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

Introduction: During the COVID-19 pandemic surgical mask-wearing was widely adopted as a means of preventing infections, but there have been several reports of mask-induced skin problems. In this report, we describe a case in which surgery was required for a mask-induced ear injury.

Case report: An otherwise healthy 63-year-old male presented to the plastic surgery department with an auricle injury. He had been using a mask that was too small for his face for more than 1 month; the tight ear loops caused the upper part of his left auricle to begin to dissect, resulting in a large tear. More than a third of the left upper auricle was torn, and the wound surface was epithelialized. The patient had no history of skin disease or psychiatric disorder but was engaged in a job that required wearing a helmet constantly. Surgery was performed to refresh the epithelialized wound surface and suture it, and the patient healed without complication.

Conclusion: While mask-wearing mandates and recommendations have considerably eased since the height of the pandemic, the current authors' experience has brought to light problems related to mask usage. Thus, efforts should be made to investigate the causes of these problems and provide appropriate advice.

Introduction: PI has been shown to be effective against a broad spectrum of bacteria and to be cytotoxic to a variety of cell types. Such findings led to the widespread belief that PI interferes with wound healing.

Objective: This article reviews laboratory studies, animal wound studies, and clinical studies that examine the efficacy and safety of iodine-based wound products in wound healing.

Methods: The authors searched PubMed and Scopus databases without time restrictions, and 62 articles were selected for complete evaluation. Fourteen RCTs and 5 comparative studies that evaluated PI and 15 RCTs that evaluated CI were included.

Results: In 63% (n = 12) of the PI studies, there was no difference between PI and controls and in 5% (n = 1) PI performed significantly better than the comparator. In 31% (n = 6), outcomes were better with controls than with PI. In the RCTs on CI, 64% (n = 9) of the studies found no difference between CI and controls. Thirty-five percent (n = 5) showed significantly positive influence of CI compared with controls.

Conclusions: Both CI and PI appear to be safe, with no evidence that these products impede wound healing, are associated with more infections, or require more amputations compared with other modalities. PI can effectively be used for short periods of time, and CI is an effective wound care modality for chronic wounds.

The management of sacral wounds is often complicated by patient comorbidities and anatomical factors. This retrospective case series describes the management of 5 complex sacral wounds in which UBM devices were applied to facilitate wound closure. The wounds in this series were exacerbated by comorbidities and challenging wound presentations including tunneling and exposed bone. In this series, application of UBM particulate and sheets supported progressive wound closure, marked by neo-tissue formation and depth reduction with closure of tunneling in all cases. Results from this series underscore the utility of UBM devices in the management of sacral wounds and especially those further hindered by extensive tunneling.

Introduction: The Meek micrografting technique used in STSG expansion is effective in achieving wide and rapid coverage of burn wounds. Certain growth factors have also been shown to modulate or mediate wound healing.

Objective: In this study, a combined treatment approach for severe burns involving the Meek micrografting technique, systemic application of rhGH, and topical application of rhEGF was evaluated.

Materials and methods: A retrospective study was conducted of 7 extensively burned patients who were treated with the Meek technique, systemic application of rhGH, and topical application of rhEGF between January 2017 and December 2019.

Results: The mean percent TBSA burned was 89%. An average of 9.5 surgical procedures were performed to obtain skin cover, with an average of 5.8 Meek micrograft procedures performed in the 6 surviving patients. Complete wound healing was achieved at an average of 120 days in the 6 surviving patients. The mean graft take rate was 81%. Infection was the main reason for graft failure. Donor sites were used for up to 5 re-harvestings without additional morbidity.

Conclusions: A multipronged treatment approach that combines the Meek micrografting technique, systemic application of rhGH, and topical application of rhEGF is a promising tool for the management of severe and extensive burns.

Introduction: Chronic wounds represent a significant burden to the health care system and patients.

Objective: This study determined the effectiveness of a wound scaffold comprised of PCMP for use in nonhealing, cutaneous wounds; this study analyzes pooled data from the population of 3 combined registries.

Materials and methods: A total of 3 combined registry populations were pooled from a single-center study of 41 patients, a single-center study of 86 patients, and the RESPOND Registry of 307 patients treated at 28 centers. All 434 patients received PCMP and were followed for up to 48 weeks. Male and female patients 18 years or older with wounds between 0.2 cm2 and 200 cm2 were included.

Results: In total, there were 95 VLUs, 78 DFUs, 90 PIs, 73 PSWs, and 98 wounds of other etiologies analyzed. The mean baseline area, depth, and volume of all 434 wounds was 15.1 cm2, 4.9 mm, and 7.2 cm3, respectively. K-M median time to wound closure for all wounds was 19 weeks. At weeks 20, 24, 28, and 48, the frequency of wound closure for all wounds was 51%, 56%, 62%, and 72%, respectively. The median time to closure by wound type was 22 weeks for VLUs, 24 weeks for DFUs, 23 weeks for PIs, 12 weeks for PSWs, and 14 weeks for other wounds. The proportion of wounds closed were 72% (VLUs), 52% (DFUs), 63% (PIs), 95% (PSWs), and 67% (other etiologies).

Conclusions: This 434-patient PCMP cohort analysis showed 72% wound closure and median time to wound closure of 19 weeks. PCMP demonstrated effectiveness for use in multiple wound types.

Introduction: Defects that remain after MMS cannot always be repaired immediately. When closure is not feasible, wounds are left to heal by secondary intention and may take weeks to close. In such cases, the use of an allograft that stimulates endogenous wound healing pathways may be desirable.

Objective: This retrospective study assessed whether the use of dHACM allograft after MMS led to a statistically significant improvement in post-Mohs wound closure rates compared with secondary intention healing.

Methods: This study evaluated 80 patients who underwent MMS and compared time to complete healing between wounds treated with dHACM allografts (n = 40) and wounds healed by secondary intention (n = 40). Wounds were assessed every 2 weeks, and photographs were taken. Statistical analysis was conducted.

Results: Average time to complete wound healing was significantly reduced with the use of dHACM allograft compared with traditional secondary intention healing (5.2 weeks and 6.5 weeks, respectively; P = .01).

Conclusion: The use of dHACM allograft resulted in more rapid wound healing, and this allograft is a potential alternative to traditional secondary intention healing methods. Further studies are needed to reinforce the results of this pilot study.

Introduction: Calcific arteriolopathy involves the deposition of insoluble calcium salts in the vasculature and soft tissues, leading to ischemia, thrombosis, and cutaneous necrosis. Calcific arteriolopathy is commonly associated with ESRD but can also occur outside of ESRD, known as NUC.

Objective: This article reviews the clinical management and outcomes of 3 cases of non-uremic calcific arteriolopathy.

Materials and methods: This case series describes the clinical presentation and successful treatment of NUC in a community hospital-based outpatient wound center in southeastern Wisconsin. Factors presumed to be involved included chronic kidney disease-associated mineral bone disorder, dysregulation and deficiencies of the inhibitors of vascular calcifications, autoimmune dysfunction, and chronic inflammation. All 3 patients received multimodal treatment with wound hygiene, pain management, and infection control. In addition to these interventions, case 2 received NLFU.

Results: All 3 patients displayed increased tolerance of compression and debridement and successfully epithelialized with no discernible effect on long-term function or quality of life. Wound infection occurred in each case. The mean overall healing time was 20 weeks.

Conclusion: The study findings suggest that successful management of NUC can be achieved using IV STS, early and aggressive infection treatment, pain control, and wound hygiene. In patients with NUC, NLFU may be an appropriate adjunct to expedite healing.