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Ahn J, Park HY, Shetty AA, Hwang W. Use of injectable acellular dermal matrix combined with negative pressure wound therapy in open diabetic foot amputation. J Wound Care 2022; 31:310-320. [DOI: 10.12968/jowc.2022.31.4.310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Objective: Skin grafts after negative pressure wound therapy (NPWT) and acellular dermal matrix (ADM) usage have both been useful for treating diabetic foot amputation. We hypothesised that injectable ADM combined with NPWT would be more useful than NPWT only for healing after amputation in patients with diabetic foot ulcers (DFUs). The aim of this study was to investigate the clinical outcomes of injectable ADM combined with NPWT in patients with DFU who have undergone amputation. Method: This retrospective study reviewed patients with infected DFUs who were administered NPWT. Patients were divided into two groups: Group 1 included patients who were treated with NPWT only, while Group 2 included patients who were treated with injectable ADM combined with NPWT. Clinical results including the number of NPWT dressing changes, wound healing duration, and full-thickness skin graft (FTSG) incident rate between the two groups were compared. Results: A total of 41 patients took part in the study (Group 1=20, Group 2=21). The mean number of NPWT dressing changes was significantly lower in Group 2 (8.71±3.77) than in Group 1 (13.90±5.62) (p=0.001). Mean wound healing period was shorter in Group 2 (3.17±1.36 weeks) than in Group 1 (5.47±1.68 weeks) (p=0.001). Finally, the rate of patients who underwent FTSG for complete wound closure was 85% in Group 1, whereas it was only 14.3% in Group 2. Conclusion: In this study, the use of injectable ADM combined with NPWT in patients with DFU who underwent amputation favoured complete wound healing, without the need to resort to the use of skin grafts.
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Affiliation(s)
- Jiyong Ahn
- 1 Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Ho Youn Park
- 1 Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Asode Ananthram Shetty
- 2 Canterbury Christ Church University, Faculty of Health and Social Sciences, Chatham Maritime, Kent, UK
| | - Wonha Hwang
- 1 Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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Gao Y, Qiu Z, Liu L, Li M, Xu B, Yu D, Qi D, Wu J. Multifunctional fibrous wound dressings for refractory wound healing. JOURNAL OF POLYMER SCIENCE 2022. [DOI: 10.1002/pol.20220008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Yujie Gao
- MOE Key Laboratory of Advanced Textile Materials & Manufacturing Technology Zhejiang Sci‐Tech University Hangzhou China
| | - Zhiye Qiu
- MOE Key Laboratory of Advanced Textile Materials & Manufacturing Technology Zhejiang Sci‐Tech University Hangzhou China
| | - Lei Liu
- MOE Key Laboratory of Advanced Textile Materials & Manufacturing Technology Zhejiang Sci‐Tech University Hangzhou China
| | - Mengmeng Li
- MOE Key Laboratory of Advanced Textile Materials & Manufacturing Technology Zhejiang Sci‐Tech University Hangzhou China
| | - Bingjie Xu
- MOE Key Laboratory of Advanced Textile Materials & Manufacturing Technology Zhejiang Sci‐Tech University Hangzhou China
| | - Dan Yu
- Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital Zhejiang University School of Medicine Hangzhou China
| | - Dongming Qi
- MOE Key Laboratory of Advanced Textile Materials & Manufacturing Technology Zhejiang Sci‐Tech University Hangzhou China
- Zhejiang Provincial Engineering Research Center for Green and Low‐carbon Dyeing & Finishing Zhejiang Sci‐Tech University Hangzhou China
| | - Jindan Wu
- MOE Key Laboratory of Advanced Textile Materials & Manufacturing Technology Zhejiang Sci‐Tech University Hangzhou China
- Zhejiang Provincial Engineering Research Center for Green and Low‐carbon Dyeing & Finishing Zhejiang Sci‐Tech University Hangzhou China
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Song YP, Wang L, Yuan BF, Shen HW, Du L, Cai JY, Chen HL. Negative-pressure wound therapy for III/IV pressure injuries: A meta-analysis. Wound Repair Regen 2020; 29:20-33. [PMID: 32989919 DOI: 10.1111/wrr.12863] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 08/24/2020] [Accepted: 09/09/2020] [Indexed: 10/23/2022]
Abstract
This meta-analysis was conducted to identify the potential benefits and the efficacy of negative-pressure wound therapy (NPWT) for III/IV pressure injuries (PIs) compared with standard wound care (SWC). Sixteen RCTs with 629 patients were included in our analysis. The methodological quality was assessed by the Cochrane Collaboration Tool. The outcomes included complete ulcer healing rate, wound healing time, pain score, the frequency of dressing change, hospitalization cost, the condition of the exudate, and the wound improvement. The percentage of healing rate was 61.45% for the NPWT group and 36.90% for SWC (95% CI: 1.32-1.70). There were significant differences in wound healing time (WMD = -16.47 days, 95% [CI (-22.36, - 10.59) days, P ≤ .001]). The pain score and hospitalization cost in NPWT was lower compared with SWC group (WMD = -2.39, 95% CI [-3.47, -1.30], P ≤ .001); (SMD = -2.55, 95% CI [-4.07, -1.03], P < .01). The frequency of dressing change in both NPWT groups was greatly reduced (SMD = -3.61, 95% [CI (-4.57, - 2.66) times, P ≤ .001]). Our meta-analysis indicated that NPWT was associated with greater improvements in improving PIs and shorting healing time for III/IV PIs. However, this conclusion needs to be confirmed by high-quality multicenter RCTs.
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Affiliation(s)
- Yi-Ping Song
- School of Medicine, Nantong University, Nantong, Jiangsu, P.R. China
| | - Lei Wang
- Information Department, The Third People's Hospital of Nantong, Nantong, Jiangsu, P.R. China
| | - Bao-Fang Yuan
- Nursing Department, Affiliated Hospital of Nantong University, Nantong, Jiangsu, P. R. China
| | - Hong-Wu Shen
- Nursing Department, Affiliated Hospital of Nantong University, Nantong, Jiangsu, P. R. China
| | - Lin Du
- School of Medicine, Nantong University, Nantong, Jiangsu, P.R. China
| | - Ji-Yu Cai
- School of Medicine, Nantong University, Nantong, Jiangsu, P.R. China
| | - Hong-Lin Chen
- School of Public Health, Nantong University, Nantong, Jiangsu, P.R. China
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Zhu C, Zhou B, Lü J, Yue P, Liu X, Huo L, Shi Y, Liu T, Zhang Z. Principles of STAGE Management for Diabetic Foot Ulcers Based on the Wagner and Texas Classification Systems. INT J LOW EXTR WOUND 2019; 18:367-375. [PMID: 31313614 DOI: 10.1177/1534734619863914] [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: 11/17/2022]
Abstract
The current Wagner and Texas classifications of diabetic foot ulcers (DFUs) are used worldwide to assess the extent of foot lesions, but wound treatment principles based on both the classification systems are lacking. We have summarized the STAGE principles of wound treatment for clinical practice based on the Wagner and Texas classification systems. The STAGE principles refer to the principles of surgical intervention during wound treatment of DFUs and emphasize that "based on anatomical layers, the management focuses on blood supply and includes layer-by-layer incision to the infected area, maintenance of effective wound drainage, and step-by-step treatment of the wound." During treatment, microcirculation improvement and microvascular angiogenesis (A) are essential for granulation tissue formation in the bone (skeleton, S) and tendons (T) and healing of the wound with reepithelialization (E). We defined the above mentioned steps as the STAGE principles, namely, layer-by-layer incision and step-by-step management (Phase A is essential for the treatments in Phases S-T and G-E). Ulcers or gangrene formed during Phases S-T or T should be treated according to the STAGE or TAGE principles, respectively. Similar treatment principles are applied in the other phases. However, treatments at each phase are not isolated and can be performed simultaneously. The STAGE principle can be combined with the tissue, infection, moisture, and wound edge (TIME) and TIME-H chronic wound treatment principles to eliminate the shortcomings of a single principle in wound management.
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Affiliation(s)
- Chaojun Zhu
- Second Affiliated Hospital of Tianjin University of TCM, Tianjin, China
| | - Bing Zhou
- Binhai New Area Hospital of TCM, Tianjin, China
| | - Jiakang Lü
- Center for Drug Evaluation, Beijing, China
| | - Ping Yue
- The First Hospital of Lanzhou University, Lanzhou, China
| | - Xianzhou Liu
- Second Affiliated Hospital of Tianjin University of TCM, Tianjin, China
| | - Lei Huo
- Second Affiliated Hospital of Tianjin University of TCM, Tianjin, China
| | - Yue Shi
- Binhai New Area Hospital of TCM, Tianjin, China
| | | | - Zhaohui Zhang
- Second Affiliated Hospital of Tianjin University of TCM, Tianjin, China
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Mohsin M, Zargar HR, Wani AH, Zaroo MI, Baba PUF, Bashir SA, Rasool A, Bijli AH. Role of customised negative-pressure wound therapy in the integration of split-thickness skin grafts: A randomised control study. Indian J Plast Surg 2019; 50:43-49. [PMID: 28615809 PMCID: PMC5469234 DOI: 10.4103/ijps.ijps_196_16] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Split-thickness skin grafting (STSG) is a time-tested technique in wound cover, but many factors lead to suboptimal graft take. Role of custom-made negative-pressure wound therapy (NPWT) is compared with conventional dress in the integration of STSG and its cost is compared with widely used commercially available NPWT. Materials and Methods: This is a parallel group randomised control study. Block randomisation of 100 patients into one of the two groups (NPWT vs. non-NPWT; 50 patients each) was done. Graft take/loss, length of hospital stay post-grafting, need for regrafting and cost of custom-made negative pressure wound therapy (NPWT) dressings as compared to widely used commercially available NPWT were assessed. Results: Mean graft take in the NPWT group was 99.74% ± 0.73% compared to 88.52% ± 9.47% in the non-NPWT group (P = 0.004). None of the patients in the NPWT group required second coverage procedure as opposed to six cases in the non-NPWT group (P = 0.035). All the patients in the NPWT group were discharged within 4–9 days from the day of grafting. No major complication was encountered with the use of custom-made NPWT. Custom-made NPWT dressings were found to be 22 times cheaper than the widely used commercially available NPWT. Conclusions: Custom-made NPWT is a safe, simple and effective technique in the integration of STSG as compared to the conventional dressings. We have been able to reduce the financial burden on the patients as well as the hospital significantly while achieving results at par with other studies which have used commercially available NPWT.
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Affiliation(s)
- Mir Mohsin
- Department of Plastic and Reconstructive Surgery, SKIMS, Srinagar, Jammu and Kashmir, India
| | - Haroon Rashid Zargar
- Department of Plastic and Reconstructive Surgery, SKIMS, Srinagar, Jammu and Kashmir, India
| | - Adil Hafeez Wani
- Department of Plastic and Reconstructive Surgery, SKIMS, Srinagar, Jammu and Kashmir, India
| | - Mohammad Inam Zaroo
- Department of Plastic and Reconstructive Surgery, SKIMS, Srinagar, Jammu and Kashmir, India
| | | | - Sheikh Adil Bashir
- Department of Plastic and Reconstructive Surgery, SKIMS, Srinagar, Jammu and Kashmir, India
| | - Altaf Rasool
- Department of Plastic and Reconstructive Surgery, SKIMS, Srinagar, Jammu and Kashmir, India
| | - Akram Hussain Bijli
- Department of Plastic and Reconstructive Surgery, SKIMS, Srinagar, Jammu and Kashmir, India
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Li Z, Wang Q, Mi W, Han M, Gao F, Niu G, Ma Y. Effects of negative-pressure wound therapy combinedwith microplasma on treating wounds of ulcer and the expression of heat shock protein 90. Exp Ther Med 2017; 13:2211-2216. [PMID: 28565829 PMCID: PMC5443267 DOI: 10.3892/etm.2017.4266] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 01/20/2017] [Indexed: 12/25/2022] Open
Abstract
The effects of negative pressure wound therapy (NPWT) combined with microplasma on treating wounds of ulcer, and blood perfusion of wound-healing of interface, angiogenesis and the expressions of heat shock protein 90 (HSP90) were explored. We selected continuously 64 patients with wounds of ulcer. The patients were divided into the conventional treatment group (just medical foam dressing and 1% silver sulfadiazine cream for dressing changes) (n=20 cases), the NPWT group (n=22 cases) and the combination group (NPWT combined with microplasma) (n=22 cases), and compared the effects. It was found that in the 7 and 14 day combination group, maturity of granulation tissues and growth degree of epithelium were significantly higher than those in other two groups, and the areas of ulcer reduced significantly, the healing rate increased significantly (P<0.05). In the 7 and 14 day combination group, blood perfusion of wounds and density of new vessels were significantly higher than the other two groups (P<0.05). In the 7 and 14 day combination group, the expression of HSP90 was significantly higher than the other two groups (P<0.05). In conclusion, NPWT combined with microplasma can improve the healing of woulds of ulcers, and it is related to the upregulated expression of HSP90.
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Affiliation(s)
- Zhihong Li
- Department of Burns Surgery, Jinan Central Hospital Affiliated to Shandong University, Jinan, Shandong 250013, P.R. China
| | - Qihong Wang
- Department of Burns Surgery, Jinan Central Hospital Affiliated to Shandong University, Jinan, Shandong 250013, P.R. China
| | - Wenxin Mi
- Department of Burns Surgery, Jinan Central Hospital Affiliated to Shandong University, Jinan, Shandong 250013, P.R. China
| | - Mei Han
- Department of Burns Surgery, Jinan Central Hospital Affiliated to Shandong University, Jinan, Shandong 250013, P.R. China
| | - Fei Gao
- Department of Burns Surgery, Jinan Central Hospital Affiliated to Shandong University, Jinan, Shandong 250013, P.R. China
| | - Guangyan Niu
- Department of Burns Surgery, Jinan Central Hospital Affiliated to Shandong University, Jinan, Shandong 250013, P.R. China
| | - Yindong Ma
- Department of Burns Surgery, Jinan Central Hospital Affiliated to Shandong University, Jinan, Shandong 250013, P.R. China
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Milcheski DA, Zampieri FMDC, Nakamoto HA, Tuma P, Ferreira MC. Negative pressure wound therapy in complex trauma of perineum. Rev Col Bras Cir 2014; 40:312-7. [PMID: 24173482 DOI: 10.1590/s0100-69912013000400010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Accepted: 10/15/2012] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To review the experience (2011 and 2012) of Wound Center of Plastic Surgery Service, Clinics Hospital, Faculty of Medicine, University of São Paulo, with treatment of complex traumatic wounds in the perineal region with the association of negative pressure wound therapy followed by a surgical skin coverage procedure. METHODS This was retrospective analysis of ten patients with complex wound in the perineum resulting from trauma assisted by the Department of Plastic Surgery in HC-USP. Negative pressure was used as an alternative for improving local conditions, seeking definitive treatment with skin grafts or flaps. RESULTS Negative pressure was used to prepare the wound bed. In patients, the mean time of use of negative pressure system was 25.9 days, with dressing changes every 4.6 days. After negative pressure therapy, 11 local flaps were performed in nine patients, with fasciocutaneous anterolateral thigh flap used in four of these. Mean hospital stay was 58.2 days and accompaniment in Plastic Surgery was 40.5 days. CONCLUSION The use of negative pressure therapy led to improvement of local wound conditions faster than traditional dressings, without significant complications, proving to be the current best alternative as an adjunct for the treatment of this type of injury, always followed by surgical reconstruction with grafts and flaps.
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Vig S, Dowsett C, Berg L, Caravaggi C, Rome P, Birke-Sorensen H, Bruhin A, Chariker M, Depoorter M, Dunn R, Duteille F, Ferreira F, Francos Martínez J, Grudzien G, Hudson D, Ichioka S, Ingemansson R, Jeffery S, Krug E, Lee C, Malmsjo M, Runkel N, Martin R, Smith J. Evidence-based recommendations for the use of negative pressure wound therapy in chronic wounds: Steps towards an international consensus. J Tissue Viability 2011; 20 Suppl 1:S1-18. [DOI: 10.1016/j.jtv.2011.07.002] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Coltro PS, Ferreira MC, Batista BPDSN, Nakamoto HA, Milcheski DA, Tuma Júnior P. Atuação da cirurgia plástica no tratamento de feridas complexas. Rev Col Bras Cir 2011; 38:381-6. [DOI: 10.1590/s0100-69912011000600003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Accepted: 03/30/2011] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: Relatar a atuação da Cirurgia Plástica no tratamento das feridas complexas em hospital terciário, analisando suas características, tipos de lesões e condutas adotadas, com ênfase no tratamento cirúrgico. MÉTODOS: Análise retrospectiva dos pacientes com feridas complexas atendidos pela Cirurgia Plástica em hospital terciário, através dos pedidos de consulta, em um período de cinco anos (2006 a 2010). A coleta dos dados foi obtida a partir de atendimentos realizados, avaliações seriadas e registros do prontuário médico. RESULTADOS: Foram atendidos 1927 pacientes (32 consultas/mês), com média de idade de 46,3 anos, predominando o sexo masculino (62%). As especialidades cirúrgicas solicitaram 1076 consultas (56%) e as clínicas, 851 (44%). A distribuição por tipo de ferida demonstrou predomínio das úlceras por pressão (635/33%), das feridas traumáticas (570/30%), cirúrgicas complicadas (305/16%) e necrotizantes (196/10%), sendo o restante representado por vasculite (83/4%), úlceras venosas (79/4%), diabéticas (41/2%) e pós-radiação (18/1%). O tratamento foi operatório em 1382 pacientes (72%) e não-operatório em 545 casos (28%). Nos pacientes operados, realizaram-se 3029 operações, predominando os desbridamentos (1988/65%) e enxertias de pele (619/21%) associadas ou não com a terapia por pressão negativa (vácuo), seguido pelos retalhos pediculados (237/8%), reimplantes digitais (81/3%), retalhos microcirúrgicos (66/2%) e outros procedimentos (38/1%). CONCLUSÃO: O cirurgião plástico demonstrou ter importante atuação no tratamento das feridas complexas por adotar o tratamento cirúrgico mais precocemente, colaborando para a efetiva resolução dos casos.
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Camargo OPD, Leme LEG. Estudo de publicações em periódicos gerais de artigos sobre ortopedia e aparelho locomotor. ACTA ORTOPEDICA BRASILEIRA 2011. [DOI: 10.1590/s1413-78522011000200010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Os autores estudam o perfil de publicação de artigos sobre ortopedia e área de interesse em aparelho locomotor em revistas gerais, não específicas de ortopedia, com registro no PUBMED, em um período de dois anos. Selecionados 67 artigos com distribuição heterogênea entre as revistas estudadas foi constatada presença de 26,47% de artigos com desenho de intervenção e 38% com desenho observacional. Os dados são comentados.
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