Wounds : a compendium of clinical research and practice最新文献

Background: Cadaveric skin grafts were initially used for the management of acute burn wounds. The biological coverage of the wound improves the quality of the wound bed, which prepares it to receive an autologous skin graft. The benefits of cadaveric skin graft in burn wounds have led to its use in the management of acute and chronic wounds of diverse etiologies.

Objective: To evaluate the use of cadaveric skin graft and subsequent autologous split-thickness skin graft (STSG) in the management of wounds of diverse etiologies at a single institution.

Materials and methods: A retrospective analysis was performed of patients with wounds of different etiologies managed with cadaveric skin grafts followed by a second procedure in which autologous STSG was performed from May 2017 through May 2022 in the Plastic and Reconstructive Surgery Department of German Hospital, Buenos Aires, Argentina.

Results: A total of 25 patients with wounds of different etiologies were included. The mean affected body surface area (BSA) was 1.87%. The mean engraftment percentage of the cadaveric skin graft was 96.6%. The mean engraftment percentage of the STSG was 90.6%. All patients demonstrated improvement in local edema and inflammation, reduced secretions, and reduced pain after treatment. Two patients (8%) had complications, with 1 case of delayed healing of the donor site and 1 case of hypertrophic scarring.

Conclusions: Cadaveric skin graft with subsequent STSG is a simple, safe, and effective alternative for the management of complex wounds of diverse etiologies. This technique is particularly useful in patients with multiple comorbidities who are at risk of recurrence and of developing multiple wounds during their lifetime.

Background: Acute and chronic wounds in the acute hospital setting are commonly managed with soft silicone multilayer foam dressings (SSMFDs). While many SSMFDs are indicated for wear time of up to 7 days, they are often changed more frequently.

Objective: To use real-world data on dressing change practices and clinical outcomes to examine whether a built-in indicator on a proprietary SSMFD could reduce unnecessary dressing changes.

Materials and methods: Health care professionals (HCPs) were screened and recruited from a health care research panel to complete per wound data capture forms. Outcomes reported included dressing wear time, healing rates, dressing change frequency, user satisfaction, and adverse events. Outcomes were reported as an aggregated data set.

Results: A total of 53 wounds were analyzed. The mean treatment period was 23.83 days, which included dressing changes every 2 to 3 days on average. Of the 53 cases analyzed, the unique change indicator on the SSMFD was used to guide dressing change frequency 98% of the time. Overall, 21% of wounds completely healed (n = 11), 70% (n = 37) showed improvement, 9% (n = 5) were static, and 0% deteriorated.

Conclusion: Real-world data on use of the proprietary SSMFD in an acute setting indicates that the SSMFD can allow for the optimization of dressing change protocols to enable appropriate dressing change frequency, allowing for undisturbed healing and maximizing HCP and dressing resources.

Background: Venous leg ulcers (VLUs) and diabetic foot ulcers (DFUs) are examples of chronic wounds that pose an ongoing health care challenge. Despite significant progress in managing such wounds, challenges persist that require innovative solutions. Cellular, acellular, and matrix-like products (CAMPs) are advanced therapies designed to facilitate chronic wound healing. Polylactic acid (PLA) is a synthetic material used in alloplastic CAMPs that has shown promise in the management of burns and traumatic injuries.

Objective: To retrospectively assess the effect of PLA in promoting chronic wound healing compared with 2 other well-established CAMPs.

Materials and methods: This retrospective chart review, which was conducted in 3 high-volume wound care clinics, aimed to compare the efficacy of 2 advanced wound care products vs a PLA alloplastic CAMP in promoting DFU and VLU closure. The study included 131 wounds treated with a non-CAMP collagen dressing, fish skin grafts (FSGs), or PLA matrices. Inclusion criteria included single Wagner grade 1 or 2 DFUs or Clinical-Etiology-Anatomy-Pathophysiology classification score C6 VLUs, present for at least 12 to 52 weeks, and measuring between 1 cm² and 20 cm². Patients received weekly treatments with 1 of 3 CAMPs, along with standard care. The primary outcome was time to achieve full healing, and the secondary outcome was the proportion of ulcers healed at 12 weeks.

Results: The PLA alloplastic CAMP demonstrated superior outcomes, with a 50% and 20% reduction in time to heal DFUs compared with collagen dressings and FSG, respectively (P < .001). For VLUs, PLA exhibited even more impressive results, achieving 95% and 40% reduction compared with collagen and FSG, respectively (P < .001). PLA allografts displayed a 55% higher rate of full healing by 12 weeks compared with collagen dressings, and a 26% higher rate compared with FSG (P < .001).

Conclusion: This study highlights the unique attributes of PLA for achieving wound closure. PLA-based alloplastic CAMPs are promising treatments, offering rapid healing, increased closure rates, and multifaceted benefits for wound healing.

Background: Wounds at sutured sites are a major postoperative complication. Uncontrolled comorbidities and certain drugs (immunosuppressants and antiproliferative chemotherapeutic agents) hamper the process of wound healing. Sutured wounds need prolonged duration of dressings and management as well as repeated hospital visits. In addition, appropriate reconstructive procedures may be needed to cover the wound. All these factors ultimately add to the cost of care.

Case report: A simple, yet effective option for the management of a refractory chronic postoperative raw area in a surgical case of breast carcinoma is reported. Acceptable wound healing was eventually achieved without disturbing the patient's chemotherapy cycles, and a major reconstructive procedure was avoided.

Conclusion: Citric acid treatment can be a cost-effective, safe, efficient, and novel option to promote faster granulation and epithelialization and may avoid the need for major reconstructive surgery.

Background: Pyoderma gangrenosum (PG) is a rare skin condition that is challenging for both patients and physicians alike. It is extremely painful and can become debilitating for many patients. PG has a mortality rate of 16% at 8 years, and patients with PG have a threefold risk of death compared to the general population. Currently, the management of PG is not standardized and is somewhat experimental as these wounds are prone to pathergy.

Case report: A single patient diagnosed with PG of both lower extremities was successfully treated with a protocol that included serial wound debridement with a sterile scrub brush and hydrodebridement followed by application of a synthetic hybrid-scale fiber matrix (SHSFM) dressing. The patient's wounds successfully healed and the resolution was maintained at 2 years, at which time the patient was discharged from the clinic.

Conclusion: To the authors' knowledge, this is the first study reporting the use of SHSFM as a primary treatment option for PG.

Background: A new indication for use of silver collagen oxidized regenerated cellulose (ORC) dressing in conjunction with negative pressure wound therapy (NPWT) and reticulated open cell foam (ROCF) dressings has recently become available.

Objective: An in-person meeting with 7 health care providers (HCPs) was held to identify clinical care settings and appropriate use of silver collagen ORC dressings in conjunction with NPWT and ROCF dressings.

Methods: Consensus statements were developed using a modified Delphi technique. An additional 25 HCPs completed an anonymous survey on the consensus statements. Consensus was defined as ≥80% agreement among survey respondents.

Results: Use of silver collagen ORC dressings with NPWT and ROCF dressings was recommended in inpatient and outpatient health care settings. Use in traumatic wounds, surgical wounds, diabetic ulcers, venous leg ulcers, and pressure injuries/ulcers was supported. Use was not recommended in the presence of exposed unprotected organs or exposed unprotected vessels, when the potential for inadequate wound hemostasis exists, acutely ischemic wounds, third-degree burns, or surgically closed incisions, or with patient hypersensitivity to product components.

Conclusions: Limited evidence exists on use of NPWT in conjunction with silver collagen ORC dressings. A panel developed 12 consensus statements detailing the recommended and contraindicated uses of NPWT in conjunction with silver collagen ORC dressings.

Background: There is substantial literature supporting the use of cellular and/or tissue-based product (CTP) in managing Wagner grade 1 and 2 diabetic foot ulcers (DFUs) and, to a lesser extent, venous leg ulcers (VLUs). Several studies advocate CTP therapy as an effective method for promoting healing in chronic DFUs and VLUs.

Objective: To evaluate how the number of CTP applications affect healing and wound area reduction (WAR) rates of DFUs and VLUs.

Methods: A multicenter private wound care practice, electronic health record, and database were used to analyze Medicare patients receiving CTPs between January 1, 2018, and December 31, 2023. Wound treatments occurred in the nursing home, private office, and home settings, not in hospital outpatient department settings. This privately funded, non-vendor-sponsored, real-world retrospective analysis included wound closure and WAR rates after each CTP application. Analysis includes current (2024) aspects of proposed local coverage determination changes that limit the number of CTP applications to 4. A paired t test was used to compare mean wound area before CTP applications and after completing CTP applications over a 16-week period. Effect sizes were analyzed using Cohen d, and correlations between the number of CTP applications and WAR were determined using the Pearson correlation coefficient.

Results: A total of 257 wounds were reviewed for analysis, of which 123 were DFUs and 134 were VLUs. For both DFUs and VLUs, there was a significant difference in the average initial wound areas (cm2) compared with the average wound areas after the CTP application series (P < .001).

Conclusion: This comprehensive retrospective real-world analysis of Medicare patients receiving CTP therapy in conjunction with standard of care treatment of DFUs and VLUs demonstrated significant reduction in the average wound area after completing a CTP application series. The results of this study could be used as a guide for the average number of CTP applications required for the effective treatment of DFUs and VLUs.

Background: Cutaneous pathology on the male chest has a broad differential diagnosis that includes both malignant and benign processes. Surgeons-including surgical oncologists, dermatologic surgeons, plastic surgeons, and thoracic surgeons-may be consulted for management or evaluation of these conditions at various stages of the diagnostic work-up. No single surgical specialty manages all cutaneous pathology that arises on the male chest.

Case report: To illustrate the challenges and utility of imaging for diagnosis in the male breast, a clinical example is provided of an 82-year-old male who presented with an ulcerated plaque on the chest with involvement of the nipple areolar complex. The patient underwent shave biopsy and was initially diagnosed with basal cell carcinoma; however, after resection he was found to have invasive mammary carcinoma.

Conclusion: Careful assessment, investigation, and understanding of pathology that may present on the male chest are key to making the correct diagnosis and avoiding treatment delays.

Fish skin has emerged as a potential candidate for improving wound healing due to its notable results in human trials, in which it has been directly applied as a dressing on wounds. The current review explores the mechanisms by which fish skin can boost the wound healing process. The natural wound healing process involves inflammation at the wound site to initiate tissue repair. The body balances this inflammation through interleukin signaling, and imbalances can cause chronic wounds or scarring. The wound site also secretes epidermal growth factor, which activates the Ras/Raf/MEK/ERK and PI3K/Akt pathways. These pathways promote angiogenesis (ie, replacing injured blood vessels) and epithelialization (ie, replacing injured skin). Delays in these pathways increase the healing time. The rich contents of omega-3, collagen, and selenium in fish skin boost wound healing by inhibiting compounds that can cause over-inflammation during interleukin signaling. They also upregulate the Ras/Raf/MEK/ERK and PI3K pathways by altering lipid composition (via omega-3), binding with collagen receptors (via collagen), and modulating selenoproteins (via selenium). The mechanisms discussed in this review support the finding that fish skin is a promising candidate with a strong potential to naturally boost the wound healing process in clinical settings. Continued investigation into the application of fish skin as a practical and commercial wound healing agent is warranted. Future study of additional wound healing properties of fish skin, such as microbial protection of open wounds, is recommended.

Background: Wound healing typically occurs in 4 sequential stages: hemostasis, inflammation, proliferation, and remodeling. During the proliferation stage, the wound undergoes granulation, angiogenesis, and epithelialization. Granulation involves the growth of connective tissue and blood vessels to fill the wound space. Granulation tissue provides a scaffold for subsequent tissue regeneration, supports angiogenesis, and aids in wound contraction. Classically, it also supports epithelialization. The timing and extent of granulation and epithelialization may vary depending on the size and type of wound. In certain cases, especially with superficial wounds or partial-thickness injuries, the intact blood supply from deeper tissue layers may be sufficient to support epithelialization without significant granulation tissue formation. However, this pathway has not been described for full-thickness wounds.

Case reports: The current case report describes wound healing in 2 patients with multiple comorbidities who presented with nonhealing stage IV pressure injuries. After extensive therapy, reepithelialization and wound healing occurred without typical granulation tissue formation.

Conclusion: The achievement of epithelialization without prior granulation may suggest the existence of an alternative wound healing pathway for full-thickness wounds in which epithelialization occurs independent of robust granulation.