maintenance desloughing and antimicrobial therapy is fast becoming the accepted treatment strategy for chronic wounds.
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Affiliation(s)
- Heather Newton
- Consultant Nurse, Tissue Viability, Royal Cornwall Hospitals NHS Trust
| | - Jacky Edwards
- Burns Nurse Consultant/Honorary Senior Lecturer, Wythenshawe Hospital, Manchester
| | - Louise Mitchell
- Clinical Lead Podiatrist, Birmingham Community Healthcare NHS Foundation Trust
| | - Steven L Percival
- CEO, 5D Health Protection Group, and Honorary Professor, University of Liverpool
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49
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Percival S, Mayer D, Malone M, Swanson T, Gibson D, Schultz G. Surfactants and their role in wound cleansing and biofilm management. J Wound Care 2017; 26:680-690. [DOI: 10.12968/jowc.2017.26.11.680] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- S.L. Percival
- CEO and Professor (honorary), Centre of Excellence in Biofilm Science and Technologies (CEBST), 5D Health Protection Group Ltd and Liverpool University, Liverpool, UK
| | - D. Mayer
- Head of Vascular Surgery Unit, Department of Surgery, HFR Fribourg—Cantonal Hospital, Fribourg, Switzerland
| | - M. Malone
- Head of Department, Podiatric Medicine/Senior Research Fellow, Infectious Disease and Microbiology, School of Medicine, Western Sydney University, Sydney, Australia
| | - T Swanson
- High Risk Foot Service, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, Australia
| | - D. Gibson
- Assistant Professor, Institute for Wound Research, University of Florida, Gainesville, US
| | - G. Schultz
- Professor, Institute for Wound Research, Department Obstetrics and Gynaecology, University of Florida, Gainesville, US
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50
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Percival SL, Mayer D, Salisbury AM. Efficacy of a surfactant-based wound dressing on biofilm control. Wound Repair Regen 2017; 25:767-773. [PMID: 28857343 DOI: 10.1111/wrr.12581] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 08/16/2017] [Indexed: 01/14/2023]
Abstract
The aim of this study was to evaluate the efficacy of both a nonantimicrobial and antimicrobial (1% silver sulfadiazine-SSD) surfactant-based wound dressing in the control of Pseudomonas aeruginosa, Enterococcus sp, Staphylococcus epidermidis, Staphylococcus aureus, and methicillin-resistant S. aureus (MRSA) biofilms. Anti-biofilm efficacy was evaluated in numerous adapted American Standards for Testing and Materials (ASTM) standard biofilm models and other bespoke biofilm models. The ASTM standard models employed included the Minimum biofilm eradication concentration (MBEC) biofilm model (ASTM E2799) and the Centers for Disease Control (CDC) biofilm reactor model (ASTM 2871). Such bespoke biofilm models included the filter biofilm model and the chamberslide biofilm model. Results showed complete kill of microorganisms within a biofilm using the antimicrobial surfactant-based wound dressing. Interestingly, the nonantimicrobial surfactant-based dressing could disrupt existing biofilms by causing biofilm detachment. Prior to biofilm detachment, we demonstrated, using confocal laser scanning microscopy (CLSM), the dispersive effect of the nonantimicrobial surfactant-based wound dressing on the biofilm within 10 minutes of treatment. Furthermore, the non-antimicrobial surfactant-based wound dressing caused an increase in microbial flocculation/aggregation, important for microbial concentration. In conclusion, this nonantimicrobial surfactant-based wound dressing leads to the effective detachment and dispersion of in vitro biofilms. The use of surfactant-based wound dressings in a clinical setting may help to disrupt existing biofilm from wound tissue and may increase the action of antimicrobial treatment.
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Affiliation(s)
- Steven L Percival
- 5D Health Protection Group Ltd, Centre of Excellence in Biofilm Science (CEBS), Liverpool Bio-Innovation Hub, Liverpool, United Kingdom
| | - Dieter Mayer
- Department of Surgery, HFR Fribourg-Cantonal Hospital, Fribourg, Switzerland
| | - Anne-Marie Salisbury
- 5D Health Protection Group Ltd, Centre of Excellence in Biofilm Science (CEBS), Liverpool Bio-Innovation Hub, Liverpool, United Kingdom
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