Use of a noncontact radiant heat bandage and Staphylococcus aureus dermal infections in an ovine model

Animal experimental models of ischemic wounds - A review of literature

Critical limb ischemia is a serious form of peripheral arterial disease (PAD). The consequences of lower limb ischemia are pain, claudication and chronic non-healing wounds. Patients with diabetes are especially at a high risk for developing non-healing ulcers. The most serious complication is major amputation. For this reason, there is a significant medical requirement to develop new therapies in order to prevent the progression of PAD. For research purposes, it is crucial to find an appropriate model of chronic ischemia to explore the processes of wound healing. According to recently acquired information, rodents are currently the most commonly used animals in these types of studies. The main advantage of using small animals is the low financial cost due to the relatively small demand for food, water and living space. The disadvantage is their anatomy, which is different from that of humans. Larger animals have a more human-like anatomy and physiology, but they require more expense and space for housing. A bipedicle skin flap and its modifications are popular models for ischemic wounds. In order to secure healing through re-epithelisation, as opposed to contraction in rodents, there is a need to remove the panniculus carnosus muscle. Wounds in other experimental animals heal primarily through re-epithelisation. The application of a silicone mesh underneath the flap prevents vascular regrowth in ischemic tissue. There is an ongoing effort to create in vivo diabetic models for chronic ulcer research. This work presents an overview of existing animal models of ischemic wounds.

A novel atmospheric-pressure air plasma jet for wound healing

Current low‐temperature plasma (LTP) devices essentially use a rare gas source with a short working distance (8 to 20 mm), low gas flow rate (0.12 to 0.3 m³/h), and small effective treatment area (1‐5 cm²), limiting the applications for which LTP can be utilised in clinical therapy. In the present study, a novel type of LTP equipment was developed, having the advantages of a free gas source (surrounding air), long working distance (8 cm), high gas flow rate (10 m³/h), large effective treatment area (20 cm²), and producing an abundance of active substances (NOγ, OH, N₂, and O), effectively addressing the shortcomings of current LTP devices. Furthermore, it has been verified that the novel LTP device displays therapeutic efficacy in terms of acceleration of wound healing in normal and Type I diabetic rats, with enhanced wound kinetics, rate of condensation of wound area, and recovery ratio. Cellular and molecular analysis indicated that LTP treatment significantly reduced inflammation and enhanced re‐epithelialization, fibroblast proliferation, deposition of collagen, neovascularization, and expression of TGF‐β, superoxide dismutase, glutathione peroxidase, and catalase in Type I diabetic rats. In conclusion, the novel LTP device provides a convenient and efficient tool for the treatment of clinical wounds.

Synthetic polymeric biomaterials for wound healing: a review

Wounds are of a variety of types and each category has its own distinctive healing requirements. This realization has spurred the development of a myriad of wound dressings, each with specific characteristics. It is unrealistic to expect a singular dressing to embrace all characteristics that would fulfill generic needs for wound healing. However, each dressing may approach the ideal requirements by deviating from the 'one size fits all approach', if it conforms strictly to the specifications of the wound and the patient. Indeed, a functional wound dressing should achieve healing of the wound with minimal time and cost expenditures. This article offers an insight into several different types of polymeric materials clinically used in wound dressings and the events taking place at cellular level, which aid the process of healing, while the biomaterial dressing interacts with the body tissue. Hence, the significance of using synthetic polymer films, foam dressings, hydrocolloids, alginate dressings, and hydrogels has been reviewed, and the properties of these materials that conform to wound-healing requirements have been explored. A special section on bioactive dressings and bioengineered skin substitutes that play an active part in healing process has been re-examined in this work.

Flexible Nanoholey Patches for Antibiotic-Free Treatments of Skin Infections

Despite the availability of different antibiotics, bacterial infections are still one of the leading causes of hospitalization and mortality. The clinical failure of antibiotic treatment is due to a general poor antibiotic penetration to bacterial infection sites as well as the development of antibiotic-resistant pathogens. In the case of skin infection, the wound is covered by exudate, making it impermeable to topical antibiotics. The development of a flexible patch allowing a rapid and highly efficient treatment of subcutaneous wound infections via photothermal irradiation is presented here. The skin patch combines the near-infrared photothermal properties of a gold nanohole array formed by self-assembly of colloidal structures on flexible polyimide films with that of reduced graphene oxide nanosheets for laser-gated pathogen inactivation. In vivo tests performed on mice with subcutaneous skin infection and treated with the photothermal skin patch show wound healing of the infected site, while nontreated areas result in necrotic muscular fibers and bacterial infiltrate. No loss in efficiency is observed upon multiple use of these patches during in vivo experiments because of their robustness.

Focal Infection Treatment using Laser-Mediated Heating of Injectable Silk Hydrogels with Gold Nanoparticles

Medical treatment of subcutaneous bacterial abscesses usually involves systemic high-dose antibiotics and incision-drainage of the wound. Such an approach suffers from two main deficiencies: bacterial resistance to antibiotics and pain associated with multiple incision-drainage-wound packing procedures. Furthermore, the efficacy of high-dose systemic antibiotics is limited because of the inability to penetrate into the abscess. To address these obstacles, we present a treatment relying on laser-induced heating of gold nanoparticles embedded in an injectable silk-protein hydrogel. Although bactericidal nanoparticle systems have been previously employed based on silver and nitric oxide, they have limitations regarding customization and safety. The method we propose is safe and uses biocompatible, highly tunable materials: an injectable silk hydrogel and Au nanoparticles, which are effective absorbers at low laser powers such as those provided by hand held devices. We demonstrate that a single 10-minute laser treatment of a subcutaneous infection in mice preserves the general tissue architecture, while achieving a bactericidal effect - even resulting in complete eradication in some cases. The unique materials platform presented here can provide the basis for an alternative treatment of focal infections.

Thermotherapy in dermatologic infections

The use of local induced hyperthermia or thermotherapy for dermatologic infections has not been fully explored in the more recent medical literature. Herein, we discuss the rationale behind the use of thermotherapy and review reported clinical experience with its use in the management of cutaneous infections.

The effect of post-burn local hyperthermia on the reducing burn injury: The possible role of opioids

PURPOSE

This paper studied the effect of post-burn local hyperthermia on burn induced injury.

METHODS

A second-degree burn injury was induced on the right and left flanks of Balb/c mice. Thirty-two burn wounds were divided into four groups. Opioid receptor blocking was done for groups 3 and 4 by intra-peritoneal administration of Naloxone (NLX) 30 min before the thermal injury. Local hyperthermia (45 degrees C, 30 s) was applied only for the burn wounds of groups 2 and 4. Twenty-four hours after burn injury, the burned wounds were assessed for the level of iNOS (by immunohistochemistry) and the number of hair follicles (as an indicator of tissue injury).

RESULTS

The wounds that received hyperthermia (group 2) had significantly more hair follicles (p < 0.001) compared to the control wounds (group 1). There was no significant difference between the number of hair follicles and acute inflammation of group 1 and group 3 (NLX + burn). Group 4 (NLX + burn + hyperthermia) had significantly fewer hair follicles compared to group 1 (p < 0.001), group 2 (p < 0.001) and group 3 (p < 0.001). The level of iNOS in groups 1, 3 and 4 was not significantly different but significantly more than group 2 (p < 0.001, p < 0.001 and p < 0.001, respectively).

CONCLUSIONS

The results showed that local hyperthermia after second degree burn decreased the tissue injury and iNOS expression. It is also concluded that endogenous opioid response may have a key role in the above mentioned effects of post-burn local hyperthermia.

Effects of warming on healing

Systemic and local warming may accelerate wound healing and minimise postoperative wound infection, although more research is needed to confirm this. The existing evidence of the benefits of warming therapies is outlined here.

Heat Treatment Enhances Healing Process of Experimental Pseudomonas Corneal Ulcer

We investigated the effects of hyperthermia on the healing process of experimental Pseudomonas corneal ulceration (PCU). Hartley guinea pigs were used to develop animal models of PCU. As a heat source, disposable chemical pocket warmers were applied. The healing process of PCU was compared between the heat-treated corneas and the control corneas. The severity of infection and the degree of angiogenesis were classified by a clinical scoring system. The animals were euthanized 14 days after infection and the corneas were submitted for histopathological examination. The expression of vascular endothelial growth factor (VEGF) was examined immunohistochemically. Comparative reverse transcription polymerase chain reaction was performed to measure the expression level of VEGF in the cornea. Hyperthermia significantly promoted corneal epithelization and neovascularization in the PCU model. Heat treatment significantly decreased the number of viable Pseudomonas organisms present in PCU. On immunohistochemistry, the heated cornea demonstrated more intense staining for VEGF. Comparative reverse transcription polymerase chain reaction showed upregulation of the expression level of VEGF mRNA in the heat-treated cornea. Hyperthermia accelerated the healing process of PCU with increased corneal neovascularization. Angiogenesis may play an important role in the PCU healing process, which is enhanced by the heat treatment.

Eradication of methicillin-resistant Staphylococcus aureus from pressure sores using warming therapy

BACKGROUND

Nosocomial infection is a major cause of surgical morbidity and mortality. Methicillin-resistant Staphylococcus aureus (MRSA) has become a prominent organism in colonization and infection in surgical patients. Pressure sores are a major reservoir of MRSA.

MATERIALS AND METHODS

In this study, 33 patients with full-thickness pressure sores were randomized to receive standard care or radiant heat therapy using a Warm Up device (Augustine Medical, Eden Prairie, MN). Weekly microbial sampling was used for assessment of bacterial presence. None of the patients received antibiotics prior to or during the eight weeks of study.

RESULTS

More than 50 species of bacteria were present in the pressure sores with a median of four organisms per sample. Methicillin-resistant S. aureus was found in 14 of the patients' pressure sores. In the warming group (n = 8), MRSA was eradicated in six patients within 2 weeks of warming, whereas in the control group none had eradication (Fisher's exact test, p = 0.01). Eradication was defined as three consecutive weekly swabs without bacterial growth.

CONCLUSION

The warming of pressure sores is being assessed as an adjunct to healing, but there is some promise that colonization by MRSA may be eradicated, thereby reducing a potential reservoir of organisms. The risk to surgical patients when patients are harboring MRSA may be minimized by warming therapy.

A randomized controlled clinical trial to evaluate the effects of noncontact normothermic wound therapy on chronic full-thickness pressure ulcers

OBJECTIVE

To determine the effect of noncontact normothermic wound therapy (NNWT) versus standard wound care on chronic full-thickness pressure ulcers.

DESIGN

Prospective, randomized, controlled trial.

SETTING

Veterans administration medical center and 7 long-term-care facilities.

PATIENTS

40 inpatients with 43 Stage III and IV pressure ulcers.

INTERVENTIONS

A sterile noncontact wound dressing was applied to 21 wounds for 24 hours per day, 7 days per week. Each day after the wound was irrigated and the noncontact dressing was changed, a heating element in the dressing was activated for 3 1-hour periods for 12 weeks or until wound closure. Twenty-two control wounds were treated with standard, moisture-retentive dressings 24 hours per day, 7 days per week for 12 weeks or until wound closure.

MAIN OUTCOME MEASURE

Measurement of wound surface area.

MAIN RESULTS

Healing rate for the NNWT group was significantly greater than for the control group (0.52 cm2 per week and 0.23 cm2 per week, respectively; P<.02). A clinically significant increase was seen among the NNWT group in the incidence of closure among wounds that completed the entire 12-week protocol compared with controls (11 of 14 or 79% and 8 of 16 or 50%, respectively; not significant). The mean slope of the individual regression analyses for the NNWT group was significantly different from the mean slope for the control group (-0.07 and -0.033, respectively; P<.05). Large wounds in the NNWT group demonstrated a significantly greater healing rate than large wounds in the control group (P <.05).

CONCLUSION

Wounds treated with NNWT healed significantly faster than wounds in the control group. The healing rate was greatest for larger wounds treated with NNWT.