Objective: Hidradenitis suppurativa (HS) presents a hard-to-heal (chronic) wound environment, which can predispose individuals to squamous cell carcinoma (SCC). This study evaluates the treatment and reconstructive options for patients with HS, who have been cared for at the author's clinic. The aim of this article is to contribute insights into effective treatment methods and to provide a roadmap for wound management for this patient group.
Method: The evaluation encompassed factors such as age, sex, presence of comorbidities, anatomical location of HS, extent of tissue involvement, incidence of SCC and details of surgical reconstruction methods.
Results: Preoperative diagnostic biopsies were conducted on 18 patients with hard-to-heal wounds and SCC was identified in four patients.
Conclusion: It is essential to take a biopsy of HS lesions before surgical intervention in order to identify potential SCC. This step provides critical information for treatment planning. For patients requiring extensive abdominopelvic resection due to HS-induced SCC, the vertical rectus abdominis myocutaneous flap is an ideal and practical option. Additionally, proactive measures can mitigate complications with the donor area.
Previous studies by the authors have shown that human amniotic membrane extract (AME) potentially improves epithelial damage in corneal and skin lesions. However, questions about its role in diabetic foot ulcer (DFU) treatment remain unanswered. In this study, patients with hard-to-heal DFUs were randomly selected after screening and, after confirming the safety of the AME in an initial selection of patients, the remaining participants were divided into two groups. The treatment group received an AME product (DiAMX, Royan Stem Cell Technology, Iran) (concentration 1mg/ml) with standard of care (SoC), topically, every 48 hours for the first week and then every 72 hours until complete closure. The control group received SoC. Patients were visited weekly, and any improvement, reduction in the wound area and any side-effects were recorded. The results of the safety phase (without the control group) showed that the AME had no adverse events. In the efficacy phase, there was no significant difference in baseline characteristics between the treatment and control groups. The results showed that the wound healing rate was 100% in the treatment group and 77.5±3.12% in the control group (p<0.0001) at week 6. All wounds (n=15) were closed in the treatment group and seven wounds had closed in the control group (p<0.0001). The findings of this study showed that the topical use of DiAMX, in addition to SoC, was patient-friendly, inexpensive, safe and effective in healing hard-to-heal DFUs.
Objective: To evaluate the use of negative pressure wound therapy (NPWT) in healing closed spinal incisions following scoliosis deformity surgery in a paediatric cohort.
Method: A retrospective review of patients <21 years of age who underwent posterior spinal instrumentation and fusion for severe scoliosis between 2019-2022. Patients were divided into two groups. The first comprised patients with idiopathic scoliosis (IS) treated with 3M Prevena (SolventumUS) application (Group P-IS). They were compared against a matched group who received standard dressings (Group S-IS). The second group comprised patients with non-idiopathic scoliosis (NIS) treated with 3M Prevena application (Group P-NIS), and who were compared against a matched group who received standard dressings (Group S-NIS).
Results: The first group had a total of 31 patients (Group P-IS) who were compared to 35 patients (Group S-IS). Seroma formation, wound dehiscence, surgical site infections (SSIs), duration of hospitalisation and the number of visits until complete wound healing was higher in Group S-IS, although statistical significance (p<0.05) was not reached. In the second group, a total of 17 patients (Group P-NIS) were compared against 13 patients (Group S-NIS). Seroma formation, duration of hospitalisation and number of visits until complete wound healing was higher in Group S-NIS.
Conclusion: In this study, NPWT following primary closure in scoliosis surgery resulted in reduced seroma formation, wound dehiscence and SSIs in patients with IS, and reduced seroma formation in NIS patients. NPWT was beneficial in augmenting wound healing following paediatric spinal surgery and should be further examined in larger-scale prospective studies.
Objective: Diabetic foot ulcer (DFU) is one of the most common complications of diabetes, and causes significant morbidity, mortality and healthcare expenditure. Multidrug-resistant organism (MDRO) infection is considered a major threat to the treatment of DFUs. This study investigated the risk factors for MDRO infections in DFUs.
Method: This was a retrospective case-control study. Patients diagnosed with DFU and MDRO infections were included in the observation group. The same number of patients hospitalised during the same period and who were diagnosed with DFU but without MDRO infection were matched and selected as the control group. Binary logistic regression analysis was performed to evaluate the risk factors for multidrug-resistant organism (MDRO) infections in DFUs by analysing the clinical data. The receiver operating characteristic (ROC) curve was used for evaluation.
Results: The electronic medical records of 110 patients (55 in each group, with similar sex and age) were reviewed. The results of binary logistic regression analysis showed that: history of antibiotic exposure (odds ratio (OR)=11.878; 95% confidence interval (CI): 3.064, 46.046; p<0.001); history of hospitalisation within one year (OR=3.198; 95% CI: 1.156, 8.846; p=0.025); hypertension (OR=3.976; 95% CI: 1.444, 10.951; p=0.008); and osteomyelitis (OR=21.667; 95% CI: 3.427, 137.002; p=0.001) were significant risk factors for MDRO infection in patients with a DFU. The logistic regression model for MDRO infection in patients with a DFU was fitted as follows: Logit (P) = (-3.482) + (2.475) × history of antibiotic exposure + (1.163) × history of hospitalisation within 1 year + (1.380) × hypertension + (3.076) × osteomyelitis. The ROC curve evaluation model was plotted. The area under the curve was 0.861 (95% CI: 0.794, 0.927; p<0.001).
Conclusion: The findings of this study showed that history of antibiotic exposure, history of hospitalisation within one year, hypertension, and osteomyelitis in combination were the risk factors for MDRO infections in patients with DFUs.
Objective: Superabsorbent wound dressings (SWDs) are often applied for the management of excess exudate in moderately-to-highly exuding wounds; however, in vitro performance characteristics, including absorptive capacity and retention of fluid, can vary significantly between SWD brands. The aims of this study were to: i. assess in vitro absorptive and retention capacities of a new non-adhesive SWD (Biatain Superabsorber, Coloplast A/S, Denmark) and four non-adhesive comparator SWDs (Zetuvit Plus (Hartmann, Germany); ConvaMax Superabsorber (Convatec, UK); Mextra Superabsorbent (Mölnlycke, Sweden); and Vliwasorb (Lohmann & Rauscher, Germany)); ii. assess the ability of the SWDs to reduce matrix metalloproteinase (MMP) activity in vitro; iii. assess bacterial retention within the new SWD; and iv. explore the clinical application of the new SWD in three cases studies.
Method: In vitro performance characteristics were assessed for the five SWDs, which included: free swell absorption; absorption under compression (40mmHg); retention of fluid under compression (40mmHg); and sequestration (protease activity reduction) of MMP-2 and MMP-9. Bacterial retention was assessed with the new SWD.
Results: Significant variations in in vitro performance characteristics between the SWDs were observed. The new SWD showed higher free swell absorption, retention of fluid under compression and absorption under compression than the comparators. MMP-2 and MMP-9-activity were reduced by 98% and 80%, respectively, after four hours' incubation with the new SWD, and it effectively absorbed and retained bacteria within the dressing. The three case reports highlighted benefits of using the new SWD in management of moderately-to-highly exuding wounds.
Conclusion: The new SWD, Biatain Superabsorber, showed good performance in the different in vitro comparative assessments, and clinical use of the dressing highlighted benefits in the management of wound exudate and in establishing an environment supporting wound healing.
Cutaneous wound healing consists of complex processes involving different types of cells and signalling pathways, and occurs in three phases (inflammatory, proliferative and tissue remodelling). The dysregulation of these processes leads to abnormal wound healing, manifesting as hard-to-heal (chronic) wounds at one extreme and pathological scarring at the other. Recent studies have shown that the tumour necrosis factor-like weak inducer of apoptosis (TWEAK)/fibroblast growth factor-inducible 14 (Fn14) signalling pathway regulates inflammatory, re-epithelialisation, collagen synthesis and angiogenesis processes, suggesting that it can modulate cutaneous wound healing. Despite numerous studies suggesting a relationship between the TWEAK/Fn14 axis and cutaneous wound healing, there has been little attention paid to this relationship to date. There is scarce direct evidence supporting that TWEAK/Fn14 axis-targeted therapies work in cutaneous wounds. This review summarises the evidence that TWEAK/Fn14 signalling is involved in wound repair as well as in tissue remodelling. In addition, TWEAK/Fn14 axis-targeted therapies in other diseases are highlighted, and their therapeutic potential in cutaneous wounds discussed.
Objective: Venous leg ulcers (VLU) are a common, recurring condition resulting from venous stasis; they are especially prevalent in Northern Europe and the US. The overall prevalence of this condition is 1%, rising to 3% in patients >65 years of age. This study analysed the effect of a combination of single-use negative pressure wound therapy (sNPWT, VivereX NPWT system (Sunmedic AB, Vällinge, Sweden) and compression bandaging (CB) in the treatment of VLUs.
Method: An experimental in vivo extremity model was used to monitor and validate sub-dressing pressure.
Results: There was no effect of the multilayer CB on the sNPWT therapeutical pressure. To the best of the author's knowledge, this is the first experimental study to examine variations in sub-dressing pressure within sNPWT systems following the application of a CB.
Conclusion: In this study, therapeutical pressure induced by the VivereX device remained unaffected when used in combination with multilayer CB in the treatment of VLUs.
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