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Polverino G, Russo F, D’Andrea F. Bioactive Dressing: A New Algorithm in Wound Healing. J Clin Med 2024; 13:2488. [PMID: 38731023 PMCID: PMC11084389 DOI: 10.3390/jcm13092488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/03/2024] [Accepted: 04/20/2024] [Indexed: 05/13/2024] Open
Abstract
Wound management presents a significant global challenge, necessitating a comprehensive understanding of wound care products and clinical expertise in selecting dressings. Bioactive dressings (BD) represent a diverse category of dressings, capable of influencing wound healing through various mechanisms. These dressings, including honey, hyaluronic acid, collagen, alginates, and polymers enriched with polyhexamethylene biguanide, chitin, and chitosan derivatives, create a conducive environment for healing, promoting moisture balance, pH regulation, oxygen permeability, and fluid management. Interactive dressings further enhance targeted action by serving as substrates for bioactive agents. The continuous evolution of BDs, with new products introduced annually, underscores the need for updated knowledge in wound care. To facilitate dressing selection, a practical algorithm considers wound exudate, infection probability, and bleeding, guiding clinicians through the process. This algorithm aims to optimize wound care by ensuring the appropriate selection of BDs tailored to individual patient needs, ultimately improving outcomes in wound management.
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Affiliation(s)
- Gianmarco Polverino
- Correspondence: (G.P.); (F.R.); Tel.: +39-32-7449-3917 (G.P.); +39-33-3834-1531 (F.R.)
| | - Francesca Russo
- Correspondence: (G.P.); (F.R.); Tel.: +39-32-7449-3917 (G.P.); +39-33-3834-1531 (F.R.)
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2
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Augustin M, Keuthage W, Lobmann R, Lützkendorf S, Groth H, Möller U, Thomassin L, Bohbot S, Dissemond J, Blome C. Clinical evaluation of UrgoStart Plus dressings in real-life conditions: results of a prospective multicentre study on 961 patients. J Wound Care 2021; 30:966-978. [PMID: 34881999 DOI: 10.12968/jowc.2021.30.12.966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
AIMS This study aimed to evaluate the performances of lipid colloid technology with nano-oligosaccharide factor (TLC-NOSF) dressings with polyabsorbent fibres in an unselected population of patients under real-life conditions. METHODS A large, prospective, multicentre, observational study with three polyabsorbent TLC-NOSF dressings (UrgoStart Plus Pad, UrgoStart Plus and UrgoStart Plus Border, Laboratoires Urgo, France) was conducted in Germany between January 2019 and June 2020. Main outcomes included wound healing rate, clinical assessment of wound healing progression, local tolerance and acceptance of dressings, and changes in health-related quality of life (HRQoL) of the patients, assessed with the validated Wound-QoL questionnaire. RESULTS A total of 961 patients with wounds of various aetiologies (leg ulcers (LU), diabetic foot ulcers (DFU), pressure ulcers (PU) and other types of wounds) were treated with the evaluated dressings in 105 centres for a mean duration of 62 days (standard deviation 37 days). By the last visit, a wound closure or an improvement in wound healing was reported in 92.0% of the treated wounds. The highest wound closure rates were achieved when the dressings were used as first-line treatment: 71.3% in DFUs, 52.9% in LUs, 53.6% in PUs and 61.8% in the other wounds. Improvement of the wound healing process was also associated with an 87.5% relative reduction of sloughy tissue, a decrease of the level of exudate in 68.9% of the wounds, and an improvement in the periwound skin condition in 66.4% of the patients at the final visit. The dressings were 'very well' or 'well' tolerated and 'very well' or 'well' accepted by the large majority of patients. The HRQoL questionnaires were completed both at initial and final visits by 337 patients, representative of the total cohort. Despite the relatively short duration of the wounds, the HRQoL of the patients was already impaired at baseline, with 81.6% of the patients being severely affected in at least one aspect of their HRQoL. By the final visit, significant improvements in each dimension of the patients' HRQoL were reported (p<0.001), along with a reduction of the proportion of patients in need of intervention and in the number of actions needed per patient in relation to their HRQoL. CONCLUSIONS These results are consistent with previous clinical evidence on TLC-NOSF dressings. They confirm the good healing properties and safety profile of these dressings, and that a significant improvement in patient HRQoL is achieved in non-selected patients treated in real-life practice. These data support the use of such dressings as a first-line intervention and until wound healing in the management of chronic wounds, in association with appropriate standard of care.
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Affiliation(s)
- Matthias Augustin
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | | | - Ralf Lobmann
- Krankenhaus Bad Cannstatt (kbc) / Klinikum, Stuttgart, Germany
| | | | - Hauke Groth
- Medical Office specialized on Diabetes Relllingen, Hamburg-Rellingen, Germany
| | | | | | - Serge Bohbot
- Medical Affairs Department, Laboratoires URGO Medical, Paris, France
| | - Joachim Dissemond
- Department of Dermatology, Venereology, and Allergology, University Hospital Essen, Essen, Germany
| | - Christine Blome
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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3
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Nair H, Venkateshwaran N, Seetharaman S S, Deng W, Uthaipaisanwong A, Galea E. Benefits of sucrose octasulfate (TLC-NOSF) dressings in the treatment of chronic wounds: a systematic review. J Wound Care 2021; 30:S42-S52. [PMID: 33856929 DOI: 10.12968/jowc.2021.30.sup4.s42] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Management of chronic wounds remains one of the major challenges for health professionals and patients. An evidence-based decision is important to ensure that patients are receiving the best treatment proven to reduce healing time and improve outcomes, including economic benefits and patients' health-related quality of life (HRQoL). Due to recent restrictions because of the COVID-19 pandemic, including closure of wound care centres within hospitals and a drop in patient volume, chronic wound management needs simple-to-use dressings which are still effective and evidence-based solutions. This systematic review was conducted to identify the clinical evidence available on a sucrose octasulfate dressing (TLC-NOSF, UrgoStart dressing range, Laboratoires Urgo, France) to explore its efficacy in the management of chronic wounds, particularly lower limb ulcers, diabetic foot ulcers and pressure ulcers. METHOD A literature search of PubMed, Cochrane Library and Google Scholar was conducted based on the PICO model (patient/population, intervention, comparison and outcomes) to retrieve publications of different levels of evidence in order to evaluate outcomes of the use of TLC-NOSF dressings. RESULTS A total of 21 publications of different levels, ranging from double-blind randomised control trials to case reports, involving over 12,000 patients, were identified through PubMed, with a further eight publications through Google Scholar and two publications through Cochrane Library. A total of seven results were omitted due to the lack of relevance or repetition. CONCLUSION All the evidence provided suggest that these dressings provide clinicians with an evidence-based option for the management of chronic wounds; that the TLC-NOSF dressings are beneficial in promoting the healing process, reducing healing times, enhancing patients' HRQoL, and in allowing a more cost-effective procedure.
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Affiliation(s)
- Harikrishna Nair
- Head and Consultant, Wound Care Unit, Department of Internal Medicine, Kuala Lumpur Hospital, Malaysia
| | - N Venkateshwaran
- Consultant Plastic and Cosmetic Surgery, Jupiter Hospital, Mumbai, India
| | - Selva Seetharaman S
- Consultant and Head of Department of Plastic and Reconstructive Surgery, Gleneagles Global Hospital, Chennai, India
| | - Wuquan Deng
- Head of Endocrinology Department. Chongqing Emergency Medical Centre, Chongqing University Central Hospital, Chongqing, China
| | - Apinan Uthaipaisanwong
- Department of Surgery, King Chulalongkorn Memorial Hospital, Patumwan, Bangkok, Thailand
| | - Emilio Galea
- International Medical Director, Urgo Education and Training Alliance, Singapore
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Sagüez FS, Gallardo RC, Pozo AP. Uso de apósitos con TLC-NOSF en el manejo de la úlcera de pie diabético, basado en la revisión de la evidencia y la práctica clínica. J Wound Care 2020; 29:31-36. [PMID: 33251957 DOI: 10.12968/jowc.2020.29.latam_sup_3.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Management of diabetic foot ulcers with a TLC-NOSF dressing, based on evidence and clinical practice The incidence of diabetic foot ulcers (DFU) has increased in the past decade, both in Chile and worldwide, as a result of the progressive growth in diabetes prevalence. Because DFU are associated with a high risk of infection and amputation, it is crucial to choose effective and evidence-based treatments. A dressing combining technology lipidocolloid with nano-oligo saccharide factor (TLC-NOSF) has demonstrated its effectiveness in managing DFU. This article reviews the evidence around TLC-NOSF and its implementation in clinical practice.
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Affiliation(s)
- Francisco Salvador Sagüez
- Hospital Regional de Antofagasta, Facultad de Medicina y Odontología Universidad de Antofagasta, Chile
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Lobmann R, Grünerbel A, Lawall H, Lüdemann C, Morbach S, Tigges W, Völkel L, Rychlik RP. Impact of wound duration on diabetic foot ulcer healing: evaluation of a new sucrose octasulfate wound dressing. J Wound Care 2020; 29:543-551. [PMID: 33052796 DOI: 10.12968/jowc.2020.29.10.543] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE A common and frequent complication of diabetes is diabetic foot ulcers (DFU), which can have high treatment costs and severe adverse events. This study aims to evaluate the effects of wound duration on wound healing and the impact on costs, including treatment with a new sucrose octasulfate dressing compared with a control dressing. METHOD Based on the Explorer study (a two-armed randomised double-blind clinical trial), a cost-effectiveness analysis compared four different patient groups distinguished by their wound duration and additionally two DFU treatment options: a sucrose octasulfate dressing and a neutral dressing (as control). Clinical outcomes and total direct costs of wound dressings were evaluated over 20 weeks from the perspective of the Social Health Insurance in Germany. Simulation of long-term outcomes and costs were demonstrated by a five cycle Markov model. RESULTS The results show total wound healing rates between 71% and 14.8%, and direct treatment costs for DFU in the range of €2482-3278 (sucrose octasulfate dressing) and €2768-3194 (control dressing). Patients with a wound duration of ≤2 months revealed the highest wound healing rates for both the sucrose octasulfate dressing and control dressing (71% and 41%, respectively) and had the lowest direct treatment costs of €2482 and €2768, respectively. The 100-week Markov model amplified the results. Patients with ≤2 months' wound duration achieved wound healing rates of 98% and 88%, respectively and costs of €3450 and €6054, respectively (CE=€3520, €6864). Sensitivity analysis revealed that the dressing changes per week were the most significant uncertainty factor. CONCLUSION Based on the findings of this study, early treatment of DFU with a sucrose octasulfate dressing is recommended from a health economic view due to lower treatment costs, greater cost-effectiveness and higher wound healing rates.
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Affiliation(s)
- Ralf Lobmann
- Klinikum Stuttgart - Krankenhaus Bad Cannstatt, Stuttgart
| | | | - Holger Lawall
- Gemeinschaftspraxis Prof. Dr. med. Curt Diehm, Dr. med. Holger Lawall, Ettlingen
| | - Claas Lüdemann
- Evangelisches Waldkrankenhaus Spandau, Ein Unternehmen der Paul Gerhardt Diakonie, Berlin
| | | | | | - Lukas Völkel
- Institute of Empirical Health Economics, Burscheid, Germany
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6
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Dissemond J, Augustin M, Dietlein M, Keuthage W, Läuchli S, Lobmann R, Münter KC, Stücker M, Traber J, Vanscheidt W, Strohal R. [Sucrose octasulfate-evidence in the treatment of chronic wounds]. Hautarzt 2020; 71:791-801. [PMID: 32638031 DOI: 10.1007/s00105-020-04637-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Patients with chronic wounds should receive wound treatment in addition to causative therapy. In this context, the lack of adequate evidence for wound healing products has been repeatedly discussed. Using the example of TLC-sucrose octasulfate (TLC: technology lipido-colloid), the present review shows that there is significant data with good evidence and comparability in this area. One therapeutic approach to promote wound healing is the inhibition of matrix-metalloproteinases, for example by sucrose octasulfate. For wound products containing TLC-sucrose octasulfate, several sequential clinical studies have been conducted in recent years. The WHAT study was an open randomized controlled trial (RCT) with 117 patients with venous leg ulcers (VLU). The CHALLENGE study was a double-blind RCT with 187 patients with VLU. The SPID study was a pilot study with 33 patients with diabetic foot ulcers (DFU). The two prospective, multicenter clinical pilot studies NEREIDES and CASSIOPEE examined a total of 88 patients with VLU in different phases of healing. In the REALITY study, a pooled data analysis was performed on eight observational studies with 10,220 patients with chronic wounds of different genesis. In the double-blind, two-armed EXPLORER RCT, 240 patients with neuro-ischemic DFU were followed from first presentation until complete healing. In all studies, a significant promotion of wound healing could be shown by the use of wound healing products with TLC-sucrose octasulfate.
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Affiliation(s)
- Joachim Dissemond
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland.
| | - Matthias Augustin
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - Michael Dietlein
- Diabetesschwerpunktpraxis Dietlein, Bauernstr. 50, 86391, Stadtbergen, Deutschland
| | - Winfried Keuthage
- Schwerpunktpraxis Diabetes und Ernährungsmedizin, MedicalCenter am Clemenshospital, Düesbergweg 128, 48153, Münster, Deutschland
| | - Severin Läuchli
- Dermatologische Klinik, Universitätsspital Zürich, Gloriastr. 31, 8091, Zürich, Schweiz
| | - Ralf Lobmann
- Klinik für Endokrinologie, Diabetologie und Geriatrie, Klinikum Stuttgart - Krankenhaus Bad Cannstatt, Prießnitzweg 24, 70374, Stuttgart, Deutschland
| | | | - Markus Stücker
- Abteilung für Dermatologie und Venerologie, LKH Feldkirch, Akademisches Lehrspital, Carinagasse 45-47, 6800, Feldkirch, Österreich
| | - Jürg Traber
- Abteilung für Dermatologie Venerologie und Allergologie am St. Josef-Hospital, Klinikum der Ruhr-Universität Bochum, Gudrunstr. 56, 44791, Bochum, Deutschland
| | | | - Robert Strohal
- Dermatologische Gemeinschaftspraxis, Paula-Modersohn-Platz 3, 79100, Freiburg, Deutschland
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7
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Dissemond J, Lützkendorf S, Dietlein M, Neßeler I, Becker E, Möller U, Thomassin L, Bohbot S, Münter KC. Clinical evaluation of polyabsorbent TLC-NOSF dressings on chronic wounds: a prospective, observational, multicentre study of 1140 patients. J Wound Care 2020; 29:350-361. [DOI: 10.12968/jowc.2020.29.6.350] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Objective: The superior wound healing properties and cost-effectiveness of TLC-NOSF dressings in the local treatment of chronic wounds have already been demonstrated by several randomised controlled trials (RCTs) at a high quality level. Therefore, this study aimed to evaluate the efficacy and safety of new TLC-NOSF dressings with polyabsorbent fibres in an unselected population of patients under real-life conditions. Method: A large, prospective, multicentre, observational study with two polyabsorbent TLC-NOSF dressings (UrgoStart Plus Pad and UrgoStart Plus Border, Laboratoires Urgo, France) was conducted in Germany between July 2017 and December 2018. Main outcomes included wound healing rate, clinical assessment of wound healing progression, local tolerability and acceptance of dressings. Results: A total of 1140 patients with chronic wounds of various aetiologies (leg ulcers, diabetic foot ulcers, pressure ulcers, etc.) were treated with the investigated dressings in 130 centres, for a mean duration of 56±34 days. By the final visit, 48.5% of wounds had healed and 44.8% had improved. Similar results were reported regardless of wound aetiology or regardless of proportions of sloughy and granulation tissue at the start of treatment. According to the subgroup analysis by wound duration, the sooner the TLC-NOSF treatment was initiated, the better the clinical outcomes for all types of wounds. The dressings were very well tolerated and accepted by the patients. Conclusion: These results are consistent with those from RCTs conducted on TLC-NOSF dressings. They complete the evidence on the good healing properties and safety profile of these dressings, especially in non-selected patients treated in current practice, and regardless of the characteristics of wounds and patients. They support the use of the dressings as a first-line intervention and until wound healing in the management of chronic wounds, in association with appropriate standard of care.
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Affiliation(s)
- Joachim Dissemond
- Department of Dermatology, Venereology, and Allergology, University Hospital Essen, Essen, Germany
| | | | | | - Ingo Neßeler
- Department of Dermatology, Venereology, and Allergology, University Hospital Essen, Essen, Germany
- Medical Office Specialized on Vascular Medicine, Köln, Germany
| | | | | | | | - Serge Bohbot
- Medical Affairs Department, Laboratoires URGO Medical, Paris, France
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Shi C, Wang C, Liu H, Li Q, Li R, Zhang Y, Liu Y, Shao Y, Wang J. Selection of Appropriate Wound Dressing for Various Wounds. Front Bioeng Biotechnol 2020; 8:182. [PMID: 32266224 PMCID: PMC7096556 DOI: 10.3389/fbioe.2020.00182] [Citation(s) in RCA: 165] [Impact Index Per Article: 41.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 02/24/2020] [Indexed: 12/30/2022] Open
Abstract
There are many factors involved in wound healing, and the healing process is not static. The therapeutic effect of modern wound dressings in the clinical management of wounds is documented. However, there are few reports regarding the reasonable selection of dressings for certain types of wounds in the clinic. In this article, we retrospect the history of wound dressing development and the classification of modern wound dressings. In addition, the pros and cons of mainstream modern wound dressings for the healing of different wounds, such as diabetic foot ulcers, pressure ulcers, burns and scalds, and chronic leg ulcers, as well as the physiological mechanisms involved in wound healing are summarized. This article provides a clinical guideline for selecting suitable wound dressings according to the types of wounds.
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Affiliation(s)
- Chenyu Shi
- School of Nursing, Jilin University, Changchun, China.,Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China
| | - Chenyu Wang
- Department of Plastic and Reconstructive Surgery, The First Hospital of Jilin University, Changchun, China
| | - He Liu
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China
| | - Qiuju Li
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China
| | - Ronghang Li
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China
| | - Yan Zhang
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China
| | - Yuzhe Liu
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China
| | - Ying Shao
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China.,Department of Plastic and Reconstructive Surgery, The First Hospital of Jilin University, Changchun, China
| | - Jincheng Wang
- School of Nursing, Jilin University, Changchun, China.,Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China
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Lobmann R, Augustin M, Lawall H, Tigges W, Potempa C, Thiem H, Fietz C, Rychlik RPT. Cost-effectiveness of TLC-sucrose octasulfate versus control dressings in the treatment of diabetic foot ulcers. J Wound Care 2019; 28:808-816. [DOI: 10.12968/jowc.2019.28.12.808] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Objective:Diabetes is one of the most widespread diseases in Germany. Common complications are diabetic foot ulcers (DFU), which are associated with a cost-intensive treatment and serious adverse events, such as infections, amputations. This cost-effectiveness analysis compares two treatment options for patients with DFU: a TLC-NOSF dressing versus a neutral dressing, assessed through a European double-blind randomised controlled trial (RCT), Explorer.Methods:The evaluation of the clinical outcomes was associated to direct costs (costs for dressings, nursing time, hospitalisation etc.) of both dressings, from the perspective of the statutory health insurance in Germany. Due to the long mean healing time of a DFU, the observation period was extended from 20 to 100 weeks in a Markov model.Results:After 20 weeks, and with complete closure as a primary endpoint, the model revealed direct treatment costs for DFU of €2,864.21 when treated with a TLC-NOSF dressing compared with €2,958.69 with the neutral control dressing (cost-effectiveness: €6,017.25 versus €9,928.49). In the Markov model (100 weeks) the costs for the TLC-NOSF dressing were €5,882.87 compared with €8,449.39 with the neutral dressing (cost-effectiveness: €6,277.58 versus €10,375.56). The robustness of results was underlined by several sensitivity analyses for varying assumptions. The frequency of weekly dressing changes had the most significant influence in terms of parameter uncertainty.Conclusion:Overall, the treatment of DFU with a TLC-NOSF dressing is supported from a health economic perspective, because both the treatment costs and the cost-effectiveness were superior compared with the neutral wound dressing.
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Affiliation(s)
- Ralf Lobmann
- Professor; Krankenhaus Bad Cannstatt (kbc) / Klinikum Stuttgart
| | | | - Holger Lawall
- Professor; Gemeinschaftspraxis (joint practice) Prof. Dr. med Curt Diehm/Dr. med Holger Lawall, Ettlingen, Germany
| | | | | | - Helena Thiem
- Institute for Empirical Health Economics, Burscheid, Germany
| | - Cornelia Fietz
- Institute for Empirical Health Economics, Burscheid, Germany
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10
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Lázaro-Martínez JL, Edmonds M, Rayman G, Apelqvist J, Van Acker K, Hartemann A, Martini J, Lobmann R, Bohbot S, Kerihuel JC, Piaggesi A. Optimal wound closure of diabetic foot ulcers with early initiation of TLC-NOSF treatment: post-hoc analysis of Explorer. J Wound Care 2019; 28:358-367. [DOI: 10.12968/jowc.2019.28.6.358] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Objective: In March 2018, the Explorer study, an international, double-blind, randomised controlled trial (RCT), established that adding a TLC-NOSF (UrgoStart Contact, Laboratoires Urgo, France) dressing to good local standard of care (SoC) significantly and substantially increases wound closure and reduces the healing time of neuroischaemic diabetic foot ulcers (DFU). Besides the TLC-NOSF treatment, the wound duration was the only other covariate that had an influence on the wound closure rate in the regression model used in the original study. The purpose of this work was to further document the impact of wound duration on the healing outcomes of the DFUs included in the Explorer study and to discuss complementary pragmatic observations on the TLC-NOSF effect. Method: In this post-hoc analysis of the Explorer data, the wound closure rates by week 20 are reported for the global cohort (n=240, Intention-to-treat population) and for the treated (n=126) and control groups (n=114) according to DFU duration and location. Results: For the combined group, wound closure rates decreased with the increase of wound duration at baseline (from 57% in wounds ≤2 months to 19% in wounds >11 months). Whatever the wound duration subgroups analysed, higher closure rates were reported in the TLC-NOSF group than in the control group. However, the maximal difference between the two treatments was reported in wounds with a duration of ≤2 months (71% versus 41%, 30 percentage points difference, Relative Risk 1.7, 95% Confidence Interval 1.1 to 2.8). Regarding wound location subgroup analyses, the outcomes were always in favour of the TLC-NOSF treatment, with closure rates ranging between 43% and 61% within the TLC-NOSF group, and between 25% and 40% within the control group. Conclusion: This clinical evidence supports that treating DFUs with TLC-NOSF dressing and good SoC results in higher wound closure rates than with a neutral dressing and the same good standard of care, whatever the duration and the location of the treated wounds. However, the earlier the TLC-NOSF dressing is initiated in DFU treatment, the greater the benefits.
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Affiliation(s)
| | | | - Gerry Rayman
- The Ipswich Diabetic Foot Unit, Diabetes Centre, The Ipswich Hospital NHS Trust, Ipswich, Suffolk, UK
| | - Jan Apelqvist
- Department of Endocrinology, University Hospital of Malmö, Malmö, Sweden
| | | | - Agnès Hartemann
- Department of Diabetology, Pitié-Salpêtrière University Hospital, Paris, France
| | - Jacques Martini
- Department of Endocrinology, Rangueil University Hospital, Toulouse, France
| | - Ralf Lobmann
- Department of Endocrinology, Diabetology and Geriatrics, Klinikum Stuttgart, Germany
| | - Serge Bohbot
- Medical Affairs Department, Laboratoires URGO, Paris, France
| | | | - Alberto Piaggesi
- Department of Endocrinology and Metabolism, University of Pisa, Pisa, Italy
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11
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Aljghami ME, Saboor S, Amini-Nik S. Emerging Innovative Wound Dressings. Ann Biomed Eng 2018; 47:659-675. [DOI: 10.1007/s10439-018-02186-w] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 12/07/2018] [Indexed: 12/11/2022]
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12
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Dumont IJ, Lepeut M, Segalen C, Guillemin Y, Gouze JN. Use of GBT013, a Collagen-Based Dressing, for the Healing of Diabetic Foot Ulcers. J Am Podiatr Med Assoc 2018; 108:419-429. [PMID: 34670344 DOI: 10.7547/16-102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The number of people with diabetes is expected to reach 592 million in the year 2035. Diabetic foot lesions are responsible for more hospitalizations than any other complication of diabetes. The aims of this study were to examine for the first time a new biocompatible and biodegradable tridimensional collagen-based matrix, GBT013, in humans for diabetic foot ulcer wound healing and to evaluate its ease of use to better define a protocol for a future clinical trial. Seven adult patients with a diabetic foot ulcer of grade 1A to 3D (University of Texas Diabetic Wound Classification) were treated using GBT013, a new collagen-based advance dressing and were monitored in two specialized foot care units for a maximum of 9 weeks. Five of seven wounds achieved complete healing in 4 to 7 weeks. Nonhealed ulcers showed a significant reduction of the wound surface (>44%). GBT013 was well tolerated and displayed positive wound healing outcomes as a new treatment strategy of chronic foot ulcers in diabetic patients.
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Affiliation(s)
| | - Marc Lepeut
- Centre Hospitalier de Roubaix, Roubaix, France
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Romanelli M, Piaggesi A, Scapagnini G, Dini V, Janowska A, Iacopi E, Scarpa C, Fauverghe S, Bassetto F. EUREKA study - the evaluation of real-life use of a biophotonic system in chronic wound management: an interim analysis. DRUG DESIGN DEVELOPMENT AND THERAPY 2017; 11:3551-3558. [PMID: 29270004 PMCID: PMC5729886 DOI: 10.2147/dddt.s142580] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Objective Interest has grown regarding photobiomodulation (PBM) with low-level light therapy, which has been shown to positively affect the stages of the wound healing process. In a real-life context clinical setting, the objective of the EUREKA study was to investigate efficacy, safety, and quality of life associated with the use of a BioPhotonic gel (LumiHeal™) in the treatment of chronic wounds such as venous leg ulcers (VLUs), diabetic foot ulcers (DFUs), and pressure ulcers (PUs). This BioPhotonic gel represents a new, first-in-class emission spectrum of light, including fluorescence, to induce PBM and modulate healing. Design The multicenter, prospective, interventional, uncontrolled, open-label study enrolled 100 patients in 12 wound centers in Italy. We performed an early interim analysis based on the first 33 subjects (13 VLU, 17 DFU, 3 PU) in seven centers who completed the study. Main results Seventeen patients (52%) achieved total wound closure (full re-epithelialization for 2 weeks) during the study period. Two patients (6%) were considered “almost closed” (decrease of the wound area of more than 90% at study end) and three others (9%) were considered “ready for skin grafting”. No related serious adverse events were observed, and the compliance was excellent. After the treatment, the average time to “pain-free” was 11.9 days in the VLU group. Quality of life was improved with overall increase of 26.4% of the total score (Cardiff Wound Impact Schedule, p=0.001). Conclusion The study revealed a positive efficacy profile of the BioPhotonic gel in promoting wound healing and reactivating the healing process in different types of chronic, hard-to-heal wounds. The treatment was shown to be safe and well tolerated by the patients, and a reduction of pain perception was also detected during the treatment period. The improvement of the quality of life was accompanied by a high level of clinician satisfaction.
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Affiliation(s)
- Marco Romanelli
- Wound Healing Research Unit, Division of Dermatology, School of Medicine, University of Pisa, Pisa
| | - Alberto Piaggesi
- Diabetic Foot Section, Department of Medicine, University of Pisa, Pisa
| | - Giovanni Scapagnini
- Department of Medicine and Health Sciences, School of Medicine, University of Molise, Campobasso
| | - Valentina Dini
- Wound Healing Research Unit, Division of Dermatology, School of Medicine, University of Pisa, Pisa
| | - Agata Janowska
- Wound Healing Research Unit, Division of Dermatology, School of Medicine, University of Pisa, Pisa
| | - Elisabetta Iacopi
- Diabetic Foot Section, Department of Medicine, University of Pisa, Pisa
| | - Carlotta Scarpa
- Clinic of Plastic and Reconstructive Surgery, Padova University-Hospital, Padova, Italy
| | | | - Franco Bassetto
- Clinic of Plastic and Reconstructive Surgery, Padova University-Hospital, Padova, Italy
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Henshaw FR, Bolton T, Nube V, Hood A, Veldhoen D, Pfrunder L, McKew GL, Macleod C, McLennan SV, Twigg SM. Topical application of the bee hive protectant propolis is well tolerated and improves human diabetic foot ulcer healing in a prospective feasibility study. J Diabetes Complications 2014; 28:850-7. [PMID: 25239451 DOI: 10.1016/j.jdiacomp.2014.07.012] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 07/07/2014] [Accepted: 07/30/2014] [Indexed: 01/13/2023]
Abstract
AIMS Propolis is a naturally occurring anti-inflammatory bee derived protectant resin. We have previously reported that topically applied propolis reduces inflammation and improves cutaneous ulcer healing in diabetic rodents. The aim of this study was to determine if propolis shows efficacy in a pilot study of human diabetic foot ulcer (DFU) healing and if it is well tolerated. MATERIALS Serial consenting subjects (n=24) with DFU ≥4 weeks' duration had topical propolis applied at each clinic review for 6 weeks. Post-debridement wound fluid was analyzed for viable bacterial count and pro-inflammatory MMP-9 activity. Ulcer healing data were compared with a matched control cohort of n=84 with comparable DFU treated recently at the same center. RESULTS Ulcer area was reduced by a mean 41% in the propolis group compared with 16% in the control group at week 1 (P<0.001), and by 63 vs. 44% at week 3, respectively (P<0.05). In addition, 10 vs. 2% (P<0.001), then 19 vs. 12% (P<0.05) of propolis treated vs. control ulcers had fully healed by weeks 3 and 7, respectively. Post-debridement wound fluid active MMP-9 was significantly reduced, by 18.1 vs. 2.8% week 3 from baseline in propolis treated ulcers vs. controls (P<0.001), as were bacterial counts (P<0.001). No adverse effects from propolis were reported. CONCLUSIONS Topical propolis is a well-tolerated therapy for wound healing and this pilot in human DFU indicates for the first time that it may enhance wound closure in this setting when applied weekly. A multi-site randomized controlled of topical propolis now appears to be warranted in diabetic foot ulcers.
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Affiliation(s)
- Frances R Henshaw
- Sydney Medical School, University of Sydney, Sydney, Australia; Diabetes Centre, Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Thyra Bolton
- Diabetes Centre, Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Vanessa Nube
- Diabetes Centre, Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Anita Hood
- Diabetes Centre, Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Danielle Veldhoen
- Diabetes Centre, Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Louise Pfrunder
- Diabetes Centre, Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Genevieve L McKew
- Sydney Medical School, University of Sydney, Sydney, Australia; Department of Microbiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Colin Macleod
- Sydney Medical School, University of Sydney, Sydney, Australia; Department of Microbiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Susan V McLennan
- Sydney Medical School, University of Sydney, Sydney, Australia; Diabetes Centre, Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Stephen M Twigg
- Sydney Medical School, University of Sydney, Sydney, Australia; Diabetes Centre, Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, Australia.
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Wicks K, Torbica T, Mace KA. Myeloid cell dysfunction and the pathogenesis of the diabetic chronic wound. Semin Immunol 2014; 26:341-53. [PMID: 24954378 DOI: 10.1016/j.smim.2014.04.006] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Accepted: 04/22/2014] [Indexed: 12/17/2022]
Abstract
Diabetes can promote a state of chronic inflammation associated with serious complications that are difficult to treat, including ulceration of the lower extremities and chronic wounds. Chronic wounds are often incurable and contribute to both a reduced quality of life for patients and an enormous burden for healthcare services. In diabetes, the inflammatory response early in wound healing is inappropriately amplified and prolonged, leading to the persistent presence in the wound of vastly elevated numbers of dysfunctional, hyperpolarised macrophages that fail to transition to a pro-healing phenotype. Recent evidence suggests that systemic chronic inflammation induces intrinsic defects in monocytes via chromatin modifications that may pre-programme monocytes to a pro-inflammatory phenotype, while the local wound environment inhibits differentiation to a pro-healing phenotype. Current understanding remains incomplete, and careful dissection of how local and systemic inflammation combine to negatively influence myeloid cell development will be key to developing effective therapies aimed at healing the diabetic wound.
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Affiliation(s)
- Kate Wicks
- The Healing Foundation Centre, Faculty of Life Sciences, University of Manchester, Manchester M13 9PT, United Kingdom
| | - Tanja Torbica
- The Healing Foundation Centre, Faculty of Life Sciences, University of Manchester, Manchester M13 9PT, United Kingdom
| | - Kimberly A Mace
- The Healing Foundation Centre, Faculty of Life Sciences, University of Manchester, Manchester M13 9PT, United Kingdom.
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Shanahan D. The Explorer study: the first double-blind RCT to assess the efficacy of TLC-NOSF on DFUs. J Wound Care 2013; 22:78-82. [DOI: 10.12968/jowc.2013.22.2.78] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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