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Guptha PM, Kanoujia J, Kishore A, Raina N, Wahi A, Gupta PK, Gupta M. A comprehensive review of the application of 3D-bioprinting in chronic wound management. Expert Opin Drug Deliv 2024:1-22. [PMID: 38809187 DOI: 10.1080/17425247.2024.2355184] [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: 01/22/2024] [Accepted: 05/10/2024] [Indexed: 05/30/2024]
Abstract
INTRODUCTION Chronic wounds require more sophisticated care than standard wound care because they are becoming more severe as a result of diseases like diabetes. By resolving shortcomings in existing methods, 3D-bioprinting offers a viable path toward personalized, mechanically strong, and cell-stimulating wound dressings. AREAS COVERED This review highlights the drawbacks of traditional approaches while navigating the difficulties of managing chronic wounds. The conversation revolves around employing natural biomaterials for customized dressings, with a particular emphasis on 3D-bioprinting. A thorough understanding of the uses of 3D-printed dressings in a range of chronic wound scenarios is provided by insights into recent research and patents. EXPERT OPINION The expert view recognizes wounds as a historical human ailment and emphasizes the growing difficulties and expenses related to wound treatment. The expert acknowledges that 3D printing is revolutionary, but also points out that it is still in its infancy and has the potential to enhance mass production rather than replace it. The review highlights the benefits of 3D printing for wound dressings by providing instances of smart materials that improve treatment results by stimulating angiogenesis, reducing pain, and targeting particular enzymes. The expert advises taking action to convert the technology's prospective advantages into real benefits for patients, even in the face of resistance to change in the healthcare industry. It is believed that the increasing evidence from in-vivo studies is promising and represents a positive change in the treatment of chronic wounds toward sophisticated 3D-printed dressings.
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Affiliation(s)
| | - Jovita Kanoujia
- Amity Institute of Pharmacy, Amity University Madhya Pradesh (AUMP), Gwalior, India
| | - Ankita Kishore
- Amity Institute of Pharmacy, Amity University Madhya Pradesh (AUMP), Gwalior, India
| | - Neha Raina
- Department of Pharmaceutics, School of Pharmaceutical Sciences, Delhi Pharmaceutical Sciences and Research University, New Delhi, India
| | - Abhishek Wahi
- Department of Pharmaceutics, School of Pharmaceutical Sciences, Delhi Pharmaceutical Sciences and Research University, New Delhi, India
| | - Piyush Kumar Gupta
- Department of Life Sciences, Sharda School of Basic Sciences & Research, Sharda University, Greater Noida, India
| | - Madhu Gupta
- Department of Pharmaceutics, School of Pharmaceutical Sciences, Delhi Pharmaceutical Sciences and Research University, New Delhi, India
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Sadeghianmaryan A, Ahmadian N, Wheatley S, Alizadeh Sardroud H, Nasrollah SAS, Naseri E, Ahmadi A. Advancements in 3D-printable polysaccharides, proteins, and synthetic polymers for wound dressing and skin scaffolding - A review. Int J Biol Macromol 2024; 266:131207. [PMID: 38552687 DOI: 10.1016/j.ijbiomac.2024.131207] [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: 09/14/2023] [Revised: 03/15/2024] [Accepted: 03/26/2024] [Indexed: 04/15/2024]
Abstract
This review investigates the most recent advances in personalized 3D-printed wound dressings and skin scaffolding. Skin is the largest and most vulnerable organ in the human body. The human body has natural mechanisms to restore damaged skin through several overlapping stages. However, the natural wound healing process can be rendered insufficient due to severe wounds or disturbances in the healing process. Wound dressings are crucial in providing a protective barrier against the external environment, accelerating healing. Although used for many years, conventional wound dressings are neither tailored to individual circumstances nor specific to wound conditions. To address the shortcomings of conventional dressings, skin scaffolding can be used for skin regeneration and wound healing. This review thoroughly investigates polysaccharides (e.g., chitosan, Hyaluronic acid (HA)), proteins (e.g., collagen, silk), synthetic polymers (e.g., Polycaprolactone (PCL), Poly lactide-co-glycolic acid (PLGA), Polylactic acid (PLA)), as well as nanocomposites (e.g., silver nano particles and clay materials) for wound healing applications and successfully 3D printed wound dressings. It discusses the importance of combining various biomaterials to enhance their beneficial characteristics and mitigate their drawbacks. Different 3D printing fabrication techniques used in developing personalized wound dressings are reviewed, highlighting the advantages and limitations of each method. This paper emphasizes the exceptional versatility of 3D printing techniques in advancing wound healing treatments. Finally, the review provides recommendations and future directions for further research in wound dressings.
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Affiliation(s)
- Ali Sadeghianmaryan
- Department of Biomedical Engineering, University of Memphis, Memphis, TN, USA; Department of Mechanical Engineering, École de Technologie Supérieure, Montreal, Canada; University of Montreal Hospital Research Centre (CRCHUM), Montreal, Canada.
| | - Nivad Ahmadian
- Centre for Commercialization of Regenerative Medicine (CCRM), Toronto, Ontario, Canada
| | - Sydney Wheatley
- Department of Mechanical Engineering, École de Technologie Supérieure, Montreal, Canada; University of Montreal Hospital Research Centre (CRCHUM), Montreal, Canada
| | - Hamed Alizadeh Sardroud
- Division of Biomedical Engineering, College of Engineering, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Emad Naseri
- School of Biomedical Engineering, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ali Ahmadi
- Department of Mechanical Engineering, École de Technologie Supérieure, Montreal, Canada; University of Montreal Hospital Research Centre (CRCHUM), Montreal, Canada
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Singh H, Dhanka M, Yadav I, Gautam S, Bashir SM, Mishra NC, Arora T, Hassan S. Technological Interventions Enhancing Curcumin Bioavailability in Wound-Healing Therapeutics. TISSUE ENGINEERING. PART B, REVIEWS 2024; 30:230-253. [PMID: 37897069 DOI: 10.1089/ten.teb.2023.0085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Abstract
Wound healing has been a challenge in the medical field. Tremendous research has been carried out to expedite wound healing by fabricating various formulations, some of which are now commercially available. However, owing to their natural source, people have been attracted to advanced formulations with herbal components. Among various herbs, curcumin has been the center of attraction from ancient times for its healing properties due to its multiple therapeutic effects, including antioxidant, antimicrobial, anti-inflammatory, anticarcinogenic, neuroprotective, and radioprotective properties. However, curcumin has a low water solubility and rapidly degrades into inactive metabolites, which limits its therapeutic efficacy. Henceforth, a carrier system is needed to carry curcumin, guard it against degradation, and keep its bioavailability and effectiveness. Different formulations with curcumin have been synthesized, and exist in the form of various synthetic and natural materials, including nanoparticles, hydrogels, scaffolds, films, fibers, and nanoemulgels, improving its bioavailability dramatically. This review discusses the advances in different types of curcumin-based formulations used in wound healing in recent times, concentrating on its mechanisms of action and discussing the updates on its application at several stages of the wound healing process. Impact statement Curcumin is a herbal compound extracted from turmeric root and has been used since time immemorial for its health benefits including wound healing. In clinical formulations, curcumin shows low bioavailability, which mainly stems from the way it is delivered in the body. Henceforth, a carrier system is needed to carry curcumin, guard it against degradation, while maintaining its bioavailability and therapeutic efficacy. This review offers an overview of the advanced technological interventions through tissue engineering approaches to efficiently utilize curcumin in different types of wound healing applications.
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Affiliation(s)
- Hemant Singh
- Department of Polymer and Process Engineering, Indian Institute of Technology Roorkee, Roorkee, India
- Department of Biological Engineering, Indian Institute of Technology Gandhinagar, Gandhinagar, India
- Department of Biology, Khalifa University, Main Campus, Abu Dhabi, United Arab Emirates
- Advanced Materials Chemistry Center, Khalifa University, SAN Campus, Abu Dhabi, United Arab Emirates
| | - Mukesh Dhanka
- Department of Biological Engineering, Indian Institute of Technology Gandhinagar, Gandhinagar, India
| | - Indu Yadav
- Department of Polymer and Process Engineering, Indian Institute of Technology Roorkee, Roorkee, India
| | - Sneh Gautam
- Department of Molecular Biology & Genetic Engineering, G. B. Pant University of Agriculture & Technology, Pantnagar, India
| | - Showkeen Muzamil Bashir
- Biochemistry and Molecular Biology Lab Division, Division of Veterinary Biochemistry, Faculty of Veterinary Sciences and Animal Husbandry, Srinagar, India
| | - Narayan Chandra Mishra
- Department of Polymer and Process Engineering, Indian Institute of Technology Roorkee, Roorkee, India
| | - Taruna Arora
- Reproductive Health Division of RBMCH, Indian Council of Medical Research, New Delhi, India
| | - Shabir Hassan
- Department of Biology, Khalifa University, Main Campus, Abu Dhabi, United Arab Emirates
- Advanced Materials Chemistry Center, Khalifa University, SAN Campus, Abu Dhabi, United Arab Emirates
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Derwin R, Patton D, Strapp H, Moore Z. Integrating Point-of-Care Bacterial Fluorescence Imaging-Guided Care with Continued Wound Measurement for Enhanced Wound Area Reduction Monitoring. Diagnostics (Basel) 2023; 14:2. [PMID: 38201311 PMCID: PMC10802895 DOI: 10.3390/diagnostics14010002] [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: 11/10/2023] [Revised: 12/07/2023] [Accepted: 12/15/2023] [Indexed: 01/12/2024] Open
Abstract
AIM This prospective observational study investigated wound area reduction (WAR) outcomes in a complex wound population composed of non-healing acute and chronic wounds. The relationship between bacterial autofluorescence signals and WAR was investigated. Area measurements were collected both manually and digitally, and both methods were compared for accuracy. METHODS Twenty-six participants with 27 wounds of varying etiologies were observed twice weekly for two weeks. Digital wound measurement, wound bacterial status assessment, and targeted debridement were performed through a point-of-care fluorescence imaging device (MolecuLight® i: X, MolecuLight Inc, Toronto, Canada). The wound area reduction (WAR) rate was calculated using baseline and last visit measurements. Statistical analyses, including t-tests, Fisher exact tests, the Wilcoxon signed rank test for method comparison, and ANOVA for bacterial subgroups, were applied as pertinent. RESULTS The overall average WAR was -3.80 cm2, or a decrease of 46.88% (manual measurement), and -2.62 cm2, or a 46.05% decrease (digital measurement via MolecuLight® device). There were no statistically significant differences between the WAR of acute and chronic wounds (p = 0.7877). A stepwise correlation between the WAR and bacterial status classification per fluorescence findings was observed, where persistent bacteria resulted in worse WAR outcomes. An overestimation of wound area by manual measurement was 23% on average. CONCLUSION Fluorescence imaging signals were linked to WAR outcome and could be considered predictive. Wounds exhibiting bacterial loads that persisted at the end of the study period had worse WAR outcomes, while those for which management was able to effectively remove them demonstrated greater WAR. Manual measurement of the wound area consistently overestimated wound size when compared to digital measurement. However, if performed by the same operator, the overestimation was uniform enough that the WAR was calculated to be close to accurate. Notwithstanding, single wound measurements are likely to result in overestimation.
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Affiliation(s)
- Rosemarie Derwin
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin D02 YN77, Ireland
| | - Declan Patton
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin D02 YN77, Ireland
- Fakeeh College of Health Sciences, Jeddah 23323, Saudi Arabia
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong NSW 2522, Australia
| | - Helen Strapp
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin D02 YN77, Ireland
| | - Zena Moore
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin D02 YN77, Ireland
- School of Nursing & Midwifery, Griffith University, Gold Coast, QLD 4222, Australia
- School of Health Sciences, Faculty of Life and Health Sciences, Ulster University, Belfast BT15 1AP, UK
- Department of Nursing, Fakeeh College for Medical Sciences, Jeddah 23323, Saudi Arabia
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, 9000 Gent, Belgium
- Lida Institute, Shanghai 201609, China
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Stelling-Férez J, Cappellacci I, Pandolfi A, Gabaldón JA, Pipino C, Nicolás FJ. Oleanolic acid rescues critical features of umbilical vein endothelial cells permanently affected by hyperglycemia. Front Endocrinol (Lausanne) 2023; 14:1308606. [PMID: 38192424 PMCID: PMC10773851 DOI: 10.3389/fendo.2023.1308606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 11/23/2023] [Indexed: 01/10/2024] Open
Abstract
Skin wound healing is a physiological process that involves several cell types. Among them, endothelial cells are required for inflammation resolution and neo-angiogenesis, both necessary for tissue restoration after injury. Primary human umbilical vein endothelial cells (C-HUVECs) are derived from the umbilical cord. When women develop gestational diabetes, chronic exposure to hyperglycemia induces epigenetic modifications in these cells (GD-HUVECs), leading to a permanent pro-inflammatory phenotype and impaired angiogenesis in contrast to control cells. Oleanolic acid (OA) is a bioactive triterpenoid known for its epithelial cell migration promotion stimulation and higher tensile strength of wounds. However, the potentially anti-inflammatory and pro-angiogenic properties of OA are still under investigation. We tested OA on C- and GD-HUVECs under inflammatory conditions induced by low levels of the inflammatory cytokine TNF-α. Reduced expression of adhesion molecules VCAM1, ICAM1, and SELE was obtained in OA-pre-treated C- and GD-HUVECs. Additionally, protein VCAM1 levels were also decreased by OA. Coherently, monocyte adhesion assays showed that a lower number of monocytes adhered to GD-HUVEC endothelium under OA pre-treatment when compared to untreated ones. It is noteworthy that OA improved angiogenesis parameters in both phenotypes, being especially remarkable in the case of GD-HUVECs, since OA strongly rescued their poor tube formation behavior. Moreover, endothelial cell migration was improved in C- and GD-HUVECs in scratch assays, an effect that was further confirmed by focal adhesion (FA) remodeling, revealed by paxillin staining on immunocytochemistry assays. Altogether, these results suggest that OA could be an emergent wound healing agent due to its capacity to rescue endothelial malfunction caused by hyperglycemia.
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Affiliation(s)
- Javier Stelling-Férez
- Department of Nutrition and Food Technology, Health Sciences PhD Program, Universidad Católica de Murcia (UCAM), Murcia, Spain
- Regeneration, Molecular Oncology, and TGF-β, IMIB-Pascual Parrilla, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Ilaria Cappellacci
- Department of Medical, Oral and Biotechnological Sciences, StemTeCh Group, Center for Advanced Studies and Technology-CAST (ex CeSI-MeT), University G. D’Annunzio Chieti-Pescara, Chieti, Italy
| | - Assunta Pandolfi
- Department of Medical, Oral and Biotechnological Sciences, StemTeCh Group, Center for Advanced Studies and Technology-CAST (ex CeSI-MeT), University G. D’Annunzio Chieti-Pescara, Chieti, Italy
| | - José Antonio Gabaldón
- Department of Nutrition and Food Technology, Health Sciences PhD Program, Universidad Católica de Murcia (UCAM), Murcia, Spain
| | - Caterina Pipino
- Department of Medical, Oral and Biotechnological Sciences, StemTeCh Group, Center for Advanced Studies and Technology-CAST (ex CeSI-MeT), University G. D’Annunzio Chieti-Pescara, Chieti, Italy
| | - Francisco José Nicolás
- Regeneration, Molecular Oncology, and TGF-β, IMIB-Pascual Parrilla, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
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Melamed E, Borkow G. Continuum of care in hard-to-heal wounds by copper dressings: a case series. J Wound Care 2023; 32:788-796. [PMID: 38060415 DOI: 10.12968/jowc.2023.32.12.788] [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: 12/18/2023]
Abstract
OBJECTIVE The quest for an ideal wound dressing has been a longstanding challenge due to the complex nature of wound healing, including stages of haemostasis, inflammation, maturation and remodelling, with overlapping timelines. This makes it difficult to find a single dressing that optimally supports all phases of wound healing. In addition, the ideal wound dressing should possess antibacterial properties and be capable of effectively debriding and lysing necrotic tissue. Copper is an essential trace element that participates in many of the key physiological wound healing processes. METHOD Copper stimulates secretion of various cytokines and growth factors, thus promoting angiogenesis, granulation tissue formation, extracellular matrix proteins secretion and re-epithelialisation. Harnessing this knowledge, we have used copper oxide-impregnated wound dressings in numerous cases and observed their benefits throughout the entire wound healing process. RESULTS This led us to postulate the 'continuum of care' hypothesis of copper dressings. In this study we describe four cases of hard-to-heal wounds of various aetiologies, in which we applied copper dressings consistently across all stages of wound healing, with rapid uneventful healing. CONCLUSION We believe we have successfully implemented the continuum of care principle.
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Affiliation(s)
- Eyal Melamed
- Foot and Ankle Service, Department of Orthopaedics, Rambam Health Care Campus, Haifa 3109601, Israel
| | - Gadi Borkow
- The Skin Research Institute, The Dead-Sea & Arava Science Center, Masada 8693500, Israel
- MedCu Technologies Ltd., Herzliya 4672200, Israel
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Marques R, Lopes M, Ramos P, Neves‐Amado J, Alves P. Prognostic factors for delayed healing of complex wounds in adults: A scoping review. Int Wound J 2023; 20:2869-2886. [PMID: 36916415 PMCID: PMC10410354 DOI: 10.1111/iwj.14128] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/08/2023] [Accepted: 02/13/2023] [Indexed: 03/15/2023] Open
Abstract
Complex or hard-to-heal wounds continue to be a challenge because of the negative impact they have on patients, caregivers, and all the associated costs. This study aimed to identify prognostic factors for the delayed healing of complex wounds. Five databases and grey literature were the sources used to research adults with pressure ulcers/injuries, venous leg ulcers, critical limb-threatening ischaemia, or diabetic foot ulcers and report the prognostic factors for delayed healing in all care settings. In the last 5 years, a total of 42 original peer-reviewed articles were deemed eligible for this scoping review that followed the JBI recommendations and checklist PRISMA-ScR. The most frequent prognostic factors found with statistical significance coinciding with various wound aetiologies were: gender (male), renal disease, diabetes, peripheral arterial disease, the decline in activities of daily life, wound duration, wound area, wound location, high-stage WIfI classification, gangrene, infection, previous ulcers, and low ankle brachial index. It will be essential to apply critical appraisal tools and assessment risk of bias to the included studies, making it possible to make recommendations for clinical practice and build prognostic models. Future studies are recommended because the potential for healing through identification of prognostic factors can be determined, thus allowing an appropriate therapeutic plan to be developed.
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Affiliation(s)
- Raquel Marques
- Centre for Interdisciplinary Research in Health, Instituto de Ciências da SaúdeUniversidade Católica PortuguesaPortoPortugal
| | - Marcos Lopes
- School of Nursing DepartmentUniversidade Federal CearáFortalezaBrazil
| | - Paulo Ramos
- Centre for Interdisciplinary Research in Health, Instituto de Ciências da SaúdeUniversidade Católica PortuguesaPortoPortugal
- Unidade de Saúde Familiar Corino de AndradePortoPortugal
| | - João Neves‐Amado
- Centre for Interdisciplinary Research in Health, Instituto de Ciências da SaúdeUniversidade Católica PortuguesaPortoPortugal
- School of Nursing DepartmentUniversidade Católica PortuguesaPortoPortugal
| | - Paulo Alves
- Centre for Interdisciplinary Research in Health, Instituto de Ciências da SaúdeUniversidade Católica PortuguesaPortoPortugal
- School of Nursing DepartmentUniversidade Católica PortuguesaPortoPortugal
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Karhana S, Dabral S, Garg A, Bano A, Agarwal N, Khan MA. Network pharmacology and molecular docking analysis on potential molecular targets and mechanism of action of BRAF inhibitors for application in wound healing. J Cell Biochem 2023. [PMID: 37334778 DOI: 10.1002/jcb.30430] [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: 03/08/2023] [Revised: 05/16/2023] [Accepted: 05/19/2023] [Indexed: 06/20/2023]
Abstract
Topical application of BRAF inhibitors has been shown to accelerate wound healing in murine models, which can be extrapolated into clinical applications. The aim of the study was to identify suitable pharmacological targets of BRAF inhibitors and elucidate their mechanisms of action for therapeutic applicability in wound healing, by employing bioinformatics tools including network pharmacology and molecular docking. The potential targets for BRAF inhibitors were obtained from SwissTargetPrediction, DrugBank, CTD, Therapeutic Target Database, and Binding Database. Targets of wound healing were obtained using online databases DisGeNET and OMIM (Online Mendelian Inheritance in Man). Common targets were found by using the online GeneVenn tool. Common targets were then imported to STRING to construct interaction networks. Topological parameters were assessed using Cytoscape and core targets were identified. FunRich was employed to uncover the signaling pathways, cellular components, molecular functions, and biological processes in which the core targets participate. Finally, molecular docking was performed using MOE software. Key targets for the therapeutic application of BRAF inhibitors for wound healing are peroxisome proliferator-activated receptor γ, matrix metalloproteinase 9, AKT serine/threonine kinase 1, mammalian target of rapamycin, and Ki-ras2 Kirsten rat sarcoma viral oncogene homolog. The most potent BRAF inhibitors that can be exploited for their paradoxical activity for wound healing applications are Encorafenib and Dabrafenib. By using network pharmacology and molecular docking, it can be predicted that the paradoxical activity of BRAF inhibitors can be used for their potential application in wound healing.
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Affiliation(s)
- Sonali Karhana
- Centre for Translational & Clinical Research, School of Chemical and Life Sciences, Jamia Hamdard, New Delhi, India
| | - Swarna Dabral
- Centre for Translational & Clinical Research, School of Chemical and Life Sciences, Jamia Hamdard, New Delhi, India
- Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, India
| | - Aakriti Garg
- Centre for Translational & Clinical Research, School of Chemical and Life Sciences, Jamia Hamdard, New Delhi, India
- Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, India
| | - Aysha Bano
- Centre for Translational & Clinical Research, School of Chemical and Life Sciences, Jamia Hamdard, New Delhi, India
| | - Nidhi Agarwal
- Centre for Translational & Clinical Research, School of Chemical and Life Sciences, Jamia Hamdard, New Delhi, India
| | - Mohd Ashif Khan
- Centre for Translational & Clinical Research, School of Chemical and Life Sciences, Jamia Hamdard, New Delhi, India
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Sili A, Zaghini F, Monaco D, Molin AD, Mosca N, Piredda M, Fiorini J. Specialized nurse-led care of chronic wounds during hospitalization and after discharge: A randomized controlled trial. Nurs Manag (Harrow) 2023; 54:46-54. [PMID: 36854004 DOI: 10.1097/01.numa.0000918196.97750.4c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Affiliation(s)
- Alessandro Sili
- At the Tor Vergata University Hospital in Rome, Italy, Alessandro Sili is the nursing and health professions director, and Francesco Zaghini is a research nurse. Dario Monaco is a PhD student in the Department of Biomedicine and Prevention at the University of Rome Tor Vergata. Alberto Dal Molin is an associate professor in the Department of Translational Medicine at the University of Piemonte Orientale in Novara. Nella Mosca is a wound care nurse at Tor Vergata University Hospital. Michela Piredda is an associate professor in the Research Unit Nursing Science at Campus Bio-Medico, Roma University. Jacopo Fiorini is a research nurse and vascular access nurse specialist at Tor Vergata University Hospital
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Jorgensen AM, Mahajan N, Atala A, Murphy SV. Advances in Skin Tissue Engineering and Regenerative Medicine. J Burn Care Res 2023; 44:S33-S41. [PMID: 36567474 PMCID: PMC9790899 DOI: 10.1093/jbcr/irac126] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
There are an estimated 500,000 patients treated with full-thickness wounds in the United States every year. Fire-related burn injuries are among the most common and devastating types of wounds that require advanced clinical treatment. Autologous split-thickness skin grafting is the clinical gold standard for the treatment of large burn wounds. However, skin grafting has several limitations, particularly in large burn wounds, where there may be a limited area of non-wounded skin to use for grafting. Non-cellular dermal substitutes have been developed but have their own challenges; they are expensive to produce, may require immunosuppression depending on design and allogenic cell inclusion. There is a need for more advanced treatments for devastating burns and wounds. This manuscript provides a brief overview of some recent advances in wound care, including the use of advanced biomaterials, cell-based therapies for wound healing, biological skin substitutes, biological scaffolds, spray on skin and skin bioprinting. Finally, we provide insight into the future of wound care and technological areas that need to be addressed to support the development and incorporation of these technologies.
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Affiliation(s)
- Adam M Jorgensen
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
| | - Naresh Mahajan
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
| | - Anthony Atala
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
| | - Sean V Murphy
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
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Sili A, Zaghini F, Monaco D, Dal Molin A, Mosca N, Piredda M, Fiorini J. Specialized Nurse-led Care of Chronic Wounds During Hospitalization and After Discharge: A Randomized Controlled Trial. Adv Skin Wound Care 2023; 36:24-29. [PMID: 36537771 DOI: 10.1097/01.asw.0000897444.78712.fb] [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: 06/17/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of specialized nurse-led care of patients with chronic wounds, provided both during hospitalization and postdischarge, on wound healing and readmission rates. METHODS An unblinded randomized controlled trial was conducted. Participants were patients with chronic wounds, randomly assigned to either the experimental group (cared for by wound care nurses both during hospitalization and postdischarge) or to the control group (cared for according to standard practice). Wound healing was identified as the primary outcome. RESULTS Overall, 1,570 patients were randomized, 1,298 of whom were included in the per-protocol analysis (707 in the experimental group and 591 in the control group). Nurse-led wound care quadrupled the probability of healing and reduced the number of treatment weeks and hospital readmissions. CONCLUSIONS Chronic wound care that was entrusted to specialized nurses improved outcomes in terms of wound healing, repair and regeneration, length of treatment, and rate of readmission, compared with standard practice. Future studies should evaluate the impact of care provided by specialized wound care nurses on patients' quality of life and healthcare costs. Nurse managers should promote the implementation of chronic wound clinical-care pathways entrusted to specialized nurses to improve patients' clinical outcomes and reduce hospital readmissions.
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Affiliation(s)
- Alessandro Sili
- At the Tor Vergata University Hospital, Rome, Italy, Alessandro Sili, PhD, RN, is Nursing and Health Professions Director; and Francesco Zaghini, PhD, RN, is Research Nurse. Dario Monaco, MSN, RN, is PhD Student, Department of Biomedicine and Prevention, University of Rome Tor Vergata. Alberto Dal Molin, PhD, RN, is Associate Professor, Department of Translational Medicine, University of Piemonte Orientale, Novara. Nella Mosca, MSN, RN, is Wound Care Nurse, Tor Vergata University Hospital. Michela Piredda, PhD, RN, is Associate Professor, Research Unit Nursing Science, Campus Bio-Medico, Roma University. Jacopo Fiorini, PhD, RN, is Research Nurse and Vascular Access Nurse Specialist, Tor Vergata University Hospital
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Treatment of Complex Wounds with NovoSorb ® Biodegradable Temporising Matrix (BTM)-A Retrospective Analysis of Clinical Outcomes. J Pers Med 2022; 12:jpm12122002. [PMID: 36556223 PMCID: PMC9781929 DOI: 10.3390/jpm12122002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 12/11/2022] Open
Abstract
Complex and chronic wounds represent a highly prevalent condition worldwide that requires a multimodal and interdisciplinary treatment approach to achieve good functional and aesthetic outcomes. Due to increasing costs of health care, an aging population and an increase in difficult-to-treat microbial colonization of wounds, complex wounds will become a substantial clinical, social and economic challenge in the upcoming years. In plastic reconstructive surgery, a variety of dermal skin substitutes have been established for clinical use. Since its approval as a dermal skin substitute in Germany, NovoSorb® Biodegradable Temporising Matrix (BTM) has become a valuable therapeutic option for the treatment of full-thickness wound defects. The clinical data published to date are limited to case reports and small-scale case series with the main focus on single wounds. The aim of this single-center study was a retrospective analysis of our own patient collective that has received treatment with BTM for complex wounds. Overall, BTM showed to be a reliable and versatile reconstructive option, especially for patients with multiple co-morbidities and microbiologically colonized wounds. Although the preliminary findings have produced promising results, further investigation and research are warranted regarding long-term outcomes and additional clinical applications.
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Jaberifard F, Ramezani S, Ghorbani M, Arsalani N, Mortazavi Moghadam F. Investigation of wound healing efficiency of multifunctional eudragit/soy protein isolate electrospun nanofiber incorporated with ZnO loaded halloysite nanotubes and allantoin. Int J Pharm 2022; 630:122434. [PMID: 36435502 DOI: 10.1016/j.ijpharm.2022.122434] [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: 08/18/2022] [Revised: 11/17/2022] [Accepted: 11/19/2022] [Indexed: 11/25/2022]
Abstract
One significant aspect of the current therapeutic agents employed in wound healing involves the engineering of nano polymeric scaffolds to mimic the properties of extracellular matrix (ECM). The present work aimed to prepare and evaluate Eudragit® L100 (EU) nanofibers in combination with soy protein isolate (SPI). Allantoin (Ala) with a 2 wt% was encapsulated as a model drug renowned for its anti-inflammatory and antioxidant agents. Moreover, the synthesized ZnO-halloysite nanotubes (ZHNTs) with different concentrations of 1, 3, and 5 wt% were incorporated into the EU/SPI/Ala nanofiber as a reinforcing filler and a remarkable antibacterial agent. The scanning electron microscope (SEM) analysis showed that by increasing the weight percentage of SPI from 1 % to 2.5 %, the average diameter of nanofibers decreased from 132.3 ± 51.3 nm to 126.7 ± 47.2 nm. It was 223.5 ± 95.6 nm for nanofibers containing 5 wt% ZHNTs (the optimal sample). The evaluation of in vitro release kinetics of Ala for 24 h, showed a burst release during the first 2 h and a sustained release during the subsequent times. Moreover, the structure, crystallinity, and thermal stability of synthesized nanofibers were characterized by Fourier Transform Infrared Spectrometry (FTIR), X-ray diffraction (XRD), and Thermo gravimetric analysis (TGA), respectively. In vitro degradation and mechanical characteristics of these nanofibers were studied. Furthermore, the capability of the nanofibers for cell proliferation was revealed through the MTT test and field emission scanning electron microscopy (FESEM) images of cell attachment. The antimicrobial activity of EU/SPI/Ala/ZHNTs showed that this sample with high ZHNTs content (5 w%t) had the most remarkable antibacterial activity against S. aureus. The results revealed that EU/SPI/Ala/ZHNTs mats could be promising potential wound dressings.
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Affiliation(s)
- Farnaz Jaberifard
- Polymer Research Laboratory, Department of Organic and Biochemistry, Faculty of Chemistry, University of Tabriz, Tabriz, Iran; Nutrition Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Soghra Ramezani
- Nanofiber Research Center, Asian Nanostructures Technology Co. (ANSTCO), Zanjan, Iran
| | - Marjan Ghorbani
- Nutrition Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Nasser Arsalani
- Polymer Research Laboratory, Department of Organic and Biochemistry, Faculty of Chemistry, University of Tabriz, Tabriz, Iran.
| | - Fatemeh Mortazavi Moghadam
- Division of Engineering in Medicine, Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Cambridge, MA 02139, USA
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Prognostic Factors for Delayed Healing of Complex Wounds in Adults: A Scoping Review Protocol. NURSING REPORTS 2022; 12:904-911. [PMID: 36548160 PMCID: PMC9787793 DOI: 10.3390/nursrep12040087] [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] [Received: 10/18/2022] [Revised: 11/12/2022] [Accepted: 11/18/2022] [Indexed: 11/24/2022] Open
Abstract
(1) Background: The high prevalence of persons with wounds and its consequences for a person's quality of life makes the issue a relevant focus of attention for healthcare professionals. Through prognostic factors for healing, the individual risk of complications can be predicted, is possible to predict imminent delays and guide decision-making, thus helping healthcare professionals. (2) Methods: A scoping review performed according to JBI methodology and guided by the Preferred Reporting Items for Systematic Reviews extension for Scoping Reviews (PRISMA-ScR) checklist will aim to identify the studies that meet predefined eligibility criteria. Five databases and gray literature will be the sources used to research adults with pressure ulcers, venous leg ulcers, arterial ulcers, or diabetic foot ulcers and report the prognostic factors for delayed healing in any care setting. (3) Results: This review will consider all quantitative and mixed studies in the last five years. The selection of articles will be carried out by two reviewers independently, using EndNoteWeb and Rayyan. Prognostic factors will be presented by design study, sampling, setting, outcome, wound type, and statistical methods. (4) Conclusions: Mapping prognostic factors for delayed healing could also be a starting point for a systematic review and meta-analyses to quantify the value of each factor.
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Herron K. Impact of a novel synthetic nanofibre matrix to treat hard-to-heal wounds. J Wound Care 2022; 31:962-968. [DOI: 10.12968/jowc.2022.31.11.962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective: Complex hard-to-heal wounds are difficult to manage, generating significant expense to the US healthcare system, costing nearly $25 billion annually. Recently, a resorbable synthetic nanofibre matrix was trialled on a variety of complex hard-to-heal wounds at Astria Sunnyside Hospital to assess clinical efficacy. Method: In this case series, five patients with multiple comorbidities presented in both the inpatient and outpatient setting with various hard-to-heal refractory wounds, including a venous leg ulcer (n=1), a diabetic foot ulcer (n=1), a Charcot foot deformity (n=1) and pressure ulcers (n=2). In an effort to treat these hard-to-heal wounds using a different treatment modality, each patient was transitioned to a care regimen utilising the synthetic nanofibre matrix. Results: Each patient, regardless of wound type, exhibited the formation of granulation tissue and a reduction in wound size. The application of this synthetic nanofibre matrix also resulted in tissue coverage over exposed structure in three cases, reduction of wound exudate in two cases, and eliminated a recurring infection with and without antibiotics in four cases. Conclusion: In this study, the treatment of hard-to-heal refractory wounds with the synthetic nanofibre matrix resulted in the desired biological responses and new tissue formation. Inclusion of the nanofibre matrix in inpatient and outpatient wound care settings may provide a much-needed solution for costly, difficult-to-treat, hard-to-heal wounds, and may offer a reduction in the total cost of care.
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Affiliation(s)
- Karena Herron
- MultiCare Wound Healing & Hyperbaric Center, Auburn, WA, US
- Good Samaritan Hospital, Puyallup, WA, US
- MultiCare Tacoma General Hospital, Tacoma, WA, US
- Multicare Auburn Medical Center, Auburn, WA, US
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A Retrospective Case Series in Fournier’s Disease: And Its Emergency Management et Grafting Technique for Penis Coverage. Emerg Med Int 2022; 2022:6710777. [PMID: 36200075 PMCID: PMC9527405 DOI: 10.1155/2022/6710777] [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: 06/09/2022] [Revised: 09/05/2022] [Accepted: 09/07/2022] [Indexed: 12/01/2022] Open
Abstract
Fournier's gangrene is a necrotizing soft tissue infection of the genital, perineal, and perirectal areas. A primary isolated involvement of the penis is rare, but it can be affected in some circumstances. The purpose of this case series is to present the findings of our thirteen years' experience in the reconstruction of the penis in Fournier's gangrene and our full-thickness grafting technique to cover the penis rod. We retrospectively reviewed patient data who underwent a penis reconstruction following Fournier's gangrene in 2018. The data was analyzed to report the estimated percentage of complications, of patients with primary or secondary gangrene of the penis, the number of reinterventions, and finally the percentage of deaths or recovery. 23 patients underwent reconstruction with our technique of full-thickness skin graft. In all cases, the skin graft was harvested from the upper arm with an arrow shape mark. No further penile revision surgery was required, and neither patient complained about retraction, nor traction, or pain during erection. The donor site healed without any complications. We believe that the coverage of the penis using our grafting technique is safe, easily reproducible, and demonstrates excellent esthetic and functional results.
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Raepsaet C, Alves P, Cullen B, Gefen A, Lázaro-Martínez JL, Lev-Tov H, Najafi B, Santamaria N, Sharpe A, Swanson T, Woo K, Beeckman D. Study protocol for the development of a core outcome set (COS) for clinical effectiveness trials of bordered foam dressings in the treatment of complex wounds. J Tissue Viability 2022; 31:625-629. [DOI: 10.1016/j.jtv.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 09/09/2022] [Accepted: 09/19/2022] [Indexed: 11/30/2022]
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Deng X, Gould M, Ali MA. A review of current advancements for wound healing: Biomaterial applications and medical devices. J Biomed Mater Res B Appl Biomater 2022; 110:2542-2573. [PMID: 35579269 PMCID: PMC9544096 DOI: 10.1002/jbm.b.35086] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/28/2022] [Accepted: 04/30/2022] [Indexed: 12/12/2022]
Abstract
Wound healing is a complex process that is critical in restoring the skin's barrier function. This process can be interrupted by numerous diseases resulting in chronic wounds that represent a major medical burden. Such wounds fail to follow the stages of healing and are often complicated by a pro‐inflammatory milieu attributed to increased proteinases, hypoxia, and bacterial accumulation. The comprehensive treatment of chronic wounds is still regarded as a significant unmet medical need due to the complex symptoms caused by the metabolic disorder of the wound microenvironment. As a result, several advanced medical devices, such as wound dressings, wearable wound monitors, negative pressure wound therapy devices, and surgical sutures, have been developed to correct the chronic wound environment and achieve skin tissue regeneration. Most medical devices encompass a wide range of products containing natural (e.g., chitosan, keratin, casein, collagen, hyaluronic acid, alginate, and silk fibroin) and synthetic (e.g., polyvinyl alcohol, polyethylene glycol, poly[lactic‐co‐glycolic acid], polycaprolactone, polylactic acid) polymers, as well as bioactive molecules (e.g., chemical drugs, silver, growth factors, stem cells, and plant compounds). This review addresses these medical devices with a focus on biomaterials and applications, aiming to deliver a critical theoretical reference for further research on chronic wound healing.
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Affiliation(s)
- Xiaoxuan Deng
- Centre for Bioengineering & Nanomedicine (Dunedin), Department of Oral Rehabilitation, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Maree Gould
- Centre for Bioengineering & Nanomedicine (Dunedin), Department of Oral Rehabilitation, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - M Azam Ali
- Centre for Bioengineering & Nanomedicine (Dunedin), Department of Oral Rehabilitation, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
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Raepsaet C, Alves P, Cullen B, Gefen A, Lázaro-Martínez JL, Lev-Tov H, Najafi B, Santamaria N, Sharpe A, Swanson T, Woo K, Beeckman D. Clinical research on the use of bordered foam dressings in the treatment of complex wounds: A systematic review of reported outcomes and applied measurement instruments. J Tissue Viability 2022; 31:514-522. [DOI: 10.1016/j.jtv.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 05/16/2022] [Indexed: 10/18/2022]
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21
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Tissue engineering in dermatology - from lab to market. Tissue Cell 2022; 74:101717. [PMID: 34973574 DOI: 10.1016/j.tice.2021.101717] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 12/11/2021] [Accepted: 12/19/2021] [Indexed: 11/24/2022]
Abstract
Tissue Engineering is a branch of regenerative medical technology which helps replace damaged tissue using appropriate scaffolding, living cells, and growth factors. Using tissue engineering products can be a promising method for treating skin lesions such as wounds and deep burns. The interaction and interconnection of cells within the bio-culture medium or within a three-dimensional scaffold provides the conditions for tissue regeneration and subsequent healing of skin wounds. Tissue engineering in the field of dermatology has evolved over time from a single application of skin cells or biopolymer scaffolds to the use of cell and scaffold combinations for the treatment, repair, and closure of acute and chronic skin wounds. It has evolved. This technology has reached a point where most products are accepted, and the body rejects a small number, which strengthens the tissue engineering market. In this article, we aimed to review and study the market of this field by reviewing various articles on tissue engineering in the field of dermatology. Tissue-engineered skin substitutes are future options for wound healing and tissue regeneration strategies.
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22
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Paolini G, Sorotos M, Firmani G, Gravili G, Ceci D, Santanelli di Pompeo F. Low-vacuum negative pressure wound therapy protocol for complex wounds with exposed vessels. J Wound Care 2022; 31:78-85. [PMID: 35077217 DOI: 10.12968/jowc.2022.31.1.78] [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: 01/01/2023]
Abstract
OBJECTIVE Treating high-risk surgical patients with complex wounds over exposed blood vessels is a challenge. Guided wound healing may be the only treatment possible. Negative pressure wound therapy (NPWT) is not recommended in these cases. The authors challenged these current recommendations and share their preliminary experience. METHOD The authors adapted a NPWT protocol that uses low-vacuum continuous pressure (-80mmHg) with a silicone sheath and gauze/foam dressing between the wound bed and the device. They monitored the clinical features of patients' wounds to detect bleeding/ischaemia early on. Dressings were changed every 72-96 hours. RESULTS This protocol was followed in five male patients (aged 23-68 years) with complex wounds over exposed vessels. Two cases were foot crush injuries, one midfoot amputation, one hand self-subamputation and one vascular bypass infection. Comorbidities included monoarterial limbs/stump, severe arteriopathy and psychiatric disorder. The exposed vessels were femoral, radial and ulnar, anterior and posterior tibial arteries and veins. Mean treatment lasted 37 days (range 20-61 days). No episodes of severe bleeding/ischaemia of the extremities were observed. Treatment was discontinued once debridement was complete and granulation tissue allowed spontaneous closure/grafting. All wounds appeared stable at 1-year follow-up. CONCLUSION The low-vacuum NPWT protocol was successful in solving five difficult cases. This regimen reduces risks associated with NPWT use on wounds with exposed vessels. The authors believe further validation is required to strengthen the evidence. However, preliminary data are encouraging and might help to change future NPWT recommendations by extending the indications for its use to exposed vessels.
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Affiliation(s)
- Guido Paolini
- Plastic Surgery Unit, Nesmos Department, Faculty of Medicine and Psychology University Sapienza of Rome, Italy.,Sant'Andrea Hospital in Rome, Rome, Italy
| | - Michail Sorotos
- Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, PhD School of Translational Medicine of Development and Active Aging, Università degli Studi di Salerno, Salerno, Italy
| | - Guido Firmani
- Plastic Surgery Unit, Nesmos Department, Faculty of Medicine and Psychology University Sapienza of Rome, Italy
| | | | - Diego Ceci
- Sant'Andrea Hospital in Rome, Rome, Italy
| | - Fabio Santanelli di Pompeo
- Plastic Surgery Unit, Nesmos Department, Faculty of Medicine and Psychology University Sapienza of Rome, Italy
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Wound coverage by the linen dressing accelerates ulcer healing. Postepy Dermatol Alergol 2021; 38:827-841. [PMID: 34849131 PMCID: PMC8610069 DOI: 10.5114/ada.2021.110116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 05/20/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Chronic ulcers are the main cause of morbidity and mortality, and the incidence of chronic wounds is expected to increase given that people live longer and that there are civil diseases. Aim Much attention in the treatment of wounds concerns a dressing that involves wound cleansing, bacterial balance, exudate management and local tissue in a wound environment. These important elements of the evaluation led to the development of an interactive dressing based entirely on flax raw materials. Material and methods The complete dressing for wound coverage was prepared from plant (flax) row products: seedcakes, oil, fiber. The content of bioactive compounds (qualitatively and quantitatively) was tested using chromatographic techniques, and their biological activity during tests on fibroblast cell cultures (NHDF). As a final step the clinical trial were performed. Results The dressings, which help control the microenvironment, combining with exudate using hydrophilic fibre, controlling the flow of exudate from the wound to the dressing were generated. They stimulate the activity in the healing cascade and accelerate the healing process by combining lignocellulose fibre with higher amounts of phenolic compounds, sterols, cannabidiol and unsaturated fatty acids simultaneously with the 3-hydroxybutyrate polymer. All constituents of linen dressing are natural, originate from two types of the engineered flax plant. Pre-clinical data reveal a reasonable reduction in wound size in patients with chronic leg ulcers treated with a linen dressing. Conclusions For the first time, a successful application of the innovative interactive linen dressing in the treatment of chronic wounds was noted.
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Tripodi D, Amabile MI, Gagliardi F, Frusone F, Varanese M, De Luca A, Pironi D, D’ Andrea V, Sorrenti S, Cannistrà C. Algorithm of rational approach to reconstruction in Fournier's disease. Open Med (Wars) 2021; 16:1028-1037. [PMID: 34286099 PMCID: PMC8272539 DOI: 10.1515/med-2021-0294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/02/2021] [Accepted: 04/10/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Fournier's gangrene is a rare form of necrotizing fasciitis that affects the genital area up to the perineal region and sometimes the abdominal wall. OBJECTIVES Our article aims to show that in the treatment of extensive forms of Fournier's gangrene, correct use of flap and skin grafts and a quick reconstruction of the exposed tissues avoid scarring retraction of the testicles and deformation of the penis. MATERIALS AND METHODS We retrospectively reviewed the clinical and photographic data of Fournier's gangrene cases treated at our Institute. The data were evaluated to obtain an estimate of the results of the reconstructive technique used, in terms of percentage of occurred healings and eventual complications. RESULTS A total of 34 patients underwent surgery for Fournier's gangrene. In nine cases (26.5%), we had minor complications: in four patients, suffering from diabetes and obesity, a retard in attachment of graft occurred, while in five patients with perianal problems there was a delay in healing due to the onset of local infection. CONCLUSION The reconstruction approach described here may reduce surgical times. In Fournier's gangrene, the exposed tissues must be reconstructed as quickly as possible.
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Affiliation(s)
- Domenico Tripodi
- Department of Surgical Sciences, Sapienza University of Rome, Rome, CAP 00161, Italy
| | - Maria Ida Amabile
- Department of Surgical Sciences, Sapienza University of Rome, Rome, CAP 00161, Italy
| | - Federica Gagliardi
- Department of Surgical Sciences, Sapienza University of Rome, Rome, CAP 00161, Italy
| | - Federico Frusone
- Department of Surgical Sciences, Sapienza University of Rome, Rome, CAP 00161, Italy
| | - Marzia Varanese
- Department of Surgical Sciences, Sapienza University of Rome, Rome, CAP 00161, Italy
| | - Alessandro De Luca
- Department of Surgical Sciences, Sapienza University of Rome, Rome, CAP 00161, Italy
| | - Daniele Pironi
- Department of Surgical Sciences, Sapienza University of Rome, Rome, CAP 00161, Italy
| | - Vito D’ Andrea
- Department of Surgical Sciences, Sapienza University of Rome, Rome, CAP 00161, Italy
| | - Salvatore Sorrenti
- Department of Surgical Sciences, Sapienza University of Rome, Rome, CAP 00161, Italy
| | - Claudio Cannistrà
- Plastic and Reconstructive Surgery Unit, Centre Hospitalier Universitaire Bichat Claude-Bernard, Paris, France
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Zoppo G, Marrone F, Pittarello M, Farina M, Uberti A, Demarchi D, Secco J, Corinto F, Ricci E. AI technology for remote clinical assessment and monitoring. J Wound Care 2021; 29:692-706. [PMID: 33320742 DOI: 10.12968/jowc.2020.29.12.692] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To report the clinical validation of an innovative, artificial intelligence (AI)-powered, portable and non-invasive medical device called Wound Viewer. The AI medical device uses dedicated sensors and AI algorithms to remotely collect objective and precise clinical data, including three-dimensional (3D) wound measurements, tissue composition and wound classification through the internationally recognised Wound Bed Preparation (WBP) protocol; this data can then be shared through a secure General Data Protection Regulation (GDPR)- and Health Insurance Portability and Accountability Act (HIPAA)-compliant data transfer system. This trial aims to test the reliability and precision of the AI medical device and its ability to aid health professionals in clinically evaluating wounds as efficiently remotely as at the bedside. METHOD This non-randomised comparative clinical trial was conducted in the Clinica San Luca (Turin, Italy). Patients were divided into three groups: (i) patients with venous and arterial ulcers in the lower limbs; (ii) patients with diabetes and presenting with diabetic foot syndrome; and (iii) patients with pressure ulcers. Each wound was evaluated for area, depth, volume and WBP wound classification. Each patient was examined once and the results, analysed by the AI medical device, were compared against data obtained following visual evaluation by the physician and research team. The area and depth were compared with a Kruskal-Wallis one-way analysis of variations in the obtained distribution (expected p-value>0.1 for both tests). The WBP classification and tissue segmentation were analysed by directly comparing the classification obtained by the AI medical device against that of the testing physician. RESULTS A total of 150 patients took part in the trial. The results demonstrated that the AI medical device's AI algorithm could acquire objective clinical parameters in a completely automated manner. The AI medical device reached 97% accuracy against the WBP classification and tissue segmentation analysis compared with that performed in person by the physician. Moreover, data regarding the measurements of the wounds, as analysed through the Kruskal-Wallis technique, showed that the data distribution proved comparable with the other methods of measurement previously clinically validated in the literature (p=0.9). CONCLUSION These findings indicate that remote wound assessment undertaken by physicians is as effective through the AI medical device as bedside examination, and that the device was able to assess wounds and provide a precise WBP wound classification. Furthermore, there was no need for manual data entry, thereby reducing the risk of human error while preserving high-quality clinical diagnostic data.
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Affiliation(s)
- Gianluca Zoppo
- Department of Electronic Engineering and Telecommunications, Politecnico di Torino, Corso Duca degli Abruzzi 24, 10129, Torino, Italy
| | - Francesco Marrone
- Department of Electronic Engineering and Telecommunications, Politecnico di Torino, Corso Duca degli Abruzzi 24, 10129, Torino, Italy
| | - Monica Pittarello
- Department of Surgery 2, Clinica San Luca, Strada della Vetta 3, 10020, Torino, Italy
| | - Marco Farina
- Department of Electronic Engineering and Telecommunications, Politecnico di Torino, Corso Duca degli Abruzzi 24, 10129, Torino, Italy
| | - Alberto Uberti
- Department of Management Engineering, Politecnico di Torino, Corso Duca degli Abruzzi 24, 10129, Torino, Italy
| | - Danilo Demarchi
- Department of Electronic Engineering and Telecommunications, Politecnico di Torino, Corso Duca degli Abruzzi 24, 10129, Torino, Italy
| | - Jacopo Secco
- Department of Electronic Engineering and Telecommunications, Politecnico di Torino, Corso Duca degli Abruzzi 24, 10129, Torino, Italy
| | - Fernando Corinto
- Department of Electronic Engineering and Telecommunications, Politecnico di Torino, Corso Duca degli Abruzzi 24, 10129, Torino, Italy
| | - Elia Ricci
- Department of Electronic Engineering and Telecommunications, Politecnico di Torino, Corso Duca degli Abruzzi 24, 10129, Torino, Italy
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Ciudad P, Vargas MI, Castillo-Soto A, Sanchez JR, Manrique OJ, Bustos SS, Forte AJ, Huayllani MT, Soto Z, Grández-Urbina JA. Manejo de heridas traumáticas de difícil cicatrización con colgajos microvasculares. J Wound Care 2021; 29:27-34. [PMID: 33048015 DOI: 10.12968/jowc.2020.29.sup10.27] [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 Present different flap alternatives when performing microvascular free-flap reconstruction in acute hard-to-heal wounds. METHOD A retrospective review of patients whose acute hard-to-heal wounds were treated with microvascular free-flap reconstruction. Data on demographics, wound aetiology, diagnostic, previous treatment, free-flap type, free-flap size, complications and follow up were analysed. RESULTS A total of 20 patients received microvascular free-flap reconstruction. The median age was 39.5 years. Twenty free-flap reconstructions were performed. These included: 3 cross-leg free flap, 1 cross-leg vascular cable bridge flap, 2 fibula osteocutaneous flap, 6 anterolateral thigh (ALT) flap, 3 thoracodorsal artery perforator (TDAP) flap, 3 fasciomyocutaneous flap, and 2 femoral artery fasciocutaneous flap. A patient required microvascular anastomosis due to hematoma; the rest did not present complications during their postoperative. Previous treatment included negative pressure wound therapy (12 patients) and surgical debridement with silver hydrogel dressings (8 patients). CONCLUSION Hard-to-heal wounds can be unresponsive to traditional wound healing practices or local flaps. They often require free-flap reconstruction, using tissues similar to those compromised. Microvascular techniques can be an effective alternative.
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Affiliation(s)
- Pedro Ciudad
- Departmento de Cirugía Plástica, Reconstructiva y Quemaduras, Hospital Nacional Arzobispo Loayza, Lima, Perú.,División de Cirujía Plástica, China Medical University Hospital, Taichung, Taiwan
| | - Maria I Vargas
- Departmento de Cirugía Plástica, Reconstructiva y Quemaduras, Hospital Nacional Arzobispo Loayza, Lima, Perú
| | - Ana Castillo-Soto
- Facultad de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Perú
| | | | - Oscar J Manrique
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota, Estados Unidos
| | - Samyd S Bustos
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota, Estados Unidos
| | - Antonio J Forte
- División de Cirugía Plástica y Reconstructiva, Mayo Clinic, Jacksonville, Florida, Estados Unidos
| | - Maria T Huayllani
- División de Cirugía Plástica y Reconstructiva, Mayo Clinic, Jacksonville, Florida, Estados Unidos
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Elhessy AH, Chaudhry AR, Hammouda AI, Giacobbe SD, Gesheff MG, Conway JD. Experience with negative-pressure wound therapy with instillation in complex infected orthopaedic wounds. Int Wound J 2021; 18:902-908. [PMID: 33783102 PMCID: PMC8613377 DOI: 10.1111/iwj.13592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 12/01/2022] Open
Abstract
Chronic exudative wounds are frequently seen in hospitalised patients, consuming hospital resources and leading to increased morbidity. Negative‐pressure therapy (NPWT) with topical instillation “NPWTi” may be used to improve the wound healing process, with the unique features (removal of wound exudate, edema reduction, promotion of tissue perfusion and granulation tissue formation, as well as drawing the edges of the wound to facilitate, in addition to the cyclic cleansing mechanism). This report is a descriptive study of our experience with NPWTi on complex infected orthopaedic wounds as a potential method to decrease the need for multiple surgical debridements required for the closure of such wounds. A prospective observational study was conducted. Twenty patients with complex infected orthopaedic wounds were enrolled in our study. These patients were consulted by the Bone and Joint Infection Service and enrolled to receive NPWTi intraoperatively and to be used during their inpatient stay. Twenty patients with 20 complex infected lower limb wounds were included in our study. Of all the 20 wounds, the etiology was post‐surgical in 80% (n = 16) and post‐traumatic in 20% (n = 4). None of the patients received previous treatment with conventional NPWT before participation in the study. There were 11 males (55%) and 9 females (45%) with an average age of 57 years (22‐83). All wounds were located in the lower limbs, with 25% leg (n = 5), 20% thigh (n = 4), 20% knee (n = 4), 20% foot (n = 4), 10% heel (n = 2), and 5% ankle (n = 1). The average length of treatment with NPWTi was 5.2 days (2‐10). Successful wound closure within 6 weeks was achieved in 65% of the cases (n = 13). Of the closed wounds (n = 13), 54% (n = 7) were closed primarily and 46% (n = 6) were closed by secondary procedures (skin graft or skin flap). NPWTi is still considered a novel technique that can be used in the management of complex wounds, and the goal of this prospective study is to report our experience with NPWTi in the management of complex infected orthopaedic lower limb wounds. Randomised control studies with optimally matched wounds comparing NPWTi to the conventional methods of treatment are warranted.
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Affiliation(s)
- Ahmed H Elhessy
- International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland, USA
| | - Arif R Chaudhry
- International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland, USA.,Omni Cosmetic, Wayzata, Minnesota, USA
| | - Ahmed I Hammouda
- International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland, USA.,Department of Orthopaedic Surgery, Al-Azhar University Hospitals, Cairo, Egypt
| | - Shawn D Giacobbe
- International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland, USA
| | - Martin G Gesheff
- International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland, USA
| | - Janet D Conway
- International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland, USA
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Healing of Chronic Wounds by Copper Oxide-Impregnated Wound Dressings-Case Series. ACTA ACUST UNITED AC 2021; 57:medicina57030296. [PMID: 33809898 PMCID: PMC8004176 DOI: 10.3390/medicina57030296] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/15/2021] [Accepted: 03/19/2021] [Indexed: 01/13/2023]
Abstract
Novel antimicrobial wound dressings impregnated with copper oxide micro-particles have been cleared for treatment of acute and chronic wounds. Our objective is to provide preliminary data regarding the potential benefit of using these novel wound dressings including in non-infected wounds. Methods involved the treatment of wounds that responded partially or poorly to conventional wound healing treatments with copper oxide impregnated wound dressings in patients with a range of etiologies. Ten cases of patients with etiologies such as diabetes mellitus, sickle cell disease, renal failure, and necrotizing fasciitis, in which the application of copper oxide impregnated wound dressings in infected and non-infected wounds, which resulted in significant enhanced wound healing, are presented. This was exemplified by clearing of the wound infections, reduction of the fibrous and/or necrotic tissue and by intense granulation, epithelialization, and wound closure. The described 10 case reports support our hypothesis that the copper oxide-containing wound dressing not only confers protection to the wound and the dressing from microbial contamination, and in some cases may help clear the wound infections, but in addition and more importantly, stimulate skin regeneration and wound healing. Our findings are in line with previous animal and in vitro studies showing that copper plays a key role in angiogenesis and skin regeneration. These case reports support the notion that the use of copper oxide impregnated wound dressings may be an important intervention in the arsenal of wound treatment modalities, especially in hard to heal wounds.
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Morgenstjerne-Schwenck LET, Knudsen JT, Prasad SC. Efficacy and safety of skin grafting in treatment of vasculitic ulcer and pyoderma gangrenosum-A systematic review. Wound Repair Regen 2020; 29:240-253. [PMID: 33377584 DOI: 10.1111/wrr.12882] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 12/02/2020] [Indexed: 11/27/2022]
Abstract
Chronic painful ulcers caused by pyoderma gangrenosum (PG) and cutaneous vasculitis remain to be a therapeutic challenge. Skin grafts have been used with success in selected cases but are generally avoided due to the fear of pathergy. The aim of this study was to investigate the safety and efficacy of skin grafting in the treatment of primary vasculitic ulcer (PVU) and PG. MEDLINE, Embase, the Cochrane Library, Clinicaltrial.gov, and WHO International Clinical Trials Registry Platform (ICTRP) were searched from inception to March 2020. A search for grey literature was conducted in May 2020. We included studies assessing the efficacy and safety of skin grafting in the treatment of PG and PVU. Studies were only included if skin grafting was performed after establishment of PG or PVU diagnosis. A total of 721 articles was identified through the database search of which 92 were included in this study. Ten articles were identified by handsearching the reference list of included studies. Finally, 102 articles describing 212 wounds in 153 patients were included. Complete healing was found in 75.5% of the wounds. The average time to complete was 10.8 weeks (95% CI 6.1-15.6). The mean donor site healing time was 1.9 weeks (95% CI 0.52-3.20). Pathergy was reported in 8 (5.2%) patients. One patient had severe infection related to skin grafting. A statistically significant difference in the number of patients receiving preoperative (P = .0079) and postoperative (P = .002) immunosuppressive therapy was found between the groups with complete healing/reduction and no improvement/aggravation. This systematic review finds the current evidence on efficacy and safety of skin grafting in treatment of PG and PVU to be promising but limited to the size and lack of studies superior to case reports and case series. Future placebo-controlled trials are required to draw a stronger conclusion.
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Affiliation(s)
| | - Jane T Knudsen
- Department of Dermatovenerology and Allergy, Odense University Hospital, Odense, Denmark
| | - Sumangali C Prasad
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Department of Dermatovenerology and Allergy, Odense University Hospital, Odense, Denmark
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30
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Saiko G, Lombardi P, Au Y, Queen D, Armstrong D, Harding K. Hyperspectral imaging in wound care: A systematic review. Int Wound J 2020; 17:1840-1856. [PMID: 32830443 PMCID: PMC7949456 DOI: 10.1111/iwj.13474] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/07/2020] [Accepted: 07/15/2020] [Indexed: 01/18/2023] Open
Abstract
Multispectral and hyperspectral imaging (HSI) are emerging imaging techniques with the potential to transform the way patients with wounds are cared for, but it is not clear whether current systems are capable of delivering real-time tissue characterisation and treatment guidance. We conducted a systematic review of HSI systems that have been assessed in patients, published over the past 32 years. We analysed 140 studies, including 10 different HSI systems. Current in vivo HSI systems generate a tissue oxygenation map. Tissue oxygenation measurements may help to predict those patients at risk of wound formation or delayed healing. No safety concerns were reported in any studies. A small number of studies have demonstrated the capabilities of in vivo label-free HSI, but further work is needed to fully integrate it into the current clinical workflow for different wound aetiologies. As an emerging imaging modality for medical applications, HSI offers great potential for non-invasive disease diagnosis and guidance when treating patients with both acute and chronic wounds.
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Affiliation(s)
| | | | | | | | - David Armstrong
- Keck School of MedicineUniversity of Southern California, Los AngelesCaliforniaCaliforniaCanada
| | - Keith Harding
- School of MedicineCardiff UniversityWalesUK
- A*STARSingapore
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31
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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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Widodo A, Rahajoe PS, Astuti RT. TGF-β expression and wound tensile strength after simple interrupted suturing and zip surgical skin closure (IN VIVO study). Ann Med Surg (Lond) 2020; 58:187-193. [PMID: 32994982 PMCID: PMC7505902 DOI: 10.1016/j.amsu.2020.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 08/05/2020] [Indexed: 11/02/2022] Open
Abstract
Primary healing occurs when both edges of the adjacent incision wound meet. To achieve primary healing, bringing the wound edges closer is generally done by suturing. At present comes one of the methods of skin incision closure without involving sutures called zip surgical skin closure. As an indicator of commonly used wound healing, tensile strength is produced by collagen that involves TGF-β in its production. This study was aimed to observe the expression of TGF-β and tensile strength of the skin incision-post wound using simple interrupted suturing or zip surgical skin closure. An experimental laboratory, this study used Sprague Dawley rats with the predetermined inclusion criteria. Thirty-six rats were applied with 3 cm-dorsal skin incisions after which they were divided into 2 groups, group 1 received simple interrupted suturing and group 2 received zip surgical skin closure. TGF-β examination was performed with BS-0086R polyclonal antibodies and wound tensile strength was observed on day 3, 7 and 14. The independent t-test showed that the tensile strength of the zip surgical skin closure group was higher and was significant as observed on day 7 (p = 0.000) than that of the simple interrupted suturing group. TGF-β expression in the zip surgical skin closure group was found more numerous and significant on day 7 and 14 than that of in the simple interrupted group, (p = 0.025) and (p = 0.032) respectively. Conclusion. Skin incision-post wound healing with zip surgical skin closure is better and shows higher tensile strength and more numerous TGF-β expressions than simple interrupted suturing.
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Affiliation(s)
- Agus Widodo
- Resident of Department Oral and Maxillofacial Surgery, Faculty of Dentistry, Universitas Gadjah Mada, yogyakarta, Indonesia
| | - Poerwati Soetji Rahajoe
- Staff of Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Riyati Titi Astuti
- Staff of Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Universitas Gadjah Mada, Yogyakarta, Indonesia
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33
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Ciudad P, Vargas MI, Castillo-Soto A, Sanchez JR, Manrique OJ, Bustos SS, Forte AJ, Huayllani MT, Soto Z, Grández-Urbina JA. Manejo de heridas traumáticas de difícil cicatrización con colgajos microvasculares. J Wound Care 2020; 29:27-34. [PMID: 33054617 DOI: 10.12968/jowc.2020.29.latam_sup_2.27] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Present different flap alternatives when performing microvascular free-flap reconstruction in acute hard-to-heal wounds. METHOD A retrospective review of patients whose acute hard-to-heal wounds were treated with microvascular free-flap reconstruction. Data on demographics, wound aetiology, diagnostic, previous treatment, free-flap type, free-flap size, complications and follow up were analysed. RESULTS A total of 20 patients received microvascular free-flap reconstruction. The median age was 39.5 years. Twenty free-flap reconstructions were performed. These included: 3 cross-leg free flap, 1 cross-leg vascular cable bridge flap, 2 fibula osteocutaneous flap, 6 anterolateral thigh (ALT) flap, 3 thoracodorsal artery perforator (TDAP) flap, 3 fasciomyocutaneous flap, and 2 femoral artery fasciocutaneous flap. A patient required microvascular anastomosis due to hematoma; the rest did not present complications during their postoperative. Previous treatment included negative pressure wound therapy (12 patients) and surgical debridement with silver hydrogel dressings (8 patients). CONCLUSION Hard-to-heal wounds can be unresponsive to traditional wound healing practices or local flaps. They often require free-flap reconstruction, using tissues similar to those compromised. Microvascular techniques can be an effective alternative.
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Affiliation(s)
- Pedro Ciudad
- Departmento de Cirugía Plástica, Reconstructiva y Quemaduras, Hospital Nacional Arzobispo Loayza, Lima, Perú.,División de Cirujía Plástica, China Medical University Hospital, Taichung, Taiwan
| | - Maria I Vargas
- Departmento de Cirugía Plástica, Reconstructiva y Quemaduras, Hospital Nacional Arzobispo Loayza, Lima, Perú
| | - Ana Castillo-Soto
- Facultad de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Perú
| | | | - Oscar J Manrique
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota, Estados Unidos
| | - Samyd S Bustos
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota, Estados Unidos
| | - Antonio J Forte
- División de Cirugía Plástica y Reconstructiva, Mayo Clinic, Jacksonville, Florida, Estados Unidos
| | - Maria T Huayllani
- División de Cirugía Plástica y Reconstructiva, Mayo Clinic, Jacksonville, Florida, Estados Unidos
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34
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Saiko G, Lombardi P, Au Y, Queen D, Armstrong D, Harding K. Hyperspectral imaging in wound care: A systematic review. Int Wound J 2020. [PMID: 32830443 DOI: 10.1111/iwj.13474.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Multispectral and hyperspectral imaging (HSI) are emerging imaging techniques with the potential to transform the way patients with wounds are cared for, but it is not clear whether current systems are capable of delivering real-time tissue characterisation and treatment guidance. We conducted a systematic review of HSI systems that have been assessed in patients, published over the past 32 years. We analysed 140 studies, including 10 different HSI systems. Current in vivo HSI systems generate a tissue oxygenation map. Tissue oxygenation measurements may help to predict those patients at risk of wound formation or delayed healing. No safety concerns were reported in any studies. A small number of studies have demonstrated the capabilities of in vivo label-free HSI, but further work is needed to fully integrate it into the current clinical workflow for different wound aetiologies. As an emerging imaging modality for medical applications, HSI offers great potential for non-invasive disease diagnosis and guidance when treating patients with both acute and chronic wounds.
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Affiliation(s)
| | | | | | | | - David Armstrong
- Keck School of Medicine, University of Southern California, Los Angeles, California, California, Canada
| | - Keith Harding
- School of Medicine, Cardiff University, Wales, UK.,A*STAR, Singapore
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35
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Diehm YF, Loew J, Will PA, Fischer S, Hundeshagen G, Ziegler B, Gazyakan E, Kneser U, Hirche C. Negative pressure wound therapy with instillation and dwell time (NPWTi-d) with V. A. C. VeraFlo in traumatic, surgical, and chronic wounds-A helpful tool for decontamination and to prepare successful reconstruction. Int Wound J 2020; 17:1740-1749. [PMID: 32716140 PMCID: PMC7948994 DOI: 10.1111/iwj.13462] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/24/2020] [Accepted: 06/28/2020] [Indexed: 01/10/2023] Open
Abstract
For nearly two decades, Negative Pressure Wound Therapy (NPWT) has been used for temporary wound coverage as well as wound bed preparation. The addition of instillation and dwell time as an adjunct to NPWT (NPWTi‐d) enables wound bed cleaning and improved wound bed granulation. Thirty patients with different types of colonised wounds (traumatic, surgical, and chronic) were treated with NPWTi‐d using saline for instillation. Patient data, microbiological data and wound characteristics were collected and analysed. Endpoints were bacterial decontamination (count and type), effect on wound bed granulation, and successful reconstruction. Additionally, subgroup analyses for traumatic, surgical, and chronic wounds as well as patients pretreated with conventional NPWT or isolated gram‐positive or negative germs were performed. NPWTi‐d was applied on average for 13 days with a total hospitalisation time of 51 days. After NPWTi‐d, decontaminated wounds were detected in 23% of cases. The number of different bacteria as well as bacterial count could be significantly reduced from 2.38 to 1.16 and 3.9 to 1.3, respectively. This was similar for all subgroups except surgical wounds, in which NPWTi‐d did not lead to a significant reduction of the bacterial count. NPWTi‐d resulted in a significant stimulation of granulation tissue. Successful reconstruction was achieved in 90% of cases. NPWTi‐d enabled wound pre‐conditioning by powerfully reducing or decontaminating the bacterial load and spectrum in most of the wounds. The wound bed integrity was re‐established to prepare successful reconstruction.
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Affiliation(s)
- Yannick F Diehm
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, Ludwigshafen, Germany.,Hand and Plastic Surgery, University of Heidelberg, Heidelberg, Germany
| | - Julia Loew
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, Ludwigshafen, Germany.,Hand and Plastic Surgery, University of Heidelberg, Heidelberg, Germany
| | - Patrick A Will
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, Ludwigshafen, Germany.,Hand and Plastic Surgery, University of Heidelberg, Heidelberg, Germany
| | - Sebastian Fischer
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, Ludwigshafen, Germany.,Hand and Plastic Surgery, University of Heidelberg, Heidelberg, Germany
| | - Gabriel Hundeshagen
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, Ludwigshafen, Germany.,Hand and Plastic Surgery, University of Heidelberg, Heidelberg, Germany
| | - Benjamin Ziegler
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, Ludwigshafen, Germany.,Hand and Plastic Surgery, University of Heidelberg, Heidelberg, Germany
| | - Emre Gazyakan
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, Ludwigshafen, Germany.,Hand and Plastic Surgery, University of Heidelberg, Heidelberg, Germany
| | - Ulrich Kneser
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, Ludwigshafen, Germany.,Hand and Plastic Surgery, University of Heidelberg, Heidelberg, Germany
| | - Christoph Hirche
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, Ludwigshafen, Germany.,Hand and Plastic Surgery, University of Heidelberg, Heidelberg, Germany
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36
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Gillespie BM, Walker R, Lin F, Roberts S, Eskes A, Perry J, Birgan S, Nieuwenhoven P, Garrahy E, Probert R, Chaboyer W. Wound care practices across two acute care settings: A comparative study. J Clin Nurs 2019; 29:831-839. [PMID: 31820850 PMCID: PMC7328782 DOI: 10.1111/jocn.15135] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 10/08/2019] [Accepted: 11/03/2019] [Indexed: 12/11/2022]
Abstract
AIMS AND OBJECTIVES Describe and compare current surgical wound care practices across two hospitals in two health services districts, Australia. BACKGROUND Surgical site infections (SSI) are a complication of surgery and occur in up to 9.5% of surgical procedures, yet they are preventable. Despite the existence of clinical guidelines for SSI prevention, there remains high variation in wound care practice. DESIGN Prospective comparative design using structured observations and chart audit. METHODS A specifically developed audit tool was used to collect data on observed wound care practices, documentation of wound assessment and practice, and patients' clinical characteristics from patients' electronic medical records. Structured observations of a consecutive sample of surgical patients receiving wound care with a convenience sample of nurses were undertaken. The manuscript adheres to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement. RESULTS In total, 154 nurses undertaking acute wound care and 257 surgical patients who received wound care were observed. Across hospitals, hand hygiene adherence after dressing change was lowest (Hospital A: 8/113, 7%; Hospital B: 16/144, 11%; χ2 : 8.93, p = .347). Most wound dressing practices were similar across sites, except hand hygiene prior to dressing change (Hospital A: 107/113, 95%; Hospital B: 131/144, 91%; (χ2 : 7.736, p = .021) and use of clean gloves using nontouch technique (Hospital A: 88/113, 78%; Hospital B: 90/144, 63%; χ2 : 8.313, p = .016). The most commonly documented wound characteristic was wound type (Hospital A: 43/113, 38%; Hospital B: 70/144, 49%). What nurses documented differed significantly across sites (p < .05). CONCLUSIONS Clinical variations in wound care practice are likely influenced by clinical context. RELEVANCE TO CLINICAL PRACTICE Using an evidence-based approach to surgical wound management will help reduce patients' risk of wound-related complications.
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Affiliation(s)
- Brigid M Gillespie
- School of Nursing & Midwifery, Health, Griffith University, Gold Coast, QLD, Australia.,Nursing, Gold Coast Hospital and Health Service, Queensland Health, Gold Coast, QLD, Australia
| | - Rachel Walker
- School of Nursing & Midwifery, Health, Griffith University, Gold Coast, QLD, Australia.,Division of Surgery, Nursing, Princess Alexandra Hospital, Brisbane, Qld, Australia
| | - Frances Lin
- School of Nursing & Midwifery, Health, Griffith University, Gold Coast, QLD, Australia
| | - Shelley Roberts
- School of Dietetics & Nutrition, Gold Coast Hospital and Health Service, Health, Griffith University, Gold Coast, Qld, Australia
| | - Anne Eskes
- Nursing, Amsterdam Medical Centre, Amsterdam, The Netherlands
| | - Jodie Perry
- Integrated & Ambulatory Services, Nursing, Gold Coast Hospital and Health Service, Gold Coast, QLD, Australia
| | - Sean Birgan
- Division of Surgery, Nursing, Princess Alexandra Hospital, Brisbane, Qld, Australia
| | - Paul Nieuwenhoven
- Surgical and Procedural Services, Nursing, Gold Coast Hospital and Health Service, Gold Coast, QLD, Australia
| | - Elizabeth Garrahy
- Division of Surgery, Nursing, Princess Alexandra Hospital, Brisbane, Qld, Australia
| | - Rosalind Probert
- Stomal Therapy and Wound Management Department, Nursing, Princess Alexandra Hospital, Brisbane, Qld, Australia
| | - Wendy Chaboyer
- School of Nursing & Midwifery, Health, Griffith University, Gold Coast, QLD, Australia
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Nunes CADB, Melo PG, Malaquias SG, Amaral KVÁ, Alves GR, Meira AA, Cardoso AL, Pereira LV, Bachion MM. Effectiveness of two bundles in venous leg ulcer healing: A randomized controlled trial. JOURNAL OF VASCULAR NURSING 2019; 37:232-245. [DOI: 10.1016/j.jvn.2019.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 09/13/2019] [Accepted: 09/14/2019] [Indexed: 01/08/2023]
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38
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Carvalho VF, Ueda T, Paggiaro AO, Nascimento ARF, Ferreira MC, Gemperli R. Comparison of neurosensory devices in detecting cutaneous thresholds related to protective sensibility: A cross-sectional study in São Paulo, Brazil. Diabetes Res Clin Pract 2019; 157:107821. [PMID: 31437560 DOI: 10.1016/j.diabres.2019.107821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 08/14/2019] [Accepted: 08/16/2019] [Indexed: 01/07/2023]
Abstract
AIMS To quantify the static and moving cutaneous sensibility threshold of diabetic patients using a neurosensory device for quantitative pressure detection. METHODS Three hundred thirty-four (n = 334) patients with type 2 diabetes and no previous history of wounds on the feet were studied using the one- and two-point static (1SP;2 SP) and one- and two-point moving (1MP;2 MP) tests through the pressure-specified sensory device (PSSD) on the cutaneous territory of the dorsal first web, hallux pulp, and medial calcaneal. In addition, patients were evaluated using the Semmes-Weinstein monofilament (SWM) No. 5.07 and tuning fork (128 Hz), which were used as normality parameters to detect the loss of protective sensibility. The same examinations were used to assess the control group (228 nondiabetic). RESULTS Altered values were observed for the static and moving tests over the three studied nerve territories. In comparing the sensibility threshold between diabetic patients who were sensitive and nonsensitive to SWM 5.07, we observed that this filament is not the most indicated for identifying the loss of sensibility in these patients. The prevalence of patients at risk varied between 85 and 89%. The biochemical marker associated with these high rates was HbA1c (p = 0.02). CONCLUSIONS Numeric quantification of the pressure threshold allowed us to determine the functional deficit of nerve fibers. Our findings suggest that the neurosensory device should be used as an adjuvant tool to evaluate the degree of loss of sensation on the skin.
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Affiliation(s)
- V F Carvalho
- Nursing Postgraduate Program of Guarulhos University, Rua: Antônio Ribeiro de Moraes, 264 - ap: 101-3, 02751-000, Brazil.
| | - T Ueda
- Plastic Surgery Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Avenida: Doutor Arnaldo, 455 - sala 1360, 01246-903, Brazil.
| | - A O Paggiaro
- Nursing Postgraduate Program of Guarulhos University, R. Dr. Ramos de Azevedo, 159 - sala 208 - Centro, Guarulhos, SP 07012-020, Brazil
| | - A R F Nascimento
- Nursing Postgraduate Program of Guarulhos University, Praça Tereza Cristina, 229 - Centro, Guarulhos, SP 07023-070, Brazil
| | - M C Ferreira
- Plastic Surgery Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua: Barata Ribeiro, 483 - sala 161 - Bela Vista, São Paulo, SP 01308-000, Brazil
| | - R Gemperli
- Plastic Surgery Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Pedroso Alvarenga, 1046 - Jardins, São Paulo, SP 04531-004, Brazil.
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Sena S, Sumeyra KN, Ulkugul G, Sema A, Betul K, Muge SB, Sayip EM, Muhammet U, Cevriye K, Mahir M, Titu MA, Ficai D, Ficai A, Gunduz O. Controlled Release of Metformin Hydrochloride from Core-Shell Nanofibers with Fish Sarcoplasmic Protein. MEDICINA (KAUNAS, LITHUANIA) 2019; 55:E682. [PMID: 31658758 PMCID: PMC6843546 DOI: 10.3390/medicina55100682] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 09/26/2019] [Accepted: 10/04/2019] [Indexed: 01/13/2023]
Abstract
Background and Objectives: A coaxial electrospinning technique was used to produce core/shell nanofibers of a polylactic acid (PLA) as a shell and a polyvinyl alcohol (PVA) containing metformin hydrochloride (MH) as a core. Materials and Methods: Fish sarcoplasmic protein (FSP) was extracted from fresh bonito and incorporated into nanofiber at various concentrations to investigate the influence on properties of the coaxial nanofibers. The morphology, chemical structure and thermal properties of the nanofibers were studied. Results: The results show that uniform and bead-free structured nanofibers with diameters ranging from 621 nm to 681 nm were obtained. A differential scanning calorimetry (DSC) analysis shows that FSP had a reducing effect on the crystallinity of the nanofibers. Furthermore, the drug release profile of electrospun fibers was analyzed using the spectrophotometric method. Conclusions: The nanofibers showed prolonged and sustained release and the first order kinetic seems to be more suitable to describe the release. MTT assay suggests that the produced drug and protein loaded coaxial nanofibers are non-toxic and enhance cell attachment. Thus, these results demonstrate that the produced nanofibers had the potential to be used for diabetic wound healing applications.
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Affiliation(s)
- Su Sena
- Center for Nanotechnology & Biomaterials Application and Research, Marmara University, 34722 Istanbul, Turkey.
- Department of Metallurgical and Materials Engineering, Faculty of Technology, Marmara University, 34722 Istanbul, Turkey.
| | - Korkmaz Nalan Sumeyra
- Department of Genetics and Bioengineering, Faculty of Engineering, Yeditepe University, 34755 Istanbul, Turkey.
| | - Guven Ulkugul
- Department of Genetics and Bioengineering, Faculty of Engineering, Yeditepe University, 34755 Istanbul, Turkey.
| | - Arslan Sema
- Department of Biochemistry, Marmara University, 34854 Istanbul, Turkey.
| | - Karademir Betul
- Department of Biochemistry, Marmara University, 34854 Istanbul, Turkey.
| | - Sennaroglu Bostan Muge
- Department of Chemical Engineering, Faculty of Engineering, Marmara University, 34722 Istanbul, Turkey.
| | - Eroglu Mehmet Sayip
- Department of Chemical Engineering, Faculty of Engineering, Marmara University, 34722 Istanbul, Turkey.
| | - Uzun Muhammet
- Department of Textile Engineering, Faculty of Technology, Marmara University 34722 Istanbul, Turkey.
| | - Kalkandelen Cevriye
- Department of Biomedical Devices Technology, Vocational School of Technical Sciences, Istanbul University-Cerrahpasa, 34500 Istanbul, Turkey.
| | - Mahirogullari Mahir
- Nanortopedi Industry and Trade Inc., Sanayi Mahallesi Teknopark Bulvari, Teknopark Istanbul, 34906 Istanbul, Turkey.
| | - Mihail Aurel Titu
- Department of Industrial Engineering and Management, "Lucian Blaga" University of Sibiu, Faculty of Engineering, RO-550025 Sibiu, Romania.
- Academy of Romanian Scientists, 54 Splaiul Independentei, Sector 5, 50085 Bucharest, Romania.
| | - Denisa Ficai
- Department of Science and Engineering of Oxidic Materials and Nanomaterials, Faculty of Applied Chemistry and Materials Science, University Politehnica of Bucharest, 011061 Bucharest, Romania.
| | - Anton Ficai
- Academy of Romanian Scientists, 54 Splaiul Independentei, Sector 5, 50085 Bucharest, Romania.
- Department of Science and Engineering of Oxidic Materials and Nanomaterials, Faculty of Applied Chemistry and Materials Science, University Politehnica of Bucharest, 011061 Bucharest, Romania.
| | - Oguzhan Gunduz
- Center for Nanotechnology & Biomaterials Application and Research, Marmara University, 34722 Istanbul, Turkey.
- Department of Metallurgical and Materials Engineering, Faculty of Technology, Marmara University, 34722 Istanbul, Turkey.
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Three Cases Describing Outcomes of Negative-Pressure Wound Therapy With Instillation for Complex Wound Healing. J Wound Ostomy Continence Nurs 2019; 46:251-255. [PMID: 31022125 DOI: 10.1097/won.0000000000000516] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND We describe 3 cases where negative-pressure wound therapy with instillation and dwell time (NPWTi-d) was used as an adjunctive therapy for 3 chronic wounds. CASES Three patients (2 males and 1 female), ranging in age from 28 to 53 years, presented with complex, infected wounds: (1) a diabetic foot ulcer with underlying infection, (2) a dehisced abdominal wound with enterocutaneous fistula, and (3) a large wound of the upper torso and axillary region resulting from soft tissue necrosis. Negative-pressure wound therapy with instillation and dwell time was initiated by instilling normal saline or an antiseptic solution; the solution was left in place for 3 to 10 minutes. Continuous negative pressure was then applied at -125 or -150 mm Hg; cycles were repeated every 1 or 3 hours. Treatment was applied for 5 to 44 days, and dressings were changed every 2 to 3 days. Granulation tissue developed in all 3 wounds; all closed after subsequent skin grafting. CONCLUSIONS Outcomes of these cases suggest that NPWTi-d may be used as an adjunctive treatment modality for a variety of chronic wounds.
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Evidence-Based Gardening: Using Palliative Approaches to Cure Complex Wounds. Ann Plast Surg 2019; 83:S45-S49. [PMID: 31513065 DOI: 10.1097/sap.0000000000002100] [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
Complex wounds are commonly thought to require aggressive surgical intervention to achieve healing. However, optimal healing results can often be achieved when greater emphasis is placed on optimizing patient factors prior to any surgical intervention. A retrospective review was performed of pressure ulcers and complex wound cases treated over 5 years at the Yale New Haven Wound Center. Optimal healing including clinical resolution of osteomyelitis and improved scarring was achieved when patient factors, such as glucose control and nutrition, were optimized. Surgical intervention can be more effective and even avoided entirely with the appropriate focus on optimizing patient factors.
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Es-Haghi A, Mashreghi M, Rezazade Bazaz M, Homayouni-Tabrizi M, Darroudi M. Fabrication of biopolymer based nanocomposite wound dressing: evaluation of wound healing properties and wound microbial load. IET Nanobiotechnol 2019; 11:517-522. [PMID: 28745283 DOI: 10.1049/iet-nbt.2016.0160] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The aim of this study is to introduce natural-based polymers, chitosan and starch, to design a remedial nanocomposite, comprising of cerium oxide nanoparticles and silver nanoparticles, to investigate their effects in accelerating wound healing and in wound microbial load. Cerium oxide nanoparticles synthesized in starch solution added to the colloidal dispersion of synthesized silver nanoparticles in chitosan to make a three-component nanomaterial. Mice were anaesthetized and two parallel full-thickness round wounds were excised under aseptic conditions with the help of sterile dermal biopsy punch. Furthermore, effects of silver-chitosan and silver-cerium-chitosan nanocomposite had evaluated on rate of wound closure and collagen density and on microbial load of wound in full-thickness model. Results showed that both silver chitosan and silver-cerium-chitosan had significant impact on acceleration of wound closure and collagen content and on reduction of wound microbial load in comparison with control group, which was, received no treatments. However, the silver-cerium-chitosan nanocomposite is more potent than silver-chitosan group and control group in wound closure. The wound healing effects of silver-cerium-chitosan nanocomposite are due to unique features of its three components and this nanocomposite promises impressive remedies for clinical application.
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Affiliation(s)
- Ali Es-Haghi
- Department of Biology, Mashhad Branch, Islamic Azad University, Mashhad, Iran.
| | - Mohammad Mashreghi
- Nanotechnology Research Center, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahere Rezazade Bazaz
- Division of Biotechnology, Faculty of Veterinary Medicine, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Masoud Homayouni-Tabrizi
- Department of Biochemistry and Biophysics, Mashhad Branch, Islamic Azad University, Mashhad, Iran
| | - Majid Darroudi
- Nuclear Medicine Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Cheng B, Tian J, Peng Y, Fu X. Iatrogenic wounds: a common but often overlooked problem. BURNS & TRAUMA 2019; 7:18. [PMID: 31165077 PMCID: PMC6544969 DOI: 10.1186/s41038-019-0155-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 04/09/2019] [Indexed: 01/06/2023]
Abstract
Iatrogenic wounds are a common but often overlooked concept. They can lead to increases in hospital stays, therapy costs, repeat surgeries, and implant removal. If not handled properly, these wounds have a very poor prognosis and will cause serious physical and psychological harm to patients, which may result in medicolegal disputes. In recent years, the incidence of iatrogenic wounds has increased because of (1) an increase in the population of older people owing to increased life expectancy, (2) the continued expansion of surgical indications, (3) an increase in difficult surgeries, and (4) the constant emergence and application of new implantable biomaterials and other therapies. Thus, there is a pressing clinical need to improve the therapy of iatrogenic wounds. However, the difficulty in treating these wounds is considerable due to the emergence of drug-resistant bacteria, the high number of patients with metabolic diseases, and complex complications in patients. In particular, iatrogenic wounds caused by surgical site infections due to implantable biomaterials could lead to material leakage and conflicts regarding whether to retain or remove the implants. This review provides a definition of iatrogenic wounds, describes their characteristics, classifies them, and provides information about the importance of analyzing iatrogenic wounds. We hope that this review will provide useful information for the diagnosis and treatment of iatrogenic wounds and help to reduce their incidence in the future.
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Affiliation(s)
- Biao Cheng
- Department of Plastic Surgery, General Hospital of Southern Theater Command of PLA, 111 Liuhua Road, Guangzhou, 510010 Guangdong People's Republic of China.,Department of Plastic Surgery and the Key Laboratory of Trauma Treatment and Tissue Repair of Tropical Area, PLA, Guangzhou, People's Republic of China
| | - Ju Tian
- Department of Plastic Surgery, General Hospital of Southern Theater Command of PLA, 111 Liuhua Road, Guangzhou, 510010 Guangdong People's Republic of China.,5Department of Plastic Surgery, Zhongshan City People's Hospital, Zhongshan, 528400 Guangdong People's Republic of China
| | - Yan Peng
- 3Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Pokulam, Hong Kong SAR People's Republic of China
| | - Xiaobing Fu
- 4Wound Healing Unit, The First Affiliated Hospital, General Hospital of PLA, 51 Fu Cheng Road, Beijing, 100048 People's Republic of China
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Ozer K, Colak O. Leucocyte- and platelet-rich fibrin as a rescue therapy for small-to-medium-sized complex wounds of the lower extremities. BURNS & TRAUMA 2019; 7:11. [PMID: 31080838 PMCID: PMC6501391 DOI: 10.1186/s41038-019-0149-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 03/20/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND Generally, advanced wound care resources are applied for complex wounds that pose a challenge to the medical and nursing teams. In this report, the use of leukocyte- and platelet-rich fibrin (L-PRF) is emphasized for complex wounds as an alternative, simple, inexpensive, time-saving process that does not require hospitalization and has a healing potential over that of bare soft tissue, including bone, tendon, and ligaments. The aim of this study is to extend the use of L-PRF in small-to-moderate-sized complex wounds of lower extremities in which L-PRF maintains the sensitive structures viable. METHODS Between January 2016 and December 2017, 17 small-to-moderate-sized complex wounds of lower extremities treated with L-PRF were recruited from the plastic and reconstructive surgery clinic in Aydin State Hospital, Turkey. The treatment was administered twice per week in the outpatient clinic. Depending on the size and extension of the complex wound, two to five blood samples were collected into 8.5 ml dry, glass vacuum tubes with no anticoagulant, and samples were immediately centrifuged at 1630×g for 5 min to obtain L-PRF. Complete healing was defined as the day of complete wound epithelialization. RESULTS The median values of the initial wound size and wound duration were 12 cm2 (interquartile range, 6 to 23 cm2) and 8 months before first admission (interquartile range, 4 to 18 months), respectively. All wounds showed significant improvements after L-PRF therapy and full closure after a median of 18 months, with an interquartile range of 11 to 34 months of L-PRF applications. There were recurrences of wounds during the first 6 months after therapy. No adverse events were observed. CONCLUSIONS Our results add to the growing evidence that L-PRF treatments protect and maintain bare soft tissue structures viable, facilitate the formation of granulation tissue and epithelization, and remarkably reduce the need for additional soft tissue surgeries in small-to-medium-sized complex wounds.
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Affiliation(s)
- Kadri Ozer
- Aydin State Hospital, Plastic, Reconstructive and Aesthetic Surgery Clinic, 09100 Aydin, Turkey
| | - Ozlem Colak
- Istanbul Okmeydani Training and Research Hospital, Plastic, Reconstructive and Aesthetic Surgery Clinic, 34384 Istanbul, Turkey
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Tian J, Cheng LHH, Cui X, Lei XX, Tang JB, Cheng B. Application of standardized platelet-rich plasma in elderly patients with complex wounds. Wound Repair Regen 2019; 27:268-276. [PMID: 30693614 DOI: 10.1111/wrr.12702] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 01/16/2019] [Accepted: 01/23/2019] [Indexed: 02/05/2023]
Abstract
In recent years, autologous platelet-rich plasma (PRP) derivatives have been used widely in the regeneration and repair of tissue, but a standard definition and preparation method for PRP are lacking. We developed a standardized method using platelet indices as quality-control indicators for PRP preparation. Twenty-one elderly patients (9 males, 12 females) with complex wounds were treated with standardized platelet-rich plasma (S-PRP). The platelet count in PRP after the second centrifugation was 1,069-1,436 × 109 /L. We adjusted the platelet concentration in PRP after a second centrifugation to 1,000 × 109 /L according to a formula using platelet-poor plasma (PPP). The standardized preparation method that we developed gave S-PRP with a relatively uniform platelet concentration. The wounds of 21 patients showed accelerated healing after S-PRP treatment, and there were no obvious side effects during treatment. These data suggest that our preparation method of S-PRP, using platelet indices as quality-control indicators with platelet count of 1,000 × 109 /L could be used for the treatment of complex wounds in the elderly. The preparation method of S-PRP proposed in the present study may be a simple and effective method of PRP quality control.
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Affiliation(s)
- Ju Tian
- Department of Plastic Surgery, People's Hospital of Zhongshan City, Zhongshan, Guangdong, China
- Department of Plastic Surgery, General Hospital of Southern Theater Command, PLA, Guangzhou, Guangdong, China
- The Key Laboratory of Trauma Treatment and Tissue Repair of Tropical Area, PLA, Guangzhou, Guangdong, China
| | - Liu-Hang-Hang Cheng
- Graduate School, Shantou University Medical College, Shantou, Guangdong, China
| | - Xiao Cui
- Department of Plastic Surgery, General Hospital of Southern Theater Command, PLA, Guangzhou, Guangdong, China
- The Key Laboratory of Trauma Treatment and Tissue Repair of Tropical Area, PLA, Guangzhou, Guangdong, China
- Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China
| | - Xiao-Xuan Lei
- Department of Plastic Surgery, General Hospital of Southern Theater Command, PLA, Guangzhou, Guangdong, China
- The Key Laboratory of Trauma Treatment and Tissue Repair of Tropical Area, PLA, Guangzhou, Guangdong, China
| | - Jian-Bing Tang
- Department of Plastic Surgery, General Hospital of Southern Theater Command, PLA, Guangzhou, Guangdong, China
| | - Biao Cheng
- Department of Plastic Surgery, General Hospital of Southern Theater Command, PLA, Guangzhou, Guangdong, China
- The Key Laboratory of Trauma Treatment and Tissue Repair of Tropical Area, PLA, Guangzhou, Guangdong, China
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Dhasmana A, Singh L, Roy P, Mishra NC. Silk fibroin protein modified acellular dermal matrix for tissue repairing and regeneration. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2019; 97:313-324. [DOI: 10.1016/j.msec.2018.12.038] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 11/13/2018] [Accepted: 12/11/2018] [Indexed: 01/01/2023]
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Krishnan K A, Thomas S. Recent advances on herb-derived constituents-incorporated wound-dressing materials: A review. POLYM ADVAN TECHNOL 2019. [DOI: 10.1002/pat.4540] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Asha Krishnan K
- International and Inter University Centre for Nanoscience and Nanotechnology; Mahatma Gandhi University; Kottayam India
| | - Sabu Thomas
- International and Inter University Centre for Nanoscience and Nanotechnology; Mahatma Gandhi University; Kottayam India
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Tian Y, Liu T, Zhao CQ, Lei ZY, Fan DL, Mao TC. Negative pressure wound therapy and split thickness skin graft aided in the healing of extensive perineum necrotizing fasciitis without faecal diversion: a case report. BMC Surg 2018; 18:77. [PMID: 30249225 PMCID: PMC6154412 DOI: 10.1186/s12893-018-0411-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 09/17/2018] [Indexed: 01/10/2023] Open
Abstract
Background Perineum necrotizing fasciitis, also known as Fournier gangrene (FG), is a rare but highly mortal infectious necrotizing fasciitis with or without involvement of the underlying muscle. Evidence exists that negative pressure wound therapy (NPWT) combined with a split thickness skin graft (STSG) can help to heal wounds with FG. However, when the wound spreads to the anal area, it can easily be contaminated by faeces, causing a more extensive wounds; thus, faecal diversion is considered. Here, we report a case of extensive perineum necrotizing fasciitis that spread to near the anus; NPWT combined with STSGs was used to help heal the wound without faecal diversion. Case presentation A 47-year-old male patient was admitted with extensive perineum fascia necrosis caused by Pseudomonas aeruginosa that rapidly spread to near the anus. After comprehensive therapy completed wound bed preparation, STSGs from the scalp were grafted to the wound, and NPWT was applied to improve STSGs survival and seal the anus without faecal diversion. After treatment, graft take was 95%, and the exposed testicular and residual wounds were repaired with a local skin flap. At discharge, the wound had decreased to two pea-sized areas. The patient received conventional moist gauze therapy to close the residual wound at the local hospital. A follow-up by telephone 1 month later showed that both wounds had healed and that the patient was satisfied with the outcome. Conclusion NPWT use combined with STSGs to cover the whole wound and the anus without faecal diversion is a safe and effective method to help with wound healing and avoid contamination with excrement.
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Affiliation(s)
- Yuan Tian
- Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, Army Medical University, Xinqiao Road, Sha Ping Ba District, Chongqing, 400037, People's Republic of China
| | - Ting Liu
- Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, Army Medical University, Xinqiao Road, Sha Ping Ba District, Chongqing, 400037, People's Republic of China
| | - Chuan-Qi Zhao
- Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, Army Medical University, Xinqiao Road, Sha Ping Ba District, Chongqing, 400037, People's Republic of China
| | - Ze-Yuan Lei
- Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, Army Medical University, Xinqiao Road, Sha Ping Ba District, Chongqing, 400037, People's Republic of China
| | - Dong-Li Fan
- Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, Army Medical University, Xinqiao Road, Sha Ping Ba District, Chongqing, 400037, People's Republic of China
| | - Tong-Chun Mao
- Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, Army Medical University, Xinqiao Road, Sha Ping Ba District, Chongqing, 400037, People's Republic of China.
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Lima RVKS, Coltro PS, Farina JA. Negative pressure therapy for the treatment of complex wounds. Rev Col Bras Cir 2018; 44:81-93. [PMID: 28489215 DOI: 10.1590/0100-69912017001001] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 12/01/2016] [Indexed: 01/05/2023] Open
Abstract
The objective of this study is to evaluate the effectiveness of negative pressure therapy (NPT) in the treatment of complex wounds, with emphasis on its mechanisms of action and main therapeutic indications. We searched the Pubmed / Medline database for articles published from 1997 to 2016, and selected the most relevant ones. The mechanisms of action of NPT involveboth physical effects, such as increased perfusion, control of edema and exudate, reduction of wound dimensions and bacterial clearance, and biological ones, such as the stimulation of granulation tissue formation, microdeformations and reduction of Inflammatory response. The main indications of NPT are complex wounds, such as pressure ulcers, traumatic wounds, operative wound dehiscences, burns, necrotizing wounds, venous ulcers, diabetic wounds, skin grafts, open abdomen, prevention of complications in closed incisions and in the association with instillation of solutions in infected wounds.
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Affiliation(s)
| | - Pedro Soler Coltro
- - Ribeirao Preto Medical School, University of Sao Paulo, Division of Plastic Surgery, Ribeirao Preto, Sao Paulo State, Brazil
| | - Jayme Adriano Farina
- - Ribeirao Preto Medical School, University of Sao Paulo, Division of Plastic Surgery, Ribeirao Preto, Sao Paulo State, Brazil
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50
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Scientific and Clinical Abstracts From the WOCN® Society's 50th Annual Conference. J Wound Ostomy Continence Nurs 2018. [DOI: 10.1097/won.0000000000000432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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