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Steinheber J, Kanz KG, Biberthaler P, Flatz W, Bogner-Flatz V. [Head injuries and their wound treatment]. Unfallchirurgie (Heidelb) 2024; 127:391-402. [PMID: 38619616 DOI: 10.1007/s00113-024-01430-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 04/16/2024]
Abstract
Head injuries are frequent occurrences in emergency departments worldwide and are notable for the fact that attention must be paid to the sequelae of intracranial and extracranial trauma. It is crucial to assess potential intracranial injuries and to strive for both medically sound and esthetically pleasing extracranial outcomes. The aim of this continuing education article is to provide a refresher on knowledge of head injuries and the associated nuances for wound care.
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Affiliation(s)
- Jakob Steinheber
- Klinik für Unfallchirurgie und Orthopädie, Wiederherstellungschirurgie, Sportmedizin, Kreisklinik Ebersberg, Ebersberg, Deutschland
| | - Karl-Georg Kanz
- Zentrale Notaufnahme, Klinikum rechts der Isar der Technischen Universität München und Ärztlicher Bezirksbeauftragter Rettungsdienst Oberbayern West, München, Deutschland
| | - Peter Biberthaler
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar der Technischen Universität München, München, Deutschland
| | - Wilhelm Flatz
- Klinik und Poliklinik für Radiologie, Ludwig-Maximilians-Universität München, München, Deutschland
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2
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Liu C, Li M, Liu Z, Shi Z, Wang X, Huang F. Chitosan thermogelation and cascade mineralization via sequential CaCO 3 incorporations for wound care. Int J Biol Macromol 2024; 266:131076. [PMID: 38531522 DOI: 10.1016/j.ijbiomac.2024.131076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 03/13/2024] [Accepted: 03/20/2024] [Indexed: 03/28/2024]
Abstract
Physically crosslinked hydrogels have shown great potential as excellent and eco-friendly matrices for wound management. Herein, we demonstrate the development of a thermosensitive chitosan hydrogel system using CaCO3 as a gelling agent, followed by CaCO3 mineralization to fine-tune its properties. The chitosan hydrogel effectively gelled at 37 °C and above after an incubation period of at least 2 h, facilitated by the CaCO3-mediated slow deprotonation of primary amine groups on chitosan polymers. Through synthesizing and characterizing various chitosan hydrogel compositions, we found that mineralization played a key role in enhancing the hydrogels' mechanical strength, viscosity, and thermal inertia. Moreover, thorough in vitro and in vivo assessments of the chitosan-based hydrogels, whether modified with mineralization or not, demonstrated their outstanding hemostatic activity (reducing coagulation time by >41 %), biocompatibility with minimal inflammation, and biodegradability. Importantly, in vivo evaluations using a rat burn wound model unveiled a clear wound healing promotion property of the chitosan hydrogels, and the mineralized form outperformed its precursor, with a reduction of >7 days in wound closure time. This study presents the first-time utilization of chitosan/CaCO3 as a thermogelation formulation, offering a promising prototype for a new family of thermosensitive hydrogels highly suited for wound care applications.
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Affiliation(s)
- Chengkun Liu
- State Key Laboratory of Heavy Oil Processing & College of Chemistry and Chemical Engineering, China University of Petroleum (East China), 66 West Changjiang Road, Qingdao, Shandong 266580, China
| | - Menghan Li
- State Key Laboratory of Heavy Oil Processing & College of Chemistry and Chemical Engineering, China University of Petroleum (East China), 66 West Changjiang Road, Qingdao, Shandong 266580, China
| | - Zhiyuan Liu
- State Key Laboratory of Heavy Oil Processing & College of Chemistry and Chemical Engineering, China University of Petroleum (East China), 66 West Changjiang Road, Qingdao, Shandong 266580, China
| | - Zhuang Shi
- State Key Laboratory of Heavy Oil Processing & College of Chemistry and Chemical Engineering, China University of Petroleum (East China), 66 West Changjiang Road, Qingdao, Shandong 266580, China
| | - Xiaoqiang Wang
- State Key Laboratory of Heavy Oil Processing & College of Chemistry and Chemical Engineering, China University of Petroleum (East China), 66 West Changjiang Road, Qingdao, Shandong 266580, China.
| | - Fang Huang
- State Key Laboratory of Heavy Oil Processing & College of Chemistry and Chemical Engineering, China University of Petroleum (East China), 66 West Changjiang Road, Qingdao, Shandong 266580, China
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3
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Ford C, Hill B. A guide to removing surgical staples. Br J Nurs 2024; 33:372-380. [PMID: 38639750 DOI: 10.12968/bjon.2024.33.8.372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
This article provides a comprehensive overview of the wound healing process, emphasising the critical role of surgical staples in primary intention healing. It outlines the four distinct phases of wound healing including haemostasis, inflammation, proliferation, and maturation - and discusses the mechanisms by which surgical staples enhance this natural biological process. Special focus is given to the aseptic non-touch technique (ANTT), which is crucial in preventing infections during the staple removal procedure. The article further explores the procedural steps involved in the removal of surgical staples and highlights the holistic aspects of patient care that need to be considered. This includes strategies for effective pain management, ensuring informed consent, and maintaining a sterile environment. By integrating clinical skills with a thorough understanding of wound care, this article aims to improve nursing practices in surgical settings, promoting better patient outcomes and recovery.
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Affiliation(s)
- Claire Ford
- Assistant Professor, Adult Nursing, Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne
| | - Barry Hill
- Associate Professor of Nursing and Critical Care, Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne
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Sanjarnia P, Picchio ML, Polegre Solis AN, Schuhladen K, Fliss PM, Politakos N, Metterhausen L, Calderón M, Osorio-Blanco ER. Bringing innovative wound care polymer materials to the market: Challenges, developments, and new trends. Adv Drug Deliv Rev 2024; 207:115217. [PMID: 38423362 DOI: 10.1016/j.addr.2024.115217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/24/2024] [Accepted: 02/18/2024] [Indexed: 03/02/2024]
Abstract
The development of innovative products for treating acute and chronic wounds has become a significant topic in healthcare, resulting in numerous products and innovations over time. The growing number of patients with comorbidities and chronic diseases, which may significantly alter, delay, or inhibit normal wound healing, has introduced considerable new challenges into the wound management scenario. Researchers in academia have quickly identified promising solutions, and many advanced wound healing materials have recently been designed; however, their successful translation to the market remains highly complex and unlikely without the contribution of industry experts. This review article condenses the main aspects of wound healing applications that will serve as a practical guide for researchers working in academia and industry devoted to designing, evaluating, validating, and translating polymer wound care materials to the market. The article highlights the current challenges in wound management, describes the state-of-the-art products already on the market and trending polymer materials, describes the regulation pathways for approval, discusses current wound healing models, and offers a perspective on new technologies that could soon reach consumers. We envision that this comprehensive review will significantly contribute to highlighting the importance of networking and exchanges between academia and healthcare companies. Only through the joint of these two actors, where innovation, manufacturing, regulatory insights, and financial resources act in harmony, can wound care products be developed efficiently to reach patients quickly and affordably.
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Affiliation(s)
- Pegah Sanjarnia
- POLYMAT, Applied Chemistry Department, Faculty of Chemistry, University of the Basque Country UPV/EHU, Paseo Manuel de Lardizábal, 3, 20018 Donostia-San Sebastián, Spain
| | - Matías L Picchio
- POLYMAT, Applied Chemistry Department, Faculty of Chemistry, University of the Basque Country UPV/EHU, Paseo Manuel de Lardizábal, 3, 20018 Donostia-San Sebastián, Spain; Instituto de Desarrollo Tecnológico para la Industria Química (INTEC), CONICET, Güemes 3450, Santa Fe 3000, Argentina
| | - Agustin N Polegre Solis
- Beiersdorf AG, Research & Development Department, Beiersdorfstraße 1-9, 22529 Hamburg, Germany
| | - Katharina Schuhladen
- Beiersdorf AG, Research & Development Department, Beiersdorfstraße 1-9, 22529 Hamburg, Germany
| | - Patricia M Fliss
- Beiersdorf AG, Research & Development Department, Beiersdorfstraße 1-9, 22529 Hamburg, Germany
| | - Nikolaos Politakos
- POLYMAT, Applied Chemistry Department, Faculty of Chemistry, University of the Basque Country UPV/EHU, Paseo Manuel de Lardizábal, 3, 20018 Donostia-San Sebastián, Spain
| | - Lutz Metterhausen
- Beiersdorf AG, Research & Development Department, Beiersdorfstraße 1-9, 22529 Hamburg, Germany
| | - Marcelo Calderón
- POLYMAT, Applied Chemistry Department, Faculty of Chemistry, University of the Basque Country UPV/EHU, Paseo Manuel de Lardizábal, 3, 20018 Donostia-San Sebastián, Spain; IKERBASQUE, Basque Foundation for Science, Plaza Euskadi 5, 48009 Bilbao, Spain
| | - Ernesto R Osorio-Blanco
- Beiersdorf AG, Research & Development Department, Beiersdorfstraße 1-9, 22529 Hamburg, Germany.
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Zuniga J, Mungai M, Chism L, Frost L, Kakkar R, Kyololo O. Pressure ulcer prevention and treatment interventions in Sub-Saharan Africa: A systematic review. Nurs Outlook 2024; 72:102151. [PMID: 38490058 DOI: 10.1016/j.outlook.2024.102151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 01/24/2024] [Accepted: 02/11/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND The high burden of pressure ulcers (PUs) in Sub-Saharan Africa (SSA), coupled with the limited resources, underscores the need for preventive and context-specific treatment strategies. PURPOSE Therefore, the purpose of this systematic review was to establish and elucidate PU prevention and treatment interventions tested in SSA. METHODS This systematic review of the literature used, PRISMA to guide the search. FINDINGS The review identified nine studies on PU prevention (three) and treatment (six). Low-cost interventions assembled from locally available materials and multifaceted policies significantly prevented and treated PUs. The interventions included wound dressing agents, simple negative pressure suction devices that significantly treated PUs, and water-based bed surfaces. DISCUSSION There were gaps in the interventions that have been proven successful in other global settings. CONCLUSION In SSA, there is a need for nurses to tailor, test, and disseminate findings from evidence-based projects for PU prevention that have been successful in similar settings.
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Affiliation(s)
- Julie Zuniga
- School of Nursing, The University of Texas at Austin, Austin, TX
| | | | - Lucy Chism
- School of Nursing, The University of Texas at Austin, Austin, TX
| | - Livia Frost
- School of Medicine, Baylor College of Medicine, Houston, TX
| | - Reha Kakkar
- College of Natural Sciences, The University of Texas at Austin, Austin, TX
| | - O'Brien Kyololo
- School of Nursing and Midwifery, Moi University, Eldoret, Kenya
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Bilik OA, Ince FM, Ozcan N, Ayaydin Z. An unusual case of Brucella melitensis-related wound infection. Infez Med 2024; 32:99-102. [PMID: 38456025 PMCID: PMC10917558 DOI: 10.53854/liim-3201-13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/08/2024] [Indexed: 03/09/2024]
Abstract
Background Brucellosis is an anthropo-zoonotic infectious disease caused by various Brucella species. It is usually transmitted through contact with infected animals or consumption of contaminated animal products. Brucellosis most commonly affects the musculoskeletal and reticuloendothelial system with additional involvement observed in gastrointestinal system, urinary tract, reproductive system, central nervous system, and cardiovascular system. Skin involvement is extremely rare in brucellosis. Here, we report a rare case of Brucella melitensis infection developing in a back wound following a lumbar disc herniation surgery over 14 years ago. Case A 34-year-old male patient, who had a herniated disc surgery 14 years ago, was admitted to the hospital with complaints of joint pain, sweating and discharge at the surgery site. Wound culture revealed the presence of Gram negative cocobacilli which was identified as Brucella melitensis. The subsequent diagnostic tests, including the Rose-Bengal and Brucella Capture test positivity at a titer of 1/320 confirmed the diagnosis. The patient received six weeks of doxycycline (200 mg/day, orally) and rifampin (600 mg/day orally) treatment, accompanied by wound care procedures. Daily cleaning, sterile dressing, and wound debridement were employed. Following treatment, the patient's condition improved, and wound discharge ceased. Continuous monitoring showed no signs of relapse, achieving complete remission. Conclusion Brucella spp. should be considered as a potential cause of wound infections developing after surgery or trauma in brucellosis-endemic areas. This report also emphasizes the importance of promptly determining the cause of infection before initiating antibiotic treatment.
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Affiliation(s)
- Ozge Alkan Bilik
- Medical Microbiology Laboratory, Selahaddin Eyyubi State Hospital, Diyarbakir, Turkey
| | - Fatma Meral Ince
- Infectious Diseases and Clinical Microbiology, Selahaddin Eyyubi State Hospital, Diyarbakir, Turkey
| | - Nida Ozcan
- Dept. of Medical Microbiology, Dicle University Faculty of Medicine, Diyarbakir, Turkey
| | - Zeynep Ayaydin
- Medical Microbiology Laboratory, Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
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Rezapanah A, Emadi E, Alamdari DH. Treatment of recalcitrant esophagocutaneous fistula by platelet-rich-plasma-fibrin glue: A case study. Int J Surg Case Rep 2024; 116:109335. [PMID: 38308979 PMCID: PMC10847784 DOI: 10.1016/j.ijscr.2024.109335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 02/05/2024] Open
Abstract
INTRODUCTION Recalcitrant esophagocutaneous fistula is a very uncommon complication after neck surgery. Management of this non-healing fistula has long been a topic of debate. This report provides an approach for treating it. PRESENTATION OF CASE A 65-year-old woman presented nineteen years after branchial cleft cyst surgery with cyst recurrence associated with swelling. Sonography displayed a collection in the front of the left carotid artery in the suprasternal notch. On the CT, a similar finding was seen, a collection with gaseous density in front of the left sternocleidomastoid and a hypodense nodule on the right lobe of the thyroid. The pathology report describes an abscess with many macrophages and neutrophils, fat necrosis, microcalcification, and foreign body reaction around amorphous bodies. Again, surgical resection of the swelling area and tract was done and an esophago-cutaneous fistula was developed after surgery which did not heal after 6 months. CLINICAL DISCUSSION According to accelerating the healing time and complete closure of chronic wounds such as lower-extremity diabetic ulcers, persistent pneumothorax, anal fistula, and recalcitrant gastrocutaneous fistula by using platelet-rich plasma (PRP) and fibrin glue (FG); PRP-FG can be considered as a safe and effective treatment option for chronic wound healing. So, for treatment of this fistula, PRP-FG was used. PRP-FG was obtained from the patient's blood and injected into the fistula tract. The discharge was stopped after one week and the fistula was cured. CONCLUSION PRP-FG injection into the fistula tract provides a simple and non-invasive approach for the treatment of recalcitrant esophagocutaneous fistula.
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Affiliation(s)
- Alireza Rezapanah
- Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Elaheh Emadi
- Vascular and Endovascular Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Daryoush Hamidi Alamdari
- Vascular and Endovascular Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
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Mitchell A, Hill B. Assessment of diabetic foot ulcers: back to basics. Br J Nurs 2024; 33:S24-S32. [PMID: 38386520 DOI: 10.12968/bjon.2024.33.4.s24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
Diabetic foot ulceration affects up to 34% of the global diabetic population as a result of poor glycaemic control. Complications resulting from diabetic foot ulceration can be complex, expensive and challenging. It is important for risk factors to be recognised early and for regular assessment to take place. Streamlining a coordinated approach that enhances communication and guides treatment approaches can help to improve wound outcomes.
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Affiliation(s)
- Aby Mitchell
- Senior Lecturer Nursing Education, Department of Adult Nursing, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London
| | - Barry Hill
- Associate Professor of Nursing and Critical Care, Northumbria University
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Stephens M, Chester-Bessell D, Rose S. Wound care in hard-to-reach populations: rough sleepers. Br J Nurs 2024; 33:S34-S37. [PMID: 38386529 DOI: 10.12968/bjon.2024.33.4.s34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
People sleeping rough commonly develop wounds and other skin disorders. Wounds vary and develop for multiple reasons. They include acute wounds such as burns, infected injection sites, abscesses and cellulitis, as well as chronic wounds such as pressure ulcers; rough sleepers have a high prevalence of lower limb wounds. Skin and soft tissue infections are common, especially in people who inject drugs via subcutaneous or intramuscular routes. Emergency departments are often the pathways into healthcare for homeless people as traditional health and care systems often fail to meet their needs. Across England, initiatives have been developed to improve access to wound care for those who sleep rough. A case study illustrates the care of a homeless man presenting with a lower limb wound.
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Beagles E, Shih A. New tender, bleeding papule on the left ear. BMJ Case Rep 2024; 17:e258101. [PMID: 38195184 PMCID: PMC10806893 DOI: 10.1136/bcr-2023-258101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024] Open
Abstract
Chondrodermatitis nodularis helicis (CNH) is a painful, inflammatory condition that impacts the skin of the ear. It is commonly associated with pressure on the pinna causing a nodule that may have erythema, bleeding and exudate. We present a case of a woman in her 60s with a history of basal cell carcinoma who presented with a new tender spot on the antihelix of her left ear. The tenderness of the new spot forced her to switch from holding her phone to her left ear to using her right ear. A shave biopsy confirmed CNH and ruled out non-melanoma skin cancer. Although most prior cases report association with sleeping on the side of the affected ear, this case was attributed to cell phone use. It is important to remember that non-traditional sources of pressure can also lead to CNH.
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Affiliation(s)
- Emma Beagles
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Allen Shih
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Allen JT, Toro D, Lough M, Griswold L. Pyoderma gangrenosum following gynaecological surgery. BMJ Case Rep 2023; 16:e256676. [PMID: 38160031 PMCID: PMC10759017 DOI: 10.1136/bcr-2023-256676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2023] [Indexed: 01/03/2024] Open
Abstract
A perimenopausal woman with abnormal uterine bleeding underwent an uncomplicated laparoscopic hysterectomy. Postoperatively, she developed fever, abdominal erythema and pain. Imaging revealed diffuse abdominal wall skin thickening, most pronounced at the right port site with a small area concerning for developing abscess. There was high clinical suspicion for necrotising fasciitis due to rapidly progressive skin deterioration. Despite antibiotics and surgical debridement, her condition progressed. Biopsy of the inflamed tissue confirmed a diagnosis of pyoderma gangrenosum (PG), and treatment with daily prednisone led to rapid improvement of symptoms.Successful diagnosis and treatment of the patient's symptoms required multidisciplinary collaboration among gynaecology, general surgery and dermatology. PG, although a well-known condition among dermatologists, is rarely, if ever, encountered by gynaecologists, and its resemblance to conditions such as necrotising fasciitis complicates early detection and intervention. This case highlights the diagnostic and management challenges associated with PG in the gynaecological setting.
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Affiliation(s)
| | - Diana Toro
- Obstetrics & Gynecology, Augusta University, Augusta, Georgia, USA
| | - Morgan Lough
- Obstetrics & Gynecology, Augusta University, Augusta, Georgia, USA
| | - Lauren Griswold
- Obstetrics & Gynecology, Walter Reed National Military Medical Center, Bethesda, MD, USA
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12
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Wang XH, Li M, Cheng Y, Wang GJ, Lin GL, Liu WN. Comprehensive treatment of deep frostbite of multiple fingers after trauma: A case report. World J Clin Cases 2023; 11:8219-8227. [PMID: 38130784 PMCID: PMC10731172 DOI: 10.12998/wjcc.v11.i34.8219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 10/27/2023] [Accepted: 11/29/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Frostbite is becoming increasingly common in urban environments, and severe cases can lead to tissue loss. The treatment goal is to preserve tissue and function; the sooner appropriate treatment is administered, the more tissue can be saved. However, not every patient with deep frostbite seeks medical care promptly. CASE SUMMARY We report the case of a 73-year-old male patient who was lost in the wilderness for 2 d due to trauma and confusion. He experienced deep frostbite on multiple fingers. Treatment should not be discontinued for patients with deep frostbite who present after the optimum treatment timing. Bullae that no longer form (bloody) blisters within 24 h of aspiration should be removed. Mucopolysaccharide polysulfate cream has clinical value in frostbite treatment. The patient was transferred to Chinese Academy of Medical Sciences and Peking Union Medical College Hospital 12 h after being rescued. The patient had contraindications for thrombolysis, the most effective treatment, due to intracranial hemorrhage and presenting past the optimum treatment timing. We devised a comprehensive treatment plan, which involved delayed use vasodilators and high-pressure oxygen therapy at day 49 post-injury. We experimented with mucopolysaccharide polysulfate cream to treat the frostbite. The aim of the treatment was to safeguard as much tissue as possible. In the end, the fingers that suffered from frostbite were able to be partially preserved. CONCLUSION The case indicated that patients with severe frostbite who missed the optimal treatment time and had contraindications for thrombolysis could still partially preserve the affected limbs through comprehensive treatment.
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Affiliation(s)
- Xi-Hua Wang
- Department of General Surgery, Peking Union Medical College Hospital and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Min Li
- Department of General Surgery, Peking Union Medical College Hospital and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Yue Cheng
- Department of Nursing, Peking Union Medical College Hospital and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Guang-Jian Wang
- Department of General Surgery, Peking Union Medical College Hospital and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Guo-Le Lin
- Department of General Surgery, Peking Union Medical College Hospital and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Wei-Nan Liu
- Department of General Surgery, Peking Union Medical College Hospital and Chinese Academy of Medical Sciences, Beijing 100730, China
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Goto T, Wang C, Kwiat C, Nguyen C, Saligan LN. Community-Based Wound Care Programs for Unhoused Individuals. J Epidemiol Glob Health 2023; 13:604-614. [PMID: 37847465 PMCID: PMC10686911 DOI: 10.1007/s44197-023-00157-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/21/2023] [Indexed: 10/18/2023] Open
Abstract
Wound care management for unhoused individuals is challenging due to the lack of healthcare infrastructure to handle the unique needs of this population. Therefore, we aimed to obtain insights for best practices and to establish a care clinic that is low threshold, community-based and meets the needs of unhoused people. We employed two approaches: (1) conduct a targeted narrative review of the literature of existing or proposed community-based program models that can address the wound care needs of unhoused individuals, and (2) assess cost-effectiveness and describe the results of a survey administered to unhoused clients and their health care providers at a community-based wound care program in Honolulu, Hawai'i. The literature search and screening yielded 11 articles relevant to the topic. Per the literature, existing community-based healthcare programs were successful when: (1) wound care services were incorporated into a broader social/health program, (2) cost-effective, and (3) comprehensive services were provided. Survey results in Honolulu found that the wound care program matched the needs of the targeted population and was cost-effective. Difficulty in following clients until wound closure and the sustainability of the program, particularly the lack of insurance reimbursement for street-based services, were perceived challenges. Additionally, the lack of insurance reimbursement for street-based wound care services continues to impact sustainability. Community-based programs can be successful in addressing the wound care needs of unhoused individuals if they address complex fundamental issues. This paper highlights existing gaps in logistics and policies that must be addressed to meet the specific medical needs of these vulnerable individuals.
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Affiliation(s)
- Taichi Goto
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Christina Wang
- Hawaii Health & Harm Reduction Center, Honolulu, HI, USA
| | - Catherine Kwiat
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Christopher Nguyen
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Leorey N Saligan
- National Institute of Nursing Research, National Institutes of Health, 3 Center Drive, Building 3, Room 5E14, Bethesda, MD, 20892, USA.
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14
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Adegboye O, Adams S. Minimal scarring in a premature neonate. JPRAS Open 2023; 38:124-128. [PMID: 37869731 PMCID: PMC10587665 DOI: 10.1016/j.jpra.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 10/01/2023] [Indexed: 10/24/2023] Open
Abstract
Background Scar formation and management is one of the major issues in plastic surgery. Scars are a chronic burden to patients, their families, and the wider healthcare system and while non-surgical and surgical options have been shown to reduce scarring and its impact, there are currently no therapeutic options to completely heal scars or to avoid scarring. Early gestation animals have been reported to heal skin wounds without scarring. Case presentation We report on a premature, underweight-for-age neonate of 30 weeks' gestation that suffered a combination of deep partial thickness abrasions and full thickness wounds following birth trauma, who eventually healed with minimal skin scarring. Conclusion This case highlights that more research is needed to understand the mechanism and timelines of foetal skin healing, so the knowledge can be used to develop better therapeutic options to treat skin scars in adults.
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Affiliation(s)
- Oluwatobi Adegboye
- Faculty of Biology, Medicine, and Health, The University of Manchester, United Kingdom
| | - Saleigh Adams
- Division of Plastic, Reconstructive and Maxillo-Facial Surgery, The University of Cape Town, South Africa
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Strader S, Mutchnick I. Brief pump externalization without ITB wean to treat a probable pocket infection. Childs Nerv Syst 2023; 39:3643-3645. [PMID: 37458770 DOI: 10.1007/s00381-023-06075-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/09/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND AND IMPORTANCE: Intrathecal baclofen (ITB) pumps are an effective management tool for spasticity and dystonia. In the pediatric population, ITB complications including infection are common, and strategies to minimize their impact are important. Current standard of care for pump infection involves a wean of the ITB therapy followed by explantation of the hardware, which can be a three to 6-month process. CLINICAL PRESENTATION: We present a 20-year-old female who developed an pump pocket infection after revision. The pump was removed from the body but left connected. The pocket was debrided, thoroughly washed, and packed with multiple microbicidal agents. Nine days later, a new pump and proximal catheter was re-implanted without complications or interruption of medication administered intrathecally. One year later, the patient is doing well without any infectious problems. CONCLUSION: To our knowledge, this is the first report of an externalized pump and expedited reimplantation without a break in ITB therapy. Further studies are required in order to best characterize this technique as a potential alternative for infected baclofen pump pockets.
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Affiliation(s)
- Shannon Strader
- Department of Physical Medicine and Rehabilitation, University of Louisville, Louisville, KY, 40202, USA.
| | - Ian Mutchnick
- Department of Neurosurgery, University of Louisville School of Medicine, Louisville, KY, USA
- Division of Pediatric Neurosurgery, Norton Neuroscience Institute and Children's Hospital, Louisville, KY, USA
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Kim J, Lee C, Choi S, Sung DI, Seo J, Na Lee Y, Hee Lee J, Jin Han E, Young Kim A, Suk Park H, Jeong Jung H, Hoon Kim J, Hee Lee J. Augmented Decision-Making in wound Care: Evaluating the clinical utility of a Deep-Learning model for pressure injury staging. Int J Med Inform 2023; 180:105266. [PMID: 37866277 DOI: 10.1016/j.ijmedinf.2023.105266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/25/2023] [Accepted: 10/16/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Precise categorization of pressure injury (PI) stages is critical in determining the appropriate treatment for wound care. However, the expertise necessary for PI staging is frequently unavailable in residential care settings. OBJECTIVE This study aimed to develop a convolutional neural network (CNN) model for classifying PIs and investigate whether its implementation can allow physicians to make better decisions for PI staging. METHODS Using 3,098 clinical images (2,614 and 484 from internal and external datasets, respectively), a CNN was trained and validated to classify PIs and other related dermatoses. A two-part survey was conducted with 24 dermatology residents, ward nurses, and medical students to determine whether the implementation of the CNN improved initial PI classification decisions. RESULTS The top-1 accuracy of the model was 0.793 (95% confidence interval [CI], 0.778-0.808) and 0.717 (95% CI, 0.676-0.758) over the internal and external testing sets, respectively. The accuracy of PI staging among participants was 0.501 (95% CI, 0.487-0.515) in Part I, improving by 17.1% to 0.672 (95% CI, 0.660-0.684) in Part II. Furthermore, the concordance between participants increased significantly with the use of the CNN model, with Fleiss' κ of 0.414 (95% CI, 0.410-0.417) and 0.641 (95% CI, 0.638-0.644) in Parts I and II, respectively. CONCLUSIONS The proposed CNN model can help classify PIs and relevant dermatoses. In addition, augmented decision-making can improve consultation accuracy while ensuring concordance between the clinical decisions made by a diverse group of health professionals.
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Affiliation(s)
- Jemin Kim
- Department of Dermatology, Yongin Severance Hospital, Yonsei University College of Medicine, Gyeonggi-do, Republic of Korea
| | - Changyoon Lee
- Department of Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sungchul Choi
- Department of Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Da-In Sung
- Department of Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jeonga Seo
- Department of Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yun Na Lee
- Department of Dermatology and Cutaneous Biology Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Joo Hee Lee
- Department of Dermatology and Cutaneous Biology Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun Jin Han
- Department of Nursing, Severance Hospital, Seoul, Republic of Korea
| | - Ah Young Kim
- Department of Nursing, Severance Hospital, Seoul, Republic of Korea
| | - Hyun Suk Park
- Department of Nursing, Severance Hospital, Seoul, Republic of Korea
| | - Hye Jeong Jung
- Department of Nursing, Severance Hospital, Seoul, Republic of Korea
| | - Jong Hoon Kim
- Department of Dermatology and Cutaneous Biology Research Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ju Hee Lee
- Department of Dermatology and Cutaneous Biology Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Mancin S, Mazzoleni B, Reggiani F, Calatroni M, Alterchi E, Donizzetti D, Finazzi S, Soekeland F, Sguanci M, Badalamenti S. Integrated protocol for the prevention and treatment of skin ulcers in patients with end-stage renal disease. MethodsX 2023; 11:102482. [PMID: 38047159 PMCID: PMC10689276 DOI: 10.1016/j.mex.2023.102482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 11/09/2023] [Indexed: 12/05/2023] Open
Abstract
Chronic Kidney Disease (CKD) is an escalating global health concern, affecting more than 10 % of the general population worldwide, amounting to over 800 million individuals. One of its major complications for patients is the high prevalence of skin ulcers . This study aims to develop a protocol for ulcer management within the context of a hospital-based dialysis center. The success of this strategy is deeply rooted in the collaboration of a multidisciplinary team, continually enriched by specialist training. The clinical nurse specialist (CNS) in wound care plays a pivotal role in this approach. By employing a systematic methodology, the protocol is tailored to emphasize holistic care for patients diagnosed with end-stage renal disease undergoing hemodialysis. It accentuates the significance of proactive prevention, in-depth patient education, and the immediate identification of early wound signs. The research underscores the necessity to further weave in specialized training for ulcer care, ensuring each hospital visit is maximized for efficiency and effectiveness. Central to this protocol is the understanding that CKD is a growing concern, that the optimal management of ulcers relies heavily on multidisciplinary collaboration, and that an emphasis on prevention, patient education, and timely wound recognition is crucial to enhance patient care and experience.
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Affiliation(s)
- Stefano Mancin
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Rome, Italy
- Nephrology and Dialysis Unit IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Beatrice Mazzoleni
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Francesco Reggiani
- Nephrology and Dialysis Unit IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Marta Calatroni
- Nephrology and Dialysis Unit IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Elena Alterchi
- Nephrology and Dialysis Unit IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Daniela Donizzetti
- Nephrology and Dialysis Unit IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Silvia Finazzi
- Nephrology and Dialysis Unit IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Fanny Soekeland
- School of Health Professions, University of Applied Sciences, Bern, Switzerland
| | - Marco Sguanci
- Department of Medicine and Surgery, Research Unit of Nursing Science, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Salvatore Badalamenti
- Nephrology and Dialysis Unit IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
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Kolessa A, Dara SSP, Lee J, Parulekar M. Chronic chest wound treated with antifungal. BMJ Case Rep 2023; 16:e257092. [PMID: 37996131 PMCID: PMC10668150 DOI: 10.1136/bcr-2023-257092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023] Open
Affiliation(s)
- Alexander Kolessa
- Internal Medicine, Hackensack Meridian, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Susan Shanthi Priya Dara
- Internal Medicine, Hackensack Meridian, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - JuYoung Lee
- Internal Medicine, Hackensack Meridian, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Manisha Parulekar
- Internal Medicine, Hackensack Meridian, Hackensack University Medical Center, Hackensack, New Jersey, USA
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Abstract
PURPOSE Peripheral arterial disease (PAD) is characterized by atherosclerotic arterial occlusive disease of the lower extremities and is associated with an increased risk of major adverse cardiovascular events (MACE) in addition to disabling clinical sequelae, including intermittent claudication and chronic limb-threatening ischemia (CLTI). Given the growing burden of disease, knowledge of modern practices to prevent MACE and major adverse limb events (MALE) is essential. This review article examines evidence for medical management of PAD and its associated risk factors, as well as wound prevention and care. METHODS A thorough review of the literature was performed, with attention to evidence for the management of modifiable atherosclerotic risk factors, claudication symptoms, wound prevention, and wound care. RESULTS Contemporary management of PAD requires a multi-faceted approach to care, with medical optimization of smoking, hypertension, hyperlipidemia, and diabetes mellitus. The use of supervised exercise therapy for intermittent claudication is highlighted. The anatomic disease patterns of smoking and diabetes mellitus are discussed further, and best practices for diabetic foot ulcer prevention, including offloading footwear, are described. Quality wound care is essential in this patient population and involves strategic use of debridement, wound-healing adjuncts, and skin substitutes, when appropriate. CONCLUSION The objective of medical management of PAD is to reduce the risk of MACE and MALE. Atherosclerotic risk factor optimization, appropriate wound care, and management of diabetic foot ulcers, foot infections, gangrene, and chronic, non-healing wounds are critical components of PAD care. Interdisciplinary care is essential to coordinate care, leverage expertise, and improve outcomes.
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Affiliation(s)
- Ian O Cook
- Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, One Baylor Plaza, BCM 390, Houston, TX, 77030, USA
| | - Jayer Chung
- Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, One Baylor Plaza, BCM 390, Houston, TX, 77030, USA.
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Pacheco YJ, Marin ELN, Ocampo DB, Gutiérrez CBB, Salom GAM, Ruiz JB, Garzon GFM, Casado JJP, Agudelo IMH, Mendez JAV, Lopez EHD, Bohorquez UM, Chamorro DR, Carrascal AO, Suarez EB, Cole W, Serena T, Marquez CA, Woodmansey E. Consenso de expertos sobre la eficacia clínica y directrices sobre la terapia de oxígeno transdérmico continuo para la cicatrización de las heridas complejas o difíciles de cicatrizar. J Wound Care 2023; 32:1-37. [PMID: 37934612 DOI: 10.12968/jowc.2023.32.latam_sup_10.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
INTRODUCTION Oxygen is pivotal for wound healing. Its lack or hypoxia can delay this process, especially in individuals with comorbidities, potentially resulting in complex or hard-to-heal wounds. The Colombian Association of Diabetes (ACD) and the Colombian Association of Internal Medicine (ACMI) collaborated with a diverse group of experts to provide recommendations on the efficacy and best practices of continuous transdermal oxygen therapy (TOTc) in the care of such wounds. METHOD A modified Delphi technique was employed to obtain controlled feedback and responses. Experts from various disciplines engaged in reviewing and discussing numerous relevant scientific studies, focusing on the role of TOTc in treating chronic ulcers. RESULTS Continuous transdermal oxygen therapy has proven to be an effective and safe treatment for chronic and/or hard-to-heal ulcers. This therapy directly addresses the wound's oxygen deficiency, providing an environment conducive to healing. Significant benefits were observed, including the acceleration of the healing process, wound size reduction, and an enhancement in patient quality of life. Its efficacy was found across various ulcer etiologies, underscoring its therapeutic versatility. CONCLUSIONS Continuous transdermal oxygen therapy is effective and safe for treating chronic and hard-to-heal ulcers. It's crucial to address each case individually and through a multidisciplinary approach to maximize this therapy's benefits. Both evidence and clinical experience back its utility across a variety of ulcer etiologies.
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Affiliation(s)
- Yamile Jubiz Pacheco
- Coordinadora zona norte de Suramérica ante el D-Foot International. Médico diabetóloga-experta en el cuidado del pie diabético y heridas complejas. Jefe unidad interdisciplinaria de pie diabético y heridas complejas
| | | | - Dora Bernal Ocampo
- Médica especialista en medicina familiar. Vicepresidenta confederación Iberoamericana de medicina familiar. Presidenta Asociación Colombiana de Sociedades Científicas
| | | | - Gustavo Adolfo Marquez Salom
- Médico especialista en medicina interna y clínica de hipertensión. Diabetólogo experto en pie diabético y heridas complejas. Director centro de atención integral de personas con diabetes y comorbilidades
| | - Jaime Brugés Ruiz
- Médico diabetólogo experto en pie diabético y heridas complejas. Director fundación Medicus - Cartagena
| | - Gary Fernando Monclou Garzon
- Médico especialista en ortopedia y traumatología. Especialista en cirugía de cadera reconstructiva. Magister en educación médica. Jefe del servicio de ortopedia Clínica Palermo - Bogotá
| | - John Jairo Perez Casado
- Médico especialista en ortopedia y traumatología. Reconstrucción, salvamento de extremidades y técnicas microquirúrgicas
| | - Iván Mauricio Hernández Agudelo
- Méico especialista en ortopedia y traumatología. Fellowship trauma y cirugía reconstructiva Medizinische Hochschule Hannover. Cirujano trauma y reconstructivo Clínica Palermo - Clínica Universidad La Sabana
| | | | - Enfermera Hilsen Duran Lopez
- Enfermera profesional especialista en cuidado de persona con heridas, ostomías, y lesiones de piel. Coordinadora de la unidad de heridas del Hospital Militar Central Colombia
| | - Ulises Múnera Bohorquez
- Médico experto en el cuidado de heridas complejas. Presidente Fundepiel Colombia 2022-2024. Autor del libro Introducción al mundo de las heridas, Editorial Bonaventuriano
| | - Damaris Romero Chamorro
- Médico especialista en cirugía plástica, Estética y reconstructiva. Miembro de la Federación IberoLatinoamericana de Cirugía Plástica FILACP. Secretaría ejecutiva, Sociedad Colombiana de Cirugía Plástica, Estética y Reconstructiva. Miembro Sociedad Americana de Cirugía Plástica
| | - Alexandra Otero Carrascal
- Médico especialista en cirugía plástica, Reconstructiva y estética. Subespecialista en mano. Miembro del Grupo Colombiano Interdisciplinario de Pie Diabético y Heridas Complejas
| | - Emerson Barajas Suarez
- Médico especialista en cirugía vascular y endovascular. Especialista en docencia universitaria
| | - Windy Cole
- Licenciatura en biología, Universidad de Cincinnati. Doctor en medicina podológica, Kent State University College. Médico especialista certificado en cuidado de heridas, American Board of Wound Management. Director de investigación de cuidado de heridas, Facultad de Medicina Podiátrica de la Universidad de Kent. Editor de la sección del consejo asesor editorial, cirugía podológica
| | - Thomas Serena
- Doctor en Medicina (MD), Universidad Estatal de Pensilvania. Vicepresidente Anterior, Colegio Americano de medicina hiperbárica. Presidente anterior, Asociación para el Avance del Cuidado de Heridas. Licenciatura en biología, pre-médica - The College of William and Mary
| | - Camilo Acosta Marquez
- MSc Magister Ingeniería Biomédica - Universidad de los Andes. Ingeniero Eléctrico - Universidad de los Andes. Doctor (PhD) en Robótica Abertay University, Dundee, Escocia. Postdoctorado en Robótica Aplicada a la Rehabilitación - Abertay University, Dundee, Escocia
| | - Emma Woodmansey
- Doctor of Philosophy (PhD), gut microbiology, University of Dundee. BSc (Hons) degree, medical microbiology, University of Dundee
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Kalluri S, Gonzalez SA, Wolfshohl J. Après Moi, Le Deluge: The identification and management of flood syndrome in the emergency department. Am J Emerg Med 2023; 72:223.e5-223.e6. [PMID: 37517872 DOI: 10.1016/j.ajem.2023.07.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 07/21/2023] [Indexed: 08/01/2023] Open
Abstract
Umbilical hernias develop in approximately 20% of patients with liver cirrhosis and ascites. Flood Syndrome is an eponym describing the spontaneous rupture of these umbilical hernias due to the elevated intrabdominal pressure associated with large-volume ascites. Though rare, Flood Syndrome is associated with several life-threatening sequela including infection, organ failure, and hypovolemic shock, leading to mortality or transplant in over 30% of patients. The following case is a single patient encounter describing an 80-year-old female with long-standing ascites who presented to the Emergency Department shortly after experiencing a spontaneous extravasation of fluid from her umbilical hernia.
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Affiliation(s)
- Sneha Kalluri
- Department of Medicine, Baylor Scott & White All-Saints Medical Center, Fort Worth, TX, United States of America.
| | - Stevan A Gonzalez
- Department of Medicine, Baylor Scott & White All-Saints Medical Center, Fort Worth, TX, United States of America; Division of Hepatology, Annette C. and Harold C. Simmons Transplant Institute, Baylor Scott & White All-Saints Medical Center, Fort Worth, TX, United States of America
| | - Jon Wolfshohl
- Department of Emergency Medicine, Baylor Scott & White All-Saints Medical Center, Fort Worth, TX, United States of America
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Silva CNS, Cruz MV, Fernandes KF, Batista KA. Production of anti-inflammatory films based on cashew gum polysaccharide and polyvinyl alcohol for wound dressing applications. 3 Biotech 2023; 13:299. [PMID: 37575597 PMCID: PMC10421841 DOI: 10.1007/s13205-023-03686-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 06/25/2023] [Indexed: 08/15/2023] Open
Abstract
In the present study, we aimed to produce CGP/PVA films containing entrapped anti-inflammatory drugs for wound dressing applications. Using a 33-1 fractional factorial design, the effect of each component was evaluated on the physicochemical and morphological properties of the produced materials. The best formulation for entrapment of diclofenac sodium and ketoprofen was also determined. The produced films presented high swelling capacity, with some formulations showing o porous structure. CGP/PVA films showed a maximum retention of 75.6% for diclofenac sodium and 32.2% for ketoprofen, and both drugs were released in a controlled manner for up to 7 h. The drug release kinetic was studied, and the data were fitted using a Korsmeyer-Peppas model, which suggested that the release mechanism is controlled by diffusion. These results indicate that CGP/PVA-based matrices have great potential to be used as drug-delivery systems for wound dressing applications, contributing to prolonging the drug's action time and then improving their anti-inflammatory efficacy.
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Affiliation(s)
- Cassio N. S. Silva
- Laboratório de Química de Polímeros, Departamento de Bioquímica e Biologia Molecular, Instituto de Ciências Biológicas 2, Campus Samambaia, Universidade Federal de Goiás, Goiânia, GO 74690-900 Brazil
| | - Maurício V. Cruz
- Laboratório de Química de Polímeros, Departamento de Bioquímica e Biologia Molecular, Instituto de Ciências Biológicas 2, Campus Samambaia, Universidade Federal de Goiás, Goiânia, GO 74690-900 Brazil
- Departamento de Áreas Acadêmicas II, Instituto Federal de Educação, Ciência e Tecnologia de Goiás, Campus Goiânia, Goiânia, GO 74055-120 Brazil
| | - Kátia F. Fernandes
- Laboratório de Química de Polímeros, Departamento de Bioquímica e Biologia Molecular, Instituto de Ciências Biológicas 2, Campus Samambaia, Universidade Federal de Goiás, Goiânia, GO 74690-900 Brazil
| | - Karla A. Batista
- Laboratório de Química de Polímeros, Departamento de Bioquímica e Biologia Molecular, Instituto de Ciências Biológicas 2, Campus Samambaia, Universidade Federal de Goiás, Goiânia, GO 74690-900 Brazil
- Departamento de Áreas Acadêmicas, Instituto Federal de Educação, Ciência e Tecnologia de Goiás, Campus Goiânia Oeste, Goiânia, GO 74395-160 Brazil
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Koumaki D, Kostakis G, Boumpoucheropoulos S, Ioannou P, Katoulis AC. A narrative review of management of wounds in palliative care setting. Ann Palliat Med 2023; 12:1089-1105. [PMID: 37859426 DOI: 10.21037/apm-23-138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 08/25/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND AND OBJECTIVE A chronic wound is one that is physiologically compromised as a result of a disturbance of the wound-healing cycle brought on by, among other parameters, poor angiogenesis, innervation, or cellular migration. Given the high frequency and incidence rates of different wound categories in clinical practice in the setting of chronically ill patients, wound management is becoming an increasingly important component and pillar of the overall care of patients with terminal illnesses. The purpose of this narrative review is to provide an overview and evaluation of the assessment methods and management of chronic wounds in the clinical practice of palliative care. METHODS Papers on the management of wounds in palliative care have been retrieved using PubMed to July 2023. The search terms used included "wounds", "ulcers", "palliative care", "palliative management", and "end of life". KEY CONTENT AND FINDINGS The review highlights the importance of early palliative care referral and total pain management in the management of wounds. Patients with wounds often report multiple symptoms, and pain is one of the most common and distressing among them. Despite the availability of multiple guidelines about treatment to relieve pain, almost half of all cancer patients still receive inappropriate care for pain. The review also discusses the etiology of pain and provides strategies for managing the painful wound once it has been identified. The greatest need today in the treatment of chronic wounds is consensus-based knowledge vetted by practical experience and backed up by scientific evidence, which is easily communicated and available to all wound care practitioners. CONCLUSIONS High-quality research together with wound care practice that leads to the best outcomes might include pain reduction, exudate management, odor management, and/or other quality-of-life benefits to wound care. There is a need for specialized palliative care teams to manage expectations throughout the process while maintaining hope.
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Affiliation(s)
- Dimitra Koumaki
- Department of Dermatology and Venereology, University Hospital of Heraklion, Heraklion, Greece
| | - George Kostakis
- Department of Oral and Maxillofacial Surgery, Athens Medical Center, Athens, Greece
| | | | - Petros Ioannou
- School of Medicine, University of Crete, Heraklion, Greece; Internal Medicine Department, University Hospital of Heraklion, Heraklion, Greece
| | - Alexander C Katoulis
- nd Department of Dermatology and Venereology, National and Kapodistrian University of Athens, Medical School, "Attikon" General University Hospital, Athens, Greece
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Ramadan F. Skin tone and wound care: bridging the knowledge and care provision gap. Br J Community Nurs 2023; 28:S20-S22. [PMID: 37643118 DOI: 10.12968/bjcn.2023.28.sup9.s20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
A wound care practitioner will likely encounter and care for an increasing number of patients with a wider variety of skin tones on a daily basis. However, wound care research and education does not yet reflect the realities of clinical practice, resulting in compromised care provision and the reinforcement of healthcare inequities. Here, Francesca Ramadan outlines both the quantitative and qualitative steps that can be taken to facilitate more inclusive and culturally sensitive care provision in research, education and clinical practice.
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25
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Poondru S, Scott K, Riley JM. Patient perspectives of wound care management in hidradenitis suppurativa. Arch Dermatol Res 2023; 315:1847-1850. [PMID: 36811730 DOI: 10.1007/s00403-023-02576-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 01/09/2023] [Accepted: 02/08/2023] [Indexed: 02/24/2023]
Abstract
Wound care management and costs in hidradenitis suppurativa (HS) are unmet needs. This study explored patient perspectives of at-home management of acute flares of HS and chronic daily wounds, their satisfaction with current wound care methods, and the financial burden of wound care supplies. An anonymous, multiple choice, cross-sectional questionnaire was distributed among online HS-related forums between August and October 2022. Participants 18 years or older with a diagnosis of HS who live in the United States were included. In total, 302 participants completed the questionnaire: 168 White (55.6%), 76 Black (25.2%), 33 Hispanic (10.9%), 7 Asian (2.3%), 12 multiracial (4.0%), and 6 other (2.0%). Dressings commonly reported included gauze, panty liners or menstrual pads, tissues or toilet paper, antiseptic dressing, abdominal pads, and adhesive bandages. Commonly reported topical remedies for acute flares of HS included warm compresses, Epsom salt baths, Vicks VapoRub, tea tree oil, witch hazel, and bleach baths. One-third of participants (n = 102) reported dissatisfaction with current wound care methods, and 48.8% (n = 103) believed that their dermatologist does not meet their wound care needs. Nearly half (n = 135) reported being unable to afford the type and quantity of dressings and wound care supplies they would ideally want. Black participants were more likely than White participants to report being unable to afford their dressings and find the cost as very burdensome. Overall, dermatologists must improve patient education of wound care methods in HS and address the financial burden of wound care supplies by exploring insurance-funded options.
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Affiliation(s)
- Sneha Poondru
- Department of Dermatology, Northwestern University Feinberg School of Medicine, 676 N St. Clair St Ste 1600, Chicago, IL, 60611, USA
| | - Kourtney Scott
- Department of Dermatology, Northwestern University Feinberg School of Medicine, 676 N St. Clair St Ste 1600, Chicago, IL, 60611, USA
| | - Julia M Riley
- Department of Dermatology, Northwestern University Feinberg School of Medicine, 676 N St. Clair St Ste 1600, Chicago, IL, 60611, USA.
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Fragoso NM, Masson R, Gillenwater TJ, Shi VY, Hsiao JL. Emerging Treatments and the Clinical Trial Landscape for Hidradenitis Suppurativa-Part II: Procedural and Wound Care Therapies. Dermatol Ther (Heidelb) 2023:10.1007/s13555-023-00957-5. [PMID: 37402030 PMCID: PMC10366058 DOI: 10.1007/s13555-023-00957-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/01/2023] [Indexed: 07/05/2023] Open
Abstract
Procedural treatments are a cornerstone of hidradenitis suppurativa (HS) management. New interventional therapies are being studied as part of the upsurge in HS research and clinical trials. Additionally, draining wounds can impart a significant negative impact on patients' quality of life, requiring daily dressing changes. However, standardized guidelines on how to best manage HS wounds both day-to-day and post-procedure are lacking. In part II of this emerging therapies review, procedural treatments and wound care dressings and devices that are being investigated for HS management are discussed.
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Affiliation(s)
- Natalie M Fragoso
- Department of Dermatology, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Rahul Masson
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - T Justin Gillenwater
- Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, CA, USA
| | - Vivian Y Shi
- Department of Dermatology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jennifer L Hsiao
- Department of Dermatology, University of Southern California, 1441 Eastlake Ave, Ezralow Tower, Suite 5301, Los Angeles, CA, 90089, USA.
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27
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Loske G. [Secondary wound closure with a new transparent negative pressure dressing]. Chirurgie (Heidelb) 2023; 94:525-529. [PMID: 37171593 DOI: 10.1007/s00104-023-01854-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/02/2023] [Indexed: 05/13/2023]
Abstract
Secondarily healing surgical wounds can be treated with negative pressure dressings. Dressing changes can be painful due to the strong adherence of the polyurethane foam placed in the wound. After debridement and conditioning of the wound bed, secondary surgical wound closure with a surgical suture can be performed. Cutaneous negative pressure treatment is used preventively after primary surgical suturing. Descriptions for secondary wound closure without a surgical suture are not known to date. The preparation and handling of an innovative transparent dressing for the cutaneous application of negative pressure treatment is demonstrated. The dressing assembly consists of a transparent drainage film and a transparent occlusion film. Negative pressure is applied via a tubing connection using a negative pressure pump. A new method of secondary wound closure using the transparent negative pressure dressing is presented based on a case example. The treatment cycle with instructions for making the dressing is shown in a video.
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Zhao P, Dang Z, Liu M, Guo D, Luo R, Zhang M, Xie F, Zhang X, Wang Y, Pan S, Ma X. Molecular hydrogen promotes wound healing by inducing early epidermal stem cell proliferation and extracellular matrix deposition. Inflamm Regen 2023; 43:22. [PMID: 36973725 PMCID: PMC10044764 DOI: 10.1186/s41232-023-00271-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/26/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Despite progress in developing wound care strategies, there is currently no treatment that promotes the self-tissue repair capabilities. H2 has been shown to effectively protect cells and tissues from oxidative and inflammatory damage. While comprehensive effects and how H2 functions in wound healing remains unknown, especially for the link between H2 and extracellular matrix (ECM) deposition and epidermal stem cells (EpSCs) activation. METHODS Here, we established a cutaneous aseptic wound model and applied a high concentration of H2 (66% H2) in a treatment chamber. Molecular mechanisms and the effects of healing were evaluated by gene functional enrichment analysis, digital spatial profiler analysis, blood perfusion/oxygen detection assay, in vitro tube formation assay, enzyme-linked immunosorbent assay, immunofluorescent staining, non-targeted metabonomic analysis, flow cytometry, transmission electron microscope, and live-cell imaging. RESULTS We revealed that a high concentration of H2 (66% H2) greatly increased the healing rate (3 times higher than the control group) on day 11 post-wounding. The effect was not dependent on O2 or anti-reactive oxygen species functions. Histological and cellular experiments proved the fast re-epithelialization in the H2 group. ECM components early (3 days post-wounding) deposition were found in the H2 group of the proximal wound, especially for the dermal col-I, epidermal col-III, and dermis-epidermis-junction col-XVII. H2 accelerated early autologous EpSCs proliferation (1-2 days in advance) and then differentiation into myoepithelial cells. These epidermal myoepithelial cells could further contribute to ECM deposition. Other beneficial outcomes include sustained moist healing, greater vascularization, less T-helper-1 and T-helper-17 cell-related systemic inflammation, and better tissue remodelling. CONCLUSION We have discovered a novel pattern of wound healing induced by molecular hydrogen treatment. This is the first time to reveal the direct link between H2 and ECM deposition and EpSCs activation. These H2-induced multiple advantages in healing may be related to the enhancement of cell viability in various cells and the maintenance of mitochondrial functions at a basic level in the biological processes of life.
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Affiliation(s)
- Pengxiang Zhao
- Faculty of Environment and Life, Beijing University of Technology, Beijing, 100124, People's Republic of China
- Beijing Molecular Hydrogen Research Center, Beijing, 100124, People's Republic of China
- Beijing International Science and Technology Cooperation Base of Antivirus Drug, Beijing, 100124, People's Republic of China
| | - Zheng Dang
- Faculty of Environment and Life, Beijing University of Technology, Beijing, 100124, People's Republic of China
- Beijing Molecular Hydrogen Research Center, Beijing, 100124, People's Republic of China
- Beijing International Science and Technology Cooperation Base of Antivirus Drug, Beijing, 100124, People's Republic of China
| | - Mengyu Liu
- Faculty of Environment and Life, Beijing University of Technology, Beijing, 100124, People's Republic of China
- Beijing Molecular Hydrogen Research Center, Beijing, 100124, People's Republic of China
- Beijing International Science and Technology Cooperation Base of Antivirus Drug, Beijing, 100124, People's Republic of China
| | - Dazhi Guo
- Department of Hyperbaric Oxygen, Sixth Medical Center of PLA General Hospital, Beijing, 100048, People's Republic of China
| | - Ruiliu Luo
- Faculty of Environment and Life, Beijing University of Technology, Beijing, 100124, People's Republic of China
- Beijing Molecular Hydrogen Research Center, Beijing, 100124, People's Republic of China
- Beijing International Science and Technology Cooperation Base of Antivirus Drug, Beijing, 100124, People's Republic of China
| | - Mingzi Zhang
- Department of Plastic Surgery, Peking Union Medical College Hospital (Dongdan campus), No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, People's Republic of China
| | - Fei Xie
- Faculty of Environment and Life, Beijing University of Technology, Beijing, 100124, People's Republic of China
- Beijing Molecular Hydrogen Research Center, Beijing, 100124, People's Republic of China
- Beijing International Science and Technology Cooperation Base of Antivirus Drug, Beijing, 100124, People's Republic of China
| | - Xujuan Zhang
- Faculty of Environment and Life, Beijing University of Technology, Beijing, 100124, People's Republic of China
- Beijing Molecular Hydrogen Research Center, Beijing, 100124, People's Republic of China
- Beijing International Science and Technology Cooperation Base of Antivirus Drug, Beijing, 100124, People's Republic of China
| | - Youbin Wang
- Department of Plastic Surgery, Peking Union Medical College Hospital (Dongdan campus), No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, People's Republic of China
| | - Shuyi Pan
- Department of Hyperbaric Oxygen, Sixth Medical Center of PLA General Hospital, Beijing, 100048, People's Republic of China
| | - Xuemei Ma
- Faculty of Environment and Life, Beijing University of Technology, Beijing, 100124, People's Republic of China.
- Beijing Molecular Hydrogen Research Center, Beijing, 100124, People's Republic of China.
- Beijing International Science and Technology Cooperation Base of Antivirus Drug, Beijing, 100124, People's Republic of China.
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Hitchman LH, Totty JP, Cai P, Smith GE, Carradice D, Chetter IC. Extracorporeal shockwave therapy for diabetic foot ulcers: a feasibility study. J Wound Care 2023; 32:182-192. [PMID: 36930191 DOI: 10.12968/jowc.2023.32.3.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
OBJECTIVE The purpose of this study was to assess the feasibility of delivering extracorporeal shockwave therapy (ESWT) to patients with diabetic foot ulcers (DFUs). It also aimed to explore any potential clinical effect of ESWT on wound healing and investigate whether ESWT offers any patient-reported benefits. METHOD In this single-centre, mixed methods feasibility study, patients with a DFU who met the eligibility criteria underwent ESWT three times over a seven-day period. Primary outcome was feasibility of delivering the intervention. Secondary outcomes included wound size, number of DFUs healed at 12 weeks and quality of life (QoL). Semi-structured interviews explored participants' experience of undergoing ESWT. RESULTS Of 106 patients screened, 24 (22.6%) were recruited. Following recruitment, two patients were withdrawn from the study with 22 patients included in the final analysis. The mean attendance at clinic was 90.9% and 65.1% for follow-up. The mean score for acceptability and tolerability was 9.86±0.48 (95% confidence interval (CI): 9.62-10.01) and 9.15±2.57 (95% CI: 7.87-10.42), respectively. There were no serious adverse events or side-effects. Of the DFUs, 45.5% healed during follow-up and QoL scores improved until eight weeks. Key themes identified from the qualitative interviews were: desire for fast healing; improved QoL; flexibility of new treatments; and accessibility of transport. CONCLUSION This study has shown that it is possible to recruit and retain patents into a single-arm study of ESWT for DFUs. This study supports development of a large randomised control trial to determine the clinical and cost-effectiveness of ESWT for DFU healing.
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Affiliation(s)
- Louise H Hitchman
- Hull York Medical School, UK
- Hull University Teaching Hospitals NHS Trust, UK
| | | | - Paris Cai
- Leeds University Teaching Hospitals, UK
| | - George E Smith
- Hull York Medical School, UK
- Hull University Teaching Hospitals NHS Trust, UK
| | - Daniel Carradice
- Hull York Medical School, UK
- Hull University Teaching Hospitals NHS Trust, UK
| | - Ian C Chetter
- Hull York Medical School, UK
- Hull University Teaching Hospitals NHS Trust, UK
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Ryu JM, Kim MS, Kim JY. Psychometric validation of the Korean Pressure Ulcer Knowledge Assessment Tool. J Wound Care 2023; 32:172-181. [PMID: 36930188 DOI: 10.12968/jowc.2023.32.3.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the psychometric properties, including content validity, validity of multiple choice items, and the reliability of the Korean version of the Pressure Ulcer Knowledge Assessment Tool (K-PUKAT 2.0), using classical test theory (CTT) and item response theory (IRT). METHOD Linguistic validation process and factor analysis were conducted among wound care nurses, staff nurses and nursing students. Items were analysed according to the CTT and IRT using a two-parameter logistic model. Intraclass correlation coefficients were used to examine reliability. RESULTS A total of 378 wound care nurses, staff nurses and nursing students participated in this study. While most items showed moderate difficulty based on the CTT, difficulty index values based on the IRT were more broadly distributed (low: 5 items; moderate: 9 items; high: 1 item). The intraclass correlation coefficient for K-PUKAT 2.0 was 0.72. CONCLUSION The K-PUKAT 2.0 demonstrated concise and good psychometric properties. Based on the results of this study, repetitive use of K-PUKAT 2.0 will not only help in distinguishing whether an individual has sufficient clinical knowledge, but will also play a key role in supporting learning.
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Affiliation(s)
- Jung Mi Ryu
- Assistant Professor, Department of Nursing, Busan Institute of Science and Technology, Busan, South Korea
| | - Myoung Soo Kim
- Professor, Department of Nursing, Pukyong National University, Busan, South Korea
| | - Jung Yoon Kim
- Wound, Ostomy and Continence Nurse, Nursing Headquarters, Seoul National University Bundang Hospital, Seongnam-si, South Korea
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31
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Oran NT, Alan N, Akokay P, Büyükçoban S, Uğur Ergür B. The healing effect of topical tea tree oil on pressure ulcers in a rat model. J Wound Care 2023; 32:xiv-xxi. [PMID: 36930536 DOI: 10.12968/jowc.2023.32.sup3a.xiv] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Objective: The effects of topical tea tree oil (TTO) on the healing of pressure ulcers (PUs) in an animal model was evaluated. Method: To induce PUs, ischaemia-reperfusion cycles were performed by the external application of magnetic plates, with an ischaemic period of eight hours and a reperfusion period of 16 hours. Male and female Wistar rats were divided into three equally sized groups (n=20): one group received topical glycerin twice daily, another group received topical 10% (volume/volume (v/v)) TTO in glycerin twice daily; and the remaining group was untreated. The animals were assessed after one, four, seven and 14 cycles of ischaemia-reperfusion by thermal camera imaging, and then euthanised and sampled to investigate the degree of inflammation, collagen synthesis and apoptosis in the PUs. Results: Although topical glycerin alone suppressed local inflammation and apoptosis, this suppressive effect was accentuated at all timepoints by the application of topical TTO + glycerin. Similarly, an increase in collagen synthesis was observed in the glycerin group and this was accentuated by TTO at all timepoints. Parallel to the histological findings, the local temperature had decreased significantly on days 4 and 7 for both treatment groups (glycerin and TTO+glycerin). Conclusion: In this study, treatment with 10% (v/v) TTO in glycerin effectively suppressed skin inflammation and apoptosis, while it increased collagen synthesis during PU formation.
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Affiliation(s)
| | - Nurten Alan
- Dokuz Eylul University, Faculty of Nursing, Izmir, Turkey
| | - Pinar Akokay
- Kavram Vocational School, Medical Laboratory Section, Izmir, Turkey
| | - Sibel Büyükçoban
- Department of Anesthesiology and Reanimation, Dokuz Eylül University Faculty of Medicine, Izmir, Turkey
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32
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Hones KM, Hones J, Satteson ES, Chim H. Treatment of complex extremity wounds with MatriDerm: first clinical experience in the US. J Wound Care 2023; 32:167-171. [PMID: 36930186 DOI: 10.12968/jowc.2023.32.3.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
OBJECTIVE Coverage of upper and lower extremity wounds with exposed vital structures such as tendon and bone is reliant on pedicled and free flaps. However, a population of patients with medical comorbidities or other social issues may not be suitable for flap coverage. We present the first in patient clinical experience in the US with MatriDerm (Billerbeck, Germany) for treatment of difficult extremity wounds, all with exposed bone or tendon. METHOD MatriDerm dermal matrix has been popular in Europe for coverage of wounds. However, MatriDerm only received full approval for use by the US Food and Drug Administration (FDA) in 2021. Here we review our clinical experience. RESULTS Locations (n=11) treated included forearm (n=1), hand (n=4), leg (n=3), and feet (n=3). Vital structures in wounds exposed included bone (n=3), bone and tendon (n=1), and tendon (n=7). Mean area of the wound treated was 59.2cm2 (range: 2 to 230). In our series, eight out of 11 wounds healed, with MatriDerm only (n=6) or following delayed skin grafting (n=2). Mean time to healing in the patients treated only with MatriDerm was 49 days (range 7 to 84). Mean time to split-thickness skin grafting in the remaining two patients was 44.5 days (range 32 to 57). CONCLUSION MatriDerm has potential for treatment of complex extremity wounds, which would otherwise require flap coverage, in patients who are not good candidates for flap surgery.
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Affiliation(s)
| | - Jaime Hones
- Division of Plastic and Reconstructive Surgery, University of Florida College of Medicine, FL, US
| | - Ellen S Satteson
- Division of Plastic and Reconstructive Surgery, University of Florida College of Medicine, FL, US
| | - Harvey Chim
- Division of Plastic and Reconstructive Surgery, University of Florida College of Medicine, FL, US
- Lillian S. Wells Department of Neurosurgery, University of Florida College of Medicine, FL, US
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Oran NT, Alan N, Akokay P, Büyükçoban S, Uğur Ergür B. The healing effect of topical tea tree oil on pressure ulcers in a rat model. J Wound Care 2023; 32:xiv-xxi. [PMID: 36930195 DOI: 10.12968/jowc.2023.32.3.xiv] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Objective: The effects of topical tea tree oil (TTO) on the healing of pressure ulcers (PUs) in an animal model was evaluated. Method: To induce PUs, ischaemia-reperfusion cycles were performed by the external application of magnetic plates, with an ischaemic period of eight hours and a reperfusion period of 16 hours. Male and female Wistar rats were divided into three equally sized groups (n=20): one group received topical glycerin twice daily, another group received topical 10% (volume/volume (v/v)) TTO in glycerin twice daily; and the remaining group was untreated. The animals were assessed after one, four, seven and 14 cycles of ischaemia-reperfusion by thermal camera imaging, and then euthanised and sampled to investigate the degree of inflammation, collagen synthesis and apoptosis in the PUs. Results: Although topical glycerin alone suppressed local inflammation and apoptosis, this suppressive effect was accentuated at all timepoints by the application of topical TTO + glycerin. Similarly, an increase in collagen synthesis was observed in the glycerin group and this was accentuated by TTO at all timepoints. Parallel to the histological findings, the local temperature had decreased significantly on days 4 and 7 for both treatment groups (glycerin and TTO+glycerin). Conclusion: In this study, treatment with 10% (v/v) TTO in glycerin effectively suppressed skin inflammation and apoptosis, while it increased collagen synthesis during PU formation.
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Affiliation(s)
| | - Nurten Alan
- Dokuz Eylul University, Faculty of Nursing, Izmir, Turkey
| | - Pinar Akokay
- Kavram Vocational School, Medical Laboratory Section, Izmir, Turkey
| | - Sibel Büyükçoban
- Department of Anesthesiology and Reanimation, Dokuz Eylül University Faculty of Medicine, Izmir, Turkey
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Barrett S, Rippon MG, Rogers AA. Effectiveness of wound contact layers in enabling undisturbed wound management: a case series. J Wound Care 2023; 32:134-144. [PMID: 36930187 DOI: 10.12968/jowc.2023.32.3.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
OBJECTIVE Wound contact layers (WCLs) are intended to protect and support wounds during the healing process. An open, non comparative, case series clinical evaluation was undertaken to assess the impact of these dressings on establishing an undisturbed wound environment that supports effective wound management, and to allow the establishment of limits of duration of the wear time for the experimental WCLs. METHOD The primary objectives of this clinical evaluation were to assess the ability of the WCLs to prevent tissue disturbance to the wound and surrounding skin and for the clinicians to have confidence to extend the wear time of the WCL dressings. For them to have confidence in leaving the dressings in place for extended periods, the assessment of the wound and periwound skin condition and an assessment of patient comfort was performed: assessment of wound and periwound condition in relation to tissue adherence of the dressing to the wound resulting in tissue damage/bleeding (to wound and/or periwound skin) and cellular infiltration into the WCL; assessment of patient wearing comfort and satisfaction; assessment of WCL wear time, relating to times between dressing changes as judged by the clinician. RESULTS Based upon five parameters used to assess the extent to which the WCLs Atrauman, Atrauman Silicone and Atrauman Ag (HARTMANN, Germany) disturbed the underlying tissues-bleeding, wound tissue damage, periwound skin damage, tissue ingrowth and dressing adherence-the majority (>95%) of assessments indicated low or no disturbance of tissue. Over the 14 days of study assessment, the mean (±standard deviation) wear time was 7.3±1.2 days for the Atrauman group, 9.9±2.8 days for the Atrauman Silicone group, and 5.8±1.0 days for the Atrauman Ag group. All dressings were well tolerated by patients and rated highly in terms of in-use dressing performance. CONCLUSION The results indicate that Atrauman WCLs are suitable for the management of a variety of wounds as they promote an undisturbed wound environment, including extended wear time.
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Affiliation(s)
- Simon Barrett
- Humber NHS Foundation Trust, The Grange Hessle, Hull, UK
| | - Mark G Rippon
- Huddersfield University, Huddersfield, UK
- Daneriver Consultancy Ltd, Holmes Chapel, Cheshire, UK
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Garbuio DC, Leite MN, Figueiredo SA, de Freitas LAP, de Carvalho EC, Frade MAC. Topical formulation containing chitosan-chamomile microparticles in cutaneous wound healing in rats. J Wound Care 2023; 32:xxii-xxx. [PMID: 36930193 DOI: 10.12968/jowc.2023.32.3.xxii] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Objective: The aim of this research was to evaluate the efficacy of a topical formulation containing chitosan-chamomile microparticles in cutaneous healing in rats. Method: Male Wistar rats (n=57) were randomly distributed into three groups: treatment; vehicle; and control. Evaluations were performed on days 2, 7 and 14 after the surgical procedure using skin lesion photography, and histological and biochemical analyses. Results: The results showed that there was no difference in the healing index and in the histological analysis of the inflammatory infiltrate among groups. Fibrogenesis was more significant in the group treated with the test formulation at day 7, and angiogenesis was greater in the vehicle and chamomile groups at day 2. The quantification of hydroxyproline showed a higher amount of collagen in the group treated with chamomile, mainly at day 14, although the histological quantification of collagen showed no difference between the groups. Conclusion: From the results of this study, it can be concluded that the formulation, although it had no effect on the healing time, improved the quality of the cicatricial tissue formed with a greater quantity of fibroblasts and collagen.
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Affiliation(s)
| | - Marcel Nani Leite
- Ribeirão Preto Medical School at São Paulo University (FMRP/USP), Ribeirão Preto, SP, Brazil
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36
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Guest JF, Fuller GW. Relative cost-effectiveness of three compression bandages in treating newly diagnosed venous leg ulcers in the UK. J Wound Care 2023; 32:146-158. [PMID: 36930185 DOI: 10.12968/jowc.2023.32.3.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
OBJECTIVE To assess the clinical outcomes and cost-effectiveness of using a two-layer cohesive compression bandage (TLCCB; Coban 2, 3M, US) compared with a two-layer compression system (TLCS; KTwo, Urgo, France) and a cohesive inelastic bandage system (CIBR; Actico, L&R, Germany) in treating newly diagnosed venous leg ulcers (VLUs) in clinical practice, from the perspective of the UK's National Health Service (NHS). METHOD This was a modelling study based on a retrospective cohort analysis of the case records of patients with a newly diagnosed VLU randomly extracted from the The Health Improvement Network (THIN) database who were treated with TLCCB, TLCS or CIBR. No significant differences were detected between the groups. Nevertheless, analysis of covariance was performed to enable differences in patients' outcomes between the groups to be adjusted for any heterogeneity in baseline covariates. Clinical outcomes and cost-effectiveness of the alternative compression systems were estimated over 12 months after starting treatment. RESULTS There were 250 patients in each group. Time from wound onset to starting compression was a mean of two months. The healing distribution of the TLCCB-treated patients was significantly different from that of the other two cohorts (p=0.003); the probability of healing at 12 months was 0.62, 0.51 and 0.49 in the TLCCB, TLCS and CIBR groups, respectively. Patients treated with TLCCB experienced better health-related quality of life (HRQoL) over 12 months (0.86 quality-adjusted life years (QALYs) per patient), compared with those treated with TLCS and CIBR (0.83 and 0.82 QALYs per patient, respectively). The 12-month NHS wound management cost was £3693, £4451 and £4399 per patient in the TLCCB, TLCS and CIBR groups, respectively. CONCLUSION Within the model's limitations, treating newly diagnosed VLUs with TLCCB instead of the other two compression systems appears to afford a more cost-effective use of NHS-funded resources in clinical practice, since it is expected to result in increased healing, better HRQoL and a lower wound management cost for the NHS.
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37
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Austin CL, Draper B, Larson KW, Thompson SJ. Biodegradable temporising matrix: use of negative pressure wound therapy shows a significantly higher success rate. J Wound Care 2023; 32:159-166. [PMID: 36930194 DOI: 10.12968/jowc.2023.32.3.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
OBJECTIVE The purpose of this case series was to evaluate the efficacy of a synthetic biodegradable temporising matrix (BTM; PolyNovo Biomaterials Pty Ltd, Australia) and compare the outcome of BTM patients with and without negative pressure wound therapy (NPWT). METHOD A retrospective chart review was conducted on patients admitted with deep full-thickness burns, traumatic or complex wound injuries treated with BTM. Electronic medical records and images were evaluated by a team of clinical professionals. Endpoints included: the measure of successful BTM integration; and comparison between patients treated with and without NPWT. Additional measures were BTM total surface area, BTM sites, timeliness of BTM application and any complications. RESULTS A total of 28 patients were evaluated and 23 (82.1%) demonstrated overall successful BTM integration. Patients treated with BTM in conjunction with NPWT (n=16) demonstrated a significantly higher (p=0.046) integration rate compared to patients treated without NPWT (n=12) (93.8% versus 58.3%, respectively). Patients treated with BTM with NPWT continued to successfully integrate and sustain favourable outcomes despite the presence of severe infection or the development of haematomas. CONCLUSION A significantly higher integration rate was demonstrated when BTM was used in conjunction with NPWT. The results of this study further support the efficacy of successful integration of BTM as a replacement for tissue loss in the treatment of deep, full-thickness burns, traumatic and complex wound injuries, and particularly favourable outcomes with the use of NPWT. To the best of our knowledge, this is the first reported case series comparing the clinical outcomes of BTM with and without the use of NPWT.
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Affiliation(s)
- Cindy L Austin
- Trauma & Burn Research, Mercy Hospital, Springfield, MO, US
| | - Brian Draper
- General & Trauma Surgery, Mercy Hospital, Springfield, MO, US
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Ozay Y, Ozkorkmaz EG, Kumas-Kulualp M, Kara SG, Yildirim Z, Uzun C, Celik A, Camlica Y, Bozgeyik I, Guler G, Erdal N, Yumrutas O, Tasdelen B, Kahraman A. Wound healing activity of Salvia huberi ethanolic extract in streptozocin-induced diabetic rats. J Wound Care 2023; 32:i-xiii. [PMID: 36930190 DOI: 10.12968/jowc.2023.32.3.i] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Objective: The aim of this study was to examine the in vivo wound healing potential of Salvia huberi Hedge (endemic to Turkey) on excision and incision wound models in diabetic rats. Method: Male Wistar albino rats, 3-4 months old and weighing 180-240g were used. The animals were randomly divided into five groups including Control, Vehicle and Fito reference, and two different concentrations (0.5% and 1% weight/weight (w/w)) of ethanol extract of Salvia huberi were investigated in both wound models on streptozocin-induced diabetic rats using macroscopic, biomechanical, biochemical, histopathological, genotoxic and gene expression methods over both seven and 14 days. Fito cream (Tripharma Drug Industry and Trade Inc., Turkey) was used as the reference drug. Results: A total of 60 rats were used in this study. Salvia huberi ointments at 0.5% and 1% (w/w) concentrations and Fito cream showed 99.3%, 99.4% and 99.1% contraction for excision wounds, and 99.9%, 97.0% and 99% contraction for incision wounds, respectively. In Salvia huberi ointments and Fito cream groups, re-epithelialisation increased dramatically by both day 7 and day 14 (p<0.05). By day 14, low hydroxyproline and malondialdehyde (MDA) levels, and high glutathione (GSH) levels were observed in the Salvia huberi ointment groups. After two application periods, damaged cell percent and genetic damage index values and micronucleus frequency of Salvia huberi ointment treatment groups were lower than Control and Vehicle groups (p<0.001). A growth factor expression reached a high level by day 7 in the Control group; in Salvia huberi-treated groups it was decreased. Conclusion: The study showed that application of Salvia huberi ointments ameliorated the healing process in diabetic rats with excisional and incisional wounds and may serve as a potent healing agent.
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Affiliation(s)
- Yusuf Ozay
- Department of Medical Biology, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey
| | - Ebru Gokalp Ozkorkmaz
- Department of Histology and Embryology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - Meltem Kumas-Kulualp
- Department of Histology and Embryology, Faculty of Veterinary Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Sevda Guzel Kara
- Department of Pharmacognosy, Faculty of Pharmacy, Mersin University, Mersin, Turkey
| | - Zuhal Yildirim
- Etimesgut Public Health Laboratory, Etimesgut, Ankara, Turkey
| | - Cosar Uzun
- Department of Biophysics, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Ayla Celik
- Department of Biology, Faculty of Science, Mersin University, Mersin, Turkey
| | - Yusuf Camlica
- Department of Biology, Faculty of Science, Mersin University, Mersin, Turkey
| | - Ibrahim Bozgeyik
- Department of Medical Biology, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey
| | - Gizem Guler
- Department of Biology, Faculty of Science, Mersin University, Mersin, Turkey
| | - Nurten Erdal
- Department of Biophysics, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Onder Yumrutas
- Department of Medical Biology, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey
| | - Bahar Tasdelen
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Ahmet Kahraman
- Department of Biology, Faculty of Arts and Science, Uşak University, Uşak, Turkey
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Garbuio DC, Leite MN, Figueiredo SA, de Freitas LAP, de Carvalho EC, Frade MAC. Topical formulation containing chitosan-chamomile microparticles in cutaneous wound healing in rats. J Wound Care 2023; 32:xxii-xxx. [PMID: 36930537 DOI: 10.12968/jowc.2023.32.sup3a.xxii] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Objective: The aim of this research was to evaluate the efficacy of a topical formulation containing chitosan-chamomile microparticles in cutaneous healing in rats. Method: Male Wistar rats (n=57) were randomly distributed into three groups: treatment; vehicle; and control. Evaluations were performed on days 2, 7 and 14 after the surgical procedure using skin lesion photography, and histological and biochemical analyses. Results: The results showed that there was no difference in the healing index and in the histological analysis of the inflammatory infiltrate among groups. Fibrogenesis was more significant in the group treated with the test formulation at day 7, and angiogenesis was greater in the vehicle and chamomile groups at day 2. The quantification of hydroxyproline showed a higher amount of collagen in the group treated with chamomile, mainly at day 14, although the histological quantification of collagen showed no difference between the groups. Conclusion: From the results of this study, it can be concluded that the formulation, although it had no effect on the healing time, improved the quality of the cicatricial tissue formed with a greater quantity of fibroblasts and collagen.
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Affiliation(s)
| | - Marcel Nani Leite
- Ribeirão Preto Medical School at São Paulo University (FMRP/USP), Ribeirão Preto, SP, Brazil
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40
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Ozay Y, Ozkorkmaz EG, Kumas-Kulualp M, Kara SG, Yildirim Z, Uzun C, Celik A, Camlica Y, Bozgeyik I, Guler G, Erdal N, Yumrutas O, Tasdelen B, Kahraman A. Wound healing activity of Salvia huberi ethanolic extract in streptozocin-induced diabetic rats. J Wound Care 2023; 32:i-xiii. [PMID: 36930535 DOI: 10.12968/jowc.2023.32.sup3a.i] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Objective: The aim of this study was to examine the in vivo wound healing potential of Salvia huberi Hedge (endemic to Turkey) on excision and incision wound models in diabetic rats. Method: Male Wistar albino rats, 3-4 months old and weighing 180-240g were used. The animals were randomly divided into five groups including Control, Vehicle and Fito reference, and two different concentrations (0.5% and 1% weight/weight (w/w)) of ethanol extract of Salvia huberi were investigated in both wound models on streptozocin-induced diabetic rats using macroscopic, biomechanical, biochemical, histopathological, genotoxic and gene expression methods over both seven and 14 days. Fito cream (Tripharma Drug Industry and Trade Inc., Turkey) was used as the reference drug. Results: A total of 60 rats were used in this study. Salvia huberi ointments at 0.5% and 1% (w/w) concentrations and Fito cream showed 99.3%, 99.4% and 99.1% contraction for excision wounds, and 99.9%, 97.0% and 99% contraction for incision wounds, respectively. In Salvia huberi ointments and Fito cream groups, re-epithelialisation increased dramatically by both day 7 and day 14 (p<0.05). By day 14, low hydroxyproline and malondialdehyde (MDA) levels, and high glutathione (GSH) levels were observed in the Salvia huberi ointment groups. After two application periods, damaged cell percent and genetic damage index values and micronucleus frequency of Salvia huberi ointment treatment groups were lower than Control and Vehicle groups (p<0.001). A growth factor expression reached a high level by day 7 in the Control group; in Salvia huberi-treated groups it was decreased. Conclusion: The study showed that application of Salvia huberi ointments ameliorated the healing process in diabetic rats with excisional and incisional wounds and may serve as a potent healing agent.
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Affiliation(s)
- Yusuf Ozay
- Department of Medical Biology, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey
| | - Ebru Gokalp Ozkorkmaz
- Department of Histology and Embryology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - Meltem Kumas-Kulualp
- Department of Histology and Embryology, Faculty of Veterinary Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Sevda Guzel Kara
- Department of Pharmacognosy, Faculty of Pharmacy, Mersin University, Mersin, Turkey
| | - Zuhal Yildirim
- Etimesgut Public Health Laboratory, Etimesgut, Ankara, Turkey
| | - Cosar Uzun
- Department of Biophysics, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Ayla Celik
- Department of Biology, Faculty of Science, Mersin University, Mersin, Turkey
| | - Yusuf Camlica
- Department of Biology, Faculty of Science, Mersin University, Mersin, Turkey
| | - Ibrahim Bozgeyik
- Department of Medical Biology, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey
| | - Gizem Guler
- Department of Biology, Faculty of Science, Mersin University, Mersin, Turkey
| | - Nurten Erdal
- Department of Biophysics, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Onder Yumrutas
- Department of Medical Biology, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey
| | - Bahar Tasdelen
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Ahmet Kahraman
- Department of Biology, Faculty of Arts and Science, Uşak University, Uşak, Turkey
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Li W, Xiong F, Yao C, Zhang T, Zhou L, Zhang Z, Wang Z, Mao Y, Zhou P, Guan J. The impact of Allgower-Donati suture pattern and postoperative sweet foods on wound suture breakage in experimental rats. Heliyon 2023; 9:e13934. [PMID: 36915567 PMCID: PMC10006471 DOI: 10.1016/j.heliyon.2023.e13934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 02/07/2023] [Accepted: 02/15/2023] [Indexed: 02/27/2023] Open
Abstract
Background Wound gnawing and/or scratching in rats often occurs in experimental models, causing suture breakage and wound dehiscence, and consequently affecting experimental results and wasting resources. This study aimed to investigate the impact of the combined postoperative use of the Allgower-Donati (A-D) suture pattern and sweet foods on suture breakage, inflammation, and healing in wounds. Materials and methods Sprague Dawley (SD) rats (n = 48) were treated for linear wounds on the back by four procedures: simple suture, simple suture with postoperative sweet foods, A-D suture, and A-D suture with postoperative sweet foods. Additionally, CD68 immunofluorescence and CD31 immunohistochemistry were used to analyze wound inflammation and vascularization, respectively, on postoperative day 7. Sirius red staining was used to assess collagen deposition on postoperative day 14. Results Gnawing and scratching of wound sutures were significantly reduced in treated rats (P < 0.01). Neovascularization and collagen deposition were significantly increased (P < 0.001), and inflammatory responses were significantly reduced (P < 0.001) in animals receiving AD sutures and postoperative sweet foods. CD31/CD68 analyses showed that A-D suture and postoperative sweet foods regulated wound angiogenesis and attenuated wound inflammation. Conclusions Sweet food provision after A-D suture union surgery could reduce wound gnawing and/or scratching, suture breakage, incisional dehiscence, wound inflammation, and promote wound healing in rats.
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Affiliation(s)
- Weifeng Li
- Department of Orthopedics, First Affiliated Hospital, Bengbu Medical College, Bengbu, China.,First Department of Orthopedics, People's Hospital of Lixin County, Bozhou, China.,Anhui Province Key Laboratory of Tissue Transplantation, Bengbu, China
| | - Feng Xiong
- Department of Orthopedics, First Affiliated Hospital, Bengbu Medical College, Bengbu, China
| | - Cheng Yao
- Department of Orthopedics, First Affiliated Hospital, Bengbu Medical College, Bengbu, China
| | - Tingbao Zhang
- Department of Orthopedics, First Affiliated Hospital, Bengbu Medical College, Bengbu, China
| | - Liangshuang Zhou
- Department of Orthopedics, First Affiliated Hospital, Bengbu Medical College, Bengbu, China
| | - Zhanyue Zhang
- Department of Orthopedics, First Affiliated Hospital, Bengbu Medical College, Bengbu, China.,Anhui Province Key Laboratory of Tissue Transplantation, Bengbu, China
| | - Zhaodong Wang
- Department of Orthopedics, First Affiliated Hospital, Bengbu Medical College, Bengbu, China.,Anhui Province Key Laboratory of Tissue Transplantation, Bengbu, China
| | - Yingji Mao
- Anhui Province Key Laboratory of Tissue Transplantation, Bengbu, China
| | - Pinghui Zhou
- Department of Orthopedics, First Affiliated Hospital, Bengbu Medical College, Bengbu, China.,Anhui Province Key Laboratory of Tissue Transplantation, Bengbu, China
| | - Jianzhong Guan
- Department of Orthopedics, First Affiliated Hospital, Bengbu Medical College, Bengbu, China.,Anhui Province Key Laboratory of Tissue Transplantation, Bengbu, China
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Gupta AK, Vyas A. Use of chitosan wound dressing for the treatment of surgical site infection: a case report. J Wound Care 2023; 32:S4-S8. [PMID: 36930280 DOI: 10.12968/jowc.2023.32.sup3.s4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Surgical site infections (SSIs) are treated using topical antiseptics and systemic antibiotics, but some cases are unresponsive to such regimens. This case study reports the effective healing of an SSI by a chitosan wound dressing (MaxioCel; Axio Biosolutions Private Limited, India) in a 63-year-old female patient. The patient presented with an infected, hard-to-heal wound in the abdominal region, developed after a hernia surgery, and was initially treated with standard procedures. However, due to the continuous progression of infection, a highly absorbent, bioactive microfibre dressing was selected for the treatment and was continued for two months with alternate-day dressing changes. After 60 days of treatment, wound healing was observed, along with remission from the infection, as well as reduction in exudate level and pain. The use of chitosan wound dressing in management of hard-to-heal infected wounds provides efficient remission of SSI and a faster healing rate.
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Affiliation(s)
- Alok Kumar Gupta
- Minimal Access Surgery and General Surgery, Max Hospital, Gurugram, Haryana, India, 122001
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Sandhu J, Miller C, Kapp S. Characteristics of COVID-19 patients who developed pressure injuries: a scoping review. J Wound Care 2023; 32:S9-S16. [PMID: 36930283 DOI: 10.12968/jowc.2023.32.sup3.s9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
OBJECTIVE To describe the characteristics of patients with COVID-19 who developed pressure injuries (PIs), the characteristics of PIs experienced, and the incidence and prevalence of PIs among the patients with COVID-19. PIs are associated with increased morbidity, mortality and healthcare expense. PIs have been reported among patients who have contracted COVID-19. Understanding the characteristics of COVID-19 patients, and how PIs are prevented and managed, may inform care and optimise the outcomes for COVID-19-positive patients. METHOD A scoping review was conducted. All study designs, including grey literature, published in the English language from December 2019 to March 2021, reporting on patients with COVID-19 and PIs, were included. RESULTS In total, 27 publications (n=4820 patients) were included in the review. The reported incidence rate of PIs was 7.3-77.0%. The causative factors noted were: prone positioning (28.5%); medical devices (21.4%); and medical devices used during prone positioning (14.2%). The most common PI sites were the cheeks (18.7%). PIs occurred on average at 14.7 days post-acute care admission. Of the PIs where staging information was specified (67.7%), the most common was Stage 2/II (45.2%). PI risk may intensify on account of the intrinsic mechanism of COVID-19-associated intensive care treatment. CONCLUSION PI prevention and management should be prioritised for patients with COVID-19, given the reported high prevalence of PIs and exacerbated risk arising from the use of prone position and medical devices. Further research is required to understand the association between COVID-19 and PIs, and to guide effective prevention and treatment approaches.
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Affiliation(s)
- Julie Sandhu
- School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, Department of Nursing, University of Melbourne, Australia
| | - Charne Miller
- School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, Department of Nursing, University of Melbourne, Australia
- School of Nursing & Midwifery, La Trobe University, Melbourne, Australia
| | - Suzanne Kapp
- School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, Department of Nursing, University of Melbourne, Australia
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Su J, Ye D, Yang L. Cryopreserved amniotic membrane in the treatment of limb skin defects of aplasia cutis congenita: a case study. J Wound Care 2023; 32:S17-S21. [PMID: 36930279 DOI: 10.12968/jowc.2023.32.sup3.s17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
OBJECTIVE To report the efficacy and long-term outcomes of treating the skin defects of aplasia cutis congenita (ACC) with cryopreserved amniotic membrane (AM). METHOD Human amnion was obtained from the caesarean delivery of a full-term healthy pregnancy and processed in a sterile laminar flow hood, and cryopreserved in liquid nitrogen. The structure of the AM was investigated histologically and the viability of the epithelial cells was assessed after cryopreservation and compared with fresh AM and with AM preserved in phosphate-buffered saline (PBS) at 4°C. The cryopreserved AM was applied onto the lower limb skin defects of a one-month old baby with ACC. Timely AM changes were performed as necessary until the wounds healed. RESULTS The structure of the cryopreserved AM was intact, with little visible difference compared with fresh AM. The viability of the epithelial cells was partially lost but still much better retained than in those preserved in PBS at 4°C. The limb skin defects were gradually re-epithelialised upon application of the AM and were completely healed after one month. The 4-month and 2-year follow-ups presented good skin texture and colour, without hypertrophic scar formation. CONCLUSION In this case study, cryopreservation of AM presented a well preserved stromal compartment and viable epithelial layer. It also offered features such as pain relief, good attachment and adhesiveness, improved wound healing and suppressed scar formation in the treatment of ACC skin defects.
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Affiliation(s)
- Jing Su
- Nursing Faculty, Shantou University Medical College, Shantou, China
| | - Danyan Ye
- Research Center for Translational Medicine, Shantou University Medical College, Shantou, China
| | - Lujun Yang
- Research Center for Translational Medicine, Shantou University Medical College, Shantou, China
- Department of Plastic Surgery and Burn Center, 2nd Affiliated Hospital of Shantou University Medical College, Shantou, China
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Tiwary SK, Choubey KK, Nath G, Kumar P, Khanna AK. Effect of four-layer dressing on the microbiological profile of venous leg ulcer. J Wound Care 2023; 32:S22-S30. [PMID: 36930281 DOI: 10.12968/jowc.2023.32.sup3.s22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
OBJECTIVE Venous leg ulcer (VLU) is a chronic disease and has periods of exacerbation and remission. Various bandage systems-single-layered, double-layered and multiple-layered with elastic and non-elastic components-have been developed. The requirement for sustained pressure brought about the introduction of the four-layer bandage. We studied the bacteriology of VLUs and the effect of four-layer bandages on their healing. METHOD Clinical details of all patients, with wound size measurement by gauze piece, wax paper and scale, were recorded. The wounds were initially debrided and photographic records of all patients were maintained. Patients were followed up every week, when the dressings and four-layer bandages were changed. RESULTS A total of 60 patients were recruited to the study with four patients having bilateral disease and so a total of 64 VLUs were evaluated. Of these, 60 (93.8%) healed completely, one (1.6%) healed partially and three (4.7%) did not heal. After excluding the four VLUs that did not fully heal, 10 (16.7%) had recurrence while 50 (83.3%) had no recurrence in the follow-up period, which lasted for one year. During the first visit (baseline), meticillin-resistant Staphylococcus aureus (MRSA) was isolated in 29 (45.31%) VLUs and Pseudomonas spp. in 20 (31.25%) VLUs. With subsequent dressing, the VLU size decreased and the culture of the VLU was sterile from the third culture onwards in 45 cases. There was a significant correlation (p<0.001) between VLU size and the number of dressings. CONCLUSION Compression therapy is the mainstay of treatment of VLU, with rapid healing and improvement in bacteriological profile. Compression in the range of 30-40mmHg is the most effective treatment for uncomplicated VLUs with adequate arterial competency.
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Affiliation(s)
- Satyendra K Tiwary
- Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | | | - Gopal Nath
- Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Puneet Kumar
- Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Ajay K Khanna
- Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
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Td P, Chinh ND, Ha TTM, Thuy MT, Notter J. Nurses' wound care competency in a sample of hospitals in Northern Vietnam. Br J Nurs 2023; 32:S10-S20. [PMID: 36840524 DOI: 10.12968/bjon.2023.32.4.s10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
BACKGROUND This study aimed to investigate the current situation regarding wound care by nurses in eight hospitals in the north of Vietnam, in order to plan the training for nurses to enable them to achieve the National Basic Competency Standards for Nurses. METHODS A cross-sectional descriptive prospective study was conducted from June 2020 to October 2020, with nurses in eight hospitals in four provinces of Northern Vietnam - Hanoi, Quang Ninh, Thai Nguyen and Bac Ninh. Data were collected based on a checklist of direct observation of nurses who provide wound care. The two main indicators were the knowledge score and the practical capacity/competence of the nurses in wound care. RESULTS A total of 518 nurses participated in the study, the mean age was 32.25±7.31; with 438 (84.6%) being female. Clinical experience of less than 10 years was reported by 63.6%; college education level (diploma) was reported by 58.1%, university level by 28.2%; and post-university level by 4%. The highest mean scores for knowledge were found in the categories of health education for patients, followed by care of clean wounds, communication skills and team work, management and professional development and pressure ulcer wound care. Under the practice domain the highest mean scores were ability to plan wound care, followed by self-evaluation, identification of wound types and implementation of wound care plans. CONCLUSIONS AND RECOMMENDATIONS The results showed that when judged against the competency standards, nurses' level of wound care competency needs to be improved. Also that there is a distinct theory-practice gap, which must be addressed. It is recommended that hospitals should conduct training for all nurses using the basic competency standards for Vietnamese nurses to improve the quality of care.
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Affiliation(s)
- Phan Td
- Deputy Dean of the Faculty of Nursing, Hanoi University of Business and Technology, President Viet Nam Surgical Nurses Branch of Viet Nam Nurses Association, and Chief of Nursing Department, Thien An Obstetrics and Gynecology Hospital, Vietnam
| | - Nguyen Duc Chinh
- Associate Professor and Advisor, Department of Septic surgery and wound care, Viet Duc University Hospital, Hanoi, Vietnam
| | | | - Mai Tt Thuy
- Chief of Nursing Department, Quang Ninh Provincial General Hospital, Vietnam
| | - Joy Notter
- Professor of Community Healthcare Studies, Faculty of Health, Education and Life Sciences, Birmingham City University, UK
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Breed HJ, Jones E, Cubitt J. Use of immersive virtual reality to reduce anxiety during complex paediatric dressing changes. BMJ Case Rep 2023; 16:16/2/e252998. [PMID: 36764742 PMCID: PMC9923275 DOI: 10.1136/bcr-2022-252998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
In recent years, there has been an increasing interest in the practical applications of virtual reality (VR) in healthcare. One discussed application of this technology is to reduce anxiety during procedures for paediatric patients. Following skin loss in paediatric patients, careful management of the wound with appropriate dressings and frequent dressing changes is a key part of the treatment process. In children, continued dressing changes are often a source of anxiety, which complicates procedures causing distress to the child, their parents and staff members. VR systems have the potential to not only reduce anxiety but also pain in children requiring frequent dressing changes. Although our knowledge of this technology is improving, further research is needed to evaluate its full potential in this population and to establish guidelines to take advantage of the full potential of VR technology.
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Affiliation(s)
- Hetty Jane Breed
- Welsh Centre for Burns & Plastic Surgery, Swansea Bay University Health Board, Port Talbot, Neath Port Talbot, UK .,Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Elizabeth Jones
- Welsh Centre for Burns & Plastic Surgery, Swansea Bay University Health Board, Port Talbot, Neath Port Talbot, UK
| | - Jonathan Cubitt
- Welsh Centre for Burns & Plastic Surgery, Swansea Bay University Health Board, Port Talbot, Neath Port Talbot, UK
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Gagnon J, Probst S, Chartrand J, Lalonde M. Self-supporting wound care mobile applications for nurses: A scoping review protocol. J Tissue Viability 2023; 32:79-84. [PMID: 36642670 DOI: 10.1016/j.jtv.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 11/29/2022] [Accepted: 01/07/2023] [Indexed: 01/11/2023]
Abstract
AIM Mobile health (mHealth) is playing an increasingly important role in the computerization of wound care on an international scale with an aim to improve care. The aim of this scoping review protocol is to present a transparent process for how we plan to search and review the existing evidence related to self-supporting mobile wound care applications used by nurses. MATERIALS AND METHODS The scoping review will follow the Joanna Briggs Institute (JBI) methodology. An exploratory search was performed using MEDLINE (Ovid), Embase, CINAHL (Ebsco), to identify concepts, keywords, MeSH terms, and headings to identify study types looking for mobile applications in wound care. The findings of this search will determine the final search strategy. Data sources will include MEDLINE, Embase, CINAHL, Web of Science, LiSSa, Cochrane Wounds (Cochrane Library) and Erudit. The titles and abstracts of the identified articles will be screened independently by two authors for relevance. Full texts will also be screened by two independent reviewers and data extraction will be performed in accordance with a pre-designed extraction form. All types of studies and literature linked to self-supporting mobile wound care application used by nurses will be included (quantitative, qualitative, mixed methods and grey literature). CONCLUSION The results of the scoping review will give an overview of the existing self-supporting mobile applications in wound care used by nurses. These will also help to identify the existing applications, and describe knowledge in nursing about their utilisation, development, and evaluation, as well as synthesize the available literature on their impacts.
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Affiliation(s)
- Julie Gagnon
- School of Nursing, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada.
| | - Sebastian Probst
- HES-SO, University of Applied Sciences and Arts Western Switzerland, 47 Avenue de Champel, 1206, Geneva, Switzerland; University Hospital, Geneva, Switzerland; Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Australia.
| | - Julie Chartrand
- School of Nursing, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada; Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada.
| | - Michelle Lalonde
- School of Nursing, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada; Institut du Savoir Montfort, Montfort Hospital, 745A Montréal Road, Suite 202, Ottawa, Ontario, Canada.
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Gunasegaran N, Ang SY, Ng YZ, Lee NES, Agus N, Lee CW, Ong CE, Mostafa SS, Aloweni F. The effectiveness of a hydrocolloid crusting method versus standard care in the treatment of incontinence-associated dermatitis among adult patients in an acute care setting: A randomised controlled trial. J Tissue Viability 2023; 32:171-178. [PMID: 36717288 DOI: 10.1016/j.jtv.2023.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 12/26/2022] [Accepted: 01/20/2023] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Incontinence-associated dermatitis (IAD) is a type of irritant contact dermatitis due to prolonged exposure of the skin to moisture induced by urine or/and faeces. The main principles when treating IAD involves protecting the skin from further exposure to irritants, establishing a healing environment, and eradicating skin infections. This study aimed to evaluate the effectiveness of the hydrocolloid crusting method (HCM) versus the standard care method (SCM) in treating IAD. METHOD A randomised controlled trial was conducted in an acute tertiary hospital in Singapore between August 2019 to September 2021. Using computer-generated numbers, patients were randomised into either HCM or SCM treatment groups. HCM treatment involved cleansing the affected area with a pH-neutral non-rinse moisturising cleanser, and the application of alternate layers of hydrocolloid powder, and non-sting film barrier spray (repeated three times during each use). Patients in the SCM treatment group received the same cleanser followed by a 30% zinc oxide barrier cream. IAD was assessed daily for up to seven days by the wound care nurses using the IAD severity tool. The primary outcome of the study was the mean difference in IAD score per day between both methods. RESULTS Forty-four patients were eligible and recruited (22 in HCM; 22 in SCM). Patients in both groups were comparable in age and gender. IAD Category 2 was more predominant in both methods. The most common location of IAD was at the perianal skin and diarrhea related to gastroenteritis was the most prevalent cause of IAD. More patients in the SCM group (n = 12; 54.5%) had their IAD healed within seven days compared to HCM, (n = 7; 31.8%) group. However, the average decrease in IAD scores per day for both methods were found to be similar. CONCLUSION HCM can be considered as a treatment of IAD along with the use of SCM. A skin care regimen should include effective cleansing, skin protection, and moisturization in IAD management.
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Affiliation(s)
| | - Shin Yuh Ang
- Nursing Division, Singapore General Hospital, Singapore.
| | - Yi Zhen Ng
- Skin Research Institute of Singapore, Singapore.
| | | | - Nurliyana Agus
- Nursing Division, Singapore General Hospital, Singapore.
| | - Chee Woei Lee
- Nursing Division, Singapore General Hospital, Singapore.
| | - Choo Eng Ong
- Nursing Division, Singapore General Hospital, Singapore.
| | | | - Fazila Aloweni
- Nursing Division, Singapore General Hospital, Singapore.
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Schul MW, Melin MM, Keaton TJ. Venous leg ulcers and prevalence of surgically correctable reflux disease in a national registry. J Vasc Surg Venous Lymphat Disord 2023; 11:511-516. [PMID: 36681297 DOI: 10.1016/j.jvsv.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 11/20/2022] [Accepted: 11/28/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Chronic venous disorders are common, with varicose veins occurring in ∼40% of the population. Venous leg ulcers affect 1% to 2% of the population, with the prevalence increasing ≤4% for those aged >65 years. Both conditions are expensive and together are responsible for ≤2% of the annual healthcare budget expenditure of Western societies. The ESCHAR (effect of surgery and compression on healing and recurrence) and EVRA (early venous reflux ablation) trials demonstrated that surgical correction of superficial venous reflux reduced ulcer recurrence, resulted in faster healing times (EVRA), and was proved cost-effective. Largescale data regarding patients with chronic venous leg ulcers presenting to venous centers with treatable superficial venous insufficiency has not been previously reported. Our study was designed to evaluate the percentage of patients with leg ulcers presenting to dedicated vein centers who were found to have surgically correctable superficial venous insufficiency. METHODS The American Vein & Lymphatic Society Patient Reported Outcome Venous Registry began collecting data in 2014 and is one of two national registries focused on chronic venous disorders. The database was queried first for the presence of an ulcer using the CEAP (clinical, etiologic, anatomic, pathophysiologic) classification (C6 status). These de-identified data were further correlated by crossing the number of ulcers for the same limb using the revised venous clinical severity score (rVCSS). The demographics, index duplex ultrasound details, and rVCSS features for ulcer duration and compression use were analyzed. Once the presence of an ulcer had been validated by CEAP and rVCSS, the population was divided into groups according to the ultrasound-reported anatomic pathology (eg, normal, reflux, obstruction, reflux plus obstruction). The query was directed toward all patients seeking a venous evaluation at participating centers from January 2018 through January 2022. RESULTS More than 270,000 unique patient records were reviewed. Of the 270,000 records, 163,027 (60%) had had duplex ultrasound scans available, for 1794 unique patients (1879 limbs), representing 1.1% with a leg wound. Of these patients, 55.4% were men and 44.6% were women. Group S included patients with isolated superficial pathology (n = 1291; 68.7%). Group M included patients with mixed superficial and deep pathology (n = 238; 12.7%). Group D included patients with isolated deep vein pathology (n = 58; 3.1%). Finally, group N included patients with leg wounds but no venous pathology (n = 292; 15.5%). The rVCSSs for groups S and M were significantly higher than those for group N. In group S, the dominant patterns involved the great saphenous vein (GSV) above the knee (54.8%), the small saphenous vein (30.7%), and the anterior accessory GSV (14.4%). The frequency of single, double, and triple axial vein reflux identified 1.45 vessels eligible for ablation treatment per limb. In group M, the dominant patterns involved the GSV above the knee (61.7%), the small saphenous vein (26.2%), and the anterior accessory GSV (12.1%), for 1.52 axial segments per limb. Of the 84.4% of venous ulcer patients, duplex ultrasound analysis revealed that 97% of this large subset had had surgically correctable disease. CONCLUSIONS The American Vein & Lymphatic Society Patient Reported Outcome Venous Registry demonstrated that 85% of the leg wounds in the present study were venous in origin and 97% possessed surgically correctable disease. Our findings support early referral to dedicated vein centers with appropriate venous reflux management as a part of the multidisciplinary team caring for patients with venous leg ulcers.
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Affiliation(s)
| | - M Mark Melin
- M Health Fairview Wound Healing Institute, Edina, MN
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