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Galiano R, Snyder R, Mayer P, Rogers LC, Alvarez O. Focused shockwave therapy in diabetic foot ulcers: secondary endpoints of two multicentre randomised controlled trials. J Wound Care 2019; 28:383-395. [PMID: 31166864 DOI: 10.12968/jowc.2019.28.6.383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The objective of this paper is to present the secondary safety and efficacy outcomes from two studies of focused extracorporeal shockwave therapy (ESWT) used adjunctively with standard care in the treatment of neuropathic diabetic foot ulcers (DFU) (1A or 2A on the University of Texas grading scheme), compared with sham treatment and standard care. METHOD We carried out two multicentre, multinational, randomised, sham-controlled, double-blinded, phase III clinical studies using standard care with adjunctive focused ESWT compared with sham treatment and standard care in patients with a DFU. DFUs that did not reduce in volume by at least 50% over two weeks' standard treatment were included. DFUs were randomised and managed with standard care and focused ESWT (pulsed acoustic cellular expression; dermaPACE System, SANUWAVE Health, Inc.) active therapy, or with standard care and sham treatment, four times over a two-week treatment phase in study 1 and up to eight times over 12 weeks in study 2. Standard care continued in both studies throughout the 12-week treatment phase. Secondary outcomes were indicators of wound closure and progression, pain, infection, amputation and recurrence, and device reliability. Efficacy-related secondary endpoints were measured at 12, 20 and 24 weeks. The studies were analysed separately and following statistical comparison to justify the method, as a pooled data set. RESULTS Wound area reduction (48.6% versus 10.7%, p=0.015, intention to treat (ITT) population with last observation carried forward (LOCF)) and perimeter reduction (46.4% versus 25.0%, p=0.022, ITT population with LOCF) were significantly greater in the active therapy group compared with the sham-treated group, respectively. The difference in time to wound closure in the pooled ITT population was significantly in favour of the active therapy group (84 days versus 112 days for 25% of subjects to reach wound closure in the active and sham-treated groups, respectively; p=0.0346). The proportion of subjects who achieved wound area reduction (WAR) from baseline at week 12 of ≥90% was significantly higher in the active therapy group. The incidence and nature of infection were consistent with previously published studies, and pain was not increased in the active therapy group. Amputation was insignificantly higher in the sham-treated group and recurrence did not differ. The ESWT device was found to be reliable. CONCLUSION The outcomes for the primary and secondary endpoints from these studies show that ESWT administered adjunctively with standard care is an effective advanced therapy for neuropathic DFUs (grade 1A and 2A) that do not respond to two weeks' standard care alone by reducing wound volume by at least 50%.
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Affiliation(s)
- Robert Galiano
- Northwestern University, Feinberg School of Medicine, Chicago, IL, US
| | | | - Perry Mayer
- The Mayer Institute, Hamilton, Ontario, Canada
| | - Lee C Rogers
- Medical Director of Amputation Prevention Centers of America
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Baltazar T, Merola J, Catarino C, Xie CB, Kirkiles-Smith NC, Lee V, Hotta S, Dai G, Xu X, Ferreira FC, Saltzman WM, Pober JS, Karande P. Three Dimensional Bioprinting of a Vascularized and Perfusable Skin Graft Using Human Keratinocytes, Fibroblasts, Pericytes, and Endothelial Cells. Tissue Eng Part A 2019; 26:227-238. [PMID: 31672103 DOI: 10.1089/ten.tea.2019.0201] [Citation(s) in RCA: 137] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Multilayered skin substitutes comprising allogeneic cells have been tested for the treatment of nonhealing cutaneous ulcers. However, such nonnative skin grafts fail to permanently engraft because they lack dermal vascular networks important for integration with the host tissue. In this study, we describe the fabrication of an implantable multilayered vascularized bioengineered skin graft using 3D bioprinting. The graft is formed using one bioink containing human foreskin dermal fibroblasts (FBs), human endothelial cells (ECs) derived from cord blood human endothelial colony-forming cells (HECFCs), and human placental pericytes (PCs) suspended in rat tail type I collagen to form a dermis followed by printing with a second bioink containing human foreskin keratinocytes (KCs) to form an epidermis. In vitro, KCs replicate and mature to form a multilayered barrier, while the ECs and PCs self-assemble into interconnected microvascular networks. The PCs in the dermal bioink associate with EC-lined vascular structures and appear to improve KC maturation. When these 3D printed grafts are implanted on the dorsum of immunodeficient mice, the human EC-lined structures inosculate with mouse microvessels arising from the wound bed and become perfused within 4 weeks after implantation. The presence of PCs in the printed dermis enhances the invasion of the graft by host microvessels and the formation of an epidermal rete. Impact Statement Three Dimensional printing can be used to generate multilayered vascularized human skin grafts that can potentially overcome the limitations of graft survival observed in current avascular skin substitutes. Inclusion of human pericytes in the dermal bioink appears to improve both dermal and epidermal maturation.
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Affiliation(s)
- Tânia Baltazar
- Department of Immunobiology, Yale School of Medicine, New Haven, Connecticut
| | - Jonathan Merola
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Carolina Catarino
- Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, Troy, New York.,Howard P. Isermann Department of Chemical and Biological Engineering, Rensselaer Polytechnic Institute, Troy, New York
| | - Catherine B Xie
- Department of Immunobiology, Yale School of Medicine, New Haven, Connecticut
| | | | - Vivian Lee
- Department of Bioengineering, Northeastern University, Boston, Massachusetts
| | - Stephanie Hotta
- Department of Biochemistry and Molecular Biology, University of Southern Denmark, Odense, Denmark
| | - Guohao Dai
- Department of Bioengineering, Northeastern University, Boston, Massachusetts
| | - Xiaowei Xu
- Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Frederico C Ferreira
- Department of Bioengineering and Institute of Bioengineering and Biosciences, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - W Mark Saltzman
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut
| | - Jordan S Pober
- Department of Immunobiology, Yale School of Medicine, New Haven, Connecticut
| | - Pankaj Karande
- Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, Troy, New York.,Howard P. Isermann Department of Chemical and Biological Engineering, Rensselaer Polytechnic Institute, Troy, New York
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Hassanin AM, Abdel-Hamid AZ. Cavernous smooth muscles: innovative potential therapies are promising for an unrevealed clinical diagnosis. Int Urol Nephrol 2019; 52:205-217. [DOI: 10.1007/s11255-019-02309-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 10/03/2019] [Indexed: 12/16/2022]
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Liang X, Zhou L, Yan J. Amniotic membrane for treating skin graft donor sites: A systematic review and meta-analysis. Burns 2019; 46:621-629. [PMID: 31623939 DOI: 10.1016/j.burns.2019.09.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 08/30/2019] [Accepted: 09/20/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of amniotic membrane (AM) for the healing of split-thickness skin graft donor sites (STSGDS). METHOD Electronic search of PubMed, Cochrane library and EMBASE for randomized controlled trials (RCTs) or non-randomized clinical trials (NRCTs) of AM therapy in STSGDS. Review Manager5.3 was utilized to analyze and present the data. RESULTS Seven studies with 219 patients were included. Compared with other treatments, the mean difference (MD) in healing time was -3.87 days (95% CI -4.39, -3.35; P < 0.00001); Relative risk for the healing rate was 1.61 (95% CI 0.0.47-5.47; P = 0.44); There was no statistical difference in the sensation of pain (P > 0.05); The relative risk for infection rate was 0.66 (95% CI 0.29, 2.18; I2 = 0%; P = 0.65). CONCLUSION This systematic review and meta-analysis indicate that it is effective and safe to use AM for treating STSGDS.
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Affiliation(s)
- Xinglong Liang
- Department of Dermatology, Maoming People's Hospital, Maoming, Guangdong, China.
| | - Li Zhou
- Department of Surgery, Maoming People's Hospital, Maoming, Guangdong, China.
| | - Jun Yan
- Department of Dermatology, Maoming People's Hospital, Maoming, Guangdong, China.
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Russell D, Atkin L, Betts A, Dowsett C, Fatoye F, Gardner S, Green J, Manu C, McKenzie T, Meally H, Mitchell L, Mullings J, Odeyemi I, Sharpe A, Yeowell G, Devlin N. Using a modified Delphi methodology to gain consensus on the use of dressings in chronic wounds management. J Wound Care 2019; 27:156-165. [PMID: 29509111 DOI: 10.12968/jowc.2018.27.3.156] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Managing chronic wounds is associated with a burden to patients, caregivers, health services and society and there is a lack of clarity regarding the role of dressings in improving outcomes. This study aimed to provide understanding on a range of topics, including: the definition of chronicity in wounds, the burden of illness, clinical outcomes of reducing healing time and the impact of early interventions on clinical and economic outcomes and the role of matrix metalloproteinases (MMPs) in wound healing. METHOD A systematic review of the literature was carried out on the role of dressings in diabetic foot ulcer (DFU), and venous leg ulcer (VLU) management strategies, their effectiveness, associated resource use/cost, and quality of life (QoL) impact on patients. From this evidence-base statements were written regarding chronicity in wounds, burden of illness, healing time, and the role of MMPs, early interventions and dressings. A modified Delphi methodology involving two iterations of email questionnaires followed by a face-to-face meeting was used to validate the statements, in order to arrive at a consensus for each. Clinical experts were selected, representing nurses, surgeons, podiatrists, academics, and policy experts. RESULTS In the first round, 38/47 statements reached or exceeded the consensus threshold of 80% and none were rejected. According to the protocol, any statement not confirmed or rejected had to be modified using the comments from participants and resubmitted. In the second round, 5/9 remaining statements were confirmed and none rejected, leaving 4 to discuss at the meeting. All final statements were confirmed with at least 80% consensus. CONCLUSION This modified Delphi panel sought to gain clarity from clinical experts surrounding the use of dressings in the management of chronic wounds. A full consensus statement was developed to help clinicians and policy makers improve the management of patients with these conditions.
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Affiliation(s)
- David Russell
- Consultant Vascular Surgeon and Honorary Clinical Associate Professor, Leeds Teaching Hospitals NHS Trust
| | - Leanne Atkin
- Vascular Nurse Specialist, Mid Yorkshire Hospitals NHS Trust
| | - April Betts
- Health Technology Assessment Project Manager, Manchester Metropolitan University
| | - Caroline Dowsett
- Nurse Consultant Tissue Viability, East London NHS Foundation Trust, London
| | - Francis Fatoye
- Professor of Health Economics and Outcomes, Manchester Metropolitan University
| | - Sarah Gardner
- Clinical Lead, Tissue Viability, Oxford Health NHS Foundation Trust
| | - Julie Green
- Senior Lecturer in Nursing, Director of Postgraduate Programmes, Keele University, School of Nursing and Midwifery
| | - Chris Manu
- Consultant Diabetologist and Clinical Researcher in Diabetic Foot, King's College Hospital, London
| | - Tracey McKenzie
- Head of Tissue Viability Services, Torbay and Southern Devon NHS Foundation Trust
| | - Helena Meally
- Hospital Podiatrist, Leeds Teaching Hospitals NHS Trust
| | | | - Julie Mullings
- Lead Tissue Viability Nurse, University Hospital of South Manchester, NHS Foundation Trust
| | - Isaac Odeyemi
- Visiting Professor of Health Technology Assessment and Health Policy, Manchester Metropolitan University
| | - Andrew Sharpe
- Advanced Podiatrist and Lecturer Practitioner, West Lancashire Community Service, Virgin Care and University of Huddersfield
| | - Gillian Yeowell
- MSc Advanced Physiotherapy Programme Leader, Manchester Metropolitan University
| | - Nancy Devlin
- Director of Research, Professor, Office of Health Economics, Victoria Street, London
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Samsell B, McLean J, Cazzell S, Dorsch K, Moyer PM, Moore M. Health economics for treatment of diabetic foot ulcers: a cost-effectiveness analysis of eight skin substitutes. J Wound Care 2019; 28:S14-S26. [DOI: 10.12968/jowc.2019.28.sup9.s14] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Aim: Skin substitutes are frequently used to treat chronic diabetic foot ulcers (DFU), and many different options are available. While the clinical efficacy of many products has been evaluated, a comprehensive cost-effectiveness analysis comparing the most popular skin substitutes and using the most recent cost data has been lacking. Methods: This study compared eight skin substitutes using published efficacy rates combined with the Centers for Medicare and Medicaid Services (CMS) 2018 cost data. The study criteria resulted in the inclusion of seven studies that described efficacy rates for treatment of DFUs using the skin substitutes. Results: The results revealed wide discrepancies between these skin substitutes for the costs of treatments and healing rates in hospital outpatient departments and physician office settings. Healing rates for 12 and 16 weeks ranged from 28% to 68%, while the average cost for treating one DFU varied from $2001 to $14,507 and $1207 to $8791 in the hospital outpatient department and physician's office setting, respectively. The estimated patient share of costs for treating a single DFU ranged from $400 to $2901 and $241 to $1758 in the hospital outpatient department and physician's office setting, respectively. Most importantly, the estimated number of wounds healed out of 100 DFUs per $1000 expenditure with each patient ranged from 3.9–26.5 DFUs in the hospital outpatient department, and 4.3–36.4 DFUs in the physicians' office setting. Conclusions: This study revealed that the costs of a skin substitute itself did not necessarily correlate with its healing efficacy. These results provide a comprehensive cost-effectiveness analysis to enable integrated health-care systems, health professionals and reimbursement payers to make informed value decisions when treating DFUs.
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Affiliation(s)
- Brian Samsell
- RTI Health Solutions, Research Triangle Park, NC, US
| | | | - Shawn Cazzell
- Limb Preservation Platform, Valley Vascular Surgical Associates, Fresno, CA, US
| | | | | | - Mark Moore
- RTI Health Solutions, Research Triangle Park, NC, US
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Placental Membrane Provides Improved Healing Efficacy and Lower Cost Versus a Tissue-Engineered Human Skin in the Treatment of Diabetic Foot Ulcerations. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2371. [PMID: 31592387 PMCID: PMC6756673 DOI: 10.1097/gox.0000000000002371] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 06/07/2019] [Indexed: 01/03/2023]
Abstract
Supplemental Digital Content is available in the text. Aseptically processed dehydrated human amnion and chorion allograft (dHACA) (AmnioBand) has shown great promise in the treatment of recalcitrant diabetic foot ulcers (DFUs) when compared with standard wound care but has not yet been compared to any other tissue forms used in treating DFUs. The hypothesis was to conduct a randomized controlled trial in which dHACA was compared to one of the earliest and most commonly accepted tissue-engineered skin substitutes (TESS) (Apligraf) in the treatment of nonhealing DFUs over a period of 12 weeks to assess the superiority of healing.
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Fowler AW, Gilbertie JM, Watson VE, Prange T, Osborne JA, Schnabel LV. Effects of acellular equine amniotic allografts on the healing of experimentally induced full-thickness distal limb wounds in horses. Vet Surg 2019; 48:1416-1428. [PMID: 31385329 DOI: 10.1111/vsu.13304] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 07/01/2019] [Accepted: 07/17/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To characterize the growth factors contained in equine amniotic membrane allograft (eAM; StemWrap scaffold and StemWrap+ injection) and to evaluate the effect of eAM on equine distal limb wound healing. STUDY DESIGN Prospective experimental controlled study. SAMPLE POPULATION Eight adult horses. METHODS Transforming growth factor (TGF)-β1, vascular endothelial growth factor (VEGF), epidermal growth factor, platelet-derived growth factor-BB, and prostaglandin E2 (PGE2 ) concentrations in StemWrap+ were assessed with enzyme-linked immunosorbent assay. Two full-thickness 6.25-cm2 skin wounds were created on each metacarpus. On one forelimb, one wound was treated with eAM, and the other was left untreated (eAM control). On the contralateral limb, one wound was treated with a silicone dressing, and the other served as negative control. Three-dimensional images were obtained to determine wound circumference and surface area analyses at each bandage change until healed. Excessive granulation tissue was debrided once weekly for 4 weeks. Biopsy samples were taken to evaluate quality of wound healing via histologic and immunohistochemistry assays. RESULTS StemWrap+ contained moderate concentrations of TGF-β1 (494.10 pg/mL), VEGF (212.52 pg/mL), and PGE2 (1811.61 pg/mL). Treatment of wounds with eAM did not affect time to healing or histologic quality of the healing compared with other groups but was associated with increased granulation tissue production early in the study, particularly on day 7. CONCLUSION Application of eAM resulted in increased granulation tissue production while maintaining appropriate healing of experimental wounds. CLINICAL SIGNIFICANCE Use of eAM is likely most beneficial for substantial wounds in which expedient production of large amounts of granulation tissue is desirable.
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Affiliation(s)
- Alexander W Fowler
- Department of Clinical Sciences, North Carolina State University College of Veterinary Medicine, Raleigh, North Carolina
| | - Jessica M Gilbertie
- Department of Clinical Sciences, North Carolina State University College of Veterinary Medicine, Raleigh, North Carolina.,Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina
| | - Victoria E Watson
- Department of Pathobiology and Diagnostic Investigation, Michigan State University College of Veterinary Medicine, East Lansing, Michigan
| | - Timo Prange
- Department of Clinical Sciences, North Carolina State University College of Veterinary Medicine, Raleigh, North Carolina
| | - Jason A Osborne
- Department of Statistics, North Carolina State University, Raleigh, North Carolina
| | - Lauren V Schnabel
- Department of Clinical Sciences, North Carolina State University College of Veterinary Medicine, Raleigh, North Carolina.,Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina
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Comparing Human Amniotic Allograft and Standard Wound Care When Using Total Contact Casting in the Treatment of Patients with Diabetic Foot Ulcers. Adv Skin Wound Care 2019; 32:272-277. [DOI: 10.1097/01.asw.0000557831.78645.85] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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McCoy AM, Arrington J, Yau PM. Effect of Preparation Method on the Protein Profile of Equine Amnion Dressings. J Proteome Res 2019; 18:2676-2685. [PMID: 31117638 DOI: 10.1021/acs.jproteome.9b00240] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The protein content of amnion is thought to be the primary contributor to its efficacy as a biological dressing for wounds. Protein elution into antibiotic processing media has been reported, but the effect of antiseptic-based processing methods is unknown. Amniotic membranes were collected from eight healthy mares. Samples were collected after removal of gross debris. Tissues were subsequently divided and processed with either 0.05% chlorhexidine or 2% iodine/0.25% acetic acid. After protein extraction and trypsin digestion, the proteins were labeled with 8-plex iTRAQ tags, combined, and analyzed by high-resolution liquid chromatography-mass spectrometry. The MaxQuant-Perseus software suite was used to identify and quantify sample proteins, with functional annotation performed in PANTHER. There were 220 unique proteins identified, of which 144 were found in all individuals and across all conditions, several with a known role in wound healing. Contrary to expectations, processing did not significantly alter the protein content of the amnion tissue. Limitations include the small sample size and single time point. These results suggest that either processing method is acceptable for use in the preparation of equine amnion dressings. The role of expressed proteins in the biological activity of amnion dressings remains to be elucidated.
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Affiliation(s)
- Annette M McCoy
- Department of Veterinary Clinical Medicine , University of Illinois Urbana-Champaign , 1008 West Hazelwood Drive , Urbana , Illinois 61802 , United States
| | - Justine Arrington
- Protein Sciences Facility, Roy J. Carver Biotechnology Center , University of Illinois Urbana-Champaign , 505 South Matthews Avenue , Urbana , Illinois 61801 , United States
| | - Peter M Yau
- Protein Sciences Facility, Roy J. Carver Biotechnology Center , University of Illinois Urbana-Champaign , 505 South Matthews Avenue , Urbana , Illinois 61801 , United States
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Berhane CC, Brantley K, Williams S, Sutton E, Kappy C. An evaluation of dehydrated human amnion/chorion membrane allografts for pressure ulcer treatment: a case series. J Wound Care 2019; 28:S4-S10. [DOI: 10.12968/jowc.2019.28.sup5.s4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Objective: Pressure ulcers (PU; also known as pressure injuries) affect about three million adults in the US and cost an estimated $11 billion dollars annually to treat. Prevention is most desirable, however, once a patient develops a PU, the focus shifts to effective treatment and rapid closure to improve health outcomes. We sought to evaluate outcomes in 10 patients with category II and III PUs treated with dehydrated human amnion/chorion membrane (dHACM) allografts. Method: All patients were treated with weekly application of dHACM plus standard wound care (SoC) and followed for eight weeks. Results: Of the PUs, two were category II and eight were category III. The average PU size at dHACM initiation was 3.42±1.76cm2. After the first application of dHACM 7/10 (70%) of PUs responded to treatment with a reduction in wound size. Within two weeks of dHACM initiation into the plan of care, 4/10 (40%) of PUs had reduced in size by >50%. By week four, 60% of PUs (6/10) had reduced in size by >50%. Overall, during the eight week evaluation period, 9/10 PUs reduced in size, three of which healed completely. Conclusion: dHACM allografts appear to be a viable treatment option for category II and III PUs.
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Affiliation(s)
- Chi Chi Berhane
- Department of Reconstructive Surgery, Shepherd Center, Atlanta, GA, US
| | - Kimberly Brantley
- Department of Reconstructive Surgery, Shepherd Center, Atlanta, GA, US
| | - Sandra Williams
- Department of Reconstructive Surgery, Shepherd Center, Atlanta, GA, US
| | - Erica Sutton
- Department of Reconstructive Surgery, Shepherd Center, Atlanta, GA, US
| | - Carlyn Kappy
- Department of Reconstructive Surgery, Shepherd Center, Atlanta, GA, US
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Atkin L, Bućko Z, Montero EC, Cutting K, Moffatt C, Probst A, Romanelli M, Schultz GS, Tettelbach W. Implementing TIMERS: the race against hard-to-heal wounds. J Wound Care 2019; 23:S1-S50. [DOI: 10.12968/jowc.2019.28.sup3a.s1] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Leanne Atkin
- Vascular Nurse Consultant. Mid Yorkshire NHS Trust/University of Huddersfield, England
| | - Zofia Bućko
- Head of Non-Healing Wounds Department, Centrum Medycznym HCP, Poznań, Poland
| | - Elena Conde Montero
- Specialist in Dermatology. Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Keith Cutting
- Clinical Research Consultant, Hertfordshire, Honorary, Tissue Viability Specialist, First Community Health and Care, Surrey, England
| | - Christine Moffatt
- Professor of Clinical Nursing Research, University of Nottingham, and Nurse Consultant, Derby Hospitals NHS Foundation Trust Lymphoedema Service, England
| | - Astrid Probst
- Advanced Nurse Practitioner Wound Care, Klinikum am Steinenberg/Ermstalklinik, Reutlingen, Germany
| | - Marco Romanelli
- President WUWHS, Associate Professor of Dermatology, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Gregory S Schultz
- Researcher, Professor of Obstetrics and Gynaecology, University of Florida, Gainesville, Florida, US
| | - William Tettelbach
- Associate Chief Medical Officer, MiMedx, Georgia. Adjunct Assistant Professor, Duke University School of Medicine, Durham, North Carolina. Medical Director of Wound Care and Infection Prevention, Landmark Hospital, Salt Lake City, Utah, US
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Gould L, Li WW. Defining complete wound closure: Closing the gap in clinical trials and practice. Wound Repair Regen 2019; 27:201-224. [DOI: 10.1111/wrr.12707] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 02/11/2019] [Indexed: 12/26/2022]
Affiliation(s)
- Lisa Gould
- South Shore Hospital Center for Wound Healing Weymouth Massachusetts
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El Masry MS, Chaffee S, Das Ghatak P, Mathew-Steiner SS, Das A, Higuita-Castro N, Roy S, Anani RA, Sen CK. Stabilized collagen matrix dressing improves wound macrophage function and epithelialization. FASEB J 2019; 33:2144-2155. [PMID: 30260708 PMCID: PMC6338656 DOI: 10.1096/fj.201800352r] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 08/27/2018] [Indexed: 12/26/2022]
Abstract
Decellularized matrices of biologic tissue have performed well as wound care dressings. Extracellular matrix-based dressings are subject to rapid degradation by excessive protease activity at the wound environment. Stabilized, acellular, equine pericardial collagen matrix (sPCM) wound care dressing is flexible cross-linked proteolytic enzyme degradation resistant. sPCM was structurally characterized utilizing scanning electron and atomic force microscopy. In murine excisional wounds, sPCM was effective in mounting an acute inflammatory response. Postwound inflammation resolved rapidly, as indicated by elevated levels of IL-10, arginase-1, and VEGF, and lowering of IL-1β and TNF-α. sPCM induced antimicrobial proteins S100A9 and β-defensin-1 in keratinocytes. Adherence of Pseudomonas aeruginosa and Staphylococcus aureus on sPCM pre-exposed to host immune cells in vivo was inhibited. Excisional wounds dressed with sPCM showed complete closure at d 14, while control wounds remained open. sPCM accelerated wound re-epithelialization. sPCM not only accelerated wound closure but also improved the quality of healing by increased collagen deposition and maturation. Thus, sPCM is capable of presenting scaffold functionality during the course of wound healing. In addition to inducing endogenous antimicrobial defense systems, the dressing itself has properties that minimize biofilm formation. It mounts robust inflammation, a process that rapidly resolves, making way for wound healing to advance.-El Masry, M. S., Chaffee, S., Das Ghatak, P., Mathew-Steiner, S. S., Das, A., Higuita-Castro, N., Roy, S., Anani, R. A., Sen, C. K. Stabilized collagen matrix dressing improves wound macrophage function and epithelialization.
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Affiliation(s)
- Mohamed S. El Masry
- Department of Surgery, Indiana University Health (IUH) Comprehensive Wound Center, Indiana Center for Regenerative Medicine and Engineering, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Surgery, The Ohio State University, Wexner Medical Center, Columbus, Ohio, USA
- Department of Plastic and Reconstructive Surgery, Zagazig University, Zagazig, Egypt
| | - Scott Chaffee
- Department of Surgery, The Ohio State University, Wexner Medical Center, Columbus, Ohio, USA
| | - Piya Das Ghatak
- Department of Surgery, Indiana University Health (IUH) Comprehensive Wound Center, Indiana Center for Regenerative Medicine and Engineering, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Surgery, The Ohio State University, Wexner Medical Center, Columbus, Ohio, USA
| | - Shomita S. Mathew-Steiner
- Department of Surgery, Indiana University Health (IUH) Comprehensive Wound Center, Indiana Center for Regenerative Medicine and Engineering, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Surgery, The Ohio State University, Wexner Medical Center, Columbus, Ohio, USA
| | - Amitava Das
- Department of Surgery, Indiana University Health (IUH) Comprehensive Wound Center, Indiana Center for Regenerative Medicine and Engineering, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Surgery, The Ohio State University, Wexner Medical Center, Columbus, Ohio, USA
| | - Natalia Higuita-Castro
- Department of Surgery, The Ohio State University, Wexner Medical Center, Columbus, Ohio, USA
| | - Sashwati Roy
- Department of Surgery, Indiana University Health (IUH) Comprehensive Wound Center, Indiana Center for Regenerative Medicine and Engineering, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Surgery, The Ohio State University, Wexner Medical Center, Columbus, Ohio, USA
| | - Raafat A. Anani
- Department of Plastic and Reconstructive Surgery, Zagazig University, Zagazig, Egypt
| | - Chandan K. Sen
- Department of Surgery, Indiana University Health (IUH) Comprehensive Wound Center, Indiana Center for Regenerative Medicine and Engineering, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Surgery, The Ohio State University, Wexner Medical Center, Columbus, Ohio, USA
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66
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Luck J, Rodi T, Geierlehner A, Mosahebi A. Allogeneic Skin Substitutes Versus Human Placental Membrane Products in the Management of Diabetic Foot Ulcers: A Narrative Comparative Evaluation of the Literature. INT J LOW EXTR WOUND 2019; 18:10-22. [DOI: 10.1177/1534734618818301] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Outcomes following standard wound care (SWC) for diabetic foot ulcers (DFUs) remain suboptimal. Supplementing SWC with tissue engineered allogeneic cellular wound therapies represents an emerging treatment strategy. This review aimed to evaluate the efficacy and safety of allogeneic skin substitutes and human placental membrane allografts in the management of DFUs. Ovid MEDLINE and Embase databases were searched from inception to October 2017. Any randomized controlled trial (RCT) with an allogeneic skin substitute or placental membrane allograft intervention group was included. Our primary outcome measure was the proportion of completely healed ulcers. Secondary outcome measures included time to complete wound healing and local adverse event rates. Each study was assessed for risk of bias and the quality of evidence was appraised using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Moderate quality evidence from 11 included RCTs demonstrated that both allogeneic cellular approaches improve the proportion of completely healed ulcers at 6 and 12 weeks. One RCT showed that a placental membrane allograft was superior to an allogeneic skin substitute, although this has yet to be repeated in other studies. The addition of allogeneic cellular wound products to SWC improves DFU outcomes. Further studies are required to conclusively establish if placental membrane allografts are superior to allogeneic skin substitutes.
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Affiliation(s)
| | - Timo Rodi
- Royal Free Hospital, Hampstead, London, UK
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67
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Bemenderfer TB, Anderson RB, Odum SM, Davis WH. Effects of Cryopreserved Amniotic Membrane-Umbilical Cord Allograft on Total Ankle Arthroplasty Wound Healing. J Foot Ankle Surg 2019; 58:97-102. [PMID: 30583786 DOI: 10.1053/j.jfas.2018.08.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Indexed: 02/03/2023]
Abstract
Relatively high rates of wound healing complications continue to be reported with a total ankle arthroplasty (TAA) anterior incision. The amniotic membrane-umbilical cord (AM-UC) allograft is a regenerative orthobiologic adjunct that modulates wound healing by down-regulating inflammation, enhancing local healing and antimicrobial factors, and reducing scar formation. The purpose of this study was to determine whether local application of a cryopreserved AM-UC allograft enhances soft tissue healing after TAA. A total of 104 patients with symptomatic ankle arthritis who failed conservative management underwent standard TAA. At skin closure, patients were allocated to either the treatment (local application of AM-UC) or control (no allograft) group. Demographic data, patient comorbidities, and radiographic findings were collected. The primary outcome was a major complication necessitating reoperation. Secondary outcomes were time to healing, minor complications (i.e., skin dehiscence, local wound care, use of antibiotics), and patient scar assessment. Local application of an AM-UC allograft significantly decreased the overall time to skin healing (28.5 days vs 40 days; p = .03). Two patients required a reoperation for soft tissue wound complications, with no difference (p = 1.00) between the groups. No statistically significant difference was detected in terms of skin dehiscence, local wound care, or antibiotic prescriptions in the 2 groups. Regenerative technology using local application of a cryopreserved AM-UC allograft may enhance TAA outcomes by decreasing the time to healing. Larger randomized controlled trials are needed to determine whether an AM-UC allograft enhances soft tissue wound healing and ultimately reduces the incidence of devastating soft tissue complications.
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Affiliation(s)
- Thomas B Bemenderfer
- Resident Physician, Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, NC.
| | | | - Susan M Odum
- Senior Research Scientist, OrthoCarolina Research Institute, Charlotte, NC
| | - W Hodges Davis
- Surgeon, OrthoCarolina Foot & Ankle Institute, Charlotte, NC
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68
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McCoy AM, Smith RL, Secor EJ, Roady PJ. Effects of 2 preparation methods and long-term storage on structural integrity and bacterial loads of equine amnion. Vet Surg 2018; 48:222-228. [DOI: 10.1111/vsu.13138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 10/11/2018] [Accepted: 11/03/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Annette M. McCoy
- Department of Veterinary Clinical Medicine; University of Illinois; Urbana Illinois
| | - Rebecca L. Smith
- Department of Pathobiology; University of Illinois; Urbana Illinois
| | - Erica J. Secor
- Department of Veterinary Clinical Medicine; University of Illinois; Urbana Illinois
| | - Patrick J. Roady
- Department of Veterinary Clinical Medicine; University of Illinois; Urbana Illinois
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69
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Braunberger TL, Fatima S, Vellaichamy G, Nahhas AF, Parks-Miller A, Hamzavi IH. Dress for Success: a Review of Dressings and Wound Care in Hidradenitis Suppurativa. CURRENT DERMATOLOGY REPORTS 2018. [DOI: 10.1007/s13671-018-0231-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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70
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Ananian CE, Dhillon YS, Van Gils CC, Lindsey DC, Otto RJ, Dove CR, Pierce JT, Saunders MC. A multicenter, randomized, single-blind trial comparing the efficacy of viable cryopreserved placental membrane to human fibroblast-derived dermal substitute for the treatment of chronic diabetic foot ulcers. Wound Repair Regen 2018; 26:274-283. [PMID: 30098272 DOI: 10.1111/wrr.12645] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 05/22/2018] [Indexed: 01/22/2023]
Abstract
Randomized controlled clinical trials, the gold standard to determine treatment efficacy against control, have demonstrated advantages of skin substitutes for the treatment of chronic diabetic foot ulcers in comparison to standard of care. However, randomized controlled clinical trials comparing efficacy between two or more skin substitutes are very limited. With growing numbers of new skin substitutes, such studies are essential for treatment and policy-making decisions by wound care providers and payers. In this study, we analyzed clinical outcomes and product cost between a viable cryopreserved placental membrane (vCPM) and a human fibroblast-derived dermal substitute (hFDS) for the treatment of chronic diabetic foot ulcers in a prospective, multicenter, single-blind study. The outcomes of 62 patients were analyzed: 31 patients in the vCPM treatment group and 31 patients in the hFDS treatment group. Utilizing a non-inferiority trial design and the established treatment regimen of 8 applications for hFDS, we demonstrated that vCPM was not inferior to hFDS for the proportion of patients achieving complete wound closure (9.68, 90% CI: [10.67, 28.94]). However, preliminary findings show that vCPM may have better outcomes for wounds ≤ 5 cm2 : 81.3% (13/16) of wounds in the vCPM group vs. 37.5% (6/16) of wounds in the hFDS group reached complete closure at the end of treatment (p = 0.0118). A preliminary product cost analysis for wounds ≤ 5 cm2 may show significant savings for patients treated with vCPM. Average per-patient costs during the course of treatment were $3,846 and $7,968 (p < 0.0001) for vCPM and hFDS patients, respectively. These results may be used as guidance to wound care providers and payers.
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Affiliation(s)
| | | | | | - D Craig Lindsey
- CHRISTUS St. Vincent Regional Wound and Hyperbaric Center, Santa Fe, New Mexico 87505, USA
| | - Raymond J Otto
- St. Luke's Clinic - Wound and Hyperbarics, Meridian, Idaho 83642, USA
| | - Cyaandi R Dove
- Advanced Foot & Ankle Center, Las Vegas, Nevada 89119, USA
| | - Jessica T Pierce
- Virginia Mason Medical Center, Federal Way, Washington 98003, USA
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71
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Tettelbach W, Cazzell S, Reyzelman AM, Sigal F, Caporusso JM, Agnew PS. A confirmatory study on the efficacy of dehydrated human amnion/chorion membrane dHACM allograft in the management of diabetic foot ulcers: A prospective, multicentre, randomised, controlled study of 110 patients from 14 wound clinics. Int Wound J 2018; 16:19-29. [PMID: 30136445 PMCID: PMC7379535 DOI: 10.1111/iwj.12976] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 06/27/2018] [Accepted: 07/20/2018] [Indexed: 01/22/2023] Open
Abstract
A randomised, controlled multicentre clinical trial was conducted at 14 wound care centres in the United States to confirm the efficacy of dehydrated human amnion/chorion membrane allograft (dHACM) for the treatment of chronic lower extremity ulcers in persons with diabetes. Patients with a lower extremity ulcer of at least 4 weeks duration were entered into a 2‐week study run‐in phase and treated with alginate wound dressings and appropriate offloading. Those with less than or equal to 25% wound closure after run‐in were randomly assigned to receive weekly dHACM application in addition to offloading or standard of care with alginate wound dressings, for 12 weeks. A total of 110 patients were included in the intent‐to‐treat (ITT) analysis, with n = 54 in the dHACM group and n = 56 in the no‐dHACM group. Of the participants, 98 completed the study per protocol, with 47 receiving dHACM and 51 not receiving dHACM. The primary study outcome was percentage of study ulcers completely healed in 12 weeks, with both ITT and per‐protocol participants receiving weekly dHACM significantly more likely to completely heal than those not receiving dHACM (ITT—70% versus 50%, P = 0.0338, per‐protocol—81% versus 55%, P = 0.0093). A Kaplan–Meier analysis was performed to compare the time‐to‐healing performance with/without dHACM, showing a significantly improved time to healing with the use of allograft, log‐rank P < 0.0187. Cox regression analysis showed that dHACM‐treated subjects were more than twice as likely to heal completely within 12 weeks than no‐dHACM subjects (HR: 2.15, 95% confidence interval 1.30–3.57, P = 0.003). At the final follow up at 16 weeks, 95% of dHACM‐healed ulcers and 86% of healed ulcers in the no‐dHACM group remained closed. These results confirm that dHACM is an efficacious treatment for lower extremity ulcers in a heterogeneous patient population.
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Affiliation(s)
- William Tettelbach
- Wound Care & Hyperbaric Medicine Clinical Services, Intermountain Healthcare, Salt Lake City, Utah
| | - Shawn Cazzell
- Limb Preservation Platform, Inc., Fresno, California
| | | | - Felix Sigal
- Foot and Ankle Clinic, Los Angeles, California
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72
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Piaggesi A, Låuchli S, Bassetto F, Biedermann T, Marques A, Najafi B, Palla I, Scarpa C, Seimetz D, Triulzi I, Turchetti G, Vaggelas A. Advanced therapies in wound management: cell and tissue based therapies, physical and bio-physical therapies smart and IT based technologies. J Wound Care 2018; 27:S1-S137. [DOI: 10.12968/jowc.2018.27.sup6a.s1] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Alberto Piaggesi
- Prof, Director, EWMA Scientific Recorder (Editor), Diabetic Foot Section of the Pisa University Hospital, Department of Endocrinology and Metabolism, University of Pisa, Lungarno Pacinotti 43, 56126 Pisa, Italy
| | - Severin Låuchli
- Chief of Dermatosurgery and Woundcare, EWMA Immediate Past President (Co-editor), Department of Dermatology, University Hospital, Zurich, Råmistrasse 100, 8091 Zärich, Schwitzerland
| | - Franco Bassetto
- Prof, Head of Department, Clinic of Plastic and Reconstructive Surgery, University of Padova, Via Giustiniani, 35100 Padova
| | - Thomas Biedermann
- Tissue Biology Research Unit, Department of Surgery, University Children's Hospital Zurich, August Forel-Strasse 7, 8008 Zürich, Switzerland
| | - Alexandra Marques
- University of Minho, 3B's Research Group in Biomaterials, Biodegradables and Biomimetics, Avepark - Parque de Ciência e Tecnologia, Zona Industrial da Gandra, 4805-017 Barco GMR, Portugal
| | - Bijan Najafi
- Professor of Surgery, Director of Clinical Research, Division of Vascular Surgery and Endovascular Therapy, Director of Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, One Baylor Plaza, MS: BCM390, Houston, TX 77030-3411, US
| | - Ilaria Palla
- Institute of Management, Sant'Anna School of Advanced Studies, Piazza Martiri della Libertà, 33, 56127 Pisa, Italy
| | - Carlotta Scarpa
- Clinic of Plastic and Reconstructive Surgery, University of Padova, Via Giustiniani, 35100 Padova
| | - Diane Seimetz
- Founding Partner, Biopharma Excellence, c/o Munich Technology Center, Agnes-Pockels-Bogen 1, 80992 Munich, Germany
| | - Isotta Triulzi
- Institute of Management, Sant'Anna School of Advanced Studies, Piazza Martiri della Libertà, 33, 56127 Pisa, Italy
| | - Giuseppe Turchetti
- Fulbright Scholar, Institute of Management, Sant'Anna School of Advanced Studies, Piazza Martiri della Libertà, 33, 56127 Pisa, Italy
| | - Annegret Vaggelas
- Consultant, Biopharma Excellence, c/o Munich Technology Center, Agnes-Pockels-Bogen 1, 80992 Munich, Germany
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73
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Howell RS, Criscitelli T, Woods JS, Gillette BM, Brem H, Gorenstein S. A Perioperative Approach to Increase Limb Salvage When Treating Foot Ulcers in Patients With Diabetes. AORN J 2018; 107:431-440. [PMID: 29595900 DOI: 10.1002/aorn.12099] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Foot ulceration in patients with diabetes increases the risk of lower extremity amputation. Major amputations produce substantial adverse consequences, increase length of hospital stay, diminish quality of life, and increase mortality. In this article, we describe approaches that decrease amputations and improve the quality of life for patients with diabetes and foot ulcers. We highlight the role of the perioperative nurse, who is essential to providing optimal patient care in the perioperative period. Perioperative care of patients with diabetes involves providing optimal surveillance for a break in the skin of the foot, screening for neuropathy, following guidelines for foot ulcer infections, preparing for pathophysiology-based debridement, using adjuvant therapies, and offloading the patient's affected foot. Nurses should understand the disease process and pathophysiology and how to use these approaches in the perioperative setting to assist in curtailing the morbidity and mortality associated with foot ulcers in patients with diabetes.
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74
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Use of bilaminar grafts as life-saving interventions for severe burns: A single-center experience. Burns 2018; 44:1336-1345. [PMID: 29573885 DOI: 10.1016/j.burns.2018.01.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 01/02/2018] [Accepted: 01/30/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Skin coverage remains a significant hurdle in large-sized burns. Recent advances have allowed to grow Bilaminar Cultured Skin Autografts (BCSGs) from patients' own donor sites. The aim of this study was to report long-term outcomes in patients with large-sized burns having received BCSGs. METHODS Nine patients received BCSGs from January 2010 to May 2015. Except one patient who died during hospitalization, all patients were contacted. Four agreed to partake in the study. Patients were tested with the Vancouver Scar Scale (VSS), QuickDASH questionnaire and Burn Specific Health Scale (BSHS). Incisional biopsies of BCSGs were compared with patients' autografts. RESULTS From nine patients, mean age was 40 years and mean TBSA was 70.3%. For the four patients included, score averaged was 2.25 on the VSS, 29.5 on QuickDASH, 36/36 for psychosocial items and 63/84 for functional abilities on the BSHS. Compared with autografts, BCSGs demonstrated better pliability VSS and functionality. Biopsies showed no evidence of malignancy or atypical changes, but areas of hyperpigmentation. CONCLUSION This is the first report investigating the long-term outcome of a newly developed BCSG. BCSGs demonstrated comparable results with patients' autografts, functional outcomes on self-reported questionnaires and excellent psychological states. Precaution given the extensive unexpected hyperpigmentation must be taken and a randomized controlled study is underway.
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75
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Paggiaro AO, Menezes AG, Ferrassi AD, De Carvalho VF, Gemperli R. Biological effects of amniotic membrane on diabetic foot wounds: a systematic review. J Wound Care 2018. [DOI: 10.12968/jowc.2018.27.2.s19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Objective: The amniotic membrane has biological properties that are beneficial to the wound healing process of diabetic foot ulcers (DFU). Our aim is to analyse the scientific evidence found in literature on the use of the amniotic membrane to stimulate DFU healing. Method: A systematic review of amniotic membrane's influence was undertaken, using the search terms ‘placenta’ ‘diabetic foot’ ‘amnion’ and biological dressing’, assessing the outcomes ‘wound healing’ and ‘wound healing time’, in DFU. Following the inclusion and exclusion criteria, randomised controlled trials (RCT) were identified, and the risk of bias was analysed according to the Cochrane risk of bias tool. We conducted a meta-analysis of the two outcomes to evaluate the level of evidence. Results: We identified six clinical trials, with a total of 331 patients. The most common risks of bias in the studies were selection, attrition, and detection biases. From the meta-analysis, the difference of the intervention group (amnion) in relation to the control group was statistically significant. We found that wound healing in the group treated with amniotic membrane occurs 2.32 times more often and is 32 days faster in comparison with the group that used conventional dressings. Conclusion: There is statistical evidence to support the effectiveness of amniotic membrane in comparison with other conventional dressings. In addition, there is a clear tendency for the use of amniotic membrane treatment to result in a larger number of DFUs healing at a quicker rate.
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Affiliation(s)
| | | | | | | | - Rolf Gemperli
- 3 Plastic Surgery, Professor; São Paulo University, Brazil
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76
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Paggiaro AO, Menezes AG, Ferrassi AD, De Carvalho VF, Gemperli R. Biological effects of amniotic membrane on diabetic foot wounds: a systematic review. J Wound Care 2018; 27:S19-S25. [PMID: 29419367 DOI: 10.12968/jowc.2018.27.sup2.s19] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
OBJECTIVE The amniotic membrane has biological properties that are beneficial to the wound healing process of diabetic foot ulcers (DFU). Our aim is to analyse the scientific evidence found in literature on the use of the amniotic membrane to stimulate DFU healing. METHOD A systematic review of amniotic membrane's influence was undertaken, using the search terms 'placenta' 'diabetic foot' 'amnion' and biological dressing', assessing the outcomes 'wound healing' and 'wound healing time', in DFU. Following the inclusion and exclusion criteria, randomised controlled trials (RCT) were identified, and the risk of bias was analysed according to the Cochrane risk of bias tool. We conducted a meta-analysis of the two outcomes to evaluate the level of evidence. RESULTS We identified six clinical trials, with a total of 331 patients. The most common risks of bias in the studies were selection, attrition, and detection biases. From the meta-analysis, the difference of the intervention group (amnion) in relation to the control group was statistically significant. We found that wound healing in the group treated with amniotic membrane occurs 2.32 times more often and is 32 days faster in comparison with the group that used conventional dressings. CONCLUSION There is no statistical evidence to support the effectiveness of amniotic membrane in comparison with other conventional dressings. However, there is a clear tendency for the use of amniotic membrane treatment to result in a larger number of DFUs healing at a quicker rate.
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Affiliation(s)
| | | | | | | | - Rolf Gemperli
- Plastic Surgery, Professor, São Paulo University, Brazil
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77
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Watt SM, Pleat JM. Stem cells, niches and scaffolds: Applications to burns and wound care. Adv Drug Deliv Rev 2018; 123:82-106. [PMID: 29106911 DOI: 10.1016/j.addr.2017.10.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Revised: 10/19/2017] [Accepted: 10/22/2017] [Indexed: 12/11/2022]
Abstract
The importance of skin to survival, and the devastating physical and psychological consequences of scarring following reparative healing of extensive or difficult to heal human wounds, cannot be disputed. We discuss the significant challenges faced by patients and healthcare providers alike in treating these wounds. New state of the art technologies have provided remarkable insights into the role of skin stem and progenitor cells and their niches in maintaining skin homeostasis and in reparative wound healing. Based on this knowledge, we examine different approaches to repair extensive burn injury and chronic wounds, including full and split thickness skin grafts, temporising matrices and scaffolds, and composite cultured skin products. Notable developments include next generation skin substitutes to replace split thickness skin autografts and next generation gene editing coupled with cell therapies to treat genodermatoses. Further refinements are predicted with the advent of bioprinting technologies, and newly defined biomaterials and autologous cell sources that can be engineered to more accurately replicate human skin architecture, function and cosmesis. These advances will undoubtedly improve quality of life for patients with extensive burns and difficult to heal wounds.
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Affiliation(s)
- Suzanne M Watt
- Stem Cell Research, Nuffield Division of Clinical Laboratory Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford OX3 9BQ, UK.
| | - Jonathan M Pleat
- Department of Plastic and Reconstructive Surgery, North Bristol NHS Trust and University of Bristol, Westbury on Trym, Bristol BS9 3TZ, UK.
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78
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79
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Schlanser V, Dennis A, Ivkovic K, Joseph K, Kaminsky M, Messer T, Poulakidas S, Starr F, Bokhari F. Placenta to the Rescue: Limb Salvage Using Dehydrated Human Amnion/Chorion Membrane. J Burn Care Res 2017; 39:1048-1052. [DOI: 10.1093/jbcr/irx031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Victoria Schlanser
- Department of Trauma and Burn, Cook County Health and Hospital Systems, Chicago, Illinois
| | - Andrew Dennis
- Department of Trauma and Burn, Cook County Health and Hospital Systems, Chicago, Illinois
| | - Katarina Ivkovic
- Institute for Healthcare Innovation at Midwestern University, Downers Grove, Illinois
| | - Kimberly Joseph
- Department of Trauma and Burn, Cook County Health and Hospital Systems, Chicago, Illinois
| | - Matthew Kaminsky
- Department of Trauma and Burn, Cook County Health and Hospital Systems, Chicago, Illinois
| | - Thomas Messer
- Department of Trauma and Burn, Cook County Health and Hospital Systems, Chicago, Illinois
| | - Stathis Poulakidas
- Department of Trauma and Burn, Cook County Health and Hospital Systems, Chicago, Illinois
| | - Frederic Starr
- Department of Trauma and Burn, Cook County Health and Hospital Systems, Chicago, Illinois
| | - Faran Bokhari
- Department of Trauma and Burn, Cook County Health and Hospital Systems, Chicago, Illinois
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80
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Howell RS, Gorenstein S, Castellano M, Slone E, Woods JS, Gillette BM, Donovan V, Criscitelli T, Brem H, Brathwaite C. Wound Care Center of Excellence: Guide to Operative Technique for Chronic Wounds. J Am Coll Surg 2017; 226:e7-e17. [PMID: 29154922 DOI: 10.1016/j.jamcollsurg.2017.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 10/16/2017] [Accepted: 11/07/2017] [Indexed: 11/18/2022]
Affiliation(s)
| | | | | | - Eric Slone
- Department of Surgery, NYU Winthrop Hospital, Mineola, NY
| | - Jon S Woods
- Department of Surgery, NYU Winthrop Hospital, Mineola, NY
| | | | | | | | - Harold Brem
- Department of Surgery, NYU Winthrop Hospital, Mineola, NY.
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81
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Affiliation(s)
- Jason Akerman
- Department of Urology, McMaster University, Hamilton, Ontario, Canada
| | - Jason R Kovac
- Men's Health Center, Indianapolis, Indiana 46260, USA
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82
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Affiliation(s)
- Adam J Singer
- From Departments of Emergency Medicine and Vascular Surgery, Stony Brook University, Stony Brook, NY (A.J.S., A.T.); and the Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami (R.S.K.)
| | - Apostolos Tassiopoulos
- From Departments of Emergency Medicine and Vascular Surgery, Stony Brook University, Stony Brook, NY (A.J.S., A.T.); and the Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami (R.S.K.)
| | - Robert S Kirsner
- From Departments of Emergency Medicine and Vascular Surgery, Stony Brook University, Stony Brook, NY (A.J.S., A.T.); and the Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami (R.S.K.)
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83
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Bianchi C, Cazzell S, Vayser D, Reyzelman AM, Dosluoglu H, Tovmassian G. A multicentre randomised controlled trial evaluating the efficacy of dehydrated human amnion/chorion membrane (EpiFix ® ) allograft for the treatment of venous leg ulcers. Int Wound J 2017; 15:114-122. [PMID: 29024419 PMCID: PMC7949978 DOI: 10.1111/iwj.12843] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 08/21/2017] [Accepted: 08/30/2017] [Indexed: 01/02/2023] Open
Abstract
A randomised, controlled, multicentre clinical trial was conducted to evaluate the efficacy of dehydrated human amnion/chorion membrane (EpiFix) allograft as an adjunct to multilayer compression therapy for the treatment of non-healing full-thickness venous leg ulcers. We randomly assigned 109 subjects to receive EpiFix and multilayer compression (n = 52) or dressings and multilayer compression therapy alone (n = 57). Patients were recruited from 15 centres around the USA and were followed up for 16 weeks. The primary end point of the study was defined as time to complete ulcer healing. Participants receiving weekly application of EpiFix and compression were significantly more likely to experience complete wound healing than those receiving standard wound care and compression (60% versus 35% at 12 weeks, P = 0·0128, and 71% versus 44% at 16 weeks, P = 0·0065). A Kaplan-Meier analysis was performed to compare the time-to-healing performance with or without EpiFix, showing a significantly improved time to healing using the allograft (log-rank P = 0·0110). Cox regression analysis showed that subjects treated with EpiFix had a significantly higher probability of complete healing within 12 weeks (HR: 2·26, 95% confidence interval 1·25-4·10, P = 0·01) versus without EpiFix. These results confirm the advantage of EpiFix allograft as an adjunct to multilayer compression therapy for the treatment of non-healing, full-thickness venous leg ulcers.
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Affiliation(s)
- Christian Bianchi
- Department of Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
| | | | | | | | | | - Gregory Tovmassian
- Center for Clinical Research, Inc. Sacramento Foot and Ankle Center, Sacramento, CA, USA
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Laurent I, Astère M, Wang KR, Cheng QF, Li QF. Efficacy and Time Sensitivity of Amniotic Membrane treatment in Patients with Diabetic Foot Ulcers: A Systematic Review and Meta-analysis. Diabetes Ther 2017; 8:967-979. [PMID: 28895073 PMCID: PMC5630554 DOI: 10.1007/s13300-017-0298-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Diabetic foot ulcers (DFUs) are complex chronic wounds which have a major long-term impact on the morbidity, mortality and quality of patients. The objective of this study was to assess the efficacy and time sensitivity of human amnion/chorion membrane treatment in patients with chronic DFUs. METHODS The Cochrane Library, PubMed, Embase and Web of Science databases were systematically searched to identify relevant articles up to 10 April 2017. All randomized controlled trials (RCTs) comparing human amnion/chorion membrane + standard therapy and standard therapy alone in patients with DFUs were included in the analysis. Eligible studies were reviewed and data extracted into standard form. The Cochrane Collaboration's tool for assessing the risk of bias was used. Review manager version 5.3 software was used for statistical analysis. Data were analyzed using a random effect model. RESULTS Overall, the initial search of the four databases identified 352 published studies; of these, seven RCTS were ultimately included in the meta-analysis. The overall test effect in the group assessed at 4 weeks was Z = 4.14 [P < 0.0001; odds ratio (OR) 0.05; 95% confidence interval (CI) 0.01-0.21]. The overall test effect in the group assessed at 6 weeks was Z = 4.28 (P < 0.0001; OR 0.07; 95% CI 0.02-0.23). The overall effect in the group assessed at 12 weeks was Z = 4.96 (P < 0.00001; OR 0.10; 95% CI 0.04-0.24. The results showed that patients receiving amniotic membrane + standard therapy had far fewer incomplete healing wounds than those receiving standard of care alone. Assessment of the wound healing state at 4 and 6 weeks revealed that the wound healing state was almost the same, but there was a net difference of wound healing state at 12 weeks. CONCLUSION Human amnion/chorion membrane + standard of care treatment heals DFUs significantly faster than standard of care alone. When using the amnion in patients with DFUs, the optimal times to assess progress in wound healing should be 4 and 12 weeks.
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Affiliation(s)
- Irakoze Laurent
- Department of Endocrinology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Manirakiza Astère
- Department of Oncology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Kan Ran Wang
- Department of Endocrinology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qing-Feng Cheng
- Department of Endocrinology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Qi Fu Li
- Department of Endocrinology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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The Use of Dehydrated Human Amnion/Chorion Membranes in the Treatment of Burns and Complex Wounds: Current and Future Applications. Ann Plast Surg 2017; 78:S11-S13. [PMID: 28079550 DOI: 10.1097/sap.0000000000000983] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Historically, biologic materials found in nature have been used for a wide variety of medicinal purposes, although their widespread use may be limited due to challenges in obtaining and properly preparing the material for safe clinical use. Amniotic membrane has long been recognized to possess unique properties favorable for healing. Dehydrated human amnion/chorion membrane allografts are commercially available for use in multiple sizes and configurations applicable for a variety of clinical settings and presentations. The purpose of this article is to review the therapeutic properties of amniotic membrane.
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87
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Can dehydrated human amnion/chorion membrane accelerate the return to potency after a nerve-sparing robotic-assisted radical prostatectomy? Propensity score-matched analysis. J Robot Surg 2017; 12:235-243. [PMID: 28656504 DOI: 10.1007/s11701-017-0719-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 06/12/2017] [Indexed: 12/20/2022]
Abstract
The objective of this study is to determine if the use of dehydrated human amnion/chorion membrane (dHACM) allograft wrapped around the NVB during a robotic-assisted radical prostatectomy (RARP) accelerates the return to potency. 940 patients with preoperative SHIM >20 underwent RARP with some degree of bilateral NS. Of these, 235 patients underwent RARP, with bilateral placement of dHACM graft around the NVBs. They were matched in a 1:3 proportion with a similar group of patients (n = 705) who did not receive the allograft (control group or group 2). Minimum follow-up was 12 months. Postoperative outcomes were analyzed between propensity-matched dHACM graft (group 1) and non-graft groups (group 2). Kaplan-Meier survival curves were compared across techniques using the log-rank test. There were no significant demographic differences between the two groups. Potency was defined as the ability to achieve and maintain satisfactory erections firm enough for sexual intercourse, with or without the use of PDE-5 inhibitors. The mean time to potency was significantly lower in group 1 (2.37 months) versus group 2 (3.94 months) (p < 0.0001). The potency recovery rates were superior for group 1 at all early time points measured except at 12 months. The time to potency was significantly shorter in the dHACM group with full NS, 2.19 ± 1.84 versus 2.78 ± 2.70 mo. in the non-dHACM with full NS (p = 0.029). In the dHACM group with partial NS, the mean time to potency was 3.05 ± 2.32 versus 3.92 ± 3.42 mo. in the non-dHACM with partial NS (p = 0.021). Patients who received the dHACM wrap around the NVB after RARP accelerates the return to potency when compared to a similar control group without the use of the allograft. We also demonstrated that this faster return to potency occurs regardless of the degree of the NS preservation. Younger patients (<55 years of age) had the highest overall advantage if they received the graft. Our results indicate that dHACM placement at the site of the prostatic NVB does not increase the risk of BCR after RARP, neither in the presence of PSM, extra-prostatic disease (≥pT3) nor high Gleason score (Gleason ≥8).
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Serena TE, Fife CE, Eckert KA, Yaakov RA, Carter MJ. A new approach to clinical research: Integrating clinical care, quality reporting, and research using a wound care network-based learning healthcare system. Wound Repair Regen 2017; 25:354-365. [PMID: 28419657 DOI: 10.1111/wrr.12538] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 02/23/2017] [Indexed: 01/31/2023]
Abstract
The disparity between ideal evidence from randomized controlled trials and real-world evidence in medical research has prompted the United States Food and Drug Administration to consider the use of real-world data to better understand safety and effectiveness of new devices for a broader patient population and to prioritize real-world data in regulatory decision making. As the healthcare system transitions from volume- to value-based care, there is a growing need to harness the power of real-world data to change the paradigm for wound care clinical research and enable more generalizable clinical trials. This paper describes the implementation of a network-based learning healthcare system by a for-profit consortium of wound care clinics that integrates wound care management, quality improvement, and comparative effectiveness research, by harnessing structured real-world data within a purpose-built electronic health record at the point of care. Centers participating in the consortium submit their clinical data and quality measures to a qualified clinical data registry for wound care, enabling benchmarking of their data across this national network. The common definitional framework of the purpose-built electronic health record and the 21 wound-specific quality measures help to standardize the potential sources of bias in real-world data, making the consortium data useful for comparative effectiveness research. This consortium can transform wound care clinical research and raise the standards of care, while helping physicians achieve success with the Merit-Based Incentive Payment System.
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Affiliation(s)
| | - Caroline E Fife
- Baylor College of Medicine, Houston, Texas.,The US Wound Registry, The Woodlands, Texas
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Gindraux F, Rondot T, de Billy B, Zwetyenga N, Fricain JC, Pagnon A, Obert L. Similarities between induced membrane and amniotic membrane: Novelty for bone repair. Placenta 2017; 59:116-123. [PMID: 28673520 DOI: 10.1016/j.placenta.2017.06.340] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 05/30/2017] [Accepted: 06/21/2017] [Indexed: 02/06/2023]
Abstract
Previous clinical studies have shown the efficacy of a two-stage surgical procedure - the induced membrane (IM) technique - for reconstruction of large bone defects or bone non-union. The first stage involves radical debridement and insertion of a cement spacer into the bone defect. The second stage, performed weeks to months later, consists of removing the spacer while leaving the foreign body membrane induced by the cement in place, and then filling the cavity with bone autograft. The IM has been shown to (1) act as a protective physical barrier by preventing bone autograft resorption and (2) act as a bioreactor by promoting healing through revascularisation and growth factor secretion, and by concentrating mesenchymal stem cells (MSC) with osteogenic properties. New solutions to reduce this surgical procedure to a single step are being explored, for example by using an IM-like bioactive and protective barrier inserted into the bone defect at the same time as bone graft.
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Affiliation(s)
- Florelle Gindraux
- Orthopaedic and Traumatology Surgery Service, University Hospital of Besancon, France; NanomedicineLab, Imagery and Therapeutics (EA 4662), SFR FED 4234, University of Franche-Comté, Besancon, France.
| | - Thomas Rondot
- Orthopaedic and Traumatology Surgery Service, University Hospital of Besancon, France
| | - Benoit de Billy
- NanomedicineLab, Imagery and Therapeutics (EA 4662), SFR FED 4234, University of Franche-Comté, Besancon, France; Paediatric Surgery Service, University Hospital of Besancon, France
| | - Narcisse Zwetyenga
- Department of Maxillofacial Surgery, Plastic - Reconstructive and Aesthetic Surgery, Hand Surgery, University Hospital of Dijon, France
| | | | | | - Laurent Obert
- Orthopaedic and Traumatology Surgery Service, University Hospital of Besancon, France; NanomedicineLab, Imagery and Therapeutics (EA 4662), SFR FED 4234, University of Franche-Comté, Besancon, France
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Amnion Membrane in Diabetic Foot Wounds: A Meta-analysis. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1302. [PMID: 28507863 PMCID: PMC5426882 DOI: 10.1097/gox.0000000000001302] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 03/01/2017] [Indexed: 11/25/2022]
Abstract
Background: Amniotic membrane is tissue obtained from human placenta rich in cytokines, growth factors, and stem cells that possess the ability to inhibit infection, improve healing, and stimulate regeneration. Methods: A meta-analysis was performed examining randomized controlled trials comparing amniotic tissue products with standard of care in nonhealing diabetic foot ulcers including PubMed, Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews. Results: A search of 3 databases identified 596 potentially relevant articles. Application of selection criteria led to the selection of 5 randomized controlled trials. The 5 selected randomized controlled trials represented a total of 311 patients. The pooled relative risk of healing with amniotic products compared with control was 2.7496 (2.05725–3.66524, P < 0.001). Conclusions: The current meta-analysis indicates that the treatment of diabetic foot ulcers with amniotic membrane improves healing rates in diabetic foot ulcers. Further studies are needed to determine whether these products also decrease the incidence of subsequent complications, such as amputation or death, in diabetic patients.
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91
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Guo X, Mu D, Gao F. Efficacy and safety of acellular dermal matrix in diabetic foot ulcer treatment: A systematic review and meta-analysis. Int J Surg 2017; 40:1-7. [PMID: 28232031 DOI: 10.1016/j.ijsu.2017.02.008] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 02/05/2017] [Accepted: 02/08/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND Diabetic foot ulcer(DFU) is a chronic, refractory disease in need of multidisciplinary endeavour, miscellaneous strategies have been adopted to address this annoying issue, including acellular dermal matrix(ADM)/negative pressure wound therapy/standard of care (SOC) etc. However, consensus has not been reached. As a promising procedure, the efficacy and safety of ADM remains controversial. We therefore performed a meta-analysis of randomized controlled trials (RCTs) to compare the efficacy and safety of acellular dermal matrix to standard of care in DFU. METHODS Databases, including Pubmed, Medline, Embase and Cochrane library were searched to identify RCTs comparing ADM to SOC in DFU patients. The outcomes mainly included complete wound healing, mean time to heal and adverse events. RESULTS A total of 632 DFU patients from 6 RCTs were subjected to meta-analysis. The results showed that compared with the merely SOC, the complete healing rate in ADM group was higher both at 12 weeks [risk ratio (RR) 2.31, 95% confidence interval (CI) 1.42 to 3.76] and 16 weeks [RR 1.57, 95% CI 1.28 to 1.93]. The mean time to complete wound healing was shorter in ADM group [MD = -2.98, 95% CI: -5.15 to -0.82]. The occurrence of adverse event in both groups showed no significant difference [RR 0.98, 95%CI 0.58 to 1.67]. CONCLUSION Compared with standard of care, acellular dermal matrix may accelerate the healing velocity of uninfected, non-ischemic, full-thickness diabetic foot ulcer. Acellular dermal matrix showed superiority compared with standard of care alone, while generating no more complications.
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Affiliation(s)
- Xiaoshuang Guo
- Breast Plastic and Reconstructive Surgery Center, Plastic Surgery Hospital, and the Plastic Surgery Institute, Chinese Academy of Medical Sciences, Peking Union Medical College, 33# Badachu Road, Shijingshan District, 100144, Beijing, People's Republic of China.
| | - Dali Mu
- Breast Plastic and Reconstructive Surgery Center, Plastic Surgery Hospital, and the Plastic Surgery Institute, Chinese Academy of Medical Sciences, Peking Union Medical College, 33# Badachu Road, Shijingshan District, 100144, Beijing, People's Republic of China.
| | - Fuqiang Gao
- Department of Orthopedic Surgery, China-Japan Friendship Hospital, 2# Yinghua Dongjie Road, Chaoyang District, 100029, Beijing, People's Republic of China.
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Johnson EL, Marshall JT, Michael GM. A comparative outcomes analysis evaluating clinical effectiveness in two different human placental membrane products for wound management. Wound Repair Regen 2017; 25:145-149. [PMID: 27997744 DOI: 10.1111/wrr.12503] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 11/20/2016] [Accepted: 11/29/2016] [Indexed: 12/19/2022]
Abstract
Advances in tissue preservation have led to the commercialization of human placental membranes for the purposes of wound management with each product being characterized by different compositions and properties. The a priori specification of the research question in this investigator-initiated study focused on the clinical outcomes in two nonrandomized, however statistically equal and homogenous patient cohorts receiving either a viable intact cryopreserved human placental membrane (vCPM) or a dehydrated human amnion/chorion membrane (dHACM), for the management of wounds at a single center. A total of 79 patients with 101 wounds were analyzed: 40 patients with 46 wounds received vCPM and 39 patients with 55 wounds received dHACM. The proportion of wounds achieving complete wound closure was 63.0% (29/46) for vCPM and 18.2% (10/55) for dHACM (p < 0.0001) for all treated wounds combined. This is the first comparative effectiveness study to report on the clinical outcomes associated with the use of different placental wound care products once broadly implemented in the clinical setting.
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Affiliation(s)
- Eric L Johnson
- Bozeman Health Deaconess Hospital, Wound and Hyperbaric Center, Bozeman, Montana, and
| | - James T Marshall
- Bozeman Health Deaconess Hospital, Wound and Hyperbaric Center, Bozeman, Montana, and
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Lafosse A, Dufeys C, Beauloye C, Horman S, Dufrane D. Impact of Hyperglycemia and Low Oxygen Tension on Adipose-Derived Stem Cells Compared with Dermal Fibroblasts and Keratinocytes: Importance for Wound Healing in Type 2 Diabetes. PLoS One 2016; 11:e0168058. [PMID: 27992567 PMCID: PMC5167273 DOI: 10.1371/journal.pone.0168058] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 11/25/2016] [Indexed: 12/11/2022] Open
Abstract
Aim Adipose-derived stem cells (ASC) are currently proposed for wound healing in those with type 2 diabetes mellitus (T2DM). Therefore, this study investigated the impact of diabetes on adipose tissue in relation to ASC isolation, proliferation, and growth factor release and the impact of hyperglycemia and low oxygen tension (found in diabetic wounds) on dermal fibroblasts, keratinocytes, and ASC in vitro. Methods Different sequences of hypoxia and hyperglycemia were applied in vitro to ASC from nondiabetic (n = 8) or T2DM patients (n = 4) to study cell survival, proliferation, and growth factor release. Comparisons of dermal fibroblasts (n = 8) and keratinocytes (primary lineage) were made. Results No significant difference of isolation and proliferation capacities was found in ASC from nondiabetic and diabetic humans. Hypoxia and hyperglycemia did not impact cell viability and proliferation. Keratinocyte Growth Factor release was significantly lower in diabetic ASC than in nondiabetic ASC group in each condition, while Vascular Endothelial Growth Factor release was not affected by the diabetic origin. Nondiabetic ASC exposition to hypoxia (0.1% oxygen) combined with hyperglycemia (25mM glucose), resulted in a significant increase in VEGF secretion (+64%, p<0.05) with no deleterious impact on KGF release in comparison to physiological conditions (5% oxygen and 5 mM glucose). Stromal cell-Derived Factor-1α (-93%, p<0.001) and KGF (-20%, p<0.05) secretion by DF decreased in these conditions. Conclusions A better profile of growth factor secretion (regarding wound healing) was found in vitro for ASC in hyperglycemia coupled with hypoxia in comparison to dermal fibroblasts and keratinocytes. Interestingly, ASC from T2DM donors demonstrated cellular growth rates and survival (in hypoxia and hyperglycemic conditions) similar to those of healthy ASC (from normoglycemic donors); however, KGF secretion was significantly depleted in ASC obtained from T2DM patients. This study demonstrated the impact of diabetes on ASC for regenerative medicine and wound healing.
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Affiliation(s)
| | - Cécile Dufeys
- Pole de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Christophe Beauloye
- Pole de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Sandrine Horman
- Pole de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Denis Dufrane
- Novadip Biosciences, Mont-Saint-Guibert, Belgium
- * E-mail:
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Abstract
Many allogeneic biologic materials, by themselves or in combination with cells or cell products, may be transformative in healing or regeneration of musculoskeletal bone and soft tissues. By reconfiguring the size, shape, and methods of tissue preparation to improve deliverability and storage, unique iterations of traditional tissue scaffolds have emerged. These new iterations, combined with new cell technologies, have shaped an exciting platform of regenerative products that are effective and provide a bridge to newer and better methods of providing care for orthopedic foot and ankle patients.
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95
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Gaspar MP, Abdelfattah HM, Welch IW, Vosbikian MM, Kane PM, Rekant MS. Recurrent cubital tunnel syndrome treated with revision neurolysis and amniotic membrane nerve wrapping. J Shoulder Elbow Surg 2016; 25:2057-2065. [PMID: 27751716 DOI: 10.1016/j.jse.2016.09.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 08/24/2016] [Accepted: 09/07/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Perineural scarring of the ulnar nerve is a predominant cause of symptom recurrence after surgical treatment for primary cubital tunnel syndrome (CuTS). We report our preliminary experience in revision ulnar nerve decompression and nerve wrapping with an amniotic membrane allograft adhesion barrier for treatment of recurrent CuTS. METHODS We performed a retrospective review with prospective follow-up of patients with recurrent CuTS who were treated with revision neurolysis with amniotic membrane nerve wrapping. Preoperative elbow motion, grip and pinch strengths, pain level on the visual analog scale level, and the 11-item version of the Disabilities of the Arm, Shoulder and Hand functional outcome score were compared with postoperative values using paired t testing. Symptom characteristics, physical examination findings, complications, and level of satisfaction were also obtained. RESULTS Eight patients (mean age, 47.5 years) who had undergone at least 2 prior ulnar nerve operations satisfied study inclusion. At mean postoperative follow-up of 30 months, significant improvements were noted across all patients in visual analog scale pain levels (-3.5 vs. preoperatively; P < .0001), 11-item version of the Disabilities of the Arm, Shoulder and Hand scores (-30 vs. preoperatively; P < .0001), and grip strength (+25 pounds vs. preoperatively; P < .0001). Pinch strength and elbow motion were also significantly improved for those patients with comparative preoperative data available. All patients expressed subjective satisfaction with their results. No adverse reactions or complications occurred in any patients. CONCLUSIONS Ulnar nerve wrapping with amniotic membrane allograft, when combined with revision neurolysis, was a safe and subjectively effective treatment for patients with debilitating recurrent CuTS.
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Affiliation(s)
- Michael P Gaspar
- Department of Orthopaedic Surgery, The Philadelphia Hand Center, P.C., Thomas Jefferson University, Philadelphia, PA, USA.
| | - Hesham M Abdelfattah
- Department of Orthopaedic Surgery, The Philadelphia Hand Center, P.C., Thomas Jefferson University, Philadelphia, PA, USA; Department of Orthopaedic Surgery and Sports Medicine, Temple University Health System, Philadelphia, PA, USA
| | - Ian W Welch
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Michael M Vosbikian
- Department of Orthopaedics, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA, USA
| | - Patrick M Kane
- Department of Orthopaedic Surgery, The Philadelphia Hand Center, P.C., Thomas Jefferson University, Philadelphia, PA, USA
| | - Mark S Rekant
- Department of Orthopaedic Surgery, The Philadelphia Hand Center, P.C., Thomas Jefferson University, Philadelphia, PA, USA
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Zheng Y, Ji S, Wu H, Tian S, Zhang Y, Wang L, Fang H, Luo P, Wang X, Hu X, Xiao S, Xia Z. Topical administration of cryopreserved living micronized amnion accelerates wound healing in diabetic mice by modulating local microenvironment. Biomaterials 2016; 113:56-67. [PMID: 27810642 DOI: 10.1016/j.biomaterials.2016.10.031] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 10/20/2016] [Accepted: 10/20/2016] [Indexed: 01/09/2023]
Abstract
Approximately 25% of diabetic patients suffer from diabetic lower-extremity ulcer throughout their lives and 7%-20% of patients will eventually need an amputation despite standard care treatment. The development of new therapies to treat diabetic wounds is urgent. In this study, we used cryopreserved living micronized amnion (300-600 μm) to treat wounds in diabetic mice. Post-thaw micronized amnion retained high cell viability, as well as intact cell morphology and membrane structure. When transplanted onto the wounds of db/db mice, the cryopreserved living micronized amnion greatly promoted wound healing in diabetic mice mainly by secreting growth, inflammation, and chemotaxis-related factors that regulated macrophage migration and phenotype switch, recruited CD34+ progenitor cells, and increased neovascularization. In addition, the micronized amnion matrix can exist in the dermis and serve as a long-term dermal scaffold. These results demonstrated the potential of the cryopreserved living micronized amnion as a ready-to-use living dermal substitute that addresses multiple defective physiological processes of impaired wounds to treat diabetic ulcers and other chronic wounds in clinics.
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Affiliation(s)
- Yongjun Zheng
- Burns Center of Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Shizhao Ji
- Burns Center of Changhai Hospital, The Second Military Medical University, Shanghai, China.
| | - Haibin Wu
- Burns Center of Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Song Tian
- Burns Center of Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Yunqing Zhang
- Burns Center of Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Li Wang
- Burns Center of Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - He Fang
- Burns Center of Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Pengfei Luo
- Burns Center of Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Xingtong Wang
- Burns Center of Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Xiaoyan Hu
- Burns Center of Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Shichu Xiao
- Burns Center of Changhai Hospital, The Second Military Medical University, Shanghai, China.
| | - Zhaofan Xia
- Burns Center of Changhai Hospital, The Second Military Medical University, Shanghai, China.
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DiDomenico LA, Orgill DP, Galiano RD, Serena TE, Carter MJ, Kaufman JP, Young NJ, Zelen CM. Aseptically Processed Placental Membrane Improves Healing of Diabetic Foot Ulcerations: Prospective, Randomized Clinical Trial. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e1095. [PMID: 27826487 PMCID: PMC5096542 DOI: 10.1097/gox.0000000000001095] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 08/31/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Allogeneic grafts derived from amnion/chorion are known to be efficacious in healing chronic diabetic foot ulcerations (DFUs). The goal of this study was to compare aseptically processed dehydrated human amnion and chorion allograft (dHACA) versus standard of care (SOC) in facilitating wound closure in nonhealing DFUs. METHODS Patients with DFUs treated with SOC (off-loading, appropriate debridement, and moist wound care) after a 2-week screening period were randomized to either SOC or wound-size-specific dHACA (AmnioBand, Musculoskeletal Transplant Foundation, Edison, N.J.) applied weekly for up to 12 weeks plus SOC. Primary endpoint was the percentage of wounds healed at 6 weeks between groups. RESULTS At 6 weeks, 70% (14/20) of the dHACA-treated DFUs healed compared with 15% (3/20) treated with SOC alone. Furthermore, at 12 weeks, 85% (17/20) of the DFUs in the dHACA group healed compared with 25% (5/20) in the SOC group, with a corresponding mean time to heal of 36 and 70 days, respectively. At 12 weeks, the mean number of grafts used per healed wound for the dHACA group was 3.8 (median 3.0), and mean cost of the tissue to heal a DFU was $1400. The mean wastage at 12 weeks was 40%. One adverse event and 1 serious adverse event occurred in the dHACA group; neither was graft related. Three adverse events and 1 serious adverse event occurred in the SOC group. CONCLUSION Aseptically processed dHACA heals diabetic foot wounds significantly faster than SOC at 6 and 12 weeks with minimal graft wastage.
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Affiliation(s)
- Lawrence A. DiDomenico
- From the Lower Extremity Institute for Research and Therapy, Youngstown, Ohio; Department of Plastic Surgery, Brigham and Women’s Hospital, Boston, Mass.; Division of Plastic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Ill.; Serena Group, Cambridge, Mass.; Strategic Solutions, Inc., Cody, Wyo.; *General Surgery, Premier Surgical, Brick, N.J.; †Martinsville Research Institute, Martinsville, Va.; and ‡Professional Education and Research Institute, Roanoke, Va
| | - Dennis P. Orgill
- From the Lower Extremity Institute for Research and Therapy, Youngstown, Ohio; Department of Plastic Surgery, Brigham and Women’s Hospital, Boston, Mass.; Division of Plastic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Ill.; Serena Group, Cambridge, Mass.; Strategic Solutions, Inc., Cody, Wyo.; *General Surgery, Premier Surgical, Brick, N.J.; †Martinsville Research Institute, Martinsville, Va.; and ‡Professional Education and Research Institute, Roanoke, Va
| | - Robert D. Galiano
- From the Lower Extremity Institute for Research and Therapy, Youngstown, Ohio; Department of Plastic Surgery, Brigham and Women’s Hospital, Boston, Mass.; Division of Plastic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Ill.; Serena Group, Cambridge, Mass.; Strategic Solutions, Inc., Cody, Wyo.; *General Surgery, Premier Surgical, Brick, N.J.; †Martinsville Research Institute, Martinsville, Va.; and ‡Professional Education and Research Institute, Roanoke, Va
| | - Thomas E. Serena
- From the Lower Extremity Institute for Research and Therapy, Youngstown, Ohio; Department of Plastic Surgery, Brigham and Women’s Hospital, Boston, Mass.; Division of Plastic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Ill.; Serena Group, Cambridge, Mass.; Strategic Solutions, Inc., Cody, Wyo.; *General Surgery, Premier Surgical, Brick, N.J.; †Martinsville Research Institute, Martinsville, Va.; and ‡Professional Education and Research Institute, Roanoke, Va
| | - Marissa J. Carter
- From the Lower Extremity Institute for Research and Therapy, Youngstown, Ohio; Department of Plastic Surgery, Brigham and Women’s Hospital, Boston, Mass.; Division of Plastic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Ill.; Serena Group, Cambridge, Mass.; Strategic Solutions, Inc., Cody, Wyo.; *General Surgery, Premier Surgical, Brick, N.J.; †Martinsville Research Institute, Martinsville, Va.; and ‡Professional Education and Research Institute, Roanoke, Va
| | - Jarrod P. Kaufman
- From the Lower Extremity Institute for Research and Therapy, Youngstown, Ohio; Department of Plastic Surgery, Brigham and Women’s Hospital, Boston, Mass.; Division of Plastic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Ill.; Serena Group, Cambridge, Mass.; Strategic Solutions, Inc., Cody, Wyo.; *General Surgery, Premier Surgical, Brick, N.J.; †Martinsville Research Institute, Martinsville, Va.; and ‡Professional Education and Research Institute, Roanoke, Va
| | - Nathan J. Young
- From the Lower Extremity Institute for Research and Therapy, Youngstown, Ohio; Department of Plastic Surgery, Brigham and Women’s Hospital, Boston, Mass.; Division of Plastic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Ill.; Serena Group, Cambridge, Mass.; Strategic Solutions, Inc., Cody, Wyo.; *General Surgery, Premier Surgical, Brick, N.J.; †Martinsville Research Institute, Martinsville, Va.; and ‡Professional Education and Research Institute, Roanoke, Va
| | - Charles M. Zelen
- From the Lower Extremity Institute for Research and Therapy, Youngstown, Ohio; Department of Plastic Surgery, Brigham and Women’s Hospital, Boston, Mass.; Division of Plastic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Ill.; Serena Group, Cambridge, Mass.; Strategic Solutions, Inc., Cody, Wyo.; *General Surgery, Premier Surgical, Brick, N.J.; †Martinsville Research Institute, Martinsville, Va.; and ‡Professional Education and Research Institute, Roanoke, Va
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Biologics in wound healing: repair versus regeneration. CURRENT ORTHOPAEDIC PRACTICE 2016. [DOI: 10.1097/bco.0000000000000420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Nicholas MN, Yeung J. Current Status and Future of Skin Substitutes for Chronic Wound Healing. J Cutan Med Surg 2016; 21:23-30. [PMID: 27530398 DOI: 10.1177/1203475416664037] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Chronic wounds, including diabetic ulcers, pressure ulcers, venous ulcers, and arterial insufficiency ulcers, are both difficult and expensive to treat. Conventional wound care may sometimes lead to suboptimal wound healing and significant morbidity and mortality for patients. The use of skin substitutes provides an alternative therapy showing superior efficacy and, in some cases, similar cost-effectiveness compared to traditional treatments. This review discusses the different types of currently available commercial skin substitutes for use in chronic wounds as well as the paucity of strong evidence supporting their use. It then delves into the limitations of these skin substitutes and examines the most recent research targeting these limitations.
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Affiliation(s)
| | - Jensen Yeung
- 2 Department of Dermatology, Women's College Hospital and Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,3 Division of Dermatology, University of Toronto, Toronto, ON, Canada
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