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van den Brand CS, van der Steen LPE, Boekema B, Paauw NJ, Ulrich MMW, Middelkoop E, Beelen RHJ, Richters CD. Silver Sulfadiazine Cream Treatment Results in More Wound Contraction and More Itch in a Standardized Porcine Scald Model. J Burn Care Res 2021; 42:1017-1022. [PMID: 33528565 DOI: 10.1093/jbcr/irab028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
A variety of dressings is available for the treatment of partial-thickness wounds, but none has strong evidence supporting their beneficial effect on healing. This may be due to variation in the type and depth of wounds in clinical studies. The aim of this study was to use a standardized porcine wound model to compare three dressings commonly used in burn centers for partial-thickness burns. Partial-thickness scalds were made on the flanks of pigs. Wounds were treated with silver sulfadiazine (SSD, flammazine), a hydrofiber dressing, or glycerol-preserved allogeneic (pig) skin. The healing process was monitored for 8 weeks. Macroscopic parameters were the itching behavior, the cosmetic appearance of the scars, and contraction. Microscopic parameters were the inflammatory response, myofibroblast influx, and the numbers of nerves. All wounds were closed on day 14 and wound infection did not occur. Treatment with SSD resulted in significantly more wound contraction compared to treatment with glycerol-preserved pig skin. Animals treated with SSD suffered more from itching (scratching) during the first 2 weeks after wounding. The number of nerves in healing wounds of these animals was significantly higher compared to wounds treated with hydrofiber dressing or allogeneic skin. In our standardized porcine partial-thickness wound model, treatment with SSD resulted in less favorable wound healing. Compared to treatment with glycerol-preserved allogeneic skin, SSD resulted in more contraction.
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Affiliation(s)
- Carlien S van den Brand
- Department of Molecular Cell Biology & Immunology, VUMC, Amsterdam, The Netherlands.,Association of Dutch Burn Centres, Beverwijk, The Netherlands
| | | | - Bouke Boekema
- Association of Dutch Burn Centres, Beverwijk, The Netherlands
| | - Nanne J Paauw
- Department of Molecular Cell Biology & Immunology, VUMC, Amsterdam, The Netherlands
| | - Magda M W Ulrich
- Department of Molecular Cell Biology & Immunology, VUMC, Amsterdam, The Netherlands.,Association of Dutch Burn Centres, Beverwijk, The Netherlands
| | | | - Robert H J Beelen
- Department of Molecular Cell Biology & Immunology, VUMC, Amsterdam, The Netherlands
| | - Cornelia D Richters
- Department of Molecular Cell Biology & Immunology, VUMC, Amsterdam, The Netherlands.,Association of Dutch Burn Centres, Beverwijk, The Netherlands
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Boekema B, Stoop M, Vlig M, van Liempt J, Sobota A, Ulrich M, Middelkoop E. Antibacterial and safety tests of a flexible cold atmospheric plasma device for the stimulation of wound healing. Appl Microbiol Biotechnol 2021; 105:2057-2070. [PMID: 33587156 PMCID: PMC7906937 DOI: 10.1007/s00253-021-11166-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/25/2021] [Accepted: 02/03/2021] [Indexed: 12/14/2022]
Abstract
Cold atmospheric plasma (CAP) devices generate an ionized gas with highly reactive species and electric fields at ambient air pressure and temperature. A flexible dielectric barrier discharge (DBD) was developed as an alternative antimicrobial treatment for chronic wounds. Treatment of Staphylococcus aureus in collagen-elastin matrices with CAP for 2 min resulted in a 4 log reduction. CAP treatment was less effective on S. aureus on dermal samples. CAP did not affect cellular activity or DNA integrity of human dermal samples when used for up to 2 min. Repeated daily CAP treatments for 2 min lowered cellular activity of dermal samples to 80% after 2 to 4 days, but this was not significant. Repeated treatment of ex vivo human burn wound models with CAP for 2 min did not affect re-epithelialization. Intact skin of 25 healthy volunteers was treated with CAP for 3× 20" to determine safety. Although participants reported moderate pain scores (numerical rating scale 3.3), all volunteers considered the procedure to be acceptable. Severe adverse events did not occur. CAP treatment resulted in a temporarily increased local skin temperature (≈3.4°C) and increased erythema. Lowering the plasma power resulted in a significantly lower erythema increase. Good log reduction (2.9) of bacterial load was reached in 14/15 volunteers artificially contaminated with Pseudomonas aeruginosa. This study demonstrated the in vitro and in vivo safety and efficacy in bacterial reduction of a flexible cold plasma device. Trial registration number NCT03007264, January 2, 2017 KEY POINTS: • CAP strongly reduced bacterial numbers both in vitro and in vivo. • Re-epithelialization of burn wound models was not affected by repeated CAP. • CAP treatment of intact skin was well tolerated in volunteers.
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Affiliation(s)
- Bouke Boekema
- Association of Dutch Burn Centres, Zeestraat 29, 1941 AJ, Beverwijk, The Netherlands.
| | - Matthea Stoop
- Burn Center, Red Cross Hospital, Beverwijk, The Netherlands
| | - Marcel Vlig
- Association of Dutch Burn Centres, Zeestraat 29, 1941 AJ, Beverwijk, The Netherlands
| | - Jos van Liempt
- Department of Applied Physics, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Ana Sobota
- Department of Applied Physics, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Magda Ulrich
- Association of Dutch Burn Centres, Zeestraat 29, 1941 AJ, Beverwijk, The Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Department of Pathology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Esther Middelkoop
- Association of Dutch Burn Centres, Zeestraat 29, 1941 AJ, Beverwijk, The Netherlands.,Burn Center, Red Cross Hospital, Beverwijk, The Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Wessing B, Boekema B, Gonzalez O. Soft tissue augmentation with a collagen‐based 3D matrix with directed pore channels. Clin Oral Implants Res 2019. [DOI: 10.1111/clr.357_13509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Bouke Boekema
- Preclinical Research, Association of Dutch Burn Centres, Netherlands
| | - Oscar Gonzalez
- Section of Post-graduate Periodontology, Faculty of Odontology, University Complutense of Madrid, Spain
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Boekema B, Ulrich MM, Middelkoop E. Models for cutaneous wound healing. Wound Repair Regen 2017; 25:347-348. [DOI: 10.1111/wrr.12545] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 04/28/2017] [Indexed: 12/30/2022]
Affiliation(s)
- Bouke Boekema
- Research, Association of Dutch Burn Centers (ADBC), Beverwijk; the Netherlands
| | - Magda M.W. Ulrich
- Research, Association of Dutch Burn Centers (ADBC), Beverwijk; the Netherlands
- Department of Molecular Cell Biology and Immunology; VU University Medical Center, Amsterdam; the Netherlands
| | - Esther Middelkoop
- Research, Association of Dutch Burn Centers (ADBC), Beverwijk; the Netherlands
- Department of Molecular Cell Biology and Immunology; VU University Medical Center, Amsterdam; the Netherlands
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