The journal of the American College of Clinical Wound Specialists最新文献

Healing is a complex multifactorial process, hence it is not easy to be studied accurately. In this paper we tried to demonstrate the potentials of application of autologous blood by injection into the raw areas and ulcers of three diabetic patients using their blood as an alternative to synthesized and cultured stem cells or growth factors. It was found that a natural easily obtained blood can be used to enrich the media of the wound. Also it was applicable in relation to its cost–effectiveness as well as availability. The healing process was accelerated in the injected side more than the non-injected one.

Purpose

Wound care in a rehabilitation environment is a costly and difficult problem. The goal of this retrospective study is to evaluate differences in wound closure outcomes in acute and chronic wounds when treated with a microcurrent-generating wound care device as compared to standard wound care methods.

Methods

Data files of 38 patients who received either standard wound treatment (SOC; n = 20), or were treated with a microcurrent-generating wound device (MCD, n = 18), were retrospectively reviewed. Wounds were assessed until deemed clinically to have closed or healed with up to 100% epithelialization. All patients (18–99 years) with single wounds were included. The number of days to wound closure and the rate of wound volume reduction were compared across groups. Persistent reduction of wound size improvement was also examined.

Results

The wounds in the SOC group closed on average at 36.25 days (SD = 28.89), while the MCD group closed significantly faster in 19.78 days (SD = 14.45), p = 0.036. The rate of volume reduction per day was −3.83% for SOC vs. −9.82% volume reduction per day (p = 0.013) for the MCD group. The SOC group had 50% of its wounds close monotonically vs. 83.3% in the MCD group (p = 0.018).

Conclusion

This two-center retrospective study demonstrated a 45.4% faster, and more robust healing of wounds with the use of the MCD, when compared to SOC in a rehabilitation center environment. This translates into improved patient care, and potentially significant cost savings. Economic benefits for the use of MCD compared to other wound care methods are planned for future research.

Bleeding is a common occurrence in practice, but occasionally it may be challenging issue to overcome. It can come from numerous sources such as, trauma, during or post-surgical intervention, disorders of platelet and coagulation factors and increased fibrinolysis, wounds and cancers. This paper was inspired from our experience with a patient admitted to a local long term acute care facility with a large fungating right breast cancerous wound. During her hospital stay spontaneous bleeding from her breast cancerous mass was encountered and became more frequent and significant over the period of her stay. Different hemostatic technologies were used to control her bleeding. We felt that it was important to share our experience with our colleagues to help with potential similar situation that they may face.

Kaposi's sarcoma (KS) is a rare malignancy that with the onset of the AIDS epidemic suggests a link between the development of disease and a transmissible agent. It is a low-grade vascular tumor associated with infection with the human herpes virus 8 (HHV-8). The first case presents a non-HIV patient with Kaposi's sarcoma of the left foot and the second case is a kidney transplant patient on immunosuppressive medications with wounds on the right leg due to non-HIV Kaposi's sarcoma.

A classical wound may be defined as a disruption of tissue integrity. Wounds, caused by trauma from accidents or surgery, that close via secondary intention rely on the biological phases of healing, i.e., hemostasis, inflammation, proliferation, and remodeling (HIPR). Depending on the wound type and severity, the inflammation phase begins immediately after injury and may last for an average of 7–14 days. Concurrent with the inflammation phase or slightly delayed, cell proliferation is stimulated followed by the activation of the remodeling (maturation) phase. The latter phase can last as long as 1 year or more, and the final healed state is represented by a scar tissue, a cross-linked collagen formation that usually aligns collagen fibers in a single direction. One may assume that skin microneedling that involves the use of dozens or as many as 200 needles that limit penetration to 1.5 mm over 1 cm² of skin would cause trauma and bleeding followed by the classical HIPR. However, this is not the case or at least the HIPR phases are significantly curtailed and healing never ends in a scar formation. Conversely dermabrasion used in aesthetic medicine for improving skin quality is based on “ablation” (destruction or wounding of superficial skin layers), which requires several weeks for healing that involves formation of new skin layers. Such procedures provoke an acute inflammatory response. We believe that a less intense inflammatory response occurs following microneedle perforation of the skin. However, the mechanism of action of microneedling appears to be different. Here we review the potential mechanisms by which microneedling of the skin facilitates skin repair without scarring after the treatment of superficial burns, acne, hyperpigmentation, and the non-advancing periwound skin surrounding the chronic ulcerations of the integument.

Evidenced-based-wound management continues to be a cornerstone for advancing patient care. The purpose of this article is to review the use of whirlpool as a wound treatment in light of evidence, outcomes, and potential harm. Whirlpool was initially harnessed as a means to impart biophysical energy to a wound or burn to enhance mechanical debridement and cleansing. Other credible single-patient-use technologies which provide an alternative to whirlpool in wound care are presented.

Drugs hypersensitivity should be remembered when placing patients on any form of medications. In this case we present skin hypersensitivity to sun light due to doxycycline ingestion causing hand partial-thickness burn.

Drug-induced hypersensitivity syndrome is a systemic autoimmune disorder that results in mucocutaneous symptoms ranging in severity from mild pruritus to life-threatening skin and mucosal loss, with different nomenclature depending on the severity of the symptoms. The purpose of this article is to review the recent advances in understanding the pathology of drug-induced hypersensitivity syndrome, as well as current recommendations for both medical and wound management.