Decrease In Wound Area Research Articles

On the significance of negative-pressure wound therapy with instillation in dermatology.

Methods used in the treatment of acute and chronic wounds undergo constant evolution, reevaluation, and innovation. While negative-pressure wound therapy (NPWT) is an established treatment modality, the combination of NPWT and instillation of normal saline as well as solutions with active antiseptic components for topical treatment of the wound bed represents a novel approach. The well-known effects of NPWT may thus be combined with those of local antisepsis. They include a decrease in wound area, induction of granulation tissue, and reduction in bacterial colonization. To date, studies have focused on NPWT with instillation for orthopedic/surgical indications, whereas clinical data in dermatosurgery is limited to case reports or small case series. There are as yet no randomized prospective studies investigating NPWT with instillation in the treatment of skin disorders. The goal of this review is to present the method of NPWT with instillation, to highlight its mode of action as well as possible complications and contraindications, and to review the recent literature. In summary, there is increasing evidence that both simple and complicated wounds may be effectively treated with NPWT with instillation, resulting in markedly accelerated tissue granulation and thus earlier defect closure.

Histopathological evaluation of the healing effects of human amniotic membrane transplantation in third-degree burn wound injuries

Skin burn injuries result in loss of its protective function as a barrier and leading to a high risk of infection. Therefore, effective treatments and healing of burn injuries are very important to prevent complications. Amniotic membrane (AM) as a biological dressing inhibits the loss of vital fluids, water, and protein. The aim of this study was to compare the healing effects of AM and silver sulfadiazine (SSD) ointment in third-degree burn injuries in experimental rat model. Fifty-four male Sprague–Dawley rats were divided randomly into three equal groups. After induction of third-degree burn, transplantation of human AM (HAM) and SSD ointment used on wound area for treatment groups. The third group was considered as control. At days 7, 14, and 21, histopathological evaluation of burn wound area was performed using light microscopy. After 21 days, burn injury in HAM group showing lack of enough wound contraction and decrease in wound area in comparison to SSD group. Also, the healing effects were demonstrated using decline of inflammatory cell infiltration and enhanced epithelium after 21 days. The total wound score was significantly higher in the HAM group than the control and SSD ointment groups, during and at the end of the experiment (P < 0.05). On day 21, significantly lesser inflammatory cell infiltration was noticed in the control group (P < 0.05). Our findings showed that HAM can be used successfully as a biological treatment for experimental third-degree burn injury in animal model.

Wound-healing potential of the fruit extract of Phaleria macrocarpa.

The wound-healing potential of Phaleria macrocarpa was evaluated by monitoring the levels of inflammatory mediators, collagen, and antioxidant enzymes. Experimentally, two-centimeter-wide full-thickness-deep skin excision wounds were created on the posterior neck area of the rats. The wounds were topically treated with gum acacia as a vehicle in the control group, intrasite gel in the reference group, and 100 and 200 mg/mL P. macrocarpa ‎fruit extract in the treatment group. Granulation tissues were excised on the 15th day and were further processed for histological and biochemical analyzes. Wound healing was evaluated by measuring the contractions and protein contents of the wounds. Cellular redistribution and collagen deposition were assessed morphologically using Masson's trichrome stain. Superoxide dismutase (SOD) and catalase (CAT) activities, along with malondialdehyde (MDA) level were determined in skin tissue homogenates of the dermal wounds. Serum levels of transforming growth factor beta 1 (TGF-β1) and tumor necrosis factor alpha (TNF-α) were evaluated in all the animals. A significant decrease in wound area was caused by a significant increase in TGF-β1 level in the treated groups. Decrease in TNF-α level and increase in the collagen formation were also observed in the treated groups. Topical treatment with P. macrocarpa fruit extract increased the SOD and CAT activities in the healing wounds, thereby significantly increasing MDA level. The topical treatment with P. macrocarpa fruit extract showed significant healing effect on excision wounds and demonstrated an important role in the inflammation process by increasing antioxidant enzyme activities, thereby accelerating the wound healing process and reducing tissue injury.

Clinical Evaluation of a Novel Topical Negative Pressure Device in Promoting Healing in Chronic Wounds.

Aim: This observational study evaluated the use of a novel, ultraportable, mechanically powered topical negative pressure device in promoting healing in chronic wounds, including venous and mixed etiology leg ulcers and neuropathic foot ulcers. Materials and Methods: Evaluable patients (n=37) received treatment with the SNaP® Wound Care System for up to 6 weeks. The primary objective was percentage change in wound size, with secondary objectives of clinical assessment of wound parameters, ease of use, and impact on quality of life. Results: A 42.64% mean percentage decrease in wound area was observed, with an overall decrease for each wound etiology subgroup. Increased granulation tissue, decreased exudate levels, and decreased wound pain were reported. Quality-of-life scores increased overall, and the device was easy to use, comfortable, portable, and inconspicuous. Conclusion: The SNaP Wound Care System has the potential to promote healing in chronic wounds of different etiologies.

Sphingosine kinase 1 improves cutaneous wound healing in diabetic rats

BackgroundDiabetes is one of the most prevalent human metabolic diseases. Wound healing in diabetes is frequently impaired and treatment remains challenging. Sphingolipid metabolites play important roles in the regulation of glucose metabolism. SPK1 is the key enzyme in the sphingolipid metabolic pathway. S1P/SPK plays a pivotal role in the signalling pathways of diverse cellular processes including proliferation, differentiation, migration, apoptosis in diverse cell types. MethodsTo investigate the role of sphingosine kinase 1 (SPK1) in skin injury, plasmids containing the SPK1 gene (pcDNA3-FLAG-SPK1) were applied to cutaneous wounds on a streptozotocin-induced diabetic rat model over a 21-day period. The wound area and rate of wound healing were determined. The histopathological features of the healed wounds were also observed, and SPK1 expression in the skin was detected by immunohistochemistry. ResultsThere was a significant decrease in wound area in diabetic rats treated with 125 and 60μg/wound pcDNA3-FLAG-SPK1 (P<0.001–0.01). The mean sizes of the wounds were 0.67±0.15cm2, 0.83±0.18cm2, and 1.09±0.23cm2 in both treated and diabetic control group at the 7th day post-treatment respectively. In addition, wound healing in diabetic rats of test group was accelerated. At the 7th day, the mean rates of healing were 73.2±5.7% and 66±7.3% in test group of 125 and 60μg/wound respectively, and 55.4±9.9% in diabetic control group (P<0.001–0.01). Histology revealed that tissue sections from the treated diabetic rats contained more granulation tissue and capillaries than that of the control rats. There was high SPK1 expression in the skin of the treated diabetic rats. ConclusionsSPK1 gene therapy may represent a novel approach to cutaneous wound healing.

Low-level laser therapy: an experimental design for wound management: a case-controlled study in rabbit model.

Background:There is a wide array of articles in medical literature for and against the laser effect on wound healing but without discrete effect determination or conclusion. This experimental study aims to evaluate the efficacy of low-level laser therapy on wound healing.Materials and Methods:Thirty-four rabbits were randomly enrolled in two groups after creating a full thickness of 3 × 3 cm wound. The intervention group received low density laser exposure (4 J/cm2) on days 0, 3 and 6 with diode helium-neon low-intensity laser device (wl = 808 nm) and in control group moist wound dressing applied. Finally, wound-healing process was evaluated by both gross and pathological assessment.Results:Fibrin formation was the same in the two groups (P = 0.4) but epithelialisation was much more in laser group (P = 0.02). Wound inflammation of the laser group was smaller than that of the control groups but statistical significance was not shown (P = 0.09). Although more smooth muscle actin was found in the wounds of the laser group but it was not statistically significant (P = 0.3). Wound diameter showed significant decrease in wound area in laser group (P = 0.003).Conclusion:According to our study, it seems that low-level laser therapy accelerates wound healing at least in some phases of healing process. So, we can conclude that our study also shows some hopes for low level laser therapy effect on wound healing at least in animal model.

Collagen matrix wound dressings and the treatment of DFUs

Objective: To obtain clinical evidence on the use of a collagen wound dressing in patients with diabetic foot ulcers (DFUs). Method: A convenience sample of patients managed in the podiatry outpatient clinic over an 8-month period were included in the evaluation, if their DFUs were not progressing. All participants received traditional adjunctive wound care as part of their treatment. Wound surface-area measurements and imaging of patients was carried out on a regular basis to allow the tracking of wound healing. Results: Six patients, with seven wounds were included in this study. There was an overall decrease in wound surface area over time. Three patients showed a relatively swift reduction in wound area, while one patient showed a slight increase in wound area. The percentage decrease in wound area levelled out quite quickly in three patients, with a mean wound duration of 14 months compared with 7.3 months in the remaining four wounds. One patient died of an unrelated cause. Conclusion: This case series evaluation provides a snapshot of experience at one clinical centre and the treatment of DFUs, and suggests that an active biological collagen dressing may support progression to healing by modulating the wound environment. Declaration of interest: S. Haycocks and P. Chadwick received supplies of ProHeal from MedSkin Solutions Dr Suwelack for use on patients in this evaluation. K.F. Cutting is a consultant to MedSkin Solutions Dr Suwelack and received a honorarium for his participation. MedSkin Solutions Dr Suwelack did not have any editorial control over the production of this manuscript.

Wound‐healing potential of an ethanol extract of Carica papaya (Caricaceae) seeds

Carica papaya L. (Linn) (Caricaceae) is traditionally used to treat various skin disorders, including wounds. It is widely used in developing countries as an effective and readily available treatment for various wounds, particularly burns. This study evaluated the wound-healing and antimicrobial activity of C. papaya seed extract. Ethanol extract of C. papaya seed (50 mg/kg/day) was evaluated for its wound-healing activity in Sprague-Dawley rats using excision wound model. Animals were randomly divided into four groups of six each (group 1 served as control, group 2 treated with papaya seed extract, group 3 treated with a standard drug mupirocin and papaya seed extract (1:1 ratio) and group 4 treated with a mupirocin ointment. Rate of wound contraction and hydroxyproline content were determined to assess the wound-healing activity of the seed extract. The group 2 animals showed a significant decrease in wound area of 89% over 13 days when compared with groups 1 (82%), 3 (86%) and 4 (84%) respectively. The hydroxyproline content was significantly higher with the granulation tissue obtained from group 2 animals which were treated with C. papaya seed extract. Histological analysis of granulation tissue of the group 2 animals showed the deposition of well-organized collagen. The extract exhibited antimicrobial activity against Salmonella choleraesuis and Staphylococcus aureus. Our results suggest that C. papaya promotes significant wound healing in rats and further evaluation for this activity in humans is suggested.

Pharmacological evaluation of ethanolic extract of Daucus carota Linn root formulated cream on wound healing using excision and incision wound model

ObjectiveDaucus carota L. (Carrot) (Apiaceae) is used in the traditional medicine for the treatment of variety of ailments. The aim of present investigation was to formulate and evaluate wound healing activity of ethanolic extract of Daucus carota L. root on excision wound model and incision wound model. MethodsThe soft paraffin based cream containing 1%, 2% and 4% w/w of ethanolic extract of Daucus carota L. (EEDC) root was formulated and evaluated for pharmaceutical parameters such as rheological properties, pH, skin irritation and external characters. Excision wounds sized 300 mm2 and 2 mm depth were used for the study of rate of contraction of wound and epithelization at different time intervals. Incision wounds six centimeter long and two linear-paravertebral incisions were used for the study of tensile strength, total protein and hydroxyproline content measured on 10th day old incision wound. ResultsEthanolic extract of Daucus carota L. root cream formulation when applied topically did not show any sign and symptoms of skin irritation. Animals treated with topical EEDC cream formulation (1%, 2% and 4% w/w) showed significance decrease in wound area, epithelization period and scar width whereas rate of wound contraction significantly increased (P <0.01, P <0.001 and P <0.001 resp.) as compared to control group animals in excision wound model. In incision wound model there was significant increase (P <0.01 and P <0.001) in tensile strength, hydroxyproline content and protein content of animals treated with topical EEDC cream formulation (2% and 4% w/w, respectively). ConclusionsWound-healing property of ethanolic extract of Daucus carota L. root may be attributed to the various phytoconstituents like flavonoids and phenolic derivatives present in the root and the quicker process of wound healing could be a function of either its antioxidant or antimicrobial potential. The present findings provide scientific evidence to the ethanomedicinal properties of Daucus carota in wounds healing activity.

Improvement in wound healing by a novel synthetic collagen-gel dressing in genetically diabetic mice

Our study aimed to develop an intelligent wound dressing containing elements that promote wound healing. Unlike conventional dressings, this is a gel-type dressing that contains basic factors required by cells in a complex of alkaline-treated collagen and atelocollagen. Full-thickness 8-mm skin defects were made with a DermaPunch ® in the left and right sides of the back of 8-week-old genetically diabetic mice (db/db). Collagen gel was applied to the fascia on the right side, while the left (control) side was left untreated. Both wounds was coated and fixed with Tegaderm ®. On days 3, 7 and 14, macroscopic appearance and percent decrease in wound area were assessed histopathologically. On the collagen-gel side, granulation tissue had formed, with wound contraction caused by migration of epidermal cells from the surrounding tissue. By day 14, wound area had decreased to 37% for the untreated side as compared to 22% on the collagen-gel side, indicating that collagen gel was associated with significantly greater wound contraction. Moreover, there were a lot of blood vessels on the collagen-gel side. Collagen-gel dressing is most effective for dry, open wounds, i.e., those with minimal effusion, and it may also be effective for depressed open wounds. Collagen-gel dressing is expected to be very useful in treating wounds such as skin defects and skin ulcers.

Enhanced healing of diabetic foot ulcers using local heat and electrical stimulation for 30 min three times per week

Electrical stimulation (ES) with heating is effective in healing chronic wounds. However, it this effect due to ES alone or both heating and ES? The aim of the present study was to deduce the individual roles of heat and ES in the healing of chronic wounds. The study was performed on 20 patients (mean age 48.4 ± 14.6 years) with non-healing diabetic foot ulcers (mean duration 38.9 ± 23.7 months) who received local dry heat (37°C; n = 10) or local dry heat + ES (n = 10) three times a week for 4 weeks. Patients were given ES using biphasic sine wave stimulation (30 Hz, pulse width 250 μs, current approximately 20 mA). Skin blood flow in and around the wound was measured with a laser Doppler flow imager. In the ES + heat group, the average wound area and volume decreased significantly by 68.4 ± 28.6% and 69.3 ± 27.1%, respectively (both P < 0.05), over the 1-month period. During the average session, blood flow increased to 102.3 ± 25.3% with local heat and to 152.3 ± 23.4% with ES + heat. In the group receiving treatment with local heat only, wounds that had not healed for at least 2 months showed 30.1 ± 22.6% healing (i.e. a decrease in wound area) after 1 month. Although this level of healing was significant, it was less than that observed in the ES + heat group (P<0.05). Local dry heat and ES work well together to heal chronic diabetic foot wounds; however, local heat would appear to be a relevant part of this therapy because ES alone has produced little healing in previous studies.

The wound healing effect of herbal ointments formulated with &lt;i&gt;Napoleona imperialis&lt;/i&gt;

The wound healing effect of herbal ointments formulated with Napoleona imperialis (NI) embedded in different ointment bases (anionic, cationic and non-ionic) has been evaluated in vivo using the excision wound healing model, on guinea pigs. Napoleona imperialis was extracted using methanol and the extract formulated as herbal ointments. The herbal ointments were used to treat wounds inflicted onexperimental guinea pigs. The wound healing effects of the formulations were compared to that of a standard antibiotic, Cicatrin®. In all cases, there was a progressive decrease in wound area with time, indicating an efficacy of the formulations in healing the induced wounds. By the 16th day, the ointment containing 100 mg/g of Napoleona imperialis in non-ionic emulsifying ointment base showed 100 % healing. The wound areas in the animals treated with the standard antibiotic, Cicatrin® showed a 100% healing by the 19th day, indicating that the plant extract, at that given concentration, had a better wound healing property than the standard antibiotic. Keywords: wounds, healing, herbal ointments, Napoleona imperialis, Cicatrin®Journal of Pharmaceutical and Allied Sciences Vol. 3(1) 2006: 294-299

Comparison of two peri-wound skin protectants in venous leg ulcers: a randomised controlled trial

A randomised controlled trial was designed to determine whether or not early intervention with a suitable skin barrier preparation could prevent skin breakdown. This study was conducted to compare the efficacy and cost-effectivenss of two skin protectants, Cavilon No Sting Barrier Film (NSBF) (3M Health Care) and zinc paste compound, in the management of maceration and irritation of the peri-wound area of venous leg ulcers. Thirty-five patients with venous leg ulcers and surrounding skin problems were randomised to receive either NSBF or zinc paste compound. The preparation was then applied at each dressing change for 12 weeks. All patients had been receiving compression bandaging before entering the study and continued wearing it throughout the 12-week study period. The decrease in wound area was 5.11+/-8.39cm2 in the NSBF group and 4.59+/-5.83cm2 in the zinc paste group. The healing rate was 0.046cm per week with NSBF and 0.039cm per week with zinc paste. There was a significant difference in the time required to remove and re-apply the skin protectants: an average of 0.19 (+/-0.17) minutes in the NSBF group and 5.53 (+/-2.10) minutes in the zinc paste group (p<0.0001). Both products were effective barrier preparations. However, NSBF was easy to apply and transparent. The zinc paste was messy to apply and difficult to remove, and thus took up considerably more nursing time than NSBF. This study was supported by 3M Health Care.

The effect of topical tripeptide-copper complex on healing of ischemic open wounds.

To evaluate the effects of topical glycyl-L-histidyl-L-lysine tripeptide-copper complex (TCC; Iamin 2% Gel; Procyte Corporation, Redmond, WA) on healing in ischemic open wounds. Experimental study. Twenty-four adult male Sprague-Dawley rats. Rats were divided into 3 groups: topical TCC, topical TCC vehicle (hydroxypropyl-methylcellulose), and no treatment (control). Six-mm-diameter, full-thickness wounds were created within an ischemic bipedicle skin flap on the dorsum of each rat. Each day, for 13 days, wound margins were traced, and the TCC and TCC vehicle groups were treated topically. Tracings were scanned, and wound perimeter and area were calculated. On days 6, 10, and 13, selected wounds were biopsied and analyzed for tumor necrosis factor alpha (TNF-alpha) and matrix metalloproteinases (MMP) 2 and 9. A significant decrease in wound area was seen in the TCC group, but not the vehicle group, when compared with the control group on days 3 to 5, 6 to 9, and 11 to 13 and when TCC was compared with TCC vehicle on days 3 and 9. On day 13, initial wound area had decreased by 64.5% in the TCC group, 45.6% in the vehicle group, and 28.2% in the control group. On days 6, 10, and 13, TCC-treated wounds contained significantly lower concentrations of TNF-alpha and MMP-2 and MMP-9 than control wounds. Topical TCC resulted in accelerated wound healing in ischemic open wounds. Topical TCC is an effective stimulant of healing of ischemic open wounds in rats and may have an application for the treatment of chronic wounds in other species. Clinical evaluation of topical TCC is warranted.

Tratamiento tópico sobre úlceras varicosas de evolución tórpida con ampollas monodosis estériles de ciprofloxacino. La efectividad frente a suero fisiológico

ObjectiveTo determine the efficacy of topical application of sterile ciprofloxacin solution and physiologic serum as local treatment of venous ulcers compared with that of physiologic serum alone. DesignTherapeutic crossover trial. Material And MethodsA crossover study was performed. Patients with varicose lesions of more than 3 weeks’ duration (n = 63) were included. The mean age was 76.33 ± 16.79 years. There were 21 men (33%; 69.9 ± 19.9 years) and 42 women (67%; 80.2 ± 12.3 years). The sample was divided in two groups: group A (n = 63) received moisture semiocclusive therapy with single-dose ciprofloxacin ampoules and physiologic serum (NaCl 0.9%) applied by syringe 20 cc and disposable needle plus cotton gauzes (3-4 per application); group B (n = 63) received physiologic serum alone, used for a maximum of 2 weeks. ResultsIn the crossover study, the response was positive in 29 patients in group B and in 41 in group A (65 vs 46%; p = 0.000). The percentage decrease in wound area was 31.2 vs 9.3%; 1.46 vs 0.47 cm2, p = 0.00 (group A vs group B). The results of cultures for the crossover study were: 37.5% Pseudomonas, 17.6% sterile, 17.1% group D Streptococcus, and 14.1% saprophyte flora. ConclusionsCombined treatment of long-standing varicose lesions with topical ciprofloxacin and physiologic serum seems to achieve a greater initial response than the use of physiologic serum alone. The presence of fibrin at the beginning of treatment with serum does not seem to modify subsequent response to fibrin. Addition of topical ciprofloxacin to lesions without fibrin improves response compared with physiologic serum alone.

Daily Observations During Healing of a Full‐Thickness Human Surgical Wound by Second Intention

After his preauricular basal cell carcinoma had been excised by Mohs micrographic surgery, a patient took daily photographs of his 6 x 3-cm full-thickness wound as it healed by second intention over the next 44 days. Wound contraction produced a linear decrease in wound area between postoperative days 3 and 40 that accounted for 57% of the area of the original wound. The remainder of the wound was resurfaced by new epithelium, beginning on day 16. Few comparable reports address the contributions of contraction and re-epithelialization in large full-thickness human wounds.

Collagenous Materials Enhance Healing of Chronic Skin Ulcers

AbstractType I collagen in a porous sponge form attracts fibroblasts in culture and accelerates repair of animal wounds. This study examines the effect of type I collagen sponge and flakes on healing of chronic skin ulcers. Patients included in this study had skin ulcers.Patients included in this study had skin ulcers characterized by loss of dermis and epidermis without exposure of muscle, tendon or bone. Patients showing evidence of systemic infection or patients with ulcers that decreased in area during an initial three week observation period were excluded.Three out of seven patients treated with a collagen sponge and twelve out of fourteen patients treated with collagen flakes showed a 40% decrease in wound area after six weeks of treatment. In comparison, eighteen control patients showed no change in wound area over the same time interval. These results suggest that collagen flakes are effective in initiating healing of chronic skin ulcers.