Advances in Wound Care

OBJECTIVE: This study aims to analyze the potential diagnostic capability of ultrasonography in detecting diabetic foot osteomyelitis (DFO) in patients with diabetic foot ulcers (DFUs). APPROACH: A 1-year prospective study was conducted on 47 consecutive patients with active DFUs and suspicion of DFO at a specialized diabetic foot unit. The following ultrasonographic (US) features were evaluated at baseline: 1) periosteal reaction; 2) periosteal elevation; 3) cortical disruption; 4) sequestrum; and 5) positive power Doppler...

SIGNIFICANCE: Burns result in irretrievable cell damage, which can occur upon exposure to hot surfaces, liquids, gases, through friction and ultraviolet or ionizing radiation. Standard of care in burn management involves protecting the patient, limiting burn progression, and achieving wound closure. Negative pressure wound therapy (NPWT) and NPWT with instillation and dwell time (NPWTi-d) are two wound management options that have been shown to improve outcomes for burn patients in recent years...

OBJECTIVE: Autologous skin transplantation is limited by donor site availability for patients with extensive burns. The objective of this study was to demonstrate the feasibility and efficacy of split-thickness skin (STS) and dermal pixel grafts (PG) in the treatment of burns. APPROACH: The study was divided into three arms of validation, expansion and combination that all followed the same study design. Sixteen deep partial-thickness burns were created on the dorsum of anesthetized pigs...

SIGNIFICANCE: Venous leg ulcers (VLUs) are the most common venous disease, mainly presenting as open skin lesions on the legs or feet and are an important concern in clinical care settings. RECENT ADVANCES: Comprehensive tactics were employed to search electronic databases PubMed, Embase, guideline databases, and society websites were searched for CPGs (Clinical Practice Guidelines) on VLU care. The basic information, recommendations for the VLUs, methodological quality, and reporting quality of VLUs CPGs were extracted and captured in Excel...

Significance: Quality of life (QoL) is important to patients with chronic wounds and is rarely formally evaluated. Understanding what comorbidities most affect the individual versus their wounds could be a key metric. Recent Advances: The last 20 years have seen substantial advances in QoL instruments and conversion of patient data to a single value known as the health utilities index (HUI). We review these advances, along with wound-related QoL, and analyze real-world comorbidities challenging wound care. Critical Issues: To understand the impact of underlying comorbidities in a real-world patient population, we examined a convenience sample of 382 patients seen at a hospital-based outpatient wound center...

Objective: Diabetic foot ulcers (DFUs) are devastating complications of diabetes, responsible for a high number of amputations worldwide. Due to its impact on chronic inflammation, psychological distress may negatively impact the healing process. Thus, this study evaluated the influence of psychological distress on physiological indicators of healing prognosis and the potential of stress-reducing therapies for DFU healing. Approach: Patients with chronic DFU were recruited and assessed at enrollment and two months later...

SIGNIFICANCE: Chronic wounds affect 10.5 million (up 2.3 million from the 2014 update) US Medicare beneficiaries. Chronic wounds impact the quality of life of nearly 2.5% of the total population of the United States. This fraction is larger in the elderly. These wounds can lead to a range of complications and healthcare costs. Given the aging population, the continued threat of diabetes and obesity worldwide, and the persistent problem of infection, it is expected that chronic wounds will continue to be a substantial clinical, social and economic challenge...

Objective This is the first clinical trial to evaluate the analgesic effect of 10 and 20 mg of morphine used in a postoperative dressing with patients after surgical debridement of burn wounds. Approach In this randomized controlled trial, 20 adult patients with third-degree flame burns who had undergone surgical debridement under general anesthesia were randomly assigned to either group A, whose members were treated with a burn dressing that contained 10 mg of morphine, or group B, whose members were treated with a burn dressing that contained 20 mg of morphine; the dressing was also soaked with octenidine and phenoxyethanol in the case of both groups...

Objective: Hydrolyzed collagen-based matrices are widely used as wound care dressings. Information on the mechanism of action of such dressings is scanty. The objective of this study was to test the effect of a specific hydrolyzed collagen powder (HCP), which is extensively used for wound care management in the United States. Approach: The effects of HCP on resolution of wound inflammation, perfusion, closure, and breaking strength of the repaired skin were studied in an experimental murine model. Results: In early (day 7) inflammatory phase of wound macrophages, HCP treatment boosted phagocytosis and efferocytosis of wound-site macrophages...

Background: Randomized controlled trials using complete healing as an endpoint suffer from poor statistical power, owing to the heterogeneity of wounds and their healing trajectories. The Food and Drug Administration (FDA) has recently consulted with expert groups to consider percentage area reduction (PAR) of the wound over a 4-week period as a valid intermediate endpoint, creating the opportunity for more powerful study designs. Methods: A within-subject controlled study design comparing the PAR of venous leg ulcers (VLU) in patients over 4 weeks receiving different interventions...

No abstract text is available yet for this article.

Significance: Tissue-engineered artificial skin for clinical reconstruction can be regarded as an established practice. Bi-layered skin equivalents are available as established allogenic or autologous therapy, and various acellular skin replacements can support tissue repair. Moreover, there is considerable commonality between the skin and other soft tissue reconstruction products. This article presents an attempt to create a comprehensive global landscape review of advanced replacement materials and associated strategies for skin and soft tissue reconstruction...

SIGNIFICANCE: In trauma care, extensive surgical intervention may be required. Damage control surgery (DCS) is applicable to patients with life or limb threatening conditions that are incapable of tolerating a traditional surgical approach. RECENT ADVANCES: The current resuscitation strategy for complex trauma patients includes limiting crystalloid fluids, balanced mass transfusion protocols, permissive hypotension, and damage control resuscitation. Recent technological advancements in surgical critical care have improved outcomes in these critically ill patients...

Objectives: Accelerating wound healing using continuous exogenous electrical stimulation is limited due to some serious side effects, including thermal damage. Many previous studies based on direct current contact stimulation may cause chemical burns or blisters, thereby increasing patients suffering. The aim of this study was to develop a safer and more convenient pulse capacitive coupling electrical field (PCCEF) stimulation to accelerate wound healing. Approach: A PCCEF-generating platform was self-designed to facilitate wound healing...

OBJECTIVE: This study aimed to evaluate the efficacy of prophylactic negative pressure wound therapy (PNPWT) in reducing the incidence of surgical site infection (SSI), and other wound complications in closed abdominal incisions. APPROACH: This was a prospective, single-center, open-label parallel arm superiority randomized controlled trial conducted over 2 years. Participants were randomly assigned to PNPWT and standard surgical dressing (SSD) group. The occurrence of postoperative SSI within 30 days, other wound related complications, length of hospital stay, and readmission within 1 month among both the study group were studied...

Significance: With the increasing diabetic population worldwide, diabetic foot ulcers (DFUs) are a significant concern. This study aimed to compare the efficacy of skin substitutes, biomaterials, and topical agents with standard care. Recent Advances: A meta-analysis was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, EMBASE, and Web of Science were searched using the following keywords: diabetes mellitus AND skin graft OR tissue replacement OR dressing OR drug...

OBJECTIVE: A few studies have focused on the QoL of patients with chronic non-responsive pressure skin ulcers. The aim of this study was to assess how correct treatment (AWC dressings alone or VAC therapy alone) changes the quality of life of these patients. APPROACH: 106 patients with chronic non-responsive pressure skin ulcers, who had previously used galenic dressings, applied without proper therapeutic indication, were included in this study. We administered the WOUND-Q, at time 0 and after one month of appropriate therapy, to assess PROMs...

No abstract text is available yet for this article.

We aimed to assess safety and dose-finding efficacy of esmolol hydrochloride (Galnobax) for healing of diabetic foot ulcer (DFU). This is phase 1/2 multicenter, randomized, double-blind vehicle-controlled study. Participants having diabetes and noninfected, full-thickness, neuropathic, grade I or II (Wagner classification) DFU, area 1.5-10 cm2 , and unresponsive to standard wound care (at least 4 weeks) were randomized to receive topical Galnobax 14% twice daily (BID), Galnobax 20% BID, Galnobax 20% once daily (OD)+vehicle, or vehicle BID with standard of care...

Objective: Recent preliminary reports indicate that extracorporeal shock wave therapy (ESWT) might be useful for chronic wounds, especially venous leg ulcers and diabetic foot ulcers. However, there is limited evidence for the utility and safety of ESWT in pressure ulcers (PUs). Therefore, this randomized controlled trial (RCT) aimed to assess immediate planimetric and clinical effects following a single radial ESWT session in PUs. Approach: A group of 40 patients with PUs was randomly assigned into 2 groups: active ESWT ( n  = 20), which underwent a single treatment with radial ESWT (300 + 100 impulses/1 cm2 , 2...