The International Journal of Lower Extremity Wounds recent issues

Evidence, Guidelines: Where Is It All Going?

Mani, R. — 2008-08-28

Evidence-Based Medicine and the Management of the Chronic Wound: Is It Enough?

Dinh, T., Veves, A. — 2008-08-28

Evidence-based medicine has become ubiquitous in modern-day medicine, including wound care. However, the application of evidence-based medicine into the arena of chronic wounds has not been uniformly performed and measured. Most wound care studies are plagued by inconsistencies in inclusion criteria, data measurements, and endpoint reporting. Furthermore, the small sample sizes prohibit drawing effective conclusions. However, that does not imply that the current guidelines of treatment are substandard. Instead, one must rely more heavily on current evidence and experts in the field until larger, more consistent studies can establish good practice patterns.

Contact Allergens in Persons With Leg Ulcers: A Canadian Study in Contact Sensitization

2008-08-28

Individuals with chronic leg ulcers often develop contact allergic reactions to topical preparations used to treat their wounds and the surrounding skin. The objective of this study was to determine the frequency of positive patch test responses to common allergens in patients with leg ulcers or venous disease. A case series of 100 consecutive, consenting patients with chronic venous disease and other causes of leg ulcers that were available for patch testing were enrolled. The patients were tested with 38 common allergens, including those most relevant to leg ulcers. A total of 46% of the patients had at least 1 positive patch test response. Multiple reactions in the same patient were common. The most frequent groups of sensitizers were fragrances, lanolin, antibacterial agents, and rubber-related allergens. Though the prevalence of positive patch test reactions is high in this population, it is lower than commonly reported. This may be the result of clinical practice that considered the avoidance of common sensitizers in the management of patients with leg ulcers.

Hyperhomocysteinemia and Lower Extremity Wounds

Schwartzfarb, E. M., Romanelli, P. — 2008-08-28

Chronic lower extremity wounds include ulceration of the leg and foot. The underlying pathology that causes these conditions includes venous insufficiency, arterial disease, diabetes, and other less common disorders. Since the introduction of the homocysteine theory more than 30 years ago, considerable evidence has demonstrated hyperhomocysteinemia to be an independent risk factor for venous and arterial thrombosis, atherosclerosis and cardiovascular disease. Although any cause—effect relationship remains to be determined, hyperhomocysteinemia as a risk factor for these events suggests that elevated levels of homocysteine may also be a marker of chronic lower limb ulceration. This review addresses the metabolism of homocysteine, mechanisms of vascular injury, a role for hyperhomocysteinemia in lower extremity wounds and possible means of treatment.

The Use of Corticosteroids to Treat Keloids: A Review

Roques, C., Teot, L. — 2008-08-28

Mechanisms for keloid formation include drastic changes in growth factor actions, collagen turnover, mechanical forces applied over the skin, and genetic and immunologic contributions. The use of corticosteroids to manage keloids increases basic fibroblast growth factor production while decreasing transforming growth factor-β1 production by human dermal fibroblasts, endogenous vascular endothelial growth factor, and insulin-like growth factor-1. The use of corticosteroid injections is, to date, the core treatment available for the management of excessive tissue production in scars. Currently, the most effective and safe regimen for keloid management appears to be the use of corticotherapy—injection of intradermal steroids after a surgical excision.

Pathologic Scars: An Overview of Surgical Strategies

Teot, L. — 2008-08-28

In most cases pathologic scars are managed using surgical procedures. In recent decades a trend towards the generalized use of flaps has been observed. Skin expanders have been applied for a while and are still useful in postburn alopecia. Large surfaces are being treated more and more with skin substitutes. These are mainly dermal substitutes covered with partial thickness skin grafts. These procedures can be combined in order to cover very large skin surfaces. Prefabricated flaps are based on angiogenesis induction via vessel carriers implanted in the depth of the skin structure. The use of skin substitutes limits skin harvesting, which may be a source of scarring.

Antimitotic Drug Injections and Radiotherapy: A Review of the Effectiveness of Treatment for Hypertrophic Scars and Keloids

2008-08-28

Scars are a common complication of surgery or burn wound management. Scars occur over the body, affecting people of both sexes and all ages. Scar therapy is a constant clinical challenge; antimitotic drugs and radiotherapy are used with varying degrees of success. This article examines the success of both these types of treatment modalities.

Avotermin: A Novel Antiscarring Agent

Durani, P., Occleston, N., O'Kane, S., Ferguson, M. W. J. — 2008-08-28

Published literature shows that both physicians and their patients are highly concerned about scarring, even relatively minor scars and those that can be concealed by clothing. Furthermore, both patients and their physicians value any opportunities to improve or minimize scarring. While a range of treatment paradigms have been evaluated, no single therapy has been adopted as a universally accepted standard of care and, currently, there are no marketed pharmaceuticals for the prophylactic reduction of scarring. Many of the available treatments are used empirically and most have not been evaluated in robust prospective, randomized, controlled clinical trials. To address this unmet medical need, translational research into the molecular mechanisms of scarring has led to the discovery and commercial development of a new class of prophylactic medicines that promote the regeneration of normal skin and improve scar appearance. Avotermin, the first agent identified in this class, is the clinical application of human recombinant transforming growth factor β3 (TGFβ3), a key protein involved in scar-free healing observed in embryos. Controlled, double-blind, randomized phase I/II clinical studies have shown that avotermin, administered as an intradermal injection at the time of surgery, leads to both short-term and longer-term (at ≥12 months) improvements in the appearance of scars compared with placebo and standard wound care.

Intralesional Cryosurgery for the Treatment of Hypertrophic Scars and Keloids Following Aesthetic Surgery: The Results of a Prospective Observational Study

2008-08-28

Hypertrophic scars and keloids following aesthetic surgery, which ignite patient dissatisfaction, are difficult to handle. Intralesional cryosurgery for the treatment of such scars has been introduced. This study was designed to evaluate the efficacy of this technology in the treatment of such scars and to assess the reduction of dissatisfaction. Eleven scars (on 11 patients) were treated by intralesional cryosurgery, following breast surgery, otoplasty, face-lifting, and brachioplasty. Each patient scored the concern from the scar and the scar deformity (scale from 1 to 5) prior and following treatment (higher score represents least satisfaction and a severe deformity). The follow-up period was between 3 months and 8 years. The results demonstrated a significant reduction in concern and deformity scores compared with before the cryotreatment (P = .001). The intralesional cryosurgery technique provides the plastic surgeon with an effective instrument to treat hypertrophic scars and keloids following aesthetic surgery, thus reducing the dissatisfaction of patients.

Postburn Scars: An Update

Stella, M., Castagnoli, C., Gangemi, E. N. — 2008-08-28

Burn wounds give rise to the largest scars we can find in human pathology, influencing patients' quality of life. Despite the improved knowledge on pathophysiology, efficacy of the various treatments remains unsatisfactory. In this short review recent literature is examined with a focus on recent data on postburn pathological scars epidemiology and risk factors, which underline the high prevalence and the long evolution, pointing to identify this illness as a systemic inflammatory one, more frequent in women and in those of younger age, regulated by local factors relevant in wound healing.

Basal Cell Carcinoma Is Not Granulation Tissue in the Venous Leg Ulcer

Jankovic, A., Binic, I., Ljubenovic, M. — 2008-08-28

The authors present a case of a 76-year-old female with a 7-year history of a nonhealing leg ulcer. The wound surface had epithelial tissue present in a diffuse way with shiny granulations on parts of the edge of the ulcer. A biopsy of the ulcer edge was performed to study the reasons for the absence of response to treatment and the presence of abnormal granulation tissue. The result showed the presence of a basal cell carcinoma. The authors conclude that skin biopsy is very important in nonhealing chronic venous ulcers because carcinomas may mimic granulation tissue and complicate venous ulcers.

Diary Dates

2008-08-28

Cochrane Abstracts

2008-08-28

The International Journal of Lower Extremity Wounds Marches on Editorial

Mani, R. — 2008-05-19

The Multidisciplinary Diabetic-Foot Clinic

Edmonds, M. — 2008-05-19

Seminar Review: Creative Compression Treatment in Challenging Situations

Flour, M. — 2008-05-19

There are globally accepted insights and country-specific standards, preferences, and traditions regarding compression therapy. Although there is a wide choice of bandaging and compression materials, the use of these materials must be planned to meet individual patient's temporary needs using the most appropriate technique and optimal timing. Even though indications and contraindications exist for elastic and nonelastic materials and techniques, professionals must use the technical advantages of the several systems for the benefit of the patient. Whatever method is chosen, the effectiveness of compression depends on several technical and personal issues, including the anatomical and functional status of the limb to be treated. Notwithstanding the guidelines for treatment, there will always be situations where either standard or optimal treatment cannot be applied and where clinicians must be creative in the treatment offered. The aim of this article is to reflect on what is possible outside the margins of the normal consensus on compression treatment to stimulate debate.

Review Paper: Considerations for Determining if a Natural Product Is an Effective Wound-Healing Agent

Lindblad, W. J. — 2008-05-19

Many research groups are examining natural products for their vulnerary activity. On the basis of the countless years of folklore and clinical observations, these preparations are being fractionated and applied to wounds in a variety of animal species. Despite this work, the number of agents that have documented ability to enhance wound healing is minimal. This article provides a brief review of some of the major historical milestones in wound care and provides a framework for studying plant products so as to achieve statistically significant results in biologically important models of healing. Only with the use of reference standards, data from appropriate animal models, and human trials can we begin to mine the great potential of these natural products.

Use of Nanotechnology-Designed Footsock in the Management of Preulcerative Conditions in the Diabetic Foot: Results of a Single, Blind Randomized Study

2008-05-19

The Difoprev system constituted by a sock loaded with nanocapsules containing a hydrating agent in the diabetic foot is tested. A total of 30 neuropathic outpatients with foot anhydrosis were randomized into group A, treated with the application of the sock with the nanocapsules, and group B wearing only the socks without the nanocapsules. Patients were blindly evaluated with a clinical score, hygrometry, transepidermal water loss, skin temperature, and skin hardness at baseline and after 6 weeks. No difference between the groups emerged at baseline. Although group B showed no changes at the end of the treatment, group A significantly ( P < .05) improved in all the parameters evaluated. No adverse events were recorded in both groups during the study. The use of hydrating agents carried by nanocapsules-loaded socks is safe and effective for the neuropathic diabetic foot.

Reducing Lower Extremity Amputations Due to Diabetes: The Application of Diabetic-Foot Protocol in Chiang Mai University Hospital

2008-05-19

The aim of this study was to determine whether intensive treatment and education strategies for diabetic patients with ulcers help in preventing leg amputation. From August 2005 to March 2007, a diabetic-foot protocol using a multidisciplinary approach was applied at our hospital. All the subjects were educated regarding diabetic-foot disease and its complications and prevention. This report compares the amputation rate in patients receiving the protocol care from August 2005 to March 2007 with those who had standard care from August 2003 to July 2005. Seventy-three and 110 diabetic-foot ulcer patients received protocol and standard foot care, respectively. The incidence of major amputations in the protocol and standard care groups was 4.1% and 13.6%, respectively (P = .03). Our protocol was associated with improved diabetic-foot care outcomes. It can be used by any hospital to improve outcomes for patients with diabetes.

Common Clinical Features of Diabetic Foot Ulcers: Perspectives From a Developing Nation

Ogbera, O. A., Osa, E., Edo, A., Chukwum, E. — 2008-05-19

Foot ulceration is a prominent cause of diabetes mellitus morbidity and mortality in developing countries. This is an observational study in which 47 consecutive diabetes mellitus patients with foot ulcers were studied over a 2-year period. Each patient's medical history, physical examination findings, and hematological and radiological features were documented. The mean age of the patients was 56 (11) years. The majority of the patients (40, 85%) had type 2 diabetes mellitus; 25% of patients with type 2 diabetes mellitus were diagnosed when they presented with foot ulceration. Grades 2 and 3 Wagner lesions were the most frequently noted grades of foot ulceration. The risk factors/precipitants of foot ulceration included neuropathy, vasculopathy, spontaneous blisters, walking unshod, and wearing inadequate shoes. Prominent hematologic abnormalities included anemia and leucocytosis. Diabetes mellitus foot ulceration often occurs in middle-aged Nigerians with diabetes mellitus, and this diabetes mellitus complication may be present at diagnosis of type 2 diabetes mellitus. Subcutaneous emphysema, osteolysis, and soft tissue swelling are often documented radiological features of DFU in our patients.

Ulcer Infection by ES{beta}L-Producing Proteus mirabilis: A Case Report

2008-05-19

In this article, a case of decubitus ulcer infection caused by an extended-spectrum β-lactamase-producing Proteus mirabilis strain, successfully treated with oral amoxicillin-clavulanate (1-month therapy) is described. This article focuses on diffusion and clinical effect of extended-spectrum β-lactamases-producing Proteus mirabilis on treatment of gram negative lower extremity infections.

Deep Ulcer Shaving Combined With Split-Skin Transplantation in Distal Calciphylaxis

2008-05-19

Calciphylaxis is a cause of painful deep ulcers. There is controversy about best wound management in this disease. A retrospective study of inpatients during the 3 years was made. Seven calciphylaxis patients were identified. All patients suffered from various associated pathologies including diabetes mellitus type II and chronic renal insufficiency. Ulcers were treated by aggressive and deep shaving combined with autologous split-skin grafting in the same session. A 30% to 90% take rate of the grafts eventually with a complete ulcer healing in 6 of 7 patients was achieved. No patient developed a deep cutaneous infection or sepsis. All patients are still alive except one. The single death was related to cardiovascular complications. In distal calciphylaxis, aggressive ulcer surgery with defect closure offers a marked improvement in quality of life and prevents early deep skin infections and sepsis as major causes of mortality.

Wound Healing Meetings 2008 DIARY DATES

2008-05-19

Cochrane Abstracts

2008-05-19

The International Journal of Lower Extremity Wounds Begins Its Seventh Year

Mani, R. — 2008-03-26

Major Developments in Wound Care: A Critical Appraisal

Wollina, U. — 2008-03-26

Measurements in Wound Healing

Falanga, V. — 2008-03-26

Seminar Review: Wounds and Dressings

van den Bulck, R. — 2008-03-26

Venous leg ulcers are the most common type of lower limb ulceration. Compression therapy combined with the use of appropriate dressings remain the gold standard for the management of venous ulcers. Although a wide range of wound dressings is available, the management of venous leg ulcers is primarily dependent on a careful assessment of the patient, the wound, and the effectiveness of the treatment.

Current Treatment of Acute Lower Extremity Deep Venous Thrombosis

Janjigian, M. P., Muhs, B. E. — 2008-03-26

The long-term complications of acute deep venous thrombosis (DVT) include recurrence, increased mortality, and the development of the postthrombotic syndrome. Rates of recurrent venous thromboembolism (VTE) are elevated in patients with cancer and thrombophilia. Heparin, administered either as unfractionated or low-molecular weight, is indicated for at least five days for acute DVT. Long-term treatment is currently a vitamin K antagonist with a variable duration depending on the etiology of the DVT and risk of bleeding. Novel anticoagulant agents that target factor Xa and directly inhibit thrombin are being studied in clinical trials and may one day replace vitamin K antagonists for the long-term treatment of VTE.

Interventional approaches such as percutaneous mechanical thrombectomy have the potential to reduce clot burden in acute DVT with lower bleeding risks and help prevent development of the postthrombotic syndrome, a common and potentially debilitating complication of DVT.

Evaluation of Wound-Healing Potential of Pisonia grandis R.Br: A Preclinical Study in Wistar Rats

Prabu, D., Nappinnai, M., Ponnudurai, K., Prabhu, K. — 2008-03-26

Pisonia grandis R.Br (family: Nyctaginaceae) is a herb claimed to be used for treatment of inflammation, wound healing, algesia, and ulcer. The present study was done to evaluate the wound-healing potential of methanolic extract of its leaves. Following preliminary photochemical evaluation, the extract was incorporated in simple ointment base and evaluated using 2 types of wound models in Wistar rats—excision wound and incision wound. The results were significantly different ( p <0.05) when compared with control group for wound contraction, tensile strength, and histopathological and biological parameters. Antibacterial studies against different bacterial strains of the test samples were performed by the disk-diffusion method and were compared with standard ofloxacin and erythromycin. Test sample showed comparable zone of inhibition to the standards. It is hypothesized that the presence of phytoconstituents with the antibacterial effect helps in wound healing.

MRSA Infection in Lower Extremity Wounds

Edris, B., Reed, J. F. — 2008-03-26

Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most frequently isolated bacteria in wound cultures. MRSA has been linked to lengthened wound healing times, an increase in adverse postoperative outcomes, and mortality. This study investigated the incidence of MRSA in lower extremity wounds and examined outcomes associated with MRSA-infected wounds versus non-MRSA-infected wounds. A retrospective study was conducted. Patients with MRSA-infected wounds were compared with those with uninfected wounds in a 1:2 ratio. Demographics, infection, and stay information were collected. Data were analyzed using SPSS 15.0. 51 patients were included (17 with MRSA and 34 without MRSA). Patients with MRSA had increased lengths of stay and a higher incidence of adverse postoperative outcomes compared with non-MRSA patients. An MRSA infection adversely affects a patient's hospital course. Preoperative screening for MRSA and postoperative surveillance should be considered to prevent and eliminate the spread of this virulent bacterium.

The Lack of Reliability of Clinical Examination in the Diagnosis of Wound Infection: Preliminary Communication

Serena, T. E., Hanft, J. R., Snyder, R. — 2008-03-26

The diagnosis of infection in chronic wounds is challenging. Clinicians tend to rely on the classic signs and the symptoms. Quantitative tissue biopsy, the most accurate method, is rarely used because it is expensive, invasive, and difficult to perform. A recently completed clinical trial evaluating collagen/oxidized regenerated cellulose/antimicrobial matrix versus standard of care in venous leg ulcerations was reviewed. Patients with infected venous leg ulcers by clinical examination were excluded. In fact, none of the subjects in the 2 arms of the study had target ulcers that appeared to be infected at any time during the study. Quantitative biopsies of the ulcers were obtained and compared with investigator evaluation. In all, 14 of 49 subjects (28%) had bacterial counts greater than 10⁵ or β-hemolytic streptococcus despite the lack of clinical signs of infection. This analysis suggests that clinical examination is unreliable in the diagnosis of wound infection in venous leg ulcerations.

Multidrug-Resistant Enterococcus raffinosus From A Decubitus Ulcer: A Case Report

2008-03-26

A case of decubitus ulcer infected with multidrug-resistant Enterococcus raffinosus is reported in this article. This is the first report of wound infection caused by an Enterococcus raffinosus isolate resistant to antibiotics other than β-lactams, gentamicin, and ciprofloxacin. This case adds to the knowledge base concerning the onset of antibiotic resistance in this uncommon species and confirms the emerging role of daptomycin as a promising alternative in therapy of severe difficult-to-treat enterococcal infections.

Fusarium solani in the Post-transplant Patient: An Unusual Fungus

Rekha, A., Kindo, A. J., Ravi, A. — 2008-03-26

The incidence of fungal infections in post-transplant patients ranges from 2% to 50%, and more uncommon pathogens are being isolated. Earlier, the fungi seen were candida, aspergillus, and cryptococcus; and of late, histoplasma, coccidiodomycoses, and dematiaceous fungi are seen. In this article, a patient with invasive fusariosis is presented, and literature of this uncommon fungus is reviewed.

Nonvenomous Bite Injuries of the Foot: Case Reports and Review of the Literature

2008-03-26

Animal bite injuries to humans are relatively common, however, bite injuries to the lower extremity and more specifically the foot are relatively uncommon. Foot injuries, once infected, may lead to further complications, such as soft tissue loss, bone loss, and the need for amputation. Patients with preexisting medical conditions, such as peripheral vascular disease and diabetes, are especially at risk for such complications. In this article, 2 recent cases are detailed and the literature to examine these injuries of the foot is reviewed.

A Case Report of the Use of Nanocrystalline Silver Dressing in the Management of Acute Surgical Site Wound Infected With MRSA to Prevent Cutaneous Necrosis Following Revision Surgery

Bhattacharyya, M., Bradley, H. — 2008-03-26

The authors report the use of nanocrystalline silver (Acticoat 7, Smith and Nephew, London, UK) in an acute surgical wound to prevent localized skin necrosis due to infection, thereby avoiding skin grafting as a secondary procedure. Two patients were successfully treated with Acticoat 7 dressings without using systemic antimicrobials after developing methicillin-resistant Staphylococcus aureus infection in the surgical site. Despite a history of smoking and incision through scar tissues, the wound did not progress into deep infection nor was there recurrence of infection at 2 years follow-up. The intention was to use this particular dressing to assess the effect of silver on infected keratinocytes in an acute wound environment. It is possible that the use of Acticoat 7 may reduce the bacterial loading at the wound site, thereby decreasing a propensity for skin necrosis caused by the infective process. This case report demonstrates that the acute surgical wound with impending cutaneous necrosis due to localized infection may be treated without oral antimicrobials.

From Tadpole Collagenase to Human Health Care, the Well-Filled Life of Charles M. Lapiere, Devoted to Creativity, Expertise, and Kindness

Coulomb, B. — 2008-03-26

To the Editor

Leijnen, M., Steenvoorde, P. — 2008-03-26

Diary Dates

2008-03-26

Cochrane Abstracts

2008-03-26

Wound Healing and Global Action on Poverty and Development

Mani, R., Teot, L., Shukla, V. — 2007-11-29

The Significance of Measurements in Wound Healing: Where Do We Go From Here?

Margolis, D., Mani, R. — 2007-11-29

Digital Imaging of Wounds: Are Measurements Reproducible Among Observers?

Quan, S. Y., Lazarus, G. S., Kohli, A. R., Kapoor, R., Margolis, D. J. — 2007-11-29

Advances in digital imaging and archiving have made the measurement and documentation of wound areas possible over time. To assess the reproducibility and precision of digital image measurements, we used WoundMatrix Web (http://www.woundmatrix.com/) and recruited a group of caregivers from the Johns Hopkins Wound Center to measure the size of wounds on digital images by measuring length and width and tracing the circumference of the same wounds. One set of images was provided by WoundMatrix (WoundMatrix Inc, Chadds Ford, PA) and a second set used our own photographs taken at the Johns Hopkins Wound Center. Our results demonstrate that digital analysis with WoundMatrix Web is reproducible and precise with acceptable variation among readers. This supports the use of digital images of wounds to follow clinical progress as well as analyze the effects of new clinical interventions in clinical trials.

A Critical Analysis of Measurements Used to Assess and Manage Scars

Roques, C., Teot, L. — 2007-11-29

Scars evolve through a maturation stage during which it is necessary to adapt different treatments. To adapt treatments, it is necessary to assess various parameters linked to inflammation. To this end, clinical scar assessments are subjective though reliable, and validation is operator dependent. The Vancouver Scar Scale, Visual Analogic Scale, Patient and Observer Scar Assessment Scale, and the Manchester Scale assess different scar characteristics. These scales are interesting, depending on the type of scars, and are easy to use but subject to errors. To use clinical a scale, the raters must be trained. Parameters can also be precisely assessed by technical means, whereby they rate only one parameter, but are more accurate. Some scales are easy to use, have low cost, and can be used for clinical assessment. Others scales are more complex and expensive, and can be used in research or treatment evaluation.

The Role of Hemodynamic Measurements in the Management of Venous and Ischemic Ulcers

Lazarides, M.K., Giannoukas, A.D. — 2007-11-29

There is a need for quantitative investigations in the vascular laboratory to manage lower extremity ulcers. The majority of leg ulcers are of venous (45%-60%) or arterial origin (10%-20%). Despite the increasing complexity of new devices used in vascular surgical practice, the anklebrachial pressure index (ABPI) remains the cornerstone for the differential diagnosis of ischemic ulcers. The toe-brachial pressure index and the pole test represent attractive alternative tests especially in patients with diabetes. Color flow Doppler imaging (CFDI) is advantageous over ABPI in cases in which wounds and ulcers prevent the use of a cuff by virtue of their size or location; additionally CFDI technology can detect nonflow limiting lesions, lesions to nonaxial arteries such as the deep femoral artery, or lesions limited to a single tibial artery. Continued improvements in the accuracy of CFDI have prompted some vascular surgeons to replace contrast arteriography in distal bypass procedures. Transcutaneous partial oxygen tension measurement (TcPO₂) is another noninvasive method that is reliable to select the level of amputation and recommended to determine tissue viability in critically ischemic limbs and in the management of the diabetic foot. CFDI has revolutionized the diagnostic approach to venous disorders and it is considered the gold standard for the assessment of the venous system of the lower limb, causes minimal inconvenience to patients, and is easily repeatable, but it is considered highly operator dependent. Various plethysmography techniques are of limited application in ulcer investigations, because of their difficulty to calibrate signal, unless time measurements such as the postexercise refilling time are used.

Wound Fluids: A Window Into the Wound Environment?

Yager, D. R., Kulina, R. A., Gilman, L. A. — 2007-11-29

Wound healing of the skin is a complex biologic process involving temporal interactions between numerous types of cells, extracellular matrix molecules, and soluble factors. The process of repair can be viewed as involving 3 or 4 phases: homeostasis, inflammation, synthesis, and remodeling. These phases occur at different times and differ in their cellular, biochemical, and physiologic requirements. Disruption of one or more of these interactions can significantly interfere with the repair process. Such comorbidities as age, nutrition, immune status, and underlying disease status (eg, diabetes or venous stasis) contribute additional intricacy to the repair process. Because of this complexity, care of chronic wounds remains highly individualized, and it should not come as a surprise that treatment of these wounds as a group with single target therapies have met with only modest success. A major hurdle in the progression toward improved treatment regimens has been the lack of objective biochemical and physiological landmarks that can be used to assess wound status. Collection and biochemical characterization of wound fluids presents the opportunity to noninvasively obtain information reflecting the status of the wound and of specific biomarkers. This review discusses the collection of wound fluid and highlights biomarkers that may be useful to this end.

A Review of the Clinical Significance of Tissue Hypoxia Measurements in Lower Extremity Wound Management

Mathieu, D., Mani, R. — 2007-11-29

The aim of this paper is to review techniques that are currently available to measure tissue hypoxia in order to benefit the management of wounds. Direct measurement of tissue partial oxygen pressure (PO₂) is invasive and therefore unappealing in clinical practice. Several techniques (PET scans, MRI derived techniques) are primarily applicable to research rather than clinical applications. Imaging techniques (duplex ultrasonography, arteriography, MRI techniques) are recommended only as part of the workup for revascularisation. Techniques that assess local perfusion include clearance methods, transcutaneous O₂ and CO₂ pressure measurement, and laser Doppler flowmetry and imaging. These techniques permit interpretation of altered perfusion states. Each technique offers subtly different information concerning microvascular function. All these techniques require strict protocols to derive reliable data. The potential of the promising near infrared reflectance spectroscopy (NIRS) technique is yet to be determined.

Outcome Measurements in Wound Healing Are Not Inclusive: A Way Forward

Matousek, S., Deva, A.K., Mani, R. — 2007-11-29

Standardized outcome measurement in wound healing has been an elusive goal. Whilst research into wound healing science and technology continues to progress rapidly, the lack of a uniform outcome assessment is making comparative analysis of results difficult. This paper seeks to outline the reported clinical, physiological, and histological outcomes that have been utilized in the literature. A minimal data set base for wound outcome evaluation is also established to be validated by future multivariate analysis of patient data.

Disabling Pansclerotic Morphea of Childhood Poses a High Risk of Chronic Ulceration of the Skin and Squamous Cell Carcinoma

2007-11-29

Disabling pansclerotic morphea of childhood (DPMC) is a rare and severe variant of scleroderma. This report presents 3 cases that presented to the authors and studies 25 patients from the literature (English language only) for the presence of chronic nonhealing ulcers of skin and skin cancer. The authors identified a total of 30 patients (9 male and 21 female) aged between 1 and 37 years at time of presentation. All cases were less than 14 years old when the disease started. The majority of patients had an aggressive course with deep sclerotic lesions leading to joint contractures and immobility. Five patients suffered from chronic nonhealing leg ulcers (17%), but ulcers were present on other parts of the body (upper limbs, trunk, head) as well (n = 6). Four patients died because of complications of the disease such as sepsis or gangrene. Two patients developed a squamous cell carcinoma at the age of 16 years and 19 years, respectively (6.7%). The available treatment of DMPC-associated ulcers is unsatisfying. Only temporary improvements have been seen in a minority of patients. We report on marked improvement of chronic leg ulcers by a combination of sildenafil 3 x 20 mg/day and repeated application of a porcine small intestinal submucosal acellular matrix.

Wound Healing Meetings 2008-2009

2007-11-29

Cochrane Abstracts

2007-11-29

Thank You

2007-11-29