Pub Date : 2017-01-01DOI: 10.1016/j.jccw.2018.06.001
Areg Grigorian MD, Megumi Sugimoto BS, Victor Joe MD, Sebastian Schubl MD, Michael Lekawa MD, Matthew Dolich MD, Eric Kuncir MD, Cristobal Barrios Jr. MD, Jeffry Nahmias MD, MHPE
Background
In a systematic review, the level of spinal cord injury (SCI) was not associated with risk for pressure ulcer (PU). We hypothesized that in the acute trauma population, upper-SCI (cervical/thoracic) has greater risk for PU when compared to lower-SCI (lumbar/sacral). We additionally sought to identify risk factors for development of PUs in trauma.
Methods
A retrospective analysis of the NTDB (2007–2015) was performed. Covariates were included in a multivariable logistic regression analysis to determine risk for PU.
Results
Of 62,929 patients (0.9%) with SCI, most had an upper-SCI (83%). The overall rate of PUs in patients with SCI was 5.1%. More patients with upper-SCI developed PUs compared to lower-SCI (5.8% vs. 2.2%, p < 0.001). SCI was the strongest predictor for PU (OR = 13.77, CI = 13.25–14.31, p < 0.001). Upper-SCI demonstrated greater risk compared to lower-SCI (OR = 2.81, CI = 2.45–3.22, p < 0.001).
Conclusions
Contrary to previous reports, a higher SCI level is associated with a three-fold greater risk for PU compared to lower SCI.
在一项系统综述中,脊髓损伤(SCI)的水平与压疮(PU)的风险无关。我们假设,在急性创伤人群中,上段脊髓损伤(颈椎/胸椎)比下段脊髓损伤(腰椎/骶骨)有更大的PU风险。我们还试图确定创伤脓毒症发展的危险因素。方法对2007-2015年NTDB病例进行回顾性分析。协变量包括在多变量逻辑回归分析中,以确定PU的风险。结果在62,929例(0.9%)脊髓损伤患者中,大多数为上肢脊髓损伤(83%)。脊髓损伤患者脓毒症的总体发生率为5.1%。上肢脊髓损伤患者出现脓肿的比例高于下肢脊髓损伤患者(5.8% vs. 2.2%, p <0.001)。SCI是PU的最强预测因子(OR = 13.77, CI = 13.25-14.31, p <0.001)。上脊髓损伤的风险高于下脊髓损伤(OR = 2.81, CI = 2.45-3.22, p <0.001)。与之前的报道相反,较高的脊髓损伤水平与较低的脊髓损伤相比,PU的风险增加了三倍。
{"title":"Pressure Ulcer in Trauma Patients: A Higher Spinal Cord Injury Level Leads to Higher Risk","authors":"Areg Grigorian MD, Megumi Sugimoto BS, Victor Joe MD, Sebastian Schubl MD, Michael Lekawa MD, Matthew Dolich MD, Eric Kuncir MD, Cristobal Barrios Jr. MD, Jeffry Nahmias MD, MHPE","doi":"10.1016/j.jccw.2018.06.001","DOIUrl":"10.1016/j.jccw.2018.06.001","url":null,"abstract":"<div><h3>Background</h3><p>In a systematic review<span>, the level of spinal cord injury<span> (SCI) was not associated with risk for pressure ulcer (PU). We hypothesized that in the acute trauma population, upper-SCI (cervical/thoracic) has greater risk for PU when compared to lower-SCI (lumbar/sacral). We additionally sought to identify risk factors for development of PUs in trauma.</span></span></p></div><div><h3>Methods</h3><p>A retrospective analysis of the NTDB (2007–2015) was performed. Covariates were included in a multivariable logistic regression analysis to determine risk for PU.</p></div><div><h3>Results</h3><p>Of 62,929 patients (0.9%) with SCI, most had an upper-SCI (83%). The overall rate of PUs in patients with SCI was 5.1%. More patients with upper-SCI developed PUs compared to lower-SCI (5.8% vs. 2.2%, p < 0.001). SCI was the strongest predictor for PU (OR = 13.77, CI = 13.25–14.31, p < 0.001). Upper-SCI demonstrated greater risk compared to lower-SCI (OR = 2.81, CI = 2.45–3.22, p < 0.001).</p></div><div><h3>Conclusions</h3><p>Contrary to previous reports, a higher SCI level is associated with a three-fold greater risk for PU compared to lower SCI.</p></div>","PeriodicalId":90358,"journal":{"name":"The journal of the American College of Clinical Wound Specialists","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jccw.2018.06.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36819675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-01-01DOI: 10.1016/j.jccw.2018.06.003
Jo Anne Lim MD, MRCP , Wooi Chiang Tan MD, MRCP, Adv M Derm , Boon Tat Khor MBBS, MRCP , Sunita Devi Hukam Gopal Chand MBBS, MRCP , Tharmalingam Palanivelu MBBS, FRCP
A 72-year-old man presented with a chronic scaly verrucous plaque over his right knee for nine months. The lesion was preceded by a well healed scar sustained five years back from a road traffic accident. He was given multiple courses of systemic antibiotic and antifungal medications but to no avail. A skin biopsy confirmed cutaneous tuberculosis. The area of plaque subsided significantly with antituberculosis treatment. However, during the second month of treatment, a new onset of a red fleshy granulating growth developed on the pre-existing site. A repeat skin biopsy revealed squamous cell carcinoma (SCC). He was subsequently referred for surgical excision.
This is presumably the first reported case of SCC arising from tuberculosis verrucosa cutis. While most malignant transformations from tuberculosis has been thought to develop after a long period of time (usually more than twenty-five years), this case report showed that it may also occur within a short period of time. Awareness on this condition is important because any delay in diagnosis and treatment may have detrimental consequences.
{"title":"Early Onset of Squamous Cell Carcinoma Arising From Tuberculosis Verrucosa Cutis","authors":"Jo Anne Lim MD, MRCP , Wooi Chiang Tan MD, MRCP, Adv M Derm , Boon Tat Khor MBBS, MRCP , Sunita Devi Hukam Gopal Chand MBBS, MRCP , Tharmalingam Palanivelu MBBS, FRCP","doi":"10.1016/j.jccw.2018.06.003","DOIUrl":"10.1016/j.jccw.2018.06.003","url":null,"abstract":"<div><p><span>A 72-year-old man presented with a chronic scaly verrucous plaque over his right knee for nine months. The lesion was preceded by a well healed scar sustained five years back from a road traffic accident. He was given multiple courses of systemic antibiotic and antifungal medications<span> but to no avail. A skin biopsy confirmed </span></span>cutaneous tuberculosis<span><span>. The area of plaque subsided significantly with antituberculosis treatment. However, during the second month of treatment, a new onset of a red fleshy granulating growth developed on the pre-existing site. A repeat skin biopsy revealed </span>squamous cell carcinoma (SCC). He was subsequently referred for surgical excision.</span></p><p>This is presumably the first reported case of SCC arising from tuberculosis verrucosa cutis. While most malignant transformations from tuberculosis has been thought to develop after a long period of time (usually more than twenty-five years), this case report showed that it may also occur within a short period of time. Awareness on this condition is important because any delay in diagnosis and treatment may have detrimental consequences.</p></div>","PeriodicalId":90358,"journal":{"name":"The journal of the American College of Clinical Wound Specialists","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jccw.2018.06.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36819677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-01-01DOI: 10.1016/j.jccw.2018.04.002
Richard Simman M.D. FACS, FACCWS , Michel H.E. Hermans M.D.
The loss of extracellular matrix in combination with the exposure of structures such as bone and tendon pose a major challenge; the development of granulation tissue and subsequent reepithelialization over these structures is extremely slow and often may not happen at all. Replacement of the matrix has been shown to significantly increase the chances of healing since, with revascularization of the matrix, a wound bed is created that may either heal by secondary intention or via the application of a skin graft.
A literature search on an esterified hyaluronic acid-based matrix (eHAM) returned five articles on the treatment of wounds with tendon and bone loss in which the eHAM was used. The etiologies of the wounds described varied among the articles, as did treatment modalities. However, all of them received proper debridement of necrosis with subsequent (although not always immediately) application of the eHAM. A very high percentage of all wounds reached the different primary endpoints in the studies, which were complete reepithelialization, complete coverage with granulation tissue and/or 10% coverage of the original wound size with epithelium, the latter being a strong indicator of the wound continuing to heal. The individual authors concluded that the esterified hyaluronic acid matrix (eHAM) is a valuable tool to assist in the complete healing of difficult to heal wounds.
{"title":"Managing Wounds with Exposed Bone and Tendon with an Esterified Hyaluronic Acid Matrix (eHAM): A Literature Review and Personal Experience","authors":"Richard Simman M.D. FACS, FACCWS , Michel H.E. Hermans M.D.","doi":"10.1016/j.jccw.2018.04.002","DOIUrl":"10.1016/j.jccw.2018.04.002","url":null,"abstract":"<div><p><span>The loss of extracellular matrix<span> in combination with the exposure of structures such as bone and tendon pose a major challenge; the development of granulation tissue and subsequent reepithelialization over these structures is extremely slow and often may not happen at all. Replacement of the matrix has been shown to significantly increase the chances of healing since, with </span></span>revascularization<span> of the matrix, a wound bed is created that may either heal by secondary intention or via the application of a skin graft.</span></p><p><span>A literature search on an esterified hyaluronic acid-based matrix (eHAM) returned five articles on the treatment of wounds with tendon and </span>bone loss<span> in which the eHAM was used. The etiologies of the wounds described varied among the articles, as did treatment modalities. However, all of them received proper debridement<span> of necrosis with subsequent (although not always immediately) application of the eHAM. A very high percentage of all wounds reached the different primary endpoints in the studies, which were complete reepithelialization, complete coverage with granulation tissue and/or 10% coverage of the original wound size with epithelium, the latter being a strong indicator of the wound continuing to heal. The individual authors concluded that the esterified hyaluronic acid matrix (eHAM) is a valuable tool to assist in the complete healing of difficult to heal wounds.</span></span></p></div>","PeriodicalId":90358,"journal":{"name":"The journal of the American College of Clinical Wound Specialists","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jccw.2018.04.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36819671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-01-01DOI: 10.1016/j.jccw.2018.06.002
Richard Simman MD, FACS, FACCWS
{"title":"Is Treating all Pressure Wound Patients with Vitamins A, C, Zinc and Arginine Justified?∗","authors":"Richard Simman MD, FACS, FACCWS","doi":"10.1016/j.jccw.2018.06.002","DOIUrl":"10.1016/j.jccw.2018.06.002","url":null,"abstract":"","PeriodicalId":90358,"journal":{"name":"The journal of the American College of Clinical Wound Specialists","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jccw.2018.06.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36809504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Total contact casts are recognized as the gold standard treatment for neuropathic plantar diabetic foot ulceration, endorsed by all national and international consensus papers. Despite this, research has shown that there is a dichotomy between the existing evidence which supports the use of total contact casts in the management of diabetic foot ulcers and its use in clinical practice. This article aims to highlight the benefits, risks, and barriers associated with total contact cast use in the management of diabetic foot ulcers in the clinical setting, with an emphasis on existing research carried out in this field to encourage change in clinical practice and utilization of this effective treatment modality.
{"title":"A Narrative Review of the Benefits and Risks of Total Contact Casts in the Management of Diabetic Foot Ulcers","authors":"Grace Messenger MRes , Richard Masoetsa MSc , Imtiaz Hussain BSc","doi":"10.1016/j.jccw.2018.05.002","DOIUrl":"10.1016/j.jccw.2018.05.002","url":null,"abstract":"<div><p><span>Total contact casts are recognized as the gold standard treatment for neuropathic plantar </span>diabetic foot<span> ulceration<span>, endorsed by all national and international consensus papers. Despite this, research has shown that there is a dichotomy between the existing evidence which supports the use of total contact casts in the management of diabetic foot ulcers and its use in clinical practice. This article aims to highlight the benefits, risks, and barriers associated with total contact cast use in the management of diabetic foot ulcers in the clinical setting, with an emphasis on existing research carried out in this field to encourage change in clinical practice and utilization of this effective treatment modality.</span></span></p></div>","PeriodicalId":90358,"journal":{"name":"The journal of the American College of Clinical Wound Specialists","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jccw.2018.05.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36819674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The global prevalence of diabetes is estimated to be 200 million people, and it is likely to increase to 333 million people by 2025. Different cells, are known to participate in three main phases of wound healing. Omega-3 fatty acids influence cytokines and growth factors which affects the presence of inflammatory cells in wound area as well, but how this event specifically influences the role of fibroblasts, macrophages and angiogenesis in wound healing is not obviously understood. In this experimental study seventy male Wistar rats after induction of diabetes type-one by streptozotocin (STZ) (55 mg/kg) were divided into two groups, Experimental group receiving omegaven intraperitoneally and control group which underwent the injection of mineral oil. Streptozotocin was used for the induction of diabetes type 1. Diabetic male wistar rats were scarified at 1, 3, 5, 7 and 15 days after the excision was made. To estimate orphometric indices, histological sections were provided by stereological methods. It was found that wound area significantly decreased on day 7 in experimental group by omega-3 fatty acids. The number of fibroblasts increased significantly on days 5 and 7 in the experimental group. The number of neovascular significantly decreased on day 7 in the experimental group. This study implied that it seems omegaven is able to improve morphometric indices during wound healing and make healing faster.
{"title":"Omegaven Improves Skin Morphometric Indices in Diabetic Rat Model Wound Healing","authors":"Saeid Babaei (Associated professor) , Mahmoodreza Nakhaei (Assistant professor) , Hadi Ansarihadipour (Assistant professor) , Mohammadhassan Sakhaei (Assistant professor) , Sirvan Hosseini (Nursing student) , Amene Nikgoftar (Anatomical Sciences MSc Student)","doi":"10.1016/j.jccw.2018.04.001","DOIUrl":"10.1016/j.jccw.2018.04.001","url":null,"abstract":"<div><p>The global prevalence of diabetes is estimated to be 200 million people, and it is likely to increase to 333 million people by 2025. Different cells, are known to participate in three main phases of wound healing. Omega-3 fatty acids influence cytokines and growth factors which affects the presence of inflammatory cells in wound area as well, but how this event specifically influences the role of fibroblasts, macrophages and angiogenesis in wound healing is not obviously understood. In this experimental study seventy male Wistar rats after induction of diabetes type-one by streptozotocin (STZ) (55 mg/kg) were divided into two groups, Experimental group receiving omegaven intraperitoneally and control group which underwent the injection of mineral oil. Streptozotocin was used for the induction of diabetes type 1. Diabetic male wistar rats were scarified at 1, 3, 5, 7 and 15 days after the excision was made. To estimate orphometric indices, histological sections were provided by stereological methods. It was found that wound area significantly decreased on day 7 in experimental group by omega-3 fatty acids. The number of fibroblasts increased significantly on days 5 and 7 in the experimental group. The number of neovascular significantly decreased on day 7 in the experimental group. This study implied that it seems omegaven is able to improve morphometric indices during wound healing and make healing faster.</p></div>","PeriodicalId":90358,"journal":{"name":"The journal of the American College of Clinical Wound Specialists","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jccw.2018.04.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36809505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-01-01DOI: 10.1016/j.jccw.2017.12.001
Michael S. Miller DO, FACOS, WCC
The concept of the Kennedy Terminal Ulcer (KTU) has been ubiquitous in attempting to explain the development of pressure based tissue injuries in patients with actual or presumed terminal conditions. The concept is problematic in that it uses factors other than pressure to explain the development and progression of pressure based tissue injuries, specifically the presence of a terminal condition. Based on the most current understanding of how pressure based tissue injuries develop and progress, the concept of The Kennedy Terminal Ulcer appears to be without physiologic basis and based solely on observation. Since systemic factors affect all tissues with relative equality, the development of a single locus of injury must logically be based on a single locus of cause and affect. The presumption that a single locus of injury will develop in an arbitrary location based on a systemic set of factors is untenable. A new concept called Miller Pressure Equivalent Injuries is proposed to refute the concept of a single pressure based tissue injury developing based solely on terminal systemic factors and why these previously presumed terminal condition associated pressure based injuries occur.
{"title":"The Death of the Kennedy Terminal Ulcer","authors":"Michael S. Miller DO, FACOS, WCC","doi":"10.1016/j.jccw.2017.12.001","DOIUrl":"10.1016/j.jccw.2017.12.001","url":null,"abstract":"<div><p>The concept of the Kennedy Terminal Ulcer<span> (KTU) has been ubiquitous in attempting to explain the development of pressure based tissue injuries in patients with actual or presumed terminal conditions. The concept is problematic in that it uses factors other than pressure to explain the development and progression of pressure based tissue injuries, specifically the presence of a terminal condition. Based on the most current understanding of how pressure based tissue injuries develop and progress, the concept of The Kennedy Terminal Ulcer appears to be without physiologic basis and based solely on observation. Since systemic factors affect all tissues with relative equality, the development of a single locus of injury must logically be based on a single locus of cause and affect. The presumption that a single locus of injury will develop in an arbitrary location based on a systemic set of factors is untenable. A new concept called Miller Pressure Equivalent Injuries is proposed to refute the concept of a single pressure based tissue injury developing based solely on terminal systemic factors and why these previously presumed terminal condition associated pressure based injuries occur.</span></p></div>","PeriodicalId":90358,"journal":{"name":"The journal of the American College of Clinical Wound Specialists","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jccw.2017.12.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36541686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-01-01DOI: 10.1016/j.jccw.2018.01.004
Natallia Maroz MD, FASN, FACP
{"title":"Impact of Renal Failure on Wounds Healing","authors":"Natallia Maroz MD, FASN, FACP","doi":"10.1016/j.jccw.2018.01.004","DOIUrl":"10.1016/j.jccw.2018.01.004","url":null,"abstract":"","PeriodicalId":90358,"journal":{"name":"The journal of the American College of Clinical Wound Specialists","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jccw.2018.01.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36547516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-01-01DOI: 10.1016/j.jccw.2018.01.003
Christopher L. Winters DPM
{"title":"Summary Article on Advanced Ulcer Treatments used in the Operating Room","authors":"Christopher L. Winters DPM","doi":"10.1016/j.jccw.2018.01.003","DOIUrl":"10.1016/j.jccw.2018.01.003","url":null,"abstract":"","PeriodicalId":90358,"journal":{"name":"The journal of the American College of Clinical Wound Specialists","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jccw.2018.01.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36547517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-01-01DOI: 10.1016/j.jccw.2018.01.006
Richard Simman MD, FACS, FACCWS
{"title":"The Role of an Esterified Hyaluronic Acid Matrix in Wound Healing, a Case Series","authors":"Richard Simman MD, FACS, FACCWS","doi":"10.1016/j.jccw.2018.01.006","DOIUrl":"10.1016/j.jccw.2018.01.006","url":null,"abstract":"","PeriodicalId":90358,"journal":{"name":"The journal of the American College of Clinical Wound Specialists","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jccw.2018.01.006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36547515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}