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Vélez González JJ, Berger M, Schiele S, Rubeck A, Müller G, Welzel J, Schuh S. Dynamic optical coherence tomography of chronic venous ulcers. J Eur Acad Dermatol Venereol 2024; 38:223-231. [PMID: 37669869 DOI: 10.1111/jdv.19496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 08/11/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND Chronic ulcers, especially venous leg ulcers, are a major burden on the healthcare system. To date there are only few non-invasive established procedures for evaluation of blood perfusion in wounds. Dynamic optical coherence tomography (D-OCT) provides images of the skin's superficial vascularisation. OBJECTIVES This study aims to investigate if and how the D-OCT measurement of chronic wounds can provide new information about the vascularisation during the healing process. METHODS We examined 16 venous ulcers over 16 weeks and evaluated the vessel morphology and density using D-OCT at the wound bed, borders, two centimetres adjacent to the wound und at non-ulcerated skin on the contralateral leg. RESULTS In D-OCT scans clumps were unique and the most common vessel type in the wound area of venous ulcers, whereas lines and serpiginous vessels were the most common in non-ulcerated skin. At the wound border mottle and cluster patterns occurred more frequently. Healthy skin showed a significant increase of mesh pattern. Vessel density significantly increased at the wound area compared to non-ulcerated skin. During the healing process the wound border showed the most vascular changes while only an increase in curves was observed in the wound centre. Non-healing wounds had fewer dots and blobs at the borders, fewer dots, coils, clumps, lines and serpiginous vessels at the centre and fewer dots in adjacent skin. Temperature analysis showed higher temperatures in non-ulcerated skin, followed by the wound margin and centre. Non-healing wounds showed the lowest temperatures in the wound centre. CONCLUSIONS These results highlight the non-invasive use of D-OCT for the examination and monitoring of wound healing in chronic venous ulcers. D-OCT imaging of blood vessels may offer the potential to detect disorders of wound healing at an early stage, differentiate ulcers of different genesis and to tailor more individualized, patient-oriented therapy.
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Affiliation(s)
| | - Maximilian Berger
- Department of Dermatology and Allergology, University Hospital Augsburg, Augsburg, Germany
| | - Stefan Schiele
- Institute of Mathematics, University of Augsburg, Augsburg, Germany
| | - Anna Rubeck
- Institute of Mathematics, University of Augsburg, Augsburg, Germany
| | - Gernot Müller
- Institute of Mathematics, University of Augsburg, Augsburg, Germany
| | - Julia Welzel
- Department of Dermatology and Allergology, University Hospital Augsburg, Augsburg, Germany
| | - Sandra Schuh
- Department of Dermatology and Allergology, University Hospital Augsburg, Augsburg, Germany
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Sebe I, Ostorhazi E, Fekete A, Kovacs KN, Zelko R, Kovalszky I, Li W, Wade JD, Szabo D, Otvos L. Polyvinyl alcohol nanofiber formulation of the designer antimicrobial peptide APO sterilizes Acinetobacter baumannii-infected skin wounds in mice. Amino Acids 2015; 48:203-11. [PMID: 26319645 DOI: 10.1007/s00726-015-2080-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 08/20/2015] [Indexed: 12/20/2022]
Abstract
Native and designer cationic antimicrobial peptides are increasingly acknowledged as host defense molecules rather than true antimicrobials. Due to their ability to activate the innate immune system, these structures are used to treat uninfected and bacterially-infected wounds, including those harboring Acinetobacter baumannii. Previously we documented that when administered intramuscularly or topically in liquid formulations, the proline-rich host defense peptide dimer A3-APO accelerates uninfected wound re-epithelization and eliminates systemic and local A. baumannii, methicillin-resistant Staphylococcus aureus and other pathogen load from infected lesions better than conventional antibiotics. In the current study we sought to produce and characterize a novel delivery system, suitable for immediate and convenient application in non-hospital environments. The APO monomer was incorporated into polyvinyl alcohol nanofibers and the complex was polymerized into a solid patch dressing. Mice were subjected to skin abrasion where the wounds were either left uninfected or were inoculated with a near lethal dose of multidrug resistant A. baumannii strain. Analyzed after 3 days, APO monomer-containing patches improved wound appearance significantly better than polymer patches without antibiotics. When compared to colistin, the APO patches accelerated wound healing, and statistically significantly reduced wound size and wound bacterial load. The in vivo antimicrobial effect was more extensive than after intramuscular administration of the peptide drug, by using only one tenth of the active pharmaceutical ingredient. These data suggest that the APO monomer-impregnated nanofiber dressing can be developed as an economical first-line treatment option to skin injuries in general and battlefield burn and blast injuries in particular.
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Affiliation(s)
- Istvan Sebe
- University Pharmacy Department of Pharmacy Administration, Semmelweis University, Hogyes Endre Street 7-9, Budapest, 1092, Hungary
| | - Eszter Ostorhazi
- Institute of Medical Microbiology, Semmelweis University, Nagyvarad ter 4, Budapest, 1089, Hungary.,Department of Laboratory Medicine, Semmelweis University, Nagyvarad ter 4, Budapest, 1089, Hungary
| | - Aron Fekete
- Institute of Medical Microbiology, Semmelweis University, Nagyvarad ter 4, Budapest, 1089, Hungary
| | - Krisztian N Kovacs
- Department of Polymer Engineering, Faculty of Mechanical Engineering, Budapest University of Technology and Economics, Muegyetem rkp. 3., Budapest, 1111, Hungary
| | - Romana Zelko
- University Pharmacy Department of Pharmacy Administration, Semmelweis University, Hogyes Endre Street 7-9, Budapest, 1092, Hungary
| | - Ilona Kovalszky
- 1st Department of Pathology and Experimental Cancer Research, Semmelweis University, Ulloi ut 26, Budapest, 1085, Hungary
| | - Wenyi Li
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, 3010, Melbourne, VIC, Australia
| | - John D Wade
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, 3010, Melbourne, VIC, Australia
| | - Dora Szabo
- Institute of Medical Microbiology, Semmelweis University, Nagyvarad ter 4, Budapest, 1089, Hungary
| | - Laszlo Otvos
- Institute of Medical Microbiology, Semmelweis University, Nagyvarad ter 4, Budapest, 1089, Hungary. .,OLPE, LLC, 801 Mockingbird Lane, Audubon, PA, 19403, USA.
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Roberts MS. Solute-vehicle-skin interactions in percutaneous absorption: the principles and the people. Skin Pharmacol Physiol 2013; 26:356-70. [PMID: 23921122 DOI: 10.1159/000353647] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
An appreciation of solute-vehicle-skin interactions underpins our current understanding of the processes of percutaneous absorption as well as in the prediction of the extent of absorption. This understanding has been reached through principles developed and validated over the last century through the work of a number of authors, including Dale Wurster, Takeru Higuchi, Irvin Blank, Robert Scheuplein, Gordon Flynn, Boyd Poulsen and Tom Franz, as well as by many scientists from my and younger generations. Their work has led to an appreciation of the rate-limiting steps in percutaneous penetration, the role played by the physicochemical properties of the solute, vehicle and skin and the variability that may arise from using various experimental/mathematical/pharmacokinetic models to quantify absorption as well as enabling the prediction of local and systemic efficacy and toxicity. In addition, unexpected behaviour may result from non-ideality in solute-vehicle-skin effects, including dehydration, chemical enhancement, supersaturation, metabolism, sequestration and vascular effects, including those of nanosystems on the local vasculature. In general, in vitro skin penetration profiles are predictive of in vivo profiles but a number of exceptions also exist.
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Affiliation(s)
- M S Roberts
- Therapeutics Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, S.A., Australia.
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Rippon M, Davies P, White R. Taking the trauma out of wound care: the importance of undisturbed healing. J Wound Care 2012; 21:359-60, 362, 364-8. [DOI: 10.12968/jowc.2012.21.8.359] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- M. Rippon
- Mölnlycke Health Care, Gothenburg, Sweden
| | - P. Davies
- Mölnlycke Health Care, Gothenburg, Sweden
| | - R. White
- Institute of Health, Social Care and Psychology, University of Worcester, UK
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