Pressure Ulcer Healing Research Articles

Protein expressions of matrix metalloproteinase-9 and its inhibitor and their ratio changes in wound healing of patients with stages Ⅲ and Ⅳ pressure ulcers

Objective: To explore the expression levels of matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of metalloproteinase-1 (TIMP-1) protein and the change of MMP-9/TIMP-1 ratio in wound exudates of patients with stages Ⅲ and Ⅳ pressure ulcers during wound healing. Methods: From July 2017 to July 2018, 30 patients with stage Ⅲ pressure ulcers [30 wounds, 16 males and 14 females, aged (65±10) years] and 34 patients with stage Ⅳ pressure ulcers [50 wounds, 17 males and 17 females, aged (65±9) years] admitted to Hebei General Hospital who met the inclusion criteria were enrolled in this prospective cohort study. According to the principle of wound treatment and the characteristics and needs of wound in different periods, individualized intervention measures were formulated for patients and appropriate dressings were selected. At the time of admission and on 7, 14, 21, 28 days of treatment, the healing of pressure ulcer wounds was evaluated by Pressure Ulcer Healing Scale. Afterwards, the wound exudate was collected at each time point to detect the expression levels of MMP-9 and TIMP-1 protein by enzyme-linked immunosorbent assay, and the MMP-9/TIMP-1 ratio was calculated. Data were processed with analysis of variance for repeated measurements of single group and linear trend test. Results: (1) There were significantly statistical differences in wound healing scores of patients with stages Ⅲ and Ⅳ pressure ulcers among the time of admission and on 7, 14, 21, 28 days of treatment within each stage (F=145.382, 153.234, P<0.01), and they all showed a gradually decreasing trend (F=170.466, 284.585, P<0.01). (2) At the time of admission and on 7, 14, 21, 28 days of treatment, the expression levels of MMP-9 protein in wound exudates of patients with stages Ⅲ and Ⅳ pressure ulcers were (171±104), (138±88), (110±70), (85±55), (62±41) ng/L and (193±107), (173±104), (139±83), (114±70), (89±56) ng/L, respectively. There were significantly statistical differences within each stage (F=58.007, 111.680, P<0.01), and they all showed a gradually decreasing trend (F=62.901, 134.628, P<0.01). At the time of admission and on 7, 14, 21, 28 days of treatment, the expression levels of TIMP-1 protein in wound exudates of patients with stages Ⅲ and Ⅳ pressure ulcers were (6.2±3.9), (5.6±3.4), (5.1±3.1), (4.4±2.5), (3.8±2.3) ng/L and (4.8±2.5), (4.7±2.6), (4.4±2.6), (4.6±2.7), (4.1±2.4) ng/L, respectively. There were significantly statistical differences within each stage (F=25.479, 7.778, P<0.01), and there was a gradually decreasing trend in stage Ⅲ (F=62.901, P<0.01) and a decreasing trend in stage Ⅳ (F=134.628, P<0.01). At the time of admission, the expression levels of MMP-9 and TIMP-1 in wound exudates of patients with stage Ⅲ pressure ulcers were similar to those of patients with stage Ⅳ pressure ulcers (t=-1.03, 1.47, P>0.05). (3) At the time of admission and on 7, 14, 21, 28 days of treatment, the MMP-9/TIMP-1 ratios in the wound exudates of patients with pressure ulcers of stages Ⅲ and Ⅳ were 30±13, 25±9, 22±9, 20±8, 17±6 and 43±19, 37±13, 32±10, 26±9, 22±9, respectively. There were significantly statistical differences within each stage (F=37.173, 97.191, P<0.01), and they all showed a gradually decreasing trend (F=54.183, 130.088, P<0.01). At the time of admission, the MMP-9/TIMP-1 ratio in wound exudates of patients with stage Ⅳ pressure ulcers was significantly higher than that of patients with stage Ⅲ pressure ulcers (t=-3.42, P<0.01). Conclusions: During the wound healing process of patients with stages Ⅲ and Ⅳ pressure ulcers, the expression levels of MMP-9 and TIMP-1 protein and the MMP-9/TIMP-1 ratio in wound exudates show a decreasing trend. The stage of wound healing can be predicted according to the expression level of MMP-9 protein and the MMP-9/TIMP-1 ratio.

Is Platelet Rich Plasma (PRP) an Effective Treatment for Pressure Ulcers?

Background: Platelet rich plasma (PRP) has been used as an effective treatment over the years indifferent medical and surgical fields. It has a high concentration of cytokines and growth factors that play a significant role in the wound healing process. This literature review is looking at whether PRP is effective in treating pressure ulcers as they are a major problem causing a significant increase in health care costs, have a huge impact on patients’ quality of life and cause great morbidity and mortality. Study design and methods: A comprehensive review of the literature was performed. Pubmed, Ovid Medline, OvidEMBASE and CINHAL were used to conduct the literature search using the following MESH headings: PRP, Platelet rich plasma, Chronic wound*, pressure ulcer*, pressure sore*. Cochrane library was searched for systemic reviews and reference lists of relevant publications were used to identify further studies. Results: The literature search identified studies that looked at PRP’s effect on different chronic wounds including pressure ulcers in terms of healing. Some studies looked at pressure ulcers separately. The included studies in this literature review are: one randomised double blind controlled trial, three randomised open label controlled trial, one observation study, five case series and two case reports. Conclusion: PRP promotes the healing of chronic wounds. Individual case series and case reports showed that PRP aids the healing of pressure ulcers improving their vascularity and decreasing ulcer area and volume. Also, some reported significant reduction in healing time. However, further research and randomised controlled trials focusing on the effect of PRP on pressure ulcers need to be conducted in order to support the hypothesis.

Photobiomodulation by dual-wavelength low-power laser effects on infected pressure ulcers.

The aim of this study was to evaluate the effects of photobiomodulation (PBM) by dual-wavelength low-power lasers on the healing and bacterial bioburden of pressure ulcer (PU) models. Twenty-five male Swiss mice were divided into five equal groups. Ischemia reperfusion cycles were employed to cause PU formation by the external application of magnetic plates. Immediately after wounding, a suspension of Pantoea agglomerans was applied at the base of all the wounds of the infected groups, using a calibrated pipette. PBM (simultaneous emission at 660 and 808nm, 142.8J/cm2, in continuous wave emission mode) was applied to the PUs for 14 sessions. The animals were euthanized 14days after PU induction, and their tissues were analyzed for wound contraction and reepithelialization, epidermis thickness, bacterial survival, and IL-1β and IL-10 mRNA level evaluations. The PU areas appeared larger in the mice from the infected groups than in those in the laser group 4days after PU induction and presented incomplete reepithelialization 14days after PU induction. However, the PBM accelerated the wound healing in the infected + laser group compared with the infected group 11 and 14days following the PU induction. The infected and irradiated PUs exhibited a thinner neo-epidermis than those in the infected group, and the bacterial survival decreased in the laser group; the relative expression IL-1β mRNA levels demonstrated an increasing tendency while the relative expression IL-10 mRNA levels demonstrated a decreasing tendency in the infected + laser and laser groups. These results suggest that PBM improves healing by killing or inhibiting bacteria in PUs as well as by accelerating the wound healing, resulting in tissue repair.

Local Growth Hormone Therapy for Pressure Ulcer Healing on a Human Skin Mouse Model.

The growth hormone is involved in skin homeostasis and wound healing. We hypothesize whether it is possible to improve pressure ulcer (PU) healing by locally applying the recombinant human growth hormone (rhGH) in a human skin mouse model. Non-obese diabetic/severe combined immunodeficient mice (n = 10) were engrafted with a full-thickness human skin graft. After 60 days with stable grafts, human skin underwent three cycles of ischemia-reperfusion with a compression device to create a PU. Mice were classified into two groups: rhGH treatment group (n = 5) and control group (n = 5). In the rhGH group for local intradermal injections, each had 0.15 mg (0.5IU) applied to the PU edges, once per week for four weeks. Evaluation of the wound healing was conducted with photographic and visual assessments, and histological analysis was performed after complete wound healing. The results showed a healing rate twice as fast in the rhGH group compared to the control group (1.25 ± 0.33 mm2/day versus 0.61 ± 0.27 mm2/day; p-value < 0.05), with a faster healing rate during the first 30 days. The rhGH group showed thicker skin (1953 ± 457 µm versus 1060 ± 208 µm; p-value < 0.05) in the repaired area, with a significant decrease in collagen type I/III ratio at wound closure (62 days, range 60–70). Local administration of the rhGH accelerates PU healing in our model. The rhGH may have a clinical use in pressure ulcer treatment.

Zinc deficiency exacerbates pressure ulcers by increasing oxidative stress and ATP in the skin

BackgroundZinc deficiency is believed to be a predisposing factor for the development and intractable healing of pressure ulcers (PUs); however, the mechanisms of this association have not been elucidated. ObjectiveObjective was to elucidate the mechanisms of the formation of severe and prolonged PUs under the zinc deficiency condition. MethodsWe assessed PUs formation after cutaneous ischemia-reperfusion (I/R) injury in mice fed with a zinc-adequate (ZA) or a zinc-deficient (ZD) diet from 2 weeks before I/R injury. Wound size, vascular damage, apoptotic cells, adenosine triphosphate (ATP) amount, and the number of Langerhans cells (LCs) in I/R area were analyzed. We evaluated the extent of oxidative stress in I/R area in OKD48 mice through bioluminescence detection. ResultsWe found that dietary zinc deficiency caused the formation of severe and prolonged PUs in mice. Zinc deficiency increased the vascular disorder, oxidative stress, and apoptosis induced by cutaneous I/R injury. I/R injury-induced oxidative stress signals were significantly higher in ZD OKD48 mice than in ZA OKD48 mice. Additionally, zinc deficiency reduced the number of LCs and increased the amount of ATP in cutaneous I/R-injured skin. Oral supplementation of zinc improved zinc deficiency-associated PUs. ConclusionZinc deficiency might increase cutaneous I/R injury-induced vascular damages, oxidative stress, and apoptosis, as well as ATP amount in I/R area due to the loss of LCs. These mechanisms might partly account for zinc deficiency-induced formation of severe and prolonged PUs. Oral supplementation of zinc might be a reasonable therapeutic choice for patients with PUs and zinc deficiency.

Evolución clínica y funcional de los pacientes que ingresan en residencias tras una fractura de cadera. Implementación de un programa de intervención multinivel

Background and objectiveThe aim of this study was to determine the clinical and functional outcomes of patients discharged to nursing homes after a hip fracture. MethodsThe study included all patients admitted to a group of nursing homes after a hip fracture in 2016. A geriatric assessment protocol was applied, and patients were treated with a specific protocol for 90 days. They were assessed for nutritional status (Mini-Nutritional Assessment and Body Mass Index), pain (Visual Analogue Scale, and the PAINAD Scale), the presence of pressure ulcers, blood test (D vitamin, haemoglobin, proteins), and functional status (Barthel index and Functional Assessment Categories). ResultsOut of a total of 175 patients, 116 (75%) met the inclusion criteria. The mean age was 84.9 years old (±6.7 SD), and 91 (78.4%) were women. At admission, 73.8% of 65 residents had anaemia, 76.7% hypovitaminosis D, 88% malnutrition or «at risk of malnutrition», and 15.3% had pressure ulcers. After 90 days, the moderate-severe functional status (Barthel index < 60) was reduced from 90.4 to 39.6%, dependence due to gait from 97.3 to 36.1%, and moderate-severe pain from 88.9 to 14.4%. Most of the pressure ulcers healed (94.4%). ConclusionsPatients admitted to nursing homes after a hip fracture had poor clinical and functional status. This study shows that after 90 days from admission these patients had positive outcomes in terms of functionality, gait, pain control, and pressure ulcers healing.

100% Whey Protein Based Diet In Enhancing Pressure Ulcer Healing- A Pilot Randomized Controlled Trial.

100% Whey Protein Based Diet In Enhancing Pressure Ulcer Healing- A Pilot Randomized Controlled Trial.

Topical Nifedipine for the Treatment of Pressure Ulcer: A Randomized, Placebo-Controlled Clinical Trial.

Effect of nifedipine on pressure ulcer (PU) healing has not been evaluated in the human subjects yet. In this study, the effect of topical application of nifedipine 3% ointment on PU healing in critically ill patients was investigated. This was a randomized, double-blind, placebo-controlled clinical. In this study, 200 patients with stage I or II PU according to 2-digit Stirling Pressure Ulcer Severity Scale were randomized to receive topical nifedipine 3% ointment or placebo twice daily for 14 days. Changes in the size and stage of the ulcers were considered as primary outcome of the study. The stage of the ulcers at baseline and on day 7 and day 14 of study was determined by using 2-digit stirling scale. In addition, the surface area of the wounds was estimated by multiplying width by length. In total, 83 patients in each group completed the study. The groups were matched for the baseline stage and size of PUs. Mean decrease in the stage of PU in the nifedipine group was significantly higher than the placebo group on day 7 (-1.71 vs. -0.16, respectively, P < 0.001) and day 14 (-0.78 vs. -0.09, respectively, P < 0.001). Furthermore, the mean decrease in the surface area of PU was significantly higher in the nifedipine group compared with the placebo group on day 7 (-1.44 vs. -0.32, respectively, P < 0.001) and day 14 (-2.51 vs. -0.24, respectively, P < 0.001) of study. Topical application of nifedipine 3% ointment for 14 days significantly improved the healing process of stage I or II PUs in critically ill patients.

Research progress of acupuncture and the related adjuvant therapy for promoting pressure ulcer healing in recent 10 years

To summarize the research progress of acupuncture-moxibustion and the related adjuvant therapy for promoting pressure ulcer healing in recent 10 years and explore the future research direction. By retrieving Chinese Journal Full-text Database (CNKI), VIP Database (VIP) and PubMed database, dated from January 2008 through to December 2017, the articles for the treatment of pressure ulcers with acupuncture-moxibustion and the related adjuvant therapy were collected. In terms of clinical research and experimental research, the research progress and the related effect mechanisms were analyzed and summarized. Through screening, 78 articles for the treatment of pressure ulcer with acupuncture-moxibustion and the adjuvant therapy were collected finally, of which, 71 articles were Chinese and 7 articles were English. The therapies with the highest frequency for pressure ulcer were the simple moxibustion or moxibusiton combined with other adjuvant measures. The local surrounding needling therapy, electroacupuncture, transcutaneous electrical nerve stimulation (TENS), neuromuscular electrical stimulation (NMES) and laser therapy were followed by regarding the use frequency. All of these interventions promoted the healing of pressure ulcers to different degrees. The underlying mechanisms were related to the regulation of the local blood perfusion, differentiation and migration of vascular endothelial growth factor, angiogenesis, superoxide dismutase SOD and eNOS/NO signaling pathway so as to promote tissue migration and proliferation. Acupuncture-moxibustion and the related adjuvant therapies achieve the definite therapeutic effects on pressure ulcers. The researches on the treatment of pressure ulcers at home and abroad are diversified, but it is still limited in the research on the effect mechanism.

Efficacy of Monochromatic Infrared Energy on Pressure Ulcer Healing

AbstractBackground: Monochromatic infrared energy has a lot of uses and in this study I use it to help patients with pressure ulcer in healing of their wounds.Aim of Study: To determine the effect of monochromatic infrared energy therapy on patients with pressure ulcers.Material and Methods: Measuring wound volume with saline and sterilized syringe.Thirty patients (19 males and 11 females) with ages ranging from 30-75 years suffering from pressure ulcer par-ticipated in this study. They were selected randomly from Medical Research Insistute and Sharq El-Madina Hospitals during the year 2018, they were randomly divided into 2 equal groups in number, one study Group (A) and a control one (B). The study Group (A) who received the monochromatic infrared energy for 30 minutes every session, application was done 5 times per week for 6 weeks as a total period of treatment in addition to their medical treatment, the control Group (B) who not received the monochromatic infrared energy but they just received standard medical treatment. Measurements were conducted before starting the treatment as a first record and at the end of the 6 weeks of treatment as a second (final) record.Results: Result showed that the polarized light therapy was effective and fruitful in increasing wound healing in pressure ulcer as evidenced by the highly significant decrease in the wound volume.Conclusion: Monochromatic infrared enenrgy therapy is beneficial in improving wound healing in pressure ulcer.

Management of Pressure Ulcers and Pressure-Related Injury

Pressure ulcers, or pressure-related injuries, result from localized injury to the skin and underlying tissues due to unrelieved pressure, usually over a bony prominence, resulting in ischemia, cell death, and tissue necrosis. Pressure injuries are increasing in incidence due to an aging population with increasing rates of obesity, diabetes, and cardiovascular disease. A rapidly expanding geriatric population with impaired mobility, diminished sensation, and poor nutrition—factors exacerbated by the end-stage effects of dementia, obesity, osteoarthritis, and diabetes as well as cardiovascular and cerebrovascular disease—have a greater propensity toward, and a higher prevalence of, pressure injury. Our aim in this paper is to determine through a review of the literature whether any new literature exists, indicating greater effectiveness in pressure ulcer prevention or treatment as compared to standard of care. We examined which studies of available support surfaces, new and currently utilized wound dressings or any other treatment modalities have provided evidence of any greater effectiveness than standard of care in the prevention of pressure injury and in promotion of pressure ulcer healing. Our objective is to provide healthcare providers with an assessment of the relative efficacy of the various interventions available to facilitate their decision-making in the healing of their patient’s pressure ulcers. Goals for pressure injury prevention or treatment, especially in the geriatric population, address repositioning for pressure redistribution and accurate diagnosis of wound etiology, including comorbidities in aging, cognition, care of aging skin, and patient or family goals in care (healing versus palliation). We performed a literature search of the Cochrane Database of Systematic Reviews, Ovid Medline, and PubMed for published studies, reviews, and meta-analyses using the keywords pressure ulcer, pressure injury, wound care, bedsore, decubitus ulcers, and support surfaces. We also examined the reference lists of included studies to identify additional trials, position statements, guidelines, and reviews. We limited our review to English language publications between January 2008 and November 2018. We identified 36 studies for review. Despite this relatively large number of studies, there remains a disturbing lack of good-quality evidence regarding the effectiveness of support surfaces or repositioning for pressure ulcer prevention or treatment, for any class of dressing or topical therapy for promotion of wound healing, or for nutritional supplementation to facilitate wound healing. These studies yielded little evidence to warrant an update to the current standard of care for pressure ulcer prevention or management. The prevention and management of pressure ulcers requires a varied approach including assessment of risk, institution of preventive measures, and interventions to promote wound healing. Several tools for pressure injury risk assessment have been developed; a comparative description of these scales is provided. Understanding comorbidities (e.g., cardiovascular disease, diabetes, and neurodegenerative disorders) as well as complicating issues common to the elderly population that can impact pressure injury treatment (e.g., malnutrition, polypharmacy, incontinence, frailty, and disability) helps tailor wound care to this population.

Management of urethrocutaneous fistulae complicating sacral and perineal pressure ulcer in neurourological patients: A national multicenter study from the French-speaking Neuro-urology Study Group and the Neuro-urology committee of the French Association of Urology.

To describe the epidemiologic characteristics of urethrocutaneous fistulae (UCF) in sacro-perineal pressure ulcer (SPPU) in neurourological patients and to assess outcomes after surgical urinary diversion. Through the French-speaking Neurourology Study Group and Association of Urology network, a retrospective multicenter study in nine major urology and physical medicine and rehabilitation (PMR) units was conducted. All patients with SPPU associated with UCF between 2000 and 2016 were included. Data concerning: sociodemography, clinical, medical and biological comorbidities, neurological and urological history, pressure ulcer characteristics, and finally urinary diversion surgery were collected. Complications and SPPU healing/relapse were assessed. In all, 74 patients were included. The median age on diagnosis: 45.9 years (interquartile range [IQR], 38.7-53.4) and median follow-up: 15.1 months (IQR, 5.7-48.8). A psychiatric disorder was the most frequent comorbidity (44.6%). Only 59.5% and 50% had regular PMR and urologic follow-up, respectively. Seventy-one patients (95.9%) underwent urinary diversion surgery. Among those, relapse occurred in 15 (21.1%) at the end of the follow-up. The diversion was noncontinent in 85.9%. The major complications rate was 26.8%. A total of 30 late complications in 21 patients were reported. The most frequent was obstructive pyelonephritis (n = 9). All of the patients who underwent surgical diversion without cystectomy (n = 5) developed a pyocyst. Finally, the pressure ulcer healing rate when patients underwent both urinary diversion and pressure ulcer surgery was 74.4%. Our retrospective data suggest that UCF complicating SPPU is a rare and severe pathology. The combination of radical urinary diversion with cystectomy and pressure ulcer surgery should be performed as often as possible.

Clinical study and nursing on vacuum sealing drainage combined with topical oxygen therapy in treating pressure ulcers within intensive care unit

Objective To investigate the efficacy and the nursing experience of vacuum sealing drainage (VSD) combined with topical oxygen therapy on healing of pressure ulcers in intensive care unit. Methods Totally 44 cases of patients in intensive care unit with pressure ulcers on stage Ⅲ and Ⅳ bedsore, from May 2015 to October 2017, were divided into 2 groups according to the random number table.22 cases, as the control group, were treated with routine methods and VSD.22 cases, as the test group, were treated with topical oxygen therapy on basis of the treatment of control group, 10 days for a cycle. The effects of the two methods were compared according to the wound healing rate, the bacterial quantitative, the cell apoptosis rate and the capillary density after a treatment cycle. Results The average wound healing rates of the control group and the test group were (16.5±6.7)% and (26.2±5.6)% respectively, between which there was a significant difference (t=5.09, P 0.05). After treatment, the bacterial quantitative, cell apoptosis rate and capillary density in the control group were (4.9±1.4) ×104CFU/g, (5.5±0.8)%, 38.64±10.14, and in the test group were (2.5±0.7) ×104CFU/g, (2.9± 0.9)%, 41.09±9.28. The differences before and after treatment in the control group were statistically significant (q=1 967.75, 3.51, 6.12, all P 0.05). Conclusion The vacuum sealing drainage combined with topical oxygen therapy can enhance wound healing and control infection significantly, is a safe and effective therapeutic method. Key words: Pressure ulcers; Drainage; Occlusive dressings; Oxygen

Human embryonic stem cell-derived exosomes promote pressure ulcer healing in aged mice by rejuvenating senescent endothelial cells

BackgroundAngiogenesis, as an endogenous repair mechanism, plays crucial roles in wound healing and tissue regeneration. However, this process is impaired in the elderly due to aging-related vascular endothelial dysfunction. This study was aimed to explore the pro-angiogenic effects of exosomes from human embryonic stem cells (ESC-Exos) in aged mice of pressure-induced ulcer model and the underlying mechanism.MethodsPressure ulcer wounds were created on the back of d-galactose-induced aging mice. ESC-Exos were locally applied onto the wound beds, with PBS as control. The effects of ESC-Exos on wound healing were analyzed by measuring wound closure rates, histological and immunofluorescence analyses. Then, the anti-aging effect of ESC-Exos on vascular endothelial cells was tested in an in vitro d-galactose-induced HUVEC senescence model.ResultsESC-Exos could accelerate wound closure and enhance angiogenesis, and the senescence of vascular endothelial cells was significantly ameliorated after ESC-Exos treatment. In vitro, ESC-Exos could rejuvenate the senescence of endothelial cells and recover compromised proliferation, migratory capacity, and tube formation. This recovery was Nrf2-activation-dependent, since cotreatment with Nrf2 inhibitor Brusatol could abolish the rejuvenative effects of ESC-Exos. Further study revealed that miR-200a was highly enriched in ESC-Exos and played a crucial role in ESC-Exos-mediated rejuvenation through downregulating Keap1, which negatively regulates Nrf2 expression.ConclusionsESC-Exos ameliorate endothelial senescence by activating Nrf2 and recover aging-related angiogenic dysfunction, thereby accelerating wound healing in aged mice. ESC-Exos might be a natural nano-biomaterial for aging-related diseases therapy.

An overview of 'Pressure ulcers: revised definition and measurement'.

British Journal of Community NursingVol. 24, No. 5 ProfessionalAn overview of ‘Pressure ulcers: revised definition and measurement’Melanie LumbersMelanie LumbersE-mail Address: [email protected]Freelance tissue viability nurse and health visitorSearch for more papers by this authorMelanie LumbersPublished Online:6 May 2019https://doi.org/10.12968/bjcn.2019.24.5.216AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Collier M. Is it time for a national wound registry across primary settings? Br J Community Nurs. 2019; 24(3):S5. bjcn.2019.24.Sup3.S5 Link, Google ScholarBeeckman D, Campbell J, Campbell K. Incontinence associ-ated dermatitis: moving prevention forward. 2015. Wounds International. http://tinyurl.com/ycvbunuz (accessed 20 March 2019) Google ScholarNHS Improvement. Pressure ulcers: revised definition and meas-urement. 2018. http://tinyurl.com/yyg4nfmw (accessed 16 March 2019) Google ScholarNHS Safety Thermometer. Classic thermometer dashboard. 2019. http://tinyurl.com/yxqe4mey (accessed 22 March 2019) Google ScholarNHS Stop the Pressure. Stop the pressure. 2019. http://tinyurl.com/yyhwgfma (accessed 2 March 2019) Google Scholar FiguresReferencesRelatedDetailsCited byThe influence of anaemia on pressure ulcer healing in elderly patientsMariusz Adam Tuz, Aby Mitchell11 August 2021 | British Journal of Nursing, Vol. 30, No. 15How to manage incontinence-associated dermatitis in older adultsMelanie Lumbers2 July 2019 | British Journal of Community Nursing, Vol. 24, No. 7 2 May 2019Volume 24Issue 5ISSN (print): 1462-4753ISSN (online): 2052-2215 Metrics History Accepted 1 March 2019 Published online 6 May 2019 Published in print 2 May 2019 Information© MA Healthcare LimitedPDF download

Use of autologous platelet rich fibrin-based bioactive membrane in pressure ulcer healing in rats.

To verify the feasibility of treating pressure ulcers (PUs) with autologous platelet-rich fibrin-based (PRF) bioactive membrane, both in vitro and in vivo. An animal model using adult male Sprague-Dawley rats was used. Pressure was periodically exerted on the skin to induce localised ischaemia by using an external magnet and transplanted metal disc. After a PU developed, the rats were divided into two groups: a treatment group and a control group. Rats in the treatment group were then treated with PRF bioactive membrane every three days. A total of 20 rats were used in this study. At days three and seven, the PU area in the PRF bioactive membrane-treated group was significantly smaller than that in the control group, and after 14 days of treatment, the PUs in the PRF bioactive membrane treatment group had healed. Haemotoxylin and eosin staining, immunohistochemistry and Western blot results indicated that PRF bioactive membrane induced wound healing by increasing the thickness of the regenerated epidermis and by upregulating vascular endothelial growth factor expression. Further, we found that different concentrations of rat autologous PRF soluble factors extraction components could significantly promote rat aortic endothelial cell proliferation, wound healing and migration ability in vitro. Overall, results indicate that PRF bioactive membrane promotes PU healing in rats. Thus, it may represent a natural and effective wound-healing tool for use in the treatment of clinical skin PUs in humans in the future.

Mouse Model of Pressure Ulcers After Spinal Cord Injury.

Pressure ulcers (PUs) are common debilitating complications of traumatic spinal cord injury (SCI) and tend to occur in soft tissues around bony prominences. There is, however, little known about the impact of SCI on skin wound healing in the context of animal models in controlled experimental settings. In this study, a simple, non-invasive, reproducible and clinically relevant mouse model of PUs in the context of complete SCI is presented. Adult male mice (Balb/c, 10 weeks old) were shaved and depilated. Post-depilation (24 h), mice were subjected to laminectomy followed by complete spinal cord transection (T9-T10 vertebrae). Immediately after, a skin fold on the back of the mice was lifted and sandwiched between two magnetic discs held in place for next 12 h, thus creating an ischemic area that developed into a PU over the following days. The wounded areas demonstrated tissue edema and epidermal disappearance by day 3 post-magnet application. PUs spontaneously developed and healed. Healing was, however, slower in the SCI mice compared to control non-SCI mice when the wound was created below the level of SCI. Conversely, no difference in healing was seen between SCI and control non-SCI mice when the wound was created above the level of SCI. This model is a potentially useful tool to study the dynamics of skin PU development and healing after SCI, as well as to test therapeutic approaches that may help heal such wounds.

Diabetic Human Adipose-Derived Stem Cells Accelerate Pressure Ulcer Healing by Inducing Angiogenesis and Neurogenesis.

Adipose-derived stem cells (ASCs) possess a well-characterized capacity to enhance cutaneous wound healing. However, many controversies exist regarding ASCs from diabetic patients (dASCs). No report exists on the administration of dASCs for the treatment of pressure ulcers. The aim of this study was to compare properties of dASCs and nondiabetic ASCs (nASCs). In addition, we studied if dASCs enhanced pressure ulcer healing in a rodent pressure ulcer model and investigated underlying mechanisms. We found similar expression of cell surface markers and characteristics in dASCs and nASCs, although dASCs exhibited decreased proliferation and osteogenic differentiation capacity and enhanced adipogenic differentiation capacity. dASCs had beneficial effects on chronic wound healing, though some aspects of their capacity were impaired. The ability of dASCs to promote nerve regeneration was not compromised. dASCs promoted pressure ulcer healing and improved healing by modulating inflammation, promoting angiogenesis and neuroregeneration, enhancing collagen deposition, and increasing re-epithelization. These data may provide a theoretical foundation for further clinical administration of ASCs for chronic wound healing in patients with diabetes.

Effects of adipose-derived mesenchymal stem cells from type 2 diabetes mellitus patients on wound healing of pressure ulcers in mice

To investigate the effects of adipose-derived mesenchymal stem cells (AMSCs) from type 2 diabetes mellitus patients on wound healing of pressure ulcers in mice. Methods: (1) In September 2016, the subcutaneous adipose tissue of a 60-year-old woman with type 2 diabetes mellitus was harvested, and then AMSCs were extracted by collagenase digestion and cultured. The third passage of cells were used for subsequent experiments. The morphology of cells was observed, and their osteogenic, chondrogenic, and adipogenic differentiation abilities were identified. The expressions of cell surface markers CD90, CD105, CD73, and CD34 were detected by flow cytometer (n=3). (2) Sixteen female C57BL/6 wild-type mice aged 6-8 weeks were selected, and one pressure ulcer wound was created on each side of the spine of each mouse by pressing the skin with two magnets. The two wounds of each mouse were paired and divided into diabetic AMSCs group and negative control group, injected with 100 μL phosphate buffer solution (PBS) containing green fluorescent protein-labeled AMSCs (1×10(6) cells) and 100 μL PBS, respectively. The wound healing status of the two groups within post injection day (PID) 21 was observed, and their wound healing rates on PID 5, 13, and 17 were calculated. Three mice were sacrificed on PID 11 and 21, respectively, and tissue of three wounds was harvested from each group. The skin structure was observed by hematoxylin-eosin staining, the collagen deposition was evaluated by Masson staining, and the positive expression of CD31, i. e., the number of new blood vessels was counted by immunohistochemistry. Wound tissue samples of two groups prepared on PID 21 as above-mentioned were harvested, and the positive cell rate of S100, representing the regeneration of Schwann cells, was detected by immunohistochemistry. Wound tissue samples of diabetic AMSCs group prepared on PID 11 as above-mentioned were harvested, and the colonization of AMSCs was observed by fluorescence tracer method. Data were processed with paired t test and Bonferroni correction. Results: (1) The third passage of cells isolated and cultured from the subcutaneous adipose tissue of a type 2 diabetes mellitus patient grew adherently to the wall in a long spindle and vortex-like manner. After induction, the cells showed osteogenic, chondrogenic, and lipogenic differentiation abilities. The positive expression rates of CD90, CD105, and CD73 on the cell surface were higher than 90.00%, and the expression rate of CD34 was 0.46%. The cells were identified as AMSCs. (2) The mice wounds of diabetic AMSCs group healed quickly, and all the wounds healed completely on PID 17, while the mice wounds in negative control group were not completely closed at this time, and there was still scab on the surface. On PID 5, 13, and 17, the healing rates of mice wounds of diabetic AMSCs group were (35.6±6.5)%, (87.1±2.5)%, and 100.0%, respectively, significantly higher than (19.8±7.2)%, (66.2±5.2)%, and (86.9±5.3)% of negative control group (t=6.49, 14.31, 9.73, P<0.05). Compared with that of negative control group, the inflammatory cell infiltration was reduced in mice wounds tissue of diabetic AMSCs group on PID 11, and thicker epidermis and dermis as well as regenerated skin appendages were observed on PID 21. On PID 11 and 21, the collagen percentages of mice wounds tissue in diabetic AMSCs group was (48.3±1.3)% and (54.1±1.7)%, respectively, significantly higher than (41.4±1.7)% and (50.3±1.2)% of negative control group (t=6.98, 3.99, P<0.01). On PID 11 and 21, the numbers of new blood vessels in mice wounds tissue of diabetic AMSCs group were 17.2±1.3 and 18.0±2.1, respectively, significantly more than 8.0±1.4 and 14.0±1.5 of negative control group (t=10.69, 3.38, P<0.01). On PID 21, the S100 positive cell percentage in mice wounds tissue of diabetic AMSCs group was (1.76±0.12)%, significantly higher than (0.55±0.03)% of negative control group (t=21.68, P<0.001). On PID 11, the colonization of AMSCs in mice wounds tissue of diabetic AMSCs group was observed. Conclusions: Transplantation of AMSCs from type 2 diabetic mellitus patients can accelerate wound healing of pressure ulcers in mice by promoting angiogenesis, collagen deposition, and Schwann cell regeneration.

Effect of alternating current microcurrent electrical neuromuscular stimulation on pressure ulcer healing

Effect of alternating current microcurrent electrical neuromuscular stimulation on pressure ulcer healing